Development of a Complex Intervention for Secondary Prevention of Coronary Heart Disease in Primary Care Using the UK Medical Research Council Framework

Objective: To apply the UK Medical Research Council (MRC) framework for development and evaluation of trials of complex interventions to a primary healthcare intervention to promote secondary prevention of coronary heart disease. Study Design: Case report of intervention development. Methods: First, literature relating to secondary prevention and lifestyle change was reviewed. Second, a preliminary intervention was modeled, based on literature findings and focus group interviews with patients (n = 23) and staff (n = 29) from 4 general practices. Participants’ experiences of and attitudes toward key intervention components were explored. Third, the preliminary intervention was pilot-tested in 4 general practices. After delivery of the pilot intervention, practitioners evaluated the training sessions, and qualitative data relating to experiences of the intervention were collected using semistructured interviews with staff (n = 10) and patient focus groups (n = 17). Results: Literature review identified 3 intervention components: a structured recall system, practitioner training, and patient information. Initial qualitative data identified variations in recall system design, training requirements (medication prescribing, facilitating behavior change), and information appropriate to the prospective study participants. Identifying detailed structures within intervention components clarified how the intervention could be tailored to individual practice, practitioner, and patient needs while preserving the theoretical functions of the components. Findings from the pilot phase informed further modeling of the intervention, reducing administrative time, increasing practical content of training, and omitting unhelpful patient information. Conclusion: Application of the MRC framework helped to determine the feasibility and development of a complex intervention for primary care research.

Diatom carbon export enhanced by silicate upwelling in the North East Atlantic.

Diatom carbon export enhanced by silicate upwelling in the northeast Atlantic John T. Allen1,2, Louise Brown1,3, Richard Sanders1, C. Mark Moore1, Alexander Mustard1, Sophie Fielding1, Mike Lucas1, Michel Rixen4, Graham Savidge5, Stephanie Henson1 and Dan Mayor1 Top of pageDiatoms are unicellular or chain-forming phytoplankton that use silicon (Si) in cell wall construction. Their survival during periods of apparent nutrient exhaustion enhances carbon sequestration in frontal regions of the northern North Atlantic. These regions may therefore have a more important role in the 'biological pump' than they have previously been attributed1, but how this is achieved is unknown. Diatom growth depends on silicate availability, in addition to nitrate and phosphate2, 3, but northern Atlantic waters are richer in nitrate than silicate4. Following the spring stratification, diatoms are the first phytoplankton to bloom2, 5. Once silicate is exhausted, diatom blooms subside in a major export event6, 7. Here we show that, with nitrate still available for new production, the diatom bloom is prolonged where there is a periodic supply of new silicate: specifically, diatoms thrive by 'mining' deep-water silicate brought to the surface by an unstable ocean front. The mechanism we present here is not limited to silicate fertilization; similar mechanisms could support nitrate-, phosphate- or iron-limited frontal regions in oceans elsewhere.

The Rights of Religious Associations to External Relations: A Comparative Study of the OSCE and the Council of Europe

This paper argues that religious associations have a number of substantive rights when it comes to their external relations. It does so though comparing the position of the OSCE and the Council of Europe. This paper considers whether the emerging framework includes: (1) a right to legal entity status, (2) a right to establish and run charitable or educational institutions, (3) a right to privileges and substantive benefits and (4) a right to anything else. It concludes that the current developments are welcome because religious freedom has a collective aspect that is essential to the lives of many believers.

Annotation of Case C-353/92, Hellenic Republic v Council, ECR 1994 I-3411, and Case C-358/92, Hellenic Republic v Commission, ECR I-3507

Action for annulment - Council Regulation (EEC) Nº 1765/92 of 30 June 1992 establishing a support system for producers of certain arable crops - Commission Regulation (EEC) Nº 2294/92 of 31 July 1992 on detailed rules for the application of the support system for producers of the oil seeds referred to in Council Regulation (EEC) Nº 1765/92 - Obligation to observe a final date for sowing and for lodging an application for a compensatory payment