The utility of pulse volume waveforms in the identification of lower limb arterial insufficiency

Background: The ankle brachial index is widely used for non-invasive assessment of lower limb arterial status, but has recognised limitations. The most significant limitation involves arterial calcification, which results in artefactually raised occlusion pressures and uninformative ankle brachial indices. Hypothesis: Analysis of the pulse volume waveform is useful for identification of lower limb arterial insufficiency in the presence of arterial calcification. Method: Individuals (n = 1101) registered at a Welsh general practice were invited to undergo cardiovascular risk assessment. The ankle brachial index was measured using an automated device utilising volume plethysmography and the traditional Doppler ultrasound method. Results: Eight percent of participants (30/368) had an ankle brachial index *1.3, suggesting possible arterial calcification; consideration of the pulse volume waveform in these cases identified possible mild peripheral arterial disease in three cases (10%). Furthermore, in one case, the ankle brachial indices were within the normal range, but the pulse volume waveforms suggested a moderate degree of arterial insufficiency; this participant was subsequently diagnosed with bilateral superficial femoral artery stenoses and treated accordingly. Conclusion: Pulse volume waveforms can be easily utilised as an adjunct to ankle brachial index measurement to identify patients who may benefit from further vascular assessment and interventio

A multi-method evaluation of a community initiative intended to improve the quality of healthcare in the Gypsy and Traveller communities

Although small-scale initiatives have taken place attempting to address the inequality in health of Gypsies and Travellers, these have had little impact nationally, being isolated and lacking impartial evaluation. Consequently, healthcare access and health status of UK Gypsy/Travellers remains very poor. This thesis is a multi-method evaluation of a complex intervention designed to improve the healthcare of Gypsies and Travellers in Wrexham. An ethnographic method was used providing both 'insiders' and 'outsiders' perspectives. Participant observations and a series of interviews with Gypsy/Travellers and service providers were undertaken, together with a study of Gypsy/Travellers' coronary and mental health status. The combination and interaction of these studies provide an overall evaluation of the community health initiative. Gypsy/Travellers' culture, lifestyle, health beliefs and experiences of healthcare are described. Gypsy/Travellers hold a strong sense of cultural identity and their lives are governed by strict rules and cultural expectations. To break the rules risks being ostracised from the community. Family life is all important and religion is fundamental to Gypsy/Traveller lives. Also, they experience wide spread discrimination which results in defensive, mistrust of non- Gypsy/Travellers. Gypsy/Travellers' CHD and mental health status have been described. Results suggest that they engage in higher CHD risk behaviours than the general population and high levels of depression and anxiety were found. The community health initiative consisting of a full-time Project Health Worker who provides an outreach service by means of a mobile health unit is described. The aim is to increase access to healthcare and develop culturally acceptable methods to improve CHD health of this group. The strengths and weaknesses of the initiative are explored and the complex interactions between culture, health and the initiative are discussed. Finally, several key elements are identified which contribute to the success of the initiative and the continuation of the initiative is discussed

The utility of pulse volume waveforms in the identification of lower limb arterial insufficiency

Background: The ankle brachial index is widely used for non-invasive assessment of lower limb arterial status, but has recognised limitations. The most significant limitation involves arterial calcification, which results in artefactually raised occlusion pressures and uninformative ankle brachial indices. Hypothesis: Analysis of the pulse volume waveform is useful for identification of lower limb arterial insufficiency in the presence of arterial calcification. Method: Individuals (n = 1101) registered at a Welsh general practice were invited to undergo cardiovascular risk assessment. The ankle brachial index was measured using an automated device utilising volume plethysmography and the traditional Doppler ultrasound method. Results: Eight percent of participants (30/368) had an ankle brachial index *1.3, suggesting possible arterial calcification; consideration of the pulse volume waveform in these cases identified possible mild peripheral arterial disease in three cases (10%). Furthermore, in one case, the ankle brachial indices were within the normal range, but the pulse volume waveforms suggested a moderate degree of arterial insufficiency; this participant was subsequently diagnosed with bilateral superficial femoral artery stenoses and treated accordingly. Conclusion: Pulse volume waveforms can be easily utilised as an adjunct to ankle brachial index measurement to identify patients who may benefit from further vascular assessment and interventio

Changes in the prevalence and correlates of weight-control behaviors and weight perception in adolescents in the UK, 1986-2015

Importance: In the context of the growing prevalence of childhood obesity, behaviors aimed at weight loss and their psychological burden might be increasing. Objective: To investigate whether the prevalence of weight-control behaviors and weight perception, including their association with depressive symptoms, has changed in the 3 decades between 1986 and 2015. Design, Setting, and Participants: This study used data from repeated cross-sections from successive longitudinal birth cohort studies. These included general population samples of UK adolescents aged 14 to 16 years from 3 ongoing birth cohorts: the British Cohort Study 1970 (children born between April 5 and 11, 1970; data collected in 1986), the Avon Longitudinal Study of Parents and Children (mothers with expected delivery between April 1, 1991, and December 21, 1992; data collected in 2005), and the Millennium Cohort Study (children born between September 1, 2000, and January 11, 2002; data collected in 2015). A total of 22 503 adolescents with data available on at least 1 weight-control or weight-perception variable in midadolescence were included in the study. Data were analyzed from August 1, 2019, to January 15, 2020. Main Outcomes and Measures: Self-reported lifetime dieting and exercise for weight loss, current intentions about weight (doing nothing, lose weight, stay the same, gain weight), and weight perception (underweight, about the right weight, overweight) adjusted for body mass index. The secondary outcome was depressive symptoms. Exposures: The main exposure was time (ie, cohort); secondary exposures were weight-change behaviors and weight perception. Results: The study cohort included 22 503 adolescents (mean [SD] age, 14.8 [0.3] years; 12 061 girls [53.6%]; and 19 942 White individuals [89.9%]). A total of 5878 participants were from the British Cohort Study, 5832 were from the Avon Longitudinal Study of Parents and Children, and 10 793 were from the Millennium Cohort Study. In 2015, 4809 participants (44.4%) had dieted and 6514 (60.5%) had exercised to lose weight compared with 1952 (37.7%) and 344 (6.8%) in 1986. Furthermore, 4539 (42.2%) were trying to lose weight in 2015 compared with 1767 (28.6%) in 2005. Although girls were more likely to report these behaviors in all years, their prevalence increased more in boys over time (lifetime dieting in boys: odds ratio [OR], 1.79; 95% CI, 1.24-2.59; in girls: OR, 1.23; 95% CI, 0.91-1.66; currently trying to lose weight in boys: OR, 2.75; 95% CI, 2.38-3.19; in girls: OR, 1.70; 95% CI, 1.50-1.92). Adolescents also became more likely to overestimate their weight (boys describing themselves as overweight adjusting for body mass index, 2005 vs 1985 OR, 1.60; 95% CI, 1.17-2.19; 2015 vs 1985 OR, 1.36; 95% CI, 1.04-1.80; girls describing themselves as underweight, after adjusting for body mass index, 2015 vs 1986 OR, 0.51; 95% CI, 0.28-0.91). Girls who described themselves as overweight experienced increasingly greater depressive symptoms over time compared to girls who described their weight as about right (mean difference 1986, 0.32; 95% CI, 0.22-0.41; mean difference 2005, 0.33; 95% CI, 0.24-0.42; mean difference 2015, 0.56; 95% CI, 0.49-0.62). Conclusions and Relevance: These findings suggest that the growing focus on obesity prevention might have had unintended consequences related to weight-control behaviors and poor mental health. Public health campaigns addressing obesity should include prevention of disordered eating behaviors and be sensitive to negative impact on mental health

Hot water immersion acutely increases postprandial glucose concentrations

Background: Chronic hot water immersion (HWI) confers health benefits, including a reduction in fasting blood glucose concentration. Here we investigate acute glycaemic control immediately after HWI. Methods: Ten participants (age: 25 ± 6 years, body mass: 84 ± 14 kg, height 1.85 ± 0.09 m) were immersed in water (39ºC) to the neck (HWI) or sat at room temperature (CON) for 60 min. One hour afterwards they underwent an oral glucose tolerance test (OGTT), with blood collected before and after HWI/CON and during the 2 h OGTT. Results: Glucose incremental area under the curve (iAUC) during the OGTT was higher for HWI (HWI 233 ± 88, CON 156 ± 79 mmol·L-1·2h, P = 0.02). Insulin iAUC did not differ between conditions (HWI 4309 ± 3660, CON 3893 ± 3031 mU·L-1·2h, P=0.32). Core temperature increased to 38.6 ± 0.2°C during HWI, but was similar between trials during the OGTT (HWI 37.0 ± 0.2, CON 36.9 ± 0.4°C, P=0.34). Directly following HWI, plasma average adrenaline and growth hormone concentrations increased 2.7 and 10.7-fold, respectively (P < 0.001). Plasma glucagon like peptide-1, peptide YY and acylated ghrelin concentrations were not different between trials during the OGTT (P > 0.11). Conclusions: HWI increased postprandial glucose concentration to an OGTT, which was accompanied by acute elevations of stress hormones following HWI. The altered glycaemic control appears to be unrelated to changes in gut hormones during the OGTT

The experience of student parents in Higher Education during COVID

While some challenges may be temporary, the Covid-19 pandemic is likely to lead to longer term changes in UK HE, particularly in terms of remote learning, and it is important to consider how these will affect different types of students. This research therefore contributes to London Metropolitan’s Education for Social Justice Framework (ESJF), particularly in relation to ‘accessibility’, ‘relationships’ and ‘identity’ (London Metropolitan University, 2022b).Our findings reflected existing research on student parents in that time (or more precisely, lack of time) was a key factor in the learning of student parents (Allison 2017)

Court Awards of Damages for Loss of future Earnings: An Empirical Study and an Alternative Method of Calculation

This article examines the effect upon damages for personal injury of methods used in the United States of America to calculate loss of future earnings. The work of lawyers is examined from the perspective of labour economists. The damages calculated by using these alternative methods are compared with those actually awarded in over a hundred cases determined by courts in England and Wales. This interdisciplinary and comparative study reveals that the tort system fails to satisfy one of its main objectives in that it does not provide recipients of damages with ‘full’ compensation

CAMAU Project: Research Report (April 2018)

‘Learning about Progression’ is a suite of research-based resources designed to provide evidence to support the building of learning progression frameworks in Wales. ‘Learning about Progression’ seeks to deepen our understanding of current thinking about progression and to explore different purposes that progression frameworks can serve to improve children and young people’s learning. These resources include consideration of how this evidence relates to current developments in Wales and derives a series of principles to serve as touchstones to make sure that, as practices begin to develop, they stay true to the original aspirations of A Curriculum for Wales – A Curriculum for Life. It also derives, from the review of evidence, a number of fundamental questions for all those involved in the development of progression frameworks to engage

CAMAU Project: Research Report (April 2018)

‘Learning about Progression’ is a suite of research-based resources designed to provide evidence to support the building of learning progression frameworks in Wales. ‘Learning about Progression’ seeks to deepen our understanding of current thinking about progression and to explore different purposes that progression frameworks can serve to improve children and young people’s learning. These resources include consideration of how this evidence relates to current developments in Wales and derives a series of principles to serve as touchstones to make sure that, as practices begin to develop, they stay true to the original aspirations of A Curriculum for Wales – A Curriculum for Life. It also derives, from the review of evidence, a number of fundamental questions for all those involved in the development of progression frameworks to engage