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Purpose: The prevalence of obesity has been increasing in the United States. We set out to investigate the use of pharmacologic and non-pharmacologic therapy for the treatment of obesity in recent years. Methods: We included 2630 men and 2702 women who took part in the National Health and Nutrition Examination Survey from 2007 to 2008. We analyzed their demographic and anthropometric data and their weight and drug history. Results: A total of 45.9% of men and 45.0% of women were candidates for treatment (body mass index ≥30 kg/m2, or ≥27 kg/m2 with risk factors). Among these participants, 85.1% considered themselves overweight, 90.1% would like to lose weight, 61.9% had dietary changes, 36.5% exercised, 3.7% took nonprescription drugs, and 2.2% took prescription drugs to control weight during the preceding year. During the preceding month, 0.5% and 0.1% of participants were taking phentermine and orlistat, respectively. There were no participants on sibutramine. Conclusions: Although obesity is highly prevalent, only a small percentage of obese Americans are on anti-obesity medication. The withdrawal of sibutramine would have minimal impact on the general population. There is a need for more lifestyle changes in the majority of obese individuals. [Copyright &y& Elsevier]

This paper studies and compares the actual historic solar photovoltaic (PV) installation data in Japan and the United States and proposes two deployment models to account for the differences. Deployment, along with research, development and demonstration, constitutes what is known as the RD3 (PCAST — President's Council of Advances in Science and Technology, United States) innovative chain of a new technology. Japan deploys PV focusing on the niche of utility grid-tied small-scale system (90 per cent of which is standardised roof-top residential PV system) using highly integrated value chain; this seems to draw upon her strong manufacturing culture and associated social technology and institutions for suppliers-dominated innovations. The United States deploys PV as a broadly defined innovation emphasising user-oriented customisation in both on and off grid, residential and industrial applications using small independent and intermediary system integrators. Empirical analysis of the diffusion patterns in the grid-tied small system category in respective contexts suggests that Japan's institutions seem to match her mass deployment strategy while the United States' combination of fragmented industry structure and diversity deployment gives rise to a complex diffusion pattern calling for continual institutional innovation or co-evolution. Our research, therefore, highlights that commercialisation of new technology or technical change, in general, is not an autonomous process and has strong institutional underpinnings. We formalise and generalise this "match" (Perez, 1983) argument in accordance with Nelson and Sampat's (2001) framework of physical technology vs social technology and their interactions. Some potential future extensions regarding utilities for this model are then highlighted. [ABSTRACT FROM AUTHOR]

Objective: To identify primary care structures and processes that have the highest and lowest impact on chronic disease management and screening and prevention outcomes as well as to assess the feasibility of implementing these structures and processes into practice., Design: A two-round Delphi study was conducted to establish consensus on the impact and feasibility of 258 primary care structures and processes., Participants: 29 primary care providers, health system leaders and health services researchers in the USA., Outcomes: Primary outcomes were (1) consensus on the impact of each structure and process on chronic disease management and screening and prevention outcomes, separately and (2) consensus on feasibility of implementation by primary care practices., Results: Consensus on high impact and feasibility of implementation was reached on four items for chronic disease management: 'Providers use motivational interviewing to help patients set goals', 'Practice has designated staff to manage patient panel', 'Practice has onsite providers or staff that speak the most dominant, non-English language spoken by patients' and 'Practice includes mental health providers and/or behavioural health specialists in care team' and seven items for screening and prevention: 'Practice utilizes standing protocols and orders', 'Practice generates reports to alert clinicians to missed targets and to identify gaps in care, such as overdue visits, needed vaccinations, screenings or other preventive services', 'Practice has designated staff to manage patient panel', 'Practice sets performance goals and uses benchmarking to track quality of care', 'Practice uses performance feedback to identify practice-specific areas of improvement', 'Practice builds quality improvement activities into practice operations' and 'Pre-visit planning data are reviewed during daily huddles'. Only 'Practice has designated staff to manage patient panel' appeared on both lists., Conclusion: Findings suggest that practices need to focus on implementing mostly distinct, rather than common, structures and processes to optimise chronic disease and preventive care., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)