The effect of multiple micronutrient supplementation on left ventricular ejection fraction in patients with chronic stable heart failure: a randomized, placebo-controlled trial:A randomized, placebo-controlled trial

Objectives: This study sought to investigate the effect of a multiple micronutrient supplement on left ventricular ejection fraction (LVEF) in patients with heart failure. Background: Observational studies suggest that patients with heart failure have reduced intake and lower concentrations of a number of micronutrients. However, there have been very few intervention studies investigating the effect of micronutrient supplementation in patients with heart failure. Methods: This was a randomized, double-blind, placebo-controlled, parallel-group study involving 74 patients with chronic stable heart failure that compared multiple micronutrient supplementation taken once daily versus placebo for 12 months. The primary endpoint was LVEF assessed by cardiovascular magnetic resonance imaging or 3-dimensional echocardiography. Secondary endpoints were Minnesota Living With Heart Failure Questionnaire score, 6-min walk test distance, blood concentrations of N-terminal prohormone of brain natriuretic peptide, C-reactive protein, tumor necrosis factor alpha, interleukin-6, interleukin-10, and urinary levels of 8-iso-prostaglandin F2 alpha. Results: Blood concentrations of a number of micronutrients increased significantly in the micronutrient supplement group, indicating excellent compliance with the intervention. There was no significant difference in mean LVEF at 12 months between treatment groups after adjusting for baseline (mean difference: 1.6%, 95% confidence interval: -2.6 to 5.8, p = 0.441). There was also no significant difference in any of the secondary endpoints at 12 months between treatment groups. Conclusions: This study provides no evidence to support the routine treatment of patients with chronic stable heart failure with a multiple micronutrient supplement. (Micronutrient Supplementation in Patients With Heart Failure [MINT-HF]; NCT01005303).

Community pharmacists and people with dementia: a cross-sectional survey exploring experiences, attitudes, and knowledge of pain and its management

Objectives
To explore community pharmacists' experiences with and attitudes towards people with dementia, and to determine the knowledge they have about pain and its management in this patient population. 

Methods
A questionnaire comprising five sections, including the Approaches to Dementia Questionnaire, was mailed, on two occasions, during February and March 2011, to all community pharmacies in Northern Ireland (n=530). 

Results
The response rate was 34.3%. A greater proportion of pharmacists provided pharmaceutical care to people with dementia living at home (91.2%) than those living in care homes (40.1%). Respondents most frequently encountered queries relating to starting and stopping medications, compliance with medication, and availability of formulation types. The mean total score for the Approaches to Dementia Questionnaire measure was 72.8, indicating a positive attitude towards people with dementia, and respondents demonstrated a strong person-centred approach towards this patient population. The majority of respondents recognised the difficulty of assessing pain in people with dementia; however, younger pharmacists (p=0.041) and pharmacists who provided pharmaceutical care to people with dementia (p=0.012) were more likely to be aware of the pain assessment tools for use in people with dementia. Pharmacists appeared uncertain about how to appropriately manage pain in people with dementia.

Conclusions
The study has revealed that community pharmacists often encounter people with dementia, especially those living in their own homes, and they have positive attitudes towards the patient population. However, training in the assessment and management of pain in people with dementia must be developed to further improve their knowledge in this area. 

Human Rights in Northern Ireland 2009-10

This report surveys the legislative and judicial developments in human rights law within Northern Ireland in the years 2009 and 2010, highlighting the respects in which the law was or was not in compliance with international human rights standards, in particular those laid down in the European Convention on Human Rights.

Does Basel Compliance Matter for Bank Performance ?

The global financial crisis underscored the importance of regulation and supervision to a well functioning banking system that efficiently channels financial resources into investment. In this paper, we contribute to the ongoing policy debate by assessing whether compliance with international regulatory standards and protocols enhances bank operating efficiency. We focus specifically on the adoption of international capital standards and the Basel Core Principles for Effective Bank Supervision (BCP). The relationship between bank efficiency and regulatory compliance is investigated using the (Simar and Wilson 2007) double bootstrapping approach on an international sample of publicly listed banks. Our results indicate that overall BCP compliance, or indeed compliance with any of its individual chapters, has no association with bank efficiency.

Does Basel Compliance Matter for Bank Performance?

The global financial crisis underscored the importance of regulation and supervision to a well-functioning banking system that efficiently channels financial resources into investment. In this paper, we contribute to the ongoing policy debate by assessing whether compliance with international regulatory standards and protocols enhances bank operating efficiency. We focus specifically on the adoption of international capital standards and the Basel Core Principles for Effective Bank Supervision (BCP). The relationship between bank efficiency and regulatory compliance is investigated using the Simar and Wilson (2007. J. Econ. 136 (1), 31) double bootstrapping approach on an international sample of publicly listed banks. Our results indicate that overall BCP compliance, or indeed compliance with any of its individual chapters,has no association with bank efficiency.

Exporting Europeanisation to the Wider Europe: the Twinning Excercise and Administrative Reform in the Candidate Countries and Beyond

This article looks at the EU's efforts to assist administrative reform in Eastern Europe, with particular attention to the twinning exercise, conceptually linked to Europeanization. The article argues that much of the debate on Europeanization has focused predominantly on the way in which existing member states are being transformed as a result of their participation in EU structures. Yet the political importance attached to EU membership by the accession applicants, as well as EU's determination to ensure compliance with the acquis communautaire prior to entry, indicates that Europeanization is not only confined to existing EU member states, but can be exported outside the geographical borders of the EU. Against this background the article argues that extending the scope of the Europeanization thesis beyond existing members can not only help us understand better the process of transformation in Eastern Europe and the ongoing accession negotiations, but can also contribute towards the refinement of the term's rather blurred conceptual content.

Design of granular pavements

The use of high-quality quarried crushed rock aggregates is generally required to comply with current specifications for unbound granular materials (UGMs) in pavements. The source of these high-quality materials can be a long distance from the site, resulting in high transportation costs. The use of more local sources of marginal materials or the use of secondary aggregates is not allowed if they do not fully comply with existing specifications. These materials can, however, be assessed for their suitability for use in a pavement by considering performance criteria such as resistance to permanent deformation and degradation instead of relying on compliance with inflexible specifications. The final thickness of the asphalt cover and the pavement depth are governed by conventional pavement design methods, which consider the number of vehicle passes, subgrade strength, and some material property, commonly the California bearing ratio or resilient modulus. A pavement design method that includes as a design criterion an assessment of the resistance to deformation of a UGM in a pavement structure at a particular stress state is proposed. The particular stress state at which the aggregate is to perform in an acceptable way is related to the in situ stress, that is, the stress that the aggregate is anticipated to experience at a particular depth in the pavement. Because the stresses are more severe closer to the pavement surface, the aggregates should be better able to resist these stresses the closer they are laid to the surface in the pavement. This method was applied to two Northern Ireland aggregates of different quality (NI Good and NI Poor). The results showed that the NI Poor aggregate performed at an acceptable level with respect to permanent deformation, provided that a minimum of 70 mm of asphalt cover was provided. It was predicted that the NI Good material would require 60 mm of asphalt cover.

From 'Good as Gold' to 'Gold Diggers': Farming Women and the Survival of British Family Farming

The survival of family farming in British agriculture has long been a topic of interest for rural researchers and is undergoing something of a current renewal of interest. However, insights from feminist approaches remain underutilised despite the crucial role farming women continue to play in family farming. This paper addresses the unity of farm, family and business by interpreting it as a patriarchal â??way of lifeâ??. An ethnographic-informed repeated life history methodology is employed to study in detail the family members of seven farms in rural mid-Wales. Findings show that the recent survival of the family farms investigated has been heavily dependent upon compliance with a patriarchal ideology that demands women be â??as good as goldâ??. However, it is discovered that a new view of women is emerging in the world of British family farming, that of â??gold diggerâ??. Women entering relationships with farming men are increasingly being considered a threat to farm survival by virtue of their entitlements if the relationship breaks down. The necessity to study the intricacies of personal relationships in family farming has important implications for most future research into this form of agricultural business arrangement.

Incorporation of chitosan in acrylic bone cement: Effect on antibiotic release, bacterial biofilm formation and mechanical properties

Bacterial infection remains a significant problem following total joint replacement. Efforts to prevent recurrent implant infection, including the use of antibiotic-loaded bone cement for implant fixation at the time of revision surgery, are not always successful. In this in vitro study, we investigated whether the addition of chitosan to gentamicin-loaded Palacos® R bone cement increased antibiotic release and prevented bacterial adherence and biofilm formation by Staphylococcus spp. clinical isolates. Furthermore, mechanical tests were performed as a function of time post-polymerisation in pseudo-physiological conditions. The addition of chitosan to gentamicin-loaded Palacos® R bone cement significantly decreased gentamicin release and did not increase the efficacy of the bone cement at preventing bacterial colonisation and biofilm formation. Moreover, the mechanical performance of cement containing chitosan was significantly reduced after 28 days of saline degradation with the compressive and bending strengths not in compliance with the minimum requirements as stipulated by the ISO standard for PMMA bone cement. Therefore, incorporating chitosan into gentamicin-loaded Palacos® R bone cement for use in revision surgery has no clinical antimicrobial benefit and the detrimental effect on mechanical properties could adversely affect the longevity of the prosthetic joint.

Cluster randomised controlled trial of an infection control education and training intervention programme focusing on meticillin-resistant Staphylococcus aureus in nursing homes for older people

The aim of this cluster randomised controlled trial was to test the impact of an infection control education and training programme on meticillin-resistant Staphylococcus aureus (MRSA) prevalence in nursing homes. Nursing homes were randomised to intervention (infection control education and training programme; N¼16) or control (usual practice continued; N¼16). Staff in intervention homes were educated and trained (0, 3 and 6 months) in the principles and implementation of good infection control practice with infection control audits conducted in all sites (0, 3, 6 and 12 months) to assess compliance with good practice. Audit scores were fed back to nursing home managers in intervention homes, together with a written report indicating where practice could be improved. Nasal swabs were taken from all consenting residents and staff at 0, 3, 6 and 12 months. The primary outcome was MRSA prevalence in residents and staff, and the secondary outcome was a change in infection control audit scores. In all, 793 residents and 338 staff were recruited at baseline. MRSA prevalence did not change during the study in residents or staff. The relative risk of a resident being colonised with MRSA in an intervention home compared with a control home at 12 months was 0.99 (95% con?dence interval: 0.69, 1.42) after adjustment for clustering. Mean infection control audit scores were signi?cantly higher in the intervention homes (82%) compared with the control homes (64%) at 12 months (P<0.0001). Consideration should be given to other approaches which may help to reduce MRSA in this setting.

Steady-State and Transient Performance of Biodiesel-Fueled Compression-Ignition-Based Electrical Generation

This paper investigates the performance characteristics of rapeseed methyl ester, EN 14214 biodiesel, when used for electrical generation in compression ignition engines. The work was inspired by the need to replace fossil diesel fuel with a sustainable low carbon alternative while maintaining generator performance, power quality, and compliance with ISO 8528-5. A 50-kVA Perkins diesel engine generator was used to assess the impact of biodiesel with particular regard to gen-set fuel consumption, load acceptance, and associated standards. Tests were performed on the diesel gen-set for islanded and grid-connected modes of operation, hence both steady-state and transient performance were fully explored. Performance comparisons were made with conventional fossil diesel fuel, revealing minimal technical barriers for electrical generation from this sustainable, carbon benign fuel. Recommendations for improved transient performance are proposed and validated through tests.

Revisioning assessment through a children’s rights approach: implications for policy, process and practice

The linkage between the impact of assessment and compliance with children’s rights is a connection, which although seemingly obvious, is nonetheless rarely made, particularly by governments, which, as signatories to the relevant human rights treaties, have the primary responsibility for ensuring that educational practice is compatible with international children’s rights standards. While some jurisdictions are explicit about an adherence to children’s rights frameworks in general policy documentation, such a commitment rarely features when the focus is on assessment and testing. Thus, in spite of significant public and academic attention given to the consequences of assessment for children and governments committed to working within children’s rights standards, the two are rarely considered together. This paper examines the implications for the policy, process and practice of assessment in light of international human rights standards. Three key children’s rights principles and standards are used as a critical lens to examine assessment policy and practice: (1) best interests; (2) non-discrimination; and (3) participation. The paper seeks new insights into the complexities of assessment practice from the critical perspective of children’s rights and argues that such standards not only provide a convenient benchmark for developing, implementing and evaluating assessment practices, but also acknowledge the significance of assessment in the delivery of children’s rights to, in and through education more generally.

Detection of 3-amino-2-oxazolidinone (AOZ), a tissue-bound metabolite of the nitrofuran furazolidone, in prawn tissue by enzyme immunoassay

Furazolidone, a nitrofuran antibiotic, is banned from use in food animal production within the European Union. Increasingly, compliance with this ban is monitored by use of analytical methods to detect a stable tissue-bound metabolite, 3-amino-2-oxazolidinone (AOZ). Widespread use of furazolidone in poultry and prawns imported into Europe highlighted the urgent need for development of nitrofuran immunoassay screening tests. The first enzyme-linked immunoabsorbant assay for detection of AOZ residues in prawns (shrimps) is now described. Prawn samples were derivatized with o-nitrobenzaldehyde, extracted into ethyl acetate, washed with hexane and applied to a competitive enzyme immunoassay based on a rabbit polyclonal antiserum. Assay limit of detection (LOD) (mean+3 s) calculated from the analysis of 20 known negative cold and warm water prawn samples was 0.1 mug kg(-1). Intra- and interassay relative standard deviations were determined as 18.8 and 38.2%, respectively, using a negative prawn fortified at 0.7 mug kg(-1). The detection capability (CCbeta), defined as the concentration of AOZ at which 20 different fortified samples yielded results above the LOD, was achieved at fortification between 0.4 and 0.7 mug kg(-1). Incurred prawn samples (n=8) confirmed by liquid chromatography coupled with tandem mass spectrometry detection to contain AOZ concentrations between 0.4 and 12.7 mug kg(-1) were all screened positive by this enzyme-linked immunoabsorbant assay. Further data are presented and discussed with regard to calculating assay LOD based on accepting a 5% false-positive rate with representative negative prawn samples. Such an acceptance improves the sensitivity of an ELISA and in this case permitted an LOD of 0.05 mug kg(-1) and a CCbeta of below 0.4 mug kg(-1).

Management of Barrett's esophagus in the UK: Overtreated and underbiopsied but improved by the introduction of a national randomized trial

OBJECTIVES: To assess the variation in practice of Barrett's esophagus (BE) management in comparison with accepted international guidelines before and after the introduction of a large BE randomized controlled trial (RCT) with protocols including those of tissue sampling.
DESIGN: A validated anonymized questionnaire was sent to 401 senior attending gastroenterologists asking for details of their current management of BE, especially histological sampling. Of the 228 respondents, 57 individuals (each from a different center) were in the first group to enter the ASPirin Esomeprazole (BE) Chemoprevention Trial (AspECT), and we assessed change in practice in these centers.
RESULTS: Ninety percent of specialists did not take adequate biopsies for histological diagnosis. Furthermore, 74% would consider aggressive surgical resection for prevalent cases of high-grade dysplasia in BE as their first-line choice despite the associated perioperative mortality. Ninety-two percent claim their lack of adherence to guidelines is because there is a need for stronger evidence for surveillance and medical interventions. Effect of the AspECT trial: Those clinicians in centers where the AspECT trial has started have improved adherence to ACG guidelines compared with their previous practice (P < 0.05). BE patients now get 18.8% more biopsies compared with previous practice, and 37.7% if the patient is entered into the AspECT trial (P < 0.01).
CONCLUSIONS: This large study indicates both wide variation in practice and poor compliance with guidelines. Because optimal histology is arguably the most important facet of BE management, the improvement in practice in centers taking part in the AspECT trial indicates an additional value of large international RCTs.

Nitrofuran antibiotic residues in pork The FoodBRAND retail survey

Use of nitrofuran drugs in food-producing animals has been prohibited within the EU because they may represent a public health risk. Monitoring compliance with the ban has focused on the detection of protein-bound nitrofuran metabolites which, in contrast to the parent compounds, are stable and persist in animal tissues. As part of the "FoodBRAND" project, an extensive survey of pork was undertaken across 15 European countries. Samples (n = 1500) purchased at retail outlets were analysed for the nitrofuran metabolites AOZ, AMOZ, AHD and SEM using LC-MS/MS determination of nitrobenzaldehyde derivatives. Limits of quantification for the method were 0.1 mug/kg (AOZ, AMOZ), 0.2 mug/kg (SEM) and 0.5 mug/kg (AHD). Of the 1500 samples tested, measurable residues of nitrofuran metabolites were confirmed in 12 samples (0.8% incidence overall) of which 10 samples were purchased in Portugal (AOZ, 0.3 mug/kg; AMOZ, 0.2-0.6 mug/kg) and one sample each in Italy (AMOZ, 1.0 mug/kg) and Greece (AOZ, 3.0 mug/kg). (C) 2004 Elsevier B.V. All rights reserved.