Coral composition and bottom-wave metrics improve understanding of the patchiness of cyclone damage on reefs.

Coral reefs are likely to be exposed to more intense cyclones under climate change. Cyclone impacts are spatially highly variable given complex hydrodynamics, and coral-specific sensitivity to wave impacts. Predicting reef vulnerability to cyclones is critical to management but requires high resolution environmental data that are difficult to obtain over broad spatial scales. Using 30m-resolution wave modelling, we tested cyclonic and non-cyclonic wave metrics as predictors of coral damage on 22 reefs after severe cyclone Ita impacted the northern Great Barrier Reef, Australia in 2014. Analyses of coral cover change accounting for the type of coral along a gradient of vulnerability to wave damage (e.g., massive, branching, Acroporids) excluded cyclone-generated surface wave metrics (derived from wave height) as important predictors. Increased bottom stress wave environment (near-bed wave orbital velocity) due to Ita (Ita-Ub) explained spatial patterns of 17% to 46% total coral cover loss only when the initial abundance of Acroporids was accounted for, and only when exceeding 35% cover. Greater coral losses occurred closer to the cyclone path irrespective of coral type. Massive and encrusting corals, however, had losses exacerbated in higher non-cyclonic bottom-wave energy environments (nc-Ub). The effect of community composition on structural vulnerability to wave damage was more important predicting damage that the magnitude of the cyclone-generated waves, especially when reefs are surveyed well beyond where damaging waves are expected to occur. Exposure to Ita-Ub was greater in typically high nc-Ub environments with relatively low cover of the most fragile morphologies explaining why these were the least affected overall. We reveal that the common surface-wave metrics of cyclone intensity may not always be able to predict spatial impacts and conclude that reef vulnerability assessments need to account for chronic wave patterns and differences in community composition in order to provide predictive tools for future conservation and restoration.

Linking fishes to multiple metrics of coral reef structural complexity using three-dimensional technology.

Structural complexity strongly influences biodiversity and ecosystem productivity. On coral reefs, structural complexity is typically measured using a single and small-scale metric ('rugosity') that represents multiple spatial attributes differentially exploited by species, thus limiting a complete understanding of how fish associate with reef structure. We used a novel approach to compare relationships between fishes and previously unavailable components of reef complexity, and contrasted the results against the traditional rugosity index. This study focused on damselfish to explore relationships between fishes and reef structure. Three territorial species, with contrasting trophic habits and expected use of the reef structure, were examined to infer the potential species-specific mechanisms associated with how complexity influences habitat selection. Three-dimensional reef reconstructions from photogrammetry quantified the following metrics of habitat quality: 1) visual exposure to predators and competitors, 2) density of predation refuges and 3) substrate-related food availability. These metrics explained the species distribution better than the traditional measure of rugosity, and each species responded to different complexity components. Given that a critical effect of reef degradation is loss of structure, adopting three-dimensional technologies potentially offers a new tool to both understand species-habitat association and help forecast how fishes will be affected by the flattening of reefs.

[Utility of bispectral vs auditory evoked potential monitoring during anesthetic maintenance in combined sevoflurane-regional anesthesia in pediatric patients: comparison with standard practice]. / Utilidad del BIS y AEP monitor/2 para el mantenimiento de la anestesia combinada sevoflurano-regional, comparada con la práctica estándar en población pediátrica.

OBJECTIVES: To compare the indices computed by a bispectral (BIS) monitor and an auditory evoked potential (AEP) monitor during maintenance of anesthesia in pediatric patients. A secondary objective was to compare anesthetic consumption and recovery times. MATERIAL AND METHODS: Patients aged 6 months to 12 years under inhaled anesthesia with sevoflurane were administered a penile or caudal nerve block. BIS and AEP monitoring was then started. The patients were randomized to 3 groups in which the sevoflurane dosage was guided by the BIS index, the A-line ARX index (AAI), or standard procedures (control group). The BIS index, the AAI, the fraction of expired sevoflurane, hemodynamic parameters, and recovery time were the variables recorded for all patients. RESULTS: Thirty-five patients were enrolled. Significant differences between the 2 monitor groups were observed. The mean (SD) AAI was lower in patients whose dosage was controlled by the BIS index (19 [2]) than in those whose dosage was based on the AEP monitor's reading (22 [4]) (P=.04). According to a Bland and Altman plot, there was good agreement between the BIS index and the AAI except for the highest and, in particular, the lowest values. The volumes of sevoflurane used and the recovery times were similar between groups. There was a positive correlation between the 2 indices (Pearson correlation coefficient, 0.207; P<.001). CONCLUSIONS: BIS monitoring provided a more stable index than did AEP monitoring and BIS-index guidance achieved a deeper level of hypnosis. There was good correlation between the 2 indices during maintenance of anesthesia. Neither monitor offered advantages over standard procedures with regard to movement, volume of anesthetic consumed, or recovery time.

Utilidad del BIS® y AEP Monitor/2® para el mantenimientode la anestesia combinada sevoflurano-regional, comparadacon la práctica estándar en población pediátrica / Utility of bispectral vs auditory evoked potential monitoring during anesthetic maintenance in combined sevofluraneregional anesthesia in pediatric patients: comparison with standard practice

OBJETIVOS: Evaluación comparativa de los índices proporcionadospor BIS® y AEP Monitor® durante el mantenimientode la anestesia en pacientes pediátricos. Objetivossecundarios comparar el consumo anestésico y eltiempo de despertar.MATERIAL Y MÉTODO: Pacientes con edades entre 6 mesesy 12 años sometidos a anestesia inhalatoria con sevoflurano,bloqueo nervioso peneano o caudal y monitorizacióncon BIS®‚ y AEP Monitor®. Se aleatorizaron en tres grupossegún el monitor utilizado para dosificar sevoflurano:grupo BIS, grupo AAI y control. Se recogieron automáticamenteBIS y AAI, fracción espirada de sevoflurano, parámetroshemodinámicos y tiempo de despertar.RESULTADOS: Se incluyeron 35 pacientes. Se encontrarondiferencias significativas entre los índices recogidosdependiendo del monitor utilizado. El AAI fue más bajoen el grupo controlado por BIS respecto al controlado porAEP Monitor/2 (media [SD], 19 [2] vs 22 [4]; p=0,04).Hubo una buena concordancia entre BIS y AAI salvo enlos valores extremos, sobre todo, los inferiores (ecuaciónde Bland-Altman). El consumo de sevoflurano y el tiempode despertar no fueron diferentes entre grupos. Se estableciócorrelación positiva entre los dos índices (coeficientede correlación de Pearson 0,207; p<0,001).CONCLUSIONES: La guía de la anestesia con BIS, respectoal AEP Monitor proporcionó un índice más establey profundizó más la hipnosis. Ambos índices presentaronuna buena correlación durante el mantenimiento. Ningunode los monitores presentó ventajas respecto a unapráctica clínica estándar en la incidencia de movimiento,gasto anestésico o tiempo de despertar (AU)

OBJECTIVES: To compare the indices computed by abispectral (BIS) monitor and an auditory evoked potential(AEP) monitor during maintenance of anesthesia inpediatric patients. A secondary objective was to compareanesthetic consumption and recovery times.MATERIAL AND METHODS: Patients aged 6 months to 12years under inhaled anesthesia with sevoflurane wereadministered a penile or caudal nerve block. BIS and AEPmonitoring was then started. The patients were randomized to3 groups in which the sevoflurane dosage was guided by theBIS index, the A-line ARX index (AAI), or standardprocedures (control group). The BIS index, the AAI, thefraction of expired sevoflurane, hemodynamic parameters,and recovery time were the variables recorded for all patients.RESULTS: Thirty-five patients were enrolled.Significant differences between the 2 monitor groupswere observed. The mean (SD) AAI was lower in patientswhose dosage was controlled by the BIS index (19 [2])than in those whose dosage was based on the AEPmonitor's reading (22 [4]) (P=.04). According to a Blandand Altman plot, there was good agreement between theBIS index and the AAI except for the highest and, inparticular, the lowest values. The volumes of sevofluraneused and the recovery times were similar betweengroups. There was a positive correlation between the 2indices (Pearson correlation coefficient, 0.207; P<.001).CONCLUSIONS: BIS monitoring provided a more stableindex than did AEP monitoring and BIS-index guidanceachieved a deeper level of hypnosis. There was goodcorrelation between the 2 indices during maintenance ofanesthesia. Neither monitor offered advantages overstandard procedures with regard to movement, volumeof anesthetic consumed, or recovery time (AU)

Servicio de información factográfica orientado a los directivos de salud en Cuba / Factographic Information Services Oriented to Cuban Health System Managers

La posibilidad de disponer de datos relevantes en el momento oportuno es actualmente un punto de apoyo muy útil para argumentar científicamente las tareas de proyección y de toma de decisiones. A partir del estudio de la bibliografía y de la observación del funcionamiento de un servicio orientado a los directivos de la salud en Cuba, se proyectó la aplicación de la información factográfica como valor agregado al servicio Información a Directivos de la Salud ( Infodir ), que se brinda actualmente en el Centro Nacional de Información de Ciencias Médicas. Se detallan las características de la información factográfica como servicio y las peculiaridades de la comunidad de usuarios que la utilizará. Se enumeran sus procesos y salidas como sistema y se examinan de modo particular los productos que ofrece. Este servicio se suministra de manera automatizada con un diseño amigable.

The possibility of disposing of relevant data at the right time is currently one of the most useful sources to scientifically support projection tasks and decision making processes. Based on the study of bibliography and the observation of the performance of a service oriented to health system managers, the application of factographic information was implemented as aggregated value to the Health System Manager Service (Infodir), currently available at the Medical Science National Information Centre. The characteristics of the factographic information as a service are described, as well as the peculiarities of the user community who will make use of it. Its processes and outcomes as a system are enumerated, and the offered products are specially analyzed. This service is provided automatically, with a friendly design.

Infodir: la gestión de información para los directivos de salud / Infodir: Information Management for Health Care Directors

Se estudian los requisitos esenciales para la creación de un servicio de información a dirigentes, los antecedentes, así como la evolución histórica y el estado actual de Infodir, el servicio de gestión de información para los directivos de la salud en Cuba, que ofrece el Centro Nacional de Información de Ciencias Médicas desde el año 2001, primero en forma de boletín y después como página Web.

The essential requisites for the creation of an information center for the directors are studied, as well as the background, historic evolution, and the current state of Infodir, the information management system for the health care system directors in Cuba, offered by the Medical Sciences National Information Center since the year 2001, first as a publication and later as a web page.

[Genitourinary rhabdomyosarcoma in childhood]. / Rabdomiosarcomas genitourinarios en la infancia.

We present the result obtained by GICOP in the treatment of 12 genitourinary rhabdomyosarcoma, located in vagina-uterus (5), bladder-prostate (4) and paratesticular (3). The age of the patients ranging from 1 to 15 years. Embryonal rhabdomyosarcoma was the most common histologic type (58 for 100) being the major number of cases in stadium II. The treatment was based in the combination of chemotherapy protocolised with vincristine, d-actinomycin, cyclophosphamide (VAC), vincristine, adriamycin (VAC-VAD) and/or iphosphamide, vincristine, d-actinomycin (IVA), use of radiotherapy, marrow auto-transplantation and radical surgery avoidance. Complete remission was achieved in 11 out of 12 cases (92 for 100), relapsing in 5 cases (38 for 100) of which 4 (80 for 100) achieved a second remission. An 82 for 100 disease free survival was achieved in a 5 year period.

[Non-Hodgkin's lymphomas in childhood. Evaluation of therapeutic results according to histopathologic criteria (Catalan Interhospital Group of Pediatric Oncology)]. / Linfomas no Hodgkin en la infancia. Valoración de resultados terapéuticos según criterios histopatológicos (GICOP).

The results obtained in the treatment of 37 children with non Hodgkin lymphoma belonging to GICOP between january 1982 and december 1986 are analysed. The therapy depend on the anatomopathology following the working formulation; LSALL2 protocol is used in lymphoblastic lymphoma, Burkitt-82 in undifferentiated Burkitt lymphoma and COMP in the remaining complete remission was archived in 94.6%. Murphy's classification is used. Disease free survival is 81% at 30 months. The actuarial survival is 0.81 for LL and 0.84 for BK at 48 months. The results obtained in the treatment of Burkitt's lymphoma with Burkitt-82 protocol and specially the absence of CNS infiltration are remarkable.

[Tumors of the CNS in childhood]. / Tumores de SNC en la infancia.

Brain tumors are the most common group of solid malignancies in childhood. The therapeutic arms available nowadays: surgery, radiotherapy and chemotherapy, have achieved considerable improvement in the survival of some types of CNS tumors, mainly due to the first two. We have carried out a retrospective study of 252 CNS tumors, diagnosed in the GICOP group during the last ten years. The primary location was: supratentorial, 42%; infratentorial, 51%; and both, 7%. Biopsies were performed in 190 cases (75%), resulting in the following histologic types: astrocytoma (38%), medulloblastoma (19%), ependymoma (14%), craniopharyngioma (7%), others (22%). The treatment was individualized according to the patient characteristics: age, location, histologic type and tumor spreading. Surgery was performed in 82% of patients (8% only derivative shunt), radiotherapy in 48% and chemotherapy in 23%. The life survival was 60% at 50 months.

Computed tomography of infantile hepatic hemangioendothelioma.

Computed tomography (CT) was performed on five infants with hepatic hemangioendothelioma. Precontrast scans showed solitary or multiple, homogeneous, circumscribed areas with reduced attenuation values. Tiny tumoral calcifications were identified in two patients. Serial scans, after injection of a bolus of contrast material, showed early massive enhancement, which was either diffuse or peripheral. On delayed scans, multinodular tumors became isodense with surrounding liver, while all solitary ones showed varied degrees of centripetal enhancement and persistent central cleftlike unenhanced areas. The authors believe that these CT features are characteristic and obviate arteriographic confirmation.