How can we best chart children’s growth in the paperless age? The UK experience

Growth charts have played an integral part in the monitoring and assessment of children’s health for the past 50 years, but their use is now under threat as paperless electronic systems become more widely used. While the obvious solution is to adopt electronic charting systems, this can prove challenging in practice. This article describes the key issues to consider in planning this transition and the charting options available, ranging from bespoke local systems to commercial packages and a new initiative by the Royal College of Paediatrics and Child Health

Sex-dependent influence of endogenous estrogen in pulmonary hypertension

Rationale: The incidence of pulmonary arterial hypertension (PAH) is greater in women suggesting estrogens may play a role in the disease pathogenesis. Experimentally, in males exogenously administered estrogen can protect against PH; however in models that display female susceptibility estrogens may play a causative role. Objectives: To clarify the influence of endogenous estrogen and gender in PH and assess the therapeutic potential of a clinically available aromatase inhibitor. Methods: We interrogated the effect of reduced endogenous estrogen in males and females using the aromatase inhibitor, anastrozole, in two models of PH; the hypoxic mouse and Sugen 5416/hypoxic rat. We also determined the effects of gender on pulmonary expression of aromatase in these models and in lungs from PAH patients. Results: Anastrozole attenuated PH in both models studied, but only in females. To verify this effect was due to reduced estrogenic activity we confirmed that in hypoxic mice inhibition of estrogen receptor alpha also has a therapeutic effect specifically in females. Female rodent lung displays increased aromatase and decreased BMPR2 and Id1 expression compared to male. Anastrozole treatment reversed the impaired BMPR2 pathway in females. Increased aromatase expression was also detected in female human pulmonary artery smooth muscle cells compared to male. Conclusions: The unique phenotype of female pulmonary arteries facilitates the therapeutic effects of anastrozole in experimental PH confirming a role for endogenous estrogen in the disease pathogenesis in females and suggests aromatase inhibitors may have therapeutic potential

Pharmacist-led management of chronic pain in primary care:results from a randomised controlled exploratory trial

To compare the effectiveness of pharmacist medication review, with or without pharmacist prescribing, with standard care, for patients with chronic pain

Facial Trustworthiness is Associated with Heritable Aspects of Face Shape

Facial trustworthiness is thought to underlie social judgements in face perception, though it is unclear whether trustworthiness judgements are based on stable facial attributes. If this were the case, we could expect a genetic component of facial trustworthiness. From facial photographs of a large sample of identical and nonidentical twins and siblings (1320 individuals), we tested for genetic variation in facial trustworthiness and genetic covariation with several stable facial attributes, including facial attractiveness, two measures of masculinity, and facial width-to-height ratio. We found a significant genetic component of facial trustworthiness in men (but not women), and significant genetic correlations with the stable morphological facial traits of attractiveness (positive), perceived masculinity (negative), and facial width-to-height ratio (negative). However, there was no significant genetic or shared environmental correlation between facial trustworthiness and an objective masculinity score based on facial landmark coordinates, despite there being a significant phenotypic correlation. Our results suggest that heritable facial traits influence trustworthiness judgements

Assessing the accuracy of perceptions of intelligence based on heritable facial features

Perceptions of intelligence based on facial features can have a profound impact on many social situations, but findings have been mixed as to whether these judgements are accurate. Even if such perceptions were accurate, the underlying mechanism is unclear. Several possibilities have been proposed, including evolutionary explanations where certain morphological facial features are associated with fitness-related traits (including cognitive development), or that intelligence judgements are over-generalisation of cues of transitory states that can influence cognition (e.g., tiredness). Here, we attempt to identify the morphological signals that individuals use to make intelligence judgements from facial photographs. In a genetically informative sample of 1660 twins and their siblings, we measured IQ and also perceptions of intelligence based on facial photographs. We found that intelligence judgements were associated with both stable morphological facial traits (face height, interpupillary distance, and nose size) and more transitory facial cues (eyelid openness, and mouth curvature). There was a significant association between perceived intelligence and measured IQ, but of the specific facial attributes only interpupillary distance (i.e., wide-set eyes) significantly mediated this relationship. We also found evidence that perceived intelligence and measured IQ share a familial component, though we could not distinguish between genetic and shared environmental sources

Facial averageness and genetic quality: testing heritability, genetic correlation with attractiveness, and the paternal age effect

Popular theory suggests that facial averageness is preferred in a partner for genetic benefits to offspring. However, whether facial averageness is associated with genetic quality is yet to be established. Here, we computed an objective measure of facial averageness for a large sample (N=. 1,823) of identical and nonidentical twins and their siblings to test two predictions from the theory that facial averageness reflects genetic quality. First, we use biometrical modelling to estimate the heritability of facial averageness, which is necessary if it reflects genetic quality. We also test for a genetic association between facial averageness and facial attractiveness. Second, we assess whether paternal age at conception (a proxy of mutation load) is associated with facial averageness and facial attractiveness. Our findings are mixed with respect to our hypotheses. While we found that facial averageness does have a genetic component, and a significant phenotypic correlation exists between facial averageness and attractiveness, we did not find a genetic correlation between facial averageness and attractiveness (therefore, we cannot say that the genes that affect facial averageness also affect facial attractiveness) and paternal age at conception was not negatively associated with facial averageness. These findings support some of the previously untested assumptions of the 'genetic benefits' account of facial averageness, but cast doubt on others

How can we best chart children’s growth in the paperless age? The UK experience

Growth charts have played an integral part in the monitoring and assessment of children’s health for the past 50 years, but their use is now under threat as paperless electronic systems become more widely used. While the obvious solution is to adopt electronic charting systems, this can prove challenging in practice. This article describes the key issues to consider in planning this transition and the charting options available, ranging from bespoke local systems to commercial packages and a new initiative by the Royal College of Paediatrics and Child Health

Longitudinal qualitative evaluation of pharmacist integration into the urgent care setting

Purpose: To describe the most effective model for managing, educating, and training pharmacist advanced clinical practitioners (ACPs) in the urgent care center (UCC) setting, role evolution and how to measure their effectiveness. Participants and methods: Ethical approval was obtained to perform a qualitative longitudinal cohort study in three sites, with three pharmacists in each trained as ACPs from 2016 to 2017. ACP role, location, management, mentorship, and supervision were locally determined. ACPs attended focus groups (FGs) at 1 and 3 months (sites 1–3), 6 and 12 months (site 1 only), and the UCC staff were interviewed once with a topic guide regarding training, integration, role, and impact. Verbatim transcriptions were analyzed thematically. Results: Eight ACP FGs and 24 stakeholder interviews produced major themes of communication, management, education and training, role, and outcomes. Effective education, training, and integration required communication of role to address concerns regarding salary differentials, supportive management structure, and multi-professional learning. ACPs reported that the model of workplace training, experiential learning, and university-based education was appropriate. Training was better located in the minor injuries and general practitioner areas. Recommended measures of effectiveness included patient satisfaction and workload transfer. Conclusion: The education and training model was appropriate. Communication and management require careful consideration to ensure effective integration and role development. Pharmacists were better located initially in the minor illness rather than major trauma areas. Quality of patient experience resulting from the new role was important in addition to reassurance that the role represented a positive contribution to workload

No relationship between intelligence and facial attractiveness in a large, genetically informative sample

Theories in both evolutionary and social psychology suggest that a positive correlation should exist between facial attractiveness and general intelligence, and several empirical observations appear to corroborate this expectation. Using highly reliable measures of facial attractiveness and IQ in a large sample of identical and fraternal twins and their siblings, we found no evidence for a phenotypic correlation between these traits. Likewise, neither the genetic nor the environmental latent factor correlations were statistically significant. We supplemented our analyses of new data with a simple meta-analysis that found evidence of publication bias among past studies of the relationship between facial attractiveness and intelligence. In view of these results, we suggest that previously published reports may have overestimated the strength of the relationship and that the theoretical bases for the predicted attractiveness–intelligence correlation may need to be reconsidered