Knowledge of Driving Vehicle Licensing Agency guidelines among NHS doctors:A multicentre observational study

Objectives: Over half of the UK population holds a driver's licence. The DVLA have produced guidelines to ensure drivers with medical conditions drive safely. Doctors should ensure that patients are given appropriate information and advice if they have a medical condition affecting their driving. We sought to evaluate doctors' knowledge of DVLA guidelines. Design: A 25-point questionnaire was designed from DVLA guidelines (‘The DVLA Questionnaire’). Five questions were included for each of neurology, cardiology, drug and alcohol abuse, visual, and respiratory disorders. Setting: Ealing Hospital, Northwick Park Hospital, Watford General Hospital, Norfolk and Norwich University Hospital and Leeds Teaching Hospitals Trust. Participants: 140 UK doctors. Main outcome measures: Questionnaire scores assessing knowledge of DVLA guidelines in five specialty areas. Results: The median overall questionnaire score was 28%, interquartile range 20–36% and range 0–100% [Watford 28%, Leeds 30%, Norfolk and Norwich 36%, Ealing 30%, Northwick Park 28%]. There were no significant differences between the scores for each centre (p = 0.1332), Mean scores for specialty areas were: neurology 33.1%, standard deviation 22.1; cardiology 35.6%, standard deviation 26.9; drug and alcohol abuse 30.6%, standard deviation 23.8; visual disorders 33.9%, standard deviation 23.5 and respiratory disorders 20.3%, standard deviation 24.8; overall score 30.7%. There was no significant difference between the scores of the specialty areas (p = 0.4060). Conclusions: Knowledge of DVLA guidelines in our cohort was low. There is a need for increased awareness among hospital doctors through focused education on driving restrictions for common medical conditions. Improving physician knowledge in this area may help optimise patient safety

The effect of sleep restriction, with or without high-intensity interval exercise, on myofibrillar protein synthesis in healthy young men

© 2020 The Authors. The Journal of Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society. Key points: Sleep restriction has previously been associated with the loss of muscle mass in both human and animal models. The rate of myofibrillar protein synthesis (MyoPS) is a key variable in regulating skeletal muscle mass and can be increased by performing high-intensity interval exercise (HIIE), although the effect of sleep restriction on MyoPS is unknown. In the present study, we demonstrate that participants undergoing a sleep restriction protocol (five nights, with 4 h in bed each night) had lower rates of skeletal muscle MyoPS; however, rates of MyoPS were maintained at control levels by performing HIIE during this period. Our data suggest that the lower rates of MyoPS in the sleep restriction group may contribute to the detrimental effects of sleep loss on muscle mass and that HIIE may be used as an intervention to counteract these effects. Abstract: The present study aimed to investigate the effect of sleep restriction, with or without high-intensity interval exercise (HIIE), on the potential mechanisms underpinning previously-reported sleep-loss-induced reductions to muscle mass. Twenty-four healthy, young men underwent a protocol consisting of two nights of controlled baseline sleep and a five-night intervention period. Participants were allocated into one of three parallel groups, matched for age, (Formula presented.), body mass index and habitual sleep duration; a normal sleep (NS) group [8 h time in bed (TIB) each night], a sleep restriction (SR) group (4 h TIB each night), and a sleep restriction and exercise group (SR+EX, 4 h TIB each night, with three sessions of HIIE). Deuterium oxide was ingested prior to commencing the study and muscle biopsies obtained pre- and post-intervention were used to assess myofibrillar protein synthesis (MyoPS) and molecular markers of protein synthesis and degradation signalling pathways. MyoPS was lower in the SR group [fractional synthetic rate (% day–1), mean ± SD, 1.24 ± 0.21] compared to both the NS (1.53 ± 0.09) and SR+EX groups (1.61 ± 0.14) (P < 0.05). However, there were no changes in the purported regulators of protein synthesis (i.e. p-AKTser473 and p-mTORser2448) and degradation (i.e. Foxo1/3 mRNA and LC3 protein) in any group. These data suggest that MyoPS is acutely reduced by sleep restriction, although MyoPS can be maintained by performing HIIE. These findings may explain the sleep-loss-induced reductions in muscle mass previously reported and also highlight the potential therapeutic benefit of HIIE to maintain myofibrillar remodelling in this context

The Work of Cultural Intermediaries and the Enduring Distance between Production and Consumption

This article raises some critical questions about cultural intermediaries as both a descriptive label and analytic concept. In doing so, it has two main aims. First, it seeks to provide some clarification, critique and suggestions that will assist in the elaboration of this idea and offer possible lines of enquiry for further research. Second, it is argued that whilst studying the work of cultural intermediaries can provide a number of insights, such an approach provides only a partial account of the practices that continue to proliferate in the space between production and consumption. Indeed, in significant ways, a focus on cultural intermediaries reproduces rather than bridges the distance between production and consumption. The paper focuses on three distinct issues. First, some questions are raised about the presumed special significance of cultural intermediaries within the production/consumption relations of contemporary capitalism. Second, how 'creative' and active cultural intermediaries are within processes of cultural production is discussed. Third, specific strategies of inclusion/exclusion adopted by this occupational grouping are highlighted in order to suggest that access to work providing 'symbolic goods and services' is by no means as fluid or open as is sometimes claimed

Genome-wide association study identifies 30 loci associated with bipolar disorder.

Bipolar disorder is a highly heritable psychiatric disorder. We performed a genome-wide association study (GWAS) including 20,352 cases and 31,358 controls of European descent, with follow-up analysis of 822 variants with P &lt; 1 × 10-4 in an additional 9,412 cases and 137,760 controls. Eight of the 19 variants that were genome-wide significant (P &lt; 5 × 10-8) in the discovery GWAS were not genome-wide significant in the combined analysis, consistent with small effect sizes and limited power but also with genetic heterogeneity. In the combined analysis, 30 loci were genome-wide significant, including 20 newly identified loci. The significant loci contain genes encoding ion channels, neurotransmitter transporters and synaptic components. Pathway analysis revealed nine significantly enriched gene sets, including regulation of insulin secretion and endocannabinoid signaling. Bipolar I disorder is strongly genetically correlated with schizophrenia, driven by psychosis, whereas bipolar II disorder is more strongly correlated with major depressive disorder. These findings address key clinical questions and provide potential biological mechanisms for bipolar disorder

“Public Service” and the Journalism Crisis: Is the BBC the Answer?

Professional journalism is under extraordinary pressure: not only are its traditional business models under enormous strain but it is also regularly accused by the Right of peddling ‘fake news’ and criticized by the Left for failing to play a robust monitorial role. In this situation, there is a temptation to see public service media, and the BBC in particular, as beacons of light in an otherwise gloomy picture. This article attempts to provide a note of caution to those who see the public service model as the most effective means of holding power to account and as the most desirable alternative to the flawed news cultures of both commercial and authoritarian landscapes. It considers some of the structural and institutional factors that constrain the BBC’s journalism and suggests that its intimate relationship with elite power has long undermined its ability to act as a reliable and independent check on power

Financial crisis and North-South gap within the main media groups in the EU

La crisis y los ajustes económicos en los grandes grupos de medios comunicación de la Unión Europea han incrementado la brecha Norte-Sur en cuanto a solidez financiera, competitividad y capitalización, a favor de los modelos centroeuropeo y anglosajón. Los resultados financieros de los 93 mayores grupos y empresas del sector en la UE evidencian no sólo los efectos perniciosos de la financiarización y la coyuntura económica, sino también el incremento de las divergencias regionales en la UE-28. Los países mediterráneos, con los peores resultados, son los más expuestos a estos peligros y muestran los escasos avances en la convergencia del sector mediático europeo en cuanto a gestión económica y solidez para cumplir sus cometidos sociales. La crisis ha reforzado la posición de los grupos mediáticos del Norte frente a un debilitado Sur, que ya partía de una mayor dependencia por su mayor exposición a intereses partidistas. La difusión diaria de prensa en la UE bajó de 115,33 millones de ejemplares distribuidos en 2008 a 82,54 millones en 2012, un 27,73% menos. El 64,5% de los grandes medios cotizados en la UE-28 se concentra en cinco países. El 52,7% de los medios cuenta con participaciones significativas de instituciones financierasThe financial crisis and the economic adjustments within the most important media groups of the European Union (EU) have enlarged the North-South gap regarding financial strength, competitiveness and capitalisation, favouring Center European and UK patterns. The financial results of the 93 biggest media groups and enterprises in the EU provide evidence of not only the pernicious effects of financialization, but also the increase of regional divergences within the EU-28. The Mediterranean countries, which have got the worst results in all of the indicators analysed, are the most exposed to those dangers and confirm the poor advances of the media sector regarding convergence of management and economic solidity, at the expense of their capability to fulfil their social aims. The crisis has strengthened the position of the media groups in the North in front of the weakened South, that already had a greater dependence by its greater exposure to partisan interests. The daily circulation of press in the EU fell from 115.33 million copies distributed in 2008 to 82.54 in 2012, 27.73% less. 64.5% of the major media listed in the EU-28 is concentrated in five countries. 52.7% of the media has significant holdings in financial institutionsS

Characterisation of age and polarity at onset in bipolar disorder

Background Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools. Aims To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics. Method Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts. Results Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO. Conclusions AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses

Dissecting the Shared Genetic Architecture of Suicide Attempt, Psychiatric Disorders, and Known Risk Factors

Background Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. Methods We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. Results Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. Conclusions Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.Peer reviewe