Prudent healthcare in practice: integration of audiology services into primary care.

BACKGROUND: Swansea Bay University Health Board (SB UHB) has been trialling a primary care audiology pathway since 2016. The pathway enables patients with hearing, tinnitus or wax problems to be triaged directly to the audiology department acting as the first point of contact, freeing up general practitioners, Ear, Nose and Throat consultants and nurses to see patients with more complex health conditions. PURPOSE: To evaluate the efficiency of the SB UHB primary care audiology pathway. PARTICULAR FOCUS: Clinical outcomes of patients seen through the SB UHB primary care audiology pathway. OVERVIEW: The vast majority of patients seen through the SB UHB primary care audiology pathway are managed without the need for onward referral (≥87%).

Acetylcholine Inhibits Monomeric C-Reactive Protein Induced Inflammation, Endothelial Cell Adhesion, and Platelet Aggregation; A Potential Therapeutic?

Objectives: In this study, we examined the possibility of using targeted antibodies and the potential of small molecular therapeutics (acetylcholine, nicotine and tacrine) to block the pro-inflammatory and adhesion-related properties of monomeric C-reactive protein (mCRP). Methods: We used three established models (platelet aggregation assay, endothelial leucocyte binding assay and monocyte inflammation via ELISA and Western blotting) to assess the potential of these therapeutics. Results: The results of this study showed that monocyte induced inflammation (raised tumor necrosis factor-alpha-TNF-α) induced by mCRP was significantly blocked in the presence of acetylcholine and nicotine, whilst tacrine and targeted antibodies (clones 8C10 and 3H12) had less of or no significant effects. Western blotting confirmed the ability of acetylcholine to inhibit mCRP-induced cell signaling phosphorylation of extracellular signal regulated kinase 1/2 (ERK1/2), p38 and nuclear factor-kappa B (NF-κB). There was no evidence of direct binding between small molecules and mCRP. mCRP also induced endothelial cell-monocyte adhesion in a dose dependent fashion, however, both acetylcholine and nicotine as well as targeting antibodies notably inhibited adhesion. Finally, we investigated their effects on mCRP-induced platelet aggregation. All three small molecules significantly attenuated platelet aggregation as did the antibody 8C10, although 3H12 had a weaker effect. Discussion: Acetylcholine and to a lesser extent nicotine show potential for therapeutic inhibition of mCRP-induced inflammation and cell and platelet adhesion. These results highlight the potential of targeted antibodies and small molecule therapeutics to inhibit the binding of mCRP by prevention of membrane interaction and subsequent activation of cellular cascade systems, which produce the pro-inflammatory effects associated with mCRP.

c-Myc deregulation induces mRNA capping enzyme dependency.

c-Myc is a potent driver of many human cancers. Since strategies for directly targeting c-Myc protein have had limited success, upstream regulators and downstream effectors of c-Myc are being investigated as alternatives for therapeutic intervention. c-Myc regulates transcription and formation of the mRNA cap, which is important for transcript maturation and translation. However, the direct mechanism by which c-Myc upregulates mRNA capping is unclear. mRNA cap formation initiates with the linkage of inverted guanosine via a triphosphate bridge to the first transcribed nucleotide, catalysed by mRNA capping enzyme (CE/RNGTT). Here we report that c-Myc increases the recruitment of catalytically active CE to RNA polymerase II and to its target genes. c-Myc-induced target gene expression, cell proliferation and cell transformation is highly dependent on CE, but only when c-Myc is deregulated. Cells retaining normal control of c-Myc expression are insensitive to repression of CE. c-Myc expression is also dependent on CE. Therefore, inhibiting CE provides an attractive route for selective therapeutic targeting of cancer cells which have acquired deregulated c-Myc.

2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern.

Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athlete's return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport.

Using criteria-based interview models for assessing clinical expertise to select physiotherapists at major multisport games.

BACKGROUND: Benchmarking is an established means of identifying levels of specialist practice and competence-based interviews are a tool used to facilitate this. The London 2012 Olympic and Paralympic Games (LOCOG) provided an opportunity to introduce a pragmatic approach to assess expert behaviour in large numbers of volunteer physiotherapists. AIM: To test inter-tester repeatability of an assessment matrix used to score clinical expertise in a sporting context, followed by reporting on the findings for physiotherapy selection. METHODS: Four volunteers were videoed answering an identical sport-specific clinical scenario. Recordings were initially scored by two experienced assessors (gold standard). Subsequently, nine assessors scored the same videos then compared with the gold standard. 602 physiotherapists were assessed during volunteer interviews for LOCOG. Scores were compared to those based on self-reported clinical experience. Cross-tabulation was used to determine levels of agreement for the initial scoring matrix and the relationship between the two scoring systems was analysed. RESULTS: Levels of agreement ranged from 22% to 88%. A good correlation (r=0.754 p>0.001) was found between self-reported clinical experience and scenario scores. Marginal data points in the correlational analysis indicated that only 52% of participants attained the same score across assessments. CONCLUSIONS: A tool to facilitate assessment for large scale selection could be used for Host Nation physiotherapist selection for Major Games. There is a need to train assessors in this environment, as well as provide detailed matrices, specific to each context being assessed, to ensure that observations can be made on domain-specific and general, non-technical aspects.

Analysis of physical activity in emmetropic and myopic university students during semester and holiday periods: a pilot study.

BACKGROUND: Previous studies (mostly questionnaire-based in children) suggest that outdoor activity is protective against myopia. There are few studies on young adults investigating both the impact of simply being outdoors versus performing physical activity. The aim was to study the relationship between the refractive error of young adults and their physical activity patterns. METHODS: Twenty-seven university students, aged 18 to 25 years, wore a pedometer (Omron HJ720ITE) for seven days both during the semester and holiday periods. They simultaneously recorded the type of activity performed, its duration, the number of steps taken (from the pedometer) and their location (indoors/outdoors) in a logbook. Mean spherical refractive error was used to divide participants into three groups (emmetropes: +1.00 to -0.50 D, low myopes: -0.62 to -3.00 D, higher myopes: -3.12 D or greater myopia). RESULTS: There were no significant differences between the refractive groups during the semester or holiday periods; the average daily times spent outdoors, the duration of physical activity, the ratio of physical activity performed outdoors to indoors and amount of near work performed were similar. The peak exercise intensity was similar across all groups: approximately 100 steps per minute, a brisk walk. Up to one-third of all physical activity was performed outdoors. There were some significant differences in activities performed during semester and holiday times. For example, low myopes spent significantly less time outside (49 ± 47 versus 74 ± 41 minutes, p = 0.005) and performed less physical activity (6,388 ± 1,747 versus 6,779 ± 2,746 steps per day; p = 0.03) during the holidays compared to during semester. CONCLUSIONS: The fact that all groups had similar low exercise intensity but many were not myopic suggests that physical activity levels are not critical. There were differences in the activity patterns of low myopes during semester and holiday periods. This study highlights the need for a larger longitudinal-based study with particular emphasis on how discretionary time is spent.

Tactile experience does not ameliorate age-related reductions in sensory function.

UNLABELLED: BACKGROUND/STUDY CONTEXT: Sensory function degrades with age, with well-established reductions in tactile spatial acuity, vibrotactile sensitivity, and thermosensation, to name but three aspects of perception. Such age-related losses might be partially stemmed by ongoing experience with tasks requiring high levels of manual dexterity or analogous tactile expertise; individuals who are highly expert in skills that have a fundamental tactile component can show improved tactile function as compared with nonexperts. METHODS: Eighty individuals (17 males, 63 females) in the 18-58 age range were assessed on their tactile experience, as measured by self-assessment on a variety of tasks and competencies, each of which required a high level of skill with the hands. Tactile sensory performance, manual dexterity ("haptic efficiency"), and the subjective response to tactile stimulation were quantified. RESULTS: Degradation in tactile sensory acuity with age was confirmed, but no strong evidence was found for variations in acuity contingent on the tactile expertise of participants. In contrast to the performance measures, differences in tactile experience were associated with differences in the subjective response to touch. Greater tactile experience was associated with the provision of richer descriptions of textured materials manipulated with the digits. CONCLUSION: The range of tactile experience reported in a convenience sample of the population was apparently insufficient to preserve sensory function during aging.

The role of sports physiotherapy at the London 2012 Olympic Games.

BACKGROUND: There is a lack of information on the utilisation of physiotherapy services at the Olympic Games. AIM: To better understand the athlete and non-athlete requirements of the physiotherapy services at the Olympic Village Polyclinic during the London 2012 Olympic Games. METHODS: From 16 July to 14 August 2012, physiotherapy encounters for athletes and non-athletes (National Olympic Committee (NOC) team officials, coaches, team managers, workforce, Olympic family, technical officials and press) were recorded on the ATOS electronic medical records system at the polyclinic in the main Athletes' Village in Stratford. RESULTS: Of the 1778 encounters, 1219 (69%) were administered to athletes and 559 (31%) to non-athletes. The anatomical areas most frequently recorded at the first visits for athletes were knee (15.4%), lumbar spine/lower back (15.2%) and upper leg (12.6%) and that for non-athletes were lumbar spine/lower back (19.8%), knee (15.8%) and neck/cervical spine. Muscle (33.3%) and joint injuries (24.8%) were the most common diagnoses in athletes and non-athletes (24.4% and 30.1%). The five most frequently used treatment modalities were therapeutic soft tissue techniques (23.3%), mobilisation techniques (21.8%), taping (8.9%), cryotherapy (6.9%) and exercise prescription (6.4%). The most common cause of athletes' injuries was overuse (43.6%). CONCLUSIONS: This study of the London 2012 Olympic Games workload highlights the physiotherapy needs of athletes as well as non-athletes and identifies the high numbers of pre-existing and overuse injuries in this setting, providing an insight into the reasons why the athletes seek physiotherapy support during the Olympic Games.

The effect of verbal context on olfactory neural responses.

Odor names refer usually to "source" object categories. For example, the smell of rose is often described with its source category (flower). However, linguistic studies suggest that odors can also be named with labels referring to categories of "practices". This is the case when rose odor is described with a verbal label referring to its use in fragrance practices ("body lotion," cosmetic for example). It remains unknown whether naming an odor by its practice category influences olfactory neural responses differently than that observed when named with its source category. The aim of this study was to investigate this question. To this end, functional MRI was used in a within-subjects design comparing brain responses to four different odors (peach, chocolate, linden blossom, and rose) under two conditions whereby smells were described either (1) with their source category label (food and flower) or (2) with a practice category label (body lotion). Both types of labels induced activations in secondary olfactory areas (orbitofrontal cortex), whereas only the source label condition induced activation in the cingulate cortex and the insula. In summary, our findings offer a new look at olfactory perception by indicating differential brain responses depending on whether odors are named according to their source or practice category.

eIF4A inhibition allows translational regulation of mRNAs encoding proteins involved in Alzheimer's disease.

Alzheimer's disease (AD) is the main cause of dementia in our increasingly aging population. The debilitating cognitive and behavioral symptoms characteristic of AD make it an extremely distressing illness for patients and carers. Although drugs have been developed to treat AD symptoms and to slow disease progression, there is currently no cure. The incidence of AD is predicted to increase to over one hundred million by 2050, placing a heavy burden on communities and economies, and making the development of effective therapies an urgent priority. Two proteins are thought to have major contributory roles in AD: the microtubule associated protein tau, also known as MAPT; and the amyloid-beta peptide (A-beta), a cleavage product of amyloid precursor protein (APP). Oxidative stress is also implicated in AD pathology from an early stage. By targeting eIF4A, an RNA helicase involved in translation initiation, the synthesis of APP and tau, but not neuroprotective proteins, can be simultaneously and specifically reduced, representing a novel avenue for AD intervention. We also show that protection from oxidative stress is increased upon eIF4A inhibition. We demonstrate that the reduction of these proteins is not due to changes in mRNA levels or increased protein degradation, but is a consequence of translational repression conferred by inhibition of the helicase activity of eIF4A. Inhibition of eIF4A selectively and simultaneously modulates the synthesis of proteins involved in Alzheimer's disease: reducing A-beta and tau synthesis, while increasing proteins predicted to be neuroprotective.

Quantitative assessment of pleasant touch.

The hedonic attributes of tactile stimulation are important to one's quality of life, yet they have rarely been studied scientifically. The earliest experimental investigations suggested soft and smooth materials as pleasant, those that were stiff, rough, or coarse as unpleasant. More recent studies conducted by the authors and described herein obtained ratings of pleasantness of different textured materials stroked across the skin of multiple body sites at controlled velocities and forces of application. Statistically significant interactions between materials, sites, velocities, forces and subject sex attest to the complexity of the percept. Less pleasant percepts arose from stimuli that were rougher. However, the difficulty in making further general statements regarding hedonic touch raises questions as to whether the body surface can be mapped affectively in a meaningful manner with a single stimulus and indeed whether pleasantness-to-touch can be viewed as a unidimensional construct.

Semantic processing of mathematical gestures.

OBJECTIVE: To examine whether or not university mathematics students semantically process gestures depicting mathematical functions (mathematical gestures) similarly to the way they process action gestures and sentences. Semantic processing was indexed by the N400 effect. RESULTS: The N400 effect elicited by words primed with mathematical gestures (e.g. "converging" and "decreasing") was the same in amplitude, latency and topography as that elicited by words primed with action gestures (e.g. drive and lift), and that for terminal words of sentences. SIGNIFICANCE AND CONCLUSION: Findings provide a within-subject demonstration that the topographies of the gesture N400 effect for both action and mathematical words are indistinguishable from that of the standard language N400 effect. This suggests that mathematical function words are processed by the general language semantic system and do not appear to involve areas involved in other mathematical concepts (e.g. numerosity).