The Integrative Migraine Pain Alleviation through Chiropractic Therapy (IMPACT) trial: Study rationale, design and intervention validation.

INTRODUCTION: Approximately 15% of the US population experiences migraine, with women afflicted three times as often as men. While medications are often used as first-line treatments, up to 50% of people with migraine pursue complementary and integrative medicine. One promising non-pharmacological approach for migraine is chiropractic care, due to the co-occurrence of migraine disease and musculoskeletal tension and pain. To date, no large-scale trials have evaluated the impact of a comprehensive model of chiropractic care on migraine. METHODS: The Integrative Migraine Pain Alleviation through Chiropractic Therapy (IMPACT) study is a two-arm pilot pragmatic randomized clinical trial evaluating a multimodal chiropractic care intervention plus enhanced usual care (UC) vs. enhanced UC alone for adult women with episodic migraine. A total of 60 women aged 20-55 who meet criteria for episodic migraine will be randomly assigned to an evidence-informed, musculoskeletal focused multimodal chiropractic care (10 sessions over 14 weeks) plus enhanced UC vs. enhanced UC alone. Enhanced UC includes conventional care, migraine education materials, and biweekly check-in phone calls. Study specific aims include: 1) Determine safety and feasibility of the study design; 2) Provide preliminary data on the effectiveness of chiropractic care on migraine frequency, severity, duration and medication use; and 3) Provide preliminary estimates of the effects of chiropractic care on disability, health-related quality of life, and psychosocial well-being. DISCUSSION: Findings will be used to inform the design of a full-scale trial evaluating chiropractic care for women with episodic migraines.

Biological motion during inflammation in humans.

Biological motion is a powerful perceptual cue that can reveal important information about the inner state of an individual. Activation of inflammatory processes likely leads to changes in gait, posture, and mobility patterns, but the specific characteristics of inflammation-related biological motion have not been characterized. The aim of this study was to determine the effect of inflammation on gait and motion in humans. Systemic inflammation was induced in 19 healthy volunteers with an intravenous injection of lipopolysaccharide (2 ng/kg body weight). Biological motion parameters (walking speed, stride length and time, arm, leg, head, and shoulder angles) were assessed during a walking paradigm and the timed-up-and-go test. Cytokine concentrations, body temperature, and sickness symptoms were measured. During inflammation, compared to placebo, participants exhibited shorter, slower, and wider strides, less arm extension, less knee flexion, and a more downward-tilting head while walking. They were also slower and took a shorter first step in the timed-up-and-go test. Higher interleukin-6 concentrations, stronger sickness symptoms, and lower body temperature predicted the inflammation-related alterations in biological motion. These findings show that biological motion contains clear information about the inflammatory status of an individual, and may be used by peers or artificial intelligence to recognize that someone is sick or contagious.

The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson's disease: A systematic review and meta-analysis.

PURPOSE: To systematically evaluate and quantify the effects of Tai Chi/Qigong (TCQ) on motor (UPDRS III, balance, falls, Timed-Up-and-Go, and 6-Minute Walk) and non-motor (depression and cognition) function, and quality of life (QOL) in patients with Parkinson's disease (PD). METHODS: A systematic search in 7 electronic databases targeted clinical studies evaluating TCQ for individuals with PD published through August 2016. Meta-analysis was used to estimate effect sizes (Hedges's g) and publication bias for randomized controlled trials (RCTs). Methodological bias in RCTs was assessed by two raters. RESULTS: Our search identified 21 studies, 15 of which were RCTs with a total of 735 subjects. For RCTs, comparison groups included no treatment (n = 7, 47%) and active interventions (n = 8, 53%). Duration of TCQ ranged from 2 to 6 months. Methodological bias was low in 6 studies, moderate in 7, and high in 2. Fixed-effect models showed that TCQ was associated with significant improvement on most motor outcomes (UPDRS III [ES = -0.444, p < 0.001], balance [ES = 0.544, p < 0.001], Timed-Up-and-Go [ES = -0.341, p = 0.005], 6 MW [ES = -0.293, p = 0.06], falls [ES = -0.403, p = 0.004], as well as depression [ES = -0.457, p = 0.008] and QOL [ES = -0.393, p < 0.001], but not cognition [ES = -0.225, p = 0.477]). I2 indicated limited heterogeneity. Funnel plots suggested some degree of publication bias. CONCLUSION: Evidence to date supports a potential benefit of TCQ for improving motor function, depression and QOL for individuals with PD, and validates the need for additional large-scale trials.

Elevated CO2 ameliorates birch response to high temperature and frost stress: implications for modeling climate-induced geographic range shifts.

Despite predictions that both atmospheric CO2 concentrations and air temperature will rise together, very limited data are currently available to assess the possible interactive effects of these two global change factors on temperate forest tree species. Using yellow birch (Betula alleghaniensis) as a model species, we studied how elevated CO2 (800 vs. 400 µl l-1) influences seedling growth and physiological responses to a 5°C increase in summer air temperatures (31/26 vs. 26/21°C day/night), and how both elevated CO2 and air temperature during the growing season influence seedling ability to survive freezing stress during the winter dormant season. Our results show that while increased temperature decreases seedling growth, temperature-induced growth reductions are significantly lower at elevated CO2 concentrations (43% vs. 73%). The amelioration of high-temperature stress was related to CO2-induced reductions in both whole-shoot dark respiration and transpiration. Our results also show that increased summer air temperature, and to a lesser degree CO2 concentration, make dormant winter buds less susceptible to freezing stress. We show the relevance of these results to models used to predict how climate change will influence future forest species distribution and productivity, without considering the direct or interactive effects of CO2.

CO2-induced growth enhancements of co-occurring tree species decline at different rates.

To elucidate how enriched CO2 atmospheres, soil fertility, and light availability interact to influence the long-term growth of tree seedlings, six co-occurring members of temperate forest communities including ash (Fraxinus americana L.), gray birch (Betula populifolia), red maple (Acer rubrum), yellow birch (Betula alleghaniensis), striped maple (Acer pensylvanicum), and red oak (Quercus rubra L.) were raised in a glasshouse for three years in a complete factorial design. After three years of growth, plants growing in elevated CO2 atmospheres were generally larger than those in ambient CO2 atmospheres, however, magnitudes of CO2-induced growth enhancements were contingent on the availability of nitrogen and light, as well as species identity. For all species, magnitudes of CO2-induced growth enhancements after one year of growth were greater than after three years of growth, though species' growth enhancements over the three years declined at different rates. These results suggest that CO2-induced enhancements in forest productivity may not be sustained for long periods of time. Additionally, species' differential growth responses to elevated CO2 may indirectly influence forest productivity via long-term species compositional changes in forests.

Morning vs afternoon sun patches in experimental forest gaps: consequences of temporal incongruency of resources to birch regeneration.

We investigated whether the timing of high light availability as sun patches within forest gaps, independent of total or peak photosynthetic photon flux (PPF), influences the physiology and growth of four coexisting birch species (Betula alleghaniensis, B. lenta, B. papyrifera, and B. populifolia). Birch seedlings were grown for two years along either the east or west sides of experimental gap structures and at two moisture levels. Seedlings positioned in the west received sun patches earlier in the day than those in the east, and environmental conditions for carbon gain were generally more favorable during the earlier sunpatches in the west; air and leaf temperatures were lower, and relative humidity higher, relative to conditions during sun patches in the cats, simulating patterns observed in natural forest gaps. Seedlings positioned along the west edges of gaps fixed more carbon earlier in the day than those in the east, and in many cases, peak net photosynthetic rates were greater for west positioned seedlings. In year two, leaf-level integrated daily carbon gain was greater for west- than eastpositioned plants, and for the most pioneer species, B. populifolia, differences between west and east seedlings were greatest at lower soil moisture levels. Despite some small effects on leaf gas exchange, the timing of high light availability, and its temporal congruence with other factors critical to carbon gain, had no significant effects on first or second year seedling biomass. The responses of birch seedlings to controlled variations in the timing of high light availability were generally much smaller than birch seedling responses to variations in other components of daily light regimes such as total integrated and peak PPF.

Elevated CO2 differentially alters the responses of coocurring birch and maple seedlings to a moisture gradient.

To determine the effects of elevated CO2 and soil moisture status on growth and niche characteristics of birch and maple seedlings, gray birch (Betula populifolia) and red maple (Acer rubrum) were experimentally raised along a soil moisture gradient ranging from extreme drought to flooded conditions at both ambient and elevated atmospheric CO2 levels. The magnitude of growth enhancement due to CO2 was largely contingent on soil moisture conditions, but differently so for maple than for birch seedlings. Red maple showed greatest CO2 enhancements under moderately moist soil conditions, whereas gray birch showed greatest enhancements under moderately dry soil conditions. Additionally, CO2 had a relatively greater ameliorating effect in flooded conditions for red maple than for gray birch, whereas the reverse pattern was true for these species under extreme drought conditions. For both species, elevated CO2 resulted in a reduction in niche breadths on the moisture gradient; 5% for gray birch and 23% for red maple. Species niche overlap (proportional overall) was also lower at elevated CO2 (0.98 to: 0.88: 11%). This study highlights the utility of of experiments crossing CO2 levels with gradients of other resources as effective tools for elucidating the potential consequences of elevated CO2 on species distributions and potential interactions in natural communities.

Assessing diversity in plant communities: The importance of within-species variation.

While the measurement of plant species diversity continues to play a central role in ecology and conservation, few formal attempts have been made at defining the concept of diversity, and, specifically, at evaluating the utility of taxonomic species as units for diversity indices. Ecological diversity is defined here as a measure of the degree of biotic and/or abiotic dissimilitude within a community that is perceivable and utilizable by organisms. Although indices based merely on 'species' may be useful for cataloging taxonomic diversity in communities, plant taxa are generally unreliable units for quantifying the ecological diversity perceived and utilized by most organisms in communities. Recent research highlights the shortcomings of the unit of species for characterizing ecological diversity, and we advocate the further exploration of alternative diversity classes with which to describe plant communities.