Medium-term Changes Research Articles

Soil physicochemical and microbiological indicators of short, medium and long term post-fire recovery in semi-arid ecosystems

Natural disturbances such as wildfires cause significant alterations to the structure and functioning of semi-arid ecosystems. After such disturbances, the recovery of the soil ecosystem as a whole, and more specifically the belowground microbial communities, is poorly understood. In this study, we aimed to (a) assess the short, medium and long term changes in soil physicochemical and microbiological indicators and indices after a wildfire in a semi-arid environment, (b) analyse the key relationships of multiple soil parameters and indices, and (c) identify the most suitable indicators of post-fire recovery. The study was conducted across a wildfire chronosequence spanning sites recently burnt (three months) through to 14 years after fire in a semi-arid hummock grassland ecosystem of northern Western Australia. Immediate effects of the fire on the soil system were evident with increases in pH, electrical conductivity, and available nutrients. These chemical indicators showed a strong correlation with fire age and were consistent in the direction of change. Variations in the microbial composition were apparent one year after the fire, with a higher proportional abundance of bacterial communities. The fungi to bacteria ratio and the microbial quotient (proportion of microbial C to total organic C) proved to be significant indices to reflect the recovery of soils in these semi-arid environments. Overall, this study highlights the importance of understanding the post-fire response of belowground ecosystems, and particularly changes and recovery of soil microbial communities, at different time periods. The approach and methods followed in this research can be effectively extrapolated to other areas. This study can be used to inform better soil management of degraded systems in a rapidly changing climate.

The Impact of Climate Change on Regional Government Expenditures: Evidence from Russia

This paper explores an almost untouched topic in the fast-growing climate econometrics literature—the implications of climate change for government expenditures. Using a rich sub-national dataset for Russia covering 1995–2009, we estimate the impacts of changes in climatic conditions through short-term variation and medium-term changes in average regional temperatures and precipitation. We show a strong and robust negative (but non-linear) relation between regional budget expenditures and population-weighted temperature. The results indicate that an increase in temperature results in a decrease in public expenditures and that the magnitude of this effect diminishes the warmer the region. Further, our results suggest that the benefits from warming accumulate and that adaptation measures could help leverage those benefits. The estimated decreases in regional government expenditure are, however, quite small. In mild warming scenarios, according to our estimates Russia saves roughly USD 3–4 billion in regional government expenditures between 2000 and the 2020s without undertaking adaptation measures, depending on the scenario. It should be noted that our results are estimated for a scenario of mild temperature increase (1–2 ^{circ }C). Larger temperature increases are likely to have dramatic consequences e.g. from loss of permafrost and methane release that are impossible to predict with available historical data.

Short- and medium-term changes in performance and metabolism of dairy calves offered different amounts of milk replacers

The objective of the present study was to evaluate short- and medium-term growth performance and glucose metabolism of dairy calves fed 2, 3 or 4L of milk replacer (MR) twice a day. One hundred and twenty female Holstein calves were randomly assigned to 3 groups: 2L of MR twice daily (4L), 3L of MR twice daily (6L), and 4L of MR twice daily (8L). The MR was mixed to have a 15.0% DM content. Daily MR and starter feed intake were recorded from days 2 to 70. Calves were weighed at days 0, 35, 63 and 300 and average daily gain (ADG) and gain to feed ratio (GtoF) was calculated. A glucose tolerance test (GTT) was performed at 42, 86, and 300d of life. Overall, total DMI during the first month of life was greatest for 8L calves (1010±22 vs 950±23g/d), but 6L and 8L calves consumed less starter feed (205±21g/d) than 4L calves (400±22g/d). Calves on 8L had the greatest ADG at 35d of life (752±29g/d) followed by 6L (564±29g/d) and 4L calves (484±29g/d). In contrast, at 63d of age, calves on 4L had the greatest ADG (660±29g/d) being 495±29 and 394±29g/d for 6L and 8L calves, respectively. At 300d of life, ADG did not differ among treatments. Allowance of MR did not affect GtoF. Age at first breeding was greater when calves received 4L/d, but no differences were found on age at pregnancy and conception rate. The amount of MR offered had short- and medium-term effects on glucose metabolism. When calves were fed 8L/d, serum insulin to glucose ratio increased independently of age and insulin sensitivity (IS) tended to decrease. However, differences in IS disappeared as calves became older. It is concluded that calves fed 8L of MR daily had greater ADG during the pre-weaning period, but were unable to compensate the lack of MR during the weaning process resulting in a decreased ADG compared with calves fed 4L daily. Also, offering 8L/d of MR had transitory negative effects on glucose metabolism, but those disappeared with age.

Sensitivity of glomalin-related soil protein to wildfires: Immediate and medium-term changes

Forest fires are part of many ecosystems, especially in the Mediterranean Basin. Depending on the fire severity, they can be a great disturbance, so it is of special importance to know their impact on the ecosystem elements. In this study, we measured the sensitivity of glomalin related soil protein (GRSP), a glycoprotein produced by arbuscular mycorrhizal fungi (AMF), to fire perturbation. Two wildfire-affected areas in the SE Spain (Gata and Gorga) were studied. Soil organic carbon (SOC) was also measured. Effects on GRSP immediately after fire were analyzed in both areas, while in Gorga a monitoring of GRSP stocks over a year period after the fire was also carried out. Soil samplings were carried out every 4months. Plots (1×2m2) were installed beneath pines and shrubs in burned and an adjacent control area. Results of GRSP content immediately after a fire only showed significant differences for shrub plots (burned vs control) (p<0.01) in the Gorga site. However, a year of monitoring showed significant fire effect on GRSP content in both plot types (pines and shrubs). Control plots varied considerably over time, while in burned plots GRSP content remained constant during the whole studied period. This research provides evidence of the sensitivity of GRSP to a wildfire perturbation.

Changes in the storage and sink of carbon dioxide in subsurface atmospheres controlled by climate-driven processes: the case of the Ojo Guareña karst system

A comprehensive environmental monitoring program was conducted in the Ojo Guarena cave system (Spain), one of the longest cave systems in Europe, to assess the magnitude of the spatiotemporal changes in carbon dioxide gas (CO2) in the cave–soil–atmosphere profile. The key climate-driven processes involved in gas exchange, primarily gas diffusion and cave ventilation due to advective forces, were characterized. The spatial distributions of both processes were described through measurements of CO2 and its carbon isotopic signal (δ13C[CO2]) from exterior, soil and cave air samples analyzed by cavity ring-down spectroscopy (CRDS). The trigger mechanisms of air advection (temperature or air density differences or barometric imbalances) were controlled by continuous logging systems. Radon monitoring was also used to characterize the changing airflow that results in a predictable seasonal or daily pattern of CO2 concentrations and its carbon isotopic signal. Large daily oscillations of CO2 levels, ranging from 680 to 1900 ppm day−1 on average, were registered during the daily oscillations of the exterior air temperature around the cave air temperature. These daily variations in CO2 concentration were unobservable once the outside air temperature was continuously below the cave temperature and a prevailing advective-renewal of cave air was established, such that the daily-averaged concentrations of CO2 reached minimum values close to atmospheric background. The daily pulses of CO2 and other tracer gases such as radon (222Rn) were smoothed in the inner cave locations, where fluctuation of both gases was primarily correlated with medium-term changes in air pressure. A pooled analysis of these data provided evidence that atmospheric air that is inhaled into dynamically ventilated caves can then return to the lower troposphere as CO2-rich cave air.

Stock prices, dividends, earnings, and investor sentiment

We investigate the relationship between fundamental market variables and investor sentiment. Our study focuses on empirical aspects that have not been explored by previous studies. We find that sentiment is co-integrated with earnings and sentiment changes cause earnings changes. Under extreme market events, however, sentiment changes tend to move more closely together with stock returns. We also find that the predictive power of sentiment changes increases with subsequent medium-term earnings changes and sentiment changes are asymmetrically more sensitive to high earnings. Our study provides a new insight to stock market participants.

Morphological changes of the floodplain reach of the Taro River (Northern Italy) in the last two centuries

Summary The quantitative analysis of the planform changes of the unconfined reach of the Taro River, in the Italian Northern Apennines, has allowed the channel evolution in the last 200 years to be outlined. Nine sets of maps and orthophotos, ranging from 1828 to 2011, have been used to evaluate the medium-term changes in channel morphology along the entire time interval, as well as the short-term changes in the most recent decade. Starting from the digitized channel limits and bars, a number of shell scripts based on GIS commands has been used for fast and automatic calculation of the main morphological parameters (channel length, width, braiding, sinuosity, centerline shifting) and for the drawing of graphs showing in detail their continuous variations along the entire study reach. The analysis of the differences in parameters on subsequent dates has revealed that, at least until the end of the 20th century, continuous reduction in channel width (up to a total of 75%) and braiding (43%), as well as continuous increase in channel length (13%) and sinuosity (29%), took place. This is in agreement with most of the previous studies on other rivers, both in Italy and abroad. In contrast with the results of other studies, the most recent evolutionary trend of the Taro River shows substantial morphological stability with possible slight narrowing. The identification of the variations along the channel, facilitated by the analysis of the parameter curves and supported by the historical documentation, reveals that these variations can be substantially attributed to human activities. In particular, the continuous narrowing is largely due to the recurrent subtraction of riverbed areas to be used for agricultural and industrial purposes, as well as to the construction of 10 bridges with the relevant bank protections. The intense mining between 1950s and 1980s seems to have caused a sharp incision and partial narrowing only. The morphological changes due to the reduction in the flow regime, which seem to emerge from the sporadic and discontinuous hydrological data, are expected to be negligible and, in any case, are immaterial when compared with the remarkable changes due to human activities.

Medium-term changes in Drosophila subobscura chromosomal inversion polymorphism: a possible relation with global warming?

Drosophila subobscura is a species with a rich chromosomal polymorphism for inversions. Evidence demonstrates that it is adaptive. In the present research, we studied whether it is possible to detect changes in the inversion chromosomal polymorphism of D. subobscura in a medium-term period of time. The Serbian population of Avala was selected and its inversion composition in 2004 and 2011 (a seven year period) was compared. Significant variation was found in the U chromosome. This result was due to a significant increase of U1+2 (warm) and a decrease of Ust (cold) and U1+2+6. Further, minimum, maximum and mean temperatures increased (although not significantly). Thus, U chromosome seems to be able to react in a medium-term to temperature changes in the way expected by the global warming.

Assessment of soil organic carbon stocks and fractions under different agroforestry systems in subtropical hill agroecosystems of north-east India

Soil total organic carbon (TOC) is not sensitive enough to measure the short and medium term changes due to land use change practices, and thus meaningful fractions of soil organic carbon (SOC) should be measured. The objective of this study was to evaluate four agroforestry systems (AFSs) in order to test the hypothesis that agroforestry systems promote an increase in the soil organic carbon stocks and fractions, thus improving soil quality. For this, four 26 years old agroforestry systems consisting of multipurpose tree species (MPTs) (Michelia oblonga Wall, Parkia roxburghii G. Don, Alnus nepalensis D. Don, and Pinus kesiya Royle ex- Gordon) maintained at ICAR Research Complex, Umiam, Meghalaya, India were tested and compared with control plot for SOC stocks, microbial biomass carbon (MBC), readily oxidizable carbon (ROC), non-labile carbon (CNL), particulate organic carbon (POC), and carbon management index (CMI). The soil samples were collected at five depths: 0–15, 15–30, 30–45, 45–60, and 60–75 cm. The TOC, POC, ROC, CNL and MBC in soils of agroforestry land use, on average, increased significantly by 26.3, 60.1, 27.1, 46.4 and 34 %, respectively in relative to control plot. However, the AFS consisting A. nepalensis recorded the highest mean SOC stocks (60.2 Mg ha−1), TOC (3.60 g 100 g−1), POC (5.42 g kg−1), ROC (10.16 g kg−1) and MBC (548 mg kg−1) than other AFSs. Furthermore, the CMI was highest under A. nepalensis (129.6) followed by M. oblonga (119.4), whereas P. kesiya showed the lowest value (91.1). The SOC stocks and fractions were, on average, 35.3 and 70 %, respectively higher in upper soil layer (0–15 cm) compared to subsurface soil layers (15–75 cm) in all the AFSs. The strong and positive correlation (P < 0.05) between labile soil carbon fractions with TOC (r = 0.680** for POC; r = 0.683** for ROC and r = 0.758** for MBC) indicates that the changes in TOC content of soils is mainly influenced by the labile C pools and are the sensitive indicators of soil quality improvements. The AFSs, A. nepalensis in particular, can, therefore, be recommended as an alternative soil management strategy for food production, and for the maintenance of soil quality and agricultural sustainability through increased SOC sequestration in the highly fragile agro-ecosystems of northeast India.

Using transcranial magnetic stimulation to quantify electrophysiological changes following concussive brain injury: a systematic review.

Mild traumatic brain injury (mTBI) and sports concussion are a growing public health concern, with increasing demands for more rigorous methods to quantify changes in the brain post-injury. Electrophysiology, and in particular, transcranial magnetic stimulation (TMS), have been demonstrated to provide prognostic value in a range of neurological conditions; however, no review has quantified the efficacy of TMS in mTBI/concussion. In the present study, we present a systematic review and critical evaluation of the scientific literature from 1990 to 2014 that has used TMS to investigate corticomotor excitability responses at short-term (< 12 months), medium-term (1-5 years), and long-term (> 5 years) post-mTBI/concussion. Thirteen studies met the selection criteria, with six studies presenting short-term changes, five studies presenting medium-term changes, and two studies presenting long-term changes. Irrespective of time post-concussion, change in intracortical inhibition was the most reported observation. Other findings included increased stimulation threshold, and slowed neurological conduction time. Although currently limited, the data suggest that TMS has prognostic value in detecting neurophysiological changes post-mTBI/concussion.

Influence of straw mulch application on the properties of a soil affected by a forest wildfire

Mulching treatment is often recommended &lt;ins cite="mailto:Michele%20Francis" datetime="2015-01-23T16:22"&gt;in order &lt;/ins&gt;to reduce post-fire erosion and sediment&lt;del cite="mailto:Michele%20Francis" datetime="2015-01-23T15:45"&gt;&lt;/del&gt; yields&lt;ins cite="mailto:Michele%20Francis" datetime="2015-01-23T15:45"&gt;,&lt;/ins&gt; but information concerning their effects on soil properties and hence on soil quality is scarce. In the present investigation&lt;ins cite="mailto:Michele%20Francis" datetime="2015-01-23T16:22"&gt;,&lt;/ins&gt; the influence of straw application on soil quality was evaluated &lt;ins cite="mailto:Michele%20Francis" datetime="2015-01-23T16:22"&gt;on&lt;/ins&gt;&lt;del cite="mailto:Michele%20Francis" datetime="2015-01-23T16:22"&gt;&lt;/del&gt;&lt;del cite="mailto:Michele%20Francis" datetime="2015-01-23T15:46"&gt; &lt;/del&gt;hillslope shrubland &lt;del cite="mailto:Michele%20Francis" datetime="2015-01-23T15:46"&gt;&lt;/del&gt;in Saviñao (Lugo, NW Spain)&lt;ins cite="mailto:Michele%20Francis" datetime="2015-01-23T15:47"&gt; &lt;/ins&gt;&lt;del cite="mailto:Michele%20Francis" datetime="2015-01-23T15:47"&gt;&lt;/del&gt;&lt;del cite="mailto:Michele%20Francis" datetime="2015-01-23T15:46"&gt;&lt;/del&gt;&lt;ins cite="mailto:Michele%20Francis" datetime="2015-01-23T15:46"&gt;th&lt;/ins&gt;&lt;ins cite="mailto:Michele%20Francis" datetime="2015-01-23T16:02"&gt;a&lt;/ins&gt;&lt;ins cite="mailto:Michele%20Francis" datetime="2015-01-23T15:46"&gt;t is &lt;/ins&gt;susceptible to &lt;del cite="mailto:Michele%20Francis" datetime="2015-01-23T15:46"&gt;&lt;/del&gt;post-fire erosion (38% slope). In this area, &lt;ins cite="mailto:Michele%20Francis" datetime="2015-01-23T16:04"&gt;which was &lt;/ins&gt;affected by a medium-high severity wildfire in September 2012, different treatments with wheat straw &lt;ins cite="mailto:Michele%20Francis" datetime="2015-01-23T16:03"&gt;were &lt;/ins&gt;applied to the burnt soil in mulch strips (0.8 and 1 Mg ha&lt;sup&gt;-1&lt;/sup&gt;) &lt;del cite="mailto:Michele%20Francis" datetime="2015-01-23T16:03"&gt;&lt;/del&gt;&lt;del cite="mailto:Michele%20Francis" datetime="2015-01-23T15:50"&gt;&lt;/del&gt;&lt;ins cite="mailto:Michele%20Francis" datetime="2015-01-23T15:50"&gt;using &lt;/ins&gt;quadruplicate &lt;ins cite="mailto:Michele%20Francis" datetime="2015-01-23T15:51"&gt;10 m x 40 m &lt;/ins&gt;&lt;ins cite="mailto:Michele%20Francis" datetime="2015-01-23T15:49"&gt;plots &lt;/ins&gt;&lt;del cite="mailto:Michele%20Francis" datetime="2015-01-23T15:51"&gt;&lt;/del&gt;&lt;del cite="mailto:Michele%20Francis" datetime="2015-01-23T15:49"&gt;&lt;/del&gt;and compared with the corresponding burnt untreated control. Soil samples were collected from the A horizon (0-2.5 cm depth) at different sampling times &lt;del cite="mailto:Michele%20Francis" datetime="2015-01-23T17:15"&gt;&lt;/del&gt;&lt;ins cite="mailto:Michele%20Francis" datetime="2015-01-23T17:15"&gt;for 12 months&lt;/ins&gt; after the wildfire&lt;del cite="mailto:Michele%20Francis" datetime="2015-01-23T16:03"&gt;&lt;/del&gt;&lt;ins cite="mailto:Michele%20Francis" datetime="2015-01-23T15:48"&gt;,&lt;/ins&gt; and a wide range of physicochemical, chemical and biochemical soil properties (water retention, pH, electric conductivity, total C, &lt;sup&gt;13&lt;/sup&gt;C, extractable C, water soluble C, soluble carbohydrates, total N, &lt;sup&gt;15&lt;/sup&gt;N, microbial biomass C, soil respiration, bacterial activity, b-glucosidase, urease and phosphatase activities) were analyzed. The results showed that the application of straw mulch had a minor influence on the post-fire soil quality but, in contrast, the sampling time showed a significant influence attributed to short- and medium term changes in soil properties induced by both fire and climatic conditions.

Values, Competencies, and Public Sector Training: The Value Base of Administrative Modernization

The article analyzes current challenges faced by schools of administration in view of value changes at societal as well as organizational levels. Despite far-reaching structural and procedural changes, the set of values, attitudes, and role understandings held by administrators may be relatively impervious to short- and medium-term changes. As a result, this likely gap between required “cultural dispositions” and dominant value patterns presents a challenge to public sector training programs. It flows from this that public sector training programs have to take values seriously. So, the design and management of training institutions and the content and teaching philosophy of their programs need to reflect those changes. Though written from a European perspective and drawing particularly on the German experience, the paper offers primarily a theoretical and conceptual discussion of the role of values, work-related attitudes, and role understandings in governance reform.

Could Climate Change Affect Government Expenditures? Early Evidence from the Russian Regions

This paper explores the implications of climate change for government expenditures. Using a rich sub-national dataset for Russia covering 1995–2009, we estimate the impacts of changes in climatic conditions through short-term variation and medium-term changes in average regional temperatures and precipitation. We show a strong and robust negative (but non-linear) relation between regional budget expenditures and population-weighted temperature. The results indicate that an increase in temperature results in a decrease in public expenditures and that the magnitude of this effect diminishes the warmer the region. Further, our results suggest that the benefits from warming accumulate and that adaptation measures could help leverage those benefits. The estimated decreases in regional government expenditure are, however, quite small. It should be noted that our results are estimated for a scenario of mild temperature increase (1–2 °C). Larger temperature increases are likely to have dramatic consequences e.g. from loss of permafrost and methane release that are impossible to predict with available historical data.

The Adoption of New Technologies in Dryland Farming Regions of Idaho, Washington, and Oregon

In the last 30 years several advanced technologies including guidance systems, auto-steer systems, variable fertilizer rate systems, and section controllers have become mainstream in modern irrigated agriculture. Although these technologies have become widely accepted under irrigated conditions in the United States, their adoption under dryland conditions has lagged. The purpose of this study was to document the adoption of these technologies in the dryland inland areas of northern Idaho, eastern Washington, and northeastern Oregon. Three mail-based surveys conducted 15 years apart in 1981, 1996, and 2011 were used to document adoption. All of the Dillman-based surveys received grower responses in excess of 50%. In 2011, guidance systems, auto steer systems, section controllers, and variable rate application systems were used by 46.8, 36.6, 25.5, and 20.4% of the survey respondents, respectively. The use of these technologies was less than 2% in 1981 and less than 10% in 1996. The factors of annual precipitation zone, grower age, number of years farmed, and farm size all had an impact on the use of modern technology. In general, variable rate systems were more popular in the drier areas. Younger farmers were more likely to have adopted the new technologies, and new technology use was more widespread on the larger farms. This article is important because it contains a 30-year history of how quickly modern technologies have been adopted in northern Idaho and eastern Washington. This article is unique because medium-term production changes (20–40 years) are seldom documented by a single research/extension program in production agriculture.

Dominance hierarchies, diversity and species richness of vascular plants in an alpine meadow: contrasting short and medium term responses to simulated global change.

We studied the impact of simulated global change on a high alpine meadow plant community. Specifically, we examined whether short-term (5 years) responses are good predictors for medium-term (7 years) changes in the system by applying a factorial warming and nutrient manipulation to 20 plots in Latnjajaure, subarctic Sweden. Seven years of experimental warming and nutrient enhancement caused dramatic shifts in dominance hierarchies in response to the nutrient and the combined warming and nutrient enhancement treatments. Dominance hierarchies in the meadow moved from a community being dominated by cushion plants, deciduous, and evergreen shrubs to a community being dominated by grasses, sedges, and forbs. Short-term responses were shown to be inconsistent in their ability to predict medium-term responses for most functional groups, however, grasses showed a consistent and very substantial increase in response to nutrient addition over the seven years. The non-linear responses over time point out the importance of longer-term studies with repeated measurements to be able to better predict future changes. Forecasted changes to temperature and nutrient availability have implications for trophic interactions, and may ultimately influence the access to and palatability of the forage for grazers. Depending on what anthropogenic change will be most pronounced in the future (increase in nutrient deposits, warming, or a combination of them both), different shifts in community dominance hierarchies may occur. Generally, this study supports the productivity–diversity relationship found across arctic habitats, with community diversity peaking in mid-productivity systems and degrading as nutrient availability increases further. This is likely due the increasing competition in plant–plant interactions and the shifting dominance structure with grasses taking over the experimental plots, suggesting that global change could have high costs to biodiversity in the Arctic.

Long- and medium-term effects of aridity on the chemical defence of a widespread Brassicaceae in the Mediterranean

Aridity does not only vary along different regions but the frequency of drought is also supposed to increase in the future as a consequence of climate change. Plants may respond to changes in abiotic conditions by adjusting their investment in resources such as chemical defences against herbivores and pathogens. However, knowledge is scarce about how such investments may differ in response to long- or medium-term changes in precipitation. Biscutella didyma (Brassicaceae) grows in Israel along a steep precipitation gradient. Four populations along this gradient (arid, semi-arid, Mediterranean, and mesic Mediterranean climate) served as source populations for the current study. In two of these populations, rainfall had been manipulated for ten years, simulating dry, normal, and wet conditions. Seeds from the four populations and the rainfall manipulation treatments were collected and grown under standardised conditions to investigate whether shifts in constitutive defences in relation to the aridity conditions have occurred over long- or medium-term. Young leaves of 10-week old plants were harvested and analysed for their glucosinolate contents, the characteristic defence metabolites of Brassicaceae. Plants originating from the arid region had the lowest glucosinolate concentrations, whereas plants originating from the opposite end of the gradient had the highest, indicating local adaptation in response to long-term conditions. This pattern may be explained by lower or modified enemy pressure, or by limited resource availability in the arid region. The rainfall manipulation over ten years did not affect glucosinolate profiles of the offspring. This may indicate limited potential for rapid evolutionary response but also other factors than drought as the selective agent.

Health effects of the London bicycle sharing system: health impact modelling study

Objective To model the impacts of the bicycle sharing system in London on the health of its users.Design Health impact modelling and evaluation, using a stochastic simulation model.Setting Central and...

Medium-Term Changes in Vaginal Accommodation and Sexual Function After Vaginal Reconstructive Surgery

Vaginal shortening and narrowing is an uncommon complication of vaginal reconstructive surgery for prolapse and may cause sexual dysfunction and dyspareunia. We hypothesize that vaginal length, caliber, and sexual function will remain unchanged between the initial (6 weeks to 6 months) and medium-term (18-36 months) postoperative periods. Women who had previously undergone native tissue vaginal reconstructive surgery for symptomatic pelvic organ prolapse and did not undergo intentional vaginal shortening and narrowing were invited to participate by completing a survey and undergoing a physical examination. Vaginal obturators of variable diameters were used to measure vaginal length and caliber. Sexual function was assessed using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12. Women were asked to complete the same checklist assessing barriers (if not sexually active) or interfering factors (if sexually active) to sexual activity. Survey results were available from 41 women with mean ± SD age at surgery of 63.7 ± 10.6 years. Among those sexually active at both postoperative periods (22 women), mean Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 scores were unchanged between the initial and medium-term postoperative periods (34.1 ± 6.0 vs 32.9 ± 6.0; P = 0.19). Vaginal dryness was the most common interfering factor to sexual activity. Vaginal length and caliber were unchanged between measurements at the initial postoperative and the medium-term postoperative periods. There was no significant change in vaginal anatomy measurements or sexual function between initial (6 weeks to 6 months) and medium-term (18-36 months) postoperative periods after vaginal reconstructive surgery.

Effect of a lifestyle intervention on weight change in south Asian individuals in the UK at high risk of type 2 diabetes: a family-cluster randomised controlled trial

The susceptibility to type 2 diabetes of people of south Asian descent is established, but there is little trial-based evidence for interventions to tackle this problem. We assessed a weight control and physical activity intervention in south Asian individuals in the UK. We did this non-blinded trial in two National Health Service (NHS) regions in Scotland (UK). Between July 1, 2007, and Oct 31, 2009, we recruited men and women of Indian and Pakistani origin, aged 35 years or older, with waist circumference 90 cm or greater in men or 80 cm or greater in women, and with impaired glucose tolerance or impaired fasting glucose determined by oral glucose tolerance test. Families were randomised (using a random number generator program, with permuted blocks of random size, stratified by location [Edinburgh or Glasgow], ethnic group [Indian or Pakistani], and number of participants in the family [one vs more than one]) to intervention or control. Participants in the same family were not randomised separately. The intervention group received 15 visits from a dietitian over 3 years and the control group received four visits in the same period. The primary outcome was weight change at 3 years. Analysis was by modified intention to treat, excluding participants who died or were lost to follow-up. We used linear regression models to provide mean differences in baseline-adjusted weight at 3 years. This trial is registered, number ISRCTN25729565. Of 1319 people who were screened with an oral glucose tolerance test, 196 (15%) had impaired glucose tolerance or impaired fasting glucose and 171 entered the trial. Participants were in 156 family clusters that were randomised (78 families with 85 participants were allocated to intervention; 78 families with 86 participants were allocated to control). 167 (98%) participants in 152 families completed the trial. Mean weight loss in the intervention group was 1.13 kg (SD 4.12), compared with a mean weight gain of 0.51 kg (3.65) in the control group, an adjusted mean difference of -1.64 kg (95% CI -2.83 to -0.44). Modest, medium-term changes in weight are achievable as a component of lifestyle-change strategies, which might control or prevent adiposity-related diseases. National Prevention Research Initiative, NHS Research and Development; NHS National Services Scotland; NHS Health Scotland.

Disability transitions after 30 months in three community-dwelling diagnostic groups in Spain

BackgroundLittle is known about changes in disability over time among community-dwelling patients. Accordingly, this study sought to assess medium-term disability transitions.Patients and Methods300 chronic obstructive pulmonary disease (COPD), chronic heart failure and stroke patients living at home in Madrid were selected from general practitioner lists. In 2009, disability was assessed after a mean of 30 months using the World Health Organisation (WHO) Disability Assessment Schedule 2.0 (WHODAS 2.0). Follow-up was completed using death registries. Losses to follow-up were due to: death, 56; institutionalisation, 9; non-location, 18; and non-participation, 17. Changes in WHODAS 2.0 scores and life status were described and analysed using Cox and multinomial regression. Disability at end of follow-up was imputed for 56 deceased and 44 surviving patients.ResultsMean disability scores for 200 surviving patients at end of follow-up were similar to baseline scores for the whole group, higher than their own baseline scores, and rose by 16.3% when imputed values were added. The strongest Cox predictors of death were: age over 84 years, adjusted hazard ratios with 95%CI 8.18 (3.06-21.85); severe/complete vs. no/mild disability, 5.18 (0.68-39.48); and stroke compared to COPD, 1.40 (0.67-2.91). Non-participants and institutionalised patients had higher proportions with severe/complete baseline disability. A one-point change in baseline WHODAS 2.0 score predicted independent increases in risk of 12% (8%-15%) for severe/complete disability or death.ConclusionsA considerably high proportion of community-dwelling patients diagnosed with COPD, CHF and stroke undergo medium-term changes in disability or vital status. The main features of the emerging pattern for this group appear to be as follows: approximately two-thirds of patients continue living at home with moderately reduced functional status; 1/3 die or worsen to severe/complete disability; and 1/10 improve. Baseline disability scores, age and diagnosis are associated with disability and death in the medium term.