Variable Growth Across Species and Life Stages in Caribbean Reef Octocorals

Growth rates often measured as linear extension rates can serve as a proxy for organismal performance across environments, yet few estimates of these growth rates exist, and fewer are reported from multi-year monitoring. We studied the effect of species, depth, exposure, and life stages on the linear extension rates of common octocorals inhabiting Caribbean reefs. We monitored 16 species from the families Briareidae, Gorgoniidae, and Plexauridae, including eight genera: Antillogorgia, Briareum, Eunicea, Gorgonia, Muricea, Muriceopsis, Plexaura, and Plexaurella. We surveyed over 2,000 colonies across eight reefs in Southwest Puerto Rico from 2003 to 2006. Our surveys include reefs along a gradient of water motion from inside protected reefs to offshore unprotected reefs and from shallow (5 m) forereefs to deeper environments reaching 25 m. We observed that linear extension rates vary across species and largely follow branch thickness variation and colony architecture, with thin plume-like shapes growing faster. We also found that in 7 out of the 16 species, colonies from shallow habitats with brighter and warmer environments have higher growth rates than colonies in deep, low energy, and darker areas. Importantly, small/juvenile corals of most species (\u3c10 cm) grew faster than adult colonies. Our data highlight the possibility that, as climate change continues to deteriorate Caribbean reefs by decimating scleractinian corals and opening new habitat for less vulnerable species, plume-like corals with fast growth rates such as species within the genus Antillogorgia may become the most abundant benthic cnidarians on Caribbean shallow forereefs

Groene diensten in Groen Waterland

Dit document levert achtergronddocumentatie bij het project "Groene diensten in Groen Waterland". In dit project zijn de mogelijkheden voor diensten op gebied van zorg, natuur- en milieu-educatie en waterbeheer in het landelijk gebied van Waterland verkend. Geïnventariseerd is, op welke activiteiten de geïnterviewde instellingen zich richten. Nadruk moet voor de boer op het werk liggen. Boer en boerin moeten werkgever zijn, geen therapeut of hulpverlener

Waterland: beleving van de groene ruimte

In opdracht van de directie Noordwest van het Ministerie van Landbouw, Natuur en Voed-selkwaliteit is aan de inwoners van Purmerend, Monnickendam en Broek in Waterland gevraagd naar het belang van en hun waardering voor rust, ruimte, donkerte, bereikbaar-heid, toegankelijkheid en cultuurhistorie zoals dat nu aanwezig is in de gemeente Waterland. Ook is specifiek gevraagd of men nu gebruikmaakt van bepaalde groene pro-ducten en diensten en of men verwacht dat het gebruik in de toekomst zal verandere

Video-Assisted Thoracoscopic Surgery in Patients With Clinically Resectable Lung Tumors

To investigate the feasibility of thoracoscopic resection, a pilot study was performed in patients with clinically resectable lung tumors. In 40 patients, Video-assisted thoracic surgery (VATS) was performed because of suspicion of malignancy. There were 29 men and 11 women with a median age of 54.8 years (range 18 to 78). Preoperative indications were suspected lung cancer and tumor in 27 patients, assessment of tumor resectability in 7 patients, and probability of metastatic tumors in 6 patients. The final diagnoses in the 27 patients with suspected lung cancer were 12 primary lung cancers, 6 lung metastases, and 9 benign lesions. The success rates for VATS (no conversion to thoracotomy) were 1 of 12 (8.3%) for resectable stage I lung cancer, 8 of 12 (66.7%) for metastatic tumors, and 9 of 9 (100%) for benign tumors. With VATS, 6 of 7 patients (85.7%), possible stage III non-small cell lung cancer, an explorative thoracotomy with was avoided, significantly reducing morbidity. The reasons for conversion to thoracotomy were 1) oncological (N2 lymph node dissection and prevention of tumor spillage) and 2) technical (inability to locate the nodule, central localization, no anatomical fissure, or poor lung function requiring full lung ventilation). The ultimate diagnoses were 19 lung cancers, 12 metastatic lung tumors, and 9 benign lung tumors. Our data show the limitations of VATS for malignant tumors in general use. These findings, together with the fact that experience in performing thoracoscopic procedures demonstrates a learning curve, may limit the use of thoracoscopic resection as a routine surgical procedure, especially when strict oncological rules are respected

Improved method for assessing iron stores in the bone marrow

Background: Bone marrow iron microscopy has been the "gold standard'' method of assessing iron deficiency. However, the commonly used method of grading marrow iron remains highly subjective. Aim: To improve the bone marrow grading method by developing a detailed protocol that assesses iron in fragments, in macrophages around fragments and in erythroblasts. Methods: A descriptive study of marrow aspirates of 303 children (aged 6-60 months) with severe anaemia and 22 controls (children undergoing elective surgery) was conducted at hospitals in southern Malawi (2002-04). Results: Using an intensive marrow iron grading method, 22% and 39% of cases and controls had deficient iron stores, and 40% and 46% had functional iron deficiency, respectively. Further evaluation of the iron status classification by the intensive method showed that functional iron deficiency was associated with significantly increased C-reactive protein concentrations (126.7 (85.6) mg/l), and iron stores deficiency with significantly increased soluble transferrin receptor concentrations (21.7 (12.5) mg/ml). Conclusions: Iron assessment can be greatly improved by a more intense marrow examination. This provides a useful iron status classification which is of particular importance in areas where there is a high rate of inflammatory conditions

Will early detection of non-axillary sentinel nodes affect treatment decisions?

Axillary lymph node involvement is the best prognostic factor for breast cancer survival. Staging breast cancers by axillary dissection remains standard management and is part of the UK national guidelines for breast cancer treatment. In the presence of involved axillary lymph nodes best treatment has been shown to be axillary clearance (Fentiman and Mansell, 1991), but clearly for women whose nodes are uninvolved avoidance of morbidity is optimal and this will be achieved by minimal dissection of the axilla. Thus, for node-negative women the introduction of the sentinel node biopsy technique may revolutionise the approach to the axilla. These will be women with mammographic screen detected small well and moderately differentiated tumours (Hadjiloucas and Bundred, 2000). The impact of sentinel node biopsy in women who have symptomatic large tumours is unproven, and around half of these women will require a second procedure to clear their axilla or radiotherapy as treatment. Even for those women found to have involved sentinel lymph nodes the ability to use early systemic chemotherapy followed by axillary clearance or radiotherapy may provide long-term survival gains. Sentinel node biopsy should not, however, become routine practice until randomised controlled trials have proven its benefit and safety in reducing morbidity. Several randomised controlled trials (including ALMANAC) are currently underway

Dialogen over verduurzaming van de Nederlandse landbouw : gestructureerde sectordialogen als onderdeel van een monitoringsmethodiek

Dit rapport beschrijft en analyseert een serie gestructureerde sectordialogen als onderdeel van een monitoringsmethodiek voor de verduurzaming van de landbouw. Deze dialogen zijn in 2006 in opdracht van het Ministerie van LNV georganiseerd met de volgende doelen: 1) Welke ambities hebben de verschillende sectoren op het gebied van het verduurzamen van de landbouw en 2) hoe vindt de sector dat zij er op dit moment voorstaat in haar ontwikkeling naar een duurzame landbouw? In een kritische reflectie wordt de kwaliteit en effectiviteit van de uitgevoerde sectordialogen behandeld. In een vergelijking met een kwantitatieve monitoringsmethodiek wordt de toegevoegde waarde van de dialogen als (aanvullend) onderdeel van een meer omvattende methodiek voor de monitoring van verduurzaming van de landbouw bediscussieerd. Trefwoorden: lerende monitoring, participatieve monitoring, dialogen, duurzame landbou

Establishing an antimicrobial stewardship program in Sierra Leone: a report of the experience of a low-income country in West Africa

Antimicrobial Resistance (AMR) is a growing global health challenge that threatens to undo gains in human and animal health. Prevention and control of AMR requires functional antimicrobial stewardship (AMS) program, which is complex and often difficult to implement in low- and middle-income countries. We aimed to describe the processes of establishing and implementing an AMS program at Connaught Hospital in Sierra Leone. The project involved the setting up of an AMS program, capacity building and performing a global point prevalence survey (GPPS) at Sierra Leone's national referral hospital. Connaught Hospital established a multidisciplinary AMS subcommittee in 2021 to provide AMS services such as awareness campaigns, education and training and review of guidelines. We performed a GPPS on 175 patients, of whom more than half (98, 56.0%) were prescribed an antibiotic: 63 (69.2%) in the surgical wards and 53 (51.2%) in the medical wards. Ceftriaxone (60, 34.3%) and metronidazole (53, 30.3%) were the most common antibiotics prescribed to patients. In conclusion, it is feasible to establish and implement an AMS program in low-income countries, where most hospitalized patients were prescribed an antibiotic

'Boeren op hoog water'; Een studie naar de toekomstperspectieven voor landbouw op natte veengronden in het Groene Hart

In dit rapport wordt verslag gedaan van een onderzoek naar de mogelijkheden voor landbouw op natte veengronden in het Groene Hart. Hiermee wordt bedoeld een bedrijfssysteem in de melkveehouderij, waarbij het slootwaterpeil verhoogd wordt van 60 naar 35 cm beneden maaiveld. Hiertoe is in eerste instantie bezien welke toekomstscenario's er momenteel zijn voor de landbouw in het Westelijke Veenweidegebied en is meer specifiek voor de regio De Venen een actoranalyse gemaakt over de standpunten van verschillende partijen daarom-trent. Onderzocht is vervolgens welke mogelijkheden agrarische ondernemers hebben om te anticiperen op de genoemde peilverhoging en welke kosten daaraan verbonden zijn. Ook is onderzocht of het mogelijk is om gebiedscontracten af te sluiten rond landbouw op natte veengronden en welke inhoud een dergelijk contract tussen overheden en agrarische onder-nemers dan zou moeten hebben. Het onderzoek is gebaseerd op een actorenanalyse middels interviews en literatuuronderzoek, berekeningen van de Animal Sciences Group van Wage-ningen UR, een GDR-meeting met experts en een workshop met vertegenwoordigers van alle betrokken belangengroepen in De Venen

Multifocality and multicentricity are not contraindications for sentinel lymph node biopsy in breast cancer surgery

BACKGROUND: After the availability of the results of validation studies, the sentinel lymph node biopsy (SLNB) has replaced routine axillary dissection (AD) as the new standard of care in early unifocal breast cancers. Multifocal (MF) and multicentric (MC) tumors have been considered a contraindication for this technique due to the possible incidence of a higher false-negative rate. This prospective study evaluates the lymphatic drainage from different tumoral foci of the breast and assesses the accuracy of SLNB in MF-MC breast cancer. PATIENTS AND METHODS: Patients with preoperative diagnosis of MF or MC infiltrating and clinically node-negative (cN0) breast carcinoma were enrolled in this study. Two consecutive groups of patients underwent SLN mapping using a different site of injection of the radioisotope tracer: a) "2ID" Group received two intradermal (ID) injections over the site of the two dominant neoplastic nodules. A lymphoscintigraphic study was performed after each injection to evaluate the route of lymphatic spreading from different sites of the breast. b) "A" Group had periareolar (A) injection followed by a conventional lymphoscintigraphy. At surgery, both radioguided SLNB (with frozen section exam) and subsequent AD were planned, regardless the SLN status. RESULTS: A total 31 patients with MF (n = 12) or MC (n = 19) invasive, cN0 cancer of the breast fulfil the selection criteria. In 2 ID Group (n = 15) the lymphoscintigraphic study showed the lymphatic pathways from two different sites of the breast which converged into one major lymphatic trunk affering to the same SLN(s) in 14 (93.3%) cases. In one (6.7%) MC cancer two different pathways were found, each of them affering to a different SLN. In A Group (n = 16) lymphoscintigraphy showed one (93.7%) or two (6.3%) lymphatic channels, each connecting areola with one or more SLN(s). Identification rate of SLN was 100% in both Groups. Accuracy of frozen section exam on SLN was 96.8% (1 case of micrometastasis was missed). SLN was positive in 13 (41.9%) of 31 patients, including 4 cases (30.7%) of micrometastasis. In 7 of 13 (53.8%) patients the SLN was the only site of axillary metastasis. SLNB accuracy was 96.8% (30 of 31), sensitivity 92.8 (13 of 14), and false-negative rate 7.1% (1 of 14). Since the case of skip metastasis was identified by the surgeon intraoperatively, it would have been no impact in the clinical practice. CONCLUSION: Our lymphoscintigraphic study shows that axillary SLN represents the whole breast regardless of tumor location within the parenchyma. The high accuracy of SLNB in MF and MC breast cancer demonstrates, according with the results of other series published in the literature, that both MF and MC tumors do not represent a contraindication for SLNB anymore