This study examined the effects of using a multidisciplinary, integrated, whole-person, team advocate approach to educate and empower participants with multiple chronic illnesses and coordinate, monitor, and support their health care process. Individuals (N = 39) from Midwest hospitals participated and completed self-report instruments. Changes in participants' functioning were also measured with diagnostic measures completed by the team advocates. The results indicate that the participants' perceptions of physical functioning, physical well-being, control, self-efficacy, and life satisfaction increased. Additionally, health-related behavior changes were reported, and short-term costs were significantly lower than projected costs. Finally, the participants rated their health care services in the program as more effective than previous health care services.

Objective: To determine the effectiveness of health checks, performed by nurses in primary care, in reducing risk factors for cardiovascular disease and cancer. Design: Randomised controlled trial. Setting: Five urban general practices in Bedfordshire. Subjects: 2205 men and women who were randomly allocated a first health check in 1989-90 and a re-examination in 1992-3 (the intervention group); 1916 men and women who were randomly allocated an initial health check in 1992-3 (the control group). All subjects were aged 35-64 at recruitment in 1989. Main outcome measures: Serum total cholesterol concentration, blood pressure, body mass index, and smoking prevalence (with biochemical validation of cessation); self reported dietary, exercise, and alcohol habits. Results: Mean serum total cholesterol was 3.1% lower in the intervention group than controls (difference 0.19 mmol/l (95% confidence interval 0.12 to 0.26); in women it was 4.5% lower (P<0.0001) and in men 1.6% (P<0.05), a significant difference between the sexes (P<0.01). Self reported saturated fat intake was also significantly lower in the intervention group. Systolic and diastolic blood pressures and body mass index were respectively 1.9%, 1.9%, and 1.4% lower in the intervention group (P<0.005 in all cases). There was a 3.9% (2.4 to 5.3) difference in the percentage of subjects with a cholesterol concentration >/=8 mmol/l, but no significant differences in the number with diastolic blood pressure >/=100 mm Hg or body mass index >/=30 kg/m2. There was no significant difference between the two groups in prevalence of smoking or excessive alcohol use. Annual rechecks were no more effective than a single recheck at three years, but health checks led to a significant increase in visits to the nurse according to patients' degree of cardiovascular risk. Conclusions: The benefits of health checks were sustained over three years. The main effects were to promote dietary change and reduce cholesterol concentrations; small differences in blood pressure may have been attributable to accommodation to measurement. The benefits of systematic health promotion in primary care are real, but must be weighed against the costs in relation to other priorities. Key messages Key messages There is little effect on smoking or alcohol use, and more targeted approaches to modifying these behaviours may be appropriate Systematic implementation of health checks might lead to a reduction in risk of myocardial infarction among those who attend of about 5-15%; men, who are at higher risk, show less change than women Health checks consume substantial resources, and their effect is attenuated by non-attendance The benefits of health promotion through primary care must be weighed against their costs and in relation to other priorities

Background The fall armyworm, Spodoptera frugiperda, is a significant and widespread pest of maize, sorghum, rice, and other economically important crops. Successful management of this caterpillar pest has historically relied upon application of synthetic insecticides and through cultivation of genetically engineered crops expressing insecticidal proteins (Bt crops). Fall armyworm has, however, developed resistance to both synthetic insecticides and Bt crops, which risks undermining the benefits delivered by these important crop protection tools. Previous modelling and empirical studies have demonstrated that releases of insecticide- or Bt-susceptible insects genetically modified to express conditional female mortality can both dilute insecticide resistance and suppress pest populations. Results Here, we describe the first germline transformation of the fall armyworm and the development of a genetically engineered male-selecting self-limiting strain, OX5382G, which exhibits complete female mortality in the absence of an additive in the larval diet. Laboratory experiments showed that males of this strain are competitive against wild-type males for copulations with wild-type females, and that the OX5382G self-limiting transgene declines rapidly to extinction in closed populations following the cessation of OX5382G male releases. Population models simulating the release of OX5382G males in tandem with Bt crops and non-Bt ‘refuge’ crops show that OX5382G releases can suppress fall armyworm populations and delay the spread of resistance to insecticidal proteins. Conclusions This article describes the development of self-limiting fall armyworm designed to control this pest by suppressing pest populations, and population models that demonstrate its potential as a highly effective method of managing resistance to Bt crops in pest fall armyworm populations. Our results provide early promise for a potentially valuable future addition to integrated pest management strategies for fall armyworm and other pests for which resistance to existing crop protection measures results in damage to crops and impedes sustainable agriculture.

A fundamental assumption regarding fantasy worlds is that they need to have a certain degree of internal coherence and consistency, otherwise the audience’s ability to immerse themselves in the storyworld will collapse under the weight of its contradictions. It is time to reconsider some of our ideas about storyworld design. “Building” imaginary worlds implies construction according to an architectural masterplan. In Imagining the Impossible volume 2, issue 1 we consider whether “assembling” may be a more productive term, implying the conjoining of different modular parts into forms that may be put together in various ways by different fans, like someone playing with Lego pieces drawn from several different sets.