79 research outputs found

    Management of Biochemical Recurrence after Primary Curative Treatment for Prostate Cancer: A Review

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    How to manage patients with prostate cancer (PCa) with biochemical recurrence (BCR) following primary curative treatment is a controversial issue. Importantly, this prostate-specific antigen (PSA)-only recurrence is a surrogate neither of PCa-specific survival nor of overall survival. Physicians are therefore challenged with preventing or delaying the onset of clinical progression in those deemed at risk, while avoiding over-treating patients whose disease may never progress beyond PSA-only recurrence. Adjuvant therapy for radical prostatectomy (RP) or local radiotherapy (RT) has a role in certain at-risk patients, although it is not recommended in low-risk PCa owing to the significant side-effects associated with RT and androgen deprivation therapy (ADT). The recommendations for salvage therapy differ depending on whether BCR occurs after RP or primary RT, and in either case, definitive evidence regarding the best strategy is lacking. Options for treatment of BCR after RP are RT at least to the prostatic bed, complete or intermittent ADT, or observation; for BCR after RT, salvage RP, cryotherapy, complete or intermittent ADT, brachytherapy, high-intensity focused ultrasound (HIFU), or observation can be considered. Many patient- and cancer-specific factors need to be taken into account when deciding on the best strategy, and optimal management depends on the involvement of a multidisciplinary team, consultation with the patient themselves, and the adoption of an individualised approach. Improvements in imaging techniques may enable earlier detection of metastases, which will hopefully refine future management decisions

    Long-term thermal sensitivity of Earth’s tropical forests

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    The sensitivity of tropical forest carbon to climate is a key uncertainty in predicting global climate change. Although short-term drying and warming are known to affect forests, it is unknown if such effects translate into long-term responses. Here, we analyze 590 permanent plots measured across the tropics to derive the equilibrium climate controls on forest carbon. Maximum temperature is the most important predictor of aboveground biomass (‚ąí9.1 megagrams of carbon per hectare per degree Celsius), primarily by reducing woody productivity, and has a greater impact per ¬įC in the hottest forests (>32.2¬įC). Our results nevertheless reveal greater thermal resilience than observations of short-term variation imply. To realize the long-term climate adaptation potential of tropical forests requires both protecting them and stabilizing Earth‚Äôs climate

    Pervasive gaps in Amazonian ecological research

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    Pervasive gaps in Amazonian ecological research

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    Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5‚Äď7 vast areas of the tropics remain understudied.8‚Äď11 In the American tropics, Amazonia stands out as the world‚Äôs most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13‚Äď15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon‚Äôs biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region‚Äôs vulnerability to environmental change. 15%‚Äď18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

    Pervasive gaps in Amazonian ecological research

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    Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%‚Äď18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

    Taking the pulse of Earth's tropical forests using networks of highly distributed plots

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    Tropical forests are the most diverse and productive ecosystems on Earth. While better understanding of these forests is critical for our collective future, until quite recently efforts to measure and monitor them have been largely disconnected. Networking is essential to discover the answers to questions that transcend borders and the horizons of funding agencies. Here we show how a global community is responding to the challenges of tropical ecosystem research with diverse teams measuring forests tree-by-tree in thousands of long-term plots. We review the major scientific discoveries of this work and show how this process is changing tropical forest science. Our core approach involves linking long-term grassroots initiatives with standardized protocols and data management to generate robust scaled-up results. By connecting tropical researchers and elevating their status, our Social Research Network model recognises the key role of the data originator in scientific discovery. Conceived in 1999 with RAINFOR (South America), our permanent plot networks have been adapted to Africa (AfriTRON) and Southeast Asia (T-FORCES) and widely emulated worldwide. Now these multiple initiatives are integrated via ForestPlots.net cyber-infrastructure, linking colleagues from 54 countries across 24 plot networks. Collectively these are transforming understanding of tropical forests and their biospheric role. Together we have discovered how, where and why forest carbon and biodiversity are responding to climate change, and how they feedback on it. This long-term pan-tropical collaboration has revealed a large long-term carbon sink and its trends, as well as making clear which drivers are most important, which forest processes are affected, where they are changing, what the lags are, and the likely future responses of tropical forests as the climate continues to change. By leveraging a remarkably old technology, plot networks are sparking a very modern revolution in tropical forest science. In the future, humanity can benefit greatly by nurturing the grassroots communities now collectively capable of generating unique, long-term understanding of Earth's most precious forests. Resumen Los bosques tropicales son los ecosistemas m√°s diversos y productivos del mundo y entender su funcionamiento es cr√≠tico para nuestro futuro colectivo. Sin embargo, hasta hace muy poco, los esfuerzos para medirlos y monitorearlos han estado muy desconectados. El trabajo en redes es esencial para descubrir las respuestas a preguntas que trascienden las fronteras y los plazos de las agencias de financiamiento. Aqu√≠ mostramos c√≥mo una comunidad global est√° respondiendo a los desaf√≠os de la investigaci√≥n en ecosistemas tropicales a trav√©s de diversos equipos realizando mediciones √°rbol por √°rbol en miles de parcelas permanentes de largo plazo. Revisamos los descubrimientos m√°s importantes de este trabajo y discutimos c√≥mo este proceso est√° cambiando la ciencia relacionada a los bosques tropicales. El enfoque central de nuestro esfuerzo implica la conexi√≥n de iniciativas locales de largo plazo con protocolos estandarizados y manejo de datos para producir resultados que se puedan trasladar a m√ļltiples escalas. Conectando investigadores tropicales, elevando su posici√≥n y estatus, nuestro modelo de Red Social de Investigaci√≥n reconoce el rol fundamental que tienen, para el descubrimiento cient√≠fico, quienes generan o producen los datos. Concebida en 1999 con RAINFOR (Suram√©rica), nuestras redes de parcelas permanentes han sido adaptadas en √Āfrica (AfriTRON) y el sureste asi√°tico (T-FORCES) y ampliamente replicadas en el mundo. Actualmente todas estas iniciativas est√°n integradas a trav√©s de la ciber-infraestructura de ForestPlots.net, conectando colegas de 54 pa√≠ses en 24 redes diferentes de parcelas. Colectivamente, estas redes est√°n transformando nuestro conocimiento sobre los bosques tropicales y el rol de √©stos en la bi√≥sfera. Juntos hemos descubierto c√≥mo, d√≥nde y porqu√© el carbono y la biodiversidad de los bosques tropicales est√° respondiendo al cambio clim√°tico y c√≥mo se retroalimentan. Esta colaboraci√≥n pan-tropical de largo plazo ha expuesto un gran sumidero de carbono y sus tendencias, mostrando claramente cu√°les son los factores m√°s importantes, qu√© procesos se ven afectados, d√≥nde ocurren los cambios, los tiempos de reacci√≥n y las probables respuestas futuras mientras el clima contin√ļa cambiando. Apalancando lo que realmente es una tecnolog√≠a antigua, las redes de parcelas est√°n generando una verdadera y moderna revoluci√≥n en la ciencia tropical. En el futuro, la humanidad puede beneficiarse enormemente si se nutren y cultivan comunidades de investigadores de base, actualmente con la capacidad de generar informaci√≥n √ļnica y de largo plazo para entender los que probablemente son los bosques m√°s preciados de la tierra. Resumo Florestas tropicais s√£o os ecossistemas mais diversos e produtivos da Terra. Embora uma boa compreens√£o destas florestas seja crucial para o nosso futuro coletivo, at√© muito recentemente os esfor√ßos de medi√ß√Ķes e monitoramento foram amplamente desconexos. √Č essencial formarmos redes para obtermos respostas que transcendem fronteiras e horizontes de ag√™ncias financiadoras. Neste estudo n√≥s mostramos como uma comunidade global est√° respondendo aos desafios da pesquisa de ecossistemas tropicais, com equipes diversas medindo florestas, √°rvore por √°rvore, em milhares de parcelas monitoradas √† longo prazo. N√≥s revisamos as maiores descobertas cient√≠ficas deste trabalho, e mostramos tamb√©m como este processo est√° mudando a ci√™ncia de florestas tropicais. Nossa abordagem principal envolve unir iniciativas de base a protocolos padronizados e gerenciamento de dados a fim de gerar resultados robustos em escalas ampliadas. Ao conectar pesquisadores tropicais e elevar seus status, nosso modelo de Rede de Pesquisa Social reconhece o papel-chave do produtor dos dados na descoberta cient√≠fica. Concebida em 1999 com o RAINFOR (Am√©rica do Sul), nossa rede de parcelas permanentes foi adaptada para √Āfrica (AfriTRON) e Sudeste asi√°tico (T-FORCES), e tem sido extensamente reproduzida em todo o mundo. Agora estas m√ļltiplas iniciativas est√£o integradas atrav√©s de uma infraestrutura cibern√©tica do ForestPlots.net, conectando colegas de 54 pa√≠ses de 24 redes de parcelas. Estas iniciativas est√£o transformando coletivamente o entendimento das florestas tropicais e seus pap√©is na biosfera. Juntos n√≥s descobrimos como, onde e por que o carbono e a biodiversidade da floresta est√£o respondendo √†s mudan√ßas clim√°ticas, e seus efeitos de retroalimenta√ß√£o. Esta duradoura colabora√ß√£o pantropical revelou um grande sumidouro de carbono persistente e suas tend√™ncias, assim como tem evidenciado quais direcionadores s√£o mais importantes, quais processos florestais s√£o mais afetados, onde eles est√£o mudando, seus atrasos no tempo de resposta, e as prov√°veis respostas das florestas tropicais conforme o clima continua a mudar. Dessa forma, aproveitando uma not√°vel tecnologia antiga, redes de parcelas acendem fa√≠scas de uma moderna revolu√ß√£o na ci√™ncia das florestas tropicais. No futuro a humanidade pode se beneficiar incentivando estas comunidades basais que agora s√£o coletivamente capazes de gerar conhecimentos √ļnicos e duradouros sobre as florestas mais preciosas da Terra. R√©sume Les for√™ts tropicales sont les √©cosyst√®mes les plus diversifi√©s et les plus productifs de la plan√®te. Si une meilleure compr√©hension de ces for√™ts est essentielle pour notre avenir collectif, jusqu'√† tout r√©cemment, les efforts d√©ploy√©s pour les mesurer et les surveiller ont √©t√© largement d√©connect√©s. La mise en r√©seau est essentielle pour d√©couvrir les r√©ponses √† des questions qui d√©passent les fronti√®res et les horizons des organismes de financement. Nous montrons ici comment une communaut√© mondiale rel√®ve les d√©fis de la recherche sur les √©cosyst√®mes tropicaux avec diverses √©quipes qui mesurent les for√™ts arbre apr√®s arbre dans de milliers de parcelles permanentes. Nous passons en revue les principales d√©couvertes scientifiques de ces travaux et montrons comment ce processus modifie la science des for√™ts tropicales. Notre approche principale consiste √† relier les initiatives de base √† long terme √† des protocoles standardis√©s et une gestion de donn√©es afin de g√©n√©rer des r√©sultats solides √† grande √©chelle. En reliant les chercheurs tropicaux et en √©levant leur statut, notre mod√®le de r√©seau de recherche sociale reconna√ģt le r√īle cl√© de l'auteur des donn√©es dans la d√©couverte scientifique. Con√ßus en 1999 avec RAINFOR (Am√©rique du Sud), nos r√©seaux de parcelles permanentes ont √©t√© adapt√©s √† l'Afrique (AfriTRON) et √† l'Asie du Sud-Est (T-FORCES) et largement imit√©s dans le monde entier. Ces multiples initiatives sont d√©sormais int√©gr√©es via l'infrastructure ForestPlots.net, qui relie des coll√®gues de 54 pays √† travers 24 r√©seaux de parcelles. Ensemble, elles transforment la compr√©hension des for√™ts tropicales et de leur r√īle biosph√©rique. Ensemble, nous avons d√©couvert comment, o√Ļ et pourquoi le carbone forestier et la biodiversit√© r√©agissent au changement climatique, et comment ils y r√©agissent. Cette collaboration pan-tropicale √† long terme a r√©v√©l√© un important puits de carbone √† long terme et ses tendances, tout en mettant en √©vidence les facteurs les plus importants, les processus forestiers qui sont affect√©s, les endroits o√Ļ ils changent, les d√©calages et les r√©actions futures probables des for√™ts tropicales √† mesure que le climat continue de changer. En tirant parti d'une technologie remarquablement ancienne, les r√©seaux de parcelles d√©clenchent une r√©volution tr√®s moderne dans la science des for√™ts tropicales. √Ä l'avenir, l'humanit√© pourra grandement b√©n√©ficier du soutien des communaut√©s de base qui sont maintenant collectivement capables de g√©n√©rer une compr√©hension unique et √† long terme des for√™ts les plus pr√©cieuses de la Terre. Abstrak Hutan tropika adalah di antara ekosistem yang paling produktif dan mempunyai kepelbagaian biodiversiti yang tinggi di seluruh dunia. Walaupun pemahaman mengenai hutan tropika amat penting untuk masa depan kita, usaha-usaha untuk mengkaji dan mengawas hutah-hutan tersebut baru sekarang menjadi lebih diperhubungkan. Perangkaian adalah sangat penting untuk mencari jawapan kepada soalan-soalan yang menjangkaui sempadan dan batasan agensi pendanaan. Di sini kami menunjukkan bagaimana sebuah komuniti global bertindak balas terhadap cabaran penyelidikan ekosistem tropika melalui penglibatan pelbagai kumpulan yang mengukur hutan secara pokok demi pokok dalam beribu-ribu plot jangka panjang. Kami meninjau semula penemuan saintifik utama daripada kerja ini dan menunjukkan bagaimana proses ini sedang mengubah bidang sains hutan tropika. Teras pendekatan kami memberi tumpuan terhadap penghubungan inisiatif akar umbi jangka panjang dengan protokol standar serta pengurusan data untuk mendapatkan hasil skala besar yang kukuh. Dengan menghubungkan penyelidik-penyelidik tropika dan meningkatkan status mereka, model Rangkaian Penyelidikan Sosial kami mengiktiraf kepentingan peranan pengasas data dalam penemuan saintifik. Bermula dengan pengasasan RAINFOR (Amerika Selatan) pada tahun 1999, rangkaian-rangkaian plot kekal kami kemudian disesuaikan untuk Afrika (AfriTRON) dan Asia Tenggara (T-FORCES) dan selanjutnya telah banyak dicontohi di seluruh dunia. Kini, inisiatif-inisiatif tersebut disepadukan melalui infrastruktur siber ForestPlots.net yang menghubungkan rakan sekerja dari 54 negara di 24 buah rangkaian plot. Secara kolektif, rangkaian ini sedang mengubah pemahaman tentang hutan tropika dan peranannya dalam biosfera. Kami telah bekerjasama untuk menemukan bagaimana, di mana dan mengapa karbon serta biodiversiti hutan bertindak balas terhadap perubahan iklim dan juga bagaimana mereka saling bermaklum balas. Kolaborasi pan-tropika jangka panjang ini telah mendedahkan sebuah sinki karbon jangka panjang serta arah alirannya dan juga menjelaskan pemandu-pemandu perubahan yang terpenting, di mana dan bagaimana proses hutan terjejas, masa susul yang ada dan kemungkinan tindakbalas hutan tropika pada perubahan iklim secara berterusan di masa depan. Dengan memanfaatkan pendekatan lama, rangkaian plot sedang menyalakan revolusi yang amat moden dalam sains hutan tropika. Pada masa akan datang, manusia sejagat akan banyak mendapat manfaat jika memupuk komuniti-komuniti akar umbi yang kini berkemampuan secara kolektif menghasilkan pemahaman unik dan jangka panjang mengenai hutan-hutan yang paling berharga di dunia

    Dysfunctional voiding

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    Purpose of review Female dysfunctional voiding (FDV) is an intermittent and/or fluctuating flow rate due to involuntary intermittent contractions of the periurethral striated or levator muscles during voiding in neurologically normal women. Despite its codified definition, because of variable causes, there is a lack of established diagnostic criteria and management. The aim of this study is to give a comprehensive, brief review of the most recent progress in the diagnosis and management of FDV. Recent findings Currently, there is the need to shed light on several issues in FDV, such as the use of standardized definitions, diagnostic criteria, and treatment modalities. The evaluation of the progress on these matters within 2013 helped to define some key advances in the field of female functional voiding dysfunction and urinary retention. Summary In 2013, many diagnostic and therapeutic questions in female voiding dysfunction remain unsolved. However, some data began to emerge. Patients with FDV did not demonstrate a difference in effortful control (effortful control is the ability to regulate one's responses to external stimuli), but did demonstrate a higher rate of surgency (surgency is a trait aspect of emotional reactivity in which a person tends towards high levels of positive affect). Toilet training method in childhood does not seem to have any long-term correlation with FDV. Training with pelvic floor physiotherapy and biofeedback still represents the first-line treatment for FDV. In the management of other causes of female voiding dysfunction, sacral neuromodulation demonstrated a satisfying long-term efficacy in the treatment of nonobstructive urinary retention
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