Concordance of gout management with European League against Rheumatism recommendations in hospital practice

Aim: To assess the concordance of gout management with the European League Against Rheumatism (EULAR) gout recommendations in hospital practice. Methods: This was a retrospective review of case notes of patients presenting to rheumatology outpatients between June and December 2009 under the care of 2 consultant rheumatologists. Data collected consisted of demographics, time lag to specialist referral, comorbidities, details about acute and recurrent attacks, lifestyle advice and use of urate lowering therapies. Documented management was assessed for concordance with the EULAR recommendations. Results: Thirty consecutive patients (27 males, 3 females) attending Rheumatology clinic at Mater Dei Hospital were recruited. Mean age at the time of survey was 59.4 ± 10.7 years, while mean age at diagnosis was 51.1 ± 14 years. Documentation of lifestyle advice was recorded for alcohol reduction (83%), weight loss (43%), diet (13%), and exercise (13%). Adequate control of comorbidities was attained in hyperlipidaemia (71%), diabetes mellitus (55%) and hypertension (30%). Advice about smoking cessation was given to 37%. Uric acid levels below target were achieved in 47%. The mean uric acid level at time of survey was 379 ± 146 μmol/l. This was significantly less than that at presentation (p=0.001). Conclusions: Current treatment of gout is poorly concordant with many of the EULAR recommendations. Documentation of lifestyle modifications advice is infrequent except for alcohol reduction. A significant number of patents on allopurinol still have hyperuricaemia implying that more aggressive management is required to improve standard of care. A proforma has been developed to make and help sustain the necessary improvements.peer-reviewe

Audit on follow-up of patients with primary Osteoporosis

Aim: To document the frequency of Dual-energy X- ray absorptiometry (DEXA) scanning and Rheumatology clinic follow-up visits of patients with primary osteoporosis, and compare these with recommended guidelines. Method: Medical notes of all primary osteoporotic patients attending a hospital Rheumatology clinic were reviewed over a period of four months. Data was collected on age, gender, frequency of follow up visits, frequency of DEXA scanning, osteoporosis treatment, any changes in such treatment during the last visit, and comparison of the last two DEXA scan results. Frequency of follow up DEXA scans was compared to Group Health Osteoporosis Screening Diagnosis and Treatment guidelines.1 Results: Eighty-two patients were included, 6 males (7.3%) and 76 females (92.7%). The age range was 35-87 years (mean age was 68.6 years). In total, 42.7% of all the patients were on combined calcium and vitamin D, with added Bisphosphonates, Strontium ranelate, or Denosumab. During their last clinic visit, 61% showed improvement in T score since their previous result, and 64.6% of patients had no change in treatment. In this audit, 29.3% were being followed up on a 13 monthly basis, and 72% had annual bone mineral density scans or more frequently Conclusion: According to the guidelines, none of the patients included in this audit should have had a repeat DEXA scan within less than two years. Patients attending the clinic have too frequent DEXA scans and therefore, too frequent follow up appointments.peer-reviewe

The Pipe Nebula as seen with Herschel: Formation of filamentary structures by large-scale compression ?

A growing body of evidence indicates that the formation of filaments in interstellar clouds is a key component of the star formation process. In this paper, we present new Herschel PACS and SPIRE observations of the B59 and Stem regions in the Pipe Nebula complex, revealing a rich, organized network of filaments. The asymmetric column density profiles observed for several filaments, along with the bow-like edge of B59, indicates that the Pipe Nebula is being compressed from its western side, most likely by the winds from the nearby Sco OB2 association. We suggest that this compressive flow has contributed to the formation of some of the observed filamentary structures. In B59, the only region of the entire Pipe complex showing star formation activity, the same compressive flow has likely enhanced the initial column density of the clump, allowing it to become globally gravitationally unstable. Although more speculative, we propose that gravity has also been responsible for shaping the converging filamentary pattern observed in B59. While the question of the relative impact of large-scale compression and gravity remains open in B59, large-scale compression appears to be a plausible mechanism for the initial formation of filamentary structures in the rest of the complexComment: 9 pages, 9 figures, accepted for publication in A&

The Aquila prestellar core population revealed by Herschel

The origin and possible universality of the stellar initial mass function (IMF) is a major issue in astrophysics. One of the main objectives of the Herschel Gould Belt Survey is to clarify the link between the prestellar core mass function (CMF) and the IMF. We present and discuss the core mass function derived from Herschel data for the large population of prestellar cores discovered with SPIRE and PACS in the Aquila Rift cloud complex at d ~ 260 pc. We detect a total of 541 starless cores in the entire ~11 deg^2 area of the field imaged at 70-500 micron with SPIRE/PACS. Most of these cores appear to be gravitationally bound, and thus prestellar in nature. Our Herschel results confirm that the shape of the prestellar CMF resembles the stellar IMF, with much higher quality statistics than earlier submillimeter continuum ground-based surveys

Cluster-formation in the Rosette molecular cloud at the junctions of filaments

For many years feedback processes generated by OB-stars in molecular clouds, including expanding ionization fronts, stellar winds, or UV-radiation, have been proposed to trigger subsequent star formation. However, hydrodynamic models including radiation and gravity show that UV-illumination has little or no impact on the global dynamical evolution of the cloud. The Rosette molecular cloud, irradiated by the NGC2244 cluster, is a template region for triggered star-formation, and we investigated its spatial and density structure by applying a curvelet analysis, a filament-tracing algorithm (DisPerSE), and probability density functions (PDFs) on Herschel column density maps, obtained within the HOBYS key program. The analysis reveals not only the filamentary structure of the cloud but also that all known infrared clusters except one lie at junctions of filaments, as predicted by turbulence simulations. The PDFs of sub-regions in the cloud show systematic differences. The two UV-exposed regions have a double-peaked PDF we interprete as caused by shock compression. The deviations of the PDF from the log-normal shape typically associated with low- and high-mass star-forming regions at Av~3-4m and 8-10m, respectively, are found here within the very same cloud. This shows that there is no fundamental difference in the density structure of low- and high-mass star-forming regions. We conclude that star-formation in Rosette - and probably in high-mass star-forming clouds in general - is not globally triggered by the impact of UV-radiation. Moreover, star formation takes place in filaments that arose from the primordial turbulent structure built up during the formation of the cloud. Clusters form at filament mergers, but star formation can be locally induced in the direct interaction zone between an expanding HII--region and the molecular cloud.Comment: A&A Letter, in pres

Reconstructing the density and temperature structure of prestellar cores from <i>Herschel</i> data: a case study for B68 and L1689B

Utilizing multiwavelength dust emission maps acquired with Herschel, we reconstruct local volume density and dust temperature profiles for the prestellar cores B68 and L1689B using an inverse-Abel transform-based technique. We present intrinsic radial dust temperature profiles of starless cores directly from dust continuum emission maps disentangling the effect of temperature variations along the line of sight, which were previously limited to the radiative transfer calculations. The reconstructed dust temperature profiles show a significant drop in the core center, a flat inner part, and a rising outward trend until the background cloud temperature is reached. The central beam-averaged dust temperatures obtained for B68 and L1689B are 9.3 ± 0.5 K and 9.8 ± 0.5 K, respectively, which are lower than the temperatures of 11.3 K and 11.6 K obtained from direct SED fitting. The best mass estimates derived by integrating the volume density profiles of B68 and L1689B are 1.6 M⊙ and 11 M⊙, respectively. Comparing our results for B68 with the near-infrared extinction studies, we find that the dust opacity law adopted by the HGBS project, κλ = 0.1 × (λ/300 μm)-2 cm2 g-1 agrees to within 50% with the dust extinction constraints

Investigating users’ perspectives on the development of bike-sharing in Shanghai

High levels of car dependence have caused tremendous challenges for sustainable transport development. Transport planners, therefore, seek ways of replacing motor vehicles, as well as increasing the proportion of active travel. The bike-sharing scheme can be seen as an effective way of doing so, particularly in Asian cities. The aim of this paper is to investigate users’ perspectives on the development of bike-sharing using Shanghai as an example. Semi-structured interviews are used to examine the main factors motivating and impeding the development of the bike-sharing scheme in Shanghai. Our findings show that convenience, saving time and financial savings are the major motivations; whereas problems with bicycles being poorly maintained and abused by users, operational issues, financial issues and an unsuitable business model are the major obstacles. In addition, the findings also suggest that a public and private partnership could be the best option for running a sustainable bike-sharing scheme with clear areas of responsibility. Financial incentives, a bicycle-friendly infrastructure, regular operational management and supportive policies should be prioritised. In order to achieve the targets set by the Shanghai Master Plan 2035, transport planners and policymakers should integrate the bike-sharing scheme within the wider active travel system