No abstract

IMPORTANCE Rural populations have a higher prevalence of obesity and poor access to weight loss programs. Effective models for treating obesity in rural clinical practice are needed.OBJECTIVE To compare the Medicare Intensive Behavioral Therapy for Obesity fee-for-service model with 2 alternatives: in-clinic group visits based on a patient-centered medical home model and telephone-based group visits based on a disease management model. DESIGN, SETTING, AND PARTICIPANTS Cluster randomized trial conducted in 36 primary care practices in the rural Midwestern US. Inclusion criteria included age 20 to 75 years and body mass index of 30 to 45. Participants were enrolled from February 2016 to October 2017. Final follow-up occurred in December 2019.INTERVENTIONS All participants received a lifestyle intervention focused on diet, physical activity, and behavior change strategies. In the fee-for-service intervention (n = 473), practice-employed clinicians provided 15-minute in-clinic individual visits at a frequency similar to that reimbursed by Medicare (weekly for 1 month, biweekly for 5 months, and monthly thereafter). In the in-clinic group intervention (n = 468), practice-employed clinicians delivered group visits that were weekly for 3 months, biweekly for 3 months, and monthly thereafter. In the telephone group intervention (n = 466), patients received the same intervention as the in-clinic group intervention, but sessions were delivered remotely via conference calls by centralized staff. MAIN OUTCOMES AND MEASURESThe primary outcome was weight change at 24 months. A minimum clinically important difference was defined as 2.75 kg. RESULTS Among 1407 participants (mean age, 54.7 [SD, 11.8] years; baseline body mass index, 36.7 [SD, 4.0]; 1081 [77%] women), 1220 (87%) completed the trial. Mean weight loss at 24 months was -4.4 kg (95% CI, -5.5 to -3.4 kg) in the in-clinic group intervention, -3.9 kg (95% CI, -5.0 to -2.9 kg) in the telephone group intervention, and -2.6 kg (95% CI, -3.6 to -1.5 kg) in the in-clinic individual intervention. Compared with the in-clinic individual intervention, the mean difference in weight change was -1.9 kg (97.5% CI, -3.5 to -0.2 kg; P = .01) for the in-clinic group intervention and -1.4 kg (97.5% CI, -3.0 to 0.3 kg; P = .06) for the telephone group intervention.CONCLUSIONS AND RELEVANCE Among patients with obesity in rural primary care clinics, in-clinic group visits but not telephone-based group visits, compared with in-clinic individual visits, resulted in statistically significantly greater weight loss at 24 months. However, the differences were small in magnitude and of uncertain clinical importance.

Purpose – Globally expanding supply chains (SCs) have grown in complexity increasing the nature and magnitude of risks companies are exposed to. Effective methods to identify, model and analyze these risks are needed. Risk events often influence each other and rarely act independently. The SC risk management practices currently used are mostly qualitative in nature and are unable to fully capture this interdependent influence of risks. The purpose of this paper is to present a methodology and tool developed for multi-tier SC risk modeling and analysis. Design/methodology/approach – SC risk taxonomy is developed to identify and document all potential risks in SCs and a risk network map that captures the interdependencies between risks is presented. A Bayesian Theory-based approach, that is capable of analyzing the conditional relationships between events, is used to develop the methodology to assess the influence of risks on SC performance Findings – Application of the methodology to an industry case study for validation reveals the usefulness of the Bayesian Theory-based approach and the tool developed. Back propagation to identify root causes and sensitivity of risk events in multi-tier SCs is discussed. Practical implications – SC risk management has grown in significance over the past decade. However, the methods used to model and analyze these risks by practitioners is still limited to basic qualitative approaches that cannot account for the interdependent effect of risk events. The method presented in this paper and the tool developed demonstrates the potential of using Bayesian Belief Networks to comprehensively model and study the effects or SC risks. The taxonomy presented will also be very useful for managers as a reference guide to begin risk identification. Originality/value – The taxonomy developed presents a comprehensive compilation of SC risks at organizational, industry, and external levels. A generic, customizable software tool developed to apply the Bayesian approach permits capturing risks and the influence of their interdependence to quantitatively model and analyze SC risks, which is lacking.

This research examined a possible gender gap in personality and social psychology. According to membership demographics from the Society for Personality and Social Psychology (SPSP), women and men are represented near parity in the field. Yet despite this equal representation, the field may still suffer from a different type of gender gap. We examined the gender of first authors in two major journals, citations to these articles, and gender of award recipients. In random samples of five issues per year across 10 years (2004–2013; N = 1,094), 34% of first authors in Journal of Personality and Social Psychology were women and 44% of first authors in Personality and Social Psychology Bulletin were women. Articles authored by men were cited more than those authored by women. In examining the gender of award recipients given by SPSP (2000–2016), on average, 25% of the recipients were women.

and the Patient Assisted Intervention for Neuropathy: Comparison of Treatment in Real Life Situations (PAIN-CONTRoLS) Study Team IMPORTANCE Cryptogenic sensory polyneuropathy (CSPN) is a common generalized slowly progressive neuropathy, second in prevalence only to diabetic neuropathy. Most patients with CSPN have significant pain. Many medications have been tried for pain reduction in CSPN, including antiepileptics, antidepressants, and sodium channel blockers. There are no comparative studies that identify the most effective medication for pain reduction in CSPN.OBJECTIVE To determine which medication (pregabalin, duloxetine, nortriptyline, or mexiletine) is most effective for reducing neuropathic pain and best tolerated in patients with CSPN.