Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes

Background The cardiovascular effect of liraglutide, a glucagon-like peptide 1 analogue, when added to standard care in patients with type 2 diabetes, remains unknown. Methods In this double-blind trial, we randomly assigned patients with type 2 diabetes and high cardiovascular risk to receive liraglutide or placebo. The primary composite outcome in the time-to-event analysis was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The primary hypothesis was that liraglutide would be noninferior to placebo with regard to the primary outcome, with a margin of 1.30 for the upper boundary of the 95% confidence interval of the hazard ratio. No adjustments for multiplicity were performed for the prespecified exploratory outcomes. Results A total of 9340 patients underwent randomization. The median follow-up was 3.8 years. The primary outcome occurred in significantly fewer patients in the liraglutide group (608 of 4668 patients [13.0%]) than in the placebo group (694 of 4672 [14.9%]) (hazard ratio, 0.87; 95% confidence interval [CI], 0.78 to 0.97; P<0.001 for noninferiority; P=0.01 for superiority). Fewer patients died from cardiovascular causes in the liraglutide group (219 patients [4.7%]) than in the placebo group (278 [6.0%]) (hazard ratio, 0.78; 95% CI, 0.66 to 0.93; P=0.007). The rate of death from any cause was lower in the liraglutide group (381 patients [8.2%]) than in the placebo group (447 [9.6%]) (hazard ratio, 0.85; 95% CI, 0.74 to 0.97; P=0.02). The rates of nonfatal myocardial infarction, nonfatal stroke, and hospitalization for heart failure were nonsignificantly lower in the liraglutide group than in the placebo group. The most common adverse events leading to the discontinuation of liraglutide were gastrointestinal events. The incidence of pancreatitis was nonsignificantly lower in the liraglutide group than in the placebo group. Conclusions In the time-to-event analysis, the rate of the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke among patients with type 2 diabetes mellitus was lower with liraglutide than with placebo. (Funded by Novo Nordisk and the National Institutes of Health; LEADER ClinicalTrials.gov number, NCT01179048 .)

Increasing risk of hospital‐treated infections and community‐based antibiotic use after hip fracture surgery: A nationwide study 2005–2016

We aimed to examine trends in the incidence of treated infections following hip fracture surgery in Denmark from 2005 to 2016. We conducted a nationwide cohort study using individual‐level linked data from Danish population‐based registries. We calculated cumulative incidence considering death as competing risk and, based on the pseudo‐observation method, risk ratios (RRs) with 95% confidence interval (CI) using the period 2005–2006 as a reference. RRs were adjusted for age, sex, and comorbidity. A total of 74,771 patients aged 65 years or older with first‐time hip fracture surgery were included. The risk of postoperative (at 15, 30, 90, and 365 days) infections increased during 2005–2016. The 30‐day cumulative incidence of all hospital‐treated infections increased from 10.8% (95% CI, 10.2% to 11.3%) in 2005–2006 to 14.3% (95% CI, 13.7% to 15.0%) in 2015–2016 (adjusted RR 1.32; 95% CI, 1.23 to 1.42). Adjusted RR for 30‐day hospital‐treated pneumonia was 1.70 (95% CI, 1.49 to 1.92). The 30‐day cumulative incidence of redeeming community‐based antibiotic prescriptions increased from 17.5% (95% CI, 16.8% to 18.2%) in 2005–2006 to 27.1% (95% CI, 26.3% to 27.9%) in 2015–2016 (adjusted RR 1.54; 95% CI, 1.47 to 1.62). The largest increase was observed for broad‐spectrum antibiotic use (adjusted RR 1.79; 95% CI, 1.68 to 1.90). During 2005–2016, risk of infections was substantially higher in hip fracture patients than in the general population. The risk of hospital‐treated pneumonia and antibiotic prescriptions increased more over time among hip fracture patients. We found increased risks of postoperative treated infections following hip fracture surgery during the 12‐year study period, which could not entirely be explained by similar infection trends in the general population. Given the high mortality following infections in the elderly, further research is needed to identify patients at increased risk to target preventive treatment and potentially reduce complications and mortality in hip fracture patients

Characteristics and drivers of forest cover change in the post-socialist era in Croatia: evidence from a mixed-methods approach

© 2016, Springer-Verlag Berlin Heidelberg.Extensive forests in Croatia represent an important biological and economic resource in Europe. They are characterised by heterogeneity in forest management practices dating back to the socialist planned economy of the pre-1991 era. In this study we investigated the difference in rates of deforestation and reforestation in private- and state-owned forests during the post-socialist period and the causal drivers of change. The selected region of Northern Croatia is characterised by a high percentage of privately owned forests with minimal national monitoring and control. We used a mixed-methods approach which combines remote sensing, statistical modelling and a household-based questionnaire survey to assess the rates of forest cover change and factors influencing those changes. The results show that predominantly privately owned forests in Northern Croatia have recorded a net forest loss of 1.8 % during the 1991–2011 period, while Croatia overall is characterised by a 10 % forest cover increase in predominantly state-owned forests. Main factors influencing forest cover changes in private forests are slope, altitude, education structure, population age and population density. The results also show that the deforestation in private forests is weakening overall, mostly due to the continuation of the de-agrarisation and de-ruralisation processes which began during socialism

Exploring subtle land use and land cover changes: a framework for future landscape studies

UMR AMAP, équipe 3International audienceLand cover and land use changes can have a wide variety of ecological effects, including significant impacts on soils and water quality. In rural areas, even subtle changes in farming practices can affect landscape features and functions, and consequently the environment. Fine-scale analyses have to be performed to better understand the land cover change processes. At the same time, models of land cover change have to be developed in order to anticipate where changes are more likely to occur next. Such predictive information is essential to propose and implement sustainable and efficient environmental policies. Future landscape studies can provide a framework to forecast how land use and land cover changes is likely to react differently to subtle changes. This paper proposes a four step framework to forecast landscape futures at fine scales by coupling scenarios and landscape modelling approaches. This methodology has been tested on two contrasting agricultural landscapes located in the United States and France, to identify possible landscape changes based on forecasting and backcasting agriculture intensification scenarios. Both examples demonstrate that relatively subtle land cover and land use changes can have a large impact on future landscapes. Results highlight how such subtle changes have to be considered in term of quantity, location, and frequency of land use and land cover to appropriately assess environmental impacts on water pollution (France) and soil erosion (US). The results highlight opportunities for improvements in landscape modelling

Determinants of job satisfaction: a European comparison of self-employed and paid employees

The job satisfaction of self-employed and paid-employed workers is analyzed using the European Community Household Panel for the EU-15 covering the years 1994-2001. We distinguish between two types of job satisfaction: job satisfaction in terms of type of work and job satisfaction in terms of job security. Findings from our generalized ordered logit regressions indicate that self-employed individuals as compared to paid employees are more likely to be satisfied with their present jobs in terms of type of work and less likely to be satisfied in terms of job security. The findings also provide many insights into the determinants of the two types of job satisfaction for both self-employed and paid-employed workers

Anatomy of terminal moraine segments and implied lake stability on Ngozumpa Glacier, Nepal, from electrical resistivity tomography (ERT)

This research was supported financially by the European Commission FP7-MC-IEF (PIEF-GA-2012-330805), the University Centre in Svalbard (UNIS), National Geographic Society GRANT #W135-10.Moraine-dammed lakes at debris-covered glaciers are becoming increasingly common and pose significant outburst flood hazards if the dam is breached. While moraine subsurface structure and internal processes are likely to influence dam stability, only few sites have so far been investigated. We conducted electrical resistivity tomography (ERT) surveys at two sites on the terminal moraine complex of the Ngozumpa Glacier, Nepal, to aid assessment of future terminus stability. The resistivity signature of glacier ice at the site (100-15 kΩ m) is more consistent with values measured from cold glacier ice and while this may be feasible, uncertainties in the data inversion introduce ambiguity to this thermal interpretation. However, the ERT data does provide a significant improvement to our knowledge of the subsurface characteristics at these sites, clearly showing the presence (or absence) of glacier ice. Our interpretation is that of a highly complex latero-terminal moraine, resulting from interaction between previous glacier advance, recession and outburst flooding. If the base-level Spillway Lake continues to expand to a fully formed moraine-dammed glacial lake, the degradation of the ice core could have implications for glacial lake outburst risk.Publisher PDFPeer reviewe

Perspectives and Integration in SOLAS Science

Why a chapter on Perspectives and Integration in SOLAS Science in this book? SOLAS science by its nature deals with interactions that occur: across a wide spectrum of time and space scales, involve gases and particles, between the ocean and the atmosphere, across many disciplines including chemistry, biology, optics, physics, mathematics, computing, socio-economics and consequently interactions between many different scientists and across scientific generations. This chapter provides a guide through the remarkable diversity of cross-cutting approaches and tools in the gigantic puzzle of the SOLAS realm. Here we overview the existing prime components of atmospheric and oceanic observing systems, with the acquisition of ocean–atmosphere observables either from in situ or from satellites, the rich hierarchy of models to test our knowledge of Earth System functioning, and the tremendous efforts accomplished over the last decade within the COST Action 735 and SOLAS Integration project frameworks to understand, as best we can, the current physical and biogeochemical state of the atmosphere and ocean commons. A few SOLAS integrative studies illustrate the full meaning of interactions, paving the way for even tighter connections between thematic fields. Ultimately, SOLAS research will also develop with an enhanced consideration of societal demand while preserving fundamental research coherency. The exchange of energy, gases and particles across the air-sea interface is controlled by a variety of biological, chemical and physical processes that operate across broad spatial and temporal scales. These processes influence the composition, biogeochemical and chemical properties of both the oceanic and atmospheric boundary layers and ultimately shape the Earth system response to climate and environmental change, as detailed in the previous four chapters. In this cross-cutting chapter we present some of the SOLAS achievements over the last decade in terms of integration, upscaling observational information from process-oriented studies and expeditionary research with key tools such as remote sensing and modelling. Here we do not pretend to encompass the entire legacy of SOLAS efforts but rather offer a selective view of some of the major integrative SOLAS studies that combined available pieces of the immense jigsaw puzzle. These include, for instance, COST efforts to build up global climatologies of SOLAS relevant parameters such as dimethyl sulphide, interconnection between volcanic ash and ecosystem response in the eastern subarctic North Pacific, optimal strategy to derive basin-scale CO2 uptake with good precision, or significant reduction of the uncertainties in sea-salt aerosol source functions. Predicting the future trajectory of Earth’s climate and habitability is the main task ahead. Some possible routes for the SOLAS scientific community to reach this overarching goal conclude the chapter

Farmers' attitudes and landscape change: evidence from the abandonment of terraced cultivations on Lesvos, Greece

Agricultural landscapes are the product of the interaction of the natural environment of an area and the practices of its farmers. In this paper, farmers' practices are examined in order to describe and understand processes of landscape change in terraced fields on the island of Lesvos, Greece. We examine the changes of the terraced fields of each farmer and the reasons for these changes, practices concerning the maintenance of terraces and how farmers view this landscape change. The concept of farming systems is used to link farmers' practices at the farm level with changes at the landscape level. Data come from research via questionnaires to farmers in order to record their practices, to explore changes in land use and the landscape elements and the reasons behind these changes, and finally to record their opinions on the landscape change that result. Findings indicate that although farm households in the case study areas depend on farming incomes by very different degrees, they employ similar cultivation and landscape management practices. At the same time, "hobby" farm households may be more prone to abandonment of fields and negligence of landscape elements (here terraces)