Salt marshes are threatened by rising sea levels and human activities, and a major mechanism of marsh loss is edge retreat or erosion. To understand and predict loss in these valuable ecosystems, ...studies have related erosion to marsh hydrodynamics and wave characteristics such as wave power. Across global studies, erosion is reported to be largely linearly related to wave power, with this relationship having implications for the resilience of marshes to extreme events such as storms. However, there is significant variability in this relationship across marshes because of marsh heterogeneity and the uniqueness of each physical setting. Here, we investigate the results of individual studies throughout the world that report a linear relationship and add a new dataset from the Great Marsh in Massachusetts (USA). We find that most marsh wave power and erosion data are not normally distributed and when these datasets are properly plotted to account for their distributions, the resulting relationships vary from previously published curves. Our Great Marsh data suggest that events from specific wind directions can have an outsized impact on edge erosion due to their larger fetch and wind speeds. We also find that factors other than wave attack such as edge erosion along tidal channels, can have a measurable impact on retreat rates. We show the importance of maintaining statistical assumptions when performing regressions, as well as emphasize the site-specificity of these relationships. Without calibration of a marsh erosion-wave power relationship using robust regressions for each individual marsh, such a relationship is not fully constrained, resulting in unreliable predictions of future marsh resilience and response to climate change.
In mid-winter 2018, an unprecedented sediment deposition event occurred throughout portions of the Great Marsh in Massachusetts. Evaluation of this event in distinct marsh areas spanning three towns ...(Essex, Ipswich, and Newbury) revealed deposition covering 29.2 hectares with an average thickness of 30.1±2.1 mm measured shortly after deposition. While sediment deposition helps marshes survive sea level rise by building elevation, effects of such a large-scale deposition on New England marshes are unknown. This natural event provided an opportunity to study effects of large-scale sediment addition on plant cover and soil chemistry, with implications for marsh resilience. Sediment thickness did not differ significantly between winter and summer, indicating sediment is not eroding or compacting. The deposited sediment at each site had similar characteristics to that of the adjacent mudflat (e.g., texture, bivalve shells), suggesting that deposited materials resulted from ice rafting from adjacent flats, a natural phenomenon noted by other authors. Vegetative cover was significantly lower in plots with rafted sediment (75.6±2.3%) than sediment-free controls (93.1±1.6%) after one growing season. When sorted by sediment thickness categories, the low thickness level (1-19 mm) had significantly greater percent cover than medium (20-39 mm) and high (40-90 mm) categories. Given that sediment accretion in the Great Marsh was found to average 2.7 mm per year, the sediment thickness documented herein represents ~11 years of sediment accretion with only a 25% reduction in plant cover, suggesting this natural sediment event will likely increase long-term marsh resilience to sea level rise.
KW-2478 is a novel non-ansamycin Hsp90 inhibitor with modest single-agent activity in relapsed/refractory myeloma but which shows synergistic antimyeloma activity with bortezomib (BTZ) in preclinical ...studies. This study determined the safety, preliminary clinical activity, and pharmacokinetics of KW-2478, an Hsp90 inhibitor, in combination with BTZ in patients with relapsed/refractory multiple myeloma (MM).
Phase I dose escalation determined the recommended phase II dose (RP2D) of KW-2478 plus BTZ, which was then used during phase II.
The maximum tolerated dose was not reached during phase I and the RP2D was KW-2478 175 mg m
plus BTZ 1.3 mg m
on days 1, 4, 8, and 11 every 3 weeks. In the efficacy evaluable phase I/II population treated at the RP2D (n=79), the objective response rate was 39.2% (95% confidence interval: 28.4-50.9%), clinical benefit rate 51.9% (40.4-63.3%), median progression-free survival 6.7 (5.9-not reached (NR)) months, and median duration of response 5.5 (4.9-NR) months. In the phase I/II safety population (n=95), the most frequently observed treatment-related grade 3/4 adverse events were diarrhoea, fatigue, and neutropenia (each in 7.4% of patients), and nausea and thrombocytopenia (each in 5.3%).
KW-2478 plus BTZ was well tolerated with no apparent overlapping toxicity in patients with relapsed/refractory MM. The antimyeloma activity of KW-2478 in combination with BTZ as scheduled in this trial appeared relatively modest; however, the good tolerability of the combination would support further exploration of alternate dosing schedules and combinations.
Introduction
Prevalence of anxiety disorders in coronary artery disease reaches up to 15% and about half of patients with coronary artery disease have anxiety or depression comorbidity. Prevalence of ...anxiety in patients undergoing percutaneous coronary intervention ranges from 24% to 72%. Anxiety can be the source of distress and is associated with poor prognosis, impaired health-related quality of life and can cause cardiac dysfunction.
Objectives
We aimed to determine the prevalence of anxiety and its association to coping strategies and personality traits in non-depressed patients undergoing elective coronary angiography, a diagnostic procedure for coronary artery disease. We also aimed to determine the correlation of state anxiety to elective coronary angiography finding and its expression over time.
Methods
This was a single-center, cross-sectional, prospective study. Anxiety was evaluated at four-time points using self-rating questionnaires: 14 days prior to and 2–4h before procedure; 24h after procedure and 6 weeks after discharge. The association between anxiety and psychological variables was assessed by multiple linear regression and by linear mixed effect model.
Results
A total of 259 non-depressed patients were included in the final analysis (median age 65, 32% were female). Prevalence of anxiety was 35% and was higher in patients with avoidance-oriented coping style (
p
<0.001), meanwhile low neuroticism (
p
<0.001) and extrovertive personality trait (p=0.032) were protective factors. Patients that had no intervention (
p
=0.022) or had percutaneous coronary intervention (
p
=0.010) during elective coronary angiography, had lower anxiety than patients in need for coronary artery bypass graft surgery.
Conclusions
Personality traits emotional stability and extroversion are protective factors against anxiety. More than one third of patients experienced clinically significant anxiety before procedure. Our results suggest that recognising anxiety in patients undergoing elective coronary angiography is important. Further on, application of effective interventions for reducing/treating anxiety before or after procedure is needed.
Disclosure of Interest
None Declared
Increasing the protection of coastal vegetated ecosystems has been suggested as one strategy to compensate for increasing carbon dioxide (CO₂) in the atmosphere as the capacity of these habitats to ...sequester and store carbon exceeds that of terrestrial habitats. Seagrasses are a group of foundation species that grow in shallow coastal and estuarine systems and have an exceptional ability to sequester and store large quantities of carbon in biomass and, particularly, in sediments. However, carbon stocks (Corg stocks) and carbon accumulation rates (Corg accumulation) in seagrass meadows are highly variable both spatially and temporally, making it difficult to extrapolate this strategy to areas where information is lacking. In this study, Corg stocks and Cxorg accumulation were determined at 11 eelgrass meadows across New England, representing a range of eutrophication and exposure conditions. In addition, the environmental factors and structural characteristics of meadows related to variation in Corg stocks were identified. The objectives were accomplished by assessing stable isotopes of δ¹³C and δ¹⁵N as well as %C and %N in plant tissues and sediments, measuring grain size and 210 Pb of sediment cores, and through assessing site exposure. Variability in Corg stocks in seagrass meadows is well predicted using commonly measured environmental variables such as grain size distribution. This study allows incorporation of data and insights for the northwest Atlantic, where few studies on carbon sequestration by seagrasses have been conducted.
The clinical outcome of seven patients who underwent reconstruction of long upper- and lower-extremity peripheral nerve gaps with interposition peripheral nerve allografts is reported. Patients were ...selected for transplantation when the nerve gaps exceeded the length that could be reconstructed with available autograft tissue. Before transplantation, cadaveric allografts were harvested and preserved for 7 days in University of Wisconsin Cold Storage Solution at 5 degrees C. In the interim, patients were started on an immunosuppressive regimen consisting of either cyclosporin A or tacrolimus (FK506), azathioprine, and prednisone. Immunosuppression was discontinued 6 months after regeneration across the allograft(s) was evident. Six patients demonstrated return of motor function and sensation in the affected limb, and one patient experienced rejection of the allograft secondary to subtherapeutic immunosuppression. In addition to providing the ability to restore nerve continuity in severe extremity injuries, successful nerve allografting protocols have direct applicability to composite tissue transplantation.
Combining the strengths of physical activity (PA) diaries and questionnaires may be needed to improve the unsatisfying measurement quality of existing PA questionnaires. This study investigated the ...construct validity of a short PA questionnaire (Physical Activity Questionnaire for 24 h PAQ24) with a recall period of one day.
In this cross-sectional study, participants completed the PAQ24 on seven consecutive days while wearing an accelerometer (GENEActiv). Thereafter, the Global Physical Activity Questionnaire (GPAQ) was completed. Spearman correlation coefficients and Bland-Altman analysis were used to assess construct validity.
Overall, 50 active adults (11 women, mean age = 25.1 ± 2.5) participated. Relative agreements between Total PA of PAQ24 and accelerometer were 0.37 ≤ ρ ≤ 0.72 for each day with satisfying agreement on five out of seven days. Weekly relative agreement for Total PA was moderate (ρ = 0.44). Relative agreements between PAQ24 and GPAQ were ρ = 0.43 for Total PA. Daily and weekly absolute agreements were poor indicated by wide limits of agreement.
In contrast to weekly Total PA, the majority of daily results of the PAQ24 showed satisfying construct validity. A short recall period may improve the measurement quality of PA questionnaires, but measurement errors and the costs of multiple administrations must be considered in future studies.
The increased incidence and geographic expansion of Lyme disease has made it the most common vector-borne infection in North America. Posttreatment Lyme disease syndrome (PTLDS) represents a subset ...of patients who remain ill following standard antibiotic therapy for Lyme disease. The spectrum of symptoms and their impact on quality of life remain largely unexplored among patients with well-documented PTLDS.
To characterize a case series of patients with well-documented PTLDS compared to a sample of healthy controls.
Sixty-one participants met the proposed case definition for PTLDS. Twenty-six healthy controls had neither a clinical history of Lyme disease nor current antibodies to
. Participants with PTLDS and controls were evaluated by physical exam, clinical laboratory testing, standardized questionnaires, and a 36-item current symptom list.
Compared to controls, participants with PTLDS reported significantly greater fatigue, pain, sleep disturbance, and depression (Fatigue Severity Scale: 50.0 ± 10.6 vs. 19.8 ± 8.6; Short-Form McGill Pain Questionnaire: 13.7 ± 8.3 vs. 0.8 ± 1.9; Pittsburgh Sleep Quality Index: 10.1 ± 4.7 vs. 4.1 ± 2.1; Beck Depression Inventory-II: 15.1 ± 7.7 vs. 2.2 ± 3.2;
< 0.001 for each), and significantly lower quality of life (SF-36 Physical Component Score: 33.9 ± 9.7 vs. 55.1 ± 6.2; Mental Component Score: 42.9 ± 10.1 vs. 54.2 ± 5.4;
< 0.001 for each). Nineteen non-PTLDS-defining symptoms were found to be significantly more severe among participants with PTLDS than controls, including sleep difficultly and visual complaints. Initial delayed or misdiagnosis was characterized in 59.0% of participants with PTLDS, and 32.2% had abnormal vibratory sense.
Although physical exam and clinical laboratory tests showed few objective abnormalities, standardized symptom questionnaires revealed that patients with PTLDS are highly and clinically significantly symptomatic, with poor health-related quality of life. PTLDS patients exhibited levels of fatigue, musculoskeletal pain, sleep disturbance, and depression which were both clinically relevant and statistically significantly higher than controls. Our study shows that PTLDS can be successfully identified using a systematic approach to diagnosis and symptom measurement. As the prevalence of PTLDS continues to rise, there will be an increased need for physician education to more effectively identify and manage PTLDS as part of integrated patient care.
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