Freshwater use is recognized as one of the nine planetary boundaries. However, water scarcity is a local or regional phenomenon, meaning that the global boundary must be spatially downscaled to... Show moreFreshwater use is recognized as one of the nine planetary boundaries. However, water scarcity is a local or regional phenomenon, meaning that the global boundary must be spatially downscaled to reflect differences in water availability. In China, as in most countries, irrigation is the major freshwater user, closely linking food security to the freshwater boundary. To provide evidence supporting environmentally sustainable water use in China's food production, this study explores how a grain production shift affects the national water-scarcity footprint (WSF) and the potential to reach sustainable water use limits while maintaining the current grain production level. We found that the historical breadbasket shift towards water-scarce northern regions has increased the WSF by 40% from 1980 to 2015. To operate within the boundary, national irrigation needs to be reduced by 18% in hotspot regions, with implications of a 21% loss of grain production. However, this loss can be reduced to around 8% by closing yield gaps in water-rich regions. It demonstrates the high potential of integrating crop redistribution and closing yield gaps to achieve grain production goals within freshwater boundaries. This Chinese case study can be representative of the challenges faced by many of the world's countries, where pressures on land and water resources are high and a sustainable means of increasing food supply must be found. (C) 2020 The Author(s). Published by Elsevier Ltd. Show less
Context: Antiresorptive therapy has been associated with osteonecrosis of the jaw (ONJ), an infrequent but potentially serious adverse event.Objective: To assess information on invasive oral... Show moreContext: Antiresorptive therapy has been associated with osteonecrosis of the jaw (ONJ), an infrequent but potentially serious adverse event.Objective: To assess information on invasive oral procedures and events (OPEs)-dental implants, tooth extraction, natural tooth loss, scaling/root planing, and jaw surgery-during the 7-year Fracture REduction Evaluation of Denosumab in Osteoporosis every 6 Months (FREEDOM) Extension study and to present details of positively adjudicated ONJ cases.Design: Randomized, double-blind, placebo-controlled, 3-year trial (FREEDOM) followed by 7 years of open-label denosumab (FREEDOM Extension). At Extension Year 3, women were asked to record their history of invasive OPEs since the start of the Extension to Year 2.5 and oral events in the prior 6 months. The questionnaire was then administered every 6 months until the end of the Extension.Setting: Multicenter, multinational clinical trial.Patients: Postmenopausal women with osteoporosis.Interventions: Subcutaneous denosumab 60 mg or placebo every 6 months for 3 years, then 7 years of open-label denosumab.Main Outcome Measures: Self-reports of OPEs and adjudicated cases of ONJ.Results: Of respondents, 45.1 % reported at least one invasive OPE. The exposure-adjusted ONJ rate in FREEDOM Extension was 5.2 per 10,000 person-years. ONJ incidence was higher in those reporting an OPE (0.68%) than not (0.05%).Conclusions: Although invasive OPEs were common in these denosumab-treated women and were associated with an increased ONJ incidence, the overall rate of ONJ was low, and all cases with complete follow-up resolved with treatment. Show less
