The experimental degradation of archaeological human bone by anaerobic bacteria and the implications for recovery of ancient DNA

DNA recovery from human bone has been key to the developing science and technology of ancient DNA studies. The recovery of macromolecules from bone however, does not correlate well with recognisable parameters of preservation and predicting DNA recovery rates from ancient bone can be very difficult. The extent of degradation of buried bones often depends on environmental taphonomy and can vary from virtually none to complete and rapid destruction. Although soil or related microbes are undoubtedly responsible for the majority of this structural degradation over time, exceptionally little is known of the mechanisms or specific bacteria involved. Fungi were previously thought to be responsible for destructive processes (tunnelling) within bone but over the last 30 years the role of bacteria has been increasingly recognised. Our aim was to develop a less complex in vitro model of the destructive effects of microbes on bone which might allow a better understanding of the recovery of mitochondrial or pathogen DNA over time

David Martin (1737-1797) : a catalogue raisonné of his portraits in oils

This catalogue raisonne of David Martin's portraits in oils documents over three hundred works. The catalogue is preceded by five chapters that establish an accurate and factual biography of the artist and discuss his artistic development in the middle and late eighteenth century. The thesis reveals Martin as an artist of national merit and illustrates his place in the development of British portraiture

A weird but interesting journey: Personal traumatic growth for individuals with hallucinations

Objectives: Hallucinations can be traumatic. However, research into 'post-traumatic growth' in relation to hallucinations is scarce. This study aims to further our understanding of personal growth in the context of hallucinations. Design: A phenomenological qualitative approach was used to explore experiences of personal growth with hallucinations, adopting Interpretative Phenomenological Analysis (IPA) methodology. Methods: Semi-structured interviews were conducted with seven people who experience hallucinations. Participants were asked about experiences of personal growth, their expectations of individual transformation, and facilitating and hindering factors in the attainment of personal growth. Transcripts were analysed ensuring suitable saturation and representation of the data was achieved. Results: One overall theme (A journey towards personal growth) and five subthemes were identified: A difficult journey taken day by day, Stigma, Acceptance, Finding the right support, and Personal growth. Conclusions: Findings supported personal growth in the context of hallucinations and highlighted facilitators and barriers. Practitioner points • There is scarce literature supporting the development of personal growth with hallucinatory experiences and it is empirically limited. The present research provides greater information into the phenomenon to inform service provision. • The importance of acceptance and maintaining hope for change was highlighted. • Services and the use of coping strategies were both identified as facilitative and hindering of personal growth. • This research provides a necessary alternative to the often negative literature; challenging societal perceptions and helping promote much needed hope in clinicians, the public and individuals experiencing hallucinations

Challenges of safeguarding via remote consulting during the COVID-19 pandemic:a qualitative interview study

BACKGROUND: The COVID-19 pandemic required general practice to rapidly adapt to remote consultations and assessment of patients, creating new, and exacerbating existing, vulnerabilities for many patients. AIM: To explore GP perspectives and concerns about safeguarding practice during the pandemic, focusing on challenges and opportunities created by remote consultation. DESIGN AND SETTING: Qualitative interview study. METHOD: Eighteen GPs from Oxford, London, Southampton, Liverpool, Manchester, and Reading were interviewed between June and November 2020, using a flexible topic guide and fictional vignettes to explore child and adult safeguarding scenarios. Interviews were audio-recorded, thematically coded, and analysed. RESULTS: GPs worried about missing observational information during remote consultations and that conversations might not be private or safe. Loss of continuity and pooled triage lists were seen as further weakening safeguarding opportunities. GPs experienced remote consulting as more ‘transactional’, with reduced opportunities to explore ‘other reasons’ including new safeguarding needs. However, they also recognised that remote consulting created opportunities for some vulnerable patients. While supporting known vulnerable patients was difficult, identifying new or unknown vulnerabilities was harder still. Most reported that remote consulting during COVID-19 was harder, riskier, and emotionally draining, contributing to increased GP anxiety and reduced job satisfaction. CONCLUSION: The GPs interviewed raised important concerns about how to identify and manage safeguarding in the context of remote consultations. Current guidance recommends face-to-face consultation for safeguarding concerns, but pressure to use remote forms of access (within or beyond the pandemic) and the fact that safeguarding needs may be unknown makes this an issue that warrants urgent attention

Evaluating pharmacist input into the pharmaceutical care of patients in dispensing medical practices in remote and rural areas of Scotland.

Background. - The Highlands and the Western Isles are the two most remote and rural areas of Scotland, with many medical practices in areas where pharmacies would not be viable. Recent regulations state that that dispensing medical practices in these areas must receive pharmacist support for patients who would benefit. Objective. - This study aimed to evaluate pilot services, which centred on the provision of patient centred pharmaceutical care. Methods. A realist type evaluation was conducted by an independent research team comprising collecting quantitative data around what occurred during the consultation followed by interviews with purposive samples of staff (n = 14) and patients (n = 18). Results. - A total of 873 medicines related issues were identified in 473 patients reviewed, with the main issue being 'inappropriate dose, frequency, duration'. Just under half (39.7%) of issues were managed by the pharmacist without any medical input. Interviews indicated a high level of appreciation, although there was an increase in workload for some staff. While the need for telephone based pharmacist consultations for some patients was understood, there was a preference for face to face. All were supportive of continuing and extending the service. Conclusion. - The clinical pharmacist service was both needed and valued highly by staff and patients. In Scotland, this aligns with the Government vision and action plan, 'Prescription for Excellence', that by 2023 all patient facing pharmacists will be independent prescribers with those in remote and rural areas entitled to 'equity of access to such expertise'

Clinical status, biochemical profile and management of a single cohort of patients with arginase deficiency.

Arginase deficiency is a rare autosomal recessive urea cycle disorder (UCD) caused by mutations in the ARG1 gene encoding arginase that catalyses the hydrolysis of arginine to ornithine and urea. Patients have hyperargininaemia and progressive neurological impairment but generally suffer fewer metabolic decompensations compared to other UCDs. The objective is to describe the clinical features, biochemical profile, neuroradiological findings and experience of managing children with arginase deficiency. Twenty-year retrospective review of patient medical records at a single metabolic centre was performed. Six patients from three unrelated families were identified. Mean age at first symptom was 3.3 (1.5-9.0) years, while mean age at diagnosis was 8.8 (0.16-15.92) years. Four patients developed spastic diplegia and two of six with spastic quadriplegia with classical features including hyperreflexia, clonus and toe walking. This resulted in gait abnormalities that have been monitored using the GAITRite system and required Achilles tendon release in five children. Generalised tonic-clonic seizures and/or absences were present in three of six children and were controlled with anticonvulsants. All patients had moderate learning difficulties. Neuroimaging showed cerebral/cerebellar atrophy in four patients and basal ganglia abnormalities in two. Arginine levels were universally elevated throughout follow-up despite protein restriction, essential amino acid supplementation and ammonia scavengers, and neurological outcome was generally poor. Two patients died following severe metabolic decompensation in adolescence. Children with arginase deficiency continue to present a management challenge of what appears to be an inexorable course of neurocognitive impairment. Further insight into disease mechanisms may provide insight into novel treatment strategies