Cumulative effects of natural and anthropogenic disturbances on the forest carbon balance in the oil sands region of Alberta, Canada; a pilot study (1985-2012).

BACKGROUND: Assessing cumulative effects of anthropogenic and natural disturbances on forest carbon (C) stocks and fluxes, because of their relevance to climate change, is a requirement of environmental impact assessments (EIAs) in Canada. However, tools have not been developed specifically for these purposes, and in particular for the boreal forest of Canada, so current forest C assessments in EIAs take relatively simple approaches. Here, we demonstrate how an existing tool, the Generic Carbon Budget Model (GCBM), developed for national and international forest C reporting, was used for an assessment of the cumulative effects of anthropogenic and natural disturbances to support EIA requirements. We applied the GCBM to approximately 1.3 million ha of upland forest in a pilot study area of the oil sands region of Alberta that has experienced a large number of anthropogenic (forestry, energy sector) and natural (wildfire, insect) disturbances. RESULTS: Over the 28 years, 25% of the pilot study area was disturbed. Increasing disturbance emissions, combined with declining net primary productivity and reductions in forest area, changed the study area from a net C sink to a net C source. Forest C stocks changed from 332.2 Mt to 327.5 Mt, declining by 4.7 Mt at an average rate of 0.128 tC ha-1 yr-1. The largest cumulative areas of disturbance were caused by wildfire (139,000 ha), followed by the energy sector (110,000 ha), insects (33,000 ha) and harvesting (31,000 ha) but the largest cumulative disturbance emissions were caused by the energy sector (9.5 Mt C), followed by wildfire (5.5 Mt C), and then harvesting (1.3 Mt C). CONCLUSION: An existing forest C model was used successfully to provide a rigorous regional cumulative assessment of anthropogenic and natural disturbances on forest C, which meets requirements of EIAs in Canada. The assessment showed the relative importance of disturbances on C emissions in the pilot study area, but their relative importance is expected to change in other parts of the oil sands region because of its diversity in disturbance types, patterns and intensity. Future assessments should include peatland C stocks and fluxes, which could be addressed by using the Canadian Model for Peatlands.

The effect of candesartan on pentraxin-3 plasma levels as marker of endothelial dysfunction in patients with essential arterial hypertension.

BACKGROUND: In the last decades, the studies performed on the field of endothelial dysfunction confirmed the fact that the starting point of this pathology is the inflammation. Several inflammatory biomarkers had been discovered and studied, ones showing systemic inflammation, and others being more specific biomarkers and showing the local inflammation. Pentraxin-3 (PTX3) is a new inflammatory biomarker, from the same family as high-selectivity C-reactive protein (hs-CRP), but it is a more specific biomarker, due to its local production: the endothelial cells and not the liver like in the case of hs-CRP. AIMS: Several antihypertensive classes of drugs seem to have a positive impact on reducing the local endothelial inflammation, beyond their effect of lowering the blood pressure, so this study aims to analyze the effect of candesartan on the two inflammatory biomarkers: PTX3 and CRP, compared with other antihypertensive drugs, in hypertensive patients with endothelial dysfunction. METHODS: A total of 365 patients were included in the study: 127 hypertensive patients were under treatment with candesartan, 134 patients were under treatment with other hypotensive medication (beta blockers, calcium channel blockers, and diuretics), both groups with controlled values of blood pressure, and 104 were normotensive persons. Classical methods of assessing the endothelial function were correlated with these biochemical markers. RESULTS: The patients treated with candesartan had a significant lower value of PTX3 and hs-CRP, compared with those under treatment with other antihypertensive medication as follows: PTX3: 0.61 ± 0.49 vs 0.95 ± 1.04 ng/ml, P = 0.006 and hs-CRP: 0.19 ± 0.20 vs 0.20 ± 0.22 mg/dl, P = 0.54. CONCLUSIONS: Candesartan decreases PTX3 and hs-CRP plasma levels more powerful than other classes of antihypertensive drugs (beta blockers, calcium channel blockers, and diuretics), so we may assume that candesartan has a more potent action in reversing endothelial dysfunction and that it offers a higher vascular protection than other classes of antihypertensive drugs. We are suggesting that this new biochemical marker, PTX3, might be better and more specific marker for endothelial dysfunction, than hs-CRP.

Personal factors in systemic sclerosis and their coverage by patient-reported outcome measures. A multicentre European qualitative study and literature review.

BACKGROUND: Systemic sclerosis (SSc) is an autoimmune disease where thickening of the skin can lead to reduced body function and limitations in activities. Severe forms can also affect and seriously damage inner organs. Patient-centred rehabilitation emphasises considerations of patients' background, experience and behavior which highlights the need to know if patient-reported outcome measures (PROMs) include such personal factors. AIM: To identify and describe personal factors in the experiences of functioning and health of persons with SSc and to examine if and to what extent PROMs in SSc research cover these factors. DESIGN: Data from a qualitative study with focus group interviews were analysed. PROMs in SSc research were identified in a literature review between 2008-2013. SETTING: Participants were recruited from outpatient clinics at rheumatology department. POPULATION: Sixty-three patients with SSc from four European countries participated. METHODS: Data from interviews were analysed using a structure of personal factors developed by Geyh et al. Identified PROMs were analysed and linked to main concepts, related to the personal factors, found in the interview data. RESULTS: Nineteen main concepts were related to the area "patterns of experience and behaviour" in the personal factor structure, 16 to "thoughts and beliefs", nine to "feelings", one to "motives" and one to "personal history and biography", respectively. Among the 35 PROMs identified, 15 did not cover any of the identified concepts. Concepts within the area "feelings" were mostly covered by the PROMs. Five of the PROMs covered "patterns of experience and behaviour", while "motives" and "personal history and biography" were not covered at all. Four of the identified PROMs covered concepts within the areas "feelings", "thoughts and beliefs" and "patterns of experience and behaviour" in the same instrument. The Illness Cognition Questionnaire and Illness Behaviour Questionnaire were such PROMs. CONCLUSION: Patterns of experience and behaviour had the highest number of concepts related to personal factors, but few of the PROMs in SSc research covered these factors. Only a few PROMs covered several personal factors areas in the same instrument. CLINICAL REHABILITATION IMPACT: The results would be of value when developing core sets for outcome measurements in SSc.

Long-term effects of nocturnal continuous positive airway pressure therapy in patients with resistant hypertension and obstructive sleep apnea.

Obstructive sleep apnea (OSA) is often linked to high blood pressure and has a particularly high prevalence in patients with resistant hypertension. The effect of continuous positive airway pressure (CPAP) therapy on blood pressure (BP) values has been evaluated in several short-term clinical trials with conflicting results. Our aim was to investigate the role of long-term CPAP treatment in achieving BP control in patients who associate OSA and resistant hypertension. We have included in the study 33 patients with resistant hypertension, diagnosed with OSA in our sleep lab. Data was collected initially and after a mean follow-up period of 4 years. Patients were divided into 2 groups according to the use of CPAP therapy. Patients under CPAP therapy (n = 12) exhibited a higher reduction in both systolic and diastolic pressure and BP control was achieved in 75% of cases, while patients without CPAP treatment (n = 21) remained with refractory hypertension in proportion of 90.5%. A de-escalation of antihypertensive drug regimen by discontinuation of 1 or more drugs was observed in 41.6% (n = 5) of patients from CPAP group and in the other 33.4% (n = 4) the medication remained unchanged, but BP control was reached. Using a direct logistic regression model for examining the impact of different confounders on the probability of diagnosis of resistant hypertension at follow-up, the only statistically significant predictor found was the lack of CPAP usage.

[Deployment of the checklist "Patient safety in the operating room" in two Lorraine hospitals. Performances and difficulties]. / Déploiement de la check-list "Sécurité du patient au bloc opératoire" dans deux hôpitaux lorrains. Performances et difficultés.

OBJECTIVE: To evaluate the implementation of the checklist HAS 2010 in two Lorraine health facilities to identify objectively brakes and levers to suggest possible improvements. STUDY DESIGN: Descriptive survey. MATERIAL AND METHODS: Operating rooms of the Neurosciences building Central University Hospital, Nancy, Belle-Isle Hospital participating public hospital service, Metz. Two stages: a retrospective audit allowed to objectify quantitatively the presence of CL in the patient record and monitor compliance with the instructions of filling. A survey by self-administered questionnaire to professionals to assess the use of CL. RESULTS: CL was present in 50 % and 100 % records. The filling did not comply with instructions of the HAS (occupancy, three different times, time out before incision, stop the procedure if "no") and it was hard for about 30 % of participants, some items have problems of understanding. CL has strengthened information sharing about one third of respondents, over half of them are of interest, it has already helped to prevent errors. The deployment strategy influences directly the involvement of professionals. The evaluation of the use of CL cannot be done only through an audit record; the association with a self-administered questionnaire appears to be relevant. CONCLUSION: Good adhesion to the concept, hope for better results after stock enhancement: optimize information and training of all professionals, avoid duplication with other documents. The audit record alone is not a good tool for evaluating the use of LBC, we must associate a self-administered questionnaire.