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Aims Maximal exercise capacity as measured by peak oxygen consumption (pVO2) in cardiopulmonary exercise testing (CPET) of heart transplant recipients (HTR) is limited to a 50–70% level of healthy age‐matched controls. This study investigated the relationship between body composition and pVO2 during the first decade post‐transplant. Methods and results Body composition was determined by dual‐energy X‐ray absorptiometry (DXA) and pVO2 by CPET in 48 HTR (n = 38 males; mean age 51 ± 12 years). A total of 95 assessments were acquired 1–9 years post‐transplant, and the results of four consecutive periods were compared [Period 1: 1–2 years (n = 25); 2: 3–4 years (n = 23); 3: 5–6 years (n = 23); 4: 7–9 years (n = 24)]. Linear regression analysis analysed the correlation between pVO2 and pairs of appendicular lean mass (ALM) and fat mass (FM). The relation between ALM and daily dose of calcineurin inhibitor (CNI) was explored using partial correlation controlling for age, gender, and height. pVO2 increased from 0.98 (0.34) to 1.35 (0.35) L/min (P 8.8 kg/m2). ALM normalized to body mass index increased from 0.690 (0.188) to 0.848 (0.204) m2 (P = 0.02) between Periods 1 and 4, explaining 45% of the variance of pVO2 (R 2 = 0.455; P

Scientists increasingly cross their disciplinary boundaries and connect with local stakeholders to jointly solve complex problems. Working with stakeholders means higher legitimacy and supports practical impact of research. Games provide a tool to achieve such transdisciplinary collaboration. In this paper, we explore the use of a game in a participatory project where scientists and local stakeholders are seeking and defining a joint problem. The literature is clear that this step is essential but remains short on concrete methods. Here, we explore this potential in practice. We conducted parallel participatory processes in two alpine regions considered as socio-ecological system (SES) in Switzerland and France, both vulnerable to global change. Based on these two case studies, we co-constructed a game, integrating scientific concerns about key land use, climate change and socio-economic elements of a mountain SES (tourism, agriculture, housing and demography). With the game, we assessed the existence of joint problems connecting scientific and local interests. The game successfully engaged participants at both sites over 11 game sessions, showing potential of use in other transdisciplinary settings. By covering a wide array of issues, the game created a discussion space for listing problems and identifying where scientist and stakeholder interests overlap. In Switzerland, the game revealed no pressing joint problem to be addressed. In France, game sessions revealed, among other problems, an enduring and complex issue regarding the co-existence of inhabitants and powerful institutions. Having demonstrated the capacity of this game for joint-problem assessment, we believe other participatory research in similar SES could benefit from an early use of such an approach to frame the potential for collaboration. Supplementary Information The online version contains supplementary material available at 10.1007/s11625-021-00983-2.

OBJECTIVE Exercise-induced respiratory symptoms (EIS) are common in childhood and reflect different diseases that can be difficult to diagnose. In children referred to respiratory outpatient clinics for EIS, we compared the diagnosis proposed by the primary care physician with the final diagnosis from the outpatient clinic and described diagnostic tests and treatments. DESIGN Observational study of respiratory outpatients aged 0-16 years nested in the Swiss Paediatric Airway Cohort (SPAC). PATIENTS We included children with EIS as main reason for referral. Information about diagnostic investigations, final diagnosis, and treatment prescribed came from outpatient records. We included 214 children (mean age 12 years, range 2-17, 54% males) referred for EIS. RESULTS The final diagnosis was asthma in 115 (54%), extrathoracic dysfunctional breathing (DB) in 35 (16%), thoracic DB in 22 (10%), asthma plus DB in 23 (11%), insufficient fitness in 10 (5%), chronic cough in 6 (3%), and other diagnoses in 3 (1%). Final diagnosis differed from referral diagnosis in 115 (54%, 95%-CI 46-60%). Spirometry, body plethysmography, and exhaled nitric oxide were performed in almost all, exercise-challenge tests in a third, and laryngoscopy in none. 91% of the children with a final diagnosis of asthma were prescribed inhaled medication and 50% of children with DB were referred to physiotherapy. CONCLUSIONS Diagnosis given at the outpatient clinic often differed from the diagnosis proposed by the referring physician. Diagnostic evaluations, management, and follow-up differed between clinics and diagnostic groups highlighting the need for evidence-based diagnostic guidelines and harmonised procedures for children seen for EIS. This article is protected by copyright. All rights reserved.

A profound understanding of actors’ perspectives on issues to be resolved is essential for researchers and practitioners in integrated natural resource management. Existing mental model approaches ...

ZusammenfassungDie vorliegende Fassung der deutschsprachigen AWMF-Leitlinie soll unter Berücksichtigung der vorliegenden Evidenz die medizinische Versorgung von Kindern und Jugendlichen mit ambulant erworbener Pneumonie (pediatric community acquired pneumonia, pCAP) verbessern. In Mitteleuropa steht einer Prävalenz von ca. 300 Fällen pro 100 000 Kinder/Jahr eine sehr geringe Mortalität gegenüber, die Prävention umfasst Hygiene-Maßnahmen und Impfung z. B. gegen Pneumokokken, Hämophilus, Masern und Influenza. Hauptsymptome der pCAP sind Fieber und Tachypnoe, die Diagnosestellung erfolgt primär klinisch durch Anamnese, körperliche Untersuchung und Pulsoxymetrie. Das zusätzliche Vorliegen von Warnsymptomen wie stark reduzierter Allgemeinzustand, Nahrungsverweigerung, Dehydratation, Bewusstseinsstörung oder Krampfanfälle definiert die schwere pCAP in Abgrenzung zur nicht-schweren pCAP. Das Erregerspektrum ist altersabhängig, zur Differenzierung zwischen viraler, bakterieller oder gemischt viral-bakterieller Infektion stehen jedoch keine zuverlässigen Biomarker zur Verfügung. Die meisten Kinder und Jugendlichen mit nicht-schwerer pCAP und O2-Sättigung > 92 % können ohne weitere Röntgen-, Labor- und Erreger-Diagnostik ambulant betreut werden. Der Einsatz von Antiinfektiva ist nicht grundsätzlich indiziert, vor allem bei jungen Kindern, bronchialer Obstruktion und anderen Hinweisen auf virale Genese kann darauf i. d. R. verzichtet werden. Zur kalkulierten Antibiotika-Therapie sind Aminopenicilline Mittel der Wahl, bei gewährleisteter Einnahme und Resorption sind die orale (Amoxicillin) und intravenöse Verabreichung (Ampicillin) von vergleichbarer Wirksamkeit. Nach 48 – 72 Stunden ist eine Verlaufsbeurteilung notwendig, um den Behandlungserfolg und mögliche Komplikationen wie z. B. parapneumonische Ergüsse oder Pleuraempyeme, die eine Erweiterung bzw. Änderung der Therapie erforderlich machen, rechtzeitig zu erfassen.

Forest frontiers worldwide reveal trade-offs that are key in mitigating global change. In the forest frontiers of northeast Madagascar, land-use changes result from decisions made by smallholder fa...

Background Asthma treatment should be modified according to symptom control and future risk, but there are scarce data on what drives treatment adjustments in routine tertiary care. Objective We studied factors that drive asthma treatment adjustment in pediatric outpatient clinics. Methods We performed a cross-sectional analysis of the Swiss Paediatric Airway Cohort, a clinical cohort of 0- to 16-year-old children seen by pediatric pulmonologists. We collected information on diagnosis, treatment, lung function, and FeNO from hospital records; and on symptoms, sociodemographic, and environmental factors from a parental questionnaire. We used reported symptoms to classify asthma control and categorized treatment according to the 2020 Global Initiative for Asthma guidelines. We used multivariable logistic regression to study factors associated with treatment adjustment (step-up or down vs no change). Results We included 551 children diagnosed with asthma (mean age, 10 years; 37% female). At the clinical visit, most children were prescribed Global Initiative for Asthma step 3 (35%). Compared with previsit treatment, 252 children remained on the same step (47%), 227 were stepped up (42%), and 58 were stepped down (11%). Female sex (adjusted odds ratio [aOR] = 1.61; 95% confidence interval [CI], 1.05-2.47), poor asthma control (aOR = 3.08; 95% CI, 1.72-5.54), and lower FEV1 Z-score (aOR = 0.70; 95% CI, 0.56-0.86 per one Z-score increase) were independently associated with treatment step-up, and low FeNO (aOR = 2.34; 95% CI, 1.23-4.45) was associated with treatment step-down, with marked heterogeneity between clinics. Conclusions In this tertiary care real-life study, we identified main drivers for asthma treatment adjustment. These findings may help improve both asthma management guidelines and clinical practice.

Frontiers in Environmental Science, 9, ISSN:2296-665X

UNLABELLED Altered arterial stiffness is a recognized risk factor of poor cardiovascular health. Chronic inflammation may increase arterial stiffness. We tested whether arterial stiffness is increased children with asthma, a chronic disease characterized by fluctuating airway and systemic inflammation. Arterial stiffness, expressed as carotid-femoral pulse wave velocity (PWVcf), was measured in 37 mild-to-moderate asthmatic children: 11 girls, median (range) age 11.1 years (6-15). PWVcf in asthma was compared to PWVcf in 65 healthy controls matched for age, height, and gender previously studied in Germany and was correlated with airway inflammation and obstruction. PWVcf was higher in asthmatic children compared to controls: PWVcf median (interquartile range) was 4.7 m/s (4.5-4.9) vs. 4.3 m/s (4.1-4.7), p

The identification of relationships between multiple ecosystem services (ES) (i.e. trade-offs, synergies and bundles) is essential for ES management. However, the identification of ES relationships may be susceptible to spatial autocorrelation — a statistical bias due to ES observations being related to each other across space. Spatial autocorrelation remains largely overlooked in the literature on ES relationships and its implications are not clear. Here we assess the implication of not accounting for spatial autocorrelation when determining ES relationships using four ES found in the city-state of Singapore. We quantify the ES relationships using some of the most common methods of determining relationships between ES: correlation, regression and principal component analysis. We then compare each method with the corresponding method that accounts for spatial autocorrelation. We found that accounting for spatial autocorrelation resulted in less statistically significant ES relationships, especially at finer resolutions, in correlations (33.3% less significant relationships) and regressions (50% less relationships). Depending on the spatial resolution, different ES were bundled when accounting for spatial autocorrelation when using principal component analysis. Our results suggest that not accounting for spatial autocorrelation in ES relationship studies is likely to result in the misidentification of ES trade-off, synergies and bundles. We thus recommend that future ES relationship studies consider the effects of spatial autocorrelation in their analyses., Ecological Indicators, 129, ISSN:1470-160X, ISSN:1872-7034

Primary ciliary dyskinesia (PCD) is a rare genetic disease characterized by dyskinetic cilia. Respiratory symptoms usually start at birth. The lack of diagnostic gold standard tests is challenging, as PCD diagnostics requires different methods with high expertise. We founded PCD-UNIBE as the first comprehensive PCD diagnostic center in Switzerland. Our diagnostic approach includes nasal brushing and cell culture with analysis of ciliary motility via high-speed-videomicroscopy (HSVM) and immunofluorescence labeling (IF) of structural proteins. Selected patients undergo electron microscopy (TEM) of ciliary ultrastructure and genetics. We report here on the first 100 patients assessed by PCD-UNIBE. All patients received HSVM fresh, IF, and cell culture (success rate of 90%). We repeated the HSVM with cell cultures and conducted TEM in 30 patients and genetics in 31 patients. Results from cell cultures were much clearer compared to fresh samples. For 80 patients, we found no evidence of PCD, 17 were diagnosed with PCD, two remained inconclusive, and one case is ongoing. HSVM was diagnostic in 12, IF in 14, TEM in five and genetics in 11 cases. None of the methods was able to diagnose all 17 PCD cases, highlighting that a comprehensive approach is essential for an accurate diagnosis of PCD.

Noise annoyance reactions in the population due to wind farms are related to visual as well as noise-related impacts of the farms. Improved understanding of these effects may support the planning of better accepted wind farms. Recently, tools for visualization and auralization of wind farms have been developed that allow mutually studying audio-visual effects on annoyance. The objective of this study was to investigate the audio-visual effects of different wind turbine noise situations on short-term noise annoyance in a psychophysical laboratory experiment, considering serial position effects (simple order and differential carryover effects). A set of 24 audio-visual situations covering a range of acoustical characteristics (sound pressure level, periodic amplitude modulation) and visual settings (landscape with visible wind turbine, landscape only, grey background) was created. The factorial design of the experiment allowed separating audio-visual effects from serial position effects on noise annoyance. Both visual and acoustical characteristics were found to affect noise annoyance, besides the participants’ attitude towards wind farms. Sound pressure level and amplitude modulation increased annoyance, the presence of a visualized landscape decreased annoyance, and the visibility of a wind turbine increased annoyance. While simple order effects could be eliminated by counterbalancing, the initial visual setting strongly affected the annoyance ratings of the subsequent settings. Due to this differential carryover effect, visual effects could be assessed reliably only as long as the participants saw the initial visual setting. Therefore, the presentation order of audio-visual stimuli should be carefully considered in experimental studies and in participatory landscape planning.

Nature Sustainability, 2 (4), ISSN:2398-9629

BackgroundExercise-induced breathing problems with similar clinical presentations can have different aetiologies. This makes distinguishing common diagnoses such as asthma, extrathoracic and thoracic dysfunctional breathing (DB), insufficient fitness, and chronic cough difficult.ObjectiveWe studied which parent-reported, exercise-induced symptoms (EIS) can help distinguish diagnoses of EIS in children seen in respiratory outpatient clinics.MethodsThis study was nested in the Swiss Paediatric Airway Cohort (SPAC), an observational study of children aged 0-17 years referred to paediatric respiratory outpatient clinics in Switzerland. We studied children aged 6-17 years and compared information on EIS from parent-completed questionnaires between children with different diagnoses. We used multinomial regression to analyse whether parent-reported symptoms differed between diagnoses (asthma as base).ResultsAmong 1109 children, EIS were reported for 732 (66%) (mean age 11 years, 318 of 732 [43%] female). Among the symptoms, dyspnoea best distinguished thoracic DB (relative risk ratio [RRR] 5.4, 95%CI 1.3-22) from asthma. Among exercise triggers, swimming best distinguished thoracic DB (RRR 2.4, 95%CI 1.3-6.2) and asthma plus DB (RRR 1.8, 95%CI 0.9-3.4) from asthma only. Late onset of EIS was less common for extrathoracic DB (RRR 0.1, 95%CI 0.03-0.5) and thoracic DB (RRR 0.4, 95%CI 0.1-1.2) compared with asthma. Localisation of dyspnoea (throat vs. chest) differed between extrathoracic DB (RRR 2.3, 95%CI 0.9-5.8) and asthma. Reported respiration phase (inspiration or expiration) did not help distinguish diagnoses.ConclusionParent-reported symptoms help distinguish different diagnoses in children with EIS. This highlights the importance of physicians obtaining detailed patient histories.Highlights boxWhat is already known about this topic?Experts suggest that information about the symptoms and their onset and duration can assist accurate diagnosis of children with exercise-induced respiratory problems, but no original studies have tested this. (29/35 words)What does this article add to our knowledge?Exercise-induced symptoms reported by parents and further information about their onset, triggers, and effects of treatment help differentiate diagnoses in children with exercise-induced respiratory problems. (25/35 words)How does this study impact current management guidelines?Our results emphasize the importance of taking detailed symptom histories of children with exercise-induced problems, and suggest which questions are most helpful.

Background Diagnosis of primary ciliary dyskinesia (PCD) is challenging since there is no gold standard test. The European Respiratory (ERS) and American Thoracic (ATS) Societies developed evidence-based diagnostic guidelines with considerable differences. Objective We aimed to compare the algorithms published by the ERS and the ATS with each other and with our own PCD-UNIBE algorithm in a clinical setting. Our algorithm is similar to the ERS algorithm with additional immunofluorescence staining. Agreement (Cohen's κ) and concordance between the three algorithms were assessed in patients with suspicion of PCD referred to our diagnostic centre. Results In 46 out of 54 patients (85%) the final diagnosis was concordant between all three algorithms (30 PCD negative, 16 PCD positive). In eight patients (15%) PCD diagnosis differed between the algorithms. Five patients (9%) were diagnosed as PCD only by the ATS, one (2%) only by the ERS and PCD-UNIBE, one (2%) only by the ATS and PCD-UNIBE, and one (2%) only by the PCD-UNIBE algorithm. Agreement was substantial between the ERS and the ATS (κ=0.72, 95% CI 0.53–0.92) and the ATS and the PCD-UNIBE (κ=0.73, 95% CI 0.53–0.92) and almost perfect between the ERS and the PCD-UNIBE algorithms (κ=0.92, 95% CI 0.80–1.00). Conclusion The different diagnostic algorithms lead to a contradictory diagnosis in a considerable proportion of patients. Thus, an updated, internationally harmonised and standardised PCD diagnostic algorithm is needed to improve diagnostics for these discordant cases., There is no gold standard test for diagnosing PCD. The use of existing diagnostic algorithms leads to contradicting results in many patients (15% in this study). Thus, an updated and internationally harmonised diagnostic guideline is needed. https://bit.ly/2U19Vvq

This work was supported by the US National Science Foundation through the Mountain Sentinels Research Coordination Network (NSF #1414106), the Swiss National Science Foundation through MtnPaths – Pathways for global change adaptation of mountain socio-ecological systems (#20521L_169916), and the Center for Collaborative Conservation at Colorado State University. As global environmental change continues to accelerate and intensify, science and society are turning to trans- disciplinary approaches to facilitate transitions to sustainability. Modeling is increasingly used as a technological tool to improve our understanding of social-ecological systems (SES), encourage collaboration and learning, and facilitate decision-making. This study improves our understanding of how SES models are designed and applied to address the rising challenges of global environmental change, using mountains as a representative system. We analyzed 74 peer-reviewed papers describing dynamic models of mountain SES, evaluating them according to characteristics such as the model purpose, data and model type, level of stakeholder involvement, and spatial extent/resolution. Slightly more than half the models in our analysis were participatory, yet only 21.6% of papers demonstrated any direct outreach to decision makers. We found that SES models tend to under-represent social datasets, with ethnographic data rarely incorporated. Modeling efforts in conditions of higher stakeholder diversity tend to have higher rates of decision support compared to situations where stakeholder diversity is absent or not addressed. We discuss our results through the lens of appropriate technology, drawing on the concepts of boundary objects and scalar devices from Science and Technology Studies. We propose four guiding principles to facilitate the development of SES models as appropriate technology for transdisciplinary applications: (1) increase diversity of stakeholders in SES model design and application for improved collaboration; (2) balance power dynamics among stakeholders by incorporating diverse knowledge and data types; (3) promote flexibility in model design; and (4) bridge gaps in decision support, learning, and communication. Creating SES models that are appropriate tech- nology for transdisciplinary applications will require advanced planning, increased funding for and attention to the role of diverse data and knowledge, and stronger partnerships across disciplinary divides. Highly contextualized participatory modeling that embraces diversity in both data and actors appears poised to make strong contributions to the world’s most pressing environmental challenges. Postprint

Ecosystem services assessments have the potential to support negotiating the complex trade-offs between conservation goals and other economic, political and social agendas across administrative borders, spatial and temporal scales. While earlier studies showed the global importance of tropical areas in supplying ecosystem services, the specific contribution of mountain areas has not been investigated in details. The degradation of mountain ecosystems driven by climate, demographic and economic changes is however increasingly threatening essential ecosystem services supply to people living in- and outside mountains. In this study, we present an assessment of eight ecosystem services in mountains across the world using high resolution earth observation datasets for 2000 and 2010. We link the ecosystem services supply data with an expert survey dataset to assess ecosystem services demand. We show that most mountain ranges show large patches of decreasing ecosystem services in areas characterized by high population pressure. By comparing ecosystem services supply of and demand for ecosystem services, we highlight the growing scarcity of highly demanded ecosystem services, in particular water, food and forage in mountain areas of Global South. Population growth in mountain regions and surrounding lowlands accentuate this trend and call for urgent solutions to sustainably manage ecosystems in mountain areas., Ecosystem Services, 46, ISSN:2212-0416

The paper evolves on the discourse of digital three-dimensional (3-D) modeling methods in the fields of landscape architecture and landscape planning. Digital design and planning methods used at present rely on mapping and modeling techniques that fall short of engaging the physical form of the landscape. However, form-specific knowledge is essential to understand how transformations can improve landscape functions, for example, in terms of providing ecosystem services and influencing climate in response to increasing heat in cities. The technical development of laser-scanning technology for landscape survey introduced new approaches over the last decade in working with geospatial data. Laser-scanning, or LiDAR, is now used to create digital 3-D representations of the landscape at high definition in the form of point clouds models. Beyond their function of representation, point cloud models can be manipulated to represent future landscape scenarios. Changes can be developed by editing the point cloud models and using the characteristics of form and scale of the physical site, resulting in an informed workflow of landscape transformation. In this paper, we address an existing gap in working concurrently with the analytical and spatio-visual properties of the landscape and propose a method that integrates landscape planning and design approaches by using point cloud models as a shared medium. We (i) propose a modeling method that employs laser-scanned data as a medium to represent landscape transformation and to enable a new level of inquiry for shaping future scenarios; (ii) exemplify with a case scenario in Singapore how point cloud models can be used to exchange analytical and spatial information for assessing thermal comfort; (iii) discuss the role that point cloud models can play in establishing a bridge between methods of landscape design and of landscape planning to develop the quality of urban landscapes. © 2020 ISSN:0169-2046 ISSN:1872-6062

Aims Mild or moderate aortic regurgitation (AR) has only little effect on cardiovascular outcome in people with normal left ventricular ejection fraction (EF); therefore, it is not perceived as a major clinical problem. This study investigates whether mild or moderate AR is associated with increased short‐term mortality in patients hospitalized for treatment of acute heart failure (AHF) and whether mild or moderate AR impacts differently on short‐term mortality in AHF patients with reduced EF (AHFrEF), mid‐range EF (AHFmrEF), or preserved EF (AHFpEF). Methods and results This mono‐centric study included 505 consecutive adult patients hospitalized for de novo or worsening chronic HF not related to acute ischaemia or severe valvular pathology in the echocardiogram at index hospitalization. Cox regression analysis studied the impact of AR on all‐cause mortality (ACM) over the 150 days' study period. Mild or moderate AR was associated with increased ACM (HR 1.75 [95% CI: 1.1–2.7]; P = 0.009). The prevalence of mild or moderate AR in the study population was 42% and not significantly different between AHFpEF (n = 227), AHFmrEF (n = 86), and AHFrEF (n = 192) study participants (37.9% vs. 50.0% vs. 42.7%; P = 0.144). In AHFpEF patients, the age‐adjusted hazard for ACM was increased in patients with AR compared with patients without AR (HR 2.17 [95% CI: 1.1–4.2]; P = 0.002). The age‐adjusted hazard for ACM was increased by a trend in AHFmrEF with AR (HR 7.11, [95% CI: 0.9–57.8]; P = 0.067) and not different between the AHFrEF groups (HR 0.95 [95% CI: 0.5–1.8]; P = 0.875). Conclusions Mild or moderate AR increased ACM only in AHFpEF patients, highlighting a distinct clinical relevance.

For centuries, mountain forests in the Alps have provided essential ecosystem services such as wood production and protection from natural hazards (e.g. avalanches and landslides), which enable mountain societies to thrive in these marginal environments. These ecosystem services are affected by climate and land use change, as well as changes in societal demand and management regimes. In recent years, the management of mountain forests has been increasingly driven by forest disturbances, such as windthrow, bark beetle outbreaks, and forest fires. The increasing rate of disturbances has the potential to convert forests from carbon sinks to carbon sources, and may also affect the provision of other ecosystem services, such as avalanche protection. The capacity of forests to provide services, their vulnerability to disturbance, and their resilience depend on their structure, composition and management regime. Forests with a heterogeneous structure and species composition are expected to better maintain their protection function after disturbances.Information on forest structure and its link to functions and services is available from a variety of sources, from Earth Observation and in-situ data, existing process-based models, to local expert knowledge. We use Bayesian Networks to integrate these different types of information and model ecosystem services (carbon sequestration, wood production, and avalanche protection) in the Swiss Alps. This probabilistic modelling approach allows us to identify knowledge gaps and explore uncertainties in the future provision of ecosystem services. Since disturbances are a major source of uncertainty, we combine remote sensing and forest management data to investigate how disturbance severity and post-disturbance recovery are influenced by stand characteristics, such as structural heterogeneity. Based on this analysis, we discuss how forest management can help ensure the provision of mountain forest ecosystem services under changing disturbance regimes.

Outcomes in acute decompensated heart failure remain poor, in particular when patients present with impaired renal function. Recent results indicate that treatment of acute decompensated heart failure patients with the Reitan catheter pump not only increases cardiac index, but also improves renal function resulting in maintained increase of diuresis. These favorable effects were achieved without significant hemolysis, bleeding or vascular complications suggesting that Reitan catheter pump treatment has the potential to facilitate recovery from acute decompensated heart failure with low output and complicated by renal dysfunction.

IntroductionDiagnosing asthma in children remains a challenge because respiratory symptoms are not specific and vary over time.AimIn a real-life observational study, we assessed the diagnostic accuracy of respiratory symptoms, objective tests and two paediatric diagnostic algorithms (proposed by the Global Initiative for Asthma (GINA) and the National Institute for Health and Care Excellence (NICE)) in the diagnosis of asthma in school-aged children.MethodsWe studied children aged 5–17 years who were referred consecutively to pulmonary outpatient clinics for evaluation of suspected asthma. Symptoms were assessed by parental questionnaire. The investigations included specific IgE measurement or skin prick tests, measurement of exhaled nitric oxide fraction (FeNO), spirometry, body plethysmography and bronchodilator reversibility (BDR). Asthma was diagnosed by paediatric pulmonologists based on all available data. We assessed diagnostic accuracy of symptoms, tests and diagnostic algorithms by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC).ResultsAmong 514 participants, 357 (70%) were diagnosed with asthma. The combined sensitivity and specificity was highest for any wheeze (sensitivity=75%, specificity=65%), dyspnoea (sensitivity=56%, specificity=76%) and wheeze triggered by colds (sensitivity=58%, specificity=78%) or by exercise (sensitivity=55%, specificity=74%). Of the diagnostic tests, the AUC was highest for specific total airway resistance (sRtot; AUC=0.73) and lowest for the residual volume (RV)/total lung capacity (TLC) ratio (AUC=0.56). The NICE algorithm had sensitivity=69% and specificity=67%, whereas the GINA algorithm had sensitivity=42% and specificity=90%.ConclusionThis study confirms the limited usefulness of single tests and existing algorithms for the diagnosis of asthma. It highlights the need for new and more appropriate evidence-based guidance.

ObjectiveExercise-induced respiratory symptoms (EIS) are common in childhood and reflect different diseases that can be difficult to diagnose. In children referred to respiratory outpatient clinics for EIS, we compared the diagnosis proposed by the referring primary care physician with the final diagnosis from the outpatient clinic and described diagnostic tests performed and treatment prescribed after the diagnostic evaluation.DesignObservational study nested in the Swiss Paediatric Airway Cohort (SPAC), which includes respiratory outpatients aged 0-16 years.PatientsWe included children with EIS as main reason for referral. Information about diagnostic investigations, final diagnosis, and treatment prescribed came from outpatient records.Results214 were referred for EIS (mean age 12 years, 99 (46%) female). The final diagnosis was asthma in 115 (54%), extrathoracic dysfunctional breathing (DB) in 35 (16%), thoracic DB in 22 (10%), asthma plus DB in 23 (11%), insufficient fitness in 10 (5%), chronic cough in 6 (3%), and other diagnoses in 3 (1%). Final diagnosis differed from referral diagnosis in 115 (54%). Spirometry, body plethysmography and measurements of exhaled nitric oxide were performed in almost all; exercise-challenge tests in a third. 91% of the children with a final diagnosis of asthma were prescribed inhaled medication and 50% of children with DB were referred to physiotherapy.ConclusionsDiagnosis given at the outpatient clinic often differed from the diagnosis suspected by the referring physician. Diagnostic evaluation, management and follow-up were inconsistent between clinics and diagnostic groups, highlighting the need for diagnostic guidelines in children seen for EIS.Mandatory statements for Archives of Disease in ChildhoodWhat is already known on this topic (2-3 statements of max 25 words)Exercise-induced symptoms are common in childhood but not easy to diagnose because different diagnoses share similar clinical presentationsOnly few studies focused on children with exercise-induced symptoms and all have included selected groups of patients with difficult-to-diagnose problemsWhat this study adds (2-3 statements of max 25 words)Exercise-induced respiratory symptoms was the main reason for referral in one fifth of the children referred to paediatric respiratory outpatient clinics.Dysfunctional breathing is an under-recognised diagnosis; it was frequently diagnosed in the outpatient clinic (in 37%) but rarely suspected by the referring physician (6%)Diagnostic evaluation, management, and follow-up were inconsistent between clinics highlighting the need for diagnostic guidelines in children seen for EIS.

Crop booms in forest frontiers are a major contributor to land conversion and deforestation. In this study, we investigate the smallholder-driven northern Laos rubber boom in two case study areas (CSAs) with different speed and intensity of rubber expansion. We assess the relative importance of market, contextual, and behavioral factors in fostering or hindering the conversion of forest to rubber plantations. We develop a Bayesian network (BN) model of land-use change based on household surveys, expert interviews, market price data, and land use maps covering the period 2000–2017. We use regression analysis to inform the structure of the BN, compare model results, and analyze time-varying effects. The BN and regression models incorporate perceived price signals as a combination of market price and local price knowledge, and local self-reinforcing imitation dynamics as a combination of aggregate rubber conversion and imitation behavior elicited in the survey. Results show that deforestation was lower in strictly protected areas but not in forests with lesser protection status. Imitation had a large effect on rubber uptake in both areas. In the CSA that experienced the most intensive spread of rubber, price signals transmitted through social networks had a significant impact, especially throughout the stage of rapid expansion. Rubber expansion continued in both areas during periods of descending prices mainly because of increased cash availability and access to inputs. Our research sheds light on the underlying dynamics of crop booms and contributes to the understanding of agricultural expansion processes., Environmental Science & Policy, 109, ISSN:1462-9011, ISSN:1873-6416

Degradation of ecosystems and the related loss of ecosystem services have called for new policies to achieve no net loss (NNL) of or even net gain between detrimental environmental impacts and restoration or preservation measures. While biodiversity offsetting has a long tradition, soils have rarely been considered in the accounting. Considering the crucial role of soil for ecosystem functioning and biodiversity and the increasing pressure on soil resources, we investigate how a NNL strategy building on a soil-based ecosystem services index can help steer sustainable spatial development. An ecosystem services’ soil quality index allows to explicitly address the interests of a broad range of stakeholder on soil uses. Using a market-driven spatial planning instrument based on a land price fee linked to the soil quality index, we demonstrate how soil quality loss and related ecosystem services could be reduced by up to 60% compared to current practice in a case study in Switzerland. More importantly, the suggested instrument allows to account for the spatial variability of the supply of the ecosystem services and the diversity of stakeholder demands for various soil qualities. We close with a discussion on the consequences of implementing a soil-based NNL strategy for spatial development and its generic application for steering settlement development., Journal of Environmental Management, 263, ISSN:0301-4797, ISSN:1095-8630

Recently, telemonitoring of vital signs has gained a lot of research interest. Especially for electrocardiogram (ECG), which is among the most frequently measured vital sign. However, the integration of classical ECG Holter in wearables is problematic since shielded cables and gel electrodes are required to get ECG signals of highest quality. We have recently introduced a novel sensing architecture based on active electrodes (so-called cooperative sensors) that significantly reduces the cabling complexity of the monitoring device. After briefly recalling the principle of cooperative sensors this paper details how they address rejection of common-mode voltage induced by electromagnetic disturbances. The proposed approach uses an auto-identification technique based on a continuous-time calibration of the sensor system and a digital control loop. To demonstrate the reliability of the proposed approach, a 12-lead ECG monitoring system was implemented with the new common-mode rejection method. Measurements on four healthy volunteers showed that the signal quality obtained with the cooperative-sensor system (using dry electrodes) is equivalent to the one measured with a gold standard medical device (using gel electrodes) in exercise stress tests.

Soils provide a broad set of vital ecosystem services (ES), yet soils are under threat worldwide. To avoid further degradation of soils and, in consequence, provision of soil-based ES, soil science has been calling for a comprehensive consideration of soil quality in decision-making, as soils are marginalized as a mere surface. Although a myriad of soil quality indicators exist, their disciplinary focus complicates discussion of conflicting soil uses. We present a novel approach to base soil quality not on soil function assessment alone but on a soil’s ability to support various ES. The soil quality index SQUID (Soil QUality InDicator) links a set of ten different soil functions to various ESs using an expert-based Delphi approach. We apply it to ten suburban municipalities in the Canton of Zurich, Switzerland, where fast development of urban structures has led to significant loss of fertile soils over the last two decades. To estimate the potential and the problems of the SQUID index, we compare it to an established soil quality index designed for spatial planning (BOKS – soil concept Stuttgart). Results suggest that SQUID is at a disadvantage for general overviews, but can be highly useful when detailed trade-off assessments are required. We conclude that the SQUID index might be a promising approach to better integrate soil quality into decision-making, as it has the potential to overcome disciplinary boundaries and to foster trade-off discussions between different, possibly conflicting soil use interests.

To protect fertile agricultural land and guarantee food security in regions that are strongly affected by urban growth, it is crucial to use and design appropriate policy instruments. In Switzerland, as well as in many other countries worldwide, one of the most important instruments for steering urban development is zoning. Zoning regulations are usually implemented at local governance levels (i.e. at municipality level) and have proven to effectively account for externalities. To determine whether zoning across municipalities could lead to a better protection of fertile agricultural soils, we developed an innovative approach based on multi-objective optimization. Using this approach we quantified the trade-off between reducing the loss of agricultural productivity and obtaining compact urban development patterns. We show that cooperation between municipalities is useful at two different stages in the decision-making process. Firstly, municipalities should cooperate when they define their environmental and socio-economic development goals and rank their preferences concerning different goals. Secondly, municipalities should cooperate when deciding on how much agricultural land should be converted into urban land. These results allow decision-makers to understand if zoning at a supra-municipal level significantly reduces the loss of agricultural productivity and should thus be favoured over zoning at the municipal level.

Recreation is a basic human need and therefore must be considered in spatial planning, which requires spatially explicit mapping of the recreation suitability of a landscape. The current methods for this type of mapping have limitations: On one hand, widely used expert-based models for large scale suitability assessments often suffer from discrepancies between the mapped values from expert assessment and actual user preferences. On the other hand, elicitation of personal preferences of potential users is complex and time-consuming, and their applicability to larger scales is limited. In this paper, we demonstrate the development of a spatially explicit model for the recreation suitability of the riverine zone that integrates the preferences of the users with an expert-based modeling process. First, we conducted an analytic hierarchy process (AHP) with experts to generate four different model variants based on physical variables. These model variants differ in terms of the strength of the influence of the variables on the recreation suitability. Second, an online survey was used to gather data on user preferences for various river sections with regard to recreation. A comparison of the expert model results with the preferences of the potential users shows a clear correlation between one model variant and the users’ preferences. This result suggests that it is possible to elaborate an expert model which corresponds to the preferences of users. We made the model results available for the planning and development of the riverine zone in the canton of Zurich. To this end, they were integrated in a decision support platform together with other planning-relevant information.

This report summarises three cases of Churg-Strauss syndrome (CSS) illustrating the diagnostic challenges associated with the cardiac manifestation of this disease. Here, we illustrate the role of cardiac magnetic resonance (CMR) for diagnosis and follow-up of CSS with a focus on new non-contrast T 2 -weighted imaging sequences for quantification of myocardial scar tissue and quantitative T 2 mapping techniques, which allow the detection of myocardial edema.

Ecosystem service (ES) mapping has been developed with the aim of supporting ecosystem management, but ES maps often lack information about uncertainty and risk, which is essential for decision-making. In this paper, we use a risk-based approach to map ES in mountain forests, which are experiencing an increasing rate of natural disturbances, such as windthrow, bark beetle outbreaks, and forest fires. These disturbances affect the capacity of forests to provide essential ecosystem services, such as protection from natural hazards, wood production, and carbon sequestration, thus posing a challenge for forest management. At the same time, disturbances may also have a positive effect on certain services, e.g. by improving habitats for species that rely on dead wood. We integrate forests’ susceptibility to natural disturbances into probabilistic Bayesian Network models of a set of ES (avalanche protection, carbon sequestration, recreation, habitats, and wood production), which combine information from remote sensing, social media and in-situ data, existing process-based models, and local expert knowledge. We use these models to map the level of the services and the associated uncertainties under scenarios with and without natural disturbances in two case study areas in the Swiss Alps. We use clustering to identify bundles of risk to ES, and compare the patterns of risk between the non-protected area of Davos and the strictly protected area of the Swiss National park with its surroundings. The spatially heterogeneous pattern of risk to ES reflects topographic variability and the forest characteristics that drive disturbance susceptibility, but also the demand for ecosystem services. In the landscape of Davos, the most relevant risks to ES are related to decreases in the protection against avalanches and carbon sequestration, as well as some risk to wood production and recreation. In the strictly protected Swiss National Park, the overall level of ES risk is lower, with an increase in habitat quality under the disturbance scenario. This risk-based approach can help identify stands with high levels of ES that are particularly susceptible to disturbances, as well as forests with a more stable ES provision, which can help define priorities in forest management planning.

Chronic respiratory symptoms, such as cough, wheeze and dyspnoea, are common in children; however, most research has, with the exception of a few large-scale clinical cohort studies, been performed in the general population or in small, highly-selected samples. The Swiss Paediatric Airway Cohort (SPAC) is a national, prospective clinical cohort of children and adolescents who visit physicians for recurrent conditions, such as wheeze and cough, and exercise-related respiratory problems. The SPAC is an observational study and baseline assessment includes standardised questionnaires for families and data extracted from hospital records, including results of clinically indicated investigations, diagnoses and treatments. Outcomes are assessed through annual questionnaires, monthly symptom reporting via mobile phone and follow-up visits. The SPAC will address important questions about clinical phenotypes, diagnosis, treatment, and the short- and long-term prognosis of common respiratory problems in children. The cohort currently consists of 347 patients from four major hospitals (Bern, Zurich, Basel and Lucerne), with 70–80 additional patients joining each month. More centres will join and the target sample size is a minimum of 3000 patients. The SPAC will provide real-life data on children visiting the Swiss healthcare system for common respiratory problems and will provide a research platform for health services research and nested clinical and translational studies., The Swiss Paediatric Airway Cohort (SPAC) is a unique research platform for common respiratory problems in children http://ow.ly/Y1v030lDnji

Aims Clinical studies suggest beneficial effects of renin–angiotensin system blockade for prevention of left ventricular (LV) dysfunction after chemotherapy. However, the efficacy of this strategy as primary prevention has been poorly studied. This study aimed at identifying the pathophysiological mechanisms by which mineralocorticoid receptor antagonism (MRA) or angiotensin converting enzyme inhibition (ACEi) provide protection against doxorubicin-induced cardiotoxicity (DIC) in mouse models of acute and chronic toxicity. Methods and results Acute DIC was induced by a single injection of Dox at 15 mg/kg and chronic DIC applied 5 injections of Dox at 4 mg/kg/week. MRA was achieved using eplerenone or cardiomyocyte-specific ablation of the MR gene in transgenic mice and ACEi using enalapril. Drugs were provided with the first dose of Dox and applied until the end of the study. In both model of DIC, Dox induced cardiac atrophy with decreased LV volume, reduced cardiomyocyte cell size, and cardiac dysfunction. In the acute model, neither MRA nor ACEi protected against these manifestations of DIC. In the chronic model, concomitant treatment with eplerenone did not protect against DIC and drastically increased plasma aldosterone levels and cardiac levels of angiotensin II type 1 receptor and of connective tissue growth factor (CTGF), as observed in acute DIC. Enalapril treatment in the chronic model, however, protected against cardiac dysfunction and cardiomyocyte atrophy and was associated with increased activation of the PI3K/AKT/mTOR pathway along with normal levels of CTGF. Conclusion Enalapril and eplerenone disparately impact on cellular signalling in DIC. Eplerenone, on top of Dox treatment was not protective and associated with increased levels of plasma aldosterone and of cardiac CTGF. In contrast, we show that primary prevention with enalapril preserves LV morphology and function in a clinically relevant model of chronic DIC, with increased stimulation of the PI3K/AKT/mTOR axis and normal CTGF levels suggesting potential therapeutic implications.

Urbanization is viewed as endangering more critical habitats of global value and is more ubiquitous than any other human activity affecting biodiversity, climate, water and nutrient cycles at multiple scales. Spatial and landscape planning can help create alternative urban patterns protecting ecosystems and thus supporting the provision of needed services they provide. While many approaches exist to make the values of nature explicit, new tools are needed to interpret the vast quantity of information in an integrated assessment to support planning. In this study, we present a new spatial decision support tool PALM (“Potential Allocation of urban development areas for sustainable Land Management”) aimed at supporting the allocation of urban development zones. A GIS-based MCDA approach was integrated into a web-based platform that allows distributing a requested amount of urban development areas within a selected perimeter based on ecosystem services and locational factors. The short running time of different user-defined scenarios allows exploring consequences and tradeoffs between decisions in an interactive way, thus making it a useful tool to support discussions in participatory planning processes. The results of the application of PALM in a case study region in Switzerland show that integrating ecosystem services when distributing urban development areas is particularly effective in urban peripheries, where building zones are shifted towards urban centers securing the productive soils located around cities. This shift of building zones from the urban peripheries to the urban centers when considering ecosystem services is less pronounced in rural areas, as they provide fewer ecosystem services. However, the results also show that integrating ecosystem services in spatial planning needs to be embedded in the right policy context: Ecosystem services can only be traded-off for locational factors if the perimeter of the case study ranges across municipalities. Whereas this transparent and flexible platform offers a suitable tool at the beginning of a planning process, we also discuss further development needs., Landscape and Urban Planning, 165, ISSN:0169-2046, ISSN:1872-6062

RationaleAcute viral respiratory tract infections in children with cystic fibrosis (CF) are known causes of disease exacerbation. The role of viral infections during infancy is, however, less known, although early infancy is thought to be a crucial period for CF disease development.We prospectively assessed symptomatic and asymptomatic viral detection in the first year of life in infants with CF and healthy controls.MethodsIn a prospective cohort study, we included 31 infants with CF from the Swiss Cystic Fibrosis Infant Lung Development Cohort and 32 unselected, healthy infants from the Basel Bern Infant Lung Development Cohort and followed them throughout the first year of life. Respiratory symptoms were assessed by weekly telephone interviews. Biweekly nasal swabs were analysed for 10 different viruses and two atypical bacteria with real-time seven duplex PCR (CF=561, controls=712).Measurements and resultsInfants with CF and healthy controls showed similar numbers of swabs positive for virus (mean 42% vs 44%; OR 0.91, 95% CI 0.66 to 1.26, p=0.6). Virus-positive swabs were less often accompanied by respiratory symptoms in infants with CF (17% vs 23%; OR 0.64, 95% CI 0.43 to 0.95, p=0.026). This finding was pronounced for symptomatic human rhinovirus detection (7% vs 11%; OR 0.52, 95% CI 0.31 to 0.9, p=0.02).ConclusionsViral detection is not more frequent in infants with CF and respiratory symptoms during viral detection occur even less often than in healthy controls. It is likely an interplay of different factors such as local epithelial properties and immunological mechanisms that contribute to our findings.

Traditionally managed agrarian landscapes provide several cultural ecosystem services (CES). Still, CES are often not adequately considered in decision-making – partly because of challenges in their quantification and economic valuation. We show that a state-of-the-art application of an economic valuation method to CES can generate meaningful data for supporting real-world, regional decision-making processes. After qualitative pre-studies (semi-structured interviews, stakeholder workshop) and a pilot study (n = 117), a discrete choice experiment (n = 252 respondents) was administered to a random sample of citizens in the Visp region of the Central Swiss Alps, a site with traditional agrarian landscapes. The design of the choice experiment followed an ecosystem services approach, and uses visualizations to support valuation of aesthetic landscape changes. A response rate of 43% was achieved. Citizen support was expressed for agricultural heritage (P

OBJECTIVES The impact of multidisciplinary care on outcome after heart transplantation (HTx) remains unclear. METHODS This retrospective study investigates the impact of multidisciplinary care on the primary end point 1-year all-cause mortality (ACM) and the secondary end point mean acute cellular rejection (ACR) grade within the first postoperative year. RESULTS This study includes a total 140 HTx recipients (median age: 53.5 years; males: 80%; donor/recipient gender mismatch: 38.3%; mean length of in-hospital stay: 34 days; mean donor age: 41 years). Multidisciplinary care was implemented in 2008, 66 HTx recipients had operation in 2000-07 and 74 patients had HTx thereafter (2008-14). Non-ischaemic dilated cardiomyopathy was more prevalent in HTx recipients of 2000-07 (63.6 vs 43.2%; P = 0.024). Pre-transplant mechanical circulatory support was more frequent in 2008-14 (9.1 vs 24.3%; P = 0.030). Groups were not different for pre-transplant cardiovascular risk factors or other comorbidity, invasive haemodynamics or echocardiographic parameters. In-hospital and 1-year ACM were numerically lower in 2008-14 (16.2 vs 22.2%; 18.9% vs 25.8%; P = 0.47/0.47, respectively). In 2000-07, pre-transplant weight and diabetes mellitus predicted in-hospital ACM (odds ratio −0.14, P = 0.02; OR 5.24, P = 0.01, respectively) while post-transplant length of in-hospital stay was related with in-hospital ACM (odds ratio −0.10; P = 0.016) and 1-year ACM (odds ratio −0.07; P = 0.007). In 2000-07, the mean grade of ACR within the first postoperative year was higher (0.65 vs 0.20; P

Ecosystem services (ES) management has to cope with a high degree of uncertainty related to changes in socio-economic and climatic conditions as well as in societal values. Information regarding the quantity and location of these uncertainties can facilitate identifying which areas require management attention and policy support. In this context, science for mapping ES is evolving rapidly, but there remains a lack of quantitative methods to integrate and visualize uncertainties related to regional and global changes that affect both ES supply and demand. Using a mountain case study in Switzerland, this paper quantifies and maps the uncertainty of future ES provision related to changes in regional and global socio-economic and climatic drivers as well as in ES preferences. We model and map patterns of (dis)agreements regarding ES in a multitude of scenarios and evaluate the magnitude and sources of uncertainty in these patterns. The results illuminate which drivers cause the highest levels of uncertainty in future ES provision and highlight areas where changes in ES are similar across scenarios or where changes are dependent on regional or global contexts. In this case study, changes in ES occur more consistently in remote areas, while in the main valley such changes are highly uncertain and particularly sensitive to national socio-economic drivers and climate change. The uncertainty maps can serve as a basis for discussing regional development plans and national policy strategies. The suggested approach could serve as a straightforward means to quantify and communicate spatial uncertainties in future ES studies.

Background Knowledge about the clinical spectrum of lung disease caused by variations in the ATP binding cassette subfamily A member 3 (ABCA3) gene is limited. Here we describe genotype-phenotype correlations in a European cohort. Methods We retrospectively analysed baseline and outcome characteristics of 40 patients with two disease-causing ABCA3 mutations collected between 2001 and 2015. Results Of 22 homozygous (15 male) and 18 compound heterozygous patients (3 male), 37 presented with neonatal respiratory distress syndrome as term babies. At follow-up, two major phenotypes are documented: patients with (1) early lethal mutations subdivided into (1a) dying within the first 6 months or (1b) before the age of 5 years, and (2) patients with prolonged survival into childhood, adolescence or adulthood. Patients with null/null mutations predicting complete ABCA3 deficiency died within the 1st weeks to months of life, while those with null/other or other/other mutations had a more variable presentation and outcome. Treatment with exogenous surfactant, systemic steroids, hydroxychloroquine and whole lung lavages had apparent but many times transient effects in individual subjects. Conclusions Overall long-term (>5 years) survival of subjects with two disease-causing ABCA3 mutations was

Background Coronary artery spasm (CAS) is an underdiagnosed disease especially in heart transplant patients, and in those patients the etiology and pathophysiology remain largely unknown, although it has been associated with cardiac allograft vasculopathy or graft rejection. Case presentation We report the case of a heart-transplant patient whose cardiac graft experienced two coronary vasospasms: the first before transplantation, and the other at one-month of a postoperative course complicated by primary graft failure. Conclusion Our case illustrates that a transplanted heart predisposed with coronary vasospasm may suffer from early relapse in the recipient despite of complete post-surgical autonomic denervation. Exacerbated endothelial dysfunction of the donor heart after transplant, with the addition of systemic factors in the recipient may be involved in the genesis of this puzzling phenomenon.

The measurement of an airborne concentration in Amosite fibers above 5035 F/m3 in a school prompted a retrospective quantitative health risk assessment. Dose estimates were built using air measurements, laboratory experiments, previous exposure data, and interviews. A dose response model was adapted for amosite-only exposure and adjusted for the life expectancy and lung cancer incidence in the Swiss population. The average yearly concentrations found were 52&ndash, 320 F/m3. The high concentration previously observed was not representative of the average exposure in the building. Overall, the risk estimates for the different populations of the school were low and in the range of 2 &times, 10&minus, 6 to 3 &times, 5 for mesothelioma and 4 &times, 7 to 8 &times, 6 for lung cancer. The results evidenced however that children have to be considered at higher risk when exposed to asbestos, and that the current reference method and target values are of limited use for amphibole-only exposures. This study confirmed that quantitative health risk assessments and participatory approaches are powerful tools to support public decisions and build constructive communication between exposed people, experts, and policy-makers.

OBJECTIVES The objective of this study was to analyse clinical characteristics, survival and adverse events of patients with advanced heart failure supported using the Abbott HeartMate 3 left ventricular assist device (LVAD). METHODS We retrospectively reviewed 42 consecutive HeartMate 3 recipients implanted in our centre between 1 November 2015 and 31 October 2019. RESULTS Our series comprised 39 males, aged 56.7 ± 11.8 years. Eleven (26%) patients had preimplant INTERMACS clinical profiles of 1 or 2. The mean duration support was 14.0 ± 10.6 months (range 0.69–44 months). During follow-up, 4 (10%) patients died while on support, 13 (35%) patients received a heart transplant and 25 patients are still ongoing. Actuarial survival after LVAD implantation was 88.4 ± 5.5% and 84.4 ± 6.6% at 1 and 2 years, respectively. There were no cases of pump thrombosis or technical malfunction. Seven (17%) patients required post-implant temporary right ventricular support. Adverse events included bleeding requiring surgery in 13 (31%) patients, gastrointestinal bleeding in 6 (14%) patients, LVAD-specific infections in 19 (45%) patients and non-disabling ischaemic stroke in 5 (12%) patients. The incidence of ischaemic stroke was significantly higher in patients where the outflow graft was anastomosed to the descending aorta as compared to those where it was anastomosed to the ascending aorta (P CONCLUSIONS We have observed satisfactory survival rates using the HeartMate 3 LVAD for long-term mechanical circulatory support. The absence of technical failure, pump thrombosis, haemolysis or need for pump exchange during our 4-year experience confirms its technical reliability and improved haemocompatibility, but bleeding complications and infections remain a concern.

Introduction Acute decompensated heart failure (ADHF) is associated with a high mortality and rehospitalization rate. The aim of this study was to assess whether echocardiographic markers of systolic and diastolic function, and their changes under treatment during hospitalization for ADHF, would predict 12-months mortality. Methods Adult patients admitted to our emergency department for ADHF between June 2015 and January 2018 were included if a complete transthoracic echocardiography (TTE) could be obtained within 12 hours of admission. TTE was repeated upon discharge. Baseline clinical and echocardiographic characteristics were collected on admission and at discharge, and outcome at 12 months was obtained by telephone interview. All parameters are given as median [interquartile range]. Results A total of 221 patients were identified but 45 excluded because of in-hospital death (n=8), early transfer to another hospital (n=31) or refusal to perform discharge TTE (n=6), leaving 176 patients for final analysis. Age was 83 [74–87] years, 95 (54%) were men and 89 (51%) were in sinus rhythm. Baseline TTE was performed within 6.6h [4.1–11.9] of admission and median duration of hospital stay was 13 days [9–19]. Admission ejection fraction (EF) was 45% [37–54] (29% HFrEF, 37% HFmrEF, 34% HFpEF). Between admission and discharge, significant changes were observed for global longitudinal LV strain (−10.3 [−7.2 to 15.1] to −11.8% [−8.1 to 15.0], p=0.017), mitral E velocity (100 [80–124] to 96 cm/s [74–117], p=0.001), E/e' ratio (16 [12–20] to 15 [11–19], p=0.003, RV basal diameter (41 [36–45] to 41mm [34–44], p=0.007), tricuspid regurgitation gradient (41 [34–52] to 35 mmHg [28–44], p=0.0001 and vena cava diameter (22 [19–26] to 19 mm [15–23],. Deaths occurred in 35 (20%) at 12 months follow-up. In our multivariable model, none of the changes in TTE parameters was predictive of mortality. Age (OR 1.09, p0.01), LVEF (OR 0.95, p0.02) and TAPSE (OR 0.86, p0.01) measured at discharge, but not LV or RV strain, were identified as independent predictors of 12-months mortality (see figure). Survival according to LVEF and TAPSE Conclusion Several changes in TTE parameters were observed during hospitalization for ADHF, reflecting effective cardiac unloading with diuretic treatment. However, none of these changes appears to have prognostic significance. LVEF and TAPSE at discharge were identified as the only independent echocardiographic predictors of 12-months mortality, in addition to age. Acknowledgement/Funding Swiss Heart Foundation