When did modern humans leave Africa?

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Conducting and reporting trials for older people

Randomised controlled trials provide the most rigorous test of efficacy and effectiveness for interventions used in healthcare. They underpin much of clinical practice, yet older people are often excluded from studies, resulting in uncertainty about risks and benefits of new treatments. Encouraging inclusion of older people in randomised controlled trials and reporting of trial results in a rigorous manner is a key function of clinical geriatrics journals such as Age and Ageing. This article provides practical advice on how to report randomised controlled trials that are targeted at older people. Some of these issues are generic, but there are specific requirements which apply to most studies of older people. Recording and reporting basic characteristics of recruits in terms of physical function, cognition, comorbidity and/or frailty is vital to allow proper interpretation of the external validity of the trial. Adverse effects should include consideration of common geriatric problems including falls. Authors should follow the CONSORT reporting guidelines (CONsolidated Standards Of Reporting Trials) to enhance the transparency and quality of their manuscript

Targeting, monitoring and effect of oral iron therapy on haemoglobin levels in older patients discharged to primary care from inpatient rehabilitation:a cohort study using routinely collected data

Background: Oral iron is commonly prescribed to older patients with suspected or confirmed iron deficiency anaemia, however few studies have examined the effectiveness of oral iron therapy in the real world in this population. We therefore determined the prevalence of iron deficiency in older people prescribed oral iron, examined the response mounted to therapy and ascertained predictors of response to oral iron.Methods: We analysed a routinely collected, linked dataset from older patients who had undergone inpatient rehabilitation between 1999 and 2011. An initial analysis examined patients within this cohort who were prescribed iron after rehabilitation and derived three groups based upon their ferritin and transferrin indices; probably, possibly and not iron deficient. A second analysis compared pre- and post-treatment haemoglobin to determine the degree of response to iron therapy across each category of deficiency. Finally, patient demographics, linked biochemistry data and comorbid disease based on International Statistical Classification of Disease (ICD-10) codes from previous hospital admissions were used in regression modelling to evaluate factors affecting response to therapy.Results: 490 patients were prescribed oral iron within 90 days of rehabilitation discharge. 413/490 (84%) had iron indices performed; 94 (23%) were possibly deficient, 224 (54%) were probably deficient, and 95 (23%) were not deficient. 360/490 patients had both pre and post treatment haemoglobin data and iron indices; probably deficient patients mounted a slightly greater response to oral iron (17g/L vs 12g/L for not deficient; p&lt;0.05). Only pre-treatment haemoglobin, mean cell volume (MCV) and lower gastrointestinal pathology were significant predictors of a response to oral iron therapy. Notably, acid-suppressant use was not a predictor of response.Conclusion: We conclude that many older patients are exposed to oral iron without good evidence of either iron deficiency or a significant response to therapy.<br/

The aged care workforce in Australia

Discussion Pape

Knapping tools in Magdalenian contexts: New evidence from Gough’s Cave (Somerset, UK)

Our knowledge of the recolonization of north-west Europe at the end of the Last Glacial Maximum depends to a large extent on finds from Gough's Cave (Somerset, UK). Ultra-high resolution radiocarbon determinations suggest that the cave was occupied seasonally by Magdalenian hunters for perhaps no more than two or three human generations, centred on 12,600 BP (~14,950-14,750 cal BP). They left behind a rich and diverse assemblage of Magdalenian lithic and osseous artefacts, butchered animal bones, and cannibalised human remains. The faunal assemblage from Gough's Cave is one of the most comprehensively studied from any Magdalenian site, yet new and unexpected discoveries continue to be made. Here, we record previously unrecognized flint-knapping tools that were identified during a survey of the Gough's Cave faunal collection at the Natural History Museum (London). We identified bones used as hammers and teeth manipulated as pressure-flakers to manufacture flint tools. Most of the pieces appear to be ad hoc (single-use?) tools, but a horse molar was almost certainly a curated object that was used over an extended period to work many stone tools. This paper explores how these knapping tools were used to support a more nuanced understanding of Magdalenian stone-tool manufacturing processes. Moreover, we provide a standard for identifying minimally-used knapping tools that will help to establish whether retouchers and other organic stone-working tools are as rare in the Magdalenian archaeological record as current studies suggest

Selecting Potential Pharmacological Interventions in Sarcopenia

Sarcopenia of age is prevalent and costly and proven pharmacological interventions are currently lacking. The pathophysiology of sarcopenia is incompletely understood but appears to involve multiple pathways, including inflammation, hormonal dysregulation, impaired regeneration, mitochondrial dysfunction and denervation. There are several ways in which we might select potential pharmacological interventions for testing in clinical trials. These include a 'bottom-up' approach using basic science to elucidate the molecular processes involved and identify potential targets from this knowledge-a strategy that has led to the development of myostatin inhibitors. A 'top-down' approach might use observational data to examine the association between physical function and use of certain medications, such as the association between angiotensin-converting enzyme inhibitors with slower decline in physical function. Once a pharmacological intervention has been proposed, efficacy must be demonstrated in this complex multi-morbid population. Both muscle mass and muscle function need to be measured as outcomes, but these outcomes require large sample sizes and sufficient follow-up to detect change. Biomarkers that can predict the response of sarcopenia to intervention after a short time would greatly assist our ability to select candidate interventions in short proof-of-concept trials. Further development of trial methods is required to accelerate progress in this important area of medicine for older people.</p

Hydrogen adsorption and cohesive energy of single-walled carbon nanotubes

Hydrogen adsorption on crystalline ropes of carbon single-walled nanotubes (SWNT) was found to exceed 8 wt.%, which is the highest capacity of any carbon material. Hydrogen is first adsorbed on the outer surfaces of the crystalline ropes. At pressures higher than about 40 bar at 80 K, however, a phase transition occurs where there is a separation of the individual SWNTs, and hydrogen is physisorbed on their exposed surfaces. The pressure of this phase transition provides a tube-tube cohesive energy for much of the material of 5 meV/C atom. This small cohesive energy is affected strongly by the quality of crystalline order in the ropes