Monkey’s Guide to Healthy Living and NHS Services An evaluation of the implementation of resources designed to support the learning of primary school aged children in England

A team of researchers from the Faculty of Education, Health and Community recently carried out a national evaluation project on behalf of the NHS Institute for Innovation and Improvement. Colleagues from across the faculty were involved in evaluating the impact of resources provided to every primary school in England. The resources were designed to enable teachers and health professionals to work together to help children learn about the NHS and the range of services they could access if they required acute of emergency care

Updated fracture incidence rates for the US version of FRAX®

# The Author(s) 2009. This article is published with open access at Springerlink.com Summary On the basis of updated fracture and mortality data, we recommend that the base population values used in the US version of FRAX ® be revised. The impact of suggested changes is likely to be a lowering of 10-year fracture probabilities. Introduction Evaluation of results produced by the US version of FRAX ® indicates that this tool overestimates the likelihood of major osteoporotic fracture. In an attempt to correct this, we updated underlying fracture and mortality rates for the model. Methods We used US hospital discharge data from 2006 t

Blood pressure variability and night-time dipping assessed by 24-hour ambulatory monitoring: Cross-sectional association with cardiac structure in adolescents

Greater blood pressure (BP) is associated with greater left ventricular mass indexed to height2.7 (LVMi2.7) in adolescents. This study examined whether greater BP variability and reduced night-time dipping are associated with cardiac remodeling in a general population of adolescents. A cross-sectional analysis was undertaken in 587 UK adolescents (mean age 17.7 years; 43.1% male). BP was measured in a research clinic and using 24-hour ambulatory monitoring. We examined associations (for both systolic and diastolic BP) of: 1) clinic and 24-hour mean BP; 2) measures of 24-hour BP variability: standard deviation weighted for day/night (SDdn), variability independent of the mean (VIM) and average real variability (ARV); and 3) night-time dipping with cardiac structures. Cardiac structures were assessed by echocardiography: 1) LVMi2.7; 2) relative wall thickness (RWT); 3) left atrial diameter indexed to height (LADi) and 4) left ventricular internal diameter in diastole (LVIDD). Higher systolic BP was associated with greater LVMi2.7. Systolic and diastolic BP were associated with greater RWT. Associations were inconsistent for LADi and LVIDD. There was evidence for associations between both greater SDdn and ARV and higher RWT (per 1 SD higher diastolic ARV, mean difference in RWT was 0.13 SDs, 95% CI 0.045 to 0.21); these associations with RWT remained after adjustment for mean BP. There was no consistent evidence of associations between night-time dipping and cardiac structure. Measurement of BP variability, even in adolescents with blood pressure in the physiologic range, might benefit risk of cardiovascular remodeling assessment

Bifidobacterium breve reduces apoptotic epithelial cell shedding in an exopolysaccharide and MyD88-dependent manner

Certain members of the microbiota genus Bifidobacterium are known to positively influence host well-being. Importantly, reduced bifidobacterial levels are associated with inflammatory bowel disease (IBD) patients, who also have impaired epithelial barrier function, including elevated rates of apoptotic extrusion of small intestinal epithelial cells (IECs) from villi—a process termed ‘cell shedding’. Using a mouse model of pathological cell shedding, we show that mice receiving Bifidobacterium breve UCC2003 exhibit significantly reduced rates of small IEC shedding. Bifidobacterial-induced protection appears to be mediated by a specific bifidobacterial surface exopolysaccharide and interactions with host MyD88 resulting in downregulation of intrinsic and extrinsic apoptotic responses to protect epithelial cells under highly inflammatory conditions. Our results reveal an important and previously undescribed role for B. breve, in positively modulating epithelial cell shedding outcomes via bacterial- and host-dependent factors, supporting the notion that manipulation of the microbiota affects intestinal disease outcomes

A meta-analytical review of the impact of mindfulness on creativity: Framing current lines of research and defining moderator variables

Findings relating to the impact of mindfulness interventions on creative performance remain inconsistent, perhaps because of discrepancies between study designs, including variability in the length of mindfulness interventions, the absence of control groups or the tendencies to explore creativity as one unitary construct. To derive a clearer understanding of the impact that mindfulness interventions may exert on creative performance, two meta-analytical reviews were conducted, drawing respectively on studies using a control group design (n = 20) and studies using a pretest–posttest design (n = 17). A positive effect was identified between mindfulness and creativity, both for control group designs (d = 0.42, 95% CIs [0.29, 0.54]) and pretest–posttest designs (d = 0.59, 95% CIs [0.38, 0.81]). Subgroup analysis revealed that intervention length, creativity task (i.e., divergent vs. convergent thinking tasks) and control group type, were significant moderators for control group studies, whereas only intervention length was a significant moderator for pretest–posttest studies. Overall, the findings support the use of mindfulness as a tool to enhance creative performance, with more advantageous outcomes for convergent as opposed to divergent thinking tasks. We discuss the implications of study design and intervention length as key factors of relevance to future research aimed at advancing theoretical accounts of the relationship between mindfulness and creativity

Modelling Future Coronary Heart Disease Mortality to 2030 in the British Isles.

OBJECTIVE: Despite rapid declines over the last two decades, coronary heart disease (CHD) mortality rates in the British Isles are still amongst the highest in Europe. This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking and physical activity levels, dietary salt and saturated fat intakes on future CHD mortality in three countries: Northern Ireland (NI), Republic of Ireland (RoI) and Scotland. METHODS: CHD mortality models previously developed and validated in each country were extended to predict potential reductions in CHD mortality from 2010 (baseline year) to 2030. Risk factor trends data from recent surveys at baseline were used to model alternative future risk factor scenarios: Absolute decreases in (i) smoking prevalence and (ii) physical inactivity rates of up to 15% by 2030; relative decreases in (iii) dietary salt intake of up to 30% by 2030 and (iv) dietary saturated fat of up to 6% by 2030. Probabilistic sensitivity analyses were then conducted. RESULTS: Projected populations in 2030 were 1.3, 3.4 and 3.9 million in NI, RoI and Scotland respectively (adults aged 25-84). In 2030: assuming recent declining mortality trends continue: 15% absolute reductions in smoking could decrease CHD deaths by 5.8-7.2%. 15% absolute reductions in physical inactivity levels could decrease CHD deaths by 3.1-3.6%. Relative reductions in salt intake of 30% could decrease CHD deaths by 5.2-5.6% and a 6% reduction in saturated fat intake might decrease CHD deaths by some 7.8-9.0%. These projections remained stable under a wide range of sensitivity analyses. CONCLUSIONS: Feasible reductions in four cardiovascular risk factors (already achieved elsewhere) could substantially reduce future coronary deaths. More aggressive polices are therefore needed in the British Isles to control tobacco, promote healthy food and increase physical activity

Discovery of mating in the major African livestock pathogen Trypanosoma congolense

The protozoan parasite, Trypanosoma congolense, is one of the most economically important pathogens of livestock in Africa and, through its impact on cattle health and productivity, has a significant effect on human health and well being. Despite the importance of this parasite our knowledge of some of the fundamental biological processes is limited. For example, it is unknown whether mating takes place. In this paper we have taken a population genetics based approach to address this question. The availability of genome sequence of the parasite allowed us to identify polymorphic microsatellite markers, which were used to genotype T. congolense isolates from livestock in a discrete geographical area of The Gambia. The data showed a high level of diversity with a large number of distinct genotypes, but a deficit in heterozygotes. Further analysis identified cryptic genetic subdivision into four sub-populations. In one of these, parasite genotypic diversity could only be explained by the occurrence of frequent mating in T. congolense. These data are completely inconsistent with previous suggestions that the parasite expands asexually in the absence of mating. The discovery of mating in this species of trypanosome has significant consequences for the spread of critical traits, such as drug resistance, as well as for fundamental aspects of the biology and epidemiology of this neglected but economically important pathogen

Unveiling buried aeolian landscapes: reconstructing a late Holocene dune environment using 3D ground-penetrating radar

Across the UK, sandy beaches and dunes protect coastal infrastructure from waves and extreme water levels during large-scale storms, while providing important habitats and recreational opportunities. Understanding their long-term evolution is vital in managing their condition in a changing climate. Recently, ground-penetrating radar (GPR) methods have grown in popularity in geomorphological applications, yielding centimetre-scale resolution images of near-surface stratigraphy and structure, thus allowing landscape evolution to be reconstructed. Additionally, abrupt changes in palaeo-environments can be visualized in three dimensions. Although often complemented by core data, GPR allows interpretations to be extended into areas with minimal ground-truth control. Nonetheless, GPR data interpretation can be non-intuitive and ambiguous, and radargrams may not initially resemble the expected subsurface geometry. Interpretation can be made yet more onerous when handling the large 3D data volumes that are facilitated with modern GPR technology. Here we describe the development of novel semi-automated GPR feature-extraction tools, based on ‘edge detection’ and ‘thresholding’ methods, which detect regions of increased GPR reflectivity which can be applied to aid in the reconstruction of a range Quaternary landscapes. Since reflectivity can be related to lithological and/or pore fluid changes, the 3D architecture of the palaeo-landscape can be reconstructed from the features extracted from a geophysical dataset. We present 500 MHz GPR data collected over a buried Holocene coastal dune system in North Wales, UK, now reclaimed for use as an airfield. Core data from the site, reaching a maximum depth 2 m, suggest rapid vertical changes from sand to silty-organic units, and GPR profiles suggest similar lateral complexity. By applying thresholding methods to GPR depth slices, these lateral complexities are effectively and automatically mapped. Furthermore, automatic extraction of the local reflection power yields a strong correlation with the depth variation of organic content, suggesting it is a cause of reflectivity contrast. GPR-interpolated analyses away from core control thus offer a powerful proxy for parameters derived from invasive core logging. The GPR data collected at Llanbedr airfield highlight a complex dune system to a depth of 2.8 m, probably deposited in several phases over ~700 years, similar to elsewhere in North Wales

Identification of patients who will not achieve seizure remission within 5 years on AEDs

Objective: To identify people with epilepsy who will not achieve a 12-month seizure remission within 5 vyears of starting treatment. Methods: The Standard and New Antiepileptic Drug (SANAD) study is the largest prospective study in patients with epilepsy to date. We applied a recently developed multivariable approach to the SANAD dataset that takes into account not only baseline covariates describing a patient’s history before diagnosis but also follow-up data as predictor variables. Results: Changes in number of seizures and treatment history were the most informative timedependent predictors and were associated with history of neurologic insult, epilepsy type, age at start of treatment, sex, and having a first-degree relative with epilepsy. Our model classified 95% of patients. Of those classified, 95% of patients observed not to achieve remission at 5 years were correctly classified (95% confidence interval [CI] 89.5%–100%), with 51% identified by 3 years and 90% within 4 years of follow-up. Ninety-seven percent (95% CI 93.3%–98.8%) of patients observed to achieve a remission within 5 years were correctly classified. Of those predicted not to achieve remission, 76% (95% CI 58.5%–88.2%) truly did not achieve remission (positive predictive value). The predictive model achieved similar accuracy levels via external validation in 2 independent United Kingdom–based datasets. Conclusion: Our approach generates up-to-date predictions of the patient’s risk of not achieving seizure remission whenever new clinical information becomes available that could influence patient counseling and management decisions

Trial Protocol: Randomised controlled trial of the effects of very low calorie diet, modest dietary restriction, and sequential behavioural programme on hunger, urges to smoke, abstinence and weight gain in overweight smokers stopping smoking

Background\ud Weight gain accompanies smoking cessation, but dieting during quitting is controversial as hunger may increase urges to smoke. This is a feasibility trial for the investigation of a very low calorie diet (VLCD), individual modest energy restriction, and usual advice on hunger, ketosis, urges to smoke, abstinence and weight gain in overweight smokers trying to quit. \ud \ud Methods\ud This is a 3 armed, unblinded, randomized controlled trial in overweight (BMI > 25 kg/$m^2$), daily smokers (CO > 10 ppm); with at least 30 participants in each group. Each group receives identical behavioural support and NRT patches (25 mg(8 weeks),15 mg(2 weeks),10 mg(2 weeks)). The VLCD group receive a 429-559 kcal/day liquid formula beginning 1 week before quitting and continuing for 4 weeks afterwards. The modest energy restricted group (termed individual dietary and activity planning(IDAP)) engage in goal-setting and receive an energy prescription based on individual basal metabolic rate(BMR) aiming for daily reduction of 600 kcal. The control group receive usual dietary advice that accompanies smoking cessation i.e. avoiding feeling hungry but eating healthy snacks. After this, the VLCD participants receive IDAP to provide support for changing eating habits in the longer term; the IDAP group continues receiving this support. The control group receive IDAP 8 weeks after quitting. This allows us to compare IDAP following a successful quit attempt with dieting concurrently during quitting. It also aims to prevent attrition in the unblinded, control group by meeting their need for weight management. Follow-up occurs at 6 and 12 months. \ud \ud Outcome measures include participant acceptability, measured qualitatively by semi-structured interviewing and quantitatively by recruitment and attrition rates. Feasibility of running the trial within primary care is measured by interview and questionnaire of the treatment providers. Adherence to the VLCD is verified by the presence of urinary ketones measured weekly. Daily urges to smoke, hunger and withdrawal are measured using the Mood and Physical Symptoms Scale-Combined (MPSS-C) and a Hunger Craving Score (HCS). 24 hour, 7 day point prevalence and 4-week prolonged abstinence (Russell Standard) is confirmed by CO < 10 ppm. Weight, waist and hip circumference and percentage body fat are measured at each visit. \ud \ud Trial Registration\ud Current controlled trials ISRCTN83865809\ud \u