Validity and reliability of the Swedish version of the Self-Efficacy for Managing Chronic Disease scale for individuals with systemic sclerosis.

OBJECTIVE: To investigate aspects of validity and reliability of the Swedish version of the Self-Efficacy for Managing Chronic Disease (SEMCD-Swe) scale in systemic sclerosis (SSc). METHOD: A forward-backward translation procedure was used. Content validity was assessed through interviews with 11 people with SSc and 10 healthcare professionals. Construct validity, internal consistency, test-retest reliability, and floor and ceiling effects were evaluated in 104 SSc patients. RESULTS: The content validity of the SEMCD-Swe was interpreted as satisfactory, but some adjustments were made to increase the understanding. Confirmatory factor analysis supported a single-factor structure. Moderate to strong correlations between the SEMCD-Swe and Scleroderma Health Assessment Questionnaire; Multidimensional Assessment of Fatigue; Patient Health Questionnaire-8 (rs = -0.4 to -0.7), and RAND-36 subscales (rs = 0.5 to 0.7) were found. Weak correlations were found between SEMCD-Swe and modified Rodnan skin score; and disease severity of peripheral vascular and lung (rs = -0.1 to -0.2) and kidney (rs = 0.1) systems (Medsger severity scale). Cronbach's alpha was sufficient (0.85) and corrected item-to-total correlations were good (≥ 0.50). The intraclass correlation coefficient for the total score was sufficient (0.82). No floor or ceiling effects were found. CONCLUSION: Support for construct validity was indicated, as the SEMCD-Swe in SSc show a single-factor structure and is more strongly associated with pain, fatigue, depressive symptoms, interferences with daily activities, disability, and quality of life than with disease severity. Our results also indicate support for content validity and reliability. However, the responsiveness of the SEMCD-Swe needs to be tested.

The effects of exercise on cardiovascular disease risk factors and cardiovascular physiology in rheumatoid arthritis.

Cardiovascular disease (CVD) morbidity and mortality is highly prevalent in patients with rheumatoid arthritis (RA) with debilitating effects for the individual as well as significant healthcare impact. Current evidence demonstrates that engaging in aerobic and resistance exercise (i.e. structured physical activity) can significantly improve patient-reported and clinical index-assessed outcomes in RA. In addition to this, engagement in exercise programmes improves, in a dose-dependent manner, the risk of developing CVD as well as CVD symptoms and outcomes. The present narrative review uses evidence from systematic reviews and meta-analyses as well as controlled trials, to synthesize the current state-of-the-art on the potential effects of aerobic and resistance exercise on CVD risk factors as well as on cardiac and vascular function and structure in people with RA. Where there is a lack of evidence in RA to explain potential mechanisms, relevant studies from the general population are also discussed and linked to RA.

Muscle endurance, strength, and active range of motion in patients with different subphenotypes in systemic sclerosis: a cross-sectional cohort study.

OBJECTIVE: Proximal muscle weakness is common in patients with systemic sclerosis (SSc). Dynamic muscle endurance, muscle strength in the lower extremities, and active range of motion (AROM) in the upper extremities are less studied. We investigated functional muscle endurance, strength, and AROM, and explored differences depending on skin and/or lung involvement in SSc patients. METHOD: The study divided 205 patients with limited/diffuse cutaneous systemic sclerosis (lcSSc/dcSSc) into no-mild and moderate-end-stage lung involvement, the latter based on the Medsger disease severity score. Dynamic muscle endurance in shoulder and hip flexion was assessed by the Functional Index-2, lower extremity muscle strength by the Timed-Stands Test (TST), and shoulder-arm AROM by the Functional Shoulder Assessment (FSA). RESULTS: Shoulder and hip flexion muscle endurance were reduced in relation to reference values median (IQR) [53% (27-100%) and 40% (23-90%), respectively, p < 0.001]. Patients with moderate-end-stage lung involvement had less endurance in shoulder [39% (21-71%) and hip flexion 35% (20-70%)] than patients with no-mild lung involvement [57% (33-99%) and 48% (28-100%), p < 0.05]. All patients, regardless of subtype/grouping, needed longer to complete the TST [21 s (17-27 s)] compared to reference values [17 s (15-18 s), p < 0.001], and patients with moderate-end-stage lung involvement had worse TST score than patients with no-mild lung involvement,  [25 s (18-30 s) vs 19 s (16-25 s), p < 0.001]. The FSA sum scores were lower compared with reference values (p < 0.01). DcSSc patients had a lower FSA-sum score [53 (48-57)] than lcSSc patients [57 (52-60), p < 0.01]. CONCLUSION: SSc patients have markedly reduced muscle endurance in the upper and lower extremities, reduced muscle strength in the lower extremities, and impaired AROM in the shoulders and arms. Patients with moderate-end-stage lung involvement had more impaired muscle endurance and strength but no differences were found between lcSSc and dcSSc patients. Not only muscle strength, but also dynamic muscle endurance should be measured in SSc patients.

Self-reported physical capacity and activity in patients with systemic sclerosis and matched controls.

OBJECTIVE: The aim was to investigate differences in self-reported physical capacity and activity between systemic sclerosis (SSc) patients and population-based controls, as well as between patients with normal-mild, or moderate-severe, lung disease and their respective controls. METHOD: The study included 106 patients fulfilling the American College of Rheumatology SSc criteria and 106 controls, individually matched for age and gender. Patients were subdivided into normal-mild and moderate-severe lung disease based on results from pulmonary function tests and SSc severity scale. Participants answered questions regarding physical capacity and activity, exercise, and time spent sitting. RESULTS: SSc patients reported overall lower capacity for walking, jogging, and running (p < 0.001), and more limiting factors for physical capacity than controls (p < 0.001). Both patients with normal-mild and moderate-severe lung disease also reported lower overall physical capacity than their respective controls (p = 0.001, p < 0.001). Normal-mild lung disease patients reported pain more often than their controls (p < 0.05), whereas moderate-severe lung disease patients reported cardiopulmonary disease (p < 0.001) and reduced muscle strength (p = 0.03) as limiting factors for physical capacity more often than their controls. More patients than controls had 'never exercised' for at least 30 min per occasion within the past year (28% vs 15%, p = 0.03); however, there were no differences overall between patients and controls in frequency of exercise, physical activity, or time spent sitting. CONCLUSION: Although SSc patients reported lower physical capacity and more limiting factors for physical capacity than controls, there were no differences in reported physical activity and time spent sitting. Further development of physical activity programmes for SSc patients, especially for patients who never exercise or have physical impairments, is needed.

Impaired bidirectional NMDA receptor dependent synaptic plasticity in the dentate gyrus of adult female Fmr1 heterozygous knockout mice.

Fragile-X syndrome (FXS) is caused by the transcriptional repression of the Fmr1 gene resulting in loss of the Fragile-X mental retardation protein (FMRP). This leads to cognitive impairment in both male and female patients, however few studies have focused on the impact of FXS in females. Significant cognitive impairment has been reported in approximately 35% of women who exhibit a heterozygous Fmr1 gene mutation, however to date there is a paucity of information regarding the mechanistic underpinnings of these deficits. We, and others, have recently reported that there is significant impairment in N-methyl-d-aspartate receptor (NMDAR)-dependent long-term potentiation (LTP) and long-term depression (LTD) in the hippocampal dentate gyrus (DG) of male Fmr1 knock out mice. Here we examined if female mice displaying a heterozygous loss of the Fmr1 gene (Fmr1+/-) would exhibit similar impairments in DG-dependent spatial memory processing and NMDAR hypofunction. We found that Female Fmr1+/- mice did not show impaired metabotropic glutamate receptor (mGluR)-LTD in the CA1 region, and could perform well on a temporal ordering task that is thought to involve this brain region. In contrast, female Fmr1+/- mice showed impairments in a pattern separation task thought to involve the DG, and also displayed a significant impairment in both NMDAR-dependent LTD and LTP in this region. The LTP impairment could be rescued by administering the NMDAR co-agonist, glycine. Our data suggests that NMDAR hypofunction in the DG may partly contribute to learning and memory impairment in female Fmr1+/- mice. Targeting NMDAR-dependent mechanisms may offer hope as a new therapeutic approach for treating female FXS patients with learning and memory impairments.

Effects of a one-year physical activity programme for women with systemic lupus erythematosus - a randomized controlled study.

OBJECTIVES: To study the effects of a one-year physical activity programme on aerobic capacity, physical activity and health-related quality of life (HRQL) in patients with systemic lupus erythematosus (SLE) by a randomized control design. METHODS: Thirty-five women with low or moderate disease activity and organ damage were randomized to intervention (I) or control (C) group. The intervention during months 0-3 consisted of education, supervised aerobic exercise at high intensity and individual coaching, as well as self-managed physical activity at low-to-moderate intensity. During months 4-12, the physical activity was self-managed and the coaching was successively reduced over time. Outcome measures included: maximal oxygen uptake (VO2 max) from a bicycle ergometer test, self-reported physical activity and HRQL (SF-36). RESULTS: VO2 at sub-max. and max. increased, independent of group, during the one-year study period (main effect of time p < 0.0001). VO2 max. increased between baseline and month 3 (p < 0.0001), between months 3 and 6 (p = 0.01) and the increase was sustained at month 12 (ns). Frequency of physical activity at high intensity also increased, independent of group, during the study period. It was increased at months 3, 6 and 12 compared to baseline (p = 0.02, p < 0.001, p = 0.03). Improvement in mental health between baseline and month 6 (p = 0.002) was seen for the I-group, not the C-group (p = 0.03). Disease activity and organ damage did not change. CONCLUSIONS: Physical activity and aerobic capacity increased after supervised exercise and coaching, and the improvement was sustained during the one-year programme. However, no interactions between the group differences were seen, which suggests that repeated measurements could motivate to increased physical activity and thereby to increased aerobic capacity. As sub-max. VO2 increased over time, training-induced changes in VO2 on-kinetics could be another explanation. Little influence on HRQL was seen after the programme. The study indicates that physical activity at high intensity over one year is tolerated by patients with mild to moderate SLE.

Rescue of NMDAR-dependent synaptic plasticity in Fmr1 knock-out mice.

Fragile X Syndrome (FXS) is the most common form of inherited intellectual disability and results from a loss of Fragile X mental retardation protein (FMRP). FMRP is important for mRNA shuttling and translational control and binds to proteins important for synaptic plasticity. Like many developmental disorders, FXS is associated with alterations in synaptic plasticity that may impair learning and memory processes in the brain. However, it remains unclear whether FMRP plays a ubiquitous role in synaptic plasticity in all brain regions. We report that a loss of FMRP leads to impairments in N-methyl-D-aspartate receptor (NMDAR)-dependent synaptic plasticity in the dentate gyrus (DG), but not in the cornu ammonis area 1 (CA1) subregion of the hippocampus of adult mice. DG-specific deficits are accompanied by a significant reduction in NMDAR GluN1, GluN2A, and GluN2B subunit levels and reduced serine 831 GluA1 phosphorylation specifically in this region. Importantly, we demonstrate that treatment with NMDAR co-agonists (glycine or D-serine) independently rescue impairments in NMDAR-dependent synaptic plasticity in the DG of the Fragile X mental retardation 1 (Fmr1) knockout mouse. These findings implicate the NMDAR in the pathophysiology of FXS and suggest that indirect agonists of the NMDAR may be a successful therapeutic intervention in FXS.

Enhanced corticosteroid signaling alters synaptic plasticity in the dentate gyrus in mice lacking the fragile X mental retardation protein.

The fragile X mental retardation protein (FMRP) is an important regulator of protein translation, and a lack of FMRP expression leads to a cognitive disorder known as fragile X syndrome (FXS). Clinical symptoms characterizing FXS include learning impairments and heightened anxiety in response to stressful situations. Here, we report that, in response to acute stress, mice lacking FMRP show a faster elevation of corticosterone and a more immediate impairment in N-methyl-d-aspartate receptor (NMDAR) dependent long-term potentiation (LTP) in the dentate gyrus (DG). These stress-induced LTP impairments were rescued by administering the glucocorticoid receptor (GR) antagonist RU38486. Administration of RU38486 also enhanced LTP in Fmr1(-/y) mice in the absence of acute stress to wild-type levels, and this enhancement was blocked by application of the NMDAR antagonist 2-amino-5-phosphonopentanoic acid. These results suggest that a loss of FMPR results in enhanced GR signaling that may adversely affect NMDAR dependent synaptic plasticity in the DG.

Lifestyle habits and fatigue among people with systemic lupus erythematosus and matched population controls.

OBJECTIVE: The objective of this paper is to identify clusters of fatigue in patients with systemic lupus erythematosus (SLE) and matched controls, and to analyze these clusters with respect to lifestyle habits, health-related quality of life (HRQoL), anxiety and depression. METHODS: Patients with SLE (n = 305) and age- and gender-matched population controls (n = 311) were included. Three measurements of fatigue (Fatigue Severity Scale (FSS), Vitality (VT, from SF-36) and Multidimensional Assessment of Fatigue scale (MAF) and hierarchic cluster analysis were used to define clusters with different degrees of fatigue. Lifestyle habits were investigated through questionnaires. HRQoL was assessed with the SF-36 and anxiety/depression with the Hospital Anxiety and Depression Scale. RESULTS: Three clusters, denominated "High," "Intermediate" and "Low" fatigue clusters, were identified. The "High" contained 80% patients, and 20% controls (median; VT 25, FSS 5.8, MAF 37.4). These had the most symptoms of depression (51%) and anxiety (34%), lowest HRQoL (p < 0.001) and they exercised least frequently. The "Intermediate" (48% patients and 52% controls) (median; VT 55, FSS 4.1, MAF 23.5) had similarities with the "Low" regarding sleep/rest whereas social status and smoking were closer to the "High." The"Low" contained 22% patients and 78% controls (median; VT 80, FSS 2.3, MAF 10.9). They had the highest perceived HRQoL (p < 0.001), least symptoms of anxiety (10%), no depression, smoked least (13%) and reported the highest percentage (24%) of exercising ≥ 3 times/week. CONCLUSION: Fatigue is common, but not a general feature of SLE. It is associated with depression, anxiety, low HRQoL and less physical exercise. Patients with SLE and population controls with a healthy lifestyle reported lower levels of fatigue. Whether lifestyle changes can reduce fatigue, which is a major problem for a majority of SLE patients, needs to be further explored.

Barriers and facilitators for physical activity in rheumatic and musculoskeletal disease: a European-based survey.

Physical activity (PA) is a key strategy for improving symptoms in people with rheumatic and musculoskeletal diseases (RMDs). The aim of this study was to investigate and rank the importance of known barriers and facilitators for engaging in PA, from the perspective of people living with RMD. Five hundred thirty-three people with RMD responded to a survey (nine questions) disseminated by the People with Arthritis and Rheumatism (PARE) network of the European Alliance of Associations for Rheumatology (EULAR). The survey required participants to rank - based on their perceived importance - known PA barriers and facilitators from the literature, and specifically RMD symptoms as well as healthcare and community factors that may affect PA participation. Of the participants, 58% reported rheumatoid arthritis as their primary diagnosis, 89% were female, and 59% were between 51 and 70 years of age. Overall, participants reported fatigue (61.4%), pain (53.6%) and painful/swollen joints (50.6%) as the highest ranked barriers for engaging in PA. Conversely, less fatigue (66.8%) and pain (63.6%), and being able to do daily activities more easy (56.3%) were identified as the most important facilitators to PA. Three literature identified PA barriers, i.e., general health (78.8%), fitness (75.3%) and mental health (68.1%), were also ranked as being the most important for PA engagement. Symptoms of RMDs, such as pain and fatigue, seem to be considered the predominant barriers to PA by people with RMD; the same barriers are also the ones that they want to improve through increasing PA, suggesting a bi-directional relationship between these factors. Key Points • Symptoms of rheumatic and musculoskeletal disease (RMD) are the predominant barriers for lack of physical activity engagement. • RMD symptoms are the factors that people with RMDs want to improve when engaging in PA. • The barriers that stop people living with RMDs to do more PA are the ones that can be significantly improved through PA engagement.

Physical activity in patients with systemic lupus erythematosus and matched controls.

BACKGROUND: As physical activity reduces cardiovascular disease (CVD) in the general population, studies concerning the frequency of physical activity in patients with systemic lupus erythematosus (SLE) are needed. Earlier studies indicate that patients with SLE are physically inactive but there are few studies that compare physical activity in SLE to that in the general population. The aim of this study was to examine different aspects of physical activity in patients with SLE and population controls and to investigate how they relate to disease activity and organ damage. METHODS: Two hundred and seventy-two patients with SLE and 272 population controls, individually matched for age, gender, and living region, were investigated clinically. For patients, the investigation included assessment of disease activity using the SLE Disease Activity Index (SLEDAI) and organ damage using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC) Damage Index. All participants filled out an extensive questionnaire concerning physical activity, exercise capacity, and sedentary behaviour. RESULTS: The mean age of the patients was 47 (SD 15) years. Patients reported lower (p < 0.001) capacity for walking, jogging, and running and more limiting factors for these activities than controls (p < 0.001). Patients exercised less often than controls (p < 0.01) and patients with SLICC ≥ 2 points reported less physical activity on 'low to moderate' intensity compared to their controls (p < 0.05). Sedentary behaviour was reported by 18% of the patients and 26% of the controls (ns). CONCLUSION: Patients with SLE reported lower exercise capacity and less frequent exercise than controls. Additionally, patients with more organ damage reported less physical activity, and these, together with patients who have a sedentary behaviour, should be the focus of intervention programmes to support increased physical activity and exercise in SLE.

Hot plasma environment at jupiter: voyager 2 results.

Measurements of the hot (electron and ion energies >/=20 and >/= 28 kiloelectron volts, respectively) plasma environment at Jupiter by the low-energy charged particle (LECP) instrument on Voyager 2 have revealed several new and unusual aspects of the Jovian magnetosphere. The magnetosphere is populated from its outer edge into a distance of at least approximately 30 Jupiter radii (R(J)) by a hot (3 x 10(8) to 5 x 10(8) K) multicomponent plasma consisting primarily of hydrogen, oxygen, and sulfur ions. Outside approximately 30 R(J) the hot plasma exhibits ion densities from approximately 10(-1) to approximately 10(-6) per cubic centimeter and energy densities from approximately 10(-8) to 10(-13) erg per cubic centimeter, suggesting a high beta plasma throughout the region. The plasma is flowing in the corotation direction to the edge of the magnetosphere on the dayside, where it is confined by solar wind pressure, and to a distance of approximately 140 to 160 R(J) on the nightside at approximately 0300 local time. Beyond approximately 150 R(J) the hot plasma flow changes into a "magnetospheric wind" blowing away from Jupiter at an angle of approximately 20 degrees west of the sun-Jupiter line, characterized by a temperature of approximately 3 x 10(8) K (26 kiloelectron volts), velocities ranging from approximately 300 to > 1000 kilometers per second, and composition similar to that observed in the inner magnetosphere. The radial profiles of the ratios of oxygen to helium and sulfur to helium (

Low-energy charged particle environment at jupiter: a first look.

The low-energy charged particle instrument on Voyager was designed to measure the hot plasma (electron and ion energies greater, similar 15 and greater, similar 30 kiloelectron volts, respectively) component of the Jovian magnetosphere. Protons, heavier ions, and electrons at these energies were detected nearly a third of an astronomical unit before encounter with the planet. The hot plasma near the magnetosphere boundary is predominantly composed of protons, oxygen, and sulfur in comparable proportions and a nonthermal power-law tail; its temperature is about 3 x 10(8) K, density about 5 x 10(-3) per cubic centimeter, and energy density comparable to that of the magnetic field. The plasma appears to be corotating throughout the magnetosphere; no hot plasma outflow, as suggested by planetary wind theories, is observed. The main constituents of the energetic particle population ( greater, similar200 kiloelectron volts per nucleon) are protons, helium, oxygen, sulfur, and some sodium observed throughout the outer magnetosphere; it is probable that the sulfur, sodium, and possibly oxygen originate at 1o. Fluxes in the outbound trajectory appear to be enhancedfrom approximately 90 degrees to approximately 130 degrees longitude (System III). Consistent low-energy particle flux periodicities were not observed on the inbound trajectory; both 5-and 10-hour periodicities were observed on the outbound trajectory. Partial absorption of > 10 million electron volts electrons is observed in the vicinity of the Io flux tube.

Low-Energy Charged Particles in Saturn's Magnetosphere: Results from Voyager 1.

The low-energy charged particle instrument on Voyager 1 measured low-energy electrons and ions (energies >/= 26 and >/= 40 kiloelectron volts, respectively) in Saturn's magnetosphere. The first-order ion anisotropies on the dayside are generally in the corotation direction with the amplitude decreasing with decreasing distance to the planet. The ion pitch-angle distributions generally peak at 90 degrees , whereas the electron distributions tend to have field-aligned bidirectional maxima outside the L shell of Rhea. A large decrease in particle fluxes is seen near the L shell of Titan, while selective particle absorption (least affecting the lowest energy ions) is observed at the L shells of Rhea, Dione, and Tethys. The phase space density of ions with values of the first invariant in the range approximately 300 to 1000 million electron volts per gauss is consistent with a source in the outer magnetosphere. The ion population at higher energies (>/= 200 kiloelectron volts per nucleon) consists primarily of protons, molecular hydrogen, and helium. Spectra of all ion species exhibit an energy cutoff at energies >/= 2 million electron volts. The proton-to-helium ratio at equal energy per nucleon is larger (up to approximately 5 x 10(3)) than seen in other magnetospheres and is consistent with a local (nonsolar wind) proton source. In contrast to the magnetospheres of Jupiter and Earth, there are no lobe regions essentially devoid of particles in Saturn's nighttime magnetosphere. Electron pitch-angle distributions are generally bidirectional andfield-aligned, indicating closed field lines at high latitudes. Ions in this region are generally moving toward Saturn, while in the magnetosheath they exhibit strong antisunward streaming which is inconsistent with purely convective flows. Fluxes of magnetospheric ions downstream from the bow shock are present over distances >/= 200 Saturn radii from the planet. Novel features identified in the Saturnian magnetosphere include a mantle of low-energy particles extending inward from the dayside magnetopause to approximately 17 Saturn radii, at least two intensity dropouts occurring approximately 11 hours apart in the nighttime magnetosphere, and a pervasive population of energetic molecular hydrogen.

Low-Energy Hot Plasma and Particles in Saturn's Magnetosphere.

The low-energy charged particle instrument on Voyager 2 measured low-energy electrons and ions (energies greater, similar 22 and greater, similar 28 kiloelectron volts, respectively) in Saturn's magnetosphere. The magnetosphere structure and particle population were modified from those observed during the Voyager 1 encounter in November 1980 but in a manner consistent with the same global morphology. Major results include the following. (i) A region containing an extremely hot ( approximately 30 to 50 kiloelectron volts) plasma was identified and extends from the orbit of Tethys outward past the orbit of Rhea. (ii) The low-energy ion mantle found by Voyager 1 to extend approximately 7 Saturn radii inside the dayside magnetosphere was again observed on Voyager 2, but it was considerably hotter ( approximately 30 kiloelectron volts), and there was an indication of a cooler ( < 20 kiloelectron volts) ion mantle on the nightside. (iii) At energies greater, similar 200 kiloelectron volts per nucleon, H(1), H(2), and H(3) (molecular hydrogen), helium, carbon, and oxygen are important constituents in the Saturnian magnetosphere. The presence of both H(2) and H(3) suggests that the Saturnian ionosphere feeds plasma into the magnetosphere, but relative abundances of the energetic helium, carbon, and oxygen ions are consistent with a solar wind origin. (iv) Low-energy ( approximately 22 to approximately 60 kiloelectron volts) electron flux enhancements observed between the L shells of Rhea and Tethys by Voyager 2 on the dayside were absent during the Voyager 1 encounter. (v) Persistent asymmetric pitch-angle distributions of electrons of 60 to 200 kiloelectron volts occur in the outer magnetosphere in conjunction with the hot ion plasma torus. (vi) The spacecraft passed within approximately 1.1 degrees in longitude of the Tethys flux tube outbound and observed it to be empty of energetic ions and electrons; the microsignature of Enceladus inbound was also observed. (vii) There are large fluxes of electrons of approximately 1.5 million electron volts and smaller fluxes of electrons of approximately 10 million electron volts and of protons greater, similar 54 million electron volts inside the orbits of Enceladus and Mimas; all were sharply peaked perpendicular to the local magnetic field. (viii) In general, observed satellite absorption signatures were not located at positions predicted on the basis of dipole magnetic field models.

Hot Plasma and Energetic Particles in Neptune's Magnetosphere.

The low-energy charged particle (LECP) instrument on Voyager 2 measured within the magnetosphere of Neptune energetic electrons (22 kiloelectron volts /=0.5 MeV per nucleon) energies, using an array of solid-state detectors in various configurations. The results obtained so far may be summarized as follows: (i) A variety of intensity, spectral, and anisotropy features suggest that the satellite Triton is important in controlling the outer regions of the Neptunian magnetosphere. These features include the absence of higher energy (>/=150 keV) ions or electrons outside 14.4 R(N) (where R(N) = radius of Neptune), a relative peak in the spectral index of low-energy electrons at Triton's radial distance, and a change of the proton spectrum from a power law with gamma >/= 3.8 outside, to a hot Maxwellian (kT [unknown] 55 keV) inside the satellite's orbit. (ii) Intensities decrease sharply at all energies near the time of closest approach, the decreases being most extended in time at the highest energies, reminiscent of a spacecraft's traversal of Earth's polar regions at low altitudes; simultaneously, several spikes of spectrally soft electrons and protons were seen (power input approximately 5 x 10(-4) ergs cm(-2) s(-1)) suggestive of auroral processes at Neptune. (iii) Composition measurements revealed the presence of H, H(2), and He(4), with relative abundances of 1300:1:0.1, suggesting a Neptunian ionospheric source for the trapped particle population. (iv) Plasma pressures at E >/= 28 keV are maximum at the magnetic equator with beta approximately 0.2, suggestive of a relatively empty magnetosphere, similar to that of Uranus. (v) A potential signature of satellite 1989N1 was seen, both inbound and outbound; other possible signatures of the moons and rings are evident in the data but cannot be positively identified in the absence of an accurate magnetic-field model close to the planet. Other results indude the absence of upstream ion increases or energetic neutrals [particle intensity (j) < 2.8 x 10(-3) cm(-2) s(-1) keV(-1) near 35 keV, at approximately 40 R(N)] implying an upper limit to the volume-averaged atomic H density at R 22 keV) input on Neptune is approximately 3 x 10(7) W, surprisingly small when compared to energy input into the atmosphere of Jupiter, Saturn, and Uranus.

Ratings of pain and activity limitation on the visual analogue scale and global impression of change in multimodal rehabilitation of back pain - analyses at group and individual level.

PURPOSE: To evaluate changes in pain intensity and activity limitation, at group and individual levels, and their associations with the global impression of change after multimodal rehabilitation in patients with back pain. METHOD: Patients with long-term back pain (n = 282) participated in a 4-week programme with a follow-up after 6 months. Visual analogue scales (VAS) were used to rate pain intensity and activity limitation. Global impression of change (GIC) was rated on a 7-category scale. The sign test, the Svensson method and the Spearman rank correlation were used for analyses. RESULTS: Significantly lower ratings in pain and activity limitation at follow-up were found at group level. However, a large individual variability was found by the Svensson method. The correlations between GIC and changes in pain and activity limitation were rs = 0.49 and rs = 0.50, respectively. A rated GIC of at least "much better" on group level showed changes of ≥20 mm on the VAS. CONCLUSIONS: At group level, lower VAS ratings were found in patients with back pain. However, a large individual variability in pain and activity limitation was also found resulting in low to moderate associations between GIC and the change in VAS ratings. The large individual variability might be due to the impreciseness in the ratings on the VAS. We have presented a critical discussion of statistical methods in connection with the VAS. Implications for Rehabilitation The use of VAS as a rating instrument may be questioned, especially for perceived pain intensity which is a too complex experience to be rated on a line without any visible categories. Single ratings of pain intensity should preferably be complemented with the ratings of activity limitation in patients with long-term back pain. Global impression of change is a suggested inclusive rating after rehabilitation. The improvement desired by the patient should preferably be determined before rehabilitation.

Personal factors in systemic sclerosis and their coverage by patient-reported outcome measures. A multicentre European qualitative study and literature review.

BACKGROUND: Systemic sclerosis (SSc) is an autoimmune disease where thickening of the skin can lead to reduced body function and limitations in activities. Severe forms can also affect and seriously damage inner organs. Patient-centred rehabilitation emphasises considerations of patients' background, experience and behavior which highlights the need to know if patient-reported outcome measures (PROMs) include such personal factors. AIM: To identify and describe personal factors in the experiences of functioning and health of persons with SSc and to examine if and to what extent PROMs in SSc research cover these factors. DESIGN: Data from a qualitative study with focus group interviews were analysed. PROMs in SSc research were identified in a literature review between 2008-2013. SETTING: Participants were recruited from outpatient clinics at rheumatology department. POPULATION: Sixty-three patients with SSc from four European countries participated. METHODS: Data from interviews were analysed using a structure of personal factors developed by Geyh et al. Identified PROMs were analysed and linked to main concepts, related to the personal factors, found in the interview data. RESULTS: Nineteen main concepts were related to the area "patterns of experience and behaviour" in the personal factor structure, 16 to "thoughts and beliefs", nine to "feelings", one to "motives" and one to "personal history and biography", respectively. Among the 35 PROMs identified, 15 did not cover any of the identified concepts. Concepts within the area "feelings" were mostly covered by the PROMs. Five of the PROMs covered "patterns of experience and behaviour", while "motives" and "personal history and biography" were not covered at all. Four of the identified PROMs covered concepts within the areas "feelings", "thoughts and beliefs" and "patterns of experience and behaviour" in the same instrument. The Illness Cognition Questionnaire and Illness Behaviour Questionnaire were such PROMs. CONCLUSION: Patterns of experience and behaviour had the highest number of concepts related to personal factors, but few of the PROMs in SSc research covered these factors. Only a few PROMs covered several personal factors areas in the same instrument. CLINICAL REHABILITATION IMPACT: The results would be of value when developing core sets for outcome measurements in SSc.

A reconsideration of visual evoked potentials for fast automated ophthalmic refractions.

Visual evoked potentials (VEP's) recorded from the scalp are sensitive to retinal image sharpness and thus to changes in the refractive state of the eye. Initially the responses to checkerboard flash or reversal stimuli were computer-averaged in order to raise the signal above the noise, primarily the electroencephalogram (EEG). Recently analogue Fourier signal analysis has been proposed for using the VEP for rapid clinical refraction. We have confirmed that this method can measure the spherical refractive state to within +/- 0.50D. However, because of large slow-wave fluctuations, measurements of changes within +/- 1.00D are not always clear. Despite its promise the method does not appear to be clinically useful at present.

Human exposure to urban air pollution.

This study deals with some methods of making human exposure estimates, aimed at describing the human exposure for selected air pollutants in Sweden that are suspected carcinogens. Nitrogen oxides (NOx) have been chosen as an indicator substance for estimating the concentration of the urban plume. Earlier investigations have shown that the traffic in Swedish cities contributes around 85% to the measured NOx concentrations, and that most of the mutagenicity in urban air originates from traffic. The first section of this paper describes measurements in Stockholm of some unregulated light hydrocarbons, such as ethene, ethyne, propane, propene, butane, and isobutane. In addition, measurements of some volatile aromatic hydrocarbons are presented. Simultaneous measurements of carbon monoxide (CO) were made. The ratios between CO and the individual specific compounds were determined by linear regression analysis. By analysis of relationships between CO and NOx, NOx concentrations can be used as a tracer to describe the exposure for these specific compounds. NOx are considered to be a better tracer than CO, because NOx or NO2 values exist for many places over a long time, while CO is measured mostly in streets with high concentrations. At low concentrations, instruments that measure normal CO levels give no detectable signals. Through use of atmospheric dispersion models and models that describe how people live and work in urban areas it has been possible to describe the average exposure to NOx in cities of different sizes. The exposure to NOx for people living in the countryside has also been estimated. In this way, it has been possible to calculate the average exposure dose for NOx for the Swedish population. This figure is 23 micrograms/m3. By use of the relationships between NOx and specific compounds the average dose has been calculated for the following compounds: polyaromatic compounds (PAH); ethene, propene, and butadiene; benzene, toluene, and xylene; formaldehyde and actaldehyde; nickel, chromium (VI), arsenic, and cadmium; asbestos; and silicon.