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Context Although viral suppression rates have recently increased among people with HIV, specific populations still experience disparities in health outcomes, a priority in the national response to end the HIV epidemic. Purpose The end+disparities ECHO Collaborative, a quality improvement initiative among HIV providers in the United States from June 2018 to December 2019, created virtual communities of practice to measurably increase viral suppression rates in populations disproportionately affected by HIV: men who have sex with men of color, Black/African American and Latina women, youth aged 13 to 24 years, and transgender people. Methods Participating Ryan White HIV/AIDS Program-funded providers prioritized their improvement efforts to focus on one target population and joined virtual affinity sessions with other providers focused on that population for guidance by subject matter experts and exchanges with peer providers. During 9 submission cycles, providers reported their viral suppression data for the preceding 12 months. Main outcome measures The principal outcome measures were changes in viral suppression rates among 4 target populations and changes in viral suppression gaps compared with the rest of HIV-infected patients served by the same agency. Results A total of 90 providers were included in the data analyses with an average of 110 775 reported patients, out of which 19 442 represented the targeted populations. The average viral suppression rates for agency-selected populations increased from 79.2% to 82.3% (a 3.9% increase), while the remaining caseload increased at a lower rate from 84.9% to 86.1% (a 1.4% increase). The viral suppression gap was reduced from 5.7% to 3.8%, a 33.5% reduction. Improvements were found across all target populations. Conclusions The collaborative demonstrated improved health outcomes and reductions in HIV-related health disparities, moving toward ending the HIV epidemic. The model of utilizing low-cost videoconferencing technologies to create virtual communities of learning is well suited to mitigate other disease-related disparities, nationally and abroad.

Alaina N Elliott-Wherry,1 Jennifer E Lee,2 Amy M Pearlman,3 Terry L Wahls4 1Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA; 2College of Nursing, The University of Iowa, Iowa City, IA, USA; 3Department of Urology, University of Iowa Carver College of Medicine, Iowa City, IA, USA; 4Department of Internal Medicine-General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USACorrespondence: Alaina N Elliott-Wherry, 145 N Riverside Dr, Iowa City, IA, 52242, USA, Tel +1 319 480 8982, Email alaina-elliott@uiowa.eduAbstract: Behavior change models are used to understand and intervene on health-related behaviors and outcomes. However, there is a gap in the literature regarding how to create and maintain behavior change in patients with complex chronic diseases such as Multiple Sclerosis (MS). To address this gap, the Wahls Behavior ChangeTM Model (WBCM) (The trademark applies to subsequent mention of the model.) was developed based on existing behavior change theory, empirical evidence, and extensive clinical experience caring for patients with complex chronic diseases. A patient-centered, comprehensive, and multimodal approach, this model provides a framework for understanding and implementing lifestyle behavior change. The overall goals of this paper are to: (1) review existing behavior change theories; (2) introduce the WBCM, including the model’s 11 Principles for behavior change in patients with complex chronic diseases; and (3) share how providers can be trained to implement the WBCM. The WBCM can potentially improve short- and longer-term function and quality of life outcomes for people with complex chronic diseases.Keywords: multiple sclerosis, lifestyle medicine, chronic conditions, guidelines, health promotion, adherence

Purpose Some individuals with chronic pain find daily life sensations (eg, noise, light, or touch) aversive. This amplification of multisensory sensations has been associated with centrally mediated plasticity; for example, greater multisensory sensitivity (MSS) occurs in patients with fibromyalgia than rheumatoid arthritis. However, whether MSS preferentially relates to pain measures which reflect central influences (eg, dynamic quantitative sensory testing (QST) or referred pain), or whether the MSS-pain relationship requires priming from chronic pain, is unknown. Thus, this cross-sectional study investigated the relationships between MSS assessed in a pain-free state and evoked pain sensitivity. Methods Experimental intramuscular infusion pain and multiple static and dynamic QST were assessed in 465 healthy, pain-free adults: pain thresholds using pressure (PPTs) and heat (HPTs), temporal summation of pain (TSP) using pressure, heat or punctate stimuli, and conditioned pain modulation (CPM) using pressure or heat test stimuli. MSS was assessed using 7 items from Barsky's Somatosensory Amplification Scale. Differences in pain and QST between sex-specific MSS quartiles were assessed, adjusting for multiple comparisons. All participants completed at least one intramuscular infusion condition, but not all were asked to complete each QST (n=166-465). Results Both static and dynamic QST differed between highest and lowest MSS quartiles using pressure stimuli: lower PPTs (adjusted-p 0.05). Odds of experiencing TSP or referred pain was not greater, whereas CPM was 8-fold less likely, in those with highest MSS. Conclusion Normal variation in non-noxious MSS is related to both static and dynamic pain sensitivity, without sensitization associated with chronic pain, but is dependent on the QST stimulus. Thus, common influences on MSS and pain sensitivity may involve central mechanisms but are likely more complex than previously recognized.

Objectives To determine the relative effectiveness of this holistic approach on metastatic cancer, breast (BC), genitourinary (GU), gynecologic (GYN), and lung (LC) cancer survival rates were compared to those from a similar oncology study investigating the impact of patient symptom reporting. As a secondary outcome, survival for BC, GU, GYN, LC, pancreatic (PC), and colon (CC) cancer patients from one through five years after metastatic cancer diagnosis was compared to normative data from the Surveillance, Epidemiology, and End Results Program (SEER) database. Methods Survival for breast, genitourinary, gynecologic, and lung cancers at one through five years was compared to (1) similar data from an electronic symptom self-reporting study; and (2) normative data from the Surveillance, Epidemiology, and End Results Program (SEER) using estimated survival curves and 95 % confidence intervals. Results Charts for 104 patients with metastatic breast, genitourinary (bladder and kidney), gynecologic (endometrial and ovarian), lung (non-small cell), pancreatic, and colon cancers were analyzed, and survival calculated. When analyzing only breast, genitourinary, gynecologic, and lung cancers to rates from the comparable study, the clinic’s one-year survival was significantly higher than with the comparable data (80.8 % vs. 75.1 % respectively) evidenced by 95 % confidence intervals. Comparison of the current population data (including all cancer types) and normative SEER data rendered statistically significant results for survival at 1, 2, 3, 4, and 5 years, evidenced by 95 % confidence intervals. Conclusions The clinic data showed survival that was higher than the computerized symptom monitoring arm of current reported research. Additionally, it was further increased when compared to normative SEER data. This suggested that results produced by electronic platforms used in large academic settings can be successfully reproduced by community oncology practices through non-electronic approaches to active symptom management and shared decision-making.

To investigate the feasibility of a modified MCT-based ketogenic diet and its impact on plasma β-hydroxybutyrate and MS outcomes compared to a modified Paleolithic diet and usual diet in people with Multiple Sclerosis (MS).Fifteen individuals with MS were randomized to 3 groups: 1) modified Paleolithic diet (Paleo;Macronutrient intake significantly shifted toward a ratio indicative of a ketogenic diet in the Keto group at 12 weeks. Similarly, plasma β-hydroxybutyrate indicated nutritional ketosis in the Keto group, whereas neither macronutrient intake nor plasma β-hydroxybutyrate indicated nutritional ketosis in the Paleo and Control groups. The Paleo group had significant within group reductions in fatigue scores and maintained cognitive function scores compared to the Control group. The Keto group had significant reductions in fasting glucose and insulin compared to baseline values; however, no clinical outcomes significantly changed.Participants consuming the MCT-based ketogenic diet achieved nutritional ketosis; however, it was not associated with significant clinical improvement in this study whereas the modified Paleolithic diet was associated with significant clinical improvements. Larger randomized controlled trials are needed to determine the safety and efficacy of the modified Paleolithic and MCT-based ketogenic diets on MS.

Purpose A critical component of breast cancer (BC) chemotherapy effectiveness is relative dose intensity (RDI), as Methods The medical records of 161 BC patients (M = 61.5 years, SD = 12.7) from a holistic cancer clinic were collected and analyzed. This clinic offers a patient-centered approach (i.e., patients actively make decisions, treatment education, chair yoga, reiki, and nutritional counseling). RDI was determined by calculating the ratio of the received dose versus the intended dose intensity. Results 92% of patients had an RDI ≥ 85% (Mean = 96%) and 8 of the 9 treatment regimens' RDI exceeded 85%. RDI had a significant positive association with BMI (p = .06), and being ER+ and/or HER2+ (p’s = .08). None of the remaining demographic or clinical characteristics were associated. Conclusions This non-pharmacologic approach led to a higher RDI than recommended, potentially improving BC patients’ prognosis. Higher RDI was related to BMI, and ER+ and HER2 status. Additional research is needed; however, these results provide promising evidence regarding the benefits of a patient-centered, holistic approach.

Purpose Some individuals with chronic pain find daily life sensations (eg, noise, light, or touch) aversive. This amplification of multisensory sensations has been associated with centrally mediated plasticity; for example, greater multisensory sensitivity (MSS) occurs in patients with fibromyalgia than rheumatoid arthritis. However, whether MSS preferentially relates to pain measures which reflect central influences (eg, dynamic quantitative sensory testing (QST) or referred pain), or whether the MSS-pain relationship requires priming from chronic pain, is unknown. Thus, this cross-sectional study investigated the relationships between MSS assessed in a pain-free state and evoked pain sensitivity. Methods Experimental intramuscular infusion pain and multiple static and dynamic QST were assessed in 465 healthy, pain-free adults: pain thresholds using pressure (PPTs) and heat (HPTs), temporal summation of pain (TSP) using pressure, heat or punctate stimuli, and conditioned pain modulation (CPM) using pressure or heat test stimuli. MSS was assessed using 7 items from Barsky’s Somatosensory Amplification Scale. Differences in pain and QST between sex-specific MSS quartiles were assessed, adjusting for multiple comparisons. All participants completed at least one intramuscular infusion condition, but not all were asked to complete each QST (n=166-465). Results Both static and dynamic QST differed between highest and lowest MSS quartiles using pressure stimuli: lower PPTs (adjusted-p0.05). Odds of experiencing TSP or referred pain was not greater, whereas CPM was 8-fold less likely, in those with highest MSS. Conclusion Normal variation in non-noxious MSS is related to both static and dynamic pain sensitivity, without sensitization associated with chronic pain, but is dependent on the QST stimulus. Thus, common influences on MSS and pain sensitivity may involve central mechanisms but are likely more complex than previously recognized.

Mitochondrial and nuclear sequence data from two Antarctic ameronothroid mites, Halozetes belgicae and Alaskozetes antarcticus, were used to address three key questions important for understanding both the evolution of biodiversity and its future conservation in the Antarctic Peninsula Region: i) Do populations of mites across the Antarctic Peninsula and Scotia Arc constitute distinct genetic lineages? ii) What implications does the spatial genetic structure in these species have for current understanding of the region’s glacial history? iii) What are the conservation implications of these findings? Our results indicate that both mite species have been present in the Antarctic since at least the Pliocene. At the regional scale, both species are comprised of a number of divergent, but sympatric, lineages that are genetically as distinct as some species within the genera Halozetes and Alaskozetes. At the local scale, complex structure suggests limited and stochastic post-Holocene dispersal. For both species, considerable spatial genetic structure exists across the region, similar to that found in other terrestrial invertebrates. These results support the implementation of stringent biosecurity measures for moving between the Scotia Arc islands and the Antarctic Peninsula, and throughout the latter, to conserve both evolutionary history and future evolutionary trajectories.

South Georgia supports globally important populations of seabirds, including the wandering albatross Diomedea exulans, black-browed albatross Thalassarche melanophris and grey-headed albatross T. chrysostoma, currently classified by the world Conservation Union (IUCN) as vulnerable, near threatened and endangered, respectively. Surveys of these species at South Georgia were conducted during the incubation stage in November 2014 to January 2015, repeating previous surveys conducted in the 2003/2004 season. Numbers of wandering albatrosses breeding annually at South Georgia decreased by 18% (1.8% per year) from 1553 pairs in 2003/2004 to an estimated 1278 pairs in 2014/2015. Over the same period, black-browed and grey-headed albatrosses decreased by 19% (1.9% per year) and 43% (5% per year), respectively. These represent a continuation of negative trends at South Georgia since the 1970s and are in contrast to some populations elsewhere, which have shown signs of recent recovery. Given the importance of South Georgia for these species, the ongoing population declines, and in the case of grey-headed albatrosses, an acceleration of the decline is of major conservation concern. Incidental fisheries mortality (bycatch) is currently considered to be the main threat. Although seabird bycatch has been reduced to negligible levels in the fisheries operating around South Georgia, wider implementation of effective seabird bycatch mitigation measures is required to improve the conservation status of the South Georgia populations of wandering, black-browed and grey-headed albatrosses. In addition, more research is required to investigate the respective roles of bycatch and climate change in driving these population trends.

Background Individuals receiving radiation for head and neck cancer (HNC) often develop painful oral mucositis that impairs function, possibly leading to feeding tubes, hospitalization, and treatment delays. Although pharmacologic medications provide some relief, many report inadequate analgesia and adverse effects. Transcutaneous electrical nerve stimulation (TENS) is a safe, nonpharmacologic intervention; it decreases pain and analgesics and improves function, yet no studies examined TENS for HNC. Objective The aim of this study was to examine the efficacy of TENS for pain and function in HNC patients. Methods This study used a randomized, double-blinded crossover design; participants received 3 TENS treatments during weeks 4 to 6 of radiation: active, placebo, and no TENS over the temporomandibular joint and upper cervical region. Pain (McGill Pain Questionnaire, visual analog scale [VAS] resting and function), function (mouth opening, tongue movement, speaking), fatigue (VAS), and treatment effectiveness (VAS) were assessed before and after TENS at 3 visits. Results Resting pain (McGill Pain Questionnaire and VAS) decreased significantly more after active TENS than placebo or no TENS; changes in function and pain with function did not differ between conditions. Active TENS decreased fatigue significantly more than no TENS and was rated as more effective than placebo TENS. Conclusion Transcutaneous electrical nerve stimulation improves pain in HNC patients receiving radiation but not function or pain with function relative to placebo or no TENS. Implications for practice Transcutaneous electrical nerve stimulation may be a viable tool for radiation-induced HNC pain to complement pharmacologic approaches. This nonpharmacologic intervention could decrease the debilitating effects of radiation and analgesics, and improve quality of life. Clinical trials should examine the effects and safety of repeated, daily TENS in HNC patients receiving radiation.

Despite the significance of biological invasions in the Antarctic region, understanding of the rates of spread and impact of introduced species is limited. Such information is necessary to develop and to justify management actions. Here we quantify rates of spread and changes in impact of the introduced wasp Aphidius matricariae Haliday, which parasitizes the invasive aphid Rhopalosiphum padi (L.), on sub-Antarctic Marion Island, to which the wasp was introduced in ca. 2001. Between 2006 and 2011, the wasp had colonised all coastal sites, with an estimated rate of spread of 3–5 km year−1. Adult abundance doubled over the period, while impact, measured as mean percentage parasitism of R. padi, had increased from 6.9 to 30.1 %. Adult wasps have thermal tolerances (LT50s) of between −18 and 33.8 °C, with a crystallization temperature of −22.9 °C, and little tolerance (ca. 37 h) of low humidity at 10 °C. Desiccation intolerance is probably limiting for the adult wasps, while distribution of their aphid host likely sets ultimate distributional limits, especially towards higher elevations where R. padi is absent, despite the presence of its host grass on the island, Poa cookii (Hook. f.). Rising temperatures are benefitting P. cookii, and will probably do the same for both R. padi and A. matricariae. Our study shows that once established, spread of introduced species on the island may be rapid, emphasizing the importance of initial quarantine.

Biological invasion is one of the key threats to the conservation of the broader Antarctic region. We provide an evidence-based assessment of the status of biological invasion in the region as a basis for future monitoring and management. We adapted the indicator framework for global biological invasion monitoring by collating information on (i) numbers of alien species and those invasive species impacting biodiversity (ii) trends in the extinction risks of native species impacted by invasive species and (iii) trends in relevant agreements, management intention and species eradications. Drivers of invasion including risk-associated human activities and trends were also evaluated. The number and trends in activities associated with invasion risk are broadly distributed across the region and increasing. Over 560 alien species from a wide range of taxa occupy the region, concentrated largely on the Southern Ocean Islands, with a high proportion of these considered to be invasive and to have negative biodiversity impacts. There has been a decline in the conservation status of species in the region that are impacted by invasives. Although policy responses to deal with the problem have increased since the 1970s, as have the number of successful eradications, management implementation statistics are patchy and progress in this area less apparent. The Antarctic Biological Invasions Indicator (ABII) provides a system for information exchange across the region and a vehicle for targeted monitoring and surveillance. It also enables inclusion of the region in global efforts to track both IAS and interventions for managing the threat. In a region that appears particularly prone to impacts from alien species, substantial further effort is needed to implement and monitor the effectiveness of management responses.

The pathogenesis of Alzheimer's disease (AD) is a critical unsolved question; and although recent studies have demonstrated a strong association between altered brain immune responses and disease progression, the mechanistic cause of neuronal dysfunction and death is unknown. We have previously described the unique CVN-AD mouse model of AD, in which immune-mediated nitric oxide is lowered to mimic human levels, resulting in a mouse model that demonstrates the cardinal features of AD, including amyloid deposition, hyperphosphorylated and aggregated tau, behavioral changes, and age-dependent hippocampal neuronal loss. Using this mouse model, we studied longitudinal changes in brain immunity in relation to neuronal loss and, contrary to the predominant view that AD pathology is driven by proinflammatory factors, we find that the pathology in CVN-AD mice is driven by local immune suppression. Areas of hippocampal neuronal death are associated with the presence of immunosuppressive CD11c+microglia and extracellular arginase, resulting in arginine catabolism and reduced levels of total brain arginine. Pharmacologic disruption of the arginine utilization pathway by an inhibitor of arginase and ornithine decarboxylase protected the mice from AD-like pathology and significantly decreased CD11c expression. Our findings strongly implicate local immune-mediated amino acid catabolism as a novel and potentially critical mechanism mediating the age-dependent and regional loss of neurons in humans with AD.

The objective of this study was to examine whether participation in a 12-month multimodal intervention would improve mood and cognitive function in adults with progressive multiple sclerosis (MS).In this one-arm, open-label feasibility trial, participants were prescribed a home-based multimodal intervention, including (1) a modified Paleolithic diet; (2) an exercise program (stretching and strengthening of the trunk and lower limb muscles); (3) neuromuscular electrical stimulation (EStim) of trunk and lower limb muscles; and (4) stress management (meditation and self-massage). Individuals completed measures of mood (Beck Anxiety and Depression Inventories) and cognitive (Cognitive Stability Index, Cognitive Screening Test, Delis-Kaplan Executive Function System) and executive function (Wechsler Adult Intelligence Scale) at baseline and 3, 6, 9, and 12 months after the start of the intervention. Dosage of the multimodal intervention was assessed at 3, 6, 9, and 12 months.The more individuals participated in the intervention activities, the greater improvements they had from baseline to 12 months on self-report measures of anxiety (Beck Anxiety Inventory [BAI]; ps = 0.001 to 0.02), depression (Beck Depression Inventory [BDI]; ps =0.0001 to 0.09), cognitive function (Cognitive Stability Index [CSI/T], Delis-Kaplan Executive Function System [DKEFS]; ps = 0.001 to 0.06), and executive function (Wechsler Adult Intelligence Scale [WAIS]; ps =0.0001 to 0.09). Mood and cognitive improvements were more closely related to a higher intake of the modified Paleolithic diet than to exercise and stress management dosage. Anxiety and depression changes were evident after just a few months, whereas changes in cognitive function were generally not observed until later in the intervention period. Mood and cognitive function changes from baseline to 12 months were significantly associated with fatigue improvements (ps =0.0001 to 0.03).A modified Paleolithic diet, exercise, EStim, and stress management intervention like this one has the potential to improve the mood and cognitive symptoms that can lead to considerable suffering in people with MS, potentially improving quality of life and function for people with progressive MS.

ApoE Receptor 2 (ApoER2) and the very low density lipoprotein receptor (VLDLR) are type I transmembrane proteins belonging to the LDLR family of receptors. They are neuronal proteins found in synaptic compartments that play an important role in neuronal migration during development. ApoER2 and VLDLR bind to extracellular glycoproteins, such as Reelin and F-spondin, which leads to phosphorylation of adaptor proteins and subsequent activation of downstream signaling pathways. It is thought that ApoER2 and VLDLR undergo clustering upon binding to their ligands, but no direct evidence of clustering has been shown. Here we show strong clustering of ApoER2 induced by the dimeric ligands Fc-RAP, F-spondin, and Reelin but relatively weak clustering with the ligand apoE in the absence of lipoproteins. This clustering involves numerous proteins besides ApoER2, including amyloid precursor protein and the synaptic adaptor protein PSD-95. Interestingly, we did not observe strong clustering of ApoER2 with VLDLR. Clustering was modulated by both extracellular and intracellular domains of ApoER2. Together, our data demonstrate that several multivalent ligands for ApoER2 induce clustering in transfected cells and primary neurons and that these complexes included other synaptic molecules, such as APP and PSD-95.

Distinguishing between species that are recent natural colonists, recent anthropogenic introductions, or previously unknown, but long-term resident native species, is a challenge for those who manage the conservation of the Antarctic region. Here, we report the discovery of two new arthropod species on sub-Antarctic Marion Island—Nabis capsiformis Germar (Heteroptera: Nabidae) and Tetragnatha sp. (Araneomorphae: Tetragnathidae). On the basis of their habitat use, dispersal abilities, historic biodiversity survey records, and limited information on genetic diversity, we conclude that the colonization events were natural.

Hypotension commonly occurs in parturients undergoing cesarean delivery under spinal anesthesia. This leads to maternal and neonatal adverse outcomes, including maternal nausea and vomiting and fetal acidosis, and might even lead to cardiovascular collapse if not treated. Arterial dilatation and reduction in systemic vascular resistance are the major contributors to spinal-induced hypotension. Therefore, strategies aimed at expanding the intravascular volume with fluid loading or increasing venous return with lower extremities mechanical compression and lateral tilt have had limited effectiveness in the management of spinal-induced hypotension. Vasopressors are therefore the mainstay for the prophylaxis and treatment of spinal-induced hypotension. Phenylephrine is associated with improved neonatal acid-base status and a lower risk of maternal nausea and vomiting compared with ephedrine and is now considered the vasopressor of choice in obstetric patients. This review discusses the various strategies for managing spinal-induced hypotension with a particular emphasis on the optimal use of vasopressors.

Background: Recent studies suggest an underlying three- or four-factor structure explains the conceptual overlap and distinctiveness of several negative emotionality and pain-related constructs. However, the validity of these latent factors for predicting pain has not been examined. Methods: A cohort of 189 (99 female, 90 male) healthy volunteers completed eight self-report negative emotionality and pain-related measures (Eysenck Personality Questionnaire – Revised, Positive and Negative Affect Schedule, State-Trait Anxiety Inventory, Pain Catastrophizing Scale, Fear of Pain Questionnaire; Somatosensory Amplification Scale, Anxiety Sensitivity Index and Whiteley Index). Using principal axis factoring, three primary latent factors were extracted: general distress, catastrophic thinking and pain-related fear. Using these factors, individuals clustered into three subgroups of high, moderate and low negative emotionality responses. Experimental pain was induced via intramuscular acidic infusion into the anterior tibialis muscle, producing local (infusion site) and/or referred (anterior ankle) pain and hyperalgesia. Results: Pain outcomes differed between clusters (multivariate analysis of variance and multinomial regression), with individuals in the highest negative emotionality cluster reporting the greatest local pain (p = 0.05), mechanical hyperalgesia (pressure pain thresholds; p = 0.009) and greater odds (2.21 odds ratio) of experiencing referred pain when compared to the lowest negative emotionality cluster. Conclusion: Our results provide support for three latent psychological factors explaining the majority of the variance between several pain-related psychological measures, and that individuals in the high negative emotionality subgroup are at increased risk for (1) acute local muscle pain; (2) local hyperalgesia; and (3) referred pain using a standardized nociceptive input.

It is widely acknowledged that in the terrestrial Antarctic, interspecific interactions are typically unimportant in determining species distributions and community structure. Therefore, correlative models should prove useful for predicting current and future spatial variation in species abundance patterns. However, this idea has not been formally tested, and the utility of such models, which have shown value for understanding the distribution of diversity elsewhere, for investigating biodiversity patterns in Antarctica remains unclear. Here we make a start at such tests by using generalized linear and simultaneous autoregressive models to demonstrate that simple environmental variables and information about the spatial structure of the environment can explain more than 90% of the variation in the abundance of Maudheimia wilsoni (Oribatida; Maudheimiidae), a representative of one of the most significant groups of Antarctic terrestrial arthropods, the mites. We show that a single environmental variable, maximum soil moisture content, can account for as much as 80% of the variance in the abundance of the mite, and that linear models with only a few environmental and spatial terms can be used to forecast the species abundance at the landscape scale. Given ongoing calls for better understanding of the distribution of Antarctic diversity and its likely future change, this initial test indicates that such modelling procedures, and more sophisticated versions thereof, hold much promise for the region and should be tested for other taxa with different life forms and habitat requirements.

Although spiders are a diverse and ecologically important group of predators across the sub-Antarctic islands, relatively little is known about their biology. Here we provide data on the abundance, body size variation and sex ratio of an indigenous spider,Myro kerguelenensis, across an altitudinal gradient on Marion Island. In so doing we test explicitly the hypotheses that density will decline with declining resource availability at higher elevations, and that a converse Bergmann body size cline will be found in this species. Density ofM. kerguelenensisdecreased with altitude and ranged from a mean density of 5.3 (SD 3.42) individuals per m2at 50 m a.s.l. to a mean density of 0.83 (SD 1.15) individuals per m2at 600 m a.s.l. Mean female sternum width was 1.39 mm (SD 0.44) and mean male sternum width was 1.40 mm (SD 0.22). No evidence for Bergmann or converse Bergmann clines was found. At increasing altitudes, sex ratios became increasingly female-biased with populations at 600 m a.s.l. comprising 0.87 (SD 0.28) females, on a proportional basis, possibly as a result of resource limitation and an increase in the prevalence of sexual cannibalism. The food web implications of this study are highlighted.

Management of non-native species introductions is a conservation priority in the Antarctic region. However, despite the recognised importance of intra-regional propagule transfer, the majority of studies have focused on inter-regional pathways (i.e. from outside of the Antarctic region). Here we quantify the number of seeds carried by expeditioners who have visited sub-Antarctic Marion Island. We recorded 420 seeds from 225 items of clothing, with seeds found on 52% of the items and soil on 45% of them. The median number of seeds for field-based and station-based personnel was 20.5 and 3 per person, respectively. Waterproof trousers and socks, particularly those of field workers, carry the greatest number of propagules (for field workers, medians of 5 and 6.5, respectively) and therefore should be the focus of intra-regional management interventions. Amongst the seeds found entrained within clothing several were from species which are widespread aliens in the Antarctic region including Agrostis stolonifera, Poa annua and Sagina procumbens, and indigenous zoochorous species (Acaena magellanica, Uncinia compacta) were also well represented. The present data provide quantitative evidence in support of previous, largely hypothetical concerns about the risks of intra-regional propagule transfer in the Antarctic.

It has long been maintained that the majority of terrestrial Antarctic species are relatively recent, post last glacial maximum, arrivals with perhaps a few microbial or protozoan taxa being substantially older. Recent studies have questioned this ‘recolonization hypothesis’, though the range of taxa examined has been limited. Here, we present the first large-scale study for mites, one of two dominant terrestrial arthropod groups in the region. Specifically, we provide a broad-scale molecular phylogeny of a biologically significant group of ameronothroid mites from across the maritime and sub-Antarctic regions. Applying different dating approaches, we show that divergences among the ameronothroid mite genera Podacarus , Alaskozetes and Halozetes significantly predate the Pleistocene and provide evidence of independent dispersals across the Antarctic Polar Front. Our data add to a growing body of evidence demonstrating that many taxa have survived glaciation of the Antarctic continent and the sub-Antarctic islands. Moreover, they also provide evidence of a relatively uncommon trend of dispersals from islands to continental mainlands. Within the ameronothroid mites, two distinct clades with specific habitat preferences (marine intertidal versus terrestrial/supralittoral) exist, supporting a model of within-habitat speciation rather than colonization from marine refugia to terrestrial habitats. The present results provide additional impetus for a search for terrestrial refugia in an area previously thought to have lacked ice-free ground during glacial maxima.

Pain is a debilitating condition affecting millions each year, yet what predisposes certain individuals to be more sensitive to pain remains relatively unknown. Several psychological factors have been associated with pain perception, but the structural relations between multiple higher- and lower-order constructs and pain are not well understood. Thus, we aimed to examine the associations between pain perception using the cold pressor task (CPT), higher-order personality traits (neuroticism, negative affectivity, trait anxiety, extraversion, positive affectivity, psychoticism), and lower-order pain-related psychological constructs (pain catastrophizing [pre- and post-], fear of pain, anxiety sensitivity, somatosensory amplification, hypochondriasis) in 66 pain-free adults. Factor analysis revealed 3 latent psychological variables: pain- or body-sensitivity, negative affect/neuroticism, and positive affect/extraversion. Similarly, pain responses factored into 3 domains: intensity, quality, and tolerance. Regression and correlation analyses demonstrated that: 1) all the lower-order pain constructs (fear, catastrophizing, and hypochondriasis) are related through a single underlying latent factor that is partially related to the higher-order negative-valence personality traits; 2) pain- or body-sensitivity was more strongly predictive of pain quality than higher-order traits; and 3) the form of pain assessment is important—only qualitative pain ratings were significantly predicted by the psychological factors. Perspective Consistent with the biopsychosocial model, these results suggest multiple pain-related psychological measures likely assess a common underlying factor, which is more predictive of qualitative than intensity pain ratings. This information may be useful for the development and advancement of pain assessments and treatments while considering the multidimensional nature of pain.

Antarctic ecosystems are at risk from the introduction of invasive species. The first step in the process of invasion is the transportation of alien species to Antarctic in a viable state. However, the effect of long-distance human-mediated dispersal, over different timescales, on propagule viability is not well known. We assessed the viability of Poa trivialis seeds transported to Antarctica from the UK, South Africa and Australia by ship or by ship and aircraft. Following transportation to the Antarctic Treaty area, no reduction in seed viability was found, despite journey times lasting up to 284 days and seeds experiencing temperatures as low as −1.5°C. This work confirms that human-mediated transport may overcome the dispersal barrier for some propagules, and highlights the need for effective pre-departure biosecurity measures.

Globalization has resulted in unprecedented movements of people, goods, and alien species across the planet. Although the impacts of biological invasions are widely appreciated, a bias exists in research effort to post-dispersal processes because of the difficulties of measuring propagule pressure. The Antarctic provides an ideal model system in which to investigate propagule movements because of the region's isolation and small number of entry routes. Here we investigated the logistics operations of the South African National Antarctic Programme (SANAP) and quantified the initial dispersal of alien species into the region. We found that over 1400 seeds from 99 taxa are transported into the Antarctic each field season in association with SANAP passenger luggage and cargo. The first ever assessment of propagule drop-off indicated that 30-50% of these propagules will enter the recipient environment. Many of the taxa include cosmopolitan weeds and known aliens in the Antarctic, indicating that logistics operations form part of a globally self-perpetuating cycle moving alien species between areas of human disturbance. In addition, propagules of some taxa native to the Antarctic region were also found, suggesting that human movements may be facilitating intra-regional homogenization. Several relatively simple changes in biosecurity policy that could significantly reduce the threat of introduction of nonnative species are suggested.

Numerous animal species have been introduced to areas from which they were previously absent, and many of these have become invasive, with substantial impacts. However, in other cases, impacts are assumed from theory. Empirical demonstrations are uncommon, making evidence-based conservation policy difficult to achieve. Here we review the broader ecological and conservation lessons from recent work on non-indigenous species in two southern systems, the policy implications thereof, and the subsequent changes to policy as a result of this work. First, we discuss invasions in the Antarctic region. Strong relationships exist between numbers of animal invasions and numbers of human visitors to Southern Ocean Islands, abiotic factors are often limiting for introduced species, homogenization across islands differs among taxonomic groups, and control actions can rapidly result in unintended consequences. This knowledge has influenced national policy and decisions within the Antarctic Treaty System. Second, we discuss ungulate introductions and translocations, both in South Africa and elsewhere. We show that substantial homogenization has resulted from both processes. However, firm evidence for impacts of ungulate introductions and translocations is sometimes difficult to find, despite the theoretical likelihood thereof. Such a lack of information may have profound consequences for the effective implementation of policy.

Although the impacts of biological invasions are widely appreciated, a bias exists in research effort to post dispersal processes because of the difficulties of measuring propagule pressure. Here we quantify the propagule pressure associated with the construction of a research station in Antarctica. Based on quantitative assessment of different classes of cargo, we predict that over 5000 seeds will be entrained during the period of building the station. Seeds from 34 taxa were identified, including known invasive species.

Introduction of non-native species poses one of the greatest, but least understood threats to marine biodiversity. Whilst considerable research effort has focused on vectors such as bal- last water, hull fouling remains poorly understood and there is a notable lack of data concerning the temporal development of fouling communities. Here we use remote video capture techniques to assess the development and change of fouling assemblages on an Antarctic supply vessel over a 2 yr period. Assemblages were dominated by cosmopolitan species, some of which are known to be inva- sive. We demonstrate that whilst areas surrounded by sea-ice are at low risk of introductions from this pathway, substantial fouling assemblages are routinely transported to sub-Antarctic islands where the thermal conditions may allow their establishment. Extent of fouling assemblages, and thus the threat of invasion, may be reduced by changing the dry docking regime and minimising port layover times and in-water cleaning of submerged hull surfaces.

Despite the importance of understanding the mechanisms underlying range limits and abundance structure, few studies have sought to do so. Here we use a terrestrial slug species, Deroceras panormitanum , that has invaded a remote, largely predator-free, Southern Ocean island as a model system to do so. Across Marion Island, slug density does not conform to an abundant centre distribution. Rather, abundance structure is characterized by patches and gaps. These are associated with this desiccation-sensitive species' preference for biotic and drainage line habitats that share few characteristics except for their high humidity below the vegetation surface. The coastal range margin has a threshold form, rapidly rising from zero to high density. Slugs do not occur where soil-exchangeable Na values are higher than 3000 mg kg −1 , and in laboratory experiments, survival is high below this value but negligible above it. Upper elevation range margins are a function of the inability of this species to survive temperatures below an absolute limit of −6.4°C, which is regularly exceeded at 200 m altitude, above which slug density declines to zero. However, the linear decline in density from the coastal peak is probably also a function of a decline in performance or time available for activity. This is probably associated with an altitudinal decline in mean annual soil temperature. These findings support previous predictions made regarding the form of density change when substrate or climatic factors set range limits.

The Southern Ocean Islands (SOI) have an exceptionally high conservation status, and human activity on the islands is low by comparison with more tropical islands. In consequence, overexploitation, pollution and habitat destruction have had little influence on the invertebrate biotas of the islands, although overexploitation of pelagic species has the potential for an indirect influence via reduction of nutrient inputs to the terrestrial systems. By contrast, invasive alien species, the local effects of global climate change, and interactions between them are having large impacts on invertebrate populations and, as a consequence, on ecosystem functioning. Climate change is not only having direct impacts on indigenous invertebrates, but also seems to be promoting the ease of establishment of new alien invertebrate species. It is also contributing to population increases of invertebrate alien species already on the islands, sometimes with pronounced negative consequences for indigenous species and ecosystem functioning. Moreover, alien plants and mammals are also affecting indigenous invertebrate populations, often with climate change expected to exacerbate the impacts. Although the conservation requirements are reasonably well-understood for terrestrial systems, knowledge of freshwater and marine near-shore systems is inadequate. Nonetheless, what is known for terrestrial, freshwater and marine systems suggests that ongoing conservation of SOI invertebrates requires intervention from the highest political levels internationally, to slow climate change, to local improvements of quarantine measures to reduce the rates and impacts of biological invasions.

Increasing numbers of scientific and tourist vessels are entering the Antarctic region and have the potential to bring with them a range of organisms that are not currently found in the region. Little is known about the frequency of such introductions or the identity and survivorship of the species associated with them. In this study, we report the findings of an inspection of the sea chests of the South African National Antarctic Programme supply vessel, the SA 'Agulhas', while the vessel was in dry dock in June 2006. Large populations of a known invasive mussel, Mytilus gallo- provincialis (Lamarck), were found. By extrapolating from shell length, the age of individuals was estimated, the results of which suggest that some specimens have survived transportation to the Antarctic region on multiple occasions. These findings are cause for concern and demonstrate that Antarctic research and supply vessels are important vectors for marine non-indigenous species into the region.

Over the past two decades seven non-indigenous vascular plant or arthropod species have established reproducing populations at sub-Antarctic Marion Island (46°54′S, 37°55′E). Here we record the eighth establishment, a braconid wasp Aphidius matricariae Haliday, which uses the aphid Rhopalosiphum padi (Linnaeus) as its only host on the island. Molecular markers (18S rDNA and mtCOI) support the conventional taxonomic identification and indicate that all individuals are characterized by a single haplotype. Surveys around the island show that adult abundance and the frequency of aphid parasitism are highest at Macaroni Bay on the east coast, and decline away from this region to low or zero values elsewhere on the coast. The South African research and supply vessel, the SA Agulhas, regularly anchors at Macaroni Bay, and Aphidius sp. have been collected from its galley hold. Current abundance structure, low haplotype diversity, and the operating procedures of the SA Agulhas all suggest that the parasitoid was introduced to the island by humans. Regular surveys indicate that this introduction took place between April 2001 and April 2003, the latter being the first month when this species was detected. The wasp’s establishment has significantly added to trophic complexity on the island. Low haplotype diversity suggests that propagule pressure is of little consequence for insect introductions. Rather, single or just a few individuals are probably sufficient for successful establishment.

Tourette syndrome (TS) is a chronic neuropsychiatric disorder characterized by involuntary motor and phonic tics. The pattern of inheritance and associated genetic abnormality has yet to be fully characterized. A dopaminergic abnormality in this disorder is supported by response to specific therapies, nuclear imaging, and postmortem studies. In this protocol, dopaminergic polymorphisms were examined for associations with TS and attention-deficit hyperactivity disorder (ADHD). Polymorphisms investigated included the dopamine transporter (DAT1 DdeI and DAT1 VNTR), dopamine receptor (D4 Upstream Repeat and D4 VNTR), dopamine converting enzyme (dopamine β-hydroxylase), and the acid phosphatase locus 1 (ACP1) gene. DNA was obtained from 266 TS individuals ± ADHD and 236 controls that were ethnicity-matched. A significant association, using a genotype-based association analysis, was identified for the TS-total and TS-only versus control groups for the DAT1 DdeI polymorphism (AG vs. AA, P = 0.004 and P = 0.01, respectively). Population structure, estimated by the genotyping of 27 informative SNP markers, identified 3 subgroups. A statistical re-evaluation of the DAT1 DdeI polymorphism following population stratification confirmed the association for the TS-total and TS-only groups, but the degree of significance was reduced (P = 0.017 and P = 0.016, respectively). This study has identified a significant association between the presence of TS and a DAT polymorphism. Since abnormalities of the dopamine transporter have been hypothesized in the pathophysiology of TS, it is possible that this could be a functional allele associated with clinical expression. © 2006 Wiley-Liss, Inc.

In previous studies we observed that some allyl sulfides can cause increased acetylation of histones and differentiation in DS19 mouse erythroleukemia cells. In the present work we observed increased acetylation of histones with allyl isothiocyanate and butanethiol but not with butyl sulfide or butyl disulfide. Increased acetylation of histones was established by change in electrophoretic mobility, incorporation of [3H]acetate or immunoblotting. Histone deacetylase in nuclei of DS19 cells was inhibited 74% by 0.5 mM allyl mercaptan and 43% by 0.5 mM butanethiol but was not significantly affected by 0.5 mM allyl isothiocyanate. There was some degree of reversibility in the effect of allyl isothiocyanate when the cells were incubated for 15 hr in fresh medium. The data suggested that allyl isothiocyanate may stimulate histone acetylation rather than inhibit histone deacetylation. Addition of allyl isothiocyanate, however, had very little or no additional effect on the induction of histone acetylation caused by trichostatin A. Histone acetyltransferase activity determined in cell homogenates was not increased by preincubation of cells with allyl isothiocyanate or inclusion of allyl isothiocyanate in the assay medium. It was concluded that treatment of mouse erythroleukemia cells with allyl isothiocyanate can cause increased acetylation of histones but the mechanism for this effect requires further elucidation. © 2001 Wiley-Liss, Inc.

International audience; Despite considerable research on biological invasions, key areas remain poorly explored, especially ways to reduce unintentional propagule transfer. The Antarctic represents a microcosm of the situation, with the numbers of established non-native species growing. Information to help reduce potential impacts is therefore critical. We measured the propagule load of seeds, and fragments of bryophytes and lichens (the number of other plant or animal fragments was too low to draw any conclusions) carried in the clothing and gear of visitors to the Antarctic, during the 2007/08 austral summer. Samples were collected from different categories of visitors associated with national research programs and tourism and different categories of clothing and gear, new as well as used. We also collected information about the timing of travel and the regions visitors had travelled to prior to Antarctic travel. Seeds were found in 20% and 45% of tourist and science visitor samples, respectively. For bryophyte and lichen fragments the proportions were 11% and 20%, respectively. Footwear, trousers and bags belonging to field scientists were the highest risk items, especially of those personnel which had previously visited protected areas, parklands/botanic gardens or alpine areas. Tourists who visited rural/agricultural areas prior to travel, and/or travel with national programs or on smaller tourist vessels had the highest probability of transferring plant propagules. Travel either during the boreal or austral autumn months increased the probability of propagule presence. Our assessment is applicable to other areas given evidence of propagule transfer patterns in those areas that are broadly similar to those documented here. The current work provides a sound evidence base for both self-regulation (e.g. taking care of personal equipment) and organization-based regulation (e.g. issuing guidelines and holding regular inspections) to reduce propagule transfer of plants to the Antarctic.

Laura A Frey-Law,1 Jennifer E Lee,2,3 Alex M Wittry,4 Myles Melyon5 1Department of Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, IA, USA; 2Mount Mercy University, Department of Psychology, Cedar Rapids, IA, USA; ³College of Nursing, The University of Iowa, 4Department of Emergency Medicine, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA; 5Midwestern University, Glendale, AZ, USA Background: While the validity of pain assessment has been well documented, the underlying schema (ie, organized, preconceived ideas) of how individuals interpret numerical pain ratings is not well understood. This study's objectives were to examine numerical pain intensity ratings, from (0 to 10 cm on the visual analog scale [VAS]) across multiple severities of commonly experienced acute pain conditions to determine whether the ratings differed between these pain conditions and/or between individuals. Methods: A community sample (N=365, 66% female) rated their anticipated pain intensity (VAS) for threshold, mild, moderate, severe, and tolerance level, using several common pain conditions: headache, toothache, joint injury, delayed-onset muscle soreness, burns, and “general pain.” Results: Cluster analysis revealed three subgroups of individuals, suggesting three types of underlying pain rating schema: 1) Low Rating subgroup (low VAS pain intensity ratings across all the pain severity categories); 2) Low/High Rating subgroup (low VAS pain intensity rating for mild, but high VAS pain intensity rating for severe pain); and 3) High Rating subgroup (high VAS pain intensity ratings across all the pain severity categories). Overall, differences between pain conditions were small: muscle soreness pain intensity was consistently rated lower than the other pain types across severities. The highest pain ratings varied between joint injury and general pain, depending on severity level. No effects of sex or current experience of pain were noted. Conclusion: The results indicate that: 1) three distinct pain schemas were present in this community-based sample, indicating significant variation in how pain scales are utilized and/or interpreted between clusters of individuals; 2) pain ratings vary by condition, but these differences are minor; and 3) pain rating schemas are not significantly different between males and females or between individuals with and without current pain. Keywords: VAS, muscle soreness, headache, toothache, joint pain

Background: Research in animal models suggests that transcutaneous electrical nerve stimulation (TENS) and conditioned pain modulation (CPM) produce analgesia via two different supraspinal pathways. No known studies have examined whether TENS and CPM applied simultaneously in human subjects will enhance the analgesic effect of either treatment alone. The purpose of the current study was to investigate whether the simultaneous application of TENS and CPM will enhance the analgesic effect of that produced by either treatment alone. Methods: Sixty healthy adults were randomly allocated into two groups: (1) CPM plus active TENS; (2) CPM plus placebo TENS. Pain threshold for heat (HPT) and pressure (PPT) were recorded from subject’s left forearm at baseline, during CPM, during active or placebo TENS, and during CPM plus active or placebo TENS. CPM was induced by placing the subjects’ contralateral arm in a hot water bath (46.5 °C) for 2 min. TENS (100 ms, 100 Hz) was applied to the forearm for 20 min at a strong but comfortable intensity. Results: Active TENS alone increased PPT (but not HPT) more than placebo TENS alone (p = 0.011). Combining CPM and active TENS did not significantly increase PPT (p = 0.232) or HPT (p = 0.423) beyond CPM plus placebo TENS. There was a significant positive association between PPT during CPM and during active TENS (r 2 = 0.46; p = 0.003). Conclusions: TENS application increases PPT; however, combining CPM and TENS does not increase the CPM’s hypoalgesic response. CPM effect on PPT is associated with the effects of TENS on PPT.

163 Background: Obesity is associated with higher breast cancer recurrence and death, and poorer health and quality of life. African-American (AA) women have the highest prevalence of obesity, obesity-related comorbidities, and breast cancer mortality compared with other racial/ethnic groups. Weight loss after breast cancer diagnosis may lower rates of recurrence and improve fitness, fatigue, and quality of life. Methods: This 6-month randomized controlled trial pilot-tests the use of a Fitbit activity tracker (Fitbit only group) versus Fitbit plus SparkPeople, a free web-based weight loss program (combined group) among 70 AA breast cancer survivors. Paired t-tests assess changes from baseline to 6-months among each participant in primary (weight, body mass index [BMI], percent body fat) and secondary (24-hour caloric intake, daily number of steps, quality of life, self-monitoring strategies, self-efficacy) outcomes. Two-group t-tests assess differences in outcomes between the two groups. Results: Currently, 36 of 46 (78.3%) eligible participants have enrolled and completed baseline assessments. Mean age of participants is 61.7 years (SD 8.7) and mean BMI is 36.9 (SD 7.0). Analyses of the first 25 participants who completed 3-month assessments (Fitbit only N = 12; combined group N = 13) show significant weight loss in both groups; Fitbit only: mean weight change -6.73 pounds, SD 4.61, p < 0.001; mean BMI change -0.96 kg/m2, SD 0.84, p = 0.002; combined group: mean weight change -5.95 pounds, SD 5.84, p = 0.003; mean BMI change -1.03 kg/m2, SD 0.77, p < 0.001. All participants significantly increased tracking of diet (Fitbit only p = 0.016; combined group p < 0.001) and physical activity (Fitbit only p < 0.001; combined group p = 0.001). Though not significant, combined group participants showed greater increases in self-efficacy for eating healthy and reducing fat and calories, and increases in daily steps (+1308 vs. +285 for Fitbit only group). Preliminary analyses show no statistically significant difference in changes in outcomes from baseline to 3 months between the two groups. Conclusions: Both programs show potential as convenient and efficient weight loss methods for African-American breast cancer survivors. Clinical trial information: NCT02699983.

Fibrillar amyloid plaques are largely composed of amyloid-beta (Aβ) peptides that are metabolized into products, including Aβ1-16, by proteases including matrix metalloproteinase 9 (MMP-9). The balance between production and degradation of Aβ proteins is critical to amyloid accumulation and resulting disease. Regulation of MMP-9 and its endogenous inhibitor tissue inhibitor of metalloproteinase (TIMP)-1 by nitric oxide (NO) has been shown. We hypothesize that nitric oxide synthase (NOS2) protects against Alzheimer's disease pathology by increasing amyloid clearance through NO regulation of MMP-9/TIMP-1 balance. We show NO-mediated increased MMP-9/TIMP-1 ratios enhanced the degradation of fibrillar Aβ in vitro, which was abolished when silenced for MMP-9 protein translation. The in vivo relationship between MMP-9, NO and Aβ degradation was examined by comparing an Alzheimer's disease mouse model that expresses NOS2 with a model lacking NOS2. To quantitate MMP-9 mediated changes, we generated an antibody recognizing the Aβ1-16 fragment, and used mass spectrometry multi-reaction monitoring assay for detection of immunoprecipitated Aβ1-16 peptides. Aβ1-16 levels decreased in brain lysates lacking NOS2 when compared with strains that express human amyloid precursor protein on the NOS2 background. TIMP-1 increased in the APPSwDI/NOS2(-/-) mice with decreased MMP activity and increased amyloid burden, thereby supporting roles for NO in the regulation of MMP/TIMP balance and plaque clearance.

Because transcutaneous electrical nerve stimulation (TENS) works by reducing central excitability and activating central inhibition pathways, we tested the hypothesis that TENS would reduce pain and fatigue and improve function and hyperalgesia in people with fibromyalgia who have enhanced central excitability and reduced inhibition. The current study used a double-blinded randomized, placebo-controlled cross-over design to test the effects of a single treatment of TENS with people with fibromyalgia. Three treatments were assessed in random order: active TENS, placebo TENS and no TENS. The following measures were assessed before and after each TENS treatment: pain and fatigue at rest and in movement; pressure pain thresholds, 6-m walk test, range of motion; 5-time sit-to-stand test, and single-leg stance. Conditioned pain modulation was completed at the end of testing. There was a significant decrease in pain and fatigue with movement for active TENS compared to placebo and no TENS. Pressure pain thresholds increased at the site of TENS (spine) and outside the site of TENS (leg) when compared to placebo TENS or no TENS. During active TENS, conditioned pain modulation was significantly stronger compared to placebo TENS and no TENS. No changes in functional tasks were observed with TENS. Thus, the current study suggests TENS has short-term efficacy in relieving symptoms of fibromyalgia while the stimulator is active. Future clinical trials should examine the effects of repeated daily delivery of TENS, similar to the way in which TENS is used clinically on pain, fatigue, function, and quality of life in individuals with fibromyalgia.

The Antarctic Treaty System, acknowledged as a successful model of cooperative regulation of one of the globe's largest commons ( 1 ), is under substantial pressure. Concerns have been raised about increased stress on Antarctic systems from global environmental change and growing interest in the region's resources ( 2 , 3 ). Although policy-makers may recognize these challenges, failure to respond in a timely way can have substantial negative consequences. We provide a horizon scan, a systematic means for identifying emerging trends and assisting decision-makers in identifying policies that address future challenges ( 2 , 3 ). Previous analyses of conservation threats in the Antarctic have been restricted to matters for which available evidence is compelling ( 4 ). We reconsider these concerns because they might escalate quickly, judging from recent rapid environmental change in parts of Antarctica and increasing human interest in the region (see the map). We then focus on a more distant time horizon.

Invasive alien species are among the primary causes of biodiversity change globally, with the risks thereof broadly understood for most regions of the world. They are similarly thought to be among the most significant conservation threats to Antarctica, especially as climate change proceeds in the region. However, no comprehensive, continent-wide evaluation of the risks to Antarctica posed by such species has been undertaken. Here we do so by sampling, identifying, and mapping the vascular plant propagules carried by all categories of visitors to Antarctica during the International Polar Year's first season (2007–2008) and assessing propagule establishment likelihood based on their identity and origins and on spatial variation in Antarctica's climate. For an evaluation of the situation in 2100, we use modeled climates based on the Intergovernmental Panel on Climate Change's Special Report on Emissions Scenarios Scenario A1B [Nakićenović N, Swart R, eds (2000) Special Report on Emissions Scenarios: A Special Report of Working Group III of the Intergovernmental Panel on Climate Change (Cambridge University Press, Cambridge, UK)]. Visitors carrying seeds average 9.5 seeds per person, although as vectors, scientists carry greater propagule loads than tourists. Annual tourist numbers (∼33,054) are higher than those of scientists (∼7,085), thus tempering these differences in propagule load. Alien species establishment is currently most likely for the Western Antarctic Peninsula. Recent founder populations of several alien species in this area corroborate these findings. With climate change, risks will grow in the Antarctic Peninsula, Ross Sea, and East Antarctic coastal regions. Our evidence-based assessment demonstrates which parts of Antarctica are at growing risk from alien species that may become invasive and provides the means to mitigate this threat now and into the future as the continent's climate changes.

While the presence of an inflammatory response in AD (Alzheimer's disease) is well known, the data on inflammation are conflicting, suggesting that inflammation either attenuates pathology, exacerbates it or has no effect. Our goal was to more fully characterize the inflammatory response in APP (amyloid precursor protein) transgenic mice with and without disease progression. In addition, we have examined how anti-A β (amyloid β-peptide) immunotherapy alters this inflammatory response. We have used quantitative RT–PCR (reverse transcription–PCR) and protein analysis to measure inflammatory responses ranging from proinflammatory to anti-inflammatory and repair factors in transgenic mice that develop amyloid deposits only (APPSw) and amyloid deposits with progression to tau pathology and neuron loss [APPSw/NOS2–/– (nitric oxide synthase 2–/–)]. We also examined tissues from previously published immunotherapy studies. These studies were a passive immunization study in APPSw mice and an active vaccination study in APPSw/NOS2–/– mice. Both studies have already been shown to lower amyloid load and improve cognition. We have found that amyloid deposition is associated with high expression of alternative activation and acquired deactivation genes and low expression of pro-inflammatory genes, whereas disease progression is associated with a mixed phenotype including increased levels of some classical activation factors. Immunotherapy targeting amyloid deposition in both mouse models resulted in decreased alternative inflammatory markers and, in the case of passive immunization, a transient increase in pro-inflammatory markers. Our results suggest that an alternative immune response favours retention of amyloid deposits in the brain, and switching away from this state by immunotherapy permits removal of amyloid.