Systematic review of the use of financial incentives in treatments for obesity and overweight

Nine studies met the criteria for inclusion in this systematic review of randomized controlled trials of treatments for obesity and overweight involving the use of financial incentives, with reported follow-up of at least 1 year. All included trials were of behavioural obesity treatments. Justification of sample size and blinding procedure were not mentioned in any study. Attrition was well described in three studies and no study was analysed on an intention to treat basis. Participants were mostly women recruited through media advertisements. Mean age ranged from 35.7 to 52.8 years, and mean body mass index from 29.3 to 31.8 kg m−2. Results from meta-analysis showed no significant effect of use of financial incentives on weight loss or maintenance at 12 months and 18 months. Further sub-analysis by mode of delivery and amount of incentives although also non-statistically significant were suggestive of very weak trends in favour of use of amounts greater than 1.2% personal disposable income, rewards for behaviour change rather than for weight, rewards based on group performance rather than for individual performance and rewards delivered by non-psychologists rather than delivered by psychologists.The Health Services Research Unit is funded by the Chief Scientist Office of the Scottish Executive Health Department. The views expressed here are those of the authors. Alison Avenell is funded by a Career Scientist Award from the Chief Scientist Office of the Scottish Executive Health Departmen

A weibull approach for improving climate model projections of tropical cyclone wind-speed distributions

This is the final version of the article. Available from the publisher via the DOI in this record.Open Access ArticleReliable estimates of future changes in extreme weather phenomena, such as tropical cyclone maximum wind speeds, are critical for climate change impact assessments and the development of appropriate adaptation strategies. However, global and regional climate model outputs are often too coarse for direct use in these applications, with variables such as wind speed having truncated probability distributions compared to those of observations. This poses two problems: How canmodel-simulated variables best be adjusted to make themmore realistic? And how can such adjustments be used to make more reliable predictions of future changes in their distribution? This study investigates North Atlantic tropical cyclone maximum wind speeds from observations (1950- 2010) and regional climate model simulations (1995-2005 and 2045-55 at 12- and 36-km spatial resolutions). The wind speed distributions in these datasets are well represented by the Weibull distribution, albeit with different scale and shape parameters. A power-law transfer function is used to recalibrate the Weibull variables and obtain future projections of wind speeds. Two different strategies, bias correction and change factor, are tested by using 36-km model data to predict future 12-km model data (pseudo-observations). The strategies are also applied to the observations to obtain likely predictions of the future distributions of wind speeds. The strategies yield similar predictions of likely changes in the fraction of events within Saffir-Simpson categories-for example, an increase from 21% (1995-2005) to 27%-37% (2045-55) for category 3 or above events and an increase from 1.6% (1995- 2005) to 2.8%-9.8% (2045-55) for category 5 events. © 2014 American Meteorological Society.Acknowledgments. Support for this work was provided by theWillis Research Network, the Research Program to Secure Energy for America, NSF EASM Grant S1048841, and the NCARWeather and Climate Assessment Science Program. We thank Sherrie Fredrick for extracting data, and Cindy Bruyère, James Done, and Ben Youngman for productive discussions that enhanced this research. We also thank Dr. Adam Monahan and one anonymous reviewer for their insightful comments and suggestions

Suture Materials, 1980s: Properties, Uses, and Abuses

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66057/1/j.1365-4362.1982.tb03154.x.pd

Access regulation and the transition from copper to fiber networks in telecoms

In this paper we study the impact of different forms of access obligations on firms' incentives to migrate from the legacy copper network to ultra-fast broadband infrastructures. We analyze three different kinds of regulatory interventions: geographical regulation of access to copper networks-where access prices are differentiated depending on whether or not an alternative fiber network has been deployed; access obligations on fiber networks and its interplay with wholesale copper prices; and, finally, a mandatory switch-off of the legacy copper network-to foster the transition to the higher quality fiber networks. Trading-off the different static and dynamic goals, the paper provides guidelines and suggestions for policy makers' decision

An interactive course to enhance self-efficacy of family practitioners to treat obesity

BACKGROUND: Physicians' awareness of their important role in defusing the obesity epidemic has increased. However, the number of family practitioners who treat obesity problems continues to be low. Self-efficacy refers to the belief in one's ability to organize and execute the courses of action required to produce given attainments. Thus, practitioners who judge themselves incapable of managing obesity do not even try. We hypothesized that practitioners' self-efficacy and motivation would be enhanced as a result of participating in an interactive course designed to enrich their knowledge of obesity management. METHODS: Twenty-nine family practitioners participated in the course, which was accompanied by qualitative interviews. The difference between the physicians' pre-course and post-course appraisals was tested by paired t-test. The interviews were analyzed by qualitative methods. RESULTS: Post-course efficacy appraisals were significantly higher than pre-course appraisals (p < 0.0005). A deeper insight on the practitioners' self-efficacy processes was gained through reflection of the practitioners on their self-efficacy during the interviews. CONCLUSIONS: Up-to-date information and workshops where skills, attitudes and social support were addressed were important in making the program effective

A genetically encoded reporter of synaptic activity in vivo

To image synaptic activity within neural circuits, we tethered the genetically encoded calcium indicator (GECI) GCaMP2 to synaptic vesicles by fusion to synaptophysin. The resulting reporter, SyGCaMP2, detected the electrical activity of neurons with two advantages over existing cytoplasmic GECIs: it identified the locations of synapses and had a linear response over a wider range of spike frequencies. Simulations and experimental measurements indicated that linearity arises because SyGCaMP2 samples the brief calcium transient passing through the presynaptic compartment close to voltage-sensitive calcium channels rather than changes in bulk calcium concentration. In vivo imaging in zebrafish demonstrated that SyGCaMP2 can assess electrical activity in conventional synapses of spiking neurons in the optic tectum and graded voltage signals transmitted by ribbon synapses of retinal bipolar cells. Localizing a GECI to synaptic terminals provides a strategy for monitoring activity across large groups of neurons at the level of individual synapses

Predictors of post-operative mortality following treatment for non-ruptured abdominal aortic aneurysm

The aim of this prospective study of patients undergoing repair of non-ruptured abdominal aortic aneurysm between 1999 and 2003 was to evaluate and compare risk factors for mortality after surgery, to determine a complex of informative factors for lethal outcome, and to define patient risk groups. Logistic regression analysis revealed a complex of informative factors, including female gender, previous myocardial infarction, age greater than 75 years, and clinical course of abdominal aortic aneurysm as important indicators for lethal outcome. A risk score model identified low-, moderate- and high-risk groups with mortality rates of 2.9%, 8.0% and 44.4%, respectively

Observation of contemporaneous optical radiation from a gamma-ray burst

The origin of gamma-ray bursts (GRBs) has been enigmatic since their discovery. The situation improved dramatically in 1997, when the rapid availability of precise coordinates for the bursts allowed the detection of faint optical and radio afterglows - optical spectra thus obtained have demonstrated conclusively that the bursts occur at cosmological distances. But, despite efforts by several groups, optical detection has not hitherto been achieved during the brief duration of a burst. Here we report the detection of bright optical emission from GRB990123 while the burst was still in progress. Our observations begin 22 seconds after the onset of the burst and show an increase in brightness by a factor of 14 during the first 25 seconds; the brightness then declines by a factor of 100, at which point (700 seconds after the burst onset) it falls below our detection threshold. The redshift of this burst, approximately 1.6, implies a peak optical luminosity of 5 times 10^{49} erg per second. Optical emission from gamma-ray bursts has been generally thought to take place at the shock fronts generated by interaction of the primary energy source with the surrounding medium, where the gamma-rays might also be produced. The lack of a significant change in the gamma-ray light curve when the optical emission develops suggests that the gamma-rays are not produced at the shock front, but closer to the site of the original explosion.Comment: 10 pages, 2 figures. Accepted for publication in Nature. For additional information see http://www.umich.edu/~rotse

Professionalism and Evolving Concepts of Quality

For much of the twentieth century, quality of care was defined specifically in terms of physician characteristics and behaviors. High-quality physicians were well trained, knowledgeable, skillful, and compassionate. More recently, quality of care has been defined in terms of systems of care. High-quality organizations develop and adopt practices to reduce adverse events and optimize outcomes. This essay discusses this transformation from physician-based to organization-based concepts of quality and the consequences for patient care and medical professionalism

Discussing atypical sexual harassment as a controversial issue in bystander programmes: One UK campus study

This research emanates from an anti-sexual violence bystander programme delivered at an English university. Fifteen students were identified through purposive and convenience sampling to take part in focus groups. Discussions emerged regarding atypical sexual harassment. There is a gap in the literature exploring sexual harassment outside of the male perpetrator and female victim narrative which this paper contributes to. This paper considers four conversational themes: ‘unwanted touching: women to men’, ‘sexual banter: women to men’, ‘sexual stereotypes: women and men’, and ‘developing stronger ethical subjectivity’. This paper recognises most sexual harassment occurs from men to women, and acknowledges criticism of focussing otherwise when resources are limited, noting this risks obscuring the enduring power differentials between the sexes. It contends that exploring a controversial issue, such as male experience of sexual harassment, might help bystander programmes by developing ethical subjectivity in undergraduate students. Exploring sexual behaviour as a spectrum may lead to counter hegemonic discourses to emerge