Fibromyalgia: management strategies for primary care providers

Aims Fibromyalgia (FM), a chronic disorder defined by widespread pain, often accompanied by fatigue and sleep disturbance, affects up to one in 20 patients in primary care. Although most patients with FM are managed in primary care, diagnosis and treatment continue to present a challenge, and patients are often referred to specialists. Furthermore, the lack of a clear patient pathway often results in patients being passed from specialist to specialist, exhaustive investigations, prescription of multiple drugs to treat different symptoms, delays in diagnosis, increased disability and increased healthcare resource utilisation. We will discuss the current and evolving understanding of FM, and recommend improvements in the management and treatment of FM, highlighting the role of the primary care physician, and the place of the medical home in FM management. Methods We reviewed the epidemiology, pathophysiology and management of FM by searching PubMed and references from relevant articles, and selected articles on the basis of quality, relevance to the illness and importance in illustrating current management pathways and the potential for future improvements. Results The implementation of a framework for chronic pain management in primary care would limit unnecessary, time-consuming, and costly tests, reduce diagnostic delay and improve patient outcomes. Discussion The patient-centred medical home (PCMH), a management framework that has been successfully implemented in other chronic diseases, might improve the care of patients with FM in primary care, by bringing together a team of professionals with a range of skills and training. Conclusion Although there remain several barriers to overcome, implementation of a PCMH would allow patients with FM, like those with other chronic conditions, to be successfully managed in the primary care setting

Granitoid rocks and associated coper skarn, Whycocomagh Mountain, Cape Breton Island, Nova Scotia

Mineralized (Fe-Cu-W-Mo) skarn in the Whycocomagh Mountain area is associated with a small pluton of Devonian (402±20 Ma) age, which intruded predominantly metasedimentary rocks of the Hadrynian George River Group. The pluton consists largely of granite porphyry with a marginal granodiorite to diorite zone, and minor porphyritlc granodiorite to monzodiorite dykes and pegmatite. The suite is calc-alkalic with I-type characteristics. Although weakly mineralized, the Whycocomagh Mountain pluton has features typical of plutons associated with porphyry-type Cu-Mo deposits. Calc-silicate rocks derived from marbles of the George River Group are the chief hosts for magnetlte ± chalcopyrlte ± scheelite ± molybdenite ± pyrite which occur in veinlets along fractures and as disseminated grains In adjacent alteration envelopes. Characteristics of the pluton and the skarn minerals suggest that the deposit is a copper skarn. RÉSUMÉ Un skarn minéralise (Fe-Cu-W-Mo), situe dans la région de la montagne Whycocomagh, est associé à une petite intrusion ignée d'âge Dévonien (402±20 m.a.) qui pénétre des roches, principalement des métasédiments, du groupe George River (Hadrynien). Le pluton consiste surtout en un granite porphyrique accompagne d'une zone marginale (granodiorite à diorite), de dykes mineurs (granodiorite à monzodiorite porphyrique) et de pegmatite. L'ensemble est calco-alcalln et de "type 1". Blen que faiblement minéralise, le pluton Whycocomagh Mountain possède lea caractérlstiques typiques des plutons associés aux dépôts porphyrlques de type Cu-Mo. Les calco-sflicates dérives des marbres du groupe George River sont les notes principaux du cortege for magnétite ± chalcopyrlte ± scheelite ± molybdenite ± pyrite que L’on retrouve dans des veinules le long des fractures et disséminés dans les enveloppes d'alteratlon volsines. Les caractérlstiques du pluton ainsi que la minéralogle du skarn font croire qu'il s'agit d'un dépôt de skarn cuprifère. (Tradult par le Journal

CD28- cells are increased in early rheumatoid arthritis and are linked with cytomegalovirus status

Objective: CD3+CD8+CD28− cells are higher in Rheumatoid Arthritis (RA). The aim of this study was to assess CD3+CD8+CD28− cells in patients with early RA and assess the effects of cytomegalovirus (CMV) seropositivity. Method: In this prospective observation study, 50 RA patients were recruited from Cardiff University Hospital of Wales (UHW) rheumatology outpatient, 25 patients with early disease (disease duration 0–6 months) and 25 patients with established disease (>2 years). These were compared with 25 healthy controls. Clinical and serological markers of inflammation were noted, and peripheral blood mononuclear cells were analyzed using flow cytometry. Results: The percentage of the CD8+CD28− T cells was increased in RA patients and was associated with disease duration. The percentage of CD8+CD28− T cells was increased in CMV positive early and established RA grouped and early RA patients in comparison to CMV negative patients (p < 0.05). There is a weak but statistically significant correlation between the percentage of CD3+CD8+CD28− cells and CRP in CMV positive RA patients (r = 0.227, p < 0.05). Conclusion: The percentage of CD8+CD28− T cells is higher in RA patients and correlates with disease duration, highlighting a potential role early in the disease process. These cells were also higher in CMV positive early RA patients which may suggest a role of CMV in disease development

Enhanced ferroelectric and piezoelectric properties in doped lead-free (Bi0.5Na0.5)0.94Ba0.06TiO3 thin films

Doping effects with respect to the electrical properties of morphotropic phase boundary Bi0.5Na0.50.94Ba0.06TiO3 thin films epitaxially grown on CaRuO3 electroded LaAlO30.3Sr2AlTaO60.35 (001) substrates were investigated. Substantial enhancement of ferroelectricity and piezoelectricity has been achieved in La+Ce codoped films with a remanent polarization Pr of 29.5 C/cm2 and a remanent piezoelectric coefficient d33f of 31 pm/V, whereas Mn doping seems more favorite to reduce the leakage current by two order of magnitude. Both doped films exhibited diodelike I-V characteristics, which are correlated with resistance switching effect

The vertical distribution and biological transport of marine microplastics across the epipelagic and mesopelagic water column.

Plastic waste has been documented in nearly all types of marine environments and has been found in species spanning all levels of marine food webs. Within these marine environments, deep pelagic waters encompass the largest ecosystems on Earth. We lack a comprehensive understanding of the concentrations, cycling, and fate of plastic waste in sub-surface waters, constraining our ability to implement effective, large-scale policy and conservation strategies. We used remotely operated vehicles and engineered purpose-built samplers to collect and examine the distribution of microplastics in the Monterey Bay pelagic ecosystem at water column depths ranging from 5 to 1000 m. Laser Raman spectroscopy was used to identify microplastic particles collected from throughout the deep pelagic water column, with the highest concentrations present at depths between 200 and 600 m. Examination of two abundant particle feeders in this ecosystem, pelagic red crabs (Pleuroncodes planipes) and giant larvaceans (Bathochordaeus stygius), showed that microplastic particles readily flow from the environment into coupled water column and seafloor food webs. Our findings suggest that one of the largest and currently underappreciated reservoirs of marine microplastics may be contained within the water column and animal communities of the deep sea

NMR studies of Successive Phase Transitions in Na0.5CoO2 and K0.5CoO2

59Co- and 23Na-NMR measurements have been carried out on polycrystalline and c-axis aligned samples of Na0.5CoO2, which exhibits successive transitions at temperatures T = 87 K (= Tc1) and T = 53 K (= Tc2). 59Co-NMR has also been carried out on c-axis aligned crystallites of K0.5CoO2 with similar successive transitions at Tc1 ~ 60 K and Tc2 ~ 20 K. For Na0.5CoO2, two sets of three NMR lines of 23Na nuclei explained by considering the quadrupolar frequencies nuQ ~1.32 and 1.40 MHz have been observed above Tc1, as is expected from the crystalline structure. Rather complicated but characteristic variation of the 23Na-NMR spectra has been observed with varying T through the transition temperatures, and the internal fields at two crystallographically distinct Na sites are discussed on the basis of the magnetic structures reported previously. The internal fields at two distinct Co sites observed below Tc1 and the 591/T1-T curves of Na0.5CoO2 and K0.5CoO2 are also discussed in a comparative way.Comment: 7 pages, 10 figures, submitted to J. Phys. Soc. Jpn, correction is made in right colum of p6 (35th line) as K0.5CoO2-->Na0.5CoO

Limited heat tolerance in a cold-adapted seabird: Implications of a warming Arctic

The Arctic is warming at approximately twice the global rate, with welldocumented indirect effects on wildlife. However, few studies have examined the direct effects of warming temperatures on Arctic wildlife, leaving the importance of heat stress unclear. Here, we assessed the direct effects of increasing air temperatures on the physiology of thick-billed murres (Uria lomvia), an Arctic seabird with reported mortalities due to heat stress while nesting on sun-exposed cliffs.We used flow-through respirometry to measure the response of body temperature, resting metabolic rate, evaporative water loss and evaporative cooling efficiency (the ratio of evaporative heat loss to metabolic heat production) in murres while experimentally increasing air temperature. Murres had limited heat tolerance, exhibiting: (1) a low maximum body temperature (43.3°C); (2) a moderate increase in resting metabolic rate relative that within their thermoneutral zone (1.57 times); (3) a small increase in evaporative water loss rate relative that within their thermoneutral zone (1.26 times); and (4) a low maximum evaporative cooling efficiency (0.33). Moreover, evaporative cooling efficiency decreased with increasing air temperature, suggesting murres were producing heat at a faster rate than they were dissipating it. Larger murres also had a higher rate of increase in resting metabolic rate and a lower rate of increase in evaporative water loss than smaller murres; therefore, evaporative cooling efficiency declined with increasing body mass. As a coldadapted bird, murres\u27 limited heat tolerance likely explains their mortality on warm days. Direct effects of overheating on Arctic wildlife may be an important but under-reported impact of climate change

High sensitivity cymbal-based accelerometer

A high sensitivity piezoelectric accelerometer has been developed by replacing the conventional piezoelectric rings with a cymbal transducer. The sensitivity of the cymbal-based accelerometers containing cymbal transducers with different endcap thicknesses and different seismic masses has been measured as a function of driving frequency. Due to the high d'₃₃ coefficient of the cymbal transducers, the cymbal-based accelerometers have a high sensitivity of ~97 pC/ms[sup -]² with the amplitude rise of 2.85% (<1 dB) at one-third of the mounted resonance frequency (3.38 kHz). The effect of the seismic mass, the resonance frequency, and d'₃₃ coefficient of the cymbal transducers on the sensitivity and the frequency range of the cymbal-based accelerometers are reported.Department of Applied PhysicsMaterials Research CentreAuthor name used in this publication: Cheng-Liang SunAuthor name used in this publication: K. H. LamAuthor name used in this publication: S. H. ChoyAuthor name used in this publication: H. L. W. ChanAuthor name used in this publication: X.-Z. ZhaoAuthor name used in this publication: C. L. Cho

Insulating charge density wave for a half-filled SU(N) Hubbard model with an attractive on-site interaction in one dimension

We study a one-dimensional SU(N) Hubbard model with an attractive on-site interaction and $N>2$ at half-filling on the bipartite lattice using density-matrix renormalization-group method and a perturbation theory. We find that the ground state of the SU(N) Hubbard model is a charge density wave state with two-fold degeneracy. All the excitations are found to be gapful, resulting in an insulating ground state, on contrary to that in the SU(2) case. Moreover, the charge gap is equal to the Cooperon gap, which behaves as $-2Nt^2/(N-1)U$ in the strong coupling regime. However, the spin gap $\Delta_{s}$ and the quasiparticle gap $\Delta_{1}$ as well open exponentially in the weak coupling region, while in the strong coupling region, they linearly depend on $U$ such that $\Delta_{s}\sim -U(N-1)$ and $\Delta_{1}\sim -U(N-1)/2$.Comment: 7 pages, 7 figure