A qualitative study of the contribution of pharmacists to heart failure management in Scotland

Study objectives: (1) To identify the medication management needs of chronic heart failure (CHF) patients and their caregivers; (2) To examine the perceived support for medication management available to these people from health professionals; (3) To identify the actual and potential perceived contribution of pharmacists to medication management. Setting: A mixed urban/ rural region in the west of Scotland. Design: Semi-structured qualitative research interviews. Participants: A total of 50 people with CHF (NYHA Class II and III) due to left ventricular systolic dysfunction (33 males; mean age 67 years, 17 females; mean age 68 years) and 30 nominated caregivers recruited from the outpatient departments of two hospitals in the West of Scotland. Sampling was purposive to include patients from a range of CHF severity, ages and sexes. Main results: Managing medications was a responsibility shared by both the patients with CHF and caregivers. Treatment regimens were reported to be difficult to comply with. Health professionals were seen to provide little support for medication management. Pharmacists were viewed as being a good and accessible source of practical assistance who were also knowledgeable about the individual’s heart health history. Participants reported valuing advice from pharmacists about the side effects of medications and for their assistance in reducing the complex logistics of medication management and in having medications delivered. Conclusions: Patients with CHF and caregivers voiced a willingness to try to manage their medication regimen accurately but had a limited capacity to do so. Pharmacists were viewed as providing valuable support to patients with CHF and their caregivers, in terms of medication management. The extended role of pharmacists in medication management of CHF should be encouraged

Responsible agriculture must adapt to the wetland character of mid‐latitude peatlands

Drained, lowland agricultural peatlands are greenhouse gas (GHG) emission hotspots and a large but vulnerable store of irrecoverable carbon. They exhibit soil loss rates of ~2.0 cm yr−1 and are estimated to account for 32% of global cropland emissions while producing only 1.1% of crop kilocalories. Carbon dioxide emissions account for >80% of their terrestrial GHG emissions and are largely controlled by water table depth. Reducing drainage depths is, therefore, essential for responsible peatland management. Peatland restoration can substantially reduce emissions. However, this may conflict with societal needs to maintain productive use, to protect food security and livelihoods. Wetland agriculture strategies will, therefore, be required to adapt agriculture to the wetland character of peatlands, and balance GHG mitigation against productivity, where halting emissions is not immediately possible. Paludiculture may substantially reduce GHG emissions but will not always be viable in the current economic landscape. Reduced drainage intensity systems may deliver partial reductions in the rate of emissions, with smaller modifications to existing systems. These compromise systems may face fewer hurdles to adoption and minimize environmental harm until societal conditions favour strategies that can halt emissions. Wetland agriculture will face agronomic, socio-economic and water management challenges, and careful implementation will be required. Diversity of values and priorities among stakeholders creates the potential for conflict. Successful implementation will require participatory research approaches and co-creation of workable solutions. Policymakers, private sector funders and researchers have key roles to play but adoption risks would fall predominantly on land managers. Development of a robust wetland agriculture paradigm is essential to deliver resilient production systems and wider environmental benefits. The challenge of responsible use presents an opportunity to rethink peatland management and create thriving, innovative and green wetland landscapes for everyone's future benefit, while making a vital contribution to global climate change mitigation

Systematic review of economic evaluations and cost analyses of guideline implementation strategies

Objectives To appraise the quality of economic studies undertaken as part of evaluations of guideline implementation strategies; determine their resources use; and recommend methods to improve future studies. Methods Systematic review of economic studies undertaken alongside robust study designs of clinical guideline implementation strategies published (1966-1998). Studies assessed against the BMJ economic evaluations guidelines for each stage of the guideline process (guideline development, implementation and treatment). Results 235 studies were identified, 63 reported some information on cost. Only 3 studies provided evidence that their guideline was effective and efficient. 38 reported the treatment costs only, 12 implementation and treatment costs, 11 implementation costs alone, and two guideline development, implementation and treatment costs. No study gave reasonably complete information on costs. Conclusions Very few satisfactory economic evaluations of guideline implementation strategies have been performed. Current evaluations have numerous methodological defects and rarely consider all relevant costs and benefits. Future evaluations should focus on evaluating the implementation of evidence based guidelines. Keywords: Cost-effectiveness analysis, physician (or health care professional) behaviour, practice guidelines, quality improvement, systematic review.Peer reviewedAuthor versio

Spatial variations in lead isotopes, Tasman Element, eastern Australia

Lead isotope data from ore deposits and mineral occurrences in the Tasman Element of eastern Australia have been used to construct isotopic maps of this region. These maps exhibit systematic patterns in parameters derived from isotope ratios. The parameters include μ (238U/204Pb), as calculated using the Cumming and Richards (1975) lead evolution model, and the difference between true age of mineralisation and the Cumming and Richards lead isotope model age of mineralisation (Δt). Variations in μ coincide with boundaries at the orogen, subprovince and zone scales. The boundary between the Lachlan and New England orogens is accompanied by a decrease in μ, and within the Lachlan Orogen, the Central Subprovince is characterised by μ that is significantly higher than in the adjacent Eastern and Western subprovinces. Within the Eastern Subprovince, the Cu-Au-rich Macquarie Arc is characterised by significantly lower μ relative to adjacent rocks. The Macquarie Arc is also characterised by very high Δt (generally above 200 Myr). Other regions characterised by very high Δt include western Tasmania, the southeastern New England Orogen, and the Hodgkinson Province in northern Queensland. These anomalies are within a broad pattern of decreasing Δt from east to west, with Paleozoic deposits within or adjacent to Proterozoic crust characterised by Δt values of 50 Myr or below. The patterns in Δt are interpreted to reflect the presence of the two major tectonic components involved in the Paleozoic Tasman margin in Australia (cf., Münker, 2000): subducting proto-Pacific crust (Δt >150 Myr), and Proterozoic Australia crust (Δt < 50 Myr) on the over-riding plate. Proterozoic Australia crustal sources are interpreted to dominate the western parts of the Tasman Element and Proterozoic crust further to the west, whereas Pacific crustal sources are inferred to characterise western Tasmania and much of the eastern part of the Tasman Element. Contrasts in Δt between the Cambrian Mount Read Volcanics in western Tasmania and similar aged rocks in western Victoria and New South Wales make direct tectonic correlation between these rocks problematic

Brane Tilings and M2 Branes

Brane tilings are efficient mnemonics for Lagrangians of N=2 Chern-Simons-matter theories. Such theories are conjectured to arise on M2-branes probing singular toric Calabi-Yau fourfolds. In this paper, a simple modification of the Kasteleyn technique is described which is conjectured to compute the three dimensional toric diagram of the non-compact moduli space of a single probe. The Hilbert Series is used to compute the spectrum of non-trivial scaling dimensions for a selected set of examples.Comment: 47 pages, 23 figure

Food availability, energetic constraints and reproductive development in a wild seasonally breeding songbird

1. In many organisms, food availability is a proximate cue that synchronizes seasonal development of the reproductive system with optimal environmental conditions. Growth of the gonads and secondary sexual characteristics is orchestrated by the hypothalamic–pituitary–gonadal (HPG) axis. However, our understanding of the physiological mechanisms by which food availability modulates activity of the HPG axis is limited. 2. It is thought that many factors, including energetic status, modulate seasonal reproductive activation. We tested the hypothesis that food availability modulates the activity of the HPG axis in a songbird. Specifically, we food‐restricted captive adult male Abert's Towhees Melozone aberti for 2 or 4 weeks during photoinduced reproductive development. A third group (control) received ad libitum food throughout. We measured multiple aspects of the reproductive system including endocrine activity of all three levels of the HPG axis [i.e. hypothalamic gonadotropin‐releasing hormone‐I (GnRH‐I), plasma luteinizing hormone (LH) and testosterone (T)], and gonad morphology. Furthermore, because gonadotropin‐inhibitory hormone (GnIH) and neuropeptide Y (NPY; a potent orexigenic peptide) potentially integrate information on food availability into seasonal reproductive development, we also measured the brain levels of these peptides. 3. At the hypothalamic level, we detected no effect of food restriction on immunoreactive (ir) GnRH‐I, but the duration of food restriction was inversely related to the size of ir‐GnIH perikarya. Furthermore, the number of ir‐NPY cells was higher in food‐restricted than control birds. Food restriction did not influence photoinduced testicular growth, but decreased plasma LH and T, and width of the cloacal protuberance, an androgen‐sensitive secondary sexual characteristic. Returning birds to ad libitum food availability had no effect on plasma LH or T, but caused the cloacal protuberance to rapidly increase in size to that of ad libitum‐fed birds. 4. Our results support the tenet that food availability modulates photoinduced reproductive activation. However, they also suggest that this modulation is complex and depends upon the level of the HPG axis considered. At the hypothalamic level, our results are consistent with a role for the GnIH and NPY systems in integrating information on energetic status. There also appears to be a role for endocrine function at the anterior pituitary gland and testicular levels in modulating reproductive development in the light of energetic status and independently of testicular growth

Production and Decay of D_1(2420)^0 and D_2^*(2460)^0

We have investigated $D^{+}\pi^{-}$ and $D^{*+}\pi^{-}$ final states and observed the two established $L=1$ charmed mesons, the $D_1(2420)^0$ with mass $2421^{+1+2}_{-2-2}$ MeV/c$^{2}$ and width $20^{+6+3}_{-5-3}$ MeV/c$^{2}$ and the $D_2^*(2460)^0$ with mass $2465 \pm 3 \pm 3$ MeV/c$^{2}$ and width $28^{+8+6}_{-7-6}$ MeV/c$^{2}$. Properties of these final states, including their decay angular distributions and spin-parity assignments, have been studied. We identify these two mesons as the $j_{light}=3/2$ doublet predicted by HQET. We also obtain constraints on {\footnotesize $\Gamma_S/(\Gamma_S + \Gamma_D)$} as a function of the cosine of the relative phase of the two amplitudes in the $D_1(2420)^0$ decay.Comment: 15 pages in REVTEX format. hardcopies with figures can be obtained by sending mail to: [email protected]

Measurement of the branching fraction for Υ(1S)→τ+τ−\Upsilon (1S) \to \tau^+ \tau^-

We have studied the leptonic decay of the $\Upsilon (1S)$ resonance into tau pairs using the CLEO II detector. A clean sample of tau pair events is identified via events containing two charged particles where exactly one of the particles is an identified electron. We find $B(\Upsilon(1S) \to \tau^+ \tau^-) = (2.61~\pm~0.12~{+0.09\atop{-0.13}})$. The result is consistent with expectations from lepton universality.Comment: 9 pages, RevTeX, two Postscript figures available upon request, CLNS 94/1297, CLEO 94-20 (submitted to Physics Letters B

Measurement of the Decay Asymmetry Parameters in Λc+→Λπ+\Lambda_c^+ \to \Lambda\pi^+ and Λc+→Σ+π0\Lambda_c^+ \to \Sigma^+\pi^0

We have measured the weak decay asymmetry parameters (\aLC ) for two \LC\ decay modes. Our measurements are \aLC = -0.94^{+0.21+0.12}_{-0.06-0.06} for the decay mode $\Lambda_c^+ \to \Lambda\pi^+$ and \aLC = -0.45\pm 0.31 \pm 0.06 for the decay mode $\Lambda_c \to \Sigma^+\pi^0$. By combining these measurements with the previously measured decay rates, we have extracted the parity-violating and parity-conserving amplitudes. These amplitudes are used to test models of nonleptonic charmed baryon decay.Comment: 11 pages including the figures. Uses REVTEX and psfig macros. Figures as uuencoded postscript. Also available as http://w4.lns.cornell.edu/public/CLNS/1995/CLNS95-1319.p