DIRECT, which stands for DIabetes REsearCh for patient straTification, brings together scientists, clinicians and the pharmaceutical industry from across Europe to improve the treatment of Type 2 Diabetes (T2D).

DIRECT collaborators will work towards developing drug therapies personalised to individual Type 2 diabetes (T2D) patients’ needs, using existing or new methods.

Key to the work will be the ‘stratifying’, or categorisation, of subtypes of T2D. Rather than one single cause T2D may have many causes and can vary greatly between those affected. Different subtypes of T2D may progress rapidly or slowly, or respond very differently to the same treatment. Despite this, at present most patients with T2D are treated in the same way.

Researchers will work to discover, develop and apply biomarkers, or tests, that can predict who gets diabetes, whose diabetes deteriorates rapidly after diagnosis, and who responds well or poorly to treatment. This in turn will lead to the development of new drugs to improve the treatment of patients with diabetes.

It is a unique collaboration of leading European academic groups and pharmaceutical companies in the field of diabetes in Europe.

Researchers from the South West join experts from 21 academic institutions and four pharmaceutical research organisations across Europe, comprising some 150 researchers.

The Royal Devon & Exeter hospital is the lead central co-ordinating laboratory for the project.  Clinical scientist, leading this laboratory work, Dr Tim McDonald said: “Our role with the DIRECT project will be to co-ordinate in the region of 250,000 blood and urine samples from across Europe over the next three years. The Royal Devon & Exeter is well placed to do this work – our chemistry laboratories already carry out about 16,000 tests a day for the healthcare community including over 80 GP surgeries and 15 community hospitals. We are delighted to be involved in this work which we hope will enhance the lives of many people with or at risk of having diabetes. The significance though of this work for the RD&E and our partners cannot be underestimated in terms of the status and profile in the international research community.”

Professor Andrew Hattersley, Professor of Molecular Medicine at PCMD, commented: “It is a testament to the success of our research in the South West that we are now part of an important pan-European collaboration between academics, clinicians and pharmaceutical companies. We will benefit from some of the resources created by DIRECT, which in turn will contribute to our internationally recognised research. This is not only good news for research in the region but also for the many millions of patients, diagnosed and yet to be discovered, who will benefit from our work and the work of our colleagues across Europe.” 

The project is supported by the Innovative Medicines Initiative (IMI), a unique Public Private Partnership (PPP) between European Union and the pharmaceutical industry (represented by the European Federation of Pharmaceutical Industries and Associations / EFPIA). The EU contributes to this PPP a total of €1billion over 10 years, which is matched in-kind by the EFPIA member companies.

The researchers are from the PCMD-based National Institute for Health Research (NIHR) Peninsula Collaboration for Health, Operational Research and Development (PenCHORD), which is part of the NIHR Peninsula Collaboration for Leadership and Applied Health Research and Care (PenCLAHRC).

The study is investigating the whole process of emergency treatment that follows when a person suffers an acute stroke from a blocked artery in the brain. For most patients in this situation, the earliest possible administration of the clot-busting drug Alteplase can greatly improve their chances of recovery – called thrombolysis. The drug is currently licensed for delivery up to three hours from the onset of a stroke, but in that time the patient needs to call an ambulance, get to hospital, have a brain scan, and be assessed by specialists before receiving the treatment.

The research team is working with healthcare professionals from SWASFT and the RD&E to analyse the various steps by which a stroke patient is identified, transported to hospital and treated. This includes paramedics, the emergency department (ED) team, triage nurses, the acute stroke team and the radiology department (which performs the brain scans).

By investigating what happens ‘on the ground’, researchers have been able to create computer simulations that imitate the various permutations of stroke victim identification, transport, arrival at hospital and treatment.

The computer model takes into account the number and level of healthcare professionals involved with each case, the time of day or night, and the ‘busy-ness’ of the various hospital departments involved in the treatment process.

Their analysis of over 1400 episodes of care has enabled them to identify the bottlenecks in the system, and take steps to speed up the process of emergency care which can lead to earlier clot-busting treatment.  The researchers estimate that the number of people whose stroke could be greatly improved by earlier treatment could treble.

The research has already led to the introduction of a pilot for early referral to the acute stroke team at the moment the ambulance arrives at the ED. The pilot was introduced in December 2011 and early figures already show that the changes have led to a doubling of the number of patients admitted with acute stroke receiving clot-busting treatment within the three hour window (the national average is just five per cent: the national target is 10 per cent).

The research team is currently working on a thorough evaluation of the pilot scheme, as well as developing a mobile phone referral method that ambulance crews can use to inform the stroke team that a patient is on their way – so reducing the time the patient spends in the ED before receiving thrombolysis.

Professor Stuart Logan, Director of PenCLAHRC, commented: “This  project shows just how powerful  close collaboration between academics, clinicians and managers can  improve patient outcome. Research can sometimes feel like a luxury, this is the kind of work that reminds us of why with proper partnerships can have immediate impact. We look forward to the next stages  of the study, which has the potential for major impact nationally and internationally.”

Dr Martin James, Consultant Physician and Lead Clinician for Stroke at the RD&E said: “Our work with academic researchers in PenCHORD to build the computer simulation has been a great example of the NHS collaborating with Universities to improve care.  Using the simulation has enabled us to identify and unblock the bottlenecks in getting the treatment to patients much more quickly than we could in the past.  What used to takes us months or even years of trial and error can be accomplished in an afternoon using the simulation. This means that research findings can be applied to the care of patients much more quickly, and reduce the misery of disability after a stroke, which is what these collaborations are all about.”

James Wenman, the Clinical Development Manager for the South Western Ambulance Service NHS Foundation Trust said, “We are delighted to be working in partnership with the Peninsula College of Medicine and Dentistry, and our colleagues at the RD&E on this important project. Improving the services we provide to patients who have experienced a stroke is a key priority for SWASFT. The sooner patients receive treatment, the greater their chance of survival, which means they are more likely to make a full recovery. The Trust aims to deliver the right care in the right place at the right time, and this initiative will undoubtedly help us to achieve this in our ongoing quest to save lives.”

The School is keen to recruit more local children to take part in dental education training and receive free dental treatment at its facilities in Truro and Derriford.

The facilities are used to train third and fourth year dental students respectively. The sort of treatments available include: dental check-ups, oral examination and diagnosis including X-rays; advice for preventing tooth decay and gum disease including tooth brushing and oral hygiene instruction, dietary advice and the application of sealants that protect the surfaces of teeth; assessment and treatment of gum disease; fillings and extractions.

Many adults have received treatments from dental students, but the Peninsula Dental School is now pleased to be able to offer more treatment sessions for children.

Meanwhile, in Exeter the School is hoping to recruit around 300 people to help train first year dental students.

The Dental Education Facility, based in Heavitree, is used between March and July each year to train dental students in treating NHS patients.

Under the supervision of qualified dental clinicians, the first year students are able to perform dental check-ups, take Xrays, provide oral health advice and provide fillings when needed.

Before coming to the Dental Education Facility in Exeter, students will have already honed their clinical skills in a dental treatment simulation lab in Plymouth, where ‘artificial heads’ are used to emulate situations and conditions the students might face with real patients.

In order for the students to gain the right level of practical experience, the Peninsula Dental School needs around 300 patients to come to the facility between 12^th March and mid-July.

Professor Gill Jones from the Peninsula Dental School commented: “This is a great way for local people to contribute to the training of the dentists of tomorrow, and receive free treatments too. All the treatments take place under the supervision of a qualified dentist and after the students have developed their clinical skills in our simulation lab in Plymouth. Treatments take slightly longer than usual, because our students are learning as well as treating.”

Appointments can be made by calling 01872 258100 in Truro, 01392 405350 in Exeter and at Derriford on 0845 155 8109.

The Peninsula Dental School is the first new dental school in the UK for 40 years and graduated its first cohort of students last July. It now runs four Dental Education Facilities across Exeter, Plymouth and Truro which, when at full capacity during term time, treat over 500 NHS patients each day.

Employment law experts at Stones have teamed up with PhD students from the Drama Department at the University of Exeter to create an event designed to shed light on what happens at an employment tribunal. It is believed that the first time that a law firm and a university have worked in partnership in this way. 

The event is a combination of seminar, presentation and dramatic representation formats, taking those attending through the paperwork that goes with a tribunal case, the roles of individuals within a tribunal and the issues that employers face when a disgruntled employee takes them to a tribunal.

The roles of the characters at the mock tribunal – claimant, defendant, legal teams, witnesses, judge, lay members – will be taken by members of the Employment Team at Stones and PhD drama students from the University of Exeter.

John Turnbull, Partner and Head of the Employment Team at Stones, said: “In many cases, the first experience an employer has of an employment tribunal is when they are taken to one by an employee. By combining our seminar/presentation with dramatic re-enactments we hope to create a realistic scenario, supported by paperwork and explanations throughout the event, which will give those who attend an authentic flavour of what is involved with an employment tribunal.”

 He added: “We are delighted to be working with PhD students from the Drama Department at the University of Exeter. Their involvement makes this event even more exciting and their skills and expertise will add additional veracity to proceedings.”

Fiona Macbeth, Senior Teaching Fellow at the Drama Department, University of Exeter, added: “Stones has provided us with an excellent opportunity to get students involved in a project that takes drama into a real life situation. Not only will it give some of our PhD students a superb experience to add to their CVs, but it will also be valuable to our other students who will be able to sit in on rehearsals and the mock tribunal event and see how the art of drama can work with the world of business.”

The mock tribunal will take place between 9.00am and 1.00pm on Thursday 22^nd March 2012, at Exeter Racecourse. Places are limited and are available free of charge to clients of Stones Solicitors, and at a charge of £25 to non-clients. The event includes refreshments and copies of supporting documentation to take away. All attendees will receive a Certificate of Attendance for the relevant hours of CPD. To book a place please contact Eleanor Wilson at Stones on 01392 666777, eleanorwilson@stones-solicitors.co.uk.

Researchers from the European Centre for Environment & Human Health, along with several Australian institutions, have found that children living in areas with lower levels of sunlight are at greater risk of developing food allergies and the skin condition eczema, compared to those in areas with higher UV.

The research team used data from a study of Australian children and analysed how rates of food allergy, eczema and asthma varied throughout the country.  As well as finding a link between latitude and allergies to peanut and egg, the results showed that on average children in the south of the country are twice as likely to develop eczema as those in the north.

The report builds upon existing evidence that suggests exposure to the sun may play a role in rising levels of food allergy and eczema.  Sunlight is important because it provides our body with the fuel to create vitamin D in the skin, and locations closer to the equator typically receive higher levels of sunshine.  Australia is a particularly good place for this type of study as it spans nearly 3000 miles from north to south, with a large variation in climate, day length and sun strength – from Queensland in the north to Tasmania in the south.

Dr Nick Osborne, who led the research, believes these findings provide us with an important insight into the prevalence of food allergies and eczema, which appear to be on the increase.  Dr Osborne also cautioned that exposure to sunlight can vary for a host of reasons beyond latitude, such as local climate variations and behaviours, and these factors will also need to be considered.

He said “This investigation has further underlined the association between food allergies, eczema and where you live.  We’re now hoping to study these effects at a much finer scale and examine which factors such as temperature, infectious disease or vitamin D are the main drivers of this relationship. As always, care has to be taken we are not exposed to too much sunlight, increasing the risk of skin cancer.”

Dr Osborne will be presenting the findings of the study at the American Academy of Allergy, Asthma & Immunology in Orlando on March 6^th 2012.

 The study is published in the Journal of Allergy and Clinical Immunology this week.

Elmo and his friends are starring in Sesame Street Live at the Plymouth Pavilions, but he is taking time out of his schedule to come to the centre between 4.00pm and 5.00pm to meet his fans.

Rachel Stephens, marketing manager at Drake Circus, said: “Elmo is hugely popular with kids of all ages and we are looking forward to welcoming him to the centre. You’re advised to arrive in plenty of time to avoid disappointment!”

Taking place between 12^th and 19^th February, businesses are encouraged to get members of staff to bring in a lunch to share, with donations made to the charity for the meal. It’s a great opportunity for star bakers and budding chefs to show off their talents to work colleagues and make a difference to the lives of older people in the region.

Businesses are also encouraged to invite elderly people to join their workplace feasts. 

One business taking the lead in the Big Hearty Meal campaign is Stones Solicitors LLP. At the law firm, different departments are preparing different courses for members of staff and guests to enjoy, on Friday 17^th February. Adrian Richards, Chief Operating Officer at the firm, said: “This is a great way to bring together everyone within the business, and to raise money for a charity that does such vital work for an often neglected section of our community. We would urge other businesses in the county to take part in the campaign, have some fun, and raise some serious money for Age UK Devon.”

As well as inviting businesses to take part, Age UK Devon is also asking individuals to hold dinner parties and other meals for family and friends as part of the Big Hearty Meal campaign. Restaurants and cafes across the county, including Moore’s restaurant in Newton Poppleford and The Anchor Inn in Sidmouth, are also taking part by donating a percentage of their takings during the Big Hearty Meal week.

Rachel Johnstone from Age UK Devon said: “Our thanks go to businesses such as Stones which are offering their support for our Big Hearty Meal campaign. We hope that as many businesses as possible across the county take part – we’d love to hear how their events went and what they had to eat!”

She added: “The money raised by this campaign will help us to assist older people with loneliness and related issues. More than half of those over the age of 75 live alone – and about one in ten say they suffer from ‘intense’ loneliness. Loneliness can lead to depression and other emotional and physical health problems.”

To take part in the Big Hearty Meal, businesses should contact Rachel on 0845 296 7810 or at r.johnstone@ageukdevon.co.uk. Donations to Age UK Devon can be made by cheque or online at www.virginmoneygiving.com/charities/ageukdevon.

 The findings add support to the calls for both-arm blood pressure checks to be performed as standard.

 The review is published in The Lancet online today (30^th January) and the study is supported by the Royal College of General Practitioners, the South West GP Trust and the National Institute for Health Research Peninsula Collaboration for Leadership in Applied Health Research and Care.

 The study reviewed 28 papers covering difference in systolic blood pressure between arms. It found significant evidence to suggest that a difference of 15mm Hg or more was associated with increased risk of: peripheral vascular disease (the narrowing and hardening of the arteries that supply blood to the legs and feet); pre-existing cerebrovascular disease (affecting the blood supply to the brain and often associated with cognitive issues such as dementia); and mortality, both as a result of cardiovascular problems and generally.

 The risk of peripheral vascular disease was also increased at a difference of 10mm Hg or more.

 The findings further support the need for both-arm blood pressure checks to be the norm – not least because most cases are ‘clinically silent’ and such checks would better identify those at risk.

 Dr. Christopher Clark, Clinical Academic Fellow at PCMD and a GP in Witheridge, Devon, led the study. He said: “We set out to investigate whether there was an association between differences in systolic blood pressure between arms and vascular disease and mortality. Our findings indicate a strong association, and that differences of 10mm Hg or 15mm Hg or more might help to identify patients who are at risk and who need further vascular assessment. More research is required in order to transfer our findings to clinical practice, but in the meanwhile we will be flagging the results of our review to the UK Vascular Check programme.”

A selection of around 2000 households has been chosen for the study, which will initially involve the completion of a health and wellbeing survey. The questionnaire will arrive in letterboxes across the city next week and is designed to be completed by household residents over the age of 16.

The study is being undertaken by researchers from the European Centre for Environment and Human Health, part of the Peninsula College of Medicine and Dentistry, and is the first part of a detailed investigation into the relationships between people and their local neighbourhoods. The team are keen to receive as many responses as possible and hope that residents will be eager to participate in future stages of the study.

Dr Ben Wheeler, who is leading the research said “There is a growing body of evidence that suggests use of the environment can improve our physical and mental health. We want to understand how this can be achieved in urban environments and Truro provides us with the perfect location to do this. Ultimately we’re hoping this study will help us to recommend measures that will enhance the health and wellbeing of city residents.”

An international team of researchers has discovered 13 new regions of the genome associated with the timing of menopause. These genes shed light on the biological pathways involved in reproductive lifespan and will provide insights into conditions connected to menopause, such as breast cancer and heart disease.

Menopause  is a major hormonal change that affects most women when they are in their early 50s. The timing of menopause can have a huge impact on fertility, as well as influencing the risk of a range of common diseases such as breast cancer.  It has been known for some time that genetic factors influenced the onset of menopause, however until recently very few genes had been identified.

In the new study, published in the journal Nature Genetics on 22 January 2012, Dr Anna Murray, University of Exeter, Peninsula College of Medicine and Dentistry (PCMD) Dr John Perry, PCMD and WTCHG, University of Oxford, and dozens of international collaborators, examined the genomes of over 50,000 women. They identified 13 novel gene regions associated with menopause onset, and confirmed four previously identified. Most of the 17 regions include genes related to DNA damage/repair or the immune system, whilst others are linked to hormonal regulation.

Dr Perry said: “The new findings highlight biological pathways not previously associated with reproductive lifespan, and may provide insights into the other conditions connected with menopause age, such as cardiovascular disease and breast cancer.”

The association with breast cancer is related to the length of time a woman menstruates in total and is thought to be related to oestrogen exposure over a lifetime – in fact earlier menopause is protective for breast cancer. Cardiovascular risk is increased in post-menopausal women compared to pre-menopausal and reduced oestrogen is thought to be a key component of this increased risk. Genetic studies will be beneficial in working out exactly what the relationships are between these conditions.

Dr. Murray added: “Menopause is a process most women go through, yet we know very little about what governs the timing of this key event in a woman’s life. By finding out which genes control the timing of menopause we hope to be able understand why this happens very early to some women, reducing their chances of having children naturally.” 

The authors said they expected further research will identify additional genes, and also assess the impact of these genetic regions on related reproductive disorders. The research team are currently investigating women who had very early menopause, before 45 years, to determine whether the new menopause genes play a role in this clinically important condition which affects over five per cent of women.

Besides Dr Murray and Dr Perry, senior authors on the study include Professor Kathryn Lunetta and Dr Joanne Murabito at the Boston University schools of Public Health and Medicine, and Jenny A. Visser, a scientist at Erasmus Medical Center in Rotterdam (Netherlands).