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The roles of forest and wetland ecosystems in regulating flooding have drawn increasing attention in the contexts of climate change adaptation and disaster risk reduction. However, data on floods are scarce in many of the countries where people are most exposed and vulnerable to their impacts. Here, our separate analyses of village interview surveys (364 villages) and news archives (16 sources) show that floods have major impacts on lives and livelihoods in Indonesian Borneo, and flooding risks are associated with features of the local climate and landscape, particularly land uses that have seen rapid expansions over the past 30 years. In contrast with government assessments, we find that flooding is far more widespread, and that frequent, local, events can have large cumulative impacts. Over three years, local news agencies reported floods that affected 868 settlements, 966 times (including 89 in urban areas), inundated at least 197 000 houses, and displaced more than 776 000 people, possibly as many as 1.5 million (i.e. 5%-10% of the total population). Spatial analyses based on surveys in 364 villages show that flood frequency is associated with land use in catchment areas, including forest cover and condition, and the area of wetlands, mines (open-cut coal or gold mines), and oil palm. The probability that floods have become more frequent over the past 30 years was higher for villages closer to mines, and in watersheds with more extensive oil palm, but lower in watersheds with greater cover of selectively-logged or intact forests. We demonstrate that in data-poor regions, multiple sources of information can be integrated to gain insights into the hydrological services provided by forest and wetland ecosystems, and motivate more comprehensive assessment of flooding risks and options for ecosystem-based adaptation.

Background Continuous positive airway pressure (CPAP) for symptomatic obstructive sleep apnoea (OSA) improves sleepiness and reduces vascular risk, but such treatment for the more prevalent, minimally symptomatic disease is contentious. Methods This multicentre, randomised controlled, parallel, hospital-based trial across the UK and Canada, recruited 391 patients with confirmed OSA (oxygen desaturation index >7.5/h) but insufficient symptoms to warrant CPAP therapy. Patients were randomised to 6 months of auto-adjusting CPAP therapy, or standard care. Coprimary endpoints were change in Epworth Sleepiness Score (ESS) and predicted 5-year mortality using a cardiovascular risk score (components: age, sex, height, systolic blood pressure, smoking, diabetes, cholesterol, creatinine, left ventricular hypertrophy, previous myocardial infarction or stroke). Secondary endpoints included some of the individual components of the vascular risk score, objectively measured sleepiness and self-assessed health status. Results Of 391 patients randomised, 14 withdrew, 347 attended for their follow-up visit at 6 months within the predefined time window, of which 341 had complete ESS data (baseline mean 8.0, SD 4.3) and 310 had complete risk score data. 22% of patients in the CPAP group reported stopping treatment and overall median CPAP use was 2 : 39 h per night. CPAP significantly improved subjective daytime sleepiness (adjusted treatment effect on ESS −2.0 (95% CI −2.6 to −1.4), p<0.0001), objectively measured sleepiness and self-assessed health status. CPAP did not improve the 5-year calculated vascular risk or any of its components. Conclusions In patients with minimally symptomatic OSA, CPAP can reduce subjective and objective daytime sleepiness, and improve self-assessed health status, but does not appear to improve calculated vascular risk.

The stable isotope data presented here significantly extend and expand upon previous isotopic investigations of the Middle to Late Jurassic interval. The belemnite samples collected from the Staffin Bay and Staffin Shale formations from the Isle of Skye, Scotland, yielded oxygen isotope values consistent with Callovian-Kimmeridgian palaeotemperatures of 6.7-20.6°C. The carbon isotope data comprise one of the first moderately high-resolution investigations of the relationship between terrestrial δ13Corg (predominantly fossil wood debris) and marine δ13Ccarb (belemnites) as derived from a geologically coeval record. The Staffin Bay data reveal a broad Early to Mid-Oxfordian positive carbon isotope excursion. The excursion maximum occurs in the cordatum Zone (British Boreal ammonite zonation), although high values persist into the tenuiserratum Zone. The correspondence between the marine and terrestrial records indicates a strong coupling of the ocean-atmosphere system and suggests that the total exchangeable carbon reservoir would have been affected at this time. The Mid-Oxfordian negative carbon isotope excursions identified in published Tethyan records and commonly attributed to methane release are not recorded in the Staffin Bay data, which may suggest that the Tethyan excursions do not represent fluctuations in the global carbon reservoir and that the fidelity of the methane hypothesis should be re-evaluated.

Study Objectives: Minimally symptomatic obstructive sleep apnea (OSA) is highly prevalent, and the effects of continuous positive airway pressure (CPAP) on myocardial function in these patients are unknown. The MOSAIC randomized, controlled trial of CPAP for minimally symptomatic OSA assessed the effect of CPAP on myocardial function in a subset of patients. Methods: Two centers taking part in the MOSAIC trial randomized 238 patients in parallel to 6 months of CPAP (120) or standard care (118). Of these, 168 patients had echocardiograms, and 68 patients had a cardiac magnetic resonance scan (CMR). A larger group (314) from 4 centers had brain natriuretic peptide (BNP) measured. Results: Mean (SD) baseline oxygen desaturation index (ODI) and Epworth sleepiness score (ESS) were 13.5 (13.2), and 8.4 (4.0), respectively. CPAP significantly reduced ESS and ODI. Baseline LV ejection fraction (LVEF) was well preserved (60.4%). CPAP had no significant effect on echo-derived left atrial (LA) area (−1.0 cm 2 , 95% CI −2.6 to +0.6, p = 0.23) or early to late left ventricular filling velocity (E/A) ratio (−0.01, 95% CI −0.07 to +0.05, p = 0.79). There was a small change in echo-derived LV end diastolic volume (EDV) with CPAP (−5.9 mL, 95% CI −10.6 to −1.2, p = 0.015). No significant changes were detected by CMR on LV mass index (+1.1 g/m 2 , 95% CI −5.9 to +8.0, p = 0.76) or LVEF (+0.8%, 95% CI −1.2 to +2.8, p = 0.41). CPAP did not affect BNP levels (p = 0.16). Conclusions: Six months of CPAP therapy does not change cardiac functional or structural parameters measured by echocardiogram or CMR in patients with minimally symptomatic mild-to-moderate OSA. Clinical Trial Registration: ISRCTN 34164388 ( http://isrctn.org ). Citation: Craig S, Kylintireas I, Kohler M, Nicoll D, Bratton DJ, Nunn AJ, Leeson P, Neubauer S, Stradling JR. Effect of CPAP on cardiac function in minimally symptomatic patients with OSA: results from a subset of the MOSAIC randomized trial. J Clin Sleep Med 2015;11(9):967–973.

Thirty-eight children (aged 2-16 years) attending a regional kidney unit had a full clinical and radiological dental examination. Twenty had previously undergone a renal transplant, 11 had chronic renal failure and 7 had other renal diseases. Periodontal disease was uncommon The presence of gingival hyperplasia (gum overgrowth), as recorded in 22 of the children, did not show any relationship with the use of immunosuppressant therapy. However, gingival overgrowth was so excessive in 2 patients that surgical removal was required. The prevalence of dental caries was low. Enamel defects were common, and of an unusual pattern, with a much higher prevalence of diffuse opacities and enamel hypoplasia than in the normal child population, 83% and 22%, respectively. This increased prevalence is probably due to disordered calcium and phosphate metabolism. The prevalence of these defects may reflect an early onset of renal disease, since there were a number of very young children in the programme. Dental and medical care should be closely integrated for children with renal disease to avoid the undesirable dental sequelae of, in particular, gingival overgrowth, carcinoma and enamel hypoplasia.

Provides a summary of the most up-to-date NZ and overseas evidence and makes recommendations based on the evidence that will lead to the best practice for patients with ST-elevation myocardial infarction (STEMI) in NZ. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

Provides a summary of the most up-to-date NZ and overseas evidence and makes recommendations based on the evidence that will lead to the best practice for patients with non-ST elevation acute coronary syndromes (NSTEACS) in NZ. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.