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In 2016, the Veterans Health Administration (VHA) held a Weight Management State of the Art conference to identify evidence gaps and develop a research agenda for population-based weight management for veterans. Included were behavioral, pharmacologic, and bariatric surgery workgroups. This article summarizes the bariatric surgery workgroup (BSWG) findings and recommendations for future research. The BSWG agreed that there is evidence from randomized trials and large observational studies suggesting that bariatric surgery is superior to medical therapy for short- and intermediate-term remission of type 2 diabetes, long-term weight loss, and long-term survival. Priority evidence gaps include long-term comorbidity remission, mental health, substance abuse, and health care costs. Evidence of the role of endoscopic weight loss options is also lacking. The BSWG also noted the limited evidence regarding optimal timing for bariatric surgery referral, barriers to bariatric surgery itself, and management of high-risk bariatric surgery patients. Clinical trials of pre- and post-surgery interventions may help to optimize patient outcomes. A registry of overweight and obese veterans and a workforce assessment to determine the VHA's capacity to increase bariatric surgery access were recommended. These will help inform policy modifications and focus the research agenda to improve the ability of the VHA to deliver population-based weight management.

Howard S Smith,1 Eric J Smith,2 Benjamin R Smith21Department of Anesthesiology, Albany Medical College, Albany, NY; 2The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USAAbstract: Chronic musculoskeletal pain is among the most frequent painful complaints that healthcare providers address. The bulk of these complaints are chronic low back pain and chronic osteoarthritis. Osteoarthritis is the most common form of arthritis in the United States. It is a chronic degenerative disorder characterized by a loss of cartilage, and occurs most often in older persons. The management of osteoarthritis and chronic low back pain may involve both nonpharmacologic (eg, weight loss, resistive and aerobic exercise, patient education, cognitive behavioral therapy) and pharmacologic approaches. Older adults with severe osteoarthritis pain are more likely to take analgesics than those with less severe pain. The pharmacologic approaches to painful osteoarthritis remain controversial, but may include topical as well as oral nonsteroidal antiinflammatory drugs, acetaminophen, duloxetine, and opioids. The role of duloxetine for musculoskeletal conditions is still evolving.Keywords: pain, musculoskeletal, duloxetine, osteoarthritis, low back, serotonin-norepinephrine reuptake inhibitor

Differences in locomotor response to an inescapable novel environment have previously been shown to predict sensitivity to amphetamine reward, where high responders (HR), compared to low responders (LR), showed greater initial sensitivity to amphetamine self-administration. The present experiments sought to extend these findings and assessed the relationship between locomotor response to an inescapable novel environment and conditioned taste aversion (CTA) with amphetamine and lithium chloride (LiCl). Male Sprague-Dawley rats were tested for their locomotor response to an inescapable novel environment and divided into high (HR) or low (LR) responders, based on whether their locomotor scores were above or below the median activity level of the subject sample. After several days, the animals were tested in a CTA procedure and conditioned with either amphetamine or lithium chloride. Compared to HR rats, LR rats showed greater sensitivity to amphetamine CTA at the doses tested. In contrast, the results with LiCl showed no relationship between locomotor response to an inescapable novel environment and CTA. Taken together, the present results suggest that LR, compared to HR, rats show less sensitivity to the rewarding effects of amphetamine because they are more sensitive to aversive effects of amphetamine, as reflected in CTA. In contrast, HR rats display less sensitivity to aversive effects of amphetamine, which may explain their greater propensity to self-administer amphetamine.

Several lines of evidence suggest that the enzyme catalase plays an important role in many of the behavioral and reinforcing effects of ethanol, through its putative role in the central production of acetaldehyde. The role of catalase in the acquisition of voluntary ethanol consumption was examined in the present experiments by administering the catalase inhibitor 3-amino-1,2,4-triazole (aminotriazole) during the presentation of an ascending series of concentrations of either ethanol or saccharin-quinine solutions. Aminotriazole (0.5g/kg) significantly attenuated consumption of both ethanol and saccharin-quinine solutions throughout the acquisition period, and this effect remained during a subsequent maintenance period during which no injections were administered. Drinking did recover, however, when the acquisition procedure was reinstated. These results suggest that the effect of aminotriazole on the consumption of ethanol and saccharin-quinine may be the result of a change in reactivity to taste, or an aversive effect caused by drug administration.

Thyroid-stimulating antibodies (TSAb) were found to inhibit the binding of labelled thyrotrophin (TSH) to thyroid membranes in a dose-dependent manner and this effect was localized in the Fab part of the TSAb molecule. Analysis of the binding data suggested that TSAb and TSH bound to the same receptor site. Production of cyclic AMP by the thyroid membranes was stimulated by TSAb and TSAb–Fab with a similar time course to that observed with TSH. Kinetic studies indicated that the binding of TSAb to the thyroid membranes was not rate-limiting in the process of stimulation of cyclic AMP production.

Thyrotrophin (TSH) receptors have been extracted from human and porcine thyroid membranes by treatment with Triton X-100.125I-Labelled bovine TSH was used to monitor receptor activity. Analysis by gel filtration and electrophoresis on acrylamide gels containing sodium dodecyl sulphate suggested that Triton extracts of human thyroid membranes contained TSH receptors with a molecular weight in the region of 50 000 closely associated with Triton micelles of approximate molecular weight 300 000. Isoelectric focusing studies indicated that the Triton-solubilized TSH binding activity had an isoelectric point of pH 4–4·5. The soluble TSH receptors were heat-labile, showed optimum TSH binding at pH 7·4 and reduced hormone binding at high ionic strength. The TSH binding characteristics of membrane-bound and solubilized human TSH receptors were similar and both preparations gave curved Scatchard plots. Solubilized porcine TSH receptors appeared to have a similar molecular weight to the human receptors and were also closely associated with Triton micelles of approximate molecular weight 300 000. Scatchard analysis of TSH binding to membrane-bound or solubilized porcine TSH receptors gave approximately linear plots with association constants of 2·8 ± 0·95 (s.e.m.) × 109 and 1·7 ± 0·27 × 1091/mol respectively. Comparison of the binding capacities of the solubilized and membrane-bound porcine receptors indicated that the 0·5% Triton extracts contained 40% of the original TSH binding activity and that this was present at a concentration of 25 ng/ml.

The relationship between the binding of thyrotrophin (TSH) to receptors and the production of cyclic AMP has been investigated using crude human thyroid membranes. Receptor binding was studied by use of 125I-labelled bovine TSH, which had been purified by absorption to and elution from human thyroid membranes. This 125I-labelled material showed the same biological activity as the unlabelled hormone. Binding studies at equilibrium indicated that the association constant of the TSH–membrane interaction decreased as the amount of TSH bound increased. Kinetic data did not provide definite evidence that this was due to an effect of increasing receptor occupancy on the dissociation rate constant. Detectable stimulation by TSH of cyclic AMP production by the membranes was observed with as little as 30 μu. (1 ng) hormone. Increasing amounts of TSH over the range 0–250 μu. caused increases in the production of cyclic AMP, proportional to the amount of hormone bound. With larger amounts of TSH, increasingly greater amounts of bound hormone were required to give corresponding increases in cyclic AMP formation, and addition of TSH in amounts greater than 16 mu. resulted in progressive inhibition of cyclic AMP formation. Kinetic studies indicated that receptor binding was not rate-limiting in the stimulation of cyclic AMP production by TSH.

A new method for the separation of enamel and dentin in various types of human teeth is proposed. The separated enamel and dentin samples have been analysed for thirteen elements by inductively-coupled plasma emission-spectroscopy and also for fluoride.

Context Synchronised acoustic recorders can be used as a non-invasive tool to detect and localise sounds of interest, including vocal wildlife and anthropogenic sounds. Due to the high cost of commercial synchronised recorders, acoustic localisation has typically been restricted to small or well funded surveys. Recently, low-cost acoustic recorders have been developed, but until now their efficacy has not been compared with higher specification recorders. Aims The present study aimed to compare the efficacy of a newly developed low-cost recorder, the Conservation at Range through Audio Classification and Localisation (CARACAL), with an established, high-end recorder, the Wildlife Acoustics Song Meter (SM). Methods Four recorders of each type were deployed in a paired set-up across five nights in Wisconsin, USA. The recordings allowed for manual identification of domestic dog (Canis familiaris), grey wolf (Canis lupus), coyote (Canis latrans) and barred owl (Strix varia) calls, and then the ability of each recorder type to detect and localise the vocalising animals was compared. Key results The CARACALs were less sensitive, detecting only 47.5% of wolf, 55% of coyote, 65% of barred owl and 82.5% of dog vocalisations detected by the paired SMs. However, when the same vocalisations were detected on both recorders, localisation was comparable, with no significant difference in the precision or maximum detection ranges. Conclusions Low-cost recording equipment can be used effectively for acoustic localisation of both wild and domestic animals. However, the lower sensitivity of the CARACALs means that a denser network of these recorders would be needed to achieve the same efficacy as the SMs. Deploying a greater number of cheaper recorders increases the labour time in the field and the quantity of data to process and store. Thus, there is a trade-off between cost and time to be considered. Implications The ability to use low-cost recorders for acoustic localisation provides new avenues for tracking, managing and researching a wide range of wildlife species. Presently, CARACALs are more suited to monitoring species that have small home ranges and high amplitude vocalisations, and for when a large time investment for in situ equipment checks and data processing is feasible.

RET/PTC1 and RET/PTC3 are the markers for papillary thyroid carcinoma. Their reported prevalence varies broadly. Nonrearranged c-RET has also been detected in a variable proportion of papillary carcinomas. The published data suggest that a wide range in expression levels may contribute to the different frequency of c-RET and, particularly, of RET/PTC detection. However, quantitative expression analysis has never been systematically carried out. We have analyzed by real-time RT-PCR 25 papillary carcinoma and 12 normal thyroid samples for RET/PTC1, RET/PTC3 and for RET exons 10–11 and 12–13, which are adjacent to the rearrangement site. The variability in mRNA levels was marked and four carcinoma groups were identified: one lacking RET/PTC rearrangement with balanced RET exon levels similar to those of the normal samples (7/25 cases, 28%), the second (6/25 cases, 24%) with balanced RET expression and very low levels of RET/PTC1, the third with unbalanced RET exons 10–11 and 12–13 expression, high RET/PTC1 levels but no RET/PTC3 (7/25 cases, 28%), and the fourth with unbalanced RET expression, high RET/PTC1 levels and low levels of RET/PTC3 (5/25 cases, 20%). Papillary carcinomas with high RET/PTC1 expression showed an association trend for large tumor size (P=0.063). Our results indicate that the variability in c-RET and RET/PTC mRNA levels contributes to the apparent inconsistencies in their reported detection rates and should be taken into account not only for diagnostic purposes but also to better understand the role of c-RET activation in thyroid tumorigenesis.