'Everything's fine, so why does it happen?' A qualitative investigation of patients' perceptions of noncardiac chest pain

Aims and objectives. To examine patients’ perceptions and experiences of noncardiac chest pain, within the framework of the common sense model. Background. Patients with noncardiac chest pain have good physical prognosis, but frequently suffer prolonged pain and psychological distress. The common sense model may provide a good framework for examining outcomes in patients with noncardiac chest pain. Design. Qualitative thematic analysis with semi-structured interviews. Methods. In 2010, participants recruited from an emergency department (N = 7) with persistent noncardiac chest pain and distress were interviewed using a semistructured schedule, and data were analysed using thematic analysis. Results. Seven themes were identified; six of which mapped onto core dimensions of the common sense model (identity, cause, timeline, consequences, personal control, treatment control). Contrary to previous research on medically unexplained symptoms, most participants perceived psychological factors to play a causal role in their chest pain. Participants’ perceptions largely mapped onto the common sense model, although there was a lack of coherence across dimensions, particularly with regard to cause. Conclusion. Patients with noncardiac chest pain lack understanding with regard to their condition and may be accepting of psychological causes of their pain. Relevance to clinical practice. Brief psychological interventions aimed at improving understanding of the causes of noncardiac chest pain and providing techniques for managing pain and stress may be useful for patients with noncardiac chest pain

Effect of HIV infection and antiretroviral therapy on hepatitis B virus (HBV)-specific T cell responses in patients who have resolved HBV infection

Coinfection with hepatitis B virus (HBV) is a common occurrence in human immunodeficiency virus (HIV)–positive patients and an increasing cause of morbidity and mortality. The CD8+ T cell response is critical for long-term control of HBV in patients resolving acute infection. Here, we examine the effect of HIV on HBV-specific CD8+ T cell responses in patients who have resolved HBV infection. A cross-sectional study showed a reduction in HBV-specific CD8+ T cell responses in HIV-positive, HBV-immune patients, compared with those in HIV-negative, HBV-immune patients. A longitudinal study of a subgroup of patients examined whether this attrition could be reversed by effective antiretroviral therapy. The introduction of highly active antiretroviral therapy (HAART) resulted in reconstitution of some HBV-specific CD4+ and CD8+ T cell responses, in association with restoration of CD4+ T cell counts. These data provide a mechanism to account for the observed impairment of control of HBV infection in the setting of HIV infection and support the ability of HAART to reconstitute functionally active T cell responses

Detailed phenotypic and genotypic characterization of bietti crystalline dystrophy

OBJECTIVE: To provide a detailed phenotype/genotype characterization of Bietti crystalline dystrophy (BCD). DESIGN: Observational case series. PARTICIPANTS: Twenty patients from 17 families recruited from a multiethnic British population. METHODS: Patients underwent color fundus photography, near-infrared (NIR) imaging, fundus autofluorescence (FAF) imaging, spectral domain optical coherence tomography (SD-OCT), and electroretinogram (ERG) assessment. The gene CYP4V2 was sequenced. MAIN OUTCOME MEASURES: Clinical, imaging, electrophysiologic, and molecular genetics findings. RESULTS: Patients ranged in age from 19 to 72 years (median, 40 years), with a visual acuity of 6/5 to perception of light (median, 6/12). There was wide intrafamilial and interfamilial variability in clinical severity. The FAF imaging showed well-defined areas of retinal pigment epithelium (RPE) loss that corresponded on SD-OCT to well-demarcated areas of outer retinal atrophy. Retinal crystals were not evident on FAF imaging and were best visualized with NIR imaging. Spectral domain OCT showed them to be principally located on or in the RPE/Bruch's membrane complex. Disappearance of the crystals, revealed by serial recording, was associated with severe disruption and thinning of the RPE/Bruch's membrane complex. Cases with extensive RPE degeneration (N = 5) had ERGs consistent with generalized rod and cone dysfunction, but those with more focal RPE atrophy showed amplitude reduction without delay (N = 3), consistent with restricted loss of function, or that was normal (N = 2). Likely disease-causing variants were identified in 34 chromosomes from 17 families. Seven were novel, including p.Met66Arg, found in all 11 patients from 8 families of South Asian descent. This mutation appears to be associated with earlier onset (median age, 30 years) compared with other substitutions (median age, 41 years). Deletions of exon 7 were associated with more severe disease. CONCLUSIONS: The phenotype is highly variable. Several novel variants are reported, including a highly prevalent substitution in patients of South Asian descent that is associated with earlier-onset disease. Autofluorescence showed sharply demarcated areas of RPE loss that coincided with abrupt edges of outer retinal atrophy on SD-OCT; crystals were generally situated on or in the RPE/Bruch's complex but could disappear over time with associated RPE disruption. These results support a role for the RPE in disease pathogenesis

The PROM1 mutation p.R373C causes an autosomal dominant bull's eye maculopathy associated with rod, rod-cone, and macular dystrophy.

PURPOSE: To characterize in detail the phenotype of five unrelated families with autosomal dominant bull's eye maculopathy (BEM) due to the R373C mutation in the PROM1 gene. METHODS: Forty-one individuals of five families of Caribbean (family A), British (families B, D, E), and Italian (family C) origin, segregating the R373C mutation in PROM1, were ascertained. Electrophysiological assessment, fundus autofluorescence (FAF) imaging, fundus fluorescein angiography (FFA), and optical coherence tomography (OCT) were performed in available subjects. Mutation screening of PROM1 was performed. RESULTS: The R373C mutant was present heterozygously in all affected patients. The age at onset was variable and ranged between 9 and 58 years, with most of the individuals presenting with reading difficulties. Subjects commonly had a mild to moderate reduction in visual acuity except for members of family C who experienced markedly reduced central vision. The retinal phenotype was characterized by macular dystrophy, with retinal pigment epithelial mottling in younger subjects, progressing to typical BEM over time, with the development of macular atrophy in older patients. In addition, all members of family C had typical features of RP. The electrophysiological findings were variable both within and between families. CONCLUSIONS: Mutations in PROM1 have been described to cause a severe form of autosomal recessive RP in two families of Indian and Pakistani descent. The results of this study have demonstrated that a distinct redundant PROM1 mutation (R373C) can also produce an autosomal dominant, fully penetrant retinopathy, characterized by BEM with little inter- and intrafamilial variability, and retinal dystrophy with variable rod or rod-cone dysfunction and marked intra- and interfamilial variability, ranging from isolated maculopathy without generalized photoreceptor dysfunction to maculopathy associated with very severe rod-cone dysfunction

Illness representations, psychological distress and non-cardiac chest pain in patients attending an emergency department

Objective: Many patients who attend an emergency department (ED) with chest pain receive a diagnosis of non-cardiac chest pain (NCCP), and often suffer poor psychological outcomes and continued pain. This study assessed the role of illness representations in explaining psychological distress and continued chest pain in patients attending an ED. Methods: ED NCCP patients (N = 138) completed measures assessing illness representations, anxiety, depression and quality of life (QoL) at baseline, and chest pain at one month. Results: Illness representations explained significant amounts of the variance in anxiety (Adj. R² = .38), depression (Adj. R² = .18) and mental QoL (Adj. R² = .36). A belief in psychological causes had the strongest associations with outcomes. At one month, 28.7% of participants reported experiencing frequent pain, 13.2% infrequent pain and 58.1% no pain. Anxiety, depression and poor QoL, but not illness representations, were associated with continued chest pain. Conclusions: The findings suggest that (i) continued chest pain is related to psychological distress and poor QoL, (ii) interventions should be aimed at reducing psychological distress and improving QoL and (iii) given the associations between perceived psychological causes and psychological distress/QoL, NCCP patients in the ED might benefit from psychological therapies to manage their chest pain

THE EFFECT OF WIND DIRECTION ON FLOW PAST SOUTH GEORGIA

A series of simulations of idealized flows past South Georgia are conducted in order to investigate how the wind direction affects the airflow around a real mesoscale mountain. Our experiments build on the work of Petersen et al. (2003) who investigated the impact of upstream wind direction on flow around an idealized mountain designed to be a similar size to Greenland. However, our experiments differ from Petersen’s experiments in two key ways. Firstly, we use real, complex multi-scale orography rather than idealized, smooth orography. Secondly, our mountain is much smaller. Results indicate that the flow features are sensitive to the wind direction, with the flow most effectively blocked when the incident flow at a slight angle to the major axis of the orography. In contrast to Petersen’s experiments around symmetrical idealized orography the flow features are also sensitive to a 180° rotation of the orography. However, the magnitude of the surface pressure force is relatively insensitive to this, varying by less than 10% when the orography is rotated by 180° from any initial orientation

Three-spined sticklebacks show dimension-specific preferences for shelter

Funding Information: We are grateful to the Association for the Study of Animal Behaviour (ASAB) for funding this work through an ASAB research grant to N.A.R.J. Thank you also to the University of St Andrews Research internship Scheme (StARIS) which provided funding for G.G.Shelter is an important resource, serving as protection from rivals, predators and environmental stressors. The physical dimensions of a potential shelter are an important factor that can affect decisions about potential shelter options. Animals must select a shelter that they can fit into and use as a refuge, but beyond that, do they show fine-scale preferences based on shelter dimensions? This question has been actively studied for species whose shelter use is closely connected to their life cycles, such as obligate shell dwellers and nest-inhabiting species. However, preferences and decision making for temporary shelters has received less attention. We tested whether three-spined sticklebacks, Gasterosteus aculeatus, a common laboratory model, exhibit preferences in shelter use (actively entering and spending time within a shelter) between shelters with different dimensions. We used PVC tubes of different dimensions as shelters and conducted a simultaneous choice assay where individual fish were presented with each of three tubes available for use as shelter. The fish showed a clear preference, using larger diameter shelters more frequently than either of the other two options. There was no difference in the number of nonsheltering visits fish made or time to enter a shelter across tube sizes, which suggests an active selection by the fish rather than passive bias. There was no difference in duration of time spent within a shelter, suggesting that despite these preferences, actual benefit derived by the fish may be decoupled from the shelter dimensions. Our results offer opportunities for future research that addresses longer term questions in both behavioural ecology and welfare. What drives the preference for larger diameter tubes, and are there are long-term benefits to shelter with preferred dimensions? Certainly, our results suggest that housing sticklebacks with larger diameter shelters may be a simple and convenient means to improve welfare.Publisher PDFPeer reviewe

Half-metallicity and Slater-Pauling behavior in the ferromagnetic Heusler alloys

Introductory chapter for the book "Halfmetallic Alloys - Fundamentals and Applications" to be published in the series Springer Lecture Notes on Physics, P. H. Dederichs and I. Galanakis (eds). It contains a review of the theoretical work on the half-metallic Heusler alloys.Comment: Introductory chapter for the book "Halfmetallic Alloys - Fundamentals and Applications" to be published in the series Springer Lecture Notes on Physics, P. H. Dederichs and I. Galanakis (eds