Environmental factors associated with biological use and surgery in inflammatory bowel disease

Background and Aim: While major efforts were made studying the complex etiology of inflammatory bowel disease (IBD) including environmental factors, less is known about underlying causes leading to the heterogeneous and highly variable course of disease. As cigarette smoking cessation is the best-known environmental factor with beneficial effect in Crohn's disease (CD), more exposome factors are likely involved. Further insights into the role of the exposome in heterogeneity of disease might not only further knowledge of underlying pathways, but also allow for better risk stratification. Methods: Seven hundred twenty-eight IBD patients completed the validated Groningen IBD Environmental Questionnaire, collecting exposome data for 93 exposome factors. Associations with disease course, that is, for need for surgery or biological therapy, were evaluated using univariate and multivariate-adjusted logistic regression modeling. Results: No significant associations were seen after Bonferroni correction. However, 11 novel exposome factors were identified with P < 0.05. Two factors were associated with course of CD and ulcerative colitis (UC): beer (CD OR0.3/UC OR0.3) and cannabis (0.5/2.2). While in CD, carpet flooring (0.5) was associated with biological use, and four factors were associated with surgery: working shifts (1.8), appendectomy (2.4), frequent tooth brushing (2.8), and large household size (0.1). For UC, migrants more often required biologicals (10.2). Childhood underweight (3.4), amphetamine use (6.2), and cocaine use (4.8) were associated with surgery. Five factors were replicated. Conclusions: We identified 16 environmental factors nominally associated with biological use and surgery in established IBD. These new insights form an important stepping stone to guide research on biological pathways involved, risk stratification, tailor-made interventions, and preventive strategies in IBD

Delphi developed syllabus for the medical specialty of sport and exercise medicine : part 2

Training in the medical specialty of sport and exercise medicine (SEM) is available in many, but not all countries. In 2015, an independent Delphi group, the International Syllabus in Sport and Exercise Medicine Group (ISSEMG), was formed to create a basic syllabus for this medical specialty. The group provided the first part of this syllabus, by identifying 11 domains and a total of 80 general learning areas for the specialty, in December 2017. The next step in this process, and the aim of this paper was to determine the specific learning areas for each of the 80 general learning areas. A group of 26 physicians with a range of primary medical specialty qualifications including, Sport and Exercise Medicine, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. SEM, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. The hierarchical syllabus developed by the ISSEMG provides a useful resource in the planning, development and delivery of specialist training programmes in the medical specialty of SEM.http://bjsm.bmj.com2021-03-01hj2020Sports Medicin

Characterizing geomorphological change to support sustainable river restoration and management

The hydrology and geomorphology of most rivers has been fundamentally altered through a long history of human interventions including modification of river channels, floodplains, and wider changes in the landscape that affect water and sediment delivery to the river. Resultant alterations in fluvial forms and processes have negatively impacted river ecology via the loss of physical habitat, disruption to the longitudinal continuity of the river, and lateral disconnection between aquatic, wetland, and terrestrial ecosystems. Through a characterization of geomorphological change, it is possible to peel back the layers of time to investigate how and why a river has changed. Process rates can be assessed, the historical condition of rivers can be determined, the trajectories of past changes can be reconstructed, and the role of specific human interventions in these geomorphological changes can be assessed. To achieve this, hydrological, geomorphological, and riparian vegetation characteristics are investigated within a hierarchy of spatial scales using a range of data sources. A temporal analysis of fluvial geomorphology supports process-based management that targets underlying problems. In this way, effective, sustainable management and restoration solutions can be developed that recognize the underlying drivers of geomorphological change, the constraints imposed on current fluvial processes, and the possible evolutionary trajectories and timelines of change under different future management scenarios. Catchment/river basin planning, natural flood risk management, the identification and appraisal of pressures, and the assessment of restoration needs and objectives would all benefit from a thorough temporal analysis of fluvial geomorphology

First Sagittarius A* Event Horizon Telescope Results. II. EHT and Multiwavelength Observations, Data Processing, and Calibration

We present Event Horizon Telescope (EHT) 1.3 mm measurements of the radio source located at the position of the supermassive black hole Sagittarius A* (Sgr A*), collected during the 2017 April 5–11 campaign. The observations were carried out with eight facilities at six locations across the globe. Novel calibration methods are employed to account for Sgr A*'s flux variability. The majority of the 1.3 mm emission arises from horizon scales, where intrinsic structural source variability is detected on timescales of minutes to hours. The effects of interstellar scattering on the image and its variability are found to be subdominant to intrinsic source structure. The calibrated visibility amplitudes, particularly the locations of the visibility minima, are broadly consistent with a blurred ring with a diameter of ∼50 μas, as determined in later works in this series. Contemporaneous multiwavelength monitoring of Sgr A* was performed at 22, 43, and 86 GHz and at near-infrared and X-ray wavelengths. Several X-ray flares from Sgr A* are detected by Chandra, one at low significance jointly with Swift on 2017 April 7 and the other at higher significance jointly with NuSTAR on 2017 April 11. The brighter April 11 flare is not observed simultaneously by the EHT but is followed by a significant increase in millimeter flux variability immediately after the X-ray outburst, indicating a likely connection in the emission physics near the event horizon. We compare Sgr A*’s broadband flux during the EHT campaign to its historical spectral energy distribution and find that both the quiescent emission and flare emission are consistent with its long-term behavior

Wood-induced backwater for lowland streams model

Placement of wood in streams has become a common method to increase ecological values in river and stream restoration and is widely used in natural environments. Water managers, however, are often hesitant to introduce wood in channels that drain agricultural and urban areas because of backwater concerns. This model aims to better understand the wood-induced backwater. A newly developed, one-dimensional stationary model demonstrates how the water level drop over the wood patch significantly increases directly after wood insertion. The model was calibrated with data from a field study in four lowland streams in the Netherlands. The backwater effects can be reduced by optimizing the location where wood patches are placed, and by manipulating the obstruction ratio. The model can function as a generic tool to achieve a stream design with wood that optimizes the hydrological and ecological potential of streams

Anatomy of simultaneous flood peaks at a lowland confluence

Lowlands are vulnerable to flooding due to their mild topography in often densely populated areas with high social and economic value. Moreover, multiple physical processes coincide in lowland areas, such as those involved in river-sea interactions and in merging rivers at confluences. Simultaneous occurrence of such processes can result in amplifying or attenuating effects on water levels. Our aim is to understand the mechanisms behind simultaneous occurrence of discharge waves in a river and its lowland tributaries. Here, we introduce a new way of analyzing lowland discharge and water level dynamics, by tracing individual flood waves based on dynamic time warping. We take the confluence of the Meuse River (∼ 33000km2) with the joining tributaries of the Dommel and Aa rivers as an example, especially because the January 1995 flood at this confluence was the result of the simultaneous occurrence of discharge peaks in the main stream and the tributaries and because independent observations of water levels and discharge are available for a longer period. The analysis shows that the exact timing of the arrival of discharge peaks is of little relevance because of the long duration of the average discharge wave compared to typical time lags between peaks. The discharge waves last on average 9 days, whereas the lag time between discharge peaks in the main river and the tributaries is typically 3 days. This results in backwaters that can rise up to 1.5&thinsp;m over a distance of 4&thinsp;km from the confluence. Thus, local measures to reduce the impact of flooding around the confluence should account for the long duration of flood peaks in the main system.</p