“Somebody to Say ‘Come On We Can Sort This’”:A Qualitative Study of Primary Care Consultation Among Older Adults With Symptomatic Foot Osteoarthritis

OBJECTIVE: To examine the experiences of primary care consultation among older adults with symptomatic foot osteoarthritis (OA). METHODS: Eleven participants (6 women and 5 men) ages 56–80 years who had radiographically confirmed symptomatic foot OA and consulted a general practitioner in the last 12 months for foot pain were purposively sampled. Semistructured interviews explored the nature of the foot problem, help-seeking behaviors, and consultation experiences. Verbatim transcripts were analyzed using interpretative phenomenological analysis. RESULTS: The decision to consult a physician was often the outcome of a complex process influenced by quantitative and qualitative changes in symptoms, difficulty maintaining day-to-day roles and responsibilities and the effect this had on family and work colleagues, and a reluctance to present a fragile or aging self to the outside world. Self-management was commonly negotiated alongside multimorbidities. Upon seeking help, participants often believed they received limited information, they were given a brief or even cursory assessment, and that treatment was focused on the prescription of analgesic drugs. CONCLUSION: This is the first qualitative study of primary care experiences among patients with symptomatic foot OA. The experience of primary care seldom appeared to move beyond a label of arthritis and an unwelcome emphasis on pharmacologic treatment

Animal and plant responses for steers grazing switchgrass and big bluestem pastures

Native warm-season grasses can provide large amounts of high-quality forage during the midsummer months. Maximum potential benefits depend on management of the entire cool-and warm-season grazing system. This study compared two grazing systems for the warm-season pasture component. Fall-born steers grazed pastures of \u27Cave-in-Rock\u27 switchgrass or \u27Roundtree\u27 big bluestem over three years using either continuous or rotational grazing systems. Pasture carrying time for switchgrass and bluestem pastures and steer weight gain were considerably higher for the rotational grazing program than for the continuous grazing regimen

The clinical effectiveness and cost-effectiveness of ablative therapies in the management of liver metastases: systematic review and economic evaluation

Background: Many deaths from cancer are caused by metastatic burden. Prognosis and survival rates vary, but survival beyond 5 years of patients with untreated metastatic disease in the liver is rare. Treatment for liver metastases has largely been surgical resection, but this is feasible in only approximately 20–30% of people. Non-surgical alternatives to treat some liver metastases can include various forms of ablative therapies and other targeted treatments.Objectives: To evaluate the clinical effectiveness and cost-effectiveness of the different ablative and minimally invasive therapies for treating liver metastases.Data sources: Electronic databases including MEDLINE, EMBASE and The Cochrane Library were searched from 1990 to September 2011. Experts were consulted and bibliographies checked.Review methods: Systematic reviews of the literature were undertaken to appraise the clinical effectiveness and cost-effectiveness of ablative therapies and minimally invasive therapies used for people with liver metastases. Studies were any prospective study with sample size greater than 100 participants. A probabilistic model was developed for the economic evaluation of the technologies where data permitted.Results: The evidence assessing the clinical effectiveness and cost-effectiveness of ablative and other minimally invasive therapies was limited. Nine studies of ablative therapies were included in the review; each had methodological shortcomings and few had a comparator group. One randomised controlled trial (RCT) of microwave ablation versus surgical resection was identified and showed no improvement in outcomes compared with resection. In two prospective case series studies that investigated the use of laser ablation, mean survival ranged from 41 to 58 months. One cohort study compared radiofrequency ablation with surgical resection and five case series studies also investigated the use of radiofrequency ablation. Across these studies the median survival ranged from 44 to 52 months. Seven studies of minimally invasive therapies were included in the review. Two RCTs compared chemoembolisation with chemotherapy only. Overall survival was not compared between groups and methodological shortcomings mean that conclusions are difficult to make. Two case series studies of laser ablation following chemoembolisation were also included; however, these provide little evidence of the use of these technologies in combination. Three RCTs of radioembolisation were included. Significant improvements in tumour response and time to disease progression were demonstrated; however, benefits in terms of survival were equivocal. An exploratory survival model was developed using data from the review of clinical effectiveness. The model includes separate analyses of microwave ablation compared with surgery and radiofrequency ablation compared with surgery and one of radioembolisation in conjunction with hepatic artery chemotherapy compared with hepatic artery chemotherapy alone. Microwave ablation was associated with an incremental cost-effectiveness ratio (ICER) of £3664 per quality-adjusted life-year (QALY) gained, with microwave ablation being associated with reduced cost but also with poorer outcome than surgery. Radiofrequency ablation compared with surgical resection for solitary metastases < 3 cm was associated with an ICER of –£266,767 per QALY gained, indicating that radiofrequency ablation dominates surgical resection. Radiofrequency ablation compared with surgical resection for solitary metastases ? 3 cm resulted in poorer outcomes at lower costs and a resultant ICER of £2538 per QALY gained. Radioembolisation plus hepatic artery chemotherapy compared with hepatic artery chemotherapy was associated with an ICER of £37,303 per QALY gained.Conclusions: There is currently limited high-quality research evidence upon which to base any firm decisions regarding ablative therapies for liver metastases. Further trials should compare ablative therapies with surgery, in particular. A RCT would provide the most appropriate design for undertaking any further evaluation and should include a full economic evaluation, but the group to be randomised needs careful selection.Source of funding: Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Research

Magnesium-dependent Association and Folding of Oligonucleosomes Reconstituted with Ubiquitinated H2A

The MgCl2-induced folding of defined 12-mer nucleosomal arrays, in which ubiquitinated histone H2A (uH2A) replaced H2A, was analyzed by quantitative agarose gel electrophoresis and analytical centrifugation. Both types of analysis showed that uH2A arrays attained a degree of compaction similar to that of control arrays in 2 mM MgCl2. These results indicate that attachment of ubiquitin to H2A has little effect on the ability of nucleosomal arrays to form higher order folded structures in the ionic conditions tested. In contrast, uH2A arrays were found to oligomerize at lower MgCl2 concentrations than control nucleosomal arrays, suggesting that histone ubiquitination may play a role in nucleosomal fiber association

Bowhead Whales Along the Chukotka Coast in Autumn

Bowhead whales (Balaena mysticetus) were seen in autumn 1992 and 1993 only along the northern coast of Chukotka, Russia, although an extensive area of the Chukchi Sea was searched during ship cruises. Single-day counts for 76 and 50 bowheads were made on 1 October 1992 and 3 October 1993, respectively, with only a few whales seen on other days. Whales seen between Cape Schmidt and Cape Vankarem on 1 October 1992 appeared to be feeding, but there was no means to detect or sample subsurface forage that year. On 3 October 1993, bowheads appeared to be feeding in an area where a 5 m x 8 km patch of zooplankton was identified, via acoustics, at 25-30 m in water 35 m deep. A vertical-tow sample near the patch indicated the euphausiid Thysanoessa rachii, a common bowhead prey species, was abundant in the water column. The location of the zooplankton patch corresponded with a sharp salinity (proxy density) gradient. In addition, whale distribution coincided with a surface thermal boundary, identified by satellite-borne Advanced Very High Resolution Radiometer (AVHRR) imagery. The confinement of bowhead sightings to the northern coast of Chukotka in 1992-93 corresponds to reports from autumn surveys in 1979, 1980 and 1990, while the association of whales with physical oceanographic fronts is similar to findings from a study of bowhead feeding areas in the southern Beaufort Sea. These observations suggest that the Chukotka coast may be an important feeding or staging area for the Bering Sea stock and that oceanographic patterns influencing whale occurrence may be identifiable from standard oceanographic measurements.Key words: bowhead whale, Balaena mysticetus, migration, Chukchi Sea, Bering Sea, Chukotka, Thysanoessa rachii, satellite imagery, AVHRRDurant l'automne de 1992 et celui de 1993, on n'a pu observer de baleines boréales (Balaena mysticetus) que le long de la côte nord de Chukotka (Russie), bien que des recherches aient eu lieu dans une zone étendue de la mer des Tchouktches lors de croisières en bateau. Des comptages de 76 et 50 baleines boréales ont été obtenus respectivement le 1er octobre 1992 et le 3 octobre 1993, alors qu'on n'en a observé que quelques-unes les autres jours. Les baleines observées entre Cape Schmidt et Cape Vankarem le 1er octobre 1992 semblaient être en train de s'alimenter, mais on ne disposait pas de moyens pour détecter le genre de nourriture sous la surface, ni pour en prélever un échantillon cette année-là. Le 3 octobre 1993, les baleines semblaient s'alimenter là où une plaque de zooplancton de 5 m x 8 km avait été identifiée par méthode acoustique entre 25 et 30 m de profondeur, dans une zone de 35 m de fond. Un échantillon prélevé par hâlage vertical près de la plaque a indiqué que l'euphausiacé Thysanoessa rachii, une proie courante de la baleine boréale, était abondant dans la colonne d'eau. L'emplacement de la plaque de zooplancton correspondait à un fort gradient de salinité (approximation par la densité). De plus, la distribution des baleines coïncidait avec une limite thermique de surface identifiée au moyen de l'imagerie par radiomètre perfectionné à très haute résolution, transporté par satellite. Le confinement des observations de baleines à la côte nord de Chukotka en 1992-93 correspond aux rapports des relevés d'automne de 1979, 1980 et 1990, tandis que l'association des baleines à des fronts physiques océanographiques cadre avec les résultats d'une étude des zones d'alimentation de la baleine boréale dans le sud de la mer de Beaufort. Ces observations suggèrent que la côte de Chukotka pourrait être une importante zone d'alimentation ou de rassemblement pour la population de la mer de Béring, et que les caractéristiques océanographiques qui influencent la présence des baleines pourraient être identifiables à partir des mesures océanographiques courantes.Mots clés: baleine boréale, Balaena mysticetus, migration, mer des Tchouktches, mer de Béring, Chukotka, Thysanoessa rachii, imagerie par satellite, radiomètre perfectionné à très haute résolutio

Bowhead whale distribution and feeding near Barrow, Alaska, in late summer 2005–06

Author Posting. © Arctic Institute of North America, 2010. This article is posted here by permission of Arctic Institute of North America for personal use, not for redistribution. The definitive version was published in Arctic 63 (2010): 195-205.Aerial surveys for bowhead whales were conducted in conjunction with oceanographic sampling near Barrow, Alaska, in late summer of 2005 and 2006. In 2005, 145 whales were seen, mostly in two distinct aggregations: one (ca. 40 whales) in deep water in Barrow Canyon and the other (ca. 70 whales) in very shallow (< 10 m) water just seaward of the barrier islands. Feeding behaviours observed in the latter group included whales lying on their sides with mouths agape and groups of 5–10 whales swimming synchronously in turbid water. In 2006, 78 bowheads were seen, with ca. 40 whales feeding in dispersed groups of 3–11 whales. Feeding behaviours observed included surface skimming, echelon swimming, and synchronous diving and surfacing. Surfacing behaviour included head lunges by single animals and groups of 2–4 whales. Of 29 whales harvested at Barrow, 24 had been feeding. Euphausiids were the dominant prey in 2006 (10 of 13 stomachs), but not in 2005 (4 of 11 stomachs). Copepods were the dominant prey in the stomachs of three whales harvested near Barrow Canyon in 2005. Mysiids were the dominant prey in four stomachs, isopods in two, and amphipods in one although these taxa were not routinely captured during plankton sampling conducted in the weeks prior to the autumn harvest.Much of the field portion of this work was supported by the NSF/SNACS program

Current Results of the EC-sponsored Catchment Modelling (CatchMod) Cluster

To support the Water Framework Directive implementation, much research has been commissioned at both national and European levels. CatchMod is a cluster of these projects, which is focusing on the development of computational catchment models and related tools. This paper presents an overview of the results of the CatchMod cluster to dat

Dynamical friction in constant density cores: a failure of the Chandrasekhar formula

Using analytic calculations and N-body simulations we show that in constant density (harmonic) cores, sinking satellites undergo an initial phase of very rapid (super-Chandrasekhar) dynamical friction, after which they experience no dynamical friction at all. For density profiles with a central power law profile, ρ∝r−α, the infalling satellite heats the background and causes α to decrease. For α < 0.5 initially, the satellite generates a small central constant density core and stalls as in the α= 0 case. We discuss some astrophysical applications of our results to decaying satellite orbits, galactic bars and mergers of supermassive black hole binaries. In a companion paper we show that a central constant density core can provide a natural solution to the timing problem for Fornax's globular cluster

Tidal stirring and the origin of dwarf spheroidals in the Local Group

N-Body/SPH simulations are used to study the evolution of dwarf irregular galaxies (dIrrs) entering the dark matter halo of the Milky Way or M31 on plunging orbits. We propose a new dynamical mechanism driving the evolution of gas rich, rotationally supported dIrrs, mostly found at the outskirts of the Local Group (LG), into gas free, pressure supported dwarf spheroidals (dSphs) or dwarf ellipticals (dEs), observed to cluster around the two giant spirals. The initial model galaxies are exponential disks embedded in massive dark matter halos and reproduce nearby dIrrs. Repeated tidal shocks at the pericenter of their orbit partially strip their halo and disk and trigger dynamical instabilities that dramatically reshape their stellar component. After only 2-3 orbits low surface brightness (LSB) dIrrs are transformed into dSphs, while high surface brightness (HSB) dIrrs evolve into dEs. This evolutionary mechanism naturally leads to the morphology-density relation observed for LG dwarfs. Dwarfs surrounded by very dense dark matter halos, like the archetypical dIrr GR8, are turned into Draco or Ursa Minor, the faintest and most dark matter dominated among LG dSphs. If disks include a gaseous component, this is both tidally stripped and consumed in periodic bursts of star formation. The resulting star formation histories are in good qualitative agreement with those derived using HST color-magnitude diagrams for local dSphs.Comment: 5 pages, 5 figures, to appear on ApJL. Simulation images and movies can be found at the Local Group web page at http://pcblu.uni.mi.astro.it/~lucio/LG/LG.htm