Associations of ambulatory blood pressure with urinary caffeine and caffeine metabolite excretions.

Intake of caffeinated beverages might be associated with reduced cardiovascular mortality possibly via the lowering of blood pressure. We estimated the association of ambulatory blood pressure with urinary caffeine and caffeine metabolites in a population-based sample. Families were randomly selected from the general population of Swiss cities. Ambulatory blood pressure monitoring was conducted using validated devices. Urinary caffeine, paraxanthine, theophylline, and theobromine excretions were measured in 24 hours urine using ultrahigh performance liquid chromatography tandem mass spectrometry. We used mixed models to explore the associations of urinary excretions with blood pressure although adjusting for major confounders. The 836 participants (48.9% men) included in this analysis had mean age of 47.8 and mean 24-hour systolic and diastolic blood pressure of 120.1 and 78.0 mm Hg. For each doubling of caffeine excretion, 24-hour and night-time systolic blood pressure decreased by 0.642 and 1.107 mm Hg (both P values <0.040). Similar inverse associations were observed for paraxanthine and theophylline. Adjusted night-time systolic blood pressure in the first (lowest), second, third, and fourth (highest) quartile of paraxanthine urinary excretions were 110.3, 107.3, 107.3, and 105.1 mm Hg, respectively (P trend <0.05). No associations of urinary excretions with diastolic blood pressure were generally found, and theobromine excretion was not associated with blood pressure. Anti-hypertensive therapy, diabetes mellitus, and alcohol consumption modify the association of caffeine urinary excretion with systolic blood pressure. Ambulatory systolic blood pressure was inversely associated with urinary excretions of caffeine and other caffeine metabolites. Our results are compatible with a potential protective effect of caffeine on blood pressure.

Comparative effectiveness of immediate antiretroviral therapy versus CD4-based initiation in HIV-positive individuals in high-income countries: observational cohort study.

BACKGROUND Recommendations have differed nationally and internationally with respect to the best time to start antiretroviral therapy (ART). We compared effectiveness of three strategies for initiation of ART in high-income countries for HIV-positive individuals who do not have AIDS: immediate initiation, initiation at a CD4 count less than 500 cells per μL, and initiation at a CD4 count less than 350 cells per μL. METHODS We used data from the HIV-CAUSAL Collaboration of cohort studies in Europe and the USA. We included 55 826 individuals aged 18 years or older who were diagnosed with HIV-1 infection between January, 2000, and September, 2013, had not started ART, did not have AIDS, and had CD4 count and HIV-RNA viral load measurements within 6 months of HIV diagnosis. We estimated relative risks of death and of death or AIDS-defining illness, mean survival time, the proportion of individuals in need of ART, and the proportion of individuals with HIV-RNA viral load less than 50 copies per mL, as would have been recorded under each ART initiation strategy after 7 years of HIV diagnosis. We used the parametric g-formula to adjust for baseline and time-varying confounders. FINDINGS Median CD4 count at diagnosis of HIV infection was 376 cells per μL (IQR 222-551). Compared with immediate initiation, the estimated relative risk of death was 1·02 (95% CI 1·01-1·02) when ART was started at a CD4 count less than 500 cells per μL, and 1·06 (1·04-1·08) with initiation at a CD4 count less than 350 cells per μL. Corresponding estimates for death or AIDS-defining illness were 1·06 (1·06-1·07) and 1·20 (1·17-1·23), respectively. Compared with immediate initiation, the mean survival time at 7 years with a strategy of initiation at a CD4 count less than 500 cells per μL was 2 days shorter (95% CI 1-2) and at a CD4 count less than 350 cells per μL was 5 days shorter (4-6). 7 years after diagnosis of HIV, 100%, 98·7% (95% CI 98·6-98·7), and 92·6% (92·2-92·9) of individuals would have been in need of ART with immediate initiation, initiation at a CD4 count less than 500 cells per μL, and initiation at a CD4 count less than 350 cells per μL, respectively. Corresponding proportions of individuals with HIV-RNA viral load less than 50 copies per mL at 7 years were 87·3% (87·3-88·6), 87·4% (87·4-88·6), and 83·8% (83·6-84·9). INTERPRETATION The benefits of immediate initiation of ART, such as prolonged survival and AIDS-free survival and increased virological suppression, were small in this high-income setting with relatively low CD4 count at HIV diagnosis. The estimated beneficial effect on AIDS is less than in recently reported randomised trials. Increasing rates of HIV testing might be as important as a policy of early initiation of ART. FUNDING National Institutes of Health.

THEODORE, a two-step heating system for the EC/OC determination of radiocarbon (14C) in the environment

Measurements of 14C in the organic carbon (OC) and elemental carbon (EC) fractions, respectively, of fine aerosol particles bear the potential to apportion anthropogenic and biogenic emission sources. For this purpose, the system THEODORE (two-step heating system for the EC/OC determination of radiocarbon in the environment) was developed. In this device, OC and EC are transformed into carbon dioxide in a stream of oxygen at 340 and 650 �C, respectively, and reduced to filamentous carbon. This is the target material for subsequent accelerator mass spectrometry (AMS) 14C measurements, which were performed on sub-milligram carbon samples at the PSI/ETH compact 500 kV AMS system. Quality assurance measurements of SRM 1649a, Urban Dust, yielded a fraction of modern fM in total carbon (TC) of 0.522 ±0.018 (n ¼ 5, 95% confidence level) in agreement with reported values. The results for OC and EC are 0.70± 0.05 (n ¼ 3) and 0.066 ± 0.020 (n ¼ 4), respectively.

GROMOS-C, a novel ground-based microwave radiometer for ozone measurement campaigns

Stratospheric ozone is of major interest as it absorbs most harmful UV radiation from the sun, allowing life on Earth. Ground-based microwave remote sensing is the only method that allows for the measurement of ozone profiles up to the mesopause, over 24 hours and under different weather conditions with high time resolution. In this paper a novel ground-based microwave radiometer is presented. It is called GROMOS-C (GRound based Ozone MOnitoring System for Campaigns), and it has been designed to measure the vertical profile of ozone distribution in the middle atmosphere by observing ozone emission spectra at a frequency of 110.836 GHz. The instrument is designed in a compact way which makes it transportable and suitable for outdoor use in campaigns, an advantageous feature that is lacking in present day ozone radiometers. It is operated through remote control. GROMOS-C is a total power radiometer which uses a pre-amplified heterodyne receiver, and a digital fast Fourier transform spectrometer for the spectral analysis. Among its main new features, the incorporation of different calibration loads stands out; this includes a noise diode and a new type of blackbody target specifically designed for this instrument, based on Peltier elements. The calibration scheme does not depend on the use of liquid nitrogen; therefore GROMOS-C can be operated at remote places with no maintenance requirements. In addition, the instrument can be switched in frequency to observe the CO line at 115 GHz. A description of the main characteristics of GROMOS-C is included in this paper, as well as the results of a first campaign at the High Altitude Research Station at Jungfraujoch (HFSJ), Switzerland. The validation is performed by comparison of the retrieved profiles against equivalent profiles from MLS (Microwave Limb Sounding) satellite data, ECMWF (European Centre for Medium-Range Weather Forecast) model data, as well as our nearby NDACC (Network for the Detection of Atmospheric Composition Change) ozone radiometer measuring at Bern.

A multi-level stakeholder approach to sustainable land management

Soils provide us with over 90% of all human food, livestock feed, fibre and fuel on Earth. Soils, however, have more than just productive functions. The key challenge in coming years will be to address the diverse and potentially conflicting demands now being made by human societies and other forms of life, while ensuring that future generations have the same potential to use soils and land of comparable quality. In a multi-level stakeholder approach, down-to-earth action will have to be supplemented with measures at various levels, from households to communities, and from national policies to international conventions. Knowledge systems, both indigenous and scientific, and related research and learning processes must play a central role. Ongoing action can be enhanced through a critical assessment of the impact of past achievements, and through better cooperation between people and institutions.