The contribution of qualitative research in designing a complex intervention for secondary prevention of coronary heart disease in two different healthcare systems

Background: Developing complex interventions for testing in randomised controlled trials is of increasing importance in healthcare planning. There is a need for careful design of interventions for secondary prevention of coronary heart disease (CHD). It has been suggested that integrating qualitative research in the development of a complex intervention may contribute to optimising its design but there is limited evidence of this in practice. This study aims to examine the contribution of qualitative research in developing a complex intervention to improve the provision and uptake of secondary prevention of CHD within primary care in two different healthcare systems.

Methods: In four general practices, one rural and one urban, in Northern Ireland and the Republic of Ireland, patients with CHD were purposively selected. Four focus groups with patients (N = 23) and four with staff (N = 29) informed the development of the intervention by exploring how it could be tailored and integrated with current secondary prevention activities for CHD in the two healthcare settings. Following an exploratory trial the acceptability and feasibility of the intervention were discussed in four focus groups (17 patients) and 10 interviews (staff). The data were analysed using thematic analysis.

Results: Integrating qualitative research into the development of the intervention provided depth of information about the varying impact, between the two healthcare systems, of different funding and administrative arrangements, on their provision of secondary prevention and identified similar barriers of time constraints, training needs and poor patient motivation. The findings also highlighted the importance to patients of stress management, the need for which had been underestimated by the researchers. The qualitative evaluation provided depth of detail not found in evaluation questionnaires. It highlighted how the intervention needed to be more practical by minimising administration, integrating role plays into behaviour change training, providing more practical information about stress management and removing self-monitoring of lifestyle change.

Conclusion: Qualitative research is integral to developing the design detail of a complex intervention and tailoring its components to address individuals' needs in different healthcare systems. The findings highlight how qualitative research may be a valuable component of the preparation for complex interventions and their evaluation.

HST/STIS observations of the high-velocity interstellar cloud HVC 291.2-41.2+80: a warm, mainly ionized high-velocity cloud

We present intermediate-resolution HST/STIS spectra of a high- velocity interstellar cloud ((LSR)-L-upsilon = + 80 kms(-1)) towards DI1388, a young star in the Magellanic Bridge located between the Small and Large Magellanic Clouds. The STIS data have a signal-to-noise ratio (S/N) of 20-45 and a spectral resolution of about 6.5 km s(-1) (FWHM), The high-velocity cloud absorption is observed in the lines of C II, O I, Si II, Si III, Si IV and S III. Limits can be placed on the amount of S II and Fe II absorption that is present. An analysis of the relative abundances derived from the observed species, particularly C II and O I, suggests that this high-velocity gas is warm (T-k similar to 10(3)-10(4) K) and predominantly ionized, This hypothesis is supported by the presence of absorption produced by highly ionized species, such as Si IV, This sightline also intercepts two other high-velocity clouds that produce weak absorption features at (LSR)-L-upsilon = + 113 and + 130kms(-1) in the STIS spectra.

Multiwavelength observations of the M15 intermediate-velocity cloud

We present Westerbork Synthesis Radio Telescope HI images, Lovell telescope multibeam H I wide-field mapping, William Herschel Telescope long-slit echelle Ca II observations, Wisconsin Halpha Mapper (WHAM) facility images, and IRAS ISSA 60- and 100-mum co-added images towards the intermediate- velocity cloud (IVC) at + 70 km s(-1), located in the general direction of the M15 globular cluster. When combined with previously published Arecibo data, the H I gas in the IVC is found to be clumpy, with a peak H I column density of similar to1.5 x 10(20) cm(-2), inferred volume density (assuming spherical symmetry) of similar to24 cm(-3)/D (kpc) and a maximum brightness temperature at a resolution of 81 x 14 arcsec(2) of 14 K. The major axis of this part of the IVC lies approximately parallel to the Galactic plane, as does the low- velocity H I gas and IRAS emission. The H I gas in the cloud is warm, with a minimum value of the full width at half-maximum velocity width of 5 km s(-1) corresponding to a kinetic temperature, in the absence of turbulence, of similar to540 K. From the H I data, there are indications of two-component velocity structure. Similarly, the Ca II spectra, of resolution 7 km s(-1), also show tentative evidence of velocity structure, perhaps indicative of cloudlets. Assuming that there are no unresolved narrow-velocity components, the mean values of log(10)[N(Ca II K) cm(2)] similar to 12.0 and Ca II/H I similar to2 5 x 10(-8) are typical of observations of high Galactic latitude clouds. This compares with a value of Ca II/H I>10(-6) for IVC absorption towards HD 203664, a halo star of distance 3 kpc, some 3.degrees1 from the main M15 IVC condensation. The main IVC condensation is detected by WHAM in Halpha with central local-standard-of-rest velocities of similar to60-70 km s(-1), and intensities uncorrected for Galactic extinction of up to 1.3 R, indicating that the gas is partially ionized. The FWHM values of the Halpha IVC component, at a resolution of 1degrees, exceed 30 km s(-1). This is some 10 km s(-1) larger than the corresponding H I value at a similar resolution, and indicates that the two components may not be mixed. However, the spatial and velocity coincidence of the Halpha and H I peaks in emission towards the main IVC component is qualitatively good. If the Halpha emission is caused solely by photoionization, the Lyman continuum flux towards the main IVC condensation is similar to2.7 x 10(6) photon cm(-2) s(-1). There is not a corresponding IVC Halpha detection towards the halo star HD 203664 at velocities exceeding similar to60 km s(- 1). Finally, both the 60- and 100-mum IRAS images show spatial coincidence, over a 0.675 x 0 625 deg(2) field, with both low- and intermediate-velocity H I gas (previously observed with the Arecibo telescope), indicating that the IVC may contain dust. Both the Halpha and tentative IRAS detections discriminate this IVC from high-velocity clouds, although the H I properties do not. When combined with the H I and optical results, these data point to a Galactic origin for at least parts of this IVC.

Optical spectroscopy of the M 15 intermediate velocity cloud

We present echelle spectrograph observations in the Na D lines, at resolutions of 6.2-8.5 km s(-1), for 11 stars located in the line-of-sight to the M15 intermediate velocity cloud (IVC), which has a radial velocity of similar to +70 km s(-1) in the Local Standard of Rest. This cloud is a part of IVC Complex gp. The targets range in magnitude from m(V) = 13.3-14.8. Seven of the observed stars are in the M15 globular cluster, the remaining four being field stars. Three of the observed cluster stars are located near a peak in intensity of the IVC Hi column density as observed at a resolution of similar to 1 arcmin. Intermediate velocity gas is detected in absorption towards 7 stars, with equivalent widths in NaD2 ranging from similar to0.09-0.20 Angstrom, corresponding to log(10)(N-Na cm(-2)) similar to 11.8-12.5, and Na I/H I column density ratios (neglecting the HII component) ranging from similar to(1-3) x 10(-8). Over scales ranging from 30 arcsec to 1 arcmin, the Na i column density and the Na i/H i ratio varies by upto 70 per cent and a factor of similar to 2, respectively. Combining the current sightlines with previously obtained Nai data from Kennedy et al. (1998b), the Na i/H i column density ratio over cluster sightlines varies by upto a factor of similar to 25, when using Hi data of resolution similar to 2 x 1 arcmin. One cluster star, M15 ZNG-1, was also observed in the Ca i (lambda(air) = 4226.728 Angstrom) and Ca ii (lambda(air) = 3933.663 Angstrom) lines. A column density ratio N(Ca i)/N(Ca ii) <0.03 was found, typical of values seen in the warm ionised interstellar medium. Towards this sightline, the IVC has a Nai/Ca ii column density ratio of &SIM; 0.25, similar to that observed in the local interstellar medium. Finally, we detect tentative evidence for IV absorption in Ki (?(air) = 7698:974 &ANGS) towards 3 cluster stars, which have N(K i)/N(H i) ratios of &SIM;0.5-3 x 10(-9).

HI and optical spectroscopy towards the M15 intermediate- velocity cloud

We present single-dish Arecibo 21-cm H i observations, covering a 0 degrees 675x0 degrees 625 RA-Dec. grid, of the intermediate-velocity cloud (IVC) centred upon the M15 globular cluster. The velocity and positional structure of the IVC gas at V-LSR=70 km s(-1) are investigated; it is found to be clumpy and has a peak surface density N(H i)similar to 8x10(19) cm(- 2). Additionally, we have performed a long H i integration towards HD 203664, a Galactic halo star some 3 degrees1 from M15, in which optical IVC absorption has previously been detected. No H i with a velocity exceeding 60 km s(-1) was found to a brightness temperature limit of 0.05 K. However, additional pointings did detect IVC gas approximately mid-way between HD 203664 and M15. Finally, we present both Arecibo H i pointings and low-resolution spectra in the Ca ii H and K lines towards 15 field stars in the general field towards M15, in an attempt to obtain the distance to the IVC. Intermediate- velocity H i is detected towards seven sightlines. Stellar spectral types are derived for 12 of the sample. Assuming that these stars lie on the main sequence, their distances are estimated to lie in the range 150 less than or equal tod less than or equal to 1350 pc. No Ca ii absorption is observed, either because the IVC is further away than similar to 1350 pc or more likely because the gas along these sightlines is of too low a density to be detected by the current observations.

HI observations of the high-velocity cloud in the direction of M 92

We present wide-field neutral hydrogen (H I) Lovell telescope multibeam, and Dominion Radio Astrophysical Observatory Hi synthesis observations, of the high velocity cloud (HVC) located in the general direction of the globular cluster M92. This cloud is part of the larger Complex C and lies at velocities between similar to -80 and -130 km s(-1) in the Local Standard of Rest. The Lovell telescope observations, of resolution 12 arcmin spatially and 3.0 km s(-1) in velocity, fully sampling a 3.1 degrees x 12.6 degrees RA-Dec grid, have found that this part of HVC Complex C comprises two main condensations, lying approximately north-south in declination, separated by similar to2 degrees and being parallel to the Galactic plane. At this resolution, peak values of the brightness temperature and Hi column density of similar to1.4 K and similar to5 x 10(19) cm(-2) are determined, with relatively high values of the full width half maximum velocity (FWHM) of similar to 22 km s(-1) being observed, equivalent to a gas kinetic temperature, in the absence of turbulence and geometric effects of similar to 10 000 K. Each of these properties, as well as the sizes of the clouds, are similar in the two components. The DRAO observations, towards the Northern HVC condensation, are the first high-resolution Hi spectra of Complex C. When smoothed to a resolution of 3 arcmin, they identify several Hi intensity peaks with column densities in the range 4-7 x 10(19) cm(-2). Further smoothing of these data to 6 arcmin resolution tentatively indicates that parts of the HVC consist of two velocity components, of similar brightness temperature, separated by similar to7 km s(-1) in velocity, and with FWHM velocity widths of similar to5-7 km s(-1). No IRAS 60 or 100 micron flux is associated with the M92 HVC. Cloud properties are briefly discussed and compared to previous observations of HVCs.

B-type supergiants in the Small Magellanic Cloud: rotational velocities and implications for evolutionary models

High-resolution spectra for 24 SMC and Galactic B-type supergiants have been analysed to estimate the contributions of both macroturbulence and rotation to the broadening of their metal lines. Two different methodologies are considered, viz. goodness-of-fit comparisons between observed and theoretical line profiles and identifying zeros in the Fourier transforms of the observed profiles. The advantages and limitations of the two methods are briefly discussed with the latter techniques being adopted for estimating projected rotational velocities ( v sin i) but the former being used to estimate macroturbulent velocities. The projected rotational velocity estimates range from approximately 20 to 60 kms(-1), apart from one SMC supergiant, Sk 191, with a v sin i similar or equal to 90 km s(-1). Apart from Sk 191, the distribution of projected rotational velocities as a function of spectral type are similar in both our Galactic and SMC samples with larger values being found at earlier spectral types. There is marginal evidence for the projected rotational velocities in the SMC being higher than those in the Galactic targets but any differences are only of the order of 5 - 10 km s(-1), whilst evolutionary models predict differences in this effective temperature range of typically 20 to 70 km s(-1). The combined sample is consistent with a linear variation of projected rotational velocity with effective temperature, which would imply rotational velocities for supergiants of 70 kms(-1) at an effective temperature of 28 000 K ( approximately B0 spectral type) decreasing to 32 km s(-1) at 12 000 K (B8 spectral type). For all targets, the macroturbulent broadening would appear to be consistent with a Gaussian distribution ( although other distributions cannot be discounted) with an 1/e half-width varying from approximately 20 km s(-1) at B8 to 60 km s(-1) at B0 spectral types.

Pulsed evaporative cooling of ion cloud in an electron beam ion trap

A technique for producing cold ensembles of trapped highly charged ions is described. The ions, trapped in an electron beam ion trap, can undergo a drastic contraction during the pulsed mode of evaporative cooling, if a truncated Boltzmann distribution is assumed. The underlying theory and the experimental results are presented.