Outcomes of a specialist weight management programme in the UK national health service: prospective study of 1838 patients

Objectives There is limited evidence on the effectiveness of weight management programmes provided within routine healthcare and inconsistent use of outcome measures. Our aim was to evaluate a large National Health Service (NHS) weight management service and report absolute and proportional weight losses over 12 months.<p></p> Design Prospective observational study.<p></p> Setting Glasgow and Clyde Weight Management Service (GCWMS), which provides care for residents of NHS Greater Glasgow and Clyde area (population 1.2 million).<p></p> Participants All patients who began GCWMS between 1 October 2008 and 30 September 2009.<p></p> Interventions Structured educational lifestyle programme employing cognitive behavioural therapy, 600 kcal deficit diet, physical activity advice, lower calorie diet and pharmacotherapy.<p></p> Primary and secondary outcomes measures Baseline observation carried forward (BOCF), last observation carried forward (LOCF) and changes in programme completers reported using outcomes of absolute 5 kg and 5% weight losses and mean weight changes at a variety of time points.<p></p> Results 6505 referrals were made to GCWMS, 5637 were eligible, 3460 opted in and 1916 (34%) attended a first session. 78 patients were excluded from our analysis on 1838 patients. 72.9% of patients were women, mean age of all patients at baseline was 49.1 years, 43.3% lived in highly socioeconomically deprived areas and mean weights and body mass indices at baseline were 118.1 kg and 43.3 kg/m2, respectively. 26% lost ≥5 kg by the end of phase 1, 30% by the end of phase 2 and 28% by the end of phase 3 (all LOCF). Weight loss was more successful among men, particularly those ≤29 years old.<p></p> Conclusions Routine NHS weight management services may achieve moderate weight losses through a comprehensive evidence-based dietary, activity and behavioural approach including psychological care. Weight losses should be reported using a range of outcome measures so that the effectiveness of different services can be compared

Twistor-Inspired Construction of Electroweak Vector Boson Currents

We present an extension of the twistor-motivated MHV vertices and accompanying rules presented by Cachazo, Svrvcek and Witten to the construction of vector-boson currents coupling to an arbitrary source. In particular, we give rules for constructing off-shell vector-boson currents with one fermion pair and n gluons of arbitrary helicity. These currents may be employed directly in the computation of electroweak amplitudes. The rules yield expressions in agreement with previously-obtained results for Z,W,\gamma^* --> qbar q + n gluons (analytically up to n=3, beyond via the Berends--Giele recursion relations). We also confirm that the contribution to a seven-point amplitude containing the non-abelian triple vector-boson coupling obtained using the next-to-MHV currents matches the previous result in the literature.Comment: 22 pages, 4 figures, v2 minor corrections and added commentary on multiple vector boson

Bootstrapping One-Loop QCD Amplitudes with General Helicities

The recently developed on-shell bootstrap for computing one-loop amplitudes in non-supersymmetric theories such as QCD combines the unitarity method with loop-level on-shell recursion. For generic helicity configurations, the recursion relations may involve undetermined contributions from non-standard complex singularities or from large values of the shift parameter. Here we develop a strategy for sidestepping difficulties through use of pairs of recursion relations. To illustrate the strategy, we present sets of recursion relations needed for obtaining n-gluon amplitudes in QCD. We give a recursive solution for the one-loop n-gluon QCD amplitudes with three or four color-adjacent gluons of negative helicity and the remaining ones of positive helicity. We provide an explicit analytic formula for the QCD amplitude A_{6;1}(1^-,2^-,3^-,4^+,5^+,6^+), as well as numerical results for A_{7;1}(1^-,2^-,3^-,4^+,5^+,6^+,7^+), A_{8;1}(1^-,2^-,3^-,4^+,5^+,6^+,7^+,8^+), and A_{8;1}(1^-,2^-,3^-,4^-,5^+,6^+,7^+,8^+). We expect the on-shell bootstrap approach to have widespread applications to phenomenological studies at colliders.Comment: 77 pages, 17 figures; v2, corrected minor typos in text and small equation

The practical management of emergencies in primary care: Taking simulation out of the classroom and into real-life environments

Life threatening emergencies in the community are relatively infrequent and therefore provide a challenge for doctors in keeping up-to-date and maintaining confidence. Training in managing emergencies typically takes place through role play and classroom based simulation. In this project, we took simulation out of the classroom and into community environments where emergencies actually occur creating 'real-life' scenarios. These included the practical management of meningitis, anaphylaxis, hypoglycaemia, convulsions and cardiac arrest. Doctors had to find and utilize the equipment in their surgeries and were asked to physically draw up the appropriate medication. The simulation training was led by a GP and a Consultant in Intensive Care Medicine. Participants' confidence in managing emergencies significantly increased after the workshops. Qualitative feedback illustrated the need for more simulation based learning: "I hope this can be done regularly as it will make a huge difference to patient care", "Excellent - life like to make more memorable", "Good to use the actual surgery equipment". Many of the participants knew the theory of what to do but lacked the practical skills to efficiently manage emergency scenarios. Training doctors through simulation needs to be taken out of the classroom and into real life environments. This is particularly important for 'time critical illnesses' where delays can have a direct impact on morbidity and mortality

Managing emergencies in primary care: does real-world simulation-based training have any lasting impact?

General Practitioners (GPs) have a responsibility to provide prompt and effective care when attending to life threatening emergencies in their GP surgeries. Primary care staff undertake mandatory, annual basic life support training. However, most emergencies are peri-arrest situations, and this is an area where GPs lack confidence and competence [1, 2]. The importance of effective, early intervention in peri-arrest scenarios was highlighted by the NCEPOD report “Time to Intervene (2012)” [3]. This report suggested that better early assessment and intervention may have prevented progression to cardiorespiratory arrest. GPs need to be equipped to manage ‘time critical’ emergencies, particularly as GP surgeries are deemed a place of safety and 999 ambulances can be redirected to other emergencies, thereby delaying transfer to secondary care for patients in GP settings. In previous work, we demonstrated that GPs’ confidence in managing time critical emergencies was initially low, and significantly improved immediately after attending ‘real-world’, simulation based workshops [1]. The value of real-world, in-house simulation based training has also been shown to increase “practical preparedness” in the context of resuscitation training (4). However, there is relatively little data regarding the long term value of simulation based training in primary care (5). In the current paper, we assessed whether our workshops had any longer-term benefit on participants’ confidence in managing emergencies and if it led to any changes in clinical practice

DNA molecules and human therapeutics

Nucleic acid molecules are championing a new generation of reverse engineered biopharmaceuticals. In terms of potential application in gene medicine, plasmid DNA (pDNA) vectors have exceptional therapeutic and immunological profiles as they are free from safety concerns associated with viral vectors, display non-toxicity and are simpler to develop. This review addresses the potential applications of pDNA molecules in vaccine design/development and gene therapy via recombinant DNA technology as well as a staged delivery mechanism for the introduction of plasmid-borne gene to target cells via the nasal route