Genetic variation and pesticide exposure influence blood DNA methylation signatures in females with early-stage Parkinson's disease.

Although sex, genetics, and exposures can individually influence risk for sporadic Parkinson's disease (PD), the joint contributions of these factors to the epigenetic etiology of PD have not been comprehensively assessed. Here, we profiled sex-stratified genome-wide blood DNAm patterns, SNP genotype, and pesticide exposure in agricultural workers (71 early-stage PD cases, 147 controls) and explored replication in three independent samples of varying demographics (n = 218, 222, and 872). Using a region-based approach, we found more associations of blood DNAm with PD in females (69 regions) than in males (2 regions, Δßadj| ≥0.03, padj ≤ 0.05). For 48 regions in females, models including genotype or genotype and pesticide exposure substantially improved in explaining interindividual variation in DNAm (padj ≤ 0.05), and accounting for these variables decreased the estimated effect of PD on DNAm. The results suggested that genotype, and to a lesser degree, genotype-exposure interactions contributed to variation in PD-associated DNAm. Our findings should be further explored in larger study populations and in experimental systems, preferably with precise measures of exposure.

Expert decision making in physical therapy--a survey of practitioners.

Four hundred American and 384 Australian physical therapists, nominated by their peers as expert clinicians, were studied to evaluate whether a particular cognitive style was prevalent among expert clinicians, to identify preferred sources of information for clinical decision making, and to determine the similarities and differences between American and Australian therapists. Results were based on usable survey responses from 348 American and 290 Australian therapists. Eighty-eight percent of the American therapists and 82% of the Australian therapists identified themselves as working primarily in general practice, orthopedics, or neurology. The physical therapy assessment and interviews with the patient were the preferred sources of information in both countries. The physician's referral and communications with other health care personnel were reported to be of limited value as sources of information by most respondents. Overall, both groups responded most positively to the receptive style of data gathering and the systematic style of information processing. Therapists working primarily with neurologically impaired patients responded most positively to the preceptive style of data gathering and the intuitive style of information processing. Therapists working primarily with patients with orthopedic disorders responded most positively to the systematic style of information processing.

Decisions made by physiotherapists: a study of private practitioners in victoria.

This paper addresses the kinds of decisions physiotherapists in Victoria are making about their clients, including those presenting with referral and those presenting to the physiotherapist as first contact. A survey of private practitioners provided data concerning the incidences of primary contact practice, and the source and content of medical referrals. The incidence of primary contact practice and the management of these clients is documented and discussed with respect to the physiotherapists' referral relationship with medical practitioners. Medical referrals are described and the physiotherapists' compliance with treatment prescription is discussed. Implications for optimal decision-making are discussed in relation to biassed choice.

What physiotherapists in private practice do: the effects of sex and training on clinical behaviour.

The past decade in Australia has witnessed the expansion of Graduate Diploma programmes designed for the practising clinician and it seemed timely to assess the effects of this type of post-graduate education. The objective of this study was to compare the clinical behaviour, defined as time allocation between different assessment and treatment procedures, of 16 generalist physiotherapists and 16 manipulative therapists. The results indicated some significant differences in the treatment choices and time allocation between qualifications groups, as well as some sex based differences. The implications of the findings are discussed with reference to decision making in clinical practice and the development of higher order clinical decision rules.