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Introduction: Gout is an increasingly common medical problem. The traditional risk factors of male sex and high red meat or alcohol consumption have been joined with newer risks such as increased life expectancy, and the metabolic syndrome (hypertension, diabetes, dyslipidaemia, truncal obesity). Methods: This was a retrospective study to determine the epidemiology, clinical features, associated conditions as well as renal related conditions in existing gout patients followed-up in Rheumatology outpatient clinic, Hospital Tuanku Ja’afar, Seremban. Results: Over a three month period, we identified 54 gouty patients on our follow-up, the majority being male, Malay ethnicity, withthe age of onset in the third and fourth decades of life. Commonly associated risk factors were hypertension, hyperlipidaemia and obesity. However, underlying history of diabetes mellitus, alcohol consumption, and family history were not commonly associated with gout in our group of patients. Half of our patients had at least two or more joints involvement. About half of the patients with tophaceous gout had renal impairment. Conclusion: Our series of gout patients highlight the high prevalence of cardiovascular risk factors. The high prevalence of tophi and renal impairment is a cause for concern.

Objectives: Side-effects of standard pain medications can limit their use. Therefore, nonpharmacologic pain relief techniques such as auriculotherapy may play an important role in pain management. Our aim was to conduct a systematic review and meta-analysis of studies evaluating auriculotherapy for pain management. Design: MEDLINE,® ISI Web of Science, CINAHL, AMED, and Cochrane Library were searched through December 2008. Randomized trials comparing auriculotherapy to sham, placebo, or standard-of-care control were included that measured outcomes of pain or medication use and were published in English. Two (2) reviewers independently assessed trial eligibility, quality, and abstracted data to a standardized form. Standardized mean differences (SMD) were calculated for studies using a pain score or analgesic requirement as a primary outcome. Results: Seventeen (17) studies met inclusion criteria (8 perioperative, 4 acute, and 5 chronic pain). Auriculotherapy was superior to controls for studies evaluating pain intensity (SMD, 1.56 [95% confidence interval (CI): 0.85, 2.26]; 8 studies). For perioperative pain, auriculotherapy reduced analgesic use (SMD, 0.54 [95% CI: 0.30, 0.77]; 5 studies). For acute pain and chronic pain, auriculotherapy reduced pain intensity (SMD for acute pain, 1.35 [95% CI: 0.08, 2.64], 2 studies; SMD for chronic pain, 1.84 [95% CI: 0.60, 3.07], 5 studies). Removal of poor quality studies did not alter the conclusions. Significant heterogeneity existed among studies of acute and chronic pain, but not perioperative pain. Conclusions: Auriculotherapy may be effective for the treatment of a variety of types of pain, especially postoperative pain. However, a more accurate estimate of the effect will require further large, well-designed trials. [ABSTRACT FROM AUTHOR]

Much of the multicultural counseling literature focuses on how White or U.S.-born therapists can work effectively with clients of color. However, with the increasing number of racial minority and international therapists and trainees, there is a need to expand the multicultural counseling literature to acknowledge and center the experiences of therapists and trainees of color, particularly the experiences of Asian international therapists. Specifically, a greater understanding and guidelines are needed regarding how Asian international therapists handle clients' xenophobia, racism, and microaggressions in therapy. This qualitative study interviewed 11 licensed practicing Asian international psychotherapists within the United States about their experiences of client-initiated microaggressions in therapy. Consensual qualitative research was used to analyze interview data. Results indicated four domains pertaining to Asian international psychotherapists' experiences in therapy: xenophobia, microaggression, impact, and strategy. Participants reported complex negative impacts of xenophobia and microaggressions on their well-being as well as the therapeutic relationship and treatment outcomes. Additionally, participants identified the difficulty and complexity of addressing client-initiated microaggressions in session. Implications for training and practice as well as suggestions for future research are provided. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Social isolation and loneliness are growing public health concerns in adults with obesity and overweight. Social media-based interventions may be a promising approach. This systematic review aims to (1) evaluate the effectiveness of social media-based interventions on weight, body mass index, waist circumference, fat, energy intake and physical activity among adults with obesity and overweight and (2) explore potential covariates on treatment effect. Eight databases, namely, PubMed, Cochrane Library, Embase, CINAHL, Web of Science, Scopus PsycINFO and ProQuest, were searched from inception until December 31, 2021. The Cochrane Collaboration Risk of Bias Tool and Grading of Recommendations, Assessment, Development and Evaluation criteria evaluated the evidence quality. Twenty-eight randomised controlled trials were identified. Meta-analyses found that social media-based interventions had small-to-medium significant effects on weight, BMI, waist circumference, body fat mass and daily steps. Subgroup analysis found greater effect in interventions without published protocol or not registered in trial registries than their counterparts. Meta-regression analysis showed that duration of intervention was a significant covariate. The certainty of evidence quality of all outcomes was very low or low. Social media-based interventions can be considered an adjunct intervention for weight management. Future trials with large sample sizes and follow-up assessment are needed., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Tomato brown rugose fruit virus (ToBRFV) has recently emerged as a major disease of tomatoes and peppers. ToBRFV is a seed- and contact-transmitted virus. In Slovenia, ToBRFV RNA was detected in samples of wastewater, river, and water used to irrigate plants. Even though the source of detected RNA could not be clearly established, this raised the question of the significance of the detection of ToBRFV in water samples and experimental studies were performed to address this question. The data presented here confirm that the release of virus particles from the roots of infected plants is a source of infectious ToBRFV particles in water and that the virus can remain infective up to four weeks in water stored at room temperature, while its RNA can be detected for much longer. These data also indicate that irrigation with ToBRFV-contaminated water can lead to plant infection. In addition, it has been shown that ToBRFV circulated in drain water in commercial tomato greenhouses from other European countries and that an outbreak of ToBRFV can be detected by regular monitoring of drain water. A simple method for concentrating ToBRFV from water samples and a comparison of the sensitivity of different methods, including the determination of the highest ToBRFV dilution still capable of infecting test plants, were also investigated. The results of our studies fill the knowledge gaps in the epidemiology and diagnosis of ToBRFV, by studying the role of water-mediated transmission, and provide a reliable risk assessment to identify critical points for monitoring and control., Competing Interests: Authors AF and YL are employed by Fera Science Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Mehle, Bačnik, Bajde, Brodarič, Fox, Gutiérrez-Aguirre, Kitek, Kutnjak, Loh, Maksimović Carvalho Ferreira, Ravnikar, Vogel, Vos and Vučurović.)

Objective: To compare clinical outcomes between patients for whom their participation in inpatient rehabilitation was and was not impacted by dementia through matching patients reporting dementia (dementia group) with those not reporting dementia (non-dementia group)., Methods: Prospectively collected data held by the Australasian Rehabilitation Outcome Centre (AROC) were analyzed for patients aged 65 years or older receiving inpatient rehabilitation in public hospitals in Australia following a hip fracture and discharged between July 1, 2014, and June 30, 2019. Patients reported as having dementia impacting their rehabilitation program were matched to patients not reporting dementia based on age, admission motor Functional Independence Measure (FIM) score, and accommodation prior to rehabilitation. The matched cohorts were compared in relation to clinical outcomes (motor and cognitive FIM improvement, FIM efficiency, length of stay, and discharge destination) following participation in hospital-based rehabilitation using univariate analysis., Results: Patients with dementia had significantly lower cognitive FIM scores on commencing rehabilitation (17.6 and 26.9, respectively, P  < 0.001) and their median length of stay was 2 days shorter than those without dementia (21 and 23 days, respectively, P  < 0.001). Relative change in FIM score and FIM efficiency (per week) were lower in the dementia group [relative FIM score change of dementia vs non-dementia, respectively, 26.2% vs . 44.0% ( P  < 0.001) and FIM efficiency, 6.5 vs . 8.9 ( P  < 0.001)]. Discharge destination between the two groups was statistically different, with 35.7% of patients with dementia being discharged to residential aged care facilities (RACFs) compared to 21.7% of those without dementia ( P  < 0.001). More patients with dementia had carers in their private residence in the post-rehabilitation phase, 82.2% vs . 57.6% ( P  < 0.001)., Conclusion: Patients with dementia who sustain a fractured hip benefit from inpatient rehabilitation, although their clinical outcomes are not as good as those without dementia. FIM change and FIM efficiency were lower in the dementia group. Length of stay in the hospital for patients with dementia was shorter due to earlier recognition for the need for placement in either an RACF or at home with carer support. The need for placement in an RACF or carer support in a private residence was significantly greater in the dementia group., Competing Interests: The authors declared no potential conflict of interest., (© 2023 The Authors. Aging Medicine published by Beijing Hospital and John Wiley & Sons Australia, Ltd.)

A growing number of two-dimensional superconductors are being discovered in the family of exfoliated van der Waals materials. Due to small sample volume, the superfluid response of these materials has not been characterized. Here, we use a local magnetic probe to directly measure this key property of the tunable, gate-induced superconducting state in MoS 2 . We find that the backgate changes the transition temperature non-monotonically whereas the superfluid stiffness at low temperature and the normal state conductivity monotonically increase. In some devices, we find direct signatures in agreement with a Berezinskii-Kosterlitz-Thouless transition, whereas in others we find a broadened onset of the superfluid response. We show that the observed behavior is consistent with disorder playing an important role in determining the properties of superconducting MoS 2 . Our work demonstrates that magnetic property measurements are within reach for superconducting devices based on exfoliated sheets and reveals that the superfluid response significantly deviates from simple BCS-like behavior., (© 2023. The Author(s).)

Rationale: Surfer's myelopathy is a rare atraumatic spinal cord injury most frequently experienced by novice surfers. Patients often experience back pain, followed by motor, sensory, bowel, and bladder involvement. Here, we report a case of surfer's myelopathy., Patient Concerns: The patient presented with acute low back pain associated with lower limb weakness, sensory loss, urinary retention, and perineal paraesthesia 1 hour after her first surf lesson., Diagnosis: On arrival at the emergency department, she was noted to have flaccid paralysis with flickers in both lower limbs, reduced sensation in the midthoracic region, reduced anal tone, and saddle anesthesia. Magnetic resonance imaging of the spine revealed evidence of restricted diffusion from T6 to the level of the conus. Extensive investigations, including cerebrospinal fluid analysis, vasculitides/paraneoplastic screening, and further imaging, were unremarkable. She was diagnosed with complete T7 spinal cord injury secondary to surfer's myelopathy., Interventions: She subsequently received methylprednisolone and was transferred to the spinal injury unit for rehabilitation. As she experienced persistent neuropathic pain at the level of the injury, she received input from the local pain team. One month after the injury, the patient developed swelling of the right thigh associated with reduced internal and external rotation of the right hip, impacting rehabilitation. The patient was diagnosed with heterotopic ossification following a triple-phase bone scan. She then received intravenous zolendronic acid, which had a good effect., Outcomes: Four months after the initial presentation, she was discharged to the community. Despite no improvement in her neurological status, she was independent of transfers and mobility with a wheelchair. In addition, she managed her neurogenic bowel and bladder independently with intermittent self-catheterization and a transanal irrigation system. At 6 months, she engaged well with returning to drive program and vocational rehabilitation., Lessons: Neurological recovery from surfer's myelopathy has been shown to vary from complete recovery to minimal recovery. With a spinal-specific rehabilitation program, this patient remains independent of her activities of daily living. Surfer's myelopathy often occurs in inexperienced surfers; therefore, it is crucial to provide education to surfers and instructors., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Cultural capital is a known factor supporting success in substance use disorder (SUD) treatment. We investigated Asian American and Pacific Islander (AAPI) State population metrics in relation to SUD treatment completion for US clients from 2006-2017 ( N  = 5,404,374). Metrics that may signify greater available cultural capital were State AAPI Percentage, State AAPI Percent Change, and State AAPI Population. AAPI Percentage, AAPI Percent Change were positively associated, while AAPI Population was negatively associated with treatment completion ( p  < 0.001). Findings suggest treatment agencies in areas with low AAPI densities may improve outcomes by supporting AAPI community and cultural social networks.

Diverse cellular phenotypes are determined by groups of transcription factors (TFs) and other regulators that influence each others' gene expression, forming transcriptional gene regulatory networks (GRNs). In many biological contexts, especially in development and associated diseases, the expression of the genes in GRNs is not static but evolves in time. Modeling the dynamics of GRN state is an important approach for understanding diverse cellular phenomena such as cell-fate specification, pluripotency and cell-fate reprogramming, oncogenesis, and tissue regeneration. In this protocol, we describe how to model GRNs using a data-driven dynamic modeling methodology, gene circuits. Gene circuits do not require knowledge of the GRN topology and connectivity but instead learn them from training data, making them very general and applicable to diverse biological contexts. We utilize the MATLAB-based gene circuit modeling software Fast Inference of Gene Regulation (FIGR) for training the model on quantitative gene expression data and simulating the GRN. We describe all the steps in the modeling life cycle, from formulating the model, training the model using FIGR, simulating the GRN, to analyzing and interpreting the model output. This protocol highlights these steps with the example of a dynamical model of the gap gene GRN involved in Drosophila segmentation and includes example MATLAB statements for each step., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)

Interpersonal feedback is an important process in group therapy. Feedback can be both positive and negative, and group researchers have noted the importance of both positive and negative feedback in fostering cohesive groups and evoking behavioral change (Yalom & Leszcz, 2005). However, there is a paucity of research examining the amount and valence (i.e., positive and negative) of interpersonal feedback on group therapy process and outcomes. Therefore, this study tested the proposition that congruent and high levels of members' perceptions of positive and negative feedback was optimal for member's perceptions of cohesion and improvement in group therapy. Data for this study consisted of 168 members across 43 interpersonal process therapy groups. Polynomial regression and response surface analysis revealed that members' perceptions of congruent and high levels of positive and negative interpersonal feedback were positively associated with members' perceptions of group cohesion and improvement. In addition, members' perceptions of discrepant high positive feedback and low negative feedback were positively associated with members' perceptions of group cohesion and improvement. These findings suggest that members' perceptions of balanced and high amounts of positive and negative feedback, as well as discrepant high positive feedback and low negative feedback, are optimal in group therapy. Group leaders should attend to the amount and proportion of positive and negative member-member feedback in therapy groups to enhance the clinical benefit of these services. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective: Over the last 3 decades, group treatment researchers have become increasingly knowledgeable of the impact of within-group dependency on analyses of group treatment data and of mutual influence processes that occur within therapy groups. Despite these advancements, there remains a lack of consensus on the magnitude of mutual influence, or group effects, in group treatment research. As such, this study sought to estimate the size of group effects on members' posttreatment outcomes by meta-analyzing the intraclass correlation coefficients (ICCs) in group treatment research. In addition, we tested several moderators of the ICC, including outcome type, outcome reactivity, outcome specificity, group format, treatment length, and group size., Method: Using robust variance estimations, we meta-analyzed 169 effect sizes from 37 group treatment studies., Results: Findings indicated an average ICC of 0.06. Group size, group format, treatment length, outcome specificity, and outcome type did not significantly moderate the ICC; however, we did find evidence to suggest that the ICC varies as a function of outcome reactivity, with observer-rated outcome measures resulting in the largest ICC., Conclusion: These findings suggest that interdependence in group treatment research is an important concept both theoretically and statistically. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Cell-fate decisions during development are controlled by densely interconnected gene regulatory networks (GRNs) consisting of many genes. Inferring and predictively modeling these GRNs is crucial for understanding development and other physiological processes. Gene circuits, coupled differential equations that represent gene product synthesis with a switch-like function, provide a biologically realistic framework for modeling the time evolution of gene expression. However, their use has been limited to smaller networks due to the computational expense of inferring model parameters from gene expression data using global non-linear optimization. Here we show that the switch-like nature of gene regulation can be exploited to break the gene circuit inference problem into two simpler optimization problems that are amenable to computationally efficient supervised learning techniques. We present FIGR (Fast Inference of Gene Regulation), a novel classification-based inference approach to determining gene circuit parameters. We demonstrate FIGR's effectiveness on synthetic data generated from random gene circuits of up to 50 genes as well as experimental data from the gap gene system of Drosophila melanogaster , a benchmark for inferring dynamical GRN models. FIGR is faster than global non-linear optimization by a factor of 600 and its computational complexity scales much better with GRN size. On a practical level, FIGR can accurately infer the biologically realistic gap gene network in under a minute on desktop-class hardware instead of requiring hours of parallel computing. We anticipate that FIGR would enable the inference of much larger biologically realistic GRNs than was possible before., (Copyright © 2019 Fehr et al.)

Mental health professionals and administrators work to improve substance use treatment for racially and ethnically diverse populations. However, a national comparison study of Asian Americans and Pacific Islanders (AAPIs) and non-AAPIs substance use outpatient treatment completion has received little attention. The present study examined treatment completion by comparing AAPI clients to White and Latinx clients, and identified demographic and treatment-related moderating factors associated with treatment completion using discharge data from the Treatment Episode Data Sets-Discharge (TEDS-D). A retrospective analysis of AAPI treatment completion was conducted using logistic regression for the years 2006-2011 (N = 2,356,883). AAPIs were significantly more likely to complete treatment than non-AAPIs when controlling for all study variables in the multivariate model, Wald χ[1]2 = 158.60, p < .001, AOR = 1.19, 95% CI = 1.15-1.21. Additionally, we found a moderating effect (Wald χ[2]2 = 69.65, p < .001) with large effect sizes in treatment completion differences between the three comparison groups (AAPI, White, and Latinx). Results demonstrated AAPI clients are more likely to complete treatment than White and Latinx clients with small effect sizes. Additionally, being female, an adolescent, in school, living with parents or adult guardians, having more frequent substance use, and being admitted to treatment at younger age in the AAPI samples were associated with higher treatment completion percentages with clinically meaningful effect sizes. These findings may help to enhance and expand culturally competent psychological services to AAPIs at risk for substance use problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Acculturation theories often describe how individuals in the United States adopt and incorporate dominant cultural values, beliefs, and behaviors such as individualism and self-reliance. Theorists tend to perceive dominant cultural values as "accessible to everyone," even though some dominant cultural values, such as preserving White racial status, are reserved for White people. In this article, the authors posit that White supremacist ideology is suffused within dominant cultural values, connecting the array of cultural values into a coherent whole and bearing with it an explicit status for White people and people of color. Consequently, the authors frame acculturation as a continuing process wherein some people of color learn explicitly via racism, microaggressions, and racial trauma about their racial positionality; White racial space; and how they are supposed to accommodate White people's needs, status, and emotions. The authors suggest that acculturation may mean that the person of color learns to avoid racial discourse to minimize eliciting White fragility and distress. Moreover, acculturation allows the person of color to live in proximity to White people because the person of color has become unthreatening and racially innocuous. The authors provide recommendations for research and clinical practice focused on understanding the connections between ideology, racism, microaggressions and ways to create psychological healing. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A quantum phase transition (QPT) occurs between two competing phases of matter at zero temperature, driven by quantum fluctuations. Though the presence of these fluctuations is well established, they have not been locally imaged in space and their local dynamics has not been studied so far. We use a scanning superconducting quantum interference device to image quantum fluctuations in the vicinity of the QPT from a superconductor to an insulator. We find fluctuations of the diamagnetic response in both space and time that survive well below the transition temperature, demonstrating their quantum nature. The fluctuations appear as telegraph-like noise with a range of characteristic times and a non-monotonic temperature dependence, revealing unexpected quantum granularity. The lateral dimension of these fluctuations grows towards criticality, offering a new measurable length scale. Our results provide physical insight about the reorganization of phases across a QPT, with implications for any theoretical description. This paves a new route for future quantum information applications., Competing Interests: The authors declare that they have no competing financial interests.

In this study, we simulated a quantum rotor model describing a Josephson junction array (JJA) in the phase representation at zero temperature in a perpendicular magnetic field [Formula: see text] (in units of [Formula: see text]) on a [Formula: see text] square lattice with spacing a for [Formula: see text]. The superconductor-insulator transition (SIT) is tuned by the ratio of charging energy to Josephson coupling, U/J. Abrupt drops in the magnetization values were observed in the bigger lattices at certain values of B and U/J caused by the formation of vortices. Increasing U/J at a fixed B field causes quantum vortex melting. The magnetization drops to zero around [Formula: see text] indicating SIT. For B  =  0.1 the SIT occurs without an intermediate vortex state and the magnetization scales as [Formula: see text], whereas for B  =  0.4 the scaling is [Formula: see text] during the vortex melting. For B between 0.1 and 0.4 the scaling is not clear. We used the diffusion Monte Carlo (DMC) method with a guiding wavefunction optimized using the variational Monte Carlo (VMC) method. The ground state energy is calculated easily in DMC and its error estimates were generally smaller than [Formula: see text], both with and without the guiding wavefunction. Quantities like magnetization and vorticity that do not commute with the Hamiltonian were calculated using an efficient forward walking algorithm. Their estimates are affected severely in absence of the guiding wavefunction. With the guiding wavefunction, errors for the magnetization were generally less than [Formula: see text] and going up to [Formula: see text] percent around the phase transition from the Meissner to the vortex state, and without the guiding wavefunction errors were generally higher than [Formula: see text] and going up to [Formula: see text] around the critical point.

Coarse-grained superconductor-insulator composites exhibit a superconductor-insulator transition governed by classical percolation, which should be describable by networks of inductors and capacitors. We study several classes of random inductor-capacitor networks on square lattices. We present a unifying framework for defining electric and magnetic response functions, and we extend the Frank-Lobb bond-propagation algorithm to compute these quantities by network reduction. We confirm that the superfluid stiffness scales approximately as [Formula: see text] as the superconducting bond fraction p approaches the percolation threshold p c . We find that the diamagnetic susceptibility scales as [Formula: see text] below percolation, and as [Formula: see text] above percolation. For models lacking self-capacitances, the electric susceptibility scales as [Formula: see text]. Including a self-capacitance on each node changes the critical behavior to approximately [Formula: see text].

The effect of biologic disease modifying anti-rheumatic drugs (bDMARDs) in treating rheumatoid arthritis (RA) in real-world clinical practice remains unknown in Southeast Asia. We aimed to assess the efficacy and safety of bDMARDs among Malaysian RA patients treated in routine clinical practice. A retrospective medical chart review of RA patients from 11 government hospitals were conducted from January 2003 to January 2014. A standardized questionnaire was used to abstract patient's demographic, clinical and treatment data. Level of disease activity was measured by DAS28 collected at baseline, 3, 6 and 12 months. Three hundred and one patients were available for analysis, mean age 41 (SD, 10.8) years, mean RA duration 12.3 (SD, 6.9) years and 98% had history of two or more conventional-synthetic DMARDs. There were 467 bDMARD courses prescribed with mean bDMARDs duration use of 12.9 months (SD 14.7). Tumour necrosis factor alpha inhibitors were the most common prescribed bDMARDs (77.1%), followed by Tocilizumab (14.6%) and Rituximab (8.4%). We observed significant improvement in mean DAS28 values from baseline to 3, 6 and 12 months (p < 0.001). Overall, 16.9% achieved DAS28 remission at 6 months. A third (35.6%) of patients reported adverse events, three commonest being infections (46.5%), allergy (22.9%) and laboratory abnormalities (12.9%). 3.7% of our patients had tuberculosis. Biologic DMARDs were effective in treating RA in real-world practice in Malaysia, despite a lower remission rate compared to developed countries. Except for higher rates of tuberculosis, the AEs were similar to the published reports.

We simulate three types of random inductor-capacitor (LC) networks on [Formula: see text] square lattices. We calculate the dynamical conductivity using an equation-of-motion method in which timestep error is eliminated and windowing error is minimized. We extract the critical exponent a such that [Formula: see text] at low frequencies. The results suggest that there are three different universality classes. The [Formula: see text] model, with capacitances from each site to ground, has a  =  0.314(4). The [Formula: see text] model, with capacitances along bonds, has a  =  0. The [Formula: see text] model, with both types of capacitances, has a  =  0.304(1). This implies that classical percolative 2D superconductor-insulator transitions (SITs) generically have [Formula: see text] as [Formula: see text]. Therefore, any experiments that give a constant conductivity as [Formula: see text] must be explained in terms of quantum effects.

Objective: There is paucity of data for Takayasu arteritis (TAK) among South Asians. We aimed to evaluate the clinical features, angiographic findings, as well as treatment and outcome of TAK among Malaysian multiethnic groups., Methods: This is a retrospective review of 40 patients with TAK seen in major rheumatology centres in Malaysia between April 2006 and September 2013., Results: Majority were female patients (92.5%), with a female-to-male ratio of 12:1. Median duration of disease from diagnosis was 66 months (interquartile range, 33-177 months). Fifteen (37.5%) were Malays, 9 (22.5%) each were Indians and indigenous from East Malaysia and 7 (17.5%) were Chinese. Indian and indigenous from East Malaysia were overrepresented in this disease. The mean (SD) age of symptom onset and diagnosis were 25.5 (8.1) and 27.4 (8.4), respectively. The 3 most common clinical presentations at diagnosis were diminished or absent pulse, which occurred in 80% of the patients, followed by blood pressure discrepancy (60%) and arterial bruit (52.5%). There was no difference in clinical presentation among ethnic groups. The subclavian artery was the commonest vessel involved (72.5%), followed by the carotid artery (65%) and renal artery (47.5%). Eight patients had coronary artery involvement, and 2 patients had pulmonary artery involvement. Type I arterial involvement was the commonest (80.0%), followed by type IV (35%), present in isolation or mixed type. Glucocorticoid was the main medical treatment (90.0%). Nineteen patients (47.5%) underwent revascularization procedures. Five patients died during the follow-up period., Conclusions: The Malaysian TAK cohort had similarities with and differences from other published TAK cohort. A nationwide TAK registry is needed to determine the prevalence of the disease among different ethnic groups.

Objectives: Little is known about Traditional Vietnamese Medicine (TVM) and its use among Vietnamese immigrants in the United States. This study aimed to characterize TVM and improve understanding of its use among Vietnamese outpatients attending an urban clinic., Methods: This cross-sectional observation study was performed by mailing bilingual surveys to a stratified random sample of 400 Vietnamese adult patients (≥18 years of age) who had visited a community health center in Boston, Massachusetts, at least once in the prior 12 months. The data were analyzed by using descriptive and multivariable regression statistics. The use of TVM and the factors influencing their use were reported., Results: Among the 216 respondents, 68% reported using TVM. Of those users, the median age was 56 years and 68% were female, 51% had lived in the United States for less than 13 years, and 91% spoke English "not well or not at all." Among the 89% who reported using TVM of indigenous origin, 62% used "wind scraping," 35% used herbal pills/products, and 30% used "wind snatching." Sixty-one percent used therapies of foreign origin; of those, 51% used Asian-originated TVM (herbs, 25%; Eastern massage, 23%) and 38% used Western-influenced TVM (diet supplements, 28%; Western massage, 8%). TVM was mostly used for pain conditions (57%), "staying well" (38%), and cough/colds (27%). Forty-five percent ignored the question on revealing TVM use to providers; of those who answered, 57% said "no." Fifty-one percent of TVM users reported using Western medicine for the same problem, while 46% used TVM and Western medicine within 2 days of each other. Self-rated health (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.34-5.06), household size (OR, 2.09; 95% CI, 1.04-4.22), and education (OR, 2.65; 95% CI, 1.03-6.80) were associated with TVM use., Conclusion: TVM is an important component of the healthcare of urban Vietnamese and needs to be further investigated. Healthcare providers need to encourage open discussion to better care for this population.

Random inductor–capacitor (LC) networks can exhibit percolative superconductor-insulator transitions (SITs). We use a simple and efficient algorithm to compute the dynamicalconductivity σ(ω,p) of one type of LC network on large (4000 × 4000) square lattices, where δ = p − p(c) is the tuning parameter for the SIT. We confirm that the conductivity obeys a scaling form, so that the characteristic frequency scales as∝|δ|(νz) with νz ≈ 1.91, the superfluid stiffness scales as ϒ∝|δ|(t) with t ≈ 1.3, and the electric susceptibility scales as χE∝|δ|(−s) with s = 2νz − t ≈ 2.52. In the insulating state, the low-frequency dissipative conductivity is exponentially small, whereas in the superconductor, it is linear in frequency.The sign of Im σ(ω) at small ω changes across the SIT. Most importantly, we find that right at the SIT Re σ(ω) ∝ ω(t/νz−1)∝ω(−0.32), so that the conductivity diverges in the DC limit, in contrast with most other classical and quantum models of SITs.

Introduction: Gout is an increasingly common medical problem. The traditional risk factors of male sex and high red meat or alcohol consumption have been joined with newer risks such as increased life expectancy, and the metabolic syndrome (hypertension, diabetes, dyslipidaemia, truncal obesity)., Methods: This was a retrospective study to determine the epidemiology, clinical features, associated conditions as well as renal related conditions in existing gout patients followed-up in Rheumatology outpatient clinic, Hospital Tuanku Ja'afar, Seremban., Results: Over a three month period, we identified 54 gouty patients on our follow-up, the majority being male, Malay ethnicity, with the age of onset in the third and fourth decades of life. Commonly associated risk factors were hypertension, hyperlipidaemia and obesity. However, underlying history of diabetes mellitus, alcohol consumption, and family history were not commonly associated with gout in our group of patients. Half of our patients had at least two or more joints involvement. About half of the patients with tophaceous gout had renal impairment., Conclusion: Our series of gout patients highlight the high prevalence of cardiovascular risk factors. The high prevalence of tophi and renal impairment is a cause for concern.

A major challenge in realizing antiferromagnetic and superfluid phases in optical lattices is the ability to cool fermions. We determine the equation of state for the 3D repulsive Fermi-Hubbard model as a function of the chemical potential, temperature, and repulsion using unbiased determinantal quantum Monte Carlo methods, and we then use the local density approximation to model a harmonic trap. We show that increasing repulsion leads to cooling but only in a trap, due to the redistribution of entropy from the center to the metallic wings. Thus, even when the average entropy per particle is larger than that required for antiferromagnetism in the homogeneous system, the trap enables the formation of an antiferromagnetic Mott phase., (© 2011 American Physical Society)

Tunneling density of states measurements of disordered superconducting Al films in high Zeeman fields reveal a significant population of subgap states which cannot be explained by standard BCS theory. We provide a natural explanation of these excess states in terms of a novel disordered Larkin-Ovchinnikov phase that occurs near the spin-paramagnetic transition at the Chandrasekhar-Clogston critical field. The disordered Larkin-Ovchinnikov superconductor is characterized by a pairing amplitude that changes sign at domain walls. These domain walls carry magnetization and support Andreev bound states that lead to distinct spectral signatures at low energy.

A system with unequal populations of up and down fermions may exhibit a Larkin-Ovchinnikov (LO) phase consisting of a periodic arrangement of domain walls where the order parameter changes sign and the excess polarization is localized. We find that the LO phase has a much larger range of stability in a lattice compared to the continuum; in a harmonic trap, the LO phase may involve 80% of the atoms in the trap, and can exist up to an entropy s approximately 0.5k(B) per fermion. We discuss detection of the LO phase (i) in real space by phase-contrast imaging of the periodic excess polarization; (ii) in k space by time-of-flight imaging of the single-particle and pair-momentum distributions; (iii) in energy space from the excess density of states within the gap arising from Andreev bound states in the domain walls.

Objective: To evaluate the efficacy of acupuncture for labor stimulation., Methods: Nulliparous women at 38 weeks or greater were randomized to traditional Chinese medicine (TCM) acupuncture, sham acupuncture, or usual care only groups. Acupuncture points LI4, SP6, BL32, and BL54 were needled bilaterally. The primary outcome was time from enrollment to delivery. Secondary outcomes included rates of spontaneous labor and cesarean delivery. Medical records were abstracted for maternal demographic, medical, and delivery outcome data. ANOVA, Student's t-test, Chi-square, and Kaplan-Meier statistics were used to compare groups., Results: Eighty-nine women were enrolled and randomized. Maternal age, gestational age, prior acupuncture experience, tobacco, alcohol and drug use, gravida, and history of gynecological surgery were similar among the groups. There were no statistically significant differences among groups for time from enrollment to delivery (p=0.20), rates of spontaneous labor (p=0.66), or rates of cesarean delivery (p=0.37). Rates of maternal and neonatal outcomes were not significantly different., Conclusion: TCM acupuncture was not effective in initiating spontaneous labor or reducing the rate of cesarean delivery compared with sham acupuncture or usual medical care.

Objectives: To evaluate the utilization, financial costs, and benefits of incorporating acupuncture into a university-based family medicine center., Design: Retrospective billing records review., Setting: An academic family medicine center located within a university-based medical center., Subjects: The entire population of consecutive patients seen in an acupuncture clinic from April, 2002 through October, 2006., Outcome Measures: Patient characteristics, number and types of visits, and charges and collections., Methods: Analysis of de-identified, electronic billing records., Results: During the 4(1/2)-year study period, 788 unique patients were seen, accounting for a total of 4953 visits. The most common clinical conditions treated were back pain, headache, and neck pain. Mean charge and collection per visit was $82 and $53, respectively. Mean annual clinic revenues and expenses were $58,653 and $74,223, respectively., Conclusions: The authors' experience with an acupuncture clinic within an academic medical center has been generally positive, but we have not been able to turn a profit within the first 4(1/2) years of operation. Advantages of including physician-acupuncturists include improved patient access to third-party payers for clinical services, and possibly better acceptance by physician colleagues and the larger medical center system. Physician-acupuncturists, however, tend to have higher salary and liability costs associated with their services. Incorporating licensed acupuncturists allows for improved access to patients as well as lower operating expenses. We postulate that patients are generally more willing to pay cash for acupuncture services provided by a licensed acupuncturist compared to a physician, whose services are generally expected to be covered by medical insurance. Our findings suggest that incorporating acupuncture into existing medical practices may benefit patients, providers, the clinic as a whole, and the larger community, but the profit margin associated with providing acupuncture in these settings is likely to be negative or slim.

We present an efficient algorithm for calculating the properties of Ising models in two dimensions, directly in the spin basis, without the need for mapping to fermion or dimer models. The algorithm computes the partition function and correlation functions at a single temperature on any planar network of N Ising spins in O(N;{3/2}) time or less. The method can handle continuous or discrete bond disorder and is especially efficient in the case of bond or site dilution, where it executes in O(NlnN) time near the percolation threshold. We demonstrate its feasibility on the ferromagnetic Ising model and the +/-J random-bond Ising model and discuss the regime of applicability in cases of full frustration such as the Ising antiferromagnet on a triangular lattice.

Using the Kubo formula approach, we study the effect of electron interaction on thermal transport in the vicinity of a metal-insulator transition, with a granular metal as our model. For small values of dimensionless intergrain tunneling conductance, g<<1, we find that the thermal conductivity surprisingly shows a phononlike algebraic decrease, kappa(T) approximately g2T3/E2c even though the electrical conductivity obeys an Arrhenius law, sigma(T) approximately ge-Ec/T ; therefore the Wiedemann-Franz (WF) law is seriously violated. We explicitly show that this violation arises from nonmagnetic bosonic excitations of low energy that transport heat but not charge. At large values of intergrain tunneling, we find it plausible that the WF law weakly deviates from the free-electron theory due to potential fluctuations. Implications for experiment are discussed.

An outbreak of infection with the Nipah virus, a novel paramyxovirus, occurred among pig farmers between September 1998 and June 1999 in Malaysia, involving 265 patients with 105 fatalities. This is a follow-up study 24 months after the outbreak. Twelve survivors (7.5%) of acute encephalitis had recurrent neurological disease (relapsed encephalitis). Of those who initially had acute nonencephalitic or asymptomatic infection, 10 patients (3.4%) had late-onset encephalitis. The mean interval between the first neurological episode and the time of initial infection was 8.4 months. Three patients had a second neurological episode. The onset of the relapsed or late-onset encephalitis was usually acute. Common clinical features were fever, headache, seizures, and focal neurological signs. Four of the 22 relapsed and late-onset encephalitis patients (18%) died. Magnetic resonance imaging typically showed patchy areas of confluent cortical lesions. Serial single-photon emission computed tomography showed the evolution of focal hyperperfusion to hypoperfusion in the corresponding areas. Necropsy of 2 patients showed changes of focal encephalitis with positive immunolocalization for Nipah virus antigens but no evidence of perivenous demyelination. We concluded that a unique relapsing and remitting encephalitis or late-onset encephalitis may result as a complication of persistent Nipah virus infection in the central nervous system.

The negative regulatory protein ExuR in Erwinia chrysanthemi regulates expression of the galacturonate uptake (exuT) and utilization (uxaA, uxaB, uxaC) genes. We cloned and determined the nucleotide sequence of the exuR gene from E. chrysanthemi EC16. Analysis of the deduced amino acid sequence indicates that this protein possesses a helix-turn-helix motif and belongs to the GntR family of transcriptional repressors. Northern blot analysis and studies with transcriptional fusions of exuT in wild-type and exuR mutant backgrounds indicate that exuT transcription is deregulated in the exuR strain in vivo and in planta. [14C]-galacturonic acid uptake was constitutively high under inducing and noninducing conditions in the exuR mutant. Maximal exuT transcription activity was observed within 8 h of bacterial inoculation into potato tubers, well before any visible symptoms of disease were detected. This suggests that ExuT transport activity in E. chrysanthemi is important in the early stages of disease development.

We present a fast method for simulating the time evolution of any linear dynamical system possessing eigenmodes. This method does not require an explicit calculation of the eigenvectors and eigenfrequencies, and is based on a Chebyshev polynomial expansion of the formal operator matrix solution in the eigenfrequency domain. It does not suffer from the limitations of ordinary time-integration methods, and can be made accurate to almost machine precision. Among its possible applications are harmonic classical mechanical systems, quantum diffusion, and stochastic transport theory. An example of its use is given for the problem of vibrational wave-packet propagation in a disordered lattice.

The origin of the boson peak in models with force-constant disorder has been established by calculations using the coherent potential approximation. The analytical results obtained are supported by precise numerical solutions. The boson peak in the disordered system is associated with the lowest van Hove singularity in the spectrum of the reference crystalline system, pushed down in frequency by disorder-induced level-repelling and hybridization effects.

A fast time-evolution method is developed for systems for which the dynamical behavior can be reduced to the eigenvector/eigenvalue problem. The method does not use the eigenvectors/eigenvalues themselves and is based on a polynominal expansion of the formal operator solution in the eigenfrequency domain. It is complementary to the standard time-integration approaches and allows one to calculate or simulate the state of a system at arbitrary times. The time evolution of, e.g., classical harmonic atomic systems and quantum systems described by linear Hamiltonians can be treated by this method.