Comparación de los índices PROFUND y PALIAR en pacientes pluripatológicos con enfermedad crónica no oncológica en fase avanzada

Background and objective: To compare the discrimination power of PROFUND and PALIAR indexes for predicting mortality in polypathological patients with advanced non-oncologic chronic disease. Material and methods: Prospective multicentre cohort study. We included polypathological patients with advanced non-oncologic chronic disease, who were admitted to internal medicine departments between July 1 st and December 31th, 2014. Data was collected from each patient on age, sex, categories of polypathology, advanced disease, comorbidity, functional and cognitive assessment, terminal illness symptoms, need for caregiver, hospitalisation in the past three and 12 months and number of drugs. We calculated the PROFUND and PALIAR indexes and conducted a 12-month follow-up. We assessed mortality with the Kaplan-Meier survival curves and the discrimination of indexes with the ROC curves. Results: We included 213 patients with a mean (standard deviation) age of 83.0 (7.0) years, 106 (49.8%) of whom were female. Mortality at six months was 40.4% and at 12 months 50.2%. Deceased patients scored higher scores on the PROFUND [11.2(4.2) vs 8.5(3.9); P <.001] and PALIAR [6.7 (4.6) vs 3.6(3.1); p < 0, 001] indexes. The discrimination of PALIAR index at six months (under the curve area 0.734 95%CI 0.665-0.803) was higher than of PROFUND, and there was no difference at 12 months. Conclusions: In polypathological patients with advanced non-oncologic chronic disease, the PALIAR index had better discrimination power than PROFUND index at 66 months and there were no differences at 12 months

The Biodiversity of the Mediterranean Sea: Estimates, Patterns, and Threats

The Mediterranean Sea is a marine biodiversity hot spot. Here we combined an extensive literature analysis with expert opinions to update publicly available estimates of major taxa in this marine ecosystem and to revise and update several species lists. We also assessed overall spatial and temporal patterns of species diversity and identified major changes and threats. Our results listed approximately 17,000 marine species occurring in the Mediterranean Sea. However, our estimates of marine diversity are still incomplete as yet—undescribed species will be added in the future. Diversity for microbes is substantially underestimated, and the deep-sea areas and portions of the southern and eastern region are still poorly known. In addition, the invasion of alien species is a crucial factor that will continue to change the biodiversity of the Mediterranean, mainly in its eastern basin that can spread rapidly northwards and westwards due to the warming of the Mediterranean Sea. Spatial patterns showed a general decrease in biodiversity from northwestern to southeastern regions following a gradient of production, with some exceptions and caution due to gaps in our knowledge of the biota along the southern and eastern rims. Biodiversity was also generally higher in coastal areas and continental shelves, and decreases with depth. Temporal trends indicated that overexploitation and habitat loss have been the main human drivers of historical changes in biodiversity. At present, habitat loss and degradation, followed by fishing impacts, pollution, climate change, eutrophication, and the establishment of alien species are the most important threats and affect the greatest number of taxonomic groups. All these impacts are expected to grow in importance in the future, especially climate change and habitat degradation. The spatial identification of hot spots highlighted the ecological importance of most of the western Mediterranean shelves (and in particular, the Strait of Gibraltar and the adjacent Alboran Sea), western African coast, the Adriatic, and the Aegean Sea, which show high concentrations of endangered, threatened, or vulnerable species. The Levantine Basin, severely impacted by the invasion of species, is endangered as well

Pseudo-nitzschia physiological ecology, phylogeny, toxicity, monitoring and impacts on ecosystem health

This paper is not subject to U.S. copyright. The definitive version was published in Harmful Algae 14 (2012): 271-300, doi:10.1016/j.hal.2011.10.025.Over the last decade, our understanding of the environmental controls on Pseudo-nitzschia blooms and domoic acid (DA) production has matured. Pseudo-nitzschia have been found along most of the world's coastlines, while the impacts of its toxin, DA, are most persistent and detrimental in upwelling systems. However, Pseudo-nitzschia and DA have recently been detected in the open ocean's high-nitrate, low-chlorophyll regions, in addition to fjords, gulfs and bays, showing their presence in diverse environments. The toxin has been measured in zooplankton, shellfish, crustaceans, echinoderms, worms, marine mammals and birds, as well as in sediments, demonstrating its stable transfer through the marine food web and abiotically to the benthos. The linkage of DA production to nitrogenous nutrient physiology, trace metal acquisition, and even salinity, suggests that the control of toxin production is complex and likely influenced by a suite of environmental factors that may be unique to a particular region. Advances in our knowledge of Pseudo-nitzschia sexual reproduction, also in field populations, illustrate its importance in bloom dynamics and toxicity. The combination of careful taxonomy and powerful new molecular methods now allow for the complete characterization of Pseudo-nitzschia populations and how they respond to environmental changes. Here we summarize research that represents our increased knowledge over the last decade of Pseudo-nitzschia and its production of DA, including changes in worldwide range, phylogeny, physiology, ecology, monitoring and public health impacts

Missing link in the Southern Ocean: sampling the marine benthic fauna of remote Bouvet Island

Bouvet (Bouvetøya) is a geologically young and very remote island just south of the Polar Front. Here we report samples taken during the RV ‘‘Polarstern’’ cruise ANTXXI/2 on 3 days in November 2003 and January 2004. This work was part of SCAR’s EASIZ programme and intended, by providing data on the marine fauna of this ‘‘white gap’’ in the Atlantic sector of the Southern Ocean, to contribute to identifying the role of Bouvet in the faunal exchange between the Suband high Antarctic. While this goal demands extensive molecular analysis of the material sampled (future work), a checklist of the samples and data at hand widens the faunal and environmental inventory substantially. We suggest some preliminary conclusions on the relationship of Bouvet Island’s fauna with that of other regions, such as Magellanic South America, the Antarctic Peninsula, and the high Antarctic Weddell Sea, which have been sampled previously. There seem to be different connections for individual higher taxa rather than a generally valid consistent picture

Composition of benthic taxa collected during POLARSTERN cruise ANT-XXI/5 (BENDEX) at Bouvet Island and Spiess Seamound

Bouvet (Bouvetøya) is a geologically young and very remote island just south of the Polar Front. Here we report samples taken during the RV "Polarstern" cruise ANTXXI/2 on 3 days in November 2003 and January 2004. This work was part of SCAR's EASIZ programme and intended, by providing data on the marine fauna of this "white gap" in the Atlantic sector of the Southern Ocean, to contribute to identifying the role of Bouvet in the faunal exchange between the Sub- and high Antarctic. While this goal demands extensive molecular analysis of the material sampled (future work), a checklist of the samples and data at hand widens the faunal and environmental inventory substantially. We suggest some preliminary conclusions on the relationship of Bouvet Island's fauna with that of other regions, such as Magellanic South America, the Antarctic Peninsula, and the high Antarctic Weddell Sea, which have been sampled previously. There seem to be different connections for individual higher taxa rather than a generally valid consistent picture