Randomized controlled trial of a lay-facilitated angina management programme

AIMS: This article reports a randomized controlled trial of lay-facilitated angina management (registered trial acronym: LAMP). BACKGROUND: Previously, a nurse-facilitated angina programme was shown to reduce angina while increasing physical activity, however most people with angina do not receive a cardiac rehabilitation or self-management programme. Lay people are increasingly being trained to facilitate self-management programmes. DESIGN: A randomized controlled trial comparing a lay-facilitated angina management programme with routine care from an angina nurse specialist. METHODS: Participants with new stable angina were randomized to the angina management programme (intervention: 70 participants) or advice from an angina nurse specialist (control: 72 participants). Primary outcome was angina frequency at 6 months; secondary outcomes at 3 and 6 months included: risk factors, physical functioning, anxiety, depression, angina misconceptions and cost utility. Follow-up was complete in March 2009. Analysis was by intention-to-treat; blind to group allocation. RESULTS: There was no important difference in angina frequency at 6 months. Secondary outcomes, assessed by either linear or logistic regression models, demonstrated important differences favouring the intervention group, at 3 months for: Anxiety, angina misconceptions and for exercise report; and at 6 months for: Anxiety; Depression; and angina misconceptions. The intervention was considered cost-effective. CONCLUSION: The angina management programme produced some superior benefits when compared to advice from a specialist nurse

X-ray, Optical, and Radio Observations of the Type II Supernovae 1999em and 1998S

Observations of the Type II-P (plateau) Supernova (SN) 1999em and Type IIn (narrow emission line) SN 1998S have enabled estimation of the profile of the SN ejecta, the structure of the circumstellar medium (CSM) established by the pre-SN stellar wind, and the nature of the shock interaction. SN 1999em is the first Type II-P detected at both X-ray and radio wavelengths. The Chandra X-ray data indicate non-radiative interaction of SN ejecta with a power-law density profile (rho \propto r^{-n} with n ~ 7) with a pre-SN wind with a low mass-loss rate of ~2 \times 10^{-6} M_sun/yr for a wind velocity of 10 km/sec, in agreement with radio mass-loss rate estimates. The Chandra data show an unexpected, temporary rise in the 0.4--2.0 keV X-ray flux at ~100 days after explosion. SN 1998S, at an age of >3 years, is still bright in X-rays and is increasing in flux density at cm radio wavelengths. Spectral fits to the Chandra data show that many heavy elements (Ne, Al, Si, S, Ar, and Fe) are overabundant with respect to solar values. We compare the observed elemental abundances and abundance ratios to theoretical calculations and find that our data are consistent with a progenitor mass of approximately 15-20 M_sun if the heavy element ejecta are radially mixed out to a high velocity. If the X-ray emission is from the reverse shock wave region, the supernova density profile must be moderately flat at a velocity ~10^4 km/sec, the shock front is non-radiative at the time of the observations, and the mass-loss rate is 1-2 \times 10^{-4} M_sun/yr for a pre-supernova wind velocity of 10 km/sec. This result is also supported by modeling of the radio emission which implies that SN 1998S is surrounded by a clumpy or filamentary CSM established by a high mass-loss rate, ~2 \times 10^{-4} M_sun/yr, from the pre-supernova star.Comment: 14 pages, 10 figures, accepted by ApJ, includes new data (one new obs. each of SN 1999em and SN 1998S), expanded discussion of spectral fit

The Vegetation of the Paleozoic Plateau, Northeastern Iowa

The present vegetation of the Paleozoic Plateau region of Iowa is a fragmented representation of the original complex of oak-hickory forest mixed with more mesophytic forest, open oak savanna and hill prairie. Because of the topographic variation and the relatively cool, moist environment of the region, the forests are the best developed of those in Iowa, and show the greatest variation, including two types of alluvial forests (Salix thickets and alluvial hardwood forest), and several kinds of upland forests (Tilia, Acer, Quercus borealis, Q, alba and Pinus forests). These types represent points along a more-or-less continuous topographic gradient. Many of the native oak savannas have been eliminated, but oak-juniper glades may be found on cliff faces and steep ridges. The remaining hill prairies are rich in species characteristic of the dry prairies farther to the west. Cold, north-facing slopes ( algific slopes ) are the setting for a unique community containing a large number of rare and disjunct species. Outcrops of sandstones and limestone have characteristic microcommunities, often distinguished by their bryophyte or pteridophyte flora. There is a dearth of quantitative vegetation data from the region, and there are numerous research questions about the communities and their plant species that need answers. Preservation and conservation of plant communities and plant species are extremely important and should be addressed by a landscape approach to inventory and management

The SuperCam Remote Sensing Instrument Suite for Mars 2020

International audienceThe Mars 2020 rover, essentially a structural twin of MSL, is being built to a) characterize the geology and history of a new landing site on Mars, b) find and characterize ancient habitable environments, c) cache samples for eventual return to Earth, and d) demonstrate in-situ production of oxygen needed for human exploration. Remote-sensing instrumentation is needed to support the first three of these goals [1]. The SuperCam instrument meets these needs with a range of instrumentation including the highest-resolution remote imaging on the rover, two different techniques for determining mineralogy , and one technique to provide elemental compositions. All of these techniques are co-boresighted, providing rapid comprehensive characterization. In addition, for targets within 7 meters of the rover the laser shock waves brush away the dust, providing cleaner surfaces for analysis. SuperCam will use an advanced version of the AEGIS robotic target selection software

Dielectric Screening in a Spherical Cavity

In this work we examine the electrostatic screening potential due to a point charge located off-centre in a spherical dielectric cavity. This potential is expanded for the case in which the dielectric constant $\epsilon$ is large, several methods of finding the terms in the expansion are investigated, and closed-form expressions are found through third order in $\epsilon$ along with error bounds. Finally, possible uses of these expressions in molecular dynamics simulations of isolated charged molecules is discussed.Comment: 15 Pages, 5 Figures, To be submitted to J. Phys. A. Uses iopart.cl

Marketing as a means to transformative social conflict resolution: lessons from transitioning war economies and the Colombian coffee marketing system

Social conflicts are ubiquitous to the human condition and occur throughout markets, marketing processes, and marketing systems.When unchecked or unmitigated, social conflict can have devastating consequences for consumers, marketers, and societies, especially when conflict escalates to war. In this article, the authors offer a systemic analysis of the Colombian war economy, with its conflicted shadow and coping markets, to show how a growing network of fair-trade coffee actors has played a key role in transitioning the country’s war economy into a peace economy. They particularly draw attention to the sources of conflict in this market and highlight four transition mechanisms — i.e., empowerment, communication, community building and regulation — through which marketers can contribute to peacemaking and thus produce mutually beneficial outcomes for consumers and society. The article concludes with a discussion of implications for marketing theory, practice, and public policy

Hospital Performance, the Local Economy, and the Local Workforce: Findings from a US National Longitudinal Study

Blustein and colleagues examine the associations between changes in hospital performance and their local economic resources. Locationally disadvantaged hospitals perform poorly on key indicators, raising concerns that pay-for-performance models may not reduce inequality

Defects in the Outer Limiting Membrane Are Associated with Rosette Development in the Nrl−/− Retina

The neural retinal leucine zipper (Nrl) knockout mouse is a widely used model to study cone photoreceptor development, physiology, and molecular biology in the absence of rods. In the Nrl−/− retina, rods are converted into functional cone-like cells. The Nrl−/− retina is characterized by large undulations of the outer nuclear layer (ONL) commonly known as rosettes. Here we explore the mechanism of rosette development in the Nrl−/− retina. We report that rosettes first appear at postnatal day (P)8, and that the structure of nascent rosettes is morphologically distinct from what is seen in the adult retina. The lumen of these nascent rosettes contains a population of aberrant cells protruding into the subretinal space that induce infolding of the ONL. Morphologically adult rosettes do not contain any cell bodies and are first detected at P15. The cells found in nascent rosettes are photoreceptors in origin but lack inner and outer segments. We show that the adherens junctions between photoreceptors and Müller glia which comprise the retinal outer limiting membrane (OLM) are not uniformly formed in the Nrl−/− retina and thus allow protrusion of a population of developing photoreceptors into the subretinal space where their maturation becomes delayed. These data suggest that the rosettes of the Nrl−/− retina arise due to defects in the OLM and delayed maturation of a subset of photoreceptors, and that rods may play an important role in the proper formation of the OLM