Evaluation of a multidisciplinary Tier 3 weight management service for adults with morbid obesity, or obesity and comorbidities, based in primary care

PubMed Central

Jennings, A; Hughes, C A; Kumaravel, B; Bachmann, M O; Steel, N; Capehorn, M; Cheema, K

2014-01-01

A multidisciplinary Tier 3 weight management service in primary care recruited patients with a body mass index ≥40 kg·m−2, or 30 kg·m−2 with obesity-related co-morbidity to a 1-year programme. A cohort of 230 participants was recruited and evaluated using the National Obesity Observatory Standard Evaluation Framework. The primary outcome was weight loss of at least 5% of baseline weight at 12 months. Diet was assessed using the two-item food frequency questionnaire, activity using the General Practice Physical Activity questionnaire and quality of life using the EuroQol-5D-5L questionnaire. A focus group explored the participants' experiences. Baseline mean weight was 124.4 kg and mean body mass index was 44.1 kg·m−2. A total of 102 participants achieved 5% weight loss at 12 months. The mean weight loss was 10.2 kg among the 117 participants who completed the 12-month programme. Baseline observation carried forward analysis gave a mean weight loss of 5.9 kg at 12 months. Fruit and vegetable intake, activity level and quality of life all improved. The dropout rate was 14.3% at 6 months and 45.1% at 1 year. Focus group participants described high levels of satisfaction. It was possible to deliver a Tier 3 weight management service for obese patients with complex co-morbidity in a primary care setting with a full multidisciplinary team, which obtained good health outcomes compared with existing services. PMID:25825858

Piloting a manualised weight management programme (Shape Up-LD) for overweight and obese persons with mild-moderate learning disabilities: study protocol for a pilot randomised controlled trial.

PubMed

Beeken, Rebecca J; Spanos, Dimitrios; Fovargue, Sally; Hunter, Rachael; Omar, Rumana; Hassiotis, Angela; King, Michael; Wardle, Jane; Croker, Helen

2013-03-12

National obesity rates have dramatically risen over the last decade. Being obese significantly reduces life expectancy, increases the risk of a range of diseases, and compromises quality of life. Costs to both the National Health Service and society are high. An increased prevalence of obesity in people with learning disabilities has been demonstrated. The consequences of obesity are particularly relevant to people with learning disabilities who are already confronted by health and social inequalities. In order to provide healthcare for all, and ensure equality of treatment for people with learning disabilities, services must be developed specifically with this population in mind. The aim of this project is to pilot the evaluation of a manualised weight management programme for overweight and obese persons with mild-moderate learning disabilities (Shape Up-LD). An individually randomised, controlled pilot trial in 60 overweight and obese (body mass index ≥ 25) adults (age ≥ 18) with mild-moderate learning disabilities and their carers will be carried out, comparing "Shape Up-LD" with usual care. The manualised Shape Up-LD intervention will involve 12 weekly sessions, which include healthy eating messages, advice on physical activity and use of behaviour change techniques to help people manage their weight. Assessments of participants will be conducted at baseline, 12 weeks and 6 months. Service users and their carers and service providers will also give their perspectives on the experience of Shape Up-LD in qualitative interviews at 12 weeks. Feasibility outcomes will include recruitment rates, loss to follow-up, compliance rates, completion rates, collection of information for a cost-effectiveness analysis and an estimation of the treatment effect on weight. The findings from this study will inform our preparation for a definitive randomised controlled trial to test the efficacy of the programme with respect to weight loss and maintenance in this population. Weight loss through Shape Up-LD could lead to improvements in health and quality of life. Costs to the National Health Service might be reduced through decreased overall service use because of improved health. The programme would also ensure a more equitable service for overweight service users with learning disabilities and fill the current gap in weight management services for this population. International Standard Randomised Controlled Trial No ISRCTN39605930.

28 CFR 549.63 - Initial medical evaluation and management.

Code of Federal Regulations, 2010 CFR

2010-07-01

... MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.63 Initial medical evaluation and management. (a... hunger strike: (1) Measure and record height and weight; (2) Take and record vital signs; (3) Urinalysis... weight and vital signs at least once every 24 hours while the inmate is on a hunger strike. Other...

Evaluation of a multidisciplinary Tier 3 weight management service for adults with morbid obesity, or obesity and comorbidities, based in primary care.

PubMed

Jennings, A; Hughes, C A; Kumaravel, B; Bachmann, M O; Steel, N; Capehorn, M; Cheema, K

2014-10-01

A multidisciplinary Tier 3 weight management service in primary care recruited patients with a body mass index ≥40 kg·m(-2) , or 30 kg·m(-2) with obesity-related co-morbidity to a 1-year programme. A cohort of 230 participants was recruited and evaluated using the National Obesity Observatory Standard Evaluation Framework. The primary outcome was weight loss of at least 5% of baseline weight at 12 months. Diet was assessed using the two-item food frequency questionnaire, activity using the General Practice Physical Activity questionnaire and quality of life using the EuroQol-5D-5L questionnaire. A focus group explored the participants' experiences. Baseline mean weight was 124.4 kg and mean body mass index was 44.1 kg·m(-2) . A total of 102 participants achieved 5% weight loss at 12 months. The mean weight loss was 10.2 kg among the 117 participants who completed the 12-month programme. Baseline observation carried forward analysis gave a mean weight loss of 5.9 kg at 12 months. Fruit and vegetable intake, activity level and quality of life all improved. The dropout rate was 14.3% at 6 months and 45.1% at 1 year. Focus group participants described high levels of satisfaction. It was possible to deliver a Tier 3 weight management service for obese patients with complex co-morbidity in a primary care setting with a full multidisciplinary team, which obtained good health outcomes compared with existing services. © 2014 The Authors. Clinical Obesity published by John Wiley & Sons Ltd on behalf of World Obesity.

Exploring the evidence base for Tier 3 specialist weight management interventions for children aged 2-18 years in the UK: a rapid systematic review.

PubMed

Brown, Tamara; O'Malley, Claire; Blackshaw, Jamie; Coulton, Vicki; Tedstone, Alison; Summerbell, Carolyn; Ells, Louisa J

2017-12-08

The impact of specialist weight management services (Tier 3) for children with severe and complex obesity in the UK is unclear. This review aims to examine the impact of child Tier 3 services in the UK, exploring service characteristics and implications for practice. Rapid systematic review of any study examining specialist weight management interventions in any UK setting including children (2-18 years) with a body mass index >99.6th centile or >98th centile with comorbidity. Twelve studies (five RCTs and seven uncontrolled) were included in a variety of settings. Study quality was moderate or low and mean baseline body mass index z-score ranged from 2.7 to 3.6 units. Study samples were small and children were predominantly older (10-14 years), female and white. Multidisciplinary team composition and eligibility criteria varied; dropout ranged from 5 to 43%. Improvements in zBMI over 1-24 months ranged from -0.13 to -0.41 units. Specialist weight management interventions for children with severe obesity demonstrated a reduction in zBMI, across a variety of UK settings. Studies were heterogeneous in content and thus conclusions on service design cannot be drawn. There is a paucity of evidence for Tier 3 services for children, and further research is required. © The Author 2017. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

The cost-effectiveness of weight management programmes in a postnatal population.

PubMed

Rawdin, A C; Duenas, A; Chilcott, J B

2014-09-01

The aim of the study was to estimate the cost-effectiveness of a weight management programme including elements of physical exercise and dietary restriction which are designed to help women lose excess weight gained during pregnancy in the vulnerable postnatal period and inhibit the development of behaviours which could lead to future excess weight gain and obesity. A mathematical model based on a regression equation predicting change in weight over a fifteen year postnatal period was developed. The model included programme effectiveness and resource data based on a randomized controlled trial of a weight management programme implemented in a postnatal population in the United States. Utility and mortality data based on body mass index categories were also included. The model adopted a National Health Service (NHS) and personal social services (PSS) perspective, a lifetime time horizon and estimated the cost effectiveness of a weight management programme against a no change comparator in terms of an incremental cost-effectiveness ratio (ICER). The baseline results show that the difference in weight between women who received the weight management programme and women who received the control intervention was 3.02 kg at six months and 3.53 kg at fifteen years following childbirth. This results in an ICER of £7355 per quality adjusted life year (QALY) for women who were married at childbirth. The estimated ICER would suggest that such a weight management programme is cost-effective at a NICE threshold of £20,000 per QALY. However significant structural and evidence based uncertainty is present in the analysis. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Military service and other socioecological factors influencing weight and health behavior change in overweight and obese Veterans: a qualitative study to inform intervention development within primary care at the United States Veterans Health Administration.

PubMed

Jay, Melanie; Mateo, Katrina F; Squires, Allison P; Kalet, Adina L; Sherman, Scott E

2015-01-01

Obesity affects 37 % of patients at Veterans Health Administration (VHA) medical centers. The VHA offers an intensive weight management program (MOVE!) but less than 10 % of eligible patients ever attend. However, VHA patients see their primary care provider about 3.6 times per year, supporting the development of primary care-based weight management interventions. To address gaps in the literature regarding Veterans' experiences with weight management and determine whether and how to develop a primary care-based weight management intervention to both improve obesity counseling and increase attendance to MOVE!, we conducted a qualitative study to assess: 1) Veterans' personal experiences with healthy weight-related behavior change (including barriers and facilitators to behavior change and experiences with primary care providers, staff, and the MOVE! program), and 2) potential new approaches to improve weight management within primary care at the VHA including goal setting and technology. Overweight/obese VHA patients (aged 18-75, BMI greater than 30 or greater than 25 with at least 1 co-morbidity) were recruited for focus group sessions stratified by gender, MOVE! referral, and attendance. Each session was facilitated by a trained moderator, audio-recorded, and professionally transcribed. Using an iterative coding approach, two coders separately reviewed and coded transcripts, and met frequently to negotiate codes and synthesize emerging themes. Of 161 eligible patients, 54 attended one of 6 focus groups (2 female, 4 male, 9-11 participants per session): 63 % were male, 46 % identified as African-American, 32 % White/Caucasian, 74 % were college-educated or higher, and 61 % reported having attended MOVE!. We identified two major themes: Impact of Military Service and Promotion and Sustainability of Healthy Behaviors. After service in a highly structured military environment, Veterans had difficulty maintaining weight on their own. They perceived physical activity as having more impact than diet, but chronic pain was a barrier. We identified individual/interpersonal-, community/environment-, and healthcare system-related factors affecting healthy behaviors. We also received input about Veteran's preferences and experiences with technology and setting health goals. Unique factors influence weight management in Veterans. Findings will inform development of a technology-assisted weight management intervention with tailored counseling and goal-setting within primary care at the VHA.

Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care.

PubMed

Miller, Margaret; Hearn, Lydia; van der Pligt, Paige; Wilcox, Jane; Campbell, Karen J

2014-01-01

Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women's weight and related lifestyle behaviours in child-bearing years is an outstanding 'missed opportunity' for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.

Referrals for pediatric weight management: the importance of proximity.

PubMed

Ambler, Kathryn A; Hagedorn, Douglas W J; Ball, Geoff D C

2010-11-01

Limited access to weight management care can have a negative impact on the health and well-being of obese children and youth. Our objectives were to describe the characteristics of clients referred to a pediatric weight management centre and explore potential differences according to proximity. All demographic and anthropometric data were abstracted from standardized, one-page referral forms, which were received by a pediatric weight management centre in Edmonton, AB (Canada) between April, 2005 and April, 2009. Referrals (n = 555; 52% male; age [mean +/- standard deviation]: 12.4 +/- 2.6 y; BMI: 32.3 +/- 6.8 kg/m2; BMI percentile: 98.4 +/- 1.7; BMI z-score: 2.3 +/- 0.4) were received from 311 physicians. Approximately 95% of referrals were for boys and girls classified as obese or very obese. Based on postal code data, individuals were dichotomized as either living within (local; n = 455) or beyond (distant; n = 100) the Edmonton Census Metropolitan Area. Numerous families resided several hundred kilometres away from our centre. Overall, distant clients were taller, weighed more, and were more overweight than their local counterparts. For distant clients, the degree of overweight was higher in youth versus children. Pediatric weight management services must be designed to optimize access to health services, especially for distant clients who may be at increased obesity-related health risk.

5 CFR 591.210 - What are weights?

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false What are weights? 591.210 Section 591.210 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS ALLOWANCES AND DIFFERENTIALS... What are weights? (a) A weight is the relative importance or share of a subpart of a group compared...

Attrition and weight loss outcomes for patients with complex obesity, anxiety and depression attending a weight management programme with targeted psychological treatment.

PubMed

McLean, R C; Morrison, D S; Shearer, R; Boyle, S; Logue, J

2016-04-01

The objective of the study is to investigate the effect of baseline anxiety and depression, using different definitions for caseness, on attrition and weight outcomes following a multidisciplinary weight management programme. The study design is a prospective observational study. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression with 'caseness' scoring ≥11 and severity ≥14. The participants were all patients who began a weight management programme between 1 October 2008 and 30 September 2009 (n = 1838). The setting was the Glasgow and Clyde Weight Management Service (GCWMS), a specialist multidisciplinary service, which aims to achieve a minimum of ≥5 kg weight loss. The results were as follows: patients with HADS score ≥14 were referred to the integrated psychology service for psychological assessment or intervention. Patients with caseness (HADS ≥11) for anxiety (33%) and depression (27%) were significantly younger, heavier, more socio-economically deprived and a higher proportion was female. There was a significant positive correlation between HADS anxiety and depression scores and increasing body mass index (r(2)  = 0.094, P < 0.001 and r(2)  = 0.175, P < 0.001, respectively). Attendance and completion was lower throughout follow-up amongst patients with anxiety or depression. More patients with HADS score ≥11 achieved ≥5 kg or ≥5% weight loss and by 12 months those with anxiety had a significantly higher mean weight loss (P = 0.032). Participants who scored for severe anxiety (HADS ≥14) achieved similar weight loss to those without, whilst participants who scored for severe depression achieved significantly greater weight loss than non-cases at 3, 6 and 12 months of follow-up (P < 0.01). Despite a less favourable case-mix of risk-factors for poor weight loss, patients who scored caseness for severe anxiety or depression and were offered additional psychological input achieved similar or better weight loss outcomes. © 2016 World Obesity.

Obesity services: how best to develop a coherent way forward.

PubMed

Barth, Julian H; O'Kane, Mary

2016-03-01

Obesity now affects 25% of the UK population. This volume of patients cannot be managed by current NHS services. It really needs a public health approach which encourages an environment where it is easier for the public to take healthy rather than unhealthy actions. However, there remain substantial numbers of patients who will benefit from medical intervention. This needs a joined-up service which extends from a healthy environment, linking gyms, weight loss groups, community cooking lessons, etc. with pathways connecting primary and secondary healthcare. To date, the National Health Service has not managed to develop a coherent policy that addresses obesity as a major cause of health and social care expenditure. The most important step in primary care is probably to identify the presence of obesity. The medical steps should be in the identification and management of comorbidities. The purpose of treating obesity is not weight loss alone but improving health, so the narrative needs to change from weight to blood pressure, glucose tolerance, physical fitness, etc. Many physicians believe that weight loss is an unwinnable battle but there are several well conducted studies in which primary care, supported by specialists, can deliver successful clinical weight loss. Specialist medical and surgical care for obesity will be required for complex cases and is essential for overseeing long-term postsurgical follow-up to prevent and treat nutritional and metabolic complications. Obesity management suffers from a lack of coherent national public health policies, fragmentation of care and a lack of knowledge of what successful treatment entails. Health benefits do not require a return to a healthy BMI. © 2015 John Wiley & Sons Ltd.

Can a pharmacy intervention improve the metabolic risks of mental health patients? Evaluation of a novel collaborative service.

PubMed

Maulavizada, Husna; Emmerton, Lynne; Hattingh, Hendrika Laetitia

2016-04-26

The pressure on healthcare services worldwide has driven the incorporation of disease state management services within community pharmacies in developed countries. Pharmacists are recognised as the most accessible healthcare professionals, and the incorporation of these services facilitates patient care. In Australia, the opportunity to manage pharmacy patients with mental illness has been underutilised, despite the existence of service models for other chronic conditions. This paper is an independent evaluation of a novel service developed by a community pharmacy in Perth, Western Australia. The service represents collaboration between a nurse practitioner and community pharmacy staff in the management of mental health patients with metabolic risks. We applied practice service standards for Australian community pharmacies to develop an evaluation framework for this novel service. This was followed by semi-structured interviews with staff members at the study pharmacy to explore service processes and procedures. Descriptive analysis of interviews was supplemented with analysis of patients' biometric data. All data were evaluated against the developed framework. The evaluation framework comprised 13 process, 5 outcomes, and 11 quality indicators. Interview data from eight staff members and biometric data from 20 community-dwelling mental health patients taking antipsychotics were evaluated against the framework. Predominantly, patients were managed by the pharmacy's nurse practitioner, with medication management provided by pharmacists. Patients' biometric measurements comprised weight, blood pressure, blood glucose levels, lipid profiles and management of obesity, smoking, hypertension and diabetes. Positive outcomes observed in the patient data included weight loss, smoking cessation, and improved blood pressure, blood glucose and lipid levels. The developed framework allowed effective evaluation of the service, and may be applicable to other pharmacy services. The metabolic clinic met key process, quality and outcomes indicators. The positive patient outcomes may assist in securing further funding.

Knowledge, attitudes and management skills of medical practitioners regarding weight management.

PubMed

Mkhatshwa, Vangile B; Ogunbanjo, Gboyega A; Mabuza, Langalibalele H

2016-11-29

Overweight and obesity have become a global problem. Health professionals are poorly prepared in weight management, which has an effect on their attitudes and management skills with regard to overweight and obese patients.Aim and setting: To assess the knowledge, attitudes and management skills of medical practitioners regarding weight management at Odi District Hospital, Gauteng Province, South Africa. We conducted a cross-sectional study on 48 medical practitioners at Odi Hospital between 01 October and 31 October 2013. A self-administered questionnaire was used to assess their knowledge, attitudes and management skills in weight management. The SPSS® statistical software (Version 22) was used for data analysis. A p < 0.05 was considered significant. Fifty medical practitioners were recruited, 48 consented to participate and 28 (58.3%) were male. Their categories were community service doctors (3), medical officers (21), registrars (22) and others (2). Thirty-seven (77.1%) never received training in weight management (p < 0.001). Thirty-two (66.7%) regarded weight management as not confined to a dietician (p < 0.001) and 27 (56.2%) regarded weight management as usually unsuccessful (p = 0.004). Forty-seven (97.9%) provided lifestyle modifications and 43 (89.6%) involved the patient's family in weight management (p < 0.001). More non-registrars [14 (77.8%)] than registrars [8 (38.1%)] measured the body mass index (BMI) routinely (p = 0.013). Few medical practitioners received training in weight management. They regarded weight management as usually unsuccessful and lacked confidence in the same owing to lack of training. They provided lifestyle modifications and involved the patient's family in weight management. Non-registrars measured the BMI routinely. There is a need for training in weight management at undergraduate and post-graduate levels.

Ecosystem Services Insights into Water Resources Management in China: A Case of Xi'an City.

PubMed

Liu, Jingya; Li, Jing; Gao, Ziyi; Yang, Min; Qin, Keyu; Yang, Xiaonan

2016-11-24

Global climate and environmental changes are endangering global water resources; and several approaches have been tested to manage and reduce the pressure on these decreasing resources. This study uses the case study of Xi'an City in China to test reasonable and effective methods to address water resource shortages. The study generated a framework combining ecosystem services and water resource management. Seven ecosystem indicators were classified as supply services, regulating services, or cultural services. Index values for each indicator were calculated, and based on questionnaire results, each index's weight was calculated. Using the Likert method, we calculated ecosystem service supplies in every region of the city. We found that the ecosystem's service capability is closely related to water resources, providing a method for managing water resources. Using Xi'an City as an example, we apply the ecosystem services concept to water resources management, providing a method for decision makers.

Patterns of service use in two types of managed behavioral health care plans.

PubMed

Merrick, Elizabeth L; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M; Azzone, Vanessa; McCann, Bernard; Ritter, Grant; Zolotusky, Galima; McGuire, Thomas G; Reif, Sharon

2010-01-01

The study examined service use patterns by level of care in two managed care plans offered by a national managed behavioral health care organization (MBHO): an employee assistance program (EAP) combined with a standard behavioral health plan (integrated plan) and a standard behavioral health plan. The cross-sectional analysis used 2004 administrative data from the MBHO. Utilization of 11 specific service categories was compared. The weighted sample reflected exact matching on sociodemographic characteristics (unweighted N=710,014; weighted N=286,750). A larger proportion of enrollees in the integrated plan than in the standard plan used outpatient mental health and substance abuse office visits (including EAP visits) (p<.01) and substance abuse intensive outpatient or day treatment (p<.05), and the proportion using residential substance abuse rehabilitation was lower (p<.05). The integrated and standard products had distinct utilization patterns in this large MBHO. In particular, greater use of certain outpatient services was observed in the integrated plan.

Patterns of Service Use in Two Types of Managed Behavioral Health Care Plan

PubMed Central

Merrick, Elizabeth Levy; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M.; Azzone, Vanessa; McCann, Bernard; Ritter, Grant; Zolotusky, Galina; McGuire, Thomas G.; Reif, Sharon

2009-01-01

Objective To describe service use patterns by level of care in two managed care products: employee assistance program (EAP) combined with behavioral health benefits, and standard behavioral health benefits. Methods This is a cross-sectional analysis of administrative data for 2004 from a national managed behavioral health care organization (MBHO). Utilization of 11 specific service categories was compared across products. The weighted sample reflected exact matching on sociodemographics (N= 710,014 unweighted; 286,750 weighted). Results In the EAP/behavioral health product,, the proportion of enrollees with outpatient mental health and substance abuse office visits (including EAP) was higher (p<.01), as was substance abuse day treatment/intensive outpatient care (p<.05). Use of residential substance abuse rehabilitation was lower (p<.05). Other differences were also found. Conclusion EAP/behavioral health and standard behavioral health care products had distinct utilization patterns in this large MBHO. In particular, greater use of certain outpatient services was observed within the EAP/behavioral health product. PMID:20044425

Barriers and facilitators to providing primary care-based weight management services in a patient centered medical home for Veterans: a qualitative study.

PubMed

Jay, Melanie; Chintapalli, Sumana; Squires, Allison; Mateo, Katrina F; Sherman, Scott E; Kalet, Adina L

2015-11-14

Obesity is highly prevalent among Veterans. In the United States, the Veterans Health Administration (VHA) offers a comprehensive weight management program called MOVE!. Yet, fewer than 10 % of eligible patients ever attend one MOVE! visit. The VHA has a patient-centered medical home (PCMH) model of primary care (PC) called Patient-Aligned Care Teams (PACT) at all Veterans Affairs (VA) Medical Centers. PACT teamlets conduct obesity screening, weight management counseling, and refer to MOVE!. As part of a needs assessment to improve delivery of weight management services, the purpose of this study was to assess PACT teamlet and MOVE! staff: 1) current attitudes and perceptions regarding obesity care; 2) obesity-related counseling practices 3) experiences with the MOVE! program; and 4) targets for interventions to improve implementation of obesity care in the PC setting. We recruited 25 PACT teamlet members from a single VA study site-11 PC physicians, 5 registered nurses, 5 licensed practical nurses, 1 clerical assistant, and 3 MOVE! staff (2 dietitians, 1 psychologist)-for individual interviews using a combination of convenience and snowball sampling. Audio recorded interviews were professionally transcribed and iteratively coded by two independent reviewers. The analytic process was guided by discourse analysis in order to discover how the participants perceived and provided weight management care and what specific attitudes affected their practices, all as bounded within the organization. Emerging themes included: 1) role perceptions, 2) anticipated outcomes of weight management counseling and programs, and 3) communication and information dissemination. Perceived role among PCPs was influenced by training, whereas personal experience with their own weight management impacted role perception among LPNs/RNs. Attitudes about whether or not they could impact patients' weight outcomes via counseling or referral to MOVE! varied. System-level communication about VHA priorities through electronic health records and time allocation influenced teams to prioritize referral to MOVE! over weight management counseling. We found a diversity of attitudes, and practices within PACT, and identified factors that can enhance the MOVE! program and inform interventions to improve weight management within primary care. Although findings are site-specific, many are supported in the literature and applicable to other VA and non-VA sites with PCMH models of care.

Ecosystem Services Insights into Water Resources Management in China: A Case of Xi’an City

PubMed Central

Liu, Jingya; Li, Jing; Gao, Ziyi; Yang, Min; Qin, Keyu; Yang, Xiaonan

2016-01-01

Global climate and environmental changes are endangering global water resources; and several approaches have been tested to manage and reduce the pressure on these decreasing resources. This study uses the case study of Xi’an City in China to test reasonable and effective methods to address water resource shortages. The study generated a framework combining ecosystem services and water resource management. Seven ecosystem indicators were classified as supply services, regulating services, or cultural services. Index values for each indicator were calculated, and based on questionnaire results, each index’s weight was calculated. Using the Likert method, we calculated ecosystem service supplies in every region of the city. We found that the ecosystem’s service capability is closely related to water resources, providing a method for managing water resources. Using Xi’an City as an example, we apply the ecosystem services concept to water resources management, providing a method for decision makers. PMID:27886137

Effect of management, marketing, and certified health programs on the sale price of beef calves sold through a livestock video auction service from 1995 through 2009.

PubMed

Seeger, Jon T; King, Michael E; Grotelueschen, Dale M; Rogers, Glenn M; Stokka, Gerald S

2011-08-15

To evaluate and update the previously quantified effects of management, marketing, and certified health programs on the sale price of beef calves sold through a livestock video auction service. Longitudinal study. 41,657 lots representing 5,042,272 beef calves sold from 1995 through 2009. Data describing each lot of beef calves marketed from 1995 through 2009 by a livestock video auction service were obtained from sale catalogues. For each year of the study, multiple regression analysis was used to quantify the effect of management, marketing, and certified health programs on sale price. Sale date, base sale weight, quadratic effect of base weight, sex of calf, region of origin, breed description, inclusion in a certified health program, and number of calves in the lot significantly affected sale price for every year of the study. Variation in body weight, flesh score, and number of days between sale and delivery date had significant effects on price in most of the years; frame score and calves with horns affected price in 7 of 15 years; age and source verification influenced sale price in every year since source verification was introduced in 2005; and the auction service's progressive genetics program increased price during the 1 year that program was available. Some management, marketing, and certified health initiatives have consistently increased the sale price of beef calves, and producers can increase the price of their calves by implementing these practices.

Acceptability of a Weight Management Intervention for Pregnant and Postpartum Women with BMI ≥30 kg/m2: A Qualitative Evaluation of an Individualized, Home-Based Service.

PubMed

Atkinson, Lou; Olander, Ellinor K; French, David P

2016-01-01

There have been recent calls for more evidence regarding effective antenatal and postnatal interventions to address the serious health risks of maternal obesity and associated childhood obesity. The Maternal and Early Years Healthy Weight Service (MAEYS) is an innovative service, delivered by specialist healthy weight advisors, for obese women (BMI ≥30 kg/m2) during pregnancy and up to 2 years after delivery. The service focuses on healthy gestational weight gain, postpartum weight loss and establishing healthy infant feeding and active play. MAEYS was adopted by six local health organizations in the U.K. as a 1 year pilot program. The aim of the present research was to assess the acceptability of this intervention among MAEYS participants. Semi-structured interviews with 20 women, with data analyzed thematically. High levels of acceptability were reported. The convenience and comfort of home visits, personalized advice on diet and physical activity, supportive approach of the healthy weight advisor and regular weight monitoring were all cited as advantages of the service. Service users suggested that more frequent contact with advisors and practical support such as recipes would improve the service. MAEYS is a novel, community-based intervention delivered in the home which has demonstrated acceptability to its recipients. It therefore shows promise as an early intervention to reduce the risks of maternal obesity and subsequently reduce childhood obesity. An evaluation of the efficacy of MAEYS in preventing excess gestational weight gain and losing weight postpartum is now needed.

Description and preliminary results from a structured specialist behavioural weight management group intervention: Specialist Lifestyle Management (SLiM) programme

PubMed Central

Brown, Adrian; Gouldstone, Amy; Fox, Emily; Field, Annmarie; Todd, Wendy; Shakher, Jayadave; Bellary, Srikanth; Teh, Ming Ming; Azam, Muhammad; John, Reggie; Jagielski, Alison; Arora, Teresa; Thomas, G Neil; Taheri, Shahrad

2015-01-01

Background Specialist Lifestyle Management (SLiM) is a structured patient education and self-management group weight management programme. Each session is run monthly over a 6-month period providing a less intensive long-term approach. The groups are patient-centred incorporating educational, motivational, behavioural and cognitive elements. The theoretical background, programme structure and preliminary results of SLiM are presented. Subjects/methods The study was a pragmatic service evaluation of obese patients with a body mass index (BMI) ≥35 kg/m2 with comorbidity or ≥40 kg/m2 without comorbidity referred to a specialist weight management service in the West Midlands, UK. 828 patients were enrolled within SLiM over a 48-month period. Trained facilitators delivered the programme. Preliminary anonymised data were analysed using the intention-to-treat principle. The primary outcome measure was weight loss at 3 and 6 months with comparisons between completers and non-completers performed. The last observation carried forward was used for missing data. Results Of the 828 enrolled within SLiM, 464 completed the programme (56%). The mean baseline weight was 135 kg (BMI=49.1 kg/m2) with 87.2% of patients having a BMI≥40 kg/m2 and 12.4% with BMI≥60 kg/m2. The mean weight change of all patients enrolled was −4.1 kg (95% CI −3.6 to −4.6 kg, p=0.0001) at the end of SLiM, with completers (n=464) achieving −5.5 kg (95% CI −4.2 to −6.2 kg, p=0.0001) and non-completers achieving −2.3 kg (p=0.0001). The majority (78.6%) who attended the 6-month programme achieved weight loss with 32.3% achieving a ≥5% weight loss. Conclusions The SLiM programme is an effective group intervention for the management of severe and complex obesity. PMID:25854970

The 5As team patient study: patient perspectives on the role of primary care in obesity management.

PubMed

Torti, Jacqueline; Luig, Thea; Borowitz, Michelle; Johnson, Jeffrey A; Sharma, Arya M; Campbell-Scherer, Denise L

2017-02-08

Over 60% of people have overweight or obesity, but only a third report receiving counselling from primary care providers. We explored patients' perspectives on the role of primary care in obesity management and their experience with existing resources, with a view to develop an improved understanding of this perspective, and more effective management strategies. Qualitative study employing semi-structured interviews and thematic analysis, with a sample of 28 patients from a cohort of 255 patients living with obesity and receiving care to support their weight management in a large Primary Care Network of family practices in Alberta. Four illustrative themes emerged: (1) the patient-physician relationship plays an important role in the adequacy of obesity management; (2) patients have clear expectations of substantive conversations with their primary care team; (3) complex conditions affect weight and patients require assistance tailored to individual obesity drivers; (4) current services provide support in important ways (accessibility, availability, accountability, affordability, consistency of messaging), but are not yet meeting patient needs for individual plans, advanced education, and follow-up opportunities. Patients have clear expectations that their primary care physician asks them about weight within a supportive therapeutic relationship. They see obesity as a complex phenomenon with multiple drivers. They want their healthcare providers to assess and address their root causes - not simplistic advice to "eat less, move more". Patients felt that the current services were positive resources, but expressed needs for tailored weight management plans, and longer-term follow-up.

Weight management and physical activity throughout the cancer care continuum.

PubMed

Demark-Wahnefried, Wendy; Schmitz, Kathryn H; Alfano, Catherine M; Bail, Jennifer R; Goodwin, Pamela J; Thomson, Cynthia A; Bradley, Don W; Courneya, Kerry S; Befort, Christie A; Denlinger, Crystal S; Ligibel, Jennifer A; Dietz, William H; Stolley, Melinda R; Irwin, Melinda L; Bamman, Marcas M; Apovian, Caroline M; Pinto, Bernardine M; Wolin, Kathleen Y; Ballard, Rachel M; Dannenberg, Andrew J; Eakin, Elizabeth G; Longjohn, Matt M; Raffa, Susan D; Adams-Campbell, Lucile L; Buzaglo, Joanne S; Nass, Sharyl J; Massetti, Greta M; Balogh, Erin P; Kraft, Elizabeth S; Parekh, Anand K; Sanghavi, Darshak M; Morris, G Stephen; Basen-Engquist, Karen

2018-01-01

Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA in routine cancer care, several barriers remain. This review summarizes key topics addressed in a recent National Academies of Science, Engineering, and Medicine workshop entitled, "Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum." Discussions related to body weight and PA among cancer survivors included: 1) current knowledge and gaps related to health outcomes; 2) effective intervention approaches; 3) addressing the needs of diverse populations of cancer survivors; 4) opportunities and challenges of workforce, care coordination, and technologies for program implementation; 5) models of care; and 6) program coverage. While more discoveries are still needed for the provision of optimal weight-management and PA programs for cancer survivors, obesity and inactivity currently jeopardize their overall health and quality of life. Actionable future directions are presented for research; practice and policy changes required to assure the availability of effective, affordable, and feasible weight management; and PA services for all cancer survivors as a part of their routine cancer care. CA Cancer J Clin 2018;68:64-89. © 2017 American Cancer Society. © 2017 American Cancer Society.

Effect of an obesity best practice alert on physician documentation and referral practices.

PubMed

Fitzpatrick, Stephanie L; Dickins, Kirsten; Avery, Elizabeth; Ventrelle, Jennifer; Shultz, Aaron; Kishen, Ekta; Rothschild, Steven

2017-12-01

The Centers for Medicare & Medicaid Services Electronic Health Record Meaningful Use Incentive Program requires physicians to document body mass index (BMI) and a follow-up treatment plan for adult patients with BMI ≥ 25. To examine the effect of a best practice alert on physician documentation of obesity-related care and referrals to weight management treatment, in a cluster-randomized design, 14 primary care clinics at an academic medical center were randomized to best practice alert intervention (n = 7) or comparator (n = 7). The alert was triggered when both height and weight were entered and BMI was ≥30. Both intervention and comparator clinics could document meaningful use by selecting a nutrition education handout within the alert. Intervention clinics could also select a referral option from the list of clinic and community-based weight management programs embedded in the alert. Main outcomes were proportion of eligible patients with (1) obesity-related documentation and (2) referral. There were 26,471 total primary care encounters with 12,981 unique adult patients with BMI ≥ 30 during the 6-month study period. Documentation doubled (17 to 33%) with implementation of the alert. However, intervention clinics were not significantly more likely to refer patients to weight management than comparator clinics (2.8 vs. 1.3%, p = 0.07). Although the alert was associated with increased physician meaningful use compliance, it was not an effective strategy for improving patient access to weight management services. Further research is needed to understand system-level characteristics that influence obesity management in primary care.

Consumer’s Resource Handbook (5th Edition)

DTIC Science & Technology

1990-01-01

Raymond Helmick Chief Director Mr. William Allen Matthews Director Weights and Measures Section Weights and Measures Division Acting Chief Weights and...2066 One Becton Drive Customer Services Representative Mr. William Fackler Franklin Lakes, NJ 07417 Block Drug Company, Inc. (201) 848-6800 257...7606 National Manager, Consumer Relations Consumer Affairs Minolta Corporation Morton Salt Mr. Bill Campbell, Vice President 100 Williams Drive 110

Evaluating the green practice of food service supply chain management based on fuzzy DEMATEL-ANP model

NASA Astrophysics Data System (ADS)

Li, Xiaoying; Zhu, Qinghua

2017-01-01

The question on how to evaluate a company's green practice has recently become a key strategic consideration for the food service supply chain management. This paper proposed a novel hybrid model that combines a fuzzy Decision Making Trial And Evaluation Laboratory(DEMATEL) and Analysis Network Process(ANP) methods, which developed the green restaurant criteria and demonstrated the complicated relations among various criteria to help the food service operation to better analyze the real-world situation and determine the different weight value of the criteria .The analysis of the evaluation of green practices will help the food service operation to be clear about the key measures of green practice to improve supply chain management.

Increasing the use of preventative health services to promote healthy eating, physical activity and weight management: the acceptability and potential effectiveness of a proactive telemarketing approach

PubMed Central

2012-01-01

Background Telephone based interventions are effective in promoting health behaviours. The use of telephone based support services to promote healthy eating, activity or weight loss, however, are currently under-utilised. The aim of this study was to assess the acceptability and potential effectiveness of a telemarketing approach in increasing community use of proactive services to encourage healthy eating, physical activity and weight loss. Methods The study employed a cross sectional design. Eligible consenting participants completed a 15 minute telephone survey conducted by trained telephone interviewers using computer assisted telephone interviewing technology. Results Overall, 87% of participants considered it acceptable for a health service to contact people by telephone to offer assistance to help them lose weight, eat healthily or be more physically active. Among participants with inadequate fruit and vegetable intake, physical activity or who were overweight, 64%, 54% and 61% respectively reported that they would use one or more of the proactive support services offered. Females and those from non -English speaking households who did not eat sufficient serves were significantly more likely to report that they would use support services. Conclusions The findings suggest that proactive telemarketing of health services to facilitate healthy eating, physical activity or weight loss is considered highly acceptable and may be effective in encouraging service use by more than half of all adults with these behavioural risks. PMID:23134686

A review of national health policies and professional guidelines on maternal obesity and weight gain in pregnancy.

PubMed

Schumann, N L; Brinsden, H; Lobstein, T

2014-08-01

Maternal obesity creates an additional demand for health-care services, as the routine obstetric care pathway requires alterations to ensure the most optimal care for obese women of childbearing age. This review examines the extent to which relevant national health documents reflect and respond to the health implications of maternal obesity and excessive gestational weight gain. A targeted search of peer-reviewed publications and grey literature was conducted for each country to identify national health documents, which were subsequently content analyzed according to an adapted framework. A total of 37 documents were identified, including one policy, 10 strategies and 26 guidelines, published within the last 10 years. Out of the 31 countries investigated, only 13 countries address maternal obesity while none address excessive gestational weight gain. We found inconsistencies and gaps in the recommendations to health-care service providers for the management of maternal obesity and weight gain in pregnancy. The findings show that only limited guidance on maternal obesity and gestational weight gain exists. The authors recommend that international, evidence-based guidelines on the management of maternal obesity and excessive gestational weight gain should be developed to reduce the associated health-care and economic costs. © 2014 The Authors. Clinical Obesity © 2014 World Obesity.

Comparing women pharmacy consumers’ experiences with weight loss treatment in Victoria and Nottingham: a cross-sectional study

PubMed Central

2014-01-01

Background There has been a recent increase in weight management services available in pharmacies across Australia and England. The aim of this study was to determine the following between women in Victoria and Nottingham: similarities and differences of what weight management options are preferred by women pharmacy consumers; how they feel about pharmacists providing advice in this area; and what they desire in a weight management program. Method Women pharmacy consumers were randomly approached by a researcher in community pharmacies in Victoria and Nottingham and asked to complete a questionnaire regarding their own weight management experiences. The questionnaire was self-completed or researcher-administered and was comprised of four main sections that focused on the participant’s general health, previous weight loss experiences, their ideal weight management program and their demographics. Data was entered in SPSS 19 and logistic regression was used to identify any differences in weight loss experiences between women. Results The participant rates were high: 86% (n = 395/460) in Victoria and 98% in Nottingham (n = 215/220). Overall, women in Victoria and Nottingham were similar with comparable demographics. Approximately 50% (250/507) of women were in the overweight or obese body mass index category, with over 70% (n = 436/610) of women having attempted to lose weight in the past. The majority of women (n = 334/436) felt comfortable receiving advice from pharmacists. In the logistic regression analysis women in Nottingham were found to be significantly less likely to have utilised a pharmacy weight management program in the last five years (OR: 0.23 CI: 0.08, 0.63) and were significantly less likely to want an ideal weight management program located in a pharmacy (OR: 0.49 CI: 0.30, 0.82) compared to women in Victoria. No significant associations between location and feeling comfortable with a pharmacist advising on weight loss or wanting a pharmacist in an ideal weight management program were seen. Conclusion Results from this study have provided information on possible ideal pharmacy weight management programs in both Victoria and Nottingham. Although differences were seen between the two populations, similarities between ideal weight management programs and comfort level with pharmacist interaction were noted. PMID:24972611

42 CFR 410.15 - Annual wellness visits providing Personalized Prevention Plan Services: Conditions for and...

Code of Federal Regulations, 2012 CFR

2012-10-01

... risk factors and improving self management, or community-based lifestyle interventions to reduce health risks and promote self-management and wellness, including weight loss, physical activity, smoking... satisfaction, stress, anger, loneliness/social isolation, pain, and fatigue. (D) Behavioral risks, including...

N-Screen Aware Multicriteria Hybrid Recommender System Using Weight Based Subspace Clustering

PubMed Central

Ullah, Farman; Lee, Sungchang

2014-01-01

This paper presents a recommender system for N-screen services in which users have multiple devices with different capabilities. In N-screen services, a user can use various devices in different locations and time and can change a device while the service is running. N-screen aware recommendation seeks to improve the user experience with recommended content by considering the user N-screen device attributes such as screen resolution, media codec, remaining battery time, and access network and the user temporal usage pattern information that are not considered in existing recommender systems. For N-screen aware recommendation support, this work introduces a user device profile collaboration agent, manager, and N-screen control server to acquire and manage the user N-screen devices profile. Furthermore, a multicriteria hybrid framework is suggested that incorporates the N-screen devices information with user preferences and demographics. In addition, we propose an individual feature and subspace weight based clustering (IFSWC) to assign different weights to each subspace and each feature within a subspace in the hybrid framework. The proposed system improves the accuracy, precision, scalability, sparsity, and cold start issues. The simulation results demonstrate the effectiveness and prove the aforementioned statements. PMID:25152921

38 CFR 17.108 - Copayments for inpatient hospital care and outpatient medical care.

Code of Federal Regulations, 2014 CFR

2014-07-01

... with military service; (4) Counseling and care for sexual trauma as authorized under 38 U.S.C 1720D. (5... provided under 38 U.S.C. 1712; (8) Readjustment counseling and related mental health services authorized...); (12) Weight management counseling (individual and group); (13) Smoking cessation counseling...

Community pharmacy-delivered interventions for public health priorities: a systematic review of interventions for alcohol reduction, smoking cessation and weight management, including meta-analysis for smoking cessation.

PubMed

Brown, Tamara J; Todd, Adam; O'Malley, Claire; Moore, Helen J; Husband, Andrew K; Bambra, Clare; Kasim, Adetayo; Sniehotta, Falko F; Steed, Liz; Smith, Sarah; Nield, Lucie; Summerbell, Carolyn D

2016-02-29

To systematically review the effectiveness of community pharmacy-delivered interventions for alcohol reduction, smoking cessation and weight management. Systematic review and meta-analyses. 10 electronic databases were searched from inception to May 2014. randomised and non-randomised controlled trials; controlled before/after studies, interrupted times series. any relevant intervention set in a community pharmacy, delivered by the pharmacy team. No restrictions on duration, country, age, or language. 19 studies were included: 2 alcohol reduction, 12 smoking cessation and 5 weight management. Study quality rating: 6 'strong', 4 'moderate' and 9 'weak'. 8 studies were conducted in the UK, 4 in the USA, 2 in Australia, 1 each in 5 other countries. Evidence from 2 alcohol-reduction interventions was limited. Behavioural support and/or nicotine replacement therapy are effective and cost-effective for smoking cessation: pooled OR was 2.56 (95% CI 1.45 to 4.53) for active intervention vs usual care. Pharmacy-based interventions produced similar weight loss compared with active interventions in other primary care settings; however, weight loss was not sustained longer term in a range of primary care and commercial settings compared with control. Pharmacy-based weight management interventions have similar provider costs to those delivered in other primary care settings, which are greater than those delivered by commercial organisations. Very few studies explored if and how sociodemographic or socioeconomic variables moderated intervention effects. Insufficient information was available to examine relationships between effectiveness and behaviour change strategies, implementation factors, or organisation and delivery of interventions. Community pharmacy-delivered interventions are effective for smoking cessation, and demonstrate that the pharmacy is a feasible option for weight management interventions. Given the potential reach, effectiveness and associated costs of these interventions, commissioners should consider using community pharmacies to help deliver public health services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Obesity services planning framework for interprofessional primary care organizations.

PubMed

Brauer, Paula; Royall, Dawna; Dwyer, John; Edwards, A Michelle; Hussey, Tracy; Kates, Nick; Smith, Heidi; Kirkconnell, Ross

2017-03-01

Aim We report on a formative project to develop an organization-level planning framework for obesity prevention and management services. It is common when developing new services to first develop a logic model outlining expected outcomes and key processes. This can be onerous for single primary care organizations, especially for complex conditions like obesity. The initial draft was developed by the research team, based on results from provider and patient focus groups in one large Family Health Team (FHT) in Ontario. This draft was reviewed and activities prioritized by 20 FHTs using a moderated electronic consensus process. A national panel then reviewed the draft. Findings Providers identified five main target groups: pregnancy to 2, 3-12, 13-18, 18+ years at health risk, and 18+ with complex care needs. Desired outcomes were identified and activities were prioritized under categories: raising awareness (eg, providing information and resources on weight-health), identification and initial management (eg, wellness care), follow-up management (eg, group programs), expanded services (eg, availability of team services), and practice initiatives (eg, interprofessional education). Overall, there was strong support for raising awareness by providing information on the weight-health connection and on community services. There was also strong support for growth assessment in pediatric care. In adults, there was strong support for wellness care/health check visits and episodic care to identify people for interventions, for group programs, and for additional provider education. Joint development by different teams proved useful for consensus on outcomes and for ensuring relevancy across practices. While priorities will vary depending on local context, the basic descriptions of care processes were endorsed by reviewers. Key next steps are to trial the use of the framework and for further implementation studies to find optimally effective approaches for obesity prevention and management across the lifespan.

Weight stigma in maternity care: women’s experiences and care providers’ attitudes

PubMed Central

2013-01-01

Background Weight stigma is pervasive in Western society and in healthcare settings, and has a negative impact on victims’ psychological and physical health. In the context of an increasing focus on the management of overweight and obese women during and after pregnancy in research and clinical practice, the current studies aimed to examine the presence of weight stigma in maternity care. Addressing previous limitations in the weight stigma literature, this paper quantitatively explores the presence of weight stigma from both patient and care provider perspectives. Methods Study One investigated associations between pre-pregnancy body mass index (BMI) and experiences of maternity care from a state-wide, self-reported survey of 627 Australian women who gave birth in 2009. Study Two involved administration of an online survey to 248 Australian pre-service medical and maternity care providers, to investigate their perceptions of, and attitudes towards, providing care for pregnant patients of differing body sizes. Both studies used linear regression analyses. Results Women with a higher BMI were more likely to report negative experiences of care during pregnancy and after birth, compared to lower weight women. Pre-service maternity care providers perceived overweight and obese women as having poorer self-management behaviours, and reported less positive attitudes towards caring for overweight or obese pregnant women, than normal-weight pregnant women. Even care providers who reported few weight stigmatising attitudes responded less positively to overweight and obese pregnant women. Conclusions Overall, these results provide preliminary evidence that weight stigma is present in maternity care settings in Australia. They suggest a need for further research into the nature and consequences of weight stigma in maternity care, and for the inclusion of strategies to recognise and combat weight stigma in maternity care professionals’ training. PMID:23339533

Weight stigma in maternity care: women's experiences and care providers' attitudes.

PubMed

Mulherin, Kate; Miller, Yvette D; Barlow, Fiona Kate; Diedrichs, Phillippa C; Thompson, Rachel

2013-01-22

Weight stigma is pervasive in Western society and in healthcare settings, and has a negative impact on victims' psychological and physical health. In the context of an increasing focus on the management of overweight and obese women during and after pregnancy in research and clinical practice, the current studies aimed to examine the presence of weight stigma in maternity care. Addressing previous limitations in the weight stigma literature, this paper quantitatively explores the presence of weight stigma from both patient and care provider perspectives. Study One investigated associations between pre-pregnancy body mass index (BMI) and experiences of maternity care from a state-wide, self-reported survey of 627 Australian women who gave birth in 2009. Study Two involved administration of an online survey to 248 Australian pre-service medical and maternity care providers, to investigate their perceptions of, and attitudes towards, providing care for pregnant patients of differing body sizes. Both studies used linear regression analyses. Women with a higher BMI were more likely to report negative experiences of care during pregnancy and after birth, compared to lower weight women. Pre-service maternity care providers perceived overweight and obese women as having poorer self-management behaviours, and reported less positive attitudes towards caring for overweight or obese pregnant women, than normal-weight pregnant women. Even care providers who reported few weight stigmatising attitudes responded less positively to overweight and obese pregnant women. Overall, these results provide preliminary evidence that weight stigma is present in maternity care settings in Australia. They suggest a need for further research into the nature and consequences of weight stigma in maternity care, and for the inclusion of strategies to recognise and combat weight stigma in maternity care professionals' training.

Weight outcomes audit for 34,271 adults referred to a primary care/commercial weight management partnership scheme.

PubMed

Stubbs, R James; Pallister, Carolyn; Whybrow, Stephen; Avery, Amanda; Lavin, Jacquie

2011-01-01

This project audited rate and extent of weight loss in a primary care/commercial weight management organisation partnership scheme. 34,271 patients were referred to Slimming World for 12 weekly sessions. Data were analysed using individual weekly weight records. Average (SD) BMI change was -1.5 kg/m² (1.3), weight change -4.0 kg (3.7), percent weight change -4.0% (3.6), rate of weight change -0.3 kg/week, and number of sessions attended 8.9 (3.6) of 12. For patients attending at least 10 of 12 sessions (n = 19,907 or 58.1%), average (SD) BMI change was -2.0 kg/m² (1.3), weight change -5.5 kg (3.8), percent weight change -5.5% (3.5), rate of weight change -0.4 kg/week, and average number of sessions attended was 11.5 (0.7) (p < 0.001, compared to all patients). Weight loss was greater in men (n = 3,651) than in women (n = 30,620) (p < 0.001). 35.8% of all patients enrolled and 54.7% in patients attending 10 or more sessions achieved at least 5% weight loss. Weight gain was prevented in 92.1% of all patients referred. Attendance explained 29.6% and percent weight lost in week 1 explained 18.4% of the variance in weight loss. Referral to a commercial organisation is a practical option for National Health Service (NHS) weight management strategies, which achieves clinically safe and effective weight loss. Copyright © 2011 S. Karger AG, Basel.

Tier 3 multidisciplinary medical weight management improves outcome of Roux-en-Y gastric bypass surgery.

PubMed

Patel, P; Hartland, A; Hollis, A; Ali, R; Elshaw, A; Jain, S; Khan, A; Mirza, S

2015-04-01

In 2013 the Department of Health specified eligibility for bariatric surgery funded by the National Health Service. This included a mandatory specification that patients first complete a Tier 3 medical weight management programme. The clinical effectiveness of this recommendation has not been evaluated previously. Our bariatric centre has provided a Tier 3 programme six months prior to bariatric surgery since 2009. The aim of our retrospective study was to compare weight loss in two cohorts: Roux-en-Y gastric bypass only (RYGB only cohort) versus Tier 3 weight management followed by RYGB (Tier 3 cohort). A total of 110 patients were selected for the study: 66 in the RYGB only cohort and 44 in the Tier 3 cohort. Patients in both cohorts were matched for age, sex, preoperative body mass index and pre-existing co-morbidities. The principal variable was therefore whether they undertook the weight management programme prior to RYGB. Patients from both cohorts were followed up at 6 and 12 months to assess weight loss. The mean weight loss at 6 months for the Tier 3 cohort was 31% (range: 18-69%, standard deviation [SD]: 0.10 percentage points) compared with 23% (range: 4-93%, SD: 0.12 percentage points) for the RYGB only cohort (p=0.0002). The mean weight loss at 12 months for the Tier 3 cohort was 34% (range: 17-51%, SD: 0.09 percentage points) compared with 27% (range: 14-48%, SD: 0.87 percentage points) in the RYGB only cohort (p=0.0037). Our study revealed that in our matched cohorts, patients receiving Tier 3 specialist medical weight management input prior to RYGB lost significantly more weight at 6 and 12 months than RYGB only patients. This confirms the clinical efficacy of such a weight management programme prior to gastric bypass surgery and supports its inclusion in eligibility criteria for bariatric surgery.

Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: lighten Up randomised controlled trial.

PubMed

Jolly, Kate; Lewis, Amanda; Beach, Jane; Denley, John; Adab, Peymane; Deeks, Jonathan J; Daley, Amanda; Aveyard, Paul

2011-11-03

To assess the effectiveness of a range of weight management programmes in terms of weight loss. Eight arm randomised controlled trial. Primary care trust in Birmingham, England. 740 obese or overweight men and women with a comorbid disorder identified from general practice records. Weight loss programmes of 12 weeks' duration: Weight Watchers; Slimming World; Rosemary Conley; group based, dietetics led programme; general practice one to one counselling; pharmacy led one to one counselling; choice of any of the six programmes. The comparator group was provided with 12 vouchers enabling free entrance to a local leisure (fitness) centre. The primary outcome was weight loss at programme end (12 weeks). Secondary outcomes were weight loss at one year, self reported physical activity, and percentage weight loss at programme end and one year. Follow-up data were available for 658 (88.9%) participants at programme end and 522 (70.5%) at one year. All programmes achieved significant weight loss from baseline to programme end (range 1.37 kg (general practice) to 4.43 kg (Weight Watchers)), and all except general practice and pharmacy provision resulted in significant weight loss at one year. At one year, only the Weight Watchers group had significantly greater weight loss than did the comparator group (2.5 (95% confidence interval 0.8 to 4.2) kg greater loss,). The commercial programmes achieved significantly greater weight loss than did the primary care programmes at programme end (mean difference 2.3 (1.3 to 3.4) kg). The primary care programmes were the most costly to provide. Participants allocated to the choice arm did not have better outcomes than those randomly allocated to a programme. Commercially provided weight management services are more effective and cheaper than primary care based services led by specially trained staff, which are ineffective. Trial registration Current Controlled Trials ISRCTN25072883.

Protocol for the Rural Engagement in Primary Care for Optimizing Weight Reduction (RE-POWER) Trial: Comparing three obesity treatment models in rural primary care.

PubMed

Befort, Christie A; VanWormer, Jeffrey J; DeSouza, Cyrus; Ellerbeck, Edward F; Kimminau, Kim S; Greiner, Allen; Gajewski, Byron; Huang, Terry; Perri, Michael G; Fazzino, Tera L; Christifano, Danielle; Eiland, Leslie; Drincic, Andjela

2016-03-01

Obesity disproportionately affects rural residents in the United States, and primary care has the potential to fill a major gap in the provision of weight management services for rural communities. The objective of this cluster-randomized pragmatic trial is to evaluate the comparative effectiveness of three obesity treatment models in rural primary care: the Intensive Behavior Therapy fee-for-service (FFS) model reimbursed by Medicare, a team-based model that recognizes the patient-centered medical home (PCMH) as a preferred delivery approach, and the centralized disease management (DM) model, in which phone-based counseling is provided outside of the primary care practice. We hypothesize that the PCMH and DM treatments will be more effective than FFS in reducing weight at 24 months. Thirty-six practices from the rural Midwestern U.S. are randomized to deliver one of the three interventions to 40 patients (N=1440) age 20 to 75 with a BMI 30-45 kg/m(2). In the FFS arm, primary care providers and their personnel counsel patients to follow evidence-based weight loss guidelines using the Medicare-designated treatment schedule. In the PCMH arm, patients receive a comprehensive weight management intervention delivered locally by practice personnel using a combination of in-person and phone-based group sessions. In the DM arm, the same intervention is delivered remotely by obesity treatment specialists via group conference calls. The primary outcome is weight loss at 24 months. Additional measures include fasting glucose, lipids, quality of life indicators, and implementation process measures. Findings will illuminate effective obesity treatment intervention(s) in rural primary care. Copyright © 2016. Published by Elsevier Inc.

Development and integration of pharmacist clinical services into the patient-centered medical home.

PubMed

Berdine, Hildegarde J; Skomo, Monica L

2012-01-01

To describe the development of pharmacist clinical services within a primary care physician practice using a standardized business plan, the extent of clinical pharmacy service integration into the patient-centered medical home (PCMH), and the clinical changes in the pharmacist's patient cohort. A two-physician primary care/occupational care practice in Pittsburgh, PA, from May 2007 to December 2011. Pharmacist-led clinic receives physician referrals for medication management, adherence, and disease management services. Pharmacist practice in a primary care setting with emphasis on integration of clinical services into the medical home model designed by the American Academy of Family Physicians. Characterization of the patient's pharmacist and services provided by the pharmacist. Glycosylated hemoglobin (A1C), body mass index (BMI), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, triglycerides, and blood pressure. The top five primary referral reasons were diabetes self-management, weight management, medication adherence, hypertension, and dyslipidemia management. Improvements in clinical parameters were demonstrated for lipids and A1C at 1 and 2 years after baseline. Statistically significant improvements in BMI also were observed. The pharmacist developed and integrated clinical services into a primary care practice, became an integral member of the clinical team in the two-physician PCMH, and improved patient outcomes.

Consensus statement: appropriate consumer education and communication programs for weight- loss agents in Asia.

PubMed

Chan, Siew Pheng; Chui, William C; Lo, Kwok Wing; Huang, Kuo-Chin; Leyesa, Normita D; Lin, Wen-Yuan; Mirasol, Roberto C; Robles, Yolanda R; Tey, Beng Hea; Paraidathathu, Thomas

2012-07-01

The increasing prevalence of overweight and obesity worldwide demands increased efforts in the prevention and management of obesity. This article aims to present consensus statements promoting appropriate consumer education and communication programs for weight-loss agents in Asia. Panel members from various disciplines developed consensus statements based on an expert meeting on the benefits of consumer education and communication programs for over-the-counter weight-loss agents. Key opinion leaders discussed relevant data that served as the basis of the recommendations. Obesity is a growing epidemic in Asia, turning the region into a potential market for weight-loss products and services. Current trends in direct-to-consumer advertising demonstrate the pervasiveness of false representations lacking adequate substantiation. Relevant issues and recommendations were established. Public education on weight management is a shared responsibility; there is a need to raise public awareness of obesity and its health-related consequences. Advertising guidelines should ensure responsible direct-to-consumer advertising of weight-loss agents.

Slimming World in Stop Smoking Services (SWISSS): study protocol for a randomized controlled trial.

PubMed

Lycett, Deborah; Aveyard, Paul; Farmer, Andrew; Lewis, Amanda; Munafò, Marcus

2013-06-19

Quitting smokers gain weight. This deters some from trying to stop smoking and may explain the increased incidence of type 2 diabetes after cessation. Dieting when stopping smoking may be counterproductive. Hunger increases cravings for smoking and tackling two behaviours together may undermine quitting success. A meta-analysis of randomized controlled trials (RCTs) showed individualized dietary support may prevent weight gain, although there is insufficient evidence whether it undermines smoking cessation. Commercial weight management providers (CWMPs), such as Slimming World, provide individualized dietary support for National Health Service (NHS) patients; however, there is no evidence that they can prevent cessation-related weight gain.Our objective is to determine whether attending Slimming World from quit date, through referral from NHS Stop Smoking Services, is more effective than usual care at preventing cessation-related weight gain. This RCT will examine the effectiveness of usual cessation support plus referral to Slimming World compared to usual cessation support alone. Healthy weight, overweight and obese adult smokers attending Stop Smoking Services will be included. The primary outcome is weight change in quitters 12 weeks post-randomization. Multivariable linear regression analysis will compare weight change between trial arms and adjust for known predictors of cessation-related weight gain.We will recruit 320 participants, with 160 participants in each arm. An alpha error rate of 5% and 90% power will detect a 2 kg (SD = 2.5) difference in weight gain at 12 weeks, assuming 20% remain abstinent by then. This trial will establish whether referral to the 12-week Slimming World programme plus usual care is an effective intervention to prevent cessation-related weight gain. If so, we will seek to establish whether weight control comes at the expense of a successful quit attempt in a further non-inferiority trial.Positive results from both these trials would provide a potential solution to cessation-related weight gain, which could be rolled out across England within Stop Smoking Services to better meet the needs of 0.75 million smokers stopping with NHS support every year. Current Controlled Trials ISRCTN65705512.

Caseload management in community children's nursing.

PubMed

Lewis, Mary; Pontin, David

2008-04-01

Little is known about the working practices of community children's nurses and how they manage the complexities of working with children and young people with life-limiting, life-threatening and chronic ill-health conditions and their families. This action research project aimed to find ways of managing community children's nursing caseloads that would improve the efficiency, effectiveness and equity of services and inform negotiations with service commissioners. A data collection template comprising six input categories was adapted from the Cornwall Community Trust's health visitor weighting framework to reflect the complexity of need and the family focus of the service provided. Data were collected for one year by nurses in one integrated community children's nursing and clinical psychology service in the Southwest of England. Qualitative interviews were held with the nurses to further explore patterns identified in the input data. From the documentary analysis and the interviews it was possible to identify a typical ratio of client numbers in each category which allowed the nurses to be proactive in meeting children's and families' assessed needs. The numbers of clients on caseloads fluctuated over time and varied between geographical caseload areas. The type of work carried out by individual nurses varied depending on the type of contract for their locale. However, by weighting the clients in each category it was possible to arrive at a means of meaningful comparison in terms of family centred nursing. The nursing input framework supports monthly caseload monitoring by community children's nurses and informs reports to the service commissioners as part of activity monitoring data. The mechanism will be tested in comparable services in the UK to gauge its transferability.

Antipsychotic induced weight gain in schizophrenia:mechanisms and management.

PubMed

Rege, Sanil

2008-05-01

The aim of the present paper was to describe the mechanisms and management of antipsychotic-induced weight gain in schizophrenia patients. A comprehensive literature review of all available articles on the mechanisms and management of antipsychotic-induced weight gain was done by searching databases PsychINFO and PubMed. A summary of the available guidelines for monitoring of antipsychotic-induced weight gain and metabolic syndrome is also provided. There has been a substantial increase in the number of studies investigating the mechanisms and management of antipsychotic-induced weight gain after 2002. These include advances in the understanding of pharmacogenomics of weight gain and several randomized controlled trials (RCTs) evaluating pharmacological and psychological treatments to promote weight loss. The most effective strategy for prevention of weight gain is the choice of antipsychotic medication with low weight gain potential. In individuals with established weight gain and metabolic issues, switching to an antipsychotic agent with lower weight gain potential and/or lifestyle modifications with physical activity are most effective in promoting weight loss. Pharmacological agents such as orlistat and sibutramine are effective in general obesity but have not been sufficiently evaluated in antipsychotic-induced weight gain. The case to prescribe routine pharmacological treatment to promote weight loss is weak. Long-term, pragmatic studies are required to inform clinical practice. Weight gain in schizophrenia is associated with significant physical and psychological morbidity. Achieving an optimal trade-off between effectiveness and side-effects of antipsychotic agents, although difficult, is achievable. This should be based on three main principles: (i) a shared decision-making model between the patient, clinician and carer(s) when choosing an antipsychotic; (ii) a commitment to baseline and follow-up monitoring with explicit identification of the responsible individual or team; and (iii) the adoption of clear structured protocols for clinicians to follow in case of clinically significant weight gain and metabolic issues, which should incorporate greater collaboration between various health professionals from psychiatric and medical specialist services.

Healthcare use, costs and quality of life in patients with end-stage kidney disease receiving conservative management: results from a multi-centre observational study (PACKS).

PubMed

Phair, Glenn; Agus, Ashley; Normand, Charles; Brazil, Kevin; Burns, Aine; Roderick, Paul; Maxwell, Alexander P; Thompson, Colin; Yaqoob, Magdi; Noble, Helen

2018-05-01

Previous research has explored the cost of providing renal replacement therapies in patients with end-stage kidney disease and their quality of life. This is the first study to examine the healthcare costs of patients receiving conservative care without dialysis for end-stage kidney disease. This alternative to dialysis is an option for patients who prefer a supportive and palliative care approach. Descriptive cost and quality of life analyses alongside a UK-based multi-centre observational study in patients receiving conservative management for end-stage kidney disease. Health service use was recorded up to 12 months after making the decision to receive conservative management. Mean costs were calculated for each 3-month time period. The annual cost was calculated in two ways: by using only patients with complete cost data and by using all available data weighted by the number of patients at each time point. In total, 42 patients who opted for conservative management over dialysis were recruited. Mean costs were £1622 (0-3 months), £1008 (3-6 months), £554 (6-9 months) and £2626 (9-12 months). Mean annual cost based on complete data ( n = 8) was £5511, and the weighted mean annual cost was £5620. The importance of this study is twofold. First, it provides substantive new information for health and social care planning of conservative management by demonstrating where demand exists for services, in both the United Kingdom and other countries with a comparable health service structure. Second, methodologically, it indicates that it is feasible to collect service use data directly from this patient population.

A Health Services Research Agenda for Bariatric Surgery Within the Veterans Health Administration.

PubMed

Funk, L M; Gunnar, W; Dominitz, J A; Eisenberg, D; Frayne, S; Maggard-Gibbons, M; Kalarchian, M A; Livingston, E; Sanchez, V; Smith, B R; Weidenbacher, H; Maciejewski, Matthew L

2017-04-01

In 2016, the Veterans Health Administration (VHA) held a Weight Management State of the Art conference to identify evidence gaps and develop a research agenda for population-based weight management for veterans. Included were behavioral, pharmacologic, and bariatric surgery workgroups. This article summarizes the bariatric surgery workgroup (BSWG) findings and recommendations for future research. The BSWG agreed that there is evidence from randomized trials and large observational studies suggesting that bariatric surgery is superior to medical therapy for short- and intermediate-term remission of type 2 diabetes, long-term weight loss, and long-term survival. Priority evidence gaps include long-term comorbidity remission, mental health, substance abuse, and health care costs. Evidence of the role of endoscopic weight loss options is also lacking. The BSWG also noted the limited evidence regarding optimal timing for bariatric surgery referral, barriers to bariatric surgery itself, and management of high-risk bariatric surgery patients. Clinical trials of pre- and post-surgery interventions may help to optimize patient outcomes. A registry of overweight and obese veterans and a workforce assessment to determine the VHA's capacity to increase bariatric surgery access were recommended. These will help inform policy modifications and focus the research agenda to improve the ability of the VHA to deliver population-based weight management.

Obesity evaluation and treatment: Expert Committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services.

PubMed

Barlow, S E; Dietz, W H

1998-09-01

The development of recommendations for physicians, nurse practitioners, and nutritionists to guide the evaluation and treatment of overweight children and adolescents. The Maternal and Child Health Bureau, Health Resources and Services Administration, the Department of Health and Human Services convened a committee of pediatric obesity experts to develop the recommendations. The Committee recommended that children with a body mass index (BMI) greater than or equal to the 85th percentile with complications of obesity or with a BMI greater than or equal to the 95th percentile, with or without complications, undergo evaluation and possible treatment. Clinicians should be aware of signs of the rare exogenous causes of obesity, including genetic syndromes, endocrinologic diseases, and psychologic disorders. They should screen for complications of obesity, including hypertension, dyslipidemias, orthopedic disorders, sleep disorders, gall bladder disease, and insulin resistance. Conditions that indicate consultation with a pediatric obesity specialist include pseudotumor cerebri, obesity-related sleep disorders, orthopedic problems, massive obesity, and obesity in children younger than 2 years of age. Recommendations for treatment evaluation included an assessment of patient and family readiness to engage in a weight-management program and a focused assessment of diet and physical activity habits. The primary goal of obesity therapy should be healthy eating and activity. The use of weight maintenance versus weight loss to achieve weight goals depends on each patient's age, baseline BMI percentile, and presence of medical complications. The Committee recommended treatment that begins early, involves the family, and institutes permanent changes in a stepwise manner. Parenting skills are the foundation for successful intervention that puts in place gradual, targeted increases in activity and targeted reductions in high-fat, high-calorie foods. Ongoing support for families after the initial weight-management program will help families maintain their new behaviors. These recommendations provide practical guidance to pediatric clinicians who evaluate and treat overweight children.

Prediction of a service demand using combined forecasting approach

NASA Astrophysics Data System (ADS)

Zhou, Ling

2017-08-01

Forecasting facilitates cutting down operational and management costs while ensuring service level for a logistics service provider. Our case study here is to investigate how to forecast short-term logistic demand for a LTL carrier. Combined approach depends on several forecasting methods simultaneously, instead of a single method. It can offset the weakness of a forecasting method with the strength of another, which could improve the precision performance of prediction. Main issues of combined forecast modeling are how to select methods for combination, and how to find out weight coefficients among methods. The principles of method selection include that each method should apply to the problem of forecasting itself, also methods should differ in categorical feature as much as possible. Based on these principles, exponential smoothing, ARIMA and Neural Network are chosen to form the combined approach. Besides, least square technique is employed to settle the optimal weight coefficients among forecasting methods. Simulation results show the advantage of combined approach over the three single methods. The work done in the paper helps manager to select prediction method in practice.

Assessing the service quality of Iran military hospitals: Joint Commission International standards and Analytic Hierarchy Process (AHP) technique

PubMed Central

Bahadori, Mohammadkarim; Ravangard, Ramin; Yaghoubi, Maryam; Alimohammadzadeh, Khalil

2014-01-01

Background: Military hospitals are responsible for preserving, restoring and improving the health of not only armed forces, but also other people. According to the military organizations strategy, which is being a leader and pioneer in all areas, providing quality health services is one of the main goals of the military health care organizations. This study was aimed to evaluate the service quality of selected military hospitals in Iran based on the Joint Commission International (JCI) standards and comparing these hospitals with each other and ranking them using the analytic hierarchy process (AHP) technique in 2013. Materials and Methods: This was a cross-sectional and descriptive study conducted on five military hospitals, selected using the purposive sampling method, in 2013. Required data collected using checklists of accreditation standards and nominal group technique. AHP technique was used for prioritizing. Furthermore, Expert Choice 11.0 was used to analyze the collected data. Results: Among JCI standards, the standards of access to care and continuity of care (weight = 0.122), quality improvement and patient safety (weight = 0.121) and leadership and management (weight = 0.117) had the greatest importance, respectively. Furthermore, in the overall ranking, BGT (weight = 0.369), IHM (0.238), SAU (0.202), IHK (weight = 0.125) and SAB (weight = 0.066) ranked first to fifth, respectively. Conclusion: AHP is an appropriate technique for measuring the overall performance of hospitals and their quality of services. It is a holistic approach that takes all hospital processes into consideration. The results of the present study can be used to improve hospitals performance through identifying areas, which are in need of focus for quality improvement and selecting strategies to improve service quality. PMID:25250364

Regional scale prioritisation for key ecosystem services, renewable energy production and urban development.

PubMed

Casalegno, Stefano; Bennie, Jonathan J; Inger, Richard; Gaston, Kevin J

2014-01-01

Although the importance of addressing ecosystem service benefits in regional land use planning and decision-making is evident, substantial practical challenges remain. In particular, methods to identify priority areas for the provision of key ecosystem services and other environmental services (benefits from the environment not directly linked to the function of ecosystems) need to be developed. Priority areas are locations which provide disproportionally high benefits from one or more service. Here we map a set of ecosystem and environmental services and delineate priority areas according to different scenarios. Each scenario is produced by a set of weightings allocated to different services and corresponds to different landscape management strategies which decision makers could undertake. Using the county of Cornwall, U.K., as a case study, we processed gridded maps of key ecosystem services and environmental services, including renewable energy production and urban development. We explored their spatial distribution patterns and their spatial covariance and spatial stationarity within the region. Finally we applied a complementarity-based priority ranking algorithm (zonation) using different weighting schemes. Our conclusions are that (i) there are two main patterns of service distribution in this region, clustered services (including agriculture, carbon stocks, urban development and plant production) and dispersed services (including cultural services, energy production and floods mitigation); (ii) more than half of the services are spatially correlated and there is high non-stationarity in the spatial covariance between services; and (iii) it is important to consider both ecosystem services and other environmental services in identifying priority areas. Different weighting schemes provoke drastic changes in the delineation of priority areas and therefore decision making processes need to carefully consider the relative values attributed to different services.

Regional Scale Prioritisation for Key Ecosystem Services, Renewable Energy Production and Urban Development

PubMed Central

Casalegno, Stefano; Bennie, Jonathan J.; Inger, Richard; Gaston, Kevin J.

2014-01-01

Although the importance of addressing ecosystem service benefits in regional land use planning and decision-making is evident, substantial practical challenges remain. In particular, methods to identify priority areas for the provision of key ecosystem services and other environmental services (benefits from the environment not directly linked to the function of ecosystems) need to be developed. Priority areas are locations which provide disproportionally high benefits from one or more service. Here we map a set of ecosystem and environmental services and delineate priority areas according to different scenarios. Each scenario is produced by a set of weightings allocated to different services and corresponds to different landscape management strategies which decision makers could undertake. Using the county of Cornwall, U.K., as a case study, we processed gridded maps of key ecosystem services and environmental services, including renewable energy production and urban development. We explored their spatial distribution patterns and their spatial covariance and spatial stationarity within the region. Finally we applied a complementarity-based priority ranking algorithm (zonation) using different weighting schemes. Our conclusions are that (i) there are two main patterns of service distribution in this region, clustered services (including agriculture, carbon stocks, urban development and plant production) and dispersed services (including cultural services, energy production and floods mitigation); (ii) more than half of the services are spatially correlated and there is high non-stationarity in the spatial covariance between services; and (iii) it is important to consider both ecosystem services and other environmental services in identifying priority areas. Different weighting schemes provoke drastic changes in the delineation of priority areas and therefore decision making processes need to carefully consider the relative values attributed to different services. PMID:25250775

Air Quality Management Using Pollution Prevention: A Joint Service Approach

DTIC Science & Technology

1998-03-01

sites to promote polymerization. High solids coatings may be one or two component systems based on acrylic , alkyd , epoxy, polyester, or urethane...formulation to form high molecular weight polymers. Examples include acrylic , epoxy/polyester hybrid , functional epoxy, thin film epoxy, and urethane...Air Human System Center (HSC/OEBQ) Naval Facilities Engineering Service Center (NFESC) 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 9

Bariatric amputee: A growing problem?

PubMed

Kulkarni, Jai; Hannett, Dominic P; Purcell, Steven

2015-06-01

This study reviewed prevalence of patients with lower limb amputations with above normal weight profile, with body mass index over 25, in seven disablement services centres managing their amputee rehabilitation in the United Kingdom. To review two clinical standards of practice in amputee rehabilitation. Ambulant lower limb amputees should have their body weight recorded on an electronic information system, with identification of cohort with body weight >100 kg. Lower limb amputees to be provided with suitable weight-rated prosthesis. Observational study of clinical practice. Data were collected from the Clinical Information Management Systems. Inclusion criteria--subjects were ambulant prosthetic users with some prosthetic intervention in the last 5 years and had at least one lower limb amputation. In 96% of patients, the weight record profile was maintained. In addition, 86% were under 100 kg, which is the most common weight limit of prosthetic componentry. Of 15,204 amputation levels, there were 1830 transfemoral and transtibial sites in users with body weight over 100 kg. In 60 cases, the prosthetic limb build was rated to be below the user body weight. In 96% of our patients, body weight was documented, and in 97%, the prosthetic limb builds were within stated body weight limits, but this may not be the case in all the other disablement services centres in the United Kingdom. Also, the incidence of obesity in the United Kingdom is a growing problem, and the health issues associated with obesity are further compounded in the amputee population. Prosthetic componentry has distinct weight limits which must be considered during prescription. As people with amputation approach the limits of specific components, clinicians are faced with the challenge of continued provision in a safe and suitable manner. This article reviews the amputee population and the current national profile to consider trends in provision and the incidence of these challenges. © The International Society for Prosthetics and Orthotics 2014.

Examining Factors of Engagement With Digital Interventions for Weight Management: Rapid Review

PubMed Central

2017-01-01

Background Digital interventions for weight management provide a unique opportunity to target daily lifestyle choices and eating behaviors over a sustained period of time. However, recent evidence has demonstrated a lack of user engagement with digital health interventions, impacting on the levels of intervention effectiveness. Thus, it is critical to identify the factors that may facilitate user engagement with digital health interventions to encourage behavior change and weight management. Objective The aim of this study was to identify and synthesize the available evidence to gain insights about users’ perspectives on factors that affect engagement with digital interventions for weight management. Methods A rapid review methodology was adopted. The search strategy was executed in the following databases: Web of Science, PsycINFO, and PubMed. Studies were eligible for inclusion if they investigated users’ engagement with a digital weight management intervention and were published from 2000 onwards. A narrative synthesis of data was performed on all included studies. Results A total of 11 studies were included in the review. The studies were qualitative, mixed-methods, or randomized controlled trials. Some of the studies explored features influencing engagement when using a Web-based digital intervention, others specifically explored engagement when accessing a mobile phone app, and some looked at engagement after text message (short message service, SMS) reminders. Factors influencing engagement with digital weight management interventions were found to be both user-related (eg, perceived health benefits) and digital intervention–related (eg, ease of use and the provision of personalized information). Conclusions The findings highlight the importance of incorporating user perspectives during the digital intervention development process to encourage engagement. The review contributes to our understanding of what facilitates user engagement and points toward a coproduction approach for developing digital interventions for weight management. Particularly, it highlights the importance of thinking about user-related and digital tool–related factors from the very early stages of the intervention development process. PMID:29061557

Why I eat at night: A qualitative exploration of the development, maintenance and consequences of Night Eating Syndrome.

PubMed

Shillito, James A; Lea, James; Tierney, Stephanie; Cleator, Jacqueline; Tai, Sara; Wilding, John P H

2018-06-01

Night Eating Syndrome (NES), as a diagnosis, presents as a combination of disordered eating, sleep and mood. Patients identified as having both NES and obesity demonstrate poorer outcomes in terms of weight loss compared to those with NES only. However, research focusing on psychological factors associated with NES remains relatively underdeveloped. This study aimed to explore the relationship between NES and the experience of emotion from the perspective of patients accessing a weight management service. Ten adults who met diagnostic criteria for moderate or full NES took part in a semi-structured interview. Data were analysed using a constructivist approach to grounded theory. A core concept to emerge from the analysis was termed 'emotional hunger'; reflecting an urge or need to satiate a set of underlying unmet emotional needs. It was underpinned by the following interrelated themes: (1) Cultivating a dependency on food; (2) Relying on food to regulate emotions; (3) Understanding the significance of night-time; (4) Acknowledging the consequences of night eating. This study provides an in-depth understanding of the relationship between NES and the experience of emotion from the perspective of patients attending a weight management service. Results have potential to inform future service development, particularly around the adoption of a more holistic approach to night eating behaviours. Copyright © 2018 Elsevier Ltd. All rights reserved.

Chip-set for quality of service support in passive optical networks

NASA Astrophysics Data System (ADS)

Ringoot, Edwin; Hoebeke, Rudy; Slabbinck, B. Hans; Verhaert, Michel

1998-10-01

In this paper the design of a chip-set for QoS provisioning in ATM-based Passive Optical Networks is discussed. The implementation of a general-purpose switch chip on the Optical Network Unit is presented, with focus on the design of the cell scheduling and buffer management logic. The cell scheduling logic supports `colored' grants, priority jumping and weighted round-robin scheduling. The switch chip offers powerful buffer management capabilities enabling the efficient support of GFR and UBR services. Multicast forwarding is also supported. In addition, the architecture of a MAC controller chip developed for a SuperPON access network is introduced. In particular, the permit scheduling logic and its implementation on the Optical Line Termination will be discussed. The chip-set enables the efficient support of services with different service requirements on the SuperPON. The permit scheduling logic built into the MAC controller chip in combination with the cell scheduling and buffer management capabilities of the switch chip can be used by network operators to offer guaranteed service performance to delay sensitive services, and to efficiently and fairly distribute any spare capacity to delay insensitive services.

Weight-Related Goal Setting in a Telephone-Based Preventive Health-Coaching Program: Demonstration of Effectiveness.

PubMed

O'Hara, Blythe J; Gale, Joanne; McGill, Bronwyn; Bauman, Adrian; Hebden, Lana; Allman-Farinelli, Margaret; Maxwell, Michelle; Phongsavan, Philayrath

2017-11-01

This study investigated whether participants in a 6-month telephone-based coaching program, who set physical activity, nutrition, and weight loss goals had better outcomes in these domains. Quasi-experimental design. The Australian Get Healthy Information and Coaching Service (GHS), a free population-wide telephone health-coaching service that includes goal setting as a key component of its coaching program. Consenting GHS coaching participants who had completed coaching between February 2009 and December 2012 (n = 4108). At baseline, participants select a goal for the coaching program, and sociodemographic variables are collected. Self-reported weight, height, waist circumference, physical activity, and nutrition-related behaviors are assessed at baseline and 6 months. Descriptive analysis was performed on key sociodemographic variables, and the relationship between goal type and change in health outcomes was assessed using a series of linear mixed models that modeled change from baseline to 6 months. Participants who set goals in relation to weight management and physical activity achieved better results in these areas than those who set alternate goals, losing more than those who set alternate goals (1.5 kg and 0.9 cm in waist circumference) and increasing walking per week (40 minutes), respectively. There was no difference in food-related outcomes for those that set nutrition-related goals. Goal setting for weight management and increasing physical activity in the overweight and obese population, undertaken in a telephone-based coaching program, can be effective.

Investigating DRG cost weights for hospitals in middle income countries.

PubMed

Ghaffari, Shahram; Doran, Christopher; Wilson, Andrew; Aisbett, Chris; Jackson, Terri

2009-01-01

Identifying the cost of hospital outputs, particularly acute inpatients measured by Diagnosis Related Groups (DRGs), is an important component of casemix implementation. Measuring the relative costliness of specific DRGs is useful for a wide range of policy and planning applications. Estimating the relative use of resources per DRG can be done through different costing approaches depending on availability of information and time and budget. This study aims to guide costing efforts in Iran and other countries in the region that are pursuing casemix funding, through identifying the main issues facing cost finding approaches and introducing the costing models compatible with their hospitals accounting and management structures. The results show that inadequate financial and utilisation information at the patient's level, poorly computerized 'feeder systems'; and low quality data make it impossible to estimate reliable DRGs costs through clinical costing. A cost modelling approach estimates the average cost of 2.723 million Rials (Iranian Currency) per DRG. Using standard linear regression, a coefficient of 0.14 (CI = 0.12-0.16) suggests that the average cost weight increases by 14% for every one-day increase in average length of stay (LOS).We concluded that calculation of DRG cost weights (CWs) using Australian service weights provides a sensible starting place for DRG-based hospital management; but restructuring hospital accounting systems, designing computerized feeder systems, using appropriate software, and development of national service weights that reflect local practice patterns will enhance the accuracy of DRG CWs.

Towards reframing health service delivery in Uganda: the Uganda Initiative for Integrated Management of Non-Communicable Diseases.

PubMed

Schwartz, Jeremy I; Dunkle, Ashley; Akiteng, Ann R; Birabwa-Male, Doreen; Kagimu, Richard; Mondo, Charles K; Mutungi, Gerald; Rabin, Tracy L; Skonieczny, Michael; Sykes, Jamila; Mayanja-Kizza, Harriet

2015-01-01

The burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is accelerating. Given that the capacity of health systems in LMICs is already strained by the weight of communicable diseases, these countries find themselves facing a double burden of disease. NCDs contribute significantly to morbidity and mortality, thereby playing a major role in the cycle of poverty, and impeding development. Integrated approaches to health service delivery and healthcare worker (HCW) training will be necessary in order to successfully combat the great challenge posed by NCDs. In 2013, we formed the Uganda Initiative for Integrated Management of NCDs (UINCD), a multidisciplinary research collaboration that aims to present a systems approach to integrated management of chronic disease prevention, care, and the training of HCWs. Through broad-based stakeholder engagement, catalytic partnerships, and a collective vision, UINCD is working to reframe integrated health service delivery in Uganda.

A systematic review and meta-analysis of interventions for weight management using text messaging.

PubMed

Siopis, G; Chey, T; Allman-Farinelli, M

2015-02-01

Obesity prevalence continues to increase worldwide, with significant associated chronic disease and health cost implications. Among more recent innovations in health service provision is the use of text messaging for health behaviour change interventions including weight management. This review investigates the efficacy of weight management programmes incorporating text messaging. Medical and scientific databases were searched from January 1993 to October 2013. Eligibility criteria included randomised controlled trials (RCTs), pseudoRCTs and before and after studies of weight management, among healthy children and adults, that used text messaging and included a nutrition component. Data extraction and quality assessment followed guidelines from PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and the Evidence Analysis Manual of the American Academy of Nutrition and Dietetics. From 512 manuscripts retrieved, 14 met the inclusion criteria (five manuscripts in children and nine in adults). Duration of interventions ranged from 1 to 24 months. Frequency of text messaging was from daily to fortnightly. Six studies in adults were included in a meta-analysis with mean body weight change as the primary outcome. The weighted mean change in body weight in intervention participants was -2.56 kg (95% confidence interval = -3.46 to -1.65) and in controls -0.37 kg (95% confidence interval = -1.22 to 0.48). The small body of evidence indicates that text messaging interventions can promote weight loss. However, lack of long-term results indicate that further efficacy studies are required. Future investigations should elucidate the determinants, such as intervention duration, text message frequency and level of interactivity that maximise the success and cost effectiveness of the delivery medium. © 2014 The British Dietetic Association Ltd.

Australian GPs' perceptions about child and adolescent overweight and obesity the Weight of Opinion study

PubMed Central

King, Lesley A; Loss, Julika HM; Wilkenfeld, Rachel L; Pagnini, Deanna L; Booth, Michael L; Booth, Susan L

2007-01-01

Background GPs can potentially play a significant role in assessing weight status, providing advice, and making referrals to address overweight and obesity and its consequences among children and adolescents. Aim To investigate the perceptions of GPs about overweight and obesity in children and adolescents, including the extent to which they perceive it as a concern, the factors they see as causal, what actions they consider might be needed, and their sense of responsibility and self-efficacy. Design of study A cross-sectional qualitative study of GPs' perceptions. Setting General practice and primary health care services in the state of New South Wales, Australia. Method Focus groups using a structured protocol were conducted with samples of GPs. Groups comprised a mix of male and female GPs from a range of cultural backgrounds and working in practices in low, medium and high socioeconomic areas. Data were recorded and transcribed. Content analysis was used to identify key themes. Results Many GPs are concerned about the increasing prevalence of childhood overweight and obesity. They are committed to dealing with the medical consequences, but are aware of the broad range of social causes. GPs perceived that parents are sensitive about this topic, making it difficult for them to raise the issue directly in clinical practice, unless they use lateral strategies. GPs were confident about providing advice, with some managing the problem independently, while others preferred to refer to specialised services. GPs perceived that there were significant barriers to patient compliance with advice. Conclusion Whereas some GPs manage patients' lifestyle change directly, including children's weight management, others prefer to refer. Programmes, service delivery systems, and resources to support both approaches are required. PMID:17263929

Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study

PubMed Central

2011-01-01

Background Primary care providers play an important role in preventing and managing cardiovascular disease. This study compared the quality of preventive cardiovascular care delivery amongst different primary care models. Methods This is a secondary analysis of a larger randomized control trial, known as the Improved Delivery of Cardiovascular Care (IDOCC) through Outreach Facilitation. Using baseline data collected through IDOCC, we conducted a cross-sectional study of 82 primary care practices from three delivery models in Eastern Ontario, Canada: 43 fee-for-service, 27 blended-capitation and 12 community health centres with salary-based physicians. Medical chart audits from 4,808 patients with or at high risk of developing cardiovascular disease were used to examine each practice's adherence to ten evidence-based processes of care for diabetes, chronic kidney disease, dyslipidemia, hypertension, weight management, and smoking cessation care. Generalized estimating equation models adjusting for age, sex, rurality, number of cardiovascular-related comorbidities, and year of data collection were used to compare guideline adherence amongst the three models. Results The percentage of patients with diabetes that received two hemoglobin A1c tests during the study year was significantly higher in community health centres (69%) than in fee-for-service (45%) practices (Adjusted Odds Ratio (AOR) = 2.4 [95% CI 1.4-4.2], p = 0.001). Blended capitation practices had a significantly higher percentage of patients who had their waistlines monitored than in fee-for-service practices (19% vs. 5%, AOR = 3.7 [1.8-7.8], p = 0.0006), and who were recommended a smoking cessation drug when compared to community health centres (33% vs. 16%, AOR = 2.4 [1.3-4.6], p = 0.007). Overall, quality of diabetes care was higher in community health centres, while smoking cessation care and weight management was higher in the blended-capitation models. Fee-for-service practices had the greatest gaps in care, most noticeably in diabetes care and weight management. Conclusions This study adds to the evidence suggesting that primary care delivery model impacts quality of care. These findings support current Ontario reforms to move away from the traditional fee-for-service practice. Trial Registration ClinicalTrials.gov: NCT00574808 PMID:22008366

The Proposal of Key Performance Indicators in Facility Management and Determination the Weights of Significance

NASA Astrophysics Data System (ADS)

Rimbalová, Jarmila; Vilčeková, Silvia

2013-11-01

The practice of facilities management is rapidly evolving with the increasing interest in the discourse of sustainable development. The industry and its market are forecasted to develop to include non-core functions, activities traditionally not associated with this profession, but which are increasingly being addressed by facilities managers. The scale of growth in the built environment and the consequential growth of the facility management sector is anticipated to be enormous. Key Performance Indicators (KPI) are measure that provides essential information about performance of facility services delivery. In selecting KPI, it is critical to limit them to those factors that are essential to the organization reaching its goals. It is also important to keep the number of KPI small just to keep everyone's attention focused on achieving the same KPIs. This paper deals with the determination of weights of KPI of FM in terms of the design and use of sustainable buildings.

NICE-Accredited Commissioning Guidance for Weight Assessment and Management Clinics: a Model for a Specialist Multidisciplinary Team Approach for People with Severe Obesity.

PubMed

Welbourn, Richard; Dixon, John; Barth, Julian H; Finer, Nicholas; Hughes, Carly A; le Roux, Carel W; Wass, John

2016-03-01

Despite increasing prevalence of obesity, no country has successfully implemented comprehensive pathways to provide advice to all the severely obese patients that seek treatment. We aimed to formulate pathways for referral into and out of weight assessment and management clinics (WAMCs) that include internal medicine/primary care physicians as part of a multidisciplinary team that could provide specialist advice and interventions, including referral for bariatric surgery. Using a National Institute of Health and Care Excellence (NICE)-accredited process, a Guidance Development Group conducted a literature search identifying existing WAMCs. As very few examples of effective structures and clinical pathways existed, the current evidence base for optimal assessment and management of bariatric surgery patients was used to reach a consensus. The model we describe could be adopted internationally by health services to manage severely obese patients.

The importance of service-users' perspectives: A systematic review of qualitative evidence reveals overlooked critical features of weight management programmes.

PubMed

Sutcliffe, Katy; Melendez-Torres, G J; Burchett, Helen E D; Richardson, Michelle; Rees, Rebecca; Thomas, James

2018-03-14

Extensive research effort shows that weight management programmes (WMPs) targeting both diet and exercise are broadly effective. However, the critical features of WMPs remain unclear. To develop a deeper understanding of WMPs critical features, we undertook a systematic review of qualitative evidence. We sought to understand from a service-user perspective how programmes are experienced, and may be effective, on the ground. We identified qualitative studies from existing reviews and updated the searches of one review. We included UK studies capturing the views of adult WMP users. Thematic analysis was used inductively to code and synthesize the evidence. Service users were emphatic that supportive relationships, with service providers or WMP peers, are the most critical aspect of WMPs. Supportive relationships were described as providing an extrinsic motivator or "hook" which helped to overcome barriers such as scepticism about dietary advice or a lack confidence to engage in physical activity. The evidence revealed that service-users' understandings of the critical features of WMPs differ from the focus of health promotion guidance or descriptions of evaluated programmes which largely emphasize educational or goal setting aspects of WMPs. Existing programme guidance may not therefore fully address the needs of service users. The study illustrates that the perspectives of service users can reveal unanticipated intervention mechanisms or underemphasized critical features and underscores the value of a holistic understanding about "what happens" in complex psychosocial interventions such as WMPs. © 2017 The Authors Health Expectations published by John Wiley & Sons Ltd.

Obesity Treatment in the UK Health System.

PubMed

Capehorn, Matthew S; Haslam, David W; Welbourn, Richard

2016-09-01

In the UK, as in most other countries in the world, levels of obesity are increasing. According to the Kinsey report, obesity has the second largest public health impact after smoking, and it is inextricably linked to physical inactivity. Since the UK Health and Social Care Act reforms of 2012, there has been a significant restructuring of the National Health Service (NHS). As a consequence, NHS England and the Department of Health have issued new policy guidelines regarding the commissioning of obesity treatment. A 4-tier model of care is now widely accepted and ranges from primary activity, through community weight management and specialist weight management for severe and complex obesity, to bariatric surgery. However, although there are clear care pathways and clinical guidelines for evidence-based practice, there remains no single stakeholder willing to take overall responsibility for obesity care. There is a lack of provision of adequate services characterised by a noticeable 'postcode lottery', and little political will to change the obesogenic environment.

Prospective association between body mass index and receipt of preventive services: Results from the Central Pennsylvania Women’s Health Study (CePAWHS)

PubMed Central

Kraschnewski, Jennifer L.; McCall-Hosenfeld, Jennifer S.; Weisman, Carol S.

2012-01-01

Objective We examine whether overweight and obesity are associated with disparities in clinical preventive services receipt in a unique, prospective, population-based cohort of reproductive-age women. Method We used data from the Central Pennsylvania Women’s Health Study (CePAWHS) longitudinal survey of women ages 18–45. The baseline random-digit-dial telephone survey was conducted in 2004–2005 and a second telephone interview two years later; 1342 participants comprised the analytic sample. Dependent variables were seven preventive services identified at follow-up. In addition to baseline body mass index (BMI) category, independent variables were selected based on the behavioral model of health services utilization. Results Forty-six percent of the sample was classified as normal weight, 28% as overweight, and 26% as obese. In adjusted analyses, women who were overweight and obese, compared to women with normal weight, were more likely to receive preventive counseling for diet/nutrition, physical activity, and weight management (p<0.01). Overweight and obese women received more cholesterol and diabetes screening (p<0.05 and p<0.01, respectively). However, there were no differences by BMI category in receipt of Pap testing or reproductive counseling. Conclusion Overall, we found that women with overweight and obesity were more likely to receive preventive services, especially services relevant for overweight and obese populations. PMID:22391575

How Pregnant African-American Women View Pregnancy Weight Gain

PubMed Central

Groth, Susan W.; Morrison-Beedy, Dianne; Meng, Ying

2012-01-01

Objective To gain insight into how low-income, pregnant African-American women viewed their weight gain while pregnant and how they managed their weight during pregnancy. Design Descriptive study using three focus groups. Setting Women were recruited from urban prenatal care sites and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) services in a medium-sized urban Northeastern city. Participants Twenty-six adult, low-income, pregnant African-American women, aged 18–39; the majority were within the first 20 weeks of pregnancy. Methods Three focus groups were conducted utilizing open-ended questions related to pregnancy weight gain. Content analysis was used to analyze the verbatim transcripts. Analysis focused on meaning, intention and context. Groups were compared and contrasted at the within and between group levels to identify themes. Results Four themes were identified that provided insight into how women viewed their pregnancy weight gain and managed weight gain during pregnancy: (a) pregnancy weight gain: no matter how much means a healthy baby; (b) weight retention: it happens; (c) there is a limit: weight gain impact on appearance; and (d) watching and waiting: plans for controlling weight. Conclusion Low-income African-American women, though cognizant of the likelihood of retention of weight following pregnancy, are not focused on limiting their gestational weight gain. The cultural acceptance of a larger body size along with the belief that gaining more weight is indicative of a healthy infant present challenges for interventions to limit excessive gestational weight gain. PMID:22789036

Doctor Referral of Overweight People to a Low-Energy Treatment (DROPLET) in primary care using total diet replacement products: a protocol for a randomised controlled trial.

PubMed

Jebb, Susan A; Astbury, Nerys M; Tearne, Sarah; Nickless, Alecia; Aveyard, Paul

2017-08-04

The global prevalence of obesity has risen significantly in recent decades. There is a pressing need to identify effective interventions to treat established obesity that can be delivered at scale. The aim of the Doctor Referral of Overweight People to a Low-Energy Treatment (DROPLET) study is to determine the clinical effectiveness, feasibility and acceptability of referral to a low-energy total diet replacement programme compared with usual weight management interventions in primary care. The DROPLET trial is a randomised controlled trial comparing a low-energy total diet replacement programme with usual weight management interventions delivered in primary care. Eligible patients will be recruited through primary care registers and randomised to receive a behavioural support programme delivered by their practice nurse or a referral to a commercial provider offering an initial 810 kcal/d low-energy total diet replacement programme for 8 weeks, followed by gradual food reintroduction, along with weekly behavioural support for 24 weeks. The primary outcome is weight change at 12 months. The secondary outcomes are weight change at 3 and 6 months, the proportion of participants achieving 5% and 10% weight loss at 12 months, and change in fat mass, haemoglobin A1c, low-density lipoprotein cholesterol and systolic and diastolic blood pressure at 12 months. Data will be analysed on the basis of intention to treat. Qualitative interviews on a subsample of patients and healthcare providers will assess their experiences of the weight loss programmes and identify factors affecting acceptability and adherence. This study has been reviewed and approved by the National Health ServiceHealth Research Authority (HRA)Research Ethics Committee (Ref: SC/15/0337). The trial findings will be disseminated to academic and health professionals through presentations at meetings and peer-reviewed journals and to the public through the media. If the intervention is effective, the results will be communicated to policymakers and commissioners of weight management services. ISRCTN75092026. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Learning and adaptation in the management of waterfowl harvests

USGS Publications Warehouse

Johnson, Fred A.

2011-01-01

A formal framework for the adaptive management of waterfowl harvests was adopted by the U.S. Fish and Wildlife Service in 1995. The process admits competing models of waterfowl population dynamics and harvest impacts, and relies on model averaging to compute optimal strategies for regulating harvest. Model weights, reflecting the relative ability of the alternative models to predict changes in population size, are used in the model averaging and are updated each year based on a comparison of model predictions and observations of population size. Since its inception the adaptive harvest program has focused principally on mallards (Anas platyrhynchos), which constitute a large portion of the U.S. waterfowl harvest. Four competing models, derived from a combination of two survival and two reproductive hypotheses, were originally assigned equal weights. In the last year of available information (2007), model weights favored the weakly density-dependent reproductive hypothesis over the strongly density-dependent one, and the additive mortality hypothesis over the compensatory one. The change in model weights led to a more conservative harvesting policy than what was in effect in the early years of the program. Adaptive harvest management has been successful in many ways, but nonetheless has exposed the difficulties in defining management objectives, in predicting and regulating harvests, and in coping with the tradeoffs inherent in managing multiple waterfowl stocks exposed to a common harvest. The key challenge now facing managers is whether adaptive harvest management as an institution can be sufficiently adaptive, and whether the knowledge and experience gained from the process can be reflected in higher-level policy decisions.

21 CFR 520.1616 - Orbifloxacin tablets.

Code of Federal Regulations, 2011 CFR

2011-04-01

... kilogram body weight once daily. (2) Indications for use. For management of diseases associated with... 21 Food and Drugs 6 2011-04-01 2011-04-01 false Orbifloxacin tablets. 520.1616 Section 520.1616 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL...

21 CFR 520.1616 - Orbifloxacin tablets.

Code of Federal Regulations, 2013 CFR

2013-04-01

... kilogram body weight once daily. (2) Indications for use. For management of diseases associated with... 21 Food and Drugs 6 2013-04-01 2013-04-01 false Orbifloxacin tablets. 520.1616 Section 520.1616 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL...

21 CFR 520.1616 - Orbifloxacin tablets.

Code of Federal Regulations, 2012 CFR

2012-04-01

... kilogram body weight once daily. (2) Indications for use. For management of diseases associated with... 21 Food and Drugs 6 2012-04-01 2012-04-01 false Orbifloxacin tablets. 520.1616 Section 520.1616 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL...

21 CFR 520.1616 - Orbifloxacin tablets.

Code of Federal Regulations, 2014 CFR

2014-04-01

... kilogram body weight once daily. (2) Indications for use. For management of diseases associated with... 21 Food and Drugs 6 2014-04-01 2014-04-01 false Orbifloxacin tablets. 520.1616 Section 520.1616 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL...

21 CFR 520.1616 - Orbifloxacin.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Orbifloxacin. 520.1616 Section 520.1616 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL DRUGS... kilogram body weight once daily. (2) Indications for use. For management of diseases associated with...

48 CFR 1615.404-4 - Profit.

Code of Federal Regulations, 2011 CFR

2011-10-01

... contracts by use of a weighted guidelines structured approach. The service charge so determined will be the... 1615.404-4 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES... Contract Pricing 1615.404-4 Profit. (a) When the pricing of FEHB Program contracts is determined by cost...

48 CFR 1615.404-4 - Profit.

Code of Federal Regulations, 2010 CFR

2010-10-01

... contracts by use of a weighted guidelines structured approach. The service charge so determined will be the... 1615.404-4 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES... Contract Pricing 1615.404-4 Profit. (a) When the pricing of FEHB Program contracts is determined by cost...

Implementing NICE obesity guidance for staff: an NHS trust audit.

PubMed

Dalton, M B

2015-01-01

The UK National Institute of Health and Clinical Excellence (NICE) has produced guidelines (CG43) on preventing and managing overweight and obesity, which apply to the National Health Service (NHS) as an employer. To record in an NHS trust baseline assessment and management of obesity by its occupational health (OH) service staff, with reference to the standards in CG43, enabling deficiencies to be identified and improvements to be recommended as a benchmark for future measurement. Criteria relevant to OH in CG43 were identified and data were collected from trust policies, interviews with managers, questionnaires to OH staff, examination of OH resources and case notes of staff attending OH. Results were checked for compliance with CG43 standards. Although the trust met NICE standards as an employer, significant lack of compliance was found in its OH service. Only 53% of staff attending medical examinations had weight recorded, OH resources were inadequate and 75% of its staff had received no training. Problems identified included lack of written guidance, time and care pathways. The resulting action plan included a consultant-led working party liaising with the trust's health and well-being committee, training, enhanced OH resources, an obesity protocol, a database and weight management clinics. We found not only a lack of OH policy guidance but apparent inertia in dealing with obesity. The action plan demonstrated how OH clinical practice can draw upon CG43 to combat obesity in an NHS workforce. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Management of pharmaceutical services in the Brazilian primary health care

PubMed Central

Gerlack, Letícia Farias; Karnikowski, Margô Gomes de Oliveira; Areda, Camila Alves; Galato, Dayani; de Oliveira, Aline Gomes; Álvares, Juliana; Leite, Silvana Nair; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Costa, Karen Sarmento; Guerra, Augusto Afonso; Acurcio, Francisco de Assis

2017-01-01

ABSTRACT OBJECTIVE To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS). METHODS This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions. RESULTS We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators. CONCLUSIONS Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening. PMID:29160449

Management of pharmaceutical services in the Brazilian primary health care.

PubMed

Gerlack, Letícia Farias; Karnikowski, Margô Gomes de Oliveira; Areda, Camila Alves; Galato, Dayani; Oliveira, Aline Gomes de; Álvares, Juliana; Leite, Silvana Nair; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Costa, Karen Sarmento; Guerra, Augusto Afonso; Acurcio, Francisco de Assis

2017-11-13

To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS). This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions. We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators. Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening.

75 FR 76282 - Domestic Shipping Services Pricing and Mailing Standards Changes

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-08

... when using a qualifying shipping label managed by the PC Postage system used. b. Permit imprint... system used. b. Permit imprint customers. * * * * * 1.8 Determining Single-Piece Weight [Revise the last... imprint customers. c. Priority Mail Open and Distribute (PMOD) customers whose account volume exceeds 600...

76 FR 65640 - New Standards for Domestic Mailing Services

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-24

...). * * * * * [Revise item 2.2c as follows:] c. Each metered piece must bear full postage at the lowest First- Class... shape, weight, construction, and size to be considered. If the request describes a mailpiece that falls... preparation level (e.g., destination NDC pallets). c. Upon acknowledgement from the manager, Operations...

Community pharmacy-delivered interventions for public health priorities: a systematic review of interventions for alcohol reduction, smoking cessation and weight management, including meta-analysis for smoking cessation

PubMed Central

Brown, Tamara J; Todd, Adam; O'Malley, Claire; Moore, Helen J; Husband, Andrew K; Bambra, Clare; Kasim, Adetayo; Sniehotta, Falko F; Steed, Liz; Smith, Sarah; Nield, Lucie; Summerbell, Carolyn D

2016-01-01

Objectives To systematically review the effectiveness of community pharmacy-delivered interventions for alcohol reduction, smoking cessation and weight management. Design Systematic review and meta-analyses. 10 electronic databases were searched from inception to May 2014. Eligibility criteria for selecting studies Study design: randomised and non-randomised controlled trials; controlled before/after studies, interrupted times series. Intervention: any relevant intervention set in a community pharmacy, delivered by the pharmacy team. No restrictions on duration, country, age, or language. Results 19 studies were included: 2 alcohol reduction, 12 smoking cessation and 5 weight management. Study quality rating: 6 ‘strong’, 4 ‘moderate’ and 9 ‘weak’. 8 studies were conducted in the UK, 4 in the USA, 2 in Australia, 1 each in 5 other countries. Evidence from 2 alcohol-reduction interventions was limited. Behavioural support and/or nicotine replacement therapy are effective and cost-effective for smoking cessation: pooled OR was 2.56 (95% CI 1.45 to 4.53) for active intervention vs usual care. Pharmacy-based interventions produced similar weight loss compared with active interventions in other primary care settings; however, weight loss was not sustained longer term in a range of primary care and commercial settings compared with control. Pharmacy-based weight management interventions have similar provider costs to those delivered in other primary care settings, which are greater than those delivered by commercial organisations. Very few studies explored if and how sociodemographic or socioeconomic variables moderated intervention effects. Insufficient information was available to examine relationships between effectiveness and behaviour change strategies, implementation factors, or organisation and delivery of interventions. Conclusions Community pharmacy-delivered interventions are effective for smoking cessation, and demonstrate that the pharmacy is a feasible option for weight management interventions. Given the potential reach, effectiveness and associated costs of these interventions, commissioners should consider using community pharmacies to help deliver public health services. PMID:26928025

Pragmatic cluster randomised trial of a free telephone-based health coaching program to support women in managing weight gain during pregnancy: the Get Healthy in Pregnancy Trial.

PubMed

Clements, Vanessa; Leung, Kit; Khanal, Santosh; Raymond, Jane; Maxwell, Michelle; Rissel, Chris

2016-08-30

Excessive gestational weight gain can result in poor maternal and child health outcomes. Estimates from single studies indicate the prevalence of excessive gestational weight gain in Australia could lie between 38 and 67 %. The risk of excessive weight gain can be reduced through healthy eating and exercise. We describe the rationale and methods of the Get Healthy in Pregnancy Service, a trial service which aims to support women in achieving appropriate gestational weight gain through an existing telephone-based health coaching service. This study aims to compare the effectiveness of a telephone-based health coaching program versus provision of information only in supporting pregnant women to achieve appropriate gestational weight gain. A pragmatic stratified clustered randomised controlled trial will be conducted with 710 women who present to 5 hospitals for their first antenatal appointment during the recruitment period (6-8 months), have a pre-pregnancy body mass index (BMI) ≥ 18.50 (healthy weight or above), are 18 years and over, singleton gestation, English speaking, have no pre-existing medical conditions that may limit their ability to exercise or require a restricted diet and are 18 weeks or less gestation. Hospitals will be randomised into one of two intervention models: a) information only; or b) information plus 10 telephone-based health coaching sessions with a university qualified coach. Both interventions will set a weight-range target with pregnant women. The women attending antenatal clinics at participating hospitals will be screened at their initial hospital appointment to assess their eligibility. Women recruited to the trial will have a number of measures recorded including anthropometrics (self-reported height and weight) and dietary and physical activity scores during and following pregnancy. These measurements will be collected at baseline (prior to 18 weeks gestation), 36 weeks gestation and 12 months post-birth. This study responds to a need for an effective intervention that targets excessive gestational weight gain at a population level. This study investigates the potential for an innovative intervention combining two existing services; a free state-wide telephone-based health coaching service and hospital-based antenatal care to support pregnant women to achieve healthy weight gain during pregnancy. The use of existing services provides the potential for immediate post-study implementation. While the impacts of telephone-based lifestyle programmes have been tested in a number of settings, there are few studies which evaluate the effectiveness and acceptability of telephone support in achieving healthy gestational weight gain in association with routine antenatal care. ACTRN12615000397516 (Registration date: 26 June 2014, retrospectively registered).

Method Extreme Learning Machine for Forecasting Number of Patients’ Visits in Dental Poli (A Case Study: Community Health Centers Kamal Madura Indonesia)

NASA Astrophysics Data System (ADS)

Sari Rochman, E. M.; Rachmad, A.; Syakur, M. A.; Suzanti, I. O.

2018-01-01

Community Health Centers (Puskesmas) are health service institutions that provide individual health services for outpatient, inpatient and emergency care services. In the outpatient service, there are several polyclinics, including the polyclinic of Ear, Nose, and Throat (ENT), Eyes, Dentistry, Children, and internal disease. Dental Poli is a form of dental and oral health services which is directed to the community. At this moment, the management team in dental poli often has difficulties when they do the preparation and planning to serve a number of patients. It is because the dental poli does not have the appropriate workers with the right qualification. The purpose of this study is to make the system of forecasting the patient’s visit to predict how many patients will come; so that the resources that have been provided will be in accordance with the needs of the Puskesmas. In the ELM method, input and bias weights are initially determined randomly to obtain final weights using Generalized Invers. The matrix used in the final weights is a matrix whose outputs are from each input to a hidden layer. So ELM has a fast learning speed. The result of the experiment of ELM method in this research is able to generate a prediction of a number of patient visit with the RMSE value which is equal to 0.0426.

Application of Analytical Hierarchy Process Approach for Service Quality Evaluation in Radiology Departments: A Cross-Sectional Study.

PubMed

Alimohammadzadeh, Khalil; Bahadori, Mohammadkarim; Hassani, Fariba

2016-01-01

Radiology department as a service provider organization requires realization of quality concept concerning service provisioning knowledge, satisfaction and all issues relating to the customer as well as quality assurance and improvement issues. At present, radiology departments in hospitals are regarded as income generating units and they should continuously seek performance improvement so that they can survive in the changing and competitive environment of the health care sector. The aim of this study was to propose a method for ranking of radiology departments in selected hospitals of Tehran city using analytical hierarchical process (AHP) and quality evaluation of their service in 2015. This study was an applied and cross-sectional study, carried out in radiology departments of 6 Tehran educational hospitals in 2015. The hospitals were selected using non-probability and purposeful method. Data gathering was performed using customized joint commission international (JCI) standards. Expert Choice 10.0 software was used for data analysis. AHP method was used for prioritization. "Management and empowerment of human resources'' (weight = 0.465) and "requirements and facilities" (weight = 0.139) were of highest and lowest significance respectively in the overall ranking of the hospitals. MS (weight = 0.316), MD (weight = 0.259), AT (weight = 0.14), TS (weight = 0.108), MO (weight = 0.095), and LH (0.082) achieved the first to sixth rankings respectively. The use of AHP method can be promising for fostering the evaluation method and subsequently promotion of the efficiency and effectiveness of the radiology departments. The present model can fill in the gap in the accreditation system of the country's hospitals in respect with ranking and comparing them considering the significance and value of each individual criteria and standard. Accordingly, it can predict an integration of qualitative and quantitative criteria involved and thereby take a decisive step towards further efficiency and effectiveness of the health care evaluation systems.

Application of Analytical Hierarchy Process Approach for Service Quality Evaluation in Radiology Departments: A Cross-Sectional Study

PubMed Central

Alimohammadzadeh, Khalil; Bahadori, Mohammadkarim; Hassani, Fariba

2016-01-01

Background: Radiology department as a service provider organization requires realization of quality concept concerning service provisioning knowledge, satisfaction and all issues relating to the customer as well as quality assurance and improvement issues. At present, radiology departments in hospitals are regarded as income generating units and they should continuously seek performance improvement so that they can survive in the changing and competitive environment of the health care sector. Objectives: The aim of this study was to propose a method for ranking of radiology departments in selected hospitals of Tehran city using analytical hierarchical process (AHP) and quality evaluation of their service in 2015. Materials and Methods: This study was an applied and cross-sectional study, carried out in radiology departments of 6 Tehran educational hospitals in 2015. The hospitals were selected using non-probability and purposeful method. Data gathering was performed using customized joint commission international (JCI) standards. Expert Choice 10.0 software was used for data analysis. AHP method was used for prioritization. Results: “Management and empowerment of human resources’’ (weight = 0.465) and “requirements and facilities” (weight = 0.139) were of highest and lowest significance respectively in the overall ranking of the hospitals. MS (weight = 0.316), MD (weight = 0.259), AT (weight = 0.14), TS (weight = 0.108), MO (weight = 0.095), and LH (0.082) achieved the first to sixth rankings respectively. Conclusion: The use of AHP method can be promising for fostering the evaluation method and subsequently promotion of the efficiency and effectiveness of the radiology departments. The present model can fill in the gap in the accreditation system of the country’s hospitals in respect with ranking and comparing them considering the significance and value of each individual criteria and standard. Accordingly, it can predict an integration of qualitative and quantitative criteria involved and thereby take a decisive step towards further efficiency and effectiveness of the health care evaluation systems. PMID:27127577

Towards reframing health service delivery in Uganda: the Uganda Initiative for Integrated Management of Non-Communicable Diseases

PubMed Central

Schwartz, Jeremy I.; Dunkle, Ashley; Akiteng, Ann R.; Birabwa-Male, Doreen; Kagimu, Richard; Mondo, Charles K.; Mutungi, Gerald; Rabin, Tracy L.; Skonieczny, Michael; Sykes, Jamila; Mayanja-Kizza, Harriet

2015-01-01

Background The burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is accelerating. Given that the capacity of health systems in LMICs is already strained by the weight of communicable diseases, these countries find themselves facing a double burden of disease. NCDs contribute significantly to morbidity and mortality, thereby playing a major role in the cycle of poverty, and impeding development. Methods Integrated approaches to health service delivery and healthcare worker (HCW) training will be necessary in order to successfully combat the great challenge posed by NCDs. Results In 2013, we formed the Uganda Initiative for Integrated Management of NCDs (UINCD), a multidisciplinary research collaboration that aims to present a systems approach to integrated management of chronic disease prevention, care, and the training of HCWs. Discussion Through broad-based stakeholder engagement, catalytic partnerships, and a collective vision, UINCD is working to reframe integrated health service delivery in Uganda. PMID:25563451

Attending to physical health in mental health services in Australia: a qualitative study of service users' experiences and expectations.

PubMed

Young, Sarah J; Praskova, Anna; Hayward, Nicky; Patterson, Sue

2017-03-01

Evidence is unequivocal: the premature death of people with severe mental health problems is attributable primarily to cardiovascular disease, and healthcare provided is often suboptimal. With the overarching aim of improving outcomes, policies and guidelines oblige mental health services and psychiatrists to monitor cardio-metabolic health of patients and intervene as appropriate. Practice is highly variable; however, with ongoing debate about resourcing and responsibilities dominated by clinicians who have identified disinterest among patients as influencing practice. Seeking to balance discussion, we posed the question 'what do patients experience and expect of mental health services in relation to their physical health?' To answer it, we interviewed a convenience sample of 40 service users recruited from a mental health service in Australia, early in 2015. Data were analysed using the framework approach. With few regarding themselves as healthy, participants were commonly concerned about side effects of medication, weight and fitness but rarely mentioned tobacco smoking. Participants' accounts reinforce extensive research demonstrating variability in attention to physical health in mental health services. Reports by some participants of comprehensive care are encouraging, but widespread uncertainty about reasons for various assessments and denial of requests for management of medication side effects, including weight gain, gives cause for concern. Although participants in this study wanted to improve their health and health-related quality of life, they acknowledged that their motivation and ability to do so fluctuated with mental health. They expected clinicians to work proactively, especially when symptoms compromised capacity for self-care, and mental health services to provide or enable access to health-promoting interventions. Attention should be given, as a matter of priority, to creating conditions (culture and infrastructure) needed to support sustained attention to physical health within services and, importantly, to full engagement of service users in management of their physical health. © 2016 John Wiley & Sons Ltd.

Development and refinement of the WAItE: a new obesity-specific quality of life measure for adolescents.

PubMed

Oluboyede, Yemi; Hulme, Claire; Hill, Andrew

2017-08-01

Few weight-specific outcome measures, developed specifically for obese and overweight adolescents, exist and none are suitable for the elicitation of utility values used in the assessment of cost effectiveness. The development of a descriptive system for a new weight-specific measure. Qualitative interviews were conducted with 31 treatment-seeking (above normal weight status) and non-treatment-seeking (school sample) adolescents aged 11-18 years, to identify a draft item pool and associated response options. 315 eligible consenting adolescents, aged 11-18 years, enrolled in weight management services and recruited via an online panel, completed two version of a long-list 29-item descriptive system (consisting of frequency and severity response scales). Psychometric assessments and Rasch analysis were applied to the draft 29-item instrument to identify a brief tool containing the best performing items and associated response options. Seven items were selected, for the final item set; all displayed internal consistency, moderate floor effects and the ability to discriminate between weight categories. The assessment of unidimensionality was supported (t test statistic of 0.024, less than the 0.05 threshold value). The Weight-specific Adolescent Instrument for Economic-evaluation focuses on aspects of life affected by weight that are important to adolescents. It has the potential for adding key information to the assessment of weight management interventions aimed at the younger population.

Quantifying the relative contribution of an ecological reserve to conservation objectives

USGS Publications Warehouse

Aagaard, Kevin; Lyons, James E.; Thogmartin, Wayne E.

2017-01-01

Evaluating the role public lands play in meeting conservation goals is an essential step in good governance. We present a tool for comparing the regional contribution of each of a suite of wildlife management units to conservation goals. We use weighted summation (simple additive weighting) to compute a Unit Contribution Index (UCI) based on species richness, population abundance, and a conservation score based on IUCN Red List classified threat levels. We evaluate UCI for a subset of the 729 participating wetlands of the Integrated Waterbird Management and Monitoring (IWMM) Program across U.S. Fish and Wildlife Service Regions 3 (Midwest USA), 4 (Southeast USA), and 5 (Northeast USA). We found that the median across-Region UCI for Region 5 was greater than Regions 3 and 4, while Region 4 had the greatest within-Region UCI median. This index is a powerful tool for wildlife managers to evaluate the performance of units within the conservation estate.

Management of diabetes by primary health care nurses in Auckland, New Zealand.

PubMed

Daly, Barbara; Arroll, Bruce; Kenealy, Timothy; Sheridan, Nicolette; Scragg, Robert

2015-03-01

The increasing prevalence of diabetes has led to expanded roles for primary health care nurses in diabetes management. To describe and compare anthropometric and glycaemic characteristics of patients with diabetes and their management by practice nurses, district nurses and specialist nurses. Primary health care nurses in Auckland randomly sampled in a cross-sectional survey, completed a postal self-administered questionnaire (n=284) and telephone interview (n=287) between 2006 and 2008. Biographical and diabetes management details were collected for 265 (86%) of the total 308 patients with diabetes seen by participants on a randomly selected day. Nurses were able to access key clinical information for only a proportion of their patients: weight for 68%; BMI for 16%; HbA1c for 76% and serum glucose levels for 34% (for either measure 82%); although most (96%) records were available about whether patients self-monitored blood glucose levels. Most nursing management activities focused on giving advice on dietary intake (70%) and physical activity (66%), weighing patients (58%), and testing or discussing blood glucose levels (42% and 43%, respectively). These proportions varied by nurse group (p<0.05), generally being highest for specialist nurses and lowest for district nurses. Most practice and specialist nurses could access patients' weight and HbA1c levels and focused their clinical management on health education to decrease these if indicated. Communication and organisational systems and contracts that allow district nurses to work across both primary and secondary health services are necessary to improve community-based nursing services for patients with diabetes.

Expectations and patients’ experiences of obesity prior to bariatric surgery: a qualitative study

PubMed Central

Homer, Catherine Verity; Thompson, Andrew R; Allmark, Peter; Goyder, Elizabeth

2016-01-01

Objectives This study aimed to understand the experiences and expectations of people seeking bariatric surgery in England and identify implications for behavioural and self-management interventions. Design A qualitative study using modified photovoice methods, triangulating photography with semistructured indepth interviews analysed using framework techniques. Setting Areas served by two bariatric surgery multidisciplinary teams in the north of England. Participants 18 adults (14 women and 4 men) who accepted for bariatric surgery, and were aged between 30 and 61 years. Participants were recruited through hospital-based tier 4 bariatric surgery multidisciplinary teams. Results The experiences of participants indicates the nature and extent of the burden of obesity. Problems included stigmatisation, shame, poor health, physical function and reliance on medications. Participants expected surgery to result in major physical and psychological improvement. They described how this expectation was rooted in their experiences of stigma and shame. These feelings were reinforced by previous unsuccessful weight loss attempts. Participants expected extreme and sometimes unrealistic levels of sustained weight loss, as well as improvements to physical and mental health. The overall desire and expectation of bariatric surgery was of ‘normality’. Participants had received previous support from clinicians and in weight management services. However, they reported that their expectations of surgery had not been reviewed by services, and expectations appeared to be unrealistic. Likewise, their experience of stigmatisation had not been addressed. Conclusions The unrealistic expectations identified here may negatively affect postoperative outcomes. The findings indicate the importance of services addressing feelings of shame and stigmatisation, and modifying patient's expectations and goals for the postoperative period. PMID:26857104

21 CFR 520.870 - Etodolac.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Etodolac. 520.870 Section 520.870 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL DRUGS, FEEDS... (4.5 to 6.8 mg per pound) of body weight per day orally. (ii) Indications for use. For the management...

Quality of nutrition services in primary health care facilities: Implications for integrating nutrition into the health system in Bangladesh

PubMed Central

Saha, Kuntal Kumar; Chowdhury, Ashfaqul Haq; Garnett, Sarah P.; Arifeen, Shams El; Menon, Purnima

2017-01-01

Background In 2011, the Bangladesh Government introduced the National Nutrition Services (NNS) by leveraging the existing health infrastructure to deliver nutrition services to pregnant woman and children. This study examined the quality of nutrition services provided during antenatal care (ANC) and management of sick children younger than five years. Methods Service delivery quality was assessed across three dimensions; structural readiness, process and outcome. Structural readiness was assessed by observing the presence of equipment, guidelines and register/reporting forms in ANC rooms and consulting areas for sick children at 37 primary healthcare facilities in 12 sub-districts. In addition, the training and knowledge relevant to nutrition service delivery of 95 healthcare providers was determined. The process of nutrition service delivery was assessed by observing 381 ANC visits and 826 sick children consultations. Satisfaction with the service was the outcome and was determined by interviewing 541 mothers/caregivers of sick children. Results Structural readiness to provide nutrition services was higher for ANC compared to management of sick children; 73% of ANC rooms had >5 of the 13 essential items while only 13% of the designated areas for management of sick children had >5 of the 13 essential items. One in five (19%) healthcare providers had received nutrition training through the NNS. Delivery of the nutrition services was poor: <30% of women received all four key antenatal nutrition services, 25% of sick children had their weight checked against a growth-chart and <1% had their height measured. Nevertheless, most mothers/caregivers rated their satisfaction of the service above average. Conclusions Strengthening the provision of equipment and increasing the coverage of training are imperative to improve nutrition services. Inherent barriers to implementing nutrition services in primary health care, especially high caseloads during the management of sick under-five children, should be considered to identify alternative and appropriate service delivery platforms before nationwide scale up. PMID:28542530

Eating well, living well and weight management: A co-produced semi-qualitative study of barriers and facilitators experienced by adults with intellectual disabilities.

PubMed

Doherty, A J; Jones, S P; Chauhan, U; Gibson, Jme

2018-01-01

Adults with intellectual disabilities in England experience health inequalities. They are more likely than their non-disabled peers to be obese and at risk of serious medical conditions such as heart disease, stroke and type 2 diabetes. This semi-qualitative study engaged adults with intellectual disabilities in a co-production process to explore their perceived barriers and facilitators to eating well, living well and weight management. Nineteen participants with intellectual disabilities took part in four focus groups and one wider group discussion. They were supported by eight of their carers or support workers. Several barriers were identified including personal income restrictions, carers' and support workers' unmet training needs, a lack of accessible information, inaccessible services and societal barriers such as the widespread advertising of less healthy foodstuffs. A key theme of frustration with barriers emerged from analysis of participants' responses. Practical solutions suggested by participants included provision of clear and accessible healthy lifestyle information, reasonable adjustments to services, training, 'buddying' support systems or schemes and collaborative working to improve policy and practice.

Weight management services for adults--highlighting the role of primary care.

PubMed

Hassan, S J; O'Shea, D

2012-01-01

Ireland has the fourth highest prevalence of overweight and obese men in the European Union and the seventh highest prevalence among women. This study focuses on 777 referrals on the waiting list for Ireland's only fully funded hospital-based adult weight management service with special emphasis on the role of primary care in the referral process. Since our last review two years ago, we found that patients are now being referred at a younger age (mean 43 years). The mean BMI at referral has increased from 44 to 46. Five hundred and forty eight (70%) referrals were from primary care with males accounting for 163 (30%) of these, despite male obesity being more prevalent. Interestingly, as the distance from Dublin increased, the number of referrals decreased. Overall this is a concerning trend showing the increasing burden of obesity on a younger population and a health system inadequately equipped to deal with the problem. It also highlights the central role of the primary care physician in the timely and appropriate referral to optimise use of our available resources.

Factor selection for service quality evaluation: a hospital case study.

PubMed

Ameryoun, Ahmad; Najafi, Seyedvahid; Nejati-Zarnaqi, Bayram; Khalilifar, Seyed Omid; Ajam, Mahdi; Ansarimoghadam, Ahmad

2017-02-13

Purpose The purpose of this paper is to develop a systematic approach to predict service quality dimension's influence on service quality using a novel analysis based on data envelopment and SERVQUAL. Design/methodology/approach To assess hospital service quality in Tehran, expectation and perception of those who received the services were evaluated using SERVQUAL. The hospital service quality dimensions were found by exploratory factor analysis (EFA). To compare customer expectation and perception, perceived service quality index (PSQI) was measured using a new method based on common weights. A novel sensitivity approach was used to test the service quality factor's impact on the PSQI. Findings A new service quality dimension named "trust in services" was found using EFA, which is not an original SERVQUAL factor. The approach was applied to assess the hospital's service quality. Since the PSQI value was 0.76 it showed that improvements are needed to meet customer expectations. The results showed the factor order that affect PSQI. "Trust in services" has the strongest influence on PSQI followed by "tangibles," "assurance," "empathy," and "responsiveness," respectively. Practical implications This work gives managers insight into service quality by following a systematic method; i.e., measuring perceived service quality from the customer viewpoint and service factors' impact on customer perception. Originality/value The procedure helps managers to select the required service quality dimensions which need improvement and predict their effects on customer perception.

Analytical Micromechanics Modeling Technique Developed for Ceramic Matrix Composites Analysis

NASA Technical Reports Server (NTRS)

Min, James B.

2005-01-01

Ceramic matrix composites (CMCs) promise many advantages for next-generation aerospace propulsion systems. Specifically, carbon-reinforced silicon carbide (C/SiC) CMCs enable higher operational temperatures and provide potential component weight savings by virtue of their high specific strength. These attributes may provide systemwide benefits. Higher operating temperatures lessen or eliminate the need for cooling, thereby reducing both fuel consumption and the complex hardware and plumbing required for heat management. This, in turn, lowers system weight, size, and complexity, while improving efficiency, reliability, and service life, resulting in overall lower operating costs.

A scoping review of weight bias by community pharmacists towards people with obesity and mental illness.

PubMed

Murphy, Andrea L; Gardner, David M

2016-07-01

Community pharmacists are accessible health care professionals who are increasingly offering weight management programs. People living with serious mental illness have markedly higher rates of obesity and associated illness outcomes than the general population, providing pharmacists who are interested in offering weight management services with an identifiable patient subgroup with increased health needs. Issues with stigma within obesity and mental illness care are prevalent and can lead to inequities and reduced quality of care. We conducted a scoping review to map and characterize the available information from published and grey literature sources regarding community pharmacists and weight bias towards obese people with lived experience of mental illness. A staged approach to the scoping review was used. Six articles and 6 websites were abstracted after we removed duplicates and applied our inclusion and exclusion criteria. The published studies that we found indicated that pharmacists and pharmacy students do demonstrate implicit and explicit weight bias. Very limited research is available regarding weight bias in pharmacists and stigma towards people with obesity, and we found no information on these phenomena relating to people with lived experience of mental illness. Investigations are needed to characterize the extent and nature of anti-fat bias and attitudes by pharmacists and the consequences of these attitudes for patient care.

Contrasting and not-so-contrasting perspectives between local stakeholders and scientists and across dryland sites in participatory assessment of land management

NASA Astrophysics Data System (ADS)

Bautista, Susana; Zucca, Claudio; Urghege, Anna M.; Ramón Vallejo, V.

2015-04-01

The participation of stakeholders and the integration of scientific and local knowledge in the assessment of environmental problems and potential solutions have been increasingly demanded by international institutions. Participatory assessment has the potential to engender social learning among all stakeholders, including scientists, which then has the potential to increase collaboration and the probability for adoption of good practices. Using PRACTICE participatory assessment tool, IAPro, a number of assessment criteria were identified, selected and weighted by local stakeholder platforms (SHPs) and scientists in 18 dryland sites distributed across 11 countries. These criteria were then applied to the assessment of a variety of local land management actions. In total, around 50 criteria were proposed by the SHPs, ranging from 6 to 14 per platform. The proposed criteria represented a wide variety of social, economic, cultural, and environmental aspects. Many of them were proposed by many of the SHPs, stressing their potential as universal assessment criteria across drylands. In most cases, these repeatedly proposed criteria were the same criteria proposed by the scientific panel. The relative importance given to the variety of criteria by each SHP was evenly distributed among the economic wealth criterion and each of the main categories of ecosystem services (provisioning, supporting & regulating, and cultural). In general, African and American sites where local people economies heavily rely on natural lands gave higher weights than European sites to "economic-wealth", "provision of goods", and "supporting and regulating services" criteria, and also to "socio-cultural services". All European SHPs selected and gave great importance to criteria that are related to security, such hydrogeological hazard, flood prevention, and fire risk. The participatory assessment process in IAPro facilitated social learning among the stakeholders, including scientists, and promoted knowledge exchange at multiple levels. The change between the initial and final perspectives on the assessment criteria and the quality of the management actions assessed was considered to be a metric of the learning gained through the IAPro process. A decrease in the variability of weights and rates given by the stakeholders to each criteria and management action reflects the consensus building process that takes place during the discussion sessions.

A qualitative evidence synthesis on the management of male obesity

PubMed Central

Archibald, Daryll; Douglas, Flora; Hoddinott, Pat; van Teijlingen, Edwin; Stewart, Fiona; Robertson, Clare; Boyers, Dwayne; Avenell, Alison

2015-01-01

Objectives To investigate what weight management interventions work for men, with which men, and under what circumstances. Design Realist synthesis of qualitative studies. Data sources Sensitive searches of 11 electronic databases from 1990 to 2012 supplemented by grey literature searches. Study selection Studies published between 1990 and 2012 reporting qualitative research with obese men, or obese men in contrast to obese women and lifestyle or drug weight management were included. The studies included men aged 16 years or over, with no upper age limit, with a mean or median body mass index of 30 kg/m2 in all settings. Results 22 studies were identified, including 5 qualitative studies linked to randomised controlled trials of weight maintenance interventions and 8 qualitative studies linked to non-randomised intervention studies, and 9 relevant UK-based qualitative studies not linked to any intervention. Health concerns and the perception that certain programmes had ‘worked’ for other men were the key factors that motivated men to engage with weight management programmes. Barriers to engagement and adherence with programmes included: men not problematising their weight until labelled ‘obese’; a lack of support for new food choices by friends and family, and reluctance to undertake extreme dieting. Retaining some autonomy over what is eaten; flexibility about treats and alcohol, and a focus on physical activity were attractive features of programmes. Group interventions, humour and social support facilitated attendance and adherence. Men were motivated to attend programmes in settings that were convenient, non-threatening and congruent with their masculine identities, but men were seldom involved in programme design. Conclusions Men's perspectives and preferences within the wider context of family, work and pleasure should be sought when designing weight management services. Qualitative research is needed with men to inform all aspects of intervention design, including the setting, optimal recruitment processes and strategies to minimise attrition. PMID:26459486

A qualitative evidence synthesis on the management of male obesity.

PubMed

Archibald, Daryll; Douglas, Flora; Hoddinott, Pat; van Teijlingen, Edwin; Stewart, Fiona; Robertson, Clare; Boyers, Dwayne; Avenell, Alison

2015-10-12

To investigate what weight management interventions work for men, with which men, and under what circumstances. Realist synthesis of qualitative studies. Sensitive searches of 11 electronic databases from 1990 to 2012 supplemented by grey literature searches. Studies published between 1990 and 2012 reporting qualitative research with obese men, or obese men in contrast to obese women and lifestyle or drug weight management were included. The studies included men aged 16 years or over, with no upper age limit, with a mean or median body mass index of 30 kg/m(2) in all settings. 22 studies were identified, including 5 qualitative studies linked to randomised controlled trials of weight maintenance interventions and 8 qualitative studies linked to non-randomised intervention studies, and 9 relevant UK-based qualitative studies not linked to any intervention. Health concerns and the perception that certain programmes had 'worked' for other men were the key factors that motivated men to engage with weight management programmes. Barriers to engagement and adherence with programmes included: men not problematising their weight until labelled 'obese'; a lack of support for new food choices by friends and family, and reluctance to undertake extreme dieting. Retaining some autonomy over what is eaten; flexibility about treats and alcohol, and a focus on physical activity were attractive features of programmes. Group interventions, humour and social support facilitated attendance and adherence. Men were motivated to attend programmes in settings that were convenient, non-threatening and congruent with their masculine identities, but men were seldom involved in programme design. Men's perspectives and preferences within the wider context of family, work and pleasure should be sought when designing weight management services. Qualitative research is needed with men to inform all aspects of intervention design, including the setting, optimal recruitment processes and strategies to minimise attrition. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

EGSIEM combination service: combination of GRACE monthly K-band solutions on normal equation level

NASA Astrophysics Data System (ADS)

Meyer, Ulrich; Jean, Yoomin; Arnold, Daniel; Jäggi, Adrian

2017-04-01

The European Gravity Service for Improved Emergency Management (EGSIEM) project offers a scientific combination service, combining for the first time monthly GRACE gravity fields of different analysis centers (ACs) on normal equation (NEQ) level and thus taking all correlations between the gravity field coefficients and pre-eliminated orbit and instrument parameters correctly into account. Optimal weights for the individual NEQs are commonly derived by variance component estimation (VCE), as is the case for the products of the International VLBI Service (IVS) or the DTRF2008 reference frame realisation that are also derived by combination on NEQ-level. But variance factors are based on post-fit residuals and strongly depend on observation sampling and noise modeling, which both are very diverse in case of the individual EGSIEM ACs. These variance factors do not necessarily represent the true error levels of the estimated gravity field parameters that are still governed by analysis noise. We present a combination approach where weights are derived on solution level, thereby taking the analysis noise into account.

Building national public health capacity for managing chemical events: A case study of the development of health protection services in the United Kingdom

PubMed Central

Palmer, Stephen; Coleman, Gary

2013-01-01

The revised International Health Regulations (2005) require that countries develop plans for chemical threats. In 2012, the World Health Assembly reported that most countries had not yet achieved ‘adequate capacity'. We review the evolution of chemical hazards services in the United Kingdom, the result of 15 years of grass-roots pressure and an accumulating weight of chemical incidents that eventually convinced the UK Department of Health of the need for a new national public health function, culminating, in 2003, in the creation of the Chemical Hazards Division of the new Health Protection Agency. Ten years later, public health services are again being radically reorganized with the creation of Public Health England, potentially destabilizing health protection arrangements and creating confusion among roles in managing chemical emergencies. Incorporating health protection into a broader public health organization, however, offers a new opportunity to broaden the scope of health protection services to embrace prevention of non-infectious environmental diseases. PMID:23447032

Building national public health capacity for managing chemical events: a case study of the development of health protection services in the United Kingdom.

PubMed

Palmer, Stephen; Coleman, Gary

2013-05-01

The revised International Health Regulations (2005) require that countries develop plans for chemical threats. In 2012, the World Health Assembly reported that most countries had not yet achieved 'adequate capacity'. We review the evolution of chemical hazards services in the United Kingdom, the result of 15 years of grass-roots pressure and an accumulating weight of chemical incidents that eventually convinced the UK Department of Health of the need for a new national public health function, culminating, in 2003, in the creation of the Chemical Hazards Division of the new Health Protection Agency. Ten years later, public health services are again being radically reorganized with the creation of Public Health England, potentially destabilizing health protection arrangements and creating confusion among roles in managing chemical emergencies. Incorporating health protection into a broader public health organization, however, offers a new opportunity to broaden the scope of health protection services to embrace prevention of non-infectious environmental diseases.

Group purchasing of workplace health promotion services for small employers.

PubMed

Harris, Jeffrey R; Hammerback, Kristen R; Hannon, Peggy A; McDowell, Julie; Katzman, Avi; Clegg-Thorp, Catherine; Gallagher, John

2014-07-01

Small employers are underserved with workplace health promotion services, so we explored the potential for group purchasing of these services. We conducted semistructured telephone interviews of member organizations serving small employers, as well as workplace health promotion vendors, in Washington State. We interviewed 22 employer organizations (chambers of commerce, trade associations, and an insurance trust) and vendors (of fitness facilities, healthy vending machines, fresh produce delivery, weight management services, and tobacco cessation quitlines). Both cautiously supported the idea of group purchasing but felt that small employers' workplace health promotion demand must increase first. Vendors providing off-site services, for example, quitline, found group purchasing more feasible than vendors providing on-site services, for example, produce delivery. Employer member organizations are well-positioned to group purchase workplace health promotion services; vendors are receptive if there is potential profit.

Decision Support Model for Introduction of Gamification Solution Using AHP

PubMed Central

2014-01-01

Gamification means the use of various elements of game design in nongame contexts including workplace collaboration, marketing, education, military, and medical services. Gamification is effective for both improving workplace productivity and motivating employees. However, introduction of gamification is not easy because the planning and implementation processes of gamification are very complicated and it needs interdisciplinary knowledge such as information systems, organization behavior, and human psychology. Providing a systematic decision making method for gamification process is the purpose of this paper. This paper suggests the decision criteria for selection of gamification platform to support a systematic decision making process for managements. The criteria are derived from previous works on gamification, introduction of information systems, and analytic hierarchy process. The weights of decision criteria are calculated through a survey by the professionals on game, information systems, and business administration. The analytic hierarchy process is used to derive the weights. The decision criteria and weights provided in this paper could support the managements to make a systematic decision for selection of gamification platform. PMID:24892075

Decision support model for introduction of gamification solution using AHP.

PubMed

Kim, Sangkyun

2014-01-01

Gamification means the use of various elements of game design in nongame contexts including workplace collaboration, marketing, education, military, and medical services. Gamification is effective for both improving workplace productivity and motivating employees. However, introduction of gamification is not easy because the planning and implementation processes of gamification are very complicated and it needs interdisciplinary knowledge such as information systems, organization behavior, and human psychology. Providing a systematic decision making method for gamification process is the purpose of this paper. This paper suggests the decision criteria for selection of gamification platform to support a systematic decision making process for managements. The criteria are derived from previous works on gamification, introduction of information systems, and analytic hierarchy process. The weights of decision criteria are calculated through a survey by the professionals on game, information systems, and business administration. The analytic hierarchy process is used to derive the weights. The decision criteria and weights provided in this paper could support the managements to make a systematic decision for selection of gamification platform.

Policies and procedures in the workplace: how health care organizations compare.

PubMed

Loo, R

1993-01-01

Many organizations are implementing programs and services to manage the human and economic costs of stress. A mail survey was conducted of 500 randomly selected Canadian organizations having at least 500 employees. The survey tapped four major areas: organizational policies and procedures for managing stress; programs and services offered; perceived benefits and constraints for the organization; and projected future directions in this area. Analyses of returns from 210 organizations-43 health and 167 non-health-revealed various findings. For example, over half of health care organizations have policies and procedures as opposed to less than half of non-health care organizations. Also, health care organizations place greater emphasis on smoking cessation, weight control programs and on stress management training. Although some Canadian organizations are addressing stress, much more could and should be done, especially by organizations that do not yet recognize the impact of stress on employees and their work performance.

Revisiting the relationship between managed care and hospital consolidation.

PubMed

Town, Robert J; Wholey, Douglas; Feldman, Roger; Burns, Lawton R

2007-02-01

This paper analyzes whether the rise in managed care during the 1990s caused the increase in hospital concentration. We assemble data from the American Hospital Association, InterStudy and government censuses from 1990 to 2000. We employ linear regression analyses on long differenced data to estimate the impact of managed care penetration on hospital consolidation. Instrumental variable analogs of these regressions are also analyzed to control for potential endogeneity. All data are from secondary sources merged at the level of the Health Care Services Area. In 1990, the mean population-weighted hospital Herfindahl-Hirschman index (HHI) in a Health Services Area was .19. By 2000, the HHI had risen to .26. Most of this increase in hospital concentration is due to hospital consolidation. Over the same time frame HMO penetration increased three fold. However, our regression analysis strongly implies that the rise of managed care did not cause the hospital consolidation wave. This finding is robust to a number of different specifications.

Revisiting the Relationship between Managed Care and Hospital Consolidation

PubMed Central

Town, Robert J; Wholey, Douglas; Feldman, Roger; Burns, Lawton R

2007-01-01

Objective This paper analyzes whether the rise in managed care during the 1990s caused the increase in hospital concentration. Data Sources We assemble data from the American Hospital Association, InterStudy and government censuses from 1990 to 2000. Study Design We employ linear regression analyses on long differenced data to estimate the impact of managed care penetration on hospital consolidation. Instrumental variable analogs of these regressions are also analyzed to control for potential endogeneity. Data Collection All data are from secondary sources merged at the level of the Health Care Services Area. Principle Findings In 1990, the mean population-weighted hospital Herfindahl–Hirschman index (HHI) in a Health Services Area was .19. By 2000, the HHI had risen to .26. Most of this increase in hospital concentration is due to hospital consolidation. Over the same time frame HMO penetration increased three fold. However, our regression analysis strongly implies that the rise of managed care did not cause the hospital consolidation wave. This finding is robust to a number of different specifications. PMID:17355590

Modeling aesthetics to support an ecosystem services approach for natural resource management decision making.

PubMed

Booth, Pieter N; Law, Sheryl A; Ma, Jane; Buonagurio, John; Boyd, James; Turnley, Jessica

2017-09-01

This paper reviews literature on aesthetics and describes the development of vista and landscape aesthetics models. Spatially explicit variables were chosen to represent physical characteristics of natural landscapes that are important to aesthetic preferences. A vista aesthetics model evaluates the aesthetics of natural landscapes viewed from distances of more than 1000 m, and a landscape aesthetics model evaluates the aesthetic value of wetlands and forests within 1000 m from the viewer. Each of the model variables is quantified using spatially explicit metrics on a pixel-specific basis within EcoAIM™, a geographic information system (GIS)-based ecosystem services (ES) decision analysis support tool. Pixel values are "binned" into ranked categories, and weights are assigned to select variables to represent stakeholder preferences. The final aesthetic score is the weighted sum of all variables and is assigned ranked values from 1 to 10. Ranked aesthetic values are displayed on maps by patch type and integrated within EcoAIM. The response of the aesthetic scoring in the models was tested by comparing current conditions in a discrete area of the facility with a Development scenario in the same area. The Development scenario consisted of two 6-story buildings and a trail replacing natural areas. The results of the vista aesthetic model indicate that the viewshed area variable had the greatest effect on the aesthetics overall score. Results from the landscape aesthetics model indicate a 10% increase in overall aesthetics value, attributed to the increase in landscape diversity. The models are sensitive to the weights assigned to certain variables by the user, and these weights should be set to reflect regional landscape characteristics as well as stakeholder preferences. This demonstration project shows that natural landscape aesthetics can be evaluated as part of a nonmonetary assessment of ES, and a scenario-building exercise provides end users with a tradeoff analysis in support of natural resource management decisions. Integr Environ Assess Manag 2017;13:926-938. © 2017 SETAC. © 2017 SETAC.

Effect of comanagement with internal medicine on hospital stay of patients admitted to the Service of Otolaryngology.

PubMed

Montero Ruiz, Eduardo; Rebollar Merino, Ángela; Rivera Rodríguez, Teresa; García Sánchez, Marta; Agudo Alonso, Rosa; Barbero Allende, José Maria

2015-01-01

Patients admitted to the Department of Otolaryngology (ENT) are increasing in age, comorbidity and complexity, leading to increased consultations/referrals to Internal Medicine (IM). An alternative to consultations/referrals is co-management. We studied the effect of co-management on length of stay (LoS) in hospital for patients admitted to ENT. This was a retrospective observational study including patients ≥14 years old discharged from ENT between 1/1/2009 and 30/06/2013, with co-management from May/2011. We analysed age, sex, type of admission, whether the patient was operated, administrative weight associated with DRG, total number of discharge diagnoses, Charlson comorbidity index (CCI), deaths, readmissions and LoS. There were statistically significant differences between both groups in age (4.5 years; 95% confidence interval [95% CI] 2.8-6.3), emergency admissions (odds ratio [OR] 1.4; 95% CI 1.1-1.8), administrative weight (0.3637; 95% CI 0.0710-0.6564), number of diagnoses (1.3; 95% CI 1-1.6), CCI (0.4; 95% CI 0.2-0.6) and deaths (OR 4.1; 95% CI 1.1-15.7). On adjustment, co-management reduced ENT LoS in hospital by 28.6%, 0.8 days (95% CI 0.1-1.6%; P=.038). This reduction represents an ENT savings of at least €165,893. Co-management patients admitted to ENT are increasing in age, comorbidity and complexity. Co-management is associated with reduced LoS and costs in ENT, similar to those observed in other surgical services. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

A qualitative study exploring midwives' perceptions and knowledge of maternal obesity: Reflecting on their experiences of providing healthy eating and weight management advice to pregnant women.

PubMed

McCann, Mary T; Newson, Lisa; Burden, Catriona; Rooney, Jane S; Charnley, Margaret S; Abayomi, Julie C

2018-04-01

Midwives are responsible for providing advice regarding the complex issues of healthy eating and weight management during pregnancy. This study utilised an inductive data-driven thematic approach in order to determine midwives' perceptions, knowledge, and experiences of providing healthy eating and weight management advice to pregnant women. Semistructured interviews with 17 midwives were transcribed verbatim and data subjected to thematic analysis. The findings offer insight into the challenges facing midwives in their role trying to promote healthy eating and appropriate weight management to pregnant women. Three core themes were identified: (a) "If they eat healthily it will bring their weight down": Midwives Misunderstood; (b) "I don't think we are experienced enough": Midwives Lack Resources and Expertise; and (c) "BMI of 32 wouldn't bother me": Midwives Normalised Obesity. The midwives recognised the importance of providing healthy eating advice to pregnant women and the health risks associated with poor diet and obesity. However, they reported the normalisation of obesity in pregnant women and suggested that this, together with their high workload and lack of expertise, explained the reasons why systematic advice was not in standard antenatal care. In addition, the current lack of UK clinical guidance, and thus, possibly lack of clinical leadership are also preventing delivery of tailored advice. Implementation literature on understanding the barriers to optimal health care delivery and informing clinical practice through research evidence needs to be further investigated in this field. This study has recommendations for policy makers, commissioners, service providers, and midwives. © 2017 John Wiley & Sons Ltd.

A framework to assess landscape structural capacity to provide regulating ecosystem services in West Africa.

PubMed

Inkoom, Justice Nana; Frank, Susanne; Greve, Klaus; Fürst, Christine

2018-03-01

The Sudanian savanna landscapes of West Africa are amongst the world's most vulnerable areas to climate change impacts. Inappropriate land use and agriculture management practices continuously impede the capacity of agricultural landscapes to provide ecosystem services (ES). Given the absence of practical assessment techniques to evaluate the landscape's capacity to provide regulating ES in this region, the goal of this paper is to propose an integrative assessment framework which combines remote sensing, geographic information systems, expert weighting and landscape metrics-based assessment. We utilized Analytical Hierarchical Process and Likert scale for the expert weighting of landscape capacity. In total, 56 experts from several land use and landscape management related departments participated in the assessment. Further, we adapted the hemeroby concept to define areas of naturalness while landscape metrics including Patch Density, Shannon's Diversity, and Shape Index were utilized for structural assessment. Lastly, we tested the reliability of expert weighting using certainty measurement rated by experts themselves. Our study focused on four regulating ES including flood control, pest and disease control, climate control, and wind erosion control. Our assessment framework was tested on four selected sites in the Vea catchment area of Ghana. The outcome of our study revealed that highly heterogeneous landscapes have a higher capacity to provide pest and disease control, while less heterogeneous landscapes have a higher potential to provide climate control. Further, we could show that the potential capacities to provide ecosystem services are underestimated by 15% if landscape structural aspects assessed through landscape metrics are not considered. We conclude that the combination of adapted land use and an optimized land use pattern could contribute considerably to lower climate change impacts in West African agricultural landscapes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Identification of the need for home visiting nurse: development of a new assessment tool.

PubMed

Taguchi, Atsuko; Nagata, Satoko; Naruse, Takashi; Kuwahara, Yuki; Yamaguchi, Takuhiro; Murashima, Sachiyo

2014-01-01

To develop a Home Visiting Nursing Service Need Assessment Form (HVNS-NAF) to standardize the decision about the need for home visiting nursing service. The sample consisted of older adults who had received coordinated services by care managers. We defined the need for home visiting nursing service by elderly individuals as the decision of the need by a care manager so that the elderly can continue to live independently. Explanatory variables included demographic factors, medical procedure, severity of illness, and caregiver variables. Multiple logistic regression was carried out after univariate analyses to decide the variables to include and the weight of each variable in the HVNS-NAF. We then calculated the sensitivity and specificity of each cutoff value, and defined the score with the highest sensitivity and specificity as the cutoff value. Nineteen items were included in the final HVNS-NAF. When the cutoff value was 2 points, the sensitivity was 77.0%, specificity 68.5%, and positive predictive value 56.8%. HVNS-NAF is the first validated standard based on characteristics of elderly clients who required home visiting nursing service. Using the HVNS-NAF may result in reducing the unmet need for home visiting nursing service and preventing hospitalization.

Integrating modeling, monitoring, and management to reduce critical uncertainties in water resource decision making.

PubMed

Peterson, James T; Freeman, Mary C

2016-12-01

Stream ecosystems provide multiple, valued services to society, including water supply, waste assimilation, recreation, and habitat for diverse and productive biological communities. Managers striving to sustain these services in the face of changing climate, land uses, and water demands need tools to assess the potential effectiveness of alternative management actions, and often, the resulting tradeoffs between competing objectives. Integrating predictive modeling with monitoring data in an adaptive management framework provides a process by which managers can reduce model uncertainties and thus improve the scientific bases for subsequent decisions. We demonstrate an integration of monitoring data with a dynamic, metapopulation model developed to assess effects of streamflow alteration on fish occupancy in a southeastern US stream system. Although not extensive (collected over three years at nine sites), the monitoring data allowed us to assess and update support for alternative population dynamic models using model probabilities and Bayes rule. We then use the updated model weights to estimate the effects of water withdrawal on stream fish communities and demonstrate how feedback in the form of monitoring data can be used to improve water resource decision making. We conclude that investment in more strategic monitoring, guided by a priori model predictions under alternative hypotheses and an adaptive sampling design, could substantially improve the information available to guide decision-making and management for ecosystem services from lotic systems. Published by Elsevier Ltd.

Lived experiences of routine antenatal dietetic services among women with obesity: A qualitative phenomenological study.

PubMed

Heslehurst, Nicola; Dinsdale, Sarah; Brandon, Helene; Johnston, Camilla; Summerbell, Carolyn; Rankin, Judith

2017-06-01

to understand the lived experiences and views of being referred to an antenatal dietetic service from the perspective of pregnant women with obesity. a qualitative, interpretive approach using one-to-one in-depth interviews to explore the lived experience of pregnant women with obesity following referral to an antenatal dietetics service. Thematic content analysis was carried out by two researchers independently to develop data-driven themes. one NHS Trust maternity and dietetic services, North East England, UK. fifteen pregnant women with a booking body mass index ≥30kg/m 2 attending an obesity-specific antenatal dietetic service. All women were White, parity between 0 and 2, and BMI range 30-51kg/m 2 . four themes were identified. (1) Women's overall experience of the service: experiences were predominately positive with only two negative cases identified. (2) Process of referral: women placed importance on informative and in-person communication about the service, with health professionals, at the point of referral. (3) Delivery of the service: dietitians were considered to be the experts and women wanted more frequent contact. (4) Content of the service: tailored advice enabled behaviour change, and women desired increased physical activity support and weight monitoring. women reported an overall positive experience and thought that dietitians were the expert health professionals to support them. Women in this study felt that tailoring advice specific to their personal circumstances helped them implement changes, and had a strong interest in the nutritional benefits for fetal development. Women considered weight monitoring to be a positive element of the service; however, further research is required given the limited and conflicting evidence-base. it is important to incorporate women's experiences in the development and delivery of antenatal weight management services to facilitate person-centred care. Communication by health professionals at the point of referral is particularly important to provide accurate expectations of services and to reduce anxieties. Dietitians are considered to be appropriate experts to deliver these services, although they may need additional support to address women's physical activity needs in pregnancy. Copyright © 2016 Elsevier Ltd. All rights reserved.

Balancing ecosystem function, services and disservices resulting from expanding goose populations.

PubMed

Buij, Ralph; Melman, Theodorus C P; Loonen, Maarten J J E; Fox, Anthony D

2017-03-01

As goose populations increase in abundance, their influence on ecological processes is increasing. We review the evidence for key ecological functions of wild goose populations in Eurasia and North America, including aquatic invertebrate and plant propagule transport, nutrient deposition in terrestrial and aquatic ecosystems, the influence of goose populations on vegetation biomass, carbon storage and methane emission, species diversity and disease transmission. To estimate the implications of their growing abundance for humans, we explore how these functions contribute to the provision of ecosystem services and disservices. We assess the weight, extent and trends among such impacts, as well as the balance of their value to society. We examine key unresolved issues to enable a more balanced assessment of the economic costs or benefits of migratory geese along their flyways, including the spatial and temporal variation in services and their contrasting value to different user groups. Many ecological functions of geese are concluded to provide neither services nor disservices and, ecosystem disservices currently appear to outweigh services, although this varies between regions. We consider an improved quantification of ecosystem services and disservices, and how these vary along population flyways with respect to variation in valuing certain cultural services, and under different management scenarios aimed at reducing their disservices, essential for a more balanced management of goose populations.

[Influence of contractual medical association on inpatient service performance].

PubMed

Wu, Zhi-jun; Jian, Wei-yan

2015-06-18

To study the influence of contractual medical association on inpatient service performance. The data came from "Database of Inpatient Record" administered by Department of Medical Insurance. Using diagnosis related groups (DRG) as the tool of risk-adjustment, the third-tier general hospitals and second-tier general hospitals in medical alliance as the intervention group, and the average level of the same grade local hospitals as the control group, the influence of medical alliance on inpatient service performance was evaluated. The difference in difference (DID) method was used for the data analysis. The assessing indicators included the number of DRG group, case mix index (CMI), the total weight, cost efficiency index and time efficiency index. After the establishment of medical association, compared with the average level of the same grade local hospitals, in the third-tier general hospitals of medical alliance, the growth rate of the total weight had declined, and cost efficiency index had increased, while in the second-tier general hospitals of medical alliance, the CMI value had declined, and the cost efficiency index had increased. Contractual medical association played a role of triage patients, and improved the service levels and management efficiency of the second-tier general hospitals.

Effects of a brief computer-assisted diabetes self-management intervention on dietary, biological and quality-of-life outcomes.

PubMed

Glasgow, Russell E; Nutting, Paul A; Toobert, Deborah J; King, Diane K; Strycker, Lisa A; Jex, Marleah; O'Neill, Caitlin; Whitesides, Holly; Merenich, John

2006-03-01

There is a need for practical, efficient and broad-reaching diabetes self-management interventions that can produce changes in lifestyle behaviours such as healthy eating and weight loss. The objective of this study was to evaluate such a computer-assisted intervention. Type 2 diabetes primary care patients (n=335) from fee-for-service and health maintenance organization settings were randomized to social cognitive theory-based tailored self-management (TSM) or computer-aided enhanced usual care (UC). Intervention consisted of computer-assisted self-management assessment and feedback, tailored goal-setting, barrier identification, and problem-solving, followed by health counsellor interaction and follow-up calls. Outcomes were changes in dietary behaviours (fat and fruit/vegetable intake), haemoglobin Alc (HbA1c), lipids, weight, quality of life, and depression. TSM patients reduced dietary fat intake and weight significantly more than UC patients at the 2-month follow-up. Among patients having elevated levels of HbA1c, lipids or depression at baseline, there were consistent directional trends favouring intervention, but these differences did not reach significance. The intervention proved feasible and was implemented successfully by a variety of staff. This relatively low-intensity intervention appealed to a large, generally representative sample of patients, was well implemented, and produced improvement in targeted behaviours. Implications of this practical clinical trial for dissemination are discussed.

Food choice can improve nursing home resident meal service satisfaction and nutritional status.

PubMed

Crogan, Neva L; Dupler, Alice E; Short, Robert; Heaton, Grace

2013-05-01

The purpose of this study was to test the feasibility of implementing the Eat Right food delivery system and measure its impact on residents' food satisfaction, food intake, and subsequent nutritional status, including serum prealbumin levels and changes in body weight. Two eastern Washington State nursing homes (NHs) were recruited based on a similar case mix, the number of beds, and management's willingness to participate in the study. A total of 61 residents (NH A = 33, NH B = 28) participated. Intervention group residents (NH A) reported significant overall improvement in food service satisfaction and significant improvement in serum prealbumin levels after the intervention (p = 0.001). Changes in intervention group body weight improved after the intervention (p = 0.029). Use of nutritional interventions such as the multidimensional Eat Right system encourages resident decision making and facilitates overall satisfaction with care and improved health. Copyright 2013, SLACK Incorporated.

Turning whine into wine: the fiscal impact of comprehensive documentation and billing for nonoperative pediatric surgical services.

PubMed

Gollin, Gerald; Moores, Donald

2006-06-01

Some pediatric surgeons rarely document nonoperative services, believing that the reimbursement provided for such care is negligible. We evaluated the impact of comprehensive documentation and billing for nonoperative, pediatric surgical care. All bills submitted for inpatient, nonoperative care for 1 year were reviewed. Total receipts for documented admissions, consultations, critical care, and daily care were determined. The Evaluation and Management code billed for each service was recorded, and the total and average payments attributable to each Evaluation and Management code were calculated. Fifty-six percent of services were covered by Medicaid and 26% by a commercial insurer. There were 607 billed admission history and physical exams for which reimbursement totaled 43,493 dollars. Critical care services were provided to 49 patients and yielded 8964 dollars in payments. Six hundred thirty-nine inpatient consultations were performed with a reimbursement of 42,830 dollars. Daily care services were billed 1044 times and produced 71,579 dollars in payments. Overall reimbursement for documented, nonoperative services was 166,866 dollars. This represented 16.2% of total, noncontracted income for the practice. Despite a payer mix heavily weighted toward Medicaid, comprehensive documentation and billing for nonoperative services increased total, noncontracted reimbursement by almost 20% over what it would have been had only operative services been billed. The yield from properly documented, nonoperative care can be substantial.

The QAP weighted network analysis method and its application in international services trade

NASA Astrophysics Data System (ADS)

Xu, Helian; Cheng, Long

2016-04-01

Based on QAP (Quadratic Assignment Procedure) correlation and complex network theory, this paper puts forward a new method named QAP Weighted Network Analysis Method. The core idea of the method is to analyze influences among relations in a social or economic group by building a QAP weighted network of networks of relations. In the QAP weighted network, a node depicts a relation and an undirect edge exists between any pair of nodes if there is significant correlation between relations. As an application of the QAP weighted network, we study international services trade by using the QAP weighted network, in which nodes depict 10 kinds of services trade relations. After the analysis of international services trade by QAP weighted network, and by using distance indicators, hierarchy tree and minimum spanning tree, the conclusion shows that: Firstly, significant correlation exists in all services trade, and the development of any one service trade will stimulate the other nine. Secondly, as the economic globalization goes deeper, correlations in all services trade have been strengthened continually, and clustering effects exist in those services trade. Thirdly, transportation services trade, computer and information services trade and communication services trade have the most influence and are at the core in all services trade.

Impact of a dedicated cancer-associated thrombosis service on clinical outcomes: a mixed-methods evaluation of a clinical improvement exercise

PubMed Central

Noble, Simon; Pease, Nikki; Sui, Jessica; Davies, James; Lewis, Sarah; Malik, Usman; Alikhan, Raza; Prout, Hayley; Nelson, Annmarie

2016-01-01

Objectives Cancer-associated thrombosis (CAT) complex condition, which may present to any healthcare professional and at any point during the cancer journey. As such, patients may be managed by a number of specialties, resulting in inconsistent practice and suboptimal care. We describe the development of a dedicated CAT service and its evaluation. Setting Specialist cancer centre, district general hospital and primary care. Participants Patients with CAT and their referring clinicians. Intervention A cross specialty team developed a dedicated CAT service , including clear referral pathways, consistent access to medicines, patient's information and a specialist clinic. Primary and secondary outcome measures The service was evaluated using a mixed-methods evaluation , including audits of clinical practice, clinical outcomes, staff surveys and qualitative interviewing of patients and healthcare professionals. Results Data from 457 consecutive referrals over an 18-month period were evaluated. The CAT service has led to an 88% increase in safe and consistent community prescribing of low-molecular-weight heparin, with improved access to specialist advice and information. Patients reported improved understanding of their condition, enabling better self-management as well as better access to support and information. Referring clinicians reported better care standards for their patients with improved access to expertise and appropriate management. Conclusions A dedicated CAT service improves overall standards of care and is viewed positively by patients and clinicians alike. Further health economic evaluation would enhance the case for establishing this as the standard model of care. PMID:27895068

Implementation of ANP Method in Determining Supplier to Improve Service towards Supermarket Consumers

NASA Astrophysics Data System (ADS)

Mulyanto, A.; Amalia, T. H.; Novian, D.; Kaluku, M. R. A.

2017-03-01

Performance assessment on the supplier by the supermarket manager is relatively difficult to conduct and implies subjectivity, because there is no measureable and objective performance indicator. This study aims to assist in the decision making process and to look for alternative solutions in assessing the performance of each supplier, so that the service towards the customers will improve as well. ANP method is used to find the weight of each sub-criteria that will be used to measure the supplier performance. The weight result of each sub-criteria derived from the ANP method is used again in measuring the performance and to rank the performance of each supplier by using TOPSIS method. Performance measuring by using the ANP and TOPSIS that generates the highest value of the supplier is 0.71666 while the lowest value is 0.24825. The result of this study shows that the ANP and TOPSIS methods can be used to measure the supplier performance therefore it can assist the selection of supplier which can increase service towards the mart’s consumers.

Research on evaluation of third-party governance operation services for environmental pollution

NASA Astrophysics Data System (ADS)

Xu, Bingsheng; Ling, Lin; Jin, Huang

2017-11-01

This paper focuses on the evaluation of third-party governance operation services for environmental pollution, and determines the evaluation indicator system composed of 5 primary indicators as the basic competence of enterprise, operation of equipment, technique economics, environmental benefit and management level, and 26 secondary indicators via policies and regulations, standards, literature research and expert consultation in combination with the composition elements, service value judgment factors and full-life cycle of the work, providing theoretical support for the effect evaluation of third-governance over the environmental pollution in China. Then, the hierarchical analytic matrix is formed by analyzing the environmental pollution governance evaluation indicator system via analytic hierarchy process and scoring the importance of various indicators by experts by applying the Delphi method. The feature vector of the matrix is then calculated to obtain the weight of each indicator and verify the effectiveness of the Delphi method and obtain the comprehensive weight by judging the consistency of the matrix, so as to finally determine the overall ordering level of the importance of secondary indicators.

Performance evaluation of medical records departments by analytical hierarchy process (AHP) approach in the selected hospitals in Isfahan : medical records dep. & AHP.

PubMed

Ajami, Sima; Ketabi, Saeedeh

2012-06-01

Medical Records Department (MRD) is an important unit for evaluating and planning of care services. The goal of this study is evaluating the performance of the Medical Records Departments (MRDs) of the selected hospitals in Isfahan, Iran by using Analytical Hierarchy Process (AHP). This was an analytic of cross-sectional study that was done in spring 2008 in Isfahan, Iran. The statistical population consisted of MRDs of Alzahra, Kashani and Khorshid Hospitals in Isfahan. Data were collected by forms and through brainstorm technique. To analyze and perform AHP, Expert Choice software was used by researchers. Results were showed archiving unit has received the largest importance weight with respect to information management. However, on customer aspect admission unit has received the largest weight. Ordering weights of Medical Records Departments' Alzahra, Kashani and Khorshid Hospitals in Isfahan were with 0.394, 0.342 and 0.264 respectively. It is useful for managers to allocate and prioritize resources according to AHP technique for ranking at the Medical Records Departments.

The experience of weight management in normal weight adults.

PubMed

Hernandez, Cheri Ann; Hernandez, David A; Wellington, Christine M; Kidd, Art

2016-11-01

No prior research has been done with normal weight persons specific to their experience of weight management. The purpose of this research was to discover the experience of weight management in normal weight individuals. Glaserian grounded theory was used. Qualitative data (focus group) and quantitative data (food diary, study questionnaire, and anthropometric measures) were collected. Weight management was an ongoing process of trying to focus on living (family, work, and social), while maintaining their normal weight targets through five consciously and unconsciously used strategies. Despite maintaining normal weights, the nutritional composition of foods eaten was grossly inadequate. These five strategies can be used to develop new weight management strategies that could be integrated into existing weight management programs, or could be developed into novel weight management interventions. Surprisingly, normal weight individuals require dietary assessment and nutrition education to prevent future negative health consequences. Copyright © 2016 Elsevier Inc. All rights reserved.

Elements of the quality management in the materials' industry

NASA Astrophysics Data System (ADS)

Ioana, Adrian; Semenescu, Augustin; Costoiu, Mihnea; Marcu, Dragoş

2017-12-01

The criteria function concept consists of transforming the criteria function (CF) in a quality-economical matrix math MQE. The levels of prescribing the criteria function was obtained by using a composition algorithm for three vectors: T¯ vector - technical parameters' vector (ti); Ē vector - economical parameters' vector (ej) and P¯ vector - weight vector (p1). For each product or service, the area of the circle represents the value of its sales. The BCG Matrix thus offers a very useful map of the organization's service strengths and weaknesses, at least in terms of current profitability, as well as the likely cash flows.

Efficiency Analysis of Integrated Public Hospital Networks in Outpatient Internal Medicine.

PubMed

Ortíz-Barrios, Miguel Angel; Escorcia-Caballero, Juan P; Sánchez-Sánchez, Fabián; De Felice, Fabio; Petrillo, Antonella

2017-09-07

Healthcare systems are evolving towards a complex network of interconnected services due to the increasing costs and the increasing expectations for high service levels. It is evidenced in the literature the importance of implementing management techniques and sophisticated methods to improve the efficiency of healthcare systems, especially in emerging economies. This paper proposes an integrated collaboration model between two public hospitals to reach the reduction of weighted average lead time in outpatient internal medicine department. A strategic framework based on value stream mapping and collaborative practices has been developed in real case study settled in Colombia.

The 1985 Army Experience Survey: Tabular Descriptions of First-Term Attritees. Volume 1

DTIC Science & Technology

1986-01-01

Assistance. Survey data were processed through survey receipt control and sample management systems . Data were also keyed, edited, coded, and weighted. The...270-271 048 R136 REGION OF RESIDENCE WHEN YOU JOINED ARMY ...... .................. ... 272-273 049 E137 # TERMS OF... system - Weed out poor soldiers - Could not get promoted - Poor Day/bonuses/benefits - Other 15: Patriotism & defense - Patriotic fulfillment - Service

Impact of a dedicated cancer-associated thrombosis service on clinical outcomes: a mixed-methods evaluation of a clinical improvement exercise.

PubMed

Noble, Simon; Pease, Nikki; Sui, Jessica; Davies, James; Lewis, Sarah; Malik, Usman; Alikhan, Raza; Prout, Hayley; Nelson, Annmarie

2016-11-28

Cancer-associated thrombosis (CAT) complex condition, which may present to any healthcare professional and at any point during the cancer journey. As such, patients may be managed by a number of specialties, resulting in inconsistent practice and suboptimal care. We describe the development of a dedicated CAT service and its evaluation. Specialist cancer centre, district general hospital and primary care. Patients with CAT and their referring clinicians. A cross specialty team developed a dedicated CAT service , including clear referral pathways, consistent access to medicines, patient's information and a specialist clinic. The service was evaluated using a mixed-methods evaluation , including audits of clinical practice, clinical outcomes, staff surveys and qualitative interviewing of patients and healthcare professionals. Data from 457 consecutive referrals over an 18-month period were evaluated. The CAT service has led to an 88% increase in safe and consistent community prescribing of low-molecular-weight heparin, with improved access to specialist advice and information. Patients reported improved understanding of their condition, enabling better self-management as well as better access to support and information. Referring clinicians reported better care standards for their patients with improved access to expertise and appropriate management. A dedicated CAT service improves overall standards of care and is viewed positively by patients and clinicians alike. Further health economic evaluation would enhance the case for establishing this as the standard model of care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Effectiveness of 6 Months of Tailored Text Message Reminders for Obese Male Participants in a Worksite Weight Loss Program: Randomized Controlled Trial

PubMed Central

Oh, Sohee; Steinhubl, Steven; Kim, Sohye; Bae, Woo Kyung; Han, Jong Soo; Kim, Jeong-Hyun; Lee, Keehyuck; Kim, Mi Jin

2015-01-01

Background Worksite nutrition and physical activity interventions are important to help overweight and obese employees lose weight, but costs and insufficient sustained motivation prevent the majority of these programs from succeeding. Tailored text messaging in aiding weight management has been effective in several studies, but no studies have evaluated the effect of a tailored text message service on weight loss in a worksite health promotion program. Objective We studied the efficacy of a tailored text-messaging intervention for obese male participants in a worksite weight loss program of 6 months duration. Methods The study was an unblinded, randomized controlled trial. Men with a body mass index greater than 25 kg/m2 were recruited from the Korea District Heating Corporation, the Korea Expressway Corporation, and the Korea Gas Corporation. The participants were identified by nurse managers. Participants were randomly allocated to 1 of the following 2 groups for 24 weeks: (1) intervention group, which received tailored text message reminders every other day plus 4 offline education sessions and brief counseling with monthly weight check by nurses for weight control over 6 months and (2) control group, which received the 4 offline education sessions and brief counseling with monthly weight check by nurses about weight control over 6 months. The primary outcome was the difference in weight loss at 6 months. A mixed-model repeated-measures analysis was performed to evaluate the effect of the intervention group’s weight loss compared with the control group. Results A total of 205 obese men were randomized into either the intervention (n=104) or the control group (n=101). At the end of 6 months, the intervention group (n=63) had lost 1.71 kg (95% CI –2.53 to –0.88) and the control group (n=59) had lost 1.56 kg (95% CI –2.45 to –0.66); the difference between the 2 groups was not significant (mean difference –0.15, 95% CI –1.36 to 1.07). At the end of the study, 60% (34/57) of the intervention group rated the message program as helpful for weight control and 46% (26/57) would recommend the text message service to their friends. Conclusions Tailored text message reminders did not have a significant effect on weight loss in obese men as part of a worksite weight loss program. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 39629189; http://www.isrctn.com/ISRCTN39629189?q=39629189&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search (Archived by WebCite at http://www.webcitation.org/6VsFkwJH6). PMID:25648325

The Diabetes Remission Clinical Trial (DiRECT): protocol for a cluster randomised trial.

PubMed

Leslie, Wilma S; Ford, Ian; Sattar, Naveed; Hollingsworth, Kieren G; Adamson, Ashley; Sniehotta, Falko F; McCombie, Louise; Brosnahan, Naomi; Ross, Hazel; Mathers, John C; Peters, Carl; Thom, George; Barnes, Alison; Kean, Sharon; McIlvenna, Yvonne; Rodrigues, Angela; Rehackova, Lucia; Zhyzhneuskaya, Sviatlana; Taylor, Roy; Lean, Mike E J

2016-02-16

Despite improving evidence-based practice following clinical guidelines to optimise drug therapy, Type 2 diabetes (T2DM) still exerts a devastating toll from vascular complications and premature death. Biochemical remission of T2DM has been demonstrated with weight loss around 15kg following bariatric surgery and in several small studies of non-surgical energy-restriction treatments. The non-surgical Counterweight-Plus programme, running in Primary Care where obesity and T2DM are routinely managed, produces >15 kg weight loss in 33% of all enrolled patients. The Diabetes UK-funded Counterpoint study suggested that this should be sufficient to reverse T2DM by removing ectopic fat in liver and pancreas, restoring first-phase insulin secretion. The Diabetes Remission Clinical Trial (DiRECT) was designed to determine whether a structured, intensive, weight management programme, delivered in a routine Primary Care setting, is a viable treatment for achieving durable normoglycaemia. Other aims are to understand the mechanistic basis of remission and to identify psychological predictors of response. Cluster-randomised design with GP practice as the unit of randomisation: 280 participants from around 30 practices in Scotland and England will be allocated either to continue usual guideline-based care or to add the Counterweight-Plus weight management programme, which includes primary care nurse or dietitian delivery of 12-20weeks low calorie diet replacement, food reintroduction, and long-term weight loss maintenance. Main inclusion criteria: men and women aged 20-65 years, all ethnicities, T2DM 0-6years duration, BMI 27-45 kg/m(2). Tyneside participants will undergo Magnetic Resonance (MR) studies of pancreatic and hepatic fat, and metabolic studies to determine mechanisms underlying T2DM remission. Co-primary endpoints: weight reduction ≥ 15 kg and HbA1c <48 mmol/mol at one year. Further follow-up at 2 years. This study will establish whether a structured weight management programme, delivered in Primary Care by practice nurses or dietitians, is a viable treatment to achieve T2DM remission. Results, available from 2018 onwards, will inform future service strategy. Current Controlled Trials ISRCTN03267836 . Date of Registration 20/12/2013.

Combination of GRACE monthly gravity field solutions from different processing strategies

NASA Astrophysics Data System (ADS)

Jean, Yoomin; Meyer, Ulrich; Jäggi, Adrian

2018-02-01

We combine the publicly available GRACE monthly gravity field time series to produce gravity fields with reduced systematic errors. We first compare the monthly gravity fields in the spatial domain in terms of signal and noise. Then, we combine the individual gravity fields with comparable signal content, but diverse noise characteristics. We test five different weighting schemes: equal weights, non-iterative coefficient-wise, order-wise, or field-wise weights, and iterative field-wise weights applying variance component estimation (VCE). The combined solutions are evaluated in terms of signal and noise in the spectral and spatial domains. Compared to the individual contributions, they in general show lower noise. In case the noise characteristics of the individual solutions differ significantly, the weighted means are less noisy, compared to the arithmetic mean: The non-seasonal variability over the oceans is reduced by up to 7.7% and the root mean square (RMS) of the residuals of mass change estimates within Antarctic drainage basins is reduced by 18.1% on average. The field-wise weighting schemes in general show better performance, compared to the order- or coefficient-wise weighting schemes. The combination of the full set of considered time series results in lower noise levels, compared to the combination of a subset consisting of the official GRACE Science Data System gravity fields only: The RMS of coefficient-wise anomalies is smaller by up to 22.4% and the non-seasonal variability over the oceans by 25.4%. This study was performed in the frame of the European Gravity Service for Improved Emergency Management (EGSIEM; http://www.egsiem.eu) project. The gravity fields provided by the EGSIEM scientific combination service (ftp://ftp.aiub.unibe.ch/EGSIEM/) are combined, based on the weights derived by VCE as described in this article.

Obesity: which drug and when?

PubMed

Lean, M; Mullan, A

2007-09-01

Obesity, with all its consequences, is audaciously confronting medical professionals and health service providers worldwide. Diet and exercise intervention is an essential part of any weight management strategy, but may not succeed in isolation. Effective approaches for routine practice are more likely to involve affordable, efficacious and well-tolerated drug therapy than the more expensive, case selective approach of bariatric surgery. Advancement of pharmacotherapy is expanding the battery of available drugs; the clinician is faced with an increasingly complex therapeutic decision. Which drug to use, and when, is influenced by a range of factors, discussed here. There is a large body of high quality evidence in the literature to support the presently available drugs; however, many questions remain unanswered including duration of therapy and whether longer-term goals of improved morbidity and mortality are achievable. Clinician and patient awareness of these issues will provide a more informed therapeutic decision and ultimately improve the potential for reaching the weight management targets.

Carbon storage, timber production, and biodiversity: comparing ecosystem services with multi-criteria decision analysis

USGS Publications Warehouse

Schwenk, W. Scott; Donovan, Therese; Keeton, William S.; Nunery, Jared S.

2012-01-01

Increasingly, land managers seek ways to manage forests for multiple ecosystem services and functions, yet considerable challenges exist in comparing disparate services and balancing trade-offs among them. We applied multi-criteria decision analysis (MCDA) and forest simulation models to simultaneously consider three objectives: (1) storing carbon, (2) producing timber and wood products, and (3) sustaining biodiversity. We used the Forest Vegetation Simulator (FVS) applied to 42 northern hardwood sites to simulate forest development over 100 years and to estimate carbon storage and timber production. We estimated biodiversity implications with occupancy models for 51 terrestrial bird species that were linked to FVS outputs. We simulated four alternative management prescriptions that spanned a range of harvesting intensities and forest structure retention. We found that silvicultural approaches emphasizing less frequent harvesting and greater structural retention could be expected to achieve the greatest net carbon storage but also produce less timber. More intensive prescriptions would enhance biodiversity because positive responses of early successional species exceeded negative responses of late successional species within the heavily forested study area. The combinations of weights assigned to objectives had a large influence on which prescriptions were scored as optimal. Overall, we found that a diversity of silvicultural approaches is likely to be preferable to any single approach, emphasizing the need for landscape-scale management to provide a full range of ecosystem goods and services. Our analytical framework that combined MCDA with forest simulation modeling was a powerful tool in understanding trade-offs among management objectives and how they can be simultaneously accommodated.

Identification of the need for home visiting nurse: development of a new assessment tool

PubMed Central

Taguchi, Atsuko; Nagata, Satoko; Naruse, Takashi; Kuwahara, Yuki; Yamaguchi, Takuhiro; Murashima, Sachiyo

2014-01-01

Objective To develop a Home Visiting Nursing Service Need Assessment Form (HVNS-NAF) to standardize the decision about the need for home visiting nursing service. Methods The sample consisted of older adults who had received coordinated services by care managers. We defined the need for home visiting nursing service by elderly individuals as the decision of the need by a care manager so that the elderly can continue to live independently. Explanatory variables included demographic factors, medical procedure, severity of illness, and caregiver variables. Multiple logistic regression was carried out after univariate analyses to decide the variables to include and the weight of each variable in the HVNS-NAF. We then calculated the sensitivity and specificity of each cutoff value, and defined the score with the highest sensitivity and specificity as the cutoff value. Results Nineteen items were included in the final HVNS-NAF. When the cutoff value was 2 points, the sensitivity was 77.0%, specificity 68.5%, and positive predictive value 56.8%. Conclusions HVNS-NAF is the first validated standard based on characteristics of elderly clients who required home visiting nursing service. Using the HVNS-NAF may result in reducing the unmet need for home visiting nursing service and preventing hospitalization. PMID:24665229

Federal Parity and Access to Behavioral Health Care in Private Health Plans.

PubMed

Hodgkin, Dominic; Horgan, Constance M; Stewart, Maureen T; Quinn, Amity E; Creedon, Timothy B; Reif, Sharon; Garnick, Deborah W

2018-04-01

The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) sought to improve access to behavioral health care by regulating health plans' coverage and management of services. Health plans have some discretion in how to achieve compliance with MHPAEA, leaving questions about its likely effects on health plan policies. In this study, the authors' objective was to determine how private health plans' coverage and management of behavioral health treatment changed after the federal parity law's full implementation. A nationally representative survey of commercial health plans was conducted in 60 market areas across the continental United States, achieving response rates of 89% in 2010 (weighted N=8,431) and 80% in 2014 (weighted N=6,974). Senior executives at responding plans were interviewed regarding behavioral health services in each year and (in 2014) regarding changes. Student's t tests were used to examine changes in services covered, cost-sharing, and prior authorization requirements for both behavioral health and general medical care. In 2014, 68% of insurance products reported having expanded behavioral health coverage since 2010. Exclusion of eating disorder coverage was eliminated between 2010 (23%) and 2014 (0%). However, more products reported excluding autism treatment in 2014 (24%) than 2010 (8%). Most plans reported no change to prior-authorization requirements between 2010 and 2014. Implementation of federal parity legislation appears to have been accompanied by continuing improvement in behavioral health coverage. The authors did not find evidence of widespread noncompliance or of unintended effects, such as dropping coverage of behavioral health care altogether.

Managing Patient-Generated Health Data Through Mobile Personal Health Records: Analysis of Usage Data.

PubMed

Park, Yu Rang; Lee, Yura; Kim, Ji Young; Kim, Jeonghoon; Kim, Hae Reong; Kim, Young-Hak; Kim, Woo Sung; Lee, Jae-Ho

2018-04-09

Personal health records (PHRs) and mHealth apps are considered essential tools for patient engagement. Mobile PHRs (mPHRs) can be a platform to integrate patient-generated health data (PGHD) and patients' medical information. However, in previous studies, actual usage data and PGHD from mPHRs have not been able to adequately represent patient engagement. By analyzing 5 years' PGHD from an mPHR system developed by a tertiary hospital in South Korea, we aimed to evaluate how PGHD were managed and identify issues in PGHD management based on actual usage data. Additionally, we analyzed how to improve patient engagement with mPHRs by analyzing the actively used services and long-term usage patterns. We gathered 5 years (December 2010 to December 2015) of log data from both hospital patients and general users of the app. We gathered data from users who entered PGHD on body weight, blood pressure (BP), blood glucose levels, 10-year cardiovascular disease (CVD) risk, metabolic syndrome risk, medication schedule, insulin, and allergy. We classified users according to whether they were patients or general users based on factors related to continuous use (≥28 days for weight, BP, and blood glucose, and ≥180 days for CVD and metabolic syndrome), and analyzed the patients' characteristics. We compared PGHD entry counts and the proportion of continuous users for each PGHD by user type. The total number of mPHR users was 18,265 (patients: n=16,729, 91.59%) with 3620 users having entered weight, followed by BP (n=1625), blood glucose (n=1374), CVD (n=764), metabolic syndrome (n=685), medication (n=252), insulin (n=72), and allergy (n=61). Of those 18,256 users, 3812 users had at least one PGHD measurement, of whom 175 used the PGHD functions continuously (patients: n=142, 81.14%); less than 1% of the users had used it for more than 4 years. Except for weight, BP, blood glucose, CVD, and metabolic syndrome, the number of PGHD records declined. General users' continuous use of PGHD was significantly higher than that of patients in the blood glucose (P<.001) and BP (P=.03) functions. Continuous use of PGHD in health management (BP, blood glucose, and weight) was significantly greater among older users (P<.001) and men (P<.001). In health management (BP, weight, and blood glucose), overall chronic disease and continuous use of PGHD were not statistically related (P=.08), but diabetes (P<.001) and cerebrovascular diseases (P=.03) were significant. Although a small portion of users managed PGHD continuously, PGHD has the potential to be useful in monitoring patient health. To realize the potential, specific groups of continuous users must be identified, and the PGHD service must target them. Further evaluations for the clinical application of PGHD, feedback regarding user interfaces, and connections with wearable devices are needed. ©Yu Rang Park, Yura Lee, Ji Young Kim, Jeonghoon Kim, Hae Reong Kim, Young-Hak Kim, Woo Sung Kim, Jae-Ho Lee. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 09.04.2018.

Users' perception as a tool to improve urban beach planning and management.

PubMed

Cervantes, Omar; Espejel, Ileana; Arellano, Evarista; Delhumeau, Sheila

2008-08-01

Four beaches that share physiographic characteristics (sandy, wide, and long) but differ in socioeconomic and cultural terms (three are located in northwestern Mexico and one in California, USA) were evaluated by beach users. Surveys (565) composed of 36 questions were handed out to beach users on weekends and holidays in 2005. The 25 questions that revealed the most information were selected by factor analysis and classified by cluster analysis. Beach users' preferences were assigned a value by comparing the present survey results with the characteristics of an "ideal" recreational urban beach. Cluster analysis separated three groups of questions: (a) services and infrastructure, (b) recreational activities, and (c) beach conditions. Cluster linkage distance (r=0.82, r=0.78, r=0.67) was used as a weight and multiplied by the value of beach descriptive factors. Mazatlán and Oceanside obtained the highest values because there are enough infrastructure and services; on the contrary, Ensenada and Rosarito were rated medium and low because infrastructure and services are lacking. The presently proposed method can contribute to improving current beach evaluations because the final score represents the beach users' evaluation of the quality of the beach. The weight considered in the present study marks the beach users' preferences among the studied beaches. Adding this weight to beach evaluation will contribute to more specific beach planning in which users' perception is considered.

Users' Perception as a Tool to Improve Urban Beach Planning and Management

NASA Astrophysics Data System (ADS)

Cervantes, Omar; Espejel, Ileana; Arellano, Evarista; Delhumeau, Sheila

2008-08-01

Four beaches that share physiographic characteristics (sandy, wide, and long) but differ in socioeconomic and cultural terms (three are located in northwestern Mexico and one in California, USA) were evaluated by beach users. Surveys (565) composed of 36 questions were handed out to beach users on weekends and holidays in 2005. The 25 questions that revealed the most information were selected by factor analysis and classified by cluster analysis. Beach users’ preferences were assigned a value by comparing the present survey results with the characteristics of an “ideal” recreational urban beach. Cluster analysis separated three groups of questions: (a) services and infrastructure, (b) recreational activities, and (c) beach conditions. Cluster linkage distance ( r = 0.82, r = 0.78, r = 0.67) was used as a weight and multiplied by the value of beach descriptive factors. Mazatlán and Oceanside obtained the highest values because there are enough infrastructure and services; on the contrary, Ensenada and Rosarito were rated medium and low because infrastructure and services are lacking. The presently proposed method can contribute to improving current beach evaluations because the final score represents the beach users’ evaluation of the quality of the beach. The weight considered in the present study marks the beach users’ preferences among the studied beaches. Adding this weight to beach evaluation will contribute to more specific beach planning in which users’ perception is considered.

Comparing methodologies for the allocation of overhead and capital costs to hospital services.

PubMed

Tan, Siok Swan; van Ineveld, Bastianus Martinus; Redekop, William Ken; Hakkaart-van Roijen, Leona

2009-06-01

Typically, little consideration is given to the allocation of indirect costs (overheads and capital) to hospital services, compared to the allocation of direct costs. Weighted service allocation is believed to provide the most accurate indirect cost estimation, but the method is time consuming. To determine whether hourly rate, inpatient day, and marginal mark-up allocation are reliable alternatives for weighted service allocation. The cost approaches were compared independently for appendectomy, hip replacement, cataract, and stroke in representative general hospitals in The Netherlands for 2005. Hourly rate allocation and inpatient day allocation produce estimates that are not significantly different from weighted service allocation. Hourly rate allocation may be a strong alternative to weighted service allocation for hospital services with a relatively short inpatient stay. The use of inpatient day allocation would likely most closely reflect the indirect cost estimates obtained by the weighted service method.

Feasibility and acceptability of a physician-delivered weight management programme.

PubMed

Sturgiss, Elizabeth A; Elmitt, Nicholas; Haesler, Emily; van Weel, Chris; Douglas, Kirsty

2017-02-01

Primary health care requires new approaches to assist patients with overweight and obesity. This is a particular concern for patients with limited access to specialist or allied health services due to financial cost or location. The Change Program is a toolkit that provides a structured approach for GPs working with patients on weight management. To assess the acceptability and feasibility of a GP-delivered weight management programme. A feasibility trial in five Australian general practices with 12 GPs and 23 patients. Mixed methods were used to assess the objective through participant interviews, online surveys and the NOrmalization MeAsure Development (NoMAD) tool based on Normalization Process Theory. Content analysis of interviews is presented alongside Likert scales, free text and the NoMAD tool. The Change Program was acceptable to most GPs and patients. It was best suited to patient-GP dyads where the patient felt a strong preference for GP involvement. Patients' main concerns were the time and possible cost associated with the programme if run outside a research setting. For sustainable implementation, it would have been preferable to recruit a whole practice rather than single GPs to enable activation of systems to support the programme. A GP-delivered weight management programme is feasible and acceptable for patients with obesity in Australian primary health care. The addition of this structured toolkit to support GPs is particularly important for patients with a strong preference for GP involvement or who are unable to access other resources due to cost or location. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Risk management for optimal land use planning integrating ecosystem services values: A case study in Changsha, Middle China.

PubMed

Liang, Jie; Zhong, Minzhou; Zeng, Guangming; Chen, Gaojie; Hua, Shanshan; Li, Xiaodong; Yuan, Yujie; Wu, Haipeng; Gao, Xiang

2017-02-01

Land-use change has direct impact on ecosystem services and alters ecosystem services values (ESVs). Ecosystem services analysis is beneficial for land management and decisions. However, the application of ESVs for decision-making in land use decisions is scarce. In this paper, a method, integrating ESVs to balance future ecosystem-service benefit and risk, is developed to optimize investment in land for ecological conservation in land use planning. Using ecological conservation in land use planning in Changsha as an example, ESVs is regarded as the expected ecosystem-service benefit. And uncertainty of land use change is regarded as risk. This method can optimize allocation of investment in land to improve ecological benefit. The result shows that investment should be partial to Liuyang City to get higher benefit. The investment should also be shifted from Liuyang City to other regions to reduce risk. In practice, lower limit and upper limit for weight distribution, which affects optimal outcome and selection of investment allocation, should be set in investment. This method can reveal the optimal spatial allocation of investment to maximize the expected ecosystem-service benefit at a given level of risk or minimize risk at a given level of expected ecosystem-service benefit. Our results of optimal analyses highlight tradeoffs between future ecosystem-service benefit and uncertainty of land use change in land use decisions. Copyright © 2016 Elsevier B.V. All rights reserved.

Military Services Fitness Database: Development of a Computerized Physical Fitness and Weight Management Database for the U.S. Army

DTIC Science & Technology

2009-01-01

lilt’ \\P1T \\ p,I,𔃻 ’lloch .11 \\\\"lIl.k.-k \\1�\\ \\Inh,.ll t <�<𔃻 1,ŕ Br... ~’ J.’llk ’’’󈧏 ’’’’\\I Ih"l Ill<" mnh ,’,lll’ �’.111\\1" ’hill:! Ih

Wide-Area Traffic Management for Cloud Services

DTIC Science & Technology

2012-04-01

performance prediction tools [11], which are usually load oblivious. Therefore, without information about link loads and capacities, a CDN may direct...powerful tool . DONAR allows its customers to dictate a replica’s (i) split weight, wi, the desired proportion of requests that a particular replica i...Diagnostic Tool (NDT) [100], which is used for the Federal Communication Commission’s Consumer Broadband Test, and NPAD [101]—are more closely integrated with

Coal gasification systems engineering and analysis. Appendix H: Work breakdown structure

NASA Technical Reports Server (NTRS)

1980-01-01

A work breakdown structure (WBS) is presented which encompasses the multiple facets (hardware, software, services, and other tasks) of the coal gasification program. The WBS is shown to provide the basis for the following: management and control; cost estimating; budgeting and reporting; scheduling activities; organizational structuring; specification tree generation; weight allocation and control; procurement and contracting activities; and serves as a tool for program evaluation.

Assessment of global water security: moving beyond water scarcity assessment

NASA Astrophysics Data System (ADS)

Wada, Y.; Gain, A. K.; Giupponi, C.

2015-12-01

Water plays an important role in underpinning equitable, stable and productive societies, and the ecosystems on which we depend. Many international river basins are likely to experience 'low water security' over the coming decades. Hence, ensuring water security along with energy and food securities has been recognised as priority goals in Sustainable Development Goals (SDGs) by the United Nations. This water security is not rooted only in the limitation of physical resources, i.e. the shortage in the availability of freshwater relative to water demand, but also on social and economic factors (e.g. flawed water planning and management approaches, institutional incapability to provide water services, unsustainable economic policies). Until recently, advanced tools and methods are available for assessment of global water scarcity. However, integrating both physical and socio-economic indicators assessment of water security at global level is not available yet. In this study, we present the first global understanding of water security using a spatial multi-criteria analysis framework that goes beyond available water scarcity assessment. For assessing water security at global scale, the term 'security' is conceptualized as a function of 'availability', 'accessibility to services', 'safety and quality', and 'management'. The Water security index is calculated by aggregating the indicators using both simple additive weighting (SAW) and ordered weighted average (OWA).

Polycystic ovary syndrome and weight management.

PubMed

Moran, Lisa J; Lombard, Catherine B; Lim, Siew; Noakes, Manny; Teede, Helena J

2010-03-01

Polycystic ovary syndrome (PCOS) is a common condition in women of reproductive age, and has reproductive, metabolic and psychological implications. Weight gain and obesity worsen the features of PCOS, while weight loss improves the features of PCOS. While there are potential barriers to successful weight management in young women who do not suffer from PCOS, women with PCOS may experience additional barriers. Weight management strategies in younger women with or without PCOS should encompass both the prevention of excess weight gain and achieving and maintaining a reduced weight through multidisciplinary lifestyle management, comprising dietary, exercise and behavioral therapy, as well as attention to psychosocial stress and practical and physiological barriers to weight management. Further research is warranted in the examination of specific barriers to weight management in women with PCOS, as well as in the determination of optimal components of lifestyle weight management interventions in young women in order to facilitate long-term compliance.

Cost-effectiveness of sibutramine in the LOSE Weight Study: evaluating the role of pharmacologic weight-loss therapy within a weight management program.

PubMed

Malone, Daniel C; Raebel, Marsha A; Porter, Julie A; Lanty, Frances A; Conner, Douglas A; Gay, Elizabeth C; Merenich, John A; Vogel, Erin A

2005-01-01

the cost-effectiveness of drug therapy when used in conjunction with a weight management program (WMP) for treatment of obesity. The objective was to compare the cost-effectiveness of sibutramine (Meridia) plus a structured WMP versus only a structured WMP in both overweight and obese individuals. The core WMP was a physician-supervised, multidisciplinary program for which each enrollee paid $100 out of pocket. A cost-effectiveness analysis was performed based upon the results of a previously published randomized controlled trial conducted within a managed care organization. The target population for this study was obese or overweight persons. The perspective of the study was that of a managed care organization. The intervention consisted of subjects receiving a WMP with or without sibutramine. The primary outcomes of this study were (a) absolute change in body weight and percentage change in body weight over 12 months, (b) change in obesity-related and total medical costs from 12 months prior to enrollment through 12 months after enrollment, and (c) cost-effectiveness in terms of cost per pound of weight loss. All costs were adjusted to 2004 dollars using the respective components of the consumer price index for each medical service or medication. A total of 501 evaluable subjects were enrolled in the study, with 281 receiving sibutramine plus a structured WMP and 220 receiving only the structured WMP. The meanSD weight loss was significantly greater in the sibutramine (13.715.5 pounds, 4.8%) group than in the nondrug group (513.2 pounds, 2.2%) (P < 0.001). The change in obesity-related total cost was a median increase of $408 for the sibutramine group compared with $31 for the nondrug group (P < 0.001). The change in total health care cost was a median $1,279 increase in the sibutramine group compared with $271 for the nondrug group (P < 0.001). Adding sibutramine to the WMP increased the total cost by $44 per additional pound of weight loss (95% confidence interval, 42-46). Sensitivity analyses found that the results were sensitive to the price of sibutramine, whereas varying the cost of clinic visits did not substantially change the results. Patients enrolled in a WMP receiving sibutramine had greater weight loss and decrease in body mass index at greater cost than did patients enrolled in the same program who did not receive sibutramine. There were no observed savings in total health care resource utilization or cost in the sibutramine group compared with the nondrug group.

Practice nurse involvement in primary care depression management: an observational cost-effectiveness analysis

PubMed Central

2014-01-01

Background Most evidence on the effect of collaborative care for depression is derived in the selective environment of randomised controlled trials. In collaborative care, practice nurses may act as case managers. The Primary Care Services Improvement Project (PCSIP) aimed to assess the cost-effectiveness of alternative models of practice nurse involvement in a real world Australian setting. Previous analyses have demonstrated the value of high level practice nurse involvement in the management of diabetes and obesity. This paper reports on their value in the management of depression. Methods General practices were assigned to a low or high model of care based on observed levels of practice nurse involvement in clinical-based activities for the management of depression (i.e. percentage of depression patients seen, percentage of consultation time spent on clinical-based activities). Linked, routinely collected data was used to determine patient level depression outcomes (proportion of depression-free days) and health service usage costs. Standardised depression assessment tools were not routinely used, therefore a classification framework to determine the patient’s depressive state was developed using proxy measures (e.g. symptoms, medications, referrals, hospitalisations and suicide attempts). Regression analyses of costs and depression outcomes were conducted, using propensity weighting to control for potential confounders. Results Capacity to determine depressive state using the classification framework was dependent upon the level of detail provided in medical records. While antidepressant medication prescriptions were a strong indicator of depressive state, they could not be relied upon as the sole measure. Propensity score weighted analyses of total depression-related costs and depression outcomes, found that the high level model of care cost more (95% CI: -$314.76 to $584) and resulted in 5% less depression-free days (95% CI: -0.15 to 0.05), compared to the low level model. However, this result was highly uncertain, as shown by the confidence intervals. Conclusions Classification of patients’ depressive state was feasible, but time consuming, using the classification framework proposed. Further validation of the framework is required. Unlike the analyses of diabetes and obesity management, no significant differences in the proportion of depression-free days or health service costs were found between the alternative levels of practice nurse involvement. PMID:24422622

Postpartum weight self-management: a concept analysis.

PubMed

Ohlendorf, Jennifer M

2013-01-01

The aim of this concept analysis is to create a clear definition and framework to guide weight self-management research and promotion of healthy weight self-management during the postpartum period. A woman's ability to manage her weight through the postpartum transition has lifelong implications for her weight status. This concept analysis was guided by Walker and Avant (2005). A broad search of sources was performed, yielding 56 articles in which postpartum weight self-management was the main focus. From consideration of the attributes of postpartum weight self-management, a descriptive, situation-specific theory emerged: Postpartum weight self-management is a process by which the transition to motherhood is viewed by the woman as an opportunity to intentionally engage in healthy weight self-management behaviors by minimizing the salient inhibitors and maximizing the salient facilitators to action. This analysis provides a clarification of the process concept of postpartum weight self-management and its consequences, giving direction for measurement, clinical application, and further research. Future nursing interventions and research should be aimed at helping women to view the postpartum period as a normative transition in which they have the opportunity to take charge of their own health and the health of their family.

Weight Management

MedlinePlus

... Expectations & Goals Healthier Lifestyle Healthier Lifestyle Physical Fitness Food & Nutrition Sleep, Stress & Relaxation Emotions & Relationships HealthyYouTXT Tools Home » Weight Management Weight Management Fear of weight gain keeps a ...

Eating for 1, Healthy and Active for 2; feasibility of delivering novel, compact training for midwives to build knowledge and confidence in giving nutrition, physical activity and weight management advice during pregnancy

PubMed Central

2014-01-01

Background Women in Wales are more likely to be obese in pregnancy than in any other United Kingdom (UK) country. Midwives are ideally placed to explore nutrition, physical activity and weight management concerns however qualitative studies indicate they lack confidence in raising the sensitive issue of weight. Acknowledging this and the reality of finite time and resources, this study aimed to deliver compact training on nutrition, physical activity and weight management during pregnancy to increase the knowledge and confidence of midwives in this subject. Methods A compact training package for midwives was developed comprising of evidence based nutrition, physical activity and weight management guidance for pregnancy. Training was promoted via midwifery leads and delivered within the Health Board. Questionnaires based on statements from national public health guidance were used to assess changes in self-reported knowledge and confidence pre and post training. Descriptive statistics were applied and 95% confidence intervals were calculated. Results 43 midwives registered for training, 32 (74%) attended and completed the questionnaires. Although, pre training knowledge and confidence varied between participants, statistically significant improvements in self-reported knowledge and confidence were observed post training. 97% indicated knowledge of pregnancy specific food and nutrition messages as ‘better’ (95% CI 85 to 100), as opposed to 3% stating ‘stayed the same’ – 60% stated ‘much better’. 83% indicated confidence to explain the risks of raised BMI in pregnancy was either ‘much’ or ‘somewhat better’ (95% CI 66 to 93), as opposed to 17% stating ‘stayed the same’. 89% indicated confidence to discuss eating habits and physical activity was ‘much’ or ‘somewhat better’ (95% CI 73 to 97) as opposed to 11% stating ‘stayed the same’. Emergent themes highlighted that training was positively received and relevant to midwifery practice. Conclusions This study provides early indications that a compact nutrition, physical activity and weight management training package improves midwives self-reported knowledge and confidence. Cascading training across the midwifery service in the Health Board and conducting further studies to elicit longer term impact on midwifery practice and patient outcomes are recommended. PMID:24996422

Managed bumble bees (Bombus impatiens) (Hymenoptera: Apidae) caged with blueberry bushes at high density did not increase fruit set or fruit weight compared to open pollination

Treesearch

J. W. Campbell; J. O' Brien; J. H. Irvin; C. B. Kimmel; J. C. Daniels; J. D. Ellis

2017-01-01

Highbush blueberry (Vaccinium corymbosum L.) is an important crop grown throughout Florida. Currently, most blueberry growers use honey bees (Apis mellifera L.) to provide pollination services for highbush blueberries even though bumble bees (Bombus spp.) have been shown to be more efficient at pollinating blueberries on a per bee basis. In general, contribution of...

Littoral Combat Ship: Additional Testing and Improved Weight Management Needed Prior to Further Investments

DTIC Science & Technology

2014-07-01

monohull design with a steel hull and aluminum superstructure, while the Austal USA Independence variant (LCS 2 and other even- Background Seaframe...including Singapore; Malaysia ; Brunei; and Indonesia. The ship also conducted some real-world operations as directed by the 7th Fleet, such as...requirements for service life allowances already fall short of the growth margins called for under Navy and industry recommended practice.21 Table 8: Navy

Donor issues in Indonesia: A developing country in South East Asia.

PubMed

Soedarmono, Yuyun S M

2010-01-01

In most developing countries in South East Asia blood services have not been treated properly as an important service to support health program. Indonesia as a large archipelago country in South East Asia has specific obstacles in managing a blood service. To position the country blood service profile especially in term of donor issues, we compared our blood service with that in other South East Asia countries. Indonesia has 17 thousand islands with 220 million inhabitants. Blood services have been mostly run by the Indonesian Red Cross as a government assignment since 1950. Donor recruitment programs have been directed toward 100% of Voluntary Non Remunerated Blood Donor (VNRD), which now have reached 81.3%. Dissemination of information on VNRD, donor recruiter's training and VNRD appreciation programs are strategies to increase and maintain the VNRD. Limited female donors and insufficient blood supply during the fasting month and holidays constitute major challenges. Low hemoglobin level, low body weight and fear are reasons for low number of female donors. Poor management of blood stock during fasting month, long holidays and also poor networking of blood supply are reasons for insufficient blood supply during the year. Considering the great size of Indonesia with different ethnic groups and cultures, worsened by lack of infrastructure, decisive and effective strategies in donor recruitment and retention programs are needed. Copyright 2010 The International Association for Biologicals. Published by Elsevier Ltd. All rights reserved.

Conceptual Model of Weight Management in Overweight and Obese African-American Females.

PubMed

Sutton, Suzanne M; Magwood, Gayenell S; Nemeth, Lynne S; Jenkins, Carolyn M

2017-04-01

Weight management of overweight and obese (OWO) African-American females (AAFs) is a poorly defined concept, leading to ineffective treatment of overweight and obesity, prevention of health sequelae, and risk reduction. A conceptual model of the phenomenon of weight management in OWO AAFs was developed through dimensional analysis of the literature. Constructs were identified and sorted into the dimensions of perspective, context, conditions, process, and consequences and integrated into an explanatory matrix. Through dimensional analysis, weight management in OWO AAFs was characterized as a multidimensional concept, defined from the perspective of weight loss in community-dwelling AAFs. Behaviors associated with weight management are strongly influenced by intrinsic factors and extrinsic conditions, which influence engagement in the processes and consequences of weight management. The resulting conceptual model of weight management in OWO AAFs provides a framework for research interventions applicable in a variety of settings. © 2016 Wiley Periodicals, Inc.

Weight Change Following US Military Service

PubMed Central

Littman, Alyson J.; Jacobson, Isabel G.; Boyko, Edward J.; Powell, Teresa; Smith, Tyler C.

2014-01-01

Background Although overweight and obesity are less prevalent among active-duty military personnel compared with similar persons not serving in the military, no such differences have been observed between veterans and nonveterans. Objective To assess the magnitude of weight changes before, concurrent with, and following discharge from the military, relative to weight during service, and to determine the demographic, service-related, and psychological characteristics associated with clinically-important weight gain among those who were discharged from military service during follow-up. Methods Eligible Millennium Cohort Study participants (n=38,686) completed questionnaires approximately every three years (2001, 2004, and 2007) that were used to estimate annual weight changes, as well as the percentage experiencing clinically-important weight gain, defined as ≥10%. Analyses were stratified by sex. Results Weight gain was greatest around the time of discharge from service and in the 3 years prior to discharge (1.0–1.3 kg/year), while it was nearly half as much during service (0.6–0.7 kg/year) and three or more years after service ended (0.7 kg/year). Consequently, 6-year weight gain was over 2 kg greater in those who were discharged compared to those who remained in the military during follow-up (5.7 vs. 3.5 kg in men; 6.3 vs. 4.0 kg in women). In those who were discharged, younger age, less education, being overweight at baseline, being in the active duty component (vs. Reserve/National Guard), and having experienced deployment with combat exposures (vs. non-deployment) were associated with increased risks of clinically-important weight gain. Conclusions This study provides the first prospectively-collected evidence for an increased rate of weight gain around the time of military discharge that may explain previously reported higher rates of obesity in veterans, and identifies characteristics of higher risk groups. Discharge from military service presents a window of risk and opportunity to prevent unhealthy weight gain in military personnel and veterans. PMID:22491091

The role of population monitoring in the management of North American waterfowl

USGS Publications Warehouse

Nichols, J.D.; Williams, B.K.; Johnson, F.A.

2000-01-01

Despite the effort and expense devoted to large-scale monitoring programs, few existing programs have been designed with specific objectives in mind and few permit strong inferences about the dynamics of monitored systems. The waterfowl population monitoring programs of the U.S. Fish and Wildlife Service, Canadian Wildlife Service and state and provincial agencies provide a nice example with respect to program objectives, design and implementation. The May Breeding Grounds Survey provides an estimate of system state (population size) that serves two primary purposes in the adaptive management process: identifying the appropriate time-specific management actions and updating the information state (model weights) by providing a basis for evaluating predictions of competing models. Other waterfowl monitoring programs (e.g., banding program, hunter questionnaire survey, parts collection survey, winter survey) provide estimates of vital rates (rates of survival, reproduction and movement) associated with system dynamics and variables associated with management objectives (e.g., harvest). The reliability of estimates resulting from monitoring programs depends strongly on whether considerations about spatial variation and detection probability have been adequately incorporated into program design and implementation. Certain waterfowl surveys again provide nice examples of monitoring programs that incorporate these considerations.

Addressing childhood obesity at school entry: Qualitative experiences of school health professionals.

PubMed

Turner, Gillian L; Owen, Stephanie; Watson, Paula M

2016-09-01

School entry provides an opportune moment for health professionals to intervene with children who are overweight, yet identification and management of childhood obesity presents challenges in practice. This multi-method qualitative study explored the experiences of 26 school health professionals in addressing childhood obesity at school entry. Methods included semi-structured interviews with service managers (n = 3); focus groups with school nurses (n = 12) and child health practitioners (n = 6); and open-ended questionnaires with school nurses (n = 4) and child health practitioners (n = 1) who were unable to attend the focus groups. A thematic analysis revealed agreement between service managers, school nurses and child health practitioners. Whilst it was felt school health professionals have an important role to play in managing childhood obesity, efforts to address child weight were limited by a lack of capacity, lack of clear protocols, challenges of engaging parents and insufficient training in childhood obesity and related lifestyle issues. School health policymakers need to recognize childhood obesity as a serious public health issue, allocate appropriate resources to nurse training and development and ensure clear pathways are established to ensure consistency of care. © The Author(s) 2015.

Unmet needs in obesity management: From guidelines to clinic.

PubMed

Ritten, Angela; LaManna, Jacqueline

2017-10-01

Despite the rather slow acceptance of obesity as a disease state, several obesity staging systems and weight-management guidelines have been developed and are in use, along with an ever-growing number of treatment options. Many primary care clinicians, including nurse practitioners (NPs), are at the forefront of clinical efforts to assist individuals with obesity, but face challenges due to lack of alignment and consensus among the various staging systems and guidelines. This is further complicated by shortfalls in clinical training related to obesity management and increasing complexities in reimbursement for obesity-related services. Unmet needs in the management of obesity thus stretch from guidelines to clinic. This article examines the principal barriers to effective management of individuals with obesity and considers how concerns might be overcome, with particular emphasis on the role of the NP. ©2017 American Association of Nurse Practitioners.

When weight management lasts. Lower perceived rule complexity increases adherence.

PubMed

Mata, Jutta; Todd, Peter M; Lippke, Sonia

2010-02-01

Maintaining behavior change is one of the major challenges in weight management and long-term weight loss. We investigated the impact of the cognitive complexity of eating rules on adherence to weight management programs. We studied whether popular weight management programs can fail if participants find the rules too complicated from a cognitive perspective, meaning that individuals are not able to recall or process all required information for deciding what to eat. The impact on program adherence of participants' perceptions of eating rule complexity and other behavioral factors known to influence adherence (including previous weight management, self-efficacy, and planning) was assessed via a longitudinal online questionnaire given to 390 participants on two different popular weight management regimens. As we show, the regimens, Weight Watchers and a popular German recipe diet (Brigitte), strongly differ in objective rule complexity and thus their cognitive demands on the dieter. Perceived rule complexity was the strongest factor associated with increased risk of quitting the cognitively demanding weight management program (Weight Watchers); it was not related to adherence length for the low cognitive demand program (Brigitte). Higher self-efficacy generally helped in maintaining a program. The results emphasize the importance of considering rule complexity to promote long-term weight management. 2009 Elsevier Ltd. All rights reserved.

Weight expectations, motivations for weight change and perceived factors influencing weight management in young Australian women: a cross-sectional study.

PubMed

Holley, Talisha J; Collins, Clare E; Morgan, Philip J; Callister, Robin; Hutchesson, Melinda J

2016-02-01

To examine young Australian women's weight expectations, motivations for weight change and perceived factors influencing weight management, and to determine if these factors differ by age, BMI, marital status, education or income. Cross-sectional study. An online survey captured respondents' weight, height, ideal weight, main reasons for wanting to change their weight and challenges to managing their weight. Online survey in Australia. Six hundred and twenty women aged 18-30 years currently living in Australia who completed the survey between 31 July and 30 September 2012. Approximately half of participants (53·1 %) were a healthy weight, 25·2 % overweight and 19·0 % obese. Women unhappy at their current weight (78·1 %) reported a median ideal weight -12·3 % less than their current weight. The key motivators for weight change were to improve health (24·4 %, ranked 1), feel better in oneself (22·3 %) and improve self-confidence (21·5 %). Lack of motivation, time constraints because of job commitments and cost were the most commonly reported factors influencing weight management. Age, BMI, marital status, education and income were found to influence weight expectations, motivations for weight change and/or factors perceived to influence weight management. The findings suggest potential implications for weight management interventions and public health messaging targeting young women, to improve long-term health outcomes. Strategies that promote the health benefits of physical activity and healthy eating, feeling better about oneself and improved self-confidence, and address the main factors influencing weight management including lack of motivation, time constraints and cost, may be used to engage this target group.

KSC-06pd1959

NASA Image and Video Library

2006-08-28

KENNEDY SPACE CENTER, FLA. - Crawler-transporter No. 2 nears Launch Pad 39B (in the background, right). The tip of the orange external tank can be seen above the rotating service structure surrounding the shuttle. The crawler is being moved nearby in the event the mission management team decides to roll back Space Shuttle Atlantis due to Hurricane Ernesto. The hurricane has been forecast on a heading north and east from Cuba, taking it along the eastern coast of Florida. NASA's lighted launch window extends to Sept. 13, but mission managers are hoping to launch on mission STS-115 by Sept. 7 to avoid a conflict with a Russian Soyuz rocket also bound for the International Space Station. The crawler is 131 feet long, 113 feet wide and 20 feet high. It weights 5.5 million pounds unloaded. The combined weight of crawler, mobile launcher platform and a space shuttle is 12 million pounds. Unloaded, the crawler moves at 2 mph. Loaded, the snail's pace slows to 1 mph. Photo credit: NASA/Kim Shiflett

KSC-06pd1958

NASA Image and Video Library

2006-08-28

KENNEDY SPACE CENTER, FLA. - Crawler-transporter No. 2 makes its way toward Launch Pad 39B (in the background). The tip of the orange external tank can be seen above the rotating service structure surrounding the shuttle. The crawler is being moved nearby in the event the mission management team decides to roll back Space Shuttle Atlantis due to Hurricane Ernesto. The hurricane has been forecast on a heading north and east from Cuba, taking it along the eastern coast of Florida. NASA's lighted launch window extends to Sept. 13, but mission managers are hoping to launch on mission STS-115 by Sept. 7 to avoid a conflict with a Russian Soyuz rocket also bound for the International Space Station. The crawler is 131 feet long, 113 feet wide and 20 feet high. It weights 5.5 million pounds unloaded. The combined weight of crawler, mobile launcher platform and a space shuttle is 12 million pounds. Unloaded, the crawler moves at 2 mph. Loaded, the snail's pace slows to 1 mph. Photo credit: NASA/Kim Shiflett

Designing for psychological change: individuals' reward and cost valuations in weight management.

PubMed

Hsu, Anne; Blandford, Ann

2014-06-26

Knowledge of the psychological constructs that underlie behavior offers valuable design opportunities for persuasive systems. We use the decision theory, which describes how behavior is underpinned by reward-cost valuations, as a framework for investigating such psychological constructs to deliver design objectives for weight management technologies. We applied a decision theory-based analysis in the domain of weight management to understand the rewards and costs that surround individuals' weight management behaviors, with the aim of uncovering design opportunities for weight management technologies. We conducted qualitative interviews with 15 participants who were or had been trying to lose weight. Thematic analysis was used to extract themes that covered the rewards and costs surrounding weight management behaviors. We supplemented our qualitative study with a quantitative survey of 100 respondents investigating the extent to which they agreed with statements reflecting themes from the qualitative study. The primary obstacles to weight management were the rewards associated with unhealthy choices, such as the pleasures of unhealthy foods and unrestricted consumption in social situations, and the significant efforts required to change habits, plan, and exercise. Psychological constructs that supported positive weight management included feeling good after making healthy choices, being good to oneself, experiencing healthy yet still delicious foods, and receiving social support and encouraging messages (although opinions about encouraging messages was mixed). A rewards-costs driven enquiry revealed a wide range of psychological constructs that contribute to discouraging and supporting weight management. The constructs extracted from our qualitative study were verified by our quantitative survey, in which the majority of respondents also reported similar thoughts and feelings. This understanding of the rewards and costs surrounding weight management offers a range of new opportunities for the design of weight management technologies that enhance the encouraging factors and alleviate the discouraging ones.

The Team to Address Bariatric Care in Canadian Children (Team ABC3): Team Grant Research Proposal.

PubMed

2017-10-05

Severe obesity (SO) in Canadian children remains poorly understood. However, based on international data, the prevalence of SO appears to be increasing and is associated with a number of psychosocial, bio-mechanical, and cardiometabolic health risks. The purpose of our national Team to Address Bariatric Care in Canadian Children (Team ABC3) is to develop and lead a series of inter-related studies to enhance the understanding and management of SO in Canadian children and adolescents (0-18 years). From 2015 to 2019, Team ABC3 will conduct a series of projects at the regional, provincial, and national levels using multiple methods and study designs to respond to key knowledge gaps by (i) generating evidence on the prevalence of SO and its impact on health services utilization in children using existing Canadian data sources from primary care settings, (ii) exploring contemporary definitions of SO that link with health outcomes, (iii) comparing and contrasting health risks across the continuum of SO, (iv) understanding potential barriers to and facilitators of treatment success in children with SO, and (v) examining innovative lifestyle and behavioral interventions designed to successfully manage SO in children and their families. Furthermore, to examine the impact of innovative interventions on the management SO, we will (vi) evaluate whether adding a health coach, who provides support via text, email, and/or phone, improves children's ability to adhere to a web-based weight management program and (vii) test the feasibility and impact of a community-based weight management program for pre-school children with SO and their parents that combines group-based parenting sessions with in-home visits. Our research aligns with national priorities in obesity research, brings together leading scientists, clinicians, and stakeholders from across Canada, and will inform health services delivery throughout the country to provide the best care possible for children with SO and their families.

Tools for Successful Weight Management in Primary Care

PubMed Central

Turer, Christy Boling

2015-01-01

Obesity is one of the most pervasive and costly public-health problems. Clinicians need effective tools to address weight management in primary care, including evaluation and communication methods, guideline-based weight-management interventions, and safe and effective weight-loss medications and surgery. The objective of this Grand-Rounds presentation is to provide practicing clinicians with the latest information regarding effective ways to care for and communicate with patients about weight loss; evidence-based guidelines for selecting weight-management therapies; and safety, efficacy, and adverse effects of weight-loss medications and surgery. PMID:26218666

48 CFR 237.7101 - Solicitation provisions and contract clauses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... and dry cleaning services to be provided on a bulk weight basis. (1) Insert a reasonable per pound..., Instruction to Offerors (Bulk Weight), in solicitations for laundry services to be provided on a bulk weight... laundry services on a bag type basis, insert reasonable per pound prices by bag type. (2) Insert an...

Use of a mobile phone diary for observing weight management and related behaviours.

PubMed

Mattila, Elina; Lappalainen, Raimo; Pärkkä, Juha; Salminen, Jukka; Korhonen, Ilkka

2010-01-01

We studied self-observations related to weight management recorded with a Wellness Diary application on a mobile phone. The data were recorded by 27 participants in a 12-week study, which included a short weight management lecture followed by independent usage of the Wellness Diary. We studied the validity of self-observed weight, and behavioural changes and weight patterns related to weight management success. Self-observed weight data tended to underestimate pre- and poststudy measurements, but there were high correlations between the measures (r >or= 0.80). The amount of physical activity correlated significantly with weight loss (r = 0.44) as did different measures representing healthy changes in dietary behaviours (r >or= 0.45). Weight changes and the weekly rhythms of weight indicated a strong tendency to compensate for high-risk periods among successful weight-losers compared to unsuccessful ones. These preliminary results suggest that the mobile phone diary is a valid tool for observing weight management and related behaviours.

The Association Between Management of the Board of Trustees and Its Effectiveness at Hospitals in Tabriz; 2011 to 2013.

PubMed

Masoudi Asl, Irvan; Iezadi, Shabnam; Akhavan Behbahani, Ali; Rahbari Bonab, Maryam

2015-06-01

Reforming the structure and improving care and service system, particularly at hospitals, are the main priorities of the health system. The board of trustees of the hospitals is the main proposed strategy in this field. Hospitals with board of trustees were created with the aim of improving accountability to the community and guaranteeing efficient management and attracting public support in running the hospital. The aim of this study was to investigate the association between hospital effectiveness and the board of trustee's management method. This cross-sectional study was conducted in Tabriz City, Iran, during the years 2011 to 2013. To assess the effectiveness of board of trustees' management, two hospitals in Tabriz City were compared. Hospitals selected through purposive typical case sampling method. Two hospitals had equal structure, same doctors, and both were gynecology hospitals of Tabriz City, but one of them was a gynecology hospital managed by the board of trustees and the other was managed by the chairman. The information about the five variables of hospital effectiveness was collected during the years 2011 to 2013 using standard lists and questionnaires, which were available in the hospitals; these variables included quality management, safety, medical equipment management, and patients and staff satisfaction. Then, each variable was weighted through the technique of hierarchical analysis and finally they were analyzed using SPSS 17 and Expert Choice 11. Among the five variables related to the effectiveness, safety showed to have the highest weight and medical equipment management had the lowest weight. According to the statistical analyses, the score of the effectiveness of the hospital with the board of trustees was 33.08 (on the scale of 0 - 100) and the score of the hospital with the chairperson was 29.52. No significant association was found between the effectiveness of hospital and the board of trustees management (P = 0.81). Because there was no significant difference in the effectiveness between hospitals with and without board of trustees, decision-makers must monitor how the commands are carried out to make board of trustees for hospitals and make sure its success in achieving its objectives.

A randomized comparison of a commercially available portion-controlled weight-loss intervention with a diabetes self-management education program

PubMed Central

Foster, G D; Wadden, T A; LaGrotte, C A; Vander Veur, S S; Hesson, L A; Homko, C J; Maschak-Carey, B J; Barbor, N R; Bailer, B; Diewald, L; Komaroff, E; Herring, S J; Vetter, M L

2013-01-01

Objective: This study examined the efficacy of a commercially available, portion-controlled diet (PCD) on body weight and HbA1c over 6 months in obese patients with type 2 diabetes. Research Design and Methods: One-hundred participants with a mean±s.d. age of 55.6±10.6 year, body weight of 102.9±18.4 kg and HbA1c of 7.7±1.3% were randomly assigned to a 9-session group lifestyle intervention that included a PCD or to a 9-session group program of diabetes self-management education (DSME). Participants in the two groups were prescribed the same goals for energy intake (1250–1550 kcal per day) and physical activity (200 min per week). Results: While both groups produced significant improvements in weight and HbA1c after 6 months of treatment, PCD participants lost 7.3 kg [95% confidence interval (CI): −5.8 to −8.8 kg], compared with 2.2 kg (95% CI: −0.7 to −3.7 kg) in the DSME group (P<0.0001). Significantly more PCD than DSME participants lost ⩾5% of initial weight (54.0% vs 14.0%, P<0.0001) and ⩾10% (26.0% vs 6.0%, P<0.0001). HbA1c declined by 0.7% (95% CI: −0.4 to −1.0%) in the PCD group, compared with 0.4% (95% CI: −0.1 to −0.7%) in DSME (P<0.026). Across both groups, larger weight losses were associated with greater reductions in HbA1c (r=0.52, P<0.0001). Conclusions: These findings demonstrate that a commercially available portion-controlled meal plan can induce clinically meaningful improvements in weight and glycemic control in obese individuals with type 2 diabetes. These data have implications for the management of obesity in primary care, as now provided by the Centers for Medicare and Medicaid Services. PMID:23507967

Food choice by people with intellectual disabilities at day centres: A qualitative study.

PubMed

Cartwright, Luke; Reid, Marie; Hammersley, Richard; Blackburn, Chrissie; Glover, Lesley

2015-06-01

People with intellectual disabilities experience a range of health inequalities. It is important to investigate possible contributory factors that may lead to these inequalities. This qualitative study identified some difficulties for healthy eating in day centres. (1) Service users and their family carers were aware of healthy food choices but framed these as diets for weight loss rather than as everyday eating. (2) Paid carers and managers regarded the principle of service user autonomy and choice as paramount, which meant that they felt limited in their capacity to influence food choices, which they attributed to the home environment. (3) Carers used food as a treat, a reward and for social bonding with service users. (4) Service users' food choices modelled other service users' and carers' choices at the time. It is suggested that healthy eating should be made more of a priority in day care, with a view to promoting exemplarily behaviour that might influence food choice at home. © The Author(s) 2014.

Strong, female and Black: Stereotypes of African Caribbean women's body shape and their effects on clinical encounters.

PubMed

Andrews, Nicole; Greenfield, Sheila; Drever, Will; Redwood, Sabi

2017-03-01

The aim of this article is to explore how tendencies to stereotype minority ethnic groups intersect with lay discourses about them in ways that can reproduce cultural prejudices and reinforce inequalities in access to services and health outcomes. Drawing upon Black feminist and cultural studies literature, we present a theoretical examination, the stereotypes of the Black woman as 'mammy' and 'matriarch'. We suggest that the influence of these two images is central to understanding the normalisation of the larger Black female body within African Caribbean communities. This representation of excess weight contradicts mainstream negative discourses of large bodies that view it as a form of moral weakness. Seeking to stimulate reflection on how unacknowledged stereotypes may shape clinical encounters, we propose that for Black women, it is the perception of strength, tied into these racial images of 'mammy' and 'matriarch' which may influence when or how health services or advice are both sought by them and offered to them. This has particular significance in relation to how body weight and weight management are/are not talked about in primary care-based interactions and what support Black women are/are not offered. We argue that unintentional bias can have tangible impacts and health outcomes for Black women and possibly other minority ethnic groups.

Efficacy and safety of a pharmacist-managed inpatient anticoagulation service for warfarin initiation and titration.

PubMed

Wong, Y M; Quek, Y-N; Tay, J C; Chadachan, V; Lee, H K

2011-10-01

Anticoagulation consultations provided by a pharmacist-staffed inpatient service, similar to the experience reported in outpatient anticoagulation clinics, can potentially improve anticoagulation control and outcomes. At Tan Tock Seng Hospital, a 1200-bed acute care teaching hospital in Singapore, pharmacist-managed anticoagulation clinics have been in place since 1997. Pharmacist-managed services were extended to inpatient consultations in anticoagulation management from April 2006. Our objective was to assess the effect of implementing a pharmacist-managed inpatient anticoagulation service. This was a single-centre cohort study. Baseline data from 1 January 2006 to 31 March 2006 were collected and compared with post-implementation data from 1 April 2006 to 31 March 2007. Patients newly started on warfarin for deep vein thrombosis, pulmonary embolism or atrial fibrillation in general medicine and surgery departments were included. The three endpoints were as follows: (i) percentage of international normalized ratios (INRs) achieving therapeutic range within 5 days, (ii) INRs more than 4 during titration and (iii) subtherapeutic INRs on discharge. A total of 26 patients in the control period were compared with 144 patients who had received dosing consultations by a pharmacist during the initiation of warfarin. The provision of pharmacist consult resulted in 88% compared to 38% (P < 0·001) of INR values achieving therapeutic range within 5 days. There was a reduction in INR values of more than 4 during titration from 27% to 2% (P < 0·001), and subtherapeutic INR values on discharge without low molecular weight heparin from 15% to 0% (P < 0·001). The mean time to therapeutic INR was reduced from 6·5 to 3·9 days (P < 0·001) and mean length of stay after initiation of warfarin from 11 to 7·7 days (P = 0·004). Inpatient anticoagulation care and outcomes were significantly improved by a pharmacist-managed anticoagulation service. The time to therapeutic INR was achieved appropriately and efficiently without compromising patient's safety. © 2010 The Authors. JCPT © 2010 Blackwell Publishing Ltd.

Availability and Accessibility of Student-Specific Weight Loss Programs and Other Risk Prevention Health Services on College Campuses

PubMed Central

Hayes, Sharon; Napolitano, Melissa; Hufnagel, Katrina

2016-01-01

Background More than one third of college students who are overweight or obese are in need of weight loss programs tailored to college students. However, the availability and accessibility of these programs is unknown. Objective The aim of this study is to examine the availability and ease of access to weight loss programs for students at 10 universities with the largest undergraduate enrollment. Methods The 10 public universities with the largest student bodies with a mean (SD) undergraduate enrollment of 41,122 (7657) students were examined. The websites of the universities were assessed to determine the availability of weight loss programs. Services for high-risk health needs common to university campuses (ie, alcohol and other drugs, victim services, sexual health, and eating disorders) were searched. Results Of the universities searched, 3 (30%, 3/10) offered weight loss programming, however, none met the predetermined criteria. Comparatively, all schools (100%, 10/10) offered no-cost and continual enrollment programming for the other high-risk health needs. Conclusions There are limited weight loss services available to undergraduate students compared with other university services. Collaboration between existing college health service providers is suggested for the delivery of appropriate programming for overweight and obese undergraduates wanting to lose weight. PMID:27278261

Managing Weight: What Do People with an Intellectual Disability Want from Mobile Technology?

PubMed

Smyth, Phil; McDowell, Claire; Leslie, Julian C; Leader, Geraldine; Donnelly, Mark; Simpson, Elizabeth; Skelly, Laura

2017-01-01

Obesity is a significant health challenge. People with Intellectual Disability (ID) are particularly vulnerable to developing obesity. Mobile technology has been developed to support the management of weight and obesity in the form of apps, although not with people with an ID in mind. As a result existing off-the-shelf weight management apps currently available may not be functional in supporting weight reduction within this population. This paper presents the results of consultations with people with ID regarding weight management, comfort with mobile technology and desired characteristics in apps designed for people with ID that target weight management.

Brief report: Weight dissatisfaction, weight status, and weight loss in Mexican-American children

USDA-ARS?s Scientific Manuscript database

The study objectives were to assess the association between weight dissatisfaction, weight status, and weight loss in Mexican-American children participating in a weight management program. Participants included 265 Mexican American children recruited for a school-based weight management program. Al...

Managed Bumble Bees (Bombus impatiens) (Hymenoptera: Apidae) Caged With Blueberry Bushes at High Density Did Not Increase Fruit Set or Fruit Weight Compared to Open Pollination.

PubMed

Campbell, J W; O'Brien, J; Irvin, J H; Kimmel, C B; Daniels, J C; Ellis, J D

2017-04-01

Highbush blueberry (Vaccinium corymbosum L.) is an important crop grown throughout Florida. Currently, most blueberry growers use honey bees (Apis mellifera L.) to provide pollination services for highbush blueberries even though bumble bees (Bombus spp.) have been shown to be more efficient at pollinating blueberries on a per bee basis. In general, contribution of bumble bees to the pollination of commercial highbush blueberries in Florida is unknown. Herein, we determined if managed bumble bees could contribute to highbush blueberry pollination. There were four treatments in this study: two treatments of caged commercial bumble bee (Bombus impatiens Cresson) colonies (low and high weight hives), a treatment excluding all pollinators, and a final treatment which allowed all pollinators (managed and wild pollinators) in the area have access to the plot. All treatments were located within a highbush blueberry field containing two cultivars of blooming plants, 'Emerald' and 'Millennia', with each cage containing 16 mature blueberry plants. We gathered data on fruit set, berry weight, and number of seeds produced per berry. When pollinators were excluded, fruit set was significantly lower in both cultivars (<8%) compared to that in all of the other treatments (>58%). Berry weight was not significantly different among the treatments, and the number of seeds per berry did not show a clear response. This study emphasizes the importance of bumble bees as an effective pollinator of blueberries and the potential beneficial implications of the addition of bumble bees in commercial blueberry greenhouses or high tunnels. © The Authors 2017. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The relationship between doctors' and nurses' own weight status and their weight management practices: a systematic review.

PubMed

Zhu, D Q; Norman, I J; While, A E

2011-06-01

It has been established that health professionals' smoking and physical activity influence their related health-promoting behaviours, but it is unclear whether health professionals' weight status also influences their related professional practices. A systematic review was conducted to understand the relationship between personal weight status and weight management practices. Nine eligible studies were identified from a search of the Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and Chinese databases. All included studies were cross-sectional surveys employing self-reported questionnaires. Weight management practice variables studied were classified under six practice indicators, developed from weight management guidelines. Syntheses of the findings from the selected studies suggest that: normal weight doctors and nurses were more likely than those who were overweight to use strategies to prevent obesity in-patients, and, also, provide overweight or obese patients with general advice to achieve weight loss. Doctors' and nurses' own weight status was not found to be significantly related to their referral and assessment of overweight or obese patients, and associations with their relevant knowledge/skills and specific treatment behaviours were inconsistent. Additionally, in female, primary care providers, relevant knowledge and training, self-efficacy and a clear professional identity emerged as positive predictors of weight management practices. This review's findings will need to be confirmed by prospective theoretically driven studies, which employ objective measures of weight status and weight management practices and involve multivariate analyses to identify the relative contribution of weight status to weight management. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.

The Association Between Residential Care Facility Manager's Educational Attainment and the Presence of Structural and Service Innovations.

PubMed

Davis, Jullet A

For many service-oriented firms, knowledge is a key commodity, and the process by which knowledge is codified is critical for firm survival. The administrator or top manager acts as the repository and disseminator of organizational knowledge. The purpose of this project is to examine the association between the administrator's educational attainment and innovation in residential care facilities. The study hypothesized that administrator academic education and certification or licensure would be positively associated with facility innovation. Data for this project comes from the 2010 National Survey of Residential Care Facilities. There were 2277 facilities included in the sample (weighted 30 811). Innovation, the dependent variable, was operationalized using 5 dichotomized measures: clinical information systems, pharmaceutical information systems, electronic health records, providing adult day care, and providing respite care. The data were analyzed using logistic regression. Overall, the results reveal that college education or certification/licensure increased the likelihood of technology use. In addition, those with a high school diploma and certification/licensure were more likely to use technology than were individuals who had, at a minimum, some college. The services models were not significant. It may be that the resources necessary to implement information systems vary substantially from the resources necessary to provide services.

Incorporation of Socio-Economic Features' Ranking in Multicriteria Analysis Based on Ecosystem Services for Marine Protected Area Planning

PubMed Central

Portman, Michelle E.; Shabtay-Yanai, Ateret; Zanzuri, Asaf

2016-01-01

Developed decades ago for spatial choice problems related to zoning in the urban planning field, multicriteria analysis (MCA) has more recently been applied to environmental conflicts and presented in several documented cases for the creation of protected area management plans. Its application is considered here for the development of zoning as part of a proposed marine protected area management plan. The case study incorporates specially-explicit conservation features while considering stakeholder preferences, expert opinion and characteristics of data quality. It involves the weighting of criteria using a modified analytical hierarchy process. Experts ranked physical attributes which include socio-economically valued physical features. The parameters used for the ranking of (physical) attributes important for socio-economic reasons are derived from the field of ecosystem services assessment. Inclusion of these feature values results in protection that emphasizes those areas closest to shore, most likely because of accessibility and familiarity parameters and because of data biases. Therefore, other spatial conservation prioritization methods should be considered to supplement the MCA and efforts should be made to improve data about ecosystem service values farther from shore. Otherwise, the MCA method allows incorporation of expert and stakeholder preferences and ecosystem services values while maintaining the advantages of simplicity and clarity. PMID:27183224

Incorporation of Socio-Economic Features' Ranking in Multicriteria Analysis Based on Ecosystem Services for Marine Protected Area Planning.

PubMed

Portman, Michelle E; Shabtay-Yanai, Ateret; Zanzuri, Asaf

2016-01-01

Developed decades ago for spatial choice problems related to zoning in the urban planning field, multicriteria analysis (MCA) has more recently been applied to environmental conflicts and presented in several documented cases for the creation of protected area management plans. Its application is considered here for the development of zoning as part of a proposed marine protected area management plan. The case study incorporates specially-explicit conservation features while considering stakeholder preferences, expert opinion and characteristics of data quality. It involves the weighting of criteria using a modified analytical hierarchy process. Experts ranked physical attributes which include socio-economically valued physical features. The parameters used for the ranking of (physical) attributes important for socio-economic reasons are derived from the field of ecosystem services assessment. Inclusion of these feature values results in protection that emphasizes those areas closest to shore, most likely because of accessibility and familiarity parameters and because of data biases. Therefore, other spatial conservation prioritization methods should be considered to supplement the MCA and efforts should be made to improve data about ecosystem service values farther from shore. Otherwise, the MCA method allows incorporation of expert and stakeholder preferences and ecosystem services values while maintaining the advantages of simplicity and clarity.

Designing for Psychological Change: Individuals’ Reward and Cost Valuations in Weight Management

PubMed Central

Blandford, Ann

2014-01-01

Background Knowledge of the psychological constructs that underlie behavior offers valuable design opportunities for persuasive systems. We use the decision theory, which describes how behavior is underpinned by reward-cost valuations, as a framework for investigating such psychological constructs to deliver design objectives for weight management technologies. Objective We applied a decision theory–based analysis in the domain of weight management to understand the rewards and costs that surround individuals’ weight management behaviors, with the aim of uncovering design opportunities for weight management technologies. Methods We conducted qualitative interviews with 15 participants who were or had been trying to lose weight. Thematic analysis was used to extract themes that covered the rewards and costs surrounding weight management behaviors. We supplemented our qualitative study with a quantitative survey of 100 respondents investigating the extent to which they agreed with statements reflecting themes from the qualitative study. Results The primary obstacles to weight management were the rewards associated with unhealthy choices, such as the pleasures of unhealthy foods and unrestricted consumption in social situations, and the significant efforts required to change habits, plan, and exercise. Psychological constructs that supported positive weight management included feeling good after making healthy choices, being good to oneself, experiencing healthy yet still delicious foods, and receiving social support and encouraging messages (although opinions about encouraging messages was mixed). Conclusions A rewards-costs driven enquiry revealed a wide range of psychological constructs that contribute to discouraging and supporting weight management. The constructs extracted from our qualitative study were verified by our quantitative survey, in which the majority of respondents also reported similar thoughts and feelings. This understanding of the rewards and costs surrounding weight management offers a range of new opportunities for the design of weight management technologies that enhance the encouraging factors and alleviate the discouraging ones. PMID:24972304

The Impact of Professional Development about Weight-Related Issues for Pre-Service Teachers: A Pilot Study

ERIC Educational Resources Information Center

Russell-Mayhew, Shelly; Ireland, Alana; Peat, Gavin

2012-01-01

Many teachers do not have a working knowledge of body image or weight issues. This pilot project examined body image satisfaction and eating/weight-related behaviours before and after a professional in-service with physical education pre-service teachers (N = 16). At the three-month follow-up, measures were repeated and qualitative data (critical…

Correlates of Body Mass Index, Weight Goals, and Weight-Management Practices among Adolescents

ERIC Educational Resources Information Center

Paxton, Raheem J.; Valois, Robert F.; Drane, J. Wanzer

2004-01-01

The study examined associations among physical activity, cigarette smoking, body mass index, perceptions of body weight, weight-management goals, and weight-management behaviors of public high school adolescents. The CDC Youth Risk Behavior Survey provided a cross-sectional sample (n = 3,089) of public high school students in South Carolina.…

Interventions targeted at primary care practitioners to improve the identification and referral of patients with co-morbid obesity: a realist review protocol.

PubMed

Blane, David N; Macdonald, Sara; Morrison, David; O'Donnell, Catherine A

2015-05-01

Obesity is one of the most significant public health challenges in the developed world. Recent policy has suggested that more can be done in primary care to support adults with obesity. In particular, general practitioners (GPs) and practice nurses (PNs) could improve the identification and referral of adults with obesity to appropriate weight management services. Previous interventions targeted at primary care practitioners in this area have had mixed results, suggesting a more complex interplay between patients, practitioners, and systems. The objectives of this review are (i) to identify the underlying 'programme theory' of interventions targeted at primary care practitioners to improve the identification and referral of adults with obesity and (ii) to explore how and why GPs and PNs identify and refer individuals with obesity, particularly in the context of weight-related co-morbidity. This protocol will explain the rationale for using a realist review approach and outline the key steps in this process. Realist review is a theory-led approach to knowledge synthesis that provides an explanatory analysis aimed at discerning what works, for whom, in what circumstances, how, and why. In this review, scoping interviews with key stakeholders involved in the planning and delivery of adult weight management services in Scotland helped to inform the identification of formal theories - from psychology, sociology, and implementation science - that will be tested as the review progresses. A comprehensive search strategy is described, including scope for iterative searching. Data analysis is outlined in three stages (describing context-mechanism-outcome configurations, exploring patterns in these configurations, and developing and testing middle-range theories, informed by the formal theories previously identified), culminating in the production of explanatory programme theory that considers individual, interpersonal, and institutional/systems-level components. This is the first realist review that we are aware of looking at interventions targeted at primary care practitioners to improve the weight management of adults with obesity. Engagement with stakeholders at an early stage is a unique feature of realist review. This shapes the scope of the review, identification of candidate theories and dissemination strategies. The findings of this review will inform policy and future interventions. PROSPERO CRD42014009391.

Exploring the need for interventions to manage weight and stress during interconception.

PubMed

Huberty, Jennifer; Leiferman, Jenn A; Kruper, Abbey R; Jacobson, Lisette T; Waring, Molly E; Matthews, Jeni L; Wischenka, Danielle M; Braxter, Betty; Kornfield, Sara L

2017-02-01

Interventions to manage weight and stress during the interconception period (i.e., time immediately following childbirth to subsequent pregnancy) are needed to promote optimal maternal and infant health outcomes. To address this gap, we summarize the current state of knowledge, critically evaluate the research focused on weight and stress management during the interconception period, and provide future recommendations for research in this area. Evidence supports the importance of weight and stress management during the reproductive years and the impact of weight on maternal and child health outcomes. However, evidence-based treatment models that address postpartum weight loss and manage maternal stress during the interconception period are lacking. This problem is further compounded by inconsistent definitions and measurements of stress. Recommendations for future research include interventions that address weight and stress tailored for women in the interconception period, interventions that address healthcare providers' understanding of the significance of weight and stress management during interconception, and long-term follow-up studies that focus on the public health implications of weight and stress management during interconception. Addressing obesity and stress during the interconception period via a reproductive lens will be a starting point for women and their families to live long and healthy lives.

Obesity: Risk factors, complications, and strategies for sustainable long-term weight management.

PubMed

Fruh, Sharon M

2017-10-01

The aims of this article are to review the effects of obesity on health and well-being and the evidence indicating they can be ameliorated by weight loss, and consider weight-management strategies that may help patients achieve and maintain weight loss. Narrative review based on literature searches of PubMed up to May 2016 with no date limits imposed. Search included terms such as "obesity," "overweight," "weight loss," "comorbidity," "diabetes," cardiovascular," "cancer," "depression," "management," and "intervention." Over one third of U.S. adults have obesity. Obesity is associated with a range of comorbidities, including diabetes, cardiovascular disease, obstructive sleep apnea, and cancer; however, modest weight loss in the 5%-10% range, and above, can significantly improve health-related outcomes. Many individuals struggle to maintain weight loss, although strategies such as realistic goal-setting and increased consultation frequency can greatly improve the success of weight-management programs. Nurse practitioners have key roles in establishing weight-loss targets, providing motivation and support, and implementing weight-loss programs. With their in-depth understanding of the research in the field of obesity and weight management, nurse practitioners are well placed to effect meaningful changes in weight-management strategies deployed in clinical practice. ©2017 American Association of Nurse Practitioners.

A biomedical and feminist perspective on women's experiences with weight management.

PubMed

Allan, J D

1994-10-01

Weight concerns and dieting have become so normative for U.S. women that weight is the lens through which experience is viewed. The obsession with weight and dieting among women is considered by feminists to be one result of the oppression by women resulting from questionable weight standards and weight control programs that foster a view of overweight as a sign of addiction and lack of control. Feminist critique is used to deconstruct both the literature related to weight standards and health and the research on weight loss/weight management. Feminist and ethnographic methods are used to describe successful and unsuccessful experiences with weight management of 20 Euro-American women who had participated in a 1985 weight study and agreed to be reinterviewed. Success at weight management was examined from a biomedical perspective using Body Mass Index (BMI) norms and from a feminist perspective using participants' subjective definitions of success. Based upon BMI, only 8 members of the study group were defined as successful, whereas based upon the women's perspectives, 11 members were successful. Participants' definitions of successful weight management were divergent from biomedical definitions and could be categorized into three perspectives: biomedical, reframed normal weight, and holistic. Women who ascribed to the biomedical definition of success embodied the cultural ideal of thinness by adhering to an underweight weight norm. Participants using the reframed normal weight definition of success rejected biomedical weight norms and created their own weight norms. The holistic perspective on success involved the use of a broader, health-focused definition of successful weight management and offers some directions for revising current health promotion care relative to weight.

Weight satisfaction, management strategies and health beliefs in knee osteoarthritis patients attending an outpatient clinic.

PubMed

Ekram, A R M S; Cicuttini, F M; Teichtahl, A J; Crammond, B R; Lombard, C B; Liew, S M; Urquhart, D M; Wluka, A E

2016-04-01

Although weight control is important in managing knee osteoarthritis (OA), it is difficult to achieve. Understanding beliefs regarding weight management in people with knee OA may improve weight control. To examine differences in bodyweight satisfaction, weight management strategies and weight-related health-beliefs in obese, overweight and normal weight people with knee OA. The beliefs and attitudes to weight in 102 people with symptomatic knee OA were ascertained. Participants were classified as being obese, overweight or of normal weight. Although obese and overweight participants were less satisfied with their bodyweight, they were more likely to want to lose weight and to report dieting compared with normal weight participants(P < 0.001 for all) and also more likely to report weight gain in the past 6 months (P < 0.001). While most participants rated food intake to be a main determinant of health, this belief was more common in normal weight participants (P = 0.04). When asked about their own weight gain, obese participants more frequently believed genetic and metabolic factors to be important than normal and overweight participants (P = 0.01). While 51 (53%) believed that increasing activity was more important than dietary change to avoid weight gain, this was more commonly believed by obese and overweight participants (P < 0.05). Despite desiring and attempting to lose weight, obese people with symptomatic knee OA more commonly reported weight gain. Overweight and obese participants attributed weight gain to non-modifiable factors but believed physical activity is more important than dietary change in weight management. Thus, education regarding the importance of diet as compared with non-modifiable factors and physical activity may improve weight management in obese people with knee OA. © 2016 Royal Australasian College of Physicians.

The Obesity Epidemic in the Veterans Health Administration: Prevalence Among Key Populations of Women and Men Veterans.

PubMed

Breland, Jessica Y; Phibbs, Ciaran S; Hoggatt, Katherine J; Washington, Donna L; Lee, Jimmy; Haskell, Sally; Uchendu, Uchenna S; Saechao, Fay S; Zephyrin, Laurie C; Frayne, Susan M

2017-04-01

Most US adults are overweight or obese. Understanding differences in obesity prevalence across subpopulations could facilitate the development and dissemination of weight management services. To inform Veterans Health Administration (VHA) weight management initiatives, we describe obesity prevalence among subpopulations of VHA patients. Cross-sectional descriptive analyses of fiscal year 2014 (FY2014) national VHA administrative and clinical data, stratified by gender. Differences ≥5% higher than the population mean were considered clinically significant. Veteran VHA primary care patients with a valid weight within ±365 days of their first FY2014 primary care visit, and a valid height (98% of primary care patients). We used VHA vital signs data to ascertain height and weight and calculate body mass index, and VHA outpatient, inpatient, and fee basis data to identify sociodemographic- and comorbidity-based subpopulations. Among nearly five million primary care patients (347,112 women, 4,567,096 men), obesity prevalence was 41% (women 44%, men 41%), and overweight prevalence was 37% (women 31%, men 38%). Across the VHA's 140 facilities, obesity prevalence ranged from 28% to 49%. Among gender-stratified subpopulations, obesity prevalence was high among veterans under age 65 (age 18-44: women 40%, men 46%; age 45-64: women 49%, men 48%). Obesity prevalence varied across racial/ethnic and comorbidity subpopulations, with high obesity prevalence among black women (51%), women with schizophrenia (56%), and women and men with diabetes (68%, 56%). Overweight and obesity are common among veterans served by the VHA. VHA's weight management initiatives have the potential to avert long-term morbidity arising from obesity-related conditions. High-risk groups-such as black women veterans, women veterans with schizophrenia, younger veterans, and Native Hawaiian/Other Pacific Islander and American Indian/Alaska Native veterans-may require particular attention to ensure that systems improvement efforts at the population level do not inadvertently increase health disparities.

Designing Flood Management Systems for Joint Economic and Ecological Robustness

NASA Astrophysics Data System (ADS)

Spence, C. M.; Grantham, T.; Brown, C. M.; Poff, N. L.

2015-12-01

Freshwater ecosystems across the United States are threatened by hydrologic change caused by water management operations and non-stationary climate trends. Nonstationary hydrology also threatens flood management systems' performance. Ecosystem managers and flood risk managers need tools to design systems that achieve flood risk reduction objectives while sustaining ecosystem functions and services in an uncertain hydrologic future. Robust optimization is used in water resources engineering to guide system design under climate change uncertainty. Using principles introduced by Eco-Engineering Decision Scaling (EEDS), we extend robust optimization techniques to design flood management systems that meet both economic and ecological goals simultaneously across a broad range of future climate conditions. We use three alternative robustness indices to identify flood risk management solutions that preserve critical ecosystem functions in a case study from the Iowa River, where recent severe flooding has tested the limits of the existing flood management system. We seek design modifications to the system that both reduce expected cost of flood damage while increasing ecologically beneficial inundation of riparian floodplains across a wide range of plausible climate futures. The first robustness index measures robustness as the fraction of potential climate scenarios in which both engineering and ecological performance goals are met, implicitly weighting each climate scenario equally. The second index builds on the first by using climate projections to weight each climate scenario, prioritizing acceptable performance in climate scenarios most consistent with climate projections. The last index measures robustness as mean performance across all climate scenarios, but penalizes scenarios with worse performance than average, rewarding consistency. Results stemming from alternate robustness indices reflect implicit assumptions about attitudes toward risk and reveal the tradeoffs between using structural and non-structural flood management strategies to ensure economic and ecological robustness.

Toward a Middle-Range Theory of Weight Management.

PubMed

Pickett, Stephanie; Peters, Rosalind M; Jarosz, Patricia A

2014-07-01

The authors of this paper present the middle-range theory of weight management that focuses on cultural, environmental, and psychosocial factors that influence behaviors needed for weight control. The theory of weight management was developed deductively from Orem's theory of self-care, a constituent theory within the broader self-care deficit nursing theory and from research literature. Linkages between the conceptual and middle-range theory concepts are illustrated using a substruction model. The development of the theory of weight management serves to build nursing science by integrating extant nursing theory and empirical knowledge. This theory may help predict weight management in populations at risk for obesity-related disorders. © The Author(s) 2014.

Complementary ecosystem services provided by pest predators and pollinators increase quantity and quality of coffee yields

PubMed Central

Classen, Alice; Peters, Marcell K.; Ferger, Stefan W.; Helbig-Bonitz, Maria; Schmack, Julia M.; Maassen, Genevieve; Schleuning, Matthias; Kalko, Elisabeth K. V.; Böhning-Gaese, Katrin; Steffan-Dewenter, Ingolf

2014-01-01

Wild animals substantially support crop production by providing ecosystem services, such as pollination and natural pest control. However, the strengths of synergies between ecosystem services and their dependencies on land-use management are largely unknown. Here, we took an experimental approach to test the impact of land-use intensification on both individual and combined pollination and pest control services in coffee production systems at Mount Kilimanjaro. We established a full-factorial pollinator and vertebrate exclosure experiment along a land-use gradient from traditional homegardens (agroforestry systems), shaded coffee plantations to sun coffee plantations (total sample size = 180 coffee bushes). The exclusion of vertebrates led to a reduction in fruit set of ca 9%. Pollinators did not affect fruit set, but significantly increased fruit weight of coffee by an average of 7.4%. We found no significant decline of these ecosystem services along the land-use gradient. Pest control and pollination service were thus complementary, contributing to coffee production by affecting the quantity and quality of a major tropical cash crop across different coffee production systems at Mount Kilimanjaro. PMID:24500173

Complementary ecosystem services provided by pest predators and pollinators increase quantity and quality of coffee yields.

PubMed

Classen, Alice; Peters, Marcell K; Ferger, Stefan W; Helbig-Bonitz, Maria; Schmack, Julia M; Maassen, Genevieve; Schleuning, Matthias; Kalko, Elisabeth K V; Böhning-Gaese, Katrin; Steffan-Dewenter, Ingolf

2014-03-22

Wild animals substantially support crop production by providing ecosystem services, such as pollination and natural pest control. However, the strengths of synergies between ecosystem services and their dependencies on land-use management are largely unknown. Here, we took an experimental approach to test the impact of land-use intensification on both individual and combined pollination and pest control services in coffee production systems at Mount Kilimanjaro. We established a full-factorial pollinator and vertebrate exclosure experiment along a land-use gradient from traditional homegardens (agroforestry systems), shaded coffee plantations to sun coffee plantations (total sample size = 180 coffee bushes). The exclusion of vertebrates led to a reduction in fruit set of ca 9%. Pollinators did not affect fruit set, but significantly increased fruit weight of coffee by an average of 7.4%. We found no significant decline of these ecosystem services along the land-use gradient. Pest control and pollination service were thus complementary, contributing to coffee production by affecting the quantity and quality of a major tropical cash crop across different coffee production systems at Mount Kilimanjaro.

[Management of anorexia nervosa in a Tunisian case].

PubMed

Ahlem, Harrathi; Soumeyya, Halayem; Nadia, Janhani; Sami, Othman; Ines, Lahmar; Samira, Blouza; Ahlem, Belhadj; Asma, Bouden; Halayem, Mohamed B

2014-07-01

Anorexia nervosa is a complex psychiatric illness that can lead to severe physical complications. This work aimed to study the approach taken by the child psychiatry service of Razi hospital in the management of anorexia nervosa and to compare it with international recommendation. We propose to illustrate by a case report and review international recommendations on this topic while undertaking a review of the literature based on a Medline search using the following keywords: anorexia, nervosa adolescence, management, guidelines. Case report: AS, 16 years old, addressed to us by the school doctor for management of anorexia nervosa evolving for two years without improvement through outpatient care. His condition was considered precarious requiring urgent care in a medical hospital. She was then hospitalized at the Institute of Nutrition with a weight contract to achieve, She received a gradual refueling strongly denied. We have provided a psychological support by moving on site three times a week to help establish a good therapeutic alliance. After three weeks, the teenager has reached an acceptable weight for its output to the hospital and additional support at the outpatient child psychiatry with supportive psychotherapy. Two months later, she developed depression because of the weight gain. The appointment at the dietician was continued three months after hospitalization. At 10 months of the hospitalization, the girl had good grades and was not amenorrheic. However, on the psychological level she kept the same traits and intrafamilial relationships were marked by the seal of the manipulation. Subsequently, the teenager has spaced the consultations then lost sight. Currently, at 15 months of the hospitalization, parents describe a relapse, with a dietary restriction without amenorrhea ad a refusal to take weight. In management of this patient, we followed the recommendations of the literature namely those of the High Authority of Health and NICE (National Institute for Clinical Excellence) which recommend a target tracking of anorexia nervosa, the establishment of a multidisciplinary team care, a long hospitalization with a weight contract, support and not effective. Similarly, for children and adolescents, family therapy is recommended as an outpatient after hospitalization. In our country, the prevalence of anorexia nervosa is gradually increasing although we have not an idea concerning the frequency or prevalence of this disease which has serious and unpredictable complications. For what, it requires a multidisciplinary and prolonged surveillance to prevent recurrence.

A cross sectional study investigating weight management motivations, methods and perceived healthy eating and physical activity influences in women up to five years following childbirth.

PubMed

Vincze, Lisa; Rollo, Megan E; Hutchesson, Melinda J; Burrows, Tracy L; MacDonald-Wicks, Lesley; Blumfield, Michelle; Collins, Clare E

2017-06-01

to explore motivations for weight change, weight loss methods used and factors perceived to influence healthy eating and physical activity for weight management following childbirth, and to evaluate differences by socio-demographic, weight status and pregnancy characteristics. cross-sectional online survey completed from May to August 2013. Australian women (n=874, aged 32.8±4.5 years, pre-pregnancy Body Mass Index 25.6±5.7kg/m 2 ) aged 18-40 years who had given birth in the previous 5 years MEASUREMENTS: women self-reported socio-demographic, weight status and pregnancy characteristics. Those who reported being unhappy at their current weight ranked their most to least important reasons for wanting to change their weight from a list of nine options. Weight control methods used in the previous two years were reported from a list of 12 options. Perceived healthy eating and physical activity factors influencing weight management were assessed across 20 items using a five-point Likert scale. the most prevalent motivators reported for weight change were to improve health (26.1%) and lift mood (20.3%). Three-quarters (75.7%) of women reported having used at least one weight loss method in the previous two years. Time constraints due to family commitments, enjoyment of physical activity and healthy eating, motivation and cost were factors most commonly reported to influence weight management. Body mass index, parity, education, household income and time since last birth were related to motivations for weight change, weight loss methods used and/or factors perceived to influence weight management. weight management support provided by health professionals should consider women's expressed motivators and factors influencing weight management, along with differences in sociodemographic, pregnancy and weight status characteristics, in order to engage women at this life-stage and facilitate adoption of healthy lifestyle behaviours. Copyright © 2017 Elsevier Ltd. All rights reserved.

Increasing Military Physician Productivity in a Managed Care Environment

DTIC Science & Technology

1992-07-13

allows us to obtain to a common denominator, or one single rating even though the services are dissimilar and the input units are not "weighted." Serway ...many ideas as possible to catalyze the process. In removing barriers to productivity in the work environment, a thorough analysis of the physical ...physician and the organization has increased. The whole text of the book "Doctor’s Decisions and the Cost of Medical Care" is dedicated to this concept

[Hip Fracture--Epidemiology, Management and Liaison Service. Risk factor for hip fracture].

PubMed

Fujiwara, Saeko

2015-04-01

Many risk factors have been identified for hip fracture, including female, advanced age, osteoporosis, previous fractures, low body weight or low body mass index, alcohol drinking, smoking, family history of fractures, use of glucocorticoid, factors related to falls, and bone strength. The factors related to falls are number of fall, frail, post stroke, paralysis, muscle weakness, anti-anxiety drugs, anti-depression drugs, and sedatives. Dementia and respiratory disease and others have been reported to be risk factors for secondary hip fracture.

Laparoscopic Adjustable Gastric Banding Revisions in Singapore: a 10-Year Experience.

PubMed

Ngiam, Kee Yuan; Khoo, Valerie Yu Hui; Kong, Lucy; Cheng, Anton Kui Sing

2016-05-01

Bariatric surgery is increasingly being carried out and revisional procedures have also risen in concert. A review of the complications and revisions might elucidate technical and patient factors that influence the outcomes of bariatric surgeries in Asian patients. The objective of this study is to review the safety and efficacy of revisional bariatric surgery in a single center in Singapore over a 10-year period. The setting of this study is a single public hospital with a multidisciplinary bariatric service including a weight management center, specialized endocrinology services, and bariatric surgical team. Participants were selected for surgery based on body mass index (BMI) and comorbidities. All patients underwent primary laparoscopic adjustable gastric banding (LAGB). Patients were then analyzed according to the types of revisional surgeries. The primary outcome was the type of complications and revisional surgeries. Secondary outcomes include short-term excess weight loss and further complications. A total of 365 patients were analyzed. 9.6% had a secondary procedure. In particular, two groups of complications required revisional surgery: failure of sustained weight loss and complications related to the LAGB insertion and use. Revisional surgeries had equivalent major complication rates (5.7%) compared to primary bariatric surgeries (6.8%). Revisional surgeries such as revisional LAGB (4.9 ± 9.8 kg), laparoscopic sleeve gastrectomy (LSG; 6.9 ± 21.0 kg), Roux-en-Y gastric bypass (RYGB; 4.6 ± 13.0 kg), and bilio-pancreatic diversion (BPD; 3.5 ± 6.3 kg) had modest weight loss compared to primary weight loss (12.7 ± 9.5 kg). Primary LAGB had a greater percentage excess weight loss in the first and second years post-surgery compared to revisional surgeries. There was one mortality post-primary surgery and no post-revisional surgical mortalities. Revisional bariatric surgery for complications related to the primary surgery is safe but had reduced excess weight loss compared to the initial surgery.

The Influence of U.S. Chain Restaurant Food Consumption and Obesity in China and South Korea: An Ecological Perspective of Food Consumption, Self-Efficacy in Weight Management, Willingness to Communicate About Weight/Diet, and Depression.

PubMed

Wright, Kevin B; Mazzone, Raphael; Oh, Hyun; Du, Joshua; Smithson, Anne-Bennett; Ryan, Diane; MacNeil, David; Tong, Xing; Stiller, Carol

2016-11-01

This study examined the impact of U.S. chain restaurant food consumption in China and South Korea from an ecological perspective. Specifically, it explored the relationships among several environmental and individual variables that have been found to affect obesity/weight management in previous research, including the prevalence/popularity of U.S. chain restaurants in these countries, frequency of U.S. chain restaurant food consumption, self-efficacy in weight management, willingness to communicate about weight/diet, self-perceptions of weight/obesity stigma, body mass index (BMI), and depression. The results indicated that willingness to communicate about weight/diet predicted increased self-efficacy in weight management. Higher BMI scores were found to predict increased weight/obesity stigma, and increased frequency of U.S. restaurant food consumption, weight/obesity stigma, and reduced self-efficacy in weight management were found to predict increased levels of depression. The theoretical and practical implications of the findings are discussed, along with limitations and directions for future research.

Body Mass Index Self-Perception and Weight Management Behaviors during Late Adolescence

ERIC Educational Resources Information Center

Yang, Kyeongra; Turk, Melanie T.; Allison, Virginia L.; James, Khara A.; Chasens, Eileen

2014-01-01

Background: This study examined the relationship between actual body weight and self-perceived weight, and how perception of one's weight affects weight management behaviors among US adolescents. Methods: Adolescents ages 16-19 years with objectively-measured weight and height and self-reported perception of weight, weight-loss efforts, and…

A Mobile Phone-Based Health Coaching Intervention for Weight Loss and Blood Pressure Reduction in a National Payer Population: A Retrospective Study

PubMed Central

Magana, Candy; Caballero Barajas, Karla

2017-01-01

Background The prevalence of obesity and associated metabolic conditions continue to be challenging and costly to address for health care systems; 71% of American adults were overweight, with 35% of men and 40% of women diagnosed with obesity in 2014. Digital health coaching is an innovative approach to decreasing the barriers of cost and accessibility of receiving health coaching for the prevention and management of chronic disease in overweight or obese individuals. Objective To evaluate the early impact of a mobile phone-based health coaching service on weight loss and blood pressure management in a commercially insured population. Methods This was a retrospective study using existing registry data from a pilot commercial collaboration between Vida Health and a large national insurance provider, which enrolled adult members who were overweight (body mass index >25 kg/m2) and able to engage in a mobile phone-based coaching intervention. Participants received 4 months of intensive health coaching via live video, phone, and text message through the Vida Health app. Participants were also provided with a wireless scale, pedometer, and blood pressure cuff. Of the 1012 enrolled, 763 (75.40%) participants had an initial weight upon enrollment and final weight between 3 and 5 months from enrollment; they served as our intervention group. There were 73 participants out of the 1012 (7.21%) who had weight data 4 months prior to and after Vida coaching, who served as the matched-pair control group. Results Participants in the intervention group lost an average of 3.23% total body weight (TBW) at 4 months of coaching and 28.6% (218/763) intervention participants achieved a clinically significant weight loss of 5% or more of TBW, with an average of 9.46% weight loss in this cohort. In the matched-pair control group, participants gained on average 1.81% TBW in 4 months without Vida coaching and lost, on average, 2.47% TBW after 4 months of Vida coaching, demonstrating a statistically significant difference of 4.28% in mean percentage weight change (P<.001). Among 151 intervention participants with blood pressure data, 112 (74.2%) had a baseline blood pressure that was above the goal (systolic blood pressure >120 mmHg); 55 out of 112 (49.1%) participants improved their blood pressure at 4 months by an entire hypertensive stage—as defined by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Conclusions Mobile phone app-based health coaching interventions can be an acceptable and effective means to promote weight loss and improve blood pressure management in overweight or obese individuals. Given the ubiquity of mobile phones, digital health coaching may be an innovative solution to decreasing barriers of access to much-needed weight management interventions for obesity. PMID:28596147

Screening and counseling for childhood obesity: results from a national survey.

PubMed

Sesselberg, Tracy S; Klein, Jonathan D; O'Connor, Karen G; Johnson, Mark S

2010-01-01

To examine family physicians' beliefs and practices about using body mass index (BMI) percentiles to screen for childhood overweight and obesity. Surveys about management of childhood overweight were mailed to 1800 American Academy of Family Physician members in 2006. 729 surveys were returned; 445 were eligible. Most (71%) members were familiar with BMI guidelines; 41% were familiar with American Academy of Family Physician recommendations about overweight. Most (78%) had tools available to calculate BMI; fewer have enough time for overweight screening (55%), and only 45% reported computing BMI percentile at most or every well visit for children older than 2. Having an electronic health record increased BMI screening rates. Family physicians felt prepared to discuss weight, but only 43% believed their counseling was effective and many (55%) lack community or referral services. Most (72%) wanted simple diet and exercise recommendations for patients. Reimbursement for weight-related services is insufficient: 86% say that patients cannot pay for services not covered by insurance. Factor analysis identified clinician self-efficacy, resources, and reimbursement as factors related to calculating BMI percentiles. BMI is underutilized by family physicians. Most believe they should try to prevent overweight and have tools to use BMI, but clinicians have few resources available for treatment, have low self-efficacy, and report inadequate reimbursement.

Weight management in obese pets: the tailoring concept and how it can improve results.

PubMed

German, Alexander J

2016-10-20

Obesity is now recognised as the most important medical disease in pets worldwide. All current strategies for weight management involve dietary energy restriction with a purpose-formulated diet. Whilst current weight management regimes can be successful, outcomes are often disappointing with the rate of weight loss progressively slowing down as time goes on. Success is most challenging for the most obese dogs and cats that are more likely to discontinue the programme before reaching target weight. To improve outcomes, clinicians must focus carefully on better tailoring programmes, paying particular to setting an appropriate target weight so as to maximise the benefits for the individual. In this opinionated review, the author will discuss findings from recent clinical research studies examining weight management in obese dogs and cats. A strategy for tailoring weight management targets will then be discussed, illustrated with case examples.

The evolving role of the community pharmacist in chronic disease management - a literature review.

PubMed

George, Pradeep P; Molina, Joseph A D; Cheah, Jason; Chan, Soo Chung; Lim, Boon Peng

2010-11-01

We appraised the roles and responsibilities assigned to community pharmacists internationally and in Singapore. A systematic search of international peer-reviewed literature was undertaken using Medline. Grey literature was identified through generic search engines. The search period was from 1 January 1991 to 30 July 2009. The search criteria were English language manuscripts and search terms "community pharmacist", "community pharmacy", "disease management" and "roles" as a major heading. Boolean operators were used to combine the search terms. Identified abstracts were independently reviewed and the findings were presented as a narrative summary. Overall, we reviewed 115 articles on an abstract level and retrieved 45 of those as full text articles for background information review and inclusion into the evidence report. Of the articles included in the review, 32% were from United Kingdom (UK). Literature highlights the multi-faceted role of the community pharmacist in disease management. Community pharmacists were involved in the management of asthma, arthritis, cardiovascular diseases, diabetes, depression, hypertension, osteoporosis and palliative care either alone or in the disease management team. Evidence of effectiveness for community pharmacy/ community pharmacist interventions exists for lipid, diabetes, and hypertension management and for preventive services such as weight management, osteoporosis prevention and fl u immunisation services. Majority of the community pharmacists in Singapore play the traditional role of dispensing. Attempts by the private community pharmacies to provide some professional services were not successful due to lack of funding. Factors found to impede the growth of community pharmacists are insufficient integration of community pharmacist input into healthcare pathways, poor relationship among pharmacists and physicians, lack of access to patient information, time constraints and inadequate compensation. Evidence from observational studies points out the wide range of roles played by the community pharmacist and provides insights into their integration into chronic disease management programmes and health promotion.

Comparing Alternative Instruments to Measure Service Quality in Higher Education

ERIC Educational Resources Information Center

Brochado, Ana

2009-01-01

Purpose: The purpose of this paper is to examine the performance of five alternative measures of service quality in the high education sector--service quality (SERVQUAL), importance-weighted SERVQUAL, service performance (SERVPERF), importance-weighted SERVPERF, and higher education performance (HEdPERF). Design/methodology/approach: Data were…

Behavioral Health Services in the Changing Landscape of Private Health Plans.

PubMed

Horgan, Constance M; Stewart, Maureen T; Reif, Sharon; Garnick, Deborah W; Hodgkin, Dominic; Merrick, Elizabeth L; Quinn, Amity E

2016-06-01

Health plans play a key role in facilitating improvements in population health and may engage in activities that have an impact on access, cost, and quality of behavioral health care. Although behavioral health care is becoming more integrated with general medical care, its delivery system has unique aspects. The study examined how health plans deliver and manage behavioral health care in the context of the Affordable Care Act (ACA) and the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA). This is a critical time to examine how health plans manage behavioral health care. A nationally representative survey of private health plans (weighted N=8,431 products; 89% response rate) was conducted in 2010 during the first year of MHPAEA, when plans were subject to the law but before final regulations, and just before the ACA went into effect. The survey addressed behavioral health coverage, cost-sharing, contracting arrangements, medical home innovations, support for technology, and financial incentives to improve behavioral health care. Coverage for inpatient and outpatient behavioral health services was stable between 2003 and 2010. In 2010, health plans were more likely than in 2003 to manage behavioral health care through internal arrangements and to contract for other services. Medical home initiatives were common and almost always included behavioral health, but financial incentives did not. Some plans facilitated providers' use of technology to improve care delivery, but this was not the norm. Health plans are key to mainstreaming and supporting delivery of high-quality behavioral health services. Since 2003, plans have made changes to support delivery of behavioral health services in the context of a rapidly changing environment.

Weight Management

MedlinePlus

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Management of immunization solid wastes in Kano State, Nigeria

DOE Office of Scientific and Technical Information (OSTI.GOV)

Oke, I.A.

Inadequate management of waste generated from injection activities can have a negative impact on the community and environment. In this paper, a report on immunization wastes management in Kano State (Nigeria) is presented. Eight local governments were selected randomly and surveyed by the author. Solid wastes generated during the Expanded Programme on Immunization were characterised using two different methods: one by weighing the waste and the other by estimating the volume. Empirical data was obtained on immunization waste generation, segregation, storage, collection, transportation, and disposal; and waste management practices were assessed. The study revealed that immunization offices were accommodated inmore » either in local government buildings, primary health centres or community health care centres. All of the stations demonstrated a high priority for segregation of the infectious wastes. It can be deduced from the data obtained that infectious waste ranged from 67.6% to 76.7% with an average of 70.1% by weight, and 36.0% to 46.1% with an average of 40.1% by volume. Non-infectious waste generated ranged from 23.3% to 32.5% with an average of 29.9% by weight and 53.9% to 64.0% with an average of 59.9% by volume. Out of non-infectious waste (NIFW) and infectious waste (IFW), 66.3% and 62.4% by weight were combustible and 33.7% and 37.6% were non-combustible respectively. An assessment of the treatment revealed that open pit burning and burial and small scale incineration were the common methods of disposal for immunization waste, and some immunization centres employed the services of the state or local government owned solid waste disposal board for final collection and disposal of their immunization waste at government approved sites.« less

A fuzzy MCDM model with objective and subjective weights for evaluating service quality in hotel industries

NASA Astrophysics Data System (ADS)

Zoraghi, Nima; Amiri, Maghsoud; Talebi, Golnaz; Zowghi, Mahdi

2013-12-01

This paper presents a fuzzy multi-criteria decision-making (FMCDM) model by integrating both subjective and objective weights for ranking and evaluating the service quality in hotels. The objective method selects weights of criteria through mathematical calculation, while the subjective method uses judgments of decision makers. In this paper, we use a combination of weights obtained by both approaches in evaluating service quality in hotel industries. A real case study that considered ranking five hotels is illustrated. Examples are shown to indicate capabilities of the proposed method.

Case management by nurses in primary care: analysis of 73 'success stories'.

PubMed

Elwyn, Glyn; Williams, Meryl; Roberts, Catherine; Newcombe, Robert G; Vincent, Judith

2008-01-01

There is interest as to whether case management reduces unplanned patient admission to hospital. However, very little is known about how the intervention is delivered and what the most salient outcome measures are. Qualitative study embedded in a wider evaluation. Primary health care. Analysis of case manager case reports in a service innovation evaluation study. Case management provides home-based care to frail elderly patients using a process of assessment and medication review. This often leads to new diagnoses, to the co-ordination of further care and the tailoring of services to suit the needs of individuals. The benefits reported are complex and relate to improving a patient's quality of life more than the prevention or otherwise of admission to hospital. The type of attention provided by these roles seems to be absent from current NHS arrangements. The role enables time to be spent assessing the individual needs of patients who live at the margins of independent living. The case managers describe having the time and the skills to assess a mix of clinical and social problems, and then accessing the correct networks to help elderly people with multiple illnesses navigate a complex system of providers. More weight should be given to the ability of this intervention to result in improved quality of life for patients, and to the investigation of costs and benefits.

Assessment of Processes of Change for Weight Management in a UK Sample

PubMed Central

Andrés, Ana; Saldaña, Carmina; Beeken, Rebecca J.

2015-01-01

Objective The present study aimed to validate the English version of the Processes of Change questionnaire in weight management (P-Weight). Methods Participants were 1,087 UK adults, including people enrolled in a behavioural weight management programme, university students and an opportunistic sample. The mean age of the sample was 34.80 (SD = 13.56) years, and 83% were women. BMI ranged from 18.51 to 55.36 (mean = 25.92, SD = 6.26) kg/m2. Participants completed both the stages and processes questionnaires in weight management (S-Weight and P-Weight), and subscales from the EDI-2 and EAT-40. A refined version of the P-Weight consisting of 32 items was obtained based on the item analysis. Results The internal structure of the scale fitted a four-factor model, and statistically significant correlations with external measures supported the convergent validity of the scale. Conclusion The adequate psychometric properties of the P-Weight English version suggest that it could be a useful tool to tailor weight management interventions. PMID:25765163

Providing QoS guarantee in 3G wireless networks

NASA Astrophysics Data System (ADS)

Chuah, MooiChoo; Huang, Min; Kumar, Suresh

2001-07-01

The third generation networks and services present opportunities to offer multimedia applications and services that meet end-to-end quality of service requirements. In this article, we present UMTS QoS architecture and its requirements. This includes the definition of QoS parameters, traffic classes, the end-to-end data delivery model, and the mapping of end-to-end services to the services provided by the network elements of the UMTS. End-to-end QoS of a user flow is achieved by the combination of the QoS control over UMTS Domain and the IP core Network. In the Third Generation Wireless network, UMTS bearer service manager is responsible to manage radio and transport resources to QoS-enabled applications. The UMTS bearer service consists of the Radio Access Bearer Service between Mobile Terminal and SGSN and Core Network bearer service between SGSN and GGSN. The Radio Access Bearer Service is further realized by the Radio Bearer Service (mostly air interface) and Iu bearer service. For the 3G air interface, one can provide differentiated QoS via intelligent burst allocation scheme, adaptive spreading factor control and weighted fair queueing scheduling algorithms. Next, we discuss the requirements for the transport technologies in the radio access network to provide differentiated QoS to multiple classes of traffic. We discuss both ATM based and IP based transport solutions. Last but not least, we discuss how QoS mechanism is provided in the core network to ensure e2e quality of service requirements. We discuss how mobile terminals that use RSVP as QoS signaling mechanisms can be are supported in the 3G network which may implement only IETF diffserv mechanism. . We discuss how one can map UMTS QoS classes with IETF diffserv code points. We also discuss 2G/3G handover scenarios and how the 2G/3G QoS parameters can be mapped.

Depression and Smoking

MedlinePlus

... Quit Stress & Mood Stress & Mood Smoking & Mood Stress Depression Anger Weight Management Weight Management Smoking and Weight Healthy Weight Loss Being Comfortable in Your Own Skin Your Weight Loss Expectations & Goals Healthier Lifestyle ... » Depression Basics » Depression and Smoking Depression and Smoking Why ...

"As soon as you've had the baby that's it…" a qualitative study of 24 postnatal women on their experience of maternal obesity care pathways.

PubMed

Dinsdale, Sarah; Branch, Kay; Cook, Lindsay; Shucksmith, Janet

2016-07-22

Maternal obesity is associated with risks to mother and infant, and has implications for healthcare costs. United Kingdom (UK) levels of maternal obesity are rising, with higher prevalence in North East (NE) England, where this study was set. Pregnancy is often seen as an opportune time for intervention - a 'teachable moment' - which is ripe for promoting behaviour change. In response to rising obesity levels, a National Health Service (NHS) Foundation Trust in NE England implemented three maternal obesity care pathways contingent on Body Mass Index (BMI) at time of booking: pathway 1 for those with BMI ≥30 kg/m(2); pathway 2 for BMI ≥35 kg/m(2); and pathway 3 for BMI ≥40 kg/m(2). These incorporated relevant antenatal, intrapartum and postnatal clinical requirements, and included a focus on weight management intervention. This evaluation explored the accounts of postnatal women who had been through one of these pathways in pregnancy. The study used a generic qualitative approach. Semi-structured interviews were carried out to explore the views and experiences of 24 recent mothers (aged 20-42), living in NE England, who had commenced on one of the pathways during pregnancy. Interviews explored experiences of weight management support during and after pregnancy, and perceived gaps in this support. Data were analysed using thematic content analysis. Three main themes emerged reflecting women's views and experiences of the pathways: communication about the pathways; treating obese pregnant women with sensitivity and respect; and appropriate and accessible lifestyle services and information for women during and after pregnancy. An overarching theme: differences in care, support and advice, was evident when comparing the experiences of women on pathways 1 or 2 with those on pathway 3. This study indicated that women were not averse to risk management and weight management intervention during and after pregnancy. However, in order to improve reach and effectiveness, such interventions need to be well communicated and offer constructive, individualised advice and support. The postnatal phase may also offer an opportune moment for intervention, suggesting that the simple notion of seeing pregnancy alone as a window of opportunity or a 'teachable moment' should be reconsidered.

Healthy Eating and Exercise: Strategies for Weight Management in the Rural Midwest

ERIC Educational Resources Information Center

Nothwehr, Faryle; Peterson, N. Andrew

2005-01-01

Obesity prevalence has increased dramatically in the United States. Rural areas have been especially affected, yet few weight management studies have been conducted in these populations. This study was designed to assess weight management attitudes and strategies used when rural adults in particular attempt to lose weight, employing measures that…

Challenges and solutions in the evaluation of a low back pain disease management program.

PubMed

Kotsos, Thomas; Muldowney, Kevin; Chapa, Griselda; Martin, J Eric; Linares, Antonio

2009-02-01

This paper examines a novel approach to evaluating a nurse-run telephonic low back pain (LBP) disease management (DM) program offered by a fully-insured commercial health plan population with approximately 150,000 members located in the northeastern United States. Members with at least 6 member months of eligibility were identified to have LBP using administrative claims and eligibility data. The LBP program relies on telephonic nurse management augmented by printed materials, adapting and advocating HEDIS imaging guidelines, and drug utilization review. Outcomes of this LBP DM program were assessed using a pre-post population-based approach as recommended in the DMAA Outcomes Guidelines Report. Baseline year and program year populations were segmented into 5 LBP clinical categories and each was weight adjusted using population size. LBP-related medical service utilization and pharmacy utilization also were evaluated. Individuals under active LBP management exhibited a decrease in LBP-related imaging and surgeries. Overall analgesic use also decreased. These data suggest the LBP DM program is associated with a decrease in imaging, surgeries, and analgesic use. The magnitude of the clinically segmented weight-adjusted return on investment (ROI) was lower than the unadjusted ROI, but was directionally positive indicating program impact. This adjustment is necessary in order to gain insight into and consistency of the results of a comprehensive LBP DM program evaluation.

Mobile Health Devices as Tools for Worldwide Cardiovascular Risk Reduction and Disease Management.

PubMed

Piette, John D; List, Justin; Rana, Gurpreet K; Townsend, Whitney; Striplin, Dana; Heisler, Michele

2015-11-24

We examined evidence on whether mobile health (mHealth) tools, including interactive voice response calls, short message service, or text messaging, and smartphones, can improve lifestyle behaviors and management related to cardiovascular diseases throughout the world. We conducted a state-of-the-art review and literature synthesis of peer-reviewed and gray literature published since 2004. The review prioritized randomized trials and studies focused on cardiovascular diseases and risk factors, but included other reports when they represented the best available evidence. The search emphasized reports on the potential benefits of mHealth interventions implemented in low- and middle-income countries. Interactive voice response and short message service interventions can improve cardiovascular preventive care in developed countries by addressing risk factors including weight, smoking, and physical activity. Interactive voice response and short message service-based interventions for cardiovascular disease management also have shown benefits with respect to hypertension management, hospital readmissions, and diabetic glycemic control. Multimodal interventions including Web-based communication with clinicians and mHealth-enabled clinical monitoring with feedback also have shown benefits. The evidence regarding the potential benefits of interventions using smartphones and social media is still developing. Studies of mHealth interventions have been conducted in >30 low- and middle-income countries, and evidence to date suggests that programs are feasible and may improve medication adherence and disease outcomes. Emerging evidence suggests that mHealth interventions may improve cardiovascular-related lifestyle behaviors and disease management. Next-generation mHealth programs developed worldwide should be based on evidence-based behavioral theories and incorporate advances in artificial intelligence for adapting systems automatically to patients' unique and changing needs. © 2015 American Heart Association, Inc.

Supportive care after curative treatment for breast cancer (survivorship care): resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement.

PubMed

Ganz, Patricia A; Yip, Cheng Har; Gralow, Julie R; Distelhorst, Sandra R; Albain, Kathy S; Andersen, Barbara L; Bevilacqua, Jose Luiz B; de Azambuja, Evandro; El Saghir, Nagi S; Kaur, Ranjit; McTiernan, Anne; Partridge, Ann H; Rowland, Julia H; Singh-Carlson, Savitri; Vargo, Mary M; Thompson, Beti; Anderson, Benjamin O

2013-10-01

Breast cancer survivors may experience long-term treatment complications, must live with the risk of cancer recurrence, and often experience psychosocial complications that require supportive care services. In low- and middle-income settings, supportive care services are frequently limited, and program development for survivorship care and long-term follow-up has not been well addressed. As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert panel identified nine key resources recommended for appropriate survivorship care, and developed resource-stratified recommendations to illustrate how health systems can provide supportive care services for breast cancer survivors after curative treatment, using available resources. Key recommendations include health professional education that focuses on the management of physical and psychosocial long-term treatment complications. Patient education can help survivors transition from a provider-intense cancer treatment program to a post-treatment provider partnership and self-management program, and should include: education on recognizing disease recurrence or metastases; management of treatment-related sequelae, and psychosocial complications; and the importance of maintaining a healthy lifestyle. Increasing community awareness of survivorship issues was also identified as an important part of supportive care programs. Other recommendations include screening and management of psychosocial distress; management of long-term treatment-related complications including lymphedema, fatigue, insomnia, pain, and women's health issues; and monitoring survivors for recurrences or development of second primary malignancies. Where possible, breast cancer survivors should implement healthy lifestyle modifications, including physical activity, and maintain a healthy weight. Health professionals should provide well-documented patient care records that can follow a patient as they transition from active treatment to follow-up care. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

PIQMIe: a web server for semi-quantitative proteomics data management and analysis

PubMed Central

Kuzniar, Arnold; Kanaar, Roland

2014-01-01

We present the Proteomics Identifications and Quantitations Data Management and Integration Service or PIQMIe that aids in reliable and scalable data management, analysis and visualization of semi-quantitative mass spectrometry based proteomics experiments. PIQMIe readily integrates peptide and (non-redundant) protein identifications and quantitations from multiple experiments with additional biological information on the protein entries, and makes the linked data available in the form of a light-weight relational database, which enables dedicated data analyses (e.g. in R) and user-driven queries. Using the web interface, users are presented with a concise summary of their proteomics experiments in numerical and graphical forms, as well as with a searchable protein grid and interactive visualization tools to aid in the rapid assessment of the experiments and in the identification of proteins of interest. The web server not only provides data access through a web interface but also supports programmatic access through RESTful web service. The web server is available at http://piqmie.semiqprot-emc.cloudlet.sara.nl or http://www.bioinformatics.nl/piqmie. This website is free and open to all users and there is no login requirement. PMID:24861615

PIQMIe: a web server for semi-quantitative proteomics data management and analysis.

PubMed

Kuzniar, Arnold; Kanaar, Roland

2014-07-01

We present the Proteomics Identifications and Quantitations Data Management and Integration Service or PIQMIe that aids in reliable and scalable data management, analysis and visualization of semi-quantitative mass spectrometry based proteomics experiments. PIQMIe readily integrates peptide and (non-redundant) protein identifications and quantitations from multiple experiments with additional biological information on the protein entries, and makes the linked data available in the form of a light-weight relational database, which enables dedicated data analyses (e.g. in R) and user-driven queries. Using the web interface, users are presented with a concise summary of their proteomics experiments in numerical and graphical forms, as well as with a searchable protein grid and interactive visualization tools to aid in the rapid assessment of the experiments and in the identification of proteins of interest. The web server not only provides data access through a web interface but also supports programmatic access through RESTful web service. The web server is available at http://piqmie.semiqprot-emc.cloudlet.sara.nl or http://www.bioinformatics.nl/piqmie. This website is free and open to all users and there is no login requirement. © The Author(s) 2014. Published by Oxford University Press on behalf of Nucleic Acids Research.

It's not just 'What' you do, it's also the 'Way' that you do it: Patient and Public Involvement in the Development of Health Research.

PubMed

Devonport, Tracey J; Nicholls, Wendy; Johnston, Lynne H; Gutteridge, Robin; Watt, Angela

2018-03-01

This article presents a reflective account of Patient and Public Involvement (PPI) in the development of obesity and binge eating research. We established Patient Advisory Groups (PAGs) at two English regional National Health Service (NHS) weight management services. PPI was evaluated as follows: (i) PAG members completed a Post Participation Evaluation Questionnaire, (ii) PAG meetings captured group discussion on PPI involvement, (iii) practitioner and researchers produced written reflections on PPI and (iv) sources one to three were consolidated during reflections that took place via e-mail and telephone correspondence between researchers and practitioners, culminating in a summary SKYPE meeting between one practitioner and one researcher involved in the PAGs. Results in the form of reflections suggest guidelines on undertaking PPI were helpful with regard 'what to do', but less helpful on 'how'. For example, suggestions for the management of interpersonal factors such as eliciting self-disclosure and managing power differentials are insufficiently addressed in existing guidelines. The present case study illustrated how interpersonal considerations can help or hinder the optimal use of PPI. Recommendations for practitioners and researchers planning PPI are offered.

Adiposity, hypertension and weight management behaviours in Ghanaian type 2 diabetes mellitus patients aged 20-70 years.

PubMed

Mogre, Victor; Apala, Peter; Nsoh, Jonas A; Wanaba, Peter

2016-01-01

This study assessed the prevalence of general and abdominal obesity and hypertension as well the weight management behaviours of type 2 diabetes mellitus patients. It included 378 diabetes patients seeking care from two hospitals in Ghana. Standard methods and tools were used to assess participants' weight, height, waist circumference (WC), blood pressure (BP) and fasting plasma glucose (FPG). Weight management behaviours were measured using a questionnaire. The prevalence of general obesity, abdominal obesity and hypertension was 20.1%, 46.6% and 67.7% respectively. Abdominal obesity was more likely in participants who: skipped breakfast, engaged in exercise to lose weight and were generally overweight/obese. General overweight and obesity was more likely in participants who: reported receipt of weight management counselling, engaged in exercise to lose weight, had a weight management plan/goal, and were abdominally obese. Hypertension was less likely in participants who had: no formal education, diabetes for ≥5 years and modified their dietary habits to lose weight but more likely in those who skipped breakfast. Abdominal obesity, general overweight/obesity, and hypertension were frequent in this sample and were influenced by weight management behaviours. Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Understanding weight management perceptions in first-year college students using the health belief model.

PubMed

Das, Bhibha M; Evans, Ellen M

2014-01-01

To examine weight management barriers, using the Health Belief Model, in first-year college students. First-year college students (n = 45), with data collected in April, May, and November 2013. Nominal group technique sessions (n = 8) were conducted. First-year students recognize benefits to weight management beyond physical attractiveness to quality-of-life domains, including social (eg, bonding opportunities and energy to socially engage) and mental health (eg, stress management). Men believe that weight management is important for career/financial reasons, whereas women voiced that it will allow them to live a full, independent life with a high level of multitasking. Men believed that their barriers were external (eg, campus resources/programs), whereas females perceived their barriers to be internal (eg, poor time management). College students are challenged by weight management and want the institution to provide resources, including curriculum, to help them manage their physical activity and nutrition behaviors.

Weight management program for treatment-emergent weight gain in olanzapine-treated patients with schizophrenia or schizoaffective disorder: A 12-week randomized controlled clinical trial.

PubMed

Kwon, Jun Soo; Choi, Jung-Seok; Bahk, Won-Myoung; Yoon Kim, Chang; Hyung Kim, Chan; Chul Shin, Young; Park, Byung-Joo; Geun Oh, Chang

2006-04-01

The main objective was to assess the efficacy of a weight management program designed for outpatients taking olanzapine for schizophrenia or schizoaffective disorder and to compare these patients with a randomized control group. The effects of the weight management program were also assessed with regard to safety and quality of life. Forty-eight patients were enrolled in a 12-week, randomized, multicenter weight management study. Thirty-three patients were randomly allocated to an intervention group in which they received olanzapine within a weight management program. Fifteen patients were allocated to a control group in which they were given olanzapine treatment as usual outpatients. Weight, body mass index (BMI), and measurements of safety and quality of life were evaluated. The study was conducted from January 7, 2003, to September 16, 2003. Thirty-six patients (75%) completed this study. We found significant differences in weight (-3.94 +/- 3.63 kg vs. -1.48 +/- 1.88 kg, p = .006) and BMI (-1.50 +/- 1.34 vs. -0.59 +/- 0.73, p = .007) change from baseline to endpoint between the intervention and control groups, respectively. Significant differences in weight reduction were initially observed at week 8 (p = .040). No significant differences were found with regard to the safety outcomes. When the ratio of low-density lipoproteins to high-density lipoproteins was calculated, change from baseline was greater in the intervention group than the control group (-0.19 vs. -0.04), but the difference was not statistically significant (p = .556). After the completion of the weight management program, there was a trend toward statistical difference in the physical health score changes between the weight management and control groups (1.12 in the intervention group vs. -0.93 in the control group, p = .067). The weight management program was effective in terms of weight reduction in patients with schizophrenia or schizoaffective disorder taking olanzapine and was also found to be safe in terms of psychiatric symptoms, vital signs, and laboratory data. In addition, such a weight management program might improve quality of life in patients with schizophrenia or schizoaffective disorder with respect to their physical well-being.

Weight Goals, Perceptions, and Practices among Hispanic and Anglo College Females

ERIC Educational Resources Information Center

Shamaley-Kornatz, Angelee; Smith, Brenda; Tomaka, Joe

2007-01-01

This study explored the weight management practices, rates overweight and obesity, perceptions of body weight, and weight management goals in a large sample (N = 467) of Hispanic (n = 421) and Anglo (n = 46) female college students on the U.S.-Mexico border. Women self-reported their height and weight, weight perceptions, and weight management…

Information needs of cancer patients and survivors regarding diet, exercise and weight management: a qualitative study.

PubMed

James-Martin, G; Koczwara, B; Smith, E L; Miller, M D

2014-05-01

While advanced cancer is often associated with weight loss, curative cancer treatment is often associated with weight gain. Weight gain during treatment may be associated with greater risk of cancer recurrence and development of lifestyle diseases. Currently, limited resources are available to cancer patients focussed on weight control. This study assessed the information needs of patients undergoing curative chemotherapy regarding diet, exercise and weight management for the purpose of developing weight management resources. Focus groups were held with oncology practitioners, patients and survivors to determine current information provision and needs. Focus groups highlighted a perception that information provision regarding diet, exercise and weight management is insufficient and no routine assessment of weight occurs during chemotherapy. Barriers to information provision described included lack of resources and time, and practitioners' uncertainty regarding appropriate messages to provide. Patients wanted more information regarding diet, exercise and weight during treatment time. The findings of this study suggest an increase in provision of diet, exercise and weight management information is needed. This information should be evidence-based and delivered at an appropriate time by the preferred health care professional. It would also be beneficial to implement protocols regarding assessment of weight during treatment. © 2013 John Wiley & Sons Ltd.

Impact of parental weight status on a school-based weight management programme designed for Mexican-American children.

PubMed

Moreno, J P; Johnston, C A; Hernandez, D C; LeNoble, J; Papaioannou, M A; Foreyt, J P

2016-10-01

While overweight and obese children are more likely to have overweight or obese parents, less is known about the effect of parental weight status on children's success in weight management programmes. This study was a secondary data analysis of a randomized controlled trial and investigated the impact of having zero, one or two obese parents on children's success in a school-based weight management programme. Sixty-one Mexican-American children participated in a 24-week school-based weight management intervention which took place in 2005-2006. Children's heights and weights were measured at baseline, 3, 6 and 12 months. Parental weight status was assessed at baseline. Repeated measures anova and ancova were conducted to compare changes in children's weight within and between groups, respectively. Within-group comparisons revealed that the intervention led to significant decreases in standardized body mass index (zBMI) for children with zero (F = 23.16, P < .001) or one obese (F = 4.99, P < .05) parent. Between-group comparisons indicated that children with zero and one obese parents demonstrated greater decreases in zBMI compared to children with two obese parents at every time point. The school-based weight management programme appears to be most efficacious for children with one or no obese parents compared to children with two obese parents. These results demonstrate the need to consider parental weight status when engaging in childhood weight management efforts. © 2015 World Obesity.

Marine debris in five national parks in Alaska.

PubMed

Polasek, L; Bering, J; Kim, H; Neitlich, P; Pister, B; Terwilliger, M; Nicolato, K; Turner, C; Jones, T

2017-04-15

Marine debris is a management issue with ecological and recreational impacts for agencies, especially on remote beaches not accessible by road. This project was implemented to remove and document marine debris from five coastal National Park Service units in Alaska. Approximately 80km of coastline were cleaned with over 10,000kg of debris collected. Marine debris was found at all 28 beaches surveyed. Hard plastics were found on every beach and foam was found at every beach except one. Rope/netting was the next most commonly found category, present at 23 beaches. Overall, plastic contributed to 60% of the total weight of debris. Rope/netting (14.6%) was a greater proportion of the weight from all beaches than foam (13.3%). Non-ferrous metal contributed the smallest amount of debris by weight (1.7%). The work forms a reference condition dataset of debris surveyed in the Western Arctic and the Gulf of Alaska within one season. Copyright © 2017. Published by Elsevier Ltd.

Stop the Pediatric Obesity Epidemic: Is the EMR a Solution to Alert Providers?

ERIC Educational Resources Information Center

Williams, Kim

2016-01-01

Introduction: Weight management is an unrelenting issue affecting people of all ages. Addressing weight management is among the priority health concerns in the United States. Evidence suggests that some health providers are not recognizing or managing patients' weight management issues. The electronic medical record and automation may help…

Influence of Highly Accessible Urban Food Environment on Weight Management: A Qualitative Study in Seoul

PubMed Central

Kwon, Soonman

2018-01-01

We explored the characteristics of the food environment and its influence on weight management in Seoul, Korea. Photo elicitation interviews were conducted with 73 participants who took three photographs per topic related to their food environment and discussed these photographs in groups. Through thematic analysis, we identified four themes concerning participants’ perceptions of the food environment and weight management: (1) “convenience comes first,” (2) “tempting food environment,” (3) “alcohol and anju,” and (4) “burden of individual effort to manage weight.” A systematic change toward an environment supportive of healthy eating and weight management is recommended. PMID:29662012

Systematic Review and Meta-Analysis: The Impact of Multicomponent Weight Management Interventions on Self-Esteem in Overweight and Obese Adolescents.

PubMed

Murray, Margaret; Dordevic, Aimee L; Bonham, Maxine P

2017-05-01

Building self-esteem in overweight adolescents is key to long-term weight management; yet, self-esteem is rarely a key outcome of adolescent weight management interventions. This systematic review investigates the impact of multicomponent weight management interventions on self-esteem in overweight and obese adolescents. Six databases were searched in December 2014. Eligible studies met the following criteria: (1) randomized controlled trial, (2) overweight or obese participants, (3) adolescents (10-19 years), (4) multicomponent weight management intervention, (5) reported self-esteem and weight changes. Thirteen studies with 1,157 overweight or obese adolescents, aged 10-19 years, were included. Meta-analyses showed no significant change in self-esteem (0.27 [-0.04, 0.59]), but body mass index z -score reduced following intervention (-0.17 [-0.22, -0.11]). The lack of change in self-esteem suggests weight loss alone is insufficient to improve self-esteem. Multicomponent weight management interventions require a specific focus on self-esteem to improve this outcome in overweight and obese adolescents. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Delivery room management of very low birth weight infants in Germany, Austria and Switzerland - a comparison of protocols

PubMed Central

2010-01-01

Background Surveys from the USA, Australia and Spain have shown significant inter-institutional variation in delivery room (DR) management of very low birth weight infants (VLBWI, < 1500 g) at birth, despite regularly updated international guidelines. Objective To investigate protocols for DR management of VLBWI in Germany, Austria and Switzerland and to compare these with the 2005 ILCOR guidelines. Methods DR management protocols were surveyed in a prospective, questionnaire-based survey in 2008. Results were compared between countries and between academic and non-academic units. Protocols were compared to the 2005 ILCOR guidelines. Results In total, 190/249 units (76%) replied. Protocols for DR management existed in 94% of units. Statistically significant differences between countries were found regarding provision of 24 hr in house neonatal service; presence of a designated resuscitation area; devices for respiratory support; use of pressure-controlled manual ventilation devices; volume control by respirator; and dosage of Surfactant. There were no statistically significant differences regarding application and monitoring of supplementary oxygen, or targeted saturation levels, or for the use of sustained inflations. Comparison of academic and non-academic hospitals showed no significant differences, apart from the targeted saturation levels (SpO2) at 10 min. of life. Comparison with ILCOR guidelines showed good adherence to the 2005 recommendations. Summary Delivery room management in German, Austrian and Swiss neonatal units was commonly based on written protocols. Only minor differences were found regarding the DR setup, devices used and the targeted ranges for SpO2 and FiO2. DR management was in good accordance with 2005 ILCOR guidelines, some units already incorporated evidence beyond the ILCOR statement into their routine practice. PMID:21159574

14 CFR 121.198 - Cargo service airplanes: Increased zero fuel and landing weights.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Cargo service airplanes: Increased zero... AND OPERATIONS OPERATING REQUIREMENTS: DOMESTIC, FLAG, AND SUPPLEMENTAL OPERATIONS Airplane Performance Operating Limitations § 121.198 Cargo service airplanes: Increased zero fuel and landing weights...

14 CFR 121.198 - Cargo service airplanes: Increased zero fuel and landing weights.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Cargo service airplanes: Increased zero... AND OPERATIONS OPERATING REQUIREMENTS: DOMESTIC, FLAG, AND SUPPLEMENTAL OPERATIONS Airplane Performance Operating Limitations § 121.198 Cargo service airplanes: Increased zero fuel and landing weights...

14 CFR 121.198 - Cargo service airplanes: Increased zero fuel and landing weights.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Cargo service airplanes: Increased zero... AND OPERATIONS OPERATING REQUIREMENTS: DOMESTIC, FLAG, AND SUPPLEMENTAL OPERATIONS Airplane Performance Operating Limitations § 121.198 Cargo service airplanes: Increased zero fuel and landing weights...

14 CFR 121.198 - Cargo service airplanes: Increased zero fuel and landing weights.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Cargo service airplanes: Increased zero... AND OPERATIONS OPERATING REQUIREMENTS: DOMESTIC, FLAG, AND SUPPLEMENTAL OPERATIONS Airplane Performance Operating Limitations § 121.198 Cargo service airplanes: Increased zero fuel and landing weights...

14 CFR 121.198 - Cargo service airplanes: Increased zero fuel and landing weights.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Cargo service airplanes: Increased zero... AND OPERATIONS OPERATING REQUIREMENTS: DOMESTIC, FLAG, AND SUPPLEMENTAL OPERATIONS Airplane Performance Operating Limitations § 121.198 Cargo service airplanes: Increased zero fuel and landing weights...

Therapy and Weight Management (For Teens)

MedlinePlus

... site Sitio para adolescentes Body Mind Sexual Health Food & Fitness Diseases & Conditions Infections Drugs & Alcohol School & Jobs Sports Expert Answers (Q&A) Staying Safe Videos for Educators Search English Español Therapy and Weight Management KidsHealth / For Teens / Therapy and Weight Management What's ...

The Effectiveness of a Weight Maintenance Intervention for Adults with Intellectual Disabilities and Obesity: A Single Stranded Study

ERIC Educational Resources Information Center

Spanos, Dimitrios; Hankey, Catherine R.; Melville, Craig A.

2016-01-01

Background: The evidence base for weight management programmes incorporating a weight loss and a weight maintenance phase for adults with intellectual disabilities (ID) is limited. This study describes the weight maintenance phase of a multicomponent weight management programme for adults with intellectual disability and obesity (TAKE 5).…

A Mobile Phone-Based Health Coaching Intervention for Weight Loss and Blood Pressure Reduction in a National Payer Population: A Retrospective Study.

PubMed

Mao, Alice Yuqing; Chen, Connie; Magana, Candy; Caballero Barajas, Karla; Olayiwola, J Nwando

2017-06-08

The prevalence of obesity and associated metabolic conditions continue to be challenging and costly to address for health care systems; 71% of American adults were overweight, with 35% of men and 40% of women diagnosed with obesity in 2014. Digital health coaching is an innovative approach to decreasing the barriers of cost and accessibility of receiving health coaching for the prevention and management of chronic disease in overweight or obese individuals. To evaluate the early impact of a mobile phone-based health coaching service on weight loss and blood pressure management in a commercially insured population. This was a retrospective study using existing registry data from a pilot commercial collaboration between Vida Health and a large national insurance provider, which enrolled adult members who were overweight (body mass index >25 kg/m2) and able to engage in a mobile phone-based coaching intervention. Participants received 4 months of intensive health coaching via live video, phone, and text message through the Vida Health app. Participants were also provided with a wireless scale, pedometer, and blood pressure cuff. Of the 1012 enrolled, 763 (75.40%) participants had an initial weight upon enrollment and final weight between 3 and 5 months from enrollment; they served as our intervention group. There were 73 participants out of the 1012 (7.21%) who had weight data 4 months prior to and after Vida coaching, who served as the matched-pair control group. Participants in the intervention group lost an average of 3.23% total body weight (TBW) at 4 months of coaching and 28.6% (218/763) intervention participants achieved a clinically significant weight loss of 5% or more of TBW, with an average of 9.46% weight loss in this cohort. In the matched-pair control group, participants gained on average 1.81% TBW in 4 months without Vida coaching and lost, on average, 2.47% TBW after 4 months of Vida coaching, demonstrating a statistically significant difference of 4.28% in mean percentage weight change (P<.001). Among 151 intervention participants with blood pressure data, 112 (74.2%) had a baseline blood pressure that was above the goal (systolic blood pressure >120 mmHg); 55 out of 112 (49.1%) participants improved their blood pressure at 4 months by an entire hypertensive stage-as defined by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Mobile phone app-based health coaching interventions can be an acceptable and effective means to promote weight loss and improve blood pressure management in overweight or obese individuals. Given the ubiquity of mobile phones, digital health coaching may be an innovative solution to decreasing barriers of access to much-needed weight management interventions for obesity. ©Alice Yuqing Mao, Connie Chen, Candy Magana, Karla Caballero Barajas, J Nwando Olayiwola. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 08.06.2017.

Informing maternity service development by surveying new mothers about preferences for nutrition education during their pregnancy in an area of social disadvantage.

PubMed

Porteous, Helen E; Palmer, Michelle A; Wilkinson, Shelley A

2014-09-01

A demonstrated link exists between maternal diet and maternal and infant health outcomes during and after pregnancy. A dietetic maternity service (0.6FTE for 3500 births) was introduced in 2012 at our hospital in a socially-disadvantaged area. We needed to develop evidence-based, patient-oriented improvements to nutrition services within resource limitations. This cross-sectional study gathered knowledge, eating behaviours, and nutrition-related needs of our women ante- and postnatally to inform this process. Women (≥ 18 years) admitted to the postnatal ward completed our survey. Data including dietary quality, nutritional knowledge and interest in nutrition education were collected. Analysis included descriptive, chi-squared and t-tests. Three hundred and nine eligible women responded (28 ± 6 years, 27 ± 7 kg/m(2) pre-pregnancy body mass index, 12% gestational diabetes). Two-fifths (42%) self-reported gaining excess weight during pregnancy. One quarter reported knowing their gestational weight gain goals, yet only 1.6% was correct. Half reported interest in receiving nutrition education during pregnancy and post-delivery (45%, n=134; 43%, n=123, respectively). Women had poor diet quality (daily serves - fruit: 1.8 ± 1.0; vegetables: 2.0 ± 1.2; dairy: 1.9 ± 1.2), despite identifying healthy eating as a personal priority. Nutrition topics requested included healthy eating for development of baby pre- and post-delivery and maternal weight management. Women attending our hospital have dietary issues and levels of interest in nutrition similar to women in tertiary maternity centres. Service changes planned will explore formats that meet higher and lower education levels; group workshops may be supplemented by formats such as internet and DVD-delivered education to overcome access and literacy issues, respectively. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Combating Obesity at Community Health Centers (COACH): A Quality Improvement Collaborative for Weight Management Programs

PubMed Central

Wilkes, Abigail E.; John, Priya M.; Vable, Anusha M.; Campbell, Amanda; Heuer, Loretta; Schaefer, Cynthia; Vinci, Lisa; Drum, Melinda L.; Chin, Marshall H.; Quinn, Michael T.; Burnet, Deborah L.

2013-01-01

Community health centers (CHCs) seek effective strategies to address obesity. MidWest Clinicians’ Network partnered with [an academic medical center] to test feasibility of a weight management quality improvement (QI) collaborative. MidWest Clinicians’ Network members expressed interest in an obesity QI program. This pilot study aimed to determine whether the QI model can be feasibly implemented with limited resources at CHCs to improve weight management programs. Five health centers with weight management programs enrolled with CHC staff as primary study participants; this study did not attempt to measure patient outcomes. Participants attended learning sessions and monthly conference calls to build QI skills and share best practices. Tailored coaching addressed local needs. Topics rated most valuable were patient recruitment/retention strategies, QI techniques, evidence-based weight management, motivational interviewing. Challenges included garnering provider support, high staff turnover, and difficulty tracking patient-level data. This paper reports practical lessons about implementing a weight management QI collaborative in CHCs. PMID:23727964

Introduction of the transtheoretical model and organisational development theory in weight management: A narrative review.

PubMed

Wu, Ya-Ke; Chu, Nain-Feng

2015-01-01

Overweight and obesity are serious public health and medical problems among children and adults worldwide. Behavioural change has been demonstrably contributory to weight management programs. Behavioural change-based weight loss programs require a theoretical framework. We will review the transtheoretical model and the organisational development theory in weight management. The transtheoretical model is a behaviour theory of individual level frequently used for weight management programs. The organisational development theory is a more complicated behaviour theory that applies to behavioural change on the system level. Both of these two theories have their respective strengths and weaknesses. In this manuscript, we try to introduce the transtheoretical model and the organisational development theory in the context of weight loss programs among population that are overweight or obese. Ultimately, we wish to present a new framework/strategy of weight management by integrating these two theories together. Copyright © 2015 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

42 CFR 412.515 - LTC-DRG weighting factors.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false LTC-DRG weighting factors. 412.515 Section 412.515 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE...-Term Care Hospitals § 412.515 LTC-DRG weighting factors. For each LTC-DRG, CMS assigns an appropriate...

Tray service generates more food waste in dining areas of a continuing-care retirement community.

PubMed

Hackes, B L; Shanklin, C W; Kim, T; Su, A Y

1997-08-01

To determine if the type of service system affects the amount of service food waste (SFW) generated in dining areas of a continuing-care retirement community. A waste stream analysis was conducted for 7 days to determine quantity of SFW generated in three service systems: health care tray service, health care dining room with wait-staff service, and ambulatory dining room with family-style service. Weight and volume were determined. Health care tray service and wait-staff service were provided to 70 residents in a health care unit. Family-style service was provided as an optional service for 130 residents in independent-living units. An average of 229 meals were served per day. Analysis of variance and a multiple comparison method were used to compare mean weight and volume of SFW on a per meal, per day, and per week basis. During the 7-day period, 482.8 lb, or 83 gal, of SFW was disposed of Health care tray service generated more SFW by weight for all three meals than either family-style service or wait-staff service, and it generated the greatest total volume of service waste. Residents eating in the dining room with family-style service disposed of significantly less SFW by weight at lunch and dinner than those receiving the other two service styles. Changing the style of service can affect not only quantity of solid waste generated and associated disposal costs but also food and supply costs, meal acceptability, and quantity of natural resources required. The systems approach should be used to assess the feasibility of changing service system so that all costs are considered.

Evaluation of supercritical cryogen storage and transfer systems for future NASA missions

NASA Technical Reports Server (NTRS)

Arif, Hugh; Aydelott, John C.; Chato, David J.

1990-01-01

Conceptual designs of Space Transportation Vehicles (STV), and their orbital servicing facilities, that utilize supercritical, single phase, cryogenic propellant were established and compared with conventional subcritical, two phases, STV concepts. The analytical study was motivated by the desire to avoid fluid management problems associated with the storage, acquisition and transfer of subcritical liquid oxygen and hydrogen propellants in the low gravity environment of space. Although feasible, the supercritical concepts suffer from STV weight penalties and propellant resupply system power requirements which make the concepts impractical.

Evaluation of supercritical cryogen storage and transfer systems for future NASA missions

NASA Technical Reports Server (NTRS)

Arif, Hugh; Aydelott, John C.; Chato, David J.

1989-01-01

Conceptual designs of Space Transportation Vehicles (STV), and their orbital servicing facilities, that utilize supercritical, single phase, cryogenic propellants were established and compared with conventional subcritical, two phase, STV concepts. The analytical study was motivated by the desire to avoid fluid management problems associated with the storage, acquisition and transfer of subcritical liquid oxygen and hydrogen propellants in the low gravity environment of space. Although feasible, the supercritical concepts suffer from STV weight penalties and propellant resupply system power requirements which make the concepts impractical.

A Slam Model of the Armed Forces Courier Service CONUS Stations: A Strategic Planning Tool.

DTIC Science & Technology

1985-09-01

ii .-- - ". . ’. . i i . - , i i . "-. - -’’" . .’’ ’- -. . . . . ... .’ 12? .2.2i?.i..- .’- .- j ’. .. . . . ... i ’< - ," ’i.-l -.- ’. ,. .l...of a simulation model that provides the ARFCOS top managers with a strategic planning tool for determining ,< .- .. -F -- ....F .,I . .. , j -.... io...i ,. i .< - j ’ ’. -.- ’i’iii ,. . - - . -.- ’ < . ,] . . F . ’I 1 " vehicle weight carrying requirements, and manpower needs for their different

Effect of Workplace Weight Management on Health Care Expenditures and Quality of Life.

PubMed

Michaud, Tzeyu L; Nyman, John A; Jutkowitz, Eric; Su, Dejun; Dowd, Bryan; Abraham, Jean M

2016-11-01

We examined the effectiveness of the weight management program used by the University of Minnesota in reducing health care expenditures and improving quality of life of its employees, and also in reducing their absenteeism during a 3-year intervention. A differences-in-differences regression approach was used to estimate the effect of weight management participation. We further applied ordinary least squares regression models with fixed effects to estimate the effect in an alternative analysis. Participation in the weight management program significantly reduced health care expenditures by $69 per month for employees, spouses, and dependents, and by $73 for employees only. Quality-of-life weights were 0.0045 points higher for participating employees than for nonparticipating ones. No significant effect was found for absenteeism. The workplace weight management used by the University of Minnesota reduced health care expenditures and improved quality of life.

Weight Management, Weight Perceptions, and Health-Compromising Behaviours Among Adolescent Girls in the COMPASS Study.

PubMed

Raffoul, Amanda; Leatherdale, Scott T; Kirkpatrick, Sharon I

2018-06-16

Evidence suggests associations between weight management intentions, weight perceptions, and health-compromising behaviours among adolescent girls. Drawing on cross-sectional data for 21,456 girls, we employed multinomial logistic regression to examine whether smoking, binge drinking, and breakfast-skipping were associated with weight management intentions and weight perceptions. According to self-reported heights and weights, 61.4% of girls were in the healthy weight category. However, most reported trying to manage their weight, with 58% trying to lose, 4.5% trying to gain, and 18% trying to maintain their weight. Smokers were more likely than non-smokers to report intentions to lose, gain, or maintain weight versus to do nothing. However, smokers were less likely than non-smokers to perceive themselves as underweight or overweight versus about the right weight. Binge drinkers were more likely than other girls to report an intention to gain and less likely to be trying to maintain their weight versus doing nothing, and breakfast-skippers were more likely to report trying to lose or gain weight but less likely to report trying to maintain weight versus doing nothing. Binge drinkers and breakfast-skippers were more likely than non-binge drinkers and non-breakfast-skippers, respectively, to perceive themselves as underweight, overweight or very overweight versus about the right weight. In sum, the majority of girls reported trying to manage their weight, and those engaging in other health-compromising behaviours were more likely to do so, though the exact nature of the associations differed by behaviour. Recognition of shared underlying risk factors for this clustering of behaviours may inform comprehensive health promotion efforts.

Broadband and scalable mobile satellite communication system for future access networks

NASA Astrophysics Data System (ADS)

Ohata, Kohei; Kobayashi, Kiyoshi; Nakahira, Katsuya; Ueba, Masazumi

2005-07-01

Due to the recent market trends, NTT has begun research into next generation satellite communication systems, such as broadband and scalable mobile communication systems. One service application objective is to provide broadband Internet access for transportation systems, temporal broadband access networks and telemetries to remote areas. While these are niche markets the total amount of capacity should be significant. We set a 1-Gb/s total transmission capacity as our goal. Our key concern is the system cost, which means that the system should be unified system with diversified services and not tailored for each application. As satellites account for a large portion of the total system cost, we set the target satellite size as a small, one-ton class dry mass with a 2-kW class payload power. In addition to the payload power and weight, the mobile satellite's frequency band is extremely limited. Therefore, we need to develop innovative technologies that will reduce the weight and maximize spectrum and power efficiency. Another challenge is the need for the system to handle up to 50 dB and a wide data rate range of other applications. This paper describes the key communication system technologies; the frequency reuse strategy, multiplexing scheme, resource allocation scheme, and QoS management algorithm to ensure excellent spectrum efficiency and support a variety of services and quality requirements in the mobile environment.

Creating a performance appraisal template for pharmacy technicians using the method of equal-appearing intervals.

PubMed

Desselle, Shane P; Vaughan, Melissa; Faria, Thomas

2002-01-01

To design a highly quantitative template for the evaluation of community pharmacy technicians' job performance that enables managers to provide sufficient feedback and fairly allocate organizational rewards. Two rounds of interviews with two convenience samples of community pharmacists and pharmacy technicians were conducted. The interview in phase 1 was qualitative, and responses were used to design the second interview protocol. During the phase 2 interviews, a new group of respondents ranked technicians' job responsibilities, identified through the initial interviewees' responses, using scales the researchers had designed using an interval-level scaling technique called equal-appearing intervals. Chain and independent pharmacies. Phase 1-20 pharmacists and 20 technicians from chain and independent pharmacies; phase 2-20 pharmacists and 9 technicians from chain and independent pharmacies. Ratings of the importance of technician practice functions and corresponding responsibilities. Weights were calculated for each practice function. A weighted list of practice functions was developed, and this may serve as a performance evaluation template. Customer service-related activities were judged by pharmacists and technicians alike to be the most important technician functions. Many pharmacies either lack formal performance appraisal systems or fail to implement them properly. Technicians may desire more consistent feedback from pharmacists and value information that may lead to organizational rewards. Using a weighted, behaviorally anchored performance appraisal system may help pharmacists and pharmacy managers meet these demands.

Dietary Management of Obesity: Cornerstones of Healthy Eating Patterns.

PubMed

Smethers, Alissa D; Rolls, Barbara J

2018-01-01

Several dietary patterns, both macronutrient and food based, can lead to weight loss. A key strategy for weight management that can be applied across dietary patterns is to reduce energy density. Clinical trials show that reducing energy density is effective for weight loss and weight loss maintenance. A variety of practical strategies and tools can help facilitate successful weight management by reducing energy density, providing portion control, and improving diet quality. The flexibility of energy density gives patients options to tailor and personalize their dietary pattern to reduce energy intake for sustainable weight loss. Copyright © 2017 Elsevier Inc. All rights reserved.

Can it be harmful for parents to talk to their child about their weight? A meta-analysis.

PubMed

Gillison, Fiona B; Lorenc, Ava B; Sleddens, Ester F C; Williams, Stefanie L; Atkinson, Lou

2016-12-01

Many parents express concern that raising the issue of weight risks harming their child's physical self-perceptions and wellbeing. Such concerns can deter families from engaging with weight management services. This systematic review aimed to investigate the evidence behind these concerns by analysing the association between parent-child weight-talk and child wellbeing. A systematic search of eight databases identified four intervention studies and 38 associative studies. Meta-analysis was only possible for the associative studies; to facilitate more meaningful comparisons, weight-talk was categorized into four communication types and effect size estimates for the association between these and wellbeing indicators were calculated through a random effects model. Encouraging children to lose weight and criticizing weight were associated with poorer physical self-perceptions and greater dieting and dysfunctional eating (effect sizes: 0.20 to 0.47). Conversely, parental encouragement of healthy lifestyles without explicit reference to weight was associated with better wellbeing, but this was only measured in two studies. Of the four intervention studies, only one isolated the effects of parents' communication on wellbeing outcomes, reporting a positive effect. There was no effect of age on the strength of associations, but dysfunctional eating was more strongly associated with parent communication for girls than boys. The findings indicate that some forms of parent-child weight-talk are associated with poor wellbeing, but suggest that this is not inevitable. Encouraging healthy behaviours without reference to weight-control, and positive parental involvement in acknowledging and addressing weight-concern may avoid such outcomes. More longitudinal research is needed to analyse the direction of these effects. Copyright © 2016 Elsevier Inc. All rights reserved.

Obese Employee Participation Patterns in a Wellness Program.

PubMed

Fink, Jennifer T; Smith, David R; Singh, Maharaj; Ihrke, Doug M; Cisler, Ron A

2016-04-01

The purpose of this research was to retrospectively examine whether demographic differences exist between those who participated in an employee wellness program and those who did not, and to identify the selection of employees' choice in weight management activities. A nonequivalent, 2-group retrospective design was used. This study involved employees at a large, not-for-profit integrated health system. Of the total organization employee pool (29,194), 19,771 (68%) employees volunteered to be weighed (mean body mass index [BMI]=28.9) as part of an employee wellness program. Weight management activities available included: (1) Self-directed 5% total body weight loss; (2) Healthy Solutions at home; (3) Weight Watchers group meetings; (4) Weight Watchers online; and (5) Employee Assistance Program (EAP)-directed healthy weight coaching. Measures were participation rate and available weight management activity participation rate among obese employees across demographic variables, including sex, age, race, job type, and job location. The analysis included chi-square tests for all categorical variables; odds ratios were calculated to examine factors predictive of participation. Of the total 19,771 employees weighed, 6375 (32%) employees were obese (defined as BMI ≥30); of those, 3094 (49%) participated in available weight management activities. Participation was higher among females, whites, those ages >50 years, and non-nursing staff. In conclusion, participation rate varied significantly based on demographic variables. Self-directed 5% weight loss was the most popular weight management activity selected. (Population Health Management 2016;19:132-135).

Chronic disease management and the development of virtual communities.

PubMed

Smith, Alan D

2007-01-01

The current volume and expected increases in the number of patients with chronic diseases are concerned significant and substantial. Patients with chronic diseases have a great need to personally manage their health-related behaviour, such as food consumption, and its impact on their health indicators, like blood pressure, body weight, blood sugar, cholesterol, to name a few. Current healthcare systems are unable to meet the needs of patients with chronic diseases for management, due to the need for acute care. An analysis of the needs was performed and recommendations for virtual communities were made to help patients with chronic diseases monitor and manage their health. Virtual communities have the potential to meet the need to assist with monitoring activities, education, community membership, and the sale of products and services. However, they also face risks inherent to accepting and storing any form of personal health information, and of remaining in compliance with the Health Insurance Portability and Accessibility Act of 2001.

Can weight management programs in worksites reduce the obesity epidemic?

USDA-ARS?s Scientific Manuscript database

Worksites can potentially be important locations for weight management programs that contribute to curbing the national obesity epidemic. In published studies, weight loss programs targeting overweight and obese employees have been relatively more effective for weight loss than programs for preventi...

Dynamic quality of service differentiation using fixed code weight in optical CDMA networks

NASA Astrophysics Data System (ADS)

Kakaee, Majid H.; Essa, Shawnim I.; Abd, Thanaa H.; Seyedzadeh, Saleh

2015-11-01

The emergence of network-driven applications, such as internet, video conferencing, and online gaming, brings in the need for a network the environments with capability of providing diverse Quality of Services (QoS). In this paper, a new code family of novel spreading sequences, called a Multi-Service (MS) code, has been constructed to support multiple services in Optical- Code Division Multiple Access (CDMA) system. The proposed method uses fixed weight for all services, however reducing the interfering codewords for the users requiring higher QoS. The performance of the proposed code is demonstrated using mathematical analysis. It shown that the total number of served users with satisfactory BER of 10-9 using NB=2 is 82, while they are only 36 and 10 when NB=3 and 4 respectively. The developed MS code is compared with variable-weight codes such as Variable Weight-Khazani Syed (VW-KS) and Multi-Weight-Random Diagonal (MW-RD). Different numbers of basic users (NB) are used to support triple-play services (audio, data and video) with different QoS requirements. Furthermore, reference to the BER of 10-12, 10-9, and 10-3 for video, data and audio, respectively, the system can support up to 45 total users. Hence, results show that the technique can clearly provide a relative QoS differentiation with lower value of basic users can support larger number of subscribers as well as better performance in terms of acceptable BER of 10-9 at fixed code weight.

Individual, social and environmental factors and their association with weight in rural-dwelling women.

PubMed

Harrison, Cheryce L; Teede, Helena J; Kozica, Samantha; Zoungas, Sophia; Lombard, Catherine B

2016-11-20

Obesity is a major public health concern and women living in rural settings present a high-risk group. With contributing factors poorly explored, we evaluated their association with weight in rural Australian women. Women aged 18-50 years of any body mass index (BMI) were recruited between October 2012 and April 2013 as part of a larger, randomised controlled trial within 42 rural towns. Measured weight and height as well as self-reported measures of individual health, physical activity, dietary intake, self-management, social support and environmental perception were collected. Statistical analysis included linear regression for continuous variables as well as chi-squared and logistic regression for categorical variables with all results adjusted for clustering. 649 women with a mean baseline age and BMI of 39.6±6.7 years and 28.8±6.9 kg/m 2 respectively, were studied. Overall, 65% were overweight or obese and 60% overall reported recent weight gain. There was a high intention to self-manage weight, with 68% attempting to lose weight recently, compared to 20% of women reporting health professional engagement for weight management. Obese women reported increased weight gain, energy intake, sitting time and prevalence of pre-existing health conditions. There was an inverse relationship between increased weight and scores for self-management, social support and health environment perception. Many women in rural communities reported recent weight gain and were attempting to self-manage their weight with little external support. Implications for Public Health: Initiatives to prevent weight gain require a multifaceted approach, with self-management strategies and social support in tandem with building a positive local environmental perception. © 2016 Public Health Association of Australia.

A three-component cognitive behavioural lifestyle program for preconceptional weight-loss in women with polycystic ovary syndrome (PCOS): a protocol for a randomized controlled trial.

PubMed

Jiskoot, G; Benneheij, S H; Beerthuizen, A; de Niet, J E; de Klerk, C; Timman, R; Busschbach, J J; Laven, J S E

2017-03-06

Obesity in women with polycystic ovary syndrome (PCOS) negatively affects all clinical features, and a 5 to 10% weight loss has shown promising results on reproductive, metabolic and psychological level. Incorporating a healthy diet, increasing physical activity and changing dysfunctional thought patterns in women with PCOS are key points in losing weight. The biggest challenge in weight management programs is to achieve a reasonable and sustainable weight loss. The aim of this study is to explore whether Cognitive Behavioural Therapy (CBT) by a mental health professional, working in a multidisciplinary team with a dietician and a physical therapist (a three-component intervention), is more effective for weight loss in the long term, within 12 months. We will also explore whether mobile phone applications are effective in supporting behavioural change and sustainable weight loss. The present study is a longitudinal randomized controlled trial (RCT) to study the effectiveness of a three-component 1-year cognitive-behavioural lifestyle intervention in overweight/obese women with PCOS. A total of 210 participants are randomly assigned to three groups: 1) CBT provided by the multidisciplinary team or; 2) CBT provided by the multidisciplinary team and Short Message Service (SMS) or; 3) usual care: encourage weight loss through publicly available services (control group). The primary aim of the 12-month intervention is to explore whether a three-component 1-year cognitive-behavioural lifestyle intervention is effective to decrease weight, when compared to usual care. Secondary outcomes include: the effect of the intervention on the PCOS phenotype, waist circumference, waist to hip ratio, ovulation rates, total testosterone, SHBG, free androgen index (FAI), AMH, hirsutism, acne, fasting glucose, blood pressure and all psychological parameters. Additionally, we assessed time to pregnancy, ongoing pregnancies, clinical pregnancies, miscarriages and birth weight. All outcome variables are measured at the start of the study, and again at 3 months, 6 months, nine months and 12 months. We expect that CBT provided by a multidisciplinary team, especially combined with SMS, is effective in developing a healthy lifestyle and achieving a long-term weight loss in women with PCOS. Losing 5- 10% body weight improves various PCOS characteristics. Consequently, we expect to show that CBT provided by a multidisciplinary team improves reproductive and metabolic outcomes, as well as quality of life, while at the same time being cost-effective. Registered at the Netherlands National Trial Register with number NTR2450 on August 2nd, 2010.

Development of MY-DRG casemix pharmacy service weights in UKM Medical Centre in Malaysia.

PubMed

Ali Jadoo, Saad Ahmed; Aljunid, Syed Mohamed; Nur, Amrizal Muhammad; Ahmed, Zafar; Van Dort, Dexter

2015-02-10

The service weight is among several issues and challenges in the implementation of case-mix in developing countries, including Malaysia. The aim of this study is to develop the Malaysian Diagnosis Related Group (MY-DRG) case-mix pharmacy service weight in University Kebangsaan Malaysia-Medical Center (UKMMC) by identifying the actual cost of pharmacy services by MY-DRG groups in the hospital. All patients admitted to UKMMC in 2011 were recruited in this study. Combination of Step-down and Bottom-up costing methodology has been used in this study. The drug and supplies cost; the cost of staff; the overhead cost; and the equipment cost make up the four components of pharmacy. Direct costing approach has been employed to calculate Drugs and supplies cost from electronic-prescription system; and the inpatient pharmacy staff cost, while the overhead cost and the pharmacy equipments cost have been calculated indirectly from MY-DRG data base. The total pharmacy cost was obtained by summing the four pharmacy components' cost per each MY-DRG. The Pharmacy service weight of a MY-DRG was estimated by dividing the average pharmacy cost of the investigated MY-DRG on the average of a specified MY-DRG (which usually the average pharmacy cost of all MY-DRGs). Drugs and supplies were the main component (86.0%) of pharmacy cost compared o overhead cost centers (7.3%), staff cost (6.5%) and pharmacy equipments (0.2%) respectively. Out of 789 inpatient MY-DRGs case-mix groups, 450 (57.0%) groups were utilized by the UKMMC. Pharmacy service weight has been calculated for each of these 450 MY-DRGs groups. MY-DRG case-mix group of Lymphoma & Chronic Leukemia group with severity level three (C-4-11-III) has the highest pharmacy service weight of 11.8 equivalents to average pharmacy cost of RM 5383.90. While the MY-DRG case-mix group for Circumcision with severity level one (V-1-15-I) has the lowest pharmacy service weight of 0.04 equivalents to average pharmacy cost of RM 17.83. A mixed approach which is based partly on top-down and partly on bottom up costing methodology has been recruited to develop MY-DRG case-mix pharmacy service weight for 450 groups utilized by the UKMMC in 2011.

Costal vulnerability systems-network using Fuzzy and Bayesian approaches

NASA Astrophysics Data System (ADS)

Taramelli, A.; Valentini, E.; Filipponi, F.; Nguyen Xuan, A.; Arosio, M.

2016-12-01

Marine drivers such as surge in the context of SLR, are threatening low-lying coastal plains. In order to deal with disturbances a deeper understanding of benefits deriving from ecosystem services assesment, management and planning (e.g. the role of dune ridges in surge mitigation and climate adaptation) can enhance the resilience of coastal systems. In this frame assessing the vulnerability is a key concern of many SOS (social, ecological, institutional) that deals with several challenges like the definition of Essential Variables (EVs) able to synthesize the required information, the assignment of different weight to be attributed to each considered variable, the selection of method for combining the relevant variables, etc.. To this end it is unclear how SLR, subsidence and erosion might affect coastal subsistence resources because of highly complex interactions and because of the subjective system of weighting many variables and their interaction within the systems. In this contribution, making the best use of many EO products, in situ data and modelling, we propose a multidimensional surge vulnerability assessment that aims at combining together geophysical and socioeconomic variable on the base of different approaches: 1) Fuzzy Logic; 2) Bayesian approach. The final goal is providing insight in understanding how to quantify regulating ecosystem services.

Knowledge, attitudes, and practices of public sector primary health care physicians of rural north karnataka towards obesity management.

PubMed

Somannavar, Manjunath S; Appajigol, Jayaprakash S

2014-01-01

Obesity is a risk factor for cardiovascular disease (CVD), diabetes mellitus (DM), and hypertension (HTN). In an era of rapidly growing prevalence of obesity, it is important to explore the current knowledge, attitude, and practices of primary care physicians. Study participants were medical officers (MOs) of primary health centers in three districts of North Karnataka. The questionnaire was developed by a review of literature in the field and validated with five participants for scope, length, and clarity. Of the 102 participants, only 15% were aware about the burden of obesity in India. HTN, DM, and CVD were indicated as comorbidities by 73, 78, and 60 participants, respectively. Only 25 and 12 participants indicated appropriate body mass index (BMI) cut-off values for overweight and obesity diagnosis. Of the 102 participants, 54 were not aware of the guidelines for obesity management. Practices and attitudes of the participants were encouraging. Nearly all of them felt that the adults with BMI within the healthy range should be encouraged to maintain their weight and, three-fourth of them agreed that most overweight persons should be treated for weight loss and small weight loss can achieve major medical benefit. However, nearly half of the participants' responses were stereotypical as they felt only obese and overweight with comorbidities should be treated for weight loss. Two-thirds of them use BMI to diagnose overweight/obese and nearly all of them advice their patients to increase physical activity and restrict fat. Most of the participants were advising their patients to restrict sugar intake, increase fruits and vegetable consumption, reduce red meat, and avoid alcohol consumption. Present study exposed the lack of knowledge regarding obesity. However, practices and attitudes of the participants were promising. There is a need of in-service training to MOs to further improve their knowledge and practices towards management of obesity.

How College Students Search the Internet for Weight Control and Weight Management Information: An Observational Study

ERIC Educational Resources Information Center

Senkowski, Valerie; Branscum, Paul

2015-01-01

Background: Few studies have attempted to examine how young adults search for health information on the Internet, especially information related to weight control and weight management. Purpose: The purpose of this study was to determine search strategies that college students used for finding information related to weight control and weight…

The application of the Yerkes-Dodson law in a childhood weight management program: Examining weight dissatisfaction

USDA-ARS?s Scientific Manuscript database

Our objective was to determine the effect of dissatisfaction with one's weight on outcomes in a weight management program. Participants included 149 children between the ages of 11 and 14 years who were enrolled in an intensive weight loss intervention. All participants had a body mass index (BMI) ...

78 FR 52975 - Amended Certification Regarding Eligibility To Apply for Worker Adjustment Assistance

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-27

... Servicing, Inc., Power Reo Management Services, Inc., and Stratus Asset Management Coppell, Texas; Homeward... Servicing, Inc., Power Reo Management Services, Inc., and Stratus Asset Management Addison, Texas; Homeward... Servicing, Inc., Power Reo Management Services, Inc., and Stratus Asset Management Jacksonville, Florida In...

Exploring Weight Management Recommendations across Australian Community Pharmacies Using Case Vignettes

ERIC Educational Resources Information Center

Fakih, Souhiela; Marriott, Jennifer L.; Hussainy, Safeera Y.

2014-01-01

With the increase in the overweight and obese population, it is critical that pharmacy staff are able to provide weight management advice to women at different stages of their life. This study utilized case vignettes to identify pharmacists' and pharmacy assistants' current weight management recommendations to women of different ages, life stages…

Level of interest in a weight management program among adult U.S. military dependents

USDA-ARS?s Scientific Manuscript database

There is little information on the extent to which different challenged populations with high rates of overweight and obesity have interest in participating in weight management programs. The purpose of this study was to identify potential rates of enrollment in a weight management program among adu...

Exploring parental factors related to weight management in survivors of childhood central nervous system tumors.

PubMed

Santa Maria, Diane; Swartz, Maria C; Markham, Christine; Chandra, Joya; McCurdy, Sheryl; Basen-Engquist, Karen

2014-01-01

Childhood central nervous system tumor survivors (CCNSTS) are at risk for adverse health issues. Little research has been conducted to explore the role of parental factors in weight management to mitigate adverse health outcomes. We conducted 9 group interviews (n=20) with CCNSTS, their parents, and health care providers to ascertain parental factors that may influence weight management practices in CCNSTS. Three main themes were identified: parenting style, parent-child connectedness, and food and physical activity (PA) environment. Although most parents adopted an authoritative parenting style related to diet and PA practices, some adopted a permissive parenting style. Participants expressed high levels of connection that may hinder the development of peer relationships and described the food and PA environments that promote or hinder weight management through parental modeling of healthy eating and PA and access to healthy food and activities. Weight management interventions for CCNSTS may experience greater benefit from using a family-focused approach, promoting positive food and PA environments, parental modeling of healthy eating and exercise, and partnering with youth to adopt weight management behaviors.

Enhancing the role of nutrition professionals in weight management: A cross sectional survey

PubMed Central

Bleich, Sara N.; Bandara, Sachini; Bennett, Wendy; Cooper, Lisa A.; Gudzune, Kimberly A.

2014-01-01

Objective 1) To determine the non-physician health profession perceived as best qualified to provide weight management; 2) To examine nutrition professionals’ current practice characteristics and perceived challenges and solutions for obesity care; and 3) To examine the association between nutrition professionals’ quality of training and self-efficacy in weight management. Design and methods We analyzed a 2014 national cross-sectional online survey of 500 U.S. non-physician health professionals (100 from each: nutrition, nursing, behavioral/mental health, exercise, pharmacy). Results Nutrition professionals most commonly self-identified as the most qualified group to help patients lose weight (92%), sentiments supported by other health professionals (57%). The most often cited challenge was lack of patient adherence (87%). Among nutrition professionals, 77% reported receiving high quality training in weight loss counseling. Nutrition professionals who reported high quality training were significantly more likely to report confidence (95% vs. 48%) and success (74% vs. 50%) in helping obese patients lose weight (p<0.05) than those reporting lower quality training. Conclusion Across all non-physician health professionals, nutrition professionals were identified as best suited to provide routine weight management counseling to obese patients. Yet, nutrition professionals’ receipt of high quality weight management training appears critical to their success in helping patients lose weight. PMID:25445319

The Biggest Loser Thinks Long-Term: Recency as a Predictor of Success in Weight Management.

PubMed

Koritzky, Gilly; Rice, Chantelle; Dieterle, Camille; Bechara, Antoine

2015-01-01

Only a minority of participants in behavioral weight management lose weight significantly. The ability to predict who is likely to benefit from weight management can improve the efficiency of obesity treatment. Identifying predictors of weight loss can also reveal potential ways to improve existing treatments. We propose a neuro-psychological model that is focused on recency: the reliance on recent information at the expense of time-distant information. Forty-four weight-management patients completed a decision-making task and their recency level was estimated by a mathematical model. Impulsivity and risk-taking were also measured for comparison. Weight loss was measured in the end of the 16-week intervention. Consistent with our hypothesis, successful dieters (n = 12) had lower recency scores than unsuccessful ones (n = 32; p = 0.006). Successful and unsuccessful dieters were similar in their demographics, intelligence, risk taking, impulsivity, and delay of gratification. We conclude that dieters who process time-distant information in their decision making are more likely to lose weight than those who are high in recency. We argue that having low recency facilitates future-oriented thinking, and thereby contributes to behavior change treatment adherence. Our findings underline the importance of choosing the right treatment for every individual, and outline a way to improve weight-management processes for more patients.

Study of the Continuous Improvement Trend for Health, Safety and Environmental Indicators, after Establishment of Integrated Management System (IMS) in a Pharmaceutical Industry in Iran.

PubMed

Mariouryad, Pegah; Golbabaei, Farideh; Nasiri, Parvin; Mohammadfam, Iraj; Marioryad, Hossein

2015-10-01

Nowadays, organizations try to improve their services and consequently adopt management systems and standards which have become key parts in various industries. One of these management systems which have been noticed in the recent years is Integrated Management System that is the combination of quality, health, safety and environment management systems. This study was conducted with the aim of evaluating the improvement trend after establishment of integrated management system for health, safety and environment indicators, in a pharmaceutical industry in Iran. First, during several inspections in different parts of the industry, indicators that should have been noted were listed and then these indicators were organized in 3 domains of health, safety and environment in the form of a questionnaire that followed Likert method of scaling. Also, the weight of each index was resulted from averaging out of 30 managers and the viewpoints of the related experts in the field. Moreover, by checking the documents and evidence of different years (5 contemplation years of this study), the score of each indicator was determined by multiplying the weight and score of the indices and were finally analysed. Over 5 years, scores of health scope indicators, increased from 161.99 to 202.23. Score in the first year after applying the integrated management system establishment was 172.37 in safety part and in the final year increased to 197.57. The changes of environmental scope rates, from the beginning of the program up to the last year increased from 49.24 to 64.27. Integrated management systems help organizations to improve programs to achieve their objectives. Although in this study all trends of health, safety and environmental indicator changes were positive, but at the same time showed to be slow. So, one can suggest that the result of an annual evaluation should be applied in planning future activities for the years ahead.

Study of the Continuous Improvement Trend for Health, Safety and Environmental Indicators, after Establishment of Integrated Management System (IMS) in a Pharmaceutical Industry in Iran

PubMed Central

Mariouryad, Pegah; Golbabaei, Farideh; Nasiri, Parvin; Mohammadfam, Iraj

2015-01-01

Background Nowadays, organizations try to improve their services and consequently adopt management systems and standards which have become key parts in various industries. One of these management systems which have been noticed in the recent years is Integrated Management System that is the combination of quality, health, safety and environment management systems. Aim This study was conducted with the aim of evaluating the improvement trend after establishment of integrated management system for health, safety and environment indicators, in a pharmaceutical industry in Iran. Materials and Methods First, during several inspections in different parts of the industry, indicators that should have been noted were listed and then these indicators were organized in 3 domains of health, safety and environment in the form of a questionnaire that followed Likert method of scaling. Also, the weight of each index was resulted from averaging out of 30 managers and the viewpoints of the related experts in the field. Moreover, by checking the documents and evidence of different years (5 contemplation years of this study), the score of each indicator was determined by multiplying the weight and score of the indices and were finally analysed. Results Over 5 years, scores of health scope indicators, increased from 161.99 to 202.23. Score in the first year after applying the integrated management system establishment was 172.37 in safety part and in the final year increased to 197.57. The changes of environmental scope rates, from the beginning of the program up to the last year increased from 49.24 to 64.27. Conclusion Integrated management systems help organizations to improve programs to achieve their objectives. Although in this study all trends of health, safety and environmental indicator changes were positive, but at the same time showed to be slow. So, one can suggest that the result of an annual evaluation should be applied in planning future activities for the years ahead. PMID:26557547

GestationaL Obesity Weight management: Implementation of National Guidelines (GLOWING): a pilot cluster randomised controlled trial of a guideline implementation intervention for the management of maternal obesity by midwives.

PubMed

Heslehurst, Nicola; Rankin, Judith; McParlin, Catherine; Sniehotta, Falko F; Howel, Denise; Rice, Stephen; McColl, Elaine

2018-01-01

Weight management in pregnancy guidelines exist, although dissemination alone is an ineffective means of implementation. Midwives identify the need for support to overcome complex barriers to practice. An evaluation of an intervention to support midwives' guideline implementation would require a large-scale cluster randomised controlled trial. A pilot study is necessary to explore the feasibility of delivery and evaluation prior to a definitive trial. The GestationaL Obesity Weight management: Implementation of National Guidelines (GLOWING) trial aims to test whether it is feasible and acceptable to deliver a behaviour change intervention to support midwives' implementation of weight management guidelines. GLOWING is a multi-centre parallel group pilot cluster randomised controlled trial comparing the delivery of a behaviour change intervention for midwives versus usual practice. Four NHS Trusts (clusters) will be randomised to intervention and control arms, stratified by size of maternity services. The intervention uses social cognitive theory and consists of face-to-face midwifery training plus information resources for routine practice. The main outcomes are whether the intervention and trial procedures are feasible and acceptable to participants and the feasibility of recruitment and data collection for a definitive trial. Target recruitment involves all eligible midwives in the intervention arm recruited to receive the intervention, 30 midwives and pregnant women per arm for baseline and outcome questionnaire data collection and 20 midwives and women to provide qualitative data. All quantitative and qualitative analyses will be descriptive with the purpose of informing the development of the definitive trial. This pilot study has been developed to support community midwives' implementation of guidelines. Community midwives have been selected as they usually carry out the booking appointment which includes measuring and discussing maternal body mass index. A cluster design is the gold standard in implementation research as there would be a high risk of contamination if randomisation was at individual midwife level: community midwives usually work in locality-based teams, interact on a daily basis, and share care of pregnant women. The results of the pilot trial will be used to further develop and refine GLOWING prior to a definitive trial to evaluate effectiveness and cost-effectiveness. ISRCTN46869894; retrospectively registered 25th May 2016.

Unique barriers and needs in weight management for obese women with fibromyalgia.

PubMed

Craft, Jennifer M; Ridgeway, Jennifer L; Vickers, Kristin S; Hathaway, Julie C; Vincent, Ann; Oh, Terry H

2015-01-01

The aim of this study was to identify barriers, needs, and preferences of weight management intervention for women with fibromyalgia (FM). Obesity appears in higher rates in women with fibromyalgia compared to the population at large, and no study to date has taken a qualitative approach to better understand how these women view weight management in relation to their disease and vice versa. We designed a qualitative interview study with women patients with FM and obesity. Women (N = 15) were recruited by their participation in a fibromyalgia treatment program (FTP) within the year prior. The women approached for the study met the following inclusion criteria: confirmed diagnosis of FM, age between 30 and 60 years (M = 51 ± 6.27), and body mass index (BMI) ≥ 30 (M = 37.88 ± 4.87). Patients completed questionnaire data prior to their participation in focus groups (N = 3), including weight loss history, physical activity data, the Revised Fibromyalgia Impact Questionnaire (FIQR), and the Patient Health Questionnaire 9-item (PHQ-9). Three focus group interviews were conducted to collect qualitative data. Consistent themes were revealed within and between groups. Patients expressed the complex relationships between FM symptoms, daily responsibilities, and weight management. Weight was viewed as an emotionally laden topic requiring compassionate delivery of programming from an empathetic leader who is knowledgeable about fibromyalgia. Patients view themselves as complex and different, requiring a specifically tailored weight management program for women with FM. Women with FM identify unique barriers to weight management, including the complex interrelationships between symptoms of FM and health behaviors, such as diet and exercise. They prefer a weight management program for women with FM that consists of an in-person, group-based approach with a leader but are open to a tailored conventional weight management program. Feasibility may be one of the biggest barriers to such a program both from an institutional and individual perspective. Copyright © 2015 Elsevier Inc. All rights reserved.

Organizational and environmental factors associated with nursing home participation in managed care.

PubMed Central

Zinn, J S; Mor, V; Castle, N; Intrator, O; Brannon, D

1999-01-01

OBJECTIVE: To develop and test a model, based on resource dependence theory, that identifies the organizational and environmental characteristics associated with nursing home participation in managed care. DATA SOURCES AND STUDY SETTING: Data for statistical analysis derived from a survey of Directors of Nursing in a sample of nursing homes in eight states (n = 308). These data were merged with data from the On-line Survey Certification and Reporting System, the Medicare Managed Care State/County Data File, and the 1995 Area Resource File. STUDY DESIGN: Since the dependent variable is dichotomous, the logistic procedure was used to fit the regression. The analysis was weighted using SUDAAN. FINDINGS: Participation in a provider network, higher proportions of resident care covered by Medicare, providing IV therapy, greater availability of RNs and physical therapists, and Medicare HMO market penetration are associated with a greater likelihood of having a managed care contract. CONCLUSION: As more Medicare recipients enroll in HMOs, nursing home involvement in managed care is likely to increase. Interorganizational linkages enhance the likelihood of managed care participation. Nursing homes interested in managed care should consider upgrading staffing and providing at least some subacute services. PMID:10029508

Lifestyle and Behavioral Management of Polycystic Ovary Syndrome.

PubMed

Brennan, Leah; Teede, Helena; Skouteris, Helen; Linardon, Jake; Hill, Briony; Moran, Lisa

2017-08-01

Polycystic ovary syndrome (PCOS) is a common condition with serious physiological and psychological health consequences. It affects women across their reproductive lifespan and is associated with pregnancy complications, including gestational diabetes, preeclampsia, and large gestational-age babies. PCOS is associated with excess weight gain, which, in turn, exacerbates the health burden of PCOS. Therefore, weight management, including a modest weight loss, maintenance of weight loss, prevention of weight gain, and prevention of excess gestational weight gain, is a first-line treatment for women with PCOS during and independent of pregnancy. Despite evidence-based guidelines, international position statements, and Cochrane reviews promoting lifestyle interventions for PCOS, the optimal complexity, intensity, and behavioral components of lifestyle interventions for women with PCOS are not well understood. The focus of this narrative review is the evidence supporting the use of behavioral strategies in weight management interventions for reproductive-aged women to apply to PCOS. Behavioral theories, behavior change strategies, and psychological correlates of weight management have been thoroughly explored in weight loss interventions in the general population, reproductive-aged women, and peri-natal women. This article uses this parallel body of research to inform suggestions regarding lifestyle interventions in women with PCOS. Outcomes of weight management programs in women with PCOS are likely to be improved with the inclusion of behavioral and psychological strategies, including goal setting, self-monitoring, cognitive restructuring, problem solving, and relapse prevention. Strategies targeting improved motivation, social support, and psychological well-being are also important. These can be applied to the clinical management of women with PCOS at different reproductive life stages.

Factors associated with first service conception in artificially inseminated nulliparous Holstein heifers.

PubMed

Donovan, G Arthur; Bennett, Fred L; Springer, Frederick S

2003-06-01

Animal and management factors associated with first service conception in nulliparous dairy heifers were determined in 601 Holstein heifers from a dairy farm in north central Florida. Animal data collected included body weight, height at the withers and tail head, body condition score at 6 months of age and just prior to first artificial insemination (AI), and pelvimetry measurements taken just prior to first AI. Management data included season of first AI, inseminator, service sire, method of estrus detection, whether the estrus of first insemination was induced using prostaglandin F(2alpha) (PGF(2alpha)), and whether the heifer received a modified live virus (MLV) vaccine within 21 days of first insemination. Data were analyzed using multivariable logistic regression. Heifers inseminated in the summer were more than four times less likely to become pregnant to first insemination than heifers bred during the rest of the year (odds ratio (OR)=0.24; 95% CI=0.14, 0.41). Using secondary signs for estrus detection instead of standing estrus resulted in significantly reduced odds of conception to first service (OR=0.37; 95% CI 0.13, 1.02). Also, heifers inseminated at estrus induced by PGF(2alpha) were approximately one-third less likely to conceive than those heifers inseminated to a naturally occurring estrus (OR=0.66; 95% CI 0.46, 0.95). An interaction between pelvic size and breeding season was found indicating that large pelvic size had a significant positive effect on fertility in the summer, but was not associated with conception to first service in the winter.

46 CFR 160.151-57 - Servicing procedure.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) It has no expiration date; or (iii) It is to return to service in an item of survival equipment, but... its weight loss exceeds five percent of the weight of the charge, it must be recharged. (c) When an... servicing of a davit-launched liferaft, the launching-load test in paragraph 2/5.2 of IMO Resolution A.689...

Lack of increase of serum adiponectin concentrations with a moderate weight loss during six months on a high-caloric diet in military service among a young male Finnish population.

PubMed

Mousavinasab, Firoozeh; Tähtinen, Tuula; Jokelainen, Jari; Koskela, Pentti; Vanhala, Mauno; Oikarinen, Jorma; Keinänen-Kiukaanniemi, Sirkka

2005-02-01

An increase of insulin resistance and a worsening of lipid profile during 6 mo of military service in young male Finnish population has previously been shown by us. The present study demonstrates unfavorable changes of serum adiponectin concentrations and their association with weight loss in these particular circumstances. Adiponectin in a range of 4.3-21.2 microg/mL was present in the serum samples and had a significant negative correlation with weight, body mass index, waist to hip ratio, and insulin. Fasting serum lipids and plasma insulin significantly increased and serum adiponectin levels significantly decreased during the military service. Even the subjects with a 5-10% decrease in body weight showed the same result. In cases with more than 10% weight reduction and a significant decrease of fasting insulin concentration, the total and low density lipoprotein cholesterol significantly increased and adiponectin concentration tended to decreased. Only in severely obese cases (BMI >/= 30 kg/m2) with more than 10% decrease in body mass index adiponectin levels tended to increase, although not statistically significantly. This study shows that serum adiponectin concentrations decreased during a 6 mo high-caloric diet in military service, and even a moderate weight reduction induced by high-energy expenditure in exercise during service did not increase its levels.

[Consequences of a Failed Project: Introduction and Management of a Hospitalization-Substituting Treatment Model].

PubMed

Peters, Uwe

2018-01-01

This article is a report on a psychiatric project introducing services that substitute in-patient treatment and a new control and management system. The implementation of the project was a failure. Nevertheless, the project has made a contribution to further development of community-based psychiatry. Design, organization and course of the project are described and analyzed from the point of view of the communal actors involved. Effects going beyond the time course of the project have been taken into consideration. The results show that the contracting authority, project developer and local actors involved had differing ideas on the weight attached to different parts of the project as well as on the project goal and resources for carrying out the project. © Georg Thieme Verlag KG Stuttgart · New York.

Effectiveness of hypnosis as an adjunct to behavioral weight management.

PubMed

Bolocofsky, D N; Spinler, D; Coulthard-Morris, L

1985-01-01

This study examined the effect of adding hypnosis to a behavioral weight-management program on short- and long-term weight change. One hundred nine subjects, who ranged in age from 17 to 67, completed a behavioral treatment either with or without the addition of hypnosis. At the end of the 9-week program, both interventions resulted in significant weight reduction. However, at the 8-month and 2-year follow-ups, the hypnosis clients showed significant additional weight loss, while those in the behavioral treatment exhibited little further change. More of the subjects who used hypnosis also achieved and maintained their personal weight goals. The utility of employing hypnosis as an adjunct to a behavioral weight-management program is discussed.

History matters: childhood weight trajectories as a basis for planning community-based obesity prevention to adolescents.

PubMed

Ekberg, J; Angbratt, M; Valter, L; Nordvall, M; Timpka, T

2012-04-01

To use epidemiological data and a standardized economic model to compare projected costs for obesity prevention in late adolescence accrued using a cross-sectional weight classification for selecting adolescents at age 15 years compared with a longitudinal classification. All children born in a Swedish county (population 440 000) in 1991 who participated in all regular measurements of height and weight at ages 5, 10 and 15 years (n=4312) were included in the study. The selection strategies were compared by calculating the projected financial load resulting from supply of obesity prevention services from providers at all levels in the health care system. The difference in marginal cost per 1000 children was used as the primary end point for the analyses. Using the cross-sectional selection strategy, 3.8% of adolescents at age 15 years were selected for evaluation by a pediatric specialist, and 96.2% were chosen for population-based interventions. In the trajectory-based strategy, 2.4% of the adolescents were selected for intensive pediatric care, 1.4% for individual clinical interventions in primary health care, 14.0% for individual primary obesity prevention using the Internet and 82.1% for population-based interventions. Costs for the cross-sectional selection strategy were projected to USD463 581 per 1000 adolescents and for the trajectory-based strategy were USD 302 016 per 1000 adolescents. Using projections from epidemiological data, we found that by basing the selection of adolescents for obesity prevention on weight trajectories, the load on highly specialized pediatric care can be reduced by one-third and total health service costs for obesity management among adolescents reduced by one-third. Before use in policies and prevention program planning, our findings warrant confirmation in prospective cost-benefit studies.

Diabetes Intervention Accentuating Diet and Enhancing Metabolism (DIADEM-I): a randomised controlled trial to examine the impact of an intensive lifestyle intervention consisting of a low-energy diet and physical activity on body weight and metabolism in early type 2 diabetes mellitus: study protocol for a randomized controlled trial.

PubMed

Taheri, Shahrad; Chagoury, Odette; Zaghloul, Hadeel; Elhadad, Sara; Ahmed, Salma Hayder; Omar, Omar; Payra, Sherryl; Ahmed, Salma; El Khatib, Neda; Amona, Rasha Abou; El Nahas, Katie; Bolton, Matthew; Chaar, Henem; Suleiman, Noor; Jayyousi, Amin; Zirie, Mahmoud; Janahi, Ibrahim; Elhag, Wahiba; Alnaama, Abdulla; Zainel, Abduljaleel; Hassan, Dahlia; Cable, Tim; Charlson, Mary; Wells, Martin; Al-Hamaq, Abdulla; Al-Abdulla, Samya; Abou-Samra, Abdul Badi

2018-05-21

Type 2 diabetes mellitus (T2DM) and obesity are syndemic and will have a significant impact on affected individuals and healthcare services worldwide. Evidence shows that T2DM remission can be achieved with significant weight loss in those who are younger with early diabetes and requiring fewer medications for glycaemic control. DIADEM-I aims to examine the impact of an intensive lifestyle intervention (ILI) using a low-energy diet (LED) meal replacement approach combined with physical activity in younger individuals with early T2DM. The planned study is an ongoing, non-blinded, pragmatic, randomised controlled, parallel-group trial examining the impact of an LED-based ILI on body weight and diabetes remission in younger (18-50 years) T2DM individuals with early diabetes (≤ 3-year duration). The ILI will be compared to usual medical care (UMC). The primary outcome will be weight loss at 12 months. Other key outcomes of interest include diabetes remission, glycaemic control, diabetes complications, cardiovascular health, physical activity, mental health, and quality of life. It is planned for the study to include 138 subjects for assessment of the primary outcome. Safety will be assessed throughout. If DIADEM-I demonstrates a clinically significant effect for younger individuals with early T2DM, it will inform clinical guidelines and services of the future for management of T2DM. ISRCTN: ISRCTN20754766 (date assigned: 7 June 2017); ClinicalTrials.gov, ID: NCT03225339 Registered on 26 June 2017.

Healthy eating and lifestyle in pregnancy (HELP): a protocol for a cluster randomised trial to evaluate the effectiveness of a weight management intervention in pregnancy

PubMed Central

2014-01-01

Background Approximately 1 in 5 pregnant women in the United Kingdom are obese. In addition to being associated generally with poor health, obesity is known to be a contributing factor to pregnancy and birth complications and the retention of gestational weight can lead to long term obesity. This paper describes the protocol for a cluster randomised trial to evaluate whether a weight management intervention for obese pregnant women is effective in reducing women’s Body Mass Index at 12 months following birth. Methods/design The study is a cluster randomised controlled trial involving 20 maternity units across England and Wales. The units will be randomised, 10 to the intervention group and 10 to the control group. 570 pregnant women aged 18 years or over, with a Body Mass Index of +/=30 (kg/m2) and between 12 and 20 weeks gestation will be recruited. Women allocated to the control group will receive usual care and two leaflets giving advice on diet and physical activity. In addition to their usual care and the leaflets, women allocated to the intervention group will be offered to attend a weekly 1.5 hour weight management group, which combines expertise from Slimming World with clinical advice and supervision from National Health Service midwives, until 6 weeks postpartum. Participants will be followed up at 36 weeks gestation and at 6 weeks, 6 months and 12 months postpartum. Body Mass Index at 12 months postpartum is the primary outcome. Secondary outcomes include pregnancy weight gain, quality of life, mental health, waist-hip ratio, child weight centile, admission to neonatal unit, diet, physical activity levels, pregnancy and birth complications, social support, self-regulation and self-efficacy. A cost effectiveness analysis and process evaluation will also be conducted. Discussion This study will evaluate the effectiveness of a theory-based intervention developed for obese pregnant women. If successful the intervention will equip women with the necessary knowledge and skills to enable them to make healthier choices for themselves and their unborn child. Trial registration Current Controlled Trials: ISRCTN25260464 Date of registration: 16th April 2010. PMID:24886352

Veteran Status and Body Weight: A Longitudinal Fixed-Effects Approach

PubMed Central

Teachman, Jay

2014-01-01

About 10–12 % of young men (and increasingly, women) have served a term in the military. Yet, we know relatively little about the consequences of military service for the lives of those who serve. In this article, we provide estimates of the relationship between men’s peacetime military service during the all-volunteer era (AVE) and body weight using longitudinal data on 6,304 men taken from the National Longitudinal Survey of 1979 (NLSY-79). Using fixed-effects estimators on up to 13 years of data and numerous controls for time-varying life-course characteristics linked to body weight, we find that veterans of active-duty military service have higher levels of BMI and obesity. We argue that eating habits learned during service, coupled with patterns of physical activity, lead to a situation whereby veterans making the transition to less active civilian lifestyles gain weight that is not lost over time. PMID:25580045

AAL service development loom--from the idea to a marketable business model.

PubMed

Kriegel, Johannes; Auinger, Klemens

2015-01-01

The Ambient Assisted Living (AAL) market is still in an early stage of development. Previous approaches of comprehensive AAL services are mostly supply-side driven and focused on hardware and software. Usually this type of AAL solutions does not lead to a sustainable success on the market. Research and development increasingly focuses on demand and customer requirements in addition to the social and legal framework. The question is: How can a systematic performance measurement strategy along a service development process support the market-ready design of a concrete business model for AAL service? Within the EU funded research project DALIA (Assistant for Daily Life Activities at Home) an iterative service development process uses an adapted Osterwalder business model canvas. The application of a performance measurement index (PMI) to support the process has been developed and tested. Development of an iterative service development model using a supporting PMI. The PMI framework is developed throughout the engineering of a virtual assistant (AVATAR) as a modular interface to connect informal carers with necessary and useful services. Future research should seek to ensure that the PMI enables meaningful transparency regarding targeting (e.g. innovative AAL service), design (e.g. functional hybrid AAL service) and implementation (e.g. marketable AAL support services). To this end, a further reference to further testing practices is required. The aim must be to develop a weighted PMI in the context of further research, which supports both the service engineering and the subsequent service management process.

Weight loss from three commercial providers of NHS primary care slimming on referral in North Somerset: service evaluation.

PubMed

Dixon, Karin J L; Shcherba, Sandra; Kipping, Ruth R

2012-12-01

The aim of this study was to analyse the effect of provider, gender and obesity class on outcomes of National Health Service (NHS) slimming on referral. Service evaluation in 12 UK general practices. Obese patients aged ≥16 were referred for 12 sessions to one of three commercial providers. Outcomes at 12 weeks were attendance, BMI, total and percentage weight loss, 5% and 5 kg weight loss and comparison across providers. Linear and multiple regression analyses were used, adjusting for confounders. One thousand four hundred and forty patients were referred; 1047 receiving vouchers and 880 attending at least one session. The mean weight change was -4.8 kg (95% CI: -5.1 to -4.5) and the percentage bodyweight loss was -4.6% (standard deviation: 3.7). Weight Watchers patients lost more weight [-1.15 kg (95% confidence interval, CI: -1.25, -1.04), P < 0.001] and were more likely to lose 5% bodyweight [odds ratio: 1.81 (95% CI: 1.78, 1.83), P < 0.001] than those attending the provider with the least weight loss. NHS slimming on referral can successfully achieve short-term weight loss. Patients attending Weight Watchers were most likely to lose weight than those attendingother providers.

75 FR 1683 - Financial Management Service; Proposed Collection of Information: Assignment Form

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-12

... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service; Proposed Collection of Information: Assignment Form AGENCY: Financial Management Service, Fiscal Service, Treasury. ACTION: Notice... Management Service, Records and Information Management Branch, Room 135, 3700 East West Highway, Hyattsville...

Effects of the weight management program based self-efficacy for body composition, blood lipid profile, weight self-efficacy lifestyles, depression in middle-aged obese women.

PubMed

Park, Nam Hee; An, Hye Gyung

2006-12-01

This study was done to determine the effects of weight management program using self-efficacy in middle-aged obese women. The study also attempted to measure the effects of the program on the weight efficacy lifestyle, body composition, and depression. The research design of this study was a nonequivalent control group pretest-posttest design. The experimental group consisted of 21 middle-aged obese women and another 21 middle-aged obese women in the control group. The women in the experimental group participated in the weight management program for 12 weeks using self-efficacy. The weight management program using self-efficacy included education on effects of exercise for weight control, aerobic exercise program, muscle training and counseling through the telephone. After 12 weeks of participation in the program, BMI (p<.0001), body fat % (p<.0001), abdominal fat (p<.0001), in the experimental group were significantly decreased compared to the control group. Weight self-efficacy lifestyle (p<.0001) and depression (p=.006) in the experimental group were significantly improved after the program compared to the control group. According to these findings, weight management program self-efficacy for middle-aged obese women could increase weight efficacy lifestyle, and decrease depression, BMI, body fat, and abdominal fat. The result also suggested that the increasing weight efficacy and lifestyle help the obese women to perform and continue exercise. This program could be used in the community such as public health center for weight care and mental health promotion of middle-aged obese women.

Scaling up functional traits for ecosystem services with remote sensing: concepts and methods.

PubMed

Abelleira Martínez, Oscar J; Fremier, Alexander K; Günter, Sven; Ramos Bendaña, Zayra; Vierling, Lee; Galbraith, Sara M; Bosque-Pérez, Nilsa A; Ordoñez, Jenny C

2016-07-01

Ecosystem service-based management requires an accurate understanding of how human modification influences ecosystem processes and these relationships are most accurate when based on functional traits. Although trait variation is typically sampled at local scales, remote sensing methods can facilitate scaling up trait variation to regional scales needed for ecosystem service management. We review concepts and methods for scaling up plant and animal functional traits from local to regional spatial scales with the goal of assessing impacts of human modification on ecosystem processes and services. We focus our objectives on considerations and approaches for (1) conducting local plot-level sampling of trait variation and (2) scaling up trait variation to regional spatial scales using remotely sensed data. We show that sampling methods for scaling up traits need to account for the modification of trait variation due to land cover change and species introductions. Sampling intraspecific variation, stratification by land cover type or landscape context, or inference of traits from published sources may be necessary depending on the traits of interest. Passive and active remote sensing are useful for mapping plant phenological, chemical, and structural traits. Combining these methods can significantly improve their capacity for mapping plant trait variation. These methods can also be used to map landscape and vegetation structure in order to infer animal trait variation. Due to high context dependency, relationships between trait variation and remotely sensed data are not directly transferable across regions. We end our review with a brief synthesis of issues to consider and outlook for the development of these approaches. Research that relates typical functional trait metrics, such as the community-weighted mean, with remote sensing data and that relates variation in traits that cannot be remotely sensed to other proxies is needed. Our review narrows the gap between functional trait and remote sensing methods for ecosystem service management.

Integration of Nutrient and Activity Analysis Software into a Worksite Weight Management Program.

ERIC Educational Resources Information Center

Dennison, Darwin; And Others

1990-01-01

A weight management program utilized the participant's own data for the participant to (1) understand energy balance; (2) compare his/her diet with U.S. dietary codes; (3) know which food selections were high in calories, fat, and cholesterol, and low in complex carbohydrates and fiber; and (4) understand weight management. (JD)

75 FR 4451 - Financial Management Service; Proposed Collection of Information: Final Rule-Management of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-27

... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service; Proposed Collection of Information: Final Rule--Management of Federal Agency Disbursements. AGENCY: Financial Management Service, Fiscal Service, Treasury. ACTION: Notice and Request for comments. SUMMARY: The Financial Management...

The role of social media in online weight management: systematic review.

PubMed

Chang, Tammy; Chopra, Vineet; Zhang, Catherine; Woolford, Susan J

2013-11-28

Social media applications are promising adjuncts to online weight management interventions through facilitating education, engagement, and peer support. However, the precise impact of social media on weight management is unclear. The objective of this study was to systematically describe the use and impact of social media in online weight management interventions. PubMed, PsycINFO, EMBASE, Web of Science, and Scopus were searched for English-language studies published through March 25, 2013. Additional studies were identified by searching bibliographies of electronically retrieved articles. Randomized controlled trials of online weight management interventions that included a social media component for individuals of all ages were selected. Studies were evaluated using 2 systematic scales to assess risk of bias and study quality. Of 517 citations identified, 20 studies met eligibility criteria. All study participants were adults. Because the included studies varied greatly in study design and reported outcomes, meta-analysis of interventions was not attempted. Although message boards and chat rooms were the most common social media component included, their effect on weight outcomes was not reported in most studies. Only one study measured the isolated effect of social media. It found greater engagement of participants, but no difference in weight-related outcomes. In all, 65% of studies were of high quality; 15% of studies were at low risk of bias. Despite the widespread use of social media, few studies have quantified the effect of social media in online weight management interventions; thus, its impact is still unknown. Although social media may play a role in retaining and engaging participants, studies that are designed to measure its effect are needed to understand whether and how social media may meaningfully improve weight management.

The Role of Social Media in Online Weight Management: Systematic Review

PubMed Central

Chopra, Vineet; Zhang, Catherine; Woolford, Susan J

2013-01-01

Background Social media applications are promising adjuncts to online weight management interventions through facilitating education, engagement, and peer support. However, the precise impact of social media on weight management is unclear. Objective The objective of this study was to systematically describe the use and impact of social media in online weight management interventions. Methods PubMed, PsycINFO, EMBASE, Web of Science, and Scopus were searched for English-language studies published through March 25, 2013. Additional studies were identified by searching bibliographies of electronically retrieved articles. Randomized controlled trials of online weight management interventions that included a social media component for individuals of all ages were selected. Studies were evaluated using 2 systematic scales to assess risk of bias and study quality. Results Of 517 citations identified, 20 studies met eligibility criteria. All study participants were adults. Because the included studies varied greatly in study design and reported outcomes, meta-analysis of interventions was not attempted. Although message boards and chat rooms were the most common social media component included, their effect on weight outcomes was not reported in most studies. Only one study measured the isolated effect of social media. It found greater engagement of participants, but no difference in weight-related outcomes. In all, 65% of studies were of high quality; 15% of studies were at low risk of bias. Conclusions Despite the widespread use of social media, few studies have quantified the effect of social media in online weight management interventions; thus, its impact is still unknown. Although social media may play a role in retaining and engaging participants, studies that are designed to measure its effect are needed to understand whether and how social media may meaningfully improve weight management. PMID:24287455

Intermittent fasting interventions for the treatment of overweight and obesity in adults aged 18 years and over: a systematic review protocol.

PubMed

Jane, Louisa; Atkinson, Greg; Jaime, Victoria; Hamilton, Sharon; Waller, Gillian; Harrison, Samantha

2015-10-01

Are intermittent fasting interventions an effective treatment for overweight and obesity in adults, when compared to usual care treatment (continuous daily energy restriction - reduced calorie diet) or no treatment (ad libitum diet)? Overweight and obesity (classified as Body Mass Index [BMI] of greater than or equal to 25 and 30 respectively) is a global public health concern, with more than 1.9 billion adults worldwide being overweight in 2014 (over 600 million of whom are obese), and resulting in more deaths than underweight. A raised BMI in adulthood is associated with an increased risk of developing a number of chronic diseases which include diabetes, cardiovascular disease, muscular skeletal disorders and some cancers. In addition to this substantial impact on individual health and well being, there are also significant wider costs, for example, in England the annual direct cost to the national health service for treating overweight, obesity and associated morbidity is estimated at over £5 billion pounds, with costs to the wider economy estimated at £27 billion. Therefore effective weight management is essential.As overweight and obesity results from an accumulation of excess body fat arising from an energy imbalance - consuming more energy (kcal) than is expended - the majority of weight management approaches center around behaviors to address this imbalance, i.e. reducing energy intake through caloric restriction and increasing energy expenditure through physical activity. However, the aetiology of overweight and obesity is highly complex, involving an interplay of biological, psychological, societal and environmental drivers. Consequently, effective weight management is challenging, and whilst there exists a plethora of available weight loss programs, not all are comprehensively evaluated and compared, and many weight loss attempts result in weight regain and poor long term results. It is therefore vitally important to review the effectiveness of all new approaches to support an evidence-based approach to weight management.Intermittent fasting (IF), also known as alternate day fasting (ADF), periodic fasting or intermittent energy restriction (IER) is a relatively new dietary approach to weight management that involves interspersing normal daily caloric intake with a short period of severe calorie restriction/fasting. In terms of the possible underlying biological benefits of intermittent fasting, there is some evidence, predominantly from animal studies, to demonstrate beneficial effects on weight loss and cardio-metabolic risk factors. Whilst the underpinning mechanistic evidence is limited, there is some evidence to suggest that the benefits may be explained mechanistically through fat utilization and nutritional stress. However current National Institute for Health and Care Excellence (NICE) guidance on the treatment of adult obesity does not recommend the routine use of very low calorie diets (VLCD) (defined as a hypocaloric diet of 800 or less kcal/day) for the treatment of adult obesity. The National Institute for Health and Care Excellence states that this approach should only be recommended if there is a clinical rationale for rapid weight loss and must be nutritionally complete, part of a multi-component weight management strategy, including ongoing support, and should be undertaken for a maximum of 12 weeks (followed continuously or intermittently). Furthermore, the British Dietetic Association raises concerns that rapid weight loss associated with fasting may largely be due to loss of water and glycogen rather than fat, and may result in fatigue, dizziness and low energy levels. Essentially IF involves the intermittent use of a VLCD, and there remain questions about the side effects of this approach, whether there is an optimal fasting pattern or calorie limit, and how sustainable it is for long term weight management.Intermittent fasting has recently gained much popularity following significant media attention. In the UK this dietary approach reached mainstream after a BBC Horizon documentary aired in August 2012, featured an IF approach called the 5:2 diet, which involves five days of regular eating patterns interchanged with two days of fasting (max 500kcal for women and 600kcal for men). However other IF patterns are used such as alternate day fasting. Despite the recent popularity of intermittent fasting and associated weight loss claims, the supporting evidence base in humans remains small and there is only one published systematic review examining the health benefits of this approach. However the aim of this review was to examine the impact of this intervention on wider health benefits (not specifically as a treatment approach for overweight and obesity), and did not provide a comprehensive methodology or meta-analysis of RCT data. This proposed review will hence address these gaps in the evidence base.

Overweight and Obesity, Weight Perception, and Weight Management Practices Among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Participants in Georgia: A Needs Assessment.

PubMed

Bailey, Claudette; Lee, Jung Sun

2017-05-01

Examine associations among weight status, weight perception, and weight management practices of Supplemental Nutrition Assistance Program-Education (SNAP-Ed) participants in Georgia. Self-reported weight, height, and weight-related practices were assessed and analyzed in 270 SNAP-Ed participants. Almost three quarters of the sample self-reported overweight or obesity. Among overweight and obese subjects, 39% and 69%, respectively, accurately perceived themselves as overweight. More than half of the sample desired weight loss and 44% had attempted weight loss in the past year. Overweight/obese subjects who accurately perceived their weight were more likely to desire and to have attempted weight loss than those who under-perceived their weight. Approximately 58% of all subjects who had attempted to lose weight reported use of both methods suggested for weight loss: exercise and dietary changes. The high prevalence of self-reported overweight/obesity combined with a desire to lose weight among the study sample demonstrated the necessity to develop SNAP-Ed curricula emphasizing weight management. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Pain, physical functioning, and overeating in obese rheumatoid arthritis patients: do thoughts about pain and eating matter?

PubMed

Somers, Tamara J; Wren, Anava A; Blumenthal, James A; Caldwell, David; Huffman, Kim M; Keefe, Francis J

2014-08-01

Obese rheumatoid arthritis (RA) patients have higher levels of pain, disability, and disease activity than do nonobese patients with RA. Patients' health-related thoughts about arthritis and weight may be important to consider in obese patients with RA who face the dual challenge of managing RA and weight. The objective of this study was to examine the relationships of pain catastrophizing, self-efficacy (ie, confidence) for arthritis management and self-efficacy for weight management to important outcomes in obese patients with RA. We expected that after controlling for demographic and medical variables, higher levels of pain catastrophizing and lower levels of confidence would account for significant and unique variance in pain, physical functioning, and overeating. Participants had a diagnosis of RA and a body mass index of 28 kg/m or greater and completed self-report questionnaires assessing pain, physical functioning, overeating, pain catastrophizing, self-efficacy for arthritis management, self-efficacy for weight management, and a 6-minute walk test. Pain catastrophizing, self-efficacy for arthritis, and self-efficacy for weight management were significantly and uniquely related to RA-related outcomes. Pain catastrophizing was a significant independent predictor of pain severity (β = 0.38); self-efficacy for arthritis was a significant independent predictor of self-report physical functioning (β = -0.37) and the 6-minute walk performance (β = 0.44), and self-efficacy for weight management was a significant independent predictor of overeating (β = -0.58). Pain catastrophizing, self-efficacy for arthritis, and self-efficacy for weight management each contributed uniquely to relate to key outcomes in obese patients with RA. Clinicians should consider assessment of thought processes when assessing and intervening with patients who face dual health challenges; unique intervention approaches may be needed for addressing the challenges of arthritis and weight.

Young Adults’ Attitudes and Perceptions of Obesity and Weight Management: Implications for Treatment Development

PubMed Central

Lanoye, Autumn; Gorin, Amy A.; LaRose, Jessica Gokee

2017-01-01

Young adults are underrepresented in standard behavioral weight loss trials, and evidence suggests that they differ from older adults on many weight related constructs. The aim of this review is to explore young adults’ attitudes toward obesity and weight management, with particular attention to those factors that may play a role in development of future treatment efforts. Both intrapersonal and interpersonal considerations unique to young adulthood are assessed; in addition, we examine young adults’ perceptions of specific weight-related behaviors such as dieting, physical activity, and self-weighing. Conclusions are consistent with other findings suggesting that weight management interventions should be adapted and designed specifically for this age group. PMID:26923688

A Systematic Quantitative-Qualitative Model: How To Evaluate Professional Services

ERIC Educational Resources Information Center

Yoda, Koji

1973-01-01

The proposed evaluation model provides for the assignment of relative weights to each criterion, and establishes a weighting system for calculating a quantitative-qualitative raw score for each service activity of a faculty member being reviewed. (Author)

Why Weight? An Analytic Review of Obesity Management, Diabetes Prevention, and Cardiovascular Risk Reduction.

PubMed

Igel, L I; Saunders, K H; Fins, J J

2018-05-21

In this review, we examine one of the ironies of American health care-that we pay more for disease management than disease prevention. Instead of preventing type 2 diabetes (T2DM) by treating its precursor, obesity, we fail to provide sufficient insurance coverage for weight management only to fund the more costly burden of overt T2DM. There is a vital need for expanded insurance coverage to help foster a weight-centric approach to T2DM management. This includes broader coverage of anti-diabetic medications with evidence of cardiovascular risk reduction and mortality benefit, anti-obesity pharmacotherapy, bariatric surgery, weight loss devices, endoscopic bariatric therapies, and lifestyle interventions for the treatment of obesity. The fundamental question to ask is why weight? Why wait to go after obesity until its end-stage sequelae cause intractable conditions? Instead of managing the complications of T2DM, consider preventing them by tackling obesity.

Status of costing hospital nursing work within Australian casemix activity-based funding policy.

PubMed

Heslop, Liza

2012-02-01

Australia has a long history of patient level costing initiated when casemix funding was implemented in several states in the early 1990s. Australia includes, to some extent, hospital payment based on nursing intensity adopted within casemix funding policy and the Diagnostic Related Group system. Costing of hospital nursing services in Australia has not changed significantly in the last few decades despite widespread introduction of casemix funding policy at the state level. Recent Commonwealth of Australia National Health Reform presents change to the management of the delivery of health care including health-care costing. There is agreement for all Australian jurisdictions to progress to casemix-based activity funding. Within this context, nurse costing infrastructure presents contemporary issues and challenges. An assessment is made of the progress of costing nursing services within casemix funding models in Australian hospitals. Valid and reliable Australian-refined nursing service weights might overcome present cost deficiencies and limitations. © 2012 Blackwell Publishing Asia Pty Ltd.

Initial draft of CSE-UCLA evaluation model based on weighted product in order to optimize digital library services in computer college in Bali

NASA Astrophysics Data System (ADS)

Divayana, D. G. H.; Adiarta, A.; Abadi, I. B. G. S.

2018-01-01

The aim of this research was to create initial design of CSE-UCLA evaluation model modified with Weighted Product in evaluating digital library service at Computer College in Bali. The method used in this research was developmental research method and developed by Borg and Gall model design. The results obtained from the research that conducted earlier this month was a rough sketch of Weighted Product based CSE-UCLA evaluation model that the design had been able to provide a general overview of the stages of weighted product based CSE-UCLA evaluation model used in order to optimize the digital library services at the Computer Colleges in Bali.

Population-based assessments of ophthalmologic and audiologic follow-up in children with very low birth weight enrolled in Medicaid: a quality-of-care study.

PubMed

Wang, C Jason; Elliott, Marc N; McGlynn, Elizabeth A; Brook, Robert H; Schuster, Mark A

2008-02-01

The purpose of our work was to determine whether children with very low birth weight (< 1500 g) who are at high risk for vision and hearing problems and enrolled in Medicaid receive recommended follow-up vision and hearing services and to examine predictors of services. We conducted a retrospective analysis of 2182 children born in South Carolina from 1996 to 1998 with birth weights of 401 to 1499 g, gestations of > or = 24 weeks, and survival of > or = 90 days of life. Receipt of services for Medicaid-enrolled children was assessed by using a linked data set that included files from vital records, death certificates, Medicaid, Chronic Rehabilitative Services, and the Early Intervention Program. We assessed the receipt of hearing rehabilitation by 6 months of age for children with nonconductive hearing loss and routine ophthalmologic examination between ages of 1 and 2 years for all children with very low birth weight. Multivariate logistic regression was restricted to ophthalmologic examinations because of sample size. Among children with very low birth weight with nonconductive hearing loss, 20% received hearing rehabilitation by 6 months of age. Twenty-three percent of children with very low birth weight received an ophthalmologic examination between the ages of 1 and 2 years. Limiting our analysis to children < 1000 g or extending the measurement period to 7 months (hearing) and age 3 years (vision) did not substantially increase the percentage of children receiving the services. The receipt of an ophthalmologic examination was associated positively with Medicaid enrollment by the time of hospital discharge and birth in a level-3 hospital and negatively associated with higher birth weight, an Apgar score of > or = 7, and black maternal race. Among children born at < 1000 g, all of whom were eligible for the Early Intervention Program, the receipt of an ophthalmologic examination was positively associated with program enrollment. There is a shortfall in the provision of critical services for children with very low birth weight. These findings reinforce the Institute of Medicine's concerns regarding inadequate outcome data and health care services for preterm infants and support the importance of enrollment in the Early Intervention Program for children with very low birth weight.

Integrating complementary and alternative medicine into mainstream healthcare services: the perspectives of health service managers.

PubMed

Singer, Judy; Adams, Jon

2014-05-22

Complementary and alternative medicine (CAM) is increasingly included within mainstream integrative healthcare (IHC) services. Health service managers are key stakeholders central to ensuring effective integrative health care services. Yet, little research has specifically investigated the role or perspective of health service managers with regards to integrative health care services under their management. In response, this paper reports findings from an exploratory study focusing exclusively on the perspectives of health service managers of integrative health care services in Australia regarding the role of CAM within their service and the health service managers rational for incorporating CAM into clinical care. Health service managers from seven services were recruited using purposive and snowball sampling. Semi-structured interviews were conducted with the health service managers. The services addressed trauma and chronic conditions and comprised: five community-based programs including drug and alcohol rehabilitation, refugee mental health and women's health; and two hospital-based specialist services. The CAM practices included in the services investigated included acupuncture, naturopathy, Western herbal medicine and massage. Findings reveal that the health service managers in this study understand CAM to enhance the holistic capacity of their service by: filling therapeutic gaps in existing healthcare practices; by treating the whole person; and by increasing healthcare choices. Health service managers also identified CAM as addressing therapeutic gaps through the provision of a mind-body approach in psychological trauma and in chronic disease management treatment. Health service managers describe the addition of CAM in their service as enabling patients who would otherwise not be able to afford CAM to gain access to these treatments thereby increasing healthcare choices. Some health service managers expressly align the notion of treating the whole person within a health promotion model and focus on the relevance of diet and lifestyle factors as central to a CAM approach. From the perspectives of the health service managers, these findings contribute to our understanding around the rationale to include CAM within mainstream health services that deal with psychological trauma and chronic disease. The broader implications of this study can help assist in the development of health service policy on CAM integration in mainstream healthcare services.

Changing the endpoints for determining effective obesity management.

PubMed

Ross, Robert; Blair, Steve; de Lannoy, Louise; Després, Jean-Pierre; Lavie, Carl J

2015-01-01

Health authorities worldwide recommend weight loss as a primary endpoint for effective obesity management. Despite a growing public awareness of the importance of weight loss and the spending of billions of dollars by Americans in attempts to lose weight, obesity prevalence continues to rise. In this report we argue that effective obesity management in today's environment will require a shift in focus from weight loss as the primary endpoint, to improvements in the causal behaviors; diet and exercise/physical activity (PA). We reason that increases in PA combined with a balanced diet are associated with improvement in many of the intermediate risk factors including cardiorespiratory fitness (CRF) associated with obesity despite minimal or no weight loss. Consistent with this notion, we suggest that a focus on healthy behaviors for the prevention of additional weight gain may be an effective way of managing obesity in the short term. Copyright © 2014 Elsevier Inc. All rights reserved.

Effectiveness of Hypnosis as an Adjunct to Behavioral Weight Management.

ERIC Educational Resources Information Center

Bolocofsky, David N.; And Others

1985-01-01

Subjects (N=109) completed a behavioral weight-management program either with or without the addition of hypnosis. Both interventions resulted in significant weight reduction. At the eight-month and two-year follow-ups, the hypnosis clients showed significant additional weight loss and were more likely to have achieved and maintained their…

Modified weighted fair queuing for packet scheduling in mobile WiMAX networks

NASA Astrophysics Data System (ADS)

Satrya, Gandeva B.; Brotoharsono, Tri

2013-03-01

The increase of user mobility and the need for data access anytime also increases the interest in broadband wireless access (BWA). The best available quality of experience for mobile data service users are assured for IEEE 802.16e based users. The main problem of assuring a high QOS value is how to allocate available resources among users in order to meet the QOS requirement for criteria such as delay, throughput, packet loss and fairness. There is no specific standard scheduling mechanism stated by IEEE standards, which leaves it for implementer differentiation. There are five QOS service classes defined by IEEE 802.16: Unsolicited Grant Scheme (UGS), Extended Real Time Polling Service (ertPS), Real Time Polling Service (rtPS), Non Real Time Polling Service (nrtPS) and Best Effort Service (BE). Each class has different QOS parameter requirements for throughput and delay/jitter constraints. This paper proposes Modified Weighted Fair Queuing (MWFQ) scheduling scenario which was based on Weighted Round Robin (WRR) and Weighted Fair Queuing (WFQ). The performance of MWFQ was assessed by using above five QoS criteria. The simulation shows that using the concept of total packet size calculation improves the network's performance.

42 CFR 440.168 - Primary care case management services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Primary care case management services. 440.168... care case management services. (a) Primary care case management services means case management related services that— (1) Include location, coordination, and monitoring of primary health care services; and (2...

42 CFR 440.168 - Primary care case management services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... care case management services. (a) Primary care case management services means case management related services that— (1) Include location, coordination, and monitoring of primary health care services; and (2... 42 Public Health 4 2014-10-01 2014-10-01 false Primary care case management services. 440.168...

42 CFR 440.168 - Primary care case management services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... care case management services. (a) Primary care case management services means case management related services that— (1) Include location, coordination, and monitoring of primary health care services; and (2... 42 Public Health 4 2011-10-01 2011-10-01 false Primary care case management services. 440.168...

42 CFR 440.168 - Primary care case management services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... care case management services. (a) Primary care case management services means case management related services that— (1) Include location, coordination, and monitoring of primary health care services; and (2... 42 Public Health 4 2012-10-01 2012-10-01 false Primary care case management services. 440.168...

42 CFR 440.168 - Primary care case management services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... care case management services. (a) Primary care case management services means case management related services that— (1) Include location, coordination, and monitoring of primary health care services; and (2... 42 Public Health 4 2013-10-01 2013-10-01 false Primary care case management services. 440.168...

The Biggest Loser Thinks Long-Term: Recency as a Predictor of Success in Weight Management

PubMed Central

Koritzky, Gilly; Rice, Chantelle; Dieterle, Camille; Bechara, Antoine

2015-01-01

Only a minority of participants in behavioral weight management lose weight significantly. The ability to predict who is likely to benefit from weight management can improve the efficiency of obesity treatment. Identifying predictors of weight loss can also reveal potential ways to improve existing treatments. We propose a neuro-psychological model that is focused on recency: the reliance on recent information at the expense of time-distant information. Forty-four weight-management patients completed a decision-making task and their recency level was estimated by a mathematical model. Impulsivity and risk-taking were also measured for comparison. Weight loss was measured in the end of the 16-week intervention. Consistent with our hypothesis, successful dieters (n = 12) had lower recency scores than unsuccessful ones (n = 32; p = 0.006). Successful and unsuccessful dieters were similar in their demographics, intelligence, risk taking, impulsivity, and delay of gratification. We conclude that dieters who process time-distant information in their decision making are more likely to lose weight than those who are high in recency. We argue that having low recency facilitates future-oriented thinking, and thereby contributes to behavior change treatment adherence. Our findings underline the importance of choosing the right treatment for every individual, and outline a way to improve weight-management processes for more patients. PMID:26696930

75 FR 54445 - Senior Executive Service; Financial Management Service Performance Review Board (PRB)

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-07

..., Management (Chief Financial Officer). Alfred J. Kopec, Assistant Commissioner, Business Architecture. Sheryl... DEPARTMENT OF THE TREASURY Fiscal Service Senior Executive Service; Financial Management Service Performance Review Board (PRB) AGENCY: Financial Management Service, Fiscal Service, Treasury. ACTION: Notice...

Care standards for non-alcoholic fatty liver disease in the United Kingdom 2016: a cross-sectional survey.

PubMed

Sheridan, David A; Aithal, Guru; Alazawi, William; Allison, Michael; Anstee, Quentin; Cobbold, Jeremy; Khan, Shahid; Fowell, Andrew; McPherson, Stuart; Newsome, Philip N; Oben, Jude; Tomlinson, Jeremy; Tsochatzis, Emmanouil

2017-10-01

Guidelines for the assessment of non-alcoholic fatty liver disease (NAFLD) have been published in 2016 by National Institute for Health and Care Excellence and European Associations for the study of the Liver-European Association for the study of Diabetes-European Association for the study of Obesity. Prior to publication of these guidelines, we performed a cross-sectional survey of gastroenterologists and hepatologists regarding NAFLD diagnosis and management. An online survey was circulated to members of British Association for the Study of the Liver and British Society of Gastroenterology between February 2016 and May 2016. 175 gastroenterologists/hepatologists responded, 116 completing the survey, representing 84 UK centres. 22% had local NAFLD guidelines. 45% received >300 referrals per year from primary care for investigation of abnormal liver function tests (LFTs). Clinical assessment tended to be performed in secondary rather than primary care including body mass index (82% vs 26%) and non-invasive liver screen (86% vs 32%) and ultrasound (81% vs 37%). Widely used tools for non-invasive fibrosis risk stratification were aspartate transaminase (AST)/alanine transaminase (ALT) ratio (53%), Fibroscan (50%) and NAFLD fibrosis score (41%). 78% considered liver biopsy in selected cases. 50% recommended 10% weight loss target as first-line treatment. Delivery of lifestyle interventions was mostly handed back to primary care (56%). A minority have direct access to community weight management services (22%). Follow-up was favoured by F3/4 fibrosis (72.9%), and high-risk non-invasive fibrosis tests (51%). Discharge was favoured by simple steatosis at biopsy (30%), and low-risk non-invasive scores (25%). The survey highlights areas for improvement of service provision for NAFLD assessment including improved recognition of non-alcoholic steatohepatitis in people with type 2 diabetes, streamlining abnormal LFT referral pathways, defining non-invasive liver fibrosis assessment tools, use of liver biopsy, managing metabolic syndrome features and improved access to lifestyle interventions.

Perceptions of factors associated with weight management in obese adults with schizophrenia.

PubMed

Lundgren, Jennifer D; Rempfer, Melisa V; Lent, Michelle R; Foster, Gary D

2014-12-01

Individuals with serious mental illnesses are at increased risk of obesity, although the behavioral factors contributing to excess weight are not well understood. We report on the eating behavior, physical activity, and body image of obese adults with and without schizophrenia spectrum disorders. Twenty-two obese adults diagnosed with schizophrenia or schizoaffective disorder were compared to demographically matched obese adults without psychiatric diagnoses on their responses to a comprehensive assessment of several psychosocial and behavioral domains relevant to obesity and weight management. The schizophrenia group, compared to controls, reported more difficulty with several eating behaviors that were self-identified as contributing to increased weight. They also reported more enjoyment of physical activity and greater satisfaction with body weight and shape compared to controls. Clinically relevant group differences were identified that should be considered when designing ecologically valid weight management assessments and interventions for individuals diagnosed with serious mental illnesses. Health care providers are encouraged to assess an individual's weight management strengths and barriers through available assessment tools and home visits, as well as offer specific environmental and behavioral changes to manage hunger and modify eating patterns. (c) 2014 APA, all rights reserved.

The effect of a mindful restaurant eating intervention on weight management in women.

PubMed

Timmerman, Gayle M; Brown, Adama

2012-01-01

To evaluate the effect of a Mindful Restaurant Eating intervention on weight management. Randomized control trial. Greater metropolitan area of Austin, Texas. Women (n = 35) 40-59 years old who eat out at least 3 times per week. The intervention, using 6 weekly 2-hour, small group sessions, focused on reducing calorie and fat intake when eating out through education, behavior change strategies, and mindful eating meditations. Weight, waist circumference, self-reported daily calorie and fat intake, self-reported calories and fat consumed when eating out, emotional eating, diet related self-efficacy, and barriers to weight management when eating out. General linear models examined change from baseline to final endpoint to determine differences in outcomes between the intervention and control group. Participants in the intervention group lost significantly more weight (P =.03), had lower average daily caloric (P = .002) and fat intake (P = .001), had increased diet-related self-efficacy (P = .02), and had fewer barriers to weight management when eating out (P = .001). Mindful Restaurant Eating intervention was effective in promoting weight management in perimenopausal women. Copyright © 2012 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

The Effect of a Mindful Restaurant Eating Intervention on Weight Management in Women

PubMed Central

Timmerman, Gayle M.; Brown, Adama

2011-01-01

Objective To evaluate the effect of a Mindful Restaurant Eating intervention on weight management. Design Random control trial. Setting Greater metropolitan area of Austin, Texas. Participants Women (n = 35) 40-59 years old who eat out at least 3 times per week. Intervention The intervention, using 6 weekly 2 hour small group sessions, focused on reducing calorie and fat intake when eating out through education, behavior change strategies, and mindful eating meditations. Main Outcome Measures Weight, waist circumference, self-reported daily calorie and fat intake, self-reported calories and fat consumed when eating out, emotional eating, diet related self-efficacy, and barriers to weight management when eating out. Analysis General linear models examined change from baseline to final endpoint to determine differences in outcomes between the intervention and control group. Results Participants in the intervention group lost significantly more weight (P =.03), had lower average daily caloric (P =.002) and fat intake (P =.001), had increased diet related self-efficacy (P =.02), and had fewer barriers to weight management when eating out (P =.001). Conclusions and Implications Mindful Restaurant Eating intervention was effective in promoting weight management in perimenopausal women. PMID:22243980

7 CFR 4284.1013 - Evaluation criteria and weights.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Evaluation criteria and weights. 4284.1013 Section 4284.1013 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE GRANTS Agriculture Innovation...

7 CFR 4284.1013 - Evaluation criteria and weights.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 15 2013-01-01 2013-01-01 false Evaluation criteria and weights. 4284.1013 Section 4284.1013 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE GRANTS Agriculture Innovation...

7 CFR 4284.1013 - Evaluation criteria and weights.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 15 2012-01-01 2012-01-01 false Evaluation criteria and weights. 4284.1013 Section 4284.1013 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE GRANTS Agriculture Innovation...

7 CFR 4284.1013 - Evaluation criteria and weights.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 15 2011-01-01 2011-01-01 false Evaluation criteria and weights. 4284.1013 Section 4284.1013 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE GRANTS Agriculture Innovation...

7 CFR 4284.1013 - Evaluation criteria and weights.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 15 2014-01-01 2014-01-01 false Evaluation criteria and weights. 4284.1013 Section 4284.1013 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE GRANTS Agriculture Innovation...

Managing bay and estuarine ecosystems for multiple services

USGS Publications Warehouse

Needles, Lisa A.; Lester, Sarah E.; Ambrose, Richard; Andren, Anders; Beyeler, Marc; Connor, Michael S.; Eckman, James E.; Costa-Pierce, Barry A.; Gaines, Steven D.; Lafferty, Kevin D.; Lenihan, Junter S.; Parrish, Julia; Peterson, Mark S.; Scaroni, Amy E.; Weis, Judith S.; Wendt, Dean E.

2013-01-01

Managers are moving from a model of managing individual sectors, human activities, or ecosystem services to an ecosystem-based management (EBM) approach which attempts to balance the range of services provided by ecosystems. Applying EBM is often difficult due to inherent tradeoffs in managing for different services. This challenge particularly holds for estuarine systems, which have been heavily altered in most regions and are often subject to intense management interventions. Estuarine managers can often choose among a range of management tactics to enhance a particular service; although some management actions will result in strong tradeoffs, others may enhance multiple services simultaneously. Management of estuarine ecosystems could be improved by distinguishing between optimal management actions for enhancing multiple services and those that have severe tradeoffs. This requires a framework that evaluates tradeoff scenarios and identifies management actions likely to benefit multiple services. We created a management action-services matrix as a first step towards assessing tradeoffs and providing managers with a decision support tool. We found that management actions that restored or enhanced natural vegetation (e.g., salt marsh and mangroves) and some shellfish (particularly oysters and oyster reef habitat) benefited multiple services. In contrast, management actions such as desalination, salt pond creation, sand mining, and large container shipping had large net negative effects on several of the other services considered in the matrix. Our framework provides resource managers a simple way to inform EBM decisions and can also be used as a first step in more sophisticated approaches that model service delivery.

Weight-loss strategies of South African female university students and comparison of weight management-related characteristics between dieters and non-dieters.

PubMed

Senekal, Marjanne; Lasker, Gabrielle L; van Velden, Lindsay; Laubscher, Ria; Temple, Norman J

2016-09-01

Female university students are at risk for weight gain and use of inappropriate weight-loss strategies. By gaining a greater understanding of the weight-loss strategies used by and weight management related characteristics of these students, effective weight management interventions for this vulnerable group can be developed. Two hundred and fifty female students from South Africa universities, aged 18-25 years, participated in this cross-sectional study; 162 attempted weight loss during the year preceding the study (dieters) and 88 were non-dieters. Weight and height were measured and BMI (kg/m(2)) computed. A self-administered questionnaire was used to record all other variables. Weight loss strategies were described for dieters and compared between BMI groups within the dieters group. Weight management related characteristics were compared between dieters and non-dieters. Statistical tests included Pearson Chi-square test, independent samples t-test or Mann-Whitney U test (depending on distribution of the data). Predictors for a higher BMI and being overweight/obese (BMI ≥25 kg/m(2)) were identified using regression models. Healthy weight-loss strategies included increased exercise and fruit/vegetable intake and decreased intake of sugar and fat containing items; unhealthy methods included eating little food and skipping meals; and extreme weight loss strategies included laxatives and vomiting. The most commonly used weight-loss product was Herbex. Dieters were characterized by a higher BMI, overestimation of their weight (especially normal weight students), dissatisfaction with weight and select body parts, higher intake of breakfast and healthy foods, lower intake of unhealthy foods, higher levels of vigorous physical activity, higher use of select informal weight-loss information sources and experiencing more pressure to lose weight from mothers, siblings and friends. Predictors of higher BMI and/or increased risk for BMI ≥25 included weight-loss attempt during the past year, race, dissatisfaction with waist, perception of currently being "chubby," and higher frequencies of intake of a snack and fatty foods. Attempting weight-loss is common among female students and predicts BMI. Healthy (mainly), unhealthy and extreme weight loss methods are used. Dieters are characterized by a less realistic body image, lower body satisfaction, higher pressure to lose weight, use of informal weight-management information and a healthier life-style.

Logistics Enterprise Evaluation Model Based On Fuzzy Clustering Analysis

NASA Astrophysics Data System (ADS)

Fu, Pei-hua; Yin, Hong-bo

In this thesis, we introduced an evaluation model based on fuzzy cluster algorithm of logistics enterprises. First of all,we present the evaluation index system which contains basic information, management level, technical strength, transport capacity,informatization level, market competition and customer service. We decided the index weight according to the grades, and evaluated integrate ability of the logistics enterprises using fuzzy cluster analysis method. In this thesis, we introduced the system evaluation module and cluster analysis module in detail and described how we achieved these two modules. At last, we gave the result of the system.

Measuring the impacts of natural amenities and the US-Mexico Border, on housing values in the Santa Cruz Watershed, using spatially-weighted hedonic modeling

USGS Publications Warehouse

Amaya, Gladys; Norman, Laura M.; Frisvold, George

2011-01-01

This presentation will provide a synopsis of the quality of life and hedonics literature review used to develop this research agenda. Variables relevant for local environmental management, having significant effects on property values, will be discussed. The final results obtained from this study can be used determine the benefits of preserving or developing land binationally and will be uploaded to the Santa Cruz Watershed Ecosystem Portfolio Model (SCWEPM), an online Ecosystem Services tool, being created to promote sustainable development in the Borderlands.

Study protocol: evaluation of 'JenMe', a commercially-delivered weight management program for adolescents: a randomised controlled trial.

PubMed

Dordevic, Aimee L; Bonham, Maxine P; Ware, Robert S; Brennan, Leah; Truby, Helen

2015-06-19

Early lifestyle intervention with overweight and obese adolescents could help to avoid serious health events in early adulthood, ultimately alleviating some of the strain on the public health system due to obesity-related morbidity. Commercial weight loss programs have wide reach into the community setting, and have demonstrated success in long term weight management in adults, beyond that of current public health care. Commercial weight-management programs have not been evaluated as a method of delivery for overweight and obese adolescents. This study aims to evaluate the efficacy of a new adolescent weight management program in a commercial environment. One hundred and forty adolescents, 13 to 17 years old, will be randomised to either a weight management program intervention or a wait-listed group for 12 weeks. The commercial program will consist of a combined dietary and lifestyle approach targeting improved health behaviours for weight-loss or weight-stability. Participants will be overweight or obese (above the 85(th) percentile for BMI) and without existing co-morbidities. Outcome measures will be assessed at baseline and after 12 weeks. Primary outcome measures will be changes in BMI Z-score and waist-height ratio. Secondary outcome measures will include changes in behaviour, physical activity and psychosocial wellbeing. Intervention participants will be followed up at 6 months following completion of the initial program. Ethics approval has been granted from the Monash University Human Research Ethics Committee (CF11/3687-2011001940). This independent evaluation of a weight management program for adolescents, delivered in a commercial setting, will provide initial evidence for the effectiveness of such programs; which may offer adolescents an avenue of weight-management with ongoing support prior to the development of obesity related co-morbidities. The protocol for this study is registered with the International Clinical Trials Registry ISRCTN13602313.

Weight management practices associated with PCOS and their relationships with diet and physical activity.

PubMed

Moran, L J; Brown, W J; McNaughton, S A; Joham, A E; Teede, H J

2017-03-01

Do weight management practices differ in women with and without PCOS? Women in the general population with self-reported PCOS are more likely to be using healthy weight management practices and alternative non-lifestyle measures for weight management than women without PCOS. Lifestyle management is the first-line treatment in PCOS. However, the specific weight management practices used by women with PCOS and their effect on diet and physical activity are unclear. The study was a population-based observational cross-sectional study involving women in the 1973-1978 cohort (n = 7767 total; n = 556 with PCOS, n = 7211 without PCOS). Women with and without self-reported PCOS were included. Self-reported outcome measures included healthy lifestyle-related or alternative non-lifestyle-related (e.g. laxatives or smoking) weight management practices, dietary intake and physical activity. Women with PCOS were more likely to be following both healthy [reducing meal or snack size (odds ratio (OR) 1.50, 95% CI 1.14, 1.96, P = 0.004) and reducing fat or sugar intake (OR 1.32, 95% CI 1.03, 1.69, P = 0.027) or following a low glycaemic index diet (OR 2.88, 95% CI 2.30, 3.59, P < 0.001)] and alternative [smoking (OR 1.60, 95% CI 1.02, 2.52, P = 0.043) or use of laxative, diet pills, fasting or diuretics (OR 1.45, 95% CI 1.07, 1.97, P = 0.017)] weight management practices than women without PCOS. In PCOS, the use of a range of healthy weight management practices was associated with increases in physical activity (P < 0.001), diet quality (P < 0.001), percentage protein intake (P < 0.001) and decreases in glycaemic index (P < 0.001), and percentages of fat (P = 0.001), saturated fat (P < 0.001) or fibre (P = 0.003). Use of alternative weight management practices was associated with decreases in diet quality. Limitations include the use of self-reported data for PCOS, height, weight, diet, physical activity and weight management behaviours. In PCOS, we should focus on improving healthy weight practices across both diet quality and quantity, and on assessing alternative weight practices and their potential adverse effect on dietary intake. L.M. is supported by a South Australian Cardiovascular Research Development Program Fellowship (ID AC11S374); a program collaboratively funded by the National Heart Foundation, the South Australian Department of Health and the South Australian Health and Medical Research Institute. H.T. is supported by the NHMRC. S.A.M. is supported by an NHMRC Career Development Fellowship Level 2, ID1104636 and was previously supported by an ARC Future Fellowship (2011-2015, FT100100581). The authors declare no conflict of interest. Not applicable. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Time perspective and weight management behaviors in newly diagnosed Type 2 diabetes: a mediational analysis.

PubMed

Hall, Peter A; Fong, Geoffrey T; Cheng, Alice Y

2012-12-01

The primary objective of the current study was to examine the extent to which domain-specific time perspective predicts weight management behaviors (dietary behavior and physical activity) among those newly diagnosed with Type 2 diabetes. A secondary objective was to test potential mediators of the hypothesized effect (behavioral intention, self-efficacy and control beliefs). A total of 204 adults newly diagnosed (≤6 months) with Type 2 diabetes participated in the study, which included a baseline assessment of domain-general and domain-specific time perspective, as well as strength of intention to perform two weight-management behaviors (dietary choice and physical activity); both weight-management behaviors were assessed again at 6 month follow-up. Hierarchical multiple regression analyses revealed a prospective association between domain-specific time perspective and uptake of weight management behaviors. Individuals with newly diagnosed T2DM possessing a future-oriented time perspective reported making less frequent fatty food choices and greater increases in physical activity over the 6-month follow-up interval. These effects were selectively mediated by intention strength, and not competing social cognitive variables. For both behaviors, the total effects and meditational models were robust to adjustments for demographics, body composition and disease variables. A future-oriented time perspective is prospectively associated with superior uptake of weight management behaviors among those with newly diagnosed Type 2 diabetes. The facilitating effect of future-oriented thinking appears to occur via enhanced strength of intentions to perform weight management behaviors.

Missing an opportunity: the embedded nature of weight management in primary care

PubMed Central

Osunlana, A. M.; Ogunleye, A. A.; Sharma, A. M.; Campbell‐Scherer, D.

2015-01-01

Summary The 5As Team study was designed to create, implement and evaluate a flexible intervention to improve the quality and quantity of weight management visits in primary care. The objective of this portion of the study was to explore how primary care providers incorporate weight management in their practice. 5AsT is a randomized controlled trial (RCT) on the implementation of a 6‐month 5 As Team (5AsT) intervention designed to operationalize the 5As of obesity management in primary care. Data for the qualitative portion of the study presented here included semi‐structured interviews with 29 multidisciplinary team providers and field notes of intervention sessions. Thematic analysis was undertaken. A key pattern that emerged from the data was that healthcare providers usually do not address obesity as a primary focus for a visit. Rather, obesity is embedded in a wide range of primary care encounters for other conditions. Implications were it can take extra time to discuss weight, it can be inappropriate to bring up weight as a topic, and treating risk factors and root causes of obesity have indirect benefits to patient weight management. Our findings have implications for obesity treatment approaches and tools that assume a discreet weight management visit. The embedded nature of obesity management in primary care can be harnessed to leverage multiple opportunities for asking and assessing root causes of obesity, and working longitudinally towards individual health goals. PMID:26303812

Self-efficacy and dietary fat reduction behaviors in obese African-American and white mothers.

PubMed

Chang, Mei-Wei; Brown, Roger L; Baumann, Linda J; Nitzke, Susan A

2008-05-01

This study examined the influence of weight management and education on five types of fat reduction behaviors mediated through three task-specific domains of self-efficacy among young, low-income obese African-American and white mothers. It also investigated interaction of race with the relationships between weight management, education, self-efficacy, and fat reduction behaviors. A sample of obese African-American and white mothers was recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Wisconsin. Participants reported their weight management status, education, self-efficacy for eating low-fat food, and fat reduction behaviors. For both racial groups, weight management status predicted low-fat food substitution and meat modification behaviors; education predicted meat modification behavior. Three task-specific domains of self-efficacy (negative mood, positive mood, and food availability) predicted different types of fat reduction behaviors and differed by race. Weight management influenced behaviors of low-fat food substitution, meat modification, and fried-food avoidance, mediated partially through self-efficacies of negative mood (African Americans), positive mood (African Americans, whites), and food availability (African Americans). Race affected the relationships between weight management, education, three task-specific domains of self-efficacy, and five types of fat reduction behaviors. Self-efficacies operated differentially for African Americans and whites. Thus, strategies to address specific fat reduction behaviors have the potential to be more effective when tailored to specific individual characteristics such as racial background, history of weight management strategies and task-specific domains of self-efficacy.

The effectiveness of weight management interventions in breastfeeding women--a systematic review and critical evaluation.

PubMed

Neville, Charlotte E; McKinley, Michelle C; Holmes, Valerie A; Spence, Dale; Woodside, Jayne V

2014-09-01

The postpartum period is a vulnerable time for excess weight retention, particularly for the increasing number of women who are overweight at the start of their pregnancy and subsequently find it difficult to lose additional weight gained during pregnancy. Although postpartum weight management interventions play an important role in breaking this potentially vicious cycle of weight gain, the effectiveness of such interventions in breastfeeding women remains unclear. Our aim was to systematically review the literature about the effectiveness of weight management interventions in breastfeeding women. Seven electronic databases were searched for eligible papers. Intervention studies included were carried out exclusively in breastfeeding mothers, ≤2 years postpartum and with a body mass index greater than 18.5 kg/m(2) , with an outcome measure of change in weight and/or body composition. Six studies met the selection criteria, and were stratified according to the type of intervention and outcome measures. Despite considerable heterogeneity among studies, the dietary-based intervention studies appeared to be the most efficacious in promoting weight loss; however, few studies were tailored toward the needs of breastfeeding women. Weight management interventions which include an energy-restricted diet may play a key role in successful postpartum weight loss for breastfeeding mothers. © 2014 Wiley Periodicals, Inc.

Do weight management interventions delivered by online social networks effectively improve body weight, body composition, and chronic disease risk factors? A systematic review.

PubMed

Willis, Erik A; Szabo-Reed, Amanda N; Ptomey, Lauren T; Steger, Felicia L; Honas, Jeffery J; Washburn, Richard A; Donnelly, Joseph E

2017-02-01

Introduction Currently, no systematic review/meta-analysis has examined studies that used online social networks (OSN) as a primary intervention platform. Therefore, the purpose of this review was to evaluate the effectiveness of weight management interventions delivered through OSN. Methods PubMed, EMBASE, PsycINFO, Web of Science, and Scopus were searched (January 1990-November 2015) for studies with data on the effect of OSNs on weight loss. Only primary source articles that utilized OSN as the main platform for delivery of weight management/healthy lifestyle interventions, were published in English language peer-reviewed journals, and reported outcome data on weight were eligible for inclusion in this systematic review. Five articles were included in this review. Results One-hundred percent of the studies ( n = 5) reported a reduction in baseline weight. Three of the five studies (60%) reported significant decreases in body weight when OSN was paired with health educator support. Only one study reported a clinical significant weight loss of ≥5%. Conclusion Using OSN for weight management is in its early stages of development and, while these few studies show promise, more research is needed to acquire information about optimizing these interventions to increase their efficacy.

Using plant traits to evaluate the resistance and resilience of ecosystem service provision

NASA Astrophysics Data System (ADS)

Kohler, Marina; Devaux, Caroline; Fontana, Veronika; Grigulis, Karl; Lavorel, Sandra; Leitinger, Georg; Schirpke, Uta; Tasser, Erich; Tappeiner, Ulrike

2015-04-01

Mountain grassland ecosystems are a hotspot of biodiversity and deliver a multiplicity of ecosystem services. Due to a long history of well adapted agricultural use and specific environmental conditions (e.g. slope, altitude, or climate), various types of grassland ecosystems have developed. Each of them shows specific attributes in forms of plant communities and abiotic characteristics, which lead to particular ranges of ecosystem service provision. However, ongoing climate and societal changes thread plant community composition and may lead to changes in plant traits, and therefore, the provision of ecosystem services. Currently it is not clear how vulnerable these ecosystems are to disturbances, or whether they have developed a high resilience over time. Thus, it is essential to know the ranges of resistance and resilience of an ecosystem service. We, therefore, developed a static approach based on community weighted mean plant traits and abiotic parameters to measure the boundaries of resistance and resilience of each ecosystem service separately. By calculating actual minimum and maximum amounts of ecosystem services, we define the range of resistance of an ecosystem service. We then calculate the potential amount of an ecosystem services (via simulated plant communities) by assuming that no species is lost or added to the system. By comparing actual and potential values, we can estimate whether an ecosystem service is in danger to lose its resilience. We selected different ecosystem services related to mountain grassland ecosystems, e.g. carbon storage, forage quality, forage quantity, and soil fertility. We analysed each ecosystem service for different grassland management types, covering meadows and pastures of very low land-use intensity through to grasslands of high land-use intensity. Results indicate that certain ecosystem services have a higher resilience than others (e.g. carbon storage) for all management types. The ecosystem may provide steady amounts of ecosystem services also in future when facing environmental or societal disturbances. In contrary, other services are very depending on actual conditions and are, therefore, less stable (e.g. forage quantity). When comparing ranges of resistance and resilience, the actual amount lies very close to the boundaries of the potential provision. This gives us a hint that the ecosystem service is in danger to lose its resilience and amount of ecosystem service provision when facing disturbances in future.

One-year postpartum outcomes following a weight management intervention in pregnant women with obesity

PubMed Central

Vesco, Kimberly K.; Leo, Michael C.; Karanja, Njeri; Gillman, Matthew W.; McEvoy, Cindy T.; King, Janet C.; Eckhardt, Cara L.; Smith, K. Sabina; Perrin, Nancy; Stevens, Victor J.

2016-01-01

Objective This analysis focuses on 1-year maternal and infant follow-up of a randomized trial that tested a weight management intervention conducted during pregnancy. Methods We randomly assigned 114 women with obesity (mean BMI 36.7 kg/m2) at a mean of 15 weeks’ gestation to a weight management intervention or usual care control condition. The intervention ended at delivery and resulted in less gestational weight gain and a lower proportion of large-for-gestational age newborns among intervention compared to control participants. The primary outcome at 12 months postpartum was maternal weight. Secondary outcomes included infant weight-for-age and weight-for-length z-scores. Results At 1 year, mothers in the intervention group weighed 96.3±18.6 kg, and in the control group, 99.7±19.2 kg. There was no significant difference between groups in change in weight from randomization to 1-year postpartum (b=-0.47, 95% CI [-4.03, 3.08]. There was a significant main effect of group for infant weight-for-age z-score (b=-0.40, 95% CI [-0.75,-0.05]) but not infant weight-for-length z-scores (b=-0.20, 95% CI [-0.59,0.20]. Conclusions A gestational weight management intervention did not influence maternal weight or infant weight-for-length at 1-year postpartum. Future studies may be warranted to determine if extending prenatal interventions into the postpartum period would be beneficial for maternal and infant outcomes. PMID:27670399

Impact of parental weight status on a school-based weight management programme designed for Mexican-American children

USDA-ARS?s Scientific Manuscript database

While overweight and obese children are more likely to have overweight or obese parents, less is known about the effect of parental weight status on children's success in weight management programmes. This study was a secondary data analysis of a randomized controlled trial and investigated the impa...

42 CFR 84.89 - Weight requirement.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Weight requirement. 84.89 Section 84.89 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES APPROVAL OF RESPIRATORY PROTECTIVE DEVICES Self-Contained Breathing...

42 CFR 84.89 - Weight requirement.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Weight requirement. 84.89 Section 84.89 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES APPROVAL OF RESPIRATORY PROTECTIVE DEVICES Self-Contained Breathing...

42 CFR 84.89 - Weight requirement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Weight requirement. 84.89 Section 84.89 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES APPROVAL OF RESPIRATORY PROTECTIVE DEVICES Self-Contained Breathing...

42 CFR 84.89 - Weight requirement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Weight requirement. 84.89 Section 84.89 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES APPROVAL OF RESPIRATORY PROTECTIVE DEVICES Self-Contained Breathing...

Effectiveness of workplace weight management interventions: a systematic review

USDA-ARS?s Scientific Manuscript database

Background: A systematic review was conducted of randomized trials of workplace weight management interventions, including trials with dietary, physical activity, environmental, behavioral and incentive based components. Main outcomes were defined as change in weight-related measures. Methods: Key w...

Integrating complementary and alternative medicine into mainstream healthcare services: the perspectives of health service managers

PubMed Central

2014-01-01

Background Complementary and alternative medicine (CAM) is increasingly included within mainstream integrative healthcare (IHC) services. Health service managers are key stakeholders central to ensuring effective integrative health care services. Yet, little research has specifically investigated the role or perspective of health service managers with regards to integrative health care services under their management. In response, this paper reports findings from an exploratory study focusing exclusively on the perspectives of health service managers of integrative health care services in Australia regarding the role of CAM within their service and the health service managers rational for incorporating CAM into clinical care. Methods Health service managers from seven services were recruited using purposive and snowball sampling. Semi-structured interviews were conducted with the health service managers. The services addressed trauma and chronic conditions and comprised: five community-based programs including drug and alcohol rehabilitation, refugee mental health and women’s health; and two hospital-based specialist services. The CAM practices included in the services investigated included acupuncture, naturopathy, Western herbal medicine and massage. Results Findings reveal that the health service managers in this study understand CAM to enhance the holistic capacity of their service by: filling therapeutic gaps in existing healthcare practices; by treating the whole person; and by increasing healthcare choices. Health service managers also identified CAM as addressing therapeutic gaps through the provision of a mind-body approach in psychological trauma and in chronic disease management treatment. Health service managers describe the addition of CAM in their service as enabling patients who would otherwise not be able to afford CAM to gain access to these treatments thereby increasing healthcare choices. Some health service managers expressly align the notion of treating the whole person within a health promotion model and focus on the relevance of diet and lifestyle factors as central to a CAM approach. Conclusions From the perspectives of the health service managers, these findings contribute to our understanding around the rationale to include CAM within mainstream health services that deal with psychological trauma and chronic disease. The broader implications of this study can help assist in the development of health service policy on CAM integration in mainstream healthcare services. PMID:24885066

Assessment of the quality of medical care among patients with early stage prostate cancer undergoing expectant management in the United States.

PubMed

Ritchey, Jamie; Gay, E Greer; Spencer, Benjamin A; Miller, David C; Wallner, Lauren P; Stewart, Andrew K; Dunn, Rodney L; Litwin, Mark S; Wei, John T

2012-09-01

Given the increased attention to the quality and cost of medical care, the Institute of Medicine and Centers for Medicare and Medicaid Services have called for performance measurement and reporting. The clinical management of prostate cancer has been outlined, yet is not intended to describe quality prostate cancer care. Therefore, RAND researchers developed quality indicators for early stage prostate cancer. The ACoS (American College of Surgeons) used these indicators to perform the first national assessment to our knowledge of the quality of care among men with early stage prostate cancer undergoing expectant management. Information from medical records was abstracted for evidence of compliance with the RAND indicators (structure and process). Weighted and stratified proportions were calculated to assess indicator compliance. Logistic regression models were fit and evaluated by hospital type and patient factors. A weighted and stratified total of 13,876 early stage prostate cancer cases on expectant management in 2000 to 2001 were investigated. Compliance with structural indicators was high (greater than 80%) and compliance with process indicators varied (19% to 87%). Differences in process indicators were observed from models by hospital type and comorbid conditions, but not for age, race or insurance status. Using the RAND quality indicators this study revealed several process areas for quality improvement among men with early stage prostate cancer on expectant management in the United States. Efforts to improve the quality of early stage prostate cancer care need to move beyond the paradigm of age, race and insurance status. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Avoiding Weight Gain in Cardiometabolic Disease: A Systematic Review

PubMed Central

Maruthur, Nisa M.; Fawole, Oluwakemi A.; Wilson, Renee F.; Lau, Brandyn D.; Anderson, Cheryl A. M.; Bleich, Sara N.; Segal, Jodi

2014-01-01

Patients with cardiometabolic disease are at higher risk for obesity-related adverse effects. Even without weight loss, weight maintenance may be beneficial. We performed a systematic review to identify the effect of nonweight loss-focused lifestyle interventions in adults with cardiometabolic disease. We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify comparative studies of lifestyle interventions (self-management, diet, exercise, or their combination) without a weight loss focus in adults with or at risk for diabetes and cardiovascular disease. Weight, BMI, and waist circumference at ≥12 months were the primary outcomes. Of 24,870 citations, we included 12 trials (self-management, n = 2; diet, n = 2; exercise, n = 2; combination, n = 6) studying 4,206 participants. Self-management plus physical activity ± diet versus minimal/no intervention avoided meaningful weight (−0.65 to −1.3 kg) and BMI (−0.4 to −0.7 kg/m2) increases. Self-management and/or physical activity prevented meaningful waist circumference increases versus control (−2 to −4 cm). In patients with cardiometabolic disease, self-management plus exercise may prevent weight and BMI increases and self-management and/or exercise may prevent waist circumference increases versus minimal/no intervention. Future studies should confirm these findings and evaluate additional risk factors and clinical outcomes. PMID:25610639

Equivalent weight loss for weight management programs delivered by phone and clinic.

PubMed

Donnelly, Joseph E; Goetz, Jeannine; Gibson, Cheryl; Sullivan, Debra K; Lee, Robert; Smith, Bryan K; Lambourne, Kate; Mayo, Matthew S; Hunt, Suzanne; Lee, Jae Hoon; Honas, Jeffrey J; Washburn, Richard A

2013-10-01

Face-to-face (FTF) weight management is costly and presents barriers for individuals seeking treatment; thus, alternate delivery systems are needed. The objective of this study was to compare weight management delivered by FTF clinic or group conference calls (phone). Randomized equivalency trial in 295 overweight/obese men/women (BMI = 35.1±4.9, Age = 43.8±10.2, Minority = 39.8%). Weight loss (0-6 months) was achieved by reducing energy intake between 1,200 and 1,500 kcal/day and progressing physical activity (PA) to 300 min/week. Weight maintenance (7-18 months) provided adequate energy to maintain weight and continued 300 min/week of PA. Behavioral weight management strategies were delivered weekly for 6 months and gradually reduced during 7-18 months. A cost analysis provided a comparison of expenses between groups. Weight change from baseline to 6 months was -13.4 ± 6.7% and -12.3 ± 7.0% for FTF clinic and phone, respectively. Weight change from 6-18 months was 6.4 ± 7.0% and 6.4 ± 5.2%, for FTF clinic and phone, respectively. The cost to FTF participants was $789.58 more per person. Phone delivery provided equivalent weight loss and maintenance and reduced program cost. Ubiquitous access to phones provides a vast reach for this approach. Copyright © 2013 The Obesity Society.

Weight outcomes audit in 1.3 million adults during their first 3 months' attendance in a commercial weight management programme.

PubMed

Stubbs, R James; Morris, Liam; Pallister, Carolyn; Horgan, Graham; Lavin, Jacquie H

2015-09-10

Over sixty percent of adults in the UK are now overweight/obese. Weight management on a national scale requires behavioural and lifestyle solutions that are accessible to large numbers of people. Evidence suggests commercial weight management programmes help people manage their weight but there is little research examining those that pay to attend such programmes rather than being referred by primary care. The objective of this analysis was to evaluate the effectiveness of a UK commercial weight management programme in self-referred, fee-paying participants. Electronic weekly weight records were collated for self-referred, fee-paying participants of Slimming World groups joining between January 2010 and April 2012. This analysis reports weight outcomes in 1,356,105 adult, non-pregnant participants during their first 3 months' attendance. Data were analysed by regression, ANOVA and for binomial outcomes, chi-squared tests using the R statistical program. Mean (SD) age was 42.3 (13.6) years, height 1.65 m (0.08) and start weight was 88.4 kg (18.8). Mean start BMI was 32.6 kg/m(2) (6.3 kg/m(2)) and 5 % of participants were men. Mean weight change of all participants was -3.9 kg (3.6), percent weight change -4.4 (3.8), and BMI change was -1.4 kg/m(2) (1.3). Mean attendance was 7.8 (4.3) sessions in their first 3 months. For participants attending at least 75 % of possible weekly sessions (n = 478,772), mean BMI change was -2.5 kg/m(2) (1.3), weight change -6.8 kg (3.7) and percent weight change -7.5 % (3.5). Weight loss was greater in men than women absolutely (-6.5 (5.3) kg vs -3.8 (3.4) kg) and as a percentage (5.7 % (4.4) vs 4.3 % (3.7)), respectively. All comparisons were significant (p < 0.001). Level of attendance and percent weight loss in the first week of attendance together accounted for 55 % of the variability in weight lost during the study period. A large-scale commercial lifestyle-based weight management programme had a significant impact on weight loss outcomes over 3 months. Higher levels of attendance led to levels of weight loss known to be associated with significant clinical benefits, which on this scale may have an impact on public health.

Women's work. Maintaining a healthy body weight.

PubMed

Welch, Nicky; Hunter, Wendy; Butera, Karina; Willis, Karen; Cleland, Verity; Crawford, David; Ball, Kylie

2009-08-01

This study describes women's perceptions of the supports and barriers to maintaining a healthy weight among currently healthy weight women from urban and rural socio-economically disadvantaged areas. Using focus groups and interviews, we asked women about their experiences of maintaining a healthy weight. Overwhelmingly, women described their healthy weight practices in terms of concepts related to work and management. The theme of 'managing health' comprised issues of managing multiple responsibilities, time, and emotions associated with healthy practices. Rural women faced particular difficulties in accessing supports at a practical level (for example, lack of childcare) and due to the gendered roles they enacted in caring for others. Family background (in particular, mothers' attitudes to food and weight) also appeared to influence perceptions about healthy weight maintenance. In the context of global increases in the prevalence of obesity, the value of initiatives aimed at supporting healthy weight women to maintain their weight should not be under-estimated. Such initiatives need to work within the social and personal constraints that women face in maintaining good health.

76 FR 63351 - Senior Executive Service; Financial Management Service Performance Review Board (PRB)

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-12

... DEPARTMENT OF THE TREASURY Senior Executive Service; Financial Management Service Performance Review Board (PRB) AGENCY: Financial Management Service, Treasury. ACTION: Notice. SUMMARY: This notice announces the appointment of members to the Financial Management Service (FMS) Performance Review Board (PRB...

77 FR 60177 - Senior Executive Service; Financial Management Service Performance Review Board (PRB)

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2012-10-02

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77 FR 30050 - Financial Management Service Proposed Collection of Information: Resolution Authorizing Execution...

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2012-05-21

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77 FR 37959 - Financial Management Service; Proposed Collection of Information: Pools and Associations-Annual...

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2012-06-25

... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service; Proposed Collection of Information: Pools and Associations--Annual Letter AGENCY: Financial Management Service, Fiscal Service, Treasury. ACTION: Notice and request for comments. SUMMARY: The Financial Management Service, as part of...

78 FR 15123 - Financial Management Service; Proposed Collection of Information: Accountable Official...

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2013-03-08

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The SysMan monitoring service and its management environment

NASA Astrophysics Data System (ADS)

Debski, Andrzej; Janas, Ekkehard

1996-06-01

Management of modern information systems is becoming more and more complex. There is a growing need for powerful, flexible and affordable management tools to assist system managers in maintaining such systems. It is at the same time evident that effective management should integrate network management, system management and application management in a uniform way. Object oriented OSI management architecture with its four basic modelling concepts (information, organization, communication and functional models) together with widely accepted distribution platforms such as ANSA/CORBA, constitutes a reliable and modern framework for the implementation of a management toolset. This paper focuses on the presentation of concepts and implementation results of an object oriented management toolset developed and implemented within the framework of the ESPRIT project 7026 SysMan. An overview is given of the implemented SysMan management services including the System Management Service, Monitoring Service, Network Management Service, Knowledge Service, Domain and Policy Service, and the User Interface. Special attention is paid to the Monitoring Service which incorporates the architectural key entity responsible for event management. Its architecture and building components, especially filters, are emphasized and presented in detail.

Self-Management Patient Education and Weight Loss

ERIC Educational Resources Information Center

Stombaugh, Angela M.

2010-01-01

Self-management of a disease is defined as "having or being able to obtain, the skills and resources necessary to best accommodate to the chronic disease and its consequences" (Holman & Lorig, 1992, p. 309). Self-management has been used in the management of several chronic conditions and this model may be useful in the management of weight loss.…

Obesity weight management and bariatric surgery case management programs: a review of literature.

PubMed

Echols, Jennie

2010-01-01

The proportion of Americans with clinically severe obesity has vast implications for the nation's healthcare system since this population have twice as many chronic medical conditions as people with normal weight. Through the use of review of literature, this article (a) describes the types of weight loss programs; (b) reviews the results from studies on effectiveness of bariatric surgery; and (c) identifies recommendations for obesity and bariatric surgery case management programs. Disease management companies appear to be concentrating on general weight loss strategies associated with wellness and other condition-specific disease management products, whereas larger national healthcare companies with at-risk and insurance products offer specific bariatric surgery management products. Case management programs within healthcare systems, health management organizations, and insurance companies are frequently faced with the management of individuals with morbid obesity and, increasingly, those who are requesting or have undergone bariatric surgery. Research shows that morbid obesity is a disease that remains generally unresponsive to diet and drug therapy but appears to respond well to bariatric surgery. Research findings suggest that surgical treatment is more effective than pharmacological treatment of weight loss and the control of some comorbidities associated with obesity. The number of Americans having weight loss surgery increased by 804% between 1998 and 2004, which appears to be a driver for the recent development of obesity disease management and bariatric surgery case management programs. Although the immaturity and lack of studies citing outcomes of obesity disease and case management programs limit the identification of best practices based on outcomes, emerging practices can be identified and recommendations for case management can be formulated. In addition to primary prevention and treatment programs for obesity, this article describes program activities in detail for the following key areas: (1) identification and engagement; (2) coaching, education, and support; (3) collaboration among treating providers; (4) preparation, management, and follow-up when bariatric surgery is indicated; (5) aggressive follow-up until personal goals are achieved; and (6) outcome measurement.

7 CFR 226.21 - Food service management companies.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 4 2010-01-01 2010-01-01 false Food service management companies. 226.21 Section 226... § 226.21 Food service management companies. (a) Any institution may contract with a food service management company. An institution which contracts with a food service management company shall remain...

Contingency management adapted for African-American adolescents with obesity enhances youth weight loss with caregiver participation: a multiple baseline pilot study.

PubMed

Hartlieb, Kathryn Brogan; Naar, Sylvie; Ledgerwood, David M; Templin, Thomas N; Ellis, Deborah A; Donohue, Bradley; Cunningham, Phillippe B

2015-12-07

Contingency management (CM) interventions, which use operant conditioning principles to encourage completion of target behavioral goals, may be useful for improving adherence to behavioral skills training (BST). Research-to-date has yet to explore CM for weight loss in minority adolescents. To examine the effects of CM in improving adolescent weight loss when added to BST. The study utilized an innovative experimental design that builds upon multiple baseline approaches as recommended by the National Institutes of Health. Six obese African-American youth and their primary caregivers living in Detroit, Michigan, USA. Adolescents received between 4 and 12 weeks of BST during a baseline period and subsequently received CM targeting weight loss. Youth weight. Linear mixed effects modeling was used in the analysis. CM did not directly affect adolescent weight loss above that of BST (p=0.053). However, when caregivers were involved in CM session treatment, contingency management had a positive effect on adolescent weight loss. The estimated weight loss due to CM when caregivers also attended was 0.66 kg/week (p<0.001, [95% CI; -1.96, -0.97]) relative to the baseline trajectory. This study demonstrates application of a novel experimental approach to intervention development and demonstrated the importance of parent involvement when delivering contingency management for minority youth weight loss. Lessons learned from contingency management program implementation are also discussed in order to inform practice.

Outpatient Therapeutic Feeding Program Outcomes and Determinants in Treatment of Severe Acute Malnutrition in Tigray, Northern Ethiopia: A Retrospective Cohort Study

PubMed Central

Yebyo, Henock Gebremedhin; Kendall, Carl; Nigusse, Daniel; Lemma, Wuleta

2013-01-01

Background Outpatient Therapeutic feeding Program (OTP) brings the services for management of Severe Acute Malnutrition (SAM) closer to the community by making services available at decentralized treatment points within the primary health care settings, through the use of ready-to-use therapeutic foods, community outreach and mobilization. Little is known about the program outcomes. This study revealed the levels of program outcome indictors and determinant factors to recovery rate. Methods A retrospective cohort study was conducted on 628 children who had been managed for SAM under OTP from April/2008 to January/2012. The children were selected using systematic random sampling from 12 health posts and 4 health centers. The study relied on information of demographic characteristics, anthropometries, Plumpy'Nut, medical problems and routine medications intakes. The results were estimated using Kaplan-Meier survival curves, log-rank test and Cox-regression. Results The recovery, defaulter, mortality and weight gain rates were 61.78%, 13.85%, 3.02% and 5.23 gm/kg/day, respectively. Routine medications were administered partially and children with medical problems were managed inappropriately under the program. As a child consumed one more sachet of Plumpy'Nut, the recovery rate from SAM increased by 4% (HR = 1.04, 95%-CI = 1.03, 1.05, P<0.001). The adjusted hazard ratios to recovery of children with diarrhea, appetite loss with Plumpy'Nut and failure to gain weight were 2.20 (HR = 2.20, 95%-CI = 1.31, 3.41, P = 0.001), 4.49 (HR = 1.74, 95%-CI = 1.07, 2.83, P = 0.046) and 3.88 (HR = 1.95, 95%-CI = 1.17, 3.23, P<0.001), respectively. Children who took amoxicillin and de-worming had 95% (HR = 1.95, 95%-CI = 1.17, 3.23) and 74% (HR = 1.74, 95%-CI = 1.07, 2.83) more probability to recover from SAM as compared to those who didn't take them. Conclusions The OTP was partially successful. Management of children with comorbidities under the program and partial administration of routine drugs were major threats for the program effectiveness. The stakeholders should focus on creating the capacity of the OTP providers on proper management of SAM to achieve fully effective program. PMID:23755286

Antenatal Weight Management: Women's Experiences, Behaviours, and Expectations of Weighing in Early Pregnancy.

PubMed

Swift, J A; Pearce, J; Jethwa, P H; Taylor, M A; Avery, A; Ellis, S; Langley-Evans, S C; McMullen, S

2016-01-01

The current emphasis on obstetric risk management helps to frame gestational weight gain as problematic and encourages intervention by healthcare professionals. However pregnant women have reported confusion, distrust, and negative effects associated with antenatal weight management interactions. The MAGIC study (MAnaging weiGht In pregnanCy) sought to examine women's self-reported experiences of usual-care antenatal weight management in early pregnancy and consider these alongside weight monitoring behaviours and future expectations. 193 women (18 yrs+) were recruited from routine antenatal clinics at the Nottingham University Hospital NHS Trust. Self-reported gestation was 10-27 weeks, with 41.5% ( n = 80) between 12 and 14 and 43.0% ( n = 83) between 20 and 22 weeks. At recruitment 50.3% of participants ( n = 97) could be classified as overweight or obese. 69.4% of highest weight women (≥30 kg/m 2 ) did not report receiving advice about weight, although they were significantly more likely compared to women with BMI < 30 kg/m 2 . The majority of women (regardless of BMI) did not express any barriers to being weighed and 40.8% reported weighing themselves at home. Women across the BMI categories expressed a desire for more engagement from healthcare professionals on the issue of bodyweight. Women are clearly not being served appropriately in the current situation which simultaneously problematizes and fails to offer constructive dialogue.

Acceptability and non-compliance in a family-led weight-management programme for obese Pacific children.

PubMed

Teevale, Tasileta; Taufa, Seini; Percival, Teuila

2015-10-01

To explore factors influencing participation and attrition in a family-led weight-management programme for obese Pacific children. Qualitative study used bilingual in-depth interviews at exit and end of an 8-week weight-management programme. New Zealand. Forty-two parents/primary caregivers of obese children who were randomised in the intervention weight-management programme. Programmatic factors that enhanced retention included: simultaneous delivery to both children and parents as participants; delivery of the programme in small group settings at local community venues; enabling trustworthy and accountable relationships; providing resources for travel to venues and regular telephone/text messaging follow-up calls reinforcing programme goals; and day and time scheduling. Suggested programme improvements included having ethnic-specific Island-language delivery and practical sessions like cooking classes and shopping expeditions at local food stores. The research found that unpredictable external life crises like extended family deaths, a change in job shift, family illnesses (both acute and those requiring chronic management) and long-term family visitations affected participation and momentum. A loss of momentum through managing life crises was often difficult to overcome for participants, leading them to drop out of the weight-management programme. Most drop-out participants preferred to defer their programme participation with hopes of re-committing to future programmes at another time. In order for weight-management programmes to be effective, participants must be able to complete them. Identifying factors that predict participation and attrition may serve as a basis for programme improvement.

75 FR 4450 - Financial Management Service; Proposed Collection of Information: Direct Deposit Sign-Up Form

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-27

... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service; Proposed Collection of Information: Direct Deposit Sign-Up Form AGENCY: Financial Management Service, Fiscal Service, Treasury. ACTION: Notice and Request for comments. SUMMARY: The Financial Management Service, as part of its...

76 FR 23859 - Financial Management Service Proposed Collection of Information; Financial Institution Agreement...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-28

... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service Proposed Collection of... Management Service, Fiscal Service, Treasury. ACTION: Notice and request for comments. SUMMARY: The Financial... collection. By this notice, the Financial Management Service solicits comments concerning the FMS 458 and FMS...

77 FR 43428 - Financial Management Service; Proposed Collection of Information: Minority Bank Deposit Program...

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2012-07-24

... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service; Proposed Collection of... Management Service, Fiscal Service, Treasury. ACTION: Notice and Request for comments. SUMMARY: The Financial... collection. By this notice, the Financial Management Service solicits comments concerning form FMS 3144...

76 FR 23860 - Financial Management Service Proposed Collection of Information: Schedule of Excess Risks

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-28

... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service Proposed Collection of Information: Schedule of Excess Risks AGENCY: Financial Management Service, Fiscal Service, Treasury. ACTION: Notice and request for comments. SUMMARY: The Financial Management Service, as part of its continuing...

Weight Management and Fruit and Vegetable Intake among US High School Students

ERIC Educational Resources Information Center

Lowry, Richard; Lee, Sarah M.; McKenna, Mary L.; Galuska, Deborah A.; Kann, Laura K.

2008-01-01

Background: Consumption of fruits and vegetables is often recommended to promote healthy weight. The purpose of this study was to examine associations between fruit and vegetable intake and common weight management behaviors among US high school students who were trying to lose or stay the same weight. Methods: Data from the 1999, 2001, and 2003…

A Mixed Methods Evaluation of a 12-Week Insurance-Sponsored Weight Management Program Incorporating Cognitive-Behavioral Counseling

ERIC Educational Resources Information Center

Abildso, Christiaan; Zizzi, Sam; Gilleland, Diana; Thomas, James; Bonner, Daniel

2010-01-01

Physical activity is critical in healthy weight loss, yet there is still much to be learned about psychosocial mechanisms of physical activity behavior change in weight loss. A sequential mixed methods approach was used to assess the physical and psychosocial impact of a 12-week cognitive-behavioral weight management program and explore factors…

7 CFR 981.9 - Kernel weight.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Kernel weight. 981.9 Section 981.9 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... Regulating Handling Definitions § 981.9 Kernel weight. Kernel weight means the weight of kernels, including...

Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials.

PubMed

Norris, S L; Engelgau, M M; Narayan, K M

2001-03-01

To systematically review the effectiveness of self-management training in type 2 diabetes. MEDLINE, Educational Resources Information Center (ERIC), and Nursing and Allied Health databases were searched for English-language articles published between 1980 and 1999. Studies were original articles reporting the results of randomized controlled trials of the effectiveness of self-management training in people with type 2 diabetes. Relevant data on study design, population demographics, interventions, outcomes, methodological quality, and external validity were tabulated. Interventions were categorized based on educational focus (information, lifestyle behaviors, mechanical skills, and coping skills), and outcomes were classified as knowledge, attitudes, and self-care skills; lifestyle behaviors, psychological outcomes, and quality of life; glycemic control; cardiovascular disease risk factors; and economic measures and health service utilization. A total of 72 studies described in 84 articles were identified for this review. Positive effects of self-management training on knowledge, frequency and accuracy of self-monitoring of blood glucose, self-reported dietary habits, and glycemic control were demonstrated in studies with short follow-up (<6 months). Effects of interventions on lipids, physical activity, weight, and blood pressure were variable. With longer follow-up, interventions that used regular reinforcement throughout follow-up were sometimes effective in improving glycemic control. Educational interventions that involved patient collaboration may be more effective than didactic interventions in improving glycemic control, weight, and lipid profiles. No studies demonstrated the effectiveness of self-management training on cardiovascular disease-related events or mortality; no economic analyses included indirect costs; few studies examined health-care utilization. Performance, selection, attrition, and detection bias were common in studies reviewed, and external generalizability was often limited. Evidence supports the effectiveness of self-management training in type 2 diabetes, particularly in the short term. Further research is needed to assess the effectiveness of self-management interventions on sustained glycemic control, cardiovascular disease risk factors, and ultimately, microvascular and cardiovascular disease and quality of life.

Evaluating the nutrition intake of U.S. military service members in garrison.

PubMed

Ramsey, Casside B; Hostetler, Cheryl; Andrews, Anne

2013-12-01

Sparse information exists on the nutrition intake of U.S. military service members in a garrison setting. The purpose of this study was to assess the eating habits of a small group of service members who had not deployed in the preceding 12 months. Nutrition intake was measured using an online food frequency questionnaire and anthropometric measurements taken. Correlations were used to assess relationships between total caloric intake and sex, age, weight, waist circumference, body mass index, rank, marital status, history in a service-specific weight control program, and time in service. There were 39 subjects (18 males, 21 females) enrolled. There was a significant difference in total caloric intake between males and females (p = 0.040). The relationships of total caloric intake to both weight and waist circumference were significant (r = 0.425, p = 0.007 and r = 0.393, p = 0.013). There was a modest relationship between total caloric intake and sex (r = 0.331, p = 0.040) and history in a weight control program (r = -0.313, p = 0.052). There was no significant correlation between body mass index, age, rank, marital status, time in service, and total caloric intake. These relationships may partially explain the eating habits of service members in garrison. Future studies should further assess intake and influential additional factors, such as deployments. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

An internet-based intervention with brief nurse support to manage obesity in primary care (POWeR+): a pragmatic, parallel-group, randomised controlled trial.

PubMed

Little, Paul; Stuart, Beth; Hobbs, Fd Richard; Kelly, Jo; Smith, Emily R; Bradbury, Katherine J; Hughes, Stephanie; Smith, Peter W F; Moore, Michael V; Lean, Mike E J; Margetts, Barrie M; Byrne, Chris D; Griffin, Simon; Davoudianfar, Mina; Hooper, Julie; Yao, Guiqing; Zhu, Shihua; Raftery, James; Yardley, Lucy

2016-10-01

The obesity epidemic has major public health consequences. Expert dietetic and behavioural counselling with intensive follow-up is effective, but resource requirements severely restrict widespread implementation in primary care, where most patients are managed. We aimed to estimate the effectiveness and cost-effectiveness of an internet-based behavioural intervention (POWeR+) combined with brief practice nurse support in primary care. We did this pragmatic, parallel-group, randomised controlled trial at 56 primary care practices in central and south England. Eligible adults aged 18 years or older with a BMI of 30 kg/m(2) or more (or ≥28 kg/m(2) with hypertension, hypercholesterolaemia, or diabetes) registered online with POWeR+-a 24 session, web-based, weight management intervention lasting 6 months. After registration, the website automatically randomly assigned patients (1:1:1), via computer-generated random numbers, to receive evidence-based dietetic advice to swap foods for similar, but healthier, choices and increase fruit and vegetable intake, in addition to 6 monthly nurse follow-up (control group); web-based intervention and face-to-face nurse support (POWeR+Face-to-face [POWeR+F]; up to seven nurse contacts over 6 months); or web-based intervention and remote nurse support (POWeR+Remote [POWeR+R]; up to five emails or brief phone calls over 6 months). Participants and investigators were masked to group allocation at the point of randomisation; masking of participants was not possible after randomisation. The primary outcome was weight loss averaged over 12 months. We did a secondary analysis of weight to measure maintenance of 5% weight loss at months 6 and 12. We modelled the cost-effectiveness of each intervention. We did analysis by intention to treat, with multiple imputation for missing data. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN21244703. Between Jan 30, 2013, and March 20, 2014, 818 participants were randomly assigned to the control group (n=279), the POWeR+F group (n=269), or the POWeR+R group (n=270). Weight loss averaged over 12 months was recorded in 666 (81%) participants. The control group lost almost 3 kg over 12 months (crude mean weight: baseline 104·38 kg [SD 21·11; n=279], 6 months 101·91 kg [19·35; n=136], 12 months 101·74 kg [19·57; n=227]). The primary imputed analysis showed that compared with the control group, patients in the POWeR+F group achieved an additional weight reduction of 1·5 kg (95% CI 0·6-2·4; p=0·001) averaged over 12 months, and patients in the POWeR+R group achieved an additional 1·3 kg (0·34-2·2; p=0·007). 21% of patients in the control group had maintained a clinically important 5% weight reduction at month 12, compared with 29% of patients in the POWeR+F group (risk ratio 1·56, 0·96-2·51; p=0·070) and 32% of patients in the POWeR+R group (1·82, 1·31-2·74; p=0·004). The incremental overall cost to the health service per kg weight lost with the POWeR+ interventions versus the control strategy was £18 (95% CI -129 to 195) for POWeR+F and -£25 (-268 to 157) for POWeR+R; the probability of being cost-effective at a threshold of £100 per kg lost was 88% and 98%, respectively. No adverse events were reported. Weight loss can be maintained in some individuals by use of novel written material with occasional brief nurse follow-up. However, more people can maintain clinically important weight reductions with a web-based behavioural program and brief remote follow-up, with no increase in health service costs. Future research should assess the extent to which clinically important weight loss can be maintained beyond 1 year. Health Technology Assessment Programme of the National Institute for Health Research. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

76 FR 23859 - Financial Management Service Proposed Collection of Information: CMIA Annual Report and Direct...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-28

... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service Proposed Collection of Information: CMIA Annual Report and Direct Cost Claims AGENCY: Financial Management Service, Fiscal Service, Treasury. ACTION: Notice and request for comments. SUMMARY: The Financial Management Service, as part of...

75 FR 5849 - Financial Management Service; Proposed Collection of Information: Claim Against the United States...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-04

... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service; Proposed Collection of... Management Service, Fiscal Service, Treasury. ACTION: Notice and Request for comments. SUMMARY: The Financial... collection. By this notice, the Financial Management Service solicits comments concerning the Form FMS-1133...

Accessibility of Catering Service Venues and Adolescent Drinking in Beijing, China.

PubMed

Lu, Shijun; Du, Songming; Ren, Zhoupeng; Zhao, Jing; Chambers, Christina; Wang, Jinfeng; Ma, Guansheng

2015-06-26

This study assessed the association between accessibility of catering service venues and adolescents' alcohol use over the previous 30 days. The data were collected from cross-sectional surveys conducted in 2014, 2223 students at 27 high schools in Chaoyang and Xicheng districts, Beijing using self-administered questionnaires to collect the adolescents information on socio-demographic characteristics and recent alcohol experiences. The accessibility of, and proximity to, catering service venues were summarized by weights, which were calculated by multiplication of the type-weight and the distance-weight. All sampled schools were categorized into three subgroups (low, middle, and high geographic density) based on the tertile of nearby catering service venues, and a multi-level logistic regression analysis was performed to explore variance between the school levels. Considering the setting characteristics, the catering service venues weighted value was found to account for 8.6% of the school level variance of adolescent alcohol use. The odds ratios (OR) and 95% confidence intervals (CI) of drinking over the past 30-days among adolescents with medium and high accessibility of catering service venues were 1.17 (0.86, 1.57) and 1.47 (1.06, 2.02), respectively (p < 0.001 for trend test). This study addressed a gap in the adolescent drinking influence by the catering service venues around schools in China. Results suggest that the greater accessibility of catering service venues around schools is associated with a growing risk of recent drinking.

Accessibility of Catering Service Venues and Adolescent Drinking in Beijing, China

PubMed Central

Lu, Shijun; Du, Songming; Ren, Zhoupeng; Zhao, Jing; Chambers, Christina; Wang, Jinfeng; Ma, Guansheng

2015-01-01

This study assessed the association between accessibility of catering service venues and adolescents’ alcohol use over the previous 30 days. The data were collected from cross-sectional surveys conducted in 2014, 2223 students at 27 high schools in Chaoyang and Xicheng districts, Beijing using self-administered questionnaires to collect the adolescents information on socio-demographic characteristics and recent alcohol experiences. The accessibility of, and proximity to, catering service venues were summarized by weights, which were calculated by multiplication of the type-weight and the distance-weight. All sampled schools were categorized into three subgroups (low, middle, and high geographic density) based on the tertile of nearby catering service venues, and a multi-level logistic regression analysis was performed to explore variance between the school levels. Considering the setting characteristics, the catering service venues weighted value was found to account for 8.6% of the school level variance of adolescent alcohol use. The odds ratios (OR) and 95% confidence intervals (CI) of drinking over the past 30-days among adolescents with medium and high accessibility of catering service venues were 1.17 (0.86, 1.57) and 1.47 (1.06, 2.02), respectively (p < 0.001 for trend test). This study addressed a gap in the adolescent drinking influence by the catering service venues around schools in China. Results suggest that the greater accessibility of catering service venues around schools is associated with a growing risk of recent drinking. PMID:26132475

Obesity Prevention and Weight Maintenance After Loss.

PubMed

German, Alexander James

2016-09-01

Obesity is one of the most prevalent medical diseases in pets. Outcomes are often disappointing; many animals either fail to reach target weight or regain weight. This article discusses managing obesity, focusing on prevention. It gives guidance on establishing monitoring programs that use regular body weight and condition assessments to identify animals at risk of inappropriate weight gain, enabling early intervention. Weight management in obese animals is a lifelong process. Regular weight and body condition monitoring are key to identifying animals that rebound early, while continuing to feed a therapeutic weight loss diet can help prevent it from happening. Copyright © 2016 Elsevier Inc. All rights reserved.

The need of a weight management control program in judo: a proposal based on the successful case of wrestling.

PubMed

Artioli, Guilherme G; Franchini, Emerson; Nicastro, Humberto; Sterkowicz, Stanislaw; Solis, Marina Y; Lancha, Antonio H

2010-05-04

Judo competitions are divided into weight classes. However, most athletes reduce their body weight in a few days before competition in order to obtain a competitive advantage over lighter opponents. To achieve fast weight reduction, athletes use a number of aggressive nutritional strategies so many of them place themselves at a high health-injury risk. In collegiate wrestling, a similar problem has been observed and three wrestlers died in 1997 due to rapid weight loss regimes. After these deaths, the National Collegiate Athletic Association had implemented a successful weight management program which was proven to improve weight management behavior. No similar program has ever been discussed by judo federations even though judo competitors present a comparable inappropriate pattern of weight control. In view of this, the basis for a weight control program is provided in this manuscript, as follows: competition should begin within 1 hour after weigh-in, at the latest; each athlete is allowed to be weighed-in only once; rapid weight loss as well as artificial rehydration (i.e., saline infusion) methods are prohibited during the entire competition day; athletes should pass the hydration test to get their weigh-in validated; an individual minimum competitive weight (male athletes competing at no less than 7% and females at no less than 12% of body fat) should be determined at the beginning of each season; athletes are not allowed to compete in any weight class that requires weight reductions greater than 1.5% of body weight per week. In parallel, educational programs should aim at increasing the athletes', coaches' and parents' awareness about the risks of aggressive nutritional strategies as well as healthier ways to properly manage body weight.

Temperament and body weight from ages 4 to 15 years.

PubMed

Sutin, A R; Kerr, J A; Terracciano, A

2017-07-01

In adulthood, conscientiousness and neuroticism are correlates of body weight and weight gain. The present research examines whether the childhood antecedents of these traits, persistence and negative reactivity, respectively, are associated with weight gain across childhood. We likewise examine sociability as a predictor of childhood weight gain and whether these three traits are associated with weight concerns and weight-management strategies in adolescence. Participants (N=4153) were drawn from the Longitudinal Study of Australian Children, an ongoing, population-based study of child and family health and well-being. At the baseline assessment, caregivers reported on their child's temperament. At every assessment from ages 4-5 to 14-15 years, study children were weighed and measured by trained staff; there were up to six biennial assessments of body mass index and waist circumference. At ages 14-15 years, study children (n=2975) also self-reported on their weight concerns and weight-management strategies. Study children rated lower in persistence or higher in negative reactivity in early childhood gained more weight between the ages of 4 and 15 years. Sociability was associated with weight gain among girls but not among boys. Lower persistence and higher negative reactivity at ages 4-5 years were also associated with greater weight concerns, restrained eating and use of unhealthy weight-management strategies at ages 14-15 years. Childhood traits related to conscientiousness and neuroticism are associated with objective weight gain across childhood and with concerns and strategies to manage weight in adolescence. These results are consistent with a lifespan perspective that indicates that trait psychological functioning contributes to health-related markers from childhood through old age.

Applying RE-AIM to the evaluation of FUEL Your Life : a worksite translation of DPP.

PubMed

Brace, Andrea M; Padilla, Heather M; DeJoy, David M; Wilson, Mark G; Vandenberg, Robert J; Davis, Marsha

2015-01-01

Weight management programs are becoming increasingly common in workplace settings; however, few target middle-aged men. The purpose of this article is to describe the process evaluation of a worksite translation of the Diabetes Prevention Program in a predominantly middle-aged male population. The translated program, FUEL Your Life, was largely self-directed, with support from peer health coaches and occupational health nurses. The RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework was used to examine the factors that influenced program implementation using data from an environmental assessment, participant surveys, peer health coach surveys, and occupational health nurse interviews. An overwhelming majority of the employees who enrolled in the study were overweight or obese (92%). Overall, the program was effective for weight maintenance; those with higher levels of participation and engagement had better weight loss outcomes. The peer health coach and family elements of the intervention were underused. The program was successful in reaching the intended population; however, the program had limited success in engaging this population. Not surprisingly, weight loss was a function of participant engagement and participation. Increasing participant engagement and participation is important to the success of weight management interventions translated to the worksite setting. Garnering buy-in and support from management can serve to increase the perceived importance of weight management in worksites. With management support, weight management protocols could be integrated as a component of the mandatory safety and health assessments already in place, fostering promotion of healthy weight in the workforce. © 2014 Society for Public Health Education.

US Registered Dietitian Nutritionists' Knowledge and Attitudes of Intuitive Eating and Use of Various Weight Management Practices.

PubMed

Schaefer, Julie T; Zullo, Melissa D

2017-09-01

Researchers have been advocating for a new weight-inclusive paradigm that focuses on health rather than weight. One important component of this model is intuitive eating. Although registered dietitian nutritionists (RDNs) are the nation's food and nutrition experts, RDNs' knowledge of and attitudes toward intuitive eating and use of traditional or restrictive strategies are unknown. The purpose of this study was to characterize RDNs' knowledge of and attitudes toward an intuitive eating lifestyle and describe use of traditional weight management and nonrestrictive lifestyle practices with clients. This was a cross-sectional study. A validated survey was distributed using online survey software to 88,834 RDNs. There were 18,622 respondents who completed the survey (25%). The majority of RDNs were knowledgeable about intuitive eating, answering 71% of items correctly. The majority of RDNs had a positive view on each attitude item. RDNs who work in weight management reported using nonrestrictive/intuitive eating practices more than traditional/restrictive practices. RDNs who were women (P<0.001), had advanced education (P<0.001), worked in a private practice setting (P<0.001), completed at least one certificate of training in weight management (P<0.001), had more experience in weight management counseling (P<0.001), and had greater intuitive eating knowledge (P<0.001) were more likely to report greater use of nonrestrictive/intuitive eating practices. This study provides evidence that RDNs are using an intuitive eating approach more often than traditional weight management practices. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Family support in the transition to adulthood in Portugal--its effects on identity capital development, uncertainty management and psychological well-being.

PubMed

Oliveira, José Egídio; Mendonça, Marina; Coimbra, Susana; Fontaine, Anne Marie

2014-12-01

In a familistic southern European society such as the Portuguese, the family has historically played a prominent role in supporting the negotiation of transition pathways into adulthood. The present study aimed at capturing (1) the relative weight of parental financial support and autonomy support in contributing to the youngsters' psychological well-being (PWB), and (2) the mediating role of identity capital and uncertainty management in this relationship. A total of 620 participants completed measures of parental support, identity capital, uncertainty management and PWB. Autonomy support was found to be the strongest predictor of PWB, both directly and indirectly through its effects on identity capital and the use of target focused uncertainty management strategies. Conversely, financial support evidenced only a minor indirect impact through the mediation of tangible identity capital. Autonomy stimulation may constitute one of the most developmentally determinant family challenges in assisting the process of coming of age in Portugal. Copyright © 2014 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Study of power management technology for orbital multi-100KWe applications. Volume 2: Study results

NASA Technical Reports Server (NTRS)

Mildice, J. W.

1980-01-01

The preliminary requirements and technology advances required for cost effective space power management systems for multi-100 kilowatt requirements were identified. System requirements were defined by establishing a baseline space platform in the 250 KE KWe range and examining typical user loads and interfaces. The most critical design parameters identified for detailed analysis include: increased distribution voltages and space plasma losses, the choice between ac and dc distribution systems, shuttle servicing effects on reliability, life cycle costs, and frequency impacts to power management system and payload systems for AC transmission. The first choice for a power management system for this kind of application and size range is a hybrid ac/dc combination with the following major features: modular design and construction-sized minimum weight/life cycle cost; high voltage transmission (100 Vac RMS); medium voltage array or = 440 Vdc); resonant inversion; transformer rotary joint; high frequency power transmission line or = 20 KHz); energy storage on array side or rotary joint; fully redundant; and 10 year life with minimal replacement and repair.

25 CFR 900.118 - Do these “construction contract” regulations apply to construction management services?

Code of Federal Regulations, 2014 CFR

2014-04-01

... construction management services? 900.118 Section 900.118 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE...” regulations apply to construction management services? No. Construction management services may be contracted separately under section 108 of the Act. Construction management services consultants and/or Indian tribe or...

31 CFR Appendix G to Subpart A of... - Financial Management Service

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Financial Management Service G...—Financial Management Service 1. In general. This appendix applies to the Financial Management Service. 2. Public reading room. The public reading room for the Financial Management Service is maintained at the...

Data analytics approach to create waste generation profiles for waste management and collection.

PubMed

Niska, Harri; Serkkola, Ari

2018-04-30

Extensive monitoring data on waste generation is increasingly collected in order to implement cost-efficient and sustainable waste management operations. In addition, geospatial data from different registries of the society are opening for free usage. Novel data analytics approaches can be built on the top of the data to produce more detailed, and in-time waste generation information for the basis of waste management and collection. In this paper, a data-based approach based on the self-organizing map (SOM) and the k-means algorithm is developed for creating a set of waste generation type profiles. The approach is demonstrated using the extensive container-level waste weighting data collected in the metropolitan area of Helsinki, Finland. The results obtained highlight the potential of advanced data analytic approaches in producing more detailed waste generation information e.g. for the basis of tailored feedback services for waste producers and the planning and optimization of waste collection and recycling. Copyright © 2018 Elsevier Ltd. All rights reserved.

Commercial Health Plan Coverage of Selected Treatments for Opioid Use Disorders from 2003 to 2014.

PubMed

Reif, Sharon; Creedon, Timothy B; Horgan, Constance M; Stewart, Maureen T; Garnick, Deborah W

2017-01-01

Opioid use disorders (OUDs) are receiving significant attention in the U.S. as a public health crisis. Access to treatment for OUDs is essential and was expected to improve following implementation of the federal parity law and the Affordable Care Act. This study examines changes in coverage and management of treatments for OUDs (opioid treatment programs (OTPs) as a covered service benefit, buprenorphine as a pharmacy benefit) before, during, and after parity and ACA implementation. Data are from three rounds of a nationally representative survey conducted with commercial health plans regarding behavioral health services in benefit years 2003, 2010, and 2014. Data were weighted to be representative of health plans' commercial products in the continental United States (2003 weighted N = 7,469, 83% response rate; 2010 N = 8,431, 89% response rate; and 2014 N = 6,974, 80% response rate). Results showed treatment for OUDs was covered by nearly all health plan products in each year of the survey, but the types and patterns varied by year. Prior authorization requirements for OTPs have decreased over time. Despite the promise of expanded access to OUD treatment suggested by parity and the ACA, improved health plan coverage for treatment of OUDs, while essential, is not sufficient to address the opioid crisis.

Commercial Health Plan Coverage of Selected Treatments for Opioid Use Disorders from 2003 to 2014

PubMed Central

Reif, Sharon; Creedon, Timothy B.; Horgan, Constance M.; Stewart, Maureen T.; Garnick, Deborah W.

2018-01-01

Opioid use disorders (OUDs) are receiving significant attention as a public health crisis. Access to treatment for OUDs is essential and was expected to improve following implementation of the federal parity law and the Affordable Care Act. This study examines changes in coverage and management of treatments for OUDs (opioid treatment programs (OTPs) as a covered service benefit, buprenorphine as a pharmacy benefit) before, during and after parity and ACA implementation. Data are from three rounds of a nationally representative survey conducted with commercial health plans regarding behavioral health services in benefit years 2003, 2010, and 2014. Data were weighted to be representative of health plans’ commercial products in the continental United States (2003 weighted N= 7,469, 83% response rate; 2010 N=8,431, 89% response rate; and 2014 N=6,974, 80% response rate). Results showed treatment for OUDs was covered by nearly all health plan products in each year of the survey, but the types and patterns varied by year. Prior authorization requirements for OTPs have decreased over time. Despite the promise of expanded access to OUD treatment suggested by parity and the ACA, improved health plan coverage for treatment of OUDs, while essential, is not sufficient to address the opioid crisis. PMID:28350229

Essential managerial attributes of the nowadays nursing service manager in the South African context.

PubMed

Jooste, K

2003-08-01

Nursing service managers need certain essential managerial attributes in taking the lead in effective management of the nowadays health care organisations in South Africa. Major changes in restructuring and human resources planning are taking place through transformation of health services and specific managerial attributes are needed in this scenario. Without nursing service managers with the necessary managerial attributes, change in the health care environment will be hampered and planning, organising, directing and control of the delivering of quality care will be negatively influenced. The research problem was addressed in the following question that guided the study: Which essential attributes/characteristics should a nursing service manager possess to run a health care service effectively? It was unclear what the opinions of all level of nurse managers were regarding the necessary managerial attributes the health services manager currently need to run the current health care services effectively. This study aimed at highlighting the necessary attributes of the nowadays nursing service manager in running a health care institution in the current health care environment of South Africa. Purposive sampling was done and forty-five functional, middle and top-level managers registered for a second year degree course in Health Services Management at a South African university participated in the study. The findings indicated important managerial and leadership attributes, which the current nursing service manager should possess. This article will only discuss the important managerial attributes needed. A conceptual framework came to the fore according to which an example of a self-evaluation instrument was compiled for nursing service managers for future use. The results of the data analysis indicated that the nursing service manager should promote good interpersonal relationships with colleagues, subordinates and patients through the attributes of openness, being inviting and empowering behavior. The purpose of this article is to make nursing service managers more aware of the necessary attributes they should possess and should develop to manage nursing services more effectively.

Effectiveness of a psychosocial weight management program for individuals with schizophrenia.

PubMed

Niv, Noosha; Cohen, Amy N; Hamilton, Alison; Reist, Christopher; Young, Alexander S

2014-07-01

The objective of this study was to examine the effectiveness of a weight loss program for individuals with schizophrenia in usual care. The study included 146 adults with schizophrenia from two mental health clinics of the Department of Veterans Affairs. The 109 individuals who were overweight or obese were offered a 16-week, psychosocial, weight management program. Weight and Body Mass Index (BMI) were assessed at baseline, 1 year later, and at each treatment session. Only 51% of those who were overweight or obese chose to enroll in the weight management program. Participants attended an average of 6.7 treatment sessions, lost an average of 2.4 pounds, and had an average BMI decrease of 0.3. There was no significant change in weight or BMI compared to the control group. Intervention strategies that both improve utilization and yield greater weight loss need to be developed.

Implementation and Effectiveness of a Psychosocial Weight Management Program for Individuals with Schizophrenia

PubMed Central

Niv, Noosha; Cohen, Amy N.; Hamilton, Alison; Reist, Christopher; Young, Alexander S.

2013-01-01

The objective of this study was to examine the effectiveness of a weight loss program for individuals with schizophrenia in usual care. The study included 146 adults with schizophrenia from two mental health clinics of the Department of Veterans Affairs. The 109 individuals who were overweight or obese were offered a 16-week, psychosocial, weight management program. Weight and BMI were assessed at baseline, 1 year later and at each treatment session. Only 51% of those who were overweight or obese chose to enroll in the weight management program. Participants attended an average of 6.7 treatment sessions, lost an average of 2.4 pounds and had an average BMI decrease of 0.3. There was no significant change in weight or BMI compared to the control group. Intervention strategies that both improve utilization and yield greater weight loss need to be developed. PMID:22430566

Physical activity and body composition changes during military service.

PubMed

Mikkola, Ilona; Jokelainen, Jari J; Timonen, Markku J; Härkönen, Pirjo K; Saastamoinen, Eero; Laakso, Mauri A; Peitso, Ari J; Juuti, Anna-Kaisa; Keinänen-Kiukaanniemi, Sirkka M; Mäkinen, Tiina M

2009-09-01

To examine how body composition changes in different body mass index (BMI) categories among young Finnish men during military service, which is associated with marked changes in diet and physical activity. In addition, this study examined how reported previous physical activity affected the body composition changes. Altogether 1003 men (19 yr) were followed throughout their military service (6-12 months). Height, weight, BMI, waist circumference, and waist-to-hip ratio (WHR) were recorded. Previous physical activity was assessed at the beginning of the service by a questionnaire. Body composition was measured by bioelectrical impedance assessments (BIA) at the beginning and at the end of the service. The measured parameters were fat mass (FM), fat percentage (fat %), fat-free mass (FFM), visceral fat area (VFA), lean body mass (LBM), and skeletal muscle mass (SMM). On average, military training decreased weight by 0.7%, FM by 9.7%, fat % by 6.6%, and VFA by 43.4%. FFM increased by 1.3%, LBM by 1.2%, and SMM by 1.7%. The group of underweight and normal-weight men gained weight, FM, and FFM, whereas overweight and obese men lost weight and FM and gained FFM. FM was most reduced in the groups of overweight (20.8%) and obese (24.9%) men. The amount of VFA was reduced in all BMI groups (38%-44%). Among overweight men who reported being inactive previous to the military service, more beneficial changes in body composition were observed compared with those who reported being physically active. The lifestyle changes associated with military service markedly reduce fat tissue and increase the amount of lean tissue. These beneficial changes are prominent among previously inactive subjects with high BMI.

A qualitative study comparing commercial and health service weight loss groups, classes and clubs.

PubMed

Allan, K; Hoddinott, P; Avenell, A

2011-02-01

Group-based interventions for weight loss are popular; however, little is known about how health service groups compare with the commercial sector, from either the participant or the group leader perspective. Currently, health professionals have little guidance on how to deliver effective group interventions. The present study aimed to compare and contrast leaders' and attendees' experiences of health service and commercial weight loss groups, through in-depth interviews and group observations. Purposive sampling, guided by a sampling frame, was employed to identify diverse groups operating in Scotland with differing content, structures and style. Data collection and analysis took place concurrently in accordance with a grounded theory approach. Thirteen semi-structured group observations and in-depth audio-recorded interviews with 11 leaders and 22 attendees were conducted. Identification of themes and the construction of matrices to identify data patterns were guided by the Framework Method for qualitative analysis. Compared to commercial groups, health service 'groups' or 'classes' tended to offer smaller periodic fixed term groups, involving gatekeeper referral systems. Commercial organisations provide a fixed branded package, for 'club' or 'class' members, and most commercial leaders share personal experiences of losing weight. Health service leaders had less opportunity for supervision, peer support or specific training in how to run their groups compared to commercial leaders. Commercial and health service groups differ in access; attendee and leader autonomy; engagement in group processes; and approaches to leadership and training, which could influence weight loss outcomes. Health service groups can provide different group content and experiences, particularly for those with chronic diseases and for populations less likely to attend commercial groups, such as men. © 2010 The Authors. Journal compilation © 2010 The British Dietetic Association Ltd.

Systems modeling to improve the hydro-ecological performance of diked wetlands

NASA Astrophysics Data System (ADS)

Alminagorta, Omar; Rosenberg, David E.; Kettenring, Karin M.

2016-09-01

Water scarcity and invasive vegetation threaten arid-region wetlands and wetland managers seek ways to enhance wetland ecosystem services with limited water, labor, and financial resources. While prior systems modeling efforts have focused on water management to improve flow-based ecosystem and habitat objectives, here we consider water allocation and invasive vegetation management that jointly target the concurrent hydrologic and vegetation habitat needs of priority wetland bird species. We formulate a composite weighted usable area for wetlands (WU) objective function that represents the wetland surface area that provides suitable water level and vegetation cover conditions for priority bird species. Maximizing the WU is subject to constraints such as water balance, hydraulic infrastructure capacity, invasive vegetation growth and control, and a limited financial budget to control vegetation. We apply the model at the Bear River Migratory Bird Refuge on the Great Salt Lake, Utah, compare model-recommended management actions to past Refuge water and vegetation control activities, and find that managers can almost double the area of suitable habitat by more dynamically managing water levels and managing invasive vegetation in August at the beginning of the window for control operations. Scenario and sensitivity analyses show the importance to jointly consider hydrology and vegetation system components rather than only the hydrological component.

77 FR 32013 - Truck Size and Weight; Technical Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-31

...-2012-0037] RIN 2125-AF45 Truck Size and Weight; Technical Correction AGENCY: Federal Highway...: This rule makes a technical correction to the regulations that govern Longer Combination Vehicles (LCV... INFORMATION CONTACT: John Nicholas, Truck Size and Weight Program Manager, Office of Freight Management and...

Adherence to a multi-component weight management program for Mexican American adolescents

USDA-ARS?s Scientific Manuscript database

This study examined weight loss among Mexican American students in a weight management program. A total of 358 participants completed a 12-week intervention that incorporated four program components: nutrition education (NE), physical activity (PA), sedentary behavior (SB), and a snacking interventi...

‘HighChest’: An Augmented Freezer Designed for Smart Food Management and Promotion of Eco-Efficient Behaviour

PubMed Central

Bonaccorsi, Manuele; Betti, Stefano; Rateni, Giovanni; Esposito, Dario; Brischetto, Alessia; Marseglia, Marco; Dario, Paolo; Cavallo, Filippo

2017-01-01

This paper introduces HighChest, an innovative smart freezer designed to promote energy efficient behavior and the responsible use of food. Introducing a novel human–machine interface (HMI) design developed through assessment phases and a user involvement stage, HighChest is state of the art, featuring smart services that exploit embedded sensors and Internet of things functionalities, which enhance the local capabilities of the appliance. The industrial design thinking approach followed for the advanced HMI is intended to maximize the social impact of the food management service, enhancing both the user experience of the product and the user’s willingness to adopt eco- and energy-friendly behaviors. The sensor equipment realizes automatic recognition of food by learning from the users, as well as automatic localization inside the deposit space. Moreover, it provides monitoring of the appliance’s usage, avoiding temperature and humidity issues related to improper use. Experimental tests were conducted to evaluate the localization system, and the results showed 100% accuracy for weights greater or equal to 0.5 kg. Drifts due to the lid opening and prolonged usage time were also measured, to implement automatic reset corrections. PMID:28604609

Physician behavior as a determinant of utilization patterns: the case of abortion.

PubMed Central

Nathanson, C A; Becker, M H

1978-01-01

Health services utilization may be influenced by the structure of the health system and the behavior of health professionals as well as by the actions of individual patients. This research examines the responses of obstetricians toward women seeking abortion. The population for this study includes all obstetrician-gynecologists with any private practice in Maryland during 1975 (473). Each responding physician (443) was presented with a case history vignette describing, in a telephone interview, a woman who is pregnant and considering an abortion. The sociodemographic characteristics of the woman were systematically varied to determine effects of patient attributes on physicians' patient management decisions. Decisions to refer the patient or to participate personally in her care were found to be associated most strongly with the patients' financial resources. Three hundred and twelve obstetricians returned a mail questionnaire, probing their own attitudes and characteristics. Physicians' liberal or conservative attitudes toward expansion of reproductive health care services and their level of disturbance by the abortion procedure were also influential in these patient management decisions. Simultaneous examination of both patient and physician characteristics indicated that the former had the greater weight in accounting for referral decisions. PMID:717619

NASA's Aeronautics Vision

NASA Technical Reports Server (NTRS)

Tenney, Darrel R.

2004-01-01

Six long-term technology focus areas are: 1. Environmentally Friendly, Clean Burning Engines. Focus: Develop innovative technologies to enable intelligent turbine engines that significantly reduce harmful emissions while maintaining high performance and increasing reliability. 2. New Aircraft Energy Sources and Management. Focus: Discover new energy sources and intelligent management techniques directed towards zero emissions and enable new vehicle concepts for public mobility and new science missions. 3. Quiet Aircraft for Community Friendly Service. Focus: Develop and integrate noise reduction technology to enable unrestricted air transportation service to all communities. 4. Aerodynamic Performance for Fuel Efficiency. Focus: Improve aerodynamic efficiency,structures and materials technologies, and design tools and methodologies to reduce fuel burn and minimize environmental impact and enable new vehicle concepts and capabilities for public mobility and new science missions. 5. Aircraft Weight Reduction and Community Access. Focus: Develop ultralight smart materials and structures, aerodynamic concepts, and lightweight subsystems to increase vehicle efficiency, leading to high altitude long endurance vehicles, planetary aircraft, advanced vertical and short takeoff and landing vehicles and beyond. 6. Smart Aircraft and Autonomous Control. Focus: Enable aircraft to fly with reduced or no human intervention, to optimize flight over multiple regimes, and to provide maintenance on demand towards the goal of a feeling, seeing, sensing, sentient air vehicle.

Hospital diversification strategy.

PubMed

Eastaugh, Steven R

2014-01-01

To determine the impact of health system restructuring on the levels of hospital diversification and operating ratio this article analyzed 94 teaching hospitals and 94 community hospitals during the period 2008-2013. The 47 teaching hospitals are matched with 47 other teaching hospitals experiencing the same financial market position in 2008, but with different levels of preference for risk and diversification in their strategic plan. Covariates in the analysis included levels of hospital competition and the degree of local government planning (for example, highly regulated in New York, in contrast to Texas). Moreover, 47 nonteaching community hospitals are matched with 47 other community hospitals in 2008, having varying manager preferences for service-line diversification and risk. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as jointly dependent. Institutional diversification is found to yield better financial position, and the better operating profits provide the firm the wherewithal to diversify. Some services are in a growth phase, like bariatric weight-loss surgery and sleep disorder clinics. Hospital managers' preferences for risk/return potential were considered. An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification, and divestiture, occasionally leading to closure or merger.

Case Management and the Integration of Services: How Service Delivery Systems Shape Case Management.

ERIC Educational Resources Information Center

Moore, Stephen

1992-01-01

Notes that primary role that case management plays in coordination of services is determined by level of service integration and by level of resources in service delivery system. Describes conditions under which case management serves as mechanism for rationing services, marketing function, brokering function, or development role. Discusses…

76 FR 25782 - Financial Management Service; Proposed Collection of Information: List of Data (A) and List of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-05

... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service; Proposed Collection of Information: List of Data (A) and List of Data (B) AGENCY: Financial Management Service, Fiscal Service, Treasury. ACTION: Notice and Request for comments. SUMMARY: The Financial Management Service, as part of...

77 FR 71035 - Financial Management Service; Proposed Collection of Information: Electronic Funds Transfer (EFT...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-28

... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service; Proposed Collection of Information: Electronic Funds Transfer (EFT) Market Research Study AGENCY: Financial Management Service, Fiscal Service, Treasury. ACTION: Notice and Request for comments. SUMMARY: The Financial Management...

75 FR 42486 - Financial Management Service; Proposed Collection of Information: Authorization Agreement for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-21

... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service; Proposed Collection of Information: Authorization Agreement for Preauthorized Payment (SF 5510) AGENCY: Financial Management Service, Fiscal Service, Treasury. ACTION: Notice and request for comments. SUMMARY: The Financial Management...

Risk preferences, probability weighting, and strategy tradeoffs in wildfire management

Treesearch

Michael S. Hand; Matthew J. Wibbenmeyer; Dave Calkin; Matthew P. Thompson

2015-01-01

Wildfires present a complex applied risk management environment, but relatively little attention has been paid to behavioral and cognitive responses to risk among public agency wildfire managers. This study investigates responses to risk, including probability weighting and risk aversion, in a wildfire management context using a survey-based experiment administered to...

Equivalent weight loss for weight management programs delivered by phone and clinic

PubMed Central

Donnelly, Joseph E.; Goetz, Jeannine; Gibson, Cheryl; Sullivan, Debra K.; Lee, Robert; Smith, Bryan K.; Lambourne, Kate; Mayo, Matthew S.; Hunt, Suzanne; Lee, Jae Hoon; Honas, Jeffrey J.; Washburn, Richard A.

2013-01-01

Objective Face-to-face weight management is costly and presents barriers for individuals seeking treatment; thus, alternate delivery systems are needed. The objective of this study was to compare weight management delivered by face-to-face (FTF) clinic or group conference calls (phone). Design and Methods Randomized equivalency trial in 295 overweight/obese men/women (BMI = 35.1±4.9, Age = 43.8±10.2, Minority = 39.8%). Weight loss (0–6 months) was achieved by reducing energy intake between 1,200– 1,500 kcal/day and progressing physical activity to 300 minutes/week. Weight maintenance (7–18 months) provided adequate energy to maintain weight and continued 300 minutes/week of physical activity. Behavioral weight management strategies were delivered weekly for 6 months and gradually reduced during months 7–18. A cost analysis provided a comparison of expenses between groups. Results Weight change from baseline to 6 months was −13.4 ± 6.7% and −12.3 ± 7.0% for FTF clinic and phone, respectively. Weight change from 6 months to 18 months was 6.4 ± 7.0% and 6.4 ± 5.2%, for FTF clinic and phone, respectively. The cost to FTF participants was $789.58 more person. Conclusions Phone delivery provided equivalent weight loss and maintenance and reduced program cost. Ubiquitous access to phones provides a vast reach for this approach. PMID:23408579

Data-as-a-Service Platform for Delivering Healthy Lifestyle and Preventive Medicine: Concept and Structure of the DAPHNE Project.

PubMed

Gibbons, Catherine; Bailador Del Pozo, Gonzalo; Andrés, Javier; Lobstein, Tim; Manco, Melania; Lewy, Hadas; Bergman, Einat; O'Callaghan, David; Doherty, Gavin; Kudrautseva, Olga; Palomares, Angel; Ram, Roni; Olmo, Alberto

2016-12-09

Overweight and obesity is related to many health problems and diseases. The current obesity epidemic, which is a major health problem, is closely related to a lack of physical activity, high levels of sedentary behavior, and increased energy intake; with evidence to show increasing incidence of these issues in the younger population. Tackling obesity and its comorbid conditions requires a holistic approach encompassing attention on physical activity, healthy diet, and behavioral activation in order to enable and maintain meaningful and long-term weight loss and weight maintenance. The objective of the Data-as-a-Service Platform for Healthy Lifestyle and Preventive Medicine (DAPHNE) project is to develop a breakthrough information communications technology (ICT) platform for tracking health, weight, physical activity, diet, lifestyle, and psychological components within health care systems, whereby the platform and clinical support is linked. The DAPHNE platform aims to deliver personalized guidance services for lifestyle management to the citizen/patient by means of (1) advanced sensors and mobile phone apps to acquire and store continuous/real-time data on lifestyle aspects, behavior, and surrounding environment; (2) individual models to monitor their health and fitness status; (3) intelligent data processing for the recognition of behavioral trends; and (4) specific services for personalized guidance on healthy lifestyle and disease prevention. It is well known that weight loss and maintenance of weight loss are particularly difficult. This tool will address some of the issues found with conventional treatment/advice in that it will collect data in real time, thereby reducing reliability issues known with recalling events once they have passed and will also allow adjustment of behavior through timely support and recommendations sent through the platform without the necessity of formal one-to-one visits between patient and clinician. Patient motivation/compliance is a particular issue with conventional weight loss regimes; DAPHNE aims to increase the individuals' awareness of their own behavior and fosters their accountability. The project has been funded and the research work has started. Results for the validation of the different components is due imminently. In contrast with previous existing solutions, the DAPHNE project tackles the obesity problem from a clinical point of view, designing the different interfaces for its use by patients (adults and children), physicians, and caregivers. A specific design for children and adolescent patients treated for obesity has been followed, guided by pediatric physicians at hospitals in Europe. The final clinical validation of the DAPHNE platform will be carried out in different European hospitals, testing the platform in both adolescents and adults. ©Catherine Gibbons, Gonzalo Bailador del Pozo, Javier Andrés, Tim Lobstein, Melania Manco, Hadas Lewy, Einat Bergman, David O'Callaghan, Gavin Doherty, Olga Kudrautseva, Angel Palomares, Roni Ram, Alberto Olmo. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 09.12.2016.

Can mindfulness influence weight management related eating behaviors? If so, how?

PubMed

Tapper, Katy

2017-04-01

Mindfulness is increasingly being used for weight management. However, the strength of the evidence for such an approach is unclear; although mindfulness-based weight management programs have had some success, it is difficult to conclude that the mindfulness components were responsible. Research in this area is further complicated by the fact that the term 'mindfulness' is used to refer to a range of different practices. Additionally, we have little understanding of the mechanisms by which mindfulness might exert its effects. This review addresses these issues by examining research that has looked at the independent effects of mindfulness and mindfulness-related strategies on weight loss and weight management related eating behaviors. As well as looking at evidence for effects, the review also considers whether effects may vary with different types of strategy, and the kinds of mechanisms that may be responsible for any change. It is concluded that there is some evidence to support the effects of (a) present moment awareness, when applied to the sensory properties of food, and (b) decentering. However, research in these areas has yet to be examined in a controlled manner in relation to weight management. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Technology-based interventions for weight management: current randomized controlled trial evidence and future directions

PubMed Central

Buscemi, Joanna; Hawkins, Misty A. W.; Wang, Monica L.; Breland, Jessica Y.; Ross, Kathryn M.; Kommu, Anupama

2018-01-01

Obesity is a prevalent health care issue associated with disability, premature morality, and high costs. Behavioral weight management interventions lead to clinically significant weight losses in overweight and obese individuals; however, many individuals are not able to participate in these face-to-face treatments due to limited access, cost, and/or time constraints. Technological advances such as widespread access to the Internet, increased use of smartphones, and newer behavioral self-monitoring tools have resulted in the development of a variety of eHealth weight management programs. In the present paper, a summary of the most current literature is provided along with potential solutions to methodological challenges (e.g., high attrition, minimal participant racial/ethnic diversity, heterogeneity of technology delivery modes). Dissemination and policy implications will be highlighted as future directions for the field of eHealth weight management. PMID:27783259

Age Weights for Health Services Derived from the Relative Social Willingness-to-Pay Instrument.

PubMed

Richardson, Jeff; McKie, John; Iezzi, Angelo; Maxwell, Aimee

2017-04-01

The effect of a patient's age on the social valuation of health services remains controversial, with empirical results varying in magnitude and implying a different age-value profile. This article employs a new methodology to re-examine these questions. Data were obtained from 2 independent Web-based surveys that administered the Relative Social Willingness to Pay instrument. In the first survey, the age of the patient receiving a life-saving service was varied. Patients were left with either poor mental or physical health. In the second survey, patient age was varied for a service that fully cured the patient's poor mental or physical health. In total, therefore, 4 sets of age weights were obtained: weights for life-extending services with poor physical or mental health outcomes and weights for quality-of-life improvement for patients in poor mental or physical health. Results were consistent. Increasing age was associated in each case with a monotonic decrease in the social valuation of the services. The decrease in value was quantitatively small until age 60 years. By age 80 years, the social value of services had declined by about 50%. The decline commenced at an earlier age in the context of physical health, although the magnitude of the decrement by age 80 years was unrelated to the type of service. With 1 exception, there was little difference in the valuation of services by the age of the survey respondent. Respondents aged >60 years placed a lower, not higher, value on quality-of-life improvement for elderly individuals than other respondents. There was no difference in the valuation of life-extending services.

Weight Management Belief is the Leading Influential Factor of Weight Monitoring Compliance in Congestive Heart Failure Patients.

PubMed

Lu, Min-Xia; Zhang, Yan-Yun; Jiang, Jun-Fang; Ju, Yang; Wu, Qing; Zhao, Xin; Wang, Xiao-Hua

2016-11-01

Daily weight monitoring is frequently recommended as a part of heart failure self-management to prevent exacerbations. This study is to identify factors that influence weight monitoring compliance of congestive heart failure patients at baseline and after a 1-year weight management (WM) program. This was a secondary analysis of an investigative study and a randomized controlled study. A general information questionnaire assessed patient demographics and clinical variables such as medicine use and diagnoses, and the weight management scale evaluated their WM abilities. Good and poor compliance based on abnormal weight gain from the European Society of Cardiology (> 2 kg in 3 days) were compared, and hierarchical multiple logistic regression analysis was used to identify factors influencing weight monitoring compliance. A total of 316 patients were enrolled at baseline, and 66 patients were enrolled after the 1-year WM program. Of them, 12.66% and 60.61% had good weight monitoring compliance at baseline and after 1 year of WM, respectively. A high WM-related belief score indicated good weight monitoring compliance at both time points [odds ratio (OR), 1.043, 95% confidence interval (CI), 1.023-1.063, p < 0.001; and OR, 2.054, 95% CI, 1.209-3.487, p < 0.001, respectively). Patients with a high WM-related practice score had good weight monitoring compliance at baseline (OR, 1.046, 95% CI, 1.027-1.065, p < 0.001), and patients who had not monitored abnormal weight had poor weight monitoring compliance after the 1-year WM program (OR, 0.244, 95% CI, 0.006-0.991, p = 0.049). Data from this study suggested that belief related to WM plays an important role in weight monitoring compliance.

A multidegree-of-freedom vibrational apparatus

NASA Technical Reports Server (NTRS)

Kerley, J. J., Jr.; Schaller, N. C.

1973-01-01

Apparatus uses prestressed cables to support vibrational table. Cables are durable, do not require frequent servicing, and provide increased safety. Because much weight rests on these cables, vibration actuating pistons can provide longer service. In event of structural failure of other supporting components, they will support entire weight of vibrational table.

A pilot test of the GoWoman weight management intervention for women with mobility impairments in the online virtual world of Second Life®.

PubMed

Nosek, Margaret A; Robinson-Whelen, Susan; Ledoux, Tracey A; Hughes, Rosemary B; O'Connor, Daniel P; Lee, Rebecca E; Goe, Rebecca; Silveira, Stephanie L; Markley, Rachel; Nosek, Thomas M

2018-06-11

Pilot test GoWoman, a small-group weight management intervention for mobility impaired women that was a disability- and gender-responsive adaptation of the Diabetes Prevention Program delivered in the online virtual world of Second Life ® . Objectives were to (1) examine pre-/post-intervention differences in weight, waist circumference, diet, physical activity, self-efficacy for diet and physical activity, nutrition knowledge and social support for weight management, (2) determine intervention feasibility (fidelity, attrition, engagement, acceptability). Single-group modified interrupted time series quasi-experimental design whereby participants served as their own controls. Thirteen women attended ≥8 of 16 GoWoman weekly sessions and lost an average of 5.97 pounds (2.71 kg) (3.31%) body weight (Cohen's d = 0.74) and 1.44 inches (3.66 cm) (3.58%) waist circumference (Cohen's d = 0.83). There were significant improvements in physical activity, diet and self-efficacy for diet and physical activity. All benchmarks for feasibility were met. Ratings of intervention content, group interactions and support and virtual world experiences were highly positive. Findings suggest that a disability- and gender-responsive weight management intervention with peer group support delivered in an online virtual world is feasible, meaningful and may assist with weight management for mobility impaired women. Implications for Rehabilitation This study addresses a gap in the general and rehabilitation research literature by addressing the disproportionately high rates of obesity among women with mobility impairments, who are generally excluded from tests of weight management interventions if they have limited ability to engage in vigorous physical activity. The GoWoman program is an adaptation of the Diabetes Prevention Program Lifestyle Change curriculum that is tailored to meet the unique weight management needs of women with mobility impairments, and was created to become a publicly available, disability- and gender-responsive intervention that can be used in community and rehabilitation settings. More rehabilitation and health promotion program should be offered in the free, online, virtual world of Second Life ® since participants in this pilot study offered many favorable comments about the new learning and social opportunities available to them there and they did not have to deal with the disability-related environmental and health challenges that often prevent them from participating in face-to-face workshops. Preliminary indications of improvements in body weight, waist circumference, diet and physical activity after attending the GoWoman weight management intervention offered in Second Life ® tell us that these strategies are feasible for helping women with mobility impairments manage their weight and should undergo further testing.

42 CFR 441.484 - Financial management services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Financial management services. 441.484 Section 441... Optional Self-Directed Personal Assistance Services Program § 441.484 Financial management services. (a) States may choose to provide financial management services to participants, or their representatives, as...

42 CFR 441.484 - Financial management services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Financial management services. 441.484 Section 441... Optional Self-Directed Personal Assistance Services Program § 441.484 Financial management services. (a) States may choose to provide financial management services to participants, or their representatives, as...

42 CFR 441.484 - Financial management services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Financial management services. 441.484 Section 441... Optional Self-Directed Personal Assistance Services Program § 441.484 Financial management services. (a) States may choose to provide financial management services to participants, or their representatives, as...

42 CFR 441.484 - Financial management services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Financial management services. 441.484 Section 441... Optional Self-Directed Personal Assistance Services Program § 441.484 Financial management services. (a) States may choose to provide financial management services to participants, or their representatives, as...

75 FR 22680 - Financial Management Service; Proposed Collection of Information: Annual Financial Statement of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-29

... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service; Proposed Collection of Information: Annual Financial Statement of Surety Companies--Schedule F AGENCY: Financial Management Service, Fiscal Service, Treasury. ACTION: Notice and Request for comments. SUMMARY: The Financial Management...

[Relationship Between Members Satisfaction with Service Club Management Processes and Perception of Club Management System.

ERIC Educational Resources Information Center

Dawson, Frances Trigg

A study was made to determine the relationships between (1) satisfaction of members with service club management processes and member's perception of management systems, (2) perception of service club management system to selected independent variables, and (3) satisfaction to perception of service club management systems with independent…

A Note on Interfacing Object Warehouses and Mass Storage Systems for Data Mining Applications

NASA Technical Reports Server (NTRS)

Grossman, Robert L.; Northcutt, Dave

1996-01-01

Data mining is the automatic discovery of patterns, associations, and anomalies in data sets. Data mining requires numerically and statistically intensive queries. Our assumption is that data mining requires a specialized data management infrastructure to support the aforementioned intensive queries, but because of the sizes of data involved, this infrastructure is layered over a hierarchical storage system. In this paper, we discuss the architecture of a system which is layered for modularity, but exploits specialized lightweight services to maintain efficiency. Rather than use a full functioned database for example, we use light weight object services specialized for data mining. We propose using information repositories between layers so that components on either side of the layer can access information in the repositories to assist in making decisions about data layout, the caching and migration of data, the scheduling of queries, and related matters.

Holism, health and data - managing the person-centred digital haystack.

PubMed

Rigby, Michael

2010-01-01

There is currently very legitimate pressure to change the function of health information systems to more explicitly serve and support the individual. Concurrently other support services to health, including condition monitoring, social care and intelligent housing, add to the complexity of patient health related data. A paradigm shift is needed, to recognize that many agencies and systems outside as well as within the health sector all work to support the citizen's health, yet the essential integrated view is not being provided, even though much needed not least by the citizen and their agents. Broker technologies can enable this new paradigm. Moreover, a move to identifying the patient's appointments and support services would enable a daily life dimension to be given due weight, and would recognize the patient's viewpoint in wanting to live an ordered life, not one subservient and reactive to the delivery of care by providers.

Target marketing for the hospital-based wellness center.

PubMed

Cangelosi, J D

1997-01-01

The American population is aging, medical technology is advancing, and life expectancies are on the rise. At the same time hospitals are looking for additional sources of income due to the pressures of government regulations and managed care. One of the options for hospitals looking for additional sources of income is the hospital-based but free-standing comprehensive wellness and fitness center. Such centers go beyond the facilities, programs and services offered by traditional health and fitness centers. In addition to physical fitness programs, hospital-based wellness centers offer programs in CPR, nutrition, weight control and many other programs of interest to an aging but active American populace. This research documents the hospital industry, wellness industry and the prospects of success or failure for he hospital attempting such a venture. The focus of the research is the experience of a particular hospital with regard to the programs, facilities and services deemed most important by its target market.

Commercial Smartphone-Based Devices and Smart Applications for Personalized Healthcare Monitoring and Management

PubMed Central

Vashist, Sandeep Kumar; Schneider, E. Marion; Luong, John H.T.

2014-01-01

Smartphone-based devices and applications (SBDAs) with cost effectiveness and remote sensing are the most promising and effective means of delivering mobile healthcare (mHealthcare). Several SBDAs have been commercialized for the personalized monitoring and/or management of basic physiological parameters, such as blood pressure, weight, body analysis, pulse rate, electrocardiograph, blood glucose, blood glucose saturation, sleeping and physical activity. With advances in Bluetooth technology, software, cloud computing and remote sensing, SBDAs provide real-time on-site analysis and telemedicine opportunities in remote areas. This scenario is of utmost importance for developing countries, where the number of smartphone users is about 70% of 6.8 billion cell phone subscribers worldwide with limited access to basic healthcare service. The technology platform facilitates patient-doctor communication and the patients to effectively manage and keep track of their medical conditions. Besides tremendous healthcare cost savings, SBDAs are very critical for the monitoring and effective management of emerging epidemics and food contamination outbreaks. The next decade will witness pioneering advances and increasing applications of SBDAs in this exponentially growing field of mHealthcare. This article provides a critical review of commercial SBDAs that are being widely used for personalized healthcare monitoring and management. PMID:26852680

Performance analysis of Supply Chain Management with Supply Chain Operation reference model

NASA Astrophysics Data System (ADS)

Hasibuan, Abdurrozzaq; Arfah, Mahrani; Parinduri, Luthfi; Hernawati, Tri; Suliawati; Harahap, Bonar; Rahmah Sibuea, Siti; Krianto Sulaiman, Oris; purwadi, Adi

2018-04-01

This research was conducted at PT. Shamrock Manufacturing Corpora, the company is required to think creatively to implement competition strategy by producing goods/services that are more qualified, cheaper. Therefore, it is necessary to measure the performance of Supply Chain Management in order to improve the competitiveness. Therefore, the company is required to optimize its production output to meet the export quality standard. This research begins with the creation of initial dimensions based on Supply Chain Management process, ie Plan, Source, Make, Delivery, and Return with hierarchy based on Supply Chain Reference Operation that is Reliability, Responsiveness, Agility, Cost, and Asset. Key Performance Indicator identification becomes a benchmark in performance measurement whereas Snorm De Boer normalization serves to equalize Key Performance Indicator value. Analiytical Hierarchy Process is done to assist in determining priority criteria. Measurement of Supply Chain Management performance at PT. Shamrock Manufacturing Corpora produces SC. Responsiveness (0.649) has higher weight (priority) than other alternatives. The result of performance analysis using Supply Chain Reference Operation model of Supply Chain Management performance at PT. Shamrock Manufacturing Corpora looks good because its monitoring system between 50-100 is good.

Commercial Smartphone-Based Devices and Smart Applications for Personalized Healthcare Monitoring and Management.

PubMed

Vashist, Sandeep Kumar; Schneider, E Marion; Luong, John H T

2014-08-18

Smartphone-based devices and applications (SBDAs) with cost effectiveness and remote sensing are the most promising and effective means of delivering mobile healthcare (mHealthcare). Several SBDAs have been commercialized for the personalized monitoring and/or management of basic physiological parameters, such as blood pressure, weight, body analysis, pulse rate, electrocardiograph, blood glucose, blood glucose saturation, sleeping and physical activity. With advances in Bluetooth technology, software, cloud computing and remote sensing, SBDAs provide real-time on-site analysis and telemedicine opportunities in remote areas. This scenario is of utmost importance for developing countries, where the number of smartphone users is about 70% of 6.8 billion cell phone subscribers worldwide with limited access to basic healthcare service. The technology platform facilitates patient-doctor communication and the patients to effectively manage and keep track of their medical conditions. Besides tremendous healthcare cost savings, SBDAs are very critical for the monitoring and effective management of emerging epidemics and food contamination outbreaks. The next decade will witness pioneering advances and increasing applications of SBDAs in this exponentially growing field of mHealthcare. This article provides a critical review of commercial SBDAs that are being widely used for personalized healthcare monitoring and management.

Primary-Care Weight-Management Strategies: Parental Priorities and Preferences

PubMed Central

Turer, Christy Boling; Upperman, Carla; Merchant, Zahra; Montaño, Sergio; Flores, Glenn

2015-01-01

Objective Examine parental perspectives/rankings of the most important weight-management clinical practices; and, determine whether preferences/rankings differ when parents disagree that their child is overweight. Methods Mixed-methods analysis of a 32-question survey of parents of 2-18 year-old overweight children assessing parental agreement that their child is overweight, the single most important thing providers can do to improve weight status, ranking AAP-recommended clinical practices, and preferred follow-up interval. Four independent reviewers analyzed open-response data to identify qualitative themes/subthemes. Multivariable analyses examined parental rankings, preferred follow-up interval, and differences by agreement with their child’s overweight assessment. Results Thirty-six percent of 219 children were overweight, 42% were obese, and 22% severely obese; 16% of parents disagreed with their child’s overweight assessment. Qualitative analysis of the most important practice to help overweight children yielded 10 themes; unique to parents disagreeing with their children’s overweight assessments was, “change weight-status assessments.” After adjustment, the three highest-ranked clinical practices included, “check for weight-related problems,” “review growth chart,” and “recommend general dietary changes” (all P<.01);” parents disagreeing with their children’s overweight assessments ranked “review growth chart” as less important, and “reducing screen time” and “general activity changes” as more important. The mean preferred weight-management follow-up interval (10-12 weeks) did not differ by agreement with children’s overweight assessments. Conclusions Parents prefer weight-management strategies that prioritize evaluating weight-related problems, growth-chart review, and regular follow-up. Parents who disagree that their child is overweight want changes in how overweight is assessed. Using parent-preferred weight-management strategies may prove useful in improving child weight status. PMID:26514648

Primary-Care Weight-Management Strategies: Parental Priorities and Preferences.

PubMed

Turer, Christy Boling; Upperman, Carla; Merchant, Zahra; Montaño, Sergio; Flores, Glenn

2016-04-01

To examine parental perspectives/rankings of the most important weight-management clinical practices and to determine whether preferences/rankings differ when parents disagree that their child is overweight. We performed mixed-methods analysis of a 32-question survey of parents of 2- to 18-year-old overweight children assessing parental agreement that their child is overweight, the single most important thing providers can do to improve weight status, ranking American Academy of Pediatrics-recommended clinical practices, and preferred follow-up interval. Four independent reviewers analyzed open-response data to identify qualitative themes/subthemes. Multivariable analyses examined parental rankings, preferred follow-up interval, and differences by agreement with their child's overweight assessment. Thirty-six percent of 219 children were overweight, 42% obese, and 22% severely obese; 16% of parents disagreed with their child's overweight assessment. Qualitative analysis of the most important practice to help overweight children yielded 10 themes; unique to parents disagreeing with their children's overweight assessments was "change weight-status assessments." After adjustment, the 3 highest-ranked clinical practices included, "check for weight-related problems," "review growth chart," and "recommend general dietary changes" (all P < .01); parents disagreeing with their children's overweight assessments ranked "review growth chart" as less important and ranked "reducing screen time" and "general activity changes" as more important. The mean preferred weight-management follow-up interval (10-12 weeks) did not differ by agreement with children's overweight assessments. Parents prefer weight-management strategies that prioritize evaluating weight-related problems, growth-chart review, and regular follow-up. Parents who disagree that their child is overweight want changes in how overweight is assessed. Using parent-preferred weight-management strategies may prove useful in improving child weight status. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Process Evaluation Results from an Environmentally Focused Worksite Weight Management Study

ERIC Educational Resources Information Center

DeJoy, David M.; Wilson, Mark G.; Padilla, Heather M.; Goetzel, Ron Z.; Parker, Kristin B.; Della, Lindsay J.; Roemer, Enid C.

2012-01-01

There is currently much interest in exploring environmental approaches to combat weight gain and obesity. This study presents process evaluation results from a workplace-based study that tested two levels of environmentally focused weight management interventions in a manufacturing setting. The moderate treatment featured a set of relatively…

Weight management for adolescents with intellectual and developmental disabilities: Rationale and design for an 18month randomized trial.

PubMed

Donnelly, J E; Ptomey, L T; Goetz, J R; Sullivan, D K; Gibson, C A; Greene, J L; Lee, R H; Mayo, M S; Honas, J J; Washburn, R A

2016-11-01

Adolescents with intellectual and developmental disabilities (IDD) are an underserved group in need of weight management. However, information regarding effective weight management for this group is limited, and is based primarily on results from small, non-powered, non-randomized trials that were not conducted in accordance with current weight management guidelines. Additionally, the comparative effectiveness of emerging dietary approaches, such as portion-controlled meals (PCMs) or program delivery strategies such as video chat using tablet computers have not been evaluated. Therefore, we will conduct an 18month trial to compare weight loss (6months) and maintenance (7-18months) in 123 overweight/obese adolescents with mild to moderate IDD, and a parent, randomized to a weight management intervention delivered remotely using FaceTime™ on an iPad using either a conventional meal plan diet (RD/CD) or a Stop Light diet enhanced with PCMs (RD/eSLD), or conventional diet delivered during face-to-face home visits (FTF/CD). This design will provide an adequately powered comparison of both diet (CD vs. eSLD) and delivery strategy (FTF vs. RD). Exploratory analyses will examine the influence of behavioral session attendance, compliance with recommendations for diet (energy intake), physical activity (min/day), self-monitoring of diet and physical activity, medications, and parental variables including diet quality, physical activity, baseline weight, weight change, and beliefs and attitudes regarding diet and physical activity on both weight loss and maintenance. We will also complete a cost and contingent valuation analysis to compare costs between RD and FTF delivery. Copyright © 2016. Published by Elsevier Inc.

Beating Obesity: Factors Associated with Interest in Workplace Weight Management Assistance in the Mining Industry.

PubMed

Street, Tamara D; Thomas, Drew L

2017-03-01

Rates of overweight and obese Australians are high and continue to rise, putting a large proportion of the population at risk of chronic illness. Examining characteristics associated with preference for a work-based weight-loss program will enable employers to better target programs to increase enrolment and benefit employees' health and fitness for work. A cross-sectional survey was undertaken at two Australian mining sites. The survey collected information on employee demographics, health characteristics, work characteristics, stages of behavior change, and preference for workplace assistance with reaching a healthy weight. A total of 897 employees participated; 73.7% were male, and 68% had a body mass index in the overweight or obese range. Employees at risk of developing obesity-related chronic illnesses (based on high body mass index) were more likely to report preference for weight management assistance than lower risk employees. This indicates that, even in the absence of workplace promotion for weight management, some at risk employees want workplace assistance. Employees who were not aware of a need to change their current nutrition or physical activity behaviors were less likely to seek assistance. This indicates that practitioners need to communicate the negative effects of excess weight and promote the benefits of a healthy lifestyle to increase the likelihood of weight management. Weight management programs should provide information, motivation. and trouble-shooting assistance to meet the needs of at-risk mining employees, including those who are attempting to change and maintain behaviors to achieve a healthy weight and be suitably fit for work.

48 CFR 1552.211-78 - Management consulting services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Management consulting... 1552.211-78 Management consulting services. As prescribed in 1511.011-78, insert the following contract clause in all contracts for management consulting services. Management Consulting Services (APR 1985) All...

Nicotine Withdrawal; Measure Your Symptoms (Quiz)

MedlinePlus

... Challenges When Quitting Nicotine Withdrawal Cravings & Triggers Handling Stress Manage Your Mood Weight Gain & Appetite Stay Smokefree for Good Stick with It Weight Management Eat Healthy Get ...

41 CFR 101-39.201 - Services available.

Code of Federal Regulations, 2010 CFR

2010-07-01

...-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.2-GSA Interagency Fleet Management System Services § 101-39.201 Services available. GSA Interagency Fleet Management System (IFMS) vehicles and services shall be used in... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Services available. 101...

Outcomes of weight management in obese pet dogs: what can we do better?

PubMed

German, Alexander J

2016-08-01

Obesity is arguably the biggest health and welfare issue affecting pet dogs. Although successful weight loss has health benefits, current strategies are far from ideal. Many obese dogs that start a weight programme fail to lose weight, or subsequently regain the weight they have lost. Given that current weight loss strategies are not perfect, clinicians need to focus carefully on tailoring the programme, perhaps setting a pragmatic target for weight loss, so as to ensure the benefits are maximised. This review will summarise key findings from recent clinical research into pet obesity, and present a framework for improving success, by better tailoring weight management regimens and end points to the individual.

76 FR 77590 - Financial Management Service; Proposed Collection of Information: Request for Payment of Federal...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-13

... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service; Proposed Collection of Information: Request for Payment of Federal Benefit by Check, EFT Waiver Form AGENCY: Financial Management... to Financial Management Service, 3700 East West Highway, Records and Information Management Branch...

Increasing physical activity for veterans in the Mental Health Intensive Case Management Program: A community-based intervention.

PubMed

Harrold, S Akeya; Libet, Julian; Pope, Charlene; Lauerer, Joy A; Johnson, Emily; Edlund, Barbara J

2018-04-01

Individuals with severe mental illness (SMI), experience increased mortality-20 years greater disparity for men and 15 years greater disparity for women-compared to the general population (Thornicroft G. Physical health disparities and mental illness: The scandal of premature mortality. Br J Psychiatr. 2011;199:441-442). Numerous factors contribute to premature mortality in persons with SMI, including suicide and accidental death (Richardson RC, Faulkner G, McDevitt J, Skrinar GS, Hutchinson D, Piette JD. Integrating physical activity into mental health services for persons with serious mental illness. Psychiatr Serv. 2005;56(3):324-331; Thornicroft G. Physical health disparities and mental illness: The scandal of premature mortality. Br J Psychiatr. 2011;199:441-442), but research has shown that adverse health behaviors-including smoking, low rate of physical activity, poor diet, and high alcohol consumption-also significantly contribute to premature deaths (Jones J. Life expectancy in mental illness. Psychiatry Services. 2010. Retrieved from http://psychcentral.com/news/2010/07/13/life-expectancy-in-mental-illness). This quality improvement (QI) project sought to improve health and wellness for veterans in the Mental Health Intensive Case Management Program (MHICM), which is a community-based intensive program for veterans with SMI at risk for decompensation and frequent hospitalizations. At the time of this QI project, the program had 69 veterans who were assessed and treated weekly in their homes. The project introduced a pedometer steps intervention adapted from the VA MOVE! Program-a physical activity and weight management program-with the addition of personalized assistance from trained mental health professionals in the veteran's home environment. Because a large percentage of the veterans in the MHICM program had high blood pressure and increased weight, these outcomes were the focus of this project. Through mental health case management involvement and the comfort of their familiar living environment, veterans were assisted to meet their physical and mental health goals with a program that could easily be integrated into their daily lives. Healthy People 2020 developed goals to improve levels of physical activity and has ranked physical activity as a leading health indicator (US DHHS. Office of Disease Prevention and Health Promotion. Physical activity topic overview. In Healthy People 2020. 2016. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/physical-activity). Individuals with SMI are significantly less active than the general population (Shor and Shalev, 2014). It is sometimes difficult for the average individual to obtain the recommended 10,000 steps and even more difficult for those with SMI. Lifestyle modifications, in particular diet and exercise, are recommended for improvement of chronic disease outcomes (US Preventive Services Counseling Task Force, 2016). The health benefits of physical activity for people with SMI are mixed (Pearsall R, Smith D, Pelosi A, Geddes J. Exercise therapy in adults with serious mental illness: A systematic review and meta-analysis. BMC Psychiatr. 2014;14:117). Some studies found significant physical health benefits, while others did not. However, according to a review by Soundy et al., physical exercise is shown to not only have physical benefits but also psychosocial benefits. One of the barriers that hinder participation in physical activities is accessibility (Shor and Shalev, 2014). Integrating a more personalized supported, and in-home pedometer program into mental healthcare should ensure better access to interventions that could possibly reverse the causes of premature death. The program was offered to 69 veterans in the MHICM. Forty-nine agreed to start the program and 20 declined. Twenty-five clients actually started the program with 17 veterans completing it. Preimplementation data included collecting blood pressure and weight measures for all veterans in the MHICM program. Additionally, a focus group was held with case managers to obtain a group perspective on motivating veterans to participate in this program. Further, a teaching session was held to review pedometers use, the client video, the client booklet, methods for getting veterans started, and the progression of the walking intervention. The pedometer physical activity intervention continued for 2 months. At the end of the 2 months, aggregate de-identified data on number of steps, blood pressure, and weight were collected. At the end of the program, the data were reviewed, synthesized, and analyzed, being careful to account for potentially intervening conditions and other chronic illnesses. The postimplementation data revealed that the mean weight decreased by 9 lbs. The percentage of controlled blood pressure increased from 60 to 84, while the percentage of uncontrolled blood pressure decreased from 40 to 16. Implementation of a multiple component personalized exercise intervention program for veterans with SMI contributed to reduction in weight and blood pressure. © 2017 Wiley Periodicals, Inc.

41 CFR 102-74.40 - What are concession services?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Management Concession Services § 102-74.40 What are concession services? Concession services are any food or... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What are concession services? 102-74.40 Section 102-74.40 Public Contracts and Property Management Federal Property Management...

Alternatives to Conservatorship: The Role of Daily Money Management Services.

ERIC Educational Resources Information Center

Wilber, Kathleen H.

1991-01-01

Tested hypothesis that daily money management services divert vulnerable elders from conservatorship. Assigned community-residing elders (n=63) to money management service or screening by Office of the Public Guardian or Adult Protective Services. Found no difference in rates of conservatorship for those offered money management service.…

From Outsourcing to Alliances: Strategies for Sharing Leadership and Exploiting Resources at Metropolitan Universities.

ERIC Educational Resources Information Center

Ender, Kenneth L.; Mooney, Kathleen A.

1994-01-01

University partnerships with private industry to effect service delivery in facilities management, food services, bookstore management, parking management, arena management, housing operations, business services, safety operations, communication services, and purchasing improves the quality of these services, reduces costs, does not affect core…

41 CFR 102-74.20 - What are occupancy services?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false What are occupancy services? 102-74.20 Section 102-74.20 Public Contracts and Property Management Federal Property Management... Management Occupancy Services § 102-74.20 What are occupancy services? Occupancy services are— (a) Building...

41 CFR 102-74.105 - What are asset services?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false What are asset services? 102-74.105 Section 102-74.105 Public Contracts and Property Management Federal Property Management... Management Asset Services § 102-74.105 What are asset services? Asset services include repairs (other than...

41 CFR 102-74.105 - What are asset services?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What are asset services? 102-74.105 Section 102-74.105 Public Contracts and Property Management Federal Property Management... Management Asset Services § 102-74.105 What are asset services? Asset services include repairs (other than...

41 CFR 102-74.20 - What are occupancy services?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What are occupancy services? 102-74.20 Section 102-74.20 Public Contracts and Property Management Federal Property Management... Management Occupancy Services § 102-74.20 What are occupancy services? Occupancy services are— (a) Building...

41 CFR 102-74.40 - What are concession services?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false What are concession services? 102-74.40 Section 102-74.40 Public Contracts and Property Management Federal Property Management... Management Concession Services § 102-74.40 What are concession services? Concession services are any food or...

U.S. health professionals' views on obesity care, training, and self-efficacy.

PubMed

Bleich, Sara N; Bandara, Sachini; Bennett, Wendy L; Cooper, Lisa A; Gudzune, Kimberly A

2015-04-01

Despite emphasis of recent guidelines on multidisciplinary teams for collaborative weight management, little is known about non-physician health professionals' perspectives on obesity, their weight management training, and self-efficacy for obesity care. To evaluate differences in health professionals' perspectives on (1) the causes of obesity; (2) training in weight management; and (3) self-efficacy for providing obesity care. Data were obtained from a cross-sectional Internet-based survey of 500 U.S. health professionals from nutrition, nursing, behavioral/mental health, exercise, and pharmacy (collected from January 20 through February 5, 2014). Inferences were derived using logistic regression adjusting for age and education (analyzed in 2014). Nearly all non-physician health professionals, regardless of specialty, cited individual-level factors, such as overconsumption of food (97%), as important causes of obesity. Nutrition professionals were significantly more likely to report high-quality training in weight management (78%) than the other professionals (nursing, 53%; behavioral/mental health, 32%; exercise, 50%; pharmacy, 47%; p<0.05). Nutrition professionals were significantly more likely to report high confidence in helping obese patients achieve clinically significant weight loss (88%) than the other professionals (nursing, 61%; behavioral/mental health, 51%; exercise, 52%; pharmacy, 61%; p<0.05), and more likely to perceive success in helping patients with obesity achieve clinically significant weight loss (nutrition, 81%; nursing, behavioral/mental health, exercise, and pharmacy, all <50%; p<0.05). Nursing, behavioral/mental health, exercise, and pharmacy professionals may need additional training in weight management and obesity care to effectively participate in collaborative weight management models. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Medical and psychosocial barriers to weight management in older veterans with and without serious mental illness.

PubMed

Muralidharan, Anjana; Klingaman, Elizabeth A; Prior, Steven J; Molinari, Victor; Goldberg, Richard W

2016-11-01

Older adults with serious mental illness (SMI) are an understudied population with complex care needs and high rates of obesity/overweight. Little is known about the experiences of older adults with SMI with weight management. The present study is an observational study of veterans ages 55 and over with a body mass index in the overweight or obese range, comparing Veterans with schizophrenia or bipolar disorder (n = 9044) to their same-age peers with no mental health disorders (n = 71156), on their responses to a questionnaire assessment of medical and psychosocial factors related to weight management. Responses to the questionnaire between August, 2005 and May, 2013 were used to examine the following: demographics, clinical characteristics, medical barriers to weight management, current weight loss plan, reliability of social support, reasons for being overweight, and weight loss barriers. Physical health concerns were highly prevalent in both groups. Veterans in the SMI group endorsed more medical issues and were significantly more likely to endorse experiences that indicated that their medical conditions were poorly controlled (e.g., shortness of breath). Veterans in the SMI group were more likely to endorse many barriers to healthy eating and physical activity, across medical, psychological, social, and environmental domains. Even within a sample at medically high-risk for complications related to obesity and metabolic syndrome, older veterans with SMI and overweight/obesity experience more challenges with weight management than their same-age peers with overweight/obesity and no mental health disorders. Weight management interventions for this population should take a multifaceted approach. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

The weight management strategies inventory (WMSI). Development of a new measurement instrument, construct validation, and association with dieting success.

PubMed

Keller, Carmen; Siegrist, Michael

2015-09-01

In an obesogenic environment, people have to adopt effective weight management strategies to successfully gain or maintain normal body weight. Little is known about the strategies used by the general population in daily life. Due to the lack of a comprehensive measurement instrument to assess conceptually different strategies with various scales, we developed the weight management strategies inventory (WMSI). In study 1, we collected 19 weight management strategies from research on self-regulation of food intake and successful weight loss and maintenance, as well as from expert interviews. We classified them under the five main categories of health self-regulation strategies - goal setting and monitoring, prospection and planning, automating behavior, construal, and inhibition. We formulated 93 items. In study 2, we developed the WMSI in a random sample from the general population (N = 658), using reliability and exploratory factor analysis. This resulted in 19 factors with 63 items, representing the 19 strategies. In study 3, we tested the 19-factor structure in a quota (age, gender) sample from the general population (N = 616), using confirmatory factor analysis. A good model fit (CFI = .918; RMSEA = .043) was revealed. Reliabilities and construct validity were high. Positive correlations of most strategies with dieting success and negative correlations of some strategies with body mass index were found among dieters (N = 292). Study 4 (N = 162) revealed a good test-retest reliability. The WMSI assesses theoretically derived, evidence-based, and conceptually different weight management strategies with different scales that have good psychometric characteristics. The scales can also be used for pre- and post measures in intervention studies. The scales provide insights into the general population's weight management strategies and facilitate tailoring and evaluating health communication. Copyright © 2015 Elsevier Ltd. All rights reserved.

Longitudinal associations between case management and supportive services use among black and Latina HIV-positive women in New York City.

PubMed

Halkitis, Perry N; Kupprat, Sandra A; Mukherjee, Preetika Pandey

2010-01-01

The literature analyzing the relationship between case management and supportive service use longitudinally among African American and Latina HIV-positive women is limited. This retrospective analysis of participant case management, supportive service, and medical charts sought to examine both descriptive and relational data on use of case management and supportive services over a 2-year period from 2002 to 2005 and to analyze moderating person- level or institution-level factors. The analyzed case management, supportive service, and medical charts revealed that participants interacted with their case manager four times and received 3.6 supportive services per month. Transportation, primary healthcare/medical specialists, and support groups were the services most used, with rates ranging from 70% to 80%. Using hierarchical linear modeling (HLM), the unconditional growth models showed that case management and supportive service use patterns remained constant over the 24-month period. Additionally, the multivariate unconditional model suggests a significant positive relationship between case management and supportive services. No moderation was indicated in the association between case management and supportive service use by person-level (e.g., mental illness, substance use) and institution-level (i.e., service delivery model) factors. Participants use supportive and case management services in a similar manner based on individual need. This synergistic relationship suggests that increases in either may result in retaining women in care. Implications for service delivery point to the need for skills building training for case managers, outreach workers, or system navigators to assist with short-term goals of establishing rapport and maintaining the client relationship, as this may lead to HIV-positive women accessing services. Additionally, outreach and engagement strategies need to be developed for those who typically underuse these services.

Weight-loss medicines

MedlinePlus

Prescription weight loss drugs; Diabetes - weight loss drugs; Obesity - weight loss drugs; Overweight - weight loss drugs ... DH, et al.; Endocrine Society. Pharmacological management of obesity: an endocrine Society clinical practice guideline. J Clin ...

Autonomy support and control in weight management: what important others do and say matters.

PubMed

Ng, Johan Y Y; Ntoumanis, Nikos; Thøgersen-Ntoumani, Cecilie

2014-09-01

Drawing from self-determination theory (Ryan & Deci, 2002, Overview of self-determination theory: An organismic-dialectical perspective. In E. L. Deci & R. M. Ryan (Eds.), Handbook of self-determination research (pp. 3-33). Rochester, NY: The University of Rochester Press.), we examined how individuals' psychological needs, motivation, and behaviours (i.e., physical activity and eating) associated with weight management could be predicted by perceptions of their important others' supportive and controlling behaviours. Using a cross-sectional survey design, 235 participants (mean age = 27.39 years, SD = 8.96 years) completed an online questionnaire. Statistical analyses showed that when important others were perceived to be more supportive, participants reported higher levels of more optimal forms of motivation for weight management, which in turn predicted more physical activity and healthy eating behaviours. In contrast, when important others were perceived to be controlling, participants reported higher levels of less optimal forms of motivation, which in turn predicted less physical activity and healthy eating behaviours, as well as more unhealthy eating behaviours. Significant indirect effects were also found from perceived support and control from important others to physical activity and eating behaviours, all in the expected directions. The findings support the importance of important others providing support and refraining from controlling behaviours in order to facilitate motivation and behaviours conducive to successful weight management. What is already known on this subject? Autonomy support is related to basic need satisfaction and autonomous motivation in the context of weight management. In turn, these variables are related to adaptive outcomes for weight management. What does this study add? Measurement of perceived controlling behaviours by important others. Measurement of perceived need thwarting. Structural model on how important others affect weight management behaviours of the individual. © 2013 The British Psychological Society.

Long-term weight loss maintenance for obesity: a multidisciplinary approach

PubMed Central

Montesi, Luca; El Ghoch, Marwan; Brodosi, Lucia; Calugi, Simona; Marchesini, Giulio; Dalle Grave, Riccardo

2016-01-01

The long-term weight management of obesity remains a very difficult task, associated with a high risk of failure and weight regain. However, many people report that they have successfully managed weight loss maintenance in the long term. Several factors have been associated with better weight loss maintenance in long-term observational and randomized studies. A few pertain to the behavioral area (eg, high levels of physical activity, eating a low-calorie, low-fat diet; frequent self-monitoring of weight), a few to the cognitive component (eg, reduced disinhibition, satisfaction with results achieved, confidence in being able to lose weight without professional help), and a few to personality traits (eg, low novelty seeking) and patient–therapist interaction. Trials based on the most recent protocols of lifestyle modification, with a prolonged extended treatment after the weight loss phase, have also shown promising long-term weight loss results. These data should stimulate the adoption of a lifestyle modification-based approach for the management of obesity, featuring a nonphysician lifestyle counselor (also called “lifestyle trainer” or “healthy lifestyle practitioner”) as a pivotal component of the multidisciplinary team. The obesity physicians maintain a primary role in engaging patients, in team coordination and supervision, in managing the complications associated with obesity and, in selected cases, in the decision for drug treatment or bariatric surgery, as possible more intensive, add-on interventions to lifestyle treatment. PMID:27013897

41 CFR 102-74.110 - What asset services must Executive agencies provide?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 74-FACILITY MANAGEMENT Facility Management Asset Services § 102-74.110 What asset services must Executive agencies... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What asset services must...

31 CFR Appendix G to Subpart C of... - Financial Management Service

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Financial Management Service G... Management Service 1. In general. This appendix applies to the Financial Management Service. It sets forth... requests for notification and access to records and accountings of disclosures for the Financial Management...

76 FR 14000 - Notice of Proposed Information Collection Requests

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-15

..., Regulatory Information Management Services, Office of Management, publishes this notice containing proposed... Collection Clearance Division, Regulatory Information Management Services, Office of Management, invites... Division, Regulatory Information Management Services, Office of Management. Federal Student Aid Type of...

75 FR 55781 - Notice of Proposed Information Collection Requests

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-14

..., Regulatory Information Management Services, Office of Management, publishes this notice containing proposed..., Information Collection Clearance Division, Regulatory Information Management Services, Office of Management... Clearance Division, Regulatory Information Management Services, Office of Management. Federal Student Aid...

Manager personality, manager service quality orientation, and service climate: test of a model.

PubMed

Salvaggio, Amy Nicole; Schneider, Benjamin; Nishii, Lisa H; Mayer, David M; Ramesh, Anuradha; Lyon, Julie S

2007-11-01

This article conceptually and empirically explores the relationships among manager personality, manager service quality orientation, and climate for customer service. Data were collected from 1,486 employees and 145 managers in grocery store departments (N = 145) to test the authors' theoretical model. Largely consistent with hypotheses, results revealed that core self-evaluations were positively related to managers' service quality orientation, even after dimensions of the Big Five model of personality were controlled, and that service quality orientation fully mediated the relationship between personality and global service climate. Implications for personality and organizational climate research are discussed. (c) 2007 APA

Decisions about weight management: a synthesis of qualitative studies of obesity.

PubMed

Brown, I; Gould, J

2011-04-01

There is a high non-attendance and dropout attrition from weight management interventions for adults with obesity. Patient dissatisfaction with consultations involving decisions about interventions may be a factor. A systematic review was undertaken of qualitative studies reporting perceptions, experiences, contexts and influences for adults facing, or reflecting on, weight management. The aim was to synthesize a generic model of influences on decision-making about weight management for adult patients. Electronic database and hand searches identified 29 qualitative studies involving 1387 participants (mean age 45.3 years; mean BMI 37.1 kg m(-2) ; 79.9% women). Seven overarching themes were inductively derived from extracted data spanning: cultural identity; social structures such as gender; responses to obesity stigma; previous weight loss experiences; personal motivators and barriers; social support; and practical resources. A model is presented in the paper. Improving decisions about weight management requires attention to how diffuse cultural and psycho-social factors, such as obesity stigma, influence patient choices. Reflection on experiences of previous attempts at weight loss is also essential, as are practical resource factors - particularly for less affluent groups. Considering these factors along with more established theories of individual psychological motivations and barriers may help to improve initial participation and retention within interventions. © 2011 The Authors. Clinical Obesity © 2011 International Association for the Study of Obesity.

13 CFR 108.900 - Fees for management services provided to a Small Business by a NMVC Company or its Associate.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Fees for management services... Small Businesses by NMVC Companies Management Services and Fees § 108.900 Fees for management services... management services that you or your Associate provide to a Small Business during the term of a Financing or...

[Phenomenological study of infertile women with obesity].

PubMed

Arranz-Lara, Lilia; Martínez-Lemus, Hugo; Ruíz-Ornelas, Jaime; Sauceda-González, Luciano; Pimentel, Elizabeth; Anguiano, Norma; Sondón, Zoé; Cedillo, Javier; Chávez, Alvaro; Regalado, Miguel Angel; Moreno, Daniel

2010-10-01

Obesity is a condition strongly associated with polycystic ovary and other conditions that interfere with or complicate the treatment of assisted reproduction. To examine, from a phenomenological point of view, the perception of infertile women obesity problem before undergoing assisted reproduction treatment. This analysis should help to design a psychotherapeutic strategy focused on this problem. One hundred patients with infertility, with a BMI equal to or greater than 30, candidates for assisted reproductive treatments in the service of Human Reproduction, Centro Médico Nacional 20 de Noviembre, ISSSTE. The phenomenological qualitative analysis was performed in 72 women who agreed to be interviewed in depth. The phenomenon is to study obesity in infertile women candidates for assisted reproduction treatment. Obese infertile women subject to assisted reproduction treatment perceive their difficulty losing weight is closely associated with infertility. Most patients had social feelings of worthlessness, sadness, worthlessness, and family rejection. The inability to obtain a steady weight loss is regarded as a minor frustration that sterility. It is very important to perform intensive, multidisciplinary labor, which is focused on concepts associated with psychological distress, such as: management of depression by sterility, control of anxiety and stress, control of social pressures and management of the illusion of motherhood. Also rely on specialists of eating habits and exercise.

Weight Optimization of Active Thermal Management Using a Novel Heat Pump

NASA Technical Reports Server (NTRS)

Lear, William E.; Sherif, S. A.

2004-01-01

Efficient lightweight power generation and thermal management are two important aspects for space applications. Weight is added to the space platforms due to the inherent weight of the onboard power generation equipment and the additional weight of the required thermal management systems. Thermal management of spacecraft relies on rejection of heat via radiation, a process that can result in large radiator mass, depending upon the heat rejection temperature. For some missions, it is advantageous to incorporate an active thermal management system, allowing the heat rejection temperature to be greater than the load temperature. This allows a reduction of radiator mass at the expense of additional system complexity. A particular type of active thermal management system is based on a thermodynamic cycle, developed by the authors, called the Solar Integrated Thermal Management and Power (SITMAP) cycle. This system has been a focus of the authors research program in the recent past (see Fig. 1). One implementation of the system requires no moving parts, which decreases the vibration level and enhances reliability. Compression of the refrigerant working fluid is accomplished in this scheme via an ejector.

40 CFR 761.207 - The manifest-general requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., AND USE PROHIBITIONS PCB Waste Disposal Records and Reports § 761.207 The manifest—general..., the earliest date of removal from service for disposal, and the weight in kilograms of the PCB waste..., the date of removal from service for disposal, and weight in kilograms of the PCB waste in each PCB...

40 CFR 761.207 - The manifest-general requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., AND USE PROHIBITIONS PCB Waste Disposal Records and Reports § 761.207 The manifest—general..., the earliest date of removal from service for disposal, and the weight in kilograms of the PCB waste..., the date of removal from service for disposal, and weight in kilograms of the PCB waste in each PCB...

Undergrad and Overweight: An Online Behavioral Weight Management Program for College Students

ERIC Educational Resources Information Center

Harvey-Berino, Jean; Pope, Lizzy; Gold, Beth Casey; Leonard, Heather; Belliveau, Cynthia

2012-01-01

Objective: Explore the feasibility of an online behavioral weight management program for college students. Methods: The program focused on behavioral strategies to modify eating and exercise behaviors of students interested in losing weight and/or developing a healthy lifestyle. Specific tools included weekly chat meetings with a facilitator,…

Weight management for Mexican American adolescents: school-based program

USDA-ARS?s Scientific Manuscript database

The objective of the current study was to assess change in weight over time for children participating in a school-based weight management program. A total of 47 participants between the ages of 10 and 14 who exceeded the 85th percentile for BMI were randomized into an intensive intervention (II) o...

76 FR 21714 - Notice of Proposed Information Collection Requests

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-18

... Collection Clearance Division, Information Management and Privacy Services, Office of Management, invites... Management and Privacy Services, Office of Management, publishes this notice containing proposed information... Division, Information Management and Privacy Services, Office of Management. Office of Postsecondary...

Understanding Consistency Maintenance in Service Discovery Architectures during Communication Failure

DTIC Science & Technology

2002-07-01

our general model include: (1) service user (SU), (2) service manager (SM), and (3) service cache manager ( SCM ), where the SCM is an optional...maintained by SMs that satisfy specific requirements. Where employed, the SCM operates as an intermediary, matching advertised SDs of SMs to...Directory Service Agent (optional) not applicableLookup ServiceService Cache Manager ( SCM ) Service URL Service Type Service Attributes Template URL

77 FR 553 - Surety Companies Acceptable on Federal Bonds: Termination; Western Bonding Company

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-05

.... Department of the Treasury, Financial Management Service, Financial Accounting and Services Division, Surety..., 2011. Laura Carrico, Director, Financial Accounting and Services Division, Financial Management Service...: Termination; Western Bonding Company AGENCY: Financial Management Service, Fiscal Service, Department of the...

Health/Service Providers' Perspectives on Barriers to Healthy Weight Gain and Physical Activity in Pregnant, Urban First Nations Women.

PubMed

Darroch, Francine E; Giles, Audrey R

2016-01-01

The purpose of this article is to examine health/service providers' perspectives of barriers to healthy weight gain and physical activity for urban, pregnant First Nations women in Ottawa, Canada. Through the use of semi-structured interviews, we explored 15 health/service providers' perspectives on the complex barriers their clients face. By using a postcolonial feminist lens and a social determinants of health framework, we identified three social determinants of health that the health/service providers believed to have the greatest influence on their clients' weight gain and physical activity during pregnancy: poverty, education, and colonialism. Our findings are then contextualized within existing Statistics Canada and the Ottawa Neighbourhood Study data. We found that health/service providers are in a position to challenge colonial relations of power. We conclude by urging health/service providers, researchers, and policymakers alike to take into consideration the ways in which these social determinants of health and their often synergistic effects affect urban First Nations women during pregnancy. © The Author(s) 2015.

Fight Cravings with Exercise

MedlinePlus

... Challenges When Quitting Nicotine Withdrawal Cravings & Triggers Handling Stress Manage Your Mood Weight Gain & Appetite Stay Smokefree for Good Stick with It Weight Management Eat Healthy Get Active Help Others Quit For ...

Let's face it: patient and parent perspectives on incorporating a Facebook group into a multidisciplinary weight management program.

PubMed

Woolford, Susan J; Esperanza Menchaca, Alicia D M; Sami, Areej; Blake, Natalie

2013-08-01

Social media may have the potential to enhance weight management efforts. However, the acceptability of incorporating this entity into pediatrics is unknown. The objective of this project was to explore patients' and parents' perspectives about developing a Facebook group as a component of a pediatric weight management program. Semistructured interviews were performed between September, 2011, and February, 2012, with patients and parents in a multidisciplinary weight management program. Interviews explored participants' perceptions of potential benefits, concerns, and preferences related to a program-specific Facebook group. Transcripts were reviewed and themes identified. The study concluded when thematic saturation was achieved. Participants (n=32) were largely enthusiastic about the idea of a program-specific Facebook group for adolescents. Most preferred a secret group, where only participants would know of the group's existence or group members' identity. No parents expressed concern about security or privacy related to a program-specific Facebook group; one parent expressed concern about undesirable advertisements. Participants endorsed a variety of ideas for inclusion on the page, including weight loss tips, live chats with providers, quizzes, and an incentive system where participants could gain points for making healthy choices. Many parents requested a separate parent-focused page, an idea that was supported by the adolescents. This study suggests that participants perceive potential benefits from incorporating social media interventions into pediatric weight management efforts. Privacy and security issues do not appear to be major parental concerns. Future work should explore the impact of program-specific social media interventions on outcomes for patients in weight management programs.

Short message service (SMS) text messaging as an intervention medium for weight loss: A literature review.

PubMed

Shaw, Ryan; Bosworth, Hayden

2012-12-01

Nearly 68% of American adults are obese or overweight. Mobile devices such as mobile phones have emerged as a mode of intervention delivery to help people improve their health, particularly in relation to weight loss. This literature review examines the relationship between the use of short message service (SMS) text messaging as an intervention medium and weight loss. Results from this literature review (n = 14) suggest that SMS as an intervention tool for weight loss is still in its infancy. Initial results are promising but continued investigation is needed. We offer several recommendations for future research.