Frequent back pain and subsequent mortality among older community-dwelling white women in the study of osteoporotic fractures (SOF)

INTRODUCTION: While the impact of back pain on morbidity in older adults is well-understood, the influence of back pain on mortality is unclear. Back pain is the leading cause of disability worldwide, and disability is associated with elevated risk of mortality. Thus, we hypothesized that older women with persistent back pain would have a higher risk of mortality over 16-years of follow-up, compared to those with no back pain among participants in the Study of Osteoporotic Fractures (SOF), a large multisite cohort study. Furthermore, we hypothesized that limitations of Instrumental Activities of Daily Living (IADLs) would mediate a greater proportion of the mortality risk, compared to two objective measures of physical function, walking and chair stand speed. METHODS: The analytic sample included 8,321 SOF participants (mean age 71.5, SD=5.1) who answered back pain questions at baseline (1986–87) and visit 2 (1989–90). We created a four-category back pain variable by combining responses at two interviews (baseline and visit 2). Categories included: no back pain (24%), non-persistent back pain (23%), and infrequent (44%) or frequent (9%) persistent back pain. Participants were followed from visit 2 through visit 9 (2006–08). Death was confirmed with receipt of death certificates. Using Cox-proportional hazards, we calculated hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and cause-specific mortality with the ‘no back pain’ participants as our reference group. We adjusted for age, sociodemographic characteristics, self-reported general health, smoking status, comorbid conditions (e.g., prevalent vertebral fractures, osteoarthritis, hip pain, diabetes, hypertension), previous stroke, history of breast cancer, hospitalizations and falls in the previous year. We evaluated self-reported IADL limitations, slow walking speed, and slow chair stand time as a priori mediators of back pain and subsequent mortality. RESULTS: A total of 4975 women (55.8%) died over the follow-up period. A higher proportion of women with frequent persistent back pain died (65.8%) compared to those with no back pain (53.5%) (adjusted HR = 1.24; 95% CI 1.11 to 1.39). We observed an increase in cardiovascular (adjusted HR = 1.34; 95% CI 1.12 to 1.62) and cancer (adjusted HR = 1.33; 95% CI 1.03 to 1.71) mortality. No increased risk was observed for other back pain groups. A larger proportion of the association was mediated by IADL limitations (47%), compared to poor performance on chair stand (27%) and walking speed (24%). CONCLUSION: Compared to older women with no back pain, those with frequent persistent back pain had an increased risk of mortality, which underscores the importance of developing safe interventions to address and prevent this condition. Therapies that address IADL limitations or improve physical function (e.g. walking speed, chair stand) may be ideal for preventing early death in individuals with back pain.2020-03-17T00:00:00

Physicality and Devotion in Heinrich Ignaz Franz Biber’s Rosary Sonatas

The Rosary Sonatas of Heinrich Ignaz Franz Biber (1644–1704) for solo violin were likely composed in the late 1670s, and were dedicated to the composer’s patron, the Archbishop of Salzburg Maximilian Gandolph von Kuenburg. The sonatas in this remarkable set of fifteen are preceded by copperplate engravings, each depicting one of the mysteries of the rosary. The pieces display Biber’s extensive use of scordatura, an unusual “discordant” tuning, notated with a semi-tablature in which the visual contours of the notation on the page are at odds with the audible contours of the phrases. Biber’s sonatas are intentionally enigmatic, revealing underlying connections to the sensual yet deliberately mysterious nature of Catholic art and culture of his day. The combination of the tactile, visual and aural is a defining characteristic of the extra-liturgical Catholic devotional practices, notably the rosary, which were widespread in mid-seventeenth-century Austria. This paper examines Biber’s violin pieces as ritual expressions synonymous with the rosary devotions practised by the Catholic confraternities in Salzburg. The cryptic nature of Biber’s sonatas not only reveals a close connection to the sensual visual art associated with rosary confraternities, it makes the performance of the pieces a devotional act in itself

FEASIBILITY ANALYSIS FOR EPA’S DRAFT GREAT BAY TOTAL NITROGEN GENERAL PERMIT IN DOVER, DURHAM, EPPING, EXETER, MILTON, NEWFIELDS, NEWINGTON, NEWMARKET, PORTSMOUTH, ROCHESTER, ROLLINSFORD, SOMERSWORTH NH AND BERWICK, KITTERY, NORTH BERWICK AND SOUTH BERWICK ME

Although this document was not produced by PREP, it is being listed with the permission of the Conservation Law Foundation here due to its importance to PREP’s mission, which is to protect the Great Bay and Hampton-Seabrook Estuaries. This report was developed by Waterstone Engineering, PLLC, and prepared for the Conservation Law Foundation. The intent of this report is to determine the feasibility and cost for regulated communities in the Great Bay watershed to implement the optional non-point source and stormwater point source nitrogen pathway outlined in EPA’s draft Greay Bay Total Nitrogen General Permit. Feasibility was evaluated for a community’s ability to reduce non-point source and stormwater-derived nitrogen by 45% over four 5-year permit periods. This study represents one scenario of many possible pathways and encourages communities to implement innovative nutrient control strategies including a combination of non-structural and low-cost best management practices in addition to more conventional strategies in order to achieve reduction targets