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Disparities in colorectal cancer (CRC) incidence and mortality persist in rural and underserved communities. Our Community Outreach and Engagement (COE) activities are grounded in a bi-directional Community-to-Bench model in which the National Outreach Network Community Health Educator (NON CHE) Screen to Save (S2S) initiative was implemented. In this study, we assessed the impact of the NON CHE S2S in rural and underserved communities. Descriptive and comparative analyses were used to examine the role of the NON CHE S2S on CRC knowledge and CRC screening intent. Data included demographics, current CRC knowledge, awareness, and future CRC health plans. A multivariate linear regression was fit to survey scores for CRC knowledge. The NON CHE S2S engaged 441 participants with 170 surveys completed. The difference in participants’ CRC knowledge before and after the NON CHE S2S intervention had an overall mean of 0.92 with a standard deviation of 2.56. At baseline, White participants had significantly higher CRC knowledge scores, correctly answering 1.94 (p = 0.007) more questions on average than Black participants. After the NON CHE S2S intervention, this difference was not statistically significant. Greater than 95% of participants agreed that the NON CHE S2S sessions impacted their intent to get screened for CRC. Equity of access to health information and the health care system can be achieved with precision public health strategies. The COE bi-directional Community-to-Bench model facilitated community connections through the NON CHE and increased awareness of CRC risk reduction, screening, treatment, and research. The NON CHE combined with S2S is a powerful tool to engage communities with the greatest health care needs and positively impact an individual’s intent to “get screened” for CRC.

Multimodal, narcotic-sparing analgesic strategies are an important part of enhanced recovery after surgery protocols. Within such protocols, regional anesthetics have proven to be superior to narcotics.This study aimed to evaluate the impact of the transversus abdominis plane block within an enhanced recovery after surgery protocol on length of stay.A retrospective analysis of patients who underwent colorectal surgery in 2015 to 2016 was completed. The primary end points for this analysis were total length of stay and total narcotics consumed during hospitalization. Length of stay and total narcotic use were compared for patients who received a transversus abdominis plane block versus those that did not.The data were obtained from the data warehouse of a university teaching hospital.This study took place at a university teaching hospital.The patients were 18 years or older.The primary outcomes measured were length of stay and the total narcotics used.A total of 347 patients underwent colorectal procedures under the enhanced recovery protocol. Among these, 186 (54%) received a transversus abdominis plane block. Overall, the mean length of stay was 5.8 days (SD ±5.6), and median length of stay was 4 days. These values compare to a mean length of stay of 9.6 days and median length of stay of 7 days before implementing the enhanced recovery protocol. Patients who received a transversus abdominis plane block had a mean length of stay of 5.1 days compared to 6.6 days for those who did not receive one (p0.01). Patients who received a transversus abdominis plane block consumed 736.5 morphine milligram equivalents of opioids compared to 1150.3 morphine milligram equivalents of opioid consumed by those without a transversus abdominis plane block (p0.05), a 36% decrease in opioid use. When comparing patients who had a mean length of stay of 4 days with those whose length of stay was4 days, there was an 80% decrease in opioid use. The readmission rate was 7.8%.The lack of randomization of patients was a limitation of this study.The use of transversus abdominis plane block in the setting of a well-structured enhanced recovery protocol was associated with a statistically significant decrease in length of stay by 1.5 days and a 36% decrease in narcotic use. See Video Abstract at http://links.lww.com/DCR/B432.ANTECEDENTES:La estrategia analgésica multimodal que consume poco medicamento de tipo narcótico es parte importante en los protocolos de recuperación mejorada postoperatoria. Dentro de dichos protocolos, los anestésicos regionales han demostrado ser superiores a la administración de medicamentos narcóticos.OBJETIVO:Estudiar el impacto del bloqueo del plano muscular de los transversos del abdomen sobre la duración de la estadía dentro de un protocolo de recuperación mejorada postoperatoria.DISEÑO:Se realizó un análisis retrospectivo de los pacientes que se sometieron a cirugía colorrectal entre 2015-2016. Los criterios principales de valoración en el presente análisis fueron la duración total de la estadía y el total de medicamentos narcóticos consumidos durante la hospitalización. Se comparó la duración de la estadía y el uso total de narcóticos en los pacientes que recibieron un bloqueo anestésico del plano muscular de los transversos del abdomen con los que no lo recibieron.FUENTE DE DATOS:Banco de datos de un hospital universitario docente.AMBIENTE:Hospital Universitario Docente.PACIENTES:Adultos desde los 18 años o mayores.PRINCIPALES MEDIDAS DE RESULTADO:Duración de la estadía, cantidad total de medicamentos narcóticos administrados.RESULTADOS:Un total de 347 pacientes se sometieron a procedimientos colorrectales bajo el protocolo ERAS. Entre ellos, 186 (54%) recibieron un bloqueo del plano muscular de los transversos del abdomen. En la globalidad, la duración media de la estadía fué de 5,8 días (DE ± 5,6) y la duración media de la estadía fué de 4 días. Estos resultados fueron comparados con la estadía media de 9,6 días y una estadía media de 7 días antes de implementar el protocolo ERAS. Los pacientes que recibieron un bloqueo del plano muscular de los transversos del abdomen tuvieron una estadía media de 5,1 días en comparación con los 6,6 días de los que no recibieron el mencionado bloqueo (p0,01). Los pacientes que recibieron el bloqueo del plano muscular consumieron 736,5 miligramos de morfina o su equivalente en opioides, comparados con los 1150,3 de aquellos sin bloqueo del plano muscular (p0,05) lo que significó una disminución del 36% en la administración de opioides. Al comparar los pacientes que tuvieron una estadía media de 4 días con aquellos cuya estadía fue mayor a 4 días, se evidenció una disminución en el 80% de la administración de opioides. La tasa de reingreso fue del 7,8%.LIMITACIONES:Estudio sin sin aleatorización de pacientes.CONCLUSIÓN:El bloqueo anestésico del plano muscular de los transversos del abdomen dentro un contexto protocolar tipo ERAS o de recuperación mejorada bien estructurada, se asoció con la disminución estadísticamente significativa de la duración de la estadía en 1,5 días y una disminución del 36% en la administración de medicamentos narcóticos. Consulte Video Resumen en http://links.lww.com/DCR/B432.

Physical activity (PA) guidelines aimed at accumulating 10,000 steps per day have become increasingly common with the advent of wristband PA monitors. However, accumulated steps measured with wristband PA monitors may not be equal to steps measured with validated, hip-worn pedometers. Consequently, evaluating and developing guidelines for step counts using wristband PA monitors for the general population is needed. We compared step counts accumulated with hip-worn pedometers with those accumulated with wrist-worn activity monitors during 1) treadmill exercise, 2) treadmill walking, and 3) activities of daily living (ADL) to determine their accuracy in meeting step count guidelines (ie, 10,000 steps/d).Eighty-six adults (aged 18-65 y; body mass index, 19-45 kg/mFewer steps were accumulated via wrist-worn PA monitors than via hip-worn pedometers during treadmill exercise (3,552 [SD, 63] steps vs 3,790 [SD, 55] steps, P.01) and treadmill walking (5,877 [SD, 83] steps vs 6,243 [SD, 49] steps, P.01). More steps were accumulated via wrist-worn PA monitors than hip-worn pedometers during ADL (7,695 [SD, 207] steps vs 6,309 [SD, 57] steps, P.01). Consequently, total steps were significantly higher for wristband PA monitors than hip-worn pedometers (11,247 [SD, 210] steps vs 10,099 [SD, 39] steps; P.01).The widely used 10,000-step recommendation may not be accurate for all users of all activity monitors, given the discrepancy in daily step count among wrist-worn and hip-worn devices. Having a more accurate indication of number of steps taken per day based on the device used could have positive effects on health.

Disparities in cancer screening and care in rural communities warrant the need to determine effective ways to reach, engage, and educate the community residents. The purpose of this cross-sectional study was to pilot methods to engage rural residents in colorectal cancer (CRC) research and education activities and assess knowledge of CRC guidelines, symptoms, and screening behaviors in this sample. The community-engaged research approach was employed to develop and distribute a CRC knowledge and screening behavior assessment using various methods such as email and community drop boxes placed throughout the community. Bivariate analysis assessed the relationship between age and CRC knowledge items. Three hundred ninety-one surveys were returned with most received from community drop boxes (60%) followed by educational events (23%). The most ineffective method to distribute surveys was through community events. Most individuals were knowledgeable of CRC symptoms (70%) and screening facts (67%). Bivariate analysis showed that individuals 50 years or older had significantly more knowledge of CRC risks and screening than those under the age of 50. This study highlights the potential of community drop boxes as an effective method for engaging rural communities. Further, findings from the survey highlight the need to focus CRC education on younger individuals in which CRC incidence has increased.

Many techniques have been proposed to address the problem of increased lateral adiposity in patients undergoing mastectomy, however, there is no standard approach. This cosmetic deformity at the lateral end of the mastectomy scar, also known as a dog ear, is especially common in obese patients. This defect can be unsightly and uncomfortable. We describe a technique for creating a winged incision to eliminate the dog ear deformity. The Angel Wings Incision results in tissue flaps that create a smooth body contour upon closure in patients with increased lateral adiposity. The technique is reproducible, aesthetically pleasing, and improves patient satisfaction.

This study utilized data from four cancer-focused research studies that recruited and retained African Americans. Strategies and outcomes across four cancer prevention and control studies were analyzed. Descriptive statistics were used to display participant characteristics. There were 712 African American (Black) participants of which 14.6% were males. Common strategies involved connecting with community stakeholders and identifying study champions. Study recruitment methods might not be generalizable to all populations of African Americans due to geographic locations, study protocols (e.g., risk reduction), target populations (i.e., eligibility criteria), and available resources. Many African Americans have a strong interest in cancer-related research as demonstrated by participation levels. Teams that connect with relevant stakeholders and include diverse teams may be useful to engage larger numbers of minorities in cancer control research to impact morbidity and mortality.

Operant behavior procedures often rely on visual stimuli to cue the initiation or secession of a response, and to provide a means for discriminating between two or more simultaneously available responses. While primate and human studies typically use LCD or OLED monitors and touch screens, rodent studies use a variety of methods to present visual cues ranging from traditional incandescent light bulbs, single LEDs, and, more recently, touch screen monitors. Commercially available systems for visual stimulus presentation are costly, challenging to customize, and are typically closed source. We developed an open-source, highly-modifiable visual stimulus presentation platform that can be combined with a 3D-printed operant response device. The device uses an eight by eight matrix of LEDs, and can be expanded to control much larger LED matrices. Implementing the platform is low-cost (Significance StatementThe design of an open source and low cost device for presenting visual stimuli is described. It is capable of presenting complex visual patterns and dynamically changing stimuli. A practical demonstration of the device is also reported, from an experiment in which rats performed a luminance based visual discrimination. The device has utility for studying visual processing, psychophysics, and decision making in a variety of species.

Background: Most men with prostate cancer lack sufficient knowledge of their illness at the time they are diagnosed to make informed decisions about treatment. The ways patients interact with physicians can influence the quality of treatment-related information that is received and impact emotional well-being. Regret is a common negative affect that patients, providers, and care givers seek to avoid. This study investigated the relationship between patient communication efficacy, treatment information seeking behaviors, and decision regret within a sample of early-stage prostate cancer survivors. Methods: Sixty-three men diagnosed with early-stage prostate cancer (Stage T1 or T2) completed self-administered questionnaires. Men who were actively monitoring or undergoing definitive treatment were eligible for inclusion. The 67-item data collection tool captured patient demographics, cancer treatment information seeking behaviors, and psychosocial characteristics. Communication efficacy was measured using the validated Perceived Efficacy Patient Physicians Interaction (PEPPI-10, α=.94) scale. Decision regret was assessed using a validated 5-item measure (Brehaut et al., 2003). Descriptive and comparative analyses were conducted using SPSS Version 25. Results: A majority of participants were White (58.7%), married/partnered (79.4%), privately insured (54.2%) and graduated college (75.0%). More than two-thirds (77.8%) wanted to assume an active role during treatment decision-making. Most respondents (58.1%) fell within the high efficacy communication group (+/- 1/2 s.d. of the mean). A majority of men did not regret their initial treatment choice (82.5%). Men who regretted their initial treatment choice reported significantly more unmet treatment information needs (Mean= 5.63) than those who did not regret (Mean= 2.78) their treatment decision [t(60) = 2.084, p = .041]. Independent samples t-test results showed a statistically significant relationship between regret and communication efficacy [t(60) = -2.38, p =.021]. The two situations where men who regretted their decisions reported lower levels of communication efficacy were getting doctors to pay attention to what they have to say [t(60) = -3.39, p = .001] and making the most of their visit with the doctor [t(60) = -2.22, p = .030]. Perceived communication efficacy marginally differentiated men who regretted and did not regret their treatment decisions in two more clinical situations [t(60) = -1.92, p = .060; t(60) = -1.97, p = .054]. Conclusion: Communication efficacy appears to impact patient treatment information seeking behaviors and decision regret. Communication interventions need to be developed to increase early stage prostate cancer patients’ level of confidence when seeking treatment information to enhance their emotional well-being and quality of life. Citation Format: Levi Ross, Jordan S. Young, Jala Lockhart, Torhonda Lee, Ashley Bowers, Guleer Shabab, Michael A. Preston. Patient communication efficacy, information seeking, and treatment regret among early-stage prostate cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3220.

Localization of nonpalpable breast lesions for breast-conserving surgery (BCS) remains highly variable and includes needle/wire localization (NL), radioactive seed localization, radar localization, and hematoma-directed ultrasound-guided (HUG) lumpectomy. The superiority of HUG lumpectomy over NL has been demonstrated repeatedly in terms of safety, accuracy, low positive margin rates, cosmesis, and patient satisfaction. In this study, we evaluate the cost effectiveness of HUG lumpectomy over NL for nonpalpable breast lesions. We performed a retrospective review of 569 patients who underwent lumpectomy at the University of Arkansas for Medical Sciences from May 2014 through December 2017. Lumpectomies were stratified by localization technique, i.e. NL versus HUG. A cost-savings estimate was determined for the HUG localization technique, and a total amount of dollars saved over the study period was calculated. Overall, 569 lumpectomies were performed: 501 (88.0%) via HUG and 68 (12.0%) via NL. Intraoperative ultrasound was used in 566 operations (99.5%). Of the lumpectomies performed by HUG, 190 lesions (33.4%) were visible only on mammogram or breast magnetic resonance imaging prior to diagnostic core needle biopsy (CNB). Cost estimates comparing HUG with NL demonstrated a cost savings of $497.00 per procedure, the cost of preoperative needle localization by a radiologist, and a total of $94,430.00 for the study period. In utilizing HUG lumpectomy, the initial CNB serves as the diagnostic and localization procedure, thus saving time and a painful second procedure on the day of operation. HUG lumpectomy is safe, accurate, reduces healthcare costs, and results in a better patient experience for the surgical removal of nonpalpable breast lesions.

To test the efficacy of a community-based intervention, Empowering Communities for Life (EC4L), designed to increase colorectal cancer (CRC) screening through fecal occult blood test (FOBT) in rural underserved communities in a randomized controlled trial. Participants were randomized into 3 groups (2 interventions and 1 control). Interventions were delivered by community lay health workers or by academic health professionals. The main outcome of interest was return rate of FOBT screening kit within 60 days. Participants included 330 screening-eligible adults. The overall return rate of FOBT kits within 60 days was 32%. The professional group (Arm 2) had the highest proportion of returned FOBTs within 60 days at 42% (n = 46/110), a significantly higher return rate than the lay group (Arm 1) [28%(n = 29/103);P = 0.0422] or control group (Arm 3) [25%(n = 29/117);P = 0.0099]. Thus, one arm (Arm 2) of our intervention produced significantly higher CRC screening through FOBT. Community-based participation partnered with academic health professionals enhanced CRC screening among rural and poor-resourced communities.

Precision public health requires research that supports innovative systems and health delivery approaches, programs, and policies that are part of this vision. This study estimated the effects of health insurance mandate (HiM) variations and the effects of physician utilization on moderating colorectal cancer (CRC) screening rates. A time-series analysis using a difference-in-difference-in-differences (DDD) approach was conducted on CRC screenings (1997–2014) using a multivariate logistic framework. Key variables of interest were HiM, CRC screening status, and physician utilization. The adjusted average marginal effects from the DDD model indicate that physician utilization increased the probability of being “up-to-date” vs. non-compliance by 9.9% points (p = 0.007), suggesting that an estimated 8.85 million additional age-eligible persons would receive a CRC screening with HiM and routine physician visits. Routine physician visits and mandates that lower out-of-pocket expenses constitute an effective approach to increasing CRC screenings for persons ready to take advantage of such policies.

Purpose: Disparities in colorectal cancer (CRC) incidence and mortality persist in rural and underserved communities. As part of the NIH NCI’s long-term outreach and education plan to provide education and increase awareness about cancer risk reduction, the National Outreach Network Community Health Educator (NON-CHE) program was established to reach underserved areas through strong community partnerships. The NON-CHE project identified barriers to CRC screening and implemented the Screen 2 Save (S2S), a national initiative, to increase community knowledge, awareness, and engagement activities. In this study, we assessed the impact of this initiative in rural and underserved communities. Methods: Descriptive and comparative analyses were used to examine the role of the NON-CHE on CRC knowledge and CRC screening intent. Participants included the Massey Cancer Center (MCC) catchment area where 170 surveys were collected from rural and underserved communities. Data included demographics, participants’ current CRC knowledge, awareness, and future CRC health plans. A multivariate linear regression was fit to participants’ survey scores for CRC knowledge. All analyses were done in R 3.5.2. Results: NON-CHE engaged 441 participants in rural and underserved communities. At baseline, White participants had significantly higher CRC knowledge scores, correctly answering 1.94 (p=0.007) more questions on average. After the NON-CHE intervention, this difference was not statistically significant. The difference in participants’ CRC knowledge had an overall mean of 0.92, with a standard deviation of 2.56. Female participants exhibited significantly higher CRC knowledge after controlling for the effect of other demographic variables (p = 0.004). Female study participants also had significantly higher differences between their CRC knowledge scores, exhibiting an average gain in CRC knowledge of 1.08 questions higher than men (p = 0.043). Older participants also tended to demonstrate less improvement – specifically, a one-year increase in participant age corresponded to an adjusted average decrease in improvement of 0.02 questions. Greater than 95% of participants agreed that S2S sessions impacted their intent to get screened for CRC. Conclusions: The NON-CHE facilitated community connections and increased awareness of CRC risk reduction, screening, treatment, and research. Such programs should be considered as mechanisms that increase the knowledge, awareness, and engagement of rural and underserved communities. Equity of access to health information and the health care system can be achieved with precision population health strategies. The NON-CHE combined with S2S is a powerful way to engage rural and underserved communities and impact participants’ intent to “Get Screened”. Citation Format: Michael A. Preston, Debbie Cadet, Rachel Hunley, Reuben Retnam, Sarah Arezo, Vanessa B. Sheppard. How to improve health equity and colorectal cancer awareness: A Community Health Educator initiative [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-018.

Background: Rural counties in Virginia have significantly higher overall cancer mortality compared to the state. Virginia is one of a few states that has both breast and colorectal cancer hotspots, driven primarily by mortality rates among African Americans. The Virginia Living Well Research and Registry (VALW), a community registry, was developed in collaboration with community partners to collect critical patient reported outcomes, including cancer protective and risk behaviors that can be tracked longitudinally. We assessed participation in cancer screening and five cancer protective behaviors, with comparison by geographical residence and race. Method: In-person and electronic recruitment by community-based staff enrolled adults (18+ years) living in Virginia, focusing on predominantly rural counties. Surveys were completed in-person, by phone or online. Questions included cancer screening (breast, cervical, colorectal), five cancer protective behaviors (physical activity, sleep, alcohol, BMI, smoking status) and demographics. Rural residence was defined using RUCC codes and calculated from mailing addresses. Results: To date, 586 participants are enrolled; 74% are rural (RUCC 4-9), 47% are Black/African American and 70% identify as female. Rural residents reported significantly lower household income (Χ2=25[1]:p< .000), greater use of Medicare (Χ2=4.5[1]:p=.034) and lower (pre-COVID) unemployment (Χ2=7.1[1]:p=.008) compared to urban participants. White participants reported significantly more alcohol use (Χ2=5.6[1]:p=.003), greater sleep disturbance (Χ2=5.6[1]:p=.018) and lower BMI(Χ2=33.4[1]:p Citation Format: Maria D. Thomson, A. Williams, M.A. Preston, A.L. Sutton, V.B. Sheppard. The Virginia Living Well Research and Registry: A community registry to assess cancer screening and lifestyle behaviors among rural Virginia residents [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-023.

Purpose. This study aimed to develop health messages that help African American breast cancer survivors reduce exposure to secondhand smoke in the home. African American women are disproportionately impacted by tobacco exposures and cancer mortality. Cigarette smoking decreases functional status (e.g., fatigue, pain) and increases complications related to breast reconstruction and the risk for secondary cancers. Understanding knowledge, attitudes, and beliefs related to tobacco and sociocultural and environmental influences may inform the development of messages that protect breast cancer survivors from the harm of smoke. Methods. We used a sequential design to conduct semi-structured interviews, photovoice interviews, and focus groups that informed message development related to secondhand smoke exposure. African American women breast cancer survivors aged 30-65 years, who smoked cigarettes or cigars in past 30 days or lived with a smoker, and were low income were invited to participate. Interviews assessed knowledge related to breast reconstruction and the prevention of secondary cancers; perceived susceptibility and severity related to the harms of tobacco; subjective norms; attitudes toward using tobacco and implementing smokefree home rules; perceived benefits and complexity of implementing smokefree home rules; and intentions to adopt smokefree home rules. Participants who completed the interviews (n=12) were invited to use photovoice to capture the socio-environmental context of survivorship and women’s motivations for making changes in tobacco exposure (n=9). Data from the interviews and photovoice were used to develop 16 messages related to secondhand smoke exposure. An iterative process was used to obtain feedback on each message (e.g., The smoke from cigarettes, pipes, and cigars of any kind is the same. Keep your home safe from secondhand smoke) from focus group participants (n=12). Results. Forty percent of African American women breast cancer survivors who completed the interviews reported current smoking and 54% had expired CO levels > 7 ppm. Most women felt that cigarettes cause some harm, but also stated that no one knows how each person is affected. Some women felt that occasional smoking was not harmful, that secondhand smoke was as bad as smoking, and that it is a gamble as to whether anything would happen if exposed to tobacco smoke. Some women expressed that smoking did not affect their breast reconstruction surgery while others felt that it slowed the healing process, or were unclear about its effects on surgery. Women who provided feedback on the messages during focus groups stated that people say secondhand smoke causes cancer, but they were unclear of its effects. Women felt that health messages needed to convey the type of cancers caused by secondhand smoke. Conclusions. Our study provided helpful information that informed the development of messages that can be used to increase awareness of the harms of secondhand smoke. Citation Format: Nakita Lovelady, Pebbles Fagan, Camille Hart, Michael Preston, Tiffany Haynes, Ronda Henry-Tillman. Using qualitative methods to develop health messages aimed to reduce secondhand smoke exposure among African American breast cancer survivors in a rural state [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A018.

Tree restoration on degraded land has been identified as an effective and affordable capture carbon strategy but it is unclear if carbon sequestration rates are comparable to rates on non-industrially impacted silvicultural forests. To this end, we resampled a jack pine (Pinus banksiana) and red pine (P. resinosa) chronosequence 16 years after the initial measurement to quantify carbon pools following ca. 40 years of regreening on an acid and metal impacted landscape. Measured carbon pools were then compared to those reported in an unpublished study to determine how carbon sequestration rates have changed over time and if repeated sampling at the stand level validates temporal trends estimated by the chronosequence. Total ecosystem carbon (TEC) within the stands ranged from 55 to 136 Mg ha−1 with a regional mean of 90.2 ± 9.6 Mg ha−1. On average, tree and soil organic pools (SOC) were the two largest carbon pools, representing 47% and 42% of TEC, respectively. Compared with unplanted sites, tree restoration resulted in a significant increase in the mean TEC among all sites of 54.4 ± 10.2 Mg ha−1 with a corresponding sequestration rate of 1.7 ± 0.3 Mg ha−1 yr−1. The chronosequence approach was only able to consistently detect a change in the tree carbon pool. In contrast, repeated sampling at the stand level identified changes in carbon sequestration rates within SOC, LFH and shrub carbon pools and showed that the chronosequence tree carbon sequestration rate was underestimated by a factor of 2.3. Chronosequence studies assume study sites have similar landscape history and environmental conditions, which may not be reasonable in highly degraded landscapes where past events (e.g., pollution, erosion, restoration) influence multiple landscape characteristics (e.g., local hydrology and topography). We conclude that tree restoration on impacted landscapes can sequester carbon at a rate comparable to silvicultural plantations in a similar climatic region and that reforestation of industrially damaged landscapes could be part of an effective carbon capture strategy.

School nurses are often sources of health-care support for teens with sexually transmitted infections (STIs) and unintended pregnancies. However, providing prevention (e.g., condoms) and teaching technical skills (e.g., condom use) needed to reduce high-risk sexual behavior may require a change in perceptions and policies. This study used a cross-sectional study design to assess nurses’ perceptions of condom availability accompanied by sex education programs among high school nurses ( n = 87) in Kansas. Results showed that school nurses in this study supported condom availability, were comfortable providing condoms, and felt condom availability was within the scope of their job but were less likely to provide condoms because of external barriers. Common barriers include administration, parents, cost, community support, and policies. School nurses, by virtue of their access to the majority of Kansas’ adolescents, have the potential to provide sex education and tools such as condoms, so young people can prevent STIs and unintended pregnancies.

This collection comprises twenty most-read posts published on the Oxford Business Law Blog in 2018. The individual contributions cover issues such as blockchain technology and cryptoassets, financial services, corporate law, and autonomous systems. In this context, and for reasons of coherence and consistency, the pieces included in this paper are arranged in a thematic order.

ObjectiveTo understand the gender-specific factors that uniquely contribute to successful ageing in a US population of men and women, 57–85 years of age. This was achieved through the examination of the correlates of subjective well-being defined by health-related quality of life (HRQoL), across several biological and psychosocial determinants of health.DesignCross-sectional study.SettingThe National Social Life, Health and Ageing Project (NSHAP), 2010–2011 a representative sample of the US population.Participants3377 adults aged 57–85 (1538 men, 1839 women) from the NSHAP.Main outcome measuresThe biopsychosocial factors of biological/physiological function, symptom status, functional status, general health perceptions and HRQoL happiness.MethodHRQoL was measured using the NSHAP wave 2 multistage, stratified area probability sample of US households (n=3377). Variable selection was guided by the Wilson and Cleary model (WCM) that classifies health outcomes at five main levels and characteristics.ResultsOur findings indicate differences in biopsychosocial factors comprised in the WCM and their relative importance and unique impact on HRQoL by gender. Women reported significantly lower HRQoL than men (t=3.5, df=3366). The most significant contributors to HRQoL in women were mental health (B=0.31; 0.22, 0.39), loneliness (B=−0.26; −0.35, –0.17), urinary incontinence (B=−0.22; −0.40, –0.05) and support from spouse/partner (B=0.27; 0.10, 0.43) and family B=0.12; 0.03, 0.20). Men indicated mental health (B=0.21; 0.14, 0.29), physical health (B=0.17; 0.10, 0.23), functional difficulties (B=0.38; 0.10, 0.65), loneliness (B=−0.20; −0.26, –0.12), depression (B=−0.36; −0.58, –0.15) and support from friends (B=0.06; 0.10, 0.11) as significant contributors. Those with greater social support had better HRQoL (F=4.22, df=4). Lack of companionship and reliance on spouse/partner were significant HRQoL contributors in both groups.ConclusionOur findings offer insight into ageing, gender and subjective well-being. The results provide an opportunity to identify biopsychosocial factors to inform interventions to support successful ageing.

Peat from four geographically separated peatlands (up to 1,500 km apart) with distinct vegetation across North America was sterilized and inoculated with microbial consortia from either the home site or from the other sites. This reciprocal inoculation microcosm experiment examined how different microbial communities adapted to various peat substrates and how this in turn influenced C-mineralization patterns. The experimental approach allows distinctions to be made as to whether microbial community structure, peat properties, or imposed environmental conditions are primary drivers of peat C mineralization. Two additional inocula collected from other freshwater environments (industrially polluted harbor and lake sediments) were also added to each peat type to investigate the response of clearly disparate microbial communities. We hypothesized that the peat properties, such as substrate quality and physical structure, would dictate microbial community composition and activity, thus inoculations from differe...

Plant genetic variation and evolutionary dynamics are predicted to impact ecosystem processes but these effects are poorly understood. Here we test the hypothesis that plant genotype and contemporary evolution influence the flux of energy and nutrients through soil, which then feedback to affect seedling performance in subsequent generations. We conducted a multiyear field evolution experiment using the native biennial plant Oenothera biennis. This experiment was coupled with experimental assays to address our hypothesis and quantify the relative importance of evolutionary and ecological factors on multiple ecosystem processes. Plant genotype, contemporary evolution, spatial variation, and herbivory affected ecosystem processes (e.g., leaf decay, soil respiration, seedling performance, N cycling), but their relative importance varied between specific ecosystem variables. Insect herbivory and evolution also contributed to a feedback that affected seedling biomass of O. biennis in the next generation. Our results show that heritable variation among plant genotypes can be an important factor affecting local ecosystem processes, and while effects of contemporary evolution were detectable and sometimes strong, they were often contingent on other ecological, factors.

Objectives. We estimated the effect of economic constraints on public health delivery systems (PHDS) density and centrality during 3 time periods, 1998, 2006, and 2012. Methods. We obtained data from the 1998, 2006, and 2012 National Longitudinal Study of Public Health Agencies; the 1993, 1997, 2005, and 2010 National Association for County and City Health Officials Profile Study; and the 1997, 2008, and 2011 Area Resource Files. We used multivariate regression models for panel data to estimate the impact of economic constraints on PHDS density and centrality. Results. Findings indicate that economic constraints did not have a significant impact on PHDS density and centrality over time but population is a significant predictor of PHDS density, and the presence of a board of health (BOH) is a significant predictor of PHDS density and centrality. Specifically, a 1% increase in population results in a significant 1.71% increase in PHDS density. The presence of a BOH is associated with a 10.2% increase in PHDS centrality, after controlling for other factors. Conclusions. These findings suggest that other noneconomic factors influence PHDS density centrality.

Background Health care reform goals involve more cost-effective methods of delivering health care. The cost-effectiveness of axillary ultrasound-guided core needle biopsy (AUS-CNB) was compared with sentinel lymph node biopsy (SLNB) when evaluating the status of the axilla in operable invasive breast cancer. Study Design We performed an IRB-approved retrospective review of patients undergoing ultrasound of the axilla plus core needle biopsy at our institution from 2007 to 2012. An accuracy of technique and cost analysis (TreeAge Pro 2009) of AUS-CNB vs SLNB was conducted. Results The cohort of 95 patients was divided into 2 groups: clinically positive (CP) (32%) and negative (CN) (68%) axilla. In the CP group, 83% had a suspicious AUS, of which 90% were positive. In the CN group, AUS was suspicious in 70%, with a positive biopsy in 59%. The sensitivity and specificity of AUS-CNB were 90% (95% CI 84.8% to 98.8%) and 100% (95% CI 27% to 59.1%), respectively. Cost estimates comparing AUS-CNB with SLNB demonstrated a cost saving of $236,517 in the CP axilla and $248,490 in the CN axilla, for a total cost savings of $485,007. Conclusions Axillary ultrasound-guided core needle biopsy is a sensitive, diagnostic, surgeon-performed procedure. It is time-saving, cost-efficient, and less invasive, making it a viable option when evaluating the status of the axilla in invasive breast cancer or staging before neoadjuvant chemotherapy.

African American women in the state of Arkansas have high breast cancer mortality rates. Breast cancer risk assessment tools developed for African American underestimate breast cancer risk. Combining African American breast cancer associated single-nucleotide polymorphisms (SNPs) into breast cancer risk algorithms may improve individualized estimates of a woman's risk of developing breast cancer and enable improved recommendation of screening and chemoprevention for women at high risk. The goal of this study was to confirm with an independent dataset consisting of Arkansas women of color, whether a genetic risk score derived from common breast cancer susceptibility SNPs can be combined with a clinical risk estimate provided by the Breast Cancer Risk Assessment Tool (BCRAT) to produce a more accurate individualized breast cancer risk estimate. A population-based cohort of African American women representative of Arkansas consisted of 319 cases and 559 controls for this study. Five-year and lifetime risks from the BCRAT were measured and combined with a risk score based on 75 independent susceptibility SNPs in African American women. We used the odds ratio (OR) per adjusted standard deviation to evaluate the improvement in risk estimates produced by combining the polygenic risk score (PRS) with 5-year and lifetime risk scores estimated using BCRAT. For 5-year risk OR per standard deviation increased from 1.84 to 2.08 with the addition of the polygenic risk score and from 1.79 to 2.07 for the lifetime risk score. Reclassification analysis indicated that 13% of cases had their 5-year risk increased above the 1.66% guideline threshold (NRI = 0.020 (95% CI -0.040, 0.080)) and 6.3% of cases had their lifetime risk increased above the 20% guideline threshold by the addition of the polygenic risk score (NRI = 0.034 (95% CI 0.000, 0.070)). Our data confirmed that discriminatory accuracy of BCRAT is improved for African American women in Arkansas with the inclusion of specific SNP breast cancer risk alleles.

Pugliese, S., Jones, T., Preston, M. D., Hazlett, P., Tran, H. and Basiliko, N. 2014. Wood ash as a forest soil amendment: The role of boiler and soil type on soil property response. Can. J. Soil Sci. 94: 621–634. Wood ash is produced in large quantities in Canada as a by-product of the pulp and paper, sawmill, and bioenergy industries and it is anticipated that its disposal in landfills will not be a viable option. An alternative option may be to use it to amend forest soils. Wood ash is a complex mixture and its composition depends on several variables, including the combustion parameters of the boiler in which it is generated. We present an analysis of the amendment of two Canadian forest soils (a Brunisol from the Great Lakes–St. Lawrence and a Luvisol from the Carolinian forest regions of Ontario) with six different wood ashes collected from different biomass boilers through short-term controlled incubations. We show that following an 8-wk incubation period, amendment of the soils with wood ash led to small to moderate increases in soil pH, but had little effect on soil microbial activity and biomass. The concentration of important base cations such as calcium, magnesium and potassium as well as phosphorus generally increased in both soil types following amendment with different ash. This practice can return nutrients lost from forest ecosystems during harvesting; however, effects were found to be boiler-specific. Lastly, we show that four ash types led to small increases in cadmium in either soil; the concentration of all other measured heavy metals was not significantly increased following amendment, and in certain cases decreased, particularly with lead. The only potentially negative aspect encountered was elevated sodium, particularly with ash from one boiler, but unacceptable Na-absorptivity ratios were not exceeded. These results demonstrate that with proper characterization and selection of wood ash type and application rates, amendment of Canadian forest soils with wood ash may benefit forest ecosystems and is unlikely to disrupt the chemical and biological processes in soil environments.

Cancer is the second leading cause of death in the U.S and a source of large racial and ethnic disparities in population health. Policy development is a powerful but sometimes overlooked public health tool for reducing cancer burden and disparities. Along with other partners in the public health system, community- based organizations such as local cancer councils can play valuable roles in developing policies that are responsive to community needs and in mobilizing resources to support policy adoption and implementation. This paper examines the current and potential roles played by local cancer councils to reduce cancer burden and disparities. Responsive public health systems require vehicles for communities to engage in policy development. Cancer councils provide promising models of engagement. Untapped opportunities exist for enhancing policy development through cancer councils, such as expanding targets of engagement to include private-sector stakeholders and expanding methods of engagement utilizing the Affordable Care Act’s Prevention and Public Health Fund.

A blended learning, competency-based class introduces new ways of learning for teens deemed “at-risk” in New York City.

Peatlands are large repositories of atmospheric carbon and concern has been raised over the stability of this carbon store because increasing dissolved organic carbon (DOC) concentrations have been observed in peatland drainage waters. A number of potential causes have been proposed in the literature, and conflicting results among studies conducted at different spatial and temporal scales suggest that the methodological approach may be an important confounding factor. The objective of this study was to determine the influence of moisture and temperature on DOC release from a south-central Ontario peatland during the fall (a major export period) following three commonly used approaches: laboratory microcosms, an intensive field study and analysis of long-term data (1980-2008). The effect of variations in temperature and moisture differed among microcosm, field study and analysis of the long-term record. Water content was important at the microcosm scale as DOC concentration and aromaticity increased with peat water-saturation. Drought caused a decrease in DOC concentration and pH, and an increase in sulphate and base cation concentrations. In contrast, the field study indicated that DOC concentration was strongly associated with temperature, and weakly correlated (negatively) with stream discharge. Average fall DOC concentration (but not export) increased over the 29 year record, and was correlated with fall discharge and precipitation (negative) and summer precipitation and fall stream pH (positive). As no common strong predictor of fall DOC was found at three scales of investigation at a single, well-studied site, it may be unreasonable to expect to identify a universal driver behind the widespread increase in DOC concentration.

THE MOST PRESSING NEED in early childhood mathematics education in the United States is to improve early childhood teacher preparation. A Web-based video system, “Video Interactions for Teaching and Learning (VITAL),” is a novel and effective approach for teacher preparation integrated into early childhood mathematics education courses. With extensive analysis of videos involving children's mathematical thinking, VITAL provides prospective teachers with engaging and intellectually stimulating hands-on and minds-on learning experiences that supplement the traditional textbook and readings.

Disparities in health care have been targeted for elimination by federal agencies and professional organizations, including the American Public Health Association. Although the Affordable Care Act (ACA) provides a valuable first step in reducing the disparities gap, progress is contingent upon whether opportunities in the ACA help or hinder populations at risk for impaired health and limited access to medical care.

The structure of the thymus provides an environment where immature thymocytes can interact with a variety of cells, including thymic epithelial cells and dendritic cells, to acquire their final functional properties—expression of a major histocompatibility complex (MHC)-restricted T-cell receptor (TCR), presence of either CD4 or CD8 in the plasma membrane, and ability to interact with antigen-presenting cells (APCs) or nucleated target cells to respond to foreign antigens. Negative selection that occurs in the thymus forms the basis for central tolerance or the process whereby the large pool of emerging mature lymphocytes is screened for self-reactivity and eliminated if improperly reactive. As with positive selection, controversy particularly exists over which cells in the thymus mediate negative selection and whether it takes place in the cortex or the medulla of the thymus. Peripheral tolerance refers to all of the tolerogenic mechanisms acting on mature lymphocytes that have already proceeded through all of the B- and T-cell maturation stages, have left the primary lymphoid organs, and have entered the periphery. The major transcription factor is NF-κB, generated from a cytoplasmic precursor held in check by binding to its inhibitor, IκB. While obviously not physiologically relevant to T-cell activation, laboratory methods represent important tools for studying the complexity of T-cell responses.

Tissue inhibitor of metalloproteinase 1 (TIMP-1)-deficient mice are resistant to Pseudomonas aeruginosa corneal infections. Corneas healed completely in TIMP-1-deficient mice, and infections were cleared faster in TIMP-1-deficient mice than in wild-type littermates. Genetic suppression studies using matrix metalloproteinase (MMP)-deficient mice showed that MMP-9, MMP-3, and MMP-7 but not MMP-2 or MMP-12 are needed for resistance. Increased resistance was also seen during pulmonary infections. These results identify a novel pathway regulating infection resistance.

Two fully human mAbs specific for epitopes dependent on intact carboxylate groups on the C6 carbon of the mannuronic acid components of Pseudomonas aeruginosa alginate were found to promote phagocytic killing of both mucoid and nonmucoid strains as well as protection against both types of strains in a mouse model of acute pneumonia. The specificity of the mAbs for alginate was determined by ELISA and killing assays. Some strains of P. aeruginosa did not make detectable alginate in vitro, but in vivo protection against lethal pneumonia was obtained and shown to be due to rapid induction of expression of alginate in the murine lung. No protection against strains genetically unable to make alginate was achieved. These mAbs have potential to be passive therapeutic reagents for all strains of P. aeruginosa and the results document that alginate is a target for the proper type of protective Ab even when expressed at low levels on phenotypically nonmucoid strains.

This article reports on the discovery of a copy of The Peace Egg Book , a previously unknown chapbook printed in Manchester, UK. The chapbook, which has an Irish text, is set within the contexts of printing and of the Irish community in mid-nineteenth-century Manchester. The textual links between The Peace Egg Book and the Belfast Christmas Rhime Books are analysed, as are the parallels to an Irish-influenced oral tradition set out in a manuscript of 1842. The article establishes the importance of the chapbook in linking together Irish and Lancashire traditional play chapbooks.

Peatlands serve as important stores of organic matter and regulators of nutrient and metal export to surface waters, yet relatively little is known regarding the impact of more than a century of metal, sulfur, and acid deposition on microbial activity in acidic, nutrient-poor peatlands that are common features around Sudbury, Ontario. In this study, eight peatlands were selected at varying distances from the Copper Cliff Smelter that was once the largest point source of sulfur dioxide and sampled for analysis of nutrient and metal content. Basal microbial respiration, relative response to substrate addition (four synthetic and four natural substrates) assessed as CO2 production rates and microbial biomass were assessed in surface (0–10 cm) peat samples. Bacterial and fungal communities within the peat samples were profiled using terminal restriction fragment length polymorphism analysis. Basal respiration (i.e., carbon mineralization in absence of substrate addition) was lowest and Cu and Ni concentrations and the degree of humification (assessed by the von Post scale) in surface peat samples were highest close to the smelter. Each peatland had a unique bacterial community when assessed using non-metric multidimensional scaling, whereas the fungal community was variable with no consistent patterns across the sites. Despite differences in microbial communities, substrate-induced respiration rates did not differ among peatlands as sites generally responded similarly to carbon substrate additions. Basal respiration rates were related to the humification status of the peat, which was potentially related to environmental degradation in the peatlands or surrounding terrestrial systems closer to the Sudbury smelters.

The heavy- and light-chain variable regions from a murine monoclonal antibody that recognize Pseudomonas aeruginosa serogroup O6 lipopolysaccharide (LPS) were used to generate a series of chimeric mouse-human monoclonal antibodies with identical variable regions. The murine variable-region gene segments were cloned into an immunoglobulin (Ig) cDNA expression vector that contained the human kappa light-chain and IgG1 constant regions. The IgG1 heavy-chain constant region was then replaced with the human IgG2, IgG3, IgG4, or IgA1 heavy-chain constant region. The five different expression vectors were transfected into Chinese hamster ovary cells for antibody production. The chimeric antibodies exhibited immunoreactivity and affinity similar to that of the parental murine IgG antibody toward whole cells of a serogroup O6 strain. In vitro complement deposition assays demonstrated that the chimeric IgG4 and IgA antibodies did not mediate the deposition of complement component C3 onto the surface of either purified LPS or whole bacteria. The chimeric IgG1 and IgG3 antibodies were similar in their ability to deposit C3 onto the surface of both bacteria and LPS, while IgG2 antibody was more effective at depositing C3 onto the surface of bacteria than onto purified LPS. The pattern of opsonophagocytic activity of the chimeric monoclonal antibodies was similar to that of complement deposition onto bacterial cells in that the chimeric IgG1 and IgG3 had the highest opsonic activity. Although IgG2 deposited more C3 onto the bacterial surface than did IgG4 or IgA, all three of these isotypes had low opsonic activity against the serogroup O6 target strain. This series of related antibodies will help reveal functional differences in efficacy among protective antibodies to P. aeruginosa and will be critical for defining the optimal formulation of either a vaccine for active immunization or a polyclonal intravenous IgG or monoclonal antibody cocktail for passive immunotherapy.

The prevention of bacterial infections by the inhibition of binding to host tissues is an oft-touted approach, but few studies with appropriate models of infection have tested its feasibility. Pseudomonas aeruginosa causes severe corneal infections in mice after inoculations with low doses, and infection is thought to depend upon an initial adherence of the bacteria to corneal cells. In vitro, adherence to corneal cells is mediated to a large degree by the complete-outer-core oligosaccharide of the bacterial lipopolysaccharide (LPS). However, bacteria adhering to tissues in vivo are difficult to differentiate from nonadherent bacteria. Since a direct correlate of P. aeruginosa adherence to corneal epithelial cells is the degree to which these cells internalize P. aeruginosa, the level of adherence in vivo can be approximated by measuring P. aeruginosa ingestion by cells by using gentamicin exclusion assays. To determine the degree to which inhibition of the corneal cell adherence affects the course of infection and disease in the murine model, we evaluated the ability of LPS-outer-core oligosaccharide to inhibit bacterial association and entry into corneal cells and to modulate the development of disease. Mice were anesthetized, and their corneas were scratched and inoculated with virulent P. aeruginosa 6294 or PAO1, along with either 50 microg of oligosaccharide derived from LPS from P. aeruginosa PAC557 (complete outer core but no O side chains) or oligosaccharide derived from LPS of P. aeruginosa PAC1RalgC::tet (incomplete-core oligosaccharide). After 4 h, there were no differences between groups in the counts of infecting and internalized bacteria. At 24 h, the complete-core oligosaccharide decreased the levels of bacteria per eye by 70 to 99.7% compared with the levels achieved by including the incomplete-core oligosaccharide in the infectious inoculum. Epithelial cell ingestion of bacteria was comparably affected. However, the effect on disease was modest and only evident at lower challenge doses that elicited mild disease in controls and when the bacterial association and ingestion were inhibited by >99%. Overall, it appears that in the murine model of P. aeruginosa corneal infection at challenge doses of bacteria 10-fold or greater than the minimal amount needed to cause disease, the absolute level of inhibition of bacterial adherence is insufficient to reduce the bacterial counts below that which elicits disease.

The purpose of this study was to determine if race is a factor on overall survival when stage at diagnosis is compared. In this study, a total of 93 women with triple negative breast cancer (TNBC) were evaluated for survival outcomes after diagnosis between the year 2000 through 2010. Thirty-five patients (38%) were African American (AA), and 58 patients (62%) were Caucasian. Overall survival rates were estimated using the Kaplan-Meier method and compared between groups using the log-rank test. Student’s t-test was used to calculate differences in cancer recurrence and mortality rates by stage and race. Cox proportional hazards ratios were used to determine the association of patient and variables with clinical outcome. Of women diagnosed with stage 1 breast cancer, the overall survival rates for AAs was 100% compared to Caucasians at 94% (95% CI, 0.003 to 19; P = 0.5). For women with stage 2 breast cancer, overall survival for AA women was 85% and for Caucasian women was 86% (HR = 0.8; 95% CI, 0.3 to 2.6; P = 0.73). For advanced stages (stage 3 and 4), survival for AA women were 78% and 40% for Caucasian women (HR = 0.6; 95% CI 0.2 to 1.98; P = 0.43). Rates of recurrence and mortality were not significantly different between AA and Caucasian TNBC patients. After controlling for patient variables, race was not significantly associated with OS (HR = 1.24; 95% CI, 0.32 to 5.08; P = 0.74) when comparing AA to Caucasian patients. Our study suggests that race does not have an effect on overall survival in African American and Caucasian women diagnosed with TNBC in Arkansas.

To study vegetation feedbacks of nutrient addition on carbon sequestration capacity, we investigated vegetation and ecosystem CO2 exchange at Mer Bleue Bog, Canada in plots that had been fertilized with nitrogen (N) or with N plus phosphorus (P) and potassium (K) for 7-12 years. Gross photosynthesis, ecosystem respiration, and net CO2 exchange were measured weekly during May-September 2011 using climate-controlled chambers. A substrate-induced respiration technique was used to determine the functional ability of the microbial community. The highest N and NPK additions were associated with 40% less net CO2 uptake than the control. In the NPK additions, a diminished C sink potential was due to a 20-30% increase in ecosystem respiration, while gross photosynthesis rates did not change as greater vascular plant biomass compensated for the decrease in Sphagnum mosses. In the highest N-only treatment, small reductions in gross photosynthesis and no change in ecosystem respiration led to the reduced C sink. Substrate-induced microbial respiration was significantly higher in all levels of NPK additions compared with control. The temperature sensitivity of respiration in the plots was lower with increasing cumulative N load, suggesting more labile sources of respired CO2 . The weaker C sink potential could be explained by changes in nutrient availability, higher woody : foliar ratio, moss loss, and enhanced decomposition. Stronger responses to NPK fertilization than to N-only fertilization for both shrub biomass production and decomposition suggest that the bog ecosystem is N-P/K colimited rather than N-limited. Negative effects of further N-only deposition were indicated by delayed spring CO2 uptake. In contrast to forests, increased wood formation and surface litter accumulation in bogs seem to reduce the C sink potential owing to the loss of peat-forming Sphagnum.