Patient delays in seeking help at the onset of rheumatoid arthritis: the problem, its causes and potential solutions

Rheumatoid arthritis (RA) is a chronic inflammatory disease for which early treatment is vital to limit long term joint damage. However, people often delay in seeking medical help at the onset of RA symptoms. The early interpretation of symptoms and the process of making sense of symptoms impacts on both help-seeking decision-making and self-management. Furthermore, the general public’s perceptions and knowledge of RA may also affect the way that symptoms are interpreted. Examining the psychology behind early symptom interpretation, the barriers to help-seeking behaviour and investigating the public understandings of RA, can help us understand how decisions are made and guide us in developing interventions which encourage people to seek help promptly at the onset of RA

Experiences of South Asian patients in early inflammatory arthritis clinic: a qualitative interview study

Objective: The aim was to explore how UK South Asian patients living with RA interact with health care professionals and experience receiving health information in an early inflammatory arthritis clinic. Methods: A semi-structured interview schedule, designed in conjunction with a patient partner, was used for face-to-face interviews. South Asian participants with RA were recruited from Central Manchester University Hospitals National Health Service Foundation Trust. Data were recorded and transcribed by an independent company. Data were analysed using inductive thematic analysis. Results: Fifteen participants were interviewed. Three predominant themes emerged around participants’ experiences and interaction with health care professionals in early inflammatory arthritis clinic. First, ‘the personal experiences of RA and cultural link to early inflammatory arthritis clinic’, where participants described the impact of RA as individuals and their altered roles within their cultural setting. Second, ‘experiences of interacting and receiving information in the early inflammatory arthritis clinic’, where participants described their limited engagement with health care professionals and the quality of information discussed in the clinic. Third, ‘views on future content for early inflammatory arthritis clinics’, where participants highlighted new innovative ideas to build on current practice. Conclusion: We believe this to be the first study to generate insight into the experiences of South Asian patients of interacting with health care professionals while attending an early inflammatory arthritis clinic. Policy directives aimed at improving access to services and delivery of information for ethnic minority groups in early inflammatory arthritis clinics should include consideration of the different roles of cultures. Professionals should be cognizant of the factors that drive health inequalities and focus on improving service delivery

On the weakening of Hurricane Lili, October 2002

This paper addresses the weakening of Hurricane Lili of October 2002 just before it made landfall in Louisiana. This hurricane weakened from a category 4 storm on October 3, 2002 at 0000 UTC to a category 1 storm on October 3, 2002 at 1300 UTC. This sudden drop in intensity has been a subject of considerable interest. In this paper we explore a forecast model diagnostic approach that explores the contribution to the hurricane intensity changes arising from a number of dynamical and physical possibilities. Running several versions of a global model at very high resolution, the relative contribution to the intensity drop of Lili arising from cooler sea surface temperatures, dry air advection into the storm, advective non-linear dynamics, non-advective dynamics, and shallow and deep cumulus convection was examined. This line of inquiry led to the conclusion that dry air advection from the north into the storm and the slightly cold sea surface temperatures were not the primary contribution to the observed pressure rise by 22 hPa. The primary contribution to the pressure rise was found to be the 'rest of dynamics' (the non-advective dynamics). The shallow convection contributed slightly to an overall cooling, i.e. a weakening of the warm core of Lili. The effects of deep cumulus convection appeared to be opposite, i.e. towards maintaining a strong storm. A primary term in the 'rest of dynamics', the advection of Earth's angular momentum into the storm, is identified as a major contributor for the intensity change in the analysis. This feature resembles an intrusion of dry air into the core of the storm. This intrusion contributes to a reduction of spin and an overall rapid weakening of the hurricane. The angular momentum partitioning appears quite revealing on the sudden demise of Lili

Gluteal compartment syndrome: a case report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Community interventions with women's groups to improve women's and children's health in India: a mixed-methods systematic review of effects, enablers and barriers

Introduction: India is home to over 6 million women’s groups, including self-help groups. There has been no evidence synthesis on whether and how such groups improve women’s and children’s health. Methods: We did a mixed-methods systematic review of quantitative and qualitative studies on women’s groups in India to examine effects on women and children’s health and to identify enablers and barriers to achieving outcomes. We searched 10 databases and included studies published in English from 2000 to 2019 measuring health knowledge, behaviours or outcomes. Our study population included adult women and children under 5 years. We appraised studies using standard risk of bias assessments. We compared intervention effects by level of community participation, scope of capability strengthening (individual, group or community), type of women’s group and social and behaviour change techniques employed. We synthesised quantitative and qualitative studies to identify barriers and enablers related to context, intervention design and implementation, and outcome characteristics. Findings: We screened 21 380 studies and included 99: 19 randomised controlled trial reports, 25 quasiexperimental study reports and 55 non-experimental studies (27 quantitative and 28 qualitative). Experimental studies provided moderate-quality evidence that health interventions with women’s groups can improve perinatal practices, neonatal survival, immunisation rates and women’s and children’s dietary diversity, and help control vector-borne diseases. Evidence of positive effects was strongest for community mobilisation interventions that built communities’ capabilities and went beyond sharing information. Key enablers were inclusion of vulnerable community members, outcomes that could be reasonably expected to change through community interventions and intensity proportionate to ambition. Barriers included limited time or focus on health, outcomes not relevant to group members and health system constraints. Conclusion: Interventions with women’s groups can improve women’s and children’s health in India. The most effective interventions go beyond using groups to disseminate health information and seek to build communities’ capabilities

Conjugated polyelectrolyte nano field emission adlayers.

Here we report on a straightforward and rapid means of enhancing the field electron emission performance of nascent vertically aligned multi-walled carbon nanotubes by introducing a polar zwitterionic conjugated polyelectrolyte adlayer at the vacuum-emitter interface. We attribute the observed 66% decrease in turn-on electric field to the augmented emitter micro-morphology and shifted surface band structure. The composite emitters can be optically modulated by exploiting the absorption cross-section of the solution cast adlayer, which increases the local carrier concentration which broadens the effective electrostatic shape of the emitter during optical excitation. Assessment via scanning anode field emission microscopy reveals a 25% improvement in DC time stability, a significant reduction in long-term hysteresis shift, and a threefold increase in bandwidth during pulsed mode operation.Oppenheimer TrustThis is the final version of the article. It first appeared from the Royal Society of Chemistry via http://dx.doi.org/10.1039/c6nh00071

Gamma-Ray Bursts in the Swift Era

With its rapid-response capability and multiwavelength complement of instruments, the Swift satellite has transformed our physical understanding of gamma-ray bursts (GRBs). Providing high-quality observations of hundreds of bursts, and facilitating a wide range of follow-up observations within seconds of each event, Swift has revealed an unforeseen richness in observed burst properties, shed light on the nature of short-duration bursts, and helped realize the promise of GRBs as probes of the processes and environments of star formation out to the earliest cosmic epochs. These advances have opened new perspectives on the nature and properties of burst central engines, interactions with the burst environment from microparsec to gigaparsec scales, and the possibilities for non-photonic signatures. Our understanding of these extreme cosmic sources has thus advanced substantially; yet more than 40 years after their discovery, GRBs continue to present major challenges on both observational and theoretical fronts.Comment: 67 pages, 16 figures; ARAA, 2009; http://arjournals.annualreviews.org/toc/astro/47/

Altered expression of microRNA in the airway wall in chronic asthma: miR-126 as a potential therapeutic target

Background: The role of microRNAs (miRNAs) in regulating gene expression is currently an area of intense interest. Relatively little is known, however, about the role of miRNAs in inflammatory and immunologically-driven disorders. In a mouse model, we have previously shown that miRNAs are potentially important therapeutic targets in allergic asthma, because inhibition of miR-126, one of a small subset of miRNAs upregulated in the airway wall, effectively suppressed Th2-driven airway inflammation and other features of asthma. In the present study, we extended investigation of the therapeutic potential of miRNA inhibition to our well-established model of chronic asthma. Methods: Female BALB/c mice were systemically sensitised with ovalbumin (OVA) and chronically challenged with low mass concentrations of aerosolised OVA for up to 6 weeks. Airway tissue was obtained by blunt dissection and RNA was isolated for miRNA profiling. On the basis of the results obtained, animals were subsequently treated with either an antagomir to miR-126 (ant-miR-126) or a scrambled control antagomir once weekly during the 6 weeks of chronic challenge, and the effects on airway inflammation and remodelling were assessed using established morphometric techniques. Results: Compared to naïve mice, there was selective upregulation of a modest number of miRNAs, notably miR-126, in the airway wall tissue of chronically challenged animals. The relative increase was maximal after 2 weeks of inhalational challenge and subsequently declined to baseline levels. Compared to treatment with the scrambled control, ant-miR-126 significantly reduced recruitment of intraepithelial eosinophils, but had no effect on the chronic inflammatory response, or on changes of airway remodelling. Conclusions: In this model of chronic asthma, there was an initial increase in expression of a small number of miRNAs in the airway wall, notably miR-126. However, this later declined to baseline levels, suggesting that sustained changes in miRNA may not be essential for perpetuation of chronic asthma. Moreover, inhibition of miR-126 by administration of an antagomir suppressed eosinophil recruitment into the airways but had no effect on chronic inflammation in the airway wall, or on changes of remodelling, suggesting that multiple miRNAs are likely to regulate the development of these lesions

Error and attack tolerance of complex networks

Many complex systems, such as communication networks, display a surprising degree of robustness: while key components regularly malfunction, local failures rarely lead to the loss of the global information-carrying ability of the network. The stability of these complex systems is often attributed to the redundant wiring of the functional web defined by the systems' components. In this paper we demonstrate that error tolerance is not shared by all redundant systems, but it is displayed only by a class of inhomogeneously wired networks, called scale-free networks. We find that scale-free networks, describing a number of systems, such as the World Wide Web, Internet, social networks or a cell, display an unexpected degree of robustness, the ability of their nodes to communicate being unaffected by even unrealistically high failure rates. However, error tolerance comes at a high price: these networks are extremely vulnerable to attacks, i.e. to the selection and removal of a few nodes that play the most important role in assuring the network's connectivity.Comment: 14 pages, 4 figures, Late