Vulnerability and resilience of high-mountain pine forests of the Gredos range (Ávila, Spanish Central System): two thousand years of socio-ecological dynamics

RESUMEN: En este trabajo se presenta el análisis palinológico de la turbera de Pozo de la Nieve, localizada en el Parque Natural del Valle de Iruelas (Ávila), un área de alto valor sociocultural dentro de la Sierra de Gredos (Sistema Central). Con el objetivo de relacionar los cambios en el paisaje con la explotación de los recursos naturales y eventos climáticos, en primer lugar se han realizado 7 dataciones radiocarbónicas que sitúan el inicio del registro sedimentario ca. 240 cal BC. Los datos polínicos indican la existencia de un denso pinar altimontano dominado por Pinus sylvestris/nigra desde la Segunda Edad de Hierro hasta el periodo islámico. A partir del periodo cristiano las actividades antrópicas se intensifican, especialmente la ganadería en la Edad Contemporánea, lo cual conlleva la progresiva desaparición del pinar de alta montaña y el desarrollo de pastizales mediante el manejo del fuego, situación que culmina con el desarrollo del paisaje actual dominado por piornales pirófilos.ABSTRACT: We present the palynological study of Pozo de la Nieve peat bog, located in a very valuable socio-cultural placement within the Iruelas Valley Natural Park (Gredos range, Iberian Central System). We have focused in relating landscape changes to natural resources management and climatic events. Firstly, we carried out seven radiocarbon dates suggesting the origin of this record ca. 240 cal BC. The palynological data show the existence of dense high-mountain pine woodlands dominated by Pinus sylvestris/nigra from the Late Iron Age to the Muslim period. Later, from the Christian period, anthropogenic activities have intensified, especially livestock grazing in the Contemporary Age. Its consequences are the progressive disappearance of highmountain pine forests and the extension of grasslands by means of fire, which has shaped current landscape dominated by broom communities.Este trabajo ha sido financiado por el proyecto Desirè-HAR2013-43701-P (Plan Nacional I+D+I, Ministerio de Economía y Competitividad de España). Sebastián Pérez Díaz está financiado por el Programa Estatal de Promoción del Talento y su Empleabilidad en I+D+i en la modalidad Juan de la Cierva-Incorporación. Mónica Ruiz Alonso está financiada por el Programa Estatal de Promoción del Talento y su Empleabilidad en I+D+i en la modalidad Juan de la Cierva-Formación

Palaeoenvironmental History of the Gredos Range (Spanish Central System, Avila) in Visigothic Times: The Impact of the Justinianic Plague (AD 541–543)

This paper evaluates the possible impact of the early medieval pandemic known as the “Justinianic plague” as one of the factors that shaped the mountain ecosystems in the Spanish Central System of the Iberian Peninsula. For this purpose, we focus on two high-resolution, radiocarbon-dated natural pollen records from the Gredos Range (Avila). These cores frame the information they offer within the general picture of the socio-political and environmental transformations of Late Antiquity. Along these three centuries, between c. AD 400 and AD 720, the palynological sequence allows us to recognize eight short phases (on a ten-year and even five-year scale) through which the forest formations traversed. This analysis has made it possible to identify olive and chestnut tree arboriculture since the beginning of the studied interval, as well as to characterize the fluctuation in the thinning processes of the high montane pine forests, due to slash-and-burn practices to open pastures, especially from the permanent occupation of the piedmont in Visigothic times (c. AD 450). The sequence also shows a significant decrease in the anthropic signal during a short period (c. AD 540-545) that can be disassociated from the early effects of the Late Antique Little Ice Age (c. AD 450-660) and which is possibly more related to the plague, as evidenced by the subsequent recovery of anthropic pressure on the pine forest and the extension of the olive and chestnut grove in the 6th and 7th centuries AD.El presente trabajo evalúa la posible influencia de la pandemia altomedieval conocida como «plaga de Justiniano» como uno de los factores que contribuyeron a configurar los ecosistemas de montaña enclavados en el Sistema Central de la península ibérica. Para ello, el artículo se centra en dos registros polínicos naturales de alta resolución y bien datados mediante radiocarbono, obtenidos en la Sierra de Gredos (Ávila), y enmarca la información que ofrecen en el cuadro general de las dinámicas sociopolíticas y ambientales de la Antigüedad Tardía. En el intervalo de tres siglos, entre c. 400 y 720 A. D., la secuencia palinológica permite reconocer ocho fases breves (de escala decenal e incluso quinquenal) que marcaron las transformaciones del paisaje. Este análisis ha posibilitado identificar la implantación de la arboricultura de olivo y castaño desde el inicio del intervalo estudiado, así como caracterizar la fluctuación en los procesos de clareo de los pinares altimontanos, por la incidencia de talas y rozas con fuego para abrir pastizales, especialmente desde la ocupación permanente del piedemonte en época visigoda (c. 450 A. D.). La secuencia analizada muestra un significativo aminoramiento de la señal antrópica durante un breve intervalo (c. 540-545 A. D.) que cabe desvincular de los efectos tempranos de la Pequeña Edad de Hielo tardoantigua (c. 450-660 A. D.) y resulta más plausible relacionar con la plaga, como avala la subsiguiente recuperación de la presión antrópica sobre el pinar y la extensión del olivar y el castañar en los siglos VI y VII A. D.- Introducción - Zona de estudio - Consideraciones metodológicas - Historia de la vegetación e impacto humano (400-720 A.D.) - Conclusiones, variabilidad climática y efectos de la pandemia (541-543 A.D.

La peste negra bajomedieval (1348-1351 AD) en el valle del Tiétar (sierra de Gredos, Ávila): aspectos económicos y paleoambientales

En el presente trabajo se evalúan los efectos de la peste negra bajomedieval (1348–1351 AD) sobre los bosques y las actividades agroforestales de un valle intramontano de la Meseta sur española, a partir de análisis polínicos de alta resolución. Para comprender mejor los efectos de aquella pandemia se analiza la secuencia paleoambiental de cinco turberas, a lo largo de un amplio recorrido cronológico entre los siglos XII y XIV. Este análisis demuestra que la peste provocó una desaceleración de las actividades agropecuarias –agricultura, arboricultura, ganadería– y la consiguiente recuperación de las masas forestales, salvo en las zonas de montaña donde un menor control de los pasos ganaderos incidió en cierta degradación del bosque.1 Introducción 2 Área de estudio y metodología 2.1 El valle del Tiétar en la provincia de Ávila 2.2 Registros polínicos fósiles 3 Resultados y discusión 3.1 Antes de la pandemia (1200–1348 AD) 3.2 La epidemia de peste negra en la sierra de Gredos (1348–1351 AD) 3.3 Recuperación tras la pandemia (1351–1400 AD) 4 Conclusione

Evaluating standards of care in psoriatic arthritis of the QUANTUM project (qualitative initiative to improve outcomes): results of an accreditation project in Spain

In Spain, the QUANTUM project has been promoted to reduce variability in clinical practice and improve the care and quality of life of people with psoriatic arthritis (PsA) by accrediting PsA units throughout the Spanish national health system. To present the results of this approach which sought to ensure an optimum level of quality for patients with PsA. Descriptive analysis of the self-assessments that the PsA units have carried out assessing their degree of compliance with the quality standards established in the QUANTUM project grouped into four blocks: shortening time to diagnosis; optimizing disease management; improving multidisciplinary collaboration; and improving patient monitoring. A total of 41 PsA units were self-evaluated. They met 64.1% of the defined quality standards. Optimize disease management obtained a higher level of standards compliance (72%) and improve multidisciplinary collaboration the lesser (63.9%). Accessibility to the treatments available for PsA in all hospitals was guaranteed (100%). Appropriate diagnostic equipment is available (97.6%). Compliance with specific quality standards leads to detect actions that should be implemented: quality of life assessment (9.8%), locomotor system assessment (12.2%), physical examination data record (14.6%), periodic cardiovascular risk assessment (17.1%). The QUANTUM project results make it possible to visualise how to care for patients with PsA is being developed in Spain. Problems identified in recent multinational reports are also identified in Spain

The Effect of Using Pazopanib With Food vs. Fasted on Pharmacokinetics, Patient Safety, and Preference (DIET Study)

Pazopanib is taken fasted in a fixed oral daily dose of 800 mg. We hypothesized that ingesting pazopanib with food may improve patients' comfort and reduce gastrointestinal (GI) adverse events. Therefore, we investigated the bioequivalent dose of pazopanib when taken with food compared with 800 mg pazopanib taken fasted. In addition, we investigated the differences in GI toxicity, patient satisfaction, and patient's preference for either intake. The intake of 600 mg pazopanib with food resulted in a bioequivalent exposure and was preferred over a standard pazopanib dose without food. No differences were seen in GI toxicities under both intake regimens. Patients seem to be more positive about their feelings about side effects and satisfaction with their therapy when pazopanib was taken with food. Forty-one of the patients (68%) preferred the intake with a continental breakfast

Palaeoecological data indicates land-use changes across Europe linked to spatial heterogeneity in mortality during the Black Death pandemic

Historical accounts of the mortality outcomes of the Black Death plague pandemic are variable across Europe, with much higher death tolls suggested in some areas than others. Here the authors use a 'big data palaeoecology' approach to show that land use change following the pandemic was spatially variable across Europe, confirming heterogeneous responses with empirical data.The Black Death (1347-1352 ce) is the most renowned pandemic in human history, believed by many to have killed half of Europe's population. However, despite advances in ancient DNA research that conclusively identified the pandemic's causative agent (bacterium Yersinia pestis), our knowledge of the Black Death remains limited, based primarily on qualitative remarks in medieval written sources available for some areas of Western Europe. Here, we remedy this situation by applying a pioneering new approach, 'big data palaeoecology', which, starting from palynological data, evaluates the scale of the Black Death's mortality on a regional scale across Europe. We collected pollen data on landscape change from 261 radiocarbon-dated coring sites (lakes and wetlands) located across 19 modern-day European countries. We used two independent methods of analysis to evaluate whether the changes we see in the landscape at the time of the Black Death agree with the hypothesis that a large portion of the population, upwards of half, died within a few years in the 21 historical regions we studied. While we can confirm that the Black Death had a devastating impact in some regions, we found that it had negligible or no impact in others. These inter-regional differences in the Black Death's mortality across Europe demonstrate the significance of cultural, ecological, economic, societal and climatic factors that mediated the dissemination and impact of the disease. The complex interplay of these factors, along with the historical ecology of plague, should be a focus of future research on historical pandemics

High mortality during tuberculosis treatment does not indicate long diagnostic delays in Vietnam: a cohort study

<p>Abstract</p> <p>Background</p> <p>Delay in tuberculosis diagnosis and treatment initiation may increase disease severity and mortality. In evaluations of tuberculosis control programmes high fatality rates during tuberculosis treatment, are used as an indicator of long delays in low HIV-prevalence settings. However, data for this presumed association between delay and fatality are lacking. We assessed the association between diagnostic delay and mortality of new smear-positive pulmonary tuberculosis patients in Vietnam.</p> <p>Methods</p> <p>Follow-up of a patient cohort included in a survey of diagnostic delay in 70 randomly selected districts. Data on diagnosis and treatment were extracted from routine registers. Patients who had died during the course of treatment were compared to those with reported cure, completed treatment or failure (survivors).</p> <p>Results</p> <p>Complete data were available for 1881/2093 (89.9%) patients, of whom 82 (4.4%) had died. Fatality was 4.5% for patients with ≤ 4 weeks delay, 5.0% for 5- ≤ 8 weeks delay (aOR 1.11, 95%CI 0.67–1.84) and 3.2% for > 9 weeks delay (aOR 0.69, 95%CI 0.37–1.30). Fatality tended to decline with increasing delay but this was not significant. Fatality was not associated with median diagnostic delay at district level (Spearman's rho = -0.08, P = 0.5).</p> <p>Conclusion</p> <p>Diagnostic delay is not associated with treatment mortality in Vietnam at individual nor district level, suggesting that high case fatality should not be used as an indicator of long diagnostic delay in national tuberculosis programmes.</p

Impact of nationwide enhanced implementation of best practices in pancreatic cancer care (PACAP-1):a multicenter stepped-wedge cluster randomized controlled trial

Background: Pancreatic cancer has a very poor prognosis. Best practices for the use of chemotherapy, enzyme replacement therapy, and biliary drainage have been identified but their implementation in daily clinical practice is often suboptimal. We hypothesized that a nationwide program to enhance implementation of these best practices in pancreatic cancer care would improve survival and quality of life. Methods/design: PACAP-1 is a nationwide multicenter stepped-wedge cluster randomized controlled superiority trial. In a per-center stepwise and randomized manner, best practices in pancreatic cancer care regarding the use of (neo)adjuvant and palliative chemotherapy, pancreatic enzyme replacement therapy, and metal biliary stents are implemented in all 17 Dutch pancreatic centers and their regional referral networks during a 6-week initiation period. Per pancreatic center, one multidisciplinary team functions as reference for the other centers in the network. Key best practices were identified from the literature, 3 years of data from existing nationwide registries within the Dutch Pancreatic Cancer Project (PACAP), and national expert meetings. The best practices follow the Dutch guideline on pancreatic cancer and the current state of the literature, and can be executed within daily clinical practice. The implementation process includes monitoring, return visits, and provider feedback in combination with education and reminders. Patient outcomes and compliance are monitored within the PACAP registries. Primary outcome is 1-year overall survival (for all disease stages). Secondary outcomes include quality of life, 3- and 5-year overall survival, and guideline compliance. An improvement of 10% in 1-year overall survival is considered clinically relevant. A 25-month study duration was chosen, which provides 80% statistical power for a mortality reduction of 10.0% in the 17 pancreatic cancer centers, with a required sample size of 2142 patients, corresponding to a 6.6% mortality reduction and 4769 patients nationwide. Discussion: The PACAP-1 trial is designed to evaluate whether a nationwide program for enhanced implementation of best practices in pancreatic cancer care can improve 1-year overall survival and quality of life. Trial registration: ClinicalTrials.gov, NCT03513705. Trial opened for accrual on 22th May 2018

Impact of nationwide enhanced implementation of best practices in pancreatic cancer care (PACAP-1): A multicenter stepped-wedge cluster randomized controlled trial

Background: Pancreatic cancer has a very poor prognosis. Best practices for the use of chemotherapy, enzyme replacement therapy, and biliary drainage have been identified but their implementation in daily clinical practice is often suboptimal. We hypothesized that a nationwide program to enhance implementation of these best practices in pancreatic cancer care would improve survival and quality of life. Methods/design: PACAP-1 is a nationwide multicenter stepped-wedge cluster randomized controlled superiority trial. In a per-center stepwise and randomized manner, best practices in pancreatic cancer care regarding the use of (neo)adjuvant and palliative chemotherapy, pancreatic enzyme replacement therapy, and metal biliary stents are implemented in all 17 Dutch pancreatic centers and their regional referral networks during a 6-week initiation period. Per pancreatic center, one multidisciplinary team functions as reference for the other centers in the network. Key best practices were identified from the literature, 3 years of data from existing nationwide registries within the Dutch Pancreatic Cancer Project (PACAP), and national expert meetings. The best practices follow the Dutch guideline on pancreatic cancer and the current state of the literature, and can be executed within daily clinical practice. The implementation process includes monitoring, return visits, and provider feedback in combination with education and reminders. Patient outcomes and compliance are monitored within the PACAP registries. Primary outcome is 1-year overall survival (for all disease stages). Secondary outcomes include quality of life, 3- and 5-year overall survival, and guideline compliance. An improvement of 10% in 1-year overall survival is considered clinically relevant. A 25-month study duration was chosen, which provides 80% statistical power for a mortality reduction of 10.0% in the 17 pancreatic cancer centers, with a required sample size of 2142 patients, corresponding to a 6.6% mortality reduction and 4769 patients nationwide. Discussion: The PACAP-1 trial is designed to evaluate whether a nationwide program for enhanced implementation of best practices in pancreatic cancer care can improve 1-year overall survival and quality of life. Trial registration: ClinicalTrials.gov, NCT03513705. Trial opened for accrual on 22th May 2018