Myutan Kulendran

Technologies for global health

Institute for Global Health Innovation (L Conteh PhD, Prof A Darzi FRCS, P Howitt MA, K Kerr PhD, Prof S Matlin DSc, R Merrifi eld PhD, Prof G-Z Yang PhD), Centre for Environmental Policy (E Wilson MSc), Centre for Health Policy (D King MRCS, M Kulendran MRCS, Prof P C Smith BA), Department of Bioengineering (Prof A M J Bull PhD, Prof R A Malkin PhD, Prof M M Stevens PhD), Department of Civil and Environmental Engineering (M R Templeton PhD), Department of Infectious Diseases (G S Cooke PhD, N Ford PhD, S D Reid PhD), Department of Infectious Disease Epidemiology (S A J Gregson PhD), Department of Materials (Prof M M Stevens), Department of Medicine (A Blakemore PhD), Department of Primary Care & Public Health (Prof A Majeed MD), Department of Surgery and Cancer (H Ashrafi an MRCS, Prof C Vincent PhD), Faculty of Medicine (Prof R Atun FRCP), Global eHealth Unit (J Car PhD), Imperial College Business School (Prof R Atun FRCP, Prof J Barlow PhD), and Imperial Innovations (HA Penfold PhD), Imperial College London, London, UK Technologies for global health

Neuropsychological assessment as a predictor of weight loss in obese adolescents.

Background:Obese individuals are known to be more impulsive than their normal-weight counterparts. Impulsivity has been postulated to be a predictor of weight loss.Design:A pre–post study was designed to determine for the first time whether impulsivity changed with weight loss during a lifestyle and physical activity intervention programme lasting 2–8 weeks.Subjects:Fifty-three obese adolescents with a body mass index (BMI) of 33.75±7.9 attending a residential camp were tested and compared at baseline with 50 non-obese adolescents with a mean BMI of 20.6±2.3.Measurements:Inhibitory control was measured with the CANTAB (Cambridge Cognition, Cambridge, UK) Stop Signal Task. MATLAB (The Mathswork Inc., Natick, MA, USA) was used to measure the temporal discounting constant.Results:The obese group was more impulsive than the normal weight adolescents. BMI reduced significantly from 33.76 kg m−2 to 30.93 kg m−2 after completing camp. The stop signal reaction time (SSRT) decreased from 225.38±94.22 to 173.76±107.05 ms (n=47, P=0.0001). A reduction in inhibitory control during camp was predictive of those who showed the greatest reduction in BMI (Wilks’ Lambda=0.9, F(1,50)=4.85, P=0.034). The number of weeks in camp (Wilks’ Lambda=0.83, F(1,50)=9.826, P=0.003) and the age of the adolescents (Wilks’ Lambda=0.87, F(1,50)=5.98, P=0.02) were significantly associated with a reduction in inhibitory control as measured by the SSRT. A longer stay in camp was associated with a greater reduction in SSRT (B=25.45, t=2.02, P=0.05). Increasing age had a significant moderating role in the reduction of inhibitory control (B=−0.3, t=−0.034, P=0.05). Temporal discounting for monetary reward also fell significantly during camp.Conclusion:This study highlights the potential to identify those who are obese by using an easy-to-measure psychometric test. Furthermore, it is the first study to report a reduction in impulsivity and an improvement in well-being as part of a government-approved residential camp for obese adolescents. The potential mechanisms for change in impulsivity with weight are discussed.

Benign tumours of the bone: A review.

Benign tumours of the bone are not cancerous and would not metastasise to other regions of the body. However, they can occur in any part of the skeleton, and can still be dangerous as they may grow and compress healthy bone tissue. There are several types of benign tumours that can be classified by the type of matrix that the tumour cells produce; such as bone, cartilage, fibrous tissue, fat or blood vessel. Overall, 8 different types can be distinguished: osteochondroma, osteoma, osteoid osteoma, osteoblastoma, giant cell tumour, aneurysmal bone cyst, fibrous dysplasia and enchondroma. The incidence of benign bone tumours varies depending on the type. However, they most commonly arise in people less than 30 years old, often triggered by the hormones that stimulate normal growth. The most common type is osteochondroma. This review discusses the different types of common benign tumours of the bone based on information accumulated from published literature.

Surgical smartphone applications across different platforms: their evolution, uses, and users.

Introduction. There are a vast array of smartphone applications that could benefit both surgeons and their patients. To review and identify all relevant surgical smartphone applications available for the Apple iPhone iOS and Google Android platform based on their user group and subspecialty for which they were designed. Method. Both the literature using PubMed and Google Scholar were searched using the following terms: application

Cognitive Task Analysis Bringing Olympic Athlete Style Training to Surgical Education

, smartphone

Impulsivity predicts weight loss after obesity surgery

, app

Change in Sexual Dysfunction Following Bariatric Surgery

, app*, surgery, surgical, surg*, general surgery, general surg*, bariatric

Global cancer burden and sustainable health development

, urology and plastic surgery, ortho*, orthop(a)edic, cardiac surgery, cardiothoracic, neurosurgery, and ophthalmology. Results. The search yielded 38 articles of which 23 were eligible. Each of the key specialties was searched in the Apple iTunes App Store for iPhone iOS and the Google Play Android application store. In total, there were 621 surgical applications for Apple iPhone iOS and 97 identified on Android’s Google Play. There has been a 9-fold increase in the number of surgical applications available for the Apple iPhone iOS from 2009 to 2012. Of these applications there were 126 dedicated to plastic surgery, 79 to orthopedics, 41 to neurosurgical, 180 to general surgery, 36 to cardiac surgery, 121 to ophthalmology, and 44 to urology. There was a wide range of applications ranging from simple flashcards to be used for revision to virtual surgery applications that provided surgical exposure and familiarization with common operative procedures. Conclusions. Despite the plethora of surgical applications available for smartphones, there is no taxonomy for medical applications. Only 12% were affiliated with an academic institution or association, which highlights the need for greater regulation of surgical applications.

Inhibitory control and perception of the future health in obese adolescents and normal weight adolescents

Background. Surgical training is changing and evolving as time, pressure, and legislative demands continue to mount on trainee surgeons. A paradigm change in the focus of training has resulted in experts examining the cognitive steps needed to perform complex and often highly pressurized surgical procedures. Objective. To provide an overview of the collective evidence on cognitive task analysis (CTA) as a surgical training method, and determine if CTA improves a surgeon’s performance as measured by technical and nontechnical skills assessment, including precision, accuracy, and operative errors. Methods. A systematic literature review was performed. PubMed, Cochrane, and reference lists were analyzed for appropriate inclusion. Results. A total of 595 surgical participants were identified through the literature review and a total of 13 articles were included. Of these articles, 6 studies focused on general surgery, 2 focused on practical procedures relevant to surgery (central venous catheterization placement), 2 studies focused on head and neck surgical procedures (cricothyroidotomy and percutaneous tracheostomy placement), 2 studies highlighted vascular procedures (endovascular aortic aneurysm repair and carotid artery stenting), and 1 detailed endovascular repair (abdominal aorta and thoracic aorta). Overall, 92.3% of studies showed that CTA improves surgical outcome parameters, including time, precision, accuracy, and error reduction in both simulated and real-world environments. Conclusion. CTA has been shown to be a more effective training tool when compared with traditional methods of surgical training. There is a need for the introduction of CTA into surgical curriculums as this can improve surgical skill and ultimately create better patient outcomes.

Cardiac autonomic regulation as a predictor for childhood obesity intervention success.

OBJECTIVE There is evidence that executive function, and specifically inhibitory control, is related to obesity and eating behavior. The goal of this study was to determine whether personality traits and inhibitory control predict weight loss after bariatric procedures. Although the impressive weight reduction after bariatric surgery has been shown in short- and medium-term studies, the effect of personality traits on this reduction is uncertain. Specifically, the effect of impulsivity is still largely unknown. SETTING Patients attending either a multidisciplinary information session or outpatient clinic at the Imperial Weight Management Centre were recruited with informed consent into the trial over a 4-month period from January to April 2013. Participants were invited to attend behavioral testing on an outpatient basis in a silent room invigilated by a single researcher. METHODS Forty-five bariatric patients participated in the study (25 patients had a gastric bypass, with a mean BMI of 41.8 and age of 39.0 years; 20 had a sleeve gastrectomy, with a mean BMI of 47.2 and age of 49.0 years). All patients completed personality measures of impulsivity-Barratts Impulsivity Scale, as well as behavioral measures of impulsivity-the stop-signal reaction-time (SSRT) task measuring inhibitory control and the temporal discounting task measuring reward processing. Those measures were examined in relation to weight loss 6 months after surgery. RESULTS The surgical procedure and changes in the behavioral measure of inhibitory control (SSRT) were found to be significant predictors of reduction in body mass index (BMI) in patients undergoing bariatric surgery. The sleeve gastrectomy group found a reduction in BMI of 14.1%, which was significantly less than the 25% reduction in BMI in the gastric bypass group. The direction (parameter estimate) of the significant effect was positive for SSRT change, which indicates that pre- and postreduction in impulsivity predicts reduction in BMI. CONCLUSION Impulsivity measures predict weight reduction in patients undergoing bariatric surgery. This result has implications for predicting outcomes from surgical treatments of obesity.