What's the best way to treat Achilles tendonopathy?

Rest and ice are considered first-line therapy for acute Achilles tendonopathy (strength of recommendation [SOR]: C, expert opinion), as is nonsteroidal anti- inflammatory drugs (NSAIDs) (SOR: B, systematic review). Chronic noninsertional Achilles tendonopathy should be treated with eccentric calf-muscle training (ECMT) (SOR: B, 3 randomized controlled trials [RCTs])

The Relative Importance of Methanogenesis in the Decomposition of Organic Matter in Northern Peatlands

Using an isotope-mass balance approach and assuming the equimolar production of CO2 and CH4 from methanogenesis (e.g., anaerobic decomposition of cellulose), we calculate that the proportion of total CO2 production from methanogenesis varies from 37 to 83% across a variety of northern peatlands. In a relative sense, methanogenesis was a more important pathway for decomposition in bogs (80 ± 13% of CO2 production) than in fens (64 ± 5.7% of CO2 production), but because fens contain more labile substrates they may support higher CH4 production overall. The concentration of CO2 produced from methanogenesis (CO2-meth) can be considered equivalent to CH4 concentration before loss due to ebullition, plant-mediated transport, or diffusion. Bogs produced slightly less CO2-meth than fens (2.9 ±1.3 and 3.7 ±1.4mmol/L, respectively). Comparing the quantity of CH4 present to CO2-meth, fens lost slightly more CH4 than bogs (89 ± 2.8% and 82 ± 5.3%, respectively) likely due to the presence of vascular plant roots. In collapsed permafrost wetlands, bog moats produced half the amount of CO2-meth (0.8 ± 0.2mmol/L) relative to midbogs (1.6 ± 0.6mmol/L) and methanogenesis was less important (42 ± 6.6% of total CO2 production relative to 55 ± 8.1%). We hypothesize that the lower methane production potential in collapsed permafrost wetlands occurs because recently thawed organic substrates are being first exposed to the initial phases of anaerobic decomposition following collapse and flooding. Bog moats lost a comparable amount of CH4 as midbogs (63 ± 7.0% and 64 ± 9.3%)

Anthropogenic activities significantly increase annual greenhouse gas (GHG) fluxes from temperate headwater streams in Germany

Anthropogenic activities increase the contributions of inland waters to global greenhouse gas (GHG; CO$_2$, CH$_4$, and N$_2$O) budgets, yet the mechanisms driving these increases are still not well constrained. In this study, we quantified year-long GHG concentrations, fluxes, and water physico-chemical variables from 28 sites contrasted by land use across five headwater catchments in Germany. Based on linear mixed-effects models, we showed that land use was more significant than seasonality in controlling the intra-annual variability of the GHGs. Streams in agriculture-dominated catchments or with wastewater inflows had up to 10 times higher daily CO$_2$, CH$_4$, and N$_2$O emissions and were also more temporally variable (CV > 55 %) than forested streams. Our findings also suggested that nutrient, labile carbon, and dissolved GHG inputs from the agricultural and settlement areas may have supported these hotspots and hot-moments of fluvial GHG emissions. Overall, the annual emission from anthropogenic-influenced streams in CO$_2$ equivalents was up to 20 times higher (∼ 71 kg CO$_2$ m$^{−2}$ yr$^{−1}$) than from natural streams (∼ 3 kg CO$_2$ m$^{−2}$ yr$^{−1}$), with CO$_2$ accounting for up to 81 % of these annual emissions, while N$_2$O and CH$_4$ accounted for up to 18 % and 7 %, respectively. The positive influence of anthropogenic activities on fluvial GHG emissions also resulted in a breakdown of the expected declining trends of fluvial GHG emissions with stream size. Therefore, future studies should focus on anthropogenically perturbed streams, as their GHG emissions are much more variable in space and time and can potentially introduce the largest uncertainties to fluvial GHG estimates

Surface Production Fuels Deep Heterotrophic Respiration in Northern Peatlands

Multiple analyses of dissolved organic carbon (DOC) from pore waters were conducted to define the processes that govern carbon balance in peatlands: (1) source, reactivity, and transport of DOC with respect to vegetation, peat, and age of carbon substrate, (2) reactivity of DOC with respect to molecular size, and (3) lability to photoxidation of surficial DOC. We found that surface organic production fuels heterotrophic respiration at depth in advection-dominated peatlands, especially in fens. Fen DOC was Δ14Cenriched relative to the surrounding fen peat, and fen respiration products were similar to this enriched DOC indicating that DOC was the main microbial substrate. Bog DOC was more variable showing either enrichment in Δ14C at depth or Δ14C values that follow peat values. This variability in bogs is probably controlled by the relative importance of vertical transport of labile carbon substrates within the peat profile versus DOC production from bog peat. These results extended our set of observations to 10 years at one bog-fen pair and add two additional bog-fen pairs to our series of observations. Anaerobic incubations of peat, rinsed free of residual DOC, produced DOC and respiration products that were strikingly similar to the peat values in a bog and two fens. This result demonstrated conclusively that downward advection is the process responsible for the presence of modern DOC found at depth in the peat column. Fen DOC has lower C/N values and up to twice as much LMW (kDa) DOC as bogs due to differences in organic inputs and greater microbial processing. Fluorescence irradiation experiments showed that fen DOC is more photolabile than bog DOC

`Hath charms to soothe . . .': An exploratory study of how high-functioning adults with ASD experience music

Semi-structured interviews were conducted with 12 highfunctioning adults on the autism spectrum, in order to examine the nature of their personal experiences of music. Consistent with the literature on typically developing people’s engagement with music, the analysis showed that most participants exploit music for a wide range of purposes in the cognitive, emotional and social domains, including mood management, personal development and social inclusion. However, in contrast to typically developing people, the ASD group’s descriptions of mood states reflected a greater reliance on internally focused (arousal) rather than externally focused (emotive) language

Climatic Drivers for Multi-Decadal Shifts in Solute Transport and Methane Production Zones within a Large Peat Basin

Northern peatlands are an important source for greenhouse gases but their capacity to produce methane remains uncertain under changing climatic conditions. We therefore analyzed a 43-year time series of pore-water chemistry to determine if long-term shifts in precipitation altered the vertical transport of solutes within a large peat basin in northern Minnesota. These data suggest that rates of methane production can be finely tuned to multi-decadal shifts in precipitation that drive the vertical penetration of labile carbon substrates within the Glacial Lake Agassiz Peatlands. Tritium and cation profiles demonstrate that only the upper meter of these peat deposits was flushed by downwardly moving recharge from 1965 through 1983 during a Transitional Dry-to-Moist Period. However, a shift to a moister climate after 1984 drove surface waters much deeper, largely flushing the pore waters of all bogs and fens to depths of 2 m. Labile carbon compounds were transported downward from the rhizosphere to the basal peat at this time producing a substantial enrichment of methane in Delta C-14 with respect to the solid-phase peat from 1991 to 2008. These data indicate that labile carbon substrates can fuel deep production zones of methanogenesis that more than doubled in thickness across this large peat basin after 1984. Moreover, the entire peat profile apparently has the capacity to produce methane from labile carbon substrates depending on climate-driven modes of solute transport. Future changes in precipitation may therefore play a central role in determining the source strength of peatlands in the global methane cycle

The effects of expressive writing before or after punch biopsy on wound healing

Objective: Recent studies have shown that written emotional disclosure (expressive writing) performed in the two weeks prior to wounding improves healing of punch biopsy wounds. In many clinical settings, it would be more practical for patients to perform this intervention after wounding. The aim of this study was to investigate whether expressive writing could speed the healing of punch biopsy wounds if writing was performed after wounds were made. Methods: One hundred and twenty-two healthy participants aged between 18 and 55 years were randomly allocated to one of four groups in a 2 (intervention) by 2 (timing) design. Participants performed either expressive writing or neutral writing, either before or after receiving a 4 mm punch biopsy wound. Wounds were photographed on day 10 (primary endpoint) and day 14 after the biopsy to measure epithelisation. Participants also completed questionnaires on stress and affect two weeks prior to the biopsy, on the day of biopsy and two weeks after biopsy. Results: There was a significant difference in healing at day 10 between groups, χ2(3, N = 97) = 8.84, p = 0.032. A significantly greater proportion of participants who performed expressive writing before the biopsy had fully reepithelialised wounds on day 10 compared to participants who performed neutral writing either before or after wounding, with no other significant differences between groups. Amongst people who wrote expressively after wounding, those who finished writing over the first 6 days were significantly more likely to be healed at 14 days than those who finished writing later. There were significant differences in positive and negative affect over the healing period between the pre and post expressive writing groups. Conclusions: Expressive writing can improve healing if it is performed prior to wounding. Performing expressive writing after wounding may be able to improve healing depending on the timing of writing and wound assessment. Expressive writing causes affect to worsen followed by subsequent improvement and it is important to consider this in the timing of intervention delivery. Further research with patient groups is required to determine the clinical relevance of these findings

Education and self-management for people newly diagnosed with type 2 diabetes: a qualitative study of patients' views.

OObjectives: We explored the perceptions, views and experiences of diabetes education in people with type 2 diabetes who were participating in a UK randomized controlled trial of methods of education. The intervention arm of the trial was based on DESMOND, a structured programme of group education sessions aimed at enabling self-management of diabetes, while the standard arm was usual care from general practices. Methods: Individual semi-structured interviews were conducted with 36 adult patients, of whom 19 had attended DESMOND education sessions and 17 had been randomized to receive usual care. Data analysis was based on the constant comparative method. Results: Four principal orientations towards diabetes and its management were identified: `resisters', `identity resisters, consequence accepters', `identity accepters, consequence resisters' and `accepters'. Participants offered varying accounts of the degree of personal responsibility that needed to be assumed in response to the diagnosis. Preferences for different styles of education were also expressed, with many reporting that they enjoyed and benefited from group education, although some reported ambivalence or disappointment with their experiences of education. It was difficult to identify striking thematic differences between accounts of people on different arms of the trial, although there was some very tentative evidence that those who attended DESMOND were more accepting of a changed identity and its implications for their management of diabetes. Discussion: No one single approach to education is likely to suit all people newly diagnosed with diabetes, although structured group education may suit many. This paper identifies varying orientations and preferences of people with diabetes towards forms of both education and self-management, which should be taken into account when planning approaches to education

Parents' experiences of an abnormal ultrasound examination - vacillating between emotional confusion and sense of reality

<p>Abstract</p> <p>Background</p> <p>An ultrasound examination is an important confirmation of the pregnancy and is accepted without reflection to any prenatal diagnostic aspects. An abnormal finding often comes unexpectedly and is a shock for the parents. The aim was to generate a theoretical understanding of parents' experiences of the situation when their fetus is found to have an abnormality at a routine ultrasound examination.</p> <p>Methods</p> <p>Sixteen parents, mothers and fathers, whose fetus had been diagnosed with an abnormality during an ultrasound scan in the second or third trimester, were interviewed. The study employed a grounded theory approach.</p> <p>Results</p> <p>The core category <it>vacillating between the emotional confusion and sense of reality </it>is related to the main concern <it>assessment of the diagnosis impact on the well-being of the fetus</it>. Two other categories <it>Entering uncertainty </it>and <it>Involved in an ongoing change and adaptation </it>have each five sub-categories.</p> <p>Conclusions</p> <p>Parents are aware of that ultrasound examination is a tool for identifying abnormalities prenatally. The information about the abnormality initially results in broken expectations and anxiety. Parents become involved in ongoing change and adaptation. They need information about the ultrasound findings and the treatment without prolonged delay and in a suitable environment. The examiner who performs the ultrasound examination must be aware of how anxiety can be intensified by environmental factors. All parents should to be offered a professional person to give them <it>s</it>upport as a part of the routine management of this situation.</p