Who wants to join preventive trials? – Experience from the Estonian Postmenopausal Hormone Therapy Trial [ISRCTN35338757]

BACKGROUND: The interest of patients in participating in randomized clinical trials involving treatments has been widely studied, but there has been much less research on interest in preventive trials. The objective of this study was to find out how many women would be interested in a trial involving postmenopausal hormone therapy (PHT) and how the women's background characteristics and opinions correlated to their interest. METHODS: The data come from recruitment questionnaires (n = 2000) sent to women in Estonia in 1998. A random sample of women aged 45 to 64 was drawn from the Population Registry. The trial is a two-group randomized trial comparing estrogen-progestogen therapy with placebo or no drugs. A brief description of the study was attached to the questionnaires. Women were not told at this stage of the recruitment which group they would be assigned to, however, they were told of the chance to receive either hormone, placebo or no treatment. RESULTS: After two reminders, 1312 women (66%) responded. Eleven percent of the women approached (17% of the respondents) were interested in joining the trial, and 8% wanted more information before deciding. When the 225 women who stated clearly that they were interested in joining and the 553 women who said they were not interested were compared, it was found that interested women were younger and, adjusting for age, that more had given birth; in other respects, the sociodemographic characteristics and health habits of the interested women were similar to those of the non-interested women. The interested women had made more use of more health services, calcium preparations and PHT, they were more often overweight, and more had chronic diseases and reported symptoms. Interested women's opinions on the menopause were more negative, and they favoured PHT more than the non-interested women. CONCLUSION: Unlike the situation described in previous reports on preventive trials, in this case Estonian women interested in participating in a PHT trial were not healthier than other women. This suggests that trials involving PHT are more similar to treatment trials than to preventive trials. In a randomized controlled trial, more information should be obtained from those women who decline to participate

Comparative Assessment of Status and Opportunities for Carbon Dioxide Capture and Storage and Radioactive Waste Disposal in North America

Aside from the target storage regions being underground, geologic carbon sequestration (GCS) and radioactive waste disposal (RWD) share little in common in North America. The large volume of carbon dioxide (CO{sub 2}) needed to be sequestered along with its relatively benign health effects present a sharp contrast to the limited volumes and hazardous nature of high-level radioactive waste (RW). There is well-documented capacity in North America for 100 years or more of sequestration of CO{sub 2} from coal-fired power plants. Aside from economics, the challenges of GCS include lack of fully established legal and regulatory framework for ownership of injected CO{sub 2}, the need for an expanded pipeline infrastructure, and public acceptance of the technology. As for RW, the USA had proposed the unsaturated tuffs of Yucca Mountain, Nevada, as the region's first high-level RWD site before removing it from consideration in early 2009. The Canadian RW program is currently evolving with options that range from geologic disposal to both decentralized and centralized permanent storage in surface facilities. Both the USA and Canada have established legal and regulatory frameworks for RWD. The most challenging technical issue for RWD is the need to predict repository performance on extremely long time scales (10{sup 4}-10{sup 6} years). While attitudes toward nuclear power are rapidly changing as fossil-fuel costs soar and changes in climate occur, public perception remains the most serious challenge to opening RW repositories. Because of the many significant differences between RWD and GCS, there is little that can be shared between them from regulatory, legal, transportation, or economic perspectives. As for public perception, there is currently an opportunity to engage the public on the benefits and risks of both GCS and RWD as they learn more about the urgent energy-climate crisis created by greenhouse gas emissions from current fossil-fuel combustion practices

Estimates of CO2 from fires in the United States: implications for carbon management

<p>Abstract</p> <p>Background</p> <p>Fires emit significant amounts of CO₂to the atmosphere. These emissions, however, are highly variable in both space and time. Additionally, CO₂emissions estimates from fires are very uncertain. The combination of high spatial and temporal variability and substantial uncertainty associated with fire CO₂emissions can be problematic to efforts to develop remote sensing, monitoring, and inverse modeling techniques to quantify carbon fluxes at the continental scale. Policy and carbon management decisions based on atmospheric sampling/modeling techniques must account for the impact of fire CO₂emissions; a task that may prove very difficult for the foreseeable future. This paper addresses the variability of CO₂emissions from fires across the US, how these emissions compare to anthropogenic emissions of CO₂and Net Primary Productivity, and the potential implications for monitoring programs and policy development.</p> <p>Results</p> <p>Average annual CO₂emissions from fires in the lower 48 (LOWER48) states from 2002–2006 are estimated to be 213 (± 50 std. dev.) Tg CO₂yr^-1and 80 (± 89 std. dev.) Tg CO₂yr^-1in Alaska. These estimates have significant interannual and spatial variability. Needleleaf forests in the Southeastern US and the Western US are the dominant source regions for US fire CO₂emissions. Very high emission years typically coincide with droughts, and climatic variability is a major driver of the high interannual and spatial variation in fire emissions. The amount of CO₂emitted from fires in the US is equivalent to 4–6% of anthropogenic emissions at the continental scale and, at the state-level, fire emissions of CO₂can, in some cases, exceed annual emissions of CO₂from fossil fuel usage.</p> <p>Conclusion</p> <p>The CO₂released from fires, overall, is a small fraction of the estimated average annual Net Primary Productivity and, unlike fossil fuel CO₂emissions, the pulsed emissions of CO₂during fires are partially counterbalanced by uptake of CO₂by regrowing vegetation in the decades following fire. Changes in fire severity and frequency can, however, lead to net changes in atmospheric CO₂and the short-term impacts of fire emissions on monitoring, modeling, and carbon management policy are substantial.</p

Functional identity versus species richness: herbivory resistance in plant communities

The resistance of a plant community against herbivore attack may depend on plant species richness, with monocultures often much more severely affected than mixtures of plant species. Here, we used a plant–herbivore system to study the effects of selective herbivory on consumption resistance and recovery after herbivory in 81 experimental grassland plots. Communities were established from seed in 2002 and contained 1, 2, 4, 8, 16 or 60 plant species of 1, 2, 3 or 4 functional groups. In 2004, pairs of enclosure cages (1 m tall, 0.5 m diameter) were set up on all 81 plots. One randomly selected cage of each pair was stocked with 10 male and 10 female nymphs of the meadow grasshopper, Chorthippus parallelus. The grasshoppers fed for 2 months, and the vegetation was monitored over 1 year. Consumption resistance and recovery of vegetation were calculated as proportional changes in vegetation biomass. Overall, grasshopper herbivory averaged 6.8%. Herbivory resistance and recovery were influenced by plant functional group identity, but independent of plant species richness and number of functional groups. However, herbivory induced shifts in vegetation composition that depended on plant species richness. Grasshopper herbivory led to increases in herb cover at the expense of grasses. Herb cover increased more strongly in species-rich mixtures. We conclude that selective herbivory changes the functional composition of plant communities and that compositional changes due to selective herbivory depend on plant species richness

Quality of care assessment in geriatric evaluation and management units: construction of a chart review tool for a tracer condition

<p>Abstract</p> <p>Background</p> <p>The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs).</p> <p>Methods</p> <p>The methodology involved a reliability and feasibility study of a retrospective chart review on 934 older inpatients admitted in 49 GEMUs during the year 2002–2003 for fall-related trauma as a tracer condition. Pertinent indicators for a chart abstraction tool, the Geriatric Care Tool (GCT), were developed and validated according to five dimensions: access to care, comprehensiveness, continuity of care, patient-centred care and appropriateness. Consensus methods were used to develop the content. Participants were experts representing eight main health care professions involved in GEMUs from 19 different sites. Items associated with high quality of care at each step of the multidisciplinary management of patients admitted due to falls were identified. The GCT was tested for intra- and inter-rater reliability using 30 medical charts reviewed by each of three independent and blinded trained nurses. Kappa and agreement measures between pairs of chart reviewers were computed on an item-by-item basis.</p> <p>Results</p> <p>Three quarters of 169 items identifying the process of care, from the case history to discharge planning, demonstrated good agreement (kappa greater than 0.40 and agreement over 70%). Indicators for the appropriateness of care showed less reliability.</p> <p>Conclusion</p> <p>Content validity and reliability results, as well as the feasibility of the process, suggest that the chart abstraction tool can gather standardized and pertinent clinical information for further evaluating quality of care in GEMU using admission due to falls as a tracer condition. However, the GCT should be evaluated in other models of acute geriatric units and new strategies should be developed to improve reliability of peer assessments in characterizing the quality of care for elderly patients with complex conditions.</p