Systematic review of the use of behaviour change techniques (BCTs) in home-based cardiac rehabilitation programmes for patients with cardiovascular disease-protocol

BACKGROUND: Cardiovascular diseases (CVDs), including myocardial infarction, heart failure, peripheral arterial disease and strokes, are highly prevalent conditions and are associated with high morbidity and mortality. Cardiac rehabilitation (CR) is an effective form of secondary prevention for CVD but there is a lack of information regarding which specific behaviour change techniques (BCTs) are included in programmes that are associated with improvements in cardiovascular risk factors. This systematic review will describe the BCTs which are utilised within home-based CR programmes that are effective at reducing a spectrum of CVD risk factors.

METHODS/DESIGN: The review will be reported in line with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidance. Randomised and quasi-randomised controlled trials of home-based CR initiated following a vascular event (myocardial infarction, heart failure, peripheral arterial disease and stroke patients) will be included. Articles will be identified through a comprehensive search of MEDLINE, Embase, PsycINFO, Web of Science and Cochrane Database guided by a medical librarian. Two review authors will independently screen articles retrieved from the search for eligibility and extract relevant data, identifying which specific BCTs are included in programmes that are associated with improvements in particular modifiable vascular risk factors.

DISCUSSION: This review will be of value to clinicians and healthcare professionals working with cardiovascular patients by identifying specific BCTs which are used within effective home-based CR. It will also inform the future design and evaluation of complex health service interventions aimed at secondary prevention in CVD.

Justifying accounting change through global discourses and legitimation strategies. The case of the UK central government.

Accounting has been viewed, especially through the lens of the recent managerial reforms, as a neutral technology that, in the hands of rational managers, can support effective and efficient decision making. However, the introduction of new accounting practices can be framed in a variety of ways, from value-neutral procedures to ideologically-charged instruments. Focusing on financial accounting, budgeting and performance management changes in the UK central government, and through extensive textual analysis and interviews in three government departments, this paper investigates: how accounting changes are discussed and introduced at the political level through the use of global discourses; and what strategies organisational actors subsequently use to talk about and legitimate such discourses at different organisational levels. The results shows that in political discussions there is a consistency between the discourses (largely NPM) and the accounting-related changes that took place. The research suggests that a cocktail of legitimation strategies was used by organisational actors to construct a sense of the changes, with authorisation, often in combination with, at the very least, rationalisation strategies most widely utilised. While previous literature posits that different actors tend to use the same rhetorical sequences during periods of change, this study highlights differences at different organisational levels.

Plus Ça Change: The 2014 Local Elections in Northern Ireland

The local government elections of 22 May 2014 in Northern Ireland were the first to be held under revised district boundaries, with 11 'super councils' replacing the 26-council model used since 1973. Despite the structural reform, little changed in terms of political party support. Although they suffered some losses, the Democratic Unionist Party and Sinn Féin remained firmly entrenched as the two dominant players at local government level in Northern Ireland. The Ulster Unionist Party enjoyed only a marginal increase in its vote share, while the Social Democratic and Labour Party recorded one of the worst electoral performances in its history. Elsewhere, the Traditional Unionist Voice enjoyed a 'breakthrough' election and the Alliance Party defied widely held predictions that it would suffer at the polls as a result of its role in the Union flag crisis. The campaign was overshadowed by both the concurrent European Parliament contest and several crises of power-sharing at Stormont. As a result, distinctly local government issues received scant and fleeting attention. The contest saw the lowest local election turnout in Northern Ireland's history, continuing a general trend of increasing voter apathy in the province.

Does climate change information affect stated risks of pine beetle impacts on forests? An application of the exchangeability method

Risks are an essential feature of future climate change impacts. We explore whether knowledge that climate change might be the source of increasing pine beetle impacts on public or private forests affects stated risk estimates of damage, elicited using the exchangeability method. We find that across subjects the difference between public and private forest status does not influence stated risks, but the group told that global warming is the cause of pine beetle damage has significantly higher risk perceptions than the group not given this information.

Shape stabilised phase change materials based on a high melt viscosity HDPE and paraffin waxes

Shape stabilised phase change materials (SSPCMs) based on a high density poly(ethylene)(hv-HDPE) with high (H-PW, Tm = 56–58 °C) and low (L-PW, Tm = 18–23 °C) melting point paraffin waxes were readily prepared using twin-screw extrusion. The thermo-physical properties of these materials were assessed using a combination of techniques and their suitability for latent heat thermal energy storage (LHTES) assessed. The melt processing temperature (160 °C) of the HDPE used was well below the onset of thermal decomposition of H-PW (220 °C), but above that for L-PW (130 °C), although the decomposition process extended over a range of 120 °C and the residence time of L-PW in the extruder was <30 s. The SSPCMs prepared had latent heats up to 89 J/g and the enthalpy values for H-PW in the respective blends decreased with increasing H-PW loading, as a consequence of co-crystallisation of H-PW and hv-HDPE. Static and dynamic mechanical analysis confirmed both waxes have a plasticisation effect on this HDPE. Irrespective of the mode of deformation (tension, flexural, compression) modulus and stress decreased with increased wax loading in the blend, but the H-PW blends were mechanically superior to those with L-PW.

Social housing tenants, Climate Change and sustainable living: A study of awareness, behaviours and willingness to adapt

Despite a focus in the UK on providing sustainable housing in recent years, it is unlikely that targets set to reduce resource consumption in housing will be achieved without a greater focus on human behaviour. It is necessary to understand the actions of people occupying dwellings, as it is invariably the occupants rather than the buildings that decided whether or not to consume resources. In this paper the authors present a pilot study where 53 social housing tenant households in Northern Ireland were interviewed to ascertain their perceptions of Climate Change, their current behaviours and their willingness to reduce energy and water consumption in the home. The intention was to explore links between perceptions and reported behaviour as well as perceptions and willingness to reduce resource consumption. Results show that 77% of tenants believed Climate Change to be an important issue; 57% accepted that it is up to the individual to take responsibility for tackling Climate Change; and demonstrated a strong desire to make a difference to reduce their impact. The researchers identified both passive (devices) and active (behaviours) resource savings currently in place and established where further resource reduction was feasible based on tenants' willingness to alter their behaviours.

Historical Dialogue and Memory in Policing Change: the Case of the Police in Northern Ireland

This paper explores the complex relationship between organisational change and historical dialogue in transitional societies. Using the policing reform process in Northern Ireland as an example, the paper does three things: the first is to explore the ways in which policing changes were understood within the policing organisation and ‘community’ itself. The second is to make use of a processual approach, privileging the interactions of context, process and time within the analysis. Thirdly, it considers this perspective through the relatively new lens of ‘historical dialogue’: understood here as a conversation and an oscillation between the past, present and future through reflections on individual and collective memory. Through this analysis, we consider how members’ understandings of a difficult past (and their roles in it) facilitated and/or impeded the organisations change process. Drawing on a range of interviews with previous and current members of the organisation, this paper sheds new light on how institutions deal with and understand the past as they experience organisational change within the a wider societal transition from conflict to non-violence.

Determinants and two-year change in anterior chamber angle width in a Chinese population

Objective: To study the population distribution and longitudinal changes in anterior chamber angle width and its determinants among Chinese adults. Design: Prospective cohort, population-based study. Participants: Persons aged 35 years or more residing in Guangzhou, China, who had not previously undergone incisional or laser eye surgery. Methods: In December 2008 and December 2010, all subjects underwent automated keratometry, and a random 50% sample had anterior segment optical coherence tomography with measurement of angle-opening distance at 500 μm (AOD500), angle recess area (ARA), iris thickness at 750 μm (IT750), iris curvature, pupil diameter, corneal thickness, anterior chamber width (ACW), lens vault (LV), and lens thickness (LT) and measurement of axial length (AL) and anterior chamber depth (ACD) by partial coherence laser interferometry. Main Outcome Measures: Baseline and 2-year change in AOD500 and ARA in the right eye. Results: A total of 745 subjects were present for full biometric testing in both 2008 and 2010 (mean age at baseline, 52.2 years; standard deviation [SD], 11.5 years; 53.7% were female). Test completion rates in 2010 varied from 77.3% (AOD500: 576/745) to 100% (AL). Mean AOD500 decreased from 0.25 mm (SD, 0.13 mm) in 2008 to 0.21 mm (SD, 13 mm) in 2010 (difference, -0.04; 95% confidence interval [CI], -0.05 to -0.03). The ARA decreased from 21.5±3.73 10^-2 mm² to 21.0±3.64 10 ^-2 mm² (difference, -0.46; 95% CI, -0.52 to -0.41). The decrease in both was most pronounced among younger subjects and those with baseline AOD500 in the widest quartile at baseline. The following baseline variables were significantly associated with a greater 2-year decrease in both AOD500 and ARA: deeper ACD, steeper iris curvature, smaller LV, greater ARA, and greater AOD500. By using simple regression models, we could explain 52% to 58% and 93% of variation in baseline AOD500 and ARA, respectively, but only 27% and 16% of variation in 2-year change in AOD500 and ARA, respectively. Conclusions: Younger persons and those with the least crowded anterior chambers at baseline have the largest 2-year decreases in AOD500 and ARA. The ability to predict change in angle width based on demographic and biometric factors is relatively poor, which may have implications for screening. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2012 American Academy of Ophthalmology.

Change in psychological distress in longer-term oesophageal cancer carers: are clusters of illness perception change a useful determinant?

Objective: This study provides a longitudinal assessment of distress in longer-term oesophageal cancer carers, while examining illness perception schema as a possible determinant of change in distress over time.
Methods: Oesophageal cancer carers (n=171), 48-months post-diagnosis, were assessed at baseline and 12-months later with the Illness Perception Questionnaire-Revised, Cancer Coping Questionnaire, Hospital Anxiety and Depression Scale and Concerns About Recurrence Scale.
Results: Findings report deterioration from normal to probable anxiety in 35.7% of carers and probable depression in 28.7% carers over time. Fear of recurrence remained stable. Changes in control, consequence and cause beliefs were identified as key determinants of a change in psychological morbidity.
Conclusions: Illness beliefs appear to be valuable targets for psychological intervention to improve wellbeing among carers of people with oesophageal cancer.