Mainstreaming of genomic medicine in gastroenterology, present and future: a Nationwide Survey of UK Gastroenterology Trainees

Objective: Genomics and personalised medicine are increasingly relevant for patients with gastroenterological conditions. We aim to capture the current state of genomics training in gastroenterology to review current understanding, clinical experience and long-term educational needs of UK trainees.Design & Setting: A web-based nationwide survey of all UK gastroenterology specialty trainees was conducted in 2017.Results: 100 trainees (14% of UK gastroenterology trainees) completed this survey. Only 9% and 16% of respondents believe that their local training programme adequately prepares them for future clinical practice utilising genomic medicine and personalised medicine respectively. Barriers identified include the need for greater trainee education (95%), inadequate clinical guidance to base interventions on the results of genomic testing (53%), concerns over misinterpretation by patients (43%) and overuse/misuse of testing by clinicians (34%).Survey respondents felt prepared to perform HFE genotyping (98%), assess TPMT status (97%), and interpret HLA-subtyping for suspected coeliac disease (85%). However, only a minority felt prepared to perform the following investigations: polyposis screening (34%), hereditary pancreatitis screening (30%), testing for Lynch Syndrome (33%), and KRAS testing for colorectal cancer (20%).Most respondents would support holding dedicated training days on genomic medicine (83%), formal training provisions for the mainstreaming of genomic testing (64%), an update to the UK gastroenterology specialty training curriculum and examinations (57%), and better-defined referral pathways for local genomic services (91%).Conclusion: Most gastroenterology trainees in this survey feel ill-equipped to practice genomic and personalised medicine as consultants. We propose specific revisions to the UK gastroenterology specialty curriculum that address trainees needs

Mainstreaming of genomic medicine in gastroenterology, present and future: a nationwide survey of UK gastroenterology trainees

Objective: Genomics and personalised medicine are increasingly relevant for patients with gastroenterological conditions. We aim to capture the current state of genomics training in gastroenterology to review current understanding, clinical experience and long-term educational needs of UK trainees. // Design and setting: A web-based nationwide survey of all UK gastroenterology specialty trainees was conducted in 2017. // Results: 100 trainees (14% of UK gastroenterology trainees) completed this survey. Only 9% and 16% of respondents believe that their local training programme adequately prepares them for the future clinical practice using genomic medicine and personalised medicine, respectively. Barriers identified include the need for greater trainee education (95%), inadequate clinical guidance to base interventions on the results of genomic testing (53%), concerns over misinterpretation by patients (43%) and overuse/misuse of testing by clinicians (34%). Survey respondents felt prepared to perform HFE genotyping (98%), assess TPMT status (97%) and interpret HLA subtyping for suspected coeliac disease (85%). However, only a minority felt prepared to perform the following investigations: polyposis screening (34%), hereditary pancreatitis screening (30%), testing for Lynch yndrome (33%) and KRAS testing for colorectal cancer (20%). Most respondents would support holding dedicated training days on genomic medicine (83%), formal training provisions for the mainstreaming of genomic testing (64%), an update to the UK gastroenterology specialty training curriculum and examinations (57%) and better-defined referral pathways for local genomic services (91%). // Conclusion: Most gastroenterology trainees in this survey feel ill equipped to practise genomic and personalised medicine as consultants. We propose specific revisions to the UK gastroenterology specialty curriculum that addresses trainees needs

Kin but less than kind:within-group male relatedness does not increase female fitness in seed beetles

Theory maintains within-group male relatedness can mediate sexual conflict by reducing male-male competition and collateral harm to females. We tested whether male relatedness can lessen female harm in the seed beetle Callosobruchus maculatus. Male relatedness did not influence female lifetime reproductive success or individual fitness across two different ecologically relevant scenarios of mating competition. However, male relatedness marginally improved female survival. Because male relatedness improved female survival in late life when C. maculatus females are no longer producing offspring, our results do not provide support for the role of within-group male relatedness in mediating sexual conflict. The fact that male relatedness improves the post-reproductive part of the female life cycle strongly suggests that the effect is non-adaptive. We discuss adaptive and non-adaptive mechanisms that could result in reduced female harm in this and previous studies, and suggest that cognitive error is a likely explanation

Lipid Oxidation and Sensory Characteristics of Grass-Fed Beef: Effect of Duration of Grazing Prior to Slaughter

Beef from cattle produced from grass has a higher concentration of fatty acids considered to be beneficial to human health than beef produced from more intensive production systems and this increase in fatty acid concentration is dependant on the duration at pasture prior to slaughter (Noci et al., 2003). Improvements in the fatty acid composition of beef must not impair other quality characteristics of beef. Little information is available on the pattern of change of quality characteristics in grazing animals. The objective of this study was to determine the shelf-life and eating quality of beef from cattle produced from a standard Irish grass silage/concentrates finishing system but allowed to graze grass for different periods prior to slaughter

Coping Among Breast Cancer Survivors: A Confirmatory Factor Analysis of the Brief COPE

BACKGROUND AND PURPOSE: Cancer survivors continue to cope with significant stressors after completing treatment. The Brief COPE (Carver, 1997) is frequently used to measure coping; however, its factor structure remains unclear. The purpose of this study was to determine the best factor conceptualization of the Brief COPE for use among breast cancer survivors. METHODS: Breast cancer survivors (N = 1,127) completed the Brief COPE. We conducted confirmatory factor analyses comparing several a priori models based on research in cancer-relevant populations. RESULTS: Of the eight models examined, the 14-factor model of the Brief COPE showed the best fit. CONCLUSIONS: Despite efforts to simplify the structure of the Brief COPE, our results suggest coping among breast cancer survivors is best assessed using Carver's (1997) original 14-factor conceptualization

The effect of additive noise on dynamical hysteresis

We investigate the properties of hysteresis cycles produced by a one-dimensional, periodically forced Langevin equation. We show that depending on amplitude and frequency of the forcing and on noise intensity, there are three qualitatively different types of hysteresis cycles. Below a critical noise intensity, the random area enclosed by hysteresis cycles is concentrated near the deterministic area, which is different for small and large driving amplitude. Above this threshold, the area of typical hysteresis cycles depends, to leading order, only on the noise intensity. In all three regimes, we derive mathematically rigorous estimates for expectation, variance, and the probability of deviations of the hysteresis area from its typical value.Comment: 30 pages, 5 figure

Driving Errors in Parkinson’s Disease: Moving Closer to Predicting On-Road Outcomes

Age-related medical conditions such as Parkinson’s disease (PD) compromise driver fitness. Results from studies are unclear on the specific driving errors that underlie passing or failing an on-road assessment. In this study, we determined the between-group differences and quantified the on-road driving errors that predicted pass or fail on-road outcomes in 101 drivers with PD (mean age 5 69.38 ± 7.43) and 138 healthy control (HC) drivers (mean age 5 71.76 ± 5.08). Participants with PD had minor differences in demographics and driving habits and history but made more and different driving errors than HC participants. Drivers with PD failed the on-road test to a greater extent than HC drivers (41% vs. 9%), x2(1) 5 35.54, HC N 5 138, PD N 5 99, p \u3c .001. The driving errors predicting on-road pass or fail outcomes (95% confidence interval, Nagelkerke R2 5.771) were made in visual scanning, signaling, vehicle positioning, speeding (mainly underspeeding, t (61) 5 7.004, p \u3c .001, and total errors. Although it is difficult to predict on-road outcomes, this study provides a foundation for doing so