Steps to a better Belfast: physical activity assessment and promotion in primary care

BACKGROUND: Low physical activity (PA) levels which increase the risk of chronic disease are reported by two-thirds of the general UK population. Promotion of PA by primary healthcare professionals is advocated but more evidence is needed regarding effective ways of integrating this within everyday practice. This study aims to explore the feasibility of a randomised trial of a pedometer-based intervention, using step-count goals, recruiting patients from primary care. METHOD: Patients, aged 35-75, attending four practices in socioeconomically deprived areas, were invited to complete a General Practice PA Questionnaire during routine consultations. Health professionals invited 'inactive' individuals to a pedometer-based intervention and were randomly allocated to group 1 (prescribed a self-determined goal) or group 2 (prescribed a specific goal of 2500 steps/day above baseline). Both groups kept step-count diaries and received telephone follow-up at 1, 2, 6 and 11 weeks. Step counts were reassessed after 12 weeks. RESULTS: Of the 2154 patients attending, 192 questionnaires were completed (8.9%). Of these, 83 were classified as 'inactive'; 41(10 men; 31 women) completed baseline assessments, with the mean age of participants being 51 years. Mean baseline step counts were similar in group 1 (5685, SD 2945) and group 2 (6513, SD 3350). The mean increase in steps/day was greater in groups 1 than 2 ((2602, SD 1957) vs (748, SD 1997) p=0.005). CONCLUSIONS: A trial of a pedometer-based intervention using self-determined step counts appears feasible in primary care. Pedometers appear acceptable to women, particularly at a perimenopausal age, when it is important to engage in impact loading activities such as walking to maintain bone mineral density. An increase of 2500 steps/day is achievable for inactive patients, but the effectiveness of different approaches to realistic goal-setting warrants further study.

Modelling Transition Due to Backward Facing Steps Using the Laminar Kinetic Energy Concept

Boundary layer transition estimation and modelling is essential for the design of many engineering products across many industries. In this paper, the Reynolds-averaged Navier–Stokes are solved in conjunction with three additional transport equations to model and predict boundary layer transition. The transition model (referred to as the kTkT–kLkL–ωω model) is based on the kk–ωω framework with an additional transport equation to incorporate the effects low-frequency flow oscillations in the form of a laminar kinetic energy (kLkL). Firstly, a number of rectifications are made to the original kTkT–kLkL–ωω framework in order to ensure an appropriate response to the free-stream turbulence level and to improve near wall predictions. Additionally, the model is extended to incorporate the capability to model transition due to surface irregularities in the form of backward-facing steps with maximum non-dimensional step sizes of approximately 1.5 times the local displacement thickness of the boundary layer where the irregularity is located (i.e k/δ∗⪅1.5k/δ∗⪅1.5) at upstream turbulence intensities in the range 0.01<Tu(%)<0.80.01<Tu(%)<0.8. A novel function is proposed to incorporate transition sensitivity due to aft-facing steps. This paper details the rationale behind the development of this new function and demonstrates its suitability for transition onset estimation on a flat plate at zero pressure gradient.

First steps: study protocol for a randomized controlled trial of the effectiveness of the Group Family Nurse Partnership (gFNP) program compared to routine care in improving outcomes for high-risk mothers and their children and preventing abuse

Background: Evidence from the USA suggests that the home-based Family Nurse Partnership program (FNP), extending from early pregnancy until infants are 24 months, can reduce the risk of child abuse and neglect throughout childhood. FNP is now widely available in the UK. A new variant, Group Family Nurse Partnership (gFNP) offers similar content but in a group context and for a shorter time, until infants are 12 months old. Each group comprises 8 to 12 women with similar expected delivery dates and their partners. Its implementation has been established but there is no evidence of its effectiveness.

Methods/Design: The study comprises a multi-site randomized controlled trial designed to identify the benefits of gFNP compared to standard care. Participants (not eligible for FNP) must be either aged <20 years at their last menstrual period (LMP) with one or more previous live births, or aged 20 to 24 at LMP with low educational qualifications and no previous live births. 'Low educational qualifications' is defined as not having both Maths and English Language GCSE at grade C or higher or, if they have both, no more than four in total at grade C or higher. Exclusions are: under 20 years and previously received home-based FNP and, in either age group, severe psychotic mental illness or not able to communicate in English. Consenting women are randomly allocated (minimized by site and maternal age group) when between 10 and 16 weeks pregnant to either to the 44 session gFNP program or to standard care after the collection of baseline information. Researchers are blind to group assignment. The primary outcomes at 12 months are child abuse potential based on the revised Adult-Adolescent Parenting Inventory and parent/infant interaction coded using the CARE Index based on a video-taped interaction. Secondary outcomes are maternal depression, parenting stress, health related quality of life, social support, and use of services.

Discussion: This is the first study of the effectiveness of gFNP in the UK. Results should inform decision-making about its delivery alongside universal services, potentially enabling a wider range of families to benefit from the FNP curriculum and approach to supporting parenting.

Four steps to interpreting arterial blood gases

This article examines acid-base balance and the interpretation of arterial blood gases (ABG). The
article begins with a brief revision of related physiology, followed by a description of the primary
disorders associated with acid-base imbalance. The normal ranges and the significance of
abnormal ABG results are explored. The article concludes by providing an easy to follow four-step
guide to ABG interpretation with practice examples presented in the CPD task section.

Taking Baby Steps in Molecular Logic-based Computation

Molecular logic-based computation is a broad umbrella covering molecular sensors at its simplest level and logic gate arrays involving steadily increasing levels of parallel and serial integration. The fluorescent PET(photoinduced electron transfer) switching principle remains a loyal servant of this entire field. Applications arise from the convenient operation of molecular information processors in very small spaces.