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Heart failure is a prevalent condition that is generally treated in primary care. The aim of this study was to assess how primary-care physicians think that heart failure should be managed, how they implement their knowledge, and whether differences exist in practice between countries. The survey was undertaken in 15 countries that had membership of the European Society of Cardiology (ESC) between Sept 1, 1999, and May 31, 2000. Primary-care physicians' knowledge and perceptions about the management of heart failure were assessed with a perception survey and how a representative sample of patients was managed with an actual practice survey. 1363 physicians provided data for 11 062 patients, of whom 54% were older than 70 years and 45% were women. 82% of patients had had an echocardiogram but only 51% of these showed left ventricular systolic dysfunction. Ischaemic heart disease, hypertension, diabetes mellitus, atrial fibrillation, and major valve disease were all common. Physicians gave roughly equal priority to improvement of symptoms and prognosis. Most were aware of the benefits of ACE inhibitors and β blockers. 60% of patients were prescribed ACE inhibitors, 34% β blockers but only 20% received these drugs in combination. Doses given were about 50% of targets suggested in the ESC guidelines. If systolic dysfunction was documented, ACE inhibitors were more likely and β blockers less likely to be prescribed than when there was no evidence of systolic dysfunction. Results from this survey suggest that most patients with heart failure are appropriately investigated, although this finding might be as a result of high rates of hospital admissions. However, treatment seems to be less than optimum, and there are substantial variations in practice between countries. The inconsistencies between physicians' knowledge and the treatment that they deliver suggests that improved organisation of care for heart failure is required.

Callus formation and growth are an essential part of secondary fracture healing. Callus growth can be observed radiographically and measured using the “Callus Index,” which is defined as the maximum diameter of the callus divided by the diameter of the bone. We compared three groups of patients with tibial fractures treated by external fixation, intramedullary nailing, and casting to assess the validity of using serial measurements of callus index as a measure of fracture healing. When callus index was plotted against time for each patient, the point at which the fracture began to remodel, indicated by the highest point of the curve, was observed as a consistent feature regardless of fixation method. This occurred on average at 2½ weeks after plaster cast removal (14 weeks post injury), 5 weeks after external fixator removal (22 weeks post injury), and 27 weeks post injury for the intramedullary nailed fractures. Because remodeling only occurs once the fracture is stable, a peak in callus index is a reliable sign that the fracture has united. Serial measurements of callus index would therefore appear to offer a simple method of quantifying secondary fracture healing regardless of the treatment method used. Level of Evidence: Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

We aimed to review published work for the efficacy and safety of electroconvulsive therapy (ECT) with simulated ECT, ECT versus pharmacotherapy, and different forms of ECT for patients with depressive illness. We designed a systematic overview and meta-analysis of randomised controlled trials and observational studies. We obtained data from the Cochrane Collaboration Depressive Anxiety and Neurosis and Schizophrenia Group Controlled trial registers, Cochrane Controlled Trials register, Biological Abstracts, CINAHL, EMBASE, LILACS, MEDLINE, PsycINFO, and SIGLE, reference lists, and specialist textbooks. Our main outcome measures were depressive symptoms, measures of cognitive function, and mortality. Meta-analysis of data of short-term efficacy from randomised controlled trials was possible. Real ECT was significantly more effective than simulated ECT (six trials, 256 patients, standardised effect size [SES] −0·91, 95% CI −1·27 to −0·54). Treatment with ECT was significantly more effective than pharmacotherapy (18 trials, 1144 participants, SES −0·80, 95% CI −1·29 to −0·29). Bilateral ECT was more effective than unipolar ECT (22 trials, 1408 participants, SES −0·32, 95% CI −0·46 to −0·19). ECT is an effective short-term treatment for depression, and is probably more effective than drug therapy. Bilateral ECT is moderately more effective than unilateral ECT, and high dose ECT is more effective than low dose.

Climate change is impacting archaeological sites around the globe, and Arctic sites are among the most vulnerable because the region is experiencing particularly rapid change. In the face of this threat, archaeologists, heritage managers, and northern communities need to develop strategies for documenting and monitoring Arctic sites and prioritizing them for further investigation. Using three case studies from Banks Island in the western Canadian Arctic, we demonstrate how magnetometer survey could assist in this process, despite the region's poorly developed soils, widespread glacial tills, and periglacial geomorphology, which pose challenges for the technique. The case studies illustrate the utility of magnetometry in mapping both archaeological and permafrost features in the Arctic, allowing it to rapidly investigate site structure and assess the level of threat due to climate change. Les changements climatiques affectent les sites archéologiques partout dans le monde et les sites arctiques sont parmi les plus vulnérables puisque cette région est caractérisée par des changements particulièrement rapides. Face à cette menace, les archéologues, les gestionnaires du patrimoine et les communautés nordiques devront développer des stratégies pour documenter et contrôler l’état de ces sites et prioriser l’étude plus approfondie de certains d'entre eux. Grâce à trois études de cas réalisées sur l'île Banks dans l'Arctique oriental canadien, nous démontrons ici comment la prospection magnétométrique peut être utile dans ce contexte, malgré l’épaisseur très mince des sols, la présence répandue de tills et la géomorphologie périglaciaire, qui posent des défis pour l'utilisation de cette technique de prospection. Ces études de cas illustrent l'utilité de la magnétométrie pour la cartographie des vestiges archéologiques et des tertres de pergélisol dans l'Arctique, permettant la documentation rapide des structures, et l’évaluation du niveau de vulnérabilité des sites causé par les changements climatiques.

Objectives To assess the benefits, if any, of the use of shock absorbing insoles in reducing lower limb injury among Air Force recruits, and to assess the differences, if any, in the efficacy of two commonly available shock absorbing insoles. Design Randomized controlled trial. Setting: RAF Halton, UK. Site of all basic training for RAF personnel. Participants: 1205 recruits participating in basic training between 17 September 2003 and 7 April 2004. Interventions: Participants were randomized to receive either standard issue Saran non-shock absorbing insoles, or shock absorbing Sorbothane or Poron insoles, on a 1:1:1 basis. Main Outcome Measures The primary outcome measure was withdrawal from training for lower limb injury. The two primary comparisons were shock absorbing insole versus non-shock absorbing insole, and Sorbothane versus Poron (comparison of different shock absorbing insoles). Secondary outcomes were medical withdrawals for reasons other than those qualifying for the primary outcome measure. Results When comparing the non-shock absorbing insole to the shock absorbing insoles 72/401 participants (18.0%) allocated to Saran insoles were removed from training because of a qualifying lower limb injury, compared with 149/ 804 (18.5%) allocated to the shock absorbing insole (Sorbothane or Poron), odds ratio 1.04 (95% CI 0.75 to 1.44; P=0.87). When comparing the two shock absorbing insole 73/ 421 participants (17.3%) randomized to Sorbothane were removed from training because of a qualifying lower limb injury, compared with 76/383 for Poron (19.8%), odds ratio 0.85 (95% CI 0.58 to 1.23; P=0.37). Conclusions Similar rates of lower limb injuries were observed for all insoles (shock absorbing and non-shock absorbing) in the trial. The trial provides no support for a change in policy to the use of shock absorbing insoles for military recruits.

Abstract This paper presents the findings of archaeological investigations at the Middle Dorset site EeBi-20 at Point Riche, Newfoundland. The site consists of approximately 17 semi-subterranean house depressions dispersed for 150 meters along a raised terrace 10 meters above sea level. It is interpreted as a spring base camp, positioned to take advantage of the large harp seal herds that migrate past the site between March and early June. Excavations during 2001 revealed the remains of a well-preserved dwelling (House Feature 30) consisting of an earth and stone platform surrounding a central depression. A cobble axial feature that incorporated a large limestone slab divides the dwelling. A number of external features are associated with the dwelling including two hearths, a \"pot-stand\" and numerous artifact clusters representing distinct activity areas. A single radiocarbon date of 1650 ± 40 B.P. (uncalibrated, Beta-160980) was obtained from the occupation deposit found on the house floor.