pinecone/core-2020-05-10-deduplication huggingface dataset:
Clinical practices and attitudes regarding the diagnosis and management of heart failure : findings from the CORE Needs Assessment Survey.

Aims\ud
CORE is a continuing medical education initiative designed to support the evidence-based management of heart failure (HF) in the primary and secondary care settings. The goal of the CORE Needs Assessment Survey is to describe current clinical practice patterns and attitudes among global stakeholders in HF care.\ud
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Methods and results\ud
The CORE Steering Committee guided the development of survey questions to assess clinical practice, confidence, and attitudes/perceptions among cardiologists, primary care physicians, and nurses involved in HF management. In total, 346 healthcare professionals from Australia (n = 59), Austria (n = 59), Canada (n = 60), Spain (n = 58), Sweden (n = 52), and the UK (n = 58) contributed survey data. Results revealed multiple gaps over the spectrum of HF care, including diagnosis (low recognition of the signs and symptoms of HF and limited use of diagnostic tests), treatment planning (underuse of recommended agents and subtherapeutic dosing), treatment monitoring and adjustment (lack of adherence to recommendations), and long-term management (low confidence in providing patient education). Although primary care and specialist physicians and nurses shared common unmet needs, healthcare professional-specific clinical gaps were also identified.\ud
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Conclusions\ud
The CORE Needs Assessment Survey provides timely data describing current clinical practices and attitudes among physicians and nurses regarding key aspects of HF care. These findings will be useful for guiding the development of interventions tailored to the specific educational needs of different provider types and designed to support the evidence-based care of patients with HF
Does cardiac resynchronization therapy restore peripheral circulatory homeostasis?

Aims: To evaluate whether peripheral circulatory ‘remodeling’ as measured by changes in vascular compliance and in markers of nitric oxide signaling contributes to patient response to cardiac resynchronization therapy (CRT) Methods and results: Effects of CRT were evaluated in 33 patients pre- and 6 months post- procedure. Peak oxygen consumption (VO2 max), six-minute walk distance (6MWD), NYHA class, and quality of life score (QOL) were evaluated. Augmentation index (AIX) and its interactions with nitric oxide (NO) were evaluated by applanation tonometry. Platelet NO responsiveness and content of thioredoxin-interacting protein (TXNIP) were assessed. Plasma concentrationsof NT-proBNP, asymmetric and symmetric dimethylarginine (ADMA and SDMA), high sensitivity C-reactive protein, catecholamines and matrix metalloproteinases-2 and -9 were assessed. Despite significant improvement in 6MWD (p=0.005), NYHA class (p<0.001), QOL (p=0.001), and all echocardiographic parameters post CRT, there were no significant changesin AIx measurements, TXNIP content and platelet NO response. Significant falls in NTproBNP (p=0.008) and SDMA (p=0.013; independent of renal function) occurred. Falls in SDMA predicted reduction in hs-CRP (p=0.04) and increases in VO2max (p=0.04). There were no correlations between changes in echocardiographic parameters and those in vascular function. Conclusions: These data suggest that the beneficial effects of CRT over 6 months are independent of any change in peripheral NO-related signaling. However there is evidence that suppression of inflammation occurs and its magnitude predicts extent of clinical improvement
Evaluation of an individualized dose titration regimen of patiromer to prevent hyperkalaemia in patients with heart failure and chronic kidney disease

AIMS  Hyperkalaemia risk precludes optimal renin-angiotensin-aldosterone system inhibitor use in patients with heart failure (HF), particularly those with chronic kidney disease (CKD). Patiromer is a sodium-free, non-absorbed potassium (K)-binding polymer approved for the treatment of hyperkalaemia. In PEARL-HF, patiromer 25.2 g (fixed dose) prevented hyperkalaemia in HF patients with or without CKD initiating spironolactone. The current study evaluated the effectiveness of a lower starting dose of patiromer (16.4 g/day) followed by individualized titration in preventing hyperkalaemia and hypokalaemia when initiating spironolactone.  METHODS AND RESULTS  This open-label 8-week study enrolled 63 patients with CKD, serum K4.3-5.1 mEq/L, and chronic HF, who, based on investigator opinion, should receive spironolactone. Eligible patients started spironolactone 25 mg/day and patiromer 16.8 g/day (divided into two doses), with patiromer titrated to maintain serum K4.0-5.1 mEq/L. Mean (standard deviation) serum Kwas 4.78 (0.51) mEq/L at baseline; weekly values were 4.48-4.70 mEq/L during treatment. Serum Kof 3.5-5.5 mEq/L at the end of study treatment (primary endpoint) was achieved by 57 (90.5%) patients; 53 (84.1%) had serum K4.0-5.1 mEq/L. One patient (1.6%) developed hypokalaemia, and two patients (3.2%) developed hypomagnesaemia. Spironolactone was increased to 50 mg/day in all patients; 43 (68%) patients required one or more patiromer dose titration. Adverse events (AEs) occurred in 36 (57.1%) patients, with a low rate of discontinuations [four (6.3%) patients]. The most common AE was mild to moderate abdominal discomfort [four (6.3%) patients].  CONCLUSIONS  In this open-label study, patiromer 16.8 g/day followed by individualized titration maintained serum Kwithin the target range in the majority of patients with HF and CKD, all of whom were uptitrated to spironolactone 50 mg/day, patiromer was well tolerated, with a low incidence of hyperkalaemia, hypokalaemia, and hypomagnesaemia
A novel cardiac output response to stress test developed to improve diagnosis and monitoring of heart failure in primary care.

Aims:\ud
Primary care physicians lack access to an objective cardiac function test. This study for the first time describes a novel cardiac output response to stress (CORS) test developed to improve diagnosis and monitoring of heart failure in primary care and investigates its reproducibility.\ud
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Methods and results:\ud
Prospective observational study recruited 32 consecutive primary care patients (age, 63 ± 9 years; female, n = 18). Cardiac output was measured continuously using the bioreactance method in supine and standing positions and during two 3 min stages of a step‐exercise protocol (10 and 15 steps per minute) using a 15 cm height bench. The CORS test was performed on two occasions, i.e. Test 1 and Test 2. There was no significant difference between repeated measures of cardiac output and stroke volume at supine standing and Stage 1 and Stage 2 step exercises (all P > 0.3). There was a significant positive relationship between Test 1 and Test 2 cardiac outputs (r = 0.92, P = 0.01 with coefficient of variation of 7.1%). The mean difference in cardiac output (with upper and lower limits of agreement) between Test 1 and Test 2 was 0.1 (−1.9 to 2.1) L/min, combining supine, standing, and step‐exercise data.\ud
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Conclusions:\ud
The CORS, as a novel test for objective evaluation of cardiac function, demonstrates acceptable reproducibility and can potentially be implemented in primary care
Are there specific MPI study parameters that can distinct ischemic from nonischemic cardiomyopathy

Many times MPI SPECT study proceeds to selective angiocardiography (CA) in patients with dilated cardiomyopathy without evidences of ischemic heart disease. But often, we faces pathological findings that results with normal CA results. The aim of our study was by retrospective analysis to identify MPI SPECT variables that can make distinction between ischemic and nonischemic dilated cardiomyopathy (ICM/NICM). MATERIAL AND METHODS We retrospectively analyzed 47 records of patients with dilated cardiomyopathy who underwent coronary arteriography 6 month prior or after MPI SPECT study. We divided them in two groups according to the CA results: Group 1 was patients with confirmed ICM, and Group 2 (patients without significant disease of major coronary arteries on CA) with NICM. We analyzed demographic data (age, gender), patient history for presence of major risk factors, functional status (CCSC and NYHA of the patient, prior MI, PCI or CABG, comorbidities, LBBB), CA data and MPI SPECT data. From MPI SPECT study we analyzed: type of stress (exercise/dypiridamol), hemodynamic, electrocardiographic and functional response to stress, MPI perfusion parameters, and left ventricular function parameters: LVEF at rest and after stress, LV volumes at rest and after stress, L/H ratio, TID, PF and PE rate at rest and after stress, type of perfusion defect (fix, reversible) extent and location of the defect
Abandonment of croplands: problem or chance for\ud
grassland restoration? Case studies from Hungary

In Central-and\ud
Eastern Europe, the collapse of socialist regimes resulted in a transformation\ud
of state-owned\ud
agricultural cooperatives to privately owned lands from the early 1990s onwards. These\ud
socioeconomic processes resulted in landscape-scale\ud
changes in biodiversity, ecosystem services and agricultural\ud
production. In parallel, large-scale\ud
abandonment of croplands, especially on sandy, salty or frequently\ud
inundated areas, became common. Abandoned croplands are usually sensitive to species invasions,\ud
and are hotspots of noxious weeds, posing threats both to agriculture and nature conservation. Grassland\ud
restoration on former croplands can be an effective strategy for suppressing these species. Thus, a common\ud
goal of nature conservation and agriculture can be the restoration of grasslands on former croplands to (1)\ud
suppress weed and/or invasive species in line with the EU policy “Good Farming Practices”, (2) support\ud
animal husbandry by creating meadows or pastures, and to (3) recover biodiversity and ecosystem services.\ud
In the present paper we report “best practices” of grassland restoration projects from Hungary. Our aim\ud
was to compare the effectiveness of spontaneous grassland recovery vs. active grassland restoration by seed\ud
sowing in terms of the recovery of biodiversity and ecosystem services, such as weed control and biomass\ud
production. Our results showed that grassland restoration on abandoned fields offers a viable solution for\ud
restoring biodiversity and ecosystem services. Seed sowing ensures higher weed control and biomass production,\ud
but results in lower biodiversity compared to spontaneous recovery. Both restoration methods can\ud
be cost-effective,\ud
or even profitable even within a relatively short period of a nature conservation project
Impacts of climate change on mangrove ecosystems: a region by region overview

Inter-related and spatially variable climate change factors including sea level rise, increased storminess, altered precipitation regime and increasing temperature are impacting mangroves at regional scales. This review highlights extreme regional variation in climate change threats and impacts, and how these factors impact the structure of mangrove communities, their biodiversity and geomorphological setting. All these factors interplay to determine spatially variable resiliency to climate change impacts, and because mangroves are varied in type and geographical location, these systems are good models for understanding such interactions at different scales. Sea level rise is likely to influence mangroves in all regions although local impacts are likely to be more varied. Changes in the frequency and intensity of storminess are likely to have a greater impact on N and Central America, Asia, Australia and East Africa than West Africa and S. America. This review also highlights the numerous geographical knowledge gaps of climate change impacts, with some regions particularly understudied (e.g., Africa and the Middle East). While there has been a recent drive to address these knowledge gaps especially in South America and Asia, further research is required to allow researchers to tease apart the processes that influence both vulnerability and resilience to climate change. A more globally representative view of mangroves would allow us to better understand the importance of mangrove type and landscape setting in determining system resiliency to future climate change
Terrestrial ecosystem health under long-term metal inputs: modeling and risk assessment

Metal contamination of soils may pose long-term risks to ecosystem health if not properly managed. Future projection of contamination trends, coupled with ecological assessment, is needed to assess such risks. This can be achieved by coupling dynamic models of soil metal accumulation and loss with risk assessment on the basis of projected metal levels. In this study, we modeled the long-term dynamics of Cu, Zn, and Cd in agricultural topsoils of a northern Chinese catchment (Guanting reservoir) and related projected metal levels to 2060 to ecological risk. Past metal dynamics were simulated using historical metal inputs from atmospheric deposition, irrigation, fertilizers, and animal manures. Modeling future dynamics was done using scenarios of projected metal input rates. Ecological risk assessment was done using the Potentially Affected Fraction (PAF) approach to estimate the combined toxic pressure due to the three metals. Modeled labile soil metals agreed well with measurements from monitoring in 2009 following adjustment of the porewater dissolved organic concentration. Metals were predicted to be largely retained in the topsoil. Projections were sensitive to changes in imposed soil pH, organic matter, and porewater dissolved organic carbon. Modeling suggests that decreases in input rates to between 5% and 7.5% of 2009 levels are required to prevent further accumulation. Computed PAFs suggest zinc makes the greatest contribution to ecological risk. Under the most conservative estimate of PAF, the threshold of potential ecological risk was reached before 2060 in two of the three future input scenarios
Forest-grassland biodiversity hotspot under siege: land conversion counteracts nature conservation

We report extent and rate of land use/land cover change in a forest–grassland mosaic of Rio Grande do Sul, Brazil, during a recent period of increasing conflicts between native habitat protection and conversion. The area is part of the Atlantic rain forest biome, a Global Biodiversity Hotspot. Analyzing Landsat and Google Earth imagery, and calculating an effective conservation risk index (ECRI) as ratio of converted to remnant area, we specifically compared the effectiveness of designated fully protected areas (FP-PAs) and Sustainable Use areas (SU-PAs) in preventing conversion of native forest and grassland habitats for agri-and silviculture, relative to areas outside. Grassland area decreased by 17%, corresponding to a net loss of 59,671 ha, in the entire area. Forest gains exceeded losses, and ECRI was zero inside Full Protection PAs. Non-native tree plantation area increased by 94% over the entire study area; cropland increased by 7%. Conversion for silviculture predominated outside the designated PAs and conversion for agriculture predominated inside the designated PAs. ECRI was generally higher for grassland than forest, and in SU-PAs, grassland ECRI was several times higher than in areas without any protection status. These developments are in stark contrast to the high standards of the Brazilian protected area system and corresponding International Union for Conservation of Nature and Natural Resources categories. They are due to protracted regularization of land conversion and establishment of designated protection areas. Furthermore, they reveal the dilemma of previously managed grasslands in strictly protected areas being eventually succeeded by forest, and the hazards of broad interpretation of the term “sustainable development”.Julia-Maria Hermann, Marion Lang, Juliana Gonçalves, and Heinrich Hasenac
Future wet grasslands: ecological implications of climate change

Wet grasslands are threatened by future climate change, yet these are vital ecosystems for both conservation and agriculture, providing livelihoods for millions of people. These biologically diverse, transitional wetlands are defined by an abundance of grasses and periodic flooding, and maintained by regular disturbances such as grazing or cutting. This study summarizes relevant climate change scenarios projected by the Intergovernmental Panel on Climate Change and identifies implications for wet grasslands globally and regionally. Climate change is predicted to alter wet grassland hydrology, especially through warming, seasonal precipitation variability, and the severity of extreme events such as droughts and floods. Changes in the diversity, composition, and productivity of vegetation will affect functional and competitive relations between species. Extreme storm or flood events will favor ruderal plant species able to respond rapidly to environmental change. In some regions, wet grasslands may dry out during heatwaves and drought. C4 grasses and invasive species could benefit from warming scenarios, the latter facilitated by disturbances such as droughts, floods, and possibly wildfires. Agriculture will be affected as forage available for livestock will likely become less reliable, necessitating adaptations to cutting and grazing regimes by farmers and conservation managers, and possibly leading to land abandonment. It is recommended that agri-environment schemes, and other policies and practices, are adapted to mitigate climate change, with greater emphasis on water maintenance, flexible management, monitoring, and restoration of resilient wet grasslands
Climate change adaptation to escape the poverty trap: role of the private sector

Climate change adaptation and poverty alleviation call for an integrated strategy, because poverty exacerbates the vulnerability to climate change and vice versa. The private sector, which has traditionally been excluded from adaptation planning, may contribute greatly to the development of an integrated strategy. Here, we identify the differences in adaptation trajectories between the private sector and communities by proposing a conceptual framework and report on a case study in a dryland area of China, where the private sector led a successful adaptation and poverty alleviation project. We found that their win–win strategy achieved both climate change adaptation and development, thereby helping a disadvantaged community to escape the poverty trap and achieve sustainable development. The private sector played a dominant role in the response, as this sector can adapt in ways that are not possible for governments or communities. We suggest that participatory governance that includes private-sector stakeholders is more likely to achieve sustainable development
Building the new international science of the agriculture–food–water–environment nexus in China and the world

The multiple, complex and systemic problems of the agriculture–food–water–environment nexus (“Nexus”) are among the most significant challenges of the 21st century. China is a key site for Nexus research amidst profound socio-environmental problems. The policy implications of these problems have been authoritatively summarized elsewhere. This study presents discussions at an international workshop in Guangzhou that asked instead “What science is needed to deliver the growing policy commitments regarding these challenges? And, What changes are needed to the science itself?” Understanding and effective intervention regarding the Nexus calls for a paradigm shift: to a new kind of science of (capacity for) international, interdisciplinary, and impactful research working with and within complex socio-natural systems. We here argue that science must become proactive in approach, striving only for “minimal harm” not “silver bullet” solutions, and adopting an explicitly long-term strategic perspective. Together, these arguments lead to calls for reorienting science and science policy in three ways: from short-term remediation to longer-term optimization; from a focus on environmental threats to one on the opportunities for international collaborative learning; and toward supporting new forms of scientific career. We bring these points together by recommending a new form of scientific institution: a global network of collaborative Nexus Centres, under the umbrella of a global Food Nexus Organization akin to those of the human genome and proteome
Guiding phosphorus stewardship for multiple ecosystem services

The essential role of phosphorus (P) for agriculture and its impact on water quality has received decades of research attention. However, the benefits of sustainable P use and management for society due to its downstream impacts on multiple ecosystem services are rarely acknowledged. We propose a conceptual framework—the “phosphorus-ecosystem services cascade” (PESC)—to integrate the key ecosystem processes and functions that moderate the relationship between P released to the environment from human actions and ecosystem services at distinct spatial and temporal scales. Indirect pathways in the cascade via soil and aquatic processes link anthropogenic P to biodiversity and multiple services, including recreation, drinking water provision, and fisheries. As anthropogenic P cascades through catchments, it often shifts from a subsidy to a stressor of ecosystem services. Phosphorus stewardship can have emergent ecosystem service co-benefits due to synergies with other societal or management goals (e.g., recycling of livestock manures and organic wastes could impact soil carbon storage). Applying the PESC framework, we identify key research priorities to align P stewardship with the management of multiple ecosystem services, such as incorporating additional services into agri-environmental P indices, assessing how widespread recycling of organic P sources could differentially impact agricultural yields and water quality, and accounting for shifting baselines in P stewardship due to climate change. Ultimately, P impacts depend on site-specific agricultural and biogeophysical contexts, so greater precision in targeting stewardship strategies to specific locations would help to optimize for ecosystem services and to more effectively internalize the downstream costs of farm nutrient management
Which metal represents the greatest risk to freshwater ecosystem in Bohai Region of China?

Metals discharged from industrial effluents, agricultural wastewater, and sewage runoff by rapid urbanization are of concern as contaminants of freshwater ecosystem because of their persistence and high toxicity to aquatic organisms. This study attempted to identify which metal posed the greatest risk to freshwater ecosystem in the Bohai Region, China. The metals arsenic (As), cadmium (Cd), chromium (Cr), copper (Cu), zinc (Zn), lead (Pb), nickel (Ni), mercury (Hg), iron (Fe), and manganese (Mn) were compared against norfloxacin and gamma-hexachlorocyclohexane (lindane). By comparing the median reported environmental and ecotoxicity concentrations, it showed that Cu, Fe, Zn, Mn, and Cr were the top five metals of concern. Of these, Cu was deemed to represent the highest risk and Hg the lowest risk. The risks for all metals were higher than those for norfloxacin and lindane. Almost all the metals except Hg had water concentrations that exceeded levels where ecotoxicity effects had been recorded in the literature. A comparison with the measurements across the UK rivers suggested that all metals examined had water concentrations about 5- to 10- fold higher than the UK median values except for Cu, Fe, Cd, and Pb. The Fuyang River, a tributary of the Haihe River Basin, seemed to be the location with the highest metal concentrations. However, comparing the post- 2010 period to 2000–2009, concentrations of all the metals had fallen except for Fe and Mn, so risks have decreased over the last 7 yr with the greatest improvements for Cd and Pb. While metals still pose high risks to freshwater ecosystem in this region, there is encouragement that some control measures are taken into effect