Medication Prescription, Common Side-effects, and Nutritional Status are Associated in Patients With Chronic Kidney Disease

Objective Chronic kidney disease (CKD) is associated with metabolic, nutritional, and extra-renal changes, as well as a high rate of comorbidities, which necessitates the prescription of numerous medications. Patients with CKD often experience poor nutritional status related to disease severity and prescribed medication; however, this association has not been investigated in depth. Therefore, this study aimed at investigating the association between prescribed medication and nutritional status in patients with CKD. Methods Assessment of nutritional status was performed using anthropometric and functional measurements and by biochemical measures. Patient history and the number and type of currently prescribed medications were collected from patients’ records. We evaluated the total number and the number of specific medicines with common or very common side-effects of nausea or xerostomia. Results Two hundred seventeen patients with CKD were included in this cross-sectional study (n = 112 with pre-dialysis CKD stages 3-5, n = 33 with hemodialysis, and n = 72 with kidney transplant). On average, patients were prescribed nine medications concurrently. The number of prescribed medications was inversely associated with mid-upper arm circumference, skinfold thickness triceps, handgrip strength, serum albumin, and hemoglobin after adjustment for age, sex, and kidney function. Prescription of medications with nausea as a side-effect showed similar associations, whereas prescription of medications with xerostomia as a side-effect was associated with lower handgrip strength. Conclusion Medication prescription was associated with poor nutritional status in patients with CKD, and monitoring of nutritional status in patients with CKD with long medication lists is warranted to identify and treat patients with poor nutritional status.publishedVersio

Effects of drought and meteorological forcing on carbon and water fluxes in Nordic forests during the dry summer of 2018

The Nordic region was subjected to severe drought in 2018 with a particularly long-lasting and large soil water deficit in Denmark, Southern Sweden and Estonia. Here, we analyse the impact of the drought on carbon and water fluxes in 11 forest ecosystems of different composition: spruce, pine, mixed and deciduous. We assess the impact of drought on fluxes by estimating the difference (anomaly) between year 2018 and a reference year without drought. Unexpectedly, the evaporation was only slightly reduced during 2018 compared to the reference year at two sites while it increased or was nearly unchanged at all other sites. This occurred under a 40 to 60% reduction in mean surface conductance and the concurrent increase in evaporative demand due to the warm and dry weather. The anomaly in the net ecosystem productivity (NEP) was 93% explained by a multilinear regression with the anomaly in heterotrophic respiration and the relative precipitation deficit as independent variables. Most of the variation (77%) was explained by the heterotrophic component. Six out of 11 forests reduced their annual NEP with more than 50 g C m(-2)yr(-1)during 2018 as compared to the reference year. The NEP anomaly ranged between -389 and +74 g C m(-2)yr(-1)with a median value of -59 g C m(-2)yr(-1). This article is part of the theme issue 'Impacts of the 2018 severe drought and heatwave in Europe: from site to continental scale'.Peer reviewe

Evaluating the performance of commonly used gas analysers for methane eddy covariance flux measurements: the InGOS inter-comparison field experiment

The performance of eight fast-response methane (CH4) gas analysers suitable for eddy covariance flux measurements were tested at a grassland site near the Cabauw tall tower (Netherlands) during June 2012. The instruments were positioned close to each other in order to minimise the effect of varying turbulent conditions. The moderate CH4 fluxes observed at the location, of the order of 25 nmol m−2 s−1, provided a suitable signal for testing the instruments' performance. Generally, all analysers tested were able to quantify the concentration fluctuations at the frequency range relevant for turbulent exchange and were able to deliver high-quality data. The tested cavity ringdown spectrometer (CRDS) instruments from Picarro, models G2311-f and G1301-f, were superior to other CH4 analysers with respect to instrumental noise. As an open-path instrument susceptible to the effects of rain, the LI-COR LI-7700 achieved lower data coverage and also required larger density corrections; however, the system is especially useful for remote sites that are restricted in power availability. In this study the open-path LI-7700 results were compromised due to a data acquisition problem in our data-logging setup. Some of the older closed-path analysers tested do not measure H2O concentrations alongside CH4 (i.e. FMA1 and DLT-100 by Los Gatos Research) and this complicates data processing since the required corrections for dilution and spectroscopic interactions have to be based on external information. To overcome this issue, we used H2O mole fractions measured by other gas analysers, adjusted them with different methods and then applied them to correct the CH4 fluxes. Following this procedure we estimated a bias of the order of 0.1 g (CH4) m−2 (8% of the measured mean flux) in the processed and corrected CH4 fluxes on a monthly scale due to missing H2O concentration measurements. Finally, cumulative CH4 fluxes over 14 days from three closed-path gas analysers, G2311-f (Picarro Inc.), FGGA (Los Gatos Research) and FMA2 (Los Gatos Research), which were measuring H2O concentrations in addition to CH4, agreed within 3% (355–367 mg (CH4) m−2) and were not clearly different from each other, whereas the other instruments derived total fluxes which showed small but distinct differences (±10%, 330–399 mg (CH4) m−2).Peer reviewe

Altered energy partitioning across terrestrial ecosystems in the European drought year 2018

Drought and heat events, such as the 2018 European drought, interact with the exchange of energy between the land surface and the atmosphere, potentially affecting albedo, sensible and latent heat fluxes, as well as CO(2)exchange. Each of these quantities may aggravate or mitigate the drought, heat, their side effects on productivity, water scarcity and global warming. We used measurements of 56 eddy covariance sites across Europe to examine the response of fluxes to extreme drought prevailing most of the year 2018 and how the response differed across various ecosystem types (forests, grasslands, croplands and peatlands). Each component of the surface radiation and energy balance observed in 2018 was compared to available data per site during a reference period 2004-2017. Based on anomalies in precipitation and reference evapotranspiration, we classified 46 sites as drought affected. These received on average 9% more solar radiation and released 32% more sensible heat to the atmosphere compared to the mean of the reference period. In general, drought decreased net CO(2)uptake by 17.8%, but did not significantly change net evapotranspiration. The response of these fluxes differed characteristically between ecosystems; in particular, the general increase in the evaporative index was strongest in peatlands and weakest in croplands. This article is part of the theme issue 'Impacts of the 2018 severe drought and heatwave in Europe: from site to continental scale'

Altered Error Processing following Vascular Thalamic Damage: Evidence from an Antisaccade Task

Event-related potentials (ERP) research has identified a negative deflection within about 100 to 150 ms after an erroneous response – the error-related negativity (ERN) - as a correlate of awareness-independent error processing. The short latency suggests an internal error monitoring system acting rapidly based on central information such as an efference copy signal. Studies on monkeys and humans have identified the thalamus as an important relay station for efference copy signals of ongoing saccades. The present study investigated error processing on an antisaccade task with ERPs in six patients with focal vascular damage to the thalamus and 28 control subjects. ERN amplitudes were significantly reduced in the patients, with the strongest ERN attenuation being observed in two patients with right mediodorsal and ventrolateral and bilateral ventrolateral damage, respectively. Although the number of errors was significantly higher in the thalamic lesion patients, the degree of ERN attenuation did not correlate with the error rate in the patients. The present data underline the role of the thalamus for the online monitoring of saccadic eye movements, albeit not providing unequivocal evidence in favour of an exclusive role of a particular thalamic site being involved in performance monitoring. By relaying saccade-related efference copy signals, the thalamus appears to enable fast error processing. Furthermore early error processing based on internal information may contribute to error awareness which was reduced in the patients

Sky Arrow - Sala 2015

Raw measurement data from the research flight with the Sky Arrow ERA over the post-forest fire area in Västmanland, Sweden, on 2015/10/03. Measurements of standard meteorological parameters as well as high frequency concentrations of CO2, H2O and CH4 and 3D wind components

Effect of meteorological exchange conditions on PM10 concentration

The short-term limit value for PM10 having become effective in January 2005 was exceeded in many regions within the EU in 2005 and 2006. Therefore, strategies, particularly with respect to traffic control, are discussed, which could cause reduced PM10 concentrations leading to a more effective compliance with the short-term PM10 limit value. These strategies are often justified on PM10 differences between a roadside and an adjacent urban background station. As PM10 is a complex mixture of species originating from different sources, the working hypothesis has been posted that the meteorological exchange conditions strongly affect the PM10 concentration. Therefore, the role of the meteorological exchange conditions with respect to different PM10 patterns, like cycles and PM10 episodes, was investigated on the basis of mean daily PM10 values from air pollution monitoring stations in Baden-Wurttemberg (SW Germany) in the period January 2001 to February 2006. To characterise the meteorological exchange conditions in a spatial resolution, different meteorological variables were used. Partly, they are directly measured at the air pollution monitoring stations or, as for the height of the mixing-layer (MLH) and the stagnation index (SI), they were derived from results of the local model (LM) of the German Weather Service. For periods without precipitation, the results show a statistically significant relationship between PM10 and MLH as well as SI. PM10 increased with decreasing MLH and increasing SI. During periods with precipitation, these relationships were very weak and had no statistical significance. The analysis of the influence of precipitation performed on a daily basis revealed a distinct reduction of PM10 on the first day with precipitation after a period without precipitation. On following days without precipitation, PM10 increased again. Characteristic of the PM10 episodes analysed were remarkably reduced meteorological exchange conditions described by MLH, near-surface wind speed and precipitation. As a case study, two extreme PM10 episodes in January/February 2006 were investigated in detail. As expected, the station-specific variability of the mean daily PM10 values correlated well with daily values of MLH and SI reflecting the pattern of the regional meteorological exchange conditions. Altogether, all results of this investigation point out the main significance of the meteorological exchange conditions on the PM10 level, which is particularly dominant during PM10 episodes

Modification of Human-Biometeorologically Significant Radiant Flux Densities by Shading as Local Method to Mitigate Heat Stress in Summer within Urban Street Canyons

Increasing heat will be a significant problem for Central European cities in the future. Shading devices are discussed as a method to mitigate heat stress on citizens. To analyze the physical processes, which are characteristic of shading in terms of urban human-biometeorology, experimental investigations on the thermal effects of shading by a building and shading by tree canopies were conducted in Freiburg (Southwest Germany) during typical Central European summer weather. Urban human-biometeorology stands for the variables air temperature T-a, mean radiant temperature T-mrt, and physiologically equivalent temperature PET, that is the human-biometeorological concept to assess the thermal environment which was applied. The measuring setup consists of specific human-biometeorological stations, which enable the direct or indirect determination of T-a, T-mrt, and PET. With respect to both shading devices, the T-a reduction did not exceed 2 C, while PET as a measure for human heat stress was lowered by two thermal sensation steps according to the ASHRAE scale. As T-mrt has the role of a key variable for outdoor thermal comfort during Central European summer weather, all radiant flux densities relevant to the determination of T-mrt were directly measured and analyzed in detail. The results show the crucial significance of the horizontal radiant flux densities for T-mrt and consequently PET