688,085 research outputs found

    An internet-based intervention with brief nurse support to manage obesity in primary care (POWeR+): a pragmatic, parallel-group, randomised controlled trial

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    Background The obesity epidemic has major public health consequences. Expert dietetic and behavioural counselling with intensive follow-up is effective, but resource requirements severely restrict widespread implementation in primary care, where most patients are managed. We aimed to estimate the effectiveness and cost-effectiveness of an internet-based behavioural intervention (POWeR+) combined with brief practice nurse support in primary care. Methods We did this pragmatic, parallel-group, randomised controlled trial at 56 primary care practices in central and south England. Eligible adults aged 18 years or older with a BMI of 30 kg/m2 or more (or ≥28 kg/m2 with hypertension, hypercholesterolaemia, or diabetes) registered online with POWeR+—a 24 session, web-based, weight management intervention lasting 6 months. After registration, the website automatically randomly assigned patients (1:1:1), via computer-generated random numbers, to receive evidence-based dietetic advice to swap foods for similar, but healthier, choices and increase fruit and vegetable intake, in addition to 6 monthly nurse follow-up (control group); web-based intervention and face-to-face nurse support (POWeR+Face-to-face [POWeR+F]; up to seven nurse contacts over 6 months); or web-based intervention and remote nurse support (POWeR+Remote [POWeR+R]; up to five emails or brief phone calls over 6 months). Participants and investigators were masked to group allocation at the point of randomisation; masking of participants was not possible after randomisation. The primary outcome was weight loss averaged over 12 months. We did a secondary analysis of weight to measure maintenance of 5% weight loss at months 6 and 12. We modelled the cost-effectiveness of each intervention. We did analysis by intention to treat, with multiple imputation for missing data. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN21244703. Findings Between Jan 30, 2013, and March 20, 2014, 818 participants were randomly assigned to the control group (n=279), the POWeR+F group (n=269), or the POWeR+R group (n=270). Weight loss averaged over 12 months was recorded in 666 (81%) participants. The control group lost almost 3 kg over 12 months (crude mean weight: baseline 104·38 kg [SD 21·11; n=279], 6 months 101·91 kg [19·35; n=136], 12 months 101·74 kg [19·57; n=227]). The primary imputed analysis showed that compared with the control group, patients in the POWeR+F group achieved an additional weight reduction of 1·5 kg (95% CI 0·6–2·4; p=0·001) averaged over 12 months, and patients in the POWeR+R group achieved an additional 1·3 kg (0·34–2·2; p=0·007). 21% of patients in the control group had maintained a clinically important 5% weight reduction at month 12, compared with 29% of patients in the POWeR+F group (risk ratio 1·56, 0·96–2·51; p=0·070) and 32% of patients in the POWeR+R group (1·82, 1·31–2·74; p=0·004). The incremental overall cost to the health service per kg weight lost with the POWeR+ interventions versus the control strategy was £18 (95% CI −129 to 195) for POWeR+F and –£25 (−268 to 157) for POWeR+R; the probability of being cost-effective at a threshold of £100 per kg lost was 88% and 98%, respectively. No adverse events were reported. Interpretation Weight loss can be maintained in some individuals by use of novel written material with occasional brief nurse follow-up. However, more people can maintain clinically important weight reductions with a web-based behavioural program and brief remote follow-up, with no increase in health service costs. Future research should assess the extent to which clinically important weight loss can be maintained beyond 1 year

    Equipping Advanced Practice Providers: Interprofessional Pediatric Airway Management Course

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    Background: Developmental differences between pediatrics and adults requires intervention adjustments for airway management. Segregated intraprofessional training and limited provider exposure could result in poor collaboration and low-quality management. Patient outcomes depend on the proficient collaborative application of skill and knowledge. Purpose: The interprofessional pediatric airway management course paired unique airway considerations with interprofessional training strategies to equip providers to deliver safe airway management. Intervention: The course was delivered as a 3-hour training session. Participants completed team simulations and skill/concept stations. Pre- and post-intervention competency and confidence scores were measured and analyzed. Methods: Baseline confidence and competency scores in managing a pediatric airway were established through an initial team simulation. Participants attended discussions and practiced aspects of airway management. Participants then completed a modified version of the initial simulation. Results: Two competency items showed statistically significant improvements. A clinically significant item could not be analyzed because there was no difference in means. There was an average improvement for all confidence measures with nine questions being statistically significant. Conclusion: This project improved participants’ confidence in several aspects of pediatric airway management. Competency was improved in fifteen of the twenty-three measured actions. However, not all of these were statistically significant, and the small sample size limited the statistical power

    Smart Vehicle to Grid Interface Project: Electromobility Management System Architecture and Field Test Results

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    This paper presents and discusses the electromobility management system developed in the context of the SMARTV2G project, enabling the automatic control of plug-in electric vehicles' (PEVs') charging processes. The paper describes the architecture and the software/hardware components of the electromobility management system. The focus is put in particular on the implementation of a centralized demand side management control algorithm, which allows remote real time control of the charging stations in the field, according to preferences and constraints expressed by all the actors involved (in particular the distribution system operator and the PEV users). The results of the field tests are reported and discussed, highlighting critical issues raised from the field experience.Comment: To appear in IEEE International Electric Vehicle Conference (IEEE IEVC 2014

    Production of Innovations within Farmer–Researcher Associations Applying Transdisciplinary Research Principles

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    Small-scale farmers in sub-Saharan West Africa depend heavily on local resources and local knowledge. Science-based knowledge is likely to aid decision-making in complex situations. In this presentation, we highlight a FiBL-coordinated research partnership between three national producer organisations and national agriculture research bodies in Mali, Burkina Faso, and Benin. The partnership seeks to compare conventional, GMObased, and organic cotton systems as regards food security and climate change

    Power quality and electromagnetic compatibility: special report, session 2

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    The scope of Session 2 (S2) has been defined as follows by the Session Advisory Group and the Technical Committee: Power Quality (PQ), with the more general concept of electromagnetic compatibility (EMC) and with some related safety problems in electricity distribution systems. Special focus is put on voltage continuity (supply reliability, problem of outages) and voltage quality (voltage level, flicker, unbalance, harmonics). This session will also look at electromagnetic compatibility (mains frequency to 150 kHz), electromagnetic interferences and electric and magnetic fields issues. Also addressed in this session are electrical safety and immunity concerns (lightning issues, step, touch and transferred voltages). The aim of this special report is to present a synthesis of the present concerns in PQ&EMC, based on all selected papers of session 2 and related papers from other sessions, (152 papers in total). The report is divided in the following 4 blocks: Block 1: Electric and Magnetic Fields, EMC, Earthing systems Block 2: Harmonics Block 3: Voltage Variation Block 4: Power Quality Monitoring Two Round Tables will be organised: - Power quality and EMC in the Future Grid (CIGRE/CIRED WG C4.24, RT 13) - Reliability Benchmarking - why we should do it? What should be done in future? (RT 15

    Evaluation of the EMC environment generated by a static var compensator

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    Describes an evaluation of the EMC environment generated by a static var compensator

    Prediction of switching transients in high voltage air-insulated substations

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    Describes the process of prediction of switching transients in high voltage air-insulated substations
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