A revision of the British Chronostratigraphy within the Last Glacial-Interglacial Cycle based on new evidence from Arclid, Cheshire UK

Of the 24 Greenland interstadials (GI) in the Last Glacial-interglacial cycle (LGIC) only five are conventionally recognised in Britain. This paper aims to improve understanding of the LGIC in Britain from a site at Arclid, Cheshire. Sediments were characterised and luminescence used to establish a chronology. This found that the Chelford Sand Formation spans 77-47 ka with sand deposited initially by aeolian but later by fluvial transportation. Coleoptera and Diptera from the basal peat lens provided a reconstruction for a heather-rich heathland environment grazed by large herbivores, with summer temperatures between 13-18° C, and winter temperatures between -14 and 1°C. Flies included the earliest records of the blood-sucking horsefly Haematopota pluvialis, and the soldierfly Chloromyia formosa. The overlying Stockport Sand Formation was deposited fluvioglacially between 47-41 ka with the upper Stockport Till formed by the advance of the last British icesheet after ~33 ka. Stenothermic beetle analysis from Arclid indicate similarities with results from other British mid LGIC sites, some of which are at or beyond the limit of radiocarbon dating and may be of a similar age to Arclid. Basal organic sediments found at Arclid along with other reassigned sites are proposed as a new Arclid Interstadial. A revised British LGIC chronostratigraphy has the Wretton, Chelford and Brimpton Interstadials and the previously suggested but not widely recognised Cassington Interstadial. The Arclid Interstadial occurred after these, but prior to the Upton Warren Interstadial complex. This closes the previous gap in interstadials between the Brimpton Interstadial and the Upton Warren Interstadial complex within the British chronostratigraphy

Desired educational outcomes of disability-related training for the generalist physician: knowledge, attitudes, and skills

The problems adults with disabilities face obtaining quality primary care services are persistent and undermine national efforts to improve the health status of this group. Efforts to address this issue by providing disability-related training to physicians are hampered by limited information about what generalist physicians need to know to care for patients with disabilities. The authors consider the desired outcomes of disability-related training for generalists by exploring the contributions of the domains of knowledge, attitudes, and skills to patient-directed behavior and summarizing the empirical data.Because disability reflects a complex interplay among individual, interpersonal, institutional, community, and societal factors, generalist physicians can promote and protect the health of adults with disabilities by interventions at multiple levels. Thus, the authors use the social-ecological framework, an approach to health promotion that recognizes the complex relationships between individuals and their environments, to delineate the recommended knowledge, attitudes, and skills in the context of primary care. The importance of role models who demonstrate the three domains, the interactions among them, and issues in evaluation are also discussed. This clear delineation of the recommended educational outcomes of disability-related training in terms of knowledge, attitudes, and skills will support efforts to better prepare generalist physicians-in training and in practice-to care for adults with disabilities and to evaluate these training strategies

Teaching health care students about disability within a cultural competency context

The training of health care providers has been identified as key to resolving the health disparities experienced by persons with disabilities. We contend that: 1) cultural competency provides a useful conceptual framework for teaching disability-related content to health professions students; 2) educational experiences can be structured to reflect the socio-cultural complexity of the \u27disability culture;\u27 3) desired competencies associated with culture can be defined with regard to professionals\u27 approach to patients with disabilities; 4) exposure to persons who have disabilities in their homes allows the student to make connections between the nuances of daily life with a disability and one\u27s health care needs; 5) the framework allows the disability culture to be integrated with other cultural contexts, including race and ethnicity; and 6) the framework acknowledges the potential impact of providers\u27 conscious or unconscious recognition of their potential membership in the disability culture on their approach to patients with disabilities

Delineation of the motor disorder of Lesch-Nyhan disease.

Contains fulltext : 51161.pdf (publisher's version ) (Open Access)Lesch-Nyhan disease (LND) is caused by deficiency of the purine salvage enzyme hypoxanthine-guanine phosphoribosyltransferase (HPRT). Affected individuals exhibit over-production of uric acid, along with a characteristic neurobehavioural syndrome that includes mental retardation, recurrent self-injurious behaviour and motor disability. Prior studies involving relatively small numbers of patients have provided different conclusions on the nature of the motor disorder. The current study includes the results of a multi-centre international prospective study of the motor disorder in the largest cohort of patients studied to date. A total of 44 patients ranging from 2 to 38 years presented a characteristic motor syndrome that involved severe action dystonia superimposed on baseline hypotonia. Although some patients also displayed other extrapyramidal or pyramidal signs, these were always less prominent than dystonia. These results are compared with a comprehensive review of 122 prior reports that included a total of 254 patients. Explanations for the differing observations available in the literature are provided, along with a summary of how the motor disorder of LND relates to current understanding of its pathophysiology involving the basal ganglia

Secular trends in adult stature among the Makushi of Guyana in the 20th Century

Objective: This study describes secular trends in physical stature, Cormic Index (CI), and body mass index (BMI) of adult Makushi Amerindians born between 1910 and 1980, compares the stature of these Makushi adults to Makushi adults measured in 1921, and provides contextual data to inform the findings. Methods: Pearson\u27s correlation was used to assess the relationship between year of birth and physical stature, BMI, and CI for 231 females and 113 males, 20 to 90 years of age measured in 2000 to 2001. Wilcoxon\u27s test was used to compare physical stature of Makushi adults measured in 2000 to 2001 with that of 40 Makushi adults measured in 1921. Results: Among Makushi measured in 2000 to 2001, females and males born more recently were taller and had a lower CI but did not differ in BMI relative to their elders. Makushi measured in 2000 to 2001 are significantly taller than those Maksuhi measured in 1921. Conclusion: The increased physical stature of and decreased CI in more recently born Makushi may be explained by a more favorable early life environment possibly due to public health measures and dietary changes. As well, trends in stature may be linked to genetic admixture with African-Guyanese migrating into the region during this time