Effects of financial incentives on motivating physical activity among older adults: Results from a discrete choice experiment

10.1186/1471-2458-14-141BMC Public Health141

Leveraging family dynamics to increase the effectiveness of incentives for physical activity: The FIT-FAM randomized controlled trial

Background: Insufficient physical activity is a global public health concern. Research indicates incentives can increase physical activity levels of children but has not tested whether incentives targeted at children can be leveraged to increase physical activity levels of their parents. This study evaluates whether a novel incentive design linking children's incentives to both their and their parent's physical activity levels can increase parent's physical activity. Methods: We conducted a two-arm, parallel, open-labelled randomized controlled trial in Singapore where parent-child dyads were randomly assigned to either (1) rewards to child contingent on child's physical activity (child-based) or (2) rewards to child contingent on both child's and parent's physical activity (family-based). Parents had to be English-speaking, computer-literate, non-pregnant, full-time employees, aged 25-65 years, and with a participating child aged 7-11 years. Parent-child dyads were randomized within strata (self-reported low vs high weekly physical activity) into study arms in a 1:1 ratio. Participants were given activity trackers to assess daily steps. The outcome of interest was the between-arm difference in the change from baseline in parent's mean steps/day measured by accelerometry at months 6 and 12 (primary endpoint). Results: Overall, 159 and 157 parent-child dyads were randomized to the child-based or family-based arms, respectively. Outcomes were evaluated on an intent-to-treat basis. At month 6, there was a 613 steps/day (95% CI: 54-1171) differential in favour of family-based parents. At month 12, our primary endpoint, the differential was reduced to 369 steps/day (95% CI: - 88-1114) and was no longer statistically significant. Conclusions: Our findings suggest that novel incentive designs that take advantage of group dynamics may be effective. However, in this design, the effectiveness of the family-based incentive to increase parent's physical activity was not sustained through one year. Trial registration: NCT02516345 (ClinicalTrials.gov) registered on August 5, 2015

Magnetoresistance and dephasing in a two-dimensional electron gas at intermediate conductances

We study, both theoretically and experimentally, the negative magnetoresistance (MR) of a two-dimensional (2D) electron gas in a weak transverse magnetic field $B$. The analysis is carried out in a wide range of zero-$B$ conductances $g$ (measured in units of $e^2/h$), including the range of intermediate conductances, $g\sim 1$. Interpretation of the experimental results obtained for a 2D electron gas in GaAs/In$_x$Ga$_{1-x}$As/GaAs single quantum well structures is based on the theory which takes into account terms of higher orders in $1/g$, stemming from both the interference contribution and the mutual effect of weak localization (WL) and Coulomb interaction. We demonstrate that at intermediate conductances the negative MR is described by the standard WL "digamma-functions" expression, but with a reduced prefactor $\alpha$. We also show that at not very high $g$ the second-loop corrections dominate over the contribution of the interaction in the Cooper channel, and therefore appear to be the main source of the lowering of the prefactor, $\alpha\simeq 1-2/\pi g$. We further analyze the regime of a "weak insulator", when the zero-$B$ conductance is low $g(B=0)<1$ due to the localization at low $T$, whereas the Drude conductance is high, $g_0>>1.$ In this regime, while the MR still can be fitted by the digamma-functions formula, the experimentally obtained value of the dephasing rate has nothing to do with the true one. The corresponding fitting parameter in the low-$T$ limit is determined by the localization length and may therefore saturate at $T\to 0$, even though the true dephasing rate vanishes.Comment: 36 pages, 16 figure

Effectiveness of activity trackers with and without incentives to increase physical activity (TRIPPA): a randomised controlled trial

Background Despite the increasing popularity of activity trackers, little evidence exists that they can improve health outcomes. We aimed to investigate whether use of activity trackers, alone or in combination with cash incentives or charitable donations, lead to increases in physical activity and improvements in health outcomes. Methods In this randomised controlled trial, employees from 13 organisations in Singapore were randomly assigned (1:1:1:1) with a computer generated assignment schedule to control (no tracker or incentives), Fitbit Zip activity tracker, tracker plus charity incentives, or tracker plus cash incentives. Participants had to be English speaking, full-time employees, aged 21–65 years, able to walk at least ten steps continuously, and non-pregnant. Incentives were tied to weekly steps, and the primary outcome, moderate-to-vigorous physical activity (MVPA) bout min per week, was measured via a sealed accelerometer and assessed on an intention-to-treat basis at 6 months (end of intervention) and 12 months (after a 6 month post-intervention follow-up period). Other outcome measures included steps, participants meeting 70 000 steps per week target, and health-related outcomes including weight, blood pressure, and quality-of-life measures. This trial is registered at ClinicalTrials.gov, number NCT01855776. Findings Between June 13, 2013, and Aug 15, 2014, 800 participants were recruited and randomly assigned to the control (n=201), Fitbit (n=203), charity (n=199), and cash (n=197) groups. At 6 months, compared with control, the cash group logged an additional 29 MVPA bout min per week (95% CI 10–47; p=0·0024) and the charity group an additional 21 MVPA bout min per week (2–39; p=0·0310); the difference between Fitbit only and control was not significant (16 MVPA bout min per week [–2 to 35; p=0·0854]). Increases in MVPA bout min per week in the cash and charity groups were not significantly greater than that of the Fitbit group. At 12 months, the Fitbit group logged an additional 37 MVPA bout min per week (19–56; p=0·0001) and the charity group an additional 32 MVPA bout min per week (12–51; p=0·0013) compared with control; the difference between cash and control was not significant (15 MVPA bout min per week [–5 to 34; p=0·1363]). A decrease in physical activity of −23 MVPA bout min per week (95% CI −42 to −4; p=0·0184) was seen when comparing the cash group with the Fitbit group. There were no improvements in any health outcomes (weight, blood pressure, etc) at either assessment. Interpretation The cash incentive was most effective at increasing MVPA bout min per week at 6 months, but this effect was not sustained 6 months after the incentives were discontinued. At 12 months, the activity tracker with or without charity incentives were effective at stemming the reduction in MVPA bout min per week seen in the control group, but we identified no evidence of improvements in health outcomes, either with or without incentives, calling into question the value of these devices for health promotion. Although other incentive strategies might generate greater increases in step activity and improvements in health outcomes, incentives would probably need to be in place long term to avoid any potential decrease in physical activity resulting from discontinuation. Funding Ministry of Health, Singapore

Deriving the mass of particles from Extended Theories of Gravity in LHC era

We derive a geometrical approach to produce the mass of particles that could be suitably tested at LHC. Starting from a 5D unification scheme, we show that all the known interactions could be suitably deduced as an induced symmetry breaking of the non-unitary GL(4)-group of diffeomorphisms. The deformations inducing such a breaking act as vector bosons that, depending on the gravitational mass states, can assume the role of interaction bosons like gluons, electroweak bosons or photon. The further gravitational degrees of freedom, emerging from the reduction mechanism in 4D, eliminate the hierarchy problem since generate a cut-off comparable with electroweak one at TeV scales. In this "economic" scheme, gravity should induce the other interactions in a non-perturbative way.Comment: 30 pages, 1 figur

Multiplicity distributions at high energies as a sum of Poissonian-like distributions

It is shown that at collider energies experimental multiplicity distributions are well parameterized by a sum of Gupta-Sarma distributions. This extends earlier description of the lower energy data by the two parameter sum of Poissonians. Implications of the proposed parametrization for LHC are discussed.Comment: 16 pages, Latex, 4 EPS figure

Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Globally, the number of patients undergoing maintenance dialysis is increasing, yet throughout the world there is significant variability in the practice of initiating dialysis. Factors such as availability of resources, reasons for starting dialysis, timing of dialysis initiation, patient education and preparedness, dialysis modality and access, as well as varied \u201ccountry-specific\u201d factors significantly affect patient experiences and outcomes. As the burden of end-stage kidney disease (ESKD) has increased globally, there has also been a growing recognition of the importance of patient involvement in determining the goals of care and decisions regarding treatment. In January 2018, KDIGO (Kidney Disease: Improving Global Outcomes) convened a Controversies Conference focused on dialysis initiation, including modality choice, access, and prescription. Here we present a summary of the conference discussions, including identified knowledge gaps, areas of controversy, and priorities for research. A major novel theme represented during the conference was the need to move away from a \u201cone-size-fits-all\u201d approach to dialysis and provide more individualized care that incorporates patient goals and preferences while still maintaining best practices for quality and safety. Identifying and including patient-centered goals that can be validated as quality indicators in the context of diverse health care systems to achieve equity of outcomes will require alignment of goals and incentives between patients, providers, regulators, and payers that will vary across health care jurisdictions

Home dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference

Home dialysis modalities (home hemodialysis [HD] and peritoneal dialysis [PD]) are associated with greater patient autonomy and treatment satisfaction compared with in-center modalities, yet the level of home-dialysis use worldwide is low. Reasons for limited utilization are context-dependent, informed by local resources, dialysis costs, access to healthcare, health system policies, provider bias or preferences, cultural beliefs, individual lifestyle concerns, potential care-partner time, and financial burdens. In May 2021, KDIGO (Kidney Disease: Improving Global Outcomes) convened a controversies conference on home dialysis, focusing on how modality choice and distribution are determined and strategies to expand home-dialysis use. Participants recognized that expanding use of home dialysis within a given health system requires alignment of policy, fiscal resources, organizational structure, provider incentives, and accountability. Clinical outcomes across all dialysis modalities are largely similar, but for specific clinical measures, one modality may have advantages over another. Therefore, choice among available modalities is preference-sensitive, with consideration of quality of life, life goals, clinical characteristics, family or care-partner support, and living environment. Ideally, individuals, their care-partners, and their healthcare teams will employ shared decision-making in assessing initial and subsequent kidney failure treatment options. To meet this goal, iterative, high-quality education and support for healthcare professionals, patients, and care-partners are priorities. Everyone who faces dialysis should have access to home therapy. Facilitating universal access to home dialysis and expanding utilization requires alignment of policy considerations and resources at the dialysis-center level, with clear leadership from informed and motivated clinical teams