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

The Growing Imbalance: Recent Trends in U.S. Postsecondary Education Finance

Compares trends at public, private, and research institutions in enrollment, revenues, and spending as well as their effect on bottom lines; analyzes widening disparities; and considers implications for improving the affordability of higher education

Producing approximate answers to database queries

We have designed and implemented a query processor, called APPROXIMATE, that makes approximate answers available if part of the database is unavailable or if there is not enough time to produce an exact answer. The accuracy of the approximate answers produced improves monotonically with the amount of data retrieved to produce the result. The exact answer is produced if all of the needed data are available and query processing is allowed to continue until completion. The monotone query processing algorithm of APPROXIMATE works within the standard relational algebra framework and can be implemented on a relational database system with little change to the relational architecture. We describe here the approximation semantics of APPROXIMATE that serves as the basis for meaningful approximations of both set-valued and single-valued queries. We show how APPROXIMATE is implemented to make effective use of semantic information, provided by an object-oriented view of the database, and describe the additional overhead required by APPROXIMATE

Management of RH Services in India and the Need for Health System Reform

For the last ten to fifteen years, a comprehensive agenda of health sector reforms and health systems development has engulfed the health system in many countries in structural and organisational changes. Experience with varying degrees and types of reforms have now been reported from many countries. In our paper, we begin by describing some important issues facing the management of RH programs in India, based on our research done in a few states over the last five years. The failures in the management of RH services are complex and multi-factorial, and cannot all be addressed through health system reform. It is therefore necessary to identify which failures in service are attributable to causes, which could be removed or changed by reform in the health system. In our paper, we identify those failures and causes which could be corrected through health system reforms and propose certain concrete steps to expedite the reforms in the health system to enable the improvement of RH services in India.

Anxiety and depression: a model for assessment and therapy in primary care

Patients who feel anxious and depressed often turn to primary care for initial professional help. However, systematic service evaluations allege poor standards of diagnosis and treatment, resulting in disappointing clinical outcomes. All the same, special educational and quality improvement initiatives have not raised standards significantly. Why this should be so and possible remedies are suggested by this article, on the basis that the empirical evidence base for criticising primary care standards is weaker than commonly acknowledged. Systematic clinical trials are often premised by assumptions that are not relevant to primary care, they tend to select subject populations unrepresentative of those typically seen by general practitioners and results are often compromised by a series of methodological flaws. This article proposes an alternative conceptualisation of anxiety and depression apposite to primary care assessment and therapy. It draws on an emergent evidence base within psychobiology that recognises that these reactions have two adaptive functions. Firstly, they are responses evoked by actual personal adversity, secondly they have the function of prompting communication to self and to others of the need for practical remedial action to be taken independently, or with assistance, to improve the quality of the recovery environment. A table summarises the phased stages of anxiety and depression and lists their adaptive and communicative functions along with some phase-appropriate primary care interventions. This new model of assessment and therapy is offered to stimulate discussion and inspire future research that is appropriate for primary care service improvement

Event--related desynchronization in diffusively coupled oscillator models

We seek explanation for the neurophysiological phenomenon of event related desynchronization (ERD) by using models of diffusively coupled nonlinear oscillators. We demonstrate that when the strength of the event is sufficient, ERD is found to emerge and the accomplishment of a behavioral/functional task is determined by the nature of the desynchronized state. We illustrate the phenomenon for the case of limit cycle and chaotic systems. We numerically demonstrate the occurrence of ERD and provide analytical explanation. We also discuss possible applications of the observed phenomenon in real physical systems other than the brain.Comment: Accepted in Physical Review Letter

Polysaccharide food matrices for controlling the release, retention and perception of flavours

Polysaccharides have many roles across both the food and pharmaceutics industries. They are commonly used to enhance viscosity, stabilise emulsions and to add bulk to food products. In the pharmaceutics industry, they are also utilised for their mucoadhesive nature. Mucoadhesive polysaccharides can facilitate retention of active ingredients at mucosal sites for a prolonged time and formulations can be designed to control their release and bioavailability. This study investigates how polysaccharides, with differing physicochemical properties (e.g. functional groups and molecular weight), affect the release and perception of flavour compounds from films. Polysaccharide films were prepared using either high or low viscosity carboxymethyl cellulose, pullulan or hydroxypropyl methylcellulose. Glucose, vanillin or a combination of both was also added to the films to assess the effect of flavour release and perception over time. The films were assessed for glucose release in vitro, swelling and disintegration times, and mucoadhesive ability. Results show that flavour release and perception depend on the polysaccharide matrix properties; this includes how quickly the films dissolves, the rate of release of tastant compounds, and the mucoadhesive strength of the polysaccharide. A higher viscosity and slower disintegration time resulted in slower release of glucose in vitro and flavour perception in vivo

QSO Absorption Line Constraints on Intragroup High-Velocity Clouds

We show that the number statistics of moderate redshift MgII and Lyman limit absorbers may rule out the hypothesis that high velocity clouds are infalling intragroup material.Comment: 4 pages, no figures; submitted to Astrophysical Journal Letters; revised version, more general and includes more about Braun and Burton CHVC