bluuebunny/crossref_metadata_2025 huggingface dataset:
The long‐term benefits of cardiac rehabilitation on depression, anxiety, physical activity and quality of life
Authors: Yohannes Abebaw M , Doherty Patrick , Bundy Christine , Yalfani Ali
Published: August 2010

Aims.  To investigate the long‐term benefits of a six‐week comprehensive cardiac rehabilitation programme on physical activity, psychological well‐being and quality of life in patients with coronary heart disease.

Background.  Cardiac rehabilitation (CR) in short term improves exercise capacity and quality of life in patients with cardiac disease. However, the long‐term benefits of CR are inconclusive.

Design.  A prospective CR programme with repeated measures follow‐up over 12 months.

Methods.  A six‐week outpatient cardiac rehabilitation programme was conducted including 147 patients with coronary heart disease. Patients completed the physical activity energy expenditure (seven‐day recall activity), MacNew Heart Disease Health‐Related Quality of Life (MacNew) and Hospital Anxiety and Depression scale (HADs) at baseline, six weeks, six and 12 months.

Results.  One hundred and five (71%) patients (76 male) mean age of 61·8 (SD 9·7) completed the four‐measurement points. Analysis of variance revealed that total energy expenditure (F (2, 231) = 131, p < 0·001), HADs (F (2, 237) = 19·3, p < 0·001), depression score (F (2, 235) = 21·06, p < 0·001), anxiety score (F (2,237) = 17·02, p < 0·001) and MacNew (F (2, 197) = 77·02, p < 0·001) were all statistically significant over time. Bonferroni pairwise follow‐up confirmed significant positive differences (p < 0·05) between baseline values and all subsequent measures over time. Depression was independently explained in 22% of the variance in quality of life at 6 or 12 months. The energy expenditure was significantly higher for men compared to women (F (1, 103) = 31, p < 0·001).

Conclusion.  A six‐week cardiac rehabilitation programme is beneficial in improving quality of life, physical activity status, anxiety and depression. These benefits were maintained at 12 months. Elevated levels of depression were associated with impaired quality of life.

Relevance to clinical practice.  All relevant health care staff should be aware of the benefits of CR and routinely refer and encourage patients with cardiac disease to attend a cardiac rehabilitation programme. Depression and anxiety intervention strategies should be incorporated in cardiac rehabilitation programmes.
‘It’s not worth stopping now’: why do smokers with chronic obstructive pulmonary disease continue to smoke? A qualitative study
Authors: Wilson Julie S , Elborn Joseph S , Fitzsimons Donna
Published: August 2010

Aim.  This study aims to explore the experience of cigarette smokers with Chronic obstructive pulmonary disease (COPD) who have received smoking cessation support and describe their personal decision‐making processes regarding their smoking behaviour.

Background.  Previous studies have demonstrated poor smoking cessation rates in people with COPD, despite this being the primary intervention for disease management. There is limited research exploring the reasons why this population continues to smoke.

Design.  Retrospective qualitative interviews were conducted and analysed using Giorgi’s (1985) process of analysis.

Method.  Following a randomised controlled trial to evaluate national smoking cessation guidelines, semi‐structured interviews were conducted with a purposive sample (n = 6) of those patients who were unable to stop smoking.

Results.  Six themes that typified patients’ decision‐making were identified during six interviews; too late to stop now, finding motivation, guilt about continued smoking, bargaining/contemplation, need to stop and reduced quality of life.

Conclusion.  The reasons why smokers with COPD continue to smoke despite poor health and following support are complex. Cigarettes are regarded as friends, despite the knowledge that they are contributing to severe disability and poor quality of life. Owing to their inability to stop smoking, many patients avoid healthcare opportunities, further contributing to their poor health.

Relevance to clinical practice.  Smoking cessation is associated with ambivalence in this population. Health professionals need to understand the volatility of patients’ decision‐making and tailor advice and support to achieve more realistic goals such as reduced consumption.
Using an online tool to support school‐based ICT policy planning in primary education
Authors: Vanderlinde R. , Van Braak J. , Tondeur J.
Published: August 2010

An important step towards the successful integration of information and communication technology (ICT) in schools is to facilitate their capacity to develop a school‐based ICT policy resulting in an ICT policy plan. Such a plan can be defined as a school document containing strategic and operational elements concerning the integration of ICT in education. To write such a plan in an efficient way is challenging for schools. Therefore, an online tool [Planning for ICT in Schools (pICTos)] has been developed to guide schools in this process. A multiple case study research project was conducted with three Flemish primary schools to explore the process of developing a school‐based ICT policy plan and the supportive role of pICTos within this process. Data from multiple sources (i.e. interviews with school leaders and ICT coordinators, school policy documents analysis and a teacher questionnaire) were collected and analysed. The results indicate that schools shape their ICT policy based on specific school data collected and presented by the pICTos environment. School teams learned about the actual and future place of ICT in teaching and learning. Consequently, different policy decisions were made according to each school's vision on ‘good’ education and ICT integration.
Beyond the ‘digital natives’ debate: Towards a more nuanced understanding of students' technology experiences
Authors: Bennett S. , Maton K.
Published: August 2010

The idea of the ‘digital natives’, a generation of tech‐savvy young people immersed in digital technologies for which current education systems cannot cater, has gained widespread popularity on the basis of claims rather than evidence. Recent research has shown flaws in the argument that there is an identifiable generation or even a single type of highly adept technology user. For educators, the diversity revealed by these studies provides valuable insights into students' experiences of technology inside and outside formal education. While this body of work provides a preliminary understanding, it also highlights subtleties and complexities that require further investigation. It suggests, for example, that we must go beyond simple dichotomies evident in the digital natives debate to develop a more sophisticated understanding of our students' experiences of technology. Using a review of recent research findings as a starting point, this paper identifies some key issues for educational researchers, offers new ways of conceptualizing key ideas using theoretical constructs from Castells, Bourdieu and Bernstein, and makes a case for how we need to develop the debate in order to advance our understanding.
Spread of invasive Phragmites australis in estuaries with differing degrees of development: genetic patterns, Allee effects and interpretation
Authors: McCormick Melissa K. , Kettenring Karin M. , Baron Heather M. , Whigham Dennis F.
Published: August 2010

1. The distribution of genetic variation can be interpreted to understand the timing and mechanisms of invasive species spread. Allee effects, positive relationships between fitness and density or number of conspecific individuals, can play a substantial role in determining the time lag between initial introduction and invasive spread and can produce genetic patterns in invading populations that can be interpreted to learn about factors affecting invasion mechanisms.

2. We examined the distribution of genetic variation in the invasive wetland grass Phragmites australis in the Chesapeake Bay, USA. We used microsatellite analysis to examine the reproductive mode (clonal vs. seed) by which the invasive haplotype of P. australis has spread and the distribution of genetic variation within and among brackish wetlands in nine subestuaries of the Chesapeake Bay. Watersheds associated with the subestuaries were dominated by forests, anthropogenic development or mixed forests and development.

3. Our results suggest that the invasive haplotype of P. australis has spread primarily sexually by seed, rather than clonally, and genetic diversity of patches within subestuaries increased while genetic similarity decreased with increasing development in the surrounding watershed.

4. This suggests a pattern whereby greater genetic diversity of patches may promote more rapid spread due to recruitment of multiple seedlings into a disturbed patch.

5. Synthesis. Evaluation of patterns of genetic distribution can help to identify factors affecting invasion in different environments and so inform management.
Stand development moderates effects of ungulate exclusion on foliar traits in the forests of New Zealand
Authors: Mason Norman W. H. , Peltzer Duane A. , Richardson Sarah J. , Bellingham Peter J. , Allen Robert B.
Published: August 2010

1. Ungulate herbivores may greatly alter the functional composition of plant communities through their selection of leaves with high nutrient concentrations and low structural or chemical defences. These impacts may have broader implications for ecosystem functions via changing rates of litter decomposition and the relative abundance of foliar traits. However, it is unlikely that ungulate impacts will be consistent across different vegetation types and different environmental conditions.

2. We compared shifts in abundance‐weighted trait means and functional diversity indices in 88 pairs of plots fenced to exclude ungulate herbivores (exclosures) and adjacent control plots for eight foliar traits related to ungulate palatability in forest ecosystems. The stem density and basal area per species were both used to weight trait means and functional diversity indices, since these are proportional to recruitment and litter production, respectively. We also regressed exclosure effects on environmental and stand development variables to test whether context influenced the impact of ungulate exclusion.

3. There was a consistent, significant trend across seven of the eight leaf traits examined for increased palatability inside exclosure plots relative to control plots when trait means were weighted by the number of stems per species, but not when weighted by basal area. This suggests that ungulate exclosure consistently increased recruitment of palatable species, but is unlikely to have yet affected mean litter quality. Exclosure effects were linked to stand development variables, with effects being greatest in disturbed stands (where total basal area decreased and the number of stems increased), and least in stands undergoing competitive thinning.

4. Synthesis. The consistency of exclosure effects indicates that ungulate impacts on plant communities in New Zealand’s indigenous forest may be reversible at zero deer density, while their dependence on stand development suggests that the ungulate control impacts may be greatest in seral shrubland or forest communities.
The shared influence of phylogeny and ecology on the reproductive patterns of Myrteae (Myrtaceae)
Authors: Staggemeier Vanessa Graziele , Diniz‐Filho José Alexandre Felizola , Morellato Leonor Patrícia Cerdeira
Published: August 2010

1. Many factors shape plant reproductive patterns including climate, competition or attraction of pollinators and seed dispersers, flower and fruit morphologies and phylogenetic relationships. South American Myrtaceae (Myrteae) were chosen to evaluate hypotheses on how abiotic and biotic factors, morphology and phylogeny influence plant reproductive phenology.

2. We examined whether Myrteae reproductive patterns are seasonal and related to climate; whether aggregated or segregated flowering and fruiting occur among species sharing pollinators or seed dispersers; the relationship between phenological and morphological traits, time of reproduction and Myrteae phylogenetic history; and the shared influence of ecological (environmental) and phylogenetic factors on Myrteae reproductive patterns.

3. We observed flowering and fruiting of 34 Myrteae species during 30 months in an Atlantic rain forest (south‐eastern Brazil). We employed circular statistics to test for seasonality and multiple regressions to relate climate and phenology. Competition and facilitation hypotheses were tested using null models. We quantified the phylogenetic signal on phenology and morphology of Myrteae species using phylogenetic eigenvector regression (PVR) analyses, and used PVR and partial regressions to quantify the influences of ecology and phylogeny on phenology.

4. Myrteae flowered seasonally, whereas fruiting was not seasonal. Environmental factors (day‐length and temperature) and associations with biotic vectors through facilitation hypothesis explained the aggregated blossom. Fruit maturation time affected the species’ flowering sequence. Plants with longer fruit maturation times flowered at the end of the appropriate season, explaining the continuous fruit availability despite the seasonal flowering. The random fruiting pattern explained the regular presence of seed dispersers. Myrteae phenology was phylogenetically structured, even when phenophases were not seasonal, i.e., closer related species fruited under more similar environmental conditions, suggesting that the reproductive phenological niche was inherited along the course of evolution. We detected a shared influence of ecology and phylogeny on Myrteae phenological responses, and the ecological component explained better phenological variation than phylogeny.

5. Synthesis. We provided a new perspective on plant phenology based on phylogeny and ecology and demonstrated the importance of considering their shared influence in phenological studies. Our analyses can be employed for the most representative families of highly diverse ecosystems to improve our understanding of evolutionary patterns and general trends in phenology.
Improving the quality of drug error reporting
Authors: Armitage Gerry , Newell Robert , Wright John
Published: August 2010

Background  Drug errors are a common and persistent problem in health care and are also associated with serious adverse events. Reporting has become the cornerstone of learning from errors, but is not without its imperfections.

Aim  The aim of this study is to improve reporting and learning from drug errors through investigating the contributory factors in drug errors and quality of reporting in an acute hospital.

Methods  A retrospective, random sample of 991 drug error reports from 1999 to 2003 were subjected to quantitative and qualitative analysis. This was followed by 40 qualitative interviews with a volunteer, multi‐disciplinary sample of health professionals. The combined analysis has been used to develop a knowledge base for improved drug error reporting.

Results  The quality of reports varied considerably, and 27% of reports lacked any contributory factors. Documentary analysis revealed a focus on individuals, sometimes culminating in blame without obvious justification. Doctors submitted few reports, and there were notable differences in reporting according to clinical location. Communication difficulties commonly featured in causation, and high workload and interruptions were predominant contributory factors in the interview data. Interviewees viewed causation as multifactorial, including cognitive and psychosocial factors. Organizational orientation to error was predominantly perceived by interviewees as individual rather than systems‐based. Staff felt obliged to report but rarely received feedback.

Implications and conclusion  Drug errors are multifactorial in causation. Current reporting schemes lack a theoretical basis, and are unlikely to capture the information required to ensure learning about causation. Health professionals have reporting fatigue and some remain concerned that reporting promotes individual blame rather than an examination of systems factors. Reporting can be strengthened by human error theory, redesigned to capture a range of contributory factors, facilitate learning and foster supportive actions. It can also be feasible in routine practice. Such an approach should be examined through multi‐centred evaluation.
Consensus on ‘core/essential’ and ‘ideal world’ criteria of a pre‐discharge occupational therapy home assessment
Authors: Barras Sarah , Grimmer‐Somers Karen , May Esther
Published: August 2010

Rationale, aims and objectives  There are no standard criteria for an occupational therapy (OT) home assessment for patients about to be discharged from an acute rehabilitation facility. This has implications for benchmarking, quality improvement and research. The aim of this paper is to establish ‘core/essential’ and ‘ideal world’ elements of OT home assessments for patients about to be discharged from acute rehabilitation settings.

Methods  A piloted open‐ended questionnaire initiated a Delphi study involving knowledgeable OTs working in Australian public and private acute rehabilitation settings. ‘Core/essential’ and ‘ideal world’ elements of OT home assessments were confirmed when 70% agreement was reached.

Results  Of 242 facilities in two Australian states, 110 were invited to participate, and 81 OTs from 84 facilities did so. Four Delphi rounds were required to reach consensus on 30 ‘core/essential’ and 25 ‘ideal world’ elements.

Conclusion  Standard use of ‘core/essential’ pre‐discharge home assessment elements should improve standards of care and the quality of discharge planning. OTs should consider including ‘ideal world’ criteria in pre‐discharge assessments to optimize recently ill patients' community independence.
Cancer patients' perception of information exchange between hospital‐based doctors and their general practitioners
Authors: Spiegel Wolfgang , Zidek Thomas , Karlic Heidrun , Maier Manfred , Vutuc Christian , Isak Karin , Micksche Michael
Published: August 2010

Rationale, aims and objectives  The quality of communication between health care professionals is a key issue determining health outcomes in cancer care. This study aims to find out what importance cancer patients in Austria attach to information exchange between hospital‐based doctors and their general practitioners (GPs) and how patients perceive this flow of information.

Methods  In this cross‐sectional study, cancer patients seeking help at a community‐based organization in the voluntary sector (Viennese Cancer League) were polled with a 16‐item questionnaire. Contingency tables were evaluated by means of the chi‐squared and Mantel–Haenszel test.

Results  The mean age of the 252 respondents – 92.6% of those polled (272) – was 51.9 years (SD ± 13.6). 87.5% [female (f): 92.1%, male (m): 80.2%] considered the exchange of information between the hospital‐based specialists and their GP ‘very important’ or ‘important’; 12.5% (f: 8.0%, m: 19.8%) ‘not so important’ or ‘not at all important’; 28.1% (f: 26.0%, m: 31.2%) of patients considered the flow of information as ‘very good’ or ‘fairly good’, but 50.9% (f: 58.7, m: 40.0%) as ‘rather poor’ or ‘poor’. Some 34.8% of patients thought that their cancer disease was first suspected by a hospital‐based specialist; 42.1% thought that it was first suspected by a doctor outside the hospital. Even when patients were counselled elsewhere they gave high importance to the provision of appropriate information to their GP.

Conclusions  Cancer patients in Austria attach high importance to the provision of appropriate information to their GP by hospitals and perceive this exchange of information as insufficient, a finding that could well be prevalent in other European health systems.
A comparison of the scientific quality of publicly and privately funded randomized controlled drug trials
Authors: Jones Richard , Younie Stuart , Macallister Andrew , Thornton Jim
Published: August 2010

Background  There is disagreement but few objective data on the relative quality of publicly or privately funded research. Cochrane reviews of randomized trials provide a good comparison opportunity because there is widespread agreement on how trial quality should be assessed and the Cochrane reviewers routinely do this.

Aims  To compare the quality of publicly or privately funded randomized controlled trials.

Methods  A total of 105 trials included in two Cochrane reviews were studied. Their quality assessments were abstracted from the relevant review and information about their funding source was collected from the original trial publications.

Main results  Funding information was obtained for 87 trials. Of these, trials funded by pharmaceutical companies were larger (median sample size 126 vs. 45, P < 0.001), more likely to have avoided ascertainment bias 11/14 vs. 15/41 (P = 0.05). Non‐significant trends in avoiding entry bias 19/19 vs. 35/37 and performance bias 13/22 vs. 14/48 also favoured the commercial trials. Commercial trials also had higher recorded attrition rates (median 6% vs. 1%, P = 0.007), but this difference was entirely caused by more non‐commercial trials reporting a zero attrition rate.

Discussion  The apparently lower attrition rate in the non‐commercial trials should be interpreted with caution. Zero attrition in clinical trials with follow‐up of many months is somewhat implausible.

Main conclusion  Commercially funded randomized trials tend to be of higher methodological quality than government‐funded ones.
The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care
Authors: Carlfjord S. , Andersson A. , Nilsen P. , Bendtsen P. , Lindberg M.
Published: August 2010

Rationale, aims and objectives The transmission of research findings into routine care is a slow and unpredictable process. Important factors predicting receptivity for innovations within organizations have been identified, but there is a need for further research in this area. The aim of this study was to describe contextual factors and evaluate if organizational climate and implementation strategy influenced outcome, when a computer‐based concept for lifestyle intervention was introduced in primary health care (PHC).

Method The study was conducted using a prospective intervention design. The computer‐based concept was implemented at six PHC units. Contextual factors in terms of size, leadership, organizational climate and political environment at the units included in the study were assessed before implementation. Organizational climate was measured using the Creative Climate Questionnaire (CCQ). Two different implementation strategies were used: one explicit strategy, based on Rogers’ theories about the innovation‐decision process, and one implicit strategy. After 6 months, implementation outcome in terms of the proportion of patients who had been referred to the test, was measured.

Results The CCQ questionnaire response rates among staff ranged from 67% to 91% at the six units. Organizational climate differed substantially between the units. Managers scored higher on CCQ than staff at the same unit. A combination of high CCQ scores and explicit implementation strategy was associated with a positive implementation outcome.

Conclusions Organizational climate varies substantially between different PHC units. High CCQ scores in combination with an explicit implementation strategy predict a positive implementation outcome when a new working tool is introduced in PHC.
Relationship between pre‐discharge occupational therapy home assessment and prevalence of post‐discharge falls
Authors: Johnston Kylie , Barras Sarah , Grimmer‐Somers Karen
Published: August 2010

Rationale, aims and objective Pre‐discharge occupational therapy home assessments are common practice, and considered important for falls prevention in older people. This prospective, observational cohort study describes the association between pre‐discharge home assessment and falls in the first month post‐discharge from a rehabilitation hospital.

Methods 342 inpatients were recruited and followed up 1 month post‐discharge. Patients were classified into diagnostic groups (cardiac, orthopaedic trauma, spinal, peripheral joint surgery, neurological and deconditioned). Age, gender, falls risk [Falls Risk Assessment Scoring System (FRASS)], functional independence scores (FIM™) and receipt (or not) of a home assessment were recorded. Patients completed a diary to document post‐discharge falls. Logistic regression analysis tested the effect on falling of receiving a home assessment, age, gender, diagnostic group, FRASS and FIM™.

Results Considering all subjects, not receiving a home assessment increased the risk of falling 1 month post‐discharge [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.4–4.7,P = 0.003]. Neurological and orthopaedic trauma patients had significantly elevated risks of falling [OR (95% CI), respectively, 12.5 (4.7–33.2), 3.4 (1.4–8.4)] relative to the orthopaedic joint group. For all diagnostic groups except neurological, falls risk was mitigated by a home assessment. In non‐neurological patients, adjusting for the effect of diagnostic group, FRASS and FIM™ scores indicated a significant association between not receiving a home assessment and falling (OR 4.2, 95% CI 2.1–8.2,P < 0.001).

Conclusions Pre‐discharge occupational therapy home assessments are sound post‐discharge falls‐prevention strategies in non‐neurological patients. The decision to conduct a home assessment should consider diagnosis, falls risk and functional independence.
Analysis of dyadic data: a guideline applied to erectile dysfunction
Authors: Cappelleri Joseph C. , Stecher Vera J.
Published: August 2010

Rationale  Research on relationships often does not refer to a single person but rather to two persons. Nonetheless, such data has been often analysed by examining individuals in isolation, which falls short of capturing their truly interpersonal and non‐independent nature.

Aims and objectives  This paper highlights and illustrates some analytic tools for such dyadic data that are essential for theories about dyadic relationships to be tested adequately.

Methods  The methodology is applied to clinical trial data from male patients treated for their erectile dysfunction and data from their partners with respect to treatment satisfaction. Multi‐level modelling was used to analyse the data.

Results  The approaches outlined allow researchers to assess both individual effects and companion effects (e.g. of baseline intercourse satisfaction on subsequent treatment satisfaction), role of participant (e.g. patient or partner) or treatment condition (e.g. test or placebo) on outcome (e.g. treatment satisfaction), and differences on individual and companion effects when couples differ on important variables (e.g. differences on the individual and companion effects of baseline intercourse satisfaction on treatment satisfaction when couples differ with respect to treatment condition).

Conclusion  Researchers are encouraged to consider implementing dyadic data analysis in their own work.
Optimal two‐stage breast cancer screening for countries with intermediate or low incidence of breast cancer
Authors: Kuo Shou‐Jen , Chen Tony Hsiu‐Hsi , Yen Amy Ming‐Fang , Chen Dar‐Ren , Chen Li‐Sheng
Published: August 2010

Objectives  This study is to identify an optimal cut‐off for two‐stage breast cancer screening making allowance for variation of the baseline incidence rate and utility values between sensitivity and specificity.

Methods  We used data from a two‐stage breast cancer screening of Taiwanese women aged 50–69 years for whom risk stratification was based on a composite risk score (conventional risk factors); subjects with a risk score greater than the cut‐off score were screened using mammography. The Bayesian posterior risk for breast cancer was computed by incorporation of the baseline incidence rate and the risk score. Bayes' maximum utility decision rule was then developed to determine the optimal screening cut‐off.

Results  With a risk score of −9 applied to the current two‐stage breast cancer screening programme, we could detect one breast cancer case for every 1406 women. Given different predetermined risks, the selected cut‐offs were −9 for 1:1200, −8 for 1:800, −4 for 1:600, −1 for 1:400 and 3 for 1:200 for women aged 50–59 years. When the regret utility ratio of positive predictive value to negative predictive value was set at 1:10, the specificity and sensitivity were 58.5% and 70.4%, respectively, and the optimal cut‐off was −5.5. When the ratio was set at 10:1, the sensitivity and specificity were 75.5% and 57.1%, respectively, and the optimal cut‐off value was −7.5.

Conclusions  This study demonstrates that Bayes' maximum utility decision rule can be used to determine optimal cut‐off values for two‐stage breast cancer screening in countries or areas with lower or intermediate incidence of breast cancer.
Effect of feedback in promoting adherence to an exercise programme: a randomized controlled trial
Authors: Shakudo Masaaki , Takegami Misa , Shibata Ai , Kuzumaki Miki , Higashi Takahiro , Hayashino Yasuaki , Suzukamo Yoshimi , Morita Satoshi , Katsuki Michio , Fukuhara Shunichi
Published: August 2010

Objective  We investigated whether providing participants in an exercise programme with regular feedback on their exercise progress affected their adherence to the programme regimen.

Method  We conducted a randomized controlled trial. Adult men and women with borderline hypertension and a body mass index ≥ 25.0 were randomized to two intervention groups (groups A and B) and one control group (group C) and were prescribed regular aerobic exercise. During the 12‐week study period, group A was provided with both feedback information on their exercise progress and a health letter, while group B was provided with the health letter only. The main outcome measure was exercise performance, per cent achievement of target exercise level (%) defined as the number of weeks during which the exercise target was reached divided by the number of weeks in the programme. Results were compared using the Kruskal–Wallis test.

Results  A total of 105 study subjects were randomized into three groups (A, n = 37; B, n = 37 and C, n = 31). Per cent achievement of target exercise level during the 12‐week period was highest in group A (26.5%), followed by groups B (22.9%) and C (17.4%) (P = 0.36). Subjects who received regular feedback during the exercise programme tended to have higher exercise performance.

Conclusions  In improving adherence to exercise intervention, the provision of regular feedback to participants in an exercise programme may be an effective intervention.
Initiation of antipsychotic treatment by general practitioners. A case–control study
Authors: Boonstra Geartsje , Grobbee Diederick E. , Hak Eelko , Kahn René S. , Burger Huibert
Published: August 2010

Rationale, aims and objectives  Antipsychotics are approved treatment for severe conditions and have serious side effects. Antipsychotics are often prescribed off‐label. Although a substantial proportion of antipsychotics are prescribed in primary care, it is largely unknown what motivates the general practitioner (GP) to initiate antipsychotic treatment. Therefore, we sought to examine the relation between pre‐defined, licensed as well as off‐label, reasons for antipsychotic treatment and the initiation of this treatment by the GP as well as report registration and incidence of antipsychotic treatment in general practice.

Methods  In a case–control study, 723 patients selected from an electronic database and with a new antipsychotic prescription were compared with 3615 controls receiving any other new prescription. Using logistic regression, six pre‐defined categories of International Classification of Primary Care (ICPC) codes (‘psychosis’, ‘depression and anxiety’, ‘sleeping disorders’, ‘acute stress and surmenage’, ‘dementia’ and ‘somatic indications’) were associated with initiating antipsychotic treatment.

Results  All, including off‐label, categories were significantly related to initiating antipsychotic treatment. The incidence of initiating antipsychotic therapy was 1.28 per 1000 persons per year (95% confidence interval: 1.09, 1.48). GPs registered an ICPC code in 50% and prescribed typical antipsychotics in 90% of the cases. Prescription of atypical antipsychotics increased almost threefold over the study period.

Conclusions  The results suggest that GPs prescribe antipsychotics off‐label. Despite serious side effects and relatively infrequent occurrence in Dutch general practices, GPs seem imprecise in underpinning and registrating the initiation of antipsychotic treatment. GPs increasingly prescribe atypical antipsychotics although the prescription of typical antipsychotics still dominates.
Roles of managers, frontline staff and local champions, in implementing quality improvement: stakeholders' perspectives
Authors: Kirchner JoAnn E. , Parker Louise E. , Bonner Laura M. , Fickel Jacqueline J. , Yano Elizabeth M. , Ritchie Mona J.
Published: August 2010

Background  Translating promising research findings into routine clinical care has proven difficult to achieve; even highly efficacious programmes remain unadopted. Critical to changing care is an understanding of the context within which the improvement effort occurs, including the climate or culture. Health care systems are multicultural due to the wide variety of professionals, subgroups, divisions and teams within them. Yet, little work describes and compares different stakeholders' views on their and others' roles in promoting successful quality improvement implementation.

Objective  To identify manager and frontline staff perspectives about which organizational stakeholders should play a role in implementation efforts as well as what implementation roles these stakeholders should perform.

Methods  We conducted qualitative semi‐structured interviews of a purposive sample of stakeholders at the clinic, medical centre and regional network levels. Participants included stakeholders across five clinics (n = 49), their four affiliated medical centres (n = 12) and three regional networks (n = 7). Working in coding teams, we conducted a content analysis utilizing Atlas.ti Version 5.

Results  According to informants, individuals at each organizational level have unique and critical roles to play in implementing and sustaining quality improvement efforts. Informants advocated for participation of a wide range of organizational members, described distinct roles for each group, and articulated the need for and defined the characteristics of frontline programme champions.

Conclusions  Involvement of multiple types of stakeholders is likely to be costly for health care organizations. Yet, if such organizations are to achieve the highest quality care, it is also likely that such involvement is essential.
Reasons for non‐use of proven pharmacotherapeutic interventions: systematic review and framework development
Authors: Barry Arden R. , Loewen Peter S. , de Lemos Jane , Lee Karen G.
Published: August 2010

Rationale, aims and objectives  The quality of patient care and safety is dependent on addressing both errors of commission (e.g. overuse of medications) and errors of omission (e.g. patients receiving too little care). Despite guidelines recommending the use of certain proven pharmacotherapeutic interventions, a large gap exists between the patients that have an indication for, and those that actually receive such interventions. To address how the rate of implementation of proven interventions can be improved is dependent on a comprehensive knowledge of the factors contributing to their underuse. The aim of the review is to create an evidence‐based framework of reasons why eligible patients do not receive proven pharmacotherapeutic interventions.

Methods  A systemic review of the published reasons for non‐use based on the Cochrane methodology.

Results  The systematic review identified 67 articles meeting the inclusion criteria. The reasons for non‐use were extracted from the studies and a framework was created from the results.

Conclusions  The factors associated with lack of implementation of proven pharmacotherapeutic interventions are complex and heterogeneous but can be understood from the perspectives of clinicians, patients and health care delivery systems. Efforts to increase the utilization of proven interventions should focus on disease/intervention‐specific programmes that take into account the identified modifiable clinician, patient and system factors.
Application of a sensitive, specific and controlled real‐time PCR assay to surveillance indicates a low prevalence of viral haemorrhagic septicaemia virus (VHSV) in wild herring, Clupea harengus L., in Scottish waters
Authors: Matejusova I , McKay P , Bland F , Snow M
Published: August 2010

Surveillance data on the distribution of viral haemorrhagic septicaemia virus (VHSV) in the North Sea (UK), targeting Atlantic herring in areas with previous virus detection, were obtained from research cruises conducted during 2005. The sensitive molecular approach of real‐time RT‐PCR (qRT‐PCR) was applied alongside a newly developed endogenous positive control assay specific for herring (elongation factor 1α) to ensure integrity of template. Three hundred and five pools from 1937 individual herring were tested, and no evidence of VHSV in association with wild Atlantic herring was detected. Samples were obtained from Scottish waters where marine aquaculture is conducted. The results confirm that previous tissue culture studies have most likely not significantly underestimated the prevalence of carrier herring in this area. The significance of migratory species such as herring as a reservoir species for VHSV, with the potential to translocate virus genotypes between geographical areas, is discussed.
Apolipoprotein B, non‐HDL cholesterol and LDL cholesterol for identifying individuals at increased cardiovascular risk
Authors: Holewijn S. , Den Heijer M. , Swinkels D. W. , H Stalenhoef A. F. , De Graaf J.
Published: August 2010

Abstract.  Holewijn S, den Heijer M, Swinkels DW, Stalenhoef AFH, de Graaf J. (Address: Division of Vascular Medicine, Department of General Internal Medicine; Department of Epidemiology and Biostatistics; Department of Endocrinology; and Department of Laboratory Medicine; Laboratory of Clinical Chemistry, all at the Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands) Apolipoprotein B, non‐HDL cholesterol and LDL cholesterol for identifying individuals at increased cardiovascular risk. J Intern Med 2010; 268: 567–577.

Background.  To compare apolipoprotein B (apoB), nonhigh‐density lipoprotein‐cholesterol (non‐HDL‐c) and low‐density lipoprotein‐cholesterol (LDL‐c) for identifying individuals with a deteriorated cardiovascular (CV) risk profile, including a panel of subclinical atherosclerosis measurements and prevalent cardiovascular disease (CVD) in a Dutch population‐based cohort.

Methods.  Clinical and biochemical measurements and a panel of noninvasive parameters of subclinical atherosclerosis were determined in 1517 individuals, aged 50–70 years.

Results.  Both men and women with increasing levels of apoB and non‐HDL‐c were more obese, had higher blood pressure and fasting glucose levels, and a more atherogenic lipid profile. Furthermore, compared to the reference group (composed of those with apoB, non‐HDL‐c and LDL‐c levels in the bottom quartiles), participants with high apoB and high non‐HDL‐c levels had a lower ankle–brachial index at rest (−3.5% and −3.1%, respectively) and after exercise (−6.3% and −4.7%, respectively), a thicker near wall (+4.8% and +4.2%, respectively), far wall (both +6.2%), and mean intima–media thickness (+5.7% and +5.3%, respectively) and more plaques (+54.2% and +54.3%, respectively). In addition, they also showed increased stiffness parameters (e.g. pulse wave velocity both +3.6%). Less clear differences in CV risk profile and subclinical atherosclerosis parameters were observed when participants were stratified by LDL‐c level. Furthermore, apoB but not LDL‐c detected prevalent CVD, and non‐HDL‐c only detected prevalent CVD in men. The discriminatory power for prevalent CVD expressed as area under the receiver operating characteristic curve was 0.60 (P < 0.001) for apoB, 0.57 (P = 0.001) for non‐HDL‐c and 0.54 (P = 0.108) for LDL‐c.

Conclusion.  Our data support the use of first apoB and secondly non‐HDL‐c above LDL‐c for identifying individuals from the general population with a compromised CV phenotype.
Obesity, smoking and secular trends in cardiovascular risk factors in middle‐aged women: data from population studies in Göteborg from 1980 to 2003
Authors: Johansson S. , Wilhelmsen L. , Welin C. , Eriksson H. , Welin L. , Rosengren A.
Published: August 2010

Abstract.  Johansson S, Wilhelmsen L, Welin C, Eriksson H, Welin L, Rosengren A. (Sahlgrenska University Hospital/Östra, Göteborg; AstraZeneca R&D, Mölndal; and Lidköping Hospital, Lidköping, Sweden) Obesity, smoking and secular trends in cardiovascular risk factors in middle‐aged women: data from population studies in Göteborg from 1980 to 2003. J Intern Med 2010; 268: 594–603.

Background.  To study the trends in cardiovascular risk factors in middle‐aged city‐dwelling Swedish women from 1980 to 2003.

Methods.  Using cross‐sectional population‐based surveys, five random population samples of a total of 1915 women aged between 45 and 54 years, participating in the BEDA study in 1980, WHO MONICA studies in 1985, 1990 and 1995, and a study of 50‐year‐old women in 2003 were measured for the following parameters: anthropometry, serum cholesterol and triglyceride levels, smoking habits, blood pressure, physical activity and stress.

Results.  Over almost 25 years, middle‐aged women gained on average 4.4 kg in weight, with a net increase in body mass index (BMI) from 24.7 to 25.6 kg m−2. The proportion of participants classified as obese (≥30 kg m−2) increased by 50% from 10.4% to 15.1%. Women who were smokers in 2003 did not have lower BMI values than nonsmokers. Mean serum cholesterol concentrations decreased markedly, whereas smoking habits did not significantly change. The prevalence of hypertension decreased by 8%, whereas that of diabetes remained stable at around 2%. Optimal risk factor status – no smoking, normotension and serum cholesterol <5 mmol l−1– was present in less than one in six women in 2003, and similar across BMI categories.

Conclusion.  The favourable decline in cholesterol levels and hypertension and the increase in leisure time physical activity were offset by an increase in obesity, triglyceride levels and experience of stress, with only a minority of participants (less than one in six) having an optimal level of risk factors with respect to smoking, serum cholesterol and hypertension in 2003. This applied also to overweight and obese women. In earlier cohorts, subjects with low BMI values were more often smokers, whereas the opposite is observed in recent cohorts. Thus, women who smoke no longer have the advantage of lower weight.
Diverse associations of 25‐hydroxyvitamin D and 1,25‐dihydroxy‐vitamin D with dyslipidaemias
Authors: Karhapää P. , Pihlajamäki J. , Pörsti I. , Kastarinen M. , Mustonen J. , Niemelä O. , Kuusisto J.
Published: August 2010

Abstract.  Karhapää P, Pihlajamäki J, Pörsti I, Kastarinen M, Mustonen J, Niemelä O, Kuusisto J (University of Eastern Finland, Kuopio; University of Tampere, Tampere; and Laboratory and Medical Research Unit, University of Tampere, Tampere; Finland). Diverse associations of 25‐hydroxyvitamin D and 1,25‐dihydroxyvitamin D with dyslipidaemias. J Intern Med 2010; 268: 604–610.

Background and Aim.  Previous studies have suggested a link between circulating levels of 25‐hydroxyvitamin D (25‐D) and dyslipidaemias. However, it is not known whether 25‐D and the active hormone 1,25‐dihydroxyvitamin D (1,25‐D) have similar associations with dyslipidaemias. Therefore, we studied the associations between both 25‐D and 1,25‐D and total cholesterol (total‐C), low‐density lipoprotein cholesterol (LDL‐C), high‐density lipoprotein cholesterol (HDL‐C) and triglycerides in a population‐based study.

Design.  Cross‐sectional population‐based study.

Setting.  Kuopio, Eastern Finland.

Subjects.  A total of 909 men, aged from 45 to 70 years, who were not receiving antidiabetic medication were enrolled.

Main Outcome Measures.  Fasting serum samples were obtained for measurement of 25‐D, 1,25‐D and lipid levels. An oral glucose tolerance test was performed, and insulin sensitivity was evaluated using the Matsuda insulin sensitivity index (Matsuda ISI).

Results.  We found a significant inverse association between 25‐D and total‐C, LDL‐C and triglycerides (β = −0.15, −0.13 and −0.17, respectively, P < 0.001), but no association between 25‐D and HDL‐C was observed. By contrast, 1,25‐D was associated with HDL‐C (β = 0.18, P < 0.001), whereas no relationship was found between 1,25‐D and LDL‐C or triglycerides. The associations remained significant after the exclusion of subjects receiving statin treatment and after adjustment for age, waist circumference, body mass index, alcohol consumption, smoking, renal function, glucose tolerance and Matsuda ISI.

Conclusion.  Low levels of active vitamin D (1,25‐D) are associated with low HDL‐C levels, whereas low levels of the storage form 25‐D are associated with high levels of total‐C, LDL‐C and triglycerides. Our findings may provide new insights into the understanding of the link between vitamin D deficiency and cardiovascular disease.
The use of laser scanning confocal microscopy (LSCM) in materials science
Authors: HOVIS D.B. , HEUER A.H.
Published: August 2010

Laser scanning confocal microscopes are essential and ubiquitous tools in the biological, biochemical and biomedical sciences, and play a similar role to scanning electron microscopes in materials science. However, modern laser scanning confocal microscopes have a number of advantages for the study of materials, in addition to their obvious uses for high resolution reflected and transmitted light optical microscopy. In this paper, we provide several examples that exploit the laser scanning confocal microscope's capabilities of pseudo‐infinite depth of field imaging, topographic imaging, photo‐stimulated luminescence imaging and Raman spectroscopic imaging.
Investigating Heterogeneity of Intracellular Calcium Dynamics in Anterior Pituitary Lactotrophs Using a Combined Modelling/Experimental Approach
Authors: Tomaiuolo M. , Bertram R. , Gonzalez‐Iglesias A. E. , Tabak J.
Published: August 2010

Cell responses are commonly heterogeneous, even within a subpopulation. In the present study, we investigate the source of heterogeneity in the Ca2+ response of anterior pituitary lactotrophs to a Ca2+ mobilisation agonist, thyrotrophin‐releasing hormone. This response is characterised by a sharp increase of cytosolic Ca2+ concentration as a result of mobilisation of Ca2+ from intracellular stores, followed by a decrease to an elevated plateau level that results from Ca2+ influx. We focus on heterogeneity of the evoked Ca2+ spike under extracellular Ca2+ free conditions. We introduce a method that uses the information provided by a mathematical model to characterise the source of heterogeneity. This method compares scatter plots of features of the Ca2+ response obtained experimentally with those made from the mathematical model. The model scatter plots reflect random variation of parameters over different ranges, and matching the experimental and model scatter plots allows us to predict which parameters are most variable. We find that a large degree of variation in Ca2+ efflux is a likely key contributor to the heterogeneity of Ca2+ responses to thyrotrophin‐releasing hormone in lactotrophs. This technique is applicable to any situation in which the heterogeneous biological response is described by a mathematical model.