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    The development, design, testing, refinement, simulation and application of an evaluation framework for communities of practice and social-professional networks
    Braithwaite, J ; Westbrook, JI ; Ranmuthugala, G ; Cunningham, F ; Plumb, J ; Wiley, J ; Ball, D ; Huckson, S ; Hughes, C ; Johnston, B ; Callen, J ; Creswick, N ; Georgiou, A ; Betbeder-Matibet, L ; Debono, D (BMC, 2009-09-15)
    BACKGROUND: Communities of practice and social-professional networks are generally considered to enhance workplace experience and enable organizational success. However, despite the remarkable growth in interest in the role of collaborating structures in a range of industries, there is a paucity of empirical research to support this view. Nor is there a convincing model for their systematic evaluation, despite the significant potential benefits in answering the core question: how well do groups of professionals work together and how could they be organised to work together more effectively? This research project will produce a rigorous evaluation methodology and deliver supporting tools for the benefit of researchers, policymakers, practitioners and consumers within the health system and other sectors. Given the prevalence and importance of communities of practice and social networks, and the extent of investments in them, this project represents a scientific innovation of national and international significance. METHODS AND DESIGN: Working in four conceptual phases the project will employ a combination of qualitative and quantitative methods to develop, design, field-test, refine and finalise an evaluation framework. Once available the framework will be used to evaluate simulated, and then later existing, health care communities of practice and social-professional networks to assess their effectiveness in achieving desired outcomes. Peak stakeholder groups have agreed to involve a wide range of members and participant organisations, and will facilitate access to various policy, managerial and clinical networks. DISCUSSION: Given its scope and size, the project represents a valuable opportunity to achieve breakthroughs at two levels; firstly, by introducing novel and innovative aims and methods into the social research process and, secondly, through the resulting evaluation framework and tools. We anticipate valuable outcomes in the improved understanding of organisational performance and delivery of care. The project's wider appeal lies in transferring this understanding to other health jurisdictions and to other industries and sectors, both nationally and internationally. This means not merely publishing the results, but contextually interpreting them, and translating them to advance the knowledge base and enable widespread institutional and organisational application.
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    Cardiovascular disease in patients with chronic kidney disease
    Wright, J ; Hutchison, A (DOVE MEDICAL PRESS LTD, 2009)
    Patients with chronic kidney disease have a high burden of cardiovascular morbidity and mortality. The vast majority of patients with chronic kidney disease do not progress to end stage renal failure, but do have a significantly higher incidence of all cardiovascular co-morbidities. Traditional cardiovascular risk factors only partially account for this increased incidence of cardiovascular disease. In patients with kidney disease the basic biology underlying cardiovascular disease may be similar to that in patients without kidney disease, but it would seem many more risk factors are involved as a consequence of renal dysfunction. Although emphasis is placed on delaying the progression of chronic kidney disease, it must be appreciated that for many patients it is vital to address their cardiovascular risk factors at an early stage to prevent premature cardiovascular death. This review examines available epidemiological evidence, discusses common cardiovascular risk factors in patients with chronic kidney disease, and suggests possible treatment strategies. Potential areas for important research are also described.
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    Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study: baseline characteristics and short-term effects of fenofibrate [ISRCTN64783481]
    Scott, R ; Best, J ; Forder, P ; Taskinen, M-R ; Simes, J ; Barter, P ; Keech, A ; Barter, P ; Best, J ; Colman, P ; d'Emden, M ; Davis, T ; Drury, P ; Ehnholm, C ; Glasziou, P ; Hunt, D ; Keech, A ; Kesaniemi, YA ; Laakso, M ; Scott, R ; Simes, RJ ; Sullivan, D ; Taskinen, M-R ; Whiting, M ; Ansquer, J-C ; Fraitag, B ; Anderson, N ; Hankey, G ; Hunt, D ; Lehto, S ; Mann, S ; Romo, M ; Li, LP ; Hennekens, C ; MacMahon, S ; Pocock, S ; Tonkin, A ; Wilhelmsen, L ; Forder, P ; Akauola, H ; Alford, F ; Barter, P ; Beinart, I ; Best, J ; Bohra, S ; Boyages, S ; Colman, P ; Connor, H ; Darnell, D ; Davis, T ; Davoren, P ; Lepre, F ; De Looze, F ; d'Emden, M ; Duffield, A ; Fassett, R ; Flack, J ; Fulcher, G ; Grant, S ; Hamwood, S ; Harmelin, D ; Jackson, R ; Jeffries, W ; Kamp, M ; Kritharides, L ; Mahar, L ; McCann, V ; McIntyre, D ; Moses, R ; Newnham, H ; Nicholson, G ; O'Brien, R ; Park, K ; Petrovsky, N ; Phillips, P ; Pinn, G ; Simmons, D ; Stanton, K ; Stuckey, B ; Sullivan, DR ; Suranyi, M ; Suthers, M ; Tan, Y ; Templer, M ; Topliss, D ; Waites, JH ; Watts, G ; Welborn, T ; Wyndham, R ; Haapamaki, H ; Kesaniemi, A ; Laakso, M ; Lahtela, J ; Levanen, H ; Saltevo, J ; Sodervik, H ; Taskinen, M ; Vanhala, M ; Baker, J ; Burton, A ; Dixon, P ; Doran, J ; Drury, P ; Dunn, P ; Graham, N ; Hamer, A ; Hedley, J ; Lloyd, J ; Manning, P ; McPherson, I ; Morris, S ; Renner, C ; Scott, R ; Smith, R ; Wackrow, M ; Young, S ; Alard, F ; Alcoe, J ; Alford, F ; Allan, C ; Amerena, J ; Anderson, R ; Arnold, N ; Arsov, T ; Ashby, D ; Atkinson, C ; Badhni, L ; Balme, M ; Barton, D ; Batrouney, B ; Beare, C ; Beattie, T ; Beggs, J ; Bendall, C ; Bendall, C ; Benz, A ; Bond, A ; Bradfield, R ; Bradshaw, J ; Brearley, S ; Bruce, D ; Burgess, J ; Butler, J ; Callary, M ; Campbell, J ; Chambers, K ; Chow, J ; Chow, S ; Ciszek, K ; Clifton, P ; Clifton-Bligh, P ; Clowes, V ; Coates, P ; Cocks, C ; Cole, S ; Colquhoun, D ; Correcha, M ; Costa, B ; Coverdale, S ; Croft, M ; Crowe, J ; Dal Sasso, S ; Davis, W ; Dunn, J ; Edwards, S ; Elder, R ; El-Kaissi, S ; Emery, L ; England, M ; Farouque, O ; Fernandez, M ; Fitzpatrick, B ; Francis, N ; Freeman, P ; Fuller, A ; Gale, D ; Gaylard, V ; Gillzan, C ; Glatthaar, C ; Goddard, J ; Grange, V ; Greenaway, T ; Griffin, J ; Grogan, A ; Guha, S ; Gustafson, J ; Hamblin, PS ; Hannay, T ; Hardie, C ; Harper, A ; Hartl, G ; Harvey, A ; Havlin, S ; Haworth, K ; Hay, P ; Hay, L ; Heenan, B ; Hesketh, R ; Heyworth, A ; Hines, M ; Hockings, G ; Hodge, A ; Hoffman, L ; Hoskin, L ; Howells, M ; Hunt, D ; Hunt, A ; Inder, W ; Inder, W ; Jackson, D ; Jovanovska, A ; Kearins, K ; Kee, P ; Keen, J ; Kilpatrick, D ; Kindellan, J ; Kingston-Ray, M ; Kotowicz, M ; Lassig, A ; Layton, M ; Lean, S ; Lim, E ; Long, F ; Lucas, L ; Ludeman, D ; Ludeman, D ; Ludeman-Robertson, C ; Lyall, M ; Lynch, L ; Maddison, C ; Malkus, B ; Marangou, A ; Margrie, F ; Matthiesson, K ; Matthiesson, J ; Maxwell, S ; McCarthy, K ; McElduff, A ; Mckee, H ; McKenzie, J ; McLachan, K ; McNair, P ; Meischke, M ; Miller, AMC ; Morrison, B ; Morton, A ; Mossman, W ; Mowat, A ; Muecke, J ; Murie, P ; Murray, S ; Nadorp, P ; Nair, S ; Nairn, J ; Nankervis, A ; Narayan, K ; Nattrass, N ; Ngui, J ; Nicholls, S ; Nicholls, V ; Nye, JA ; Nye, E ; O'Neal, D ; O'Neill, M ; O'Rourke, S ; Pearse, J ; Pearson, C ; Phillips, J ; Pittis, L ; Playford, D ; Porter, L ; Porter, L ; Portley, R ; Powell, M ; Preston, C ; Pringle, S ; Quinn, WA ; Raffaele, J ; Ramnath, G ; Ramsden, J ; Richtsteiger, D ; Roffe, S ; Rosen, S ; Ross, G ; Ross, Z ; Rowe, J ; Rumble, D ; Ryan, S ; Sansom, J ; Seymour, C ; Shanahan, E ; Shelly, S ; Shepherd, J ; Sherman, G ; Siddall, R ; Silva, D ; Simmons, S ; Simpson, R ; Sinha, A ; Slobodniuk, R ; Smith, M ; Smith, P ; Smith, S ; Smith-Orr, V ; Snow, J ; Socha, L ; Stack, T ; Steed, K ; Steele, K ; Stephensen, J ; Stevens, P ; Stewart, G ; Stewart, R ; Strakosch, C ; Sullivan, M ; Sunder, S ; Sunderland, J ; Tapp, E ; Taylor, J ; Thorn, D ; Thorn, D ; Tolley, A ; Torpy, D ; Truran, G ; Turner, F ; Turner, J ; van de Velde, J ; Varley, S ; Wallace, J ; Walsh, J ; Walsh, J ; Walshe, J ; Ward, G ; Watson, B ; Watson, J ; Webb, A ; Werner, F ; White, E ; Whitehouse, A ; Whitehouse, N ; Wigg, S ; Wilkinson, J ; Wilmshurst, E ; Wilson, D ; Wittert, G ; Wong, B ; Wong, M ; Worboys, S ; Wright, S ; Wu, S ; Yarker, J ; Yeo, M ; Young, K ; Youssef, J ; Yuen, R ; Zeimer, H ; Ziffer, RW ; Aura, A ; Friman, A ; Hanninen, J ; Henell, J ; Hyvarinen, N ; Ikonen, M ; Itkonen, A ; Jappinen, J ; Jarva, A ; Jerkkola, T ; Jokinen, V ; Juutilainen, J ; Kahkonen, H ; Kangas, T ; Karttunen, M ; Kauranen, P ; Kortelainen, S ; Koukkunen, H ; Kumpulainen, L ; Laitinen, T ; Laitinen, M ; Lehto, S ; Lehto, R ; Leinonen, E ; Lindstron-Karjalainen, M ; Lumiaho, A ; Makela, J ; Makinen, K ; Mannermaa, L ; Mard, T ; Miettinen, J ; Naatti, V ; Paavola, S ; Parssinen, N ; Ripatti, J ; Ruotsalainen, S ; Salo, A ; Siiskonen, M ; Soppela, A ; Starck, J ; Suonranta, I ; Ukkola, L ; Valli, K ; Virolainen, J ; Allan, P ; Arnold, W ; Bagg, W ; Balfour, K ; Ball, T ; Ballantine, B ; Ballantyne, C ; Barker, C ; Barker, C ; Bartley, F ; Berry, E ; Braatvedt, G ; Campbell, A ; Clarke, T ; Clarke, R ; Claydon, A ; Clayton, S ; Cresswell, P ; Cutfield, R ; Daffurn, J ; Delahunt, J ; Dissnayake, A ; Eagleton, C ; Ferguson, C ; Florkowski, C ; Fry, D ; Giles, P ; Gluyas, M ; Grant, C ; Guile, P ; Guolo, M ; Hale, P ; Hammond, M ; Hammond, M ; Healy, P ; Hills, M ; Hinge, J ; Holland, J ; Hyne, B ; Ireland, A ; Johnstone, A ; Jones, S ; Kerr, G ; Kerr, K ; Khant, M ; Krebs, J ; Law, L ; Lydon, B ; MacAuley, K ; McEwan, R ; McGregor, P ; McLaren, B ; McLeod, L ; Medforth, J ; Miskimmin, R ; Moffat, J ; Pickup, M ; Prentice, C ; Rahman, M ; Reda, E ; Ross, C ; Ryalls, A ; Schmid, D ; Shergill, N ; Snaddon, A ; Snell, H ; Stevens, L ; Waterman, A ; Watts, V ; Jayne, K ; Keirnan, E ; Newman, P ; Ritchie, G ; Rosenfeld, A ; Beller, E ; Forder, P ; Gebski, V ; Pillai, A ; Anderson, C ; Blakesmith, S ; Chan, S-Y ; Czyniewski, S ; Dobbie, A ; Doshi, S ; Dupuy, A ; Eckermann, S ; Edwards, M ; Fields, N ; Flood, K ; Ford, S ; French, C ; Gillies, S ; Greig, C ; Groshens, M ; Gu, J ; Guo, Y ; Hague, W ; Healy, S ; Hones, L ; Hossain, Z ; Howlett, M ; Lee, J ; Li, L-P ; Matthews, T ; Micallef, J ; Martin, A ; Minns, I ; Nguyen, A ; Papuni, F ; Patel, A ; Pearse, J ; Pike, R ; Pena, M ; Pinto, K ; Schipp, D ; Schroeder, J ; Sim, B ; Sodhi, C ; Sourjina, T ; Sutton, C ; Taylor, R ; Vlagsma, P ; Walder, S ; Walker, R ; Wong, W ; Zhang, J ; Zhong, B ; Keech, A ; Simes, RJ ; Kokkonen, A ; Narva, P ; Niemi, E-L ; Salo, A ; Syrjanen, A-M ; Taskinen, M-R ; Lintott, C ; Scott, R ; Tirimacco, R ; Whiting, M ; Ehnholm, C ; Ikonen, M ; Kajosaari, M ; Raman, L ; Sundvall, J ; Tukianen, M ; Ansquer, J-C ; Fraitag, B ; Crimet, D ; Sirugue, I ; Aubonnet, P (BMC, 2005-01-01)
    OBJECTIVE: The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study is examining the effects of long-term fibrate therapy on coronary heart disease (CHD) event rates in patients with diabetes mellitus. This article describes the trial's run-in phase and patients' baseline characteristics. RESEARCH DESIGN AND METHODS: FIELD is a double-blind, placebo-controlled trial in 63 centres in 3 countries evaluating the effects of fenofibrate versus placebo on CHD morbidity and mortality in 9795 patients with type 2 diabetes mellitus. Patients were to have no indication for lipid-lowering therapy on randomization, but could start these or other drugs at any time after randomization. Follow-up in the study was to be for a median duration of not less than 5 years and until 500 major coronary events (fatal coronary heart disease plus nonfatal myocardial infarction) had occurred. RESULTS: About 2100 patients (22%) had some manifestation of cardiovascular disease (CVD) at baseline and thus high risk status. Less than 25% of patients without CVD had a (UKPDS determined) calculated 5-year CHD risk of <5%, but nearly all had a 5-year stroke risk of <10%. Despite this, half of the cohort were obese (BMI > 30), most were men, two-thirds were aged over 60 years, and substantial proportions had NCEP ATP III features of the metabolic syndrome independent of their diabetes, including low HDL (60%), high blood pressure measurement (41%), high waist measurement (65%), and raised triglycerides (52%). After a 6-week run-in period before randomisation with all participants receiving 200 mg comicronized fenofibrate, there were declines in total and LDL cholesterol (10%) and triglycerides (26%) and an increase in HDL cholesterol (6.5%). CONCLUSION: The study will show the effect of PPAR-alpha agonist action on CHD and other vascular outcomes in patients with type 2 diabetes including substantial numbers with low to moderate CVD risk but with the various components of the metabolic syndrome. The main results of the study will be reported in late 2005.
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    The need for a large-scale trial of fibrate therapy in diabetes: the rationale and design of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. [ISRCTN64783481]
    Barter, P ; Best, J ; Colman, P ; d'Emden, M ; Davis, T ; Drury, P ; Ehnholm, C ; Glasziou, P ; Hunt, D ; Keech, A ; Kesaniemi, YA ; Laakso, M ; Scott, R ; Simes, RJ ; Sullivan, D ; Taskinen, M-R ; Whiting, M ; Ansquer, J-C ; Fraitag, B ; Anderson, N ; Hankey, G ; Hunt, D ; Lehto, S ; Mann, S ; Romo, M ; Li, LP ; Hennekens, C ; MacMahon, S ; Pocock, S ; Tonkin, A ; Wilhelmsen, L ; Forder, P ; Akauola, H ; Alford, F ; Barter, P ; Beinart, I ; Best, J ; Bohra, S ; Boyages, S ; Colman, P ; Connor, H ; Darnell, D ; Davis, T ; Davoren, P ; Lepre, F ; De Looze, F ; d'Emden, M ; Duffield, A ; Fassett, R ; Flack, J ; Fulcher, G ; Grant, S ; Hamwood, S ; Harmelin, D ; Jackson, R ; Jeffries, W ; Kamp, M ; Kritharides, L ; Mahar, L ; McCann, V ; McIntyre, D ; Moses, R ; Newnham, H ; Nicholson, G ; O'Brien, R ; Park, K ; Petrovsky, N ; Phillips, P ; Pinn, G ; Simmons, D ; Stanton, K ; Stuckey, B ; Sullivan, DR ; Suranyi, M ; Suthers, M ; Tan, Y ; Templer, M ; Topliss, D ; Waites, JH ; Watts, G ; Welborn, T ; Wyndham, R ; Haapamaki, H ; Kesaniemi, A ; Laakso, M ; Lahtela, J ; Levanen, H ; Saltevo, J ; Sodervik, H ; Taskinen, M ; Vanhala, M ; Baker, J ; Burton, A ; Dixon, P ; Doran, J ; Drury, P ; Dunn, P ; Graham, N ; Hamer, A ; Hedley, J ; Lloyd, J ; Manning, P ; McPherson, I ; Morris, S ; Renner, C ; Scott, R ; Smith, R ; Wackrow, M ; Young, S ; Alard, F ; Alcoe, J ; Alford, F ; Allan, C ; Amerena, J ; Anderson, R ; Arnold, N ; Arsov, T ; Ashby, D ; Atkinson, C ; Badhni, L ; Balme, M ; Barton, D ; Batrouney, B ; Beare, C ; Beattie, T ; Beggs, J ; Bendall, C ; Bendall, C ; Benz, A ; Bond, A ; Bradfield, R ; Bradshaw, J ; Brearley, S ; Bruce, D ; Burgess, J ; Butler, J ; Callary, M ; Campbell, J ; Chambers, K ; Chow, J ; Chow, S ; Ciszek, K ; Clifton, P ; Clifton-Bligh, P ; Clowes, V ; Coates, P ; Cocks, C ; Cole, S ; Colquhoun, D ; Correcha, M ; Costa, B ; Coverdale, S ; Croft, M ; Crowe, J ; Dal Sasso, S ; Davis, W ; Dunn, J ; Edwards, S ; Elder, R ; El-Kaissi, S ; Emery, L ; England, M ; Farouque, O ; Fernandez, M ; Fitzpatrick, B ; Francis, N ; Freeman, P ; Fuller, A ; Gale, D ; Gaylard, V ; Gillzan, C ; Glatthaar, C ; Goddard, J ; Grange, V ; Greenaway, T ; Griffin, J ; Grogan, A ; Guha, S ; Gustafson, J ; Hamblin, PS ; Hannay, T ; Hardie, C ; Harper, A ; Hartl, G ; Harvey, A ; Havlin, S ; Haworth, K ; Hay, P ; Hay, L ; Heenan, B ; Hesketh, R ; Heyworth, A ; Hines, M ; Hockings, G ; Hodge, A ; Hoffman, L ; Hoskin, L ; Howells, M ; Hunt, D ; Hunt, A ; Inder, W ; Inder, W ; Jackson, D ; Jovanovska, A ; Kearins, K ; Kee, P ; Keen, J ; Kilpatrick, D ; Kindellan, J ; Kingston-Ray, M ; Kotowicz, M ; Lassig, A ; Layton, M ; Lean, S ; Lim, E ; Long, F ; Lucas, L ; Ludeman, D ; Ludeman, D ; Ludeman-Robertson, C ; Lyall, M ; Lynch, L ; Maddison, C ; Malkus, B ; Marangou, A ; Margrie, F ; Matthiesson, K ; Matthiesson, J ; Maxwell, S ; McCarthy, K ; McElduff, A ; McKee, H ; McKenzie, J ; McLachan, K ; McNair, P ; Meischke, M ; Merkel, A ; Miller, C ; Morrison, B ; Morton, A ; Mossman, W ; Mowat, A ; Muecke, J ; Murie, P ; Murray, S ; Nadorp, P ; Nair, S ; Nairn, J ; Nankervis, A ; Narayan, K ; Nattrass, N ; Ngui, J ; Nicholls, S ; Nicholls, V ; Nye, JA ; Nye, E ; O'Neal, D ; O'Neill, M ; O'Rourke, S ; Pearse, J ; Pearson, C ; Phillips, J ; Pittis, L ; Playford, D ; Porter, L ; Porter, L ; Portley, R ; Powell, M ; Preston, C ; Pringle, S ; Quinn, WA ; Raffaele, J ; Ramnath, G ; Ramsden, J ; Richtsteiger, D ; Roffe, S ; Rosen, S ; Ross, G ; Ross, Z ; Rowe, J ; Rumble, D ; Ryan, S ; Sansom, J ; Seymour, C ; Shanahan, E ; Shelly, S ; Shepherd, J ; Sherman, G ; Siddall, R ; Silva, D ; Simmons, S ; Simpson, R ; Sinha, A ; Slobodniuk, R ; Smith, M ; Smith, P ; Smith, S ; Smith-Orr, V ; Snow, J ; Socha, L ; Stack, T ; Steed, K ; Steele, K ; Stephensen, J ; Stevens, P ; Stewart, G ; Stewart, R ; Strakosch, C ; Sullivan, M ; Sunder, S ; Sunderland, J ; Tapp, E ; Taylor, J ; Thorn, D ; Thorn, D ; Tolley, A ; Torpy, D ; Truran, G ; Turner, F ; Turner, J ; van de Velde, J ; Varley, S ; Wallace, J ; Walsh, J ; Walsh, J ; Walshe, J ; Ward, G ; Watson, B ; Watson, J ; Webb, A ; Werner, F ; White, E ; Whitehouse, A ; Whitehouse, N ; Wigg, S ; Wilkinson, J ; Wilmshurst, E ; Wilson, D ; Wittert, G ; Wong, B ; Wong, M ; Worboys, S ; Wright, S ; Wu, S ; Yarker, J ; Yeo, M ; Young, K ; Youssef, J ; Yuen, R ; Zeimer, H ; Ziffer, RW ; Aura, A ; Friman, A ; Hanninen, J ; Henell, J ; Hyvarinen, N ; Ikonen, M ; Itkonen, A ; Jappinen, J ; Jarva, A ; Jerkkola, T ; Jokinen, V ; Juutilainen, J ; Kahkonen, H ; Kangas, T ; Karttunen, M ; Kauranen, P ; Kortelainen, S ; Koukkunen, H ; Kumpulainen, L ; Laitinen, T ; Laitinen, M ; Lehto, S ; Lehto, R ; Leinonen, E ; Lindstron-Karjalainen, M ; Lumiaho, A ; Makela, J ; Makinen, K ; Mannermaa, L ; Mard, T ; Miettinen, J ; Naatti, V ; Paavola, S ; Parssinen, N ; Ripatti, J ; Ruotsalainen, S ; Salo, A ; Siiskonen, M ; Soppela, A ; Starck, J ; Suonranta, I ; Ukkola, L ; Valli, K ; Virolainen, J ; Allan, P ; Arnold, W ; Bagg, W ; Balfour, K ; Ball, T ; Ballantine, B ; Ballantyne, C ; Barker, C ; Barker, C ; Bartley, F ; Berry, E ; Braatvedt, G ; Campbell, A ; Clarke, T ; Clarke, R ; Claydon, A ; Clayton, S ; Cresswell, P ; Cutfield, R ; Daffurn, J ; Delahunt, J ; Dissnayake, A ; Eagleton, C ; Ferguson, C ; Florkowski, C ; Fry, D ; Giles, P ; Gluyas, M ; Grant, C ; Guile, P ; Guolo, M ; Hale, P ; Hammond, M ; Hammond, M ; Healy, P ; Hills, M ; Hinge, J ; Holland, J ; Hyne, B ; Ireland, A ; Johnstone, A ; Jones, S ; Kerr, G ; Kerr, K ; Khant, M ; Krebs, J ; Law, L ; Lydon, B ; MacAuley, K ; McEwan, R ; McGregor, P ; McLaren, B ; McLeod, L ; Medforth, J ; Miskimmin, R ; Moffat, J ; Pickup, M ; Prentice, C ; Rahman, M ; Reda, E ; Ross, C ; Ryalls, A ; Schmid, D ; Shergill, N ; Snaddon, A ; Snell, H ; Stevens, L ; Waterman, A ; Watts, V ; Jayne, K ; Keirnan, E ; Newman, P ; Ritchie, G ; Rosenfeld, A ; Beller, E ; Forder, P ; Gebski, V ; Pillai, A ; Anderson, C ; Blakesmith, S ; Chan, S-Y ; Czyniewski, S ; Dobbie, A ; Doshi, S ; Dupuy, A ; Eckermann, S ; Edwards, M ; Fields, N ; Flood, K ; Ford, S ; French, C ; Gillies, S ; Greig, C ; Groshens, M ; Gu, J ; Guo, Y ; Hague, W ; Healy, S ; Hones, L ; Hossain, Z ; Howlett, M ; Lee, J ; Li, L-P ; Matthews, T ; Micallef, J ; Martin, A ; Minns, I ; Nguyen, A ; Papuni, F ; Patel, A ; Pearse, J ; Pike, R ; Pena, M ; Pinto, K ; Schipp, D ; Schroeder, J ; Sim, B ; Sodhi, C ; Sourjina, T ; Sutton, C ; Taylor, R ; Vlagsma, P ; Walder, S ; Walker, R ; Wong, W ; Zhang, J ; Zhong, B ; Keech, A ; Simes, RJ ; Kokkonen, A ; Narva, P ; Niemi, E-L ; Salo, A ; Syrjanen, A-M ; Taskinen, M-R ; Lintott, C ; Scott, R ; Tirimacco, R ; Whiting, M ; Ehnholm, C ; Ikonen, M ; Kajosaari, M ; Raman, L ; Sundvall, J ; Tukianen, M ; Ansquer, J-C ; Fraitag, B ; Crimet, D ; Sirugue, I ; Aubonnet, P (BMC, 2004-01-01)
    BACKGROUND: Fibrates correct the typical lipid abnormalities of type 2 diabetes mellitus, yet no study, to date, has specifically set out to evaluate the role of fibrate therapy in preventing cardiovascular events in this setting. METHODS: Subjects with type 2 diabetes, aged 50-75 years, were screened for eligibility to participate in a long-term trial of comicronized fenofibrate 200 mg daily compared with matching placebo to assess benefits of treatment on the occurrence of coronary and other vascular events. People with total cholesterol levels 3.0-6.5 mmol/L plus either a total-to-HDLc ratio > 4.0 or triglyceride level > 1.0 mmol/L with no clear indication for lipid-modifying therapy were eligible. RESULTS: A total of 9795 people were randomized into the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial. All received dietary advice, followed by a 6-week single-blind placebo run-in, then a 6-week active run-in period before randomization. Participants are being followed up every 6 months for outcome events and safety assessments. The study is designed to yield at least 500 coronary events (primary endpoint: first nonfatal myocardial infarction or coronary death) over 5 years, to have 80% power to identify as statistically significant at 2P = 0.05 a 22% reduction in such events, using intention-to-treat methods. CONCLUSIONS: Type 2 diabetes is the most common endocrine disorder worldwide, and its prevalence is increasing. The current evidence about use of fibrates in type 2 diabetes, from around 2000 people treated, will increase with FIELD to evidence from around 12000. FIELD will establish the role of fenofibrate treatment in reducing cardiovascular risk in people with type 2 diabetes. The main results are expected to be available in late 2005.
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    Biological function and molecular mapping of M antigen in yeast phase of Histoplasma capsulatum.
    Guimarães, AJ ; Hamilton, AJ ; de M Guedes, HL ; Nosanchuk, JD ; Zancopé-Oliveira, RM ; Nielsen, K (Public Library of Science (PLoS), 2008)
    Histoplasmosis, due to the intracellular fungus Histoplasma capsulatum, can be diagnosed by demonstrating the presence of antibodies specific to the immunodominant M antigen. However, the role of this protein in the pathogenesis of histoplasmosis has not been elucidated. We sought to structurally and immunologically characterize the protein, determine yeast cell surface expression, and confirm catalase activity. A 3D-rendering of the M antigen by homology modeling revealed that the structures and domains closely resemble characterized fungal catalases. We generated monoclonal antibodies (mAbs) to the protein and determined that the M antigen is present on the yeast cell surface and in cell wall/cell membrane preparations. Similarly, we found that the majority of catalase activity was in extracts containing fungal surface antigens and that the M antigen is not significantly secreted by live yeast cells. The mAbs also identified unique epitopes on the M antigen. The localization of the M antigen to the cell surface of H. capsulatum yeast and the characterization of the protein's major epitopes have important implications since it demonstrates that although the protein may participate in protecting the fungus against oxidative stress it is also accessible to host immune cells and antibody.
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    Carbodiimide-mediated cross-linking of RNA to nylon membranes improves the detection of siRNA, miRNA and piRNA by northern blot.
    Pall, GS ; Codony-Servat, C ; Byrne, J ; Ritchie, L ; Hamilton, A (Oxford University Press (OUP), 2007)
    The northern blot, or RNA gel blot, is a widely used method for the discovery, validation and expression analysis of small regulatory RNA such as small interfering RNA (siRNA), microRNA (miRNA) and piwi-interacting RNA (piRNA). Although it is straightforward and quantitative, the main disadvantage of a northern blot is that it detects such RNA less sensitively than most other approaches. We found that the standard dose of UV used in northern blots was not the most efficient at immobilizing small RNA of 20-40 nt on nylon membranes. However, increasing the dose of UV reduced the detection of miRNA by hybridization in northern blotting experiments. We discovered that using the soluble carbodiimide, EDC, to cross-link RNA to nylon membranes greatly improved the detection of small RNA by hybridization. Compared to standard UV cross-linking procedures, EDC cross-linking provided a 25-50-fold increase in the sensitivity of detection of siRNA from plants and miRNA or piRNA from mammalian cells. All types of hybridization probes tested benefited from the new cross-linking procedure. Cross-linking was dependent on a terminal phosphate and so, should be applicable to other related categories of small RNA.
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    "There's no place like home" a pilot study of perspectives of international health and social care professionals working in the UK.
    Moran, A ; Nancarrow, S ; Butler, A (Springer Science and Business Media LLC, 2005-10-27)
    BACKGROUND: Many countries are reporting health workforce shortages across a range of professions at a time of relatively high workforce mobility. Utilising the global market to supply shortage health skills is now a common recruitment strategy in many developed countries. At the same time a number of countries report a 'brain drain' resulting from professional people leaving home to work overseas. Many health and social care professionals make their way to the UK from other countries. This pilot study utilises a novel 'e-survey' approach to explore the motives, experiences and perspectives of non-UK health and social care professionals who were working or had worked in the UK. The study aims to understand the contributions of international health and social care workers to the UK and their 'home' countries. The purpose of the pilot study is also in part to test the appropriateness of this methodology for undertaking a wider study. RESULTS: A 24-item questionnaire with open-ended and multiple choice questions was circulated via email to 10 contacts who were from a country outside the UK, had trained outside the UK and had email access. These contacts were requested to forward the email to other contacts who met these criteria (and so on). The email was circulated over a one month pilot period to 34 contacts. Responses were from physiotherapists (n = 11), speech therapists (n = 4), social workers (n = 10), an occupational therapist (n = 1), podiatrists (n = 5), and others (n = 3). Participants were from Australia (n = 20), South Africa (n = 10), New Zealand (n = 3) and the Republic of Ireland (n = 1). Motives for relocating to the UK included travel, money and career opportunities. Participants identified a number of advantages and disadvantages of working in the UK compared to working in their home country health system. Respondents generally reported that by working in the UK, they had accumulated skills and knowledge that would allow them to contribute more to their profession and health system on their return home. CONCLUSION: This pilot study highlights a range of issues and future research questions for international learning and comparison for the health and social care professions as a result of international workforce mobility. The study also highlights the usefulness of an e-survey technique for capturing information from a geographically diverse and mobile group of professionals.
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    Variability in depression prevalence in early rheumatoid arthritis: a comparison of the CES-D and HAD-D Scales
    Covic, T ; Pallant, JF ; Tennant, A ; Cox, S ; Emery, P ; Conaghan, PG (BIOMED CENTRAL LTD, 2009-02-07)
    BACKGROUND: Depression is common in rheumatoid arthritis (RA), however reported prevalence varies considerably. Two frequently used instruments to identify depression are the Center for Epidemiological Studies Depression (CES-D) scale, and the Hospital Anxiety and Depression Scale (HADS). The objectives of this study were to test if the CES-D and HADS-D (a) satisfy current modern psychometric standards for unidimensional measurement in an early RA sample; (b) measure the same construct (i.e. depression); and (c) identify similar levels of depression. METHODS: Data from the two scales completed by patients with early RA were fitted to the Rasch measurement model to show that (a) each scale satisfies the criteria of fit to the model, including strict unidimensionality; (b) that the scales can be co-calibrated onto a single underlying continuum of depression and to (c) examine the location of the cut points on the underlying continuum as indication of the prevalence of depression. RESULTS: Ninety-two patients with early RA (62% female; mean age = 56.3, SD = 13.7) gave 141 sets of paired CES-D and HAD-D data. Fit of the data from the CES-D was found to be poor, and the scale had to be reduced to 13 items to satisfy Rasch measurement criteria whereas the HADS-D met model expectations from the outset. The 20 items combined (CES-D13 and HADS-D) satisfied Rasch model expectations. The CES-D gave a much higher prevalence of depression than the HADS-D. CONCLUSION: The CES-D in its present form is unsuitable for use in patients with early RA, and needs to be reduced to a 13-item scale. The HADS-D is valid for early RA and the two scales measure the same underlying construct but their cut points lead to different estimates of the level of depression. Revised cut points on the CES-D13 provide comparative prevalence rates.
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    Impact, distress and HRQoL among Malaysian men and women with a mobility impairment
    Misajon, R ; Manderson, L ; Pallant, JF ; Omar, Z ; Bennett, E ; Rahim, RBA (BMC, 2006-12-12)
    BACKGROUND: Although non-communicable and chronic disease now accounts for 47% of the global burden of disease, little is known of the everyday experiences and social aspects of disability and disablement in middle and low income countries. This article aims to address this gap by exploring the subjective experience of mobility impairment in Malaysia. Specifically, it examines health-related quality of life and the impact and distress related to impaired mobility, and investigates any gender differences in relation to the experience of disability. METHODS: The data were collected as part of an interdisciplinary, multi-country study known as RESILIENCE (Research into Social Inclusion, Locomotive Impairment and Empowerment through Networking, Collaboration and Education). Cluster sampling was used to administer the EQ-5D and the Perceived Impact of Problems Profile (PIPP) to 210 adults from Selangor state, west coast Peninsular Malaysia. RESULTS: The participants consisted of 94 males and 116 females, aged between 18-90 years (mean 60 years), with the majority being Malay. The majority of participants were also married, from rural areas and had primary education only. Very few participants lived alone. In addition, males were more likely to attribute their impaired mobility to an accident. The majority of participants with mobility impairment experienced a moderate to high level of pain/discomfort (79%) and anxiety/depression (72%), and at least some problems with performing usual activities (71%), as measured by the EQ-5D. In addition, using the Perceived Impact of Problems Profile (PIPP), participants also reported high levels of impact and distress related to participation in community life. In general, males reported higher impact and distress across several items, most significantly in regard to participation in community activities, moving around the neighbourhood, ability to live independently, and ability to assist their family members. CONCLUSION: This paper provides preliminary data regarding the health-related quality of life among Malaysians with impaired mobility, and highlights the multifaceted impact of disability and the importance of acknowledging the diverse cultural contexts in which disability can occur. It also raises questions regarding gender differences in the subjective experience of disability in Malaysia.
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    Measuring the impact and distress of osteoarthritis from the patients' perspective
    Pallant, JF ; Keenan, A-M ; Misajon, R ; Conaghan, PG ; Tennant, A (BMC, 2009-04-29)
    BACKGROUND: To assess the internal construct validity of the Perceived Impact of Problem Profile (PIPP), a patient based outcome measure based on the International Classification of Functioning, Disability and Health (ICF), which assesses impact and distress, in an osteoarthritis (OA) cohort. METHODS: A questionnaire comprising the 23-item PIPP, which assesses five domains (mobility, participation, self care, psychological well being and relationships), the Western Ontario McMasters University Osteoarthritis Index (WOMAC), the General Well-Being Index (GWBI), and the Hospital Anxiety and Depression Scale (HADS) was posted to people with clinician diagnosed OA. Assessment of the internal construct validity of the PIPP was undertaken using Rasch analysis performed with RUMM2020 software and concurrent validity through comparator measures. RESULTS: Two hundred and fifty-nine participants with OA responded. Analysis of the five individual domains of the PIPP indicated that there was good fit to the Rasch model, with high person separation reliability. One item required removal from the Mobility subscale and the Participation subscale. There were strong correlations between the PIPP Mobility scores and the WOMAC disability and pain subscales (rho = .73 and rho = .68), and between the PIPP Psychological well-being and HADS Depression (rho = .71) and GWBI (rho = -.69). High inter-correlations between the impact and distress subscales for each domain (range rho = .85 to .96), suggested redundancy of the latter. CONCLUSION: This study demonstrates that the PIPP has good psychometric properties in an OA population. The PIPP, using just the impact subscales, provides a brief, reliable and valid means of assessing the impact of OA from the individual's perspective and operationalizing the bio-psychosocial model by the application of a single multi-domain questionnaire.