Pain and depression are associated with both physical and mental fatigue independently of comorbidities and medications in primary Sjögren's syndrome.

Objectives: To report on fatigue in patients from the United Kingdom primary Sjögren's syndrome (pSS) registry identifying factors associated with fatigue and robust to assignable causes such as comorbidities and medications associated with drowsiness. Methods: From our cohort (n = 608), we identified those with comorbidities associated with fatigue, and those taking medications associated with drowsiness. We constructed dummy variables, permitting the contribution of these potentially assignable causes of fatigue to be assessed. Using multiple regression analysis, we modelled the relationship between Profile of Fatigue and Discomfort physical and mental fatigue scores and potentially related variables. Results: Pain, depression and daytime sleepiness scores were closely associated with both physical and mental fatigue (all p ≤ 0.0001). In addition, dryness was strongly associated with physical fatigue (p ≤ 0.0001). These effects were observed even after adjustment for comorbidities associated with fatigue or medications associated with drowsiness. Conclusions: These findings support further research and clinical interventions targeting pain, dryness, depression and sleep to improve fatigue in patients with pSS.This finding is robust to both the effect of other comorbidities associated with fatigue and medications associated with drowsiness.

Review of pharmacotherapy options for the management of obesity.

PURPOSE: To highlight the prevalence and impact of obesity in the United States and provide nurse practitioners (NPs) with an overview of pharmacotherapy options for treatment of overweight and obese individuals. DATA SOURCE: A comprehensive review of the literature was conducted using multiple databases, including PubMed, MEDLINE, and Ovid. Keywords used to obtain relevant articles included obesity and drug, or orlistat, topiramate/phentermine, lorcaserin, bupropion/naltrexone, and liraglutide. CONCLUSIONS: Obesity is a prevalent disease with more than two thirds of Americans being considered overweight and one third being obese. Obesity places patients at an increased risk for many comorbidities that impact patient health as well as public health. There are currently five approved medications for the chronic management of obesity, two of which were approved in 2014. These pharmacological therapies are options to aid weight loss in patients that are obese or those who are overweight with additional risk factors. IMPLICATIONS FOR PRACTICE: NPs can assist patients struggling with their weight. With new pharmacotherapy options, there is an opportunity to add to diet and exercise in order to achieve increased weight loss. A decrease in obesity would potentially alleviate the burden on the healthcare system, both socially and economically, and improve patient quality of life.

Mirabegron: a Beta-3 agonist for overactive bladder.

OBJECTIVE: To review the literature regarding the efficacy and safety of mirabegron for the treatment of overactive bladder (OAB). DATA SOURCES: A literature search was performed using MEDLINE (PubMed) prior to December 31, 2013, using the terms "mirabegron" and "randomized-controlled trial." STUDY SELECTION/DATA EXTRACTION: All published, double-blind, randomized-controlled trials assessing mirabegron were included. Articles were reviewed and included if mirabegron was used as monotherapy and if the primary outcome analyzed drug efficacy. DATA SYNTHESIS: The efficacy of mirabegron for the treatment of OAB has been demonstrated in the selected five randomized, placebo-controlled trials. The majority of these trials lasted 12 weeks and compared various doses of mirabegron with placebo and/or tolterodine extended-release (ER). Primary efficacy outcomes for the trials included mean number of micturitions per 24 hours and mean number of incontinence episodes per 24 hours. Included trials showed statistically significant reductions in both efficacy outcomes for various doses of mirabegron when compared with placebo. CONCLUSION: Based on the trials reviewed, mirabegron has been efficacious in reducing mean number of micturitions and incontinence episodes per 24 hours, as well as in improving other secondary outcomes such as OAB symptoms and quality-of-life measures. Common adverse drug events seen with mirabegron include: hypertension, nasopharyngitis, urinary tract infections, headache, constipation, upper respiratory tract infection, arthralgia, diarrhea, tachycardia, abdominal pain, and fatigue. Given the efficacy and safety data currently available, mirabegron represents a reasonable alternative to antimuscarinics for patients with OAB. Future studies are needed to determine the utility of mirabegron for OAB in a variety of demographics.

Composition, disintegrative properties, and labeling compliance of commercially available taurine and carnitine dietary products.

OBJECTIVE: To test the quality, disintegration properties, and compliance with labeling regulations for representative commercially available taurine and carnitine dietary products. DESIGN: Evaluation study. SAMPLE POPULATION: 11 commercially available taurine and 10 commercially available carnitine products. PROCEDURES: For each product, the amount of taurine or carnitine was determined and compared with the label claim. All products were evaluated for concentrations of mercury, arsenic, and selenium. Disintegration properties of 5 taurine and 8 carnitine products were determined in vitro. Labels were evaluated for compliance with FDA guidelines. RESULTS: 10 of 11 taurine and 10 of 10 carnitine products were within 10% of the stated label claim. Three of 11 taurine and 6 of 10 carnitine products were within 5% of the stated label claim. The median percentage difference between laboratory analysis and label claim was -5.7% (range, -26.3% to 2.5%) for taurine and 3.6% (range, -2.6% to 8.8%) for carnitine. No substantial amount of contamination with mercury, arsenic, or selenium was found in any of the products. During disintegration testing, 1 of 5 taurine products and 5 of 8 carnitine products did not disintegrate within 45 minutes during at least 1 test. Disintegration time for those that did disintegrate ranged from 1.7 to 37.0 minutes. All product labels conformed with FDA regulations. CONCLUSIONS AND CLINICAL RELEVANCE: Taurine and carnitine products evaluated in this study closely adhered to manufacturer claims and labeling guidelines. However, disintegration testing suggested high variability in some products, possibly limiting uptake and use by animals that receive them.

Detection of targets colocalized in clutter by big brown bats (Eptesicus fuscus).

Echolocating big brown bats (Eptesicus fuscus) frequently catch insects during aerial pursuits in open spaces, but they also capture prey swarming on vegetation, and from substrates. To evaluate perception of targets on cluttered surfaces, big brown bats were trained in a two-alternative forced-choice task to locate a target, varying in height, that was embedded partway in holes (clutter) cut in a foam surface. The holes were colocalized with the possible positions of the target at distances ranging from 25 to 35 cm. For successful perception of the target, the bat had to detect the echoes contributed by the target in the same time window that contained echoes from the clutter. Performance was assessed in terms of target reflective strength relative to clutter strength in the same time window. The bats detected the target whenever the target strength was greater than 1-2 dB above the clutter.

Evidence for spatial representation of object shape by echolocating bats (Eptesicus fuscus).

Big brown bats were trained in a two-choice task to locate a two-cylinder dipole object with a constant 5 cm spacing in the presence of either a one-cylinder monopole or another two-cylinder dipole with a shorter spacing. For the dipole versus monopole task, the objects were either stationary or in motion during each trial. The dipole and monopole objects varied from trial to trial in the left-right position while also roving in range (10-40 cm), cross range separation (15-40 cm), and dipole aspect angle (0 degrees -90 degrees ). These manipulations prevented any single feature of the acoustic stimuli from being a stable indicator of which object was the correct choice. After accounting for effects of masking between echoes from pairs of cylinders at similar distances, the bats discriminated the 5 cm dipole from both the monopole and dipole alternatives with performance independent of aspect angle, implying a distal, spatial object representation rather than a proximal, acoustic object representation.