Factors influencing survival after kidney transplant failure

BACKGROUND: The failure of a kidney transplant is now a common reason for initiation of dialysis therapy. Kidney transplant recipients commencing dialysis have greater morbidity and mortality than transplant-naïve, incident dialysis patients. This study aimed to identify variables associated with survival after graft failure.

METHODS: All recipients of first, deceased donor kidney transplants performed in Northern Ireland between 1986 and 2005 who had a functioning graft at 12 months were included (n = 585). Clinical and blood-derived variables (age, gender, primary renal disease, diabetic status, smoking status, human leukocyte antigen (HLA) mismatch, acute rejection episodes, immunosuppression, cardiovascular disease, graft survival, haemoglobin, albumin, phosphate, C reactive protein, estimated glomerular filtration rate (eGFR), rate of eGFR decline, dialysis modality, and access) were collected prospectively and investigated for association with re-transplantation and survival. The association between re-transplantation and survival was explored by modelling re-transplantation as a time-dependent covariate.

RESULTS: Median follow-up time was 12.1 years. Recipients with a failing graft (158/585) demonstrated rapid loss of eGFR prior to graft failure, reducing the time available to plan for alternative renal replacement therapy. Median survival after graft failure was 3.0 years. In multivariate analysis, age and re-transplantation were associated with survival after graft failure. Re-transplantation was associated with an 88% reduction in mortality.

CONCLUSIONS: Optimal management of kidney transplant recipients with failing grafts requires early recognition of declining function and proactive preparation for re-transplantation given the substantial survival benefit this confers. The survival benefit associated with re-transplantation persists after prolonged exposure to immunosuppressive therapy.

Design of a Dissolving Microneedle Platform for Transdermal Delivery of a Fixed-Dose Combination of Cardiovascular Drugs

Microneedles (MNs) are a minimally invasive drug delivery platform, designed to enhance transdermal drug delivery by breaching the stratum corneum. For the first time, this study describes the simultaneous delivery of a combination of three drugs using a dissolving polymeric MN system. In the present study, aspirin, lisinopril dihydrate, and atorvastatin calcium trihydrate were used as exemplar cardiovascular drugs and formulated into MN arrays using two biocompatible polymers, poly(vinylpyrrollidone) and poly(methylvinylether/maleic acid). Following fabrication, dissolution, mechanical testing, and determination of drug recovery from the MN arrays, in vitro drug delivery studies were undertaken, followed by HPLC analysis. All three drugs were successfully delivered in vitro across neonatal porcine skin, with similar permeation profiles achieved from both polymer formulations. An average of 126.3 ± 18.1 μg of atorvastatin calcium trihydrate was delivered, notably lower than the 687.9 ± 101.3 μg of lisinopril and 3924 ± 1011 μg of aspirin, because of the hydrophobic nature of the atorvastatin molecule and hence poor dissolution from the array. Polymer deposition into the skin may be an issue with repeat application of such a MN array, hence future work will consider more appropriate MN systems for continuous use, alongside tailoring delivery to less hydrophilic compounds.

Performance of a Novel Molecular Method in the Diagnosis of Late-Onset Sepsis in Very Low Birth Weight Infants

OBJECTIVE: To compare the use of a generic molecular assay to 'standard' investigations used to assist the diagnosis of late onset bacterial sepsis in very low birth weight infants (VLBW, <1500g).

METHODS: VLBW infants, greater than 48 hours of age, who were clinically suspected to have sepsis were investigated using standard tests (full blood count, C-reactive protein (at presentation) and blood culture), in addition, blood was taken for a universal molecular assay (16S rRNA reverse transcriptase PCR) for comparison. Clinical data were recorded during the suspected infection episode. A validated sepsis score (NEO-KISS) was used to retrospectively determine the presence of sepsis (independent of blood culture). The performance of each of the tests were compared by sensitivity, specificity, positive/negative likihood ratios (+/-LR) and postive/negative predictive values (PPV/NPV).

RESULTS: Sixty-five babies with suspected clinical sepsis were prospectively included. The performance indicators are presented with 95% confidence limits. For the detection of bacteria, blood culture had sensitivity of 0.57 (0.34-0.78), specificity of 0.45 (0.30-0.61); +LR of 1.05 (0.66-1.66) and-LR of 0.94 (0.52-1.7); PPV of 33.3 (18.56-50.97) and NPV of 68.97 (49.17-87.72). Serum CRP had sensitivity of 0.92 (0.64-1) and specificity of 0.36 (0.17-0.59); +LR of 1.45 (1-2.1) and-LR of 0.21 (0.03-1.5); PPV of 44.46 (26.6-66.6) and NPV of 88.9 (51.8-99.7). The universal molecular assay had sensitivity of 0.76 (0.53-0.92), specificity of 0.95 (0.85-0.99); +LR of 16.8 (4.2-66.3) and-LR of 0.25 (0.1-0.5); PPV of 88.9 (65.3-98.6) and NPV of 89.4 (76.9-96.5).

CONCLUSIONS: In VLBW infants this universal molecular assay performed better in the diagnosis of late onset sepsis (LOS) than blood culture and CRP. Further development is required to explore and improve the performance of the assay in real-time diagnosis.

Scotland’s Curriculum for Excellence: a defence of autonomy and personhood.

Curriculum for Excellence, Scotland’s 3-18 curriculum, has been described as ‘the most significant curricular change in Scotland for a generation’ (McAra, Broadley and McLauchlan, 2013:223). The purpose of the curriculum is ‘encapsulated’ in four capacities in order that learners become i) successful learners, ii) confident individuals, iii) responsible citizens, and iv) effective contributors. With particular reference to these capacities, we explore the principle of autonomy as it pertains to both individual and collective flourishing seeking to disarm commonplace criticisms of autonomy by arguing that it might be put to work in CfE as a potentially multi-dimensional, context-sensitive concept that is relational as well as individual. We conclude that the four capacities lend themselves to re-consideration and re-mapping in pursuit of autonomy and flourishing premised on the principles of liberal personhood.

Carbons, Ionic Liquids, and Quinones for Electrochemical Capacitors

Carbons are the main electrode materials used in supercapacitors, which are electrochemical energy storage devices with high power densities and long cycling lifetimes. However, increasing their energy density capacity will improve their potential for commercial implementation.
In this regard, the use of high surface area carbons and high voltage electrolytes are well known strategies to increase the attainable energy density, and lately ionic liquids have been explored as promising alternatives to current state of the art acetonitrile-based electrolytes. Also, in terms of safety and sustainability ionic liquids are attractive electrolyte materials for supercapacitors. In addition, it has been shown that the matching of the carbon pore size with the electrolyte ion size further increases the attainable electrochemical double layer (ECDL) capacitance and energy density.
The use of pseudocapacitive reactions can significantly increase the attainable energy density, and quinonic-based materials offer a potentially sustainable and cost effective research avenue for both the electrode and the electrolyte.
This perspective will provide an overview of the current state of the art research on supercapacitors based on combinations of carbons, ionic liquids and quinonic compounds, highlighting performances and challenges and discussing possible future research avenues. In this regard, current interest is mainly focused on strategies which may ultimately lead to commercially competitive sustainable high performance supercapacitors for different applications including those requiring mechanical flexibility and biocompatibility.

Willingness to pay for potential enhancements to a low-cost cataract surgical package in rural southern China.

PURPOSE: To assess determinants of patients' willingness to pay (WTP) for potential components of a multi-tiered cataract surgical package offered by a non-governmental organization (NGO) in rural China. DESIGN: Cross-sectional study. METHODS: Demographic and clinical data were collected from 505 patients presenting for cataract screening or surgery in Yangjiang, China. Willingness to pay for potential enhancements to the current surgery package was assessed using a bidding format with random payment cards. RESULTS: Among 426 subjects (84.4%) completing interviews, the mean age was 73.9 ± 7.3 years, 67.6% were women and 73% (n = 310) would pay for at least one offering, with 33-38% WTP for each item. Among those who would pay, the mean WTP for food was US$1.68 ± 0.13, transportation US$3.24 ± 0.25, senior surgeon US$50.0 ± 3.36 and US$89.4 ± 4.19 for an imported intra-ocular lens (IOL). The estimated total recovery from these enhancements under various assumptions would be US$20-50 (compared to the current programme price of US$65). In multivariate models, WTP for the senior surgeon increased with knowledge of a person previously operated for cataract (OR = 2.13, 95% CI 1.42-3.18, p < 0.001). Willingness to pay for the imported IOL increased with knowledge of a previously operated person (OR = 1.85, 95% CI 1.24-2.75, p < 0.01) and decreased with age >75 years (OR = 0.61, 0.40-0.93, p < 0.05). CONCLUSIONS: Opportunities exist to increase cataract programme revenues through multi-tiered offerings in this setting, allowing greater subsidization of low-income patients. Personal familiarity with cataract surgery is important in determining WTP. © 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.

Introducing the CTA concept

The Cherenkov Telescope Array (CTA) is a new observatory for very high-energy (VHE) gamma rays. CTA has ambitions science goals, for which it is necessary to achieve full-sky coverage, to improve the sensitivity by about an order of magnitude, to span about four decades of energy, from a few tens of GeV to above 100 TeV with enhanced angular and energy resolutions over existing VHE gamma-ray observatories. An international collaboration has formed with more than 1000 members from 27 countries in Europe, Asia, Africa and North and South America. In 2010 the CTA Consortium completed a Design Study and started a three-year Preparatory Phase which leads to production readiness of CTA in 2014. In this paper we introduce the science goals and the concept of CTA, and provide an overview of the project. © 2013 Elsevier B.V. All rights reserved.

Improving allied health professionals' research implementation behaviours for children with cerebral palsy: protocol for a before-after study

BACKGROUND: Cerebral palsy is a permanent disorder of posture and movement caused by disturbances in the developing brain. It affects approximately 1 in every 500 children in developed countries and is the most common form of childhood physical disability. People with cerebral palsy may also have problems with speech, vision and hearing, intellectual difficulties and epilepsy. Health and therapy services are frequently required throughout life, and this care should be effective and evidence informed; however, accessing and adopting new research findings into day-to-day clinical practice is often delayed.

METHODS/DESIGN: This 3-year study employs a before and after design to evaluate if a multi-strategy intervention can improve research implementation among allied health professionals (AHPs) who work with children and young people with cerebral palsy and to establish if children's health outcomes can be improved by routine clinical assessment. The intervention comprises (1) knowledge brokering with AHPs, (2) access to an online research evidence library, (3) provision of negotiated evidence-based training and education, and (4) routine use of evidence-based measures with children and young people aged 3-18 years with cerebral palsy. The study is being implemented in four organisations, with a fifth organisation acting as a comparison site, across four Australian states. Effectiveness will be assessed using questionnaires completed by AHPs at baseline, 6, 12 and 24 months, and by monitoring the extent of use of evidence-based measures. Children's health outcomes will be evaluated by longitudinal analyses.

DISCUSSION: Government, policy makers and service providers all seek evidence-based information to support decision-making about how to distribute scarce resources, and families are seeking information to support intervention choices. This study will provide knowledge about what constitutes an efficient, evidence-informed service and which allied health interventions are implemented for children with cerebral palsy.

TRIAL REGISTRATION: Trial is not a controlled healthcare intervention and is not registered.

Modellierung und Analyse lastinduzierter Speicherfehler

Ein sehr großer Anteil der in Rechensystemen auftretenden Fehler ereignet sich im Speicher. In dieser Arbeit wird ein zerlegungsorientiertes Modell entwickelt, das die Wechselwirkungen zwischen Speicherfehlern und Systemleistung untersucht. Zunächst wird das Speicherverhalten eines Auftrags durch ein mehrphasiges Independent-Reference-Modell charakterisiert. Dies dient als Grundlage eines Modells zum Auftreten von Störungen, in das Lastcharakteristika wie die Auftrags-Verweildauer, die Seitenzugriffs-Rate und die Paging-Rate eingehen. Anschließend kann die Wahrscheinlichkeit, mit der ein Speicherfehler entdeckt wird, berechnet werden. Die zur Behandlung von Speicherfehlern erforderlichen Maßnahmen bestimmen die mittlere durch Fehler induzierte Last. Die Wechselwirkungen zwischen Fehler- und Leistungsverhalten werden durch ein System nichtlinearer Gleichung beschrieben, für dessen Lösung ein iteratives Verfahren abgeleitet wird. Abschließend wird mit ausführlichen Beispielen das Modell erläutert und der Einfluß einiger Modell-Parameter auf Leistungs- und Zuverlässigkeitskenngrößen untersucht.

Mehrzweckschutzrelais für Mittelspannungsnetze unter Berücksichtigung von Stationsleitsystemen

Ein universell verwendbares Mehrzweckschutzrelais (MZR)wird vorgestellt, dessen Schutzfunktionen ausschließlich durch Software bestimmt sind. Mit dem MZR wird nachgewiesen, daß die vorhandene Typenvielfalt von Schutzrelais für Mittelspannungsnetze auf einen Grundtypus reduziert werden kann. Das MZR kann in Stationsleitsysteme eingebunden werden. Die Schutzfunktionen des MZR sind Überstromschutz (MZR-I), Distanzschutz (MZR-Z) und Differentialschutz (MZR-D). Ergänzend werden ausgeführt thermisches Abbild, Erdschlußerkennung, Erdschlußrichtungsbestimmung, Kurzunterbrechung und Betriebsmeßtechnik. Für jede Schutzfunktion wurde ein spezielles Programmsegment erstellt. Je nach Komplexität der Schutzaufgabe übernimmt ein Signalprozessor bestimmte Aufgaben im MZR, wie z.B. digitale Filterung der Meßsignale, Impedanzbestimmung, Diskrete Fouriertransformation, Bestimmung des Mitsystems nach dem Verfahren der symmetrischen Komponenten. Die von der Schutzfunktion unabhängigen Programmbestandteile sind zu einem echtzeitfähigen Multitask-Betriebssystem zusammengefaßt. Ein kostengünstiges MZR-Modul zur Speicherung von Störungsereignissen wird als Erweiterung gegenüber konventionellen Schutzrelais vorgestellt. Hiermit können vom MZR erkannte Störungen achtkanalig erfaßt und mit Echtzeitmarken versehen auf Disketten im standardisierten AufZeichnungsformat gespeichert werden. Ein neues Verfahren zur Simulation des Meßverhaltens der erstellten MZR-Varianten mit dem Programm "EMTP" auf einem Personalcomputer der AT—Klasse wurde entwickelt.

Drucktrennen sprödharter Werkstoffe

Drucktrennen ist ein Verfahren zum spanlosen Trennen zylindrischer oder prismatischer Bauteile durch in einem Teilbereich der Mantelfläche auf das Werkstück wirkenden Fluidhochdruck. In der vorliegenden Arbeit werden die Wirkzusammenhänge zwischen der Bearbeitung sprödharter zylindrischer Werkstücke und den resultierenden Oberflächen- und Randzoneneigenschaften theoretisch analysiert und die Ergebnisse mit denen experimenteller Untersuchungen verglichen. Der Fluidhochdruck bewirkt einen hauptsächlich von der Werkstückgeometrie und dem Aufbau der für die Versuchsdurchführung entwickelten Trennkammer abhängigen Spannungszustand des Werkstücks. Gleichzeitig dringt das Trennmedium in Oberflächenanrisse ein und ruft dort lokale Zugspannungen im Bereich der Rißspitze hervor. Erreicht der Fluiddruck einen vom Spannungszustand und der Rißlänge abhängigen kritischen Wert, so wird die Bruchzähigkeit des Werkstoffs überschritten und ein Sprödbruch des Werkstücks ausgelöst. Durch gezielt eingebrachte Kerben kann der Ort der Trennung exakt vorgegeben werden. Die Werkstücktrennung erfolgt senkrecht zur Richtung der größten Hauptspannung, welche stets ungefähr parallel zur Werkstückmittelachse orientiert ist. Um eine völlig ebene Bruchfläche zu erreichen, muß eine Ankerbung in Kammermitte erfolgen und das Werkstück absolut symmetrisch zur Trennfläche ausgerichtet sein. Der vom nachdrängenden Fluid vorangetriebene Bruch wird durch Druckspannungen in bestimmten Bereichen des belasteten Bauteils gehemmt. Die Bruchgeschwindigkeit ist demzufolge in der Regel so niedrig, daß für amorphe und einkristalline Werkstoffe keine Bruchverzweigung erfolgt. Dadurch ist beispielsweise für optisches Glas und einkristallines Silizium die Herstellung spiegelglatter Oberflächen möglich. Die Trennflächen vielkristalliner Werkstoffe weisen dagegen eine geringe Oberflächengüte auf, da der Energieüberschuß im Bereich der Rißspitze nicht ausreicht, um einen transkristallinen Sprödbruch voranzutreiben, sondern stets erhebliche interkristalline Bruchanteile vorliegen.

Contraceptive Choices Pre and Post Pregnancy in Adolescence

STUDY OBJECTIVE: The main aim of this study is to evaluate the impact of adolescent pregnancy in the future contraceptive choices. A secondary aim is to verify whether these choices differ from those made after an abortion. DESIGN: Retrospective study. SETTING:Adolescent Unit of a tertiary care center. PARTICIPANTS:212 pregnant teenagers. INTERVENTIONS: Medical records review. MAIN OUTCOME MEASURES:Intended pregnancy rate and contraceptive methods used before and after pregnancy. For contraceptive choices after pregnancy we considered: Group 1 - teenagers who continued their pregnancy to delivery (n = 106) and Group 2 - the same number of adolescents who chose to terminate their pregnancy. RESULTS: The intended pregnancy rate was 14.2%. Prior to a pregnancy continued to delivery, the most widely used contraceptive method was the male condom (50.9%), followed by oral combined contraceptives (28.3%); 18.9% of adolescents were not using any contraceptive method. After pregnancy, contraceptive implant was chosen by 70.8% of subjects (P < .001) and the oral combined contraceptives remained the second most frequent option (17.9%, P = .058). Comparing these results with Group 2, we found that the outcome of the pregnancy was the main factor in the choices that were made. Thus, after a pregnancy continued to delivery, adolescents prefer the use of LARC [78.4% vs 40.5%, OR: 5,958 - 95% (2.914-12.181), P < .001)], especially contraceptive implants [70.8% vs 38.7%, OR: 4.371 - 95% (2.224-8.591), P < .001], to oral combined contraceptives [17.9% vs 57.5%, OR: 0.118 - 95% CI (0.054-0.258), P < .001]. CONCLUSION:Adolescent pregnancy and its outcome constitute a factor of change in future contraceptive choice.

Genetic variation in IL28B is associated with chronic hepatitis C and treatment failure: a genome-wide association study.

BACKGROUND & AIMS: Hepatitis C virus (HCV) induces chronic infection in 50% to 80% of infected persons; approximately 50% of these do not respond to therapy. We performed a genome-wide association study to screen for host genetic determinants of HCV persistence and response to therapy. METHODS: The analysis included 1362 individuals: 1015 with chronic hepatitis C and 347 who spontaneously cleared the virus (448 were coinfected with human immunodeficiency virus [HIV]). Responses to pegylated interferon alfa and ribavirin were assessed in 465 individuals. Associations between more than 500,000 single nucleotide polymorphisms (SNPs) and outcomes were assessed by multivariate logistic regression. RESULTS: Chronic hepatitis C was associated with SNPs in the IL28B locus, which encodes the antiviral cytokine interferon lambda. The rs8099917 minor allele was associated with progression to chronic HCV infection (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.74-3.06; P = 6.07 x 10(-9)). The association was observed in HCV mono-infected (OR, 2.49; 95% CI, 1.64-3.79; P = 1.96 x 10(-5)) and HCV/HIV coinfected individuals (OR, 2.16; 95% CI, 1.47-3.18; P = 8.24 x 10(-5)). rs8099917 was also associated with failure to respond to therapy (OR, 5.19; 95% CI, 2.90-9.30; P = 3.11 x 10(-8)), with the strongest effects in patients with HCV genotype 1 or 4. This risk allele was identified in 24% of individuals with spontaneous HCV clearance, 32% of chronically infected patients who responded to therapy, and 58% who did not respond (P = 3.2 x 10(-10)). Resequencing of IL28B identified distinct haplotypes that were associated with the clinical phenotype. CONCLUSIONS: The association of the IL28B locus with natural and treatment-associated control of HCV indicates the importance of innate immunity and interferon lambda in the pathogenesis of HCV infection.

Notulae biographicae præpositorum generalium carmelitarum discalceatorum congregationis italicae, 1600-1787.

Ce ms. constitue la mise au net du ms. B. n. F., lat. 17652 qui a servi de brouillon. F. 1 Titre : «Series chronologica præpositorum generalium carmelitarum discalceatorum congregationis italicae, cum singulorum effigie ad vivum nitidissime æri incisa [ce dernier membre de phrase est cancellé], necnon elogio manuscripto». F. 3-14v Notice biographique de chacun des préposés généraux des Carmes déchaux de la congrégation d'Italie de 1600 à 1787; chaque nom est précédé d'un ou plusieurs chiffres romains donnant le numéro d'ordre du préposé. Pour les derniers, seul figure le nom et le numéro d'ordre. Chaque page est divisée en deux cadres, et chaque notice en occupe un, rarement deux. «I. IV. IX. Ferdinandus a Sancta Maria. In saeculo dictus Ferdinandus Martinez...-... LIII. Hilarion ab Omnibus Sanctis» (14v); cf. A. Fortes, Acta capituli generalis O. C. D. congregationis s. Eliae, 3 vol., Rome, 1990-1992 (Monumenta historica Carmeli Teresiani 11, 13-14). À noter, parmi les références bibliographiques, celles qui concernent directement les Carmes déchaux : elles sont données ci-dessous sous une forme normalisée (entre parenthèses le feuillet où figure la première occurrence), alors que l'auteur donne en général le titre et le nom de l'auteur, sous une forme latinisée approximative, avec parfois le lieu et la date d'impression : Juan Caramuel Lobkowitz, Caramuelis Dominicus..., Vienne, 1655 (3v); Jean Chardin, Voyages de Monsieur le chevalier Chardin en Perse, Paris, 1723 (4v); Daniel a Virgine Maria, Speculum carmelitanum, Anvers, 1680 (3); Eusebius ab Omnibus Sanctis, Enchyridion chronologicum carmelitarum discalceatorum congregationis Italiae, Rome, 1737 (4), cet ouvrage est le plus fréquemment cité, on en trouve un exemplaire à la Vaticane et un microfilm à la Library of Congress; Francisco de Santa Maria, Historia general profetica de la orden de Nuestra Señora del Carmen, Madrid, 1630 (3); Franciscus Joseph a Sancta Margarita, Necrologium præpositorum generalium, non identifié (5); Isidore de Saint-Joseph, Historia reformationis s. Theresiae, non identifié (4v); Isidore de Saint-Joseph et Pierre de Saint-André, Historia generalis Fratrum discalceatorum ordinis B. M. V. de Monte Carmelo congregationis s. Eliae, Rome, 1668-1671 (4v); Louis Jacob, Bibliotheca carmelitana manuscripta, non identifié (5v); Juan de Jesus Maria, Historia missionum; Vita Petri a Matre Dei (3), ces deux ouvrages n'ont pu être identifiés, ils ne figurent pas dans les Opera omnia publiées à Cologne en 1622; Aubert Le Mire, Bibliotheca ecclesiastica, 2e partie, Anvers, 1649 (3v); Louis de Sainte-Thérèse, Annales carmelitarum excalceatorum Galliae (4v), non identifié; Martial de Saint-Jean-Baptiste, Bibliotheca scriptorum utriusque congregationis et sexus carmelitarum discalceatorum, Bordeaux, 1730 (3); Paulus ab Omnibus Sanctis, Clavis aurea thesauri partheno-carmelitici..., Vienne, 1669, si ce titre correspond au «Catalogus scriptorum» du f. 3; Philippe de la Très Sainte Trinité, Decus carmelitanum, ouvrage non identifié (4v); Id., Historia carmelitani ordinis..., Lyon, 1656 (3); Id., Itinerarium orientale R.P.F. Philippi a SS. Trinitate, Lyon, 1649 (4v); Id., La Vie du vénérable père Dominique de Jésus Maria..., Lyon, 1669 (5); le P.Théophile Raynaud, Scapulare partheno-carmeliticum, Paris, 1654 (3v); [Cosme de Villiers de Saint-Étienne] «editor anonymus», Bibliotheca carmelitana, Orléans, 1752 (5).

Health-related quality of life among patients attending cardiovascular rehabilitation

Purpose: f i rst , an investigation of baseline differences in Health-Related Quality of l i fe (HRQOl) among adhere and non-adhere patients of Phase III cardiac rehabilitation (CR) was examined. Second, among patients who adhered to the program, effectiveness of t reatment based on HRQOl was evaluated. Methods: Data was collected by the Brock University Heart Institute. Participants completed a questionnaire battery at baseline and again at six months i f they were still a client. Results: The physical dimension of HRQOl differed at baseline between the adhere and non-adhere groups. for everyone point increase in physical HRQOl scores there was an associated 1.06 times greater likelihood that an individual would adhere to the program. Second, in those who adhered to the program for six months, physical HRQOl scores improved 3.18 points. Conclusions: Phase III CR significant improves HRQOl in patients suffering f rom cardiovascular disease.