Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery.

Despite major improvements in diagnostics and interventional therapies, cardiovascular diseases remain a major health care and socio-economic burden both in western and developing countries, in which this burden is increasing in close correlation to economic growth. Health authorities and the general population have started to recognize that the fight against these diseases can only be won if their burden is faced by increasing our investment on interventions in lifestyle changes and prevention. There is an overwhelming evidence of the efficacy of secondary prevention initiatives including cardiac rehabilitation in terms of reduction in morbidity and mortality. However, secondary prevention is still too poorly implemented in clinical practice, often only on selected populations and over a limited period of time. The development of systematic and full comprehensive preventive programmes is warranted, integrated in the organization of national health systems. Furthermore, systematic monitoring of the process of delivery and outcomes is a necessity. Cardiology and secondary prevention, including cardiac rehabilitation, have evolved almost independently of each other and although each makes a unique contribution it is now time to join forces under the banner of preventive cardiology and create a comprehensive model that optimizes long term outcomes for patients and reduces the future burden on health care services. These are the aims that the Cardiac Rehabilitation Section of the European Association for Cardiovascular Prevention & Rehabilitation has foreseen to promote secondary preventive cardiology in clinical practice.

Radiochromic film spectroscopy of laser-accelerated proton beams using the FLUKA code and dosimetry traceable to primary standards

A new approach to spectroscopy of laser induced proton beams using radiochromic film (RCF) is presented. This approach allows primary standards of absorbed dose-to-water as used in radiotherapy to be transferred to the calibration of GafChromic HD-810 and EBT in a 29 MeV proton beam from the Birmingham cyclotron. These films were then irradiated in a common stack configuration using the TARANIS Nd:Glass multi-terawatt laser at Queens University Belfast, which can accelerate protons to 10-12 MeV, and a depth-dose curve was measured from a collimated beam. Previous work characterizing the relative effectiveness (RE) of GafChromic film as a function of energy was implemented into Monte Carlo depth-dose curves using FLUKA. A Bragg peak (BP) "library" for proton energies 0-15 MeV was generated, both with and without the RE function. These depth-response curves were iteratively summed in a FORTRAN routine to solve for the measured RCF depth-dose using a simple direct search algorithm. By comparing resultant spectra with both BP libraries, it was found that the effect of including the RE function accounted for an increase in the total number of protons by about 50%. To account for the energy loss due to a 20 mu m aluminum filter in front of the film stack, FLUKA was used to create a matrix containing the energy loss transformations for each individual energy bin. Multiplication by the pseudo-inverse of this matrix resulted in "up-shifting" protons to higher energies. Applying this correction to two laser shots gave further increases in the total number of protons, N of 31% and 56%. Failure to consider the relative response of RCF to lower proton energies and neglecting energy losses in a stack filter foil can potentially lead to significant underestimates of the total number of protons in RCF spectroscopy of the low energy protons produced by laser ablation of thin targets.

EMAS and ISO 14001 in the German industry – complements or substitutes?

The two environmental management system (EMS) standards EMAS and ISO 14001 have been available in Europe for the last 15 years. ISO 14001 has been taken up at a much larger scale but many firms in the German automotive and engineering industry have certified their EMSs according to both standards. Two research questions are addressed: (i) What explains why companies adopt both EMAS and ISO 14001? (ii) Are EMAS and ISO 14001 complements or substitutes? Based on 21 interviews with industrial and institutional representatives, this study finds that, first, the two standards are adopted for completely different reasons: while ISO 14001 is often done as a response to external pressure, EMAS tends to be motivated internally. Second, it is argued that EMAS and ISO 14001 are likely in a situation of direct competition at present which may well turn into complementarity in the future.

Getting to the bottom of arsenic standards and guidelines

Public health policy for arsenic needs to better reflect the ability to detect the risk(s).

Inorganic arsenic levels in rice milk exceed EU and US drinking water standards

Under EU legislation, total arsenic levels in drinking water should not exceed 10 microg l(-1), while in the US this figure is set at 10 microg l(-1) inorganic arsenic. All rice milk samples analysed in a supermarket survey (n = 19) would fail the EU limit with up to 3 times this concentration recorded, while out of the subset that had arsenic species determined (n = 15), 80% had inorganic arsenic levels above 10 microg l(-1), with the remaining 3 samples approaching this value. It is a point for discussion whether rice milk is seen as a water substitute or as a food, there are no EU or US food standards highlighting the disparity between water and food regulations in this respect.

Chlorobenzenes in rivers draining industrial catchments

Eleven chlorobenzenes (out of a total of 12 in the congener series) were monitored weekly on four industrialized rivers (Aire, Calder, Don and Trent) of the Southern Humber Catchment in whole water samples. 1,2- and 1,4-dichlorobenzene were present at relatively high levels on both the Aire and Calder, having mean concentrations of approximately 30 ng/l. They were both at lower concentrations on the Don and Trent, although the 1,4-isomer dominated. All other chlorobenzenes monitored were routinely found on all the rivers, with the exception of hexachlorobenzene, which was only regularly detected on the Trent. Again, the rivers fell into two classes with respect to their total chlorobenzene concentrations, with the Aire and Calder being more polluted. The higher levels of chlorobenzenes (excluding hexachlorobenzene which was used widely as a agricultural pesticide) on the Aire and Calder, and the dominance of the 1,4-dichlorobenzene congener (accounting for 60-70% of sigma chlorobenzenes) on the Don and Trent, indicated that the Aire and Calder were predominately contaminated with chlorobenzenes through industrial sources, while the Don and Trent were mainly contaminated through domestic sources (1,4-dichlorobenzene is widely used as a toilet deodorant). 1,4-Dichlorobenzene dominated flux, with the Aire, Don and Trent exporting 52.5 kg/year into the Humber estuary, followed by the 1,2-dichlorobenzene at 38.8 kg/year. Sigma chlorobenzenes exported to the Humber was 133 kg/year. This is the first study to calculate chlorobenzene fluxes to the North Sea from a UK catchment.

Inscribing value on business model innovations: Insights from industrial projects commercializing disruptive digital innovations

In this paper we seek to show how marketing activities inscribe value on business model innovation, representative of an act, or sequence of socially interconnecting acts. Theoretically we ask two interlinked questions: (1) how can value inscriptions contribute to business model innovations? (2) how can marketing activities support the inscription of value on business model innovations? Semi-structured in-depth interviews were conducted with the thirty-seven members from across four industrial projects commercializing disruptive digital innovations. Various individuals from a diverse range of firms are shown to cast relevant components of their agency and knowledge on business model innovations through negotiation as an ongoing social process. Value inscription is mutually constituted from the marketing activities, interactions and negotiations of multiple project members across firms and functions to counter destabilizing forces and tensions arising from the commercialization of disruptive digital innovations. This contributes to recent conceptual thinking in the industrial marketing literature, which views business models as situated within dynamic business networks and a context-led evolutionary process. A contribution is also made to debate in the marketing literature around marketing's boundary-spanning role, with marketing activities shown to span and navigate across functions and firms in supporting value inscriptions on business model innovations.

Assessing Lifetime Homes Standards and Part M Building Regulations for Housing Design in the UK

The aims of this article are to examine Lifetime Home Standards (LTHS) and Part M of the UK Building Regulations and to discuss how relevant and successful they are. The UK government expects all new homes to be built to LTHS by 2013. This is increasingly important with an ageing population. The home environment can enable independence and provide a therapeutic place for everyone. As Part M of the building regulations are compulsory in all housing and LTHS are mandatory for public sector housing, a review of research articles was undertaken on these standards. The paper begins with a brief background on accessibility regulations, followed by a critical review of the standards that takes the body of literature that has been written around them into account. This review suggests that the standards should be improved and that designers and architects face challenges to creatively incorporate them into housing design.

Affective disruption: Walter Benjamin and the 'history' of Ireland's industrial schools

What role do organizations play in writing history? In this paper, I address the part played by organizations in the enactment of large-scale violence, and focus on the ways in which the resulting histories come to be written. Drawing on the case of Ireland's industrial schools, I demonstrate how such accounts can act to serve the interests of those in power, effectively silencing and marginalizing weaker people. A theoretical lens that draws on ideas from Walter Benjamin and Judith Butler is helpful in understanding this; the concept of 'affective disruption' enables an exploration of how people's experiences of organizational violence can be reclaimed from the past, and protected in a continuous remembrance. Overall, this paper contributes a new perspective on the writing of organizational histories, particularly in relation to the enactment of violence.