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Objective To evaluate the impact of a population-based telephonic wellness coaching program on weight loss. Methods Individual-level segmented regression analysis of interrupted time series data comparing the BMI trajectories in the 12 months before versus the 12 months after initiating coaching among a cohort of Kaiser Permanente Northern California members (n = 954) participating in The Permanente Medical Group Wellness Coaching program in 2011. The control group was a 20:1 propensity-score matched control group (n = 19,080) matched with coaching participants based on baseline demographic and clinical characteristics. Results Wellness coaching participants had a significant upward trend in BMI in the 12 months before their first wellness coaching session and a significant downward trend in BMI in the 12 months after their first session equivalent to a clinically significant reduction of greater than one unit of baseline BMI (P < 0.01 for both). The control group did not have statistically significant decreases in BMI during the post-period. Conclusions Wellness coaching has a positive impact on BMI reduction that is both statistically and clinically significant. Future research and quality improvement efforts should focus on disseminating wellness coaching for weight loss in patients with diabetes and those at risk for developing the disease.

Purpose. Many Americans continue to smoke, increasing their risk of disease and premature death. Both telephone-based counseling and in-person tobacco cessation classes may improve access for smokers seeking convenient support to quit. Little research has assessed whether such programs are effective in real-world clinical populations. Design. Retrospective cohort study comparing wellness coaching participants with two groups of controls. Setting. Kaiser Permanente Northern California, a large integrated health care delivery system. Subjects. Two hundred forty-one patients who participated in telephonic tobacco cessation coaching from January 1, 2011, to March 31, 2012, and two control groups: propensity-score–matched controls, and controls who participated in a tobacco cessation class during the same period. Wellness coaching participants received an average of two motivational interviewing–based coaching sessions that engaged the patient, evoked their reason to consider quitting, and helped them establish a quit plan. Measures. Self-reported quitting of tobacco and fills of tobacco cessation medications within 12 months of follow-up. Analysis. Logistic regressions adjusting for age, gender, race/ethnicity, and primary language. Results. After adjusting for confounders, tobacco quit rates were higher among coaching participants vs. matched controls (31% vs. 23%, p < .001) and comparable to those of class attendees (31% vs. 29%, p = .28). Coaching participants and class attendees filled tobacco-cessation prescriptions at a higher rate (47% for both) than matched controls (6%, p < .001). Conclusion. Telephonic wellness coaching was as effective as in-person classes and was associated with higher rates of quitting compared to no treatment. The telephonic modality may increase convenience and scalability for health care systems looking to reduce tobacco use and improve health.

This paper demonstrates that the widely prophesied doubling of atmospheric carbon dioxide levels from natural, pre-industrial values will enhance the so-called ‘greenhouse effect’ but will amount to less than 1°C of global warming. It also points out that such a scenario is unlikely to arise given our limited reserves of fossil fuels—certainly not before the end of this century. Furthermore, the paper argues that general circulation models are as yet insufficiently accurate for civil engineers to rely on their predictions in any forward-planning decisions—the omission of solar wind effects being a potentially significant shortcoming. It concludes that the only certainty is that the world's fossil fuel resources are finite and should be used prudently and with proper respect to the environment.

Introduction Health coaching can improve lifestyle behaviors known to prevent or manage chronic conditions. Little is known about effective ways to encourage health and wellness coaching among people who might benefit. The purpose of this randomized encouragement trial was to assess the relative success of 3 outreach methods (secured email message, telephone message, and mailed letter) on the use of wellness coaching by people with prediabetes. Methods A total of 14,584 Kaiser Permanente Northern California (KPNC) patients with diagnosed prediabetes (fasting plasma glucose, 110–125mg/dL) were randomly assigned to be contacted via 1 of 4 intervention arms from January through May 2013. The uptake rate (making an appointment at the Wellness Coaching Center [WCC]) was assessed, and the association between uptake rate and patient characteristics was examined via multivariable logistic regression. Results The overall uptake rate across intervention arms was 1.9%. Secured email message had the highest uptake rate (3.0%), followed by letters and telephone messages (P < .05 for all pairwise comparisons). No participants in the usual-care arm (ie, no outreach) made an appointment with the WCC. For each year of increased age, the estimated odds of the uptake increased by 1.02 (odds ratio [OR] = 1.02; 95% CI, 1.01–1.04). Women were nearly twice as likely to make an appointment at the WCC as men (OR = 1.87; 95% CI, 1.40–2.51). Conclusion Our results suggest that the WCC can recruit and encourage KPNC members with prediabetes to participate in the WCC. Future research should focus on increasing participation rates in health coaching among patients who may benefit.

Many Americans continue to smoke, increasing their risk of disease and premature death. Both telephone-based counseling and in-person tobacco cessation classes may improve access for smokers seeking convenient support to quit. Little research has assessed whether such programs are effective in real-world clinical populations.Retrospective cohort study comparing wellness coaching participants with two groups of controls.Kaiser Permanente Northern California, a large integrated health care delivery system.Two hundred forty-one patients who participated in telephonic tobacco cessation coaching from January 1, 2011, to March 31, 2012, and two control groups: propensity-score-matched controls, and controls who participated in a tobacco cessation class during the same period. Wellness coaching participants received an average of two motivational interviewing-based coaching sessions that engaged the patient, evoked their reason to consider quitting, and helped them establish a quit plan.Self-reported quitting of tobacco and fills of tobacco cessation medications within 12 months of follow-up.Logistic regressions adjusting for age, gender, race/ethnicity, and primary language.After adjusting for confounders, tobacco quit rates were higher among coaching participants vs. matched controls (31% vs. 23%, p.001) and comparable to those of class attendees (31% vs. 29%, p = .28). Coaching participants and class attendees filled tobacco-cessation prescriptions at a higher rate (47% for both) than matched controls (6%, p.001).Telephonic wellness coaching was as effective as in-person classes and was associated with higher rates of quitting compared to no treatment. The telephonic modality may increase convenience and scalability for health care systems looking to reduce tobacco use and improve health.

This paper represents a criticism of the Intergovernmental Panel on Climate Change (IPCC) use of the value 0.5 K (W m−2)−1 for the climate sensitivity parameter, λ. A simple model is introduced which shows that the non-radiative effect of water vapour is a negative feedback ensuring that the Earth's surface temperature is cooler by some 17°C than if it did not participate in the energy budget.

This paper argues that the current ecological crises caused by use of non renewable energy sources, degradation of forests, destruction of sustainable agrarian and fishing lifestyles (with its resultant loss of crop varieties from the genestock), and the destructive impact of tourism could be positively addressed by labour intensive land management and redevelopment programmes, and by instituting National Heritage Services. This would have the dual impact of meeting the challenges identified at the Rio Earth Summit and rekindling the work ethic by putting people back into the economics of life.

Introduction Health coaching can improve lifestyle behaviors known to prevent or manage chronic conditions such as diabetes. However, little is known about the patient experience with telephonic coaching programs in real-world care settings. We examined patient satisfaction, patient’s perceived success in achieving program goals, and the patient-level correlates of these outcomes in a voluntary telephonic coaching program at a large integrated health care delivery system in northern California. Methods Kaiser Permanente Northern California patients who participated in a telephonic coaching program in 2011 were sent a cross-sectional survey about their satisfaction with health coaching and perceived success with program goals. We examined associations with patient characteristics. Results The survey response rate was 34%; analyses were based on the 32% who completed the survey. Of those who had completed 2 or more sessions (n = 232 [52%]), most reported being satisfied (70%) or neutral (20%) with the program, and 71% would recommend health coaching. Healthy weight, healthful eating, and physical activity were the most common topics discussed (88%). Adjusting for demographic characteristics, 73% of those who had 2 or more sessions reported that health coaching helped achieve their weight-related goal. Outcomes were positively correlated with patient activation but not consistently correlated with patient demographic characteristics. Conclusion Levels of satisfaction and perceived success with telephonic health coaching provided by a health plan were high and positively correlated with the number of sessions completed and patient activation. Voluntary telephonic health coaching programs should promote retention and assess patients’ activation levels.

The speaker first surveys the history of the human depredation of the environment during the last 500,000 years, stressing the rapid growth of the population. While the human population was about 300 million at 1000 A.D., i.e. about 50 hectares of land per person, it more than trebled by 1750 A.D., so that there were about 15 hectares of land per person; at present, the population is surging towards 6 billion, thus leaving only about 2.5 hectares per person. Next, the speaker analyses the consequences of this rapid growth in terms of the ecological damage, energy and water problems, transport and urbanisation, etc.. The lecturer concludes with an outline of possible remedies, citing examples of measures adopted with success in various parts of the world where ‘the environment is taken seriously’.

Water samples (132) were collected from selected mires in eastern Canada. Sites chosen included ombrotrophic, transition, and minerotrophic mire in both maritime and continental areas in Nova Scotia, New Brunswick, and Quebec. Chemical analysis of the major ions found in mire waters revealed that concentrations increased from ombrotrophic to minerotrophic conditions. Chloride, sodium, and magnesium were more abundant in maritime mires, while calcium, potassium, and sulfate had higher levels in transition and ombrotrophic mire in agricultural areas. Comparison with studies in Europe indicates similar ionic conditions for the three mire categories with respect to proximity to the sea and human disturbance.

A survey of the holdfast fauna of Laminaria hyperborea was carried out at thirty-five sites around the UK, mostly along the North Sea and south coasts. Data from different age classes of holdfast from a polluted and unpolluted site indicate that volume of holdfast space is a most important measurement of sample size, a minimum size of sample being one litre and, preferably, three. Gradients of increased heavy metals were defined down the North Sea and west coasts and, by utilising measurements of kelp penetration, water clarity gradients were determined as increasing northwards on the west coast and both north and southwards on the North Sea coast from a point near Tyne and Wear county. Analysis of holdfast fauna showed numerous gradients of total numbers, species and diversity which correlate closely with the heavy metal and water clarity gradients, or with undetermined parameters analogous to latitude and longitude. Where there were increases of heavy metals or decreases of water clarity, various reciprocal relationships between suspension feeders and all other trophic groups were commonly observed. In the North Sea numbers of suspension feeders increased while numbers of all other trophic groups declined. On the west coast a heavy metal increase correlated with a decreasing species richness of all trophic categories except suspension feeders, while with total numbers only suspension feeders showed an increase. On the south coast transect neither gradient existed, and only here did all trophic categories covary, except at one very polluted site where the same reciprocal relationship was again indicated. In terms of species similarity the North Sea showed a greater pool of common species than occurred between sites of other regions and between North Sea sites with other regions, despite the widest range of heavy metal levels and wate clarity that existed there. Between-site similarity appeared to be much more dependent on geographical proximity than on the two measured environmental factors. It is suggested that effects of clarity-reduction can be measured by trophic analysis more successfully than by species presence or absence, and that changes of holdfast fauna along the North Sea coast are due largely to pollution.

The paper investigates the relationships that exist between the airform pattern, hydrology, and ontogeny of the muskegs of Canada. A new interpretive classification based on the concept of hydroform is proposed and some practical examples of its application are given. Cet article etudie les relations existant entre 1' "airform pattern", I'hydrologie, et I'ontogenese des fondrieres de mousse du Canada. Une nouvelle classification d'interpretation basee sur le concept d' "hydroform" est proposee. Quelques exemples pratiques de son application sont donnks. [Traduit par le journal]

On the basis of field evidence, two hypotheses are advanced to account for the existence of “arctic alpine” plants in Upper Teesdale. They involve a critical limit of primary production and boundary instability.

The heavy vehicles of the oilmen roam widely over Northern Canada, leaving trails gouged out of the virgin tundra. The damage they inflict on the vegetation may mark them as a basic problem in the conservation of the Arctic.

It is proven that every homeomorphism of a product of pseudo-arcs is a composition of a product homeomorphism with a homeomorphism which only permutes the factors

DURING phase 6 of the Royal Society expedition to Aldabra the sublittoral structure of the reef front was studied by means of one detailed reference transect (marked 1 in Fig. 1) and thirteen survey transects. All were levelled by SCUBA divers in the following way. Two divers holding the ends of a 10 m tape “leapfrogged” over each other in turn while swimming along a bearing and recorded depths at each fixed interval using wrist gauges. Transects 10 and 11 were levelled by diving from the boat at known distances from the reef front.

“LIVING organisms (biota) and their non-living (abiotic) environment are inseparably interrelated and interact on each other. Any area of nature that includes living organisms and non-living substances interacting to produce an exchange of materials between the living (biotic) and the non-living (abiotic) parts is an ecosystem” (modified after Odum1). The driving force which causes this exchange is the energy incident on the given area. That part of the energy which is fixed by the photo-synthetic biomass is either used by the respiring biomass or is stored in chemical form as standing crop, extracellular produce, humus or peat.

Succession may be defined as a linked change of the biotic and abiotic components of an ecosystem. In a mire ecosystem, this change is mediated through the storage of energy in the form of peat. The deposition of peat affecting the hydrologic and edaphic conditions within the system brings about a change in the flora of the mire. A study of succession in a mixed mire is presented together with measurements of the dynamics of the process. In the ecosystem studied, deposition of 1804 g dry weight of peat, representing the storage of 8326 kilocalories of energy, can bring about the complete transformation of one square metre of "extreme rich fen" to bog (Du Rietz 1949) in all characteristics. At the present net rate of production by Sphagnum fuscum (the main peat former), this process would take only seven years. Pe3IoMe

Moorland, dominated by heather (Calluna vulgaris), is an important ecosystem in upland Britain (Pearsall 1950). Large areas of vegetation which come within this category have developed over deep blanket peat and are managed by controlled rotational burning for the rearing of the red grouse (Lagopus scoticus). A well managed grouse moor shows a pattern of small patches of young and old heather and where present over deep ombrophilous peat (Kulczynski 1949) presents an aged series of edaphically uniform ecosystems where the performance of a number of species can be studied. This paper presents the results of a study of the net aerial production of Calluna vulgaris on such a grouse moor which lies between 440 and 550 m O.D. in the Upper Teesdale National Nature Reserve in the Northern Pennines of England. The value for net annual production obtained in this study appears to be sufficiently accurate to be used as a reference figure for a regional phyochorology of this species. A simple and rapid method to obtain the necessary comparative data from other sites is outlined.

DURING investigations on the autecology of some mire carices, it was necessary to prepare a range of culture solutions with widely varying calcium contents. The culture solution used was full-strength Long Ashton basic formula1, minus the calcium nitrate, bulked with the required quantities of either calcium chloride or calcium nitrate. On measuring the pH of the resultant solutions (see Table 1) the fallaciousness of the term ‘base rich’, as applied to natural waters by ecologists, was made1 painfully obvious. We had indeed produced what ecologically would have been termed a base rich water with a remarkably low pH, a paradox, be it in ecological or chemical terminology.