Isotopic ratios of H, C, N, O, and S in comets C/2012 F6 (Lemmon) and C/2014 Q2 (Lovejoy)

The apparition of bright comets C/2012 F6 (Lemmon) and C/2014 Q2 (Lovejoy) in March-April 2013 and January 2015, combined with the improved observational capabilities of submillimeter facilities, offered an opportunity to carry out sensitive compositional and isotopic studies of the volatiles in their coma. We observed comet Lovejoy with the IRAM 30m telescope between 13 and 26 January 2015, and with the Odin submillimeter space observatory on 29 January - 3 February 2015. We detected 22 molecules and several isotopologues. The H$_2^{16}$O and H$_2^{18}$O production rates measured with Odin follow a periodic pattern with a period of 0.94 days and an amplitude of ~25%. The inferred isotope ratios in comet Lovejoy are $^{16}$O/$^{18}$O = 499 $\pm$ 24 and D/H = 1.4 $\pm$ 0.4 $\times 10^{-4}$ in water, $^{32}$S/$^{34}$S = 24.7 $\pm$ 3.5 in CS, all compatible with terrestrial values. The ratio $^{12}$C/$^{13}$C = 109 $\pm$ 14 in HCN is marginally higher than terrestrial and $^{14}$N/$^{15}$N = 145 $\pm$ 12 in HCN is half the Earth ratio. Several upper limits for D/H or 12C/13C in other molecules are reported. From our observation of HDO in comet C/2014 Q2 (Lovejoy), we report the first D/H ratio in an Oort Cloud comet that is not larger than the terrestrial value. On the other hand, the observation of the same HDO line in the other Oort-cloud comet, C/2012 F6 (Lemmon), suggests a D/H value four times higher. Given the previous measurements of D/H in cometary water, this illustrates that a diversity in the D/H ratio and in the chemical composition, is present even within the same dynamical group of comets, suggesting that current dynamical groups contain comets formed at very different places or times in the early solar system.Comment: Accepted for publication in Astronomy and Astrophysic

Caregiver Burden in Late-Stage Parkinsonism and Its Associations

Background: Patients in the late stages of parkinsonism are highly dependent on others in their self-care and activities of daily living. However, few studies have assessed the physical, psychological and social consequences of caring for a person with late-stage parkinsonism. Patients and methods: Five hundred and six patients and their caregivers from the Care of Late Stage Parkinsonism (CLaSP) study were included. Patients’ motor and non-motor symptoms were assessed using the UPDRS and Non-motor symptom scale (NMSS), Neuropsychiatric inventory (NPI-12), and caregivers’ health status using the EQ-5D-3 L. Caregiver burden was assessed by the Zarit Burden Interview (ZBI). Results: The majority of caregivers were the spouse or life partner (71.2%), and were living with the patient at home (67%). Approximately half of caregivers reported anxiety/depression and pain/discomfort (45% and 59% respectively). The factors most strongly associated with caregiver burden were patients’ neuropsychiatric features on the total NPI score (r = 0.38, p < 0.0001), total NMSS score (r = 0.28, p < 0.0001), caring for male patients and patients living at home. Being the spouse, the hours per day assisting and supervising the patient as well as caregivers’ EQ-5D mood and pain scores were also associated with higher ZBI scores (all p < 0.001). Conclusion: The care of patients with late stage parkinsonism is associated with significant caregiver burden, particularly when patients manifest many neuropsychiatric and non-motor features and when caring for a male patient at home

The late stage of Parkinson's –results of a large multinational study on motor and non-motor complications

INTRODUCTION: There is little information on the late stages of parkinsonism. METHODS: We conducted a multicentre study in 692 patients with late stage parkinsonism in six European countries. Inclusion criteria were disease duration of ≥7 years and either Hoehn and Yahr stage ≥4 or Schwab and England score of 50 or less. RESULTS: Average disease duration was 15.4 (SD 7.7) years and mean total UPDRS score was 82.7 (SD 22.4). Dementia according to MDS-criteria was present in 37% of patients. Mean levodopa equivalence dose was 874.1 (SD 591.1) mg/d. Eighty two percent of patients reported falls, related to freezing (16%) or unrelated to freezing (21% of patients) or occurring both related and unrelated to freezing (45%), and were frequent in 26%. Moderate-severe difficulties were reported for turning in bed by 51%, speech by 43%, swallowing by 16% and tremor by 11%. Off-periods occurred in 68% and were present at least 50% of the day in 13%, with morning dystonia occurring in 35%. Dyskinesias were reported by 45% but were moderate or severe only in 7%. Moderate-severe fatigue, constipation, urinary symptoms and nocturia, concentration and memory problems were encountered by more than half of participants. Hallucinations (44%) or delusions (25%) were present in 63% and were moderate-severe in 15%. The association with overall disability was strongest for severity of falls/postural instability, bradykinesia, cognitive score and speech impairment. CONCLUSION: These data suggest that current treatment of late stage parkinsonism in the community remains insufficiently effective to alleviate disabling symptoms in many patients

Principes de subdivision stratigraphique de l’histoire de la terre ; le cas du Quaternaire, sa signification et son rang hiérarchique

Historiquement, les unités stratigraphiques furent différenciées sur la base des caractéristiques de la biosphère. Pour les dépôts où les fossiles sont communs, l’unité de base est l’Étage ; chaque Étage correspondant, originellement, à une faune. Ils sont regroupés en unités de rang supérieur d’après l’importance des coupures biologiques. Dans la pratique, les Étages historiques étaient des formations (ensembles de couches) fossilifères régionales. Ce fondement a conduit à des difficultés d’application au niveau des limites car la base de ces Étages était localisée dans des dépôts transgressifs sur la plate forme continentale succédant à une lacune de dépôt. On a alors proposé de fixer les limites à la base du stratotype de l’Étage. Ainsi tous les dépôts antérieurs, connus ou inconnus, appartenaient à l’Étage inférieur ; il restait qu’une portion du temps n’était pas représentée par des dépôts dans ces stratotypes historiques. Par la suite, la communauté des stratigraphes a élaboré un nouveau principe, celui des Points Stratotypiques Mondiaux (PSM). Selon cette convention, un Étage est défini par un point, choisi par les experts dans une succession continue ; ce point définit l’Étage situé au-dessus. Dès lors, la limite était parfaitement définie par des dépôts antérieurs et postérieurs. Pour les stratigraphes francophones, le seul concept de PSM ne suffit pas à la définition complète d’une unité stratigraphique. Celle-ci nécessite trois composantes : le PSM de la limite inférieure, le PSM de la limite supérieure et un contenu dont l’essentiel est l’ensemble des couches du stratotype historique qui a donné son nom à l’Étage. L’intérêt de ce type de définition est que les notions de couches et de temps coïncident parfaitement ce qui a conduit à proposer, pour les langues où les deux notions étaient distinguées jusque là, une terminologie unique pour désigner les unités représentées par les couches (Erathème, Système, Série, Étage, sous étage inférieur, sous étage supérieur), et les unités de temps correspondantes (Ère, Période, Époque, Âge, sous âge “ancien”, “tardif”). C’est dans le cadre de l’Union Internationale des Sciences Géologiques (U.I.S.G) que sont élaborées les conventions internationales. La Commission Internationale de Stratigraphie est chargée de la question des unités stratigraphiques. Dans ce cadre, des sous commissions sont créées, lesquelles chargent des groupes de travail de prendre en main chaque convention. Ces conventions, proposées dans le cadre de ces Groupes de Travail, sont votées et avalisées par les instances de l’U.I.S.G. L’action, dans ces structures, est très influencée par un petit nombre de personnes sollicitant le travail d’un très grand nombre de personnes. Les outils utilisés par les stratigraphes pour caractériser les couches ne sont pas disponibles de façon uniforme au cours des temps géologiques. Dans cette optique, il existe trois sortes de stratigraphies : 1- celle où les Étages sont adaptés à la subdivision de l’histoire de la planète avec leur concept fondateur actuel, les PSM et le moyen de corrélation le plus commun, les fossiles ; 2- pour les temps plus anciens, les moyens de corrélation sont différents et obligent à changer la règle ; aujourd’hui, les conventions acceptées le plus généralement sont des âges conventionnels ; 3- au Quaternaire, une large palette d’outils est applicable et, selon les milieux, l’un ou l’autre outil sera appliqué et conduira à une subdivision propre. L’exploitation de la diversité des outils disponibles nécessite de ne pas s’encombrer d’unités uniques, mondiales, quand de nombreux outils peuvent être associés avec des âges en années. Les conventions, concept fixe et contraignant, sont remplacées par des connaissances, concept variable laissant une plus grande liberté de progrès. En outre, le Quaternaire n’est pas une subdivision comparable aux unités antérieures. Sa durée n’est pas supérieure à celle d’un Étage mais son rang hiérarchique doit aussi prendre en compte sa signification. Pour la première fois de l’histoire du globe, les temps quaternaires s’inscrivent dans une biosphère influencée, et même considérablement influencée à long terme, par une espèce unique. C’est une révolution fondamentale dans l’évolution. Cette prise en compte est aussi une nécessité pour la prise de conscience des responsabilités de l’homme vis à vis de son environnement ; elle se traduirait par le fait que l’unité Quaternaire pourrait se situer, de façon justifiable, au niveau d’une Ère succédant au Cénozoïque (ou Tertiaire) sinon d’un Éon de même rang que le Phanérozoïque. La question de la position précise de sa limite inférieure est autre ; il ne manque pas d’exemples, dans la colonne stratigraphique, dans lesquels le fait dominant caractérisant une unité n’apparaît pas précisément au premier moment de l’unité en question. Cependant, il serait souhaitable que l’“événement guide” pour situer la base du Quaternaire soit en relation avec le fondement de l’influence de l’homme : l’apparition de la pensée conceptuelle, marquée par l’apparition des outils vers 2,6 Ma.Throughout the history of geology, stratigraphical units have been identified and named according to the observation that macrofossils evolved over time from one deposit to the next. For example, the Aptian Stage is named after the particular fossils observed in deposits near Apt, SE France (Orbigny, 1840 in Moullade et al., 2006) or the Campanian Stage named after the deposits of the Champagne Charentaise area, SW France (Coquand, 1857 in Neumann and Odin, 2001). The sections selected as typical for a stage are called stratotypes. Thus, for deposits where fossils are common, the fundamental stratigraphical unit is the Stage which most commonly corresponds to a particular fauna found in a given three-dimensional-formation. The quite constant mechanism of evolution has led to the fact that those Stages have duration of the same order of magnitude (3 to 10 Ma) from the Cambrian System to the Neogene System, which lends to the concept of Stage an approximate time-significant value. These Stages are grouped in higher ranking units according to the significance of the cuts in terms of changes in the biosphere. These changes are reported in figure 1 according to modern information gathered by Lethiers (1998). It is clear that the pioneer stratigraphers recognised most of the main cuts in the biological evolution and used them as major unit boundaries (Era or System). So, from the practical point of view, historical Stages are defined as strata characterised by a particular fauna. This practice has led to some difficulties as far as the location of the boundaries is concerned. Often, the apparently “new fauna” results from transgressive deposits on the continental platform following a sedimentary break (and corresponding lack of record, see case 2, fig. 2). In a few other cases, the successive Stages defined in different basins include contemporaneous deposits with different faunas due to endemism or environmental differences (case 1, fig. 2). In order to solve these problems, it was first accepted that boundaries would be defined at the base of the historical stratotypes; in this situation, all deposits, known or unknown, and older than those located at the base of the stratotype pertain to the previous Stage. The remaining problem is that deposits immediately older than the boundary were not necessarily documented in the stratotypes. In order to solve the latter problem, stratigraphers (mainly represented by experts of the Phanerozoic interval of time) have decided to create a new kind of convention using the concept of Global Standard Stratotype Section and Point (GSSP or PSM –Point Stratotypic Global– in French, see fig. 3). According to this new convention, Stage boundaries (instead of Stage bodies) become the key for defining Stages. The GSSP defines a Stage by a point selected in a section where deposition is continuous and the Stage located above the point is defined by this point (Remane et al., 1996). According to this approach, the boundary becomes perfectly defined with deposits able to characterise the geological history above and below. French speaking stratigraphers have discussed this kind of definition (see Odin et al., 2004, 2005) and suggested that a single GSSP is not enough for the full definition of a stratigraphical unit. A complete definition needs three conventions : 1- the GSSP for the lower (older) boundary, 2- the GSSP for the upper (younger) boundary and 3- the historical stratotype which gives its name to the unit and generally documents the major portion of the unit’s content. This new approach using GSSP is interesting in that the distinct concepts of time on the one hand and strata deposited during (and documenting) this time on the other hand are fully coincident. This coincidence suggests that a single terminology is sufficient for designating time and rock units (Zalasiewicz et al., 2004) i.e., the differentiation previously made in some languages between rock units (Erathem, System, Series, Stage, Lower and Upper sub Stages), and the corresponding time units (Era, Period, Epoch, Age, Early and Late sub Stages, see fig. 5) is no longer necessary. The question is : which are the best words to be selected ? Zalasiewicz et al. (2004) would prefer the words shown in the right hand column (fig. 5) while Odin et al. (2004, 2005) would recommend the words shown in bold type in the same figure because they are distinct from the confusing words of the common language (such as epoch or period) and because they have long been used in many languages (upper, lower), even when geological time is concerned. These conventions are worked out within the International Union of Geological Sciences Organisation (IUGS). Within it, the International Commission of Stratigraphy is the appropriate body in charge for these conventions regarding stratigraphical units. This Commission is organised in sub commissions which create Working Groups each in charge for a particular convention (fig. 6). When a 60 % majority vote is obtained for a proposal within a Working Group, it is voted by the parent sub Commission, and the proposal is submitted to the Commission which votes and the accepted convention is submitted to IUGS for ratification. Within this organisation, a comparatively small number of people is usually able to significantly influence the work and decision of a large number of experts. An example of practical GSSP is given in figure 7. The conventions discussed above are mainly valid and of easy application for the fossil-bearing deposits, those which are the subject of interest of a majority of stratigraphers. However, the stratigraphical tools (the techniques of investigation documented in the deposits) applicable in the rocks are not the same in the deposits of different geological age (fig. 8). From that point of view, there are three distinct stratigraphies (Odin, 1994) : 1- the one where Stages are applicable for subdividing the geological history using the presently accepted and fully relevant concept of GSSP ; there, there is an abundant documentation by fossils (biostratigraphy is the key unequivocal dating tool) ; 2- for older time, the key unequivocal dating tool is geochronology ; accordingly, the appropriate sub commission on Precambrian Stratigraphy decided to select numerical ages for definition of conventional unit boundaries (Plumb, 1991) ; 3- for the Quaternary history, there is a large variety of particular tools often applicable in particular deposits or more or less local areas each one being able to generate its own scale (fig. 10). In this situation, the best use of the information suggests that each particular tool may be accepted for subdivision of the geological history. The use of a single series of integrated boundaries would not be easily applicable because all tools do not necessarily locate cuts at the same place while each kind of cut is an interesting piece of information. The correlation between the diversified columns may be achieved with more or less precise connection, using the known age (in years) of the key events. As a result, the Quaternary interval of time does not need unique conventions but is better based on evolving knowledge. According to us, conventions which are constraining and fixed concepts should thus be replaced by knowledge which gives a wider freedom for adapting to evolving information. The Quaternary is not similar to the older stratigraphical units. It is short but its hierarchical ranking must first depend on the significance one wants to give to it. Taking into account the major role of the biosphere in the previous subdivision of the geological history, the ranking of the Quaternary unit should reflect the considerable change in the process of evolution of life brought when the genus Homo appears. From that point of view, the history of the biosphere may be subdivided as shown in figure 9. Looking at this scheme, it is clear that there is a single taxon (man) which is able to influence the whole biosphere to its benefit (?) for the first time on Earth. This is not a detail of the history. The key role of this species is an observation but it is also necessary to point out this key role for becoming conscious of its responsibility with regard to its environment for the future. Taking this into account, the stratigraphical unit where man becomes a major actor of evolution must have the highest ranking, at least at the level of an Era (see fig. 5) distinct from the Cenozoic (or Tertiary) or possibly a sub Era if this kind of unit is useful in order to conform to the proposal of Pillans and Naish (2004). This means that the base of the Quaternary must cut all previous units of lower ranking in the hierarchy and cannot be part of a previous System as suggested in the proposal of inclusion in the Neogene System considered by Clague (2006). The question of the location of the lower boundary of the Quaternary is different from that of its ranking. As far as the nature of the key character of the unit (influence of man on the biosphere) is concerned, there are plenty of units of the time scale for which the key factor is NOT perceptible immediately above the base of the unit (trilobites do not appear at the base of the Palaeozoic, large dinosaurs do not appear at the base of the Mesozoic; mammals do not dominate at the base of the Tertiary). However, it would be advisable to locate the base of the Quaternary near the “guide event” related to the funding of the influence of man on biosphere which is the appearance of the conceptual thinking documented in the deposits by the first man artefacts about 2,5 Ma ago (Semaw et al., 1997, 2003)

Pore Shape Modification of a Microporous Metal-Organic Framework Using High Pressure:Accessing a New Phase with Oversized Guest Molecules

The authors thank the Royal Society of Edinburgh and the Scottish Government for a fellowship to S.A.M. The authors thank EPSRC (EP/J02077X/1) and Leverhulme Trust for a research project grant (RPG-209) for financial support. They also thank the UK Carr Parinello consortium for allocation of computing time on the EPSRC high performance computing resource ARCHER (managed by the Edinburgh Parallel Computing Centre, the EaSTCHEM Research Computing Facility and the University of Edinburgh ECDF facility).Pressures up to 0.8 GPa have been used to squeeze a range of sterically "oversized" C5-C8 alkane guest molecules into the cavities of a small-pore Sc-based metal?organic framework. Guest inclusion causes a pronounced reorientation of the aromatic rings of one-third of the terephthalate linkers, which act as "torsion springs", resulting in a fully reversible change in the local pore structure. The study demonstrates how pressure-induced guest uptake can be used to investigate framework flexibility relevant to "breathing" behavior and to understand the uptake of guest molecules in MOFs relevant to hydrocarbon separation.PostprintPeer reviewe

Characteristics of Patients with Late-Stage Parkinsonism who are Nursing Home Residents Compared with those Living at Home

OBJECTIVES: To determine clinical characteristics and treatment complications of patients with late-stage Parkinsonism living in nursing homes compared with those living at home. DESIGN: Cross-sectional analysis. SETTING AND PARTICIPANTS: This study is an analysis of 692 patients with late stage Parkinsonism recruited to an in-depth international study, Care of Late-Stage Parkinsonism (CLaSP). MEASURES: Sociodemographic characteristics were compared between patients who were living in a nursing home (n = 194) and those living at home (n = 498). Clinical assessments included the Unified Parkinson's Disease Rating Scale (UPDRS), the nonmotor symptom scale, the neuropsychiatric inventory, and a structured interview of patients and carers. Predictors of nursing home status were determined in a multivariate analysis. RESULTS: Nursing home placement was strongly associated with more severe cognitive impairment, worse UPDRS motor scores and disability, and with being unmarried and older. Although nursing home residents had significantly higher axial scores, falls were less common. Despite similar levodopa equivalence doses, they had less dyskinesia. Nonmotor symptom burden, particularly delusion, hallucination, and depression scores were higher in nursing home residents, and they were more frequently on psychotropic medication. They had lower rates of dopamine agonist use and lower rates of impulse control disorders. In multivariate analysis, being unmarried, presence of cognitive impairment, worse disease severity as assessed on the UPDRS parts II and III, severity of delusions, and lower rate of dyskinesia were associated with nursing home placement. CONCLUSIONS AND IMPLICATIONS: These clinical characteristics suggest that in patients with Parkinsonsim who are nursing home residents, presence of cognitive impairment and delusions particularly add to the higher overall symptom burden, and more often require specific treatments, including clozapine. Despite similar levodopa equivalent daily dose, motor severity is higher, and dyskinesias, indicative of a response to levodopa, are less common. Falls, however, also occur less commonly, and dopamine agonists are less frequently used, with lower rates of impulse control disorder

King's Parkinson's disease pain scale, the first scale for pain in PD: An international validation

Pain is a key unmet need and a major aspect of non‐motor symptoms of Parkinson's disease (PD). No specific validated scales exist to identify and grade the various types of pain in PD. We report an international, cross‐sectional, open, multicenter, one‐point‐in‐time evaluation with retest study of the first PD‐specific pain scale, the King's PD Pain Scale. Its seven domains include 14 items, each item scored by severity (0‐3) multiplied by frequency (0‐4), resulting in a subscore of 0 to 12, with a total possible score range from 0 to 168. One hundred seventy‐eight PD patients with otherwise unexplained pain (age [mean ± SD], 64.38 ± 11.38 y [range, 29‐85]; 62.92% male; duration of disease, 5.40 ± 4.93 y) and 83 nonspousal non‐PD controls, matched by age (64.25 ± 11.10 y) and sex (61.45% males) were studied. No missing data were noted, and floor effect was observed in all domains. The difference between mean and median King's PD Pain Scale total score was less than 10% of the maximum observed value. Skewness was marginally high (1.48 for patients). Factor analysis showed four factors in the King's PD Pain Scale, explaining 57% of the variance (Kaiser‐Mayer‐Olkin, 0.73; sphericity test). Cronbach's alpha was 0.78, item‐total correlation mean value 0.40, and item homogeneity 0.22. Correlation coefficients of the King's PD Pain Scale domains and total score with other pain measures were high. Correlation with the Scale for Outcomes in PD‐Motor, Non‐Motor Symptoms Scale total score, and quality of life measures was high. The King's PD Pain Scale seems to be a reliable and valid scale for grade rating of various types of pain in PD. © 2015 International Parkinson and Movement Disorder Societ

Low temperature, authigenic illite and carbonates in a mixed dolomite-clastic lagoonal and pedogenic setting, Spanish Central System, Spain

The aim of this study was to further our understanding of the pedogenic and lacustrine modification of clay minerals. Some of these modifications are of special interest because they constitute reverse weathering reactions, rare in surface environments, and because there is not yet an accurate assessment of their global relevance in mineralogical and geochemical cycles. For this study, two sections from the Central System in Spain were selected. Both are sections through the Uppper Cenomanian-Turonian mixed clastic and carbonate succession, containing both calcite and dolomite, in the Sierra de Guadarrama. Mid-Turonian sea level fall resulted in the formation of a coastal plain environment in which extensive pedogenesis occurred around saline lagoons. The mineralogical changes that have occurred as a result of sedimentation in saline lagoons and as a consequence of pedogenesis are described. Textural relationships indicate that the dolomite cement pre-dates the calcite. Silicate minerals are represented by quartz, kaolinite, illite-smectite, illite, minor plagioclase and alkali feldspar, and trace chlorite and palygorskite. There is a positive correlation between the intensity of pedogenesis and the proportion of illite in the clay assemblage in one of the sections, indicating pedogenic illitisation. In this section, the intensity of the illitisation process increases up, reaching a maximum where pedogenesis is most intense in the middle part, and then decreases as marine influence increases towards the top of the Alcorlo Formation and the overlying marine Tranquera Formation. The clay assemblages are consistent with a slow transformation process from 42 kaolinite to illite by way of illite-smectite, taking place under surface conditions. The illitisation process has resulted in a less Fe-rich, more Mg-, and Al-rich illite than the majority of previously documented cases in the near surface. Formation of Al-rich illite is not therefore restricted to the deep subsurface. The mechanism for low temperature illitisation involves enhanced layer charge resulting from Mg2+ substitution for Al3+ (or Fe3+) and Fe3+ to Fe2+ reduction. Mg2+ enrichment may have occurred principally in saline lagoons or lakes, while Fe3+ to Fe2+ reduction occurred as a result of wetting and drying in a pedogenic environment. So far as it has been possible to establish, this dual mechanism has not previously been documented. This study indicates clearly that the dolomite and calcite are authigenic cements that precipitated in a clastic sediment, probably soon after deposition. Dolomitisation and Mg enrichment of the clay may have occurred at the same time. Seawater is the most probable source of Mg

First comprehensive tool for screening pain in Parkinson's disease: the King's Parkinson's Disease Pain Questionnaire.

BACKGROUND AND PURPOSE: Pain is highly prevalent in Parkinson's disease (PD), impacting patients' ability, mood and quality of life. Detecting the presence of pain in its multiple modalities is necessary for adequate personalized management of PD. A 14-item, PD-specific, patient-based questionnaire (the King's Parkinson's Disease Pain Questionnaire, KPPQ) was designed corresponding to the rater-based KPP Scale (KPPS). The present multicentre study was aimed at testing the validity of this screening tool. METHODS: First, a comparison between the KPPQ scores of patients and matched controls was performed. Next, convergent validity, reproducibility (test-retest) and diagnostic performance of the questionnaire were analysed. RESULTS: Data from 300 patients and 150 controls are reported. PD patients declared significantly more pain symptoms than controls (3.96 ± 2.56 vs. 2.17 ± 1.39; P < 0.0001). The KPPQ convergent validity was high with KPPS total score (rS  = 0.80) but weak or moderate with other pain assessments. Test-retest reliability was satisfactory with kappa values ≥0.65 except for item 5, Dyskinetic pains (κ = 0.44), and the intraclass correlation coefficient (ICC) for the KPPQ total score was 0.98. After the scores of the KPPS were adapted for screening (0, no symptom; ≥1, symptom present), a good agreement was found between the KPPQ and the KPPS (ICC = 0.88). A strong correlation (rS  = 0.80) between the two instruments was found. The diagnostic parameters of the KPPQ were very satisfactory as a whole, with a global accuracy of 78.3%-98.3%. CONCLUSIONS: These results suggest that the KPPQ is a useful, reliable and valid screening instrument for pain in PD to advance patient-related outcomes

A comprehensive assessment of environmental exposures among 1000 North American patients with primary sclerosing cholangitis, with and without inflammatory bowel disease

BACKGROUND: The relationships between primary sclerosing cholangitis (PSC) and the environment are largely unknown. AIM: To validate associations reported in previous studies and to identify novel environmental exposures among PSC patients. METHODS: We performed a multicenter, case-control analysis utilising self-administered questionnaires. Responses between cases (n = 1000) and controls (n = 663) were compared using multivariable logistic regression adjusted for age and gender. The model was further stratified based on inflammatory bowel disease (IBD) status (with IBD n = 741 without IBD n = 259). RESULTS: Smoking was associated with PSC only when IBD was present (OR, 0.5; 95% CI 0.4-0.7) but not among those PSC patients without IBD (OR, 0.9; 95% CI 0.7-1.2). Compared to controls, women with PSC (irrespective of the presence of IBD) were less likely to have received hormone replacement therapy (HRT; OR, 0.5; 95% CI 0.4-0.7) and were more likely to have recurrent urinary tract infections (OR, 1.6; 95% CI 1.2-2.3). PSC patients regardless of gender or IBD status were less likely to eat fish (OR, 0.4; 95% CI 0.3-0.6) and grilled/barbecued meat (OR, 0.8; 95% CI 0.7-0.9). In contrast, PSC patients with and without IBD were more likely to consume steak/burgers that were more well done (OR, 1.3; 95% CI 1.2-1.5). CONCLUSIONS: IBD (rather than PSC) is associated with smoking. Women with PSC are more likely to have recurrent urinary tract infections and less likely to receive HRT. Dietary intake and methods of food preparation differ in PSC patients when compared to controls