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Patient-reported outcome (PRO) questionnaires considered in this paper contain multiple subscales, although not all subscales are equally relevant for administration in all target patient populations. A group of measurement experts, developers, license holders, and other scientific-, regulatory-, payer-, and patient-focused stakeholders participated in a panel to discuss the benefits and challenges of a modular approach, defined here as administering a subset of subscales out of a multi-scaled PRO measure. This paper supports the position that it is acceptable, and sometimes preferable, to take a modular approach when administering PRO questionnaires, provided that certain conditions have been met and a rigorous selection process performed. Based on the experiences and perspectives of all stakeholders, using a modular approach can reduce patient burden and increase the relevancy of the items administered, and thereby improve measurement precision and eliminate wasted data without sacrificing the scientific validity and utility of the instrument. The panelists agreed that implementing a modular approach is not expected to have a meaningful impact on item responses, subscale scores, variability, reliability, validity, and effect size estimates; however, collecting additional evidence for the impact of context may be desirable. It is also important to recognize that adequate rationale and evidence (e.g., of fit-for-purpose status and relevance to patients) and a robust consensus process that includes patient perspectives are required to inform selection of subscales, as in any other measurement circumstance, is expected. We believe that the considerations discussed within (content validity, administration context, and psychometric factors) are relevant across multiple therapeutic areas. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this retrospective study was to determine the feasibility of measuring frailty using patient responses to relevant EORTC QLQ-C30 items as proxy criteria for the Fried Frailty Phenotype, in a cohort of patients with Relapsed/Refractory Multiple Myeloma (RRMM). Methods: Data were pooled from nine Phase III randomized clinical trials submitted to the FDA for regulatory review between 2010 and 2021, for the treatment of RRMM. Baseline EORTC QLQ-C30 responses were used to derive a patient-reported frailty phenotype (PRFP), based on the Fried definition of frailty. PRFP was assessed for internal consistency reliability, structural validity, and known groups validity. Results: This study demonstrated the feasibility of adapting patient responses to relevant EORTC QLQ-C30 items to serve as proxy Fried frailty criteria. Selected items were well correlated with one another and PRFP as a whole demonstrated adequate internal consistency reliability and structural validity. Known groups analysis demonstrated that PRFP could be used to detect distinct comorbidity levels and distinguish between different functional profiles, with frail patients reporting more difficulty in walking about, washing/dressing, and doing usual activities, as compared to their pre-frail and fit counterparts. Among the 4928 patients included in this study, PRFP classified 2729 (55.4%) patients as fit, 1209 (24.5%) as pre-frail, and 990 (20.1%) as frail. Conclusion: Constructing a frailty scale from existing PRO items commonly collected in cancer trials may be a patient-centric and practical approach to measuring frailty. Additional psychometric evaluation and research is warranted to further explore the utility of such an approach. [ABSTRACT FROM AUTHOR]

Protecting global biodiversity is one of the most urgent tasks for the coming decades. Area-based conservation is a pillar for preserving ecosystems and species. Strictly protected areas specifically preserve biodiversity and ecosystem processes. The "EU Biodiversity Strategy for 2030" targets strict protection for 10% of land area. Here we performed the first analysis of strictly protected areas (as IUCN type Ia, Ib, and II) across Europe, by investigating their area coverage at the level of biogeographical regions, countries and elevation gradients. We show that, with few exceptions, the amount of strictly protected area is very limited and the spatial distribution of such protected areas is biased towards higher elevation sites, as in the case of other protected areas. Then, we suggest that potential areas should be identified to expand strictly protected areas with low economic and social costs including, for instance, areas with high biodiversity value, low population, and low productive land use. Finally, we propose that a coordinated effort and a strategic plan to achieve continental-scale conservation are fundamental, and at least half of this land under strict conservation (i.e. 5%) should be under the protection categories Ia and Ib. [ABSTRACT FROM AUTHOR]

Cumulative area under protection (%) for each country is shown for all strictly protected areas in the upper panel and for the 3 different IUCN categories (Ia, Ib, and II) in the lower panels The original article has been corrected. Cumulative area under protection (%) for each biogeographical region is shown for all strictly protected areas in the upper panel and for the 3 different IUCN categories (Ia, Ib, and II) in the lower panels Graph: Fig. [Extracted from the article]

A universal construction is a general mechanism for obtaining a concurrent implementation of any shared object from its sequential implementation. We present the family of RedBlue universal constructions which produce adaptive, linearizable, wait-free, concurrent implementations of shared objects. The proposed universal constructions improve upon previous universal constructions in terms of their step and/or space complexity. The first of these universal constructions, which serves as the keystone for the design of the other RedBlue algorithms, produces concurrent implementations with better step complexity than those produced by all previously presented universal constructions but it uses large LL/SC registers. The second universal construction significantly reduces the size of the required registers, whereas the last two are appropriate for the purpose of simulating large objects. [ABSTRACT FROM AUTHOR]

Purpose: On August 2, 2017, the Food and Drug Administration approved ibrutinib (IMBRUVICA) for the treatment of patients with chronic graft versus host disease (cGVHD) after the failure of one or more lines of systemic therapy. The approval was based on results from a single-arm, multicenter trial that enrolled patients with refractory cGVHD. This paper describes the FDA review of patient-reported outcomes (PRO) data from Study PCYC-1129-CA and the decision to incorporate descriptive PRO data in the FDA label to support the primary clinician-reported outcome results.Methods: In this trial, the Lee Chronic GVHD Symptom Scale (LSS) was used to capture patient-reported symptom bother. The 42 patients who received treatment were included in the analysis and completed the PRO tool. Post hoc descriptive analyses were conducted to further understand the measurement properties of the LSS.Results: The analysis submitted to FDA reported that 18 patients had a ≥ 7-point improvement on the LSS overall summary score at any point during the assessment period. For 10 patients, the ≥ 7-point improvement was sustained for ≥ 2 consecutive PRO assessments. An assessment of the responder threshold suggested the threshold submitted to the FDA was reasonable and in line with clinical findings.Conclusions: Overall, study PCYC-1129-CA demonstrated favorable clinician-reported cGVHD efficacy results that were complemented by results from PRO data, supporting the FDA's positive benefit-risk assessment leading to regular approval. Limitations included the single-arm trial design, responder definition, and instrument shortcomings. These limitations were thoroughly explored through additional FDA post hoc analyses. [ABSTRACT FROM AUTHOR]

Ruderal plant species typically occur and prevail in frequently disturbed areas especially in sites with pronounced direct or indirect human activity. In Greece ruderal taxa (both exclusive and non-exclusive) account for 23.9% of all recorded plant taxa. This study presents an analysis of the ruderal plant diversity patterns in the 13 floristic regions of Greece and different aspects of ruderal diversity related to alien taxa and to taxa of conservation interest. Although many ruderal plant taxa are common and widespread, their contribution to the diversity of each floristic region ranges between 27.8% in the North Central and 41.6% in the Cyclades region. Spatial distribution analysis revealed that the ruderal flora presents higher frequency of occurrence in major urban areas, in coastal and low to medium elevation mainland and island areas. The total number of ruderal taxa per floristic region is strongly correlated with the total number of taxa per region. The richness in exclusive ruderal taxa is highly correlated with surface area proportions of settlements and other built-up areas, as well as with artificial land, wetlands, sparsely vegetated land and shrublands. Ruderals account for a greater proportion of taxa in species-poor regions than in species-rich ones. Patterns of ruderal taxa diversity proved to be rather complicated and different spatial scales must be considered if ruderal biodiversity of the cultural landscapes in Greece is to be preserved. [ABSTRACT FROM AUTHOR]

Background: Little is known on the impact of emerging treatments for advanced melanoma (stages III and IV) on patients' functioning and well-being. The objective of this study was to describe the patient-reported treatment-related symptom (TRS) burden in advanced melanoma.Method: Twenty-nine in-depth, qualitative interviews were conducted among adult patients with advanced melanoma in Canada using a semi-structured interview method. Interviews were transcribed verbatim, and key concepts were identified using a grounded theory analytic approach.Results: The 29 patients reported 13 unique treatment journeys involving the following drug therapy categories: cytotoxic chemotherapies, CTLA-4 inhibitors, BRAF or MEK inhibitors, and PD-1 inhibitors. Patients typically underwent multiple treatment episodes over time. Common TRSs included nausea, fatigue, diarrhea or constipation, and skin rashes. Patients described these as impacting their physical functioning, ability to perform activities of daily living, social functioning, and overall quality of life.Conclusion: Our findings provide a description of the patient's experience with treatment for advanced melanoma. Our sample included patients typically diagnosed in mid-life, facing an urgent sequence of medical procedures and a pharmacological treatment journey that was burdensome. There is a need for less toxic and more efficacious treatments earlier in the patient journey to alleviate the impact of advanced melanoma treatment on patients' health-related quality of life. [ABSTRACT FROM AUTHOR]

Background: Metastatic melanoma is a highly aggressive cancer, often striking in the prime of life. This study provides new information directly from advanced melanoma (stage III and IV) patients on how their disease impacts their health-related quality of life (HRQL).Methods: Twenty-nine in-depth, qualitative interviews were conducted with adult patients with advanced melanoma in Canada. A semi-structured interview guide was used. Interviews were transcribed verbatim and key concepts were identified using a grounded theory analytic approach.Results: Many patients' journeys began with the startling diagnosis of an invasive disease and a vastly shortened life expectancy. By the time they reached an advanced stage of melanoma, these patients' overall functioning and quality of life had been greatly diminished by this quickly progressing cancer. The impact was described in terms of physical pain and disability, emotional distress, diminished interactions with friends and family, and burden on caregivers.Conclusion: Our findings provide evidence of signs, symptoms, and functional impacts of advanced melanoma. Signs and symptoms reported (physical, mental, and social) confirm and expand on those reported in the existing clinical literature. Primary care physicians should be better trained to identify melanomas early. Oncology care teams can improve on their current approaches for helping patients navigate treatment options, with information about ancillary services to mitigate disease impacts on HRQL, such as mental health and social supports, as well as employment or financial support services. [ABSTRACT FROM AUTHOR]

Monitoring of habitat types conservation status is an essential task in the frame of the European policy for biodiversity conservation. The parameters to be assessed for the purposes of habitat types’ conservation status assessment are described in several European documents, but the methodology for their determination has not yet been standardized or optimized. This study presents methods for the assessment of the actual status and the future prospects of structure and functions of habitat types. Specifically, it presents a bottom-up approach for the assessment of these two parameters at different spatial scales. In the proposed method, conservation status assessment is based on a classification of habitat types to subtypes, with the latter representing the basic monitoring entities. The conservation status is assessed by recording: (i) the presence/absence of specific indicators of structure and functions per habitat type, and (ii) the presence/absence, abundance, and vitality of the typical species of the habitat subtypes. The typical species are determined objectively using algorithms and fidelity coefficient values. The conservation status and future prospects of structure and functions (including the typical species) are estimated quantitatively with the help of numerical methods and algorithms, but their assignment to conservation status classes is based on thresholds defined by experts. Assessments are made at the local scale, but can be upscaled to coarser ones (up to the national level). The proposed methods have been applied in Greece and were effective both in terms of results obtained and costs needed. [ABSTRACT FROM AUTHOR]

We present a collection of upper and lower bounds on the complexity of asynchronous, wait-free, linearizable, single-scanner snapshot implementations from read-write registers. We argue that at least m registers are needed to implement a single-scanner snapshot with m components and we prove that, in space-optimal implementations, SCANS execute $$\varOmega (m^2)$$ steps. We present an algorithm that runs in $$O(m^2)$$ steps and uses $$m+1$$ registers. We also present three implementations (namely, T-Opt, RT and RT-Opt) that beat the $$\varOmega (m^2)$$ lower bound by using more registers. Specifically, T-Opt has step complexity O(1) for UPDATE and O( m) for SCAN. This step complexity is optimal, but the number of registers that T-Opt uses is unbounded. We then present interesting recycling techniques to bound the number and the size of registers used, resulting in RT and RT-Opt. Specifically, RT-Opt, which has optimal step complexity, uses O( mn) bounded-size registers, where n is the total number of processes. Our implementations are the first with step complexities that are (linear or quadratic) functions only of m (and not of n). Moreover, T-Opt and RT-Opt are the first implementations with optimal step complexity. [ABSTRACT FROM AUTHOR]

Fire affects diversity and structure of flower-visitor communities. We explored the effect of fire history on the diversity patterns and structure of the flower-visitor guilds (bees, beetles, flies, sawflies, and wasps), across a post-fire regeneration sequence of pine forests in Rhodes Island, Greece. Fire history was defined by fire frequency and post-fire age of sites. We did not find significant differences in species richness and abundance per guild between fire-history regimes except for the abundance of flies, sawflies and the entire flower-visitor community. Fire strongly affected the community structure of bees, beetles, and sawflies. Some of the most abundant and common species responded significantly to fire in terms of abundance; yet, we observed no significant variation in the abundance of the common species of bees, the most prominent pollinator group, implying that provision of pollination services may not be considerably affected by fire. Long-unburnt sites displayed higher heterogeneity in species composition compared to recently-burnt sites (either burnt once or twice). This pattern deviated significantly from null expectations when analyzing the abundance-based metric of β-diversity and was obscure in the case of the presence/absence-based metric, indicating that fire affected mainly the spatial distribution of individuals, i.e. the main change is not due to species turnover but to changes in relative abundance. Furthermore, the species composition in recently-burnt sites (burnt once in 2008) were more similar than in twice-burnt sites (including areas burnt once between 1984 and 1992, and in 2008), indicating that fire frequency affected post-fire heterogeneity of species composition. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to develop and validate the Trust in Oncologist Scale (TiOS), which aims to measure cancer patients' trust in their oncologist. Structure, reliability and validity were examined.Methods: Construction of the TiOS was based on a multidimensional theoretical framework. Cancer patients were surveyed within a week after their consultation. Trust, satisfaction, trust in health care, self-reported health and background variables were assessed. Dimensionality, internal consistency, test-retest reliability and construct validity were investigated.Results: Data of 423 patients were included (response rate = 65%). After item reduction, the TiOS included 18 items. Trust scores were high. Exploratory factor analysis suggested one-dimensionality. Confirmatory factor analysis nevertheless indicated a reasonable fit of our four-dimensional theoretical model, distinguishing competence, fidelity, honesty and caring. Internal consistency and test-retest reliabilities were high. Good construct validity was indicated by moderate correlations of trust (TiOS) with satisfaction, trust in health care, willingness to recommend and number of consultations with the oncologist. Exploratory analyses suggested significant correlations of trust with ethnicity and age.Conclusions: The TiOS reliably and validly assesses cancer patients' trust in their oncologist. The questionnaire can be employed in both clinical practice and future research of cancer patients' trust. [ABSTRACT FROM AUTHOR]

Purpose: To illustrate how structural equation modeling (SEM) can be used for response shift detection with random measurement occasions and health state operationalized as fixed group membership (Study 1) or with fixed measurement occasions and health state operationalized as time-varying covariates (Study 2).Methods: In Study 1, we explored seven items of the Performance Scales measuring physical and mental aspects of perceived disability of 771 stable, 629 progressive, and 1,552 relapsing MS patients. Time lags between the three measurements varied and were accounted for by introducing time since diagnosis as an exogenous variable. In Study 2, we considered the SF-12 scales measuring physical and mental components of HRQoL of 1,767 patients. Health state was accounted for by exogenous variables relapse (yes/no) and symptoms (worse/same/better).Results: In Study 1, progressive and relapsing patients reported greater disability than stable patients but little longitudinal change. Some response shift was found with stable and relapsing patients. In Study 2, relapse and symptoms were associated with HRQoL, but no change and only little response shift was found.Conclusions: While small response shifts were found, they had little impact on the evaluation of true change in performance and HRQoL. [ABSTRACT FROM AUTHOR]

Trait selection is a critical step of functional diversity (FD) studies and is often hampered by the limited availability of trait data for large sets of species. Thus, most studies examine FD using traits determined primarily by the availability of data rather than a specific function. This practice implicitly assumes that the subset of functional traits available will be representative of the trait data of interest. Here, we test whether the different functional trait groups (FTGs-distinct axes of ecological niches of the species e.g. morphological, reproductive, physiological) show congruent FD spatial patterns and if one FTG could act as a surrogate for another FTG. We used data on the 85 amphibian species of Europe and 12 traits to estimate three aspects of FD (richness, evenness and dispersion) for three different FTGs (Morphological, Reproductive and Habitat-related) and the complete set of traits. Our results challenge the surrogacy value of one set of FTGs for another set of FTGs. We further found that this has an impact on identifying hotspots (different functions will have different hotspots). So the argument that FD is easier to preserve in less area due to the redundancy of traits may hold true for a specific function, but will not necessarily be the same for different functions. Finally, our results reveal that, for any given community, FD is not characterized by a single spatial pattern, but by many depending on the function analyzed. [ABSTRACT FROM AUTHOR]

EU conservation policy is primarily based on the Natura 2000 network of protected areas (PAs). We analyzed the land-cover changes between 2000 and 2006 inside 25,703 Natura 2000 sites in 24 EU Member States, and compared them with those observed outside the PAs. At the EU level, 'Artificial surfaces' and 'Agricultural areas' exhibit lower rates of transformation within PAs than outside. 'Forests and semi-natural areas' marginally increased inside PAs, while they marginally decreased outside. In States that joined the EU before 2000, landscape transformation rates were low, and inside PAs 'Forest' preservation was accompanied with a shift from intensive agricultural practices 'Permanent arable land' to more diverse 'Agricultural mosaics'. In new Member States (most of them located in Eastern Europe), there was agricultural abandonment, with conversion to 'Artificial surfaces' or 'Natural vegetation', both within and outside PAs. Broad scale EU policies (like the Common Agricultural Policy) and socio-economic drivers (like the transition from planned to market economy) seem to be dominant factors in explaining land-cover transformations, while conservation policies may moderate these trends inside PAs. [ABSTRACT FROM AUTHOR]

We study a simple technique, originally presented by Herlihy (ACM Trans. Program. Lang. Syst. 15(5):745-770, ), for executing concurrently, in a wait-free manner, blocks of code that have been programmed for sequential execution and require significant synchronization in order to be performed in parallel. We first present an implementation of this technique, called Sim, which employs a collect object. We describe a simple implementation of a collect object from a single shared object that supports atomic Add (or XOR) in addition to read; this implementation has step complexity O(1). By plugging in to Sim this implementation, Sim exhibits constant step complexity as well. This allows us to derive lower bounds on the step complexity of implementations of several shared objects, like Add, XOR, collect, and snapshot objects, from LL/SC objects. We then present a practical version of Sim, called PSim, which is implemented in a real shared-memory machine. From a theoretical perspective, PSim has worse step complexity than Sim, its theoretical analog; in practice though, we experimentally show that PSim is highly-efficient: it outperforms several state-of-the-art lock-based and lock-free synchronization techniques, and this given that it is wait-free, i.e. that it satisfies a stronger progress condition than all the algorithms that it outperforms. We have used PSim to get highly-efficient wait-free implementations of stacks and queues. [ABSTRACT FROM AUTHOR]

Abstract: Background: Depression is an important public health outcome in the older adult population. It is associated with declining physical and psychological well-being and increasing healthcare utilisation. The Center for Epidemiological Studies Depression Scale (CES-D) although widely accepted as a screening tool for depressive symptoms in older adults, can be long and exhaustive as part of a comprehensive geriatric assessment. Aim: We investigated the consistency, reliability and validity of the original and three short formats of the CES-D. Methods: Six thousand six hundred and thirty-seven community-living adults, aged ≥50years from The Irish Longitudinal Study on Ageing (TILDA), completed the 20-item CES-D. Confirmatory factor analysis determined the factor structures of the 20-, 10- and two 8-item formats of the CES-D. Latent factors from each format were validated against disability and perceived stress, particularly the Positive Affect factor. Analysis was also performed in a subset aged 65+years. Results: All formats of the CES-D displayed good internally consistency (0.87–0.72) and good model fit for the expected four- and three-factor structures of the CES-D. Latent factors from all formats were representative of each other and the Positive Affect factor was negatively correlated with disability and perceived stress on all CES-D formats. Conclusion: Short forms of the CES-D are consistent, reliable and valid for use in the older adult population (50+ or 65+years), where avoiding long assessments and response fatigue is warranted. These formats may be used to measure Positive Affect, an important construct related to physical health, resilience and psychological well-being in later life. [Copyright &y& Elsevier]

Purpose: The objectives of this study were to investigate the psychometric properties of the SF-36 in a sample of older adults with chronic conditions and to test whether measurement bias exists based on the levels of comorbidity. Methods: Participants included were 979 cognitively intact older adults with comorbidities who were interviewed at their homes. We examined the psychometric properties of the SF-36 and conducted confirmatory factor analysis (CFA) to investigate the assumption of measurement invariance by the levels of comorbidity. Results: Overall data quality was high and scaling assumptions were generally met with few exceptions. Floor and ceiling effects were present for the role-physical and role-emotional subscales. Using CFA, we found that a three-factor measurement model fits the data well. We identified two violations of measurement invariance. Results showed that participants with high comorbidity level place more emphasis on social functioning (SF) and bodily pain (BP) in relation to physical health-related quality of life (HRQoL) than those with low comorbidity level. Conclusions: Measurement bias was present for the SF and BP components of the SF-36 physical HRQoL measure. Researchers should be cautious when considering the use of SF-36 in clinical studies among older adults with comorbidities. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the validity of current measurement models for the control, autonomy, self-realisation, and pleasure (CASP) measure of quality of life (QoL)—a second-order four-factor CASP-19 model and a second-order three-factor CASP-12 version—in a recent population survey. A previous large sample study did not report good fit for these measurement models. The study also aims to re-develop the model and propose a well-fitting alternative. Methods: To evaluate the current measurement models, confirmatory factor analysis (CFA) was used. A cross-sectional sample ( n = 6,823) representative of the Irish community-dwelling population aged 50 and over was obtained from the Irish Longitudinal Study of Ageing (TILDA). Model revision was based on descriptive statistics, exploratory factor analysis and examination of fit diagnostic statistics. Revised models were tested using CFA. Results: The results of the CFA did not support the validity of the established measurement models. A reformulated 12-item, two-factor model comprising control/autonomy and self-realisation/pleasure, with residual covariances for negatively worded items, had excellent fit to the data (χ 2 161.90, df = 44, p < 0.001; RMSEA = 0.03, 90 % CI 0.02–0.03), and a clearer conceptual rationale. The same model with one overall QoL factor had similar excellent fit. Conclusions: We recommend the use of the single-factor model (CASP-R12) when assessing overall quality of life. The dimensions of control/autonomy and self-realisation/pleasure can be examined separately by researchers interested in those constructs. Researchers using structural equation modelling can use the well-fitting measurement model outlined here including adjustment for residual covariances. [ABSTRACT FROM AUTHOR]

Periodic monitoring of biodiversity changes at a landscape scale constitutes a key issue for conservation managers. Earth observation (EO) data offer a potential solution, through direct or indirect mapping of species or habitats. Most national and international programs rely on the use of land cover (LC) and/or land use (LU) classification systems. Yet, these are not as clearly relatable to biodiversity in comparison to habitat classifications, and provide less scope for monitoring. While a conversion from LC/LU classification to habitat classification can be of great utility, differences in definitions and criteria have so far limited the establishment of a unified approach for such translation between these two classification systems. Focusing on five Mediterranean NATURA 2000 sites, this paper considers the scope for three of the most commonly used global LC/LU taxonomies-CORINE Land Cover, the Food and Agricultural Organisation (FAO) land cover classification system (LCCS) and the International Geosphere-Biosphere Programme to be translated to habitat taxonomies. Through both quantitative and expert knowledge based qualitative analysis of selected taxonomies, FAO-LCCS turns out to be the best candidate to cope with the complexity of habitat description and provides a framework for EO and in situ data integration for habitat mapping, reducing uncertainties and class overlaps and bridging the gap between LC/LU and habitats domains for landscape monitoring-a major issue for conservation. This study also highlights the need to modify the FAO-LCCS hierarchical class description process to permit the addition of attributes based on class-specific expert knowledge to select multi-temporal (seasonal) EO data and improve classification. An application of LC/LU to habitat mapping is provided for a coastal Natura 2000 site with high classification accuracy as a result. [ABSTRACT FROM AUTHOR]

The Natura 2000 network was established across the European Union's (EU) Member States with the aim to conserve biodiversity, while ensuring the sustainability of human activities. However, to what kind and to what extent Natura 2000 sites are subject to human activities and how this varies across Member States remains unspecified. Here, we analyzed 111,269 human activity records from 14,727 protected sites in 20 Member States. The frequency of occurrence of activities differs among countries, with more than 86 % of all sites being subjected to agriculture or forestry. Activities like hunting, fishing, urbanization, transportation, and tourism are more frequently recorded in south European sites than in northern or eastern ones. The observed variations indicate that Natura 2000 networks are highly heterogeneous among EU Member States. Our analysis highlights the importance of agriculture in European landscapes and indicates possible targets for policy interventions at national, European, or 'sub-European' level. The strong human presence in the Natura 2000 network throughout Member States, shows that conservation initiatives could succeed only by combining social and ecological sustainability and by ensuring the integration of policies affecting biodiversity. [ABSTRACT FROM AUTHOR]

This study examined the assumption of measurement invariance of the SAMSHA Mental Health and Alcohol Abuse Stigma Assessment. This is necessary to make valid comparisons across time and groups. The data come from the Primary Care Research in Substance Abuse and Mental Health for Elderly trial, a longitudinal multisite, randomized trial examining two modes of care (Referral and Integrated). A sample of 1,198 adults over the age of 65 who screened positive for depression, anxiety, and/or at-risk drinking was used. Structural equation modeling was used to assess measurement invariance in a two-factor measurement model (Perceived Stigma, Comfort Level). Irrespective of their stigma level, one bias indicated that with time, respondents find it easier to acknowledge that it is difficult to start treatment if others know they are in treatment. Other biases indicated that sex, mental quality of life and the subject of stigma had undue influence on respondents' feeling people would think differently of them if they received treatment and on respondents' comfort in talking to a mental health provider. Still, in the present study, these biases in response behavior had little effect on the evaluation of group differences and changes in stigma. Stigma decreased for patients of both the Referral and Integrated care groups. [ABSTRACT FROM AUTHOR]

Objective: If the assumption of measurement invariance is not tested, we cannot be sure whether differences observed are due to true differences in health-related quality-of-life (HRQoL), or are measurement artifacts. We aim to investigate this assumption in a sample of heterogeneous cancer patients, focusing on whether age, sex, previous treatment for cancer, and information regarding treatment preferences result in biased HRQoL scores. Methods: 155 cancer patients who were about to begin their first session of radiotherapy were included. HRQoL was measured using the EORTC QLQ-C30. Structural equation modeling was applied to assess whether there was a violation of the assumption of invariance. Results: A satisfactory single construct (Functioning HRQoL) measurement model was found and two violations of invariance were identified. Irrespective of patients' Functioning HRQoL, older patients reported worse physical functioning and patients who had received treatment prior to radiotherapy reported worse emotional functioning than we would otherwise expect. Conclusions: In the present study, accounting for measurement bias lead to a substantial improvement in the overall fit of the model. By ignoring the bias, we would have concluded that the model fit was unsatisfactory. The findings underline the importance of investigating measurement invariance in scales designed for heterogeneous samples. [ABSTRACT FROM AUTHOR]

Grazing is one of the prevalent human activities that even today are taking place inside protected areas with direct or indirect effects on ecosystems. In this study we analyzed the effects of grazing on plant species diversity, plant functional group (PFG) diversity and community composition of shrublands. We analyzed plant diversity data from 582 sampling plots located in 66 protected areas of the Greek Natura 2000 network, containing in total 1102 plant species and subspecies. We also classified a priori all plant species in seven PFGs: annual forbs, annual grasses/sedges, legumes, perennial forbs, perennial grasses/sedges, small shrubs and tall shrubs. For each site, grazing intensity was estimated in four classes (no grazing, low, medium and high grazing intensity). We found that, at the spatial and temporal scale of this study, as grazing intensity increased, so did total species richness. However, each PFG displayed a different response to grazing. Short-lived species (annual grasses or forbs and legumes) benefited from grazing and their species richness and proportion in the community increased with grazing. Perennial grasses and forbs species richness increased with grazing intensity, but their dominance decreased, since their proportion in the community declined. Short shrub species richness remained unaffected by grazing, while tall shrub diversity decreased. Finally, in sites without grazing the spatial pattern of species richness of the different PFGs was not congruent with each other, while in grazed sites they were significantly positively correlated (with the exception of tall shrubs). This finding may imply that grazing is a selective pressure organizing the community structure, and imposing a certain contribution of each PFG. So, in Mediterranean shrublands in protected areas with a long historical record of grazing, it seems that grazing promotes species diversity and its continuation on a portion of the landscape may be a necessary part of an effective management plan. [ABSTRACT FROM AUTHOR]

We investigated the potential associations of habitat type richness patterns with a series of environmental variables in 61 protected aquatic ecosystems of the Greek Natura 2000 network. Habitat type classification followed the Natura 2000 classification scheme. Habitat type richness was measured as the number of different habitat types in an area. To overcome a potential area effect in quantifying habitat type richness, we applied the 'moving window' technique. The environmental variables were selected to account for some of the major threats to biodiversity, such as fragmentation, habitat loss and climate change. We run GLMs to associate habitat type richness with different combinations of climatic, spatial and topographic variables. Habitat type richness seemed to significantly associate with climatic variables, more than spatial or topographic ones. In particular, for the climatic ones, the importance of precipitation surpassed that of temperature and especially the precipitation of the wettest and driest month had a limiting contribution to richness unlike average climate estimators. Moreover, the landscape's latitude and longitude and fragmentation were significantly associated to richness. Our findings are in accordance to those observed in recent literature at lower (i.e. species) levels of ecological organization, fact showing that large-scale phenomena (such as climate change) can also be observed at the habitat type level, at least in our case. Thus, following the context of the Habitats Directive (92/43/EEC), that habitat types and not solely species of community interest should be protected and restored, this study serves as a first step towards investigating habitat type richness patterns. [ABSTRACT FROM AUTHOR]

We propose a three step procedure to investigate measurement bias and response shift, a special case of measurement bias in longitudinal data. Structural equation modelling is used in each of the three steps, which can be described as (1) establishing a measurement model using confirmatory factor analysis, (2) detecting measurement bias by testing the equivalence of model parameters across measurement occasions, (3) detecting measurement bias with respect to additional exogenous variables by testing their direct effects on the indicator variables. The resulting model can be used to investigate true change in the attributes of interest, by testing changes in common factor means. Solutions for the issue of constraint interaction and for chance capitalisation in model specification searches are discussed as part of the procedure. The procedure is illustrated by applying it to longitudinal health-related quality-of-life data of HIV/AIDS patients, collected at four semi-annual measurement occasions. [ABSTRACT FROM AUTHOR]

We examined the relationship between plant species richness and biogeographical variables (island area, island maximum elevation, distance from nearest inhabited island, distance from nearest mainland) using a data set comprising 201 islands of the Aegean archipelago. We found that endemic species richness was strongly correlated to total species richness. Single-island endemic species richness was most strongly correlated to island maximum elevation, and then to island area, with an apparent small island effect for islands smaller than 47 km2. Total species richness was most strongly correlated to island area (with no apparent small island effect), and less strongly correlated to island maximum elevation. Distance from the mainland or other inhabited islands displayed limited predictive value in our data set. The slope of the relationship between species richness and geographical factors (island area, elevation, distance from island/mainland) was steeper for endemic species richness than for total richness. Finally, the different scales of endemicity (single-island endemics, island group endemics and Aegean regional endemics) displayed similar qualitative trends and only differed quantitatively. Thus, we conclude that different biogeographical factors act as drivers for total species richness than for endemic species richness. [ABSTRACT FROM AUTHOR]

So far landscape analysis meant analysis of the spatial pattern of land cover or land use. However, biological organisms do not perceive the landscape only as land cover or land use, but they use all their senses, in order to become familiar with and react to their surroundings. We analyzed the acoustic environment as an additional layer of spatial information in landscape analysis, shortening the monopoly of visual patterns as landscape descriptors. We recorded sounds from a rural protected area into seven categories based on their origin, and examined their spatiotemporal variability and their correlation with landscape characteristics. The sounds were distinguished as Foreground or Background sounds. Foreground sounds correspond to sharp sounds originating near the observer and usually are understood as signals of urgent information, triggering reactions; while background sounds carry information over longer distances and may be used as landmarks to help individuals find their bearing even in the absence of visual signs. We found that the acoustic environment varies both temporally and spatially reflecting anthropogenic, geophysical and biological activities. The spatial pattern of the background sounds correlates, to an extent, with the visually perceived landscape features, but it does not correlate with the spatial pattern of the foreground sounds, which do not correlate strongly with the landscape pattern. This spatial pattern mismatch between acoustic environment and landscape, along with the highly dynamic nature of the acoustic environment compared to the relatively static nature of the land cover and land use spatial pattern highlight a limitation of the classical landscape analysis, and expands our understanding of the cognitive landscape. [ABSTRACT FROM AUTHOR]

We investigate the persistent soil seed bank composition and its relation to the above-ground flora of grazed and non-grazed sub-Mediterranean deciduous oak forests of NW Greece. Twenty-eight taxa were recorded in the soil seed bank and 83 taxa (70 taxa in plots of seed bank sampling) in the above-ground vegetation. The dominant tree species and many woodland species found in the above-ground vegetation were absent from the soil seed bank. Similarity between the soil seed bank and the above-ground vegetation decreased with grazing, and grazing led to a decrease of species richness in above-ground vegetation and soil seed bank. Beta diversity of vegetation among grazed and among non-grazed plots did not differ, but was significantly higher between grazed and non-grazed areas. Beta diversity of the soil seed bank declined with grazing. When applying classification tree and logistic regression analyses, non-grazed forest sites are clearly differentiated by the presence of Phillyrea latifolia, Euphorbia amygdaloides and Brachypodium sylvaticum. PCA ordination of above-ground species composition reflected a gradient from sites grazed by ruminants to non-grazed sites, but no clear structure was detected in the seed bank. [ABSTRACT FROM AUTHOR]

Understanding how overall patterns of spatial variation in species richness are affected by distributional patterns of species has been an area of growing concern. In the present study, we investigated the relative importance of common and rare species as contributors in overall plant species richness. We further examined if the effects of common or rare species in richness patterns are affected by the size of the sampling units and if the observed patterns hold at different habitats. We used a dataset of 5,148 higher plant species distributed across 16,114 sampling plots located in 240 sites of the NATURA 2000 network of Greece. We ranked all species based on the number of sites they occupied and we developed a common to rare and a rare to common sequence. We correlated those sequences with cumulative species distributions. We performed this analysis in nine different sizes of sampling units and in three different datasets referring to (a) all habitat types together, (b) coniferous habitats only and (c) alpine habitats only. Our analysis showed that despite the proportionally higher numbers of restricted species, widespread species make a greater contribution to overall richness patterns and that this observed pattern does not depend on the size of the sampling units. Moreover, the observed pattern stands for different habitat types. Our findings support the generality of this pattern and highlight the importance of widespread species as adequate indicators of biodiversity patterns at various habitat types. [ABSTRACT FROM AUTHOR]

We examine the spatial pattern of woody species diversity at different scales, in two sites of Mt. Holomontas in northern Greece, which falls within the transitional zone between temperate forests and Mediterranean-type ecosystems. We investigate how diversity is distributed in space and whether the perceived pattern changes with the scale of observation. We use two different metrics of diversity: species richness and species turnover. Our main finding is that the spatial pattern of diversity changes with the scale of observation or analysis. For a given scale, the pattern of species richness (alpha diversity) is negatively correlated with the pattern of species turnover (beta diversity). Species-rich areas have more species in common with their neighbors than species-poor areas. The between-scale disparity of the spatial pattern of diversity may be a general feature of ecological systems. For this to be validated, studies with different groups of species in different biomes and in different biogeographical areas are required; our study contributes to this direction providing evidence that this holds true for woody species in Mediterranean communities. Finally, we discuss how these findings might affect important issues in theoretical and applied ecology, such as identifying the environmental factors driving biodiversity. [ABSTRACT FROM AUTHOR]

Different environmental factors act as driving forces of diversity at different scales of analysis; and also the effect of one environmental factor changes as the scale of analysis changes. Most studies rely on multiple regression models, and such models tend to mix-up the effect of all factors and assume that factors effects are additive. We believe that the effect of environment on diversity should be characterized by a hierarchical structure with coarse scale factors, like geographical tropics to poles gradients, defining the envelope of possible diversity conditions, and other more local factors, like habitat structure, being responsible for the fine tuning of diversity. This structure is most efficiently modeled with regression trees. We show that for six habitat types in Greek protected areas regression tree models were able to describe plant species richness based upon environmental factors considerably more efficiently than multiple regression models. More importantly when the models were extrapolated to other sites in Greece, outside their domain, the differences between the predictive ability of the two approaches was magnified. The tree models picked up important ecological characteristics, and a hierarchical structure that used coarse scale factors, like latitude and longitude, for the coarse scale estimate of alpha diversity, and finer scale factors like fragmentation, for the fine-tuning of the estimation. Therefore, we advocate that the regression tree methodology is most appropriate for modeling the relationship between diversity and environmental factors, and the use of the classical regression approaches might be misleading. [ABSTRACT FROM AUTHOR]

This report describes phenanthrene uptake as well as the effect of phenanthrene on the membrane phospholipid and fatty acid composition in a newly isolated bacterial strain, Sphe3, that we taxonomically identified as Arthrobacter sp. Strain Sphe3 is able to utilize phenanthrene as a carbon source at high rates and appears to internalize phenanthrene with two mechanisms: a passive diffusion when cells are grown on glucose, and an inducible active transport system when cells are grown on phenanthrene as a sole carbon source. Active transport followed Michaelis-Menten kinetics, and it was amenable to inhibition by 2,4-dinitrophenol and sodium azide. Evidence provided here indicates that apart from inducing an active PAH uptake, the presence of phenanthrene elicits significant changes in membrane fluidity. [ABSTRACT FROM AUTHOR]

Germline mutations in genes encoding proteins involved in DNA mismatch repair are responsible for the autosomal dominantly inherited cancer predisposition syndrome hereditary nonpolyposis colorectal cancer (HNPCC). We describe here analysis of hMLH1 and hMSH2 in nine Greek families referred to our centre for HNPCC. A unique disease-causing mutation has been identified in seven out of nine (78%) families. The types of mutations identified are nonsense (five out of seven) (hMLH1: E557X, R226X; hMSH2: Q158X, R359X and R711X), a 2 bp deletion (hMSH2 1704_1705delAG) and a 2.2 kb Alu-mediated deletion encompassing exon 3 of the hMSH2 gene. The majority of mutations identified in this cohort are found in hMSH2 (77.7%). Furthermore, four of the mutations identified are novel. Finally, a number of novel benign variations were observed in both genes. This is the first report of HNPCC analysis in the Greek population, further underscoring the differences observed in the various geographic populations. [ABSTRACT FROM AUTHOR]

Three bacterial strains, designated as Wphe1, Sphe1, and Ophe1, were isolated from Greek soils contaminated with polycyclic aromatic hydrocarbon (PAH)-containing waste from the wood processing, steel, and oil refinery industries. Wphe1, Sphe1, and Ophe1 were characterized and identified as species of Pseudomonas, Microbacterium, and Paracoccus, respectively, based on Gram staining, biochemical tests, phospholipid analysis, FAME analysis, G+C content and 16S rRNA gene sequence analysis. The results of gas chromatography showed that strain Wphe1 degraded naphthalene, phenanthrene, and m-cresol over a wide temperature range; strain Sphe1 was a degrader of phenanthrene and n-alkanes; most interestingly, strain Ophe1 degraded anthracene, phenanthrene, fluorene, fluoranthene, chrysene, and pyrene, as well as cresol compounds and n-alkanes as sole carbon source. This is the first report of a representative of the genus Paracoccus capable of degrading PAHs with such versatility. These three strains may be useful for bioremediation applications. [ABSTRACT FROM AUTHOR]

Focuses on the accuracy of fractal dimension estimating for small samples of ecological distributions. Use of method to measure fractal dimension of a species distribution; Criteria to measure the accuracy of fractal dimension.

Examines the effect of nematofauna on the nitrogen content of the soil and soil microbiology in major grasslands of Europe. Impact of nematofauna on the microflora present in mineral soils; Percentage of soil nitrogen contributed by nematode excretion; Lack of significant correlation among nematodes, microbial parameters, or nitrogen pools in wet organic soils.

Purpose: The Functional Assessment of Cancer Therapy item (FACT-GP5) has the potential to provide an understanding of global treatment tolerability from the patient perspective. Longitudinal evaluations of the FACT-GP5 and challenges posed by data missing-not-at-random (MNAR) have not been explored. Robustness of the FACT-GP5 to missing data assumptions and the responsiveness of the FACT-GP5 to key side-effects are evaluated.In a randomized, double-blind study (NCT00065325), postmenopausal women (n = 618) with hormone receptor-positive (HR+), advanced breast cancer received either fulvestrant or exemestane and completed FACT measures monthly for seven months. Cumulative link mixed models (CLMM) were fit to evaluate: (1) the trajectory of the FACT-GP5 and (2) the responsiveness of the FACT-GP5 to CTCAE grade, Eastern Cooperative Oncology Group (ECOG) Performance Status scale, and key side-effects from the FACT. Sensitivity analyses of the missing-at-random (MAR) assumption were conducted.Odds of reporting worse side-effect bother increased over time. There were positive within-person relationships between level of side-effect bother (FACT-GP5) and severity of other FACT items, as well as ECOG performance status and Common Terminology Criteria for Adverse Events (CTCAE) grade. The number of missing FACT-GP5 assessments impacted the trajectory of the FACT-GP5 but did not impact the relationships between the FACT-GP5 and other items (except for nausea [FACT-GP2]).Results support the responsiveness of the FACT-GP5. Generally speaking, the responsiveness of the FACT-GP5 is robust to missing assessments. Missingness should be considered, however, when evaluating change over time of the FACT-GP5.NCT00065325.2003.Methods: The Functional Assessment of Cancer Therapy item (FACT-GP5) has the potential to provide an understanding of global treatment tolerability from the patient perspective. Longitudinal evaluations of the FACT-GP5 and challenges posed by data missing-not-at-random (MNAR) have not been explored. Robustness of the FACT-GP5 to missing data assumptions and the responsiveness of the FACT-GP5 to key side-effects are evaluated.In a randomized, double-blind study (NCT00065325), postmenopausal women (n = 618) with hormone receptor-positive (HR+), advanced breast cancer received either fulvestrant or exemestane and completed FACT measures monthly for seven months. Cumulative link mixed models (CLMM) were fit to evaluate: (1) the trajectory of the FACT-GP5 and (2) the responsiveness of the FACT-GP5 to CTCAE grade, Eastern Cooperative Oncology Group (ECOG) Performance Status scale, and key side-effects from the FACT. Sensitivity analyses of the missing-at-random (MAR) assumption were conducted.Odds of reporting worse side-effect bother increased over time. There were positive within-person relationships between level of side-effect bother (FACT-GP5) and severity of other FACT items, as well as ECOG performance status and Common Terminology Criteria for Adverse Events (CTCAE) grade. The number of missing FACT-GP5 assessments impacted the trajectory of the FACT-GP5 but did not impact the relationships between the FACT-GP5 and other items (except for nausea [FACT-GP2]).Results support the responsiveness of the FACT-GP5. Generally speaking, the responsiveness of the FACT-GP5 is robust to missing assessments. Missingness should be considered, however, when evaluating change over time of the FACT-GP5.NCT00065325.2003.Results: The Functional Assessment of Cancer Therapy item (FACT-GP5) has the potential to provide an understanding of global treatment tolerability from the patient perspective. Longitudinal evaluations of the FACT-GP5 and challenges posed by data missing-not-at-random (MNAR) have not been explored. Robustness of the FACT-GP5 to missing data assumptions and the responsiveness of the FACT-GP5 to key side-effects are evaluated.In a randomized, double-blind study (NCT00065325), postmenopausal women (n = 618) with hormone receptor-positive (HR+), advanced breast cancer received either fulvestrant or exemestane and completed FACT measures monthly for seven months. Cumulative link mixed models (CLMM) were fit to evaluate: (1) the trajectory of the FACT-GP5 and (2) the responsiveness of the FACT-GP5 to CTCAE grade, Eastern Cooperative Oncology Group (ECOG) Performance Status scale, and key side-effects from the FACT. Sensitivity analyses of the missing-at-random (MAR) assumption were conducted.Odds of reporting worse side-effect bother increased over time. There were positive within-person relationships between level of side-effect bother (FACT-GP5) and severity of other FACT items, as well as ECOG performance status and Common Terminology Criteria for Adverse Events (CTCAE) grade. The number of missing FACT-GP5 assessments impacted the trajectory of the FACT-GP5 but did not impact the relationships between the FACT-GP5 and other items (except for nausea [FACT-GP2]).Results support the responsiveness of the FACT-GP5. Generally speaking, the responsiveness of the FACT-GP5 is robust to missing assessments. Missingness should be considered, however, when evaluating change over time of the FACT-GP5.NCT00065325.2003.Conclusions: The Functional Assessment of Cancer Therapy item (FACT-GP5) has the potential to provide an understanding of global treatment tolerability from the patient perspective. Longitudinal evaluations of the FACT-GP5 and challenges posed by data missing-not-at-random (MNAR) have not been explored. Robustness of the FACT-GP5 to missing data assumptions and the responsiveness of the FACT-GP5 to key side-effects are evaluated.In a randomized, double-blind study (NCT00065325), postmenopausal women (n = 618) with hormone receptor-positive (HR+), advanced breast cancer received either fulvestrant or exemestane and completed FACT measures monthly for seven months. Cumulative link mixed models (CLMM) were fit to evaluate: (1) the trajectory of the FACT-GP5 and (2) the responsiveness of the FACT-GP5 to CTCAE grade, Eastern Cooperative Oncology Group (ECOG) Performance Status scale, and key side-effects from the FACT. Sensitivity analyses of the missing-at-random (MAR) assumption were conducted.Odds of reporting worse side-effect bother increased over time. There were positive within-person relationships between level of side-effect bother (FACT-GP5) and severity of other FACT items, as well as ECOG performance status and Common Terminology Criteria for Adverse Events (CTCAE) grade. The number of missing FACT-GP5 assessments impacted the trajectory of the FACT-GP5 but did not impact the relationships between the FACT-GP5 and other items (except for nausea [FACT-GP2]).Results support the responsiveness of the FACT-GP5. Generally speaking, the responsiveness of the FACT-GP5 is robust to missing assessments. Missingness should be considered, however, when evaluating change over time of the FACT-GP5.NCT00065325.2003.Trial Registration: The Functional Assessment of Cancer Therapy item (FACT-GP5) has the potential to provide an understanding of global treatment tolerability from the patient perspective. Longitudinal evaluations of the FACT-GP5 and challenges posed by data missing-not-at-random (MNAR) have not been explored. Robustness of the FACT-GP5 to missing data assumptions and the responsiveness of the FACT-GP5 to key side-effects are evaluated.In a randomized, double-blind study (NCT00065325), postmenopausal women (n = 618) with hormone receptor-positive (HR+), advanced breast cancer received either fulvestrant or exemestane and completed FACT measures monthly for seven months. Cumulative link mixed models (CLMM) were fit to evaluate: (1) the trajectory of the FACT-GP5 and (2) the responsiveness of the FACT-GP5 to CTCAE grade, Eastern Cooperative Oncology Group (ECOG) Performance Status scale, and key side-effects from the FACT. Sensitivity analyses of the missing-at-random (MAR) assumption were conducted.Odds of reporting worse side-effect bother increased over time. There were positive within-person relationships between level of side-effect bother (FACT-GP5) and severity of other FACT items, as well as ECOG performance status and Common Terminology Criteria for Adverse Events (CTCAE) grade. The number of missing FACT-GP5 assessments impacted the trajectory of the FACT-GP5 but did not impact the relationships between the FACT-GP5 and other items (except for nausea [FACT-GP2]).Results support the responsiveness of the FACT-GP5. Generally speaking, the responsiveness of the FACT-GP5 is robust to missing assessments. Missingness should be considered, however, when evaluating change over time of the FACT-GP5.NCT00065325.2003.Trial Registration Year: The Functional Assessment of Cancer Therapy item (FACT-GP5) has the potential to provide an understanding of global treatment tolerability from the patient perspective. Longitudinal evaluations of the FACT-GP5 and challenges posed by data missing-not-at-random (MNAR) have not been explored. Robustness of the FACT-GP5 to missing data assumptions and the responsiveness of the FACT-GP5 to key side-effects are evaluated.In a randomized, double-blind study (NCT00065325), postmenopausal women (n = 618) with hormone receptor-positive (HR+), advanced breast cancer received either fulvestrant or exemestane and completed FACT measures monthly for seven months. Cumulative link mixed models (CLMM) were fit to evaluate: (1) the trajectory of the FACT-GP5 and (2) the responsiveness of the FACT-GP5 to CTCAE grade, Eastern Cooperative Oncology Group (ECOG) Performance Status scale, and key side-effects from the FACT. Sensitivity analyses of the missing-at-random (MAR) assumption were conducted.Odds of reporting worse side-effect bother increased over time. There were positive within-person relationships between level of side-effect bother (FACT-GP5) and severity of other FACT items, as well as ECOG performance status and Common Terminology Criteria for Adverse Events (CTCAE) grade. The number of missing FACT-GP5 assessments impacted the trajectory of the FACT-GP5 but did not impact the relationships between the FACT-GP5 and other items (except for nausea [FACT-GP2]).Results support the responsiveness of the FACT-GP5. Generally speaking, the responsiveness of the FACT-GP5 is robust to missing assessments. Missingness should be considered, however, when evaluating change over time of the FACT-GP5.NCT00065325.2003. [ABSTRACT FROM AUTHOR]