Artificial light at night (ALAN) is increasing exponentially worldwide, accelerated by the transition to new efficient lighting technologies. However, ALAN and resulting light pollution can cause unintended physiological consequences. In vertebrates, production of melatonin—the “hormone of darkness” and a key player in circadian regulation—can be suppressed by ALAN. In this paper, we provide an overview of research on melatonin and ALAN in vertebrates. We discuss how ALAN disrupts natural photic environments, its effect on melatonin and circadian rhythms, and different photoreceptor systems across vertebrate taxa. We then present the results of a systematic review in which we identified studies on melatonin under typical light-polluted conditions in fishes, amphibians, reptiles, birds, and mammals, including humans. Melatonin is suppressed by extremely low light intensities in many vertebrates, ranging from 0.01–0.03 lx for fishes and rodents to 6 lx for sensitive humans. Even lower, wavelength-dependent intensities are implied by some studies and require rigorous testing in ecological contexts. In many studies, melatonin suppression occurs at the minimum light levels tested, and, in better-studied groups, melatonin suppression is reported to occur at lower light levels. We identify major research gaps and conclude that, for most groups, crucial information is lacking. No studies were identified for amphibians and reptiles and long-term impacts of low-level ALAN exposure are unknown. Given the high sensitivity of vertebrate melatonin production to ALAN and the paucity of available information, it is crucial to research impacts of ALAN further in order to inform effective mitigation strategies for human health and the wellbeing and fitness of vertebrates in natural ecosystems.

Interventions aimed at improving patients' knowledge of medications possess the greatest potential clinical value in improving adherence with antihypertensive therapy. However, we identified several limitations of these studies, and advise future researchers to focus on using validated adherence measures, well-designed randomized controlled trials with relevant adherence and clinical outcomes, and guidelines on the appropriate design and analysis of adherence research.

Background-Cardiac mortality rates vary substantially between countries and ethnic groups. It is unclear, however, whether South Asian, Chinese, and white populations have a variable prognosis after acute myocardial infarction (AMI).To clarify this association, we compared mortality, use of revascularization procedures, and risk of recurrent AMI and hospitalization for heart failure between these ethnic groups in a universal-access healthcare system. Methods and Results-We used a population cohort study design using hospital administrative data linked to cardiac procedure registries from British Columbia and the Calgary Health Region Area in Alberta (1994Alberta ( to 2003 to identify AMI cases. Patient ethnicity was categorized using validated surname algorithms. There were 2190 South Asian, 946 Chinese, and 38479 white patients with AMI identified. There was no significant difference in use of revascularization procedures between ethnic groups at 30 d and 1 year. Short-term (30-day) mortality was higher among Chinese relative to white patients (odds ratio, 1.23; 95% confidence interval, 1.02 to 1.48). There was no significant difference in 30-day mortality between South Asian and white patients. South Asian patients had a 35% lower relative risk of long-term mortality compared with white patients (hazard ratio, 0.65; 95% confidence interval, 0.57 to 0.72). There was no significant difference in long-term mortality between Chinese and white patients. Among AMI survivors, Chinese patients had a lower risk of recurrent AMI, whereas there was no difference between South Asian and white patients. Conclusion-The ethnic groups studied have striking differences in outcomes after AMI, with South Asian patients having significantly lower long-term mortality after AMI. (Circulation. 2010;122:1570-1577.)

Drastic declines in insect populations, 'Ecological Armageddon', have recently gained increased attention in the scientific community, and are commonly considered to be the consequence of large-scale factors such as land-use changes, use of pesticides, climate change and habitat fragmentation. Artificial light at night (ALAN), a pervasive global change that strongly impacts insects, remains, however, infrequently recognised as a potential contributor to the observed declines. Here, we provide a summary of recent evidence of impacts of ALAN on insects and discuss how these impacts can drive declines in insect populations in light-polluted areas. ALAN can increase overall environmental pressure on insect populations, and this is particularly important in agroecosystems where insect communities provide important ecosystem services (such as natural pest control, pollination, conservation of soil structure and fertility and nutrient cycling), and are already under considerable environmental pressure. We discuss how changes in insect populations driven by ALAN and ALAN itself may hinder these services to influence crop production and biodiversity in agricultural landscapes. Understanding the contribution of ALAN and other factors to the decline of insects is an important step towards mitigation and the recovery of the insect fauna in our landscapes. In future studies, the role of increased nocturnal illumination also needs to be examined as a possible causal factor of insect declines in the ongoing 'Ecological Armageddon', along with the more commonly examined factors. Given the large scale of agricultural land use and the potential of ALAN to indirectly and directly impact crop production and biodiversity, a better understanding of effects of ALAN in agroecosystems is urgently needed. (Hallmann et al., 2017), popularly named 'Ecological Armageddon'. The authors used Malaise traps to collect data from 63 sites located within protected areas that are embedded in an agricultural landscape in two regions in Germany and found that biomass of flying insects decreased more than 75% over 27 years. This trend could not be explained by the changes in habitat, climate or land use (Hallmann et al., 2017), suggesting that another large-scale factor must therefore be involved. We suggest

Background The incidence of atherosclerotic cardiovascular disease has declined in the past 2 decades. However, these benefits may not extend to young patients. The objective of this work was to assess temporal trends in the incidence, risk profiles, sex‐related differences, and outcomes in a contemporary population of young patients presenting with coronary artery disease ( CAD ) in British Columbia, Canada. Methods and Results We used a provincial cardiac registry to identify young patients (men aged <50 years, women aged <55 years), with a first presentation of CAD between 2000 and 2016, who had either ≥50% stenosis of ≥1 coronary arteries on angiography or underwent coronary revascularization. A total of 12 519 patients (30% women) met our inclusion criteria. The incidence of CAD remained stable and was higher for men than women (46–53 versus 18–23 per 100 000). Of patients, 92% had at least one traditional cardiovascular risk factor and 67% had multiple risk factors. The prevalence of diabetes mellitus, obesity, and hypertension increased during the study period and was higher for women. Women had fewer emergent procedures and revascularizations. Mortality rates decreased by 31% between 2000 and 2007, then were stable for the remaining 9 years. Mortality was significantly higher for women aged <45 years compared with men. Conclusions The incidence of premature CAD has not declined, and the prevalence of 3 major cardiovascular risk factors increased between 2000 and 2016. The risk burden and mortality rates were worse for women. These data have important implications for the design of strategies to prevent CAD in young adults.

BackgroundFailure to adhere to cardiac medications after acute myocardial infarction (AMI) is associated with increased mortality. Language barriers and preference for traditional medications may predispose certain ethnic groups at high risk for non-adherence. We compared prescribing and adherence to ACE-inhibitors (ACEI), beta-blockers (BB), and statins following AMI among elderly Chinese, South Asian, and Non-Asian patients.MethodsRetrospective-cohort study of elderly AMI survivors (1995-2002) using administrative data from British Columbia. AMI cases and ethnicity were identified using validated ICD-9/10 coding and surname algorithms, respectively. Medication adherence was assessed using the 'proportion of days covered' (PDC) metric with a PDC ≥ 0.80 indicating optimal adherence. The independent effect of ethnicity on adherence was assessed using multivariable modeling, adjusting for socio-demographic and clinical characteristics.ResultsThere were 9926 elderly AMI survivors (258 Chinese, 511 South Asian patients). More Chinese patients were prescribed BBs (79.7% vs. 73.1%, p = 0.04) and more South Asian patients were prescribed statins (73.5% vs. 65.2%, p = 0.001). Both Chinese (Odds Ratio [OR] 0.53; 95%CI, 0.39-0.73; p < 0.0001) and South Asian (OR 0.78; 95%CI, 0.61-0.99; p = 0.04) patients were less adherent to ACEI compared to Non-Asian patients. South Asian patients were more adherent to BBs (OR 1.3; 95%CI, 1.04-1.62; p = 0.02). There was no difference in prescribing of ACEI, nor adherence to statins among the ethnicities.ConclusionDespite a higher likelihood of being prescribed evidence-based therapies following AMI, Chinese and South Asian patients were less likely to adhere to ACEI compared to their Non-Asian counterparts.

Objective. Knee osteoarthritis (OA) is a commonly undiagnosed condition and care is often not provided. Pharmacists are uniquely placed for launching a multidisciplinary intervention for knee OA. Methods. We performed a cluster randomized controlled trial with pharmacies providing either intervention care or usual care (14 and 18 pharmacies, respectively). The intervention included a validated knee OA screening questionnaire, education, pain medication management, physiotherapy-guided exercise, and communication with the primary care physician. Usual care consisted of an educational pamphlet. The primary outcome was the pass rate on the Arthritis Foundation's quality indicators for OA. Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Lower Extremity Function Scale (LEFS), the Paper Adaptive Test-5D (PAT-5D), and the Health Utilities Index Mark 3 (HUI3). Results. One hundred thirty-nine patients were assigned to the control (n ‫؍‬ 66) and intervention (n ‫؍‬ 73) groups. There were no differences between the groups in baseline measures. The overall quality indicator pass rate was significantly higher in the intervention arm compared to the control arm (difference of 45.2%; 95% confidence interval 34.5, 55.9). Significant improvements were observed for the intervention care group as compared to the usual care group in the WOMAC global, pain, and function scores at 3 and 6 months (all P < 0.01); the PAT-5D daily activity scores at 3 and 6 months (both P < 0.05); the PAT-5D pain scores at 6 months (P ‫؍‬ 0.05); the HUI3 single-attribute pain scores at 3 and 6 months (all P < 0.05); and the LEFS scores at 6 months (P < 0.05). Conclusion. Pharmacists can launch a multidisciplinary intervention to identify knee OA cases, improve the utilization of treatments, and improve function, pain, and quality of life.

Artificial light at night (ALAN) is recognized as a contributor to environmental change and a biodiversity threat on a global scale. Despite its widespread use and numerous potential ecological effects, few studies have investigated the impacts on aquatic ecosystems and primary producers. Light is a source of energy and information for benthic autotrophs that form the basis of food webs in clear, shallow waters. Artificial night-time illumination may thus affect biomass and community composition of primary producers. We experimentally mimicked the light conditions of a light-polluted area (approximately 20 lux, white LED) in streamside flumes on a sub-alpine stream. We compared the biomass and community composition of periphyton grown under ALAN with periphyton grown under a natural light regime in two seasons using communities in early (up to 3 weeks) and later (4-6 weeks) developmental stages. In early periphyton, ALAN decreased the biomass of autotrophs in both spring (57% at 3 weeks) and autumn (43% at 2 weeks), decreased the proportion of cyanobacteria in spring (54%), and altered the proportion of diatoms in autumn (11% decrease at 2 weeks and 5% increase at 3 weeks). No effects of ALAN were observed for later periphyton. Further work is needed to test whether streams with frequent physical disturbances that reset the successional development of periphyton are more affected by ALAN than streams with more stable conditions. As periphyton is a fundamental component of stream ecosystems, the impact of ALAN might propagate to higher trophic levels and/or affect critical ecosystem functions.