Your Choice : Weight Management in Primary Care

The aims of this intervention are 1) To be a targeted intervention: BMI >30 or > 28 for patients with comorbidities provided with support to lose weight. 2) To help patients achieve weight loss (with an initial 5% goal over the 12 week intervention period) 3) To establish primary care weight management services in thecounty 4) To train the primary care workforce in weight managementintervention 5)To help patients make sustainable lifestyle changes in terms ofhealthy eating and physical activity 6)To ensure an appropriate exit strategy was in place

Evaluation of the Birmingham My Choice Adult Weight Management Programme

The aims of this intervention are: To reduce adult obesity levels To improve access to weight management services in primary care. To improve access to weight management services for areas with high BME populations or poor access to commercial weight loss providers To improve diet and nutrition, promote healthy weight and increase levels of physical activity in overweight or obese patients. To support patients to make lifestyle changes to enable them to lose weight

Wie wirkt Pluralität auf individuelle Religiosität? Eine Konfrontation von Wissenssoziologie und Rational Choice

Interdisziplinär konzipiert, zeigt dieses Buch in historischer und gegenwartsbezogener Perspektive die Komplexität und den Facettenreichtum des religiösen Pluralismus auf, der unsere gesellschaftliche Wirklichkeit zunehmend bestimmt. Die hier dokumentierten religionswissenschaftlichen, soziologischen, rechtlichen und philosophischen Zugänge sind dabei behilflich, sich mit Religion und ihrer weltweit wachsenden gesellschaftlichen Relevanz auseinander zu setzen. Die Beiträge zeigen, wie der Herausforderung des Religionspluralismus im europäischen und außereuropäischen Raum begegnet wird und welche große Bandbreite an Themen hierbei zu Tage tritt.

Scoring Methods for Ordinal Multidimensional Forced-Choice Items

In most psychological tests and questionnaires, a test score is obtained bytaking the sum of the item scores. In virtually all cases where the test orquestionnaire contains multidimensional forced-choice items, this traditionalscoring method is also applied. We argue that the summation of scores obtained with multidimensional forced-choice items produces uninterpretabletest scores. Therefore, we propose three alternative scoring methods: a weakand a strict rank preserving scoring method, which both allow an ordinalinterpretation of test scores; and a ratio preserving scoring method, whichallows a proportional interpretation of test scores. Each proposed scoringmethod yields an index for each respondent indicating the degree to whichthe response pattern is inconsistent. Analysis of real data showed that withrespect to rank preservation, the weak and strict rank preserving methodresulted in lower inconsistency indices than the traditional scoring method;with respect to ratio preservation, the ratio preserving scoring method resulted in lower inconsistency indices than the traditional scoring method

Freedom of choice of specialist physicians is important to Swiss resident: a cross-sectional study.

QUESTION UNDER STUDY: To assess how important the possibility to choose specialist physicians is for Swiss residents and to determine which variables are associated with this opinion. METHODS: This cross-sectional study used data from the 2007 Swiss population-based health survey and included 13,642 non-institutionalised adults who responded to the telephone and paper questionnaires. The dependent variable included answers to the question "How important is it for you to be able to choose the specialist you would like to visit?" Independent variables included socio-demographics, health and past year healthcare use measures. Crude and adjusted logistic regressions for the importance of being able to choose specialist physicians were performed, accounting for the survey design. RESULTS: 45% of participants found it very important to be able to choose the specialist physician they wanted to visit. The answers "rather important", "rather not important" and "not important" were reported by 28%, 20% and 7% of respondents. Women, individuals in middle/high executive position, those with an ordinary insurance scheme, those reporting ≥2 chronic conditions or poorer subjective health, or those who had had ≥2 outpatient visits in the preceding year were more likely to find this choice very important. CONCLUSIONS: In 2007, almost half of all Swiss residents found it very important to be able to choose his/her specialist physician. The further development of physician networks or other chronic disease management initiatives in Switzerland, towards integrated care, need to pay attention to the freedom of choice of specialist physicians that Swiss residents value. Future surveys should provide information on access and consultations with specialist physicians.

Shape complexity based on mutual information

Shape complexity has recently received attention from different fields, such as computer vision and psychology. In this paper, integral geometry and information theory tools are applied to quantify the shape complexity from two different perspectives: from the inside of the object, we evaluate its degree of structure or correlation between its surfaces (inner complexity), and from the outside, we compute its degree of interaction with the circumscribing sphere (outer complexity). Our shape complexity measures are based on the following two facts: uniformly distributed global lines crossing an object define a continuous information channel and the continuous mutual information of this channel is independent of the object discretisation and invariant to translations, rotations, and changes of scale. The measures introduced in this paper can be potentially used as shape descriptors for object recognition, image retrieval, object localisation, tumour analysis, and protein docking, among others

Mate and fuse: how yeast cells do it.

Many cells are able to orient themselves in a non-uniform environment by responding to localized cues. This leads to a polarized cellular response, where the cell can either grow or move towards the cue source. Fungal haploid cells secrete pheromones to signal mating, and respond by growing a mating projection towards a potential mate. Upon contact of the two partner cells, these fuse to form a diploid zygote. In this review, we present our current knowledge on the processes of mating signalling, pheromone-dependent polarized growth and cell fusion in Saccharomyces cerevisiae and Schizosaccharomyces pombe, two highly divergent ascomycete yeast models. While the global architecture of the mating response is very similar between these two species, they differ significantly both in their mating physiologies and in the molecular connections between pheromone perception and downstream responses. The use of both yeast models helps enlighten both conserved solutions and species-specific adaptations to a general biological problem.

Molecular and physiological characterisation of lonotropic receptors in the sacculus in drosophila

Chemosensation is the detection of chemical signals in the environment that enable an animal to make informed decisions about food choice, mate preference or predator detection. Dissecting the molecular and neural mechanisms by which animals detect chemical cues is an important goal towards understanding how they interact with the environment. An attractive system to dissect the mechanisms of chemosensation is the olfactory system. One of the most-investigated olfactory systems is that of Drosophila melanogaster, a model organism that is amenable to a powerful combination of genetic and physiological analyses. Embedded within the antennal olfactory organ of Drosophila is an unusual sensory structure called the sacculus. The sacculus is comprised of three distinct chambers, each lined with several sensilla housing two to three neurons. Previous morphological, anatomical and surgical studies of sacculus neurons have implicated sacculus neurons in chemosensation, hygrosensation and/or thermosensation. While a subset of sacculus neurons have been physiologically characterised as temperature sensors, the role of this organ has remained largely mysterious, due to its inaccessibility to peripheral electrophysiological analysis. Recently a new family of olfactory receptors, the lonotropic Receptors (IRs), was identified. Five IRs are expressed in sacculus neurons providing the first selective molecular markers for these cells. In this thesis I describe the molecular, physiological and anatomical characterisation of these neurons. Genetic labelling of specific populations of sacculus neurons with anatomical (CD8:GFP) reporters has identified neurons in sacculus chambers I and II express IR40a+IR93a together with their co- receptor IR25a, while neurons in chamber III express IR64a with its co-receptor IR8a. Both these sets of neurons project to two distinct glomeruli in the antennal lobe; IR40a neurons project to the column and arm, IR64a neurons project to DC4 and DP1m. Through a live optical imaging screen I showed that these neurons are indeed olfactory and IR64a neurons recognise acidic ligands, while IR40a neurons recognise amine ligands. IR40a and IR64a neurons are in fact composed of anatomically and physiologically distinct subpopulations, strongly implying the existence of other factors that define their functional properties. My thesis identifies the sacculus as a specialised olfactory organ capable of detecting acids and bases, which are of widespread importance to insects. The data from my thesis along with data from other labs show the sacculus is composed of different populations of olfactory sensory neurons and thermosensory neurons. Comparative genomic analysis of sacculus IRs across insects reveals them to be among the most conserved of this receptor repertoire, suggesting that the sacculus represents an evolutionarily ancient insect olfactory acid-base sensor. - La détection des produits chimiques se trouvant dans l'environnement (perception chimiosensorielle) permet à un animal de choisir sa nourriture, son partenaire ou encore d'identifier ses prédateurs. Décortiquer les mécanismes moléculaires et neuronaux grâce auxquels les animaux détectent ces signaux chimiques permet de comprendre comment ces animaux interagissent avec leur environnement. Un système intéressant pour décortiquer ces mécanismes de perception chimiosensorielle est le système olfactif, de la drosophile (Drosophila melanogaster), aussi appelée mouche du vinaigre. C'est un animal modèle très utile grâce à la combinaison d'outils génétiques puissants et d'analyses physiologiques facilement réalisables. Dans l'antenne de la drosophile, qui est l'organe olfactif principal de cet animal, se trouve une structure appelée sacculus. Celui-ci est composé de trois chambres distinctes, chacune comprenant plusieurs sensilles à l'intérieur desquelles se trouvent deux à trois neurones. De précédentes études morphologiques et anatomiques des ces neurones ont déterminé qu'ils sont impliqués dans la perception des odeurs, de l'humidité et de la température. Malgré ceci, la fonction principale de cet organe reste largement inconnue, principalement car il est inaccessible aux analyses électrophysiologiques. Récemment, une nouvelle famille de soixante-six récepteurs olfactifs, nommés Récepteurs lonotropiques (IRs), a été découverte chez la drosophile. Cinq IRs sont exprimés dans les neurones du sacculus. Pour la première fois, une sélection de marqueurs moléculaires est disponible pour l'étude de ces cellules. Dans cette thèse, les caractéristiques moléculaires, physiologiques et anatomiques des neurones du sacculus sont décrites. Ces populations de neurones situés dans le sacculus ont été marquées avec des gènes rapporteurs (CD8:GFP). Ceci a montré que les récepteurs IR40a et IR93a sont exprimés ensemble avec le co-récepteur IR25a dans les chambres I et II, tandis que les neurones de la chambre III expriment IR64a avec son co-récepteur IR8a. Ces deux groupes de neurones projettent vers deux glomérules distincts du lobe antennaire : les neurones IR40a projettent vers la column et le arm, alors que les neurones IR64a projettent vers DC4 et DP1m. Un screen d'imagerie optique a démontré que ces neurones sont en effet des neurones olfactifs, et que les neurones IR64a reconnaissent des ligands acides, tandis que les neurones IR40a reconnaissent des ligands aminés. De plus, les neurones IR40a et IR64a sont séparés en sous-populations distinctes anatomiquement et physiologiquement, et d'autres facteurs permettant de définir leurs propriétés fonctionnelles sont probablement impliqués. Cette thèse identifie ainsi le sacculus comme un organe olfactif spécialisé capable de détecter des acides et amines, lesquels sont très importants pour les insectes. Toutes les données collectées durant cette thèse, combinées aux données d'autres laboratoires, montrent que le sacculus est composé de différentes populations de neurones olfactifs et thermosenseurs. Ces IRs sont très conservés parmi les insectes, suggérant que le sacculus représente révolution d'un ancien détecteur olfactif d'acides et de bases chez l'insecte. - Tous les animaux sont capables de percevoir les signaux chimiques dans leur environnement, comme les odeurs ou le goût, via différents organes. L'odorat est le sens qui permet de percevoir les odeurs, et il est implique des neurones olfactifs qui se trouvent dans le nez des mammifères ou les antennes des insectes. La capacité d'un neurone olfactif à détecter une molécule odorante dépend des types de récepteurs olfactifs qu'il exprime. Il existe deux grandes familles de récepteurs qui perçoivent les odeurs : les Récepteurs Olfactifs, ORs, et Récepteurs lonotropiques IRs, qui détectent différents types d'odeurs avec différents mécanismes. Lorsqu'un récepteur reconnaît une molécule odorante, il convertit ce signal en un signal électrique qui est ensuite transmis au centre olfactif dans le cerveau. La drosophile (Drosophila melanogaster), aussi appelée mouche du vinaigre, est utilisée comme animal modèle pour étudier l'odorat, parce que son génome entier a été séquencé et que ses gènes sont facilement manipulables. De plus, l'anatomie du système olfactif de la mouche est similaire à celui des mammifères, malgré qu'il possède moins de neurones, ce qui le rend moins complexe. Ma thèse a pour objectif d'étudier les Récepteurs lonotropiques dans un organe spécifique, appelé le sacculus, situé dans les antennes. Les neurones du sacculus exprimant des IRs envoient leurs projections au centre olfactif du cerveau, suggérant que ces neurones perçoivent les odeurs. Une technique d'imagerie optique a été utilisée sur le cerveau de mouches vivantes afin de mesurer la réponse des neurones du le sacculus à différentes odeurs. J'ai démontré que ces récepteurs détectent des acides et des amines, qui sont très importants pour les insectes. Par exemple, les acides se retrouvent dans les fruits mûrs sur lesquels les mouches vont se nourrir, s'accoupler et poser leurs oeufs, et les amines sont souvent produites par des bactéries pouvant être nuisible pour la mouche. La principale découverte de ma thèse est donc l'identification du sacculus comme un organe capable de détecter deux des principales odeurs importantes pour la mouche. Ces récepteurs sont aussi présents dans d'autres insectes où ils jouent peut-être des rôles différents. Les acides et les amines se retrouvent aussi dans les excrétions (comme la sueur ou l'urine) de beaucoup de mammifères, qui pourraient potentiellement être dangereux pour la mouche, mais qui attirent les moustiques se nourrissant de leur sang.

Subjective health assessments and active labor market participation of older men: evidence from a semiparametric binary choice model with nonadditive correlated individual-specific effects

We use panel data from the U. S. Health and Retirement Study, 1992-2002, to estimate the effect of self-assessed health limitations on the active labor market participation of older men. Self-assessments of health are likely to be endogenous to labor supply due to justification bias and individual-specific heterogeneity in subjective evaluations. We address both concerns. We propose a semiparametric binary choice procedure that incorporates nonadditive correlated individual-specific effects. Our estimation strategy identifies and estimates the average partial effects of health and functioning on labor market participation. The results indicate that poor health plays a major role in labor market exit decisions.

Patients' and physicians' preferences for type 2 diabetes mellitus treatments in Spain and Portugal: a discrete choice experiment.

OBJECTIVE To assess Spanish and Portuguese patients' and physicians' preferences regarding type 2 diabetes mellitus (T2DM) treatments and the monthly willingness to pay (WTP) to gain benefits or avoid side effects. METHODS An observational, multicenter, exploratory study focused on routine clinical practice in Spain and Portugal. Physicians were recruited from multiple hospitals and outpatient clinics, while patients were recruited from eleven centers operating in the public health care system in different autonomous communities in Spain and Portugal. Preferences were measured via a discrete choice experiment by rating multiple T2DM medication attributes. Data were analyzed using the conditional logit model. RESULTS Three-hundred and thirty (n=330) patients (49.7% female; mean age 62.4 [SD: 10.3] years, mean T2DM duration 13.9 [8.2] years, mean body mass index 32.5 [6.8] kg/m(2), 41.8% received oral + injected medication, 40.3% received oral, and 17.6% injected treatments) and 221 physicians from Spain and Portugal (62% female; mean age 41.9 [SD: 10.5] years, 33.5% endocrinologists, 66.5% primary-care doctors) participated. Patients valued avoiding a gain in bodyweight of 3 kg/6 months (WTP: €68.14 [95% confidence interval: 54.55-85.08]) the most, followed by avoiding one hypoglycemic event/month (WTP: €54.80 [23.29-82.26]). Physicians valued avoiding one hypoglycemia/week (WTP: €287.18 [95% confidence interval: 160.31-1,387.21]) the most, followed by avoiding a 3 kg/6 months gain in bodyweight and decreasing cardiovascular risk (WTP: €166.87 [88.63-843.09] and €154.30 [98.13-434.19], respectively). Physicians and patients were willing to pay €125.92 (73.30-622.75) and €24.28 (18.41-30.31), respectively, to avoid a 1% increase in glycated hemoglobin, and €143.30 (73.39-543.62) and €42.74 (23.89-61.77) to avoid nausea. CONCLUSION Both patients and physicians in Spain and Portugal are willing to pay for the health benefits associated with improved diabetes treatment, the most important being to avoid hypoglycemia and gaining weight. Decreased cardiovascular risk and weight reduction became the third most valued attributes for physicians and patients, respectively.

Understanding the hierarchy governance choice of some wineries in Brazil - case study of 3 Brazilian wineries

ABSTRACT This study aims to contribute towards understanding the multiple factors, which influence firm's governance decisions. To identify some of these factors, three cases in the Brazilian wine industry were analyzed: Miolo located in Vale dos Vinhedos (South of Brazil) and in Vale do Rio São Francisco (Northeast of Brazil); Don Laurindo located in Vale dos Vinhedos; and ViniBrasil located in Vale do Rio São Francisco. For the most part, all three firms procure the grapes they use for their wine production in-house. Only Miolo purchases an insignificant amount of grapes outside of its production. By Brazilian standards, these regions have a long tradition of grape production and it is not difficult to purchase sufficient quantity of grapes to produce wine. However, the wineries are concerned also about the quality of the grapes they use and purchasing high-quality grapes might be critical issue. On the other hand, the quality of grapes is easily measured and the cost to buy in the market is cheaper than producing in-house. Furthermore, also the level of asset specificity present in the grape-grower-wine-producer transaction seems, by itself, insufficient to justify the use of hierarchical governance forms. Then, the aim of the article is to analyze the reasons why these wineries largely rely on hierarchy governance forms to procure their grape-inputs. What explains their use of hierarchy governance, given that both asset specificity and measurement problems appear to be relatively low?

Information overload, choice deferral, and moderating role of need for cognition: Empirical evidence

ABSTRACT Choice deferral due to information overload is an undesirable result of competitive environments. The neoclassical maximization models predict that choice avoidance will not increase as more information is offered to consumers. The theories developed in the consumer behavior field predict that some properties of the environment may lead to behavioral effects and an increase in choice avoidance due to information overload. Based on stimuli generated experimentally and tested among 1,000 consumers, this empirical research provides evidence for the presence of behavioral effects due to information overload and reveals the different effects of increasing the number of options or the number of attributes. This study also finds that the need for cognition moderates these behavioral effects, and it proposes psychological processes that may trigger the effects observed.