BackgroundNo studies report if improvements to commercial weight loss programs affect retention and weight loss. Similarly, no studies report if enrolling in a program through work (with a corporate partner) affects retention and weight loss.ObjectivesTo determine if: 1) adding evidenced-based improvements to a commercial weight loss program increased retention and weight loss, 2) enrolling in a program through work increased retention and weight loss, and 3) if increased weight loss was due to longer retention.Design, Setting, and ParticipantsData were collected on 60,164 adults who enrolled in Jenny Craig’s Platinum Program over one year in 2001–2002. The program was subsequently renamed the Rewards Program and improved by increasing treatment personalization and including motivational interviewing. Data were then collected on 81,505 Rewards participants who enrolled during 2005 (2,418 of these participants enrolled through their employer, but paid out-of-pocket).MeasurementsRetention (participants were considered active until ≥42 consecutive days were missed) and weight loss (percent of original body weight) from baseline to the last visit (data were evaluated through week 52).ResultsAlpha was set at .001. Mean (95% CI) retention (weeks), was significantly higher among Rewards [19.5 (19.4–19.6)] compared to Platinum [16.3 (16.2–16.4)] participants, and Rewards Corporate [25.9 (25.0–26.8)] compared to Non-corporate [21.9 (21.7–22.1)] participants. Modified intent-to-treat analyses indicated that mean (95% CI) percent weight loss was significantly larger among Rewards [6.36 (6.32–6.40)] compared to Platinum [5.45 (5.41–5.49)] participants, and Rewards Corporate [7.16 (6.92–7.40)] compared to Non-corporate [6.20 (6.16–6.24)] participants, with and without adjustment for baseline participant characteristics. In all cases, greater weight loss was secondary to longer retention.LimitationsThe study was not a randomized controlled trial, rather, a translational effectiveness study.ConclusionsImprovements to a commercial program and enrolling through a corporate partner are associated with greater weight loss that is due to improved retention.

In a wide range of circumstances, it is important to perceive and represent the sequence of events. For example, sequence perception is necessary to learn statistical contingencies between events, and to generate predictions about events when segmenting actions. However, viewer's awareness of event sequence is rarely tested, and at least some means of encoding event sequence are likely to be resource-intensive. Therefore, previous research may have overestimated the degree to which viewers are aware of specific event sequences. In the experiments reported here, we tested viewers' ability to detect anomalies during visual event sequences. Participants viewed videos containing events that either did or did not contain an out-of-order action. Participants were unable to consistently detect the misordered events, and performance on the task decreased significantly to very low levels when performing a secondary task. In addition, participants almost never detected misorderings in an incidental version of the task, and performance increased when videos ended immediately after the misordering, We argue that these results demonstrate that viewers can effectively perceive the elements of events, but do not consistently test their expectations about the specific sequence of natural events unless bidden to do so by task-specific demands. (PsycINFO Database Record

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Study Design. This is a retrospective review of prospectively collected data. Objective. The aim was to evaluate the impact of frailty and sarcopenia on outcomes after lumbar spine surgery. Summary of Background Data. Elderly patients are commonly diagnosed with degenerative spine disease requiring surgical intervention. Frailty and sarcopenia result from age-related decline in physiological reserve and can be associated with complications after elective spine surgery. Little is known about the impact of these factors on patient-reported outcomes (PROs). Methods. Patients older than 70 years of age undergoing elective lumbar spine surgery were included. The modified 5-item frailty index (mFI-5) was calculated. Sarcopenia was defined using total psoas index, which is obtained by dividing the mid L3 total psoas area by VB area (L3-TPA/VB). PROs included Oswestry disability index (ODI), EuroQual-5D (EQ-5D), numeric rating scale (NRS)-back pain, NRS leg pain (LP), and North American Spine Society (NASS) at postoperative 12 months. Clinical outcomes included length of stay (LOS), 90-day readmission and complications. Univariate and multivariable regression analyses were performed. Results. Total 448 patients were included. The mean mFI-5 index was 1.6±1.0 and mean total psoas index was 1.7±0.5. There was a significant improvement in all PROs from baseline to 12 months (P<0.0001). After adjusting for age, body mass index, smoking status, levels fused, and baseline PROs, higher mFI-5 index was associated with higher 12-month ODI (P<0.001), lower 12-month EQ-5D (P=0.001), higher NRS-LP (P=0.039), and longer LOS (P=0.007). Sarcopenia was not associated with 12-month PROs or LOS. Neither sarcopenia or mFI-5 were associated with 90-day complication and readmission. Conclusions. Elderly patients demonstrate significant improvement in PROs after elective lumbar spine surgery. Frailty was associated with worse 12 months postoperative ODI, EQ-5D, NRS-LP scores, and longer hospital stay. While patients with sarcopenia can expect similar outcomes compared with those without, the mFI-5 should be considered preoperatively in counseling patients regarding expectations for disability, health-related quality of life, and leg pain outcomes after elective lumbar spine surgery. Level of Evidence. 3.

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