Patient perspectives of managing fatigue in ankylosing spondylitis, and views on potential interventions: a qualitative study

<p>Background: Fatigue is a major component of living with ankylosing spondylitis (AS), though it has been largely over-looked, and currently there are no specific agreed management strategies.</p> <p>Methods: This qualitative exploratory study involved participants who are members of an existing population-based ankylosing spondylitis (PAS) cohort. Participants residing in South West Wales were invited to participate in a focus group to discuss; (1) effects of fatigue, (2) self-management strategies and (3) potential future interventions. The focus groups were audio-recorded and the transcripts were analysed using thematic analysis.</p> <p>Results: Participants consisted of 3 males/4 females (group 1) and 4 males/3 females (group 2), aged between 35 and 73 years (mean age 53 years). Three main themes were identified: (1) The effects of fatigue were multi-dimensional with participants expressing feelings of being ‘drained’ (physical), ‘upset’ (emotional) and experiencing ‘low-mood’ (psychological); (2) The most commonly reported self-management strategy for fatigue was a balanced combination of activity (exercise) and rest. Medication was reluctantly taken due to side-effects and worries over dependency; (3) Participants expressed a preference for psychological therapies rather than pharmacological for managing fatigue. Information on Mindfulness-Based Stress Reduction (MBSR) was received with interest, with recommendations for delivery in a group format with the option of distance-based delivery for people who were not able to attend a group course.</p> <p>Conclusions: Patients frequently try and manage their fatigue without any formal guidance or support. Our research indicates there is a need for future research to focus on psychological interventions to address the multi-faceted aspects of fatigue in AS.</p&gt

A Model for the Ultrastructure of Bone Based on Electron Microscopy of Ion-Milled Sections

The relationship between the mineral component of bone and associated collagen has been a matter of continued dispute. We use transmission electron microscopy (TEM) of cryogenically ion milled sections of fully-mineralized cortical bone to study the spatial and topological relationship between mineral and collagen. We observe that hydroxyapatite (HA) occurs largely as elongated plate-like structures which are external to and oriented parallel to the collagen fibrils. Dark field images suggest that the structures (“mineral structures”) are polycrystalline. They are approximately 5 nm thick, 70 nm wide and several hundred nm long. Using energy-dispersive X-ray analysis we show that approximately 70% of the HA occurs as mineral structures external to the fibrils. The remainder is found constrained to the gap zones. Comparative studies of other species suggest that this structural motif is ubiquitous in all vertebrates

Phenotypic and functional analysis of monocyte populations in cattle peripheral blood identifies a subset with high endocytic and allogeneic T-cell stimulatory capacity

International audienceAbstractCirculating monocytes in several mammalian species can be subdivided into functionally distinct subpopulations based on differential expression of surface molecules. We confirm that bovine monocytes express CD172a and MHC class II with two distinct populations of CD14+CD16low/-CD163+ and CD14−CD16++CD163low- cells, and a more diffuse population of CD14+CD16+CD163+ cells. In contrast, ovine monocytes consisted of only a major CD14+CD16+ subset and a very low percentage of CD14−CD16++cells. The bovine subsets expressed similar levels of CD80, CD40 and CD11c molecules and mRNA encoding CD115. However, further mRNA analyses revealed that the CD14−CD16++ monocytes were CX3CR1highCCR2low whereas the major CD14+ subset was CX3CR1lowCCR2high. The former were positive for CD1b and had lower levels of CD11b and CD86 than the CD14+ monocytes. The more diffuse CD14+CD16+ population generally expressed intermediate levels of these molecules. All three populations responded to stimulation with phenol-extracted lipopolysaccharide (LPS) by producing interleukin (IL)-1β, with the CD16++ subset expressing higher levels of IL-12 and lower levels of IL-10. The CD14−CD16++ cells were more endocytic and induced greater allogeneic T cell responses compared to the other monocyte populations. Taken together the data show both similarities and differences between the classical, intermediate and non-classical definitions of monocytes as described for other mammalian species, with additional potential subpopulations. Further functional analyses of these monocyte populations may help explain inter-animal and inter-species variations to infection, inflammation and vaccination in ruminant livestock

Expert system design for long term care underwriting

The project presents a mathematical model created to determine a risk score for applicants for long term care insurance. We developed software to assist in the implementation and testing of the model. We analyze the suitability of our model, including the sensitivity of scores to the model's parameters. We formulate methods which could help train the model, including numerical regression to solve for model parameters and pair-wise comparisons between applicants to verify consistency of parameters and risk factors

AmeriCorps Outcomes Assessment

This project, conducted under the sponsorship of the Urban Institute, provided the Corporation for National and Community Service with an assessment of the outcomes of AmeriCorps. We analyzed data received from six surveys given to members, organizations, and end beneficiaries of AmeriCorps. Using our analysis, we provided detailed results as well as recommendations for the survey questionnaires and the survey interviewers to help develop a more effective survey

Simplified isometric model of unit volume of bone.

<p>The model shows the composite fibril/mineral structural makeup of cortical bone for the purpose of using EDXS data to estimate spatial distribution of mineral. The subvolumes H, G, V and O are identified in the text. EDXS X-rays are recorded emerging from top of this structure.</p

Human femur sectioned parallel to long axis of femur.

<p>a) bright field (BF) image: faint bands oriented NW-SE, repeated every 68 nm, denote concentration of HA in gap zones in collagen fibrils which run perpendicular to the bands. Perpendicular to the bands are ∼23 nm wide bundles spaced ∼50 nm apart comprised of clusters of linear features (arrow) 5±1 nm wide, and up to 200 nm in length; b) selected area diffraction pattern indexed to HA; note that 00l reflections form arcs indicating preferred orientation of the c axes of the HA parallel to the to the fibrils, while other reflections form complete circles, lack of alignment of the a and b axes.</p

Sharply defined borders between gap zone and overlap zone.

<p>Bright field TEM image of longitudinal section of human bone. Image shows sharp border between high-contrast gap zones and low-contrast overlap zones. There is no evidence that the higher-contrast material (presumably HA) penetrates into the overlap zone. Arrows point to possible boundaries of constituent crystals (see <i>Conclusions</i>).</p

Measurements of Mineral Sections in Cross-section Image (Figure 3).

<p>Measurements of Mineral Sections in Cross-section Image (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029258#pone-0029258-g003" target="_blank">Figure 3</a>).</p

Dark field images.

<p>(a) bright-field and (b) dark-field images (using 002 reflections) of same region in a sample of human bone cut parallel to the long axis of the bone. Bragg reflections from the 002 planes of HA are concentrated along the long dark structures, showing that they contain crystals of HA. Note lack of 002 reflections from gap zones. c) Dark field image of a second area showing Moiré fringes in area between lanes of mineral structures that are not visible in this image.</p