Rewetting does not return drained fen peatlands to their old selves.

Peatlands have been drained for land use for a long time and on a large scale, turning them from carbon and nutrient sinks into respective sources, diminishing water regulation capacity, causing surface height loss and destroying biodiversity. Over the last decades, drained peatlands have been rewetted for biodiversity restoration and, as it strongly decreases greenhouse gas emissions, also for climate protection. We quantify restoration success by comparing 320 rewetted fen peatland sites to 243 near-natural peatland sites of similar origin across temperate Europe, all set into perspective by 10k additional European fen vegetation plots. Results imply that rewetting of drained fen peatlands induces the establishment of tall, graminoid wetland plants (helophytisation) and long-lasting differences to pre-drainage biodiversity (vegetation), ecosystem functioning (geochemistry, hydrology), and land cover characteristics (spectral temporal metrics). The Paris Agreement entails the rewetting of 500,000 km2 of drained peatlands worldwide until 2050-2070. A better understanding of the resulting locally novel ecosystems is required to improve planning and implementation of peatland rewetting and subsequent management.

Disruption of p53 function in immortalized human cells does not affect survival or apoptosis after taxol or vincristine treatment.

In the present study, we report our findings on the impact of p53 disruption on the sensitivity of human cell lines to the antimitotic agents Taxol and vincristine. Comparisons of cell survival and apoptosis were made with y-irradiation and, in some cases, several other DNA-damaging chemotherapeutic agents. Studies in eight Burkitt's lymphoma and lymphoblastoid cell lines (four wild-type p53 and four mutant p53 cell lines) revealed that the DNA-damaging agents assayed tended to exhibit less growth inhibition in the mutant p53 cell lines compared to the wild-type p53 cell lines. In contrast, no significant correlation was apparent between p53 gene status and the growth-inhibitory potency of Taxol or vincristine in these eight cell lines. We also found that contrary to gamma-irradiation, Taxol and vincristine could induce apoptosis in lymphoma cell lines harboring p53 mutations. These observations were explored further in lymphoblastoid VDSO cells (wild-type p53) from a normal individual and stably transfected VDSO derivatives lacking p53 function due to expression of the human papillomavirus type-16 E6 gene. We found that p53 disruption in VDSO/E6 cells blocked y-ray-induced apoptosis and afforded a survival advantage to VDSO/E6 cells compared to control-transfected cells. In contrast, p53 disruption did not affect Taxol- or vincristine-induced apoptosis or survival in VDSO cells. The effect of p53 disruption on Taxol sensitivity was explored further in the breast carcinoma MCF-7 and colon carcinoma HCT-116 cell lines that had been stably transfected with either the human papillomavirus type-16 E6 gene or a dominant-negative mutant p53 gene. Again, in these cell model systems, we found that p53 disruption did not affect the growth-inhibitory potency of Taxol. Taken together, our results suggest that p53 status is not a dominant factor in the mechanism by which antimitotic agents induce apoptosis and reduce survival in immortalized human cell lines.

Predicting subsequent employment status of SSA disability applicants with chronic pain.

OBJECTIVE: The study assessed the predictive ability of the standardized Multiperspective Multidimensional Pain Assessment Protocol (MMPAP). An assessment tool that predicts return to work with chronic pain patients is needed, as increasing numbers of disability applications are adjudicated in the courts. DESIGN: National randomized validation sample of disability applicants. Each MMPAP consisted of physical examinations by two physiatrists and the participant's subjective assessment. Criterion standards were Multidimensional Pain Inventory and McGill Pain Questionnaire. There was phone follow-up 6 months postdecision. SETTING: Six clinical sites were ambulatory referral centers, both public and private. PARTICIPANTS: Population-based random national sample of 710 Social Security disability applicants claiming chronic pain related to their disability, stratified by national Social Security Administration (SSA) applicant demographics. Seventy-eight were lost to follow-up, and 688 initially refused. INTERVENTIONS: No interventions were continued or initiated by the research team between assessment and follow-up. MAIN OUTCOME MEASURES: Claimant employment status 6 months after disability decision was primary outcome, change in pain intensity, and change in employment situation. RESULTS: The MMPAP predicted with 90% accuracy employment status of SSA disability applicants with chronic pain 6 months postdecision when assessed at application by two physicians trained in Physical Medicine and Rehabilitation (physiatry). Accuracy of employment situation change was 93%, and pain intensity change was 65%. Self-report measures, physical examination results, psychological status, functional limitations, and physician's subjective appraisal predict future employment. CONCLUSIONS: The MMPAP accurately predicts future employment of disability applicants claiming chronic pain. The introduction of this standardized protocol will assist in standardizing disability determination for claimants with chronic pain.

Standardization of chronic pain assessment: a multiperspective approach.

OBJECTIVE: this study reports the results of reliability and validity analyses on the Multiperspective Multidimensional Pain Assessment Protocol (MMPAP). When pain becomes chronic it intertwines with the many dimensions of a patient's life, increasing the complexity of the patient's perception of the pain and, subsequently, the prescribed treatment. Both the patient's perspective and the physician's perspective are crucial in the assessment of these multiple dimensions, creating a fundamental need for a valid and reliable, multiperspective, multidimensional pain assessment tool. DESIGN: A randomized regional sample of outpatients complaining of chronic pain. Each MMPAP consisted of physical examinations by two physicians and the participant's subjective self-report. Primary criterion standards were the Multidimensional Pain Instrument and the McGill Pain Questionnaire. SETTING: Ambulatory referral centers, both public and private. PARTICIPANTS: A population-based random sample of 651 outpatients claiming chronic pain. Thirty-six patients who were originally recruited refused participation, and four patients did not complete the entire assessment. INTERVENTIONS: No interventions were continued or initiated by the research team. MAIN OUTCOME MEASURES: As this was a validation of the instruments used, no patient outcomes were influenced or assessed. The MMPAP is a recently developed pain assessment protocol, which uses both subjective information and objective medical evidence. RESULTS: The MMPAP proved to be a reliable and valid tool that may assist in the assessment of chronic pain when two physicians independently assess the patient and this information is combined with the patient's self-reported pain perceptions. Test-retest and interrater reliability analyses confirmed that the data collected with the MMPAP were repeatable. A combination of concurrent comparisons with previously validated instruments, construct corroboration with factor analysis, and internal consistency analyses ascertained the validity of the MMPAP. CONCLUSIONS: The introduction of this standardized protocol will assist in standardizing assessments of patients with chronic pain. The MMPAP has potential as a diagnostic tool, a measure of treatment effectiveness, and a tool to compare various pain treatment center outcomes.

Clinical practice guidelines for chronic non-malignant pain syndrome patients.

The current paper provides specific guidelines for treating chronic non-malignant pain syndrome patients. The guidelines were developed from an extensive review of existing literature on practice guidelines, the research literature, and common clinical practice across major pain treatment facilities in the USA. They are intended for application to all chronic pain syndrome patients (other than cancer pain) regardless of specific site or etiology of pain. They advocate goal directed treatment to reduce medication misuse and invasive medical procedures, maximize and maintain physical activity, return to productive activity, increase the patient's ability to manage pain, reduce subjective pain intensity, reduce or eliminate the use of healthcare services for primary pain complaint, provide useful information for case settlement, and minimize treatment cost without sacrificing quality. The guidelines recommend interdisciplinary integrated evaluation and treatment on a time limit basis with a focus on conservative medical, psychological behavioral, physical, and vocational interventions based upon the patient's needs. There is emphasis on increasing the patient's level of function and ability to manage pain and related problems. Outpatient care is strongly recommended, with specific upper limits regarding treatment intensity and the use of trigger point injections and nerve blocks delineated. The guidelines also recommend that the long term use of opioid or sedative-hypnotic medications, surgery, implantable spinal devices, or brain stimulation techniques be avoided with chronic pain syndrome patients. These guidelines are intended to serve as a starting point to effectively extend and complement those released by the Agency for Health Care Policy and Research for other types of pain problems such as cancer and acute low back pain.

Guidelines for program evaluation in chronic non-malignant pain management.

The current article offers guidelines to systematically evaluate programs which treat chronic non-malignant pain syndrome patients. The guidelines represent a basic program evaluation strategy and include specific recommendations and choices on measurement-assessment tools based upon available research literature and common clinical practice. They are based on evaluation by objectives, which include the program's ability to reduce the misuse of medications, increase physical function, increase productive activity at home, work and socially, improve overall mood, reduce subjective pain intensity, reduce the use of healthcare, when applicable, achieve equitable case settlement, and minimize pain treatment program cost without compromising quality of care. The method and timing of assessing each of these objectives are delineated with an emphasis on using reliable, valid measures which can be applied effectively within a clinical setting. The guidelines also advocate patient and staff satisfaction assessment, thus offering a fully integrated program evaluation system which can measure effectiveness and allow ongoing improvement in care.