Primary care organisational interventions for secondary prevention of IHD: a systematic review and meta-analysis.

Background: Ischaemic heart disease (IHD) is the most common cause of death worldwide.

Aim: To determine the long-term impact of organisational interventions for secondary prevention of IHD.

Design and setting: Systematic review and meta-analysis of studies from CENTRAL, MEDLINE®, Embase, and CINAHL published January 2007 to January 2013.

Method: Searches were conducted for randomised controlled trials of patients with established IHD, with long-term follow-up, of cardiac secondary prevention programmes targeting organisational change in primary care or community settings. A random-effects model was used and risk ratios were calculated.

Results: Five studies were included with 4005 participants. Meta-analysis of four studies with mortality data at 4.7–6 years showed that organisational interventions were associated with approximately 20% reduced mortality, with a risk ratio (RR) for all-cause mortality of 0.79 (95% confidence interval [CI] = 0.66 to 0.93), and a RR for cardiac-related mortality of 0.74 (95% CI = 0.58 to 0.94). Two studies reported mortality data at 10 years. Analysis of these data showed no significant differences between groups. There were insufficient data to conduct a meta-analysis on the effect of interventions on hospital admissions. Additional analyses showed no significant association between organisational interventions and risk factor management or appropriate prescribing at 4.7–6 years.

Conclusion: Cardiac secondary prevention programmes targeting organisational change are associated with a reduced risk of death for at least 4–6 years. There is insufficient evidence to conclude whether this beneficial effect is maintained indefinitely.

Are Computer Scientists Geeks? Gender Differences In Attitudes And Experiences Related To Computing Among Secondary Education Students In Northern Ireland.

The worldwide scarcity of women studying or employed in ICT, or in computing related disciplines, continues to be a topic of concern for industry, the education sector and governments. Within Europe while females make up 46% of the workforce only 17% of IT staff are female. A similar gender divide trend is repeated worldwide, with top technology employers in Silicon Valley, including Facebook, Google, Twitter and Apple reporting that only 30% of the workforce is female (Larson 2014). Previous research into this gender divide suggests that young women in Secondary Education display a more negative attitude towards computing than their male counterparts. It would appear that the negative female perception of computing has led to representatively low numbers of women studying ICT at a tertiary level and consequently an under representation of females within the ICT industry. The aim of this study is to 1) establish a baseline understanding of the attitudes and perceptions of Secondary Education pupils in regard to computing and 2) statistically establish if young females in Secondary Education really do have a more negative attitude towards computing.

Impact of an enhanced antibiotic stewardship on reducing methicillin-resistant Staphylococcus aureus in primary and secondary healthcare settings

The objective of this study was to evaluate the impact of restricting high-risk antibiotics on methicillin-resistant Staphylococcus aureus (MRSA) incidence rates in a hospital setting. A secondary objective was to assess the impact of reducing fluoroquinolone use in the primary-care setting on MRSA incidence in the community. This was an interventional, retrospective, ecological investigation in both hospital and community (January 2006 to June 2010). Segmented regression analysis of interrupted time-series was employed to evaluate the intervention. The restriction of high-risk antibiotics was associated with a significant change in hospital MRSA incidence trend (coefficient=-0·00561, P=0·0057). Analysis showed that the intervention relating to reducing fluoroquinolone use in the community was associated with a significant trend change in MRSA incidence in community (coefficient=-0·00004, P=0·0299). The reduction in high-risk antibiotic use and fluoroquinolone use contributed to both a reduction in incidence rates of MRSA in hospital and community (primary-care) settings. 

Ionic liquids containing secondary hydroxyl-groups and a method for their preparation.

The invention provides ionic liqs., [R'1CH(OH)CH2]NR'nX (X = anion, R' = alkyl, alkenyl, alkynyl, cycloalkyl, alkylcarbonylalkyl, alkoxy, haloalkyl, haloalkoxy, alkenyloxy, alkynyloxy, cycloalkyloxy, aryl), having a secondary hydroxyl group, and an atom-efficient method for the prepn. of these ionic liqs., by epoxidn. of a protonated nitrogen- contg. org. base (which can optionally be prepd. in situ) in the presence of an anion suitable for supporting ionic liq. formation. Thus, reaction of 1-methylimidazole with HCl in EtOH ∼ 25° followed by treatment with propylene oxide gave 1-(2-hydroxypropyl)-3-methylimidazolium chloride. [on SciFinder(R)]

‘Reading Aran knitting: stitches, text andinterpretation’

The densely textured surfaces of Aran knitting seem to invite interpretation. They have been ‘read’ as identity documents, family trees, references to natural and spiritual phenomena, or even maps. This paper traces the search for meaning in Aran knitting, examining how these stitch patterns have been ‘read’ in the contexts of tourism, fine art and fashion. As Jo Turney (2013:55) argues, the idea of knitted textiles as communicative media in non-literate societies ‘consigns the garments to a preindustrial era of more rural and simple times’, situating them in an imagined state of ‘stasis’. Thus the ways in which Aran stitches are ‘read’ sometimes obscure the processes through which they are ‘written’, whether in terms of individual authorship and creativity, or in terms of their manufacture. Regardless of the historical veracity of claims that particular Aran stitch patterns index features of the social, natural or spiritual worlds, analysing the ways they have been ‘read’ in the context of comparable textile traditions, other crafts which have taken on ‘heritage’ souvenir status, and Irish national identity, reveals how Aran knitting has performed broader communicative functions (see Sonja Andrew 2008), which continue to be subverted and elaborated by fine artists, and translated into couture and mass market fashion products.

The Gentle Island (Staged Reading): by Brian Friel

Staged Reading on Arranmore Island, West Donegal for the Lughnasa International Friel Festival

Learning to be Boys: Reading the Lessons of Shakespeare’s Love’s Labour’s Lost and Marston’s What You Will

This essay focuses on the lessons of Love’s Labour’s Lost’s pageboy-schoolboy-boy actor, Moth, to examine the production of boyhood in early modern culture. It reads Shakespeare’s boy character alongside John Marston’s schoolboy, Holofernes Pippo, in What You Will to investigate the ways in which school lessons might be deployed to produce aged and gendered identities that complicate traditional understandings of early modern masculinity. Reading the comic staging of lessons in these plays, it will suggest that while the educational system aimed to produce gendered subjects, early modern masculine identities exist as a range of categories on a developmental scale. It will propose that although Moth and Pippo comically expose the limits of many pedagogical methods to produce ‘men’, they demonstrate the ways in which these characters learn to be boys. Finally, it will consider the extent to which this production of early modern age and gender identity in the plays is paralleled by the historical boy actors performing these roles.

The white dwarf's carbon fraction as a secondary parameter of Type Ia supernovae

Context. Binary stellar evolution calculations predict thatChandrasekhar-mass carbon/oxygen white dwarfs (WDs) show a radiallyvarying profile for the composition with a carbon depleted core. Manyrecent multi-dimensional simulations of Type Ia supernovae (SNe Ia),however, assume the progenitor WD has a homogeneous chemicalcomposition.
Aims: In this work, we explore the impact ofdifferent initial carbon profiles of the progenitor WD on the explosionphase and on synthetic observables in the Chandrasekhar-mass delayeddetonation model. Spectra and light curves are compared to observationsto judge the validity of the model.
Methods: The explosion phaseis simulated using the finite volume supernova code Leafs, which isextended to treat different compositions of the progenitor WD. Thesynthetic observables are computed with the Monte Carlo radiativetransfer code Artis. Results: Differences in binding energies ofcarbon and oxygen lead to a lower nuclear energy release for carbondepleted material; thus, the burning fronts that develop are weaker andthe total nuclear energy release is smaller. For otherwise identicalconditions, carbon depleted models produce less 56Ni.Comparing different models with similar 56Ni yields showslower kinetic energies in the ejecta for carbon depleted models, butonly small differences in velocity distributions and line velocities inspectra. The light curve width-luminosity relation (WLR) obtained formodels with differing carbon depletion is roughly perpendicular to theobserved WLR, hence the carbon mass fraction is probably only asecondary parameter in the family of SNe Ia.
Tables 3 and 4 are available in electronic form at http://www.aanda.org

Single nucleotide polymorphisms in the APCS gene influence geographic atrophy secondary to VEGF inhibition therapy in neovascular macular degeneration.

Introduction: Age-related macular degeneration (AMD) is a leading cause of vision loss in the elderly mostly due to the development of neovascular AMD (nAMD) or geographic atrophy (GA). Intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents are an effective therapeutic option for nAMD. Following anti-VEGF treatments, increased atrophy of the retinal pigment epithelium (RPE) and choriocapillaries that resembles GA has been reported. We sought to evaluate the underlying genetic influences that may contribute to this process. Methods: We selected 68 single nucleotide polymorphisms (SNPs) from genes previously identified as susceptibility factors in AMD, along with 43 SNPs from genes encoding the VEGF protein and its cognate receptors as this pathway is targeted by treatment. We enrolled 467 consecutive patients (Feb 2009 to October 2011) with nAMD who received anti-VEGF therapy. The acutely presenting eye was designated as the study eye and retinal tomograms graded for macular atrophy at study exit. Statistical analysis was performed using PLINK to identify SNPs with a P value < 0.01. Logistic regression models with macular atrophy as dependent variable were fitted with age, gender, smoking status, common genetic risk factors and the identified SNPs as explanatory variables. Results: Grading for macular atrophy was available in 304 study eyes and 70% (214) were classified as showing macular atrophy. In the unadjusted analysis we observed significant associations between macular atrophy and two independent SNPs in the APCS gene: rs6695377: odds ratio (OR) = 1.98; 95% confidence intervals (CI): 1.23, 3.19; P = 0.004; rs1446965: OR = 2.49, CI: 1.29, 4.82; P = 0.006 and these associations remained significant after adjustment for covariates. Conclusions: VEGF is a mitogen and growth factor for choroidal blood vessels and the RPE and its inhibition could lead to atrophy of these key tissues. Anti-VEGF treatment can interfere with ocular vascular maintenance and may be associated with RPE and choroidal atrophy. As such, these medications, which block the effects of VEGF, may influence the development of GA. The top associated SNPs are found in the APCS gene, a highly conserved glycoprotein that encodes Serum amyloid P (SAP) which opsonizes apoptotic cells. SAP can bind to and activate complement components via binding to C1q, a mechanism by which SAP may remove cellular debris, affecting regulation of the three complement pathways.

Six-year follow-up of the SPHERE RCT: secondary prevention of heart disease in general practice.

Objective: To determine the long-term effectiveness of a complex intervention in primary care aimed at improving outcomes for patients with coronary heart disease.

Design: A 6-year follow-up of a cluster randomised controlled trial, which found after 18 months that both total and cardiovascular hospital admissions were significantly reduced in intervention practices (8% absolute reduction).

Setting: 48 general practices in the Republic of Ireland and Northern Ireland.

Participants: 903 patients with established coronary heart disease at baseline in the original trial.

Intervention: The original intervention consisted of tailored practice and patient plans; training sessions for practitioners in medication prescribing and behavioural change; and regular patient recall system. Control practices provided usual care. Following the intervention period, all supports from the research team to intervention practices ceased.

Outcome measures: Primary outcome: hospital admissions, all cause and cardiovascular; secondary outcomes: mortality; blood pressure and cholesterol control.

Results: At 6-year follow-up, data were collected from practice records of 696 patients (77%). For those who had died, we censored their data at the point of death and cause of death was established. There were no significant differences between the intervention and control practices in either total (OR 0.83 (95% CI 0.54 to 1.28)) or cardiovascular hospital admissions (OR 0.91 (95% CI 0.49 to 1.65)). We confirmed mortality status of 886 of the original 903 patients (98%). There were no significant differences in mortality (15% in intervention and 16% in control) or in the proportions of patients above target control for systolic blood pressure or total cholesterol.

Conclusions: Initial significant differences in the numbers of total and cardiovascular hospital admissions were not maintained at 6 years and no differences were found in mortality or blood pressure and cholesterol control. Policymakers need to continue to assess the effectiveness of previously efficacious programmes.

Trial registration number: Current Controlled Trials ISRCTN24081411.

Identification and validation of the dopamine agonist bromocriptine as a novel therapy for high-risk myelodysplastic syndromes and secondary acute myeloid leukemia

Myelodysplastic syndromes (MDS) represent a broad spectrum of diseases characterized by their clinical manifestation as one or more cytopenias, or a reduction in circulating blood cells. MDS is predominantly a disease of the elderly, with a median age in the UK of around 75. Approximately one third of MDS patients will develop secondary acute myeloid leukemia (sAML) that has a very poor prognosis. Unfortunately, most standard cytotoxic agents are often too toxic for older patients. This means there is a pressing unmet need for novel therapies that have fewer side effects to assist this vulnerable group. This challenge was tackled using bioinformatic analysis of available transcriptomic data to establish a gene-based signature of the development and progression of MDS. This signature was then used to identify novel therapeutic compounds via statistically-significant connectivity mapping. This approach suggested re-purposing an existing and widely-prescribed drug, bromocriptine as a novel potential therapy in these disease settings. This drug has shown selectivity for leukemic cells as well as synergy with current therapies.

Spectacle design preferences among Chinese primary and secondary students and their parents: A qualitative and quantitative study

Purpose: To identify the specific characteristics making glasses designs, particularly those compatible with adjustable glasses, more or less appealing to Chinese children and their parents. Patients and Methods: Primary and secondary school children from urban and rural China with < = -1.00 diopters of bilateral myopia and their parents ranked four conventional-style frames identified by local optical shops as popular versus four child-specific frames compatible with adjustable spectacles. Scores based on the proportion of maximum possible ranking were computed for each style. Selected children and their parents also participated in Focus Groups (FGs) discussing spectacle design preference. Recordings were transcribed and coded by two independents reviewers using NVivo software. Results: Among 136 urban primary school children (age range 9-11 years), 290 rural secondary school children (11-17 years) and 16 parents, all adjustable-style frames (scores on 0-100 scale 25.7-62.4) were ranked behind all conventional frames (63.0-87.5). For eight FGs including 12 primary children, 26 secondary children and 16 parents, average kappa values for NVivo coding were 0.81 (students) and 0.70 (parents). All groups agreed that the key changes to make adjustable designs more attractive were altering the round lenses to rectangular or oval shapes and adding curved earpieces for more stable wear. The thick frames of the adjustable designs were considered stylish, and children indicated they would wear them if the lens shape were modified. Conclusions: Current adjustable lens designs are unattractive to Chinese children and their parents, though this study identified specific modifications which would make them more appealing.