Comparison of estimates and calculations of risk of coronary heart disease by doctors and nurses using different calculation tools in general practice: cross sectional study

OBJECTIVE: To assess the effect of using different risk calculation tools on how general practitioners and practice nurses evaluate the risk of coronary heart disease with clinical data routinely available in patients' records. DESIGN: Subjective estimates of the risk of coronary heart disease and results of four different methods of calculation of risk were compared with each other and a reference standard that had been calculated with the Framingham equation; calculations were based on a sample of patients' records, randomly selected from groups at risk of coronary heart disease. SETTING: General practices in central England. PARTICIPANTS: 18 general practitioners and 18 practice nurses. MAIN OUTCOME MEASURES: Agreement of results of risk estimation and risk calculation with reference calculation; agreement of general practitioners with practice nurses; sensitivity and specificity of the different methods of risk calculation to detect patients at high or low risk of coronary heart disease. RESULTS: Only a minority of patients' records contained all of the risk factors required for the formal calculation of the risk of coronary heart disease (concentrations of high density lipoprotein (HDL) cholesterol were present in only 21%). Agreement of risk calculations with the reference standard was moderate (kappa=0.33-0.65 for practice nurses and 0.33 to 0.65 for general practitioners, depending on calculation tool), showing a trend for underestimation of risk. Moderate agreement was seen between the risks calculated by general practitioners and practice nurses for the same patients (kappa=0.47 to 0.58). The British charts gave the most sensitive results for risk of coronary heart disease (practice nurses 79%, general practitioners 80%), and it also gave the most specific results for practice nurses (100%), whereas the Sheffield table was the most specific method for general practitioners (89%). CONCLUSIONS: Routine calculation of the risk of coronary heart disease in primary care is hampered by poor availability of data on risk factors. General practitioners and practice nurses are able to evaluate the risk of coronary heart disease with only moderate accuracy. Data about risk factors need to be collected systematically, to allow the use of the most appropriate calculation tools.

Placements and degree performance:do placements lead to better marks, or do better students choose placements?

There has been a strong move recently to make degrees more applicable to employment; including work placements as part of the programme is one way of achieving this. Such placements are advocated to increase employability, but also for improving academic performance. This paper examines the relationship between undertaking a work placement and the class of degree achieved. It challenges earlier findings that undertaking a placement increases degree results. Studying seven cohorts of students, a well tested approach was employed that allows for sample selection – i.e. whether better students do placements rather than whether placements produce better students. The paper concludes that the sample selection is much stronger, i.e. placement students do better because they are better students. The results highlight that it is not merely doing a placement that matters, but a successful placement adds significantly to subsequent performance. The paper concludes with advice to students and policy makers.

Obstacles and solutions to maximising urban biodiversity throughout the lifecycles of major developments in England

Thus far, achieving net biodiversity gains through major urban developments has been neither common nor straightforward - despite the presence of incentives, regulatory contexts, and ubiquitous practical guidance tools. A diverse set of obstructions, occurring within different spatial, temporal and actor hierarchies, are experienced by practitioners and render the realisation of maximised biodiversity, a rarity. This research aims to illuminate why this is so, and what needs to be changed to rectify the situation. To determine meaningful findings and conclusions, capable of assisting applied contexts and accommodating a diverse range of influences, a ‘systems approach’ was adopted. This approach led to the use of a multi-strategy research methodology, to identify the key obstructions and solutions to protecting and enhancing biodiversity - incorporating the following methods: action research, a questionnaire to local government ecologists, interviews and personal communications with leading players, and literature reviews. Nevertheless, ‘case studies’ are the predominant research method, the focus being a ‘nested’ case study looking at strategic issues of the largest regeneration area in Europe ‘the Thames Gateway’, and the largest individual mixeduse mega-development in the UK (at the time of planning consent) ‘Eastern Quarry 2’ - set within the Gateway. A further key case study, focussing on the Central Riverside development in Sheffield, identifies the merits of competition and partnership. The nested cases, theories and findings show that the strategic scale - generally relating to governance and prioritisation - impacts heavily upon individual development sites. It also enables the identification of various processes, mechanisms and issues at play on the individual development sites, which primarily relate to project management, planning processes, skills and transdisciplinary working, innovative urban biodiversity design capabilities, incentives, organisational cultures, and socio-ecological resilience. From these findings a way forward is mapped, spanning aspects from strategic governance to detailed project management.

A snapshot of the lives of women with polycystic ovary syndrome:a photovoice investigation

Polycystic ovary syndrome affects 6  percent of women. Symptoms include hirsutism, acne, and infertility. This research explores the impact of polycystic ovary syndrome on women's lives using photovoice. Nine participants photographed objects related to their quality of life and made diary entries explaining each photograph. Three themes emerged from thematic analysis of the diaries: control (of symptoms and polycystic ovary syndrome controlling their lives), perception (of self, others, and their situation), and support (from relationships, health care systems, and education). These findings illuminate positive aspects of living with polycystic ovary syndrome and the role pets and social networking sites play in providing support for women with polycystic ovary syndrome.

Tissue transglutaminase and the progression of human renal scarring

ABSTRACT. Experimental renal scarring indicates that tissue transglutaminase (tTg) may be associated with the accumulation of extracellular matrix (ECM), both indirectly via TGF-β1 activation and directly by the formation of ε(γ-glutamyl) lysine dipeptide bonds within the ECM. The latter potentially accelerates deposition and confers the ECM with resistance to proteolytic digestion. Studied were 136 human renal biopsy samples from a range of chronic renal diseases (CRD) to determine changes in tTg and ε(γ-glutamyl) lysine crosslinking. Immunofluorescence for insoluble tTg showed a 14-fold increase in the kidneys of CRD patients (5.3 ± 0.5 versus 76 ± 54 mV/cm2), which was shown to be active by a similar 11-fold increase in the ε(γ-glutamyl) lysine crosslink (1.8 ± 0.2 versus 19.3 ± 14.2 mV/cm2). Correlations were obtained with renal function for tTg and crosslink. In situ hybridization for tTg mRNA showed that tubular epithelial cells were the major source of tTg; however, both mesangial and interstitial cells also contributed to elevated levels in CRD. This mRNA pattern was consistent with immunohistochemistry for soluble tTg. Changes in renal tTg and its product, the ε(γ-glutamyl) lysine crosslink, occur in progressive renal scarring in humans independently of the original etiology and in a similar manner to experimental models. tTg may therefore play a role in the pathogenesis of renal scarring and fibrosis in patients with CRD and can therefore be considered a potential therapeutic target. E-mail: T.Johnson@sheffield.ac.uk

The effect of ocular nutritional supplements on macular pigment optical density

This thesis describes the investigation of the effects of ocular supplements with different levels of nutrients on the macular pigment optical density (MPOD) in participants with healthy eyes. Abstract A review of the literature highlighted that ocular supplements are produced in various combinations of nutrients and concentrations. The ideal concentrations of nutrients such as lutein (L) have not been established. It was unclear whether different stages of eye disease require different concentrations of key nutrients, leading to the design of this study. The primary aim was to determine the effects of ocular supplements with different concentrations of nutrients on the MPOD of healthy participants. The secondary aim was to determine L and zeaxanthin (Z) intake at the start and end of the study through completion of food diaries. The primary study was split into two experiments. Experiment 1 was an exploratory study to determine sample size and experiment 2 the main study. Statistical power was calculated and a sample size of 38 was specified. Block stratification for age, gender and smoking habit was applied and from 101 volunteers 42 completed the study, 31 with both sets of food diaries. Four confounders were accounted for in the design of the study; gender, smoking habit, age and diet. Further factors that could affect comparability of results between studies were identified during the study and were not monitored; ethnicity, gastro-intestinal health, alcohol intake, body mass index and genetics. Comparisons were made between the sample population and the Sheffield general population according to recent demographic results in the public domain. Food diaries were analysed and shown to have no statistical difference when comparing baseline to final results. The average L and Z intake for the 31 participants who returned both sets of food diaries was initially 1.96mg and 1.51mg for the final food diaries. The effect of the two ocular supplements with different levels of xanthophyll (6mg lutein/zeaxanthin and 10mg lutein only) on MPOD was not significantly different over a four-month period.

Social and environmental accountability in developing countries

The principal aim of this chapter is to undertake a critical review of the social and environmental accountability of global business activities in developing countries. While global business activities have contributed to the economic development of developing countries they have many adverse social and environmental consequences which are often under-studied. I explore the role of accounting in making those consequences visible. The chapter, however, concludes that while social and environmental accounting has the potential to raise the visibility of social and environmental impacts of corporate activities it often fails to do so particularly under the current voluntary disclosure regime where corporations can choose what to report and how to report. This is even more pronounced in the developing countries because of their vulnerabilities arising from various social and environmental problems. The chapter argues for a case of ‘surrogate accountability’ as an alternative to the current corporate driven form of accountability.

‘Everything’s from the inside out with PCOS’:exploring women’s experiences of living with Polycystic Ovary Syndrome (PCOS) and co-morbidities through Skype™ interviews

Polycystic ovary syndrome is an endocrine disorder affecting 1 in 10 women. Women with polycystic ovary syndrome can experience co-morbidities, including depressive symptoms. This research explores the experience of living with polycystic ovary syndrome and co-morbidities. Totally, 10 participants with polycystic ovary syndrome took part in Skype™ interviews and analysed using thematic analysis. Four themes emerged from the data: change (to life plans and changing nature of condition); support (healthcare professionals, education and relationships); co-morbidities (living with other conditions and depression, self-harm and suicidal ideation) and identity (feminine identity and us and them). The findings highlight the need for screening of women with polycystic ovary syndrome for depressive disorders.

Managing the multiplicities of graduate level education! Are Master’s students’ expectations matched by their experiences?

With rapid increases in student fees reflecting moves towards a QUASI Market model of Higher Education in the UK and across much of the Western World[1], many universities find themselves having to meet progressively higher levels of student expectations[2]. This is particularly the case at undergraduate level, where increases in fees over the past decade have far exceeded inflation. Yet with so much attention on ‘consumer savvy’ undergraduates, the question of whether Master’s level students’ expectations are matched by their experiences is one which remains largely unanswered. Grounded in an empirically grounded approach to learning and teaching developed by the paper authors[3], this paper sets out to being to answer this question. In doing so it makes a distinctive contribution to debates about graduate level engineering education and concludes with a number of recommendations. Discussion: The ‘MSc: Managing Expectations’ Project analyses the expectations and experiences of Graduate level Engineering Management Students over a two year period. Focusingon the ‘student experience’, three main concepts are identified as being particular relevant to enhancing learning [3]: Relationships: Variety: Synergy. Relationships: Based on empirical research, the significance of Relationships within the academic environment is discussed with particular attention being paid to the value of students’ social and academic support networks, including academic tutoring. Variety: Grounded in a statistical analysis of ‘engagement data’ together with survey and interview findings, the concept of variety critically examines students’ perspectives and experiencesof different approaches to learning and teaching. Synergy: Possibly the most important concept discussed within this paper, the need for constructively aligned curriculum is extended to reflect the students’ apriori knowledge and experienceas well as employer and societal demands and expectations. The conclusion brings the different concepts within the discussion together, providing a set of practical recommendations for colleagues working both at graduate and undergraduate level. References 1.Gibbs, P. (2001) "Higher education as a market: a problem or solution?." Studies in Higher Education 26. 1. pp. 85-94. 2.Tricker, T., (2005) Student Expectations-How do we measure up. University of Sheffield. Available from: http://www.persons.org.uk/tricker%20paper.pdf Accessed 9/10/14 3.Clark, R. & Andrews, J. (2014). Relationships, Variety & Synergy [RVS]: The Vital Ingredients for Scholarship in Engineering Education? A Case-Study. European Journal of Engineering Education. 39.6. pp. 585-600.

Failing to meet expectations:the meaning of intimate partner violence for Pakistanis

Background: Intimate Partner Violence (IPV) is a major social and public health problem affecting people across cultures, religions and societies. Much research has been undertaken to offer understanding and explanations of this phenomenon, its determinants, and its consequences in developed countries around the world. However, there is still a paucity of research on IPV in many areas of the developing world such as Pakistan. Although various studies have been conducted to demonstrate the prevalence of IPV in the country, none of the studies have tried to explore the meaning of IPV from the perspective of Pakistani people. Aim: This study aimed to explore understandings of Pakistani men and women of IPV. It aimed to develop a theory to explain the meaning of IPV and the process through which it occurs, from the perspective of Pakistani people. Methods: The study utilised a qualitative approach with constructivist grounded theory methods and analysis techniques. Data was collected from Karachi, Pakistan and Sheffield, UK. Forty one people (20 from Pakistan and 21 from UK) participated in the study. Findings: The participants identified IPV as a serious concern. Although verbal abuse is often included in definitions of IPV, the participants did not consider shouting, raising the voice or scolding as a type of violence. Hitting, beating, pushing, throwing objects, and pulling hair were identified as acts of physical violence, and non-consensual sex was identified as a form of sexual abuse. Participants identified failure to meet role expectations of a husband or wife as a key contributor to the development of conflict between partners which could lead to IPV. Examples of various expectations from a wife include completing household chores, looking after husband, looking after children, looking after in laws, respecting and adjusting to in-law's customs and traditions. Important expectation from a husband include provision of finances, acting as a bridge, maintaining a balance between his wife and other family members particularly his mother and sisters, and taking the responsibility for his wife and children. Failure to meet these expectations could contribute to conflict and subsequent violence. This appeared to be shaped by cultural issues such as common use of arranged marriages, the rarity of divorce and the centrality of the extended family to the intimate partnership. Implications: Any interventions aimed at reducing IPV in Pakistani people must consider the meaning and causes of IPV from the perspective of that group.

The local dimension of employment-related welfare policy in Germany, England and Sweden

The link between work and welfare is a key pathway of modern welfare state development in Western Europe. National governments face a constant balancing act between the welfare expectations of the labour forces and the labour market liberalisation demands of the business communities. Facilitating the transit from welfare into employment has therefore become an important tool for the British, German and Swedish governments, providing labour as and when needed while keeping welfare expenditure in check. However, the approaches to organising active labour market policies are quite different, notably with regard to the territorial dimension. Although labour markets are quite diverse in all three cases, the role of local authorities, local agencies and local labour market actors from the private and voluntary sector are generally under-developed and apparently under-appreciated, but in different ways and for different reasons. The article compares current employment-related welfare provisions and approaches to develop active labour market policies in the three countries, and concludes that while certain structural and procedural similarities exist, the basic political priorities and actual support and services provided remain very far apart.