Acceptance and commitment therapy for fibromyalgia: A randomized controlled trial

Background

Recent developments within cognitive behavior therapy (CBT) have emphasized the utility of acceptance and mindfulness strategies, contrasting interventions focused on reduction or control of symptoms. A study of fMRI changes after CBT in females with fibromyalgia (FM) has been performed and results are presented elsewhere (under review). The aim of the present study was evaluate the effectiveness of Acceptance and Commitment Therapy (ACT)-based intervention for patient diagnosed with FM in comparison with a wait-list control

Method

Female patients aged 18–55 years, fulfilling the American College of Rheumatology classification criteria for FM, and with a weekly self-reported average pain intensity of >40 (VAS 0–100) were considered eligible for inclusion. Participants completed a set of questionnaires prior to treatment, immediately following the treatment and at follow 3–4 months post treatment. Primary outcome variable was pain disability (PDI). FIQ, SF36, SES, STAI, pain intensity, BDI, PIPS (psychological inflexibility in pain scale) were also used. The ACT-intervention consisted of twelve weekly group sessions, ten with psychologist and two with pain physician. Treatment was evaluated and mediation analyses were performed.

Results

Primary outcome measure (PDI): A significant improvement in pain disability for ACT in relation to the control condition, p < 0.001. Secondary outcome measures: ACT showed significant improvement in mental health quality of life, self-efficacy, depression, and anxiety. Consistent with hypotheses, ACT did not result in significant changes in either physical quality of life or pain intensity. Mediation analyses: A decrease in psychological inflexibility from pre to post assessments significantly mediated the improvement in pain disability.

Conclusion

The present study supports the utility of using a relatively brief ACT intervention in a group format for women diagnosed with fibromyalgia, and data suggests a mediating function on improvements in psychological flexibility.

Temperature- and magnetic-field-dependent longitudinal spin relaxation in nitrogen-vacancy ensembles in diamond

We present an experimental study of the longitudinal electron-spin relaxation time (T1) of negatively charged nitrogen-vacancy (NV) ensembles in diamond. T1 was studied as a function of temperature from 5 to 475 K and magnetic field from 0 to 630 G for several samples with various NV and nitrogen concentrations. Our studies reveal three processes responsible for T1 relaxation. Above room temperature, a two-phonon Raman process dominates; below room temperature, we observe an Orbach-type process with an activation energy of 73(4) meV, which closely matches the local vibrational modes of the NV center. At yet lower temperatures, sample dependent cross-relaxation processes dominate, resulting in temperature independent values of T1 from milliseconds to minutes. The value of T1 in this limit depends sensitively on the magnetic field and can be tuned by more than 1 order of magnitude.

Increased steady-state VO2 and larger O2 deficit with CO2 inhalation during exercise

AIM

To examine whether inhalation of CO(2) -enriched gas would increase steady-state VO(2) during exercise and enlarge O(2) deficit.

METHODS

Ten physically active men (VO(2) 53.7 ± 3.6 mL min(-1) kg(-1) ; x ± SD) performed transitions from low-load cycling (baseline; 40 W) to work rates representing light (≈ 45% VO(2); 122 ± 15 W) and heavy (≈ 80% VO(2); 253 ± 29 W) exercise while inhaling normal air (air) or a CO(2) mixture (4.2% CO(2) , 21% O(2) , balance N(2) ). Gas exchange was measured with Douglas bag technique at baseline and at min 0-2, 2-3 and 5-6.

RESULTS

Inhalation of CO(2) -enriched air consistently induced respiratory acidosis with increases in PCO(2) and decreases in capillary blood pH (P < 0.01). Hypercapnic steady-state VO(2) was on average about 6% greater (P < 0.01) than with air in both light and heavy exercise, presumably because of increased cost of breathing (ΔVE 40-50 L min(-1) ; P < 0.01), and a substrate shift towards increased lipid oxidation (decline in R 0.12; P < 0.01). VO(2) during the first 2 min of exercise were not significantly different whereas the increase in VO(2) from min 2-3 to min 5-6 in heavy exercise was larger with CO(2) than with air suggesting a greater VO(2) slow component. As a result, O(2) deficit was greater with hypercapnia in heavy exercise (2.24 ± 0.51 L vs. 1.91 ± 0.45 L; P < 0.05) but not in light (0.64 ± 0.21 L vs. 0.54 ± 0.20 L; ns).

CONCLUSION

Inhalation of CO(2)-enriched air and the ensuing respiratory acidosis increase steady-state VO(2) in both light and heavy exercise and enlarges O(2) deficit in heavy exercise.

Slide-based ergometer rowing: effects on force production and neuromuscular activity

Force production profile and neuromuscular activity during slide-based and stationary ergometer rowing at standardized submaximal power output were compared in 14 male and 8 female National Team rowers. Surface electromyography (EMG) was obtained in selected thoracic and leg muscles along with synchronous measurement of handle force and rate of force development (RFD). Compared to stationary conditions, slide-based peak force decreased by 76 (57-95) N (mean 95% CI) in males (P < 0.001) and 20 (8-31) N (P < 0.05) in females. Stroke rate increased (+10.7%) and late-phase RFD decreased (-20.7%) in males (P < 0.05). Neuromuscular activity in m. vastus lateralis decreased in the initial drive phase from 59% to 51% of EMG max in males and from 57% to 52% in females (P < 0.01-0.05), while also decreasing in the late recovery phase from 20% to 7% in males and 17% to 7% in females (P < 0.01). Peak force and maximal neuromuscular activity in the shoulder retractors always occurred in the second quartile of the drive phase. In conclusion, peak force and late-phase RFD (males) decreased and stroke rate increased (males) during slide-based compared to stationary ergometer rowing, potentially reducing the risk of overuse injury. Neuromuscular activity was more affected in leg muscles than thoracic muscles by slide-based ergometer rowing.

Results of ambulatory pH monitoring do not reliably predict response to therapy in patients with eosinophilic oesophagitis

BACKGROUND

The consensus statements for eosinophilic oesophagitis recommend that ambulatory pH monitoring is one means of determining if gastro-oesophageal reflux is the cause of oesophageal eosinophilia and should guide pharmacological therapy.

AIM

To evaluate prospectively the accuracy of pH monitoring as a predictor of endoscopic, histological and symptomatic response in patients with oesophageal eosinophilia.

METHODS

We conducted a prospective trial in which patients with oesophageal eosinophilic infiltration with ≥15 eos/hpf underwent a 24-h pH study and were placed in one of two treatment arms for 6 weeks based on positive or negative results. Patients with abnormal acid exposure were treated with esomeprazole 40 mg twice daily and others were treated with oral viscous budesonide 1 g twice daily. Response to treatment was assessed by oesophageal histology (<5 eos/hpf) and symptoms.

RESULTS

A total of 51 patients were enrolled in the study. The average patient age was 39 years and 31 patients (61%) were male. The average number of eosinophils per hpf, prior to study enrolment was 41.2 (range 15-140, s.d. 27.7). Nineteen (37%) had positive pH studies and 32 (63%) had negative pH studies. Eighteen patients completed treatment with esomeprazole. Only eleven (61%) had histological response and, of these eleven, five (46%) had symptomatic improvement. A total of 28 patients with normal acid exposure completed treatment with budesonide. Only 16 (57%) had histological and 11 (69%) had symptomatic improvement.

CONCLUSION

In this prospective trial of pH-guided treatment, neither positive nor negative results of initial pH monitoring accurately predicted response to therapy.

Ultrasound-guided bilateral dual transversus abdominis plane block: a new four-point approach

BACKGROUND

We describe a new ultrasound-guided bilateral dual transversus abdominis plane block. Our hypothesis was that we could anaesthetize both the upper (Th6-Th9) and the lower (Th10-Th12) abdominal wall bilaterally using a four-point single-shot technique to provide effective post-operative analgesia.

METHODS

A prospective cohort of 25 recovery room patients was included. They had undergone major open or laparoscopic abdominal surgery under general anaesthesia and had severe post-operative pain. The blocks were conducted using a high-frequency linear transducer and a 22 G, 80-mm-long needle. The needle was inserted in-plane from medial to lateral for each injection. Fifteen millilitres of bupivacaine 2.5 mg/ml was injected at each of the four sites.

RESULTS

Block performance took on average 16 min (range 10-20 min). The 25 patients reported a reduction of their maximum pain (visual analogue scale 0-10) from a mean of 8.2 to a mean of 2.2 10 min after block performance (P<0.001). They were discharged from the post-anaesthesia care unit after an average of 34 min. Twenty-one patients (84%) did not require any i.v. opioids in the following 6 h. Sixteen patients (64%) were mobilized within 6 h after the block. Data were similar irrespective of open or laparoscopic surgery (P=0.68).

CONCLUSION

This new four-point single-shot technique was effective in decreasing severe pain after a major abdominal surgery. The block, although short-lived, facilitated discharge from the post-anaesthesia care unit, few patients required opioids on the day of surgery and mobilization was improved.

Patent data mining: a tool for accelerating HIV vaccine innovation

Global access to advanced vaccine technologies is challenged by the interrelated components of intellectual property (IP) management strategies, technology transfer (legal and technical) capabilities and the capacity necessary for accelerating R&D, commercialization and delivery of vaccines. Due to a negative association with the management of IP, patents are often overlooked as a vast resource of freely available, information akin to scientific journals as well as business and technological information and trends fundamental for formulating policies and IP management strategies. Therefore, a fundamental step towards facilitating global vaccine access will be the assembly, organization and analysis of patent landscapes, to identify the amount of patenting, ownership (assignees) and fields of technology covered. This is critical for making informed decisions (e.g., identifying licensees, building research and product development collaborations, and ascertaining freedom to operate). Such information is of particular interest to the HIV vaccine community where the HIV Vaccine Enterprise, have voiced concern that IP rights (particularly patents and trade secrets) may prevent data and materials sharing, delaying progress in research and development of a HIV vaccine. We have compiled and analyzed a representative HIV vaccine patent landscape for a prime-boost, DNA/adenoviral vaccine platform, as an example for identifying obstacles, maximizing opportunities and making informed IP management strategy decisions towards the development and deployment of an efficacious HIV vaccine.

Ultrasound-guided continuous suprascapular nerve block for adhesive capsulitis: one case and a short topical review

We present a case with an ultrasound-guided (USG) placement of a perineural catheter beneath the transverse scapular ligament in the scapular notch to provide a continuous block of the suprascapular nerve (SSN). The patient suffered from a severe and very painful adhesive capsulitis of the left shoulder secondary to an operation in the same shoulder conducted 20 weeks previously for impingement syndrome and a superior labral anterior-posterior tear. Following a new operation with capsular release, the placement of a continuous nerve block catheter subsequently allowed for nearly pain-free low impact passive and guided active mobilization by the performing physiotherapist for three consecutive weeks. This case and a short topical review on the use of SSN block in painful shoulder conditions highlight the possibility of a USG continuous nerve block of the SSN as sufficient pain management in the immediate post-operative period following capsular release of the shoulder. Findings in other painful shoulder conditions and suggestions for future studies are discussed in the text.

Ergometer rowing with and without slides

A rowing ergometer can be placed on a slide to imitate 'on-water' rowing. The present study examines I) possible differences in biomechanical and physiological variables of ergometer rowing with and without slides and II) potential consequences on training load during exercise. 7 elite oars-women rowed in a randomized order in a slide or stationary ergometer at 3 predefined submaximal and at maximal intensity. Oxygen uptake was measured and biomechanical variables of the rowing were calculated based upon handle force (force transducer) and velocity/length (potentiometer) of the stroke. Stroke frequency was higher (%-difference between conditions) at each intensity level (1-11.4%, p<0.05) during slide compared to stationary rowing. Furthermore, at the 2 highest intensities a lower mean force (4.7-9.0%, p<0.05) and max force (3.2-10.6%, p<0.05) were observed on the slide ergometer. During maximal rowing no difference was seen in heart rate, mean oxygen uptake and R-value while maximal oxygen deficit was higher (30.8%, p<0.05) during slide rowing. In conclusion the biomechanical load is lower on a slide than on a stationary ergometer. However, as a training tool the slide ergometer seems just as demanding with regard to aerobic energy sources, and for anaerobic sources possibly even higher, compared with the stationary ergometer.

Quantum noise limited and entanglement-assisted magnetometry

We study experimentally the fundamental limits of sensitivity of an atomic radio-frequency magnetometer. First, we apply an optimal sequence of state preparation, evolution, and the backaction evading measurement to achieve a nearly projection noise limited sensitivity. We furthermore experimentally demonstrate that Einstein-Podolsky-Rosen entanglement of atoms generated by a measurement enhances the sensitivity to pulsed magnetic fields. We demonstrate this quantum limited sensing in a magnetometer utilizing a truly macroscopic ensemble of 1.5x10(12) atoms which allows us to achieve subfemtotesla/square root(Hz) sensitivity.

High quality anti-relaxation coating material for alkali atom vapor cells

We present an experimental investigation of alkali atom vapor cells coated with a high quality anti-relaxation coating material based on alkenes. The prepared cells with single compound alkene based coating showed the longest spin relaxation times which have been measured up to now with room temperature vapor cells. Suggestions are made that chemical binding of a cesium atom and an alkene molecule by attack to the C = C bond plays a crucial role in such improvement of anti-relaxation coating quality.

Non-linear analysis of the structure of variability in midfoot kinematics

INTRODUCTION

Evaluation of structural variability in biological time series through measures such as sample entropy (SaEn) has provided important information in neurology and cardiology. This has contributed to the development of the "loss of complexity hypothesis" where high variability has been described as healthy flexibility and low variability associated with pathology. The purpose of this study was to calculate sample entropy (SaEn) to establish normal values of non-linear variability and to examine which factors are associated with SaEn in midfoot kinematics.

METHOD

Static foot posture was measured using Foot Posture Index. A video sequence analysis system was used to quantify midfoot kinematics during walking in the sagittal plane. SaEn was calculated for navicular drop during stand phase as an expression of the dynamic complexity.

RESULTS

A significant difference was observed between the three major foot types and between genders (p<0.001). Mean SaEn in women were 1.10+/-0.19 (supinated foot posture), 0.96+/-0.17 (neutral foot posture) and 0.77+/-0.16 (pronated foot posture) and 1.25+/-0.24 (supinated foot posture), 1.06+/-0.23 (neutral foot posture) and 0.86+/-0.19 (pronated foot posture) in males. The regression model showed that foot posture and dynamic navicular drop (dND) were both associated with SaEn.

CONCLUSION

This study confirmed that non-linear analysis is of relevance in the interpretation of kinematic data. Pronated foot posture, large navicular drop and women were characterized by low values of non-linear variability. Future studies should investigate if measurements of SaEn are capable of identifying subjects with an increased risk of injury.

Kinetic analysis of evoked IPSCs discloses mechanism of antagonism of synaptic GABAA receptors by picrotoxin

BACKGROUND AND PURPOSE

Although picrotoxin is a well-established antagonist of GABA(A) receptors, detailed studies of its action on inhibitory synaptic transmission have not previously been made.

EXPERIMENTAL APPROACH

Electrophysiological techniques were used to study the action of picrotoxin on inhibitory postsynaptic currents (IPSCs) evoked in hippocampal neurones, in culture and slice preparations prepared from Wistar rat embryos and juveniles, respectively.

KEY RESULTS

Picrotoxin gradually reduced the amplitude of GABA(A) receptor-mediated eIPSCs in a concentration-dependent manner. This was accompanied by a marked acceleration of the eIPSC decay kinetics, which, in contrast to the effect on amplitude, developed immediately and was completely reversed on washing. The decaying phase of the IPSC could be resolved into two components; 30 microM picrotoxin reduced tau(fast) by 34% and increased its relative amplitude, while tau(slow) was reduced by 38%, and its relative amplitude decreased. The area under the decaying phase of the normalized eIPSC showed an immediate reduction by 36% in 30 microM picrotoxin. With increasing concentrations of picrotoxin, this normalized area converged towards 55% of the control, indicating that the rate of relaxation and block has a finite maximum. This implies that picrotoxin does not act by a pore-occluding mechanism (open-channel blocking), and suggests allosteric stabilization of desensitized receptor states as a more likely alternative. This was corroborated by modelling, based on two established microscopic GABA(A) receptor transition schemes.

CONCLUSIONS AND IMPLICATIONS

Although the identity of the stabilized state has not been determined unequivocally, picrotoxin effectively traps synaptic GABA(A) receptors in a desensitized state.

Tuning nanoelectromechanical resonators with mass migration

We demonstrate tuning of nanoelectromechanical resonators via mass migration. Indium nanoparticles can be reversibly migrated to different locations along cantilevered multiwalled carbon nanotube resonators using electrical currents as the control parameter. Nonvolatile mass redistributions result in stable resonant frequency shifts as large as 20%. The tuning method is robust and can be utilized for nanoelectromechanical resonators operating at frequencies from audio to microwave.

Generation of two-mode squeezed and entangled light in a single temporal and spatial mode

We analyse a novel squeezing and entangling mechanism which is due to correlated Stokes and anti-Stokes photon forward scattering in a multi-level atom vapour. We develop a full quantum model for an alkali atomic vapour including quantized collective atomic states which predicts high degree of squeezing for attainable experimental conditions. Following the proposal we present an experimental demonstration of 3.5 dB pulsed frequency nondegenerate squeezed (quadrature entangled) state of light using room temperature caesium vapour. The source is very robust and requires only a few milliwatts of laser power. The squeezed state is generated in the same spatial mode as the local oscillator and in a single temporal mode. The two entangled modes are separated by twice the Zeeman frequency of the vapour which can be widely tuned. The narrow-band squeezed light generated near an atomic resonance can be directly used for atom-based quantum information protocols. Its single temporal mode characteristics make it a promising resource for quantum information processing.

The successful use of peripheral nerve blocks for femoral amputation

We present a case report of four patients with severe cardiac insufficiency where peripheral nerve blocks guided by either nerve stimulation or ultrasonography were the sole anaesthetic for above-knee amputation. The patients were breathing spontaneously and remained haemodynamically stable during surgery. Thus, use of peripheral nerve blocks for femoral amputation in high-risk patients seems to be the technique of choice that can lower perioperative risk.

SSADH deficiency leads to elevated extracellular GABA levels and increased GABAergic neurotransmission in the mouse cerebral cortex

Succinic semialdehyde dehydrogenase (SSADH) deficiency is an inherited disorder in which patients display neurodevelopmental retardation, ataxia, and epileptic seizures. The recently engineered SSADH knock-out (KO) mouse models the severe form of the human disorder. The SSADH enzyme participates in the breakdown of the inhibitory neurotransmitter GABA, and studies have shown increases in brain GABA and downregulation of GABA(A) receptor beta(2) subunits in the cerebral cortex of these mice. Here, we used brain slice electrophysiology to investigate the alterations in GABA neurotransmission in SSADH KO mouse cortex. In layer 2/3 pyramidal cells, spontaneous inhibitory postsynaptic currents (IPSCs), reflecting activity of GABAergic synaptic contacts, were normal in SSADH KO mice. Also, IPSCs evoked by electrical single-axon stimulation in KO mice were normal. In contrast, tonic inhibition mediated by presumed extrasynaptic GABA(A) receptors was strongly increased, indicating significantly raised extracellular GABA levels. The excessive cortical GABAergic neurotransmission may participate in the seizure activity in SSADH deficiency.

An atomic-resolution nanomechanical mass sensor

Mechanical resonators are widely used as inertial balances to detect small quantities of adsorbed mass through shifts in oscillation frequency. Advances in lithography and materials synthesis have enabled the fabrication of nanoscale mechanical resonators, which have been operated as precision force, position and mass sensors. Here we demonstrate a room-temperature, carbon-nanotube-based nanomechanical resonator with atomic mass resolution. This device is essentially a mass spectrometer with a mass sensitivity of 1.3 x 10(-25) kg Hz(-1/2) or, equivalently, 0.40 gold atoms Hz(-1/2). Using this extreme mass sensitivity, we observe atomic mass shot noise, which is analogous to the electronic shot noise measured in many semiconductor experiments. Unlike traditional mass spectrometers, nanomechanical mass spectrometers do not require the potentially destructive ionization of the test sample, are more sensitive to large molecules, and could eventually be incorporated on a chip.

Spin squeezing of atomic ensembles via nuclear-electronic spin entanglement

We demonstrate spin squeezing in a room temperature ensemble of approximately 10(12) cesium atoms using their internal structure, where the necessary entanglement is created between nuclear and electronic spins of each individual atom. This state provides improvement in measurement sensitivity beyond the standard quantum limit for quantum memory experiments and applications in quantum metrology and is thus a complementary alternative to spin squeezing obtained via interatom entanglement. Squeezing of the collective spin is verified by quantum state tomography.

Nanotube radio

We have constructed a fully functional, fully integrated radio receiver from a single carbon nanotube. The nanotube serves simultaneously as all essential components of a radio: antenna, tunable band-pass filter, amplifier, and demodulator. A direct current voltage source, as supplied by a battery, powers the radio. Using carrier waves in the commercially relevant 40-400 MHz range and both frequency and amplitude modulation techniques, we demonstrate successful music and voice reception.

Post-operative recovery profile after laparoscopic cholecystectomy: a prospective, observational study of a multimodal anaesthetic regime

BACKGROUND

Laparoscopic cholecystectomy is now often an ambulatory procedure, but dependent on short-term post-operative complaints of pain and post-operative nausea and vomiting (PONV). The efficacy of post-anaesthesia care units (PACUs) is therefore important to facilitate return to normal functions. We investigated the feasibility and efficacy of a standardized, evidence-based anaesthesia/analgesic regime to identify residual problems in the early post-operative phase.

METHODS

One hundred and thirty-four consecutive patients admitted for elective laparoscopic cholecystectomy at Hvidovre University Hospital between 15 March and 30 September 2005 were included in the study. The standardized, evidence-based regime consisted of total intravenous (i.v.) anaesthesia (propofol-remifentanil), well-defined fluid therapy, dexamethasone, ketorolac, ondansetron, sufentanil and incisional bupivacaine intra-operatively, and in the PACU on demand (prn) administration of sufentanil, morphine, paracetamol, ondansetron, droperidol, oral fluids and oxygen (if SpO(2) < 93%) with PACU discharge using a modified Aldrete score.

RESULTS

Protocol violations were moderate and occurred unsystematically, 8% had medical violations and 10% did not receive the pre-planned fluid amount. Severe PONV was seen in 2%. Thirteen per cent experienced severe pain, and the presence of any pain and/or PONV were predictors of an extended PACU stay. Mean oxygen demand was 46 min (range, 0-300 min), which influenced time to discharge (mean, 88 min). There were on average 2.7 treatment interventions (range, 0-11) before discharge.

CONCLUSION

An evidence-based, multimodal approach to the anaesthetic/analgesic management in laparoscopic cholecystectomy is feasible and advantageous in the early post-operative phase. Pain and PONV are predictors of a complicated recovery profile and deserve further attention. Transient oxygen desaturations postpone discharge from the PACU, but the clinical significance of this fact is questionable.

SEVEN NEW YORKERIA SPECIES (CESTODA: TETRAPHYLLIDEA) FROM BORNEO AND AUSTRALIA AND THEIR IMPLICATIONS FOR IDENTIFICATION OF CHILOSCYLLIUM (ELASMOBRANCHII: ORECTOLOBIFORMES) SPECIES

New material of Yorkeria Southwell, 1927, collected from Chiloscyllium Müller & Henle species, i.e., bamboo sharks, from Malaysian Borneo and eastern Australia was found to include specimens that appear to be consistent with, and thus allow redescription of, the poorly characterized type of the genus, Yorkeria parva Southwell, 1927, as well as 7 new species of tetraphyllidean cestodes from the genus Yorkeria. Discovered in Borneo were Y. parva and Yorkeria teeveeyi n. sp. from Chiloscyllium indicum (Gmelin), Yorkeria garneri n. sp. from Chiloscyllium hasselti Bleeker, Yorkeria pusillulus n. sp., Yorkeria saliputium n. sp., and Yorkeria yubodohensis n. sp. from Chiloscyllium punctatum Miller & Henle. In Australia, a shark species tentatively identified as Chiloscyllium cf. punctatum was found to host Yorkeria izardi n. sp. and Yorkeria longstaffae n. sp. Three of the new species resemble Yorkeria kelleyae Caira & Tracy, 2002, described from sharks identified as C. punctatum in Thailand, in their possession of medial and lateral hooks that are approximately equal in length. All 3 can be distinguished from Y. kelleyae, however, in their possession of vitelline follicles that are not interrupted at the level of the ovary; they differ from one another in that 1 is hyperapolytic (Y. saliputium n. sp.), and the other 2 possess round (Y. pusillulus n. sp.) versus tapered (Y. longstaffae n. sp.) bothridia. Among species with medial and lateral hooks that are conspicuously unequal in length, only Y. izardi n. sp. possesses bothridia that taper posteriorly and almost completely overlap the cephalic peduncle, stopping just short of its posterior margin. Yorkeria garneri n. sp. is distinctive in its possession of mature proglottids that are only slightly longer than wide, rather than distinctly longer than wide. Particularly notable is Y. teeveeyi n. sp., which bears a stobila on which 2-3 of the subterminal proglottids are consistently more mature than the terminal proglottid. Yorkeria yubodohensis n. sp. most closely resembles Y. parva, differing in the pattern of microtriches seen on its scolex, and also in its possession of relatively fewer proglottids. This brings the total number of Yorkeria species described worldwide to 12. The host associations of these cestodes raise questions about the conspecificity of bamboo shark specimens identified as C. punctatum in Thailand, Borneo, and Australia, since individuals in each of these 3 regions appear to host distinctive, nonoverlapping Yorkeria faunas. A key to the 12 known species of Yorkeria is provided.