Impact of a comprehensive nutrition and lifestyle education intervention on body weight and health-related outcomes in morbidly-obese Hispanic-Americans following laparoscopic Roux-en-Y gastric bypass

As morbid obesity increasingly affects Hispanic-Americans, the incidence of Roux-en-Y gastric bypass procedures (RYGB) among this population rises. Prospective research on the impact of postoperative educational interventions focused on Hispanic- Americans is needed to prevent premature weight loss plateau, weight regain, nutritional deficiencies, and relapse of obesity-related comorbidities. This randomized-controlled study evaluated the impact of a comprehensive nutrition and lifestyle education intervention (6 biweekly postoperative sessions that incorporated motivational strategies for behavioral change) as compared to a non-comprehensive approach (printed guidelines for healthy lifestyle). The variables to consider are body weight, obesity-related comorbidities (depression, diabetes, dyslipidemia, and others), nutrient status, physical activity, and eating habits in 144 morbidly-obese adult Hispanic-Americans 6 to 12 months following RYGB. Patients were randomly assigned to either the comprehensive intervention (n=72) or the comparison group (n=72). Participants (mean age 44.5 ± 13.5 years) were mainly Cuban-born females (83.3%). Intervention sessions attendance was 64%. At 12 months, both groups lost weight significantly, but those in the comprehensive intervention experienced greater excess weight loss than those in the comparison group (80% vs. 64% from preoperative excess weight, P<.001). Intervention participants were significantly more involved in physical activity (+ 14 min/week vs. – 4 min/week), had decreased depression, joint illness, and required less medication for comorbidities than comparison participants. Additionally, those in the comprehensive intervention had sustained supplement intake experiencing less folate deficiency (P=.014). The non-comprehensive intervention group significantly decreased their protein and supplement intake compared to the intervention group. Patients in the comprehensive intervention had significantly better eating habits reflected by fewer episodes of dumping syndrome, constipation, and night eating, than those in the comparison group who reported greater eating in response to negative emotions (P=.003). These findings support the importance of a comprehensive educational approach to achieve more effective weight reduction and health-related outcomes to prevent relapse of obesity-related comorbidities and nutritional deficiencies in Hispanic-Americans 6 to 12 months following RYGB.

Patronage and bribery in sixteenth-century Peru: The government of Viceroy Conde del Villar and the visita of Licentiate Alonso Fernandez de Bonilla

This dissertation deals with the nature of the political system in sixteenth-century colonial Spanish America through an analysis of the administration of Viceroy Fernando de Torres y Portugal, Conde del Villar, in Peru (1585–1590). The political conflicts surrounding his government and the accusations of bribery leveled against him and members of his household provide the documentation for a case study in a system in which prestige and authority were defined through a complex network of patronage and personal relationships with the Spanish monarch, the ultimate source of legitimate power. ^ This dissertation is conceptualized using categories presented in Max Weber's theory on the nature of political order and authority in the history of human societies and the definition of the patrimonial system as one in which the power of he king confers legitimacy and authority on the whole political structure. ^ The documentary base for this dissertation is an exceptionally detailed and complete record related to the official administrative review ( visita) ordered by Philip II in 1588 to assess the government of Viceroy Torres y Portugal. Additionally, letters as well as other primary and secondary sources are scattered in repositories on both sides of the Atlantic. ^ The study of this particular case offers an excellent opportunity to gain an understanding of a political order in which jurisdictional boundaries between institutions and authorities were not clearly defined. The legal system operating in the viceroyalty was subordinated to the personal decisions of the king, and order and equilibrium were maintained through the interaction of patronage networks that were reproduced at all levels of the colonial society. ^ The final charges against Viceroy Conde del Villar, as well as their impact on the political career of those involved in the accusations, reveal that situations today understood to constitute bribery had a different meaning in the context of a patrimonial order. ^

An investigation into equations for estimating water requirements and the development of new equations for predicting total water intake

The primary purpose of this study was to investigate agreement among five equations by which clinicians estimate water requirements (EWR) and to determine how well these equations predict total water intake (TWI). The Institute of Medicine has used TWI as a measure of water requirements. A secondary goal of this study was to develop practical equations to predict TWI. These equations could then be considered accurate predictors of an individual’s water requirement. ^ Regressions were performed to determine agreement between the five equations and between the five equations and TWI using NHANES 1999–2004. The criteria for agreement was (1) strong correlation coefficients between all comparisons and (2) regression line that was not significantly different when compared to the line of equality (x=y) i.e., the 95% CI of the slope and intercept must include one and zero, respectively. Correlations were performed to determine association between fat-free mass (FFM) and TWI. Clinically significant variables were selected to build equations for predicting TWI. All analyses were performed with SAS software and were weighted to account for the complex survey design and for oversampling. ^ Results showed that the five EWR equations were strongly correlated but did not agree with each other. Further, the EWR equations were all weakly associated to TWI and lacked agreement with TWI. The strongest agreement between the NRC equation and TWI explained only 8.1% of the variability of TWI. Fat-free mass was positively correlated to TWI. Two models were created to predict TWI. Both models included the variables, race/ethnicity, kcals, age, and height, but one model also included FFM and gender. The other model included BMI and osmolality. Neither model accounted for more than 28% of the variability of TWI. These results provide evidence that estimates of water requirements would vary depending upon which EWR equation was selected by the clinician. None of the existing EWR equations predicted TWI, nor could a prediction equation be created which explained a satisfactory amount of variance in TWI. A good estimate of water requirements may not be predicted by TWI. Future research should focus on using more valid measures to predict water requirements.^

Neglected Masterpieces of Cinema

This article will acquaint you with ten of the more important leftwing films I have reviewed over the past sixteen years as a member of New York Film Critics Online. You will not see listed familiar works such as “The Battle of Algiers” but instead those that deserve wider attention, the proverbial neglected masterpieces. They originate from different countries and are available through Internet streaming, either freely from Youtube or through Netflix or Amazon rental. In several instances you will be referred to film club websites that like the films under discussion deserve wider attention since they are the counterparts to the small, independent theaters where such films get premiered. The country of origin, date and director will be identified next to the title, followed by a summary of the film, and finally by its availability.