Use of spinal cord stimulation in managing neuropathic foot pain: an observational pilot case series study

Objective: In cases of complex regional pain syndrome where conservative treatment is unsuccessful in controlling neuropathic foot pain spinal cord stimulation may be considered. To our knowledge there have been no such cases reported in the foot & ankle literature. The aim of the study was to establish useful information that may supplement our understanding of this complex multifactorial problem and help toinform future management of similar cases. Methods: A pilot observational case series study was undertaken to investigate the use of spinal cord stimulation in the management of neuropathic foot pain using five cases with complex regional pain syndrome (type I). Results: Reduced pain following spinal cord stimulation was reported. The interval between diagnosis and commencement of spinal cord stimulation was variable between cases and maybe responsible for differing levels and timing of pain relief experienced. Conclusion: Careful preoperative diagnosis, robust patient selection and close postoperative monitoring are vital for a successful outcome. The small sample size and potential for bias, limit the generalizability to a larger population. A larger study is therefore indicated to expand upon preliminary findings

The structure and petrology of the eastern part of the central Igneous Complex of Arran

The central Igneous Complex of Arran is one of the Tertiary volcanic centres of the West coast of Scotland. The thesis describes the structure and petrology of the eastern part of the Complex, and includes a detailed account of the area of Glen Dubh. Three main divisions of the Complex are recognised; the volcanic caldera of Ard Bheinn, in the West; the granite and agglomerate masses of the eastern part on A'Chruach and the Tir Dubh; and the instructions of diorite, dolerite and gabbro on the eastern margin on the Complex in Glen Dubh and Glen Ormidale. The complex is emplaced in rocks of Old Red Sandstone, Carboniferous and Permian age and chalk occur. The country rocks of the Glen Dubh area are Old Red Sandstone sediments, bleached and partly recrystallised by thermal metamorphism. A sinous fault divides the Glen Dubh area, and forms, to the North, the boundary of the Complex. In Glen Dubh, the inner area is mainly of dolerite forming an irregular margin to the gabbro. A dyke of felsite occurs along the fault for a short distance and to the West in the Innner Area, there is a thick sill-like body of felsite breccia. Veins of breccia extend into the over-overlying dolerite. In two places the brecciation of the dolerite above the felsite is so intense as to form small vents. In the Outer area Glen Dubh, there is a layered sequence. Sediments of Old Red Sandstone age were intruded by a concordant gabbro and dolerite body (the base is not exposed) and subsequently, before cooling of the basic rocks, a thin sheet of microgranite was intruded along the contact. Reaction between the microgranite and basic rocks resulted in the formation of a variable suite of diorites- finegrained diorites formed as a result of the alternation of solid gabbro or dolerite, mainly by diffusion of granite material, and diorites formed by contamination of the microgranite, which intrude the other rocks in places. Alternation of the gabbros is by the introduction of granitic material. No occurrence of assimilation of sedimentary material has been found, although small-scale assimilation of quartzite fragments in fine hornblende diorite occurs in one locality.The igneous history determined for the Glen Dubh area is correlated with that of the rest of the Central Complex thus. The isolated areas of diorite around the northern edge of the Complex are equivalent to the diorites of Glen Dubh. The rocks of Glen Dubh area are interpreted as being relics of the early stages of the igneous period which culminated in the formation of the vents and caldera of Ard Bheinn. The equivalent rocks in the Ard Bheinn areas have been removed durin the volcanic episode, or are present only as small isolated remnants

Feasibility and Acceptability of a Web-Based Treatment with Telephone Support for Postpartum Women With Anxiety: Randomized Controlled Trial

BACKGROUND: Postpartum anxiety can have adverse effects on the mother and child if left untreated. Time constraints and stigma are common barriers to postpartum treatment. Web-based treatments offer potential flexibility and anonymity. What Am I Worried About (WaWa) is a self-guided treatment based on cognitive-behavioral and mindfulness principles for women experiencing postpartum anxiety. WaWa was developed in Australia and consists of 9 modules with optional weekly telephone support. WaWa was adapted to a Web-based version for use in England (Internet-based What Am I Worried About, iWaWa). OBJECTIVE: This study aimed to investigate the feasibility (engagement and usability) and acceptability (usefulness, satisfaction, and helpfulness) of iWaWa among English postpartum women with anxiety. METHODS: Postpartum (<12 months) women with mild-to-severe anxiety were recruited anonymously via social media during an 8-week period. Participants were randomized to the iWaWa treatment (8 weeks) or wait-list control group. Treatment and study feasibility and acceptability were assessed after the treatment, and anxiety symptoms were assessed at baseline, 8 weeks postrandomization, and 12 weeks postrandomization (treatment group only) using Web-based questionnaires. Semistructured telephone interviews were carried out after the treatment period for a more in-depth exploration of treatment acceptability and feasibility. RESULTS: A total of 89 eligible women were recruited through social media and randomized into the treatment (n=46) or wait-list control group (n=43). Women were predominantly Caucasian, well-educated, married, on maternity leave, first-time mothers and reported moderate levels of anxiety. Dropout rates were high, especially in the treatment group (treatment: 82%, 38/46; wait-list control: 51%, 22/43). A total of 26 women started iWaWa with only 2 women completing all 9 modules. Quantitative and qualitative data suggest iWaWa was experienced as generally useful and helpful. Participants enjoyed iWaWa's accessibility, anonymity, and weekly reminders, as well as the introduction to the principles of cognitive-behavioral therapy (CBT) and mindfulness. However, iWaWa was also experienced as not user-friendly enough, too long, and not smartphone-friendly. Parts of the content were experienced as not always relevant and appropriate. Participants felt that iWaWa could be improved by having it in a smartphone app format and by making the content more concise and inclusive of different parenting styles. CONCLUSIONS: Despite interest in iWaWa, the results suggest that both the study and iWaWa were not feasible in the current format. However, this first trial provides useful evidence about treatment format and content preferences that can inform iWaWa's future development, as well as research and development of Web-based postpartum anxiety treatments, in general, to optimize adherence. TRIAL REGISTRATION: ClinicalTrials.gov NCT02434406; https://clinicaltrials.gov/ct2/show/NCT02434406 (Archived by WebCite at http://www.webcitation.org/6xTq7Bwmd)

Internet-based interventions for postpartum anxiety: exploring health visitors’ views

Objective: This study aimed to explore health visitors’ (HVs) views on the acceptability and potential implementation of internet-based postpartum anxiety interventions in their practice. Background: Internet-based self-help has been shown to be effective and acceptable for postpartum depression. Recently, an internet-based intervention has been developed for postpartum anxiety. Before implementing new anxiety interventions in postpartum care, it is important to determine the acceptability and ways of implementing such interventions. This study therefore explored HVs’ views on this, as they are the some of the key healthcare professionals supporting women postpartum. Methods: Semi-structured interviews were conducted with 13 HVs across the UK. Audio-recorded interviews were transcribed verbatim and analysed using thematic analysis. Results: Five themes emerged – suitability; benefits; concerns; importance of one-to-one support; implementation. Internet-based interventions were seen as suitable as an additional option for a sub-group of postpartum women. Identified benefits included increased availability of a treatment tool for postpartum anxiety and treatment anonymity and flexibility. Reported concerns were the women’s state of mind, decreased human and professional contact, as well as IT access and literacy and language skills. HVs considered the most feasible way to implement internet-based interventions would be to have flyers for HVs to include with other information provided after birth or to hand out and discuss during their visits. The need for sufficient evidence of treatment efficacy and appropriate training was highlighted. Conclusion: This study highlights the opportunities and challenges that need to be considered before implementing internet-based interventions for postpartum anxiety in the postpartum care

How do foragers decide when to leave a patch? A test of alternative models under natural and experimental conditions.

This is the peer reviewed version of the article which has been published in final form at DOI: http://dx.doi.org/10.1111/1365-2656.12089. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.© 2013 The Authors. Journal of Animal Ecology © 2013 British Ecological Society.A forager's optimal patch-departure time can be predicted by the prescient marginal value theorem (pMVT), which assumes they have perfect knowledge of the environment, or by approaches such as Bayesian updating and learning rules, which avoid this assumption by allowing foragers to use recent experiences to inform their decisions. In understanding and predicting broader scale ecological patterns, individual-level mechanisms, such as patch-departure decisions, need to be fully elucidated. Unfortunately, there are few empirical studies that compare the performance of patch-departure models that assume perfect knowledge with those that do not, resulting in a limited understanding of how foragers decide when to leave a patch. We tested the patch-departure rules predicted by fixed rule, pMVT, Bayesian updating and learning models against one another, using patch residency times (PRTs) recorded from 54 chacma baboons (Papio ursinus) across two groups in natural (n = 6175 patch visits) and field experimental (n = 8569) conditions. We found greater support in the experiment for the model based on Bayesian updating rules, but greater support for the model based on the pMVT in natural foraging conditions. This suggests that foragers may place more importance on recent experiences in predictable environments, like our experiment, where these experiences provide more reliable information about future opportunities. Furthermore, the effect of a single recent foraging experience on PRTs was uniformly weak across both conditions. This suggests that foragers' perception of their environment may incorporate many previous experiences, thus approximating the perfect knowledge assumed by the pMVT. Foragers may, therefore, optimize their patch-departure decisions in line with the pMVT through the adoption of rules similar to those predicted by Bayesian updating.Natural Environment Research Council (NERC)Fenner School of Environment and SocietyLeakey FoundationAnimal Behavior Society (USA)International Primatological SocietyExplorers Club Exploration Fun

The role of insulin receptor substrate 2 in hypothalamic and β cell function

Insulin receptor substrate 2 (Irs2) plays complex roles in energy homeostasis. We generated mice lacking Irs2 in β cells and a population of hypothalamic neurons (RIPCreIrs2KO), in all neurons (NesCreIrs2KO), and in proopiomelanocortin neurons (POMCCreIrs2KO) to determine the role of Irs2 in the CNS and β cell. RIPCreIrs2KO mice displayed impaired glucose tolerance and reduced β cell mass. Overt diabetes did not ensue, because β cells escaping Cre-mediated recombination progressively populated islets. RIPCreIrs2KO and NesCreIrs2KO mice displayed hyperphagia, obesity, and increased body length, which suggests altered melanocortin action. POMCCreIrs2KO mice did not display this phenotype. RIPCreIrs2KO and NesCreIrs2KO mice retained leptin sensitivity, which suggests that CNS Irs2 pathways are not required for leptin action. NesCreIrs2KO and POMCCreIrs2KO mice did not display reduced β cell mass, but NesCreIrs2KO mice displayed mild abnormalities of glucose homeostasis. RIPCre neurons did not express POMC or neuropeptide Y. Insulin and a melanocortin agonist depolarized RIPCre neurons, whereas leptin was ineffective. Insulin hyperpolarized and leptin depolarized POMC neurons. Our findings demonstrate a critical role for IRS2 in β cell and hypothalamic function and provide insights into the role of RIPCre neurons, a distinct hypothalamic neuronal population, in growth and energy homeostasis

The role of insulin receptor substrate 2 in hypothalamic and beta cell function

Insulin receptor substrate 2 (Irs2) plays complex roles in energy homeostasis. We generated mice lacking Irs2 in beta cells and a population of hypothalamic neurons (RIPCreIrs2KO), in all neurons (NesCreIrs2KO), and in proopiomelanocortin neurons (POMCCreIrs2KO) to determine the role of Irs2 in the CNS and beta cell. RIPCreIrs2KO mice displayed impaired glucose tolerance and reduced P cell mass. Overt diabetes did not ensue, because beta cells escaping Cre-mediated recombination progressively populated islets. RIPCreIrs2KO and NesCreIrs2KO mice displayed hyperphagia, obesity, and increased body length, which suggests altered melanocortin action. POMCCreIrs2KO mice did not display this phenotype. RIPCreIrs2KO and NesCreIrs2KO mice retained leptin sensitivity, which suggests that CNS Irs2 pathways are not required for leptin action. NesCreIrs2KO and POMCCreIrs2KO mice did not display reduced beta cell mass, but NesCreIrs2KO mice displayed mild abnormalities of glucose homeostasis. RIPCre neurons did not express POMC or neuropeptide Y. Insulin and a melanocortin agonist depolarized RIPCre neurons, whereas leptin was ineffective. Insulin hyperpolarized and leptin depolarized POMC neurons. Our findings demonstrate a critical role for IRS2 in beta cell and hypothalamic function and provide insights into the role of RIPCre neurons, a distinct hypothalamic neuronal population, in growth and energy homeostasis

Avian malaria is absent in juvenile colonial herons (Ardeidae) but not Culex pipiens mosquitoes in the Camargue, Southern France

Apicomplexan blood parasites Plasmodium and Haemoproteus (together termed “Avian malaria”) and Leucocytozoon are widespread, diverse vector-transmitted blood parasites of birds, and conditions associated with colonial nesting in herons (Ardeidae) and other waterbirds appear perfect for their transmission. Despite studies in other locations reporting high prevalence of parasites in juvenile herons, juvenile Little Egrets (Egretta garzetta) previously tested in the Camargue, Southern France, had a total absence of malaria parasites. This study tested the hypotheses that this absence was due to insufficient sensitivity of the tests of infection; an absence of infective vectors; or testing birds too early in their lives. Blood was sampled from juveniles of four species shortly before fledging: Little Egret (n = 40), Cattle Egret (Bubulcus ibis; n = 40), Black-crowned Night-Heron (Nycticorax nycticorax, n = 40), and Squacco Heron (Ardeola ralloides; n = 40). Sensitive nested-Polymerase Chain Reaction was used to test for the presence of parasites in both birds and host-seeking female mosquitoes captured around the colonies. No malaria infection was found of in any of the heron species. Four different lineages of Plasmodium were detected in pooled samples of female Culex pipiens mosquitoes, including two in potentially infective mosquitoes. These results confirm that the absence of malaria parasites previously demonstrated in Little Egret is not due to methodological limitations. Although the prevalence of infection in mosquitoes was low, conditions within the colonies were suitable for transmission of Plasmodium. These colonial heron species may have evolved strategies for resisting malaria infection through physiological or behavioral mechanisms