Influence of Angiotensin II Subtype 2 Receptor (AT2R) Antagonist, PD123319, on Cardiovascular Remodelling of Aged Spontaneously Hypertensive Rats during Chronic Angiotensin II Subtype 1 Receptor (AT1R) Blockade

Cardiac AT2R expression is upregulated in the normal process of aging. In this study we determined the contribution of AT2R to chronic antihypertensive and remodelling effects of AT1R blockade in aged hypertensive rats. Adult (20 weeks) and senescent (20 months) spontaneously hypertensive rats (SHRs) were treated with either the AT1R antagonist, candesartan cilexetil (2 mg/kg/day), the AT2R antagonist, PD123319 (10 mg/kg/day), or a combination of the 2 compounds. Mean arterial pressure (MAP) and left ventricular volume were markedly decreased by candesartan cilexetil, however, simultaneous treatment with PD123319 had no additional effect on either parameter. Perivascular fibrosis was significantly reduced by candesartan cilexetil in aged animals only, and this effect was reversed by concomitant PD123319 administration. Vascular hypertrophy was reduced by candesartan cilexetil, and these effects were reversed by simultaneous PD123319. These results suggest that AT2R stimulation does not significantly influence the antihypertensive effect of chronic AT1R blockade, but plays a role in the regulation of vascular structure. The severe degree of cardiac perivascular fibrosis in senescent animals was regressed by AT1R blockade and this effect was reversed by simultaneous AT2R inhibition, demonstrating an antifibrotic role of AT2R stimulation in the aging hypertensive heart

Measured parental height in Turner syndrome—a valuable but underused diagnostic tool

Early diagnosis of Turner syndrome (TS) is necessary to facilitate appropriate management, including growth promotion. Not all girls with TS have overt short stature, and comparison with parental height (Ht) is needed for appropriate evaluation. We examined both the prevalence and diagnostic sensitivity of measured parental Ht in a dedicated TS clinic between 1989 and 2013. Lower end of parental target range (LTR) was calculated as mid-parental Ht (correction factor 12.5 cm minus 8.5 cm) and converted to standard deviation scores (SDS) using UK 1990 data, then compared with patient Ht SDS at first accurate measurement aged > 1 year. Information was available in 172 girls of whom 142 (82.6%) were short at first measurement. However, both parents had been measured in only 94 girls (54.6%). In 92 of these girls age at measurement was 6.93 ± 3.9 years, Ht SDS vs LTR SDS − 2.63 ± 0.94 vs − 1.77 ± 0.81 (p < 0.001), Ht SDS < LTR in 78/92 (85%). Eleven of the remaining 14 girls were < 5 years, while karyotype was 45,X/46,XX in 2 and 45,X/47,XXX in 3. Conclusion: This study confirms the sensitivity of evaluating height status against parental height but shows that the latter is not being consistently measured

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

Systematic review of community business related approaches to health and social care

This report provides insight into the impact of community business-related approaches to health and social care on users’ outcomes, in particular exploring how effectivethey are in delivering outcomes for users. Community businesses are rooted within a particular area, trade for the benefit of the local community, are accountable to and led by the local community and demonstrate broad community impact. In recent years community businesses have emerged in the wider health and social care market to address factors in local communities that may benefit or harm health and wellbeing. Moreover, publications focused on the evaluation of health and wellbeing benefits of community businesses have also increasedwithin the last four years

Sampling re-design increases power to detect change in the Great Barrier Reef’s inshore water quality

Monitoring programs are fundamental to understanding the state and trend of aquatic ecosystems. Sampling designs are a crucial component of monitoring programs and ensure that measurements evaluate progress toward clearly stated management objectives, which provides a mechanism for adaptive management. Here, we use a well-established marine monitoring program for inshore water quality in the Great Barrier Reef (GBR), Australia to investigate whether a sampling re-design has increased the program’s capacity to meet its primary objectives. Specifically, we use bootstrap resampling to assess the change in statistical power to detect temporal water quality trends in a 15-year inshore marine water quality data set that includes data from both before and after the sampling re-design. We perform a comprehensive power analysis for six water quality analytes at four separate study areas in the GBR Marine Park and find that the sampling re-design (i) increased power to detect trends in 23 of the 24 analyte-study area combinations, and (ii) resulted in an average increase in power of 34% to detect increasing or decreasing trends in water quality analytes. This increase in power is attributed more to the addition of sampling locations than increasing the sampling rate. Therefore, the sampling re-design has substantially increased the capacity of the program to detect temporal trends in inshore marine water quality. Further improvements in sampling design need to focus on the program’s capability to reliably detect trends within realistic timeframes where inshore improvements to water quality can be expected to occur

Food for life: A social return on investment analysis of the locally commissioned programme. Full Report

A Social Return on Investment Analysis of two locally commissioned Food for Life programme

Evaluation of Food for Life 2013-15: Summary and synthesis report

This is the final report of the phase two evaluation of Food for Life undertaken by the University of the West of England, Bristol 2013-15. The research encompassed five workstreams: 1.Long term impacts and durability - understanding how and why the Food for Life approach is embedded in schools for the medium to long-term. 2.Review of local commissions - understanding strategic support for Food for Life, and recommending monitoring and evaluation systems.3.Cross sectional study of pupils’ diets in Food for Life local commissions - evaluating Food for Life’s impact on healthy eating behaviours in schools in local commission areas. 4.New settings - exploring innovative approaches to extending the Food for Life whole setting approach beyond schools.5.Social value of Food for Life in local authority commissions – understanding the social, health, economic and environmental value of Food for Life commissions. The report presents summaries of the findings of each workstream, discusses themes emerging across the research, and sets out recommendations for Food for Life and associated evaluation activity

The “problem” of teacher quality: exploring challenges and opportunities in developing teacher quality during the Covid-19 global pandemic in England

Teachers and teacher education are often presented as “problems” to be solved, with policy solutions that focus on ways to make teachers “better” and improve teacher “quality” by introducing prescriptive strategies. We investigate the ways Covid-19-related changes to university and school-based facets of Initial Teacher Education (ITE) in England influence teacher quality in relation to both student teachers and early career teachers, working in secondary schools. Drawing on 34 interviews with school leaders, school mentors and ITE tutors, we critically explore the ways in which teacher quality was developed through key aspects of teachers’ pedagogy and practice during the pandemic crisis when schools were closed and teaching moved online. Our findings show that the pandemic crisis has highlighted the different facets of teacher quality which arguably disrupt narrow and prescriptive understandings of what constitutes “quality” in policy terms. Although there were many instances of challenge in the development of new and student teachers, our data also shows how ITE tutors, school mentors and leaders responded creatively to the crisis. Participants highlighted the opportunities afforded by the pandemic to develop diverse and innovative pedagogies and practice, enhance students’ subject knowledge, as well as overcome some of the challenges in other areas of pedagogy and practice. Furthermore, the study shows that teacher quality was not substantially reduced despite the challenges arising from the pandemic and concerns that pre-service teachers would not be ready and prepared for a career in the classroom