No Water, No Energy. No Energy, No Water.

Deloitte Center for Energy Solutions urges businesses to consider the consequences of upward trends in water and energy demand and be prepared with strategies for water stewardship. The report points out that in addition to risk management being a motivator, improved supply chain efficiencies, consumer perceptions, and profitability can result from comprehensive water strategies. Understanding that water is not a free good and considering the interdependence between various stakeholders are key to grasping the consequences of the water energy nexus and acting appropriately

Labour market segmentation in the New England region

The purpose in this thesis is to discuss the framework of labour market segmentation and provide a thorough and detailed description of the groups that are distinguished by labour market segmentation. As described by M.J. Piore, the concept of labour market segmentation depicts a labour market that is comprised of a set of three sub -markets or segments distinguished by different labour market characteristics and rules. A conspectus of the literature on the distribution of personal income and the labour market is given to outline the nature and direction of academic economic analysis that led to the development of this concept of labour market segmentation. Before an analysis of the labour market segments is conducted, it is necessary to have data that accommodate such an analysis. To this end, we transformed the 1970 New England Region Public Use Sample Data into a form suitable for our analysis. The data is used in a classification analysis of labour market segmentation. A statistical and illustrative presentation of the techniques of hierarchical classification and discriminant analysis is given. These are the techniques used in the empirical work for developing and analysing the labour market segments in terms of sixty socio- economic factors. The analysis serves to identify the socio- economic factors that distinguish the similarities and differences between the characteristics of the segments in the labour market

Thermal Environment and Microhabitat of Ornate Box Turtle Hibernacula

Box turtle populations are under significant threat from historic and current alterations of land-use where remaining populations often occur in remnant patches of suitable habitat surrounded by a heterogeneous mixture of anthropogenically altered, unsuitable habitat. Ornate box turtles Terrapene ornata are a prairie-dependent species, are considered Near Threatened by the International Union for Conservation of Nature (IUCN), and are Endangered or Threatened within many US states. Since their range exists largely in northern latitudes, aspects of hibernacula are particularly important for winter survival. How box turtles select hibernacula within prairies is likely of great importance to better understand which microhabitats are selected for and to identify areas of suitable habitat for management purposes. Using radio telemetry in conjunction with temperature dataloggers (iButtons), we examined the phenology and thermal characteristics of box turtle hibernation, and quantified microhabitat selection of their hibernacula in remnant prairie patches. We monitored hibernation initiation/termination phenology and turtle carapace temperatures, and quantified vegetative and soil microhabitat variables of hibernacula for seven turtles in 2014/2015 and 18 turtles in 2015/2016. Box turtles initiated (descended into hibernacula) and terminated (ascended out of hibernacula) at similar time periods across two years. Although the ambient thermal environment consistently experienced temperatures below freezing, turtle hibernacula offered a buffer against those temperatures and thus the temperature of turtle carapaces never fell below freezing. Turtles selected microhabitat hibernacula with higher percentages of sand, leaf litter and bare ground, and lower percentages of clay, silt, shrubs and herbaceous ground cover. Our study suggests the phenology of box turtle hibernation may be similar across years and that hibernacula selection is driven by above- and belowground characteristics that ultimately lead to a more stable and warmer thermal environment

Home ranges of Ornate Box Turtles in remnant prairies in north-central Illinois

Habitat loss has been a primary driver of biodiversity declines throughout the United States. Native prairie ecosystems represent some of the most significant losses in land cover, and subsequently, prairie-dependent species are some of the most imperiled. Therefore, understanding the ecology of species remaining in remnant portions of these ecosystems is important to help manage their populations. Using radio-telemetry, we examined minimum convex polygon (MCP) and 95% kernel density (KD) home ranges of 20 (5 females, 15 males) Ornate Box Turtles (Terrapene ornata) inhabiting two remnant prairies in north-central Illinois across two years and six seasons. Results showed that MCP and 95% KD home range estimates were comparable but smaller than other published studies, differed between years, across seasons, and among individual turtles within sites. These results provide valuable data to quantify the ecology of this threatened species in a remnant prairie habitat

Mechanism of opiate mediated systemic and coronary vasoconstriction

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24142/1/0000399.pd

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049