Restoring Lake Urmia: Moving beyond a Uniform Lake Level (2-page Summary)

More than 5 million people live near Lake Urmia in northwestern Iran, one of the world\u27s largest hypersaline lakes. Over the past two decades, the lake has lost 95% of its volume, lake level has dropped more than 7 m, and lake restoration has gained widespread interest. The government seeks a uniform ecological target lake level of 1274.1 m above sea level to lower salinity below 240 gL-1 and recover brine shrimp (Artemia spp.) and flamingos (Phoenicopterus roseus). We have synthesized over 40 years of available data, defined 8 ecosystem services for human health, water quality, ecology, recreation, and economy (Box 1), and related each service to lake levels with uncertainties (Box 2)

Managing Lake Urmia, Iran for Diverse Restoration Objectives: Moving Beyond a Uniform Target Lake Level

There is widespread interest in restoring drying saline lakes. At Iran’s hypersaline Lake Urmia, managers have sought a uniform target lake level of 1274.1 m above sea level to lower salinity below 263 g L−1 and recover Artemia to sufficient densities to support flamingos. We suggest that addressing a broader range of objectives will allow more flexibility for managing the lake. We define eight restoration objectives to lower salinity, sustain Artemia and flamingo populations, separate islands from each other and the mainland, reduce lakebed dust, maintain commercially valuable ions, and improve recreational access from resort beaches. We use 40 years of experimental, field, satellite, and model data to relate each objective to lake level. We describe variations through time and associated uncertainties for meeting each objective

Effectiveness of Text Messaging and Face to Face Training on Improving Knowledge and Quality of Life of Patients undergoing Hemodialysis: a Randomized Clinical Trial

Background: The quality of life of patients undergoing hemodialysis is lower; to improve their living conditions, patients need further training. This study conducted to compare the effectiveness of two methods of text messaging and face to face education on knowledge and quality of life of patients under hemodialysis. Methods: In a semi-experimental study, 60 patients undergoing hemodialysis in Sina-teaching hospital of Tabriz, Iran were selected by convenience sampling and randomly allocated into three groups: two intervention groups: text massaging (p=20), face to face group (n=20) and one control group (n=20). Their knowledge and quality of life were assessed and compared by Chronic Hemodialysis Knowledge Survey (CHeKS) and Kidney Disease Quality of Life-short form (KDQOL-SF) questionnaires. Data were analyzed by SPSS version 13. Results: After intervention, the knowledge of text messaging and face to face groups was significantly more than the control group (p<0.001), but the quality of life scores after intervention had not any significant difference among the three groups (p=0.762). Intra-group comparisons showed that quality of life in face to face group have been significantly increased (p=0.015). Conclusion: Text messaging and face to face was effective on improving knowledge of patients undergoing hemodialysis. However, the effectiveness of these methods on quality of life needs further evaluations in different setting for longer times in hemodialysis patients

Fecal carriage of Escherichia coli and Klebsiella spp. as major reservoirs of clinically important resistance markers

Intestinal normal flora can become reservoirs of antibiotic resistance genes present among the strains responsible for nosocomial infections. It is suggested that gram negative intestinal bacterial flora have increased capacities to obtain antibiotic resistance genes and therefore can act as main reservoirs for transfer of resistance genes to other pathogenic bacteria. This study aimed to compare fecal carriage of clinically important resistance markers for more frequent members of enterobacteriacae between nondiarrheal and community associated diarrheal patients (control group) versus their counterparts from the patients with nosocomial infections (case group). 261 stool and 190 clinical samples were collected from outpatient and hospitalized patients from 6 hospitals in Tehran, Iran. The samples were cultured on MacConkey agar plates and colonies were identified by standard biochemical methods. Antibiotic sensitivity testing of the isolates against 13 antibiotics was performed according to the CLSI guideline using the disk diffusion method.   Among stool and clinical samples, more frequent identified enterobacteriaceae bacteria were included E. coli (58.99/ 3.15%), Klebsiella spp. (22.61/7.36%), and other members of enterobacteriaceae (8.86/1.06%), respectively. Overall, resistance against four of the main antibiotics (3th and 4th generation cephalosporins, gentamicin, imipenem, and ciprofloxacin) was significantly higher among the case group (50-75% versus 10-14%). Analysis of these results showed similar dissemination of resistance phenotypes among the isolates from the control group in ranges of 1.5-7.6% and 4.4% for E. coli and Klebsiella spp., respectively. Our results suggested that the fecal carriage of resistant phenotypes related to the β-lactam antibiotics in E. coli and Klebsiella spp. in compare to the clinical isolates is rapidly increasing. This may be caused by dissemination of β-lactamase producing E. coli in the community from the hospitals. There were no significant correlations between the two groups of the samples, as the clinical samples had shown 3 to 7 folds excess resistance phenotypes. Surveillance studies of the resistance patterns among the samples from different regions will provide awareness about dissemination of these bacteria within the community as reservoirs of main resistance markers

40-Years of Lake Urmia Restoration Research: Synthesis and Next Steps

Lake Urmia’s desiccation and recent nascent recovery have garnered international and Iranian attention. Lake restoration at this scale requires integration across many sciences, technology, engineering, management, and governance topics. Here, we synthesized 544 peer-reviewed articles on Lake Urmia indexed in the Scopus database, answered nine restoration questions of scientific and popular interest, and recommended next steps for consequential lake restoration. We find: (1) research on diverse topics is fragmented and needs more integration. (2) Ecological and limnological studies have mostly focused on salinity, Artemia, and Flamingos. (3) Dust from the dry lakebed and nearby regions has negatively impacted human health. (4) Most research seeks to restore the lake to a single, uniform level of 1274.1 m thought to recover Artemia. (5) The lake’s north and south arms have different chemical and physical properties but researchers disagree on how newly breaching the causeway that separates the arms will impact salinities, evaporation, and ecosystems. (6) Expanding irrigated agriculture, dam construction, and mismanagement had a larger impact on lake decline than temperature increases and precipitation decreases. (7) The Iranian government’s 5-year recovery effort helped raise lake level about 1 m and immobilize lakebed dust. (8) Only one study publicly shared data, and only three studies described engagement with stakeholders or managers. (9) Numerous suggestions to improve economic conditions, work with farmers, or change farmer-government processes require varying effort and most still require implementation. We see next steps for lake recovery to monitor ungauged or poorly characterized water flows throughout the basin; develop alternative livelihoods beyond agriculture; describe the entire food web that supports migratory birds; manage for diverse ecosystem objectives and their associated lake levels; adapt basin water management to available water and lake evaporation; build capacity to share data, models, and code; train researchers in data-sharing tools and best practices; and better connect research topics, researchers, stakeholders, and managers. All of our findings and next steps encourage Lake Urmia managers to extend restoration efforts beyond five years and cultivate more public support

How Can Researchers and Managers Better Collaborate on Lake Urmia Restoration?

The large decline in Lake Urmia\u27s level since 1995 has prompted a correspondingly large increase in research to help inform lake restoration. Here we synthesize results from 451 English-language articles (Figure 1) to answer four lake restoration questions of interest to the public and lake managers. We ask: 1) What lake restoration levels were considered besides the ecological level of 1274.1 m? 2) How has the causeway affected lake conditions? 3) Do we know enough about lake limnology and ecology to facilitate recovery? And 4) what to learn from Great Salt Lake management? We seek to share these findings with Lake Urmia managers, solicit feedback, and identify next steps for restoration and collaborative work

Remdesivir associated sinus bradycardia in patients with COVID-19: A prospective longitudinal study

Background: Remdesivir is effective against SARS-Cov-2 with little evidence of its adverse effect on the cardiac system. The aim of the present study is investigating the incidence of bradycardia in COVID-19 patients treated with Remdesivir.Methods: This prospective longitudinal study was conducted in a tertiary center on COVID-19 patients for Remdesivir therapy. The objectives were to investigate the incidence of sinus bradycardia, and also the association between their demographics, underlying diseases, and the disease severity with developing bradycardia in COVID-19 patients treated with Remdesivir.Results: Of 177 patients, 44% were male. The mean (±standard deviation) age of patients was 49.79 ± 15.16 years old. Also, 33% were hospitalized due to more severe symptoms. Oxygen support was required for all hospitalized subjects. A total of 40% of the patients had comorbidities, with the most common comorbidity being hypertension. The overall incidence of bradycardia (heart rate&lt;60 bpm) in patients receiving Remdesivir was 27%, of whom 70% had extreme bradycardia (heart rate &lt;50 bpm). There was also a statistically significant reduction in heart rate after five doses of Remdesivir compared to the baseline heart rates. In the multivariable model, none of the covariates including age above 60 years, female sex, CRP&gt;50 mg/L, O2 saturation&lt;90%, underlying cardiovascular disease, hypertension and diabetes mellitus, and beta-blockers were associated with Remdesivir-induced bradycardia. No association was found between the COVID-19 severity indicators and bradycardia.Conclusion: As sinus bradycardia is a prevalent adverse cardiac effect of Remdesivir, it is recommended that all COVID-19 patients receiving Remdesivir, be evaluated for heart rate based on examination; and in the case of bradyarrhythmia, cardiac monitoring should be performed during administration to prevent adverse drug reactions

Concern with COVID-19 pandemic threat and attitudes towards immigrants: The mediating effect of the desire for tightness

Tightening social norms is thought to be adaptive for dealing with collective threat yet it may have negative consequences for increasing prejudice. The present research investigated the role of desire for cultural tightness, triggered by the COVID-19 pandemic, in increasing negative attitudes towards immigrants. We used participant-level data from 41 countries (N = 55,015) collected as part of the PsyCorona project, a crossnational longitudinal study on responses to COVID-19. Our predictions were tested through multilevel and SEM models, treating participants as nested within countries. Results showed that people’s concern with COVID19 threat was related to greater desire for tightness which, in turn, was linked to more negative attitudes towards immigrants. These findings were followed up with a longitudinal model (N = 2,349) which also showed that people’s heightened concern with COVID-19 in an earlier stage of the pandemic was associated with an increase in their desire for tightness and negative attitudes towards immigrants later in time. Our findings offer insight into the trade-offs that tightening social norms under collective threat has for human groups

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries