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Rheumatic and musculoskeletal diseases (RMDs) represent a multitude of degenerative, inflammatory and auto-immune conditions affecting millions of people worldwide. Persons with these diseases may potentially experience severe chronic pain, joint damage, increasing disability and even death. With an increasingly ageing population, the prevalence and burden of RMDs are predicted to increase, placing greater demands on the global practice of rheumatology and related healthcare budgets. Effective treatment of RMDs currently faces a number of challenges in both the developed and developing world, and individual countries may face more specific local challenges. However, limited understanding of the burden of RMDs amongst public health professionals and policy-makers means that these diseases are often not considered a public health priority. The objective of this review is to increase awareness of the RMDs and to identify opportunities to address RMD challenges on both a local and global scale. On 26 September 2014, rheumatology experts from five different continents met at the World Forum on Rheumatic and Musculoskeletal Diseases (WFRMD) to discuss and identify some key challenges for the RMDs community today. The outcomes are presented in this review, focusing on access to rheumatology services, diagnostics and therapies, rheumatology education and training and on clinical trials, as well as investigator-initiated and epidemiological research. The long-term vision of the WFRMD is to increase perception of the RMDs as a major burden to society and to explore potential opportunities to improve global and local RMD care.

This study investigated the use of National Forests by the Confederated Salish and Kootenai Tribes of the Flathead Reservation in Montana. Although public lands in the interior American west often surround Tribal lands, managers know little about how the Forest Service (FS) rules and regulations impact the traditional values and culture of American Indians. Interviews were conducted in 2001 with a sample of 60 enrolled Tribal members. Results indicate that Tribal members participate in a variety of outdoor activities in national forests: hunting, fishing, berry and mushroom picking, camping, hiking, and collecting medicinal plants. Perceived racism from both managers and the visiting public, coupled with feelings of resentment at being pushed out of their aboriginal lands has created distrust among Tribal members. In order to preserve and respect Tribal culture and values, FS managers need to approach Tribal members with mutual trust and respect according to Tribal customs before requesting input and expecting open dialogue.

Rheumatoid Arthritis Tofacitinib combined with conventional disease-modifying antirheumatic drug therapy led to improvements in patient-reported outcomes, according to a recently published phase 3 trial. Vibeke Strand, MD, at the Stanford University School of Medicine, and colleagues performed a 12-month phase 3 trial - called ORAL SYNC - of 795 patients with active rheumatoid arthritis who had a previous inadequate response to therapy with at least one disease-modifying antirheumatic drug (DMARD). More patients treated with tofacitinib reported improvements of greater than or equal to the minimum clinically important differences vs. placebo for all patient-reported outcomes, except for the SF-36 emotional domain, which remained significant for the 10-mg group only. – by Will A. Offit Disclosure: Strand reports she received consulting fees and is an advisory board member for AbbVie, Amgen, Biogen Idec, Bristol Myers Squibb, Crescendo, Genentech/Roche, GlaxoSmithKline, Janssen, Eli Lilly, Novartis, Pfizer, Regeneron, Sanofi, Takeda, UCB and Vertex; received consulting fees from Alder, AstraZeneca, Biotest, Celgene, Celltrion, Corrona LLC, Horizon, Hospira, Incyte, Merck, Serono and Protalex.

The project contributes to the general theme of complex chemical systems and strengthens ties with Innospec, a multi-national chemical company. Sodium lauroyl methyl isethionate (SLMI. Trade name “Iselux”) is a newly developed surfactant with attractive product properties for personal care applications. Little is known about the fundamental surface and solution properties of SLMI, and it is not currently possible to use information on available surfactants to predict phase behaviour. We characterise the solution and liquid crystalline phase behaviour of the SLMI/water system using a combination of optical microscopy, X-ray scattering and differential scanning calorimetry techniques. SLMI is synthesised using a batch process that leads to variable component concentrations. Preliminary studies conducted by Innospec indicate that the presence of particular process components has a significant influence on SLMI formulation rheological properties. We investigate the effects of synthesis-derived components on the rheological properties of the SLMI/sodium {(3-(dodecanoylamino)propyl)(dimethyl)ammonio)}acetate/water system using rheology and light scattering (static and dynamic) techniques. SLMI is often formulated into personal care products on mixing aqueous formulation components. Micelle growth occurs via a mechanistic process that is not understood and the equilibrium viscosity is attained at a time after mixing that ranges from seconds to weeks. Developing an improved understanding of the micelle growth mechanism is of both academic and industrial value. We utilise static light scattering and nuclear magnetic resonance techniques to probe a range of samples in the viscoelastic region of the SLMI/(carboxymethyl) hexadecyldimethyl ammonium hydroxide/water system. Experimental findings improve our current understanding of micelle growth process and provide a platform for future research on non-equilibrium mixing kinetics. In the final section we investigate salt-induced cloud point and precipitation phenomena in the SLMI/salt/water system. The cloud point is commonly observed in surfactant and protein systems by increasing the solution temperature above a critical value, resulting in phase separation of solute-rich and solute-depleted layers. Cloud point induced phase separation may also be prompted by addition of salt. The mechanistic process driving electrolyte-induced cloud point phenomena is not understood. We use a combination of turbidimetry measurements and lightscattering (static and dynamic) techniques to measure cloud point curves andcharacterise micellar behaviour prior to clouding.

Recently, focus groups are being employed to address isses in natural resource management. Although the use of focus groups to assist managers in developing management solutions is in its infancy, providing a forum for participants to share insights, knowledge and love of the outdoors can only make management efforts both more effective and more acceptable to the public.

The purpose of this study was to explore how observing heavily impacted wilderness campsites and restoration activities to restore them influences the quality of visitor experience and opinions of managers. The study conducted in the Mission Mountains Wilderness (“MMW”) used data collected from 293 visitor surveys, 33 field interviews and 2 visitor focus groups. Located in Northwestern Montana, the MMW is managed by the USDA Forest Service. In addition, data from a national survey of 33 Forest Service wilderness managers were used for this study. The visitor survey results indicate that visitors noticed heavily impacted campsites that diminished their experience. Visitors who observed restoration activities during their visit felt it positively influenced their experience and opinions of managers. Visitor reactions to campsite conditions and support for restoration are based on information gained from prior visits, visitor perceptions of what wilderness should look like, and by comparing the conditions of campsites observed at other wilderness areas. Results from the visitor interviews indicate that visitors support restoration activities, do not like to see heavily impacted campsites, and hold managers responsible. Results from the focus group with restoration volunteers indicate that visitor participation in wilderness restoration resulted in strong feelings about the need to actively restore heavily impacted campsites. For these volunteers attachment to a particular place seems to coincide with an equally strong resistance to increased limitations on access. Results from the focus group with long-time visitors indicate that these visitors possess a rich source of historical and contemporary information about the area and its visitors and support most management actions. The manager results show that well executed restoration plans are positive for visitors, managers and for the wilderness resource as well. Comparing visitor and manager responses indicate that observing restoration of heavily impacted campsites improves the quality of visitor experience, visitor opinions of managers and demonstrates that the area is well cared for. These findings provide researchers and managers with both an increased understanding of how management actions influence wilderness visitor experiences, and a set of recommendations to address heavily impacted campsites in wilderness.