Increased risk of bone fractures in hemodialysis patients treated with proton pump inhibitors in real world: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Long-term treatment with Proton Pump Inhibitors (PPIs) is associated with an increased risk of fractures in the general population. PPIs are widely prescribed to dialysis patients but to date no study specifically tested, by state-of-art statistical methods, the relationship between PPIs use and fractures in this patient-population. This study aimed to assess whether PPIs use is associated with bone fractures (i.e. hip fractures and fractures other than hip fractures) in a large international cohort of hemodialysis patients. We considered an observational prospective cohort of 27097 hemodialysis patients from the DOPPS study. Data analysis was performed by the Fine & Gray method, considering the competitive risk of mortality, as well as by a cause-specific hazards Cox model dealing death as a censoring event and matching patients according to the prescription time. Out of 27,097 hemodialysis patients, 13,283 patients (49%) were on PPI treatment. Across the follow-up (median:19\u2009months), 3.8 bone fractures x 100 person-years and 1.2 hip fractures x 100 person-years occurred. In multiple Cox models, considering the competitive risk of mortality, the incidence rate of bone (SHR: 1.22, 95% CI: 1.10-1.36, P\u2009<\u20090.001) and hip fractures (SHR: 1.35, 95% CI: 1.13-1.62, P = 0.001) was significantly higher in PPI treated than in PPI untreated patients. These findings held true also in multiple, cause-specific, hazards Cox models matching patients according to the prescription time (bone fractures, HR: 1.47, 95% CI: 1.23-1.76, P\u2009<\u20090.001, hip fractures (HR: 1.85, 95% CI: 1.37-2.50, P\u2009<\u20090.001). The use of PPIs requires caution and a careful evaluation of risks/benefits ratio in hemodialysis patients

Increased adult mortality and reduced breeding success with age in a population of common guillemot Uria aalge using birds of unknown age

Although there is general consensus about the existence of senescence in vertebrates, empirical evidence of senescence in demographic parameters in wild populations is limited. Data on breeding success and survival of breeding common guillemots Uria aalge were collected over 20 years on the Isle of May (Scotland) using a pool of individuals marked as adults. Because the years of hatching of individuals were not known, we used the time (years) elapsed since first capture (TFC) as a measure of age. The use of this proxy did not create any bias in estimating senescence in the case of a linear decline, nor did it greatly decrease the power of a test for senescence. Breeding success declined significantly from 0.81 (95% CI: 0.77–0.84) to 0.62 (0.54–0.68) over the study period. It also varied in relation to age, initially increasing (from 0.62 (0.54–0.68) at TFC of 0 year to 0.76 (0.73–0.79) at TFC of 9 years) up to a plateau (from TFC of 9 years with 0.76 (0.73–0.79) until TFC of 13 years with 0.77 (0.74–0.79) before declining in later life to 0.70 (0.61–0.78) at TFC of 19 years). Survival was generally high and varied significantly from year to year. It also declined with TFC: survival of birds marked in 1982 decreased from 0.92 (0.85–0.96) at a TFC of 0 year to 0.88 (0.82–0.92) at a TFC of 19 years. Resighting probabilities also declined with TFC suggesting that the oldest birds do not come back to the colony to breed as regularly as younger individuals. These findings indicate that individual common guillemots on the Isle of May showed both actuarial and reproductive senescence

Reduced atrial connexin43 expression after pediatric heart surgery

Myocardial dysfunction and arrhythmias may be induced by congenital heart defects, but also be the result of heart surgery with cardiopulmonary bypass (CPB), potentially caused by differential expression of connexin40 (Cx40) and connexin43 (Cx43). In 16 pediatric patients undergoing corrective heart surgery, connexin mRNA expression was studied in volume overloaded (VO group, n=8) and not overloaded (NO group, n=8) right atrial myocardium, excised before and after CPB. Additionally, in eight of these patients ventricular specimens were investigated. The atrial Cx43 expression decreased during CPB, which was restricted to the VO group (p=0.008). In contrast, atrial Cx40 mRNA did not change during CPB. In ventricular myocardium compared to atrial mRNA levels, Cx40 was lower (p=0.006) and Cx43 higher (p=0.017) expressed, without significant change during CPB. This study revealed a significant influence of CPB and the underlying heart defect on Cx43 expression

Retailer-driven agricultural restructuring-Australia, the UK and Norway in comparison

In recent decades, the governance of food safety, food quality, on-farm environmental management and animal welfare has been shifting from the realm of 'the government' to that of the private sector. Corporate entities, especially the large supermarkets, have responded to neoliberal forms of governance and the resultant 'hollowed-out' state by instituting private standards for food, backed by processes of certification and policed through systems of third party auditing. Today's food regime is one in which supermarkets impose 'private standards' along the food supply chain to ensure compliance with a range of food safety goals-often above and beyond those prescribed by government. By examining regulatory governance in Australia, Norway and the United Kingdom we highlight emerging trajectories of food governance. We argue that the imposition of the new private forms of monitoring and compliance continue the project of agricultural restructuring that began with government support for structural adjustment schemes in agriculture and that these are most evident in the UK and Australia where neoliberalism is an entrenched philosophy. However, despite Norway's identity as a social democracy, we also identify neoliberal 'creep' into the system of food governance. Small-scale producers in all three nations are finding themselves increasingly subject to governance through private, market-based mechanisms that, to varying degrees, are dominated by major supermarket chains. The result is agricultural restructuring not through the traditional avenues of elected governments, but via non-elected market operatives