A two-year randomized trial of obesity treatment in primary care practice

BACKGROUND Calls for primary care providers (PCPs) to offer obese patients behavioral weight-loss counseling have not been accompanied by adequate guidance on how such care could be delivered. This randomized trial compared weight loss during a 2-year period in response to three lifestyle interventions, all delivered by PCPs in collaboration with auxiliary health professionals (lifestyle coaches) in their practices. METHODS We randomly assigned 390 obese adults in six primary care practices to one of three types of intervention: usual care, consisting of quarterly PCP visits that included education about weight management; brief lifestyle counseling, consisting of quarterly PCP visits combined with brief monthly sessions with lifestyle coaches who instructed participants about behavioral weight control; or enhanced brief lifestyle counseling, which provided the same care as described for the previous intervention but included meal replacements or weight-loss medication (orlistat or sibutramine), chosen by the participants in consultation with the PCPs, to potentially increase weight loss. RESULTS Of the 390 participants, 86% completed the 2-year trial, at which time, the mean (±SE) weight loss with usual care, brief lifestyle counseling, and enhanced brief lifestyle counseling was 1.7±0.7, 2.9±0.7, and 4.6±0.7 kg, respectively. Initial weight decreased at least 5% in 21.5%, 26.0%, and 34.9% of the participants in the three groups, respectively. Enhanced lifestyle counseling was superior to usual care on both these measures of success (P=0.003 and P=0.02, respectively), with no other significant differences among the groups. The benefits of enhanced lifestyle counseling remained even after participants given sibutramine were excluded from the analyses. There were no significant differences between the intervention groups in the occurrence of serious adverse events

A test of good citizenship in the junior high school

Thesis (M.A.)--Boston University, 1947. This item was digitized by the Internet Archive

Painful Virtue, Marginalisation, and Resistance

This paper argues a potentially controversial thesis in virtue ethics, i.e., in situations of oppression and marginalisation, it is better to be a person of atypical virtue, one who has struggled to resist oppressive circumstances, than it is to be a traditionally defined virtuous agent. As such, those who have been through a tragic dilemma (or several) are more important for successful resistance movements than their traditionally defined counterparts. This paper does not romanticise oppressive situations or their influence on some individuals developing virtuous actions and behaviours. Instead, it acknowledges that these are tragic circumstances that permanently affect some individuals for the rest of their lives. However, the argument here is that these individuals can utilise their experiences as reasons to continue resisting until a time comes where future generations will not need to experience such tragic circumstances. To demonstrate the applicability of this argument, this paper will consider the struggles of queer individuals in a Canadian context. This is achieved by demonstrating how those individuals who led the fight for queer rights used their experiences of marginalisation in early resistance movements. It then shifts focus to address current issues in Canadian queer lives

Generating recommendations for entity-oriented exploratory search

We introduce the task of recommendation set generation for entity-oriented exploratory search. Given an input search query which is open-ended or under-specified, the task is to present the user with an easily-understandable collection of query recommendations, with the goal of facilitating domain exploration or clarifying user intent. Traditional query recommendation systems select recommendations by identifying salient keywords in retrieved documents, or by querying an existing taxonomy or knowledge base for related concepts. In this work, we build a text-to-text model capable of generating a collection of recommendations directly, using the language model as a "soft" knowledge base capable of proposing new concepts not found in an existing taxonomy or set of retrieved documents. We train the model to generate recommendation sets which optimize a cost function designed to encourage comprehensiveness, interestingness, and non-redundancy. In thorough evaluations performed by crowd workers, we confirm the generalizability of our approach and the high quality of the generated recommendations

The Effect of Moderation on Online Mental Health Conversations

Many people struggling with mental health issues are unable to access adequate care due to high costs and a shortage of mental health professionals, leading to a global mental health crisis. Online mental health communities can help mitigate this crisis by offering a scalable, easily accessible alternative to in-person sessions with therapists or support groups. However, people seeking emotional or psychological support online may be especially vulnerable to the kinds of antisocial behavior that sometimes occur in online discussions. Moderation can improve online discourse quality, but we lack an understanding of its effects on online mental health conversations. In this work, we leveraged a natural experiment, occurring across 200,000 messages from 7,000 conversations hosted on a mental health mobile application, to evaluate the effects of moderation on online mental health discussions. We found that participation in group mental health discussions led to improvements in psychological perspective, and that these improvements were larger in moderated conversations. The presence of a moderator increased user engagement, encouraged users to discuss negative emotions more candidly, and dramatically reduced bad behavior among chat participants. Moderation also encouraged stronger linguistic coordination, which is indicative of trust building. In addition, moderators who remained active in conversations were especially successful in keeping conversations on topic. Our findings suggest that moderation can serve as a valuable tool to improve the efficacy and safety of online mental health conversations. Based on these findings, we discuss implications and trade-offs involved in designing effective online spaces for mental health support.Comment: Accepted as a full paper at ICWSM 2021. 13 pages, 12 figures, 3 table