Hypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trial

Background Hawthorn (Crataegus laevigata) leaves, flowers and berries are used by herbal practitioners in the UK to treat hypertension in conjunction with prescribed drugs. Small-scale human studies support this approach. Aim To investigate the effects of hawthorn for hypertension in patients with type 2 diabetes taking prescribed drugs. Design of study Randomised controlled trial. Setting General practices in Reading, UK. Method Patients with type 2 diabetes (n = 79) were randomised to daily 1200 mg hawthorn extract (n = 39) or placebo (n = 40) for 16 weeks. At baseline and outcome a wellbeing questionnaire was completed and blood pressure and fasting blood samples taken. A food frequency questionnaire estimated nutrient intake. Results Hypotensive drugs were used by 71% of the study population with a mean intake of 4.4 hypoglycaemic and/or hypotensive drugs. Fat intake was lower and sugar intake higher than recommendations, and low micronutrient intake was prevalent. There was a significant group difference in mean diastolic blood pressure reductions (P = 0.035): the hawthorn group showed greater reductions (baseline: 85.6 mmHg, 95% confidence interval [Cl] = 83.3 to 87.8; outcome: 83.0 mmHg, 95% Cl = 80.5 to 85.7) than the placebo group (baseline: 84.5 mmHg, 95% Cl = 82 to 87; outcome: 85.0 mmHg, 95% Cl = 82.2 to 87.8). There was no group difference in systolic blood pressure reduction from baseline (3.6 and 0.8 mmHg for hawthorn and placebo groups, respectively; P = 0.329). Although mean fat intake met current recommendations, mean sugar intake was higher and there were indications of potential multiple micronutrient deficiencies. No herb-drug interaction was found and minor health complaints were reduced from baseline in both groups. Conclusions This is the first randomised controlled trial to demonstrate a hypotensive effect of hawthorn in patients with diabetes taking medication.

The graduate teacher programme in England: mentor training, quality assurance and the findings of inspection

In its recent report on the Graduate Teacher Programme (GTP), an employment-based route to Qualified Teacher Status (QTS) in England, the Government's Office for Standards in Education found that, although almost all trainees meet the standards required to qualify, too often they do so at an adequate level, rather than achieving the high levels of which they should be capable. The underlying reason for this is the quality of mentoring provided in the schools. The inspectors concluded that schoolbased trainers are often not adequately prepared for their role in implementing wide-ranging training programmes for trainee teachers. Despite this generally bleak picture, Ofsted concluded that 'the minority of cases of good practice in the training programmes and of high quality teaching by trainees indicate that the GTP can be an effective alternative route for training teachers'™. This article considers the strengths and weaknesses of the Graduate Teacher Programme, introduced in January 1998, and also reports on a small-scale project, funded by the Teacher Training Agency (TTA), the key objective of which was to strengthen the existing partnerships by improving the quality of school-based tutor training and continuous professional development of staff.

Creating teaching and learning in Europe: promoting a new paradigm

The tides of globalization and the unsteady surges and distortions in the evolution of the European Union are causing identities and cultures to be in a state of flux. Education is used by politicians as a major lever for political and social change through micro-management, but it is a crude tool. There can, however, be opportunities within educational experience for individual learners to gain strong, reflexive, multiple identities and multiple citizenship through the engagement of their creative energies. It has been argued that the twenty-first century needs a new kind of creativity characterized by unselfishness, caring and compassion—still involving monetary wealth, but resulting in a healthy planet and healthy people. Creativity and its economically derived relation, innovation, have become `buzz words' of our times. They are often misconstrued, misunderstood and plainly misused within educational conversations. The small-scale pan-European research study upon which this article is founded discovered that more emphasis needs to be placed on creative leadership, empowering teachers and learners, reducing pupils' fear of school, balancing teaching approaches, and ensuring that the curriculum and assessment are responsive to the needs of individual learners. These factors are key to building strong educational provision that harnesses the creative potential of learners, teachers and other stakeholders, values what it is to be human and creates a foundation upon which to build strong, morally based, consistent, participative democracies.

Changing Standards? Children's awareness and knowledge of features of written standard English at ages 10-11

This paper reports the findings of a small-scale research project, which investigated the levels of awareness and knowledge of written standard English of 10- and 11-year-old children in two English primary schools over a six-year period, coinciding with the implementation in the schools of the National Literacy Strategy (NLS). A questionnaire was used to provide quantitative and qualitative data relating to: features of writing which were recognised as standard or non-standard; children's understanding of technical terminology; variations between boys' and girls' performance; and the impact of the NLS over time. The findings reveal variations in levels of recognition of different non-standard features, differences between girls' and boys' recognition, possible examples of language change, but no evidence of a positive impact of the NLS. The implications of these findings are discussed both in terms of changes in educational standards and changes to standard English.

Hypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trial

Background: Hawthorn (Crataegus laevigata) leaves, flowers and berries are used by herbal practitioners in the UK to treat hypertension in conjunction with prescribed drugs. Small-scale human studies support this approach. Aim: To investigate the effects of hawthorn for hypertension in patients with type 2 diabetes taking prescribed drugs. Design of study: Randomised controlled trial. Setting: General practices in Reading, UK. Method: Patients with type 2 diabetes (n = 79) were randomised to daily 1200 mg hawthorn extract (n = 39) or placebo (n = 40) for 16 weeks. At baseline and outcome a wellbeing questionnaire was completed and blood pressure and fasting blood samples taken. A food frequency questionnaire estimated nutrient intake. Results: Hypotensive drugs were used by 71% of the study population with a mean intake of 4.4 hypoglycaemic and/or hypotensive drugs. Fat intake was lower and sugar intake higher than recommendations, and low micronutrient intake was prevalent. There was a significant group difference in mean diastolic blood pressure reductions (P = 0.035): the hawthorn group showed greater reductions (baseline: 85.6 mmHg, 95% confidence interval [Cl] = 83.3 to 87.8; outcome: 83.0 mmHg, 95% Cl = 80.5 to 85.7) than the placebo group (baseline: 84.5 mmHg, 95% Cl = 82 to 87; outcome: 85.0 mmHg, 95% Cl = 82.2 to 87.8). There was no group difference in systolic blood pressure reduction from baseline (3.6 and 0.8 mmHg for hawthorn and placebo groups, respectively; P = 0.329). Although mean fat intake met current recommendations, mean sugar intake was higher and there were indications of potential multiple micronutrient deficiencies. No herb-drug interaction was found and minor health complaints were reduced from baseline in both groups. Conclusions: This is the first randomised controlled trial to demonstrate a hypotensive effect of hawthorn in patients with diabetes taking medication.

In vitro fermentation of oat and barley derived beta-glucans by human faecal microbiota

Fermentation of beta-glucan fractions from barley [average molecular mass (MM), of 243, 172, and 137 kDa] and oats (average MM of 230 and 150 kDa) by the human faecal microbiota was investigated. Fractions were supplemented to pH-controlled anaerobic batch culture fermenters inoculated with human faecal samples from three donors, in triplicate, for each substrate. Microbiota changes were monitored by fluorescent in situ hybridization; groups enumerated were: Bifidobacterium genus, Bacteroides and Prevotella group, Clostridium histolyticum subgroup, Ruminococcus-Eubacterium-Clostridium (REC) cluster, Lactobacillus-Enterococcus group, Atopobium cluster, and clostridial cluster IX. Short-chain fatty acids and lactic acid were measured by HPLC. The C. histolyticum subgroup increased significantly in all vessels and clostridial cluster IX maintained high populations with all fractions. The Bacteroides-Prevotella group increased with all but the 243-kDa barley and 230-kDa oat substrates. In general beta-glucans displayed no apparent prebiotic potential. The SCFA profile (51 : 32 : 17; acetate : propionate : butyrate) was considered propionate-rich. In a further study a beta-glucan oligosaccharide fraction was produced with a degree of polymerization of 3-4. This fraction was supplemented to small-scale faecal batch cultures and gave significant increases in the Lactobacillus-Enterococcus group; however, the prebiotic potential of this fraction was marginal compared with that of inulin.

The ethical challenges of ubiquitous healthcare

Ubiquitous healthcare is an emerging area of technology that uses a large number of environmental and patient sensors and actuators to monitor and improve patients’ physical and mental condition. Tiny sensors gather data on almost any physiological characteristic that can be used to diagnose health problems. This technology faces some challenging ethical questions, ranging from the small-scale individual issues of trust and efficacy to the societal issues of health and longevity gaps related to economic status. It presents particular problems in combining developing computer/information/media ethics with established medical ethics. This article describes a practice-based ethics approach, considering in particular the areas of privacy, agency, equity and liability. It raises questions that ubiquitous healthcare will force practitioners to face as they develop ubiquitous healthcare systems. Medicine is a controlled profession whose practise is commonly restricted by government-appointed authorities, whereas computer software and hardware development is notoriously lacking in such regimes.

Wiener-System subspace identification for mobile wireless mm-wave networks

We discuss the feasibility of wireless terahertz communications links deployed in a metropolitan area and model the large-scale fading of such channels. The model takes into account reception through direct line of sight, ground and wall reflection, as well as diffraction around a corner. The movement of the receiver is modeled by an autonomous dynamic linear system in state space, whereas the geometric relations involved in the attenuation and multipath propagation of the electric field are described by a static nonlinear mapping. A subspace algorithm in conjunction with polynomial regression is used to identify a single-output Wiener model from time-domain measurements of the field intensity when the receiver motion is simulated using a constant angular speed and an exponentially decaying radius. The identification procedure is validated by using the model to perform q-step ahead predictions. The sensitivity of the algorithm to small-scale fading, detector noise, and atmospheric changes are discussed. The performance of the algorithm is tested in the diffraction zone assuming a range of emitter frequencies (2, 38, 60, 100, 140, and 400 GHz). Extensions of the simulation results to situations where a more complicated trajectory describes the motion of the receiver are also implemented, providing information on the performance of the algorithm under a worst case scenario. Finally, a sensitivity analysis to model parameters for the identified Wiener system is proposed.

Decreased frequency of North Atlantic polar lows associated with future climate warming

Every winter, the high-latitude oceans are struck by severe storms that are considerably smaller than the weather-dominating synoptic depressions1. Accompanied by strong winds and heavy precipitation, these often explosively developing mesoscale cyclones—termed polar lows1—constitute a threat to offshore activities such as shipping or oil and gas exploitation. Yet owing to their small scale, polar lows are poorly represented in the observational and global reanalysis data2 often used for climatological investigations of atmospheric features and cannot be assessed in coarse-resolution global simulations of possible future climates. Here we show that in a future anthropogenically warmed climate, the frequency of polar lows is projected to decline. We used a series of regional climate model simulations to downscale a set of global climate change scenarios3 from the Intergovernmental Panel of Climate Change. In this process, we first simulated the formation of polar low systems in the North Atlantic and then counted the individual cases. A previous study4 using NCEP/NCAR re-analysis data5 revealed that polar low frequency from 1948 to 2005 did not systematically change. Now, in projections for the end of the twenty-first century, we found a significantly lower number of polar lows and a northward shift of their mean genesis region in response to elevated atmospheric greenhouse gas concentration. This change can be related to changes in the North Atlantic sea surface temperature and mid-troposphere temperature; the latter is found to rise faster than the former so that the resulting stability is increased, hindering the formation or intensification of polar lows. Our results provide a rare example of a climate change effect in which a type of extreme weather is likely to decrease, rather than increase.

Child labour in African Artisanal Mining Communities: experiences from Northern Ghana

The issue of child labour in the artisanal and small-scale mining (ASM) economy is attracting significant attention worldwide. This article critically examines this ‘problem’ in the context of sub-Saharan Africa, where a lack of formal sector employment opportunities and/or the need to provide financial support to their impoverished families has led tens of thousands of children to take up work in this industry. The article begins by engaging with the main debates on child labour in an attempt to explain why young boys and girls elect to pursue arduous work in ASM camps across the region. The remainder of the article uses the Ghana experience to further articulate the challenges associated with eradicating child labour at ASM camps, drawing upon recent fieldwork undertaken in Talensi-Nabdam District, Upper East Region. Overall, the issue of child labour in African ASM communities has been diagnosed far too superficially, and until donor agencies and host governments fully come to grips with the underlying causes of the poverty responsible for its existence, it will continue to burgeon.

Overseas trained teachers: part of a problem or part of a solution?

Overseas trained teachers (OTTs) have grown in numbers during the past decade, particularly in London and the South East of England. In this recruitment explosion many OTTs have experienced difficulties. In professional literature as well as press coverage OTTs often become part of a deficit discourse. A small-scale pilot investigation of OTT experience has begun to suggest why OTTs have been successful as well as the principal challenges they have faced. An important factor in their success was felt to be the quality of support in school from others on the staff. Major challenges included the complexity of the primary curriculum. The argument that globalisation leads to brain-drain may be exaggerated. Suggestions for further research are made, which might indicate the positive benefits OTTs can bring to a school.

Livelihood diversification and the expansion of artisanal mining in rural Tanzania: drivers and policy implications

This paper provides an extended analysis of livelihood diversification in rural Tanzania, with special emphasis on artisanal and small-scale mining (ASM). Over the past decade, this sector of industry, which is labour-intensive and comprises an array of rudimentary and semi-mechanized operations, has become an indispensable economic activity throughout Sub-Saharan Africa, providing employment to a host of redundant public sector workers, retrenched large-scale mine labourers and poor farmers. In many of the region’s rural areas, it is overtaking subsistence agriculture as the primary industry. Such a pattern appears to be unfolding within the Morogoro and Mbeya regions of southern Tanzania, where findings from recent research suggest that a growing number of smallholder farmers are turning to ASM for employment and financial support. It is imperative that national rural development programmes take this trend into account and provide support to these people.

Sting jets in simulations of a real cyclone by two mesoscale models

The existence of sting jets as a potential source of damaging surface winds during the passage of extratropical cyclones has recently been recognized However, there are still very few published studies on the subject Furthermore, although ills known that other models are capable of reproducing sting jets, in the published literature only one numerical model [the Met Office Unified Model (MetUM)] has been used to numerically analyze these phenomena This article alms to improve our understanding of the processes that contribute to the development of sting jets and show that model differences affect the evolution of modeled sting jets A sting jet event during the passage of a cyclone over the United Kingdom on 26 February 2002 has been simulated using two mesoscale models namely the MetUM and the Consortium for Small Scale Modeling (COSMO) model to compare their performance Given the known critical importance of vertical resolution in the simulation of sting jets the vertical resolution of both models has been enhanced with respect to their operational versions Both simulations have been verified against surface measurements of maximum gusts, satellite imagery and Met Office operational synoptic analyses, as well as operational analyses from the ECMWF It is shown that both models are capable of reproducing sting jets with similar, though not identical. features Through the comparison of the results from these two models, the relevance of physical mechanisms, such as evaporative cooling and the release of conditional symmetric instability, in the generation and evolution of sting jets is also discussed

De-agrarianization, re-agrarianization and local economic development: re-orientating livelihoods in African artisanal mining communities

This article contributes to the debate on livelihood diversification in rural sub-Saharan Africa, focusing specifically on the growing economic importance of artisanal and small-scale mining (ASM) in the region. The precipitous decline in the value of many export crops and the removal of subsidies on crucial inputs such as fertilizers have made smallholder production unviable, forcing many farmers to ‘branch out’ into non-farm activities to supplement their incomes. One of the more popular destinations for poor farmers is the low-tech ASM sector which, because of its low barriers to entry, has absorbed millions of rural Africans over the past two decades, the majority of whom are engaged in the extraction of near-surface mineral deposits located on concessions that have been demarcated to multinational corporations. The efforts made hitherto to control this illegal mining activity, both through force and regulation, however, have had little effect, forcing many of the region’s governments and private sector partners to ‘re-think’ their approaches. One strategy that has gained considerable attention throughout the region is intensified support for agrarian-orientated activities, many of which, despite the problems plaguing smallholder agricultural sector and challenges with making it more economically sustainable, are being lauded as appropriate ‘alternative’ sources of employment to artisanal mining. After examining where artisanal mining fits into the de-agrarianization ‘puzzle’ in sub-Saharan Africa, the article critiques the efficacy of ‘re-agrarianization’ as a strategy for addressing the region’s illegal mining problem. A case study of Ghana is used to shed further light on these issues.

Working together? Parent and local authority views on the process of obtaining appropriate educational provision for children with autism spectrum disorders

Background: There is general agreement across all interested parties that a process of working together is the best way to determine which school or educational setting is right for an individual child with autism spectrum disorder. In the UK, families and local authorities both desire a constructive working relationship and see this as the best means by which to reach an agreement to determine where a child should be educated. It has been shown in published works 1 1. Batten and colleagues (Make schools make sense. Autism and education: the reality for families today; London: The National Autistic Society, 2006). View all notes that a constructive working relationship is not always achieved. Purpose: This small-scale study aims to explore the views of both parents and local authorities, focussing on how both parties perceive and experience the process of determining educational provision for children with autism spectrum disorders (ASD) within an English context. Sample, design and method: Parental opinion was gathered through the use of a questionnaire with closed and open responses. The questionnaire was distributed to two national charities, two local charities and 16 specialist schools, which offered the questionnaire to parents of children with ASD, resulting in an opportunity sample of 738 returned surveys. The views of local authority personnel from five local authorities were gathered through the use of semi-structured interviews. Data analyses included quantitative analysis of the closed response questionnaire items, and theme-based qualitative analysis of the open responses and interviews with local authority personnel. Results: In the majority of cases, parents in the survey obtained their first choice placement for their child. Despite this positive outcome, survey data indicated that parents found the process bureaucratic, stressful and time consuming. Parents tended to perceive alternative placement suggestions as financially motivated rather than in the best interests of the child. Interviews with local authority personnel showed an awareness of these concerns and the complex considerations involved in determining what is best for an individual child. Conclusions: This small-scale study highlights the need for more effective communication between parents of children with ASDs and local authority personnel at all stages of the process