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OBJECTIVE Patients with type 2 diabetes are encouraged to lose weight, but excessive weight loss in older adults may be a marker of poor health and subsequent mortality. We examined weight change during the postintervention period of Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) with diabetes support and education (DSE) (control) in overweight/obese individuals with type 2 diabetes and sought to identify predictors of excessive postintervention weight loss and its association with mortality. RESEARCH DESIGN AND METHODS These secondary analyses compared postintervention weight change (year 8 to final visit; median 16 years) in ILI and DSE in 3,999 Look AHEAD participants. Using empirically derived trajectory categories, we compared four subgroups: weight gainers (n = 307), weight stable (n = 1,561), steady losers (n = 1,731), and steep losers (n = 380), on postintervention mortality, demographic variables, and health status at randomization and year 8. RESULTS Postintervention weight change averaged −3.7 ± 9.5%, with greater weight loss in the DSE than the ILI group. The steep weight loss trajectory subgroup lost on average 17.7 ± 6.6%; 30% of steep losers died during postintervention follow-up versus 10–18% in other trajectories (P < 0001). The following variables distinguished steep losers from weight stable: baseline, older, longer diabetes duration, higher BMI, and greater multimorbidity; intervention, randomization to control group and less weight loss in years 1–8; and year 8, higher prevalence of frailty, multimorbidity, and depressive symptoms and lower use of weight control strategies. CONCLUSIONS Steep weight loss postintervention was associated with increased risk of mortality. Older individuals with longer duration of diabetes and multimorbidity should be monitored for excessive unintentional weight loss.

A hydrogen-containing inorganic clathrate with the nominal composition, K(7)(H(2))(3)Si(46), has been prepared in 98% yield by the reaction of K(4)Si(4) with NH(4)Br. Rietveld refinement of the powder X-ray diffraction data is consistent with the clathrate type I structure. Elemental analysis and (1)H MAS NMR confirmed the presence of hydrogen in this material. Type I clathrate structure is built up from a Si framework with two types of cages where the guest species, in this case K and H(2), can reside: a large cage composed of 24 Si, in which the guest resides in the 6d position, and a smaller one composed of 20 Si, in which the guest occupies the 2a position (cubic space group Pm3n). Potassium occupancy was examined using spherical aberration (Cs) corrected scanning transmission electron microscopy (STEM). The high-angle annular dark-field (HAADF) STEM experimental and simulated images indicated that the K is deficient in both the 2a and the 6d sites. (1)H and (29)Si MAS NMR are consistent with the presence of H(2) in a restricted environment and the clathrate I structure, respectively. FTIR and (29)Si{(1)H} CP MAS NMR results show no evidence for a Si-H bond, suggesting that hydrogen is present as H(2) in interstitial sites. Thermal gravimetry (TG) mass spectrometry (MS) provide additional confirmation of H(2) with hydrogen loss at approximately 400 degrees C.

Background Decision aids serve to prepare families for a meaningful discussion with their physician during the shared decision-making (SDM) process. Although SDM processes have been used primarily in adult health care settings, we sought to develop a decision aid for use in pediatrics. The treatment of neuromuscular scoliosis was selected due to the complexity of decision making when surgery is considered. Our objective was to determine whether this tool would improve families' knowledge and satisfaction while decreasing decisional conflict. Methods The decision aid was created using a multistep process to provide unbiased evidence-based information about the risks and benefits of the treatment options for neuromuscular scoliosis. The initial draft was written by an orthopaedic surgeon and then formatted by a multidisciplinary group to meet international decision aid standards. The document underwent local, national, and international peer review before prospective implementation by 4 orthopaedic surgeons at a single institution. The decision aid was evaluated and revised for further use. Results Eleven children, mean age 12 years (range, 8 to 17 y), were included in the study. Nine of the 11 families opted for surgery. The mean scores on the knowledge test increased from 3.0 (range, 2 to 5) to 4.0 (range, 3 to 5) of a possible 5 points (P=0.067). The mean item score on the SDM satisfaction scale was 3.8 (range, 3.5 to 4.0). The mean score on the SURE test for decisional conflict was 3.7 (range, 3 to 4) of a maximum score of 4. The mean total score on the clinician SDM satisfaction scale was 22.5 (range, 17 to 25). Conclusions The decision aid created for this complex decision resulted in improvements in knowledge gain, satisfaction, and decisional conflict while gaining acceptance of the physicians who utilized it. Consideration should be given to developing additional decision aids within professional societies to maximize efficiency and consensus.

A hydrogen-containing inorganic clathrate with the nominal composition, K(7)(H(2))(3)Si(46), has been prepared in 98% yield by the reaction of K(4)Si(4) with NH(4)Br. Rietveld refinement of the powder X-ray diffraction data is consistent with the clathrate type I structure. Elemental analysis and (1)H MAS NMR confirmed the presence of hydrogen in this material. Type I clathrate structure is built up from a Si framework with two types of cages where the guest species, in this case K and H(2), can reside: a large cage composed of 24 Si, in which the guest resides in the 6d position, and a smaller one composed of 20 Si, in which the guest occupies the 2a position (cubic space group Pm3n). Potassium occupancy was examined using spherical aberration (Cs) corrected scanning transmission electron microscopy (STEM). The high-angle annular dark-field (HAADF) STEM experimental and simulated images indicated that the K is deficient in both the 2a and the 6d sites. (1)H and (29)Si MAS NMR are consistent with the presence of H(2) in a restricted environment and the clathrate I structure, respectively. FTIR and (29)Si{(1)H} CP MAS NMR results show no evidence for a Si-H bond, suggesting that hydrogen is present as H(2) in interstitial sites. Thermal gravimetry (TG) mass spectrometry (MS) provide additional confirmation of H(2) with hydrogen loss at approximately 400 degrees C.

Historically, the operative treatment of neuromuscular scoliosis has been associated with a high rate of complication. Recent literature has shown a decreased rate of complication (less 50%) in the management of neuromuscular scoliosis with spinal arthrodesis techniques. A retrospective chart and radiographic review of 62 spinal fusions for neuromuscular scoliosis was performed. There were 53 posterior spinal fusions and 9 anteroposterior spinal fusions. The Galveston technique was used in all patients. The average age at surgery was 13 years 7 months, with an average follow-up of 23 months (minimum 10 months). The mean preoperative and postoperative curve magnitudes were 66 degree and 31 degree, respectively. There were 20 minor complications and 5 major complications in 20 patients. There were no neurologic complications or deaths.