Genes, environment and sport performance: why the nature-nurture dualism is no longer relevant

The historical debate on the relative influences of genes (i.e. nature) and environment (i.e. nurture) on human behaviour has been characterised by extreme positions leading to reductionist and polemic conclusions. Our analysis of research on sport and exercise behaviours shows that currently there is little support for either biologically or environmentally deterministic perspectives on elite athletic performance. In sports medicine, recent molecular biological advances in genomic studies have been over-interpreted, leading to a questionable 'single-gene-as-magic-bullet' philosophy adopted by some practitioners. Similarly, although extensive involvement in training and practice is needed at elite levels, it has become apparent that the acquisition of expertise is not merely about amassing a requisite number of practice hours. Although an interactionist perspective has been mooted over the years, a powerful explanatory framework has been lacking. In this article, we propose how the complementary nature of degenerate neurobiological systems might provide the theoretical basis for explaining the interactive influence of genetic and environmental constraints on elite athletic performance. We argue that, due to inherent human degeneracy, there are many different trajectories to achieving elite athletic performance. While the greatest training responses may be theoretically associated with the most favourable genotypes being exposed to highly specialised training environments, this is a rare and complex outcome. The concept of degeneracy provides us with a basis for understanding why each of the major interacting constraints might act in a compensatory manner on the acquisition of elite athletic performance.     

Acceptance of PACS utilizing a PACS QI Program

This article describes the quality improvement program that Mercy Hospital (Alegent Health System) initiated after it implemented a picture archiving and communication system (PACS) in November 2003. The radiology department encountered numerous PACS-related issues that directly affected the quality and workflow of patient care. In order to get a better understanding of the situation, the department developed a quality improvement plan for its PACS program. The first step was to dedicate a resource--in this case, a radiology information technology (RIT) support specialist--who would serve as a PACS subject matter expert while dealing with day-to-day PACS-related issues--specifically, errors. The error data were collected and categorized for consistency using statistical process control (SPC) tools. The information gathered was then traced back to the team members responsible for the errors and used as a training tool to further educate them. As a result of this program, the average error rate was reduced from 12% to 4% because the radiology team developed a better understanding of the errors by identifying the root causes and being accountable for eliminating errors within their control. In addition, the radiology staff learned to accept and trust the PACS, resulting in a positive culture change that benefited teamwork and staff morale as well as improve the workflow and the quality of patient care.     

Establishing a contract for a PACS managed service

This review considers the process of contracting for a picture archiving and communication system (PACS) using the private finance initiative (PFI) managed service route. The PFI process is reviewed and the advantages and disadvantages of a managed service detailed. During contract negotiations several areas of conflict were encountered. These are discussed with an outline of how they were resolved. CONCLUSION: A contract for a PACS has been achieved by a large acute hospital Trust using a managed service provision through PFI. In detailing the specific problems encountered in the course of negotiations, it is intended that other Trusts entering on this course will be equipped and strengthened in the finalizing of satisfactory and robust contracts.     

Where there is no PET/CT

Technology assessment should touch upon four areas; utility, target population, cost and alternatives. Hybrid Positron Emission Tomography/Computed Tomography (PET/CT) is a promising modality for oncologic imaging. However, reservations about its accessibility and affordability prevail. Magnetic Resonance Imaging (MRI) is an alternative with certain key advantages that can potentially prove equivalent if not better than PET/CT. We have highlighted the value of comparative studies between PET/CT and whole body MRI. Diffusion Weighted sequences may aid in better diagnosis of malignancies on MRI. The ‘Eye of Medicine’ should not have a restricted vision even where there is no PET/CT.     

Creation of an educational CD-ROM using a PACS

Presentation of MIRIAM 2: We describe the materials used for the creation of and the content of a CD-ROM entitled '77 neuroradiological case reports'. We mention the gathering of clinical and imaging data, exclusively provided by a PACS. Our work demonstrates that a CD-ROM is an appropriate interactive medium for radiological teaching. Its creation can be simplified thanks to a PACS, but it nonetheless remains work intensive.