ObjectiveThe Eat Well Move More (EWMM) family and child weight management service is a 12-week intervention integrating healthy eating and physical activity education and activities for families and children aged 4–16. EWMM service providers identified low uptake 12 months prior to the evaluation. The aims of this study were to describe referral practices and pathways into the service to identify potential reasons for low referral and uptake rates.ResultsWe conducted interviews and focus groups with general practitioners (GPs) (n = 4), school nurses, and nursing assistants (n = 12). Data were analysed using thematic analysis. School nurses highlighted three main barriers to making a referral: parent engagement, child autonomy, and concerns over the National Child Measurement Programme letter. GPs highlighted that addressing obesity among children is a ‘difficult conversation’ with several complex issues related to and sustaining that difficulty. In conclusion, referral into weight management services in the community may persistently lag if a larger and more complex tangle of barriers lie at the point of school nurse and GP decision-making. The national prevalence of, and factors associated with this hesitation to discuss weight management issues with parents and children remains largely unknown.
A deck-based game is a modification of a game that normally permits the players to use any number of moves of any type. This freedom of choice of moves is limited by handing each player a deck of cards, each of which with a single move printed on it. The player must then play from their deck rather than simply choosing the moves. This study documents that deck-based iterated prisoner's dilemma is radically different from standard prisoner's dilemma when the entire deck must be expended during play. The restrictions imposed by the deck change the game into a coordination game or an anti-coordination game. The game is shown to transform smoothly into standard prisoner's dilemma as the fraction of the deck used in play is reduced, assuming that a constant ratio of the two types of moves are used in the deck. The size of the deck, ratio of defects to cooperates, and evolutionary algorithm parameters are all studied using a string based representation. An adaptive agent representation is also developed, based on augmented finite state machines called deck automata. Deck automata evolve to play the game more effectively than the string based agents for three different situations; experiments in which agents expend all, three-quarters, or half the available cards.
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