Trazodone for the treatment of fibromyalgia: an open-label, 12-week study

Background: Despite its frequent use as a hypnotic, trazodone has not been systematically assessed in fibromyalgia patients. In the present study have we evaluated the potential effectiveness and tolerability of trazodone in the treatment of fibromyalgia. Methods: A flexible dose of trazodone (50-300 mg/day), was administered to 66 fibromyalgia patients for 12 weeks. The primary outcome measure was the Pittsburgh Sleep Quality Index (PSQI). Secondary outcome measures included the Fibromyalgia Impact Questionnaire (FIQ), the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale (HADS), the Brief Pain Inventory (BPI), the Short-Form Health Survey (SF-36), and the Patients' Global Improvement Scale (PGI). Trazodone's emergent adverse reactions were recorded. Data were analyzed with repeated measures one-way ANOVA and paired Student's t test. Results: Trazodone markedly improved sleep quality, with large effect sizes in total PSQI score as well on sleep quality, sleep duration and sleep efficiency. Significant improvement, although with moderate effect sizes, were also observed in total FIQ scores, anxiety and depression scores (both HADS and BDI), and pain interference with daily activities. Unexpectedly, the most frequent and severe side effect associated with trazodone in our sample was tachycardia, which was reported by 14 (21.2%) patients. Conclusions: In doses higher than those usually prescribed as hypnotic, the utility of trazodone in fibromyalgia management surpasses its hypnotic activity. However, the emergence of tachycardia should be closely monitored. Trial registration: This trial has been registered with ClinicalTrials.gov number NCT-00791739

Variations in travel time for N loading to groundwaters in four case studies in Ireland: Implications for policy makers and regulators

Mitigation measures to protect waterbodies must be implemented by 2012 to meet the requirements of the EU Water Framework Directive. The efficacy of these measures will be assessed in 2015. Whilst diffuse N pathways between source and receptor are generally long and complex, EU legislation does not account for differences in hydrological travel time distributions that may result in different water quality response times. The “lag time” between introducing mitigation measures and first improvements in water quality is likely to be different in different catchments; a process that should be considered by policy makers and catchment managers. Many examples of travel time variations have been quoted in the literature but no Irish specific examples are available. Lag times based on initial nutrient breakthrough at four contrasting sites were estimated to a receptor 500 m away from a source. Vertical travel times were estimated using a combination of depth of infiltration calculations based on effective rainfall and subsoil physical parameters and existing hydrological tracer data. Horizontal travel times were estimated using a combination of Darcian linear velocity calculations and existing tracer migration data. Total travel times, assuming no biogeochemical processes, ranged from months to decades between the contrasting sites; the shortest times occurred under thin soil/subsoil on karst limestone and the longest times through thick low permeability soils/subsoils over poorly productive aquifers. Policy makers should consider hydrological lag times when assessing the efficacy of mitigation measures introduced under the Water Framework Directive. This lagtime reflects complete flushing of a particular nutrient from source to receptor. Further research is required to assess the potential mitigation of nitrate through denitrification along the pathway from source to receptor

Terrestrial hydrological processes

Field measurements of soil water content have many potential uses beyond merely monitoring changes in water storage of a soil profile. The neutron probe method has been applied widely to measure the effect of differences in evaporation losses from different vegetation on soil water balances. A number of key studies of unsaturated zone water balances in the UK were undertaken, with particular attention to the Chalk, which is the country's most important aquifer. Much of the classical work in soil physics assumes that water flows in a regular fashion through a soil matrix which is homogeneous, or at least comprises a series of identifiable layers with uniform properties. Soils exert a key role on the hydrology of an area influencing the distribution of rain water between evaporation, runoff and recharge. The primary flood reducing role claimed for planting hedge lines and trees may be more subtle than thought

CO<SUB>2</SUB> evasion along streams driven by groundwater inputs and geomorphic controls

International audienceHeadwaters are hotspots of carbon dioxide (CO2) evasion from rivers. While emerging evidence suggests that groundwater contributes disproportionately to CO2 in headwater streams, the processes of CO2 delivery to streams and subsequent evasion to the atmosphere remain largely unknown. Here we show the variability of CO2 input and evasion fluxes based on coupled measurements of dissolved CO2 along streams and in adjacent groundwater from two headwater catchments of the tropical and temperate zones. We find that the processes can be highly localized in both space and time. Spatially, they are significantly influenced by heterogeneities in the subsurface and stream landscape; temporally, they predominately occur during the transient activation of connected subsurface water flows. We highlight sharp increases and decreases in the stream CO2 flux, and suggest that current models fail to capture the true magnitude of CO2 evasion. The high spatial and temporal variability of CO2 input from groundwater and evasion to the atmosphere makes accurate assessment of CO2 evasion fluxes difficult, and will require a collaborative effort by catchment hydrologists and aquatic ecologists to fully understand the contribution of groundwater to stream CO2 emissions