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Background: The need for organisational development in primary care has increased as it is accepted as a means of curbing rising costs and responding to demographic transitions. It is only within such inter-organisational networks that small-scale practices can offer treatment to complex patients and continuity of care. The aim of this paper is to explore, through the experience of professionals and patients, whether, and how, project management and network governance can improve the outcomes of projects which promote inter-organisational collaboration in primary care. Methods: This paper describes a study of projects aimed at improving inter-organisational collaboration in Dutch primary care. The projects' success in project management and network governance was monitored by interviewing project leaders and board members on the one hand, and improvement in the collaboration by surveying professionals and patients on the other. Both qualitative and quantitative methods were applied to assess the projects. These were analysed, finally, using multi-level models in order to account for the variation in the projects, professionals and patients. Results: Successful network governance was associated positively with the professionals’ satisfaction with the collaboration; but not with improvements in the quality of care as experienced by patients. Neither patients nor professionals perceived successful project management as associated with the outcomes of the collaboration projects. Conclusions: This study shows that network governance in particular makes a difference to the outcomes of inter-organisational collaboration in primary care. However, project management is not a predictor for successful inter-organisational collaboration in primary care.

Thirty 7-year-old and 26 10-year-old boys were presented with temporal sequences of meaningful and meaningless figures to determine the differences in perception and retention of above- and below-average readers. (Author/AJ)

Using measurements of the surface-ocean CO2 partial pressure (pCO2) and 14 different pCO2 mapping methods recently collated by the Surface Ocean pCO2 Mapping intercomparison (SOCOM) initiative, variations in regional and global sea–air CO2 fluxes are investigated. Though the available mapping methods use widely different approaches, we find relatively consistent estimates of regional pCO2 seasonality, in line with previous estimates. In terms of interannual variability (IAV), all mapping methods estimate the largest variations to occur in the eastern equatorial Pacific. Despite considerable spread in the detailed variations, mapping methods that fit the data more closely also tend to agree more closely with each other in regional averages. Encouragingly, this includes mapping methods belonging to complementary types – taking variability either directly from the pCO2 data or indirectly from driver data via regression. From a weighted ensemble average, we find an IAV amplitude of the global sea–air CO2 flux of 0.31 PgC yr−1 (standard deviation over 1992–2009), which is larger than simulated by biogeochemical process models. From a decadal perspective, the global ocean CO2 uptake is estimated to have gradually increased since about 2000, with little decadal change prior to that. The weighted mean net global ocean CO2 sink estimated by the SOCOM ensemble is −1.75 PgC yr−1 (1992–2009), consistent within uncertainties with estimates from ocean-interior carbon data or atmospheric oxygen trends.

Nederland is officieel vrij van rundertuberculose. Toch komt af en toe nog Mycobacterium bovis-tuberculose voor bij relatief jonge autochtone Nederlanders. Ook zijn er recent nog wel boviene-uitbraken geweest. Dat roept de vraag op of er ook nu nog transmissie is van M.bovis tussen mens en dier. Daarom zijn in een studie de DNA fingerprints van patiënten met M.bovis en van dieren met rundertuberculose met elkaar vergeleken.

Over the last years major advances have been made in the field of C. difficile research. Despite the continuous progress of research in C. difficile epidemiology and molecular biology. This thesis shows that the development of molecular based techniques in detecetion and typing of C. difficile could be very valuable in combatting CDI. This also applies for the genetics and molecular biology of C. difficile in understanding the virulence of C. difficile. However, the continuing development of new techniques, both typing and genetics manipulation tools, has also led to the recognition of potential weaknesses of the currently frequent used techniques. Therefore, it is of utmost importance to keep up with the technical progress in the field of C. difficile research to enable further elucidation of the mechanisms that determine the virulence of C. difficile.

Accurate assessment of anthropogenic carbon dioxide (CO2) emissions and their redistribution among the atmosphere, ocean, and terrestrial biosphere is important to better understand the global carbon cycle, support the development of climate policies, and project future climate change. Here we describe data sets and a methodology to quantify all major components of the global carbon budget, including their uncertainties, based on the combination of a range of data, algorithms, statistics and model estimates and their interpretation by a broad scientific community. We discuss changes compared to previous estimates, consistency within and among components, alongside methodology and data limitations. CO2 emissions from fossil-fuel combustion and cement production (EFF) are based on energy statistics, while emissions from land-use change (ELUC), mainly deforestation, are based on combined evidence from land-cover change data, fire activity associated with deforestation, and models. The global atmospheric CO2 concentration is measured directly and its rate of growth (G ATM) is computed from the annual changes in concentration. The mean ocean CO2 sink (SOCEAN) is based on observations from the 1990s, while the annual anomalies and trends are estimated with ocean models. The variability in SOCEAN is evaluated for the first time in this budget with data products based on surveys of ocean CO2 measurements. The global residual terrestrial CO2 sink (SLAND) is estimated by the difference of the other terms of the global carbon budget and compared to results of independent dynamic global vegetation models forced by observed climate, CO2 and land cover change (some including nitrogen-carbon interactions). All uncertainties are reported as ±1σ , reflecting the current capacity to characterise the annual estimates of each component of the global carbon budget. For the last decade available (2003-2012), EFF was 8.6±0.4 GtC yr-1, ELUC 0.9±0.5 GtC yr-1, GATM 4.3±0.1 GtC yr-1, SOCEAN 2.5±0.5 GtC yr -1, and SLAND 2.8±0.8 GtC yr-1. For year 2012 alone, EFF grew to 9.7±0.5 GtC yr-1, 2.2% above 2011, reflecting a continued growing trend in these emissions, G ATM was 5.1±0.2 GtC yr-1, SOCEAN was 2.9±0.5 GtC yr-1, and assuming an ELUC of 1.0±0.5 GtC yr-1 (based on the 2001-2010 average), S LAND was 2.7±0.9 GtC yr-1. GATM was high in 2012 compared to the 2003-2012 average, almost entirely reflecting the high EFF. The global atmospheric CO2 concentration reached 392.52±0.10 ppm averaged over 2012. We estimate that EFF will increase by 2.1% (1.1- 3.1 %) to 9.9±0.5 GtC in 2013, 61% above emissions in 1990, based on projections of world gross domestic product and recent changes in the carbon intensity of the economy.With this projection, cumulative emissions ofCO2 will reach about 535±55 GtC for 1870-2013, about 70% from EFF (390±20 GtC) and 30% from ELUC (145±50 GtC). This paper also documents any changes in the methods and data sets used in this new carbon budget from previous budgets (Le Quéré et al., 2013). All observations presented here can be downloaded from the Carbon Dioxide Information Analysis Center (doi:10.3334/CDIAC/GCP-2013-V2.3).

Accurate assessment of anthropogenic carbon dioxide (CO2) emissions and their redistribution among the atmosphere, ocean, and terrestrial biosphere is important to better understand the global carbon cycle, support the development of climate policies, and project future climate change. Here we describe data sets and a methodology to quantify all major components of the global carbon budget, including their uncertainties, based on the combination of a range of data, algorithms, statistics and model estimates and their interpretation by a broad scientific community. We discuss changes compared to previous estimates, consistency within and among components, alongside methodology and data limitations. CO2 emissions from fossil-fuel combustion and cement production (EFF) are based on energy statistics, while emissions from land-use change (ELUC), mainly deforestation, are based on combined evidence from land-cover change data, fire activity associated with deforestation, and models. The global atmospheric CO2 concentration is measured directly and its rate of growth (GATM) is computed from the annual changes in concentration. The mean ocean CO2 sink (SOCEAN) is based on observations from the 1990s, while the annual anomalies and trends are estimated with ocean models. The variability in SOCEAN is evaluated for the first time in this budget with data products based on surveys of ocean CO2 measurements. The global residual terrestrial CO2 sink (SLAND) is estimated by the difference of the other terms of the global carbon budget and compared to results of independent dynamic global vegetation models forced by observed climate, CO2 and land cover change (some including nitrogen–carbon interactions). All uncertainties are reported as ± 1 σ, reflecting the current capacity to characterise the annual estimates of each component of the global carbon budget. For the last decade available (2003–2012), EFF was 8.6 ± 0.4 GtC yr − 1, ELUC 0.9 ± 0.5 GtC yr − 1, GATM 4.3 ± 0.1 GtC yr − 1, S OCEAN 2.5 ± 0.5 GtC yr − 1, and S LAND 2.8 ± 0.8 GtC yr − 1. For year 2012 alone, EFF grew to 9.7 ± 0.5 GtC yr − 1, 2.2 % above 2011, reflecting a continued growing trend in these emissions, GATM was 5.1 ± 0.2 GtC yr − 1, SOCEANwas 2.9 ± 0.5 GtC yr −1, and assuming an ELU Cof 1.0 ± 0.5 GtC yr − 1 (based on the 2001–2010 average), SLAND was 2.7 ± 0.9 GtC yr − 1. GATM was high in 2012 compared to the 2003–2012 average, almost entirely reflecting the high EFF. The global atmospheric CO2 con- centration reached 392.52 ± 0.10 ppm averaged over 2012. We estimate that EFF will increase by 2.1 % (1.1–3.1 %) to 9.9 ± 0.5 GtC in 2013, 61 % above emissions in 1990, based on projections of world gross domestic product and recent changes in the carbon intensity of the economy. With this projection, cumulative emissions of CO2 will reach about 535 ± 55 GtC for 1870–2013, about 70 % from EFF (390 ± 20 GtC) and 30 % from ELUC (145 ± 50 GtC). This paper also documents any changes in the methods and data sets used in this new carbon budget from previous budgets (Le Quéré et al., 2013). All observations presented here can be downloaded from the Carbon Dioxide Information Analysis Center.

AimsTo investigate short‐ and long‐term effects of real‐time monitoring medication use combined with short message service (SMS) reminders for missed doses on refill adherence to oral anti‐diabetic medication.MethodsA randomized controlled trial with two intervention groups and one control group involving 161 participants with Type 2 diabetes with suboptimal adherence. For 6 months, participants in the SMS group (n = 56) were monitored and received SMS reminders if they missed their medication. Participants in the non‐SMS group (n = 48) were only monitored. The control group (n = 57) was not exposed to any intervention. Primary outcome measure was refill adherence to oral anti‐diabetic medication. Multi‐level regression analyses were performed to examine intervention effects on adherence between and within groups after 1 and 2 years of follow‐up.ResultsAt baseline, mean refill adherence was comparable between the groups. After 1 year, adherence in the SMS group was significantly higher than in the control group (79.5% vs. 64.5%; P < 0.001) and showed a significant improvement from baseline (+16.3%; P < 0.001). Mean adherence in the non‐SMS group reached 73.1% (+7.3%; P < 0.05), but did not differ from the control group (P = 0.06). After 2 years, the improved adherence in the SMS group persisted and remained significantly higher than in the control group (80.4% vs. 68.4%; P < .01), contrary to the non‐SMS group whose adherence approached baseline level again (65.5%).ConclusionsThis study shows the long‐term effectiveness of real‐time medication monitoring combined with SMS reminders in improving refill adherence. This new reminder system can strengthen the self‐management of people with diabetes.