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Using hospital-reported price data, we analyzed whether various market factors including radiation oncology practice consolidation were associated with higher commercial prices for radiation therapy (RT).We evaluated commercial prices paid by private insurers for 4 common RT procedures-intensity modulated RT (IMRT) planning, IMRT delivery, 3-dimensional RT (3D-RT) planning, and 3D-RT delivery-reported among the 2096 hospitals in the United States that deliver RT according to the Medicare Provider of Service file. To assess price variation within hospitals, we evaluated the ratio of the 90th percentile price to the 10th percentile price among different private insurers. To assess regional variation, we similarly compared median commercial prices at the 90th and 10th percentile hospitals in each Hospital Referral Region. We generated multivariable models to test the association of various hospital, health system, regional, and market factors on median hospital commercial prices.A total of 1004 hospitals (47.9%) reported at least 1 commercial price for any of the 4 RT procedures considered in this study. National median commercial prices for IMRT planning and IMRT delivery were $4073 (interquartile ratio [IQR], $2242-$6305) and $1666 (IQR, $1014-$2619), respectively. Prices for 3D-RT planning and 3D-RT delivery were $2824 (IQR, $1339-$4738) and $616 (IQR, $419-877), respectively. Within hospitals, the 90th percentile price paid by a private insurer was 2.3 to 2.5 times higher on average than the 10th percentile price, depending on the procedure. Within each Hospital Referral Region, the median price at the 90th percentile hospital was between 2.4 and 3.2 times higher than at the 10th percentile hospital. On multivariable analysis, higher prices were generally observed at hospitals with for-profit ownership, teaching status, and affiliation with large health systems. Levels of radiation oncology practice consolidation were not significantly associated with any prices.Commercial prices for common RT procedures vary by more than a factor of 2 depending on a patient's private insurer and hospital of choice. Higher prices were more likely to be found at for-profit hospitals, teaching hospitals, and hospitals affiliated with large health systems.

Purpose of Review Mounting evidence indicates that habitats such as wastewater and environmental waters are pathways for the spread of antibiotic-resistant bacteria (ARB) and mobile antibiotic resistance genes (ARGs). We identified antibiotic-resistant members of the genera Acinetobacter, Aeromonas, and Pseudomonas as key opportunistic pathogens that grow or persist in built (e.g., wastewater) or natural aquatic environments. Effective methods for monitoring these ARB in the environment are needed to understand their influence on dissemination of ARB and ARGs, but standard methods have not been developed. This systematic review considers peer-reviewed papers where the ARB above were cultured from wastewater or surface water, focusing on the accuracy of current methodologies. Recent Findings Recent studies suggest that many clinically important ARGs were originally acquired from environmental microorganisms. Acinetobacter, Aeromonas, and Pseudomonas species are of interest because their ability to persist and grow in the environment provides opportunities to engage in horizontal gene transfer with other environmental bacteria. Pathogenic strains of these organisms resistant to multiple, clinically relevant drug classes have been identified as an urgent threat. However, culture methods for these bacteria were generally developed for clinical samples and are not well-vetted for environmental samples. Summary The search criteria yielded 60 peer-reviewed articles over the past 20 years, which reported a wide variety of methods for isolation, confirmation, and antibiotic resistance assays. Based on a systematic comparison of the reported methods, we suggest a path forward for standardizing methodologies for monitoring antibiotic resistant strains of these bacteria in water environments.

The number of pulmonary nodules discovered incidentally or through screening programs has increased markedly. Multidisciplinary review and management are recommended, but the involvement of radiation oncologists in this context has not been defined.To assess the role of stereotactic body radiation therapy among patients enrolled in a lung cancer screening program.This prospective cohort study was performed at a pulmonary nodule and lung cancer screening clinic from October 1, 2012, to September 31, 2019. Referrals were based on chest computed tomography with Lung Imaging Reporting and Data System category 4 finding or an incidental nodule 6 mm or larger. A multidisciplinary team of practitioners from radiology, thoracic surgery, pulmonology, medical oncology, and radiation oncology reviewed all nodules and coordinated workup and treatment as indicated.Patients referred to the pulmonary nodule and lung cancer screening clinic with an incidental or screen-detected pulmonary nodule.The primary outcome was the proportion of patients undergoing therapeutic intervention with radiation therapy, stratified by the route of detection of their pulmonary nodules (incidental vs screen detected). Secondary outcomes were 2-year local control and metastasis-free survival.Among 1150 total patients (median [IQR] age, 66.5 [59.3-73.7] years; 665 [57.8%] female; 1024 [89.0%] non-Hispanic White; 841 [73.1%] current or former smokers), 234 (20.3%) presented with screen-detected nodules and 916 (79.7%) with incidental nodules. For patients with screen-detected nodules requiring treatment, 41 (17.5%) received treatment, with 31 (75.6%) undergoing surgery and 10 (24.4%) receiving radiation therapy. Patients treated with radiation therapy were older (median [IQR] age, 73.8 [67.1 to 82.1] vs 67.6 [61.0 to 72.9] years; P .001) and more likely to have history of tobacco use (67 [95.7%] vs 128 [76.6%]; P = .001) than those treated with surgery. Fifty-eight patients treated with radiation therapy (82.9%) were considered high risk for biopsy, and treatment recommendations were based on a clinical diagnosis of lung cancer after multidisciplinary review. All screened patients who received radiation therapy had stage I disease and were treated with stereotactic body radiation therapy. For all patients receiving stereotactic body radiation therapy, 2-year local control was 96.3% (95% CI, 91.1%-100%) and metastasis-free survival was 94.2% (95% CI, 87.7%-100%).In this unique prospective cohort, 1 in 4 patients with screen-detected pulmonary nodules requiring intervention were treated with stereotactic body radiation therapy. This finding highlights the role of radiation therapy in a lung cancer screening population and the importance of including radiation oncologists in the multidisciplinary management of pulmonary nodules.

Limited data exists regarding the efficacy of curative hypofractionated radiotherapy (hypo-RT) regimens compared to conventionally-fractionated radiotherapy (conv-RT) for Merkel cell carcinoma (MCC).A retrospective analysis of 241 patients diagnosed with non-metastatic MCC from 2005-2021 and who received RT at Dana-Farber/BrighamWomen's Cancer Center. The primary outcome was cumulative incidence of in-field locoregional relapse using Gray's test with competing risks of death and isolated out-of-field recurrence. Secondary outcomes included overall survival (OS) and MCC-specific survival using log-rank tests, and risk factors of recurrence using Cox-proportional hazards regression.There were 50 (20.6 %) and 193 (79.4 %) courses of hypo-RT and conv-RT, respectively. The hypo-RT cohort was older (≥73 years at diagnosis: 78.0 % vs 41.5 %, p 0.01), and received a lower equivalent total RT dose in 2 Gy per fraction (50 Gy: 58.0 % vs 5.2 %, p 0.01). Median follow-up was 65.1 months (range: 1.2-194.5) for conv-RT and 25.0 months (range: 1.6-131.3) for hypo-RT cohorts. Two-year cumulative incidence of in-field locoregional relapse was low in both groups (1.1 % conv-RT vs 4.1 % hypo-RT, p = 0.114). While two-year OS was lower for the hypo-RT group (62.6 % vs 84.4 %, p = 0.0008), two-year MCC-specific survival was similar (84.7 % vs 86.6 %, p = 0.743). On multivariable analysis, immunosuppression, clinical stage III disease, and lymphovascular invasion were associated with any-recurrence when controlling for sex, age, and hypo-RT.There was no difference in cumulative incidence of in-field locoregional relapse or MCC-specific survival between hypo-RT and conv-RT. Prospective studies are needed to confirm hypo-RT as an efficacious treatment option for MCC.

Introduction/Objectives Ankylosing spondylitis (AS) is a chronic inflammatory immune-mediated condition. We compared AS diagnosis, treatment, and burden in Central Eastern European countries (CEE), where this has been less researched, and the United States (US) from a real-world perspective. Methods Point-in-time survey of rheumatologists and their AS patients was conducted in the US (Apr–Oct 2018) and CEE (Aug–Nov 2019) via physician- and patient-completed record forms, including clinical and patient-reported outcomes. Statistical analysis included descriptive statistics, t-tests, Fisher’s exact tests, and generalized linear models. Results In total, 487 patients were recruited from 88 rheumatologists in the US and 922 patients from 126 rheumatologists in CEE. Time from onset of symptoms to final AS diagnosis was longer in CEE than the US (4.2 vs 2.7 years, p p p p p p p Conclusions AS patients in CEE vs the US faced slower diagnosis and worse access to biologics, disease activity, and QoL. Whether early access to biologics can improve symptoms, QoL, and daily activities in AS patients in CEE remains to be seen. Key Points• The study provided evidence on the real-world approach to the diagnosis, treatment, and burden of axSpA (axial spondyloarthritis) in CEE compared with the US.• The study reported patients in CEE experienced longer delays in diagnosis and poorer access to biologics than in the US.• This may have resulted in higher disease activity, greater levels of pain, and poorer outcomes, as reported by patients with axSpA in CEE.

Floc size, density, and settling velocity were investigated in the Connecticut River estuary over 3 years spanning varying fluvial discharge regimes to determine the role of cohesive suspended particle characteristics in the sediment-transport patterns of an energetic estuary. Concurrent measurements of flow, bed stress, salinity, and suspended sediment concentration were used to identify primary controls on floc size variability. Water discharge ranged from 202 to 910 m3/s between the three sampling campaigns, and the timing of major sediment-discharge events preceding measurement periods from 23 to 162 days. Two distinct particle populations were observed under high and low sediment-discharge regimes. With abundant fluvial sediment input, flocculation occurred resulting in large, loosely packed flocs dominating the suspended signal (median sizes of 194–209 μm; median excess densities of 13–17 kg/m3). Following an extended period of low sediment discharge, small, dense aggregates resuspended from the bed were observed throughout the water column (median size of 171 μm and excess density of 60 kg/m3). The timing and partial decoupling of water and sediment discharge led to inter-annual patterns of particle packaging controlled by fresh sediment supply. When the estuary is “charged” with sediment following high discharge events, the characteristic large, less dense flocs with lower settling velocities primarily bypass the estuary. The similar disaggregated grain size distribution of the suspended material of the two regimes suggests the same source sediment is reintroduced to the estuary with the intrusion of the salt wedge, which extends farther up-estuary during low-discharge regimes. The fines repackaged as dense aggregates ultimately supply the channel margins and off-channel coves currently experiencing sediment accumulation.

Background: Ibrance Real World Insights (IRIS) is a multi-country study aimed to describe clinical characteristics, treatment patterns and clinical outcomes of patients receiving palbociclib plus aromatase inhibitor. Previously the results on the overall population within the US have been communicated. The current analysis focuses on subgroups stratified by age, performance status and visceral status. Materials and methods: A retrospective chart review of HR+/HER2- ABC/MBC patients who received palbociclib plus aromatase inhibitor as initial endocrine based therapy for their advanced disease was conducted between June and October 2017. Physicians completed electronic case report forms, extracting data on patient demographics, clinical characteristics, treatment history/patterns and clinical outcomes.Progression free and survival rates at 12 and 24 months were estimated via Kaplan-Meier analysis. Results: Data for the US are reported here. In total 63 physicians completed 360 eCRFs with a mean follow up time since palbociclib initiation of 12 months. Majority of the patients were >65 years (53%), and had ECOG status of 0 (30%) or 1 (56%). Overall 293 (81%) patients had metastatic disease, of which 50% had visceral metastases. Across all sub-groups, majority of patients prescribed an initial palbociclib dose of 125mg did not require a change of dose while on treatment. The 12-month and 24-month progression free and overall survival rates across subgroups are presented in Table 1. Patients with a performance status of ECOG=1 had a slightly lower progression and survival rates at 12 and 24 months compared to those with a score =0. Likewise, patients with visceral disease were observed to have slightly lower progression free and survival rates than others. Table 1:Clinical Outcomes for the different sub-groups.Patient Sub-groups AgeECOG statusVisceral Status Up to 65 n=169Over 65 n=1910 n=1071 n=200Visceral metastases n=147Non-visceral metastases n=146Progression free survival rate at 12 months, %86.382.194.386.580.285.8Progression free survival rate at 24 months, %59.769.071.267.450.780.6Overall survival rate At 12 months, %97.992.8100.099.590.599.3Overall survival rate at 24 months, %95.185.695.796.487.290.7 Conclusions: The analysis indicates consistent trends in different clinical outcomes were observed with palbociclib plus aromatase inhibitor across patients sub-groups based on age, performance status and visceral metastases. Citation Format: Taylor-Stokes G, Mitra D, Waller J, Gibson K, Milligan G, Zhan L, Iyer S. Real world treatment patterns and outcomes of patients receiving palbociclib plus aromatase inhibitor in the United States: Sub-groups analysis based on age, performance status and sites of metastases from the IRIS study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-36.

Background: Ibrance Real World Insights (IRIS) is a multi-country study aimed to describe the clinical characteristics and understand treatment patterns and clinical outcomes of patients receiving palbociclib plus fulvestrant in real world clinical practice. Previously the results on the overall population within the US have been communicated. The current analyses focus on subgroups stratified by age, performance status and visceral status. Materials and methods: A retrospective chart review of HR+/HER2- ABC/MBC patients was conducted between June and October 2017. Physicians extracted data from patient medical records for HR+/HER2- ABC patients who received palbociclib plus fulvestrant following disease progression with endocrine based therapy for their advanced disease. Electronic case report forms collected data covering patient demographics, clinical characteristics, treatment history/patterns and clinical outcomes.Progression free rates and survival rates at 6 and 12 months were estimated via Kaplan-Meier analysis. Results: Data for the US are reported here. In total, 65 physicians extracted data for 292 patients who had a mean follow up time of 7.4 months. Majority of the patients were >65 years (54%), and had ECOG status of 0 (32%) or 1 (48%). Overall 224 (77%) patients had metastatic disease, of which 93 (42%) had visceral metastases. Across all sub-groups, majority of patients prescribed an initial palbociclib dose of 125mg did not require a change of dose while on treatment. The 6-month and 12-month progression free and survival rates across subgroups are presented in Table 1. Patients with a performance status of ECOG ≥ 2 had a slightly lower progression and survival rates at 6 and 12 months compared to those with a score Table 1:Clinical Outcomes by Patient Sub-groups.Patient Sub-groups AgeECOGstatusVisceral Status Up to 65 n=158Over 65 n=1340 n=931 n=1392+ n=60Visceral Metastases n=93Non-visceral Metastases n=131Progression free survival rate at 6 months, %95.293.297.893.490.689.694.8Progression free survival rate at 12 months, %81.277.884.683.0-73.276.5Survival rate at 6 months, %98.096.3100.098.290.692.298.9Survival rate at 12 months, %90.085.197.695.1-80.892.7 Conclusions: The analysis indicates consistent trends in different clinical outcomes were observed with palbociclib plus fulvestrant across patients sub-groups based on age, performance status and visceral metastases. Citation Format: Waller J, Mitra D, Taylor-Stokes G, Gibson K, Milligan G, Zhan L, Iyer S. Real world treatment patterns and outcomes of patients receiving palbociclib plus fulvestrant in the United States: Sub-groups analysis based on age, performance status and sites of metastases [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-21.

Plant soil feedback (PSF) occurs when a plant modifies soil biotic properties and those changes in turn influence plant growth, survival or reproduction. These feedback effects are not well understood as mechanisms for invasive plant species. Eragrostis lehmanniana is an invasive species that has extensively colonized the southwest US. To address how PSFs may affect E. lehmanniana invasion and native Bouteloua gracilis growth, soil inoculant from four sites of known invasion age at the Appleton-Whittell Audubon Research Ranch in Sonoita, AZ were used in a PSF greenhouse study, incorporating a replacement series design. The purpose of this research was to evaluate PSF conspecific and heterospecific effects and competition outcomes between the invasive E. lehmanniana and a native forage grass, Bouteloua gracilis. Eragrostis lehmannianaPSFs were beneficial to B. gracilis if developed in previously invaded soil. Plant-soil feedback contributed to competitive suppression of B. gracilis only in the highest ratio of E. lehmanniana to B. gracilis. Plant-soil feedback did not provide an advantage to E. lehmanniana in competitive interactions with B. gracilis at low competition levels but were advantageous to E. lehmanniana at the highest competition ratio, indicating a possible density-dependent effect. Despite being beneficial to B. gracilis under many conditions, E. lehmanniana was the superior competitor.

Background Presentation and risks of progression and complications differ according to Crohn’s disease (CD) location. The objective of this study was to investigate how disease burden differs based on CD location, from physician and patient perspective. Methods Data drawn from the Adelphi Inflammatory Bowel Disease (IBD) Disease Specific Programme™, a point-in-time survey of gastroenterologists (GEs) and their IBD patients from two waves (Nov 2014-Mar 2015; Sep 2017-Jan 2018) in the United States, and 5EU. GEs completed physician-reported questionnaires for 5–10 consecutively consulting patients with CD, covering demographics, treatment, symptoms, and CD location. Same patients completed voluntary patient-reported questionnaire including outcome measures such as Short IBD Questionnaire (SIBDQ), EuroQol 5-dimension questionnaire (EQ-5D), and Work Productivity and Activity Impairment questionnaire. Comparisons were drawn between patients with CD in 3 locations: ileal only (IL), ileocolonic (IC), and colonic only (CO). Outcomes such as patient-reported level of pain, sleep disturbance, and fatigue, were compared between locations using linear regression analyses that included potential confounding variables age, gender, body mass index, comorbidities (using Charlson Comorbidity Index [CCI]) and severity at diagnosis. Least square (LS) means were generated for each location and compared using a p-value generated from Wald tests. Variables such as current treatment and symptoms, were compared using univariate tests (ANOVA, chi2 test). Base sizes varied due to the voluntary nature of patient participation. Results 686 GEs collected data on 2354 patients with moderate-severe CD, identifying patients with IL (28.3%), IC (45.7%), and CO (26.0%) location. Overall demographic characteristics were similar, mean age 39 years, proportion of male patients 51.4%, mean Body Mass Index 24.0, mean CCI 0.14. Differences were observed between the 3 groups (Table 1). Patients with ileal involvement (IL and IC) were prescribed biologics more often and had greater symptom burden than CO patients, except for rectal urgency. IL patients tended to have slightly greater burden overall in terms of symptomatology and severity. There was similarity across SIBDQ and EQ-5D scores; however, absenteeism was higher amongst IL and IC patients, compared with CO patients. Conclusion Differences were observed between IL, IC, and CO CD location groups. Despite IC patients experiencing the greatest burden overall, there were key distinctions between IL and CO patients, particularly in medication, symptoms, and work productivity impairment, suggesting that disease management with attention to CD location could lead to better patient outcomes.

Understanding the processes that lead to seasonal changes in grain size on muddy macro-tidal flat and channel complexes will assist efforts to predict future changes caused by climate change and construction of infrastructure like tidal power generators, wind farms, and causeways. Surficial sediment samples were collected for disaggregated inorganic grain size (DIGS) analysis every month for 1 year from a tidal flat and from a tidal channel and its banks in Kingsport, NS, Canada, which is located in the Minas Basin of the Bay of Fundy. A process-based parameterization of the DIGS distribution was used to determine floc fraction, representative of the percentage of fine-grained material deposited to the seabed in flocs. Small changes in floc fraction occurred seasonally in the channel. Values were higher in late winter and lower in late summer. A more pronounced seasonal variation in floc fraction was observed on the tidal flats. Observed changes in floc fraction correlated with elevation. Results from this study are discussed in terms of the controls on floc fraction which include suspended particulate matter concentration (SPM), turbulence, and stickiness in the water column, all of which can be used to understand the formative processes responsible for shaping the bottom sediment texture.

Most plants engage in symbioses with mycorrhizal fungi in soils and net consequences for plants vary widely from mutualism to parasitism. However, we lack a synthetic understanding of the evolutionary and ecological forces driving such variation for this or any other nutritional symbiosis. We used meta-analysis across 646 combinations of plants and fungi to show that evolutionary history explains substantially more variation in plant responses to mycorrhizal fungi than the ecological factors included in this study, such as nutrient fertilization and additional microbes. Evolutionary history also has a different influence on outcomes of ectomycorrhizal versus arbuscular mycorrhizal symbioses; the former are best explained by the multiple evolutionary origins of ectomycorrhizal lifestyle in plants, while the latter are best explained by recent diversification in plants; both are also explained by evolution of specificity between plants and fungi. These results provide the foundation for a synthetic framework to predict the outcomes of nutritional mutualisms. Jason Hoeksema et al. report a meta-analysis of the drivers of outcomes in mycorrhizal mutualisms across 646 plant–fungi combinations. They find that evolutionary history explains substantially more variation in the strength of mycorrhizal mutualisms than do ecological factors.

The effect of prescribed burning for conservation management of plant communities is controversial for moorlands growing on peat. These ecosystems provide many services that may be damaged by fire, hence it is important to fully assess its impact on all aspects of ecosystem structure and function experimentally over relatively long time‐scales. This paper describes change in community composition, major plant species, and plant functional types on moorland on peat in upland Britain over 60 years subject to 3 burning treatments after an initial burn in 1954/1955: no further burn and burning at 10‐ and 20‐year intervals (all ± sheep grazing). Data were analysed using multivariate and univariate methods. Vegetation composition and individual species abundance reflected the degree of disturbance. The least disturbed was dominated by Calluna vulgaris and pleurocarpous mosses, whereas the most disturbed treatment (burned every 10 years) had greater Eriophorum vaginatum , Sphagnum spp., acrocarpous mosses, liverworts, and lichens. The 20‐year treatment was intermediate in response disturbance. Repeated burning increased species abundance‐weighted Ellenberg values for moisture, reaction, light through time, and fertility; the exception was the 10‐year rotation for fertility. These confirm that prescribed burning is not deleterious to peat‐forming species (Eriophorum spp. and Sphagnum spp.), indeed these species were found in greater abundance in frequently burned treatments. It also confirms that a no‐burn policy will lead to increasing dominance of C. vulgaris , a flammable, fire‐adapted shrub, which increases summer wildfire risk. These results inform conservation management policy for moorland vegetation growing on peat; for this site, a 20‐year prescribed burning rotation is recommended.

Genetic monitoring estimates temporal changes in population parameters from molecular marker information. Most populations are complex in structure and change through time by expanding or contracting their geographic range, becoming fragmented or coalescing, or increasing or decreasing density. Traditional approaches to genetic monitoring rely on quantifying temporal shifts of specific population metrics—heterozygosity, numbers of alleles, effective population size—or measures of geographic differentiation such as FST. However, the accuracy and precision of the results can be heavily influenced by the type of genetic marker used and how closely they adhere to analytical assumptions. Care must be taken to ensure that inferences reflect actual population processes rather than changing molecular techniques or incorrect assumptions of an underlying model of population structure. In many species of conservation concern, true population structure is unknown, or structure might shift over time. In these cases, metrics based on inappropriate assumptions of population structure may not provide quality information regarding the monitored population. Thus, we need an inference model that decouples the complex elements that define population structure from estimation of population parameters of interest and reveals, rather than assumes, fine details of population structure. Encompassing a broad range of possible population structures would enable comparable inferences across biological systems, even in the face of range expansion or contraction, fragmentation, or changes in density. Currently, the best candidate is the spatial Λ‐Fleming‐Viot (SLFV) model, a spatially explicit individually based coalescent model that allows independent inference of two of the most important elements of population structure: local population density and local dispersal. We support increased use of the SLFV model for genetic monitoring by highlighting its benefits over traditional approaches. We also discuss necessary future directions for model development to support large genomic datasets informing real‐world management and conservation issues.

Alien invasive species have strategies that can maintain fitness in a variety of environments. This flexibility is associated with environmental tolerance in several traits, such as allocation of resources to shoots versus roots, clonal versus sexual reproduction, and survival of seedlings. These traits were explored in the chandelier plant (Kalanchoe delagoensis Eckl. & Zeyh.), which has invasive populations in several countries. Light and water tolerance and herbicide treatments were tested on plantlet survival. Plantlet survival in the most extreme cases (full sunlight and no watering) was close to 30%, whereas in less severe conditions (water and shaded), it was close to 100%. Stress conditions triggered the onset of plantlet production from the margin of leaves, which increased clonality. Biomass was allocated primarily to aboveground structures. Although all herbicides resulted in high plantlet mortality (>85%), only 2,4-D and glyphosate+2,4-D amine achieved the maximum recorded mortality a few days after the chemical application. The high tolerance of K. delagoensis plantlets to varying conditions shows that under stress, plantlet production is enhanced as survival of established individuals decreases. Biomass is primarily aboveground, which can potentially alter nitrogen and carbon in poor arid environments, and the proportion of the biomass assigned to belowground roots increased with an increase in sunlight received. Even though the chemical treatments 2,4-D and glyphosate+2,4-D amine have been shown to be the only effective treatments, the 2,4-D treatment may be the most viable (cost+quantity) to reduce the propagation of K. delagoensis. Plantlets have become the main reason for population persistence, partially due to the plant’s environmental tolerance and ability to reproduce asexually in short time periods. Susceptibility of plantlets to the two herbicides presents a means to adequately manage invasions of K. delagoensis in Mexico.

Illegal logging is a worldwide problem that degrades ecosystems, and even low-risk markets like the United States report ~1000 significant hardwood timber theft cases per year. Due to its high value, bigleaf maple (Acer macrophyllum Pursh) is a common target of timber theft in western North America. Using samples from Washington, USA, a single nucleotide polymorphism [SNP] assay was recently developed to facilitate timber poaching investigations in this species based on the single base extension Agena MassARRAY® genotyping system and 133 loci. Our study expands earlier evaluations to include the full 2000 km latitudinal range of bigleaf maple, using 1142 samples collected from California, USA to British Columbia, CAN. Populations in this study are equivalent to level 3 ecoregions, with sample sizes ranging from 28 (California Coast) to 191 (Washington Coast). Wood-derived DNA concentrations between 0.24 and 6 ng/μL yielded SNP call rates >92%, and DNA concentrations within this range did not influence genotyping call rates. DNA from different tissues showed a weak but significant difference in call rate, with DNA from wood showing a slightly higher call rate than leaves (99.4% vs 97.9%, respectively). Analysis of 108 sample replicates showed that missing genotypes occurred at 0.165% of all loci, and that allelic drop-outs and drop-ins each occurred at frequencies of 0.022% and 0.032%, respectively. Population-specific genotype profile probabilities for Pacific Northwest ecoregions were lower than 1.9×10−33; profile probabilities are higher (less powerful) in Californian trees due to lower variability across these SNP loci. Conversely, the geographic origin of trees from Southern Californian ecoregions could be predicted with lower error (8.5–11.7%) than trees from the Pacific Northwest (36–80%), based on random forest classification. This study provides a rich database for forensic individualization of bigleaf maple across its complete range in western North America.

Optical instruments that measure the particulate beam attenuation and backscattering coefficients have been used widely to estimate suspended particulate mass (SPM) in various environments. In pycnoclines, density differences can cause significant forward light scattering (schlieren). This fluid-induced scattering increases the measured by instruments with small acceptance angles that are open to the environment (not pumped). When the 1-m bin-averaged buoyancy frequency (N) exceeds 0.05 s−1 in the Columbia River estuary, inaccurate estimates of are observed by such instruments. The schlieren phenomena do not affect the and measured with a pumped transmissometer or a backscattering meter. It follows that to obtain a reliable proxy of SPM in a highly stratified environment, the use of either a backscattering sensor or a pumped transmissometer is required.

Seasonal variability in the sediment dynamics of a Bay of Fundy tidal creek and salt marsh system was analyzed to better understand the ecomorphodynamics of a high suspended sediment concentration intertidal habitat. Data were collected over 62 tides for velocity, suspended sediment concentration, deposition, and grain size at four stations from the creek thalweg to the marsh surface. Five topographic surveys were also conducted throughout the 14-month study. Deposition rates per tide varied spatially from 56.4 g m-2 at the creek thalweg to 15.3 g m-2 at the marsh surface. Seasonal variations in deposition in the creek and marsh surface were from 38.0 g m-2 to 97.7 g m-2 and from 12.2 g m-2 to 19.6 g m-2 respectively. Deposition and erosion were greatest in late fall and winter. This seasonal change, led by higher suspended sediment concentrations, was observed in the creek and at the marsh bank but notably absent from the marsh edge and marsh surface. Sediments were predominantly deposited in floc form (76–83%). Because of high floc content, higher suspended sediment concentrations led to more rapid loss of sediment from suspension. With increasing sediment concentration, deposition increased in the tidal creek and at the marsh bank but not at the marsh edge or marsh surface. This suggests that in highly flocculated environments the water column clears fast enough that very little sediment remains in suspension when the water reaches the marsh and that the sediment concentration during marsh inundation is independent of the initial concentration in the creek.

Ecological restoration of high-quality, semi-natural communities of conservation value on ex-arable soils with raised fertility has been a major problem in northern Europe. One suggested way of tackling this problem is to use Full-Inversion Tillage (FIT) where the fertile top-soil is moved below infertile sub-surface layers. This should provide infertile conditions at least in the short- to medium-term for the establishment of communities that require these conditions. Here, we pioneer a rigorous test of the efficacy of this approach. Our new method, using Principal Response Curves (PRCs), overcomes the difficulty in testing for change in soil physico-chemical properties down soil profiles with the inherent problem of autocorrelations between soil layers. Principal Response Curves (PRCs) is a multivariate technique, usually used to test for effects of treatment effects through time on a community matrix. We propose an extension of their use for the multivariate analysis of properties down a soil-depth profile. We tested the effects of FIT in two contrasting soils, before and after treatment. In a clay loam soil, FIT was effective in reducing the soil fertility in the surface 12 cm. Indeed the soil available P concentration, a key variable, was more than halved in the surface layers, and was below the lowest literature target threshold for the establishment of semi-natural grassland. In contrast, in the sandy soil, soil properties increased throughout the profile after FIT, primarily because of the pre-treatment nutrient distribution within the soil. Before FIT treatment, the maximum concentrations of most measured variables were at mid-depth and FIT redistributed these to the surface and bottom layers. Our results demonstrate the potential for FIT in ecological restoration, but indicate that its efficacy depends on soil type and the site history. We recommend that in future a pre-treatment assessment of soil properties with depth is undertaken before FIT is implemented, and that afterwards our PRC approach can be used to test efficacy immediately after treatment, and has the potential for measuring soil resilience to perturbation through time.

In most aquatic environments, suspended sediment is composed of loosely packed particle aggregates, termed flocs that have variable apparent densities. The apparent density of flocs, which is defined as particle dry mass over wet volume, is an important variable because it affects settling velocity and vertical sediment flux. Two established methods exist for measuring apparent density. One method uses physical measurements of sediment mass concentration combined with measurements of particle volume concentration from optical instruments to estimate apparent density. This method is laborious because it requires the collection of water samples, so it is not conducive to construction of high-resolution time series of density. Another method uses video observations of particles in a settling column to measure particle size and settling velocity. These measurements are used to solve for apparent density according to Stokes Law. The goal of this study is to develop a new method that uses the ratio of particulate beam attenuation to particle volume to estimate apparent density of sediment in suspension. Data from five studies are used to compare density estimates with the new method to the previous methods. The new optical method produces apparent densities that are correlated linearly with measurements of the ratio of dry mass to wet volume. However, the new optical method produces density estimates that do not correlate with video estimates of apparent density. This lack of correlation is due to sampling bias of the video method, which has a relatively large lower limit of resolution in particle size. Development of a higher resolution camera would eliminate the current bias in particle size and would enable further assessment of the new optical method as an accurate proxy for apparent density.

A laboratory study was carried out to examine the effect of bed sediment texture on the erodibility of salmon aquaculture waste fecal material and salmon feed pellets. Erodibility measurements of this material were made using a Gust microcosm erosion chamber and artifi- cially composed substrates of mud, sand, sand and gravel, sand and cobble, and cobble. Results show that cumulative mass eroded (CME) and erodibility constant (M)can vary by up to an order of magnitude depending on substrate composition, with a mud substrate having higher CME and M values than those of substrates composed of sand, gravel and cobble. Findings from this study suggest that bottom sediment texture plays a major role in aquaculture waste resuspension and subsequent transport and that predictive models of the transport of aquaculture waste should include the erosion dynamics of bottom texture.

Background:Long delays in the diagnosis of ankylosing spondylitis (AS) and in receiving advanced therapies signify a critical unmet need. Little is known about delays or treatment patterns in Central Eastern European (CEE) countries.Objectives:To describe patient time to diagnosis of and its treatment patterns in CEE and the US.Methods:Data were collected via a cross-sectional survey of rheumatologists in Czech Republic, Poland, Russia, Ukraine (Sept–Dec 2019) and US (Jun–Aug 2018) via physician-completed patient record forms. In consecutive patients with a physician-reported diagnosis of AS, rheumatologists recorded patient demographics, clinical features, time to first consultation and diagnosis and treatment history. Data were compared for CEE vs US using t-test for independent samples (continuous outcomes) and Fisher’s exact test (categorical outcomes). Low rates of HLA-B27 and sacroiliitis at diagnosis may reflect combining non-radiographic axial spondyloarthritis under the diagnosis of AS in real-world practice.Results:209 physicians (121 CEE; 88 US) provided data for 1363 patients (876 CEE; 487 US). While some demographic differences existed between regions, estimated prevalence of HLA-B27 in patients with AS was the same between US and CEE. Not all patients were stated to have sacroiliitis at diagnosis (Table 1). Time to first consultation and time to diagnosis were longer in CEE, with more patients experiencing a delay due to another condition initially being diagnosed (Table 2). At diagnosis a similar proportion of patients in CEE and US were prescribed NSAIDs, with higher use of csDMARDs in CEE. bDMARDs were more commonly prescribed at diagnosis in the US, with increased usage continuing after diagnosis (Figure 1).Table 1.Patient demographic and clinical characteristicsCEE(n=876)US(n=487)P value*Demographic characteristicsAge, mean (SD)45.4 (12.7)46.4 (14.1)0.21 (TT)Male, n (%)6319 (72.0)344 (70.6)0.62 (FE)BMI, mean (SD)25.9 (4.1)27.4 (4.5)Full time employment, n (%)460 (53.9)342 (70.8)Caucasian, n (%)853 (97.4)393 (80.7)Clinical features at diagnosisHLA-B27 positive, n (%)592 (67.6)329 (67.6)1.00 (FE)Inflammatory back pain, n (%)712 (82.0)369 (76.7)0.02 (FE)Sacroiliitis identified by X-ray, n (%)598 (68.9)272 (56.5)Back pain >3 months, n (%)427 (49.2)225 (46.8)0.46 (FE)Physician perceived severity, n (%)0.02 (FE)- Mild69 (8.7)20 (5.1)- Moderate414 (52.1)233 (59.1)- Severe312 (39.2)141 (35.8)*Statistical test legend: TT=t-test; FE=Fisher’s Exact.Table 2.Patient diagnosis journeyCEE(n=876)US(n=487)P value*Time from first symptoms to first consultationα, mean months (SD)27.7 (53.7)18.5 (57.1)0.02 (TT)Time from first consultationαto diagnosis, mean months (SD)17.8 (48.6)6.0 (13.2)0.02 (TT)Reasons for delayβ, n (%)- Other condition initially diagnosed108 (33.3)9 (11.8)- Waiting for referral to correct HCP69 (21.3)22 (28.9)0.17 (FE)- Needed test conducting to confirm diagnosis100 (30.9)21 (27.6)0.68 (FE)*Statistical test legend: TT=t-test; FE=Fisher’s exact;αFirst consultation with any healthcare professional about AS symptoms;βDelay defined as >3 months from first consultation to diagnosis.Conclusion:Time to diagnosis was three times longer in CEE vs the US. Despite similar prescription of NSAIDs at diagnosis in US and CEE, a greater proportion of patients currently received NSAIDs and csDMARDs in CEE, while bDMARD use in the US was greater. This suggests different treatment approaches and differences in medication access across the regions.Disclosure of Interests:Tatiana Korotaeva Grant/research support from: Pfizer, Consultant of: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB, Speakers bureau: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB, Oluwaseyi Dina Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Elizabeth Holdsworth Employee of: Adelphi Real World, Lara Fallon Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Gary Milligan Employee of: Adelphi Real World, Sophie Meakin Employee of: Adelphi Real World, Lisy Wang Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Radu Serban VASILESCU Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Joseph C Cappelleri Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB

Measurements of optical properties have been used for decades to study particle distributions in the ocean. They are useful for estimating suspended mass concentration as well as particle-related properties such as size, composition, packing (particle porosity or density), and settling velocity. Measurements of optical properties are, however, biased, as certain particles, because of their size, composition, shape, or packing, contribute to a specific property more than others. Here, we study this issue both theoretically and practically, and we examine different optical properties collected simultaneously in a bottom boundary layer to highlight the utility of such measurements. We show that the biases we are likely to encounter using different optical properties can aid our studies of suspended sediment. In particular, we investigate inferences of settling velocity from vertical profiles of optical measurements, finding that the effects of aggregation dynamics can seldom be ignored.