Topic 1 Resources

Salters-Nuffield Advanced Biology Resources Activity 1.
1 Student Sheet
MARK’S AND PETER’S STORIES
Purpose
 To provide an overview of some symptoms and treatments of cardiovascular disease (CVD) using
personal accounts.
 To identify some risk factors for the development of CVD.
 To provide an introduction to the topic.
 To practise extracting relevant information when reading text.
Procedure
The two passages below are Mark’s and Peter’s own accounts of their experiences with CVD. As you
read each account, note down relevant information about:
a symptoms
b diagnostic tests
c treatments
d any features of each person’s lifestyle that you think might have contributed to their
development of the disease.
When identifying information in this way, try to be selective and concise in the notes you make.
Mark’s story
By Mark Tolley
I’m 34 now, but 19 years ago something momentous happened that changed my life.
On 28th July 1995, I was sitting in my bedroom playing on my computer when I started to feel dizzy
with a slight headache. Standing, I lost all balance and was feeling very poorly. I think I can remember
trying to get downstairs and into the kitchen before fainting. People say that unconscious people can
still hear. I don’t know if it’s true, but I can remember my Dad phoning for a doctor and that was it. It
took five minutes from me being an average 15-year-old to being in a coma.
I was rushed to Redditch Alexandra Hospital where they did some reaction tests on me. They asked
my parents questions about my lifestyle (did I smoke, take drugs, etc.?). Failing to respond to any
stimulus, I was transferred in an ambulance to Coventry Walsgrave Neurological Ward. Following CT
and MRI scans on my brain it was concluded that I had suffered a bleed on my brain. My parents
signed the consent form for me to have an operation lasting many hours. I was given about a 30%
chance of survival.
They stopped the bleed by clipping the blood vessels that had burst with metal clips, removing the
excess blood with a vacuum. I was then transferred to the intensive care unit to see if I would recover.
Within a couple of days I was conscious and day by day regained my sight, hearing and movement
(although walking and speech were still distorted). They had shaved all my hair off!
I had a remarkably quick recovery considering the severity of the operation. I was talking again
(although slurred and jumbled) within five days. By the end of the week, I was transferred back to
Redditch Alexandra Hospital to continue the rest of my recovery.
There I received occupational therapy, physiotherapy, and speech and language therapy to improve my
coordination, speech and strength. Within seven days I could walk aided and talk better – I was then
discharged to complete my recovery at home. I was given a wheelchair and was admitted for therapy
as an outpatient. The occupational therapy trained my ability to perform everyday tasks. They made
me make tea, do jigsaws, etc. to improve my cognitive skills.
Another effect that the haemorrhage had on me was that the whole right-hand side of my body was
weakened (the haemorrhage happened on the left side of my brain) and things that I took for granted
Safety checked, but not trialled by CLEAPSS. Users may need to adapt the risk assessment information to local circumstances.
© 2015 University of York, developed by University of York Science Education Group.
This sheet may have been altered from the original. Page 1 of 4
Salters-Nuffield Advanced Biology Resources Activity 1.1 Student Sheet
before became a challenge. My left hand compensated for the weakness and gradually I became
stronger, albeit on my former weaker side!
Three weeks later I returned to Coventry Walsgrave for an angiogram, where an X-ray dye was
injected into my veins to show up my blood vessels on a scan. However, this showed that there was
still a bleed occurring and so I was prepared for surgery once again.
The operation was lengthy, but not an emergency. However, I was still warned of the dangers of such
surgery. The operation did not leave me with much disability this time and I woke up within a day of
being transferred back into the intensive care unit again. Speech and movement were regained quickly.
I was discharged to outpatients within three weeks, after undergoing another angiogram, and MRI and
CT scans on my brain. Embarrassingly, they had shaved only half my hair off this time!
The following Wednesday I was called back to the Coventry & Warwick Hospital where my
neurosurgeon held a clinic. He said that there was still a small bleed that needed to be clipped. So I
was transferred to Walsgrave for my third operation. This one not being as severe, I woke up minutes
after the operation with my faculties fully intact. I could talk and walk aided. Following more scans,
the next week I was discharged again to complete my recovery at home. This was now late October
1995. Things such as stair climbing became easier and I no longer required my wheelchair.
I have had no further episodes of brain haemorrhage activity apart from occasional headaches. I am on
anti-convulsant tablets (phenytoin) as I am now at a much higher risk from epileptic seizures because
of the surgery (although I have not had a fit since the operations). I completed physiotherapy in
November 1995, by doing exercises that improved my stamina, motor skills and coordination.
Although I have never been told a full reason why I suffered my stroke, I am certain that it was due to
being born with weak blood vessels in my brain that gave way after years of increasing pressure. I’m
glad I was at home when it happened: I could have been swimming or walking in the countryside with
nobody around!
Returning to school in November, I found reading, writing and walking a challenge. I was treated
differently from other students, which I found difficult as I wanted to fit back into my normal routine.
In 2001, I passed my exams, my driving test and travelled around the world. In 2004, I met my wife
whom I married in 2008. We now live together with our two cats. I have held several jobs, including
building computers and working in a wine merchants. I now repair and maintain computers at a
Further Education College, which is a challenging but enjoyable job.
Despite my stroke being some time ago, there are many residual effects that I have to deal with,
particularly my short term memory, despite my best efforts of keeping a diary (I forget to fill it in!).
My mind seems to go into ‘autopilot’; simple, day-to-day actions and processes we take for granted
suddenly became challenging and unpredictable. However, with some cognitive behavioural therapy I
have learned to live with my limitations and find my memory loss less stressful to deal with.
With social media, getting in touch with other survivors has never been easier and I made several
friends who have been through similar experiences to my own. We share our stories, advice, coping
mechanisms and companionship via a forum, which helps us all live our post-stroke lives.
I felt that in the rush to get me back to school and complete my education, my emotional recovery was
overlooked, which led to me struggling to deal with my thoughts and feelings about the stroke.
Needing an outlet for this frustration, I poured all my effort into my love of writing and music. I began
to tell my stroke story in the form of a blog that quickly became a full-sized paperback book that I
completed in the summer of 2010, called Four Minute Warning (referring to the four minutes it
approximately took for me to go from a normal teenager to falling unconscious). My book has been
well received, leading to several press and BBC Radio interviews and an opportunity to speak at the
Annual UK Stroke Forum. Keen to further my goal of becoming a full-time author, I have begun to
create a range of books about the ‘Frisson’ effect music has on the body (goosebumps, cold chills,
etc.), called ‘Shiver Project’. I am hoping to one day find a publisher and see ‘Shiver Project’ become
a success.
Thank you for reading this.
Mark xx
Peter’s story
By Peter Kempson
I remember clearly the first time I held a hockey stick at school; football wasn’t on the sports
programme, so it became hockey, rugby and cricket in each of the terms.
During my time at the school I developed a keen interest in all sports, representing the school in
hockey and athletics. It did not distract me from my school work, but seemed to make me more
attentive and kept my mind more active.
After leaving school I still maintained my sporting interest, representing Bedfordshire at hockey and
taking part in the athletics team at my place of work.
In 1961, aged 23, I got the first indication of cardiovascular problems. I was told that I had high blood
pressure. I didn’t really take much notice. Well, you don’t think much about that at 23, do you? My
father had died at the age of 53 from a heart attack, but as he was about four stone overweight, had a
passion for fatty foods and smoked 60 full-strength cigarettes a day, I didn’t compare his condition to
mine.
Throughout the rest of my working life I continued to play sport, mainly hockey, and was never
overweight. I must admit that I probably drank too much at times and didn’t bother too much about
calories and cholesterol in food.
As I got older I found it more difficult to keep fit during the summer break between the hockey
seasons and so reverted to road running. I ran my first marathon in Leeds at the age of 42 and I
subsequently did another five, including two in London.
All was going well I thought, until a medical I had for a new job showed my blood pressure reading to
be 240 over 140. The doctor could not believe that I was still walking around, let alone running, and
sent me straight to my GP. Since then I have taken tablets for blood pressure and have also reviewed
my dietary intake.
I continued running and completed the Great North Run at the age of 63. A few months later, and
thinking about doing the Great North Run again, I was running eight miles a week and playing
hockey, when my eight-day holiday in Ireland became three days touring and 12 days in hospital.
At 2 o’clock in the morning on May 8th I woke up with a terrific pain in my chest. I was sweating
profusely and looking very pale. My wife rang the hotel reception and within 10 minutes a doctor had
arrived, checked me over and pronounced that I had had a heart attack. Within an hour I was in
intensive care and being closely monitored. At 5 am I had a second attack and a specialist inserted a
temporary pacemaker to keep my heart rate up as it was dropping below 40.
After five days in intensive care I was transferred to the general ward for recuperation. I gradually
increased my walks each day and was watched by the Lifestyle Nurse while I climbed stairs. The
nurse also discussed my lifestyle. Did I smoke? No. Did I eat fatty foods? Yes. Did I exercise? Yes.
Was I overweight? No. Did I have a history of cardiac problems in my family? Yes! This then
appeared to be the probable cause. I was told that it was possible that had I not looked after myself I
might have had a heart attack much earlier in life.
After 10 days I was given a stress test, which involved running on a treadmill to determine my ability
to cope with normal life. Having passed the test I was brought home by the travel insurance company,
escorted by a doctor.
On returning to Huddersfield I eventually had an angiogram and was told that I needed a triple bypass
operation, but that my heart might not be strong enough to take it. The specialist at Leeds General
Infirmary, Mr McGoldrick, gave me a detailed analysis of the situation and the operation, but the final
decision was up to me.
I found it very difficult to walk more than 100 yards without using my Nitro-spray. This was very
difficult to cope with considering that nine months earlier I had been so active. The decision was easy:
I would have the operation.
I have to say it was not pleasant, but I had decided that it was necessary and I would cope with
anything that happened if it would get me back to a decent lifestyle. Well, the operation, a quadruple
bypass, was a success and after eight days I was back home.
Recuperation involved plenty of walking and visits to cardiac rehabilitation. At that time I was
introduced to Heartline, which is a group of people who have suffered cardiac problems, encouraging
exercise and recuperation by being able to talk to others with similar experiences. I go swimming once
a week and have increased my distance from two lengths at first to 40 lengths after 12 weeks.
Although I feel fit enough to resume running I think I will put it on hold for a while. I don’t think I
will ever play hockey again. There again, that’s probably not a bad decision!
Peter Kempson
In about 2009, one SNAB student got a bit of a shock when he opened his biology textbook at the start
of his new A level course. His teacher was amazed when, during the introduction to Mark’s and
Peter’s story, a voice said ‘That’s my granddad’. There was no mistake and shortly afterwards
‘Granddad’ came to talk to the A-level biologists in his class.
Salters-Nuffield Advanced Biology Resources Activity 1.1 Teacher Sheet
MARK’S AND PETER’S STORIES
Purpose
 To provide an overview of some symptoms and treatments of cardiovascular disease (CVD) using
personal accounts.
 To identify some risk factors for the development of CVD.
 To provide an introduction to the topic.
 To practise extracting relevant information when reading text.
It also gives practice of reading fairly lengthy text.
Answers
Summary of points that can be extracted from the texts:
Mark
a Symptoms: dizziness; slight headache; loss of balance; unconsciousness; ongoing effects:
memory difficulties.
b Diagnostic tests: reaction tests; CT scan; MRI scan; angiogram.
c Treatments: operation to clip blood vessels in the brain; occupational therapy; physiotherapy;
speech and language therapy; anti-convulsant tablets.
d Lifestyle risks: none identified.
Peter
a Symptoms: high blood pressure; pain in chest; sweating; paleness.
b Diagnostic tests: heart monitor; stress test; angiogram.
c Treatments: tablets for high blood pressure; heart pacemaker; quadruple bypass surgery.
d Lifestyle risks: may have drunk too much at times and had a fatty diet, but was not overweight;
possible inheritance of genes for CVD from father. Took plenty of exercise, which should reduce
risk.
DEMONSTRATING MASS FLOW

Purpose
 To calculate rate of diffusion.
 To appreciate speed of diffusion in air.
 To observe mass flow.
SAFETY
Wear eye protection. Wear disposable gloves when handling the ammonia solution.
The experiment must be undertaken in a fume cupboard.
See CLEAPSS Student Safety Sheet 30 for further details on safe handling of ammonia
and ammonium hydroxide.
YOU NEED
● Dilute ammonium hydroxide ● Forceps
● Two glass tubes ● Dropping pipette
● Bungs to fit glass tubes ● Stopclock
● 16 small pieces of litmus paper ● Clamp stand, boss and clamp or piece of
● Glass or wooden rod adhesive tack
● Two small pieces of cotton wool ● Ruler
Procedure
1 Your teacher/lecturer will set up a glass tube
with litmus paper as shown in Figure 1 and rubber bung
measure the distance between the pieces of
litmus paper.
2 In a fume cupboard add a few drops (about six)
of ammonium hydroxide solution to a small ball
litmus paper (red)
of cotton wool and then place it at one end of
the glass tube. Seal both ends of the tube with
rubber bungs. Immediately start a stopclock.
clamp stand
Ammonia is given off by the solution and
diffuses along the tube. The litmus paper
changes colour from red to blue in the presence
of ammonia gas.
3 Record how long it takes each piece of litmus Figure 1 Glass tube with litmus paper.
paper to change colour.
4 Using a second tube without rubber bungs, place the cotton wool with ammonium hydroxide at
one end.
5 Using a large syringe, blow air gently through the tube. Observe how quickly the litmus paper
changes colour when the syringe is used.
Questions
Q1 Explain how the ammonia moves along the tube with sealed ends.
Q2 Calculate the speed of diffusion along the tube and comment on your findings.
Q3 Explain how each of these factors would affect the rate of diffusion:
a higher concentration of ammonium hydroxide
b higher temperature
c larger molecules replacing ammonium hydroxide.
Q4 Explain what is happening in the tube without bungs and how the model is similar to mass
flow in a transport system, such as the mammalian circulatory system.

Purpose
SAFETY
Ensure eye protection is worn throughout the activity. Ensure disposable gloves are worn by
anyone handling the ammonia solution.
See CLEAPSS Hazcard 6 for further details on safe handling of ammonia and ammonium
hydroxide.
Notes on the procedure

It is presumed that most students will have observed diffusion in practicals at KS3 or KS4. However,
it is worth students completing this practical or having it demonstrated to them to highlight the
difference between diffusion and mass flow.
If students take an active part in this practical they need to know, in advance, how to use a fume
cupboard.
The sealed tube allows measurements to be taken to determine the speed of diffusion. The open-ended
tube demonstrates mass flow of ammonium hydroxide. It is virtually impossible to measure how
quickly the litmus paper changes colour.
Stapling pieces of litmus paper to wooden splints and then sliding the splint into the tube overcomes
the difficulty of getting the pieces along the tube.
If teaching topics in parallel (or when teaching Topic 2), the ideas here could relate to Fick’s law
(Topic 2 2.1), which states that:
Surface area to volume ratio  Concentration difference
Rate of diffusion 
thickness of surface
Answers
Q1 Molecules are continuously moving due to their kinetic energy. There are more ammonia
molecules at the cotton wool end of the tube (high concentration) compared with the other end
(a region of low concentration). There is a net movement of molecules due to their random
movement from the region of their high concentration to the region of their low concentration.
Q2 The speed of diffusion at the end of the tube away from the cotton wool is slower than near the
cotton wool. Rate of diffusion is dependent on the concentration gradient. Near the cotton
wool there is a high concentration compared with the rest of the tube: this gives a steep
diffusion gradient. Large numbers of ammonia molecules will be diffusing away from the
cotton wool so the net movement is rapid. As the molecules diffuse away, their concentration
decreases and further along the tube the diffusion gradient is less steep. As a result, the time
taken for enough molecules to diffuse between the final two pieces of litmus paper and turn the
last one blue will be much longer.
Q3 a Higher concentration will speed up diffusion because there is a steeper gradient.
b Higher temperature will speed up diffusion because the molecules will have more kinetic
energy.
c Larger molecules would diffuse more slowly because in a vapour or gas, at a given
temperature, the larger the molecule, the more slowly it moves.
Q4 The air in the tube moves through the tube and carries the ammonia with it. Blood works in the
same way. The fluid is pumped around the body and carries within it substances to be
transported.
Salters-Nuffield Advanced Biology Resources Activity 1.2 Technician Sheet
Purpose
SAFETY
Wear eye protection and disposable gloves.
All ammonia solutions must be dispensed in a fume cupboard as the vapour, ammonia gas,
is toxic and extremely irritating to the eyes and lungs. See CLEAPSS Hazcard 6 for further
details on safe handling of ammonia and ammonium hydroxide.
Requirements per student or Notes

group of students
Eye protection, disposable gloves and
access to a fume cupboard
Two glass tubes Approximately 50 cm long and 2 cm in diameter.
Two bungs to fit glass tubes The bungs should have ventilation holes through them: one to fit the
syringe; the other as a vent.
Eight small pieces of red litmus paper Each piece approximately 1 cm in length. For ease of positioning in
the tube the pieces of litmus paper can be stapled at intervals along
a wooden splint.
Glass or wooden rod To position the litmus paper in the glass tube.
Two pieces of cotton wool Approximately 1.5  1.5 cm.
Forceps
Dilute ammonium hydroxide Any concentration around 0.5 M should work well.
Large syringe Any size is fine as long as it provides a good draught of air when the
plunger is pushed in.
Dropping pipette
Stopwatch/clock
Two bosses, clamps and stands or Instead of using a boss and clamp, rest the tubes on the bench with
pieces of adhesive tack a piece of adhesive tack acting as a wedge to stop them rolling off.
Ruler
Notes
cotton wool litmus paper (red)

with ammonium
hydroxide
clamp stand
Figure 1 Glass tube with litmus paper (red).
AN IDEAL TRANSPORT MEDIUM
Purpose
 To understand the importance of the dipole nature of water.
 To relate the solvent properties of water to some of the functions of water in living systems.
Properties and polarity

Water is unusual because it is a liquid at room temperature whereas other small molecules are gases.
This is because the water molecule is polar; the different ends of the molecule have different charges.
Water is a dipole. To help you understand the dipole nature of water and how it affects water’s
properties, read the Key Biological Principles box on page 8 of the Year 1 Student Book and complete
the interactive tutorial that accompanies this activity. Then complete the questions below.
Questions
Q1 Complete and annotate the diagram of water molecules in Figure 1 to explain why water is a
liquid at room temperature, unlike other small molecules, such as carbon dioxide.
You should include the following words/ideas in your diagram:
hydrogen bonds
polar charges on oxygen and hydrogen atoms.
Figure 1 Why water is a liquid at room temperature.
Q2 Oil and water do not mix. They remain as two separate layers, with the less dense oil floating
on top of the water. Oil is non-polar; it is hydrophobic (water-repelling).
a Predict what will happen if some drops of water-soluble dye were added to a water-oil
mixture.
b Then try doing it, to check if you were correct. Suggest an explanation for what you
observe happening.
………………………………………………………………………………………………
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Q3 a Vitamin C is water-soluble. Vitamin A is fat-soluble. Give a possible explanation for this

difference.
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
b A celebrity chef announces on his TV show that it would be better to boil a joint of meat
rather than roast it. He says this is because the fat will dissolve out of the meat, making
the meal lower in fat and healthier. Is he correct in his explanation of what is happening
during the cooking?
Explain your answer.
………………………………………………………………………………………………
………………………………………………………………………………………………
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Q4 Complete the table below, to show why water is ideal as the transport medium in blood.
Property Explanation Role in blood

The positively charged end of a water
molecule is attracted to the negative ends
of surrounding molecules. Hydrogen bonds
form; these hold the water molecules
together.
Solvent for ionic and

polar substances.
Blood helps to regulate body

temperature because water
resists changes in
temperature.
Q5 Your young cousins are worried that the fish in their large garden pond will get too hot on very
sunny days in summer. What would you say to make them realise that they do not need to
worry?
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Purpose
 To relate the solvent properties of water to some of the functions of water in living systems.

Before completing the questions on the Student Sheet, students should read the Key Biological
Principles box on page 8 of the Year 1 Student Book and complete the interactive tutorial that
accompanies this activity.
The questions on the Student Sheet are to get students thinking about hydrogen bonding between
water molecules. Note that in chemistry, students may well use the term intermolecular bonds; we
have included this in the interactive tutorial; at this stage students do not need to have detailed
knowledge of cohesion. This is included in Topic 4.
The interactive tutorial on water is within the Biochemistry Support section on SNAB Online. It
includes material relevant to Topic 4. In Topic 1, students only have to cover those sections that
support ideas about the dipole nature of water and its role as a solvent in transport. There is a small
amount of information about temperature. This introduces the role of water in temperature regulation
and shows that the blood also transfers energy; this is not required for examination purposes.
An additional task could be completed by students. Students are asked how many drops of water will
sit on a penny. A penny will take about 27 drops of water from a fine glass pipette, with a large dome
of water created before it overflows. There is no requirement to go into surface tension. The large
volume able to sit on a penny can be explained by the hydrogen bonds that are holding the water
molecule together. This highlights the polarity of water and hydrogen bonds between water molecules.
A smear of detergent will reduce the amount of water that can sit on the penny to just a few drops. It is
sufficient for students to say that the detergent prevents the formation of hydrogen bonds between the
water molecules.
Magnetic water molecule models are very good for demonstrating polarity and solvent properties.
They are available from Philip Harris.
Answers
Q1 Students should annotate the diagram to show the polar charges on oxygen and hydrogen
atoms, and hydrogen bonds between the molecules.
Q2 The lack of mixing of oil and water in a container could be demonstrated. The water-soluble
dye will only dissolve in the water component because of the dipole nature of the water
molecule. This can be explained in terms of the formation of hydrogen bonds between the dye
molecules and water, but not between the oil and dye.
Q3 a Vitamin C is a polar molecule. Vitamin A is not polar. Therefore hydrogen bonds will
only form between Vitamin C and water, allowing it to dissolve. Vitamin A is transported
in the blood bound to a protein.
b The celebrity chef is not correct to say that the fat dissolves in the water; fat does not
dissolve in water. However, at higher temperatures the fat may melt and be released into
the water. So, when the meat is removed from the water there is less fat. There may also
have been less fat if the meat had been roasted and the fat poured off.
Q4
Property Explanation Role in blood

Liquid at room temperature. The positively charged end of a Blood does not change state, but
water molecule is attracted to the remains as a liquid solvent,
negative ends of surrounding transporting substances around
molecules. Hydrogen bonds form: the body.
these hold the water molecules
together.
Solvent for ionic and polar The positively charged end of a Polar substances dissolve in
substances. water molecule is attracted to water, so are transported around
negative ends of surrounding the body as solutes in blood.
molecules, or negative ions. The
negative oxygen atoms in water
attract positively charged ions or
molecules.
High specific heat capacity. A large amount of energy is Blood helps to regulate body
needed to break the hydrogen temperature because water resists
bonds between water molecules. changes in temperature.
Q5 Water warms up and cools down slowly, so the fish will not experience rapid changes in water
temperature. For older or more able cousins you might add that on a sunny day, a large input
of energy causes only a small increase in water temperature. This is because a large amount of
energy is required to break hydrogen bonds between the water molecules.
Purpose
 To relate the solvent properties of water to its function in living systems.
The oil and water mixture may be completed as a teacher demonstration.

group of students
Glass measuring cylinder Large, if for teacher demonstration.
Vegetable oil Sufficient to half-fill the glass measuring cylinder.
Water-soluble dye Enough to colour the water in the oil-water mix.
STRUCTURE OF THE HEART (DISSECTION)

Purpose
 To revise your knowledge of the structure of the heart.
 To relate heart structure to function.
 To locate and compare the structure of the main arteries leaving the heart with the main veins
entering the heart.
 To observe the coronary arteries.
 To develop practical dissection skills.
SAFETY
Wash your hands carefully after completing the dissection and putting all the equipment
ready to be cleaned. Hands should be washed before leaving the lab.
Take care with sharp dissecting instruments.
Wear a plastic apron to protect your clothes. Long sleeved clothing should be rolled up to prevent
contamination.
YOU NEED
● Heart ● Clamp to seal blood vessel
● Dissecting board or tray ● Access to water supply
● Dissecting instruments ● Plastic apron to protect your clothes
● Rubber tube
Procedure
1 Before starting the dissection, use the Student Book to help you label the heart diagram in
Figure 2.
2 Locate the four main blood vessels attached to the heart. The two thicker-walled vessels are the
arteries; they leave the heart at the more rounded front (ventral) side. The thinner-walled veins
enter the heart at the top of the back (dorsal) side. They are often damaged on removal of the heart
from the animal.
3 Looking at the front side of the heart, identify the following external features using Figure 1 to
help:
a right and left atria
b right and left ventricles
c coronary arteries and veins.
pulmonary artery
aorta
left atrium
right atrium
left coronary
artery
right coronary
artery
left ventricle
right ventricle
Cut along this line Cut along this line

to view inside the to view inside the
right ventricle. left ventricle.
Figure 1 Ventral (front) view of the heart. The pulmonary vein and vena cava enter the atria on the dorsal
(back) side of the heart so are not visible on this diagram.
4 Draw a sketch of the heart to show the position of the atria and ventricles.
Q1 Why are the right and left sides apparently on the wrong side?
Q2 a Can you distinguish coronary arteries and veins?
b What are their functions?
c Make a sketch showing how they branch across the surface of the heart.
5 If the heart is undamaged you can identify which vessel is the aorta by attaching a rubber tube to a
water supply and inserting it into the pulmonary vein. Only use the water supply designated for
this activity. Do not attach the rubber tube directly to a tap unless told to do so. Allowing water to
flow through the heart (gently!), it will emerge from the aorta. Make sure all the water flowing
out of the heart either drains down the sink or is captured in a glass bowl for proper disposal. The
same procedure can be used with the superior vena cava after clamping the inferior vena cava
shut.
Q3 In this case from which vessel will the water emerge?
Q4 What does this tell us about the internal structure of the heart?
6 To inspect the internal structure of the heart, cut through the ventricle walls, along the lines shown
in Figure 1. This is best done with a pair of sharp scissors. Be careful at this stage only to cut
through the ventricle walls, leaving the walls of the atria intact.
Q6 Q5 Look carefully inside each ventricle and answer these questions:
a Which ventricle has thicker walls?
b Estimate the ratio of the thickness of the two walls.
c Suggest why the ventricle walls are of different thicknesses.
Q6 Locate and carefully observe the atrioventricular valves between the atrium and ventricle
on each side of the heart.
a Why is the atrioventricular valve in the right ventricle also called the tricuspid valve?
b Why is the atrioventricular valve in the left ventricle also called the bicuspid valve?
Q7 Locate the semilunar valves at the entrance to the aorta and pulmonary artery. Why are
these valves called semilunar?
Q8 Identify the tendons that stretch between the atrioventricular valves and the ventricle walls.
a What is the function of these valves and what is the role of the tendons in their
operation?
b Work out how you can test your ideas about valves by inverting the heart and using
some water.
Q9 Cut open the atria and examine their internal structure. Explain the relative difference in
size between the atria and ventricles.
7 Locate the opening of the coronary vein in the wall of the right atrium.
8 Cut open the aorta and locate the opening to the coronary artery just above the semilunar valve.
Q10 Examine the openings to the vena cava and pulmonary vein. Do these entry points to the
heart contain valves? If not, why not?
Q11 Describe the safety precautions you took during the practical.
Vertical section of the heart

Label the diagram. Add arrows to show the route of blood flow through the heart.
Figure 2 Vertical section of the heart.
Purpose
 To revise knowledge of the structure of the heart.
entering the heart.
In preparation for the dissection or as an alternative, there is a simulated dissection in Activity 1.5 and
a stepwise photo dissection accessible through the weblinks for both activities.
SAFETY
Hands should be washed carefully after completing the dissection and putting all the
equipment ready to be cleaned. Hands should be washed before leaving the lab.
Take care with sharp dissecting instruments.
Plastic aprons should be available to protect students’ clothes whilst doing a dissection. Long
sleeved clothing should be rolled up to prevent contamination.
See CLEAPSS Guidance leaflets G267 and G268 for further details.
Notes on the procedure and answers

1 The diagram in the Student Book (page 9) and Figure 1 on page 2 of this sheet show the labels
and blood-flow arrows needed to complete the heart diagram sheet.
2 The two arteries leave the heart at the front (ventral) side. The thinner-walled veins enter the heart
at the top of the back (dorsal) side.
3 Deciding which side is the front of the heart is difficult for the student particularly if the heart is
damaged. The ventral (front) side of the heart is more convex.
4 Sketch will be similar to one on the Student Sheet.
Q1 The right and left sides appear to be on the wrong side because the drawing is done as if the
student is looking down on the heart inside the chest. The sides refer to the sides of the
person’s/animal’s body.
Q2 a Coronary arteries and veins are very hard to distinguish as they lie alongside each other.
b They supply blood to the heart muscle.
5 Running water through the heart will only be successful if it is not damaged.
Q3 If water is run into the superior vena cava it will emerge through the pulmonary artery.
Q4 The water flowing into and out of the heart through the separate vessels shows that the heart is
separated into two distinct halves internally.
Q5 The left ventricle has thicker walls. They need to generate a greater force to push blood around
the body.
Q6 a The valve in the right ventricle is called the tricuspid valve because it is composed of
three triangular flaps.
b The valve in the left ventricle is called the bicuspid valve because it is made up of two
flaps.
Q7 The valves at the entrance to the aorta and the pulmonary artery are called semilunar because
of their half-moon shape.
Q8 a The function of the atrioventricular valves is to prevent blood returning into the atria
when the ventricles contract. The tendons stop the valves from inverting when blood
pressure builds up in the ventricle.
b A small quantity of water poured into the heart through the artery should not run out
through the veins due to the closing of the semilunar valves.
Q9 The relative difference in size between the atria and ventricles should be explained with
respect to thickness of ventricle walls and their need to generate a greater force.
Q10 Valves in veins prevent any backflow that might occur. However, there are no valves at the
openings to the vena cava and pulmonary vein. When the atria contract, blood is forced
downwards into the ventricles; blood is not pushed back out along the veins so there is no need
for valves.
Q11 Safety precautions: washing hands; care with sharp instruments; careful and safe disposal of
the heart; thorough cleaning of apparatus; disinfection of bench; washing hands at end of
practical.
aorta
vena cava
(superior)
pulmonary artery
pulmonary artery pulmonary veins
semilunar valves in aorta
pulmonary veins left atrium
right atrium left atrioventricular

right atrioventricular valve/bicuspid valve
valve/tricuspid valve
right ventricle
vena cava
(inferior) semilunar valve in
pulmonary artery
left ventricle
Figure 1 Vertical section of the heart showing direction of blood flow.
Purpose
entering the heart.
SAFETY
You should wash your hands after handling the hearts. Hands should be washed before
leaving the lab.
Work surfaces should be disinfected after the practical with 1% Virkon™ and dissecting
instruments should be washed and autoclaved to make sure all organic matter is removed.
See CLEAPSS Guidance leaflets G267 and G268 for further details.
See CLEAPSS Guidance Notes G14 for details on laboratory water supplies.

group of students
Heart A cow’s or pig’s heart is the best size for viewing detail, but use of
lambs’ hearts presents the fewest religious or cultural issues. Ask
the butcher to leave the heart intact otherwise he/she may cut
through the wall when removing it. Ask for the hearts to be removed
with as much of the blood vessels attached as possible. A ‘pluck’
(heart and lungs removed together) is best for obtaining blood
vessels. Make it clear that you do not want the liver, as this should
reduce the price dramatically. After using the heart in this dissection,
the vessels should be kept for use in the arteries and veins activity
(1.6). They can be frozen. The rest of the hearts should be wrapped
in an opaque plastic bag and disposed of as normal waste.
Dissecting board or tray Enamel trays are fine; they can be lined with paper towels to make
them less ‘slippy and drippy’.
Dissecting instruments Scissors (often the best for cutting open the heart), seekers and
forceps.
Clamp to seal blood vessel This can be any suitable clip to hold the vein closed.
Disinfectant For cleaning benches.
1% Virkon™ can be used for general disinfection. Allow 10 minutes
disinfection time. (NB: Virkon™ is not recommended for soaking
metal instruments – they should be autoclaved.)
Cloth For cleaning benches.
Soap and paper towels For washing hands.
Access to a sink Ensure the laboratory water supply has backflow preventing valves
(see CLEAPSS G14 for details). If not, use a large beaker of water
poured through a funnel and rubber tube.
Rubber tube This needs to be attached to the water supply so that water can be
run gently through the heart. A washing-up bowl may be useful if
sinks are small.
STRUCTURE OF THE HEART (SIMULATED

DISSECTION)
Purpose
entering the heart.
Procedure
Complete the activity by referring to diagrams and photographs in textbooks, and the animation that
accompanies this activity. There are also some useful websites in the weblinks for this activity.
1 Draw a sketch of the external features of the heart viewed from the front (ventral) side. The two
thicker-walled vessels are the arteries; they leave the heart at the front (ventral) side. The thinner-
walled veins enter the heart at the top of the back (dorsal) side. You should draw and label the
following features: atria, ventricles, aorta, pulmonary artery and coronary arteries.
2 Label the vertical section diagram of the heart in Figure 1. Add arrows to show the route of blood
flow through the heart.
Questions
Q1 Why are the right and left sides apparently on the wrong side?
Q2 What are the functions of the coronary arteries and veins?
Q3 If water were poured into the vena cava, through which vessel would it emerge from the heart?
Q4 What does this tell us about the internal structure of the heart?
Q5 Which ventricle has thicker walls?
Q6 Suggest why the walls of the left and right ventricles are of different thicknesses.
Q7 Why is the atrioventricular valve in the right ventricle called the tricuspid valve and the
atrioventricular valve in the left ventricle called the bicuspid valve?
Q8 What is the function of the atrioventricular valves?
Q9 Why are the valves at the entrance to the aorta and pulmonary artery called semilunar?
Q10 What is the function of the tendons that connect the atrioventricular valves and the ventricle
walls?
Vertical section of the heart

Label the diagram. Add arrows to show the route of blood flow through the heart.
Figure 1 Vertical section of the heart.
STRUCTURE OF THE HEART (SIMULATED

DISSECTION)
Purpose
entering the heart.
The simulation can be used in preparing for the real dissection or as an alternative to the dissection.

1 The sketch should be similar to the one that appears on the Student Sheet of Activity 1.4.
2 The diagram in the Student Book (page 9) and Figure 1 in the Teacher Sheet of Activity 1.4 show
the labels and blood-flow arrows needed to complete the heart diagram.
Answers
Q1 The right and left side of the heart appear to be on the wrong side because the diagram is
drawn from the perspective of the person whose heart it is, not from the point of view of a
spectator looking at the front of the person whose heart it is.
Q2 The coronary arteries and veins supply blood to the heart muscle.
Q3 If water is poured into the vena cava it will emerge from the pulmonary artery.
Q4 The heart is separated internally into distinct halves.
Q5 The left ventricle has thicker walls.
Q6 The left ventricle walls are thicker because they need to generate a greater force to push blood
around the body. The right ventricle walls only pump blood to the lungs, so the walls need to
generate a relatively smaller force.
Q7 The tricuspid valve is composed of three triangular flaps. The bicuspid valve has only two
flaps.
Q8 The atrioventricular valves prevent blood returning into the atria when the ventricles contract.
Q9 The semilunar valves are formed of (three) half-moon-shaped flaps.
Q10 These tendons stop the atrioventricular valves from inverting when blood pressure builds up in
the ventricles during ventricular contraction.
INVESTIGATING ARTERIES AND VEINS
Purpose
 To investigate how the structures of blood vessels relate to their functions.
 To develop practical skills.
SAFETY
Wear eye protection and plastic aprons. Long sleeves should be rolled up to prevent
contamination.
Benches should be thoroughly cleaned with 1% Virkon™ or other suitable disinfectant.
Wash your hands after handling tissue once cleaning is finished. Hands should be washed
before leaving the lab.
Place a tray under any suspended masses in case the blood vessel snaps.
Be aware of the danger of using microscopes where direct sunlight may strike the mirror.
YOU NEED
● Ring of artery and vein ● Prepared slide of artery and vein transverse
● Mass carrier section (T.S.)
● 5 × 10 g masses ● Prepared slide of lung or thyroid gland T.S. to
● Hook show capillaries
● Clamp stand, boss and clamp ● Microscope
● Metre rule ● Histology book for microscope images and notes
● Graph paper ● Drawing paper
Procedure
Before you start the practical work:
 read the practical instructions carefully
 identify the dependent and independent variables, and any others that might need to be controlled
or taken into account
 draw up a table in which to record your results.
A good table of results should have:
 an informative title
 the first column containing the independent variable (the factor that is varied by the experimenter;
in this experiment it is the mass)
 the second and subsequent columns containing the dependent variables. (The value of the
dependent variable depends on the value of the independent variable. In this case, the length of
the ring depends on how much mass is added, so ring length is the dependent variable.)
 informative column headings; each column should have a descriptive heading
 units in the heading, not next to the numerical data in the table.
 results recorded with appropriate precision, for example, if the ruler you are using to measure
lengths in this experiment has mm divisions you can probably measure to 0.5 mm, but no less, so
when recording a length of eleven millimetres you would enter 11.0 in the table; the measurement
uncertainty is ±0.5 mm.
Additional columns can be added to include calculations based on raw data such as percentage change
in length, etc. Now follow the instructions, carrying out the practical in a safe and well-organised
manner.
Part A: Elastic recoil in arteries and veins

1 Suspend a ring of artery from a hook on a clamp stand. Use a metre rule to record the length of
the ring once the mass carrier has been attached to the free end of the ring.
2 Attach a 10 g mass (see Figure 1) and record the length of the ring after the mass is added.
3 Remove the mass and record the length of the ring.
4 Repeat steps 2 and 3 using 20, 30, 40 and 50 g masses. Record the length with and without the
masses each time.
clamp stand
hook
ring of tissue
metre rule
10 g masses
Figure 1 Measuring the length of the ring.
Part B: Histology of blood vessels

5 Examine slides of artery and vein. Identify the three main regions of the vessel wall, and the
tissues in these regions:
a external, middle and inner layers of tissue
b elastic and collagen fibres
c smooth muscle.
6 Use an eyepiece graticule to measure the thickness of the walls of the artery and the vein. For
more detail on how to use a microscope and how to measure using an eyepiece graticule read
Practical Skills Support Sheet 8 – using a microscope and Sheet 9 – size and scale.
7 Sketch a plan of a cross-section across both vessels to show the amount and distribution of each
type of tissue. See Practical Skills Support Sheet 8 for guidance on biological drawing.
8 Annotate the sketch with notes on the three regions and other features of the vessel, for example,
thickness of wall, tissues in the three regions.
9 Using H.P. (high power) examine a capillary in a section of an organ, for example, lung or
thyroid. Measure the average diameter of a capillary.
Analysis and interpretation of data

1 Calculate percentage change in length:
(new length - original length)
% change in length =
original length
2 Enter all your results into an appropriate table.
3 Plot two appropriate graphs, one for artery and one for vein. Remember that the most appropriate
type of graph should be chosen to represent data, for example, bar chart, pie chart, histogram or
line graph.
A bar chart is used when the independent variable is non-numerical or discontinuous, for example,
the different stages of mitosis.
A pie chart can be used to display data that are proportions or percentages.
A histogram is used when the independent variable is numerical and the data are continuous, but
classified into groups, for example, mass in kg, which is divided into classes, such as 41–50 kg,
51–60 kg, etc. There are no gaps between the bars of a histogram and the area of the bar represents the
frequency.
A line graph can be used to show relationships in data that are not immediately obvious from tables.
Both the dependent and independent variables are continuous. The independent variable normally goes
on the x-axis.
Remember to include:
 an informative title
 sensible scales on each axis, if appropriate
 labels on both axes
 units on both axes, if appropriate
 a key.
(For more detail on presenting data see Cadogan A. (ed.) (2000) Biological Nomenclature: Standard
terms and expressions used in the teaching of biology, 3rd edition. London: Institute of Biology.)
In this experiment plot percentage change in length against mass.
Values for adding and removing masses should be plotted on the same graph. (You could colour-code
the points to show which are adding and which removing masses.)
4 Identify any trends or patterns in your data. Think about answering the following question: how
do the results for artery and vein compare when looking at percentage change in length on
loading, and return to the original length on unloading?
Conclusion
Bearing in mind the purpose of this practical work – to investigate how the structures of blood vessels
relate to their function – state a conclusion to your work: this should summarise what you have found
out. You should explain any trends or patterns in the data, supporting your ideas with evidence from
the data and your biological knowledge of the structure of arteries and veins.
Evaluation
1 If you made changes to the method provided, describe them and explain the reasons for the
alterations.
2 Comment on any safety issues that you had to consider when performing this experiment.
3 Describe any systematic or random errors you noticed when completing the practical work.
4 Comment on the validity of the experimental design and of your conclusion. An experimental
design is valid if the procedure used is suitable for the investigation being undertaken, measures
what is supposed to be measured and allows one to answer any question being asked.
A conclusion is valid if it is supported by data obtained from a valid experimental design, and it is
based on sound scientific reasoning.
Purpose
SAFETY
Ensure eye protection is worn while vessels are being stretched.
All organic material should be collected for disposal. All equipment should be cleaned
thoroughly with detergent.
Benches where fresh biological material has been handled should be thoroughly cleaned
with 1% Virkon™ or other suitable disinfectant.
Hands should be washed before leaving the lab.
Be aware of the danger of using microscopes where direct sunlight may strike the mirror.
Demonstrate how to insert the slide correctly onto the stage. Ramming the slide may produce glass
shards.

This activity has two parts. In Part A students stretch blood vessels to compare their elasticity. In
Part B they look at the histology of blood vessels. Part B could be completed in advance of the
practical work on elastic recoil so students can draw on this understanding when analysing the results
of the experiment.

In the procedure on the Student Sheet there is no instruction as to the cutting of the rings. It is assumed
that the rings will have been cut in advance. If this is not the case students may need to be reminded
that the rings of arteries and veins should be cut to the same width (about 2 mm).
If veins are not available, students could complete the investigation using an artery and then compare
their results with the sample ones shown below. These results are for rings of a vein approximately
2 mm in width, so rings of artery the same length should be used to allow valid comparisons.
Mass/g Length of vein/mm

Vein 1 with mass Vein 1 without mass
0 (original length) 21
10 36 36
20 38 37
30 40 39
40 41 39
50 41 41

Instead of making the sketches, students could use images of blood vessels downloaded from the
website, or captured themselves using video-cam. They could paste these into a word document, then
label and annotate using lines and textboxes.
For help on this see the Digital Capture Tutorial in ICT Support.
Guidance on the use of the eyepiece graticule for measuring can be found in Practical Skills Support
Sheet 9 – size and scale.
Notes
Students should calculate the percentage change in length and present all the results in a suitable table.
The most suitable graph for this practical work is a line graph plotting percentage change in length
against mass.
Students should describe any trends or patterns, with supporting data. The artery is expected to show a
greater percentage increase in length than the vein. The artery should return closer to the original
length than the vein.
Conclusion
Students need to explain any trends or patterns using biological knowledge, for example, ‘The artery
has a greater proportion of elastic tissue in its walls, so would be expected to be more extensible and
more elastic than the vein, which has a greater proportion of collagen’.
This should link structure and properties of arteries and veins with their function. Arteries are
stretched during systole. During diastole, the walls recoil, helping to smooth the flow of blood through
the vessel. There is no pulse in the venous system, therefore veins do not extend and recoil as blood
enters them. Contraction of skeletal muscles assists in movement of blood through veins.
Evaluation
Any changes or additions to the method provided need to be explained with an appropriate reason, for
example, use of finer scale ruler to increase precision, or eye level when recording to avoid a
systematic error.
Relevant safety comments would include: hand-washing after handling tissue, disinfection of
equipment and bench, care with suspended masses.
There is not really a clear question to address or hypothesis to test so assessing the validity of the
experimental design should highlight this flaw. At this stage of the course one might decide to
structure the write-up as a series of questions to guide students more directly to the areas of interest.
Questions might be
Q1 How do the results for artery and vein compare when looking at:
a percentage change in length on loading?
b return to the original length on unloading?
Q2 What are the main properties of:
a elastic fibres?
b collagen?
Q3 Explain any trends or patterns in the data, supporting your ideas with evidence from the data
and your biological knowledge of the histology of arteries and veins.
Q4 Explain how the properties of arteries and veins that you have investigated link to the
functions of arteries and veins in the body.
Q5 Comment on any safety issues that should be considered when performing this experiment.
Q6 Suggest modifications to the experimental procedure that would ensure that more valid results
are produced. Remember that valid results are produced with apparatus and experimental
procedures that are suitable for the task.
Answers would be:

Q1 a The artery is expected to show a greater percentage increase in length than the vein.
b The artery should return closer to the original length than the vein.
Q2 a Elastic and extensible.
b Inelastic and inextensible.
Q3 Describe any trend or pattern, support with data and explain using biological knowledge, for
example, ‘The artery has a greater proportion of elastic tissue in its walls, so would be
expected to be more extensible and more elastic than the vein, which has a greater proportion
of collagen’.
Q4 Arteries are stretched during systole. During diastole, the walls recoil, helping to smooth the
flow of blood through the vessel. There is no pulse in the venous system. Veins do not extend
as blood enters them.
Q5 Relevant comments would include: hand-washing after handling tissue, disinfection of
equipment and bench, care with suspended masses.
Q6 Any comments about repeating measurements and appropriate modifications to improve
precision and validity, for example, use of finer scale rulers, use of calipers, eye level when
recording.

Purpose
This activity has two parts. In part A students stretch blood vessels (a piece of artery and a piece of
vein) and measure how elastic they are. In part B they look at the histology of the blood vessels using
a microscope.
SAFETY
Eye protection should be used in case of ‘flyback’ from bits of animal tissue when the tissue
breaks. Place a tray under the suspended masses.
You should wash your hands after handling the sections of blood vessels. Hands should be
washed before leaving the lab.
Work surfaces should be disinfected after the practical with 1% Virkon™.
All apparatus should be thoroughly cleaned with detergent ensuring all organic material is
completely removed.
Do not soak metal instruments in Virkon™.
Wrap all organic matter together and dispose of as normal food waste. Store in freezer/refrigerator
until the day of disposal.
Ensure students are aware of the danger of using microscopes where direct sunlight may strike the
mirror.

Requirements per student or group Notes
of students
Rings cut from aorta and vein (1 of each) Rings cut during the heart dissection practical can be frozen for
this investigation. Rings from arteries and veins should be cut to
be the same width (e.g. 2 mm). A ‘pluck’ (heart and lungs
removed together) is best for obtaining blood vessels.
Hook suspended on cotton thread Hooks can be made from paperclips or piano wire. Check that
the cotton is not stretchy too.
Mass carrier and five 10 g and five 50 g The mass needed varies. Some centres report that a total mass
masses of up to 300 g has to be used.
Clamp stand, boss and clamp
Metre rule
Disinfectant and cloths for wiping down Use 1% Virkon™ or suitable alternative.
benches
Soap and (paper) towels for washing hands
Graph paper
Calculator A few spares per class (students should bring their own).
Eye protection
clamp stand
hook
ring of tissue
mass carrier metre rule
10 g mass
Figure 1 Measuring the length of the ring.

group of students
Prepared slides of artery and vein T.S.
Prepared slides of lung or thyroid gland
T.S. to show capillaries
Microscope Microscopes with high power lenses are needed.
Lamp if not built into microscope
Eyepiece graticule
Stage micrometer
Histology book
Drawing paper
Pencils
Notes
HARVEY’S CIRCULATION EXPERIMENTS
Purpose
 To demonstrate the function of valves in veins.
Perform Harvey’s experiment

In 1603, Hieronymous Fabricus (1537–1619), an Italian professor of anatomy and surgery, was the
first to publish a description of the valves in veins, although he was uncertain as to their function. The
English anatomist, William Harvey, one of Fabricus’s medical students, completed some simple
experiments to solve the puzzle and demonstrate circulation. Harvey’s book, ‘De Motu Cordis’
(Concerning the Motion of the Heart and Blood), published in 1628, described the experiments, which
you can perform for yourself or get a friend to help.
The experiments
 Allow your hand to hang downwards below waist level until the veins on the back of the hand
stand out.
 Press hard on a vein close to your knuckle.
 Keep pressing and at the same time with another finger, push along the vein towards your wrist.
You will see the vein seems to disappear.
 Lift the second finger and observe what happens. Sometimes you have to repeat several times
pushing further up towards the wrist to see the effect that Harvey will have observed.
 Now lift your first finger and see what happens.
Explain how the results of this experiment provided evidence supporting Harvey’s idea that veins
contain one-way valves. You could use the questions below to help you structure your answer.
Q1 What will pressing the vein close to your knuckle do to blood in the vein?
Q2 What does pushing along the length of the vein do to blood in the vein?
Q3 What did you observe happen when you removed your second finger from the vein?
Q4 What can you conclude from this observation?
Q5 What happened when you lifted your first finger?
More evidence
DO NOT do this experiment yourself
Figure 1 is similar to the one in Harvey’s book. He pressed the vein at point H to block the flow from
the wrist. He pushed the blood out of the vein to point O, then he tried to force the blood back along
the vein; a swelling occurred at point K in the vein.
Figure 1 Illustration of Harvey’s experiment from his book on the motion of the heart and blood.
Q6 What did he conclude from this observation?
HARVEY’S CIRCULATION EXPERIMENTS
Purpose
 To demonstrate the function of valves in veins.
Perform Harvey’s experiment

The simple experiment described is based on the one completed by William Harvey, which
demonstrated that veins contain one-way valves. It can be completed by students individually although
working in pairs will make it easier. Boys have less subcutaneous fat so the effect is often more
obvious in them.
The original Harvey diagram included a ligature around the upper arm: this use of a ligature on the
arm must not be attempted by students.
An additional question could be set as outlined below. It is omitted from the Student Sheet due to
space constraints and its somewhat gruesome nature.
Additional question
In another experiment operating on a live snake Harvey bound the vena cava and observed that the
heart failed to fill with blood. He then bound the aorta and showed that the heart became engorged
with blood as it was unable to escape.
Q7 What could Harvey conclude from these observations?
Answers
The explanation of evidence supporting Harvey’s idea that veins contain one-way valves should
include the answers to the questions.
Q1 Pressing the vein close to your knuckle stops the blood flowing along the vein back towards
the wrist and arm.
Q2 Pushing along the length of the vein moves blood out of that section of the vein towards the
wrist.
Q3 When you removed your second finger from the vein it does not refill.
Q4 Valves in the veins allow the movement of blood in one direction; they prevent back flow of
blood along the vein.
Q5 On lifting your first finger, the vein refills with blood.
More evidence
DO NOT do this experiment
Q6 The blood is stopped by a valve and it cannot go any further so the swelling occurs as the
blood collects in front of the valve.
Additional question
DO NOT do this experiment
Q7 Harvey could have made conclusions about the circulation of the blood, into the heart from the
vena cava and out of the heart through the aorta.
THE CARDIAC CYCLE
Purpose
 To describe the sequence of events in a single heartbeat, the cardiac cycle.
Use the section on the cardiac cycle in your Student Book or the interactive tutorial that accompanies
this activity to help you complete this worksheet.
Procedure
1 Cut out the pictures from page 2 and stick these into the
correct boxes on the right to match the order of descriptions
below.
2 Complete the descriptions and make deletions as appropriate,
i.e. when you are provided with two alternatives separated
by a /.
3 Add arrows to each diagram to show blood flow.
Cardiac diastole
During diastole blood flows into the atria from the _____________
_____________ and _____________ _____________. Elastic
recoil of the atrial walls generates low pressure in the atria, helping
to draw blood into the heart.
Initially the atrioventricular valves are open/closed.
As the ventricles begin to relax, blood tends to fall back from the
aorta and pulmonary artery causing the _____________________
valves to close. This causes the second heart sound ‘dub’.
Atrial systole
As the atria fill with blood, the pressure in the atria
increases/decreases, the atrioventricular valves are pushed open
and blood flows into the relaxing ventricles. The two atria contract
simultaneously, forcing the remaining blood into the ventricles.
Ventricular systole
After a slight delay, the ventricles contract. This
increases/decreases the pressure in the ventricles so the
atrioventricular valves open/close. This causes the first heart sound
‘lub’.
Blood is forced into the _______________ and _______________.
The semilunar valves are open/closed.
Blood begins to flow into the relaxing _______________.
THE CARDIAC CYCLE

Purpose
 To describe the sequence of events in a single heartbeat, the cardiac cycle.

Each student needs one strip of heart pictures to
cut up. The Student Sheet has a single strip of
pictures on page 2, and the Technician Sheet has
a master with multiple strips for photocopying.
Cardiac diastole
During diastole blood flows into the atria from
the pulmonary veins and vena cava. Elastic
recoil of the atrial walls generates low pressure
in the atria, helping to draw blood into the heart.
Initially the atrioventricular valves are closed.
As the ventricles begin to relax, blood tends to Figure 1 Cardiac diastole.
fall back from the aorta and pulmonary artery
causing the semilunar valves to close. This
causes the second heart sound ‘dub’.
Atrial systole
As the atria fill with blood, the pressure in the
atria increases, the atrioventricular valves are
pushed open and blood flows into the relaxing
ventricles. The two atria contract
simultaneously, forcing the remaining blood into
the ventricles.
Figure 2 Atrial systole.
Ventricular systole
After a slight delay, the ventricles contract. This
increases the pressure in the ventricles so the
atrioventricular valves close. This causes the
first heart sound ‘lub’.
Blood is forced into the aorta and pulmonary
artery. The semilunar valves are open.
Blood begins to flow into the relaxing atria.
Figure 3 Ventricular systole.
THE CARDIAC CYCLE
Purpose
 To describe the sequence of events in a single heart beat, the cardiac cycle.
This is a cut-and-stick exercise.

group of students
Copy of the Student Sheet
Strip of heart pictures This is on a separate photocopiable sheet.
Pair of scissors
Glue
ATHEROSCLEROSIS
Purpose
 To explain the course of events that lead to atherosclerosis.
 To describe the blood-clotting process.
Effects of atherosclerosis
Atherosclerosis is the name given to the process that occurs within arteries, causing them to narrow.
This can lead to coronary heart disease (CHD). A patient may only be aware that they have CHD
when their blood flow is restricted, causing angina – pain associated with a lack of oxygen in the heart
muscle. Ultimately, atherosclerosis can result in thrombosis – the blockage of an artery by a blood
clot. If the blood supply to the heart muscle cells is stopped they are said to be ischaemic, i.e. without
blood. The cells will die if they are starved of oxygen and nutrients for an extended period.
Procedure
Cut up the table below to make a set of cards with key words and phrases written on them. Sort the
cards into a sequence that follows the events in the development of atherosclerosis and thrombosis.
Using the key words and phrases, create a complete description, a flow chart or an annotated diagram
of the processes of atherosclerosis and blood clotting.
Platelets in contact with

1 Fibrin 13
damaged artery wall
2 Hard plaque forms 14 Artery narrows
3 Tangled mesh 15 Platelet plug forms
4 Large white cells enter wall 16 Rising blood pressure
5 Platelets become sticky 17 Artery wall damaged
6 Inflammatory response 18 Wall elasticity reduced
7 Thrombin 19 Atheroma forms
8 Cholesterol accumulates 20 Blood cells trapped
9 Prothrombin 21 Fibrinogen
Calcium salts and fibrous

10 22 Atherosclerosis
tissue accumulate
Thromboplastin released from
11 Cascade of chemical changes 23
platelets/damaged tissue
12 A blood clot forms
ATHEROSCLEROSIS
Purpose

The key words and phrases are provided in a table with the Student Sheet. This can be used as a table
or cut up to provide a set of cards. These are then sorted into the order of events that occur in the
process of atherosclerosis and blood clotting. The Student Book could be used to help with this
process or students could be encouraged to work out what is happening, using the cards, before
checking in the textbook to see if they are correct. Once the sorting is completed, students can write a
full description based on the cards, produce some sort of flow chart, or use the phrases as annotations
on a diagram to represent the processes of atherosclerosis and blood clotting.
The correct order for the cards is shown below.
17 Artery wall damaged 5 Platelets become sticky
6 Inflammatory response 15 Platelet plug forms

4 Large white cells enter wall 23
8 Cholesterol accumulates 11 Cascade of chemical changes
19 Atheroma forms 9 Prothrombin

10 7 Thrombin
tissue accumulate
2 Hard plaque forms 21 Fibrinogen
18 Wall elasticity reduced 1 Fibrin
14 Artery narrows 3 Tangled mesh
16 Raising blood pressure 20 Blood cells trapped
22 Atherosclerosis 12 A blood clot forms

13
damaged artery wall
ATHEROSCLEROSIS
Purpose

group of students
Set of key word cards The master sheet can be photocopied onto card.
Scissors if cards not cut up in advance

1 Fibrin 13
damaged artery wall
2 Hard plaque forms 14 Artery narrows
3 Tangled mesh 15 Platelet plug forms
4 Large white cells enter wall 16 Rising blood pressure
5 Platelets become sticky 17 Artery wall damaged
6 Inflammatory response 18 Wall elasticity reduced
7 Thrombin 19 Atheroma forms
8 Cholesterol accumulates 20 Blood cells trapped
9 Prothrombin 21 Fibrinogen

10 22 Atherosclerosis
tissue accumulate
11 Cascade of chemical changes 23
12 A blood clot forms
BLOOD FLOW
Purpose
 To describe what factors affect blood flow in arteries.
 To describe what has the greatest effect on blood flow.
What has the greatest effect on blood flow in arteries?

Blood flows through arteries due to a difference in pressure between one end of the vessel and the
other end. High pressure is generated at one end of the artery by the action of the heart pumping blood.
Blood entering the aorta is under pressure.
Flow in blood vessels or any tubes can be modelled using the equation:
P is pressure
P r 4
F= r is radius
8l
l is length
 is viscosity (η is the Greek letter Eta)

We are not going to do calculations of flow so don’t panic: by just looking at the equation you can tell
what factors determine flow rate, F.
What effect will these factors have on flow?

1 For each of the factors decide what impact an increase and a decrease will have on flow rate.
Draw a table to summarise your suggestions, the first row of the table is shown below. Give a
reason for each suggestion.
Thinking about the equation will help here, an increase in a factor that is on the top of the equation
will result in an increase in flow, whereas an increase in a factor that is on the bottom of the equation
will decrease the calculated value for flow.
Factor Change in factor Effect on flow Reason for effect on flow

increase/decrease
Pressure Increase
Decrease
2 Look at the equation and decide which factor you think will have the largest effect and give a
reason for your choice.
If you double viscosity or length you half the flow, the number being used to divide in the equation
has doubled. The effect of a change in radius is very different.
Blood flows through a vessel in layers, with the blood closest to the walls affected by friction. The
width of the blood vessel will affect how much blood is slowed by this resistance.
Think about a vessel with a radius of 1 mm and a flow rate of 1 arbitrary unit.
If it dilates to a give a radius of 2 mm, flow would be affected by r4, that is 24 or 16. Thus, doubling
the radius of a blood vessel increases the flow by 16 times.
3 Use the ideas above to work out how much the flow will increase if the vessel dilates further to
3 mm.
4 What implications does the relationship between radius and flow have for the effects of
atherosclerosis?
BLOOD FLOW
Purpose
 To describe what factors affect blood flow in arteries.
 To describe what has the greatest effect on blood flow.
What has the greatest effect on blood flow in arteries?

The aim of this activity is to get students thinking about blood flow in arteries and how the change in
radius has a major impact when considering atherosclerosis. Blood flow is proportional to the fourth
power of the radius, F  r4. There are no calculations to be completed using the equation on the sheet;
however, thinking about the equation allows students to estimate the impact of changing quantities in
the mathematical equation. The Student Sheet guides this thinking.
What effect will these factors have on flow?

1 For each of the factors students decide what impact an increase and a decrease will have on flow
rate and give a reason for each suggestion.
Factor Change in factor Effect on flow Reason for effect on flow

increase/decrease
pressure increase increase Blood flow is due to a difference in pressure:
if the difference is greater the flow rate will be
decrease decrease
faster and vice versa.
radius increase increase Less blood is in contact with the wall so less
friction to slow the blood and vice versa
decrease decrease
length increase decrease The longer a blood vessel the greater the
resistance to flow and vice versa. However,
decrease increase
the length of vessels does not change much
in vivo so will have little impact.
viscosity increase decrease The less fluid (more viscous) the blood the
higher the friction within the moving liquid and
decrease increase
hence the slower the flow and vice versa.
2 As explained on the Student Sheet it is change in radius that has the largest effect on flow.
3 If the blood vessel dilates to 3 mm the flow will increase by 34, that is 81 times faster.
4 The narrowing of a blood vessel due to atherosclerosis will have a very significant effect,
reducing flow rate and hence supply of oxygen and nutrients to cells. A two-fold decrease in
radius will decrease flow by 16-fold.
A graph of flow rate against radius would look something like this:
Flow rate
Radius
 a small change in radius will have a very significant impact on flow rate.
ESTIMATING RISK
Purpose
 To estimate risks and investigate people’s perceptions of risk.
 To analyse and interpret quantitative data on illness and mortality rates.
 To distinguish between correlation and causation.
Estimating risks and analysing data

Q1 In the year 2012, there was a total of 499 331 deaths in England and Wales. Of these, 1754
were due to road accidents. For each of the causes of death in Table 1, estimate the number of
deaths occurring in 2012. (Note that there are causes of death other than those listed here.)
Cause of death in England Estimated number of deaths Actual number of deaths

and Wales in 2012 in 2012
Accidental falls
Appendicitis
Asthma
Cancer
Diabetes
Epilepsy
Heart disease
Huntington’s disease
Influenza
Lightning strike
Meningitis
Murder
Pregnancy
Railway accidents
Road accidents
Table 1 Causes of death in England and Wales, 2012.
Disease Incidence of disease in 2012 Number of deaths in 2012

(new cases)
All cancers 299 147 142 107
Lung cancer 38 273 30 273
Breast cancer 44 851 10 373
Prostate cancer 39 555 9 698
Chlamydia 99 086 –
Table 2 Incidence of disease and number of deaths in England and Wales, 2012.
(Source: Office for National Statistics, Health Protection Agency, and Public Health Wales.)
Q2 Your teacher/lecturer will provide you with the actual number of deaths that occurred in 2012
due to each of the causes in Table 1. The figures come from the Office of National Statistics.
Compare your estimates with these figures. If there are discrepancies between your estimates
and the official statistics, try to explain why you may have overestimated the risks.
Q3 It is not unusual for people to overestimate the risk of death from train accidents. Suggest
reasons for this overestimation.
Q4 It is not unusual for people to underestimate the risk to their health of smoking. Suggest
reasons for this underestimation.
Study the year 2012 incidence (number of new cases) and number of deaths data for England and
Wales in Table 2 and then answer the questions below. The 2012 population of England and Wales
was 56 567 800. The total number of deaths in England and Wales during the year 2012 was 499 331.
Q5 Calculate the percentage of total deaths in England and Wales in 2012 that resulted from each
of the five categories of disease in Table 2. (Hint: The number of deaths due to a particular
disease is divided by the total number of deaths for the year 2012 and multiplied by 100 to
give a percentage. So the percentage of total deaths in the year 2012 due to all cancers is
142 107 ÷ 499 331  100.)
Q6 a Use the 2012 data to estimate the probability of an average person in England and Wales
developing each of the diseases. Express your answers as 1 in ? values or as decimals.
The population of England and Wales in 2012 was 56 567 800. (See section 1.2 in your
Student Book, or Maths and Stats Support Sheet 8 – probability, if you need help in
getting started with the calculations.)
When completing these calculations, think about the number of significant figures you
use when presenting your answers. For information on significant figures see Maths and
Stats Support Sheet 4 – significant figures.
b Use the 2012 data to estimate the probability of an average person dying from each of the
diseases in any year.
c The probabilities you have calculated are for the population as a whole. Why is it that the
probability for each individual will typically be very different?
Risk calculator
Risk calculator models provide scientists and other medical professionals with a useful tool to analyse
information based on research data. The models can predict the interaction of biological factors and
the impact of these factors on a range of disorders. Models can be used to support decisions involving
interventions, for example, drug prescriptions, changes to lifestyle and dietary changes. There are
many examples of risk calculators to be found on the Internet.
You can create your own coronary heart disease (CHD) risk calculator or use the one in the weblinks
for this activity to compare risk factors for a certain patient with ‘normal range’ of risk. It will also
show how CHD is influenced by the complex interaction of different factors. Full details of how to
create your own risk predictor using a Microsoft Excel® spreadsheet are provided in the ICT Support
section of the resources.
The data used to develop the risk calculator model were taken from the Framingham Heart Study,
started in 1948 in the USA. For more details about this study see the Student Book page 22.
Using the risk calculator model

Use the information below and the risk calculator model to answer the questions.
PATIENT A
A 46 year old male
Height: 6 feet 0 inches
Cholesterol levels: LDL = 4.95 mmol l–1 (191 mg/dl), HDL = 1.2 mmol l–1 (46.33 mg/dl)
Blood pressure reading: systolic = 145, diastolic = 90
Diabetic
Smoker
No symptoms of CHD experienced.
Q7 What is the risk of patient A developing CHD over the next 10 years?
Q8 Use Table 3 to describe patient A’s risk compared with that of a low risk and average risk man
of the same age.
Q9 Suggest lifestyle changes that might help patient A to reduce his risk of developing CHD.
Q10 What are the two most significant risk factors for patient A?
Comparative risk
Age (years) Average 10 year CHD risk (%) Low* 10 year CHD risk (%)
30–34 3 2
35–39 5 3
40–44 7 4
45–49 11 4
50–54 14 6
55–59 16 7
60–64 21 9
65–69 25 11
70–74 30 14
*Low risk was calculated for a man the same age, normal blood pressure, LDL cholesterol 100–129 mg/dl, HDL
cholesterol 45 mg/dl, non-smoker, no diabetes.
Table 3 Risk values for an average man and a low risk man of the same age.
ESTIMATING RISK
Purpose
 To estimate risks and investigate people’s perceptions of risk.
 To analyse and interpret quantitative data on illness and mortality rates.
Answers
Q1 and Q2 In question 1, students have to estimate how many deaths occur in one year from various
causes, with only the figures for total number of deaths and the number of deaths due to road
accidents for comparison. It is likely that students will overestimate some and underestimate
others, depending on their perception of the risk associated with that cause of death. Once
students have made their estimates they are given the figures in Table 1 below so they can tell
which they have over- or underestimated and answer question 2.
Cause of death in England Estimated number of Actual number of deaths

and Wales deaths in 2012 in 2012
Accidental falls 3790
Appendicitis 128
Asthma 1126
Cancer 145 395
Diabetes 4931
Epilepsy 986
Heart disease 126 621
Huntington’s disease 222
Influenza 83
Lightning strike 1
Meningitis 240
Murder 552
Pregnancy 46
Railway accidents 32
Road accidents 1754 1754
Table 1 Causes of death in England and Wales, 2012.
(Source: Office for National Statistics.)
Typical reasons for underestimates:

● the risk is undertaken voluntarily
● the risk is natural
● the risk is familiar
● the risk is not feared (the activity is looked forward to)
● the risk is fair
● the risk is common
● the consequences are in the long term.
● Reasons for overestimates:

● the risk is undertaken involuntarily
● the risk is unnatural
● the risk is unfamiliar
● the risk is feared
● the risk is unfair
● the risk is rare
● the consequences are sudden.
Q3 Any valid point, such as the risk is involuntary, unnatural, feared, unfair and sudden. In
addition, press coverage of these incidents make them appear frequent and have severe
consequences.
Q4 Any valid point, such as the risk is voluntary, familiar and the effects are a long time in the
future.
Q5 Figures in Table 2 as percentages. When discussing these results with students there is an
opportunity to discuss significant figures.
As an extension to question 5 students could be asked to calculate the number of deaths per 100 000 of
the population for each cause. The answers are in Table 2.
Q6 a and b Figures in Table 2 as probabilities.
c The development of these diseases is affected by genetic inheritance and environment.
The probability of an individual developing the disease will depend on their genes and
lifestyle. For example, a smoker is likely to have a higher chance of developing cancer
than a non-smoker. The type of treatment that someone with the disease receives may
influence whether the condition is fatal.
Disease Incidence Probability of Number of % of total Probability of Extension:
of disease developing deaths in deaths in 2005 death in 2005 deaths per
in 2012 disease in 2012 100 000
2012
All 299 147 56 567 800* 142 107 142 107 1 in 0.0025 ×
1 in × 100
cancers 299 147 499 33** 56 567 800* 100 000
=
142 107 = 250
= 1 in 189 = 29
or 0.005 1 in 398
or 0.0025
Lung 38 273 1 in 1478 30 273 6 1 in 1868 or 50
cancer or 0.0007 0.0005
Breast 44 851 1 in 1261 10 373 2 1 in 5453 or 20
cancer or 0.0008 0.0002
Prostate 39 555 1 in 1430 9698 2 1 in 5833 or 20
cancer or 0.0007 0.0002
Chlamydia 99 086 1 in 571 _
or 0.002
Table 2
*England and Wales population 2012.
**Total number of deaths in England and Wales 2012.
Q7 38%.
Q8 Patient A has a much higher risk than both the average (11%) and low risk (4%) man.
The final two questions could be left until later in the topic when students have studied risk factors in
more detail. Answers at this stage of the topic may be superficial, although they could be revisited and
extended towards the end of the topic.
Q9 Reduce fat intake, give up smoking and take action to reduce blood pressure, for example,
reduce salt intake and take more exercise.
Q10 Stopping smoking and lowering LDL cholesterol levels cause large falls in risk. But reducing
blood pressure also reduces risk.
CORRELATION AND CAUSATION
Purpose
Correlation and causation

A positive correlation between two variables occurs when an increase (or a decrease) in one variable
is accompanied by an increase (or a decrease) in the other variable. For example, an increase in the
number of cigarettes smoked is positively correlated with the incidences of lung cancer and coronary
heart disease (CHD). This is a positive correlation because as the number of cigarettes smoked
increases, the incidences of these diseases also increase. Similarly, the amount of alcohol in the
bloodstream of drivers positively correlates with the likelihood that they will have a car accident. In
both of these cases there is likely to be a causal link between the two variables. In a causal
relationship, a change in one variable brings about a change in another variable. The more a person
smokes, the greater the amount of chemicals in the bloodstream that can cause damage that results in
lung cancer and CHD. The more alcohol a person consumes, the slower their reaction times and the
more likely they are to have an accident. However, a strong correlation between two variables does
not necessarily prove a causal link between them.
The strength of any correlation can be tested using Spearman’s rank correlation. For information about
this statistical test see Maths and Stats Support Sheet 12 – Spearman’s rank correlation.
Q1 Look at the data in Table 1 on the next page and then attempt the questions.
a Is there any correlation between the two sets of data? If yes, is it a positive or negative
correlation? It might help to draw a graph using the two sets of data and test statistically.
A Microsoft Excel® file of the data is available with this activity.
b It is unlikely that improving Internet access in countries with a short life expectancy
would increase people’s lifespan. Suggest a plausible explanation for the relationship
between the variables.
Q2 A World Health Organisation preliminary investigation suggested that high levels of
background noise (for example, traffic noise) can affect your risk of heart disease.
a Suggest other factors that may account for the increased incidence of heart disease in
areas with high levels of background noise.
b Suggest how noise could increase the risk of heart disease.
Country Healthy life Internet Country Healthy life Internet

expectancy access expectancy access
at birth* (Internet at birth* (Internet
users per 100 users per 100
people)** people)**
Argentina 76 55.8 Morocco 71 55.0
Bangladesh 70 6.3 Myanmar 66 1.1
(Burma)
Brazil 74 49.8 Pakistan 65 10.0
Canada 82 86.8 Peru 77 38.2
China 75 42.3 Philippines 69 36.2
Colombia 79 49.0 Poland 77 65.0
Egypt 71 44.1 Romania 74 50.0
Ethiopia 64 1.5 Russian 69 53.3
Federation
France 82 83.0 South Africa 59 41.0
Germany 81 84.0 Spain 82 72.0
India 66 12.6 Sudan 63 21.0
Indonesia 71 15.4 Thailand 75 26.5
Iran 74 26.0 Togo 58 4.0
Italy 83 58.0 Turkey 75 45.1
Japan 84 79.1 Ukraine 71 33.7
Kenya 61 32.1 United Kingdom 81 87.0
Korea, South 81 84.1 United States 79 81.0
Liberia 62 3.8 Venezuela 76 44.0
Mexico 76 38.4 Vietnam 76 39.5
Table 1
*Source: World Health Organisation (WHO) 2012.
**Source: The World Bank 2012.
The most recent data for each country can be downloaded from the WHO and The World Bank websites.
CORRELATION AND CAUSATION
Purpose
Q1 a There is a positive correlation; as Internet access increases, life expectancy increases.
b Any valid reason that might explain the correlation, such as countries with better Internet
access may be wealthier and have better healthcare systems, fewer epidemic diseases and
better nutrition. The arguments presented from the opposite position – countries with
poor Internet access may have poorer health services – are, of course, equally valid.
As part of question 1 students could use the Spearmann Rank statistical test to analyse the strength of
the positive correlation. See Maths and Stats Support Sheet 12 – Spearman’s rank correlation.
Q2 a Other lifestyle factors may account for the increased incidence of heart disease, for
example, high fat diet/poor diet, higher rates of smoking, greater alcohol consumption, or
less physical activity.
b Increased background noise could increase stress and irritation, causing release of
adrenaline, which leads to high blood pressure, increasing the risk of atherosclerosis.
IDENTIFYING HEALTH RISKS
Purpose
 To evaluate the design of studies used to identify health risk factors.
Epidemiological studies
There are several different study designs used to look for correlations between a disease and specific
risk factors. Any study must be carefully designed to ensure that the results identify true correlations.
Cohort studies and case-control studies are two commonly used designs. Read the section in the
Student Book on the design of epidemiological studies, pages 22–25, before completing this activity
sheet.
MMR vaccination and autism

A large number of studies have investigated if the MMR (measles, mumps and rubella) vaccination is
a risk factor for the development of autism or other developmental disorders. Some of these studies are
outlined below. Read the summaries and then answer the questions that follow.
Autism is a developmental disorder. People with autism have difficulties with communications and
social interactions, displaying repetitive and rigid behaviour. In most cases, signs of abnormal
development can be recognised by the time a child is two years old. The MMR vaccination is given to
about 600 000 UK children each year, mostly when they are about two years old.
1998 Wakefield Study

In 1998 a link between the MMR vaccination and autism was suggested by Dr Andrew Wakefield and
his co-workers from the results of an uncontrolled case study of 12 children that had been referred to
the hospital’s gastroenterology group with intestinal symptoms (diarrhoea, abdominal pain, bloating
and food intolerance) and development disorder. They had been developing normally, but then lost
some of their acquired skills. Medical and developmental histories were obtained for each child,
including details of immunisations and exposure to infectious diseases. Neurological and psychiatric
assessments were completed. Clinical and laboratory investigations were completed, including
endoscope investigations of the bowels with tissue samples taken for analysis. The researchers
suggested that the chronic bowel symptoms might be linked with autism. They noted that in most
cases (eight), onset of symptoms was after MMR immunisation and further investigations were needed
to examine this syndrome and its possible relation to the MMR vaccine.
1998 Finnish Study

In the same year, 1998, the results of a long-term vaccination project to eliminate MMR diseases from
Finland were published. The project launched in 1982 saw all children vaccinated twice, at age 14–18
months and 6 years. Any children who had adverse reactions to the vaccine were reported to the
Institute. By the end of 1996 about three million vaccinations had been given to children and some
adults. Thirty-one children developed gastrointestinal symptoms after vaccination; none went on to
develop signs of autism.
1999 North Thames Study

A study in the North Thames health district of 293 children with confirmed autism in vaccinated and
non-vaccinated groups concluded that there was no evidence to support an association between autism
and MMR. The results were published in The Lancet in 1999.
2004 UK General Practice Research Database Study

Results of a matched case-control study conducted using data from the General Practice Research
Database (GPRD) were published in The Lancet in 2004. This database contains detailed information
about every consultation by over 280 medical practices serving over two million people selected to be
representative of the whole UK population. 1294 children affected by autism or other developmental
disorders were identified from the database. Two child psychiatrists using 10 diagnostic criteria for
autistic disorders reviewed the medical information for each child. Some children with medical
disorders that are thought to have a causal association with autism, such as fragile X disorder,
phenylketonuria or congenital rubella, were excluded. For each of these affected children up to five
matched controls were also identified from the database, children with no record of developmental
disorders matched on age, sex and medical practice. A questionnaire to parents of all cases and
controls included questions about the family size, socioeconomic status, education of parents and
medical history. The following dates were recorded for each affected child.
 First attendance to the GP with symptoms.
 First concerns or symptoms recorded in hospital letters.
 Definitive diagnosis from hospital letters.
 Parents’ first concern about symptoms of autism collected retrospectively.
 MMR vaccination from GP records.
1294 cases and 4469 controls were included in the study. 1010 cases had MMR vaccination recorded
before diagnosis, 3671 controls had MMR vaccination before the age at which their matched case was
diagnosed. The study concluded that MMR vaccination was not associated with an increased risk of
autism or other developmental disorders.
Wakefield Study Fraud identified

The findings by Wakefield and colleagues were widely reported by the media, creating a vaccine
scare, which led to a decline in vaccinations. Over the following decade epidemiological studies found
no evidence of a link between MMR vaccine and autism. The paper was retracted by The Lancet in
2011 after a General Medical Council hearing. It had been shown that the study did not have ethical
approval and when Wakefield wrote the final version of the paper he fraudulently altered information
about patients’ medical histories to support his claims. Wakefield was struck off the Medical Register
barring him from practicing medicine in the UK. Vaccination rates have improved since the scandal
was exposed; 92.3% of two year olds were vaccinated in 2012–13. However, this coverage is below
the 95% level recommended by the World Health Organisation to ensure herd immunity and hundreds
of thousands of children are unprotected against measles, mumps and rubella.
Questions
Q1 Wakefield suggested a causal association between the MMR vaccine and a new syndrome of
chronic inflammatory bowel disease and autism. On publication in 1998, the study and its
conclusions were widely criticised. Suggest some of the weaknesses that the critics identified
in this epidemiological study. At this time they were unaware of the fraud.
Q2 Explain how the Finnish study provided more reliable results than those of the Wakefield
study.
Q3 What type of study was undertaken in the North Thames health district?
Q4 Why were children with conditions such as fragile X syndrome excluded from the GPRD
study?
Q5 Explain why the GPRD questionnaire was sent to all participants?
Q6 In the GPRD study which of the dates recorded for each affected child are more reliable for
investigating the relationship between the timing of the MMR vaccination and development of
autism?
Q7 A working party of the UK Committee on Safety of Medicines undertook a study to assess
reports of children who had developed autism or similar disorders following MMR
vaccination. The parents of all children included had sought legal advice about possible
damage as a result of vaccination. How might this method of selecting participants affect the
results of the study?
Q8 Suggest how the Wakefield MMR scandal could have been avoided.
Making decisions about publication of a study

All papers submitted to academic journals are peer reviewed, that is, the papers are sent to experts who
decide if they are suitable for publication. Read the description below of an epidemiological study
undertaken to investigate whether blood cholesterol concentrations can be used to predict stroke.
Decide whether or not you would publish the paper based on this study in the medical journal for
which you referee papers. Write a letter of response to the epidemiologists who undertook the study
explaining the reasons for your decision. You may conclude that a decision cannot be made unless
additional information is provided and in that case you must tell the epidemiologists what information
they need to supply.
Study outline
A prospective cohort study by the Korean National Health Service to determine risk factors for stroke
and heart attack was completed. 661 700 male and 125 742 female public servants were included in
the study. They were all between 30–64 years of age, with a mean age of about 42. They had a health
check by the Korean Medical Insurance Company, one of the main national health insurance providers
who provide medical insurance services for all public servants and their unemployed family members.
Information about exposure to risk factors came from the medical examination and a self-administered
questionnaire.
The study found that high concentrations of blood cholesterol were associated with ischaemic stroke
(associated with atherosclerosis). Low blood cholesterol was associated with haemorrhagic stroke (not
associated with atherosclerosis).
IDENTIFYING HEALTH RISKS
Purpose
 To evaluate the design of studies used to identify health risk factors.
Epidemiological studies
Students should read pages 22–25 of the Student Book about the design of epidemiological studies
before completing this activity. They may benefit from completing Checkpoint question 1.5, which
requires them to produce a checklist of features of a well-designed study used to collect valid and
reliable data used to determine health risk. The activity sheet provides some information on a number
of studies investigating a possible link between the MMR vaccination and development of autism.
Students do not need to learn the details of the studies, but are required to apply their knowledge of
good study design.
As described on the sheet the results Wakefield published in The Lancet had been altered to support
his claim of a link between the MMR vaccine and autism. Wakefield was found guilty and struck off
the medical register with the research paper retracted by The Lancet. The case highlights the ethical
aspects of medical research.
The Wakefield and the GPRD studies are published in The Lancet. Wakefield, A.J., Murch, S.H.,
Linnell, A.A.J., Casson, D.M., Malik, M., Berelowitz, M., Dhillon, A.P., Thomson, M.A., Harvey, P.,
Valentine, A., Davies, S.E., and Walker-Smith, J.A. (1998) Ileal-lymphoid-nodular hyperplasia, non-
specific colitis and pervasive developmental disorder in children. The Lancet 351: 637–41 (Retracted
2011). Smeeth, L., Cook, C., Fombonne, E., Heavey, L., Rodrigues, L.C., Smith, P.G., Hall, A.J.
(2004) MMR vaccination and pervasive developmental disorders: a case-control study. The Lancet
364: 963–9.
The sheet goes on to consider a Korean epidemiological study; students have to decide, based on the
brief outline of the study, whether it is suitable for publication.
Answers
MMR vaccination and autism
Q1 The study only looks at 12 cases that had been specifically referred to a group interested in
studying the link between the vaccine and the development disorders. It was not a population-
based study and there are no cases or controls to find out whether the rate of a given syndrome
in vaccinated individuals exceeds that among unvaccinated controls. Children receive the
MMR vaccination at the time when symptoms of autism can first be recognised, so it is very
likely that some cases will coincidently appear following MMR vaccination.
Critics gave more detailed comments on the study based on details that are not included in the
summary provided on the activity sheet. For example, the report suggested that MMR
immunisation might lead to the bowel disorder resulting in malabsorption of peptides that
caused the development disorder. Critics noted that behavioural changes preceded bowel
symptoms in almost all their reported cases. The researchers hypothesised that measles vaccine
viral infection plays a part in causing the disorder; critics noted that they did not present any
evidence from viral studies. As described on the Student Sheet, the study results were later
found to be fraudulent.
Q2 This Finnish study is a large-scale cohort study. The whole population vaccinated is used so
there is not a sample that could have produced a result by chance.
Q3 The North Thames health district study is a type of cohort study, it is known as a case series
method using only cases and no controls. The cohort all has the condition and are investigated
to determine if there is a causal link to the vaccination. It was developed to investigate adverse
reactions to vaccines. Students will not know this type of design from the description on the
sheet or in the Student Book, the question should make students realise that there are other
study designs that have not been included in the materials.
Q4 Children with conditions such as Fragile X syndrome are excluded from the study because it is
known that these conditions may have a causal link with the development of the disorder.
Q5 The information provided is used to look for common features that contributed to the
development of the developmental disorders.
Q6 The dates extracted from GP and hospital records are more reliable as they do not rely on the
parents’ memories. They are also not affected by any adverse publicity about a link between
MMR.
Q7 Only including children of people who sought legal advice may not be representative of the
population to whom the results will be applied. All the people that sought legal advice may
have some other factor in common that was the cause of the disease.
Q8 Students may suggest a number of points based on the information on the sheet, for example,
the poor quality of the study should have meant that the peer reviewers rejected it for
publication; the study should have been ethically approved and The Lancet should have a
system in place to check this before accepting a paper for publication. In this case, it has been
reported that Wakefield made the alterations when writing the final version of the paper, with
his co-authors unaware of the changes. It could be suggested that the co-authors should have
checked the paper before publications as they have shared responsibility for the publication. It
has been suggested that research ethics committees, in addition to giving ethical approval
before a study is undertaken, should check that a study has been completed in accordance with
the method they approved.
Making decisions about publication of a study

It does not matter if students decide that the study should or should not be published, they just need to
support their decisions with some suitable reasons.
Reasons for publication might include:
 large sample size
 suitable sample age range if results only to be applied to this group
 suitable methods of data collection appear to be used.
Reasons for not publishing:
 cohort are all public servants so are not representative of the general population
 age range of people included does not include older people who are more likely to have strokes
 information about exposure to risk factors obtained from the self-administered questionnaire may
not be reliable if people do not remember the exposure details accurately.
Students may not be able to decide for or against and request more information about the study. They
may request more detailed information about the occupations of the public servants to better judge if
the sample is representative of the wider population. They may also request more detailed information
on the medical examination and questionnaire to assess if these will produce valid results.
The study was published in the British Medical Journal. Ebrahim, S., Sung, J., Song, Y.M., Ferrer,
R.L., Lwalor, D.A., Davey Smith, G. (2006) Serum cholesterol, haemorrhagic stroke, ischaemic
stroke, and myocardial infarction: Korean national health system prospective cohort study. BMJ 333:
22–7. A letter from an epidemiologist in a German university published in response to the paper raised
concerns about the ages of people used in the study. He was concerned that the study looked at young
and middle aged people whereas the majority of strokes occur in elderly people to whom the results of
the study could not be applied.
ANALYSIS OF CARDIOVASCULAR DISEASE DATA
Purpose
 To analyse quantitative data on cardiovascular disease (CVD).
 To consider the effect of age and gender on the risk of CVD.
Analysis of risk: haemorrhagic stroke

Mark had his haemorrhagic stroke in 1995 at the age of 15. In this type of stroke a blood vessel in the
brain bursts. With the correct data it is possible to calculate his risk of having a fatal stroke, and to see
how this risk is affected by age and gender. Tables 1 and 2 present data for the year that Mark had his
stroke.
Age Male Female

0–4 6 7
5–9 6 –
10–14 7 5
15–19 8 6
20–24 19 10
Table 1 Number of UK deaths from haemorrhagic stroke in 1995.
Gender
Females Males
Age group 15–19 1 682 000 1 780 000
Table 2 Population of the UK in 1995 separated by gender for the 15–19 age group.
Q1 Estimate the probability of a 15-year-old male in the UK dying from a haemorrhagic stroke
during 1995 and explain how you determined your answer.
Q2 Estimate the probability of a 15-year-old female in the UK dying from a haemorrhagic stroke
during 1995 and explain how you determined your answer.
Analysis of coronary heart disease data

Use the data on age-specific death rates from coronary heart disease (CHD) over a number of years in
Table 3 to answer the questions that follow.
Age/years 35–44 45–54 55–64 65–74

Men Women Men Women Men Women Men Women
1980 56 9 270 50 733 215 1621 688
1985 43 7 221 43 687 213 1601 702
1990 37 6 159 33 536 179 1352 594
1995 26 5 117 24 408 124 1133 498
2000 19 5 92 20 291 84 823 347
2005 19 4 73 16 204 54 558 225
2010 15 4 62 14 165 40 396 148
Table 3 Death rates per 100 000 of population of the United Kingdom due to CHD.
Q3 Comment on what happens to the average risk of death due to CHD as you get older. Give a
reason for any changes in risk.
Q4 Use the data to produce an appropriate graph to show clearly the gender differences for a
particular year. For guidance on drawing graphs see Maths and Stats Support Sheet 2 –
Presenting data – graphs.
Q5 a Describe the trend in the number of deaths per 100 000 from CHD between 1980 and
2010. Use examples from the data to quantify your answer. Estimate the percentage
decrease in each case.
b Suggest reasons for this trend.
Q6 a Compare the incidence of CHD deaths in men and women. Remember to quantify your
answers.
b Suggest reasons for any differences described.
Q7 a Has this gender difference changed over the time period shown?
b Suggest reasons for any changes observed.
Study Year Sex Age Incidence

group /100 000
4th National Study of Morbidity Statistics from 1991/92 Men 45–64 1080
General Practice
65–74 2250
75–84 2730
Royal College of General Practitioners, the Office
of Population Censuses and Surveys and the 85+ 2020
Women
Department of Health (1995) Morbidity Statistics 45–64 660
from General Practice, Fourth National Study
1991–1992. London: HMSO. 65–74 1760
75–84 2240
85+ 2150
One general practice in Oxford (Gill et al, 1999) 1989/91 Men 45–54 830
55–64 1353
65–74 930
Women
45–54 643
55–64 1257
65–74 827
Table 4 Incidence of angina per 100 000 adults determined in two UK studies.
Use the data on the incidence of angina in adults in Table 4 to answer the question that follows.
Q8 a Comment on the risk for men and women of suffering angina as they get older and on any
conflicting evidence in the two studies.
b Which of the studies is likely to have a better design? Give reasons for your answer.
ANALYSIS OF CARDIOVASCULAR DISEASE DATA
Purpose
 To analyse quantitative data on cardiovascular disease (CVD).
 To consider the effect of age and gender on the risk of CVD.
Answers
Haemorrhagic stroke
Q1 From the data presented, it is only possible to estimate for a 15-year-old because the values
given are for 15–19-year-olds: Number of 15–19-year-old males in 1995 in the UK who died
from haemorrhagic stroke ÷ total number of 15–19-year-old males in the UK in 1995.
8
=
1 780 000
= 4.4  10–6
or 1 in 1 780 000/8 = 1 in 222 500
6
Q2
1 682 000
= 3.5  10–6
or 1 in 280 333
Coronary heart disease

Q3 The risk increases. Reasons for the increase include: reduced elasticity of the arteries with age,
increasing the likelihood of higher blood pressure and damage to arteries, leading to
atherosclerosis. The effect of other risk factors for CVD may increase with age.
Q4 A histogram showing male and female figures for each age category in a single year is ideal.
Q5 a The number of deaths decreases in all age categories for both men and women. Students
should quantify their answers appropriately. This could be used as an opportunity to
estimate the outcome of calculations without using a calculator. All fall to about 20–25%
of the 1980 value except women aged 35–44 who fall to 44% of the 1980 value.
b Improvements in diet (for example, lower fat); increased awareness of risks and lifestyle
factors that increase risk, leading to positive changes (for example, diet, exercise);
improved screening, diagnosis and treatment of CHD.
Q6 a At all ages, men have a higher rate of death from CHD than women do. The difference
between men and women decreases in the older age groups. (Students should quantify
their answers appropriately.)
b Men have a greater inherited predisposition.
Men smoke more/drink more alcohol.
Protective effect of oestrogen for women is not present after menopause.
Q7 a The gender difference has decreased over time for the younger age groups, but has not
decreased for the older age groups. Examining the data to show this involves calculating
the gender difference for each age group over the years, for example, for 1980 and for
2005.
b Decrease in gender lifestyle differences, for example, more women are smoking.
Q8 a The results of the 4th National Study of Morbidity Statistics from General Practice show
the risk of angina for both men and women increases with age from 45 to 84 but after this
age the incidence decreases. This may be because in the oldest age group people are more
likely to die from the disease and/or old age more than suffer the angina symptoms. The
Oxford study also shows an increase followed by a decrease with age. However, the age
bands studied are different and this study suggests that the decrease occurs after the age
of 64 for both men and women, which conflicts with the National GP data.
In the Oxford study men aged 45–64 had a 1 in 46 chance of having angina, those
between 65 and 74 had a 1 in 107 chance of angina: this conflicts with the findings of the
National GP study. Males in the National GP study aged 45–64 had a 1 in 93 chance of
having angina, those between 65 and 74 had a 1 in 45 chance of angina. This pattern is
repeated for women. The differences in the two studies may be due to the different year
of the study, the size of the sample studied (one is a national study, the other draws data
from a single general practice) or the methods used in the study.
b The National GP study has a much larger database collected across the country, so it will
be less affected by local environmental effects. Assuming it uses valid survey methods it
should be more accurate with results that are representative of the wider population.
MEASURING BLOOD PRESSURE
Purpose
 To measure blood pressure.
 To explain the significance of high blood pressure in cardiovascular disease (CVD).
SAFETY
Never use a sphygmomanometer or blood pressure monitor unsupervised.
Do not over-inflate the cuff or leave it inflated for longer than necessary.
Do not worry if your blood pressure seems too high or too low. This is not a definitive
medical measurement of blood pressure, just an estimate.
Do not take repeat measurements until the blood flow to the lower arm has been restored for
several minutes.
You should not use one of these monitors if:
You have a cardiac pacemaker, or you know you suffer from heart rhythm disorders, or you already
suffer from severe atherosclerosis.
YOU NEED
● A sphygmomanometer and stethoscope, or a blood pressure monitor
Blood pressure
Blood pressure is one of the easiest and quickest measures used by the medical profession to check the
health of your heart and circulation system.
If you have ever had your blood pressure taken or seen it done on one of the many TV hospital
dramas, you will know that an inflatable cuff is generally put around your upper arm and held loosely
in place with Velcro. Air is pumped into the cuff inflating it and measurements are taken as the cuff
is deflated.
‘Normal’ blood pressure is often quoted in books as 120/80 mmHg, but how many people actually
have this blood pressure? Find out by using a sphygmomanometer or digital blood pressure
monitor to determine the blood pressure of several members of your group. Are they all the same?
Are there any patterns within the values obtained? If you have time, take three or more readings each
to see if the measurements are precise.
The interactive tutorial that accompanies this activity can help you understand exactly what is
happening when blood pressure is measured. It can be used as an alternative to measuring blood
pressure with a sphygmomanometer, which is difficult to use.
But remember that taking pressure measurements can cause anxiety which may affect the
measurement. Eating, smoking, drinking alcohol and sports can all affect your blood pressure. Any
high or low measurements made in the classroom should not be regarded as indicative of a blood-
pressure problem. Even with the blood-pressure monitors that are widely available on the high street,
unusual measurements should be checked by a qualified health professional.
Procedure
1 Make yourself comfortable and try to relax before having your blood pressure taken.
2 Remove any clothing with tight sleeves: it is important that blood flow is not constricted. If you
push up your sleeve, make sure that it doesn’t become so tight that it impedes blood flow.
3 Most sphygmomanometers or digital meters have a cuff that must cover the brachial artery in the
upper arm. The cuff must be closed firmly so that the artery is well covered, as shown in Figure 1.
4 Try to lay your arm on a surface such as your lab bench, ensuring that the cuff is at approximately
the same height as your heart. (Think why!) The palm of your hand should be facing upwards.
Figure 1 Using a sphygmomanometer and stethoscope to measure blood pressure.
Using a sphygmomanometer
5 With traditional sphygmomanometers you use a stethoscope to listen for the sound of blood flow
in the brachial artery. The stethoscope is positioned on the inside forearm below the elbow as
shown in Figure 1.
6 Pump air into the cuff, inflating it until the pulse sound disappears.
7 Deflate the cuff until the sound of blood can be heard as it starts to push through the artery.
8 Take a reading at this point. This first reading gives systolic pressure.
9 Further deflate the cuff. As the sound disappears take a second reading. This gives diastolic
pressure, a measure of the pressure in the artery when the heart is relaxed. The overall blood
pressure is given in mmHg. It is usually expressed as systolic over diastolic, for example,
120/70 mmHg.
Unless you are an experienced nurse or paramedic, it is often difficult to recognise the change in
sound of blood flow. The animation lets you see what should happen.
Using a digital blood-pressure monitor

10 Digital blood-pressure monitors have a pre-set switch. This means that when you start to inflate
the cuff, you should set this switch at a value slightly higher than your expected systolic pressure
(the upper value). For instance, if you are young and healthy, you will probably need to set the
switch at 140. If you have doubts, your teacher or lecturer will be able to advise you.
11 Press the start button to automatically inflate the cuff to the pre-selected pressure. Most models
continue to inflate past the pre-set value if you have set it too low.
12 When the monitor reaches the target inflation value, the air is automatically released and the value
in the digital display begins to count downwards.
13 When the monitor first detects your pulse, the majority of monitors will begin to ‘beep’ and a
symbol will start to flash. Here, the monitor is determining the upper value for your blood
pressure, the systolic blood pressure. Notice that the ‘beeping’ is fairly regular. What do you think
the ‘beeps’ show?
14 As the pressure in the cuff continues to drop, there comes a point when the monitor can no longer
detect your pulse. This gives the lower value for your blood pressure, the diastolic blood pressure.
Can you think what has happened to your brachial artery at this point?
15 When all the air has been released, the monitor will display both your systolic and your diastolic
blood pressures. Most machines will also show your pulse rate at the same time.
16 You may wish to store these measurements using the monitor’s memory facility, so that you can
monitor changes in your blood pressure, perhaps in accordance with exercise or possibly over a
period of time.
Most people’s blood pressure falls within the range of 100–140 mmHg for systolic pressure and
60–90 mmHg for diastolic pressure. Pressures below these values are considered to be low pressure;
above about 160/95 mmHg is classed as high blood pressure.
Unusual measurements should be checked by a qualified health professional.
Questions
Q1 What do you think the beeps made by a digital pressure monitor at step 13 of the procedure
represent?
Q2 What is happening to blood flow in the brachial artery at the final step of both procedures?
Q3 Comment on your results if you have taken several readings from different people within the
group.
Q4 A person has a blood-pressure reading of about 170/95 mmHg. Would this be classed as high
blood pressure?
Q5 Why can elevated blood pressure increase the risk of CVD?
Investigating blood pressure

Blood pressure can vary between individuals and can change through the day. What effect might
posture or relaxation have on blood pressure? Plan an experiment that would let you check out your
idea. Use the Developing Practical Skills sheet to help you plan the investigation: you can find this in
the Practical Skills Support section of SNAB Online.
Purpose
SAFETY
Important: these monitors should not be used with a student who:
● suffers from heart rhythm disorders or valve defects
● suffers from severe atherosclerosis
● has a cardiac pacemaker.
Never allow students to use a sphygmomanometer or blood-pressure monitor unsupervised. Do not
over-inflate the cuff or leave it inflated for longer than necessary. Do not allow measurements to be
repeated until the blood flow to the lower arm has been restored for several minutes.
Tell students that they will not get an accurate medical indication of their blood pressure. If, after
this activity, they think their blood pressure is too high or too low they should seek medical advice.

This activity could be completed as an investigation to provide practice in practical skills. A null
hypothesis, such as ‘Body mass has no effect on blood pressure’ or ‘posture (sitting or standing) has
no effect on blood pressure’, or a hypothesis, such as ‘A high salt diet causes higher blood pressure’
(this would involve students assessing the average salt content of their diets) could be tested.
A traditional sphygmomanometer is very difficult to use. Recognising the change in sound of blood
flow in the brachial artery is hard for the inexperienced user. The use of a digital model is
recommended. Sensitivity will be needed to avoid anxiety in students who obtain an unusual reading.
In these situations, only if unusual readings are obtained repeatedly should any suggestion be made
about seeking medical advice. See the answer to question three below, which details the range of
values that might be expected; this information also appears on the Student Sheet.
An animated explanation of blood pressure accompanies this activity.
Answers
Q1 The beeps represent the passage of the pulse through the artery.
Q2 Blood flows continuously.
Q3 It is likely that a wide range of values will be obtained. There is really no such thing as a
‘normal’ blood-pressure value. A cardiologist we consulted stated that in 35 years of practice
he had only measured one person with a blood pressure of 120/80 mmHg – the value often
quoted in textbooks as ‘normal’. Most systolic values fall within the range 100–140 mmHg
with diastolic values of 60–90 mmHg. Above about 160/95 mmHg is classified as high blood
pressure.
Q4 Yes.
Q5 High blood pressure increases the chance of damage to artery walls, triggering the deposition
of atheroma and development of atherosclerosis.
Investigating blood pressure

In any experiment that is planned, look for appropriate valid measurements to test the hypothesis,
repeated measurements and control of any other variables that might affect the results. The
Developing Practical Skills sheet in the Practical Skills Support section of SNAB Online guides
students in planning an investigation.
Purpose
SAFETY
Never allow students to use a sphygmomanometer or blood-pressure monitor unsupervised. Do not

group of students
Sphygmomanometer and stethoscope A traditional sphygmomanometer is difficult to use. Recognising the
or Blood pressure monitor change in sound of blood flow in the brachial artery is hard for the
inexperienced user. The use of a digital model is recommended.
Notes
BLOOD PRESSURE SUMMARY
Purpose
 To draw together all the blood pressure ideas.
 To introduce the use of concept maps.
Procedure
The concept map is one method of producing a summary of what you think you know about a
particular subject area, in this case blood pressure. The construction of the map allows you to think
through the ideas covered and clarify your understanding. A map will often highlight errors or
omissions. It can provide a useful tool in learning.
If you have never constructed a concept map you may need to read the Exam and Study Skill
Coursework Support before getting started.
Starting with the idea of blood pressure, construct your own concept map or use the template
provided.
You might include what blood pressure is and what it is the result of, then expand out from these
ideas.
If you would like a helping hand use the template below.
is Blood pressure
is the result of
cardiac output
aga inst is the result of of
blood vessel walls heart rate stroke volume blood vessels
is is that can vary in
whose elastic fibres allow amount of blood pumped

by left ventricle
changed by so that obese people have
stretching during longer blood vessels
during which we feel as a during is controlled by may may to raise
contract
arteriole walls
maintaining to reduce to raise
thus maintaining
Figure 1 Blood pressure concept map.
BLOOD PRESSURE SUMMARY

Purpose
 To draw together all the blood pressure ideas.
 To introduce the use of concept maps.

Students could produce their own map from scratch or use the template provided. Additional help
could be given by providing a list of words to be added to the map – see below Figure 1.
The template includes cardiac output and stroke volume, which are covered in Topic 6 of the course,
so it might be better for students to draw their own at this stage and use the template to revise the ideas
during Topic 6.
is Blood pressure
is the result of
hydrostatic force of blood cardiac output peripheral resistance
aga inst is the result of of
blood vessel walls heart rate stroke volume blood vessels
is is that can vary in
whose elastic fibres allow number of beats amount of blood pumped diameter length
per minute by left ventricle
changed by so that obese people have
recoil stretching smooth muscle longer blood vessels

during
during which we feel as a during is controlled by may may to raise
diastole pulse systole nerves and relax contract

hormones arteriole walls arteriole walls
maintaining to reduce to raise
hydrostatic force
of blood
thus maintaining
blood pressure
Figure 1 Blood pressure concept map completed.
blood pressure number of beats per minute

diameter peripheral resistance
diastole pulse
hydrostatic force of blood recoil
hydrostatic force of blood relax arteriole walls
length smooth muscle
nerves and hormones
CARBOHYDRATE STRUCTURE
Purpose
 To describe condensation and hydrolysis reactions.
 To distinguish between monosaccharides, disaccharides and polysaccharides, and relate their
structure to their roles in providing and storing energy.
Procedure
Complete the interactive tutorial that accompanies this activity or read the section on carbohydrates in
your Student Book and then use what you have learned to complete this worksheet.
Joining sugar units
Splitting sugar units
1 Complete the table below with the names of three disaccharides and their monosaccharide
components.
Name of disaccharide Sugar monosaccharides making up disaccharide
Building complex carbohydrates

2 Fill in descriptions of the molecules below; include detail about their structures and formation.
3 On the monosaccharide diagram above, label the carbons 1 to 6; start with 1 on the carbon to the
right of the oxygen in the ring.
4 On the diagram below, draw in 1,4 glycosidic bonds. Label one glucose monomer. On that
molecule, draw in a hydroxyl group and side group in the correct position.
Joining glucose molecules to form starch and glycogen
Structural formula of starch

Starch is a polymer made up of glucose monomers.
Branching glucose chains are possible when 1,4 and 1,6 glycosidic links are present.
5 On the diagram below, add the 1,4 and 1,6 glycosidic bonds. Label one 1,4 glycosidic link and
one 1,6 glycosidic link.
Starch is made up of amylose and amylopectin.
6 Fill in the table with information about the structure of these two molecules.
Name of molecule Type of glycosidic bonds present and

structure formed
7 On page 2 of this Activity Sheet label the diagram that shows part of an amylose molecule and the
diagram that shows part of an amylopectin molecule.
8 In the box below, describe how the structure of glycogen is similar to that of amylopectin starch.
9 Use information from the interactive tutorial and Student Book to complete the table below.
Name of molecule Structure and chemical Biological role and use by

properties humans
Sweet, soluble, crystalline. Monomer of polysaccharides.
Monosaccharide. Substrate for cell respiration in all
living organisms, releasing energy.
Insoluble polysaccharide formed

from two glucose polymers:
branched amylopectin with 1,4 and
1,6 glycosidic links and helical
amylose with 1,4 glycosidic bonds
only.
Maltose
Sweet, soluble, crystalline.

Disaccharide formed by
condensation reaction between
glucose and fructose.
Glycogen
In the ICT Support there is a data logging sheet on testing for sugars using a colorimeter.
CARBOHYDRATE STRUCTURE
Purpose
 To describe condensation and hydrolysis reactions.
 To distinguish between monosaccharides, disaccharides and polysaccharides and relate their
structure to their roles in providing and storing energy.
This worksheet can be completed using the Student Book or the accompanying interactive tutorial.
Answers
Joining sugar units
Splitting sugar units
1 Table completed in any order.
Name of disaccharide Sugar monosaccharides making up disaccharide

Maltose Glucose
Sucrose Glucose and fructose
Lactose Glucose and galactose
2 A monosaccharide is a single sugar unit, general formula (CH2O)n, where n is the number of
carbon atoms in the molecule, most commonly six carbon atoms.
A disaccharide is a double sugar unit, made up of two monosaccharides, joined by a glycosidic
bond, formed in a condensation reaction.
A polysaccharide is a polymer made up from sugar monomers, joined by glycosidic bonds. It may
be a straight chain or branched, and may have a helical structure.
3
6
Name of molecule Type of glycosidic bonds present and
structure formed
Amylose 1,4 glycosidic bonds, unbranched chain coils to form
spiral
Amylopectin 1,4 and 1,6 glycosidic bonds, branched chain, each
branch coils to form a spiral
7 See answers to Questions 4 and 5.
8 Amylopectin and glycogen are both made of branched chains of -glucose with 1,4 and 1,6
glycosidic bonds.
9
Name of molecule Structure and chemical Biological role and use by
properties humans
Glucose Sweet, soluble, crystalline. Monomer of polysaccharides.
Monosaccharide. Substrate for cell respiration in all
living organisms releasing energy.
Starch Insoluble polysaccharide formed Energy storage molecule in fruit,

from two glucose polymers: vegetables and cereals.
branched amylopectin with 1,4 and Used in making bread, pasta and
1,6 glycosidic links and helical other carbohydrate-rich prepared
amylose with 1,4 glycosidic bonds foods.
only.
Maltose Sweet, soluble, crystalline. Found in germinating seeds when
Disaccharide formed by starch is broken down by the
condensation reaction between enzyme amylase.
glucose molecules. Used in brewing.
Sucrose Sweet, soluble, crystalline. Molecule used for transporting
Disaccharide formed by energy in plants.
condensation reaction between Extracted from sugar beet and
glucose and fructose. sugar cane and commonly used in
cooking, in crystalline form and as
golden syrup or molasses.
Glycogen Insoluble highly branched Energy storage molecule found in
polysaccharide with 1,4 and 1,6 animal cells.
glycosidic links. Can be rapidly hydrolysed due to
numerous side branches.
BIOTECHNOLOGY TO THE RESCUE
Purpose
 To reinforce the idea that disaccharides can be converted into monosaccharides by hydrolysis.
 To test for glucose using a semi-quantitative technique.
SAFETY
Wear eye protection. Wear a plastic apron to protect your clothes. Long sleeved clothing
should be rolled up to prevent contamination.
Take care to not splash any enzyme-containing liquids. Wash off any splashes immediately.
Lactase is a relatively safe enzyme, but contact with or inhalation of any enzyme should be
protected against to avoid allergic reaction or sensitisation.
The products from the column should not be tasted unless the experiment has been
conducted in a food preparation area with equipment for food use only using food grade reagents
(including food grade enzyme) and observing strict hygiene rules.
Do not touch the colour-producing end of the glucose test strip as the indicator chemical may be
hazardous.
YOU NEED
2 cm3 lactase 3
● ● 10 cm syringe barrel
● 8 cm3 sodium alginate solution (2%) ● Clamp stand, boss and clamp
3
● 20 cm 1.5% calcium chloride solution ● Tea strainer
3
● 20–50 cm distilled water ● Two small beakers
3
● Glass rod ● 10 cm measuring cylinder
● Glucose test strips
Is there a use for lactose?

Lactose is the disaccharide found in milk. It is not actually a very useful sugar:
 It is rarely used in food products because many people are intolerant to lactose. Of the Thai,
Chinese and Afro-Caribbean populations, 97%, 90% and 73%, respectively, are reported to be
lactose-intolerant, often resulting in severe digestive problems.
 Lactose has low solubility and tends to produce crystals at concentrations above 11%. If lactose is
used in food products, the crystals can produce an unpleasant sandy texture.
 Lactose is only 20% as sweet as sucrose. If it were to be used in foods, the large amount needed to
achieve sweetness would substantially increase the calorie content of the food.
 When cheese is made, the large quantities of liquid whey produced contain lactose and protein. If
whey is disposed of into the sewage system, its high nutrient content encourages growth of
microorganisms and fines can be imposed on the industry for this pollution.
How can enzymes help?

Hydrolysis of lactose yields the monosaccharides glucose and galactose, which are much sweeter
sugars. The enzyme lactase can be used to hydrolyse lactose and this process is now used in the
production of ice cream and sweetened, flavoured and condensed milks. Syrup made from the
products of hydrolysis of the lactose-rich whey from the cheese industry can be made into a useful
product: a hygroscopic (water-retaining) toffee that has a low melting point. The toffee can be poured
into chocolate cups at relatively low temperatures, and because it is hygroscopic it can be used to coat
biscuits without making them soggy. Milk treated with lactase is suitable for lactose-intolerant people
to drink.
In industry hydrolysis of lactose is carried out using immobilised enzymes, as shown in Figure 1. In
the experiment that follows, lactase is used to make lactose-free milk.
Figure 1 Enzyme immobilisation.
Procedure
Immobilising the enzyme
1 Mix 2 cm3 lactase with 8 cm3 alginate gel solution. Stir gently with glass rod.
2 Pour 20 cm3 calcium chloride solution into a clean beaker.
3 Clamp a 10 cm3 plastic syringe barrel above the beaker of calcium chloride solution. Position the
syringe close to the top of the beaker taking care not to let the syringe touch the solution.
4 Pour the alginate gel into the syringe, allowing the gel to drip slowly into the calcium chloride
solution. It is best to add about 2 cm3 of gel to the syringe at a time.
5 The gel beads must be left in the calcium chloride solution for 10 minutes to harden, then strained
in a tea strainer and rinsed with distilled water.
Making a column of beads

6 Clamp a syringe barrel above a small beaker and place a small piece of nylon gauze in the bottom
of the syringe (see Figure 2 below).
7 Attach a short length of rubber tubing to the syringe outlet and screw a Hoffman clip onto this to
seal the end of the syringe. The Hoffman clip can be used to control the flow of liquid from the
syringe.
8 Pour the beads into the syringe barrel – you can use a small spoon or spatula for this.
Figure 2 Making a column of immobilised lactase.
Hydrolysing the lactose

9 Pour the milk into the column. Adjust the clip so that the milk slowly drips into a beaker.
10 Use a glucose test strip to test for glucose in the liquid collected from the column. Glucose test
strips are semi-quantitative; you can get a reading of glucose concentration by comparing the
colour produced with a colour scale.
If you have time, investigate the effect of the rate of flow of the milk over the beads on the production
of glucose.
How glucose test strips work

The detection of glucose using test strips (Figure 3) provides a quick and easy way for diabetics to
monitor their own blood and urine glucose levels. The advantage of this method over some chemical
methods is that it is specific for glucose; glucose can be distinguished from the presence of other
sugars.
The enzymes glucose oxidase and peroxidase

are immobilised onto a cellulose fibre pad with
chromagen dye.
Figure 3 Glucose test strip.
The test strip is dipped into the solution to be tested.

Two reactions take place:
1 catalysed by glucose oxidase
glucose + oxygen + water → hydrogen peroxide + gluconic acid
2 catalysed by peroxidase
hydrogen peroxide + colourless chromagen dye → coloured, oxidised chromagen dye + water
The amount of coloured chromagen produced is a measure of the amount of glucose that has reacted.
A colour reference card gives an indication of the concentration of glucose present in the solution.
Q1 Explain what happened to the milk as it passed through the column of beads. Use biochemical
detail and diagrams in your answer as appropriate.
Purpose
SAFETY
Ensure eye protection is worn. Wear a plastic apron to protect your clothes. Long sleeved
clothing should be rolled up to prevent contamination.
Ensure care is taken to not splash any enzyme-containing liquids. Wash off any splashes
immediately.
Lactase is a relatively safe enzyme, but contact with or inhalation of any enzyme should be
protected against to avoid allergic reaction or sensitisation.
The products from the column should not be tasted unless the experiment has been
conducted in a food preparation area with equipment for food use only using food grade
reagents (including food grade enzyme).
Supervise the use of the glucose test strips to ensure they are not handled at the colour-producing
end.
Note
Knowledge of the use of immobilised enzymes is not required by the specification. No detailed
knowledge of enzymes is required here. This is covered in Topic 2. This experiment could be
completed before Activity 1.14 to introduce disaccharide hydrolysis to monosaccharides.
Burettes can be used to hold the alginate beads instead of syringe barrels. The beads need to be
washed out immediately after use to avoid problems with removal, which occur if they dry out. Gauze
is required in the burette to prevent beads entering the tap and blocking the tip. Burettes make rate of
flow investigations easier.
Answers
Q1 Lactose is a disaccharide sugar found in milk. It is made up of the monosaccharides glucose
and galactose. As the milk passes over the immobilised lactase enzyme, hydrolysis of the
lactose is catalysed by the enzyme. The addition of water to the bond between the glucose and
galactose separates the two monosaccharides in the hydrolysis reaction.
Experiment adapted from NCBE ‘Better Milk for Cats’ (1993) In Practical Biotechnology: A Guide
for Schools and Colleges. Reading: NCBE. pp. 26–27. (For more information see their website listed
in the weblinks for this activity.)
Purpose
This is based on the National Centre of Biotechnology Education (NCBE) practical – ‘Better milk for
cats’. It is in two parts. In the first part, students immobilise the lactose in alginate beads. In the second
part, they use the beads to remove the lactose from milk. The beads can be kept in a fridge if necessary
for a few days.
SAFETY
Avoid unnecessary contact with the enzyme. Wear eye protection. Wear a plastic apron to
protect your clothes. Long sleeved clothing should be rolled up to prevent contamination.
Take care to not splash any enzyme-containing liquids. Wash off any splashes immediately.
Inhalation of the dust from dried up enzyme spills should be avoided. In case of spillage
or contact with eyes, rinse by flushing with water.
Lactase is a relatively safe enzyme, but contact with, or inhalation of, any enzyme should be
protected against to avoid allergic reaction and sensitisation.
The products from the column should not be tasted unless the experiment has been conducted in a
food preparation area with equipment for food use only using food grade reagents (including food
grade enzyme).
Calcium chloride is an irritant to eyes, skin and respiratory system. Avoid raising dust. Wear eye
protection while preparing it. The anhydrous salt is dangerous with water.
If cutting the glucose strips in half to economise, then wear nitrile gloves and cut the strip inside a
clear plastic bag to capture any dust particles produced. Dispose of the bag immediately, inspect
the strips to ensure the test sections are well-adhered and then thoroughly wash your hands.
Immobilising the lactase

group of students
2 cm3 lactase Available from NCBE, see suppliers list on the website. Use this
neat, as provided.
8 cm3 sodium alginate solution (2%) Mix 2 g sodium alginate powder with 100 cm3 of warm distilled or
3
deionised water to make 100 cm of solution. NB: Water must be
distilled or deionised – if calcium ions are present the solution will
set. Sodium alginate is hard to dissolve – it will need a lot of stirring
even in warm water. Alternatively, make it up and leave overnight in
the fridge. The solution will keep for about a week if stored in a
fridge.
20 cm3 1.5% calcium chloride solution To make up use 1.5 g calcium chloride to 100 cm3 of distilled water.
Glass rod For stirring.
3
20–50 cm distilled water To rinse the beads.
3
10 cm syringe barrel
Syringe tip If smaller beads are required (for example, for use in a burette)
syringe needles can be fitted, or fine tipped pipettes used.
Clamp stand and boss
Tea strainer To pour beads into and to hold beads while rinsing with distilled
water.
Two small beakers
10 cm3 measuring cylinder
Making a column of beads and hydrolysing the lactose in the milk

group of students
The sodium alginate beads they made
in part A
10 cm3 or 20 cm3 syringe barrel A burette with a tap can be used to replace the syringe, clip and
tubing if the beads are made so that they are small enough to be put
in the burette. Using a burette will make rate of flow investigations
easier. Wash out burette immediately after use, if left to dry the
beads stick and removal is extremely difficult.
10 cm3 milk
Short length of rubber tubing
Hoffman clip Cheap plastic ones work fine.
Small piece of nylon mesh or net This prevents the beads blocking the tip of the syringe or burette. (Glass
2
curtain (approximately 1 cm ) wool can be used instead.)
Semi-quantitative glucose test strips These can be cut longitudinally to make twice as many (see note in
safety box). Glucose test strips can be obtained from pharmacists.
Reference colour charts for test strips
Notes
LIPIDS
Purpose
 To describe the synthesis of a triglyceride.
 To describe the formation of ester bonds in condensation reactions between glycerol and fatty
acids.
 To explain differences between saturated and unsaturated lipids.
Procedure
Complete the interactive tutorial that accompanies this activity or read the section on lipids in your
Student Book and then use what you have learned to complete this worksheet.
Fats and oils belong to a group of molecules called lipids. Lipids do not dissolve in water, but do
dissolve in non-polar solvents.
Questions
Q1 a Add the following labels to Figure 1: fatty acids, glycerol, ester bond.
b Add the name of the reaction, the total number of water molecules removed and the name
of the product.
Q2 In Figure 1, circle and label the atoms removed during the formation of an ester bond between
one fatty acid and glycerol.
Figure 1 Formation of a triglyceride.
Q3 Using the information about joining and splitting sugar units in the section on carbohydrates in
the Student Book and Activity 1.17, name the reaction on Figure 1 that would split an ester
bond to release a fatty acid.
Q4 What do you think are the products of lipid digestion?
……………………………………………………………………………………………………
Q5 Draw a simple diagram in the space below to show a monounsaturated fatty acid.
Name Formula No. of No. of double bonds in Melting

carbons hydrocarbon chain point/°C
Lauric acid C12H24COOH 12 0 44.2
Palmitic acid C16H32COOH 16 0 63.1
Stearic acid C18H36COOH 18 0 69.6
Oleic acid C18H34COOH 18 1 13.4
Linoleic acid C18H32COOH 18 2 –5.0
Arachidonic acid C20H32COOH 20 4 –49.5
Arachidic acid C20H40COOH 20 0 76.5
Table 1 Fatty acid information.
Q6 Referring to the data in Table 1, what effect does an increase in the number of double bonds
have on the melting point of a fatty acid?
……………………………………………………………………………………………………
……………………………………………………………………………………………………
Q7 What effect does an increase in the number of carbon atoms have on the melting point?
……………………………………………………………………………………………………
……………………………………………………………………………………………………
Q8 Explain why most polyunsaturated oils are liquid at room temperature.
……………………………………………………………………………………………………
……………………………………………………………………………………………………
……………………………………………………………………………………………………
……………………………………………………………………………………………………
LIPIDS
Purpose
 To describe the synthesis of a triglyceride.
 To describe the formation of ester bonds in condensation reactions between glycerol and fatty
acids.
 To explain differences between saturated and unsaturated lipids.
Answers
Q1 and Q2 See Figure 1.
Q3 Hydrolysis.
Q4 Glycerol and fatty acids.
Figure 1
Q5
OH
C
O
Q6 An increase in the number of double bonds lowers the melting point.

Q7 If there are no double bonds, more carbon atoms increase the melting point.
Q8 The double bonds in the hydrocarbon chain cause kinks in the fatty acid tail. They are unable
to pack closely together. The weaker intermolecular forces between the unsaturated fatty acids
give them a lower melting point, so they are usually liquid at room temperature.
YOUR ENERGY BUDGET
Purpose
 To analyse data on energy budgets and diet.
Energy budget
The calories that you need each day depend on:
 the amount of energy your body uses when completely at rest (basal metabolic rate)
 the energy used as a result of eating (specific dynamic action)
 the amount of physical activity (PA) you take part in.
To analyse your energy budget you need to calculate energy expenditure and energy intake from food.
The calculations can be completed on the interactive tutorial that accompanies this activity, or by
working through the sections on this worksheet.
energy
intake
energy
requirement
weight gain
energy energy
requirement intake
weight loss
energy energy
requirement intake
no change in weight
Figure 1 If the balance between energy consumed and energy used is not equal, you will lose or gain weight.
Procedure
Calculating energy requirements
Calculating your basal metabolic rate (BMR)
There are various formulae for calculating basal metabolic rate (BMR). The formula used here is the
Harris-Benedict formula, which takes height, mass and age into account. Calculate your BMR:
Formula gives calorific requirements in kcal per day My mass in kg M = ________
Adult females 655.1 + (9.563 × M) + (1.850 × H) – (4.676 × A) My height in cm H = ________

My age in years A = ________
Adult males 66.5 + (13.75 × M) + (5.003 × H) – (6.775 × A)
My BMR = ________
H = height/cm; M = mass/kg; A = age/years
Although scientists normally use kilojoules (kJ) as the unit of energy, Calories (kcal) are very widely
used by the food industry for energy content of food. A Calorie is the same as a kilocalorie.
1 kcal = 4.18 kJ.
Calculating physical activity (PA)

Calculate your total daily calorific expenditure using the formula:
Daily energy expenditure during exercise = (M × E × T)
M = mass/kg; E = energy expenditure/kcal per kg per min; T = time/min
To do this you need to:

1 Work out roughly how long you spend in minutes each day on the equivalent of the activities
below. If an activity you participate in, for example, football, is not shown, select an activity that
you think would use about the same amount of energy per minute.
2 Work out the energy used for each activity each day and then sum these values to give the total
for each day. The values are energy used per kg of your mass.
3 Multiply the energy used by your mass to give your total energy expenditure during physical
activity per day.
Activity Energy Time Energy Activity Energy Time Energy
expendi- spent on used*/ expendi- spent on used*/
ture/kcal activity/ kcal per ture/kcal activity/ kcal per
per kg min kg per kg min kg
per min per min
Running 12 0.14 Cycling 0.07
min per mile 5 mph
min per mile 10 mph
min per mile 15 mph
Running 7 0.24 Swimming 0.09
min per mile crawl 25 m
per min
Running 6 0.28 Swimming 0.18
min per mile crawl 50 m
per min
Walking 20 0.03 Standing 0.014
min per mile
Walking 15 0.06 Driving 0.029
min per mile
Walking 11 0.14 Writing/ 0.014
min per mile deskwork
Sitting 0.014 Sleeping 0.014
(watching TV)
Showering 0.06 My total energy expenditure per
kg**/kcal per kg
*Energy used = energy expenditure in kcal per kg per min × time in minutes.
**Sum of energy used in one day for all activities.
My daily energy expenditure in exercise (PA)

= total energy expenditure per kg × mass
= _________________ kcal per day
Calculate specific dynamic action (SDA)

Specific dynamic action is the amount of energy needed to digest, absorb, transport and metabolise
your food. It can be assumed to be 10% of your BMR and PA. This additional 10% is added to your
daily energy expenditure on BMR and PA to give total daily energy expenditure. The easy way to do
this is by multiplying PA + BMR by 1.1, see below.
Total daily energy expenditure

Use this formula to calculate your energy needs for one day:
1.1 × (BMR + PA) =
Calorific input from food

Use tables of nutritional values to analyse your diet for a typical day. Compare the total energy input
from food with the value that you calculated above, which is your total daily energy requirement.
Do your daily energy requirements and daily energy input from food balance? If not, which is greater
and by what percentage?
Questions
Q1 Suggest how age, gender and body size may all affect BMR.
……………………………………………………………………………………………………
……………………………………………………………………………………………………
Q2 Suggest how environmental temperature may affect BMR.

……………………………………………………………………………………………………
……………………………………………………………………………………………………
Q3 When you diet, after a couple of weeks your BMR will slow down as your body attempts to
conserve energy. Use this to explain why exercise may be a more effective way of losing
weight than dieting.
……………………………………………………………………………………………………
……………………………………………………………………………………………………
……………………………………………………………………………………………………
Extension questions
Q4 Assume that an 80 kg person loses 1 kg of body fat for every 7700 kcal that their energy
expenditure exceeds intake. How long in minutes would they need to run at 6 min per mile in
order to lose 1 kg of body fat?
The smaller an animal, the larger their surface area compared with their volume. A mouse loses a
larger proportion of body heat through its surface than an elephant. A baby will lose body heat more
easily than an adult will.
Q5 Use the information above to suggest how the BMR of a baby per kilogram of its body mass
will compare with that of an adult.
YOUR ENERGY BUDGET
Purpose
 To analyse data on energy budgets and diet.

Students calculate their energy requirements and energy input from their diet using either the
interactive tutorial that accompanies this activity or by working through the steps on the worksheet.
Tables of nutritional values can be downloaded from the Internet. The Nuffield Coordinated Science
course had good examples. These can be downloaded from the National STEM Centre elibrary. Sheet
6B How much energy do we need? contains appropriate tables.
To develop mathematical skills it would be worth students calculating their own BMR before going on
to use the interactive turorial.
It is worth telling students that the software uses kilocalories although they are not the recognised SI
unit for energy.
The diet analysis on the web tutorial is very simple. The aim is not to spend a huge amount of time
working out a very accurate figure, but rather to do some analysis and illustrate the principle of
balanced energy budgets. More sophisticated diet analysis software is available – a search on ‘diet
analysis’ on the Internet should provide examples.
Answers
Q1 BMR is highest in young infants in part due to the need to maintain body temperature. BMR
declines with age, although the fall is slower in children and adolescents who are still actively
growing. BMR declines partly due to loss of muscle tissue. Males have more lean tissue –
muscle – than females, which burns more calories even when at rest. Larger people have more
metabolising tissue, so have a higher BMR.
Q2 A cold environment is associated with a raised BMR. Cold temperatures result in more
thermogenesis – heat creation – which raises BMR.
Q3 In addition to burning calories for muscle contraction, exercise will raise BMR, and increase
the amount of muscle, further increasing BMR. Dieting will result in a drop in BMR which
causes fat to be deposited once diet returns to normal.
Q4 Energy to lose 1 kilogram running 6 minutes per mile
energy expenditure during exercise = M × E × T
energy expenditure during exercise
Time =
Mass  Energy expenditure per minute
= 7700 ÷ (80 × 0.28)
= 7700 ÷ 22.4
= 344 minutes.
Q5 A baby will have a higher BMR per kilogram of its body mass.
OBESITY INDICATORS
Purpose
 To calculate obesity indicators and explain their significance.
The National Institute for Health and Care Excellence (NICE) recommends the assessment of health
risks due to being overweight or obese should be based on both Body Mass Index (BMI) and waist
circumference. It recommends the use of the two measures because although BMI takes account of
height, it does not differentiate between mass due to muscle development and mass due to body fat. In
addition, BMI does not consider fat distribution, which has been identified as contributing to increased
health risk. The health risk consequences of obesity can be significant; an obese man is five times
more likely to develop type 2 diabetes and a woman is 13 times more likely. Obese men and women
are about three times more likely to develop cancer of the colon, and both have increased risk of a
number of other diseases including cardiovascular disease (CVD).
Calculate your BMI

BMI is used to classify a person’s body mass relative to their height.
It gives an indication of whether a person is underweight, normal weight, overweight or obese.
BMI is calculated using the formula:
body mass/kg
BMI =
height 2 /m 2
Calculate your BMI and decide your category of bodyweight using the table below.
BMI Classification of bodyweight

<18.5 underweight
18.5–24.9 normal
25.0–29.9 overweight
30.0–39.9 obese
>40.0 severely obese
Questions
Q1 Edgar is 165 cm tall and weighs 65 kg. Work out his BMI. What advice would you give him
regarding his weight?
Q2 A fully grown adult man has a daily energy requirement of approximately 3052 kcal, and has a
daily energy intake of about 3500 kcal. What will be the consequences for his BMI if he
maintains this energy budget?
Q3 Explain why doctors would advise patients with BMIs above 30 to reduce their weight.
Calculate waist-to-hip ratio

Waist-to-hip ratio has been identified as a better measure of obesity. There is a positive correlation
between waist-to-hip ratio and risk of heart attack.
Waist-to-hip ratio is calculated by dividing waist circumference by hip circumference. The waist is
measured unclothed at the narrowest point between the top of the hip bone and the rib margin. The hip
measurement is taken at the widest point around the buttocks wearing light clothing using a non-
stretchable tape measure attached to a spring scale with a tension of 750g.
Women’s waist-to-hip ratio should not be greater than 0.85, men’s should not exceed 0.90. The higher
the value above these figures, the greater the risk.
Q4 Two female friends measure their waist and hip circumferences. One has a waist measurement
of 76 cm and hips of 102 cm, the other has a waist circumference of 110 cm and hips of
138 cm. Calculate their waist-to-hip ratio and decide if either should be concerned. The two
friends are the same height, 170 cm.
Q5 Edgar has a hip measurement of 85 cm and waist of 90 cm. Would your advice remain the
same as that given in response to question 1?
Q6 Suggest why waist-to-hip ratios combined with BMI are better than BMI alone as an indicator
of obesity and heart disease risk.
OBESITY INDICATORS
Purpose
 To calculate obesity indicators and explain their significance.

Students could calculate their own BMI and waist-to-hip ratio. However, some students may be self-
conscious about their weight and body image. If this is likely to be the case, avoid distress by avoiding
class wide measurements; either use volunteers or provide figures for the completion of calculations.
Calculating BMI
Q1 Edgar’s BMI = 65 ÷ 1.652 = 23.9.
His BMI value falls within the ‘normal weight’ category.
Q2 The person will put on weight, increasing their BMI.
Q3 People with BMIs over 30 are obese. They should lose weight to avoid the health
consequences of obesity, for example, increased risk of coronary heart disease (CHD) and
diabetes.
Calculating waist-to-hip ratio

Q4 0.74 and 0.79. Both women have ratios below the recommended 0.85.
Q5 Edgar’s waist-to-hip ratio is 1.06. His ratio is above the ideal for men of 0.90 so he is probably
carrying some excess abdominal fat. He would be advised to increase his exercise or decrease
energy intake to reduce his waist-to-hip ratio.
Q6 BMI will give a body weight classification that takes into account height but not the
distribution of fat. Waist-to-hip ratio takes account of the amount of abdominal fat. A larger
waist, the result of higher fat deposits, is associated with increased risk of heart disease.
CHOLESTEROL AND CARDIOVASCULAR DISEASE
Purpose
 To look at evidence for a correlation and a causal link between cholesterol levels and
cardiovascular disease (CVD).
Correlation or cause?
Most people have heard that cholesterol is ‘bad for you’. But this is not entirely true; cholesterol is
essential for the body in small amounts. It is needed for maintaining the correct level of fluidity in cell
membranes. Cholesterol is also needed in the manufacture of steroid hormones and some of the
components of bile (an alkaline fluid secreted by the liver, which aids digestion).
We normally obtain around 25% of our blood cholesterol from our food and our liver makes the other
75%. There are major concerns about the high levels of fat in many people’s diets and the impact this
can have on blood cholesterol levels, health and, in particular, the development of CVD, including
coronary heart disease (CHD) and stroke.
Q1 Many studies have looked in more detail at the relationship between cholesterol and CHD.
Table 1 below shows the total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride
levels in the blood of the participants in the Atherosclerosis Risk in Communities (ARIC)
study. In a 10 year follow-up of this US study involving 12 339 participants, 725 CHD events
occurred. The difference between the CHD and non-CHD participants was shown to be
statistically significant.
Using the data in Table 1, suggest the possible significance to health of different types of
blood cholesterol.
Women Men
CHD No CHD CHD No CHD
Number of participants 216 6691 509 4923
mean total cholesterol/ 5.96 5.59 5.72 5.40

–1
mmol l
mean LDL cholesterol/ 3.89 3.48 3.91 3.56
–1
mmol l
mean HDL cholesterol/ 1.30 1.51 1.07 1.18
mmol l–1
mean triglycerides/ 1.68 1.30 1.63 1.44
–1
mmol l
Table 1 The mean values for lipids in ARIC women and men with and without CHD.
Table 2 shows summary results of a review of 49 trials looking at the effect of lowering blood
cholesterol on CHD risk.
Time since lowering of Reduction in risk/%

cholesterol/years
1 11
2 24
3–5 33
>5 36
Table 2 The effect of lowering blood cholesterol levels by 1 mmol l–1 on CHD risk.
Q2 What conclusions can be drawn from the results in Table 2 about the relationship between
blood cholesterol and heart disease?
Q3 From the data shown in Figure 1, what conclusions can be made about the interaction between
HDL cholesterol, LDL cholesterol and CVD risk? (Look carefully at the axes!)
Figure 1 The interaction between LDL cholesterol, HDL cholesterol and CVD risk, data from the Framingham
study.
The passage below concerns the development of atherosclerotic plaques in experimental animals. This
is a modified extract from an article published in Nature on atherosclerosis.
The first observable change in the artery wall following the feeding of a high-fat, high-
cholesterol diet is the accumulation of lipoprotein particles and their aggregates in the intima.
Within days or weeks, monocytes can be observed adhering to the surface of the endothelium.
The monocytes then move across the endothelial monolayer into the intima, where they
proliferate, differentiate into macrophages and take up the lipoproteins, forming foam cells.
With time, the foam cells die, contributing their lipid-filled contents to the necrotic core of the
lesion. Some fatty streaks subsequently accumulate SMCs [smooth muscle cells], which migrate
from the medial layer. With the secretion of fibrous elements by the smooth muscle cells,
fibrous plaques develop and increase in size. Initially, the lesions grow towards the adventitia
[inner layer] until a critical point is reached, after which they begin to expand outwards and
encroach on the lumen.
Modified from Aldons J. Lusis 2000 Nature 407:233–241.
Q4 List the evidence presented on this Activity Sheet that supports:

a correlation between blood lipid levels and CVD risk, and
b a causal link between blood lipid levels and CVD risk.
Q5 The extract above only refers to a high cholesterol diet and accumulation of lipoproteins.
Suggest what additional evidence would be required to make a causal link between high LDL
cholesterol levels with the development of atherosclerosis lesions.
Q6 Explain why both the data from studies, such as those shown in Table 1 and Figures 1 and 2,
and evidence from histology and animal studies, is needed to construct a convincing theory
linking blood lipid levels and CVD.
A study in women looked at the relationship between LDL cholesterol/HDL cholesterol levels and the
formation of a protein that is involved in the attraction of blood cells into artery walls. Figure 2 shows
the results of the study.
Figure 2 Relationship between HDL cholesterol and formation of blood cell attracting protein in women.
Q7 Describe the effect of the different levels of LDL and HDL cholesterol on the formation of the
protein.
Q8 Suggest why these results support a beneficial effect of HDL cholesterol (for women at least).
CHOLESTEROL AND CARDIOVASCULAR DISEASE
Purpose
 To look at evidence for correlation and a causal link between cholesterol levels and
cardiovascular disease (CVD).
Correlation or cause?
This activity gives students an opportunity to distinguish between correlation and causation with
respect to cholesterol levels and CVD. Students interpret data and identify correlations between the
two factors. They also have to consider the evidence for a causal link between cholesterol and the
development of CVD. Questions revisit the idea of epidemiological studies.
Answers
Q1 In both men and women there are higher levels of total cholesterol, triglycerides, and LDL
cholesterol in the participants who have experienced CHD events compared with those who
have no CHD. There are lower levels of HDL cholesterol in individuals who have CHD
compared with those who have no CHD. These data suggest that to reduce the chances of
CHD one should lower total cholesterol and triglycerides, and increase the amount of HDL.
Q2 Lowering cholesterol level reduces the risk of CHD. These trials also suggest that the longer
the cholesterol is kept low, the greater the reduction in risk. Initially there is a negative
correlation; as the length of time cholesterol is lowered increases, the greater the reduction in
risk. But the increased reduction after five years is relatively small compared with the
reduction in the first few years.
Q3 At all LDL cholesterol levels, HDL cholesterol is inversely related to CHD risk. There is a
negative correlation – decreasing HDL cholesterol increases the risk of CHD. At all HDL
cholesterol levels, increasing LDL cholesterol increases CHD risk. The lowest risk of CHD is
associated with the lowest LDL cholesterol level combined with the highest HDL cholesterol
level.
Q4 a All data on blood cholesterol levels and CVD incidence/risk (Tables 1, 2 and Figure 1).
b Data that supports the mechanism for how cholesterol can result in the development of
CVD, information from the Nature extract.
Q5 The type of cholesterol that accumulates in the foam cells would need to be determined. This
has been done experimentally and it is found to be LDL cholesterol.
Q6 The correlated data from the table and graphs suggest a causal link, but this needs to be
supported by a plausible mechanism to explain the link. In this case, a mechanism for how
blood lipids cause atherosclerosis is provided by observation of tissues in animal studies.
Q7 In women with low LDL, the level of HDL does not affect the amount of protein produced.
With high LDL, low HDL is linked to greater production of the protein.
Q8 In women with high LDL, a high HDL reduces production of the protein, which should help
reduce the formation of atheroma.
SUDDEN DEATH IN ATHLETES
Purpose
 To illustrate how the predisposition for cardiovascular disease (CVD) can be inherited.
 To apply knowledge of atherosclerosis and blood clotting.
Procedure
The article describes how possession of one gene can increase the risk of developing the disease
without the presence of other risk factors. Read the article and then answer the questions that follow.
Sudden Death in Athletes

Why do athletes who are in peak physical condition, who do not smoke or drink too much suddenly
have a heart attack?
In March 2012, 24 year old footballer Fabrice Muamba suffered a heart attack while playing for
Bolton in an FA Cup match against Tottenham Hotspur. His heart stopped for 78 minutes but
fortunately he recovered. He had an undiagnosed heart condition – hypertrophic cardiomyopathy
(HCM). In December of the same year Mitchell Cole, who played for Oxford, died at the age of 27
also due to HCM. Research suggests that this type of sudden cardiac death affects both men and
women and is two to four times more common in athletes than in non-athletes.
Researchers examining the Office for National Statistics data for causes of death and estimated that
each week about 8 people under the age of 35 die from undiagnosed cardiac conditions.
A study of 158 deaths in young athletes from 1985 to 1995, published in the Journal of the American
Medical Association found that HCM was the most common cause of death in young athletes. HCM is
recognised as the most common cause of sudden cardiac arrest in young people. Mutations in one of
several genes cause abnormal thickening of the ventricle walls particularly the left ventricle. The
contraction of the heart muscles may be disrupted causing an irregular heartbeat.
For the majority of people with HCM it does not affect the quality of their life or their life expectancy
although there is an increased risk of sudden death. There have been calls for a national screening
programme for young people. For more than 35 years in Italy, there has been screening of young
athletes before participating in competitive sport. A study published in the New England Journal of
Medicine concluded that this screening may have prevented sudden death. However, the UK screening
committee consider that the tests are not accurate enough to correctly identify the condition and it
would result in false positives.
HCM is not the only cause of sudden death in young athletes. In November, 1995, the 28 year old
Olympic and four-times World champion Russian skater, Sergei Grimke, died of a sudden cardiac
arrest while training. Tests showed that he had severe atherosclerosis in his coronary arteries which
led to the heart attack. Hearing that Grinkov’s father died at 52, researchers at Johns Hopkins
University tested samples of Grinkov’s blood. DNA analysis found that he had inherited a form of a
gene, called the platelet antigen gene. This form of the gene causes platelets to form blood clots more
readily and may increase cholesterol binding to endothelial cells lining blood vessels.
Q1 Explain in detail how possession of this form of the platelet antigen gene affects the process of
atherosclerosis and can result in sudden death.
Q2 Why might having an abnormally thick left ventricle wall create a problem? To find out more
information about cardiomyopathy you can visit the Cardiomyopathy Association website.
In most cases, CVD is not the result of inheriting a single faulty gene. Several genes can affect the risk
of developing the multifactorial disease. Reading pages 45–46 of the Student Book will help you
answer the questions that follow.
Q3 Outline how inheritance of different forms of the APOE gene can affect the chance of
inheriting CVD.
Q4 Describe what is meant by multifactorial disease.
SUDDEN DEATH IN ATHLETES
Purpose
 To illustrate how the predisposition for cardiovascular disease (CVD) can be inherited.
 To apply knowledge of atherosclerosis and blood clotting.
Note that the detail of the platelet gene does not have to be learnt. In the questions, students apply their
knowledge of atherosclerosis and clotting.
This activity also provides practice at reading extended text.
Answers
Q1 The mutation may cause increased deposition of cholesterol in the walls of coronary arteries;
this would cause more rapid development of atheroma and narrowing of the blood vessel. As
the blood slows, the platelets are sticky and are more likely to form a clot. Any damage to the
vessel walls will result in rapid formation of a clot.
Q2 The amount of blood the heart can hold may be reduced. If the thickening narrows the area of
the heart where blood flows out to the aorta, this can interfere with ejection of blood from the
heart. It can result in turbulent flow or an obstruction to flow. Reduced blood flow could
produce shortness of breath and angina, and could result in cardiac arrest.
Q3 One form of the APOE gene (E2) produces a protein that helps lower cholesterol in the blood
reducing the risk of developing CVD. Another form (E4) is less effective at removing
cholesterol so increases the risk of CVD.
Q4 A multifactorial disease is one whose development is affected by a range of factors, for
example heredity, physical environment, social environment and lifestyle choices all
contribute to the risk of developing the disease; CVD is multifactorial.
ARE YOU GETTING ENOUGH ANTIOXIDANTS?
Purpose
 To highlight the importance of antioxidants in the diet.
Antioxidants
Antioxidants are chemicals that help prevent damage within cells by unstable radicals. Chemical
reactions within cells produce radicals. These are atoms or molecules with one or more unpaired
electrons. Radicals are oxidising agents – they accept electrons from other molecules that become
oxidised (oxidation is loss of electrons). The unpaired electron in the radical is restored to a pair by
pulling a hydrogen atom with its single unpaired electron from another molecule. These reactions
cause damage to DNA, proteins, lipids and other molecules in the cell. Although cells have a number
of antioxidants that help to minimise the effect of the radicals, the damage accumulates over time and
has been linked to the changes that occur with ageing and with diseases such as coronary heart disease
(CHD) and cancer. Oxidised, low-density lipoproteins are thought to be more readily taken up by the
white blood cells involved in atherosclerosis.
The cell has antioxidant defences against radical damage. For example, oxidised DNA is repaired by
enzymes and oxidised proteins are destroyed by proteases. Antioxidants in the diet, such as vitamin C,
vitamin E and beta-carotene (used by the body to make vitamin A), also help prevent the damage
caused by radicals in the cell by providing hydrogen atoms whose electrons pair up with the unpaired
electrons in the radicals.
To help reduce radical damage it is recommended that a healthy balanced diet contains at least three
portions of vegetables and two portions of fruit a day.
Some sources of radicals

Radicals are produced in many reactions within cells. Within mitochondria, respiration reactions,
which reduce oxygen to water, produce by-products with unpaired electrons, namely superoxide (O2–)
and hydroxyl radical (OH). Some of these radicals leak in to the cell’s cytoplasm.
In a rat cell about 1012 oxygen molecules per day are converted in this way and about 2% of these
molecules leak into the cell partially reduced. This is 2 × 1010 in a day.
The breakdown of fatty acids and other molecules within peroxisomes (membrane-bound organelles in
the cytoplasm that contain enzymes) produces hydrogen peroxide as a by-product. The breakdown of
this molecule is normally catalysed by the enzyme catalase within the peroxisomes. However,
occasionally some of the hydrogen peroxide (H2O2) is not broken down and leaks into the cytoplasm.
Reactions involving hydrogen peroxide in the cytoplasm give rise to hydroxyl radicals.
Toxic chemicals in our diet are broken down by enzymes within the cytoplasm. This avoids them
having a toxic effect, but some of the breakdown products are radicals. Oxides of nitrogen (NOx) in
cigarette smoke and other pollutants also cause oxidation of molecules in cells.
It is thought that some white blood cells destroy bacteria and virus-infected cells by bombarding them
with a mixture of oxidants including hydrogen peroxide. Although this prevents infection it also
releases radicals. Other researchers suggest that it is not radicals involved in this process but enzymes.
Questions
Q1 a What are radicals?
b How are they formed within cells?
Q2 Will large numbers of radicals in the body increase the risk of developing CHD? Explain your
answer
Q3 Low plasma concentrations of the antioxidant vitamin C are associated with increased risk of
heart disease.
a Explain how the results shown in Figure 1 support a negative correlation between these
two factors
b What other conclusion can be drawn from the data in Figure 1?
Figure 1 Plasma vitamin C concentrations in patients with acute heart attack (n = 179) and apparently healthy
control subjects (n = 172), by smoking status.
(Source: Riemersma, R.A., Carruthers, K.F., Elton, R.A., Fox, K.A.A. (2000) Vitamin C and the risk of acute
myocardial infarction. American Journal of Clinical Nutrition 71(5): 1181–1186.)
Q4 Do the data support a causal link between vitamin C and CHD? Give a reason for your answer.
Q5 Explain how the Department of Health recommendation that everyone should eat five portions
of fruit and vegetables a day should help protect against:
a CHD
b cancer.
Q6 Check below to find out how frequently you consume foods containing these important health-
promoting vitamins and decide if you are getting enough antioxidants.
How often do you eat these? Never Seldom 1–2 3–5 Daily
times times
per week per week
Vitamin C-rich foods:
1 Grapefruits, lemons, oranges or
pineapples
2 Strawberries, kiwi fruits or honeydew
melons
3 Orange, cranberry or tomato juices
4 Green, red or chilli peppers
5 Broccoli, Chinese cabbage or
cauliflower
6 Asparagus, tomatoes or potatoes
Beta-carotene-rich foods:
7 Carrots, sweet potatoes, pumpkins
8 Spinach, spring greens or chard
9 Cantaloupe melons, papayas or
mangoes
10 Nectarines, peaches or apricots
Vitamin E-rich foods:
11 Wholegrain breads, cereals or
wheatgerm
12 Crabs, shrimps or fish
13 Peanuts, almonds or sunflower seeds
14 Oil, margarine, butter, mayonnaise or
salad dressing
(Source: Brown, J.E. (1995) Nutrition Now. St Paul: West Publishing Company.)
Scoring: Several responses in the last two columns indicate adequate antioxidant vitamin
consumption. If you need to boost your intake, increase the overall amount of fruit, vegetable and
wholegrains in your diet. Although nuts, seeds, oils, mayonnaise and salad dressing all contribute
vitamin E, they are high fat and should only be consumed in moderation.
Q7 These sorts of tests are extremely popular and often found in food and other magazines.
a How valid (giving true results) do you think they are and why?
b How useful do you think they are and why?
ARE YOU GETTING ENOUGH ANTIOXIDANTS?
Purpose
 To highlight the importance of antioxidants in the diet.
The description on the worksheet provides some detailed information about antioxidants. The
questions that follow require students to extract information from the text.
Answers
Q1 a Radicals are atoms or molecules with one or more unpaired electrons.
b Radicals are formed within cells as products of normal metabolic reactions or in reactions
that break down toxins.
Q2 Yes, large numbers of radicals in the body increase the risk of developing CHD. They oxidise
lipoproteins; oxidised LDLs are more readily absorbed in plaque formation. Large numbers of
radicals will mean more oxidised LDLs so faster uptake into artery walls, increasing the risk of
CHD.
Q3 a The results support a negative correlation because plasma vitamin C concentrations in
patients with acute heart attack are lower than the healthy control subjects.
b The results also show that the association between vitamin C and CHD is independent of
smoking status. The results also show that plasma vitamin C concentrations may be
affected by smoking, with low vitamin C associated with smoking. They also suggest that
giving up smoking leads to improved vitamin C concentrations.
Q4 No; the results support a correlation between CHD and vitamin C levels. The results do not
provide evidence of a mechanism involving vitamin C that prevents CHD. Evidence of vitamin
C as an antioxidant reducing oxidation of LDLs and plaque formation would be needed to
prove a causal link.
Q5 a Fruits and vegetables contain a high concentration of antioxidants, which reduce radical
damage. Less oxidation of LDLs will mean less plaque formation so reduced risk of
CHD.
b Antioxidants in fruits and vegetables reduce damage to DNA. DNA damage can result in
cancer.
Q6 Students complete the table and use the scoring information below to decide if they get enough
antioxidants.
Q7 a These tests are not very valid. They rely on average estimates of frequency of eating and
may be very inaccurate. There is no indication of how much of each category is eaten at
any one time which would significantly affect the quantity of antioxidants obtained.
b The test could be useful if it highlights that a person is getting hardly any of these
antioxidant vitamins and encourages them to make changes to their diet.
Activity modified from Brown, J.E. (1995) Nutrition Now. St Paul: West Publishing Company.
Activity 1.25 Student Sheet
Salters-Nuffield Advanced Biology Resources Core Practical
IS HIGH C ALL IT CLAIMS TO BE?
Purpose
 To investigate the vitamin C content of fruit juice.
Schoolgirls expose false vitamin C claims

Fruit juice is recommended as a good source of the antioxidant vitamin C and large volumes are sold
every day. In 2004, two high school students in New Zealand conducting an experiment to determine
the vitamin C levels of their favourite fruit drinks found that the levels in one well-known blackcurrant
juice drink were much lower than those claimed by the manufacturer. The manufacturer dismissed the
concerns, saying the claim related only to the blackcurrant fruit and not the product. However, the case
was taken up by a television consumer affairs show and after further testing it was found that
statements about the levels of vitamin C had been misleading. Fifteen charges were brought under the
Fair Trading Act. In March 2007, the manufacturer pleaded guilty to all 15 charges and was fined
NZ$217,500. The manufacturer maintains that the issue only affected juice in Australia and New
Zealand.
Which juice contains the most vitamin C?

The quantity of vitamin C in food and drink can be determined using a simple colour test. Vitamin C
decolourises the blue dye DCPIP (dichlorophenolindolphenol). Vitamin C is an antioxidant and
reduces the DCPIP. DCPIP changes from blue to colourless (or slightly pink) as it becomes reduced.
Use the method described below to investigate the amount of vitamin C in fruit juice.
Read the procedure below carefully and decide if it will validly answer the question posed. Complete a
risk assessment before you start.
You need
 1% DCPIP solution
 1% vitamin C solution
 A range of fruit juices
 Test tubes
 Pipette to accurately measure 1 cm3
 Pipette or burette.
Procedure
1 Pipette 1 cm3 of 1% DCPIP solution into a test tube.
2 Record the start volume of 1% vitamin C solution in a pipette or burette. Add 1% vitamin C
solution drop by drop to the DCPIP solution. After adding each drop, shake the tube gently.
Continue to add drops of the vitamin C solution until the blue colour of the DCPIP has just
disappeared. Record the end volume. Calculate the exact volume of 1% vitamin C solution needed
to decolourise the DCPIP by subtracting the start volume from the end volume. Repeat the
procedure and average the result.
3 Repeat this procedure with the fruit juices provided. If only one or two drops of the fruit juice
decolourises the DCPIP, dilute the juice and repeat the test.
4 The 1% vitamin C solution contains 10 mg of vitamin C in 1.0 cm3. Calculate the mass of vitamin
C that is required to decolourise 1 cm3 of the DCPIP solution. Use this value to work out how
much vitamin C each of the fruit juices contain, in mg cm–3.

5 Present your results in the most appropriate way.
Conclusion and evaluation

6 Discuss your findings with reference to your question or problem. State a clear conclusion to your
work, summarising what you have found. Support your statements with evidence from your
results and relevant biological knowledge.
7 Comment on any systematic or random errors in the data.
8 Comment on the accuracy and precision of your results.
9 Propose any changes to the procedure that would improve the quality of the results.
Activity 1.25 Teacher Sheet

Purpose
Investigating vitamin C content in fruit juice

The student activity sheet presents a case that appeared in the news and this could be used to put the
practical work in context. Students use the procedure provided to investigate the amount of vitamin C
in fruit juice. Students could plan their own investigation using the planning sheet provided in these
notes, although support on the method would need to be provided first. They might investigate the
story on the activity sheet, testing the vitamin C levels in juice and comparing their values with the
quantity stated on the product. Alternatively, they may investigate the vitamin C content of a range of
different juices to determine which contain the highest level of the vitamin, or whether drinking fruit
juice from a carton is just as good as eating fresh fruit to maintain high levels of antioxidant vitamin C
in your diet. Note that heat treated fruit juice often has vitamin C added. The effect of heat treatment
could be investigated; see CLEAPSS guidance leaflet GL146 for additional details.
Note that the Edexcel GCE Biology (Salters-Nuffield) specification requires that students know how
to investigate the vitamin C content of food and drink. Even if students only test juices, they also need
to know how they might test foods.

The Student Sheet includes a procedure for the experiment. It would help in the development of
students’ practical skills if the procedure was reviewed before starting the practical work. This can be
done using the Developing Practical Skills Framework that can be found in the Practical Skills
Support materials in the SNAB Online resources. Alternatively students could plan the investigation
themselves using the planning sheet provided with these notes. Students will not necessarily have
addressed all of the practical skills in every practical activity, for example, this activity could focus on
suitability of method, accuracy, precision and risk assessment. Students can be directed to CLEAPSS
student safety sheets which can be downloaded free from the CLEAPSS website.
Unfortunately, using blackcurrant fruit drink can be problematic due to the dark colour of the juice. It
would need to be diluted to give a pale colour that would not affect the viewing of the DCPIP
decolourisation.
On completion of the practical investigation students could use the Self-evaluation Sheet to reflect on
what they have done in this practical. This can be found with the Practical Skills Support materials.
Sample results
The table below gives the volume of various carton fruit juices that decolourised 1 cm3 of 0.1%
DCPIP solution. The end point was when the blue tinge had completely disappeared.
0.6 cm3 of 1% vitamin C solution decolourised 1 cm3 of 0.1% DCPIP solution. 1 cm3 of the 1%
vitamin C contains 10 mg of vitamin C, so it takes 6 mg of vitamin C to decolourise 1 cm3 of DCPIP.
Juice tested Volume of juice required to Average volume Vitamin C content of

decolourise 1 cm3 of 0.1% of juice juice/mg cm–3
DCPIP solution/cm3 required/cm3
Grapefruit juice 1.50 1.70 1.65 1.61 3.8

Pineapple juice 12.00 11.20 11.50 11.56 0.5
Orange juice 2.00 2.25 2.10 2.12 2.8
Orange drink 1.40 1.50 1.45 1.45 4.1
Fresh lemon juice 1.90 1.70 1.60 1.73 3.5
Bottled lemon juice 24.00 23.50 24.50 24.00 0.25
Student Planning Sheet

Purpose
Investigating vitamin C content in fruit juice

1 Scientific questions and information research
 State what you are going to investigate – you should express this as a question to answer, a
problem to investigate or a hypothesis to test. You might be interested in which type of fruit juice
provides the most vitamin C, or if drinking fruit juice from a carton is just as good as eating fresh
fruit to maintain high levels of vitamin C in your diet, or does ‘long life’ heat-treated juice in a
carton provide as much vitamin C as freshly squeezed juice in cartons.
 Research relevant information – to help you decide on what you are going to investigate and how
you will carry out the practical work, you might need to research the background science and
methods people have used to investigate similar problems. When you write up your plan
remember to give full details of any information sources you use and comment on their reliability.
2 Planning and experimental design

The quantity of vitamin C in food and drink can be determined using a simple colour test. Vitamin C
decolourises the blue dye DCPIP (dichlorophenolindolphenol). Vitamin C is an antioxidant and
reduces the DCPIP. DCPIP changes from blue to colourless (or slightly pink) as it becomes reduced.
 Design an experiment that you can use to complete your investigation – the Developing Practical
Skills Framework on SNAB Online will help you plan your investigation.
You will be provided with the following equipment:
 Range of fruit and/or fruit juices
 Standard 1% vitamin C solution
 DCPIP 0.1%
 Pipette, syringe or burette to measure volumes accurately
 Standard laboratory glassware and apparatus.
Make sure your plan:
 includes a question, problem or hypothesis that you are testing
 identifies the independent and dependent variables
 identifies any other variables that may affect the outcome of the experiment and, where possible,
controls or allows for them
 includes a procedure that uses suitable apparatus to test your question or problem
 has a control, if appropriate, and this control is fully explained
 includes replicates and an explanation of why this is necessary
 says what measurements you will make, how they will be made and the level of accuracy that you
can expect in your measurements
 identifies any potential sources of error (systematic or random) and how errors can be minimised
 includes a risk assessment that identifies potential safety issues and how they can be minimised.
Have your plan checked by your teacher/lecturer before you start the experiment.
Activity 1.25 Technician Sheet
Purpose
The requirements will depend on the hypothesis being tested and whether the students first plan the
investigation themselves. The requirements below are for an experiment to compare the vitamin C
content of a range of fruit juices.
Requirements per Notes

student or group of
students
For each solution students test
they will need:
1 cm3 0.1% DCPIP solution 0.1% in aqueous solution freshly made up.
Fruit juice to test or standard The volume of fruit juice required will depend on the concentration of vitamin
1% vitamin C solution C it contains; see the sample results on the teacher sheet.
3
The 1% vitamin C solution contains 10 mg per cm .
Test tube
Pipette To accurately measure 1 cm3 of DCPIP solution.
Pipette, syringe or burette To add the test solution drop-wise to the DCPIP solution.
Notes
REDUCING STRESS
Purpose
 To reinforce the idea that high blood pressure is a risk factor for cardiovascular disease (CVD) by
investigating how stress can affect blood pressure.
 To highlight practical skills.
SAFETY
Never use a sphygmomanometer or blood pressure monitor unsupervised.
Do not over-inflate the cuff or leave it inflated for longer than necessary.
Do not worry if your blood pressure seems too high or too low. This is not a definitive
medical measurement of blood pressure, just an estimate.
Do not take repeat measurements until the blood flow to the lower arm has been restored for
several minutes.
You should not use one of these monitors if:
You have a cardiac pacemaker, or you know you suffer from heart rhythm disorders, or you already
suffer from severe atherosclerosis.
Measuring the effects of stress

Students were asked to investigate the idea that stress increases heart rate and blood pressure.
A rather weak plan is included below. Comment critically on the method suggested in the plan. Then
go on and plan your own investigation which addresses any concerns raised in this plan. Support your
ideas using biological knowledge.
My investigation report
I am going to investigate the effect of stress on heart rate and blood pressure. Heart rate and blood
pressure will increase when you are stressed because your heart is having to work harder.
Method
I will ask everyone in the group to take their blood pressure and their heart rate when they come into
the classroom. Everyone will then complete a set of test questions. They will be told that if they do not
get over 50% correct they will have to stay behind and do them again at lunchtime. After they have
completed the tests I will take their pulse rate again and measure their blood pressure. There will be at
least 10 people in the group so this will give enough repeated measurements. They will use a
stopclock to take their pulse rates and a digital blood pressure monitor for measuring blood pressure.
REDUCING STRESS
Purpose
This activity can be completed either using a teacher/lecturer-led practical style or with an
investigation planning approach.
SAFETY
Any student obviously suffering undue stress from this activity should be taken aside and told
that it is only an exercise and that they need not continue. Any student known to be
medically unfit should be considered for exclusion from this activity.
Never allow students to use a sphygmomanometer or blood pressure monitor unsupervised. Do not
Procedure: Teacher/lecturer-led activity

Measuring the effects of stress
On entering the classroom, students are placed in a stressful situation and the effects on their blood
pressure and heart rate are determined. A procedure for the activity is outlined below.
Following the guidelines of British Psychological Society for using human participants in
experiments, students should be fully informed as to the nature of the investigation and consent to
their involvement. See Practical Skills Support Sheet 12 – using human subjects in experiments – on
SNAB Online.
1 As students enter the class, ask them to determine their own pulse rate. Take blood pressure
measurements of three or four students (depending on time constraints).
2 Allow students to relax, sitting down quietly for a few minutes. After relaxing ask the students to
take their pulse and blood pressure again.
3 Now get students to complete a stressful activity, for example, an instant test, or tell students they
have just five minutes to plan an experiment and draw up results tables for an investigation into
stress-relief techniques.
The intention of this is to put students into a (stressful) situation where they have to act under
pressure. You could tell them that they are going to be assessed, for example, on how they
perform within a group/how effective they can be in a short space of time, etc.
4 Get students to take their pulse rate and blood pressure immediately after the stressful activity.
5 Explain that they are going to listen to a tape/watch a video to help them to relax and they need to
measure the effect of this. Play a relaxation/meditation audio/video. A good period of time, say 15
minutes, should be allowed for this if it is to have an effect. A relaxation animation accompanies
this activity.
If it is possible, carry out the ‘meditation’ in a suitable area (hall, sports hall, common room).
Lying down or reclining on comfortable chairs is preferable to sitting on lab stools.
6 Get students to take their pulse rate and blood pressure again after relaxing.
7 The comparisons between the blood pressures and pulse rates should be discussed. This could
lead to a discussion on the different stresses that are faced in everyday life and the consequences
for health, in particular the increased risk of CVD.
8 Students could present the class results in a suitable graph and write a brief summary report.
Procedure: Student investigation activity

A weak plan for an investigation into the effects of stress is included on the Student Sheet. Students
can critically evaluate this plan and/or plan their own investigation. They should be referred to
Practical Sheet 12 – using human subjects in experiments.
Comments on ‘My investigation report’

 It says ‘I will…measure blood pressure’ and then it says ‘they will take measurements’.
 No indication of what the independent and dependent variables are or how other variables will be
controlled. For example, when students arrive in the classroom will they all sit down for five
minutes before they take the first measurements? How many blood pressure monitors does the
school/college have? If there is only one monitor and they all do the test at once, some members
of the group will have to wait a long time after completing the activity before it is their turn to
take the measurement.
 No indication of how students will ensure that the results are reliable beyond doing repeats.
Precision and accuracy are not considered.
 No indication that the author appreciates whether or not the measurements will validly test the
hypothesis.
 No clear hypothesis to be tested and biological knowledge lacking.
 No safety awareness.
 No consideration of the ethics of putting students under stress.
REDUCING STRESS
Purpose
This is a class demonstration. The teacher may wish to do this in a different room to the lab to allow
students to lie down or sit comfortably.
SAFETY
Never allow students to use a sphygmomanometer or blood pressure monitor unsupervised. Do not

group of students
A way of showing relaxation There is an interactive relaxation animation in SNAB Online. A
projector or interactive whiteboard or large television screen linked to
a computer can be used to show this to the whole group, or students
can access it individually. Teachers/lecturers may prefer to play their
own relaxation tapes or videos, in which case they will need a video,
a CD or an audio tape player.
Stopclocks For measuring pulse rates.
Sphygmomanometer and stethoscope
or blood pressure monitor
Notes
DOES CAFFEINE AFFECT HEART RATE?
Purpose
 To investigate the effect of caffeine on the heart rate of Daphnia (water fleas).
Caffeine
Plants produce caffeine as an insecticide. Cocoa in South America, coffee in Africa and tea in Asia
have all been used for hundreds of years to produce ‘pick me up’ drinks containing caffeine. These
days, caffeine is also used as a flavour enhancer in a wide range of soft drinks. In addition, it has
medicinal uses in painkiller preparations and is found in weight-loss drugs and as a stimulant in
students’ exam-time favourites like PRO PLUS and Red Bull.
In humans, caffeine acts as a stimulant drug, causing increased amounts of stimulatory
neurotransmitters to be released. At high levels of consumption caffeine has been linked to
restlessness, insomnia and anxiety, causing raised stress and blood pressure. This can lead to heart and
circulation problems.
The effect of caffeine on heart rate can be investigated using Daphnia (water fleas). The beating heart
of a water flea can be seen through its translucent body, by placing the flea in a few drops of water in a
cavity slide under the microscope. A mobile phone can be used to video the heart beat.
Investigating the effect of caffeine on heart rate
SAFETY
Wash your hands thoroughly after handling the Daphnia or the pond water.
1 Scientific questions and information research

 State what you are going to investigate – try to express this as a hypothesis to test. What do you
think will be the effect of caffeine on the heart rate of water fleas? Write down your ideas and a
prediction, and present relevant biological knowledge to support your suggestions.
 Research relevant information – to help you decide on what you are going to investigate and how
you will carry out the practical work, you might need to research the background science and
methods people have used to investigate similar problems. When you write up your plan
remember to give full details of any information sources you use and comment on their reliability.
2 Planning and experimental design
 Design an experiment that you can use to test your hypothesis – the Developing Practical Skills
Framework in the Practical Skills Support section of SNAB Online will help you plan your
investigation. Note: Daphnia are poikilothermic (cold blooded). Turn off the microscope lamp
when not viewing the fleas.
The following equipment will be available:
 Culture of Daphnia (water fleas)
 Cavity slides
 Dropping pipettes
 Distilled water
 Caffeine tablets
 Cotton wool
 Standard glassware (beakers, measuring cylinders, etc.)
 Stopclock
 Paper towels or filter paper
 Microscope.
Make sure your plan:

 includes the hypothesis that you are testing
 identifies the independent and dependent variables
 identifies any other variables which may affect the outcome of the experiment and, where
possible, controls or allows for them
 includes a procedure which uses suitable apparatus that will give you measurements that will
validly test your hypothesis, and explains why the apparatus is suitable and how the results will
let you test the hypothesis
 has a control, if appropriate, and this control is fully explained
 includes replicates, and an explanation of why this is necessary
 says what measurements you will make, how they will be made and the level of precision that you
can expect in your measurements
 identifies any potential sources of error (systematic or random) and how errors can be minimised
 comments on any ethical issues that arise from using invertebrates in the experiment and explains
how these will be taken into account in the practical method used
 includes a risk assessment that identifies any risks and explains any safety precautions that need
to be taken so as to reduce those risks.
3 Carrying out practical work safely and ethically

Either use the plan you have created after it has been checked by your teacher/lecturer or use a method
supplied by your teacher/lecturer. If unexpected ethical or safety issues arise, deal with them sensibly,
taking advice where needed and make a note of them. Record all measurements, including repeated
ones, as soon as they are taken; with appropriate precision (i.e. a suitable number of significant
figures) and units. Note any possible errors.
4 Analysis and interpretation of data

Present your data in an appropriate table and graph. For information on the features of a good table
and graph see the Maths and Stats Support in the SNAB Online resources. If you have lots of repeated
results, remember that you should work out mean values and present these in your report. This also
lets you comment on the significance of your results. If the results that are used to calculate the means
are very variable, any differences between the treatment means may not be significant. The range of
values can be shown on the graph using bars on each point as a measure of the variation of the data.
See Maths and Stats Support Sheet 10 – standard deviation – for details of how to work out standard
error. NB: you need to make it clear what any bars on a graph are showing.
5 Conclusion and evaluation

In the discussion of your results you should use evidence from your data to identify any trends and
patterns. You should quote some data that show the trend. You should then use biological knowledge
to explain any patterns or trends identified. You should state a clear conclusion, summarising what
you found out and comment on the validity of your conclusion. You should evaluate your
experimental apparatus and methods, commenting on the accuracy and precision of your results.
Remember that the hypothesis you suggested may not be correct. In this case, the results will not show
the patterns or trends that you expected. There may be a different trend or no trend at all. This is
perfectly OK. You may be able to suggest an alternative explanation for your results. You may still
think your hypothesis is sound, but that there are concerns about the experimental method used and
that the results obtained are not very valid, i.e. they may not be testing the hypothesis appropriately. In
this case, you cannot draw valid conclusions from the results and this should be explained in any write
up. An experiment that does not produce the expected results is often as valuable to other researchers
as a report that supports the original hypothesis. It allows other researchers to make informed
decisions about the methods they will use in the future and it may allow them to suggest alternative
ideas.
Purpose
SAFETY
Ensure anyone who handles the Daphnia or the pond water thoroughly washes their hands
afterwards.

The Student Sheet that accompanies this activity guides students through planning and writing up this
investigation. The Developing Practical Skills Framework can be used in conjunction with this sheet:
this can be found in the Practical Skills Support section of SNAB Online. After students plan the
investigation their plans can then be discussed with the group to highlight any omissions.
To support less able students, or to help with the organisation of practical work for a large group,
students could be given the practical procedure at the end of these notes (see page 4). It provides a
basic outline and will need to be read by students before starting the practical with decisions and
modifications made as appropriate. The procedure is for a simple experiment; more able students
could complete a more complex experiment using serial dilutions, with several Daphnia used at each
concentration. Note that high concentrations of caffeine can be fatal for Daphnia.
The Daphnia hearts are fairly easily seen, but counting the number of beats can be difficult. Counting
is easier if each heartbeat is recorded by tapping a pencil on a piece of paper and counting up the
pencil marks after the specified time. In addition, cooling the Daphnia before the experiment may help
slow their heart rate: heart rate is highly temperature dependent. A webcam above the eyepiece of the
microscope to project an image of the slide onto a large screen may also help with counting. There are
videos available on the Internet that can be used to help students distinguish between the Daphnia
heart and gills.
A mobile phone can be used to film the heart beat and then replay the video to count the heart beats in
a set period of time. For additional information, see CLEAPSS leaflet TL019.
A dissecting microscope with a light source under the stage works well for this experiment. To prevent
the Daphnia from overheating while on the microscope turn off the microscope light between
observations and use a heat sink.
Using pond water/Daphnia culture solution is recommended for both the control group and to dissolve
the caffeine as this may give more valid results and be less stressful to the Daphnia. In distilled water
the heart rate may rise due to lack of oxygen.
In the trial of the experiment caffeine was used at 0.1% and 0.5% w/v with no ill effect. At 1% the
Daphnia stopped swimming after 5 minutes.
It is suggested that a ‘blind’ study is done. This means that the person counting the heart rate is
unaware as to whether the Daphnia is in water with or without caffeine. It has been shown that
observer expectations influence the result.
It is difficult to get clear-cut results from this experiment and significant differences between
treatments may not be found. The sets of results below indicate the sorts of results that can be
expected. It should be impressed upon students that it does not matter if they do not get differences
between treatments. Indeed, the experiment provides a good opportunity to focus on the critical
evaluation of the technique used. Published results (see the weblinks) report a slowing of heart rate by
a maximum of 20% at 15–20 mM caffeine. The control mechanism is unknown.
Experiment 1
Daphnia were cooled on ice before the experiment. Beakers containing Daphnia in pond water were
put on ice for about half an hour. This had the effect of slowing the heart rate and thus facilitating
counting. The temperature of the pond water in which the Daphnia were swimming fell to about 5 °C.
A single Daphnia was placed in a beaker containing test solution for 5 minutes: either pond water, or
pond water + 0.5% caffeine. After the 5 minutes, the Daphnia (in a few drops of test solution) was
transferred to the slide for measurement of heart rate. Each individual was counted for 4 × 30 seconds.
A blind counting method was used.
Overall means:
Caffeine – 173 beats per minute
Control – 172 beats per minute
There were no immediately observable ill effects of caffeine at this concentration (0.5% w/v).
Experiment 2
The experiment was conducted at room temperature. A single Daphnia was transferred to the slide. A
paper towel was used to remove the pond water from the slide. A few drops of test solution – either
pond water or pond water + 0.5% caffeine – were dripped onto the Daphnia. The clock was started
immediately and the heart rate recorded for 15 seconds at 2, 4, 6, 8 and 10 minutes. A webcam was
used to facilitate counting.
The results from the two experiments do not show that caffeine increases heart rate in Daphnia.
Mean for individual
Treatment Heart rate/beats 30 s–1
beats min–1
Trial 1 Trial 2 Trial 3 Trial 4 Mean
Caffeine 87 85 81 88 85 170
Caffeine 83 84 78 82 82 164
Caffeine 84 86 86 84 85 170
Caffeine 89 91 93 99 93 186
Caffeine 86 87 90 90 88 176
Control 62 70 73 74 70 140
Control 81 101 - - 91 182
Control 88 75 74 85 81 162
Control 93 98 98 100 97 194
Control 89 91 85 94 90 180
Table 1 Results for Experiment 1.
Number of heartbeats in 15 seconds

Length of time in solution/minutes 2 4 6 8 10
Treatment Caffeine 49 53 49 44 48
Caffeine 54 54 57 51 55
Caffeine 54 59 55 61 64
Caffeine 59 65 64 68 62
Mean 54 58 56 56 57
Control 57 55 59 50 58
Control 58 60 54 58 60
Control 56 56 58 57 59
Control 60 64 61 66 62
Mean 58 59 58 58 60
Table 2 Results for Experiment 2.
Purpose
To investigate the effect of caffeine on the heart rate of Daphnia (water fleas).
Caffeine
Caffeine is produced by plants as an insecticide. Cocoa in South America, coffee in Africa and tea in
Asia have all been used for hundreds of years to produce ‘pick me ups’ containing caffeine. These
days caffeine is also used as a flavour enhancer in a wide range of cola and other soft drinks. In
addition, it has medicinal uses in aspirin preparations and is found in weight-loss drugs and as a
stimulant in students’ exam-time favourites like PRO-PLUS® and Red Bull®.
In humans, caffeine acts as a stimulant drug, causing increased amounts of stimulatory
neurotransmitters to be released. At high levels of consumption caffeine has been linked to
restlessness, insomnia and anxiety, causing raised stress and blood pressure. This can lead to heart and
circulation problems.
You need
 Culture of Daphnia (water fleas)
 Three cavity slides
 Three dropping pipettes
 Distilled water
 Caffeine solution
 Cotton wool
 Pipettes
 Test tubes
 Stopclock Figure 1 Daphnia.
 Paper towels or filter paper
 Microscope
Procedure
1 Place a few strands of cotton wool on a cavity slide; this will help restrict the movement of the
water flea. Using a pipette, transfer one large water flea to a cavity slide. Remove the water from
around the water flea using filter paper, then add one or two drops of distilled water or pond
water. Use as much water as you can and do not use a cover slip. Together these precautions will
help maintain sufficient oxygen supply to the flea. View the water flea under low power. Focus on
its heart, which can be seen through its translucent body. The location of the heart is shown in
Figure 1.
2 Use a stopwatch to record the number of heartbeats per minute. This is made easier by working in
a pair, with one person counting beats while the other person tells them the time period. Tap a
pencil on a piece of paper and count up the pencil marks at the end of the time period. Record the
heart rate at intervals of 2 minutes over a 10 minute period. It is a good idea to do a ‘blind’ study
to avoid bias in the results. The person counting the heartbeats should be unaware as to whether
the Daphnia is in water or water with added caffeine.
3 Repeat the procedure using other water fleas from the culture solution and fresh, clean slides.
Replace the water with caffeine solution. Repeat the procedure using several different
concentrations of caffeine.
4 Record your results in a suitable format and present them in an appropriate graph.
5 Compare the treatments and try to explain the effect of each treatment on the heart rate.
6 Comment on the validity of your study. For example, would it have been better or worse to use
the same Daphnia throughout the study?
7 If time permits, you could also look at the effect of other chemicals, for example, ethanol, on the
heart rate.
Activity 1.27 Technician Sheet
Purpose
This is an activity that students may plan themselves. There is also a support sheet giving a suggested
method. The list below gives the apparatus and approximate quantities needed for the suggested
method. However, students may ask for things outside of this list.
SAFETY
Wash your hands thoroughly after handling the Daphnia or the pond water.
Requirements per Notes

student or group of
students
Culture of Daphnia Daphnia may be killed by chlorine in tap water. Any tap water used should be
left to stand for 24 hours first to let the chlorine dissipate.
Allow at least nine Daphnia per student or pair. They should be unharmed by
the activity, but may need too long to recover after the caffeine to use the
same one for different concentrations in the same practical. They can be
bought from an aquarist or Blades Biological Supplies.
To catch them use a plastic pipette with the tip cut off to make it wider.
Container for ‘used’ Daphnia This will stop them getting mixed up with the ‘fresh’ ones. Dispose of Daphnia
ethically, preferably by returning them to a freshwater pond or stream.
Six cavity slides Students can wash and reuse the slides if needed.
3 3
Approximately 5 cm caffeine Dissolve 0.5 g caffeine in 100 cm water. Instant coffee can be used.
solution (0.5%) Make up the solution with culture water or distilled water.
Students will need to dilute this to make weaker solutions. If time is limited it
may be easier to provide made-up solutions of 0.25%. (Consult with the
teacher/lecturer – they may prefer to use more concentrations, for example,
0.1%, 0.2%, 0.3%, 0.4% if time permits.)
Cotton wool Students will only need a small amount – about as much as is in a single
cotton wool ball will supply the whole class. They put a few strands on the
slide to stop the Daphnia moving.
Three dropping pipettes
5–10 cm3 distilled water or For adding to the Daphnia during the experiment.
water from the Daphnia culture
Test tubes/small beakers For students to collect or mix their caffeine solutions in. They will need more
if they are doing more concentrations.
Small measuring cylinder or For making dilutions of caffeine solution.
3
5 cm syringe
Approximately 100 cm3 For making dilutions of caffeine solution.
distilled or pond water Amount required will depend on the dilutions made.
Stopclock
Paper towels or filter paper
Microscope For use at low power. Some centres find that it is useful, if available, to use a
microscope-mounted video camera to show students the heart.
Mobile phone with video
function
HEALTHY HEART QUIZ
Purpose
 To review ideas about risk factors for coronary heart disease (CHD).
Questions
Identify each of the following statements as ‘true’ or ‘false’ to test your knowledge of heart disease
and its risk factors.
Q1 The risk factors for CHD that you can do something about are: high blood pressure, high blood
cholesterol, smoking, obesity and physical inactivity.
Q2 A stroke is often the first symptom of high blood pressure and a heart attack is often the
symptom of high blood cholesterol.
Q3 A blood pressure greater than or equal to 160/95 mmHg is generally considered to be high.
Q4 High blood pressure affects the same number of black people as it does white people.
Q5 The best ways to treat and control high blood pressure are to control your weight, exercise
regularly, eat less salt (sodium chloride), restrict your intake of alcohol and take any medicine
to reduce blood pressure, if prescribed by your doctor.
Q6 A low blood cholesterol is needed to prevent heart attacks in adults.
Q7 The most effective dietary way to lower the level of your blood cholesterol is to eat foods low
in cholesterol.
Q8 Lowering blood cholesterol levels can help many people who have already had a heart attack.
Q9 The only children who need to have their blood cholesterol levels checked are from families at
high risk of heart disease.
Q10 Smoking is a major risk factor for four of the five leading causes of death, including heart
attack, stroke, cancer and lung diseases such as emphysema and bronchitis.
Q11 If you have had a heart attack, quitting smoking can reduce your chances of having a second
attack.
Q12 Someone who has smoked for 30 to 40 years will not be able to quit smoking.
Q13 The best way to lose weight is to increase physical activity and eat fewer calories.
Q14 Eating five portions of fruit and vegetables a day will provide antioxidant vitamins that reduce
the risk of CHD.
Q15 Heart disease is the leading killer of men and women in the UK and in the USA.
HEALTHY HEART QUIZ
Purpose
 To review ideas about risk factors for coronary heart disease (CHD).
Answers (and reasons for the answers)

Q1 True. High blood pressure, smoking and high blood cholesterol are the three most important
risk factors for heart disease. On average, each one doubles your chance of developing heart
disease. So, a person who has all three of the risk factors is eight times more likely to develop
heart disease than someone who has none. Obesity increases the likelihood of developing high
blood cholesterol and high blood pressure, which increase your risk of heart disease. Physical
inactivity increases your risk of heart attack. Regular exercise and good nutrition are effective
ways of reducing high blood pressure, high blood cholesterol and being overweight. People
who exercise are also more likely to cut down or stop smoking.
Q2 True. A person with high blood pressure or high blood cholesterol may feel fine and look
great; there are often no signs that anything is wrong until a stroke or heart attack occurs. To
find out if you have high blood pressure or high blood cholesterol, you should be tested by a
doctor, nurse or other health professional.
Q3 True. A blood pressure of 160/95 mmHg or greater is generally classified as high blood
pressure. However, blood pressure that is less than 140/90 mmHg can sometimes be a
problem. If the diastolic pressure, the second or lower number, is between 85 and 89, a person
is at an increased risk of heart disease or stroke and should have his/her blood pressure
checked at least once a year by a health professional. The higher your blood pressure, the
greater your risk of developing heart disease or stroke. Controlling high blood pressure reduces
your risk.
Q4 False. There is evidence that British people of black African or Caribbean origin are more
likely to have high blood pressure. Also, with ageing, high blood pressure is generally more
severe among black people than among white people and therefore causes more strokes, heart
disease and kidney failure.
Q5 True. Recent studies show that lifestyle changes can help keep blood pressure levels normal
even into advanced age and are important in treating and preventing high blood pressure. Limit
high-salt foods which include: many snack foods, such as potato crisps; processed foods, such
as canned soups; and sauces, such as ketchup and soy sauce. Also, it is extremely important to
take blood pressure medication, if prescribed by your doctor, to make sure your blood pressure
stays under control.
Q6 False. A total blood cholesterol of under 200 mg/dl is desirable and usually puts you at a lower
risk of heart disease. However, it does not prevent someone having a heart attack. A blood
cholesterol level of 240 mg/dl or above is high and increases your risk of heart disease. If your
cholesterol level is high, your doctor will want to check your levels of LDL cholesterol (‘bad’
cholesterol) and HDL cholesterol (‘good’ cholesterol). A high level of LDL cholesterol
increases your risk of heart disease. If your cholesterol is borderline-high, you should speak to
your doctor to see if additional cholesterol tests are needed. All adults 20 years of age or older
should have their blood cholesterol level checked at least once every five years.
Q7 False. Reducing the amount of cholesterol in your diet is important. However, eating foods
low in saturated fat is the most effective dietary way to lower blood cholesterol levels, along
with eating less total fat and cholesterol. Choose low-saturated fat foods, such as grains, fruits
and vegetables; low-fat or skimmed milk and milk products; lean cuts of meat, fish and
chicken. Trim fat from meat before cooking; bake or grill meat rather than fry; use less fat and
oil; and take the skin off chicken and turkey. Reducing your weight will also help lower your
level of LDL cholesterol.
Q8 True. People who have had one heart attack are at a much higher risk of a second attack.
Reducing blood cholesterol levels can greatly slow down (and, in some people, even reverse)
the build up of cholesterol and fat in the walls of the arteries and significantly reduce the
chances of a second heart attack.
Q9 True. Children from ‘high-risk’ families, in which a parent has high blood cholesterol (240
mg/dl or above) or in which a parent or grandparent has had heart disease at an early age (at 55
years of age or younger) should have their cholesterol levels tested. If a child from such a
family has a cholesterol level that is high, it should be lowered under medical supervision,
primarily with diet, to reduce the risk of developing heart disease as an adult. For most
children who are not from high-risk families, the best way to reduce the risk of adult heart
disease is to eat a balanced diet, avoid getting overweight, take regular exercise and not start
smoking.
Q10 True. Heavy smokers are two to four times more likely to have a heart attack than non-
smokers and the heart attack death rate among all smokers is 70% greater than that of non-
smokers. Older male smokers are also nearly twice as likely to die from stroke as older men
who do not smoke and these odds are nearly as high for older female smokers. Further, the risk
of dying from lung cancer is 22 times higher for male smokers than male non-smokers and 12
times higher for female smokers than female non-smokers. Finally, 80% of all deaths from
emphysema and bronchitis are directly due to smoking.
Q11 True. One year after quitting, ex-smokers cut their extra risk of heart attack by about half or
more and eventually the risk will return to normal in healthy ex-smokers. Even if you have
already had a heart attack, you can reduce your chances of a second attack if you quit smoking.
Ex-smokers also reduce their risk of developing cancer, improve blood flow and lung function
and help stop diseases like emphysema and bronchitis from getting worse. A survey of nine
hospitals six months after the introduction of the smoking ban in Scotland reported a 17%
reduction in admissions for heart attacks. The 2007 introduction of the smoking ban in
England also saw a reduction in hospital admissions for heart attacks. Although the fall was
only 2.4%, this is 1200 fewer emergency admissions during the year after introduction of the
ban.
Q12 False. Even someone who has smoked for over 30 years can quit. Older smokers are more
likely to succeed at quitting smoking than younger smokers. Quitting helps relieve smoking-
related symptoms like shortness of breath, coughing and chest pain. Many quit to avoid further
health problems and take control of their lives.
Q13 True. Weight control is a question of balance. You get calories from the foods you eat. You
burn off calories by exercising. Cutting down on calories, especially calories from fat, is key to
losing weight. Combining this with a regular physical activity, like walking, cycling, jogging
or swimming, can not only help in losing weight, but also in maintaining weight loss. A steady
weight loss of a half a pound to one pound (250–500 g) a week is safe for most adults and the
weight is more likely to stay off over the long run. Losing weight, if you are overweight, may
also reduce your blood pressure and lower your LDL cholesterol.
Being physically active and eating fewer calories will also help you control your weight if you
quit smoking.
Q14 True. Antioxidant vitamins reduce oxidation of LDLs by radicals. Oxidised LDLs are more
readily absorbed in the process of atherosclerosis.
Q15 True. CHD is the most common cause of death in the UK and United States. The British Heart
Foundation ‘Heart Stats’ website publishes the most recent CHD statistics.
MAKING DECISIONS
Purpose
 To consider how people use scientific information to reduce their risk of cardiovascular disease
(CVD).
To change or not to change

People often use scientific information to help make decisions about their lifestyle that may directly
(and deliberately) or indirectly reduce their risk of developing CVD. Answer the questions below.
Q1 The three information panels in Figure 1 below come from the front of crisp multi-packs.
Discuss how you might use the information provided to decide which pack would be the most
‘healthy’ choice, if you are concerned about your risk of heart disease.
1 2 3
Figure 1 Nutritional information panels from three different varieties of crisps. All bags contain the same mass of
crisps.
Q2 Look at the dietary information provided on two packs of chicken tikka masala below. Decide
which would be the better buy if you were trying to reduce your risk of heart disease. Give
reasons for your answer.
A
Figure 2 Nutritional information on two ready meals, each with a mass of 400 g.
Q3 Table 1 shows data for the sales of different types of milk over an eight-year period. Describe
any changes in market share over this period. Comment on possible reasons for any changes.
% share
Whole Semi-skimmed Skimmed
2005 28.3 61.9 9.8
2006 29.6 60.4 10.1
2007 26.7 62.3 11.0
2008 26.3 63.4 10.1
2009 26.3 63.2 10.5
2010 23.3 65.3 11.4
2011 23.6 65.3 11.1
2012 19.7 69.8 10.5
Table 1 Milk sales (average purchase per person) in Great Britain by fat content.
(Source: MDC Datum, the market information service of the Milk Development Council.)
Q4 In 2005, a dairy foods manufacturer that makes cholesterol-lowering dairy products made a
controversial agreement with a French private healthcare insurer. The insurance company will
refund up to €40 (£27) a year to customers who buy the dairy company’s cholesterol-lowering
yoghurts, margarine and milk. Suggest why the insurance company would decide to enter into
this agreement.
Q5 A leading brand of margarine added plant sterols to help reduce LDL cholesterol. In the UK,
this brand took 5% of the market share in the four weeks after its May launch; this declined to
3.2% by the middle of July. The dip was thought to coincide with the scaling back of the
advertising campaign after the launch. People have decided to try the new product based on the
health benefit information provided in the advertising, but have not continued with its use.
Suggest a reason why they may not have continued to buy the product.
Q6 A Glasgow University study published in September 2007 reported a 17% fall in heart attacks
in Scotland following the introduction of the smoking ban in public places. In the 10 months
before the ban there were 3235 admissions for heart attacks in the nine hospitals that took part
in the study. In the same period after the ban the admissions for heart attacks fell to 2684.
Blood tests were done on patients to check if they were smokers. It was found that in non-
smokers, the fall in heart attack admissions was 20%, compared with a 14% drop among
smokers.
a Discuss whether these are the findings that you would have expected in the 10 month
period following the smoking ban.
b Suggest which factors may have contributed to the decrease in heart attacks after the ban.
Q7 Which of the following is the most ‘scientifically sound’ advertising claim to help people
decide whether butter or margarine is the most healthy option? Give reasons for selecting or
rejecting each statement.
1 Butter is a natural product, so is better for your health.
2 Margarine contains less fat than butter.
3 Butter contains a higher proportion of saturated fat than soft margarine.
4 Margarine contains lots of chemicals, so can’t be good for you.
Q8 In 2006, the European Union introduced a new health claims regulation, to avoid misleading or
confusing health claims being used on foods. For example, a claim that a food is low in fat
may only be made where the product contains no more than 3 g of fat per 100 g of solid food,
or 1.5 g of fat per 100 ml of liquid (1.8 g of fat per 100 ml are permitted for semi-skimmed
milk). Suggest at least two other possible claims made by manufacturers about food where the
regulation should set guidelines to allow people to choose foods that will reduce their risk of
CVD.
MAKING DECISIONS
Purpose
 To consider how people use scientific information to reduce their risk of cardiovascular disease
(CVD).
Answers
Q1 Pack 2 is the best option if buying one of the three, it has the lowest number of calories, lowest
fat and lowest saturated fat. These are important if trying to maintain an energy-balanced diet
and reduced blood fat levels. All three packs contain the same salt levels. Pack 2 contains more
sugar, but this is less energy dense than fat.
Q2 Ready meal B is the better buy if you were trying to reduce your risk of heart disease. It has
much lower saturated fat levels, so will produce less of a rise in blood triglyceride levels. In
particular, the LDL cholesterol levels will be lower – these are associated with development of
atherosclerosis. Both packs have high salt content, with pack B higher than A. The person
buying and eating these meals would need to consider their salt intake during the rest of the
day, if they are not to exceed the guideline daily salt intake of no more than 6 g. Excess salt
intake can lead to high blood pressure, a trigger in the development of atherosclerosis.
Q3 Over the eight year period there is a decline in the market share of whole milk, from 28.3% to
19.7%. There is an increase in the sales of semi-skimmed by about 8%. There is little change
in skimmed milk share. As people become more aware of the need to reduce fat intake to
reduce the risk of CVD and help in weight control, they decide to switch from whole milk to
lower fat milk. A graph of the results would look like Figure 1.
Figure 1 Graph to show market share of milk with different fat content.
Q4 The insurance company will have considered the scientific data on the effect of cholesterol-
lowering dairy products on the risk of having a cardiovascular event – something which would
result in individuals making a claim on their health insurance. The reduction in cholesterol has
been shown to reduce the risk of CVD. Therefore if high risk individuals eat these products it
should reduce the incidence of heart attacks. This will reduce the number of claims that are
made, thus saving the company money and allowing them to reduce the cost of their insurance
cover. This agreement was very controversial. Many people complained that it was a
marketing ploy and should not be allowed.
Q5 People may have listened to the advertising information about the health benefits and have
tried the new product. They may feel no benefit from the new product. This and the higher
price for the product may put some people off continued use. The risk of long-term
consequences of behaviour tends to be underestimated. Therefore actions to reduce the risk are
not taken. This is particularly so when people do not continue to be reminded by advertising
about the risks they run and the benefits of the new product. Of course, they may not have
liked the taste!
Q6 a The findings are surprising because the reduction was so rapid. One might expect a more
gradual decline for a disease that takes a long period to develop. (The decrease after the
ban introduced in England was only 2.4%.) It is surprising that the smokers also show a
decrease, because they are still smoking and are exposed to the toxins and smoke
particles that may contribute to the triggering of heart attack.
b Smokers may be smoking less, and the non-smokers are no longer being exposed to
passive smoke, so this may account for the decline in heart attack admissions.
Q7 Reject statement 1. There is no indication of why it is better for your health. The high saturated
fat in butter compared with polyunsaturated fat spreads would be a less healthy option.
Reject statement 2. Margarine and butter contain different types of fat, but both contain a
similar amount of fat.
Accept statement 3. This is scientifically sound for any soft margarine although if the
margarine fats are trans fats these have been associated with higher risk for CVD.
Reject statement 4. Butter and margarine both contain chemicals!
Q8 The 2006 European Union health claims regulations set down a wide range of guidelines for
nutritional claims. A few examples are shown below. The full list appears in an annex that can
be accessed on the Europa website – see the weblinks for this activity.
● Low saturated fat
A claim that a food is low in saturated fat, and any claim likely to have the same meaning for
the consumer, may only be made where the sum of saturated fat and trans-fatty acids in the
product does not exceed 1.5 g per 100 g for solids or 0.75 g per 100 ml for liquid; in either
case, the sum of saturated fatty acids and trans-fatty acids must not provide more than 10% of
energy.
● Low sugars
A claim that a food is low in sugars, and any claim likely to have the same meaning for the
consumer, may only be made where the product contains no more than 5 g of sugar per 100 g
for solids or 2.5 g of sugars per 100 ml for liquid.
● Low sodium/salt
A claim that a food is low in sodium/salt, and any claim likely to have the same meaning for
the consumer, may only be made where the product contains no more than 0.12 g of sodium,
or the equivalent value for salt, per 100 g or per 100 ml.
A 2013 EU ruling required that when a health claim is made, it must be accompanied by
statements telling the consumer the quantity of the food and pattern of consumption required to
obtain the claimed health benefit. In addition there must be statements on the importance of a
balanced diet and healthy lifestyle, and warnings for products that could present a health risk if
consumed in excess.
CHECK YOUR NOTES FOR TOPIC 1:

LIFESTYLE, HEALTH AND RISK
Purpose
 To help you get your notes in order at the end of this topic.
Topic 1 summary
Make sure your notes cover the following points. The points are listed in the approximate order they
appear within the topic. All the points are covered in the Student Book, but where there is supporting
information within the activities this is indicated.
There are suggestions on making notes and on revision in the Exam and Study Skill Support.
You should:
 Understand why many animals have a heart and circulation (mass transport to overcome
limitations of diffusion in meeting the requirements of organisms). (Checkpoint question 1.1)
(Activity 1.2)
 Understand the importance of water as a solvent in transport, including its dipole nature. (Activity
1.3)
 Understand how the structures of blood vessels (capillaries, arteries and veins) relate to their
functions. (Checkpoint question 1.2) (Activities 1.6 and 1.7)
 Know the cardiac cycle (atrial systole, ventricular systole and cardiac diastole). (Checkpoint
question 1.3) (Activity 1.8)
 Relate the structure and operation of the mammalian heart to its function, including the major
blood vessels. (Activities 1.4 and 1.5)
 Know how the relationship between heart structure and function can be investigated practically.
(Activity 1.4)
 Understand the course of events that leads to atherosclerosis (endothelial dysfunction,
inflammatory response, plaque formation, raised blood pressure). (Activities 1.9 and 1.10)
 Understand the blood clotting process (thromboplastin release, conversion of prothrombin to
thrombin and fibrinogen to fibrin) and its role in cardiovascular disease (CVD). (Activity 1.9)
 Be able to analyse and interpret quantitative data on illness and mortality rates to determine health
risks (including distinguishing between correlation and causation and recognising conflicting
evidence). (Activities 1.11 and 1.12)
 Understand why people’s perceptions of risks are often different from the actual risks, including
underestimating and overestimating the risks due to diet and other lifestyle factors in the
development of heart disease. (Checkpoint question 1.4) (Activity 1.11)
 Be able to evaluate the design of studies used to determine health risk factors, including sample
selection and sample size used to collect data that is both valid and reliable. (Checkpoint question
1.5) (Activity 1.13)
 Know how factors such as genetics, diet, age, gender, high blood pressure, smoking and inactivity
increase the risk of cardiovascular disease (CVD). (Checkpoint question 1.7) (Age and gender –
Activity 1.14. Genetic inheritance – Activity 1.23. Blood pressure – Activities 1.15, 1.16 and
1.26. Diet – Activities 1.20, 1.21 and 1.24)
 Know the difference between monosaccharides, disaccharides and polysaccharides, including
glycogen and starch (amylose and amylopectin) and be able to relate their structures to their roles
in providing and storing energy (β-glucose and cellulose are not required in this topic).
(Checkpoint question 1.6) (Activities 1.17)
 Know how monosaccharides join to form disaccharides (sucrose, lactose and maltose) and
polysaccharides (glycogen and amylose) through condensation reactions forming glycosidic
bonds, and how these can be split through hydrolysis reactions. (Activities 1.17 and 1.18)
 Know how a triglyceride is synthesised by the formation of ester bonds during condensation
reactions between glycerol and three fatty acids, and know the differences between saturated and
unsaturated lipids. (Activity 1.19)
 Be able to analyse data on energy budgets and diet and understand the consequences of energy
imbalance, including weight loss, weight gain, and development of obesity. (Activities 1.20 and
1.21)
 Be able to analyse and interpret data on the possible significance for health of blood cholesterol
levels and levels of high-density lipoproteins (HDLs) and low-density lipoproteins (LDLs).
(Activity 1.22)
 Know the evidence for a causal relationship between blood cholesterol levels (total cholesterol
and LDL cholesterol) and CVD. (Activity 1.22)
 Investigate the vitamin C content of food and drink. (Activity 1.25)
 Investigate the effect of caffeine on heart rate in Daphnia, and be able to discuss whether there are
ethical issues in the use of invertebrates in research. (Activity 1.27)
 Understand how people use scientific knowledge about the effects of diet, including obesity
indicators (BMI and waist-to-hip ratio), exercise and smoking to reduce their risk of coronary
heart disease (CHD). (Activities 1.21 and 1.29)
 Know the benefits and risks of treatments for CVD (antihypertensives, plant statins,
anticoagulants and platelet inhibitory drugs).
Topic 1 Lifestyle, Health and Risk
Salters-Nuffield Advanced Biology Resources Exam-style End-of-topic Test
Topic 1 Exam-style test

Instructions
 Answer all questions in the spaces provided – there may be more space than you need.
 Show your working in any calculation questions and include units in your answer where
appropriate.
 You may use a scientific calculator.
 In questions marked with an asterisk (*), marks will be awarded for your ability to structure your
answer logically showing how the points that you make are related or follow on from each other
where appropriate.
 Some questions must be answered with a cross in a box (). If you change your mind about an
answer, put a line through the box () and then mark your new answer with a cross.
Information
 The total mark for this paper is 35.
 The marks for each question are shown in brackets – use this as a guide as to how much time to
spend on each question.
Advice
 Read each question carefully before you start to answer it.
 Try to answer every question.
 Check your answers if you have time at the end.
1 (a) A variety of factors can contribute to a person’s risk of developing cardiovascular disease
(CVD); these can be a mixture of controllable and non-controllable risk factors.
(i) State two controllable risk factors for CVD. (2)
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(ii) State two non-controllable risk factors for CVD. (2)
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(b) If excess carbohydrates are eaten they are stored.

(i) Below are four carbohydrates found in animals and plants. Put a cross in the box to
indicate which molecule is used for storage in animal cells.
A □ Starch
B □ Galactose
C □ Glycogen
D □ Sucrose (1)
(ii) Name the type of chemical reaction that occurs when this storage carbohydrate is
created from glucose molecules. (1)
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1 of
(c) Explain how people could use obesity indicators to reduce their risk of coronary heart
disease. (4)
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(Total for question 1 = 10 marks)

2 (a) Although there is a constant movement of blood through the chambers of the heart, the
heart muscle has its own supply of blood vessels.
(i) Name the blood vessels supplying the heart muscle with blood. (1)
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(ii) Explain why the heart muscle must have its own blood supply. (2)
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(b) Name, in the correct sequence, which heart chambers, heart valves and blood vessels a
drop of blood would pass through as it flows out of the right atrium until it reaches the
aorta. (3)
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(c) Describe the benefits and risks of antihypertensives used in the treatment of
cardiovascular disease. (3)
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3 Researchers at Virginia Commonwealth University in the USA have developed a bandage
made entirely from fibrinogen molecules. Pre-clinical trials are being carried out on this new
type of bandage.
(a) Describe the role of fibrinogen in blood clotting. (3)
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(b) Suggest one advantage of this new type of bandage. (1)
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4 A study was carried out in a group of people on the number of cigarettes smoked per day and
the risk of getting lung cancer. The results are shown in the graph below.
(a) (i) Put a cross in the box to indicate what can be concluded from the graph. (1)
A □ Correlation between smoking and lung cancer but no evidence that
smoking causes lung cancer
B □ No correlation between smoking and lung cancer but evidence that
C □ Correlation between smoking and lung cancer and evidence that
D □ No correlation between smoking and lung cancer and no evidence that
(ii) State two additional pieces of information that would help assess the validity of the
conclusions made from this study. (2)
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*(b) Graph A below shows some results from a 1950s study on over 12 000 men to show the
relationship between fat and death from coronary heart disease (CHD). Graph B shows
the results of a 1980s study on over 12 000 men to show the relationship between
cholesterol levels and death from all cardiovascular disease (CVD), CHD and strokes.
Some studies have claimed that saturated fats and the resulting increase in blood
cholesterol cause CHD.
Evaluate this claim and how far the evidence in graphs A and B support the claim. (9)
Graph A Graph B
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Salters-Nuffield Advanced Biology Resources Mark Scheme for Exam-style End-of-topic Test
General information
Mark schemes should be applied positively. Candidates must be rewarded for what they have shown
they can do rather than be penalised for omissions.
Where some judgement is required, mark schemes will provide the principles by which marks will be
awarded and exemplification/indicative content will not be exhaustive.
Crossed out work should be marked unless the candidate has replaced it with an alternative response.
Question number Mark
1(a)(i) High blood {cholesterol / Low density lipoprotein / LDL} levels;
High saturated fat intake;
High salt intake;
High levels of radicals in the diet;
Excessive alcohol intake;
Lack of exercise;
High blood pressure;
Stress;
Obesity;
Smoking; (2)
1(a)(ii) Age;
Genetic predisposition;
Gender; (2)
1(b)(i) C; (1)
1(b)(ii) Condensation; (1)
1(c) Calculate obesity indicator;
BMI / Waist-to-hip ratio;
Details of measurement;
Threshold for obesity / healthy weight / equivalent;
Change of lifestyle / change diet / have a low fat diet / reduced intake of cholesterol / do
more exercise;
To reduce BMI / maintain healthy BMI / reduce risk of obesity / reduce risk of CVD; (4)
(Total for Question 1 = 10 marks)
2(a)(i) Coronary arteries; (1)
2(a)(ii) Every heart muscle cell needs to be close to a capillary;
For diffusion {to provide sufficient {oxygen / glucose / nutrients} / to remove {waste
products / carbon dioxide}};
Walls of atria and ventricles have too small a surface area to allow diffusion of substances
to / from all heart cells; (2)
2(b) Atrioventricular / tricuspid valve
Right ventricle
Pulmonary artery
Pulmonary vein
Left atrium
Atrioventricular / bicuspid valve
Left ventricle
1 mark for correct order of heart chambers, 1 mark for correct order of blood vessels and
1 mark for correct position of valves in sequence of events. (3)
2(c) Benefits: {Reduced / less} {vasoconstriction / constriction of blood vessels};

{Reduced / lower / equivalent} blood pressure;
Reduced risk of CVD;
Risks: side effects;
Any examples given for a named antihypertensive; (3)
3(a) Fibrinogen to fibrin;
Mesh of insoluble fibrin fibres forms;
Traps blood cells / forms a clot; (3)
3(b) Speeds up clotting process;
More fibrinogen available to convert to fibrin;
Bandage forms part of clot so does not need to be removed; (1)
4(a)(i) A; (1)
4(a)(ii) Sample size;
Location of the study;
Gender balance of subjects;
Medical history of subjects;
Age of subjects;
Information about lifestyle / diet of subjects; (2)
*4(b) Answers will be credited according to candidates’ deployment of knowledge and
understanding of material in relation to the qualities and skills outlined in the generic mark
scheme.
The indicative content below is not prescriptive and candidates are not required to include all
the material that is indicated as relevant. Additional content included in the response must be
scientific and relevant.
Candidates are expected to reach a decision/judgement on whether saturated fats and the
resulting increase in blood cholesterol cause CHD.
● Idea that saturated fat/cholesterol does increase blood cholesterol levels
● Causal link has been identified
● Cholesterol role in atherosclerosis
● Other factors contribute to risk of developing CHD / examples of other risk factors
● Multifactorial nature of CHD
● Both graphs support correlation between fat and increased risk
● Graph B indicates correlation between cholesterol and CHD
● Low cholesterol slightly higher risk of death from graph B/1980s study
● Data does not support causal link
● Idea that calories from fat in graph A give no indication of type of fat so weaker
evidence
● Studies only involved men so conclusion can be applied only to men
● Idea about quality of evidence/ both have large sample size
Level Mark Descriptor
0 No rewardable material.
Level 1 1–3 Demonstrates isolated elements of biological knowledge and

understanding.
Provides little or no reference to a range of scientific ideas,

processes, techniques and procedures.
Scientific argument may be attempted, but fails to link biological

concepts and/or ideas in order to support decision/conclusion.
Limited attempt to address the question.
Level 2 4–6 Demonstrates adequate biological knowledge and understanding

with selection of some biological facts/concepts to support the
argument or decision/conclusion being made.
Scientific reasoning occasionally supported through the linkage of

a range of scientific ideas, processes, techniques and procedures.
Scientific argument is partially developed. Attempts to synthesise

and integrate relevant knowledge with linkages to biological
concepts and/or ideas, leading to a notional scientific argument or
decision/conclusion based on evidence.
Level 3 7–9 Demonstrates comprehensive knowledge and understanding by

selecting and applying relevant knowledge of biological
facts/concepts to support the argument or decision/conclusion
being made.
Scientific reasoning supported throughout by sustained linkage of

a range of scientific ideas, processes, techniques or procedures.
Scientific argument is well developed and logical. Demonstrating

throughout the skills of synthesising and integrating relevant
knowledge with consistent linkages to biological concepts and/or
ideas, leading to nuanced and balanced scientific argument or
decision/conclusion based on evidence.
Salters-Nuffield Advanced Biology Resources Extension 1.1 Student Sheet
SOMEONE SAVED MY LIFE TODAY
Cardiopulmonary resuscitation
You’ve probably heard of ‘artificial respiration’. Nowadays this is generally known as
cardiopulmonary resuscitation or just CPR. In the UK about 30% of people who have a heart attack
die before reaching hospital. If we all knew how to carry out cardiopulmonary resuscitation literally
thousands of lives in the UK would be saved each year.
The British Heart Foundation has produced an app that is free to download. It contains videos and step
by step instructions on what to do if someone has a heart attack. After calling for help and phoning
999, it recommends performing hands-only CPR. The app provides training on how to undertake
hands-only CPR, pushing hard on the person’s chest to the beat of the Bee Gees song ‘Staying Alive’
until help arrives. The app includes an interactive animation that uses mobile phone technology to
allow the user to practise the rate and depth of push required, instructing you whether you need to
push harder or not.
The best way to learn about cardiopulmonary resuscitation is to have a training session on it,
particularly if you want to be able to use the Call, Push, Rescue method of CPR: call 999 immediately,
push hard and fast on the centre of the chest 30 times and give two rescue breaths. Training sessions
are run by such organisations as the Red Cross and St John Ambulance. The BHF also runs courses to
teach CPR and other emergency life-saving skills. These Heartstart courses are free to attend. In
addition, the BHF produces a free training kit for schools; see the BHF website for details. They will
come and run courses at schools and colleges – so pester your teachers/lecturers for one!
Questions
Q1 Why do you think the term ‘artificial respiration’ has been replaced by ‘cardiopulmonary
resuscitation’?
Q2 What causes the crushing pain that usually accompanies a heart attack?
Q3 Why do you think a person suffering a heart attack is often pale?
Q4 Suggest one reason why you should approach an unconscious person with care.
Q5 Explain how cardiopulmonary resuscitation compressions help save a person who has
experienced a heart attack.
Q6 If giving rescue breaths it is recommended you tilt the person’s head back, lift their chin and
then pinch the person’s nose before commencing rescue breaths. Explain why these actions are
recommended.
Q7 Cardiopulmonary resuscitation can save lives even if the person has not suffered a heart attack.
Suggest two other reasons why someone might be unconscious yet benefit from
cardiopulmonary resuscitation.
Q8 If you are trained to carry out cardiopulmonary resuscitation by practising on a training
manikin (life-size doll), the manikin’s lips will be cleaned before each person practises.
Suggest the possible physical health benefit of this.
Q9 Why do you think the British Heart Foundation has produced an app focusing on hands-only
CPR?
Salters-Nuffield Advanced Biology Resources Extension 1.1 Teacher Sheet
SOMEONE SAVED MY LIFE TODAY
Answers
Q1 Respiration is to do with the release of energy in cell metabolism; to resuscitate means ‘to
revive or restore to life or vigour’; ‘cardiopulmonary’ indicates the importance of the heart
(‘cardio’) and lungs (‘pulmonary’) in resuscitation.
Q2 Lack of oxygen in the heart muscles triggers the pain.
Q3 Blood is pumped less by the arteries than usual so does not reach the skin.
Q4 You might be at risk of whatever caused them to become unconscious, e.g. an electric shock.
Q5 Empties the ventricles to maintain blood flow around the body, maintains oxygen supply to the
brain preventing brain damage.
Q6 Tilting the head and lifting the chin will open the airways, allowing passage of oxygen in and
carbon dioxide out. Pinching the nose ensures oxygen goes into the person’s lungs rather than
simply out via their nose.
Q7 Any two from: drowning; choking; poisoning; injury to the head or chest; blocked airways.
Q8 Reduce risk of transmitting pathogens.
Q9 Practising compressions using the app will encourage people to attempt some CPR even if they
would rather not give rescue breaths; hands-only CPR is likely to increase a person’s chance of
survival.
TECHNIQUES USED IN MEDICAL DIAGNOSIS
How is cardiovascular disease diagnosed?

If a patient is suspected of having cardiovascular disease (CVD), the doctor will examine them, review
their medical history and ask for tests to be carried out. The most common test to check for problems
with the heart is an electrocardiogram (ECG). Contraction of heart muscle is initiated by small
changes in the electrical charge of heart cells. An electrocardiogram is a graphic record of the
electrical activity of the heart as it contracts and rests (Figure 1). The test is easy to carry out and any
patient with suspected cardiac problems will probably have one. An electrocardiogram is also used on
a patient with a suspected stroke to check for any heart condition that would increase the likelihood of
stroke.
In an ECG, leads are attached to the person’s chest and limbs to record the electrical currents produced
during the cardiac cycle; a small electrical current can be detected at the skin’s surface.
Figure 1 A normal ECG trace. The vertical axis shows electrical activity; the horizontal axis shows time.
The waves on the ECG represent each stage in the electrical activity of the heart:
 P wave – depolarisation of the atria that leads to atrial contraction (atrial systole)
 QRS complex – the wave of depolarisation that results in contraction of the ventricles (ventricular
systole)
 T wave – repolarisation (recovery) of the ventricles during the heart’s relaxation phase (diastole).
During a coronary event, the normal electrical activity and rhythm of the heart are disrupted, and
arrhythmias (irregular beatings caused by electrical disturbances) can affect a larger area of heart
muscle than initially affected by any reduced blood flow.
An ECG trace can provide information about heart rate, abnormal heartbeats, areas of damage and
inadequate blood flow. You will study the control of the cardiac cycle and ECGs in Topic 7.
Medical imaging
The term medical imaging refers to any technique used by doctors to look at the body – more
specifically, non-invasive internal imaging. Medical imaging is important because it allows diseases to
be diagnosed, injuries to be assessed, surgery to be planned and recovery monitored without the need
for dangerous and expensive exploratory operations. The primary techniques used are X-rays,
ultrasound, computerised axial tomography (CAT) scans, and magnetic resonance imaging (MRI).
X-ray imaging was the first of these techniques to be developed and is typically used for inspecting
injuries sustained to bones. It is particularly suited to this because it is quick and easy to take pictures
and the contrast observed between bone and soft tissue is high. In addition, a chest X-ray reveals any
enlargement of the heart and allows the state of blood vessels to be assessed.
Coronary angiography uses X-rays to detect obstructions in the coronary arteries of the heart. A
radiologist or cardiologist inserts a catheter (thin flexible tube) through a small incision in a blood
vessel in the arm, neck or groin (Figure 2). The catheter is then carefully threaded into the heart
(Figure 3). The blood vessels of the heart are then studied by injection of a dye through the catheter. A
rapid succession of X-rays is taken to view blood flow. Prior to the procedure the patient may be given
a mild sedative; the site will be cleaned and numbed with a local anaesthetic. Angiography was once
commonly used to check the condition of arteries, but now non-invasive techniques are used.
Figure 2 Coronary angiography – a catheter Figure 3 The catheter is carefully fed through the aorta into the
is inserted into an artery in the groin. coronary artery. Cardiac catheterisation can determine pressure
and blood flow in the heart’s chambers, collect blood samples from
the heart and examine the arteries of the heart. It is clearly a highly
useful procedure. However, it is invasive and not without some
risk.
Ultrasound is an imaging technique that works like radar – a pulse of sound energy is sent into the
body and the reflections from internal tissue boundaries are detected. Ultrasound is used for viewing
babies in the womb and is particularly well suited for this because it is very safe (compared to X-rays)
and good for viewing tissue–tissue boundary features. The main drawback of ultrasonic imaging is the
very high signal-to-noise ratio. This makes features hard to see against the background.
A CT, CAT or computerised tomography scan (Figure 4) is a method of taking pictures of the inside
of the body using a very thin X-ray beam. As this X-ray beam passes through the body, it is absorbed
in varying amounts by bones, tissues or fluid in the body, so that the beam that emerges from the body
varies in intensity. This varying intensity is measured by a special device that converts this
information into a detailed picture. Sometimes dye is injected into a vein before a CT scan to improve
the visibility of certain blood vessels and organs on the picture.
CT scanning was originally developed to help in diagnosing disorders of the brain. CT imaging of the
head and brain can detect tumours, blood clots and blood vessel defects. However, the use of CT
scanning has been expanded to include nearly every part of the body because it provides good soft
tissue resolution (contrast). The short scan times (500 milliseconds to a few seconds) mean that CT
can be used for all regions of the body, including moving parts. Thus, many internal organs can be
seen with a CT scan, but not with regular X-rays.
The CT image can be processed after scanning in several ways. For instance, 3D display further
enhances the value of CT imaging for surgeons. So-called multi-slice spiral CT scanning used with an
ECG is a non-invasive method of imaging the heart and coronary arteries. It can show narrowing of
the arteries and calcium deposits in the coronary arteries that form with plaque build-up. Thus, it can
allow diagnosis that could prevent a heart attack.
Figure 4 A CT scan of a healthy human brain.
To find out exactly how a CT scan 3D image is produced, see the weblinks associated with this topic.
EBCT is a special type of computed tomography that uses a sweeping electron beam to create the
effect needed to make a CT image. EBCT is a very fast, non-invasive means of imaging the heart and
coronary arteries. It eliminates the need for catheterisation and contrast injection which is required in
conventional cardiac angiography. It is particularly useful in that it can show calcium deposits in the
coronary arteries. These form along with the plaque build-up and can eventually lead to heart failure.
Early imaging of calcium deposits in the coronary arteries allows aggressive preventive measures to
be implemented, thus lowering the risk of heart attack.
MRI was formerly known as nuclear magnetic resonance (NMR) imaging – the name was dropped
due to public fears about irradiation during scans, prompted by the word ‘nuclear’. The body to be
examined is placed in a magnetic field and all the atoms are shaken up. The field is removed and the
atoms emit their excess energy. The rate of emission is detected and is dependent on tissue type. It is
this that determines the resulting image contrast. The main applications of MRI are in brain imaging
and breast scanning. Others include the visualisation of torn ligaments and shoulder injuries, and the
diagnosis of the early stages of stroke. MRI systems can also image flowing blood in virtually any part
of the body. In many cases, the MRI system can do this without a contrast injection.
The MRI system builds up a 2D or 3D map of tissue types and then integrates all of this information to
create 2D images or 3D models. MRI provides an unparalleled view deep inside the human body. The
level of detail we can see is extraordinary compared with any other imaging technique. It is the
method of choice for the diagnosis of many types of injuries and medical conditions.
If you had to undergo an MRI scan, you might be as confused as the author of this question, posted on
a website:
Dear Alice,
What is the difference between CT and MRI? And what does with or without dye mean?
Write a reply from Alice and then compare your reply to the one given by Alice at the ‘Go Ask Alice’
website, which can be found in the weblinks for this topic.
Ambulatory or 24 hour monitoring: If no abnormality, disease or damage can be detected using the
standard techniques but the patient still feels uneasy when performing stressful activities (such as
climbing stairs) but feels okay under normal activity, then an ambulatory monitor may be used. An
ambulatory monitor is a portable ECG system (often worn around the waist) that continuously
monitors the heart’s electrical activity.
Scanning techniques are studied in detail in Topic 8.
FUNCTIONAL FOODS AND CORONARY HEART

DISEASE
Purpose
 To reinforce how changing diet can affect the risk of coronary heart disease (CHD).
Functional foods
Functional foods are foods that contain an added ingredient that gives them a health-promoting
property in addition to their usual nutritional value, for example calcium added to orange juice or iron
added to breakfast cereal.
High-profile functional foods are margarine spreads and yoghurts with added plant sterols or stanol.
Plant sterols and stanol occur in small quantities in many fruits, vegetables, nuts and seeds. They both
have a similar structure to that of cholesterol and compete with LDL cholesterol for absorption; the
result is that less enters the bloodstream from the digestive system and liver.
The normal dietary intake of plant sterols, which are found mostly in cooking oils and margarine, is
200–400 mg a day. The normal intake of plant stanol is negligible. Research has shown that
consuming 1–3 g of plant sterols and stanol per day lowered total and low-density lipoprotein (LDL)
cholesterol in the blood. Intakes higher than 3 g per day produced no further decrease in blood
cholesterol. No further reductions were achieved with intakes above 3 g. In epidemiological studies it
has been found that a daily intake of 1.5–3 g plant sterols or plant stanol per day will typically lower
LDL cholesterol by about 11% and the minimum time required to achieve this effect is two to three
weeks. It has also been shown that the lowering can be increased to about 15% if combined with a diet
low in saturated fats.
Research has shown that if 2 g a day of plant sterol or stanol was added to the average daily portion of
margarine, there would be a reduction in the risk of heart disease of about 25%, an article in the
British Medical Journal concluded. Ironically some of the plant sterol and stanol enriched spreads use
trans-fats (polyunsaturated oils hydrogenated to make them more solid), which can increase the risk of
cardiovascular disease.
Functional foods would normally carry an approved health and nutritional claim. The regulation on
Nutrition and Health Claims was enacted in 2007 to enforce the European Commission requirements
on wording of these claims. The regulation requires that any claims should be clear, accurate and
based on scientific evidence. Vague statements such as ‘beneficial to health’ are not permitted, nor are
statements that make medical claims about preventing, treating or curing diseases, for example ‘eating
omega-3 may prevent or improve symptoms of heart disease’.
Questions
In one randomised, double-blind, placebo-controlled study the effects of a control spread with no
added sterol, a spread with about 3 g of added sterol, and butter were compared. Volunteers, all of
whom had normal levels of cholesterol in their blood, ate controlled quantities of each spread. At the
end of the 3.5 week trial period, the blood LDL cholesterol levels of the three groups were: control
3.05 mmol per l; sterol-enriched spread 2.75 mmol per l; and butter 3.17 mmol per l.
Q1 Work out the percentage change in LDL cholesterol relative to the control spread.
Q2 Comment on the percentage change in LDL cholesterol observed.
Q3 What effect would the change in the LDL cholesterol as a result of eating the sterol-enriched
spread or butter be expected to have on the chances of developing CHD?
Q4 To ensure a fair trial, in what way must the control spread have been similar to the sterol-
enriched margarine?
Cholesterol and fat-soluble nutrients including certain vitamins are absorbed along similar pathways
so it was important for scientists to see whether the plant sterols reduced the absorption of such
nutrients. Some lowering of carotenoid absorption was found with plant sterols: the degree depended
on the level of sterol intake.
Q5 Name three vitamins whose absorption might be affected by plant sterols.
Q6 Propose how the manufacturers might overcome this problem of reduced vitamin content.
Facts and figures

After extensive trials, including the one above, the dairy foods manufacturer maintained that using
such products reduced LDL cholesterol levels by between 10 and 15% within a few weeks.
Interestingly, the Advertising Standards Agency scrutinised the studies submitted by the dairy foods
manufacturer and found that people with a healthy diet and active lifestyles were likely to reduce LDL
cholesterol levels by only 10% and concluded that the claim was misleading!
Bodies such as the Food Standards Agency have signified broad approval of the use of sterol-enriched
spreads and concluded that their use would lead to a real reduction in the risk of heart disease. Recent
research has shown that raised cholesterol levels are no longer thought to be as important by the
general public as they were a few years ago. Eighty per cent of adults in the UK still don’t know their
cholesterol levels, and even fewer are aware of the significance of the difference between the cardio-
protective, high-density lipoprotein (HDL) ‘good’ cholesterol and the dangerous, arterial-damaging,
low-density lipoprotein (LDL) cholesterol.
A 2004 European regulation requires all foods containing added plant sterols to be labelled with
information about the use of the product, including that it is not appropriate for children under 5.
Salters-Nuffield Advanced Biology Resources Extension 1.3 Teacher Sheet
FUNCTIONAL FOODS AND CORONARY HEART

DISEASE
Purpose
● To reinforce how changing diet can affect the risk of coronary heart disease (CHD).
Answers
Q1 Percentage change in LDL cholesterol with sterol-enriched spread 6.8%; butter +3.9%;
Q2 Addition of sterol to the spread decreased LDL cholesterol compared to the control; butter
produced an increase in LDL cholesterol compared to the control.
Q3 The change in the LDL cholesterol as a result of eating the sterol-enriched spread would
reduce the risk of developing CHD, whereas eating butter would increase the chances of
developing CHD.
Q4 Similar in fatty acid content and composition. Not low-fat, spreadable, light or ‘enriched’
spread is another possible answer.
Q5 Vitamins A, D, E and K which are all fat soluble.
Q6 Add supplementary vitamins to the spread.
NEW TREATMENTS FOR CARDIOVASCULAR

DISEASE
Surgery
If someone has had a heart attack or stroke, or is identified as being at high risk of one, in addition to
the lifestyle changes and drug treatments, those with severe coronary heart disease (CHD) (who have
had a heart attack like Peter) may need surgery. Coronary angioplasty techniques may be used when
coronary arteries narrow or become blocked. A catheter is inserted into an artery in the groin and
guided by X-ray imaging up to the narrowed coronary artery. A tiny balloon at the tip of the catheter is
inflated to stretch or open the constriction and improve the passage for blood flow (Figure 1). Usually
there is a short wire-mesh tube, called a stent, around the balloon. The stent expands when the balloon
is inflated. The balloon is deflated and the balloon-tipped catheter is removed leaving the stent in place
permanently. The procedure is completed under local anaesthetic so the patient remains awake
throughout the procedure.
Figure 1 Research suggests that balloon angioplasty may give better long-term survival rates than the use of
drugs.
In a coronary artery bypass operation, a blood vessel, usually taken from the leg or chest, is grafted
onto the blocked artery, bypassing the blocked area. Two, three or four blocked arteries can be
bypassed at once – a double, triple or quadruple bypass (Figure 2). The blood can then go around the
obstruction to supply the heart with enough blood to relieve chest pain. Peter had a quadruple bypass.
Figure 2 A vein taken from the patient’s leg is used to bypass the sections of coronary artery that are narrowed.
Other approaches
In an emergency situation when an artery is blocked, a clot-busting drug may be administered.
Streptokinase is frequently used. Injected into the patient, the enzyme circulates within the blood and
breaks down the clot.
There are other enzymes used to prevent CHD, such as lipase inhibitors. Orlistat is one example; it
inhibits lipase enzymes in the digestive system so lipids are not broken down and absorbed in the gut.
Lipase inhibitors are used to help weight loss in people who are obese.
Research into different proteins, such as nerve growth factor, suggests that it may be possible to
prevent damage to heart muscle and aid recovery of heart tissue after an attack. Research into gene
therapy suggests that injecting genes which code for a protein that enhances blood vessel growth may
prove successful in helping to relieve some patients’ symptoms.
The scarring that follows a heart attack can be treated by injecting stem cells which go on to make new
heart tissue. (You will find out more about stem cells in Topic 3.) This treatment is still being
developed and its success rate varies.
New developments seem to occur daily in this truly exciting area of biomedical science.

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Salters-Nuffield Advanced Biology Resources Activity 1.

MARK’S AND PETER’S STORIES

MARK’S AND PETER’S STORIES

DEMONSTRATING MASS FLOW

DEMONSTRATING MASS FLOW

Notes on the procedure

DEMONSTRATING MASS FLOW

Requirements per student or Notes

cotton wool litmus paper (red)

Figure 1 Glass tube with litmus paper (red).

AN IDEAL TRANSPORT MEDIUM

Properties and polarity

Figure 1 Why water is a liquid at room temperature.

Q3 a Vitamin C is water-soluble. Vitamin A is fat-soluble. Give a possible explanation for this

Property Explanation Role in blood

Solvent for ionic and

Blood helps to regulate body

AN IDEAL TRANSPORT MEDIUM

Notes on the procedure

Property Explanation Role in blood

AN IDEAL TRANSPORT MEDIUM

Requirements per student or Notes

STRUCTURE OF THE HEART (DISSECTION)

Cut along this line Cut along this line

Vertical section of the heart

Figure 2 Vertical section of the heart.

STRUCTURE OF THE HEART (DISSECTION)

Notes on the procedure and answers

semilunar valves in aorta

pulmonary veins left atrium

right atrium left atrioventricular

Figure 1 Vertical section of the heart showing direction of blood flow.

STRUCTURE OF THE HEART (DISSECTION)

Requirements per student or Notes

STRUCTURE OF THE HEART (SIMULATED

Vertical section of the heart

Figure 1 Vertical section of the heart.

STRUCTURE OF THE HEART (SIMULATED

Notes on the procedure

INVESTIGATING ARTERIES AND VEINS

Part A: Elastic recoil in arteries and veins

Figure 1 Measuring the length of the ring.

Part B: Histology of blood vessels

Analysis and interpretation of data

INVESTIGATING ARTERIES AND VEINS

Notes on the procedure

Part A: Elastic recoil in arteries and veins

Mass/g Length of vein/mm

Part B: Histology of blood vessels

Answers would be:

INVESTIGATING ARTERIES AND VEINS

Part A: Elastic recoil in arteries and veins

Figure 1 Measuring the length of the ring.

Part B: Histology of blood vessels

HARVEY’S CIRCULATION EXPERIMENTS

Perform Harvey’s experiment

Q6 What did he conclude from this observation?

HARVEY’S CIRCULATION EXPERIMENTS

Perform Harvey’s experiment

THE CARDIAC CYCLE

THE CARDIAC CYCLE

Notes on the procedure

Figure 2 Atrial systole.

Figure 3 Ventricular systole.