Testing evapotranspiration estimates based on MODIS satellite data in the assessment of the groundwater recharge of karst aquifers in southern Italy

In many Italian regions, and particularly in southern Italy, karst aquifers are the main sources of drinking water and play a crucial role in the socio-economic development of the territory. Hence, estimating the groundwater recharge of these aquifers is a fundamental task for the proper management of water resources, while also considering the impacts of climate changes. In the southern Apennines, the assessment of hydrological parameters that is needed for the estimation of groundwater recharge is a challenging issue, especially for the spatial and temporal inhomogeneity of networks of rain and air temperature stations, as well as the variable geomorphological features and land use across mountainous karst areas. In such a framework, the integration of terrestrial and remotely sensed data is a promising approach to limit these uncertainties. In this research, estimations of actual evapotranspiration and groundwater recharge using remotely sensed data gathered by the Moderate Resolution Imaging Spectrometer (MODIS) satellite in the period 2000–2014 are shown for karst aquifers of the southern Apennines. To assess the uncertainties affecting conventional methods based on empirical formulas, the values estimated by the MODIS dataset were compared with those calculated by Coutagne, Turc, and Thornthwaite classical empirical formulas, which were based on the recordings of meteorological stations. The annual rainfall time series of 266 rain gauges and 150 air temperature stations, recorded using meteorological networks managed by public agencies in the period 2000–2014, were considered for reconstructing the regional distributed models of actual evapotranspiration (AET) and groundwater recharge. Considering the MODIS AET, the mean annual groundwater recharge for karst aquifers was estimated to be about 448 mm·year−1 . In contrast, using the Turc, Coutagne, and Thornthwaite methods, it was estimated as being 494, 533, and 437 mm·year−1, respectively. The obtained results open a new methodological perspective for the assessment of the groundwater recharge of karst aquifers at the regional and mean annual scales, allowing for limiting uncertainties and taking into account a spatial resolution greater than that of the existing meteorological networks. Among the most relevant results obtained via the comparison of classical approaches used for estimating evapotranspiration is the good matching of the actual evapotranspiration estimated using MODIS data with the potential evapotranspiration estimated using the Thornthwaite formula. This result was considered linked to the availability of soil moisture for the evapotranspiration demand due to the relevant precipitation in the area, the general occurrence of soils covering karst aquifers, and the dense vegetation

What is the evidence for the clinical value of SBRT in cancer of the cervix?

AimThe aim of this review is to describe and analyze indications and results of the use of SBRT in uterine cervix cancer, reviewing articles published from January 2010 up to August 2017, for any one of the four indications listed:1Patient refusal or anatomic impediments to interstitial or intracavitary brachytherapy (BCT), i.e. SBRT as an “alternative” for BCT;2Patients with voluminous tumors, or asymmetric tumors where BCT alone would not achieve curative doses, i.e. SBRT as a primary adjunct to BCT;3Pelvic and para aortic adenopathy where SBRT could be used as a boost, i.e. SBRT as a primary adjunct to external beam pelvic radiotherapy;4Small volume recurrences (postoperative or post radiotherapy), i.e. SBRT for salvage.BackgroundCervix cancer standard treatment involves pelvic irradiation and chemotherapy, recent advances in irradiation techniques might offer new possible approaches.Material and methodsSystematic review of the English language literature about Cervix cancer, SBRT, published from January 2010 to January 2018 identified through a database search of PubMed, and Ovid MEDLINE, using pre-defined search phrases.ResultsThe results in the literature, in general, demonstrate rather weak efficacy of SBRT. In this review, we did not find strong evidence to recommend routine SBRT as a primary treatment for cervico-uterine cancers, i.e. as a replacement for BCT; in highly selected cases it might be considered useful as salvage therapy for relapsed cervix cancer.ConclusionThe existing data to not warrant recommending SBRT for the definitive treatment of cervix cancer, but may have some value in the recurrent/relapsed setting

TRIBOS DA ORLA

Esta pesquisa integra o Projeto Orla, dos espaços públicos de lazer da Orla de Atalaia, Aracaju/SE, construído no grupo Observatório da Mídia Esportiva da Universidade Federal de Sergipe. A Nova Orla de Atalaia reúne um número diversificado de espaços destinados às práticas corporais de esporte e lazer, fato que atrai pessoas de diferentes gostos e estilos que formam grupos sociais aos quais denominamos tribos. Considerando a acessibilidade, localização e estrutura do espaço, buscou-se identificar quais os seus interesses dos grupos em relação aos espaços públicos de lazer da Orla de Atalaia. Na pesquisa de caráter Qualitativo/descritivo foram utilizados como instrumentos de coleta de dados a Entrevista Semi-estruturada e o Diário de Campo, bem como alguns recursos tecnológicos como: câmara fotográfica e a filmadora. As observações e análises nortearam a pesquisa a três temáticas de discussão: a questão pública e privada do acesso aos espaços; a versão mercadológica fetichizada do esporte e do lazer; e as práticas não convencionais. Alguns resultados demonstram a acessibilidade e a qualidade das estruturas como fatores primordiais de interesse às tribos e que o lazer pode ser meio de produção cultural e de formação de grupos, bem como uma mercadoria, um fetiche do espetáculo consumismo

Preoperative bi-fractionated accelerated radiation therapy for combined treatment of locally advanced rectal cancer in a consectutive series of unselected patients

Background: although preoperative RT (Radiation Therapy) is becoming the preferred approach for combined treatment of locally advanced rectal adenocarcinoma, no regimen can be now considered as a standard. Since the toxicity of preoperative RT isn't yet completely known, and the advantages of preoperative RT could be counterbalanced by increased postoperative morbidity and mortality, a monocentre series of preoperative bifractionated accelerated RT was retrospectively reviewed to clarify toxicity and outcomes after a prolonged follow up. Methods: patients were screened following these eligibility criteria: histology-proven adenocarcinoma of the rectum; distal tumour extent at 12 cm or less from the anal verge; clinical stage T3-4/anyN, or anyT/ N1-2; ECOG Performance Status 0-2. A total dose of 41.6 Gy (26 twice daily fractions of 1.6 Gy) was delivered. Surgery was carried out 17 \ub1 2 days after RT completion, adopting the total mesorectal excision technique. Results: 24 men and 23 women were enrolled; median age was 55 years (r.: 39-77). Twenty-eight patients were stage II and 19 stage III. 9 patients suffered from a recurrent tumour. 2 patients experienced a severe grade 4 gastrointestinal toxicity (a colo-vaginal fistula and an intestinal obstruction, both successfully treated). Operative mortality was nil; postoperative early complications occurred in 13 cases; mean length of hospital stay was 15 days. After a mean follow up of 44 months (r.: 18-84) 8 patients had deceased for recurrent disease, 15 were alive with a disease progression (2 pelvic recurrences and 13 pure distant deposits) and 24 were alive, without disease. The 5-year actuarial overall survival was 74.2%, the disease-free survival 62.9% and the regional control rate 84.7%. Long-term complications included 1 case of radiation enteritis requiring surgery, 2 cases of anastomotic stricture and 3 cases of bladder incontinence. Conclusion: bifractionated accelerated RT administered in the preoperative setting to patients bearing locally advanced rectal cancer is reliable and safe, as its immediate and late toxicity (mainly infectious) is acceptably low and long-term survivals are achievable. These findings support the increasing use of preoperative RT for treatment of this malignancy in experienced centres. Ongoing multicentric trials are expected to address still unsolved issues, including the benefit of CT adjunct to preoperative RT

Risk of hospitalization for heart failure in patients with type 2 diabetes newly treated with DPP-4 inhibitors or other oral glucose-lowering medications: A retrospective registry study on 127,555 patients from the Nationwide OsMed Health-DB Database

Aims Oral glucose-lowering medications are associated with excess risk of heart failure (HF). Given the absence of comparative data among drug classes, we performed a retrospective study in 32 Health Services of 16 Italian regions accounting for a population of 18 million individuals, to assess the association between HF risk and use of sulphonylureas, DPP-4i, and glitazones. Methods and results We extracted data on patients with type 2 diabetes who initiated treatment with DPP-4i, thiazolidinediones, or sulphonylureas alone or in combination with metformin during an accrual time of 2 years. The endpoint was hospitalization for HF (HHF) occurring after the first 6 months of therapy, and the observation was extended for up to 4 years. A total of 127 555 patients were included, of whom 14.3% were on DPP-4i, 72.5% on sulphonylurea, 13.2% on thiazolidinediones, with average 70.7% being on metformin as combination therapy. Patients in the three groups differed significantly for baseline characteristics: age, sex, Charlson index, concurrent medications, and previous cardiovascular events. During an average 2.6-year follow-up, after adjusting for measured confounders, use of DPP-4i was associated with a reduced risk of HHF compared with sulphonylureas [hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.62-0.97; P = 0.026]. After propensity matching, the analysis was restricted to 39 465 patients, and the use of DPP-4i was still associated with a lower risk of HHF (HR 0.70; 95% CI 0.52-0.94; P = 0.018). Conclusion In a very large observational study, the use of DPP-4i was associated with a reduced risk of HHF when compared with sulphonylureas

Development of mental health first aid guidelines for Aboriginal and Torres Strait Islander people experiencing problems with substance use: a Delphi study

<p>Abstract</p> <p>Background</p> <p>Problems with substance use are common in some Aboriginal communities. Although problems with substance use are associated with significant mortality and morbidity, many people who experience them do not seek help. Training in mental health first aid has been shown to be effective in increasing knowledge of symptoms and behaviours associated with seeking help. The current study aimed to develop culturally appropriate guidelines for providing mental health first aid to an Aboriginal or Torres Strait Islander person who is experiencing problem drinking or problem drug use (e.g. abuse or dependence).</p> <p>Methods</p> <p>Twenty-eight Aboriginal health experts participated in two independent Delphi studies (n = 22 problem drinking study, n = 21 problem drug use; 15 participated in both). Panellists were presented with statements about possible first aid actions via online questionnaires and were encouraged to suggest additional actions not covered by the content. Statements were accepted for inclusion in the guidelines if they were endorsed by ≥ 90% of panellists as either 'Essential' or 'Important'. At the end of the two Delphi studies, participants were asked to give feedback on the value of the project and their participation experience.</p> <p>Results</p> <p>From a total of 735 statements presented over two studies, 429 were endorsed (223 problem drinking, 206 problem drug use). Statements were grouped into sections based on common themes (n = 7 problem drinking, n = 8 problem drug use), then written into guideline documents. Participants evaluated the Delphi method employed, and the guidelines developed, as useful and appropriate for Aboriginal and Torres Strait Islander people.</p> <p>Conclusions</p> <p>Aboriginal health experts were able to reach consensus about culturally appropriate first aid for problems with substance use. Many first aid actions endorsed in the current studies were not endorsed in previous international Delphi studies, conducted on problem drinking and problem drug use in non-Indigenous people, highlighting the need for culturally specific first aid strategies to be employed when assisting Aboriginal or Torres Strait Islander people.</p