External validation of the SYNTAX score II 2020 in patients with chronic renal insufficiency.

BACKGROUND: The SYNTAX score Ⅱ 2020 (SSⅡ-2020) was created as a customized decision-making tool for individuals diagnosed with complex coronary artery disease (CAD). Nevertheless, there has been a scarcity of research investigating the long-term predictive significance of SSⅡ-2020 for patients with both CAD and chronic renal insufficiency (CRI) who undergo percutaneous coronary intervention (PCI). AIMS: We sought to showcase the prognostic capacity of SSII-2020 in evaluating long-term all-cause mortality (ACM) within this high-risk patient cohort. METHODS: A retrospective cohort comprising 1156 individuals diagnosed with CRI and exhibiting left main CAD, three-vessel CAD or both was included in this investigation. We categorized participants into three groups based on the optimal SSII-2020 threshold for predicting long-term ACM, determined using the X-tile software. RESULTS: At the median follow-up duration of 6.3 years, the ACM rates were determined to be 10% in the low, 17% in the moderate, and 28% in the high SSII-2020 groups (p < 0.001). Employing multivariate Cox regression analysis, it was observed that the high SSII-2020 group exhibited a 3.289-fold increased risk of ACM (95% confidence interval [CI]: 2.229-4.856, p < 0.001) compared with the low SSII-2020 group, whereas the high SSII-2020 group displayed a 1.757-fold (95% CI: 1.190-2.597, p = 0.005) in comparison to the median SSII-2020 groups. Compared with SSII, the SSII-2020 had an incremental value for predicting 7-year ACM (C-index: 0.662 vs. 0.534, p = 0.007; IDI: 0.016, p < 0.001). CONCLUSIONS: SSII-2020 enhances long-term ACM prediction, facilitates improved risk stratification, and improves clinical utility for PCI patients with complex CAD and CRI.

Analysis of Firework-Related Injuries to the Upper Extremity in the United States: 2011-2020.

INTRODUCTION: The purpose of this study is to examine and characterize patterns of injury to the upper extremity caused by fireworks in a nationally representative sample of emergency department patients from 2011 to 2020. METHODS: The National Electronic Injury Surveillance System was queried for upper-extremity injuries caused by fireworks between 2011 and 2020. RESULTS: One thousand two hundred fifty-one injuries were identified from the database representing 47,235 national cases that presented to emergency departments in the United States. Case frequency was stable during the period until 2020, which was nearly 70% higher than the previous 9-y average. Patients were generally young and male, with most cases in the 10-29-y age group and males over three times as likely to be injured as females. The most common injury was burn, and the week of July 4th accounted for 53% of cases alone. Diagnosis was also significantly associated with device type. CONCLUSIONS: These data can be used to target prevention measures and campaigns to specific patient populations most at risk of injury, specifically young males. They may also be used to highlight the impact of policy changes on availability of fireworks, the need for public health education coinciding with injury incidence peaks, and secondary pandemic effects.

Return on investment in science: twenty years of European Commission funded research in Alzheimer's dementia, breast cancer and prostate cancer.

Alzheimer's disease (AD), breast cancer (BC) and prostate cancer (PC) continue to be high in the research and innovation agenda of the European Commission (EC). This is due to their exceptionally large burden to the national health systems, the profound economic effects of opportunity costs attributable to decreased working ability, premature mortality and the ever-increasing demand for both hospital and home-based medical care. Over the last two decades, the EC has been steadily increasing both the number of proposals being funded and the amounts of financial resources being allocated to these fields of research. This trend has continued throughout four consecutive science funding cycles, namely framework programme (FP)5, FP6, FP7 and Horizon 2020 (H2020). We performed a retrospective assessment of the outputs and outcomes of EC funding in AD, BC and PC research over the 1999-2019 period by means of selected indicators. These indicators were assessed for their ability to screen the past, present and future for an array of causal relationships and long-term trends in clinical, epidemiological and public health sphere, while considering also the broader socioeconomic impact of funded research on the society at large. This analysis shows that public-private partnerships with large industry and university-based consortia have led to some of the most impactful proposals being funded over the analysed time period. New pharmaceuticals, small molecules and monoclonal antibodies alike, along with screening and prevention, have been the most prominent sources of innovation in BC and PC, extending patients' survival and enhancing their quality of life. Unlike oncology, dementia drug development has been way less successful, with only minor improvements related to the quality of supportive medical care for symptoms and more sensitive diagnostics, without any ground-breaking disease-modifying treatment(s). Significant progresses in imaging diagnostics and nanotechnology have been largely driven by the participation of medical device industry multinational companies. Clinical trials funded by the EC were conducted, leading to the development of brand-new drug molecules featuring novel mechanisms of action. Some prominent cases of breakthrough discoveries serve as evidence for the European capability to generate cutting-edge technological innovation in biomedicine. Less productive areas of research may be reconsidered as priorities when shaping the new agenda for forthcoming science funding programmes.

Validation of a digital food frequency questionnaire for the Northern Sweden Diet Database.

BACKGROUND: Dietary habits strongly influence health, with poor diets contributing to numerous deaths annually. Addressing this requires improved dietary habits and consistent monitoring thereof. In northern Sweden, a validated food frequency questionnaire (FFQ) has been used for decades, but trends show that its ability to accurately measure intake has diminished. With changing eating habits and food supply, updating the FFQ was crucial, leading to the development of FFQ2020. This study assessed FFQ2020's relative validity using 24-hour recalls and evaluated its reproducibility. METHODS: Participants were recruited from one of the northern-Sweden population-based health screenings and by advertising. Food intake was registered in an electronic food frequency questionnaire (FFQ2020) (test instrument) and reference data were obtained by six repeated electronic 24-hour dietary recalls (24HDR). Intakes of single foods were aggregated into food groups and healthy diet index scores, and daily energy and nutrient intakes were estimated. Results from the two methods were described and tested in univariate analyses and correlation tests, Bland Altman plots, cross-classification validity, and intra-class correlation analyses. RESULTS: Totally, 628 adults were invited to participate in the study. Of these, 320 joined, and 244 completed at least four 24HDRs. The median intakes in food groups, as well as the mean index scores and estimated nutrient intakes, were largely similar between the FFQ2020 and 24HDR recordings. The correlation coefficients between the two assessments ranged from 0.253 to 0.693 for food groups, 0.520 to 0.614 for diet indices, and 0.340 to 0.629 for energy and nutrients. Intra-class correlation coefficients indicated at least good reproducibility for intakes of food groups, diet index scores, and nutrients. Generally, Bland-Altman plots did not reveal any gross systematic disagreement between the two methods for any of the assessments. However, there were single observations located outside the upper or lower 95% confidence interval (CI) limits for the difference between FFQ2020 and the 24HDR recordings. CONCLUSION: In concert, the results suggest that the relative validity and reproducibility of FFQ2020 are acceptable for trend analyses and group comparisons in large-scale studies but also that extended reference periods would improve the precision of less frequently consumed foods.

Reevaluating the Spatial Scale of Residential Segregation: Racial Change Within and Between Neighborhoods.

This study evaluates the extent to which metropolitan racial segregation occurs between neighborhoods-from tract to tract-and within neighborhoods-from block to block-and is framed theoretically by Putnam's (2007) "hunkering down" hypothesis. Analyses are based on complete-count block, tract, and metropolitan data from the last four U.S. decennial censuses. We document recent patterns of block-to-block segregation between Whites and racial and ethnic minorities (Blacks, Asians, and Hispanics) and between different minority pairs. For example, roughly 40% of all metro Black-White segregation is due to segregation from block to block within neighborhoods. Among Asians, the between-neighborhood component of metropolitan segregation has increased over time but was largely compensated by declines in the within-neighborhood (or block) component. Metropolitan fixed-effects models show that trends and racial and ethnic differences in segregation-overall and within and between neighborhoods-are broadly observed across metro areas but are most evident in the largest, oldest, and most highly segregated metro areas. The results are robust to alternative estimates that adjust for differential privacy, metropolitan reclassification, and neighborhood boundary changes. Analyses of neighborhood change in Atlanta, Georgia, further reinforce the generality of our multiscale approach.

Cancer statistics in Yemen: incidence and mortality, in 2020.

BACKGROUND: The current cancer epidemiological profile in Yemen suffers from a lack of locally representative data and resources, posing a challenge in determining the real incidence, prevalence, survival and mortality rates, particularly data extracted from national hospitals. This study aims to provide a comprehensive overview of the cancer burden and trends in Yemen for 2020, including incidence and mortality rates. METHODS: The current study provides cancer statistics and their trends in Yemen, including incidence and mortality, in 2020 by using descriptive statistics. The data was obtained using the Global Cancer Observatory (GCO) 2020 online database. RESULTS: According to the (GCP) database in 2020, the crude incidence rate (CIR) of all cancers in Yemen was 55.2 per 100.000. The age-standardized rate (ASR) was 97.0 per 100.000, and the cumulative risk (0-74) was 22.0 per 100.000. The age-standardized rate (ASR) was 76.5 per 100.000, and the cumulative risk (0-74) was 19.6 per 100.000. Furthermore, the crude mortality rate (CIR) of all cancers was 40.6 per 100.000. Breast cancer was most prevalent in Yemen across all age groups and genders (31.1%), followed by colorectal cancer (7.7%) and leukemia (5.7%). Breast cancer also ranked as the primary cause of mortality at an estimated percentage of 13.5%, followed by colorectal cancer (8.8%) and stomach cancer (7.1%). CONCLUSION: Cancer has become a significant life-threatening illness in Yemen with an increase in the disease burden of breast cancer in women. Furthermore, leukemia in children and colorectal cancer in both sexes have experienced a more significant burden as well. Therefore, it is imperative for initiatives for cancer control and prevention to be prioritised at national and regional levels.

Diet quality as assessed by the healthy eating index-2020 among different smoking status: an analysis of national health and nutrition examination survey (NHANES) data from 2005 to 2018.

BACKGROUND: Combining smoking with poor eating habits significantly elevates the risk of chronic illnesses and early death. Understanding of how dietary quality shifts post-smoking cessation remains limited. The objective of this study is to examine dietary quality - using Healthy Eating Index (HEI - 2020) and its 13 components, among current, former, and never smokers, and particularly the impact of quitting and the duration of cessation on dietary habits. METHODS: A cross-sectional analysis of 31,569 adults from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 was conducted. Dietary quality was assessed using HEI-2020 scores, which were determined by NIH developed - simple HEI scoring algorithm per person. Smoking status was categorized into current, former, and never smokers, with further subdivisions for current (heavy/light smokers) and former smokers (duration post-cessation). Descriptive analysis and multiple regression models weighted to represent the US population were performed. RESULTS: The current smoking rate was 19.4%, with a higher prevalence in males (22.5%) than females (17.5%). Current smokers reported statistically significantly lower HEI total score than both former and never smokers. Former smokers exhibited HEI scores similar to those of never smokers. The adjusted HEI total scores for current, former, and never smokers were 49.2, 54.0, and 53.3, respectively, with a statistically significant difference (p < 0.001). Moreover, light smokers had better total HEI score than heavy smokers (46.8 vs. 50.8, p < 0.001, respectively), but former and never smokers scored even higher. Quitting smoking immediately improved dietary quality, with former smokers reaching the dietary levels of never smokers within 5-10 years (53.8 vs. 53.3, p > 0.05, respectively). Compared to current smokers, former smokers tended to consume more beneficial foods (e.g., fruits, vegetables, greens and beans, whole grains, proteins, and fatty acids), while also consuming more sodium and less added sugar. CONCLUSIONS: Current smokers, particularly heavy smokers, exhibit poorer dietary habits than former and never smokers. The dietary quality of former smokers aligns with never smokers over time, highlighting the positive impact of smoking cessation on diet. This has implications for reducing chronic disease risks associated with poor diet and smoking.

Suicidal ideation, suicide plans and suicide attempts among Australian adults: Findings from the 2020-2022 National Study of Mental Health and Wellbeing.

OBJECTIVE: This study aimed to describe the epidemiology of suicidal ideation, suicide plans and suicide attempts, examine services received for suicide attempts, and explore the relationship between suicide attempts and self-harm without suicidal intent. METHODS: We used survey data from the 2020-2022 National Study of Mental Health and Wellbeing, which involved a nationally representative sample of Australian adults aged 16-85 (n = 15,893). Comparisons were made with the 2007 National Study of Mental Health and Wellbeing (n = 8841). RESULTS: In 2020-2022, the proportions of adults who had experienced suicidal ideation, suicide plans and suicide attempts during their lifetime were 16.6%, 7.5% and 4.9%, respectively. The proportions who had experienced these in the past 12 months were 3.3%, 1.1% and 0.3%. The odds of experiencing suicidal ideation and making a suicide plan were significantly higher in 2020-2022 than in 2007. Groups at heightened risk of suicidal ideation, suicide plans and/or suicide attempts in the previous 12 months were males, young people, people who were gay, lesbian, or bisexual or used some other term to describe their sexual identity, people outside the labour force, people from disadvantaged areas and people with mental disorders. Two-fifths of those who attempted suicide during the previous 12 months did not use health services following their attempt, and two-thirds also self-harmed without suicidal intent. CONCLUSION: The implications of these findings for the forthcoming National Suicide Prevention Strategy are discussed. Suicidal thoughts and behaviours confer risk for suicide and are significant problems in their own right. Their prevention requires a strong whole-of-government response.

Young graduates and economic recession: Lessons from the pandemic to prevent the (re)incidence of mental health symptoms.

Economic conditions affect the youth labour market and can leave deep scars. This exploratory study examines the emotional responses and mental health symptoms of young graduates during their transition into the labour market in the pandemic context. It draws on 42 news articles with statements from 86 graduates from a set of European and non-European countries. The graduates had jobs or internships cancelled, numerous applications unanswered or were dismissed from jobs they had recently started. Young people adopt a variety of coping strategies, which are often invisible and cause deep suffering due to anxiety, disappointment, fear, and depression. Their apprehension and uncertainty leave them in a state of limbo. The specific impacts of the pandemic on young people's lives serve as a warning of the need to protect future generations of graduates. More support is required worldwide to manage the mental health issues that affect young graduates, especially during economic recessions.

Optimizing the Steering of Driverless Personal Mobility Pods with a Novel Differential Harris Hawks Optimization Algorithm (DHHO) and Encoder Modeling.

This paper aims to improve the steering performance of the Ackermann personal mobility scooter based on a new meta-heuristic optimization algorithm named Differential Harris Hawks Optimization (DHHO) and the modeling of the steering encoder. The steering response in the Ackermann mechanism is crucial for automated driving systems (ADS), especially in localization and path-planning phases. Various methods presented in the literature are used to control the steering, and meta-heuristic optimization algorithms have achieved prominent results. Harris Hawks optimization (HHO) algorithm is a recent algorithm that outperforms state-of-the-art algorithms in various optimization applications. However, it has yet to be applied to the steering control application. The research in this paper was conducted in three stages. First, practical experiments were performed on the steering encoder sensor that measures the steering angle of the Landlex mobility scooter, and supervised learning was applied to model the results obtained for the steering control. Second, the DHHO algorithm is proposed by introducing mutation between hawks in the exploration phase instead of the Hawks perch technique, improving population diversity and reducing premature convergence. The simulation results on CEC2021 benchmark functions showed that the DHHO algorithm outperforms the HHO, PSO, BAS, and CMAES algorithms. The mean error of the DHHO is improved with a confidence level of 99.8047% and 91.6016% in the 10-dimension and 20-dimension problems, respectively, compared with the original HHO. Third, DHHO is implemented for interactive real-time PID tuning to control the steering of the Ackermann scooter. The practical transient response results showed that the settling time is improved by 89.31% compared to the original response with no overshoot and steady-state error, proving the superior performance of the DHHO algorithm compared to the traditional control methods.

A Clinical, Pharmacological, and Formulation Evaluation of Melatonin in the Treatment of Ocular Disorders-A Systematic Review.

Melatonin's cytoprotective properties may have therapeutic implications in treating ocular diseases like glaucoma and age-related macular degeneration. Literature data suggest that melatonin could potentially protect ocular tissues by decreasing the production of free radicals and pro-inflammatory mediators. This study aims to summarize the screened articles on melatonin's clinical, pharmacological, and formulation evaluation in treating ocular disorders. The identification of relevant studies on the topic in focus was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. The studies were searched in the following databases and web search engines: Pubmed, Scopus, Science Direct, Web of Science, Reaxys, Google Scholar, Google Patents, Espacenet, and Patentscope. The search time interval was 2013-2023, with the following keywords: melatonin AND ocular OR ophthalmic AND formulation OR insert AND disease. Our key conclusion was that using melatonin-loaded nano-delivery systems enabled the improved permeation of the molecule into intraocular tissues and assured controlled release profiles. Although preclinical studies have demonstrated the efficacy of developed formulations, a considerable gap has been observed in the clinical translation of the results. To overcome this failure, revising the preclinical experimental phase might be useful by selecting endpoints close to clinical ones.

Governance, institutional and economic frameworks for Urban Forests as a Nature-Based Solution in Europe.

Urban forests as nature-based solutions (UF-NbS) play a crucial role for promoting the health and well-being of urban populations. Despite increasing recognition of their importance, knowledge gaps remain regarding UF-NbS implementation, particularly with respect to their performance, their perception, and on decision-making and governance practices for their implementation and management. Grounded in a project-as-practice approach and based on sixteen UF-NbS case histories, this paper seeks to gain insights into UF-NbS project actualities by an identification of characteristic trends as a function of a projects' scope and purpose, or challenge-orientation, respectively. A particular emphasis is on project structure and coordination, on the scope and depth of participation and stakeholder involvement, and on funding mechanisms. Identified trends reveal centrally coordinated, single-responsible public authorities as the most common project structure, but with certain feature contents, i.e., regeneration and reclamation, as being associated with more decentralised forms of governance. It is concluded that irrespective of challenge-orientation, comparatively broad participation appears to be realised within the UF-NbS framework, however, the depth of participation differs considerably. With respect to funding, a strong reliance on public capital is asserted for the UF-NbS context, however, various forms of private contributions appear reasonably common across the assessed case histories. Recommendations for policy-making and avenues of future research are identified, including the validation of identified trends, the fostering of collaboration, the dispersal of decision-making authority, the encouragement for implementing non-tokenistic modes of participation in UF-NbS governance, and the promotion of potentially under-utilised funds.

Landscape-scale habitat fragmentation is positively related to biodiversity, despite patch-scale ecosystem decay.

Positive effects of habitat patch size on biodiversity are often extrapolated to infer negative effects of habitat fragmentation on biodiversity at landscape scales. However, such cross-scale extrapolations typically fail. A recent, landmark, patch-scale analysis (Chase et al., 2020, Nature 584, 238-243) demonstrates positive patch size effects on biodiversity, that is, 'ecosystem decay' in small patches. Other authors have already extrapolated this result to infer negative fragmentation effects, that is, higher biodiversity in a few large than many small patches of the same cumulative habitat area. We test whether this extrapolation is valid. We find that landscape-scale patterns are opposite to their analogous patch-scale patterns: for sets of patches with equal total habitat area, species richness and evenness decrease with increasing mean size of the patches comprising that area, even when considering only species of conservation concern. Preserving small habitat patches will, therefore, be key to sustain biodiversity amidst ongoing environmental crises.

Detection of Hantavirus during the COVID-19 Pandemic, Arizona, USA, 2020.

We identified 2 fatal cases of persons infected with hantavirus in Arizona, USA, 2020; 1 person was co-infected with SARS-CoV-2. Delayed identification of the cause of death led to a public health investigation that lasted ≈9 months after their deaths, which complicated the identification of a vector or exposure.

Addenda to ISCN 2020.

Since the publication of ISCN 2020, the ISCN Standing Committee have noted some clarification of the text and additional examples were needed. These addenda have already been published online (https://iscn.karger.com/) and this short report summarises the ISCN 2020 addenda for the benefit of participants. These addenda will be included in the release of the next version of ISCN.

Global epidemiological trends and variations in the burden of gallbladder cancer.

BACKGROUND: Gallbladder cancer (GBC) is a rare but lethal malignancy with a dismal prognosis. The aim of this study is to analyze the burdens and trends of GBC across the world based on geography, socioeconomic development (based on human development index [HDI]), and gender. METHODS: GLOBOCAN 2020 database was used to extract data (2020-2040) relating to the incidence and mortality of GBC across the world. RESULTS: Asia had the highest burden of GBC with India and China contributing to majority of the absolute burden. The burden of GBC by age standardized rate was highest in Latin America (Bolivia and Chile) and Southeast Asia (Bangladesh and Nepal). Medium HDI countries had a higher mortality rate compared to very high HDI countries. Females had a higher predilection for GBC across different regions and socioeconomic groups. GBC burden is expected to significantly increase across the world by 2040 with variable trends across different regions, age groups, and genders. CONCLUSION: The global burden of GBC will significantly increase over the next two decades with marked regional and demographic variations. The results of this study will empower national and global health leaders to develop policies to address the increasing burden of this lethal malignancy.

Global trends in the incidence and mortality of pancreatic cancer based on geographic location, socioeconomic status, and demographic shift.

BACKGROUND: Pancreatic cancer (PC) is a lethal malignancy with a significantly rising rate of incidence and mortality. This study aims to describe the influence of geography, socioeconomic development (based on the Human Development Index [HDI]), gender, and demographic shift on the temporal trends in the global burden of PC. METHODS: Data (2020-2040) relating to the incidence, mortality of PC, and demographic shifts based on continents and HDI areas were extracted from GLOBOCAN 2020. RESULTS: PC was associated with a higher socioeconomic status. Asia contributed to the majority of the burden, led by China. Advanced age (≥65 years) contributed to the majority of the burden in all socioeconomic regions except in Medium HDI and Low HDI countries, where the younger population (<65 years) contributed more. Females contributed to a higher burden in certain countries. Future trends for 2040 showed a >60% increase in the incidence and mortality of PC with an associated demographic shift. CONCLUSION: The global burden of PC is expected to rise significantly over the next few decades regardless of geography, socioeconomic development, age, and gender. Advance knowledge of this data can help to formulate strategies and public health policies to specifically target countries and populations at risk.

Obstruction of biodiversity conservation by minimum patch size criteria.

Minimum patch size criteria for habitat protection reflect the conservation principle that a single large (SL) patch of habitat has higher biodiversity than several small (SS) patches of the same total area (SL > SS). Nonetheless, this principle is often incorrect, and biodiversity conservation requires placing more emphasis on protection of large numbers of small patches (SS > SL). We used a global database reporting the abundances of species across hundreds of patches to assess the SL > SS principle in systems where small patches are much smaller than the typical minimum patch size criteria applied for biodiversity conservation (i.e., ∼85% of patches <100 ha). The 76 metacommunities we examined included 4401 species in 1190 patches. From each metacommunity, we resampled species-area accumulation curves to evaluate how biodiversity responded to habitat existing as a few large patches or as many small patches. Counter to the SL > SS principle and consistent with previous syntheses, species richness accumulated more rapidly when adding several small patches (45.2% SS > SL vs. 19.9% SL > SS) to reach the same cumulative area, even for the very small patches in our data set. Responses of taxa to habitat fragmentation differed, which suggests that when a given total area of habitat is to be protected, overall biodiversity conservation will be most effective if that habitat is composed of as many small patches as possible, plus a few large ones. Because minimum patch size criteria often require larger patches than the small patches we examined, our results suggest that such criteria hinder efforts to protect biodiversity.

Obstrucción de la conservación de la biodiversidad por el criterio del tamaño mínimo del fragmento Resumen Los criterios de tamaño mínimo de los fragmentos para la protección de los hábitats reflejan el principio de conservación según el cual un fragmento único grande (UG) de hábitat tiene mayor biodiversidad que varios fragmentos pequeños (VP) de la misma superficie total (UG > VP). Sin embargo, este principio a menudo es incorrecto; en su lugar, la conservación de la biodiversidad debería enfatizar más la protección de un gran número de pequeñas parcelas (VP > UG). Utilizamos una base de datos mundial que recopila la abundancia de especies en cientos de fragmentos para evaluar el principio UG > VP en sistemas donde los fragmentos pequeños son mucho menores que los criterios comunes de tamaño mínimo de fragmento aplicados para la conservación de la biodiversidad (es decir, ∼85% de parches <100 ha). Las 76 metacomunidades analizadas incluyeron 4,401 especies en 1,190 parcelas. Volvimos a muestrear las curvas de acumulación especie-área en cada metacomunidad para evaluar cómo respondía la biodiversidad al hábitat: como unas pocas manchas grandes o como fragmentos de muchas manchas pequeñas. Contrario al principio UG > VP y en congruencia con síntesis anteriores, la riqueza de especies se acumuló con mayor rapidez al añadir varios fragmentos pequeños (45.2% VP > UG frente a 19.9% UG > VP) para alcanzar la misma área acumulada, incluso para los fragmentos muy pequeños de nuestro conjunto de datos. Las respuestas de los taxones a la fragmentación del hábitat fueron diferentes, lo que sugiere que, cuando se trata de proteger una determinada superficie total de hábitat, la conservación global de la biodiversidad será más efectiva si ese hábitat está compuesto por el mayor número posible de pequeños fragmentos, más unos cuantos fragmentos grandes. Dado que los criterios de tamaño mínimo exigen a menudo fragmentos más grandes que los pequeños que examinamos, nuestros resultados sugieren que tales criterios dificultan los esfuerzos por proteger la biodiversidad.

Retaining natural vegetation to safeguard biodiversity and humanity.

Global efforts to deliver internationally agreed goals to reduce carbon emissions, halt biodiversity loss, and retain essential ecosystem services have been poorly integrated. These goals rely in part on preserving natural (e.g., native, largely unmodified) and seminatural (e.g., low intensity or sustainable human use) forests, woodlands, and grasslands. To show how to unify these goals, we empirically derived spatially explicit, quantitative, area-based targets for the retention of natural and seminatural (e.g., native) terrestrial vegetation worldwide. We used a 250-m-resolution map of natural and seminatural vegetation cover and, from this, selected areas identified under different international agreements as being important for achieving global biodiversity, carbon, soil, and water targets. At least 67 million km2 of Earth's terrestrial vegetation (∼79% of the area of vegetation remaining) required retention to contribute to biodiversity, climate, soil, and freshwater conservation objectives under 4 United Nations' resolutions. This equates to retaining natural and seminatural vegetation across at least 50% of the total terrestrial (excluding Antarctica) surface of Earth. Retention efforts could contribute to multiple goals simultaneously, especially where natural and seminatural vegetation can be managed to achieve cobenefits for biodiversity, carbon storage, and ecosystem service provision. Such management can and should co-occur and be driven by people who live in and rely on places where natural and sustainably managed vegetation remains in situ and must be complemented by restoration and appropriate management of more human-modified environments if global goals are to be realized.

Retención de la vegetación natural para salvaguardar la biodiversidad y la humanidad Resumen Hoy en día hay muy poca integración de los esfuerzos mundiales para alcanzar los objetivos internacionales de reducción de las emisiones de carbono, impedimento de la pérdida de biodiversidad y conservación de los servicios ambientales esenciales. Estos objetivos dependen parcialmente de la conservación de los bosques, selvas y praderas naturales (por ejemplo, nativos y en su mayoría sin alteraciones) y seminaturales (por ejemplo, de uso humano sostenible o de baja intensidad). Obtuvimos de manera empírica objetivos espacialmente explícitos, cuantitativos y basados en áreas para la conservación de la vegetación terrestre natural y seminatural (por ejemplo, nativa) en todo el mundo para mostrar cómo unificar los objetivos internacionales. Usamos un mapa de 250 m de resolución de la cubierta vegetal natural y seminatural y, a partir de él, seleccionamos las áreas identificadas como importantes en diferentes acuerdos internacionales para alcanzar los objetivos globales de biodiversidad, carbono, suelo y agua. Al menos 67 millones de km2 de la vegetación terrestre de la Tierra (∼79% de la superficie de vegetación restante) requieren ser conservados para contribuir a los objetivos de conservación de la biodiversidad, el clima, el suelo y el agua dulce en virtud de cuatro de las resoluciones de las Naciones Unidas. Esto equivale a conservar la vegetación natural y seminatural en al menos el 50% de la superficie terrestre total de la Tierra (sin contar a la Antártida). Los esfuerzos de retención podrían contribuir a alcanzar múltiples objetivos simultáneamente, especialmente en donde la vegetación natural y seminatural puede gestionarse para lograr beneficios colaterales para la biodiversidad, el almacenamiento de carbono y la provisión de servicios ambientales. Esta gestión puede y debe ser impulsada y llevada a cabo por las personas que viven en y dependen de los lugares donde la vegetación natural y gestionada de forma sostenible permanece in situ y debe complementarse con la restauración y la gestión adecuada de entornos modificados por el hombre si se quieren alcanzar los objetivos globales.

STereotactic Arrhythmia Radioablation (STAR): the Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary consortium (STOPSTORM.eu) and review of current patterns of STAR practice in Europe.

The EU Horizon 2020 Framework-funded Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary (STOPSTORM) consortium has been established as a large research network for investigating STereotactic Arrhythmia Radioablation (STAR) for ventricular tachycardia (VT). The aim is to provide a pooled treatment database to evaluate patterns of practice and outcomes of STAR and finally to harmonize STAR within Europe. The consortium comprises 31 clinical and research institutions. The project is divided into nine work packages (WPs): (i) observational cohort; (ii) standardization and harmonization of target delineation; (iii) harmonized prospective cohort; (iv) quality assurance (QA); (v) analysis and evaluation; (vi, ix) ethics and regulations; and (vii, viii) project coordination and dissemination. To provide a review of current clinical STAR practice in Europe, a comprehensive questionnaire was performed at project start. The STOPSTORM Institutions' experience in VT catheter ablation (83% ≥ 20 ann.) and stereotactic body radiotherapy (59% > 200 ann.) was adequate, and 84 STAR treatments were performed until project launch, while 8/22 centres already recruited VT patients in national clinical trials. The majority currently base their target definition on mapping during VT (96%) and/or pace mapping (75%), reduced voltage areas (63%), or late ventricular potentials (75%) during sinus rhythm. The majority currently apply a single-fraction dose of 25 Gy while planning techniques and dose prescription methods vary greatly. The current clinical STAR practice in the STOPSTORM consortium highlights potential areas of optimization and harmonization for substrate mapping, target delineation, motion management, dosimetry, and QA, which will be addressed in the various WPs.