Spironolactone improves endothelial and cardiac autonomic function in non heart failure hemodialysis patients

OBJECTIVES: Hemodialysis patients have a cardiovascular mortality rate of 20-40 times that of the general population. Aldosterone inhibition by spironolactone has exerted beneficial, prognostically significant cardiovascular effects in patients with heart failure maintained on hemodialysis or peritoneal dialysis. Our aim was to investigate spironolactone\u27s effect in non heart failure hemodialysis patients. METHODS: Fourteen stable chronic hemodialysis patients (nine men), 59.5 +/- 3.1 years of age were evaluated in a sequential, fixed-dose, placebo-controlled study. Heart failure was diagnosed on the basis of signs and symptoms of heart failure or left ventricular ejection fraction less than 50%. Following an initial 4-month period of placebo administration after each dialysis, patients received spironolactone (25 mg thrice weekly after dialysis) for the next 4 months. Data were recorded at baseline, at the end of placebo administration, and at the end of spironolactone treatment and included endothelial function by forearm reactive hyperemia during venous occlusion plethysmography, cardiac autonomic status by heart rate variability in the time and frequency domain, blood pressure response, and echocardiographic and laboratory data. RESULTS: Placebo induced no changes in the aforementioned parameters. Following spironolactone, salutary effects were observed in the extent and duration of reactive hyperemia (P < 0.05 for both), as well as in heart rate variability (P < 0.05) and blood pressure control (P < 0.05). No changes occurred in echocardiographically derived left ventricular dimensions or mass. CONCLUSION: Low-dose spironolactone therapy in clinically stable non heart failure hemodialysis patients is associated with favorable effects on cardiovascular parameters known to adversely affect survival, such as endothelial dysfunction and heart rate variability. Spironolactone treatment might benefit long-term cardiovascular outcome of such patients

A multidisciplinary critical review of ecosystem services studies in Greece: approaches, shortcomings and the pathway to implementation

During the last two decades, ecosystem services (ES) research is used to inform the various steps of decision- and policy- making process, regarding environmental management, spatial planning and natural capital accounting. In the EU, this vast and rapid publication boom was triggered by the enactment of Action 5 of the EU Biodiversity Strategy to 2020, urging Member States to implement Mapping and Assessment of Ecosystem and their Services (MAES); few countries pioneered, while others are still lagging behind. In Greece, the implementation of MAES started in 2014 and since then an impressive progress has been made, with Greece now being among the countries with the most rapid progress. However, there are still major knowledge and data gaps on ecosystem services in Greece; know-how on specific methods, tools and practices is still to be developed. This poses obstacles in integrative efforts to identify and/or interpret the various co-variates affecting ecosystems and their services in space and time and hinders the incorporation of the ES generated information into the decision-making process. Making the first steps towards overcoming these hurdles, the present study aims to (i) synthesize the ecosystem services literature relevant to the ES implementation in Greece, (ii) validate and classify each literature source to the relevant ecosystem services categories, (iii) identify shortcomings in terms of ES assessed and data available, and (iv) critically review the variety of approaches to ES assessments that are followed. The outcomes of this study will facilitate the efficient implementation of ecosystem services assessments in Greece

Finding the essential : improving conservation monitoring across scales

To account for progress towards conservation targets, monitoring systems should capture not only information on biodiversity but also knowledge on the dynamics of ecological processes and the related effects on human well-being. Protected areas represent complex social-ecological systems with strong human-nature interactions. They are able to provide relevant information about how global and local scale drivers (e.g., climate change, land use change) impact biodiversity and ecosystem services. Here we develop a framework that uses an ecosystem-focused approach to support managers in identifying essential variables in an integrated and scalable approach. We advocate that this approach can complement current essential variable developments, by allowing conservation managers to draw on system-level knowledge and theory of biodiversity and ecosystems to identify locally important variables that meet the local or sub-global needs for conservation data. This requires the development of system narratives and causal diagrams that pinpoints the social-ecological variables that represent the state and drivers of the different components, and their relationships. We describe a scalable framework that builds on system based narratives to describe all system components, the models used to represent them and the data needed. Considering the global distribution of protected areas, with an investment in standards, transparency, and on active data mobilisation strategies for essential variables, these have the potential to be the backbone of global biodiversity monitoring, benefiting countries, biodiversity observation networks and the global biodiversity community

Satellite sensor requirements for monitoring essential biodiversity variables of coastal ecosystems.

The biodiversity and high productivity of coastal terrestrial and aquatic habitats are the foundation for important benefits to human societies around the world. These globally distributed habitats need frequent and broad systematic assessments, but field surveys only cover a small fraction of these areas. Satellite-based sensors can repeatedly record the visible and near-infrared reflectance spectra that contain the absorption, scattering, and fluorescence signatures of functional phytoplankton groups, colored dissolved matter, and particulate matter near the surface ocean, and of biologically structured habitats (floating and emergent vegetation, benthic habitats like coral, seagrass, and algae). These measures can be incorporated into Essential Biodiversity Variables (EBVs), including the distribution, abundance, and traits of groups of species populations, and used to evaluate habitat fragmentation. However, current and planned satellites are not designed to observe the EBVs that change rapidly with extreme tides, salinity, temperatures, storms, pollution, or physical habitat destruction over scales relevant to human activity. Making these observations requires a new generation of satellite sensors able to sample with these combined characteristics: (1) spatial resolution on the order of 30 to 100-m pixels or smaller; (2) spectral resolution on the order of 5 nm in the visible and 10 nm in the short-wave infrared spectrum (or at least two or more bands at 1,030, 1,240, 1,630, 2,125, and/or 2,260 nm) for atmospheric correction and aquatic and vegetation assessments; (3) radiometric quality with signal to noise ratios (SNR) above 800 (relative to signal levels typical of the open ocean), 14-bit digitization, absolute radiometric calibration <2%, relative calibration of 0.2%, polarization sensitivity <1%, high radiometric stability and linearity, and operations designed to minimize sunglint; and (4) temporal resolution of hours to days. We refer to these combined specifications as H4 imaging. Enabling H4 imaging is vital for the conservation and management of global biodiversity and ecosystem services, including food provisioning and water security. An agile satellite in a 3-d repeat low-Earth orbit could sample 30-km swath images of several hundred coastal habitats daily. Nine H4 satellites would provide weekly coverage of global coastal zones. Such satellite constellations are now feasible and are used in various applications

Automated office blood pressure measurements in primary care are misleading in more than one third of treated hypertensives: The VALENTINE-Greece Home Blood Pressure Monitoring study

Abstract Background This study assessed the diagnostic reliability of automated office blood pressure (OBP) measurements in treated hypertensive patients in primary care by evaluating the prevalence of white coat hypertension (WCH) and masked uncontrolled hypertension (MUCH) phenomena. Methods Primary care physicians, nationwide in Greece, assessed consecutive hypertensive patients on stable treatment using OBP (1 visit, triplicate measurements) and home blood pressure (HBP) measurements (7 days, duplicate morning and evening measurements). All measurements were performed using validated automated devices with bluetooth capacity (Omron M7 Intelli-IT). Uncontrolled OBP was defined as ≥140/90 mmHg, and uncontrolled HBP was defined as ≥135/85 mmHg. Results A total of 790 patients recruited by 135 doctors were analyzed (age: 64.5 ± 14.4 years, diabetics: 21.4%, smokers: 20.6%, and average number of antihypertensive drugs: 1.6 ± 0.8). OBP (137.5 ± 9.4/84.3 ± 7.7 mmHg, systolic/diastolic) was higher than HBP (130.6 ± 11.2/79.9 ± 8 mmHg; difference 6.9 ± 11.6/4.4 ± 7.6 mmHg, p Conclusions In primary care, automated OBP measurements are misleading in approximately 40% of treated hypertensive patients. HBP monitoring is mandatory to avoid overtreatment of subjects with WCH phenomenon and prevent undertreatment and subsequent excess cardiovascular disease in MUCH

Marine and coastal ecosystem services on the science–policy–practice nexus: challenges and opportunities from 11 European case studies

We compared and contrasted 11 European case studies to identify challenges and opportunitiestoward the operationalization of marine and coastal ecosystem service (MCES) assessments inEurope. This work is the output of a panel convened by the Marine Working Group of theEcosystemServices Partnership in September 2016. TheMCES assessments were used to (1) addressmultiple policy objectives simultaneously, (2) interpret EU-wide policies to smaller scales and (3)inform local decision-making. Most of the studies did inform decision makers, but only in a fewcases, the outputswere applied or informed decision-making. Significant limitations among the 11assessments were the absence of shared understanding of the ES concept, data and knowledgegaps, difficulties in accounting for marine social–ecological systems complexity and partial stakeholderinvolvement. The findings of the expert panel call for continuous involvement of MCES ‘endusers’, integrated knowledge onmarine social–ecological systems, defining thresholds to MCES useand raising awareness to the general public. Such improvements at the intersection of science,policy and practice are essential starting points toward building a stronger science foundationsupporting management of European marine ecosystems

Satellite sensor requirements for monitoring essential biodiversity variables of coastal ecosystems

© The Author(s), 2018. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Ecological Applications 28 (2018): 749-760, doi: 10.1002/eap.1682.The biodiversity and high productivity of coastal terrestrial and aquatic habitats are the foundation for important benefits to human societies around the world. These globally distributed habitats need frequent and broad systematic assessments, but field surveys only cover a small fraction of these areas. Satellite‐based sensors can repeatedly record the visible and near‐infrared reflectance spectra that contain the absorption, scattering, and fluorescence signatures of functional phytoplankton groups, colored dissolved matter, and particulate matter near the surface ocean, and of biologically structured habitats (floating and emergent vegetation, benthic habitats like coral, seagrass, and algae). These measures can be incorporated into Essential Biodiversity Variables (EBVs), including the distribution, abundance, and traits of groups of species populations, and used to evaluate habitat fragmentation. However, current and planned satellites are not designed to observe the EBVs that change rapidly with extreme tides, salinity, temperatures, storms, pollution, or physical habitat destruction over scales relevant to human activity. Making these observations requires a new generation of satellite sensors able to sample with these combined characteristics: (1) spatial resolution on the order of 30 to 100‐m pixels or smaller; (2) spectral resolution on the order of 5 nm in the visible and 10 nm in the short‐wave infrared spectrum (or at least two or more bands at 1,030, 1,240, 1,630, 2,125, and/or 2,260 nm) for atmospheric correction and aquatic and vegetation assessments; (3) radiometric quality with signal to noise ratios (SNR) above 800 (relative to signal levels typical of the open ocean), 14‐bit digitization, absolute radiometric calibration <2%, relative calibration of 0.2%, polarization sensitivity <1%, high radiometric stability and linearity, and operations designed to minimize sunglint; and (4) temporal resolution of hours to days. We refer to these combined specifications as H4 imaging. Enabling H4 imaging is vital for the conservation and management of global biodiversity and ecosystem services, including food provisioning and water security. An agile satellite in a 3‐d repeat low‐Earth orbit could sample 30‐km swath images of several hundred coastal habitats daily. Nine H4 satellites would provide weekly coverage of global coastal zones. Such satellite constellations are now feasible and are used in various applications.National Center for Ecological Analysis and Synthesis (NCEAS); National Aeronautics and Space Administration (NASA) Grant Numbers: NNX16AQ34G, NNX14AR62A; National Ocean Partnership Program; NOAA US Integrated Ocean Observing System/IOOS Program Office; Bureau of Ocean and Energy Management Ecosystem Studies program (BOEM) Grant Number: MC15AC0000

Satellite Sensor Requirements for Monitoring Essential Biodiversity Variables of Coastal Ecosystems

The biodiversity and high productivity of coastal terrestrial and aquatic habitats are the foundation for important benefits to human societies around the world. These globally distributed habitats need frequent and broad systematic assessments, but field surveys only cover a small fraction of these areas. Satellite-based sensors can repeatedly record the visible and near-infrared reflectance spectra that contain the absorption, scattering, and fluorescence signatures of functional phytoplankton groups, colored dissolved matter, and particulate matter near the surface ocean, and of biologically structured habitats (floating and emergent vegetation, benthic habitats like coral, seagrass, and algae). These measures can be incorporated into Essential Biodiversity Variables (EBVs), including the distribution, abundance, and traits of groups of species populations, and used to evaluate habitat fragmentation. However, current and planned satellites are not designed to observe the EBVs that change rapidly with extreme tides, salinity, temperatures, storms, pollution, or physical habitat destruction over scales relevant to human activity. Making these observations requires a new generation of satellite sensors able to sample with these combined characteristics: (1) spatial resolution on the order of 30 to 100-m pixels or smaller; (2) spectral resolution on the order of 5 nm in the visible and 10 nm in the short-wave infrared spectrum (or at least two or more bands at 1,030, 1,240, 1,630, 2,125, and/or 2,260 nm) for atmospheric correction and aquatic and vegetation assessments; (3) radiometric quality with signal to noise ratios (SNR) above 800 (relative to signal levels typical of the open ocean), 14-bit digitization, absolute radiometric calibratio

Key criteria for developing ecosystem service indicators to inform decision making

Decision makers are increasingly interested in information from ecosystem services (ES) assessments. Scientists have for long recognised the importance of selecting appropriate indicators. Yet, while the amount and variety of indicators developed by scientists seems to increase continuously, the extent to which the indicators truly inform decision makers is often unknown and questioned. In this viewpoint paper, we reflect and provide guidance on how to develop appropriate ES indicators for informing decision making, building on scientific literature and practical experience collected from researchers involved in seven case studies. We synthesized 16 criteria for ES indicator selection and organized them according to the widely used categories of credibility, salience, legitimacy (CSL). We propose to consider additional criteria related to feasibility (F), as CSL criteria alone often seem to produce indicators which are unachievable in practice. Considering CSL & F together requires a combination of scientific knowledge, communication skills, policy and governance insights and on-field experience. We present a checklist to evaluate CSL & F of your ES indicators. This checklist helps to detect and mitigate critical shortcomings in an early phase of the development process, and aids the development of effective indicators to inform actual policy decisions

The Earth: Plasma Sources, Losses, and Transport Processes

This paper reviews the state of knowledge concerning the source of magnetospheric plasma at Earth. Source of plasma, its acceleration and transport throughout the system, its consequences on system dynamics, and its loss are all discussed. Both observational and modeling advances since the last time this subject was covered in detail (Hultqvist et al., Magnetospheric Plasma Sources and Losses, 1999) are addressed