The health potential of urban water: Future scenarios on local risks and opportunities

Although cities can be characterised as sources of economic, environmental and social challenges, they can also be part of the solution for healthy and sustainable societies. While most cities are situated close to water, whether inland waterways, lakes, or the sea, these blue spaces are not integrated into urban planning to their full potential and their public health impacts are not always recognised by planning authorities. Furthermore, cities face future challenges regarding climate change, socio-economic developments like tourism, urbanization, and rising social inequalities. The development of healthy blue spaces can support cities in their pursuit of ways to confront these challenges. Interdisciplinary and transdisciplinary analyses of the local impacts of these trends and promising interventions have been scarce to date. This study explores the use of such methodology by presenting experiences related to five European cities: Amsterdam, Barcelona, Plymouth, Tallinn and Thessaloniki, using an interactive and participative approach with local experts and stakeholders. Future scenarios have been developed based on the question: How can blue spaces contribute to a healthier city population, given the long term trends? The results highlight the importance of addressing the local context when seeking sustainable solutions for cities. The future scenarios deliver information that could serve as useful input for local planning processes

The health potential of urban water: Future scenarios on local risks and opportunities

This is the final version. Available on open access from Elsevier via the DOI in this recordAlthough cities can be characterised as sources of economic, environmental and social challenges, they can also be part of the solution for healthy and sustainable societies. While most cities are situated close to water, whether inland waterways, lakes, or the sea, these blue spaces are not integrated into urban planning to their full potential and their public health impacts are not always recognised by planning authorities. Furthermore, cities face future challenges regarding climate change, socio-economic developments like tourism, urbanization, and rising social inequalities. The development of healthy blue spaces can support cities in their pursuit of ways to confront these challenges. Interdisciplinary and transdisciplinary analyses of the local impacts of these trends and promising interventions have been scarce to date. This study explores the use of such methodology by presenting experiences related to five European cities: Amsterdam, Barcelona, Plymouth, Tallinn and Thessaloniki, using an interactive and participative approach with local experts and stakeholders. Future scenarios have been developed based on the question: How can blue spaces contribute to a healthier city population, given the long term trends? The results highlight the importance of addressing the local context when seeking sustainable solutions for cities. The future scenarios deliver information that could serve as useful input for local planning processes.European Union Horizon 202

Biological variation of cardiac markers in patients with aortic valve stenosis

Objective Cardiac biomarkers hold promise for followup and management of aortic valve stenosis (AVS). When interpreting serial biomarker measurements of patients with AVS, it can be challenging to distinguish 'real changes' from 'random fluctuation'. Hence, robust estimation of the biological variation of these biomarkers is essential. In the present study we assessed biological variation of B-type natriuretic peptide (BNP), N-terminus pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin-T and high-sensitivity troponin-I (hs-TnT and hsTnI), and ST2 in subjects with stable AVS. Methods Serial blood sampling was performed in 25 subjects with moderate AVS-confirmed by echocardiography-and all free from acute cardiovascular events in the past 6 months. Blood samples were taken on seven standardised occasions during 1 year. Analytical variation (CV A), within-subject biological variation (CV I), between-subject biological variation (CV G), index of individuality (II) and reference change values were calculated for all cardiac biomarkers. Results CV I was highest for BNP (62.0%, 95% CI 52.5 to 75.4) and lowest for hs-TnI (9.2%, 95% CI 2.8 to 13.8). CV G exceeded the CV I for all biomarkers except BNP, and ranged from 19.8% (95% CI 13.8 to 33.4) for ST2 to 57.2% (95% CI 40.4 to 97.3) for hs-TnT. NT-proBNP, hsTnT and ST2 revealed CV A <5%, while BNP and hs-TnI showed a higher CV A (19.7 and 14.9, respectively). All biomarkers except BNP showed marked individuality, with II ranging from 0.21 to 0.67 (BNP 1.34). Conclusion This study provides the first biological variation estimates of cardiac biomarkers in patients with stable AVS. These estimates allow a more evidence-based interpretation of biomarker changes in the follow-up and management of patients with AVS

Within-day biological variation and hour-to-hour reference change values for hematological parameters

Background: Middle- and long-term biological variation data for hematological parameters have been reported in the literature. Within-day 24-h variability profiles for hematological parameters are currently lacking. However, comprehensive hour-to-hour variability data are critical to detect diurnal cyclical rhythms, and to take into account the 'time of sample collection' as a possible determinant of natural fluctuation. In this study, we assessed 24-h variation profiles for 20 hematological parameters.Methods: Blood samples were collected under standardized conditions from 24 subjects every hour for 24 h. At each measurement, 20 hematological parameters were determined in duplicate. Analytical variation (CVA), within-subject biological variation (CVI), between-subject biological variation (CVG), index of individuality (II), and reference change values (RCVs) were calculated. For the parameters with a diurnal rhythm, hour-to-hour RCVs were determined.Results: All parameters showed higher CVG than CVI. Highest CVG was found for eosinophils (46.6%; 95% CI, 34.9%-70.1%) and the lowest value was mean corpuscular hemoglobin concentration (MCHC) (3.2%; 95% CI, 2.4%-4.8%). CVI varied from 0.4% (95% CI, 0.32%-0.42%) to 20.9% (95% CI, 19.4%-22.6%) for red cell distribution width (RDW) and eosinophils, respectively. Six hematological parameters showed a diurnal rhythm.Conclusions: We present complete 24-h variability profiles for 20 hematological parameters. Hour-to-hour reference changes values may help to better discriminate between random fluctuations and true changes in parameters with rhythmic diurnal oscillations.</p

Origin of Cardiac Troponin T Elevations in Chronic Kidney

[Extract] Plasma concentrations of cardiac troponins, the preferred biomarkers for the diagnosis of acute myocardial infarction, are often persistently elevated in patients with chronic kidney disease (CKD). The origin of these elevations is unknown: Is it the heart, by increased release, or the kidneys, by decreased renal elimination? In clinical practice, this equivocal view on troponin elevations in patients with reduced glomerular clearance underlies countless clinical discussions among physicians and may delay rapid initiation of adequate treatment when these patients present with chest pain