The SPHERE Study: Secondary prevention of heart disease in general practice: protocol of a randomised controlled trial of tailored practice and patient care plans with parallel qualitative, economic and policy analyses. [ISRCTN24081411]

Background: The aim of the SPHERE study is to design, implement and evaluate tailored practice and personal care plans to improve the process of care and objective clinical outcomes for patients with established coronary heart disease (CHD) in general practice across two different health systems on the island of Ireland.CHD is a common cause of death and a significant cause of morbidity in Ireland. Secondary prevention has been recommended as a key strategy for reducing levels of CHD mortality and general practice has been highlighted as an ideal setting for secondary prevention initiatives. Current indications suggest that there is considerable room for improvement in the provision of secondary prevention for patients with established heart disease on the island of Ireland. The review literature recommends structured programmes with continued support and follow-up of patients; the provision of training, tailored to practice needs of access to evidence of effectiveness of secondary prevention; structured recall programmes that also take account of individual practice needs; and patient-centred consultations accompanied by attention to disease management guidelines.

Methods: SPHERE is a cluster randomised controlled trial, with practice-level randomisation to intervention and control groups, recruiting 960 patients from 48 practices in three study centres (Belfast, Dublin and Galway). Primary outcomes are blood pressure, total cholesterol, physical and mental health status (SF-12) and hospital re-admissions. The intervention takes place over two years and data is collected at baseline, one-year and two-year follow-up. Data is obtained from medical charts, consultations with practitioners, and patient postal questionnaires. The SPHERE intervention involves the implementation of a structured systematic programme of care for patients with CHD attending general practice. It is a multi-faceted intervention that has been developed to respond to barriers and solutions to optimal secondary prevention identified in preliminary qualitative research with practitioners and patients. General practitioners and practice nurses attend training sessions in facilitating behaviour change and medication prescribing guidelines for secondary prevention of CHD. Patients are invited to attend regular four-monthly consultations over two years, during which targets and goals for secondary prevention are set and reviewed. The analysis will be strengthened by economic, policy and qualitative components.

Performance analysis of an improved power-saving medium access protocol for IEEE 802.11 point coordination function WLAN

Wireless enabled portable devices must operate with the highest possible energy efficiency while still maintaining a minimum level and quality of service to meet the user's expectations. The authors analyse the performance of a new pointer-based medium access control protocol that was designed to significantly improve the energy efficiency of user terminals in wireless local area networks. The new protocol, pointer controlled slot allocation and resynchronisation protocol (PCSAR), is based on the existing IEEE 802.11 point coordination function (PCF) standard. PCSAR reduces energy consumption by removing the need for power saving stations to remain awake and listen to the channel. Using OPNET, simulations were performed under symmetric channel loading conditions to compare the performance of PCSAR with the infrastructure power saving mode of IEEE 802.11, PCF-PS. The simulation results demonstrate a significant improvement in energy efficiency without significant reduction in performance when using PCSAR. For a wireless network consisting of an access point and 8 stations in power saving mode, the energy saving was up to 31% while using PCSAR instead of PCF-PS, depending upon frame error rate and load. The results also show that PCSAR offers significantly reduced uplink access delay over PCF-PS while modestly improving uplink throughput.

A UKST survey of blue objects towards the Galactic centre - seven additional fields

We are searching for early-type stars towards the Galactic centre which are potentially young objects situated within the inner few kiloparsecs of the disk. Photographic photometry from the UK Schmidt Telescope has been used to identify the bluest candidates in nineteen Schmidt fields (centred close to the Galactic centre). We have previously obtained FLAIR low dispersion spectroscopy for three of these fields to estimate spectral types and here we present spectroscopy for an additional seven fields. Combining the results for all ten fields, 56 stars were initially classified as early-B type. Estimates of the equivalent widths of their Balmer and He I lines have been used to estimate atmospheric parameters and 32 targets have effective temperatures greater than or equal to 17 000 K (corresponding to a spectral type of B3 or earlier). The spectra of seven of these targets also have absorption lines due to O II and Si III and can be reliably classified as early- B type. Additionally 78 stars have estimated effective temperatures between 11 000 and 16 000 K with a further a further 50 objects identified as late-B (or early-A) type. All but two of the early B-type candidates have magnitudes in the range 12.0 less than or equal to V less than or equal to 16.0, and our best estimates of their distance suggest that they could be close to (i.e. R-g <3 kpc), or even beyond the Galactic centre.

A chemical analysis of five hot stars towards the Galactic centre

High resolution echelle spectroscopy is presented for thirteen stars lying in the direction of the Galactic centre which, on the basis of photographic photometry and low dispersion spectroscopy, have been classified as early-B-type. Eight of these stars have large rotational velocities which preclude a detailed analysis. The five stars with moderate to low projected rotational velocities have been analysed using model atmosphere techniques to determine atmospheric parameters and chemical compositions. Two of these stars appear to be evolved blue horizontal branch objects on the basis of their chemical compositions and small projected rotational velocity. The evolutionary status of a third is ambiguous but it is probably a post-asymptotic-giant branch star. The remaining two objects are probably young massive stars and show enhanced abundances of N, C, Mg and Si, consistent with their formation in the inner part of the Galactic disk. However their O abundances are normal, confirming results found previously for other early- type stars, which would imply a flat abundance gradient for this element in the inner region of our Galaxy.

Assessment of data quality in a multi-centre cross-sectional study of participation and quality of life of children with cerebral palsy

Background: SPARCLE is a cross-sectional survey in nine European regions, examining the relationship of the environment of children with cerebral palsy to their participation and quality of life. The objective of this report is to assess data quality, in particular heterogeneity between regions, family and item non-response and potential for bias. Methods: 1,174 children aged 8–12 years were selected from eight population-based registers of children with cerebral palsy; one further centre recruited 75 children from multiple sources. Families were visited by trained researchers who administered psychometric questionnaires. Logistic regression was used to assess factors related to family non-response and self-completion of questionnaires by children. Results: 431/1,174 (37%) families identified from registers did not respond: 146 (12%) were not traced; of the 1,028 traced families, 250 (24%) declined to participate and 35 (3%) were not approached. Families whose disabled children could walk unaided were more likely to decline to participate. 818 children entered the study of which 500 (61%) self-reported their quality of life; children with low IQ, seizures or inability to walk were less likely to self-report. There was substantial heterogeneity between regions in response rates and socio-demographic characteristics of families but not in age or gender of children. Item non-response was 2% for children and ranged from 0.4% to 5% for questionnaires completed by parents. Conclusion: While the proportion of untraced families was higher than in similar surveys, the refusal rate was comparable. To reduce bias, all analyses should allow for region, walking ability, age and socio-demographic characteristics. The 75 children in the region without a population based register are unlikely to introduce bias

A simplified protocol for routine total DNA isolation from salmonid fishes

An efficient total DNA isolation protocol, suitable for routine population genetic screening purposes is described. This phenol based extraction can utilize fresh, frozen or ethanol preserved tissues.