The HealthyFood program offers members up to 25% cash back monthly on healthy food purchases. In this randomized controlled trial, we tested the efficacy of financial incentives combined with text messages in increasing healthy food purchases among HF members. Members receiving the lowest cash back level were randomized to one of six arms: Arm 1 : 10% cash back, no weekly text, standard monthly text; Arm 2: 10% cash back, generic weekly text, standard monthly text; Arm 3: 10% cash back, (...) personalized weekly text, standard monthly text; Arm 4: 25% cash back, personalized weekly text, standard monthly text; Arm 5: 10 + 15%NET cash back, personalized weekly text, standard monthly text; and, Arm 6: 10 + 15%NET cash back, personalized weekly text, unbundled monthly text. In the 10 + 15%NET cash back, the cash back amount was the baseline 10% plus 15% of the net difference between healthy and unhealthy spending. The generic text included information on HF and healthy eating, while the personalized text had individualized feedback on purchases. The standard monthly text contained the cash back amount. The unbundled monthly text included the amount lost due to unhealthy purchases. The primary outcome was the average monthly percent healthy food spending. Secondary outcomes were the percent unhealthy food spending, and the percent healthy and unhealthy food items. Of the members contacted, 20 opted out, and 2841 met all inclusion criteria. There were no between-arm differences in the examined outcomes. The largest mean difference in percent healthy spending was between Arm 1 and Arm 2, and the largest mean difference in percent unhealthy spending was also between Arm 1 and Arm 2, but no differences were statistically significant after correction for multiple comparisons. None of the tested financial incentive structures or text strategies differentially affected food purchasing. Notably, more than doubling the cash back amount and introducing a financial disincentive for unhealthy purchases did not affect purchasing. These findings speak to the difficulty of changing shopping habits and to the need for innovative strategies to shift complex health behaviors. NCT02486588 Increasing Engagement with a Healthy Food Benefit. The trial was prospectively registered on July 1, 2015. (shrink)

BackgroundClinical trials should be as inclusive as possible to facilitate equitable access to research and better reflect the population towards which any intervention is aimed. Informed by the UK’s National Institute for Health and Care Research (NIHR) Innovations in Clinical Trial Design and Delivery for the Under-served (INCLUDE) guidance, we audited oncology trials conducted by the Clinical Trials and Statistics Unit at The Institute of Cancer Research, London (ICR-CTSU) to identify whether essential documents were overtly excluding any groups and whether (...) sufficient data were collected to assess diversity of trial participants from groups suggested by INCLUDE as under-served by research in the UK.MethodsThirty cancer clinical trials managed by ICR-CTSU and approved between 2011–2021 were audited. The first ethics approved version of each trial’s protocol, patient information sheet, and patient completed questionnaire, together with the first case report forms (CRFs) version were reviewed. A range of items aligned with the INCLUDE under-served groups were assessed, including age, sex and gender, socio-economic and health factors. The scope did not cover trial processes in participating hospitals.ResultsData relating to participants’ age, ethnic group and health status were well collected and no upper age limit was specified in any trials’ eligibility criteria. 23/30 (77%) information sheets used at least one gendered term to address patients. Most CRFs did not specify whether they were collecting sex or gender and only included male or female categories. The median reading age for information sheets was 15–16 years (IQR: 14–15 – 16–17). Socio-economic factors were not routinely collected and not commonly mentioned in trial protocols.ConclusionsNo systemic issues were identified in protocols which would explicitly prevent any under-served group from participating. Areas for improvement include reducing use of gendered words and improving readability of patient information. The challenge of fully assessing adequate inclusion of under-served populations remains, as socio-economic factors are not routinely collected because they fall beyond the data generally required for protocol-specified trial endpoint assessments. This audit has highlighted the need to agree and standardise demographic data collection to permit adequate monitoring of the under-served groups identified by the NIHR. (shrink)

Innovations and Turning Points: Toward a History of Kāvya Literature. Edited by Yigal Bronner, David Shulman, and Gray Tubb. South Asia Research. New Delhi: Oxford University Press, 2014. Pp. xvi + 805. Rs. 1295, $39.95.

Some have referred to relatively recent forms of popular Buddhism as an ‘engaged’ Buddhism that has revived or redirected traditional Buddhist ideas and practices found in meditation texts to reflect a greater social or worldly emphasis than suggested in earlier historical moments. One of these ideas is the quadripartite framework of the ‘immeasurable states’ (aprameya/appameya) or ‘divine abidings’ (brahmavihāra), the most prominent of which in popular Buddhism is mettā (friendliness/loving-kindness). This article traces the philosophy of the ‘immeasurable states’ found in (...) meditation texts from various Indic traditions (Buddhist, Jain, and Hindu) and then presents the ways in which these traditional ideas (especially mettā) have informed popular Buddhist movements in the twentieth century. Points of discussion include: ‘engaged’ Buddhism's relationship with traditional Buddhist ethics; arguments concerning the coalescence of monastic-centred meditation practices with popular Buddhist notions of social service; and the distinct utilization of mettā in contemporary Buddhist societies in contrast to the mobilizing impulses of comparable religious communities (Hindu and Jain) with a similar heritage of mettā discourse in South Asia. (shrink)

This paper brings kāmaśāstra into conversation with poetics (alaṅkāraśāstra) and modes of literary criticism associated with Sanskrit literature (kāvya). It shows how historical intersections between kāvya, kāmaśāstra, and alaṅkāraśāstra have produced insightful cross-domain typologies to understand the nature and value of canonical works of Sanskrit literature. In addition to exploring kāmaśāstra typologies broadly as conceptual models and analytical categories useful in literary-critical contexts, this paper takes up a specific formulation from the kāmaśāstra (the padminī-citriṇī-śaṅkhinī-hastinī type-casting of females) used by a (...) twentieth century literary critic to frame the relationships between canonical poets of Sanskrit literature. (shrink)

In this paper we describe the nature and problems of business and define one aspect of the business environment. We then propose a framework based on augmented soft systems methodology and object technology that captures both the soft and hard aspects of a business environment within the context of organisational culture. We also briefly discuss cognitive informatics and its relevance to understanding problems and solutions. Pólya's work, which is based around solving mathematical problems, is considered within the context of information (...) systems development. We propose a generic reusable business object model based on general systems theory. We also show how these approaches can be integrated to provide a strategy for understanding business problems and developing integrated solutions. (shrink)

In this paper we describe the nature and problems of business and define one aspect of the business environment. We then propose a framework based on augmented soft systems methodology and object technology that captures both the soft and hard aspects of a business environment within the context of organisational culture. We also briefly discuss cognitive informatics and its relevance to understanding problems and solutions. Pólya's work, which is based around solving mathematical problems, is considered within the context of information (...) systems development. We propose a generic reusable business object model based on general systems theory. We also show how these approaches can be integrated to provide a strategy for understanding business problems and developing integrated solutions. (shrink)