The gap between policy and practice: a systematic review of patient-centred care interventions in chronic heart failure.

Patient-centred care (PCC) is recommended in policy documents for chronic heart failure (CHF) service provision, yet it lacks an agreed definition. A systematic review was conducted to identify PCC interventions in CHF and to describe the PCC domains and outcomes. Medline, Embase, CINAHL, PsycINFO, ASSIA, the Cochrane database, clinicaltrials.gov, key journals and citations were searched for original studies on patients with CHF staged II-IV using the New York Heart Association (NYHA) classification. Included interventions actively supported patients to play informed, active roles in decision-making about their goals of care. Search terms included 'patient-centred care', 'quality of life' and 'shared decision making'. Of 13,944 screened citations, 15 articles regarding 10 studies were included involving 2540 CHF patients. Three studies were randomised controlled trials, and seven were non-randomised studies. PCC interventions focused on collaborative goal setting between patients and healthcare professionals regarding immediate clinical choices and future care. Core domains included healthcare professional-patient collaboration, identification of patient preferences, patient-identified goals and patient motivation. While the strength of evidence is poor, PCC has been shown to reduce symptom burden, improve health-related quality of life, reduce readmission rates and enhance patient engagement for patients with CHF. There is a small but growing body of evidence, which demonstrates the benefits of a PCC approach to care for CHF patients. Research is needed to identify the key components of effective PCC interventions before being able to deliver on policy recommendations.

New evidence on the state of stress of the san andreas fault system.

Contemporary in situ tectonic stress indicators along the San Andreas fault system in central California show northeast-directed horizontal compression that is nearly perpendicular to the strike of the fault. Such compression explains recent uplift of the Coast Ranges and the numerous active reverse faults and folds that trend nearly parallel to the San Andreas and that are otherwise unexplainable in terms of strike-slip deformation. Fault-normal crustal compression in central California is proposed to result from the extremely low shear strength of the San Andreas and the slightly convergent relative motion between the Pacific and North American plates. Preliminary in situ stress data from the Cajon Pass scientific drill hole (located 3.6 kilometers northeast of the San Andreas in southern California near San Bernardino, California) are also consistent with a weak fault, as they show no right-lateral shear stress at approximately 2-kilometer depth on planes parallel to the San Andreas fault.

Forecasting southern california earthquakes.

Since 1978 and 1979, California has had a significantly higher frequency of moderate to large earthquakes than in the preceding 25 years. In the past such periods have also been associated with major destructive earthquakes, of magnitude 7 or greater, and the annual probability of occurrence of such an event is now 13 percent in California. The increase in seismicity is associated with a marked deviation in the pattern of strain accumulation, a correlation that is physically plausible. Although great earthquakes (magnitude greater than 7.5) are too infrequent to have clear associations with any pattern of seismicity that is now observed, the San Andreas fault in southern California has accumulated sufficient potential displacement since the last rupture in 1857 to generate a great earthquake along part or all of its length.

An experiment in earthquake control at rangely, colorado.

An experiment in an oil field at Rangely, Colorado, has demonstrated the feasibility of earthquake control. Variations in seismicity were produced by controlled variations in the fluid pressure in a seismically active zone. Precise earthquake locations revealed that the earthquakes clustered about a fault trending through a zone of high pore pressure produced by secondary recovery operations. Laboratory measurements of the frictional properties of the reservoir rocks and an in situ stress measurement made near the earthquake zone were used to predict the fluid pressure required to trigger earthquakes on preexisting fractures. Fluid pressure was controlled by alternately injecting and recovering water from wells that penetrated the seismic zone. Fluid pressure was monitored in observation wells, and a computer model of the reservoir was used to infer the fluid pressure distributions in the vicinity of the injection wells. The results of this experiment confirm the predicted effect of fluid pressure on earthquake activity and indicate that earthquakes can be controlled wherever we can control the fluid pressure in a fault zone.

Petrology of unshocked crystalline rocks and shock effects in lunar rocks and minerals.

On the basis of rock modes, textures, and mineralogy, unshocked crystalline rocks are classified into a dominant ilmenite-rich suite (subdivided into intersertal, ophitic, and hornfels types) and a subordinate feldspar-rich suite (subdivided into poikilitic and granular types). Weakly to moderately shocked rocks show high strain-rate deformation and solid-state transformation of minerals to glasses; intensely shocked rocks are converted to rock glasses. Data on an unknown calcium-bearing iron metasilicate are presented.