Search

Background: Patient-reported outcomes and perceptions are critical to the overall efficacy and acceptability of a surgical procedure. Outcomes, such as patient satisfaction and perceived success of the surgery and adverse symptoms, have not been described in detail following bariatric surgery. The associations and predictors of patient satisfaction have not been defined. This study aimed to examine long-term outcomes and perceptions after laparoscopic adjustable gastric banding (LAGB). Methods: We conducted a prospective study of outcomes, satiety and adverse upper gastrointestinal symptoms, as well as quality of life and subjective patient satisfaction in LAGB patients. Data were collected at 3 years (T1) and 8 years post-operatively (T2). Results: One-hundred and sixty patients completed follow-up at T1 and T2. The average age was 44.0 ± 11.2 years. At T2, the total body weight loss was 17.8 ± 11.9 %. Satisfaction decreased significantly between time points (8.6 ± 1.8 vs 7.2 ± 2.9, p < 0.01), and quality of life reduced slightly across all domains. Hunger scores remained low (3.8 ± 1.8 vs 3.9 ± 1.8, p = 0.61). The dysphagia score did not change significantly ( p = 0.54). There was minimal change in frequency of regurgitation, although there was significant increase in patient assessment of how bothered they were by regurgitation. Multivariate analysis identified increased awareness of regurgitation as a principal driver of reduced satisfaction. Conclusions: Weight loss, satiety and adverse symptoms demonstrated only slight changes between 3 and 8 years post-operatively. Despite this, overall satisfaction and perception of success of the procedure reduced markedly. This appeared mediated by reduced tolerance of adverse symptoms. These data inform follow-up practises aimed at optimizing outcomes. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to identify the efficacy and safety of combining laparoscopic adjustable gastric banding with repair of large para-oesophageal hernias. Background: Para-oesophageal hernias are more common in the obese with higher recurrence rates following repair. The effect and safety of combining para-oesophageal hernia repair with laparoscopic adjustable gastric banding is unknown. Methods: One-hundred fourteen consecutive patients undergoing primary laparoscopic adjustable gastric banding with concurrent repair of a large para-oesophageal hernia were prospectively identified and matched to a control group undergoing primary laparoscopic adjustable gastric banding only. Weight loss and complication data were retrieved from a prospectively maintained database, and a standardised bariatric outcome questionnaire was used to assess post-operative symptoms, satisfaction with surgery and satiety scores. Results: At a mean follow up of 4.9 ± 2.1 years, total weight loss was 16.4 ± 9.9 % in the hernia repair group and 17.6 ± 12.6 % in the control group ( p = 0.949), with 17 vs. 11 % loss to follow up rates ( p = 0.246). No statistically significant difference in revisional surgery rate and symptomatic recurrence of hiatal hernia was documented in four patients in the hernia repair group (3.5 %). No statistically significant difference in mean reflux (9.9 vs. 10.3, p = 0.821), dysphagia (20.7 vs. 20.1, p = 0.630) or satiety scores was identified. Conclusions: Concurrent repair of large para-oesophageal hiatal hernia and laparoscopic adjustable gastric banding placement is safe and effective both in terms of symptom control and weight loss over the intermediate term. In obese patients with large hiatal hernias, consideration should be given to combining repair of the hernia with a bariatric procedure. [ABSTRACT FROM AUTHOR]

Background/Objectives: Diabetes and obesity are common and serious health challenges for indigenous people worldwide. The feasibility of achieving substantial weight loss, leading to remission of diabetes, was evaluated in a regional indigenous Australian community. Subjects/Methods: A prospective cohort study of 30 obese indigenous adults from the Rumbalara Aboriginal Co-operative in Central Victoria was performed. Inclusion criteria included aboriginality, BMI > 30 kg/m and diabetes diagnosed within the last 10 years. Weight loss was achieved using laparoscopic adjustable gastric banding (LAGB). Participants were treated in their community and followed for 2 years. Outcomes were compared with those of non-indigenous Australians from an earlier randomized controlled trial (RCT) using a similar protocol. Results: 30 participants (26 females, mean age 44.6 years; mean BMI 44.3) had LAGB at the regional hospital. Twenty-six participants completed diabetes assessment at 2 years follow-up. They showed diabetes remission (fasting blood glucose < 7.0 mmol/L and haemoglobin A1c (HbA1c) < 6.2 % while off all therapy except metformin) in 20 of the 26 and a mean weight loss (SD) of 26.0 (14) kilograms. Based on intention-to-treat, remission rate was 66 %. Quality of life improved. There was one early event and 12 late adverse events. The outcomes for weight loss and diabetes remission were not different from the LAGB group of the RCT. Conclusions: For obese indigenous people with diabetes, a regionalized model of care centred on the LAGB is an effective approach to a serious health problem. The model proved feasible and acceptable to the indigenous people. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN 12609000319279). [ABSTRACT FROM AUTHOR]

Background and aims: During the recent decades, cork oak ( Q. suber) mortality has been increasing in Mediterranean oak woodland endangering the economical and environmental sustainability of the 'montado' ecosystem. This fact in combination with climate change and conversion of forestland to pasture may significantly affect the soil-atmosphere greenhouse gases (GHGs) exchange. Our study evaluates the impact of oak trees as compared to pasture on net ecosystem GHG (CH NO, and CO) exchange as well as the main environmental factors influencing this exchange. Methods: We used field chamber measurements for the collection of GHGs under three different conditions: 1) open area (OA), 2) under tree canopy area (UC) and 3) improved pasture (IP). Experiments were done under typical Mediterranean climate at central Portugal in 2010 and 2011. Results: The UC had higher nitrification potential, soil C/N ratio, electrical conductivity, litter input and soil organic matter (SOM) than OA and IP. SOM positively correlated with soil CH and NO fluxes but not with soil CO respiration rates. Soil water content (SWC) drives both CH and NO fluxes. Under certain conditions, when SWC reached a threshold (7 % for CH and 3 % for NO) the result was net uptake and that net uptake increased with SWC. This was the case for the UC and OA. Conversely, for the IP soil water content above 4 % promoted net CH release. Conclusions: Our results show that cork oak influences soil properties and consequently GHGs fluxes. In the UC the input of litter for SOM together with soil moisture, favoured microbiological activity and related GHGs fluxes. Soil temperature is a secondary factor in the studied conditions. Our results also emphasized the potential impact posed by decreased cork oak tree density in the functioning of the 'montado' ecosystem. [ABSTRACT FROM AUTHOR]

Background: This study aimed to test the hypothesis that the amount of weight lost on a mandatory 2-week pre-operative very-low-calorie diet (VLCD) would predict the longer-term outcomes of laparoscopic adjustable gastric banding (LAGB). Methods: All patients treated with a primary LAGB from 21 October 2008 until 30 June 2010, who were prescribed a 2-week pre-operative VLCD, have been included in the study. Patient age, weight, BMI and excess weight (defined as weight above a BMI of 25) were extracted on the day of first visit, day of surgery and at the post-operative visits at 3, 12 and 24 months. From these data, percent excess weight loss (EWL) was calculated and compared at all time points. Results: The weight loss achieved on a mandatory 2-week pre-operative diet did not predict weight outcomes at 2 years ( r = −0.008; p = 0.931). Using multivariate analysis, the best predictor of 24-month percent EWL was percent EWL at 3 months post operation (sr = 0.34; p = 0.003). Conclusions: Results from a pre-operative diet should not be used to predict the ultimate outcome of bariatric surgery. The weight loss at 3 months following LAGB was a strong predictor of longer-term outcomes. There may be potential for improving longer-term results with LAGB by better supporting patients who are not achieving good weight loss at this early time point. [ABSTRACT FROM AUTHOR]

Background: Follow-up is critical to the success of laparoscopic adjustable gastric banding (LAGB). Few data guide this and expected norms of satiety, adverse symptoms, and outcomes have not been defined. Methods: Consecutive patients, who underwent LAGB, were evaluated using a newly developed instrument that assessed satiety, adverse upper gastrointestinal (dysphagia, reflux, and epigastric pain), and outcomes (overall satisfaction, weight loss, and quality of life (SF-36)). Results: Three hundred twenty-three of 408 patients responded (80%; mean age 44.4 ± 11.8 years, 56 males). Excess weight loss was 52%. Satiety was greater at breakfast compared to lunch (5.3 ± 1.9 vs. 4.1 ± 1.7, p < 0.005) or dinner (3.8 ± 1.8, p < 0.005). The satisfaction score was 8.3 ± 2.1 out of 10, and 91% would have the surgery again. Quality of life was less than community norms, except in physical functioning (83.4 ± 20.5 vs. 84.7 ± 22.0, p = 0.25) and bodily pain (78.4 ± 15.2 vs. 75.9 ± 25.3, p = 0.004). Inability to consume certain foods was cited as the biggest problem by 66% of respondents. The dysphagia score was 19.9 ± 8.7; softer foods were tolerated, although difficulty was noted with firmer foods. The reflux score was 8.7 ± 9.8 and regurgitation occurred a mean of once per week. Weight loss and the mental component score were the only predictors of overall satisfaction ( r = 0.46, p = 0.01). Conclusions: Patients are highly satisfied with the outcome of LAGB and achieve substantial weight after 3 years. Expected ranges of satiety, adverse symptoms, and outcomes have been defined. The most troublesome symptom is the inability to consume certain foods. Weight loss predicted overall satisfaction, regardless of adverse symptoms. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic adjustable gastric banding (LAGB) is a safe and effective method for the treatment of obesity. The most common problem after LAGB has been the occurrence of prolapse (slippage) of the stomach through the band. It has been proposed that the pars flaccida (PF) pathway (dissection from the base of the right crus, along the left crus to the angle of His) is less likely to be associated with prolapse than the traditional perigastric (PG) pathway (dissection between the lesser curvature of stomach and lesser omentum, across the apex of the lesser sac, to the angle of His). We have tested this hypothesis using a randomized controlled trial format. Methods: We have performed a randomized controlled trial to compare the outcomes after LAGB using PF and PG pathways. 202 patients (mean age 40 years, mean weight 123 kg, mean BMI 45) were randomly allocated to the PF or PG pathway and followed for 2 years. Results: At 24 months, there have been 16 revisional procedures for prolapse, 4 in the PF group (all anterior prolapse) and 15 in the PG group (12 posterior and 3 anterior). This difference is significant ( P<0.001). The mean % excess weight lost was 53% for the PF group and 46% for the PG group. There was equally significant improvements in the metabolic syndrome in both groups (59% preoperatively and 19% at 2 years). All 8 paired domain scores of the SF-36 measures of quality of life were improved significantly in both group ( P<0.001). Conclusions: The PF pathway is as effective as the PG pathway in generating substantial weight loss, improved health and improved quality of life and is significantly less likely to be associated with prolapse (slippage). It is recommended as the primary dissection pathway. [ABSTRACT FROM AUTHOR]

Presents information on the presidential address from the 27th Annual Meeting of the Society for Computers in Psychology. Details on the use of computers to facilitate teaching and research; Information on the dramatic changes in computer technology.

Discusses computer attitudes and the use of computers in psychology courses. Survey of students enrolled in psychology; Participation in the courses that involved computer activities; Possibility that courses that have higher levels of direct involvement with computer applications may lead to the most positive attitude changes.

Discusses the characteristics of a Society for Computers in Psychology (SCiP) Internet-based general discussion list that could serve the needs of SCiP members. Possibility of virtual conference sessions; Recruitment system; Pitfalls of discussion lists; Dissemination of potentially proprietary information; Use of electronic mail for data collection in research.

Reports on the results of a national survey of psychology faculty in the United States regarding their instructional use of computers. Institutional characteristics; Individual characteristics; Institutional support for instructional computing; Individual use of computers; Institutional factors related to instructional computing.

This article discusses theoretical explanations of rape and shows how these theories are reflected in the beliefs of practicing rape crisis counselors. Al- though the researchers have not studied the process by which the counselors adopt these explanations,one do consider the solutions which the logic of each theory implies for social change. In so doing, they hope to demonstrate the relationship between theoretical accounts of rape and the perspective of practitioners in this field and also to make the point that an adequate theory must provide the solution to prevent rape. The paper is both a review of academic theories of rape and an empirical case study of the beliefs of' rape crisis counselors, An argument is developed which shows that, in the absence of a theoretical framework which analyzes the political and economic causes of rape, popular explanations of the problem mask an understanding of rape as the rules of women's position in society. This is shown by a discussion of the rape counselors' beliefs about feminism and the individualistic theories of rape which they tend to hold.

This paper provides a description and evaluation of commercial software available for simulations, demonstrations, and experiments in introductory psychology instruction. Packages for IBM, Apple II, Macintosh, and Commodore computers are included. The review contains descriptions of content, hardware requirements, supporting documentation, cost, recommended use, and general strengths and weaknesses for each of 18 packages. [ABSTRACT FROM AUTHOR]

COMPsych, a computerized software information system for psychologists, is described. Also included is information on how to access the system and a description of the information available from the system. A summary and analysis of the activity on the system during the first 5 months of operation and a consideration of possible future directions are also provided. [ABSTRACT FROM AUTHOR]

This paper describes our experience during the past 2 years in establishing a computer-based laboratory for introductory psychology. Discussion includes selection of hardware; physical design of the laboratory; locating, reviewing, and selecting courseware; development of supplementary materials; operation and management of the laboratory; and integration of the laboratory into the curriculum. These factors are examined from the point of view of the decisions made, the difficulties encountered, and the lessons learned. [ABSTRACT FROM AUTHOR]

Discusses the use of computer-mediate conferencing (CMC) to facilitate group projects in an educational psychology course. Use of electronic mail and electronic bulletin board system to communicate within student groups and with the instructor; Elements in the implementation of CMC; Suggestions to avoid problems in the system.

Presents a general description of COMPsych and specific instructions for using the archive service. History of COMPsych; Features; Requirements for joining; Files available; Use of file transfer protocol (ftp) for getting files; Use of Gopher to obtain files; Submitting files to the archive; COMPsych responsibilities.

This paper describes the development of COMPsych, a computerized system to disseminate information about software dealing with ail aspects of psychology. The need for such a service, the various components, and the general operation of the system are described. The system will contain a catalog of commercial and public domain software, a library of freeware, a directory of computer users, and a bulletin board. [ABSTRACT FROM AUTHOR]

A correction to the article "Comparison of methane, nitrous oxide fluxes and CO2 respiration rates from a Mediterranean cork oak ecosystem and improved pasture" that was published in the April 2, 2014 issue is presented.