Showing papers by "University of East Anglia published in 2005"

An improved method of constructing a database of monthly climate observations and associated high-resolution grids

Abstract: A database of monthly climate observations from meteorological stations is constructed. The database includes six climate elements and extends over the global land surface. The database is checked for inhomogeneities in the station records using an automated method that refines previous methods by using incomplete and partially overlapping records and by detecting inhomogeneities with opposite signs in different seasons. The method includes the development of reference series using neighbouring stations. Information from different sources about a single station may be combined, even without an overlapping period, using a reference series. Thus, a longer station record may be obtained and fragmentation of records reduced. The reference series also enables 1961–90 normals to be calculated for a larger proportion of stations. The station anomalies are interpolated onto a 0.5° grid covering the global land surface (excluding Antarctica) and combined with a published normal from 1961–90. Thus, climate grids are constructed for nine climate variables (temperature, diurnal temperature range, daily minimum and maximum temperatures, precipitation, wet-day frequency, frost-day frequency, vapour pressure, and cloud cover) for the period 1901–2002. This dataset is known as CRU TS 2.1 and is publicly available (http://www.cru.uea.ac.uk/). Copyright  2005 Royal Meteorological Society.

Climate Change and Distribution Shifts in Marine Fishes

Abstract: We show that the distributions of both exploited and nonexploited North Sea fishes have responded markedly to recent increases in sea temperature, with nearly two-thirds of species shifting in mean latitude or depth or both over 25 years. For species with northerly or southerly range margins in the North Sea, half have shown boundary shifts with warming, and all but one shifted northward. Species with shifting distributions have faster life cycles and smaller body sizes than nonshifting species. Further temperature rises are likely to have profound impacts on commercial fisheries through continued shifts in distribution and alterations in community interactions.

Successful adaptation to climate change across scales

Abstract: Climate change impacts and responses are presently observed in physical and ecological systems. Adaptation to these impacts is increasingly being observed in both physical and ecological systems as well as in human adjustments to resource availability and risk at different spatial and societal scales. We review the nature of adaptation and the implications of different spatial scales for these processes. We outline a set of normative evaluative criteria for judging the success of adaptations at different scales. We argue that elements of effectiveness, efficiency, equity and legitimacy are important in judging success in terms of the sustainability of development pathways into an uncertain future. We further argue that each of these elements of decision-making is implicit within presently formulated scenarios of socio-economic futures of both emission trajectories and adaptation, though with different weighting. The process by which adaptations are to be judged at different scales will involve new and challenging institutional processes.

Global Iron Connections Between Desert Dust, Ocean Biogeochemistry, and Climate

Abstract: The environmental conditions of Earth, including the climate, are determined by physical, chemical, biological, and human interactions that transform and transport materials and energy. This is the "Earth system": a highly complex entity characterized by multiple nonlinear responses and thresholds, with linkages between disparate components. One important part of this system is the iron cycle, in which iron-containing soil dust is transported from land through the atmosphere to the oceans, affecting ocean biogeochemistry and hence having feedback effects on climate and dust production. Here we review the key components of this cycle, identifying critical uncertainties and priorities for future research.

Social-Ecological Resilience to Coastal Disasters

Abstract: Social and ecological vulnerability to disasters and outcomes of any particular extreme event are influenced by buildup or erosion of resilience both before and after disasters occur. Resilient social-ecological systems incorporate diverse mechanisms for living with, and learning from, change and unexpected shocks. Disaster management requires multilevel governance systems that can enhance the capacity to cope with uncertainty and surprise by mobilizing diverse sources of resilience.

The determinants of vulnerability and adaptive capacity at the national level and the implications for adaptation

Abstract: We present a set of indicators of vulnerability and capacity to adapt to climate variability, and by extension climate change, derived using a novel empirical analysis of data aggregated at the national level on a decadal timescale. The analysis is based on a conceptual framework in which risk is viewed in terms of outcome, and is a function of physically defined climate hazards and socially constructed vulnerability. Climate outcomes are represented by mortality from climate-related disasters, using the emergency events database data set, statistical relationships between mortality and a shortlist of potential proxies for vulnerability are used to identify key vulnerability indicators. We find that 11 key indicators exhibit a strong relationship with decadally aggregated mortality associated with climate-related disasters. Validation of indicators, relationships between vulnerability and adaptive capacity, and the sensitivity of subsequent vulnerability assessments to different sets of weightings are explored using expert judgement data, collected through a focus group exercise. The data are used to provide a robust assessment of vulnerability to climate-related mortality at the national level, and represent an entry point to more detailed explorations of vulnerability and adaptive capacity. They indicate that the most vulnerable nations are those situated in sub-Saharan Africa and those that have recently experienced conflict. Adaptive capacity—one element of vulnerability—is associated predominantly with governance, civil and political rights, and literacy.

Antarctic climate change during the last 50 years

Abstract: The Reference Antarctic Data for Environmental Research (READER) project data set of monthly mean Antarctic nearsurface temperature, mean sea-level pressure (MSLP) and wind speed has been used to investigate trends in these quantities over the last 50 years for 19 stations with long records. Eleven of these had warming trends and seven had cooling trends in their annual data (one station had too little data to allow an annual trend to be computed), indicating the spatial complexity of change that has occurred across the Antarctic in recent decades. The Antarctic Peninsula has experienced a major warming over the last 50 years, with temperatures at Faraday/Vernadsky station having increased at a rate of 0.56 °C decade −1 over the year and 1.09 °C decade −1 during the winter; both figures are statistically significant at less than the 5% level. Overlapping 30 year trends of annual mean temperatures indicate that, at all but two of the 10 coastal stations for which trends could be computed back to 1961, the warming trend was greater (or the cooling trend less) during the 1961–90 period compared with 1971–2000. All the continental stations for which MSLP data were available show negative trends in the annual mean pressures over the full length of their records, which we attribute to the trend in recent decades towards the Southern Hemisphere annular mode (SAM) being in its high-index state. Except for Halley, where the trends are constant, the MSLP trends for all stations on the Antarctic continent for 1971–2000 were more negative than for 1961–90. All but two of the coastal stations have recorded increasing mean wind speeds over recent decades, which is also consistent with the change in the nature of the SAM. Copyright  2005 Royal Meteorological Society.

Atmospheric global dust cycle and iron inputs to the ocean

Abstract: [1] Since iron is an important micronutrient, deposition of iron in mineral aerosols can impact the carbon cycle and atmospheric CO2. This paper reviews our current understanding of the global dust cycle and identifies future research needs. The global distribution of desert dust is estimated from a combination of observations of dust from in situ concentration, optical depth, and deposition data; observations from satellite; and global atmospheric models. The anthropogenically influenced portion of atmospheric desert dust flux is thought to be smaller than the natural portion, but is difficult to quantify due to the poorly understood response of desert dust to changes in climate, land use, and water use. The iron content of aerosols is thought to vary by a factor of 2, while the uncertainty in dust deposition is at least a factor of 10 in some regions due to the high spatial and temporal variability and limited observations. Importantly, we have a limited understanding of the processes by which relatively insoluble soil iron (typically ∼0.5% is soluble) becomes more soluble (1–80%) during atmospheric transport, but these processes could be impacted by anthropogenic emissions of sulfur or organic acids. In order to understand how humans will impact future iron deposition to the oceans, we need to improve our understanding of: iron deposition to remote oceans, iron chemistry in aerosols, how desert dust sources will respond to climate change, and how humans will impact the transport of bioavailable fraction of iron to the oceans.

Synthesis of iron fertilization experiments: From the iron age in the age of enlightenment

Abstract: Comparison of eight iron experiments shows that maximum Chl a, the maximum DIC removal, and the overall DIC/Fe efficiency all scale inversely with depth of the wind mixed layer (WML) defining the light environment. Moreover, lateral patch dilution, sea surface irradiance, temperature, and grazing play additional roles. The Southern Ocean experiments were most influenced by very deep WMLs. In contrast, light conditions were most favorable during SEEDS and SERIES as well as during IronEx-2. The two extreme experiments, EisenEx and SEEDS, can be linked via EisenEx bottle incubations with shallower simulated WML depth. Large diatoms always benefit the most from Fe addition, where a remarkably small group of thriving diatom species is dominated by universal response of Pseudo-nitzschia spp. Significant response of these moderate (10–30 μm), medium (30–60 μm), and large (>60 μm) diatoms is consistent with growth physiology determined for single species in natural seawater. The minimum level of “dissolved” Fe (filtrate < 0.2 μm) maintained during an experiment determines the dominant diatom size class. However, this is further complicated by continuous transfer of original truly dissolved reduced Fe(II) into the colloidal pool, which may constitute some 75% of the “dissolved” pool. Depth integration of carbon inventory changes partly compensates the adverse effects of a deep WML due to its greater integration depths, decreasing the differences in responses between the eight experiments. About half of depth-integrated overall primary productivity is reflected in a decrease of DIC. The overall C/Fe efficiency of DIC uptake is DIC/Fe ∼ 5600 for all eight experiments. The increase of particulate organic carbon is about a quarter of the primary production, suggesting food web losses for the other three quarters. Replenishment of DIC by air/sea exchange tends to be a minor few percent of primary CO2 fixation but will continue well after observations have stopped. Export of carbon into deeper waters is difficult to assess and is until now firmly proven and quite modest in only two experiments.

The ADAMTS metalloproteinases.

Abstract: The ADAMTSs (a disintegrin and metalloproteinase with thrombospondin motifs) are a group of proteases that are found both in mammals and invertebrates. Since the prototype ADAMTS-1 was first described in 1997, there has been a rapidly expanding body of literature describing this gene family and the proteins they encode. The complete human family has 19 ADAMTS genes, together with three members of a newly identified subgroup, the ADAMTSL (ADAMTS-like) proteins, which have several domains in common with the ADAMTSs. The ADAMTSs are extracellular, multidomain enzymes whose known functions include: (i) collagen processing as procollagen N-proteinase; (ii) cleavage of the matrix proteoglycans aggrecan, versican and brevican; (iii) inhibition of angiogenesis; and (iv) blood coagulation homoeostasis as the von Willebrand factor cleaving protease. Roles in organogenesis, inflammation and fertility are also apparent. Recently, some ADAMTS genes have been found to show altered expression in arthritis and various cancers. This review highlights progress in understanding the structural organization and functional roles of the ADAMTSs in normal and pathological conditions.

Sicily statement on evidence-based practice

Abstract: A variety of definitions of evidence-based practice (EBP) exist. However, definitions are in themselves insufficient to explain the underlying processes of EBP and to differentiate between an evidence-based process and evidence-based outcome. There is a need for a clear statement of what Evidence-Based Practice (EBP) means, a description of the skills required to practise in an evidence-based manner and a curriculum that outlines the minimum requirements for training health professionals in EBP. This consensus statement is based on current literature and incorporating the experience of delegates attending the 2003 Conference of Evidence-Based Health Care Teachers and Developers ("Signposting the future of EBHC"). Evidence-Based Practice has evolved in both scope and definition. Evidence-Based Practice (EBP) requires that decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources. Health care professionals must be able to gain, assess, apply and integrate new knowledge and have the ability to adapt to changing circumstances throughout their professional life. Curricula to deliver these aptitudes need to be grounded in the five-step model of EBP, and informed by ongoing research. Core assessment tools for each of the steps should continue to be developed, validated, and made freely available. All health care professionals need to understand the principles of EBP, recognise EBP in action, implement evidence-based policies, and have a critical attitude to their own practice and to evidence. Without these skills, professionals and organisations will find it difficult to provide 'best practice'.

Ecosystem dynamics based on plankton functional types for global ocean biogeochemistry models

Abstract: Ecosystem processes are important determinants of the biogeochemistry of the ocean, and they can be profoundly affected by changes in climate. Ocean models currently express ecosystem processes through empirically derived parameterizations that tightly link key geochemical tracers to ocean physics. The explicit inclusion of ecosystem processes in models will permit ecological changes to be taken into account, and will allow us to address several important questions, including the causes of observed glacial-interglacial changes in atmospheric trace gases and aerosols, and how the oceanic uptake of CO2 is likely to change in the future. There is an urgent need to assess our mechanistic understanding of the environmental factors that exert control over marine ecosystems, and to represent their natural complexity based on theoretical understanding. We present a prototype design for a Dynamic Green Ocean Model (DGOM) based on the identification of (a) key plankton functional types that need to be simulated explicitly to capture important biogeochemical processes in the ocean; (b) key processes controlling the growth and mortality of these functional types and hence their interactions; and (c) sources of information necessary to parameterize each of these processes within a modeling framework. We also develop a strategy for model evaluation, based on simulation of both past and present mean state and variability, and identify potential sources of validation data for each. Finally, we present a DGOM-based strategy for addressing key questions in ocean biogeochemistry. This paper thus presents ongoing work in ocean biogeochemical modeling, which, it is hoped will motivate international collaborations to improve our understanding of the role of the ocean in the climate system.

RNA polymerase IV directs silencing of endogenous DNA

Abstract: Plants encode subunits for a fourth RNA polymerase (Pol IV) in addition to the well-known DNA-dependent RNA polymerases I, II, and III. By mutation of the two largest subunits (NRPD1a and NRPD2), we show that Pol IV silences certain transposons and repetitive DNA in a short interfering RNA pathway involving RNA-dependent RNA polymerase 2 and Dicer-like 3. The existence of this distinct silencing polymerase may explain the paradoxical involvement of an RNA silencing pathway in maintenance of transcriptional silencing.

Tracing the geographical origin of food: The application of multi-element and multi-isotope analysis

Abstract: The globalisation of food markets and the relative ease with which food commodities are transported through and between countries and continents, means that consumers are increasingly concerned about the origin of the foods they eat. A growing number of research articles have been published in the last 5 years detailing the use of natural abundance isotope variation and elemental concentrations as geographic ‘tracers’ to determine the provenance of food. These investigations exploit the systematic global variations of stable hydrogen and oxygen isotope ratios in combination with elemental concentrations, including heavy isotope variations (e.g. strontium-87) and other biogeochemical indicators. This article reviews the developments in the application of multi-isotopic and multi-element methods in the emerging field of ‘Food Forensics’.

Psychological investigation of the structure of paranoia in a non-clinical population.

Abstract: Background Previous studies of paranoia have assessed only limited numbers of paranoid thoughts, and have notconsidered the experience from a multidimensional perspective or examined the relationship between different suspicious thoughts. Aims To assess a wide range of paranoid thoughts multidimensionally and examine their distribution, to identify the associated coping strategies and to examine social–cognitive processes and paranoia. Method Six questionnaire assessments were completed by 1202 individuals using the internet. Results Paranoid thoughts occurred regularly in approximately a third of the group.Increasing endorsement of paranoid thoughts was characterised by the recruitment of rarer and odder ideas. Higher levels of paranoia were associated with emotional and avoidantcoping, less use of rational and detached coping, negative attitudes to emotional expression, submissive behaviours and lower social rank. Conclusions Suspiciousnessis common and there may be a hierarchical arrangement of such thoughts that builds on common emotional concerns.

Globalization, Corporate Social Responsibility and poverty

Abstract: Corporate Social Responsibility (CSR) has become a major focus of interest for development practitioners in recent years. While development NGOs have been critical of voluntary corporate initiatives, official development agencies have taken a more positive view and in some cases encouraged CSR. This article locates the growth of CSR in the context of global deregulation since the early 1980s, highlighting the key drivers that have led to its adoption by many leading transnational corporations. It then describes the factors that have led to the recent emphasis given to CSR by both bilateral and multilateral development agencies and the United Nations. A framework for analysing the links between foreign direct investment and poverty is developed focusing on the impacts on the poor as producers, consumers and beneficiaries of government expenditures. This framework is used to illustrate the limitations of CSR in terms of likely impacts on poverty reduction through each of the channels identified and also to point to areas in which CSR may have some positive benefits. Overall, the article concludes that it is unlikely to play the significant role in poverty reduction in development countries that its proponents claim for it.

The Rise of ‘New’ Policy Instruments in Comparative Perspective: Has Governance Eclipsed Government?

Abstract: Governance is a term in good currency, but there are still too few detailed empirical analyses of the precise extent to which it has or has not eclipsed government. This article explores the temporal and spatial characteristics of the governance transition by charting the deployment of new policy instruments in eight industrialised states and the European Union. The adoption and implementation of (‘old’ and ‘new’) policy instruments offer a useful analytical touchstone because governance theory argues that regulation is the quintessence of government. Although there are many ‘new’ environmental policy instruments in these nine jurisdictions, this article finds that the change from government to governance is highly differentiated across political jurisdictions, policy sectors and even the main instrument types. Crucially, many of the new policy instruments used require some state involvement (that is, ‘government’), and very few are entirely devoid of state involvement (that is, pure ‘governance’). Far fr...

Experienced Utility as a Standard of Policy Evaluation

Abstract: This paper explores the possibility of basing economic appraisal on the measurement of experienced utility (utility as hedonic experience) rather than decision utility (utility as a representation of preference). Because of underestimation of the extent of hedonic adaptation to changed circumstances and because of the “focusing illusion” (exaggerating the importance of the current focus of one’s attention), individuals’ forecasts of experienced utility are subject to systematic error. Such errors induce preference anomalies which the experienced utility approach might circumvent. The “day reconstruction method” of measuring experienced utility is considered as a possible alternative to stated preference methods.

Changes in precipitation and temperature extremes in Central America and northern South America, 1961–2003

Abstract: [1] In November 2004, a regional climate change workshop was held in Guatemala with the goal of analyzing how climate extremes had changed in the region. Scientists from Central America and northern South America brought long-term daily temperature and precipitation time series from meteorological stations in their countries to the workshop. After undergoing careful quality control procedures and a homogeneity assessment, the data were used to calculate a suite of climate change indices over the 1961–2003 period. Analysis of these indices reveals a general warming trend in the region. The occurrence of extreme warm maximum and minimum temperatures has increased while extremely cold temperature events have decreased. Precipitation indices, despite the large and expected spatial variability, indicate that although no significant increases in the total amount are found, rainfall events are intensifying and the contribution of wet and very wet days are enlarging. Temperature and precipitation indices were correlated with northern and equatorial Atlantic and Pacific Ocean sea surface temperatures. However, those indices having the largest significant trends (percentage of warm days, precipitation intensity, and contribution from very wet days) have low correlations to El Nino–Southern Oscillation. Additionally, precipitation indices show a higher correlation with tropical Atlantic sea surface temperatures.

Prediction of twin-arginine signal peptides

Abstract: Background: Proteins carrying twin-arginine (Tat) signal peptides are exported into the periplasmic compartment or extracellular environment independently of the classical Secdependent translocation pathway. To complement other methods for classical signal peptide prediction we here present a publicly available method, TatP, for prediction of bacterial Tat signal peptides. Results: We have retrieved sequence data for Tat substrates in order to train a computational method for discrimination of Sec and Tat signal peptides. The TatP method is able to positively classify 91% of 35 known Tat signal peptides and 84% of the annotated cleavage sites of these Tat signal peptides were correctly predicted. This method generates far less false positive predictions on various datasets than using simple pattern matching. Moreover, on the same datasets TatP generates less false positive predictions than a complementary rule based prediction method. Conclusion: The method developed here is able to discriminate Tat signal peptides from cytoplasmic proteins carrying a similar motif, as well as from Sec signal peptides, with high accuracy. The method allows filtering of input sequences based on Perl syntax regular expressions, whereas hydrophobicity discrimination of Tat- and Sec-signal peptides is carried out by an artificial neural network. A potential cleavage site of the predicted Tat signal peptide is also reported. The TatP prediction server is available as a public web server at http://www.cbs.dtu.dk/services/TatP/.

The dynamics of vulnerability: locating coping strategies in Kenya and Tanzania

Abstract: We investigate how smallholder farmers at two sites in Kenya and Tanzania cope with climate stress and how constraints and opportunities shape variations in coping strategies between households and over time during a drought. On the basis of this analysis, we draw out implications for adaptation and adaptive policy. We find that households where an individual was able to specialize in one favoured activity, such as employment or charcoal burning, in the context of overall diversification by the household, were often less vulnerable than households where each individual is engaged in many activities at low intensity. Many households had limited access to the favoured coping options due to a lack of skill, labour and/or capital. This lack of access was compounded by social relations that led to exclusion of certain groups, especially women, from carrying out favoured activities with sufficient intensity. These households instead arried out a multitude of less favoured and frequently complementary activities, such as collecting indigenous fruit. While characterized by suitability to seasonal environmental variations and low demands on time and cash investments, these strategies often yielded marginal returns. Both the marginalization of local niche products and the commercialization of forest resources exemplify processes leading to differential vulnerability. We suggest that vulnerability can usefully be viewed in terms of the interaction of such processes, following the concept of locality. We argue that coping is a distinct component of vulnerability and that understanding the dynamism of coping and vulnerability is critical to developing adaptation measures that support people as active agents.

The ‘Little Ice Age’: Re-evaluation of an evolving concept

Abstract: Matthews, J.A. and Briffa, K.R., 2005: The 'Little Ice Age': re- evaluation of an evolving concept. Geogr. Ann., 87 A (1): 17-36. ABSTRACT. This review focuses on the develop- ment of the 'Little Ice Age' as a glaciological and cli- matic concept, and evaluates its current usefulness in the light of new data on the glacier and climatic variations of the last millennium and of the Holocene. 'Little Ice Age' glacierization occurred over about 650 years and can be defined most pre- cisely in the European Alps (c. AD 1300-1950) when extended glaciers were larger than before or since. 'Little Ice Age' climate is defined as a shorter time interval of about 330 years (c. AD 1570-1900) when Northern Hemisphere summer temperatures (land areas north of 20°N) fell significantly below the AD 1961-1990 mean. This climatic definition overlaps the times when the Alpine glaciers attained their lat- est two highstands (AD 1650 and 1850). It is empha- sized, however, that 'Little Ice Age' glacierization was highly dependent on winter precipitation and that 'Little Ice Age' climate was not simply a matter of summer temperatures. Both the glacier-centred and the climate-centred concepts necessarily en- compass considerable spatial and temporal varia- bility, which are investigated using maps of mean summer temperature variations over the Northern Hemisphere at 30-year intervals from AD 1571 to 1900. 'Little Ice Age'-type events occurred earlier in the Holocene as exemplified by at least seven gla- cier expansion episodes that have been identified in southern Norway. Such events provide a broader context and renewed relevance for the 'Little Ice Age', which may be viewed as a 'modern analogue' for the earlier events; and the likelihood that similar events will occur in the future has implications for climatic change in the twenty-first century. It is con- cluded that the concept of a 'Little Ice Age' will re- main useful only by (1) continuing to incorporate the temporal and spatial complexities of glacier and climatic variations as they become better known, and (2) by reflecting improved understanding of the Earth-atmosphere-ocean system and its forcing factors through the interaction of palaeoclimatic re- construction with climate modelling.

Observed Trends in Indices of Daily Temperature Extremes in South America 1960–2000

Abstract: A workshop on enhancing climate change indices in South America was held in Maceio, Brazil, in August 2004. Scientists from eight southern countries brought daily climatological data from their region for a meticulous assessment of data quality and homogeneity, and for the preparation of climate change indices that can be used for analyses of changes in climate extremes. This study presents an examination of the trends over 1960–2000 in the indices of daily temperature extremes. The results indicate no consistent changes in the indices based on daily maximum temperature while significant trends were found in the indices based on daily minimum temperature. Significant increasing trends in the percentage of warm nights and decreasing trends in the percentage of cold nights were observed at many stations. It seems that this warming is mostly due to more warm nights and fewer cold nights during the summer (December–February) and fall (March–May). The stations with significant trends appear to be loca...

The Convention on Biological Diversity's 2010 target

Abstract: Governments are often accused of responding only to short-term and parochial considerations. It is therefore remarkable that representatives of 190 countries recently committed themselves at the Convention on Biological Diversity to reducing biodiversity loss. This presents conservation biologists with perhaps their greatest challenge of the decade. The authors of this Policy Forum describe approaches to identifying more of the earth9s biological diversity; understanding how biological, geophysical, and geochemical processes interact; and presenting scientific knowledge in time to contribute to and achieve the 2010 target.

Comparison of a Single Infusion of Zoledronic Acid with Risedronate for Paget's Disease

Abstract: Background The advent of bisphosphonates advanced therapy for Paget's disease, but more effective and convenient agents are needed to increase adherence. Zoledronic acid, a bisphosphonate administered as a single intravenous infusion, might meet these needs. Methods In two identical, randomized, double-blind, actively controlled trials of 6 months' duration, we compared one 15-minute infusion of 5 mg of zoledronic acid with 60 days of oral risedronate (30 mg per day). The primary efficacy end point was the rate of therapeutic response at six months, defined as a normalization of alkaline phosphatase levels or a reduction of at least 75 percent in the total alkaline phosphatase excess. The results of the studies were pooled. Results At six months, 96.0 percent of patients receiving zoledronic acid had a therapeutic response (169 of 176), as compared with 74.3 percent of patients receiving risedronate (127 of 171, P<0.001). Alkaline phosphatase levels normalized in 88.6 percent of patients in the zoledronic...

Systematic review of multidisciplinary interventions in heart failure

Abstract: Objective: To determine the impact of multidisciplinary interventions on hospital admission and mortality in heart failure. Design: Systematic review. Thirteen databases were searched and reference lists from included trials and related reviews were checked. Trial authors were contacted if further information was required. Setting: Randomised controlled trials conducted in both hospital and community settings. Patients: Trials were included if all, or a defined subgroup of patients, had a diagnosis of heart failure. Interventions: Multidisciplinary interventions were defined as those in which heart failure management was the responsibility of a multidisciplinary team including medical input plus one or more of the following: specialist nurse, pharmacist, dietician, or social worker. Interventions were separated into four mutually exclusive groups: provision of home visits; home physiological monitoring or televideo link; telephone follow up but no home visits; and hospital or clinic interventions alone. Pharmaceutical and exercise based interventions were excluded. Main outcome measures: All cause hospital admission, all cause mortality, and heart failure hospital admission. Results: 74 trials were identified, of which 30 contained relevant data for inclusion in meta-analyses. Multidisciplinary interventions reduced all cause admission (relative risk (RR) 0.87, 95% confidence interval (CI) 0.79 to 0.95, p = 0.002), although significant heterogeneity was found (p = 0.002). All cause mortality was also reduced (RR 0.79, 95% CI 0.69 to 0.92, p = 0.002) as was heart failure admission (RR 0.70, 95% CI 0.61 to 0.81, p Conclusion: Multidisciplinary interventions for heart failure reduce both hospital admission and all cause mortality. The most effective interventions were delivered at least partly in the home.