Altrenogest is commonly utilised for hormonal support of pregnancy, with undefined effects. We investigated effects of altrenogest supplementation on endogenous progesterone (P4) production in embryo recipient mares (RM). RM were managed onsite and selected on the basis of ‘best tone' on transfer day. Thirty RM received a 150mg depot altrenogest intramuscularly from transfer, at 7-day intervals, through to 42 days (ALT), a further 31 RM received no altrenogest (CON). Blood was collected at 7-day intervals, starting 7 days after transfer and P4 assayed by amplified enzyme-linked immunoassay. Data were analysed by total (tP4, ng/ml) and P4 corrected by number of corpora lutea (CL; cP4). Statistical comparisons of non-parametric data were performed by Kruskal-Wallis ANOVA and Friedman repeated measures; values presented as median and 95% confidence interval. Odds ratios (OR) were calculated to evaluate associations between ALT and secondary ovulation, and tP4 values of <3ng/ml. In ALT, tP4 was lower on days 21, 28 and 35 when compared to days 14 and 42 (p<0.01), and no difference was seen between days 14 and 42 (p=0.715). The same pattern was seen with cP4 lower on days 21, 28 and 35 compared to days 14 and 42 (p<0.01), and no difference between days 14 and 42 (p=0.273). A similar profile was seen in CON, with tP4 loweron days 21, 28 and 35 compared to days 14 and 42 (p<0.01) and no difference between days 14 and 42 (p=0.095). However, compared to day 14, cP4 was lower on days 21, 28, 35 (p<0.01), and also on day 42 (p=0.026). When compared to days 21, 28 and 35 there were no differences with day 42 (p>0.10). Secondary CL occurred in 17.24% CON and in 26.67% ALT (OR 1.55; 0.45-5.28, p=0.487). Total P4 was lower in ALT 4.8 (3.9-6.3), compared with CON 6.0 (5.4-7.3, p=0.04), and in ALT 4.7 (3.9-5.3), compared with CON 5.7 (5.1-7.4, p=0.02) at 21 and 28 days respectively. This held true for cP4 at 21 (ALT 3.7; 2.8-4.3 versus CON 4.7; 3.7-6.6, p=0.03) and 28 days (ALT 3.4; 2.5-4.3 versus CON 5.0; 4.0-5.8, p=0.005) where effect of multiple ovulations was nullified. In 40% of ALT, tP4 was <3.0 at ≥1 time-point compared to 3.2% in CON. The odds of a mare having a tP4 concentration <3.0 at any time-point was greater for ALT (OR 11.2; 1.37-91.83, p=0.024). Three ALT (10%) and no CON had tP4 ≤3.0 at 42 days (p=0.212). In conclusion, altrenogest led to suppressed endogenous P4 production with the greatest magnitude at 28 days of gestation; we hypothesize that this is mediated via negative feedback of altrenogest on pituitary LH release and effective reduction of its luteotrophic influence.

The Council for Exceptional Children studied the profession of special education and found that a substantial number of special educators rated their confidence as lower in culturally responsive instruction strategies (Fowler, et al., 2019). The recommendations in this article highlight how to confront the intersection of racism and ableism and eradicate deficit ideology in educational structures. Leading with an equity lens requires a conceptual framework and diversifying the workforce, adopting a theoretical framework, engaging with diverse students and families, developing skills through systemic professional development, and using practices such as culturally and linguistically sustaining practices, and anti-racist Universal Design for Learning (UDL).

AbstractThe lockdown measures put in place in March 2020 in England to counter the spread of the coronavirus have had significant implications for the lives and well‐being of young carers and young adult carers. In such unprecedented times, little was known about the potential impact on this group and their specific experience of the Covid‐19 lockdown restrictions. A rapid review was conducted, 28 young carers responded to a survey and an additional 20 participants were interviewed in January 2021; the survey was repeated with a further 149 responses. Findings show that the level of care that young carers are required to provide had increased as external agency support for their families had been withdrawn while their own coping strategies had been challenged, in particular through school closures. These restrictions had a significant impact on every aspect of their lives, from their ability to meet their own mental health needs to managing the requirements of home schooling. The needs of young carers should be acknowledged within the political agenda, especially at times of crisis. It is crucial that health and social care services increase their capacity to identify and support young carers and that work is done within educational settings to provide a flexible response to individual needs.

Purpose: National guidance documents support the development of first contact practitioner (FCP) physiotherapist services for the management of musculoskeletal (MSK) conditions in primary care. During the development of an FCP pilot, it became clear that GPs had a range of hopes and concerns about this service development.

How do you feel when you leave work? Have you celebrated all your individual and collective achievements during the day, or do you leave thinking of those jobs left undone, those patients you could not find quite enough time for, the colleagues you brushed aside? We all have an innate negativity bias which means that we attend to and remember the negative parts of our days more than the positive. This evolutionary mechanism makes us strive to do better, but out of fear of the possible consequences of poor performance rather than the magnetic draw towards excellence. A …

This column has already highlighted the pitfalls of striving for perfection. The medic is often encouraged to achieve beyond other mortals. Long hours, physical and mental pressure are a routine part of the job. Although striving for better is an admiral quality in medicine, I would encourage you to disregard such high standards outside of work. Doing something different from your day-to-day job can bring many benefits.1 Hobbies and time outside are …

It seems very timely to review this book, not long after the death of development worker, academic and former Community Development Journal board member, David Marsden (Craig and Mayo, 2021). A well-thumbed copy of Measuring the Process (Marsden et al., 1994), written by Marsden—along with Peter Oakley (who was also an active journal board member) and Brian Pratt—sits on my desk. I have therefore drawn on some of their work to help frame this review. The impact of community work: how to gather evidence follows in the Marsden, Oakley and Pratt publication tradition. It begins with a contextual discussion of key concepts in community work and moves into what is primarily a practical handbook. The book is split into three parts. The first has a focus on understanding impact power and values; Part II takes us through a series of methods for evidence gathering, along with...

> He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all. – William Osler We were reflecting recently what a privilege it is to have heard so many narratives over the years. The trust families build with us as they share their often very personal and poignant thoughts and feelings. We as humans connect through these reflections and stories. We like to make sense from them. Each family becomes like …