Patients with heart attacks are increasingly treated with balloons and stents (angioplasty) to open large arteries blocked by blood clots. Despite removing the blockage, blood flow to the heart muscle may not be fully restored due to poor flow in the small blood vessels of the heart. This ‘small vessel obstruction’ is variable and often hard to detect but when it occurs is associated with higher rates of repeat heart attacks, heart failure and death. Heart specialists do not know currently how best to limit ‘small vessel obstruction’. Strategies to improve blood flow to the heart following angioplasty for a heart attack are very important to reduce death and long term complications. This study will take place at 2 major hospitals in the UK: Glenfield Hospital (Leicester) and Leeds General Infirmary. 297 patients presenting within 6 hours of a heart attack will be allocated randomly to 1 of 3 groups: Group1. standard angioplasty to serve as control group. Groups 2 and 3 will receive standard therapy and either one of the study's two drugs, both of which may improve blood supply by limiting the amount of small vessel obstruction, given via a very small tube placed beyond the blockage in the affected heart artery (Group 2. adenosine and Group 3. sodium nitroprusside). The effectiveness of the drugs in reducing ‘small vessel obstruction’ will be assessed using state of the art MRI scanners. MRI can accurately quantify the amount of ‘small vessel obstruction’ and heart muscle damage that will ultimately form scar tissue. Importantly, the size of the heart attack and the degree of obstruction to blood flow on MRI are strongly related to subsequent complications following a heart attack. Additionally the effect of the drugs on how the ‘sticky’ cells in the blood function, which contribute to small vessel obstruction, will be assessed. Ethical issues: Heart attacks must be treated very quickly to limit the amount of heart muscle that is damaged and thus patients will be given a short information sheet and be asked to give written assent before being randomly allocated to one of the treatment arms in the study. Patients will subsequently be asked to give fully informed consent for continued participation in the study, on the day following their heart attack. This strategy has been used in several studies and allows scientists to investigate new treatments which may save lives in patients with a heart attack. The research team is being led by Prof. Gershlick from Leicester, who is a world recognised expert in the treatment of patients with heart attacks. He will be supported by experts in heart MRI scanning, and Prof. Keith Abrams, an expert in running clinical trials. The money used in the grant will support the research team, 2 part-time nurses, a laboratory technician and will cover the costs of the MRI scans. The NHS will cover other important blood tests that will tell us how effective the respective study drugs are.

Chronic diseases are a major challenge for human health in the 21st century. The UK and worldwide burden of chronic disease is expected to increase in future years. Chronic Obstructive Pulmonary Disease (COPD) is an important chronic disease of the chest and is a leading cause of disability among older people. Muscle wasting and weakness is an important feature of COPD. Patients with muscle wasting are more disabled, have a poorer prognosis and require more healthcare resources. Loss of muscle bulk and function is important because it may be a treatable consequence of a condition in which the underlying lung disease is usually irreversible. The value of this approach is illustrated by the benefits of physical training, which have been clearly demonstrated in COPD. However, little is known about the causes of muscle wasting and weakness or the mechanisms by which physical training improves muscle function in COPD. We have recently identified genes involved in the regulation of muscle wasting and growth in healthy young and elderly humans and demonstrated that the functioning of these genes is profoundly affected by periods of immobility and exercise. Recent work has also demonstrated that dietary supplementation of protein enhances muscle growth during exercise training in healthy humans. We will extend these observations to study muscle wasting and growth in the clinical setting of COPD. We will study the functioning of genes recently identified as important in the regulation of muscle growth and wasting in patients with COPD compared with healthy volunteers of the same age. We will also study the effects of an eight-week lower limb strength-training programme on the functioning of these genes. This will help us understand how training works and how training affects the genes that regulate muscle growth. It may be beneficial to supplement individuals with additional dietary protein at the time of training. We will test this theory by randomly allocating patients in the study to receive a protein rich drink or a non-nutritive placebo after each bout of training. We will also measure muscle bulk and muscle function during the study. This research will provide new insights into the genetic mechanisms of muscle wasting and weakness and how the functioning of these genes can be influenced by interventions such as training and nutrition. This information will be a significant advance in the development of new treatments aimed at improving muscle function in chronic diseases such as COPD.

Abstracts are not currently available in GtR for all funded research. This is normally because the abstract was not required at the time of proposal submission, but may be because it included sensitive information such as personal details.

The Department of Health (DH) and the NHS are particularly exercised by climate change. Whereas the occupants of other building types might consider raising their comfort temperature thresholds a little in summer and suspend the use of mechanical cooling, NHS patients' well being and safety may well be compromised by higher summer temperatures. In fact the DH and the NHS are hit by a double whammy, the pressure to reduce energy consumption, colliding with the pressure to protect their patients and staff from overheating, the dangers of which were manifest in recent years' summer heatwaves. Innovative low energy design strategies and techniques will be required both for new buildings and, most importantly, for the existing building stock, the 27,701,676 square metres of the NHS Retained Estate. However there are many barriers to the implementation of such innovative interventions in NHS buildings, patient safety being paramount. Worries include the inability to achieve stable temperature control and safe ventilation (the airborne transmission of pathogens is an emerging science as our colleague Dr.Cath Noakes freely admits), the proliferation in the use of medical equipment adding heat to hospital interiors and the mechanics of modern contractual arrangements which place private companies in charge of the Facilities Management of health buildings, which, unsurprisingly, given the penalties they face, are ultra-cautious about adopting change.This project, 'Design and delivery of Robust Hospital Environments in a Changing Climate' (DeDeRHECC), will investigate these conundra to come up with economical and practical low energy refurbishment strategies for existing hospitals. It will derive a closer definition of resilience in the context of an acute hospital and, most particularly, the criteria set for hospital environments for the various categories of space found in hospitals; non-clinical, patient rooms, diagnostic and treatment, even operating theatres. The team is sceptical that these all align into a cherent requirement and will review UK and US criteria. Using four sets of hospital sites drawn from the project's four participating major NHS Trusts, it will 'catalogue' basic hospital building types from this sizeable sample of NHS stock, identify those most frequently occurring, assess their current resilience to climate change and propose appropriate solutions or clusters of interventions for each 'type'. It will model these ideas so that relative energy savings can be quantified and their resilience to warming external temperatures determined. It will cost them. It will calculate the lifetime running costs and energy savings and assess Value for Money. It will also examine the procurement environment in which these innovative solutions need to be delivered, the protocols by which refurbishment projects are designed, approved and implemented. Their delivery will incur risks. The project will take innovative risk assessment tools for change, developed for engineering design, and apply them to these future large and medium scale construction projects. It will develop processes to make the integration of these innovative, low energy interventions into hospital refurbishment projects smoother and more familiar to those who will be delivering them. It will produce guidance and worked examples in text and web form and, most significantly, as a DVD film of participants discussing the challenges, their anxieties, the ideas and how to deliver them. Accompanying animations will communicate the strategies and communications vividly and quickly to very busy people.

Since 2001 government policy has created a new set of professionals, Emergency Care Practitioners (ECPs), and a new style of urgent healthcare provision to support the vision of a healthcare service designed around the patient. ECPs are paramedics and nurses with additional training to treat patients at home, in minor injuries units or to stabilise patients for transport to specialist clinical units. Although professional training has been developed for ECPs there has been no research to look at the technologies needed to support this new role. This project is looking at emergency and urgent care work in detail. We propose that supporting technologies can be delivered as Smart Pods with three components: a vehicle/docking system, a treatment (vehicle) unit and a treatment package system (equipment and consumables). The first stage of the project is to model the operational systems to determine the distribution of the vehicle/docking systems for the Smart Pods to deliver the right care at the right time in the right place. At the same time we will be working with clinical partners in the East Midlands and South West to look at 4-6 treatment types (including chest pain, minor head injuries, minor illnesses and falls). These treatment types will be analysed in detail in A&E departments, minor injuries units and ambulance services to look for similarities and differences in clinical practice to provide the framework for the treatment packages and initial data for the layout in the treatment (vehicle) unit. We will propose a standardised pathway for the treatment types and will use a simulation mannequin to test the clinical treatment unit layout in a laboratory with doctors, nurses and ECPs.We will start working on the design of the vehicle by reviewing the current systems and looking at distribution and delivery systems in other industries, e.g. military, car breakdown services, food delivery. We will look at how new emergency care vehicles are ordered, purchased and manufactured and compare this with other low-volume vehicle manufacturing (e.g. Lotus, Maclaren) to help us develop viable solutions. This information will be used to look at both manufacturing and purchasing issues to explore if the Smart Pods concept is viable.Vehicle engineering and associated systems options will be surveyed, in particular chassis/drive chain and intelligent vehicle technologies and we will consider sustainability issues in terms of full life-cycle energy usage. Computer models and animation scenarios covering the full range of proposed SmartPod applications will be developed. The final part of this first phase of the project will start to consider issues of implementation in more depth with patient groups representing people affected by a range of urgent and emergency care conditions. We will also consult members of the lay public, clinicians, and those involved in the planning for, managing, and evaluating urgent and emergency care to investigate views on change in the provision of urgent and emergency care and to identify any unanticipated challenges (e.g. political, organisational, cultural) in implementing change.