The Transmural Trauma Care Model can be implemented well but some barriers and facilitators should be considered during implementation: a mixed methods study.

QUESTIONS: What is the reach, dose delivered, dose received and fidelity of the Transmural Trauma Care Model (TTCM)? What are the barriers and facilitators associated with the implementation of the TTCM? DESIGN: Mixed-methods process evaluation with quantitative evaluation of the extent to which the TTCM was implemented as intended and qualitative evaluation of barriers and facilitators to its implementation. PARTICIPANTS: Focus group participants included trauma patients, trauma surgeons, hospital-based physiotherapists and primary care network physiotherapists. OUTCOME MEASURES: Implementation was assessed with reach, dose delivered, dose received and fidelity. DATA ANALYSIS: A framework method was used to analyse the focus groups and the 'constellation approach' was used to categorise barriers and facilitators into three categories: structure, culture and practice. RESULTS: The TTCM's reach was 81%, its dose delivered was 99% and 100%, and its dose received was 95% and 96% for the multidisciplinary TTCM consultation hours at the outpatient clinic for trauma patients and the primary care network physiotherapists, respectively. Various fidelity scores ranged from 66 to 93%. Numerous barriers and facilitators associated with the implementation of the TTCM were identified and categorised. CONCLUSION: This process evaluation showed that the TTCM was largely implemented as intended. Furthermore, various facilitators and barriers were identified that need to be considered when implementing the TTCM more widely. Differences were found among stakeholders but they were generally of the opinion that if the barriers were overcome, the quality of care and patient satisfaction were likely to improve significantly after implementing the TTCM. REGISTRATION: NTR5474.

Is desire to eat in response to positive emotions an 'obese' eating style: Is Kummerspeck for some people a misnomer?

Is desire to eat in response to positive emotions an 'obese' eating style: a style more prevalent in people with obesity? In other words: Is Kummerspeck (German: sorrow-fat) for some people a misnomer? This question was addressed in three studies on women. Study 1 (n = 188) tested the moderator effect of subjective well-being on the association of BMI with the scale on desire to eat in response to negative emotions (DEBQ-E). Study 2 tested in women (n = 832) whether items on desire to eat in response to positive emotions loaded on the same factor as those in response to negative emotions and body mass. Study 3 assessed in the total sample (n = 203) and an overweight subsample (n = 40) a) whether self-reported desire to eat in response to positive emotions predicted actual food intake and b) whether this also held true over and above self-reported desire to eat in response to negative emotions. Study 1 showed only for women with low positive affect a significant positive association of BMI with DEBQ-E. In Study 2, only items on desire to eat in response to negative emotions loaded on the same factor as BMI. Study 3: In the total sample, the significant effect on food intake of the scale on desire to eat in response to positive emotions disappeared when a scale on desire to eat in response to negative emotions was added to the model. In the overweight-subsample there was only an effect on food intake for desire to eat in response to negative emotions. It is concluded that only desire to eat in response to negative emotions is an 'obese' eating style, suggesting that Kummerspeck is not a misnomer.

Pedological characterisation of sites along a transect from a primary cadmium/lead/zinc smelting works.

A pedological characterisation of seven sites along a transect from a smelter at Avonmouth, UK, was undertaken. Site locations comprised a mixture of both grassland (5 sites) and oak tree dominated (2 sites) areas. Geographically, sites were either low lying or on adjacent elevated ground. Across the transect, a severe gradient of metal concentrations was found with highest values for organic soil horizons from close to the factory. Comparisons with quality standards indicate that these metal levels are likely to be a major ecological stressor. In addition to the strong metal gradient, a number of other between site differences were also observed. These were firstly water regime, which at the low lying sites close to the smelter showed influence by both, groundwater and stagnant water, while at more distant sites indicated susceptibility to stagnant water only, and secondly soil pH, which showed large between site variations, although no consistent trend along the transect. Humus forms at sites more than 1.5 km from the smelter were characteristic for the soil conditions and land-use present, while those at sites within 1.5 km showed disturbed profiles. Indeed, the humus types present at these locations suggest that the activity of soil invertebrates may be inhibited. This is almost certainly due primarily to the high concentrations of metals that were present in mineral soil and organic horizons at the sites. However, the potential influences of water regime and pH could also be relevant factors influencing the results of any further studies conducted at these study sites.