The 'price' of Olympic Gold

In 1981 the Commonwealth Government established the Australian Institute of Sport (AIS). The Australian Sports Commission (ASC) which administers the AIS has 2 objectives: (1) excellence in sports performances; and (2) increased participation in sports and sports activities. State-based institutes of sport have also been established with the same or very similar objectives. Federal policy directs the bulk of the ASC budget to elite athlete programs. A smaller proportion goes towards community participation. The official reason is based on the notion of the 'trickle-down' or 'demonstration' effect. That is, a flow-on of benefits to the broader community in the form of increased participation as a direct result of elite sports success. The aims of this study were to determine the (1) spending pattern to elite sports programs for the 5 Olympics 1976/77 to 1995/96, (2) evidence for the two ASC objectives having been met, and (3) expected medal tally at the 2000 Olympic Games. Results show funding (in 1998 dollars), has accelerated from about $1.2 million (1976/77) to $106 million in (1997/98), particularly since the Games were awarded to Sydney. The total amount spent on elite athletes was $0.918 billion. In the period 1980-96 Australia won 25 gold and 115 total Olympic medals. This equates to approximately $37 million per gold and $8 million per medal in general. There was a significant linear relationship between money spent and total medals won. This was also found when all medal types were analysed independently. The predicted medal tally in 2000 (based on the cost per medal and the expenditure towards Sydney) indicates the medal count will be about 14+/-1 gold, 15+/-2 silver and 33+/-4 bronze. Based on our nation's record of international sporting achievement, there is little doubt we have fulfilled the ASC's first objective. Current data on physical activity patterns of Australians suggest the second objective has not been met. Focusing attention on and achieving the first objective does not appear to have any bearing on the second objective. It is time to revisit the notion that elite sporting success leads to greater mass participation as a result of the so-called 'trickle-down' effect.

Stroke-specific FIM models in an urban population

Data from the Functional Independence Measure (FIM) are important outcome measures in the stroke population undergoing rehabilitation. The FIM consists of 18 scales scored from 1 to 7; higher numbers mean greater ability. Several different scores can be obtained from the FIM: a total score (sum of all the scales), individual scale scores, and a physical and cognitive score (a two-dimensional interpretation). Research has shown that FIM data can have multidimensional components. That implies different groupings of scales may exist and with this the possibility of developing more sophisticated and robust measures within stroke populations. This study examined the multidimensional aspects of FIM using an urban sample of ischemic and hemorrhagic stroke patients. We found a three-dimensional FIM solution for both stroke groups that included self-care, cognitive function, and toileting as the major grouping of scales. These findings confirm a multidimensional nature of FIM scores and show a condition-specific pattern of FIM scores in stroke patients. This knowledge will help nurses, clinicians, and researchers develop more sensitive ways of recording care outcomes; improved prediction of stroke outcomes may also emerge from this knowledge.

Structure and alternative splicing of the gene encoding the human beta1 subunit of voltage dependent calcium channels

The structure of the gene encoding the human brain beta1 subunit of voltage dependent calcium channels (CACNB1) was determined by comparison of its genomic sequence with beta1 cDNA sequence. CACNB1 is distributed over 25 kb and contains 13 exons. Alternative splicing of CACNB1 RNA occurs within the central domain at exon 7, and the 3' domain at exon 13, producing the variably expressed beta1a, beta1b and beta1c isoforms. Exon/intron boundaries and exon lengths are conserved for the nine exons shared by the beta1 and related brain beta3 and beta4 genes.

The integrated exposure uptake biokinetic model for lead in children: independent validation and verification

The U.S. Environmental Protection Agency employs a model, the integrated exposure biokinetic (IEUBK) model for lead in children, for the assessment of risks to children posed by environmental lead at hazardous waste sites. This paper describes results of an effort to verify the consistency of the documentation with the computer model and to test the computer code using a group that is independent from those involved in the model development. This review concluded that the IEUBK model correctly calculates the equations specified in the IEUBK model theory documentation. However, several issues were identified on model documentation, model performance, and the C++ programming language code (i.e., IEUBK model source code) documentation. These issues affect the ability of an independent reviewer to understand the workings of the IEUBK model but not the model's reliability. As a result of these findings, recommendations have been provided for updating documentation to the model as well as associated adjustments to the model documentation.

Integrated exposure uptake biokinetic model for lead in children: empirical comparisons with epidemiologic data

The concept of model validation is evolving in the scientific community. This paper addresses the comparison of observed and predicted estimates as one component of model validation as applied to the integrated exposure uptake biokinetic (IEUBK) model for lead in children. The IEUBK model is an exposure (dose)-response model that uses children's environmental lead exposures to estimate risk of elevated blood lead (typically > 10 micrograms/dl) through estimation of lead body burdens in a mass balance framework. We used residence-specific environmental lead measurements from three epidemiologic datasets as inputs for the IEUBK model to predict blood lead levels, and compared these predictions with blood lead levels of children living at these residences. When the IEUBK modeling focused on children with representative exposure measurements, that is, children who spent the bulk of their time near the locations sampled, there was reasonably close agreement between observed and predicted blood lead distributions in the three studies considered. Geometric mean observed and predicted blood lead levels were within 0.7 microgram/dl, and proportions of study populations expected to be above 10 micrograms/dl were within 4% of those observed.

The anesthetic myopathies and malignant hyperthermias

Fatal destruction of skeletal muscle coincident with exposure to specific drugs used during anethesia has been recognized as a potentially heritable disorder for more than 30 years. Variable expressivity and incomplete penetrance of the clinical malignant hyperthermia phenotype, together with inherent drawbacks of the in-vitro contracture test confounded efforts to discover the underlying pathogenesis until the application of molecular genetic techniques. On the basis of linkage analysis and mapping of positional candidate genes, mutant alleles at loci on chromosomes 1q, (dihydropyridine-sensitive L-type calcium channel-A1S); 3q, 5p, 7q (dihydropyridine-sensitive L-type calcium channel-LA2), and 19q (ryanodine receptor) are now believed to account for up to 50% of human malignant hyperthermia susceptibility. Although inconsistent genotype-phenotype correlations and doubts regarding the causality of each mutant allele persist, the definition of malignant hyperthermia and relevance of molecular genetic data to the problems of family counseling, population screening, and improved resolution of the malignant hyperthermia phenotype must now be appraised in view of significant locus and allelic genetic heterogeneity.

Renal transplantation in a patient with methylmalonic acidaemia

Renal insufficiency is frequently reported in mutase-deficient methylmalonic acidaemia. We present a case report of a patient with mut- methylmalonic acidaemia who developed chronic tubulointerstitial nephropathy during adolescence. At 24 years of age, she developed end-stage renal failure and underwent renal transplantation. Both plasma and urine methylmalonic acid levels decreased significantly with improved renal function following transplantation. Complications included cyclosporin toxicity and development of diabetes. Renal, metabolic, and clinical status remained improved at 3 years after the kidney transplant.

Do IDSs really benefit from affiliating with managed care plans?

Integrated delivery systems (IDSs) affiliate with HMOs primarily to gain access to patients enrolled in managed care plans. Outright ownership of an HMO offers an IDS additional advantages, including opportunities to create a more seamless care process, improve patient outcomes, draw on the HMOs' experience in reducing costs, and administer health management and delivery at a significantly lower cost than the industry standard. The current trend toward IDS ownership of HMOs suggests that the line between providers and payers is blurring. Some states have encouraged this trend by enacting legislation that allows IDSs to act as insurers. Recent data indicate that IDSs with HMO components tend to be more vertically integrated than those without such components. These data suggest that close alignment with an HMO may be a key element in the effort to achieve vertical integration.

Hospital-based patient information services: a model for collaboration

Crouse Hospital in Syracuse, New York, is a 612-bed, not-for-profit teaching hospital with 2,500 employees. A close examination of operations at Crouse facilitated the development of a patient education task force that used a comprehensive, multidisciplinary approach to meet the educational needs of both patients and clinicians. The collaborative process involved all hospital departments. Within eighteen months, patient requests for information rose from 3% to 30% of total requests made at the hospital. Requests were made directly to the library or through a member of the health care team. Hospital staff members were surveyed about information needs and availability, and a library work plan was devised, setting standards of service for a multimedia approach. Work redesign improved the library staff's ability to integrate patient education into daily operations. Cost savings were achieved through the elimination of duplicated resources and services throughout the hospital. The management model developed at Crouse was the result of a needs assessment and a multidisciplinary, collaborative process. The model emphasizes communication links among disciplines rather than physical locations. The Crouse experience validates the development of hospital-based consumer health information services.

Polysome-associated mRNAs are substrates for the nonsense-mediated mRNA decay pathway in Saccharomyces cerevisiae

In eukaryotic cells, premature termination of translation at nonsense codons has been implicated as the cause of a variety of posttranscriptional events, including rapid mRNA decay in the cytoplasm or the nucleus, altered splice site selection, and exon skipping. In the yeast Saccharomyces cerevisiae, nonsense codons promote accelerated mRNA decay, and we sought to determine the cellular location in which this degradation occurs. In this report, we demonstrate that six different mRNAs, including nonsense-containing transcripts of the LEU2, HIS4, PGK1, and CYH2 genes, and two wild-type mRNAs (the MAT(alpha)1 and CYH2 mRNAs), were stabilized when the translation elongation inhibitor cycloheximide was added to cellular growth media. Subsequent removal of cycloheximide resulted in resumption of translation and degradation of wild-type and nonsense-containing mRNAs. A significant fraction of the CYH2 pre-mRNA that accumulated in the presence of cycloheximide was associated with polysomes, but disappeared from that fraction when decay resumed in the absence of the drug. Moreover, the abundance of the spliced and unspliced forms of the untranslated U3 snRNA was shown to be unaffected in strains harboring mutations that stabilize nonsense-containing mRNAs. Taken together, these observations indicate that nonsense-containing mRNAs in yeast are degraded within the polysome compartment of the cell.

Genotype-phenotype correlations of DHP receptor alpha 1-subunit gene mutations causing hypokalemic periodic paralysis

Hypokalemic periodic paralysis (hypoKPP) is an autosomal dominant or sporadic disorder characterized by periodic, reversible attacks of muscle weakness. Mutations in the skeletal muscle dihydropyridine receptor alpha 1-subunit that functions as a calcium channel (CACNL1A3) cause hypoKPP. We studied a group of 45 hypoKPP probands and demonstrated mutations in 30 of them. When compared with patients in whom CACNL1A3 mutations were not identified, those with mutations had an earlier age of onset and more often had a family history of hypoKPP. To date, three mutations have been identified. The R1239G mutation has only been found in one family. Of the 30 probands with recognized mutations, R528H accounted for 43% and R1239H was seen in 53%. Age of onset and potassium levels during attacks were lower in patients with the R1239H mutation than those with R528H. Cardiac dysrhythmias co-segregated with hypoKPP in one small kindred with the R528H mutation. No mutations were identified in exons of the gene encoding the S4 segments of domains one and three or the cytoplasmic loop between domains two and three. In addition to the 45 hypoKPP probands, an additional 11 probands with clinical variants of hypoKPP (three thyrotoxic hypoKPP and eight Andersen syndrome patients) were examined for CACNL1A3 mutations and none were found.

Brief report: two case studies using virtual reality as a learning tool for autistic children

The children complied with most requests. Some of our teaching goals were limited by technology or space while others were limited by the difficulty of presenting a task to the children in a way that was understandable within their environment. However, the opportunity to introduce this technology to children was an important first step in exploring the potential VR offers to understanding the perceptual processes involved in autism. Our results indicate that the will accept a VR helmet and wear it, identify familiar objects and qualities of these objects in their environment while using the helmet, and locate and move toward objects in their environment while wearing the helmet. More research is necessary to verify the potential in this area, especially to discover if learning experiences through VR generalize to other environments, but it appears virtual reality may provide a useful tool for furthering our understanding of autism and guiding efforts at treatment and intervention.

Prevalence of HIV infection among pregnant women in Newfoundland

OBJECTIVE

To determine the prevalence of HIV infection among pregnant women in Newfoundland.

DESIGN

Anonymous unlinked seroprevalence study.

SETTING

Newfoundland.

PATIENTS

A total of 14911 women receiving prenatal care or undergoing an abortion, representing nearly all pregnancies in Newfoundland from Nov. 1, 1991, to Oct. 31, 1993.

OUTCOME MEASURES

HIV antibody status, as determined by enzyme immunoassay of leftover serum samples (initially obtained for routine screening) and confirmation of reactive samples by the Western blot technique, health region of residence, and age group.

RESULTS

Of the 14911 serum samples 13 were positive for HIV, for an overall crude prevalence rate of 1 per 1147 or 8.7 per 10000 pregnant women (95% confidence interval [CI] 4.7 to 14.9). Seven of the positive samples were from women residing in the Eastern Health Region of the province, for a crude prevalence rate of 1 per 376 or 26.6 per 10000 pregnant women (95% CI 10.7 to 54.8) for that region. All women found to be HIV positive were 15 to 29 years of age, the peak prevalence (20.8 per 10000 pregnant women [95% CI 9.5 to 39.4]) was observed among those 20 to 24 years.

CONCLUSIONS

The overall prevalence rate of 8.7 per 10 000 pregnant women in Newfoundland is the highest provincial rate recorded among those from similar studies in Canada. Although it may be concluded that there are an estimated 125 HIV-positive women of childbearing age in Newfoundland (95% CI 67 to 213), the age-adjusted estimate is 84 (95% CI 36 to 131). This study provides an independent confirmation of an outbreak of HIV infection among women in the Eastern Health Region of the province.

The structure of the gene encoding the human skeletal muscle alpha 1 subunit of the dihydropyridine-sensitive L-type calcium channel (CACNL1A3)

The structure of the gene encoding the human skeletal muscle alpha 1 subunit (CACNL1A3) of the dihydropyridine-sensitive voltage-dependent calcium channel was determined by isolation of overlapping genomic DNA clones from human cosmid, phage, and P1 libraries. Genomic fragments containing exons were subcloned, and the sequences of the exons and flanking introns were defined. Knowledge of the genomic structure of the CACNL1A3 gene, which spans 90 kb and consists of 44 exons, will facilitate the search for additional mutations in CACNL1A3 that cause neuromuscular disease.

Self-measurement of blood pressure: issues related to the training of patients. Canadian Coalition for High Blood Pressure Prevention and Control

For effective self-measurement of blood pressure, patients need to be able to obtain accurate and reproducible measurements. Criteria for measuring blood pressure have been well developed in research studies, and through the use of standardized training programs it has been established that nonmedically trained individuals can obtain valid measurements. These recommendations for blood pressure measurement were adapted to the self-measurement situation. Either manual sphygmomanometers or automated electronic devices can be used effectively. Although automated devices may be easier to use, the health care practitioner should ensure that any such device has been demonstrated to be accurate and reliable before its adoption. There are no reported programs available for training individuals in the use of self-measurement. A check-list has been developed for use by health care practitioners. It is estimated that proper training will usually take more than 20 mins. Since many health care practitioners do not use the recommended blood pressure measurement technique, there is also a need to develop programs to 'train the trainers'. Finally, individuals undertaking regular self-measurement should have their technique and the calibration of their instruments checked at regular intervals (six to 12 months).

Self-measurement of blood pressure: recommendations of the Canadian Coalition for High Blood Pressure Prevention and Control

OBJECTIVE

To provide health care professionals with guidelines on the use of blood pressure self-measurement.

METHODS

Recommendations were devised after consideration of expert reviews and guidelines, personal files, international standards documents, personal communication with investigators and the results of a MEDLINE search (1966-94) using the term 'blood pressure determination'.

BENEFITS, HARMS, COSTS

Self-measurement of blood pressure can be used to detect white coat hypertension, monitor changes in blood pressure closely, more rapidly achieve desired blood pressure goals, increase adherence to antihypertensive therapy and improve patient self-reliance. However, self-measured blood pressure readings may be misleading because there is insufficient normative, prognostic and outcome data and because some patients may not take accurate measurements. The use of self-measurement of blood pressure has a relatively small direct cost and may result in an overall reduction in treatment costs.

RECOMMENDATIONS

Self-measured blood pressure readings can be a valuable supplement to clinic (or office) blood pressure readings. However, self-measurement is appropriate neither for patients who are physically or mentally incapable of accurate assessment and interpretation of readings nor for those who do not want to participate. Patients who self-monitor blood pressure require careful training in blood pressure measurement and instruction on the recording and interpretation of blood pressure readings. Advice to patients using monitoring equipment must take into account the needs and abilities of the patient. Although only a few electronic devices for the self-measurement of blood pressure have met recommended performance standards, their use may be more appropriate for some patients and the training requirements fewer than if manual devices are used.

VALIDATION

The guidelines of several expert groups were examined in the preparation of these recommendations. The recommendations were presented at the World Conference on Hypertension Control in 1995 and were reviewed by the parent societies of the Canadian Coalition for High Blood Pressure Prevention and Control.

The assessment of student nurse learning styles using the Kolb Learning Styles Inventory

The learning styles of 192 Registered General Nursing/DipHE students was determined using the Kolb Learning Styles Inventory prior to the students having any formal contact with lecturing staff. The percentage of students having a predominantly concrete learning style was 53.7%, while 46.3% were predominantly reflective. This finding is in keeping with those of Laschinger & Boss (1984), who suggest that they are supportive of Kolb's theoretical tenet that concrete learners tend to choose people-oriented professions. Chi-squared tests were used to determine if the respondent's learning styles varied with either age, sex or having been in employment prior to becoming a nursing student; no statistically significant associations were found. A further chi-squared analysis was performed to see if there was a relationship between learning style and those students who possessed: 1) only the DC test, 2) O-levels as highest qualifications, and 3) A-levels as highest qualifications--no statistically significant associations were found. There remain measurement problems with the Kolb inventory, and a discussion of some of these issues are presented. The findings have reinforced the need for using a variety of delivery styles with students, with an emphasis on participation and experiential learning. This need for variety is essential given the distribution of learning styles found with the students. Nurse educators are urged to re-examine perceptions and assumptions about student learning needs.