Case-control study of stroke and the quality of hypertension control in north west England

Objective: To examine the risk of stroke in relation to quality of hypertension control in routine general practice across an entire health district. Design: Population based matched case-control study. Setting: East Lancashire Health District with a participating population of 388,821 aged < or = 80. Subjects: Cases were patients under 80 with their first stroke identified from a population based stroke register between 1 July 1994 and 30 June 1995. For each case two controls matched with the case for age and sex were selected from the same practice register. Hypertension was defined as systolic blood pressure > or = 160 mm Hg or diastolic blood pressure > or = 95 mm Hg, or both, on at least two occasions within any three month period or any history of treatment with antihypertensive drugs. Main outcome measures: Prevalence of hypertension and quality of control of hypertension assessed by using the mean blood pressure recorded before stroke) and odds ratios of stroke (derived from conditional logistic regression). Results: Records of 267 cases and 534 controls were examined; 61% and 42% of these subjects respectively were hypertensive. Compared with non-hypertensive subjects hypertensive patients receiving treatment whose average pre-event systolic blood pressure was controlled to or = 160 mm Hg) or untreated had progressively raised odds ratios of 1.6, 2.2, 3.2, and 3.5 respectively. Results for diastolic pressure were similar; both were independent of initial pressures before treatment. Around 21% of strokes were thus attributable to inadequate control with treatment, or 46 first events yearly per 100,000 population aged 40-79. Conclusions: Risk of stroke was clearly related to quality of control of blood pressure with treatment. In routine practice consistent control of blood pressure to below 150/90 mm Hg seems to be required for optimal stroke prevention

Acceptability of a technology-supported and solution-focused intervention (DIALOG+) for chronic depression: views of service users and clinicians.

BACKGROUND: Treating chronic depression represents a significant burden for the NHS, yet there is a lack of evidence-based interventions and research specifically focused on this condition. DIALOG+, a technology-assisted and resource-oriented intervention found effective for people with psychosis, may improve care for this service user group. The aim of this study was to explore the acceptability and relevance of DIALOG+ for the treatment of chronic depression in community-based settings. METHODS: A convenience sample of 16 mental health professionals and 29 service users with chronic depression tested the DIALOG+ intervention in routine community care appointments for 3 months across 3 different mental health NHS Trusts in England. Of these, 15 clinicians and 19 service users were individually interviewed about their experiences. Interview transcripts were analysed using thematic analysis by an analytic team which included a service user researcher. RESULTS: Analysis of the combined dataset identified five overarching themes: DIALOG+ Structure; Therapeutic Communication; Reflecting and Monitoring; Empowerment and Powerlessness; and The Impact of Technology. Overall, service users and clinicians were interested in the continued use of DIALOG+ as part of routine care. CONCLUSIONS: DIALOG+ was viewed as acceptable by both service users with chronic depression and their clinicians who work in community care settings, albeit with some caveats. Clinician training required significant improvements to address the issues that were referenced, most notably around support with using technology

Financial Doping in the English Premier League

Whilst the relationship between money and success in elite sport is acknowledged, the exact nature, extent and implications of this relationship is one that has not been carefully examined. In this paper we have three main aims. Firstly, to provide empirical evidence of the extent that money buys success in the English Premier League. Secondly, to evaluate this evidence from a sports ethics perspective, and, finally, to discuss potential solutions to the problem. We argue that the evident performance advantage teams gain through financial investments is contrary to the spirit of sport as it undermines athletic excellence and the ‘sweet tension of uncertainty of outcome’ that is central to good competition. Consequently, financial investments in elite football ought to be regulated and controlled. We argue, however, that current attempts to do so (via Financial Fair Play Regulations) are inadequate as they focus on issues concerning financial health, rather than the health of the game in terms of spirit and fairness

The Off Shell ρ\rho-ω\omega Mixing in the QCD Sum Rules

The $q^2$ dependence of the $\rho-\omega$ mixing amplitude is analyzed with the use of the QCD sum rules and the dispersion relation. Going off shell the mixing decreases, changes sign at $q^2 \simeq 0.4 m_{\rho}^2 > 0$ and is negative in the space like region. Implications of this result to the isospin breaking part of the nuclear force are discussed.Comment: 26 pages + 11 figures (PostScript

Levosimendan for the prevention of acute organ dysfunction in sepsis

BACKGROUND Levosimendan is a calcium-sensitizing drug with inotropic and other properties that may improve outcomes in patients with sepsis. METHODS We conducted a double-blind, randomized clinical trial to investigate whether levosimendan reduces the severity of organ dysfunction in adults with sepsis. Patients were randomly assigned to receive a blinded infusion of levosimendan (at a dose of 0.05 to 0.2 μg per kilogram of body weight per minute) for 24 hours or placebo in addition to standard care. The primary outcome was the mean daily Sequential Organ Failure Assessment (SOFA) score in the intensive care unit up to day 28 (scores for each of five systems range from 0 to 4, with higher scores indicating more severe dysfunction; maximum score, 20). Secondary outcomes included 28-day mortality, time to weaning from mechanical ventilation, and adverse events. RESULTS The trial recruited 516 patients; 259 were assigned to receive levosimendan and 257 to receive placebo. There was no significant difference in the mean (±SD) SOFA score between the levosimendan group and the placebo group (6.68±3.96 vs. 6.06±3.89; mean difference, 0.61; 95% confidence interval [CI], −0.07 to 1.29; P=0.053). Mortality at 28 days was 34.5% in the levosimendan group and 30.9% in the placebo group (absolute difference, 3.6 percentage points; 95% CI, −4.5 to 11.7; P=0.43). Among patients requiring ventilation at baseline, those in the levosimendan group were less likely than those in the placebo group to be successfully weaned from mechanical ventilation over the period of 28 days (hazard ratio, 0.77; 95% CI, 0.60 to 0.97; P=0.03). More patients in the levosimendan group than in the placebo group had supraventricular tachyarrhythmia (3.1% vs. 0.4%; absolute difference, 2.7 percentage points; 95% CI, 0.1 to 5.3; P=0.04). CONCLUSIONS The addition of levosimendan to standard treatment in adults with sepsis was not associated with less severe organ dysfunction or lower mortality. Levosimendan was associated with a lower likelihood of successful weaning from mechanical ventilation and a higher risk of supraventricular tachyarrhythmia. (Funded by the NIHR Efficacy and Mechanism Evaluation Programme and others; LeoPARDS Current Controlled Trials number, ISRCTN12776039.

Ethics, Nanobiosensors and Elite Sport: The Need for a New Governance Framework

Individual athletes, coaches and sports teams seek continuously for ways to improve performance and accomplishment in elite competition. New techniques of performance analysis are a crucial part of the drive for athletic perfection. This paper discusses the ethical importance of one aspect of the future potential of performance analysis in sport, combining the field of biomedicine, sports engineering and nanotechnology in the form of ‘Nanobiosensors’. This innovative technology has the potential to revolutionise sport, enabling real time biological data to be collected from athletes that can be electronically distributed. Enabling precise real time performance analysis is not without ethical problems. Arguments concerning (1) data ownership and privacy; (2) data confidentiality; and (3) athlete welfare are presented alongside a discussion of the use of the Precautionary Principle in making ethical evaluations. We conclude, that although the future potential use of Nanobiosensors in sports analysis offers many potential benefits, there is also a fear that it could be abused at a sporting system level. Hence, it is essential for sporting bodies to consider the development of a robust ethically informed governance framework in advance of their proliferated use

Clinical- and cost-effectiveness of a technology-supported and solution-focused intervention (DIALOG plus ) in treatment of patients with chronic depression-study protocol for a multi-site, cluster randomised controlled trial [TACK]

Background Many with an acute depressive disorder go on to develop chronic depression, despite ongoing care. There are few specifically designed interventions to treat chronic depression. DIALOG+, a technology-assisted intervention based on the principles of solution-focused therapy, may be beneficial. It has been shown to be effective as a treatment for patients with psychotic disorders, especially in regards to increasing quality of life. DIALOG+ was designed to be flexibly applied and not diagnosis-specific, aiming to structure communication and generate a personally-tailored care plan. This cluster randomised controlled trial (RCT) is part of a programme of research to adapt and test DIALOG+ for patients with chronic depression. Methods Patients will be eligible for the trial, if they have exhibited symptoms of depression or non-psychotic low mood for at least 2 years, have regular contact with a clinician and have a low subjective quality of life and moderate depressive symptoms. Clinicians, who routinely see eligible patients, will be recruited from a number of sites across NHS England. Clusters will have between 1 and 6 patients per clinician and will be randomised in a 1:1 ratio to either the intervention (DIALOG+) or active control group (treatment as usual + DIALOG scale). Clinicians in the intervention group are trained and asked to deliver the intervention regularly for 12 months. Active control participants receive treatment as usual and are asked to rate their satisfaction with areas of life and treatment on the DIALOG scale at the end of the clinical session. Approximately 112 clinician clusters will be recruited to reach a total patient sample size of 376. Clinical and social outcomes including costs are assessed at baseline and 3, 6 and 12 months post randomisation. The primary outcome will be subjective quality of life at 12 months. Discussion This definitive multi-site, cluster RCT aims to evaluate the clinical- and cost-effectiveness of DIALOG+ for people with chronic depression. If shown to be effective for this patient population it could be used to improve outcomes of mental health care on a larger scale, ensuring that patients with complex and co-morbid diagnoses can benefit. Trial registration ISRCTN11301686. Registered on 13 Jun 2019

Off-Shell Rho-Omega Mixing Through Quark Loops With Non-Perturbative Meson Vertex And Quark Mass Functions

The momemtum dependence of the off-shell $\rho$-$\omega$ mixing amplitude is calculated through a two-quark loop diagram, using non-perturbative meson-quark vertex functions for the $\rho$ and $\omega$ mesons, as well as non-perturbative quark propagators. Both these quantities are generated self-consistently through an interlinked BSE-cum-SDE approach with a 3D support for the BSE kernel with two basic constants which are pre- checked against a wide cross section of both meson and baryon spectra within a common structural framework for their respective 3D BSE's. With this pre-calibration, the on-shell strength works out at -2.434$\delta(m_q^2)$ in units of the change in "constituent mass squared", which is consistent with the $e^+e^-$ to $\pi^+\pi^-$ data for a u-d mass difference of ~4 MeV ,while the relative off-shell strength (0.99 $\pm$ 0.01) lies midway between quark-loop and QCD-SR results. We also calculate the photon-mediated $\rho$-$\omega$ propagator whose off-shell structure has an additional pole at $q^2$=0. The implications of these results vis-a-vis related investigations are discussed.Comment: 12 Pages, latex file, NTUTH-94-0

Beings in their own right? Exploring Children and young people's sibling and twin relationships in the Minority World

This paper examines the contributions that the sociological study of sibship and twinship in the Minority World can make to childhood studies. It argues that, in providing one forum within which to explore children and young people's social relationships, we can add to our understanding of children and young people's interdependence and develop a more nuanced understanding of agency. As emergent subjects, children, young people and adults are in a process of ‘becoming’. However, this does not mean that they can ‘become’ anything they choose to. The notion of negotiated interdependence (Punch 2002) is useful in helping us to grasp the contingent nature of children and young people's agency

Electromagnetic Form Factors of the SU(3) Octet Baryons in the semibosonized SU(3) Nambu-Jona-Lasinio Model

The electromagnetic form factors of the SU(3) octet baryons are investigated in the semibosonized SU(3) Nambu--Jona-Lasinio model (chiral quark-soliton model). The rotational $1/N_c$ and strange quark mass corrections in linear order are taken into account. The electromagnetic charge radii of the nucleon and magnetic moments are also evaluated. It turns out that the model is in a remarkable good agreement with the experimental data.Comment: RevTex is used. 37 pages. The final version to appear in Phys. Rev. D. 13 figures are include