The welfare state after the Great Recession

The economic crisis has given rise to significant challenges to the welfare state. Given that welfare expenses account for a large proportion of all state spending in the member countries of the European Union, reducing government spending means cutting welfare measures. Yet social protection, in particular unemployment insurance benefits and minimum income support, has significantly softened the impact of the crisis for millions of individuals. The global recession calls into question the financial viability of current programmes, and the crisis is being used by some as an opportunity to roll back the welfare state permanently. The present Forum discusses challenges to and opportunities for the welfare state after the crisis

Long-term nitrogen addition raises the annual carbon sink of a boreal forest to a new steady-state

The boreal forest is an important global carbon (C) sink. Since low soil nitrogen (N) availability is commonly a key constraint on forest productivity, the prevalent view is that increased N input enhances its C sink-strength. This understanding however relies primarily on observations of increased aboveground tree biomass and soil C stock following N fertilization, whereas empirical data evaluating the effects on the whole ecosystem-scale C balance are lacking. Here we use a unique long-term experiment consisting of paired forest stands with eddy covariance measurements to explore the effect of ecosystem-scale N fertilization on the C balance of a managed boreal pine forest. We find that the annual C uptake (i.e. net ecosystem production, NEP) at the fertilized stand was 16 +/- 2% greater relative to the control stand by the end of the first decade of N addition. Subsequently, the ratio of NEP between the fertilized and control stand remained at a stable level during the following five years with an average NEP to N response of 7 & PLUSMN; 1 g C per g N. Our study reveals that this non-linear response of NEP to long-term N fertilization was the result of a cross-seasonal feedback between the N-induced increases in both growing-season C uptake and subsequent winter C emission. We further find that one decade of N addition altered the sensitivity of ecosystem C fluxes to key environmental drivers resulting in divergent responses to weather patterns. Thus, our study highlights the need to account for ecosystem-scale responses to perturbations to improve our understanding of nitrogen-carbon-climate feedbacks in boreal forests.Peer reviewe

Long-term nitrogen addition raises the annual carbon sink of a boreal forest to a new steady-state

The boreal forest is an important global carbon (C) sink. Since low soil nitrogen (N) availability is commonly a key constraint on forest productivity, the prevalent view is that increased N input enhances its C sink-strength. This understanding however relies primarily on observations of increased aboveground tree biomass and soil C stock following N fertilization, whereas empirical data evaluating the effects on the whole ecosystem-scale C balance are lacking. Here we use a unique long-term experiment consisting of paired forest stands with eddy covariance measurements to explore the effect of ecosystem-scale N fertilization on the C balance of a managed boreal pine forest. We find that the annual C uptake (i.e. net ecosystem production, NEP) at the fertilized stand was 16 +/- 2% greater relative to the control stand by the end of the first decade of N addition. Subsequently, the ratio of NEP between the fertilized and control stand remained at a stable level during the following five years with an average NEP to N response of 7 & PLUSMN; 1 g C per g N. Our study reveals that this non-linear response of NEP to long-term N fertilization was the result of a cross-seasonal feedback between the N-induced increases in both growing-season C uptake and subsequent winter C emission. We further find that one decade of N addition altered the sensitivity of ecosystem C fluxes to key environmental drivers resulting in divergent responses to weather patterns. Thus, our study highlights the need to account for ecosystem-scale responses to perturbations to improve our understanding of nitrogen-carbon-climate feedbacks in boreal forests.Peer reviewe

Novel Rodent Models for Macular Research

BACKGROUND: Many disabling human retinal disorders involve the central retina, particularly the macula. However, the commonly used rodent models in research, mouse and rat, do not possess a macula. The purpose of this study was to identify small laboratory rodents with a significant central region as potential new models for macular research. METHODOLOGY/PRINCIPAL FINDINGS: Gerbillus perpallidus, Meriones unguiculatus and Phodopus campbelli, laboratory rodents less commonly used in retinal research, were subjected to confocal scanning laser ophthalmoscopy (cSLO), fluorescein and indocyanine green angiography, and spectral-domain optical coherence tomography (SD-OCT) using standard equipment (Heidelberg Engineering HRA1 and Spectralis™) adapted to small rodent eyes. The existence of a visual streak-like pattern was assessed on the basis of vascular topography, retinal thickness, and the topography of retinal ganglion cells and cone photoreceptors. All three species examined showed evidence of a significant horizontal streak-like specialization. cSLO angiography and retinal wholemounts revealed that superficial retinal blood vessels typically ramify and narrow into a sparse capillary net at the border of the respective area located dorsal to the optic nerve. Similar to the macular region, there was an absence of larger blood vessels in the streak region. Furthermore, the thickness of the photoreceptor layer and the population density of neurons in the ganglion cell layer were markedly increased in the visual streak region. CONCLUSIONS/SIGNIFICANCE: The retinal specializations of Gerbillus perpallidus, Meriones unguiculatus and Phodopus campbelli resemble features of the primate macula. Hence, the rodents reported here may serve to study aspects of macular development and diseases like age-related macular degeneration and diabetic macular edema, and the preclinical assessment of therapeutic strategies

Implementation of a standardized protocol to manage elderly patients with low energy pelvic fractures: can service improvement be expected?

Purpose: The incidence of low energy pelvic fractures (FPFs) in the elderly is increasing. Comorbidities, decreased bone-quality, problematic fracture fixation and poor compliance represent some of their specific difficulties. In the absence of uniform management, a standard operating procedure (SOP) was introduced to our unit, aiming to improve the quality of services provided to these patients. Methods: A cohort study was contacted to test the impact of (1) using a specific clinical algorithm and (2) using different antiosteoporotic drugs. Multivariate regression analysis was used to determine prognostic factors. Study endpoints were the time-to-healing, length-of-stay, return to pre-injury mobility, union status, mortality and complications. Results: A total of 132 elderly patients (≥65 years) admitted during the period 2012–2014 with FPFs were enrolled. High-energy fractures, acetabular fractures, associated trauma affecting mobility, pathological pelvic lesions and operated FPFs were used as exclusion criteria. The majority of included patients were females (108/132; 81.8%), and the mean age was 85.8 years (range 67–108). Use of antiosteoporotics was associated with a shorter time of healing (p = 0.036). Patients treated according to the algorithm showed a significant protection against malunion (p < 0.001). Also, adherence to the algorithm allowed more patients to return to their pre-injury mobility status (p = 0.039). Conclusions: The use of antiosteoporotic medication in elderly patients with fragility pelvic fractures was associated with faster healing, whilst the adherence to a structured clinical pathway led to less malunions and non-unions and return to pre-injury mobility state

An action plan for pan-European defence against new SARS-CoV-2 variants.

COVID-19 cases are very high across Europe. Current measures are not reducing virus spread sufficiently, and new SARS-CoV-2 variants are emerging. The B.1.1.7 and B1.351 variants, first identified in the UK and South Africa, respectively, have spread to many European countries.1–5 Although the biological properties of these variants are yet to be characterised, epidemiological data suggest they have a higher transmissibility than the original variant.6,7 These viral properties could increase the effective reproduction number R in the population. In the case of B.1.1.7, estimates suggest R could increase from 1 to about 1.4 with no change in population behavior.3,4 If true, many countries that have succeeded in reducing R to 1 or less will be confronted with a novel wave of viral spread despite the current measures.8,9 Once a more contagious variant has established itself, stabilising the number of new infections will become increasingly difficult

Electrocardiographic findings in patients with arrhythmogenic cardiomyopathy and right bundle branch block ventricular tachycardia

AIMS: Little is known about patients with right bundle branch block (RBBB)-ventricular tachycardia (VT) and arrhythmogenic cardiomyopathy (ACM). Our aims were: (i) to describe electrocardiogram (ECG) characteristics of sinus rhythm (SR) and VT; (ii) to correlate SR with RBBB-VT ECGs; and (iii) to compare VT ECGs with electro-anatomic mapping (EAM) data. METHODS AND RESULTS: From the European Survey on ACM, 70 patients with spontaneous RBBB-VT were included. Putative left ventricular (LV) sites of origin (SOOs) were estimated with a VT-axis-derived methodology and confirmed by EAM data when available.  Overall, 49 (70%) patients met definite Task Force Criteria. Low QRS voltage predominated in lateral leads (n = 37, 55%), but QRS fragmentation was more frequent in inferior leads (n = 15, 23%). T-wave inversion (TWI) was equally frequent in inferior (n = 28, 42%) and lateral (n = 27, 40%) leads. TWI in inferior leads was associated with reduced LV ejection fraction (LVEF; 46 ± 10 vs. 53 ± 8, P = 0.02). Regarding SOOs, the inferior wall harboured 31 (46%) SOOs, followed by the lateral wall (n = 17, 25%), the anterior wall (n = 15, 22%), and the septum (n = 4, 6%). EAM data were available for 16 patients and showed good concordance with the putative SOOs. In all patients with superior-axis RBBB-VT who underwent endo-epicardial VT activation mapping, VT originated from the LV. CONCLUSIONS: In patients with ACM and RBBB-VT, RBBB-VTs originated mainly from the inferior and lateral LV walls. SR depolarization and repolarization abnormalities were frequent and associated with underlying variants

Real-world effectiveness and safety of SDZ ETN, an etanercept biosimilar, in patients with rheumatic diseases: final results from multi-country COMPACT study

[Abstract] Introduction: COMPACT, a non-interventional study, evaluated the persistence, effectiveness, safety and patient-reported outcomes (PROs) in patients with rheumatoid arthritis (RA), axial-spondyloarthritis (axSpA) or psoriatic arthritis (PsA) treated with SDZ ETN (etanercept [ETN] biosimilar) in Europe and Canada. Methods: Patients (aged ≥ 18 years) who have been treated with SDZ ETN were categorised on the basis of prior treatment status (groups A-D): patients in clinical remission or with low disease activity under treatment with reference ETN or biosimilar ETN and switched to SDZ ETN; patients who received non-ETN targeted therapies and switched to SDZ ETN; biologic-naïve patients who started SDZ ETN after conventional therapy failure; or disease-modifying anti-rheumatic drug (DMARD)-naïve patients with RA considered suitable for treatment initiation with a biologic and started on treatment with SDZ ETN. The primary endpoint was drug persistence, defined as time from study enrolment until discontinuation of SDZ ETN treatment. Results: Of the 1466 patients recruited, 844 (57.6%) had RA, 334 (22.8%) had axSpA and 288 (19.6%) had PsA. Patients had an ongoing SDZ ETN treatment at the time of enrolment for an observed average of 138 days (range 1-841); 22.7% of patients discontinued SDZ ETN through 12 months of study observation. Overall, all the patients receiving SDZ ETN showed good treatment persistence at 12 months with discontinuation rates of 15.2%, 25.7% and 27.8% in groups A, B and C, respectively. Across all patient groups, no major differences were observed in the disease activity and PRO scores between baseline and month 12. Injection-site reactions were low across the treatment groups. Conclusion: These results support the effectiveness and safety of SDZ ETN treatment in patients with RA, axSpA or PsA in real-life conditions. The treatment persistence rates observed were consistent with previously published reports of patients treated with reference or other biosimilar ETN. No new safety signals were identified

Design of a Trichromatic Cone Array

Cones with peak sensitivity to light at long (L), medium (M) and short (S) wavelengths are unequal in number on the human retina: S cones are rare (<10%) while increasing in fraction from center to periphery, and the L/M cone proportions are highly variable between individuals. What optical properties of the eye, and statistical properties of natural scenes, might drive this organization? We found that the spatial-chromatic structure of natural scenes was largely symmetric between the L, M and S sensitivity bands. Given this symmetry, short wavelength attenuation by ocular media gave L/M cones a modest signal-to-noise advantage, which was amplified, especially in the denser central retina, by long-wavelength accommodation of the lens. Meanwhile, total information represented by the cone mosaic remained relatively insensitive to L/M proportions. Thus, the observed cone array design along with a long-wavelength accommodated lens provides a selective advantage: it is maximally informative