Trends in Medical and Device Therapies Following Incident Heart Failure in Denmark during 1996-2019: A Nationwide Register-Based Follow-Up Study.

Introduction: Data on temporal trends in guideline-based medical and device therapies in real-world chronic heart failure (HF) patients are lacking. Methods: Register-based nationwide follow-ups of temporal trends in characteristics, guideline-recommended therapies, one-year all-cause mortality, and HF rehospitalizations in incident HF patients in Denmark during 1996-2019. Results: Among 291,720 incident HF patients, the age at the onset of HF was stable over time. While initially fairly equal, the sex distribution markedly changed over time with more incidents occurring in men overall. Hypertension and diabetes increased significantly over time, while other comorbidities remained stable. Between 1996 and 2019, significant increases in angiotensin-converting enzyme inhibitor and angiotensin II-receptor blocker (ACEi/ARB) therapy (38.2% to 69.9%), beta-blocker therapy (15.5% to 70.6%), and mineralocorticoid receptor antagonist (MRA) therapy (11.8% to 34.5%) were seen. Angiotensin receptor-neprilysin inhibitor (ARNI) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) were introduced in the middle of the past decade, with minor increases but overall low uses: ARNI (2015: 0.1% vs. 2019: 3.9%) and SGLT2i (2012: <0.1% vs. 2019: 3.9%). Between 1999 and 2019, implantable cardioverter-defibrillator (ICD) use increased significantly: 0.1% to 3-4%. Cardiac resynchronization therapy (CRT) use similarly increased between 2000 and 2019: 0.2% to 2.3%. Between 1996 and 2019, one-year all-cause mortality decreased significantly: 34.6% to 20.9%, as did HF rehospitalizations (6% to 1.3%). Conclusions: Among 291,720 incident HF patients in Denmark during 1996-2019, significant increases in the use of ACEi/ARB, beta-blockers, MRAs, and devices were seen, with concurrent significant decreases in the one-year all-cause mortality and HF rehospitalization rates. The use of CRT, ARNI, and SGLT2i remained low, and MRAs were relatively underutilized, thereby representing future targets to potentially further improve HF prognoses.

Bioenergetics modelling of growth processes in parasitized Eastern Baltic cod (Gadus morhua L.).

Changes in physiological processes can reveal how individuals respond to environmental stressors. It can be difficult to link physiological responses to changes in vital rates such as growth, reproduction and survival. Here, bioenergetics modelling can aid in understanding non-intuitive outcomes from stressor combinations. Building on an established bioenergetics model, we examine the potential effects of parasite infection on growth rate and body condition. Parasites represent an overlooked biotic factor, despite their known effects on the physiology of the host organism. As a case study, we use the host-parasite system of Eastern Baltic cod (Gadus morhua) infected with the parasitic nematode Contraceacum osculatum. Eastern Baltic cod have during the past decade experienced increasing infection loads with C. osculatum that have been shown to lead to physiological changes. We hypothesized that infection with parasites affects cod growth negatively as previous studies reveal that the infections lead to reduced energy turnover, severe liver disease and reduced nutritional condition. To test this, we implemented new variables into the bioenergetics model representing the physiological changes in infected fish and parameterized these based on previous experimental data. We found that growth rate and body condition decreased with increased infection load. Highly infected cod reach a point of no return where their energy intake cannot maintain a surplus energy balance, which may eventually lead to induced mortality. In conclusion, parasite infections cannot be ignored when assessing drivers of fish stock dynamics.

Simulating transport and distribution of marine macro-plastic in the Baltic Sea.

We simulated the spatial distribution and dynamics of macro plastic in the Baltic Sea, using a new Lagrangian approach called the dynamical renormalization resampling scheme (DRRS). This approach extends the super-individual simulation technique, so the weight-per-individual is dynamic rather than fixed. The simulations were based on a mapping of the macro plastic sources along the Baltic coast line, and a five year time series of realistic wind, wave and current data to resolve time-variability in the transport and spatial distribution of macro plastics in the Baltic Sea. The model setup has been validated against beach litter observations and was able to reproduce some major spatial trends in macroplastic distributions. We also simulated plastic dispersal using Green's functions (pollution plumes) for individual sources. e.g. rivers, and found a significant variation in the spatial range of Green's functions corresponding to different pollution sources. We determined a significant temporal variability (up to 7 times the average) in the plastic concentration locally, which needs to be taken into account when assessing the ecological impact of marine litter. Accumulation patterns and litter wave formation were observed to be driven by an interplay between positive buoyancy, coastal boundaries and varying directions of physical forcing. Finally we determined the range of wind drag coefficients for floating plastic, where the dynamics is mostly directly wind driven, as opposed to indirectly by surface currents and waves. This study suggests that patterns of litter sorting by transport processes should be observable in many coastal and off-shore environments.

Weak genetic structure despite strong genomic signal in lesser sandeel in the North Sea.

Sandeels are an ecologically important group of fishes; they are a key part of the food chain serving as food for marine mammals, seabirds and fish. Sandeels are further targeted by a large industrial fishery, which has led to concern about ecosystem effects. In the North Sea, the lesser sandeel Ammodytes marinus is by far the most prevalent species of sandeel in the fishery. Management of sandeel in the North Sea plus the Kattegat is currently divided into seven geographical areas, based on subtle differences in demography, population dynamics and results from simulations of larval dispersal. However, little is known about the underlying genetic population structure. In this study, we used 2,522 SNPs derived from restriction site-associated DNA sequencing (RADseq) typed in 429 fish representing four main sandeel management areas. Our main results showed (a) a lack of a clear spatially defined genetic structure across the majority of genetic markers and (b) the existence of a group of at least 13 SNPs under strong linkage disequilibrium which together separate North Sea sandeel into three haplotype clusters, suggestive of one or more structural variants in the genome. Analyses of the spatial distribution of these putative structural variants suggest at least partial reproductive isolation of sandeel in the western management area along the Scottish coast, supporting a separate management. Our results highlight the importance of the application of a large number of markers to be able to detect weak patterns of differentiation. This study contributes to increasing the genetic knowledge of this important exploited species, and results can be used to improve our understanding of population dynamics and stock structure.

Feasibility of continuous noninvasive arterial pressure monitoring in a prehospital setting, measurements during emergency transfer.

OBJECTIVES: In severely injured or acutely ill patients close monitoring of blood pressure (BP) can be crucial. At the prehospital scene and during transfer to hospital, the BP is usually monitored using intermittent oscillometric measurements with an upper arm cuff every 3-5 min. The BP can be monitored noninvasively and continuously using the continuous noninvasive arterial pressure (CNAP) device. In this study, we investigated the feasibility of a CNAP device in a prehospital setting. PATIENTS AND METHODS: The study was an observational convenience study. The CNAP device was applied to the patient once in the ambulance and measurements were carried out during transfer to hospital. The primary object was the number of patients in whom the CNAP device could monitor the BP continuously in a prehospital area en route to hospital. RESULTS: Fifty-nine patients were enrolled in this study. Fifty-four (92%) patients had their BP monitored continuously by the CNAP device. The main reasons for missing data were a mean BP below the detectable range, reduced pulse wave caused by constricted arteries in the fingers, or patients' excessive movements. The CNAP device provided continuous measurements after a median of 164.5 s. No complications and no adverse events were observed. CONCLUSION: Continuous measurement of the BP obtained by the CNAP device is feasible and safe in a prehospital setting under potentially difficult conditions.

The Baltic Sea Atlantis: An integrated end-to-end modelling framework evaluating ecosystem-wide effects of human-induced pressures.

Achieving good environmental status in the Baltic Sea region requires decision support tools which are based on scientific knowledge across multiple disciplines. Such tools should integrate the complexity of the ecosystem and enable exploration of different natural and anthropogenic pressures such as climate change, eutrophication and fishing pressures in order to compare alternative management strategies. We present a new framework, with a Baltic implementation of the spatially-explicit end-to-end Atlantis ecosystem model linked to two external models, to explore the different pressures on the marine ecosystem. The HBM-ERGOM initializes the Atlantis model with high-resolution physical-chemical-biological and hydrodynamic information while the FISHRENT model analyses the fisheries economics of the output of commercial fish biomass for the Atlantis terminal projection year. The Baltic Atlantis model composes 29 sub-areas, 9 vertical layers and 30 biological functional groups. The balanced calibration provides realistic levels of biomass for, among others, known stock sizes of top predators and of key fish species. Furthermore, it gives realistic levels of phytoplankton biomass and shows reasonable diet compositions and geographical distribution patterns for the functional groups. By simulating several scenarios of nutrient load reductions on the ecosystem and testing sensitivity to different fishing pressures, we show that the model is sensitive to those changes and capable of evaluating the impacts on different trophic levels, fish stocks, and fisheries associated with changed benthic oxygen conditions. We conclude that the Baltic Atlantis forms an initial basis for strategic management evaluation suited for conducting medium to long term ecosystem assessments which are of importance for a number of pan-Baltic stakeholders in relation to anthropogenic pressures such as eutrophication, climate change and fishing pressure, as well as changed biological interactions between functional groups.

A generic framework for individual-based modelling and physical-biological interaction.

The increased availability of high-resolution ocean data globally has enabled more detailed analyses of physical-biological interactions and their consequences to the ecosystem. We present IBMlib, which is a versatile, portable and computationally effective framework for conducting Lagrangian simulations in the marine environment. The purpose of the framework is to handle complex individual-level biological models of organisms, combined with realistic 3D oceanographic model of physics and biogeochemistry describing the environment of the organisms without assumptions about spatial or temporal scales. The open-source framework features a minimal robust interface to facilitate the coupling between individual-level biological models and oceanographic models, and we provide application examples including forward/backward simulations, habitat connectivity calculations, assessing ocean conditions, comparison of physical circulation models, model ensemble runs and recently posterior Eulerian simulations using the IBMlib framework. We present the code design ideas behind the longevity of the code, our implementation experiences, as well as code performance benchmarking. The framework may contribute substantially to progresses in representing, understanding, predicting and eventually managing marine ecosystems.

[Prehospital arterial blood gas analysis after collapse connected to triathlon participation].

Long-distance athletes are at risk of serious fluid and electrolyte disturbances, such as hypernatraemia (dehydration). Recently, cases of serious morbidity have been reported, due to acute exercise-associated hyponatraemia, which can advance to encephalopathy. An arterial blood gas analysis (ABG) was drawn from collapsed athletes at the championship of full-distance triathlon 2015, and different electrolyte imbalances were found. Our findings show that prehospital ABG can assist in differentiating the cause of collapse, and presumably, targeted treatment can be initiated already on scene.

Patterns and mechanisms of dispersal in a keystone seagrass species.

Mechanisms and vectors of long-distance dispersal remain unknown for many coastal benthic species, including plants. Indications for the possibility for long-distance dispersal come from dispersal modelling and from genetic assessments, but have rarely been assessed with both methods. To this end, we assessed dispersal of the seagrass Zostera noltei, an important foundation species of the coastal zone. We investigate whether small scale seed dispersal and long-distance propagule dispersal do play a role for meta-population dynamics, using both genetic assessments based on eight microsatellite markers and physical modelling of ocean currents. Such assessments enhance our understanding of the biology and population dynamics of an important coastal foundation species. They are relevant for large scale conservation strategies as they give insights in the maintenance of genetic diversity and connectivity that may enhance resilience and resistance to stresses associated with seagrass loss.

Route optimisation and solving Zermelo's navigation problem during long distance migration in cross flows.

The optimum path to follow when subjected to cross flows was first considered over 80 years ago by the German mathematician Ernst Zermelo, in the context of a boat being displaced by ocean currents, and has become known as the 'Zermelo navigation problem'. However, the ability of migrating animals to solve this problem has received limited consideration, even though wind and ocean currents cause the lateral displacement of flyers and swimmers, respectively, particularly during long-distance journeys of 1000s of kilometres. Here, we examine this problem by combining long-distance, open-ocean marine turtle movements (obtained via long-term GPS tracking of sea turtles moving 1000s of km), with a high resolution basin-wide physical ocean model to estimate ocean currents. We provide a robust mathematical framework to demonstrate that, while turtles eventually arrive at their target site, they do not follow the optimum (Zermelo's) route. Even though adult marine turtles regularly complete incredible long-distance migrations, these vertebrates primarily rely on course corrections when entering neritic waters during the final stages of migration. Our work introduces a new perspective in the analysis of wildlife tracking datasets, with different animal groups potentially exhibiting different levels of complexity in goal attainment during migration.

General classification of maturation reaction-norm shape from size-based processes.

Phenotypic plasticity of size at maturation is commonly described using size-age maturation reaction norms (MRNs). MRNs for age and size at maturation are analyzed and classified into three general categories related to different size scalings of growth and mortality. The underlying model for growth and mortality is based on processes at the level of the individual, and is motivated by the energy budget of fish. MRN shape is a balance between opposing factors and depends on subtle details of size dependence of growth and mortality. MRNs with both positive and negative slopes are predicted, and for certain mortality conditions also a lower critical spawning mass. The model is applied to predict a generic fishery-induced evolutionary response and allows assessment of climate change impact on MRNs. Our work stresses the importance of using realistic size dependence of mortality and growth, since this strongly influences the predicted MRNs and sensitivity to harvest pressure.