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- Dyer, A. H., et al.
(författare)
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Cognitive Outcomes of Long-term Benzodiazepine and Related Drug (BDZR) Use in People Living With Mild to Moderate Alzheimer's Disease: Results From NILVAD
- 2020
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610. ; 21:2, s. 194-200
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Benzodiazepines and related drugs (BDZRs) have been associated with an increased risk of Alzheimer's disease (AD) in later life. Despite this, it remains unclear whether ongoing BDZR use may further accelerate cognitive decline in those diagnosed with mild to moderate AD. Design: This study was embedded within NILVAD, a randomized controlled trial of nilvadipine in mild to moderate AD. Cognition was measured at baseline and 18 months using the Alzheimer Disease Assessment Scale, Cognitive Subsection (ADAS-Cog). We assessed predictors of long-term BDZR use and analyzed the effect of ongoing BDZR use on ADAS-Cog scores at 18 months. Additionally, the impact of BDZR use on adverse events, incident delirium, and falls over 18-month follow-up was assessed adjusting for relevant covariates. Setting and Participants: 448 participants with mild to moderate AD recruited from 23 academic centers in 9 European countries. Results: Overall, 14% (62/448) were prescribed an ongoing BDZR for the study duration. Increasing total number of (non-BDZR) medications was associated with a greater likelihood of BDZR prescription (odds ratio 1.16, 95% confidence interval 1.05-1.29). At 18 months, BDZR use was not associated with greater cognitive decline on the ADAS-Cog controlling for baseline ADAS-Cog scores, age, gender, study arm, and other clinical covariates (beta = 1.62, -1.34 to 4.56). However, ongoing BDZR use was associated with a greater likelihood of adverse events [incidence rate ratio (IRR) 1.19, 1.05-1.34], incident delirium (IRR 2.31, 1.45-3.68), and falls (IRR 1.66, 1.02-2.65) over 18 months that persisted after robust adjustment for covariates. Conclusions and Implications: This study found no effect of ongoing BDZR use on ADAS-Cog scores in those with mild to moderate AD over 18 months. However, ongoing use of these medications was associated with an increased risk of adverse events, delirium, and falls. Thus, BDZR use should be avoided where possible and deprescribing interventions should be encouraged in older adults with AD. (C) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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- Gomez-Gener, L., et al.
(författare)
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Global carbon dioxide efflux from rivers enhanced by high nocturnal emissions
- 2021
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Ingår i: Nature Geoscience. - : Springer Science and Business Media LLC. - 1752-0894 .- 1752-0908. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Carbon dioxide (CO2) emissions to the atmosphere from running waters are estimated to be four times greater than the total carbon (C) flux to the oceans. However, these fluxes remain poorly constrained because of substantial spatial and temporal variability in dissolved CO2 concentrations. Using a global compilation of high-frequency CO2 measurements, we demonstrate that nocturnal CO2 emissions are on average 27% (0.9 gC m(-2) d(-1)) greater than those estimated from diurnal concentrations alone. Constraints on light availability due to canopy shading or water colour are the principal controls on observed diel (24 hour) variation, suggesting this nocturnal increase arises from daytime fixation of CO2 by photosynthesis. Because current global estimates of CO2 emissions to the atmosphere from running waters (0.65-1.8 PgC yr(-1)) rely primarily on discrete measurements of dissolved CO2 obtained during the day, they substantially underestimate the magnitude of this flux. Accounting for night-time CO2 emissions may elevate global estimates from running waters to the atmosphere by 0.20-0.55 PgC yr(-1). Failing to account for emission differences between day and night will lead to an underestimate of global CO2 emissions from rivers by up to 0.55 PgC yr(-1), according to analyses of high-frequency CO2 measurements.
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- Guseva, S., et al.
(författare)
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Variable Physical Drivers of Near-Surface Turbulence in a Regulated River
- 2021
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Ingår i: Water resources research. - : American Geophysical Union (AGU). - 0043-1397 .- 1944-7973. ; 57:11
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Tidskriftsartikel (refereegranskat)abstract
- Inland waters, such as lakes, reservoirs and rivers, are important sources of climate forcing trace gases. A key parameter that regulates the gas exchange between water and the atmosphere is the gas transfer velocity, which itself is controlled by near-surface turbulence in the water. While in lakes and reservoirs, near-surface turbulence is mainly driven by atmospheric forcing, in shallow rivers and streams it is generated by bottom friction of gravity-forced flow. Large rivers represent a transition between these two cases. Near-surface turbulence has rarely been measured in rivers and the drivers of turbulence have not been quantified. We analyzed continuous measurements of flow velocity and quantified turbulence as the rate of dissipation of turbulent kinetic energy over the ice-free season in a large regulated river in Northern Finland. Measured dissipation rates agreed with predictions from bulk parameters, including mean flow velocity, wind speed, surface heat flux, and with a one-dimensional numerical turbulence model. Values ranged from to . Atmospheric forcing or gravity was the dominant driver of near-surface turbulence for similar fraction of the time. Large variability in near-surface dissipation rate occurred at diel time scales, when the flow velocity was strongly affected by downstream dam operation. By combining scaling relations for boundary-layer turbulence at the river bed and at the air-water interface, we derived a simple model for estimating the relative contributions of wind speed and bottom friction of river flow as a function of depth.Plain Language SummaryInland water bodies such as lakes, reservoirs and rivers are an important source of climate forcing trace gases to the atmosphere. Gas exchange between water and the atmosphere is regulated by the gas transfer velocity and the concentration difference between the water surface and the atmosphere. The gas transfer velocity depends on near-surface turbulence, but robust formulations have not been developed for river systems. Their surface area is sufficiently large for meteorological forcing to cause turbulence, as in lakes and reservoirs, but turbulence generated from bed and internal friction of gravity-driven flows is also expected to contribute. Here we quantify near-surface turbulence using data from continuous air and water side measurements conducted over the ice-free season in a large subarctic regulated river in Finland. We find that turbulence, quantified as the dissipation rate of turbulent kinetic energy, is well described using equations for predicting turbulence from meteorological data for sufficiently high wind speeds whereas the contribution from bottom shear dominated at higher flow velocities. A one-dimensional river model successfully captured these processes. We provide a fundamental model for estimating the relative contributions of atmospheric forcing and bottom friction as a function of depth.
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