Pressure ulcer related pain in community populations: a prevalence survey.

BACKGROUND: Pressure ulcers are costly to the healthcare provider and can have a major impact on patient's quality of life. One of the most distressing symptoms reported is pain. There is very little published data on the prevalence and details of pain experienced by patients with pressure ulcers, particularly in community populations. The study was conducted in two community NHS sites in the North of England. METHODS: The aim was to estimate the prevalence of pressure area related pain within a community population. We also explored the type and severity of the pain and its association with pressure ulcer classification. A cross-sectional survey was performed of community nurses caseloads to identify adult patients with pressure ulcers and associated pain. Consenting patients then had a full pain assessment and verification of pressure ulcer grade. RESULTS: A total of 287 patients were identified with pressure ulcers (0.51 per 1000 adult population). Of the 176 patients who were asked, 133 (75.6%) reported pain. 37 patients consented to a detailed pain assessment. Painful pressure ulcers of all grades and on nearly all body sites were identified. Pain intensity was not related to number or severity of pressure ulcer. Both inflammatory and neuropathic pain were reported at all body sites however the proportion of neuropathic pain was greater in pressure ulcers on lower limbs. CONCLUSIONS: This study has identified the extent and type of pain suffered by community patients with pressure ulcers and indicates the need for systematic and regular pain assessment and treatment

Magnetization Relaxation via Quantum and Classical Vortex Motion in a Bose Glass Superconductor

I show that in Bose Glass superconductor with high $j_c$ and at low $T$ the magnetization relaxation (S), dominated by quantum tunneling, is $\propto{\sqrt j_c}$, which crosses over to the conventional classical rate $\propto T/j_c$ at higher $T$ and lower $j_c$, with the crossover $T^*\sim j_c^{3/2}$. I argue that due to interactions between flux lines there exist three relaxation regimes, depending on whether $BB_\phi$, corresponding to Strongly-pinned Bose Glass (SBG) with large $j_{c2}$, Mott Insulator (MI) with vanishing S, and Weakly-pinned Bose Glass (WBG) characterized by small $j_{c1}$. I discuss the effects of interactions on $j_c$ and focus attention on the recent experiment which is consistently described by the theory.Comment: 4 pages, self-unpacking uuencoded compressed postscript file with figures already inside text; to appear in Phys. Rev. Lett.(1995

Global N-body simulations of circumbinary planet formation around Kepler-16 and -34 analogues I: Exploring the pebble accretion scenario

Numerous circumbinary planets have been discovered in surveys of transiting planets. Often, these planets are found to orbit near to the zone of dynamical instability, close to the central binary. The existence of these planets has been explained by hydrodynamical simulations that show that migrating circumbinary planets, embedded in circumbinary discs, halt at the central cavity that is formed by the central binary. Transit surveys are naturally most sensitive to finding circumbinary planets with the shortest orbital periods. The future promise of detecting longer period systems using radial-velocity searches, combined with the anticipated detection of numerous circumbinary planets by ESA's PLATO mission, points to the need to model and understand the formation and evolution of circumbinary planets in a more general sense than has been considered before. With this goal in mind, we present a newly developed global model of circumbinary planet formation that is based on the mercury6 symplectic N-body integrator, combined with a model for the circumbinary disc and prescriptions for a range of processes involved in planet formation such as pebble accretion, gas envelope accretion and migration. Our results show that under reasonable assumptions, the pebble accretion scenario can produce circumbinary systems that are similar to those observed, and in particular is able to produce planets akin to Kepler-16b and Kepler-34b. Comparing our results to other systems, we find that our models also adequately reproduce such systems, including multi-planet systems. Resonances between neighbouring planets are frequently obtained, whilst ejections of planets by the central binary acts as an effective source of free floating planets.Comment: Accepted for publication in MNRAS, 23 pages, 16 figure

Dusty circumbinary discs: inner cavity structures and stopping locations of migrating planets

We present the results of two-fluid hydrodynamical simulations of circumbinary discs consisting of gas and dust, with and without embedded planets, to examine the influence of the dust on the structure of the tidally truncated inner cavity and on the parking locations of migrating planets. In this proof-of-concept study, we consider Kepler-16 and -34 analogues, and examine dust fluids with Stokes numbers in the range $10^{-4} \le St \le 10^{-1}$ and dust-to-gas ratios of 0.01 and 1. For the canonical dust-to-gas ratio of 0.01, we find the inclusion of the dust has only a minor effect on the cavity and stopping locations of embedded planets compared to dust-free simulations. However, for the enhanced dust-to-gas ratio of unity, assumed to arise because of significant dust drift and accumulation, we find that the dust can have a dramatic effect by shrinking and circularising the inner cavity, which brings the parking locations of planets closer to the central binary. This work demonstrates the importance of considering both gas and dust in studies of circumbinary discs and planets, and provides a potential means of explaining the orbital properties of circumbinary planets such as Kepler-34b, which have hitherto been difficult to explain using gas-only hydrodynamical simulations.Comment: Accepted for publication in MNRAS, 20 pages, 17 figure

Sine-Gordon Field Theory for the Kosterlitz-Thouless Transitions on Fluctuating Membranes

In the preceding paper, we derived Coulomb-gas and sine-Gordon Hamiltonians to describe the Kosterlitz-Thouless transition on a fluctuating surface. These Hamiltonians contain couplings to Gaussian curvature not found in a rigid flat surface. In this paper, we derive renormalization-group recursion relations for the sine-Gordon model using field-theoretic techniques developed to study flat space problems.Comment: REVTEX, 14 pages with 6 postscript figures compressed using uufiles. Accepted for publication in Phys. Rev.

Genetic background influences murine prostate gene expression: implications for cancer phenotypes

Microarray analyses to quantitate transcript levels in the prostates of five inbred mouse strains identified differences in gene expression in benign epithelium that correlated with the differentiation state of adjacent tumors

Exploring the role of pain as an early predictor of category 2 pressure ulcers: a prospective cohort study

Objective To explore pressure area related pain as a predictor of category ≥2 pressure ulcer (PU) development. Design Multicentre prospective cohort study. Setting UK hospital and community settings. Participants inclusion Consenting acutely ill patients aged ≥18 years, defined as high risk (Braden bedfast/chairfast AND completely immobile/very limited mobility; pressure area related pain or; category 1 PU). Exclusion Patients too unwell, unable to report pain, 2 or more category ≥2 PUs. Follow-up Twice weekly for 30 days. Primary and secondary outcome measures Development and time to development of one or more category ≥2 PUs. Results Of 3819 screened, 1266 were eligible, 634 patients were recruited, 32 lost to follow-up, providing a 602 analysis population. 152 (25.2%) developed one or more category ≥2 PUs. 464 (77.1%) patients reported pressure area related pain on a healthy, altered or category 1 skin site of whom 130 (28.0%) developed a category ≥2 PU compared with 22 (15.9%) of those without pain. Full stepwise variable selection was used throughout the analyses. (1) Multivariable logistic regression model to assess 9 a priori factors: presence of category 1 PU (OR=3.25, 95% CI (2.17 to 4.86), p<0.0001), alterations to intact skin (OR=1.98, 95% CI (1.30 to 3.00), p=0.0014), pressure area related pain (OR=1.56, 95% CI (0.93 to 2.63), p=0.0931). (2) Multivariable logistic regression model to account for overdispersion: presence of category 1 PU (OR=3.20, 95% CI (2.11 to 4.85), p<0.0001), alterations to intact skin (OR=1.90, 95% CI (1.24 to 2.91), p=0.0032), pressure area related pain (OR=1.85, 95% CI (1.07 to 3.20), p=0.0271), pre-existing category 2 PU (OR=2.09, 95% CI (1.35 to 3.23), p=0.0009), presence of chronic wound (OR=1.66, 95% CI (1.06 to 2.62), p=0.0277), Braden activity (p=0.0476). (3) Accelerated failure time model: presence of category 1 PU (AF=2.32, 95% CI (1.73 to 3.12), p<0.0001), pressure area related pain (AF=2.28, 95% CI (1.59 to 3.27), p<0.0001). (4) 2-level random-intercept logistic regression model: skin status which comprised 2 levels (versus healthy skin); alterations to intact skin (OR=4.65, 95% CI (3.01 to 7.18), p<0.0001), presence of category 1 PU (OR=17.30, 95% CI (11.09 to 27.00), p<0.0001) and pressure area related pain (OR=2.25, 95% CI (1.53 to 3.29), p<0.0001). Conclusions This is the first study to assess pain as a predictor of category ≥2 PU development. In all 4 models, pain emerged as a risk factor associated with an increased probability of category ≥2 PU development

Information Content of Spontaneous Symmetry Breaking

We propose a measure of order in the context of nonequilibrium field theory and argue that this measure, which we call relative configurational entropy (RCE), may be used to quantify the emergence of coherent low-entropy configurations, such as time-dependent or time-independent topological and nontopological spatially-extended structures. As an illustration, we investigate the nonequilibrium dynamics of spontaneous symmetry-breaking in three spatial dimensions. In particular, we focus on a model where a real scalar field, prepared initially in a symmetric thermal state, is quenched to a broken-symmetric state. For a certain range of initial temperatures, spatially-localized, long-lived structures known as oscillons emerge in synchrony and remain until the field reaches equilibrium again. We show that the RCE correlates with the number-density of oscillons, thus offering a quantitative measure of the emergence of nonperturbative spatiotemporal patterns that can be generalized to a variety of physical systems.Comment: LaTeX, 9 pages, 5 figures, 1 tabl

Constraining the formation history of the TOI-1338/BEBOP-1 circumbinary planetary system

The recent discovery of multiple planets in the circumbinary system TOI-1338/BEBOP-1 raises questions about how such a system formed. The formation of the system was briefly explored in the discovery paper, but only to answer the question do current pebble accretion models have the potential to explain the origin of the system? We use a global model of circumbinary planet formation that utilises N-body simulations, including prescriptions for planet migration, gas and pebble accretion, and interactions with a circumbinary disc, to explore the disc parameters that could have led to the formation of the TOI-1338/BEBOP-1 system. With the disc lifetime being the main factor in determining how planets form, we limit our parameter space to those that determine the disc lifetime. These are: the strength of turbulence in the disc, the initial disc mass, and the strength of the external radiation field that launches photoevaporative winds. When comparing the simulated systems to TOI-1338/BEBOP-1, we find that only discs with low levels of turbulence are able to produce similar systems. The radiation environment has a large effect on the types of planetary systems that form, whilst the initial disc mass only has limited impact since the majority of planetary growth occurs early in the disc lifetime. With the most TOI-1338/BEBOP-1 like systems all occupying similar regions of parameter space, our study shows that observed circumbinary planetary systems can potentially constrain the properties of planet forming discs.Comment: Accepted for publication in MNRAS, 15 pages, 10 figure

Sudden stratospheric warmings seen in MINOS deep underground muon data

The rate of high energy cosmic ray muons as measured underground is shown to be strongly correlated with upper-air temperatures during short-term atmospheric (10-day) events. The effects are seen by correlating data from the MINOS underground detector and temperatures from the European Centre for Medium Range Weather Forecasts during the winter periods from 2003-2007. This effect provides an independent technique for the measurement of meteorological conditions and presents a unique opportunity to measure both short and long-term changes in this important part of the atmosphere. Citation: Osprey, S., et al. (2009), Sudden stratospheric warmings seen in MINOS deep underground muon data, Geophys. Res. Lett., 36, L05809, doi: 10.1029/2008GL036359