Kyphoplasty for the Treatment of Pain Distant to Osteoporotic Thoracolumbar Compressive Fractures

Vertebral fractures are one of the most common osteoporotic fractures. We sought to investigate the incidence of distant pain after osteoporotic vertebral compressive fracture (OVCF) at the thoracolumbar junction, and to explore the effect of kyphoplasty in the treatment of distant pain post-OVCF. Eighty-seven patients diagnosed OVCF between T11 and L2 were included in the study. The region of pain and its proximity to the thoracolumbar compressive fracture was recorded. For pain management, all patients received kyphoplasty. The follow-up period was every 3 months for 1-year post-surgery. The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used pre-operatively, post-operatively, and at 3-, 6-, and 12-month follow-ups to assess patient status. All patients completed the operation, with 72 patients having focal pain over the compression fracture. Eleven cases also had pain distal to the fracture region in the following areas: lower back, near the iliac crest (n = 6), the groin (n = 3), and the trochanteric region (n = 2). Four cases had pain in distant to the fracture: lower back, near iliac crest (n = 3), and the trochanteric region (n = 1). All patients had a significant improvement in clinical symptoms. The average VAS and the ODI decreased significantly pre-operatively to post-operatively (p < 0.05). In addition to focal tenderness, many patients with thoracolumbar compression fractures may have pain distant to the fracture. This can be successfully treated using kyphoplasty. This phenomenon also indicates that patients at risk of osteoporosis who also have lower back pain should not neglect the potential for a thoracolumbar fracture.     

The impact of wool in the patients with chronic non-specific low back pain

The aim was to assess the effect of wool underwear use in patients with chronic non specific low back pain. The study employed two-group, experimental design. A total of 48 patients with chronic non specific low back pain were selected for the study. They were distributed into two groups: a control group and a treatment group. The 24 patients in each group were randomly selected and the compositions of the two groups. The patients in the treatment group wore woolen underwear during the experimental period of 2 month. All patients were assessed at the beginning the trial (pre-test) and the end of 8th (post-test) week. Data were collected using the visual analogue pain scale, Oswestry Disability Index and Schober test measurements. Patients in the treatment group reported significant improvements in their conditions including a reduction in pain levels and Oswestry Disability Index, and Schober test measurements increased (p<0.001). Patients with chronic non-specific low back pain who wore wool underwear experienced significant improvements in pain intensity, disability, and lower back flexibility.     

Soil geochemistry confines microbial abundances across an arctic landscape; implications for net carbon exchange with the atmosphere

A large portion of the World’s terrestrial organic carbon is stored in Arctic permafrost soils. However, due to permafrost warming and increased in situ microbial mineralisation of released carbon, greenhouse gas releases from Arctic soils are increasing, including methane (CH_4(g)). To identify environmental controls on such releases, we characterised soil geochemistry and microbial community conditions in 13 near-surface Arctic soils collected across Kongsfjorden, Svalbard. Statistically significant correlations were found between proxies for carbonate mineral content (i.e. Ca and Mg) and soil pH (Spearman rho = 0.87, p < 0.001). In turn, pH significantly inversely correlated with bacterial and Type I methanotroph gene abundances across the soils (r = ?0.71, p = 0.01 and r = ?0.74, p = 0.006, respectively), which also co-varied with soil phosphorous (P) level (r = 0.79, p = 0.01 and r = 0.63, p = 0.02, respectively). These results suggest that soil P supply, which is controlled by pH and other factors, significantly influences in situ microbial abundances in these Arctic soils. Overall, we conclude microbial responses to increasing ‘old carbon’ releases in this Arctic region are constrained by nutrient-deficiency in surface soils, with consequential impacts on the flux and composition of carbon gasses released to the atmosphere.     

Characterization of RNA isolated from eighteen different human tissues: results from a rapid human autopsy program

Many factors affect the integrity of messenger RNA from human autopsy tissues including postmortem interval (PMI) between death and tissue preservation and the pre-mortem agonal and disease states. In this communication, we describe RNA isolation and characterization of 389 samples from 18 different tissues from elderly donors who were participants in a rapid whole-body autopsy program located in Sun City, Arizona (www.brainandbodydonationprogram.org). Most tissues were collected within a PMI of 2–6 h (median 3.15 h; N = 455), but for this study, tissue from cases with longer PMIs (1.25–29.25 h) were included. RNA quality was assessed by RNA integrity number (RIN) and total yield (ng RNA/mg tissue). RIN correlated with PMI for heart (r = ?0.531, p = 0.009) and liver (r = ?558, p = 0.0017), while RNA yield correlated with PMI for colon (r = ?485, p = 0.016) and skin (r = ?0.460, p = 0.031). RNAs with the lowest integrity were from skin and cervix where 22.7 and 31.4 % of samples respectively failed to produce intact RNA; by contrast all samples from esophagus, lymph node, jejunum, lung, stomach, submandibular gland and kidney produced RNA with measurable RINs. Expression levels in heart RNA of 4 common housekeeping normalization genes showed significant correlations of Ct values with RIN, but only one gene, glyceraldehyde-3 phosphate dehydrogenase, showed a correlation of Ct with PMI. There were no correlations between RIN values obtained for liver, adrenal, cervix, esophagus and lymph node and those obtained from corresponding brain samples. We show that high quality RNA can be produced from most human autopsy tissues, though with significant differences between tissues and donors. The RNA stability and yield did not depend solely on PMI; other undetermined factors are involved, but these do not include the age of the donor.     

Knee Pain and Low Back Pain Additively Disturb Sleep in the General Population: A Cross-Sectional Analysis of the Nagahama Study

Introduction

Association of knee and low back pain with sleep disturbance is poorly understood. We aimed to clarify the independent and combined effects of these orthopedic symptoms on sleep in a large-scale general population.

Methods

Cross-sectional data about sleep and knee/low back pain were collected for 9,611 community residents (53±14 years old) by a structured questionnaire. Sleep duration less than 6 h/d was defined as short sleep. Sleep quality and the presence of knee and low back pain were evaluated by dichotomous questions. Subjects who complained about knee or low back pains were graded by tertiles of a numerical response scale (NRS) score and a Roland-Morris disability questionnaire (RDQ) score respectively. Multivariate regression analyses were performed to determine the correlates of short sleep duration and poor sleep quality.

Results

Frequency of participants who complained of the orthopedic symptoms was as follows; knee pain, 29.0%; low back pain, 42.0% and both knee and low back pain 17.6%. Both knee and low back pain were significantly and independently associated with short sleep duration (knee pain: odds ratio (OR) = 1.19, p<0.01; low back pain: OR = 1.13, p = 0.01) and poor sleep quality (knee pain: OR = 1.22, p<0.01; low back pain; OR = 1.57, p<0.01). The group in the highest tertile of the NRS or RDQ score had the highest risk for short sleep duration and poor sleep quality except for the relationship between the highest tertile of the RDQ score and short sleep duration.(the highest tertile of the NRS: OR for short sleep duration = 1.31, p<0.01; OR for poor sleep quality = 1.47, p<0.01; the highest tertile of the RDQ: OR for short sleep duration = 1.11, p = 0.12; OR for poor sleep quality = 1.81, p<0.01) Further, coincident knee and low back pain raised the odds ratios for short sleep duration (either of knee or low back pain: OR = 1.10, p = 0.06; both knee and low back pain: OR = 1.40, p<0.01) and poor sleep quality (either of knee or low back pain: OR = 1.61, p<0.01; both knee and low back pain: OR = 2.17, p<0.01).

Conclusion

Knee and low back pains were independently associated with short sleep duration and poor sleep quality. Further, they additively increased the correlation with these sleep problems in the general population.     

Level of Thyroid-Stimulating Hormone (TSH) in Patients with Acute Schizophrenia,Unipolar Depression or Bipolar Disorder

The aim of this study is to investigate differences in thyroid-stimulating hormone (TSH) level in patients with acute schizophrenia, unipolar depression, bipolar depression and bipolar mania. Serum level of TSH was measured in 1,685 Caucasian patients (1,064 women, 63.1 %; mean age 46.4). Mean serum TSH concentration was: schizophrenia (n = 769) 1.71 μIU/mL, unipolar depression (n = 651) 1.63 μIU/mL, bipolar disorder (n = 264) 1.86 μIU/mL, bipolar depression (n = 203) 2.00 μIU/mL, bipolar mania (n = 61) 1.38 μIU/mL (H = 11.58, p = 0.009). Depending on the normal range used, the overall rate of being above or below the normal range was 7.9–22.3 % for schizophrenia, 13.9–26.0 % for unipolar depression, 10.8–27.6 % for bipolar disorder, 12.2–28.5 % for bipolar depression, and 11.4–24.5 % for bipolar mania. We have also found differences in TSH levels between the age groups (≤20, >20 years and ≤40, >40 years and ≤60 years and >60 years). TSH level was negatively correlated with age (r = ? 0.23, p < 0.001). Weak correlations with age have been found in the schizophrenia (r = ? 0.21, p < 0.001), unipolar depression (r = ? 0.23, p < 0.001), bipolar depression (r = ? 0.25, p = 0.002) and bipolar disorder (r = ? 0.21, p = 0.005) groups. Our results confirm that there may be a higher prevalence of thyroid dysfunctions in patients with mood disorders (both unipolar and bipolar) and that these two diagnostic groups differ in terms of direction and frequency of thyroid dysfunctions.     

Cardiac Autonomic Function Associated with Treatment Adherence After a Brief Intervention in Patients with Chronic Pain

The goal of this study was to investigate psychophysiological characteristics in chronic pain patients during a pain stressor (cold pressor test) and after a brief diaphragmatic breathing intervention. Laboratory procedures were designed to quantify the effects of diaphragmatic breathing training at six breaths per minute on cardiac autonomic reactivity as indexed by root mean square of successive differences (RMSSD) and sequential baroreflex sensitivity (sBRS). Participants (n = 22) completed an initial laboratory assessment including the diaphragmatic breathing training session and were instructed to practice the technique for three ten-minute sessions daily. Self-monitoring of the use of the technique along with daily pain and fatigue scores was accomplished with hand-held computers. Participants returned to the lab for a second assessment after two-weeks. Participants demonstrating improved resting physiological status as indexed by change in RMSSD and sBRS after training (improvers) were compared to those not demonstrating any change in these variables (non-improvers). After two weeks of training, the improvers showed higher tolerance (p < .05) and lower blood pressure reactivity to the cold pressor test (p < .05) compared to the non-improvers. Time spent practicing the breathing technique was significantly different between the groups with the improvers maintaining daily practice close to the intervention recommendations. These results suggest the potential for significant improvements in autonomic functioning and inhibitory response to stress after a single intervention session and two weeks of practice.     

Application of two-parameter scoliometer values for predicting scoliotic Cobb angle

Background

Adolescent idiopathic scoliosis, in which obvious curves are visible in radiographic images, is also seen in combination with lumps in the back. These lumps contribute to inclination, which can be measured by a scoliometer. To the authors’ knowledge, there are no previous formulas combining thoracic and lumbar scoliometer values simultaneously to predict thoracic and lumbar Cobb angles, respectively. This study aimed to create more accurate two-parameter mathematical formulas for predicting thoracic and lumbar Cobb angles.

Methods

Between Dec. 2012 and Jan. 2013, patients diagnosed with idiopathic scoliosis in an outpatient clinic were enrolled. The maximal trunk rotations at the thoracic and lumbar regions were recorded with a scoliometer. Right asymmetry hump was deemed positive (+), and left asymmetry hump was deemed negative (?). The Cobb angles were measured with a Picture Archiving and Communication System. Statistical analysis included Pearson’s correlation coefficient, multivariate regression and Bland–Atman analysis.

Results

One-hundred and one patients were enrolled in our study. The average thoracic curve (TC) was 23.3 ± 1.8°, while the average lumbar curve (LC) was ? 23.3 ± 1.4°. The thoracic inclination (TI) and lumbar inclination (LI) were 4.5 ± 0.7 and ? 5.9 ± 0.6, respectively. The one-parameter formula for the thoracic curve was TC = 2.0 TI + 14.3 (r = 0.813); for the lumbar curve, it was LC = 0.9 LI ? 16.9 (r = 0.409). By multivariate regression, the two-parameter formulas for the thoracic and lumbar curves were TC = 2.6 TI ? 1.4 LI (r = 0.931) and LC = ? 1.5 TI + 2.0 LI (r = 0.874), respectively. The two-parameter formulas were more accurate than the one-parameter formulas.

Conclusions

Based on the results of these two-parameter formulas for thoracic and lumbar curves, the Cobb angles can be predicted more accurately by the readings of the scoliometer. Physicians and other healthcare practitioners can thus evaluate patients with scoliosis more precisely than before with a scoliometer.

     

Coping with shift work-related circadian disruption: A mixed-methods case study on napping and caffeine use in Australian nurses and midwives

ABSTRACT

Introduction: Two of the most ubiquitous fatigue countermeasures used by shift-working nurses are napping and caffeine. This mixed-methods case study investigated the ways nurses and midwives utilised napping and caffeine countermeasures to cope with shift work, and associated sleep, physical health and psychological health outcomes.

Materials and Methods: N = 130 Australian shift-working nurses and midwives (mean age = 44 years, range = 21–67, 115F, 15M) completed the Standard Shiftwork Index. A sub-set of 22 nurses and midwives completed an in-depth interview.

Results: Nearly 70% of participants reported napping. Those who napped during night shifts had significantly less total sleep time before (F_2,75 = 5.5, p < 0.01) and between days off (F_2,82 = 3.9, p < 0.05). By the end of the night shift, average hours of time awake were significantly less for prophylactic and on-shift nappers compared to non-nappers (F_2,85 = 97.2, p < 0.001). Since starting shift work, the percentage of high caffeine consumers (>400 mg/day) increased from 15% to 33% of the sample and an average of 4 (SD = 2) caffeinated beverages per day was reported. Increased caffeine consumption was associated with greater sleep disturbance (r = 0.26, p < 0.05), psychological distress (r = 0.37, p < 0.001), abdomen pain (r = 0.27, p < 0.05) and weight gain since starting shift work (r = 0.25, p < 0.05). Interviews confirmed these relationships and revealed that caffeine consumption on night shift was common, whereas napping on night shift was dependent on a number of factors including ability to sleep during the day.

Conclusion: This study identified reasons shift workers chose to engage in or abstain from napping and consuming caffeine, and how these strategies related to poor sleep and health outcomes. Further research is required to help develop recommendations for shift workers regarding napping and caffeine consumption as fatigue countermeasures, whilst taking into account the associated hazards of each strategy.     

Plasma Urotensin II Act as a Diagnostic Biomarker for Acute Coronary Syndromes

Urotensin II (U-II), one of powerful vasoconstrictor peptides, is involved in the pathogenesis of hypertension, diabetes, myocardial infarction and heart failure. However, its role in patients with acute coronary syndromes (ACS) is still unknown. We performed the present study to measure plasma U-II level in patients with ACS and the healthy subjects in the Chinese Han population. Plasma U-II level in patients with unstable angina (UA 313 ± 286 pg/dl) and acute myocardial infarction (AMI 333 ± 269 pg/dl) was higher than in healthy controls (183 ± 154 pg/dl). Plasma U-II level is positively correlated with the Gensini score (r = 0.285, P = 0.003) and Apo B level (r = 0.239, P = 0.015). Moreover, the area under the receiver operating characteristic curve for the combination of CRP and U-II was significantly higher than it for CRP (P = 0.024). We conclude that U-II, which is elevated in ACS patients, may act as a clinical non-invasive biomarker for ACS diagnosis.     

Expression of tumor necrosis factor-alpha and vascular endothelial growth factor in different zones of fetal membranes: a possible relation to onset of labor

This study aimed to explore whether the altered expression of tumor necrosis factor-alpha (TNF-α), vascular endothelial growth factor (VEGF) and apoptotic changes in mid zone (MZ) and rupture zone (RZ) of fetal membranes (FM) are regulatory mechanisms associated with labor at term. Fifteen FM specimens were collected after vaginal deliveries and 13 specimens after elective caesarian section. Histological and immunohistochemical analysis were employed. Area percent of TNF-α and VEGF immunostaining and apoptotic index (AI) were evaluated using image analysis. The statistical data revealed significantly higher area % for TNF-α, VEGF immunoexpression and AI in labor compared to non-labor specimens (p < 0.0001). There was a significantly higher percentage of TNF-α immunoexpressed area in MZ compared with RZ in both groups (p < 0.0001). VEGF expression in RZ of both groups proved nearly double or triple the area % of expression relative to MZ with highly significant difference (p < 0.0001). quantitative analysis revealed near two fold increase in the AI in RZ (13.42 % ± 1.2 in labor; 11.20 % ± 0.96 in non-labor groups) when compared to MZ (7.20 % ± 0.6 in labor; 5.08 % ± 0.76 in non-labor groups) with highly significant zonal difference (p < 0.0001). Correlation analysis revealed significant correlation between apoptotic indices and area % of TNF-α (r = 0.575, p = 0.002 in non-labor; r = 0.652, p < 0.0001 in labor) and VEGF (r = 0.795, p < 0.0001 in non-labor; r = 0.668, p < 0.0001 in labor). In conclusion, Apoptosis may be regulated by TNF-α and VEGF expression in FM at labor. MZ is a step back from RZ and could participate actively in rupture of the FM during labor. TNF-α and VEGF increase with onset of labor and differentially expressed in the RZ and the MZ. These findings call for further study with tissue cultures or animal models.     

Erythropoietin stimulates the coronary collateral development in patients with coronary chronic total occlusion

Objective

Erythropoietin (EPO) improves cardiac function and induces neovascularisation in post-myocardial infarction heart failure. The aim of this study was to analyse the association between the serum erythropoietin level and coronary collateral development in patients with coronary artery disease and chronic total occlusion.

Methods

A total of 168 patients consisting of 117 with coronary artery disease (CAD, (62 with chronic total occlusion (CTO), 55 without CTO)) and 51 with healthy coronary arteries were included in the study. The patients were assigned as coronary artery disease without CTO (group 0), CAD with CTO (group 1: poor collateral development, group 2: good collateral development) and normal coronary arteries (group 3).

Results

There was a significant positive correlation between serum EPO levels and the Rentrop scores in angiography (r = 0.243, p = 0.001). Similarly, a positive correlation was found between serum EPO levels and the Syntax scores (r = 0.253, p = 0.001). Echocardiography revealed a negative correlation between serum EPO levels and the cardiac ejection fraction (r = ?0.210, p = 0.006).

Conclusions

Serum EPO is a useful biomarker for coronary collateral development in patients with CTO.

     

Reduced expression of aquaporin 9 in tubal ectopic pregnancy

Previous studies demonstrate significant roles for passive water channels (aquaporins, AQPs) in maintaining water homeostasis in cell membranes of endometrial cells during decidualisation and embryo implantation. However, there is little information regarding the role of AQPs in the human fallopian tube, specifically their role in human tubal ectopic pregnancy. In this study we took tissue samples from the site of implantation of tubal ectopic pregnancy (group 1, N = 30, mean age 32 years, range 23–42) and the corresponding non-implantation site in women undergoing salpingectomy for tubal pregnancy (group 2). Ampullary fallopian tubes during mid-secretory phase were collected as control group (group 3, N = 17, mean age 37 years, range 30–50). Thin sections were prepared and stained with anti-AQP9, and, for estrogen and progesterone receptors in each group. Immunohistochemical studies showed that AQP9 proteins localize in the cytoplasm of epithelial cells of Fallopian tube. Expression of AQP9 was significantly reduced during tubal pregnancy compared to controls (group 1 vs. group 3, P = 0.036; group 2 vs. group 3, P = 0.029), and, this reduced expression was not related to estrogen receptor or progesterone receptor status (group 2, ER vs. AQP9, Pearson r = 0.173, P = 0.361; PR vs. AQP9, Pearson r = 0.124, P = 0.514, respectively). Similarly, there is no correlation between AQP9 and estrogen receptor or progesterone receptor status in the normal group (group 3, ER vs. AQP9, Pearson r = ?0.026, P = 0.923; PR vs. AQP9, Pearson r = ?0.292, P = 0.255, respectively). Reduced expression of AQP9 in human fallopian tube may contribute to aspects of pathophysiology of tubal ectopic pregnancy.     

Monitoring of spine curvatures and posture during pregnancy using surface topography – case study and suggestion of method

Background

Low back and pelvic pain is one of the most frequently reported disorders in pregnancy, however etiology and pathology of this problem have not been fully determined. The relationship between back pain experienced during pregnancy and posture remains unclear. It is challenging to measure reliably postural and spinal changes at the time of pregnancy, since most imaging studies cannot be used due to the radiation burden. 3D shape measurement, or surface topography (ST), systems designed for posture evaluation could potentially fill this void. A pilot study was conducted to test the potential of monitoring the change of spine curvatures and posture during pregnancy using surface topography. A single case was studied to test the methodology and preliminarily assess the usefulness of the procedure before performing a randomized trial. The apparatus used in this study was metrologically tested and utilized earlier in scoliosis screening.

Case presentation

The subject was measured using a custom-made structured light illumination scanner with accuracy of 0.2 mm. Measurement was taken every 2 weeks, between 17th and 37th week of pregnancy, 11 measurements in total. From the measurement the thoracic kyphosis and lumbar lordosis angles, and vertical balance angle were extracted automatically. Custom-written software was used for analysis. Oswestry Low Back Pain Disability Questionnaire (ODI) was done with every measurement. The values were correctly extracted from the measurement. The results were: 50.9 ± 2.4° for kyphosis angle, 58.1 ± 2.1° for lordosis angle and 4.7 ± 1.7° for vertical balance angle. The registered change was 7.4° in kyphosis angle, 8.4° in lordosis angle and 5.5° in vertical balance angle. The calculated ODI values were between moderate disability and severe disability (22 to 58 %).

Conclusions

This case study presents that surface topography may be suitable for monitoring of spinal curvature and posture change in pregnant women. The ionizing radiation studies are contraindicated during pregnancy. Surface topography data connected with information from pain level questionnaires allows to investigate the connection between changes in posture and back pain.

     

A Pilot Study of Audio–Visual Stimulation as a Self-Care Treatment for Insomnia in Adults with Insomnia and Chronic Pain

This pilot study tested the efficacy of an audio–visual stimulation (AVS) program for the promotion of sleep in individuals with chronic pain. Insomnia and chronic pain are common comorbid conditions and their relationship has been viewed as bidirectional. Recent studies suggest a relatively dominant role of sleep in this dyad. The premise of this pilot study was that AVS enhances low frequency while reducing high frequency brain activity resulting in decreased hyperarousal and improved sleep with potential consequent reduction in pain. We conducted a pilot intervention study of AVS using a pre–post design. Participants self-administered a 30-min AVS program nightly at bedtime for 1 month. Sleep and pain were assessed at baseline and at the conclusion of the 4-week intervention phase. Nine adults (mean age 33 ± 15.8 years; female, 89 %) completed the study. After using the AVS device for 4 weeks, significant improvement was seen in reported insomnia (ISI, p = 0.003), pain severity (BPI, p = 0.005), and pain interference with functioning (BPI, p = 0.001). Large effect sizes (Partial η² 0.20–0.94) (Cohen’s d 0.44–1.45) were observed. The results of this pilot study suggest that the AVS program may be efficacious in decreasing both insomnia and pain symptoms. In order to better assess the efficacy of AVS for sleep promotion and possible pain reduction, more definitive randomized controlled trials will be needed. These should include appropriate sample sizes, objective measures of sleep and pain, and longitudinal follow-up.     

Risk Factors and Outcomes of Invasive Fungal Infections in Allogeneic Hematopoietic Cell Transplant Recipients

Allogeneic hematopoietic cell transplant (HCT) recipients are at increased risk of invasive fungal infections (IFI), which are associated with a high mortality rate. We evaluated the impact of IFI in allogeneic HCT patients. In total, 541 consecutive allogeneic HCT recipients were included. The cumulative incidence of any IFI and mold infections at 1-year post-HCT was 10 and 7%, respectively. Median times to IFI and mold infection were 200 and 210 days, respectively. There was a trend toward fewer IFI and mold infections in the last several years. Both acute graft-versus-host disease (GVHD) (OR 1.83, p = 0.05) and corticosteroid duration (OR 1.0, p = 0.026) were significantly associated with increased risk of IFI, acute GVHD (OR 2.3, p = 0.027) emerged as the most important association with mold infections. Any IFI [HR 4.1 (2.79–6.07), p < 0.0001] and mold infections [HR 3.34 (2.1–5.1), p < 0.0001] were independently associated with non-relapse mortality (NRM). This association persisted in the setting of both acute and chronic GVHD. Corticosteroid treatment for >90 days was also significantly associated with higher NRM [HR 1.9 (1.3–2.6), p < 0.0001]. This study highlights the impact of IFI on NRM among HCT patients. The decrease in number of IFI and mold infections over the last several years may reflect the benefit of prophylaxis with mold-active antifungal agents.     

Preference for Outbreeding in Inbred Littledale’s Whistling Rats <Emphasis Type="Italic">Parotomys littledalei</Emphasis>

Inbreeding is sometimes tolerated in species occupying patchy, unpredictable habitats, when it becomes too costly to outbreed. Although traits leading to inbreeding depression may be selected against, the accumulation of deleterious alleles from constant inbreeding might promote outbreeding. Littledale’s whistling rat Parotomys littledalei occupies patchy habitats in arid western South Africa, and inbreeds in captivity without suffering inbreeding depression. We tested whether female whistling rats make different mate choice decisions based on their inbreeding status, by providing inbred and outbred females with male odours in four pairwise combinations: unrelated outbred (r = 0) versus either familiar littermate sibling (r = 0.5), half-sibling (r = 0.25), first cousin (r = 0.125), or unrelated inbred (r = 0). Inbred females generally preferred unrelated males, but did not show a preference between unrelated males and first cousins. In contrast, outbred females did not generally show a preference, but preferred first cousins to unrelated males. In breeding trials, reproductive success (output and viability of young) of outbred females paired with unrelated or related males was equally high, whereas inbred females suffered reduced reproductive success when paired with closely-related males. Our results indicate that the inbreeding status of female whistling rats influences their decision to outbreed or inbreed, which might influence their fitness. While outbred whistling rats do not suffer inbreeding depression, the costs of constant inbreeding could promote outbreeding by inbred females. We propose that the choice to inbreed or outbreed in female whistling rats depends on their inbreeding status and the genetic relatedness of available mates, with outbreeding more likely to occur unless unrelated mates are not available.     

Mercury concentrations in Irish headwater lake catchments

An estimated 215,000 tonnes of mercury (Hg) have been emitted to the atmosphere from anthropogenic sources since the nineteenth century, igniting widespread environmental monitoring owing to its toxicity. The environmental fate of Hg is strongly determined by catchment characteristics, especially soil organic matter. In this study, concentrations and pools of Hg were determined for lakes and soils in upland peat-dominated catchments in Ireland to assess controls of aquatic Hg and soil response to changes in emissions. Headwater lakes in upland coastal regions were surveyed for water chemistry and total Hg (THg) during spring 2008. In addition, a sub-set of lakes (n = 5) were repeatedly sampled during 2009–2011, and their surface soils collected for Hg analysis, including a short (30 cm) peat core to assess temporal Hg fluxes using radiometric ²¹⁰Pb dating. Peat cores indicated a significant decrease in Hg deposition since the 1980s, in broad agreement with other ‘background’ regions. Total Hg was correlated with total organic carbon (TOC) in the survey and intensive study lakes (r = 0.70 and 0.45), indicative of the strong affinity of Hg to organic matter. At the intensive lakes, monomethylmercury (MMHg) made up 3.3 % of mean THg and exhibited a positive correlation with total SO₄ ^2? (r = 0.55). Further, both THg and MMHg were significantly correlated with conductivity (r = 0.48 and 0.54, respectively) potentially owing to marine inputs, and negatively correlated with pH (r = ?0.59 and ?0.56 respectively). Significant differences in THg (and MMHg) were observed between the five lakes, the highest concentrations (4.45 and 0.16 ng L^?1, respectively) tended to be associated with TOC in lakes and occurred at sites in the northwest, characterized by higher levels of soil organic matter (peat) and soil moisture relative to the other sites. In contrast, surface soil pools of THg ranged between 13.6 and 20.8 μg m^?2 across study sites and did not vary significantly, but were typical of global background regions. Nonetheless, the organic rich soils that dominate Ireland are a natural sink for THg, and peat harvesting for energy production may release long-term stores of Hg from deeper soil layers.     

McMaster-Toronto Arthritis Patient Preference Disability Questionnaire sensitivity to change in low back pain: influence of shifts in priorities

Objective

To assess the sensitivity to change of the McMaster Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR) in chronic low back pain (CLBP) and shifts in patients'' priorities of disabling activities over time.

Methods

A prospective longitudinal survey of 100 patients (38 males) with CLBP in a tertiary care teaching hospital. Evaluation at baseline and 6 months by the MACTAR, Quebec Back Pain Disability Questionnaire (QUEBEC), Hospital Anxiety and Depression scale (HAD), Fear-Avoidance Beliefs Questionnaire (FABQ), Coping Strategies Questionnaire (CSQ), and pain and handicap visual analogue scales (VASs). Patients'' perceived improvement or worsening of condition was assessed at 6 months. Effect size (ES) and Standardized response mean (SRM) and effect size (ES) were used to evaluate sensitivity to change of the MACTAR.

Results

The MACTAR SRM and ES values (SRM = 0.25; ES = 0.37) were among the highest for the instruments evaluated. For patients considering their condition as improved, the SRM was 0.66 and the ES 1. The 3 disability domains, classified by the International Classification of Functioning, Disability and Health (ICF), most often cited as priorities at baseline remained the most cited at follow-up: mobility (40.9% of patients); community, social and civic life (22.7%); and domestic life (22.4%). At 6 months, 48 patients shifted their priorities, for a decrease in MACTAR SRM and ES values for patients considering their condition improved and an increase in these values for those considering their condition deteriorated.

Conclusions

Although the MACTAR has similar sensitivity to change as other outcome measures widely used in CLBP, shifts in patient priorities over time are common and influence scores and sensitivity to change.