Towards an inclusive nature conservation initiative: Preliminary assessment of stakeholders' representations about the Makay region, Madagascar.

The existence of multiple perspectives and representations of different stakeholders poses critical challenges to conservation initiatives worldwide. Thus, to foster more just and sustainable agendas in protected areas (PAs), this diversity of perspectives must be better understood, acknowledged, and tackled. In this article, we aimed to initiate this understanding for the Makay region in Madagascar, a poorly-known region where a 'New Protected Area' has been gazetted. In combining mental models and social representation theory, we explored different stakeholders' perspectives about the Makay social-ecological system, and how differences in stakeholders' viewpoints could challenge the success of an inclusive, just, and sustainable conservation program. We conducted semi-structured interviews with 32 respondents having different expertise on the Makay. During interviews, respondents were guided towards the elicitation of their individual cognitive map (ICM) of the Makay social-ecological system. ICMs were then analyzed in combining quantitative and qualitative. Respondents described the Makay through a total of 162 components, including 51 components that constituted the central zone of the Makay's representation. In particular, respondents pointed to insecurity issues caused by zebu thieves, as well as to environmental challenges relative to anthropogenic fires and hunting. On the contrary, they considered mining activities and timber harvesting as more peripheral problems. Through a multivariate clustering analysis, we discriminated two clusters of respondents with contrasting visions about the Makay, ecocentric vs. social-ecological, which was largely influenced by respondents' background. In comparing the two clusters' representations, we found that they had dissimilar diagnoses about key socio-environmental challenges in the Makay and how to address them. This ambiguity in respondents' viewpoints stresses the need to increase research efforts in the Makay region to fill current knowledge gaps about this poorly known social-ecological system, and to foster social learning between stakeholders concerned by the Makay new PA.

How ecological research on human-dominated ecosystems incorporates agricultural and forestry practices: A literature analysis.

Understanding the nexus between practices and ecosystems is a critical challenge for sustainability, but it is unclear how ecological sciences have explored the question. To bring clarification, we conducted an analysis of ecology literature dealing with agricultural and forestry practices (AF practices), scanning a total of 27 556 references. Scientometric analyses showed that AF practices were addressed by 5.5% of ecology literature, and that this proportion increased from 2.5 to 8.1% between 1956 and 2017. Content analyses showed that research has mainly focused on monospecific systems in the Global North, predominantly using plot-level experimental approaches. Temporal monitoring, real-world practices and their social context were poorly investigated. This analysis stresses the need to reinforce research in complex agroecosystems, in particular in non-Western countries. Multilevel and spatio-temporal approaches, as well as participatory research, should also be encouraged to build a social-ecological understanding and formulate more grounded, relevant policy recommendations for sustainability.

Interface processes between protected and unprotected areas: A global review and ways forward.

Land-use changes and the expansion of protected areas (PAs) have amplified the interaction between protected and unprotected areas worldwide. In this context, 'interface processes' (human-nature and cross-boundary interactions inside and around PAs) have become central to issues around the conservation of biodiversity and ecosystem services. This scientific literature review aimed to explore current knowledge and research gaps on interface processes regarding terrestrial PAs. At first, 3,515 references related to the topic were extracted through a standardized search on the Web of Science and analyzed with scientometric techniques. Next, a full-text analysis was conducted on a sample of 240 research papers. A keyword analysis revealed a wide diversity of research topics, from 'pure' ecology to sociopolitical research. We found a bias in the geographical distribution of research, with half the papers focusing on eight countries. Additionally, we found that the spatial extent of cross-boundary interactions was rarely assessed, preventing any clear delimitation of PA interactive zones. In the 240 research papers we scanned, we identified 403 processes that were studied. The ecological effects of PAs were well documented and appeared to be positive overall. In contrast, the effects of PAs on local communities were understudied and, according to the literature focusing on these, were very variable according to local contexts. Our findings highlight key research advances on interface processes, especially regarding the ecological outcomes of PAs, the influence of human activities on biodiversity, and PA governance issues. In contrast, main knowledge gaps concern the spatial extent of interactive zones, as well as the interactions between local people and conservation actions and how to promote synergies between them. While the review was limited to terrestrial PAs, its findings allow us to propose research priorities for tackling environmental and socioeconomic challenges in the face of a rapidly changing world.

Inflammation and Aortic Stiffness: An Individual Participant Data Meta-Analysis in Patients With Inflammatory Bowel Disease.

BACKGROUND: The recent finding that aortic pulse wave velocity (aPWV) is increased in patients with inflammatory bowel disease may explain why the cardiovascular risk is increased despite the low prevalence of traditional cardiovascular risk factors. We aimed to test whether inflammation is associated with aortic stiffening in this setting after adjustment for major confounders and to perform subgroup analyses. METHODS AND RESULTS: A systematic literature search for aPWV in inflammatory bowel disease was performed using PubMed, Scopus, Web of Science, and Google Scholar databases (last accessed May 7, 2017). Inclusion criterion was peer-reviewed publications on clinical studies reporting original data. This study followed the Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data 2015 guidelines. Data were provided for 4 cohorts in 3 countries (151 participants with ulcerative colitis, 159 with Crohn's disease, and 227 control patients). Using aPWV, cohort-specific z scores were calculated after loge-transform and combined in meta-analysis to form pooled effects using a random-effects model. Compared with controls, aPWV was increased in patients with Crohn's disease (mean difference 0.78 z score; 95% confidence interval, 0.56-1.00 z score [P<0.001]) and ulcerative colitis (mean difference 0.75 z score; 95% confidence interval, 0.52-0.97 z score [P<0.001]). In an outlier-robust multivariate linear regression model adjusted for prespecified confounders, aPWV was associated with disease duration (years, ß=0.05 z score; 95% confidence interval, 0.02-0.08 z score [P<0.001]) and white blood cell count (billion cells/L, ß=0.07 z score; 95% confidence interval, 0.02-0.11 z score [P=0.002]) but not with markers of acute inflammation (C-reactive protein and erythrocyte sedimentation rate), cardiovascular risk factors, and therapy. CONCLUSIONS: The increased aPWV reported in patients with inflammatory bowel disease is associated with inflammation. CLINICAL TRIAL REGISTRATION: URL: http://www.crd.york.ac.uk. Unique identifier: PROSPERO 2016: CRD42016053070.

Natural ecosystem mimicry in traditional dryland agroecosystems: Insights from an empirical and holistic approach.

While the aim of Ecological Intensification is to enable the design of more sustainable and productive agricultural systems, it is not suited to dryland agroecosystems that are driven by non-equilibrium dynamics and intrinsic variability. Instead, a model based on mobility and variability management has been proposed for these agroecosystems. However, this model remains under-applied in southern Morocco where there have been few studies on the functioning of traditional agroecosystems. This paper focuses on an agroecosystem in the Moroccan Saharan fringe zone that combines agriculture and pastoralism in an acacia parkland. A grounded theory approach was used over a three-year investigation period (i) to highlight how agro-pastoral activities interface with environmental variability, and (ii) to analyze the formal and informal institutions that support these activities. Results show that farmers interface with rainfall variability through (i) an opportunistic agricultural calendar, (ii) a variation of cultivated areas, and (iii) crop diversification. Herders combine macro-mobility (nomads move over long distances to track rainfall) and micro-mobility (nomadic and sedentary herds are driven on a daily basis around settlements) to optimize the exploitation of ecological heterogeneity. During droughts, they also resort to State-subsidized forage supplies. Both cultivation and pastoral activities tend to interface with ecological dynamics and to mimic nature, resulting in a human-modified parkland that could be considered as a 'green agroecosystem'. The sustainability of natural resource use relies on flexible property rights, backed up by a social and cultural norm-based regulation system, that allow crop-livestock integration and landscape collective management. Despite encouraging results, the agroecosystem appears to be threatened by current agricultural policies, rural exodus and the lack of social recognition of nomadism. Nevertheless, because ecosystem mimicry of nature is often considered as a sound agricultural model for drylands, this case study could provide a basis for local development policies, and thus merits further attention from local managers and researchers.

[Metformin and kidney]. / Metformina e rene.

Metformin is the first choice among drugs used for the treatment of type II diabetes mellitus mainly because of several advantages: proven hypoglycemic effect, good safety profile, virtually no risk of hypoglycemia, body weight reduction, lipid-lowering effect, efficacy in preventing micro- and macrovascular complications as well as adverse cardiac and cerebrovascular events and reduced cost. Previous reports had shown an increased risk of lactic acidosis in patients receiving metformin. However, the current Guidelines have greatly limited this risk to certain categories of patients, such as those with severe chronic renal failure, particularly when predisposing risk factors such as administration of iodinated contrast are present. In this review, we reported the main data of the literature on the use of metformin in patients with chronic renal failure and both highly expected benefits and high potential risks.

Non-hemodynamically significant renal artery stenosis predicts cardiovascular events in persons with ischemic heart disease.

BACKGROUND/AIMS: Recently, we reported that small renal arteries, defined by a low reference diameter (RD) or minimal luminal diameter (MD), are independently associated with a low GFR, resistant hypertension, and onset of contrast-induced nephropathy and suggested a post-hoc analysis of CORAL trial based on RD categories. Here we hypothesized that RD and MD are markers of nontraditional cardiovascular risk factors and tested whether low RD and MD could impact the prognosis of patients with ischemic heart disease. METHODS: Prospective cohort study. We used proportional hazards models to analyze the first onset of cardiovascular events in relation with RD, MD, or percentage of renal artery stenosis (RAS) in those with low-to-moderate RAS (10-70%) (n = 181). RESULTS: During the median follow-up of 4.5 (range, 0.1-5) years, 27.8% participants (n = 623; mean age, 64 years; 29% women) experienced a cardiovascular event (35.4% in those with RAS 10-70%). The presence of low-to-moderate RAS was associated with cardiovascular events. In these subjects, those with low MD were associated with a higher risk of cardiovascular events (MD >4.2 mm, HR: 1; MD 3.2-4.2 mm, HR: 1.66, 95% CI: 0.74-3.72, p = 0.22; MD <3.2 mm, HR: 3.72, 95% CI: 1.65-8.40, p = 0.002). When MD was added to a standard risk-factor model, risk prediction improvement was by 4.1%. Results were qualitatively similar if MD was replaced by RD or percentage of stenosis, but with smaller improvement of risk prediction and model fit. CONCLUSIONS: In patients with ischemic heart disease and low-to-moderate RAS, MD is a significant predictor of cardiovascular events, improves risk prediction, and may represent a valuable biomarker of cardiovascular disease risk.

Reference renal artery diameter is a stronger predictor of contrast-induced nephropathy than chronic kidney disease in patients with high cardiovascular risk.

INTRODUCTION: The incidence of contrast-induced nephropathy (CIN) increases in high cardiovascular risk patients. Chronic kidney disease (CKD) is a known risk factor for CIN development. In a previous report, we demonstrated that the mean reference renal artery diameter (RVD) is an important determinant of CKD in patients undergoing coronary angiography for ischemic heart disease. However, RVD was never tested as a predictor of CIN. AIM: To look at the predictors of CIN. METHODS: A total of 218 consecutive patients undergoing coronary and renal angiography were enrolled from the cohort of the RAS-CAD study (NCT 01173666). CIN was defined as a relative increase in baseline serum creatinine ≥25% within 1 week of contrast administration. RESULTS: The incidence of CIN was 22%. In a fully adjusted model, contrast medium dose (20 ml increase, OR 1.12, 95% CI 1.06-1.19, p < 0.001), iso-osmolar contrast media (OR 0.28, 95% CI 0.09-0.99, p < 0.05), atherosclerotic renovascular disease (OR 2.69, 95% CI 1.32-5.48, p < 0.05), and RVD (1 mm/1.73 m(2) increase, OR 0.59, 95% CI 0.41-0.86, p < 0.05) had the greatest effect on outcome and were identified as independent predictors of CIN. CKD was selected as a predictor of CIN only in a model without RVD. CONCLUSIONS: In patients undergoing coronary angiography for ischemic heart disease, RVD is a stronger predictor of CIN than CKD.