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Osteoporotic Fractures: Diagnosis, Evaluation, and Significance From the International Working Group on DXA Best Practices.
Get PDFOsteoporotic fractures, also known as fragility fractures, are reflective of compromised bone strength and are associated with significant morbidity and mortality. Such fractures may be clinically silent, and others may present clinically with pain and deformity at the time of the injury. Unfortunately, and even at the time of detection, most individuals sustaining fragility fractures are not identified as having underlying metabolic bone disease and are not evaluated or treated to reduce the incidence of future fractures. A multidisciplinary international working group with representation from international societies dedicated to advancing the care of patients with metabolic bone disease has developed best practice recommendations for the diagnosis and evaluation of individuals with fragility fractures. A comprehensive narrative review was conducted to identify key articles on fragility fractures and their impact on the incidence of further fractures, morbidity, and mortality. This document represents consensus among the supporting societies and harmonizes best practice recommendations consistent with advances in research. A fragility fracture in an adult is an important predictor of future fractures and requires further evaluation and treatment of the underlying osteoporosis. It is important to recognize that most fragility fractures occur in patients with bone mineral density T scores higher than -2.5, and these fractures confirm the presence of skeletal fragility even in the presence of a well-maintained bone mineral density. Fragility fractures require further evaluation with exclusion of contributing factors for osteoporosis and assessment of clinical risk factors for fracture followed by appropriate pharmacological intervention designed to reduce the risk of future fracture. Because most low-trauma vertebral fractures do not present with pain, dedicated vertebral imaging and review of past imaging is useful in identifying fractures in patients at high risk for vertebral fractures. Given the importance of fractures in confirming skeletal fragility and predicting future events, it is recommended that an established classification system be used for fracture identification and reporting
Identifying the optimal landscape configuration for landscape multifunctionality
Get PDFIncreased pressure on land resources to provide multiple benefits calls for landscape strategies that optimize the supply of multiple ecosystem services (ES). Previous research into the drivers of landscape multifunctionality have focused on land use composition changes, but the spatial configuration of different land use types also drives ES supply. While the impact of landscape configuration on individual ES is well understood, the net outcome of these influences when considering many ES is not. Here we present the net-balance spatial interactions hypothesis, which posits that the strength and direction of local and surrounding landscape influences on the local supply of an individual ES will drive its optimal landscape configuration. Accordingly, the net balance of these influences across multiple prioritized ES will determine the optimal configuration for landscape multifunctionality. Further, ES that share the same optimal configuration strategy form a bundle that can be managed together. Using data from German grasslands we demonstrate that the net-balance spatial interactions hypothesis is applicable to land-use planning scenarios that aim to maximize multiple ES. It allows general rules to be applied when local, detailed ES data is not available, and can help identify the best option to minimize trade-offs in the face of multiple competing land-use objectives
Holocene vegetation dynamics in southern Ukraine under changing land use and climate
Get PDFThe Holocene vegetation dynamics of the Eurasian steppe are underinvestigated despite its vast extension, chiefly because of the scarcity of suitable sites for palaeoecological research. Here, we present a palaeoecological reinvestigation from Kardashynskyi mire (southern Ukraine), approximately 4 km from a previously cored site. Using pollen, spores and microscopic charcoal, we have reconstructed vegetation dynamics, fire history and land use for the past c. 8300 years. Regionally, steppe vegetation with Poaceae, Chenopodiaceae and Artemisia was always dominant. However, pollen assemblages also reflect the presence of floodplain and upland tree stands. At the beginning of the sequence, c. 8300 years ago, Pinus stands were growing on the sandy terraces of the Dnipro dry upland sites. Later, at c. 7950 cal yr BP, diverse stands with Quercus, Ulmus, Fraxinus, Tilia and Alnus established along the riverbanks, where moisture availability was sufficient. Around 6100 cal yr BP, those deciduous broadleaved stands experienced a severe decline, likely in response to changing water table levels. Cultural indicators suggest land use activities after c. 7900 cal yr BP. During the Bronze Age, human impact intensified. Overall, both climate and humans drove vegetation dynamics in the Pontic steppe for millennia. Nowadays, this once extensive biome has almost completely been converted to cropland. Similarly, the wetland vegetation, the riparian forests and, above all, the pine forests growing on the sandy terraces were strongly reduced by millennial-long land use. Under the current conditions, even the last remnants of these special vegetation types are severely threatened
ReSurveyEurope : A database of resurveyed vegetation plots in Europe
Get PDFAims
We introduce ReSurveyEurope — a new data source of resurveyed vegetation plots in Europe, compiled by a collaborative network of vegetation scientists. We describe the scope of this initiative, provide an overview of currently available data, governance, data contribution rules, and accessibility. In addition, we outline further steps, including potential research questions.
Results
ReSurveyEurope includes resurveyed vegetation plots from all habitats. Version 1.0 of ReSurveyEurope contains 283,135 observations (i.e., individual surveys of each plot) from 79,190 plots sampled in 449 independent resurvey projects. Of these, 62,139 (78%) are permanent plots, that is, marked in situ, or located with GPS, which allow for high spatial accuracy in resurvey. The remaining 17,051 (22%) plots are from studies in which plots from the initial survey could not be exactly relocated. Four data sets, which together account for 28,470 (36%) plots, provide only presence/absence information on plant species, while the remaining 50,720 (64%) plots contain abundance information (e.g., percentage cover or cover–abundance classes such as variants of the Braun-Blanquet scale). The oldest plots were sampled in 1911 in the Swiss Alps, while most plots were sampled between 1950 and 2020.
Conclusions
ReSurveyEurope is a new resource to address a wide range of research questions on fine-scale changes in European vegetation. The initiative is devoted to an inclusive and transparent governance and data usage approach, based on slightly adapted rules of the well-established European Vegetation Archive (EVA). ReSurveyEurope data are ready for use, and proposals for analyses of the data set can be submitted at any time to the coordinators. Still, further data contributions are highly welcome
Correcting mortality estimates among children and youth on antiretroviral therapy in southern Africa: A comparative analysis between a multi-country tracing study and linkage to a health information exchange.
Get PDFOBJECTIVES
The objective of this study is to assess the outcomes of children, adolescents and young adults with HIV reported as lost to follow-up, correct mortality estimates for children, adolescents and young adults with HIV for unascertained outcomes in those loss to follow-up (LTFU) based on tracing and linkage data separately using data from the International epidemiology Databases to Evaluate AIDS in Southern Africa.
METHODS
We included data from two different populations of children, adolescents and young adults with HIV; (1) clinical data from children, adolescents and young adults with HIV aged ≤24 years from Lesotho, Malawi, Mozambique, Zambia and Zimbabwe; (2) clinical data from children, adolescents and young adults with HIV aged ≤14 years from the Western Cape (WC) in South Africa. Outcomes of patients lost to follow-up were available from (1) a tracing study and (2) linkage to a health information exchange. For both populations, we compared six methods for correcting mortality estimates for all children, adolescents and young adults with HIV.
RESULTS
We found substantial variations of mortality estimates among children, adolescents and young adults with HIV reported as lost to follow-up versus those retained in care. Ascertained mortality was higher among lost and traceable children, adolescents and young adults with HIV and lower among lost and linkable than those retained in care (mortality: 13.4% [traced] vs. 12.6% [retained-other Southern Africa countries]; 3.4% [linked] vs. 9.4% [retained-WC]). A high proportion of lost to follow-up children, adolescents and young adults with HIV had self-transferred (21.0% and 47.0%) in the traced and linked samples, respectively. The uncorrected method of non-informative censoring yielded the lowest mortality estimates among all methods for both tracing (6.0%) and linkage (4.0%) approaches at 2 years from ART start. Among corrected methods using ascertained data, multiple imputation, incorporating ascertained data (MI(asc.)) and inverse probability weighting with logistic weights were most robust for the tracing approach. In contrast, for the linkage approach, MI(asc.) was the most robust.
CONCLUSIONS
Our findings emphasise that lost to follow-up is non-ignorable and both tracing and linkage improved outcome ascertainment: tracing identified substantial mortality in those reported as lost to follow-up, whereas linkage did not identify out-of-facility deaths, but showed that a large proportion of those reported as lost to follow-up were self-transfers
A cellular mechanism contributing to pain-induced analgesia.
No full textThe anterior cingulate cortex (ACC) plays a crucial role in the perception of pain. It is consistently activated by noxious stimuli and its hyperactivity in chronic pain indicates plasticity in the local neuronal network. However, the way persistent pain effects and modifies different neuronal cell types in the ACC and how this contributes to sensory sensitization is not completely understood. This study confirms the existence of 2 primary subtypes of pyramidal neurons in layer 5 of the rostral, agranular ACC, which we could classify as intratelencephalic (IT) and cortico-subcortical (SC) projecting neurons, similar to other cortical brain areas. Through retrograde labeling, whole-cell patch-clamp recording, and morphological analysis, we thoroughly characterized their different electrophysiological and morphological properties. When examining the effects of peripheral inflammatory pain on these neuronal subtypes, we observed time-dependent plastic changes in excitability. During the acute phase, both subtypes exhibited reduced excitability, which normalized to pre-inflammatory levels after day 7. Daily conditioning with nociceptive stimuli during this period induced an increase in excitability specifically in SC neurons, which was correlated with a decrease in mechanical sensitization. Subsequent inhibition of the activity of SC neurons projecting to the periaqueductal gray with in vivo chemogenetics, resulted in reinstatement of the hypersensitivity. Accordingly, it was sufficient to enhance the excitability of these neurons chemogenetically in the inflammatory pain condition to induce hypoalgesia. These findings suggest a cell type-specific effect on the descending control of nociception and a cellular mechanism for pain-induced analgesia. Furthermore, increased excitability in this neuronal population is hypoalgesic rather than hyperalgesic
Impact of deformable image registration uncertainties for external beam radiotherapy applications
No full text[High-5-jD] Die European Association of Urology Risikogruppen Einteilung liefert eine zuverlässige Vorhersage für das BPFS und MFS bei Patienten, die eine PSMA-PET geplante salvage Strahlentherapie bei einem biochemischen Rezidiv eines Prostatakarzinoms erhalten
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Cervical cancer prevention and care in HIV clinics across sub-Saharan Africa: results of a facility-based survey.
Get PDFINTRODUCTION
To eliminate cervical cancer (CC), access to and quality of prevention and care services must be monitored, particularly for women living with HIV (WLHIV). We assessed implementation practices in HIV clinics across sub-Saharan Africa (SSA) to identify gaps in the care cascade and used aggregated patient data to populate cascades for WLHIV attending HIV clinics.
METHODS
Our facility-based survey was administered between November 2020 and July 2021 in 30 HIV clinics across SSA that participate in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We performed a qualitative site-level assessment of CC prevention and care services and analysed data from routine care of WLHIV in SSA.
RESULTS
Human papillomavirus (HPV) vaccination was offered in 33% of sites. Referral for CC diagnosis (42%) and treatment (70%) was common, but not free at about 50% of sites. Most sites had electronic health information systems (90%), but data to inform indicators to monitor global targets for CC elimination in WLHIV were not routinely collected in these sites. Data were collected routinely in only 36% of sites that offered HPV vaccination, 33% of sites that offered cervical screening and 20% of sites that offered pre-cancer and CC treatment.
CONCLUSIONS
Though CC prevention and care services have long been available in some HIV clinics across SSA, patient and programme monitoring need to be improved. Countries should consider leveraging their existing health information systems and use monitoring tools provided by the World Health Organization to improve CC prevention programmes and access, and to track their progress towards the goal of eliminating CC
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