Climate adaptation services for the Netherlands: An operational approach to support spatial adaptation planning

There is a growing availability of climate change information, offered to scientists and policy makers through climate services. However, climate services are not well taken up by the policy-making and planning community. Climate services focus on primary impacts of climate change, e.g., the disclosure of precipitation and temperature data, and this seems insufficient in meeting their needs. In this paper, we argue that, in order to reach the spatial planning community, climate services should take on a wider perspective by translating climate data to policy-relevant indicators and by offering support in the design of adaptation strategies. We argue there should be more focus on translating consequences of climate change to land-use claims and subsequently discuss the validity, consequences and implications of these claims with stakeholders, so they can play a role in spatial planning processes where much of the climate adaptation takes place. The term Climate Adaptation Services is introduced as being a stepwise approach supporting the assessment of vulnerability in a wider perspective and include the design and appraisal of adaptation strategies in a multi-stakeholder setting. We developed the Climate Adaptation Atlas and the Climate Ateliers as tools within the Climate Adaptation Services approach to support decision-making and planning processes. In this paper, we describe the different steps of our approach and report how some of the challenges were addresse

Deficits in geriatric assessment associate with disease activity and burden in older patients with inflammatory bowel disease

BACKGROUND & AIMS: We aimed to perform geriatric assessment in older patients with inflammatory bowel disease (IBD) to evaluate which IBD characteristics associate with deficits in geriatric assessment and the impact of deficits on disease burden (health-related quality of life).METHODS: A prospective multicenter cohort study including 405 consecutive outpatient patients with IBD aged >= 65 years. Somatic domain (comorbidity, polypharmacy, malnutrition), impairments in (instrumental) activities of daily living, physical capacity (handgrip strength, gait speed), and mental (depressive symptoms, cognitive impairment) and social domain (life-partner) were assessed. Deficits in geriatric assessment were defined as >= 2 abnormal domains; 2-3 moderate deficits and 4-5 severe deficits. Clinical (Harvey Bradshaw Index >4/partial Mayo Score >2) and biochemical (C-reactive protein >= 10 mg/L and/or fecal calprotectin >= 250 mu g/g) disease activity and disease burden (short Inflammatory Bowel Disease Questionnaire) were assessed.RESULTS: Somatic domain (51.6%) and activities of daily living (43.0%) were most frequently impaired. A total of 160 (39.5%) patients had moderate deficits in their geriatric assessment; 32 (7.9%) severe. Clinical and biochemical disease activity associated with deficits (clinical: adjusted odds ratio, 2.191; 95% confidence interval, 1.284-3.743; P = .004; biochemical: adjusted odds ratio, 3.358; 95% confidence interval, 1.936-5.825; P <.001). Deficits in geriatric assessment independently associate with lower health-related quality of life.CONCLUSION: Deficits in geriatric assessment are highly prevalent in older patients with IBD. Patients with active disease are more prone to deficits, and deficits associate with lower health-related quality of life, indicating higher disease burden. Prospective data validating impact of frailty and geriatric assessment on outcomes are warranted to further improve treatment strategies.</p

Deficits in Geriatric Assessment Associate With Disease Activity and Burden in Older Patients With Inflammatory Bowel Disease

BACKGROUND & AIMS: We aimed to perform geriatric assessment in older patients with inflammatory bowel disease (IBD) to evaluate which IBD characteristics associate with deficits in geriatric assessment and the impact of deficits on disease burden (health-related quality of life).METHODS: A prospective multicenter cohort study including 405 consecutive outpatient patients with IBD aged >= 65 years. Somatic domain (comorbidity, polypharmacy, malnutrition), impairments in (instrumental) activities of daily living, physical capacity (handgrip strength, gait speed), and mental (depressive symptoms, cognitive impairment) and social domain (life-partner) were assessed. Deficits in geriatric assessment were defined as >= 2 abnormal domains; 2-3 moderate deficits and 4-5 severe deficits. Clinical (Harvey Bradshaw Index >4/partial Mayo Score >2) and biochemical (C-reactive protein >= 10 mg/L and/or fecal calprotectin >= 250 mu g/g) disease activity and disease burden (short Inflammatory Bowel Disease Questionnaire) were assessed.RESULTS: Somatic domain (51.6%) and activities of daily living (43.0%) were most frequently impaired. A total of 160 (39.5%) patients had moderate deficits in their geriatric assessment; 32 (7.9%) severe. Clinical and biochemical disease activity associated with deficits (clinical: adjusted odds ratio, 2.191; 95% confidence interval, 1.284-3.743; P = .004; biochemical: adjusted odds ratio, 3.358; 95% confidence interval, 1.936-5.825; P <.001). Deficits in geriatric assessment independently associate with lower health-related quality of life.CONCLUSION: Deficits in geriatric assessment are highly prevalent in older patients with IBD. Patients with active disease are more prone to deficits, and deficits associate with lower health-related quality of life, indicating higher disease burden. Prospective data validating impact of frailty and geriatric assessment on outcomes are warranted to further improve treatment strategies.Pathophysiology, epidemiology and therapy of agein

Genes and gene pathways in Candida infection

Advances in genetic technology have promoted an explosive increase in our knowledge of genes relevant to Candida infection, and our understanding of their mode of action. Although the major influence on susceptibility to systemic infection is the presence or absence of complement C5, at least two other genes, as yet unidentified, influence the severity of tissue damage. Mice in which specific genes have been deleted (gene-knockout) mice are now readily available, and have been used both in the analysis of receptor interactions with Candida, and to study the role of T cell-derived cytokines in clearance of the infection and the development of host resistance, but results have not always been consistent. Gene profiling studies, in both humans and mice, will no doubt resolve some of the present anomalie