There is limited evidence of the effectiveness of non-surgical interventions for severe obesity.Our aim was to evaluate a group intervention delivered by a National Health Service (NHS) specialist weight management service to contribute to the evidence base and inform the development of future services. Participants in this prospective cohort study were patients attending NHS Grampian Specialist Weight Management Services. The intervention was an interactive 12-session group programme based on evidence-based psychological model, with combined dietetic and psychological knowledge and support provided. The primary outcome was mean weight change at the end of the intervention and for 12-mo follow-up (including programme completers, baseline observation carried forward [BOCF], last observation carried forward). Secondary outcome measures included mood, anxiety, binge eating and quality of life. A total of 166 patients accepted a place on the group programme, mean body mass index was 48.9 kg/m 2 . Mean weight loss at 6 mo was 5.6 kg and 35.2% of those who completed the group (n = 88) lost ≥5%. Using BOCF, 18.7% lost ≥5% at 6 mo. Those who remained in the programme maintained their weight loss 12 and 18 mo after the start of the intervention. Significant improvements were also found in psychological variables, including reduced depression, anxiety, binge eating and improved emotion regulation. This real-world evaluation of an NHS intervention for patients with severe obesity suggests that individuals who engage achieve a moderate weight loss, which most maintain a year later, although further research is needed to strengthen this conclusion.
As large-scale, sophisticated open and distance learning environments expand in higher education globally, so does the need to support learning at scale in real time. Valid, reliable rubrics of critical discourse are an essential foundation for developing artificial intelligence tools that automatically analyse learning in educator-student dialogue. This article reports on a validation study where discussion transcripts from a target massive open online course (MOOC) were categorised into phases of cognitive presence to cross validate the use of an adapted rubric with a larger dataset and with more coders involved. Our results indicate that the adapted rubric remains stable for categorising the target MOOC discussion transcripts to some extent. However, the proportion of disagreements between the coders increased compared to the previous experimental study with fewer data and coders. The informal writing styles in MOOC discussions, which are not as prevalent in for-credit courses, caused ambiguities for the coders. We also found most of the disagreements appeared at adjacent phases of cognitive presence, especially in the middle phases. The results suggest additional phases may exist adjacent to current categories of cognitive presence when the educational context changes from traditional, smaller-scale courses to MOOCs. Other researchers can use these findings to build automatic analysis applications to support online teaching and learning for broader educational contexts in open and distance learning. We propose refinements to methods of cognitive presence and suggest adaptations to certain elements of the Community of Inquiry (CoI) framework when it is used in the context of MOOCs.
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