Prospective cohort study of procalcitonin levels in children with cancer presenting with febrile neutropenia

BACKGROUND: Febrile neutropenia (FNP) causes significant morbidity and mortality in children undergoing treatment for cancer. The development of clinical decision rules to help stratify risks in paediatric FNP patients and the use of inflammatory biomarkers to identify high risk patients is an area of recent research. This study aimed to assess if procalcitonin (PCT) levels could be used to help diagnose or exclude severe infection in children with cancer who present with febrile neutropenia, both as a single measurement and in addition to previously developed clinical decision rules. METHODS: This prospective cohort study of a diagnostic test included patients between birth and 18 years old admitted with febrile neutropenia to the Paediatric Oncology and Haematology Ward in Leeds between 1(st) October 2012 and 30(th) September 2013. Each admission with FNP was treated as a separate episode. Blood was taken for a procalcitonin level at admission with routine investigations. 'R' was used for statistical analysis. Likelihood ratios were calculated and multivariable logistic regression. RESULTS: Forty-eight episodes from 27 patients were included. PCT >2 ng/dL was strongly associated with increased risk of severe infection (likelihood ratio of 26 [95% CI 3.5, 190]). The data suggests that the clinical decision rules are largely ineffective at risk stratification, frequently over-stating the risk of individual episodes. High procalcitonin levels on admission are correlated with a greatly increased risk of severe infection. CONCLUSIONS: This study does not show a definitive benefit in using PCT in FNP though it supports further research on its use. The benefit of novel biomarkers has not been proven and before introducing new tests for patients it is important their benefit above existing features is proven, particularly due to the increasing importance of health economics

Scenario planning with linked land-sea models inform where forest conservation actions will promote coral reef resilience

We developed a linked land-sea modeling framework based on remote sensing and empirical data, which couples sediment export and coral reef models at fine spatial resolution. This spatially-explicit (60 × 60 m) framework simultaneously tracks changes in multiple benthic and fish indicators as a function of land-use and climate change scenarios. We applied this framework in Kubulau District, Fiji, to investigate the effects of logging, agriculture expansion, and restoration on coral reef resilience. Under the deforestation scenario, models projected a 4.5-fold sediment increase (>7,000 t. yr) coupled with a significant decrease in benthic habitat quality across 1,940 ha and a reef fish biomass loss of 60.6 t. Under the restoration scenario, models projected a small

Best‐practice forestry management delivers diminishing returns for coral reefs with increased land‐clearing

Protection of coastal ecosystems from deforestation may be the best way to protect coral reefs from sediment runoff. However, given the importance of generating economic activities for coastal livelihoods, the prohibition of development is often not feasible. In light of this, logging codes of practice have been developed to mitigate the impacts of logging on downstream ecosystems. However, no studies have assessed whether managed land‐clearing can occur in tandem with coral reef conservation goals. This study quantifies the impacts of current land use and the risk of potential logging activities on downstream coral reef condition and fisheries using a novel suite of linked land‐sea models, using Kolombangara Island in the Solomon Islands as a case study. Further, we examine the ability of erosion reduction strategies stipulated in logging codes of practice to reduce these impacts as clearing extent increases. We found that with present‐day land use, reductions in live and branching coral cover and increases in turf algae were associated with exposure to sediment runoff from catchments and log ponds. Critically, reductions in fish grazer abundance and biomass were associated with increasing sediment runoff, a functional group that accounts for ~25% of subsistence fishing. At low clearing extents, although best management practices minimize the exposure of coral reefs to increased runoff, it would still result in 32% of the reef experiencing an increase in sediment exposure. If clearing extent increased, best management practices would have no impact, with a staggering 89% of coral reef area at risk compared to logging with no management. Synthesis and applications. Assessing trade‐offs between coastal development and protection of marine resources is a challenge for decision makers globally. Although development activities requiring clearing can be important for livelihoods, our results demonstrate that new logging in intact forest risks downstream resources important for both food and livelihood security. Importantly, our approach allows for spatially explicit recommendations for where terrestrial management might best complement marine management. Finally, given the critical degradation feedback loops that increased sediment runoff can reinforce on coral reefs, minimizing sediment runoff could play an important role in helping coral reefs recover from climate‐related disturbances

Linking Land and Sea through Collaborative Research to Inform Contemporary applications of Traditional Resource Management in Hawai‘i

Across the Pacific Islands, declining natural resources have contributed to a cultural renaissance of customary ridge-to-reef management approaches. These indigenous and community conserved areas (ICCA) are initiated by local communities to protect natural resources through customary laws. To support these efforts, managers require scientific tools that track land-sea linkages and evaluate how local management scenarios affect coral reefs. We established an interdisciplinary process and modeling framework to inform ridge-to-reef management in Hawai‘i, given increasing coastal development, fishing and climate change related impacts. We applied our framework at opposite ends of the Hawaiian Archipelago, in Hā‘ena and Ka‘ūpūlehu, where local communities have implemented customary resource management approaches through government-recognized processes to perpetuate traditional food systems and cultural practices. We identified coral reefs vulnerable to groundwater-based nutrients and linked them to areas on land, where appropriate management of human-derived nutrients could prevent increases in benthic algae and promote coral recovery from bleaching. Our results demonstrate the value of interdisciplinary collaborations among researchers, managers and community members. We discuss the lessons learned from our culturally-grounded, inclusive research process and highlight critical aspects of collaboration necessary to develop tools that can inform placed-based solutions to local environmental threats and foster coral reef resilience

Identification of potentially dangerous glacial lakes in the northern Tien Shan

Like in many other parts of the world, the glaciers in northern Tien Shan are receding, and the permafrost is thawing. Concomitantly, glacial lakes are developing. Historically, outbursts of these glacial lakes have resulted in severe hazards for infrastructures and livelihood. Multi-temporal space imageries are an ideal means to study and monitor glaciers and glacial lakes over large areas. Geomorphometric analysis and modelling allows to estimate the potential danger for glacial lake outburst floods (GLOFs). This paper presents a comprehensive approach by coupling of remote sensing, geomorphometric analyses aided with GIS modelling for the identification of potentially dangerous glacial lakes. We suggest a classification scheme based on an additive ratio scale in order to prioritise sites for detailed investigations. The identification and monitoring of glacial lakes was carried out semi-automatically using band ratioing and the normalised difference water index (NDWI) based on multi-temporal space imagery from the years 1971 to 2008 using Corona, ASTER and Landsat data. The results were manually edited when required. The probability of the growth of a glacial lake was estimated by analysing glacier changes, glacier motion and slope analysis. A permafrost model was developed based on geomorphometric parameters, solar radiation and regionalised temperature conditions which permitted to assess the influence of potential permafrost thawing. Finally, a GIS-based model was applied to simulate the possibly affected area of lake outbursts. The findings of this study indicate an increasing number and area of glacial lakes in the northern Tien Shan region. We identified several lakes with a medium to high potential for an outburst after a classification according to their outburst probability and their downstream impact. These lakes should be investigated more in detail