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Lands devoted to military use are globally important for the production of ecosystem services and for the conservation of biodiversity. The United States has one of the largest military land estates in the world, and most of these areas occur in water-limited landscapes. Despite many of these areas receiving intense or sustained disturbance from military training activities, the structure and function of ecosystems contained within their boundaries continue to provide critical benefits to people across spatial scales. The land owned and managed by the Department of Defense is subject to regulation across local, state, and federal governing bodies, constraining and shaping both how land management is conducted and how ecosystem services are prioritized. Here, we explored the supply of ecosystem services from military lands in dryland areas of the United States using key indicators of ecosystem services: biodiversity estimates derived from range maps, ecosystem productivity estimates from satellite observations, and spatially explicit, hierarchical ecosystem classifications. Additionally, we utilized content analysis of the environmental management plans of these areas to describe the unique set of demands and regulatory constraints on these areas. We found that the US military land estate in drylands contains many types of ecosystems and provides a large and diverse supply of ecosystem services, comparable to the sum of services from public lands in these areas. Additionally, the degree to which the ecosystem services concept is captured in environmental management plans is strongly shaped by the language of the governing legislation that mandated the use of environmental management plans in these areas, although these plans do not explicitly address land management using the concept of ecosystem services. Collectively, our findings suggest that military use and management of land represents an important source of ecosystem services, that military land use can be considered a cultural ecosystem service unto itself, and that top-down regulation can affect how these services are identified and valued. Our work highlights the need for the research and conservation communities to quantify ecosystem services from individual military installations so that both services and biodiversity can be safeguarded in an era of military conflict across the globe., (© 2024 The Ecological Society of America.)

Objective: Delay in initiating cervical cancer treatment may impact outcomes. In a cohort of patients initially treated by surgery, chemoradiation, chemotherapy, or in a clinical trial, we aim to define factors contributing to prolonged time to treatment initiation., Methods: Data from patients initiating treatment for cervical cancer at a single institution was abstracted. Time to treatment initiation was defined as the interval from the date of cancer diagnosis to the date of treatment initiation. Poisson regression model was used for analysis., Results: Of 274 patients studied, the median time to treatment initiation was 60 days (range 0-551). The median times to initiate surgery (54 days, range 3-96) and chemoradiation (58 days, range 4-187) were not significantly different (relative risk (RR) 1.01, 95% CI 0.98 to 1.04, p=0.54). The shortest median initiation time was for chemotherapy (47 days; RR 1.13, 95% CI 1.08 to 1.19, p<0.0001) and the longest was for clinical trial (62 days; RR 1.18, 95% CI 1.12 to 1.24, p<0.0001). Charity care (RR 1.09, 95% CI 1.05 to 1.14, p<0.0001), Medicare or Medicaid (RR 1.10, 95% CI 1.06 to 1.14, p<0.0001), and self-pay (RR 1.38, 95% CI 1.32 to 1.45, p<0.0001) delayed treatment initiation more than private insurance. Hispanic White women (RR 0.69, 95% CI 0.66 to 0.73, p<0.0001) had a shorter treatment initiation time compared with non-Hispanic White patients, while Afro-Caribbean/Afro-Latina women (RR 0.86, 95% CI 0.81 to 0.90, p<0.0001) and African-American patients (RR 1.13, 95% CI 1.07 to 1.19, p<0.0001) had longer initiation times. Spanish speaking patients did not have a prolonged treatment initiation (RR 0.68, 95% CI 0.66 to 0.71, p<0.0001), though Haitian-Creole speaking patients did (RR 1.07, 95% CI 1.01 to 1.13, p<0.002). Diagnosis at an outside institution delayed treatment initiation time (RR 1.24, 95% CI 1.18 to 1.30, p<0.0001) compared with diagnosis at the cancer center., Conclusion: Factors associated with prolonged time to treatment initiation include treatment modality, insurance status, language spoken, and institution of diagnosis. By closely examining each of these factors, barriers to treatment can be identified and modified to shorten treatment initiation time., Competing Interests: Competing interests: None declared., (© IGCS and ESGO 2022. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.)