Cancer-related fatigue: clinical practice versus practice guidelines

Purpose This study investigated adherence to treatment guidelines on cancer-related anaemia and fatigue (CRA/CRF) and factors influencing the choice of intervention. Methods In this prospective, observational study, 136 cancer patients being treated with chemotherapy in a large community hospital completed a questionnaire at consecutive outpatient visits assessing fatigue (the Functional Assessment of Chronic Illness Therapy—Fatigue) and fatigue-related counselling and advice received. Data on administration of chemotherapy and use of epoetin or blood transfusions were abstracted from the medical records. Results Fifty-three percent of patients with severe anaemia (Hb<10 g/dl) and 6% of patients with less severe anaemia (Hb levels 10-12 g/dl) received treatment (epoetin and/or blood transfusions). Half of the patients with less severe anaemia reported clinically relevant levels of fatigue. More than 50% of all patients received fatigue-related counselling, primarily at the start of chemotherapy. Most counselling was directed at energy conservation. Fatigue was not associated significantly with the use of epoetin or blood transfusion. Patients receiving palliative treatment (17%), male patients (16%) and patients with a low Hb level (<6.2 g/dl, 38%) were treated significantly more often with epoetin. Conclusions In daily clinical practice, guidelines concerning the use of epoetin or blood transfusion in severe CRA are adhered to in about half of the cases. In patients with less severe anaemia, the level of fatigue did not play a significant role in the use of epoetin. According to current guidelines, counselling on CRF should be directed primarily at activity enhancement. However, only a minority of patients receive such counselling

A prehistoric tsunami induced long-lasting ecosystem changes on a semi-arid tropical island--the case of Boka Bartol (Bonaire, Leeward Antilles)

The Caribbean is highly vulnerable to coastal hazards. Based on their short recurrence intervals over the intra-American seas, high-category tropical cyclones and their associated effects of elevated storm surge, heavy wave impacts, mudslides and floods represent the most serious threat. Given the abundance of historical accounts and trigger mechanisms (strike-slip motion and oblique collision at the northern and southern Caribbean plate boundaries, submarine and coastal landslides, volcanism), tsunamis must be considered as well. This paper presents interdisciplinary multi-proxy investigations of sediment cores (grain size distribution, carbonate content, loss-on-ignition, magnetic susceptibility, microfauna, macrofauna) from Washington-Slagbaai National Park, NW Bonaire (Leeward Antilles). No historical tsunami is recorded for this island. However, an allochthonous marine layer found in all cores at Boka Bartol reveals several sedimentary criteria typically linked with tsunami deposits. Calibrated (14)C data from these cores point to a palaeotsunami with a maximum age of 3,300 years. Alternative explanations for the creation of this layer, such as inland flooding during tropical cyclones, cannot entirely be ruled out, though in recent times even the strongest of these events on Bonaire did not deposit significant amounts of sediment onshore. The setting of Boka Bartol changed from an open mangrove-fringed embayment into a poly- to hyperhaline lagoon due to the establishment or closure of a barrier of coral rubble during or subsequent to the inferred event. The timing of the event is supported by further sedimentary evidence from other lagoonal and alluvial archives on Bonaire

Island biodiversity conservation needs palaeoecology

The discovery and colonization of islands by humans has invariably resulted in their widespread ecological transformation. The small and isolated populations of many island taxa, and their evolution in the absence of humans and their introduced taxa, mean that they are particularly vulnerable to human activities. Consequently, even the most degraded islands are a focus for restoration, eradication, and monitoring programmes to protect the remaining endemic and/or relict populations. Here, we build a framework that incorporates an assessment of the degree of change from multiple baseline reference periods using long-term ecological data. The use of multiple reference points may provide information on both the variability of natural systems and responses to successive waves of cultural transformation of island ecosystems, involving, for example, the alteration of fire and grazing regimes and the introduction of non-native species. We provide exemplification of how such approaches can provide valuable information for biodiversity conservation managers of island ecosystems

Morphology and genetics reveal an intriguing pattern of differentiation at a very small geographic scale in a bird species, the forest thrush Turdus lherminieri.

12 pagesInternational audienceMobile organisms are expected to show population differentiation only over fairly large geographical distances. However, there is growing evidence of discrepancy between dispersal potential and realized gene flow. Here we report an intriguing pattern of differentiation at a very small spatial scale in the forest thrush (Turdus lherminieri), a bird species endemic to the Lesser Antilles. Analysis of 331 individuals from 17 sampling sites distributed over three islands revealed a clear morphological and genetic differentiation between these islands isolated by 40-50 km. More surprisingly, we found that the phenotypic divergence between the two geographic zones of the island of Guadeloupe was associated with a very strong genetic differentiation (Fst from 0.073-0.153), making this pattern a remarkable case in birds given the very small spatial scale considered. Molecular data (mitochondrial control region sequences and microsatellite genotypes) suggest that this strong differentiation could have occurred in situ, although alternative hypotheses cannot be fully discarded. This study suggests that the ongoing habitat fragmentation, especially in tropical forests, may have a deeper impact than previously thought on avian populations