Impact of food craving and calorie intake on body mass index (BMI) changes during an 18-month behavioral weight loss trial

The purpose of this study was to explore relations between food craving, caloric intake, and body mass index (BMI) changes over the course of an 18-month weight loss trial. Two-hundred two obese adults (mean BMI = 34.9 kg/m²; mean age = 51.30 years, 92.2% White; 57.8% female) who participated in a behavioral weight loss trial completed measures of food craving, caloric intake, and BMI at baseline, 6 and 18 months. From baseline to 6 months, higher initial food cravings were associated with more gradual and less steep reductions in BMI. Additionally, the relation between changes in food craving and BMI changes varied by levels of change in caloric intake, such that BMI change and change in food cravings were positively associated at low levels of change in caloric intake, but were unrelated at average and high levels of change in caloric intake. Similarly, from baseline to 6 months and from 6 to 18 months, the relation between changes in food craving and BMI changes also varied by initial levels of caloric intake. Explicit clinical targeting of food craving management may be beneficial for individuals beginning weight loss programs, especially for those who report higher levels of food craving at baseline. Baseline caloric intake and change in calorie intake over time may serve as moderators of the relation between food cravings and BMI.     

Statistically comparing EEG/MEG waveforms through successive significant univariate tests: How bad can it be?

When making statistical comparisons, the temporal dimension of the EEG signal introduces problems. Guthrie and Buchwald (1991) proposed a formally correct statistical approach that deals with these problems: comparing waveforms by counting the number of successive significant univariate tests and then contrasting this number to a well‐chosen critical value. However, in the literature, this method is often used inappropriately. Using real EEG data and Monte Carlo simulations, we examined the problems associated with the incorrect use of this approach under circumstances often encountered in the literature. Our results show inflated false‐positive or false‐negative rates depending on parameters of the data, including filtering. Our findings suggest that most applications of this method result in an inappropriate familywise error rate control. Solutions and alternative methods are discussed.     

Effects of Oral Supplementation With Nitrate-Rich Beetroot Juice in Patients With Pulmonary Arterial Hypertension—Results From BEET-PAH,an Exploratory Randomized,Double-Blind,Placebo-Controlled,Crossover Study

Background

The nitrate–nitrite–nitric oxide (NO) pathway may represent a potential therapeutic target in patients with pulmonary arterial hypertension (PAH). We explored the effects of dietary nitrate supplementation, with the use of nitrate-rich beetroot juice (BRJ), in patients with PAH.

Individual patient risk stratification of high‐risk neuroblastomas using a two‐gene score suited for clinical use

Several gene expression‐based prognostic signatures have been described in neuroblastoma, but none have successfully been applied in the clinic. Here we have developed a clinically applicable prognostic gene signature, both with regards to number of genes and analysis platform. Importantly, it does not require comparison between patients and is applicable amongst high‐risk patients. The signature is based on a two‐gene score (R‐score) with prognostic power in high‐stage tumours (stage 4 and/or MYCN‐amplified diagnosed after 18 months of age). QPCR‐based and array‐based analyses of matched cDNAs confirmed cross platform (array‐qPCR) transferability. We also defined a fixed cut‐off value identifying prognostically differing subsets of high‐risk patients on an individual patient basis. This gene expression signature independently contributes to the current neuroblastoma classification system, and if prospectively validated could provide further stratification of high‐risk patients, and potential upfront identification of a group of patients that are in need of new/additional treatment regimens.     

Swedish guidelines for the management of community-acquired pneumonia in immunocompetent adults

This document presents the evidence-based guidelines of the Swedish Society of Infectious Diseases for the management of adult immunocompetent patients with community-acquired pneumonia (CAP), who are assessed at hospital. The prognostic score 'CURB-65' is recommended for all CAP patients in the emergency room. The score provides an assessment tool for the decision regarding outpatient treatment or level of hospital supervision, the choice of microbiological investigations, and empirical antibiotic treatment. In patients with non-severe CAP (CURB-65 score 0-2) we recommend initial narrow-spectrum antibiotic treatment, orally or intravenously, primarily directed at Streptococcus pneumoniae. In those with CURB-65 score 3, penicillin G or a cephalosporin intravenously is recommended. For CURB-65 score 0-3 atypical pathogens should be covered only when they are suspected on clinical or epidemiological grounds. In patients with CURB-65 score 4-5 intravenous combination therapy with either cephalosporin/macrolide or penicillin G/fluoroquinolone is recommended. Efforts should be made to identify the CAP aetiology in order to support the ongoing antibiotic treatment or to suggest treatment alterations. Recommended measures for prevention of CAP include influenza -- and pneumococcal -- vaccination to risk groups and efforts for smoking cessation.     

Reduction of treatment delay in patients with ST-elevation myocardial infarction: impact of pre-hospital diagnosis and direct referral to primary percutanous coronary intervention.

AIMS: The majority of patients with ST-elevation myocardial infarction (STEMI) are admitted to local hospitals without primary percutaneous coronary intervention (primary PCI) facilities. Acute transferral to an interventional centre is necessary to treat these patients with primary PCI. The present study assessed the reduction in treatment delay achieved by pre-hospital diagnosis and referral directly to an interventional centre. METHODS AND RESULTS: Two local hospitals without primary PCI facilities were serving the study region. Pre-hospital diagnoses were established with the use of telemedicine, by ambulance physicians, or by general practitioners. Primary PCI was accepted as the preferred reperfusion therapy in patients with STEMI. From 31 October 2002 to 31 January 2004 all patients transported by ambulance and transferred for primary PCI were registered. Patients with STEMI were divided into three groups: (A) patients diagnosed at a local hospital (n = 55), (B) patients diagnosed pre-hospitally and admitted to a local hospital (n = 85), and (C) patients diagnosed pre-hospitally and referred directly to the interventional centre (n = 21). When comparing group A with group B and C, no difference was found in age, sex, infarct location, or distance from the scene of event to the interventional centre, whereas the median time from ambulance call to first balloon inflation was 41 min shorter in group B compared with group A (P<0.001) and 81 min shorter in group C compared with group A (P<0.001). CONCLUSION: In a cohort of patients scheduled for admission to a local hospital and subsequent transferral to an interventional centre for primary PCI, those diagnosed pre-hospitally had shorter treatment delay compared with those diagnosed in hospital, both in the setting of initial admission to a local hospital, and to an even larger extent in the setting of referral directly to the interventional centre.     

A comparison of technologies for database-driven websites for medical education

Static web pages may be easy to setup using text processors or user-friendly web editing software. However, some basic knowledge of the implementation (HTML) is usually needed for final editing and maintenance. As a result many static web pages are left without appropriate updating. With a database driven, dynamic approach web contents may change through user interaction, the pages are usually easier to maintain, and design elements are separated from contents. Database driven solutions (or content management systems) for larger organizations may be purchased at many different levels of complexity. For smaller systems, such as separate courses or projects, they may, however, be developed locally. The present study compares four alternative technologies for database driven web pages. Each technology offers advantages and disadvantages and many issues need to be considered when selecting platform. The present study demonstrates that database driven web pages may be effectively deployed using free Open Source software. Details may be found at www.intermed.dk/datadriven.