The management of acute myocardial infarction in the Russian Federation: Protocol for a study of patient pathways [version 2; referees: 2 approved]

Source at https://doi.org/10.12688/wellcomeopenres.12478.2. Background: Death rates from cardiovascular disease in Russia are among the highest in the world. In recent years, the Russian government has invested substantially in the healthcare system, with a particular focus on improving access to advanced technology, especially for acute myocardial infarction (AMI). This protocol describes a study to understand the management of AMI in different Russian regions, investigating the role of patient, clinical, and health system characteristics. Methods: A prospective observational study has recruited a representative sample of AMI patients within 16 hospitals from 13 regions across Russia. Criteria for inclusion are being aged 35-70 years with a confirmed diagnosis of AMI and surviving until the day after admission. Information being collected includes health system contacts and features of clinical management prior to the event and in the 12 months following discharge from hospital. Following initial exploration of the data to generate hypotheses, multivariate analyses will be applied to assess the role of these characteristics in both treatment decisions and any delays in time critical interventions. Between June 2015 and August 2016, 1,122 patients have been recruited at baseline and follow-up to 12 months post-discharge is scheduled to be completed by autumn 2017. The study is unique in examining patient factors, clinical management prior to admission and in hospital in the acute phase and throughout the critical first year of recovery across a diverse range of geographies and facilities. It uses standardized instruments to collect data from patients and health care providers and includes regions that are diverse in terms of geography and development of cardiology capacity. However, given the limited health services research capacity in the Russian Federation, it was not possible to obtain a sample that was truly nationally representative

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Corridors animation

Animation for the monthly predicted movement corridors (current and future fencing scenarios

Movement corridors (current and future scenario)

Predictive current flow surfaces for current and future fencing scenarios. Th surfaces were modeled based on step-selection functions resistance surfaces and using Linkage Mapper ArcGIS 10.5.

Surrogate species protection in Bolivia under climate and land cover change scenarios

The Amazon rainforest covers more than 60% of Bolivia\u27s lowlands, providing habitat for many endemic and threatened species. Bolivia has the highest rates of deforestation of the Amazon biome, which degrades and fragments species habitat. Anthropogenic habitat changes could be exacerbated by climate change, and therefore, developing relevant strategies for biodiversity protection under global change scenarios is a necessary step in conservation planning. In this research we used multi-species umbrella concept to evaluate the degree of habitat impacts due to climate and land cover change in Bolivia. We used species distribution modeling to map three focal species (Jaguar, Lowland Tapir and Lesser Anteater) and assessed current protected area network effectiveness under future climate and land cover change scenarios for 2050. The studied focal species will lose between 70% and 83% of their ranges under future climate and land-cover change scenarios, decreasing the level of protection to 10% of their original ranges. Existing protected area network should be reconsidered to maintain current and future biodiversity habitats

Data from: Fencing solves human‐wildlife conflict locally but shifts problems elsewhere: a case study using functional connectivity modelling of the African elephant

1. Fencing is one of the commonest methods for mitigating human-wildlife conflicts. At the same time, fencing is considered to be of one of the most pressing emerging threats to conservation globally. Although fences act as barriers and eventually can cause population isolation and fragmentation, it is challenging to quantitatively predict the possible consequences fences have for wildlife. 2. Here, we model how fencing designed to mitigate human-elephant conflict (HEC) on the Borderlands between Kenya and Tanzania will affect functional connectivity and movement corridors for African elephants. Specifically, we (1) model functional landscape connectivity integrating natural and anthropogenic factors; (2) predict seasonal movement corridors used by elephants in non-protected areas; and (3) evaluate whether fencing in one area can potentially intensify human-wildlife conflicts elsewhere. 3. We used GPS movement and remote sensing data to develop monthly step-selection functions to model functional connectivity. For future scenarios, we used a currently ongoing fencing project designed for human-elephant conflict mitigation within the study area. We modelled movement corridors using least-cost path and circuit theory methods, evaluated their predictive power and quantified connectivity changes resulting from the planned fencing. 4. Our results suggest that fencing will not cause landscape fragmentation and will not change functional landscape connectivity dramatically. However, fencing will lead to a loss of connectivity locally and will increase the potential for HEC in new areas. We estimated that wetlands important for movement corridors will be more intensively used by the elephants, which may also cause problems of overgrazing. Seasonal analysis highlighted an increasing usage of non-protected lands in the dry season and equal importance of the pinch point wetlands for preserving overall function connectivity. 5. Synthesis and applications. Fencing is a solution to small-scale HEC problems, but will not solve the issue at a broader scale. Moreover, our results highlight that it may intensify the conflicts and overuse of habitat patches in other areas, thereby negating any conservation benefits. If fencing is employed on a broader scale, then it is imperative that corridors are integrated within the protected area network to ensure local connectivity of affected species

Hospital stage of myocardial infarction treatment in 13 regions of Russian Federation by results of the international research

Aim: To describe the characteristics of the patient with MI who is admitted to a hospital and to characterize the main diagnostic and treatment interventions in clinic. Material and methods: This study is observational and the part of big international project. It includes a representative sample of patients with MI admitted to 16 clinics in 13 regions of Russian Federation (Arkhangelsk region, Belgorod region, Bryansk region, Tver region, Saratov region, Rostov region, Samara region, the Republic of Tatarstan, Perm region, Tyumen region, Khanty-Mansiysk Autonomous district, Kemerovo region, Altai region). Patients were selected at random from among those experiencing a MI that were alive on the next morning after hospitalization. Enrollment took place from June 2015 to August 2016. Results: Of 1,128 patients included in the study, 872 were male (77.3%) and 256 females. 21.4% of patients had a previous MI, 8.3% had undergone PCI, and 2.2% CABG. Turning to cardiovascular risk factors, 46.2% of patients smoked prior to hospitalization, 34.6% were obese and 52.1% had a high cholesterol level. Only 40.0% of patients had no contact with the health care system within 12 months before the MI. Every fourth patient (25.1%) had undergone dispensarisation within 12 months before MI, women significantly often than men (33.5% and 22.6%, p<0.001). Initial revascularization was performed in 73.2% of patients, PCI was the initial revascularization attempt in 49.4% of patients, and PCI with stenting in 46.7%. Conclusion: Patient with a MI in Russian clinics is likely to have had a history of cardiovascular disease, and to have regular contact with the health care system within 12 months before the development of cardiovascular event. We demonstrated the high rates of appropriate MI treatment, without significant gender and age difference (except for thrombolysis), however, there is a reserve for increasing the proportion of patients who are undergoing revascularization.<p

Intergenerational inequity : stealing the joy and benefits of nature from our children

No abstract available.The Australia-Africa Universities Network— Partnership Research and Development Fund, a PRIME-DAAD fellowship and the Australian Research Council Linkage Grant. he article processing charge was covered by the Baden-Wuerttemberg Ministry of Science, Research and Art and the University of Freiburg through the funding programme Open Access Publishing.http://frontiersin.org/Ecology_and_Evolutiondm2022Mammal Research InstituteZoology and Entomolog

Reintroducing rewilding to restoration – a search for novelty

Rewilding is emerging as a major issue in conservation. However, there are currently a dozen definitions of rewilding that include Pleistocene rewilding, island rewilding, trophic rewilding, functional rewilding and passive rewilding, and these remain fuzzy, lack clarity and, hence, hinder scientific discourse. Based on current definitions, it is unclear how the interventions described under the rewilding umbrella differ from those framed within the long-standing term 'restoration'. Even projects held up as iconic rewilding endeavours invariably began as restoration projects (e.g., Oostvaaderplassen; Pleistocene Park; the return of wolves to Yellowstone, etc.). Similarly, rewilding organisations (e.g., Rewilding Europe) typically began with a restoration focus. Scientific discourse requires precise language. The fuzziness of existing definitions of rewilding and lack of distinction from restoration practices means that scientific messages cannot be transferred accurately to a policy or practice framework. We suggest that the utility of 'rewilding' as a term is obsolete, and hence recommend scientists and practitioners use 'restoration' instead233255259MWH and MJS are funded by the Australia-Africa Universities Network - Partnership Research & Development Fund 201