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Biomedical subjects

A Wells

Publications and source records attributed to A Wells.

At least 55 records · Page 3Linked to original sources

Epidermal growth factor receptor activation of calpain is required for fibroblast motility and occurs via an ERK/MAP kinase signaling pathway.

To become migratory, cells must reorganize their connections to the substratum, and during locomotion they must break rear attachments. The molecular and biochemical mechanisms underlying these biophysical processes are unknown. Recent studies have implicated both extracellular signal-regulated kinase/mitogen-activated protein (ERK/MAP) kinase and calpain (EC 3.4.22.17) in these processes, but it is uncertain whether these are two distinct pathways acting on different modes of motility. We report that cell deadhesion involved in epidermal growth factor (EGF) receptor-mediated fibroblast motility requires activation of M-calpain downstream of ERK/MAP kinase signaling. NR6 fibroblasts expressing full-length wild type epidermal growth factor receptor required both calpain and ERK activation, as demonstrated by pharmacological inhibitors (calpeptin and calpain inhibitor I and PD98059, respectively) for EGF-induced deadhesion and motility. EGF induced rapid activation of calpain that was preventable by molecular inhibition of the Ras-Raf-MEK but not phospholipase Cgamma signaling pathway, and calpain was stimulated by transfection of constitutively active MEK. Enhanced calpain activity was not mirrored by increased calpain protein levels or decreased levels of its endogenous inhibitor calpastatin. The link between ERK/MAP kinase signaling and cell motility required the M-isoform of calpain (calpain II), as determined by specific antisense-mediated down-regulation. These data promote a previously undescribed signaling pathway of ERK/MAP kinases activating calpain to destabilize cell-substratum adhesions in response to EGF stimulation.

Animals↗

Performance evaluation of a new chemiluminescent assay for prostate specific antigen.

Prostate specific antigen (PSA) is a glycoprotein found in the epithelial cells of the prostatic duct and acini. PSA is elevated in all four stages of prostate cancer as well as in benign prostatic hypertrophy. We evaluated a new chemiluminescent assay for PSA by comparing this assay with the microparticle enzyme immunoassay for PSA (MEIA) on the AxSYM analyzer (Abbott Laboratories, Abbott Park, IL) and a Hybritech Tandem R assay for PSA. The new chemiluminescent assay is recently available from Bayer Diagnostics (Tarrytown, NY) and can be run using the ACS: 180 Plus analyzer. Precision of the new chemiluminescent assay was evaluated using commercially available controls (Bayer Diagnostics). The within-run and total CVs were 6.4 and 8.7% for the low control (mean: 0.43 microg/L), 1.6 and 5.2% for the next level control (mean:1.94 mg/L), 4.3 and 4.9% for the medium control (mean: 2.10 mg/L), 1.2 and 3.9% for the high control 1 (mean: 11.52 mg/L), and finally 3.2 and 6.9% for the high control 2 (mean: 21.52 mg/L). The spike recovery varied from 94.2 to 109.6% for five different specimens we studied. We also observed excellent dilution recoveries. For example, in the specimen supplemented with 3.02 mg/L of PSA, the dilution recoveries were 102. 1, 104.7, and 103.7% for 1:2, 1:4, and 1:8 dilutions, respectively. We analyzed 113 serum specimens from patients with various concentrations of PSA (range 0.5 mg/L-2040 mg/L) using the new chemiluminescent assay and compared our results with the MEIA and Hybridtech (Tandem-R PSA) assays. Using x axis as the PSA concentrations obtained by the Tandem-R assay and the y axis as the PSA values obtained by the new chemiluminescent assay, we observed the following regression equations: y = 1.04 x -0.19 (r = 0.99, n = 112). One specimen with PSA concentrations of 2040 microg/L by the MEIA and 2156 microg/L by the chemiluminescent assay was not used for regression analysis. Similarly using x axis as the PSA concentrations obtained by the MEIA assay and y axis as the PSA concentrations obtained by the chemiluminescent assay, we observed the following regression equation: y = 0.88 + 0.02 (r = 0.99, n = 112). We conclude that the new chemiluminescent assay has excellent precision and the results compared well with the existing assays.

Chemistry, Clinical↗

Inhaled steroids for bronchiectasis.

BACKGROUND: Bronchiectasis is a progressive condition characterised by irreversible destruction and dilatation of airways, generally associated with chronic bacterial infection. The two distinct therapeutic goals are: symptom control and reduction in morbidity; and prevention of progression of the underlying disease. OBJECTIVES: To determine whether regular inhaled corticosteroids produce improvement in symptom control and whether they beneficially influence the natural history of the disease. SEARCH STRATEGY: The Cochrane Airways Group RCT register and Cochrane Controlled Clinical Trials Register were searched using the following search terms; bronchiectasis AND [corticosteroid* OR beclomethasone OR budesonide OR fluticasone OR triamcinolone OR flunisolide]. Bibliographies of each included RCT was searched for additional trials. Pharmaceutical companies that manufacture inhaled corticosteroids were also contacted. SELECTION CRITERIA: Only randomised double blind studies controlled trials were included. Patients with radiographic evidence of bronchiectasis were included, but patients with cystic fibrosis were excluded. DATA COLLECTION AND ANALYSIS: Data was extracted by one of the reviewers (FR). Continuous outcomes were analysed as effect sizes (weighted mean difference or as standardised mean difference with 95% confidence intervals). MAIN RESULTS: Only two trials on a total of 54 patients could be included. The studies were of 4 and 6 weeks duration. Inhaled corticosteroids had no significant effect on any of the outcomes included in this review, however there was a trend towards improving: FEV1, FVC, PEFR, RV and DLco. REVIEWER'S CONCLUSIONS: In bronchiectasis, regular use of inhaled corticosteroids may improve lung function. The available studies were too short and too small to provide any clear evidence to guide practice. Larger and longer studies should include rate of decline of lung function, exacerbation frequency, hospitalisations and healthy status as outcomes.

Administration, Inhalation↗

Distribution of novel polymorphisms of the interleukin-8 and CXC receptor 1 and 2 genes in systemic sclerosis and cryptogenic fibrosing alveolitis.

OBJECTIVE: To search for single-nucleotide polymorphisms in the interleukin-8 (IL-8) and IL-8 receptor CXCR-1 and CXCR-2 genes, and to compare their distribution among patients with systemic sclerosis (SSc) with fibrosing alveolitis (FASSc) or without fibrosing alveolitis (NFASSc), or patients with cryptogenic fibrosing alveolitis (CFA), and normal healthy subjects. METHODS: Fifty control subjects were screened for potential polymorphisms by using polymerase chain reaction in association with sequence-specific primers incorporating mismatches at the 3' end. The novel polymorphisms were subsequently examined in British Caucasian subjects, including 194 healthy controls, 71 patients with CFA, and 128 patients with SSc who were further subdivided into 78 FASSc patients and 50 NFASSc patients. RESULTS: Three novel biallelic polymorphisms were identified in the IL-8 gene (all in noncoding areas of the gene), 1 was found in the CXCR-1 gene (resulting in a conservative amino acid change), and 3 were observed in the CXCR-2 gene, of which the first resulted in a silent codon change and the others were in the 3' untranslated area of exon 3. Compared with controls, a significant increase in the frequency of the CXCR-2 +785 CC homozygote and of the CXCR-2 +1208 TT homozygote was found in the SSc patients (37% versus 22% [P = 0.01] and 33% versus 17% [P = 0.003], respectively). A subgroup analysis revealed this association to be significant both in the FASSc patients and in the NFASSc patients. CONCLUSION: This report describes an association between SSc and 2 polymorphisms occurring close to each other in the CXCR-2 gene. This finding and its functional significance need to be confirmed and analyzed in future studies.

Antigens, CD↗

The nuclear accumulation of a variant epidermal growth factor receptor (EGFR) lacking the transmembrane domain requires coexpression of a full-length EGFR.

Both the epidermal growth factor (EGF) and its receptor (EGFR) accumulate in the nucleoplasm during liver regeneration. This localization in a nonmembraneous compartment presents a challenge in that the standard form of EGFR is a transmembrane protein and suggests the existence of a variant, soluble form of EGFR. To investigate the localization of such a putative EGFR splice variant, we generated a transmembrane-devoid form of EGFR. We placed this transmembrane-negative [TM(-)] EGFR construct and full-length wild-type (wt) EGFR either in a retroviral transfection vector or in an inducible expression vector. Mouse 3T3 cells, which express endogenous EGFR, were transfected with the TM(-) EGFR construct. The expression of these TM(-) EGFR, detected with a specific antibody against human EGFR using a confocal laser-scanning microscope, was predominantly found in the cytoplasm with no nuclear localization. After an overnight incubation with EGF the TM(-) EGFR accumulated in the nucleus. In mouse NR6 cells, which lack endogenous EGFR, transfected TM(-) EGFR were found in the cytoplasm, but incubation with EGF did not result in a nuclear accumulation of TM(-) EGFR. However, NR6 cells transfected with both TM(-) EGFR and wt EGFR showed nuclear accumulation after EGF treatment. These results suggest that both the wt EGFR and the TM(-) EGFR are required for nuclear accumulation of TM(-) EGFR and may implicate a model of homotypic recognition and translocation of a splice variant of EGFR.

3T3 Cells↗

Thought control strategies in schizophrenia: a comparison with non-patients.

This study tested the hypothesis that patients with a diagnosis of schizophrenia would report the use of different thought control strategies in comparison with non-patients. The Thought Control Questionnaire [TCQ; Wells, A. & Davies, M. (1994). The thought control questionnaire: a measure of individual differences in the control of unwanted thoughts. Behaviour Research and Therapy, 32, 871-878.] was administered to 22 patients who met DSM-IV criteria for schizophrenia and 22 non-patients. The results showed that schizophrenic patients used different thought control strategies (more worry and punishment-based strategies, less distraction-based strategies) in compairison with non-patients. The theoretical and clinical implications of these findings are discussed.

Adult↗

Falsely elevated serum digitoxin concentrations due to cross-reactivity of water-extractable digitoxin-like immunoreactivity of Chinese medicine Chan SU: elimination of interference by use of a chemiluminescent assay.

Chinese medicines are available without prescription in health food stores. One such Chinese preparation, Chan SU, is used as a cardiotonic agent. Digoxin-like immunoreactivity of Chan SU has been reported in the past. In this report we demonstrated significant digitoxin-like immunoreactivity of Chan SU. For example, when a 20-microl aliquot of an aqueous extract of Chan SU (2 mg/ml) was added to drug-free serum, the observed digitoxin-like immunoreactivity was 51.40 ng/ml by the fluorescence polarization assay. In contrast, a new chemiluminescent assay for digitoxin did not show any immunoreactivity. When very small amount of aqueous extract of Chan SU was added into serum containing digitoxin, the observed digitoxin concentrations were falsely elevated when measured by the fluorescence polarization immunoassay (FPIA), but did not change significantly when measured by the chemiluminescent immunoassay (CLIA). Significant digitoxin-like immunoreactivity was also observed (FPIA) in mice after feeding with Chan SU. Because bufalin, cinobufotalin and cinobufagin are major components of Chan SU, digitoxin-like immunoreactivity of these purified compounds was also studied. Bufalin was identified as the major digitoxin-like immunoreactive compound responsible for most of the interference in serum digitoxin measurement using the FPIA.

Animals↗

Unexpected suppression of free phenytoin concentration by salicylate in uremic sera due to the presence of inhibitors: MALDI mass spectrometric determination of molecular weight range of inhibitors.

Salicylate displaces phenytoin from protein binding leading to an increase in free phenytoin concentration. We observed unexpected decreases in free phenytoin concentration in the presence of salicylate. Serum pools containing no phenytoin or salicylate were supplemented with the same concentrations of phenytoin. Then to the aliquots of the individual pool, no salicylate (control), 150, 300 and 500 microg/ml of salicylate (therapeutic range: 15-300 microg/ml) were added. Specimens were incubated at 37 degrees C for 2 h and after re-equilibration at room temperature for 20 min, total and free phenytoin (in the protein free ultrafiltrates) concentrations were measured using fluorescence polarization immunoassay on the TDx/FLX analyzer. We observed an increase in free phenytoin concentration from 1.91 microg/ml (in the absence of salicylate) to 2.39 microg/ml in the presence of 500 microg/ml salicylate (total phenytoin: 13.3 microg/ml) in the normal pool. In sharp contrast, the free phenytoin concentrations decreased from an initial concentration of 3.82 microg/ml to 2.52 microg/ml in the presence of 500 microg/ml of salicylate (total phenytoin: 13.2 microg/ml) in the uremic pool. We also treated the uremic pool with activated charcoal. In the original uremic pool, the initial free phenytoin concentration was 3.05 microg/ml and the free concentrations then decreased to 2.28 microg/ml in the presence of 300 microg/ml of salicylate. In contrast, in the charcoal treated pool, the initial free phenytoin concentration increased from 1.61 microg/ml to 3.23 microg/ml in the presence of 300 microg/ml of salicylate. More interestingly when uremic toxins were extracted back from charcoal with methanol and the dry residue was added to an aliquot of normal serum, the normal serum behaved like a uremic serum and free phenytoin concentration was significantly decreased in the presence of salicylate. When an aliquot of methanol extract was studied by Matrix-Assisted Laser Desorption Ionization Mass Spectrometry (scan up to 10,000), we observed no peak at molecular weight over 551, indicating that these inhibitors are small molecules. We also identified hippuric acid as one of the inhibitors.

Anticonvulsants↗

Tumor invasion: role of growth factor-induced cell motility.

Cancer progression to the invasive and metastatic stage represents the most formidable barrier to successful treatment. To develop rational therapies, we must determine the molecular bases of these transitions. Cell motility is one of the defining characteristics of invasive tumors, enabling tumors to migrate into adjacent tissues or transmigrate limiting basement membranes and extracellular matrices. Invasive tumor cells have been demonstrated to present dysregulated cell motility in response to extracellular signals from growth factors and cytokines. Recent findings suggest that this growth factor receptor-mediated motility is one of the most common aberrations in tumor cells leading to invasiveness and represents a cellular behavior distinct from-adhesion-related haptokinetic and haptotactic migration. This review focuses on the emerging understanding of the biochemical and biophysical foundations of growth factor-induced cell motility and tumor cell invasiveness, and the implications for development of targeted agents, with particular emphasis on signaling from the epidermal growth factor (EGF) and hepatocyte growth factor (HGF) receptors, as these have most often been associated with tumor invasion. The nascent models highlight the roles of various intracellular signaling pathways including phospholipase C-gamma (PLC gamma), phosphatidylinositol (PI)3'-kinase, mitogen-activated protein (MAP) kinase, and actin cytoskeleton-related events. Development of novel agents against tumor invasion will require not only a detailed appreciation of the biochemical regulatory elements of motility but also a paradigm shift in our approach to and assessment of cancer therapy.

Actins↗

Increased nitric oxide production in the respiratory tract in asymptomatic pacific islanders: an association with skin prick reactivity to house dust mite.

BACKGROUND: Exhaled nitric oxide (NO) is increased in asthma and may also be increased in subclinical airway inflammation. The relationship between atopy and subclinical airway inflammation in the pathogenesis of asthma remains unclear. We have evaluated the relationship between exhaled NO levels and skin prick test reactivity to 8 common allergens in 64 asymptomatic adult Pacific Islanders. Pacific Islanders were studied as a racial group with major morbidity from asthma. OBJECTIVE: Our purpose was to determine whether asymptomatic subjects with skin prick test reactivity to common allergens have elevated NO levels. METHODS: All subjects underwent full lung function testing and skin prick testing. Exhaled and nasal NO levels were measured by chemiluminescence (Logan LR2000 analyzer) with use of the single-breath and breath-holding techniques, respectively. RESULTS: House dust mite (HDM) reactivity was seen in 38 of 64 (56%). Exhaled NO levels (median 8.9 ppb, range 2.9-47.3 ppb) and nasal NO levels (527.5 +/- 181.5 ppb) lay above the normal European range in 30% and 25% of subjects, respectively. HDM reactivity was associated with higher exhaled NO levels (P <. 0005) and higher nasal NO levels (P =.01). In HDM-sensitive subjects the wheal size for HDM correlated with exhaled NO levels (r = 0.35, P =.04) and nasal NO levels (r = 0.40, P =.01). On multivariate analysis, exhaled NO levels were independently and positively related to the severity of HDM reactivity (P =.01) and nasal NO levels (P <.02), equation R(2) = 0.27. CONCLUSION: NO levels are elevated in a significant proportion of asymptomatic Pacific Islanders and are associated with HDM sensitivity. This may denote subclinical airway inflammation in this population and suggests that exposure to HDM in atopic individuals might play an important role in the early pathogenesis of asthma.

Adolescent↗

Stereospecificity of antibody: quinine, the optical isomer of quinidine and anti-malarial drug chloroquine do not cross-react with quinidine immunoassays.

Quinine is an optical isomer of quinidine. Both quinine and chloroquine (an aminoquinoline derivative) are used in treating malaria. The authors studied cross-reactivity of quinine and chloroquine with the quinidine immunoassays using the TDx and AxSYM analyzers (Abbott Laboratories, Abbott Park, IL). The authors observed no cross-reactivity of chloroquine with quinidine immunoassays (TDx and AXSYM) even when drug-free serum was supplemented with 1000 microg/mL chloriquine. The authors observed no cross-reactivity of quinine up to a concentration of 250 microg/mL. At higher concentrations, the authors observed a small cross-reactivity. The cross-reactivity of a substance should be studied in the presence of the primary analyte. When serum pools prepared from patients receiving quinidine were supplemented with various concentrations of quinine or chloroquine, the authors observed statistically significant declines in quinidine concentrations with higher concentrations of both quinine and chloroquine. The authors observed significant cross-reactivity of L-amphetamine with the amphetamine immunoassay also marketed by Abbott Laboratories and run on the AxSYM analyzer. The authors conclude that although the antibody used in the quinidine assay is stereospecific, the antibody used in the amphetamine assay by the same manufacturer is not stereospecific.

Antibodies↗

Time-dependent absorption of therapeutic drugs by the gel of the Greiner Vacuette blood collection tube.

Stability of therapeutic drugs in sera collected in Becton-Dickinson VACUTAINER serum separator SST tubes has been well studied. Recently, the Greiner Vacuette serum separator tube has become available for blood collection. However, stability of therapeutic drugs in sera when the specimen is collected in the Greiner tube has not been reported. The authors studied the stability of 15 commonly monitored drugs in sera when stored on the gel of the Greiner serum separator tubes. The drugs studied were amikacin, gentamycin, tobramycin, vancomycin, digoxin, quinidine, theophylline, carbamazepine, phenobarbital, phenytoin, valproic acid, tricyclic antidepressants, salicylate, acetaminophen, and ethanol. The authors compared the concentrations of drugs in sera stored in plain tubes (no gel) and in sera stored in the Greiner tubes containing serum separator gel. They observed a significant decline in the concentrations of tricyclic antidepressants when stored in the Greiner tubes. Interestingly, concentrations of amitriptyline declined more than its metabolite nortriptyline and concentration of imipramine also decreased more than its metabolite desipramine. The concentration of carbamazepine also decreased slightly over time when serum was stored in the Greiner tube. Although declines in carbamazepine concentrations on prolonged storage in the Greiner tubes were statistically significant, the decreases may not be clinically significant. The concentrations of the other drugs studied did not decline when stored in the Greiner tubes. The authors conclude that the Greiner brand tube is not suitable for blood collection for analysis of tricyclic antidepressants.

Absorption↗

Attention, automaticity, and affective disorder.

This article reviews possible mechanisms for attentional bias in affective disorders and anxiety. Attentional bias is sometimes conceptualized as automatic in nature. However, there are methodological difficulties with studies purporting to demonstrate automaticity, and empirical and simulation evidence suggest that bias may be predominantly strategic. Bias in the voluntary control of attention may be driven by coping strategies, which in turn depend on appraisal of external demands, metacognitions of mental function, access of self-relevant knowledge in long-term memory, and self-focus of attention. The Self-Regulatory Executive Function (S-REF) model of emotion and attention specifies how these processes interact to influence attentional control. Clinical disorder is associated with loss of dynamic adaptability and a syndrome of perseverative rumination and worry that directs attention toward monitoring for threat and away from restructuring of maladaptive self-knowledge. Implications of the S-REF model for therapeutic interventions directed toward attentional control are discussed.

Adaptation, Psychological↗

Cell adhesion and motility depend on nanoscale RGD clustering.

Integrin adhesion receptors play a crucial role in regulating interactions between cells and extracellular matrix (ECM). Integrin activation initiates multiple intracellular signaling pathways and results in regulation of cell functions such as motility, proliferation and differentiation. Two key observations regarding the biophysical nature of integrin-mediated cell-matrix interactions motivated the present study: (1) cell motility can be regulated by modulating the magnitude of cell-substratum adhesion, by varying cell integrin expression level, integrin-ECM binding affinity or substratum ECM surface density; and (2) integrin clustering enables assembly of multiple cytoplasmic regulatory and structural proteins at sites of aggregated integrin cytoplasmic domains, activating certain intracellular signalling pathways. Here, using a minimal integrin adhesion ligand, YGRGD, we test the hypothesis that ligand clustering can affect cell migration in a manner related to its modulation of cell-substratum adhesion. We employ a synthetic polymer-linking method, which allows us to independently and systematically vary both the average surface density and the local (approx. 50 nm scale) spatial distribution of the YGRGD peptide, against a background otherwise inert with respect to cell adhesion. In this system, the ligand was presented in three alternative spatial distributions: singly, in clusters with an average of five ligands per cluster, or in clusters with an average of nine ligands per cluster; for each of these spatial distributions, a range of average ligand densities (1,000-200,000 ligands/micrometer(2)) were examined. Cluster spacing was adjusted in order to present equivalent average ligand densities independently of cluster size. The murine NR6 fibroblast cell line was used as a model because its migration behavior on ECM in the presence and absence of growth factors has been well-characterized and it expresses integrins known to interact with the YGRGD peptide. Using time-lapse videomicroscopy and analysis of individual cell movement paths, we find that NR6 cells can migrate on substrata where adhesion is mediated solely by the YGRGD peptide. As previously observed for migration of NR6 cells on fibronectin, migration speed on YGRGD is a function of the average surface ligand density. Strikingly, clustering of ligand significantly reduced the average ligand density required to support cell migration. In fact, non-clustered integrin ligands support cell attachment but neither full spreading nor haptokinetic or chemokinetic motility. In addition, by quantifying the strength of cell-substratum adhesion, we find that the variation of cell speed with spatial presentation of YGRGD is mediated via its effect on cell adhesion. These effects on motility and adhesion are also observed in the presence of epidermal growth factor (EGF), a known motility-regulating growth factor. Variation in YGRGD presentation also affects the organization of actin filaments within the cell, with a greater number of cells exhibiting stress fibers at higher cluster sizes of YGRGD. Our observations demonstrate that cell motility may be regulated by varying ligand spatial presentation at the nanoscale level, and suggest that integrin clustering is required to support cell locomotion.

3T3 Cells↗

Positive and negative interference of the Chinese medicine Chan Su in serum digoxin measurement. Elimination of interference by using a monoclonal chemiluminescent digoxin assay or monitoring free digoxin concentration.

An over-the-counter Chinese medicine, Chan Su, is used as a cardiotonic agent. We demonstrated significant digoxin-like immunoreactivity in various organic and aqueous extracts of Chan Su. For example, when a 20-microL aliquot of an aqueous extract of Chan Su powder (1 mg/mL) was added to a 2-mL aliquot of a drug-free serum, the observed digoxin-like immunoreactivity was 2.76 ng/mL (3.53 nmol/L) digoxin equivalent using the fluorescence polarization immunoassay (FPIA). The magnitude of interference was much lower (0.94 ng/mL [1.20 nmol/L]) with the microparticle enzyme immunoassay (MEIA), and no interference was observed with the chemiluminescent assay (CLIA). We also observed a significant positive interference of the extract with the serum digoxin measurement using FPIA. In contrast, we observed a negative interference (falsely lowered digoxin concentration) of the extract in the serum digoxin measurement with the MEIA. The extract had no effect on the serum digoxin measurement with the CLIA. By taking advantage of the high protein binding of Chan Su and only 25% protein binding of digoxin, we further demonstrated that positive interference of Chan Su in the FPIA and negative interference of Chan Su in the MEIA of digoxin could be eliminated by monitoring the free digoxin concentration.

Amphibian Venoms↗

Cognitive factors in predisposition to auditory and visual hallucinations.

OBJECTIVES: This study adapted the Launay Slade Hallucination Scale (LSHS) to measure predisposition to auditory and visual hallucinations and examine the relationship between meta-cognition and predisposition in a non-psychiatric population. It also tested the hypothesis that individuals highly predisposed to hallucination would show positive and negative meta-cognitive beliefs and report the use of different thought control strategies. DESIGN: A within participants correlational design was employed. METHODS: A revised LSHS was administered to 105 normal participants who were also asked to complete questionnaires assessing paranoia, meta-cognitive beliefs, thought control strategies, anxiety, depression and beliefs about unusual perceptual experiences. RESULTS: Two empirically distinct but correlated hallucinatory traits (auditory and visual) were measured by the modified LSHS. Consistent with predictions, it was found that positive beliefs about unusual perceptual experiences were the best predictor of predisposition to auditory and visual hallucinations and that those participants who scored higher on predisposition to hallucination used different thought control strategies and had different negative meta-cognitive beliefs in comparison with participants of low predisposition. CONCLUSIONS: Meta-cognitive beliefs about thoughts and hallucinatory phenomena appear to be implicated in predisposition to hallucination. The theoretical and clinical implications of the findings are discussed.

Adult↗

Non-ergot dopamine agonist-induced sleep attacks.

Two patients with Parkinson's disease received treatment with ropinirole and/or pramipexole, during which both experienced sleep attacks. These attacks may be a class effect of non-ergot dopamine agonists. Health care professionals should be aware of the potential of these agents to cause sleep attacks and caution patients about this potentially life-threatening adverse effect.

Aged↗

A competency model for general practice: implications for selection, training, and development.

BACKGROUND: The role of the general practitioner (GP) has changed significantly over the past decade. This problem is compounded by growing concern over postgraduate attrition rates from medicine, with current estimates as high as 19%. AIM: To define a comprehensive model of the competencies required for the job role of GP. METHOD: Three independent studies were conducted to define GP competencies including (1) critical incidents focus groups with GPs, (2) behavioural coding of GP-patient consultations, and (3) critical incidents interviews with patients. Study 1 was conducted with GPs (n = 35) from the Trent region. Study 2 involved observation of GP-patient consultations (n = 33 consultations), and Study 3 was conducted with patients (n = 21), all from a Midlands-based medical practice. RESULTS: The data collected from the three studies provided strong evidence for a competency model comprising 11 categories with a summary of the associated behavioural descriptions. Example competencies included empathy and sensitivity, communication skills, clinical knowledge and expertise, conceptual thinking, and coping with pressure. CONCLUSIONS: Triangulation of results was achieved from three independent studies. The competencies derived imply that a greater account of personal attributes needs to be considered in recruitment and training, rather than focusing on academic and clinical competency alone. The model could be employed for future research in design of selection techniques for the role of GP.

Clinical Competence↗