Areas of global importance for conserving terrestrial biodiversity, carbon and water

To meet the ambitious objectives of biodiversity and climate conventions, the international community requires clarity on how these objectives can be operationalized spatially and how multiple targets can be pursued concurrently. To support goal setting and the implementation of international strategies and action plans, spatial guidance is needed to identify which land areas have the potential to generate the greatest synergies between conserving biodiversity and nature's contributions to people. Here we present results from a joint optimization that minimizes the number of threatened species, maximizes carbon retention and water quality regulation, and ranks terrestrial conservation priorities globally. We found that selecting the top-ranked 30% and 50% of terrestrial land area would conserve respectively 60.7% and 85.3% of the estimated total carbon stock and 66% and 89.8% of all clean water, in addition to meeting conservation targets for 57.9% and 79% of all species considered. Our data and prioritization further suggest that adequately conserving all species considered (vertebrates and plants) would require giving conservation attention to ~70% of the terrestrial land surface. If priority was given to biodiversity only, managing 30% of optimally located land area for conservation may be sufficient to meet conservation targets for 81.3% of the terrestrial plant and vertebrate species considered. Our results provide a global assessment of where land could be optimally managed for conservation. We discuss how such a spatial prioritization framework can support the implementation of the biodiversity and climate conventions.

The Role of Metabolite-Sensing G Protein-Coupled Receptors in Inflammation and Metabolic Disease

SIGNIFICANCE

Great attention has been placed on the link between metabolism and immune function giving rise to the term "immunometabolism." It is widely accepted that inflammation and oxidative stress are key processes that underlie metabolic complications during obesity, diabetes, and atherosclerosis. Therefore, identifying the mechanisms and mediators that are involved in the regulation of both inflammation and metabolic homeostasis is of high scientific and therapeutic interest. Recent Advances: G protein-coupled receptors (GPCRs) that signal in response to metabolites have emerged as attractive therapeutic targets in inflammatory disease. Critical Issues and Future Directions: In this review, we discuss recent findings about the physiological role of the main metabolite-sensing GPCRs, their implication in immunometabolic disorders, their principal endogenous and synthetic ligands, and their potential as drug targets in inflammation and metabolic disease. Antioxid. Redox Signal. 29, 237-256.

Evaluation of a new linker system cleaved using samarium(ii) iodide. Application in the solid phase synthesis of carbonyl compounds

A new linker design for solid phase synthesis has been developed that is cleaved under mild, neutral conditions using samarium(II) iodide. The feasibility of the linker approach has been illustrated in the solid phase synthesis of ketones and amides using an oxygen linker. Insights into the mechanism of the samarium(II) iodide cleavage reaction are described and the potential of a sequential cleavage carbon-carbon bond forming process is assessed.

Reduction of alpha-aryloxy carbonyl compounds with samarium(II) iodide. A new traceless linker for the solid phase synthesis of carbonyl compounds

A new linker for the solid phase synthesis of functionalised carbonyl compounds which is cleaved under mild, neutral conditions using samarium(II) iodide has been developed; the manipulation of an immobilised gamma-butyrolactone has been carried out to illustrate the utility of the linker.

Student nurses can defibrillate within 90 seconds. An evaluation of a training programme for third year student nurses in the use of an automatic external defibrillator

Automatic external defibrillators (AEDs) provide a means of reducing the response time in cardiac arrests but policies based on their use must take into account the costs of retraining. These depend on the level of retention of skills over time. This paper describes the retention of skills by student nurses following a training programme on the use of AEDs in cardiac resuscitation. Sixty-three student nurses were studied at intervals of 1 week, 1, 3 and 6 months following training. There was a slight deterioration in skills at 1 week and 1 month but the scores returned to the baseline level at 3 months and remained there. We conclude that there is now a case for a major study of the use of nurse-operated AEDs in the hospital setting.

Instructors--a weak link in resuscitation training

One explanation for the well documented poor basic resuscitation skills of health-care professionals is that these skills are not acquired during initial training. The first aim of our study was to assess the basic life-support skills of trainers teaching basic resuscitation. The second aim was to examine the relationship between the trainers' confidence and actual skill. We found that practical basic life-support skills prior to the two-day training course were poor. They were still inadequate after training. Assessments before and after the course showed significant positive correlation between confidence at performing basic life-support and actual skill. There is an urgent need for formal instructor training in the UK. The training programme should be evaluated, as should the performance of both trainers and trainees, to ensure that all have acquired the requisite skills.

Clinical efficacy of spinal instrumentation in lumbar degenerative disc disease

In review of 871 lumbar fusion procedures performed during the last 8 years, the theoretical advantages of lumbar spinal instrumentation are not borne out in simple discogenic disease. Four groups of 30-35 patients without previous surgery who underwent fusion by different techniques were matched for age, sex, length of follow-up, surgeons, number of levels fused, duration of preoperative symptoms, diagnosis, and type of third party payer. At least for the diagnoses of herniated disc with segmental instability and the instrumentation systems used in this study, results were superior with no internal fixation. This is in keeping with the higher complication rates and frequent need for implant removal reported by many authors.

An advanced resuscitation training course for preregistration house officers

Preregistration house officers need to be able to manage the first 5-10 minutes of a cardiac arrest. A course has been designed based on the recommendations of the Resuscitation Council UK 1984 and the format of the American Heart Association advanced cardiac life support course. Fifty-nine newly qualified doctors from the same medical school class were studied in two consecutive groups: Group 1 (n = 31) were commencing their first post and Group 2 (n = 28), whose first preregistration post had been at other hospitals without practical resuscitation training, were commencing their second post. They were pretested and taught in three 2-hour sessions. Five months later they were tested to measure retention of knowledge and skills. Before training there was no difference in knowledge between the two groups but Group 1 were more skilled. The knowledge and skills of both groups immediately after training were significantly improved and at 5 months skills were subject to modest decay only. Experience of managing cardiac arrests was not a substitute for formal practical training.

ABC of resuscitation. Training and retention of skills

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Knodt rod distraction lumbar fusion

Ninety-nine cases of Knodt rod fusions have been followed for an average of 18 months postoperatively. These patients were all severely incapacitated with pain for an average of 5.3 years prior to surgery. They all had a thorough preoperative work-up including myelogram, EMG and extensive conservative care. The procedure performed was an extensive bilateral laminectomy of the L5 vertebra with foramenotomy and a posterior lateral intertransverse fusion with the use of Knodt rods between the L4-5 and S1 levels. There was an overall average improvement after surgery in 70.35% of the cases. When the consideration of psychological problems and industrial cases were eliminated, the overall improvement was 80.38%. There were no major complications except that in five patients the Knodt rods were removed from between one week and one year postoperatively. Knodt rod fusions have results reported in the literature of frequent complications and very poor success rates. They can be a very good adjunct to the spine surgeon's armamentarium. In patients with long-range back pain who plan to return to heavy labor, the Knodt rods can give a surprisingly high rate of success.

Epidural injections for the diagnosis and treatment of low-back pain

Three hundred four consecutive patients with low-back pain were given epidural anesthetic and steroid injections. A prospective study demonstrated that selected patients had 87% short-term success and 34% relief of pain for as long as 6 months. No patient was cured by these injections. Needle placement during epidural injections was incorrect 25% of the time in experienced hands.

Total hip replacement as a salvage in traumatic lesions about the hip

One hundred and eight total hip replacements have been accomplished in an attempt to salvage a problem caused by trauma. Many times, patients with traumatic arthritic problems have a quick transition from a normal existence to a severe disability. They may not have had the ability physically or mentally to handle this disability seen in patients with rheumatoid disease or idiopathic osteoarthritis. It has been shown that these patients with total joint replacement can be rehabilitated to almost a normal degree of function. Complications occur, but with careful planning and execution, they can be held to a minimum. In the long run, a high incidence of degenerative disease is seen in these problems. The primary procedure should not be done so as to jeopardize a secondary reconstruction.