Design and technology (D&T) and citizenship: changing attitudes?

By linking the Design Against Crime (DAC) Education initiative, funded by the Home Office and the Design Council, to the emerging Citizenship curriculum in schools it has been possible to provide D&T teachers with the opportunities to make their contribution to this new cross-curricular subject. The DAC education hypothesis is that understanding of, and attitudes to, crime issues can be modified if pupils are presented with a D&T project which has study of crime, and a focus on crime issues, embedded in it. The research, conducted during 2003, was to establish the extent to which this hypothesis can be proved. Two schools were involved in the project, one a large comprehensive school serving a mainly rural community, the second an urban comprehensive school with a varied catchment area. The research involved in excess of 100 pupils. Year 8 pupils in each school were divided into research and control groups. The initial research involved both groups in each school engaging in focus group activities to establish a bench mark about their attitudes to crime issues. The research groups did a DAC D&T project while the control groups worked through the school’s usual D&T scheme of work. Further focus group activities were used to establish the effects, if any, in pupils’ understanding and attitudes to crime. Teachers were also consulted about their experiences of managing DAC projects within D&T. The paper describes focus group work with pupils which included several innovative features, for example set tasks used to promote discussion and establish decision making. The paper concludes with a discussion about the encouraging results which demonstrate that the DAC projects did bring about a change. One aspect was a change in pupils’ ability to be discriminating when making complex judgements. Additionally, the interviews revealed fascinating information about pupils’ attitudes to social issues

Hypertension:A problem of organ blood flow supply-demand mismatch

This review introduces a new hypothesis that sympathetically mediated hypertensive diseases are caused, in the most part, by the activation of visceral afferent systems that are connected to neural circuits generating sympathetic activity. We consider how organ hypoperfusion and blood flow supply–demand mismatch might lead to both sensory hyper-reflexia and aberrant afferent tonicity. We discuss how this may drive sympatho-excitatory-positive feedback and extend across multiple organs initiating, or at least amplifying, sympathetic hyperactivity. The latter, in turn, compounds the challenge to sufficient organ blood flow through heightened vasoconstriction that both maintains and exacerbates hypertension

Long-term effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: follow-up of the CoBalT randomised controlled trial

Background: Cognitive behavioural therapy (CBT) is an effective treatment for people whose depression has not responded to antidepressants. However, the long-term outcome is unknown. In a long-term follow-up of the CoBalT trial, we examined the clinical and cost-effectiveness of cognitive behavioural therapy as an adjunct to usual care that included medication over 3–5 years in primary care patients with treatment-resistant depression. Methods: CoBalT was a randomised controlled trial done across 73 general practices in three UK centres. CoBalT recruited patients aged 18–75 years who had adhered to antidepressants for at least 6 weeks and had substantial depressive symptoms (Beck Depression Inventory [BDI-II] score ≥14 and met ICD-10 depression criteria). Participants were randomly assigned using a computer generated code, to receive either usual care or CBT in addition to usual care. Patients eligible for the long-term follow-up were those who had not withdrawn by the 12 month follow-up and had given their consent to being re-contacted. Those willing to participate were asked to return the postal questionnaire to the research team. One postal reminder was sent and non-responders were contacted by telephone to complete a brief questionnaire. Data were also collected from general practitioner notes. Follow-up took place at a variable interval after randomisation (3–5 years). The primary outcome was self-report of depressive symptoms assessed by BDI-II score (range 0–63), analysed by intention to treat. Cost-utility analysis compared health and social care costs with quality-adjusted life-years (QALYs). This study is registered with isrctn.com, number ISRCTN38231611. Findings: Between Nov 4, 2008, and Sept 30, 2010, 469 eligible participants were randomised into the CoBalT study. Of these, 248 individuals completed a long-term follow-up questionnaire and provided data for the primary outcome (136 in the intervention group vs 112 in the usual care group). At follow-up (median 45·5 months [IQR 42·5–51·1]), the intervention group had a mean BDI-II score of 19·2 (SD 13·8) compared with a mean BDI-II score of 23·4 (SD 13·2) for the usual care group (repeated measures analysis over the 46 months: difference in means −4·7 [95% CI −6·4 to −3·0, p<0·001]). Follow-up was, on average, 40 months after therapy ended. The average annual cost of trial CBT per participant was £343 (SD 129). The incremental cost-effectiveness ratio was £5374 per QALY gain. This represented a 92% probability of being cost effective at the National Institute for Health and Care Excellence QALY threshold of £20 000. Interpretation: CBT as an adjunct to usual care that includes antidepressants is clinically effective and cost effective over the long-term for individuals whose depression has not responded to pharmacotherapy. In view of this robust evidence of long-term effectiveness and the fact that the intervention represented good value-for-money, clinicians should discuss referral for CBT with all those for whom antidepressants are not effective

Food security outcomes under a changing climate: impacts of mitigation and adaptation on vulnerability to food insecurity

Climate change is a potential threat to achieving food security, particularly in the most food insecure regions. However, interpreting climate change projections to better understand the potential impacts of a changing climate on food security outcomes is challenging. This paper addresses this challenge through presenting a framework that enables rapid country-level assessment of vulnerability to food insecurity under a range of climate change and adaptation investment scenarios. The results show that vulnerability to food insecurity is projected to increase under all emissions scenarios, and the geographic distribution of vulnerability is similar to that of the present-day; parts of sub-Saharan Africa and South Asia are most severely affected. High levels of adaptation act to off-set these increases; however, only the scenario with the highest level of mitigation combined with high levels of adaptation shows improvements in vulnerability compared to the present-day. The results highlight the dual requirement for mitigation and adaptation to avoid the worst impacts of climate change and to make gains in tackling food insecurity. The approach is an update to the existing Hunger and Climate Vulnerability Index methodology to enable future projections, and the framework presented allows rapid updates to the results as and when new information becomes available, such as updated country-level yield data or climate model output. This approach provides a framework for assessing policy-relevant human food security outcomes for use in long-term climate change and food security planning; the results have been made available on an interactive website for policymakers ( www.metoffice.gov.uk/food-insecurity-index )

Massive Open Online Courses (MOOCs) as a Window into the Veterinary Profession

Catriona Bell – ORCID: 0000-0001-8501-1697 https://orcid.org/0000-0001-8501-1697Item not available in this repository.Previously deposited in Edinburgh University repository at: https://www.research.ed.ac.uk/en/publications/massive-open-online-courses-moocs-as-a-window-into-the-veterinaryMassive open online courses (MOOCs) are freely available online courses open to anyone who registers and typically are associated with thousands or hundreds of thousands of participants. Using an established online platform, the authors created and delivered a five-week MOOC aimed primarily at prospective veterinary students, but open to anyone with an interest in finding out more about the veterinary profession in general. 11,911 people signed up for the course, and of these, 8137 interacted in some way with the course and 1716 received a certificate of completion. The majority of participants (84 per cent) were female, and there was a wide age range (under 18 to over 65). Most participants were from North America or the UK. 65 per cent of those completing the entry survey were hoping or intending to work in the vet profession in the future, while 33 per cent were not. Qualitative data indicated that the course was helpful in aiding those undecided as to whether they wanted to be a veterinarian or not to decide one way or another whether they want to pursue veterinary medicine as a career. Furthermore, the course was seen as being a useful introduction to the veterinary profession even for those who had no intention of working in the field.https://doi.org/10.1136/vr.103979180pubpub

The Characteristics and Biological Relevance of Inorganic Amorphous Calcium Carbonate (ACC) Precipitated from Seawater

The importance of amorphous calcium carbonate (ACC) as a precursor phase in the biomineralization of marine calcifiers is increasingly being reported, particularly as the presence of ACC has been observed or inferred in several major groups. Here, we investigate the structure of ACC and the conditions required for its precipitation from seawater-based solutions, with an emphasis on the coinfluence of the carbonate system (pH, dissolved inorganic carbon (DIC) concentration), seawater Mg/Ca ratio, and presence of amino acids. We find that Mg2+ and the presence of aspartic acid, glutamic acid, and glycine strongly inhibit ACC precipitation. Moreover, we were unable to precipitate ACC from seawater with a carbonate chemistry within the range of that thought to characterize the calcification site of certain marine calcifiers (i.e., DIC < 6 mM, pH < 9.3), although substantial modification of the seawater Mg/Ca ratio (Mg/Casw) allowed precipitation at a reduced DIC with the implication that this could be an important component of utilizing an ACC pathway. In addition, the degree to which Mg/Casw and the presence of amino acids influences the structure of ACC and the necessary seawater [CO3 2-] for precipitation is strongly pH dependent. At lower, more biologically relevant pH than that typical of much inorganic work, decreasing Mg/Casw can result in greater long-range order and less water of crystallization but facilitates precipitation at a considerably lower [CO3 2-] than at higher pH