The role of primary care in adult weight management: qualitative interviews with key stakeholders in weight management services

Background: Primary care has a key role to play in the prevention and management of obesity, but there remain barriers to engagement in weight management by primary care practitioners. The aim of this study was to explore the views of key stakeholders in adult weight management services on the role of primary care in adult weight management. Methods: Qualitative study involving semi-structured interviews with nine senior dietitians involved in NHS weight management from seven Scottish health boards. Transcripts were analysed using an inductive thematic approach. Results: A range of tensions were apparent within three key themes: weight management service issues, the role of primary care, and communication with primary care. For weight management services, these tensions were around funding, the management model of obesity, and how to configure access to services. For primary care, they were around what primary care should be doing, who should be doing it, and where this activity should fit within wider weight management policy. With regard to communication between weight management services and primary care, there were tensions related to the approach taken (locally adapted versus centralised), the message being communicated (weight loss versus wellbeing), and the response from practitioners (engagement versus resistance). Conclusions: Primary care can do more to support adult weight management, but this requires better engagement and communication with weight management services, to overcome the tensions highlighted in this study. This, in turn, requires more secure, sustained funding. The example of smoking cessation in the UK, where there is a network of well-resourced NHS Stop Smoking Services, accessible via different means, could be a model to follow

Patient and practice characteristics predicting attendance and completion at a specialist weight management service in the UK: a cross-sectional study

Objective: To determine the association between patient and referring practice characteristics and attendance and completion at a specialist health service weight management service (WMS). Design: Cross-sectional study. Setting: Regional specialist WMS located in the West of Scotland. Participants: 9677 adults with obesity referred between 2012 and 2014; 3250 attending service and 2252 completing. Primary and secondary outcome measures: Primary outcome measure was attendance at the WMS; secondary outcome was completion, defined as attending four or more sessions. Analysis: Multilevel binary logistic regression models constructed to determine the association between patient and practice characteristics and attendance and completion. Results: Approximately one-third of the 9677 obese adults referred attended at least one session (n=3250, 33.6%); only 2252 (23%) completed by attending four or more sessions. Practice referrals ranged from 1 to 257. Patient-level characteristics were strongest predictors of attendance; odds of attendance increased with age (OR 4.14, 95% CI 3.27 to 5.26 for adults aged 65+ compared with those aged 18–24), body mass index (BMI) category (OR 1.83, 95% CI 1.56 to 2.15 for BMI 45+ compared with BMI 30–35) and increasing affluence (OR 1.96, 95% CI 1.17 to 3.28). Practice-level characteristics most strongly associated with attendance were being a non-training practice, having a larger list size and not being located in the most deprived areas. Conclusions: There was wide variation in referral rates across general practice, suggesting that there is still much to do to improve engagement with weight management by primary care practitioners. The high attrition rate from referral to attendance and from attendance to completion suggests ongoing barriers for patients, particularly those from the most socioeconomically deprived areas. Patient and practice-level characteristics can help us understand the observed variation in attendance at specialist WMS following general practitioner (GP) referral and the underlying explanations for these differences merit further investigation

Growing Farm Size and the Distribution of Farm Payments

Crop production is shifting to much larger farms. Since government commodity payments reflect production volumes for program commodities, payments are also shifting to larger farms. In turn, the operators of very large farms have substantially higher household incomes than other farm households, and as a result government commodity payments are also shifting to much higher-income households. Since the changes in farm structure appear to be ongoing, commodity payments will likely, under current policies, continue to shift to higher income households. This brief uses 2003 Agricultural Resource Management Survey (ARMS) data to detail the shifts.Farm structure, commodity programs, farm payments, farm household income, farm income, farm program payments, ERS, USDA, Agricultural and Food Policy, Industrial Organization,

Anisotropic Thermal Conduction in Supernova Remnants: Relevance to Hot Gas Filling Factors in the Magnetized ISM

We explore the importance of anisotropic thermal conduction in the evolution of supernova remnants via numerical simulations. The mean temperature of the bubble of hot gas is decreased by a factor of ~3 compared to simulations without thermal conduction, together with an increase in the mean density of hot gas by a similar factor. Thus, thermal conduction greatly reduces the volume of hot gas produced over the life of the remnant. This underscores the importance of thermal conduction in estimating the hot gas filling fraction and emissivities in high-stage ions in Galactic and proto-galactic ISMs.Comment: Submitted to Astrophysical Journal Letters. 4 pages, 3 figure

Trapping of magnetic flux by the plunge region of a black hole accretion disk

The existence of the radius of marginal stability means that accretion flows around black holes invariably undergo a transition from a MHD turbulent disk-like flow to an inward plunging flow. We argue that the plunging inflow can greatly enhance the trapping of large scale magnetic field on the black hole, and therefore may increase the importance of the Blandford-Znajek (BZ) effect relative to previous estimates that ignore the plunge region. We support this hypothesis by constructing and analyzing a toy-model of the dragging and trapping of a large scale field by a black hole disk, revealing a strong dependence of this effect on the effective magnetic Prandtl number of the MHD turbulent disk. Furthermore, we show that the enhancement of the BZ effect depends on the geometric thickness of the accretion disk. This may be, at least in part, the physical underpinnings of the empirical relation between the inferred geometric thickness of a black hole disk and the presence of a radio jet.Comment: 18 pages, 3 figures, accepted for publication in the Astrophysical Journal. See http://www.astro.umd.edu/~chris/publications/movies/flux_trapping.html for animation

A real-time hybrid aurora alert system:combining citizen science reports with an auroral oval model

Accurately predicting when, and from where, an aurora will be visible is particularly difficult, yet it is a service much desired by the general public. Several aurora alert services exist that attempt to provide such predictions but are, generally, based upon fairly coarse estimates of auroral activity (e.g. Kp or Dst). Additionally, these services are not able to account for a potential observer's local conditions (such as cloud cover or level of darkness). Aurorasaurus, however, combines data from the well-used, solar wind driven, OVATION Prime auroral oval model with real-time observational data provided by a global network of citizen scientists. This system is designed to provide more accurate and localized alerts for auroral visibility than currently available. Early results are promising and show that over 100,000 auroral visibility alerts have been issued, including nearly 200 highly localized alerts, to over 2,000 users located right across the globe