From plot to regional scales: Interactions of slope and catchment hydrological and geomorphic processes in the Spanish Pyrenees

32 Pag., 7 Fig.The hydrological and geomorphic effects of land use/land cover changes, particularly those associated with vegetation regrowth after farmland abandonment were investigated in the Central Spanish Pyrenees. The main focus was to assess the interactions among slope, catchment, basin, and fluvial channel processes over a range of spatial scales. In recent centuries most Mediterranean mountain areas have been subjected to significant human pressure through deforestation, cultivation of steep slopes, fires, and overgrazing. Depopulation commencing at the beginning of the 20th century, and particularly since the 1960s, has resulted in farmland abandonment and a reduction in livestock numbers, and this has led to an expansion of shrubs and forests. Studies in the Central Spanish Pyrenees, based on experimental plots and catchments, in large basins and fluvial channels, have confirmed that these land use changes have had hydrological and geomorphic consequences regardless of the spatial scale considered, and that processes occurring at any particular scale can be explained by such processes acting on other scales. Studies using experimental plots have demonstrated that during the period of greatest human pressure (mainly the 18th and 19th centuries), cultivation of steep slopes caused high runoff rates and extreme soil loss. Large parts of the small catchments behaved as runoff and sediment source areas, whereas the fluvial channels of large basins showed signs of high torrentiality (braided morphology, bare sedimentary bars, instability, and prevalence of bedload transport). Depopulation has concentrated most human pressure on the valley bottoms and specific locations such as resorts, whereas the remainder of the area has been affected by an almost generalized abandonment. Subsequent plant recolonization has resulted in a reduction of overland flow and declining soil erosion. At a catchment scale this has caused a reduction in sediment sources, and channel incision in the secondary streams. At the regional scale, the most important consequences include a reduction in the frequency of floods, reduced sediment yields, increasing stabilization of fluvial channels (colonization of sedimentary bars by riparian vegetation and a reduction in the braiding index), and stabilization of alluvial fans. These results demonstrate the complexity and multiscalar nature of the interactions among land use and runoff generation, soil erosion, sediment transport, and fluvial channel dynamics, and highlight the need to adopt a multiscale approach in other mountain areas of the world.Support for this research was provided by the projects PROBASE (CGL2006-11619/HID, Consolider) financed by the Spanish Commission of Science and Technology; ACQWA (FP7-ENV-2007-1), financed by the European Commission; and PI032/08, financed by the Aragón Regional Government. The authors also acknowledge support from the Program of Research Groups of the Aragón Regional Government, and from RESEL (the Spanish Ministry of the Environment). N. Lana-Renault and E. Nadal-Romero benefited from a research contract (I+D+I 2008–2011 National Program), funded by the Spanish Ministry of Education and Science.Peer reviewe

Healthcare utilization and costs of children with attention deficit/hyperactivity disorder initiating atomoxetine versus extended-release guanfacine

<p><b>Objectives:</b> To compare 1-year direct healthcare costs and utilization among children and adolescents initiating non-stimulant medications atomoxetine (ATX) or extended-release guanfacine (GXR).</p> <p><b>Methods:</b> In this retrospective, observational cohort study, children and adolescents aged 6–17 years with attention deficit/hyperactivity disorder (ADHD) who had ≥1 prescription claim for ATX or GXR between December 31, 2009 and January 1, 2011 were identified in the MarketScan Commercial or Multi-State Medicaid claims databases. The first claim was set as the index. Patients with no claims for other ADHD medications that overlapped with the days’ supply for the index therapy during the post-period were classified as initiating monotherapy. All-cause and ADHD-related utilization and costs (2011 US$) and treatment patterns (adherence and persistence) were evaluated during the 12 months following index. Propensity score adjustment accounted for differences in patient characteristics, and bootstrapping was used for comparisons.</p> <p><b>Results:</b> A total of 13,239 children and adolescents with ADHD met the study criteria (4,411 ATX initiators and 8,828 GXR initiators). There were 2,699 ATX monotherapy patients. In propensity-score-adjusted analyses, mean all-cause total costs were significantly less for monotherapy ATX initiators than for GXR initiators ($7,553 vs $10,639; difference = –$3,086, <i>p</i> < .0001), as were mean ADHD-related total costs ($3,213 vs$4,544; difference = –$1,330, <i>p</i> < .0001). Monotherapy ATX initiators had significantly fewer all-cause and ADHD-related total medical visits and ∼22 days shorter persistence to index therapy (<i>p</i> < .0001). Results were similar for secondary analyses comparing all ATX with all GXR initiators, regardless of monotherapy or combination regimen, and comparing only monotherapy initiators.</p> <p><b>Conclusions:</b> Children and adolescents with ADHD who initiated ATX monotherapy incurred lower all-cause and ADHD-related total healthcare costs than patients who initiated GXR. This was due in part to less healthcare resource utilization and slightly shorter persistence for ATX patients. These findings may aid decision-making and inform future studies, but must be tempered due to inherent observational research limitations.</p

Guía de práctica clínica para el manejo del cáncer de pulmón de células pequeñas: enfermedad extensa

Antecedentes: El cáncer de células pequeñas (CPCP) representa el 13-15% del total de neoplasias primarias de pulmón. Se caracteriza por su rapidez en la tasa de crecimiento y en el desarrollo de metástasis a distancia. Objetivos: Orientar y estandarizar el tratamiento del CPCP enfermedad extensa en México basado en evidencia clínica nacional e internacional. Material y métodos: Este documento se desarrolló como una colaboración del Instituto Nacional de Cancerología y la Sociedad Mexicana de Oncología en cumplimiento con estándares internacionales. Se integró un grupo conformado por oncólogos médicos, cirujanos oncólogos, cirujanos de tórax, radio-oncólogos y metodólogos con experiencia en revisiones sistemáticas de la literatura y guías de práctica clínica. Resultados: Se consensaron, por el método Delphi y en reuniones a distancia, las recomendaciones en CPCP enfermedad extensa, producto de preguntas de trabajo. Se identificó y evaluó la evidencia científica que responde a cada una de dichas preguntas clínicas antes de incorporarla al cuerpo de la guía. Conclusión: Esta guía proporciona recomendaciones clínicas para el manejo de la enfermedad extensa del CPCP y durante el proceso de toma de decisiones de los clínicos involucrados con su manejo en nuestro país para mejorar la calidad de la atención clínica para estos pacientes