Here, we examine the effect of long-term pH differences and short-term pH change on N₂O emissions from soil, and the microbial source (ammonia oxidation versus denitrification) of ¹⁵N-N₂O emissions. ...¹⁵N-fertiliser (20 g N m⁻²; 10 atom% excess ¹⁵N) was applied to (1) a silt loam soil of pH 7 held at 50% and 65% water-filled pore space (WFPS) (experiment 1) and (2) a loamy sand soil maintained at pH 4.5 and pH 7 for over 40 years (experiment 2). Soils were limed with CaCO₃ or acidified with H₂SO₄, and comparisons were made with unadjusted soils. Ammonia oxidation was the main microbial source of ¹⁵N-N₂O in soils limed to pH 7.0-8.1, unadjusted pH 7.1 (Experiment 1) and long-term pH 7 (experiment 2) soils. Eighty percent of ¹⁵N-N₂O from the long-term pH 4.5 soil (experiment 2) was derived from denitrification suggesting a possible inhibition of N₂O reduction. Short-term acidification to pH 5.6 or 4.3 lowered N₂O emissions. Liming of the pH 4.5 soil resulted in over four times greater N₂O emission (11 mg ¹⁴⁺¹⁵N-N₂O m⁻² over 41 days) than from the long-term pH 7.0 soil (experiment 2), with an associated increase in ammonia oxidiser-N₂O and decrease in denitrifier-N₂O production. This is the first report of a pH-induced change in microbial source of N₂O. Our results highlight the importance of distinguishing between short- and long-term effects of pH management when predicting N₂O emissions from soil, as they exhibit predominance of different microbial groups in N₂O production, with likely adaptation of the microbial community.
Electrodiagnostic evaluations are commonly requested for patients with suspected radiculopathy. Understanding lower extremity musculoskeletal conditions is essential for electrodiagnostic medicine ...specialists, as musculoskeletal disorders often mimic or coexist with radiculopathy. This review delineates radicular pain from other types originating from the lumbosacral spine and describes musculoskeletal conditions frequently mimicking radiculopathy, such as those that cause radiating pain and sensorimotor dysfunction. In clinical evaluation, a history of pain radiating along a specific dermatomal territory with associated sensory disturbance suggests radiculopathy. Physical examination findings consistent with radiculopathy include myotomal weakness, depressed or absent muscle stretch reflexes, focal atrophy along a discrete nerve root territory, and potentially positive dural tension maneuvers like the straight leg raise. However, electrodiagnostic medicine specialists must be knowledgeable of musculoskeletal mimics, which may manifest as incomplete radiation within or beyond a dermatomal territory, non-radiating pain, tenderness, and give-way weakness, in the context of a normal neurological examination. A systematic approach to musculoskeletal examination is vital, and this review focuses on high-yield physical examination maneuvers and diagnostic investigations to differentiate between musculoskeletal conditions and radiculopathy. This approach ensures accurate diagnoses, promotes resource stewardship, enhances patient satisfaction, and optimizes care delivery. Musculoskeletal conditions resembling L1 to S4 radiculopathy are reviewed, emphasizing their distinctive features in history, physical examination, and diagnostic investigation. Among the more than 30 musculoskeletal disorders reviewed are hip and knee osteoarthritis, lumbar facet syndrome, myofascial pain syndrome, greater trochanteric pain syndrome, and plantar fasciitis.
ABSTRACTResearch training equips residents with the skills to consume and produce research evidence and deliver evidence-based care. Within Physical Medicine and Rehabilitation, studies have ...historically demonstrated low rates of resident research productivity. Although Canadian residency requirements mandate research participation, little is known about Canadian residents’ research productivity. Using standard systematic review search strategies, we evaluated the rate and type of peer-reviewed publications produced by resident physicians during postgraduate medical training for a historic cohort of Physical Medicine and Rehabilitation residents who successfully passed the Canadian Royal College Fellowship examination in 2015, 2016, and 2017 (N = 74). Resident physicians produced 62 peer-reviewed publications during the study period. A total of 43.2% of resident physicians produced at least one such publication and 20.3% produced more than one. The resident physician was the first author for 51.6% of publications. Reviews were the most frequent publication type (19.4%), followed by observational studies (16.1%) and case reports (16.1%). Musculoskeletal conditions (11.3%) and stroke (9.7%) were the most frequent areas of study. Most publications were in nonrehabilitation journals. These findings demonstrate modest research productivity despite mandatory research participation; although research productivity is higher than in previous cohorts, publications of convenience, such as reviews and case reports, are similarly frequent.
Burnout, a state of emotional exhaustion related to work or patient-care activities, is prevalent in all stages of medical training and clinical practice. The syndrome has serious consequences, ...including medical errors, poorer quality of care, substance abuse, and suicide. The aim of this study is to evaluate the prevalence of burnout in Physical Medicine and Rehabilitation (PMandR) specialists and trainees.
Systematic literature searches were conducted in MEDLINE, CINAHL and EMBASE for peer-reviewed articles in English before March 2019 about the prevalence of burnout amongst PMandR specialists and trainees.
This systematic review yielded 359 results. Of these, 33 full-text records were reviewed; 5 met the inclusion criteria: 3 surveys of PMandR specialists and 2 of PMandR residents (total n?=?1,886 physicians; year of publication 20122019). Data extracted included prevalence and severity of burnout and, if available, risk or protective factors. Data were analysed using descriptive statistics. Incidence of burnout ranged from 22.2% to 83.3% in trainees and 48% to 62% in specialists. Organizational and system challenges were the primary risk factors for burnout amongst specialists.
Emerging evidence positions physicians in PMandR among the most likely to experience burnout. Although there is limited literature regarding PMandR specialists and trainees, the available evidence suggests that more than half of physicians in PMandR experience burnout.
Abstract Electrodiagnostic evaluation is often requested for persons with peripheral nerve injuries and plays an important role in their diagnosis, prognosis, and management. Peripheral nerve ...injuries are common and can have devastating effects on patients' physical, psychological, and socioeconomic well‐being; alongside surgeons, electrodiagnostic medicine specialists serve a central function in ensuring patients receive optimal treatment for these injuries. Surgical intervention—nerve grafting, nerve transfers, and tendon transfers—often plays a critical role in the management of these injuries and the restoration of patients' function. Increasingly, nerve transfers are becoming the standard of care for some types of peripheral nerve injury due to two significant advantages: first, they shorten the time to reinnervation of denervated muscles; and second, they confer greater specificity in directing motor and sensory axons toward their respective targets. As the indications for, and use of, nerve transfers expand, so too does the role of the electrodiagnostic medicine specialist in establishing or confirming the diagnosis, determining the injury's prognosis, recommending treatment, aiding in surgical planning, and supporting rehabilitation. Having a working knowledge of nerve and/or tendon transfer options allows the electrodiagnostic medicine specialist to not only arrive at the diagnosis and prognosticate, but also to clarify which nerves and/or muscles might be suitable donors, such as confirming whether the branch to supinator could be a nerve transfer donor to restore distal posterior interosseous nerve function. Moreover, post‐operative testing can determine if nerve transfer reinnervation is occurring and progress patients' rehabilitation and/or direct surgeons to consider tendon transfers.
Conferences are important platforms for sharing research, but full-text publication is necessary for broader dissemination and impact. Few studies have examined the abstract-to-publication rate for ...physical medicine and rehabilitation. This study aimed to determine the abstract-to-publication rate of research abstracts presented from 2009-2018 at the Canadian Association of Physical Medicine and Rehabilitation annual scientific meetings. Using the official book of abstracts from 2009 to 2018, year of conference, abstract title, author names, and the affiliation/level of training of the first author were extracted. Systematic searches of abstract key words, authors' names, and the abstract title were performed using PubMed and Google Scholar to determine whether an abstract proceeded to full-text publication; if so, the date and journal of publication were extracted. Of the 524 total abstracts presented at the Canadian Association of Physical Medicine and Rehabilitation from 2009 to 2018, 187 went on to full-text publication for an abstract-to-publication rate of 35.8%. The mean time to full-text publication was 23.4 ± 8.63 mos. The abstract-to-publication rate was 18.6% for medical students, 28.7% for residents, 41.1% for physical medicine and rehabilitation consultants, and 49.4% for nonphysician presenters. This study highlights that low abstract-to-publication rates for novel research presented at the Canadian Association of Physical Medicine and Rehabilitation disproportionately affects trainees. Further research is needed to identify and remedy barriers to publication.
Cytotoxicity (i.e. cell death) is the core mechanism by which chemotherapy induces its anti-cancer effects. Unfortunately, this same mechanism underpins the collateral damage it causes to healthy ...tissues. The gastrointestinal tract is highly susceptible to chemotherapy's cytotoxicity, resulting in ulcerative lesions (termed gastrointestinal mucositis, GI-M) that impair the functional capacity of the gut leading to diarrhea, anorexia, malnutrition and weight loss, which negatively impact physical/psychological wellbeing and treatment adherence. Preventing these side effects has proven challenging given the overlapping mechanisms that dictate chemotherapy efficacy and toxicity. Here, we report on a novel dietary intervention that, due to its localized gastrointestinal effects, is able to protect the intestinal mucosal from unwanted toxicity without impairing the anti-tumor effects of chemotherapy. The test diet (containing extensively hydrolyzed whey protein and medium chain triglycerides (MCTs)), was investigated in both tumor-naïve and tumor-bearing models to evaluate its effect on GI-M and chemo-efficacy, respectively. In both models, methotrexate was used as the representative chemotherapeutic agent and the diet was provided ad libitum for 14 days prior to treatment. GI-M was measured using the validated biomarker plasma citrulline, and chemo-efficacy defined by tumor burden (cm
/g body weight). The test diet significantly attenuated GI-M (P = 0.03), with associated reductions in diarrhea (P < 0.0001), weight loss (P < 0.05), daily activity (P < 0.02) and maintenance of body composition (P < 0.02). Moreover, the test diet showed significant impact on gut microbiota by increasing diversity and resilience, whilst also altering microbial composition and function (indicated by cecal short and brained chain fatty acids). The test diet did not impair the efficacy of methotrexate against mammary adenocarcinoma (tumor) cells. In line with the first model, the test diet minimized intestinal injury (P = 0.001) and diarrhea (P < 0.0001). These data support translational initiatives to determine the clinical feasibility, utility and efficacy of this diet to improve chemotherapy treatment outcomes.
Post-traumatic headache (PTH) is a disabling headache disorder and the most common sequela of mild traumatic brain injury. The pathophysiology of PTH is poorly understood and there is limited ...available evidence to guide prophylactic medication selection. Emerging understanding of the pathophysiology of migraine headaches has led to the development of monoclonal antibodies, including erenumab. Erenumab has shown promise for the prevention of primary migraine headache; however, it has not yet been studied in PTH.
five women (average age 43.0 ± 17.9y) received treatment with erenumab for PTH secondary to mTBI. The average duration of PTH prior to starting erenumab was 32.0 ± 18.2 months. All patients were taking at least one daily headache prophylactic therapy prior to erenumab. The average pre-erenumab headache intensity was 86/100. On erenumab, the average reported reduction in headache intensity was 51.1%. After starting erenumab, all five patients were able to discontinue one or more medication(s). The most common side effect was constipation (three patients). There were no serious adverse events after an average follow-up of 3.4 ± 1.5 months. One patient discontinued erenumab during this period of follow-up after the resolution of her headaches.
Erenumab appears to be safe and effective for the management of PTH.
Purpose
The aim of this study was to update the clinical practice guidelines for the use of agents for the prevention and/or treatment of gastrointestinal mucositis (GIM).
Methods
A systematic review ...was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: Recommendation, Suggestion, and No Guideline Possible.
Results
A total of 78 papers across 13 interventions were examined of which 25 were included in the final review. No new guidelines were possible for any agent due to inadequate and/or conflicting evidence. Existing guidelines for probiotics and hyperbaric oxygen were unchanged.
Conclusions
Of the agents studied for the prevention and treatment of GIM, the evidence continues to support use of probiotics containing
Lactobacillus
spp. for prevention of chemoradiotherapy and radiotherapy-induced diarrhea in patients with pelvic malignancy, and hyperbaric oxygen therapy to treat radiation-induced proctitis. Additional well-designed research is encouraged to enable a decision regarding palifermin, glutamine, sodium butyrate, and dietary interventions, for the prevention or treatment of GIM.
Standardization of first principles has transformed stroke rehabilitation in developed countries and helped guide the appropriate allocation of resources to ensure better outcomes for patients. There ...have been challenges in incorporating new evidence into stroke rehabilitation practices. The sheer number of RCTs can be daunting to the average clinician, made worse by the lack of a framework for their application.
To develop a framework for the introduction of adjunct practices for the motor recovery of the upper extremity post stroke into clinical practice.
A literature search following PRISMA guidelines revealed 1,307 RCTs involving rehabilitation interventions for the hemiparetic upper extremity post stroke.
Therapies were divided into three categories of therapies: (1) Basic Conventional Therapy Approaches (<15% of interventions), (2) Adjunct Therapies Designed to Enhance Conventional Therapies (>85% of interventions), and (3) Treatment to Manage Complications (~9% of interventions). Adjunct Therapies, despite having a spectacular evidence base, are often not employed clinically. To encourage their clinical use, we have developed a framework that divides adjunct therapies into two categories: (1) Treatments that Stimulate the Brain (i.e. rTMS, mental practice, and virtual reality) and (2) Treatments that Peripherally Facilitate the Hemiparetic Upper Extremity (i.e. robotics, EMG Biofeedback, and Constraint-induced Movement Therapy).
To allow stroke rehabilitation to continue to improve upper extremity recovery and outcomes, we propose a new intuitive framework that is based on a strong evidence base to guide clinicians and improve stroke rehabilitation.
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