•Ecosystem Services provision is, in part, closely linked to biodiversity and forest cover.•We analyse forest cover data for 4 countries that experience armed conflicts in the last 20 years.•The ...results show alarming forest loss right after armed conflicts end.•We propose adaptive co-management to address governance challenges during the transition period.
Ecosystem Services are commonly understood as the goods and services people obtain from nature, such as carbon sequestration, provision of food and fibres, pollination, etc. The provision of these services is in part closely related to the level of biodiversity in a region. Since some forested regions are considered biodiversity hotspots, the loss of such forested areas would affect the provision of ecosystem services. Among others, expansion of the agricultural frontier, demand for timber, weak enforcement of environmental regulations, or illegal logging are some of the key factors contributing to forest loss. These factors can be supported or enhanced during or after periods of extreme social instability such as armed conflicts or wars. Analyzing forest cover data for four different countries that have experienced armed conflicts in the recent past (Nepal, Sri Lanka, Ivory Coast and Peru), we seek to understand the influence of armed conflicts in ecosystem services provision, aiming to identify social, political and institutional drivers. Our four case studies show that at the end of their armed conflicts, on an average there was a 68.08% increase of annual forest loss in the five years following the end of conflict, as compared to the worldwide 7.20% mean. We identified inappropriate governance and institutional arrangements as the key driver during the transition period. We argue that as part of a family of bottom-up approaches, the adaptiveco-management approach is a promising option to deal with similar situations in the future, helping to keep a sustainable provision of ecosystem services.
Abstract
Small Island Developing States (SIDS) face enormous sustainability challenges such as heavy reliance on imports to meet basic needs, tenuous resource availability, coastal squeeze, and ...reduced waste absorption capacity. At the same time, the adverse effects of global environmental change such as global warming, extreme events, and outbreaks of pandemics significantly hinder SIDS’ progress towards sustainable development. This paper makes a conceptual contribution by framing the vulnerability of small islands from the perspective of socio-metabolic risk (SMR). SMR is defined as systemic risk associated with the availability of critical resources, the integrity of material circulation, and the (in)equitable distribution of derived products and societal services in a socio-ecological system. We argue that specific configurations and combinations of material stocks and flows on islands and their ‘resistance to change’ contribute to the system’s proliferation of SMR. For better or for worse, these influence the system’s ability to consistently and effectively deliver societal services necessary for survival. By positioning SMR as a subset of systemic risk, the paper illustrates SMRs and tipping points on small islands using insights from three sectors: water, waste, and infrastructure. We also identify effective leverage points and adaptation strategies for building system resilience on small islands. In conclusion, our synthesis suggests that governing SMR on SIDS would mean governing socio-metabolic flows to avoid potential disruptions in the circulation of critical resources and the maintenance of vital infrastructures and services while inducing interventions towards positive social tipping dynamics. Such interventions will need strategies to reconfigure resource-use patterns and associated services that are sustainable and socially equitable.
Aims/hypothesis
Diabetes is associated with an increased incidence of colorectal cancer (CRC). There exists conflicting evidence regarding the impact of diabetes on CRC-specific mortality (herein ...also referred to as cancer-specific mortality). The objectives of this study were to determine whether diabetes is associated with a more advanced CRC stage at diagnosis and with higher all-cause and cancer-specific mortality.
Methods
This retrospective cohort study used linked, population-based health databases from Ontario, Canada. Among individuals diagnosed with CRC from 2007 to 2015, we compared the likelihood of presenting with later- (III or IV) vs early- (I or II) stage CRC between patients with and without diabetes adjusting for relevant covariates. We then determined the association between diabetes and all-cause and CRC-specific mortality, after adjusting for CRC stage at diagnosis and other covariates.
Results
Of the 44,178 individuals with CRC, 11,822 (26.7%) had diabetes. After adjustment for CRC screening and other covariates, individuals with diabetes were not more likely to present with later-stage CRC (adjusted OR 0.97, 95% CI 0.93, 1.01). Over a median follow-up of 2.63 (interquartile range IQR 0.97–5.10) years, diabetes was associated with higher all-cause mortality (adjusted HR 1.08, 95% CI 1.04, 1.12) but similar cancer-specific survival (adjusted HR 1.0, 95% CI 0.95, 1.06).
Conclusions/interpretation
Individuals with diabetes who develop CRC are not more likely to present with a later stage of CRC and have similar cancer-specific mortality compared with those without diabetes. Diabetes was associated with higher all-cause mortality in CRC patients, indicating that greater attention to non-cancer care is needed for CRC survivors with diabetes.
Introduction: The Metabolism of Islands Singh, Simron Jit; Fischer-Kowalski, Marina; Chertow, Marian
Sustainability,
11/2020, Letnik:
12, Številka:
22
Journal Article
Recenzirano
Odprti dostop
This editorial introduces the Special Issue “Metabolism of Islands”. It makes a case why we should care about islands and their sustainability. Islands are hotspots of biocultural diversity, and home ...to 600 million people that depend on one-sixth of the earth’s total area, including the surrounding oceans, for their subsistence. Today, they are on the frontlines of climate change and face an existential crisis. Islands are, however, potential “hubs of innovation” and are uniquely positioned to be leaders in sustainability and climate action. We argue that a full-fledged program on “island industrial ecology” is urgently needed with the aim to offer policy-relevant insights and strategies to sustain small islands in an era of global environmental change. We introduce key industrial ecology concepts, and the state-of-the-art in applying them to islands. Nine contributions in this Special Issue are briefly reviewed to highlight the metabolic risks inherent in the island cases. The contributors explore how reconfiguring patterns of resource use will allow island governments to build resilience and adapt to the challenges of climate change.
In the phase III RADIANT‐4 study, everolimus improved median progression‐free survival (PFS) by 7.1 months in patients with advanced, progressive, well‐differentiated (grade 1 or grade 2), ...non‐functional lung or gastrointestinal neuroendocrine tumors (NETs) vs placebo (hazard ratio, 0.48; 95% confidence interval CI, 0.35‐0.67; P < .00001). This exploratory analysis reports the outcomes of the subgroup of patients with lung NETs. In RADIANT‐4, patients were randomized (2:1) to everolimus 10 mg/d or placebo, both with best supportive care. This is a post hoc analysis of the lung subgroup with PFS, by central radiology review, as the primary endpoint; secondary endpoints included objective response rate and safety measures. Ninety of the 302 patients enrolled in the study had primary lung NET (everolimus, n = 63; placebo, n = 27). Median PFS (95% CI) by central review was 9.2 (6.8‐10.9) months in the everolimus arm vs 3.6 (1.9‐5.1) months in the placebo arm (hazard ratio, 0.50; 95% CI, 0.28‐0.88). More patients who received everolimus (58%) experienced tumor shrinkage compared with placebo (13%). Most frequently reported (≥5% incidence) grade 3‐4 drug‐related adverse events (everolimus vs. placebo) included stomatitis (11% vs. 0%), hyperglycemia (10% vs. 0%), and any infections (8% vs. 0%). In patients with advanced, progressive, well‐differentiated, non‐functional lung NET, treatment with everolimus was associated with a median PFS improvement of 5.6 months, with a safety profile similar to that of the overall RADIANT‐4 cohort. These results support the use of everolimus in patients with advanced, non‐functional lung NET. The trial is registered with ClinicalTrials.gov (no. NCT01524783).
This exploratory subgroup analysis of the RADIANT‐4 study is the first study to demonstrate that everolimus, a systemic targeted therapy, was associated with clinically meaningful improvement of 5.6 months in the median progression‐free survival with 50% reduction in risk of disease progression or death compared to placebo, in patients with advanced, progressive, well‐differentiated, nonfunctional lung neuroendocrine tumors (NET). This is the largest lung NET population ever included in a phase 3 trial.
•A land management decision process was conducted in the Cuitzmala watershed (Mexico).•An iterative transdisciplinary research approach was applied.•Qualitative and quantitative data was generated in ...the process.•The data was handled with the new software OPTamos.•The results from OPTamos provided impetus to stakeholder discussions and agreement on next steps.
Payments for Ecosystem Services (PES) are incentives offered to land owners or managers in exchange for practices that benefit society with ecological goods and/or services. For the success of PES schemes, the involvement of stakeholders, their needs, knowledge, and perspectives has been found beneficial. This paper presents a new approach in engaging stakeholders based on an iterative transdisciplinary framework for a Social Multi-Criteria Evaluation (SMCE) decision-making process. After a comprehensive review of existing options, the paper describes the development and application of a new software, OPTamos, to allow for efficient handling and processing of large volumes of quantitative and qualitative data generated from stakeholder workshops. Applied to a land use related decision in the Cuitzmala watershed, in the state of Jalisco in Mexico, the outcomes from this approach resulted in acceptable land management options for the entire area of the watershed that satisfied criteria generated by the stakeholders themselves and to finally develop an action plan.
Fecal occult blood tests (FOBT) are colorectal cancer screening tests used to identify individuals requiring further investigation with colonoscopy. Delayed colonoscopy after positive FOBT (FOBT+) is ...associated with poorer cancer outcomes. We assessed the effect of comorbidity on colonoscopy receipt within 12 months after FOBT+.
Population-based healthcare databases from Ontario, Canada, were linked to assemble a cohort of 50-74-year-olds with FOBT+ results between 2008 and 2017. The associations between comorbidities and colonoscopy receipt within 12 months after FOBT+ were examined using multivariable cause-specific hazard regression models.
Of 168,701 individuals with FOBT+, 80.5% received colonoscopy within 12 months. In multivariable models, renal failure (hazard ratio, HR 0.71, 95% confidence interval, CI 0.62 to 0.82), heart failure (HR 0.77, CI 0.75 to 0.80), and serious mental illness (HR 0.88, CI 0.85 to 0.92) were associated with the lowest colonoscopy rates, compared to not having each condition. The number of medical conditions was inversely associated with colonoscopy uptake (≥4 vs. 0: HR 0.64, CI 0.58 to 0.69; 3 vs. 0: HR 0.75, CI 0.72 to 0.78; 2 vs. 0: HR 0.87, CI 0.85 to 0.89). Having both medical and mental illness was associated with lower colonoscopy uptake relative to no comorbidity (HR 0.88, CI 0.87 to 0.90).
Persons with medical and mental health conditions had lower colonoscopy rates after FOBT+ than those without these conditions. Better strategies are needed to optimize colorectal cancer screening and follow-up in individuals with comorbidities.
In the past decades, the Caribbean economy has transformed to rely primarily on tourism with a vast amount of infrastructure dedicated to this sector. At the same time, the region is subject to ...repeated crises in the form of extreme weather events that are becoming more frequent, deadly, and costly. Damages to buildings and infrastructure (or the material stocks) from storms disrupt the local economy by an immediate decline in tourists and loss of critical services. In Antigua and Barbuda (A&B), tourism contributes 80% to the GDP and is a major driver for adding new material stocks to support the industry. This research analyzes A&B’s material stocks (MSs) in buildings (aggregates, timber, concrete, and steel) using geographic information systems (GIS) with physical parameters such as building size and footprint, material intensity, and the number of floors. In 2004, the total MSs of buildings was estimated at 4.7 million tonnes (mt), equivalent to 58.5 tonnes per capita, with the share of non-metallic minerals to be highest (2.9 mt), followed by aggregates (1.2 mt), steel (0.44 mt), and timber (0.18 mt). Under the National Oceanic and Atmospheric Administration’s (NOAA’s) 2 meter (m) sea level rise scenario, an estimated 4% of the island’s total MSs would be exposed. The tourism sector would disproportionately experience the greatest exposure of 19% of its MSs. By linking stocks to services, our research contributes to the understanding of the complexities between the environmental and economic vulnerability of island systems, and the need for better infrastructure planning as part of resilience building.
This article is the result of the North American Neuroendocrine Tumor Society consensus conference on the medical management of pancreatic neuroendocrine tumors from July 19 to 20, 2018. The ...guidelines panel consisted of medical oncologists, pathologists, gastroenterologists, endocrinologists, and radiologists. The panel reviewed a series of questions regarding the medical management of patients with pancreatic neuroendocrine tumors as well as questions regarding surveillance after resection. The available literature was reviewed for each of the question and panel members voted on controversial topics, and the recommendations were included in a document circulated to all panel members for a final approval.
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