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Spatial prioritization in systematic conservation planning has traditionally been developed for several to many species and/or habitats, and single-species applications are rare. We developed a novel spatial prioritization model based on accurate estimates of remotely-sensed data and maps of threats potentially affecting long-term species persistence. We used this approach to identify priority areas for the conservation of the Endangered Greek meadow viper Vipera graeca, a cold-adapted species inhabiting mountaintops in the Pindos Mountains of Greece and Albania. We transformed the mapped threats into nine variables to estimate conservation value: habitat suitability (climate suitability, habitat size, occupancy, vegetation suitability), climate change (future persistence, potential for altitudinal range shift) and land-use impact (habitat alteration, degradation, disturbance). We applied the Zonation systematic conservation planning tool with these conservation value variables as biodiversity features to rank the areas currently occupied by the species and to identify priority areas where the chances for population persistence are highest. We found that 90% of current habitats will become unsuitable by the 2080s and that conservation actions need to be implemented to avoid extinction as this is already a threatened species with a narrow ecological niche. If threats are appropriately quantified and translated into variables of conservation value, spatial conservation planning tools can successfully identify priority areas for the conservation of single species. Our study demonstrates that spatial prioritization for single umbrella, flagship or keystone species is a promising approach for the conservation of species for which few data are available.

Background: Takotsubo cardiomyopathy (TTC) is an important complication of subarachnoid hemorrhage (SAH), that may delay surgical or endovascular treatment and may influence patient outcome. This prospective follow-up study intended to collect data on the prevalence, severity, influencing factors and long-term outcome of TTC in patients suffering from non-traumatic SAH. Methods: Consecutive patients admitted with the diagnosis of non-traumatic SAH were included. Intitial assessment consisted of cranial CT, Hunt-Hess, Fisher and WFNS scoring, 12-lead ECG, transthoracic echocardiography (TTE), transcranial duplex sonography and collecting laboratory parameters (CK, CK-MB, cardiac troponin T, NT-proBNP and urine metanephrine and normetanephrine). Diagnosis of TTC was based on modified Mayo criteria. TTC patients were dichotomized to mild and severe forms. Follow-up of TTE, Glasgow Outcome Scale assessment, Barthel’s and Karnofsky scoring occurred on days 30 and 180.Results: One hundred thirty six patients were included. The incidence of TTC in the entire cohort was 28.7 %; of them, 20.6% and 8.1% were mild and severe, respectively. TTC was more frequent in females (30/39; 77%) than in males (9/39; 23%) and was more severe. The occurrence of TTC was related to mFisher scores and WFNS scores. Although the severity of TTC was related to mFisher score, Hunt-Hess score, WFNS score and GCS, multivariate analysis showed the strongest relationship with mFisher scores. Ejection fraction differences between groups were present on day 30, but disappeared by day 180, whereas wall motion score index was still higher in the severe TTC group at day 180. By the end of the follow-up period (180 days), 70 (74.5%) patients survived in the non-TTC, 22 (81.5%) in the mild TTC and 3 (27%) in the severe TTC group (n = 11) (p = 0.002). At day 180, GOS, Barthel, and Karnofsky outcome scores were higher in patients in the control (non-TTC) and the mild TTC groups than in the severe TTC group. Conclusions: Takotsubo cardiomyopathy is a frequent finding in patients with SAH, and severe TTC may be present in 8% of SAH cases. The severity of TTC may be an independent predictor of mortality and outcome at 6 months after disease onset. Therefore, a regular follow-up of ECG and TTE abnormalities is warranted in patients with subrachnoid hemorrhage for early detection of TTC. Trial registration: The study was registered at the Clinical Trials Register under the registration number of NCT02659878 (date of registration: January 21, 2016)

Background The paucity of easy-to-use, reliable objective neuromuscular monitors is an obstacle to universal adoption of routine neuromuscular monitoring. Electromyography (EMG) has been proposed as the optimal neuromuscular monitoring technology since it addresses several acceleromyography limitations. This clinical study compared simultaneous neuromuscular responses recorded from induction of neuromuscular block until recovery using the acceleromyography-based TOF-Watch SX and EMG-based TetraGraph. Methods Fifty consenting patients participated. The acceleromyography and EMG devices analyzed simultaneous contractions (acceleromyography) and muscle action potentials (EMG) from the adductor pollicis muscle by synchronization via fiber optic cable link. Bland–Altman analysis described the agreement between devices during distinct phases of neuromuscular block. The primary endpoint was agreement of acceleromyography- and EMG-derived normalized train-of-four ratios greater than or equal to 80%. Secondary endpoints were agreement in the recovery train-of-four ratio range less than 80% and agreement of baseline train-of-four ratios between the devices. Results Acceleromyography showed normalized train-of-four ratio greater than or equal to 80% earlier than EMG. When acceleromyography showed train-of-four ratio greater than or equal to 80% (n = 2,929), the bias was 1.3 toward acceleromyography (limits of agreement, –14.0 to 16.6). When EMG showed train-of-four ratio greater than or equal to 80% (n = 2,284), the bias was –0.5 toward EMG (–14.7 to 13.6). In the acceleromyography range train-of-four ratio less than 80% (n = 2,802), the bias was 2.1 (–16.1 to 20.2), and in the EMG range train-of-four ratio less than 80% (n = 3,447), it was 2.6 (–14.4 to 19.6). Baseline train-of-four ratios were higher and more variable with acceleromyography than with EMG. Conclusions Bias was lower than in previous studies. Limits of agreement were wider than expected because acceleromyography readings varied more than EMG both at baseline and during recovery. The EMG-based monitor had higher precision and greater repeatability than acceleromyography. This difference between monitors was even greater when EMG data were compared to raw (nonnormalized) acceleromyography measurements. The EMG monitor is a better indicator of adequate recovery from neuromuscular block and readiness for safe tracheal extubation than the acceleromyography monitor. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Background Certain surgical interventions may require a deep neuromuscular block (NMB). Reversal of such a block before tracheal extubation is challenging. Because anticholinesterases are ineffective in deep block, sugammadex 4 mg/kg has been recommended for the reversal of rocuronium- or vecuronium-induced deep NMB. However, this recommendation requires opening 2 vials of 200 mg sugammadex, which results in an increase in drug costs. Therefore, we sought a less expensive solution for the induction and reversal of deep NMB. Although the optimal dose of sugammadex for antagonism of deep block from pipecuronium has not been established, data pertaining to moderate block are available. Accordingly, we hypothesized that sugammadex 2 mg/kg would be a proper dose to reverse deep pipecuronium block, enabling us to avoid cost increases. In the present study, we compared sugammadex 2 mg/kg with the standard dose of 4 mg/kg for reversal of deep block from pipecuronium. Methods This single-center, randomized, double-blind, 2 parallel-arms, noninferiority study comprised 50 patients undergoing general anesthesia with propofol, sevoflurane, fentanyl, and pipecuronium. Neuromuscular monitoring was performed with acceleromyography (TOF-Watch SX). Noninferiority margin was specified beforehand as an increase in reversal time of no >10% (corresponding to 1 minute for the primary outcome). When the block spontaneously recovered to posttetanic count 1, the patients randomly received sugammadex 2 or 4 mg/kg, and the time from the injection to the train-of-four (TOF) ratio of 1.0 was measured. Primary outcome was the time to achieve the normalized TOF ratio of 0.9 in a particular patient. Residual or recurrent postoperative NMB was additional end point. Results Each patient recovered to the normalized TOF ratio of 0.9. In the 2 mg/kg group, reversal time was 1.73 ± 1.03 minutes (95% confidence interval [CI], 1.33-2.13; n = 25), and in the 4 mg/kg group, reversal time was 1.42 ± 0.63 minutes (mean ± standard deviation) (95% CI, 1.17-1.67; n = 25). The mean difference in reversal times between the 2 groups was 0.31 minutes (95% CI, -0.18 to 0.8), and the upper limit of CI was below the noninferiority margin of 1 minute. Postoperative block did not occur. Conclusions The effect of sugammadex 2 mg/kg was noninferior to that of 4 mg/kg in reversing posttetanic count-1 degree pipecuronium block. Sugammadex reversal of deep pipecuronium block appears to be effective.

International audience; The biodiversity crisis has led to a surge of interest in the theory and practice of biodiversity monitoring. Although guidelines for monitoring have been published since the 1920s, we know little on current practices in existing monitoring schemes.Based on metadata on 646 species and habitat monitoring schemes in 35 European countries, we developed indicators for sampling design, sampling effort, and data analysis to evaluate monitoring practices. We also evaluated how socio-economic factors such as starting year, funding source, motivation and geographic scope of monitoring affect these indicators.Sampling design scores varied by funding source and motivation in species monitoring and decreased with time in habitat monitoring. Sampling effort decreased with time in both species and habitat monitoring and varied by funding source and motivation in species monitoring.The frequency of using hypothesis-testing statistics was lower in species monitoring than in habitat monitoring and it varied with geographic scope in both types of monitoring. The perception of the minimum annual change detectable by schemes matched spatial sampling effort in species monitoring but was rarely estimated in habitat monitoring.Policy implications: Our study identifies promising developments but also options for improvement in sampling design and effort, and data analysis in biodiversity monitoring. Our indicators provide benchmarks to aid the identification of the strengths and weaknesses of individual monitoring schemes relative to the average of other schemes and to improve current practices, formulate best practices, standardize performance and integrate monitoring results.

Electronic neuromuscular monitoring is not widely used to determine either the reversal requirements for neuromuscular block before extubation of the trachea, or to determine if there is any subsequent postoperative residual neuromuscular block (PORNB).To investigate the incidence of PORNB using acceleromyography after spontaneous recovery of rocuronium-induced block and to compare this with the administration of sugammadex, neostigmine or a placebo.Partially randomised, partially randomised, placebo-controlled, double-blind, four-group parallel-arm study.Single-centre study performed between October 2013 and December 2015 in a university hospital.Of the 134 eligible patients, 128 gave their consent and 125 of these completed the study.Patients received general anaesthesia with propofol, sevoflurane, fentanyl and rocuronium. Neuromuscular transmission was measured by acceleromyography (TOF-Watch-SX; Organon Teknika B.V., Boxtel, the Netherlands) but the anaesthetist was blind to the results. If the anaesthetist deemed pharmacological reversal to be necessary before extubation of the trachea then patients were assigned randomly to receive either sugammadex (2.0 mg kg), neostigmine (0.05 mg kg) or a placebo. In the postanaesthesia care unit, an independent anaesthetist, unaware of the treatment given, assessed the neuromuscular function using acceleromyography.The incidence of a normalised train-of-four ratio less than 0.9 on arrival in the recovery room.In total, 125 patients were recruited. Neuromuscular block was allowed to recover spontaneously in 50 patients, whereas the remainder received either sugammadex (27), neostigmine (26) or placebo (22). The number of cases with PORNB were one (3.7%), four (15%), 13 (26%) and 10 (45%) after sugammadex, neostigmine, spontaneous recovery and placebo, respectively. Sugammadex and neostigmine were more effective than placebo [odds ratio (OR): 0.05, 95% confidence interval (CI): 0.005 to 0.403, P = 0.005; OR: 0.22, 95% CI: 0.056 to 0.85, P = 0.028, respectively]. Sugammadex performed better than spontaneous recovery (OR: 0.11, 95% CI: 0.014 to 0.89, P = 0.039) unlike neostigmine (OR: 0.52, 95% CI: 0.15 to 1.79, P = 0.297). Yet, antagonism (pooled data) was more effective than spontaneous recovery (OR: 0.3, 95% CI: 0.1 to 0.9, P = 0.03).Although pharmacological reversal based on clinical signs was superior to spontaneous recovery it did not prevent PORNB, irrespective of the reversal agent.The study is registered under EUDRACT number 2013-001965-17.

Background Rocuronium-induced neuromuscular block that spontaneously recovered to a train-of-four count of four can be reversed with sugammadex 0.5 or 1.0 mg/kg. We investigated whether these doses of sugammadex can also reverse vecuronium at a similar level of block. Methods Sixty-five patients were randomly assigned, and 64 were analyzed in this controlled, superiority study. Participants received general anesthesia with propofol, sevoflurane, fentanyl, and vecuronium. Measurement of neuromuscular function was performed with acceleromyography (TOF-Watch-SX, Organon Teknika B.V., The Netherlands ). Once the block recovered spontaneously to four twitches in response to train-of-four stimulation, patients were randomly assigned to receive sugammadex 0.5, 1.0, or 2.0 mg/kg; neostigmine 0.05 mg/kg; or placebo. Time from study drug injection to normalized train-of-four ratio 0.9 and the incidence of incomplete reversal within 30 min were the primary outcome variables. Secondary outcome was the incidence of reparalysis (normalized train-of-four ratio less than 0.9). Results Sugammadex, in doses of 1.0 and 2.0 mg/kg, reversed a threshold train-of-four count of four to normalized train-of-four ratio of 0.9 or higher in all patients in 4.4 ± 2.3 min (mean ± SD) and 2.6 ± 1.6 min, respectively. Sugammadex 0.5 mg/kg reversed the block in 6.8 ± 4.1 min in 70% of patients (P < 0.0001 vs. 1.0 and 2.0 mg/kg), whereas neostigmine produced reversal in 11.3 ± 9.7 min in 77% of patients (P > 0.05 vs. sugammadex 0.5 mg/kg). The overall frequency of reparalysis was 18.7%, but this incidence varied from group to group. Conclusions Sugammadex 1.0 mg/kg, unlike 0.5 mg/kg, properly reversed a threshold train-of-four count of four vecuronium-induced block but did not prevent reparalysis.

Summary The conservation of freshwater ecosystems has lagged behind that of marine and terrestrial ecosystems and often requires the integration of large-scale approaches and transboundary considerations. This study aims to set the foundations of a spatial conservation strategy by identifying the most important catchments for the conservation of freshwater biodiversity in Europe. Using data on 1296 species of fish, mollusc, odonate and aquatic plant, and the key biodiversity area criteria (species Red List status, range restriction and uniqueness of species assemblages), we identified a network of Critical Catchments for the conservation of freshwater biodiversity. Applying spatial prioritisation, we show how the prioritised network differs from the ideal case of protecting all Critical Catchments and how it changes when protected areas are included, and we also identify gaps between the prioritised network and existing protected areas. Critical Catchments (n = 8423) covered 45% of the area of Europe, with 766 qualifying (‘trigger’) species located primarily in southern Europe. The prioritised network, limited to 17% of the area of Europe, comprised 3492 catchments mostly in southern and eastern Europe and species targets were met for at least 96% of the trigger species. We found the majority of Critical Catchments to be inadequately covered by protected areas. However, our prioritised network presents a possible solution to augment protected areas to meet policy targets while also achieving good species coverage. Policy implications. While Critical Catchments cover almost half of Europe, priority catchments are mostly in southern and eastern Europe where the current level of protection is not sufficient. This study presents a foundation for a Europe-wide systematic conservation plan to ensure the persistence of freshwater biodiversity. Our study provides a powerful new tool for optimising investment on the conservation of freshwater biodiversity and for meeting targets set forth in international biodiversity policies, conventions and strategies.

The Corncrake is a threatened umbrella species for wet meadows, which mostly depends on managed grasslands. Therefore, effective conservation requires bird-friendly land management schemes and subsidies. Although the most important populations in Hungary usually breed in protected areas, some of these are regularly flooded, which forces Corncrakes to find breeding sites elsewhere. Such movements from protected/subsidised areas to suboptimal sites have risks for Corncrake populations and their conservation. Here, we describe a large-scale dynamic system of interlinked populations based on data from 4194 Corncrake territories found at four different sites (Aggtelek, Bodrogzug, Szatmár-Bereg and Zemplén regions) across eight years between 1997 and 2006 in NE Hungary (c. 1500 km2). The results showed that the total population fluctuated between 407 and 631 pairs and that the populations were more-or-less stable in the first four years (1997–2000). However, extended floods caused the disappearance of the species from the Bodrogzug region in 2005–2006, while in the other sites, the number of territories increased five-fold (Zemplén), three-fold (Aggtelek) and two-fold (Szatmár-Bereg). The correlation between the number of territories and maximum water level of river Tisza in April-May was negative in the Bodrogzug site and positive in the three other sites, indicating that interlinkages of the populations were associated with water levels. Our data thus support the hypothesis that many of the birds driven out by inundation of floodplain meadows moved to other sites in NE Hungary in flood years. These results suggest that even large, centrally located populations of Corncrake can be greatly exposed to risks of flooding and that it is highly important to maintain suitable alternative breeding sites for the species. The High Natural Value Areas programme may allow administrative and funding support to provide or extend protection and/or subsidies to maintain this large-scale dynamic system. To this end, the area managed in bird-friendly ways and subsidised under agri-environmental schemes was extended by 35,000 hectares in NE Hungary in 2009.

This study proposes a two-stage conservation planning approach. Firstly, the Land-Use Pattern Optimization-library is used to maximize the suitability of habitats for target species by optimizing configuration based on the current landscape. Secondly, the systematic conservation planning tool, Marxan is used to identify protected areas based on the estimated species distributions from the optimal landscape configuration. We compared our conservation plan for three target bird species from a highland farm with the conservation plan produced using Marxan alone. Our comparison showed the effectiveness of our approach by selecting a reserve network with higher habitat suitability, better connection, and smaller size after relatively minor landscape modification. The proposed approach advances previous reserve site selection algorithms by considering optimal landscape configuration and potential species distributions for a reserve network design. Our approach yields priority maps to guide the design of a reserve network as well as identify landscape management for conservation.

The aim of this study was to obtain epidemiological data and to determine the prevalence of adolescent hypertension implementing a blood pressure (BP) screening.We performed a cross-sectional, population-based survey in a major Hungarian city (Debrecen, population 230,000). After a 10-min resting period, three consecutive BP measurements were taken.Complete records were obtained for 10,194 subjects (5163 boys and 5031 girls). The mean age was 16.6±1.0 years. BP for boys was higher than for girls (ΔBP(syst)=11 mmHg; ΔBP(diast)=2 mmHg, p0.001). A significant decrease was observed in BP during the three consecutive measurements (time 1-3: ΔBP(syst)=4 mmHg; ΔBP(diast)=2.5 mmHg; p0.001). Systolic and/or diastolic BP exceeded the age-, gender- and height-adjusted 90th percentile in 1614 (15.84%) adolescents. Following two lots of three extra measurements on 1461 subjects of this sub-sample, hypertension (systolic and/or diastolic BP exceeded the 95th percentile) was confirmed in 2.12% of the subjects (male: 2.27%, female: 1.97%). Considering there were individuals either already diagnosed with hypertension (n=19) or refusing further participation, the prevalence of hypertension was 2.53% in adolescents in the age range 15-18 years.Our population-based study was the first to determine the point-prevalence of adolescent hypertension in Central-Eastern Europe. Identifying and following-up cases of confirmed hypertension is inevitable to prevent or delay the manifestations of target organ damage and reduce hypertension-related mortality.

AIMS AND SCOPE The aim of the present study was to assess whether a difference exists between intima-media thickness and the left ventricular mass index in healthy nonhypertensive, white-coat hypertensive and sustained hypertensive adolescents. PATIENTS AND METHODS Fifty-nine normotensive and 120 hypertensive adolescents were enrolled in our study. Hypertensive patients were classified into white-coat hypertension (WCH) and sustained hypertension groups based on 24-h ambulatory blood pressure measurements. Both normotensive and hypertensive individuals underwent routine laboratory tests, intima-media thickness measurements on the common carotid arteries and transthoracic echocardiography to measure the left ventricular mass index (LVMI). RESULTS Intima-media thickness was higher both in WCH and sustained hypertension compared with healthy normotensive individuals (controls: 0.048 ± 0.01 cm, WCH: 0.056 ± 0.01 cm, sustained hypertension: 0.054 ± 0.012 cm, both P < 0.001 compared with controls, nonsignificant difference between the two hypertensive groups). There was no difference between the LVMI of control individuals and WCH (LVMI: 35.5 ± 10.3 g/m and 37.7 ± 11.2 g/m respectively, P = 0.87). LVMI in sustained hypertension group (LVMI: 44.1 ± 14.1 g/m) was significantly higher both compared with WCH (P < 0.05), and healthy adolescents (P < 0.001). CONCLUSION Target-organ damage develops in a stepwise fashion in adolescent hypertension. An increased intima-media thickness can be demonstrated not only in the sustained but also in the white-coat form of adolescent hypertension.

The monitoring of biodiversity at the level of habitats is becoming widespread in Europe and elsewhere as countries establish national habitat monitoring systems and various organisations initiate regional and local schemes. Parallel to this growth, it is increasingly important to address biodiversity changes on large spatial (e.g. continental) and temporal (e.g. decade-long) scales, which requires the integration of currently ongoing monitoring efforts. Here we review habitat monitoring and develop a framework for integrating data or activities across habitat monitoring schemes. We first identify three basic properties of monitoring activities: spatial aspect (explicitly spatial vs. non-spatial), documentation of spatial variation (field mapping vs. remote sensing) and coverage of habitats (all habitats or specific habitats in an area), and six classes of monitoring schemes based on these properties. Then we explore tasks essential for integrating schemes both within and across the major classes. Finally, we evaluate the need and potential for integration of currently existing schemes by drawing on data collected on European habitat monitoring in the EuMon project. Our results suggest a dire need for integration if we are to measure biodiversity changes across large spatial and temporal scales regarding the 2010 target and beyond. We also make recommendations for an integrated pan-European habitat monitoring scheme. Such a scheme should be based on remote sensing to record changes in land cover and habitat types over large scales, with complementary field mapping using unified methodology to provide ground truthing and to monitor small-scale changes, at least in habitat types of conservation importance.

BACKGROUND: Pipecuronium is a steroidal neuromuscular blocking agent. Sugammadex, a relaxant binding [gamma]-cyclodextrin derivative, reverses the effect of rocuronium, vecuronium, and pancuronium. We investigated whether sugammadex reverses moderate pipecuronium-induced neuromuscular blockade (NMB) and the doses required to achieve reversal. METHODS: This single-center, randomized, double-blind, 5-group parallel-arm study comprised 50 patients undergoing general anesthesia with propofol, sevoflurane, fentanyl, and pipecuronium. Neuromuscular monitoring was performed with acceleromyography (TOF-Watch SX(R)) according to international standards. When the NMB recovered spontaneously to train-of-four count 2, patients randomly received 1.0, 2.0, 3.0, or 4.0 mg/kg of sugammadex or placebo. Recovery time from sugammadex injection to normalized train-of-four (TOF) ratio 0.9 was the primary outcome variable. The recovery time from the sugammadex injection to final T1 was the secondary end point. Postoperative neuromuscular functions were also assessed. RESULTS: Each patient who received sugammadex recovered to a normalized TOF ratio of 0.9 within 5.0 minutes (95% lower confidence interval for the lowest dose 70.1%; for all doses 90.8%) and 79% of these patients reached a normalized TOF ratio 0.9 within 2.0 minutes (95% lower confidence interval for the lowest dose 26.7%; for all doses 63.7%). T1 recovered several minutes after the TOF ratio. No residual postoperative NMB was observed. CONCLUSIONS: Sugammadex adequately and rapidly reverses pipecuronium-induced moderate NMB during sevoflurane anesthesia. Once the train-of-four count has spontaneously returned to 2 responses following pipecuronium administration, a dose of 2.0 mg/kg of sugammadex is sufficient to reverse the NMB.

Background Peritoneal insufflation results in hemodynamic changes during laparoscopic cholecystectomy. The aim of the present work is to test whether non-invasive applanation tonometry is suitable for reflecting these hemodynamic alterations. Methods 41 patients undergoing laparoscopic cholecystectomies were monitored using the SphygmoCor pulse wave analysing system. Peripheral blood pressures (PBP), central aortic blood pressures (CBP), augmentation index (ALX@HR75) and subendocardial viability ratio (SVR) were measured at rest (Phase 1), after anesthetic induction (Phase 2), after peritoneal inflation (Phase 3) and after peritoneal deflation (Phase 4). Results Induction of anesthesia resulted in a statistically significant reduction in both the peripheral blood pressure and central aortic pressures, accompanied by a decrease in augmentation pressure and augmentation index. Peripheral blood pressures did not change along with the peritoneal cavity insufflation, except for a moderate increase in systolic blood pressure. In contrast to this, an increase could be observed in central aortic pressure (106.77 ± 18.78 vs. 118.05 ± 19.85 mmHg, P

The aim of the present study was to assess whether a difference exists between endothelial function, intima–media thickness (IMT) and left ventricular mass index (LVMI) in healthy non-hypertensive, white-coat hypertensive (WCH) and sustained hypertensive (SH) adolescents. All young people attending high school in Debrecen, Hungary (n = 10,359) participated in the study. Three blood pressure (BP) measurements were taken separated by 5 min intervals. If their BP exceeded the 90th percentile stratified for gender, age and height, the measurements were repeated 2 more times. Based on 9 readings we found 216 hypertensive individuals. All measurements were obtained by a validated Omron M4 device. Fifty-nine normotensive and 120 hypertensive adolescents were enrolled in this study. Hypertensive patients were classified into WCH (n = 47) and SH (n = 73) based on 24-h ambulatory blood pressure measurements. Both normotensive and hypertensive individuals underwent routine laboratory tests, IMT measurements on the common carotid arteries and transthoracic echocardiography to measure LVMI. The nitric-oxide level of WCH adolescents were lower than the normotensives (30.6 ± 11 μmol/l vs. 38.8 ± 7.9 μmol/l; p

Setting aside protected areas is widely recognized as one of the most effective measures to prevent species from extinction. Accordingly, there has been a tremendous effort by governments worldwide to establish protected areas, resulting in over 100,000 sites, which are set aside, to achieve the 10% target proposed at the Fourth World Park Congress in 1992 in Caracas. The main effort of the European to achieve this target is the Natura 2000 network of protected areas, comprising over 25,000 sites representing 18 % of the area of the 27 Member States of the European Union. The designation of Natura 2000 sites was based on species and habitats listed in the Annexes of the Habitats and Birds Directive. The effectiveness of the selection process and the resulting Natura 2000 network has often been questioned as each country made its designations largely independently and in most cases without considering the theories of optimal reserve site selection. However, the effectiveness of the selection process and the Natura 2000 network has never been explicitly analysed at the European scale. Here we present such an analysis focusing on the representation of Annex II species of the Habitats Directive in the Natura 2000 network relative to a random allocation of species to sites. Our results show that the network is effective in covering target species and minimizing the number of gap species (i.e. species not represented in a single site of the Natura 2000 network). We demonstrate that the representation is uneven among species. Some species are overrepresented and many species are only represented in a low number of sites. We show that this is mainly due to differing patterns in species ranges, as wide-spread species are inevitably represented in many sites, but narrow ranged species are often covered only by a small number of sites in a particular area. Finally, we propose a representation index that detects species that are underrepresented and could be used to direct future conservation efforts.

This Editorial presents the focus, scope and policies of the inaugural issue of Nature Conservation, a new open access, peer-reviewed journal bridging natural sciences, social sciences and hands-on applications in conservation management. The journal covers all aspects of nature conservation and aims particularly at facilitating better interaction between scientists and practitioners. The journal will impose no restrictions on manuscript size or the use of colour. We will use an XML-based editorial workflow and several cutting-edge innovations in publishing and information dissemination. These include semantic mark-up of, and enhancements to published text, data, and extensive cross-linking within the journal and to external sources. We believe the journal will make an important contribution to better linking science and practice, offers rapid, peer-reviewed and flexible publication for authors and unrestricted access to content. The journal Nature Conservation was established within the framework of the European Union's Framework Program 7 large-integrated project SCALES: Securing the Conservation of biodiversity across Administrative Levels and spatial, temporal, and Ecological Scales, www.scales-project.net (grant 226852; Henle et al. 2010).

In recent decades, elevated levels of homocysteine (Hcy) have been found to be associated with an increased risk of vascular events. Additionally, in some case-control studies, hyperhomocysteinaemia has been found to be related to higher intima-media thickness (IMT), but the results are inconclusive. Therefore, in the present study we intended to assess the relationship between serum levels of Hcy and IMT in normotensive and hypertensive adolescents.59 normotensive 47 white coat hypertensive and 73 sustained hypertensive adolescents were included in our study. IMT of the common carotid arteries was measured by B-mode ultrasonography. Plasma NOx as well as homocysteine levels were measured in all cases. The relationship between IMT and Hcy and NOx were assessed by a pooled analysis. Additionally, serum levels of Hcy and NOx were compared between normotensives and hypertensive subgroups.IMT was elevated in hypertensive adolescents (means ± SD: 0.055 ± 0.01 cm) compared with normotensives (0.048 ± 0.008 cm, p0.01). Higher serum concentrations of homocysteine were measured in hypertensive teenagers (11.9 ± 7.25 µmol/l for hypertensive and 9.85 ± 3.12 µmol/l for normotensives respectively, p0.01). In contrast to this, serum NOx was lower in patients (28.8 ± 14.9 µmol/l) compared with controls (38.8 ± 7.6 µmol/l, p0.01). The pooling of homocysteine and IMT data of hypertensive and normotensive adolescents revealed a significant positive relationship between the two parameters (r = 0.43, p0.001).We conclude that elevated serum levels of homocysteine may play a role in increased IMT in adolescent hypertension.

Aim: To obtain epidemiological data on the blood pressure (BP) status of high school students and factors influencing BP. Methods: Subjects filled out a questionnaire and three repeated BP measurements were taken. All high school attending students in Debrecen (final sample n = 10,194, mean age 16.6 ± 1.0 years) participated in the study. Results: Boys had significantly higher systolic BP (+11.3 mm Hg) and diastolic BP (+2.2 mm Hg) than girls (p < 0.001). There was a positive correlation between weight and BP (rsyst = 0.42, rdiast = 0.29), height and BP (rsyst = 0.33, rdiast = 0.15), body mass index (BMI) and BP (rsyst = 0.31, rdiast = 0.27). Multiple regression was used for statistical analysis. Gender (β = 0.36), BMI (β = 0.25), hypertension of parents (father β = 0.04 and mother β = 0.02), smoking, alcohol consumption and age determined systolic outcomes in descending order. For the diastolic model, BMI remained a strong determining factor (β = 0.25) and gender was also significant (β = –0.09). Entering independents together accounted for 28.2% of the total variance in systolic and for 18.1% in diastolic BP. Conclusion: Body weight is central to determining BP. Because that is an alterable cardiovascular risk factor, we presume that lifestyle modification will not only result in reduced weight, but also in decreased BP.

Biodiversity conservation measures and biological processes often do not match in scale. The EU funded project SCALES (Securing the Conservation of biodiversity across Administrative Levels and spatial, temporal, and Ecological Scales) is intended to solve this challenge. SCALES analyses how selected pressures (climate change, habitat loss, fragmentation, disturbance), their drivers, and their impacts on biodiversity change with spatial and temporal scale. The project develops methods for a better understanding of scaling properties of biological processes from the genetic level to populations, communities, and ecosystem functions. SCALES also seeks ways to integrate the issue of scale into policy, decision-making, and biodiversity management, focusing on networks of protected areas, regional connectivity, and biodiversity monitoring.

The prevalence of adolescent hypertension is increasing. The national epidemiological study found 2.5% prevalence, while it is 4.5% according to the newest international survey. Repeated casual blood pressure measurements, but not ambulatory blood pressure monitoring is needed for the diagnosis of adolescent hypertension on the basis of the presently available European guideline. At the last decade growing evidence came into light for ambulatory blood pressure monitoring in adolescence. These data show better correlation with end-organ damages than casual measurements. In patients with hypertension diagnosed based on repeated casual blood pressure measurements, 24-hour monitoring showed normal blood pressure in 21-47%, so this is the rate of white coat hypertension. Masked hypertension can also be diagnosed with the help of this method, which has a prevalence of 7-11%. We can also get useful data for secondary forms of hypertension. Until the appearance of the new European guidelines, more frequent use of ambulatory blood pressure monitoring is affordable. The confirmation of the diagnosis based on elevated casual blood pressure data is important. Ambulatory blood pressure monitoring is suggested in cases suspicious for white coat or masked hypertension, in cases of target organ damages or therapy resistant hypertension. Before administration of pharmaceutical therapy in adolescence hypertension - according to author's opinion - ambulatory blood pressure monitoring is absolutely necessary.

Without robust and unbiased systems for monitoring, changes in natural systems will remain enigmatic for policy makers, leaving them without a clear idea of the consequences of any environmental policies they might adopt. Generally, biodiversity-monitoring activities are not integrated or evaluated across any large geographic region. The EuMon project conducted the first large-scale evaluation of monitoring practices in Europe through an on-line questionnaire and is reporting on the results of this survey. In September 2007 the EuMon project had documented 395 monitoring schemes for species, which represents a total annual cost of about 4 million euro, involving more than 46,000 persons devoting over 148,000 person-days/year to biodiversity-monitoring activities. Here we focused on the analysis of variations of monitoring practices across a set of taxonomic groups (birds, amphibians and reptiles, mammals, butterflies, plants, and other insects) and across 5 European countries (France, Germany, Hungary, Lithuania, and Poland). Our results suggest that the overall sampling effort of a scheme is linked with the proportion of volunteers involved in that scheme. Because precision is a function of the number of monitored sites and the number of sites is maximized by volunteer involvement, our results do not support the common belief that volunteer-based schemes are too noisy to be informative. Just the opposite, we believe volunteer-based schemes provide relatively reliable data, with state-of-the-art survey designs or data-analysis methods, and consequently can yield unbiased results. Quality of data collected by volunteers is more likely determined by survey design, analytical methodology, and communication skills within the schemes rather than by volunteer involvement per se.

International audience; Halting the loss of biodiversity comes along with the need to quantify biodiversity composition and dynamics at large spatial and temporal scales. Highly standardized, international monitoring networks would be ideal, but they do not exist yet. If we are to assess changes in biodiversity now, combining output available from ongoing monitoring initiatives is the only option. However, integration of biodiversity information across schemes is still very poorly developed. In this paper, we outline practical issues to be considered when planning to combine existing monitoring information. First, we provide an overview of avenues for integration along the four dimensions that characterize a monitoring design: sample size, biological coverage, spatial coverage and temporal coverage. We also emphasize that complementarity in monitoring targets across schemes enables to describe complex processes of biodiversity dynamics, e.g. through relating species traits to the impacts of environmental changes. Second, we review some methods to overcome differences in designs among monitoring schemes, such as site selection, post-stratification and measurement error. Finally, we point out some commonly used statistical methods that are at hand for combining data or parameter estimates. We especially emphasize the possible levels of data integration (raw data, parameter estimates, or effect size estimates), and the largely under-exploited potential of meta-analysis methods and weighted analyses. This contribution aims to bolster the practice and use of integration of ongoing monitoring initiatives for biodiversity assessment.

Monitoring of biodiversity at the level of habitats is becoming increasingly common. Here we describe current practices in habitat monitoring based on 150 schemes in Europe. Most schemes were initiated after 1990 in response to EU nature directives or habitat management/restoration actions, with funding mostly from European or national sources. Schemes usually monitor both the spatial distribution and the quality of the habitats, and they frequently collect data on environmental parameters and potential causes of changes. Many schemes are local or regional rather than national or international in scope, and sampling effort varies greatly across spatial and temporal scales. Experimental design is used in half of the schemes, however, data are rarely analysed by advanced statistics. Most schemes require two months or less per year in manpower and are typically run by professionals rather than by volunteers. Estimated salaries plus equipment costs average 650,000 Euro per year per scheme, and add up to 80 million Euros annually. Costs are particularly high for schemes based on European or international law and for schemes funded by European or national sources. Costs are also high in schemes in which sampling sites are selected subjectively rather than based on sampling theory, and in schemes that do not use field mapping or remote sensing to document spatial variation in habitats. Our survey demonstrates promising developments in European habitat monitoring but also underlines the need for better spatial coverage, documentation of spatial variaton, improved sampling design and advanced data analysis. Such improvements are essential if we are to judge progress towards the 2010 biodiversity targets.