Be SMART:examining the experience of implementing the NHS Health Check in UK primary care

Background: The NHS Health Check was designed by UK Department of Health to address increased prevalence of cardiovascular disease by identifying risk levels and facilitating behaviour change. It constituted biomedical testing, personalised advice and lifestyle support. The objective of the study was to explore Health Care Professionals' (HCPs) and patients' experiences of delivering and receiving the NHS Health Check in an inner-city region of England. Methods: Patients and HCPs in primary care were interviewed using semi-structured schedules. Data were analysed using Thematic Analysis. Results: Four themes were identified. Firstly, Health Check as a test of 'roadworthiness' for people. The roadworthiness metaphor resonated with some patients but it signified a passive stance toward illness. Some patients described the check as useful in the theme, Health check as revelatory. HCPs found visual aids demonstrating levels of salt/fat/sugar in everyday foods and a 'traffic light' tape measure helpful in communicating such 'revelations' with patients. Being SMART and following the protocolrevealed that few HCPs used SMART goals and few patients spoke of them. HCPs require training to understand their rationale compared with traditional advice-giving. The need for further follow-up revealed disparity in follow-ups and patients were not systematically monitored over time. Conclusions: HCPs' training needs to include the use and evidence of the effectiveness of SMART goals in changing health behaviours. The significance of fidelity to protocol needs to be communicated to HCPs and commissioners to ensure consistency. Monitoring and measurement of follow-up, e.g., tracking of referrals, need to be resourced to provide evidence of the success of the NHS Health Check in terms of healthier lifestyles and reduced CVD risk

Antibacterial activity of Artemisia nilagirica leaf extracts against clinical and phytopathogenic bacteria

<p>Abstract</p> <p>Background</p> <p>The six organic solvent extracts of <it>Artemisia nilagirica </it>were screened for the potential antimicrobial activity against phytopathogens and clinically important standard reference bacterial strains.</p> <p>Methods</p> <p>The agar disk diffusion method was used to study the antibacterial activity of <it>A. nilagirica </it>extracts against 15 bacterial strains. The Minimum Inhibitory Concentration (MIC) of the plant extracts were tested using two fold agar dilution method at concentrations ranging from 32 to 512 μg/ml. The phytochemical screening of extracts was carried out for major phytochemical derivatives in <it>A. nilagirica</it>.</p> <p>Results</p> <p>All the extracts showed inhibitory activity for gram-positive and gram-negative bacteria except for <it>Klebsiella pneumoniae, Enterococcus faecalis </it>and <it>Staphylococcus aureus</it>. The hexane extract was found to be effective against all phytopathogens with low MIC of 32 μg/ml and the methanol extract exhibited a higher inhibition activity against <it>Escherichia coli, Yersinia enterocolitica, Salmonella typhi</it>, <it>Enterobacter aerogenes</it>, <it>Proteus vulgaris</it>, <it>Pseudomonas aeruginosa </it>(32 μg/ml), <it>Bacillus subtilis </it>(64 μg/ml) and <it>Shigella flaxneri </it>(128 μg/ml). The phytochemical screening of extracts answered for the major derivative of alkaloids, amino acids, flavonoids, phenol, quinines, tannins and terpenoids.</p> <p>Conclusion</p> <p>All the extracts showed antibacterial activity against the tested strains. Of all, methanol and hexane extracts showed high inhibition against clinical and phytopathogens, respectively. The results also indicate the presence of major phytochemical derivatives in the <it>A. nilagirica </it>extracts. Hence, the isolation and purification of therapeutic potential compounds from <it>A. nilagirica </it>could be used as an effective source against bacterial diseases in human and plants.</p

Summer warming explains widespread but not uniform greening in the Arctic tundra biome

Arctic warming can influence tundra ecosystem function with consequences for climate feedbacks, wildlife and human communities. Yet ecological change across the Arctic tundra biome remains poorly quantified due to field measurement limitations and reliance on coarse-resolution satellite data. Here, we assess decadal changes in Arctic tundra greenness using time series from the 30 m resolution Landsat satellites. From 1985 to 2016 tundra greenness increased (greening) at ~37.3% of sampling sites and decreased (browning) at ~4.7% of sampling sites. Greening occurred most often at warm sampling sites with increased summer air temperature, soil temperature, and soil moisture, while browning occurred most often at cold sampling sites that cooled and dried. Tundra greenness was positively correlated with graminoid, shrub, and ecosystem productivity measured at field sites. Our results support the hypothesis that summer warming stimulated plant productivity across much, but not all, of the Arctic tundra biome during recent decades

Tuberculose vertebral (doença de Pott) associada a abscesso de psoas: relato de dois casos e revisão da literatura Spinal tuberculosis (Pott's disease) associated to psoas abscess: report of two cases and a literature review

A tuberculose é uma das principais doenças infecciosas de acometimento mundial com 3,9 milhões de casos notificados no mundo, em 2002. A forma esquelética pode corresponder a 3% do número total de casos, sendo 50% devido à tuberculose vertebral. O abscesso de psoas é uma entidade clínica rara com aproximadamente 12 casos relatados por ano na literatura médica e tem no Mycobacterium tuberculosis, um dos seus agentes etiológicos. O objetivo deste trabalho é relatar dois casos de tuberculose vertebral associada a abscesso de psoas atendidos em nosso serviço, bem como uma revisão da literatura.<br>Tuberculosis is one of the most important infectious disease worldwide, with 3,9 million reported cases in the world in 2002. The skeletal form is responsible for 3% of the total number of cases, with 50% of these due to spinal tuberculosis. The psoas abscess is a rare clinical entity with approximately 12 cases per year described in the medical literature and has in the Mycobacterium tuberculosis , one of its etiologic agents. The objective of this work is to report two cases of spinal tuberculosis associated with psoas abscess attended at our service, as well as a review of the literature

Calculation of CO 2 activities using scapolite equilibria: constraints on the presence and composition of a fluid phase during high grade metamorphism

Thermodynamic and phase equilibrium data for scapolite have been used to calculate CO 2 activities ( a CO 2 ) and to evaluate the presence or absence of a fluid phase in high-grade scapolite bearing meta-anorthosite, granulites, calc-silicates, and mafix xenoliths. The assemblage scapolite-plagioclase-garnet±quartz may be used to calculate or limit a CO 2 by the reaction Meionite+Quartz = Grossular+Anorthite+CO 2 . Granulites from four high-grade terranes (Grenville Province, Canada; Sargut Belt, India; Furua Complex, Tanzania; Bergen Arcs, Norway) yield a CO 2 =0.4-1, with most >0.7. For scapolite-bearing granulites from the Furua Complex, in which a CO 2 ≥0.9, calculated H 2 O activities ( a H 2 O) based on phlogopite dehydration equilibria are uniformly low (0.1–0.2). The a CO 2 calculated for meta-anorthosite from the Grenville Province, Ontario, ranges from 0.2 to 0.8. For Grenville meta-anorthosite also containing epidote, the a H 2 O calculated from clinozoisite dehydration ranges from 0.2 to 0.6. Calc-silicates from the Grenville, Sargur, and Furua terranes mostly yield a CO 2 1). The calculated fluid activities are consistent with metamorphism (1) in the presence of a mixed CO 2 −H 2 O fluid phase in which CO 2 is the dominant fluid species but other C−O−H−S species are minor, (2) in the absence of a bulk fluid phase (“fluid-absent metamorphism”), or (3) in the presence of a fluid-bearing melt phase. The results for many granulites and Grenville meta-anorthosite are consistent with the presence of a CO 2 -rich, mixed CO 2 −H 2 O fluid phase. In contrast the relatively restricted and low values of a CO 2 for calc-silicates require an H 2 O-rich fluid or absence of a fluid phase during metamorphism. The range of values for xenoliths are most consistent with absence of a fluid phase. The primary implication of these results is that a CO 2 -rich fluid accounts for the reduced a H2 O in scapolite-bearing granulites. However, scapolite may be stable with a wide range of fluid compositions or in the absence of a fluid phase, and the presence of scapolite is not a priori evidence of a CO 2 -rich fluid phase. In addition, close association of scapolite-free mafic granulites with scapolite-bearing granulites having identical mineral compositions in the Furua Complex, and the absence of scapolite from most granulite terranes implies that a CO 2 -rich fluid phase is not pervasive on an outcrop scale or common to all granulite terranes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47295/1/410_2004_Article_BF00307340.pd