Mean Annual Reduction Research Articles

Brief admission by self-referral as an add-on to usual care for individuals with self-harm at risk of suicide: cost-effectiveness and 4-year health-economic consequences after a Swedish randomized controlled trial

Background Brief Admission by self-referral (BA) is a crisis-management intervention standardized for individuals with self-harm at risk of suicide. We analyzed its health-economic consequences. Materials and methods BA plus treatment as usual (TAU) was compared with TAU alone in a 12-month randomized controlled trial with 117 participants regarding costs for hospital admissions, coercive measures, emergency care and health outcomes (quality-adjusted life years; QALYs). Participants were followed from 12 months before baseline to up to five years after. Results Over one year BA was associated with a mean annual cost reduction of 4800 or incremental cost of 4600 euros, depending on bed occupancy assumption. Cost-savings were greatest for individuals with >180 admission days in the year before baseline. In terms of health outcomes BA was associated with a QALY gain of 0.078. Uncertainty analyses indicated a significant QALY gain and ambiguity in costs, resulting in BA either dominating TAU or costing 59 000 euros per gained QALY. Conclusion BA is likely to produce QALY gains for individuals living with self-harm and suicidality. Cost-effectiveness depends on targeting high-need individuals and comparable bed utilization between BA and other psychiatric admissions. Future research should elaborate the explanatory factors for individual variations in the usage and benefit of BA.

Amazon savannization and climate change are projected to increase dry season length and temperature extremes over Brazil

Land use change and atmospheric composition, two drivers of climate change, can interact to affect both local and remote climate regimes. Previous works have considered the effects of greenhouse gas buildup in the atmosphere and the effects of Amazon deforestation in atmospheric general circulation models. In this study, we investigate the impacts of the Brazilian Amazon savannization and global warming in a fully coupled ocean-land-sea ice-atmosphere model simulation. We find that both savannization and global warming individually lengthen the dry season and reduce annual rainfall over large tracts of South America. The combined effects of land use change and global warming resulted in a mean annual rainfall reduction of 44% and a dry season length increase of 69%, when averaged over the Amazon basin, relative to the control run. Modulation of inland moisture transport due to savannization shows the largest signal to explain the rainfall reduction and increase in dry season length over the Amazon and Central-West. The combined effects of savannization and global warming resulted in maximum daily temperature anomalies, reaching values of up to 14 °C above the current climatic conditions over the Amazon. Also, as a consequence of both climate drivers, both soil moisture and surface runoff decrease over most of the country, suggesting cascading negative future impacts on both agriculture production and hydroelectricity generation.

Abstract 14276: Using Artificial Intelligence and Natural Language Processing on Electronic Health Records of Heart Failure Patients to Examine the Impact of Estimated Glomerular Filtration Rate Trend on Mortality

Introduction and Hypothesis: Heart failure (HF) often leads to an imbalance between heart and kidney function, with a poor prognosis in HF patients linked to dynamic changes in renal function as well as chronic kidney disease (CKD). This study aimed to determine the incidence of reduced renal function upon HF diagnosis and to explore the potential for dynamic changes in kidney function to predict short- and long-term outcomes in a real-world cohort of HF patients. Methods: Clinical data of patients with a diagnosis of HF (index event) were gathered retrospectively using natural language processing. Patients were classified as having CKD based on their eGFR (<60 mL/min/1.73m2) and a history of CKD and/or dialysis. eGFR trajectories were analyzed using linear mixed effects models. Cox proportional hazard models were used to analyze the relationship between baseline variables and mortality. Joint modeling was employed to assess the relationship between the eGFR trend and mortality. Results: There were 1986 patients in the study population, with a mean (SD) age of 74.8 ± 11.7 years and 58% of males. At the index event, 58% (n = 1156) had CKD, and 17% (n = 339) had HF with preserved ejection fraction (HFpEF). Median follow-up was 3.16 years. After 2 years, 10% (n = 198) of the patients had passed away. The proportion of CKD at index was considerably lower in the 2-year survivors group (55% vs 76%, p < 0.001) in this group. The calculated mean annual eGFR reduction was 4.2 mL/min/1.73m 2 . Age, CVA, diastolic blood pressure, hemoglobin, HDL, potassium, and NT-proBNP levels in blood serum were found to be the primary predictors of mortality in multivariate Cox PH model. Joint modeling revealed that a current eGFR value that was 10 mL/min/1.73m 2 lower between patients corresponded with a higher mortality hazard of 1.22 ± 0.05 (p < 0.001). In addition, a drop in eGFR of 10 mL/min/1.73m 2 over the previous year showed an the elevated mortality hazard of 1.97 ± 0.16 (p < 0.001). Conclusions: We show that the prevalence of CKD is significant in a real-world population of HF patients, and CKD is a standalone predictor of mortality. Current eGFR value and the eGFR slope from the previous year have a potential to be used for individual mortality hazard assessment in the clinical follow-up of HF patients.

MAGLIO study: epideMiological Analysis on invasive meninGococcaL disease in Italy: fOcus on hospitalization from 2015 to 2019.

This study analyzed hospital admissions for invasive meningococcal disease (IMD) in epidemiological and economic terms in Italy from 2015 to 2019. The volume of acute admissions for meningococcal diagnosis was analyzed in the period from 2015 to 2019. IMD admissions were identified by ICD-9-CM diagnoses. Costs were assessed using current DRG tariffs. In 2019, a total of 237 admissions for meningococcal disease were recorded in Italy. The mean age of patients was 36.1years. Lumbar puncture was reported in only 14% of hospital discharge forms. From 2015 to 2019, there was a mean annual reduction of - 1.2% nationally for IMD hospitalizations. For 2019, the total costs for acute inpatient admissions were €2,001,093. Considering annual incidence due to IMD, a significant decrease was noted in the age group from 0 to 1year (p = 0.010) during 2015-2019. For all years, mortality associated with meningeal syndrome was lower compared to septic shock with or without meningitis. From 2015 to 2019, hospitalizations for IMD appear to be decreasing slightly in Italy, even if mortality remains high. Favorable trends in hospitalizations for IMD were seen in the 0-1-year age group, which may be attributable to increased vaccination. Costs of hospitalizations for IMD remain high.

Natural revegetation has dominated annual runoff reduction since the Grain for Green Program began in the Jing River Basin, Northwest China

The Grain for Green Program (GFGP) has successfully increased the vegetation cover in northern China over the last two decades through large-scale natural and artificial revegetation approaches. Unfortunately, an obvious runoff reduction has been observed in many basins, especially on the semiarid Loess Plateau. Past studies generally attributed this runoff reduction to the artificial revegetation of the GFGP, i.e., the land cover type change from cropland to forest, since there was no significant annual precipitation decrease. Such cognition has led to widespread concern about the hydrological effects of the GFGP. In fact, in addition to artificial revegetation, natural revegetation relies on natural processes of vegetation succession without land cover type changes directed by humans. Therefore, it is necessary to separate and quantify the contributions of natural and artificial revegetation to runoff reduction to assess the GFGP and optimize revegetation in the future. In this study, the contributions of natural and artificial revegetation to annual runoff change after the implementation of the GFGP were quantified in fifteen subbasins of the Jing River Basin in the central Loess Plateau. The mean annual runoff of the Jing River Basin decreased by 11.8 mm after the GFGP, although the climate (precipitation and potential evapotranspiration) inversely increased the mean annual runoff by 6.6 mm. This is due to that the direct effect of climate change was much less than the ecohydrological effect of revegetation on runoff reduction, i.e., the revegetation caused the mean annual runoff reduction of 18.4 mm. Natural revegetation (50.5% of basin area) was the dominant reason for runoff reduction rather than artificial revegetation (9% of basin area). The natural revegetated area with vegetation quality improvement, i.e., an NDVI increase without land cover type change, contributed to a runoff reduction of 15.5 mm, accounting for 131.1% of the total runoff reduction after the GFGP, and the grassland of natural revegetation was the main vegetation type, with runoff reductions of 9.8 mm. However, artificial revegetation by area increase and quality improvement, i.e., NDVI increase, contributed to a runoff reduction of 8.4 mm, accounting for 49.6% of the total runoff reduction. These results demonstrated that the GFGP needs to be properly adjusted, i.e., natural revegetated areas should be opened in a timely manner and properly utilized, and improving vegetation quality improvement rather than increasing vegetation area would be a priority management measure in artificial revegetated areas.

Intensive compared with less intensive blood pressure control to prevent adverse cardiac remodelling in children with chronic kidney disease (HOT-KID): a parallel-group, open-label, multicentre, randomised, controlled trial

Optimal target blood pressure to reduce adverse cardiac remodelling in children with chronic kidney disease is uncertain. We hypothesised that lower blood pressure would reduce adverse cardiac remodelling. HOT-KID, a parallel-group, open-label, multicentre, randomised, controlled trial, was done in 14 clinical centres across England and Scotland. We included children aged 2-15 years with stage 1-4 chronic kidney disease-ie, an estimated glomerular filtration rate (eGFR) higher than 15 mL/min per 1·73 m2-and who could be followed up for 2 years. Children on antihypertensive medication were eligible as long as it could be changed to angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) if they were not already receiving these therapies. Participants were randomly assigned (1:1) to standard treatment (auscultatory office systolic blood pressure target between the 50th and 75th percentiles) or intensive treatment (systolic target <40th percentile) by the chief investigator using a rapid, secure, web-based randomisation system. ACE inhibitors or ARBs were used as first-line agents, with the dose titrated every 2-4 weeks to achieve the target blood pressure levels. The primary outcome was mean annual difference in left ventricular mass index (LVMI) by echocardiography measured by a masked observer and was assessed in the intention-to-treat population, defined as all the children who underwent randomisation irrespective of the blood pressure reached. Secondary and safety outcomes were the differences between groups in mean left ventricular relative wall thickness, renal function, and adverse effects and were also assessed in the intention-to-treat population. This trial is registered with ISRCTN, ISRCTN25006406. Between Oct 30, 2012, and Jan 5, 2017, 64 participants were randomly assigned to the intensive treatment group and 60 to the standard treatment group (median age of participants was 10·0 years [IQR 6·8-12·6], 69 [56%] were male and 107 [86%] were of white ethnicity). Median follow-up was 38·7 months (IQR 28·1-52·2). Blood pressure was lower in the intensive treatment group compared with standard treatment group (mean systolic pressure lower by 4 mm Hg, p=0·0012) but in both groups was close to the 50th percentile. The mean annual reduction in LVMI was similar for intensive and standard treatments (-1·9 g/m2·7 [95% CI -2·4 to -1·3] vs -1·2 g/m2·7 [-1·5 to 0·8], with a treatment effect of -0·7 g/m2·7 [95% CI -1·9 to 2·6] per year; p=0·76) and mean value in both groups at the end of follow-up within the normal range. At baseline, elevated relative wall thickness was more marked than increased LVMI and a reduction in relative wall thickness was greater for the intensive treatment group than for the standard treatment group (-0·010 [95% CI 0·015 to -0·006] vs -0·004 [-0·008 to 0·001], treatment effect -0·020 [95% CI -0·039 to -0·009] per year, p=0·0019). Six (5%) participants reached end-stage kidney disease (ie, an eGFR of <15 mL/min per 1·73 m2; three in each group) during the course of the study. The risk difference between treatment groups was 0·02 (95% CI -0·15 to 0·19, p=0·82) for overall adverse events and 0·07 (-0·05 to 0·19, p=0·25) for serious adverse events. Intensive treatment was not associated with worse renal outcomes or greater adverse effects than standard treatment. These results suggest that cardiac remodelling in children with chronic kidney disease is related to blood pressure control and that a target office systolic blood pressure at the 50th percentile is close to the optimal target for preventing increased left ventricular mass. British Heart Foundation.

Contribution of straw disposal to carbon source and sink under the framework of carbon neutrality

Exploring the spatio-temporal variation characteristics of carbon source and carbon sink under different disposal methods of crop straw is of great significance for optimizing the utilization policy of crop straw resources in China and realizing the goal of maximizing carbon emission reduction and carbon neutralization. Based on data from National Statistical Yearbook, we examined the changing trends of both the amount and value of carbon emission, carbon emission reduction, carbon sink enhancement under different crop straw disposal methods in 31 provinces of Chinese mainland. The results showed that the mean annual carbon emissions of straw burning in China from 2008 to 2019 were 8.74 million tons of CO2e. Since 2014, the mean annual reduction rate of carbon emissions was 17.3%. The mean annual carbon emission reduction of energy utilization was 39.82 million tons of CO2e, with solid briquette fuel produced by straw contributing the most with a contribution of about 98%. The amount of carbon sequestration of straw returning to field was increasing annually, with an average annual value of 271 million tons of CO2e. There was a carbon ecological surplus in straw disposal in China. The annual growth rate of net carbon emission reduction was 9.8%. The net carbon emission reduction intensity and its value were increasing, reaching 2.62 t·hm-2 and 76.19 yuan·hm-2 in 2019, respectively. A spatial pattern of 'high in the east and low in the west' was observed for the mean annual carbon emissions of straw, energy carbon emission reduction, carbon sink of straw returning to the field, and net carbon emission reduction in China, with main external characteristics of the regional differences and spatial aggregation.

Safety of Peptide Receptor Radionuclide Therapy with 177Lu-DOTATATE in Neuroendocrine Tumor Patients with Chronic Kidney Disease.

Our purpose was to assess the efficacy and safety of 177Lu-DOTATATE in neuroendocrine tumor patients with reduced renal function. Methods: A single-center retrospective analysis was performed on 33 patients with an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2 Of these, 26 had chronic kidney disease (CKD) stage 3a (eGFR, 45-60 mL/min/1.73 m2) and 7 had CKD 3b (eGFR, 30-45 mL/min/1.73 m2). Renal toxicity and temporal changes in eGFR were recorded. The association between potential risk factors and any kidney function deterioration (>10% reduction in eGFR) was evaluated. Data on survival, the radiologic response assessment, and quality of life were collected. Results: The incidence of permanent grade 3 or 4 nephrotoxicity was 3% (a single patient with grade 4 nephrotoxicity). The mean annual reduction in eGFR was estimated at 2.5%. A permanent decline of less than 10% in eGFR of any grade was recorded in 45% of patients (n = 15). Nine patients moved into higher CKD categories (8 patients who moved from CKD 3a to CKD 3b and 1 patient who moved from CKD 3b to CKD 5). No significant relationship was found between renal risk factors and a permanent reduction in renal function. Grade 3 or 4 bone marrow toxicity was observed in 9% of patients. The estimated median progression-free survival was 42 mo, and the median overall survival was 47 mo. At the end of treatment, the radiologic assessment showed a partial response in 33%, stable disease in 55%, and progressive disease in 12%. There was an improvement in global quality of life and endocrine score (European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire-Gastrointestinal NET-21) (P = 0.046 and 0.041, respectively). Conclusion: 177Lu-DOTATATE appears to be generally well tolerated in patients with preexisting CKD 3, with a low incidence of permanent major nephrotoxicity. 177Lu-DOTATATE appears to have a good therapeutic effect, with most patients reporting improvement in quality of life.

The effect of increasing surface cover vegetation on urban microclimate and energy demand for building heating and cooling

The study examines the potential effects of adding vegetation to an urban neighborhood in Tel Aviv on the microclimate, and subsequently on the potential for cooling by night ventilation and on energy consumption for heating and air conditioning. Computer simulation was employed to first generate modified weather files that account for urban effects of location, surface cover and density in different building configurations. These files were then used to assess the climatic cooling potential (CCP) by night ventilation and as inputs for detailed computer simulation of building energy performance. The microclimate model simulation indicates that elevated urban night-time temperatures will increase summer cooling loads relative to the reference rural site, but this penalty will be more than offset by reduced winter heating loads, resulting in a net decrease of between 2 and 7% in electricity use for heating and cooling (depending on building characteristics). The main impact of the urban heat island in this case is the reduction in the potential for cooling by night ventilation, which is almost completely absent in the summer months. Consequently, the urban climate of Tel Aviv may increase the prevalence of air conditioning use and will make buildings more vulnerable to potential loss of electric power in case of shortages or blackouts during episodes of extreme heat. Implementing a strategy of extensive planting, so that a green surface fraction of 0.5 is obtained, results in a mean annual temperature reduction of about 0.3 °C and an energy saving relative to the current condition of about 2–3%.

Distribution, Dominance Structure, Species Richness, and Diversity of Bats in Disturbed and Undisturbed Temperate Mountain Forests

The increase in mean annual temperature and reduction in summer rainfall from climate change seem to increase the frequency of natural and human-made disturbances to forest vegetation. This type of rapid vegetation change also significantly affects bat diversity. The aim of our study was to document differences in the ecological parameters of bat assemblages in different types of temperate mountain forests, particularly between disturbed and undisturbed coniferous and deciduous forests. Additionally, these issues were considered along an elevation gradient. We mist netted bats on 73 sites, between 931 and 1453 m elevation, in the forests of the Tatra Mountains in southern Poland. During 2016–2020, 745 bats, representing 15 species, were caught. The most abundant were Myotis mystacinus (Kuhl, 1817) (53.0%) and M. brandtii (Eversmann, 1845) (21.5%). We observed differences in species diversity, elevational distribution, and dominance between different types of forests and forest zones. Species richness peaked at around 1000–1100 m elevation. The highest species richness and other indices were observed in undisturbed beech stands, although they constituted only about 2.7% of the forest area. The lowest species diversity was observed in disturbed coniferous forests, in both the lower and upper forest zone. The species richness and dominance structure of bat assemblages were also found to depend on the location above sea level. In some bat species, the sex ratio was higher at higher elevations, and differences in the sex ratio in a few bat species, between different types of forests, were observed. Our findings suggest that disturbed, beetle-killed spruce forests are an unsuitable environment for some bat species.

Efficacy of Low-Dose versus High-Dose Continuous Cyclic Azithromycin Therapy for Preventing Acute Exacerbations of COPD

Background: Long-term azithromycin therapy significantly reduces the frequency of COPD exacerbations (ECOPD). However, previous studies have used different dosing regimens, and the efficacy of these regimens has not been compared. Objective: Compare the efficacy of low-dose with high-dose continuous cyclic azithromycin (CC-A) in severe COPD. Methods: Patients with severe COPD and repeated exacerbations (ECOPD ≥4 or ≥3 with at least 1 hospital admission in the previous year) were prospectively recruited (January 2017 to December 2019) as a multicenter cohort (from 3 university hospitals in the Barcelona area) and treated with low-dose CC-A: 250 mg 3 times per week (250-CC-A group). This cohort was compared with a historical (January 2007 to December 2013) single-center cohort of severe COPD with frequent ECOPD treated with high-dose CC-A: 500 mg 3 times per week (500-CC-A group). To assess differences in ECOPD prevention according to the administration of low-dose or high-dose CC-A, moderate-to-severe ECOPD was evaluated during the 12-month period before and after starting CC-A therapy. Results: Fifty-eight patients with severe COPD were evaluated: 37 in the low-dose group and 21 in the high-dose group. The 250-CC-A therapy group achieved a mean reduction in moderate-to-severe ECOPD of 65.6% at 12 months after starting CC-A therapy (with a 61.5% reduction in hospitalizations), while the 500-CC-A group achieved a reduction of 60.5% (with a 44.8% reduction in hospitalizations). No significant differences between 250-CC-A and 500-CC-A dosages were observed in the mean annual reduction of moderate-to-severe ECOPD (p = 0.55) or hospitalizations (p = 0.07) with respect to the year prior to starting CC-A. Conclusions: Low-dose 250-CC-A therapy over a 1-year period is similar to high-dose 500-CC-A in reducing exacerbation frequency in severe COPD patients with frequent ECOPD despite maximal medical therapy.

Trend analysis and longitudinal clustering of tuberculosis mortality in Asian and North African countries: Results from the global burden of disease 2017 study.

Background: Tuberculosis (TB) is still a serious health problem with a remarkable global burden. In this study, we aimed to assess the trend of TB mortality in Asian and North African countries in the period 1990-2017 and provide a new classification according to TB mortality trend. Methods: TB mortality rates from 1990 to 2017 were extracted from the Global Burden of Disease website for 55 Asian and North African countries. Trend analysis of TB mortality rates for males, females, and the total population was performed using the marginal modeling approach. Moreover, the latent growth mixture modeling (LGMM) framework was applied to classify these 55 countries based on their trend of TB mortality rate. Results: In the period between 1990 and 2017, South Asia and High Income Asia-Pacific regions had the highest and lowest death rates due to TB, respectively. The marginal modeling results showed that the Asian and North African countries had experienced a downward trend with an intercept of 28.79 (95%CI: 19.64, 37.94) and a slope (mean annual reduction) of -0.67 (95%CI: -0.91, -0.43) per 100,000 the study period. Finally, the LGMM analysis classified these 55 countries into four distinct classes. Conclusion: In general, our findings revealed that although the countries in Asia and North Africa super region experienced a descending TB mortality trend in the past decades, the slope of this reduction is quite small. Also, our new classification may be better suited for combating TB through future healthcare planning in lieu of the commonly used geographic classifications.

Identification of Key Factors to Reduce Transport-Related Air Pollutants and CO2 Emissions in Asia

Asian countries are major contributors to global air pollution and greenhouse gas emissions, with transportation demand and emissions expected to increase. However, few studies have been performed to evaluate policies that could reduce transport-related emissions in the region. This study explores transport-related CO2 and air pollutant emissions in major Asian nations along with the impacts of transport, climate, and emission control policies using the Asia-Pacific Integrated Model (AIM)/Transport model. Our results show that by 2050, CO2 emissions in developing countries will be 1.4–4.7-fold greater than the levels in 2005, while most air pollutant emissions will show large reductions (mean annual reduction rates of 0.2% to 6.1%). Notably, implementation of transport, emission control, and carbon pricing policies would reduce CO2 emissions by up to 33% and other air pollutants by 43% to 72%, depending on the emission species. An emission control policy represents the strongest approach for short-term and mid-term reduction of air pollutants. A carbon pricing policy would lead to a direct reduction in CO2 emissions; more importantly, air pollutant emissions would also be effectively reduced. Shifting to public transportation in developing countries can also greatly influence emissions reductions. An increase in traffic speed shows relatively small effects, but can be meaningful in Japan.

Suicide, fatal injuries and drowning among the crews of United Kingdom and Bermuda registered cruise and passenger ships from 1976 to 2018.

Little has been reported about mortality among crews in passenger shipping. The aim of the study was to determine the detailed causes and circumstances of deaths from unnatural causes among crews employed in United Kingdom (UK) and Bermudan registered passenger shipping, their trends, how they relate to the type of passenger ship and crew rank and to discuss preventative measures. A longitudinal study from 1976 to 2018, based on reviews of marine accident investigation reports, death inquiry files, cruise shipping websites and online searches. One hundred and forty crew fatalities in UK (127) and Bermudan (13) passenger ships were identified: from accidents and drowning (91), suicides and disappearances at sea (38), homicide, other and unexplained causes (11). Over the 43-year study period, a reduction in mortality (per 1000 ship-years) from accidents and drowning was identified (mean annual reduction: 4.3%; 95% confidence interval: 2.1-6.5%) but no significant reduction for suicides and disappearances at sea (annual reduction: 1.2% confidence interval: -1.3% to +3.7%). Most suicides and disappearances (70%) were among customer service Staff and, of 19 employed on large cruise ships, most (79%) were non-Europeans. The number of suicides and probable suicides is a cause for concern, especially among customer service staff on cruise ships. These findings indicate the need for interventions to reduce suicide risks. Further studies are needed to improve the targeting of interventions. These will need both to analyse the circumstances of individual deaths and derive suicide rates according to rank, department and nationality, based on reliable population denominators.

Spatiotemporal heterogeneity of actual and potential respiration in two contrasting floodplains

AbstractFloodplains are vital components of river ecosystems and play an important role in carbon cycling and storage at catchment and global scales. For efficient river management and conservation, it is critical to understand the functional role of spatiotemporally complex and dynamic habitat mosaics of river floodplains. Unfortunately, the fundamental understanding of mineralization and carbon flux patterns across complex floodplains is still fragmentary. In this study, respiratory potential (i.e., electron transport system activity [ETSA]) was quantified seasonally across different aquatic and terrestrial habitats (wetted channels, gravel bars, islands, riparian forests, and grasslands) of 2 Alpine floodplains differing in climate, altitude, discharge, flow alteration intensity, and land use (Soča [natural flow regime, 12% grassland area] and Urbach [mean annual discharge reduction by 30% due to water abstraction, 69% grassland area]). In situ respiration (R) was measured, and ETSA–R ratios were calculated to examine differences in exploitation intensity of the overall respiratory capacity among floodplain habitats and seasons. ETSA and R provided potential and actual estimates, respectively, of organic matter mineralization in the different floodplain habitats. Hierarchical linear regression across habitat types showed that organic matter, grain sizes &lt;0.063 mm, and water content were the most important predictors of ETSA in both floodplains, and grain sizes 2–0.063 and &gt;8 mm were also highly important for the Soča floodplain. The combination of ETSA and R measurements conducted in contrasting floodplains increased our understanding of the relationships between floodplain habitat heterogeneity, organic matter mineralization and human impacts, that is, structural–functional linkages in floodplains. These data are integral towards predicting changes in floodplain function in response to environmental alterations from increasing human pressures and environmental change.

Blood pressure and proteinuria control remains a challenge in patients with type 2 diabetes mellitus and chronic kidney disease: experience from the prospective observational ALICE-PROTECT study.

BackgroundType 2 diabetes (T2DM) is the leading cause of chronic kidney disease (CKD) in western countries. The combination of both increases the risk of end stage renal disease (ESRD), cardiovascular events and all-cause mortality. Early control of blood pressure (BP) and proteinuria (Pu) is crucial to slow down the progression of the CKD and prevent cardiovascular events and mortality. The primary objective of the study was to assess BP and Pu control after a 2-year follow-up in T2DM patients with CKD.MethodsProspective, multicenter, observational study. Overall, 153 French nephrologists included 986 T2DM patients with Pu (≥0.5 g/day) and an eGFR >15 ml/min/1.73 m2. Data from 729 patients were available after a 2-year follow-up. BP and Pu control were respectively defined as less than 140/90 mmHg and 0.5 g/day. We also looked at renal and cardiovascular events.ResultsAt baseline, 74 % of the patients were male, mean age was 70 years. The mean T2DM duration was 17 years with a mean HbA1c of 7.4 %. All were treated for hypertension and 33 % had a controlled BP; 81 % had dyslipidemia and LDLc was <1 g/L for 54 %; 44 % had retinopathy, 40 % macrovascular complications and 12 % heart failure. Mean Pu was 2 g/day and eGFR 40 ± 20 mL/min/1.73 m2, with 13, 18, 32 and 37 % of the patients in respectively stage 2, 3a, 3b and 4 CKD.After two years, 21 % reached the Pu target and 39 % the BP target. The mean eGFR of 40 ± 20.3 ml/min/1.73 m2 at baseline dropped to 33.9 ± 22.6 ml/min/1.73 m2 by year two (p < 0.001). This corresponded to a mean annual eGFR reduction of 3.2 ml/min/1.73 m2. 118 patients presented a renal event (16.2 %): doubling of serum creatinine for 86 patients (11.8 %) and start of dialysis for 72 (9.9 %); 176 patients (24.1 %) developed at least one cardiovascular complication (mainly coronary events and acute heart failure) during the follow-up period, and among these, 50 had also developed renal complications. Sixty patients died, i.e., 8.2 %, 26 patients from cardiovascular causes.ConclusionOur study highlights that achieving BP and Pu targets remains a major challenge in patients with T2DM and nephropathy. Renal failure emerges as a more frequent event than death.

Temporal Trends in the Utilization of Noninvasive Diagnostic Tests for Coronary Artery Disease in Ontario Between 2008 and 2014: A Population-Based Study

The proliferation of cardiac diagnostic tests over the past few decades has received substantial attention from policymakers. However, contemporary population-based temporal trends of the utilization of noninvasive cardiac diagnostic tests for coronary artery disease are not known. Our objective was to examine the temporal trends in the utilization of coronary computed tomography angiography (CCTA), myocardial perfusion imaging (MPI), exercise stress testing (GXT), and stress echocardiography between 2008 and 2014. We performed a population-based repeated cross-sectional study of the adult population of Ontario between January 1, 2008 and December 31, 2014. Annual utilization rates of noninvasive cardiac diagnostic tests were computed. For each cardiac testing modality, a negative binomial regression model was used to assess temporal changes in test utilization. GXT and MPI collectively accounted for 88% of all cardiac noninvasive diagnostic tests throughout our study period. Age- and sex-standardized rates of GXT declined from 26.7/1000 adult population to 21.6/1000 adult population (mean annual reduction of 3.4%; P < 0.001). MPI rates declined from 21.1/1000 adult population to 19.5/1000 adult population (mean annual reduction of 1.3%; P < 0.001). Although utilization rates for both CCTA and stress echocardiography increased over time, the combined rate of all available tests decreased from 50.8/1000 adult population to 49.1/1000 adult population (mean annual reduction of 1.1%; P < 0.001). In conclusion, utilization rates for the most prevalent noninvasive cardiac diagnostic tests—GXT and MPI—declined over our study period. Furthermore, the overall test utilization rate also declined over time. We believe our findings are encouraging from a health policy perspective. Nonetheless, rising utilization rates for CCTA and stress echocardiography will need to be monitored in the future.

Hydrological simulation in a basin of typical tropical climate and soil using the SWAT Model Part II: Simulation of hydrological variables and soil use scenarios

The study was developed for the Pomba river basin, which is located in southeast region of Brazil in the continent of South America. Hydrological simulation may be used to estimate the water availability, flood streamflows and the basin's hydrological response due to changes in soil use. Thus, aimed to apply the SWAT model, version 2005, to simulate (i) the minimum and maximum annual daily streamflows associated to different return times, (ii) minimum reference streamflows for water rights, and (iii) scenarios of changes in soil use. Were simulated the following scenarios of soil use: S1—preservation, considering the permanent preservation areas (PPAs); S2—reforestation expansion and S3—agricultural expansion, considering the replacement of 10% of the basin's total area covered with pastures for eucalyptus and crops, respectively. The current use (S0) being employed as the baseline. It was observed that the values of maximum and minimum annual daily streamflows with different return times, and of minimum reference streamflows for water rights simulated by the SWAT did not statistically differ from the values observed according to T-test at 5% probability level. When assessing the effects of changes in soil use, a mean annual reduction in runoff from 13.6, 4.0, and 6.5 mm was observed for scenarios S1, S2, and S3, respectively.

Do energy efficiency measures really reduce household energy consumption? A difference-in-difference analysis

This study investigates the impact of energy efficiency measures installed through the Carbon Emission Reduction Target (CERT) and the Community Energy Saving Programme (CESP) on domestic gas and total energy consumptions. The recently released National Energy Efficiency Data-Framework (NEED) database is used to examine the changes in domestic gas and total energy consumptions for the dwellings in the sample relative to the changes in gas and total energy consumptions for a comparable control group in the year after installation. The results obtained from this difference-in-difference analysis confirm that observed energy consumption decreases significantly in dwellings following upgrades such as cavity wall insulation, loft insulation and a new efficient boiler. The single most effective energy efficiency measure when installed alone is found to be cavity wall insulation, reducing annual gas consumption by 10.5 % and annual total energy consumption by 8.0 % in the year following installation. Comparing bundles of different energy efficiency measures, we find that dwellings retrofitted with both cavity wall insulation and a new efficient boiler experience the largest reductions in annual gas and total energy consumptions of 13.3 and 13.5 %, respectively. This is followed by a mean annual reduction of 11.9 and 10.5 % in gas and total energy consumptions for dwellings with all three energy efficiency measures installed in the same year. Contrary to expectations, installing cavity wall insulation on its own is found to be more effective in reducing measured energy consumption than combining loft insulation and a new efficient boiler.

Review article: the prevalence of Helicobacter pylori and the incidence of gastric cancer across Europe.

There is little up-to-date review evidence on the prevalence of Helicobacter pylori across Europe. To establish regional and national patterns in H. pylori prevalence across Europe. Secondly, to establish trends over time in H. pylori prevalence and gastric cancer incidence and, thirdly, to report on the relationship between H. pylori prevalence and age group across Europe. A review of H. pylori prevalence from unselected surveys of adult or general populations across 35 European countries and four European regions since 1990. Secondly, an analysis of trends over time in H. pylori prevalence and in gastric cancer incidence from cancer registry data. Helicobacter pylori prevalence was lower in northern and western Europe than in eastern and southern Europe (P < 0.001). In 11 of 12 European studies that reported on trends, there were sharp reductions in H. pylori prevalence (mean annual reduction = 3.1%). The mean annual reduction in the incidence of gastric cancer across Europe from 1993 to 2007 was 2.1% with little variation regionally across Europe (north 2.2%, west 2.3%, east 1.9% and south 2.0%). Sharp increases in age-related prevalence of H. pylori often levelled off for middle age groups of about 50 years onwards, especially in areas with high prevalence. This review shows that H. pylori prevalence is much higher in less affluent regions of Europe and that age-related increases in prevalence are confined to younger age groups in some areas. There were sharp reductions in both H. pylori prevalence and gastric cancer incidence throughout Europe.