Interventions targeted at primary care practitioners to improve the identification and referral of patients with co-morbid obesity: a realist review protocol

<b>Background </b>Obesity is one of the most significant public health challenges in the developed world. Recent policy has suggested that more can be done in primary care to support adults with obesity. In particular, general practitioners (GPs) and practice nurses (PNs) could improve the identification and referral of adults with obesity to appropriate weight management services. Previous interventions targeted at primary care practitioners in this area have had mixed results, suggesting a more complex interplay between patients, practitioners, and systems. The objectives of this review are (i) to identify the underlying ‘programme theory’ of interventions targeted at primary care practitioners to improve the identification and referral of adults with obesity and (ii) to explore how and why GPs and PNs identify and refer individuals with obesity, particularly in the context of weight-related co-morbidity. This protocol will explain the rationale for using a realist review approach and outline the key steps in this process. <p></p> <b>Methods</b> Realist review is a theory-led approach to knowledge synthesis that provides an explanatory analysis aimed at discerning what works, for whom, in what circumstances, how, and why. In this review, scoping interviews with key stakeholders involved in the planning and delivery of adult weight management services in Scotland helped to inform the identification of formal theories - from psychology, sociology, and implementation science - that will be tested as the review progresses. A comprehensive search strategy is described, including scope for iterative searching. Data analysis is outlined in three stages (describing context-mechanism-outcome configurations, exploring patterns in these configurations, and developing and testing middle-range theories, informed by the formal theories previously identified), culminating in the production of explanatory programme theory that considers individual, interpersonal, and institutional/systems-level components. <p></p> <b>Discussion </b>This is the first realist review that we are aware of looking at interventions targeted at primary care practitioners to improve the weight management of adults with obesity. Engagement with stakeholders at an early stage is a unique feature of realist review. This shapes the scope of the review, identification of candidate theories and dissemination strategies. The findings of this review will inform policy and future interventions. Systematic review registration PROSPERO CRD4201400939

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

Paper Session I-A - Benchmarking: A Tool For Sharing and Cooperation

Kennedy Space Center, AmericaÕs gateway to the universe, leads the world in preparing and launching missions from earth to the frontiers of space. NASAÕs mission is to advance and communicate scientific knowledge and understanding; explore, use, and develop space; and research, develop, and transfer aerospace technologies. Like any private or public organization, NASA and its contractors are faced with the challenge of performing work better, faster, and cheaper, while maintaining world-class levels of safety and quality. To meet this challenge, the KSC team is using benchmarking as one tool to achieve the goal of improving the bottom-line. Benchmarking is a disciplined approach for comparing and measuring work processes against best-in-class organizations. One outcome of performing a benchmarking study is the identification of best practices that enable superior performance. These best practices can then be adapted and incorporated to achieve improvements in cost, quality, schedule, and cycle time

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

Recovery from disability after stroke as a target for a behavioural intervention: Results of a randomised controlled trial

Purpose: Disability following stroke is highly prevalent and is predicted by psychological variables such as control cognitions and emotions, in addition to clinical variables. This study evaluated the effectiveness of a workbook-based intervention, designed to change cognitions about control, in improving outcomes for patients and their carers. Method: At discharge, stroke patients were randomly allocated (with their carers) to a 5-week intervention (n = 103) or control (normal care: n = 100). The main outcome (at 6 months) was recovery from disability using a performance measure, with distress and satisfaction as additional outcomes. Results: The intervention group showed significantly better disability recovery, allowing for initial levels of disability, than those in the control group, F(1,201) = 5.61, p = 0.019. Groups did not differ in distress or satisfaction with care for patients or carers. The only psychological process variable improved by the intervention was Confidence in Recovery but this did not mediate the effects on recovery. Conclusions: A large proportion of intervention participants did not complete the workbook tasks. This was perhaps associated with the fairly low level of personal contact with workbook providers. The modest success of this intervention suggests that it may be possible to develop effective behavioural interventions to enhance recovery from disability in stroke patients

Sign Tracking and Goal Tracking Are Characterized by Distinct Patterns of Nucleus Accumbens Activity

During Pavlovian conditioning, if a cue (e.g., lever extension) predicts reward delivery in a different location (e.g., a food magazine), some individuals will come to approach and interact with the cue, a behavior known as sign tracking (ST), and others will approach the site of reward, a behavior known as goal tracking (GT). In rats, the acquisition of ST versus GT behavior is associated with distinct profiles of dopamine release in the nucleus accumbens (NAc), but it is unknown whether it is associated with different patterns of accumbens neural activity. Therefore, we recorded from individual neurons in the NAc core during the acquisition, maintenance, and extinction of ST and GT behavior. Even though NAc dopamine is specifically important for the acquisition and expression of ST, we found that cue-evoked excitatory responses encode the vigor of both ST and GT behavior. In contrast, among sign trackers only, there was a prominent decrease in reward-related activity over the course of training, which may reflect the decreasing reward prediction error encoded by phasic dopamine. Finally, both behavior and cue-evoked activity were relatively resistant to extinction in sign trackers, as compared with goal trackers, although a subset of neurons in both groups retained their cue-evoked responses. Overall, the results point to the convergence of multiple forms of reward learning in the NAc

Should GPs provide spiritual care?

No abstract available

Salamander limb regeneration involves the activation of a multipotent skeletal muscle satellite cell population

In contrast to mammals, salamanders can regenerate complex structures after injury, including entire limbs. A central question is whether the generation of progenitor cells during limb regeneration and mammalian tissue repair occur via separate or overlapping mechanisms. Limb regeneration depends on the formation of a blastema, from which the new appendage develops. Dedifferentiation of stump tissues, such as skeletal muscle, precedes blastema formation, but it was not known whether dedifferentiation involves stem cell activation. We describe a multipotent Pax7+ satellite cell population located within the skeletal muscle of the salamander limb. We demonstrate that skeletal muscle dedifferentiation involves satellite cell activation and that these cells can contribute to new limb tissues. Activation of salamander satellite cells occurs in an analogous manner to how the mammalian myofiber mobilizes stem cells during skeletal muscle tissue repair. Thus, limb regeneration and mammalian tissue repair share common cellular and molecular programs. Our findings also identify satellite cells as potential targets in promoting mammalian blastema formation

Interviews with John O. Carter, Carol Charlotte, Paul T. Sissell, Virgie Stevenson, Addie May Morrison, and Clarence A. Morrison

Interviews with John O. Carter, Carol Charlotte, Paul T. Sissell, Virgie Stevenson, Addie May Morrison, and Clarence A. Morrison 00:00:00 - Introduction, John 0. Carter of Garden City, KS on February 16, 1966 00:00:31 - Founding of Garden City 00:16:46 - Introduction, Carol Charlotte of Kinsley, KS 00:17:18 - Song, The Chinaman , vocal 00:18:37 - Song, True Blue Bill , vocal 00:20:52 - Song, Tie Pin Knots in the Devil\u27s Tail , vocal 00:24:18 - Song, Put me in your pocket , vocal 00:30:15 - Song, My True Love , vocal 00:32:42 - Introduction, Paul T. Sissell of Palco, KS 00:33:11 - Song, When I was a little boy , vocal 00:35:23 - Tall tale, Melted stove 00:36:55 - Song, Madelina Catalina , vocal by an unnamed woman 00:38:15 - Introduction, Virgie F. Stevenson of Iola, KS 00:38:40 - Move to Abilene, KS in 1871 00:39:58 - Grasshopper swarm in 1872 00:40:50 - Fear of Indigenous Americans 00:41:56 - Housing 00:42:36 - Introduction, Addie May Morrison of Elkhart, KS 00:43:03 - Father\u27s trip to Santa Fe, NM in 1860 00:45:13 - Discovery of coal in Kansas (beginning of the story is cut off) 00:46:26 - Introduction, Clarence A. Morrison of Elkhart, KS 00:46:44 - Grandfather\u27s stories about Indigenous Americans and their relationship with the gray wolfhttps://scholars.fhsu.edu/sackett/1125/thumbnail.jp

Understanding the recovery of rare-earth elements by ammonium salts

While the recovery of rare earth elements (REEs) from aqueous solution by ionic liquids (ILs) has been well documented, the metal compounds that are formed in the organic phase remain poorly characterized. Using spectroscopic, analytical, and computational techniques, we provide detailed chemical analysis of the compounds formed in the organic phase during the solvent extraction of REEs by [(n-octyl)3NMe][NO3] (IL). These experiments show that REE recovery using IL is a rapid process and that IL is highly durable. Karl-Fischer measurements signify that the mode of action is unlikely to be micellar, while ions of the general formula REE(NO3)4(IL)2− are seen by negative ion electrospray ionization mass spectrometry. Additionally, variable temperature 139La nuclear magnetic resonance spectroscopy suggests the presence of multiple, low symmetry nitrato species. Classical molecular dynamics simulations show aggregation of multiple ILs around a microhydrated La3+ cation with four nitrates completing the inner coordination sphere. This increased understanding is now being exploited to develop stronger and more selective, functionalized ILs for REE recovery