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.

Arching action in high strength concrete slabs

The corrosion of reinforcement in bridge deck slabs has been the cause of major deterioration and high costs in repair and maintenance.This problem could be overcome by reducing the amount of reinforcement and/or altering the location.This is possible because, in addition to the strength provided by the reinforcement, bridge deck slabs have an inherent strength due to the in-plane arching forces set up as a result of restraint provided by the slab boundary conditions. This is known as arching action or Compressive Membrane Action (CMA). It has been recognised for some time that laterally restrained slabs exhibit strengths far in excess of those predicted by most design codes but the phenomenon has not been recognised by the majority of bridge design engineers. This paper presents the results of laboratory tests on fifteen reinforced concrete slab strips typical of a bridge deck slab and compares them to predicted strengths using the current codes and CMA theory. The tests showed that the strength of laterally restrained slabs is sensitive to both the degree of external lateral restraint and the concrete compressive strength.The tests particularly highlighted the benefits in strength obtained from very high strength concrete slabs. The theory extends the existing knowledge of CMA in slabs with concrete compressive strengths up to 100 N/mm[2] and promotes more economical and durable bridge deck construction by utilising the benefits of high strength concrete.

Serviceability of bridge deck slabs with arching action

The deterioration of infrastructure, such as bridges, has been one of the major challenges facing both the designers and the owners of such utilities. Sustainable development and a climate of increasing commercialism has led to a requirement for more accurate means of structural analysis. Bridge assessment is one area where this is particularly relevant. It has been known for some time that bridge deck slabs have inherent enhanced strength due to the presence of arching or compressive membrane action (CMA) but only in recent years has there been some acceptance of a rational treatment of this phenomenon for design and assessment purposes. To use the benefits of arching action, this paper presents the results of tests carried out on a reinforced-concrete beam and slab bridge in Northern Ireland that incorporated novel reinforcement type and position. The research was aimed at extending previous laboratory tests on 1/3scale bridge deck edge panels. The measured crack widths and deflections have been compared with the current code requirements.

The (in)visible scar. Representation of the body in blogs by women with breast cancer

In this paper we analyze the representation of the body in blogs by women with breast cancer. Taking into account both texts and images, we study the representation of the body on the basis of the body problems proposed by Frank (1995): control, body-relatedness, other-relatedness and desire. In the blogs studied we find a desiring and dyadic body, which is understood as part of a network of affection and care. The diagnosis of cancer can generate both dissociation, when the body is experienced as a threat, and association, a wish to be connected to it. In relation to control, a clear will of predictability is observed but traces of assumption of contingency also appear.

Unraveling EU Policies: the ““Common Basic Principles”” and the ““European Integration Fund”” as a technology of government

this paper is about EU “soft policies” on immigrant integration. It analyzes the “Common Basic Principles” (CBPs) and the “European Integration Fund” (EIF), two devices that have been recently established within this framework. It adopts the theoretical perspective of the “anthropology of policy” and “governmentality studies”. It shows the context of birth of the aforementioned devices, as well as their functioning and the assessment done by the actors implied in the elaboration/implementation/evaluation of the related policies. It is based both on documentary research as well as direct observation and interviews done to the actors implied. It concludes that the PBC and the EIF should be considered as a “technology of government”, that strives to align the conduct of the actors with the governmental aims, as well as it produces specific practices and knowledge. It also underlines an intrinsic feature of many policies: their “congenital failure”, since they are (often) disputed and resignified by situated actors, who are embedded in asymmetrical power relations.