Graded Exercise Therapy Guided Self-Help Trial for Patients with Chronic Fatigue Syndrome (GETSET): Protocol for a Randomized Controlled Trial and Interview Study

Background: Chronic fatigue syndrome, also known as myalgic encephalomyelitis (CFS/ME), is characterized by chronic disabling fatigue and other symptoms, which are not explained by an alternative diagnosis. Previous trials have suggested that graded exercise therapy (GET) is an effective and safe treatment. GET itself is therapist-intensive with limited availability. Objective: While guided self-help based on cognitive behavior therapy appears helpful to patients, Guided graded Exercise Self-help (GES) is yet to be tested. Methods: This pragmatic randomized controlled trial is set within 2 specialist CFS/ME services in the South of England. Adults attending secondary care clinics with National Institute for Health and Clinical Excellence (NICE)-defined CFS/ME (N=218) will be randomly allocated to specialist medical care (SMC) or SMC plus GES while on a waiting list for therapist-delivered rehabilitation. GES will consist of a structured booklet describing a 6-step graded exercise program, supported by up to 4 face-to-face/telephone/Skype™ consultations with a GES-trained physiotherapist (no more than 90 minutes in total) over 8 weeks. The primary outcomes at 12-weeks after randomization will be physical function (SF-36 physical functioning subscale) and fatigue (Chalder Fatigue Questionnaire). Secondary outcomes will include healthcare costs, adverse outcomes, and self-rated global impression change scores. We will follow up all participants until 1 year after randomization. We will also undertake qualitative interviews of a sample of participants who received GES, looking at perceptions and experiences of those who improved and worsened. Results: The project was funded in 2011 and enrolment was completed in December 2014, with follow-up completed in March 2016. Data analysis is currently underway and the first results are expected to be submitted soon. Conclusions: This study will indicate whether adding GES to SMC will benefit patients who often spend many months waiting for rehabilitative therapy with little or no improvement being made during that time. The study will indicate whether this type of guided self-management is cost-effective and safe. If this trial shows GES to be acceptable, safe, and comparatively effective, the GES booklet could be made available on the Internet as a practitioner and therapist resource for clinics to recommend, with the caveat that patients also be supported with guidance from a trained physiotherapist. The pragmatic approach in this trial means that GES findings will be generalizable to usual National Health Service (NHS) practice

Squeezing based on nondegenerate frequency doubling internal to a realistic laser

We investigate theoretically the quantum fluctuations of the fundamental field in the output of a nondegenerate second harmonic generation process occuring inside a laser cavity. Due to the nondegenerate character of the nonlinear medium, a field orthogonal to the laser field is for some operating conditions indepedent of the fluctuations produced by the laser medium. We show that this fact may lead to perfect squeezing for a certain polarization mode of the fundamental field. The experimental feasibility of the system is also discussed.Comment: 6 pages, 5 figure

Hyperhomocysteinemia is detrimental to pregnancy in mice and is associated with preterm birth

AbstractElevated levels of homocysteine produce detrimental effects in humans but its role in preterm birth is not known. Here we used a mouse model of hyperhomocysteinemia to examine the relevance of homocysteine to preterm birth. The mouse carries a heterozygous deletion of cystathionine β-synthase (Cbs+/−). Gestational period was monitored in wild type and Cbs+/− female mice. Mouse uterine and placental tissues, human primary trophoblast cells, and human myometrial and placental cell lines were used to determine the influence of homocysteine on expression of specific genes in vitro. The activity of BKCa channel in the myometrial cell line was monitored using the patch-clamp technique. We found that hyperhomocysteinemia had detrimental effects on pregnancy and induced preterm birth in mice. Homocysteine increased the expression of oxytocin receptor and Cox-2 as well as PGE2 production in uterus and placenta, and initiated premature uterine contraction. A Cox-2 inhibitor reversed these effects. Gpr109a, a receptor for niacin, induced Cox-2 in uterus. Homocysteine upregulated GPR109A and suppressed BKCa channel activity in human myometrial cells. Deletion of Gpr109a in Cbs+/− mice reversed premature birth. We conclude that hyperhomocysteinemia causes preterm birth in mice through upregulation of the Gpr109a/Cox-2/PGE2 axis and that pharmacological blockade of Gpr109a may have potential in prevention of preterm birth

The hypertoric intersection cohomology ring

We present a functorial computation of the equivariant intersection cohomology of a hypertoric variety, and endow it with a natural ring structure. When the hyperplane arrangement associated with the hypertoric variety is unimodular, we show that this ring structure is induced by a ring structure on the equivariant intersection cohomology sheaf in the equivariant derived category. The computation is given in terms of a localization functor which takes equivariant sheaves on a sufficiently nice stratified space to sheaves on a poset.Comment: Significant revisions in Section 5, with several corrected proof

Expansion algorithm for the density matrix

A purification algorithm for expanding the single-particle density matrix in terms of the Hamiltonian operator is proposed. The scheme works with a predefined occupation and requires less than half the number of matrix-matrix multiplications compared to existing methods at low (90%) occupancy. The expansion can be used with a fixed chemical potential in which case it is an asymmetric generalization of and a substantial improvement over grand canonical McWeeny purification. It is shown that the computational complexity, measured as number of matrix multiplications, essentially is independent of system size even for metallic materials with a vanishing band gap.Comment: 5 pages, 4 figures, to appear in Phys. Rev.

Decoupling of the S=1/2 antiferromagnetic zig-zag ladder with anisotropy

The spin-1/2 antiferromagnetic zig-zag ladder is studied by exact diagonalization of small systems in the regime of weak inter-chain coupling. A gapless phase with quasi long-range spiral correlations has been predicted to occur in this regime if easy-plane (XY) anisotropy is present. We find in general that the finite zig-zag ladder shows three phases: a gapless collinear phase, a dimer phase and a spiral phase. We study the level crossings of the spectrum,the dimer correlation function, the structure factor and the spin stiffness within these phases, as well as at the transition points. As the inter-chain coupling decreases we observe a transition in the anisotropic XY case from a phase with a gap to a gapless phase that is best described by two decoupled antiferromagnetic chains. The isotropic and the anisotropic XY cases are found to be qualitatively the same, however, in the regime of weak inter-chain coupling for the small systems studied here. We attribute this to a finite-size effect in the isotropic zig-zag case that results from exponentially diverging antiferromagnetic correlations in the weak-coupling limit.Comment: to appear in Physical Review

OC-040 A pre-endoscopy point of care test (iga/igg-deamidated gliadin peptide) as a case finding tool for coeliac diseasein secondary care

Coeliac disease (CD) is common yet underdiagnosed. 12.4% CD patients had a gastroscopy within 5 years without duodenal biopsies taken, and coeliac serology was performed in only 30% of patients with anaemia or suspected CD. A pre-endoscopy point of care test (POCT) could potentially fill this gap. We aimed to evaluate the diagnostic accuracy and acceptability of the POCT, Simtomax (IgA/IgG-deamidated gliadin peptide, Tillotts Pharma, Rheinfelden, Switzerland), in detecting CD