Support Arm Research Articles

Research on the influence of rigid body modes on the operating vibration of arc gate

Abstract The 5# arc working gate of Jiangshan Wanyao Reservoir is composed of the suspension system of the gate and the steel wire rope, which has a serious vibration phenomenon when running without water. Firstly, the rigid body modal analysis of the gate suspension system is analyzed, the position size of key components such as gate support hinge shaft, gate motion guide embedded parts, and main beam position state is measured and evaluated on site, and the dynamic stress and vibration of the support arm are tested and analyzed during gate operation. It is concluded that the influence rule and weight of the steel wire rope on the rigid body mode of the gate, the torsional position of the gate, and the uneven operation condition of the side guide lead to the rigid body mode of the gate. It is suggested to improve the twisting state of the gate, adjust the unevenness of the embedded parts, and weaken the factors that induce the modal vibration of the rigid body.

Image-to-Joint Inverse Kinematic of a Supportive Continuum Arm Using Deep Learning

Image-to-Joint Inverse Kinematic of a Supportive Continuum Arm Using Deep Learning

Impact of cash transfer programs on healthcare utilization and catastrophic health expenditures in rural Zambia: a cluster randomized controlled trial.

Nearly 100 million people are pushed into poverty every year due to catastrophic health expenditures (CHE). We evaluated the impact of cash support programs on healthcare utilization and CHE among households participating in a cluster-randomized controlled trial focusing on adolescent childbearing in rural Zambia. The trial recruited adolescent girls from 157 rural schools in 12 districts enrolled in grade 7 in 2016 and consisted of control, economic support, and economic support plus community dialogue arms. Economic support included 3 USD/month for the girls, 35 USD/year for their guardians, and up to 150 USD/year for school fees. Interviews were conducted with 3,870 guardians representing 4,110 girls, 1.5-2 years after the intervention period started. Utilization was defined as visits to formal health facilities, and CHE was health payments exceeding 10% of total household expenditures. The degree of inequality was measured using the Concentration Index. In the control arm, 26.1% of the households utilized inpatient care in the previous year compared to 26.7% in the economic arm (RR = 1.0; 95% CI: 0.9-1.2, p = 0.815) and 27.7% in the combined arm (RR = 1.1; 95% CI: 0.9-1.3, p = 0.586). Utilization of outpatient care in the previous 4 weeks was 40.7% in the control arm, 41.3% in the economic support (RR = 1.0; 95% CI: 0.8-1.3, p = 0.805), and 42.9% in the combined arm (RR = 1.1; 95% CI: 0.8-1.3, p = 0.378). About 10.4% of the households in the control arm experienced CHE compared to 11.6% in the economic (RR = 1.1; 95% CI: 0.8-1.5, p = 0.468) and 12.1% in the combined arm (RR = 1.1; 95% CI: 0.8-1.5, p = 0.468). Utilization of outpatient care and the risk of CHE was relatively higher among the least poor than the poorest households, however, the degree of inequality was relatively smaller in the intervention arms than in the control arm. Economic support alone and in combination with community dialogue aiming to reduce early childbearing did not appear to have a substantial impact on healthcare utilization and CHE in rural Zambia. However, although cash transfer did not significantly improve healthcare utilization, it reduced the degree of inequality in outpatient healthcare utilization and CHE across wealth groups. https://classic.clinicaltrials.gov/ct2/show/NCT02709967, ClinicalTrials.gov, identifier (NCT02709967).

Dynamic Manipulation and Stiffness Modulation of Cooperative Continuum Robots: Theory and Experiment

Abstract Cooperative continuum robots (CCRs) are composed of multiple coupled continuum arms to cooperatively conduct manipulation tasks. They can highly enhance the performance of individual continuum arms by providing extra stiffness, leading to increased accuracy, payload capacity, and dynamic stability of the robot. This study aimed to investigate the stiffness analysis of tendon-driven supportive-type CCRs (S-CCRs). For this purpose, first, a generalized framework for the dynamic mathematical formulation and numerical solution of S-CCRs was proposed, their dynamic response to complex scenarios was obtained, and the accuracy of the model was experimentally evaluated. Then, the capability of stiffness modulation of S-CCRs was studied. Tendon-driven S-CCRs are potentially capable of changing the stiffness with structural configuration, providing active stiffness control at the design level. Hence, in this study, the effects of the connection point location/angle of the supportive arms to the operative arm, as well as the imposed tendon limitations of the supportive arm on the stiffness of the robot, and consequently on the dynamic payload manipulation, were studied and practical solutions were proposed to develop a simple but effective stiffness control mechanism. This study showed that a typical S-CCR can increase its stiffness, just by a modular connector design up to 84% during manipulation, bringing a novel opportunity for stiffness modulation of CCRs.

Developing and testing a web-based platform for antiretroviral therapy (ART) adherence support among adolescents and young adults (AYA) living with HIV

ObjectiveDescribe the development and testing of a web-based platform for antiretroviral treatment (ART) adherence support among HIV+ adolescents and young adults (AYA) in a randomized controlled trial (RCT). MethodsA seven-member multi-disciplinary team operationalized the flat, password protected, web-based platform. Manualized protocols guided the objectives and content for each of the eight web-based sessions. Team members evaluated usability and content validity. Client satisfaction and perceived ease of use was evaluated with the first ten HIV+ AYA participants. ResultsThe web-based platform was developed, evaluated, refined, implemented and pilot tested between September 2020 to April 2022. Usability was rated as high; the evaluation of content validity showed an excellent fit between session content and objectives. HIV+ AYA participants (mean age = 24.2 years) were satisfied with the quality, type, and amount of support/education received, and found the platform easy to use, operate, and navigate. Average time spent per session was 6.5 min. ConclusionFindings support the usability, validity, acceptability, and feasibility of this web-based platform for ART adherence support among HIV+ AYA. InnovationOur research and findings are responsive to research gaps and the need for transparency in the methodological development and testing of web-based control arms for ART adherence support among HIV+ AYA.

Effectiveness of immediate appointment scheduling in smoking cessation clinics for patients with chronic airway diseases: Preliminary results from a randomized trial.

Patients with airway diseases who bear the burden of smoking need access to smoking cessation support. We aimed to investigate the impact of immediately scheduled appointments on access to smoking cessation clinics compared with usual care in this patient group. This multicenter, prospective, randomized, open-label study was conducted between November 2022 and June 2023 at pulmonary outpatient clinics. The study included adult patients who were current smokers and had a diagnosis of asthma, COPD, or bronchiectasis for at least six months. Sequentially randomization was used for the allocation of patients in a 1:1 ratio to two study arms: the usual support arm (representing the current standard care procedure) and the immediate support arm (involving intensive brief cessation advice followed by the immediate arrangement of an appointment at the same clinic's smoking cessation service). After one week, both patient groups were contacted by phone to assess their quit attempts and whether they had sought assistance from smoking cessation outpatient clinics (SCCs). A total of 397 patients were enrolled in the study, with 199 allocated to the usual support arm and 198 allocated to the immediate support arm. Within the first week, 18.1% of patients in the usual support arm and 77.3% of patients in the immediate support arm sought assistance from the smoking cessation clinic (p<0.001). The rate of smokers without an intention to quit was 56.7% in the usual support arm and 27.7% in the immediate support arm in the first week of follow-up. Immediate appointment scheduling was significantly associated with a 13-fold (OR=13.38; 95% CI: 8.00-22.38) increase in referral rates in the multivariate logistic regression model. Arranging instant appointments has increased access to SCCs by 13 times compared to the usual care, this group of patients should be given an immediate appointment to SCCs.

#61 : Frugal Exoscope: A Potential Option for Microsurgery and Training Program in Male Infertility in the Context of Emerging Markets

Background and Aims: Conventional microscopes and exoscopes currently play pivotal roles in the microsurgery or training of male infertility. However, they are expensive and unaffordable in low resource settings which limits training or application of advanced methods. The study aimed to introduce a new, low–cost exoscope system and evaluate its frugal innovation. Method: Using animal models, we evaluated a new frugal exoscope system (called DKTA) in experimental microsurgery of vas deferens repair. Five experts in male infertility surgery undertook an anonymous survey to elucidate their experience with DKTA system use. Three crucial criteria (i.e., substantial cost reduction, concentration on core functionalities, optimised performance level) were evaluated to determine whether the DKTA is effective as frugal innovation. The survey used a 5-point Likert scaling of responses to eight statements investigating surgical, ergonomic, and educational aspects. Results: The DKTA system, including an optical microscope and ultrahigh definition camera (4K), was an exoscope placed between 20–40 cm from the surgical field. It was held in position with a camera support arm on casters and connected to a 65-inches smart TV. DKTA system met the three crucial criteria of frugal innovation, including substantial cost reduction, concentration on core functionalities, and optimised performance level. Five male infertility microsurgeons reported positive evaluations of the DKTA system (use modal scores) when performing experimental vasovasostomy. Conclusions: DKTA system, a frugal innovation, has a valuable contribution to the training programme and performance of male infertility microsurgery in low–resource settings. Acknowledgements: We want to send special thanks to the Centre for Training and Scientific Research staff, Tam Anh General Hospital for their logistics support.

A computational aeroacoustic study of a multi-rotor powered urban air mobility vehicle

The multi-rotor propulsion system has become one of the popular configurations for urban air mobility vehicles due to its capability of high-density vertical take-off and landing operations. The noise characteristics, as a critical criterion for urban air mobility, usually differ for a multi-rotor configuration from a single-rotor configuration. In this work, we investigate the noise generated by a hexacopter configuration using delayed detached eddy simulations and the Ffowcs-Williams and Hawkings acoustic-analogy-based solver. The overall length and the rotor diameter of the vehicle are 4 m and 2 m, respectively, and the target maximum take-off mass is 500 kg. The full configuration and three simplified setups that reduce several individual components are numerically studied to isolate the corresponding effect of each component and to identify their flow/acoustic interactions. The results show that the rotor-rotor interaction leads to remarkable thrust fluctuations and further results in a considerable increase in tonal noise over a broad frequency range. The interaction between the rotors and the support arms also leads to significant thrust fluctuations on the surfaces of both rotor blades and arms, which produces additional tonal noise at high-order harmonics of the blade passing frequency. In contrast, for the current configuration, the existence of the fuselage does not have a significant effect on noise generation. The research should benefit low-noise vehicle design and operation.

Testing the Effectiveness of a Community-Based Peer Support Intervention to Mitigate Social Isolation and Stigma of Adolescent Motherhood in Zimbabwe

ObjectivesSocial isolation and stigma contribute to poor mental health outcomes. Adolescent mothers in Zimbabwe often experience isolation and stigma, lacking social support and resources to navigate motherhood. The study tested the effectiveness of a community-based peer support intervention to mitigate social isolation and stigma of adolescent motherhood in Harare, Zimbabwe.MethodsCommunity health workers (n = 12) and peer educators (n = 12) in the intervention arm were recruited and trained on co-facilitating peer support groups. Adolescent mothers aged 15–18 years from two low-income high-density communities in Harare were recruited, using a quasi-experimental design. The intervention arm (n = 104) participated in the peer support groups and both arms completed sociodemographic, base-, mid-, and end-line surveys (control arm n = 79). Peer support groups (12 groups with 6–12 participants in each) met in-person twice a month and completed 12 sessions from May to August 2019 addressing participant-identified topics such as income generation and depression. WhatsApp Messenger was used for training and implementation support. Key community stakeholders discussed project progress and recommendations to improve adolescent mothers’ health. Data were analyzed using Stata 15.ResultsThe intervention arm reported lower depressive symptoms and common mental disorders and higher overall, family, friends, and significant-other support, compared to control. The intervention arm felt more engaged with peers, knew who and where to turn to for help, and had coping, parenting and communication strategies to manage life challenges.Conclusions for PracticeThe intervention mitigated social isolation and stigma and thereby improved mental health and social support among adolescent mothers in Harare.Trial Registration This trial is registered at Clinical Trials.gov, NCT05213182 https://clinicaltrials.gov/ct2/show/NCT05213182.

RADT-37. INTERIM RESULTS OF ACCELERATOR-BASED BORON NEUTRON CAPTURE THERAPY, RANDOMIZED CONTROLLED TRIAL FOR RECURRENT AND REFRACTORY HIGH-GRADE MENINGIOMAS

Abstract BACKGROUND High-grade meningiomas (HGMs) recurred after X-ray treatment showed 5.2 months as median progression free survival (mPFS) and only 24.6 months as median overall survival (mOS) from the literatures. Recently, we showed much more excellent OS and PFS using reactor-based boron neutron capture therapy (BNCT) (Neuro-Oncology 24:90-98, 2022). Based on these data, we started “A phase II investigator-lead RCT using accelerator-based BNCT system for refractory recurrent high-grade meningioma”, with the aid of Japanese governmental financial support. METHODS We prepared 2 study arms, BNCT test treatment arm (12 subjects) and control best supportive care arm (6 subjects) in RCT fashion. PFS judged by third party committee was set-up as primary endpoint and PFS judged by investigators themselves and OS of BNCT arm were set-up as secondary endpoints. To diminish ethical problems of this RCT, rescue BNCT is permitted for control group patients, if they showed progress disease during the observation period. Macdonald criteria was adopted for assessment. The first patient-in was August 2019 and the last patient-in was August 2021. Interim results of this trial: Three and two grade 3 subjects were included in BNCT and control arm, respectively. Others were grade 2 subjects. As of April 20, 2023, mPFS judged by investigators showed 90 weeks and 8 weeks for BNCT and control arm, respectively (P = 0.0004). OS-2 year rates of BNCT and control arms are 91.7% and 25%, respectively (p = 0.01) CONCLUSION Primary endpoint, mPFS judged by third party committee is still being closed and unknown, so far, until the end of the trial (August 2024). With regard to secondary endpoints, there are marked differences in both arms in mPFS judged by investigators. Also, OS in BNCT arm is extremely excellent in comparison with EORTC RCT of “trabectedine” and PD-1 blockade reports, just recently appeared.

Randomized Trial of a Social Support Intervention to Improve Home Blood Pressure Monitoring in Patients With Cerebrovascular Disease.

A pilot randomized trial evaluating whether a social support intervention improves adherence to home blood pressure (BP) monitoring among patients with cerebrovascular disease. Subjects with ischemic stroke, intracerebral hemorrhage, or transient ischemic attack within 5 years with BP >140/90, were given a centrally monitored home BP cuff and asked to check their BP twice a day for 90 ± 7 days. Subjects received text and/or email reminders for missed measurements and weekly reports on adherence/BP control. Subjects were randomized 1:1 to a social support intervention, in which close personal contact also received all study-related education and communications. The primary outcome was the proportion of requested measurements completed. A secondary outcome was a change in BP over time. Thirty-three subjects were enrolled, 15 in the control arm and 18 in the social support arm. The social support arm completed a greater proportion of BP measurements at day 30 (88% vs 78%), day 60 (72% vs 54%), and day 83 (60% vs 40%), but none of these differences were statistically significant (P > 0.05). Comparing the first 7 days of BP readings to the last 7 days across subjects, there was a nonsignificant decrease in BP over time (systolic BP = -2.8 mm Hg, P = 0.29 and diastolic BP = -1.7, P = 0.36). The social support intervention did not modify the change in BP over time. A social support intervention may increase adherence to home BP monitoring. This pilot study provides important preliminary data to inform the design of larger more definitive trials utilizing self-monitoring of BP in patients with cerebrovascular disease.

Supporting adolescents’ participation in muscle-strengthening physical activity: protocol for the ‘Resistance Training for Teens’ (RT4T) hybrid type III implementation–effectiveness trial

IntroductionIn Australia, only 22% of male and 8% of female adolescents meet the muscle-strengthening physical activity guidelines, and few school-based interventions support participation in resistance training (RT). After promising findings...

Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta-analyses.

Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta-analyses.

Metasurface-Enabled Uncooled Silicon Germanium Oxide Infrared Microbolometers for Long-Wave Infrared Detection

This paper investigated metasurface enabled uncooled silicon germanium oxide (Si <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">0.425</sub> Ge <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">0.512</sub> O <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">0.063</sub> ) infrared (IR) microbolometers. The metasurface was used to engineer the IR absorption to achieve broadband or narrowband spectral response, eliminate the need for Fabry-Perot quarter wave resonant cavity typically used in conventional microbolometer under the pixel, and significantly improve the electrical performance of the temperature-sensing layer. This has facilitated the fabrication of the microbolometer with the supporting arms placed underneath the pixel without disrupting the Fabry-Perot cavity, and as a result, the supporting arms were fabricated with longer length without sacrificing the fill factor. The longer support arms reduced the thermal conductance between the microbolometer pixel and the underlying substrate and thus increased the voltage responsivity. The spectral responsivity and detectivity for the fabricated devices were measured in vacuum and demonstrated tunablility with narrow bands between 7 to 12 μm by changing the metasurface disk diameter and periodicity. The measured voltage responsivity, detectivity and thermal response time were > 10 <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">4</sup> V/W and > 10 <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">7</sup> cm Hz <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">1/2</sup> /W and 2.01 ms to filtered blackbody infrared radiation between > 2 μm. The voltage noise power spectral density (PSD) of the fabricated devices were reduced by annealing the devices in vacuum.

Design of an Automatic Ground Cleaning Machine for Dedusting Rooms of Chicken Houses

In this paper, we designed an automatic ground cleaning machine for the dedusting rooms of chicken houses to replace the manual daily cleaning of dust particles and fluff. The machine mainly comprised a power system, control system, frame and walking structure, ground cleaning system, and dedusting system. The automatic movement of the machine body in two vertical directions without turning, lifting, and lowering of the sweeper; the retraction and expansion of the sweeper support arm; the reciprocating movement of the sweeper relative to the machine body; and the timely separation of the dust particles and fluff from gas mixtures were achieved. Parameter optimization experiments on the machine were performed using a quadratic general rotary combination design considering the movement speed, rotation speed of the sweeper, and distance between the suction head nozzle and ground as experimental factors. The regression equations describing the relationship between the three experimental factors and the dust particle removal rate and fluff removal rate were obtained using Design-Expert 12 software, adequately reflecting the impact of the three experimental factors on the two experimental indexes. Further parameter optimization was conducted to obtain the optimized parameter combination at the same weight as the two experimental indexes: movement speed of 0.1 m/s, rotation speed of the sweeper of 198 r/min, and distance between the suction head nozzle and ground of 12 mm. The performance experiment on the machine was conducted using the optimized parameter combination, yielding a dust particle removal rate of 90.7% and fluff removal rate of 91.7%. The experimental results show that the machine exhibits good performance and stable operation, meeting the daily cleaning needs of large-, medium-, and small-scale rectangular dedusting rooms of chicken houses.

A CMOS-based highly scalable flexible neural electrode interface.

Perception, thoughts, and actions are encoded by the coordinated activity of large neuronal populations spread over large areas. However, existing electrophysiological devices are limited by their scalability in capturing this cortex-wide activity. Here, we developed an electrode connector based on an ultra-conformable thin-film electrode array that self-assembles onto silicon microelectrode arrays enabling multithousand channel counts at a millimeter scale. The interconnects are formed using microfabricated electrode pads suspended by thin support arms, termed Flex2Chip. Capillary-assisted assembly drives the pads to deform toward the chip surface, and van der Waals forces maintain this deformation, establishing Ohmic contact. Flex2Chip arrays successfully measured extracellular action potentials ex vivo and resolved micrometer scale seizure propagation trajectories in epileptic mice. We find that seizure dynamics in absence epilepsy in the Scn8a+/- model do not have constant propagation trajectories.

Frugal Exoscope: A Minimal Cost Option for Microsurgery and Training Program in Male Infertility

Background: Conventional microscopes and exoscopes currently play pivotal roles in the microsurgery or training for male infertility. However, they are expensive and unaffordable in low-resource settings, which limits training or application of advanced methods. Objectives: To introduce a new, low-cost exoscope system and to determine whether it is an effective frugal innovation. Methods: Using animal models, we evaluated a new frugal exoscope system named DKTA in experimental microsurgery of vas deferens repair. Five experts in male infertility surgery undertook an anonymous survey to elucidate their experience with DKTA system use. Three crucial criteria (i.e., substantial cost reduction, concentration on core functionalities, and optimized performance level) were evaluated to determine whether the DKTA is effective as frugal innovation. The survey used a 5-point Likert scale of responses to eight statements investigating surgical, ergonomic, and educational aspects. Results: The DKTA system, including an optical microscope and ultra-high-definition (UHD) camera (4K), was an exoscope placed between 20 and 40 cm from the surgical field. It was held in position with a camera support arm on casters and connected to a 65-in. smart TV. DKTA system met the three crucial criteria of frugal innovation. Five male infertility microsurgeons reported positive evaluations based on modal scores of the DKTA system when performing experimental vasovasostomy. Conclusions: DKTA system, a frugal innovation, has a valuable contribution to the training program and performance of male infertility microsurgery in low-resource settings.

Longitudinal association between N-terminal B-type natriuretic peptide, anxiety and social support in patients with HFpEF: results from the multicentre randomized controlled Aldo-DHF trial

BackgroundHigher plasma levels of natriuretic peptides (NPs) have been associated with reduced anxiety in experimental research and a number of patient samples. As NP levels are elevated in heart failure patients, we investigate whether this elevation is related to anxiety in patients with heart failure with preserved ejection fraction (HFpEF).MethodsPost-hoc regression and mediation analyses were conducted, using data of 422 patients with HFpEF from the randomized, placebo-controlled, double-blinded, two-armed, multicentre aldosterone in diastolic heart failure trial, testing associations and their mediators between the N-terminal B-type natriuretic peptide (NT-proBNP) and anxiety at baseline and over 12-month follow-up. Anxiety was measured by the Hospital Anxiety and Depression Scale (HADS), social support by the ENRICHD Social Support Inventory and physical functioning by the Short Form 36 Health Survey.ResultsThe mean age of the study population was 66.8 ± 7.6 years, 47.6% were male and 86.0% had NYHA class II. NT-proBNP showed a weak negative correlation with HADS anxiety scores at baseline (r = − 0.087; p = 0.092), which was significant (r = − 0.165; p = 0.028) in men but not in women. NT-proBNP also tended to predict lower anxiety at 12-months in men. On the other hand, higher anxiety at baseline was associated with lower NT-proBNP scores 12 months later (r = − 0.116; p = 0.026). All associations lost significance in multivariate regression for age, perceived social support (ESSI), physical function (SF-36) and study arm. Mediation analyses revealed that social support acts as a full mediator for the link between NT-proBNP levels and anxiety.ConclusionThe mechanisms linking NT-proBNP to anxiety may be more complex than originally assumed. While effects of NT-proBNP on anxiety may be mediated by perceived social support, there may be an additional negative effect of anxiety on NT-proBNP. Future research should consider this possible bi-directionality of the association and assess the potential influence of gender, social support, oxytocin and vagal tone on the interaction of anxiety and natriuretic peptide levels.Trial Registrationhttp://www.controlled-trials.com (ISRCTN94726526) on 07/11/2006.Eudra-CT-number: 2006–002,605-31.

Design of Measurement and Control System for Small Electromechanical Airplane Jack Based on Embedded Technology

To make the hydraulic jack meet the requirements of modern mechanical and electrical equipment, such as intelligence, high sensitivity, and good operation performance, this paper presents the design of an embedded measurement and control system for a small electric mechanical airplane jack. A new type of electric mechanical jack is designed. According to its need for strong maneuverability, a new intelligent jack measurement, and control system based on the C8051F410 single-chip microcomputer is developed. The system mainly takes the stepping motor as the power source, and the selection requirements, the parameter design of stepping motors, and their supporting drivers and controllers are mainly introduced through the control of multiple stepper motors. Two schemes are listed in the selection of controllers, and the second scheme is selected according to the actual operational needs of the system. It can control the movement of the jack, such as fast-forward, working, and walking. The test system also realizes the load stress signal of the key parts of the jack support arm, as well as the real-time acquisition and display of the height displacement signal during work. The performance of the control part of the jack control system and part of the acquisition system was verified through experiments. The experimental results prove that the system meets the design requirements of the system and the actual design requirements.

Effect of intensive lifestyle intervention on the association between weight variability and major adverse cardiovascular events in overweight or obese adults with type 2 diabetes mellitus

Weight variability is associated with cardiovascular outcomes in diabetic patients. However, whether the guideline-recommended intensive lifestyle intervention (ILI) will affect this association in overweight or obese adults with diabetes is not well established. In 3,859 participants from the Action for Health in Diabetes (Look AHEAD) trial, the associations of 4 year weight variability measured by variability independent of the mean (VIM) with major adverse cardiovascular event (MACE) and secondary outcomes in ILI and diabetes support & education (DSE) arm were evaluated. During a median follow-up of 9.6 years, 255 (12.9%) participants in the ILI arm and 247 (13.2%) participants in the DSE arm developed MACE. Participants with the highest quartile of weight variability (VIM Q4) experienced a 2.23-fold higher risk of MACE compared with the lowest quartile (VIM Q1) in the DSE arm (hazard ratio [HR] 2.23; 95% CI 1.51-3.30). Compared with the lowest weight variability (VIM Q1), participants with the highest weight variability (VIM Q4) were associated with higher risks of secondary cardiovascular composite outcome (HR 1.88; 95% CI 1.20-2.95), all-cause mortality (HR 3.19; 95% CI 1.75-5.82), and myocardial infarction (HR 1.95; 95% CI 1.12-3.37) in the DSE arm. Among the overweight or obese individuals with type 2 diabetes mellitus, rising weight variability was independently associated with increased MACE risks in the DSE arm. Therefore, a guideline-recommended ILI strategy for weight loss should be adopted to improve cardiovascular outcomes without worrying about the effect of weight fluctuations.