The NHS Health Check programme aims to reduce the risk of common preventable diseases by providing risk information and behaviour change advice. Failure to deliver the consultation appropriately could undermine its efficacy. To date, to the authors' knowledge, there are no published data on the fidelity of delivery of NHS Health Checks. To assess the fidelity of delivery of NHS Health Checks in general practice. Fidelity assessment of video and audio recordings of NHS Health Check consultations conducted in four GP practices across the East of England. A secondary analysis of 38 NHS Health Check consultations, which were video or audio recorded as part of a pilot study of introducing discussions of cancer risk into NHS Health Checks. Using a checklist based on the , fidelity of delivery was assessed as the proportion of key elements completed during the consultations. The mean number of elements of the NHS Health Check completed across all consultations was 14.5/18 (80.6%), with a range of 10 to 17 (55.6% to 94.4%). The mean fidelity for risk assessment, risk communication, and risk management sections was 8.7/10 (87.0%), 4.1/5 (82.0%), and 1.7/3 (56.7%), respectively. Clinically appropriate lifestyle advice was given in 34/38 consultations. Elements with the lowest fidelity were ethnicity assessment ( = 12/38; 31.6%), family history of cardiovascular disease (CVD) assessment ( = 25/38; 65.8%), AUDIT-C communication ( = 13/38; 34.2%), and dementia risk management ( = 6/38; 15.8%). Although fidelity of delivery was high overall, important elements of the NHS Health Check were being regularly omitted. Opportunities for behaviour change, particularly relating to alcohol consumption and dementia risk management, may be being missed.Although fidelity of delivery was high overall, important elements of the NHS Health Check were being regularly omitted. Opportunities for behaviour change, particularly relating to alcohol consumption and dementia risk management, may be being missed. Advance care planning (ACP) can help to enhance the care of patients with limited life expectancy. Despite physicians' key role in ACP, the ways in which physicians estimate and communicate prognosis can be improved. To determine how physicians in different care settings self-assess their performance in estimating and communicating prognosis to patients in palliative care, and how they perceive their communication with other physicians about patients' poor prognosis. A survey study was performed among a random sample of GPs, hospital physicians (HPs), and nursing home physicians (NHPs) in the southwest of the Netherlands ( = 2212). A questionnaire was developed that had three versions for GPs, HPs, and NHPs. Each specialism filled in an appropriate version. A total of 547 physicians participated 259 GPs, 205 HPs, and 83 NHPs. In the study, 61.1% of physicians indicated being able to adequately estimate whether a patient will die within 1 year, which was associated with use of the Surprise Questions for care. However, more physicians should be trained in communicating about patients' poor prognosis and care preferences. To quantify the association of indices of central obesity, including waist circumference, hip circumference, thigh circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, with the risk of all cause mortality in the general population, and to clarify the shape of the dose-response relations. Systematic review and meta-analysis. PubMed and Scopus from inception to July 2019, and the reference lists of all related articles and reviews. Prospective cohort studies reporting the risk estimates of all cause mortality across at least three categories of indices of central fatness. Studies that reported continuous estimation of the associations were also included. A random effects dose-response meta-analysis was conducted to assess linear trend estimations. A one stage linear mixed effects meta-analysis was used for estimating dose-response curves. Of 98 745 studies screened, 1950 full texts were fully reviewed for eligibility. The finalhe results suggest that measures of central adiposity could be used with body mass index as a supplementary approach to determine the risk of premature death.Using over a century of ground-based observations over the contiguous United States, we show that the frequency of compound dry and hot extremes has increased substantially in the past decades, with an alarming increase in very rare dry-hot extremes. Our results indicate that the area affected by concurrent extremes has also increased significantly. Further, we explore homogeneity (i.e., connectedness) of dry-hot extremes across space. We show that dry-hot extremes have homogeneously enlarged over the past 122 years, pointing to spatial propagation of extreme dryness and heat and increased probability of continental-scale compound extremes. Last, we show an interesting shift between the main driver of dry-hot extremes over time. Galunisertib nmr While meteorological drought was the main driver of dry-hot events in the 1930s, the observed warming trend has become the dominant driver in recent decades. Our results provide a deeper understanding of spatiotemporal variation of compound dry-hot extremes.Meltwater and ice discharge from a retreating Antarctic Ice Sheet could have important impacts on future global climate. Here, we report on multi-century (present-2250) climate simulations performed using a coupled numerical model integrated under future greenhouse-gas emission scenarios IPCC RCP4.5 and RCP8.5, with meltwater and ice discharge provided by a dynamic-thermodynamic ice sheet model. Accounting for Antarctic discharge raises subsurface ocean temperatures by >1°C at the ice margin relative to simulations ignoring discharge. In contrast, expanded sea ice and 2° to 10°C cooler surface air and surface ocean temperatures in the Southern Ocean delay the increase of projected global mean anthropogenic warming through 2250. In addition, the projected loss of Arctic winter sea ice and weakening of the Atlantic Meridional Overturning Circulation are delayed by several decades. Our results demonstrate a need to accurately account for meltwater input from ice sheets in order to make confident climate predictions.