Beyond peer observation of teaching

OBJECTIVE To summarize the evidence on effectiveness of translational diabetes prevention programs, based on promoting lifestyle change to prevent type 2 diabetes in real-world settings and to examine whether adherence to international guideline recommendations is associated with effectiveness. RESEARCH DESIGN AND METHODS Bibliographic databases were searched up to July 2012. Included studies had a follow-up of ≥12 months and outcomes comparing change in body composition, glycemic control, or progression to diabetes. Lifestyle interventions aimed to translate evidence from previous efficacy trials of diabetes prevention into real-world intervention programs. Data were combined using random-effects meta-analysis and meta-regression considering the relationship between intervention effectiveness and adherence to guidelines. RESULTS Twenty-five studies met the inclusion criteria. The primary meta-analysis included 22 studies (24 study groups) with outcome data for weight loss at 12 months. The pooled result of the direct pairwise meta-analysis shows that lifestyle interventions resulted in a mean weight loss of 2.12 kg (95% CI -2.61 to -1.63; I(2) = 91.4%). Adherence to guidelines was significantly associated with a greater weight loss (an increase of 0.3 kg per point increase on a 12-point guideline-adherence scale). CONCLUSIONS Evidence suggests that pragmatic diabetes prevention programs are effective. Effectiveness varies substantially between programs but can be improved by maximizing guideline adherence. However, more research is needed to establish optimal strategies for maximizing both cost-effectiveness and longer-term maintenance of weight loss and diabetes prevention effects

Magnetic ordering in the pyrochlore Ho₂CrSbO₇ determined from neutron diffraction, and the magnetic properties of other RE₂CrSbO₇ phases (RE=Y, Tb, Dy, Er)

AbstractThe magnetic structure of the pyrochlore Ho2CrSbO7, which orders magnetically below 13K, has been studied using neutron powder diffraction. Ho2CrSbO7 is found to form an “ordered spin-ice structure” where the magnetic moments are constrained along the 111 axes, but with a ferromagnetic moment in one direction. The Cr3+ ions order ferromagnetically and this is thought to lift the degeneracy of the x, y and z directions in the cubic structure causing the ferromagnetic component from the Ho3+ ions to align. The pyrochlores RE2CrSbO7 where RE=Y, Tb, Dy and Er have also been prepared and studied using SQUID magnetometry

Evidence, theory and context - using intervention mapping to develop a school-based intervention to prevent obesity in children

© 2011 Lloyd et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Only limited data are available on the development and feasibility piloting of school-based interventions to prevent and reduce obesity in children. Clear documentation of the rationale, process of development and content of such interventions is essential to enable other researchers to understand why interventions succeed or fail

Variable temperature neutron diffraction study of crystal structure and transport pathways in oxide ion conductors Bi_12.5Ln_1.5ReO_24.5 (Ln=Lu, Er)

AbstractSamples of highly conducting Bi12.5Lu1.5ReO24.5 and Bi12.5Er1.5ReO24.5 have been studied by neutron powder diffraction at room temperature for both phases and at 25°C≤T≤500°C in the case of Bi12.5Er1.5ReO24.5. Both materials crystallize in the cubic δ-Bi2O3 related system, space group Fm-3m. Changes in the oxygen sublattice at 25°C≤T≤500°C have been investigated by the Rietveld and maximum entropy methods

Improving cardiovascular health in patients with an abdominal aortic aneurysm:development of the cardiovascular risk reduction in patients with aneurysms (CRISP) behaviour change intervention

Background: Abdominal aortic aneurysm (AAA) is an important cardiovascular health problem. Ultrasound screening is proven to reduce AAA mortality and programmes have been implemented in some healthcare systems. Those who are identified as having a small AAA in screening enter into a surveillance programme to monitor AAA size. Individuals in AAA surveillance are at elevated risk of cardiovascular events, which is not currently addressed sufficiently. We aimed to develop a simple intervention to reduce cardiovascular risk, which could be embedded in AAA surveillance pathways. Methods: Intervention mapping methods were used to co-develop the intervention with individuals with AAA, families/carers, and healthcare staff. We identified “targets for change” by synthesising research evidence and international guidelines and consulting with patients, caregivers and health service providers. We conducted a series of workshops to identify barriers to and facilitators of change and used taxonomies of behaviour change theories and techniques to match intervention strategies to each target. Further stakeholder involvement work helped refine the intervention. Results: The developed intervention focusses on assessment and individually tailored discussion of risk factors, exchanging information, building motivation and action planning, followed by review of progress and problem-solving. Workbooks covering physical activity, diet, stress management, alcohol, smoking, blood pressure and mental health are provided to support behaviour change. The intervention is facilitated by trained healthcare professionals during the patient’s AAA screening appointment for the duration that they are in surveillance. Discussion: The developed intervention will now be tested to assess whether it can be integrated with the current AAA screening programme. The developed intervention is a novel approach to reducing cardiovascular disease in the AAA population, it is also the first intervention which tries to do this in this population. Trial registration: International Clinical Trial Registration: ISRCTN93993995

Evaluation of living well, taking control: A community-based diabetes prevention and management programme

IntroductionType 2 diabetes is a serious, expensive and growing public health challenge. In England, national guidance recommends intensive lifestyle interventions promoting weight loss for people at risk of diabetes and programmes of individualised care, information and advice for those recently diagnosed with type 2 diabetes (NICE, 2012; NICE, 2015). There has been little formal evaluation of ‘real-world’ type 2 diabetes prevention and management programmes in the UK, particularly those delivered by community and voluntary agencies. To inform options for action on type 2 diabetes, there is an urgent need for evidence on the implementation and effectiveness of innovative service models.Living Well, Taking ControlLiving Well, Taking Control (LWTC) is a programme designed to prevent and manage type 2 diabetes in non-clinical, community settings. Between July 2013 and October 2015, LWTC was led by Westbank Community Health and Care, and funded as part of the Big Lottery Fund’s (BLF) Wellbeing Programme. LWTC was delivered through third-sector agencies Westbank based in Devon, and Health Exchange in the West Midlands. The programme is compliant with NICE guidance. Evaluation questionsThe evaluation sought to address the following research questions:1.What are the characteristics of the population that the programme attracts?2.What are the patterns of participation in the programme?3.How well does the programme perform in terms of the main outcomes of weight loss and change in glycated haemoglobin (HbA1c), and secondary outcomes (e.g. physical activity, diet, mental wellbeing)?4.What is the association between programme exposure and outcomes?5.What is the association between practice effects (changes in delivery over time) and outcomes?Evaluation methodsThe evaluation is based upon a pre-post assessment of the experiences of programme participants, with additional data derived from programme delivery records. All individuals taking part in LWTC were asked to complete questionnaires and provide biometric measures at the point of enrolment between November 2013 and April 2015. Participants provided follow-up data for a minimum of six months post-enrolment up to the end of October 2015. In addition, all participants who had reached the point of 12 months post-enrolment were asked to provide further follow-up data.Key FindingsParticipants enrolled in LWTC achieved statistically significant improvements in weight and most associated measures (BMI, waist circumference), for those with pre-diabetes and diabetes, at six-month and 12-month measurement points. Of those participants who provided data, 2kg weight loss was achieved by 41.9% (n=156/372) at Month 6 and 44.2% (n=73/165) at Month 12. The 2kg weight loss was achieved by more participants with pre-diabetes than those with diabetes, with 42.9% (n=115/268) and 39.4% (n=41/104), respectively at Month 6. Weight loss and HbA1c were, in the main, closely paralleled by changes in the secondary outcome measures. Overall, there were statistically significant positive changes in general health state, overall life satisfaction, mental wellbeing, anxiety and depression, and self-reported diet at both Months 6 and 12. However, changes in self-reported physical activity were not statistically significant at either measurement point.Further details on the findings are available in the main report.ConclusionsThe evaluation findings suggest potential positive effects of LWTC on diabetes risk and the early stage management of diabetes. The LWTC programme model offers a number of features that are important for scaling up and embedding action on type 2 diabetes. LWTC incorporates key elements of NICE guidance on both the prevention and management of type 2 diabetes. It has developed successful methods for recruitment in partnership with primary care agencies. The programme builds upon the local expertise and capacity of third sector providers, trained community facilitators and local partner agencies

Needs of caregivers in heart failure management: A qualitative study

This is a freely-available open access publication. The final version of this paper has been published in Chronic Illness, March 2015 by SAGE Publications Ltd, All rights reserved. It is available via the DOI in this record.Objectives: To identify the needs of caregivers supporting a person with heart failure and to inform the development of a caregiver resource to be used as part of a home-based selfmanagement programme. Methods: A qualitative study informed by thematic analysis involving 26 caregivers in individual interviews or a focus group. Results: Three distinct aspects of caregiver support in heart failure management were identified. Firstly, caregivers identified needs about supporting management of heart failure including: coping with the variability of heart failure symptoms, what to do in an emergency, understanding and managing medicines, providing emotional support, promoting exercise and physical activity, providing personal care, living with a cardiac device and supporting depression management. Secondly, as they make the transition to becoming a caregiver, they need to develop skills to undertake difficult discussions about the role; communicate with health professionals; manage their own mental health, well-being and sleep; and manage home and work. Thirdly, caregivers require skills to engage social support, and voluntary and formal services while recognising that the longterm future is uncertain. Discussion: The identification of the needs of caregiver has been used to inform the development of a home-based heart failure intervention facilitated by a trained health care practitioner.NIHR (Programme Grants for Applied Research

The Structures and Magnetic Properties of FexCo1 xSb2O4 and MnxCo1 xSb2O4, 0 ≤ x ≤ 1

MxCo1−xSb2O4 (M = Mn, Fe) shows rotation of magnetic moments within the structure, tuneable with increasing x.</p

Supplementary data for The Structures and Magnetic Properties of FexCo1 xSb2O4 and MnxCo1 xSb2O4, 0 ≤ x ≤ 1

MnxCo1-xSb2O4 and FexCo1-xSb2O4 have been synthesised for 0 ≤ x ≤ 1 and their structures and magnetic properties examined. For all compounds, neutron powder diffraction (NPD) data reveal a canted AFM structure that changes gradually from C-type (x = 0) to A-type (x = 1). This transition corresponds to a gradual rotation of the moments through 90o, from ±[001] to ± [100]. It is primarily caused by a change in the relative magnitudes of the three types of magnetic exchange that exist between cations. Within a given chain, direct exchange promotes an antiferromagnetic ground state for the two cations and 90o superexchange that favours ferromagnetic order. Between chains, antiferromagnetic order is preferred. However, the observed magnetic moments (from NPD) are significantly lower than expected except for the end-members of the series; this suggests that incomplete magnetic order is present. Magnetic susceptibility data also suggest complex magnetic behaviour except for the end-member compounds. The complex magnetic features appear to originate from composition inhomogeneity, local magnetic order in the chains of octahedra being dependent on small clusters of the same transition metal ion and the delicate energy balance that clearly exists between the two ordered configurations in the mid-composition region where x is near to 0.5

Structural, Magnetic, Magnetocaloric, and Magnetostrictive Properties of Pb_1-xSr_xMnBO₄(x = 0, 0.5, and 1.0)

The solid solution Pb1-xSrxMnBO4 is reported with an orthorhombic, Pnma, structure throughout; here studies on compounds with x = 0, 0.5 and 1 are described. The structure contains chains of MnO6 octahedra that exhibit intra-chain ferromagnetic (FM) order at low temperatures. Neutron powder diffraction (NPD) reveals dominant FM order in PbMnBO4 (Tc = 30 K), whereas SrMnBO4 is primarily antiferromagnetic (AFM) with TN = 16 K; the difference is related to the link between the chains that involves the BO3 groups. PbMnBO4 has its moment along a but also has a previously unreported AFM contribution along c (magnetic space group Pnm'a'), whereas SrMnBO4 has its moment along a but also a FM canting along c (magnetic space group Pn'm'a). The end members show distinct magnetostriction at Tc/TN which correlates with the different magnetic exchange in these compounds. NPD in variable applied magnetic field shows that SrMnBO4 is converted to fully FM at 8 T. The behavior above the magnetic ordering temperature is consistent with short-range FM correlations within the chains, which is particularly apparent in PbMnBO4. The magnetocaloric effect (MCE) has been measured and compared with those previously reported for the mineral gaudefroyite. PbMnBO4 has excellent MCE behavior, especially near Tc, 30 K. The strong FM exchange within the chains and FM correlations above Tc are vital for the MC properties