Rapid Mix Preparation of Bioinspired Nanoscale Hydroxyapatite for Biomedical Applications

Hydroxyapatite (HA) has been widely used as a medical ceramic due to its good biocompatibility and osteoconductivity. Recently there has been interest regarding the use of bioinspired nanoscale hydroxyapatite (nHA). However, biological apatite is known to be calcium-deficient and carbonate-substituted with a nanoscale platelet-like morphology. Bioinspired nHA has the potential to stimulate optimal bone tissue regeneration due to its similarity to bone and tooth enamel mineral. Many of the methods currently used to fabricate nHA both in the laboratory and commercially, involve lengthy processes and complex equipment. Therefore, the aim of this study was to develop a rapid and reliable method to prepare high quality bioinspired nHA. The rapid mixing method developed was based upon an acid-base reaction involving calcium hydroxide and phosphoric acid. Briefly, a phosphoric acid solution was poured into a calcium hydroxide solution followed by stirring, washing and drying stages. Part of the batch was sintered at 1,000 °C for 2 h in order to investigate the products' high temperature stability. X-ray diffraction analysis showed the successful formation of HA, which showed thermal decomposition to β-tricalcium phosphate after high temperature processing, which is typical for calcium-deficient HA. Fourier transform infrared spectroscopy showed the presence of carbonate groups in the precipitated product. The nHA particles had a low aspect ratio with approximate dimensions of 50 x 30 nm, close to the dimensions of biological apatite. The material was also calcium deficient with a Ca:P molar ratio of 1.63, which like biological apatite is lower than the stoichiometric HA ratio of 1.67. This new method is therefore a reliable and far more convenient process for the manufacture of bioinspired nHA, overcoming the need for lengthy titrations and complex equipment. The resulting bioinspired HA product is suitable for use in a wide variety of medical and consumer health applications

Using participatory and creative methods to facilitate emancipatory research with people facing multiple disadvantage: a role for health and care professionals

Participatory and creative research methods are a powerful tool for enabling active engagement in the research process of marginalised people. It can be particularly hard for people living with multiple disadvantage, such as disabled people from ethnic minority backgrounds, to access research projects that are relevant to their lived experience. This article argues that creative and participatory methods facilitate the co-researchers’ engagement in the research process, which thus becomes more empowering. Exploring the congruence of these methods with their professional ethos, health and care professionals can use their skills to develop them further. Both theory and practice examples are presented

Evidence-based interventions in dementia: A pragmatic cluster-randomised trial of an educational intervention to promote earlier recognition and response to dementia in primary care (EVIDEM-ED)

Background: The National Dementia Strategy seeks to enhance general practitioners' diagnostic and management skills in dementia. Early diagnosis in dementia within primary care is important as this allows those with dementia and their family care networks to engage with support services and plan for the future. There is, however, evidence that dementia remains under-detected and sub-optimally managed in general practice. An earlier unblinded, cluster randomised controlled study tested the effectiveness of educational interventions in improving detection rates and management of dementia in primary care. In this original trial, a computer decision support system and practice-based educational workshops were effective in improving rates of detecting dementia although not in changing clinical management. The challenge therefore is to find methods of changing clinical management. Our aim in this new trial is to test a customised educational intervention developed for general practice, promoting both earlier diagnosis and concordance with management guidelines.Design/Method: The customised educational intervention combines practice-based workshops and electronic support material. Its effectiveness will be tested in an unblinded cluster randomised controlled trial with a pre-post intervention design, with two arms; normal care versus the educational intervention. Twenty primary care practices have been recruited with the aim of gaining 200 patient participants. We will examine whether the intervention is effective, pragmatic and feasible within the primary care setting. Our primary outcome measure is an increase in the proportion of patients with dementia who receive at least two dementia-specific management reviews per year. We will also examine important secondary outcomes such as practice concordance with management guidelines and benefits to patients and carers in terms of quality of life and carer strain.Discussion: The EVIDEM-ED trial builds on the earlier study but the intervention is different in that it is specifically customised to the educational needs of each practice. If this trial is successful it could have implications for the implementation of the National Dementia Strategy

Crime Victims’ Demographics Inconsistently Relate to Self-Reported Vulnerability

© 2016 The Australian and New Zealand Association of Psychiatry, Psychology and LawPrevious research has found a discrepancy between the number of individuals who self-report as being vulnerable and official prevalence estimations. Both this discrepancy and victims’ views about their vulnerability need addressing in order to identify further training needs for criminal justice system agencies and to that ensure victims receive the appropriate support. Using data from the Metropolitan Police Service (MPS) User Satisfaction Survey (USS) (n = 47,560), the present study explores 1) crime victims’ self-reported vulnerability and its association with demographics; 2) police identification of vulnerability; and 3) whether the needs of vulnerable victims are catered for. The results indicate that 38% of the sample self-identified as being vulnerable, a considerably higher percentage than estimated in previous literature. Although associations have been found between vulnerability and demographics, these have been negligible or have had weak effect sizes. The findings are discussed in relation to the current definition of a vulnerable victim, and the role of personal circumstances in self-identification are highlighted

Osteoblasts contribute to a protective niche that supports melanoma cell proliferation and survival

Melanoma is the deadliest form of skin cancer; a primary driver of this high level of morbidity is the propensity of melanoma cells to metastasize. When malignant tumours develop distant metastatic lesions the new local tissue niche is known to impact on the biology of the cancer cells. However, little is known about how different metastatic tissue sites impact on frontline targeted therapies. Intriguingly, melanoma bone lesions have significantly lower response to BRAF or MEK inhibitor therapies. Here, we have investigated how the cellular niche of the bone can support melanoma cells by stimulating growth and survival via paracrine signalling between osteoblasts and cancer cells. Melanoma cells can enhance the differentiation of osteoblasts leading to increased production of secreted ligands, including RANKL. Differentiated osteoblasts in turn can support melanoma cell proliferation and survival via the secretion of RANKL that elevates the levels of the transcription factor MITF, even in the presence of BRAF inhibitor. By blocking RANKL signalling, either via neutralizing antibodies, genetic alterations or the RANKL receptor inhibitor SPD304, the survival advantage provided by osteoblasts could be overcome

A Bayesian Secondary Analysis in an Asthma Study

A recent study published in the New England Journal of Medicine by the Asthma Clinical Research Network (ACRN) compared three different treatments for their effectiveness in treating adults with uncontrolled asthma. This paper will describe the study design and its results, then detail the beginnings of a secondary analysis using Bayesian methods to estimate the parameters of interest. The methods will be explained, and the preliminary estimates given and contextualized. The paper will conclude with a discussion of the next steps and the goals for further analysis of the data in this study

Decolonising occupational science education through learning activities based on a study from the Global South

If occupational science education is to become more globally relevant, it must highlight more voices and practices from diverse communities. Learning about occupational justice from the perspectives of Global South communities addresses cognitive injustice and the need to decolonise occupational science education. This paper offers some critical reflections concerning the author’s pedagogic approach, and the ways his research about olive growing in Palestine (Simaan, 2018) informed students’ learning about occupational justice. It focuses on the processes in which students and lecturers engaged within a decolonising approach to occupational science education. A learning activity based on pedagogical processes of ‘conscientization’ (Freire, 1996), critical reflexivity (Whiteford & Townsend, 2011) and intercultural translation (Santos, 2014) is discussed, and lessons learnt by lecturer and students about themselves, their communities, and occupational science are reflected upon. Selected students’ reflections, which illustrate how they positioned themselves in relation to the community studied, and how they interrogated their own reactions to learning about daily lives in Palestine, are discussed. These processes demonstrate the benefits of highlighting local knowledge on occupational justice produced by Global South groups, and how this knowledge might begin to address cognitive injustice and the need to decolonise occupational science pedagogy. More empirical and theoretical work is needed in occupational science education regarding intercultural translations concerning occupational justice, and means of doing and knowing from diverse Global South perspectives

Stopping, rationalising or optimising antipsychotic drug treatment in people with intellectual disability and/or autism

Intellectual disability (ID; also known as learning disability) is characterised by significant impairment of both cognitive functioning and adaptive behaviours, and an onset in early childhood. People with ID experience a different pattern of morbidity to the general population and die considerably younger than their counterparts without ID. Autism is a neurodevelopmental disorder characterised by troubles with social interaction and communication, and by restricted and repetitive behaviour. In both conditions, complex mental and physical health problems, as well as social issues, are common and are associated with communication difficulties that can result in maladaptive behavioural patterns (often referred to as ‘behaviour that challenges’). Ideally, all people presenting with behaviour that challenges should be assessed by a specialist multidisciplinary team (comprising psychiatrists, psychologists, speech and language therapists, occupational therapists) to develop an understanding of the behaviour and an appropriate support plan with tailored treatment strategies and specialist follow-up. Non-pharmacological interventions for challenging behaviour, such as positive behavioural support or cognitive–behavioural therapy and manipulation of environmental triggers, are preferred to psychotropic medication. However, antipsychotic medication is often prescribed to adults with ID and/or autism to manage behaviour that challenges in the absence of severe mental illness, despite there being little research evidence that antipsychotics are effective in this context