Arterial O2 content and tension in regulation of cardiac output and leg blood flow during exercise in humans

[EN] A universal O2 sensor presumes that compensation for impaired O2 delivery is triggered by low O2 tension, but in humans, comparisons of compensatory responses to altered arterial O2 content (CaO2) or tension (PaO2) have not been reported. To directly compare cardiac output (QTOT) and leg blood flow (LBF) responses to a range of CaO2 and PaO2, seven healthy young men were studied during two-legged knee extension exercise with control hemoglobin concentration ([Hb] = 144.4 +/- 4 g/l) and at least 1 wk later after isovolemic hemodilution ([Hb] = 115 +/- 2 g/l). On each study day, subjects exercised twice at 30 W and on to voluntary exhaustion with an FIO2 of 0.21 or 0.11. The interventions resulted in two conditions with matched CaO2 but markedly different PaO2 (hypoxia and anemia) and two conditions with matched PaO2 and different CaO2 (hypoxia and anemia + hypoxia). PaO2 varied from 46 +/- 3 Torr in hypoxia to 95 +/- 3 Torr (range 37 to >100) in anemia (P < 0.001), yet LBF at exercise was nearly identical. However, as CaO2 dropped from 190 +/- 5 ml/l in control to 132 +/- 2 ml/l in anemia + hypoxia (P < 0.001), QTOT and LBF at 30 W rose to 12.8 +/- 0.8 and 7.2 +/- 0.3 l/min, respectively, values 23 and 47% above control (P < 0.01). Thus regulation of QTOT, LBF, and arterial O2 delivery to contracting intact human skeletal muscle is dependent for signaling primarily on CaO2, not PaO2. This finding suggests that factors related to CaO2 or [Hb] may play an important role in the regulation of blood flow during exercise in humans.

Role of caloric content on gastric emptying in humans

[EN] 1. This study examined the effects of caloric content (caloric density and the nature of calories) on the rate of gastric emptying using the double-sampling gastric aspiration technique. Four test meals of 600 ml (glucose, 0.1 kcal ml-1; pea and whey peptide hydrolysates, both 0.2 kcal ml-1; milk protein, 0.7 kcal ml-1) were tested in six healthy subjects in random order on four separate occasions. 2. The glucose solution was emptied the fastest with a half-time of 9.4 +/- 1.2 min (P < 0.05) and the milk protein the slowest with a half-time of 26.4 +/- 10.0 min (P < 0.05); the pea peptide hydrolysate and whey peptide hydrolysate solutions had half-times of emptying of 16.3 +/- 5.4 and 17.2 +/- 6.1 min, respectively. The rates of gastric emptying for the peptide hydrolysate solutions derived from different protein sources were not different. 3. Despite the lower rate of gastric emptying for the milk protein solution, the rate of caloric delivery to the duodenum during the early phase of the gastric emptying process was higher than that for the other three solutions (46.3 +/- 6, 63.5 +/- 22, 62.5 +/- 19 and 113.8 +/- 25 cal min-1 kg-1 for the glucose, pea peptide hydrolysate, whey peptide hydrolysate and milk protein meals, respectively; P < 0.05). The caloric density of the test solutions was linearly related to the half-time of gastric emptying (r = 0.96, P < 0.05) as well as to the rate at which calories were delivered to the duodenum (r = 0.99, P < 0.001). 4. This study demonstrates that the rate of gastric emptying is a function of the caloric density of the ingested meal and that a linear relationship exists between these variables. Furthermore, the nature of the calories seems to play a minor role in determining the rate of gastric emptying in humans.

Content and English Language Integrated Learning: The use of Moodle in Aircraft Maintenance Training Programs

The aim of this work is to develop a prototype of an e-learning environment that can foster Content and Language Integrated Learning (CLIL) for students enrolled in an aircraft maintenance training program, which allows them to obtain a license valid in all EU member states. Background research is conducted to retrace the evolution of the field of educational technology, analyzing different learning theories – behaviorism, cognitivism, and (socio-)constructivism – and reflecting on how technology and its use in educational contexts has changed over time. Particular attention is given to technologies that have been used and proved effective in Computer Assisted Language Learning (CALL). Based on the background research and on students’ learning objectives, i.e. learning highly specialized contents and aeronautical technical English, a bilingual approach is chosen, three main tools are identified – a hypertextbook, an exercise creation activity, and a discussion forum – and the learning management system Moodle is chosen as delivery medium. The hypertextbook is based on the technical textbook written in English students already use. In order to foster text comprehension, the hypertextbook is enriched by hyperlinks and tooltips. Hyperlinks redirect students to webpages containing additional information both in English and in Italian, while tooltips show Italian equivalents of English technical terms. The exercise creation activity and the discussion forum foster interaction and collaboration among students, according to socio-constructivist principles. In the exercise creation activity, students collaboratively create a workbook, which allow them to deeply analyze and master the contents of the hypertextbook and at the same time create a learning tool that can help them, as well as future students, to enhance learning. In the discussion forum students can discuss their individual issues, content-related, English-related or e-learning environment-related, helping one other and offering instructors suggestions on how to improve both the hypertextbook and the workbook based on their needs.

Leukocyte- and Platelet-Rich Fibrin (L-PRF) for Long-Term Delivery of Growth Factor in Rotator Cuff Repair: Review, Preliminary Results and Future Directions

Surgical repair of the rotator cuff repair is one of the most common procedures in orthopedic surgery. Despite it being the focus of much research, the physiological tendon-bone insertion is not recreated following repair and there is an anatomic non-healing rate of up to 94%. During the healing phase, several growth factors are upregulated that induce cellular proliferation and matrix deposition. Subsequently, this provisional matrix is replaced by the definitive matrix. Leukocyte- and platelet-rich fibrin (L-PRF) contain growth factors and has a stable dense fibrin matrix. Therefore, use of LPRF in rotator cuff repair is theoretically attractive. The aim of the present study was to determine 1) the optimal protocol to achieve the highest leukocyte content; 2) whether L-PRF releases growth factors in a sustained manner over 28 days; 3) whether standard/gelatinous or dry/compressed matrix preparation methods result in higher growth factor concentrations. 1) The standard L-PRF centrifugation protocol with 400 x g showed the highest concentration of platelets and leukocytes. 2) The L-PRF clots cultured in medium showed a continuous slow release with an increase in the absolute release of growth factors TGF-β1, VEGF and MPO in the first 7 days, and for IGF1, PDGF-AB and platelet activity (PF4=CXCL4) in the first 8 hours, followed by a decrease to close to zero at 28 days. Significantly higher levels of growth factor were expressed relative to the control values of normal blood at each culture time point. 3) Except for MPO and the TGFβ-1, there was always a tendency towards higher release of growth factors (i.e., CXCL4, IGF-1, PDGF-AB, and VEGF) in the standard/gelatinous- compared to the dry/compressed group. L-PRF in its optimal standard/gelatinous-type matrix can store and deliver locally specific healing growth factors for up to 28 days and may be a useful adjunct in rotator cuff repair.

TV Signal Delivery to Cable Operators and DTH Platform Operators

The paper discusses new business models of transmission of television programs in the context of definitions of broadcasting and retransmission. Typically the whole process of supplying content to the end user has two stages: a media service provider supplies a signal assigned to a given TV channel to the cable operators and satellite DTH platform operators (dedicated transmission), and cable operators and satellite DTH platform operators transmit this signal to end users. In each stage the signals are encoded and are not available for the general public without the intervention of cable/platform operators. The services relating to the supply and transmission of the content are operated by different business entities: each earns money separately and each uses the content protected by copyright. We should determine how to define the actions of the entity supplying the signal with the TV program directly to the cable/digital platform operator and the actions of the entity providing the end user with the signal. The author criticizes the approach presented in the Chellomedia and Norma rulings, arguing that they lead to a significant level of legal uncertainty, and poses the basic questions concerning the notion of “public” in copyright.

Content of prenatal care and spontaneous preterm birth: Findings from the 1988 National Maternal and Infant Health Survey

The purposes of this study were to examine (1) the relationship between selected components of the content of prenatal care and spontaneous preterm birth; and (2) the degree of comparability between maternal and caregivers' responses regarding the number of prenatal care visits, selected components of the content of prenatal care, and gestational age, based on analyses of the 1988 National Maternal and Infant Health Survey conducted by the National Centers for Health Statistics. Spontaneous preterm birth was subcategorized into very preterm and moderately preterm births, with term birth as the controls. The study population was limited to non-Hispanic Anglo- and African-American mothers. The racial differences in terms of birth outcomes were also compared.^ This study concluded that: (1) there was not a high degree of comparability (less than 80%) between maternal and prenatal care provider's responses regarding the number of prenatal care visits and the content of prenatal care; (2) there was a low degree of comparability (less than 50%) between maternal and infant's hospital of delivery responses regarding gestational age at birth; (3) there were differences in selected components of the content of prenatal care between the cases and controls, overall and stratified by ethnicity (i.e., hemoglobin/hematocrit test, weight measurement, and breast-feeding counseling), but they were confounded with missing values and associated preterm delivery bias; (4) there were differences in selected components of the content of prenatal care between Anglo- and African-American cases (i.e., vitamin/mineral supplement advice, weight measurement, smoking cessation and drug abuse counseling), but they, too, were difficult to interpret definitively due to item nonresponse and preterm delivery biases; (5) no significant predictive association between selected components of the content of prenatal care and spontaneous preterm birth was found; and (6) inadequate/intermediate prenatal care and birth out of wedlock were found to be associated with moderately preterm birth.^ Future research is needed to examine the validity of maternal and prenatal care providers' responses and identify the sources of disagreement between their responses. In addition, further studies are needed to examine the relationship between the quality of prenatal care and preterm birth. Finally, the completeness and quality of patient and provider data on the utilization and content of prenatal care needs to be strengthened in subsequent studies. ^

Prenatal care content and utilization among pregnant women enrolled in managed care programs in Harris County, Texas

This research study was conducted as a descriptive study of prenatal care experiences of women enrolled in public and private managed care programs. The study's aim was to describe the demographic characteristics of the women in the study and to analyze and compare their prenatal care experiences. ^ The objective of this study was to examine the research question: Do pregnant women enrolled in Medicaid Managed Care receive the same level of care as women enrolled in other Managed Care Programs in Harris County, Texas? ^ The study population was a convenience sample of pregnant women enrolled in managed care programs who presented to one of the two hospital study sites for delivery of their infant. The study utilized a self administered survey to measure adequacy and content of prenatal care received by the women during this pregnancy. Adequacy of prenatal care utilization was determined based on the Kessner Index criteria of timing of initiation of care and number of visits. Content of care was measured by the number of different medical services the women reported they had received and the number of health information topics the women reported on which they had received information. Demographic characteristics were described with univariate and bivariate statistics of frequencies and cross tabulations. Associations were evaluated using measures of linear correlations. ^ Results from the study showed there is an association between enrollment in Medicaid Managed Care (public) and prenatal care received compared to women enrolled in other Managed Care Programs (private). The results were derived from statistical tests on data the postpartum women gave when they completed the self-administered survey. Provider type was a moderate predictor of quality and quantity of prenatal care. The results also indicate that in the study population, minority ethnicity, income and lower educational status were associated with intermediate and inadequate prenatal care. ^

The effects of adequacy and content of prenatal care on birth outcomes in a high -risk Missouri population

The purpose of this observational study was investigation of the relationship between quantitative adequacy of prenatal care, specific prenatal care content and pregnancy outcome in a high risk Missouri population. A sample of 1484 women from three Missouri regions known to have high rates of low birth weight, infant mortality, and inadequate prenatal care rates participated in structured post-partum interviews. Approximately one-half of the sample had received adequate prenatal care and the other half inadequate prenatal care as determined by an index utilized by the Missouri Department of Health.^ Prenatal care content was assessed by reports of prenatal education in six different areas: Diet, smoking, alcohol, drug, preterm labor counseling, and advice on when to call the health provider if preterm labor was suspected by the woman. Low birth weight, in both term and preterm infants, were the two birth outcomes examined. A variety of maternal socio-demographic variables were also considered.^ The results of this study suggest that specific educational content, delivered during prenatal care, may have lessen the risk of giving birth to a preterm-low birth weight infant. Prenatal education for recognition of preterm labor, and advice on when to call the health provider if preterm labor was suspected were found to be associated with a decreased risk of preterm delivery. Specific educational content was not, however, associated with risk of term-low weight birth nor was quantitative adequacy of care associated with the risk of either term- or preterm-low birth weight.^ These findings reinforce a body of literature which stresses the importance of appropriate prenatal care in preventing preterm low birth weight. Additionally, the findings suggest interventions that may be specifically effective for prematurity prevention. ^

Analysis of the alternatives for stereo multiplex in 3DTV broadcast delivery

Although 3DTV has led the evolution of television market, its delivery by broadcast networks is still small. Now, 3DTV transmis-sions are usually done by combining both views into one common frame (side by side) to be able to use standard HDTV transmission equipment. Today, orthogonal subsampling is mostly used, but other alternatives will appear soon. Here, different subsampling schemes for both progressive and interlaced 3DTV are considered. For each possible scheme, its pre-served frequency content is analyzed and a simple interpolation filter is designed. The analysis is carried out for progressive and interlaced video and the designed filters are applied on different sequences, showing the advantages and disadvantages of the different options

Route-back delivery protocol for collection tree protocol-based applications

We propose the Route-back Delivery (RBD) protocol; a routing mechanism to create reverse routes exploiting the Collection Tree Protocol to allow unicast data dissemination from the sink. The main goal of this work is to provide a mechanism to enable bi-directional communications among the root(s) and specific sensor nodes in data gathering applications that does not use broadcast only mechanisms. The main objective of the root-to-remote-nodes route creation is to disseminate short messages to change application parameters in a unicast fashion. This facilitates remote configurability in heterogeneous WSN deployments.

Effect of content characteristics on quality of experience of adaptive streaming

The growing popularity of adaptive streaming-based video delivery nowadays has raised the interest about the user's perception when experiencing quality adaptation. The impact of the video content characteristics on user's perceptual quality has already become evident. The aim of this study is to investigate the influence of this factor on the quality of experience of adaptive streaming scenarios. Our results show that the perceptual quality of adaptation strategies applied on videos with high spatial and low temporal amount of activity is significantly lower compared to the other content types.

Design of a new neutron delivery system for high flux source

La construcción en la actualidad de nuevas fuentes para el uso de haces de neutrones así como los programas de renovación en curso en algunas de las instalaciones experimentales existentes han evidenciado la necesidad urgente de desarrollar la tecnología empleada para la construcción de guías de neutrones con objeto de hacerlas mas eficientes y duraderas. Esto viene motivado por el hecho de que varias instalaciones de experimentación con haces de neutrones han reportado un número de incidentes mecánicos con tales guías, lo que hace urgente el progresar en nuestro conocimiento de los susbtratos vítreos sobre los cuales se depositan los espejos que permiten la reflexión total de los neutrones y como aquellos se degradan con la radiación. La presente tesis se inscribe en un acuerdo de colaboración establecido entre el Institut Max von Laue - Paul Langevin (ILL) de Grenoble y el Consorcio ESS-Bilbao con objeto de mejorar el rendimiento y sostenibilidad de los sistemas futuros de guiado de neutrones. El caso de la Fuente Europea de Espalación en construcción en Lund sirve como ejemplo ya que se contempla la instalación de guías de neutrones de más de 100 metros en algunos de los instrumentos. Por otro lado, instalaciones como el ILL prevén también dentro del programa Endurance de rejuvenecimiento la reconstrucción de varias líneas de transporte de haz. Para el presente estudio se seleccionaron cuatro tipos de vidrios borosilicatados que fueron el Borofloat, N-ZK7, N-BK7 y SBSL7. Los tres primeros son bien conocidos por los especialistas en instrumentación neutrónica ya que se han empleado en la construcción de varias instalaciones mientras que el último es un candidato potencial en la fabricación de substratos para espejos neutrónicos en un futuro. Los cuatro vidrios tiene un contenido en óxido de Boro muy similar, approximadamente un 10 mol.%. Tal hecho que obedece a las regulaciones para la fabricación de estos dispositivos hace que tales substratos operen como protección radiológica absorbiendo los neutrones transmitidos a través del espejo de neutrones. Como contrapartida a tal beneficio, la reacción de captura 10B(n,_)7Li puede degradar el substrato vítreo debido a los 2.5 MeV de energía cinética depositados por la partícula _ y los núcleos en retroceso y de hecho la fragilidad de tales vidrios bajo radiación ha sido atribuida desde hace ya tiempo a los efectos de esta reacción. La metodología empleada en esta tesis se ha centrado en el estudio de la estructura de estos vidrios borosilicatados y como esta se comporta bajo condiciones de radiación. Los materiales en cuestión presentan estructuras que dependen de su composición química y en particular del ratio entre formadores y modificadores de la red iono-covalente. Para ello se han empleado un conjunto de técnicas de caracterización tanto macro- como microscópicas tales como estudios de dureza, TEM, Raman, SANS etc. que se han empleado también para determinar el comportamiento de estos materiales bajo radiación. En particular, algunas propiedades macroscópicas relacionadas con la resistencia de estos vidrios como elementos estructurales de las guías de neutrones han sido estudiadas así como también los cambios en la estructura vítrea consecuencia de la radiación. Para este propósito se ha diseñado y fabricado por el ILL un aparato para irradiación de muestras con neutrones térmicos en el reactor del ILL que permite controlar la temperatura alcanzada por la muestra a menos de 100 °C. Tal equipo en comparación con otros ya existences permite en cuestión de dias acumular las dosis recibidas por una guía en operación a lo largo de varios años. El uso conjunto de varias técnicas de caracterización ha llevado a revelar que los vidrios aqui estudiados son significativamente diferentes en cuanto a su estructura y que tales diferencias afectan a sus propiedades macroscópicas asi como a su comportamiento bajo radiación. Tal resultado ha sido sorprendente ya que, como se ha mencionado antes, algunos de estos vidrios eran bien conocidos por los fabricantes de guías de neutrones y hasta el momento eran considerados prácticamente similares debido a su contenido comparable en óxido de Boro. Sin embargo, los materiales N-BK7 and S-BSL7 muetran gran homogeneidad a todas las escalas de longitud, y más específicamente, a escalas nanométricas las subredes de Sílice y óxido de Boro se mezclan dando logar a estructuras locales que recuerdan a la del cristal de Reedmergnerita. Por el contrario, N-ZK7 y Borofloat muestran dominios separados ricos en Sílice o Boro. Como era de esperar, las importantes diferencias arriba mencionadas se traducen en comportamientos dispares de estos materiales bajo un haz de neutrones térmicos. Los resultados muestran que el N-BK7 y el S-BSL7 son los más estables bajo radiación, lo que macroscópicamente hace que estos materiales muestren un comportamiento similar expandiéndose lentamente en función de la dosis recibida. Por el contario, los otros dos materiales muestran un comportamiento mucho más reactivo, que hace que inicialmente se compacten con la dosis recibida lo que hace que las redes de Silicio y Boro se mezclen resultando en un incremento en densidad hasta alcanzar un valor límite, seguido por un proceso de expansión lenta que resulta comparable al observado para N-BK7 y SBSL7. Estos resultados nos han permitido explicar el origen de las notorias diferencias observadas en cuanto a las dosis límite a partir de las cuales estos materiales desarrollan procesos de fragmentación en superficie. ABSTRACT The building of new experimental neutron beam facilities as well as the renewal programmes under development at some of the already existing installations have pinpointed the urgent need to develop the neutron guide technology in order to make such neutron transport devices more efficient and durable. In fact, a number of mechanical failures of neutron guides have been reported by several research centres. It is therefore important to understand the behaviour of the glass substrates on top of which the neutron optics mirrors are deposited and how these materials degrade under radiation conditions. The case of the European Spallation Source (ESS) at present under construction at Lund is a good example. It previews the deployment of neutron guides having more than 100 metres of length for most of the instruments. Also, the future renovation programme of the ILL, called Endurance, foresees the refurbishment of several beam lines. This Ph.D. thesis was the result of a collaboration agreement between the ILL and ESS-Bilbao aiming to improve the performance and sustainability of future neutron delivery systems. Four different industrially produced alkali-borosilicate glasses were selected for this study: Borofloat, N-ZK7, N-BK7 and SBSL7. The first three are well known within the neutron instrumentation community as they have already been used in several installations whereas the last one is at present considered as a candidate for making future mirror substrates. All four glasses have a comparable content of boron oxide of about 10 mol.%. The presence of such a strong neutron absorption element is in fact a mandatory component for the manufacturing of neutron guides because it provides a radiological shielding for the environment. This benefit is however somewhat counterbalanced since the resulting 10B(n,_)7Li reactions degrade the glass due to the deposited energy of 2.5 MeV by the _ particle and the recoil nuclei. In fact, the brittleness of some of these materials has been ascribed to this reaction. The methodology employed by this study consisted in understanding the general structure of borosilicates and how they behave under irradiation. Such materials have a microscopic structure strongly dependent upon their chemical content and particularly on the ratios between network formers and modifiers. The materials have been characterized by a suite of macroscopic and structural techniques such as hardness, TEM, Raman, SANS, etc. and their behaviour under irradiation was analysed. Some macroscopic properties related to their resistance when used as guide structural elements were monitored. Also, changes in the vitreous structure due to radiation were observed by means of several experimental tools. For such a purpose, an irradiation apparatus has been designed and manufactured to enable irradiation with thermal neutrons within the ILL reactor while keeping the samples below 100 °C. The main advantage of this equipment if compared to others previously available was that it allowed to reach in just some days an equivalent neutron dose to that accumulated by guides after several years of use. The concurrent use of complementary characterization techniques lead to the discovery that the studied glasses were deeply different in terms of their glass network. This had a strong impact on their macroscopic properties and their behaviour under irradiation. This result was a surprise since, as stated above, some of these materials were well known by the neutron guide manufacturers, and were considered to be almost equivalent because of their similar boron oxide content. The N-BK7 and S-BSL7 materials appear to be fairly homogeneous glasses at different length scales. More specifically, at nanometre scales, silicon and boron oxide units seem to mix and generate larger structures somewhat resembling crystalline Reedmergnerite. In contrast, N-ZK7 and Borofloat are characterized by either silicon or boron rich domains. As one could expect, these drastic differences lead to their behaviour under thermal neutron flux. The results show that N-BK7 and S-BSL7 are structurally the most stable under radiation. Macroscopically, such stability results in the fact that these two materials show very slow swelling as a function or radiation dose. In contrast, the two other glasses are much more reactive. The whole glass structure compacts upon radiation. Specifically, the silica network, and the boron units tend to blend leading to an increase in density up to some saturation, followed by a very slow expansion which comes to be of the same order than that shown by N-BK7 and S-BSL7. Such findings allowed us to explain the drastic differences in the radiation limits for macroscopic surface splintering for these materials when they are used in neutron guides.

Socialising Around Media (SAM): Dynamic Social and Media Content Syndication for Second Screen

Today's generation of Internet devices has changed how users are interacting with media, from passive and unidirectional users to proactive and interactive. Users can use these devices to comment or rate a TV show and search for related information regarding characters, facts or personalities. This phenomenon is known as second screen. This paper describes SAM, an EU-funded research project that focuses on developing an advanced digital media delivery platform based on second screen interaction and content syndication within a social media context, providing open and standardised ways of characterising, discovering and syndicating digital assets. This work provides an overview of the project and its main objectives, focusing on the NLP challenges to be faced and the technologies developed so far.

Classifying client goals in community-based ABI rehabilitation: a taxonomy for profiling service delivery and conceptualizing outcomes

Purpose: To develop, confirm and trial a framework for analysing the content of goals set within community-based rehabilitation. This framework (taxonomy) is proposed as a tool to assist in service evaluation and outcome exploration. Method: Qualitative thematic analysis and categorization of 1765 rehabilitation goal statements in a four phase process of synthesis, refinement, verification and application. Results: A taxonomy of goal content was developed comprising 21 categories within five domains, utilizing 125 descriptors. The taxonomy demonstrated good inter-rater consistency and was able to discriminate between similar but related data sets comprising goal statements. Conclusion: Structured analysis of the content of goal setting (particularly in community rehabilitation) utilizing a framework such as the proposed taxonomy has considerable potential as a 'window' into service delivery to broaden the parameters of existing service evaluation and to more clearly link outcome exploration to intervention.

Mediated approaches for influencing physical activity: Update of the evidence on mass media, print, telephone and website delivery of interventions

The aim of this paper is to review evidence published since 1997 on the effectiveness of mass media, print, telephone and website-delivered physical activity (PA) interventions. For mass media, there is consistent evidence for impacts on recall of campaign tag lines and message content and modest evidence of short-term impacts on behaviour in some population subgroups. Print-based delivery of programs can have a modest impact on behaviour; research is needed on supplementary strategies to support print programs. Although there is a strong case for the potential of telephone and Internet delivered interventions, there is as yet little evidence that they can be effective. All of these 'mediated' approaches to PA program delivery are likely to be important elements of future public health interventions. The body of evidence for their effectiveness in changing behaviour is currently modest, however, and it is clear that these approaches have not yet been fully developed and evaluated. Combinations of different media and mutually supportive, integrated strategies are likely to be more effective and need to be developed and evaluated systematically, building on the current research evidence base.