The impact of physiological load on anticipation skills in badminton: From testing to training.

Research remains unclear on the impact of physiological load on perceptual-cognitive skills in sport. Moreover, no study has examined the training of perceptual-cognitive skills under physiological load. The current study comprised two phases. Firstly, we examined the impact of badminton-specific physiological load on anticipatory skills in expert badminton players (n = 13), including key underlying mechanisms, such as gaze behaviour. Under high physiological load, participants displayed less efficient visual search behaviour and showed a reduction in response accuracy. Secondly, we examined the effects of combining perceptual-cognitive simulation training with the high physiological load. Ten of the expert badminton players were assigned to a combined training group, where the simulation training and the physiological load intervention occurred simultaneously or an independent training group, whereby the two components were completed independently. The combined training group showed a positive change in the efficiency of their visual search behaviours compared to the independent training group, but no significant performance improvements were found. Overall, findings demonstrate that high physiological load is detrimental to experts' anticipatory skills. However, combining perceptual-cognitive simulation training with high physiological load can potentially negate these debilitating effects.

Dysregulation of the fibroblast growth factor system in major depression.

In this report we describe findings that imply dysregulation of several fibroblast growth factor (FGF) system transcripts in frontal cortical regions of brains from human subjects with major depressive disorder (MDD). This altered gene expression was discovered by microarray analysis of frontal cortical tissue from MDD, bipolar, and nonpsychiatric control subjects and was verified by quantitative real-time PCR analysis and, importantly, in a separate cohort of MDD subjects. Furthermore, we show, through a separate analysis of specific serotonin reuptake inhibitor (SSRI)-treated and non-SSRI-treated MDD subjects that the observed changes in expression of FGF transcripts are not secondary to drug treatment. Rather, changes in specific FGF transcripts are attenuated by SSRIs and may thus be partially responsible for the mechanism of action of these drugs. We also make available the gene-expression profile of all of the other growth factors and growth factor receptors detected in these postmortem samples.

A simple pragmatic system for detecting new cases of type 2 diabetes and impaired fasting glycaemia in primary care.

BACKGROUND: Although whole population screening for type 2 diabetes is not currently considered to be justified, targeted screening within higher risk groups may be more cost-effective, and more pragmatic. OBJECTIVES: Our aim was to investigate the feasibility and performance of a pragmatic system for identifying patients with type 2 diabetes and impaired fasting glycaemia (IFG). METHODS: A clustered observational survey of the prevalence of diabetes and IFG was carried out in randomly selected patients from four at-risk groups. Patients were identified by computerized searching of practice databases for age and body mass index (BMI) risk criteria. Sixteen practices in South West England screened 1287 Caucasian patients from four groups with progressive levels of theoretical risk (age >70 and BMI >or=33, age >65 and BMI >or=31, age >60 and BMI >or=29, and age >50 and BMI >or=27). Fasting plasma glucose was measured and repeated if abnormal to determine the prevalence of new cases in each group. BMI and age data were validated against measures taken at the clinic. RESULTS: The response rate was 60.6% and the prevalence of new cases of type 2 diabetes in each group was 4.7% [95% confidence interval (CI) 2.8-7.7], 5.7% (95% CI 4.0-8.2), 3.8% (95% CI 2.4-6.0) and 2.6% (95%CI 1.4-4.7), respectively. An additional 5.2-8.4% had IFG. CONCLUSIONS: Targeted screening by searching existing GP records for age and BMI criteria is feasible for use in general practice in the UK. Screening of patients with a BMI of >or=27 and aged >50 by fasting glucose identified a substantial prevalence of undetected type 2 diabetes and IFG. The relative costs and benefits as well as the pragmatic advantages of different systems need further evaluation.

Converting to insulin in primary care: an exploration of the needs of practice nurses.

BACKGROUND: In order to optimize glycaemic control, substantial numbers of people with type 2 diabetes may require transfer from oral medication to insulin therapy. Although insulin conversion is traditionally a specialist secondary care function, as nursing roles change and expand there is growing pressure for this to be performed within primary care. However, little is known about the potential barriers to such a change, particularly from the standpoint of the frontline staff involved. AIMS: The study aimed to explore the views of practice nurses in the United Kingdom (UK) about converting diabetic patients from oral hyperglycaemic agents to injected insulin within primary care, and to investigate what structures and resources might be useful in supporting such a change. METHODS: Semi-structured interviews were conducted with 25 practice nurses, and interpreted using content analysis to extract key conceptual themes from the transcribed interview texts. FINDINGS: Most of the nurses felt that converting to insulin in primary care had considerable benefits for patients. However, issues of time, training, confidence about performing the change, and the adequacy of support systems, both for patient and nurse, emerged as the main perceived barriers to performing insulin conversions in primary care. Worries about legal and accountability issues surrounding the nurse prescribing elements were also raised. CONCLUSIONS: Where insulin conversion within primary care is being considered, it is suggested that specific training is provided for practice nurses and general practitioners, protected time is made available, and a team-working approach is fostered to prevent isolation and boost patient support. Formal mentoring or supervision support for practice nurses may also help them to adapt to this new approach. LIMITATIONS: These findings are based on the views of nurses from a single UK locality, and so widespread consultation is recommended before applying them in other settings.

School peer relationships of 'minority' children in Scotland.

This paper examines selected issues arising from two studies in mainstream education of two minority groupings of children in Scotland-those with serious medical conditions and refugee children-completed in 1997 and 1999, respectively. It draws on first-person accounts of children, parents and teachers and focuses on school-based peer relationships, including friendships. Many of the described peer experiences were unhappy or mixed, only a minority were positive. The paper relates the research and its findings to current social and educational policy contexts and to theories on peer relationships, friendship and rejection. It challenges the problematizing of groups or individuals with minority experiences and school staff's acceptance of inevitable difficulty in these children's peer relationships. It hypothesizes that ways of developing all children's peer relationships need to be addressed in schools if the well-being of children who may be socially vulnerable is to be improved.

A comparison of professionals' and patients' understanding of asthma: evidence of emerging dualities?

Despite an increase in the provision of services to patients with asthma, morbidity from the disease remains high. Recent research (outside asthma) has raised the possibility that patients may develop a conceptualisation of illnesses which is not entirely compatible with the prevailing biomedical view. This paper compares the way in which health care professionals and patients with asthma described various aspects of the illness, using an approach which considered the type of knowledge which might be used to construct the respective conceptualisations of asthma. A qualitative method is empliyed, using focus groups. Eight focus groups were convened, four of professionals and four of patients with asthma. Following the initial data analysis, the results were reviewed linguistically, with particular attention to the use of metaphor.The health care professionals and patients participating in this study agreed broadly in their explanations of the aetiology and drug treatment of asthma. The data suggest lack of congruence in the development of treatment strategies and locus of control. Health care professionals and patients in this study used linguistically different metaphors to represent the disease: the former more frequently used metaphors evoking on-going processes, the latter visualising the chest (in their use of metaphor) as a static container, emptying and filling throughout the course of the disease. Two commentaries from philosophical and anthropological literature are considered in order to offer theoretical accounts relevant to this interpretation. The data suggest an emerging duality in the approach to treatment plans, in the roles played by professionals and patients with asthma, and in the different types of knowledge used by professionals and patients to construct their respective working models of asthma.

Influence of allele lineage on the role of the insulin minisatellite in susceptibility to type 1 diabetes.

The insulin minisatellite or variable number of tandem repeats locus (INS VNTR) is the best candidate for the type 1 diabetes mellitus (T1DM) susceptibility locus IDDM2. Small class I alleles associate with predisposition to T1DM, whereas large class III alleles associate with dominant protection. We have analysed variant repeat distribution within the minisatellite and combined this with flanking haplotypes to define five new ancestral allele lineages. Class III alleles divide into two highly diverged lineages, IIIA and IIIB, which correspond perfectly to the previously defined Protective (PH) and Very Protective (VPH) haplotypes, respectively. Class I alleles are divided into three newly defined lineages, IC+, ID+ and ID-, by a combination of variant repeat distributions and flanking haplotypes. All class I alleles are equally predisposing to T1DM except for ID- alleles which are protective when transmitted from ID-/III heterozygous fathers. Similar results have been previously reported for alleles of 42 repeats in length (allele 814) which represent a subset of the ID- lineage. Division of class ID- alleles into those of 42 repeats and those of other sizes suggested that this protective effect was a feature of all ID- alleles, irrespective of size. ID- alleles are only clearly distinguished from all other alleles by an MSPI(-) variant within IGF2 downstream of the minisatellite, suggesting that the apparent role of the minisatellite in susceptibility to T1DM may be modified by neighbouring haplotype and therefore that IDDM2 could have a multi-locus aetiology.

Improving foot care for people with diabetes mellitus--a randomized controlled trial of an integrated care approach.

AIMS: To evaluate a model of integrated diabetic footcare, for identification and clinical management of the high risk diabetic foot, centred on the primary care-based diabetic annual review. METHODS: A pragmatic randomized controlled study was undertaken with matched cluster randomization of practices from 10 towns drawn from mid and east Devon responsible for the care of 1,939 people with diabetes (age > or =18 years). Outcome measures were patients' attitudes regarding the value and importance of footcare, patients' footcare knowledge, healthcare professionals' footcare knowledge and pattern of service utilization. RESULTS: Attitudes towards footcare improved in both intervention and control groups (mean percentage change 3.91, 0.68) with a significant difference in change of 3.18 (95% confidence interval (CI) 1.29-5.07) between the groups. Patients' knowledge about diabetic foot problems improved significantly in both groups (mean percentage change 1.09, 1.32) but with no significant difference in change: -0.09 (95% CI -1.81-1.63) between groups. Health professionals' knowledge scores improved in the intervention group (mean percentage change 13.2; P < 0.001). No improvement was seen in the control group (mean percentage change -0.2; P = 0.1) with a significant difference in change of 13.46 (95% CI 8.30-18.62) between groups. Appropriate referrals from intervention practices to the specialized foot clinic rose significantly (P = 0.05) compared with control practices (P = 0.14). CONCLUSIONS: Provision of integrated care arrangements for the diabetic foot has a positive impact on primary care staffs' knowledge and patients' attitudes resulting in an increased number of appropriate referrals to acute specialist services.

Allele diversity and germline mutation at the insulin minisatellite.

Previous analysis of germline mutation at highly unstable GC-rich minisatellites with continuous allele size distributions revealed similar meiotic recombinational mechanisms operating at all loci investigated. The insulin minisatellite has been studied intensively due to its associations with diabetes, polycystic ovary syndrome, obesity and birth size. Its bimodal allele size distribution in Caucasians suggests a much lower mutation rate and possible differences in the mutation process compared with highly unstable minisatellites. Mutation at the insulin minisatellite therefore was studied both indirectly from allele diversity surveys and directly by recovering de novo mutants from sperm DNA. Structural analysis of variant repeat distributions in 876 alleles identified 189 different alleles, almost all of which could be assigned to one of three very distinct lineages. Variation within a lineage was minor and due mainly to the gain or loss of one or a few repeat units. These events most probably arise by mitotic replication slippage at a frequency of perhaps 10(-3)per gamete. Sperm DNA analysis revealed a second class of mutation occurring at a frequency of approximately 2 x 10(-5)that involved highly complex intra- and inter-allelic rearrangements very similar to those seen at unstable minisatellites. These complex rearrangements were not seen in somatic DNA and are probably meiotic in origin. Minisatellite homozygosity did not reduce the frequency of these mutants in sperm. The insulin minisatellite therefore appears to evolve by two distinct processes: one involving slippage-like events and the second resulting in complex recombinational turnover of allele structure.

Significant event audit in practice: a preliminary study.

BACKGROUND: While well described and promoted as a useful activity, there remains a paucity of evidence on the process and experience of significant event audit (SEA) in primary care. To date, the most comprehensive evaluation of the process has been produced by comparing SEA with conventional audit. The current study intends to contribute to the debate by examining the attitudes and perceptions of a range of primary care staff who have been involved in the process. OBJECTIVES: The aim of this study was to identify participants' perceptions of the benefits and problems associated with SEA in the context of primary care, and to derive suggestions which might improve the process of SEA. METHODS: Semi-structured interviews of 12 participants from a variety of primary care disciplines were conducted, using grounded theory to analyse the results. RESULTS: A set of six perceptions and seven recommendations for the facilitation of SEA were produced. CONCLUSIONS: SEA constitutes a powerful tool, which can contribute to team building, enhanced communication and improved patient care, and represents a vital contributor to the development of clinical governance in primary care. However, its implementation and sustenance require sensitive handling for optimal benefit and to minimize difficulties. Our research has enabled us to propose suggestions to facilitate these processes.

Human minisatellites, repeat DNA instability and meiotic recombination.

Minisatellites include some of the most variable loci in the human genome and are superb for dissecting processes of tandem repeat DNA instability. Single DNA molecule analysis has revealed different mutation processes operating in the soma and germline. Low-level somatic instability results in simple intra-allelic rearrangements. In contrast, high frequency germline instability involves complex gene conversions and is therefore recombinational in nature, almost certainly occurring at meiosis. To determine whether true meiotic crossovers occur at human minisatellites, we have used polymorphisms near the repeat array to recover recombinant DNA molecules directly from sperm DNA. Analysis of minisatellite MS32 has revealed an intense and highly localised meiotic crossover hotspot centred upstream of the array, the first example of a human hotspot defined at the molecular level. This hotspot extends into the beginning of the repeat array, resulting in unequal and equal crossovers. Array crossovers occur much less frequently than array conversions but appear to arise by a common process, most likely by alternative processing of a recombination initiation complex. The location of MS32 at the boundary of a recombination hotspot suggests that this locus has evolved as a by-product of localised meiotic recombination activity, and that minisatellites might in general mark recombinationally proficient hotspots or hot domains in the genome. Finally, sperm crossover analysis makes it possible to explore the molecular rules that govern human meiotic recombination, and to detect phenomena such as meiotic drive that could provide a possible connection between recombination and DNA sequence diversity itself.

Isolation and characterization of mouse minisatellites.

Minisatellites provide the most informative system for analyzing processes of tandem repeat turnover in humans. However, little is known about minisatellites and the mechanisms by which they mutate in other species. To this end, we have isolated and characterized 76 endogenous mouse VNTRs. Fifty-one loci have been localized on mouse chromosomes and, unlike in humans, show no clustering in proterminal regions. Sequence analysis of 25 loci revealed the majority to be authentic minisatellites with GC-rich repeat units ranging from 14 to 47 bp in length. We have further characterized 3 of the most polymorphic loci both in Mus musculus subspecies and in inbred strains by using minisatellite variant repeat mapping (MVR) by PCR to gain insight into allelic diversity and turnover processes. MVR data suggest that mouse minisatellites mutate mainly by intra-allelic nonpolar events at a rate well below 10(-3) per gamete, in contrast to the high-frequency complex meiotic gene conversion-like events seen in humans. These results may indicate a fundamental difference in mechanisms of minisatellite mutation and genome turnover between mice and humans.

Spontaneous and induced minisatellite instability.

Minisatellites provide not only the basis for DNA fingerprinting and DNA profiling but also extremely informative systems for analysing processes of tandem repeat turnover in the human genome. Minisatellite instability appears to involve distinct mutation processes in somatic and germline cells; in the germline, mutation is frequently dominated by inter-allelic conversion-like events most likely occurring at meiosis and apparently regulated by cis-acting mutation initiator elements. Attempts to define these initiators in transgenic mice have so far been thwarted by what appears to be a major human/mouse barrier to the inter-species transfer of repeat instability. Minisatellites not only show high frequency spontaneous mutation in the germline, but also appear to be very sensitive to mutation induction by ionizing radiation, both in experimentally irradiated mice and in human populations exposed following the Chernobyl disaster; the mechanisms of mutation induction by radiation remain enigmatic.

Co-existing endometrial adenocarcinoma and tubal ectopic pregnancy: a case report.

Adenocarcinoma of the endometrium co-existing with pregnancy is a rare event. Twelve such cases have been reported in patients with intrauterine pregnancies. Co-existence with tubal ectopic pregnancy is even more uncommon. Only one such patient with tubal ectopic pregnancy was found in the literature; the pathologic findings were not, however, illustrated. We report on a very rare event, co-existing adenocarcinoma of the endometrium and ectopic tubal pregnancy, with illustration of the pathologic finding.

Rapid microscopic detection of cytomegalovirus and PCP in bronchoalveolar lavage specimens.

This article describes how bronchoalveolar lavage specimens can be screened rapidly and inexpensively for Pneumocystis carinii and cytomegalovirus infections with materials available in any hospital laboratory.

A report on the use of technician ophthalmoscopy combined with the use of the Canon non-mydriatic camera in screening for diabetic retinopathy in the community.

This paper describes a general practice based diabetic retinopathy screening service employing a technician trained in direct and indirect ophthalmoscopy and taking photographs with a Canon CR3 45 NM non-mydriatic polaroid camera analysed by a consultant ophthalmologist to provide a comparison with the screener's opinion. Prospective data is presented from the first 1050 patients screened for diabetic retinopathy in the Exeter Health Authority area. Analysis of data collected showed a prevalence of diabetic retinopathy in the screened population of 27%, 14% previously undetected with a 0.5% prevalence of sight-threatening retinopathy. There was almost complete agreement between ophthalmoscopy findings and the consultant analysis of photographs. Screening costs were calculated at 10.38 pounds per patient screened. A specially trained non-medically qualified technician can provide a good quality cost-effective screening service for diabetic retinopathy within a primary care setting.

The Exeter Diabetic Project: an acceptable district-wide education programme for general practitioners.

The Health District is a logical administrative unit for planning health services, and therefore the feasibility of delivering education for general practitioners across one such area was studied. By providing a suitable educational programme at convenient locations, it was possible to involve 89% out of 180 principals in General Practice in the Exeter Health District. Two-thirds of these general practitioners attended educational sessions away from the District Postgraduate Centre. In a questionnaire answered by 81% of the involved general practitioners, 98% acknowledged responsibility for managing their diabetic patients, but 76% admitted to inadequate skills in retinal assessment. In a follow-up postal questionnaire answered by 64% of general practitioners involved in the project, 74% found that they learnt from the retinopathy screening clinic and 100% found the sessions on eye disease helpful. The education programme was designed to link with a District-wide retinopathy screening initiative.