GPs' perceptions of the service needs of South Asian people with chronic pain: a qualitative enquiry.

This qualitative study describes GPs' experiences of and needs for management of people from a South Asian community who have chronic pain. Semi-structured interviews were conducted with 18 GPs from practices in two PCTs in Leicester. The data was analysed using grounded theory. The results indicate that managing patients from a South Asian community with chronic pain can be challenging due to differing pain expression and presentation. Emerging themes refer to shortages of services for these patients including the need for CBT, counselling, community support and GP education and training. Potential implications of the results for service provision are discussed.

An inverted continental Moho and serpentinization of the forearc mantle.

Volatiles that are transported by subducting lithospheric plates to depths greater than 100 km are thought to induce partial melting in the overlying mantle wedge, resulting in arc magmatism and the addition of significant quantities of material to the overlying lithosphere. Asthenospheric flow and upwelling within the wedge produce increased lithospheric temperatures in this back-arc region, but the forearc mantle (in the corner of the wedge) is thought to be significantly cooler. Here we explore the structure of the mantle wedge in the southern Cascadia subduction zone using scattered teleseismic waves recorded on a dense portable array of broadband seismometers. We find very low shear-wave velocities in the cold forearc mantle indicated by the exceptional occurrence of an 'inverted' continental Moho, which reverts to normal polarity seaward of the Cascade arc. This observation provides compelling evidence for a highly hydrated and serpentinized forearc region, consistent with thermal and petrological models of the forearc mantle wedge. This serpentinized material is thought to have low strength and may therefore control the down-dip rupture limit of great thrust earthquakes, as well as the nature of large-scale flow in the mantle wedge.

Fluid processes in subduction zones.

Fluids play a critical role in subduction zones and arc magmatism. At shallow levels in subduction zones (<40 kilometers depth), expulsion of large volumes of pore waters and CH(4)-H(2)O fluids produced by diagenetic and low-grade metamorphic reactions affect the thermal and rheological evolution of the accretionary prism and provide nutrients for deep-sea biological communities. At greater depths, H(2)O and CO(2) released by metamorphic reactions in the subducting oceanic crust may alter the bulk composition in the overlying mantle wedge and trigger partial melting reactions. The location and conse-quences of fluid production in subduction zones can be constrained by consideration of phase diagrams for relevant bulk compositions in conjunction with fluid and rock pressure-temperature-time paths predicted by numerical heat-transfer models. Partial melting of subducting, amphibole-bearing oceanic crust is predicted only within several tens of million years of the initiation of subduction in young oceanic lithosphere. In cooler subduction zones, partial melting appears to occur primarily in the overlying mantle wedge as a result of fluid infiltration.