Cardiovascular Disease Risk Factors Predict the Development and Numbers of Common Musculoskeletal Disorders in a Prospective Cohort

OBJECTIVE

The aim of the study is to assess risk of common musculoskeletal disorders (MSDs) based on cardiovascular disease (CVD) risk scores.

METHODS

Data from a 9-year prospective cohort of 1224 workers in three states were analyzed. Baseline data included questionnaires, structured interviews, physical examinations, anthropometric measurements, nerve conduction studies, and individualized measurement of job physical factors. Monthly follow-ups were conducted. Framingham risk scores were calculated. A priori case definitions were constructed for carpal tunnel syndrome, lateral epicondylopathy, medial epicondylopathy, and rotator cuff tendinopathy.

RESULTS

Adjusted RRs for one or more MSDs increased to 3.90 (95% confidence interval, 2.20-6.90) among those with 10-year cardiovascular disease risk scores greater than 15% and 17.4 (95% confidence interval, 3.85-78.62) among those with more than 4 disorders.

CONCLUSIONS

Cardiovascular disease factors are strongly associated with the subsequent development of common MSDs. Risks among those with multiple MSDs are considerably stronger.

Climate-driven variation in dispersal ability predicts responses to forest fragmentation in birds

Species sensitivity to forest fragmentation varies latitudinally, peaking in the tropics. A prominent explanation for this pattern is that historical landscape disturbance at higher latitudes has removed fragmentation-sensitive species or promoted the evolution of more resilient survivors. However, it is unclear whether this so-called extinction filter is the dominant driver of geographic variation in fragmentation sensitivity, particularly because climatic factors may also cause latitudinal gradients in dispersal ability, a key trait mediating sensitivity to habitat fragmentation. Here we combine field survey data with a morphological proxy for avian dispersal ability (hand-wing index) to assess responses to forest fragmentation in 1,034 bird species worldwide. We find that fragmentation sensitivity is strongly predicted by dispersal limitation and that other factors-latitude, body mass and historical disturbance events-have relatively limited explanatory power after accounting for species differences in dispersal. We also show that variation in dispersal ability is only weakly predicted by historical disturbance and more strongly associated with intra-annual temperature fluctuations (seasonality). Our results suggest that climatic factors play a dominant role in driving global variation in the impacts of forest fragmentation, emphasizing the need for more nuanced environmental policies that take into account local context and associated species traits.

The effect of urban environments on the diversity of plants in unmanaged grasslands in Los Angeles, United States

Urbanization is a strong driver of plant diversity and may have complex effects on developed ecosystems. Nevertheless, it remains unclear whether urban environments increase or decrease plant biodiversity compared with rural environments. Further, it is also unclear how non-native plant species contribute to spatial diversity patterns and ecosystem services. Better understanding these diversity drivers across gradients of urbanization has the potential to enhance native species conservation (e.g., targeted restoration activities), leading to positive feedbacks for broader promotion of biodiversity and societal benefits (e.g., links with native biodiversity and human health). In this study, we hypothesized that for plant species in unmanaged grasslands, urbanization would lead to declines in diversity at both small and medium scales. We established a network of remnant grassland sites across an urban to rural gradient in Los Angeles, CA, USA. Across this gradient we assessed patterns of alpha and beta diversity during the 2019 growing season. We found that local plant alpha diversity in remnant grasslands declined in urban landscapes (measured by surrounding percent development) due mostly to loss of native species. However, at intermediate scales across unmanaged parks and greenspaces, we saw increases in beta diversity at more urban locations. This was possibly due to the patchy dominance of different exotic species at urban locations; whereas, in rural locations non-native and native species were common across plots. Conservation is often informed by examinations of large scale, city-wide assessment of diversity, however, our results show that urban plant diversity, particularly native species, is affected at all spatial scales and beta-diversity can add important insights into how to manage urban ecosystems. Conservation that accounts for alpha and beta diversity may promote “virtuous cycle” frameworks where the promotion and protection of biodiversity simultaneously reduces the negative effects of invasion.

Urban parks are a refuge for birds in park-poor areas

Urban parks provide amenities that support both human and animal communities. However, parks are often unevenly distributed within cities. One metric used to assess the distribution of parks to the public is termed the Park Score. The Park Score is an approach to measure access, acreage, investment, and amenities, and is designed to understand a city’s needs for greenspace, with a major focus on public health. In addition to issues related to public health, a disparity in the distribution of urban parks may pose a barrier for wildlife, such as birds. Yet, this remains unclear. We designed a study to quantify the role of parks in providing a refuge for birds across a park-needs gradient in Greater Los Angeles (LA), a metropolis with one of the lowest park scores in the United States. We had two objectives to address our goal. First, we quantified patterns in habitat features and avian communities within and adjacent to parks. Second, we analyzed relationships among habitat features within and adjacent to parks on avian abundance. We sampled birds and habitat features at 48 parks across a park-needs gradient in L.A. from October to March of 2017/2018 and 2018/2019. We found three lines of evidence supporting the refugia effect of parks. First, habitat features within parks were similar between low- and high-needs areas of LA, and this likely influenced avian abundance patterns, which were also alike. Second, avian communities were generally similar across the park-needs gradient, where parks in high-needs areas harbored birds affiliated with forest and shrub ecosystems. Third, bird abundance patterns were related to numerous habitat features within parks, regardless of where parks occurred in the city. The patterns we uncovered were opposite to what is found in residential areas (i.e., luxury effect), suggesting that parks provide important habitat for birds, whether in high- or low-needs sections of LA. Our results stress the role of parks as refugia in park-poor areas because they provide habitat in otherwise inhospitable urban conditions. Continued investment in park development in high-needs areas can thus potentially be a win-win when considering the benefits to people and birds.

The Coexistence of Carpal Tunnel Syndrome in Workers With Trigger Digit

Background: The objective of this study was to investigate the prevalence of carpal tunnel syndrome (CTS) in workers with trigger digit. There are few cross-sectional studies that assess this relationship. Methods: A baseline examination of 1216 workers from 17 diverse manufacturing facilities was conducted. Worker demographics, medical history, and symptoms of trigger digit were assessed. Age, sex, and body mass index were obtained. Biomechanical factors were individually measured using the Strain Index (SI). Prevalence was assessed with univariate and multivariate logistic regression. Results: Unadjusted prevalence of trigger digit was 12.0%, and among those workers, there was an unadjusted CTS prevalence of 26.7%. The adjusted multivariate model found an odds ratio (OR) of CTS of 1.56 (95% confidence interval [CI], 1.03-2.36) among the workers with trigger digit. The ORs of CTS for SI (OR = 1.53 [95% CI, 1.04-2.23]), age (OR = 1.03 [95% CI, 1.01-1.04]), and current smoking (OR = 1.76 [95% CI, 1.12-2.75]) were also significant. Sex and diabetes were not statistically significant covariates. Conclusion: The prevalence of CTS is higher among workers with trigger digit.

Large Cities Fall Behind in “Neighborhood Biodiversity”

Urbanization is a major driver of global species loss. While cities with suitable habitats and conservation policies may support locally-high biodiversity levels, we suspected that the complexity of managing very large cities might counteract the advantage of large geographic area, and these cities may be less effective at biodiversity conservation. To answer this, we examined the relationship between the number of native indicator wildlife species (mean and maximum) in 112 cities across three metropolitan areas in California (Los Angeles, San Diego, and San Jose), with metrics related to scale and environmental variables. We found that indicator species richness is positively related to area, income (the luxury effect), and pervious cover—including trees, shrubs, and grasses. Despite having a high maximum number of indicator species within their boundaries, the largest cities in our study, Los Angeles, San Jose, and San Diego, do a relatively poor job compared with smaller cities at distributing native biodiversity throughout neighborhoods, as measured by their mean species richness. Such variation in “neighborhood biodiversity” may exacerbate existing inequities in residents' access to nature. Using Los Angeles County as a case study, we compared biodiversity management within the County's 88 cities of various sizes and characteristics. We ranked General Plan wording in terms of references to biodiversity and conservation and created a management metric. We found that municipalities of various sizes that had high management scores generally had high indicator species richness. This suggests that robust policies may be able to overcome the challenges posed by city size and population.

The importance of street trees to urban avifauna

Street trees are public resources planted in a municipality's right-of-way and are a considerable component of urban forests throughout the world. Street trees provide numerous benefits to people. However, many metropolitan areas have a poor understanding of the value of street trees to wildlife, which presents a gap in our knowledge of conservation in urban ecosystems. Greater Los Angeles (LA) is a global city harboring one of the most diverse and extensive urban forests on the planet. The vast majority of the urban forest is nonnative in geographic origin, planted throughout LA following the influx of irrigated water in the early 1900s. In addition to its extensive urban forest, LA is home to a high diversity of birds, which utilize the metropolis throughout the annual cycle. The cover of the urban forest, and likely street trees, varies dramatically across a socioeconomic gradient. However, it is unknown how this variability influences avian communities. To understand the importance of street trees to urban avifauna, we documented foraging behavior by birds on native and nonnative street trees across a socioeconomic gradient throughout LA. Affluent communities harbored a unique composition of street trees, including denser and larger trees than lower-income communities, which in turn, attracted nearly five times the density of feeding birds. Foraging birds strongly preferred two native street-tree species as feeding substrates, the coast live oak (Quercus agrifolia) and the California sycamore (Platanus racemosa), and a handful of nonnative tree species, including the Chinese elm (Ulmus parvifolia), the carrotwood (Cupaniopsis anacardioides), and the southern live oak (Quercus virginiana), in greater proportion than their availability throughout the cityscape (two to three times their availability). Eighty-three percent of street-tree species (n = 108, total) were used in a lower proportion than their availability by feeding birds, and nearly all were nonnative in origin. Our findings highlight the positive influence of street trees on urban avifauna. In particular, our results suggest that improved street-tree management in lower-income communities would likely positively benefit birds. Further, our study provides support for the high value of native street-tree species and select nonnative species as important habitat for feeding birds.

What can we learn from wildlife sightings during the COVID-19 global shutdown?

During the worldwide shutdown in response to the COVID-19 pandemic, many reports emerged of urban wildlife sightings. While these images garnered public interest and declarations of wildlife reclaiming cities, it is unclear whether wildlife truly reoccupied urban areas or whether there were simply increased detections of urban wildlife during this time. Here, we detail key questions and needs for monitoring wildlife during the COVID-19 shutdown and then link these with future needs and actions with the intent of improving conservation within urban ecosystems. We discuss the tools ecologists and conservation scientists can use to safely and effectively study urban wildlife during the shutdown. With a coordinated, multicity effort, researchers and community scientists can rigorously investigate the responses of wildlife to changes in human activities, which can help us address long-standing questions in urban ecology, inspire conservation of wildlife, and inform the design of sustainable cities.

Support for the habitat amount hypothesis from a global synthesis of species density studies

Decades of research suggest that species richness depends on spatial characteristics of habitat patches, especially their size and isolation. In contrast, the habitat amount hypothesis predicts that (1) species richness in plots of fixed size (species density) is more strongly and positively related to the amount of habitat around the plot than to patch size or isolation; (2) habitat amount better predicts species density than patch size and isolation combined, (3) there is no effect of habitat fragmentation per se on species density and (4) patch size and isolation effects do not become stronger with declining habitat amount. Data on eight taxonomic groups from 35 studies around the world support these predictions. Conserving species density requires minimising habitat loss, irrespective of the configuration of the patches in which that habitat is contained.

International haemovigilance: what have we learned and what do we need to do next?

The International Haemovigilance Network (IHN) defines haemovigilance as 'a set of surveillance procedures covering the whole transfusion chain (from the collection of blood and its components to the follow-up of recipients), intended to collect and assess information on unexpected or undesirable effects resulting from the therapeutic use of labile blood products, and to prevent their occurrence or recurrence'. IHN, the International Society of Blood Transfusion and World Health Organization work together to support both developing and established haemovigilance systems. Haemovigilance systems provide valuable data on a range of adverse events related to blood donation and clinical transfusion, from donor syncopal events to transfusion-transmitted infections, immunological complications and the impact of human errors. Harmonised definitions for most adverse reactions have been developed and validated internationally. Definitions of pulmonary complications are again under review. Haemovigilance data have resulted in changes in policy, products and practice, and can complement and inform clinical audit and research, leading to improved blood donor safety, optimised product use and better clinical outcomes after transfusion. However, more work is needed. Not all countries have haemovigilance systems in place. More robust data and careful analysis are required to improve the understanding of the causes, occurrence and clinical outcomes of these events. Wider dissemination of results will facilitate health policy development internationally, and implementation of haemovigilance recommendations will support further important progress in blood safety.

A time-driven, activity-based costing methodology for determining the costs of red blood cell transfusion in patients with beta thalassaemia major

OBJECTIVES

To describe the methodology to estimate the total cost of administration of a single unit of red blood cells (RBC) in adults with beta thalassaemia major in an Australian specialist haemoglobinopathy centre.

BACKGROUND

Beta thalassaemia major is a genetic disorder of haemoglobin associated with multiple end-organ complications and typically requiring lifelong RBC transfusion therapy. New therapeutic agents are becoming available based on advances in understanding of the disorder and its consequences. Assessment of the true total cost of transfusion, incorporating both product and activity costs, is required in order to evaluate the benefits and costs of these new therapies.

METHODS

We describe the bottom-up, time-driven, activity-based costing methodology used to develop process maps to provide a step-by-step outline of the entire transfusion pathway. Detailed flowcharts for each process are described. Direct observations and timing of the process maps document all activities, resources, staff, equipment and consumables in detail. The analysis will include costs associated with performing these processes, including resources and consumables. Sensitivity analyses will be performed to determine the impact of different staffing levels, timings and probabilities associated with performing different tasks.

RESULTS

Thirty-one process maps have been developed, with over 600 individual activities requiring multiple timings. These will be used for future detailed cost analyses.

CONCLUSIONS

Detailed process maps using bottom-up, time-driven, activity-based costing for determining the cost of RBC transfusion in thalassaemia major have been developed. These could be adapted for wider use to understand and compare the costs and complexities of transfusion in other settings.

Massive transfusions for critical bleeding: is everything old new again?

Massive transfusion or major haemorrhage protocols have been widely adopted in the treatment of critically bleeding patients. Following evidence that higher ratios of transfused plasma and platelets to red blood cells may offer survival benefits in military trauma patients, these ratios are now commonly incorporated into massive transfusion protocols. They more closely resemble the effects of whole blood transfusion, which in the second half of last century was largely replaced by individual blood component transfusion based on laboratory-guided indicators. However, high-quality evidence to guide transfusion support for critically bleeding patients across the range of bleeding contexts is lacking, including for both trauma and non-trauma patients. More data on major haemorrhage support and clinical outcomes are needed to inform guidelines and practice.

Day or overnight transfusion in critically ill patients: does it matter?

BACKGROUND AND OBJECTIVES

The timing of blood administration in critically ill patients is first driven by patients' needs. This study aimed to define the epidemiology and significance of overnight transfusion in critically ill patients.

MATERIALS AND METHODS

This is a post hoc analysis of a prospective multicentre observational study including 874 critically ill patients receiving red blood cells, platelets, fresh frozen plasma (FFP) or cryoprecipitate. Characteristics of patients receiving blood only during the day (8 am up until 8 pm) were compared to those receiving blood only overnight (8 pm up until 8 am). Characteristics of transfusion were compared, and factors independently associated with major bleeding were analysed.

RESULTS

The 287 patients transfused during the day only had similar severity and mortality to the 258 receiving blood products overnight only. Although bleeding-related admission diagnoses were similar, major bleeding was the indication for transfusion in 12% of patients transfused in daytime only versus 30% of patients transfused at night only (P < 0·001). Similar total amount of blood products were transfused at day and night (2856 versus 2927); however, patients were more likely to receive FFP and cryoprecipitate at night compared with daytime. Overnight transfusion was independently associated with increased odds of major bleeding (odds ratio, 3·16, 95% confidence interval, 2·00-5·01).

CONCLUSION

Transfusion occurs evenly across day and night in ICU; nonetheless, there are differences in type of blood products administered that reflect differences in indication. Critically ill patients were more likely to receive blood for major bleeding at night irrespective of admission diagnosis.

Winter range expansion of a hummingbird is associated with urbanization and supplementary feeding

Anthropogenic changes to the landscape and climate cause novel ecological and evolutionary pressures, leading to potentially dramatic changes in the distribution of biodiversity. Warm winter temperatures can shift species' distributions to regions that were previously uninhabitable. Further, urbanization and supplementary feeding may facilitate range expansions and potentially reduce migration tendency. Here we explore how these factors interact to cause non-uniform effects across a species's range. Using 17 years of data from the citizen science programme Project FeederWatch, we examined the relationships between urbanization, winter temperatures and the availability of supplementary food (i.e. artificial nectar) on the winter range expansion (more than 700 km northward in the past two decades) of Anna's hummingbirds (Calypte anna). We found that Anna's hummingbirds have colonized colder locations over time, were more likely to colonize sites with higher housing density and were more likely to visit feeders in the expanded range compared to the historical range. Additionally, their range expansion mirrored a corresponding increase over time in the tendency of people to provide nectar feeders in the expanded range. This work illustrates how humans may alter the distribution and potentially the migratory behaviour of species through landscape and resource modification.

Association between wrist ratio and carpal tunnel syndrome: Effect modification by body mass index

INTRODUCTION

Previous studies have reported higher wrist ratios (WR) related to carpal tunnel syndrome (CTS) but have not assessed effect modification by obesity and may have inadequately controlled for confounders.

METHODS

Baseline data of a multicenter prospective cohort study were analyzed. CTS was defined by nerve conduction study (NCS) criteria and symptoms.

RESULTS

Among the 1,206 participants, a square-shaped wrist was associated with CTS after controlling for confounders (prevalence ratio = 2.27; 95% confidence interval [95% CI], 1.33-3.86). Body mass index (BMI) was a strong effect modifier on the relationship between WR and both CTS and abnormal NCS results, with normal weight strata of rectangular versus square wrists = 8.18 (95% CI, 1.63-49.96) and 7.12 (95% CI, 2.19-23.16), respectively.

DISCUSSION

A square wrist is significantly associated with CTS after controlling for confounders. Effect modification by high BMI masked the eightfold magnitude adjusted relationship seen between WR and CTS among normal weight participants. Muscle Nerve 56: 1047-1053, 2017.

Association between Epicondylitis and Cardiovascular Risk Factors in Pooled Occupational Cohorts

Background

The pathophysiology of lateral epicondylitis (LE) is unclear. Recent evidence suggests some common musculoskeletal disorders may have a basis in cardiovascular disease (CVD) risk factors. Thus, we examined CVD risks as potential LE risks.

Methods

Workers (n = 1824) were enrolled in two large prospective studies and underwent structured interviews and physical examinations at baseline. Analysis of pooled baseline data assessed the relationships separately between a modified Framingham Heart Study CVD risk score and three prevalence outcomes of: 1) lateral elbow pain, 2) positive resisted wrist or middle finger extension, and 3) a combination of both symptoms and at least one resisted maneuver. Quantified job exposures, personal and psychosocial confounders were statistically controlled. Odds ratios (ORs) and 95% Confidence Intervals (CIs) were calculated.

Results

There was a strong relationship between CVD risk score and lateral elbow symptoms, resisted wrist or middle finger extension and LE after adjustment for confounders. The adjusted ORs for symptoms were as high as 3.81 (95% CI 2.11, 6.85), for positive examination with adjusted odds ratios as high as 2.85 (95% CI 1.59, 5.12) and for combined symptoms and physical examination 6.20 (95% CI 2.04, 18.82). Relationships trended higher with higher CVD risk scores.

Conclusions

These data suggest a potentially modifiable disease mechanism for LE.

Evaluation of clinical coding data to determine causes of critical bleeding in patients receiving massive transfusion: a bi-national, multicentre, cross-sectional study

OBJECTIVES

To evaluate the use of routinely collected data to determine the cause(s) of critical bleeding in patients who receive massive transfusion (MT).

BACKGROUND

Routinely collected data are increasingly being used to describe and evaluate transfusion practice.

MATERIALS/METHODS

Chart reviews were undertaken on 10 randomly selected MT patients at 48 hospitals across Australia and New Zealand to determine the cause(s) of critical bleeding. Diagnosis-related group (DRG) and International Classification of Diseases (ICD) codes were extracted separately and used to assign each patient a cause of critical bleeding. These were compared against chart review using percentage agreement and kappa statistics.

RESULTS

A total of 427 MT patients were included with complete ICD and DRG data for 427 (100%) and 396 (93%), respectively. Good overall agreement was found between chart review and ICD codes (78·3%; κ = 0·74, 95% CI 0·70-0·79) and only fair overall agreement with DRG (51%; κ = 0·45, 95% CI 0·40-0·50). Both ICD and DRG were sensitive and accurate for classifying obstetric haemorrhage patients (98% sensitivity and κ > 0·94). However, compared with the ICD algorithm, DRGs were less sensitive and accurate in classifying bleeding as a result of gastrointestinal haemorrhage (74% vs 8%; κ = 0·75 vs 0·1), trauma (92% vs 62%; κ = 0·78 vs 0·67), cardiac (80% vs 57%; κ = 0·79 vs 0·60) and vascular surgery (64% vs 56%; κ = 0·69 vs 0·65).

CONCLUSION

Algorithms using ICD codes can determine the cause of critical bleeding in patients requiring MT with good to excellent agreement with clinical history. DRG are less suitable to determine critical bleeding causes.

Improving outcomes for hospital patients with critical bleeding requiring massive transfusion: the Australian and New Zealand Massive Transfusion Registry study methodology

Background

The Australian and New Zealand (ANZ) Massive Transfusion (MT) Registry (MTR) has been established to improve the quality of care of patients with critical bleeding (CB) requiring MT (≥ 5 units red blood cells (RBC) over 4 h). The MTR is providing data to: (1) improve the evidence base for transfusion practice by systematically collecting data on transfusion practice and clinical outcomes; (2) monitor variations in practice and provide an opportunity for benchmarking, and feedback on practice/blood product use; (3) inform blood supply planning, inventory management and development of future clinical trials; and (4) measure and enhance translation of evidence into policy and patient blood management guidelines. The MTR commenced in 2011. At each participating site, all eligible patients aged ≥18 years with CB from any clinical context receiving MT are included using a waived consent model. Patient information and clinical coding, transfusion history, and laboratory test results are extracted for each patient’s hospital admission at the episode level.

Results

Thirty-two hospitals have enrolled and 3566 MT patients have been identified across Australia and New Zealand between 2011 and 2015. The majority of CB contexts are surgical, followed by trauma and gastrointestinal haemorrhage. Validation studies have verified that the definition of MT used in the registry correctly identifies 94 % of CB events, and that the median time of transfusion for the majority of fresh products is the ‘product event issue time’ from the hospital blood bank plus 20 min. Data linkage between the MTR and mortality databases in Australia and New Zealand will allow comparisons of risk-adjusted mortality estimates across different bleeding contexts, and between countries. Data extracts will be examined to determine if there are differences in patient outcomes according to transfusion practice. The ratios of blood components (e.g. FFP:RBC) used in different types of critical bleeding will also be investigated.

Conclusions

The MTR is generating data with the potential to have an impact on management and policy decision-making in CB and MT and provide benchmarking and monitoring tools for immediate application.

The International Haemovigilance Network Database for the Surveillance of Adverse Reactions and Events in Donors and Recipients of Blood Components: technical issues and results

BACKGROUND AND OBJECTIVES

The International Haemovigilance Network's ISTARE is an online database for surveillance of all adverse reactions (ARs) and adverse events (AEs) associated with donation of blood and transfusion of blood components, irrespective of severity or the harm caused. ISTARE aims to unify the collection and sharing of information with a view to harmonizing best practices for haemovigilance systems around the world.

MATERIALS AND METHODS

Adverse reactionss and adverse events are recorded by blood component, type of reaction, severity and imputability to transfusion, using internationally agreed standard definitions.

RESULTS

From 2006 to 2012, 125 national sets of annual aggregated data were received from 25 countries, covering 132.8 million blood components issued. The incidence of all ARs was 77.5 per 100 000 components issued, of which 25% were severe (19.1 per 100 000). Of 349 deaths (0.26 per 100 000), 58% were due to the three ARs related to the respiratory system: transfusion-associated circulatory overload (TACO, 27%), transfusion-associated acute lung injury (TRALI, 19%) and transfusion-associated dyspnoea (TAD, 12%). Cumulatively, 594 477 donor complications were reported (rate 660 per 100 000), of which 2.9% were severe.

CONCLUSIONS

ISTARE is a well-established surveillance tool offering important contributions to international efforts to maximize transfusion safety.

Wildlife Conservation and Private Protected Areas: The Discrepancy Between Land Trust Mission Statements and Their Perceptions

In 2010, land trusts in the U.S. had protected nearly 50 million acres of land, with much of it providing habitat for wildlife. However, the extent to which land trusts explicitly focus on wildlife conservation remains largely unknown. We used content analysis to assess land trust involvement in wildlife and habitat conservation, as reflected in their mission statements, and compared these findings with an organizational survey of land trusts. In our sample of 1358 mission statements, we found that only 17 % of land trusts mentioned "wildlife," "animal," or types of wildlife, and 35 % mentioned "habitat" or types. Mission statements contrasted sharply with results from a land trust survey, in which land trusts cited wildlife habitat as the most common and significant outcome of their protection efforts. Moreover, 77 % of land trusts reported that at least half of their acreage protected wildlife habitat, though these benefits are likely assumed. Importantly, mission statement content was not associated with the percentage of land reported to benefit wildlife. These inconsistencies suggest that benefits to wildlife habitat of protected land are recognized but may not be purposeful and strategic and, thus, potentially less useful in contributing toward regional wildlife conservation goals. We outline the implications of this disconnect, notably the potential omission of wildlife habitat in prioritization schema for land acquisition and potential missed opportunities to build community support for land trusts among wildlife enthusiasts and to develop partnerships with wildlife conservation organizations.

A Clinical Trial on Weight Loss among Truck Drivers

Background:

The high prevalence of obesity among commercial truck drivers may be related to sedentary nature of the job, lack of healthy eating choices, and lack of exercise. There may be a link between obesity and crash risk, therefore an intervention to reduce obesity in this population is needed.

Objective:

To assess feasibility of a 12-week weight loss intervention for truck drivers with a weight loss goal of 10% of initial body weight.

Methods:

Drivers were selected based on age (≥21 years) and body mass index (≥30 kg/m²). The drivers participated in a before-after clinical trial. The intervention included a 12-week program that provided information on healthy diet and increasing exercise, and telephone-based coaching using SMART goals. Outcomes included change from baseline in reported energy intake, measured weight, waist, hip, and neck circumference, blood pressure, and point of care capillary blood lipids and hemoglobin A1c. Exit interviews were conducted to gain insight into driver opinions on the program features and usefulness. This study was registered with the NIH Clinical Trials Registry, number NCT02348983.

Results:

12 of 13 drivers completed the study. Weight loss was statistically significant (p=0.03). Reported energy (p=0.005), total fat consumption (p=0.04), and saturated fat consumption (p=0.02) intake were also lower after the 12-week intervention. Drivers attributed their weight loss to health coaching and suggested a longer intervention so that they could reach their goal and become accustomed to the changes.

Conclusion:

This weight loss intervention is feasible for this difficult population. Additional research is needed to compare this intervention with a control group.

Systematic temporal patterns in the relationship between housing development and forest bird biodiversity

As people encroach increasingly on natural areas, one question is how this affects avian biodiversity. The answer to this is partly scale-dependent. At broad scales, human populations and biodiversity concentrate in the same areas and are positively associated, but at local scales people and biodiversity are negatively associated with biodiversity. We investigated whether there is also a systematic temporal trend in the relationship between bird biodiversity and housing development. We used linear regression to examine associations between forest bird species richness and housing growth in the conterminous United States over 30 years. Our data sources were the North American Breeding Bird Survey and the 2000 decennial U.S. Census. In the 9 largest forested ecoregions, housing density increased continually over time. Across the conterminous United States, the association between bird species richness and housing density was positive for virtually all guilds except ground nesting birds. We found a systematic trajectory of declining bird species richness as housing increased through time. In more recently developed ecoregions, where housing density was still low, the association with bird species richness was neutral or positive. In ecoregions that were developed earlier and where housing density was highest, the association of housing density with bird species richness for most guilds was negative and grew stronger with advancing decades. We propose that in general the relationship between human settlement and biodiversity over time unfolds as a 2-phase process. The first phase is apparently innocuous; associations are positive due to coincidence of low-density housing with high biodiversity. The second phase is highly detrimental to biodiversity, and increases in housing density are associated with biodiversity losses. The long-term effect on biodiversity depends on the final housing density. This general pattern can help unify our understanding of the relationship of human encroachment and biodiversity response.

Prevalence of low back pain by anatomic location and intensity in an occupational population

Background

Low Back Pain (LBP) is a common and costly problem, with variation in prevalence. Epidemiological reports of rating of pain intensity and location within the low back area are rare. The objective is to describe LBP in a large, multi-center, occupational cohort detailing both point and 1-month period prevalence of LBP by location and intensity measures at baseline.

Methods

In this cross-sectional report from a prospective cohort study, 828 participants were workers enrolled from 30 facilities performing a variety of manual material handling tasks. All participants underwent a structured interview detailing pain rating and location. Symptoms in the lower extremities, demographic and other data were collected. Body mass indices were measured. Outcomes are pain rating (0–10) in five defined lumbar back areas (i) LBP in the past month and (ii) LBP on the day of enrollment. Pain ratings were reported on a 0–10 scale and subsequently collapsed with ratings of 1–3, 4–6 and 7–10 classified as low, medium and high respectively.

Results

172 (20.8%) and 364 (44.0%) of the 828 participants reported pain on the day of enrollment or within the past month, respectively. The most common area of LBP was in the immediate paraspinal area with 130 (75.6%) participants with point prevalence LBP and 278 (77.4%) with 1-month period prevalence reported having LBP in the immediate paraspinal area. Among those 364 reporting 1-month period prevalence pain, ratings varied widely with 116 (31.9%) reporting ratings classified as low, 170 (46.7%) medium and 78 (21.4%) providing high pain ratings in any location. Among the 278 reporting 1-month period prevalence pain in the immediate paraspinal area, 89 (32.0%) reported ratings classified as low, 129 (46.4%), medium and 60 (21.6%) high pain ratings.

Conclusions

Pain ratings varied widely, however less variability was seen in pain location, with immediate paraspinal region being the most common. Variations may suggest different etiological factors related to LBP. Aggregation of different locations of pain or different intensities of pain into one binary classification of LBP may result in loss of information which may potentially be useful in prevention or treatment of LBP.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2474-15-283) contains supplementary material, which is available to authorized users.

Elucidating the clinical characteristics of patients captured using different definitions of massive transfusion

BACKGROUND AND OBJECTIVES

The type and clinical characteristics of patients identified with commonly used definitions of massive transfusion (MT) are largely unknown. The objective of this study was to define the clinical characteristics of patients meeting different definitions of MT for the purpose of patient recruitment in observational studies.

MATERIALS AND METHODS

Data were extracted on all patients who received red blood cell (RBC) transfusions in 2010 at three tertiary Australian hospitals. MT patients were identified according to three definitions: ≥10 units RBC in 24 h (10/24 h), ≥6 units RBC in 6 h (6/6 h) and ≥5 units RBC in 4 h (5/4 h). Clinical coding data were used to assign bleeding context. Data on in-hospital mortality were also extracted.

RESULTS

Five hundred and forty-two patients met at least one MT definition, with 236 (44%) included by all definitions. The most inclusive definition was 5/4 h (508 patients, 94%) followed by 6/6 h (455 patients, 84%) and 10/24 h (251 patients, 46%). Importantly, 40-55% of most types of critical bleeding events and 82% of all obstetric haemorrhage cases were excluded by the 10/24 h definition. Patients who met both the 5/4 h and 10/24 h definitions were transfused more RBCs (19 vs. 8 median total RBC units; P < 0·001), had longer ventilation time (120 vs. 55 h; P < 0·001), median ICU (149 vs. 99 h; P < 0·001) and hospital length of stay (23 vs. 18 h; P = 0·006) and had a higher in-hospital mortality rate (23·3% vs. 16·4%; P = 0·050).

CONCLUSION

The 5/4 h MT definition was the most inclusive, but combination with the 10/24 h definition appeared to identify a clinically important patient cohort.

Impacts of differences in epidemiological case definitions on prevalence for upper-extremity musculoskeletal disorders

OBJECTIVE

The aim of this study was to systematically evaluate prevalence based on variations in case definitions used for epidemiological studies of musculoskeletal disorders (MSDs).

BACKGROUND

Prior studies of MSDs have mostly relied on a single case definition based on questionnaires.

METHOD

In a multicenter prospective cohort study, we systematically collected data to evaluate impacts of differences in case definitions of MSDs on prevalence of three common musculoskeletal disorders: (a) shoulder tendinosis, (b) lateral epicondylalgia, and (c) carpal tunnel syndrome. Production workers were from 21 employment settings in three diverse U.S. states and performed widely varying work. All workers completed laptop-administered structured interviews, two standardized physical examinations, and nerve conduction studies (NCS). Case definitions included symptoms only, and symptoms plus physical examinations and/or NCS.

RESULTS

A total of 1,227 subjects had complete health data at baseline. The prevalence for shoulder tendinosis is 23.0% if only glenohumeral pain is used for a case definition, compared with 8.0% if a combination of pain plus a positive supraspinatus test is used. The prevalence for lateral epicondylalgia varied on the basis of lateral elbow pain (12.0%), pain plus tenderness on palpation (9.9%), or pain plus tenderness on palpation plus resisted wrist or middle finger extension (3.5%). Carpal tunnel syndrome prevalence varied on the basis of tingling or numbness in a median nerve-served digit (29.9%) or tingling or numbness plus NCS abnormalities consistent with carpal tunnel syndrome (9.0%).

CONCLUSION

Variations in epidemiological case definitions have major impacts on prevalence of common MSDs. Wide-ranging differences in prevalence may have impacts on purported risk factors that need to be determined.

Low-back pain ratings for lifetime, 1-month period, and point prevalences in a large occupational population

OBJECTIVE

This manuscript systematically quantifies multiple measures of low-back pain (LBP) prevalence by pain rating in a large, multisite cohort of workers.

BACKGROUND

Published LBP prevalence rates vary. Studies rely on one measure of LBP and none report prevalence stratified by pain rating.

METHOD

Cross-sectional analyses of baseline data from a multicenter prospective cohort study were performed to evaluate differences in lifetime prevalence, 1-month period prevalence, and point prevalence of LBP. Workers were from 28 different employment settings in 4 diverse U.S. states. All workers completed computerized questionnaires and structured interviews. LBP prevalence measures were stratified by pain ratings.

RESULTS

A total of 828 subjects had complete health data at baseline. Lifetime prevalence, 1-month period prevalence, and point prevalence for any LBP (> or = 1/10) were 63.4%, 44.0%, and 20.8% respectively. Prevalence of LBP decreased with increasing pain ratings. As an example, using a threshold of LBP > or = 3/10 pain, prevalence measures were 61.0%, 37.6%, and 16.7% respectively. A threshold of LBP > or = 5/10 had prevalence measures of 51.2%, 22.9%, and 9.9% respectively. Age, systolic and diastolic blood pressure, high cholesterol, high blood pressure, and tobacco use were statistically significantly related to lifetime prevalence of LBP.

CONCLUSION

Lifetime LBP prevalence, 1-month period prevalence, and point prevalence stratified by pain ratings demonstrate a wide variation of prevalence measures of LBP and self-reported pain ratings. Higher pain rating thresholds yield lower prevalence measures and may impact assessments of risk factors. Differences in pain ratings may allow for focused surveillance within an occupational cohort.

Housing development erodes avian community structure in U.S. protected areas

Protected areas are a cornerstone for biodiversity conservation, but they also provide amenities that attract housing development on inholdings and adjacent private lands. We explored how this development affects biodiversity within and near protected areas among six ecological regions throughout the United States. We quantified the effect of housing density within, at the boundary, and outside protected areas, and natural land cover within protected areas, on the proportional abundance and proportional richness of three avian guilds within protected areas. We developed three guilds from the North American Breeding Bird Survey, which included Species of Greatest Conservation Need, land cover affiliates (e.g., forest breeders), and synanthropic species associated with urban environments. We gathered housing density data for the year 2000 from the U.S. Census Bureau, and centered the bird data on this year. We obtained land cover data from the 2001 National Land Cover Database, and we used single- and multiple-variable analyses to address our research question. In all regions, housing density within protected areas was positively associated with the proportional abundance or proportional richness of synanthropes, and negatively associated with the proportional abundance or proportional richness of Species of Greatest Conservation Need. These relationships were strongest in the eastern forested regions and the central grasslands, where more than 70% and 45%, respectively, of the variation in the proportional abundance of synanthropes and Species of Greatest Conservation Need were explained by housing within protected areas. Furthermore, in most regions, housing density outside protected areas was positively associated with the proportional abundance or proportional richness of synanthropes and negatively associated with the proportional abundance of land cover affiliates and Species of Greatest Conservation Need within protected areas. However, these effects were weaker than housing within protected areas. Natural land cover was high with little variability within protected areas, and consequently, was less influential than housing density within or outside protected areas explaining the proportional abundance or proportional richness of the avian guilds. Our results indicate that housing development within, at the boundary, and outside protected areas impacts avian community structure within protected areas throughout the United States.

Bacterial safety of cell-based therapeutic preparations, focusing on haematopoietic progenitor cells

Bacterial safety of cellular preparations, especially haematopoietic progenitor cells (HPCs), as well as advanced therapy medicinal products (ATMPs) derived from stem cells of various origins, present a challenge for physicians, manufacturers and regulators. The article describes the background and practical issues in this area and illustrates why sterility of these products cannot currently be guaranteed. Advantages and limitations of approaches both for classical sterility testing and for microbiological control using automated culture systems are discussed. The review considers novel approaches for growth-based rapid microbiological control with high sensitivity and faster availability of results, as well as new methods for rapid bacterial detection in cellular preparations enabling meaningful information about product contamination within one to two hours. Generally, however, these direct rapid methods are less sensitive and have greater sampling error compared with the growth-based methods. Opportunities for pyrogen testing of cell therapeutics are also discussed. There is an urgent need for development of novel principles and methods applicable to bacterial safety of cellular therapeutics. We also need a major shift in approach from the traditional view of sterility evaluation (identify anything and everything) to a new thinking about how to find what is clinically relevant within the time frame available for the special clinical circumstances in which these products are used. The review concludes with recommendations for optimization of microbiological control of cellular preparations, focusing on HPCs.

Image texture predicts avian density and species richness

For decades, ecologists have measured habitat attributes in the field to understand and predict patterns of animal distribution and abundance. However, the scale of inference possible from field measured data is typically limited because large-scale data collection is rarely feasible. This is problematic given that conservation and management typical require data that are fine grained yet broad in extent. Recent advances in remote sensing methodology offer alternative tools for efficiently characterizing wildlife habitat across broad areas. We explored the use of remotely sensed image texture, which is a surrogate for vegetation structure, calculated from both an air photo and from a Landsat TM satellite image, compared with field-measured vegetation structure, characterized by foliage-height diversity and horizontal vegetation structure, to predict avian density and species richness within grassland, savanna, and woodland habitats at Fort McCoy Military Installation, Wisconsin, USA. Image texture calculated from the air photo best predicted density of a grassland associated species, grasshopper sparrow (Ammodramus savannarum), within grassland habitat (R² = 0.52, p-value <0.001), and avian species richness among habitats (R² = 0.54, p-value <0.001). Density of field sparrow (Spizella pusilla), a savanna associated species, was not particularly well captured by either field-measured or remotely sensed vegetation structure variables, but was best predicted by air photo image texture (R² = 0.13, p-value = 0.002). Density of ovenbird (Seiurus aurocapillus), a woodland associated species, was best predicted by pixel-level satellite data (mean NDVI, R² = 0.54, p-value <0.001). Surprisingly and interestingly, remotely sensed vegetation structure measures (i.e., image texture) were often better predictors of avian density and species richness than field-measured vegetation structure, and thus show promise as a valuable tool for mapping habitat quality and characterizing biodiversity across broad areas.

Establishment of the first international repository for transfusion-relevant bacteria reference strains: ISBT working party transfusion-transmitted infectious diseases (WP-TTID), subgroup on bacteria

BACKGROUND

Bacterial contamination of platelet concentrates (PCs) still remains a significant problem in transfusion with potential important clinical consequences, including death. The International Society of Blood Transfusion Working Party on Transfusion-Transmitted Infectious Diseases, Subgroup on Bacteria, organised an international study on Transfusion-Relevant Bacteria References to be used as a tool for development, validation and comparison of both bacterial screening and pathogen reduction methods.

MATERIAL AND METHODS

Four Bacteria References (Staphylococcus epidermidis PEI-B-06, Streptococcus pyogenes PEI-B-20, Klebsiella pneumoniae PEI-B-08 and Escherichia coli PEI-B-19) were selected regarding their ability to proliferate to high counts in PCs and distributed anonymised to 14 laboratories in 10 countries for identification, enumeration and bacterial proliferation in PCs after low spiking (0·3 and 0·03 CFU/ml), to simulate contamination occurring during blood donation.

RESULTS

Bacteria References were correctly identified in 98% of all 52 identifications. S. pyogenes and E. coli grew in PCs in 11 out of 12 laboratories, and K. pneumoniae and S. epidermidis replicated in all participating laboratories. The results of bacterial counts were very consistent between laboratories: the 95% confidence intervals were for S. epidermidis: 1·19-1·32 × 10(7) CFU/ml, S. pyogenes: 0·58-0·69 × 10(7) CFU/ml, K. pneumoniae: 18·71-20·26 × 10(7) CFU/ml and E. coli: 1·78-2·10 × 10(7) CFU/ml.

CONCLUSION

The study was undertaken as a proof of principle with the aim to demonstrate (i) the quality, stability and suitability of the bacterial strains for low-titre spiking of blood components, (ii) the property of donor-independent proliferation in PCs, and (iii) their suitability for worldwide shipping of deep frozen, blinded pathogenic bacteria. These aims were successfully fulfilled. The WHO Expert Committee Biological Standardisation has approved the adoption of these four bacteria strains as the first Repository for Transfusion-Relevant Bacteria Reference Strains and, additionally, endorsed as a project the addition of six further bacteria strain preparations suitable for control of platelet contamination as the next step of enlargement of the repository.

Duffy antigen expression on reticulocytes does not alter following blood loss in an autologous donation model

BACKGROUND

The Duffy blood group (Fy) antigen functions as the receptor whereby the malarial parasite Plasmodium vivax invades reticulocytes. In this study, we evaluated an autologous blood donation model to measure Fy expression during the anticipated response to blood loss.

AIMS

This study aims to examine Fy expression following anticipated reticulocytosis in response to blood loss from autologous whole blood donation.

METHOD

Subjects were healthy blood donors presenting for planned collection of two or three autologous units. Whole blood (450 ml +/- 10%) was collected and processed. Blood samples for Fy testing were obtained from the donations. These were assayed by flow cytometry by measuring binding of a phycoerythrin-labelled anti-Fy6 antibody and compared against reticulocyte numbers. Reticulocyte numbers were measured using thiazole orange. Results were compared from baseline (first donation) with samples at second and, if available, third, donations. Phenotyping for Fy a and b antigens was performed.

RESULTS

Reticulocytes increased by a mean of 37% over baseline [0.93% (range 0.31-1.93) to 1.23% (0.32-3.51%)] following donation of two (n = 32) or three (n = 9) autologous whole blood units. Absolute reticulocyte count remained low. Mean and median Fy expression on mature red blood cells and reticulocytes did not change from baseline levels despite individual variation. No apparent relationship to serologically determined Fy a and/or b antigen status was present.

CONCLUSION

Baseline expression of Fy antigen on mature red blood cells and reticulocytes is quite variable between individuals, but appears not to be greatly affected by mild to moderate reticulocytosis following blood loss in an autologous blood donation model.

Particle size distribution and composition in a mechanically ventilated school building during air pollution episodes

Particle count-based size distribution and PM(2.5) mass were monitored inside and outside an elementary school in Salt Lake City (UT, USA) during the winter atmospheric inversion season. The site is influenced by urban traffic and the airshed is subject to periods of high PM(2.5) concentration that is mainly submicron ammonium and nitrate. The school building has mechanical ventilation with filtration and variable-volume makeup air. Comparison of the indoor and outdoor particle size distribution on the five cleanest and five most polluted school days during the study showed that the ambient submicron particulate matter (PM) penetrated the building, but indoor concentrations were about one-eighth of outdoor levels. The indoor:outdoor PM(2.5) mass ratio averaged 0.12 and particle number ratio for sizes smaller than 1 microm averaged 0.13. The indoor submicron particle count and indoor PM(2.5) mass increased slightly during pollution episodes but remained well below outdoor levels. When the building was occupied the indoor coarse particle count was much higher than ambient levels. These results contribute to understanding the relationship between ambient monitoring station data and the actual human exposure inside institutional buildings. The study confirms that staying inside a mechanically ventilated building reduces exposure to outdoor submicron particles.

PRACTICAL IMPLICATIONS

This study supports the premise that remaining inside buildings during particulate matter (PM) pollution episodes reduces exposure to submicron PM. New data on a mechanically ventilated institutional building supplements similar studies made in residences.

A 'dangerous' group O donor: severe hemolysis in all recipients of organs from a donor with multiple red cell alloantibodies

Alloimmune hemolysis is a recognized but infrequent complication of solid organ transplantation, particularly where there is incompatibility within the ABO blood group system. We describe severe hemolysis due to passenger lymphocyte syndrome (PLS) in all three recipients of organs from a single donor with multiple red cell (RC) alloantibodies. The first patient, a liver transplant recipient, required augmentation of immunosuppression to treat immune hemolysis due to anti-B, -D, -C and -Cellano (k). This is the first description of PLS caused by alloantibody to the high incidence RC antigen, k. The two single lung transplant recipients developed hemolysis due to anti-D. Both required escalation of immunosuppression and early transfusion support. Three months posttransplant, all three patients have ongoing evidence of compensated hemolysis. This series highlights the potential for severe non-ABO-mediated immune hemolysis following solid organ transplantation. A positive donor RC antibody screen should prompt careful monitoring of organ recipients for hemolysis.

Comparison of family histories in FTLD subtypes and related tauopathies

Pedigrees from 269 patients with frontotemporal lobar degeneration (FTLD), including frontotemporal dementia (FTD), FTD with ALS (FTD/ALS), progressive nonfluent aphasia, semantic dementia (SD), corticobasal degeneration, and progressive supranuclear palsy were analyzed to determine the degree of heritability of these disorders. FTD/ALS was the most and SD the least heritable subtype. FTLD syndromes appear to have different etiologies and recurrence risks.

Expression of Duffy antigen receptor for chemokines during reticulocyte maturation: using a CD71 flow cytometric technique to identify reticulocytes

Flow cytometric methods commonly used to identify reticulocytes are of limited usefulness in malarious areas, since RNA staining also detects plasmodia. An important antigen expressed on reticulocytes is Duffy antigen receptor for chemokines (DARC, also known as Fy), the receptor for Plasmodium vivax. An early marker for reticulocytes is CD71 (transferrin receptor). We have been interested in CD71 as an alternative marker for reticulocytes in the context of Fy expression. Flow cytometry was used to determine the expression of Fy on CD71-positive and -negative reticulocytes and to correlate serology and genotype. A reduction of 13 percent was seen in Fy6 expression between CD71-positive reticulocytes and RNA-positive reticulocytes. CD71 disappears early during reticulocyte maturation, while Fy6 expression is relatively preserved. CD71 is an alternative to staining for RNA for reticulocyte assays relating to Fy6 expression.

Audit of a paediatric directed donation programme

OBJECTIVE

A paediatric directed donation programme (DDP) was instituted by Women's and Children's Health in conjunction with the Australian Red Cross Blood Service, Melbourne, Victoria, Australia, in response to public demand following a case of transfusion-transmitted HIV. This audit assesses the first 18 months of the programme.

METHODS

Retrospective analysis, from February 2000 to July 2001, examining the number of units of blood requested, donated, and transfused, as well as the use of allogeneic (non-directed) blood.

RESULTS

The DDP received 125 referrals. Most (78%) were for elective surgery. Of the 89 eligible children, 76% (68) had blood donated for them by an ABO/Rhesus-compatible parent, 81% of whom were first-time blood-donors. No donor tested positive for infectious markers. In total, 221 units of blood were requested and 116 units were collected. Non-collection was mainly a result of parent-child ABO incompatibility or medical ineligibility of the proposed donor. Of the children for whom blood was collected, 28 (41%) received no transfusion and eight (12%) received non-directed components in addition to DDP blood; thus, 32 (47%) received solely the blood from their directed donor. Of the units collected, 53 (46%) were transfused and 63 (54%) were discarded.

CONCLUSIONS

While the paediatric DDP serves a community need, the programme has a high wastage rate, is time-consuming, labour-intensive and an expensive alternative when compared with the provision of non-directed volunteer blood. In continuing the programme, appropriateness of referral needs to be refined to reduce wastage rates.