Exploring methods for predicting multiple pressures on ecosystem recovery: A case study on marine eutrophication and fisheries

AbstractEfforts to attain good environmental status in the marine realm require decisions which cannot be done without knowledge of effects of different management measures. Given the wide diversity of marine ecosystems, multitude of pressures affecting it and the still poor understanding on linkages between those, there are likely no models available to give all the required answers. Hence, several separate approaches can be used in parallel to give support for management measures. We tested three completely different methods – a spatial impact index, a food web model and a Bayesian expert method. We found that a large uncertainty existed regarding the ecosystem response to the management scenarios, and that the three different modelling approaches complemented each other. The models indicated that in order to reach an improved overall state of the ecosystem nutrient reductions are the more effective of the two management variables explored, and that cumulative effects of the management of nutrient inputs and fishing mortality are likely to exist

Personalized text message and checklist support for initiation of antihypertensive medication: the cluster randomized, controlled check and support trial

Objective: To assess whether the use of a checklist combined with text message support improves systolic blood pressure (SBP) control. Design and setting: A cluster randomized controlled trial in Finnish primary care. Interventions: Personalized text message support and a checklist for initiation of antihypertensive medication. Patients: 111 newly diagnosed hypertensive patients aged 30-75 years. Main outcome measures: The proportion of patients achieving 1) the office SBP target Results: 28% (n = 16) and 31% (n = 17) of patients in the intervention and control groups met the office SBP target, respectively (p = 0.51). The corresponding proportions were 36% (n = 18) and 42% (n = 21) for the home SBP target (p = 0.21). Office SBP decreased 23 mmHg (95% CI: 29-17) in the intervention group and 21 mmHg (95% CI: 27-15) in the control group (p = 0.61). Medication changes, number of antihypertensives at 12 months and health care utilization were similar in both study groups. Patients considered checklist and text message support useful and important. Conclusion: Only a small proportion of patients in the intervention and control groups reached their treatment target despite multiple health care contacts and medication changes. The study interventions did not improve SBP control. However, this study demonstrates new information about hypertension control, antihypertensive medication and health service utilization during the first treatment year.</div

Effect of Inhaled Xenon on Cerebral White Matter Damage in Comatose Survivors of Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial

IMPORTANCE: Evidence from preclinical models indicates that xenon gas can prevent the development of cerebral damage after acute global hypoxic-ischemic brain injury but, thus far, these putative neuroprotective properties have not been reported in human studies. OBJECTIVE: To determine the effect of inhaled xenon on ischemic white matter damage assessed with magnetic resonance imaging (MRI). DESIGN, SETTING, AND PARTICIPANTS: A randomized single-blind phase 2 clinical drug trial conducted between August 2009 and March 2015 at 2 multipurpose intensive care units in Finland. One hundred ten comatose patients (aged 24-76 years) who had experienced out-of-hospital cardiac arrest were randomized. INTERVENTIONS: Patients were randomly assigned to receive either inhaled xenon combined with hypothermia (33°C) for 24 hours (n = 55 in the xenon group) or hypothermia treatment alone (n = 55 in the control group). MAIN OUTCOMES AND MEASURES: The primary end point was cerebral white matter damage as evaluated by fractional anisotropy from diffusion tensor MRI scheduled to be performed between 36 and 52 hours after cardiac arrest. Secondary end points included neurological outcome assessed using the modified Rankin Scale (score 0 [no symptoms] through 6 [death]) and mortality at 6 months. RESULTS: Among the 110 randomized patients (mean age, 61.5 years; 80 men [72.7%]), all completed the study. There were MRI data from 97 patients (88.2%) a median of 53 hours (interquartile range [IQR], 47-64 hours) after cardiac arrest. The mean global fractional anisotropy values were 0.433 (SD, 0.028) in the xenon group and 0.419 (SD, 0.033) in the control group. The age-, sex-, and site-adjusted mean global fractional anisotropy value was 3.8% higher (95% CI, 1.1%-6.4%) in the xenon group (adjusted mean difference, 0.016 [95% CI, 0.005-0.027], P = .006). At 6 months, 75 patients (68.2%) were alive. Secondary end points at 6 months did not reveal statistically significant differences between the groups. In ordinal analysis of the modified Rankin Scale, the median (IQR) value was 1 (1-6) in the xenon group and 1 (0-6) in the control group (median difference, 0 [95% CI, 0-0]; P = .68). The 6-month mortality rate was 27.3% (15/55) in the xenon group and 34.5% (19/55) in the control group (adjusted hazard ratio, 0.49 [95% CI, 0.23-1.01]; P = .053). CONCLUSIONS AND RELEVANCE: Among comatose survivors of out-of-hospital cardiac arrest, inhaled xenon combined with hypothermia compared with hypothermia alone resulted in less white matter damage as measured by fractional anisotropy of diffusion tensor MRI. However, there was no statistically significant difference in neurological outcomes or mortality at 6 months. These preliminary findings require further evaluation in an adequately powered clinical trial designed to assess clinical outcomes associated with inhaled xenon among survivors of out-of-hospital cardiac arrest. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00879892

Review of the research knowledge and gaps on fish populations, fisheries and linked ecosystems in the Central Arctic Ocean (CAO)

This report presents a review of the research knowledge and gaps on fish populations, fisheries and linked ecosystems in the Central Arctic Ocean (CAO). The CAO comprises the deep basins of the Arctic Ocean beyond the shelf break, which largely overlap with the High Seas of the Arctic Ocean, i.e. the marine areas outside the Exclusive Economic Zones (EEZs) of the Arctic coastal nations. The authors of the report are members of the European Fisheries Inventory in the Central Arctic Ocean (EFICA) Consortium. This study was funded by the European Commission as an EU contribution to the international cooperation within the Agreement to Prevent Unregulated High Seas Fisheries in the Central Arctic Ocean. The report contains desk-based research, using scientific research data bases as well as any available research performed by the EFICA Consortium partners and EU institutions or others. In Chapters 2-8 the authors review the literature and identify specific knowledge gaps. The gap analyses involve comparisons of actual knowledge with desired knowledge on the fish stocks of the CAO to be able to evaluate possibilities for future sustainable fisheries in the area. Chapter 1 is an introductory chapter, and Chapter 9 presents a holistic gap analysis based on Chapters 2-8 and recommendations for research priorities and the next steps. The critical gap analysis highlights that the knowledge gaps for the CAO are enormous and obstruct any quantitative analyses of its fish stocks. This agrees with the conclusions from the Fifth FiSCAO Report (FiSCAO 2018). While data for the physical environment in the CAO (oceanography, bottom topography and ice-cover dynamics) would be sufficient for fish stock modelling and assessment, there is a massive lack of biological and ecological data. The CAO is not a closed system and some aspects of the shelf seas are of high relevance for the CAO, notably connectivity of fish stocks and fish species moving north with climate warming. Scientific research and monitoring programs are established in the shelf seas, and new data are constantly being produced. Fish stock data are available from scientific projects and monitoring programs for some of the shelf seas (Barents Sea, Bering Sea, and to a lesser extent for the Beaufort Sea and the Chukchi Sea). Data exist also for the Russian shelf seas (Kara Sea, Laptev Sea, East Siberian Sea), but these data are not internationally available, while for the areas north of Canada/Greenland data are missing; they do not exist because of the severe ice conditions there. More data from all shelf seas may be hidden in reports that are not publicly accessible. We recommend to make current knowledge generally available by translating key publications and identification of valuable data reports. Research priorities comprise the collection and analysis of primary data in the CAO, and – to a limited extent – from adjacent waters through collaborations with other Signatories of the Agreement (e.g. on population genetics). Further research priorities include an evaluation of ecosystem vulnerability, social-ecological analyses, i.e. recognizing the close and often complex interactions between humans and nature, and recommendations for governance of the CAO. Fulfilling the 14 specific research priorities mentioned in Chapter 9 to “sufficient knowledge available” could enable the potential, future application of an Ecosystem Approach to Management for the CAO

Genome-wide association study of nocturnal blood pressure dipping in hypertensive patients

Abstract Background Reduced nocturnal fall (non-dipping) of blood pressure (BP) is a predictor of cardiovascular target organ damage. No genome-wide association studies (GWAS) on BP dipping have been previously reported. Methods To study genetic variation affecting BP dipping, we conducted a GWAS in Genetics of Drug Responsiveness in Essential Hypertension (GENRES) cohort (n = 204) using the mean night-to-day BP ratio from up to four ambulatory BP recordings conducted on placebo. Associations with P < 1 × 10− 5 were further tested in two independent cohorts: Haemodynamics in Primary and Secondary Hypertension (DYNAMIC) (n = 183) and Dietary, Lifestyle and Genetic determinants of Obesity and Metabolic Syndrome (DILGOM) (n = 180). We also tested the genome-wide significant single nucleotide polymorphism (SNP) for association with left ventricular hypertrophy in GENRES. Results In GENRES GWAS, rs4905794 near BCL11B achieved genome-wide significance (β = − 4.8%, P = 9.6 × 10− 9 for systolic and β = − 4.3%, P = 2.2 × 10− 6 for diastolic night-to-day BP ratio). Seven additional SNPs in five loci had P values < 1 × 10− 5. The association of rs4905794 did not significantly replicate, even though in DYNAMIC the effect was in the same direction (β = − 0.8%, P = 0.4 for systolic and β = − 1.6%, P = 0.13 for diastolic night-to-day BP ratio). In GENRES, the associations remained significant even during administration of four different antihypertensive drugs. In separate analysis in GENRES, rs4905794 was associated with echocardiographic left ventricular mass (β = − 7.6 g/m2, P = 0.02). Conclusions rs4905794 near BCL11B showed evidence for association with nocturnal BP dipping. It also associated with left ventricular mass in GENRES. Combined with earlier data, our results provide support to the idea that BCL11B could play a role in cardiovascular pathophysiology

Diabetes and heart failure associations in women and men: results from the MORGAM consortium

Background: Diabetes and its cardiovascular complications are a growing concern worldwide. Recently, some studies have demonstrated that relative risk of heart failure (HF) is higher in women with type 1 diabetes (T1DM) than in men. This study aims to validate these findings in cohorts representing five countries across Europe. Methods: This study includes 88,559 (51.8% women) participants, 3,281 (46.3% women) of whom had diabetes at baseline. Survival analysis was performed with the outcomes of interest being death and HF with a follow-up time of 12 years. Sub-group analysis according to sex and type of diabetes was also performed for the HF outcome. Results: 6,460 deaths were recorded, of which 567 were amongst those with diabetes. Additionally, HF was diagnosed in 2,772 individuals (446 with diabetes). A multivariable Cox proportional hazard analysis showed that there was an increased risk of death and HF (hazard ratio (HR) of 1.73 [1.58–1.89] and 2.12 [1.91–2.36], respectively) when comparing those with diabetes and those without. The HR for HF was 6.72 [2.75–16.41] for women with T1DM vs. 5.80 [2.72–12.37] for men with T1DM, but the interaction term for sex differences was insignificant (p for interaction 0.45). There was no significant difference in the relative risk of HF between men and women when both types of diabetes were combined (HR 2.22 [1.93–2.54] vs. 1.99 [1.67–2.38] respectively, p for interaction 0.80). Conclusion: Diabetes is associated with increased risks of death and heart failure, and there was no difference in relative risk according to sex

Substantial Fat Loss in Physique Competitors Is Characterized by Increased Levels of Bile Acids, Very-Long Chain Fatty Acids, and Oxylipins

Weight loss and increased physical activity may promote beneficial modulation of the metabolome, but limited evidence exists about how very low-level weight loss affects the metabolome in previously non-obese active individuals. Following a weight loss period (21.1 ± 3.1 weeks) leading to substantial fat mass loss of 52% (−7.9 ± 1.5 kg) and low body fat (12.7 ± 4.1%), the liquid chromatography-mass spectrometry-based metabolic signature of 24 previously young, healthy, and normal weight female physique athletes was investigated. We observed uniform increases (FDR < 0.05) in bile acids, very-long-chain free fatty acids (FFA), and oxylipins, together with reductions in unsaturated FFAs after weight loss. These widespread changes, especially in the bile acid profile, were most strongly explained (FDR < 0.05) by changes in android (visceral) fat mass. The reported changes did not persist, as all of them were reversed after the subsequent voluntary weight regain period (18.4 ± 2.9 weeks) and were unchanged in non-dieting controls (n = 16). Overall, we suggest that the reported changes in FFA, bile acid, and oxylipin profiles reflect metabolic adaptation to very low levels of fat mass after prolonged periods of intense exercise and low-energy availability. However, the effects of the aforementioned metabolome subclass alteration on metabolic homeostasis remain controversial, and more studies are warranted to unravel the complex physiology and potentially associated health implications. In the end, our study reinforced the view that transient weight loss seems to have little to no long-lasting molecular and physiological effects

Substantial Fat Loss in Physique Competitors Is Characterized by Increased Levels of Bile Acids, Very-Long Chain Fatty Acids, and Oxylipins

Weight loss and increased physical activity may promote beneficial modulation of the metabolome, but limited evidence exists about how very low-level weight loss affects the metabolome in previously non-obese active individuals. Following a weight loss period (21.1 ± 3.1 weeks) leading to substantial fat mass loss of 52% (−7.9 ± 1.5 kg) and low body fat (12.7 ± 4.1%), the liquid chromatography-mass spectrometry-based metabolic signature of 24 previously young, healthy, and normal weight female physique athletes was investigated. We observed uniform increases (FDR < 0.05) in bile acids, very-long-chain free fatty acids (FFA), and oxylipins, together with reductions in unsaturated FFAs after weight loss. These widespread changes, especially in the bile acid profile, were most strongly explained (FDR < 0.05) by changes in android (visceral) fat mass. The reported changes did not persist, as all of them were reversed after the subsequent voluntary weight regain period (18.4 ± 2.9 weeks) and were unchanged in non-dieting controls (n = 16). Overall, we suggest that the reported changes in FFA, bile acid, and oxylipin profiles reflect metabolic adaptation to very low levels of fat mass after prolonged periods of intense exercise and low-energy availability. However, the effects of the aforementioned metabolome subclass alteration on metabolic homeostasis remain controversial, and more studies are warranted to unravel the complex physiology and potentially associated health implications. In the end, our study reinforced the view that transient weight loss seems to have little to no long-lasting molecular and physiological effects