The impact of rheumatoid arthritis on foot function in the early stages of disease: a clinical case series

BACKGROUND Foot involvement occurs early in rheumatoid arthritis but the extent to which this impacts on the structure and function leading to impairment and foot related disability is unknown. The purpose of this study was to compare clinical disease activity, impairment, disability, and foot function in normal and early rheumatoid arthritis (RA) feet using standardised clinical measures and 3D gait analysis. METHODS Twelve RA patients with disease duration ≤2 years and 12 able-bodied adults matched for age and sex underwent 3D gait analysis to measure foot function. Disease impact was measured using the Leeds Foot impact Scale (LFIS) along with standard clinical measures of disease activity, pain and foot deformity. For this small sample, the mean differences between the groups and associated confidence intervals were calculated using the t distribution RESULTS Moderate-to-high foot impairment and related disability were detected amongst the RA patients. In comparison with age- and sex-matched controls, the patients with early RA walked slower (1.05 m/s Vs 1.30 m/s) and had a longer double-support phase (19.3% Vs 15.8%). In terminal stance, the heel rise angle was reduced in the patients in comparison with normal (-78.9° Vs -85.7°). Medial arch height was lower and peak eversion in stance greater in the RA patients. The peak ankle plantarflexion power profile was lower in the patients in comparison with the controls (3.4 W/kg Vs 4.6 W/kg). Pressure analysis indicated that the RA patients had a reduced lesser toe contact area (7.6 cm2 Vs 8.1 cm2), elevated peak forefoot pressure (672 kPa Vs 553 kPa) and a larger mid-foot contact area (24.6 cm2 Vs 19.4 cm2). CONCLUSION Analysis detected small but clinically important changes in foot function in a small cohort of RA patients with disease duration <2 years. These were accompanied by active joint disease and impairment and disability

Kinematic, kinetic and electromyographic response to customized foot orthoses in patients with tibialis posterior tenosynovitis, pes plano valgus and rheumatoid arthritis

Objective. To describe the effect of customized foot orthoses (FOs) on the kinematic, kinetic and EMG features in patients with RA, tibialis posterior (TP) tenosynovitis and associated pes plano valgus.&lt;p&gt;&lt;/p&gt; Methods. Patients with RA and US-confirmed tenosynovitis of TP underwent gait analysis, including three-dimensional (3D) kinematics, kinetics, intramuscular EMG of TP and surface EMG of tibialis anterior, peroneus longus, soleus and medial gastrocnemius. Findings were compared between barefoot and shod with customized FO conditions.&lt;p&gt;&lt;/p&gt; Results. Ten patients with RA with a median (range) disease duration of 3 (1–18) years were recruited. Moderate levels of foot pain and foot-related impairment and disability were present with moderately active disease states. Altered timing of the soleus (P = 0.05) and medial gastrocnemius (P = 0.02) and increased magnitude of tibialis anterior (P = 0.03) were noted when barefoot was compared with shod with FO. Trends were noted for reduced TP activity in the contact period (P = 0.09), but this did not achieve statistical significance. Differences in foot motion characteristics were recorded for peak rearfoot eversion (P = 0.01), peak rearfoot plantarflexion (P &#60; 0.001) and peak forefoot abduction (P = 0.02) in the shod with FOs compared with barefoot conditions. No differences in kinetic variables were recorded.&lt;p&gt;&lt;/p&gt; Conclusion. This study has demonstrated, for the first time, alterations in muscle activation profiles and foot motion characteristics in patients with RA, pes plano valgus and US-confirmed TP tenosynovitis in response to customized FOs. Complex adaptations were evident in this cohort and further work is required to determine whether these functional alterations lead to improvements in patient symptoms.&lt;p&gt;&lt;/p&gt

Microwave conductivity of a d-wave superconductor disordered by extended impurities: a real-space renormalization group approach

Using a real-space renormalization group (RSRG) technique, we compute the microwave conductivity of a d-wave superconductor disordered by extended impurities. To do this, we invoke a semiclassical approximation which naturally accesses the Andreev bound states localized near each impurity. Tunneling corrections (which are captured using the RSRG) lead to a delocalization of these quasiparticles and an associated contribution to the microwave conductivity.Comment: 8 pages, 4 figures. 2 figures added to previous versio

Constraints on diffuse neutrino background from primordial black holes

We calculated the energy spectra and the fluxes of electron neutrino emitted in the process of evaporation of primordial black holes (PBHs) in the early universe. It was assumed that PBHs are formed by a blue power-law spectrum of primordial density fluctuations. We obtained the bounds on the spectral index of density fluctuations assuming validity of the standard picture of gravitational collapse and using the available data of several experiments with atmospheric and solar neutrinos. The comparison of our results with the previous constraints (which had been obtained using diffuse photon background data) shows that such bounds are quite sensitive to an assumed form of the initial PBH mass function.Comment: 18 pages,(with 7 figures

Photon mixing in universes with large extra-dimensions

In presence of a magnetic field, photons can mix with any particle having a two-photon vertex. In theories with large compact extra-dimensions, there exists a hierachy of massive Kaluza-Klein gravitons that couple to any photon entering a magnetic field. We study this mixing and show that, in comparison with the four dimensional situation where the photon couples only to the massless graviton, the oscillation effect may be enhanced due to the existence of a large number of Kaluza-Klein modes. We give the conditions for such an enhancement and then investigate the cosmological and astrophysical consequences of this phenomenon; we also discuss some laboratory experiments. Axions also couple to photons in the same way; we discuss the effect of the existence of bulk axions in universes with large extra-dimensions. The results can also be applied to neutrino physics with extra-dimensions.Comment: 41 pages, LaTex, 6 figure

Food meanings in HIV and AIDS caregiving trajectories: Ritual, optimism and anguish among caregivers in Lesotho

The article describes the caregiving responsibility to provide food for chronically ill family members and the meanings attached to food and eating when ill created stress for family caregivers. The results come from a qualitative phenomenological study using in-depth interviews with 21 family caregivers of chronically ill HIV and AIDS patients in one district in Lesotho. Analysis of the interview data showed that the caregivers attached profound meanings to food and feeding care recipients. Their perceptions about food as part of family life and caring, the role of food and eating in curbing disease progression, the link between food and medical efficacy and the link between food and life led to ritualised behaviour around food, and moments of optimism and anguish in caregiving. Patients’ behaviour in relation to food was in most instances inconsistent with the caregivers’ goals, thus leading this aspect of caregiving to induce stress. Services intended to support home-based caregivers and patients could contribute to the reduction of stress associated with food through suitably tailored food assistance and professional support to caregivers to enhance their competences and understanding of the dynamics of food intake as AIDS progressed

Anisotropic optical response of the diamond (111)-2x1 surface

The optical properties of the 2$\times$1 reconstruction of the diamond (111) surface are investigated. The electronic structure and optical properties of the surface are studied using a microscopic tight-binding approach. We calculate the dielectric response describing the surface region and investigate the origin of the electronic transitions involving surface and bulk states. A large anisotropy in the surface dielectric response appears as a consequence of the asymmetric reconstruction on the surface plane, which gives rise to the zigzag Pandey chains. The results are presented in terms of the reflectance anisotropy and electron energy loss spectra. While our results are in good agreement with available experimental data, additional experiments are proposed in order to unambiguously determine the surface electronic structure of this interesting surface.Comment: REVTEX manuscript with 6 postscript figures, all included in uu file. Also available at http://www.phy.ohiou.edu/~ulloa/ulloa.html Submitted to Phys. Rev.

The cosmic ray positron excess and neutralino dark matter

Using a new instrument, the HEAT collaboration has confirmed the excess of cosmic ray positrons that they first detected in 1994. We explore the possibility that this excess is due to the annihilation of neutralino dark matter in the galactic halo. We confirm that neutralino annihilation can produce enough positrons to make up the measured excess only if there is an additional enhancement to the signal. We quantify the `boost factor' that is required in the signal for various models in the Minimal Supersymmetric Standard Model parameter space, and study the dependence on various parameters. We find models with a boost factor greater than 30. Such an enhancement in the signal could arise if we live in a clumpy halo. We discuss what part of supersymmetric parameter space is favored (in that it gives the largest positron signal), and the consequences for other direct and indirect searches of supersymmetric dark matter.Comment: 11 pages, 6 figures, matches published version (PRD