A Delphi Exercise to Identify Characteristic Features of Gout -- Opinions from Patients and Physicians, the First Stage in Developing New Classification Criteria

Item does not contain fulltextOBJECTIVE: To identify a comprehensive list of features that might discriminate between gout and other rheumatic musculoskeletal conditions, to be used subsequently for a case-control study to develop and test new classification criteria for gout. METHODS: Two Delphi exercises were conducted using Web-based questionnaires: one with physicians from several countries who had an interest in gout and one with patients from New Zealand who had gout. Physicians rated a list of potentially discriminating features that were identified by literature review and expert opinion, and patients rated a list of features that they generated themselves. Agreement was defined by the RAND/UCLA disagreement index. RESULTS: Forty-four experienced physicians and 9 patients responded to all iterations. For physicians, 71 items were identified by literature review and 15 more were suggested by physicians. The physician survey showed agreement for 26 discriminatory features and 15 as not discriminatory. The patients identified 46 features of gout, for which there was agreement on 25 items as being discriminatory and 7 items as not discriminatory. CONCLUSION: Patients and physicians agreed upon several key features of gout. Physicians emphasized objective findings, imaging, and patterns of symptoms, whereas patients emphasized severity, functional results, and idiographic perception of symptoms

Specimen collection: An essential tool

10.1126/science.344.6186.814Science3446186814-815SCIE

Glacial geomorphology: towards a convergence of glaciology and geomorphology

This review presents a perspective on recent trends in glacial geomorphological research, which has seen an increasing engagement with investigating glaciation over larger and longer timescales facilitated by advances in remote sensing and numerical modelling. Remote sensing has enabled the visualization of deglaciated landscapes and glacial landform assemblages across continental scales, from which hypotheses of millennial-scale glacial landscape evolution and associations of landforms with palaeo-ice streams have been developed. To test these ideas rigorously, the related goal of imaging comparable subglacial landscapes and landforms beneath contemporary ice masses is being addressed through the application of radar and seismic technologies. Focusing on the West Antarctic Ice Sheet, we review progress to date in achieving this goal, and the use of radar and seismic imaging to assess: (1) subglacial bed morphology and roughness; (2) subglacial bed reflectivity; and (3) subglacial sediment properties. Numerical modelling, now the primary modus operandi of 'glaciologists' investigating the dynamics of modern ice sheets, offers significant potential for testing 'glacial geomorphological' hypotheses of continental glacial landscape evolution and smaller-scale landform development, and some recent examples of such an approach are presented. We close by identifying some future challenges in glacial geomorphology, which include: (1) embracing numerical modelling as a framework for testing hypotheses of glacial landform and landscape development; (2) identifying analogues beneath modern ice sheets for landscapes and landforms observed across deglaciated terrains; (3) repeat-surveying dynamic subglacial landforms to assess scales of formation and evolution; and (4) applying glacial geomorphological expertise more fully to extraterrestrial cryospheres