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The Gamka Karoo is a low-lying vegetation type in the semi-arid Nama Karoo in the south-western part of South Africa with extensive rangelands used for livestock ranching and wildlife. Although the Nama Karoo is generally resilient to grazing and most responsive to variable rainfall, chronic overstocking, particularly in the driest regions and around water points, could degrade vegetation and soils. The interactive effects of rainfall (MAP) and grazing (stocking rate, percentage overstocking, resting system) on plant species composition and soil chemical characteristics were examined on 36 farms across a regional rainfall gradient (120–300 mm y−1) and around water points (n = 3) on farms. Multivariate direct gradient analyses revealed regional species compositional differences were related most strongly to MAP (r = 0.736), but not to grazing, with no MAP × grazing interaction. On a smaller scale, grazing intensity (1/distance from water point) had a weak negative impact on the vegetation (r = 0.36) and soil chemistry (r = 0.49) with nutrient enrichment around water points in paddocks. Our findings suggest that the Karoo is responsive to rainfall, but loosely coupled to grazing. Adaptive management with livestock numbers matched to rainfall and forage supply is recommended to sustain animal production, vegetation and soils. [ABSTRACT FROM AUTHOR]

Urban and agricultural land uses have the potential to severely compromise the quality of impoundments, if ineffectively managed and operated. A case in point is the upper uMngeni Catchment, including Midmar Dam, which is integral to the freshwater supply infrastructure in KwaZulu-Natal, South Africa. Monitoring sites were established in varying land use types in three subcatchments of the upper uMngeni Catchment to assess water quality and ecosystem health impacts of current land uses. Conclusions about water quality were drawn using pairing of SASS5 and spot water quality data. Water quality and ecological condition were highest in commercial plantations and upstream of a high-density settlement where natural land cover and sparse settlement occurred. Although marked declines in water quality and ecological condition were observed under commercial agriculture. The most notable declines in water quality and ecological condition were observed downstream of the settlement with elevated nutrient loads. Shifts in aquatic biota were highly correlated with seasonal shifts in water quality, influenced markedly by land use. The cumulative effects of current land use activities, urban development and agriculture on Midmar Dam's water quality should be viewed with concern. Additional development in the form of additional social housing projects may exacerbate impacts. [ABSTRACT FROM AUTHOR]

Wetlands are increasingly exposed to human activities, resulting in degradation. As the wetland degrades, it loses functionality. In South Africa, wetlands can play an important water-regulating role. This study aims to establish the ecological condition of a historically utilised wetland on the Lions River floodplain in the uMngeni catchment, to provide a guide for the planning and implementation of rehabilitation interventions. A comprehensive assessment of the wetland's structure was undertaken in 2014, using vegetation and soil parameters, mapped and compared with changes in landuse on the wetland from historical aerial photographs. The study concluded that the wetland's ecological condition had declined, as a result of historical cultivation and commercial forestry. The wetland vegetation present is still generally aligned with the prevailing hydro-edaphic gradient and soil water regime; however, some areas of the wetland showed a mismatch in the soil water indicators and vegetation wetness indicators (the level of wetness based on vegetation being higher than that showed by the soil), suggesting localised drying out. A moderately high abundance of ruderal indigenous and invasive alien species in 61% of the wetland, particularly the drier areas of the wetland, contributed to the altered ecological condition. [ABSTRACT FROM AUTHOR]

Soil seed banks provide not only a historical record of vegetation composition but also the potential for post-disturbance revegetation.Pechuel-Loeschea leubnitziae(wild sage) is a multistemmed, aromatic shrub, occurring in Namibia, Botswana, Swaziland, Zimbabwe and the northern regions of South Africa, that colonises disturbed regions on sandy, alkaline soils. The influence of differing levels ofP. leubnitziaecover on soil seed-bank characteristics and aboveground herbaceous species composition was determined by examining aboveground species composition, recorded in the field, and soil seed-bank species composition, determined by recording germinations from topsoil samples collected at each of 104 sites in the southern Okavango Delta. No correlation was observed between aboveground and soil seed-bank composition (p= 0.209). Cover ofP. leubnitziaedid not affect soil seed-bank species composition (p= 0.31) or the grass:non-grass ratio within the seed bank (p= 0.308). It did, however, affect aboveground grass composition (p= 0.018), with increasingP. leubnitziaecover associated with increasing abundance of poor-quality, shade-tolerant grass species. This confirms the observations that encroachment ofP. leubnitziaemay be associated with a decrease in veld quality and carrying capacity, and highlights the necessity for further study to facilitate a better understanding of the species for management purposes. [ABSTRACT FROM PUBLISHER]

Background: Pathologic proximal femur fractures result in substantial morbidity for patients with skeletal metastases. Surgical treatment is widely regarded as effective; however, failure rates associated with the most commonly used operative treatments are not well defined.Questions/purposes: We therefore compared surgical treatment failure rates among intramedullary nailing, endoprosthetic reconstruction, and open reduction-internal fixation when applied to impending or displaced pathologic proximal femur fractures.Patients and Methods: We retrospectively compared the clinical course of 298 patients who underwent intramedullary nailing (n = 82), endoprosthetic reconstruction (n = 197), or open reduction-internal fixation (n = 19) from 1993 to 2008. Primary outcome was treatment failure, which was defined as reoperation for any reason. Treatment groups were compared for differences in demographic and clinical parameters.Results: The number of treatment failures in the endoprosthetic reconstruction group (3.1%) was significantly lower than in the intramedullary nailing (6.1%) and open reduction-internal fixation (42.1%) groups. The number of revisions requiring implant exchange also was significantly lower for endoprosthetic reconstruction (0.5%), compared with intramedullary nailing (6.1%) and open reduction-internal fixation (42.1%).Conclusions: Endoprosthetic reconstruction is associated with fewer treatment failures and greater implant durability. Prospective studies are needed to determine the impact of operative strategy on function and quality of life.Level Of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: The increasing use of complementary and alternative medicine (CAM) treatment is paralleled by a growing demand for an evidence-based approach to CAM practice. In 2007, the Helfgott Research Institute at the National College of Natural Medicine (NCNM), in partnership with Oregon Health & Science University (OHSU), both in Portland, OR, began a National Institutes of Health-funded initiative to increase the quality and quantity of evidence-based medicine (EBM) content in the curricula at NCNM. Design: One key strategy of the Research in Complementary and Alternative Medicine Program (R-CAMP) initiative was to create a faculty development program that included four components: intensive training in EBM; professional skills enhancement; peer and mentored support; and, ultimately, utilization of these skills to incorporate EBM into the curricula. This initiative is centered on a core group of faculty at NCNM, called the Vanguard Faculty, who receives early, intensive training in EBM and works to incorporate this training into classes. Training consists of an intensive, week-long course, monthly group meetings, and periodic individualized meetings. Vanguard Faculty members also receive mentorship and access to resources to pursue individualized faculty development, research or scholarly activities. Conclusions: Early evaluations indicate that this effort has been successful in increasing EBM content in the curricula at NCNM. This article describes the Vanguard Faculty program in an effort to share the successes and challenges of implementing a wide-ranging faculty development and curricular initiative at a complementary and alternative medicine institution. [ABSTRACT FROM AUTHOR]

Unlabelled: Periprosthetic fractures after massive endoprosthetic reconstructions pose a reconstructive challenge and jeopardize limb preservation. Compressive osseointegration technology offers the promise of relative ease of prosthetic revision, since fixation is achieved by means of a short intramedullary device. We retrospectively reviewed the charts of 221 patients who had Compress((R)) devices implanted in two centers between December, 1996 and December, 2008. The mean followup was 50 months (range, 1-123 months). Six patients (2.7%) sustained periprosthetic fractures and eight (3.6%) had nonperiprosthetic ipsilateral limb fractures occurring from 4 to 79 months postoperatively. All periprosthetic fractures occurred in patients with distal femoral implants (6/154, 3.9%). Surgery was performed in all six patients with periprosthetic femur fractures and for one with a nonperiprosthetic patellar fracture. The osseointegrated interface was radiographically stable in all 14 cases. All six patients with periprosthetic fracture underwent limb salvage procedures. Five patients had prosthetic revision; one patient who had internal fixation of the fracture ultimately underwent amputation for persistent infection. Periprosthetic fractures involving Compress((R)) fixation occur infrequently and most can be treated successfully with further surgery. When implant revision is needed, the bone preserved by virtue of using a shorter intramedullary Compress((R)) device as compared to conventional stems, allows for less complex surgery, making limb preservation more likely.Level Of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Unlabelled: Bone ingrowth promises more durable biologic fixation of megaprostheses. The relative performance of different types of fixation is unknown. We compared the fixation of two forms of biologically fixed femoral components: an intramedullary uncemented press-fit stem (UCS; Group 1, 50 patients) and a Compress((R)) uncemented fixation (CPS; Group 2, 41 patients). In Group 1, the overall Kaplan-Meier prosthetic survival rates were 85% at 5 and 71% at 10 years. Most failures were long-term developments. Aseptic loosening was the primary cause of failure. Stem diameters less than 13.5 mm and a diaphyseal/stem coefficient greater than 2.5 mm were associated with decreased prosthetic survival. In Group 2, the overall rate of CPS survival was 88% at 5 years. Failure of femoral fixation or fracture during the first year was the main reason for revision. Five-year survival rates were similar between the groups and we observed no difference in the functional success of the implants. We found no failures after 1-year followup in Group 2 (CPS). Any difference in prosthetic survival can only be proven by longer-term study or a randomized trial.Level Of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Unlabelled: While low-grade juxtacortical and low-grade intramedullary osteogenic sarcomas are histologically indistinguishable, they have been studied as separate entities. We retrospectively reviewed the clinical, radiographic, histologic features and treatment of 59 patients treated surgically to compare the rate of local recurrence, grade progression, and survival between low-grade intramedullary and low-grade juxtacortical osteogenic sarcoma. Forty-five (76%) patients were treated for low-grade juxtacortical osteogenic sarcoma and 14 (24%) were treated for low-grade intramedullary osteogenic sarcoma. Local recurrence rates of 7% were similar for both groups studied. The rate of distant metastases was also similar for both groups. . The rate of dedifferentiation for the entire group was 29%. Dedifferentiated lesions were treated with adjuvant chemotherapy in 16 of 17 cases. Recurrence preceded dedifferentiation in four cases. Five-year survival was over 90% in both groups. Low-grade intramedullary and low-grade juxtacortical osteogenic sarcoma were clinically indistinguishable with identical rates of local recurrence, distant metastases, dedifferentiation, and survival.Level Of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Quality of life measures have neglected to include a critical self-assessment component in pediatric sarcoma patients. Our report shows how children rate their own quality of life and how that varies over time after surgery. Using the Pediatric Outcomes Data Collection Instrument, quality of life data was prospectively collected and combined with a retrospective review of clinical parameters on 43 children with primary bone sarcoma, with an average followup of 3 years. Children reported good yet variable scores in five of the six domains. Lower scores were noted in the Sports/Physical Functioning domain, particularly in the first 12 months after surgery, with improvement seen up to 24 months after surgery. Tumor specific factors such as size larger than 8 cm and lower extremity location were negative predictors for Sports/Physical Functioning. The only demographic factor that predicted perceived quality of life scores was gender, with girls reporting lower scores in Sports/Physical Functioning, Pain/Comfort, and Global Functioning domains. The Pediatric Outcomes Data Collection Instrument gives discriminatory detailed textured evaluation of the outcome of children treated for skeletal sarcoma. Further development of quality of life measures is needed to allow its use in treatment selection. [ABSTRACT FROM AUTHOR]

We assessed our ability to achieve limb length equality (LLE) in children following limb-sparing surgery for distal femur osteogenic sarcoma using coaxial extendible prostheses in 12 children, averaging 11.6 years old at the time of tumor resection (range, 5.9-15.5 years). All but one child achieved clinical limb length equality. There were 23 extensions, averaging 3.8 extensions per patient (range, 1-5), by an average 13 mm per extension and an average total extension of 49.3 mm per patient extended. Eight children underwent revision surgery after an average of 45.1 months (range, 3-115 months). Aseptic loosening occurred more frequently among children with greater femoral diameter growth. The overall prosthetic survival was 60% at 3 years and 35% at 5 years. The survival until aseptic loosening at 3 and 5 years was 85% and 45%, respectively. Press-fit components survived longer than cemented stems. None of the devices loosened. At skeletal maturity the MSTS functional scores averaged 25. Using a coaxial extendible implant, we efficiently achieved LLE in this population. Prosthetic revision was needed frequently. Younger age and longer resection percentages were associated with shorter prosthetic survival and higher revision/aseptic loosening rates. Femoral diameter growth may contribute to loosening. Early experience with this extendible implant is promising. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study used statewide administrative data sets to estimate the prevalence of tobacco use among persons with mental illnesses who were accessing public-sector mental health care in Colorado and to determine the relationships between tobacco use and primary diagnosis and alcohol and drug use. METHODS: This study utilized the Colorado Client Assessment Record to examine predictors of tobacco use among 111,984 persons with mental illnesses who were receiving services in the public mental health system. RESULTS: Thirty-nine percent of the sample (N=43,508) used tobacco. Multiple logistic regression analysis found that schizophrenia, schizoaffective disorder, and bipolar disorder (p<.001 for all), and depression or dysthymia (p<.01) were associated with greater tobacco use than other diagnoses. Significant differences in tobacco use existed across gender, age group, race or ethnicity, and substance use categories. CONCLUSIONS: Findings suggest that an administrative database is a low-burden means of identifying persons at high risk of tobacco use to inform resource allocation. [ABSTRACT FROM AUTHOR]

Bisphosphonates are the most clinically important class of antiresorptive agents available to treat diseases characterized by osteoclast-mediated bone resorption. Currently, seven bisphosphonates have the approval of the United States Food and Drug Administration. The most common adult diseases treated with bisphosphonates include osteoporosis, Paget disease, and metastatic bone disease. The treatment of pediatric disorders such as osteogenesis imperfecta and fibrous dysplasia with bisphosphonates has gained momentum, and initial investigations have demonstrated an acceptable safety profile. Currently, there is a lack of long-term follow-up data, which will be necessary for the development of responsible guidelines for therapy. [ABSTRACT FROM AUTHOR]

Preclinical evidence led to the development of clinical trials that are examining supraphysiologic concentrations of 1,25-dihydroxyvitamin D for the treatment of cancer. Restriction of dietary calcium intake may reduce the dose-dependent hypercalcemia and hypercalcuria expected with such regimens. Conventional methods for monitoring dietary calcium intake require substantial effort by study participants and are ill-suited for patients with advanced malignancies. An easy-to-use 7day food frequency questionnaire was developed, validated, and tested in a cancer clinical trial of high dose calcitriol. The questionnaire identified with a sensitivity of 88% patients whose daily calcium intake exceeded the goal of 500 mg. The acceptability of dietary calcium restriction was evaluated using selected questions from the previously published Nutritional Health Perceptions Scale and Nutritional Hassles Questionnaire. No change in the nutrition health perceptions score or the irritability score was observed with the introduction of a calcium restricted diet. [ABSTRACT FROM AUTHOR]

Background: Elevated blood homocysteine is a risk factor for cardiovascular disease. A 5-Rmol/L increase is associated with an approximately 70% increase in relative risk of cardiovascular disease in adults. For patients with established risk factors, this risk is likely even greater. Objective: Effects of increased dietary folate and recommended intakes of vitamins B-12 and B-6 on serum total homocysteine (tHcy) were assessed in individuals at high risk of cardiovascular disease. Design: This trial was conducted at 10 medical research centers in the United States and Canada and included 491 adults with hypertension, dyslipidemia, type 2 diabetes, or a combination thereof. Participants were randomly assigned to follow a prepared meal plan (PMP; n = 244) or a self-selected diet (SSD; ii = 247) for 10 wk, which were matched for macronutrient content. The PMP was fortified to provide >/= 100% of the recommended dietary allowances for 23 micronutrients, including folate. Results: Mean folate intakes at 10 wk were 601 +/= 143 mu g/d with the PMP and 270 +/= 107 mu g/d with the SSD. With the PMP, serum tHcy concentrations fell from 10.8 +/= 5.8 to 9.3 +/= 4.9 mu mol/L (P < 0.0001) between weeks 0 and 10 and the change was associated with increased intakes of folate, vitamin B-12, and vitamin B-6 and with increased serum and red blood cell folate and serum vitamin B-12 concentrations. tHcy concentrations did not change significantly with the SSD. Conclusions: The PMP resulted in increased intakes and serum concentrations of folate and vitamin B-12. These changes were associated with reduced serum tHcy concentrations in persons at high risk of cardiovascular disease. Copyright (c) 1999 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]