Global trends and scenarios for terrestrial biodiversity and ecosystem services from 1900 to 2050.

Based on an extensive model intercomparison, we assessed trends in biodiversity and ecosystem services from historical reconstructions and future scenarios of land-use and climate change. During the 20th century, biodiversity declined globally by 2 to 11%, as estimated by a range of indicators. Provisioning ecosystem services increased several fold, and regulating services decreased moderately. Going forward, policies toward sustainability have the potential to slow biodiversity loss resulting from land-use change and the demand for provisioning services while reducing or reversing declines in regulating services. However, negative impacts on biodiversity due to climate change appear poised to increase, particularly in the higher-emissions scenarios. Our assessment identifies remaining modeling uncertainties but also robustly shows that renewed policy efforts are needed to meet the goals of the Convention on Biological Diversity.

Quantifying and mapping species threat abatement opportunities to support national target setting.

The successful implementation of the Convention on Biological Diversity's post-2020 Global Biodiversity Framework will rely on effective translation of targets from global to national level and increased engagement across diverse sectors of society. Species conservation targets require policy support measures that can be applied to a diversity of taxonomic groups, that link action targets to outcome goals, and that can be applied to both global and national data sets to account for national context, which the species threat abatement and restoration (STAR) metric does. To test the flexibility of STAR, we applied the metric to vascular plants listed on national red lists of Brazil, Norway, and South Africa. The STAR metric uses data on species' extinction risk, distributions, and threats, which we obtained from national red lists to quantify the contribution that threat abatement and habitat restoration activities could make to reducing species' extinction risk. Across all 3 countries, the greatest opportunity for reducing plant species' extinction risk was from abating threats from agricultural activities, which could reduce species' extinction risk by 54% in Norway, 36% in South Africa, and 29% in Brazil. Species extinction risk could be reduced by a further 21% in South Africa by abating threats from invasive species and by 21% in Brazil by abating threats from urban expansion. Even with different approaches to red-listing among countries, the STAR metric yielded informative results that identified where the greatest conservation gains could be made for species through threat-abatement and restoration activities. Quantifiably linking local taxonomic coverage and data collection to global processes with STAR would allow national target setting to align with global targets and enable state and nonstate actors to measure and report on their potential contributions to species conservation.

Impact of membranous septum length on pacemaker need with different transcatheter aortic valve replacement systems: The INTERSECT registry.

BACKGROUND: New permanent pacemaker implantation (new-PPI) remains a compelling issue after Transcatheter Aortic Valve Replacement (TAVR). Previous studies reported the relationship between a short MS length and the new-PPI post-TAVR with a self-expanding THV. However, this relationship has not been investigated in different currently available THV. Therefore, the aim of this study was to investigate the association between membranous septum (MS)-length and new-PPI after TAVR with different Transcatheter Heart Valve (THV)-platforms. METHODS: We included patients with a successful TAVR-procedure and an analyzable pre-procedural multi-slice computed tomography. MS-length was measured using a standardized methodology. The primary endpoint was the need for new-PPI within 30 days after TAVR. RESULTS: In total, 1811 patients were enrolled (median age 81.9 years [IQR 77.2-85.4], 54% male). PPI was required in 275 patients (15.2%) and included respectively 14.2%, 20.7% and 6.3% for Sapien3, Evolut and ACURATE-THV(p â€‹< â€‹0.01). Median MS-length was significantly shorter in patients with a new-PPI (3.7 â€‹mm [IQR 2.2-5.1] vs. 4.1 â€‹mm [IQR 2.8-6.0], p â€‹= â€‹<0.01). Shorter MS-length was a predictor for PPI in patients receiving a Sapien3 (OR 0.87 [95% CI 0.79-0.96], p â€‹= â€‹<0.01) and an Evolut-THV (OR 0.91 [95% CI 0.84-0.98], p â€‹= â€‹0.03), but not for an ACURATE-THV (OR 0.99 [95% CI 0.79-1.21], p â€‹= â€‹0.91). By multivariable analysis, first-degree atrioventricular-block (OR 2.01 [95% CI 1.35-3.00], p = <0.01), right bundle branch block (OR 8.33 [95% CI 5.21-13.33], p = <0.01), short MS-length (OR 0.89 [95% CI 0.83-0.97], p â€‹< â€‹0.01), annulus area (OR 1.003 [95% CI 1.001-1.005], p â€‹= â€‹0.04), NCC implantation depth (OR 1.13 [95% CI 1.07-1.19] and use of Evolut-THV(OR 1.54 [95% CI 1.03-2.27], p â€‹= â€‹0.04) were associated with new-PPI. CONCLUSION: MS length was an independent predictor for PPI across different THV platforms, except for the ACURATE-THV. Based on our study observations within the total cohort, we identified 3 risk groups by MS length: MS length ≤3 â€‹mm defined a high-risk group for PPI (>20%), MS length 3-7 â€‹mm intermediate risk for PPI (10-20%) and MS length > 7 â€‹mm defined a low risk for PPI (<10%). Anatomy-tailored-THV-selection may mitigate the need for new-PPI in patients undergoing TAVR.

Association of Left Ventricular Remodeling Assessment by Cardiac Magnetic Resonance With Outcomes in Patients With Chronic Aortic Regurgitation.

Importance: Chronic aortic regurgitation (AR) causes left ventricular (LV) volume overload, which results in progressive LV remodeling negatively affecting outcomes. Whether cardiac magnetic resonance (CMR) volumetric quantification can provide incremental risk stratification over standard clinical and echocardiographic evaluation in patients with chronic moderate or severe AR is unknown. Objective: To compare LV remodeling measurements by CMR and echocardiography between patients with and without heart failure symptoms and to verify the association of remodeling measurements of patients with chronic moderate or severe AR but no or minimal symptoms with clinical outcomes receiving medical management. Design, Setting, and Participants: This multicenter retrospective cohort study included consecutive patients with at least moderate chronic native AR evaluated by 2-dimensional transthoracic echocardiography and CMR examination within 90 days from each other between January 2012 and February 2020 at Allina Health System. Data were analyzed from June 2021 to January 2022. Exposures: Clinical evaluation and risk stratification by CMR. Main Outcomes and Measures: The end point was a composite of death, heart failure hospitalization, or progression of New York Heart Association functional class while receiving medical management, censoring patients at the time of aortic valve replacement (when performed) or at the end of follow-up. Results: Of the 178 included patients, 119 (66.9%) were male, 158 (88.8%) presented with no or minimal symptoms (New York Heart Association class I or II), and the median (IQR) age was 58 (44-69) years. Compared with patients with no or minimal symptoms, symptomatic patients had greater LV end-systolic volume index (LVESVi) by CMR (median [IQR], 66 [46-85] mL/m2 vs 42 [30-58] mL/m2; P < .001), while there were no significant differences by echocardiography (LVESVi: median [IQR], 38 [30-58] mL/m2 vs 27 [20-42] mL/m2; P = .07; LV end-systolic diameter index: median [IQR], 21 [17-25] mm/m2 vs 18 [15-22] mm/m2; P = .17). During the median (IQR) follow-up of 3.3 (1.6-5.8) years, 50 patients with no or minimal symptoms receiving medical management developed the composite end point, which, in multivariate analysis adjusted for age and EuroSCORE II, was independently associated with LVESVi of 45 mL/m2 or greater and aortic regurgitant fraction of 32% or greater, the latter adding incremental prognostic value to CMR volumetric assessment. Conclusions and Relevance: In patients with chronic moderate or severe AR, patients presenting with heart failure symptoms have greater LVESVi by CMR than those with no or minimal symptoms. In patients with no or minimal symptoms, CMR quantification of LVESVi and AR severity may identify those at risk of death or incident heart failure and therefore should be considered in the clinical evaluation and decision-making of these patients.

Short-term mortality of patients ≥80 years old admitted to European intensive care units: an international observational study.

BACKGROUND: Limited evidence suggests variation in mortality of older critically ill adults across Europe. We aimed to investigate regional differences in mortality among very old ICU patients. METHODS: Multilevel analysis of two international prospective cohort studies. We included patients ≥80 yr old from 322 ICUs located in 16 European countries. The primary outcome was mortality within 30 days from admission to the ICU. Results are presented as n (%) with 95% confidence intervals and odds ratios (ORs). RESULTS: Of 8457 patients, 2944 (36.9% [35.9-38.0%]) died within 30 days. Crude mortality rates varied widely between participating countries (from 10.1% [6.4-15.6%] to 45.1% [41.1-49.2%] in the ICU and from 21.3% [16.3-28.9%] to 55.3% [51.1-59.5%] within 30 days). After adjustment for confounding variables, the variation in 30-day mortality between countries was substantially smaller than between ICUs (median OR 1.14 vs 1.58). Healthcare expenditure per capita (OR=0.84 per $1000 [0.75-0.94]) and social health insurance framework (OR=1.43 [1.01-2.01]) were associated with ICU mortality, but the direction and magnitude of these relationships was uncertain in 30-day follow-up. Volume of admissions was associated with lower mortality both in the ICU (OR=0.81 per 1000 annual ICU admissions [0.71-0.94]) and in 30-day follow-up (OR=0.86 [0.76-0.97]). CONCLUSION: The apparent variation in short-term mortality rates of older adults hospitalised in ICUs across Europe can be largely attributed to differences in the clinical profile of patients admitted. The volume-outcome relationship identified in this population requires further investigation.

Remote sensing-based assessment of land degradation and drought impacts over terrestrial ecosystems in Northeastern Brazil.

The spatio-temporal assessment of water and carbon fluxes in Brazil's Northeast region (NEB) allows for a better understanding of these surface flux patterns in areas with different vegetation physiognomies. The NEB is divided into four biomes: Amazon, Cerrado, Caatinga, and Atlantic Forest. Land degradation is a growing problem, particularly in susceptible areas of the Caatinga biome, such as the seasonally dry tropical forest. Furthermore, this region has experienced climatic impacts, such as severe droughts. Due to increasing human pressure, the Caatinga's natural land cover undergoes drastic changes, making it a region particularly vulnerable to desertification. In this study, the Moderate Resolution Imaging Spectroradiometer (MODIS) estimates of evapotranspiration (ET) and gross primary production (GPP) were validated in two contrasting areas, dense Caatinga and sparse Caatinga, using eddy covariance (EC) data and then investigated their behavior over 21 years (2000-2021) for the NEB. MODIS products explained around 60% of the variations in ET and GPP, showing higher accuracy in dense Caatinga, while areas of sparse Caatinga presented the lowest GPP, indicating that land degradation has reduced the photosynthetic activity of the vegetation in this area. Based on the analysis of ET and GPP over 21 years, we observed a greater dependence of the sparse Caatinga on climate variability, demonstrating a stronger resilience of dense Caatinga to climate effects. In comparison with the other biomes of the NEB region, we found lower rates of ET and GPP in the Caatinga biome, with averages similar to the Sparse Caatinga. In comparison with the other biomes in the NEB region, we found the lowest averages of ET and GPP in the Caatinga biome, similar to values found in the sparse Caatinga. In forest areas, similar to the monitored DC, they allowed the Caatinga to behave closer to the other biomes present in the region.

Quantifying and categorising national extinction-risk footprints.

Biodiversity, essential to delivering the ecosystem services that support humanity, is under threat. Projections show that loss of biodiversity, specifically increases in species extinction, is likely to continue without significant intervention. Human activity is the principal driver of this loss, generating direct threats such as habitat loss and indirect threats such as climate change. Often, these threats are induced by consumption of products and services in locations far-removed from the affected species, creating a geographical displacement between cause and effect. Here we quantify and categorise extinction-risk footprints for 188 countries. Seventy-six countries are net importers of extinction-risk footprint, 16 countries are net exporters of extinction-risk footprint, and in 96 countries domestic consumption is the largest contributor to the extinction-risk footprint. These profiles provide insight into the underlying sources of consumption which contribute to species extinction risk, a valuable input to the formulation of interventions aimed at transforming humanity's interactions with biodiversity.

Variations in end-of-life care practices in older critically ill patients with COVID-19 in Europe.

BACKGROUND: Previous studies reported regional differences in end-of-life care (EoLC) for critically ill patients in Europe. OBJECTIVES: The purpose of this post-hoc analysis of the prospective multicentre COVIP study was to investigate variations in EoLC practices among older patients in intensive care units during the coronavirus disease 2019 pandemic. METHODS: A total of 3105 critically ill patients aged 70 years and older were enrolled in this study (Central Europe: n = 1573; Northern Europe: n = 821; Southern Europe: n = 711). Generalised estimation equations were used to calculate adjusted odds ratios (aORs) to population averages. Data were adjusted for patient-specific variables (demographic, disease-specific) and health economic data (gross domestic product, health expenditure per capita). The primary outcome was any treatment limitation, and 90-day mortality was a secondary outcome. RESULTS: The frequency of the primary endpoint (treatment limitation) was highest in Northern Europe (48%), intermediate in Central Europe (39%) and lowest in Southern Europe (24%). The likelihood for treatment limitations was lower in Southern than in Central Europe (aOR 0.39; 95% confidence interval [CI] 0.21-0.73; p = 0.004), even after multivariable adjustment, whereas no statistically significant differences were observed between Northern and Central Europe (aOR 0.57; 95%CI 0.27-1.22; p = 0.15). After multivariable adjustment, no statistically relevant mortality differences were found between Northern and Central Europe (aOR 1.29; 95%CI 0.80-2.09; p = 0.30) or between Southern and Central Europe (aOR 1.07; 95%CI 0.66-1.73; p = 0.78). CONCLUSION: This study shows a north-to-south gradient in rates of treatment limitation in Europe, highlighting the heterogeneity of EoLC practices across countries. However, mortality rates were not affected by these results.

Diverse 3-Methylthio-4-Substituted Maleimides through a Novel Rearrangement Reaction: Synthesis and Selective Cell Imaging.

A transition metal-free protocol for the preparation of fluorescent and non-fluoresent 3-methylthio-4-arylmaleimides in a single step through a new rearrangement from thiazolidine-2,4-diones is described. By employing the optimized reaction conditions, a broad scope of derivatives was prepared in ≤97% yield. The reaction tolerated several substituted aryl groups, including the challenging preparation of pyridyl-containing derivatives. A series of control experiments strongly suggested that the new rearrangement involves a key isocyanate intermediate and a further reaction with in situ-generated methylthiomethyl acetate. The photophysical properties of some of the synthesized derivatives as well as their use in live cell imaging were also investigated, revealing that some of the substituted maleimides are capable of selectively staining different regions of the cells.

Computed Tomography Planning for Transcatheter Mitral Valve Replacement.

Transcatheter mitral valve replacement (TMVR) is a rapidly evolving treatment for mitral regurgitation. As with transcatheter aortic valve replacement, multidetector computed tomography analysis plays a central role in defining the candidacy, device selection and safety for TMVR procedures. This contemporary review will describe in detail the multidetector computed tomography data collection, analysis, and planning for TMVR procedures in patients with native mitral regurgitation as well as in those with failed surgical prosthetic mitral valve replacement or surgical mitral valve repair.

Association of baseline and change in global longitudinal strain by computed tomography with post-transcatheter aortic valve replacement outcomes.

AIMS: Transcatheter aortic valve replacement (TAVR) procedural planning requires computed tomography angiography (CTA) which allows for the assessment of left ventricular global longitudinal strain (CTA-LVGLS). There is, however, limited data on the feasibility of CTA-LVGLS, and its prognostic value. This study sought to evaluate the incremental prognostic value of baseline CTA-LVGLS, change in CTA-LVGLS after TAVR, and their association with post-TAVR outcomes. METHODS AND RESULTS: A total of 431 patients who underwent multiphasic gated CTA using dual-source system for TAVR planning at baseline and 1-month follow-up were included [median (interquartile range) age, 83 (77-87) years; 44% female, STS-PROM score: 3.3 (2.3-5.1)%, Echo-left ventricular ejection fraction (LVEF): 60 (55-65)%, CTA-LVGLS: -18.0 (-21.6 to -14.2)%, feasible in 97% of patients]. CTA-LVGLS was measured using dedicated feature-tracking software. Over a median follow-up of 19 (13-27) months, 99 endpoints of all-cause death or heart failure hospitalization occurred. The relative hazard of the endpoint increased as baseline CTA-LVGLS worsened with -18.2% as the threshold for higher events (P = 0.005). After adjustment for baseline characteristics, CTA-LVGLS remained associated with the endpoint [hazard ratio (HR) (95% confidence interval, CI), 1.08 (1.03-1.14); P = 0.005] and incrementally improved prognostication (C-index difference, 0.026). Although CTA-LVGLS improved after TAVR [-18.3 (-21.6 to -14.3)% vs. -18.7 (-21.9 to -15.4)%, P < 0.001], patients without CTA-LVGLS improvement had higher risk of the endpoint than those with improvement or preserved baseline global longitudinal strain [HR (95% CI), 1.92 (1.19-3.12); P = 0.008]. CONCLUSIONS: In this predominantly low-risk TAVR cohort of patients, mostly with normal LVEF, assessment of CTA-LVGLS is highly feasible improving risk stratification by providing independent and incremental prognostic value over clinical and echocardiographic characteristics.

Predicting landscape-scale biodiversity recovery by natural tropical forest regrowth.

Natural forest regrowth is a cost-effective, nature-based solution for biodiversity recovery, yet different socioenvironmental factors can lead to variable outcomes. A critical knowledge gap in forest restoration planning is how to predict where natural forest regrowth is likely to lead to high levels of biodiversity recovery, which is an indicator of conservation value and the potential provisioning of diverse ecosystem services. We sought to predict and map landscape-scale recovery of species richness and total abundance of vertebrates, invertebrates, and plants in tropical and subtropical second-growth forests to inform spatial restoration planning. First, we conducted a global meta-analysis to quantify the extent to which recovery of species richness and total abundance in second-growth forests deviated from biodiversity values in reference old-growth forests in the same landscape. Second, we employed a machine-learning algorithm and a comprehensive set of socioenvironmental factors to spatially predict landscape-scale deviation and map it. Models explained on average 34% of observed variance in recovery (range 9-51%). Landscape-scale biodiversity recovery in second-growth forests was spatially predicted based on socioenvironmental landscape factors (human demography, land use and cover, anthropogenic and natural disturbance, ecosystem productivity, and topography and soil chemistry); was significantly higher for species richness than for total abundance for vertebrates (median range-adjusted predicted deviation 0.09 vs. 0.34) and invertebrates (0.2 vs. 0.35) but not for plants (which showed a similar recovery for both metrics [0.24 vs. 0.25]); and was positively correlated for total abundance of plant and vertebrate species (Pearson r = 0.45, p = 0.001). Our approach can help identify tropical and subtropical forest landscapes with high potential for biodiversity recovery through natural forest regrowth.

Predicción de la Recuperación de la Biodiversidad a Escala de Paisaje según la Regeneración Natural del Bosque Tropical Resumen La regeneración natural del bosque es una solución rentable para la recuperación de la biodiversidad basada en la naturaleza, sin embargo, los diferentes factores socioambientales pueden derivar en resultados variables. Cómo predecir la ubicación en donde la regeneración natural del bosque recuperará los niveles de biodiversidad, los cuales son un indicador del valor de la conservación y un suministro potencial de diferentes servicios ambientales, es un vacío de conocimiento importante en la planeación de la restauración forestal. Buscamos predecir y mapear la recuperación a escala de paisaje de la riqueza de especies y la abundancia total de vertebrados, invertebrados y plantas en bosques tropicales y subtropicales de segundo crecimiento para guiar la planeación de la restauración. Primero, realizamos un metaanálisis mundial para cuantificar la medida a la que se desvió la recuperación de la riqueza y la abundancia total de especies en los bosques de segundo crecimiento de los valores de biodiversidad en los bosques antiguos referenciales en el mismo paisaje. Después, utilizamos un algoritmo de aprendizaje automático y un conjunto integral de factores socioambientales para predecir espacialmente la desviación a escala de paisaje para después mapearla. Los modelos explicaron en promedio el 34% de la varianza observada en la recuperación (rango de 9-51%). La recuperación de la biodiversidad a escala de paisaje en los bosques de segundo crecimiento pudo predecirse espacialmente con base en los factores socioambientales del paisaje (demografía humana, uso y cobertura del suelo, alteraciones naturales y antropogénicas, productividad del ecosistema, tipo de topografía y de suelo); fue significativamente más alta para la riqueza de especies que para la abundancia total de vertebrados (desviación media pronosticada ajustada al rango de 0.09 versus 0.34) e invertebrados (0.2 versus 0.35) pero no para las plantas (las cuales mostraron una recuperación similar para ambas medidas [0.24 versus 0.25]); y tuvo una correlación positiva para la abundancia de especies de plantas y vertebrados (Pearson r =0.45, p=0.001). Nuestra estrategia puede ayudar a identificar los paisajes de bosques tropicales y subtropicales con un potencial alto para la recuperación de la biodiversidad por medio de la regeneración natural del bosque.

Cardiac Computed Tomography and Magnetic Resonance Imaging of the Tricuspid Valve: Preprocedural Planning and Postprocedural Follow-up.

Transcatheter tricuspid valve interventions (TTVIs) are rapidly growing as a less invasive treatment of high surgical risk patients with advanced TR. A comprehensive anatomic and functional assessment of the tricuspid valve and right-sided chambers is essential for candidate selection and procedural planning. Advanced imaging with cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) can provide accurate anatomic and functional assessment of the tricuspid valve, its apparatus, and the right-sided chambers. In this review, we provide an updated overview of the emerging role of CCT and CMR for TR patient evaluation, TTVI planning, and follow-up.

Right ventricular dysfunction by computed tomography associates with outcomes in severe aortic stenosis patients undergoing transcatheter aortic valve replacement.

BACKGROUND: Although cardiac computed tomography angiography (CCTA) assessment of right ventricular dysfunction (RVD) is feasible, the incremental prognostic value remains uncertain in patients undergoing transcatheter aortic valve replacement (TAVR) evaluation. This study sought to determine the incremental clinical utility of RVD identification by CCTA while accounting for clinical and echocardiographic parameters. METHODS: Patients who underwent multiphasic ECG-gated functional CCTA using dual-source system for routine TAVR planning were evaluated. Biphasic contrast protocol injection allowed for biventricular contrast enhancement. CCTA-based RVD was defined as right ventricular ejection fraction (RVEF) â€‹< â€‹50%. The association of CCTA-RVD with all-cause mortality and the composite outcome of death or heart failure hospitalization after TAVR was evaluated and examined for its incremental utility beyond clinical risk assessment and echocardiographic parameters. RESULTS: A total of 502 patients were included (median [IQR] age, 82 [77 to 87] years; 56% men) with a median follow-up of 22 [16 to 32] months. Importantly, 126 (25%) patients were identified as having RVD by CCTA that was not identified by echocardiography. CCTA-defined RVD predicted death and the composite outcome in both univariate analyses (HR for mortality, 2.15; 95% CI, 1.44-3.22; p â€‹< â€‹0.001; HR for composite outcome, 2.11; 95% CI, 1.48-3.01; p â€‹< â€‹0.001) and in multivariate models that included clinical risk factors and echocardiographic findings (HR for mortality, 1.74; 95% CI, 1.11-2.74; p â€‹= â€‹0.02; HR for composite outcome, 1.63; 95% CI, 1.09-2.44; p â€‹= â€‹0.02). CONCLUSIONS: Functional CCTA assessment pre-TAVR correctly identified 25% of patients with RVD that was not evident on 2D echocardiography. The presence of RVD on CCTA independently associates with clinical outcomes post-TAVR.