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OBJECTIVE: Up to 37% of bariatric surgery patients suffer from insufficient weight loss or weight regain and mental health symptoms in the longer term. Cognitive behavioral therapy (CBT) may be an effective adjunct intervention to optimize patients' psychological functioning and weight loss results. To examine the value of adding preoperative CBT to bariatric surgery, three- and five-year follow-up data are presented.METHOD: In this multi-center randomized controlled trial (RCT; N = 130), a CBT group was compared to a treatment-as-usual (TAU) control group. Measurements were conducted at five time points: pretreatment (T0) and posttreatment/presurgery (T1) and at one- (T2; N = 120), three- (T3; N = 117), and five-year postsurgery (T4; N = 115). The intervention group received a 10-weeks, individual, preoperative CBT focused on self-monitoring, identifying triggers for disordered eating and goal setting for eating behavior and physical exercise, as well as postoperative lifestyle. Outcome measures included weight change, eating behavior, eating disorders, depression, quality of life (QoL), and overall psychological health.RESULTS: Preoperative CBT was not associated with better three- and five-year results than TAU regarding weight, dysfunctional eating behaviors, eating disorders, depression, overall psychological health, and QoL.DISCUSSION: Contrary to our hypothesis, three- and five-year postsurgery differences between groups regarding weight change and mental health were not significant.. Further exploration suggested that in both groups weight problems and depressive symptoms worsened at three and five-year follow-up. Future research should focus on long-term postoperative monitoring of weight and mood and on associated postoperative interventions and their specific timing.PUBLIC SIGNIFICANCE: After bariatric surgery, in the longer term weight problems re-occur in 30% of patients, which is probably partly related to psychopathology. We investigated whether cognitive behavior therapy (CBT) prior to bariatric surgery improved weight maintenance and mental health after surgery. Our study provided definite proof that preoperative CBT is not effective. Long-term postoperative monitoring and prompt psychological intervention after first signs of deterioration, are important to prevent further problems.

Feeling safe has been suggested to reflect a state of beneficial autonomic regulation, which might facilitate physical and mental health. We aimed to examine the relationship between the perception of safety in everyday life and cardiac activity (heart rate, heart rate variability) via ecological momentary assessment (EMA). Sixty participants volunteered in a 3-day EMA protocol with parallel recordings of the ECG and subjective ratings of safety. Higher experienced safety in everyday life was associated with better sleep quality, being at home (vs. other locations), being surrounded by close others, as well as more positive and less negative social interactions, thus suggesting valid assessment. Moreover, perceived safety was positively associated with heart rate variability, although this association vanished when controlling for heart rate. Conversely, perceived safety was significantly negatively associated with heart rate, even after controlling for heart rate variability. Findings suggest that feeling safe is associated with attenuated cardiac activity and this effect is probably mediated by sympathetic nervous system activity.

Previous studies suggest that task-irrelevant changing-state sound interferes specifically with the processing of serial order information in the focal task (e.g., serial recall from short-term memory), whereas a deviant sound in the auditory background is supposed to divert central attention, thus producing distraction in various types of cognitive tasks. Much of the evidence for this distinction rests on the observed dissociations in auditory distraction between serial and non-serial short-term memory tasks. In this study, both the changing-state effect and the deviation effect were contrasted between serial digit recall and mental arithmetic tasks. In three experiments (two conducted online), changing-state sound was found to disrupt serial recall, but it did not lead to a general decrement in performance in different mental arithmetic tasks. In contrast, a deviant voice in the stream of irrelevant speech sounds did not cause reliable distraction in serial recall and simple addition/subtraction tasks, but it did disrupt a more demanding mental arithmetic task. Specifically, the evaluation of math equations (multiplication and addition/subtraction), which was combined with a pair-associate memory task to increase the task demand, was found to be susceptible to auditory distraction in participants who did not serially rehearse the pair-associates. Together, the results support the assumption that the interference produced by changing-state sound is highly specific to tasks that require serial-order processing, whereas auditory deviants may cause attentional capture primarily in highly demanding cognitive tasks (e.g., mental arithmetic) that cannot be solved through serial rehearsal.

Background The role of the gastric microbiome in development or persistence of equine glandular gastric disease (EGGD) remains to be investigated. Hypothesis/objectives The objective was to characterize the glandular mucosal and gastric fluid microbiomes of horses with and without EGGD. It was hypothesized that differences in the mucosal microbiome are associated with EGGD. Animals Twenty-four horses were enrolled. Methods Gastroscopy was performed and EGGD scores recorded (score 0, n = 6; score 1, n = 8; score ≥2, n = 10). Gastric fluid and pinch biopsies of healthy glandular mucosa and EGGD lesions were collected via gastroscope. 16S rRNA amplicon sequencing of the gastric fluid and glandular mucosal biopsies was performed. Relationships between gastric fluid and mucosal microbial community composition were evaluated among EGGD score groups (EGGD 0-BX, EGGD 1-BX, EGGD ≥2-BX) and among endoscopic appearances: controls from horses without EGGD and normal areas, hyperemic areas, and lesions from horses with EGGD. Results Microbial community structure of mucosal biopsies differed among EGGD score groups (Jaccard similarity index; P = .009). Principal coordinate analysis showed separate clusters for EGGD 0-BX and EGGD ≥2-BX. Conclusions and clinical importance A modest difference was detected in the community structure of the gastric glandular mucosal microbiome in association with EGGD score.

BackgroundAlthough early results of bariatric surgery are beneficial for most patients, some patients regain weight later. Cognitive behavioral therapy (CBT) has been suggested as a way to improve patients’ psychological health and maintaining weight loss in the longer term. The added value of preoperative CBT to bariatric surgery was examined. Pre- and posttreatment and 1-year follow-up data are presented.MethodsIn a multi-center randomized controlled trial, CBT was compared to a treatment-as-usual (TAU) control group. Measurements were conducted pre- and posttreatment/pre-surgery (T0 and T1) and at 1-year post-surgery (T2). Patients in the intervention group received 10 individual, weekly sessions of preoperative CBT focused on modifying thoughts and behaviors regarding eating behavior, physical exercise, and postoperative life style. Outcome measures included weight change, eating behavior, eating disorders, depression, quality of life, and overall psychological health.ResultsThough no significant differences between conditions were found per time point, in the CBT, condition scores on external eating, emotional eating, depressive symptoms, and psychological distress decreased significantly more over time between pre- (T0) and posttreatment (T1) pre-surgery compared to TAU. No significant time x condition differences were found at 1-year post-surgery (T2).ConclusionsCompared to TAU, preoperative CBT showed beneficial effects on eating behavior and psychological symptoms only from pretreatment to posttreatment/pre-surgery, but not from pre-surgery to 1-year post-surgery. Preoperative CBT does not seem to contribute to better long-term outcomes post-surgery. Recent studies suggest that the optimal time to initiate psychological treatment may be early in the postoperative period, before significant weight regain has occurred.Trial Registrationhttps://www.trialregister.nlIdentifier: Trial NL3960.

Background Phenylbutazone is commonly prescribed for treatment of various painful or inflammatory disorders in horses, but is associated with gastrointestinal (GI) adverse effects. Anecdotally, many practitioners prescribe omeprazole concurrently with phenylbutazone to reduce development of equine gastric ulcer syndrome (EGUS), but the efficacy and safety of this practice remains unknown. Objectives To evaluate the effect of omeprazole on phenylbutazone-induced equine glandular gastric disease (EGGD) and equine squamous gastric disease (ESGD). Study design Randomised block experimental design. Methods Twenty-two horses with EGGD and ESGD scores ≤2 were included. Horses were assigned to treatment groups: phenylbutazone (4.4 mg/kg PO q 12 h; PBZ), phenylbutazone plus omeprazole (4 mg/kg PO q. 24 h; PBZ/OME) or placebo (CON) in a randomised block design based upon initial EGGD score. Horses were treated for up to 14 days. Gastroscopy was performed weekly; CBC and biochemistry were performed at Day 0 and study end. Horses were monitored for signs of colic and/or diarrhoea. Results EGGD score increased in PBZ (median change 1, inter-quartile range, [IQR], 0-2) compared to PBZ/OME (median change 0, IQR -1 to 0; P = .05). PBZ/OME (6/8) had more intestinal complications than CON (0/6; difference between proportions = 75%; 95% CI, 23%-93%; P = .03). Plasma protein concentrations decreased in PBZ, compared to CON (mean difference between groups, 14 g/L; 95% CI, 1.04-27; P = .03). Five horses were withdrawn from the study due to intestinal complications (n = 3 PBZ/OME and n = 2 PBZ); one horse (PBZ) was withdrawn due to severe grade 4 EGGD. Main limitations Small sample size and changes in management for the 2-3 days prior to study initiation; variable treatment duration among groups due to development of complications. Conclusions Administration of omeprazole ameliorated PBZ-induced EGGD, but was associated with an increase in intestinal complications. Caution should be exercised when co-prescribing NSAIDs and omeprazole in horses, particularly in association with change in management.

PURPOSE OF REVIEW: Bariatric surgery is the most effective treatment for morbid obesity. However, 20-30% of patients undergoing bariatric surgery experience premature weight stabilization or weight regain postoperatively. We report on the recent literature of predictors of weight loss and the efficacy of cognitive behavioral therapy (CBT) in bariatric patients.RECENT FINDINGS: Preoperative disordered eating behaviors do not appear to be significantly predictive of postoperative weight loss. Postoperative disordered eating behaviors, eating disorders, and depressive symptoms have been found to be associated with less optimal weight loss results. Recent studies show that CBT can contribute in reducing disordered eating behaviors and depressive symptoms. Some studies also show that pre and postoperative CBT interventions can promote weight loss. New applications of CBT such as by telephone, internet, or virtual reality might contribute to more accessible and low-cost treatments for the large group of bariatric patients worldwide.SUMMARY: CBT seems to be effective in reducing risk factors for weight regain after bariatric surgery, such as disordered eating behavior and depression. Controlled studies with long-term follow-up and larger sample sizes are needed to investigate the long-term effect of CBT interventions on weight loss results and psychological well-being.

Objective: To determine if future studies of coenzyme Q10 and GPI-1485 in Parkinson disease (PD) may be warranted. Methods: We conducted a randomized, double-blind, calibrated futility clinical trial of coenzyme Q10 and GPI-1485 in early untreated PD using placebo data from the DATATOP study to establish the futility threshold. Results: The primary outcome measure (change in total Unified Parkinson's Disease Rating Scale scores over 1 year) did not meet the prespecified criteria for futility for either agent. Secondary analyses using calibration controls and other more recent placebo data question the appropriateness of the predetermined definition of futility, and suggest that a more restrictive threshold may be needed. Conclusions: Coenzyme Q10 and GPI-1485 may warrant further study in Parkinson disease, although the data are inconsistent. Additional factors (cost, availability of other agents, more recent data on placebo outcomes, other ongoing trials) should also be considered in the selection of agents for Phase III studies. NEUROLOGY 2007;68:20-28

Background: (Extreme) obesity is a chronic harmful condition with high risk of medical comorbidities and negative social and emotional consequences. Bariatric surgery is an effective intervention for obesity, but approximately 20 to 30% of the patients experience adverse outcomes after surgery and there is a need for augmentation of current treatment strategies. This study examines the added value of pre-operative cognitive behavioral therapy (CBT) focused on modification of thoughts and behaviors in terms of eating behavior and physical exercise as well as preparation for surgery and postoperative life style. We hypothesize that pre-operative CBT will result in better weight loss maintenance, reduction of maladaptive eating behavior and better adherence to postoperative lifestyle on the long term as compared to bariatric surgery alone.Methods: One hundred and twenty eight patients that are on a waiting list for bariatric surgery are randomly assigned to the control or treatment condition. Patients in the treatment condition receive 10 sessions of CBT before surgery aimed at modifying dysfunctional eating habits and behaviors and developing more rational weight and body-related beliefs in order to enable long term maintenance of a healthier lifestyle after surgery. Weight loss, eating behavior, eating disorders, depression, quality of life and psychological distress are assessed before and after treatment, as well as 1, 3, and 5 year following surgery. (C) 2015 Elsevier Inc. All rights reserved.

Executive functions play an important role in problem-solving and self-control. Set-shifting is an aspect of executive functioning and represents cognitive flexibility. The inability to control eating in Binge Eating Disorder (BED) may imply deficits in set-shifting which could be exacerbated by negative mood and depressive symptoms. The aim of the study was to test whether there is a causal relationship between set-shifting ability, changes in mood and loss of control over eating in BED. Seventy-five participants diagnosed with BED were randomly assigned to a negative or neutral mood induction. Set-shifting abilities, depressive symptoms, current mood and loss of control over eating were assessed. Having depressive symptoms and poorer set-shifting abilities resulted in a more negative mood after a negative mood induction, whereas this was not observed in the neutral mood induction. Post-hoc analyses revealed that individuals with poorer set-shifting abilities and more changes in negative mood, experienced more feelings of loss of control over eating than individuals whose set-shifting abilities were better and whose mood did not change. The results suggest that both depressive symptoms and deficits in set-shifting abilities may decrease an individual's ability to handle negative affect and increase loss of control over eating in individuals with BED.

Pediatric primary care clinicians have unique opportunities and a growing sense of responsibility to prevent and address mental health and substance abuse problems in the medical home. In this report, the American Academy of Pediatrics proposes competencies requisite for providing mental health and substance abuse services in pediatric primary care settings and recommends steps toward achieving them. Achievement of the competencies proposed in this statement is a goal, not a current expectation. It will require innovations in residency training and continuing medical education, as well as a commitment by the individual clinician to pursue, over time, educational strategies suited to his or her learning style and skill level. System enhancements, such as collaborative relationships with mental health specialists and changes in the financing of mental health care, must precede enhancements in clinical practice. For this reason, the proposed competencies begin with knowledge and skills for systems-based practice. The proposed competencies overlap those of mental health specialists in some areas; for example, they include the knowledge and skills to care for children with attention-deficit/hyperactivity disorder, anxiety, depression, and substance abuse and to recognize psychiatric and social emergencies. In other areas, the competencies reflect the uniqueness of the primary care clinician's role: building resilience in all children; promoting healthy lifestyles; preventing or mitigating mental health and substance abuse problems; identifying risk factors and emerging mental health problems in children and their families; and partnering with families, schools, agencies, and mental health specialists to plan assessment and care. Proposed interpersonal and communication skills reflect the primary care clinician's critical role in overcoming barriers (perceived and/or experienced by children and families) to seeking help for mental health and substance abuse concerns.

Objectives:Leadership practices of health care managers can positively or negatively influence outcomes for organizations, providers and, ultimately, patients. Understanding the factors that contribute to nursing leadership is fundamental to ensuring a future supply of nursing leaders who can positively influence outcomes for health care providers and patients. The purpose of this study was to systematically review the multidisciplinary literature to examine the factors that contribute to nursing leadership and the effectiveness of educational interventions in developing leadership behaviours among nurses.Methods:The search strategy began with 10 electronic databases (e.g. CINAHL, Medline). Published quantitative studies were included that examined the factors that contribute to leadership or the development of leadership behaviours in nurse leaders. Quality assessments, data extraction and analysis were completed on all included studies.Results:A total of 27,717 titles/abstracts were screened resulting in 26 included manuscripts reporting on 24 studies. Twenty leadership factors were examined and categorized into four groups - behaviours and practices of individual leaders, traits and characteristics of individual leaders, influences of context and practice settings, and leader participation in educational activities. Specific behaviours and practices of individual leaders, such as taking on or practising leadership styles, skills and roles, were reported as significantly influencing leadership in eight studies. Traits and characteristics of individual leaders were examined in six studies with previous leadership experience (three studies) and education levels (two of three studies) having positive effects on observed leadership. Context and practice settings had a moderate influence on leadership effectiveness (three of five studies). Nine studies that examined participation in leadership development programs all reported significant positive influences on observed leadership.Conclusion:These findings suggest that leadership can be developed through specific educational activities, and by modelling and practising leadership competencies. However, the relatively weak study designs provide limited evidence for specific factors that could increase the effectiveness of current nursing leadership or guide the identification of future nurse leaders. Robust theory and research on interventions to develop and promote viable nursing leadership for the future are needed to achieve the goal of developing healthy work environments for health care providers and optimizing care for patients.

Professors often claim that students who attend their classes regularly receive better grades and learn more than those who do not. Romer (Journal of Economic Perspectives 7, 1993), Launius (College Student Journal 31, 1997), Van Blerkom (Journal of Psychology: Interdisciplinary and Applied 126, 1992), and Park and Kerr (Journal of Economic Education 21, 1999) find evidence in support of this hypothesis. However, many studies on class attendance conducted by economists focus on the principles of economics courses in which students are drawn from a narrow range of majors like accounting, business, and economics. In contrast, this study analyzes how class attendance affects academic performance in the introductory economics course that all students at Shepherd University must complete. The students enrolled in this course represent a very diverse group with various academic skills and interests and a broad range of majors including the arts, humanities, sciences, and applied fields like nursing. Using a uniquely diverse sample of students from a one-semester introductory economics course, we show that attendance has a very large and statistically significant effect on academic performance even after factoring out the motivation component.We test the hypothesis that class attendance has a positive effect on academic performance. The model to be estimated can be expressed as a general production function that relates output in terms of academic performance to three key inputs such as ability, attendance, and motivation. All three independent variables are hypothesized to be Atl Econ J (2008) 36:493–494 DOI 10.1007/s11293-008-9142-x

From 2011 onwards, the European aviation sector is scheduled to join the Greenhouse Gas Emission Allowances Trading System (EU ETS). European policy makers and airlines alike have now raised concerns that this will lead to a competitive disadvantage for EU carriers relative to those from the USA in the market for transatlantic flights. We use a Cournot model with economies of density on long haul flights to analyse the effects of emission trading. We find that the EU airlines’ competitive position is affected, but not hurt as severely as feared. Rather than trying to fight European carriers, US carriers escape fiercer competition due to emission trading costs and revert to other markets in which they have a competitive advantage.

Premenstrual changes (PMCs) in mood and behavior are very prevalent. Nonetheless, their pathophysiology is still obscure and no proven treatment is yet available. Evaluation of the plethora of available data leads to the suggestion that PMCs may result from a temporary impairment of homeostasis among a multitude of systems. This impairment is triggered by a differential pace and magnitude of change-over-time in levels of several hormones and other substances during the luteal phase.

The fine structure of the cerebellar cortex has been studied by means of scanning electron microscopy (SEM). The neuropil is revealed by careful tearing of aldehydefixed tissue specimens which are prepared by means of dehydration, critical point freeze-drying, and sputter-coating with gold-palladium. Specimens are subsequently viewed at magnifications of up to × 16,000 with capabilities for extension up to about × 40,000. The technique provides remarkable three-dimensional views of neuropil including cell bodies and dendrites, details of presynaptic and postsynaptic morphology, axonal structure, neuroglia, and the microvasculature. It seems particularly powerful in demonstrating relationships between neuropil elements such as the terminal synaptic array on neuron somata and the arrangements of structures on membrane surfaces.

Rat pups were given daily subcutaneous injections of Naltrexone, an opiate antagonist, throughout infancy. Compared to saline-treated controls, the ontogeny of reflex behavior and body growth was not altered by the chronic drug treatment. However, the latency to morphine-induced analgesia was shorter in Naltrexone-treated pups 9 days following their last injections of Naltrexone.

Hippocampi of seizure-sensitive and seizure-resistant Mongolian gerbils were examined in search of structural correlates of seizure behavior. In animals with well-established seizure histories, differences were found in both presynaptic and postsynaptic structures. Seizing animals had less dense dendritic spines, a greater proportion of mossy tuft area devoted to presynaptic vesicles, and a smaller proportion devoted to spines. The possible relationship of these findings to epilepsy is discussed.

Students with physical disabilities in professional schools face both practical and attitudinal problems, and these problems continue when they seek employment after graduation. Two recent graduates — one partially sighted, the other totally blind — describe their experiences and make recommendations.

Premenstrual changes (PMCs) in mood and behavior are very prevalent. Nonetheless, their pathophysiology is still obscure and no proven treatment is yet available. Evaluation of the plethora of available data leads to the suggestion that PMCs may result from a temporary impairment of homeostasis among a multitude of systems. This impairment is triggered by a differential pace and magnitude of change-over-time in levels of several hormones and other substances during the luteal phase.