Clin Med
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An online survey of consultant diabetologists in the UK examined the interface between specialist services and acute-general internal medicine (acute-GIM). Out of 592 consultants, 289 (49%) responded. Of these, 94% contributed to acute-GIM, devoting equivalent time to acute-GIM and specialist diabetes services. ⋯ The increased commitment to acute-GIM compromised specialist diabetes activity through reduced consultant and training-grade time for outpatient activity and service development. The shift to primary care of chronic disease led to further conflict between acute-GIM and delivery of a specialist service, given the current systems for provision of consultant-led care. The large number of specialist trainees in diabetes and endocrinology will require innovative commissioning mechanisms that reflect the need to sustain and develop specialist diabetes and endocrine care in the appropriate settings as well as the continued input in acute trusts for acute-GIM.
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Performing music at a professional level requires the integration of multimodal sensory and motor information and precise monitoring of the performance via auditory feedback. In the context of Western classical music, musicians are forced to reproduce highly controlled movements almost perfectly with a high reliability. These specialised sensorimotor skills are acquired during extensive training periods over many years. ⋯ Auditory-sensorimotor integration, for example, is accompanied by rapid modulations of neuronal connectivity in the time range of 20 minutes. Finally, dysfunctional plasticity in musicians, known as musician's dystonia, leads to deterioration of extensively trained fine motor skills. Musician's dystonia may be caused by training induced dysplasticity with pathological fusion of central nervous representations in sensorimotor cortical and subcortical brain regions.
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Rheumatoid arthritis (RA) is a multisystem disease with high rates of morbidity and mortality. In recent years, there has been increasing focus on the growing rates of cardiovascular disease (CVD) in RA, over and above expected levels allowing for 'traditional' risk factors. In this paper the impact of CVD in RA, the relative contributions of traditional risk factors and novel risk factors (including homocysteine, oxidised low-density lipoprotein, high-sensitivity C-reactive protein and leptin), and the need to address cardiovascular risk in the fight against premature death from coronary artery and stroke disease in RA are discussed.