Effect of a Web-Based Behavior Change Program on Weight Loss and Cardiovascular Risk Factors in Overweight and Obese Adults at High Risk of Developing Cardiovascular Disease:Randomized Controlled Trial

BACKGROUND: Web-based programs are a potential medium for supporting weight loss because of their accessibility and wide reach. Research is warranted to determine the shorter- and longer-term effects of these programs in relation to weight loss and other health outcomes.

OBJECTIVE: The aim was to evaluate the effects of a Web-based component of a weight loss service (Imperative Health) in an overweight/obese population at risk of cardiovascular disease (CVD) using a randomized controlled design and a true control group.

METHODS: A total of 65 overweight/obese adults at high risk of CVD were randomly allocated to 1 of 2 groups. Group 1 (n=32) was provided with the Web-based program, which supported positive dietary and physical activity changes and assisted in managing weight. Group 2 continued with their usual self-care (n=33). Assessments were conducted face-to-face. The primary outcome was between-group change in weight at 3 months. Secondary outcomes included between-group change in anthropometric measurements, blood pressure, lipid measurements, physical activity, and energy intake at 3, 6, and 12 months. Interviews were conducted to explore participants' views of the Web-based program.

RESULTS: Retention rates for the intervention and control groups at 3 months were 78% (25/32) vs 97% (32/33), at 6 months were 66% (21/32) vs 94% (31/33), and at 12 months were 53% (17/32) vs 88% (29/33). Intention-to-treat analysis, using baseline observation carried forward imputation method, revealed that the intervention group lost more weight relative to the control group at 3 months (mean -3.41, 95% CI -4.70 to -2.13 kg vs mean -0.52, 95% CI -1.55 to 0.52 kg, P<.001), at 6 months (mean -3.47, 95% CI -4.95 to -1.98 kg vs mean -0.81, 95% CI -2.23 to 0.61 kg, P=.02), but not at 12 months (mean -2.38, 95% CI -3.48 to -0.97 kg vs mean -1.80, 95% CI -3.15 to -0.44 kg, P=.77). More intervention group participants lost ≥5% of their baseline body weight at 3 months (34%, 11/32 vs 3%, 1/33, P<.001) and 6 months (41%, 13/32 vs 18%, 6/33, P=.047), but not at 12 months (22%, 7/32 vs 21%, 7/33, P=.95) versus control group. The intervention group showed improvements in total cholesterol, triglycerides, and adopted more positive dietary and physical activity behaviors for up to 3 months verus control; however, these improvements were not sustained.

CONCLUSIONS: Although the intervention group had high attrition levels, this study provides evidence that this Web-based program can be used to initiate clinically relevant weight loss and lower CVD risk up to 3-6 months based on the proportion of intervention group participants losing ≥5% of their body weight versus control group. It also highlights a need for augmenting Web-based programs with further interventions, such as in-person support to enhance engagement and maintain these changes.

A web-based telemedicine system for low-resource settings 13 years on: insights from referrers and specialists

Background: One way to tackle health inequalities in resource-poor settings is to establish links between doctors and health professionals there and specialists elsewhere using web-based telemedicine. One such system run by the Swinfen Charitable Trust has been in existence for 13 years which is an unusually long time for such systems.

Objective: We wanted to gain some insights into whether and how this system might be improved.

Methods: We carried out a survey by questionnaire of referrers and specialists over a six months period.

Results: During the study period, a total of 111 cases were referred from 35 different practitioners, of whom 24% were not doctors. Survey replies were received concerning 67 cases, a response rate of 61 per cent. Eighty-seven per cent of the responding referrers found the telemedicine advice useful, and 78% were able to follow the advice provided. As a result of the advice received, the diagnosis was changed in 22% of all cases and confirmed in a further 18 per cent. Patient management was changed in 33 per cent. There was no substantial difference between doctors and non-doctors. During the study period, the 111 cases were responded to by 148 specialists, from whom 108 replies to the questionnaire were received, a response rate of 73 per cent. About half of the specialists (47%) felt that their advice had improved the management of the patients. There were 62 cases where it was possible to match up the opinions of the referrer and the consultants about the value of a specific teleconsultation. In 34 cases (55%) the referrers and specialists agreed about the value. However, in 28 cases (45%) they did not: specialists markedly underestimated the value of a consultation compared to referrers. Both referrers and specialist were extremely positive about the system which appears to be working well. Minor changes such as a clearer referral template and an improved web interface for specialists may improve it.

Supporting active learning in an undergraduate geotechnical engineering course using group-based audience response systems quizzes

The use of audience response systems (ARSs) or ‘clickers’ in higher education has increased over the recent years, predominantly owing to their ability to actively engage students, for promoting individual and group learning, and for providing instantaneous feedback to students and teachers. This paper describes how group-basedARSquizzes have been integrated into an undergraduate civil engineering course on foundation design. Overall, theARSsummary quizzes were very well received by the students. Feedback obtained from the students indicates that the majority believed the group-based quizzes were useful activities, which helped to improve their understanding of course materials, encouraged self-assessment, and assisted preparation for their summative examination. Providing students with clickers does not, however, necessarily guarantee the class will be engaged with the activity. If an ARS activity is to be successful, careful planning and design must be carried out and modifications adopted where necessary, which should be informed by the literature and relevant student feedback.

Application of poly(ethylene glycol)-based aqueous biphasic systems as reaction and reactive extraction media

Poly(ethylene glycol)-based aqueous biphasic systems (PEG-ABSs) have been investigated as tunable reaction media, in the example presented here, to control the oxidation of cyclohexene to adipic acid with hydrogen peroxide. The production of adipic acid was found to increase from the monophasic to the biphasic regimes, was greatest at short tie-line lengths (close to the system's critical point), and demonstrates how control of the ABS media, through changes in system composition, PEG, salt, and tie-line length, can be used to readily tune and control reactivity and product isolation in these aqueous biphasic reactive extraction systems. Challenges in using this system, including possible oxidation reactions of the PEG-OH end groups, are also discussed.

Analysis of Receiver Algorithms for LTE SC-FDMA Based Uplink MIMO Systems

This letter derives mathematical expressions for the received signal-to-interference-plus-noise ratio (SINR) of uplink Single Carrier (SC) Frequency Division Multiple Access (FDMA) multiuser MIMO systems. An improved frequency domain receiver algorithm is derived for the studied systems, and is shown to be significantly superior to the conventional linear MMSE based receiver in terms of SINR and bit error rate (BER) performance.

Microneedle-based drug delivery systems: Microfabrication, drug delivery, and safety

Many promising therapeutic agents are limited by their inability to reach the systemic circulation, due to the excellent barrier properties of biological membranes, such as the stratum corneum (SC) of the skin or the sclera/cornea of the eye and others. The outermost layer of the skin, the SC, is the principal barrier to topically-applied medications. The intact SC thus provides the main barrier to exogenous substances, including drugs. Only drugs with very specific physicochemical properties (molecular weight <500 Da, adequate lipophilicity, and low melting point) can be successfully administered transdermally. Transdermal delivery of hydrophilic drugs and macromolecular agents of interest, including peptides, DNA, and small interfering RNA is problematic. Therefore, facilitation of drug penetration through the SC may involve by-pass or reversible disruption of SC molecular architecture. Microneedles (MNs), when used to puncture skin, will by-pass the SC and create transient aqueous transport pathways of micron dimensions and enhance the transdermal permeability. These micropores are orders of magnitude larger than molecular dimensions, and, therefore, should readily permit the transport of hydrophilic macromolecules. Various strategies have been employed by many research groups and pharmaceutical companies worldwide, for the fabrication of MNs. This review details various types of MNs, fabrication methods and, importantly, investigations of clinical safety of MN.

Conceptions of Teacher Identity: Creating Self-Boxes as Arts-Based Self-Study

This paper presents a palimpsest of ways in which self-study draws upon arts-based methods not just as processes towards teacher development, but also as means to problematize and inquire into conceptualizations of the self. It focuses on the creation of individual self-boxes that mediate teachers’ dynamic narratives of identity. Concepts of the unitary self, the decentred self and the relationship between inner and outer experience are challenged and illustrated through two interlapping stories made manifest through the creation of self-boxes. From time immemorial man has known that he is the subject most deserving of his own study, but he has also fought shy of treating this subject as a whole, that is, in accordance with its total character. (Buber, 1947, p. 140)

A web-based overview of semiconductor photochemistry-based current commercial applications

The major current commercial applications of semiconductor photochemistry promoted on the world wide web are reviewed. The basic principles behind the different applications are discussed, including the use of semiconductor photochemistry to: photo-mineralise organics, photo-sterilise and photo-demist. The range of companies, and their products, which utilise semiconductor photochemistry are examined and typical examples listed. An analysis of the geographical distribution of current commercial activity in this area is made. The results indicate that commercial activity in this area is growing world-wide, but is especially strong in Japan. The number and geographical distribution of patents in semiconductor photocatalysis are also commented on. The trends in the numbers of US and Japanese patents over the last 6 years are discussed. (C) 2002 Elsevier Science B.V. All rights reserved.