Throughout the precolonial era, monumentality in the midcontinent was expressed through a variety of earthen constructions from circular mounds to animal effigies to geometric shapes to depictions of spiritual beings. Here, we describe an example of megalithic monumentality located at the Menominee Reservation in Wisconsin, USA. This archaeological feature uses a mix of the natural geology alongside anthropogenic efforts to depict the Menominee legend of a battle between the Thunderbird and Serpent. The encountering and documentation of this megalith were the result of ongoing collaborative efforts that brought together archaeological techniques with Menominee knowledge sets. We describe the megalith and draw on the only other known megalithic effigy from Wisconsin, a serpent effigy, located in ancestral Menominee territory and documented more than a century ago. Together, these two megalithic features illustrate currently unrecognized monumental construction efforts in the midcontinent and highlight the value and importance of collaborative approaches to documenting and preserving archaeological heritage.

Plasma levels of procollagen type 1 N-propeptide (P1NP) and C-terminal telopeptide of type 1 collagen (CTX) are bone turnover markers (BTM) used to predict risk of fracture. We compared the effects of vitamin D supplements on plasma levels of P1NP and CTX in the Biochemical Efficacy and Safety Trial of vitamin D (BEST-D) trial (305 participants) after treatment with 2000 IU/d or 4000 IU/d vitamin D3 or placebo. The results of BEST-D were combined in a meta-analysis of all trials of vitamin D v. placebo on levels of P1NP (12 trials, 2654 participants) or CTX (16 trials, 2695 participants). In BEST-D, allocation to vitamin D3 resulted in a dose-dependent increase in 25-hydroxy-vitamin D (25(OH)D) levels but had no effects on P1NP or CTX. Geometric mean (se) levels at 12 months were similar for P1NP (41·7 (0·7) v. 42·9 (1·0) ng/ml; P = 0·29: either dose v. placebo) and likewise for CTX (0·23 (0·01) v. 0·23 (0·01) ng/ml; P = 0·98). In a meta-analysis of eighteen trials, the average difference between the within-trial change in P1NP for allocated vitamin D and control was −3·3 % (95 % CI −5·6, −1·0, P < 0·005). For CTX, this difference was slightly greater (−3·8 % (−6·8, −0·8); P = 0·01). There was no significant heterogeneity between these trials after stratifying trials with or without Ca, higher or lower doses of vitamin D, or lower v. higher pre-treatment levels of 25(OH)D. Overall, vitamin D supplementation was associated with modest reductions in both P1NP and CTX, and results provide support for further trials of vitamin D for prevention of fracture in older people.

Variation between general practices in the rate of consultations for musculoskeletal pain conditions may signal important differences in access to primary care, perceived usefulness, or available alternative sources of care; however, it might also just reflect differences in underlying ‘need’ between practices’ registered populations. In a study of 30 general practices in Staffordshire, we calculated the proportion of adults consulting for a musculoskeletal pain condition, then examined this in relation to selected practice and population characteristics, including the estimated prevalence of self-reported musculoskeletal problems and chronic pain in each practices’ registered population. Between September 2021 and July 2022, 18,388 adults were consulted for a musculoskeletal pain condition. After controlling for length of recruitment, time of year, and age-sex structure, the proportion consulting varied up to two-fold between practices but was not strongly associated with the prevalence of self-reported long-term musculoskeletal problems, chronic pain, and high-impact chronic pain.

Previous observational studies suggested that vitamin D may control the absorption of iron (Fe) by inhibition of hepcidin, but the causal relevance of these associations is uncertain. Using placebo-controlled randomisation, we assessed the effects of supplementation with vitamin D on biochemical markers of Fe status and erythropoiesis in community-dwelling older people living in the UK. The BEST-D trial, designed to establish the optimum dose of vitamin D3 for future trials, had 305 participants, aged 65 years or older, randomly allocated to 4000 IU vitamin D3 (n 102), 2000 IU vitamin D3 (n 102) or matching placebo (n 101). We estimated the effect of vitamin D allocation on plasma levels of hepcidin, soluble transferrin receptor (sTfR), ferritin, Fe, transferrin, saturated transferrin (TSAT%) and the sTfR–ferritin index. Despite increases in 25-hydroxy-vitamin D, neither dose had significant effects on biochemical markers of Fe status or erythropoiesis. Geometric mean concentrations were similar in vitamin D3 arms v. placebo for hepcidin (20·7 [se 0·90] v. 20·5 [1·21] ng/ml), sTfR (0·69 [0·010] v. 0·70 [0·015] µg/ml), ferritin (97·1 [2·81] v. 97·8 [4·10] µg/l) and sTfR–ferritin ratio (0·36 [0·006] v. 0·36 [0·009]), respectively, while arithmetic mean levels were similar for Fe (16·7 [0·38] v. 17·3 [0·54] µmol/l), transferrin (2·56 [0·014] v. 2·60 [0·021] g/dl) and TSAT% (26·5 [0·60] v. 27·5 [0·85]). The proportions of participants with ferritin < 15 µg/l and TSAT < 16 % were unaltered by vitamin D3 suggesting that 12 months of daily supplementation with moderately high doses of vitamin D3 are unlikely to alter the Fe status of older adults.