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Abstract Background Obesity is associated with an increased risk of atrial fibrillation (AF). Bariatric surgery results insubstantial long-term weight loss and the amelioration of several chronic comorbidities. We hypothesized that weightreduction with bariatric surgery would reduce the long-term incidence of AF. Objectives To assess the association between bariatric surgery and AF prevention. Setting University Hospital, United States. Methods All patients who underwent bariatric surgery at a single institution from 1985–2015 (n = 3,572) were propensity score matched 1:1 to a control population of obese patients with outpatient appointments (n = 45,750) in our clinical data repository. Patients with a prior diagnosis of AF were excluded. Demographics, relevant comorbidities, and insurance status were collected and a chart review was performed for all patients with AF. Paired univariate analyses were used to compare the two groups. Results After propensity score matching, 5,044 total patients were included (2,522 surgical, 2,522 non-surgical). There were no differences in preoperative body mass index (BMI) (47.1 vs 47.7 kg/m2, P = 0.76) or medical comorbidities between groups. The incidence of AF was lower among surgical patients (0.8% vs 2.9%, P = 0.0001). In patients ultimately diagnosed with AF, time from enrollment to development of AF did not differ between groups; however, surgical patients with AF experienced a significantly higher reduction in excess BMI compared to non-surgical patients with AF (57.9% vs −3.8%, P <0.001). Conclusion The incidence of AF was lower among patients who underwent bariatric surgery compared to their medically managed counterparts. Weight reduction with bariatric surgery may reduce the long-term incidence of AF. Highlights • Bariatric surgery lowered the long-term risk of new onset atrial fibrillation in propensity score matched cohorts of surgically and non-surgically managed obese patients. • Bariatric surgery patients who developed new onset atrial fibrillation did so despite significantly greater weight loss compared to non-surgically managed obese patients who developed AF. • Bariatric surgery patients who developed atrial fibrillation were more likely to be older, male, or have obstructive sleep apnea at baseline relative to surgical patients who did not develop AF. • Among patients who developed atrial fibrillation, there was a non-significant trend towards earlier onset of atrial fibrillation in patients who underwent bariatric surgery relative to patients who did not. [ABSTRACT FROM AUTHOR]

Background Although Roux-en-Y gastric bypass (RYGB) induces short-term weight loss and co-morbidity amelioration, long-term data suggest that a subset of patients return to their preoperative body mass index (BMI). Objectives To identify the clinical implications of 10-year weight loss failure after RYGB. Setting An academic teaching hospital. Methods Adults undergoing RYGB (1985–2004) were included in this study (n = 1087). Absolute weight loss failure was defined as ≤0% reduction in excess BMI 10 years after surgery. Univariate analyses compared co-morbidity rates and resolution by weight loss classification. Multivariable regression modeling analyzed preoperative predictors of 10-year percent reduction in excess BMI and weight loss failure. Results Complete follow-up was available for 617 (57%) patients with a 10-year median percent reduction in excess BMI of 57.1%; 10.2% of patients had weight loss failure. Prevalence of all co-morbidities decreased, even in patients with weight loss failure (all P <.05). Compared with patients with successful weight loss, patients with weight loss failure had similar rates of resolution of pre-existing co-morbidities, except for reduced resolution of apnea and cardiac co-morbidities (both P <.05). Risk factors for weight loss failure included lower BMI, nongovernmental insurance, longer travel time to hospital, and year of surgery. Nongovernmental insurance (odds ratio 2.03, P = .036) conferred the highest adjusted odds of weight loss failure. Conclusions The vast majority of patients experience dramatic health improvement 10 years after RYGB, even though some patients fail to maintain their weight loss. Renewed focus should be placed on prevention and treatment of chronic disease, with further investigation of weight loss independent mechanisms of health improvement. [ABSTRACT FROM AUTHOR]

Background Many insurance companies have considerable prebariatric surgery requirements despite a lack of evidence for improved clinical outcomes. The hypothesis of this study is that insurance-specific requirements will be associated with a decreased progression to surgery and increased delay in time to surgery. Methods Retrospective data collection was performed for patients undergoing bariatric surgery evaluation from 2010–2015. Patients who underwent surgery (SGY; n = 827; mean body mass index [BMI] 49.1) were compared with those who did not (no-SGY; n = 648; mean BMI: 49.4). Univariate and multivariate analysis were performed to identify specific co-morbidity and insurance specific predictors of surgical dropout and time to surgery. Results A total of 1475 patients using 12 major insurance payors were included. Univariate analysis found insurance requirements associated with surgical drop out included longer median diet duration (no-SGY = 6 mo; SGY = 3 mo; P <.001); primary care physician letter of necessity ( P <.0001); laboratory testing ( P = .019); and evaluation by cardiology ( P <.001), pulmonology ( P <.0001), or psychiatry ( P = .0003). Using logistic regression to control for co-morbidities, longer diet requirement (odds ratio [OR] .88, P <.0001), primary care physician letter (OR .33, P <.0001), cardiology evaluation (OR .22, P = .038), and advanced laboratory testing (OR 5.75, P = .019) independently predicted surgery dropout. Additionally, surgical patients had an average interval between initial visit and surgery of 5.8±4.6 months with significant weight gain (2.1 kg, P <.0001). Conclusion Many prebariatric surgery insurance requirements were associated with lack of patient progression to surgery in this study. In addition, delays in surgery were associated with preoperative weight gain. Although prospective and multicenter studies are needed, these findings have major policy implications suggesting insurance requirements may need to be reconsidered to improve medical care. [ABSTRACT FROM AUTHOR]

Background Hypoglycemia is a known risk of intensive postoperative glucose control in patients undergoing cardiac operations. However, neither the consequences of hypoglycemia relative to hyperglycemia, nor the possible interaction effects, have been well described. We examined the effects of postoperative hypoglycemia, hyperglycemia, and their interaction on short-term morbidity and mortality. Methods Single-institution Society of Thoracic Surgeons (STS) database patient records from 2010 to 2014 were merged with clinical data, including blood glucose values measured in the intensive care unit (ICU). Exclusion criteria included fewer than three glucose measurements and absence of an STS predicted risk of morbidity or mortality score. Primary outcomes were operative mortality and composite major morbidity (permanent stroke, renal failure, prolonged ventilation, pneumonia, or myocardial infarction). Secondary outcomes included ICU and postoperative length of stay. Hypoglycemia was defined as below 70 mg/dL, and hyperglycemia as above 180 mg/dL. Simple and multivariable regression models were used to evaluate the outcomes. Results A total of 2,285 patient records met the selection criteria for analysis. The mean postoperative glucose level was 140.8 ± 18.8 mg/dL. Overall, 21.4% of patients experienced a hypoglycemic episode (n = 488), and 1.05% (n = 24) had a severe hypoglycemic episode (<40 mg/dL). The unadjusted odds ratio (UOR) for operative mortality for patients with any hypoglycemic episode compared with those without was 5.47 (95% confidence interval [CI] 3.14 to 9.54), and the UOR for major morbidity was 4.66 (95% CI 3.55 to 6.11). After adjustment for predicted risk of morbidity or mortality and other significant covariates, the adjusted odds (AOR) of operative mortality were significant for patients with any hypoglycemia (AOR 4.88, 95% CI 2.67 to 8.92) and patients with both events (AOR 8.29, 95% CI 1.83 to 37.5) but not hyperglycemia alone (AOR 1.62, 95% CI 0.56 to 4.69). The AOR of major morbidity for patients with both hypoglycemic and hyperglycemic events was 14.3 (95% CI 6.50 to 31.4). Conclusions Postoperative hypoglycemia is associated with both mortality and major morbidity after cardiac operations. The combination of both hyperglycemia and hypoglycemia represents a substantial increase in risk. Although it remains unclear whether hypoglycemia is a cause, an early warning sign, or a result of adverse events, this study suggests that hypoglycemia may be an important event in the postoperative period after cardiac operations. [ABSTRACT FROM AUTHOR]

Abstract: Given the reciprocal influences of emotion dysregulation and relationship functioning, it is important to target such emotional difficulties within an interpersonal context. Treating emotion dysregulation within intimate relationships can offer valuable opportunities for both emotional and relationship difficulties to be addressed. This paper reports the development and implementation of one such intervention, which helped couples to address both emotion dysregulation and relationship dynamics. Integrating dialectical behavior therapy and cognitive-behavioral couple therapy, this 16-week group intervention taught couples emotion regulation, communication, and problem-solving skills, and led them through an exploration of how strong feelings affect and are affected by their relationship. This paper provides a clinical description of this treatment, along with a case study and empirical data for this case. [Copyright &y& Elsevier]

Given the bidirectional association between psychopathology and relationship distress, an in-depth understanding of couples' interaction processes that contribute to psychopathology is needed. This study examined the interpersonal dynamics of vocally-encoded emotional arousal (fundamental frequency, f 0) during couple conversations and their associations with depressive symptoms, anxiety symptoms, and relationship distress. Data from eight samples were pooled (N = 404 couples) to examine (a) overall trajectories of f 0 across the interaction and (b) moment-by-moment intraindividual changes in and interpersonal reactivity to partners' f 0. Multilevel growth models and repeated-measures actor-partner interdependence models demonstrated that individuals with more severe depression showed more synchronizing reactivity to their partners' f 0 on a moment-by-moment basis, and their overall baseline level of f 0 was lower. More severe relationship distress was associated with more steeply increasing trajectories of f 0 and with greater synchronizing reactivity to partners' f 0. Relative differences in depressive symptoms between the two members of a couple were associated with interpersonal dynamics of f 0 as well. There were no associations with anxiety symptoms. Thus, depressive symptoms were associated with characteristic interpersonal dynamics of vocally-encoded emotional arousal; yet, most consistent associations emerged for relationship distress, which future studies on individual psychopathology should take into account. • Examined interpersonal dynamics of vocally-encoded emotional arousal, depression, anxiety, relationship distress in couples. • Depressive symptoms associated with greater reactivity between partners. • Relationship distress associated with greater increases in emotional arousal and greater reactivity between partners. • Relationship distress relevant to interpersonal emotion dynamics in psychopathology. [ABSTRACT FROM AUTHOR]

Abstract: The current paper discusses general principles, therapeutic strategies, common factors, and domains commonly addressed in the treatment of couples who have a partner with a medical condition. Couple-based interventions for medical problems are contrasted with couple therapy and relationship education in that the emphasis is on assisting the patient in addressing the medical disorder, along with being attentive to the patient''s partner and their relationship. Guidelines are provided showing how knowledge and understanding of medical disorders and couple functioning are integrated in order to conduct such interventions. Five common domains addressed during intervention are elaborated upon: (a) psychoeducation about the disorder, (b) sharing thoughts and feeling regarding the disorder, (c) making decisions focal to the medical disorder, (d) implementing relationship changes that are nonmedical but that result from the disorder, and (e) addressing relationship functioning unrelated to the disorder. The importance of empirically demonstrating the utility of each domain in future investigations is noted. [Copyright &y& Elsevier]

In the correctional field, researchers have increasingly focused on interventions that will reduce recidivism rates, such as parent training programs. Due to inconsistent implementation and other factors, parent training in correctional settings have produced varying results; however, behavioral parent training programs (BPTs) have proven most effective. Despite their effectiveness, BPTs have predominantly been used with mothers, even though incarcerated men, and thus incarcerated fathers, are the majority in correctional settings. The current study examines the effectiveness of a Parent-Child Interaction Therapy-based BPT in a rural correctional setting population for both mothers and fathers, as compared to treatment as usual. Results showed that men's and women's experimental groups demonstrated better outcomes in knowledge of behavioral principles and treatment acceptability compared with control groups, and they also exhibited non-inferior outcomes in those same measures when comparing scores of the men's and women's experimental groups. [ABSTRACT FROM AUTHOR]

• A low calorie diet with interval exercise improved sexual life and emotions quality of life domains as well as total score more than a low calorie diet alone. • Oxidized and non-oxidized phospholipids decreased with a 13 day low calorie diet in relation to caloric restriction. • Adding interval exercise to a calorie restricted diet may blunt the reductions in oxidized and non-oxidized phospholipids following a short-term low calorie diet in relation to fitness adapation. The objective of this study was to test if a low-calorie diet plus interval exercise (LCD+INT) reduced oxidized and non-oxidized phospholipids in relation to improved weight-related quality of life (QoL) to a greater extent than an energy-deficit matched LCD in obese females. Subjects (age: 47.2 ± 2.6 years, body mass index: 37.5 ± 1.3 kg/m2) were randomized to a 13-day LCD (n = 12; mixed meals of ∼1200 kcal/day) or LCD+INT (n = 13; 12 sessions of 60 min/day alternating 3 min at 50% and 90% peak heart rate plus an additional 350 kcal shake fed after exercise to match energy availability between groups). Weight-related QoL (Laval Questionnaire) as well as oxidized (POVPC, HOOA-PC, HPETE-PC, HETE-PC, PEIPC, KOOA-PC) and non-oxidized (PAPC and lysoPC) phospholipids were assessed pre- and post-intervention. Fitness (VO 2 peak), body composition (BodPod), and clinical bloods were also tested. LCD+INT significantly increased VO 2 peak (mL/kg/min, P = 0.03) compared to LCD despite similar fat loss, blood glucose, insulin sensitivity, and inflammatory responses. LCD+INT had significantly greater increases in QoL sexual life domain (P = 0.05) and tended to have a greater increase in the emotions domain (P = 0.09) and total score (P = 0.10) compared to LCD. There were no significant differences between treatments for changes in phospholipids despite LCD+INT increasing measured oxidized and non-oxidized phospholipids while LCD decreased POVPC, HOOA-PC, and PEIPC as well as non-oxidized PAPC and lysoPC. Interestingly, the rise in PEIPC correlated with elevated VO 2 peak (mL/kg/min r = 0.42, P = 0.05). Decreased caloric intake was, however, linked to a decrease in PAPC (r = 0.53, P = 0.01), lysoPC (r = 0.52, P = 0.02), POVPC (r = 0.43, P = 0.05), and HPETE-PC (r = 0.43, P = 0.05). The decrease in HETE-PC also correlated with increases in the QoL domains symptoms (r = -0.46, P = 0.04), hygiene/clothing (r = -0.53, P = 0.01), emotions (r = -0.53, P = 0.01), social interactions (r = -0.49, P = 0.02), and total score (r = -0.52, P = 0.02). In conclusion, although LCD and LCD+INT improved weight related QoL over 13 days in females with obesity, LCD+INT tended to improve sexual life, emotions as well as total QoL score more than LCD. These data suggest caloric restriction and fitness may act through different mechanisms to support QoL. [ABSTRACT FROM AUTHOR]