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Purpose: The use of medical expulsive therapy to hasten stone passage potentially decreases expenditures around episodes of renal colic. However, these efficiency gains may be mitigated if patients treated with medical expulsive therapy have frequent health care encounters due to pain while waiting for the stones to pass. Materials and Methods: Using claims data (2002 to 2006) we identified adult men with acute renal colic. We compared 6-week payments as well as frequency of hospitalization and emergency department revisits associated with an initial course of medical expulsive therapy with those for early endoscopic stone removal. To account for unmeasured confounding we performed an instrumental variable analysis, exploiting variation in recommended treatments based on the day of the week that a patient's first emergency department visit occurred. Results: Overall 1,835 and 4,397 men underwent medical expulsive therapy or early endoscopic stone removal, respectively. Although minimal differences existed between men with respect to the day of the week of emergency department presentation, weekend encounters were strongly associated with receiving medical expulsive therapy (p <0.001). Two-stage least squares regression revealed 6-week payments to be tenfold lower for men on medical expulsive therapy who were candidates for either treatment (p <0.001). While there was no difference in frequency of hospitalization, these men were more likely to have a repeat emergency department visit compared to those who underwent endoscopic stone removal (68.8% vs 39.6%, respectively, p = 0.025). Conclusions: Findings on medical expulsive therapy are mixed, with lower 6-week payments but more frequent repeat emergency department visits. These data inform patients who are candidates for medical expulsive therapy or endoscopic stone removal when making decisions about their care. [Copyright &y& Elsevier]

Purpose: The cost implications associated with offloading outpatient surgery from hospitals to ambulatory surgery centers and the physician office remain poorly defined. Therefore, we determined whether payments for outpatient surgery vary by location of care. Materials and Methods: Using national Medicare claims from 1998 to 2006, we identified elderly patients who underwent 1 of 22 common outpatient urological procedures. For each procedure we measured all relevant payments (in United States dollars) made during the 30-day claims window that encompassed the procedure date. We then categorized payment types (hospital, physician and outpatient facility). Finally, we used multivariable regression to compare price standardized payments across hospitals, ambulatory surgery centers and the physician office. Results: Average total payments for outpatient surgery episodes varied widely from $200 for urethral dilation in the physician office to $5,688 for hospital based shock wave lithotripsy. For all but 2 procedure groups, ambulatory surgery centers and physician offices were associated with lower overall episode payments than hospitals. For instance, average total payments for urodynamic procedures performed at ambulatory surgery centers were less than a third of those done at hospitals (p <0.001). Compared to hospitals, office based prostate biopsies were nearly 75% less costly (p <0.001). Outpatient facility payments were the biggest driver of these differences. Conclusions: These data support policies that encourage the provision of outpatient surgery in less resource intensive settings. [Copyright &y& Elsevier]

Purpose: Laser prostatectomy has increased in popularity in the last decade. However, traditional transurethral resection of the prostate remains common. To understand decisions about the use of laser prostatectomy vs transurethral prostate resection, we evaluated trends in transurethral surgery for benign prostatic hyperplasia in an all payer data set, focusing on patient and provider factors associated with the receipt of laser prostatectomy. Materials and Methods: Using Florida State Inpatient Database and Ambulatory Surgery Database, we identified patients who underwent laser prostatectomy or transurethral prostate resection from 2001 to 2009. We calculated surgery rates with time, stratified by procedure type. We used multilevel regression to examine patient (age, race and comorbidity level) and provider (surgeon volume) factors associated with the receipt of laser prostatectomy vs transurethral prostate resection. Results: While the overall rates of transurethral surgery remained stable during the study period (p = 0.227), laser prostatectomy use increased 400% from 25 to 114 procedures per 100,000 men (p <0.001), replacing about half of all transurethral prostate resections. Patients were less likely to undergo laser prostatectomy if they were older (OR 0.65, 95% CI 0.61–0.70) and less healthy (OR 0.48, 95% CI 0.45–0.51). While these factors were predictive of surgery type, most of the variation in laser prostatectomy use (69%) was determined by the urologist seen by the patient. Conclusions: Laser prostatectomy use has increased in the last decade at the expense of transurethral prostate resection, driven largely by provider effects. However, elderly and more infirm patients are least likely to undergo it, raising concern about underuse in this population. [ABSTRACT FROM AUTHOR]

Purpose: Current therapies for male lower urinary tract symptoms secondary to prostate enlargement prevent hormonal effects on prostate growth and inhibit smooth muscle contraction to ease bladder neck and urethral pressure. However, lower urinary tract symptoms can be refractory to these therapies, suggesting that additional biological processes not addressed by them may also contribute to lower urinary tract symptoms. Aging associated fibrotic changes in tissue architecture contribute to dysfunction in multiple organ systems. Thus, we tested whether such changes potentially have a role in impaired urethral function and perhaps in male lower urinary tract symptoms. Materials and Methods: Periurethral tissues were obtained from a whole prostate ex vivo and from 28 consecutive men treated with radical prostatectomy. Lower urinary tract symptoms were assessed using the American Urological Association symptom index. Prostate tissues were subjected to mechanical testing to assess rigidity and stiffness. Fixed sections of these tissues were evaluated for collagen and elastin content, and glandularity to assess fibrosis. Statistical analysis included the Student t test and calculation of Pearson correlation coefficients to compare groups. Results: Periurethral prostate tissues demonstrated nonlinear viscoelastic mechanical behavior. Tissue from men with lower urinary tract symptoms was significantly stiffer (p = 0.0016) with significantly higher collagen content (p = 0.0038) and lower glandularity than that from men without lower urinary tract symptoms (American Urological Association symptom index 8 or greater vs 7 or less). Conclusions: Findings show that extracellular matrix deposition and fibrosis characterize the periurethral prostate tissue of some men with lower urinary tract symptoms. They point to fibrosis as a factor contributing to lower urinary tract symptom etiology. [Copyright &y& Elsevier]

Purpose: The cost efficiency gains achieved from moving procedures to ambulatory surgery centers and offices may be mitigated if the quality of surgical care at these facilities is not comparable to that at the hospital. Motivated by this, we assessed short-term morbidity and mortality for patients by location of care. Materials and Methods: Using a national sample of Medicare claims (1998 to 2006), we identified elderly beneficiaries who underwent one of 22 common outpatient urological procedures. After determining the facility type where each procedure was performed, we measured 30-day mortality, unexpected admissions and postoperative complications. Finally, we fit multivariable logistic regression models to evaluate the association between occurrence of an adverse event and the ambulatory setting where surgical care was delivered. Results: During the study period, there was a substantial increase in the frequency of nonhospital based outpatient surgery. Compared to ambulatory surgery centers and offices, hospitals treated more women (p <0.001). Those patients also tended to be less healthy (p <0.001). While patients experienced fewer postoperative complications following surgery at an ambulatory surgery center, procedures performed outside the hospital were associated with a higher likelihood of a same day admission (ambulatory surgery centers OR 6.96, 95% CI 4.44–10.90 and offices OR 3.64, 95% CI 2.48–5.36). However, notably with case mix adjustment the probability of any adverse event was exceedingly low across all ambulatory settings. Conclusions: These data indicate that small but measurable variation in surgical quality exists by location of care delivery. [Copyright &y& Elsevier]

Purpose: Compared to physicians paid on salary (ie employed), those who own their practice (ie self-employed) derive financial benefit from providing more care. Whether the volume based incentives of ownership influence physician use of other ancillary services, like diagnostic imaging, remains unknown. We explored this possibility among urologists. Materials and Methods: We used data from the National Ambulatory Medical Care Survey (2006 to 2007) to identify outpatient urology visits. We determined whether the urologist who was responsible for the encounter was employed or self-employed. We calculated the proportion of visits at which imaging was ordered, and we evaluated for a difference between visits directed by employed vs self-employed urologists. We used multivariable logistic regression to measure the relationship between urologist employment status and imaging use, adjusting for patient, provider and practice level characteristics. Results: More than 1 in 5 urology visits resulted in imaging. While imaging use did not vary by measurable patient or practice level characteristics, self-employed urologists ordered imaging more often than employed urologists (24.2% vs 13.2%, respectively, p <0.001). In fact, the odds of a patient receiving imaging were almost 2-fold greater if seen by a self-employed urologist (OR 1.84, 95% CI 1.18–2.87). On stratified analysis an independent association between employment status and imaging use was observed for urolithiasis (OR 4.76, 95% CI 1.30–17.4) and hematuria visits (OR 5.52, 95% CI 1.23–24.8). Conclusions: Compared with employed urologists, those who are self-employed have more resource intense practice styles with respect to imaging use. [Copyright &y& Elsevier]

Purpose: Increasing trial evidence suggests that a course of medical expulsive therapy is warranted for patients with ureteral stones who are amenable to conservative treatment, and that this efficacious process of care is underused. To better understand the barriers to the dissemination of medical expulsive therapy we analyzed health care claims of working age adults with urinary stone disease. Materials and Methods: Using MarketScan® data (2002 to 2006) we identified patients with urinary stone disease who were treated in the emergency department. We characterized differences between patients who were prescribed medical expulsive therapy and those who were not. After assigning patients to their principal providers we determined how much of the variation in medical expulsive therapy prescribing rates was attributable to patient vs provider level factors. Results: A total of 79,688 patients were seen for an acute stone episode. They received care from 12,328 providers. In general those patients prescribed medical expulsive therapy tended to be older (p <0.001) and were more likely male (p <0.001). A higher percentage of medical expulsive therapy recipients were salaried (p = 0.003) and had full-time employment (p <0.001). Of the unexplained variation in medical expulsive therapy prescription 21% was accounted for by unmeasured provider factors and patient odds of receiving medical expulsive therapy were 5-fold higher if seen by a urologist (OR 4.94, 95% CI 2.96–8.28, p <0.001). Conclusions: These data reveal that the provider seen for an episode of renal colic substantially determines whether the patient will receive medical expulsive therapy. As such, an educational intervention directed toward emergency department physicians might hasten the uptake of medical expulsive therapy within the broader medical community. [Copyright &y& Elsevier]

Purpose: Since health care in the United States is fragmented and expensive, 1 reform option focuses on improving care coordination as in the medical home model. To better understand care coordination in the context of prostate cancer we examined how the delivery of prostate cancer care is partitioned across primary care providers and specialists. Materials and Methods: We identified 105,961 patients diagnosed with prostate cancer between 1992 and 2005 using Surveillance, Epidemiology and End Results-Medicare data. We assigned all health care for prostate cancer and nonprostate cancer diagnoses by provider specialty across 3 distinct phases of care, including initial, continuing care and end of life. We then identified service types and proportions of care across specialties. Results: Urologists provided most prostate cancer care (45.2%). Radiation oncologist involvement decreased from 27.4% of claims in the initial phase to 5.5% and 5.7% in the continuing care and end of life phases, respectively. Conversely medical oncology and to a lesser degree primary care captured a greater percent of ongoing prostate cancer care. In patients with prostate cancer 7,120,343 of 36,837,904 services (19.3%) were directly related to prostate cancer care. Primary care providers were responsible for 47% of overall health care in men with prostate cancer. Conclusions: Urologists provided most prostate cancer care while primary care providers were responsible for most overall health care in men with prostate cancer. In light of current reforms directed at improving care coordination urologists serve as a logical starting point to improve care delivery in the broader context of a medical home. [Copyright &y& Elsevier]

Purpose: Ambulatory surgery centers deliver surgical care more efficiently than hospitals but may increase overall procedure use and adversely affect competing hospitals. Motivated by these concerns we evaluated how opening of an ambulatory surgery center impacts stone surgery use in a health care market and assessed the effect of its opening on the patient mix at nearby hospitals. Materials and Methods: In a 100% sample of outpatient surgery from Florida we measured annual stone surgery use between 1998 and 2006. We used multiple regression to determine if the rate of change in use differed between markets, defined by the hospital service area, without and with a recently opened ambulatory surgery center. Results: Stone surgery use increased an average of 11 procedures per 100,000 individuals per year (95% CI 1–20, p <0.001) after an ambulatory surgery center opened in a hospital service area. Four years after opening the relative increase in the stone surgery rate was approximately 64% higher (95% CI 27 to 102) in hospital service areas where a center opened vs hospital service areas without a center. These market level increases in surgery were not associated with decreased surgical volume at competing hospitals and the absolute change in patient disease severity treated at nearby hospitals was small. Conclusions: While opening of an ambulatory surgery center did not appear to have an overly detrimental effect on competing hospitals, it led to a significant increase in the population based rate of stone surgery in the hospital service area. Possible explanations are the role of physician financial incentives and unmet surgical demand. [ABSTRACT FROM AUTHOR]

Information about DNA barcode for land plants discussed at the 3rd International Barcode of Life Conference in Mexico City, Mexico in November 2009 is presented. Topics include chloroplast microsatellite, mononucleotide repeat, and DNA barcoding. The conference features the announcement of the Consortium for the Barcode of Life (CBOL) on the standard core DNA barcode for plants.

Abstract A robust phylogeny for the genus Hyacinthoides (bluebells) was established using cpDNA sequences and evaluated in light of a re-assessment of morphological diversity, cytology, distribution patterns and field observations. The genus is distributed in the western Mediterranean-Atlantic region and the northern African mountains. Within this area, there is a major divide between an eastern and western dade, each of them with their own radiations, mainly in autumn-winter flowering taxa in northern Africa and spring flowering taxa in the Iberian Peninsula. We now recognise eleven taxa and one hybrid taxon, which are separated into five clades. Polyploidy is confined to the H. non-scripta-hispanica dade with diploid and triploid taxa as well as a newly recognized tetraploid taxon. For the eleven taxa, distribution ranges, taxonomy, morphology, descriptions and a new key are presented. The nomenclatural history of the genus has been reviewed. Generitypes have been designated for Hyacinthoides Heist. ex Fabr. and Endymion Dumort. and lectotypes selected for four species, three of which are combined for the first time in Hyacinthoides: H. cedretorum, H. ciliolata and H.flahaultiana. Several important questions worthy of further investigation, such as evolutionary processes and their major drivers, e.g. environmental change in the Mediterranean basin, flower morphology and associated pollinators, or sympatric versus allopatric speciation have come into sharper focus through this phylogenetic investigation. [ABSTRACT FROM AUTHOR]

Purpose: In controlled trials medical expulsive therapy has improved outcomes in patients with ureteral stones but its real-world use and effectiveness outside a clinical trial have not been thoroughly examined. We studied the impact of targeted education of emergency department physicians about medical expulsive therapy and analyzed its impact on patient outcomes and cost. Materials and Methods: In 2006 emergency department physicians at our institution were formally educated about medical expulsive therapy. Retrospective emergency department data were collected on patients with ureteral stones from 2003 and 2005 (before educational intervention), and 2007 (after intervention). Cost and 90-day post-emergency department event data were gathered from a health maintenance organization owned and operated by our medical center. Medical expulsive therapy prescribing trends, adverse outcome (repeat emergency department visit, hospital admission or surgery) and total cost related to ureteral calculus diagnosis were analyzed. Results: Of 166 health maintenance organization patients with ureteral calculi who met all study requirements 97 (58.4%) were prescribed medical expulsive therapy and 53 (31.9%) filled the medical expulsive therapy prescription, while 113 did not. Analysis revealed a 2-fold increase in medical expulsive therapy prescribing and a 4-fold increase in prescribing α-blockers in each time increment. Bivariate analysis showed that the frequency of adverse outcomes was lower in the medical expulsive therapy group (37.7% vs 53.1%) and medical expulsive therapy was associated with a lower mean total cost per patient ($1,805 vs $2,372). Conclusions: Targeted educational intervention can increase the use of preferred medical expulsive therapy (α-blockers) in the emergency department. Medical expulsive therapy decreases the incidence of adverse events by 29% and decreases the total cost associated with ureteral stones by 24%. [Copyright &y& Elsevier]

Purpose: The introduction of efficacious pharmacotherapies has effectively transformed benign prostatic hyperplasia into a chronic disease that requires ongoing medical care. With this transformation primary care physicians have become more involved in the management of benign prostatic hyperplasia. The impact of the increasing role of the primary care physician on the use of benign prostatic hyperplasia related health services remains unknown. Materials and Methods: We performed a retrospective cohort study using medical claims from a nonprofit managed care organization. Between 1997 and 2005 we identified incident cases of benign prostatic hyperplasia and the provider responsible for the initial care. We fitted logistic regression models to measure the association between subject receipt of an evaluative process and the treating physician specialty. Furthermore, we examined differences between primary care physicians and urologists with respect to the use of medical therapy. Results: Less than a third of incident cases received initial care from a urologist. Use of office based procedures and urodynamic tests was exclusive to urology. Urologists performed urinalysis testing and transrectal ultrasonography more frequently than primary care physicians (p <0.001). The odds of having a laboratory study doubled with treatment by a urologist (OR 2.03, 95% CI 1.51–2.74). Men seen by a urologist were also more likely to be prescribed a benign prostatic hyperplasia medication (p <0.001). Among those who received medical therapy, prescription of selective α-adrenergic blockers, 5α-reductase inhibitors and combination therapy was higher among urologists (p = 0.002). Conclusions: On average, urologists had a higher intensity practice style for benign prostatic hyperplasia than primary care physicians. Further studies are needed to determine how these practice style differences relate to patient clinical outcomes. [Copyright &y& Elsevier]

Purpose: To decrease the cost of surgical care Medicare has introduced a new facility fee schedule for ambulatory surgical centers. This prospective payment system increases reimbursement for many urological procedures, while decreasing reimbursement for others. All stakeholders, including physicians, the Medicare program and hospitals, will be affected by these changes. Materials and Methods: Using the Agency for Healthcare Research and Quality State Ambulatory Surgery Databases we identified Medicare patients in Florida who underwent urological procedures in ambulatory surgical centers from 1998 to 2005. Three facility groupings were created, including urology dominant, multispecialty and other specialty dominant. The impact of reimbursement changes at the procedure and facility levels was assessed using 2005 data. Projections of ambulatory surgical center use and reimbursement in 2008 were then generated using all available data. Results: In 2008 we project total payments by Medicare to increase by $4,233,080 (26%, range 22% to 32%) under the new reimbursement system compared to the old system. At the facility level reimbursement to multispecialty facilities should increase substantially (49%), while urology specialty facilities will receive less benefit (10% increase). Compared to multispecialty facilities, at urology specialty facilities a higher proportion of cases is performed for which reimbursement is set to decrease. Conclusions: Under the new payment scheme for ambulatory surgical centers winners and losers emerge. Facilities with diversified procedure mixes will find increased revenue, while those with less diversification will find slower growth to their revenue streams. In contrast to the desire of the Medicare program to decrease surgical costs, the new program may increase the payments made for urological surgery. [Copyright &y& Elsevier]

Purpose: The diffusion of laparoscopic renal surgery has been gradual. While surgery for benign and malignant kidney disease is usually within the urological domain, donor nephrectomy is multidisciplinary. Therefore, we compared the use of laparoscopy by procedure indication (kidney donor, and benign and malignant kidney disease) to examine potential specialty specific associations with the slow uptake of this technology. Materials and Methods: Data on 53,461 patients undergoing nephrectomy for all indications between 1998 and 2003 were abstracted from the Nationwide Inpatient Sample using International Classification of Diseases, 9th Revision, Clinical Modification procedure and diagnostic codes. Generalized estimating equations were fitted to measure the association between laparoscopy use and the procedure indication (kidney donor, benign kidney disease and kidney cancer). Results: The use of laparoscopy varied by treatment indication. In 2003, 33% of kidney donors underwent a laparoscopic approach compared to 22% and 16% of patients with benign and malignant kidney disease, respectively (p <0.0001). After adjusting for patient and hospital differences patients with benign (adjusted OR 0.71, 95% CI 0.58–0.94) and malignant (adjusted OR 0.51, 95% CI 0.35–0.74) kidney disease were significantly less likely to undergo laparoscopic nephrectomy than kidney donors. Conclusions: These data highlight that the use of laparoscopic renal surgery varies by procedure indication with slower adoption of laparoscopy for malignant or benign indications than for donor nephrectomy. This variation was not readily explained by differences in measurable patient and hospital factors. Further characterization of provider and nonclinical characteristics may provide additional insight into differences in the adoption of this technology, which appears to be a specialty specific phenomenon. [Copyright &y& Elsevier]

Purpose: Currently there are 64 accredited renal transplantation fellowships in Canada and the United States. Only 27% are limited in scope to kidney transplants. In the remaining fellowships the trainee learns to transplant multiple abdominal organs. Given this evolution to the multiorgan transplant surgeon, we evaluated the effect of the current training paradigm on practice patterns and outcomes for kidney transplants. Materials and Methods: Using data from the Nationwide Inpatient Sample, discharge records for kidney transplants (6,674) were abstracted (1993 to 2003). Through the Nationwide Inpatient Sample unique surgeon identifier we determined the proportion of kidney transplants performed by multiorgan and kidney only transplant surgeons. We fit multilevel regression models to examine the relationship between surgeon type and transplant outcome. Results: We identified 99 multiorgan and 196 kidney only transplant surgeons who performed 3,255 and 3,419 kidney transplants, respectively. Kidney only transplant surgeons were more likely than multiorgan surgeons to practice in nonteaching, private, for-profit hospitals (p <0.05). Unadjusted operative mortality was higher in patients treated by kidney only vs multiorgan transplant surgeons (1.7% vs 0.9%, p = 0.002). After adjusting for patient and hospital factors, those who underwent renal transplantation performed by multiorgan transplant surgeons had 55% lower odds of inpatient death (OR 0.45, 95% CI 0.26–0.76) vs kidney only transplant surgeons. Conclusions: Despite the current training paradigm, kidney only transplant surgeons have a prominent role in renal transplantation. However, given the current donor organ shortage and the implications for quality, the observed mortality difference suggests that additional investigation is needed to determine whether this role should be decreased. [Copyright &y& Elsevier]

We propose in this paper to use three regions of plastid DNA as a standard protocol for barcoding all land plants. We review the other markers that have been proposed and discuss their advantages and disadvantages. The low levels of variation in plastid DNA make three regions necessary; there are no plastid regions, coding or non-coding, that evolve as rapidly as mitochondrial DNA generally does in animals. We outline two, three-region options, (1) rpoC1, rpoB and matK or (2) rpoC1, matK and psbA-trnH as viable markers for land plant barcoding. [ABSTRACT FROM AUTHOR]

Purpose: There may be inherent costs associated with the cultivation of laparoscopic expertise. We compared the cost trends for laparoscopy during the development of our program with that of open surgery for renal neoplasms. Materials and Methods: We retrospectively reviewed the records of 381 patients treated surgically for renal cortical neoplasms from 1998 to 2003. Demographic information and cancer specific data were recorded on each subject. Direct variable costs, which are directly traceable to the patient care service provided and vary with patient volume, were used to analyze cost. Temporal trends were assessed using multivariate models developed to determine smoothed mean costs by year. Results: Although it was initially more expensive, by 2003 mean costs were lower for laparoscopic than for open radical nephrectomy ($5,157 vs $5,808). This reflected a significantly lower annual increase in direct variable costs for laparoscopy vs open surgery even after adjustment for patient age, sex, race and clinical stage (p = 0.013). Although a similar trend was observed when comparing nephron sparing procedures vs open surgery, this did not attain statistical significance. In addition to surgical technique, only higher clinical stage was independently associated with increased direct variable costs after adjustment for operative year (p <0.0001). Conclusions: Relative to their open counterparts the costs of laparoscopic treatment of renal cortical neoplasms have increased at a lower rate in the last 6 years. When considered in the context of the well established benefits of laparoscopy, our findings lend additional support in favor of laparoscopy as the standard of care. [Copyright &y& Elsevier]

The liverwort Anastrophyllum joergensenii Schiffn., reported from Norway, Scotland, Alaska and the Sino-Himalaya is shown to consist of two distinct species, A. alpinum Steph. (treated before as a synonym of A. joergensenii) in the Himalaya, western China, Alaska and Scotland, and A. joergensenii Schiffn. s. str. in Norway, Scotland and western China. The two species are distinguished on genetic characters, size, leaf and perianth characters, and appear to have different ecological preferences. Anastrophyllum alpinum, although the more widespread of the two in Scotland, is there known only as non-fertile plants, whereas in the Sino-Himalaya fertile populations and sporophytes are not infrequent; in contrast, the rarer A. joergensenii can produce perianths in Scotland, Norway and Yunnan but androecia and sporophytes are unknown. The differences between the two are detailed and the ecology and distribution outlined. [ABSTRACT FROM AUTHOR]

The genetic structure of populations of an arctic-montane herb, Saxifraga hirculus (Saxifragaceae), was analysed by means of chloroplast restriction fragment-length polymorphism. Sampled populations were distributed across Europe and North America (Alaska and Colorado). There was no evidence for geographically structured genetically divergent lineages, and although no haplotypes were shared between North America and Europe, the haplotypes from different continents were intermixed on a minimum spanning tree. European populations were much more highly differentiated and had much lower levels of haplotype diversity than their Alaskan counterparts. Centres of haplotype diversity were concentrated in those Alaskan populations located outside the limits of the last (Wisconsin) glaciation, suggesting that they may have acted as refugia during the Pleistocene. It was not possible to identify putative migration routes or corresponding refugia in the European genepool. One British population, from the Pentland Hills, was genetically very distant from all the others, for reasons that are as yet unknown.Heredity (2006) 96, 222–231. doi:10.1038/sj.hdy.6800785; published online 8 February 2006 [ABSTRACT FROM AUTHOR]

Purpose: The recent popularization of laparoscopic radical nephrectomy may beget underuse of partial nephrectomy. To evaluate this concern we used the SEER registry to characterize national practice patterns for the surgical management of small renal masses. Materials and Methods: Between 1988 and 2001, 14,647 patients with primary tumor size 7 cm or less were treated surgically for locoregional kidney cancer. The proportion of patients treated with PN was determined and stratified by year of diagnosis and tumor size. Multivariate models were developed to identify independent determinants of PN use and overall survival following surgical treatment of kidney cancer. Results: Overall 1,401 patients (9.6%) were treated with PN vs 13,246 (90.4%) who underwent total nephrectomy. For tumors 7 cm or less, the use of PN increased progressively between 1988 (4.6%) and 2001 (17.6%, p <0.001). Despite this trend PN remained fairly uncommon even for the smallest renal masses. Among patients with tumors less than 2 cm, 14% underwent PN in 1988 to 1989 vs 42% in 2000 to 2001. For tumors 2 to 4 cm the corresponding proportions were 5% and 20%, respectively (p <0.001). Younger patient age, smaller tumor size and more recent diagnostic year were independent determinants of PN use (all p values <0.05). All cause mortality was similar for patients treated with PN vs TN (HR 0.9, 95% CI 0.8-1.1). Conclusions: Despite more frequent application during the last 2 decades, nationwide use of PN remains relatively uncommon, even for the smallest renal masses. Recognizing the favorable outcomes associated with preservation of renal parenchyma, our findings identify a possible quality of care concern that should be addressed by the urological community. [Copyright &y& Elsevier]

Restoration of scrub and woodland in deforested upland sites is an important conservation activity. However, little is known about the mycorrhizal colonisation potential of upland soils or the factors that influence the distribution of mycorrhizal inoculum. We investigated the effect of existing vegetation on mycorrhizal colonisation potential for a sub-arctic willow (Salix lapponum) by planting uninoculated cuttings into plots representing two upland habitats with either grass and herbs (‘grass’) or Vaccinium myrtillus (‘vaccinium’) and assessing mycorrhizal colonisation after 14 months using morphological and molecular techniques. From 40 willow cuttings (20 in each habitat), DNA sequences of five ectomycorrhizal (EcM) fungal taxa were recovered: Laccaria proxima, Thelephora terrestris, Hebeloma sp., ‘Thelephoraceae sp.’ and ‘Pezizales sp.’ Cuttings in the ‘grass’ habitat were dominated by Laccaria proxima and ‘Pezizales sp.’ and in the ‘vaccinium’ habitat by Thelephora terrestris which was absent from the ‘grass’ habitat. There were no significant differences between habitats in frequency of EcM inoculum (overall percentage of cuttings colonised = 70%) or colonisation potential (overall mean percentage of root tips colonised per cutting = 20%). These data suggest that the mycorrhizal colonisation potential and diversity of fungi available to willow in these upland soils are low and planted willow may benefit from inoculum enhancement. [ABSTRACT FROM AUTHOR]

To examine the performance and information content of different marker systems, comparative assessment of population genetic diversity was undertaken in nine populations ofAthyrium distentifoliumusing nine genomic and 10 expressed sequence tag (EST) microsatellite (SSR) loci, and 265 amplified fragment length polymorphism (AFLP) loci from two primer combinations. In range-wide comparisons (European vs. North American populations), the EST-SSR loci showed more reliable amplification and produced more easily scorable bands than genomic simple sequence repeats (SSRs). Genomic SSRs showed significantly higher levels of allelic diversity than EST-SSRs, but there was a significant correlation in the rank order of population diversities revealed by both marker types. When AFLPs, genomic SSRs, and EST-SSRs are considered, comparisons of different population diversity metrics/markers revealed a mixture of significant and nonsignificant rank–order correlations. However, no hard incongruence was detected (in no pairwise comparison of populations did different marker systems or metrics detect opposingly significant different amounts of variation). Comparable population pairwise estimates ofFST were obtained for all marker types, but whilst absolute values for genomic and EST-SSRs were very similar (FST = 0.355 and 0.342, respectively), differentiation was consistently higher for AFLPs in pairwise and global comparisons (global AFLPFST = 0.496). The two AFLP primer combinations outperformed 18 SSR loci in assignment tests and discriminatory power in phenetic cluster analyses. The results from marker comparisons onA. distentifoliumare discussed in the context of the few other studies on natural plant populations comparing microsatellite and AFLP variability. [ABSTRACT FROM AUTHOR]

Agroforestry ecosystems may be an important resource for conservation and sustainable use of tropical trees, but little is known of the genetic diversity they contain.Inga edulis, a widespread indigenous fruit tree in South America, is used as a model to assess the maintenance of genetic diversity in five planted vs. five natural stands in the Peruvian Amazon. Analysis of five SSR (simple sequence repeat) loci indicated lower allelic variation in planted stands[mean corrected allelic richness 31.3 (planted) and 39.3 (natural),P = 0.009]. Concerns regarding genetic erosion in planted Amazonian tree stands appear valid, although allelic variation on-farm is still relatively high. [ABSTRACT FROM AUTHOR]

The genus Euphrasia in Britain comprises a taxonomically complex group of self-compatible, morphologically similar, hemi-parasitic, annual plant species of high conservation importance. The 19 diploid and tetraploid taxa currently recognised show striking variation in flower size. The objective of this paper is to determine whether a relationship exists between flower size and breeding system within Euphrasia. Following a survey of flower size variation among the 19 taxa, seven diploid populations, encompassing a broad range of flower sizes, were selected for detailed study. Four nuclear microsatellite loci were used to estimate the inbreeding coefficient Fis within each population. Fis values varied from to 0.17-0.77 and showed a significant, negative correlation with flower size. These results are best explained as the consequence of variation in selfing rate among the Euphrasia populations, with selfing rate increasing as flower size decreases. The potential factors influencing breeding system evolution in Euphrasia are discussed, together with the role of autogamy in generating taxonomic complexity and facilitating lineage differentiation within the genus.Heredity (2005) 94, 44-51. doi:10.1038/sj.hdy.6800553 Published online 18 August 2004 [ABSTRACT FROM AUTHOR]

Spiranthes romanzoffiana Cham. is restricted in Europe to the British Isles, where it is recognised as a conservation priority species due to frequent extirpation of populations along with no evidence of seed set; vegetative reproduction has been invoked as the sole means of perpetuation and dispersal. To investigate the reproductive ecology of this species, 17 populations have been sampled for chloroplast microsatellites and amplified fragment length polymorphisms (AFLPs). These markers revealed a previously unsuspected genetic-geographic split in the species, which correlates with differences in patterns of within-population variation. Northern populations were fixed for one chloroplast haplotype but showed high levels of AFLP genotypic diversity consistent with sexual reproduction (proportion of genotypes distinguishable, PD=0.98). More southerly populations showed fixed differences from the northern populations in their chloroplast haplotype and for 10 AFLP markers. They harboured only 12 unique multilocus genotypes among 113 individuals from six populations (PD=0.11). These genotypes differed mostly by single bands, and none by more than 4/138 loci, with identical multilocus genotypes occurring in widely separated populations. This uniformity in southern populations is consistent with agamospermous or autogamous reproduction, and/or an extreme population bottleneck. Finally, the observed patterns of population differentiation in S. romanzoffiana are compared with other studies of orchids, revealing a wide range of values that belie recent contrasting published generalisations that claim that orchids show either higher, or lower, levels of population differentiation than other plant families.Heredity (2004) 92, 218-227, advance online publication, 3 December 2003; doi:10.1038/sj.hdy.6800399 [ABSTRACT FROM AUTHOR]

Reports on the morphological and molecular investigation of the percentage and maternity of Anacamptis albuferensis in Mallorca, Spain. Sequencing of nuclear Internal Transcribed Spacer and plastid trnL regions with polymerase chain reaction-restriction Fragment Length Polymorphism analysis; Provision of further evidence of the generic cohesion of the genus Anacamptis; Morphological contrast between the parents that is matched by an intermediacy of the hybrid.

Provides information about the treatment of allergic rhinoconjunctivitis. Signs and symptoms of allergic rhinoconjunctivitis; Its pathogenesis; Antihistamines and intranasal corticosteroids commonly used to treat allergic rhinitis;

Background: Studies have shown that Black patients die more frequently following coronary artery bypass grafting than their White counterparts for reasons not fully explained by disease severity or comorbidity. To examine whether provider care team segregation within hospitals contributes to this inequity, we analyzed national Medicare data.Methods: Using national Medicare data, we identified beneficiaries who underwent coronary artery bypass grafting at hospitals where this procedure was performed on at least 10 Black and 10 White patients between 2008 and 2014 (n=12 646). After determining the providers who participated in their perioperative care, we examined the extent to which Black and White patients were cared for by unique networks of provider care teams within the same hospital. We then evaluated whether a lack of overlap in composition of the provider care teams treating Black versus White patients (ie, high segregation) was associated with higher 90-day operative mortality among Black patients.Results: The median level of provider care team segregation was high (0.89) but varied across hospitals (interquartile range, 0.85-0.90). On multivariable analysis, after controlling for patient-, hospital-, and community-level differences, mortality rates for White patients were comparable at hospitals with high and low levels of provider care segregation (5.4% [95% CI, 4.7%-6.1%] versus 5.8% [95% CI, 4.7%-7.0%], respectively; P=0.601), while Black patients treated at high-segregation hospitals had significantly higher mortality than those treated at low-segregation hospitals (8.3% [95% CI, 5.4%-12.4%] versus 3.3% [95% CI, 2.0%-5.4%], respectively; P=0.017). The difference in mortality rates for Black and White patients treated at low-segregation hospitals was nonsignificant (-2.5%; P=0.098).Conclusions: Black patients who undergo coronary artery bypass grafting at a hospital with a higher level of provider care team segregation die more frequently after surgery than Black patients treated at a hospital with a lower level. [ABSTRACT FROM AUTHOR]