Search Results (15)

Overweight and obesity represent a significant global health challenge, requiring comprehensive, long-term approaches. Digital weight-loss services (DWLSs) have emerged as promising obesity care models, as they facilitate access to continuous multidisciplinary care. This study aimed to evaluate 12-month weight-loss and adherence patterns in a large unsubsidized DWLS in the UK, which combined lifestyle therapy with semaglutide treatment. A retrospective cohort design was used to analyze data from 7279 patients who initiated treatment between 1 January 2023, and 1 May 2024. Of these patients, 1678 (23.05%) met all criteria for inclusion in the efficacy estimand, which included receiving a minimum of 8 medication orders and submitting weight data within 341–379 days after program initiation. The efficacy estimand achieved a mean weight loss of 15.67%, with 92.49% losing a clinically meaningful amount of weight (≥5%). A strong positive association was found between weight tracking frequency and weight loss, to the extent that a percentage discrepancy of 8.41 points was observed between patients who tracked on less than 20 occasions (Median = 11.83%) and those who tracked at least 100 times (Median = 20.24%). A significant association between weight loss and semaglutide orders was also observed, with a clear distinction existing between patients who received less than 12 orders, and those who received 12 or more orders. Patients whose DWLS experience was supplemented with Wegovy recorded significantly higher mean weight loss than those who were treated with Ozempic (17.68% vs. 14.72%). The findings highlight the importance of program engagement in DWLS outcomes and suggest the need for a comparative analysis of unsubsidized and subsidized services. The study is limited by its real-world observational design and reliance on self-reported data; future research should compare outcomes between unsubsidized and subsidized DWLS cohorts. Full article

Background: Obesity management is evolving with the integration of dual GIP/GLP-1 receptor agonists (Tirzepatide) into comprehensive Digital Weight-Loss Services (DWLSs). This model leverages virtual, app-based multidisciplinary care (MDT) to deliver continuous, supervised treatment, distinguishing it from traditional, intermittent clinic-based care. While clinical trials demonstrate high efficacy, real-world data are necessary to evaluate long-term adherence and identify predictive markers for patient persistence in these scalable care models. Specifically, there is a knowledge gap regarding the specific behavioral factors that govern 12-month persistence in these comprehensive, medicated DWLS settings. This study retrospectively assessed the 12-month effectiveness and adherence of a Tirzepatide-supported DWLS and identified demographic, clinical, and behavioral predictors of weight loss and program attrition. Methods: Data from 19,693 patients enrolled in the Juniper UK DWLS were analyzed. Adherence was defined by a minimum of 10 medication orders and 12-month weight submission. Weight loss in the full cohort was evaluated using the Last Observation Carried Forward (LOCF) method. Binary logistic and multiple linear regression models identified predictors of adherence and weight loss, respectively, using a comprehensive set of demographic, clinical (e.g., BMI, comorbidities), and behavioral variables. Results: The 12-month adherence rate was 27%. The adherent sub-cohort (n = 5322) achieved a mean weight loss of 22.60 (±7.46) percent, compared to 13.62 (±10.85) percent in the full cohort (LOCF). This difference in 12-month mean weight loss was statistically significant (p < 0.001). Consistent weekly weight tracking and health coach communication were the strongest positive predictors of long-term adherence and weight loss. Conversely, hyper-engagement, specifically intensive tracking frequency and high weight loss velocity in the first month, was a significant inverse predictor of 12-month adherence. Reporting side effects was positively correlated with adherence, suggesting a reporting bias among engaged patients. Conclusions: The DWLS model facilitates the maximum therapeutic effectiveness for adherent patients. However, patient persistence remains the primary translational challenge. As consistent weekly engagement (tracking, coaching) is the strongest predictor of success, clinical strategies should prioritize promoting sustainable, moderate behavioral pacing (i.e., emphasizing consistent weekly engagement over intensive daily tracking and rapid early weight loss) to mitigate attrition risk and optimize the public health effectiveness of medicated DWLSs. Full article

The spatiotemporal evolution of ecosystem services has a profound influence on the fragile eco-environment in Inner Mongolia and the arid/semi-arid and the ecological barrier regions of Northern China; in particular, the small-scale and high-value land variables may lead to large eco-environment effects through altering the ecosystem services, which is still unclear in this vulnerable area. The differential driving mechanism of both human activities and natural factors on ecosystem services also needs to be revealed. To solve this scientific issue, the synergistic methodology of spatial analysis technology, the improved ecosystem service assessment method, flow gain/loss model, global/local Moran’s I approach, and the Geographically and Temporally Weighted Regression (GTWR) model were applied. Our main results are as follows: remote sensing monitoring showed that the land changes featured a persistent expansion of cropland and built-up areas, with a decline in grassland and wetland, along the east–west gradient from forests, grasslands, and unused-lands, to become the dominant cover type. According to our improved model, the ecosystem services considering the internal structure of build-up lands were first investigated in this ecologically fragile area of China, and the evaluated ecosystem service value (ESV) reduced from CNY 5515.316 billion to CNY 5425.188 billion, with an average annual decrease of CNY 3.004 billion from 1990 to 2020. Another finding was that the small-scale land variables with large ecological service impacts were quantified; namely, the proportion of grassland, woodland, wetland, and water body decreased from 62.71% to 61.34%, with only a relatively minor fluctuation of −1.37%, but this decline resulted in a large ESV loss of CNY 116.141 billion from 1990 to 2020. From the driving perspective, the temperature, digital elevation model (DEM), and slope exhibited negative effects on ESV changes, whereas a positive association was analyzed in terms of the precipitation and human footprint during the studied period. This study provides important support for optimizing land resource allocation, guiding the development of agriculture and animal husbandry, and protecting the ecological environment in arid/semi-arid and ecological barrier regions. Full article

Against the backdrop of the energy crisis and a rapidly advancing digital economy, electricity–computing synergy has become a strategic pathway to resolve energy constraints in computing power center and overcome renewable energy consumption challenges. This study breaks through the existing single-factor fragmented analysis method and systematically constructs a vertically progressive and horizontally coupled electricity–computing synergy planning model to deconstruct the core elements of computing power center construction and reconstruct the path of electricity–computing value co-creation. It proposes a multi-objective site selection decision-making method for computing power center based on linear weighting and the principle of reusability and universality, effectively avoiding the problem of overall system efficiency loss caused by single-objective optimization. Based on the empirical results from data from 31 provinces in China, this study classifies the endowments for computing power center construction, conducts targeted analyses of each province’s situation, and finds three major contradictions facing China’s computing power center: a spatial mismatch between green energy resources and service demand, a dynamic imbalance between electricity price advantages and comprehensive costs, and structural contradictions between talent reserves and sustainable development. Finally, a multi-dimensional integrated strategy was systematically constructed, encompassing demand-driven initiatives, electricity price adjustments, talent innovation, natural cold-source activation, and network upgrades, to provide guidance and policy toolkits for the government planning of computing power infrastructure development. Full article

Introduction: Goal setting is an effective strategy in altering fitness and dietary behaviours. The goal attainment scale (GAS) is a patient-reported outcome measure that can be used to quantify goal achievement. The GAS has not been extensively assessed in lifestyle intervention trials. This study aimed to describe the goal setting process and assess the impact of a digital exercise and diet service and self-efficacy on goal attainment in people with chronic disease and at increased cardiometabolic risk. Methods: This study presents a single-centre, 26-week, randomised controlled trial (RCT) comparing standard care to digital health technologies (text messages, nutrition/exercise app, video consultations with dietitian and/or exercise physiologist). The comparator group was offered dietitian review (per standard care), and both groups received a wearable activity monitor. Individualised goal setting was facilitated prior to randomisation. Goal importance, performance measures, and self-efficacy were determined by participants. Goal outcome and ‘Change in GAS’ scores, reflecting the difference between baseline and follow-up performance, were calculated using validated formulae. Results: Goal setting was completed and reviewed by 66 participants, with a median age of 51 years and 56% being male. The most common goals related to weight loss (46%), fitness (29%), and diet (15%). Most participants (62%) reported improvements in their goals, with most improvements in dietary (71%), fitness (52%), and weight loss (39%) goals. There was no significant difference in goal outcomes between intervention and comparator groups (p = 0.99). There was, however, a significant correlation between nutrition self-efficacy and dietary goal achievement (p = 0.04). Conclusions: The novelty and feasibility of goal setting and attainment were demonstrated in this RCT of lifestyle interventions in people with chronic disease. Though the intervention did not significantly improve goal attainment, most participants reported improvements in their lifestyle goals. There were greater improvements in dietary goals than in fitness or weight loss goals. Participant-led goal setting with GAS and participant self-efficacy has potentially important applications in future lifestyle modification research and clinical implementation endeavours. Full article

Background/Objectives: Clinicians are becoming increasingly interested in the use of large language models (LLMs) in obesity services. While most experts agree that LLM integration would increase access to obesity care and its efficiency, many remain skeptical of their scientific accuracy and capacity to convey human empathy. Recent studies have shown that ChatGPT-3 models are capable of emulating human dietitian responses to a range of basic dietary questions. Methods: This study compared responses of two ChatGPT-4o models to those from human dietitians across 10 complex questions (5 broad; 5 narrow) derived from patient–clinician interactions within a real-world medicated digital weight loss service. Results: Investigators found that neither ChatGPT-4o nor Chat GPT-4o1 preview were statistically outperformed (p < 0.05) by human dietitians on any of the study’s 10 questions. The same finding was made when scores were aggregated from the ten questions across the following four individual study criteria: scientific correctness, comprehensibility, empathy/relatability, and actionability. Conclusions: These results provide preliminary evidence that advanced LLMs may be able to play a significant supporting role in medicated obesity services. Research in other obesity contexts is needed before any stronger conclusions are made about LLM lifestyle coaching and whether such initiatives increase care access. Full article

Background: Digital weight loss services (DWLSs) that use Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated potential in contributing to a shift in global obesity rates. However, reasonable concerns have been raised about the prescribing safety of these services. Prior to this study, electronic prescribing safety had only been investigated in hospital settings and community clinics. Methods: This study retrospectively analyzed prescribing errors committed over a 6-month period in 2023 at Australia’s largest GLP-1 RA-supported DWLS. Results: The analysis found that 1654 (4.4%) of the 37323 audited GLP-1 RA prescriptions contained an error. Most errors pertained to insufficient safety counselling (49.15%) and inadequate investigations of potential contraindications (30.29%). Although a large portion of prescribing errors were detected via the automated query method (64.9%), the other three auditing methods all detected a significant number of true errors (>100). Patients from the highest body mass index category (40+ kg/m²) were overrepresented in the service’s prescribing error data. Conclusions: These findings lay a vital foundation in the emerging literature on GLP-1 RA-supported DWLSs. Full article

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were originally developed in the late 1980s as a class of antidiabetic medication. However, research over the past decade has found them to be a safe and effective weight-loss agent, which has led to the approval of GLP-1 RAs such as Semaglutide as a supplement to lifestyle obesity interventions in multiple countries. When Semaglutide has become commercially unavailable, digital weight-loss services (DWLSs) have prescribed a compounded form of the medication—a practice in which health professionals formulate a replica of the commercial medication to serve ongoing patient needs. Although compounding has been relatively common over the past century, prominent medical bodies have argued that compounding a relatively novel medication such as Semaglutide represents a major safety risk. This study retrospectively compared the weight and side effect outcomes of patients from a large Australian DWLS whose lifestyle coaching was supplemented with either compounded or pure Semaglutide (both groups following the same titration schedule). All data were extracted from the service’s central data repository. To be included in the weight loss analysis, patients needed to have received a minimum of four monthly medication orders between June 2023 and May 2024 and have submitted weight data between 90 and 150 days after the arrival of their first order. All patients who received at least one medication order within the same period were included in the side effect analysis. The mean four-month weight loss percentage was statistically lower in the compounded Semaglutide group (N = 923, M = 9.11, SD = ±5.76) compared to those in the pure Semaglutide group (n = 1858, M = 9.87, SD = ±6.46), t (2032) = −3.15, p = 0.0017. A statistically lower proportion of patients in the compounded Semaglutide group (71.61%) reported at least one side effect than patients in the pure Semaglutide group (77.40%) during the study period, X² (1, N = 7683) = 32.32, p < 0.001. When side effects were disaggregated into severity categories, a statistical difference was only observed in mild side effects, X² (1, N = 7683) = 59.16, p < 0.001. A significantly higher rate of patients from the pure Semaglutide group achieved the ten (50.54% vs. 44.64%), X² (1, N = 7683) = 10.34, p < 0.001, and fifteen (21.42% vs. 12.78%), X² (1, N = 7683) = 30.43, p < 0.001, percent weight loss thresholds than patients from the compounded Semaglutide group. The findings indicate that compounded Semaglutide can be used as a component of tightly controlled DWLSs with slightly less effectiveness but with slightly lower side effect incidence when compared to pure Semaglutide. Full article

Digital weight-loss services (DWLSs) combining pharmacotherapy and health coaching have the potential to make a major contribution to the global struggle against obesity. However, the degree to which DWLSs compromise patient safety through the dispensation of Glucagon-like peptide-1 receptor agonist (GLP-1 RA) medications is unknown. This study retrospectively analysed the rate at which patients reported GLP-1 RA dispensing errors from patient-selected and partner pharmacies of Australia’s largest DWLS provider over a six-month period. The analysis found that 99 (0.35%) of the 28,165 dispensed semaglutide orders contained an error. Incorrect dose (58.6%) and unreasonable medication expiry window (21.2%) were the two most common error types. Most errors (84.9%) were deemed to have been of medium urgency, with 11.1% being considered high-urgency errors. Incorrect doses (45.5%) and supplies of the wrong medication (36.3%) comprised most errors reported in high-urgency cases. Female patients reported more dispensing errors than male patients (0.41% vs. 0.12%, p < 0.001). Similarly, reported dispensing error rates were highest among patients aged 18 to 29 years (0.6%) and 30 to 39 years (0.5%). This research provides preliminary evidence that GLP-1 RA dispensing errors within comprehensive Australian DWLSs are relatively low. Full article

Quality glucose-like peptide-1 receptor agonist (GLP-1 RA)-supported digital weight-loss services (DWLSs) have the potential to play a significant role in shifting the alarming global obesity rate. Previous studies have demonstrated various aspects of their utility in Australian and British populations, but nothing has hitherto been investigated in real-world European settings, where GLP-1 RA weight therapy and digital healthcare are widely used. This study retrospectively analysed the 5-month (Mean = 160.14 days) weight-loss outcomes in a cohort of patients who received email-based health coaching and Semaglutide therapy via the Juniper Germany DWLS (n = 833). Mean weight loss was 9.52 (±5.46) percent, with 81.51% of the cohort losing a ‘meaningful’ (5% or more) amount of weight. Females (Mean = 9.75) tended to lose more weight than males (Mean = 8.41) and patients from the lowest two BMI categories (27.5–29.99 kg/m² Mean = 10.1; 30–34.99 kg/m² Mean = 9.74) lost significantly more weight than those in the highest BMI category (≥40 kg/m² Mean = 8.11). These findings indicate that GLP-1 RA-supported DWLSs can contribute to meaningful weight loss in Germany. Future research should seek to conduct a dedicated adherence analysis of the Juniper Germany DWLS and measure the effect of subsidisation and baseline body mass index on general DWLS effectiveness. Full article

Increasingly large numbers of people are using digital weight loss services (DWLSs) to treat being overweight and obesity. Although it is widely agreed that digital modalities improve access to care in general, obesity stakeholders remain concerned that many DWLSs are not comprehensive or sustainable enough to deliver meaningful health outcomes. This study adopted a mixed methods approach to assess why and after how long patients tend to discontinue Australia’s largest DWLS, a program that combines behavioural and pharmacological therapy under the guidance of a multidisciplinary care team. We found that in a cohort of patients who commenced the Eucalyptus DWLS between January and June 2022 (n = 5604), the mean program adherence was 171.2 (±158.2) days. Inadequate supplying of a patient’s desired glucose-like peptide-1 receptor agonist medication was the most common reason for discontinuation (43.7%), followed by program cost (26.2%), result dissatisfaction (9.9%), and service dissatisfaction (7.2%). Statistical tests revealed that ethnicity and age both had a significant effect on patient adherence. These findings suggest that DWLSs have the potential to improve access to comprehensive, continuous obesity care, but care models need to improve upon the one observed in the Eucalyptus Australia DWLS to mitigate common real-world program attrition factors. Full article

Wind turbines (WT) are a clean renewable energy source that have gained popularity in recent years. Gearboxes are complex, expensive, and critical components of WT, which are subject to high maintenance costs and several stresses, including high loads and harsh environments, that can lead to failure with significant downtime and financial losses. This paper focuses on the development of a digital twin-based approach for the modelling and simulation of WT gearboxes with the aim to improve their design, diagnosis, operation, and maintenance by providing insights into their behavior under different operating conditions. Powerful commercial computer-aided design tools (CAD) and computer-aided engineering (CAE) software are embedded into a computationally efficient multi-objective optimization framework (modeFrontier) with the purpose of maximizing the power density, compactness, performance, and reliability of the WT gearbox. High-fidelity models are used to minimize the WT weight, volume, and maximum stresses and strains achieved without compromising its efficiency. The 3D CAD model of the WT gearbox is carried out using SolidWorks (version 2023 SP5.0), the Finite Element Analysis (FEA) is used to obtain the stresses and strains, fields are modelled using Ansys Workbench (version 2024R1), while the multibody kinematic and dynamic system is analyzed using Adams Machinery (version 2023.3, Hexagon). The method has been successfully applied to different case studies to find the optimal design and analyze the performance of the WT gearboxes. The simulation results can be used to determine safety factors, predict fatigue life, identify potential failure modes, and extend service life and reliability, thereby ensuring proper operation over its lifetime and reducing maintenance costs. Full article

Natural hazards due to climate change have become the new norm in our cities. These events show the vulnerabilities of our cities to extreme conditions, mainly displayed as flash wadi flooding as a result of a short duration of intensive and eroded its shoreline along the coast, resulting in huge impacts, including human losses and urban and infrastructural damages. This study used the urban flood risk mitigation model through an open-source tool—Integrated Evaluation of Ecosystem Services and Trade-off (InVEST)—to estimate the amount of runoff due to two extreme rainfall events for each watershed considered. We used a digital shoreline analysis system (DSAS) to quantify the Al Khaboura shoreline erosion as a result of Shaheen’s storm surge. With the DSAS, the model showed that, during the short period of the event, the Al Khaboura coastal line was eroded by 16.33 m/y, representing 7.82% of its coastal line, up to a maximum erosion distance of 1428.5 m. The weighted linear regression showed the average mean rate of shoreline change of 6.79 m/y. These models could provide a clear picture of the city vulnerability to allow us to propose a corrective measure for interventions at local and regional scales. Full article

Soil is fundamental for the functioning of terrestrial ecosystems, but our knowledge about soil organisms and the habitat they provide (shortly: Soil biodiversity) is poorly developed. For instance, the European Atlas of Soil Biodiversity and the Global Soil Biodiversity Atlas contain maps with rather coarse information on soil biodiversity. This paper presents a methodology to map soil biodiversity with limited data and models. Two issues were addressed. First, the lack of consensus to quantify the soil biodiversity function and second, the limited data to represent large areas. For the later issue, we applied a digital soil mapping (DSM) approach at the scale of the Netherlands and Europe. Data of five groups of soil organisms (earthworms, enchytraeids, micro-arthropods, nematodes, and micro-organisms) in the Netherlands were linked to soil habitat predictors (chemical soil attributes) in a regression analysis. High-resolution maps with soil characteristics were then used together with a model for the soil biodiversity function with equal weights for each group of organisms. To predict soil biodiversity at the scale of Europe, data for soil biological (earthworms and bacteria) and chemical (pH, soil organic matter, and nutrient content) attributes were used in a soil biodiversity model. Differential weights were assigned to the soil attributes after consulting a group of scientists. The issue of reducing uncertainty in soil biodiversity modelling and mapping by the use of data from biological soil attributes is discussed. Considering the importance of soil biodiversity to support the delivery of ecosystem services, the ability to create maps illustrating an aggregate measure of soil biodiversity is a key to future environmental policymaking, optimizing land use, and land management decision support taking into account the loss and gains on soil biodiversity. Full article

Recently, the work environments of organizations have been in the process of transitioning into smart work environments by applying cloud computing technology in the existing work environment. The smart work environment has the characteristic of being able to access information assets inside the company from outside the company through cloud computing technology, share information without restrictions on location by using mobile terminals, and provide a work environment where work can be conducted effectively in various locations and mobile environments. Thus, in the cloud computing-based smart work environment, changes are occurring in terms of security risks, such as an increase in the leakage risk of an organization’s information assets through mobile terminals which have a high risk of loss and theft and increase the hacking risk of wireless networks in mobile environments. According to these changes in security risk, the reactive digital forensic method, which investigates digital evidence after the occurrence of security incidents, appears to have a limit which has led to a rise in the necessity of proactive digital forensic approaches wherein security incidents can be addressed preemptively. Accordingly, in this research, we design a digital forensic readiness model at the level of preemptive prevention by considering changes in the cloud computing-based smart work environment. Firstly, we investigate previous research related to the cloud computing-based smart work environment and digital forensic readiness and analyze a total of 50 components of digital forensic readiness. In addition, through the analysis of the corresponding preceding research, we design seven detailed areas, namely, outside the organization environment, within the organization guideline, system information, terminal information, user information, usage information, and additional function. Then, we design a draft of the digital forensic readiness model in the cloud computing-based smart work environment by mapping the components of digital forensic readiness to each area. To verify the draft of the designed model, we create a survey targeting digital forensic field-related professionals, analyze their validity, and deduce a digital forensic readiness model of the cloud computing-based smart work environment consisting of seven detailed areas and 44 components. Finally, through an analytic hierarchy process analysis, we deduce the areas that should be emphasized compared to the existing work environment to heighten the forensic readiness in the cloud computing-based smart work environment. As a result, the weightings of the terminal information Universal Subscriber Identity Module(USIM) card, collect/gain virtual machine image, etc.), user information (user account information analysis, analysis of user’s used service, etc.), and usage information (mobile OS artifact timeline analysis, action analysis through timeline, etc.) appear to be higher than those of the existing work environment. This is analyzed for each organization to preemptively prepare for the components of digital forensic readiness in the corresponding areas. Full article