University of Cuenca

To the Editor: Fisher et al. (1) state, “Little common agreement exists on the definition of the terms seizure and epilepsy,” and they propose ILAE-endorsed definitions for these terms. Although their proposed definition of “seizure” is consistent with that which has been in use throughout the field for decades, their proposed definition of epilepsy is not. Fisher and colleagues (1) propose the following definition of epilepsy: “Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive, psychological, and social consequences of this condition.” The definition of epilepsy in Fisher's Table 1 (1) requires the occurrence of at least one epileptic seizure but not that the seizure be unprovoked. Although it may be helpful to consider diverse conditions (febrile seizure, acute symptomatic seizure, single unprovoked seizure, and epilepsy) within the context of studying the seizure disorders, it is not helpful to consider all of these conditions as epilepsy. The more restrictive definition of epilepsy (recurrent unprovoked seizures), adopted by the ILAE Commission on Epidemiology and Prognosis (2), is related to therapeutic, management, and counseling approaches and supported by epidemiologic studies of seizure disorders. Furthermore, this definition has been largely adopted in clinical practice and was instrumental in developing practice guidelines (3). The failure to clarify the concept of “enduring” is a problem with the proposed definition, and it is unclear how Fisher et al. (1) would define or make operational this term. Making operational “enduring alteration of the brain that increases the likelihood of future seizures (1)” would require a list of indicators of such an alteration. These, in turn, would have to be qualified and changed as knowledge increases. For clinical and scientific purposes, the operational criteria must be simple and robust. We suggest instead that the best way to know whether a person has an enduring alteration of the brain that increases the likelihood of future unprovoked seizures after a first seizure is the occurrence of a second unprovoked seizure. This new definition would reclassify many situations previously excluded from the term epilepsy in recent studies. Examples include a single provoked seizure secondary to a neurologic insult (e.g., stroke), a single provoked or unprovoked seizure in someone with depression or migraine, and a febrile seizure in a child with cerebral palsy, with an epileptiform EEG, or with febrile seizure recurrence. The all-inclusive definition proposed by Fisher et al. (1) is consistent with use before the emergence of the epidemiologic studies of seizure disorders and epilepsy over the past 60-year period. The exclusion of these conditions from the diagnosis of epilepsy was based on large, carefully conducted clinical and population-based studies. Most acute symptomatic seizures would be recategorized as epilepsy under the definition proposed by Fisher et al. (1). Acute symptomatic seizures have been defined as seizures in close temporal association with a transient CNS insult and presumed to be an acute manifestation of the insult. Although the risk of developing unprovoked seizure is higher in people with acute symptomatic seizures, in most, later seizures do not develop. Although the incidence of acute symptomatic seizure is similar to the incidence of epilepsy, the high early mortality and the protective effect of anticonvulsants on the development of acute symptomatic seizures dramatically distinguish this category of seizures from epilepsy. By the proposed definition (1), many children with febrile seizures, the most common convulsive disorder, would be reclassified as having epilepsy. This would be true for children with developmental delay, neurologic abnormalities, epileptiform EEG abnormalities, complex febrile seizure, and recurrent febrile seizure. Regardless of the presence of such factors, in most children with febrile seizure, later unprovoked seizures do not develop (4,5). Restricting the diagnostic labeling of epilepsy to the few who truly have recurrent unprovoked seizures would seem prudent. It is useful to study single unprovoked seizures within the context of epilepsy to better understand the underlying processes to increase the risk for the development of recurrent unprovoked seizures. Contrary to the proposed definition (1), the epidemiologic data on recurrence risks support separating single unprovoked seizure from recurrent unprovoked seizures (i.e., epilepsy). The recurrence risk is lower after a first unprovoked seizure (typically <50%) than the recurrence risk after a second unprovoked seizure for both children and adults (6,7), suggesting that the recurrence of unprovoked seizure or lack thereof delineates different entities. A major problem with the proposed definition (1), particularly for those with single seizure and with febrile seizure, is that labeling patients with only a single seizure as having epilepsy, when many will never experience another seizure, will cause unnecessary use of anticonvulsant drugs, increase stigma, and result in social and occupational limitation. This does not serve the needs of these patients and is inconsistent with epidemiologic data. The inclusion of associated conditions in the proposed definition (1) raises concerns on several levels. Although general agreement may exist that “for some people with epilepsy, behavioral disturbances such as interictal and postictal cognitive problems, can be part of the epileptic condition (1),” the definition as written seems to require these disturbances for the condition to be epilepsy. Thus a person with multiple unprovoked seizures and a likelihood of more would not have epilepsy by the definition of Fisher et al. unless one of these associated conditions also was present. This aspect of the proposal creates a new unnamed category that may be quite large—people who clearly have recurrent unprovoked seizures, but lack documentation of associated conditions. Even if the proposed behavioral component is accepted as an essential ingredient in the definition of epilepsy, it is unclear how this would be made operational. Other consequences ensue from this definition. The incidence of “epilepsy” will increase at least threefold, and the increase in prevalence will be greater, particularly in developing countries, which may provide political leverage. Undesired consequences of use of this definition will be the invalidation of prognostic studies, including those of mortality, long-term prognosis for seizure remission, and response to initial therapy. Contrary to the proposal of Fisher et al. (1), widespread acceptance of and agreement over the definitions of seizures and epilepsy are in general use in the field. We fail to see the advantages of the proposed definitions to the individual patient, to epilepsy as a condition, or to the study of epilepsy and the convulsive disorders. Maintaining a common language has been acknowledged in several ILAE Commission and Task Force reports as a prerequisite to communication and comparability of research from different groups. In addition, the medical, social, and emotional implications of epilepsy and seizures speak in favor of a separation between acute symptomatic seizures, febrile seizures, and unprovoked seizures and, for those with unprovoked seizures, between single and repeated episodes. To this end, the current definitions have been most successful. They are based on a process similar to the evidence-based approaches used for evaluating therapies and therapeutic policies. They may be subject to revision as new information comes to light, but this process should be respected. It does not appear that proposed definitions advance the field in any way.

PURPOSE: To consider the definition of acute symptomatic seizures for epidemiological studies, and to refine the criteria used to distinguish these seizures from unprovoked seizures for specific etiologies. METHODS: Systematic review of the literature and of epidemiologic studies. RESULTS: An acute symptomatic seizure is defined as a clinical seizure occurring at the time of a systemic insult or in close temporal association with a documented brain insult. Suggestions are made to define acute symptomatic seizures as those events occurring within 1 week of stroke, traumatic brain injury, anoxic encephalopathy, or intracranial surgery; at first identification of subdural hematoma; at the presence of an active central nervous system (CNS) infection; or during an active phase of multiple sclerosis or other autoimmune diseases. In addition, a diagnosis of acute symptomatic seizure should be made in the presence of severe metabolic derangements (documented within 24 h by specific biochemical or hematologic abnormalities), drug or alcohol intoxication and withdrawal, or exposure to well-defined epileptogenic drugs. DISCUSSION: Acute symptomatic seizures must be distinguished from unprovoked seizures and separately categorized for epidemiologic purposes. These recommendations are based upon the best available data at the time of this report. Systematic studies should be undertaken to better define the associations in question, with special reference to metabolic and toxic insults, for which the time window for the occurrence of an acute symptomatic seizure and the absolute values for toxic and metabolic dysfunction still require a clear identification.

In human blood two monocyte populations can be distinguished, i.e., the CD14(++)CD16(-)DR(+) classical monocytes and the CD14(+)CD16(+)DR(++) proinflammatory monocytes that account for only 10% of all monocytes. We have studied TNF production in these two types of cells using three-color immunofluorescence and flow cytometry on whole peripheral blood samples stimulated with either LPS or with the bacterial lipopeptide S-(2,3-bis(palmitoyloxy)-(2-RS)-propyl)-N-palmitoyl-(R)-Cys-(S)-Ser-(S)-Lys(4)-OH,trihydrochloride (Pam3Cys). After stimulation with LPS the median fluorescence intensity for TNF protein was 3-fold higher in the proinflammatory monocytes when compared with the classical monocytes. After stimulation with Pam3Cys they almost exclusively responded showing 10-fold-higher levels of median fluorescence intensity for TNF protein. The median fluorescence intensity for Toll-like receptor 2 cell surface protein was found 2-fold higher on CD14(+)CD16(+)DR(++) monocytes, which may explain, in part, the higher Pam3Cys-induced TNF production by these cells. When analyzing secretion of TNF protein into the supernatant in PBMCs after depletion of CD16(+) monocytes we found a reduction of LPS-induced TNF by 28% but Pam3Cys-induced TNF was reduced by 64%. This indicates that the minor population of CD14(+)CD16(+) monocytes are major producers of TNF in human blood.

Abstract Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities 1,2 . This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity 3–6 . Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

Lipid droplets (LDs) are dynamic, cytosolic lipid-storage organelles found in nearly all cell types. Too many or too few LDs during excess or deficient fat storage lead to many different human diseases. Recent insights into LD biology and LD protein functions shed new light on mechanisms underlying those metabolic pathologies. These findings will likely provide opportunities for treatment of diseases associated with too much or too little fat.

Grazing represents the most extensive use of land worldwide. Yet its impacts on ecosystem services remain uncertain because pervasive interactions between grazing pressure, climate, soil properties, and biodiversity may occur but have never been addressed simultaneously. Using a standardized survey at 98 sites across six continents, we show that interactions between grazing pressure, climate, soil, and biodiversity are critical to explain the delivery of fundamental ecosystem services across drylands worldwide. Increasing grazing pressure reduced ecosystem service delivery in warmer and species-poor drylands, whereas positive effects of grazing were observed in colder and species-rich areas. Considering interactions between grazing and local abiotic and biotic factors is key for understanding the fate of dryland ecosystems under climate change and increasing human pressure.

Circular economy strategies encourage, among others, concrete actions to extend the product lifetime. Product's repair and reuse, and component harvesting for reuse, all require the facilitated access to product components. Consequently, a reduction of the disassembly time and the related costs will increase the economic feasibility of product lifetime extension and therefore increase the viability of a circular economy in industrialised regions. Furthermore, disassembly has the potential to significantly increase the recycling yield and purity for precious metals, critical metals and plastics. For this reason, the European Commission and several ecolabels have considered to include design for disassembly requirements in legislation or voluntary environmental instruments. However, up to date, there is no standardised method to evaluate the ease of disassembly in an unambiguous manner with a good trade-off between the efforts required to apply the method and the accuracy of the determined disassembly time. The article proposes a robust method "eDiM" (ease of Disassembly Metric), to calculate the disassembly time based on the Maynard operation sequence technique (MOST). A straightforward calculation sheet is employed in eDiM to calculate the disassembly time given the sequence of actions and basic product information. This makes the results fully verifiable in an unambiguous manner, which makes eDiM suited to be used in policy measures in contrast to the results of prior developed methods One of the innovative aspects of eDiM is the categorization of disassembly tasks in six categories, which provides better insights on which disassembly tasks are the most time consuming and how the product design could be improved. The proposed method is illustrated by means of a case study of an LCD monitor. The presented case study demonstrates how the proposed method can be used in a policy context and how the calculated disassembly times per category can provide insights to manufacturers to improve the disassemblability of their products. The results also demonstrate how the proposed method can produce realistic results with only limited detail of input data.

ABSTRACT We surveyed the population status of the Neotropical toad genus Atelopus , and document recent catastrophic declines that are more severe than previously reported for any amphibian genus. Of 113 species that have been described or are candidates for description, data indicate that in 42 species, population sizes have been reduced by at least half and only ten species have stable populations. The status of the remaining taxa is unknown. At least 30 species have been missing from all known localities for at least 8 yr and are feared extinct. Most of these species were last seen between 1984 and 1996. All species restricted to elevations of above 1000 m have declined and 75 percent have disappeared, while 58 percent of lowland species have declined and 38 percent have disappeared. Habitat loss was not related to declines once we controlled for the effects of elevation. In fact, 22 species that occur in protected areas have disappeared. The fungal disease Batrachochytrium dendrobatidis has been documented from nine species that have declined, and may explain declines in higher elevation species that occur in undisturbed habitats. Climate change may also play a role, but other potential factors such as environmental contamination, trade, and introduced species are unlikely to have affected more than a handful of species. Widespread declines and extinctions in Atelopus may reflect population changes in other Neotropical amphibians that are more difficult to survey, and the loss of this trophic group may have cascading effects on other species in tropical ecosystems.

This paper provides a review of pyrolysis technologies, focusing on reactor designs and companies commercializing these technologies. The renewed interest in pyrolysis is driven by the potential to convert lignocellulosic materials into bio-oil and biochar and the use of these intermediates for the production of biofuels, biochemicals, and engineered biochars for environmental services. This review presents slow, intermediate, fast, and microwave pyrolysis as complementary technologies that share some commonalities in their designs. While slow pyrolysis technologies (traditional carbonization kilns) use wood trunks to produce char chunks for cooking, fast pyrolysis systems process small particles to maximize bio-oil yield. The realization of the environmental issues associated with the use of carbonization technologies and the technical difficulties of operating fast pyrolysis reactors using sand as the heating medium and large volumes of carrier gas, as well as the problems with refining the resulting highly oxygenated oils, are forcing the thermochemical conversion community to rethink the design and use of these reactors. Intermediate pyrolysis reactors (also known as converters) offer opportunities for the large-scale balanced production of char and bio-oil. The capacity of these reactors to process forest and agricultural wastes without much preprocessing is a clear advantage. Microwave pyrolysis is an option for modular small autonomous devices for solid waste management. Herein, the evolution of pyrolysis technology is presented from a historical perspective; thus, old and new innovative designs are discussed together.

Abstract High blood cholesterol is typically considered a feature of wealthy western countries 1,2 . However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world 3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health 4,5 . However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.

Summary: Neurocysticercosis (NC) remains a major public health problem in developing and some developed countries. Currently, the best procedures for diagnosing NC are neuroimaging studies. Immunoserologic assays, such as enzyme‐linked immunoelectrotransfer blot assay (EITB) or enzyme‐linked immunosorbent assay (ELISA), detect antibodies against Taenia solium , or cysticercus. Consequently, they are useful in identifying a population at risk of contact with the parasite but do not necessarily indicate a systemic active infection. Most seropositive individuals are asymptomatic. No data from prospective studies concern the proportion of these individuals that will develop seizures or other neurologic symptoms. There is a discrepancy between the results of serologic assays and neuroimaging studies: &gt;50% of those individuals with NC diagnosed by computed tomography (CT) scan test EITB negative. Pathophysiologic classification of NC into active, transitional, and inactive forms permits a good correlation between clinical manifestations and neuroimaging procedures and facilitates medical and surgical management and research. The most frequent clinical manifestations of NC are seizures. We assume that NC is the main cause of symptomatic epilepsy in developing countries; however, no case‐control or cohort studies demonstrate this association. Most patients with NC with seizures have a good prognosis; nevertheless, further studies analyzing factors related to recurrence of seizures and possibilities of discontinuation of antiepileptic medications (AEDs) are needed. Regarding treatment of NC with antihelminthic drugs, no controlled clinical trials exist that establish specific indications, definitive doses, and duration of treatment. The most effective approach to taeniasis/cysticercosis infection is prevention. This should be a primary public health focus for developing countries. We critically review the available information regarding the epidemiology and diagnosis of human cysticercosis, the physiopathology and imaging correlation of the parasite in the central nervous system (CNS) of the host, the relation between seizures or epilepsy and NC, and the issues surrounding the treatment and prognosis of NC, including the use of antihelminthic therapy.

Conservation of wildlife is especially challenging when the targeted species damage crops or livestock, attack humans, or take fish or game. Affected communities may retaliate and destroy wildlife or their habitats. We summarize recommendations from the literature for 13 distinct types of interventions to mitigate these human-wildlife conflicts. We classified eight types as direct (reducing the severity or frequency of encounters with wildlife) and five as indirect (raising human tolerance for encounters with wildlife) interventions. We analyzed general cause-and-effect relationships underlying human-wildlife conflicts to clarify the focal point of intervention for each type. To organize the recommendations on interventions we used three standard criteria for feasibility: cost-effective design, wildlife specificity and selectivity, and sociopolitical acceptability. The literature review and the feasibility criteria were integrated as decision support tools in three multistakeholder workshops. The workshops validated and refined our criteria and helped the participants select interventions. Our approach to planning interventions is systematic, uses standard criteria, and optimizes the participation of experts, policy makers, and affected communities. We argue that conservation action generally will be more effective if the relative merits of alternative interventions are evaluated in an explicit, systematic, and participatory manner.

Evidence on what people eat globally is limited in scope and rigour, especially as it relates to children and adolescents. This impairs target setting and investment in evidence-based actions to support healthy sustainable diets. Here we quantified global, regional and national dietary patterns among children and adults, by age group, sex, education and urbanicity, across 185 countries between 1990 and 2018, on the basis of data from the Global Dietary Database project. Our primary measure was the Alternative Healthy Eating Index, a validated score of diet quality; Dietary Approaches to Stop Hypertension and Mediterranean Diet Score patterns were secondarily assessed. Dietary quality is generally modest worldwide. In 2018, the mean global Alternative Healthy Eating Index score was 40.3, ranging from 0 (least healthy) to 100 (most healthy), with regional means ranging from 30.3 in Latin America and the Caribbean to 45.7 in South Asia. Scores among children versus adults were generally similar across regions, except in Central/Eastern Europe and Central Asia, high-income countries, and the Middle East and Northern Africa, where children had lower diet quality. Globally, diet quality scores were higher among women versus men, and more versus less educated individuals. Diet quality increased modestly between 1990 and 2018 globally and in all world regions except in South Asia and Sub-Saharan Africa, where it did not improve.

O ano de 2020 se iniciou com uma crise que vai entrar para a História: a pandemia do novo coronavírus (COVID-19). Impondo o isolamento social como a principal estratégia de prevenção, a pandemia impacta a vida humana em todos os seus aspectos, dentre eles a forma do trabalho, tendo grande destaque a difusão do teletrabalho ou home office. Diante da implantação urgente desse regime de trabalho, trabalhadores e gestores se veem desafiados a encontrar a medida adequada da distribuição e execução de metas e prazos que concorrem com o tempo do convívio familiar, tarefas domésticas e atividades escolares. A reflexão sobre o aprimoramento do regime de teletrabalho de forma a conciliar em harmonia a produtividade e a saúde mental dos trabalhadores será útil mesmo após o fim do isolamento, uma vez que as práticas remotas vão continuar caracterizando relações de trabalho.

Abstract. Climate change is expected to have a large impact on water resources worldwide. A major problem in assessing the potential impact of a changing climate on these resources is the difference in spatial scale between available climate change projections and water resources management. Regional climate models (RCMs) are often used for the spatial disaggregation of the outputs of global circulation models. However, RCMs are time-intensive to run and typically only a small number of model runs is available for a certain region of interest. This paper investigates the value of the improved representation of local climate processes by a regional climate model for water resources management in the tropical Andes of Ecuador. This region has a complex hydrology and its water resources are under pressure. Compared to the IPCC AR4 model ensemble, the regional climate model PRECIS does indeed capture local gradients better than global models, but locally the model is prone to large discrepancies between observed and modelled precipitation. It is concluded that a further increase in resolution is necessary to represent local gradients properly. Furthermore, to assess the uncertainty in downscaling, an ensemble of regional climate models should be implemented. Finally, translating the climate variables to streamflow using a hydrological model constitutes a smaller but not negligible source of uncertainty.

Abstract The inelastic response of single‐degree‐of‐freedom (SDOF) systems subjected to earthquake motions is studied and a method to derive hysteretic energy dissipation spectra is proposed. The amount of energy dissipated through inelastic deformation combined with other response parameters allow the estimation of the required deformation capacity to avoid collapse for a given design earthquake. In the first part of the study, a detailed analysis of correlation between energy and ground motion intensity indices is carried out to identify the indices to be used as scaling parameters and base line of the energy dissipation spectrum. The response of elastoplastic, bilinear, and stiffness degrading systems with 5 per cent damping, subjected to a world‐wide ensemble of 52 earthquake records is considered. The statistical analysis of the response data provides the factors for constructing the energy dissipation spectrum as well as the Newmark–Hall inelastic spectra. The combination of these spectra allows the estimation of the ultimate deformation capacity required to survive the design earthquake, capacity that can also be presented in spectral form as an example shows. Copyright © 2001 John Wiley &amp; Sons, Ltd.

Societal Impact Statement Plants and fungi have provided, or inspired, key pharmaceuticals for global health challenges, including cancer, heart disease, dementia, and malaria, and are valued as traditional medicines worldwide. Global demand for medicinal plants and fungi has threatened certain species, contributing to biodiversity loss and depletion of natural resources that are important for the health of humanity. We consider the evolving role of plants and fungi in global healthcare as new challenges to human health and to biodiversity arise. We present current and emerging scientific approaches, to uncover and preserve nature‐based health solutions for the future, through harmonization with biodiversity conservation strategies. Summary Non‐communicable diseases, including cardiovascular disease, cancer, and diabetes, are the main causes of deaths globally, and communicable diseases such as malaria and tuberculosis affect billions of people. Plants and fungi have provided key pharmaceuticals in our armory against these global health challenges, while in some regions of the world, they continue to have a central role in healthcare systems as traditional medicines. Consequently, global demand for plants and fungi in healthcare has threatened certain medicinal species, and is a driving factor in biodiversity loss. Yet the future of therapeutics from nature is evolving. Scientific advances are enabling the untapped potential of the world's plants and fungi to be explored for their medicinal value, and to reveal other roles they may have for improving health and well‐being; this demonstrates the value of natural capital as an incentive for biodiversity conservation. Emerging technologies also offer new hope for safeguarding essential medicines for the future, by revealing more sustainable solutions for sourcing key natural products. This review discusses recent developments and future approaches for the discovery of natural products as medicines, for health and well‐being, and strategies to harmonize the therapeutic use of biodiversity with its proactive conservation through nature‐based solutions.

Radar-based rainfall information has been widely used in hydrological and meteorological applications, as it provides data with a high spatial and temporal resolution that improve rainfall representation. However, the broad diversity of studies makes it difficult to gather a condensed overview of the usefulness and limitations of radar technology and its application in particular situations. In this paper, a comprehensive review through a categorization of radar-related topics aims to provide a general picture of the current state of radar research. First, the importance and impact of the high temporal resolution of weather radar is discussed, followed by the description of quantitative precipitation estimation strategies. Afterwards, the use of radar data in rainfall nowcasting as well as its role in preparation of initial conditions for numerical weather predictions by assimilation is reviewed. Furthermore, the value of radar data in rainfall-runoff models with a focus on flash flood forecasting is documented. Finally, based on this review, conclusions of the most relevant challenges that need to be addressed and recommendations for further research are presented. This review paper supports the exploitation of radar data in its full capacity by providing key insights regarding the possibilities of including radar data in hydrological and meteorological applications.

BACKGROUND: Chronic diseases are the leading cause of premature death and disability in the world with overnutrition a primary cause of diet-related ill health. Excess energy intake, saturated fat, sugar, and salt derived from processed foods are a major cause of disease burden. Our objective is to compare the nutritional composition of processed foods between countries, between food companies, and over time. DESIGN: Surveys of processed foods will be done in each participating country using a standardized methodology. Information on the nutrient composition for each product will be sought either through direct chemical analysis, from the product label, or from the manufacturer. Foods will be categorized into 14 groups and 45 categories for the primary analyses which will compare mean levels of nutrients at baseline and over time. Initial commitments to collaboration have been obtained from 21 countries. CONCLUSIONS: This collaborative approach to the collation and sharing of data will enable objective and transparent tracking of processed food composition around the world. The information collected will support government and food industry efforts to improve the nutrient composition of processed foods around the world.

The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.8-14.4 million) incident T2D cases, representing 70.3% (68.8-71.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.0-27.1%)), excess refined rice and wheat intake (24.6% (22.3-27.2%)) and excess processed meat intake (20.3% (18.3-23.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.4-87.7%)) and Latin America and the Caribbean (81.8% (80.1-83.4%)); and lowest proportional burdens were in South Asia (55.4% (52.1-60.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally.