Understanding cognition in older patients with cancer

Cancer and neurocognitive disorders, such as dementia and delirium, are common and serious diseases in the elderly that are accompanied by high degree of morbidity and mortality. Furthermore, evidence supports the under-diagnosis of both dementia and delirium in older adults. Complex questions exist regarding the interaction of dementia and delirium with cancer, beginning with guidelines on how best measure disease severity, the optimal screening test for either disorder, the appropriate level of intervention in the setting of abnormal findings, and strategies aimed at preventing the development or progression of either process. Ethical concerns emerge in the research setting, pertaining to the detection of cognitive dysfunction in participants, validity of consent, disclosure of abnormal results if screening is pursued, and recommended level of intervention by investigators. Furthermore, understanding the ways in which comorbid cognitive dysfunction and cancer impact both cancer and non-cancer-related outcomes is essential in guiding treatment decisions. In the following article, we will discuss what is presently known of the interactions of pre-existing cognitive impairment and delirium with cancer. We will also discuss identified deficits in our knowledge base, and propose ways in which innovative research may address these gaps

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

A global action agenda for turning the tide on fatty liver disease

Background and Aims: Fatty liver disease is a major public health threat due to its very high prevalence and related morbidity and mortality. Focused and dedicated interventions are urgently needed to target disease prevention, treatment, and care. Approach and Results: We developed an aligned, prioritized action agenda for the global fatty liver disease community of practice. Following a Delphi methodology over 2 rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the action priorities using Qualtrics XM, indicating agreement using a 4-point Likert-scale and providing written feedback. Priorities were revised between rounds, and in R2, panelists also ranked the priorities within 6 domains: epidemiology, treatment and care, models of care, education and awareness, patient and community perspectives, and leadership and public health policy. The consensus fatty liver disease action agenda encompasses 29 priorities. In R2, the mean percentage of “agree” responses was 82.4%, with all individual priorities having at least a super-majority of agreement (> 66.7% “agree”). The highest-ranked action priorities included collaboration between liver specialists and primary care doctors on early diagnosis, action to address the needs of people living with multiple morbidities, and the incorporation of fatty liver disease into relevant non-communicable disease strategies and guidance. Conclusions: This consensus-driven multidisciplinary fatty liver disease action agenda developed by care providers, clinical researchers, and public health and policy experts provides a path to reduce the prevalence of fatty liver disease and improve health outcomes. To implement this agenda, concerted efforts will be needed at the global, regional, and national levels.publishedVersio

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Prey size selection and bottom type influence multiple predator effects in a crab–bivalve system

ABSTRACT: Consumption by multiple conspecific or interspecific predators on shared prey is not always predicted when data from isolated predators are combined. Predator interactions can result in non-independent predator effects on prey, and may be influenced by prey size selection and bottom type. We examined stone crab Menippe mercenaria and blue crab Callinectes sapidus predation of hard clams Mercenaria mercenaria. Interactions between these predators may become common in mid-Atlantic estuaries as stone crab abundance increases with a poleward range shift driven by climate change. Crabs in isolation, in conspecific pairs and in the interspecific pair were offered clams in 5 size classes simultaneously (10–60 mm shell length [SL]) or 1 size class (10–20 mm SL). Trials were on sand and hard bottom. On sand, all predator pairs had independent effects on prey, regardless of the presence or absence of multiple prey sizes. On hard bottom, when multiple prey sizes were present, blue crab conspecific and the interspecific pairs consumed less than predicted from isolated crabs. Strong selection of small clams by blue crabs led to conspecific interactions that reduced foraging compared to isolated crabs. Because stone crabs consumed all clam sizes, behaviours other than prey size selection caused the non-independent effect on prey by the interspecific pair. When multiple prey sizes were absent on hard bottom, most predator pairs had independent effects on prey. Thus, an expected poleward range shift of stone crabs may not increase interactions with blue crabs when foraging on sand. However, on hard bottom, increased predator interactions could reduce overall predation risk for prey, especially when consuming multiple prey sizes. In a climate-changed mid-Atlantic estuary, stone crabs will consume a wide range of clam sizes, and the size refuge large clams usually have from blue crab predation will be lost

Murphy et al. 2019 FACETS supplementary material 2

Bay scale impact scores for Murphy et al. 2019 FACET

Murphyetal_2019_FACETS_supplementary_material3_May2019

Local scale impact metrics for Murphy et al. 2019 FACET

Evaluating estuarine habitats using secondary production as a proxy for food web support

ABSTRACT: The management, restoration, and conservation of estuarine habitats would benefit from knowledge of habitat-specific functions that reflect important ecosystem services. Secondary production may provide a comprehensive metric of food web support because it synthesizes contributions of local primary production, food subsidies from other habitats, and the protective influences of habitat structure. Despite widespread perceptions of how habitats compare in food web contribution, few methodologically comparable studies on secondary production across multiple estuarine habitats exist. At field sites in North Carolina, USA, annual secondary production was estimated for macrobenthic infaunal and epifaunal communities in salt marshes, seagrass meadows, oyster reefs, intertidal and subtidal flats, and on shoreline stabilization structures. Habitats with hard emergent or biogenic structure generally exhibited higher secondary production than habitats lacking structure. Oyster reef had the highest secondary production, ranging from 467.3 to 853.7 g ash free dry mass (AFDM) m−2 yr−1, while shoreline stabilization structures ranked high because of dense epifaunal communities. Estimates of secondary production suggest ranking of natural habitats as oyster reef > salt marsh > seagrass > intertidal flat and subtidal flat. Undesirable impacts of shoreline stabilization structures on adjacent habitats made their inclusion in this ranking of food web support by habitat difficult. The importance of suspension feeders on oyster reefs, shoreline stabilization structures, and in some marshes suggests that secondary production patterns are partly influenced by external subsidies facilitated by support from habitat structure. Consequently, estuarine rehabilitation should include structural habitat elements that will contribute to ecosystem production at higher trophic levels. Without such habitat restoration, the fate of estuaries in the USA affected by anthropogenic stressors may be loss of habitat diversity and prevalence of low-trophic-supporting habitats