Evaluation of perceptions of general physicians regarding the association of obstructive sleep apnoea with depression in the real world setting in the United Kingdom

Background: Patients with depression may also have obstructive sleep apnoea (OSA). Management of OSA in patients with depression may improve depression and neurocognitive functions. Hence it is important to identify OSA early when assessing patients with depression or cognitive impairment. Aim of the study was to evaluate the knowledge attitude and practices of general practitioners (GPs) in the United Kingdom (UK) regarding OSA in patients with depression.Methods: A questionnaire (11 questions) regarding OSA symptoms and relevant questions to be asked during history taking by the GP was prepared. Twenty GPs across UK were sent the questionnaire by email and were asked to send their responses to the questionnaire.Results: All the respondents concurred that OSA can have a correlation with depression. Yet, only 33% of respondents asked questions related to OSA to their patients. 67% of GPs reported not asking their patients relevant questions about OSA citing lack of time. The symptom most commonly reported by their patients was difficulty concentrating during the day. 79% GPs reported that they diagnosed OSA from the history in less than 10% of their patients. The chief barriers for initiating treatment for OSA in patients with depression included need for referral of patients with OSA to a specialist (50%), patient acceptance (34%) and 13% GPs were uncertain about the barriers to initiating treatment.Conclusions: Primary care physician should determine the underlying cause of depression rather than simply diagnosing the patient as depressed. OSA must be evaluated in patients with depression by the primary care physician

Case report of missed evolving cauda equina syndrome: pitfalls to avoid in remote consultations

A 44-year-old lady presented with complaints of lumbosacral back pain radiating to the front of both thighs and up to the front of both knees. She was offered Teleconsultation by 2 GPs and was treated with analgesics. But her pain was not relieved. The third GP took a detailed history and elicited the red flags pointing towards a cauda equina syndrome (CES) in progression. She was called for examination and then was referred to the specialist for immediate further investigations and action. She underwent surgery for CES and her recovery was uneventful. Teleconsultation has the chief limitation of not being able to examine the patient. The importance of taking a detailed clear history regarding the symptoms of cauda equina and documenting the presence or absence of each of the red flag symptoms cannot be overemphasised. Clear, candid and honest discussion of the concerns of the symptoms and the rationale for the referral to the spinal surgeon must be discussed with the patient so as to prevent any miscommunication which can lead to medicolegal claims later on

In situ analysis of garnet inclusion in diamond using single-crystal X-ray diffraction and X-ray micro-tomography

none9A single crystal of garnet enclosed in a diamond from the Jericho kimberlite (Slave Craton, Canada) has been investigated using X-ray diffraction and X-ray micro-tomography. The novel experimental approach allowed us to determine the crystal structure of the garnet. The unit-cell edge a and fractional atomic coordinates of oxygen were used to determine the composition via an updated Margules model for garnets. The composition is Pyr(0.41(5))Alm(0.36(7))Gro(0.22(1))Uva(0.01(1)), which is indistinguishable from the eclogitic garnets found in other Jericho diamonds. We also demonstrated that residual pressures on the inclusion of up to 1 GPa do not affect significantly the determination of the garnet composition by structure refinement.noneFABRIZIO NESTOLA;M. MERLI;PAOLO NIMIS;M. PARISATTO;M. KOPYLOVA;A. DE;M. LONGO;L. ZIBERNA;M. MANGHNANINestola, Fabrizio; M., Merli; Nimis, Paolo; Parisatto, Matteo; M., Kopylova; A., De; Longo, Micaela; Ziberna, Luca; M., Manghnan

Melting of tantalum at high pressure determined by angle dispersive x-ray diffraction in a double-sided laser-heated diamond-anvil cell

The high pressure and high temperature phase diagram of Ta has been studied in a laser-heated diamond-anvil cell (DAC) using x-ray diffraction measurements up to 52 GPa and 3800 K. The melting was observed at nine different pressures, being the melting temperature in good agreement with previous laser-heated DAC experiments, but in contradiction with several theoretical calculations and previous piston-cylinder apparatus experiments. A small slope for the melting curve of Ta is estimated (dTm/dP = 24 K/GPa at 1 bar) and a possible explanation for this behaviour is given. Finally, a P-V-T equation of states is obtained, being the temperature dependence of the thermal expansion coefficient and the bulk modulus estimated.Comment: 31 pages, 8 figures, to appear in J.Phys.:Cond.Matte

The effect of compressive strain on the Raman modes of the dry and hydrated BaCe0.8Y0.2O3 proton conductor

The BaCe0.8Y0.2O3-{\delta} proton conductor under hydration and under compressive strain has been analyzed with high pressure Raman spectroscopy and high pressure x-ray diffraction. The pressure dependent variation of the Ag and B2g bending modes from the O-Ce-O unit is suppressed when the proton conductor is hydrated, affecting directly the proton transfer by locally changing the electron density of the oxygen ions. Compressive strain causes a hardening of the Ce-O stretching bond. The activation barrier for proton conductivity is raised, in line with recent findings using high pressure and high temperature impedance spectroscopy. The increasing Raman frequency of the B1g and B3g modes thus implies that the phonons become hardened and increase the vibration energy in the a-c crystal plane upon compressive strain, whereas phonons are relaxed in the b-axis, and thus reveal softening of the Ag and B2g modes. Lattice toughening in the a-c crystal plane raises therefore a higher activation barrier for proton transfer and thus anisotropic conductivity. The experimental findings of the interaction of protons with the ceramic host lattice under external strain may provide a general guideline for yet to develop epitaxial strained proton conducting thin film systems with high proton mobility and low activation energy

Upper mantle velocity-temperature conversion and composition determined from seismic refraction and heat flow

International audience[1] We compile upper mantle P n velocities from seismic refraction/wide-angle reflection surveys in the southern Superior Province of the Canadian Shield and compare them with temperatures at the Moho deduced from heat flow data. Calculated Moho temperatures and P n velocities correlate well, showing that in this area, P n depends primarily on temperature. The obtained values of @V(P n)/@T depend weakly on the assumed value of Moho heat flow and are on the order of À6.0 Â 10 À4 ± 10% km s À1 K À1 , within the range of temperature derivatives obtained in laboratory studies of ultramafic rocks. Comparison between observed P n velocities and predicted values for several mineralogical models at Moho temperatures allows constraints on both the Moho heat flow and the shallow mantle composition. For all Moho heat flows, undepleted (clinopyroxene-rich) mantle compositions do not allow a good fit to the data. For depleted mantle compositions, temperatures consistent with the observed P n velocities correspond to values of Moho heat flow larger than 12 mW m À2. For our preferred Moho heat flow of 15 mW m À2 , the best fit mantle composition is slightly less depleted than models for average Archean subcontinental lithospheric mantle. This may be due to rejuvenation by melt-related metasomatism during the Keweenawan rifting event. The similarity in P n À T conversion factors estimated from this empirical large-scale geophysical study and those from laboratory data provides confidence in the absolute temperature values deduced from heat flow measurements and seismic studies. Citation: Perry, H. K. C., C. Jaupart, J.-C. Mareschal, and N. M. Shapiro (2006), Upper mantle velocity-temperature conversion and composition determined from seismic refraction and heat flow

Eclogite-facies shear zones--deep crustal reflectors?

Strongly foliated eclogite-facies rocks in 30-150 m thick shear zones of Caledonian age occur within a Grenvillian garnet granulite-facies gabbro-anorthosite terrain in the Bergen Arcs of Norway. The predominant eclogite-facies mineral assemblages in the shear zones are omphacite + garnet + zoisite + kyanite in gabbroic anorthosite and omphacite + garnet in gabbro. Eclogite-facies rocks in shear zones are generally fine-grained; alternating omphacite/garnet- and kyanite/clinozoisite-rich layers define gneissic layering. A strong shape preferred orientation of omphacite, kyanite, and white mica (phengitic muscovite and/or paragonite) define the foliation. The anorthositic eclogites show omphacite b-axis maxima approximately normal to the foliation and c-axis girdles within the foliation plane. P-wave velocities (Vp) determined at confining pressures to 600 MPa for samples from eclogite-facies shear zones range from 8.3 to 8.5 km s-1 and anisotropy ranges from 1 to 7%. The few samples with more pronounced anisotropy tend to be approximately transversely isotropic with minimum velocities for propagation directions normal to foliation and maximum velocities for propagation directions parallel to foliation. The fast propagation direction lies within the c-axis girdles (parallel to foliation) and the slow propagation direction is parallel to the b-axis concentration (normal to foliation) in samples for which omphacite crystallographic preferred orientation was determined. Vp for the granulite-facies protoliths average about 7.5 km s-1. High calculated reflection coefficients for these shear zones, 0.04-0.14, indicate that they are excellent candidates for deep crustal reflectors in portions of crust that experienced high-pressure conditions but escaped thermal reactivation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31633/1/0000567.pd