Direct observation of the nutrition care practices of australian general practitioners

INTRODUCTION: Nutrition care refers to nutrition-related advice or counselling provided by health professionals in an attempt to improve the nutrition behaviour of patients

The ciliary machinery is repurposed for T cell immune synapse trafficking of LCK

Upon engagement of the T cell receptor with an antigen-presenting cell, LCK initiates TCR signaling by phosphorylating its activation motifs. However, the mechanism of LCK activation specifically at the immune synapse is a major question. We show that phosphorylation of the LCK activating Y394, despite modestly increasing its catalytic rate, dramatically focuses LCK localization to the immune synapse. We describe a trafficking mechanism whereby UNC119A extracts membrane-bound LCK by sequestering the hydrophobic myristoyl group, followed by release at the target membrane under the control of the ciliary ARL3/ARL13B. The UNC119A N terminus acts as a “regulatory arm” by binding the LCK kinase domain, an interaction inhibited by LCK Y394 phosphorylation, thus together with the ARL3/ARL13B machinery ensuring immune synapse focusing of active LCK. We propose that the ciliary machinery has been repurposed by T cells to generate and maintain polarized segregation of signals such as activated LCK at the immune synapse

Motor control or graded activity exercises for chronic low back pain? A randomised controlled trial

Background: Chronic low back pain remains a major health problem in Australia and around the world. Unfortunately the majority of treatments for this condition produce small effects because not all patients respond to each treatment. It appears that only 25-50% of patients respond to exercise. The two most popular types of exercise for low back pain are graded activity and motor control exercises. At present however, there are no guidelines to help clinicians select the best treatment for a patient. As a result, time and money are wasted on treatments which ultimately fail to help the patient

A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people

Background: Lesbian, gay and bisexual (LGB) people may be at higher risk of mental disorders than heterosexual people.Method: We conducted a systematic review and meta-analysis of the prevalence of mental disorder, substance misuse, suicide, suicidal ideation and deliberate self harm in LGB people. We searched Medline, Embase, PsycInfo, Cinahl, the Cochrane Library Database, the Web of Knowledge, the Applied Social Sciences Index and Abstracts, the International Bibliography of the Social Sciences, Sociological Abstracts, the Campbell Collaboration and grey literature databases for articles published January 1966 to April 2005. We also used Google and Google Scholar and contacted authors where necessary. We searched all terms related to homosexual, lesbian and bisexual people and all terms related to mental disorders, suicide, and deliberate self harm. We included papers on population based studies which contained concurrent heterosexual comparison groups and valid definition of sexual orientation and mental health outcomes.Results: Of 13706 papers identified, 476 were initially selected and 28 (25 studies) met inclusion criteria. Only one study met all our four quality criteria and seven met three of these criteria. Data was extracted on 214,344 heterosexual and 11,971 non heterosexual people. Meta-analyses revealed a two fold excess in suicide attempts in lesbian, gay and bisexual people [ pooled risk ratio for lifetime risk 2.47 (CI 1.87, 3.28)]. The risk for depression and anxiety disorders (over a period of 12 months or a lifetime) on meta-analyses were at least 1.5 times higher in lesbian, gay and bisexual people (RR range 1.54-2.58) and alcohol and other substance dependence over 12 months was also 1.5 times higher (RR range 1.51-4.00). Results were similar in both sexes but meta analyses revealed that lesbian and bisexual women were particularly at risk of substance dependence (alcohol 12 months: RR 4.00, CI 2.85, 5.61; drug dependence: RR 3.50, CI 1.87, 6.53; any substance use disorder RR 3.42, CI 1.97-5.92), while lifetime prevalence of suicide attempt was especially high in gay and bisexual men (RR 4.28, CI 2.32, 7.88).Conclusion: LGB people are at higher risk of mental disorder, suicidal ideation, substance misuse, and deliberate self harm than heterosexual people

Some new rearrangements in nitrogen heterocyclic chemistry.

The oxidation of 3-niono- and 3, 4-di-substituted 2-pyrazolin-5-ones was studied to determine whether the pyrazol-3-one intermediates generated would decompose with loss of nitrogen to give cyclopropenones. Cyclopropenones were not formed however; this parallels the behaviour of 3-indazolones which had been shown not to give benzocyclopropenone. 4, 5-Diphenylpyrazol-3-one lost nitrogen and carbon monoxide to give diphenylacetylene, and nitrogen to give 2, 3, 6, 7-tetraphenylpyrazolo-(l,2a)-pyrazol-l,5- dione. The unstable alpha-carbonyl-azo intermediates from 2-pyrazolin-5-ones were trapped with tetracyclone to give stable Diels Alder adducts in good yield. When heated these adducts partly undergo a retro-Diels Alder reaction and partly undergo a novel molecular rearrangement, paralleled in the mass spectrometer, to give carbon dioxide and 1, 7a-diazaindenes. (This is described in Section 1). Efforts towards the synthesis of 5, 6-diphenyl-l, 2, 3-triazin- 4-one are described since its 3-amino derivative should give diphenylcyclopropenone on oxidation. Amination of 3, 4-diphenyl-2-pyrazolin-5-one caused ring expansion to 5, 6-diphenyl-l, 2, 3, 4-tetrahydro-1, 2, 4-triazin-3-one, which on oxidation gave 5, 6-diphenyl-1, 2, 4-triazin-3-one. Amination of the latter caused ring contraction, however, to give 4, 5-diphenylimidazolin-2-one with hydroxylamine-0-sulphonic acid, and 4, 5-diphenyl-l, 2, 3-triazole with chloramine. (This is described in Section 2). l-Amino-3, 4, 5, 6-tetraphenyl-2-pyridone was prepared as a possible precursor to hexaphenyl-1, 7a-diazaindene (see above). When oxidised with lead tetra-acetate it underwent an unusual rearrangement to give 3, 4, 5, 6-tetraphenylpyridazine; evidence for a nitrene intermediate was provided by oxidation of the N-amino-pyridone in dimethyl sulphoxide when the nitrene was trapped as the sulphoximine. Pyrolysis of this gave the same products as the oxidation reaction. The nitrene formed by oxidation of the hydrazine, and by photolysis of the sulphoximine, was trapped with cyclohexene to give the same aziridine. By contrast, oxidation of N-aminophenanthridone gave 4, 5-benzocoumarin and l-amino-2, 3-diphenyl-4-quinolone gave a bis-quinolone. (This is described in Section 3). The preparation of 2, 3-bis-(m-methoxyphenyl)-cyclopropenone and the attempted oxidative coupling of this and the bis-phenol to give the phenanthracyclopropenone system are described in the Appendix. Mechanisms are proposed for all the new reactions described

Defining worthwhile and desired responses to treatment of chronic low back pain

Objective To describe patients' perceptions of minimum worthwhile and desired reductions in pain and disability upon commencing treatment for chronic low back pain. Design and Setting Descriptive study nested within a community-based randomized controlled trial on prolotherapy injections and exercises. Patients A total of 110 participants with chronic low back pain. Interventions Prior to treatment, participants were asked what minimum percentage reductions in pain and disability would make treatment worthwhile and what percentage reductions in pain and disability they desired with treatment. Outcome Measures. Minimum worthwhile reductions and desired reductions in pain and disability. Results. Median (inter-quartile range) minimum worthwhile reductions were 25% (20%, 50%) for pain and 35% (20%, 50%) for disability. This compared with desired reductions of 80% (60%, 100%) for pain and 80% (50%, 100%) for disability. The internal consistency between pain and disability responses was high (Spearman's coefficient of association of 0.81 and 0.87, respectively). A significant association existed between minimum worthwhile reductions and desired reductions, but no association was found between these two factors and patient age, gender, pain severity or duration, disability, anxiety, depression, response to treatment, or treatment satisfaction. Conclusions. Inquiring directly about patients' expectations of reductions in pain and in disability is important in establishing realistic treatment goals and setting benchmarks for success. There is a wide disparity between the reductions that they regard as minimum worthwhile and reductions that they hope to achieve. However, there is a high internal consistency between reductions in pain and disability that they expect

Key findings on ECGs: Level of agreement between GPs and cardiologists

Background: Previous research has demonstrated accuracies of 70% for the detection of electrocardiogram (ECG) abnormalities by general practitioners. This study aimed to retrospectively assess the level of agreement between GPs and cardiologists of key findings on ECGs. Methods: A retrospective study of all patient referrals from GPs sent to a cardiology clinic at a medium sized public hospital over a 3 year period. The ECG diagnosis of the GP and the interpretive function of the ECG was compared with the ECG diagnosis of the cardiologist. Results: A total of 2143 referrals were received from 292 GPs from 111 different practices. The level of agreement between the GPs and the cardiologists key findings was 58.9%. In comparison, the level of agreement between the key findings of the interpretive function on the GPs' ECG machines and of the cardiologists was 44.4%. Discussion: The GPs' ability to accurately diagnose key findings on the ECG was modest, however, the GPs' ability to appropriately refer based on clinical presentation was exceptional. Based on our findings, the interpretive function on ECG machines should be viewed with extreme caution, particularly when using this to diagnose key findings