Experimentally simulating environmental change in a montane meadow system via reduced snowpack and passive warming: soil and plant responses

Global and regional climate patterns suggest that the environment in the western United States is trending towards warmer and drier conditions. The ecological effects of climate change could include shifts in distribution and phenological changes for many plants and animals. This study provides an initial examination of climatic and phenological (timing of key biological events) trends in an effort to understand how montane plants may be affected by climatic changes. To explore the consequences of increased temperatures and decreased snow cover, we conducted an experiment in a montane meadow where snow removal and passive heating were used to mimic the effects of predicted environmental changes. We manipulated soil temperature using open-sided passive warming chambers, and soil moisture by manually removing snow in the spring of 2010 and 2011. Our treatments included control, snow removal, passive warming, and snow removal + passive warming. We measured soil temperature at the surface and soil moisture at a 25cm depth to confirm that open-sided passive warming chambers and manual snow removal had the intended effects on temperature and moisture. In 2011, we recorded plant phenological response dates for emergence (green-up), budding, flowering, and senescence in three common perennial plants (Arrowleaf Balsamroot (Balsamorhiza sagitatta), Wild Buckwheat (Eriogonum umbellatum), and Western Groundsel (Senecio integerrimus)) in each of the treatments. Frost damage was recorded in Arrowleaf Balsamroot (Balsamorhiza sagitatta) in 2011. We concluded that open-sided passive warming chambers significantly increased soil minimum nighttime temperatures at a 25 cm depth but had no impact on maximum daily temperatures. The range between the 25 cm soil maximum daily temperature and the minimum daily was significantly increased due to the increase in minimum temperatures. Soil moisture at 25 cm depth was decreased throughout the season in the snow removal treatment when compared to the control in 2011 but not 2010, when there was less snow to remove. Soil moisture was not significantly different in 2010 or 2011 when any of the other treatments were compared. Plant responses to the treatments differed between the three species measured. Time to emergence was significantly increased in B. sagitatta in the snow removal and passive warming treatments but not when snow removal and passive warming were combined. Budding time was also advanced in B. sagitatta in the snow removal and snow removal + passive warming treatments but not the passive warming only treatments. Green-up time was advanced in E. umbellatum in the snow removal and snow removal + passive warming treatments. The treatments had no impact on the S. integerrimus

Carbon in the Galaxy: Studies from Earth and Space

Presented here is the text of the invited papers presented during a meeting entitled, Carbon in the Galaxy: Studies from Earth and Space, that was held at NASA Ames Research Center on November 5 and 6, 1987. For completeness, abstracts from all of the poster papers and the text of a paper summarizing what was learned during the course of the meeting are also included. The underlying premise for the meeting was that there is much to be gained by bringing together scientists from very different disciplines, all of whom study carbon in different ways for different reasons. The interchanges took place during the meeting and the contents of the enclosed papers validate that premise

Understanding the Role of Relationship Maintenance in Enduring Couple Partnerships in Later Adulthood

Intimate relationships in later adulthood are understudied despite their positive association with health and well-being. This cross-sectional mixed methods study sought to redress this gap by investigating relationship maintenance in later adulthood. Our international sub-sample comprised 1,565 participants aged 55 + and in an ongoing relationship. Results from hierarchical multiple regression indicated that overall happiness with the relationship had the largest effect size on relationship maintenance, with 53% of the variance explained. Content analyses of open-ended questions identified companionship and laughter as some of the “best liked” aspects of the relationship. Housework/cooking and saying “I love you” were among the behaviors that made participants feel appreciated. Results illustrated the types of maintenance behaviors adults in later adulthood who are in enduring partnerships employ

Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

Objective: The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. Design: Unmasked randomised controlled trial with automated ascertainment of primary endpoint. Setting: 76 general practices in the United Kingdom. Participants: 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. Interventions: Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. Main outcome measures: The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. Results: After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. Conclusions: The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. Trial registration: ISRCTN13790648

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Experimentally simulating environmental change in a montane meadow system via reduced snowpack and passive warming: soil and plant responses

Global and regional climate patterns suggest that the environment in the western United States is trending towards warmer and drier conditions. The ecological effects of climate change could include shifts in distribution and phenological changes for many plants and animals. This study provides an initial examination of climatic and phenological (timing of key biological events) trends in an effort to understand how montane plants may be affected by climatic changes. To explore the consequences of increased temperatures and decreased snow cover, we conducted an experiment in a montane meadow where snow removal and passive heating were used to mimic the effects of predicted environmental changes. We manipulated soil temperature using open-sided passive warming chambers, and soil moisture by manually removing snow in the spring of 2010 and 2011. Our treatments included control, snow removal, passive warming, and snow removal + passive warming. We measured soil temperature at the surface and soil moisture at a 25cm depth to confirm that open-sided passive warming chambers and manual snow removal had the intended effects on temperature and moisture. In 2011, we recorded plant phenological response dates for emergence (green-up), budding, flowering, and senescence in three common perennial plants (Arrowleaf Balsamroot (Balsamorhiza sagitatta), Wild Buckwheat (Eriogonum umbellatum), and Western Groundsel (Senecio integerrimus)) in each of the treatments. Frost damage was recorded in Arrowleaf Balsamroot (Balsamorhiza sagitatta) in 2011. We concluded that open-sided passive warming chambers significantly increased soil minimum nighttime temperatures at a 25 cm depth but had no impact on maximum daily temperatures. The range between the 25 cm soil maximum daily temperature and the minimum daily was significantly increased due to the increase in minimum temperatures. Soil moisture at 25 cm depth was decreased throughout the season in the snow removal treatment when compared to the control in 2011 but not 2010, when there was less snow to remove. Soil moisture was not significantly different in 2010 or 2011 when any of the other treatments were compared. Plant responses to the treatments differed between the three species measured. Time to emergence was significantly increased in B. sagitatta in the snow removal and passive warming treatments but not when snow removal and passive warming were combined. Budding time was also advanced in B. sagitatta in the snow removal and snow removal + passive warming treatments but not the passive warming only treatments. Green-up time was advanced in E. umbellatum in the snow removal and snow removal + passive warming treatments. The treatments had no impact on the S. integerrimus.</p