Psychosocial Morbidity and its Correlates in Cancer Patients of the Mediterranean Area: Findings from the Southern European Psycho-Oncology Study

BACKGROUND: A few and partial data are available on psychosocial morbidity among cancer patients in Mediterranean countries. As a part of a more general investigation (Southern European Psycho-Oncology Study-SEPOS), the rate of psychosocial morbidity and its correlation with clinical and cultural variables were examined in cancer patients in Italy, Portugal and Spain. METHODS: A convenience sample of cancer outpatients with good performance status and no cognitive impairment were approached. The Hospital Anxiety-Depression scale (HAD-S), the Mini-Mental Adjustment to Cancer scale (Mini-MAC), and the Cancer Worries Inventory (CWI) were used to measure psychological morbidity, coping strategies and concerns about illness. RESULTS: Of 277 patients, 34% had pathological scores ("borderline cases" plus "true cases") on HAD-S Anxiety and 24.9% on HAD-S Depression. Total psychiatric "caseness" was 28.5% and 16.6%, according to different HAD cut-offs (14 and 19, respectively). Significant relationships of HAD-S Anxiety, HAD-S Depression, HAD-S Total score, with Mini-MAC Hopeless and Anxious Preoccupation, and CWI score were found. No differences emerged between countries on psychosocial morbidity, while some differences emerged between the countries on coping mechanisms. Furthermore, Fatalism, Avoidance and marginally Hopeless were higher compared to studies carried out in English-speaking countries. LIMITATIONS: The relatively small sample size and the good performance status prevent us to generalize data on patients with different cancer sites and advanced phase of illness. CONCLUSIONS: One-third of the patients presented anxiety and depressive morbidity, with significant differences in characteristics of coping in Mediterranean countries in comparison with English-speaking countries.

The EU as a security provider in its neighbourhood: the case of non-proliferation of WMD in the Mediterranean area

As a consequence of the terrorist attacks of 9/11 and the US-led war against Iraq, WMD and their proliferation have become a central element of the EU security agenda. In December 2003, the European Council adopted even a EU Strategy against Proliferation of WMD. The approach adopted in this Strategy can be largely described as a ‘cooperative security provider’ approach and is based on effective multilateralism, the promotion of a stable international and regional environment and the cooperation with key partners. The principal objective of this paper is to examine in how far the EU has actually implemented the ‘cooperative security provider’ approach in the area which the Non-proliferation Strategy identifies as one of its priorities – the Mediterranean. Focusing on the concept of security interdependence, the paper analyses first the various WMD dangers with which the EU is confronted in the Mediterranean area. Afterwards, it examines how the EU has responded to these hazards in the framework of the Barcelona process and, in particular, the new European Neighbourhood Policy. It is argued that despite its relatively powerful rhetoric, the EU has largely failed, for a wide range of reasons, to apply effectively its non-proliferation approach in the Mediterranean area and, thus, to become a successful security provider.

Characterization of Mycobacterium tuberculosis Beijing isolates from the Mediterranean area

BACKGROUND. The Beijing lineage of Mycobacterium tuberculosis is causing concern due to its global distribution and its involvement in severe outbreaks. Studies focused on this lineage are mainly restricted to geographical settings where its prevalence is high, whereas those in other areas are scarce. In this study, we analyze Beijing isolates in the Mediterranean area, where this lineage is not prevalent and is mainly associated with immigrant cases. RESULTS. Only 1% (N = 26) of the isolates from two population-based studies in Spain corresponded to Beijing strains, most of which were pan-susceptible and from Peruvian and Ecuadorian patients. Restriction fragment length polymorphism typing with the insertion sequence IS6110 identified three small clusters (2-3 cases). Mycobacterial interspersed repetitive unit-variable number tandem repeat typing (MIRU-15) offered low discriminatory power, requiring the introduction of five additional loci. A selection of the Beijing isolates identified in the Spanish sample, together with a sample of Beijing strains from Italy, to broaden the analysis context in the Mediterranean area, were assayed in an infection model with THP-1 cells. A wide range of intracellular growth rates was observed with only two isolates showing an increased intracellular replication, in both cases associated with contained production of TNF-alpha. No correlation was observed between virulence and the Beijing phylogenetic group, clustered/orphan status, or resistance. The Beijing strain responsible for extensive spread on Gran Canaria Island was also identified in Madrid, but did not lead to secondary cases and did not show high infectivity in the infection model. CONCLUSIONS. The Beijing lineage in our area is a non-homogeneous family, with only certain highly virulent representatives. The specific characterization of Beijing isolates in different settings could help us to accurately identify the virulent representatives before making general assumptions about this lineage.

Social perceptions of floods and flood management in a Mediterranean area (Costa Brava, Spain)

Taking as an example three study cases in the Costa Brava area, this paper examines the social perceptionof floods through surveys, interviews and Focus Group sessions. Perception is then related to vulnerability, flood management, and citizen’s preferences regarding alternatives to curb flood losses in the future. The study concludes that flood awareness and the willingness to take actions regarding this hazard are clearly related to the degree of social involvement with the affairs of the local community. Furthermore, participatory settings such as Focus Group sessions appear to enable a better environment for assessing and implementing flood management options that attempt to modify human activities rather than modify natural processes as has been frequently the case in the past

Anomalous rainfall and associated atmospheric circulation in the northeast Spanish Mediterranean area and its relationship to sediment fluidization events in a lake

Changes in the dynamics of sediment transport in a Mediterranean lake (sediment fluidization events) are linked to atmospheric circulations patterns (trough monthly precipitation). In the basins of Lake Banyoles, located in the northeast of Spain, water enters mainly through subterranean springs, and associated fluctuations in the vertical migration of sediment distribution (fluidization events) present episodic behavior as a result of episodic rainfall in the area. The initiation of the fluidization events takes place when the monthly rainfall is ∼2.7 times greater than the mean monthly rainfall of the rainiest months in the area, especially in spring (April and May), October, and December. The duration of these events is found to be well correlated with the accumulated rainfall of the preceding 10 months before the process initiation. The rainfall, in turn, is mainly associated with six atmospheric circulation patterns among the 19 fundamental circulations that emerged in an earlier study focused on significant rainfall days in Mediterranean Spain. Among them, accentuated surface lows over the northeast of Spain, general northeasterly winds by low pressure centered to the east of Balearic Islands and short baroclinic waves over the Iberian Peninsula, with easterly flows over the northeastern coast of Spain, are found the most relevant atmospheric circulations that drive heavy rainfall events

Distribution Patterns of Soil Properties in a Rural Mediterranean Area in Northeastern Spain

Soil properties on the Cap de Creus Peninsula, NE Spain depend primarily on scarce agricultural practices and early abandonment. In the study area, 90% of which is mainly covered by Cistus shrubs, 8 environments representing variations in land use/land cover and soil properties at different depths were identified. In each environment variously vegetated areas were selected and sampled. The soils, collected at different depths, were classified as Lithic Xerorthents according to the United States Department of Agriculture system of soil classification (USDA-NRCS 1975). Differences in soil properties were largely found according to the evolution of the plant canopy and the land use history. To identify underlying patterns in soil properties related to environmental evolution, factor analysis was performed and factor scores were used to determine how the factor patterns varied between soil variables, soil depths and selected environments. The three-factor model always accounted for 80% of the total variation in the data at the different soil depths. Organic matter was the more relevant soil property at 0–2 cm depth, whereas active minerals (silt and clay) were found to be the most relevant soil parameters controlling soil dynamics at the other depths investigated. Results showed that vineyards and olive tree soils are poorly developed and present worse conditions for mineral and organic compounds. Analysis of factor scores allowed independent assessment of soils, depth and plant cover and demonstrated that soils present the best physico-chemical characteristics under Erica arborea and meadows. In contrast, soils under Cistus monspeliensis were less nutrient rich and less well structured

Persistence and effectiveness of pyrethroids in plastic strips against Varroa jacobsoni (Acari : Varroidae) and mite resistance in a mediterranean area

An apiary trial was conducted in 1997 in Sardinia, Italy, to verify the effectiveness of fluvalinate in polyvinyl chloride strips and flumethrin in polyethylene strips against Varroa jacobsoni Oudemans. Two indices to evaluate the efficacy of the treatments were adopted: percentage change in mite infestation of worker-sealed brood cells considering only treated hives and percentage change in mite mortality, and the natural variation in mite populations recorded in control hives during the trial. All acaricide treatments reduced the level of mite infestation of both sealed brood and adult bees. However, their effectiveness was slightly reduced in comparison to previous studies because of mite resistance phenomena. Portions of polyethylene strips of flumethrin from treated hives were sampled weekly to determine acaricide persistence using gas chromatography. After 4 wk, a slight reduction (approximate to9%) of the active ingredient content was observed, A laboratory bioassay also was performed to establish the resistance of adult female mites to fluvalinate, Mites were sampled from the experimental apiary and from various Sardinian apiaries which had primarily been subjected to fluvalinate applications in plastic strips or wood inserts for years. Mite resistance varied from 0 to 96%, depending on the acaricide management adopted, the lowest resistance level occurred in an apiary where pyrethroids had never been used, whereas the highest level occurred in an apiary with intensive use of fluvalinate in wood inserts.

Modelización de servicios ecosistémicos en una cuenca hidrológica del área mediterránea = Modeling ecosystem services in a mediterranean area river basin

La modelización es un proceso por el que se obtienen modelos de los procesos del ´mundo real´ mediante la utilización de simplificaciones. Sin embargo, las estimaciones obtenidas con el modelo llevan implícitas incertidumbre que se debe evaluar. Mediante un análisis de sensibilidad se puede mejorar la confianza en los resultados, sin embargo, este paso a veces no se realiza debido básicamente al trabajo que lleva consigo este tipo de análisis. Además, al crear un modelo, hay que mantener un equilibrio entre la obtención de resultados lo más exactos posible mediante un modelo lo más sencillo posible. Por ello, una vez creado un modelo, es imprescindible comprobar si es necesario o no incluir más procesos que en un principio no se habían incluido. Los servicios ecosistémicos son los procesos mediante los cuales los ecosistemas mantienen y satisfacen el bienestar humano. La importancia que los servicios ecosistémicos y sus beneficios asociados tienen, junto con la necesidad de realizar una buena gestión de los mismos, han estimulado la aparición de modelos y herramientas para cuantificarlos. InVEST (Integrated Valuation of Ecosystem Services and Tradoffs) es una de estas herramientas específicas para calcular servicios eco-sistémicos, desarrollada por Natural Capital Project (Universidad de Stanford, EEUU). Como resultado del creciente interés en calcular los servicios eco-sistémicos, se prevé un incremento en la aplicación del InVEST. La investigación desarrollada en esta Tesis pretende ayudar en esas otras importantes fases necesarias después de la creación de un modelo, abarcando los dos siguientes trabajos. El primero es la aplicación de un análisis de sensibilidad al modelo en una cuenca concreta mediante la metodología más adecuada. El segundo es relativo a los procesos dentro de la corriente fluvial que actualmente no se incluyen en el modelo mediante la creación y aplicación de una metodología que estudiara el papel que juegan estos procesos en el modelo InVEST de retención de nutrientes en el área de estudio. Los resultados de esta Tesis contribuirán a comprender la incertidumbre involucrada en el proceso de modelado. También pondrá de manifiesto la necesidad de comprobar el comportamiento de un modelo antes de utilizarlo y en el momento de interpretar los resultados obtenidos. El trabajo en esta Tesis contribuirá a mejorar la plataforma InVEST, que es una herramienta importante en el ámbito de los servicios de los ecosistemas. Dicho trabajo beneficiará a los futuros usuarios de la herramienta, ya sean investigadores (en investigaciones futuras), o técnicos (en futuros trabajos de toma de decisiones o gestión ecosistemas). ABSTRACT Modeling is the process to idealize real-world situations through simplifications in order to obtain a model. However, model estimations lead to uncertainties that have to be evaluated formally. The role of the sensitivity analysis (SA) is to assign model output uncertainty based on the inputs and can increase confidence in model, however, it is often omitted in modelling, usually as a result of the growing effort it involves. In addition, the balance between accuracy and simplicity is not easy to assess. For this reason, when a model is developed, it is necessary to test it in order to understand its behavior and to include, if necessary, more complexity to get a better response. Ecosystem services are the conditions and processes through which natural ecosystems, and their constituent species, sustain and fulfill human life. The relevance of ecosystem services and the need to better manage them and their associated benefits have stimulated the emergence of models and tools to measure them. InVEST, Integrated Valuation of Ecosystem Services and Tradoffs, is one of these ecosystem services-specific tools developed by the Natural Capital Project (Stanford University, USA). As a result of the growing interest in measuring ecosystem services, the use of InVEST is anticipated to grow exponentially in the coming years. However, apart from model development, making a model involves other crucial stages such as its evaluation and application in order to validate estimations. The work developed in this thesis tries to help in this relevant and imperative phase of the modeling process, and does so in two different ways. The first one is to conduct a sensitivity analysis of the model, which consists in choosing and applying a methodology in an area and analyzing the results obtained. The second is related to the in-stream processes that are not modeled in the current model, and consists in creating and applying a methodology for testing the streams role in the InVEST nutrient retention model in a case study, analyzing the results obtained. The results of this Thesis will contribute to the understanding of the uncertainties involved in the modeling process. It will also illustrate the need to check the behavior of every model developed before putting them in production and illustrate the importance of understanding their behavior in terms of correctly interpreting the results obtained in light of uncertainty. The work in this thesis will contribute to improve the InVEST platform, which is an important tool in the field of ecosystem services. Such work will benefit future users, whether they are researchers (in their future research), or technicians (in their future work in ecosystem conservation or management decisions).

Modelización de servicios ecosistémicos en una cuenca hidrológica del área mediterránea = Modeling ecosystem services in a mediterranean area river basin

La modelización es un proceso por el que se obtienen modelos de los procesos del ´mundo real´ mediante la utilización de simplificaciones. Sin embargo, las estimaciones obtenidas con el modelo llevan implícitas incertidumbre que se debe evaluar. Mediante un análisis de sensibilidad se puede mejorar la confianza en los resultados, sin embargo, este paso a veces no se realiza debido básicamente al trabajo que lleva consigo este tipo de análisis. Además, al crear un modelo, hay que mantener un equilibrio entre la obtención de resultados lo más exactos posible mediante un modelo lo más sencillo posible. Por ello, una vez creado un modelo, es imprescindible comprobar si es necesario o no incluir más procesos que en un principio no se habían incluido. Los servicios ecosistémicos son los procesos mediante los cuales los ecosistemas mantienen y satisfacen el bienestar humano. La importancia que los servicios ecosistémicos y sus beneficios asociados tienen, junto con la necesidad de realizar una buena gestión de los mismos, han estimulado la aparición de modelos y herramientas para cuantificarlos. InVEST (Integrated Valuation of Ecosystem Services and Tradoffs) es una de estas herramientas específicas para calcular servicios eco-sistémicos, desarrollada por Natural Capital Project (Universidad de Stanford, EEUU). Como resultado del creciente interés en calcular los servicios eco-sistémicos, se prevé un incremento en la aplicación del InVEST. La investigación desarrollada en esta Tesis pretende ayudar en esas otras importantes fases necesarias después de la creación de un modelo, abarcando los dos siguientes trabajos. El primero es la aplicación de un análisis de sensibilidad al modelo en una cuenca concreta mediante la metodología más adecuada. El segundo es relativo a los procesos dentro de la corriente fluvial que actualmente no se incluyen en el modelo mediante la creación y aplicación de una metodología que estudiara el papel que juegan estos procesos en el modelo InVEST de retención de nutrientes en el área de estudio. Los resultados de esta Tesis contribuirán a comprender la incertidumbre involucrada en el proceso de modelado. También pondrá de manifiesto la necesidad de comprobar el comportamiento de un modelo antes de utilizarlo y en el momento de interpretar los resultados obtenidos. El trabajo en esta Tesis contribuirá a mejorar la plataforma InVEST, que es una herramienta importante en el ámbito de los servicios de los ecosistemas. Dicho trabajo beneficiará a los futuros usuarios de la herramienta, ya sean investigadores (en investigaciones futuras), o técnicos (en futuros trabajos de toma de decisiones o gestión ecosistemas). ABSTRACT Modeling is the process to idealize real-world situations through simplifications in order to obtain a model. However, model estimations lead to uncertainties that have to be evaluated formally. The role of the sensitivity analysis (SA) is to assign model output uncertainty based on the inputs and can increase confidence in model, however, it is often omitted in modelling, usually as a result of the growing effort it involves. In addition, the balance between accuracy and simplicity is not easy to assess. For this reason, when a model is developed, it is necessary to test it in order to understand its behavior and to include, if necessary, more complexity to get a better response. Ecosystem services are the conditions and processes through which natural ecosystems, and their constituent species, sustain and fulfill human life. The relevance of ecosystem services and the need to better manage them and their associated benefits have stimulated the emergence of models and tools to measure them. InVEST, Integrated Valuation of Ecosystem Services and Tradoffs, is one of these ecosystem services-specific tools developed by the Natural Capital Project (Stanford University, USA). As a result of the growing interest in measuring ecosystem services, the use of InVEST is anticipated to grow exponentially in the coming years. However, apart from model development, making a model involves other crucial stages such as its evaluation and application in order to validate estimations. The work developed in this thesis tries to help in this relevant and imperative phase of the modeling process, and does so in two different ways. The first one is to conduct a sensitivity analysis of the model, which consists in choosing and applying a methodology in an area and analyzing the results obtained. The second is related to the in-stream processes that are not modeled in the current model, and consists in creating and applying a methodology for testing the streams role in the InVEST nutrient retention model in a case study, analyzing the results obtained. The results of this Thesis will contribute to the understanding of the uncertainties involved in the modeling process. It will also illustrate the need to check the behavior of every model developed before putting them in production and illustrate the importance of understanding their behavior in terms of correctly interpreting the results obtained in light of uncertainty. The work in this thesis will contribute to improve the InVEST platform, which is an important tool in the field of ecosystem services. Such work will benefit future users, whether they are researchers (in their future research), or technicians (in their future work in ecosystem conservation or management decisions).

Is Microarray Analysis Really Useful and Sufficient to Diagnose Nut Allergy in the Mediterranean Area?

Background: Component-based diagnosis on multiplex platforms is widely used in food allergy but its clinical performance has not been evaluated in nut allergy. Objective: To assess the diagnostic performance of a commercial protein microarray in the determination of specific IgE (sIgE) in peanut, hazelnut, and walnut allergy. Methods: sIgE was measured in 36 peanut-allergic, 36 hazelnut-allergic, and 44 walnut-allergic patients by ISAC 112, and subsequently, sIgE against available components was determined by ImmunoCAP in patients with negative ISAC results. ImmunoCAP was also used to measure sIgE to Ara h 9, Cor a 8, and Jug r 3 in a subgroup of lipid transfer protein (LTP)-sensitized nut-allergic patients (positive skin prick test to LTP-enriched extract). sIgE levels by ImmunoCAP were compared with ISAC ranges. Results: Most peanut-, hazelnut-, and walnut-allergic patients were sensitized to the corresponding nut LTP (Ara h 9, 66.7%; Cor a 8, 80.5%; Jug r 3, 84% respectively). However, ISAC did not detect sIgE in 33.3% of peanut-allergic patients, 13.9% of hazelnut-allergic patients, or 13.6% of walnut-allergic patients. sIgE determination by ImmunoCAP detected sensitization to Ara h 9, Cor a 8, and Jug r 3 in, respectively, 61.5% of peanut-allergic patients, 60% of hazelnut-allergic patients, and 88.3% of walnut-allergic patients with negative ISAC results. In the subgroup of peach LTP?sensitized patients, Ara h 9 sIgE was detected in more cases by ImmunoCAP than by ISAC (94.4% vs 72.2%, P<.05). Similar rates of Cor a 8 and Jug r 3 sensitization were detected by both techniques. Conclusions: The diagnostic performance of ISAC was adequate for hazelnut and walnut allergy but not for peanut allergy. sIgE sensitivity against Ara h 9 in ISAC needs to be improved.

Explaining the saproxylic beetle diversity of a protected Mediterranean area

Saproxylic beetle diversity is high at the Cabañeros National Park (central Spain), where woodland habitats exhibit remarkable heterogeneity. Our aim was to explain the diversity of saproxylic beetles, focusing on species turnover among mature woodland types. We surveyed five woodland types that represented the heterogeneity of the park’s woodland habitats. Beetles were collected using window traps over a period of 20 months. The Jaccard Similarity Index was used as indirect value of beta diversity among woodlands and to test the relation between species turnover and geographical distance. We also identified the contribution of species turnover to landscape diversity by using a partitioning model. Moreover, the presence of mixed woodlands (more than one tree species) allowed us to attempt to valorise the effect of tree species (coupled with their historical management) on species turnover among woodlands. Finally, we looked for different saproxylic beetle preferences for habitat and tree species using an indicator value method. We found that saproxylic beetle species composition varied significantly among the studied woodlands. The variation in species turnover was independent from the distance among woodlands, which suggested that beetle dispersal abilities could not explain this high turnover. Tree species within woodlands were a key factor that increased diversity turnover in woodlands and, consequently, the diversity of the park. Moreover, we found saproxylic beetle species that had different habitat and tree species preferences. We conclude that woodland heterogeneity (highly affected by woodland composition) seems to be the driving force for saproxylic beetle diversity in this protected area.