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.

Adsorption characteristics of Cu and Ni on Irish peat moss

Peat has been widely used as a low cost adsorbent to remove a variety of materials including organic compounds and heavy metals from water. Various functional groups in lignin allow such compounds to bind on active sites of peat. The adsorption of Cu²⁺ and Ni²⁺ from aqueous solutions on Irish peat moss was studied both as a pure ion and from their binary mixtures under both equilibrium and dynamic conditions in the concentration range of 5–100 mg/L. The pH of the solutions containing either Cu²⁺ or Ni²⁺ was varied over a range of 2–8. The adsorption of Cu²⁺ and Ni⁺² on peat was found to be pH dependent. The adsorption data could be fitted to a two-site Langmuir adsorption isotherm and the maximum adsorption capacity of peat was determined to be 17.6 mg/g for Cu²⁺ and 14.5 mg/g for Ni²⁺ at 298 K when the initial concentration for both Cu²⁺ and Ni²⁺ was 100 mg/L, and the pH of the solution was 4.0 and 4.5, respectively. Column studies were conducted to generate breakthrough data for both pure component and binary mixtures of copper and nickel. Desorption experiments showed that 2 mM EDTA solution could be used to remove all of the adsorbed copper and nickel from the bed.

Progressive Audio Scrambling in Compressed Domain

Audio scrambling can be employed to ensure confidentiality in audio distribution. We first describe scrambling for raw audio using the discrete wavelet transform (DWT) first and then focus on MP3 audio scrambling. We perform scrambling based on a set of keys which allows for a set of audio outputs having different qualities. During descrambling, the number of keys provided and the number of rounds of descrambling performed will decide the audio output quality. We also perform scrambling by using multiple keys on the MP3 audio format. With a subset of keys, we can descramble to obtain a low quality audio. However, we can obtain the original quality audio by using all of the keys. Our experiments show that the proposed algorithms are effective, fast, simple to implement while providing flexible control over the progressive quality of the audio output. The security level provided by the scheme is sufficient for protecting MP3 music content.

Late Holocene climatic changes in Tierra del Fuego based on multiproxy analyses of peat deposits

A ca. 1400-yr record from a raised bog in Isla Grande, Tierra del Fuego, Argentina, registers climate fluctuations, including a Medieval Warm Period, although evidence for the 'Little Ice Age' is less clear. Changes in temperature and/or precipitation were inferred from plant macrofossils, pollen, fungal spores, testate amebae, and peat humification. The chronology was established using a C-14 wiggle-matching technique that provides improved age control for at least part of the record compared to other sites. These new data are presented and compared with other lines of evidence from the Southern and Northern Hemispheres. A period of low local water tables occurred in the bog between A.D. 960-1020, which may correspond to the Medieval Warm Period date range of A.D. 950-1045 generated from Northern Hemisphere tree-ring data. A period of cooler and/or wetter conditions was detected between ca. A.D. 1030 and I 100 and a later period of cooler/wetter conditions estimated at ca. cal A.D. 1800-1930, which may correspond to a cooling episode inferred from Law Dome, Antarctica. (C) 2004 University of Washington. All rights reserved.

Thermodynamic Properties of Mixtures Containing Ionic Liquids. 4. LLE of Binary Mixtures of [C2MIM][NTf2] with Propan-1-ol, Butan-1-ol, and Pentan-1-ol and [C4MIM][NTf2] with Cyclohexanol and 1,2-Hexanediol Including Studies of the Influence of Small Amounts of Water

Experimental data are presented for liquid-liquid equilibria of mixtures of the room-temperature ionic liquid 1-ethyl-3-methyl-imidazolium bis(trifluoromethylsulfonyl)imide ([C2MIM][NTf2]) with the three alcohols propan-1-ol, butan-1-ol, and pentan-1-ol and for the 1-butyl-3-methyl-imidazolium bis(trifluoromethylsulfonyl) imide ([C4MIM][NTf2]) with cyclohexanol and 1,2-hexanediol in the temperature range of 275 K to 345 K at ambient pressure. The synthetic method has been used. Cloud points at a given composition were observed by varying the temperature and using light scattering to detect the phase splitting. In addition, the influence of small amounts of water on the demixing temperatures of binary mixtures of [C2MIM][NTf2] and propan-1-ol, butan-1-ol, and pentan-1-ol was investigated.

PLL with secondary loop control for self tracking antennas

This paper shows a simple, yet highly effective, tracking phase locked loop circuit which has applications for self steered antenna arrays. The tracking PLL has been demonstrated to accurately phase track signal levels as low as -120 dBm, making it suitable for applications such as SATCOM ground terminals. The implementation is simple requiring a low Q voltage controlled oscillator, a downconverting mixer and a PLL circuit.

Blueberries decrease cardiovascular risk factors in obese men and women with metabolic syndrome

Among all fruits, berries have shown substantial cardio-protective benefits due to their high polyphenol content. However, investigation of their efficacy in improving features of metabolic syndrome and related cardiovascular risk factors in obesity is limited. We examined the effects of blueberry supplementation on features of metabolic syndrome, lipid peroxidation, and inflammation in obese men and women. Forty-eight participants with metabolic syndrome [4 males and 44 females; BMI: 37.8 +/- 2.3 kg/m(2); age: 50.0 +/- 3.0 y (mean +/- SE)] consumed freeze-dried blueberry beverage (50 g freeze-dried blueberries, approximately 350 g fresh blueberries) or equivalent amounts of fluids (controls, 960 mL water) daily for 8 wk in a randomized controlled trial. Anthropometric and blood pressure measurements, assessment of dietary intakes, and fasting blood draws were conducted at screening and at wk 4 and 8 of the study. The decreases in systolic and diastolic blood pressures were greater in the blueberry-supplemented group (- 6 and - 4%, respectively) than in controls (- 1.5 and - 1.2%) (P lt 0.05), whereas the serum glucose concentration and lipid profiles were not affected. The decreases in plasma oxidized LDL and serum malondialdehyde and hydroxynonenal concentrations were greater in the blueberry group (- 28 and - 17%, respectively) than in the control group (- 9 and - 9%) (P lt 0.01). Our study shows blueberries may improve selected features of metabolic syndrome and related cardiovascular risk factors at dietary achievable doses.

Cyanoacrylate glue versus suture in peripheral nerve reanastomosis

OBJECTIVE: To assess the effectiveness of n-butyl-2-cyanoacrylate glue compared with microsuturing technique in peripheral nerve reanastomosis in rats.

STUDY DESIGN: Fourteen young adult white rats were used. Bilateral sciatic neurotomies were performed in 12 of them and then reanastomosed with 3 epineural microsutures in the right side (study group G1) and with n-butyl-2-cyanoacrylate glue in the left side (study group G2). On the remaining 2 rats (control group G3), sham surgery was done on both sides. Biopsies were harvested 12 weeks after surgery and examined under light microscope using Osmic acid stains. The number of nerve fibers was counted in the distal and proximal nerve segments, and the results were analyzed and compared in all groups.

RESULTS: Adequate regeneration with no anastomotic ruptures was seen 12 weeks after surgery in G1 and G2. The histomorphometric assessment showed no statistically significant difference (P = .960) in the neurotization index of G1 (89.01%) compared with G2 (88.97%). There was a significant (P = .001) reduction in the mean number of axon counts distal to the repair in G1 (271.3) and G2 (272.8) compared with that of the proximal segments of each study group (304.6 and 303, respectively, as well as to that of G3 (348.5).

CONCLUSION: Both n-butyl-2-cyanoacrylate adhesive and 3-microsuture techniques showed comparable neurotization indices and were equally adequate to stabilize the nerve during regeneration period.

Identifying PV module mismatch faults by a thermography-based temperature distribution analysis

Photovoltaic (PV) solar power generation is proven to be effective and sustainable but is currently hampered by relatively high costs and low conversion efficiency. This paper addresses both issues by presenting a low-cost and efficient temperature distribution analysis for identifying PV module mismatch faults by thermography. Mismatch faults reduce the power output and cause potential damage to PV cells. This paper first defines three fault categories in terms of fault levels, which lead to different terminal characteristics of the PV modules. The investigation of three faults is also conducted analytically and experimentally, and maintenance suggestions are also provided for different fault types. The proposed methodology is developed to combine the electrical and thermal characteristics of PV cells subjected to different fault mechanisms through simulation and experimental tests. Furthermore, the fault diagnosis method can be incorporated into the maximum power point tracking schemes to shift the operating point of the PV string. The developed technology has improved over the existing ones in locating the faulty cell by a thermal camera, providing a remedial measure, and maximizing the power output under faulty conditions.

Voltammetric in situ measurements of heavy metals in soil using a portable electrochemical instrument

This paper presents a portable electrochemical instrument capable of detecting and identifying heavy metals in soil, in situ. The instrument has been developed for use in a variety of situations to facilitate contaminated land surveys, avoiding expensive and time-consuming procedures. The system uses differential pulse anodic stripping voltammetry which is a precise and sensitive analytical method with excellent limits of detection. The identification of metals is based on a statistical microprocessor-based method. The instrument is capable of detecting six different toxic metals (lead, cadmium, zinc, nickel, mercury and copper) with good sensitivity

Hydroclimatic shifts in northeast Thailand during the last two millennia - the record of Lake Pa Kho

The Southeast Asian mainland is located in the central path of the Asian summer monsoon, a region where paleoclimatic data are still sparse. Here we present a multi-proxy (TOC, C/N, δ¹³C, biogenic silica, and XRF elemental data) study of a 1.5m sediment/peat sequence from Lake Pa Kho, northeast Thailand, which is supported by 20 AMS ¹⁴C ages. Hydroclimatic reconstructions for Pa Kho suggest a strengthened summer monsoon between BC 170-AD 370, AD 800-960, and after AD 1450; and a weakening of the summer monsoon between AD 370-800, and AD 1300-1450. Increased run-off and a higher nutrient supply after AD 1700 can be linked to agricultural intensification and land-use changes in the region. This study fills an important gap in data coverage with respect to summer monsoon variability over Southeast Asia during the past 2000 years and enables the mean position of the Intertropical Convergence Zone (ITCZ) to be inferred based on comparisons with other regional studies. Intervals of strengthened/weaker summer monsoon rainfall suggest that the mean position of the ITCZ was located as far north as 35°N between BC 170-AD 370 and AD 800-960, whereas it likely did not reach above 17°N during the drought intervals of AD 370-800 and AD 1300-1450. The spatial pattern of rainfall variation seems to have changed after AD 1450, when the inferred moisture history for Pa Kho indicates a more southerly location of the mean position of the summer ITCZ.

Acute Cocoa Supplementation Increases Postprandial HDL Cholesterol and Insulin in Obese Adults with Type 2 Diabetes after Consumption of a High-Fat Breakfast

BACKGROUND: Dietary cocoa is an important source of flavonoids and is associated with favorable cardiovascular disease effects, such as improvements in vascular function and lipid profiles, in nondiabetic adults. Type 2 diabetes (T2D) is associated with adverse effects on postprandial serum glucose, lipids, inflammation, and vascular function.

OBJECTIVE: We examined the hypothesis that cocoa reduces metabolic stress in obese T2D adults after a high-fat fast-food-style meal.

METHODS: Adults with T2D [n = 18; age (means ± SEs): 56 ± 3 y; BMI (in kg/m(2)): 35.3 ± 2.0; 14 women; 4 men) were randomly assigned to receive cocoa beverage (960 mg total polyphenols; 480 mg flavanols) or flavanol-free placebo (110 mg total polyphenols; <0.1 mg flavanols) with a high-fat fast-food-style breakfast [766 kcal, 50 g fat (59% energy)] in a crossover trial. After an overnight fast (10-12 h), participants consumed the breakfast with cocoa or placebo, and blood sample collection [glucose, insulin, lipids, and high-sensitivity C-reactive protein (hsCRP)] and vascular measurements were conducted at 0.5, 1, 2, 4, and 6 h postprandially on each study day. Insulin resistance was evaluated by homeostasis model assessment.

RESULTS: Over the 6-h study, and specifically at 1 and 4 h, cocoa increased HDL cholesterol vs. placebo (overall Δ: 1.5 ± 0.8 mg/dL; P ≤ 0.01) but had no effect on total and LDL cholesterol, triglycerides, glucose, and hsCRP. Cocoa increased serum insulin concentrations overall (Δ: 5.2 ± 3.2 mU/L; P < 0.05) and specifically at 4 h but had no overall effects on insulin resistance (except at 4 h, P < 0.05), systolic or diastolic blood pressure, or small artery elasticity. However, large artery elasticity was overall lower after cocoa vs. placebo (Δ: -1.6 ± 0.7 mL/mm Hg; P < 0.05), with the difference significant only at 2 h.

CONCLUSION: Acute cocoa supplementation showed no clear overall benefit in T2D patients after a high-fat fast-food-style meal challenge. Although HDL cholesterol and insulin remained higher throughout the 6-h postprandial period, an overall decrease in large artery elasticity was found after cocoa consumption. This trial was registered at clinicaltrials.gov as NCT01886989.

Economical and coordinated dispatch of CHP based microgrid with renewable energy resources

The advantages of high energy efficiency and economic benefit promote the wide application of combined heat and power system (CHP) based microgrid. Firstly, a mathematical model of the CHP based microgrid is developed. Then, a cost function for the coordination of heat and electric load is proposed. Finally, an optimal dispatch model is developed to achieve the economical and coordinated operation of the CHP based microgrid system. Simulation results verify effectiveness of the proposed dispatch model, which is a powerful tool for the energy management of CHP based microgrid with renewable energy resources.