Pharmacist intervention in primary care to improve outcomes in patients with left ventricular systolic dysfunction

<b>Background</b> Meta-analysis of small trials suggests that pharmacist-led collaborative review and revision of medical treatment may improve outcomes in heart failure.<p></p> <b>Methods and results</b> We studied patients with left ventricular systolic dysfunction in a cluster-randomized controlled, event driven, trial in primary care. We allocated 87 practices (1090 patients) to pharmacist intervention and 87 practices (1074 patients) to usual care. The intervention was delivered by non-specialist pharmacists working with family doctors to optimize medical treatment. The primary outcome was a composite of death or hospital admission for worsening heart failure. This trial is registered, number ISRCTN70118765. The median follow-up was 4.7 years. At baseline, 86% of patients in both groups were treated with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. In patients not receiving one or other of these medications, or receiving less than the recommended dose, treatment was started, or the dose increased, in 33.1% of patients in the intervention group and in 18.5% of the usual care group [odds ratio (OR) 2.26, 95% CI 1.64–3.10; P< 0.001]. At baseline, 62% of each group were treated with a β-blocker and the proportions starting or having an increase in the dose were 17.9% in the intervention group and 11.1% in the usual care group (OR 1.76, 95% CI 1.31–2.35; P< 0.001). The primary outcome occurred in 35.8% of patients in the intervention group and 35.4% in the usual care group (hazard ratio 0.97, 95% CI 0.83–1.14; P = 0.72). There was no difference in any secondary outcome.<p></p> <b>Conclusion</b> A low-intensity, pharmacist-led collaborative intervention in primary care resulted in modest improvements in prescribing of disease-modifying medications but did not improve clinical outcomes in a population that was relatively well treated at baseline

Isospin Splitting in the Baryon Octet and Decuplet

Baryon mass splittings are analyzed in terms of a simple model with general pairwise interactions. At present, the $\Delta$ masses are poorly known from experiments. Improvement of these data would provide an opportunity to make a significant test of our understanding of electromagnetic and quark-mass contributions to hadronic masses. The problem of determining resonance masses from scattering and production data is discussed.Comment: 9 pages, LATEX inc. 2 LATEX "pictures", CMU-HEP91-24-R9

The political context of AIDS-related stigma and knowledge in a South African township

The purpose of this study was to examine the presentation of AIDS-related stigma and knowledge within the political context of the South African government\'s response to the AIDS epidemic. It was during the 2000 - 2004 period that key government officials publicly challenged the orthodox views of HIV/AIDS, with the South African president, Thabo Mbeki, actively positing the primary role of poverty and other socio-economic stressors in the progression of the AIDS epidemic. This discursive position had real-time effects for AIDS policy-making and ultimately delayed the implementation of a national antiretroviral (ARV) rollout programme. Consequently this position was criticised by commentators in the media and elsewhere for contributing to an already widespread climate of AIDS stigmatisation and misinformation. To shed more light on these claims we conducted a survey in 2005 in Atteridgeville, a South African township, and compared results with those of a similar survey conducted shortly after ARV medications became available in 2004. Results indicated a reduction in AIDS stigma levels across the 1-year period, and that those participants who endorsed contentious political views (such as those expressed by key government officials) were more likely to have a higher level of AIDS-related stigma than those who disagreed. Nevertheless, this study cautions against drawing a causal relationship between the South African government\'s position and AIDS-stigmatising attitudes, and suggests that further political and social factors be accounted for in an attempt to gain a fuller understanding of this seemingly complex relationship. Keywords: HIV/AIDS, AIDS-related stigma, South African government, AIDS debate, antiretroviral rollout, Atteridgeville.SAHARA J Vol. 5 (2) 2008: pp. 74-8

Open solar flux estimates from near-Earth measurements of the interplanetary magnetic field: comparison of the first two perihelion passes of the Ulysses spacecraft

Results from all phases of the orbits of the Ulysses spacecraft have shown that the magnitude of the radial component of the heliospheric field is approximately independent of heliographic latitude. This result allows the use of near- Earth observations to compute the total open flux of the Sun. For example, using satellite observations of the interplanetary magnetic field, the average open solar flux was shown to have risen by 29% between 1963 and 1987 and using the aa geomagnetic index it was found to have doubled during the 20th century. It is therefore important to assess fully the accuracy of the result and to check that it applies to all phases of the solar cycle. The first perihelion pass of the Ulysses spacecraft was close to sunspot minimum, and recent data from the second perihelion pass show that the result also holds at solar maximum. The high level of correlation between the open flux derived from the various methods strongly supports the Ulysses discovery that the radial field component is independent of latitude. We show here that the errors introduced into open solar flux estimates by assuming that the heliospheric field’s radial component is independent of latitude are similar for the two passes and are of order 25% for daily values, falling to 5% for averaging timescales of 27 days or greater. We compare here the results of four methods for estimating the open solar flux with results from the first and second perehelion passes by Ulysses. We find that the errors are lowest (1–5% for averages over the entire perehelion passes lasting near 320 days), for near-Earth methods, based on either interplanetary magnetic field observations or the aa geomagnetic activity index. The corresponding errors for the Solanki et al. (2000) model are of the order of 9–15% and for the PFSS method, based on solar magnetograms, are of the order of 13–47%. The model of Solanki et al. is based on the continuity equation of open flux, and uses the sunspot number to quantify the rate of open flux emergence. It predicts that the average open solar flux has been decreasing since 1987, as Correspondence to: M. Lockwood ([email protected]) is observed in the variation of all the estimates of the open flux. This decline combines with the solar cycle variation to produce an open flux during the second (sunspot maximum) perihelion pass of Ulysses which is only slightly larger than that during the first (sunspot minimum) perihelion pass

The complex multiferroic phase diagram of Mn1−x_{1-x}Cox_xWO4_4

The complete magnetic and multiferroic phase diagram of Mn$_{1-x}$Co$_{x}$WO$_4$ single crystals is investigated by means of magnetic, heat capacity, and polarization experiments. We show that the ferroelectric polarization $\overrightarrow{P}$ in the multiferroic state abruptly changes its direction twice upon increasing Co content, x. At x$_{c1}$=0.075, $\overrightarrow{P}$ rotates from the $b-$axis into the $a-c$ plane and at x$_{c2}$=0.15 it flips back to the $b-$axis. The origin of the multiple polarization flops is identified as an effect of the Co anisotropy on the orientation and shape of the spin helix leading to thermodynamic instabilities caused by the decrease of the magnitude of the polarization in the corresponding phases. A qualitative description of the ferroelectric polarization is derived by taking into account the intrachain ($c-$axis) as well as the interchain ($a-$axis) exchange pathways connecting the magnetic ions. In a narrow Co concentration range (0.1$\leq$x$\leq$0.15), an intermediate phase, sandwiched between the collinear high-temperature and the helical low-temperature phases, is discovered. The new phase exhibits a collinear and commensurate spin modulation similar to the low-temperature magnetic structure of MnWO$_4$.Comment: 18 pages, 6 figure

The effect of (Ti + Al): V ratio on the structure and oxidation behaviour of TiAlN/VN nano-scale multilayer coatings

Nano-scaled multilayered TiAlN/VN coatings have been grown on stainless steel and M2 high speed steel substrates at U-B = - 85 V in an industrial, four target, Hauzer HTC 1000 coater using combined cathodic steered arc etching/unbalanced magnetron sputtering. X-ray diffraction (XRD) has been used to investigate the effects of process parameters (Target Power) on texture evolution (using texture parameter T*), development of residual stress (sin(2) psi method) and nano-scale multilayer period. The composition of the coating was determined using energy dispersive X-ray analysis. The thermal behaviour of the coatings in air was studied using thermo-gravimetric analysis, XRD and scanning electron microscopy. The bi-layer period varied between 2.8 and 3.1 nm and in all cases a {1 1 0} texture developed with a maximum value T* = 4.9. The residual stress varied between -5.2 and -7.4 GPa. The onset of rapid oxidation occurred between 628 and 645 degreesC depending on the (Ti+Al):V ratio. After oxidation in air at 550 degreesC AlVO4, TiO2 and V2O5 Phases were identified by XRD with the AlVO4, TiO2 being the major phases. The formation of AlVO4 appears to disrupt the formation of Al2O3 which imparts oxidation resistance to TiAlN based coatings. Increasing the temperature to 600 and 640 degreesC led to a dramatic increase in the formation of V2O5 which was highly oriented (0 0 1) with a plate-like morphology. At 640 degreesC there was no evidence of the coating on XRD. Increasing the temperature to 670 degreesC led to further formation of AlVO4 and a dramatic reduction in V2O5. (C) 2003 Elsevier B.V. All rights reserved