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Chronic fatigue syndrome; an approach combining self-management with graded exercise to avoid exacerbations.

Controversy regarding the aetiology and treatment of patients with chronic fatigue syndrome (CFS) continues to affect the medical professions. The Cochrane collaboration advises practitioners to implement graded exercise therapy for CFS sufferers using cognitive behavioural principles. In contrast there is evidence that exercise can induce symptom exacerbations in CFS where too vigorous exercise/activity promotes immune dysfunction, which in turn increases symptoms in patients with CFS. When designing and implementing an exercise programme it is important to be aware of both these seemingly opposing view points in order to deliver a programme without any detrimental effects on CFS pathophysiology. Using evidence from both the biological and clinical sciences, the present manuscript explains that graded exercise therapy for people with CFS can be safely undertaken without detrimental effects to the immune system. Exercise programs should be designed to cater for individual physical capabilities and should also account for the fluctuating nature of symptoms commonly reported by people with CFS. In line with cognitive behaviourally and graded exercise-based strategies, self-management for people with CFS involves encouraging the patients to pace their activities and respect their physical and mental limitations with the ultimate aim of improving their everyday function

Vision-related symptoms as a clinical feature of chronic fatigue syndrome/myalgic encephalomyelitis? Evidence from the DePaul Symptom Questionnaire

Chronic Fatigue Syndrome (CFS) or Myalgic Encephalomyelitis (ME) is a debilitating disorder, affecting at least 250,000 people in the UK. Marked by debilitating fatigue, its aetiology is poorly understood and diagnosis controversial. A number of symptoms overlap with other illnesses with the result that CFS/ME is commonly misdiagnosed. It is important therefore that significant clinical features are investigated. People diagnosed with CFS/ME consistently report that they experience vision-related symptoms associated with their illness1-3 with some of these reports being verified experimentally. Although vision-related symptoms may represent a significant clinical feature of CFS/ME that could be useful in its diagnosis, they have yet to be included in clinical guidelines

Reduced heart rate variability predicts fatigue severity in individuals with chronic fatigue syndrome/myalgic encephalomyelitis

Heart rate variability (HRV) is an objective, non-invasive tool to assessing autonomic dysfunction in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). People with CFS/ME tend to have lower HRV; however, in the literature there are only a few previous studies (most of them inconclusive) on their association with illness-related complaints. To address this issue, we assessed the value of different diurnal HRV parameters as potential biomarker in CFS/ME and also investigated the relationship between these HRV indices and self-reported symptoms in individuals with CFS/ME.Peer ReviewedPostprint (published version

Association of the clinical frailty scale with hospital outcomes.

BACKGROUND: The clinical frailty scale (CFS) was validated as a predictor of adverse outcomes in community-dwelling older people. In our hospital, the use of the CFS in emergency admissions of people aged ≥ 75 years was introduced under the Commissioning for Quality and Innovation payment framework. AIM: We retrospectively studied the association of the CFS with patient characteristics and outcomes. DESIGN: Retrospective observational study in a large tertiary university National Health Service hospital in UK. METHODS: The CFS was correlated with transfer to specialist Geriatric ward, length of stay (LOS), in-patient mortality and 30-day readmission rate. RESULTS: Between 1st August 2013 and 31st July 2014, there were 11 271 emergency admission episodes of people aged ≥ 75 years (all specialties), corresponding to 7532 unique patients (first admissions); of those, 5764 had the CFS measured by the admitting team (81% of them within 72 hr of admission). After adjustment for age, gender, Charlson comorbidity index and history of dementia and/or current cognitive concern, the CFS was an independent predictor of in-patient mortality [odds ratio (OR) = 1.60, 95% confidence interval (CI): 1.48 to 1.74, P < 0.001], transfer to Geriatric ward (OR = 1.33, 95% CI: 1.24 to 1.42, P < 0.001) and LOS ≥ 10 days (OR = 1.19, 95% CI: 1.14 to 1.23, P < 0.001). The CFS was not a multivariate predictor of 30-day readmission. CONCLUSIONS: The CFS may help predict in-patient mortality and target specialist geriatric resources within the hospital. Usual hospital metrics such as mortality and LOS should take into account measurable patient complexity

Transference of Transport Anisotropy to Composite Fermions

When interacting two-dimensional electrons are placed in a large perpendicular magnetic field, to minimize their energy, they capture an even number of flux quanta and create new particles called composite fermions (CFs). These complex electron-flux-bound states offer an elegant explanation for the fractional quantum Hall effect. Furthermore, thanks to the flux attachment, the effective field vanishes at a half-filled Landau level and CFs exhibit Fermi-liquid-like properties, similar to their zero-field electron counterparts. However, being solely influenced by interactions, CFs should possess no memory whatever of the electron parameters. Here we address a fundamental question: Does an anisotropy of the electron effective mass and Fermi surface (FS) survive composite fermionization? We measure the resistance of CFs in AlAs quantum wells where electrons occupy an elliptical FS with large eccentricity and anisotropic effective mass. Similar to their electron counterparts, CFs also exhibit anisotropic transport, suggesting an anisotropy of CF effective mass and FS.Comment: 5 pages, 5 figure

Strong Magnetization Measured in the Cool Cores of Galaxy Clusters

Tangential discontinuities, seen as X-ray edges known as cold fronts (CFs), are ubiquitous in cool-core galaxy clusters. We analyze all 17 deprojected CF thermal profiles found in the literature, including three new CFs we tentatively identify (in clusters A2204 and 2A0335). We discover small but significant thermal pressure drops below all nonmerger CFs, and argue that they arise from strong magnetic fields below and parallel to the discontinuity, carrying 10%-20% of the pressure. Such magnetization can stabilize the CFs, and explain the CF-radio minihalo connection.Comment: PRL accepted, additional control tests adde