Is any but a tiny fraction of handedness variance likely to be due to the external environment?

Non-shared environmental variance (NSEV) accounts for 76% of variance in genetic modelling of handedness. However, it is very misleading to suggest that NSEV, "highlights the importance of non-genetic factors for the ontogenesis of hemispheric asymmetries". NSEV is poorly named, is calculated only by subtraction, and provides no direct evidence for environmental effects in the sense of the external environment. Miller suggested that it would be better named as "residual effect". Mitchell has suggested that much or indeed most of NSEV is "developmental variance" and should be included under the heading of nature rather than nurture, and in handedness, "largely reflect[s] the outcome of randomness in brain development". Overall only a very small proportion of NSEV in handedness is likely to be related to external environmental factors in the usual sense of the term.

Factors affecting recruitment into General Practice: a double binary choice approach.

Recruitment to General Practice (GP) is currently low in many countries. Here we focus on two binary choices for junior doctors: first, whether to apply to GP; second, whether to accept a GP training place if offered. Previous attitudinal studies have indicated factors claimed to affect recruitment. The current study goes further by quantifying the relative impact of different factors on the propensity of candidates to apply to GP and accept a training place. An online questionnaire was sent to candidates applying to United Kingdom (UK) specialty training in 2015. Descriptive statistics and a path analysis evaluated the importance of various factors on GP applications. Our results were synthesised with an analysis of data from the online applications portal. With 3838 candidates responding to the survey, the path analysis showed that personality and previous GP experiences were strongly associated with the decision to apply. There was some evidence that it was easier to enter GP than other specialties; in terms of deciding whether to accept, the evidence suggests GP was a backup plan for around 9% of candidates who accepted a GP post. Our results indicate that recruitment initiatives should focus on candidates who apply to GP but not as first choice or consider GP but do not apply, particularly by providing substantial experience of GP and accentuating the positives of the specialty such as work-life balance and the intellectual challenge of working with patients in primary care. Acceptance of a GP place may also depend on competition for places in other specialties.

Using recruitment and selection to build a primary care workforce for the future.

Recruitment and selection are critical components of human resource management. They influence both the quantity and quality of the healthcare workforce. In this article, we use two different examples of primary care workers, General Practitioners in the UK and Community Health Workers in low- and middle- income countries, to illustrate how recruitment and selection are, and could be, used to enhance the primary care workforce in each setting. Both recruitment and selection can be costly, so when funding is limited, decisions on how to spend the human resources budget must be made. It could be argued that human resource management should focus on recruitment in a seller's market (an insufficient supply of applicants) and on selection in a buyer's market (sufficient applicants but concerns about their quality). We use this article to examine recruitment and selection in each type of market and highlight the interactions between these two human resource management decisions. Recruitment and selection, we argue, must be considered in both types of market; particularly in sectors where workers' labour impacts upon population health. We note the paucity of high-quality research in recruitment and selection for primary care and the need for rigorous study designs such as randomised trials.

The UK medical education database (UKMED) what is it? Why and how might you use it?

BACKGROUND: Educating doctors is expensive and poor performance by future graduates can literally cost lives. Whilst the practice of medicine is highly evidence based, medical education is much less so. Research on medical school selection, undergraduate progression, Fitness to Practise (FtP) and postgraduate careers has been hampered across the globe by the challenges of uniting the data required. This paper describes the creation, structure and access arrangements for the first UK-wide attempt to do so. OVERVIEW: A collaborative approach has created a research database commencing with all entrants to UK medical schools in 2007 and 2008 (UKMED Phase 1). Here the content is outlined, governance arrangements considered, system access explained, and the potential implications of this new resource discussed. The data currently include achievements prior to medical school entry, admissions tests, graduation point information and also all subsequent data collected by the General Medical Council, including FtP, career progression, annual National Training Survey (NTS) responses, career choice and postgraduate exam performance data. UKMED has grown since the pilot phase with additional datasets; all subsequent years of students/trainees and stronger governance processes. The inclusion of future cohorts and additional information such as admissions scores or bespoke surveys or assessments is now being piloted. Thus, for instance, new scrutiny can be applied to selection techniques and the effectiveness of educational interventions. Data are available free of charge for approved studies from suitable research groups worldwide. CONCLUSION: It is anticipated that UKMED will continue on a rolling basis. This has the potential to radically change the volume and types of research that can be envisaged and, therefore, to improve standards, facilitate workforce planning and support the regulation of medical education and training. This paper aspires to encourage proposals to utilise this exciting resource.

Applied Sports Nutrition Support, Dietary Intake and Body Composition Changes of a Female Athlete Completing 26 Marathons in 26 Days: A Case Study.

The aim of this case study is to describe the nutrition practices of a female recreational runner (VO2max 48.9 ml·kg-1·min-1) who completed 26 marathons (42.195 km) in 26 consecutive days. Information relating to the nutritional intake of female runners during multi-day endurance events is extremely limited, yet the number of people participating year-on-year continues to increase. This case study reports the nutrition intervention, dietary intake, body composition changes and performance in the lead-up and during the 26 days. Prior to undertaking the 26 marathon challenge, three consultations were held between the athlete and a sports nutrition advisor; planning and tailoring the general diet and race-specific strategies to the endurance challenge. During the marathons, the mean energy and fluid intake was 1039.7 ± 207.9 kcal (607.1 - 1453.2) and 2.39 ± 0.35 L (1.98 - 3.19). Mean hourly carbohydrate intake was 38.9 g·hr-1. 11 days following the completion of the 26 marathons, body mass had reduced by 4.6 kg and lean body mass increasing by 0.53 kg when compared with 20 days prior. This case study highlights the importance of providing general and event-specific nutrition education when training for such an event. This is particularly prudent for multi-day endurance running events.

The effects of 7-week participation in football on personal well-being among male asylum seekers in a UK hotel.

Background: This study examines the impact of participating in a seven-week football programme on the personal well-being of male asylum seekers residing in contingency accommodation in the UK. Methods: This repeated measures study included a cohort of participants who engaged in weekly football sessions and completed a well-being questionnaire (ONS4) over a continuous seven-week period. Longitudinal linear regression analysis using generalized estimating equations (GEE) was used to assess the relationship between personal well-being and weekly minutes of football participation (M1). A second model incorporating the total number of non-football activity sessions in the past week as a covariate was also implemented (M2). Results: Of the 73 participants who completed the questionnaire, 23 responded twice or more across the study period and were subsequently included in the analysis. Results revealed that 2 h of football participation within 7 days significantly improved aspects of personal well-being when compared with no football participation, including improved life satisfaction, feeling life is worthwhile, and happiness. Both models demonstrated a shift from 'low' to 'medium' ONS4 categorical score. Anxiety levels remained unchanged regardless of participation and model. Conclusion: We provide important evidence on the potential benefits of football participation for promoting personal well-being among male asylum seekers residing in contingency accommodation.

Cold-Water Immersion and Lower Limb Muscle Oxygen Consumption as Measured by Near-Infrared Spectroscopy in Trained Endurance Athletes.

CONTEXT: Cold-water immersion (CWI) has been reported to reduce tissue metabolism postimmersion, but physiological data are lacking regarding the muscle metabolic response to its application. Near-infrared spectroscopy (NIRS) is a noninvasive optical technique that can inform muscle hemodynamics and tissue metabolism. OBJECTIVE: To investigate the effects of CWI at 2 water temperatures (10°C and 15°C) on NIRS-calculated measurements of muscle oxygen consumption (mVO2). DESIGN: Crossover study. SETTING: University sports rehabilitation center. PATIENTS OR OTHER PARTICIPANTS: A total of 11 male National Collegiate Athletic Association Division II long-distance runners (age = 23.4 ± 3.4 years, height = 1.8 ± 0.1 m, mass = 68.8 ± 10.7 kg, mean adipose tissue thickness = 6.7 ± 2.7 mm). INTERVENTION(S): Cold-water immersion at 10°C and 15°C for 20 minutes. MAIN OUTCOME MEASURE(S): We calculated mVO2 preimmersion and postimmersion at water temperatures of 10°C and 15°C. Changes in tissue oxyhemoglobin (O2Hb), deoxyhemoglobin (HHb), total hemoglobin (tHb), hemoglobin difference (Hbdiff), and tissue saturation index (TSI %) were measured during the 20-minute immersion at both temperatures. RESULTS: We observed a decrease in mVO2 after immersion at both 10°C and 15°C (F1,9 = 27.7801, P = .001). During the 20-minute immersion at both temperatures, we noted a main effect of time for O2Hb (F3,27 = 14.227, P = .001), HHb (F3,27 = 5.749, P = .009), tHb (F3,27 = 24.786, P = .001), and Hbdiff (F3,27 = 3.894, P = .020), in which values decreased over the course of immersion. Post hoc pairwise comparisons showed that these changes occurred within the final 5 minutes of immersion for tHb and O2Hb. CONCLUSIONS: A 20-minute CWI at 10°C and 15°C led to a reduction in mVO2. This was greater after immersion at 10°C. The reduction in mVO2 suggests a decrease in muscle metabolic activity (ie, O2 use after CWI). Calculating mVO2 via the NIRS-occlusion technique may offer further insight into muscle metabolic responses beyond what is attainable from observing the NIRS primary signals.

Genotypic Variations Associated with Changes in Body Mass in Response to Endurance Training.

This study investigates the extent to which different genotypes can explain changes in body mass following an 8-week running program, in a UK population. Participants were randomly assigned to either a training (n = 17) or control group (n = 21). Participants' diets were not altered, only the exercise regime was manipulated to isolate effects. The exercise group completed a periodized running program consisting of 20-30 min, over an agreed route, three times per-week, whilst the control groups refrained from daily exercise. Participants were screened at the end of the study for 1,000 gene variants using a DNA test kit. Results demonstrated a significant reduction in body mass, within the exercise, compared to the control group (p = .002). This reduction in body mass varied significantly (p = .024) between individuals within the exercise group. Moreover, genetic analysis identified 17 single nucleotide polymorphisms (SNPs) associated with this variation (r2 = .74; p < .001). These findings indicate that individuals with specific alleles are better predisposed to weight-management, compared to their counterparts, following an exercise program. This study helps to bridge the gap between population health and exercise science and can inform research in the application of genetics to help develop individually tailored health interventions.

Blood pressure control among US veterans: a large multiyear analysis of blood pressure data from the Veterans Administration health data repository.

BACKGROUND: Hypertension treatment and control remain low worldwide. Strategies to improve blood pressure control have been implemented in the United States and around the world for several years. This study was designed to assess improvement in blood pressure control over a 10-year period in a large cohort of patients in the Department of Veterans Affairs. METHODS AND RESULTS: A cohort of 582 881 hypertensive patients and 260 924 normotensive individuals treated in 15 Department of Veterans Affairs medical centers between 2000 and 2010 were examined. Strategies used system-wide included blood pressure control as a performance measure, automatic notification to healthcare providers, electronic reminders, and a systematic revisit schedule. The main outcome measure was the percentage of hypertensive patients whose hypertension was controlled and the level of blood pressure each month. In the hypertensive cohort (mean age 62.9±13.4 years, 96.0% male), 52.3% of patients were white, 25.1% were black, and 21.1% were Hispanic. Blood pressure control rates improved from 45.7% in September 2000 to 76.3% in August 2010. Improvements were similar across ethnic, racial, age, and sex groups. Average systolic/diastolic blood pressure decreased from 142.6/77.1 mm Hg in 2000 to 131.2/74.8 mm Hg in 2010, a decrease of 11.3/2.3 mm Hg (P<0.0001 for both). Systolic and diastolic blood pressures were lower in summer than in winter, and this trend continued through 2010. On average, control rates increased by 3.0% per year and were 6.8% higher in summer than in winter. CONCLUSIONS: High rates of blood pressure control can be achieved in all age and ethnic groups and in both sexes.

Ellis-van Creveld syndrome: its history.

The story of Ellis-van Creveld syndrome is one of serendipity. By chance, Simon van Creveld and Richard Ellis purportedly met on a train and combined their independently encountered patients with short stature, dental anomalies and polydactyly into one landmark publication in 1940. They included a patient used in work published previously by Rustin McIntosh without naming McIntosh as a coauthor. This patient was followed radiologically by Caffey for nearly two decades. In 1964, Victor McKusick felt compelled to investigate a brief report in an obscure pharmaceutical journal on an unusual geographic cluster of short-statured Amish patients in Pennsylvania. This review highlights the lives of the individuals involved in the discovery of Ellis-van Creveld syndrome in their historic context.

"The anti-developmental, the anti-narrative, the anti-historical": Mondrian as a paradigmatic artist for empirical aesthetics.

In addition to general criticisms of scientific studies on empirical aesthetics, Bullot & Reber (B&R) particularly criticise two "representative studies" that manipulated paintings by Mondrian, those studies seemingly, "fail[ing] to consider the predictions suggested by a contextualist approach to the appreciation of imbalance" (sect. 4.2, para.2). Those criticisms are unjustified, both within the approaches of empirical aesthetics and the historical context and aims of Mondrian's work.

The feasibility, safety, and efficacy of lower limb garment-integrated blood flow restriction training in healthy adults.

OBJECTIVES: Explore the feasibility of lower-limb garment-integrated BFR-training. DESIGN: Observational study. SETTING: Human performance laboratory. PARTICIPANTS: Healthy males with no experience of BFR-training. MAIN OUTCOME MEASURES: Feasibility was determined by a priori thresholds for recruitment, adherence, and data collection. Safety was determined by measuring BFR torniquet pressure and the incidence of side effects. Efficacy was determined by measuring body anthropometry and knee isokinetic dynamometry. Feasibility and safety outcomes were reported descriptively or as a proportion with 95% confidence intervals (95% CI), with mean change, 95% CIs, and effect sizes for efficacy outcomes. RESULTS: Twelve participants (mean age 24.8 years [6.5]) were successfully recruited; 11 completed the study. 134/136 sessions were completed (adherence = 98.5%) and 100% of data were collected. There was one event of excessive pain during exercise (0.7%, 95% CI 0.0%, 4.0%), two events of excessive pain post-exercise (1.5%, 95% CI 0.4%, 5.5%), and one event of persistent paraesthesia post-exercise (0.7%, 95% CI 0.0%, 4.0%). Mean maximal BFR torniquet pressure was <200 mmHg. We observed an increase in knee extension peak torque (mean change 12.4 Nm), but no notable changes in body anthropometry. CONCLUSIONS: Lower-limb garment-integrated BFR-training is feasible, has no signal of important harm, and could be used independently.

Changing PACES: developments to the examination in 2009.

As a consequence of change in medical, educational and regulatory practice, MRCP(UK) successfully modified the international PACES examination in 2009. This brief paper explains the rationale for change and summarises the development and implementation process.

Assessment for selection for the health care professions and specialty training: consensus statement and recommendations from the Ottawa 2010 Conference.

Assessment for selection in medicine and the health professions should follow the same quality assurance processes as in-course assessment. The literature on selection is limited and is not strongly theoretical or conceptual. For written testing, there is evidence of the predictive validity of Medical College Admission Test (MCAT) for medical school and licensing examination performance. There is also evidence for the predictive validity of grade point average, particularly in combination with MCAT for graduate entry but little evidence about the predictive validity of school leaver scores. Interviews have not been shown to be robust selection measures. Studies of multiple mini-interviews have indicated good predictive validity and reliability. Of other measures used in selection, only the growing interest in personality testing appears to warrant future work. Widening access to medical and health professional programmes is an increasing priority and relates to the social accountability mandate of medical and health professional schools. While traditional selection measures do discriminate against various population groups, there is little evidence on the effect of non-traditional measures in widening access. Preparation and outreach programmes show most promise. In summary, the areas of consensus for assessment for selection are small in number. Recommendations for future action focus on the adoption of principles of good assessment and curriculum alignment, use of multi-method programmatic approaches, development of interdisciplinary frameworks and utilisation of sophisticated measurement models. The social accountability mandate of medical and health professional schools demands that social inclusion, workforce issues and widening of access are embedded in the principles of good assessment for selection.

The attitudes, perceptions and experiences of medical school applicants following the closure of schools and cancellation of public examinations in 2020 due to the COVID-19 pandemic: a cross-sectional questionnaire study of UK medical applicants.

OBJECTIVE: Describe the experiences and views of medical applicants from diverse social backgrounds following the closure of schools and universities and the cancellation of public examinations in the UK due to COVID-19. DESIGN: Cross-sectional questionnaire study, part of the longitudinal UK Medical Applicant Cohort Study (UKMACS). SETTING: UK medical school admissions in 2020. PARTICIPANTS: 2887 participants completed an online questionnaire from 8 April to 22 April 2020. Eligible participants had registered to take the University Clinical Admissions Test in 2019 and agreed to be invited to take part, or had completed a previous UKMACS questionnaire, had been seriously considering applying to medicine in the UK for entry in 2020, and were UK residents. MAIN OUTCOME MEASURES: Views on calculated grades, views on medical school admissions and teaching in 2020 and 2021, reported experiences of education during the national lockdown. RESULTS: Respondents were concerned about the calculated grades that replaced A-level examinations: female and Black Asian and Minority Ethnic applicants felt teachers would find it difficult to grade and rank students accurately, and applicants from non-selective state schools and living in deprived areas had concerns about the standardisation process. Calculated grades were generally not considered fair enough to use in selection, but were considered fair enough to use in combination with other measures including interview and aptitude test scores. Respondents from non-selective state (public) schools reported less access to educational resources compared with private/selective school pupils, less online teaching in real time and less time studying during lockdown. CONCLUSIONS: The COVID-19 pandemic has and will have significant and long-term impacts on the selection, education and performance of our medical workforce. It is important that the views and experiences of applicants from diverse backgrounds are considered in decisions affecting their future and the future of the profession.

Investigating Friendship Difficulties in the Pathway from ADHD to Depressive Symptoms. Can Parent-Child Relationships Compensate?

Attention deficit/hyperactivity disorder (ADHD) is associated with friendship difficulties. This may partly account for the increasingly recognised association between ADHD and subsequent depression. Little is known about the types of friendship difficulties that could contribute to the association between ADHD and depressive symptoms and whether other relationships, such as parent-child relationships, can mitigate against potential adverse effects of friendship difficulties. In a representative UK school sample (n = 1712), three main features of friendship (presence of friends, friendship quality and characteristics of the individual's classroom friendship group) were assessed in a longitudinal study with two assessment waves (W1, W2) during the first year of secondary school (children aged 11-12 years). These friendship features (W1) were investigated as potential mediators of the prospective association between teacher-rated ADHD symptoms (W1) and self-rated depressive symptoms (W2) seven months later. Parent-child relationship quality (W1) was tested as a moderator of any indirect effects of ADHD on depression via friendship. ADHD symptoms were inversely associated with friendship presence, friendship quality and positive characteristics of classroom friendship groups. Depressive symptoms were inversely associated with presence and quality of friendships. Friendship quality had indirect effects in the association between ADHD and subsequent depressive symptoms. There was some evidence of moderated mediation, whereby indirect effects via friendship quality attenuated slightly as children reported warmer parent-child relationships. This highlights the importance of considering the quality of friendships and parent-child relationships in children with ADHD symptoms. Fostering good quality relationships may help disrupt the link between ADHD symptomology and subsequent depression risk.

Reversed bodies, reversed brains, and (some) reversed behaviors: of zebrafish and men.

Although zebrafish with situs inversus show complete reversal of normal visceral and cerebral asymmetries, they show left-right reversal of only some behaviors, with others continuing to show species-typical lateralization. The implication is that, as in humans, there are at least two independent mechanisms for generating asymmetry.

A pre-post test evaluation of the impact of the PELICAN MDT-TME Development Programme on the working lives of colorectal cancer team members.

BACKGROUND: The PELICAN Multidisciplinary Team Total Mesorectal Excision (MDT-TME) Development Programme aimed to improve clinical outcomes for rectal cancer by educating colorectal cancer teams in precision surgery and related aspects of multidisciplinary care. The Programme reached almost all colorectal cancer teams across England. We took the opportunity to assess the impact of participating in this novel team-based Development Programme on the working lives of colorectal cancer team members. METHODS: The impact of participating in the programme on team members' self-reported job stress, job satisfaction and team performance was assessed in a pre-post course study. 333/568 (59%) team members, from the 75 multidisciplinary teams who attended the final year of the Programme, completed questionnaires pre-course, and 6-8 weeks post-course. RESULTS: Across all team members, the main sources of job satisfaction related to working in multidisciplinary teams; whilst feeling overloaded was the main source of job stress. Surgeons and clinical nurse specialists reported higher levels of job satisfaction than team members who do not provide direct patient care, whilst MDT coordinators reported the lowest levels of job satisfaction and job stress. Both job stress and satisfaction decreased after participating in the Programme for all team members. There was a small improvement in team performance. CONCLUSIONS: Participation in the Development Programme had a mixed impact on the working lives of team members in the immediate aftermath of attending. The decrease in team members' job stress may reflect the improved knowledge and skills conferred by the Programme. The decrease in job satisfaction may be the consequence of being unable to apply these skills immediately in clinical practice because of a lack of required infrastructure and/or equipment. In addition, whilst the Programme raised awareness of the challenges of teamworking, a greater focus on tackling these issues may have improved working lives further.

Half a century of handedness research: Myths, truths; fictions, facts; backwards, but mostly forwards.

Although most people are right-handed and have language in their left cerebral hemisphere, why that is so, and in particular why about ten per cent of people are left-handed, is far from clear. Multiple theories have been proposed, often with little in the way of empirical support, and sometimes indeed with strong evidence against them, and yet despite that have become modern urban myths, probably due to the symbolic power of right and left. One thinks in particular of ideas of being right-brained or left-brained, of suggestions that left-handedness is due to perinatal brain damage, of claims that left-handers die seven years earlier than right-handers, and of the unfalsifiable ramifications of the byzantine Geschwind-Behan-Galaburda theory. This article looks back over the past fifty years of research on brain asymmetries, exploring the different themes and approaches, sometimes in relation to the author's own work. Taking all of the work together it is probable that cerebral asymmetries are under genetic control, probably with multiple genetic loci, only a few of which are now beginning to be found thanks to very large databases that are becoming available. Other progress is also seen in proper meta-analyses, the use of fMRI for studying multiple functional lateralisations in large number of individuals, fetal ultra-sound for assessing handedness before birth, and fascinating studies of lateralisation in an ever widening range of animal species. With luck the next fifty years will make more progress and show fewer false directions than had much of the work in the previous fifty years.

Even one star at A level could be "too little, too late" for medical student selection.

BACKGROUND: More and more medical school applicants in England and Wales are gaining the maximum grade at A level of AAA, and the UK Government has now agreed to pilot the introduction of a new A* grade. This study assessed the likely utility of additional grades of A* or of A**. METHODS: Statistical analysis of university selection data collected by the Universities and Colleges Admissions Service (UCAS), consisting of data from 1,484,650 applicants to UCAS for the years 2003, 2004 and 2005, of whom 23,628 were medical school applicants, and of these 14,510 were medical school entrants from the UK, aged under 21, and with three or four A level results. The main outcome measure was the number of points scored by applicants in their best three A level subjects. RESULTS: Censored normal distributions showed a good fit to the data using maximum likelihood modelling. If it were the case that A* grades had already been introduced, then at present about 11% of medical school applicants and 18% of entrants would achieve the maximum score of 3 A*s. Projections for the years 2010, 2015 and 2020 suggest that about 26%, 35% and 46% of medical school entrants would have 3 A* grades. CONCLUSION: Although A* grades at A level will help in medical student selection, within a decade, a third of medical students will gain maximum grades. While revising the A level system there is a strong argument, as proposed in the Tomlinson Report, for introducing an A** grade.