Effect of tailored practice and patient care plans on secondary prevention of heart disease in general practice: cluster randomised controlled trial

Objective: To test the effectiveness of a complex intervention designed, within a theoretical framework, to improve outcomes for patients with coronary heart disease. Design: Cluster randomised controlled multicentre trial. Setting: General practices in Northern Ireland and the Republic of Ireland, regions with different healthcare systems. Participants: 903 patients with established coronary heart disease registered with one of 48 practices. Intervention: Tailored care plans for practices (practice based training in prescribing and behaviour change, administrative support, quarterly newsletter), and tailored care plans for patients (motivational interviewing, goal identification, and target setting for lifestyle change) with reviews every four months at the practices. Control practices provided usual care. Main outcome measures: The proportion of patients at 18 month follow-up above target levels for blood pressure and total cholesterol concentration, and those admitted to hospital, and changes in physical and mental health status (SF-12). Results: At baseline the numbers (proportions) of patients above the recommended limits were: systolic blood pressure greater than 140 mm Hg (305/899; 33.9%, 95% confidence interval 30.8% to 33.9%), diastolic blood pressure greater than 90 mm Hg (111/901; 12.3%, 10.2% to 14.5%), and total cholesterol concentration greater than 5 mmol/l (188/860; 20.8%, 19.1% to 24.6%). At the 18 month follow-up there were no significant differences between intervention and control groups in the numbers (proportions) of patients above the recommended limits: systolic blood pressure, intervention 98/360 (27.2%) v control, 133/405 (32.8%), odds ratio 1.51 (95% confidence interval 0.99 to 2.30; P=0.06); diastolic blood pressure, intervention 32/360 (8.9%) v control, 40/405 (9.9%), 1.40 (0.75 to 2.64; P=0.29); and total cholesterol concentration, intervention 52/342 (15.2%) v control, 64/391 (16.4%), 1.13 (0.63 to 2.03; P=0.65). The number of patients admitted to hospital over the 18 month study period significantly decreased in the intervention group compared with the control group: 107/415 (25.8%) v 148/435 (34.0%), 1.56 (1.53 to 2.60; P=0.03). Conclusions: Admissions to hospital were significantly reduced after an intensive 18 month intervention to improve outcomes for patients with coronary heart disease, but no other clinical benefits were shown, possibly because of a ceiling effect related to improved management of the disease. Trial registration: Current Controlled Trials ISRCTN24081411.

The redox-Bohr group associated with iron-sulfur cluster N2 of complex I

Proton pumping respiratory complex I (NADH: ubiquinone oxidoreductase) is a major component of the oxidative phosphorylation system in mitochondria and many bacteria. In mammalian cells it provides 40% of the proton motive force needed to make ATP. Defects in this giant and most complicated membrane-bound enzyme cause numerous human disorders. Yet the mechanism of complex I is still elusive. A group exhibiting redox-linked protonation that is associated with iron-sulfur cluster N2 of complex I has been proposed to act as a central component of the proton pumping machinery. Here we show that a histidine in the 49-kDa subunit that resides near iron-sulfur cluster N2 confers this redox-Bohr effect. Mutating this residue to methionine in complex I from Yarrowia lipolytica resulted in a marked shift of the redox midpoint potential of iron-sulfur cluster N2 to the negative and abolished the redox-Bohr effect. However, the mutation did not significantly affect the catalytic activity of complex I and protons were pumped with an unchanged stoichiometry of 4 H+/2e(-). This finding has significant implications on the discussion about possible proton pumping mechanism for complex I.

Cluster randomised controlled trial of an infection control education and training intervention programme focusing on meticillin-resistant Staphylococcus aureus in nursing homes for older people

The aim of this cluster randomised controlled trial was to test the impact of an infection control education and training programme on meticillin-resistant Staphylococcus aureus (MRSA) prevalence in nursing homes. Nursing homes were randomised to intervention (infection control education and training programme; N¼16) or control (usual practice continued; N¼16). Staff in intervention homes were educated and trained (0, 3 and 6 months) in the principles and implementation of good infection control practice with infection control audits conducted in all sites (0, 3, 6 and 12 months) to assess compliance with good practice. Audit scores were fed back to nursing home managers in intervention homes, together with a written report indicating where practice could be improved. Nasal swabs were taken from all consenting residents and staff at 0, 3, 6 and 12 months. The primary outcome was MRSA prevalence in residents and staff, and the secondary outcome was a change in infection control audit scores. In all, 793 residents and 338 staff were recruited at baseline. MRSA prevalence did not change during the study in residents or staff. The relative risk of a resident being colonised with MRSA in an intervention home compared with a control home at 12 months was 0.99 (95% con?dence interval: 0.69, 1.42) after adjustment for clustering. Mean infection control audit scores were signi?cantly higher in the intervention homes (82%) compared with the control homes (64%) at 12 months (P<0.0001). Consideration should be given to other approaches which may help to reduce MRSA in this setting.

Dielectronic recombination in He-like, Li-like, and Be-like highly charged ions in the KLL and KLM manifolds

This paper reports a systematic study of the dependence on atomic number of the dielectronic recombination resonance strengths for He-like, Li-like and Be-like ions. Recent measurements of dielectronic recombination resonance strengths for the KLL and KLM manifolds for iron, yttrium, iodine, holmium, and bismuth are also described. The resonance strengths were normalized to calculated electron impact ionization cross sections. The measured resonance strengths generally agree well with theoretical calculations using the distorted wave approximation. However, KLM resonance strength measurements on high atomic number open-shell ions gave higher values than those suggested by calculations. Using recently measured data, along with existing results, scaling laws have been generated as a function of atomic number for He-like, Li-like, and Be-like ions in the KLL and KLM manifolds.

Electron attachment to SF(6) and lifetimes of SF(6)(-) negative ions

We study the process of low-energy electron capture by the SF(6) molecule. Our approach is based on the model of Gauyacq and Herzenberg [J. P. Gauyacq and A. Herzenberg, J. Phys. B 17, 1155 (1984)] in which the electron motion is coupled to the fully symmetric vibrational mode through a weakly bound or virtual s state. By tuning the two free parameters of the model, we achieve an accurate description of the measured electron attachment cross section and good agreement with vibrational excitation cross sections of the fully symmetric mode. An extension of the model provides a limit on the characteristic time of intramolecular vibrational relaxation in highly excited SF(6)(-). By evaluating the total vibrational spectrum density of SF(6)(-), we estimate the widths of the vibrational Feshbach resonances of the long-lived negative ion. We also analyze the possible distribution of the widths and its effect on the lifetime measurements, and investigate nonexponential decay features in metastable SF(6)(-).

Ionic Liquids Containing Boron Cluster Anions

The combination of different boron cluster anions and some of the cations typically found in the composition of ionic liquids has been possible by straightforward metathetic reactions, producing new low melting point salts; the imidazolium cations have been systematically studied, [C(n)mim](+) (when [C(n)mim](+) = 1-alkyl-3-methylimidazolium; n = 2, 4, 6, 8, 10, 12, 14, 16, or 18). Melting points increase in the anionic order [Co(C2B9H11)(2)](-) =-34 degrees C). The salts [C(n)mim](2)[X] ([X](2-) = [B10Cl10](2-) or [B12Cl12](2-), n = 16 or 18) show liquid crystal phases between the solid and liquid states. Tetraalkylphosphonium salts of [B10Cl10](2-) have also been prepared. Physical properties, such as thermal stability, density, or viscosity, have been measured for some selected samples. The presence of the perhalogenated dianion [B12Cl12](2-) in the composition of the imidazolium salts renders highly thermally stable compounds. For example, [C(2)mim](2)[B12Cl12] starts to decompose above 480 degrees C in a dynamic TGA analysis under a dinitrogen atmosphere. Crystal structures of [C(2)mim][Co(C2B9H11)(2)] and [C(2)mim](2)[B12Cl12] have been determined. H-1 NMR spectra of selected imidazolium-boron cluster anion salts have been recorded from solutions as a function of the concentration, showing trends related to the cation-anion interactions.