A Global Strategy for Ecologically Sustainable Transport and other Linear Infrastructure

The current Global Strategy for Ecologically Sustainable Transport and other Linear Infrastructure primarily sets up the objectives and principles for governments and organizations for mainstreaming biodiversity and ecological connectivity on transport infrastructure development. Additionally, it addresses the overall framework of stakeholders who must be engaged as key players in: • launching proactive policies, • establishing appropriate legal frameworks, • supporting better planning, • promoting multi-sector cooperation, and • encouraging innovative science-based solutions. We consider this as a living document as future versions may integrate additional elements with regards to governance, policy, and financing, in the attempt to develop a common comprehensive language and grounds for cooperation. This “Global Strategy” has been developed by an international working group coordinated by IENE and supported by an international coalition formed from the international conferences on transport and ecology and conservation organisations as IENE, ICOET, ANET, ACLIE, WWF and IUCN. The working group is drawn from global experts in transport and ecology and aims to work towards finding a ‘win-win’ solution for securing mainstreaming biodiversity and ecological connectivity and avoiding, mitigating, or compensating ecosystems’ fragmentation during transport infrastructure development or adaptation. This Strategy builds upon five years of development of the guidelines “International Guidance for Ecologically - Friendly Linear Infrastructure (IGELI)” initiated at the ICOET 2015 conference in North Carolina, USA. IGELI was an international debate with experts from all over the world continued during workshops held at the international conferences of IENE (Lyon, France, 2016 and Eindhoven, Holland, 2018), ICOET (Salt Lake City, USA, 2017 and Sacramento, USA, 2019), IUCN (Hawaii, USA, 2016) and ACLIE (Kruger National Park, South Africa, 2019). Summarising the Decision 14/3 on mainstreaming of biodiversity in the energy and mining, infrastructure, manufacturing, and processing sectors (CBD/ COP/DEC/14/3/30 November 2018) of 14th COP CBD (Sharm El Sheikh, Egypt, Nov 2018) (Convention on Biological Diversity 2018), the international coalition of the working group, initiated to promote the Strategy at the CBD COP 15 in China. We hope, this Strategy provides a useful tool and roadmap for promoting the urgent need of supporting biodiversity conservation and securing ecological connectivity at all scales of governance, policies, planning and implementation of transport projects internationally. The creation of an International Observatory for monitoring the fragmentation status globally as an important threat for biodiversity loss is proposed as a common ambition of the working group members and their organizations.IENE, ICOET, ANET, ACLIE, WWF, IUCN, WWF, WCPA, Connectivity Conservation Specialist Grou

3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial

Background: Liraglutide 3·0 mg was shown to reduce bodyweight and improve glucose metabolism after the 56-week period of this trial, one of four trials in the SCALE programme. In the 3-year assessment of the SCALE Obesity and Prediabetes trial we aimed to evaluate the proportion of individuals with prediabetes who were diagnosed with type 2 diabetes. Methods: In this randomised, double-blind, placebo-controlled trial, adults with prediabetes and a body-mass index of at least 30 kg/m2, or at least 27 kg/m2 with comorbidities, were randomised 2:1, using a telephone or web-based system, to once-daily subcutaneous liraglutide 3·0 mg or matched placebo, as an adjunct to a reduced-calorie diet and increased physical activity. Time to diabetes onset by 160 weeks was the primary outcome, evaluated in all randomised treated individuals with at least one post-baseline assessment. The trial was conducted at 191 clinical research sites in 27 countries and is registered with ClinicalTrials.gov, number NCT01272219. Findings: The study ran between June 1, 2011, and March 2, 2015. We randomly assigned 2254 patients to receive liraglutide (n=1505) or placebo (n=749). 1128 (50%) participants completed the study up to week 160, after withdrawal of 714 (47%) participants in the liraglutide group and 412 (55%) participants in the placebo group. By week 160, 26 (2%) of 1472 individuals in the liraglutide group versus 46 (6%) of 738 in the placebo group were diagnosed with diabetes while on treatment. The mean time from randomisation to diagnosis was 99 (SD 47) weeks for the 26 individuals in the liraglutide group versus 87 (47) weeks for the 46 individuals in the placebo group. Taking the different diagnosis frequencies between the treatment groups into account, the time to onset of diabetes over 160 weeks among all randomised individuals was 2·7 times longer with liraglutide than with placebo (95% CI 1·9 to 3·9, p<0·0001), corresponding with a hazard ratio of 0·21 (95% CI 0·13–0·34). Liraglutide induced greater weight loss than placebo at week 160 (–6·1 [SD 7·3] vs −1·9% [6·3]; estimated treatment difference −4·3%, 95% CI −4·9 to −3·7, p<0·0001). Serious adverse events were reported by 227 (15%) of 1501 randomised treated individuals in the liraglutide group versus 96 (13%) of 747 individuals in the placebo group. Interpretation: In this trial, we provide results for 3 years of treatment, with the limitation that withdrawn individuals were not followed up after discontinuation. Liraglutide 3·0 mg might provide health benefits in terms of reduced risk of diabetes in individuals with obesity and prediabetes. Funding: Novo Nordisk, Denmark

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Millennials and generation Z employees’ financial knowledge and behaviour nexus perspective for public entities within eThekwini Municipality, South Africa

Financial knowledge and behaviour in millennials and Gen Z's turbulent and volatile environment are fundamental behavioural traits for a desirable work-life balance. They could contribute to work motivation and a comfortable social life. However, the financial knowledge, financial literacy and financial behaviour viewed from an organizational context are still far from homogeneity and linearity as Gen Y and Z have to navigate through challenging settings while thriving to enjoy financial and investment-balanced decision-making and problem-solving albeit limited disposable income against a plethora of spending pressures. This study explores the synergy between financial knowledge contribution and financial behaviour that culminates in sound investment prioritisation amongst Gen Y and Z professionals in the employment of public entities. The study used the qualitative research approach to unpack the challenges facing Gen Y and Z from fifteen professionals in navigating a prosperous financial future. The findings revealed that the existential restrictive nature of the economic climate and the sluggish economic growth, characterised by the heightened cost of living and inflationary pressure, have not exempted Gen Y and Z, while the broader society is experiencing the worst unemployment. The findings also revealed that even though the participants are in relatively well-remunerating positions from their respective positions, their financial knowledge and commensurate financial literacy could be superseded by actual financial behaviour, which is symptomatic with the current era of rampant price increases on almost every product, assets and purchases which are meant to improve their standard of living and stable quality of life. &nbsp

Acute Phase Response and Non-Reproducible Elevated Concentrations with a High-Sensitivity Cardiac Troponin I Assay

High-sensitivity cardiac troponin (hs-cTn) testing has enabled physicians to make earlier diagnostic and prognostic decisions in the hospital setting than previous cardiac troponin assays. Analytical improvements have permitted one to measure cardiac troponin precisely in the nanogram per litre (ng/L) range with hs-cTn assays which has resulted in fast 0/1-h and 0/2-h algorithms for ruling-in and ruling-out myocardial infarction. Although analytical interferences that affect the reporting of hs-cTn are uncommon, not all hs-cTn assays are designed the same nor have undergone the same clinical and analytical validations. Here, after investigating an initial case of discrepant hs-cTnI results, we report that patients with an acute phase response (e.g., patients with inflammatory or infectious illnesses) can yield high and non-reproducible results with the Ortho Clinical Diagnostics hs-cTnI assay. Compared to Abbott Diagnostics hs-cTnI, Ortho Clinical Diagnostics hs-cTnI assay misclassifies biochemical injury in approximately 10% of the population being assessed for myocardial injury with imprecise results in approximately half of this population (i.e., 5%). In conclusion, caution is warranted in interpreting Ortho Clinical Diagnostics hs-cTnI alone in patients being evaluated for myocardial injury, especially in patients whose primary presentation is related to an acute phase response and not an acute coronary syndrome symptom.</jats:p