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Summary: The risk of subsequent major osteoporotic and hip fracture following an initial fracture was increased in both sexes over 25 years, with modest time-dependent attenuation. This risk was highest in men, underscoring the importance of targeted treatment strategies particularly in this under-treated population. Introduction: The risk of subsequent fractures is increased following an index fracture, and declines over time. We aimed to determine whether this risk was sustained over 25 years and evolved similarly in men and women. Methods: Using population-based databases, we performed a matched cohort study in 16,876 men and 39,230 women ≥ 50 years who sustained an index fracture during 1989–2006. Rates of subsequent major osteoporotic fractures (MOF) and hip fractures until 2016 were compared to rates for matched controls (n = 160,983). Age- and sex-stratified cumulative incidences to 25 years were estimated in the presence of competing mortality. Hazard ratios (HRs) with 95% confidence intervals (CI) for subsequent fractures were estimated for each on the first 15 years of follow-up with a final category ≥ 15 years, adjusted for comorbidities. Results: Risk for MOF and hip fractures remained elevated up to 25 years in both sexes. The cumulative incidence of fractures was higher in cases vs controls in both sexes and across all age categories except in those > 90 years. Crude rate ratios for subsequent MOF were 2.5 (95% CI 2.3–2.7) in men and 1.6 (95% CI 1.6–1.7) in women and were higher in the younger age groups. Adjusted HRs (aHRs) for subsequent MOF were higher in men than in women in the first year (men aHR 2.6, 95% CI 2.1–3.3; women aHR 1.6, 95% CI 1.4–1.7). Conclusions: The risk of subsequent fractures following an initial fracture was increased over 25 years and the magnitude of risk was initially greater in men than in women. [ABSTRACT FROM AUTHOR]

Indicators are widely used in climate variability and climate change assessments to simplify the tracking of complex processes and phenomena in the state of the environment. Apart from the climatic criteria, the snow indicators in ski tourism have been increasingly extended with elements that relate to the technical, operational, and commercial aspects of ski tourism. These non-natural influencing factors have gained in importance in comparison with the natural environmental conditions but are more difficult to comprehend in time and space, resulting in limited explanatory power of the related indicators when applied for larger/longer scale assessments. We review the existing indicator approaches to derive quantitative measures for the snow conditions in ski areas, to formulate the criteria that the indicators should fulfill, and to provide a list of indicators with their technical specifications which can be used in snow condition assessments for ski tourism. For the use of these indicators, a three-step procedure consisting of definition, application, and interpretation is suggested. We also provide recommendations for the design of indicator-based assessments of climate change effects on ski tourism. Thereby, we highlight the importance of extensive stakeholder involvement to allow for real-world relevance of the achieved results. [ABSTRACT FROM AUTHOR]

Summary: This registry-based cohort study assessed the percentage of women with prior or incident fracture who had normal bone defined as a normal bone mineral density T-score and normal trabecular bone score (TBS). Inclusion of TBS reduced the percentage with normal bone. Normal bone measurement is rare in women with fracture. Introduction: Some fractures occur in women with normal BMD. We hypothesized that adding trabecular bone score (TBS) to DXA would (1) demonstrate that few women with fracture have normal bone, i.e., normal BMD T-score and TBS and (2) increase the percentage of women with fracture that have abnormal bone defined as a BMD T-score ≤ − 2.5 or low TBS. Methods: The public healthcare system in Manitoba, Canada, makes it possible to link clinical DXA data to population databases. This study included all women age 50+ with a first DXA from February 1999 to March 2018 with valid BMD, TBS, and fracture data. Bone status was defined as Normal = BMD T-score of the spine, femoral neck, and total femur ≥ − 1.0 AND TBS > 1.31; Abnormal = BMD T-score ≤ − 2.5 OR TBS < 1.23; and borderline = all others. Analyses were stratified by age decade. Results: Among women with prior (n = 4649) or incident (n = 2547) fracture, bone status assessed by both BMD and TBS was normal in only 6% and 4%, respectively. In women with prior or incident hip fracture, normal bone was present in < 1%. The prevalence of normal bone declined (p trend < 0.001) with age as expected. BMD T-score osteoporosis was present in 40% with any prior and 46% with any incident fracture. BMD T-score osteoporosis was present in 65% and 60% with prior and incident hip fracture, respectively. Including TBS with BMD increased the percentage of women with abnormal bone to 61% and 68% for any prior or incident fracture and to 80% and 81% for prior or incident hip fracture, respectively (all p < 0.001). Conclusion: Including TBS with BMD increases identification of abnormal bone in women with fracture compared with BMD alone. Normal bone is present in < 6% of women with any fracture and < 1% of those with hip fracture. What is thought to be normal bone in women with fracture is rarely normal. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were (1) to assess the prevalence of ultrasound (US) features of adenomyosis in an infertile population undergoing in-vitro fertilization (IVF), (2) to define the inter- and intrarater agreement of three-dimensional (3D) US assessment of adenomyosis, and (3) to evaluate sonographic features of adenomyosis with respect to pregnancy outcome following transfer of a single thawed euploid blastocyst.Methods: This was a prospective cohort study. Subjects scheduled to undergo a single thawed euploid blastocyst transfer between April and December 2017 at a large IVF center were eligible for inclusion. Enrolled subjects underwent endometrial preparation for frozen embryo transfer. 3D-US was performed on the day prior to embryo transfer, with images stored for subsequent evaluation. Subjects then underwent transfer of a single thawed euploid blastocyst, and pregnancy outcomes were collected. All 3D-US volumes were de-identified and reviewed independently by five reproductive endocrinologists/infertility specialists with expertise in gynecological US for the presence of seven sonographic features of adenomyosis: global uterine enlargement, myometrial wall asymmetry, heterogeneous echogenicity, irregular junctional zone, myometrial cysts, fan-shaped shadowing and ill-defined myometrial lesions. Adenomyosis was considered to be present if the majority of the reviewers noted at least one of the seven sonographic features. Inter- and intrarater agreement was evaluated using Fleiss's kappa. Clinical and cycle characteristics of subjects with and those without adenomyosis were compared. The primary outcome of interest was live birth rate. Secondary outcomes included clinical pregnancy rate and miscarriage rate. Logistic regression analysis was performed to account for potential confounders.Results: A total of 648 subjects were included. The prevalence of adenomyosis on US was 15.3% (99/648). On retrospective chart review, very few patients with adenomyosis had symptoms. The inter- and intrarater agreement amongst five independent specialists conducting the 3D-US assessments of adenomyosis were poor (κ = 0.23) and moderate (κ = 0.58), respectively. Subjects with adenomyosis were older (37.1 vs 35.9 years, P = 0.02) and more likely to undergo a gonadotropin-releasing hormone agonist downregulation protocol when compared with those without adenomyosis (12.1% vs 5.1%, P = 0.02). Clinical pregnancy (80.0% vs 75.0%) and live birth (69.5% vs 66.5%) rates were similar between the groups. When adjusting for potential confounders, there was no difference in the rate of clinical pregnancy (adjusted odds ratio (aOR), 1.47 (95% CI, 0.85-2.56)), miscarriage (aOR, 1.3 (95% CI, 0.62-2.72)) or live birth (aOR, 1.28 (95% CI, 0.78-2.08)) between subjects with and those without adenomyosis. No individual sonographic marker of adenomyosis was predictive of pregnancy outcome.Conclusions: The inter-rater agreement of 3D-US assessment of adenomyosis is poor. Furthermore, sonographic markers of adenomyosis in asymptomatic patients may not be associated with altered pregnancy outcome following transfer of a single thawed euploid blastocyst. These findings suggest that routine screening for asymptomatic adenomyosis in an unselected infertile patient population undergoing frozen embryo transfer may not be warranted. © 2020 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Summary: Patient engagement in clinical guidelines development is essential. The results of a self-administered online survey identified themes important to people living with osteoporosis and will inform the development of Osteoporosis Canada clinical guidelines recommendations. Introduction: Patient engagement is essential in the development of high-quality and relevant guidelines for osteoporosis management. Osteoporosis Canada (OC) is updating its national clinical practice guidelines in collaboration with people living with osteoporosis in the process. Methods: Using electronic mail, we contacted 6937 members of the Canadian Osteoporosis Patient Network (COPN) to provide input on the selection of relevant content, outcomes, and research questions via a self-administered online survey. Close-ended questions were analyzed using descriptive statistics, and conventional content analysis was conducted for open-ended questions. Results: A total of 1108 individuals completed the survey (97% women, 86% stated they lived with osteoporosis). Most participants considered it critical to have recommendations on physical activity and exercise (74%), fall prevention (69%), nutrition (68%), and initial bone mineral density testing (67%). In addition to preventing fractures, over 75% of respondents stated that consideration of preserving quality of life and ability to perform daily activities, preventing admission to long-term care and fracture-related death, and avoiding serious harms from medications were essential outcomes to consider in evaluating the evidence. In terms of selection of research questions, seven themes emerged from the content analysis including pharmacotherapy, screening and monitoring, diet and supplements, education, exercise, alternative therapies, and pain management. Conclusions: Patients emphasized that autonomy, mobility, and quality of life are highly valued outcomes and must be integral to practice guideline development. As expected, guidance on pharmacotherapy, screening and monitoring, and fracture prevention were priorities identified to be included in osteoporosis management guidelines. [ABSTRACT FROM AUTHOR]

Objective: The objective of this investigation was to examine the distribution of galcanezumab and a control immunoglobulin 4 antibody containing the same constant regions as galcanezumab, into peripheral and central tissues.Methods: Galcanezumab and a control immunoglobulin 4 antibody were radioiodinated with Iodine-125 to specific activities of 0.11 mCi/mg and 0.16 mCi/mg, respectively. At 24, 72, and 168 hours following subcutaneous injection of either antibody (4 mg/kg), cerebrospinal fluid and plasma were obtained followed by saline perfusion to remove residual blood and collection of selected tissues for determination of Iodine-125 content by gamma counting.Results: The peak plasma levels of Iodine-125 galcanezumab and Iodine-125 control immunoglobulin 4 were observed at 72 hours and remained high at 168 hours post-dose. The rank order of tissue levels was dura mater = spleen > trigeminal ganglia ≫hypothalamus = spinal cord = prefrontal cortex = cerebellum. Iodine-125 galcanezumab levels in peripheral tissue (dura mater, spleen, and trigeminal ganglia) averaged 5% to 11% of plasma, whereas all of the central nervous system (CNS) tissue levels and the cerebrospinal fluid levels were < 0.4% of plasma. Distribution of the antibodies into the dura mater and the trigeminal ganglia was similar to that observed in the spleen and significantly greater than exposure in the brain or spinal cord.Conclusions: The central levels of galcanezumab were relatively low, which would favor the dura mater and trigeminal ganglia as sites of action for its observed clinical efficacy. However, a central site of action cannot be excluded. [ABSTRACT FROM AUTHOR]

Background Many patients with migraines suffer from allergies and vice versa, suggesting a relationship between biological mechanisms of allergy and migraine. It was proposed many years ago that mast cells may be involved in the pathophysiology of migraines. We set out to investigate the relationship between mast cell activation and known neurogenic peptides related to migraine. Methods Cultured human mast cells were assayed for the presence of neuropeptides and their receptors at the RNA and protein level. Immunohistochemistry analyses were performed on tissue resident and cultured mast cells. Mast cell degranulation assays were performed and pituitary adenylate cyclase-activating polypeptide (PACAP) activity was measured with a bioassay. Results We found that cultured and tissue resident human mast cells contain PACAP in cytoplasmic granules. No other neurogenic peptide known to be involved in migraine was detected, nor did mast cells express the receptors for PACAP or other neurogenic peptides. Furthermore, mast cell degranulation through classic IgE-mediated allergic mechanisms led to the release of PACAP. The PACAP released from mast cells was biologically active, as demonstrated using PACAP receptor reporter cell lines. We confirmed existing literature that mast cell degranulation can also be induced by several neurogenic peptides, which also resulted in PACAP release. Conclusion Our data provides a potential biological explanation for the association between allergy and migraine by demonstrating the release of biologically active PACAP from mast cells. [ABSTRACT FROM AUTHOR]

Study Question: Do infertile women aged <38 years with quantitative evidence of diminished ovarian reserve and/or poor response to stimulation also exhibit poor oocyte quality as measured by blastulation rates, aneuploidy rates, and live birth rates?Summary Answer: Young women with evidence of accelerated follicular depletion, either by precycle ovarian reserve testing or postcycle evidence of low oocyte yield, exhibit equivalent blastulation rates, aneuploidy rates and live birth rates per euploid embryo transfer as age-matched controls with normal precycle and postcycle parameters.What Is Known Already: Previous studies are conflicted as to whether women with evidence of diminished ovarian reserve and/or poor ovarian response are also at increased risk of exhibiting evidence of poor oocyte quality. Most prior studies have failed to adequately control for the confounding effect of female age on typical markers of oocyte quality in poor responders. The rate of follicular depletion occurs at around 38 years on average; thus, evidence of quantitative depletion before this would indicate a premature diminution of ovarian reserve and allow evaluation of whether markers of oocyte quality are tied to quantitative markers.Study Design, Size, Duration: This was a retrospective cohort study at a single center between 2012 and 2016. This time frame was specifically chosen as all embryos were cultured to the blastocyst stage at this center during the study period (no cleavage stage transfers were performed). Two comparisons were made: precycle assessment of ovarian reserve (based on anti-mullerian hormone (AMH) level) and postcycle oocyte yield results. For each comparison, patients in <10th percentile were compared to patients in the interquartile range (IQR) with respect to blastulation rate, aneuploidy rate and live birth rate. A mixed effects model was created to control for female age (in the <38 year old range) and correlation among oocytes from a given cohort.Participants/materials, Setting, Methods: For the precycle blastulation analysis, only patients with AMH data available were included (345 patients with AMH in the <10th percentile versus 1758 patients with AMH in the 25th to 75th percentile (IQR)). To compare aneuploidy rates, the subset of these patients who pursued preimplantation genetic testing for aneuploidy (PGT-A) was then analyzed (124 patients in the <10th percentile versus 782 patients in the IQR). For the postcycle blastulation analysis, all patients who proceeded to retrieval (whether or not they also had AMH data available) were included (535 patients with oocyte yield in the <10th percentile versus 2675 patients in the IQR). To compare aneuploidy rates, the subset of these patients who pursued PGT-A was then analyzed (156 patients in the <10th percentile versus 1100 patients in the IQR).Main Results and the Role Of Chance: The adjusted odds of a given fertilized oocyte developing to a blastocyst, being aneuploid or leading to a live birth after euploid transfer were no different if the oocyte was retrieved from a cycle with ovarian reserve parameters or oocyte yield in the <10th percentile compared to an oocyte retrieved in a cycle with those parameters in the 25-75th percentile. An AMH level in the <10th percentile did more commonly result in cycle cancellation prior to retrieval and after retrieval prior to transfer due to global arrest of embryos.Limitations, Reasons For Caution: The timing of retrieval in patients with fewer oocytes may be more optimal given the greater ability to discern the overall maturity of the cohort, thus enhancing performance per retrieved oocyte. Analyses included only first cycles. Subsequent adjustment of protocol due to prior performance may mean that some patients in the <10th percentile for oocyte yield are actually better prognosis patients than their first cycle indicates. Data on whether or not patients were on oral contraceptives at time that AMH level drawn was not available. Other unknown biases are also likely to be present given retrospective nature of the study.Wider Implications Of the Findings: While young women with evidence of quantitative depletion of ovarian reserve have lower live birth rates per stimulation cycle, this not attributable to poor oocyte quality because the blastulation rate per fertilized oocyte and live birth rate per embryo transfer are equivalent to that in women with normal quantitative markers of ovarian reserve. Thus, the pathophysiology mediating a premature quantitative decline in ovarian reserve appears different than that which mediates markers of oocyte quality, such as aneuploidy. Young poor responders may use this information to help guide embryo accumulation strategies when considering their family building plans.Study Funding/competing Interest(s): None.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Summary: In this large registry-based study, women with diabetes had marginally greater bone mineral density (BMD) loss at the femoral neck but not at other measurement sites, whereas obesity was not associated with greater BMD loss. Our data do not support the hypothesis that rapid BMD loss explains the increased fracture risk associated with type 2 diabetes and obesity observed in prior studies. Introduction: Type 2 diabetes and obesity are associated with higher bone mineral density (BMD) which may be less protective against fracture than previously assumed. Inconsistent data suggest that rapid BMD loss may be a contributing factor. Methods: We examined the rate of BMD loss in women with diabetes and/or obesity in a population-based BMD registry for Manitoba, Canada. We identified 4960 women aged ≥ 40 years undergoing baseline and follow-up BMD assessments (mean interval 4.3 years) without confounding medication use or large weight fluctuation. We calculated annualized rate of BMD change for the lumbar spine, total hip, and femoral neck in relation to diagnosed diabetes and body mass index (BMI) category. Results: Baseline age-adjusted BMD was greater in women with diabetes and for increasing BMI category (all P < 0.001). In women with diabetes, unadjusted BMD loss was less at the lumbar spine ( P = 0.017), non-significantly greater at the femoral neck ( P = 0.085), and similar at the total hip ( P = 0.488). When adjusted for age and BMI, diabetes was associated with slightly greater femoral neck BMD loss (− 0.0018 g/cm/year, P = 0.012) but not at the lumbar spine or total hip. There was a strong linear effect of increasing BMI on attenuated BMI loss at the lumbar spine with negligible effects on hip BMD. Conclusions: Diabetes was associated with slightly greater BMD loss at the femoral neck but not at other measurement sites. BMD loss at the lumbar spine was reduced in overweight and obese women but BMI did not significantly affect hip BMD loss. [ABSTRACT FROM AUTHOR]

An initial inventory of diatom biodiversity at 12 sites draining into Lake Ichkeul, northern Tunisia, was performed in summer 2014, together with the characterisation of metal pollution status by analysing trace metal concentrations to determine Water Quality Indices. The maximum values of Fe, Mn, Sb, Zn, Cu and Pb were all below the national and international standard, except for Fe in Hammam Ben Abbes thermal spring and Sb in Wadi Tinja, indicating that the surface water of the Ichkeul basin was largely acceptable. Diatom community composition and specific descriptors, including quantification of morphological alterations and mortality, were used to diagnose environmental stress. High abundances ofAchnanthidium minutissimum(Kützing) Czarnecki were observed at the Fe-rich site, which could reflect a response to metal contamination. Diatoms were stressed mostly by the influence of temperature and salinity, which drove species composition and increased mortality. Further research is required on the ecology of diatoms in Ichkeul thermal springs. The use of diatoms as indicators of ecosystem health in the Ichkeul area requires additional knowledge of diatom diversity in the ecoregion. [ABSTRACT FROM AUTHOR]

The present study was carried out on a 380 alloy containing 9.13% Si, 3.22% Cu, 1.01% Fe, 0.06% Mg, 0.16% Mn, and 2.28% Zn. The magnesium level was increased to 0.3 and 0.55%, by adding pure Mg to the melt. Tensile and fatigue samples were produced using low pressure die casting. The results show that the average dendrite arm spacing was about 6 μm. Increasing the amount of Mg from 0.06% to 0.55% increased the volume fraction of π-Al8Mg3FeSi6 and Q-Al5Cu2Mg8Si6 phases from 0.8% to 1.7%. Following solutionizing at 490°C for 8 h, the maximum ultimate tensile strength was obtained from alloys containing 0.3% Mg. Further increases in Mg content resulted in an increase in the amount of insoluble intermetallics and, hence, low tensile strength. Aging at 155°C for times up to 25 h resulted in a linear increase in the alloy strength regardless of the amount of added Mg. Aging at 220°C, however, revealed multiple peaks corresponding to the precipitation of various phases. A good relation between the applied force and the number of cycles prior to failure was established. The alloy containing 0.3% Mg produced the best fatigue resistance. The effect of porosity was more pronounced on the fatigue samples than on the tensile bars. [ABSTRACT FROM AUTHOR]

The understanding and implementation of snow management in detailed snowpack models is a major step towards a more realistic assessment of the evolution of snow conditions in ski resorts concerning past, present and future climate conditions. Here we describe in a detailed manner the integration of snow management processes (grooming, snowmaking) into the snowpack model Crocus. The effect of the tiller is explicitly taken into account and its effects on snow properties (density, snow microstructure) are simulated in addition to the compaction induced by the weight of the grooming machine. The production of snow in Crocus is carried out with respect to specific rules and current meteorological conditions. Model configurations and results are described in detail through sensitivity tests of the model of all parameters related to snow management processes. In-situ observations were carried out in four resorts in the French Alps during the 2014–2015 winter season considering for each resort natural, groomed only and groomed plus snowmaking conditions. The model provides realistic simulations of the snowpack properties with respect to these observations. The main uncertainty pertains to the efficiency of the snowmaking process. The observed ratio between the mass of machine-made snow on ski slopes and the water mass used for production was found to be lower than was expected from the literature, in every resort. Nevertheless, the model now referred to as “Crocus-Resort” has been proven to provide realistic simulations of snow conditions on ski slopes and may be used for further investigations. [ABSTRACT FROM AUTHOR]

This is the first report of Bactra bactrana (Kennel, 1901) (Lepidoptera: Tortricidae) attacking a major solanaceous crop, sweet pepper Capsicum annuum L. The infestation was detected in two greenhouses at the area of Tympaki (Southern Crete, Greece). The moth larvae caused typical symptoms of a fruit borer with numerous small holes on the surface of the peppers and extensive damage on the inside of the fruit as a result of the feeding activity. Unknown factors facilitated this major shift in host range since B. bactrana is typically a stem borer of sedges. In addition, the pest status of B. bactrana is currently under question, as in both cases the infestations by the moth were associated with significant yield losses. B. bactrana was moderately controlled with chemicals registered for Lepidoptera management in sweet pepper due to the boring nature of the infestation. Some comparative taxonomic notes are provided to facilitate accurate pest discrimination of related Bactra species. Finally, biological attributes of the species are summarized and are discussed from pest control and ecological perspectives. Because Bactra species have been used in augmentative releases for the control of sage, the implications of our findings on the release of biocontrol agents are placed in perspective. [ABSTRACT FROM AUTHOR]

Background/objectives:Lymphocytes have a critical role in visceral adipose tissue (AT) inflammation. The CD28 costimulatory molecule is required for lymphocyte activation and for the development of a functional regulatory T cells (Tregs) compartment; however, its role during obesity is unknown.Methods:During diet-induced obesity, we investigated the effects of selective interference with CD28 signaling using knockout mice (Cd28KO) and a CTLA4-Ig fusion protein inhibiting CD28-B7 interactions.Results:Cd28 deficiency decreased pathogenic T cells and Treg content within AT without changing the macrophages number. Cd28KO epididymal but not subcutaneous fat was characterized by enlarged adipocytes, reduced levels of inflammatory cytokines and increased Glut4, adiponectin and lipogenic enzyme mRNA levels. This was associated with reduced inflammation, fat accumulation and enhanced glucose metabolism in liver. Weight gain and fasting glucose tolerance were not affected. CTLA4-Ig injections reduced the number of T cells in epididymal AT (epiAT) but not the inflammatory cytokines levels and failed to improve liver fat accumulation.Conclusions:Deletion of CD28 creates a new pro/anti-inflammatory balance in epiAT and liver and exerts a protective effect against hepatic steatosis. [ABSTRACT FROM AUTHOR]

Summary: In an observational study population of 62,413 individuals (6,455 [10 %] with diabetes), diabetes was independently associated with major osteoporotic fractures (MOFs) but did not significantly modify the effect of FRAX risk factors or prior fracture site. However, the presence of diabetes exerted a much stronger effect on hip fracture risk in younger versus older individuals. Introduction: Diabetes mellitus increases fracture risk independent of risk factors that comprise the WHO FRAX tool. We explored whether diabetes modifies the effect of FRAX clinical risk factors on MOF and hip fracture risk. Methods: Using a registry of clinical dual-energy X-ray absorptiometry (DXA) results for Manitoba, Canada, we identified women and men aged 40 years and older undergoing baseline DXA in 1996-2011. Health services data were used to identify diabetes diagnosis, FRAX risk factors and incident fractures using previously validated algorithms. Prior fracture was stratified as clinical vertebral, hip, humerus, forearm, pelvis and 'other'. Cox proportional hazards models were used to test for statistical interactions of diabetes with FRAX clinical risk factors and prior fracture site. Results: During a mean follow-up of 6 years, there were 4,218 MOF and 1,108 hip fractures. Diabetes was a significant independent risk factor for MOF adjusted for FRAX risk factors including bone mineral density (BMD) (adjusted hazard ratio [aHR] 1.32 [95 % confidence interval (CI) 1.20-1.46]). No significant interactions of FRAX risk factors or prior fracture site with diabetes were identified in analyses of MOF. For predicting hip fractures, age significantly modified the effect of diabetes (aHR age <60, 4.67 [95 % CI 2.76-7.89], age 60-69, 2.68 [1.77-4.04], age 70-79, 1.57 [1.20-2.04], age >80, 1.42 [1. 10-1.99]; pinteraction <0.001). Conclusions: Diabetes is an independent risk factor for MOFs and does not significantly modify the effect of FRAX risk factors or prior fracture site. However, diabetes exerts a much stronger effect on hip fracture risk in younger than older individuals which needs to be considered in hip fracture prediction. [ABSTRACT FROM AUTHOR]

Snow on the ground is a critical resource for winter tourism in mountain regions and in particular ski tourism. Ski resorts are significantly vulnerable to the variability of meteorological conditions already at present and threatened by climate change in the longer term. Here we introduce an approach where detailed snowpack simulation results were crossed with a resort-level geographical and socio-economic database containing information from about 142 ski resorts spanning the entire French Alps domain. This allows us to take into account explicitly the geographical, topographical (altitude, slope and aspect) and spatial organization (distribution of ski-lifts and slopes) features of the ski resorts considered. A natural snow resort viability index was built using all the above information and simulated natural snow conditions from 2000 to 2012. Results were compared to economically relevant information (skier day values) highlighting a complex relationship between ski resort operation and natural snow conditions. The method introduced in this study holds great potential for physically-based and socio-economically-relevant analyses of the functioning of winter tourism economy and projections into the future under climate change conditions. This requires, however, that further improvements are carried out, in particular the explicit integration of snow management practices (e.g. snowmaking and grooming) into the modeling suite. [ABSTRACT FROM AUTHOR]

The permeability (K) of snow to air flow affects the transfer of energy, water vapor and chemical species between the snow and the atmosphere. Yet today little is known about the temporal evolution of snow permeability as a function of metamorphic regime. Furthermore, our ability to simulate snow permeability over the seasonal evolution of a snowpack has not been tested. Here we have measured the evolution of snow permeability in a subarctic snowpack subject to high temperature-gradient (TG) metamorphism. We have also measured the evolution of the same snowpack deposited over tables so that it evolved in the equi-temperature (ET) regime. Permeability varies in the range 31 × 10−10 (ET regime) to 650 × 10−10 m2 (TG regime). Permeability increases over time in TG conditions and decreases under ET conditions. Using measurements of density ρ and of specific surface area (SSA), from which the equivalent sphere radius r is determined, we show that the equation linking SSA, density ρ and permeability, K = 3.0 r2 e(−0.013 ρ) (with K in m2, r in m and ρ in kg m−3) obtained in a previous study adequately predicts permeability values. The detailed snowpack model Crocus is used to simulate the physical properties of the TG and ET snowpacks. For the most part, all variables are well reproduced. Simulated permeabilities are up to a factor of two greater than measurements for depth hoar layers, which we attribute to snow microstructure and its aerodynamic properties. Finally, the large difference in permeabilities between ET and TG metamorphic regimes will impact atmosphere-snow energy and mass exchanges. These effects deserve consideration in predicting the effect of climate change on snow properties and snow–atmosphere interactions. [ABSTRACT FROM AUTHOR]

Summary: This study provides evidence that a number of frailty-related characteristics (older age, de novo admission to long-term care (LTC), comorbidities [Charlson Index, osteoporosis, osteoporosis risk factors, sarcopenia risk factors, and dementia]) have increased in the hip fracture population from 2001-2008. This will have significant impact on community resources, as the number of people discharged to the community is also increasing. Introduction: The aim of this study is to estimate secular changes in the prevalence of selected frailty-related characteristics among the hip fracture population in the Canadian province of Quebec (2001-2008) and the potential impact of these changes on healthcare services. Methods: The Quebec hospitalization database was used to identify nontraumatic hip fractures for the purposes of calculating age- and sex-specific rates. Also estimated were time trends for selected frailty-related characteristics and discharge destinations. Results: A significant decline in fracture rates was evident for all age groups except for those <65; sex differences were also observed. Almost all frailty-related characteristics increased over time, ranging from 2 to 14 % per year, which translates to an estimated increase from 16 to 112 %, over the study period. For those whose prior living arrangement was LTC, rates of hip fractures declined significantly (women OR = 0.93, 0.91-0.95; men OR = 0.97, 0.94-0.99). In-hospital mortality and discharge to inpatient rehabilitation decreased, while discharges back to community and to LTC increased. Conclusions: Although hip fracture rates decreased for older hip fracture patients, the absolute number and prevalence of specific frailty-related characteristics increased. Policy makers should review care models to ensure that adequate resources are provided to the community to offset the expected increase in demand arising from ongoing changes in patients' characteristics. [ABSTRACT FROM AUTHOR]

Summary: Although systemic glucocorticoids are commonly used, it is difficult to obtain accurate exposure history. In 50,000 patients, we confirmed that glucocorticoids were associated with reductions in bone mineral density (BMD) and increases in fracture and documented that recent and prolonged durations of exposure were particularly associated with adverse events-dose information did not improve risk prediction. Introduction: Systemic glucocorticoid use, defined as ever having taken supra-physiologic doses for 90-days or more, is a risk factor for low BMD and fractures. This definition does not distinguish recent (vs remote) exposure. Methods: Within a population-based clinical BMD registry in Manitoba, Canada, we identified all adults over age 40 years tested between 1998 and 2007 and then undertook a cohort study. We identified all oral glucocorticoid dispensations from 1995 to 2009 and stratified exposure by timing ('recent' if within 12 months vs 'remote') and duration (short [<90 days] vs prolonged [≥90 days]). Osteoporosis-related risk factors and treatments and major fractures were obtained using administrative health data. Results: A total of 12,818 of 52,070 (25 %) subjects had used glucocorticoids prior to BMD testing; the most common exposure was remote short ( n = 6453) vs recent prolonged ( n = 2896) vs recent short ( n = 2644) vs remote prolonged ( n = 825). Compared to 39,252 never-users, only recent prolonged glucocorticoid use was significantly associated with femoral neck T-score (ANCOVA-adjusted difference −0.13, 95 % CI −0.16 to −0.10, p < 0.001). There were 2,842 major (566 hip) fractures over median 5-year follow-up. Compared with never-users, only recent prolonged glucocorticoid use was significantly associated with BMD-independent increases in risk of incident major fracture (5.4 vs 7.7 %, adjusted HR 1.25, 95 % CI 1.07-1.45, p = 0.004) and hip fracture (1.1 vs 1.8 %, adjusted HR 1.61, 95 % CI 1.18-2.20, p = 0.003). Conclusions: Recent and prolonged glucocorticoid use (but neither remote nor recent short courses) was independently associated with reduced BMD and increased risk of fractures. These findings should permit clinicians to identify a high-risk group of patients that might benefit from osteoporosis prevention. [ABSTRACT FROM AUTHOR]

Abstract: The specific surface area of snow (SSA) is a useful variable to describe the physical and chemical properties of snow, including a quantitative link to snow metamorphism and the optical properties of snow. Here we present a series of 16 weekly profiles of snow physical properties including SSA measured using the DUFISSS instrument spanning the period from January to April 2010 at the Col de Porte field site in the French Alps near Grenoble. Measured SSA values for dry snow ranged between ca. 5 and 80m2 kg−1, and generally decreased over time in a given snow layer. Wet snow conditions encountered towards the end of the snow season show SSA values between 3 and 10m2 kg−1. This unique dataset is compared with simulations carried out using the Crocus snowpack model, using two parameterizations of snow SSA: one simply derived from the internal computation of the optical radius in Crocus, and the other one determined from density and snow type. Both parameterizations perform rather satisfactorily qualitatively and quantitatively, compared to the performance in terms of snow density profile. Ample room for improvement exists, in particular through the implementation of SSA as a fully fledged prognostic variable in Crocus, which is currently in progress. [Copyright &y& Elsevier]

Summary: Institutionalization after hip fracture occurs in at least 30% of patients in the year following hospital discharge. We demonstrate that the risk of transfer to a long-term care facility, after adjustment for age and burden of co-morbidity, is also increased following fractures at other osteoporotic sites in men and women. For most fractures, men are at greater risk than women. Introduction: High institutionalization rates have been documented following non-traumatic hip fractures; however, there is lack of knowledge regarding the frequency of transfer to long-term care institutions of patients who sustain such fractures at other anatomical sites. Methods: Using the comprehensive health care databases of the province of Manitoba, Canada, we performed a retrospective matched cohort study of community-dwelling men and women aged 50 years and older who sustained an incident non-traumatic fracture between April 1, 1986, and March 31, 2006. Using Cox proportional hazards regression analysis, we estimated the sex-specific relative risk of transfers to long-term care institutions in the year following fracture at osteoporotic sites. Results: We identified a total of 70,264 individuals with incident fractures (70.0% in women) among whom 3,996 new admissions to long-term care institutions were documented in the year following the index fracture. New admissions increased over time ( p < 0.0001 for temporal trends). The age- and co-morbidity-adjusted hazard ratio (HR) of institutionalization following a hip fracture was 4.89 (95% confidence interval [CI], 4.19 to 5.69) in men, and this risk was consistently at least twice that of controls for all other fracture sites (all p < 0.0001). In women, the relative risks were highest subsequent to a hip (HR, 2.79; 95% CI, 2.56 to 3.04) or vertebral fracture (HR, 2.18; 95% CI, 1.82 to 2.62). Conclusions: Non-traumatic fractures at any site have serious consequences, including institutionalization. Men are at greater risk of transfer to long-term care following fracture than women. [ABSTRACT FROM AUTHOR]

Summary: Fracture probability assessed without bone mineral density (BMD) could potentially be sufficient for clinical decision making in many individuals categorized as low or high fracture risk. For individuals falling in a moderate risk range, there is incremental value in using BMD in the probability calculation as this appropriately reclassifies risk in over one third of the individuals. Introduction: A new fracture risk assessment tool from the World Health Organization (FRAX®) estimates 10-year major osteoporotic and hip fracture probabilities from multiple clinical risk factors with or without hip BMD. The objective of this study is to determine whether fracture probability derived without BMD can be used to identify individuals who would be designated for treatment. Methods: A historical cohort of 36,730 women and 2,873 men aged 50 years and older drawn from the Manitoba Bone Density Program database, which contains clinical BMD results for the Province of Manitoba, Canada, was included in the study. Results: When 10-year probability for major osteoporotic fracture estimated without knowledge of BMD was high (≥20%), the vast majority (92.8%) qualified for intervention under the National Osteoporosis Foundation (NOF) guidelines, whereas among those at low risk (<10%), the vast majority (80.5%) did not satisfy any NOF intervention criteria. The benefit of including BMD in the risk assessment was greatest among those initially at moderate risk (10-19%) when fracture probability was derived without BMD, but this represented only 29.4% of the cohort (9.3% of those aged <65 years and 48.7% of those ≥65 years). Conclusions: Fracture probability derived without BMD is able to risk stratify women in terms of future fracture risk and could potentially be sufficient for clinical decision making in many of those designated at low or high fracture risk. [ABSTRACT FROM AUTHOR]

The article offers information on the quality-controlled snow and meteorological dataset derived from the experimental station located in Col de Porte in France gathered from August 1, 1993 to July 31, 2011. It states that the information in the dataset include measurement of air temperature, wind speed, and precipitation rate that focus on snow and rainfall. It says that the dataset was used to develop a snowpack model and development of a multi-year model performance assessment.

Summary: Non-traumatic fractures at typical osteoporotic sites are associated with increased mortality across all age groups, particularly in men. Furthermore, in certain age subgroups of women and men, this rate remained elevated beyond 5 years for fractures of the hip, vertebrae, humerus, and other sites. Introduction: Increased mortality rates have been documented following non-traumatic hip, vertebral, and shoulder fractures. However, data are lacking as to the duration of excess mortality and whether there is increased mortality following fractures at other sites. We determined mortality up to 15 years following incident fractures at typical osteoporotic sites. Methods: Using healthcare databases for the Province of Manitoba, Canada, we identified individuals 50 years and older with an incident non-traumatic fracture between 1986 and 2007. Each fracture case was matched to three fracture-free controls. Generalized linear models were used to test for trends in mortality and to estimate the relative risk for cases after adjusting for co-morbidity and living arrangements. Results: During the study period, we identified 21,067 incident fractures in men followed by 10,724 (50.1%) deaths and 49,197 incident fractures in women followed by 22,018 deaths (44.8%). Seventy-six percent of the fractures were at sites other than the hip and vertebrae. After adjustment for age, number of co-morbidities, and level of dependence in living arrangements, the risk of death in cases, relative to controls, was increased in both sexes for hip, vertebral, humerus, wrist (in men only), and other fracture sites. Post-fracture mortality was higher in men than women. Relative mortality was the highest in the younger age groups across the spectrum of fracture sites. Conclusions: Fractures at typical osteoporotic sites are associated with increased mortality across all age groups, particularly in men. Better understanding of factors associated with increased post-fracture mortality should inform the development of management strategies. [ABSTRACT FROM AUTHOR]

Abstract: The effects of the herbicide Diuron (DIU) and the bactericide Triclosan (TCS) were assessed on laboratory-grown stream biofilms. Four week-old biofilms were exposed in mesocosms to 48-hours of short pulses of either DIU or TCS. The direct and indirect effects of each toxicant on the biofilms, and the subsequent recovery of the biofilms, were evaluated according to structural and functional biomarkers. These parameters were analyzed immediately before exposure, immediately after exposure, and 9 and 16days post-exposure. DIU caused an increase in diatom mortality (+79%), which persisted until the end of the experiment. TCS also affected diatom mortality (+41%), although the effect did not appear until 1week post-exposure. TCS caused an increase in bacterial mortality (+45%); however, this parameter returned to normal values 1week post-exposure. TCS compromised the cellular integrity of the green alga Spirogyra sp., whereas DIU did not. TCS also strongly inhibited phosphate uptake (−71%), which did not return to normal values until 2weeks post-exposure. DIU directly affected algae, but barely affected the heterotrophs, whereas TCS seriously impaired bacteria (direct effect) as well as autotrophs (indirect effect). However, the biofilms recovered their normal structure and function within only a few days to a few weeks. These findings demonstrate the capacity of biofilms to cope with periodic inputs of toxicants, but also the risks associated to repeated exposure or multi-contamination in aquatic ecosystems. [Copyright &y& Elsevier]

Background: In developing countries, most people infected with HIV do not know their infection status. We aimed to assess whether HIV testing could be increased by combination of community mobilisation, mobile community-based voluntary counselling and testing (VCT), and support after testing.Methods: Project Accept is underway in ten communities in Tanzania, eight in Zimbabwe, and 14 in Thailand. Communities at each site were paired according to similar demographic and environmental characteristics, and one community from each pair was randomly assigned to receive standard clinic-based VCT (SVCT), and the other community was assigned to receive community-based VCT (CBVCT) plus access to SVCT. Randomisation and assignment of communities to intervention groups was done by the statistics centre by computer; no one was masked to treatment assignment because the interventions were community based. Intervention was provided for about 3 years (2006-09). The primary endpoint of HIV incidence is pending completion of assessments after the intervention. In this interim analysis, we examined the secondary endpoint of uptake in HIV testing, differences in characteristics of clients receiving their first HIV test, and repeat testing. Analyses were limited to clients aged 16-32 years. This study is registered with ClinicalTrials.gov, number NCT00203749.Findings: The proportion of clients receiving their first HIV test during the study was higher in CBVCT communities than in SVCT communities in Tanzania (2341 [37%] of 6250 vs 579 [9%] of 6733), Zimbabwe (5437 [51%] of 10,700 vs 602 [5%] of 12,150), and Thailand (7802 [69%] of 11,290 vs 2319 [23%] 10,033). The mean difference in the proportion of clients receiving HIV testing between CBVCT and SVCT communities was 40·2% (95% CI 15·8-64·7; p=0·019) across three community pairs (one per country). HIV prevalence was higher in SVCT communities than in CBVCT communities, but CBVCT detected almost four times more HIV cases than did SVCT across the three study sites (952 vs 264; p=0·003). Repeat HIV testing in CBVCT communities increased in all sites to reach 28% of all those testing for HIV by the end of the intervention period.Interpretation: CBVCT should be considered as a viable intervention to increase detection of HIV infection, especially in regions with restricted access to clinic-based VCT and support services after testing.Funding: US National Institute of Mental Health, HIV Prevention Trials Network (via US National Institute of Allergy and Infectious Diseases), and US National Institutes of Health. [ABSTRACT FROM AUTHOR]

Abstract: We report on a 3-month long time series of in-situ measurements of the effective thermal conductivity (k eff) of snow at 6 heights in an Alpine snowpack in the Mont-Blanc mountain range, France, at an altitude of 2400m. Measurements were carried out automatically every 2days using heated-needle probes embedded in the snowpack. The experimental procedure used is presented in detail and demonstrates the applicability of single heated-needle probes for the evaluation of k eff in snow, both for long-term measurements within the snowpack and occasional use in the field. Results based on 139 automatically collected data show k eff values ranging between 0.04 and 0.35Wm−1 K−1, and a consistent pattern of effective thermal conductivity increase throughout the measurements campaign. The temporal rate of change of k eff varies up to 0.01W m− 1 K−1day−1, with maximum values just after snowfall. [ABSTRACT FROM AUTHOR]

Abstract: Vineyard areas are important causes of water contamination, especially by pesticides and residues. These compounds can markedly disturb aquatic communities particularly photosynthetic organisms that are targeted by herbicides. Biofilms and diatoms were used as bioindicators for quality assessment in the Morcille watershed, an area impacted by Beaujolais vineyards (SE France), during the pesticide spreading period (April–May 2008). Biofilms were allowed to settle on glass slides for 4 or 8 weeks at three sites along a 7-km long gradient of trophic (mainly orthophosphate) and pesticide pollution. After a 4-week colonization, samples from the two contaminated downstream sites were transferred upstream to the clean site for 4 weeks while others were left in the same place. In vivo fluorescence measurements indicated that the periphytic communities were dominated by diatoms. Going downstream, biofilm biomass and diatom species richness decreased; normalized diatom indices (including the French standard BDI) expressed the increase in trophic status quite well. The species composition of the assemblages was used to discriminate between the effects of nutrients and toxicants, which increased simultaneously as the river continued downstream. The way in which the biofilm samples transferred upstream recovered was quite different depending on the location of the original site in the contamination gradient. Most of the quantitative descriptors reached a level comparable to that of the reference communities, but the diatom assemblages (cell density per surface unit, taxonomic composition) varied between dates and along the gradient. These communities did not entirely recover a reference structure but the increase in diversity, associated with the settlement of sensitive species, suggested an elevated recovery potential. [Copyright &y& Elsevier]

Abstract: A large-scale field survey was undertaken in the Neste system (South-West France) to investigate the impact of pesticide inputs on the structure of riverine benthic diatom communities. A total of 18 sites in the “Coteaux de Gascogne” study area were sampled during periods of pesticide use over two consecutive years (2005–2006). The typology of the diatoms collected was determined using artificial neural networks generating patterns in diatom community composition that indicated the species influenced by pesticide inputs, combined with organic pollution. Small, pioneer species of the Achnanthales group were more frequent in the pesticide-contaminated assemblages, whereas slower colonizers were more often found in the sites where disturbance was lower. The Phytopixal approach, a means to assess the spatial contamination potential, provided valuable information about pesticide exposure and was a successful means of discriminating diatom assemblages, suggesting that a global estimate of pesticide pollution risk, although rough, would be more appropriate and more representative than sporadic pesticide analyses. [Copyright &y& Elsevier]

High BMD is an infrequent finding. In this retrospective cohort study of women 50 years and older, we documented a strong association between high BMD and high BMI. High bone mineral density (BMD) has been associated with genetic disorders and a variety of dietary, endocrine, metabolic, infectious and neoplastic diseases that in many cases warrant medical attention. Since body mass index (BMI) is closely correlated with BMD, we sought to explore the relationship between these two parameters in older women. We conducted a retrospective clinical cohort study of 16,500 women 50 years and older who underwent baseline BMD testing between May 1998 and October 2002. Mean T-scores and Z-scores, and the proportions of women with high BMD ( T-score +2.5 or greater, Z-score +2.0 or greater), were assessed according to BMI category. Higher BMI category was associated with higher mean T-scores and Z-scores at all sites ( P < 0.001). The proportion of women with high BMD increased with each BMI category ( P for trend <0.05). In women with a lumbar spine T-score of +2.5 or more, 43.5% were obese with BMI > 30 kg/m2 (55.6% for the femoral neck and 73.1% for the total hip). For women with a lumbar spine Z-score of +2.0 or more, 37.2% were obese (42.0% for the femoral neck and 50.9% for the total hip). There was no evidence of a paradoxical increase in fracture rates in women with high BMD. High BMD is closely associated with elevated BMI in women. This should be taken into consideration prior to initiating extensive investigations for rare pathologies. [ABSTRACT FROM AUTHOR]

Weight and body mass index are associated with low bone mineral density and fractures in older women. This retrospective cohort study confirms a similar relationship in women aged 40 to 59 years. Risk factors for the prediction of osteoporosis and fractures have been less thoroughly studied in younger women. We evaluated the associations between weight, body mass index (BMI), the Osteoporosis Self-Assessment Tool (OST), bone mineral density (BMD) and fracture risk in women aged 40 to 59 years. Using administrative health management databases, we conducted a retrospective cohort study in 8,254 women aged 40–59 years who had baseline BMD testing. Linear regression and Cox proportional multivariate models were created to examine the associations with weight, BMI, OST, BMD, and subsequent fractures throughout a 3.3-year follow-up. Body weight, BMI, and OST had a similar overall performance in their ability to classify women with femoral neck T-score ≤ −2.5. Throughout 27,256 person years of observation, 225 women experienced one or more fractures. After adjustment for age, prevalent fractures, and use of corticosteroids, each standard deviation decrease in weight was associated with a 19% increase in the risk of incident fracture (95% CI: 1.01–1.35). Femoral neck BMD and the presence of prevalent fractures were also associated with the risk of incident fractures. Low weight and BMI predict osteoporosis and are associated with increased fracture risk in younger women. The negative impact of low body weight on bone health should be more widely recognized. [ABSTRACT FROM AUTHOR]

Observational studies are needed to quantify real-life effectiveness of antiresorptive therapy in the prevention of clinical fractures. Antiresorptive therapies were associated with an overall 32% reduction in low-trauma nonvertebral fracture risk among women 50 and older. Effectiveness may be lower among older women and those without risk factors. Randomized controlled trials have shown that antiresorptive therapies reduce the risk of fracture in selected populations, but further study is needed to quantify their real-life effectiveness. The study objective was to determine the association between antiresorptive use and low-trauma nonvertebral fracture in women 50 and older. The design was a retrospective nested case-control study (density-based sampling) within the Canadian Multicentre Osteoporosis Study. There were 5,979 eligible women with 453 cases and 1,304 matched controls. The current use of antiresorptives was associated with a decreased risk of fracture with OR = 0.68, 95% CI: 0.52–0.91; where OR is the adjusted odds ratio and CI is the confidence interval. Subgroup analysis yielded OR = 0.61, 95% CI: 0.42–0.89 for ages 50–74; OR = 0.76, 95% CI: 0.50–1.17 for ages 75+; OR = 0.58, 95% CI: 0.40–0.83 for those with a major risk factor; and OR = 0.92; 95% CI: 0.59–1.42 for those without a major risk factor. Major risk factors were prevalent low-trauma fracture, vertebral deformity (grade 2+), and BMD T-score ≤ −2.5. Antiresorptive therapy is associated with a clinically important reduction in low-trauma nonvertebral fracture risk among community-dwelling women aged 50 and older. Antiresorptive therapy may be less effective for women 75 and older and women without major risk factors. [ABSTRACT FROM AUTHOR]

In 2001, the Quebec Ministry of Environment modified its livestock waste management regulations and required dairy farms to treat or land spread their milk house wastewaters because of the contamination load exerted when discharged into a water course without treatment. For small dairy farms with fewer than 60 cows, conventional technologies implied an investment of at least $15 000 Can. The objective of the project was, therefore, to develop a modified, low cost and sustainable septic tank - seepage field system for the treatment and disposal of milk house wastewaters while fully valorizing the nutrients and using the water for irrigation. On two dairy farms with 40 and 50 cows, a sediment and milk fat trap was installed before, and a drained 0.45 ha seepage field was built after, the existing septic tank. The project consisted of checking the two modified systems for clogging by digging out sections of sewer pipes after two years of operation; measuring and sampling milk house wastewaters to establish the annual nutrient load; and comparing the contamination load of the seepage field drainage waters to that of a control area. The milk house wastewaters produced by the farms lead to an average field TN, TP, and TK loading of 60, 50, and 80 kg ha-1 y-1, respectively. The average volume of wastewater generated, of 17.5 mm/month, did not saturate the soil as no sign of saturation was observed when excavating the sewer pipes. The accumulation of milk fat inside the sewer pipes on one farm resulted from the disposal of wasted milk into the septic system, the absence of a water softener, and the fact that this fat was not regularly removed from the trap as required. The modified septic system had no major impact on the quality of its drainage water. The low system modification cost of $4400 Can and the treatment efficiency achieved meant that the concept is a feasible solution for most small dairy farms. [ABSTRACT FROM AUTHOR]

In 2001, the Quebec Ministry of Environment modified its livestock waste management regulations and required dairy farms to treat or land spread their milk house wastewaters because of the contamination load exerted when discharged into a water course without treatment. For small dairy farms with fewer than 60 cows, conventional technologies implied an investment of at least $15 000 Can. The objective of the project was, therefore, to develop a modified, low cost and sustainable septic tank - seepage field system for the treatment and disposal of milk house wastewaters while fully valorizing the nutrients and using the water for irrigation. On two dairy farms with 40 and 50 cows, a sediment and milk fat trap was installed before, and a drained 0.45 ha seepage field was built after, the existing septic tank. The project consisted of checking the two modified systems for clogging by digging out sections of sewer pipes after two years of operation; measuring and sampling milk house wastewaters to establish the annual nutrient load; and comparing the contamination load of the seepage field drainage waters to that of a control area. The milk house wastewaters produced by the farms lead to an average field TN, TP, and TK loading of 60, 50, and 80 kg ha-1 y-1, respectively. The average volume of wastewater generated, of 17.5 mm/month, did not saturate the soil as no sign of saturation was observed when excavating the sewer pipes. The accumulation of milk fat inside the sewer pipes on one farm resulted from the disposal of wasted milk into the septic system, the absence of a water softener, and the fact that this fat was not regularly removed from the trap as required. The modified septic system had no major impact on the quality of its drainage water. The low system modification cost of $4400 Can and the treatment efficiency achieved meant that the concept is a feasible solution for most small dairy farms [ABSTRACT FROM AUTHOR]

Hip fracture is associated with recurrent fractures and increased mortality. The results of our retrospective cohort study support the use of antiresorptive agents to prevent recurrent hip fractures in this population. Hip fracture, the most serious consequence of osteoporosis, is associated with recurrent fractures and increased mortality. Antiresorptive therapy has proven efficacy in the prevention of fractures after vertebral fractures. It is unknown if it can prevent recurrent fractures after a hip fracture. We designed a population based, retrospective cohort study, using administrative databases and identified patients hospitalized for a hip fracture between 1996 and 2002. The exposure was defined as being dispensed a prescription for an antiresorptive agent at any time following discharge. Multivariate Cox regression models were used to estimate the hazard ratio of recurrent hip fracture. Subgroup and propensity score analyses were performed. A total of 20,644 patients were identified; 6,779 filled a prescription for antiresorptive agents. There were 992 recurrent hip fractures. Patients exposed to antiresorptives had a 26% reduction in the rate of recurrent fractures (adjusted hazard ratio 0.74; 95% CI, 0.64–0.86) compared to patients who were not. All subgroups experienced a reduction in recurrent fracture, except the very elderly. Propensity score analyses were consistent with the main analysis. Antiresorptive therapy reduces the risk of recurrent hip fractures in elderly patients. These results provide evidence that this therapy should be considered for secondary prevention of hip fractures. [ABSTRACT FROM AUTHOR]

When handled separately from manures, dairy farm effluents (DE) are costly to manage because of their low nutrient content and large volume. In anticipation of using surface irrigation to lower the land application cost of DE, this projects investigated the impact, on DE characteristics, of different sources and storage systems. Milk house wastewaters were monitored on two farms using a 500 l manhole intercepting these before entering the septic tank. Manure runoff, with and without milk house wastewater, was also characterised on six farms for 1yr, and on two farms for three consecutive years, where each farm used a different management system. The results indicated that DE containing milk house wastewater, manure runoff or a mixture of both had a relatively low nutrient load, confirming that their application rate needed to range between 205 and 2050m3 ha−1, depending on the management system used. Stored along with solid manure, DE generally had a higher total solids (TS), nutrient loads and bacterial count, as compared to that drained away from the solid manure. Furthermore, for effluent drained away from solid manures, rainfall rather than snow occurring from October to May, inclusively, tended to increase their TS and nutrient load. The ratio of faecal coliforms to faecal streptococci (FC/FS) was greater than 1·0 when milk house wastewaters were stored along with the manure runoff because milk house wastewaters increased the death rate for FS compared to FC. [Copyright &y& Elsevier]

Abstract: Complexation with nitrite ions in aqueous medium was used to prepare highly dispersed Pd° particles supported on alumina. It has been possible to obtain catalysts with different Pd loading keeping the particle size lower than 1nm as shown by HRTEM, chemisorption, or extended X-ray absorption fine structure (EXAFS) characterizations, and as a consequence with different particle surface density. We observed that electronic properties measured by IR(CO) or X-ray photoelectron spectroscopy (XPS) measurements are strongly influenced by this last parameter and that the origin of these variations can be related to the different strengths of the interactions of the palladium precursor with the alumina surface sites as shown by low temperature CO adsorption followed by FTIR spectroscopy. On increasing Pd loading, saturation of unsaturated Lewis surface sites follows their acid strength: the more acidic ones are the first to react as germination sites, followed by the medium and finally the weaker sites. These different interactions may explain the variation of electronic properties of such small reduced particles which appears to be very sensitive to the chemical nature of their initial germination site on the oxide support. On the other hand, no such effects were observed on changing the type of alumina (δ or γ) support, in agreement with the principle of the synthesis method which tends to limit strong interaction with the support. Comparison with Pd° particles with the same particle size and particle surface density but prepared with the well known grafting of acetylacetonate precursor shows marked differences in terms of electronic properties followed by CO FTIR. This result illustrates the possibility to prepare highly dispersed Pd particles with different physico-chemical properties. [Copyright &y& Elsevier]

The voltage-gated sodium channel is the primary target site of pyrethroid insecticides. In some insects, super knockdown resistance (super-kdr) to pyrethroids is caused by point mutations in the linker fragment between transmembrane segments 4 and 5 of the para-type sodium channel protein domain II (IIS4-5). Here, we identify two mutations in the IIS4-5 linker of the para-type sodium channel of the whitefly, Bemisia tabaci: methionine to valine at position 918 (M918V) and leucine to isoleucine at position 925 (L925I). Although each mutation was isolated independently from strains >100-fold resistant to a pyrethroid (fenpropathrin) plus organophosphate (acephate) mixture, only L925I was associated with resistance in strains derived from the field in 2000 and 2001. The L925I mutation occurred in all individuals from nine different field collections that survived exposure to a discriminating concentration of fenpropathrin plus acephate. Linkage analysis of hemizygous male progeny of unmated heterozygous F1 females (L925I×wild-type) shows that the observed resistance is tightly linked to the voltage-gated sodium channel locus. The results provide a molecular tool for better understanding, monitoring and managing pyrethroid resistance in B. tabaci. [Copyright &y& Elsevier]

Summary : Fractures are associated with increased long-term mortality in patients surviving to undergo baseline DXA. Notably, excess mortality risk does not decline with increasing time since prior hip or humerus fractures, even after accounting for comorbid medical conditions and other risk factors. Introduction: Mortality risk increases following most types of fracture. In routine clinical practice, patients with prior fractures seen for dual-energy X-ray absorptiometry scan (DXA) are "survivors;" whether they remain at increased mortality risk is unknown. We tested the association between prior fracture and all-cause mortality, stratified by time since fracture, in patients undergoing baseline DXA. Methods: We conducted a DXA registry-based cohort study and linked to population-based health services data for the Province of Manitoba, Canada. We identified women and men ≥ 40 years with minimum 10 years of prior healthcare coverage undergoing baseline DXA and ascertained prior fracture codes since 1984 and mortality to 2017. Time since prior fracture was calculated between the clinical encounter for the fracture and baseline DXA (index date). Cox proportional hazards models estimated hazard ratios for all-cause mortality in those with compared to those without prior fracture adjusted for (1) age and sex, and (2) age, sex, comorbidities, and other covariates. Results: The study cohort consisted of 74,474 individuals (mean age 64.6 years, 89.7% female). During mean follow-up 9.2 years, we ascertained 14,923 (20.0%) deaths. Except for forearm fractures, all fracture sites were associated with increased mortality risk compared to those without prior fracture, even after multivariable adjustment. Excess mortality risk tended to decline slightly with time since fracture and was no longer significant > 10 years after vertebral fracture. However, excess mortality persisted > 10 years following hip or humerus fracture. Conclusions: Prior fractures are associated with increased long-term mortality in patients surviving to undergo baseline DXA. Excess mortality risk does not decline with time since prior hip or humerus fractures, after accounting for potential confounders. Fracture prevention may have important long-term benefits preserving life expectancy. [ABSTRACT FROM AUTHOR]

• The frequency of summer heat waves has increased over the last decades in the French Alps. • Canopy greenness significantly increased during warmer summers when climatic water balance was non-limiting. • Heat waves coinciding with water deficit lead to an accelerated canopy senescence at the end of summer. Heat waves are becoming more frequent in a warming climate and understanding the impacts of these extreme events on terrestrial ecosystems remains a major challenge. Seasonally snow-covered mountain grasslands are temperature-limited ecosystems and one may question whether the summer heat waves there have the same negative effect on primary productivity as they have on lowland ecosystems. Here, we examined the remotely-sensed phenology of mountain grasslands in the French Alps with a particular focus on the four unusually warm summers that occurred in 2003, 2012, 2015, and 2016. Our results showed that an early and rapid senescence and a lack of late-season regrowth were the most significant responses in 2003 and 2012 when heat waves coincided with climatic water deficit, i.e. negative anomalies of precipitation minus reference evapotranspiration. Mountain grasslands located below 2350 m were the most affected. In contrast, we found low senescence and moderate to high regrowth in 2015 and 2016 which were years unaffected by severe water deficit. When water was non-limiting, warm and even very warm summers have a positive effect on the canopy greenness of the highest grasslands, particularly by extending the green period in late summer and early fall. Our study highlights the pivotal role that summer water balance has in the phenological response of mountain grasslands exposed to heat waves. [ABSTRACT FROM AUTHOR]

Summary: Awareness of the prevalence of osteoporosis and fractures across jurisdictions can guide the development of local preventive programs and healthcare policies. We observed geographical variations in total hip bone mineral density and in the prevalence of major osteoporotic fractures across Canadian provinces, which persisted after adjusting for important covariates. Purpose: We aimed to describe sex-specific total hip bone mineral density (aBMD) and prevalent major osteoporotic fractures (MOF) variation between Canadian provinces. Methods: We used baseline data from 21,227 Canadians (10,716 women, 10,511 men) aged 50–85 years in the Canadian Longitudinal Study on Aging (CLSA; baseline: 2012–2015). Linear and logistic regression models were used to examine associations between province of residence and total hip aBMD and self-reported MOF, stratified by sex. CLSA sampling weights were used to generate the prevalence and regression estimates. Results: The mean (SD) age of participants was 63.9 (9.1) years. The mean body mass index (kg/m2) was lowest in British Columbia (27.4 [5.0]) and highest in Newfoundland and Labrador (28.8 [5.3]). Women and men from British Columbia had the lowest mean total hip aBMD and the lowest prevalence of MOF. Alberta had the highest proportion of participants reporting recent falls (12.0%), and Manitoba (8.4%) the fewest (p-value=0.002). Linear regression analyses demonstrated significant differences in total hip aBMD: women and men from British Columbia and Alberta, and women from Manitoba and Nova Scotia had lower adjusted total hip aBMD than Ontario (p-values<0.02). Adjusted odds ratios (95% confidence intervals, CI) for prevalent MOF were significantly lower in women from British Columbia (0.47 [95% CI: 0.32; 0.69]) and Quebec (0.68 [95% CI: 0.48; 0.97]) and in men from British Columbia (0.40 [95% CI:0.22; 0.71]) compared to Ontario (p-values<0.03). Results were similar when adjusting for physical performance measures and when restricting the analyses to participants who reported White race/ethnicity. Conclusion: Geographical variations in total hip aBMD and in the prevalence of MOF between provinces persisted after adjusting for important covariates which suggests an association with unmeasured individual and environmental factors. [ABSTRACT FROM AUTHOR]

Background: Perioperative administration of corticosteroid is common and variable. Guidelines for perioperative corticosteroid administration before non-cardiac non-transplant surgery in patients with current or previous corticosteroid use to reduce the risk of adrenal insufficiency are lacking. Perioperative use of corticosteroid may be associated with serious adverse events, namely hyperglycemia, infection, and poor wound healing. Objective: To determine whether perioperative administration of corticosteroids, compared to placebo or no intervention, reduces the incidence of adrenal insufficiency in adult patients undergoing non-cardiac surgery who were or are exposed to corticosteroids. Methods: We searched MEDLINE via Ovid and PubMed, EMBASE via Ovid, and the Cochrane Central Register of Controlled Trials, all from 1995 to January 2017. Selection criteria: We included randomized controlled trials (RCTs), cohort studies, case-studies, and systematic reviews involving adults undergoing non-cardiac non-transplant surgery and reporting the incidence of postoperative adrenal insufficiency. Data collection and analysis: Two authors independently assessed studies' quality and extracted data. A descriptive and bias assessment analysis was performed. Results: Two RCTs (total of 37 patients), five cohort studies (total of 462 patients), and four systematic reviews were included. Neither RCT showed a significant difference in the outcome. This result was like that of the five cohort studies. The quality of the evidence was low. Conclusion: The current use of perioperative corticosteroid supplementation to prevent adrenal insufficiency is not supported by evidence. Given the significant studies' limitations, it is not possible to conclude that perioperative administration of corticosteroids, compared to placebo, reduces the incidence of adrenal insufficiency. [ABSTRACT FROM AUTHOR]

Summary: Prior high-trauma fractures identified through health services data are associated with low bone mineral density (BMD) and future fracture risk to the same extent as fractures without high-trauma. Introduction: Some have questioned the usefulness of distinguishing high-trauma fractures from low-trauma fractures. The aim of this study is to compare BMD measurements and risk of subsequent low-trauma fracture in patients with prior high- or low-trauma fractures. Methods: Using a clinical BMD registry for the province of Manitoba, Canada, we identified women and men age 40 years or older with fracture records from linked population-based healthcare data. Age- and sex-adjusted BMD Z-scores and covariate-adjusted hazard ratios (HR) with 95% confidence intervals (CI) for incident fracture were studied in relation to prior fracture status, categorized as high-trauma if associated with external injury codes and low-trauma otherwise. Results: The study population consisted of 64,428 women and men with no prior fracture (mean age 63.7 years), 858 with prior high-trauma fractures (mean age 65.1 years), and 14,758 with prior low-trauma fractures (mean age 67.2 years). Mean Z-scores for those with any prior high-trauma fracture were significantly lower than in those without prior fracture (P < 0.001) and similar to those with prior low-trauma fracture. Median observation time for incident fractures was 8.8 years (total 729,069 person-years). Any prior high-trauma fracture was significantly associated with increased risk for incident major osteoporotic fracture (MOF) (adjusted HR 1.31, 95% CI 1.08–1.59) as was prior low-trauma fracture (adjusted HR 1.55, 95% CI 1.47–1.63), and there was no significant difference between the two groups (prior trauma versus low-trauma fracture P = 0.093). A similar pattern was seen when incident MOF was studied in relation to prior hip fracture or prior MOF, or when the outcome was incident hip fracture or any incident fracture. Conclusions: High-trauma and low-trauma fractures showed similar relationships with low BMD and future fracture risk. This supports the inclusion of high-trauma fractures in clinical assessment for underlying osteoporosis and in the evaluation for intervention to reduce future fracture risk. [ABSTRACT FROM AUTHOR]

Atmospheric nitrate shows a large oxygen isotope anomaly (Δ 17O), characterized by an excess enrichment of 17O over 18O, similar to the ozone molecule. Modeling and observations assign this specific isotopic composition mainly to the photochemical steady state that exists in the atmosphere between ozone and nitrate precursors, namely, the nitrogen oxides (NOx=NO+NO2). However, this transfer is poorly quantified and is built on unverified assumptions about which oxygen atoms of ozone are transferred to NOx, greatly weakening any interpretation of the nitrate oxygen isotopic composition in terms of chemical reaction pathways and the oxidation state of the atmosphere. With the aim to improve our understanding and quantify how nitrate inherits this unusual isotopic composition, we have carried out a triple isotope study of the reaction NO+O3. Using ozone intramolecular isotope distributions available in the literature, we have found that the central atom of the ozone is abstracted by NO with a probability of (8±5)%(±2σ) at room temperature. This result is at least qualitatively supported by dynamical reaction experiments, the non-Arrhenius behavior of the kinetic rate of this reaction, and the kinetic isotope fractionation factor. Finally, we have established the transfer function of the isotope anomaly of O3 to NO2, which is described by the linear relationship Δ 17O(NO2)=A×Δ 17O(O3)+B, with A=1.18±0.07(±1σ) and B=(6.6±1.5)‰(±1σ). Such a relationship can be easily incorporated into models dealing with the propagation of the ozone isotope anomaly among oxygen-bearing species in the atmosphere and should help to better interpret the oxygen isotope anomaly of atmospheric nitrate in terms of its formation reaction pathways. [ABSTRACT FROM AUTHOR]

Summary/Rationale: We identified a knowledge gap in the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. Main results: This international consensus process established multidisciplinary biopsychosocial recommendations on pain, nutrition, safe movement, and exercise for individuals with acute and chronic vertebral fractures. Significance: These recommendations will guide clinical practice and inform interventions for future research. Purpose: To establish international consensus on recommendations for the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. Methods: We adopted a five-step modified Delphi consensus process: (1) literature search and content analysis, (2) creation of the survey, (3) selection of the expert panel, (4) first round of the rating process, and (5) second round of the rating process. The first round included 49 statements and eight open-ended questions; the second round included 30 statements. Panelists were asked to rate their agreement with each of the statements using a 9-point scale, with the option to provide further comments. Consensus for each statement was determined by counting the number of panelists whose rating was outside the 3-point region containing the median. Results: We invited 76 people with degree in medicine, physiotherapy, kinesiology, and experience in the management of osteoporotic vertebral; 31 (41%) and 27 (36%) experts agreed to participate to the first and the second round, respectively. The mean percentage agreement after the first and second rounds was 76.6% ± 16.0% and 90.7% ± 6.5%, respectively. We established consensus on recommendations on pain, early satiety, weight loss, bracing, safe movement, and exercise for individuals with acute and chronic vertebral fractures. Conclusion: Our international consensus provides multidisciplinary biopsychosocial recommendations to guide the management of osteoporotic vertebral fractures and inform interventions for future research. [ABSTRACT FROM AUTHOR]