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.

HOME-BASED REHABILITATION AND ITS IMPACT ON HOSPITAL UTILIZATION

There is compelling evidence for the effectiveness of home-based occupational therapy and physiotherapy rehabilitation for community dwelling elderly who may struggle with basic activities and the functions of daily living and mobility. Nonetheless, an estimated 2% of home care’s elderly clients receive these therapies. Ontario’s home care data indicates that 78% of clients that could benefit from these specific therapies are not receiving them. The study examined a subset of elderly clients receiving home care following a hospital discharge during 2009-2010. The aim of this study was to: understand the difference between those home care clients who received occupational therapy or physiotherapy and those who did not; and determine if receiving these therapies impacted the utilization of hospital emergency departments and inpatient admissions. A retrospective cohort design and multivariate and survival analysis of hospital and home care administrative data structured the study. Results suggest that home-based rehabilitation is offered to a minority of the home care population. Distinct client characteristics and process variables significantly associated with the increased likelihood of receiving home-based occupational and physical therapies included: clients who were older, females, admitted to home care from hospital inpatient units, assessed as non-acute for clinical and service needs and required more home making support and assistance with activities of daily living. Almost one quarter of the total sample returned to hospital. Visits to emergency departments accounted for the greater part of hospital utilization and primarily for sub-acute general symptoms and signs, post-procedural complications, infections or acute episodes from chronic obstructive pulmonary disease and renal failure. Slightly over half of the clients returning to hospital did not receive home-based rehabilitation. Clients who received occupational therapy returned to the hospital sooner following their home care admission whereas clients receiving physiotherapy spent the longest time before rehospitalizing. The majority of the clients receiving occupational therapy were admitted to home care having just resolved sub-acute conditions or symptoms, many of which are known to influence functional and physical decline. Moreover, analysis of process variables indicated that the wait time for a referral to occupational therapy was two times longer compared to physiotherapy. These same clients also waited, on average, over one month before an occupational therapist’s first visit. The need to discriminate who receives home-based rehabilitation is essential to understanding how specific therapies contribute to improving systems outcomes. This study is the first examination that focuses specifically on home-based occupational therapy and physiotherapy rehabilitation and the client characteristics and process variables associated with receiving/not receiving these therapies and the impact these factors have on the time-to-rehospitalization.

The diversity of extradiol dioxygenase (<i>edoi>) genes in cresol degrading rhodococci from a creosote-contaminated site that express a wide range of degradative abilities.

Analysis of the bacterial population of soil surface samples from a creosote-contaminated site showed that up to 50% of the culturable micro-organisms detected were able to utilise a mixture of cresols. From fifty different microbial isolates fourteen that could utilise more than one cresol isomer were selected and identified by 16S rRNA analysis. Eight isolates were Rhodococcus strains and six were Pseudomonas strains. In general, the Rhodococcus strains exhibited a broader growth substrate range than the Pseudomonas strains. The distribution of various extradiol dioxygenase (edo) genes, previously associated with aromatic compound degradation in rhodococci, was determined for the Rhodococcus strains by PCR detection and Southern-blot hybridization. One strain, Rhodococcus sp. I1 exhibited the broadest growth substrate range and possessed five different edo genes. Gene disruption experiments indicated that two genes (edoC and edoD) were associated with isopropylbenzene and naphthalene catabolism respectively. The other Rhodococcus strains also possessed some of the edo genes and one (edoB) was present in all of the Rhodococcus strains analysed. None of the rhodococcal edo genes analysed were present in the Pseudomonas strains isolated from the site. It was concluded that individual strains of Rhodococcus possess a wide degradative ability and may be very important in the degradation of complex mixtures of substrates found in creosote.

Early-type stars observed in the ESO UVES Paranal Observatory Project - I. Interstellar NaIUV, TiII and CaIIKobservations

We present an analysis of interstellar NaI (lambda(air) = 3302.37 and 3302.98 angstrom), TiII (lambda(air) = 3383.76 angstrom) and CaII K (lambda(air) = 3933.66 angstrom) absorption features for 74 sightlines towards O- and B-type stars in the Galactic disc. The data were obtained from the Ultraviolet and Visual Echelle Spectrograph Paranal Observatory Project, at a spectral resolution of 3.75 km s(-1) and with mean signal-to-noise ratios per pixel of 260, 300 and 430 for the NaI, TiII and CaII observations, respectively. Interstellar features were detected in all but one of the TiII sightlines and all of the CaII sightlines. The dependence of the column density of these three species with distance, height relative to the Galactic plane, HI column density, reddening and depletion relative to the solar abundance has been investigated. We also examine the accuracy of using the NaI column density as an indicator of that for HI. In general, we find similar strong correlations for both Ti and Ca, and weaker correlations for Na. Our results confirm the general belief that Ti and Ca occur in the same regions of the interstellar medium ( ISM) and also that the TiII/CaII ratio is constant over all parameters. We hence conclude that the absorption properties of Ti and Ca are essentially constant under the general ISM conditions of the Galactic disc.

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.

Spanish Sociology and Anti-Semitism Between passed prejudice and key to civilization

There is a significant lack of sociological research in Spain about anti-Semitism. At the same time there are alarming anti-Semitic tendencies and anti-Jewish stereotypes which are above the European average. This article aims to explain this lack of sociological research about anti-Semitism in Spain. Therefore two types of explications are offered: on the one hand side some structural problems will be shown which sociology in general had since its beginnings and which complicate the understanding of anti-Semitism. Furthermore explications regarding the specific social and historic situation in Spain and of Spanish sociology in particular will be exposed. It will be shown that for its rationalistic character and with the exception of very few authors – who are considered marginalized for practical research – sociology in general has had enormous problems in understanding anti-Semitism. The specific historic situation, Francoism, the dispute about the historic memory and the delayed institutionalisation of sociology could also explain the lack of sociological interest in the topic especially in Spain. The article shows that the study of anti-Semitism is not only relevant for struggling against this burden of society in many of its variants. Furthermore, thinking about anti-Semitism can help sociology to recognise its own epistemological problems. It can serve to criticise and improve instruments of sociological research by showing the limitations of the sociological approach and to uncover the importance of interdisciplinary research for understanding specific social phenomena. In that sense, anti-Semitism, far from being a marginal subject, can be considered a key topic in the process of civilisation and it can help us to decipher the contemporary Spanish society.

Structural and chemical embrittlement of grain boundaries by impurities: A general theory and first-principles calculations for copper

First-principles calculations of the Sigma 5(310)[001] symmetric tilt grain boundary in Cu with Bi, Na, and Ag substitutional impurities provide evidence that in the phenomenon of Bi embrittlement of Cu grain boundaries electronic effects do not play a major role; on the contrary, the embrittlement is mostly a structural or "size" effect. Na is predicted to be nearly as good an embrittler as Bi, whereas Ag does not embrittle the boundary in agreement with experiment. While we reject the prevailing view that "electronic" effects (i.e., charge transfer) are responsible for embrittlement, we do not exclude the role of chemistry. However, numerical results show a striking equivalence between the alkali metal Na and the semimetal Bi, small differences being accounted for by their contrasting "size" and "softness" (defined here). In order to separate structural and chemical effects unambiguously if not uniquely, we model the embrittlement process by taking the system of grain boundary and free surfaces through a sequence of precisely defined gedanken processes; each of these representing a putative mechanism. We thereby identify three mechanisms of embrittlement by substitutional impurities, two of which survive in the case of embrittlement or cohesion enhancement by interstitials. Two of the three are purely structural and the third contains both structural and chemical elements that by their very nature cannot be further unraveled. We are able to take the systems we study through each of these stages by explicit computer simulations and assess the contribution of each to the net reduction in intergranular cohesion. The conclusion we reach is that embrittlement by both Bi and Na is almost exclusively structural in origin; that is, the embrittlement is a size effect.

Project evaluation SOU-estuTUtor: mentors’ perception

The introduction of new degrees in the Faculty of Education and the relevance of educational guidance comes to them, as a compulsory subject in all four grades started from 2009-2010, gives the opportunity to return and boost the University Guidance Service (UGS) as a means of consistency with the profile of their education and professional development of its students. The aim of the paper focuses on the evaluation of the results after the first year of implementing a peer mentoring project, SOU-estuTUtor Project, developed from UGS with all degree students of the Faculty of Education for Students new entrants. Program has been evaluated through the perception and satisfaction of the mentors on the organization, training, skills developed and adapted to the needs of students. After one academic year of implementation, the results show, on the one hand, the satisfaction and commitment of those involved and the partial response to the needs of the students served, as well as the optimization of the personal resources of the university but also some limitations that make it necessary to review the mentoring program in terms of control and duration of the process.

University students with disabilities in Universities. A study of their inclusion

Access to higher education has increased among students with disabilities, and universities are adopting different alternatives which must be assessed. The purpose of this study was to identify the situation of a sample of students with disabilities (n=91) who attend a university in Spain, through the design and validation of the “CUNIDIS-d” scale, with satisfactory psychometric properties. The results show the importance of making reasoned curriculum adaptations, adapting teacher training, improving accessibility and involving all the university community. Different proposals were provided which support the social dimension of the EHEA.

Art as an educative and social tool

Since remote times, certain sectors of society have been exposed to inequality and vulnerability, where adequate intervention processes have become conspicuous because of their absence. Nowadays, current societies have the responsibility of contributing, based on their experience and knowledge, with more efficient policies and programs that improve the life quality of the most disadvantaged. It is here where art and its different tools play a very important role, not only on a physical level, but also as an education tool that allows the development of emotional, mental and communicative skills. The aim of this paper is to make clear the potential of art as an instrument of social and educational intervention. It starts by showing worldwide-collected experience related to education and arts, and then, it acquaints the reader with two parallel intervention projects that worked with youths under social vulnerability conditions. These interventions were developed based on a qualitative research (Grounded theory), using as methodology “The Artistic Mediation” with emphasis on body language. This methodology helped researchers to get close to the participants and to know their experiences and emotions. At the same time, it was possible to evidence the positive effects of educative interventions through art. These workshops were based on an artistic methodology especially focused on body language. Data in this work is qualitative, and as such, it permits a special approach to the personal and emotional experiences of the participants; clearly showing the positive effects of the referenced practice on them.

General insight into CO oxidation: A density functional theory study of the reaction mechanism on platinum oxides

CO oxidation on PtO2(110) has been studied using density functional theory calculations. Four possible reaction mechanisms were investigated and the most feasible one is the following: (i) the O at the bridge site of PtO2(110) reacts with CO on the coordinatively unsaturated site (CUS) with a negligible barrier; (ii) O-2 adsorbs on the bridge site and then interacts with CO on the CUS to form an OO-CO complex; (iii) the bond of O-OCO breaks to produce CO2 with a small barrier (0.01 eV). The CO oxidation mechanisms on metals and metal oxides are rationalized by a simple model: The O-surface bonding determines the reactivity on surfaces; it also determines whether the atomic or molecular mechanism is preferred. The reactivity on metal oxides is further found to be related to the 3rd ionization energy of the metal atom.

General trends in the barriers of catalytic reactions on transition metal surfaces

A catalyst preparation by design is one of the ultimate goals in chemistry. The first step towards this goal is to understand the origin of reaction barriers. In this study, we have investigated several catalytic reactions on some transition metal surfaces, using density functional theory. All the reaction barriers have been determined. By detailed analyses we obtain some insight into the reaction barrier. Each barrier is related to (i) the potential energy surface of reactants on the surface, (ii) the total chemisorption energy of reactants, and (iii) the metal d orbital occupancy and the reactant valency. (C) 2001 American Institute of Physics.