Functional trait trade-offs define plant population stability across different biomes.

Ecological theory posits that temporal stability patterns in plant populations are associated with differences in species' ecological strategies. However, empirical evidence is lacking about which traits, or trade-offs, underlie species stability, especially across different biomes. We compiled a worldwide collection of long-term permanent vegetation records (greater than 7000 plots from 78 datasets) from a large range of habitats which we combined with existing trait databases. We tested whether the observed inter-annual variability in species abundance (coefficient of variation) was related to multiple individual traits. We found that populations with greater leaf dry matter content and seed mass were more stable over time. Despite the variability explained by these traits being low, their effect was consistent across different datasets. Other traits played a significant, albeit weaker, role in species stability, and the inclusion of multi-variate axes or phylogeny did not substantially modify nor improve predictions. These results provide empirical evidence and highlight the relevance of specific ecological trade-offs, i.e. in different resource-use and dispersal strategies, for plant populations stability across multiple biomes. Further research is, however, necessary to integrate and evaluate the role of other specific traits, often not available in databases, and intraspecific trait variability in modulating species stability.

Synchrony matters more than species richness in plant community stability at a global scale.

The stability of ecological communities is critical for the stable provisioning of ecosystem services, such as food and forage production, carbon sequestration, and soil fertility. Greater biodiversity is expected to enhance stability across years by decreasing synchrony among species, but the drivers of stability in nature remain poorly resolved. Our analysis of time series from 79 datasets across the world showed that stability was associated more strongly with the degree of synchrony among dominant species than with species richness. The relatively weak influence of species richness is consistent with theory predicting that the effect of richness on stability weakens when synchrony is higher than expected under random fluctuations, which was the case in most communities. Land management, nutrient addition, and climate change treatments had relatively weak and varying effects on stability, modifying how species richness, synchrony, and stability interact. Our results demonstrate the prevalence of biotic drivers on ecosystem stability, with the potential for environmental drivers to alter the intricate relationship among richness, synchrony, and stability.

Colorectal Cancer Screening in Castilla La Mancha, Spain: The Influence of Social, Economic, Demographic and Geographic Factors.

Colorectal cancer (CRC) is a health problem with a significant social impact, accounting for 700,000 deaths a year globally. CRC survival rates are increasing as a result of early detection and improvements in society and labor conditions. Differences in CRC have been found depending on place of residence (urban or rural), socioeconomic situation and unemployment, although studies in this regard are limited. The aims of the present study were to determine whether differences exist in diagnostic delay according to place of residence, to analyze the association between socioeconomic level and colonoscopy results and to evaluate CRC risk according to place of residence, income level and unemployment. Retrospective, descriptive and observational study based on colonoscopies performed between May 2015 and November 2018, analyzing relationships between colonoscopy findings of a population screening program and various socioeconomic and demographic variables included in the study (sex, age, place of residence, average annual income, unemployment rate, etc.), and determining any association between such factors and related increases in adenocarcinoma risk. A total of 1422 patients were included in the study. The difference in participation according to sex was greater in rural population (63,4% men/36,6% women in rural areas, 58% men/42% women in urban areas). The mean delayed diagnosis was 59,26 days in both groups. Adenocarcinoma risk was 1.216 times higher in rural population. High-grade dysplasic lesions and adenocarcinoma were more common in municipalities with income < 9000€. However, advanced stage adenocarcinoma was higher in municipalities with income > 9000€. Adenocarcinoma risk was 1,088 times higher in municipalities with an unemployment rate of > 10%. Living in rural areas is not a barrier to access to health care, with no disadvantages identified regarding diagnosis and treatment, thanks to public health policies and the large number of small municipalities near the referral hospital in Cuenca.

Satisfaction and perceived quality of life results in patients operated on for primary hernia of the abdominal wall.

INTRODUCTION: Outpatient surgery is currently the standard procedure in 60-70% of the most prevalent surgical procedures. Minimally invasive models in health care have improved basic aspects such as postoperative pain and hospital stay, but there are few publications related to perceived quality shown by patients, such as the need for informal care at home or delay before surgery. The aim of the study was to determine the global satisfaction perceived by patients undergoing abdominal wall hernia repair. METHODS: An ad hoc split questionnaire has been completed on satisfaction after a week and postoperative quality a month after intervention by 203 patients operated on for abdominal hernia in a year. Variables included postoperative pain, need for informal care, surgical delay, information supplied, professional management and overall satisfaction. RESULTS: A total of 48.28% of patients needed informal care at home. They were largely attended by women, wives or daughters, for a few days. In 45.81% they were discharged on the same day, and 53.2% in less than 72 h. Overall satisfaction in the program of day surgery and short hospital stay was 94.6%. CONCLUSIONS: The overall process of satisfaction was not related to age, sex or educational level of patients, while there was an inverse relationship between satisfaction and days of hospitalization and days of pain that required analgesia at home.

Drivers of a riparian forest specialist (Carex remota, Cyperaceae): it is not only a matter of soil moisture.

UNLABELLED: • PREMISE OF THE STUDY: Plants respond to the prevailing conditions in the surrounding environment, but since they are dynamic systems this response may vary during their life. Thus, the identification of key aspects for the maintenance of plant populations requires the consideration of plant performance across environmental gradients and along life stages. This study examines how abiotic conditions and biotic interactions and processes determine the spatial distribution of two life-story stages that play a key role in the functioning of a representative population of Carex remota.• METHODS: We used structural equation modeling (SEM) to test for direct and indirect influences of abiotic and biotic factors on seedlings and adults of Carex remota. The variables used in the analysis were number of seedlings, cover of adults, soil moisture, leaf litter cover, relative light, and topographic position.• KEY RESULTS: Population patterns partially depend on direct and indirect effects of abiotic conditions. Whereas adult individuals were only affected by topsoil moisture, seedling emergence was largely affected by multiple environmental conditions. The number of seedlings increased with high topsoil moisture, low leaf-litter values, high light values as well as in low parts of the study area. The importance of adult individuals in determining seedling success is also highlighted: higher abundance provides seed rain in the surroundings and modifies the microenvironmental conditions favoring high seedling establishment.• CONCLUSIONS: As hypothesized, adults and seedlings responded to the environmental conditions differently. Seedling emergence was a critical aspect in C. remota performance, and abrupt changes in the environment during this stage may strongly influence population performance.

Growth of tree (Pinus sylvestris) and shrub (Amelanchier ovalis) species is constrained by drought with higher shrub sensitivity in dry sites.

We lack understanding of how variable is radial growth of coexisting tree and shrub species, and how growth is constrained by drought depending on site aridity. Here, we compared the radial growth of two widespread and coexisting species, a winter deciduous shrub (Amelanchier ovalis Medik.) and an evergreen conifer tree (Pinus sylvestris L.). We sampled four sites in Northeastern Spain subjected to different aridity levels and used dendrochronological methods to quantify growth patterns and responses to climate variables. The growth of the two species varied between regions, being lower in the driest sites. The first-order autocorrelation (growth persistence) was higher in more mesic sites but without clear differences between species. Tree and shrub growth negatively responded to elevated summer temperatures and positively to spring-summer precipitation and wet conditions. However, negative growth responses of the shrub to drought were only observed in the two driest sites in contrast to widespread responses of the tree. Abrupt growth reductions were common in the drier sites, but resilience indices show that the two species rapidly recovered pre-drought growth levels. The lower growth synchrony of the shrub as compared to the tree can be due to the multistemmed architecture, fast growth and low stature of the shrub. Besides, the high dependency of the shrub growth on summer rainfall can explain why drought limitations were only apparent in the two driest sites. In any case, results point out to the dendrochronological potential of shrubs, which is particularly relevant giving its ability to inhabit woodlands and treeless regions under harsh climatic conditions. Nevertheless, further research is required to elucidate the capacity of shrub species to tolerate drought, as well as to understand how shrubs thrive in water- and cold-limited environments.

Colorectal Cancer Prevalence and Survival in Cuenca (Spain).

BACKGROUND: Colorectal cancer is the most commonly diagnosed cancer type and the second cause of cancer death in Spain. The primary risk factor for colorectal cancer is age, with 90% of all diagnosed patients aged over 50 years. Prognosis mainly depends on tumour stage. AIM: Conduct a colorectal cancer prevalence and survival study in Cuenca (Spain) since there are almost no studies based on small populations. This is the first study about survival in screening of colorectal cancer carried out in hospitals in Castilla-La Mancha. METHODS: Retrospective descriptive cohort study was performed to include patients with colorectal cancer diagnosed by colonoscopy between May 2015 and April 2016, and who were followed up for 48 months. The study considered sociodemographic and clinical data of the patients. Survival curves were estimated using the Kaplan-Meier method. The proportional hazard rate associated with age, gender, stage, and presence of metastasis was calculated using the Cox regression method. RESULTS: Fifty-seven patients were included in the study. The mean follow-up was 45.5 months. Ten patients died during the study; in seven cases, the cause was colorectal cancer. The percentage of patients alive at a 48-month follow-up was 82.4%. CONCLUSION: Colon cancer is a high-prevalence pathology, with adenocarcinoma being the most common histology. The results seem to indicate that it affects men more frequently, mortality rises with tumour stage at diagnosis and declines with use of chemotherapy. We present a study that could justify large-scale epidemiological studies for the regional surveillance and evolution of colorectal cancer in Spain.

[Study of accessibility costs and satisfaction comparing a MAS unit incorporated in a Hospital versus a theoretical model in a peripheral centre]. / Estudio del coste de la accesibilidad y de la satisfacción comparando una unidad de CMA integrada en un hospital frente a un modelo teórico en un centro periférico.

INTRODUCTION: Geographical barriers are a determining factor in the accessibility of Hospital health care, and structural changes to improve geographic accessibility must be introduced. The purpose of this study is to compare accessibility costs and the level of satisfaction obtained in an adapted Specialist Centre with a peripheral MAS (Major Ambulatory Surgery) Unit, with an already existing one incorporated into the Virgen de la Luz Hospital (Cuenca, Spain) to obtain quality health care in the sub-population nearest the peripheral Centre. MATERIAL AND METHODS: A study was made on a comparison of the costs attributable to accessibility of 133 patients operated on due to hernia disorders in 2008 in the Cuenca Hospital of Castille-La Mancha Health Service (SESCAM), and who lived in its health area. These were compared using a simulation study for an ambulatory surgical Centre, functionally operational, but with no Major Ambulatory Surgery activity nearest to this patient population. The opinions of the patients and the increased cost-effectiveness for each alternative proposal were studied. RESULTS: The accessibility cost, taking into account the theoretical use of the Ambulatory Centre would be 208,028.09 € and the real costs of the Hospital were 209,088.94 €, with a minimum difference between the two of 1,060.85 €, assuming similar clinical results. CONCLUSIONS: Although there are no significant differences in accessibility costs by using an ambulatory surgery Centre compared to the Hospital, a special assessment of the use of the former is important, expressed in the satisfaction of the patients.

[Colorectal cancer screening pilot program in Castilla-La mancha. Partial results after first round: 2015-2018.] / Programa piloto de cribado poblacional de cáncer colorrectal en Castilla-La Mancha. Resultados parciales tras primera ronda: 2015-2018.

OBJECTIVE: Colorectal cancer is considered a public health problem due to its high incidence and mortality in developed countries. Primary preventions is not easy owing to the lack of knowledge of the main risk factors and the difficulty of modifying known risk factors, but it is one of the few tumors that meet the criteria for screening. In Spain, the Colorectal Cancer Population Screening Program was implemented in Catalonia in 2000, followed by the Valencian Community in 2005, beginning in Castilla La Mancha in April 2015. The objetive was to carry out a descriptive study of the results obtained in the first round of the Colorectal Cancer Screening Program at the Virgen de la Luz Hospital in Cuenca. METHODS: A retrospective, descriptive and observational study was carried out from the colonoscopies carried out from May 1, 2015 to November 2018, analyzing the number of lesions detected, the histology, the sex and the age range with the greatest affectation, as well as if there was a relationship between the different variables using Pearson's Chi square test. The qualitative variables were presented by means of their distribution in absolute and relative frequencies, and the quantitative ones by mean and standard deviation. RESULTS: The participation rate was 48.06%. 7.25% of fecal occult blood test were positive and 89% with a positive test had a colonoscopy. The positive of inmunological fecal occult test and the detection rate of adenomas were higher in men. 70.7% of colorectal cancers were diagnosed in early stages. There was no relationship between age and the presence of advanced lesions. CONCLUSIONS: The rates of people with adenomas and people with invasive cancers in Cuenca province are lower than those registered in Castilla-La Mancha.

OBJETIVO: El cáncer colorrectal (CCR) es considerado un problema de salud pública por su alta incidencia y mortalidad en los países desarrollados. La prevención primaria no es fácil, debido al desconocimiento de los principales factores de riesgo y a la dificultad de modificar factores de riesgo conocidos, pero se trata de uno de los pocos tumores que cumple los criterios para ser susceptible de cribado. En España, el Programa de Cribado Poblacional de CCR se implantó en Cataluña en el año 2000, seguida de la Comunidad Valenciana en 2005, comenzando en Castilla-La Mancha en abril de 2015. El objetivo del trabajo fue realizar un estudio descriptivo de los resultados obtenidos en la primera ronda del Programa de Cribado Poblacional de CCR en el Hospital Virgen de la Luz de Cuenca. METODOS: Se realizó un estudio retrospectivo, descriptivo y observacional a partir de las colonoscopias realizadas desde el 1 de mayo de 2015 hasta noviembre de 2018, analizándose el número de lesiones detectadas, la histología, el sexo y la franja de edad con mayor afectación, así como si existió relación entre las distintas variables mediante prueba de Chi cuadrado de Pearson. Las variables cualitativas se presentaron mediante su distribución en frecuencias absolutas y relativas, y las cuantitativas por media y desviación estándar. RESULTADOS: La tasa de participación fue del 48,06%. El 7,25% de los test de sangre oculta en heces (TSOHi) realizados fueron positivos y el 89% de las personas con test positivo se realizaron una colonoscopia. La positividad del test de sangre oculta en heces inmunológico y la tasa de detección de adenomas fueron mayores en hombres. El 70,7% de los cánceres colorrectales se diagnosticaron en estadios precoces. No existió relación entre la edad y la presencia de lesiones avanzadas. CONCLUSIONES: Las tasas de personas con adenomas y con cánceres invasivos en la provincia de Cuenca resultan inferiores a las registradas en toda Castilla-La Mancha.