Genetic studies in osteoporosis – the end of the beginning

Osteoporosis and disorders of bone fragility are highly heritable, but despite much effort the identities of few of the genes involved has been established. Recent developments in genetics such as genome-wide association studies are revolutionizing research in this field, and it is likely that further contributions will be made through application of next-generation sequencing technologies, analysis of copy number variation polymorphisms, and high-throughput mouse mutagenesis programs. This article outlines what we know about osteoporosis genetics to date and the probable future directions of research in this field

Role of home visiting in improving parenting and health in families at risk of abuse and neglect : results of a multicentre randomised controlled trial and economic evaluation

Objectives – To evaluate the effectiveness and cost-effectiveness of an intensive home visiting programme in improving outcomes for vulnerable families. Design – Multicentre randomised controlled trial in which eligible women were allocated to receive home visiting (n=67) or standard services (n=64). Incremental cost analysis. Setting – 40 GP practices across two counties in the UK Participants – 131 vulnerable pregnant women. Intervention: Selected health visitors were trained in the Family Partnership Model to provide a weekly home visiting service from 6-months antenatally to 12 months postnatally. Main outcome measures – mother-child interaction, maternal psychological health attitudes and behaviour, infant functioning and development, and risk of neglect or abuse. Results – At 12-months differences favouring the home visited group were observed on an independent assessment of maternal sensitivity (p<0.04) and infant cooperativeness (p<0.02). No differences were identified on any other measures. There was a non-significant increase in the likelihood of intervention group infants being the subject of child protection proceedings, or being removed from the home, and one death in the control group. The mean incremental cost per infant of the home visiting intervention was £3,246 (bootstrapped 95% confidence interval for the difference: £1,645 - £4,803). Conclusion – This intervention may have the potential to improve parenting and increase the identification of infants at risk of abuse and neglect in vulnerable families. Further investigation is needed together with long term follow up to assess possible sleeper effects

Investigating the use of coca and other psychoactive plants in Pre-Columbian mummies from Chile and Peru. An analytical investigation into the feasibility of testing ancient hair for drug compounds.

Psychoactive plants have played a significant role in Andean cultures for millennia. Whilst there is evidence of the importance of psychoactive plants in the Andean archaeological record, none of these are direct proof that these culturally significant plants were used by ancient Andean populations. This project utilised liquid chromatography tandem mass spectrometry (LC-MS/MS) to investigate the use of psychoactive plants in individuals from cemetery sites in Chile and Peru by analysing hair specimens for a variety of psychoactive compounds. Hair specimens from 46 individuals buried at cemetery sites in the Azapa Valley (northern Chile) belonging to the Cabuza culture (c AD 300 ¿ 1000) indicated around half of these people ingested coca, as evidenced by the detection of BZE in hair specimens. Two individuals from this population tested positive for bufotenine, the main alkaloid in Anadenanthera snuff. There is a specific material culture associated with snuffing. These findings confirm Anadenanthera was consumed in the Azapa Valley. The 11 individuals from Peru came from the necropolis at Puruchuco-Huaquerones in the Rímac valley near Lima. These individuals belonged to the Ichma culture, but would have been under Inca imperial control during the Late Horizon. Although only a small sample, two-thirds tested positive for BZE, suggestive that access to coca was widespread. This project presents a synthesis of the archaeological evidence for the use of various psychoactive plants in Andes. Also presented is the first report of the detection of bufotenine in ancient hair samples and additional data contributing to the understanding of the use of coca in the Andes.Arts and Humanities Research Council (AHRC). Andy Jagger and Francis Raymond Hudson funds at the University of Bradfor

Evidence-Based Veterinary Medicine Learning: an open access tutorial for practitioners and students

EBVM Learning, an open access online tutorial, has been developed to support the teaching of evidence-based veterinary medicine (EBVM). &nbsp;This paper provides the project background and teaching examples.&nbsp; The authors request JEAHIL readers share this resource with colleagues who support evidence-based practices including veterinary medicine

The clinical effectiveness of different parenting programmes for children with conduct problems : a systematic review of randomised controlled trials

Background Conduct problems are common, disabling and costly. The prognosis for children with conduct problems is poor, with outcomes in adulthood including criminal behaviour, alcoholism, drug abuse, domestic violence, child abuse and a range of psychiatric disorders. There has been a rapid expansion of group based parent-training programmes for the treatment of children with conduct problems in a number of countries over the past 10 years. Existing reviews of parent training have methodological limitations such as inclusion of non-randomised studies, the absence of investigation for heterogeneity prior to meta-analysis or failure to report confidence intervals. The objective of the current study was to systematically review randomised controlled trials of parenting programmes for the treatment of children with conduct problems. Methods Standard systematic review methods were followed including duplicate inclusion decisions, data extraction and quality assessment. Twenty electronic databases from the fields of medicine, psychology, social science and education were comprehensively searched for RCTs and systematic reviews to February 2006. Inclusion criteria were: randomised controlled trial; of structured, repeatable parenting programmes; for parents/carers of children up to the age of 18 with a conduct problem; and at least one measure of child behaviour. Meta-analysis and qualitative synthesis were used to summarise included studies. Results 57 RCTs were included. Studies were small with an average group size of 21. Meta-analyses using both parent (SMD -0.67; 95% CI: -0.91, -0.42) and independent (SMD -0.44; 95% CI: -0.66, -0.23) reports of outcome showed significant differences favouring the intervention group. There was insufficient evidence to determine the relative effectiveness of different approaches to delivering parenting programmes. Conclusion Parenting programmes are an effective treatment for children with conduct problems. The relative effectiveness of different parenting programmes requires further research

Experiences with a universal mindfulness and wellbeing programme at a UK medical school

Evaluation of a universal, mental wellbeing and mindfulness programme in a UK graduate entry medical school Design: Mixed methods: measurement of mental wellbeing and mindfulness in 2 cohorts at 3 time points over 15mths; descriptive, regression and repeated measures analysis with post hoc pairwise comparisons; qualitative interviews with purposive sample of 13 students after 1yr analysed thematically; spontaneous anonymous feedback on the course. Findings: The course was a surprise to students, and reactions mixed. Respect for its contents grew over the first year. Most students had actively implemented a wellbeing strategy by the end of the course and an estimated quarter were practicing some mindful activity. In the context of an overall decline in wellbeing and limited engagement with mindfulness practice, increases in mindfulness were protective against this decline in both cohorts (p<001). A small minority of students thought the course was a waste of time. Their attitudes influenced engagement by their peers. The mindfulness and wellbeing practices of the facilitators were evident to students and influenced perceived effects. Research Limitations: The uncontrolled nature of this observational study and low response rates to the survey limit conclusions. Further research in other medical education settings is needed. Practice Implications: Results are encouraging, suggesting modest benefit in terms of changing attitudes and practices and a modest protective effect on the wellbeing of students who engaged. Originality/value: This is the first study of a universal wellbeing and mindfulness programme in a UK medical school. Universal programmes are rare and evaluation studies are scarce

Morphine and fentanyl exposure during therapeutic hypothermia does not impair neurodevelopment

Background Hypothermia-treated and intubated infants with moderate or severe hypoxic-ischemic encephalopathy (HIE) usually receive morphine for sedation and analgesia (SA) during therapeutic hypothermia (TH) and endotracheal ventilation. Altered drug pharmacokinetics in this population increases the risk of drug accumulation. Opioids are neurotoxic in preterm infants. In term infants undergoing TH, the long-term effects of morphine exposure are unknown. We examined the effect of opioid administration during TH on neurodevelopmental outcome and time to extubation after sedation ended. Methods In this prospectively collected population-based cohort of 282 infants with HIE treated with TH (2007–2017), the cumulative opioid dose of morphine and equipotent fentanyl (10–60 µg/kg/h) administered during the first week of life was calculated. Clinical outcomes and concomitant medications were also collected. Of 258 survivors, 229 underwent Bayley-3 neurodevelopmental assessments of cognition, language and motor function at 18–24 months. Multivariate stepwise linear regression analysis was used to examine the relation between cumulative opioid dose and Bayley-3 scores. Three severity-groups (mild-moderate-severe) were stratified by early (<6 h) amplitude-integrated electroencephalography (aEEG) patterns. Findings The cumulative dose of opioid administered as SA during TH was median (IQR) 2121 µg/kg (1343, 2741). Time to extubation was independent of SA dose (p > 0.2). There was no significant association between cumulative SA dose and any of the Bayley-3 domains when analysing the entire cohort or any of the aEEG severity groups. Interpretation Higher cumulative opioid doses in TH-treated infants with HIE was not associated with worse Bayley-3 scores at 18–24 months of age. Funding The Bristol cooling program was funded by the Children's Medical Research Charity SPARKS managing donations for our research from the UK and US, the UK Moulton Foundation, the Lærdal Foundation for Acute Medicine in Norway and the Norwegian Research Council (JKG)

A systematic review evaluating the implementation of technologies to assess, monitor and treat neurodevelopmental disorders: A map of the current evidence

Technology-based interventions provide an attractive option for improving service provision for neurodevelopmental disorders (NDD), for example, widening access to interventions, objective assessment, and monitoring; however, it is unclear whether there is sufficient evidence to support their use in clinical settings. This review provides an evidence map describing how technology is implemented in the assessment/diagnosis and monitoring/ treatment of NDD (Prospero CRD42018091156). Using predefined search terms in six databases, 7982 articles were identified, 808 full-texts were screened, resulting in 47 included papers. These studies were appraised and synthesised according to the following outcomes of interest: effectiveness (clinical effectiveness/ service delivery efficiencies), economic impact, and user impact (acceptability/ feasibility). The findings describe how technology is currently being utilised clinically, highlights gaps in knowledge, and discusses future research needs. Technology has been used to facilitate assessment and treatment across multiple NDD, especially Autism Spectrum (ASD) and attention-deficit/hyperactivity (ADHD) disorders. Technologies include mobile apps/tablets, robots, gaming, computerised tests, videos, and virtual reality. The outcomes presented largely focus on the clinical effectiveness of the technology, with approximately half the papers demonstrating some degree of effectiveness, however, the methodological quality of many studies is limited. Further research should focus on randomised controlled trial designs with longer follow-up periods, incorporating an economic evaluation, as well as qualitative studies including process evaluations and user impact

Multi-wavelength aperture polarimetry of debris disc host stars

Debris discs around main sequence stars have been extensively characterised from infrared to millimetre wavelengths through imaging, spectroscopic, and total intensity (scattered light and/or thermal emission) measurements. Polarimetric observations have only been used sparingly to interpret the composition, structure, and size of dust grains in these discs. Here we present new multi-wavelength aperture polarisation observations with parts-per-million sensitivity of a sample of twelve bright debris discs, spanning a broad range of host star spectral types, and disc properties. These measurements were mostly taken with the HIgh Precision Polarimetric Instrument on the Anglo-Australian Telescope. We combine these polarisation observations with the known disc architectures and geometries of the discs to interpret the measurements. We detect significant polarisation attributable to circumstellar dust from HD 377 and HD 39060, and find tentative evidence for HD 188228 and HD 202628.Comment: 25 pages, 8 figures, 9 tables, accepted for publication in MNRA

Reevaluating the role of verbalisation of faces for composite production: Descriptions of offenders matter!

Standard forensic practice necessitates that a witness describes an offender’s face prior to constructing a visual likeness, a facial composite. However, describing a face can interfere with face recognition, although a delay between description and recognition theoretically should alleviate this issue. In Experiment 1, participants produced a free recall description either 3-4 hours or 2 days after intentionally or incidentally encoding a target face, and then constructed a composite using a modern ‘feature’ system immediately or after 30-minutes. Unexpectedly, correct naming of composites significantly reduced following the 30-minute delay between description and construction for targets encoded 2 days previously. In, Experiment 2, participants in these conditions gave descriptions that were better matched to their targets by independent judges, a result which suggests that the 30-minute delay actually impairs access to details of recalled descriptions that are valuable for composite effectiveness. Experiment 3 found the detrimental effect of description delay extended to composites constructed from a ‘holistic’ face production system. The results have real-world but counterintuitive implications for witnesses who construct a face one or two days after a crime: after having recalled the face to a practitioner, an appreciable delay (here, 30 minutes) should be avoided before starting face construction