Feasibility of Physiotherapist-Led Rheumatology Triage: A Randomized Study.

Objective: Given global shortages in the rheumatology workforce, the demand for rheumatology assessment often exceeds the capacity to provide timely access to care. Accurate triage of patient referrals is important to ensure appropriate utilization of finite resources. We assessed the feasibility of physiotherapist (PT)-led triage using a standardized protocol in identifying cases of inflammatory arthritis (IA), as compared to usual rheumatologist triage of referrals for joint pain, in a tertiary care rheumatology clinic.

Out-of-plane arrivals recorded by drifting hydrophones during the Northern Ocean Rapid Surface Evolution Experiment.

This paper reports on an observation of three-dimensional (3D) arrivals for which the change in the direction of horizontally refracted sound is nearly 180°. The experimental site is Jan Mayen Channel (JMCh), which connects the Greenland and Norwegian Seas. During the experiment, signals from a moored source transmitting a 500-1500 Hz sweep every 4 h were recorded by three surface drifters equipped with hydrophone arrays.

Rapid vertical exchange at fronts in the Northern Gulf of Mexico.

Over the Texas-Louisiana Shelf in the Northern Gulf of Mexico, the eutrophic, fresh Mississippi/Atchafalaya river plume isolates saltier waters below, supporting the formation of bottom hypoxia in summer. The plume also generates strong density fronts, features of the circulation that are known pathways for the exchange of water between the ocean surface and the deep. Using high-resolution ocean observations and numerical simulations, we demonstrate how the summer land-sea breeze generates rapid vertical exchange at the plume fronts.

A warm jet in a cold ocean.

Unprecedented quantities of heat are entering the Pacific sector of the Arctic Ocean through Bering Strait, particularly during summer months. Though some heat is lost to the atmosphere during autumn cooling, a significant fraction of the incoming warm, salty water subducts (dives beneath) below a cooler fresher layer of near-surface water, subsequently extending hundreds of kilometers into the Beaufort Gyre. Upward turbulent mixing of these sub-surface pockets of heat is likely accelerating sea ice melt in the region.

Missed opportunities to prevent cardiovascular disease in women with prior preeclampsia.

Background: Cardiovascular disease (CVD) is the leading cause of death in women in every major developed country and in most emerging nations. Complications of pregnancy, including preeclampsia, indicate a subsequent increase in cardiovascular risk. There may be a primary care provider knowledge gap regarding preeclampsia as a risk factor for CVD.

Climate Process Team on Internal Wave-Driven Ocean Mixing.

Diapycnal mixing plays a primary role in the thermodynamic balance of the ocean and, consequently, in oceanic heat and carbon uptake and storage. Though observed mixing rates are on average consistent with values required by inverse models, recent attention has focused on the dramatic spatial variability, spanning several orders of magnitude, of mixing rates in both the upper and deep ocean. Away from ocean boundaries, the spatio-temporal patterns of mixing are largely driven by the geography of generation, propagation and dissipation of internal waves, which supply much of the power for turbulent mixing.

Near-Inertial Internal Gravity Waves in the Ocean.

We review the physics of near-inertial waves (NIWs) in the ocean and the observations, theory, and models that have provided our present knowledge. NIWs appear nearly everywhere in the ocean as a spectral peak at and just above the local inertial period f, and the longest vertical wavelengths can propagate at least hundreds of kilometers toward the equator from their source regions; shorter vertical wavelengths do not travel as far and do not contain as much energy, but lead to turbulent mixing owing to their high shear. NIWs are generated by a variety of mechanisms, including the wind, nonlinear interactions with waves of other frequencies, lee waves over bottom topography, and geostrophic adjustment; the partition among these is not known, although the wind is likely the most important.

The formation and fate of internal waves in the South China Sea.

Internal gravity waves, the subsurface analogue of the familiar surface gravity waves that break on beaches, are ubiquitous in the ocean. Because of their strong vertical and horizontal currents, and the turbulent mixing caused by their breaking, they affect a panoply of ocean processes, such as the supply of nutrients for photosynthesis, sediment and pollutant transport and acoustic transmission; they also pose hazards for man-made structures in the ocean. Generated primarily by the wind and the tides, internal waves can travel thousands of kilometres from their sources before breaking, making it challenging to observe them and to include them in numerical climate models, which are sensitive to their effects.

Idiopathic granulomatous mastitis--a prospective study of 49 women and treatment outcomes with steroid therapy.

Idiopathic granulomatous mastitis (IGM) is an infrequently reported benign breast disease of unknown etiology. Surgical treatment has been widely advocated but can be disfiguring. We describe demographic and clinico-pathologic features of women with IGM in a safety net hospital, and evaluate steroid therapy as a breast-conserving modality of treatment.

Update in women's health.

Introduction: The aim of this clinical update is to summarize articles and guidelines published in the last year with the potential to change current clinical practice as it relates to women's health.

Methods: We used two independent search strategies to identify articles relevant to women's health published between March 1, 2007 and February 29, 2008. First, we reviewed the Cochrane Database of Systematic Reviews and journal indices from the ACP Journal Club, Annals of Internal Medicine, Archives of Internal Medicine, British Medical Journal, Circulation, Diabetes, JAMA, JGIM, Journal of Women's Health, Lancet, NEJM, Obstetrics and Gynecology, and Women's Health Journal Watch.