Patient delays in seeking help at the onset of rheumatoid arthritis: the problem, its causes and potential solutions

Rheumatoid arthritis (RA) is a chronic inflammatory disease for which early treatment is vital to limit long term joint damage. However, people often delay in seeking medical help at the onset of RA symptoms. The early interpretation of symptoms and the process of making sense of symptoms impacts on both help-seeking decision-making and self-management. Furthermore, the general public’s perceptions and knowledge of RA may also affect the way that symptoms are interpreted. Examining the psychology behind early symptom interpretation, the barriers to help-seeking behaviour and investigating the public understandings of RA, can help us understand how decisions are made and guide us in developing interventions which encourage people to seek help promptly at the onset of RA

Distribution of the Water Scorpion \u3ci\u3eNepa Apiculata\u3c/i\u3e (Hemiptera: Nepidae) in Wisconsin

The water scorpion Nepa apiculata Uhler was considered rare in Wiscon- sin by Hilsenhoff (1984), who collected only 11 individuals during a 25-year period. All of his collections were from overwintering sites, especially debris in streams, during early spring or autumn (Hilsenhoff, pers. comm.). He concluded that the species was restricted to southern Wisconsin. Recent collections indicate that N. apiculata is more widely distributed. These records, summarized below, are documented with specimens in the University of Wisconsin-Madison insect collection

An algorithm to identify rheumatoid arthritis in primary care: a Clinical Practice Research Datalink study

Objective: Rheumatoid arthritis (RA) is a multisystem, inflammatory disorder associated with increased levels of morbidity and mortality. While much research into the condition is conducted in the secondary care setting, routinely collected primary care databases provide an important source of research data. This study aimed to update an algorithm to define RA that was previously developed and validated in the General Practice Research Database (GPRD). Methods: The original algorithm consisted of two criteria. Individuals meeting at least one were considered to have RA. Criterion 1:≥1 RA Read code and a disease modifying antirheumatic drug (DMARD) without an alternative indication. Criterion 2:≥2RA Read codes, with at least one 'strong' code and no alternative diagnoses. Lists of codes for consultations and prescriptions were obtained from the authors of the original algorithm where these were available, or compiled based on the original description and clinical knowledge. 4161 people with a first Read code for RA between 1 January 2010 and 31 December 2012 were selected from the Clinical Practice Research Datalink (CPRD, successor to the GPRD), and the criteria applied. Results: Code lists were updated for the introduction of new Read codes and biological DMARDs. 3577/ 4161 (86%) of people met the updated algorithm for RA, compared to 61% in the original development study. 62.8% of people fulfilled both Criterion 1 and Criterion 2. Conclusions: Those wishing to define RA in the CPRD, should consider using this updated algorithm, rather than a single RA code, if they wish to identify only those who are most likely to have RA

UK-South Asian patients' experiences of and satisfaction toward receiving information about biologics in rheumatoid arthritis

Background: Rheumatoid arthritis (RA) causes painful joint inflammation and is incurable, but treatments control RA. Drug regimens are complex, and patients often do not take their medication as expected. Poor medication adherence can lead to poorly controlled disease and worse patient outcomes. Biologics treatments are expensive and require full engagement from patients. We have previously shown that patients from Black ethnic minority backgrounds do not fully engage into treatment plan. This study explored the patients’ experiences in and satisfaction toward receiving information about biologics and future support preferences in South Asian patients with RA. Methods: Twenty South Asian patients with RA from Royal Wolverhampton Hospitals NHS Trust and Central Manchester University Hospitals NHS Foundation Trust participated in individual semi-structured interviews. Interviews were transcribed and data were analyzed by using thematic analysis approach. Results: Four overarching themes describe the patients’ experience in and satisfaction toward receiving information on biologics: 1) current provision of information regarding the “biologics journey” and understanding of RA: in this theme, non-English-speaking patients expressed heightened anxiety about stepping up to biologics; 2) experience and perceptions of biologics: many patients were positive about the biologic experience; however, there were patient-perceived delays in getting on to the biologics; 3) factors influencing willingness to try biologics: in this theme, a number of factors were identified including seeking advice from doctors abroad; and 4) recommendations on the desired information to fully understand the use of biologics: some patients valued group discussions, while others suggested receiving RA and biologic information through a video interaction. Conclusion: This novel study provides insight into South Asian RA patients’ experiences in and satisfaction toward receiving information about biologics. South Asian patients with RA reported a range of perceptions about biologics and support preferences, many of which may not be shared with the non-South Asian population

Chemical variations in Yellowknife Bay formation sedimentary rocks analyzed by ChemCam on board the Curiosity rover on Mars

The Yellowknife Bay formation represents a ~5 m thick stratigraphic section of lithified fluvial and lacustrine sediments analyzed by the Curiosity rover in Gale crater, Mars. Previous works have mainly focused on the mudstones that were drilled by the rover at two locations. The present study focuses on the sedimentary rocks stratigraphically above the mudstones by studying their chemical variations in parallel with rock textures. Results show that differences in composition correlate with textures and both manifest subtle but significant variations through the stratigraphic column. Though the chemistry of the sediments does not vary much in the lower part of the stratigraphy, the variations in alkali elements indicate variations in the source material and/or physical sorting, as shown by the identification of alkali feldspars. The sandstones contain similar relative proportions of hydrogen to the mudstones below, suggesting the presence of hydrous minerals that may have contributed to their cementation. Slight variations in magnesium correlate with changes in textures suggesting that diagenesis through cementation and dissolution modified the initial rock composition and texture simultaneously. The upper part of the stratigraphy (~1 m thick) displays rocks with different compositions suggesting a strong change in the depositional system. The presence of float rocks with similar compositions found along the rover traverse suggests that some of these outcrops extend further away in the nearby hummocky plains.

Vortex critical behavior at the de-confinement phase transition

The de-confinement phase transition in SU(2) Yang-Mills theory is revisited in the vortex picture. Defining the world sheets of the confining vortices by maximal center projection, the percolation properties of the vortex lines in the hypercube consisting of the time axis and two spatial axis are studied. Using the percolation cumulant, the temperature for the percolation transition is seen to be in good agreement with the critical temperature of the thermal transition. The finite size scaling function for the cumulant is obtained. The critical index of the finite size scaling function is consistent with the index of the 3D Ising model.Comment: 4 pages, 4 PS figures, using revtex4, paragraph and refs added, typo correcte

Moving beyond the ‘language problem': developing an understanding of the intersections of health, language and immigration status in interpreter-mediated health encounters

Health systems internationally are dealing with greater diversity in patient populations. However the focus on ‘the language problem’ has meant little attention is paid to diversity within and between migrant populations; and how interpreted consultations are influenced by intersecting migratory, ethnicity and sociodemographic variables. Our analysis of the experiences of patients, health care providers and interpreters in Scotland evidences the need to move beyond language, addressing multiple hidden inequalities in health care access and provision that operate in both clinic and, especially, home-based settings. We call for a practice-evidenced research agenda promoting cultural communication across health care and home settings, acknowledging immigration status as a social determinant of health. Sur le plan international, des systèmes de santé font face à une diversité croissante dans ses populations de patients. Cependant, l’accent sur ‘le problème de langue’ se traduit dans une manque d’attention à la diversité a l’intérieur même et entre des populations des migrants; et la façon par laquelle des variables migratoire, ethnique et sociodémographique influencent elles-mêmes des consultations interprétées. Notre analyse des expériences des patients, des professionnels fournissant de soins de santé et des interprètes offre des preuves du besoin de dépasser le problème de langue. Et en faisant cela, nous adressons des multiples inégalités, souvent cachées dans des contextes de soins de santé, dans les milieux clinique et domicile. Nous proposons un programme de recherche basé sur la pratique, qui favorise la communication culturelle dans des milieux clinique et domicile, et qui reconnait le statut d’immigration comme un déterminant social de la santé

Delays in help seeking at the onset of the symptoms of rheumatoid arthritis: a systematic synthesis of qualitative literature

A systematic review of qualitative peer-reviewed publications was conducted to identify drivers of and barriers to help-seeking behaviour in adults with new-onset rheumatoid arthritis (RA). 1058 abstracts were searched to identify relevant publications. 21 relevant publications were identified assessed for quality and subjected to analysis informed by thematic and grounded theory frameworks. Several interacting themes were identified including the early experience of symptoms in relation to disease prototypes, minimising the impact of symptoms, speaking to others, gathering information and seeking alternative treatments, and issues related to accessing health services and attitudes towards healthcare professionals. Many people suggested that they had little knowledge of RA before diagnosis, believing RA to be a mild condition that affected older people. These misperceptions made correct symptom interpretation unlikely. Normalising and ignoring symptoms led people to delay in help-seeking. However, when symptoms impacted on daily activities help was usually sought. Individual interpretations of symptoms are both drivers of and barriers to help seeking. Targeted public health interventions are required to inform symptom interpretation and reduce delays

Subaqueous shrinkage cracks in the Sheepbed mudstone: Implications for early fluid diagenesis, Gale crater, Mars

The Sheepbed mudstone, Yellowknife Bay formation, Gale crater, represents an ancient lakebed now exhumed and exposed on the Martian surface. The mudstone has four diagenetic textures, including a suite of early diagenetic nodules, hollow nodules, and raised ridges and later diagenetic light-toned veins that crosscut those features. In this study, we describe the distribution and characteristics of the raised ridges, a network of short spindle-shaped cracks that crosscut bedding, do not form polygonal networks, and contain two to four layers of isopachous, erosion-resistant cement. The cracks have a clustered distribution within the Sheepbed member and transition laterally into concentrations of nodules and hollow nodules, suggesting that these features formed penecontemporaneously. Because of the erosion-resistant nature of the crack fills, their three-dimensional structure can be observed. Cracks that transition from subvertical to subhorizontal orientations suggest that the cracks formed within the sediment rather than at the surface. This observation and comparison to terrestrial analogs indicate that these are syneresis cracks—cracks that formed subaqueously. Syneresis cracks form by salinity changes that cause sediment contraction, mechanical shaking of sediment, or gas production within the sediment. Examination of diagenetic features within the Sheepbed mudstone favors a gas production mechanism, which has been shown to create a variety of diagenetic morphologies comparable to the raised ridges and hollow nodules. The crack morphology and the isopachous, layered cement fill show that the cracks were filled in the phreatic zone and that the Sheepbed mudstone remained fluid saturated after deposition and through early burial and lithification

Compact lattice formulation of Cho-Faddeev-Niemi decomposition: string tension from magnetic monopoles

In this paper we begin on a new lattice formulation of the non-linear change of variables called the Cho--Faddeev--Niemi decomposition in SU(2) Yang-Mills theory. This is a compact lattice formulation improving the non-compact lattice formulation proposed in our previous paper. Based on this formulation, we propose a new gauge-invariant definition of the magnetic monopole current which guarantees the magnetic charge quantization and reproduces the conventional magnetic-current density obtained in the Abelian projection based on the DeGrand--Toussaint method. Finally, we demonstrate the magnetic monopole dominance in the string tension in SU(2) Yang-Mills theory on a lattice. Our formulation enables one to reproduce in the gauge-invariant way remarkable results obtained so far only in the Maximally Abelian gauge.Comment: 14 pages, v2: minor corrections; v3: explanations added and improve