The influence of light attenuation on the biogeomorphology of a marine karst cave: a case study of Puerto Princesa Underground River, Palawan, the Philippines

Karst caves are unique biogeomorphological systems. Cave walls offer habitat for microorganisms which in-turn have a geomorphological role via their involvement in rock weathering, erosion and mineralisation. The attenuation of light with distance into caves is known to affect ecology, but the implications of this for biogeomorphological processes and forms have seldom been examined. Here we describe a semi-quantitative microscopy study comparing the extent, structure, and thickness of biocover and depth of endolithic penetration for samples of rock from the Puerto Princesa Underground River system in Palawan, the Philippines, which is a natural UNESCO World Heritage Site. Organic growth at the entrance of the cave was abundant (100% occurrence) and complex, dominated by phototrophic organisms (green microalgae, diatoms, cyanobacteria, mosses and lichens). Thickness of this layer was 0.28 ± 0.18 mm with active endolith penetration into the limestone (mean depth = 0.13 ± 0.03 mm). In contrast, phototrophs were rare 50 m into the cave and biofilm cover was significantly thinner (0.01 ± 0.01 mm, p < 0.000) and spatially patchy (33% occurrence). Endolithic penetration here was also shallower (< 0.01 mm, p < 0.000) and non-uniform. Biofilm was found 250 m into the cave, but with a complete absence of phototrophs and no evidence of endolithic bioerosion. We attribute these findings to light-induced stress gradients, showing that the influence of light on phototroph abundance has knock-on consequences for the development of limestone morphological features. In marine caves this includes notches, which were most well-developed at the sheltered cave entrance of our study site, and for which variability in formation rates between locations is currently poorly understood

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

REMOTELY PILOTED AIRCRAFT SYSTEMS (RPAS) APPLICATION FOR STRUCTURE DESCRIPTION OF MEDITERRANEAN VERMETID REEFS

Vermetid gastropods are coastal habitat engineers which build biogenic platforms typical of intertidal rocky shores of central and south -east of the Mediterranean. These bioconstructions create a secondary habitat which increases resource availability and space for organisms, locally transforming the environment and modifying coastal geomorphology. Biological characteristics and physical structure of these bioconstructions are commonly studied by field-based sampling. Nevertheless, a lot of time is required to collect data over large areas of reef, field conditions can impair data collection and direct reef image interpretation may be a challenge due to their intertidal position. In this study, a small RPAS is used to describe the macrostructure of two vermetid reefs in different areas: Capo Gallo (NW Sicily) and Favignana Island (W Sicily). 800 m of each reef have been surveyed by using high-resolution aerial orthophotomosaics (2cm/px). Detailed 3D maps have been realized for both reefs and the following measures of ecological relevance have been estimated: external rim length, internal rim length, surface of external rim (mq), cuvette surface (mq) and reef surface (mq). Index of external rim development and Index of internal rim development have been calculated as a relationship between a standardized linear length and the length of the external and internal rim respectively. Total area for Capo Gallo reef is 2563,26 mq; indexes of external and internal rim development are respectively 3,40 and 1,90. For Favignana, reef area is 1263,15 mq and indexes of external and internal rim development are respectively 2,56 and 1,80. These results reveal RPAS as a powerful tool for physical description of vermetid reefs and to calculate how this biogenic habitat shapes the coast and increases habitat complexity on rocky shores. This study, moreover, shows the high potential for RPAS technique to be applied for mapping vermetid reefs and to aid the management and conservation of natural systems, as required by the EU Strategy on Biodiversity which declares the necessity of mapping habitats and the ecosystem services they provide

Enhanced interpretation of newborn screening results without analyte cutoff values

A collaboration among 157 newborn screening programs in 47 countries has lead to the creation of a database of 705,333 discrete analyte concentrations from 11,462 cases affected with 57 metabolic disorders, and from 631 heterozygotes for 12 conditions. This evidence was first applied to establish disease ranges for amino acids and acylcarnitines, and clinically validate 114 cutoff target ranges. Objective: To improve quality and performance with an evidence-based approach, multivariate pattern recognition software has been developed to aid in the interpretation of complex analyte profiles. The software generates tools that convert multiple clinically significant results into a single numerical score based on overlap between normal and disease ranges, penetration within the disease range, differences between specific conditions, and weighted correction factors. Design: Eighty-five on-line tools target either a single condition or the differential diagnosis between two or more conditions. Scores are expressed as a numerical value and as the percentile rank among all cases with the condition chosen as primary target, and are compared to interpretation guidelines. Tools are updated automatically after any new data submission (2009- 2011: 5.2 new cases added per day on average). Main outcome measures: Retrospective evaluation of past cases suggest that these tools could have avoided at least half of 277 false positive outcomes caused by carrier status for fatty acid oxidation disorders, and could have prevented 88% of false negative events caused by cutoff 7 values set inappropriately. In Minnesota, their prospective application has been a major contributing factor to the sustained achievement of a false positive rate below 0.1% and a positive predictive value above 60%. Conclusions: Application of this computational approach to raw data could make cutoff values for single analytes effectively obsolete. This paradigm is not limited to newborn screening and is applicable to the interpretation of diverse multi-analyte profiles utilized in laboratory medicine. Abstract wor

Pattern of comorbidities and 1-year mortality in elderly patients with COPD hospitalized in internal medicine wards: data from the RePoSI Registry

Currently, chronic obstructive pulmonary disease (COPD) represents the fourth cause of death worldwide with significant economic burden. Comorbidities increase in number and severity with age and are identified as important determinants that influence the prognosis. In this observational study, we retrospectively analyzed data collected from the RePoSI register. We aimed to investigate comorbidities and outcomes in a cohort of hospitalized elderly patients with the clinical diagnosis of COPD. Socio-demographic, clinical characteristics and laboratory findings were considered. The association between variables and in-hospital, 3-month and 1-year follow-up were analyzed. Among 4696 in-patients, 932 (19.8%) had a diagnosis of COPD. Patients with COPD had more hospitalization, a significant overt cognitive impairment, a clinically significant disability and more depression in comparison with non-COPD subjects. COPD patients took more drugs, both at admission, in-hospital stay, discharge and 3-month and 1-year follow-up. 14 comorbidities were more frequent in COPD patients. Cerebrovascular disease was an independent predictor of in-hospital mortality. At 3-month follow-up, male sex and hepatic cirrhosis were independently associated with mortality. ICS-LABA therapy was predictor of mortality at in-hospital, 3-month and 1-year follow-up. This analysis showed the severity of impact of COPD and its comorbidities in the real life of internal medicine and geriatric wards