Platform trials

Platform trials focus on the perpetual testing of many interventions in a disease or a setting. These trials have lasting organizational, administrative, data, analytic, and operational frameworks making them highly efficient. The use of adaptation often increases the probabilities of allocating participants to better interventions and obtaining conclusive results. The COVID-19 pandemic showed the potential of platform trials as a fast and valid way to improved treatments. This review gives an overview of key concepts and elements using the Intensive Care Platform Trial (INCEPT) as an example.</p

TRY plant trait database – enhanced coverage and open access

Plant traits - the morphological, anatomical, physiological, biochemical and phenological characteristics of plants - determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait‐based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits - almost complete coverage for ‘plant growth form’. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait–environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives

Life cycle inventory modeling of phosphorus substitution, losses and crop uptake after land application of organic waste products

Purpose: Life cycle assessments (LCAs) that attempt to provide advice on treatment options for phosphorus (P) containing organic waste products encounter problems related to the quantification of mineral P fertilizer substitution, P loss and crop P uptake after land application. The purpose of this study was to develop a relatively easy to use life cycle inventory model, known as PLCI, that could be used to estimate these values. Methods: A life cycle inventory model for P was developed, which estimates the effect of an application of organic waste followed by ordinary fertilizer management in the modeling period. This was compared with a simulation without the initial waste application. The difference in mineral P fertilizer application (substitution), P loss and crop P uptake was then calculated and expressed as a proportion of the amount of waste applied. As an example, the effect of an initial application of mineral fertilizer, sewage sludge and ash on two farm types was simulated. These results were applied in an LCA case study of different sewage sludge treatment options. Results and discussion: Farm type influenced the P fertilizer substitution, loss and crop uptake factors. The application on an arable farm showed a substitution of 28 to 31%, relatively low P loss and a large spread in crop P uptake for the different P sources, compared with the pig farm. Application on a pig farm showed no mineral P substitution. For substitution, mineral fertilizer outperformed waste product fertilizer with a short modeling period, due to higher immediate P availability, which was not the case with a long period. The LCA case study showed that the P substitution factor had an influence on the environmental impact categories climate change and depletion of reserve-based abiotic resources while the P loss factor influenced freshwater eutrophication. Application of the P loss and substitution factors generated from the PLCI model resulted in higher environmental burdens and lower savings than using conventional factors. Conclusions: The soil P status mainly affected P substitution and loss, with the fertilizer type only having a small influence when soils had a low P status. The PLCI model can facilitate more coherent and rigorous estimates of P substitution and loss to be used in LCA studies involving application of waste products on agricultural land. This is important since P substitution and loss can have an important influence on impact categories, such as freshwater eutrophication and resource depletion

Incidence of hypertension in people with HIV who are treated with integrase inhibitors versus other antiretroviral regimens in the RESPOND cohort consortium

Objective: To compare the incidence of hypertension in people living with HIV receiving integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) versus non-nucleoside reverse transcriptase inhibitors (NNRTIs) or boosted protease inhibitors (PIs) in the RESPOND consortium of HIV cohorts. Methods: Eligible people with HIV were aged ≥18 years who initiated a new three-drug ART regimen for the first time (baseline), did not have hypertension, and had at least two follow-up blood pressure (BP) measurements. Hypertension was defined as two consecutive systolic BP measurements ≥140 mmHg and/or diastolic BP ≥90 mmHg or initiation of antihypertensives. Multivariable Poisson regression was used to determine adjusted incidence rate ratios (aIRRs) of hypertension, overall and in those who were ART naïve or experienced at baseline. Results: Overall, 4606 people living with HIV were eligible (INSTIs 3164, NNRTIs 807, PIs 635). The median baseline systolic BP, diastolic BP, and age were 120 (interquartile range [IQR] 113–130) mmHg, 78 (70–82) mmHg, and 43 (34–50) years, respectively. Over 8380.4 person-years (median follow-up 1.5 [IQR 1.0–2.7] years), 1058 (23.0%) participants developed hypertension (incidence rate 126.2/1000 person-years, 95% confidence interval [CI] 118.9–134.1). Participants receiving INSTIs had a higher incidence of hypertension than those receiving NNRTIs (aIRR 1.76; 95% CI 1.47–2.11), whereas the incidence was no different in those receiving PIs (aIRR 1.07; 95% CI 0.89–1.29). The results were similar when the analysis was stratified by ART status at baseline. Conclusion: Although unmeasured confounding and channelling bias cannot be excluded, INSTIs were associated with a higher incidence of hypertension than were NNRTIs, but rates were similar to those of PIs overall, in ART-naïve and ART-experienced participants within RESPOND

TRY plant trait database - enhanced coverage and open access

10.1111/gcb.14904GLOBAL CHANGE BIOLOGY261119-18