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X-linked hypophosphatemia (XLH) is the most common monogenetic cause of chronic hypophosphatemia, characterized by rickets and osteomalacia. Disease manifestations and treatment of XLH patients in the Netherlands are currently unknown. Characteristics of XLH patients participating in the Dutch observational registry for genetic hypophosphatemia and acquired renal phosphate wasting were analyzed. Eighty XLH patients, including 29 children, were included. Genetic testing, performed in 78.8% of patients, showed a PHEX mutation in 96.8%. Median (range) Z-score for height was − 2.5 (− 5.5; 1.0) in adults and − 1.4 (− 3.7; 1.0) in children. Many patients were overweight or obese: 64.3% of adults and 37.0% of children. All children received XLH-related medication e.g., active vitamin D, phosphate supplementation or burosumab, while 8 adults used no medication. Lower age at start of XLH-related treatment was associated with higher height at inclusion. Hearing loss was reported in 6.9% of children and 31.4% of adults. Knee deformities were observed in 75.0% of all patients and osteoarthritis in 51.0% of adult patients. Nephrocalcinosis was observed in 62.1% of children and 33.3% of adults. Earlier start of XLH-related treatment was associated with higher risk of nephrocalcinosis and detection at younger age. Hyperparathyroidism longer than six months was reported in 37.9% of children and 35.3% of adults. This nationwide study confirms the high prevalence of adiposity, hearing loss, bone deformities, osteoarthritis, nephrocalcinosis and hyperparathyroidism in Dutch XLH patients. Early start of XLH-related treatment appears to be beneficial for longitudinal growth but may increase development of nephrocalcinosis.

Background: In 2018, a grant was provided for an evidence-based guideline on osteoporosis and fracture prevention based on 10 clinically relevant questions. Methods: A multidisciplinary working group was formed with delegates from Dutch scientific and professional societies, including representatives from the patient’s organization and the Dutch Institute for Medical Knowledge. The purpose was to obtain a broad consensus among all participating societies to facilitate the implementation of the updated guideline. Results: Novel recommendations in our guideline are as follows: - In patients with an indication for DXA of the lumbar spine and hips, there is also an indication for VFA. - Directly starting with anabolic drugs (teriparatide or romosozumab) in patients with a very high fracture risk; - Directly starting with zoledronic acid in patients 75 years and over with a hip fracture (independent of DXA); - Directly starting with parenteral drugs (denosumab, teriparatide, zoledronic acid) in glucocorticoid-induced osteoporosis with very high fracture risk; - A lifelong fracture risk management, including lifestyle, is indicated from the start of the first treatment. Conclusion: In our new multidisciplinary guideline osteoporosis and fracture prevention, we developed 5 “relatively new statements” that are all a crucial step forward in the optimization of diagnosis and treatment for fracture prevention. We also developed 5 flowcharts, and we suppose that this may be helpful for individual doctors and their patients in daily practice and may facilitate implementation.

To effectively navigate out of the climate crisis, a new interdisciplinary approach is needed to guide and facilitate research that integrates diverse understandings of how transitions evolve in intertwined social–environmental systems.The concept of tipping points, frequently used in the natural sciences and increasingly in the social sciences, can help elucidate processes underlying major social–environmental transitions. We develop the notion of interlinked ‘social–climatic tipping points’ in which desirability and intentionality are key constitutive features alongside stable states, feedbacks, reversibility and abruptness.We demonstrate the new insights that our interdisciplinary framework can provide by analysing the slowdown of the Atlantic Meridional Overturning Circulation and associated flooding of the Ahr Valley in Germany as a social–climatic tipping point.This framework can enable more sustainable and equitable futures by prioritising social–climatic tipping points for interdisciplinary research, identifying opportunities for action, and evaluating the nuanced desirability and acceptability of proposed solutions.

Beliefs about other people's opinions on climate change influence one's own opinion. Such beliefs can, however, suffer from biases in perception. Using two nationally representative surveys, we examine this issue in a new context, namely of carbon-tax acceptance in Spain. We find that the more one expects the tax to be accepted by others, the more one accepts it personally. But opponents of a carbon tax tend to strongly overestimate the prevalence of their opinion, i.e. they exhibit a so-called false consensus effect. In contrast, despite holding the majority view, tax supporters somewhat underestimate the prevalence of their own view, which is known as pluralistic ignorance. We further test the role of information provision by providing participants with different percentages of people accepting the tax. Overall, we find little evidence that such information provision significantly increases tax acceptance. The impact of information provision on tax acceptance tends to be moderated by the degree of false consensus. © 2022 Elsevier Ltd

Public support for stringent climate policies is currently weak. We develop a model to study the dynamics of public support for climate policies. It comprises three interconnected modules: one calculates policy impacts; a second translates these into policy support mediated by social influence; and a third represents the regulator adapting policy stringency depending on public support. The model combines general-equilibrium and agent-based elements and is empirically grounded in a household survey, which allows quantifying policy support as a function of effectiveness, personal wellbeing and distributional effects. We apply our approach to compare two policy instruments, namely carbon taxation and performance standards, and identify intertemporal trajectories that meet the climate target and count on sufficient public support. Our results highlight the importance of social influence, opinion stability and income inequality for public support of climate policies. Our model predicts that carbon taxation consistently generates more public support than standards. Finally, we show that under moderate social influence and income inequality, an increasing carbon tax trajectory combined with progressive revenue redistribution receives the highest average public support over time. © 2022 The Author(s)

Since the onset of the COVID-19 crisis many have opinionated on how it may affect society’s response to climate change. Two key questions here are how COVID-19 is expected to influence climate action by citizens and by the government. We answer these by applying topic modelling to textual responses from a survey of Spanish citizens. The identified topics tend to be more negative than positive, and more optimistic concerning future climate action by citizens. Positive views involve increasing pro-environmental behavior and are more common among younger, higher educated and male respondents as well as among those who perceive climate change as a serious threat or positively assessed COVID-19 confinement. Negative topics express concern that financial resources for climate action will be limited due to a focus on healthcare and economic recovery. In addition, they mention government mismanagement and waste due to use of protective measures like masks and gloves as impediments to effective climate action. Copyright: © 2022 Savin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

It remains unclear how COVID-19 has affected public engagement with the climate crisis. According to the finite-pool-of-worry hypothesis, concern about climate change should have decreased after the pandemic, in turn reducing climate-policy acceptance. Here we test these and several other conjectures by using survey data from 1172 Spanish participants who responded before and after the first wave of COVID-19, allowing for both aggregate and within-person analyses. We find that on average climate concern has decreased, while acceptance of most climate policies has increased. At the individual-level, adverse health experiences are unrelated to these changes. The same holds for negative economic experiences, with the exception that unemployment is associated with reduced acceptance of some policies. Complementary to the finite-pool-of-worry test, we examine three additional pandemic-related issues. As we find, (1) higher climate concern and policy acceptance are associated with a belief that climate change contributed to the COVID-19 outbreak; (2) higher policy acceptance is associated with a positive opinion about how the government addressed the COVID-19 crisis; (3) citizens show favorable attitudes to a carbon tax with revenues used to compensate COVID-19-related expenditures. Overall, we conclude there is support for addressing the global climate crisis even during a global health crisis. © 2022 Elsevier B.V.

PURPOSE: The aim of this longitudinal study was to assess trabecular bone scores (TBS) in institutionalized adults with refractory epilepsy and intellectual disability and to study the association of TBS and incident fractures during seven years of follow-up.METHODS: In 2009 and 2016, all institutionalized adult patients of a long-stay care facility in the Netherlands (n=261) were invited to undergo a dual-energy X-ray absorptiometry (DXA) including vertebral fracture assessment (VFA) and assessment of TBS. Vertebrae T4-L4 were analyzed using quantitative morphometry. New and worsening vertebral fractures (VFs) were considered as incident VFs. Data regarding clinical fractures were extracted from the medical files. Patients were treated with anti-osteoporosis medication according to the Dutch guideline.RESULTS: Baseline and follow-up DXA, VFA and TBS could be obtained in 136 patients (83 male) aged between 18 and 79 years old (44.7±15.5). At baseline, 36 patients (26.5%) were diagnosed with osteoporosis, 68 (50.0%) with osteopenia and 32 patients (23.5%) had a normal bone mineral density (BMD). As for TBS, 26 patients (19.1%) had a partially degraded microarchitecture and 26 patients (19.1%) a degraded microarchitecture. During seven years of follow-up, 80 patients (59%) sustained at least one fracture, of which 28 patients (35%) had one or more major osteoporotic fractures. Thirty-four patients (25.0%) had at least one new or worsening morphometric VF. Compared to baseline, TBS significantly decreased over seven years of follow-up in non-treated patients (-0.039±0.064, p<.001). In patients who were treated with bisphosphonates for more than one year during follow-up, TBS did not change significantly (p=.093). In multivariate analyses, no significant associations were found between TBS at baseline and incident fractures during follow-up.CONCLUSION: In this study, we found a high incidence of fractures and TBS decreased significantly over s

Ambitious climate mitigation policies face social and political resistance. One reason is that existing policies insufficiently capture the diversity of relevant insights from the social sciences about potential policy outcomes. We argue that agent-based models can serve as a powerful tool for integration of elements from different disciplines. Having such a common platform will enable a more complete assessment of climate policies, in terms of criteria like effectiveness, equity and public support.

Ambitious climate mitigation policies face social and political resistance. One reason is that existing policies insufficiently capture the diversity of relevant insights from the social sciences about potential policy outcomes. We argue that agent-based models can serve as a powerful tool for integration of elements from different disciplines. Having such a common platform will enable a more complete assessment of climate policies, in terms of criteria like effectiveness, equity and public support.

Ambitious climate mitigation policies face social and political resistance. One reason is that existing policies insufficiently capture the diversity of relevant insights from the social sciences about potential policy outcomes. We argue that agent-based models can serve as a powerful tool for integration of elements from different disciplines. Having such a common platform will enable a more complete assessment of climate policies, in terms of criteria like effectiveness, equity and public support.

Ambitious climate mitigation policies face social and political resistance. One reason is that existing policies insufficiently capture the diversity of relevant insights from the social sciences about potential policy outcomes. We argue that agent-based models can serve as a powerful tool for integration of elements from different disciplines. Having such a common platform will enable a more complete assessment of climate policies, in terms of criteria like effectiveness, equity and public support.

Ambitious climate mitigation policies face social and political resistance. One reason is that existing policies insufficiently capture the diversity of relevant insights from the social sciences about potential policy outcomes. We argue that agent-based models can serve as a powerful tool for integration of elements from different disciplines. Having such a common platform will enable a more complete assessment of climate policies, in terms of criteria like effectiveness, equity and public support.

Cognitive decline and osteoporosis often coexist and some evidence suggests a causal link. However, there are no data on the longitudinal relationship between cognitive decline, bone loss and fracture risk, independent of aging. This study aimed to determine the association between: (i) cognitive decline and bone loss; and (ii) clinically significant cognitive decline (>= 3 points) on Mini Mental State Examination (MMSE) over the first 5 years and subsequent fracture risk over the following 10 years. A total of 1741 women and 620 men aged >= 65 years from the population-based Canadian Multicentre Osteoporosis Study were followed from 1997 to 2013. Association between cognitive decline and (i) bone loss was estimated using mixed-effects models; and (ii) fracture risk was estimated using adjusted Cox models. Over 95% of participants had normal cognition at baseline (MMSE >= 24). The annual % change in MMSE was similar for both genders (women -0.33, interquartile range [IQR] -0.70 to +0.00; and men -0.34, IQR: -0.99 to 0.01). After multivariable adjustment, cognitive decline was associated with bone loss in women (6.5%; 95% confidence interval [CI], 3.2% to 9.9% for each percent decline in MMSE from baseline) but not men. Approximately 13% of participants experienced significant cognitive decline by year 5. In women, fracture risk was increased significantly (multivariable hazard ratio [HR], 1.61; 95% CI, 1.11 to 2.34). There were too few men to analyze. There was a significant association between cognitive decline and both bone loss and fracture risk, independent of aging, in women. Further studies are needed to determine mechanisms that link these common conditions. (c) 2021 American Society for Bone and Mineral Research (ASBMR).

The original article’s title has been updated. The article title should be referenced as noted in this correction: Impact of Carbon Pricing on Low‑Carbon Innovation and Deep Decarbonisation: Controversies and Path Forward. Additionally, the year for the reference Lilliestam et al., appearing in three places: abstract, Section 1, and list of references should be noted as 2021. The original article has been corrected. © Springer Nature B.V. 2021

We assess evidence from theoretical-modelling, empirical and experimental studies on how interactions between instruments of climate policy affect overall emissions reduction. Such interactions take the form of negative, zero or positive synergistic effects. The considered instruments comprise performance and technical standards, carbon pricing, adoption subsidies, innovation support, and information provision. Based on the findings, we formulate climate-policy packages that avoid negative and employ positive synergies, and compare their strengths and weaknesses on other criteria. We note that the international context of climate policy has been neglected in assessments of policy mixes, and argue that transparency and harmonization of national policies may be key to a politically feasible path to meet global emission targets. This suggests limiting the complexity of climate-policy packages. Key policy insights Combining technical standards or targets, such as renewable-energy quota, or adoption subsidies with a carbon market can produce negative synergy, up to the point of adding no emissions reduction beyond the cap. For maximum emissions reduction, renewable energy policy should be combined with carbon taxation and target expensive reduction options not triggered by the tax. Evidence regarding synergy of information provision with pricing is mixed, indicating a tendency for complementary roles (zero synergy). Positive synergy is documented only for cases where information provision improves effectiveness of price instruments, e.g. by stimulating social imitation of low-carbon choices. We conclude that the most promising packages are combining innovation support and information provision with either a carbon tax and adoption subsidy, or with a carbon market. We further argue that the latter could have stronger potential to harmonize international policy, which would allow to strengthen mitigation policy over time. © 2021 Informa UK Limited, trading as Taylor & Fran

Public acceptability of carbon taxation depends on its revenue use. Which single or mixed revenue use is most appropriate, and which perceptions of policy effectiveness and fairness explain this, remains unclear. It is, moreover, uncertain how people’s prior knowledge about carbon taxation affects policy acceptability. Here we conduct a survey experiment to test how distinct revenue uses, prior knowledge, and information provision about the functioning of carbon taxation affect policy perceptions and acceptability. We show that spending revenues on climate projects maximises acceptability as well as perceived fairness and effectiveness. A mix of different revenue uses is also popular, notably compensating low-income households and funding climate projects. In addition, we find that providing information about carbon taxation increases acceptability for unspecified revenue use and for people with more prior tax knowledge. Furthermore, policy acceptability is more strongly related to perceived fairness than to perceived effectiveness. © 2021, The Author(s).

There is an ongoing discussion about the effectiveness of carbon pricing, with a strong division between optimists and pessimists. A recent review study by Lilliestam, Patt and Bersalli (2021) of the impact of carbon pricing on low-carbon innovation and deep carbonization concludes that there is no evidence for such an impact. We evaluate this study and identify various shortcomings of it, which together cast strong doubts on its main conclusion. Instead, we conclude, based on the studies reviewed by the authors and additional, overlooked literature, that carbon pricing has had a small but positive and significant effect on low-carbon innovation. Our evaluation provides lessons for undertaking a systematic and objective review of research on this topic. Since the main goal of carbon pricing is changing choices by firms and consumers that affect carbon emissions, we also point the reader towards recent evidence for the broader effectiveness of carbon pricing. © 2021, The Author(s).

Climate policies can be applied either upstream, where fossil fuels are extracted, or downstream, where emissions are generated. Specific policy instruments can be defined for either level, and can take the form of a price signal such as through a tax, or a quantity limit such as through direct regulation or a permit market. In this study, we present an agent-based model to compare the performance of these different instruments and regulation levels. Since policy coverage is often limited, i.e. not all firms being under the regulator's control, we also examine the impact of incomplete coverage on relative policy performance. Our analysis shows that only upstream regulation leads to an increase in fossil fuel prices, which is benefitial under limited coverage as it also affects firms not directly affected by the policy instruments; that prices under quantity-based regulation can decline after an initial peak, stabilizing at a lower level than under the tax; and that direct regulation is more efficient when applied upstream. © 2021.

The megalithic jar sites of Laos (often referred to as the Plain of Jars) remain one of Southeast Asia's most mysterious and least understood archaeological cultures. The sites, recently inscribed as UNESCO World Heritage, host hollowed stone jars, up to three metres in height, which appear scattered across the landscape, alone or clustered in groups of up to more than 400. Until now, it has not been possible to estimate when the jars were first placed on the landscape or from where the stone was sourced. Geochronological analysis using the age of detrital zircons demonstrates a likely quarry source for one of the largest megalithic jar sites. Optically Stimulated Luminescence (OSL) dating suggests the jars were positioned at the sites potentially as early as the late second millennium BC. Radiocarbon dating of skeletal remains and charcoal samples places mortuary activity around the jars from the 9-13th century AD, suggesting the sites have maintained ritual significance from the period of their initial placement until historic times.

Segmentation of survey respondents is a common tool in environmental communication as it helps to understand opinions of people and to deliver targeted messages. Prior research has segmented people based on their opinions about the relationship between economic growth and environmental sustainability. This involved an evaluation of 16 statements, which means considerable survey time and cost, particularly if administered by a third party, as well as cognitive burden on respondents, increasing the chance of incomplete responses. In this study, we apply a machine learning algorithm to results from past surveys among citizens and scientists to identify a robust, minimal set of questions that accurately segments respondents regarding their opinion on growth versus the environment. In particular, we distinguish three groups, called Green growth, Agrowth and Degrowth. To this end, we identify five perceptions, namely regarding ‘environmental protection’, ‘public services’, ‘life satisfaction’, ‘stability’ and ‘development space’. Prediction accuracy ranges between 81% and 89% across surveys and opinion segments. We apply the proposed set of questions on growth-vs-environment to a new survey from 2020 to illustrate its use as an efficient instrument in future surveys. © 2021 The Authors

We analyze the effectiveness of environmental policy when consumers are subject to social influence. To this end, we build a model of consumption decisions driven by socially-embedded preferences formed under the influence of peers in a social network. This setting gives rise to a social multiplier of environmental policy. In an application to climate change, we derive Pigouvian and target-achieving carbon taxes under socially-embedded preferences. Under realistic assumptions the social multiplier is equal to 1.30, allowing to reduce the effective tax by 38%. We show that the multiplier depends on four factors: strength of social influence, initial taste distribution, network topology and income distribution. The approach provides a basis for rigorously analyzing a transition to low-carbon lifestyles and identifying complementary information and network policies to maximize the effectiveness of carbon taxation. © 2020 Elsevier Inc.

We assess evidence from theoretical-modelling, empirical and experimental studies on how interactions between instruments of climate policy affect overall emissions reduction. Such interactions take the form of negative, zero or positive synergistic effects. The considered instruments comprise performance and technical standards, carbon pricing, adoption subsidies, innovation support, and information provision. Based on the findings, we formulate climate-policy packages that avoid negative and employ positive synergies, and compare their strengths and weaknesses on other criteria. We note that the international context of climate policy has been neglected in assessments of policy mixes, and argue that transparency and harmonization of national policies may be key to a politically feasible path to meet global emission targets. This suggests limiting the complexity of climate-policy packages. Key policy insights Combining technical standards or targets, such as renewable-energy quota, or adoption subsidies with a carbon market can produce negative synergy, up to the point of adding no emissions reduction beyond the cap. For maximum emissions reduction, renewable energy policy should be combined with carbon taxation and target expensive reduction options not triggered by the tax. Evidence regarding synergy of information provision with pricing is mixed, indicating a tendency for complementary roles (zero synergy). Positive synergy is documented only for cases where information provision improves effectiveness of price instruments, e.g. by stimulating social imitation of low-carbon choices. We conclude that the most promising packages are combining innovation support and information provision with either a carbon tax and adoption subsidy, or with a carbon market. We further argue that the latter could have stronger potential to harmonize international policy, which would allow to strengthen mitigation policy over time.

Summary: This is a survey study concerning osteoporosis care during the COVID-19 pandemic in the Netherlands. Respondents reported that osteoporosis care stagnated and lower quality of care was provided. This leads to the conclusion that standardization of osteoporosis care delivery in situations of crisis is needed. Purpose: During the initial phase of the COVID-19 pandemic, there was no guidance of professional societies or guidelines on the organization of osteoporosis care in case of such a crisis, and treatment relied on local ad hoc strategies. Experiences from the current pandemic need to be taken into account for the near future, and therefore, a national multidisciplinary survey was carried out in the Netherlands. Methods: A survey of 17 questions concerning the continuation of bone mineral density measurements by Dual Energy X-ray absorptiometry (DXA), outpatient clinic visits, and prescription of medication was sent to physicians, nurses, nurse practitioners, and physician assistants working in the field of osteoporosis. Results: 77 respondents finished the questionnaire, of whom 39 (50.6%) reported a decline in DXA-scanning and 36 (46.8%) no scanning at all during the pandemic. There was an increase in remote consultations for both new and control patient visits (n = 48, 62.3%; n = 62, 81.7% respectively). Lower quality of care regarding fracture prevention was reported by more than half of the respondents (n = 44, 57.1%). Treatment with intravenous bisphosphonates and denosumab was delayed according to 35 (45.4%) and 6 (6.3%) of the respondents, respectively. Conclusion: During the COVID-19 pandemic, osteoporosis care almost completely arrested, especially because of the discontinuation of DXA-scanning and closing of outpatient clinics. More than half of the respondents reported a substantial lower quality of osteoporosis care during the COVID pandemic. To prevent an increase in fracture rates and a decrease in patient motivation, adherence and satis

Cognitive decline and osteoporosis often coexist and some evidence suggests a causal link. However, there are no data on the longitudinal relationship between cognitive decline, bone loss and fracture risk, independent of aging. This study aimed to determine the association between: (i) cognitive decline and bone loss; and (ii) clinically significant cognitive decline (≥3 points) on Mini Mental State Examination (MMSE) over the first 5 years and subsequent fracture risk over the following 10 years. A total of 1741 women and 620 men aged ≥65 years from the population-based Canadian Multicentre Osteoporosis Study were followed from 1997 to 2013. Association between cognitive decline and (i) bone loss was estimated using mixed-effects models; and (ii) fracture risk was estimated using adjusted Cox models. Over 95% of participants had normal cognition at baseline (MMSE ≥ 24). The annual % change in MMSE was similar for both genders (women -0.33, interquartile range [IQR] -0.70 to +0.00; and men -0.34, IQR: -0.99 to 0.01). After multivariable adjustment, cognitive decline was associated with bone loss in women (6.5%; 95% confidence interval [CI], 3.2% to 9.9% for each percent decline in MMSE from baseline) but not men. Approximately 13% of participants experienced significant cognitive decline by year 5. In women, fracture risk was increased significantly (multivariable hazard ratio [HR], 1.61; 95% CI, 1.11 to 2.34). There were too few men to analyze. There was a significant association between cognitive decline and both bone loss and fracture risk, independent of aging, in women. Further studies are needed to determine mechanisms that link these common conditions. © 2021 American Society for Bone and Mineral Research (ASBMR).

Cognitive decline and osteoporosis often coexist and some evidence suggests a causal link. However, there are no data on the longitudinal relationship between cognitive decline, bone loss and fracture risk, independent of aging. This study aimed to determine the association between: (i) cognitive decline and bone loss; and (ii) clinically significant cognitive decline (>= 3 points) on Mini Mental State Examination (MMSE) over the first 5 years and subsequent fracture risk over the following 10 years. A total of 1741 women and 620 men aged >= 65 years from the population-based Canadian Multicentre Osteoporosis Study were followed from 1997 to 2013. Association between cognitive decline and (i) bone loss was estimated using mixed-effects models; and (ii) fracture risk was estimated using adjusted Cox models. Over 95% of participants had normal cognition at baseline (MMSE >= 24). The annual % change in MMSE was similar for both genders (women -0.33, interquartile range [IQR] -0.70 to +0.00; and men -0.34, IQR: -0.99 to 0.01). After multivariable adjustment, cognitive decline was associated with bone loss in women (6.5%; 95% confidence interval [CI], 3.2% to 9.9% for each percent decline in MMSE from baseline) but not men. Approximately 13% of participants experienced significant cognitive decline by year 5. In women, fracture risk was increased significantly (multivariable hazard ratio [HR], 1.61; 95% CI, 1.11 to 2.34). There were too few men to analyze. There was a significant association between cognitive decline and both bone loss and fracture risk, independent of aging, in women. Further studies are needed to determine mechanisms that link these common conditions. (c) 2021 American Society for Bone and Mineral Research (ASBMR).

PURPOSE OF REVIEW: Diabetes mellitus (DM) is associated with increased fracture risk. The aim of this systematic review was to examine the effects of different classes of glucose-lowering drugs on fracture risk in patients with type 2 DM. The heterogeneity of the included studies did not allow formal statistical analyses.RECENT FINDINGS: Sixty studies were included in the review. Metformin, dipeptidylpeptidase-IV inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter 2-inhibitors do not appear to increase fracture risk. Results for insulin and sulphonylureas were more disparate, although there may be an increased fracture risk related to hypoglycemia and falls with these treatments. Glitazones were consistently associated with increased fracture risk in women, although the evidence was sparser in men. New glucose-lowering drugs are continuously being developed and better understanding of these is leading to changes in prescription patterns. Our findings warrant continued research on the effects of glucose-lowering drugs on fracture risk, elucidating the class-specific effects of these drugs.

Background: Computed tomography (CT), magnetic resonance imaging, and bone scintigraphy are second-line imaging techniques that are frequently used for the evaluation of patients with a clinically suspected scaphoid fracture. However, as a result of varying diagnostic performance results, no true reference standard exists for scaphoid fracture diagnosis. We hypothesized that the use of high-resolution peripheral quantitative CT (HR-pQCT) in patients with a clinically suspected scaphoid fracture could improve scaphoid fracture detection compared with conventional CT in the clinical setting.Methods: The present study included 91 consecutive patients (>= 18 years of age) who presented to the emergency department with a clinically suspected scaphoid fracture between December 2017 and October 2018. All patients were clinically reassessed within 14 days after first presentation, followed by CT and HR-pQCT. If a scaphoid fracture was present, the fracture type was determined according to the Herbert classification system and correlation between CT and HR-pQCT was estimated with use of the Kendall W statistic or coefficient of concordance (W) (the closer to 1, the higher the correlation).Results: The cohort included 45 men and 46 women with a median age of 52 years (interquartile range, 29 to 67 years). HR-pQCT revealed a scaphoid fracture in 24 patients (26%), whereas CT revealed a scaphoid fracture in 15 patients (16%). Patients with a scaphoid fracture were younger and more often male. The correlation between CT and HR-pQCT was high for scaphoid fracture type according to the Herbert classification system (W = 0.793; 95% confidence interval [CI], 0.57 to 0.91; p < 0.001) and very high for scaphoid fracture location (W = 0.955; 95%, CI 0.90 to 0.98; p < 0.001).Conclusions: In the present study, the number of patients diagnosed with a scaphoid fracture was 60% higher when using HR-pQCT as compared with CT. These findings imply that a substa

Introduction: Cortical bone thinning and a rarefaction of the trabecular architecture represent possible causes of increased femoral neck (FN) fracture risk. Due to X-ray exposure limits, the bone microstructure is rarely measurable in the FN of subjects but can be assessed at the tibia. Here, we studied whether changes of the tibial cortical microstructure, which were previously reported to be associated with femur strength, are also associated with structural deteriorations of the femoral neck.Methods: The cortical and trabecular architectures in the FN of 19 humans were analyzed ex vivo on 3D microcomputed tomography images with 30.3 mu m voxel size. Cortical thickness (Ct.Th-tibia), porosity (Ct.Po-tibia) and pore size distribution in the tibiae of the same subjects were measured using scanning acoustic microscopy (12 mu m pixel size). Femur strength during sideways falls was simulated with homogenized voxel finite element models.Results: Femur strength was associated with the total (vBMD(tot); R-2 = 0.23, p <0.01) and trabecular (vBMD(trab); R-2 = 0.26, p <0.01) volumetric bone mineral density (vBMD), with the cortical thickness (Ct.Th-FN; R-2 = 0.29, p <0.001) and with the trabecular bone volume fraction (Tb.BV/TVFN; R-2 = 0.34, p <0.001), separation (Tb.Sp(FN); R-2 = 0.25, p <0.01) and number (Tb.N-FN; R-2 = 0.32, p <0.001) of the femoral neck. Moreover, smaller Ct.Th-tibia was associated with smaller CLThFN (R-2 = 0.31, p <0.05), lower Tb.BV/TVFN (R-2 = 0.29, p <0.05), higher Tb.Sp(FN) (R-2 = 0.33, p <0.05) and lower Tb.N-FN (R-2 = 0.42, p <0.01). A higher prevalence of pores with diameter > 100 mu m in tibial cortical bone (relCt.Po100 mu m-tibia) indicated higher Tb.Sp(FN) (R-2 = 0.36, p <0.01) and lower Tb.N-FN (R-2 = 0.45, p <0.01).Conclusion: Bone resorption and structural decline of the femoral neck may be identified in vivo by measuring cortical bone thickness and large pores in the tibia.

Patients with diabetes have an increased risk of fractures. In this study, subtrochanteric and femoral shaft fractures were increased in patients with type 1 diabetes compared with the general population. In the light of this, more evidence points towards an association between diabetes and atypical femoral fractures.INTRODUCTION: Patients with diabetes have an increased risk of femoral fractures, but little is known about the risk of atypical femoral fractures (AFFs). The aim of this study was to identify the risk of subtrochanteric and femoral shaft (ST/FS) fractures and estimate the risk of AFFs in patients with type 1 (T1D) and type 2 diabetes (T2D).METHODS: From the nationwide Danish National Patient Register, we identified patients with T1D (n = 19,896), T2D (n = 312,188), and sex- and aged-matched controls without diabetes (n = 996,252) from the general population and all ST/FS fractures (n = 7509). Data were analyzed using a Cox proportional-hazards model and the incidence rate and rate ratio of ST/FS fractures were estimated.RESULTS: The incidence rate of ST/FS fractures in T1D was 52.14 events per 100,000 person years and 73.21 per 100,000 person years in T2D. T1D was associated with an increased risk of ST/FS (HR 2.07 (95% CI 1.68-2.56)), whereas T2D was not (HR 0.99 (95% CI 0.94-1.10)). Previous ST/FS fractures were associated with an increased risk of subsequent ST/FS fractures (HR 6.95 (95% CI 6.00-8.05)) and the use of bisphosphonates with an increased risk of ST/FS fractures (HR 1.72 (95% CI 1.54-1.91)).CONCLUSION: Patients with T1D have a higher risk of ST/FS fractures compared with sex- and age-matched controls. Since a proportion of ST/FS fractures are classified as AFFs, this could point towards the fact that AFFs also are increased in patients with T1D, but not T2D.

Carbon taxes evoke a variety of public responses, often with negative implications for policy support, implementation, and stringency. Here we use topic modeling to analyze associations of Spanish citizens with a policy proposal to introduce a carbon tax. This involves asking two key questions, to elicit (1) citizens’ associations with a carbon tax and (2) their judgment of the fairness of such a policy for distinct uses of tax revenues. We identify 11 topics for the first question and 18 topics for the second. We perform regression analysis to assess how respondents’ associations relate to their carbon tax acceptability, knowledge, and sociodemographic characteristics. The results show that, compared to people accepting the carbon tax, those rejecting it show less trust in politicians, think that the rich should pay more than the poor, consider the tax to be less fair, and stress more a lack of renewable energy or low-carbon transport. Respondents accepting a carbon tax emphasize more the need to solve environmental problems and care about a just society. These insights can help policymakers to improve the design and communication of climate policy with the aim to increase its public acceptability. © 2020, Springer Nature B.V.

Agent-based models (ABMs) have recently seen much application to the field of climate mitigation policies. They offer a more realistic description of micro behavior than traditional climate policy models by allowing for agent heterogeneity, bounded rationality and nonmarket interactions over social networks. This enables the analysis of a broader spectrum of policies. Here, we review 61 ABM studies addressing climate-energy policy aimed at emissions reduction, product and technology diffusion, and energy conservation. This covers a broad set of instruments of climate policy, ranging from carbon taxation, and emissions trading through adoption subsidies to information provision tools such as smart meters and eco-labels. Our treatment pays specific attention to behavioral assumptions and the structure of social networks. We offer suggestions for future research with ABMs to answer neglected policy questions. This article is categorized under: Climate Economics > Economics of Mitigation. © 2020 Wiley Periodicals, Inc.

Xieng Khouang and neighboring provinces in Central Laos are home to a vast megalithic landscape featuring large stone jars, discs, and imported boulders located in elevated positions. Sites were first noted in the late nineteenth century, with systematic recording commencing in the 1930s. Despite subsequent survey efforts and more recent excavations, many previously noted sites remain unconfirmed and others undiscovered, limiting our understanding of the geographic extent of the jar sites and the culture that created the jars. Here we present the results of a 2019 survey across Xieng Khouang Province which led to the documentation of 15 previously unreported megalithic sites and one potential habitation site. With the inclusion of the survey data, the Lao PDR Government database of jar sites will grow from 83 to 102, with 94 of the sites now geo-located.

Invasive species are costly for human health, the environment and the economy while their burden is expected to rise. With limited budgets to address biological invasions, effective resource allocation is important. In the past decade, multiple frameworks have emerged to support this budgeting, but it is not clear if current strategies are consistent with these. Amongst invasive species, insects are the costliest. In this article we evaluate a set of conservation policies in response to the arrival of the invasive beetle, the red palm weevil (Rhynchophorus ferrugineus) in Catalonia, Spain. The purpose of the selected schemes was to preserve palm species (Phoenix. spp) serving ornamental purposes. In a region with a large portion of land dedicated to agricultural activities and with densely populated coastal areas, budgets to address biological invasions should be carefully allocated. Through a comprehensive cost-benefit analysis based on the total economic value framework, we find that current policies were not justified as their net social benefits are negative. © 2019 Elsevier B.V.