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.

Politicians, elections and catastrophe: the general election of 1847

Over the last decade, much new research has appeared on the subject of the Great Irish Famine but, remarkably, a major political event during the famine - the 1847 general election - has received virtually no mention. Recent work on politics in this period has tended to concentrate on political reaction in Britain rather than Ireland. The aim of this article is to examine the response of Irish politicians to the famine during the general election of 1847. The main source has been the political addresses and nomination speeches of most of the 140 candidates. The evidence from this material shows that, although the famine was an important matter in many constituencies, it was not the dominant issue countrywide. Various proposals to deal with the famine emerged, but there was an absence of agreed, practical measures to deal with immediate problems. The parties in Ireland failed to create a common platform to challenge the government over its efforts. Ideological constraints played an important part in these failures. The general election of 1847 represents a lost opportunity to tackle some of the effects of the famine.

Optical colors of 56 near-Earth objects: trends with size and orbit

We present the results of BVRIZ photometry of 56 near-Earth objects (NEOs) obtained with the 1-m Jacobus Kapteyn telescope on La Palma during 2000 and 2001. Our sample includes many NEOs with particularly deep 1 - mum pyroxene/olivine absorption bands, similar to Q-type asteroids. We also classify three NEOs with particularly blue colors. No D-type asteroids were found, placing an upper limit of similar to2% on the fraction of the NEO population originating in the outer main belt or the Trojan clouds. The ratio of dark to bright objects in our sample was found to be 0.40, significantly higher than current theoretical predictions. As well as classifying the NEOs, we have investigated color trends with size and orbit. We see a general trend for larger silicate objects to have shallower absorption bands but find no significant difference in the distribution of taxonomic classes at small and large sizes. Our data clearly show that different taxonomic classes tend to occupy different regions of (a, e) space. By comparing our data with current model predictions for NEO dynamical evolution we see that Q- R-, and V-type NEOs tend to have orbits associated with "fast track" delivery from the main belt, whereas S-type NEOs tend to have orbits associated with "slow track" delivery. This outcome would be expected if space weathering occurs on time scales of >10(6) years. (C) 2003 Elsevier Science (USA). All rights reserved.

Is the General Public Licence a Rational Choice?

Open source projects are networks of developers, distributors and end-users of non-proprietary created knowledge goods. It has been argued that this form of organization has some advantages over the firm or market coordination. I show that for sufficiently convex and modular projects proprietary licences are not able to sustain sequential knowledge production which, however, can be carried out if the project is run on the open source basis.