Arrecifes de coral como sistemas complejos: degradación y perspectivas de recuperación

The present century is witness to unprecedented levels of coral reef degradation worldwide. Current understanding based on traditional ideas is unlikely to capture adequately the dynamics of phenomena accompanying this trend. In this regard, the ideas of complexity are reviewed. Some applications to coral reefs as complex systems have already been discussed in the literature although further progress is warranted as the search for new and more effective management tools continues, and the direction towards more holistic, integrative and large scale approaches gains wider acceptance. We distinguish between the concepts of robustness and resilience in the face of disturbance, highlight the various mechanisms that foster these stability properties and provide some coral reef examples. We identify some of the driving forces behind succession that are critical for community assembly and possible reef recovery. Finally, we consider how self-organization arises out of apparently random and chaotic processes and interactions to exhibit certain regularities and patterns especially when moving up on the scale of space and/or time.El presente siglo es testigo de niveles de degradación sin precedentes de los arrecifes de coral. El conocimiento previo basado en estudios tradicionales no es capaz de entender la dinámica de esta tendencia de degradación. En este contexto, las ideas sobre la complejidad de los arrecifes se revisa en este trabajo. Algunas aproximaciones sobre la complejidad de los arrecifes ya han sido mencionados en la literatura, pero se necesita progresar más y ser más efectivos en la línea de enfoques más holísticos, integrativos y de mayor escala que son, al mismo tiempo, los más aceptados actualmente. En el trabajo distinguimos conceptos de robustez y de resilencia dentro del marco de las perturbaciones, hacemos énfasiz en los mecanismos que confieren propiedad de estabilidad y planteamos ejemplos en los arrecifes de coral. Identificamos algunas fuerzas que gobiernan aspectos críticos para los arrecifes como es la sucesión ecológica y la posible recuperación de los mismos. Finalmente, consideramos cómo los procesos de auto-organización surgen de procesos aparentemente caóticos o al azar y de interacciones que permiten mostrar ciertas regularidades y pautas, especialmente cuando se aumenta la escala espacio temporal de observación.

One-ecosystem analysis for environmental conservation and sustainable livelihood [version 1; peer review: 2 approved]

In order to achieve the objectives of resource conservation, it is important to recognize that habitats are connected by material and energy flows, and that humans often play a central role, directly or indirectly. Hence, ecological research should be designed that treats all interlinked habitats, including human populations, as one ecosystem. Examples would be coastal habitats that are impacted by effluent from the upland, which in turn can be generated by deforestation and harmful agricultural practices. All of these aspects, including the river systems that deliver run-off, should be included in the investigation. This approach entails a carefully articulated hypothesis or set of hypotheses drawing on the natural as well as social sciences, and an appropriate sampling and statistical design. It clearly imposes high demands on resources, financial and otherwise. But the continued compartmentalization of efforts along disciplines and specializations will likely slow down progress in environmental conservation

Frequent mutation of histone-modifying genes in non-Hodgkin lymphoma

Follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL) are the two most common non-Hodgkin lymphomas (NHLs). Here we sequenced tumour and matched normal DNA from 13 DLBCL cases and one FL case to identify genes with mutations in B-cell NHL. We analysed RNA-seq data from these and another 113 NHLs to identify genes with candidate mutations, and then re-sequenced tumour and matched normal DNA from these cases to confirm 109 genes with multiple somatic mutations. Genes with roles in histone modification were frequent targets of somatic mutation. For example, 32% of DLBCL and 89% of FL cases had somatic mutations in MLL2, which encodes a histone methyltransferase, and 11.4% and 13.4% of DLBCL and FL cases, respectively, had mutations in MEF2B, a calcium-regulated gene that cooperates with CREBBP and EP300 in acetylating histones. Our analysis suggests a previously unappreciated disruption of chromatin biology in lymphomagenesis

Clinical development of new drug-radiotherapy combinations.

In countries with the best cancer outcomes, approximately 60% of patients receive radiotherapy as part of their treatment, which is one of the most cost-effective cancer treatments. Notably, around 40% of cancer cures include the use of radiotherapy, either as a single modality or combined with other treatments. Radiotherapy can provide enormous benefit to patients with cancer. In the past decade, significant technical advances, such as image-guided radiotherapy, intensity-modulated radiotherapy, stereotactic radiotherapy, and proton therapy enable higher doses of radiotherapy to be delivered to the tumour with significantly lower doses to normal surrounding tissues. However, apart from the combination of traditional cytotoxic chemotherapy with radiotherapy, little progress has been made in identifying and defining optimal targeted therapy and radiotherapy combinations to improve the efficacy of cancer treatment. The National Cancer Research Institute Clinical and Translational Radiotherapy Research Working Group (CTRad) formed a Joint Working Group with representatives from academia, industry, patient groups and regulatory bodies to address this lack of progress and to publish recommendations for future clinical research. Herein, we highlight the Working Group's consensus recommendations to increase the number of novel drugs being successfully registered in combination with radiotherapy to improve clinical outcomes for patients with cancer.National Institute for Health ResearchThis is the final version of the article. It first appeared from Nature Publishing Group via http://dx.doi.org/10.1038/nrclinonc.2016.7

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes