The fluvial geomorphology and stratigraphy on the middle Snake River at Bancroft Springs, Idaho, provide evidence for numerous episodes of Snake River aggradation and incision since the Bonneville Flood at ca. 18 ka. A suite of seven terraces ranging from 20–1 m above modern bankfull elevation records multiple cut-and-fill cycles during the latest Pleistocene and Holocene in response to local base-level controls, variations in sediment supply, and hydroclimate change. Radiocarbon and luminescence dating show that the ages of fluvial aggradation generally coincide with increased sediment supply and likely wetter hydroclimate during onset of the Younger Dryas stadial (ca. 13.2 ka), deglaciation and termination of the Younger Dryas stadial (ca. 11.3 ka), Early Holocene cooling (ca. 8.8 ka), and Neoglacial (ca. 4.5, 2.9, 1.1 ka). Six intervening periods of incision and channel stability may also reflect either reduced sediment supply, drier hydroclimate, or both. The terrace chronology can be correlated to a variety of local and regional paleoclimate proxy records and corresponds well with periods of continental- and global-scale rapid climate change during the Holocene. The fluvial record demonstrates the geomorphic response and sensitivity of large river systems to changes in hydroclimate variability, which has important implications for inferring paleoenvironmental conditions in the region.

Hereditary transthyretin-mediated (hATTR) amyloidosis is a progressive disease caused by mutations in the TTR gene leading to multisystem organ dysfunction. Pathogenic TTR aggregation, misfolding, and fibrillization lead to deposition of amyloid in multiple body organs and frequently involve the peripheral nerve system and the heart. Common neurologic manifestations include: sensorimotor polyneuropathy (PN), autonomic neuropathy, small-fiber PN, and carpal tunnel syndrome. Many patients have significant progression due to diagnostic delays as hATTR PN is not considered within the differential diagnosis. Recently, two effective novel disease-modifying therapies, inotersen and patisiran, were approved by Health Canada for the treatment of hATTR PN. Early diagnosis is crucial for the timely introduction of these disease-modifying treatments that reduce impairments, improve quality of life, and extend survival. In this guideline, we aim to improve awareness and outcomes of hATTR PN by making recommendations directed to the diagnosis, monitoring, and treatment in Canada.

The COVID-19 pandemic has had a major impact on clinical practice. Safe standards of practice are essential to protect health care workers while still allowing them to provide good care. The Canadian Society of Clinical Neurophysiologists, the Canadian Association of Electroneurophysiology Technologists, the Association of Electromyography Technologists of Canada, the Board of Registration of Electromyography Technologists of Canada, and the Canadian Board of Registration of Electroencephalograph Technologists have combined to review current published literature about safe practices for neurophysiology laboratories. Herein, we present the results of our review and provide our expert opinion regarding the safe practice of neurophysiology during the COVID-19 pandemic in Canada.

For a French translation of the executive summary, please see the Supplementary Material at DOI: 10.1017/cem.2017.429

Background: Preliminary studies have supported the utility of exercise as a treatment for Charcot–Marie–Tooth disease (CMT) patients. Despite being the most common inherited neuropathy, there remains a paucity of guidelines for CMT management. Methods: A retrospective chart review was performed on 297 CMT patients. Self-reported exercise and strength results from standardized dynamometer testing were obtained from adult patients’ first visits. Values were converted and analyzed based on previously reported age- and sex-matched normative values. Results: Participants with CMT2 had greater strength values than those with CMT1 in hand grip, elbow flexion, and dorsiflexion (p<0.05). Participants with CMT1 and CMT2 who exercised were statistically significantly stronger in elbow flexion and dorsiflexion than those who did not exercise. Conclusions: These preliminary results suggest that self-directed exercise is associated with greater strength in CMT patients of both CMT1 and CMT2 subtypes. Self-directed exercise may be a convenient, sustainable, and effective method of improving strength and decreasing disability in this population. Future research should explore the type of exercise prescription that best addresses the needs of the CMT population.

The fate of field-applied herbicides, including losses in surface runoff with water and sediment, is highly dependent on herbicide properties. The two most important properties are soil adsorption and persistence. Adsorption affects the potential for a herbicide to be lost primarily with sediment, runoff water, or possibly leaching water. Solubility, often though not always inversely correlated with adsorption, is of secondary importance, although low solubility can limit transport with water. Persistence affects the time available to be lost in runoff. Studies have shown that for soil-applied herbicides; extraction into runoff water or movement with sediment takes place from a thin soil layer at the surface. In addition, for herbicides studied, there is little interaction between surface crop residue and applied herbicides, and washoff from the residue readily occurs with small amounts of rainfall. Runoff loss equals the volume of carrier (water or sediment) times the concentration in that carrier; therefore, practices that reduce either, or both, can reduce losses. Rate of application has been directly related to concentration and therefore loss. Reducing rate, such as by banding, soil incorporation, and avoidance of application to crop residue reduce losses. The choice of herbicide and herbicide formulation, in conjunction with application technology, as they affect properties, rate, and placement, play a large role in determining runoff loss. Runoff losses of herbicides that are strongly adsorbed and therefore transported mainly with sediment can be reduced by erosion control; runoff volume reduction can reduce losses with water of moderately to weakly adsorbed herbicides. Conservation tillage has potential to reduce both runoff and erosion. Timing of application relative to expected intense storms, both in the short and long term, can reduce the potential for runoff. If possible to determine thresholds, herbicide use could be avoided if weed infestation is below the economic effect level. Buffer or filter strips have the potential to reduce transport of herbicides lost from fields to surface water resources.

The rapid development of Information and Communications Technologies (ICT) is profoundly transforming the social order, into what Spanish sociologist Manuel Castells calls the network society. Mobile technologies, such as smartphones and tablet computers, are perhaps the definitive tools of the network society; however, cultural and economic barriers exist that restrict access to these transformative tools and to the information networks in which they operate. One group that is particularly at risk is rural older people from disadvantaged backgrounds. This paper reports on one aspect of a larger action research project that involved working with a small group of rural, socially isolated older people with histories of homelessness and complex needs (N = 7) and their social workers. This paper focuses on the older participants who, having been provided tablet computers, were then supported to use the device in their homes over the course of eight months. Despite most participants having never used a computing device of any kind prior to the research project, findings suggested that participants gained confidence, independence and social engagement as a result of their ICT use. Results also highlighted that they experienced challenges in utilising ICT, specifically technical, economic and social barriers. Findings highlight the individual and structural issues that must be addressed to enable all citizens to participate fully in the network society.

The statins have emerged as the dominant class of drug for the treatment of hypercholesterolemia. These medications are generally well tolerated. However, myalgias, the most frequent side-effect, occur in up to 7% of patients. Transaminitis and skeletal myotoxicity, with elevated serum creatine kinase (CK) levels (i.e., >10 times the upper limit of normal), occur with reported frequencies of 1% and 0.1%, respectively. Various hypotheses have been proposed to explain the relationship between statin therapy and the spectrum of muscle dysfunction manifested by myalgia, myopathy, and rhabdomyolysis.

Statin-mediatd inhibition of mevalonate metabolism impairs the synthesis of isoprenylated products–the most notable of which is ubiquinone. However, isoprenylation is responsible for the post-translational modification of up to 2% of cellular proteins. Therefore, numerous metabolic pathways are potentially modified by statin-mediated hypoprenylation. Subclinical defects in one or more energy-deriving pathways may be unmasked upon exposure to the pleotropic effects of statins. Such pharmacogenomic synergism may underlie the development of “statin myopathy” in a subset of patients. In this regard, we describe four patients with mutations in the myophosphorylase (PYGM; MIM 232600), myoadenylate deaminase (AMPD1; MIM 102770), and carnitine palmitoyltransferase (CPT2; MIM 600650) genes whose diagnoses became apparent during the course of investigations for statin-induced myalgias and hyperCKemia.

Approximately 95% of statin-treated patients tolerate this form of cholesterol management without any adverse effects. However, given their efficacy in reducing low density lipoproteins and cardiovascular events large numbers of patients are selected for statin therapy. Therefore muscle complications are, in fact, quite common. Limited understanding of the underlying pathophysiology has hampered physicians' ability to identify patients at risk for developing statin myotoxicity. A growing number of published case reports/series have implicated statins in the exacerbation of both acquired and genetic myopathies. A clinical management algorithm is presented which outlines a variety of co-morbidities which can potentiate the adverse effects of statins on muscle. In addition, a rational approach to the selection of those patients most likely to benefit from skeletal muscle biopsy is discussed. Ongoing work will define the extent to which statin-intolerant patients represent carriers of recessive metabolic myopathies or pre-symptomatic acquired myopathies. The expanding importance of pharmacogenomics will undoubtedly be realized in the field of statin myopathy research within the next few years. Such critical information is needed to establish more definitive management and diagnostic strategies.