Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with ...synchronous colorectal cancer and liver metastases with a focus on terminology, diagnosis and management.
This project was a multi-organisational, multidisciplinary consensus. The consensus group produced statements which focused on terminology, diagnosis and management. Statements were refined during an online Delphi process and those with 70% agreement or above were reviewed at a final meeting. Iterations of the report were shared by electronic mail to arrive at a final agreed document comprising twelve key statements.
Synchronous liver metastases are those detected at the time of presentation of the primary tumour. The term “early metachronous metastases” applies to those absent at presentation but detected within 12 months of diagnosis of the primary tumour with “late metachronous metastases” applied to those detected after 12 months. Disappearing metastases applies to lesions which are no longer detectable on MR scan after systemic chemotherapy. Guidance was provided on the recommended composition of tumour boards and clinical assessment in emergency and elective settings. The consensus focused on treatment pathways including systemic chemotherapy, synchronous surgery and the staged approach with either colorectal or liver-directed surgery as first step. Management of pulmonary metastases and the role of minimally invasive surgery was discussed.
The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.
The sustainable management of coupled social-ecological systems, such as water resource systems, requires institutional mechanisms for managing uncertainties and building more resilient ...social-ecological systems. Adaptive governance is an outcome of the search for a way to manage uncertainties and complexities within social-ecological systems. The concept of adaptive governance has emerged as a product of resilience theory and theoretical insights on common pool resources management. Adaptive governance refers to flexible multi-level institutions that connect state and non-state actors to facilitate a collaborative and learning-based approach to ecosystem management. As such, it has the potential to integrate social considerations into the decision process while also dealing with uncertainties in complex water resource systems. However, little is understood on how transitions toward adaptive governance systems take place and what criteria qualify a given institutional mechanism as an adaptive governance regime. This thesis presents results on a study that was aimed at understanding the process and outcomes of transitions toward adaptive water governance by using the Cache River Joint Venture Partnership (CRWJVP) within the Cache River Watershed in Southern Illinois as a case study. Qualitative data for the study were generated through key informant interviews among members of the CRWJVP and other knowledgeable actors, document review, and participant observation. The results revealed that the transformation of the governance of the Cache River watershed through the emergence of the CRWJVP was the result of ecological crises that began a citizen-led effort to preserve the Cache River wetlands. Additionally, the transition process was facilitated through trust-building, incentives, leadership, enabling legislation, and the role of bridging organizations. The results also showed that when compared to the attributes of an adaptive governance system, the current governance system of the Cache River watershed does not fully exhibit all the ideal attributes. However, the CRWJVP is moving towards an adaptive governance regime through the recent utilization of decision-making processes for recognizing and managing conflicts and uncertainties in the management of the watershed. Barriers in the transition process and recommendations for overcoming them are also discussed in the thesis. In all, findings from this study should be of relevance to scientists and decision-makers interested in understanding and enhancing transitions toward adaptive governance for the sustainable management of land and water resources in the Cache River watershed and elsewhere.
The sustainable management of coupled social-ecological systems, such as water resource systems, requires institutional mechanisms for managing uncertainties and building more resilient ...social-ecological systems. Adaptive governance is an outcome of the search for a way to manage uncertainties and complexities within social-ecological systems. The concept of adaptive governance has emerged as a product of resilience theory and theoretical insights on common pool resources management. Adaptive governance refers to flexible multi-level institutions that connect state and non-state actors to facilitate a collaborative and learning-based approach to ecosystem management. As such, it has the potential to integrate social considerations into the decision process while also dealing with uncertainties in complex water resource systems. However, little is understood on how transitions toward adaptive governance systems take place and what criteria qualify a given institutional mechanism as an adaptive governance regime.
This thesis presents results on a study that was aimed at understanding the process and outcomes of transitions toward adaptive water governance by using the Cache River Joint Venture Partnership (CRWJVP) within the Cache River Watershed in Southern Illinois as a case study. Qualitative data for the study were generated through key informant interviews among members of the CRWJVP and other knowledgeable actors, document review, and participant observation. The results revealed that the transformation of the governance of the Cache River watershed through the emergence of the CRWJVP was the result of ecological crises that began a citizen-led effort to preserve the Cache River wetlands. Additionally, the transition process was facilitated through trust-building, incentives, leadership, enabling legislation, and the role of bridging organizations. The results also showed that when compared to the attributes of an adaptive governance system, the current governance system of the Cache River watershed does not fully exhibit all the ideal attributes. However, the CRWJVP is moving towards an adaptive governance regime through the recent utilization of decision-making processes for recognizing and managing conflicts and uncertainties in the management of the watershed. Barriers in the transition process and recommendations for overcoming them are also discussed in the thesis. In all, findings from this study should be of relevance to scientists and decision-makers interested in understanding and enhancing transitions toward adaptive governance for the sustainable management of land and water resources in the Cache River watershed and elsewhere.
Understanding the vulnerability of marine calcifiers to ocean acidification is a critical issue, especially in the Southern Ocean (SO), which is likely to be the one of the first, and most severely ...affected regions. Since the industrial revolution, ~30% of anthropogenic CO
2
has been absorbed by the global oceans. Average surface seawater pH levels have already decreased by 0.1 and are projected to decline by ~0.3 by the year 2100. This process, known as ocean acidification (OA), is shallowing the saturation horizon, which is the depth below which calcium carbonate (CaCO
3
) dissolves, likely increasing the vulnerability of many resident marine calcifiers to dissolution. The negative impact of OA may be seen first in species depositing more soluble CaCO
3
mineral phases such as aragonite and high-Mg calcite (HMC). Ocean warming could further exacerbate the effects of OA in these particular species. Here we combine a review and a quantitative meta-analysis to provide an overview of the current state of knowledge about skeletal mineralogy of major taxonomic groups of SO marine calcifiers and to make projections about how OA might affect a broad range of SO taxa. We consider a species' geographic range, skeletal mineralogy, biological traits, and potential strategies to overcome OA. The meta-analysis of studies investigating the effects of the OA on a range of biological responses such as shell state, development and growth rate illustrates that the response variation is largely dependent on mineralogical composition. Species-specific responses due to mineralogical composition indicate that taxa with calcitic, aragonitic, and HMC skeletons, could be at greater risk to expected future carbonate chemistry alterations, and low-Mg calcite (LMC) species could be mostly resilient to these changes. Environmental and biological control on the calcification process and/or Mg content in calcite, biological traits, and physiological processes are also expected to influence species-specific responses.
Coastal roadways with tall, full-spectrum streetlights along sea turtle nesting beaches present a challenge for managers seeking to balance protection of sea turtles with public safety. Many ...communities extinguish these lights during nesting season to avoid impacting nesting and hatchling sea turtles. Long-wavelength light emitting diodes (LEDs) offer an alternative for managers in these communities, but additional information on sea turtle response to these lights is warranted prior to installation. We conducted arena assays on Florida's west coast to evaluate hatchling orientation when exposed to a shielded, long-wavelength (624 nm) prototype lamp compared to an adjacent beach with the streetlights turned off. We compared orientation in test and control arenas simultaneously over two consecutive nights, recording crawl direction and timing for individual hatchlings. Hatchlings in test and control arenas oriented correctly toward the ocean in all trials, with no differences in hatchling dispersion or circling. Thus, the fully shielded, long-wavelength LED streetlight fixture tested provides an appropriate option to minimize impacts to sea turtles along coastal roadways throughout the Unites States and elsewhere. As such, this alternative solution to extinguishing necessary streetlights can aid coastal managers in concurrently protecting nesting habitat and providing light for public safety.
The growth and metabolic actions of growth hormone (GH) are believed to be mediated through the GH receptor (GHR) by JAK2 activation. The GHR exists as a constitutive homodimer, with signal ...transduction by ligand-induced realignment of receptor subunits. Based on the crystal structures, we identify a conformational change in the F'G' loop of the lower cytokine module, which results from binding of hGH but not G120R hGH antagonist. Mutations disabling this conformational change cause impairment of ERK but not JAK2 and STAT5 activation by the GHR in FDC-P1 cells. This results from the use of two associated tyrosine kinases by the GHR, with JAK2 activating STAT5, and Lyn activating ERK1/2. We provide evidence that Lyn signals through phospholipase Cγ, leading to activation of Ras. Accordingly, mice with mutations in the JAK2 association motif respond to GH with activation of hepatic Src and ERK1/2, but not JAK2/STAT5. We suggest that F'G' loop movement alters the signalling choice between JAK2 and a Src family kinase by regulating TMD realignment. Our findings could explain debilitated ERK but not STAT5 signalling in some GH-resistant dwarfs and suggest pathway-specific cytokine agonists.
Oct. 28--BREEDERS' CUP PHOTOGRAPHERS START THEIR DAYS EARLY: The Super Bowl of horse racing is coming to Lone Star Park on Saturday. The Breeders' Cup draws top horses from around the world to race ...for purses totaling $14 million, the richest day in horse racing. This is the first time the Breeders' Cup has been held in the Southwest. The Dallas Morning News will deploy a six-person photo team to cover the eight races that make up the Breeders' Cup. Covering a Breeders' Cup is like covering eight Kentucky Derbys in one day. Our photographers will use Canon EOS-1D Mark II digital bodies and lenses from 16 mm to 1200 mm on race day. The plan is to vary the views of the races to offer a complete visual package of the day, including the use of remotely fired cameras.
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