High Prevalence of Hypermobility and Benign Joint Hypermobility Syndrome (BJHS) in Oman

PURPOSE: To ascertain the prevalence of hypermobility and BJHS in a female patient population with musculoskeletal pain and compare the associated features with a pain free control group. RELEVANCE: Hypermobility is linked with increased musculoskeletal signs and symptoms. The existence of hypermobility with pain may indicate the presence of BJHS, which is a heritable connective tissue disorder synonymous with Ehlers-Danlos type III. Hypermobility is known to be race dependant with Asians and Africans being more hypermobile than Caucasians. The fragility of tissues in those with BJHS makes them more vulnerable to pain associated with soft tissue overuse injuries, traumatic synovitis, sprains and recurrent shoulder dislocations (Grahame 2000; Grahame et al 1981; Finterbush and Pogund 1982) it is also associated with delayed tissue healing, impaired proprioception (Mallik et al 1994; Hall et al 1995) and chronic pain. (Harding and Grahame 1990) PARTICIPANTS: 94 Female Omani patients with musculoskeletal pain attending the rehabilitation department outpatient clinics of the Khoula Hospital aged 18–50 were examined. 90 controls of the same age were recruited from the female Omani hospital staff. METHODS: All patients and controls were examined and questioned by one physiotherapist (CC), who had received training from a rheumatologist (RG) in clinical examination of patients at the hypermobility clinic, University College Hospital, London. Patients and controls were examined using the Beighton score and Brighton Criteria. ANALYSIS: Analysis was by χ2 for number of individuals and t-test for joint mobility scores. (Excel® 2002) RESULTS: 51% of patients were found to be hypermobile as opposed to 30% of controls (p = 0.015). 55.3% of patients had features of BJHS as opposed to 21.1% of controls. (p ≤ 0.0001). Significantly more patients presenting with knee pain had BJHS (p = 0.02). There was a non-significant trend for patients with BJHS to re-attend the out patient clinics (p= 0.06). CONCLUSIONS: This study established that this patient population was significantly more hypermobile than a control population. The incidence of BJHS in patients in this study was higher than that noted amongst female Caucasians, but similar to non Caucasians attending rheumatological clinics in the UK. (Grahame and Hakim 2004). Further epidemiological studies are required in other populations to look at patient re-attendance in musculoskeletal clinics and more specifically for those presenting with back and knee pain. IMPLICATIONS: Better recognition and awareness of hypermobility and BJHS will enable patients to receive treatment programmes, modified to take into account tissue fragility, hypermobile joints, impaired proprioception and chronic pain. KEYWORDS: Hypermobility, Pain, Joints. FUNDING ACKNOWLEDGEMENTS: No funding. Jane Simmonds, UCL supervising team, Professor R. Grahame and Dr. A. Hakim from the Hypermobility clinic UCH, London, Professor H. Holmberg, Khoula Hospital Director, Samia Al Marjeby head of rehabilitation, the staff and patients of Khoula Hospital, Muscat, Oman. CONTACT: [email protected] ETHICS COMMITTEE: Khoula Hospital Ethics committee, Khoula Hospital, Muscat, Oman (12/11/2003

Pinhole calculations of the Josephson effect in 3He-B

We study theoretically the dc Josephson effect between two volumes of superfluid 3He-B. We first discuss how the calculation of the current-phase relationships is divided into a mesoscopic and a macroscopic problem. We then analyze mass and spin currents and the symmetry of weak links. In quantitative calculations the weak link is assumed to be a pinhole, whose size is small in comparison to the coherence length. We derive a quasiclassical expression for the coupling energy of a pinhole, allowing also for scattering in the hole. Using a selfconsistent order parameter near a wall, we calculate the current-phase relationships in several cases. In the isotextural case, the current-phase relations are plotted assuming a constant spin-orbit texture. In the opposite anisotextural case the texture changes as a function of the phase difference. For that we have to consider the stiffness of the macroscopic texture, and we also calculate some surface interaction parameters. We analyze the experiments by Marchenkov et al. We find that the observed pi states and bistability hardly can be explained with the isotextural pinhole model, but a good quantitative agreement is achieved with the anisotextural model.Comment: 20 pages, 21 figures, revtex

Tripartite interactions between two phase qubits and a resonant cavity

The creation and manipulation of multipartite entangled states is important for advancements in quantum computation and communication, and for testing our fundamental understanding of quantum mechanics and precision measurements. Multipartite entanglement has been achieved by use of various forms of quantum bits (qubits), such as trapped ions, photons, and atoms passing through microwave cavities. Quantum systems based on superconducting circuits have been used to control pair-wise interactions of qubits, either directly, through a quantum bus, or via controllable coupling. Here, we describe the first demonstration of coherent interactions of three directly coupled superconducting quantum systems, two phase qubits and a resonant cavity. We introduce a simple Bloch-sphere-like representation to help one visualize the unitary evolution of this tripartite system as it shares a single microwave photon. With careful control and timing of the initial conditions, this leads to a protocol for creating a rich variety of entangled states. Experimentally, we provide evidence for the deterministic evolution from a simple product state, through a tripartite W-state, into a bipartite Bell-state. These experiments are another step towards deterministically generating multipartite entanglement in superconducting systems with more than two qubits

Depression, anxiety, pain and quality of life in people living with chronic hepatitis C: A systematic review and meta-analysis

Objectives: Individuals infected with hepatitis C virus (HCV) can develop extrahepatic conditions which may have a significant impact on life expectancy and quality of life. We conducted a systematic review to assess the causal relationship between HCV and extrahepatic conditions and the impact of HCV upon health-related quality of life of people in the UK. / Methods: HCV advocacy groups identified conditions that they thought most important to research, and the perspectives of various stakeholders informed the scope of the review. A comprehensive literature search of a range of electronic databases and websites was undertaken. Screening, quality assessment and data extraction were conducted using specialist software. The key criterion for inclusion in a synthesis was a study’s testing of the association between HCV and either quality of life or conditions specified as important by advocacy groups: depression, anxiety or painful conditions. Other criteria relating to study populations, measures and matching of study groups were also applied. Two reviewers assessed included studies, with disagreements resolved by a third reviewer where necessary. Studies were assessed for methodological quality using standardised appraisal tools. Metaanalyses were performed. Based on the consistency and sufficiency of research evidence, the findings were graded as strong, promising, tentative or inconclusive. / Results: 71 studies were included in the review’s syntheses. All studies were judged to be at a moderate or high risk of bias. Only two UK studies met our inclusion criteria. / Quality of life: Evidence from 22 studies indicates that people with HCV have worse quality of life than ‘general’ or ‘healthy’ populations; meta-analysis of nine studies indicated\ud that the physical (PCS) and mental health (MCS) domains of quality of life on the Health-Related Quality of Life Scale were both statistically and clinically worse among HCV-infected people (PCS: MD 5.54, 95% CI 3.73-7.35, MCS: MD 3.81, 95% CI 1.97-5.64). Evidence from seven included studies suggests that people co-infected with HCV and HIV have worse quality of life than individuals with HIV only; metaanalysis of five studies indicated that both the physical and mental health domains of quality of life were significantly worse among people who were co-infected (PCS: MD 2.57, 95% CI 1.08-4.06, MCS: MD 1.88, 95% CI 0.06-3.69). / Depression and anxiety: Evidence from 22 studies indicates that depression and anxiety are more severe, and depression is more common among people with HCV compared to those without it. Meta-analysis of 12 studies identified the severity of depression in people with HCV to be significantly greater than in those without HCV (Mean difference 0.98, 95% CI 0.43-1.53). Meta-analysis of nine studies identified the severity of clinical anxiety to be significantly greater among people with HCV (Mean difference 0.47, 95% CI 0.09-0.86). Meta-analysis of seven studies identified participants with HCV to be approximately three times more likely to be depressed compared to those without HCV (OR 2.77, 95% CI 1.62-4.74). No statistically significant evidence that anxiety is more common among people with HCV was found. / Pain: Evidence was appraised from 26 studies on painful conditions. A meta-analysis of four studies indicates that people with HCV are 17% more likely to suffer from arthralgia than those without HCV (RR 1.17, 95% CI 1.04-1.31). A meta-analysis of five studies suggested that people with HCV are significantly more likely to suffer from fibromyalgia; key differences across the studies in terms of the health status (co-morbidities) of HCV patients and comparison groups mean it is not possible to quantify the increased risk attributable to HCV. Other studies, including those on arthritis, were not amenable to meta-analysis. / Conclusions: Evidence suggests an association between HCV infection and depression, anxiety, fibromyalgia, arthralgia and health-related quality of life. However, the evidence was graded as ‘promising’ or ‘tentative’ rather than ‘strong’. More high-quality research on the association between HCV and these conditions is needed

Josephson Effect between Condensates with Different Internal Structures

A general formula for Josephson current in a wide class of hybrid junctions between different internal structures is derived on the basis of the Andreev picture. The formula extends existing formulae and also enables us to analyze novel B-phase/A-phase/B-phase (BAB) junctions in superfluid helium three systems, which are accessible to experiments. It is predicted that BAB junctions will exhibit two types of current-phase relations associated with different internal symmetries. A ``pseudo-magnetic interface effect'' inherent in the system is also revealed.Comment: 4 pages, 2 figure

Coherent quantum state storage and transfer between two phase qubits via a resonant cavity

A network of quantum-mechanical systems showing long lived phase coherence of its quantum states could be used for processing quantum information. As with classical information processing, a quantum processor requires information bits (qubits) that can be independently addressed and read out, long-term memory elements to store arbitrary quantum states, and the ability to transfer quantum information through a coherent communication bus accessible to a large number of qubits. Superconducting qubits made with scalable microfabrication techniques are a promising candidate for the realization of a large scale quantum information processor. Although these systems have successfully passed tests of coherent coupling for up to four qubits, communication of individual quantum states between qubits via a quantum bus has not yet been demonstrated. Here, we perform an experiment demonstrating the ability to coherently transfer quantum states between two superconducting Josephson phase qubits through a rudimentary quantum bus formed by a single, on chip, superconducting transmission line resonant cavity of length 7 mm. After preparing an initial quantum state with the first qubit, this quantum information is transferred and stored as a nonclassical photon state of the resonant cavity, then retrieved at a later time by the second qubit connected to the opposite end of the cavity. Beyond simple communication, these results suggest that a high quality factor superconducting cavity could also function as a long term memory element. The basic architecture presented here is scalable, offering the possibility for the coherent communication between a large number of superconducting qubits.Comment: 17 pages, 4 figures (to appear in Nature

Pragmatic randomized controlled trial of the Mind Management Skills for Life Programme as an intervention for occupational burnout in mental healthcare professionals

Background Occupational burnout is highly prevalent in the mental healthcare workforce and associated with poorer job satisfaction, performance and outcomes. Aims To evaluate the effects of the Mind Management Skills for Life Programme on burnout and wellbeing. Methods N = 173 mental health nurses were recruited from the English National Health Service during the acute phase of the COVID-19 crisis. Participants were allocated to an immediate intervention or a delayed intervention control group, using a stepped wedge randomized controlled trial design. Measures of burnout (OLBI) and wellbeing (WEMWBS) were completed at four time-points: [1] baseline; [2] after the first group finished the intervention; [3] after the second group finished the intervention; and [4] six-months follow-up. Results Between-group differences were compared at each time-point using ANCOVA adjusting for baseline severity. Statistically significant effects on burnout (d = 0.60) and wellbeing (d = −0.62) were found at time-point 2, favouring the intervention relative to waitlist control. No significant differences were found at subsequent time-points, indicating that both groups improved and maintained their gains after the intervention. Conclusions This intervention led to moderate improvements in burnout and wellbeing, despite the adverse circumstances of the COVID-19 pandemic at the time of the study