Background: As obesity prevalence and health-care costs increase, Health Care providers must prevent and manage obesity cost-effectively. Methods: Using the 2006 NICE obesity health economic model, a primary care weight management programme ( Counterweight) was analysed, evaluating costs and outcomes associated with weight gain for three obesity-related conditions ( type 2 diabetes, coronary heart disease, colon cancer). Sensitivity analyses examined different scenarios of weight loss and background ( untreated) weight gain. Results: Mean weight changes in Counterweight attenders was -3 kg and -2.3 kg at 12 and 24 months, both 4 kg below the expected 1 kg/year background weight gain. Counterweight delivery cost was 59.83 pound per patient entered. Even assuming dropouts/non-attenders at 12 months (55%) lost no weight and gained at the background rate, Counterweight was 'dominant' (cost-saving) under 'base-case scenario', where 12-month achieved weight loss was entirely regained over the next 2 years, returning to the expected background weight gain of 1 kg/year. Quality-adjusted Life-Year cost was 2017 pound where background weight gain was limited to 0.5 kg/year, and 2651 pound at 0.3 kg/year. Under a 'best-case scenario', where weights of 12-month-attenders were assumed thereafter to rise at the background rate, 4 kg below non-intervention trajectory ( very close to the observed weight change), Counterweight remained 'dominant' with background weight gains 1 kg, 0.5 kg or 0.3 kg/year. Conclusion: Weight management for obesity in primary care is highly cost-effective even considering only three clinical consequences. Reduced healthcare resources use could offset the total cost of providing the Counterweight Programme, as well as bringing multiple health and Quality of Life benefits.

Objectives: To examine relationships between body mass index (BMI), prevalence of physician-recorded cardiovascular disease (CVD) risk factors in primary care, and changes in risk with 10% weight change.Methods: The Counterweight Project conducted a baseline cross-sectional survey of medical records of 6150 obese (BMI >= 30 kg/ml), 1150 age- and sex-matched overweight (BMI 25 to <30kg/m(2)), and 1150 age- and sex-matched normal weight (BMI 18.5 to <25kg/m(2)) controls, in primary care. Data were collected for the previous 18 months to examine BMI and disease prevalence, and then modelled to show the potential effect of 10% weight loss or gain on risk.Results: Obese patients develop more CVD risk factors than normal weight controls. BMI >= 40 kg/m(2) exhibits increased prevalence of type 2 diabetes mellitus (DM), odds ratio (OR) men: 6.16 (p < 0.001); women: 7.82 (p < 0.001) and hypertension OR men: 5.51 (p < 0.001); women: 4.16 (p < 0.001). Dyslipidaemia peaked around BMI 35 to <37.5 kg/m(2), OR men: 3.26 (p < 0.001); women 3.76 (p < 0.001) and CVD at BMI 37.5 2 to <40 kg/m(2) in men, OR 4.48 (p < 0.001) and BMI >= 40 kg/m(2) in women, OR 3.98 (P < 0.001).A 10% weight loss from the sample mean of 32.5 kg/m(2) reduced the OR for type 2 DM by 30% and CVD by 20%, while 10% weight gain increased type 2 DM risk by more than 35% and CVD by 20%.Conclusion: Obesity plays a fundamental role in CVD risk, which is reduced with weight loss. Weight management intervention strategies should be a public health priority to reduce the burden of disease in the population. (C) 2008 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Objective: To improve the management of obese adults (18-75 y) in primary care.Design: Cohort study.Settings: UK primary care.Subjects: Obese patients (body mass index >= 30 kg/m(2)) or BMI >= 28 kg/m(2) with obesity-related comorbidities in 80 general practices.Intervention: The model consists of four phases: (1) audit and project development, (2) practice training and support, (3) nurse-led patient intervention, and (4) evaluation. The intervention programme used evidence-based pathways, which included strategies to empower clinicians and patients. Weight Management Advisers who are specialist obesity dietitians facilitated programme implementation.Main outcome measures: Proportion of practices trained and recruiting patients, and weight change at 12 months.Results: By March 2004, 58 of the 62 (93.5%) intervention practices had been trained, 47 (75.8%) practices were active in implementing the model and 1549 patients had been recruited. At 12 months, 33% of patients achieved a clinically meaningful weight loss of 5% or more. A total of 49% of patients were classed as 'completers' in that they attended the requisite number of appointments in 3, 6 and 12 months. 'Completers' achieved more successful weight loss with 40% achieving a weight loss of 5% or more at 12 months.Conclusion: The Counterweight programme provides a promising model to improve the management of obesity in primary care.

BACKGROUND/AIMS:Primary care is expected to develop strategies to manage obese patients as part of coronary heart disease and diabetes national service frameworks. Little is known about current management practices for obesity in this setting. The aim of this study is to examine current approaches to obesity management in UK primary care and to identify potential gaps in care.METHOD:A total of 141 general practitioners (GPs) and 66 practice nurses (PNs) from 40 primary care practices participated in structured interviews to examine clinician self-reported approaches to obesity management. Medical records were also reviewed for 100 randomly selected obese patients from each practice [body mass index (BMI) >/=30 kg m(-2), n = 4000] to review rates of diet counselling, dietetic or obesity centre referrals, and use of anti-obesity medication. Computerized medical records for the total practice population (n = 206 341, 18-75 years) were searched to examine the proportion of patients with a weight/BMI ever recorded.RESULTS:Eighty-three per cent of GPs and 97% of PNs reported that they would raise weight as an issue with obese patients (P < 0.01). Few GPs (15%) reported spending up to 10 min in a consultation discussing weight-related issues, compared with PNs (76%; P < 0.001). Over 18 months, practice-based diet counselling (20%), dietetic (4%) and obesity centre (1%) referrals, and any anti-obesity medication (2%) were recorded. BMI was recorded for 64.2% of patients and apparent prevalence of obesity was less than expected.CONCLUSION:Obesity is under-recognized in primary care even in these 40 practices with an interest in weight management. Weight management appears to be based on brief opportunistic intervention undertaken mainly by PNs. While clinicians report the use of external sources of support, few patients are referred, with practice-based counselling being the most common intervention.

BACKGROUND/AIMS:Obesity has become a global epidemic, and a major preventable cause of morbidity and mortality. Management strategies and treatment protocols are however poorly developed and evaluated. The aim of the Counterweight Programme is to develop an evidence-based model for the management of obesity in primary care.METHODS:The Counterweight Programme is based on the theoretical model of Evidence-Based Quality Assessment aimed at improving the management of obese adults (18-75 years) in primary care. The model consists of four phases: (1) practice audit and needs assessment, (2) practice support and training, (3) practice nurse-led patient intervention, and (4) evaluation. Patient intervention consisted of screening and treatment pathways incorporating evidence-based approaches, including patient-centred goal setting, prescribed eating plans, a group programme, physical activity and behavioural approaches, anti-obesity medication and weight maintenance strategies. Weight Management Advisers who are specialist obesity dietitians facilitated programme implementation. Eighty practices were recruited of which 18 practices were randomized to act as controls and receive deferred intervention 2 years after the initial audit.RESULTS:By February 2004, 58 of the 62 (93.5%) intervention practices had been trained to run the intervention programme, 47 (75.8%) practices were active in implementing the model and 1256 patients had been recruited (74% female, 26% male, mean age 50.6 years, SD 14). At baseline, 75% of patients had at one or more co-morbidity, and the mean body mass index (BMI) was 36.9 kg/m(2) (SD 5.4). Of the 1256 patients recruited, 91% received one of the core lifestyle interventions in the first 12 months. For all patients followed up at 12 months, 34% achieved a clinical meaningful weight loss of 5% or more. A total of 51% of patients were classed as compliant in that they attended the required level of appointments in 3, 6, and 12 months. For fully compliant patients, weight loss improved with 43% achieving a weight loss of 5% or more at 12 months.CONCLUSION:The Counterweight Programme is an evidence-based weight management model which is feasible to implement in primary care.

Due to detrimental effects of the relative vertical motion of a laser Fluorosensor system and an oil spill on the sea surface during airborne operations, it was necessary to develop a trigger synchronization procedure which was independent of the motion. This was accomplished by using the laser radiation scattered from the oil spill to start the triggering process. To compensate for unavoidable electronic delays, it was necessary to delay the fluorescence pulses accompanying the scatter by passing them through an optical fiber. An analysis was carried out to investigate the pulse broadening effects arising from the use of the fiber.

A simple isolation system, based on passive pneumatic isolators, was designed and developed for mounting a Laser Fluorosensor on a Puma helicopter. The vibration characteristics of the helicopter were measured during a wide range of flight attitudes, including taxi mode, take off and landing. The choice of pneumatic isolator and the design of the Laser Fluorosensor mounting system were based on the results of the vibration measurements. A customized power spectral density (PSD) analysis procedure was used to determine vibrational frequencies and their amplitudes.

A laser fluorosensor system has been developed for remotely detecting and identifying crude oils and oil based products from an airborne platform. A streak camera system is the essential detection element in the laser fluorosensor. The capability of this device for rapidly measuring intrinsic temporal characteristics of oil fluorescence has been investigated. These characteristics have been used with spectral parameters for oil spill identification.

Four wavelengths (266, 355, 428, and 532 nm) generated from a prototype laser fluorosensor system were used to investigate the fluorescence spectral and temporal characteristics of crude and refined Kuwaiti oils in the laboratory. Temporal and spectral measurements were gathered for fresh and naturally weathered oil samples. Furthermore, a principal-components algorithm was developed for the purpose of identifying and classifying unknown oils.

A laser fluorosensing procedure has been developed for remotely detecting and identifying crude oils and oil based products from an airborne platform. Selected spectral and temporal characteristics of laser induced fluorescence in an unknown oil are subjected to principal component analysis followed by linear discriminant analysis, thereby facilitating an effective compression of required identification parameters and an enhanced separation of possible groups to which the unknown oil belongs. Identification relies on the availability of a trained data set, comprising principal components with large associated variance and discriminant components with large spread, of all oils likely to be involved in oil spillage at sea. Identification of the unknown oil then involves the application of a classification procedure, (such as K-nearest neighbour or SIMCA), which uses the principal components and discriminant components of the unknown oil and the trained data set.

Four patients with spontaneous rupture of the liver due to preeclampsia of pregnancy underwent diagnostic angiography followed by successful transcatheter embolization of the hepatic artery with gelatin particles. All patients stopped bleeding and were discharged in good condition. Transcatheter embolization of the hepatic artery may be an attractive alternative to surgery for control of spontaneous rupture of the liver in preeclampsia.

The right hepatic artery was catheterized for chemoembolization in a patient with liver-dominant metastatic breast carcinoma and occlusion of the celiac artery by tumor compression. This was accomplished by use of a new coaxial infusion catheter-steerable guidewire system passed through the superior mesenteric artery and posterior pancreatic arcade.

A simple deconvolution procedure using FT was developed for determining the average lifetime of samples excited by a nitrogen laser pumped dye laser operating at 428 nm. To overcome the noise limitations imposed by including higher frequency harmonics in the analysis, we used an alternative approach. This approach relied on taking the Fourier transform at 21 subharmonic frequencies and using an appropriate weighting procedure in the calculation of amplitude and lifetime of the sample impulse response. A single exponential decay was assumed.

The results of lifetime measurements carried out on a number of organic laser dyes are reported. The measurements were conducted over a wide range of solution concentrations. A modified version of a previously reported experimental system was developed for these measurements giving greater reliability and incorporating a higher degree of automation. A comparison with corresponding lifetimes determined by a standard fluorescence tail fitting technique was made to test the method. The reliability of the method is discussed.

The photosynthetic growth action spectrum of a green alga at three bands of visible light (blue, orange, and red) at fixed quanta input and under light-limiting conditions was measured in a batch cultivation system. Quantum efficiencies (biomass dry weight increment per quanta absorbed) were better in the yellow-red region than in the blue region. Results served as a basis for the design and optimization of a dye system that would shift the energy of solar radiation to the required wavelength range by absorbing ultraviolet to blue radiation and emitting in the yellow-red, thus enhancing algae growth. Direct incorporation of dyes into the growth medium, although theoretically expected to enhance growth, in fact resulted in dye decomposition, toxicity to algae and consequently in growth inhibition. Indirect application of dyes in a double tubular reactor (algae inside and dye solution outside) demonstrated growth enhancement for certain dyes with high quantum yields and stability, which had suitable absorption/emission spectra for artificial light sources used. The maximum indirect growth enhancement was obtained using rhodamine 6G at a concentration of 3x10(-5)M with tungsten filament lamp sources.

An experimental system is described for measuring the total hemispherical and spectrally resolved directional downward infrared sky radiation and complementary weather data in Kuwait. The accuracy of the measurement system is discussed and its use for evaluating the potential of the Kuwait sky as a heat sink for passive radiative cooling applications is presented.