Differences across health care systems in outcome and cost-utility of surgical and conservative treatment of chronic low back pain: a study protocol

BACKGROUND: There is little evidence on differences across health care systems in choice and outcome of the treatment of chronic low back pain (CLBP) with spinal surgery and conservative treatment as the main options. At least six randomised controlled trials comparing these two options have been performed; they show conflicting results without clear-cut evidence for superior effectiveness of any of the evaluated interventions and could not address whether treatment effect varied across patient subgroups. Cost-utility analyses display inconsistent results when comparing surgical and conservative treatment of CLBP. Due to its higher feasibility, we chose to conduct a prospective observational cohort study. METHODS: This study aims to examine if1. Differences across health care systems result in different treatment outcomes of surgical and conservative treatment of CLBP2. Patient characteristics (work-related, psychological factors, etc.) and co-interventions (physiotherapy, cognitive behavioural therapy, return-to-work programs, etc.) modify the outcome of treatment for CLBP3. Cost-utility in terms of quality-adjusted life years differs between surgical and conservative treatment of CLBP.This study will recruit 1000 patients from orthopaedic spine units, rehabilitation centres, and pain clinics in Switzerland and New Zealand. Effectiveness will be measured by the Oswestry Disability Index (ODI) at baseline and after six months. The change in ODI will be the primary endpoint of this study.Multiple linear regression models will be used, with the change in ODI from baseline to six months as the dependent variable and the type of health care system, type of treatment, patient characteristics, and co-interventions as independent variables. Interactions will be incorporated between type of treatment and different co-interventions and patient characteristics. Cost-utility will be measured with an index based on EQol-5D in combination with cost data. CONCLUSION: This study will provide evidence if differences across health care systems in the outcome of treatment of CLBP exist. It will classify patients with CLBP into different clinical subgroups and help to identify specific target groups who might benefit from specific surgical or conservative interventions. Furthermore, cost-utility differences will be identified for different groups of patients with CLBP. Main results of this study should be replicated in future studies on CLBP.

Tracer profiles across argillaceous formations: A tool to constrain transport processes.

The spatial distributions of non-reactive natural tracers (anions, stable water isotopes, noble gases) in pore water of clay-rich formations were studied at nine sites. Regular curved profiles were identified in most cases. Transport modeling considering diffusion, advection and available constraints on the paleo-hydrogeological evolution indicates generally that diffusion alone can explain the observations, whereas a marked advective component would distort the profiles and so is not consistent with the data.

More adaptive versus less maladaptive coping: What is more predictive of symptom severity? Development of a new scale to investigate coping profiles across different psychopathological syndromes

BACKGROUND: Lack of adaptive and enhanced maladaptive coping with stress and negative emotions are implicated in many psychopathological disorders. We describe the development of a new scale to investigate the relative contribution of different coping styles to psychopathology in a large population sample. We hypothesized that the magnitude of the supposed positive correlation between maladaptive coping and psychopathology would be stronger than the supposed negative correlation between adaptive coping and psychopathology. We also examined whether distinct coping style patterns emerge for different psychopathological syndromes. METHODS: A total of 2200 individuals from the general population participated in an online survey. The Patient Health Questionnaire-9 (PHQ-9), the Obsessive-Compulsive Inventory revised (OCI-R) and the Paranoia Checklist were administered along with a novel instrument called Maladaptive and Adaptive Coping Styles (MAX) questionnaire. Participants were reassessed six months later. RESULTS: MAX consists of three dimensions representing adaptive coping, maladaptive coping and avoidance. Across all psychopathological syndromes, similar response patterns emerged. Maladaptive coping was more strongly related to psychopathology than adaptive coping both cross-sectionally and longitudinally. The overall number of coping styles adopted by an individual predicted greater psychopathology. Mediation analysis suggests that a mild positive relationship between adaptive and certain maladaptive styles (emotional suppression) partially accounts for the attenuated relationship between adaptive coping and depressive symptoms. LIMITATIONS: Results should be replicated in a clinical population. CONCLUSIONS: Results suggest that maladaptive and adaptive coping styles are not reciprocal. Reducing maladaptive coping seems to be more important for outcome than enhancing adaptive coping. The study supports transdiagnostic approaches advocating that maladaptive coping is a common factor across different psychopathologies.

Magnetic and gravity measurements on North-South profiles across the Grosse Meteor Bank, North Atlantic

During the first section of the "Meteor" cruise No. 2 a profile was run from the Azores to the south across the flanks of the Mid-Atlantic Ridge with a chain of seamounts. The profile extended between the Cruiser (living) and the Hyeres seamounts, which, according to our soundings, form a connected massif, and across the centre of the Grosse Meteor Bank (30°N, 28.5 °W). These seamounts rise from a depth of more than 4000 m up till close to the surface of the sea forming there a large almost flat plateau. In the case of the Grosse Meteor Bank, this plateau has a N-S extension of approx. 30 nautical miles and an E-W extension of approx. 20 nautical miles and reaches a height of 275 m in water depth. The gravity measurements yielded a density of the topographic masses of 2.6 g/cm**3 for the Grosse Meteor Bank. Magnitude and shape of the measured free-air anomaly are very well shown in a model computation with this density. The theoretical gravity effects of the seismically detected swell of cristalline rock and of the Moho depression (mountain root) are not indicated by the observational data. It can, therefore, be assumed that the latter two neutralize each other. It seems, accordingly, that there is no local isostatic compensation of the topographic masses. Hence, the density of 2.6 g/cm**3 obtained would be about the true density of rock. In connection with the mean velocity of P waves (Aric et al., 1968) obtained by seismic refraction methods it must be concluded that the material of the 1200-4000 m thick surface layer of the Grosse Meteor Bank consists of consolidated sediments. This finding is supported by the total intensity of the Earth's magnetic field over the Grosse Meteor Bank. On the assumption of a homogeneous magnetization in the direction of the present Earth's field, the computed anomaly of the massif deviates considerably from the measured anomaly while the magnetic field of the seismically detected crystalline body is capable of interpreting the observed data. Deviating from the prevailing interpretation of the seamounts' plateau as a volcanic cone with submarine abrasion, the Grosse Meteor Bank and the seamounts in the vicinity are assumed to be of continental origin. The questions whether these seamounts submerged later on or whether the sealevel has risen subsequently are, therefore, largely nonexistent.

Do cover crops enhance N2O, CO2 or CH4 emissions from soil in Mediterranean arable systems?

This study evaluates the effect of planting three cover crops (CCs) (barley, Hordeum vulgare L.; vetch, Vicia villosa L.; rape, Brassica napus L.) on the direct emission of N2O, CO2 and CH4 in the intercrop period and the impact of incorporating these CCs on the emission of greenhouse gas (GHG) from the forthcoming irrigated maize (Zea mays L.) crop. Vetch and barley were the CCs with the highest N2O and CO2 losses (75 and 47% increase compared with the control, respectively) in the fallow period. In all cases, fluxes of N2O were increased through N fertilization and the incorporation of barley and rape residues (40 and 17% increase, respectively). The combination of a high C:N ratio with the addition of an external source of mineral N increased the fluxes of N2O compared with − Ba and − Rp. The direct emissions of N2O were lower than expected for a fertilized crop (0.10% emission factor, EF) compared with other studies and the IPCC EF. These results are believed to be associated with a decreased NO3− pool due to highly denitrifying conditions and increased drainage. The fluxes of CO2 were in the range of other fertilized crops (i.e., 1118.71–1736.52 kg CO2–C ha− 1). The incorporation of CC residues enhanced soil respiration in the range of 21–28% for barley and rape although no significant differences between treatments were detected. Negative CH4 fluxes were measured and displayed an overall sink effect for all incorporated CC (mean values of − 0.12 and − 0.10 kg CH4–C ha− 1 for plots with and without incorporated CCs, respectively).

Geometry of profiles across Inner Continental Shelves of the Atlantic and Gulf coasts of the United States /

Along most of the U.S. east and gulf coasts from Long Island to the Mexican Border, bottom profiles extending over the Inner Continental Shelves normal from the coast display a characteristic two-sector shape. Near the coast, the 'shoreface' profile sector is steep and concave-up; the seaward 'ramp' sector is planar with a gradual slope away from the coast. As part of the Beach Evaluation Program at this Center, 9 profiles extending from the coast 30.5 km (19 miles) seaward at each of 49 localities were averaged to mathematically characterize the profiles and to develop and test criteria for discriminating among groups of profiles. Results indicate Inner Continental Shelf profiles can be mathematically defined by 4 parameters: a = ramp slope (0 - 0.00107); b = depth of the ramp at the shoreline, when the ramp is extended as a straight line below the shoreface sector (0 - 24.7 meters, 0 - 81 feet); c = distance from the shoreline to the shoreface-ramp boundary (0.2 - 20.6 km, 0.12 - 12.9 miles); and f = index of concavity of the shoreface sector (0.21 - 1.72). Values in parentheses are the range of values obtained for the 49 averaged profiles. An equation was developed to define bottom depth as a function of distance from shore incorporating these four parameters. Computed depths using the equation were found to be generally within 5% of actual profile depths. In most cases, no relationship was found between the geometric characteristics of the shoreface and the ramp.

The response of lake margin sedimentary systems to climatically driven lake level fluctuations : Middle Devonian, Orcadian Basin, Scotland

Peer reviewed

The response of lake margin sedimentary systems to climatically driven lake level fluctuations : Middle Devonian, Orcadian Basin, Scotland

Peer reviewed

The response of lake margin sedimentary systems to climatically driven lake level fluctuations : Middle Devonian, Orcadian Basin, Scotland

Peer reviewed

Native Phloem and Wood Borers in Australian Mediterranean Forest Trees

Native Mediterranean forests in Australia are dominated by two tree genera, Eucalyptus and Acacia, while Pinus and Eucalyptus dominate plantation forestry. In native forests, there is a high diversity of phloem and wood borers across several families in the Coleoptera and Lepidoptera. In the Coleoptera, cerambycid beetles (Cerambycidae), jewel beetles (Buprestidae), bark, ambrosia and pinhole beetles (Curculionidae) and pinworms (Lymexelidae) are some of the most commonly found beetles attacking eucalypts and acacias. In the Lepidoptera, wood moths (Cossidae), ghost moths (Hepialidae) and borers in the Xyloryctidae (subfamily Xyloryctinae) are most common. In contrast to native forests, there is a much more limited range of native insects present in Australian plantations, particularly in exotic Pinus spp. plantations, although eucalypt plantations do share some borers in common with native forests. This chapter reviews the importance of these borers in Australian forests primarily from an economic perspective (i.e. those species that cause damage to commercial tree species) and highlights a paucity of native forest species that commonly kill trees relative to the large scales regularly seen in North America and Europe.

Soil food web properties explain ecosystem services across European land use systems

Intensive land use reduces the diversity and abundance of many soil biota, with consequences for the processes that they govern and the ecosystem services that these processes underpin. Relationships between soil biota and ecosystem processes have mostly been found in laboratory experiments and rarely are found in the field. Here, we quantified, across four countries of contrasting climatic and soil conditions in Europe, how differences in soil food web composition resulting from land use systems (intensive wheat rotation, extensive rotation, and permanent grassland) influence the functioning of soils and the ecosystem services that they deliver. Intensive wheat rotation consistently reduced the biomass of all components of the soil food web across all countries. Soil food web properties strongly and consistently predicted processes of C and N cycling across land use systems and geographic locations, and they were a better predictor of these processes than land use. Processes of carbon loss increased with soil food web properties that correlated with soil C content, such as earthworm biomass and fungal/bacterial energy channel ratio, and were greatest in permanent grassland. In contrast, processes of N cycling were explained by soil food web properties independent of land use, such as arbuscular mycorrhizal fungi and bacterial channel biomass. Our quantification of the contribution of soil organisms to processes of C and N cycling across land use systems and geographic locations shows that soil biota need to be included in C and N cycling models and highlights the need to map and conserve soil biodiversity across the world.

N2O emissions and N efficiency due to tillage systems and crop rotation under a rainfed Mediterranean agroecosystem

Application of nitrogen (N) fertilizers in agricultural soils increases the risk of N loss to the atmosphere in the form of ammonia (NH3), nitrous oxide (N2O) and nitric oxide (NO)and the water bodies as nitrate (NO3-). The implementation of agricultural management practices can affect these losses. In Mediterranean irrigation systems, the greatest losses of NO3-through leaching occur within the irrigation and the intercropperiod. One way to abate these losses during the intercrop period is the use of cover crops that absorb part of the residual N from the root zone (Gabriel and Quemada, 2011). Moreover, during the following crop, these species could be applied as amendments to the soil, providing both C and N to the soil. This effect of cover and catch crops on decreasing the pool of N potentially lost has focused primarily on NO3-leaching. The aim of this work was to evaluate the effect of cover crops on N2O emission during the in tercrop period in a maize system and its subsequent incorporation into the soil in the following maize crop.