Prescribing for weight loss in primary care: evidence from a population based study

Background Taking antiobesity medication can be a cost effective way to lose weight. Uptake is determined in part by a General Practitioner's decision to prescribe weight loss medication and, in part, by patient preference. It is probable that the latter may indicate a patient's readiness to lose weight.


Methods Analysis of cross-sectional data (from February 2003 to March 2011) from a population based prescribing database (~1.75 million people) using an adjusted Poisson regression.


Results The number of antiobesity medications increased from 23.4 per 1000 population in 2004 to 30.7 per 1000 population in 2010 and was three times higher in female than in male subjects. Against this background, a marked seasonal variation in the number of antiobesity medications dispensed was evident (p<0.001), peaking in June/July with a trough in December/January (±8.0% peak to trough). The seasonal component was stronger in female subjects, ±11.2% peak to trough, compared with ±3.5% for male subjects.


Conclusions Obese patients, particularly women, increase their uptake of weight loss medication in the months leading up to the summer holiday period. The period prior to the summer may represent a time that health professionals could promote increased participation of obese patients in weight loss programmes.

Counselling for sight loss: Using systematic case study research to build a client informed practice model

There is compelling evidence to suggest that acquired sight loss negatively impacts on emotional well-being. Despite increasing recognition of the need to provide emotional support for people with sight loss, we still do not fully understand what counselling interventions help and why they help. The aim of this study was to examine the process and outcome of counselling for a 70-year-old client who had experienced complete, irreversible, post-operative sight loss in order to gain a deeper understanding of client-defined helpful aspects of therapy. A Hermeneutic Single-Case Efficacy Design study was undertaken having received ethical approval from the University's Research Ethics Committee. The client received six sessions of counselling from a vision-impaired counsellor working within a pluralistic framework. Measures were completed by the client at every session, as well as at pre-and post-counselling. All sessions were recorded and transcribed. The client also participated in pre-and post-counselling interviews. Data formed a rich case record that was analysed by a quasi-judicial enquiry team. Results suggested that this was a successful outcome case. Client-defined helpful aspects of therapy were (1) feeling understood; (2) being able to express emotions around the loss of sight; (3) finding a new identity; (4) finding ways to cope with fear, loss, dependency, and other people's perceptions; (5) exploring the possibility of a positive future without sight; (6) making sense of things; and (7) finding ways to become more socially connected. Relevant therapeutic tasks are proposed, and four key aspects of therapy are identified, which may have implications for the development of a practice model.

Loss of Synaptic Connectivity, Particularly in Second Order Neurons Is a Key Feature of Diabetic Retinal Neuropathy in the Ins2Akita Mouse

Retinal neurodegeneration is a key component of diabetic retinopathy (DR), although the detailed neuronal damage remains ill-defined. Recent evidence suggests that in addition to amacrine and ganglion cell, diabetes may also impact on other retinal neurons. In this study, we examined retinal degenerative changes in Ins2^Akita diabetic mice. In scotopic electroretinograms (ERG), b-wave and oscillatory potentials were severely impaired in 9-month old Ins2^Akita mice. Despite no obvious pathology in fundoscopic examination, optical coherence tomography (OCT) revealed a progressive thinning of the retina from 3 months onwards. Cone but not rod photoreceptor loss was observed in 3-month-old diabetic mice. Severe impairment of synaptic connectivity at the outer plexiform layer (OPL) was detected in 9-month old Ins2Akita mice. Specifically, photoreceptor presynaptic ribbons were reduced by 25% and postsynaptic boutons by 70%, although the density of horizontal, rod- and cone-bipolar cells remained similar to non-diabetic controls. Significant reductions in GABAergic and glycinergic amacrine cells and Brn3a+ retinal ganglion cells were also observed in 9-month old Ins2^Akita mice. In conclusion, the Ins2^Akita mouse develops cone photoreceptor degeneration and the impairment of synaptic connectivity at the OPL, predominately resulting from the loss of postsynaptic terminal boutons. Our findings suggest that the Ins2^Akita mouse is a good model to study diabetic retinal neuropathy.

Polarization retention loss in PbTiO3 ferroelectric films due to leakage currents

The relationship between retention loss in single crystal PbTiO3 ferroelectric thin films and leakage currents is demonstrated by piezoresponse and conductive atomic force microscopy measurements. It was found that the polarization reversal in the absence of an electric field followed a stretched exponential behavior 1-exp[-(t/k)(d)] with exponent d>1, which is distinct from a dispersive random walk process with d <. The latter has been observed in polycrystalline films for which retention loss was associated with grain boundaries. The leakage current indicates power law scaling at short length scales, which strongly depends on the applied electric field. Additional information of the microstructure, which contributes to an explanation of the presence of leakage currents, is presented with high resolution transmission electron microscopy analysis.

Loss-of-Mains Protection System by Application of Phasor Measurement Unit Technology with Experimentally Assessed Threshold Settings

Loss-of-mains protection is an important component of the protection systems of embedded generation. The role of loss-of-mains is to disconnect the embedded generator from the utility grid in the event that connection to utility dispatched generation is lost. This is necessary for a number of reasons, including the safety of personnel during fault restoration and the protection of plant against out-of-synchronism reclosure to the mains supply. The incumbent methods of loss-of-mains protection were designed when the installed capacity of embedded generation was low, and known problems with nuisance tripping of the devices were considered acceptable because of the insignificant consequence to system operation. With the dramatic increase in the installed capacity of embedded generation over the last decade, the limitations of current islanding detection methods are no longer acceptable. This study describes a new method of loss-of-mains protection based on phasor measurement unit (PMU) technology, specifically using a low cost PMU device of the authors' design which has been developed for distribution network applications. The proposed method addresses the limitations of the incumbent methods, providing a solution that is free of nuisance tripping and has a zero non-detection zone. This system has been tested experimentally and is shown to be practical, feasible and effective. Threshold settings for the new method are recommended based on data acquired from both the Great Britain and Ireland power systems.

Electron-induced hydrogen loss in uracil in a water cluster environment

Low-energy electron-impact hydrogen loss due to dissociative electron attachment (DEA) to the uracil and thymine molecules in a water cluster environment is investigated theoretically. Only the A'-resonance contribution, describing the near-threshold behavior of DEA, is incorporated. Calculations are based on the nonlocal complex potential theory and the multiple scattering theory, and are performed for a model target with basic properties of uracil and thymine, surrounded by five water molecules. The DEA cross section is strongly enhanced when the attaching molecule is embedded in a water cluster. This growth is due to two effects: the increase of the resonance lifetime and the negative shift in the resonance position due to interaction of the intermediate negative ion with the surrounding water molecules. A similar effect was earlier found in DEA to chlorofluorocarbons. 

A new method for transmission loss allocation considering the circulating currents between generators

A new method is presented for transmission loss allocation based on the separation of transmission loss caused by load and the loss due to circulating currents between generators. The theoretical basis for and derivation of the loss formulae are presented using simple systems. The concept is then extended to a general power system using the Ybus model. Details of the application of the proposed method to a typical power system are presented along with results from the IEEE 30 bus test system. The results from both the small system and the standard IEEE test system demonstrate the validity of the proposed method.

Consistent effects of consumer species loss across different habitats

Our knowledge of the effects of consumer species loss on ecosystem functioning is limited by a paucity of manipulative field studies, particularly those that incorporate inter-trophic effects. Further, given the ongoing transformation of natural habitats by anthropogenic activities, studies should assess the relative importance of biodiversity for ecosystem processes across different environmental contexts by including multiple habitat types. We tested the context-dependency of the effects of consumer species loss by conducting a 15-month field experiment in two habitats (mussel beds and rock pools) on a temperate rocky shore, focussing on the responses of algal assemblages following the single and combined removals of key gastropod grazers (Patella vulgata, P. ulyssiponensis, Littorina littorea and Gibbula umbilicalis). In both habitats, the removal of limpets resulted in a larger increase in macroalgal richness than that of either L. littorea or G. umbilicalis. Further, by the end of the study, macroalgal cover and richness were greater following the removal of multiple grazer species compared to single species removals. Despite substantial differences in physical properties and the structure of benthic assemblages between mussel beds and rock pools, the effects of grazer loss on macroalgal cover, richness, evenness and assemblage structure were remarkably consistent across both habitats. There was, however, a transient habitat-dependent effect of grazer removal on macroalgal assemblage structure that emerged after three months, which was replaced by non-interactive effects of grazer removal and habitat after 15 months. This study shows that the effects of the loss of key consumers may transcend large abiotic and biotic differences between habitats in rocky intertidal systems. While it is clear that consumer diversity is a primary driver of ecosystem functioning, determining its relative importance across multiple contexts is necessary to understand the consequences of consumer species loss against a background of environmental change.

Do removable dental prosthesis have an impact on tooth loss?

DESIGN: A multi-centre randomised controlled study in 14 dental schools. This report is an interim analysis at 3 years.

INTERVENTION: Patients were allocated to either the Removable dental prosthesis group (RPD)-109 patients or the no prosthesis group (SDA) -106 patients. Patients had to be older than 35 years with no molars in the study jaw. Follow-up visits were scheduled at 4 to 8 wks (baseline), at 6 months, and at 1, 2, 3, 4, and 5 yrs after treatment.

OUTCOME MEASURE: Time to loss of first tooth following intervention or no intervention.

RESULTS: 81 patients received a RDP and 69 patients received no treatment in the end. This is a reduction of 26% and 35% respectively from the time when they were randomised to the two groups. Tooth loss occurred in 13 of the RDP group (16% of those who received the RDP, 12% of those allocated to the group at the start) with 5 of these being in the study jaw and 8 in the opposing jaw. Tooth loss occurred in 9 of the SDA group (13% of those who received SDA, 9% of those who were allocated to the group at the start) with 5 in the study jaw and 4 in the opposing jaw. The respective Kaplan-Meier survival rates at 38 months were 0.83 (95% CI: 0.74-0.91) in the RDP group and 0.86 (95% CI: 0.78-0.95) in the SDA group.

CONCLUSIONS: The difference in tooth loss at three years between patients treated with RDP and those not treated with RDP was not significant.

Holistic Design Strategy for High-Selectivity Low-Loss Integrated Millimetre-Wave Image-Reject Filters

To alleviate practical limitations in the design of mm-wave on-chip image-reject filters, systematic design methodologies are presented. Three low-order filters with high-selectivity and low-loss characteristics are designed and compared. Transmission zeroes are created by means of a quarter-wave transmission line (filter 1) and a series LC resonator (filters 2 and 3). Implemented on SiGe, the filters occupy 0.125, 0.064, and 0.079 mm2 chip area including pads. The measured transmission
losses across 81-86 GHz E-Band frequency range are 3.6-5.2 dB for filter 1, 3.1-4.7 dB for filter 2 and 3.6-5 dB for filter 3 where rejection levels at the image band are greater than 30 dB.