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BackgroundOral disease modifying therapies (DMTs) for multiple sclerosis (MS) differ in efficacy, tolerability, and safety. ObjectiveWe sought to understand how these attributes impact patient preference and predicted DMT non-adherence among oral-naïve MS patients. MethodsAdult MS patients from the “PatientsLikeMe” Web-based health data-sharing platform completed a discrete choice exercise where they were asked to express their preference for one of three hypothetical oral DMTs, each with a certain combination of levels of tested attributes. Another Web-based exercise tested a number of possible drivers of non-adherence, mainly side effects. Data from an MS clinic were used to adjust for sample bias. Respondents’ preferences were analyzed using Hierarchical Bayesian estimation. ResultsA total of 319 patients completed all questions. Most respondents were female (77.7%, 248/319) with mean age 48 years (SD 10). Liver toxicity was the attribute that emerged as the most important driver of patient preference (25.8%, relative importance out of 100%), followed by severe side effects (15.3%), delay to disability progression (10.7%), and common side effects (10.4%). The most important drivers of predicted non-adherence were frequency of daily dosing (17.4% out of 100%), hair thinning (14.8%), use during pregnancy (14.1%), severe side effects (13.8%), and diarrhea (13.0%). ConclusionsUnderstanding the important concerns expressed by patients may help health care providers to understand and educate their patients more completely about these concerns. This knowledge may therefore improve both choices of appropriate therapy and adherence to therapy over time.

Flashiness is a hydrologic signature used to describe the responsiveness of streamflow to precipitation. In practise, flashiness has most often been correlated with rainfall intensity and the presence of urban land cover or imperviousness. However, a number of watershed characteristics can influence flashiness, necessitating further investigation of how this particular watershed behaviour and its associated drivers vary at regional scales. We investigated how ten measurable watershed characteristics are empirically related to flashiness of 195 gauged streams in the Mid‐Atlantic region using linear regression analysis. The selected gauges had drainage areas ranging in size from 15 to 250 km2. To explore multiple quantifications of flashiness, we determined both the Richards‐Baker flashiness index, calculated from the continuous hydrograph, and number of peaks‐over‐threshold, for all watersheds for a 10‐year period. As found in other studies, the percentage of watershed development was strongly correlated with stream flashiness, though significant inverse relationships also existed for forest cover, water and wetlands and carbonate geology. Differences in flashiness values between rural and suburban watersheds were not significant, with a significant increase in flashiness (p < 0.01) occurring at 80% development or ~ 25% imperviousness. In addition, we found significant differences in relationships between watershed characteristics and flashiness when differentiated by physiographic regions. For the study area and each of its five physiographic sub‐regions, we identified the four most important predictors through multiple regression. The overall mid‐Atlantic model suggested that development, wetlands and compactness ratio as the most important predictors (adj R2 = 0.57). Significant predictors of stream flashiness varied among regions; however, wetlands served as a significant buffer of flashiness in four of five sub‐regions demonstrating the importance of wetlands in modulating flash‐flooding. In all physiographic regions, empirical models of flashiness values outperformed the Mid‐Atlantic regional model, underscoring the value of local landscape characteristics in augmenting or modulating flashy watershed responses. Our findings suggest the potential for improvements to operational flash‐flood forecasting using hydrologic characteristics of the landscape. [ABSTRACT FROM AUTHOR]

Variation is key to the adaptability of species and their ability to survive changes to the Earth's climate and habitats. Plasticity in movement strategies allows a species to better track spatial dynamics of habitat quality. We describe the mechanisms that shape the movement of a long-distance migrant bird (turkey vulture, Cathartes aura) across two continents using satellite tracking coupled with remote-sensing science. Using nearly 10 years of data from 24 satellite-tracked vultures in four distinct populations, we describe an enormous amount of variation in their movement patterns. We related vulture movement to environmental conditions and found important correlations explaining how far they need to move to find food (indexed by the Normalized Difference Vegetation Index) and how fast they can move based on the prevalence of thermals and temperature. We conclude that the extensive variability in the movement ecology of turkey vultures, facilitated by their energetically efficient thermal soaring, suggests that this species is likely to do well across periods of modest climate change. The large scale and sample sizes needed for such analysis in a widespread migrant emphasizes the need for integrated and collaborative efforts to obtain tracking data and for policies, tools and open datasets to encourage such collaborations and data sharing.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jenvman.2006.01.014 Byline: Arthur D. Kney, David Brandes Keywords: Alkalinity; Specific conductance; Graphical method; Base flow and water quality Abstract: In areas of varying geology, it is difficult to infer water quality from specific conductance or electrical conductivity (EC) data without an understanding of the expected range of EC values based on local bedrock composition. This paper describes a user-friendly graphical screening method that addresses this issue by plotting the EC against concurrent alkalinity data, which correlates well with the presence of carbonate bedrock under natural conditions, and thus serves as an index of bedrock type. The upper limit of EC vs. alkalinity expected in a stream is determined using regional groundwater quality data, based on the assumption that stream chemistry reflects groundwater under baseflow conditions. Stream samples with EC/alkalinity values that consistently plot above this limit are considered impacted by anthropogenic sources. The effect of dilution and runoff on the EC vs. alkalinity plot of stream samples is considered using a simple baseflow/storm runoff-mixing model. The graphical method's utility as a screening tool is demonstrated by application to stream chemistry data from watersheds of southeastern Pennsylvania and northwestern New Jersey in several distinct geologic settings; however the method is general and widely applicable to watersheds in humid temperate regions. Its use is intended for watershed stewards of both professional and nonprofessional qualification. Author Affiliation: Department of Civil and Environmental Engineering, Acopian Engineering Center, Lafayette College, Easton, PA 18042, USA Article History: Received 25 June 2005; Revised 24 December 2005; Accepted 20 January 2006

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Byline: David. Brandes In this article the authors present the results of treatment of 21 treatment-naive MS patients and 2 NMO patients with mitoxantrone in a prospective non-blinded study without [...]