Obstructive sleep apnea is common among patients referred for coronary artery bypass grafting and can be diagnosed by portable monitoring

Background Obstructive sleep apnea (OSA) is common among patients with coronary artery disease. However, OSA remains largely under recognized. The lack of clinical suspicion and difficulties to access full polysomnography (PSG) are limiting factors. The aim of this study was to evaluate, among patients referred to coronary artery bypass grafting (CABG): (i) the prevalence of OSA, (ii) the association of OSA with clinical symptoms, (iii) the performance of overnight unattended portable monitoring (PM) as an alternative method for the diagnosis of OSA. Methods Consecutive patients referred for CABG were evaluated by standard physical evaluation and validated questionnaires (Berlin questionnaire and Epworth Sleepiness Scale) and underwent full PSG and PM (Stardust II). Results We studied 70 consecutive patients (76% men), age 58 +/- 7 years (mean +/- SD), BMI [median (interquartile range)] 27.6 kg/m(2) (25.8-31.1). The prevalence of OSA (full PSG) using an apnea-hypopnea index of at least 5 events/h was 87%. Commonly used clinical traits for the screening of OSA such as the Epworth Sleepiness Scale and neck circumference had low sensitivities to detect OSA. In contrast, the Berlin questionnaire showed a good sensitivity (72%) to detect OSA. PM showed good sensitivity (92%) and specificity (67%) for the diagnosis of OSA. Conclusion OSA is strikingly common among patients referred for CABG. The Berlin questionnaire, but not symptom of excessive daytime sleepiness is a useful tool to screen OSA. PM is useful for the diagnosis of OSA and therefore is an attractive tool for widespread use among patients with coronary artery disease. Coron Artery Dis 23:31-38 (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Influence of habitat and climate change on European bird communities

Die Fragmentierung von Waldgebieten, der Verlust geeigneter Habitate, die Invasion exotischer Arten und globale Klimaveränderung haben auf Artengemeinschaften erhebliche Auswirkungen. Vögel dienen in vielen Fällen als Indikatorarten für Umweltveränderungen und, besonders, für Veränderungen im Zusammenhang mit globaler Erwärmung. In meiner Arbeit habe ich zuerst einen Literaturüberblick über die Auswirkungen globaler Klimaveränderung auf die Verbreitungsgebiete, den Artenreichtum und die Zusammensetzung von Vogelgemeinschaften dargestellt. Zahlreiche Untersuchungen zeigen, daß die Grenzen der Verbreitungsgebiete der meisten Vogelarten mit klimatischen Faktoren korrelieren. Verschiebungen der Verbreitungsgebiete in nördliche Richtung oder in höhere Regionen im Gebirge konnten bereits für viele temperate Vogelarten beobachtet werden. Weiterhin wurde ein zunehmender Artenreichtum besonders in nördlichen Breiten und in höheren Lagen für viele temperate Vogelgemeinschaften vorhergesagt. In trockenen Gebieten ist dagegen mit einer Abnahme des Artenreichtums zu rechnen. Im zweiten Teil meiner Arbeit habe ich untersucht, ob beobachtete Veränderungen in der Zusammensetzung europäischer Vogelgemeinschaften tatsächlich durch aktuelle Klimaveränderungen beeinflußt werden. Das Zugverhalten der Arten war dabei ein Schwerpunkt der Untersuchung, weil zu erwarten war, daß Vogelarten mit verschiedenem Zugverhalten unterschiedlich auf Klimaveränderungen reagieren. Ich habe ein Regressionsmodell genutzt, welches die räumliche Beziehung zwischen dem Anteil von Langstreckenziehern, Kurzstreckenziehern und Standvögeln in europäischen Vogelgemeinschaften und verschiedenen Klimavariablen beschreibt. Für 21 Gebiete in Europa habe ich Daten über beobachtete Veränderungen in der Struktur der Vogelgemeinschaften und isochrone Klimaveränderungen zusammengetragen. Mit Hilfe dieser Klimaveränderungen und dem räumlichen Regressionsmodell konnte ich berechnen, welche Veränderungen in den Vogelgemeinschaften aufgrund der veränderten Klimabedingungen zu erwarten wären und sie mit beobachteten Veränderungen vergleichen. Beobachtete und berechnete Veränderungen korrelierten signifikant miteinander. Die beobachteten Veränderungen konnten nicht durch räumliche Autokorrelationseffekte oder durch alternative Faktoren, wie z.B. Veränderungen in der Landnutzung, erklärt werden. Im dritten Teil der Arbeit untersuchte ich für eine mitteleuropäische Vogelgemeinschaft welchen Einfluß Habitatveränderungen, die Invasion exotischer Arten und die Klimaveränderung auf Veränderungen der Häufigkeit und Verbreitungsgröße der 159 Vogelarten am Bodensee zwischen 1980-1981 und 2000-2002 hatten. Dabei konnte gezeigt werden, daß Veränderungen in der regionalen Abundanz sowohl durch Habitatveränderungen als auch durch Klimavänderungen hervorgerufen wurden. Exotische Arten schienen in dieser Zeit keinen bedeutenden Einfluß zu haben. Besonders bei Agrarlandarten, Arten mit nördlicheren Verbreitungsgebieten und bei Langstreckenziehern konnten signifikante Abnahmen in der Abundanz beobachtet werden. Vor allem die anhaltenden negativen Bestandsveränderungen bei Langstreckenziehern und die in den letzten zehn Jahren aufgetretenen Abnahmen nördlicher verbreiteter Vogelarten deuten darauf hin, daß die Klimaveränderung aktuell als der größte Einfluß für Vögel in Europa angesehen werden muß. Insgesamt zeigen die Ergebnisse dieser Arbeit, daß sich der anhaltende Druck auf die Umwelt in erster Linie durch Habitat- und Klimaveränderungen manifestiert.

The role of self-monitoring of blood glucose in glucagon-like Peptide-1-based treatment approaches: a European expert recommendation

The role of glucagon-like peptide (GLP)-1-based treatment approaches for type 2 diabetes mellitus (T2DM) is increasing. Although self-monitoring of blood glucose (SMBG) has been performed in numerous studies on GLP-1 analogs and dipeptidyl peptidase-4 inhibitors, the potential role of SMBG in GLP-1-based treatment strategies has not been elaborated. The expert recommendation suggests individualized SMBG strategies in GLP-1-based treatment approaches and suggests simple and clinically applicable SMBG schemes. Potential benefits of SMBG in GLP-1-based treatment approaches are early assessment of treatment success or failure, timely modification of treatment, detection of hypoglycemic episodes, assessment of glucose excursions, and support of diabetes management and diabetes education. Its length and frequency should depend on the clinical setting and the quality of metabolic control. It is considered to play an important role for the optimization of diabetes management in T2DM patients treated with GLP-1-based approaches.

A common ancestral glycoprotein (GP) 9 1828A>G (Asn45Ser) gene mutation occurring in European families from Australia and Northern Europe with Bernard-Soulier Syndrome (BSS)

Bernard-Soulier syndrome (BSS) is an extremely rare hereditary bleeding disorder, caused by mutations occurring in the Glycoprotein (GP) Ibalpha, GPIbbeta and GP9 genes that encode for the corresponding subunits of platelet GPIb-V-IX adhesion receptor complex. BSS has been reported in many populations, mostly behaving in an autosomal-recessive manner.While the great majority of BSS mutations are unique to a single individual or family, the GP9 1828A>G Asn45Ser mutation, which we have identified in an undocumented Australian Caucasian, has already been reported in multiple unrelated Caucasian families from various Northern and Central European countries. Haplotype analysis of 19 BSS patients from 15 unrelated Northern European families (including 2 compound heterozygote siblings from a British family previously published, and 17 1828A>G Asn45Ser homozygotes), showed that 14 of these BSS patients from 11 of the 1828A>G Asn45Ser homozygote families share a common haplotype at the chromosomal region 3' to the GP9 gene. Hence, the results suggest that the GP9 1828A>GAsn45Ser mutation in these families is ancient, and its frequent emergence in the European population is the result of a founder effect rather than recurrent mutational events. Association of the 1828A>G Asn45Ser mutation with variant haplotypes in 4 other Northern European BSS families raised the possibility of a second founder event, or rare recombinations in these families. Additional members from these 'atypical' lineages would need to be screened to resolve this question.

Psoriasis beyond the skin: an expert group consensus on the management of psoriatic arthritis and common co-morbidities in patients with moderate-to-severe psoriasis

BACKGROUND Psoriatic arthritis (PsA) and co-morbidities of psoriasis represent a significant clinical and economic burden for patients with moderate-to-severe psoriasis. Often these co-morbidities may go unrecognized or undertreated. While published data are available on the incidence and impact of some of them, practical guidance for dermatologists on detection and management of these co-morbidities is lacking. OBJECTIVE To prepare expert recommendations to improve the detection and management of common co-morbidities in patients with moderate-to-severe psoriasis. METHODS A systematic literature review was conducted on some common co-morbidities of psoriasis-cardiovascular (CV) diseases (including obesity, hypertension, hyperglycaemia and dyslipidaemia), psychological co-morbidities (including depression, alcohol abuse and smoking) and PsA-to establish the incidence and impact of each. Data gaps were identified and a Delphi survey was carried out to obtain consensus on the detection and management of each co-morbidity. The expert panel members for the Delphi survey comprised 10 dermatologists with substantial clinical expertise in managing moderate-to-severe psoriasis patients, as well as a cardiologist and a psychologist (see appendix) with an interest in dermatology. Agreement was defined using a Likert scale of 1-7. Consensus regarding agreement for each statement was defined as ≥75% of respondents scoring either 1 (strongly agree) or 2 (agree). RESULTS The expert panel members addressed several topics including screening, intervention, monitoring frequency, and the effects of anti-psoriatic treatment on each co-morbidity. Consensus was achieved on 12 statements out of 22 (3 relating to PsA, 4 relating to psychological factors, 5 relating to CV factors). The panel members felt that dermatologists have an important role in screening their psoriasis patients for PsA and in assessing them for psychological and CV co-morbidities. In most cases, however, patients should be referred for specialist management if other co-morbidities are detected. CONCLUSION This article provides useful and practical guidance for the detection and management of common co-morbidities in patients with moderate-to-severe psoriasis.

The impact of retrieval processes, age, general achievement level, and test scoring scheme for children's metacognitive monitoring and controlling

This multi-phase study examined the influence of retrieval processes on children’s metacognitive processes in relation to and in interaction with achievement level and age. First, N = 150 9/10- and 11/12-year old high and low achievers watched an educational film and predicted their test performance. Children then solved a cloze test regarding the film content including answerable and unanswerable items and gave confidence judgments to every answer. Finally, children withdrew answers that they believed to be incorrect. All children showed adequate metacognitive processes before and during test taking with 11/12- year-olds outperforming 9/10-year-olds when considering characteristics of on-going retrieval processes. As to the influence of achievement level, high compared to low achievers proved to be more accurate in their metacognitive monitoring and controlling. Results suggest that both cognitive resources (operationalized through achievement level) and mnemonic experience (assessed through age) fuel metacognitive development. Nevertheless, when facing higher demands regarding retrieval processes, experience seems to play the more important role.

Lake surface water temperatures of European Alpine lakes (1989–2013) based on the Advanced Very High Resolution Radiometer (AVHRR) 1 km data set

Lake water temperature (LWT) is an important driver of lake ecosystems and it has been identified as an indicator of climate change. Consequently, the Global Climate Observing System (GCOS) lists LWT as an essential climate variable. Although for some European lakes long in situ time series of LWT do exist, many lakes are not observed or only on a non-regular basis making these observations insufficient for climate monitoring. Satellite data can provide the information needed. However, only few satellite sensors offer the possibility to analyse time series which cover 25 years or more. The Advanced Very High Resolution Radiometer (AVHRR) is among these and has been flown as a heritage instrument for almost 35 years. It will be carried on for at least ten more years, offering a unique opportunity for satellite-based climate studies. Herein we present a satellite-based lake surface water temperature (LSWT) data set for European water bodies in or near the Alps based on the extensive AVHRR 1 km data record (1989–2013) of the Remote Sensing Research Group at the University of Bern. It has been compiled out of AVHRR/2 (NOAA-07, -09, -11, -14) and AVHRR/3 (NOAA-16, -17, -18, -19 and MetOp-A) data. The high accuracy needed for climate related studies requires careful pre-processing and consideration of the atmospheric state. The LSWT retrieval is based on a simulation-based scheme making use of the Radiative Transfer for TOVS (RTTOV) Version 10 together with ERA-interim reanalysis data from the European Centre for Medium-range Weather Forecasts. The resulting LSWTs were extensively compared with in situ measurements from lakes with various sizes between 14 and 580 km2 and the resulting biases and RMSEs were found to be within the range of −0.5 to 0.6 K and 1.0 to 1.6 K, respectively. The upper limits of the reported errors could be rather attributed to uncertainties in the data comparison between in situ and satellite observations than inaccuracies of the satellite retrieval. An inter-comparison with the standard Moderate-resolution Imaging Spectroradiometer (MODIS) Land Surface Temperature product exhibits RMSEs and biases in the range of 0.6 to 0.9 and −0.5 to 0.2 K, respectively. The cross-platform consistency of the retrieval was found to be within ~ 0.3 K. For one lake, the satellite-derived trend was compared with the trend of in situ measurements and both were found to be similar. Thus, orbital drift is not causing artificial temperature trends in the data set. A comparison with LSWT derived through global sea surface temperature (SST) algorithms shows lower RMSEs and biases for the simulation-based approach. A running project will apply the developed method to retrieve LSWT for all of Europe to derive the climate signal of the last 30 years. The data are available at doi:10.1594/PANGAEA.831007.

Management of Joint Research Activities within ERA-ARD: Guidelines for ARD programme planning, monitoring, evaluation and impact assessment

The present document has been elaborated in the context of the ERA-ARD project “The Agricultural Research for Development (ARD) dimension of the European Research Area (ERA) “. It is based on work done within Task 3.2 to identify a set of common or compatible methodologies for ARD planning, monitoring and evaluation and impact assessment. This set should serve as a guide for the management of joint ARD activities that are presently developed within the framework of the ERA-ARD project.

Analysis of Contributions to NO2 Ambient Air Quality Levels in Madrid City (Spain) through Modeling. Implications for the Development of Policies and Air Quality Monitoring

As environmental standards become more stringent (e.g. European Directive 2008/50/EC), more reliable and sophisticated modeling tools are needed to simulate measures and plans that may effectively tackle air quality exceedances, common in large cities across Europe, particularly for NO2. Modeling air quality in urban areas is rather complex since observed concentration values are a consequence of the interaction of multiple sources and processes that involve a wide range of spatial and temporal scales. Besides a consistent and robust multi-scale modeling system, comprehensive and flexible emission inventories are needed. This paper discusses the application of the WRF-SMOKE-CMAQ system to the Madrid city (Spain) to assess the contribution of the main emitting sectors in the region. A detailed emission inventory was compiled for this purpose. This inventory relies on bottom-up methods for the most important sources. It is coupled with the regional traffic model and it makes use of an extensive database of industrial, commercial and residential combustion plants. Less relevant sources are downscaled from national or regional inventories. This paper reports the methodology and main results of the source apportionment study performed to understand the origin of pollution (main sectors and geographical areas) and define clear targets for the abatement strategy. Finally the structure of the air quality monitoring is analyzed and discussed to identify options to improve the monitoring strategy not only in the Madrid city but the whole metropolitan area.