Gluteal Hidradenitis Suppurativa: Analysis of 83 Patients.

BACKGROUND: In 2013, Canoui-Poitrine et al. identified three hidradenitis suppurativa (HS) phenotypes by a latent class (LC) analysis, based on anatomical sites of involvement. OBJECTIVE: To improve the classification of the gluteal phenotype (LC3) patients given their diverse lesion types and differences in clinical profile. MATERIAL AND METHODS: We designed a bicentric study gathering all LC3 patients (n=83) from two hospitals. We conducted a two-step cluster analysis among them and also compared their characteristics with the rest of the HS patients (n=661). RESULTS: Compared with global HS series, LC3 patients were more frequently non-obese men, with smoking habit, an associated arthropathy, and a more frequent history of pilonidal sinus. The analysis of LC3 patients yielded two clusters: cluster 1 (38.3%) included elderly female patients, with later diagnosis of the disease and more sinus tracts; cluster 2 (61.7%) encompassed more men with earlier disease onset and more nodules and folliculitis lesions. LIMITATIONS: The study's limitations include its retrospective nature, bicentric design, and small sample size. CONCLUSION: The heterogeneous clinical presentation of HS makes it essential to have a good classification of the patients. Gluteal phenotype could actually be classified into two "subphenotypes" with a different clinical profiles and management.

Gluteal Hidradenitis Suppurativa: Analysis of 83 Patients. / [Artículo traducido] Hidradenitis supurativa con afectación glútea: análisis de 83 pacientes.

BACKGROUND: In 2013, Canoui-Poitrine et al. identified three hidradenitis suppurativa (HS) phenotypes by a latent class (LC) analysis, based on anatomical sites of involvement. OBJECTIVE: To improve the classification of the gluteal phenotype (LC3) patients given their diverse lesion types and differences in clinical profile. MATERIAL AND METHODS: We designed a bicentric study gathering all LC3 patients (n=83) from two hospitals. We conducted a two-step cluster analysis among them and also compared their characteristics with the rest of the HS patients (n=661). RESULTS: Compared with global HS series, LC3 patients were more frequently non-obese men, with smoking habit, an associated arthropathy, and a more frequent history of pilonidal sinus. The analysis of LC3 patients yielded two clusters: cluster 1 (38.3%) included elderly female patients, with later diagnosis of the disease and more sinus tracts; cluster 2 (61.7%) encompassed more men with earlier disease onset and more nodules and folliculitis lesions. LIMITATIONS: The study's limitations include its retrospective nature, bicentric design, and small sample size. CONCLUSION: The heterogeneous clinical presentation of HS makes it essential to have a good classification of the patients. Gluteal phenotype could actually be classified into two "subphenotypes" with a different clinical profiles and management.

Introducing a common taxonomy to support learning from failure in conservation.

Although some sectors have made significant progress in learning from failure, there is currently limited consensus on how a similar transition could best be achieved in conservation and what is required to facilitate this. One of the key enabling conditions for other sectors is a widely accepted and standardized classification system for identifying and analyzing root causes of failure. We devised a comprehensive taxonomy of root causes of failure affecting conservation projects. To develop this, we solicited examples of real-life conservation efforts that were deemed to have failed in some way, identified their underlying root causes of failure, and used these to develop a generic, 3-tier taxonomy of the ways in which projects fail, at the top of which are 6 overarching cause categories that are further divided into midlevel cause categories and specific root causes. We tested the taxonomy by asking conservation practitioners to use it to classify the causes of failure for conservation efforts they had been involved in. No significant gaps or redundancies were identified during this testing phase. We then analyzed the frequency that particular root causes were encountered by projects within this test sample, which suggested that some root causes were more likely to be encountered than others and that a small number of root causes were more likely to be encountered by projects implementing particular types of conservation action. Our taxonomy could be used to improve identification, analysis, and subsequent learning from failed conservation efforts, address some of the barriers that currently limit the ability of conservation practitioners to learn from failure, and contribute to establishing an effective culture of learning from failure within conservation.

Introducción de una taxonomía común como apoyo al aprendizaje a partir del fracaso en la conservación Resumen Mientras que algunos sectores han progresado significativamente en el aprendizaje a partir del fracaso, actualmente hay un consenso limitado sobre cómo podría lograrse una transición similar en la conservación y qué se requiere para facilitarla. Una de las condiciones habilitantes más importantes en otros sectores es un sistema de clasificación estandarizado y aceptado por la mayoría para la identificación y análisis de las causas fundamentales del fracaso. Diseñamos una taxonomía completa de las causas fundamentales del fracaso que afecta a los proyectos de conservación. Para desarrollarla, solicitamos ejemplos de esfuerzos de conservación reales que de alguna manera se consideraron como fracasos, identificamos las causas fundamentales no aparentes de su fracaso y luego las usamos para desarrollar una taxonomía genérica de tres niveles de las maneras en las que fracasan los proyectos, en cuyo nivel superior están seis categorías de causas generales que después se dividen en categorías de nivel medio de categorías de causas y causas fundamentales específicas. Pusimos a prueba la taxonomía al pedirle a los practicantes de la conservación que la usaran para clasificar las causas del fracaso de los esfuerzos de conservación en los que han participado. No identificamos vacíos o redundancias importantes durante esta fase de prueba. Después, analizamos la frecuencia con la que los proyectos de esta muestra se enfrentaron a causas fundamentales particulares, lo que sugirió que algunas causas fundamentales tienen mayor probabilidad de ocurrir y que un número reducido de causas fundamentales tiene mayor probabilidad de ocurrir en proyectos que implementan ciertos tipos de acciones de conservación. Nuestra taxonomía podría usarse para mejorar el análisis, identificación y aprendizaje subsecuente a partir del fracaso de los esfuerzos de conservación; tratar algunas de las barreras que en la actualidad limitan a los practicantes de la conservación a aprender del fracaso; y contribuir al establecimiento de una cultura efectiva del aprendizaje a partir del fracaso dentro de la conservación.

Catalyzing success in community-based conservation.

Efforts to devolve rights and engage Indigenous Peoples and local communities in conservation have increased the demand for evidence of the efficacy of community-based conservation (CBC) and insights into what enables its success. We examined the human well-being and environmental outcomes of a diverse set of 128 CBC projects. Over 80% of CBC projects had some positive human well-being or environmental outcomes, although just 32% achieved positive outcomes for both (i.e., combined success). We coded 57 total national-, community-, and project-level variables and controls from this set, performed random forest classification to identify the variables most important to combined success, and calculated accumulated local effects to describe their individual influence on the probability of achieving it. The best predictors of combined success were 17 variables suggestive of various recommendations and opportunities for conservation practitioners related to national contexts, community characteristics, and the implementation of various strategies and interventions informed by existing CBC frameworks. Specifically, CBC projects had higher probabilities of combined success when they occurred in national contexts supportive of local governance, confronted challenges to collective action, promoted economic diversification, and invested in various capacity-building efforts. Our results provide important insights into how to encourage greater success in CBC.

Los esfuerzos por transferirle derechos e involucrar a los pueblos originarios y a las comunidades locales en la conservación han incrementado la demanda de evidencia sobre la eficiencia de la conservación basada en la comunidad (CBC) y de conocimiento sobre lo que posibilita su éxito. Analizamos los resultados ambientales y de bienestar humano en un conjunto diverso de 28 proyectos de CBC. Más del 80% de estos proyectos tuvieron resultados positivos para el ambiente o el bienestar humano, aunque sólo el 32% logró resultados positivos para ambos (es decir, éxito combinado). Codificamos en total 57 variables y controles a nivel nacional, comunitario y de proyecto en este conjunto, aplicamos una clasificación aleatoria de bosque para identificar las variables más importantes para el éxito combinado y calculamos los efectos locales acumulados para describir su influencia sobre la probabilidad de alcanzar el éxito combinado. Los mejores pronósticos del éxito combinado se obtuvieron con 17 variables sugerentes de varias políticas y oportunidades para los practicantes de la conservación relacionadas con los contextos nacionales, las características de la comunidad y la implementación de varias estrategias e intervenciones guiadas por los marcos existentes de CBC. Específicamente, los proyectos de CBC tuvieron mayor probabilidad de tener éxito combinado cuando se dieron dentro de contextos nacionales que respaldan la gobernanza local, enfrentan los retos de la acción colectiva, promueven la diversificación económica e invierten en varios esfuerzos por construir capacidades. Nuestros resultados proporcionan información importante sobre cómo alentar un mayor éxito en la CBC.

Nonvenereal Infections in Spanish Dermatology Clinics: Results of the DIADERM Study. / Enfermedades infecciosas no venéreas atendidas en consultas de Dermatología en España: resultados del estudio DIADERM.

BACKGROUND AND OBJECTIVE: The burden of nonvenereal infections in Spanish dermatology practice has not yet been evaluated. The aim of this study was to analyze the overall weight of these infections in outpatient dermatology caseloads. MATERIAL AND METHODS: Observational cross-sectional study of diagnoses made by a random selection of dermatologists from the Spanish Association of Dermatology and Venereology (AEDV) working in outpatient dermatology clinics. The data were obtained through the anonymous DIADERM survey. Diagnoses of infectious diseases were selected using codes from the International Classification of Diseases, Tenth Revision. After excluding sexually transmitted infections, the diagnoses were classified into 22 groups. RESULTS: Spanish dermatologists diagnosed an estimated 16190 (95% CI, 9338-23042) nonvenereal infections on average per week, a figure that accounted for 9.33% of the dermatology caseload. The most common diagnostic groups were nonanogenital viral warts (7475 diagnoses, 46.17% of nonvenereal infections), dermatophytosis (3336, 20.61%), and other viral infections (1592, 9.84%), which included Molluscum contagiosum infections. Nonvenereal infections were more common than noninfectious dermatologic conditions in private clinics (P<.0020) and adults (P<.00001). Patients with these infections were also more likely to be discharged than those with other conditions in both public (P<.0004) and private (P<.0002) practices. CONCLUSIONS: Nonvenereal infections are frequent in dermatology. They are the third most common reason for outpatient visits, behind actinic keratosis and nonmelanoma skin cancer. By enhancing the participation of dermatologists in the management of skin infections and encouraging interactions with other specialists, we will be able to carve out a niche in an area we have scarcely ventured into to date.

What Proportion of the Spanish Dermatology Caseload Corresponds to Pediatric Dermatoses? Results From the DIADERM National Random Sampling Survey. / ¿Cuánta carga asistencial suponen las dermatosis pediátricas en la actividad ambulatoria en la dermatología española? Resultados del muestreo aleatorio nacional DIADERM.

BACKGROUND: Visits for skin conditions are very common in pediatric primary care, and many of the patients seen in outpatient dermatology clinics are children or adolescents. Little, however, has been published about the true prevalence of these visits or about their characteristics. MATERIAL AND METHODS: Observational cross-sectional study of diagnoses made in outpatient dermatology clinics during 2 data-collection periods in the anonymous DIADERM National Random Survey of dermatologists across Spain. All entries with an International Classification of Diseases, Tenth Revision code related to dermatology in the 2 periods (84 diagnoses) were collected for patients younger than 18 years and classified into 14 categories to facilitate analysis and comparison. RESULTS: In total, the search found 20 097 diagnoses made in patients younger than 18 years (12% of all coded diagnoses in the DIADERM database). Viral infections, acne, and atopic dermatitis were the most common, accounting for 43.9% of all diagnoses. No significant differences were observed in the proportions of diagnoses in the respective caseloads of specialist vs. general dermatology clinics or public vs. private clinics. Seasonal differences in diagnoses (January vs. May) were also nonsignificant. CONCLUSIONS: Pediatric care accounts for a significant proportion of the dermatologist's caseload in Spain. Our findings are useful for identifying opportunities for improving communication and training in pediatric primary care and for designing training focused on the optimal treatment of acne and pigmented lesions (with instruction on basic dermoscopy use) in these settings.

Translating habitat class to land cover to map area of habitat of terrestrial vertebrates.

Area of habitat (AOH) is defined as the "habitat available to a species, that is, habitat within its range" and is calculated by subtracting areas of unsuitable land cover and elevation from the range. The International Union for the Conservation of Nature (IUCN) Habitats Classification Scheme provides information on species habitat associations, and typically unvalidated expert opinion is used to match habitat to land-cover classes, which generates a source of uncertainty in AOH maps. We developed a data-driven method to translate IUCN habitat classes to land cover based on point locality data for 6986 species of terrestrial mammals, birds, amphibians, and reptiles. We extracted the land-cover class at each point locality and matched it to the IUCN habitat class or classes assigned to each species occurring there. Then, we modeled each land-cover class as a function of IUCN habitat with (SSG, using) logistic regression models. The resulting odds ratios were used to assess the strength of the association between each habitat and land-cover class. We then compared the performance of our data-driven model with those from a published translation table based on expert knowledge. We calculated the association between habitat classes and land-cover classes as a continuous variable, but to map AOH as binary presence or absence, it was necessary to apply a threshold of association. This threshold can be chosen by the user according to the required balance between omission and commission errors. Some habitats (e.g., forest and desert) were assigned to land-cover classes with more confidence than others (e.g., wetlands and artificial). The data-driven translation model and expert knowledge performed equally well, but the model provided greater standardization, objectivity, and repeatability. Furthermore, our approach allowed greater flexibility in the use of the results and uncertainty to be quantified. Our model can be modified for regional examinations and different taxonomic groups.

Conversión de la Categoría de Hábitat a Cobertura de Terreno para Mapear el Área de Hábitat de los Vertebrados Terrestres Resumen El área del hábitat (AOH) está definida como "el hábitat disponible para una especie, es decir, el hábitat dentro del área de distribución de la especie" y se calcula mediante la sustracción de las áreas de terreno inadecuado y la elevación del área de distribución. El Esquema de Clasificación de Hábitats de la Unión Internacional para la Conservación de la Naturaleza proporciona información sobre las asociaciones entre los hábitats de las especies y con frecuencia se utilizan las opiniones no validadas de expertos para cotejar el hábitat con los tipos de cobertura de terreno, lo que genera una fuente de incertidumbre en los mapas de AOH. Desarrollamos un método orientado por datos para convertir las categorías de hábitat que maneja la UICN en cobertura de terreno basado en los datos de localidad puntual de 6,986 especies de mamíferos terrestres, aves, anfibios y reptiles. Extrajimos la categoría de cobertura de terreno en cada localidad puntual y la cotejamos con la categoría o categorías de hábitat de UICN asignada a cada especie incidente en la localidad. Después modelamos cada categoría de cobertura de terreno como función del hábitat según la UICN usando modelos de regresión logística. Las proporciones de probabilidad resultantes fueron usadas para evaluar la solidez de la asociación entre cada categoría de hábitat y de cobertura de terreno. Después comparamos el desempeño de nuestro modelo orientado por datos con el desempeño de una tabla de conversión publicada basada en el conocimiento de expertos. Calculamos la asociación entre las categorías de hábitat y las de cobertura de terreno como una variable continua, pero para mapear el AOH como una presencia o ausencia binaria, fue necesario aplicar un umbral de asociación. Este umbral puede ser elegido por el usuario de acuerdo con el balance requerido entre los errores de omisión y comisión. Algunos hábitats (p. ej.: bosques y desiertos) fueron asignados a las categorías de cobertura de terreno con más confianza que otros (p. ej.: humedales y artificiales). El modelo de conversión orientado por los datos y el conocimiento de los expertos tuvieron un desempeño igual de eficiente, pero el modelo proporcionó una mayor estandarización, objetividad y repetitividad. Además, nuestra estrategia permitió una mayor flexibilidad en el uso de los resultados y de la incertidumbre para ser cuantificados. Nuestro modelo puede modificarse para análisis regionales y para diferentes grupos taxonómicos.

What Proportion of the Spanish Dermatology Caseload Corresponds to Primarily Sexually Transmitted Infections and Other Anogenital Dermatoses? Results From the DIADERM National Random Survey. / ¿Cuánta carga asistencial suponen las infecciones de transmisión predominantemente sexual y otras dermatosis anogenitales en las consultas de Dermatología en España? Resultados del muestreo aleatorio nacional DIADERM.

BACKGROUND AND OBJECTIVE: Predominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system. MATERIAL AND METHODS: Observational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups. RESULTS: Only 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians. CONCLUSIONS: STIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made.

Automated detection of frog calls and choruses by pulse repetition rate.

Anurans (frogs and toads) are among the most globally threatened taxonomic groups. Successful conservation of anurans will rely on improved data on the status and changes in local populations, particularly for rare and threatened species. Automated sensors, such as acoustic recorders, have the potential to provide such data by massively increasing the spatial and temporal scale of population sampling efforts. Analyzing such data sets will require robust and efficient tools that can automatically identify the presence of a species in audio recordings. Like bats and birds, many anuran species produce distinct vocalizations that can be captured by autonomous acoustic recorders and represent excellent candidates for automated recognition. However, in contrast to birds and bats, effective automated acoustic recognition tools for anurans are not yet widely available. An effective automated call-recognition method for anurans must be robust to the challenges of real-world field data and should not require extensive labeled data sets. We devised a vocalization identification tool that classifies anuran vocalizations in audio recordings based on their periodic structure: the repeat interval-based bioacoustic identification tool (RIBBIT). We applied RIBBIT to field recordings to study the boreal chorus frog (Pseudacris maculata) of temperate North American grasslands and the critically endangered variable harlequin frog (Atelopus varius) of tropical Central American rainforests. The tool accurately identified boreal chorus frogs, even when they vocalized in heavily overlapping choruses and identified variable harlequin frog vocalizations at a field site where it had been very rarely encountered in visual surveys. Using a few simple parameters, RIBBIT can detect any vocalization with a periodic structure, including those of many anurans, insects, birds, and mammals. We provide open-source implementations of RIBBIT in Python and R to support its use for other taxa and communities.

Los anuros (ranas y sapos) se encuentran dentro de los grupos taxonómicos más amenazados a nivel mundial. La conservación exitosa de los anuros dependerá de información mejorada sobre el estado y los cambios en las poblaciones locales, particularmente para las especies raras y amenazadas. Los sensores automatizados, como las grabadoras acústicas, tienen el potencial para proporcionar dicha información al incrementar masivamente la escala espacial y temporal de los esfuerzos de muestreo poblacional. El análisis de dicha información requerirá herramientas robustas y eficientes que puedan identificar automáticamente la presencia de una especie en las grabaciones de audio. Como las aves y los murciélagos, muchas especies de anuros producen vocalizaciones distintivas que pueden ser capturadas por las grabadoras acústicas autónomas y también son excelentes candidatas para el reconocimiento automatizado. Sin embargo, a diferencia de las aves y los murciélagos, todavía no se cuenta con una disponibilidad extensa de herramientas para el reconocimiento acústico automatizado de los anuros. Un método efectivo para el reconocimiento automatizado del canto de los anuros debe ser firme ante los retos de los datos reales de campo y no debería requerir conjuntos extensos de datos etiquetados. Diseñamos una herramienta de identificación de las vocalizaciones: la herramienta de identificación bioacústica basada en el intervalo de repetición (RIBBIT), el cual clasifica las vocalizaciones de los anuros en las grabaciones de audio con base en su estructura periódica. Aplicamos la RIBBIT a las grabaciones de campo para estudiar a dos especies: la rana coral boreal (Pseudacris maculata) de los pastizales templados de América del Norte y la rana arlequín variable (Atelopus varius), críticamente en peligro de extinción, de las selvas tropicales de América Central. Mostramos que RIBBIT puede identificar correctamente a las ranas corales boreales, incluso cuando vocalizan en coros con mucha superposición, y puede identificar las vocalizaciones de la rana arlequín variable en un sitio de campo en donde rara vez se le ha visto durante censos visuales. Mediante relativamente unos cuantos parámetros simples, RIBBIT puede detectar cualquier vocalización con una estructura periódica, incluyendo aquellas de muchos anuros, insectos, aves y mamíferos. Proporcionamos implementaciones de fuente abierta de RIBBIT en Python y en R para fomentar su uso para otros taxones y comunidades.

Loss and vulnerability of lowland forests in mainland Southeast Asia.

Despite containing extraordinary levels of biodiversity, lowland (<200 m asl) tropical forests are extremely threatened globally. Southeast Asia is an area of high species richness and endemicity under considerable anthropogenic threat with, unfortunately, scant focus on its lowland forests. We estimated extent of lowland forest loss from 1998 to 2018, including inside protected areas and determined the vulnerability of this remaining forest. Maximum likelihood classification techniques were used to classify Landsat images to estimate lowland forest cover in 1998 and 2018. We used Bayesian belief networks with 20 variables to evaluate vulnerability of the forest that remained in 2018. Analyses were conducted at two spatial scales: landscape patch (analogous to ecoregion) and country level. Over 20 years, >120,000 km2 of forest (50% of forest present in 1998) was lost. Of the 14 lowland forest patches, 6 lost >50% of their area. At the country scale, Cambodia had the greatest deforestation (>47,500 km2 ). In 2018, 18% of the lowlands were forested, and 20% of these forests had some formal protection. Approximately 50% of the lowland forest inside protected areas (c. 11,000 km2 ) was also lost during the study period. Most lowland forest remaining is highly vulnerable; eight landscape patches had >50% categorized as such. Our results add to a growing body of evidence that the presence of protected areas alone will not prevent further deforestation. We suggest that more collaborative conservation strategies with local communities that accommodate conservation concessions specifically for lowland forests are urgently needed to prevent further destruction of these valuable habitats.

Pérdida y Vulnerabilidad de los Bosques de Tierras Bajas en la Parte Continental del Sudeste Asiático Resumen A pesar de que contienen niveles extraordinarios de biodiversidad, los bosques tropicales de tierras bajas (<200 m snm) se encuentran bajo amenazas extremas en todo el mundo. El sudeste de Asia es un área con una riqueza alta de especies y endemismos bajo amenazas antropogénicas considerables, desafortunadamente, con un enfoque exiguo sobre sus bosques de tierras bajas. Estimamos la extensión de la pérdida de bosques de tierras bajas desde 1998 hasta 2018, incluyendo aquellos bosques que se encuentran dentro de áreas protegidas, y determinamos la vulnerabilidad del bosque que permanece. Usamos técnicas de clasificación de la probabilidad máxima para clasificar imágenes Landsat y así estimar la cobertura de bosque de tierras bajas en 1998 y 2018. Usamos redes de opinión bayesiana con 20 variables para evaluar la vulnerabilidad del bosque que permanecía en pie en 2018. Los análisis fueron realizados a dos escalas espaciales: a nivel de fragmento de paisaje (análogo a la ecorregión) y a nivel de país. A lo largo de 20 años, se perdieron >120,000 km2 de bosque (50% del bosque presente en 1998). De los 14 fragmentos de bosque de tierras bajas, seis perdieron >50% de su área. A la escala de país, Camboya tuvo la mayor deforestación (>47,500 km2 ). En 2018, el 18% de las tierras bajas contaban con bosque y el 20% de estos bosques tenían algún tipo de protección formal. Aproximadamente el 50% del bosque de tierras bajas que se encuentra dentro de áreas protegidas (aprox. 11,000 km2 ) también se perdió durante el periodo de estudio. La mayoría del bosque de tierras bajas que todavía permanece tiene una vulnerabilidad muy alta; ocho de los fragmentos de paisaje tenían >50% categorizado de tal manera. Nuestros resultados se suman a un cuerpo creciente de evidencia de que la sola presencia de las áreas protegidas no va a prevenir una mayor deforestación. Sugerimos que se necesitan urgentemente más estrategias de conservación colaborativa con comunidades locales que acomoden las concesiones de conservación específicamente para los bosques de tierras bajas para prevenir una mayor destrucción de estos hábitats tan valiosos.

Ki-67 labelling index is related to the risk classification and prognosis of gastrointestinal stromal tumours: a retrospective study.

BACKGROUND AND AIMS: Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the digestive tract with malignant potential. The current risk classification standard is unable to accurately evaluate the invasiveness and clinical outcomes of GISTs. Ki-67 labelling index (LI) may be an effective indicator in assessing tumour invasiveness and prognosis, however, its exact value in GISTs is still uncertain. The aims of our study were to evaluate the correlation of the Ki-67 LI and clinicopathological features of GISTs and to assess the potential value of the Ki-67 LI in GISTs classification and prognosis. METHODS: The clinical, pathological and prognostic data were collected and analysed to identify the independent influential factors of GISTs risk stratification and the predictors of GISTs prognosis. RESULTS: The Ki-67 LI was significantly associated with the clinicopathological features of tumour progression (P<0.05). It was an independent influential factor of GISTs risk classification (odds ratio: 1.322; 95% confidence interval: 1.031-1.696) (P=0.028), and the area under the curve (AUC) value of the Ki-67 LI on the discrimination ability of GISTs risk stratification was 0.906 (P<0.001). The optimal cutoff value of the Ki-67 LI was 6% (sensitivity of 87.5% and specificity of 76.2%), and patients with Ki-67 LI≥6% exhibited significantly poorer progression-free survival (PFS) than those with Ki-67 LI<6% (P<0.001). The AUC value of the Ki-67 LI for predicting PFS in postoperative patients was 0.813 (P=0.03). CONCLUSIONS: The Ki-67 LI has appreciated value to predict the risk grade and prognosis of GISTs. Patients with Ki-67 LI≥6% are prone to recurrence and metastasis after operation and may need a close follow-up.

Applying science to pressing conservation needs for penguins.

More than half of the world's 18 penguin species are declining. We, the Steering Committee of the International Union for Conservation of Nature Species Survival Commission Penguin Specialist Group, determined that the penguin species in most critical need of conservation action are African penguin (Spheniscus demersus), Galápagos penguin (Spheniscus mendiculus), and Yellow-eyed penguin (Megadyptes antipodes). Due to small or rapidly declining populations, these species require immediate scientific collaboration and policy intervention. We also used a pairwise-ranking approach to prioritize research and conservation needs for all penguins. Among the 12 cross-taxa research areas we identified, we ranked quantifying population trends, estimating demographic rates, forecasting environmental patterns of change, and improving the knowledge of fisheries interactions as the highest priorities. The highest ranked conservation needs were to enhance marine spatial planning, improve stakeholder engagement, and develop disaster-management and species-specific action plans. We concurred that, to improve the translation of science into effective conservation for penguins, the scientific community and funding bodies must recognize the importance of and support long-term research; research on and conservation of penguins must expand its focus to include the nonbreeding season and juvenile stage; marine reserves must be designed at ecologically appropriate spatial and temporal scales; and communication between scientists and decision makers must be improved with the help of individual scientists and interdisciplinary working groups.

Aplicación de Ciencia en las Necesidades de Conservación Urgentes para los Pingüinos. Resumen Más de la mitad de las 18 especies de pingüinos del mundo están disminuyendo. Nosotros, el Comité Directivo de la Unión Internacional para la Conservación de la Naturaleza, Grupo de Especialistas en Pingüinos, determinamos que las especies de pingüinos con necesidades críticas de conservación son el pingüino africano (Spheniscus demersus), el pingüino de las Galápagos (Spheniscus mendiculus) y el pingüino de ojos amarillos (Megadyptes antipodes). Debido a que sus poblaciones son pequeñas o están declinando rápidamente, estos pingüinos requieren colaboración científica e intervención política inmediatas. También utilizamos un método de clasificación por pares para priorizar las necesidades de investigación y conservación para todas las especies de pingüinos. Entre las 12 áreas de investigación que identificamos, las más prioritarias fueron: cuantificación de las tendencias poblacionales, estimación de las tasas demográficas, predicción de las patrones de cambio ambiental y mejora del conocimiento de las interacciones con pesquerías. Las mayores necesidades de conservación fueron: optimizar la planificación marina espacial, mejorar la colaboración de las partes interesadas y desarrollar planes de manejo de desastres y de acción para cada especie. Coincidimos en que, para mejorar la traducción de la ciencia en la conservación efectiva de los pingüinos, la comunidad científica y los organismos financiadores deben reconocer la importancia de la investigación a largo plazo y apoyarla; la investigación sobre pingüinos y su conservación debe expandir su enfoque para incluir la época no reproductiva y la etapa juvenil; las reservas marinas deben ser diseñadas a escalas espaciotemporales ecológicamente apropiadas; y la comunicación entre científicos y tomadores de decisiones debe mejorar con la ayuda de científicos individuales y grupos de trabajo interdisciplinario.

Use of standardized methods to improve extinction-risk classification.

Standardized classification methods based on quantifiable risk metrics are critical for evaluating extinction threats because they increase objectivity, consistency, and transparency of listing decisions. Yet, in the United States, neither federal nor state agencies use standardized methods for listing species for legal protection, which could put listing decisions at odds with the magnitude of the risk. We used a recently developed set of quantitative risk metrics for California herpetofauna as a case study to highlight discrepancies in listing decisions made without standardized methods. We also combined such quantitative metrics with classification tree analysis to attempt to increase the transparency of previous listing decisions by identifying the criteria that had inherently been given the most weight. Federally listed herpetofauna in California scored significantly higher on the risk-metric spectrum than those not federally listed, whereas state-listed species did not score any higher than species that were not state listed. Based on classification trees, state endemism was the most important predictor of listing status at the state level and distribution trend (decline in a species' range size) and population trend (decline in a species' abundance at localized sites) were the most important predictors at the federal level. Our results emphasize the need for governing bodies to adopt standardized methods for assessing conservation risk that are based on quantitative criteria. Such methods allow decision makers to identify criteria inherently given the most weight in determining listing status, thus increasing the transparency of previous listing decisions, and produce an unbiased comparison of conservation threat across all species to promote consistency, efficiency, and effectiveness of the listing process.

Uso de Métodos Estandarizados para Mejorar la Clasificación del Riesgo de Extinción Resumen Los métodos estandarizados de clasificación basados en medidas cuantificables del riesgo de extinción son sumamente importantes para evaluar las amenazas de extinción ya que incrementan la objetividad, consistencia y transparencia de las decisiones de listado. Aún así, en los Estados Unidos, ni las agencias federales ni las estatales usan métodos estandarizados para enlistar a las especies para su protección legal, lo que podría poner en discrepancia a las decisiones de listado con la magnitud del riesgo. Usamos un conjunto de medidas cuantitativas del riesgo, desarrollado recientemente para la herpetofauna de California, como un estudio de caso que nos permitiera resaltar las discrepancias en las decisiones de listado hechas sin métodos estandarizados. También combinamos dichas medidas cuantitativas con un análisis de árbol de clasificación para intentar incrementar la transparencia de las decisiones de listado previas al identificar los criterios a los cuales se les había otorgado mayor peso inherentemente. La herpetofauna de California que se encontraba enlistada a nivel federal tuvo un puntaje significativamente más alto en el espectro de la medida del riesgo que aquellas especies que no estaban enlistadas, mientras que las especies enlistadas a nivel estatal no tuvieron un puntaje más alto que aquellas especies que no estaban enlistadas a nivel estatal. Con base en los árboles de clasificación, el endemismo estatal fue el indicador más importante del estado de listado a nivel estatal y tanto la tendencia de distribución (declinación del tamaño de la extensión de una especie) y como la tendencia poblacional (declinación de la abundancia de una especie en sitios localizados) fueron los indicadores más importantes a nivel federal. Nuestros resultados enfatizan la necesidad que tienen los cuerpos de gobierno de adoptar los métodos estandarizados que están basados en criterios cuantitativos para la evaluación del riesgo de conservación. Dichos métodos permiten que quienes toman las decisiones identifiquen los criterios a los cuales se les otorga inherentemente el mayor peso al determinar el estado de listado, lo que incrementa la transparencia de las decisiones previas de listado, y produce una comparación sin sesgos de la amenaza de conservación en todas las especies para promover la regularidad, eficiencia y efectividad de los procesos de listado.

Shared ways of thinking in Brazil about the science-practice interface in ecology and conservation.

The debate in the literature on the science-practice interface suggests a diversity of opinions on how to link science and practice to improve conservation. Understanding this diversity is key to addressing unequal power relations, avoiding the consideration of only dominant views, and identifying strategies to link science and practice. In turn, linking science and practice should promote conservation decisions that are socially robust and scientifically informed. To identify and describe the viewpoints of scientists and decision makers on how the science-practice interface should work in order to improve conservation decisions, we interviewed Brazilian scientists (ecologists and conservation scientists, n = 11) and decision makers (n = 11). We used Q methodology and asked participants to rank their agreement with 48 statements on how the science-practice interface should work in order to improve conservation decisions. We used principal component analysis to identify shared viewpoints. The predominant viewpoint, shared by scientists and decision makers, was characterized by valuing the integration of scientific and strategic knowledge to address environmental problems. The second viewpoint, held mostly by decision makers, was distinguished by assigning great importance to science in the decision-making process and calling for problem-relevant research. The third viewpoint, shared only by scientists, was characterized by an unwillingness to collaborate and a perception of scientists as producers of knowledge that may help decision makers. Most participants agreed organizations should promote collaboration and that actors and knowledge from both science and practice are relevant. Disagreements concerned specific roles assigned to actors, willingness to collaborate, and organizational and institutional arrangements considered effective to link science and practice. Our results suggest there is ample room for collaborations and that impediments lie mainly in existing organizations and formal institutional arrangements rather than in negative attitudes between scientists and decision makers.

Formas de Pensar Compartidas en Brasil sobre la Interrelación Ciencia-Práctica en la Ecología y la Conservación Resumen El debate en la literatura sobre la interrelación ciencia-práctica sugiere una diversidad de opiniones sobre cómo conectar a la ciencia con la práctica para mejorar la conservación. La comprensión de esta diversidad es clave para tratar con las relaciones desiguales de poder, evitar la considerar únicamente de los puntos de vista dominantes, e identificar las estrategias para vincular a la ciencia con la práctica. En cambio, la vinculación entre la ciencia y la práctica debería promover las decisiones de conservación que son socialmente fuertes y científicamente informadas. Entrevistamos a científicos (ecólogos y conservadores, n = 11) y tomadores de decisiones (n = 11) en Brasil para identificar y describir los puntos de vista de los científicos y de quienes toman las decisiones sobre cómo la interrelación ciencia-práctica debería trabajar con tal de mejorar las decisiones de conservación. Usamos la metodología Q y les pedimos a los participantes que clasificaran su acuerdo con 48 declaraciones sobre cómo la interrelación ciencia-práctica debería trabajar para mejorar las decisiones de conservación. Utilizamos un análisis de componentes principales para identificar los puntos de vista compartidos. El punto de vista predominante, compartido entre los científicos y quienes toman las decisiones, se caracterizó por el valor que le dio a la integración del conocimiento científico y el estratégico para tratar los problemas ambientales. El segundo punto de vista, compartido por la mayoría de quienes toman las decisiones, se distinguió por asignarle una gran importancia a la ciencia en cuanto al proceso de toma de decisiones y a la petición de investigación relevante para los problemas. El tercer punto de vista, compartido sólo entre los científicos, se caracterizó por el rechazo a colaborar y por la percepción de los científicos como productores de conocimiento que puede ayudar a quienes toman las decisiones. La mayoría de los participantes estuvo de acuerdo en que las organizaciones deberían promover la colaboración y en que los actores y el conocimiento científico y práctico son relevantes. Los desacuerdos estuvieron relacionados con los roles específicos asignados a los actores, el deseo de colaborar, y los arreglos institucionales y de organización considerados como efectivos para vincular a la ciencia con la práctica. Nuestros resultados sugieren que existe suficiente espacio para las colaboraciones y que los impedimentos se deben principalmente a las organizaciones existentes y a los arreglos institucionales formales en lugar de a las actitudes negativas entre los científicos y quienes toman las decisiones.

Agreement analysis of three mandibular third molar retention classifications.

INTRODUCTION: Pell & Gregory and Winter classifications are basic in third molar categorization; Sánchez-Torres classification is used in Mexico, but it has not been previously evaluated. OBJECTIVE: To assess the degree of agreement in the radiographic evaluation of impacted mandibular third molar with the use of three classifications: Pell & Gregory, Winter and Sánchez-Torres. METHOD: Observational, descriptive, inter-observer degree of agreement study that included 10 oral and maxillofacial surgeons and 10 training residents, who recorded the radiographic categorization of third mandibular molars (left and right) according to Pell and Gregory, Sánchez-Torres and Winter classifications. Inter-observer degree of agreement was assessed with Fleiss' kappa test. RESULTS: Pell and Gregory classification obtained the lowest degree of agreement (kappa = 0.05 and 0.185), followed by Sánchez-Torres classification (kappa = 0.125 and 0.326); Winter had the best agreement, with kappa = 0.28 and 0.636 for oral and maxillofacial surgeons and training residents, respectively. CONCLUSION: The Winter classification showed an acceptable (moderate) degree of agreement to classify mandibular third molars by training residents.

INTRODUCCIÓN: Las clasificaciones de Pell y Gregory y de Winter son básicas en la categorización de terceros molares; la clasificación de Sánchez Torres es usada en México, pero no había sido evaluada previamente. OBJETIVO: Evaluar el grado de acuerdo en la valoración radiográfica de terceros molares mandibulares impactados, con el empleo de tres clasificaciones: Pell y Gregory, Winter y Sánchez Torres. MÉTODO: Estudio observacional, descriptivo, de concordancia interobservador, que incluyó a 10 cirujanos orales y maxilofaciales y 10 residentes en formación, quienes registraron la categorización radiográfica de terceros molares mandibulares (izquierdos y derechos) de acuerdo con las clasificaciones de Pell y Gregory, Sánchez Torres y Winter. Se evaluó el grado de acuerdo entre observadores mediante la prueba de kappa de Fleiss. RESULTADOS: La clasificación de Pell y Gregory obtuvo el menor grado de acuerdo (kappa = 0.05 y 0.185), seguida de la clasificación de Sánchez Torres (kappa = 0.125 y 0.326); el mejor valor lo obtuvo la clasificación de Winter, con kappa = 0.28 y 0.636 para cirujanos orales y maxilofaciales y residentes en formación, respectivamente. CONCLUSIÓN: La clasificación de Winter mostró un grado de acuerdo aceptable (moderado) para categorizar terceros molares mandibulares en los residentes en formación.

Monitoring mosaic biotopes in a marine conservation zone by autonomous underwater vehicle.

The number of marine protected areas (MPAs) has increased dramatically in the last decade and poses a major logistic challenge for conservation practitioners in terms of spatial extent and the multiplicity of habitats and biotopes that now require assessment. Photographic assessment by autonomous underwater vehicle (AUV) enables the consistent description of multiple habitats, in our case including mosaics of rock and sediment. As a case study, we used this method to survey the Greater Haig Fras marine conservation zone (Celtic Sea, northeast Atlantic). We distinguished 7 biotopes, detected statistically significant variations in standing stocks, species density, species diversity, and faunal composition, and identified significant indicator species for each habitat. Our results demonstrate that AUV-based photography can produce robust data for ecological research and practical marine conservation. Standardizing to a minimum number of individuals per sampling unit, rather than to a fixed seafloor area, may be a valuable means of defining an ecologically appropriate sampling unit. Although composite sampling represents a change in standard practice, other users should consider the potential benefits of this approach in conservation studies. It is broadly applicable in the marine environment and has been successfully implemented in deep-sea conservation and environmental impact studies. Without a cost-effective method, applicable across habitats, it will be difficult to further a coherent classification of biotopes or to routinely assess their conservation status in the rapidly expanding global extent of MPAs.

Monitoreo de Mosaicos de Biotopos en una Zona Marina de Conservación por medio de un Vehículo Submarino Autónomo Resumen El número de áreas marinas protegidas (AMP) ha incrementado dramáticamente en la última década y ahora presenta un gran reto logístico para quienes practican la conservación en términos de extensión espacial y la multitud de hábitats y biotopos que ahora requieren ser evaluados. La evaluación fotográfica por medio de vehículos submarinos autónomos (VSA) habilita la descripción constante de múltiples hábitats, y en nuestro caso incluso mosaicos de rocas y sedimento. Como estudio de caso usamos este método para censar la zona marina de conservación de Greater Haig Fras (Mar Celta, noreste del Atlántico). En él distinguimos siete biotopos; detectamos variaciones estadísticamente significativas en el stock permanente, la densidad de especies, la diversidad de especies y la composición faunística; e identificamos especies indicadoras significativas para cada hábitat. Nuestros resultados demuestran que la fotografía basada en VSA puede producir datos sólidos para la investigación ecológica y la conservación marina práctica. La estandarización a un número mínimo de individuos por unidad de muestreo, en lugar de a un área fija del fondo marino, puede ser un recurso valioso para definir una unidad de muestreo ecológicamente adecuada. Aunque el muestreo compuesto representa un cambio en la práctica habitual, otros usuarios deberían considerar los beneficios potenciales de esta estrategia en los estudios de conservación. Este método puede aplicarse de manera generalizada en el ambiente marino y ha sido implementado exitosamente en la conservación y en estudios de impacto ambiental en mares profundos. Si no existe un método rentable, aplicable en todos los hábitats, será difícil avanzar hacia una clasificación coherente de los biotopos o hacia una evaluación rutinaria de su estado de conservación en la extensión mundial de rápida expansión de las AMP.

Five-assay microbiological system for the screening of antibiotic residues.

A novel microbiological system in microtiter plates consisting of five bioassays is presented for the detection and classification of antibiotic residues in milk. The bioassays were optimized for the detection of beta-lactams (Bioassay B: Geobacillus stearothermophilus), macrolides (Bioassay M: Bacillus megaterium with fusidic acid), tetracyclines (Bioassay T: B. megaterium with chloramphenicol), quinolones (Bioassay Q: Bacillus licheniformis) and sulfamides (Bioassay QS: B. licheniformis with trimethoprim) at levels near the maximum residue limits (MRL). The response of each bioassay was interpreted visually (positive or negative) after 4-5.5h of incubation. The system detects and classifies beta-lactams (5µg/l of amoxicillin, 4µg/l of ampicillin, 36µg/l of cloxacillin, 22µg/l of amoxicillin, 3µg/l of penicillin, 114µg/l of cephalexin, 89µg/l of cefoperazone and 116µg/l of ceftiofur), tetracyclines (98µg/l of chlortetracycline, 92µg/l of oxytetracycline and 88µg/l of tetracycline), macrolides (33µg/l of erythromycin, 44µg/l of tilmicosin and 50µg/l of tylosin), sulfonamides (76µg/l of sulfadiazine, 85µg/l of sulfadimethoxine, 77µg/l of sulfamethoxazole and 87µg/l of sulfathiazole) and quinolones (94µg/l of ciprofloxacin, 98µg/l of enrofloxacin and 79µg/l marbofloxacin). In addition, the specificity values were high for B, T, Q (99.4%), M (98.8%) and QS (98.1%) bioassays. The control of antibiotics through this system can contribute to improving the quality and safety of dairy products.

[Design and validation of the scale to assess the fragility of chronic patients]. / Diseño y validación de la escala para valorar la fragilidad de los pacientes crónicos.

OBJECTIVE: To create a scale and tool that allows us to measure the fragility of the chronic patient. DESIGN: Observational study on the area's chronicles. LOCATION: Between January 2011 and December 2015, a population of 2108 individuals. Data were collected from the medical history and expressed application for the registration of fragile patients, on structured data collection sheet. PARTICIPANTS: Fragile subjects of the North Sanitary Area of Malaga. INTERVENTION: Design and validation of a scale. MAIN MEASUREMENTS: Study variables. MAIN OUTCOME VARIABLE: Antequera Fragility Scale (EPADI) consisting of five criteria / factors: age, Pfeiffer, Barthell, Charlson, sociofamiliar and pluripatological. Accessibility outcome variables were used as prediction variables. Quantitative variables are described by mean and standard deviation. The qualitative variables are presented in frequencies along with their percentages. To obtain a predictive model of resource utilization the sample was divided into two subsamples of equal size. RESULTS: From the variables of interest by experts, univariate predictors were identified in the use of resources in the sample M_EPADI1, to construct a model of multivariate logistic regression that allows to predict the resource utilization. For the validation of the scale, the sample M_EPADI2 was used. CONCLUSIONS: It was verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly values the degree of fragility of chronic users based on the resources consumed. CONCLUSIONS: It has been verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly evaluates the degree of fragility of chronic users based on the resources consumed.

Historical review of our knowledge of acute pancreatitis. / Revisión histórica de algunos conocimientos sobre pancreatitis aguda.

Acute pancreatitis is one of most common causes of consultation due to abdominal pain in medical emergency units and it requires hospital admission. Although the majority of cases are mild and patients tend to recover quickly, a small percentage of cases is severe, with mortality in the region of 5-10%. This historical review considers how our understanding of this disease has changed since it was first described in 1579 thanks to the contributions of renowned experts such as Nicolaes Tulp, Reginald Fitz, Nicholas Senn and many others who, through their expertise and dedication, have improved the survival of patients with this disease.

TOP-DOWN AND BOTTOM-UP: THE ROLE OF SOCIAL INFORMATION PROCESSING AND MINDFULNESS AS PREDICTORS IN MATERNAL-INFANT INTERACTION.

The cross-generational transmission of attachment appears to reflect a complex interplay of factors, which have been challenging to identify. The current longitudinal study explored the maternal cognitive model of relationships through language use, maternal mindfulness, and attachment style assessed prenatally, as predictors of maternal response to distress and infant behavior at 6 months' postpartum. Infant behavior to the mother also was examined to provide an understanding of the evolving relationship. Thirty-two females were interviewed prenatally regarding social and family experiences. At 6 months' postpartum, each mother participated in a video-recorded session where she was asked to teach her infant a developmentally appropriate task. Videos were analyzed using the NCAST Teaching Protocol. Language use prenatally as well as the mindfulness facets (acting with awareness and describing) predicted the mothers' ability to respond to infant distress, indicating greater attunement. Infant's response to mother and clarity of cues also were predicted by maternal pronoun use. The study highlights the role of internal working models reflective of interpersonal beliefs, cognitive models, and current-moment awareness in maternal behavior. The effect of maternal language on infant behavior arguably indicates the infant's integration of maternal internal working models.