"Extreme" or tariff sports: their injuries and their prevention (with particular reference to diving, cheerleading, gymnastics, and figure skating).

The interface between sports medicine and performing arts medicine is closest for "tariff" sports, where the sportsperson can select their own programme of varying difficulty with the more complex skills carrying potential for higher marks. Inevitably, some performers over-reach themselves. Examples of injuries and prevention strategies to avoid such injuries are discussed in a preliminary analysis of four sports: diving, cheerleading, gymnastics, and figure skating.

Hypermobility in dance: asset, not liability.

Opinions vary on whether joint hypermobility is an asset or liability in dance. This paper argues that it is an asset, the arguments for its being a liability often confounded by inadequate scoring systems inappropriately applied. The ambiguity and distress this presents to dancers, the several different causes of joint hypermobility and the separate needs of the many different diverse styles of dance are all discussed. A strategy for the future care and training of hypermobile dancers is proposed.

Differential expression of glutamate receptor subtypes in human brainstem sites involved in perinatal hypoxia-ischemia.

This study delineates the development of N-methyl-D-aspartate (NMDA) and non-NMDA receptor binding in the human brainstem, particularly as it relates to issues of the trophic effects of glutamate, the glutamate-mediated ventilatory response to hypoxia, and regional excitotoxic vulnerability to perinatal hypoxia-ischemia. We used tissue autoradiography to map the development of binding to NMDA, alpha-amino-3-hydroxy-5-methyl-4-isoxazole-proprionate (AMPA), and kainate receptors in brainstem sites involved in the glutamate ventilatory response to hypoxia, as well as recognized sites vulnerable to perinatal hypoxia-ischemia. NMDA receptor/channel binding was virtually undetectable in all regions of the human fetal brainstem at midgestation, an unexpected finding given the trophic role for NMDA receptors in early central nervous system maturation in experimental animals. In contrast, non-NMDA (AMPA and kainate) receptor binding was markedly elevated in multiple nuclei at midgestation. Although NMDA binding increased between midgestation and early infancy to moderately high adult levels, AMPA binding dramatically fell over the same time period to low adult levels. High levels of kainate binding did not change significantly between midgestation and infancy, except for an elevation in the infant compared with fetal inferior olive; after infancy, kainate binding decreased to negligible adult levels. Our data further suggest a differential development of components of the NMDA receptor/channel complex. This baseline information is critical in considering glutaminergic mechanisms in human brainstem development, physiology, and pathology.

Clinical practice arrangements of physician faculty in family practice residency programs.

BACKGROUND AND OBJECTIVES: This descriptive study sought information on the types of clinical practice arrangements and the nature of clinical responsibilities of full-time physician faculty in family practice residency programs. METHODS: A four-page, 37-item, self-administered questionnaire was sent to a 20% proportionate, systematic randomly sampled group of family practice faculty. Simple descriptive statistics were used for demographic and clinical practice data. Clinical practice characteristics were compared by the three most frequent clinical practice arrangements (private practice, on-site practice, and off-site practice) to determine differences. RESULTS: The majority of respondents were white, board-certified males. Most faculty saw patients two (26.9%) or three (27.7%) half days per week and between 6-10 (47.5%) and 11-15 (41.1%) patients per session. The most frequent clinical practice arrangements were having faculty see patients in their own private practice (5.3%), as part of the faculty practice in the residency program's health center (72.9%), and as part of the faculty practice remote from the residency program's health center (11.7%). There were no differences among the three arrangements with respect to clinical sessions per week, taking call at night to back up the resident on call, seeing patients outside of regularly scheduled office hours, making house calls, following patients in the nursing home, or offering pregnancy care. CONCLUSIONS: Further research is needed to determine the advantages and disadvantages of different clinical practice arrangements for the clinical skills and role-modeling ability of family physician faculty.

Five-year follow-up of a nurse-initiated intervention to improve mammography recommendation.

BACKGROUND: In a previous study we found immediate effectiveness of a nurse-initiated intervention on improving mammography recommendation rates in a family practice residency program. To determine the long-term effectiveness of this ongoing intervention, we performed a chart audit study on two different groups of charts 5 years after the institution of the intervention. METHODS: Chart audits for mammogram recommendation and completion rates were conducted on an original cohort group of women aged 40 years and older (n = 91) and a new 5-year postintervention group of women aged 53 years and older (n = 189). Preintervention, postintervention, and 5-year postintervention rates were compared within the cohort group. Rates of the new 5-year postintervention group were compared with rates of women 50 years and older from the original preintervention group and postintervention group. RESULTS: For the original cohort group the improvement in "mammograms done at least once in the past 3 years" was maintained 5 years later, and there was a statistically significant increased rate from the postintervention to 5 years later (73.9 percent versus 86.8 percent, P < 0.02) for "mammograms done or recommended at least once in the past 3 years." This improvement was also noted for the new 5-year postintervention group when their rates were compared with the preintervention and postintervention group rates. For "mammograms done at least once in the past 3 years," the rates were 34.2 percent, 45.5 percent, and 64 percent, respectively. For "mammograms done or recommended at least once in the past 3 years," the rates were 42.6 percent, 72.7 percent, and 90.0 percent, respectively. In a separate analysis, annual mammogram rates in the new 5-year postintervention group for the 3 years preceding this study were 44.8 percent (1990), 36.5 percent (1991), and 36.5 percent (1992). Eleven percent of women had a mammogram done in each of the 3 consecutive years. CONCLUSION: An ongoing nurse-initiated intervention is a feasible method of improving and maintaining mammogram recommendation and completion rates. Further studies of interventions to improve the rate at which eligible women get consecutive annual mammograms are needed.

Improving mammography recommendation: a nurse-initiated intervention.

We attempted to improve our compliance with recommendations for screening mammography, according to the American Cancer Society (ACS) guidelines, for eligible women patients seen by family practice residents by using a multipart intervention designed to eliminate identified barriers of knowledge and behavior on the part of the residents. Copies of the ACS cancer screening guidelines were posted in all examination and conference rooms and were provided to all residents. The intervention addressing the behavioral barriers had three components: (1) identification by the nursing staff of eligible women who were overdue for a mammogram as they presented for care, (2) completion of a checklist by residents indicating whether a mammogram was or was not recommended and why, and (3) a nurse-initiated backup reminder system for patients who escaped the primary checklist system. An audit of 200 preintervention and 270 postintervention charts showed statistically and clinically significant increases in mammograms recommended or done. Similar statistically significant increases were found in a cohort of 111 charts of patients in both the pre- and the postintervention audits. Results indicate that an intervention designed to eliminate identified resident-dependent barriers to compliance with screening mammography guidelines can be effective in increasing recommended mammography rates.

Identification and purification of the Lon+ (capR+) gene product, a DNA-binding protein.

The polypeptide product of the lon (capR) gene was identified and partially purified from bacterial strains homozygous for the capR(+) or capR9 (ochre mutation) alleles cloned with pSC101. A 94,000-dalton polypeptide was identified as the lon (capR) gene product. Studies of binding to DNA cellulose columns and nitrocellulose filters indicate that the capR(+) and capR9 proteins bind DNA.