Factors that affect serum levels of ferritin in Australian adults and implications for Follow-up

Background & Aims Serum levels of ferritin are commonly measured to assess iron stores but are affected by factors such as obesity and chronic disease. Published reference ranges have not changed in decades, and the number of patients whose levels exceed the upper limits has been increasing. As a result, more patients are evaluated for iron overload. Methods We compared serum levels of ferritin in 1188 Australian adults who participated in the 2005 Busselton Population Survey with levels from the 1995 survey. Parametric regression was used to assess the effects of body weight and biochemical parameters on serum level of ferritin to derive contemporary population-appropriate reference ranges. Results In 2005, age-adjusted levels of ferritin were 21% higher in men (P < .0001) and 10% higher in women (P = .01) than in 1995; 31% of men exceeded levels of 300 μg/L, compared with 23% in 1995. Body mass index (BMI) ≥25 kg/m2 was associated with higher levels of ferritin in men ≥35 years old and in postmenopausal women (P ≤ .002). Serum level of γ-glutamyltransferase (GGT) correlated with serum level of ferritin (P < .0001). In men, the estimated 95th percentiles ranged from 353 to 495 μg/L (<35 years), from 350 to 511 μg/L (≥35 years, BMI <25 kg/m2), and from 413 to 696 μg/L (≥35 years, BMI ≥25 kg/m2) when GGT levels were 10–75 IU/L. In women, the 95th percentiles ranged from 106 to 235 μg/L (premenopausal), from 222 to 323 μg/L (postmenopausal, BMI <25 kg/m2), and from 249 to 422 μg/L (postmenopausal, BMI ≥25 kg/m2) when GGT levels were 8–45 IU/L. Conclusion Serum levels of ferritin increased significantly between 1995 and 2005. Reference ranges that accommodate demographic and biomedical variations will assist clinicians in identifying individuals who require further evaluation for iron overload

The Effect of Senior Medical Student Tutors Compared to Faculty Tutors on Examination Scores of First- and Second-Year Medical Students in Two Problem-Based Learning Courses

At the University of Hawaii John A. Burns School of Medicine, senior medical student volunteers are used as tutors for some problem-based learning groups in both the first and second years. Previous studies on the advantages and disadvantages of student tutors compared to faculty tutors have been equivocal. This study expected to answer the following question: Are there differences in examination scores for learners in their first or second year tutored by fourth-year medical students compared to those tutored by faculty members on two different types of examinations? Students were assessed using more clinically relevant, modified essay question examinations and multiple-choice question examinations. Student grades for eight consecutive years were sorted for year and type of examination into those tutored by a faculty member and those tutored primarily by a senior medical student. The only difference favored faculty tutors on second-year examinations that contained more clinically relevant questions. This phenomenon may be explained by the clinical expertise of faculty tutors making a difference in the second year but not the first year

Finding Fault? Divorce Law and Practice in England and Wales

This is the final version of the report. Available from Nuffield Foundation via the link in this record.1. Key messages The law of divorce in England and Wales has been subject to criticism for decades, most recently following the rare defended case of Owens v Owens. This major research study aimed to explore how the law is working in practice. The current law and use of fault The sole ground for divorce in England and Wales is the irretrievable breakdown of the marriage. But a divorce may be granted only if one of five ‘Facts’ is proved. Whilst many people might assume this is required, it is not necessary to prove that that ‘Fact’ was a cause of the breakdown. Three Facts are fault-based: adultery, behaviour, and desertion. Two Facts are based on separation: two years if the other spouse consents to divorce, five years if they do not. In 2015, 60% of English and Welsh divorces were granted on adultery or behaviour. In Scotland, where different procedural and related legal rules create different incentive structures, it was just 6%. Elsewhere, fault has been abolished or is just one option, and often a practically insignificant one, among several divorce grounds. The continuing problems of fault Academic research and Law Commission reviews from the 1970s onwards reported serious problems with the divorce law, including the lack of honesty of the system with the parties exaggerating behaviour allegations to get a quick divorce, while the court could do little more than ‘pretend’ to inquire into allegations. This study found that those problems continue and have worsened in some respects. Fault, especially behaviour, continues to be relied on to secure a faster divorce. The consequence is that parties often feel under pressure to exaggerate allegations or retro-fit the reasons for their separation into one of the legal Facts, even though the court’s expectations of what is required to make out each Fact is now actually very low, particularly for behaviour. The court has a duty to inquire into allegations but in practice in undefended cases only has the capacity to take the petitioner’s allegations at face value. That is procedurally unfair for the great majority of respondents who cannot defend themselves against the allegations. Parties embarking on the process might reasonably assume that the law is underpinned by a fault-based logic: that petitions should reflect who and what was to blame for the relationship breakdown. Yet whilst the law invites parties to rely on fault-based Facts, it does not require the court to adjudicate on responsibility in that way – not least because it will very often be impossible to allocate blame accurately in this context. Yet respondents on the receiving end of fault-based petitions inevitably feel cast as the ‘guilty’ party. The study found no evidence that fault prevents or slows down the decision to divorce and some evidence that it may shorten the time from break up to filing. We also found, as previously, that producing evidence of fault can create or exacerbate unnecessary conflict with damaging consequences for children and contrary to the thrust of family law policy. 10 The current divorce law is now nearly 50 years old. Its apparent rationale and operation are at odds with a modern, transparent, problem-solving family justice system that seeks to minimise the consequences of relationship breakdown for both adults and children. The need for law reform to finally remove fault The study shows that we already have something tantamount to immediate unilateral divorce ‘on demand’, but masked by an often painful, and sometimes destructive, legal ritual with no obvious benefits for the parties or the state. A clearer and more honest approach, that would also be fairer, more child-centred and cost-effective, would be to reform the law to remove fault entirely. We propose a notification system where divorce would be available if one or both parties register that the marriage has broken down irretrievably and that intention is confirmed by one or both parties after a minimum period of six months.Nuffield Foundatio

Iron uptake from plasma transferrin by the duodenum is impaired in the Hfe knockout mouse

Hereditary hemochromatosis (HH) is a disorder of iron metabolism in which enhanced iron absorption of dietary iron causes increased iron accumulation in the liver, heart, and pancreas. Most individuals with HH are homozygous for a C282Y mutation in the HFE gene. The function of HFE protein is unknown, but it is hypothesized that it acts in association with β2-microglobulin and transferrin receptor 1 to regulate iron uptake from plasma transferrin by the duodenum, the proposed mechanism by which body iron levels are sensed. The aim of this study was to test this hypothesis by comparing clearance of transferrin-bound iron in Hfe knockout (KO) mice with that observed in C57BL/6 control mice. The mice were fed either an iron-deficient, control, or iron-loaded diet for 6 weeks to alter body iron status. The mice then were injected i.v. with 59Fe-transferrin, and blood samples were taken over 2 h to determine the plasma 59Fe turnover. After 2 h, the mice were killed and the amount of radioactivity in the duodenum, liver, and kidney was measured. In both Hfe KO and C57BL/6 mice, plasma iron turnover and iron uptake from plasma transferrin by the duodenum, liver, and kidney correlated positively with plasma iron concentration. However, duodenal iron uptake from plasma transferrin was decreased in the Hfe KO mice compared with the control mice. Despite this difference in duodenal uptake, the Hfe KO mice showed no decrease in iron uptake by the liver and kidney or alteration in the plasma iron turnover when compared with C57BL/6 mice. These data support the hypothesis that HFE regulates duodenal uptake of transferrin-bound iron from plasma, and that this mechanism of sensing body iron status, as reflected in plasma iron levels, is impaired in HH

Scaling up research on family justice using large-scale administrative data: an invitation to the socio-legal community

This article outlines the value of administrative data for family justice research. Although socio-legal scholars have extended their research beyond purely theoretical or doctrinal analyses, studies using large-scale digital datasets remain few in number. As new opportunities arise to link large-scale administrative datasets across health, education, welfare and justice, it is vital that the community of family justice researchers and analysts are supported to deliver research based on entire service or family court populations. In this context, this article provides a definition of administrative data, before outlining the potential of single, linked or blended administrative data sets for family justice research. The remaining sections of the article speak to questions that are pertinent to this particular academic community, including the distinctive contribution of the socio-legal scholar to interdisciplinary teams and the place of data providers in collaborative research. Drawing on the sociological concept of ‘publics’, the final section considers the multiple interest groups whose social licence must be secured, when personal records are used to understand the relationship between law and family life

Iron status and the acute post-exercise hepcidin response in athletes

This study explored the relationship between serum ferritin and hepcidin in athletes. Baseline serum ferritin levels of 54 athletes from the control trial of five investigations conducted in our laboratory were considered; athletes were grouped according to values 100 mg/L (SF\u3e100). Data pooling resulted in each athlete completing one of five running sessions: (1) 8x3 min at 85% vVO2peak; (2) 5x4 min at 90% vVO2peak; (3) 90 min continuous at 75% vVO2peak; (4) 40 min continuous at 75% vVO 2peak; (5) 40 min continuous at 65% vVO2peak. Athletes from each running session were represented amongst all four groups; hence, the mean exercise duration and intensity were not different (p\u3e0.05). Venous blood samples were collected pre-, post- and 3 h post-exercise, and were analysed for serum ferritin, iron, interleukin-6 (IL-6) and hepcidin-25. Baseline and post-exercise serum ferritin levels were different between groups (p0.05). Post-exercise IL-6 was significantly elevated compared to baseline within each group (p100;

Gender Gap in Repartnering: The Role of Parental Status and Custodial Arrangements : Gender Gap in Repartnering

Objective: This study assesses whether parenthood influences repartnering for women and men and explores how repartnering is associated with parental status of the prospective partners. Background: Previous research has not demonstrated whether gender differences in repartnering are conditional on the presence of children. This study aims to better disentangle the specific gender differentials in repartnering probabilities conditional on parenthood and child custody status. Method: The analytical sample consists of 5,372 women and 3,375 men who reported at least one partnership dissolution in the British Understanding Society survey. Multilevel event history models with Markov Chain Monte Carlo simulations are used to estimate the probabilities of (a) finding a new partner and (b) finding a new childless partner or a new partner who has children. Results: The results suggest that mothers, and to a lesser extent fathers, are less likely to repartner than their childless counterparts. Among parents who have child custody, there emerges a distinct gender gap because mothers exhibit a significantly lower rate of repartnering than fathers. Finally, coresident single parents are relatively less likely to repartner with childless individuals, and single fathers more frequently form two-parent stepfamilies than do mothers. Conclusion: This suggests the presence of a gender divide in repartnering that is especially apparent when child custody is taken into account. The presence of children also reduces the possibility of forming unions with childless individuals

Observational study to estimate the changes in the effectiveness of bacillus Calmette-Guérin (BCG) vaccination with time since vaccination for preventing tuberculosis in the UK.

Until recently, evidence that protection from the bacillus Calmette-Guérin (BCG) vaccination lasted beyond 10 years was limited. In the past few years, studies in Brazil and the USA (in Native Americans) have suggested that protection from BCG vaccination against tuberculosis (TB) in childhood can last for several decades. The UK's universal school-age BCG vaccination programme was stopped in 2005 and the programme of selective vaccination of high-risk (usually ethnic minority) infants was enhanced. To assess the duration of protection of infant and school-age BCG vaccination against TB in the UK. Two case-control studies of the duration of protection of BCG vaccination were conducted, the first on minority ethnic groups who were eligible for infant BCG vaccination 0-19 years earlier and the second on white subjects eligible for school-age BCG vaccination 10-29 years earlier. TB cases were selected from notifications to the UK national Enhanced Tuberculosis Surveillance system from 2003 to 2012. Population-based control subjects, frequency matched for age, were recruited. BCG vaccination status was established from BCG records, scar reading and BCG history. Information on potential confounders was collected using computer-assisted interviews. Vaccine effectiveness was estimated as a function of time since vaccination, using a case-cohort analysis based on Cox regression. In the infant BCG study, vaccination status was determined using vaccination records as recall was poor and concordance between records and scar reading was limited. A protective effect was seen up to 10 years following infant vaccination [&lt; 5 years since vaccination: vaccine effectiveness (VE) 66%, 95% confidence interval (CI) 17% to 86%; 5-10 years since vaccination: VE 75%, 95% CI 43% to 89%], but there was weak evidence of an effect 10-15 years after vaccination (VE 36%, 95% CI negative to 77%; p = 0.396). The analyses of the protective effect of infant BCG vaccination were adjusted for confounders, including birth cohort and ethnicity. For school-aged BCG vaccination, VE was 51% (95% CI 21% to 69%) 10-15 years after vaccination and 57% (95% CI 33% to 72%) 15-20 years after vaccination, beyond which time protection appeared to wane. Ascertainment of vaccination status was based on self-reported history and scar reading. The difficulty in examining vaccination sites in older women in the high-risk minority ethnic study population and the sparsity of vaccine record data in the later time periods precluded robust assessment of protection from infant BCG vaccination &gt; 10 years after vaccination. Infant BCG vaccination in a population at high risk for TB was shown to provide protection for at least 10 years, whereas in the white population school-age vaccination was shown to provide protection for at least 20 years. This evidence may inform TB vaccination programmes (e.g. the timing of administration of improved TB vaccines, if they become available) and cost-effectiveness studies. Methods to deal with missing record data in the infant study could be explored, including the use of scar reading. The National Institute for Health Research Health Technology Assessment programme. During the conduct of the study, Jonathan Sterne, Ibrahim Abubakar and Laura C Rodrigues received other funding from NIHR; Ibrahim Abubakar and Laura C Rodrigues have also received funding from the Medical Research Council. Punam Mangtani received funding from the Biotechnology and Biological Sciences Research Council