The relationship between headache-attributed disability and lost productivity: 3 Attack frequency is the dominating variable.

BACKGROUND: In an earlier paper, we examined the relationship between headache-attributed disability, measured as proportion of time in ictal state, and lost productivity. In a linear model, we found positive and significant associations with lost paid worktime, lost household worktime and total lost productivity (paid + household), but with high variance, which was increased when headache intensity was introduced as a factor. We speculated that analyses based on headache frequency alone as the independent variable, eliminating both the subjectivity of intensity estimates and the uncertainties of duration, might show stronger associations. METHODS: Focusing on migraine, we used individual participant data from 16 countries surveyed either in population-based studies or in the Eurolight project. These data included frequency (headache days/month), usual attack duration (hours), usual headache intensity ("not bad", "quite bad", "very bad") and lost productivity from paid and household work according to enquiries using the Headache-Attributed Lost Time (HALT) questionnaire. We used multiple linear regressions, calculating regression equations along with unstandardized and standardized regression coefficients. We made line and bar charts to visualize relationships. RESULTS: Both frequency and intensity were significant predictors of lost productivity in all multiple linear regressions, but duration was a non-significant predictor in several of the regressions. Predicted productivity in paid work decreased among males by 0.75-0.85 days/3 months for each increase of 1 headache day/month, and among females by 0.34-0.53 days/3 months. In household chores, decreases in productivity for each added day/month of headache were more similar (0.67-0.87 days/3 months among males, 0.83-0.89 days/3 months among females). Visualizations showed that the impact of duration varied little across the range of 2-24 h. The standardized regression coefficients demonstrated that frequency was a much better predictor of lost productivity than intensity or duration. CONCLUSION: In the relationship between migraine-attributed impairment (symptom burden) and lost productivity, frequency (migraine days/month) is the dominating variable - more important than headache intensity and far more important than episode duration. This has major implications for current practice in headache care and for health policy and health-resource investment. Preventative drugs, grossly underutilized in current practice, offer a high prospect of economic benefit (cost-saving), but new preventative drugs are needed with better efficacy and/or tolerability

Structured education can improve primary-care management of headache: the first empirical evidence, from a controlled interventional study

Headache disorders are under-recognized and under-diagnosed. A principal factor in their suboptimal management is lack of headache-related training among health-care providers, especially in primary care. In Estonia, general practitioners (GPs) refer many headache patients to neurological specialist services, mostly unnecessarily. GPs request diagnostic investigations, which are usually unhelpful and therefore wasteful. GP-made headache diagnoses are often arcane and non-specific, and treatments based on these are inappropriate. The aim of this study was to develop, implement and test an educational model intended to improve headache-related primary health care in Estonia.This was a controlled study consisting of baseline observation, intervention and follow-up observation using the same measures of effect. It involved six GPs in Põlva and the surrounding region in Southern Estonia, together with their future patients presenting consecutively with headache as their main complaint, all with their consent. The primary outcome measure was referral rate (RR) to neurological specialist services. Secondary measures included number of GP-requested investigations, GP-made headache diagnoses and how these conformed to standard terminology (ICD-10), and GP-recommended or initiated treatments.RR at baseline (n = 490) was 39.5 %, falling to 34.7 % in the post-intervention group (n = 295) (overall reduction 4.8 %; p = 0.21). In the large subgroup of patients (88 %) for whom GPs made clearly headache-related ICD-10 diagnoses, RR fell by one fifth (from 40 to 32 %; p = 0.08), but the only diagnosis-related RR that showed a statistically significant reduction was (pericranial) myalgia (19 to 3 %; p = 0.03). There was a significant increase towards use of more specific diagnoses. Use of investigations in diagnosing headache reduced from 26 to 4 % (p < 0.0001). Initiation of treatment by GPs increased from 58 to 81 % (p < 0.0001).These were modest changes in GPs entrenched behaviour. Nevertheless they were empirical evidence that GPs practice in the field of headache could be improved by structured education. Furthermore, the changes were likely to be cost-saving. To our knowledge this study is the first to produce such evidence

Transport in the XX chain at zero temperature: Emergence of flat magnetization profiles

We study the connection between magnetization transport and magnetization profiles in zero-temperature XX chains. The time evolution of the transverse magnetization, m(x,t), is calculated using an inhomogeneous initial state that is the ground state at fixed magnetization but with m reversed from -m_0 for x0. In the long-time limit, the magnetization evolves into a scaling form m(x,t)=P(x/t) and the profile develops a flat part (m=P=0) in the |x/t|1/2 while it expands with the maximum velocity, c_0=1, for m_0->0. The states emerging in the scaling limit are compared to those of a homogeneous system where the same magnetization current is driven by a bulk field, and we find that the expectation values of various quantities (energy, occupation number in the fermionic representation) agree in the two systems.Comment: RevTex, 8 pages, 3 ps figure

Prospective evaluation of the impact of intermenstrual bleeding on natural fertility

To evaluate the impact of an episode of intermenstrual bleeding on the probability of conception in a menstrual cycle (fecundability)

Prospective evaluation of luteal phase length and natural fertility

OBJECTIVE: To evaluate the impact of a short luteal phase on fecundity. DESIGN: Prospective time-to-pregnancy cohort study. SETTING: Not applicable. PATIENT(S): Women trying to conceive, ages 30-44 years, without known infertility. INTERVENTION(S): Daily diaries, ovulation prediction testing, standardized pregnancy testing. MAIN OUTCOME MEASURE(S): Subsequent cycle fecundity. RESULT(S): Included in the analysis were 1,635 cycles from 284 women. A short luteal phase (≤11 days including the day of ovulation) occurred in 18% of observed cycles. Mean luteal phase length was 14 days. Significantly more women with a short luteal phase were smokers. After adjustment for age, women with a short luteal phase had 0.82 times the odds of pregnancy in the subsequent cycle immediately following the short luteal phase compared with women without a short luteal phase. Women with a short luteal length in the first observed cycle had significantly lower fertility after the first 6 months of pregnancy attempt, but at 12 months there was no significant difference in cumulative probability of pregnancy. CONCLUSION(S): Although an isolated cycle with a short luteal phase may negatively affect short-term fertility, incidence of infertility at 12 months was not significantly higher among these women. CLINICAL TRIAL REGISTRATION NUMBER: NCT01028365

Efficiency of self-cleaning properties in wheat (Triticum aestivum L.)

An experimental study was carried out to assess the efficiency of self-cleaning properties of three wheat cultivars and their potential in the protection against Blumeria graminis f. sp. tritici, a fungus that causes powdery mildew. Leaf samples with intact epicuticular structure were compared to such with wiped wax crystals. Contact angles were determined and the surfaces were subjected to a standardized contamination test with hydrophobic fluorescence powder. Another set of samples was inoculated with conidia of B. graminis and, after various time intervals, exposed to artificial fog or rain. For the intact surfaces of all cultivars contact angles of about 165° were measured. It is therefore suggested that wheat should be termed superhydrophobic. The wiping of the wax crystals led to a significant decrease of contact angles. This fact underlines the importance of surface roughness for achieving extreme water-repellency. In the standardized contamination test significantly more particles remained on the wiped surfaces than on those who had been left intact. This result was ascribed to increased adhesion on the smoothed samples.The inoculation with subsequent precipitation revealed a significantly better removal effect of conidia from intact than from wiped surfaces. This was irrespective of the wheat cultivar. In general, conidia were more effectively removed by rain than by fog. This was probably due to the higher kinetic energy and the greater amount of water when using rain. If fog application was delayed by 3 hours a higher percentage of conidia remained on the surface. As possible causes are discussed increased adhesion by conidia secretions or the development of primary germ tubes.Despite its highly efficient self-cleaning properties proved here, wheat is frequently infected by Blumeria graminis. We conclude that the high water content of the mildew conidia, the ability of Blumeria graminis to germinate at very low humidities and its rapid irreversible adhesion are effective adaptations in order to overcome the barrier of a superhydrophobic self-cleaning surface

A calculation of the QCD phase diagram at finite temperature, and baryon and isospin chemical potentials

We study the phases of a two-flavor Nambu-Jona-Lasinio model at finite temperature $T$, baryon and isospin chemical potentials: $\mu_{B}=(\mu_{u}+\mu_{d})/2$, $\mu_{I}=(\mu_{u}-\mu_{d})/2$. This study completes a previous analysis where only small isospin chemical potentials $\mu_{I}$ were consideredComment: 21 pages, 13 figures included, two more refernces adde

Evaluation of headache service quality indicators: pilot implementation in two specialist-care centres

Background Evaluating quality of health care is increasingly recognized as an important contributor to the advancement of health-care delivery. We recently developed a set of quality indicators for headache care, intended to be applicable across countries, cultures and settings so that deficiencies in headache care worldwide might be recognized and rectified. These indicators themselves require evaluation and proof of fitness for purpose. This pilot study begins this process. Methods We tested the quality indicators in the tertiary headache centres of the University of Duisburg-Essen in Essen, Germany, and the Hospital da Luz in Lisbon, Portugal. Using seven previously-developed enquiry instruments, we interrogated health-care providers (HCPs), including doctors, nurses, psychologists and physiotherapists, as well as consecutive patients and their medical records. Results The questionnaires were easily understood by both HCPs and patients and were not unduly time-consuming. The results from the two headache centres were comparable despite their differences in structure, staffing and language. These findings met the purpose of the study. Diagnoses were made according to ICHD criteria and critically evaluated during follow-up. However, diagnostic diaries and instruments assessing burden and response to treatment were not always in place or routinely utilised. Triage systems adjusted waiting times to urgency of need. Treatment plans included pathways to other specialities. Patients felt welcomed, reassured and educated, and were mostly satisfied. Discussion points arose over inclusion of psychological therapies in treatment plans; over recording of outcomes; over indicators of efficiency and equitability (protocols to limit wastage of resources, systems to measure input costs and means of ensuring equal access to the services); and over protocols for reporting serious adverse events. Conclusion This pilot study to assess feasibility of the methods and acceptability of the instruments of headache service quality evaluation was successful. The project is ready to be taken into its next stages

A Persistent Disk Wind in GRS 1915+105 with NICER

The bright, erratic black hole X-ray binary GRS 1915+105 has long been a target for studies of disk instabilities, radio/infrared jets, and accretion disk winds, with implications that often apply to sources that do not exhibit its exotic X-ray variability. With the launch of NICER, we have a new opportunity to study the disk wind in GRS 1915+105 and its variability on short and long timescales. Here we present our analysis of 39 NICER observations of GRS 1915+105 collected during five months of the mission data validation and verification phase, focusing on Fe XXV and Fe XXVI absorption. We report the detection of strong Fe XXVI in 32 (>80%) of these observations, with another four marginal detections; Fe XXV is less common, but both likely arise in the well-known disk wind. We explore how the properties of this wind depends on broad characteristics of the X-ray lightcurve: mean count rate, hardness ratio, and fractional RMS variability. The trends with count rate and RMS are consistent with an average wind column density that is fairly steady between observations but varies rapidly with the source on timescales of seconds. The line dependence on spectral hardness echoes known behavior of disk winds in outbursts of Galactic black holes; these results clearly indicate that NICER is a powerful tool for studying black hole winds.Comment: Accepted for publication in ApJL. Comments welcom