The significance of planning and management of the subsurface to achieve sustainable cities

Introduction: The subsurface is the foundation upon which all cities rest. But the subsurface is not only a construction basis which provide physical space for infrastructure and the possibility to create a better surface living environment: the subsurface is a multifunctional natural resource. Apart from physical space, it provides water, energy, materials, habitats for ecosystems, support for surface life, and a repository for cultural heritage and geological archives. Currently, the subsurface is often utilised according to the “first-come-first-served” principle, which hinders possibilities to take strategic decisions on prioritisation and optimisation of competing subsurface uses, as well as fair inter- and intragenerational distribution of limited natural resources. A great disadvantage is the invisibility of the subsurface and consequently a lack of understanding of it as a multifunctional resource: the recently launched concept of geosystem services could help mitigate its underrating. Methods: In order to better acknowledge and lift forward the significance of the subsurface in achieving a sustainable future, the 17 SDGs are scrutinized in relation to the resources of subsurface, and specifically how better planning and management of the subsurface can contribute in achieving the goals. Results: Subsurface planning and management is relevant to at least seven (3, 6, 7, 9, 11, 12, 13) out of seventeen SDGs. Although the subsurface is not explicitly mentioned in the SDGs (except for aquifers), the subsurface can significantly contribute in achieving several of these goals. Conclusions: Sound planning and management of the subsurface can support the achievement of the mapped SDGs in various ways. The subsurface must be recognised as a precious and multifunctional resource which require careful planning and sensitive management in accordance with its potential and its value to society.Grant support: Swedish Research Council Formas (942-2016-50), Swedish Rock Engineering Research Foundation (BeFo 385), Swedish Institute Visby Programme (23887/2017)

Subsurface planning: Towards a common understanding of the subsurface as a multifunctional resource

In response to powerful trends in technology, resource and land supply and demand, socioeconomics and geopolitics, cities are likely to increase use of the subsurface in the near future. Indeed, the subsurface and its appropriate use have been put forward as being of crucial importance if we are to achieve resilient and sustainable cities. In recent years, quite apart from being seen primarily as a construction basis to provide physical space for infrastructure and to create a better surface living environment, the subsurface has been recognised as a multifunctional natural resource, one which provides physical space, water, energy, materials, habitats for ecosystems, support for surface life, and a repository for cultural heritage and geological archives. Currently, the subsurface is often utilised according to the “first-come-first-served” principle, which hinders possibilities to take strategic decisions on prioritisation and optimisation of competing subsurface uses, as well as fair inter- and intragenerational distribution of limited natural resources. Taking a broad international perspective, this paper investigates the subsurface as a multifunctional resource from five focal points: (1) what professionals with different backgrounds mean when using different terms related to the subsurface; (2) how professionals describe the subsurface and its multiple resources, functions and services; (3) how planning of subsurface use is supported in policy and regulations; (4) how the subsurface is included in the planning process; and (5) frameworks that can support decision-making on responsible use of the subsurface. The study reveals that the subsurface must be recognised (not only by scientists but also by decision- and policy-makers and other stakeholders) as a precious and multifunctional resource requiring careful planning and sensitive management in accordance with its potential and its value to society. Utilisation of the different subsurface functions to yield services requires careful planning and a framework to support decision-makers in achieving a balance between utilisation and preservation, and between the subsurface functions themselves in the case of outright utilisation. Further, to facilitate the necessary change towards transdisciplinary work settings in the planning process and form a platform for knowledge exchange and capacity building, there is an urgent need for a common language, i.e. mutually understandable terminology, and a common understanding, i.e. an all-inclusive view on the subsurface as a complex multifunctional resource

The geosystem services concept – What is it and can it support subsurface planning?

The subsurface is a multifunctional natural resource. However, a mindset of “out of sight, out of mind” and a first-come-first-served principle are prevalent when accessing these resources, compromising fair intergenerational and intragenerational distribution and sustainable development. As with the ecosystem services (ES) concept, which acknowledges the contribution of the living part of nature to human well-being, the concept of geosystem services (GS) has been suggested as a way to highlight abiotic services and services provided by the subsurface. The overall aim of this study was to review current definitions of GS and their categorisation, and to suggest how the concept of GS can support subsurface planning. A systematic literature review on GS was carried out following the PRISMA protocol drawing from the Scopus database. The emerging picture from the reviewed articles is that the GS concept is both one of novelty and one currently showing inconsistency, with two prominent definitions: A) GS are abiotic services that are the direct result of the planet\u27s geodiversity, independent of the interactions with biotic nature – there is no differentiation between suprasurface and subsurface features, and B) GS provide benefits specifically resulting from the subsurface. Thirty-one out of thirty-nine GS listed in the reviewed literature are included in the abiotic extension of the common ES framework CICES v5.1, but some essential services are omitted. A unified definition of GS is desirable to build a common framework for classifying and describing GS, potentially following the CICES structure for ES. Such a framework can support systematic inclusion of GS in planning processes and contribute to improved subsurface planning. In planning practice, there are examples of important GS that are already included under the ES umbrella because planners are aware of their importance but a comprehensive framework to handle these services is lacking

General practitioners' reasoning when considering the diagnosis heart failure: a think-aloud study

BACKGROUND: Diagnosing chronic heart failure is difficult, especially in mild cases or early in the course of the disease, and guidelines are not easily implemented in everyday practice. The aim of this study was to investigate general practitioners' diagnostic reasoning about patients with suspected chronic heart failure in comparison with recommendations in European guidelines. METHODS: Think-aloud technique was used. Fifteen general practitioners reasoned about six case vignettes, representing authentic patients with suspected chronic heart failure. Information about each case was added successively in five steps. The general practitioners said their thoughts aloud while reasoning about the probability of the patient having chronic heart failure, and tried to decide about the diagnosis. Arguments for and against chronic heart failure were analysed and compared to recommendations in guidelines. RESULTS: Information about ejection fraction was the most frequent diagnostic argument, followed by information about cardiac enlargement or pulmonary congestion on chest X-ray. However, in a third of the judgement situations, no information about echocardiography was utilized in the general practitioners' diagnostic reasoning. Only three of the 15 doctors used information about a normal electrocardiography as an argument against chronic heart failure. Information about other cardio-vascular diseases was frequently used as a diagnostic argument. CONCLUSIONS: The clinical information was not utilized to the extent recommended in guidelines. Some implications of our study are that 1) general practitioners need more information about how to utilize echocardiography when diagnosing chronic heart failure, 2) guidelines ought to give more importance to information about other cardio-vascular diseases in the diagnostic reasoning, and 3) guidelines ought to treat the topic of diastolic heart failure in a clearer way

ProteinSeq: High-Performance Proteomic Analyses by Proximity Ligation and Next Generation Sequencing

Despite intense interest, methods that provide enhanced sensitivity and specificity in parallel measurements of candidate protein biomarkers in numerous samples have been lacking. We present herein a multiplex proximity ligation assay with readout via realtime PCR or DNA sequencing (ProteinSeq). We demonstrate improved sensitivity over conventional sandwich assays for simultaneous analysis of sets of 35 proteins in 5 µl of blood plasma. Importantly, we observe a minimal tendency to increased background with multiplexing, compared to a sandwich assay, suggesting that higher levels of multiplexing are possible. We used ProteinSeq to analyze proteins in plasma samples from cardiovascular disease (CVD) patient cohorts and matched controls. Three proteins, namely P-selectin, Cystatin-B and Kallikrein-6, were identified as putative diagnostic biomarkers for CVD. The latter two have not been previously reported in the literature and their potential roles must be validated in larger patient cohorts. We conclude that ProteinSeq is promising for screening large numbers of proteins and samples while the technology can provide a much-needed platform for validation of diagnostic markers in biobank samples and in clinical use

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362