Development and validation of the Exercise-Induced Laryngeal Obstruction Dyspnea Index (EILODI).

BACKGROUND: Exercise-induced laryngeal obstruction (EILO) causes exertional dyspnea and is important for its effect on quality of life, diagnostic confusion with exercise-induced asthma, and health care resource utilization. There is no validated patient-reported outcome measure specific to EILO. OBJECTIVE: We sought to develop, validate, and define a minimal clinically important difference for a patient-reported outcome measure to be used with adolescents and young adults with EILO. METHODS: A multidisciplinary group created a preliminary measure, modified by a 10-member participant focus group, with 20 items scored along a 5-point Likert scale. A subsequent cohort of participants recruited from a clinic, aged 12 to 21 years, with confirmed EILO by continuous laryngoscopy during exercise testing (1) completed the measure at 3 points in time over 28 days and (2) provided anchoring data in the form of a daily exercise log and categorical self-assessments of clinical improvement. Thirty additional participants without exertional dyspnea served as controls. RESULTS: Two hundred nineteen subjects with mild to severe EILO participated in the exploratory factor analysis, which identified 7 factors within the preliminary outcome measure. After a process of item reduction, a 12-item metric with a total score ranging from 0 to 48 was developed. Mean scores of patients with EILO and healthy controls at baseline were 28.8 ± 7.4 and 4.5 ± 7.4, respectively. A minimal clinically important difference of 6 was determined by comparison of index change with changes in categorical self-assessments of improvement. CONCLUSIONS: This is the first patient-reported outcome measure specifically designed for adolescents and young adults with EILO.

Apple phenology occurs earlier across South Korea with higher temperatures and increased precipitation.

This study examined relationships between temperature, precipitation, geo-topography, and the spring phenology of Fuji and Hongro apple cultivars along spatial gradients across South Korea. Phenology data was gathered from 2011 to 2014 in 42 uniformly managed research orchards which span a range in climate, latitude, and elevation. We used linear models and spatially explicit forecasts to study apple phenology under climate change scenarios. Given dry winters and complex terrain in South Korea, we hypothesized that, in addition to temperature, precipitation and geo-topographic factors influence apple phenology. We also expected responses to climate variation to be similar between (spatial) and within (temporal) orchards, given the controlled conditions and the use of apple clones in this study. With other factors held constant, phenological sensitivity ranged from - 3.2 to - 3.4 days °C-1 for air temperature and - 0.5 to - 0.6 days cm-1 for March precipitation in a combined model. When modeled without temperature, phenology changed by up to 10 days over the full range in March precipitation. Spring temperatures and precipitation in March had very little cross-correlation (r < 0.05), suggesting these patterns are independent; however, in a combined model including temperature, predicted changes in precipitation over the next 80 years have only a small impact on future apple phenology. Combining the best models with climate forecasts for South Korea, spring phenology continues to occur earlier over the next 80 years, mostly due to warming temperatures but with strong variation between regions. This suggests regionally specific climate change adaptation strategies are needed for future apple production in South Korea.

Repeated Genetic Targets of Natural Selection Underlying Adaptation of Fishes to Changing Salinity.

Ecological transitions across salinity boundaries have led to some of the most important diversification events in the animal kingdom, especially among fishes. Adaptations accompanying such transitions include changes in morphology, diet, whole-organism performance, and osmoregulatory function, which may be particularly prominent since divergent salinity regimes make opposing demands on systems that maintain ion and water balance. Research in the last decade has focused on the genetic targets underlying such adaptations, most notably by comparing populations of species that are distributed across salinity boundaries. Here, we synthesize research on the targets of natural selection using whole-genome approaches, with a particular emphasis on the osmoregulatory system. Given the complex, integrated and polygenic nature of this system, we expected that signatures of natural selection would span numerous genes across functional levels of osmoregulation, especially salinity sensing, hormonal control, and cellular ion exchange mechanisms. We find support for this prediction: genes coding for V-type, Ca2+, and Na+/K+-ATPases, which are key cellular ion exchange enzymes, are especially common targets of selection in species from six orders of fishes. This indicates that while polygenic selection contributes to adaptation across salinity boundaries, changes in ATPase enzymes may be of particular importance in supporting such transitions.