Interventions aimed to increase average 24-h systolic blood pressure reduce blood pressure drops in patients with reflex syncope and orthostatic intolerance.

AIMS: Systolic blood pressure (SBP) drops recorded by 24-h ambulatory blood pressure (BP) monitoring (ABPM) identify patients with susceptibility to reflex syncope and orthostatic intolerance. We tested the hypothesis that treatments aimed to increase BP (reassurance, education, and lifestyle measures plus pharmacological strategies) can reduce SBP drops. METHODS AND RESULTS: This was a multicentre, observational proof-of-concept study performed in patients with reflex syncope and/or orthostatic intolerance and with SBP drops on a screening ABPM. Among 144 eligible patients, 111 underwent a second ABPM on average 2.5 months after start of treatment. Overall, mean 24-h SBP increased from 114.1 ± 12.1 to 121.4 ± 14.5 mmHg (P < 0.0001). The number of SBP drops <90 and <100 mmHg decreased by 61%, 46% during daytime, and by 48% and 37% during 24-h period, respectively (P < 0.0001 for all). The dose-response relationship between difference in 24-h average SBP increase and reduction in number of SBP drops reached a plateau around ∼15 mmHg increase of 24-h SBP. The reduction in SBP drop rate was consistent and significant in patients who underwent deprescription of hypotensive medications (n = 44) and in patients who received BP-rising drugs (n = 67). CONCLUSION: In patients with reflex syncope and/or orthostatic intolerance, an increase in average 24-h SBP, regardless of the implemented strategy, significantly reduced the number of SBP drops and symptom burden. A 13 mmHg increase in 24-h SBP appears to represent the optimal goal for aborting the maximal number of SBP drops, representing a possible target for future interventions. ClincalTrials.gov identifier: NCT05729724.

Upscaling DAC Hubs with Wind Energy and CO2 Mineral Storage: Considerations for Large-Scale Carbon Removal from the Atmosphere.

Continued fossil fuel emissions will increase CO2 concentrations in the atmosphere and could require removal of 10 Gt of CO2 per year or more to reach IPCC global climate goals. Large-scale construction of direct air capture (DAC) hubs to scrub CO2 from the atmosphere paired with geological storage is a prominent approach to potentially meet this target. We consider one location for theoretical scale-up of a DAC hub: the Kerguelen plateau in the Southern Indian Ocean which has high-potential renewable energy resources (wind) and large volumes of basalt rock for mineral storage. With consistent wind, previous studies indicate a hub in this location could collect approximately 75 Mt of CO2 annually, with conservative storage resources for 150-300 Mt of CO2 each year. Even with its immense wind and storage potentials, 14 Kerguelen-scale hubs would be needed to capture and store 1 Gt of CO2 per year. This brings into focus the important social, economic, and environmental trade-offs that must be considered in finding an acceptable balance between climate solutions, renewable energy requirements, and nature. Engaging public groups on these trade-off considerations will be crucial for gigaton scale-up of CO2 removal in just and responsible ways.

Broaden Research on Ocean Alkalinity Enhancement to Better Characterize Social Impacts.

Ocean alkalinity enhancement (OAE) is being considered as a way of achieving large-scale removals of carbon dioxide from the atmosphere. Research on the risks and benefits of different OAE approaches is expanding apace, but it remains difficult to anticipate and appraise the potential impacts to human communities that OAE might generate. These impacts, however, will be critical to evaluating the viability of specific OAE projects. This paper draws on the authors' involvement in interdisciplinary assessment of OAE (1) to identify the factors that currently limit characterization of potential social impacts and (2) to propose ways of reconfiguring OAE research to better consider these.

Climate solution or corporate co-optation? US and Canadian publics' views on agricultural gene editing.

The dexterity and affordability of gene-editing technologies promise wide-ranging applications in agriculture. Aiming to take advantage of this, proponents emphasize benefits such as the climate-mitigating promises of gene editing. Critics, on the other hand, argue that gene editing will perpetuate industrialized forms of agriculture and its concomitant environmental and social problems. Across a representative sample of US and Canadian residents (n = 1478), we investigate public views and perceptions of agricultural gene editing. We advance existing survey-based studies, which tend to focus on whether knowledge, familiarity, trust, or perceptions of naturalness predict views on gene editing. Instead, we examine whether broader societal concerns about industrialized food systems-a key claim about genetic engineering launched by critics-predicts comfort with gene editing. We also explore the predictive power of views of climate change as an urgent problem, following proponent arguments. Survey results explore gene editing views in reference to specific cases (e.g., drought-tolerant wheat) and specific alternatives (e.g., versus pesticide use). We find that people critical of industrialized food systems were most likely to express overall absolute opposition to the technology, whereas those concerned with the imminence of climate change were more likely to support climate-relevant gene editing. Our findings suggest the need for further research into the conditions upon which public groups find gene editing compelling or not-namely, if applications enhance or counter industrial food systems, or offer particular climate adaptive benefits. Furthermore, we argue that attention to broader societal priorities in surveys of perceptions may help address calls for responsible research and innovation as concerns gene editing.

Social comfort zones for transformative conservation decisions in a changing climate.

Novel management interventions intended to mitigate the impacts of climate change on biodiversity are increasingly being considered by scientists and practitioners. However, resistance to more transformative interventions remains common across both specialist and lay communities and is generally assumed to be strongly entrenched. We used a decision-pathways survey of the public in Canada and the United States (n = 1490) to test two propositions relating to climate-motivated interventions for conservation: most public groups are uncomfortable with interventionist options for conserving biodiversity and given the strong values basis for preferences regarding biodiversity and natural systems more broadly, people are unlikely to change their minds. Our pathways design tested and retested levels of comfort with interventions for forest ecosystems at three different points in the survey. Comfort was reexamined given different nudges (including new information from trusted experts) and in reference to a particular species (bristlecone pine [Pinus longaeva]). In contrast with expectations of public unease, baseline levels of public comfort with climate interventions in forests was moderately high (46% comfortable) and increased further when respondents were given new information and the opportunity to change their choice after consideration of a particular species. People who were initially comfortable with interventions tended to remain so (79%), whereas 42% of those who were initially uncomfortable and 40% of those who were uncertain shifted to comfortable by the end of the survey. In short and across questions, comfort levels with interventions were high, and where discomfort or uncertainty existed, such positions did not appear to be strongly held. We argue that a new decision logic, one based on anthropogenic responsibility, is beginning to replace a default reluctance to intervene with nature.

Zonas de Comodidad Social ante las Decisiones de Conservación Transformadoras en un Clima Cambiante Resumen Los científicos y los practicantes de la conservación cada vez consideran más a las intervenciones novedosas de manejo con la intención de mitigar los impactos del cambio climático sobre la biodiversidad. Sin embargo, la resistencia a las intervenciones más transformadoras es común en especialistas y no profesionales y generalmente se asume que está fuertemente arraigada. Usamos una encuesta sobre toma de decisiones del público en Canadá y en los Estados Unidos (n = 1490) para evaluar dos propuestas relacionadas a intervenciones de conservación motivadas por el clima: la mayoría de los grupos de público están incómodos con las opciones intervencionistas para conservar la biodiversidad y dada la sólida base de valores para las preferencias con respecto a la biodiversidad y a los sistemas naturales en general, es poco probable que las personas cambien de opinión. Nuestro diseño de encuesta analizó y reanalizó los niveles de comodidad con respecto a las intervenciones para los ecosistemas boscosos en tres puntos distintos dentro del estudio. La comodidad fue reexaminada con diferentes impulsos (incluyendo información nueva proveniente de expertos confiables) y en referencia a una especie particular (Pinus longaeva). Contrario a las expectativas de malestar del público, los niveles de línea base de la comodidad del público frente a las intervenciones climáticas en los bosques fueron moderadamente altos (46% de comodidad) e incrementaron cuando a los respondientes se les proporcionó información nueva y la oportunidad de cambiar su elección después de considerar a una especie particular. Las personas que al inicio estaban cómodas con las intervenciones tendieron a permanecer así (79%), mientras que el 42% de aquellos que estuvieron incómodos inicialmente y el 40% de aquellos que estuvieron inseguros cambiaron a estar cómodos para el final del estudio. En resumen, los niveles de comodidad frente a las intervenciones fueron elevados, y cuando existieron malestar o incertidumbre, dichas posiciones no parecieron mantenerse con fuerza. Argumentamos que una lógica de decisión basada en la responsabilidad antropogénica está comenzando a reemplazar una renuencia predeterminada a intervenir en la naturaleza.

Reference intervals for free T3 and free T4 in Pakistani euthyroid patients: effect of age and gender on thyroid function.

OBJECTIVE: To establish reference intervals for Free Triiodothyronine (FT3) and Free Thyroxine (FT4) in euthyroid subjects and to assess the effect of age and gender on FT3 and FT4. STUDY DESIGN: Cross-sectional, analytical study. PLACE AND DURATION OF STUDY: Institute of Nuclear Medicine and Oncology (INMOL), Lahore, from January 2009 to April 2011. METHODOLOGY: FT3 and FT4 were measured in 852 euthyroid patients. Those with previous thyroid surgery, on thyroidrelated medication and severe non-thyroid illness were excluded. RESULTS: There were 215 males and 637 females with mean age of 46 years. The reference intervals, revealed by this study, for FT3 and FT4 were 2.80 - 5.39 pmol/L and 11.9 - 22.2 pmol/L respectively. The mean difference between gender groups and age groups was found statistically significant for FT3 (gender: p < 0.001; age: p < 0.001) but statistically insignificant for FT4 (gender: p=0.147; age: p=0.201). CONCLUSION: There was no effect of gender and age on FT3 and FT4. The age with serum FT3 and FT4 significantly negatively correlated but this correlation was stronger for FT3 as compared to FT4 levels. Reference intervals of FT3 and FT4 for male (2.99 - 5.63 pmol/L, 12.3 - 22.6 pmol/L) and female (2.77 - 5.29 pmol/L, 11.7 - 22.1 pmol/L) respectively are suggested.