Comparison of Two Models of Family-Based Treatment for Childhood Obesity: A Pilot Study

BACKGROUND

Family-based weight loss treatment (FBT) for childhood obesity, the current "gold standard," is typically provided in weekly groups for 6 months. Although this program is considered effective, it poses limitations to treatment engagement, due to time commitment and lack of widespread availability. A guided self-help version of FBT (gshFBT; eleven 20-minute sessions and one 1-hour over 5 months) was developed to circumvent such limitations. The current study examined the comparative efficacy of a 5-month FBT and gshFBT program.

METHODS

Participants included 50 parent-child dyads enrolled in FBT between 2011 and 2013 and 50 parent-child dyads enrolled in gshFBT between 2009 and 2010. Data were collected at baseline, posttreatment, and 6-month follow-up. Noninferiority analyses were conducted to assess comparative efficacy of changes in parent and child weight status, child nutrition, child physical activity, and drop-out.

RESULTS

Results indicated that gshFBT was noninferior to FBT in changes in child BMI z-score, overweight parent BMI, child nutritional intake, child vigorous physical activity, and drop-out. Results did not support noninferiority for changes in moderate to vigorous physical activity.

CONCLUSIONS

gshFBT is less intensive, more flexible, and may be similarly effective to FBT and could reach a greater proportion of the pediatric overweight population. Further research, including a randomized clinical trial, is needed to confirm these results.

An Open Trial Targeting Food Cue Reactivity and Satiety Sensitivity in Overweight and Obese Binge Eaters

Data suggests that individuals who binge eat are more responsive to food cues in the environment and less sensitive to satiety cues. The aim of this open trial was to evaluate the feasibility, acceptability, and initial effectiveness of a novel treatment grounded in Schachter's externality theory targeting food cue reactivity and satiety responsiveness with obese adults who binge eat. Treatment was provided in groups, and utilized appetite monitoring, cue-exposure treatment, in vivo exercises, self-monitoring, and coping skills. Twenty-eight overweight and obese adults who binge eat (82% female; mean age = 47.5 years [SD = 12.8]; BMI = 38.9 [SD = 10.3]; 79% White non-Hispanic) participated in a 4-month group-based treatment program. Assessments were conducted at baseline, posttreatment, and 3-month follow-up time points. Results indicated that this treatment was well accepted and had high retention at posttreatment. Initial effectiveness showed significant decreases in BMI, and improvements in loss of control and overeating episodes, food responsiveness, and power of food. The majority of results were maintained at the 3-month follow-up time point. This open trial provides preliminary evidence for the feasibility, acceptability, and initial effectiveness of this treatment on both eating disorder symptoms and weight in obese adults who binge eat. Because these data are preliminary, further treatment development and randomized controlled studies are needed.

Parent binge eating and depressive symptoms as predictors of attrition in a family-based treatment for pediatric obesity

BACKGROUND

Attrition is a significant problem in family-based treatment (FBT) for childhood obesity. Despite this, very few studies have examined factors associated with attrition. The current study examined parent symptoms of depression and binge eating as predictors of attrition in FBT.

METHODS

Participants included 77 parents of overweight children enrolled in FBT for childhood obesity. Data were collected at baseline and post-treatment. Binary logistic regression was used to assess associations between parent binge eating symptoms, depressive symptoms, and attrition.

RESULTS

Results showed that parent binge eating symptoms (p=0.02), but not depressive symptoms (p=0.07), were significantly associated with attrition, after controlling for parent BMI, treatment group assignment, and family income.

CONCLUSIONS

Higher reported parent binge eating symptoms were significantly related to attrition in FBT. Assessment of parent binge eating may be important in identifying families at risk for dropping out of FBT. Further, FBT may need to be adapted for families with parents who have a high level of psychopathology.

Low within- and between-day variability in exposure to new insulin glargine 300 U/ml

AIMS

To characterize the variability in exposure and metabolic effect of insulin glargine 300 U/ml (Gla-300) at steady state in people with type 1 diabetes (T1DM).

METHODS

A total of 50 participants with T1DM underwent two 24-h euglycaemic clamps in steady-state conditions after six once-daily administrations of 0.4 U/kg Gla-300 in a double-blind, randomized, two-treatment, two-period, crossover clamp study. Participants were randomized to receive Gla-300 as a standard cartridge formulation in the first treatment period, and as a formulation with enhanced stability through polysorbate-20 addition in the second treatment period, or vice versa. This design allowed the assessment of bioequivalence between formulations and, subsequently, within- and between-day variability.

RESULTS

The cumulative exposure and effect of Gla-300 developed linearly over 24 h, and were evenly distributed across 6- and 12-h intervals. Diurnal fluctuation in exposure (within-day variability) was low; the peak-to-trough ratio of insulin concentration profiles was <2, and both the swing and peak-to-trough fluctuation were <1. Day-to-day reproducibility of exposure was high: the between-day within-subject coefficients of variation for total systemic exposure (area under the serum insulin glargine concentration time curve from time 0 to 24 h after dosing) and maximum insulin concentration were 17.4% [95% confidence interval (CI) 15-21] and 33.4% (95% CI 28-41), respectively. Reproducibility of the metabolic effect was lower than that of exposure.

CONCLUSIONS

Gla-300 provides predictable, evenly distributed 24-h coverage as a result of low fluctuation and high reproducibility in insulin exposure, and appears suitable for effective basal insulin use.

Investigational new insulin glargine 300 U/ml has the same metabolism as insulin glargine 100 U/ml

Insulin glargine is processed in vivo into soluble 21(A) -Gly-human insulin (M1), the principal moiety responsible for metabolic effects, and subsequently into M2. This sub-study compared metabolism and metabolite pharmacokinetic (PK) profiles of investigational new insulin glargine U300 (Gla-300) with insulin glargine 100 U/ml (Gla-100, Lantus®, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany) in people with type 1 diabetes. Participants received 0.4 (n = 18) or 0.6 U/kg Gla-300 (n = 12), and 0.4 U/kg Gla-100 (n = 30) once daily in randomized order for 8 days prior to a 36-h euglycaemic clamp. Metabolites were quantified using immunoaffinity enrichment and liquid chromatography tandem mass spectrometry (LC-MS/MS). Glargine metabolism was the same regardless of Gla-100 or Gla-300 administration; M1 was confirmed as the principal active moiety circulating in blood. Steady state concentrations of M1 were achieved after 2 days for Gla-100, and 4 days for Gla-300. Steady state M1 values defined prolonged and even flatter PK profiles after Gla-300 administration compared with M1 profiles after Gla-100.

Evidence for Polymorphism within the So-called "Blue Phase" of Cholesteric Esters. IV. Temperature and Angular Dependence of Selective Reflection

From selective reflection (SR) measurements as a function of temperature it has been shown that cholesteryl myristate exhibits two "blue phases" (BP) between the isotropic and the cholesteric state. The SR of the two BP shows the same angular dependence as found in the cor-responding cholesteric state. From our results a model of the BP is proposed with the molecular axes inclined to the helix axis by a critical angle of 54.74° explaining the absence of birefringence as well as the cholesteric-like optical properties.

Evidence for Polymorphism within the So-called “Blue Phase” of Cholesteric Esters. I. Calorimetric and Microscopic Measurements

Calorimetric measurements as well as microscopic observations confirm the existence of two thermodynamically stable polymorphic forms of the so-called “blue phase” of cholesteryl nonanoate and myristate

Prospective pilot intervention study to prevent medication errors in drugs administered to children by mouth or gastric tube: a programme for nurses, physicians and parents

BACKGROUND

Drug administration in children is an error-prone task for nurses and parents because individual dose adjustment is often necessary, and suitable formulations for children are frequently lacking. Hence, in the absence of measures for their prevention, medication errors are likely to occur.

OBJECTIVE

To assess the error prevalence in drug administration by mouth or gastric tube before and after implementing a programme for quality improvement for nurses and parents.

DESIGN, SETTING AND PARTICIPANTS

Prospective, two-period cohort intervention study on a paediatric neurology ward of a university hospital where drug administration procedures of nurses and parents were consecutively monitored during the routine drug administration hours.

MAIN OUTCOMES MEASURE

Prevalence of administration errors before and after implementing instructions for appropriate drug administration, and a teaching and training programme supported by information pamphlets.

RESULTS

Altogether, 1164 predefined administration tasks were assessed, 675 before and 489 after the intervention. Of these, 95.7% (after the

INTERVENTION

92.6%) were performed by nurses. Errors addressed by the intervention were reduced from 261/646 tasks (40.4%) to 36/453 (7.9%, p<0.001) in nurses and from 28/29 (96.6%) to 2/36 (5.6%, p<0.001) in parents. Errors in predefined categories concerning tablet dissolution, tablet storage, oral liquids, tablet splitting, administration by gastric tube and others were all considerably less frequent after the intervention (each p<0.001).

CONCLUSION

Errors of drug administration by mouth and gastric tube represent a considerable and often neglected drug-related problem in paediatric inpatients. Targeted quality-improvement programmes can substantially and rapidly reduce error prevalence. Appropriate teaching and training of both nurses and parents supported by pamphlets was a highly efficient way to reduce error prevalence.

Dynamics of frequency shifted feedback lasers: simulation studies

The operation of an intracavity frequency shifted feedback (FSF) laser exhibits a remarkable range of properties, some of which have been described previously. Here we report a more complete analysis of the dependence of the output power upon pump-laser power, based on simulations with an extended rate equation model and the use of phase space analysis. The effect of FSF is discussed in detail. The simulation of the operation of a titanium-sapphire laser with FSF reveals five separate regimes of operation, a superset of those observed in experiment. We predict the thresholds for each of these regimes for FSF-lasers with titanium-sapphire or neodymium doped crystals as gain medium.

Preparation of entangled states by adiabatic passage

We propose a novel technique for the creation of entangled pairs of two-state systems based upon adiabatic passage induced by a suitably crafted time-dependent external field.

Epigenetic targeting in the mouse zygote marks DNA for later methylation: a mechanism for maternal effects in development

The transgenic sequences in the mouse line TKZ751 are demethylated on a DBA/2 inbred strain background but become highly methylated at postimplantation stages in offspring of a cross with a BALB/c female. In the reciprocal cross the transgene remains demethylated suggesting that imprinted BALB/c methylation modifiers or egg cytoplasmic factors are responsible for this striking maternal effect on de novo methylation. Reciprocal pronuclear transplantation experiments were carried out to distinguish between these mechanisms. The results indicate that a maternally-derived oocyte cytoplasmic factor from BALB/c marks the TKZ751 sequences at fertilization; this mark and postzygotic BALB/c modifiers are both required for de novo methylation of the target sequences at postimplantation stages. Using genetic linkage analyses we mapped the maternal effect to a locus on chromosome 17. Moreover, seven postzygotic modifier loci were identified that increase the postimplantation level of methylation. Analysis of interactions between the maternal and the postzygotic loci shows that both are needed for de novo methylation in the offspring. The combined experiments thus reveal a novel epigenetic marking process at fertilization which targets DNA for later methylation in the foetus. The most significant consequence is that the genotype of the mother can influence the epigenotype of the offspring by this marking process. A number of parental and imprinting effects may be explained by this epigenetic marking.

Molecular biology and clinical manifestation of hereditary factor VII deficiency

Inherited factor VII (FVII) deficiency is a rare autosomal recessive disorder. Mutations and polymorphisms of the FVII gene were characterized in more than 40 unrelated patients with FVII deficiency. Among the 29 different mutations, the most frequent were Ala294 Val, Ala294Val;404delC, IVS7+7, and Val281 Phe. Four novel mutations (IVS2+1G>C, Arg247 Cys, Glu265 Lys, Asp343 His) were detected. The relationships between genotypes of mutations and polymorphisms of the FVII gene, FVII deficiency, and clinical phenotype were investigated. Homozygosity of the Phe4 Leu, IVS4+1G>A, Cys135 Arg, Ala244 Val, and Ala294 Val;404delC and the double heterozygosity of Tyr68 Cys / IVS3-1G>A, Val252 Met / IVS2+5G>T, Val281 Phe / Cys135 Arg, Ala294 Val / Val281 Phe, Ala294 Val;404delC / Val281Phe, Ala294 Val;404delC / Arg152 stop, Ala294Val;404delC / Gln(-35) stop, Ala294 Val / Val252 Met, Ala294 Val / Gly156 Asp, and Thr359 Met / Asp242 His were related to clinical symptoms. Double heterozygotes for Arg247 Cys / IVS2+1G>C, Ala206 Thr / Pro303 Arg, Leu(-20) Pro / Val252 Met as well as IVS7+7 /Ala294 Val, IVS7+7 /Ala206 Thr, and IVS7+7 / Met298 Ile were asymptomatic. The clinical symptomatology is rather poor in correlation with the FVII activity. Concerning the clinical phanotype, a correlation seems to exist between specific mutations and clinical symptoms.

Laser-induced population transfer by adiabatic passage techniques

We review some basic techniques for laser-induced adiabatic population transfer between discrete quantum states in atoms and molecules.