Most patients have a good baseline of knowledge about hypertension but there are still important areas that need to be addressed. The booklet and tracker were well received by patients but the simple leaflet was as effective at improving knowledge.
The chasm between knowledge and practice decried by the Institute of Medicine (IOM) is the result of other chasms that have not been addressed. They include the chasm between what we know and what we need to know to improve care; the chasm between those who provide primary care and those who do not fund, study, support, or publish practical primary care studies; and the chasm between research and quality improvement (QI). These chasms are a result of problematic concepts, attitudes, traditions, time frames, and fi nancing approaches among the various participants. If we are to facilitate the production and use of the knowledge needed for primary care to cross IOM's chasm, major changes are needed. These changes include the following: (1) admission by all primary care professions that we have quality problems that require our unifi ed attention and action; (2) conversion of the paradigm from "translate research into practice" to "optimizing health and health care through research and QI"; (3) development and facilitation of more partnerships among clinicians, researchers, and care delivery leaders for engaged scholarship in both research and QI; (4) modifi cation of the agendas and methods of funders and researchers so they emphasize the problems of patients and patient care and support practical time frames and research designs; and (5) facilitation by funders and journals of the dissemination and implementation of lessons from QI and practical research.
Field and laboratory studies provided information concerning the onset, development, and possible control of cannibalism by pond‐reared juvenile walleyes (Stizostedion vitreum) longer than 30 mm. Cannibalism began in early summer and was associated with increases in length ranges. Cannibal walleyes were the largest, and their prey the smallest, fish in field collections; cannibals had a higher growth rate, which led to the appearance of bimodal length‐frequency distributions in samples collected in late summer and early autumn. In laboratory experiments, cannibalism did not occur in aquaria containing juvenile walleyes and fathead minnows (Pimephales promelas). Cannibalism was most frequent in aquaria that contained only walleyes and intermediate in frequency in aquaria that contained zooplankton and walleyes. Cannibals in the walleye‐only aquarium consumed 6‐33%/d of the fish present, and 41% of the vulnerable walleyes overall; when zooplankton were present, losses to cannibalism dropped to 28%. Walleyes consumed 44‐86%/d of the fathead minnows present in aquaria stocked with these prey. Cannibalism occurred at prey‐length: cannibal‐length ratios greater than 60% in only 1 of 14 experiments. An abundance of zooplankton and the availability of a suitable forage species such as the fathead minnow should reduce cannibalism by walleyes in ponds.
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