The rupture of atherosclerotic plaques is the prerequisite for adverse cardiovascular events. Calcification morphology plays a critical role in plaque stability, therefore accurate calcification classification is essential for favourable patient management. Blood biomarkers may be a worthwhile approach to stratify patients based on calcification phenotype. Vitamin K-dependent Matrix γ-carboxyglutamate (Gla) protein (MGP) is a potent inhibitor of vascular calcification. Recent studies have demonstrated the potential utility of circulating non-functional MGP (dp-ucMGP) measurements to determine arterial stiffness and calcification levels. The objective of this study was to examine the relationship between circulating dp-ucMGP and calcification phenotype within symptomatic atherosclerotic lesions. Consenting patients undergoing standard endarterectomy procedures were recruited (n = 29). Fasting venous blood was collected preoperatively. Circulating plasma levels of dp-ucMGP were quantified using the inaKtif MGP (dp-ucMGP) iSYS kit. A bicinchoninic acid assay was used to standardise the total protein content present in each sample. High-resolution micro-CT imaging was conducted on the excised atherosclerotic specimens postoperatively. ImageJ post-processing was used to accurately quantify the calcification volume (≥ 130 Hounsfield Units) and determine the total number of calcified particles (3D objects counter plugin). Thirteen carotid (average age 71 years, 9 male) and fourteen peripheral lower limb (average age 65 years, 12 male) patients were examined. One patient had a carotid and a peripheral lower limb plaque (age 79, male). Peripheral lower limb specimens have larger volumes of calcification and higher numbers of calcified particles than carotid samples (472 ± 310 vs 85 ± 113mm3, p < 0.0005; 13919 ± 16034 vs 3476 ± 6208, p = 0.061.) While a higher dp-ucMGP value was noted in carotid than peripheral lower limb patients (214 ± 52 vs 169 ± 36pmol/L, p = 0.014) there was no correlation between circulating dp-ucMGP and calcification volume or number of calcified particles (rs = -0.329 and rs = 0.046). Previous research also found that peripheral lower limb lesions contain higher volumes of calcification than carotid lesions. There is currently no published data on calcified particle comparisons. Patients with symptomatic carotid disease are assumed to have a degree of peripheral arterial disease, this could explain the higher levels of circulating dp-ucMGP in carotid patients. The current study did not examine the dietary patterns of individuals with regards to Vitamin K intake or analyse other areas of the vasculature for additional calcification. This may interfere with dp-ucMGP measurements. This study serves as a preliminary investigation into the potential of dp-ucMGP as a blood based biomarker to distinguish between symptomatic atherosclerotic calcification phenotypes.

Fe is an essential nutrient for many bacteria, and Fe supplementation has been reported to affect the composition of the gut microbiota in both Fe-deficient and Fe-replete individuals outside pregnancy. This study examined whether the dose of Fe in pregnancy multivitamin supplements affects the overall composition of the gut microbiota in overweight and obese pregnant women in early pregnancy. Women participating in the SPRING study with a faecal sample obtained at 16 weeks’ gestation were included in this substudy. For each subject, the brand of multivitamin used was recorded. Faecal microbiome composition was assessed by 16S rRNA sequencing and analysed with the QIIME software suite. Dietary intake of Fe was assessed using a FFQ at 16 weeks’ gestation. Women were grouped as receiving low (<60 mg/d, n 94) or high (≥60 mg/d; n 65) Fe supplementation. The median supplementary Fe intake in the low group was 10 (interquartile range (IQR) 5–10) v. 60 (IQR 60–60) mg/d in the high group (P<0·001). Dietary Fe intake did not differ between the groups (10·0 (IQR 7·4–13·3) v. 9·8 (IQR 8·2–13·2) mg/d). Fe supplementation did not significantly affect the composition of the faecal microbiome at any taxonomic level. Network analysis showed that the gut microbiota in the low Fe supplementation group had a higher predominance of SCFA producers. Pregnancy multivitamin Fe content has a minor effect on the overall composition of the gut microbiota of overweight and obese pregnant women at 16 weeks’ gestation.

Anti-N-methyl-d-aspartate (NMDA) receptor encephalitis is a form of encephalitis occurring primarily in women and associated with antibodies against NR1 or NR2 subunits of the NMDA receptor. As a potentially treatable differential for symptoms and signs seen in neurology and psychiatric clinics, clinicians practising across the lifespan should be aware of this form of encephalitis. Common clinical features include auditory and visual hallucinations, delusions, behavioural change (frequently with agitation), impaired consciousness, motor disturbance (ranging from dyskinesia to catatonia), seizures, and autonomic dysfunction. We present a review of the literature on the disorder, including its clinical presentation, differential diagnosis, epidemiology, treatment and prognosis.

Coming out to their children is a dilemma that concerns many gay, bisexual, and lesbian parents with children from previous heterosexual relationships. How children found out about having a father who identified himself as gay, and their feelings about their father's sexual identity, were explored through qualitative analysis of semi-structured interviews with 36 sons and daughters (aged 19 to 36 years) whose gay fathers participated in the Gay & Bisexual Parenting Survey (Barrett and Tasker, 2001). Interpretative Phenomenological Analysis revealed that awareness of their father's sexual identity was often left unspoken for various reasons, and that acceptance came about through gradual understanding as well as direct discussion. Interview data indicated the complexity of the relationship between the young adult's personal acceptance of their father's gay identity and their consideration of social context when deciding how open to be to others about their father's sexual identity. This research has varied implications for therapeutic work with gay and bisexual fathers coming out to their children from previous heterosexual relationships.

A total of 1,018 signs in one deaf child's naturalistic interaction with her deaf mother, between the ages of 19 and 24 months were analyzed. This study summarizes regular modification processes in the phonology of the child sign's handshape, location, movement, and prosody. First, changes to signs were explained by the notion of phonological markedness. Second, the child managed her production of first signs through two universal processes: structural change and substitution. Constraints unique to the visual modality also caused sign language-specific acquisition patterns, namely, more errors for handshape articulation in locations in peripheral vision, a high frequency of whole sign repetitions and feature group rather than one-to-one phoneme substitutions as in spoken language development.

There is a policy drive in the UK National Health Services (NHS) towards public involvement in service, education and research, with a number of national initiatives such as INVOLVE that have championed effective user input on research and development (R&D). The requisites of research governance include a balance of professional and public input, and the structures for this now exist at primary care level. There is a need for examples of how such policies can be implemented in Primary Care Trusts, and this article aims to show in detail the way in which a systematic approach to user involvement in R&D has been implemented. The PPIRes (Public and Patient Involvement in Research) project, whose progress over two years from 2003 to 2005 is reported, has been funded by NHS R&D monies allocated through a research consortium in Norfolk, and has been hosted in an NHS – academic partnership between Norwich Primary Care Trust and the Institute of Health at the University of East Anglia. The profile of volunteers, recommendations for good practice in public involvement, and the ‘facilitators and challenges’ to the programme are described.