Hydrographic-hydrochemical assessment of the Baltic Sea 2017

ENGLISH ABSTRACT: The article summarizes the hydrographic-hydrochemical conditions in the western and central Baltic Sea in 2017. Based on meteorological conditions, the horizontal and vertical distribution of temperature, salinity, oxygen/hydrogen sulphide and nutrients are described on a seasonal scale. For the southern Baltic Sea area, the “cold sum” of the air temperature of 31.7 Kd in Warnemünde amounted to a mild winter in 2014/15 and ranks as 15th warmest winter since the beginning of the record in 1948. The summer “heat sum” of 159.5 Kd ranks on 28th position of the warmest summers over the past 70 years and is slightly above the long-term average of 153.4 Kd. Based on satellite derived Sea Surface Temperature (SST) 2017 was the eleventh-warmest year since 1990 and with 0.24 K slightly above the long-term SST average. March, April and October - December contributed to the average by their positive anomalies. July and August were characterized by negative anomalies. The anomalies reached maximum values of +2 K and -3 K. The situation in the deep basins of the Baltic Sea was mainly coined by beginning stagnation at bottom-near water depths of the eastern Gotland Basin and ongoing ventilation of the upper part 5 of the deep-water above 150 m as a consequence of weak inflows. For the first time within this phase of intensified inflow activity, starting in 2014, the ventilation of the Farö Deep at the Northern Central Basin was registered at the beginning of the year. In the course of 2017 two weak inflows showing total volumes of 210 km^³ (February) and 188 km^³ (October) were registered. In conclusion, the impact of the observed phase of intensified water exchange processes with subsequent consequences for the biogeochemical cycles is weakening. GERMAN ABSTRACT: Die Arbeit beschreibt die hydrographisch-hydrochemischen Bedingungen in der westlichen und zentralen Ostsee für das Jahr 2017. Basierend auf den meteorologischen Verhältnissen werden die horizontalen und vertikalen Verteilungsmuster von Temperatur, Salzgehalt, Sauerstoff/ Schwefelwasserstoff und Nährstoffen mit saisonaler Auflösung dargestellt. Für den südlichen Ostseeraum ergab sich eine Kältesumme der Lufttemperatur an der Station Warnemünde von 31,7 Kd. Im Vergleich belegt der Winter 2016/17 den 15. Platz der wärmsten Winter seit Beginn der Aufzeichnungen im Jahr 1948 und wird als mild klassifiziert. Mit einer Wärmesumme von 159,5 Kd rangiert der Sommer im Mittelfeld der 70jährigen Datenreihe und reiht sich auf Platz 28 der wärmsten Sommer ein. Das Langzeitmittel liegt bei 153,4 Kd. Auf der Grundlage von satellitengestützten Meeresoberflächentemperaturen (SST) war 2017 das elft- wärmste Jahr seit 1990 und mit 0,24 K etwas über dem langfristigen SST-Mittel. März, April und Oktober - Dezember trugen durch ihre positiven Anomalien zum Durchschnitt bei. Juli und August waren durch negative Anomalien gekennzeichnet. Die Anomalien erreichten Höchstwerte von +2 K und -3 K. Die Situation in den Tiefenbecken der Ostsee war im Wesentlichen geprägt durch bodennah einsetzende Stagnation im östlichen Gotland Becken und Belüftung der mittleren Wassersäule oberhalb 150 m im Zuge kleinerer Einströme. Zu Jahresbeginn wurde das im nördlichen Zentralbecken gelegene Farö Tief erstmals innerhalb der aktuellen Einstromphase belüftet. Im Jahresverlauf 2017 wurden zwei weitere schwache Einströme mit Volumina zwischen 210 km³ und 188 km³ im Februar sowie Oktober registriert. Zusammenfassend kann gesagt werden, dass die Auswirkungen der seit 2014 beobachten Phase von verstärkten Wasseraustauschprozessen mit entsprechenden Konsequenzen für die biogeochemischen Kreisläufe abklingen

Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses : second panel on cost-effectiveness in health and medicine

Importance  Since publication of the report by the Panel on Cost-Effectiveness in Health and Medicine in 1996, researchers have advanced the methods of cost-effectiveness analysis, and policy makers have experimented with its application. The need to deliver health care efficiently and the importance of using analytic techniques to understand the clinical and economic consequences of strategies to improve health have increased in recent years.Objective  To review the state of the field and provide recommendations to improve the quality of cost-effectiveness analyses. The intended audiences include researchers, government policy makers, public health officials, health care administrators, payers, businesses, clinicians, patients, and consumers.Design  In 2012, the Second Panel on Cost-Effectiveness in Health and Medicine was formed and included 2 co-chairs, 13 members, and 3 additional members of a leadership group. These members were selected on the basis of their experience in the field to provide broad expertise in the design, conduct, and use of cost-effectiveness analyses. Over the next 3.5 years, the panel developed recommendations by consensus. These recommendations were then reviewed by invited external reviewers and through a public posting process.Findings  The concept of a “reference case” and a set of standard methodological practices that all cost-effectiveness analyses should follow to improve quality and comparability are recommended. All cost-effectiveness analyses should report 2 reference case analyses: one based on a health care sector perspective and another based on a societal perspective. The use of an “impact inventory,” which is a structured table that contains consequences (both inside and outside the formal health care sector), intended to clarify the scope and boundaries of the 2 reference case analyses is also recommended. This special communication reviews these recommendations and others concerning the estimation of the consequences of interventions, the valuation of health outcomes, and the reporting of cost-effectiveness analyses.Conclusions and Relevance  The Second Panel reviewed the current status of the field of cost-effectiveness analysis and developed a new set of recommendations. Major changes include the recommendation to perform analyses from 2 reference case perspectives and to provide an impact inventory to clarify included consequences

Efficacy of Infection Control Interventions in Reducing the Spread of Multidrug-Resistant Organisms in the Hospital Setting

Multidrug-resistant organisms (MDRO) continue to spread in hospitals globally, but the population-level impact of recommended preventive strategies and the relative benefit of individual strategies targeting all MDRO in the hospital setting are unclear. To explore the dynamics of MDRO transmission in the hospital, we develop a model extending data from clinical individual-level studies to quantify the impact of hand hygiene, contact precautions, reducing antimicrobial exposure and screening surveillance cultures in decreasing the prevalence of MDRO colonization and infection. The effect of an ongoing increase in the influx of patients colonized with MDRO into the hospital setting is also quantified. We find that most recommended strategies have substantial effect in decreasing the prevalence of MDRO over time. However, screening for asymptomatic MDRO colonization among patients who are not receiving antimicrobials is of minimal value in reducing the spread of MDRO

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

The ubiquitin-conjugating enzyme CDC34 is essential for cytokinesis in contrast to putative subunits of a SCF complex in Trypanosoma brucei

The ubiquitin-proteasome system is a post-translational regulatory pathway for controlling protein stability and activity that underlies many fundamental cellular processes, including cell cycle progression. Target proteins are tagged with ubiquitin molecules through the action of an enzymatic cascade composed of E1 ubiquitin activating enzymes, E2 ubiquitin conjugating enzymes, and E3 ubiquitin ligases. One of the E3 ligases known to be responsible for the ubiquitination of cell cycle regulators in eukaryotes is the SKP1-CUL1-F-box complex (SCFC). In this work, we identified and studied the function of homologue proteins of the SCFC in the life cycle of Trypanosoma brucei, the causal agent of the African sleeping sickness. Depletion of trypanosomal SCFC components TbRBX1, TbSKP1, and TbCDC34 by RNAi resulted in decreased growth rate and contrasting cell cycle abnormalities for both procyclic (PCF) and bloodstream (BSF) forms. Depletion of TbRBX1 in PCF cells interfered with kinetoplast replication, whilst depletion of TbSKP1 arrested PCF and BSF cells in the G1/S transition. Silencing of TbCDC34 in BSF cells resulted in a block in cytokinesis and caused rapid clearance of parasites from infected mice. We also show that TbCDC34 is able to conjugate ubiquitin in vitro and in vivo, and that its activity is necessary for T. brucei infection progression in mice. This study reveals that different components of a putative SCFC have contrasting phenotypes once depleted from the cells, and that TbCDC34 is essential for trypanosome replication, making it a potential target for therapeutic intervention

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Prenatal care : Effectiveness and implementation

xiii, 349 hal; 17 x 25 c

Return of aggregate results to study participants: Facilitators, barriers, and recommendations

Background: Most researchers and study participants believe that the summary, or aggregate, results of health research should be returned to study participants. However, researchers often do not return aggregate results. A better understanding of the impediments to results return could support improvements in this practice. Methods: This qualitative study convened eight virtual focus groups, four with investigators and four with patient partners from research studies funded by the Patient-Centered Outcomes Research Institute (PCORI). In total, 23 investigators and 20 partners participated. We explored perspectives, experiences, influences, and recommendations related to aggregate results return. Results: Focus group participants described the ethical importance of returning aggregate results, as well as the benefits to study participants. They also noted important impediments to results return, emphasizing IRB and logistical challenges and describing a lack of support for the practice both on the part of institutions and the field at large. Participants highlighted the value of patients and caregivers' perspectives and contributions to results return, which focused on returning the most relevant findings through effective channels and formats. They further emphasized the importance of planning and identified resources that could support results return. Conclusion: Researchers, funders, and the field can better facilitate results return by promoting standardized processes in research, such as the earmarking of funds for results return and inclusion of results returns milestones in research plans. More intentional policies, infrastructures, and resources that support results return may lead to more widespread return of study results to those who make these studies possible