A globally relevant change taxonomy and evidence-based change framework for land monitoring.

A globally relevant and standardized taxonomy and framework for consistently describing land cover change based on evidence is presented, which makes use of structured land cover taxonomies and is underpinned by the Driver-Pressure-State-Impact-Response (DPSIR) framework. The Global Change Taxonomy currently lists 246 classes based on the notation 'impact (pressure)', with this encompassing the consequence of observed change and associated reason(s), and uses scale-independent terms that factor in time. Evidence for different impacts is gathered through temporal comparison (e.g., days, decades apart) of land cover classes constructed and described from Environmental Descriptors (EDs; state indicators) with pre-defined measurement units (e.g., m, %) or categories (e.g., species type). Evidence for pressures, whether abiotic, biotic or human-influenced, is similarly accumulated, but EDs often differ from those used to determine impacts. Each impact and pressure term is defined separately, allowing flexible combination into 'impact (pressure)' categories, and all are listed in an openly accessible glossary to ensure consistent use and common understanding. The taxonomy and framework are globally relevant and can reference EDs quantified on the ground, retrieved/classified remotely (from ground-based, airborne or spaceborne sensors) or predicted through modelling. By providing capacity to more consistently describe change processes-including land degradation, desertification and ecosystem restoration-the overall framework addresses a wide and diverse range of local to international needs including those relevant to policy, socioeconomics and land management. Actions in response to impacts and pressures and monitoring towards targets are also supported to assist future planning, including impact mitigation actions.

Distribution and drivers of global mangrove forest change, 1996-2010.

For the period 1996-2010, we provide the first indication of the drivers behind mangrove land cover and land use change across the (pan-)tropics using time-series Japanese Earth Resources Satellite (JERS-1) Synthetic Aperture Radar (SAR) and Advanced Land Observing Satellite (ALOS) Phased Array-type L-band SAR (PALSAR) data. Multi-temporal radar mosaics were manually interpreted for evidence of loss and gain in forest extent and its associated driver. Mangrove loss as a consequence of human activities was observed across their entire range. Between 1996-2010 12% of the 1168 1°x1° radar mosaic tiles examined contained evidence of mangrove loss, as a consequence of anthropogenic degradation, with this increasing to 38% when combined with evidence of anthropogenic activity prior to 1996. The greatest proportion of loss was observed in Southeast Asia, whereby approximately 50% of the tiles in the region contained evidence of mangrove loss, corresponding to 18.4% of the global mangrove forest tiles. Southeast Asia contained the greatest proportion (33.8%) of global mangrove forest. The primary driver of anthropogenic mangrove loss was found to be the conversion of mangrove to aquaculture/agriculture, although substantial advance of mangroves was also evident in many regions.

Mangrove response to environmental change in Australia's Gulf of Carpentaria.

Across their range, mangroves are responding to coastal environmental change. However, separating the influence of human activities from natural events and processes (including that associated with climatic fluctuation) is often difficult. In the Gulf of Carpentaria, northern Australia (Leichhardt, Nicholson, Mornington Inlet, and Flinders River catchments), changes in mangroves are assumed to be the result of natural drivers as human impacts are minimal. By comparing classifications from time series of Landsat sensor data for the period 1987-2014, mangroves were observed to have extended seawards by up to 1.9 km (perpendicular to the coastline), with inland intrusion occurring along many of the rivers and rivulets in the tidal reaches. Seaward expansion was particularly evident near the mouth of the Leichhardt River, and was associated with peaks in river discharge with LiDAR data indicating distinct structural zones developing following each large rainfall and discharge event. However, along the Gulf coast, and particularly within the Mornington Inlet catchment, the expansion was more gradual and linked to inundation and regular sediment supply through freshwater input. Landward expansion along the Mornington Inlet catchment was attributed to the combined effects of sea level rise and prolonged periods of tidal and freshwater inundation on coastal lowlands. The study concluded that increased amounts of rainfall and associated flooding and sea level rise were responsible for recent seaward and landward extension of mangroves in this region.

Reliability of self-report versus chart-based prostate cancer, PSA, DRE and urinary symptoms.

INTRODUCTION: Medical chart-review and self-reported questionnaire are two common methods of determining cancer screening and symptoms. We investigate the validity of these methods and therefore of a class of clinical/epidemiological studies. We compare variables on prostate cancer, any prostate-specific antigen (PSA) test, asymptomatic screening PSA, any digital rectal exam (DRE), and urinary symptoms. We used data from a 2005 case control study of PSA and metastatic prostate cancer (253 cases and 496 controls). Data were collected from 1999 to 2002. METHODS: We calculated kappa, percent agreement (PPA) and prevalence adjusted bias adjusted kappa (PABAK). We compared percentage positive response (PPR) and sensitivities/specificities of questionnaire against chart and vice versa. We measured the degree of differential agreement between cases and controls using odds ratios. RESULTS: We found almost perfect agreement on prostate cancer, moderate agreement on any PSA and DRE, and slight agreement on asymptomatic screening PSA and urinary symptoms. PABAK ranged from 0.134 (urinary symptoms) to 0.879 (prostate cancer). Differences between cases/controls in PPR are similar according to chart or questionnaire, though PPR itself is usually higher on the questionnaire. Only for any PSA (including diagnostic), cases had better recall than controls. We found no evidence of differential agreement that might lead to bias in a case control study. CONCLUSIONS: Some variables are more reliable than others comparing medical chart review and self-report. Diagnosis of prostate cancer has near perfect agreement, but for less catastrophic events such as PSA (especially asymptomatic screening tests), DRE or urinary symptoms, agreement ranges from slight to moderate.

Do guidelines for the diagnosis and monitoring of diabetes mellitus fulfill the criteria of evidence-based guideline development?

BACKGROUND: Although the methodological quality of therapeutic guidelines (GLs) has been criticized, little is known regarding the quality of GLs that make diagnostic recommendations. Therefore, we assessed the methodological quality of GLs providing diagnostic recommendations for managing diabetes mellitus (DM) and explored several reasons for differences in quality across these GLs. METHODS: After systematic searches of published and electronic resources dated between 1999 and 2007, 26 DM GLs, published in English, were selected and scored for methodological quality using the AGREE Instrument. Subgroup analyses were performed based on the source, scope, length, origin, and date and type of publication of GLs. Using a checklist, we collected laboratory-specific items within GLs thought to be important for interpretation of test results. RESULTS: The 26 diagnostic GLs had significant shortcomings in methodological quality according to the AGREE criteria. GLs from agencies that had clear procedures for GL development, were longer than 50 pages, or were published in electronic databases were of higher quality. Diagnostic GLs contained more preanalytical or analytical information than combined (i.e., diagnostic and therapeutic) recommendations, but the overall quality was not significantly different. The quality of GLs did not show much improvement over the time period investigated. CONCLUSIONS: The methodological shortcomings of diagnostic GLs in DM raise questions regarding the validity of recommendations in these documents that may affect their implementation in practice. Our results suggest the need for standardization of GL terminology and for higher-quality, systematically developed recommendations based on explicit guideline development and reporting standards in laboratory medicine.

Mass colorectal cancer screening: methodological quality of practice guidelines is not related to their content validity.

OBJECTIVES: It is not clear if good methodological quality in developing practice guidelines (GLs) necessarily leads to valid recommendations that, when implemented, are more likely to improve the balance between benefits and harms/costs. We assessed whether or not there is a link between methodological quality and recommendation validity in GLs for the use of fecal occult blood test (FOBT) as a screening test for colorectal cancer (CRC) in the average-risk population. METHODS: We systematically searched for such practice GLs published in English or in French within the last 7 years. Our inclusion criteria limited the initial 36 GLs to 12. Scores for methodological quality based on the AGREE criteria were attributed to each of these 12 GLs. Likewise, we searched for meta-analysis and other systematic reviews (SRs) addressing the issue, and we selected for inclusion 8 SRs that met basic quality criteria according to the Critical Appraisal Skills Programme (CASP) of the National Health Service of the United Kingdom (NHS). We used the results and conclusions of these 8 SRs to establish the validity of recommendations made in the 12 included GLs. RESULTS: Regarding methodological quality, the GLs were labeled either "strongly recommend" (n=3), "recommend with provisos or alterations" (n=3), "would not recommend" (n=2), or "unsure" (n=4). The nine GLs recommending for, as well as the three GLs recommending against, mass-screening are equally valid, because the former base their recommendation on the fact that this can decrease CRC-mortality, whereas the latter base their recommendation on the facts that: (1) this procedure would be too expensive and/or not adapted to their local organization of care, and (2) to a lesser extent, the balance between benefits and harms is not crystal-clear from an individual patient perspective. CONCLUSION: The fact that the 12 GLs fell short of basic quality criteria confirms many previous observations in various areas of medicine. Because the 12 GLs were found to be equally valid regarding their FOBT-related recommendations, no relation could be found between their methodological quality and their content validity.

Conflict between guideline methodologic quality and recommendation validity: a potential problem for practitioners.

BACKGROUND: It is not clear if good methodologic quality in current practice guidelines necessarily leads to more valid recommendations, i.e., those that are supported with consistent research evidence or, when evidence is conflicting or lacking, with sufficient consensus among the guideline development team. To help clarify this issue, we assessed whether there is a link between methodologic quality and recommendation validity in practice guidelines for the use of laboratory tests in the management of patients with non-small cell lung cancer (NSCLC). METHODS: We conducted a systematic review of data on laboratory tests in NSCLC published in English or in French within the last 10 years and retrieved 11 practice guidelines for the use of these tests. The guidelines were critically appraised and scored for methodologic quality and recommendation validity based on the Appraisal of Guidelines Research and Evaluation (AGREE) criteria and on the systematic review. RESULTS: Overall, these 11 guidelines had considerable shortcomings in methodologic quality and, to a lesser extent, in recommendation validity. Practice guidelines with the best methodologic quality were not necessarily the most valid in their recommendations, and conversely. CONCLUSIONS: Poor methodologic quality and lack of recommendation validity in laboratory medicine call for methodologic standards of guideline development and for international collaboration of guideline development agencies. We advise readers of guidelines to critically evaluate the methods used as well as the content of the recommendations before adopting them for use in practice.

Reliability of point-of-care testing for glucose measurement in critically ill adults.

BACKGROUND: Glycemic control is increasingly being recognized as a priority in the treatment of critically ill patients. Titration and monitoring of insulin infusions involve frequent blood glucose measurement to achieve target glucose ranges and prevent adverse events related to hypoglycemia. Therefore, it is imperative that bedside glucose testing methods be safe and accurate. OBJECTIVE: To determine the accuracy and clinical impact of three common methods of bedside point-of-care testing for glucose measurements in critically ill patients receiving insulin infusions. DESIGN: Prospective observational study. SETTING: A 21-bed mixed medical/surgical intensive care unit of a tertiary care teaching hospital. PATIENTS: Thirty consecutive critically ill patients who were vasopressor-dependent (n = 10), had significant peripheral edema (n = 10), or were admitted following major surgery (n = 10). MEASUREMENTS: Findings from three different methods of glucose measurement were compared with central laboratory measurements: (1) glucose meter analysis of capillary blood (fingerstick); (2) glucose meter analysis of arterial blood; and (3) blood gas/chemistry analysis of arterial blood. Patients were enrolled for a maximum of 3 days and had a maximum of nine sets of measurements determined during this time. RESULTS: Clinical agreement with the central laboratory was significantly better with arterial blood analysis (69.9% and 76.5% for glucose meter and blood gas/chemistry analysis, respectively) than with capillary blood analysis (56.8%; p = .039 and .001, respectively). During hypoglycemia, clinical agreement was only 26.3% with capillary blood analysis and 55.6% and 64.9% for glucose meter and blood gas/chemistry analysis of arterial blood (p = .010 and <.001, respectively). Glucose meter analysis of both arterial and capillary blood tended to provide higher glucose values, whereas blood gas/chemistry analysis of arterial blood tended to yield lower glucose values. CONCLUSIONS: The magnitude of the differences in the glucose values offered by the four different methods of glucose measurement led to frequent clinical disagreements regarding insulin dose titration in the context of an insulin infusion protocol for aggressive glucose control.

Screening with prostate specific antigen and metastatic prostate cancer risk: a population based case-control study.

PURPOSE: Screening of asymptomatic men with prostate specific antigen (PSA) remains a controversial issue. There is limited evidence that screening is effective in reducing mortality from prostate cancer. In the current study we determined if screening with PSA reduces the risk of metastatic prostate cancer. MATERIALS AND METHODS: We conducted a population based case-control study among the residents of Metropolitan Toronto and 5 surrounding counties in Ontario, Canada. Data were obtained from 236 cases of metastatic prostate cancer and 462 controls randomly sampled from the source population and frequency matched to cases for age and area of residence. History of PSA testing, digital rectal examination, symptoms and other data were obtained from medical records and a self-administered questionnaire. The association between PSA screening and metastatic prostate cancer was measured by the Mantel-Haenszel odds ratio stratified by exposure observation time and other potential confounding factors. RESULTS: In asymptomatic men, the frequency of PSA screening as determined from medical records was significantly lower among the cases compared with the controls (odds ratio 0.65, 95% confidence interval 0.45 to 0.93). The odds ratio was 0.52 (0.28 to 0.98) in men 45 to 59 years old and 0.67 (0.41 to 1.09) in those 60 to 84 years old. CONCLUSIONS: In this case-control study screening of asymptomatic men with PSA was associated with a significantly reduced risk of metastatic prostate cancer. The results need to be confirmed in randomized controlled trials.

A reliable coding system to define screening prostate-specific antigen tests was developed in a case-control study.

OBJECTIVE: To establish the reliability of a coding system for screening and diagnostic prostate-specific antigen (PSA) testing from patient charts. STUDY DESIGN AND SETTING: Two investigators reviewed 448 chart abstractions from a population-based case-control study of PSA screening in the Toronto area. The tests evaluated for reliability were transrectal ultrasound (TRUS), digital rectal examination (DRE), and prostate-specific antigen (PSA). RESULTS: DRE results were found in 87%, PSA results in 65%, and TRUS results in 12% of the 749 charts. Interobserver agreement was 94% for DRE texture (kappa =.885), 95% for DRE asymmetry (kappa = .868), 85% for DRE physician interpretation (kappa = .698), 97% for final DRE result (kappa = .856), and 87% for TRUS (kappa = .769). Physician interpretation modified the final result in only 6.2% of DREs. Interobserver agreement for PSA coding was 91% (kappa = .787). Of PSA results, pure PSA screening with no symptoms of obstructive urination was found in 19%, symptomatic PSA screening in 46%, and diagnostic PSA testing in 35%. CONCLUSION: We have developed a practical and reliable coding system for TRUS, DRE, and PSA in the context of a case-control study of PSA screening.

Has there been a change in practice of screening for prostate cancer with prostate-specific antigen in Ontario?

OBJECTIVE: To determine whether there has been a change in the rate of screening in Ontario in 2002 compared to 1995. METHODS: A questionnaire was mailed to 520 physicians, associated with PSA records selected randomly from the database of a large community laboratory. Physicians were asked to consult their records as to the reasons for PSA testing. RESULTS: There were 285 usable responses from 520 mailings (response rate 55%), mostly (91%) from family or general practice. Reasons for testing, expressed as proportions of responses, were as follows (this study, 1995 study and P value for the differences): screening for prostate cancer (74%, 63%; P = 0.059), diagnosis of urinary symptoms (30%, 40%; P = 0.027), follow-up of a medical procedure or drug therapy (14%, 32%; P = 0.001), confirmation of a previous PSA result (14%, 6%; P = 0.015) and other reasons (7%, 8%; P = 0.73). Of those records with screening as one reason for testing, 80% vs. 66% (P = 0.003) indicated it was the only reason; 86% vs. 73% (P = 0.003) indicated that it was part of a routine examination, and 54% vs. 64% (P = 0.052) indicated that the test was requested by the patient. CONCLUSION: These findings are consistent with increased screening for prostate cancer with PSA.

Effect of a controlled feedback intervention on laboratory test ordering by community physicians.

BACKGROUND: Most studies of interventions to reduce laboratory test utilization have occurred in academic hospital settings, used historical controls, or have had short post intervention follow-up. Interventions with the greatest impact use multiple approaches, are repeated regularly, include comparisons with physician peers, and have a personal approach. We determined whether laboratory test utilization by community physicians could be reduced by a multifaceted program of education and feedback. METHODS: We identified 200 physicians who ordered the largest number of common laboratory tests during 1 year in a nonhospital, commercial community (reference) laboratory. They were assigned to intervention and control groups (100 each). Intervention physicians were visited individually up to three times by laboratory representatives over a 2-year period. At each visit, educational material and the physician's personal laboratory test utilization data were presented and discussed briefly in general terms, with the latter compared with utilization data for the physician's peers. Overall test utilization rates 1 year before, during, and 2 years after the intervention were measured using population-based databases. Time-series analysis was used to determine the effect of the intervention on laboratory test utilization. RESULTS: The two groups began with similar test utilization: control group, 4.06 x 10(6) tests in 1.48 x 10(6) visits (2.73 tests/visit); intervention group, 3.90 x 10(6) tests in 1.41 x 10(6) visits (2.77 tests/visit). During the 2-year intervention, intention-to-treat analysis showed that utilization decreased significantly in the intervention group compared with the controls [relative reduction of 7.9% (P <0.0001); absolute reduction of 0.22 tests/visit (95% confidence interval, 0.20-0.24)]. This difference persisted until the end of study observation, or more than 2 years after the intervention ended. CONCLUSION: A multifaceted education and feedback strategy can significantly and persistently decrease laboratory utilization by practicing community physicians.

Intraindividual variation of PSA, free PSA and complexed PSA in a cohort of patients with prostate cancer managed with watchful observation.

OBJECTIVE: To determine the intraindividual variation of prostate-specific antigen (PSA) isoforms in prostate cancer patients managed conservatively with watchful observation. METHODS: Patients with favorable clinical parameters (stage T1b-T2b N0 M0, Gleason score

Feasibility study: watchful waiting for localized low to intermediate grade prostate carcinoma with selective delayed intervention based on prostate specific antigen, histological and/or clinical progression.

PURPOSE: We assessed the feasibility of a watchful waiting protocol with selective delayed intervention using clinical, prostate specific antigen (PSA) or histological progression as treatment indications for clinically localized prostate cancer. MATERIALS AND METHODS: In this prospective, single arm cohort study patients with favorable clinical parameters (stage T1b to T2b N0M0, Gleason score 7 or less and PSA 15 ng./ml. or less) are conservatively treated with watchful waiting. When a patient meets disease progression criteria, arbitrarily defined by the 3 parameters of the rate of PSA increase, clinical progression or histological upgrade on repeat prostate biopsy, appropriate treatment is implemented. Patients are followed every 3 months for the first 2 years and every 6 months thereafter. Serum PSA measurement and digital rectal examination are done at each visit and repeat prostate biopsy is performed 18 months after study enrollment. RESULTS: Since November 1995, the study has accrued 206 patients with a median followup of 29 months (range 2 to 66). Of these men 137 remain on the surveillance protocol with no disease progression, while 69 were withdrawn from study for various reasons. There was clinical, PSA and histological progression in 16, 15 and 5 cases, respectively. The estimated actuarial probability of remaining on the surveillance protocol was 67% at 2 years and 48% at 4. The probability of remaining progression-free was 81% and 67% at 2 and 4 years, respectively. CONCLUSIONS: A policy of watchful waiting with selectively delayed intervention based on predefined criteria of disease progression is feasible. This strategy offers the benefit of an individualized approach based on the demonstrated risk of clinical or biochemical progression with time and, thus, it may decrease the burden of therapy in patients with indolent disease, while providing definitive therapy for those with biologically active disease.

Screening for prostate cancer with prostate-specific antigen: beware the biases.

BACKGROUND: The evidence relating to the use of prostate-specific antigen (PSA) as a screening test is a highly controversial, as demonstrated by the lack of agreement among experts. There may be biases associated with various studies. ISSUES: The main controversy is the relatively high prevalence of prostate cancer (PC) found at autopsy compared with the relatively low death rate from the disease. The lack of modifiable risk factors has led to early detection as a strategy to reduce mortality, as there is evidence for a significant burden of disease. Important issues are the accuracy of current screening tests, some attempts to improve on them, and whether there are good prognostic markers. The consequences of PSA testing (usually further testing including biopsy) and outcomes of treatment are presented in terms of mortality and morbidity; quality of life (QOL) must also be considered. Also important are the benefits from, and the difficulties associated with the "informed choice" approach to PSA screening. CONCLUSION: There is evidence to suggest that biases can have a significant impact on the utility of PSA as a screening test for PC.