The water-energy-food (WEF) nexus is rapidly expanding in scholarly literature and policy settings as a novel way to address complex resource and development challenges. The nexus approach aims to ...identify tradeoffs and synergies of water, energy, and food systems, internalize social and environmental impacts, and guide development of cross-sectoral policies. However, while the WEF nexus offers a promising conceptual approach, the use of WEF nexus methods to systematically evaluate water, energy, and food interlinkages or support development of socially and politically-relevant resource policies has been limited. This paper reviews WEF nexus methods to provide a knowledge base of existing approaches and promote further development of analytical methods that align with nexus thinking. The systematic review of 245 journal articles and book chapters reveals that (a) use of specific and reproducible methods for nexus assessment is uncommon (less than one-third); (b) nexus methods frequently fall short of capturing interactions among water, energy, and food-the very linkages they conceptually purport to address; (c) assessments strongly favor quantitative approaches (nearly three-quarters); (d) use of social science methods is limited (approximately one-quarter); and (e) many nexus methods are confined to disciplinary silos-only about one-quarter combine methods from diverse disciplines and less than one-fifth utilize both quantitative and qualitative approaches. To help overcome these limitations, we derive four key features of nexus analytical tools and methods-innovation, context, collaboration, and implementation-from the literature that reflect WEF nexus thinking. By evaluating existing nexus analytical approaches based on these features, we highlight 18 studies that demonstrate promising advances to guide future research. This paper finds that to address complex resource and development challenges, mixed-methods and transdisciplinary approaches are needed that incorporate social and political dimensions of water, energy, and food; utilize multiple and interdisciplinary approaches; and engage stakeholders and decision-makers.
Background
Harmonized protocols to collect imaging data must be devised, employed, and maintained in multicentric studies to reduce interscanner variability in subsequent analyses.
Purpose
To present ...a standardized protocol for multicentric research on dementia linked to neurodegeneration in aging, harmonized on all three major vendor platforms. The protocol includes a common procedure for qualification, quality control, and quality assurance and feasibility in large‐scale studies.
Study Type
Prospective.
Subjects
The study involved a geometric phantom, a single individual volunteer, and 143 cognitively healthy, mild cognitively impaired, and Alzheimer's disease participants in a large‐scale, multicentric study.
Field Strength/Sequences
MRI was perform with 3T scanners (GE, Philips, Siemens) and included 3D T1w, PD/T2w,
T2*, T2w‐FLAIR, diffusion, and BOLD resting state acquisitions.
Assessment
Measures included signal‐ and contrast‐to‐noise ratios (SNR and CNR, respectively), total brain volumes, and total scan time.
Statistical Tests
SNR, CNR, and scan time were compared between scanner vendors using analysis of variance (ANOVA) and Tukey tests, while brain volumes were tested using linear mixed models.
Results
Geometric phantom T1w SNR was significantly (P < 0.001) higher in Philips (mean: 71.4) than Siemens (29.5), while no significant difference was observed between vendors for T2w (32.0 and 37.2, respectively, P = 0.243). Single individual volunteer T1w CNR was higher in subcortical regions for Siemens (P < 0.001), while Philips had higher cortical CNR (P = 0.044). No significant difference in brain volumes was observed between vendors (P = 0.310/0.582/0.055). The average scan time was 41.0 minutes (SD: 2.8) and was not significantly different between sites (P = 0.071) and cognitive groups (P = 0.853).
Data Conclusion
The harmonized Canadian Dementia Imaging Protocol suits the needs of studies that need to ensure quality MRI data acquisition for the measurement of brain changes across adulthood, due to aging, neurodegeneration, and other etiologies. A detailed description, exam cards, and operators' manual are freely available at the following site: www.cdip-pcid.ca.
Level of Evidence: 2
Technical Efficacy: Stage 2
J. Magn. Reson. Imaging 2019;49:456–465.
Visible Virchow-Robin spaces (VRS) are commonly used markers for small vessel disease in aging and dementia.
However, as previous reports were based on subjective visual ratings, the goal of this ...project was to validate and apply an MRI-based quantitative measure of VRS as a potential neuroimaging biomarker.
A modified version of Lesion Explorer was applied to MRIs from Alzheimer's disease patients (AD: n = 203) and normal elderly controls (NC: n = 94). Inter-rater reliability, technique validity, group/gender differences, and correlations with other small vessel disease markers were examined (lacunes and white matter hyperintensities, WMH).
Inter-rater reliability and spatial congruence was excellent (ICC = 0.99, SI = 0.96), and VRS volumes were highly correlated with established rating scales (CS: ρ = 0.84, p < 0.001; BG: ρ = 0.75, p < 0.001). Compared to NC, AD had significantly greater volumes of WMH (p < 0.01), lacunes (p < 0.001), and VRS in the white matter (p < 0.01), but not in the basal ganglia (n.s.). Compared to women, demented and non-demented men had greater VRS in the white matter (p < 0.001), but not in the basal ganglia (n.s.). Additionally, VRS were correlated with lacunes and WMH, but only in AD (r = 0.3, p < 0.01).
Compared to women, men may be more susceptible to greater volumes of VRS, particularly in the white matter. RESULTS support the hypothesis that VRS in the white matter may be more related to AD-related vascular pathology compared to VRS found in the basal ganglia. Future work using this novel VRS segmentation tool will examine its potential utility as an imaging biomarker of vascular rather than parenchymal amyloid.
Abstract Background Wild-type transthyretin cardiac amyloidosis (ATTRwt) is increasingly recognized as an important cause of heart failure. Objectives The purpose of this study was to determine the ...natural history of ATTRwt and the predictors of survival. Methods We retrospectively reviewed patients diagnosed with ATTRwt at the Mayo Clinic through 2013 and recorded clinical data and survival data. Factors affecting overall survival (OS) were identified, and a prognostic staging system was developed. Results The median age of the 360 patients diagnosed before death was 75 years (range: 47 to 94 years), and 91% were male. Presenting signs and symptoms included dyspnea or heart failure in 67% and atrial arrhythmias in 62%. Median OS from diagnosis was 3.6 years and did not change over time. Multivariate predictors of mortality included age, ejection fraction, pericardial effusion, N-terminal pro–B-type natriuretic peptide, and troponin T. A staging system was developed that used thresholds of troponin T (0.05 ng/ml) and N-terminal pro–B-type natriuretic peptide (3,000 pg/ml). The respective 4-year OS estimates were 57%, 42%, and 18% for stage I (both values below cutoff), stage II (one above), and stage III (both above), respectively. Stage III patients were at an increased risk of mortality after adjustment for age and sex compared with stage I patients (hazard ratio: 3.6; p < 0.001). Conclusions The natural history of ATTRwt is poor. We report a novel cardiac biomarker staging system that enables risk stratification in an era of emerging treatment strategies.
Asymptomatic left ventricular dysfunction (ALVD) is present in 3-6% of the general population, is associated with reduced quality of life and longevity, and is treatable when found
. An inexpensive, ...noninvasive screening tool for ALVD in the doctor's office is not available. We tested the hypothesis that application of artificial intelligence (AI) to the electrocardiogram (ECG), a routine method of measuring the heart's electrical activity, could identify ALVD. Using paired 12-lead ECG and echocardiogram data, including the left ventricular ejection fraction (a measure of contractile function), from 44,959 patients at the Mayo Clinic, we trained a convolutional neural network to identify patients with ventricular dysfunction, defined as ejection fraction ≤35%, using the ECG data alone. When tested on an independent set of 52,870 patients, the network model yielded values for the area under the curve, sensitivity, specificity, and accuracy of 0.93, 86.3%, 85.7%, and 85.7%, respectively. In patients without ventricular dysfunction, those with a positive AI screen were at 4 times the risk (hazard ratio, 4.1; 95% confidence interval, 3.3 to 5.0) of developing future ventricular dysfunction compared with those with a negative screen. Application of AI to the ECG-a ubiquitous, low-cost test-permits the ECG to serve as a powerful screening tool in asymptomatic individuals to identify ALVD.
Objective
The goal of this study was to report short term clinical and radiographic outcomes after distal ulnar ostectomy in dogs with carpal valgus due to discordant radial-ulnar growth.
Study ...design
Retrospective case study.
Sample group
Client owned dogs under 1 year of age with carpal valgus and open distal radial physes pre-operatively.
Methods
Medical records from four veterinary referral centers were searched from January 1, 2015 to January 1, 2022 for juvenile dogs that had been treated with distal ulnar ostectomy for carpal valgus due to premature closure of the distal ulnar physis. Patients were excluded if they were skeletally mature at the time of ostectomy; medical records were incomplete; radial physis was closed at surgery; or definitive corrective osteotomy was performed. Radiographs were evaluated pre-operatively and for short term follow up at ~8 weeks. Complications and short term clinical outcomes were evaluated also.
Results
31 limbs from 23 dogs were evaluated. Patients ranged from 4 to 10.8 months of age. All dogs presented for visible carpal valgus and varying degrees of thoracic limb lameness. Sixty-four percent of patients showed resolution of lameness while an additional 13% showed an improvement in clinical lameness without complete resolution. Complications were seen in 32% of patients with 70% percent of those being minor, bandage related complications. Radiographically, 38% of limbs showed bridging callus formation of the ostectomy at an average of 7.5 weeks post operatively and 75% percent of patients with elbow incongruity improved radiographically. There was no significant difference in radial joint angles pre-operatively and at the time of follow up.
Conclusion
Distal ulnar ostectomy ameliorates lameness in juvenile dogs with premature distal ulnar physeal closure and shows lack of progression of distal carpal valgus deformity, but does not improve joint angulation.
Clinical significance
Distal ulnar ostectomy is associated with mild bandage-related complications and halting of progressive limb deformity within the time frame evaluated, and should therefore be considered a treatment for premature closure of the distal ulnar physis. It does not lead to deformity correction at 8 weeks following surgery but is associated with improved elbow congruity.
Amongst the lysosomal cysteine cathepsin family of proteases, cathepsin S (CTSS) holds particular interest due to distinctive properties including a normal restricted expression profile, inducible ...upregulation and activity at a broad pH range. Consequently, while CTSS is well-established as a member of the proteolytic cocktail within the lysosome, degrading unwanted and damaged proteins, it has increasingly been shown to mediate a number of distinct, more selective roles including antigen processing and antigen presentation, and cleavage of substrates both intra and extracellularly. Increasingly, aberrant CTSS expression has been demonstrated in a variety of conditions and disease states, marking it out as both a biomarker and potential therapeutic target. This review seeks to contextualise CTSS within the cysteine cathepsin family before providing an overview of the broad range of pathologies in which roles for CTSS have been identified. Additionally, current clinical progress towards specific inhibitors is detailed, updating the position of the field in exploiting this most unique of proteases.
The processing of brain diffusion tensor imaging (DTI) data for large cohort studies requires fully automatic pipelines to perform quality control (QC) and artifact/outlier removal procedures on the ...raw DTI data prior to calculation of diffusion parameters. In this study, three automatic DTI processing pipelines, each complying with the general ENIGMA framework, were designed by uniquely combining multiple image processing software tools. Different QC procedures based on the RESTORE algorithm, the DTIPrep protocol, and a combination of both methods were compared using simulated ground truth and artifact containing DTI datasets modeling eddy current induced distortions, various levels of motion artifacts, and thermal noise. Variability was also examined in 20 DTI datasets acquired in subjects with vascular cognitive impairment (VCI) from the multi-site Ontario Neurodegenerative Disease Research Initiative (ONDRI). The mean fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were calculated in global brain grey matter (GM) and white matter (WM) regions. For the simulated DTI datasets, the measure used to evaluate the performance of the pipelines was the normalized difference between the mean DTI metrics measured in GM and WM regions and the corresponding ground truth DTI value. The performance of the proposed pipelines was very similar, particularly in FA measurements. However, the pipeline based on the RESTORE algorithm was the most accurate when analyzing the artifact containing DTI datasets. The pipeline that combined the DTIPrep protocol and the RESTORE algorithm produced the lowest standard deviation in FA measurements in normal appearing WM across subjects. We concluded that this pipeline was the most robust and is preferred for automated analysis of multisite brain DTI data.
Three interlinked processes drive groundwater balances in diverse regions globally: (1) groundwater‐irrigation intensification, (2) electrical energy supply for agriculture, and (3) climatic ...variability. Mexico's water‐energy‐climate nexus offers generic lessons because of its water scarcity and institutional reforms followed in other emerging economies. This paper analyzes data for 280 aquifers in Mexico, all registered water users, population projections, 2010–2100 precipitation and temperature projections for A1B and A2 emissions scenarios from 15 general circulation models, and 1999–2009 agricultural electricity use. Under A2 emissions, aquifers with negative balances will increase from 92 to 130 in number between 2010 and 2100, and the national groundwater deficit will increase by 21.3 km3. Under A2 and medium‐variant population growth (which peaks midcentury), negative‐balance aquifers will increase from 92 to 133, and the national groundwater deficit will increase by 22.4 km3. Agricultural power pricing offers a nexus‐based policy tool to address aquifer depletion, an opportunity that was lost with the 2003 reduction in nighttime tariffs. Under A2, medium‐variant population, and simulated 2% real annual increases in agricultural power tariffs, negative‐balance aquifers will increase from 92 to 111, and the national groundwater deficit will increase by 17.5 km3 between 2010 and 2100. Regulatory and user‐based groundwater management initiatives indicate growing awareness of aquifer depletion; however, the long‐term outlook points to continued depletion. This raises the need to harness nexus‐based policy options, i.e., increasing agricultural power tariffs, eliminating reduced nighttime tariffs, enforcing legislation linking groundwater extraction to power use, and limiting new power connections for groundwater wells.
Key Points
Aquifer depletion is driven by a nexus groundwater use, energy, and climate
The nexus represents an important policy tool that Mexico has experimented with
Mexico' aquifer management offer lessons for other water‐scarce regions
Sex and age have long been known to affect the ECG. Several biologic variables and anatomic factors may contribute to sex and age-related differences on the ECG. We hypothesized that a convolutional ...neural network (CNN) could be trained through a process called deep learning to predict a person's age and self-reported sex using only 12-lead ECG signals. We further hypothesized that discrepancies between CNN-predicted age and chronological age may serve as a physiological measure of health.
We trained CNNs using 10-second samples of 12-lead ECG signals from 499 727 patients to predict sex and age. The networks were tested on a separate cohort of 275 056 patients. Subsequently, 100 randomly selected patients with multiple ECGs over the course of decades were identified to assess within-individual accuracy of CNN age estimation.
Of 275 056 patients tested, 52% were males and mean age was 58.6±16.2 years. For sex classification, the model obtained 90.4% classification accuracy with an area under the curve of 0.97 in the independent test data. Age was estimated as a continuous variable with an average error of 6.9±5.6 years (R-squared =0.7). Among 100 patients with multiple ECGs over the course of at least 2 decades of life, most patients (51%) had an average error between real age and CNN-predicted age of <7 years. Major factors seen among patients with a CNN-predicted age that exceeded chronologic age by >7 years included: low ejection fraction, hypertension, and coronary disease (P<0.01). In the 27% of patients where correlation was >0.8 between CNN-predicted and chronologic age, no incident events occurred over follow-up (33±12 years).
Applying artificial intelligence to the ECG allows prediction of patient sex and estimation of age. The ability of an artificial intelligence algorithm to determine physiological age, with further validation, may serve as a measure of overall health.
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