N-terminal pro-B-type natriuretic peptide by itself predicts death and cardiovascular events in high-risk patients with type 2 diabetes

Background: NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) improves the discriminatory ability of risk‐prediction models in type 2 diabetes mellitus (T2DM) but is not yet used in clinical practice. We assessed the discriminatory strength of NT‐proBNP by itself for death and cardiovascular events in high‐risk patients with T2DM. Methods and Results: Cox proportional hazards were used to create a base model formed by 20 variables. The discriminatory ability of the base model was compared with that of NT‐proBNP alone and with NT‐proBNP added, using C‐statistics. We studied 5509 patients (with complete data) of 8561 patients with T2DM and cardiovascular and/or chronic kidney disease who were enrolled in the ALTITUDE (Aliskiren in Type 2 Diabetes Using Cardiorenal Endpoints) trial. During a median 2.6‐year follow‐up period, 469 patients died and 768 had a cardiovascular composite outcome (cardiovascular death, resuscitated cardiac arrest, nonfatal myocardial infarction, stroke, or heart failure hospitalization). NT‐proBNP alone was as discriminatory as the base model for predicting death (C‐statistic, 0.745 versus 0.744, P=0.95) and the cardiovascular composite outcome (C‐statistic, 0.723 versus 0.731, P=0.37). When NT‐proBNP was added, it increased the predictive ability of the base model for death (C‐statistic, 0.779 versus 0.744, P<0.001) and for cardiovascular composite outcome (C‐statistic, 0.763 versus 0.731, P<0.001). Conclusions: In high‐risk patients with T2DM, NT‐proBNP by itself demonstrated discriminatory ability similar to a multivariable model in predicting both death and cardiovascular events and should be considered for risk stratification

The Challenge of Resilience in a Globalised World

Resilience determines the capacity to successfully deal with difficult events and to adapt and overcome adversity. It creates stability in a changing world which in turn promotes job creation, economic growth and environmental sustainability. Resilience is a fundamental prerequisite for Europe as the largest integrated economic area in the world and has an important social dimension which requires the active cooperation of all stakeholders; citizens, the private sector, governments and NGOs included. This report discusses the concept of resilience from different perspectives and the role of science in the continuous process of building a resilient, stable, competitive and prosperous Europe.JRC.G-Institute for the Protection and Security of the Citizen (Ispra

Talaromyces atroroseus, a new species efficiently producing industrially relevant red pigments

Some species of Talaromyces secrete large amounts of red pigments. Literature has linked this character to species such as Talaromyces purpurogenus, T. albobiverticillius, T. marneffei, and T. minioluteus often under earlier Penicillium names. Isolates identified as T. purpurogenus have been reported to be interesting industrially and they can produce extracellular enzymes and red pigments, but they can also produce mycotoxins such as rubratoxin A and B and luteoskyrin. Production of mycotoxins limits the use of isolates of a particular species in biotechnology. Talaromyces atroroseus sp. nov., described in this study, produces the azaphilone biosynthetic families mitorubrins and Monascus pigments without any production of mycotoxins. Within the red pigment producing clade, T. atroroseus resolved in a distinct clade separate from all the other species in multigene phylogenies (ITS, β-tubulin and RPB1), which confirm its unique nature. Talaromyces atroroseus resembles T. purpurogenus and T. albobiverticillius in producing red diffusible pigments, but differs from the latter two species by the production of glauconic acid, purpuride and ZG-1494α and by the dull to dark green, thick walled ellipsoidal conidia produced. The type strain of Talaromyces atroroseus is CBS 133442

Future Scenarios and Environmental Education

This article explores a number of questions about visions of the future and their implications for environmental education (EE). If the future were known, what kind of actions would be needed to maintain the positive aspects and reverse the negative ones? How could these actions be translated into the aims of EE? Three future scenarios are discussed: the limits to growth (the great tragedy and demise); sustainable development and ecological modernization (hope and innovation); and the Anthropocene park. These scenarios are linked to corresponding EE/ESD approaches and instrumentalism in education is argued as a morally justifiable goal. Finally, education for deep ecology is advocated in order to address the ethical implications of the last scenario.FSW – Publicaties zonder aanstelling Universiteit Leide

Juvenile female sex offenders: Offender and offence characteristics

Almost all research on juvenile sex offending pertains to adolescent males. This study comprises all female juveniles convicted for sexual offences in the Netherlands between 1993 and 2008 (N = 66). From analysis of their court files and their criminal records, these female offenders are described in terms of demographics, family background, (psychiatric) disorders, victim characteristics and co-offending patterns. Heterogeneity in offending patterns and offending motives are studied, by using a reconstruction of the sexual offences. Almost 60 percent of the juvenile female sex offenders committed the abuse with someone else. Summarizing the offender motives as they emerged from offender and victim statements, five offender subtypes are identified. The findings are discussed in terms of implications for research and treatment