Search

Despite a noticeable trend of delayed fatherhood, less is known about the impact of paternal age on the paternally programmed placenta. We hypothesize that paternal aging affects seminal quality and as such induces ageing-related epigenetic alterations that influence placental growth. Our main aim is to investigate associations between paternal age and first trimester (vascular) placental growth trajectories. Pregnant women were enrolled before 10 weeks of gestation in the Rotterdam Periconceptional Cohort (Predict study). Placental volumes (PV) and utero-placental vascular volumes (uPVV) were measured at 7, 9, and 11 weeks gestation. Associations between paternal age and PV and uPVV were investigated using linear mixed models and the maximum likelihood ratio test to test non-linear relationships. We adjusted for gestational age, fetal sex, parental smoking and maternal age, BMI, education and parity, and stratified for conception mode. From 808 pregnancies we obtained 1313 PV and from 183 pregnancies 345 uPVV measurements. We show no associations between paternal age and PV (p = 0.934) and uPVV (p = 0.489) in our total population or in pregnancies conceived naturally (PV p = 0.166; uPVV p = 0.446) and after IVF/ICSI (PV p = 0.909; uPVV p = 0.749). For example, PV was 0.9% smaller (95% CI -5.7%—7.1%) in fathers aged 40 compared to 30 years old at 9 weeks gestation in the total study population. We are not demonstrating a significant impact of paternal age on first trimester placental growth in a tertiary care population. Given the trend of increasing paternal age, our study should be repeated in the general population. • 3D ultrasound techniques enable assessment of first trimester placental growth. • Paternal age did not impact placental growth in cohort of >800 high-risk pregnancies. • Study should be repeated in general population given the trend of delayed fatherhood. [ABSTRACT FROM AUTHOR]

The Half Earth (HE) and Sharing the Planet (SP) scenario narratives are two distinctly different scenarios on how to restore and conserve biodiversity while accounting for the need for agricultural production. Yet, the equity implications of both scenarios are not clear. We conducted a questionnaire to better understand what experts with various backgrounds perceive as the main equity implications of these scenarios. We find that, overall, distributive, recognitional, and procedural equity barriers are perceived as higher in the HE scenario, as is the possibility of reaching equity. Especially people depending on local biodiversity to sustain their livelihoods are perceived to face challenges due to inequities. Although equity risks are perceived to be lower in the SP scenario, the measures needed to achieve this scenario are seen as hard to implement, since existing economic and political power structures need to change. Some respondents perceive the SP scenario as anthropocentric, and therefore not equitable to non-humans. The equity perceptions are linked to the respondents' attitudes to nature, their professional focus, and their view on equity in nature conservation and agriculture discussions and agreements today. These results indicate that it is important to recognise the different equity implications of the different scenarios and the challenge to provide equity implications for such scenarios. Explicitly recognising different equity understandings in scenario development and science-policy interfaces could lead to more inclusive policies. • Addressing equity is essential in working towards a sustainable future. • Equity in the Half Earth and Sharing the Planet narrative is perceived differently. • Perceptions of equity risks and barriers are larger in the Half Earth narrative. • Making equity implications explicit add to the credibility of scenarios. • Discussing equity implications make scenarios better connected to policy realities. [ABSTRACT FROM AUTHOR]

Although observational cohort studies report that interventions to achieve functionality are clinically successful in 85% of patients, the proportion of newly created autologous arteriovenous fistulas that result in functional vascular access typically is only 70 – 80%. To address this discrepancy, the selection and outcomes of interventions to achieve functionality in a multicentre prospective cohort study were analysed. The Shunt Simulation Study enrolled 222 patients who needed a first arteriovenous fistula in nine dialysis units in The Netherlands from 2015 to 2018 and followed these patients until one year after access creation. In this observational study, the technical and clinical success rates of interventions to achieve functionality based on lesion and intervention characteristics were analysed and the clinical outcomes of arteriovenous fistulas with assisted and unassisted functionality were compared. For patients who were on dialysis treatment at the end of the study, unassisted fistula functionality was 54% and overall fistula functionality was 78%. Thirty-four per cent of arteriovenous fistulas required an intervention to achieve functionality, 68% of which eventually became functional. Seventy-five per cent of these interventions were percutaneous balloon angioplasties of vascular access stenoses. Patients with clinically successful interventions to achieve functionality had larger pre-operative vein diameters (2.8 ± 1.0 mm vs. 2.3 ± 0.6 mm, p =.036) and less often presented with thrombosed fistulas than patients with unsuccessful interventions (7% vs. 43%, p =.006). Arteriovenous fistulas with assisted functionality had similar secondary patency as fistulas with unassisted functionality (100% and 98% at six months, p =.44), although they required more interventions to maintain function (2.6 vs. 1.7 per year; rate ratio 1.52, 95% CI 1.04 – 2.18, p =.032). Interventions to achieve functionality were needed in about a third of newly created arteriovenous fistulas. Most thrombosed fistulas were abandoned, and when selected for thrombectomy rarely reached clinical success. On the other hand, interventions to achieve functionality of patent fistulas had high clinical success rates and therefore can be done repeatedly until the fistula has become functional. [ABSTRACT FROM AUTHOR]

Early and complete restoration of target vessel patency in ST-elevation myocardial infarction (STEMI) is associated with improved outcomes. Oral P2Y 12 inhibitors have failed to demonstrate either improved patency or reduced mortality when administered in the prehospital setting. Thus, there is a need for antiplatelet agents that achieve prompt and potent platelet inhibition, and that restore patency in the prehospital setting. Zalunfiban, a novel subcutaneously administered glycoprotein IIb/IIIa inhibitor designed for prehospital administration, has shown to achieve rapid, high-grade platelet inhibition that exceeds that of P2Y 12 inhibitors. Whether prehospital administration of zalunfiban can improve clinical outcome is unknown. The present study is designed to assess the hypothesis that a single, prehospital injection of zalunfiban given in the ambulance, in addition to standard-of-care in patients with STEMI with intent to undergo primary percutaneous coronary intervention (PCI) will improve clinical outcome compared to standard-of-care with placebo. The ongoing CELEBRATE trial (NCT04825743) is a phase 3, randomized, double-blinded, placebo-controlled, international trial. Patients with STEMI intended to undergo primary PCI will receive treatment with a single subcutaneous injection containing either zalunfiban dose 1 (0.110 mg/kg), zalunfiban dose 2 (0.130 mg/kg) or placebo, and the study drug will be administered in the ambulance before transportation to the hospital. A target of 2499 patients will be randomly assigned to one of the treatment groups in a 1:1:1 ratio, ie, to have approximately 833 evaluable patients per group. The primary efficacy outcome is a ranked 7-point scale on clinical outcomes. The primary safety outcome is severe or life-threatening bleeding according to the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) criteria. The CELEBRATE trial will assess whether a single prehospital subcutaneous injection of zalunfiban in addition to standard-of-care in patients with STEMI with intent to undergo primary PCI will result in improved clinical outcome. [ABSTRACT FROM AUTHOR]

The mechanisms underlying the increased risk of bleeding that female patients with ST-segment Elevation Myocardial Infarction (STEMI) exhibit, remains unclear. The present report assessed sex-related differences in response to pre-hospital dual antiplatelet therapy (DAPT) initiation in patients with STEMI. The COMPARE CRUSH trial randomized patients presenting with STEMI to receive a pre-hospital loading dose of crushed or integral prasugrel tablets in the ambulance. In this substudy, we compared platelet reactivity levels and the occurrence of high platelet reactivity (HPR; defined as platelet reactivity ≥208) between sexes at 4 prespecified time points after DAPT initiation, and evaluated post-PCI bleeding between groups. Out of 633 STEMI patients, 147 (23%) were female. Females compared with males presented with significantly higher levels of platelet reactivity and higher HPR rates at baseline (232 [IQR, 209-256] vs 195 [IQR, 171-220], P <.01, and 76% vs 41%, OR 4.58 [95%CI, 2.52-8.32], P <.01, respectively). Moreover, female sex was identified as the sole independent predictor of HPR at baseline (OR 5.67 [95%CI, 2.56-12.53], P <.01). Following DAPT initiation, levels of platelet reactivity and the incidence of HPR were similar between sexes. Post-PCI bleeding occurred more frequently in females compared with males (10% vs 2%, OR 6.02 [95%CI, 2.61-11.87], P <.01). Female sex was an independent predictor of post-PCI bleeding (OR 3.25 [95%CI, 1.09-9.72], P =.04). In this contemporary STEMI cohort, female STEMI patients remain at risk of bleeding complications after primary PCI. However, this is not explained by sex-specific differences in the pharmacodynamic response to pre-hospital DAPT initiation. [ABSTRACT FROM AUTHOR]

Complementary medicine such as yoga, massage and art therapy has become increasingly popular among patients with cancer. However, the topic remains under-discussed during oncology consultations: patients seem hesitant to disclose complementary medicine use, and healthcare providers lack resources to discuss complementary medicine. This study aims to gain an understanding of how to improve communication and information provision in oncological settings about complementary medicine by assessing the experiences and needs of patients and healthcare providers. Semi-structured interviews were conducted with 17 patients with cancer and 13 oncology healthcare providers recruited from two general hospitals and one breast cancer center in the Netherlands. Nine (former) patients with breast cancer collaborated with the research team as 'co-researchers'. Reflexive thematic analysis was used. The main themes identified were barriers to patient-provider communication about complementary medicine (e.g. lack of time and knowledge among healthcare providers, negative attitudes toward complementary medicine), facilitators of communication (e.g. openness of healthcare providers, complementary medicine as a routine topic) and information provision needs (e.g. easy access to information, the hospital being involved in providing information). Patients with cancer and healthcare providers report issues with the current approach to discussing complementary medicine and are of the opinion that complementary medicine should be a routine topic in oncology consultations. Future studies should focus on effective methods for standardizing complementary medicine discussions into oncology care and making reliable information available for patients and healthcare providers. • Oncology care providers lack time and knowledge to discuss complementary medicine. • Scepticism towards complementary medicine prevails but is shifting to more openness. • Open, routine discussions about complementary medicine are warranted in oncology. • Complementary medicine information should be centralized and provided in hospitals. [ABSTRACT FROM AUTHOR]

• We project direction and magnitude of subnational migration in South Asia. • Machine learning models reach an accuracy of 75% and R2 of 0.44, respectively. • Variable importance is similar between both approaches. • Yet, scenario projections differ for several regions. • The study adds to a more complete understanding of developing migration scenarios. Projecting migration is challenging, due to the context-specific and discontinuous relations between migration and the socioeconomic and environmental conditions that drive this process. Here, we investigate the usefulness of Machine Learning (ML) Random Forest (RF) models to develop three net migration scenarios in South Asia by 2050 based on historical patterns (2001–2019). The model for the direction of net migration reaches an accuracy of 75%, while the model for the magnitude of migration in percentage reaches an R2 value of 0.44. The variable importance is similar for both models: temperature and built-up land are of primary importance for explaining net migration, aligning with previous research. In all scenarios we find hotspots of in-migration North-western India and hotspots of out-migration in eastern and northern India, parts of Nepal and Sri Lanka, but with disparities across scenarios in other areas. These disparities underscore the challenge of obtaining consistent results from different approaches, which complicates drawing firm conclusions about future migration trajectories. We argue that the application of multi-model approaches is a useful avenue to project future migration dynamics, and to gain insights into the uncertainty and range of plausible outcomes of these processes. [ABSTRACT FROM AUTHOR]

The present research letter reports the 1-year clinical outcomes of the randomized COMPARE CRUSH trial, which allocated STEMI patients at first medical contact in the ambulance to receive either crushed or integral tablets of prasugrel loading dose. This trial aimed to investigate whether early enhanced antiplatelet effect constituted by the crushed potent oral P2Y12 inhibitor prasugrel could lead to improved early myocardial reperfusion and clinical outcomes. [ABSTRACT FROM AUTHOR]

Traditionally, curettage has been the most widely performed surgical intervention for removing retained products of conception. However, hysteroscopic removal is increasingly performed as an alternative because of the potentially lower risk of intrauterine adhesions and higher rates of complete removal. Until recently, studies comparing curettage with hysteroscopic removal regarding reproductive and obstetrical outcomes were limited, and data conflicting. This study aimed to assess reproductive and obstetrical outcomes in women wishing to conceive after removal of retained products of conception by hysteroscopy or ultrasound-guided electric vacuum aspiration. This was a prospective long-term follow-up study, conducted in 3 teaching hospitals and 1 university hospital. Patients were included from April 2015 until June 2022 for follow-up, either in a randomized controlled, nonblinded trial on the risk of intrauterine adhesions after removal of retained products of conception, or in a cohort alongside the randomized trial. Women with an ultrasonographic image suggestive of retained products of conception ranging from 1 to 4 cm were eligible. Surgical procedures in the randomized controlled trial were hysteroscopic morcellation or ultrasound-guided electric vacuum aspiration. In the cohort study, hysteroscopic treatment included hysteroscopic morcellation or cold loop resection compared with ultrasound-guided electric vacuum aspiration. A total of 261 out of 305 patients (85.6%) were available for follow-up after removal of retained products of conception, resulting in a cohort of 171 women after hysteroscopic removal and 90 women after removal by ultrasound-guided vacuum aspiration. Respectively, 92 of 171 women (53.8%) in the hysteroscopic removal group and 56 of 90 (62.2%) in the electric vacuum aspiration group wished to conceive (P =.192). Subsequent pregnancy rates were 88 of 91 (96.7%) after hysteroscopic removal and 52 of 56 (92.9%) after electric vacuum aspiration (P =.428). The live birth rates were 61 of 80 (76.3%) and 37 of 48 (77.1%) after hysteroscopic removal and electric vacuum aspiration, respectively (P =.914), with 8 of 88 pregnancies (9.1%) in the hysteroscopic removal group and 4 of 52 (7.7%) in the electric vacuum aspiration group still ongoing at follow-up (P= 1.00). The median time to conception was 8.2 weeks (interquartile range, 5.0–17.2) in the hysteroscopic removal group and 6.9 weeks (interquartile range, 5.0–12.1) in the electric vacuum aspiration group (P =.262). The overall placental complication rate was 13 of 80 (16.3%) in the hysteroscopic removal group and 11 of 48 (22.9%) in the electric vacuum aspiration group (P =.350). Hysteroscopic removal and ultrasound-guided electric vacuum aspiration of retained products of conception seem to have no significantly different effects on subsequent live birth rate, pregnancy rate, time to conception, or pregnancy complications. Reproductive and obstetrical outcomes after removal of retained products of conception are reassuring, albeit with a high risk of placental complications. [ABSTRACT FROM AUTHOR]

Globally, urban disaster risk is being affected by changing patterns of natural hazards due to climate change and rapid urbanization. While we have a relatively good understanding of the hazard and exposure in cities, we know little about their vulnerability. In this study, we investigate the drivers and dynamics of urban vulnerability for six different natural hazards by conducting a systematic literature review on the peer-reviewed scientific literature. Out of an initial set of 3168 studies, we included 462 studies for in-depth analysis. We present VulneraCity, the urban vulnerability drivers database, in which we record the drivers and classify them based on topic and acquisition method. Overall, we list 1460 unique drivers of vulnerability in VulneraCity, of which 37.3 % are empirically acquired in the source studies. Other drivers are either modeled (7.9 %), theorized (22.9 %), adopted (27.0 %), or acquired with an unknown method (5.0 %). Furthermore, the relationships between drivers and impact are often assumed to be linear, but we identify six types of directional dynamics - one-directional, bidirectional, transferable, asynergies, conditional, and compound - which describe the complexities in these relationships to show that the linearity assumption is regularly violated. These results shed light on the necessary drivers that should be taken into account in urban vulnerability assessments. VulneraCity can facilitate discussions in local-scale vulnerability analyses, but could also provide input for larger-scale comparative studies of cities. We recommend further research into multi-hazard (instead of multiple hazards') vulnerability and vulnerability dynamics as next steps towards more comprehensive urban disaster risk studies. • We present VulneraCity, an urban vulnerability drivers database. • 1460 vulnerability drivers are gathered from over 400 articles. • We find that around 1/3rd of all the vulnerability drivers are empirically derived. • Additionally, six types of directional dynamics are identified and conceptualized. • We suggest future research avenues on multi-hazard vulnerability and dynamics. [ABSTRACT FROM AUTHOR]

Digital twins have emerged as novel technology in the wind energy sector that enables the design, monitoring and prediction of wind turbine performance. Despite growing attention on their potential, little is known about how digital twins are designed, by whom and how their design choices affect multiple aspects of decision making in the development of wind energy. Using a framework of co-production, this paper examines digital twins as boundary objects and the role of twinning as boundary work that involves an active process of design and affects multiple aspects of decision making in the development of wind energy. Our results demonstrate how the design of digital twins evolves throughout the twinning process, affected by regulation, choices of expert twinners on data and models, and what constitutes a matter of concern. We shed light on the role of these twinners in influencing which actors and their matters of concern are included and excluded during the twinning process. Our understanding of twinning as an active process of governance by design more clearly reveals how digital twins are not objective representations of reality, but a function of boundary work. We conclude that more transparency is needed over how digital twins are designed to enhance their role as technologies that foster a transition towards more sustainable energy systems and decision-making over wind energy technologies and their integration in landscapes. • There is limited understanding of how digital twins are designed • We focus on wind energy and 'twinning' as an act of governance • We unpack twinning as boundary work and digital twins as boundary objects • Twinning involves choices about data, models, concerns and regulation • Priorities and focus in twinning may steer wind energy transitions [ABSTRACT FROM AUTHOR]

Local perspectives can conflict with national and international climate targets. This study explores three stakeholder (community, provincial, and federal) perspectives on the Alberta oil sands as risks for a sustainability transition in Canada. In an ex-post analysis, we compared outputs from stakeholder consultations and energy-economy models. Our research shows that different local stakeholders groups disregarded some policy risks for the Alberta oil sands and Canadian energy transition. These stakeholders expected the sector to grow, despite increasing environmental penalties and external market pressures. The study revealed that blind-spots on risks, or "risk blindness", increased as stakeholders became less certain about policy climate goals. We argue that "risk blindness" could be amplified by dominant institutional narratives that contradict scientific research and international climate policy. Strategies that integrate local narratives, considered as marginalized, provide perspectives beyond emission reductions and are essential for meeting climate targets while supporting a just transition. [ABSTRACT FROM AUTHOR]

This study sought to compare the pharmacodynamic effects of pre-hospitally administered P2Y 12 inhibitor prasugrel in crushed versus integral tablet formulation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). Early dual antiplatelet therapy is recommended in STEMI patients. Yet, onset of oral P2Y 12 inhibitor effect is delayed and varies according to formulation administered. The COMPARE CRUSH (Comparison of Pre-hospital Crushed Versus Uncrushed Prasugrel Tablets in Patients With STEMI Undergoing Primary Percutaneous Coronary Interventions) trial randomized patients with suspected STEMI to crushed or integral prasugrel 60-mg loading dose in the ambulance. Pharmacodynamic measurements were performed at 4 time points: before antiplatelet treatment, at the beginning and end of pPCI, and 4 h after study treatment onset. The primary endpoint was high platelet reactivity at the end of pPCI. The secondary endpoint was impact of platelet reactivity status on markers of coronary reperfusion. A total of 441 patients were included. In patients with crushed prasugrel, the occurrence of high platelet reactivity at the end of pPCI was reduced by almost one-half (crushed 34.7% vs. uncrushed 61.6%; odds ratio [OR] = 0.33; 95% confidence interval [CI] = 0.22 to 0.50; p < 0.01). Platelet reactivity <150 P2Y 12 reactivity units at the beginning of coronary angiography correlated with improved Thrombolysis In Myocardial Infarction flow grade 3 in the infarct artery pre-pPCI (OR: 1.78; 95% CI: 1.08 to 2.94; p = 0.02) but not ST-segment resolution (OR: 0.80; 95% CI: 0.48 to 1.34; p = 0.40). Oral administration of crushed compared with integral prasugrel significantly improves platelet inhibition during the acute phase in STEMI patients undergoing pPCI. However, a considerable number of patients still exhibit inadequate platelet inhibition at the end of pPCI, suggesting the need for alternative agents to bridge the gap in platelet inhibition. [Display omitted] [ABSTRACT FROM AUTHOR]

Malnutrition has a negative impact on quality of life and survival in renal transplant recipients (RTR). Therefore, malnutrition detection is important in RTR, but this may be hampered by concomitant presence of weight gain and overweight. Recently, the Global Leadership Initiative on Malnutrition (GLIM) developed a set of diagnostic criteria for malnutrition. We aimed to assess the prevalence of malnutrition according to the GLIM criteria and the distribution of phenotypic criteria in RTR. Additionally, we examined the potential value of 24-h urinary creatinine excretion rate (CER) as alternative measure for the criterion reduced muscle mass. We used data from stable outpatient RTR included in the TransplantLines Cohort and Biobank Study (NCT02811835). Presence of weight loss and reduced intake or assimilation were derived from Patient-Generated Subjective Global Assessment (PG-SGA) item scores. Reduced muscle mass was assessed by multi-frequency bio-electrical impedance analysis (MF-BIA) and defined as an appendicular skeletal muscle mass index (ASMI) < 7 kg/m2 for men and <5.5 kg/m2 for women, and in additional analysis defined as creatinine-height index (CHI, based on 24 h urine CER) < 80%. Inflammation was present if C-reactive protein (CRP) was >5 mg/L. Malnutrition was defined as presence of at least one phenotypic (weight loss and/or low BMI and/or reduced muscle mass) and one etiologic criterion (reduced intake/assimilation and/or disease burden/inflammation). We included 599 RTR (55 ± 13 years old, 62% male, BMI 27.2 ± 4.7 kg/m2) at a median of 3.1 years after transplantation. According to GLIM criteria, 14% was malnourished, of which 91% met the phenotypic criterion for reduced muscle mass. Similar results were found by using CHI as measure for muscle mass (13% malnutrition of which 79% with reduced muscle mass). Malnutrition is present in one in 7 stable RTR, with reduced muscle mass as the predominant phenotypic criterion. Assessment of nutritional status, most importantly muscle status, is warranted in routine care, to prevent malnutrition in RTR from remaining undetected and untreated. The diagnostic value of 24-h urinary CER in this regard requires further investigation. • Using to the GLIM criteria, 14% of RTR were diagnosed with malnutrition. • Reduced muscle mass was the predominant phenotypic criterion, present in 91% of malnourished RTR. • Of the malnourished RTR, 22% was classified as overweight or obese. • Assessment of muscle mass in RTR is important to prevent malnutrition from remaining undetected. • More research is needed on the diagnostic value of 24-h creatinine excretion rate in the diagnosis of malnutrition. [ABSTRACT FROM AUTHOR]

Identifying the risks that could impact a low-carbon transition is a prerequisite to assessing and managing these risks. We systematically characterise risks associated with decarbonisation pathways in fifteen case studies conducted in twelve countries around the world. We find that stakeholders from business, government, NGOs, and others supplied some 40 % of these risk inputs, significantly widening the scope of risks considered by academics and experts. Overall, experts and academics consider more economic risks and assess these with quantitative methods and models, while other stakeholders consider political risks more. To avoid losing sight of risks that cannot be easily quantified and modelled, including some economic risks, impact assessment modelling should be complemented with qualitative research and active stakeholder engagement. A systematic risk elicitation facilitates communication with stakeholders, enables better risk mitigation, and increases the chance of a sustainable transition. [ABSTRACT FROM AUTHOR]

Background: Dual antiplatelet therapy constitutes the cornerstone of medical treatment in patients with ST elevation myocardial infarction (STEMI). However, oral antiplatelet agents, such as prasugrel or ticagrelor, are characterized by slow gastrointestinal drug absorption in the acute phase of STEMI, leading to decreased bioavailability and therefore delayed onset of platelet inhibition. Evidence suggests that administration of crushed tablets of the P2Y12 inhibitor prasugrel improves drug absorption and achieves earlier antiplatelet effects in STEMI patients undergoing primary percutaneous coronary intervention (PCI). However, the clinical implications of these pharmacokinetic and pharmacodynamic findings are unknown.Hypothesis: The present study is designed to test the hypothesis that patients presenting with STEMI planned for primary PCI will have improved markers of optimal reperfusion and clinical outcomes by prehospital administration of crushed tablets of prasugrel loading dose.Study Design: COMPARE CRUSH (NCT03296540) is a randomized trial in a regionally organized ambulance care setting evaluating the efficacy and safety of pre-hospital loading dose with prasugrel crushed tablets versus integral tablets in approximately 674 patients presenting with STEMI planned for primary PCI. The independent primary endpoints are percentage of patients reaching thrombolysis in myocardial infarction (TIMI) flow grade 3 in the infarct-related artery at initial angiography, or achieving ≥70% ST-segment elevation resolution at 1 hour post-PCI. Secondary clinical endpoints are death, myocardial infarction, revascularization, and stent thrombosis followed up to 1 year. Moreover, the primary safety endpoint is bleeding events assessed at 48 hours.Conclusions: The COMPARE CRUSH trial will assess whether prehospital administration of loading dose prasugrel in form of crushed tablets - which is expected to provide faster platelet inhibition compared to standard treatment with integral tablets - results in improved reperfusion and clinical outcomes. RCT# NCT03296540. [ABSTRACT FROM AUTHOR]

Study Objective: To evaluate the reproductive outcomes in women treated for retained products of conception (RPOC) by hysteroscopy (morcellation vs loop resection).Design: Cohort study.Setting: A teaching and university hospital.Patients: Patients included in a previous randomized controlled trial on hysteroscopic removal of RPOC comparing morcellation (n = 46) with loop resection (n = 40).Interventions: Hysteroscopic morcellation versus loop resection.Measurements and Main Results: The primary outcome measures were live birth and pregnancy complications (including abnormal placentation [placenta accreta/increta/percreta], placenta previa, vasa previa, retained placenta after delivery or incomplete expulsion with the need for manual removal or curettage, and RPOC), uterine rupture, and other complications (blood loss, preterm labor, preterm premature rupture of membranes, hypertensive disorders of pregnancy, and intrauterine growth restriction). The live birth rate was 88.9% in the morcellation group and 68.2% in the loop resection group (p = .09). Uterine rupture occurred in 1 patient in the morcellation group (4.2%) (p = 1.00). Placental complications were found in 20.8% and 22.2% of the hysteroscopic morcellation and loop resection groups, respectively (p = .33), and other pregnancy complications were seen in 33.3% and 16.6% of the 2 groups (p = .33). The secondary outcome was time to pregnancy. The median time to pregnancy was 14 weeks (interquartile range [IQR], 5-33 weeks) in the morcellation group and 15 weeks (IQR, 6-37 weeks) in the loop resection group (p = .96).Conclusion: Hysteroscopic removal of RPOC seems to have no detrimental effect on reproductive outcome and no significant effect on pregnancy rate. [ABSTRACT FROM AUTHOR]

Background: To determine the clinical outcomes of perimesencephalic subarachnoid hemorrhages based on the computed tomography (CT) bleeding patterns.Methods: This retrospective cohort study included: (1) patients (≥18 years) admitted to a comprehensive stroke center (January 2015-May 2018), (2) with angiography-negative, nontraumatic subarachnoid hemorrhage in a perimesencephalic or diffuse bleeding pattern, and (3) had CT imaging performed in ≤ 72 hours of symptom onset. Patients were stratified by location of bleeding on CT: Peri-1: focal prepontine hemorrhage; Peri-2: prepontine with suprasellar cistern +/- intraventricular extension; and diffuse.Results: Of the 39 patients included, 13 were Peri-1, 11 were Peri-2, and 15 were diffuse. The majority were male (n = 26), with a mean (standard deviation) age of 55.3 (11.3) years, who often presented with headache (n = 37) and nausea (n = 28). Overall, patients in Peri-1 were significantly less likely to have hydrocephalus compared to Peri-2 and dSAH (P= .003), and 4 patients required an external ventricular drain. Five patients developed symptomatic vasospasm. Patients in Peri-1, compared to Peri-2 and diffuse, had a significantly shorter median neuro critical care unit length of stay (LOS) and hospital LOS. Most patients (n = 35) had a discharge modified Rankin Score between 0 and 2 with no significant differences found between groups.Conclusion: These data suggest that patients with the best clinical course were those in Peri-1, followed by Peri-2, and then diffuse. Because these patients often present with similar clinical signs, stratifying by hemorrhage pattern may help clinicians predict which patients with perimesencephalic subarachnoid hemorrhage develop complications. [ABSTRACT FROM AUTHOR]

• Land use model are a central tool in land system science. • There is a lack of new land use modelling concepts published in recent years. • Land use models are frequently insufficiently evaluated. • Opportunities to better represent human agency in land use models are identified. • There is large potential for land use models to contribute to the identification and design of sustainability solutions. Land use models play an important role in exploring future land change dynamics and are instrumental to support the integration of knowledge in land system science. However, only modest progress has been made in achieving these aims due to insufficient model evaluation and limited representation of the underlying socio-ecological processes. We discuss how land use models can better represent multi-scalar dynamics, human agency and demand-supply relations, and how we can achieve learning from model evaluation. By addressing these issues we outline pathways towards a new generation of land use models that allow not only the assessment of future land cover pattern changes, but also stimulate envisioning future land use by society to support debate on sustainability solutions and help design alternative solutions. [ABSTRACT FROM AUTHOR]

People increasingly collaborate with others across cultures and distances with the help of technology. Bridging individuals via technology does not, however, ensure that the cultures of the individuals involved are similarly bridged. This study introduced an interculturally enriched collaboration script (IECS) to foster collaboration and to bridge intercultural differences when students were working in a computer-supported collaborative learning (CSCL) environment. A randomized, two group, pretest-posttest research design was used to compare the effects of the IECS with the effects of a general collaboration script (CS). The outcome variables were student attitudes towards online collaboration, online collaborative learning behavior, and learning performance of the culturally heterogeneous groups working in the CSCL environment. A total of 74 MSc students representing 22 countries worked in dyads on the environmental problem of biodiversity collapse. The IECS positively affected student attitudes towards online collaboration and their online collaborative learning behavior but not their learning performance. The IECS can thus be used to improve collaborative learning processes across cultures and distance in education. [ABSTRACT FROM AUTHOR]

Highlights • In 2015, 32% of Cambodian large-scale land acquisitions is converted to plantation. • We simulate the impact of different LSLA policies on LSLA underuse. • Interventionist policies maximize tree cover and natural areas in Cambodia. • Preventive policies result in less fragmentation of core natural areas. • Future policies affect where and to what extent a tiger reintroduction is possible. Abstract This paper investigates how large-scale land acquisitions (LSLAs) can be governed to avoid underuse and thereby spare room for other land claims, specifically nature conservation. LSLA underuse occurs when land in LSLAs is not converted to its intended use. Taking Cambodia as a case, we map converted and unconverted areas within LSLAs using remote sensing. We develop three scenarios of alternative LSLA policies until 2040, and use a land system change model to evaluate how governing the underuse of LSLAs affects overall land use. Specifically, we evaluate the impact of these policies on future tree cover, the size and spatial integrity of natural areas, and the potential these natural areas can offer to meet the conservation target of a successful tiger reintroduction. In 2015, only 32% of LSLA area was converted. Simulations suggest that both interventionist (reclaim unconverted areas) and preventive (avoid non-conversion) policies dramatically reduce underuse. Interventionist policies perform best in limiting tree cover loss and in preserving natural areas, but preventive measures lead to significantly less fragmentation. Noninterventionist policies (no enforced policies) make tiger reintroduction in the Eastern Plains impossible. Preventive policies with well-enforced protected areas succeed in creating the largest potential for tiger reintroduction. Our results suggest that Cambodia can reconcile LSLAs with tiger reintroduction in the Eastern Plains only when using preventive land use policies. In the absence of such policies, tiger survival in the Eastern Plains is unlikely and only the Cardamom or Virachey forest may offer such potential. [ABSTRACT FROM AUTHOR]

In chronic pain, pain-related fear seems to overgeneralize to safe stimuli, thus contributing to excessive fear and avoidance behavior. Evidence shows that pain-related fear can be acquired and generalized based on conceptual knowledge. Using a fear conditioning paradigm, we investigated whether this concept-based pain-related fear could also be extinguished. During acquisition, exemplars of 1 action category (conditioned stimuli [CSs]; eg, opening boxes) were followed by pain (CS+), whereas exemplars of another action category were not (CS-; eg, closing boxes). Participants reported more pain-related fear and expectancy toward exemplars of the CS+ category compared with those of the CS- category. During generalization, fear and expectancy spread to novel exemplars (generalization stimuli [GSs]) of the CS+ category (GS+), but not to those of the CS- category (GS-). During extinction, exemplars of both categories were presented in the absence of pain. At the end of extinction, participants no longer reported elevated fear or expectancy toward CS+ exemplars compared to CS- exemplars. These findings were not replicated in either the eye-blink startle or skin conductance measures. This is the first study to demonstrate extinction of concept-based pain-related fear, thus providing evidence for the potential of extinction-based techniques in the treatment of conceptual pain-related fear. PERSPECTIVE: This study demonstrates the acquisition, generalization, and extinction of concept-based pain-related fear in healthy participants. These are the first results to show that concept-based pain-related fear can be extinguished, suggesting that conceptual relationships between fear-inducing stimuli may also be important to consider in clinical practice. [ABSTRACT FROM AUTHOR]

Highlights • Salinisation degrades water quality in many regions worldwide. • Irrigation, road de-icers, domestic and industrial wastewater are main sources. • Salinisation as a marker to identify trade-offs between SDGs. • Models as tools to identify hotspots, analyse pathways and assess solutions. Salinisation can have different adverse impacts on water resources that are used for drinking, irrigation, or industrial purposes. In addition, salinisation in its turn is also strongly influenced by anthropogenic activities such as irrigation. This paper maps trade-offs between water quality (SDG 6.3) and other Sustainable Development Goals (SDGs) using salinisation as an example. Many interlinkages exist between SDG 6.3 and other SDGs as identified in the literature review part. These are however not yet fully addressed in studies applying a comprehensive systems approach or modelling frameworks. In order to find solution options for achieving a sustainable future the interlinkages between SDGs related to salinisation and its impacts need to be considered as they play a key role in mitigating impacts, prioritising measures for action and hence turning trade-offs into synergies. [ABSTRACT FROM AUTHOR]

Highlights • Global WQ models need sufficient consideration of mechanistic understanding. • Multiscale WQ modeling facilitates more consistent water management across scales. • Process-based parsimonious models are proposed for global WQ model development. • Water management requires active collaboration among WQ modelers and policy-makers. Global water quality (WQ) modeling is an emerging field. In this article, we identify the missing linkages between global and basin/local-scale WQ models, and discuss the possibilities to fill these gaps. We argue that WQ models need stronger linkages across spatial scales. This would help to identify effective scale-specific WQ management options and contribute to future development of global WQ models. Two directions are proposed to improve the linkages: nested multiscale WQ modeling towards enhanced water management, and development of next-generation global WQ models based-on basin/local-scale mechanistic understanding. We highlight the need for better collaboration among WQ modelers and policy-makers in order to deliver responsive water policies and management strategies across scales. [ABSTRACT FROM AUTHOR]

Highlights • Model inter-comparison projects (MIPs) can identify robustness in estimates of water quality hotspots and trends. • Water quality MIPs can improve understanding of pollution causes and model uncertainties. • MIP design should focus on using consistent input datasets and harmonize output variables and spatial/temporal resolutions. • MIPs of lumped models should focus on pollutant loadings at river basin outlets. • MIPs of grid-based models can compare spatial water quality heterogeneity within basins. Several model inter-comparison projects (MIPs) have been carried out recently by the climate, hydrological, agricultural and other modelling communities to quantify modelling uncertainties and improve modelling systems. Here we focus on MIP design for large-scale water quality models. Water quality MIPs can be useful to improve our understanding of pollution problems and facilitate the development of harmonized estimates of current and future water quality. This can provide new opportunities for assessing robustness in estimates of water quality hotspots and trends, improve understanding of processes, pollution sources, water quality model uncertainties, and to identify priorities for water quality data collection and monitoring. Water quality MIP design should harmonize relevant model input datasets, use consistent spatial/temporal domains and resolutions, and similar output variables to improve understanding of water quality modelling uncertainties and provide harmonized water quality data that suit the needs of decision makers and other users. [ABSTRACT FROM AUTHOR]

Highlights • Assessing global water quality issues requires a multi-pollutant modelling approach. • Challenges relate to consistent inputs, multi-pollutant modelling approaches and model evaluation. • Our illustrative example shows hotspots of river pollution with multiple pollutants. • Multi-pollutant models are highly policy relevant. Assessing global water quality issues requires a multi-pollutant modelling approach. We discuss scientific challenges and future directions for such modeling. Multi-pollutant river models need to integrate information on sources of pollutants such as plastic debris, nutrients, chemicals, pathogens, their effects and possible solutions. In this paper, we first explain what we consider multi-pollutant modelling. Second, we discuss scientific challenges in multi-pollutant modelling relating to consistent model inputs, modelling approaches and model evaluation. Next, we illustrate the potential of global multi-pollutant modelling for hotspot analyses. We show hotspots of river pollution with microplastics, nutrients, triclosan and Cryptosporidium in many sub-basins of Europe, North America and South Asia. Finally, we reflect on future directions for multi-pollutant modelling, and for linking model results to policy-making. [ABSTRACT FROM AUTHOR]

A recent analysis by Stylianou et al. (2021) estimated the impact of small dietary changes in the consumption of individual foods on human health and the environment, expressed as minutes of healthy life lost or gained daily combined with dietary carbon footprints. While an appealing concept given its simplistic interpretation, we aim to draw the attention of nLCA practitioners and developers to the significant limitations and uncertainties of this analysis, based on existing evidence. Stylianou's approach produces results that fail to recognize the importance of essential nutrient density and the risks associated with ultra-processed foods, added sugar, and refined starches. The novel impact assessment undoubtedly brings a new perspective to the growing field of nutritional Life Cycle Assessment. However, the authors neglect numerous methodological limitations, fail to direct the readers' attention to (mis)interpretation risks, and draw highly definitive recommendations aiming to directly influence consumer choices and policymaking. Due to extensive data limitations and associated uncertainties in extant databases (both environmental and nutritional), we recommend caution in the use of this (or any other) food classification system to inform consumer behavior, front-of-package labelling, policies, and programs. • Assuming causal relations between single foods and health outcomes is problematic. • Dietary recommendations must be inclusive of diverse dietary patterns and cultures. • Food processing is a key aspect of a foods healthfulness. • Transparency about inherent uncertainties in Life Cycle Assessment is essential. • Average environmental impacts mask vast variation across systems and practices. [ABSTRACT FROM AUTHOR]

Highlights • Environmental NGOs have good contribution in natural resource management. • NGOs role in the land policy cycle is limited by legal and administrative barriers. • There is poor cooperation and networking among NGOs and between NGOs and the state. • NGOs with multiple donors and unrestricted type of fund rely on their own objective. • Most NGOs avoid involvement in policy advocacy in fear of collusions with the state. Abstract By law, non-governmental organizations (NGOs) in Ethiopia are severely restricted in their activities towards policy development. In this study we explore to what extent these restrictions have affected NGOs in Natural Resource Management in the Oromia regional state of Ethiopia. We quantitatively analyzed 106 semi-structured questionnaires, in order to assess 1) the general characteristics of these NGO, 2) the role of NGOs in natural resource management, 3) the factors that constrain their activities, especially in relation to the proclamation, and 4) the cooperation between NGOs as well as other stakeholders. Results indicate that NGOs are mainly involved in policy implementation, including afforestation, forest management, and soil and water conservation. We find that a more active role in agenda setting and policy formulation is hampered by the 2009 proclamation, which explicitly restricts the role of Ethiopian Residence Charities/Societies (ERCS) and Foreign Charities (FC). Consistently, NGOs, as well as their donors, often avoid involvement in policy development, in fear of potential collusion with the government. In addition, NGOs listed legal and administrative barriers, poor networking and cooperation among NGOs, lack of capacity, lack of information, and a lack of clear role on policy issues as constraints for influencing policies for natural resource management. The extent to which these factors affect NGOs is dependent on their type and the source of their funding. [ABSTRACT FROM AUTHOR]

Fear-avoidance models propose that pain-related fear may spur avoidance behavior leading to chronic pain disability. Pain-related fear elicits avoidance behavior, which is typically aimed at reducing fear. We hypothesized that engaging in avoidance may (paradoxically) increase rather than decrease pain-related fear (ie, bidirectionality hypothesis). In a between-subject design, participants (n = 64) were randomly assigned to the avoidance group or the control group. Avoidance group participants were led to believe they could avoid full exposure to a painful heat stimulus by pressing the stop button, whereas control group participants believed they were exposed to the full painful heat stimulus at all times. In reality and unknown to the participants, the intensity and duration of the heat stimulus was independent of the avoidance response, and was identical in both groups. During the test, the avoidance response (ie, pressing the stop button) was no longer available. As expected, pain-related fear levels were higher after avoiding the painful heat stimulus. Interestingly, in the avoidance group, pain-related fear increased after receiving instructions that avoidance would be possible, even before actually engaging in avoidance behavior. In the control group, no significant change was observed in pain-related fear throughout the experiment. The eyeblink startle measures did not corroborate this data pattern.Perspective: These observations provide partial support for the bidirectionality hypothesis between avoidance behavior and fear. These findings may have clinical implications and suggest that allowing avoidance behaviors during treatment may thwart fear reduction. [ABSTRACT FROM AUTHOR]

The combination of emerging antibiotic resistance and lack of discovery of new antibiotic classes poses a threat to future human welfare. Antibiotics are administered to livestock at a large scale and these may enter the environment by the spreading of manure on agricultural fields. They may leach to groundwater, especially in the Netherlands which has some of the most intensive livestock farming and corresponding excessive manure spreading in the world. This study investigates the presence of antibiotics in groundwater in two regions with the most intensive livestock farming in the Netherlands. If so, the hydrochemical conditions were further elaborated. Ten multi-level wells with in total 46 filters were sampled, focusing on relatively young, previously age-dated groundwater below agricultural fields. Twenty-two antibiotics were analyzed belonging to the following antibiotic groups: tetracyclines, sulfonamides, trimethoprims, β-lactams, macrolides, lincosamides, quinolones, nitrofurans and chloramphenicol. The samples were analyzed for these antibiotics by LC-MS/MS ESI-POS/NEG (MRM) preceded by solid phase extraction which resulted in importantly low detection limits. Six antibiotics were found above detection limits in 31 filters in seven wells: sulfamethazine, sulfamethoxazole, lincomycin, chloramphenicol, ciprofloxacin, and sulfadiazine. The concentrations range from 0.3 to 18 ng L −1 . Sulfonamides were detected at all measured depths down to 23 meters below surface level with apparent groundwater ages up to 40 years old. No antibiotics were detected below the nitrate/iron redox cline, which suggests that the antibiotics might undergo degradation or attenuation under nitrate-reducing redox conditions. This study provides proof that antibiotics are present in groundwater below agricultural areas in the Netherlands due to the spreading of animal manure. [ABSTRACT FROM AUTHOR]

The high-velocity impact response of gelatin and synthetic hydrogel samples is investigated using a laser-based microballistic platform for launching and imaging supersonic micro-particles. The micro-particles are monitored during impact and penetration into the gels using a high-speed multi-frame camera that can record up to 16 images with nanosecond time resolution. The trajectories are compared with a Poncelet model for particle penetration, demonstrating good agreement between experiments and the model for impact in gelatin. The model is further validated on a synthetic hydrogel and the applicability of the results is discussed. We find the strength resistance parameter in the Poncelet model to be two orders of magnitude higher than in macroscopic experiments at comparable impact velocities. The results open prospects for testing high-rate behavior of soft materials on the microscale and for guiding the design of drug delivery methods using accelerated microparticles. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: The objective of this study was to develop and validate a predictive magnetic resonance imaging (MRI) activity score for ileocolonic Crohn disease activity based on both subjective and semiautomatic MRI features.Materials and Methods: An MRI activity score (the "virtual gastrointestinal tract [VIGOR]" score) was developed from 27 validated magnetic resonance enterography datasets, including subjective radiologist observation of mural T2 signal and semiautomatic measurements of bowel wall thickness, excess volume, and dynamic contrast enhancement (initial slope of increase). A second subjective score was developed based on only radiologist observations. For validation, two observers applied both scores and three existing scores to a prospective dataset of 106 patients (59 women, median age 33) with known Crohn disease, using the endoscopic Crohn's Disease Endoscopic Index of Severity (CDEIS) as a reference standard.Results: The VIGOR score (17.1 × initial slope of increase + 0.2 × excess volume + 2.3 × mural T2) and other activity scores all had comparable correlation to the CDEIS scores (observer 1: r = 0.58 and 0.59, and observer 2: r = 0.34-0.40 and 0.43-0.51, respectively). The VIGOR score, however, improved interobserver agreement compared to the other activity scores (intraclass correlation coefficient = 0.81 vs 0.44-0.59). A diagnostic accuracy of 80%-81% was seen for the VIGOR score, similar to the other scores.Conclusions: The VIGOR score achieves comparable accuracy to conventional MRI activity scores, but with significantly improved reproducibility, favoring its use for disease monitoring and therapy evaluation. [ABSTRACT FROM AUTHOR]

Pain is a common but often ignored symptom in patients with myotonic dystrophy type 2 (DM2). In this explorative study, we assessed qualitative and quantitative aspects of pain in DM2 using 4 questionnaires and quantitative sensory testing. A disease control group (fibromyalgia [FMS]) as well as healthy controls were used to compare the results, because pain in DM2 shows many clinical similarities to pain in FMS. Thirty-four patients with genetically confirmed DM2 (71% female, mean age 54 years), 28 patients with FMS, and 33 healthy controls were included, age- as well as sex-matched. Pain prevalence was 65% in DM2, 100% in FMS (P < .001), and 15% in healthy controls (P < .001). The mean of the pressure pain thresholds was lower in DM2 than in healthy controls (P = .016), with the largest differences in the rectus femoris, trapezius, and thenar muscles. Mechanical and electric pain thresholds were significantly higher in DM2 than in FMS, and no differences were found in electric pain thresholds between DM2 and healthy controls. These results confirm that pain is a frequent and important symptom in patients with DM2, affecting quality of life. Peripheral mechanisms of pain seem to play a role in DM2. The widespreadness of the hyperalgesia suggests central sensitization, but this finding was not supported by the other results. This study opens new avenues for further research and eventually novel treatment strategies, in DM2 as well as in other muscular disorders.Perspective: This article presents qualitative as well as quantitative aspects of pain in patients with DM2. Pain is a frequent and important symptom in patients with DM2, affecting quality of life. We found mechanical hyperalgesia, indicative of a peripheral mechanism of pain. The widespreadness of hyperalgesia may suggest central sensitization, but this finding was not supported by other results and needs further exploration. [ABSTRACT FROM AUTHOR]

Urbanization has been responsible for the loss of cropland worldwide, especially in China. To guarantee national food security, China has implemented a series of policies to protect cropland. One of these policies requires that one-hectare cropland should be reclaimed when urban expansion occupies one-hectare cropland. Since most cropland reclamation leads to a conversion of natural habitat, such as wetland and grassland, urban expansion may lead to (indirect) natural habitat loss in addition to direct loss from conversion of into urban area. While several studies assessed the direct habitat loss resulted from built-up area expansion, few studies investigated the indirect losses caused by cropland displacement. In this paper, a model-based approach is applied to explore both direct and indirect impacts of built-up area expansion on natural habitat loss for the city of Wuhan, China, between 2010 and 2020 using different scenarios. Our scenarios differ in the implementation of strict cropland protection policies and ecosystem conservation strategies. Results show that the indirect loss of natural habitat due to cropland displacement under strict cropland protection policies far outweighs the direct loss due to built-up area expansion alone. Moreover, we found that ecosystem conservation strategies mainly influence the type of natural habitat that is affected, while the total amount of natural habitat loss remains relatively constant. [ABSTRACT FROM AUTHOR]

Precise and accurate measurement of viscoelastic mechanical properties becomes increasingly challenging as sample stiffness decreases to elastic moduli <1 kPa, largely due to difficulties detecting initial contact with the compliant sample surface. This limitation is particularly relevant to characterization of biological soft tissues and compliant gels. Here, we employ impact indentation which, in contrast to shear rheology and conventional indentation, does not require contact detection a priori , and present a novel method to extract viscoelastic moduli and relaxation time constants directly from the impact response. We first validate our approach by using both impact indentation and shear rheology to characterize polydimethylsiloxane (PDMS) elastomers of stiffness ranging from 100 s of Pa to nearly 10 kPa. Assuming a linear viscoelastic constitutive model for the material, we find that the moduli and relaxation times obtained from fitting the impact response agree well with those obtained from fitting the rheological response. Next, we demonstrate our validated method on hydrated, biological soft tissues obtained from porcine brain, murine liver, and murine heart, and report the equilibrium shear moduli, instantaneous shear moduli, and relaxation time constants for each tissue. Together, our findings provide a new and straightforward approach capable of probing local mechanical properties of highly compliant viscoelastic materials with millimeter scale spatial resolution, mitigating complications involving contact detection or sample geometric constraints. Statement of significance Characterization and optimization of mechanical properties can be essential for the proper function of biomaterials in diverse applications. However, precise and accurate measurement of viscoelastic mechanical properties becomes increasingly difficult with increased compliance (particularly for elastic moduli <1 kPa), largely due to challenges detecting initial contact with the compliant sample surface and measuring response at short timescale or high frequency. By contrast, impact indentation has highly accurate contact detection and can be used to measure short timescale (glassy) response. Here, we demonstrate an experimental and analytical method that confers significant advantages over existing approaches to extract spatially resolved viscoelastic moduli and characteristic time constants of biological tissues ( e.g. , brain and heart) and engineered biomaterials. [ABSTRACT FROM AUTHOR]

Understanding of cropland dynamics in a large geographical extent is mostly based on observations of area change, while the changes in landscape pattern are hardly assessed. The total amount of cropland in China has remained relatively stable in recent years, which might suggest there was little change. In this analysis, we combine the number of cropland patches (NP) with the total cropland area (TA) for a more comprehensive characterization of cropland change in China. We use GlobeLand30–a global land cover dataset with a 30 m resolution for the years 2000 and 2010–and characterize changes in TA and NP for each county as increase, stable, or decrease. This characterization shows that 703 out of 2420 counties experienced both cropland loss and increased fragmentation. The predominant cropland loss in these areas, especially in the North China Plain, is converted to artificial land. Another 212 are characterized by the opposite developments: an increase in cropland and decreased fragmentation. These counties, are mainly characterized by a conversion of forest areas and grassland areas. It suggests that the cropland conservation policy in China effectively protected the total cropland area in overall, but the consequences in terms of fragmentation might be underestimated. Counties with no obvious change in both indicators, measuring 279 counties, are mainly located in the Southeast. Our results are further compared with local level case studies: the fair consistency indicates alternatives of applying GlobeLand30 for analyzing landscape changes across scales and for cross-site comparisons. [ABSTRACT FROM AUTHOR]

Female sterilization is the most popular and common contraceptive method worldwide. Because hysteroscopic sterilization techniques are used less often due to side effects, the number of laparoscopic sterilization is increasing. A systematic overview concerning the most optimal anesthetic technique for laparoscopic sterilization is lacking. We performed a systematic review to compare conscious sedation with general anesthesia for laparoscopic sterilization procedures with respect to clinical relevant outcome measures, such as operating times, perioperative parameters and complications, patient comfort, recovery, and patient satisfaction. We searched Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE for randomized controlled trials comparing general anesthesia with conscious sedation for laparoscopic sterilization. Two authors (AGH and HAAMvV) abstracted and entered data into RevMan. Methodologic quality of the included trials was critically appraised. For our main outcome measures mean differences (continuous variables) and risk ratios (dichotomous variables) with 95% confidence intervals using random-effect models were calculated. Four randomized controlled trials were included comparing general anesthesia versus local anesthesia with conscious sedation for laparoscopic sterilization. The methodologic quality of the studies was moderate to good. Both techniques were comparable with regard to operating times, complications, and postoperative pain. However, local anesthesia with conscious sedation showed better results compared with general anesthesia with respect to recovery times, patient complaints of sore throat, and patient recovery and satisfaction. In conclusion, this systematic review about anesthetic techniques for laparoscopic sterilization showed that both general anesthesia and conscious sedation have no major anesthetic complications and may therefore be safe. Patients might benefit from conscious sedation in terms of recovery times, sore throat, and patient recovery and satisfaction, but only a few studies are included in the review and are relatively old. New research regarding this subject is needed to advise our patients most optimally in the future about the best anesthetic technique to be used when choosing for a laparoscopic sterilization procedure. [ABSTRACT FROM AUTHOR]

Farmers in Ethiopia are elementary for the implementation of land use policies. However, in order to effectively implement these policies, they need to be aware of them, and accept them accordingly. In this study we assess to what extent farmers in the Central Rift Valley are aware of prevailing land use policies in their area, to what extent they participated in the development of these policies, and how they perceive the impacts of these policies, using interviews with local farmers as well as stakeholders from governmental institutions at various levels. Farmers and local governments indicated that there was very little participation in the development of land use policies. Contrary, government informants at higher level indicated the opposite, suggesting a gap between farmers and local governmental institutions on the one side and higher governmental institutions on the other side. The perceived lack of participation of farmers led to a lack of ownership, involuntary participation, and failure to use the local knowledge, all hampering the effective implementation of these policies. The recently introduced land registration and certification process was identified as an exception, as it was the result of a participatory process, generally leading to acceptance upon implementation. Despite their low policy awareness, farmers could identify the impacts of land use policies on land use and land cover change, as well as its impacts on their. Further improvement farmer participation in the development of land use policies could increase ownership and thus yield more effective implementation and avoid social unrest. [ABSTRACT FROM AUTHOR]

Urban green spaces are crucial for citizens’ wellbeing. Nonetheless, many Latin American cities struggle to provide sufficient and equitable green space distribution for their citizens. By looking at the Chilean capital Santiago as an example, this paper examines whether the growing urban agriculture movement provides a feasible opportunity to increase public urban green space access. It does so by using the policy arrangement approach to analyse change and stability in two policy domains: urban green space planning and urban agriculture. The paper investigates urban green spaces and urban agriculture and the role of practitioners, urban planners and policymakers. The analysis found opportunities for urban agriculture to facilitate the expansion of urban green spaces in Santiago if policy mechanisms enable private or public spaces to be maintained by citizen organizations. Such mechanisms may, however, encounter resistance from public agencies, as it is unresolved who is involved and who benefits from urban agriculture. The paper concludes that urban agriculture is an opportunity for urban greening in Santiago, although changes are needed in how green areas are planned and conceived. Additionally, urban agriculture should not be understood as a substitute for parks but as a complementary form of green space provision with a distinctive value. [ABSTRACT FROM AUTHOR]

This paper explains the capability theory of how HFT firms make allocation decisions under uncertainty, and shows how capability maximization is precisely consistent with utility theory. The issue, however, is how these firms actually make allocation decisions in practice. Using the Gioia methodology, this paper presents evidence from interviews with HFT professionals and specialist media that suggest that these firms are capability satisficers. Capability theory is also consistent with bounded rationality and the adaptive markets hypothesis, and defines the point at which these firms reach a satisfactory solution. Thus, capability reconciles mainstream theory and the more realistic, behavioral theories based on observation of industry practice. The methodology developed can be applied to any firm that makes algorithmic decisions under uncertainty. [ABSTRACT FROM AUTHOR]

Adenomyosis is a benign gynecologic condition arising from the uterine junctional zone. Recent studies suggest a relationship between adenomyosis and adverse obstetrical outcomes, but evidence remains conflicting. There is no large-scale study investigating obstetrical outcomes in women with adenomyosis using the gold standard of histopathologic diagnosis. This study aimed to investigate the prevalence of adverse obstetrical and neonatal outcomes in women with histopathologic adenomyosis and that of the general (Dutch) population. This retrospective population-based study used 2 Dutch national databases (Perined, the perinatal registry, and the nationwide pathology databank [Pathologisch Anatomisch Landelijk Geautomiseerd Archief], from 1995 to 2018) to compare obstetrical outcomes in women before histopathologic adenomyosis diagnosis to the general Dutch population without registered histopathologic adenomyosis. The adjusted odds ratios (95% confidence interval) were calculated for adverse obstetrical outcomes. The outcomes were adjusted for maternal age, parity, ethnicity, year of registered birth, induction of labor, hypertensive disorders in previous pregnancies, multiple gestation, and low socioeconomic status. The pregnancy outcomes of 7925 women with histopathologic adenomyosis were compared with that of 4,615,803 women without registered adenomyosis. When adjusted for confounders, women with adenomyosis had adjusted odds ratios of 1.37 (95% confidence interval, 1.25–1.50) for hypertensive disorders, 1.37 (95% confidence interval, 1.25–1.51) for preeclampsia, 1.15 (95% confidence interval, 1.07–1.25) for small-for-gestational-age infants, 1.54 (95% confidence interval, 1.41–1.68) for emergency cesarean delivery, 1.24 (95% confidence interval, 1.12–1.37) for failure to progress, 1.29 (95% confidence interval, 1.10–1.48) for placental retention, and 1.23 (95% confidence interval, 1.10–1.38) for postpartum hemorrhage. No increased risk of HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, placental abruption, or operative vaginal delivery or need for oxytocin stimulation was found. Women with a histopathologic diagnosis of adenomyosis showed an increased prevalence of hypertensive disorders of pregnancy and small-for-gestational-age infants, failure to progress in labor, and placental retention compared with the general population in previous pregnancies. This suggests that uterine (contractile) function in labor and during pregnancy is impaired in women with adenomyosis. [ABSTRACT FROM AUTHOR]

We have used two techniques (i.e. K–Ar and 40Ar/39Ar) on Icelandic obsidian samples to produce and more specially to estimate the quality and accuracy of the ages that can be obtained. Following a meticulous protocol, we were able to date six rhyolitic eruptions with an accuracy 7 to 40 times better than those obtained previously. Among these six rhyolites are the first published K–Ar and 40Ar/39Ar ages of Krafla. The combined K–Ar and 40Ar/39Ar approach produces not only highly precise but also accurate ages. Such high precision makes it possible to produce accurate reconstructions of ice thickness at a given location and time, to test whether there was a possible link between deglaciation and rhyolitic volcanism onset in Iceland, and to explore other possible applications of the 40Ar/39Ar dating method to paleo-environmental and paleo-climatic reconstruction at Iceland's latitude. Then, we investigate, by combining geochemistry (i.e. determination of major and trace element composition) and geochronology (i.e. dating of rhyolitic eruptions via K–Ar and 40Ar/39Ar dating) for a number of Icelandic rhyolitic volcanoes whose activity could be recorded in North Atlantic sedimentary cores as well as in Arctic ice. The aim of this approach is to provide new independent anchors and correlations between climate records. Of the six dated eruptions, we propose that one is record in North Atlantic sediments, the Loðmundur eruption that constitutes one of the Kerlingarfjöll tuyas, which we date at 189.9 ± 1.1 ka and assume to be the source of the tephra recognized in core MD04-2822 at a depth of 3630–3631 cm. [ABSTRACT FROM AUTHOR]

• We provide a detailed insight into the complex coevolution dynamics that shape the alignment process. • We make clear that alignment is not a stable "state", as the factors and their interplay are subject to continuous change. • We provide cumulative visualizations of the complex network of feedback loops shaping the alignment process. • Our study does justice to the complexity of alignment by acknowledging the complex interplay between several factors. In this paper, we provide a detailed insight into the complex coevolution dynamics that shape the alignment process by analyzing how different mechanisms and factors are mutually related in complex networks of feedback loops. We combine insights from the literature on alignment as a (coevolution) process with literature on alignment as a state to identify the different components of the organization's socio-technical system that influence alignment, the relationships between these components, and the role that different factors play. In our empirical analysis (based multiple case studies) we then focus on the actual interplay between relevant factors. Using a causal loop diagramming approach - based on system dynamics – we analyze how these factors mutually influence each other through various feedback loops and thus shape the alignment process. We extend previous literature on the alignment process by identifying the way that the complex interplay between different factors shapes this process. By identifying the feedback loops between relevant factors, we also provide more insight into the complex bottom-up and top-down dynamics that shape the process, and that provide explanations for why this process is characterized by transitions between alignment and misalignment. For practice, our paper provides a deeper understanding of the alignment process, which is a precondition for improving alignment practices in organisations. [ABSTRACT FROM AUTHOR]