Analyzing the effectiveness of environmental impact assessment in Paraná, Brazil and California, United States with fuzzy-set qualitative comparative analysis and the analytical hierarchy process.

Environmental impact assessment (EIA) has become one of the most widespread environmental management instruments. Despite this, EIA is routinely criticized for being ineffective at impacting decision-making. This study compared the EIA systems of Paraná, Brazil and California, United States using the effectiveness dimensions from the EIA literature. This study formats the cases into contextual conditions using the fuzzy-set qualitative comparative analysis (fsQCA) to identify the necessary or sufficient conditions that cause effective outcomes. These effectiveness outcomes are then ranked by EIA stakeholders via the analytical hierarchy process (AHP) to identify stakeholder priorities and to improve stakeholder management. The results show that in Paraná stakeholders identified normative effectiveness as the most important dimension, while stakeholders in California identified this dimension as the second-most important following substantive effectiveness. Public participation was found to be a necessary condition for both substantive and normative effectiveness to occur. Early project definition was found to be sufficient for substantive effectiveness and necessary for normative effectiveness, for which stakeholder coordination was a sufficient condition. This suggests that in order for EIA to influence decision-making and foster sustainable development, greater care needs to be taken to actively engage stakeholders in public participation, with clear roles and project design communicated early on, and a clear role for regulatory authority to promote stakeholder coordination for acceptable outcomes. These findings suggest that some effectiveness dimensions are caused by similar conditions, which could help focus stakeholder management efforts and point to new avenues for future EIA effectiveness research.

Technology-enhanced community forest management in tropical regions: A state of the art.

Tropical forests provide ecosystem services to around 2.7 billion people. Yet they are reaching tipping points due to social, economic, and environmental pressures. Technology is increasingly being leveraged to expand Community Forest Management (CFM) monitoring capabilities and to potentially increase its effectiveness, but a systematic accounting of this is lacking in the scientific literature. This study employed a mixed-methods approach combining a systematic literature review (SLR) with semi-structured interviews of technology-enhanced CFM (tech-CFM) case studies in tropical forests. From the SLR, evaluation criteria were identified and applied to 23 case studies that employed one or more novel technologies, 8 on the African continent, 9 in the Asia Pacific region, 5 in Latin America, and 1 in multiple regions. The results include classifying 22 monitoring technologies, with satellite remote sensing technology being the most common (17 case studies), followed by mobile devices (10 case studies), which are often integrated with geographic information system (8 case studies) analysis and data platforms. These technologies tend to be deployed in packages that augment each technology's capabilities, beyond their individual uses. Nonetheless, they are limited by poor internet coverage in remote regions, impeding the ability to develop real-time integrated monitoring systems. Tech-CFM shows potential for complementing and integrating with national monitoring system when adequate data collection protocols are in place. Practical social-cultural, technical, and project design recommendations are made for the integration of technology into CFM. Finally, a multi-criteria decision-making framework is developed from the literature-based evaluation criteria to assist practitioners in selecting appropriate technology suites.

Elements of the water - food - environment nexus for integrated sustainability analysis.

Water and food security are constantly on the sustainable development agenda since they are interrelated with anthropogenic and ecosystemic issues present in the economic, environmental, and social spheres. The non-integrative management of these issues points to unsustainable futures. In this context, nexus approaches deserve considerable attention in the search for integrative management solutions capable of contributing to leveraging synergies that increase agricultural productivity, while simultaneously reducing environmental impacts, including water resources. This systematic literature review article aims to analyze the integration factors from the perspective of the water - food - environment nexus in the context of water and agricultural sustainability. The systematic methodology, including a content analysis, allowed the identification of analytical categories composed of the most present integrating factors and discussed in the scientific scope and how they are correlated from the perspective of the nexus. Among the extensive number of factors, the systemic management inserted in the integrated management of watersheds, the sustainable intensification from the perspective of food security and the demand for water resources, categorized in water security, presented higher frequency of occurrence when compared with the other factors. It is proposed that these factors can be considered as indicators of sustainability in the context of integrated water resources management and agricultural food production, since their synergistic effects have consequences in the water, agricultural and environmental management sectors. Thus, this study stands out for identifying trends and gaps in the water - food - environment nexus that can contribute to the development of innovative decision-making tools, in order to assist in the management of the watershed, where agriculture plays a key role in socio-environmental issues.

Demographic disparities of penile cancer in Appalachian Kentucky.

INTRODUCTION: Appalachian Kentucky is a region characterized by poor healthcare literacy and access. We investigate the disparities in demographic distribution and outcomes of penile squamous cell carcinoma (pSCC) in rural Kentucky. MATERIALS AND METHODS: Data were retrieved for patients with pSCC from 1995-2015 from the Kentucky Cancer Registry and the Surveillance, Epidemiology and End Results Program (SEER) and were used to investigate differences between Appalachian Kentucky and the remainder of the state and country. RESULTS: The incidence of pSCC from 1995-2015 in Appalachian Kentucky was over 60% higher than non-Appalachian regions (2.6 vs. 1.6 cases/100,000 people). Nearly 40% were from Appalachian counties. They presented with similar grade and pT stage at diagnosis but were more likely to have pN+ disease (p < 0.001). Rates of cancer-specific mortality (CSM) were similar between the two regions, but patients with CSM exhibited shorter survival interval from diagnosis in Appalachia (median 20 vs. 26 months, p = 0.016). Compared to national SEER data, patients from Appalachian Kentucky presented with similar grade and stage but exhibited higher rates of CSM (24.0% vs. 20.1%, p = 0.029). African Americans (AA) comprised only 5% of patients but exhibited high pathologic stage at presentation (p = 0.041) and shorter survival intervals (median 12 vs. 23 months, p = 0.023) compared to Caucasians. CONCLUSIONS: There is a disproportionately high rate of pSCC in Appalachian Kentucky. Both Appalachian and AA men exhibited more advanced disease at presentation and shorter survival, identifying socioeconomic and racial disparities which can be targeted to improve outcomes in high risk individuals.

Open Radical Nephrectomy for Suspected Renal Malignancy-Tips and Tricks.

OBJECTIVE: To present the surgical approach to a cystic renal mass suspicious for malignancy in a 22-month-old female. MATERIALS: The patient was a healthy female was found to have an abdominal mass by her parents. Her mother underwent a nephrectomy as a child for unknown pathology. Physical examination was otherwise unremarkable and laboratory workup was normal. Imaging workup revealed a large cystic renal mass suspicious for malignancy. Surgical resection was planned. RESULTS: A nonsyndromic 22-month-old female underwent open radical nephrectomy on the left with regional lymph node dissection. A transverse abdominal incision was used, followed by medial reflection of the colon and complete renal mobilization. The distal ureter and renal vasculature were identified and controlled and the kidney removed. A retractor was then assembled and regional lymph node dissection performed. Final pathology was cystic nephroma with 10 benign lymph nodes. The patient recovered well and was discharged home 3 days after surgery. CONCLUSION: Open radical nephrectomy is an important part of protocol management for patients with renal masses suspicious for malignancy.

Assessment of Radiation Safety Knowledge Among Urology Residents in the United States.

Introduction: Urologists are increasingly exposed to fluoroscopy, which can cause cellular damage. Appropriate awareness and safety precautions concerning fluoroscopy are necessary and likely should be a focus during training. We sought to assess radiation safety knowledge among Urology residents in the United States. Methods: A 19-question survey was constructed to assess radiation safety training, knowledge, behavior, and attitudes. The survey was sent through REDCap™ (Research Electronic Data Capture) to all Urology program directors and coordinators in the United States with a request to distribute to their residents. The survey was closed after 3 weeks. Results: One hundred thirty-six urology trainees responded during the study period. Thirteen percent learned fluoroscopic radiation safety formally, 46% informally, 35% both informally and formally, and 6% no education. Forty-six percent reported radiation safety being part of their curriculum. When asked about directional X-ray travel and exposure, only 54% answered correctly. Regarding conditions related to radiation exposure, 94% believe infertility is potentially related, 83% cataracts, 93% leukemia and lymphoma, 57% central nervous system tumors, 77% birth defects, and 4% diabetes. Regarding protection, 9% wear lead-lined glasses, 30% dosimeters, 99% thyroid shields, 0% lead gloves, 97% lead apron, 26% lead shield, and 0% nothing. Regarding fluoroscopy machine settings, 7% knew the machine used was set to continuous, 73% pulse, and 21% were unsure. Sixty-six percent had awareness of the directional travel of the machine routinely used. Regarding safety techniques, 99% knew decreasing time and 100% knew wearing protective materials decrease exposure. However, when asked about distance and exposure, 55% answered incorrectly. Most respondents believe radiation safety is important (89%) and desire more formal education (64%). Conclusions: Trainees lack sufficient knowledge in several key areas regarding radiation safety. Formal education may be considered during training and is desired by trainees. This education is likely needed to ensure trainees learn methods to keep them safe during their career.

Ecosystem service flows from a migratory species: Spatial subsidies of the northern pintail.

Migratory species provide important benefits to society, but their cross-border conservation poses serious challenges. By quantifying the economic value of ecosystem services (ESs) provided across a species' range and ecological data on a species' habitat dependence, we estimate spatial subsidies-how different regions support ESs provided by a species across its range. We illustrate this method for migratory northern pintail ducks in North America. Pintails support over $101 million USD annually in recreational hunting and viewing and subsistence hunting in the U.S. and Canada. Pintail breeding regions provide nearly $30 million in subsidies to wintering regions, with the "Prairie Pothole" region supplying over $24 million in annual benefits to other regions. This information can be used to inform conservation funding allocation among migratory regions and nations on which the pintail depends. We thus illustrate a transferrable method to quantify migratory species-derived ESs and provide information to aid in their transboundary conservation.

Assessment of Radiation Safety Knowledge among House Staff Exposed to Fluoroscopic Radiation.

INTRODUCTION: Urologists are increasingly exposed to fluoroscopy as minimally invasive techniques continue to proliferate. Fluoroscopy, or electromagnetic radiation, can cause cellular damage. Appropriate knowledge of safety precautions for fluoroscopy are necessary and ideally should be taught to physicians in training. METHODS: A 20-question survey was created to assess radiation safety training, knowledge, behavior and attitudes. The survey was sent via REDCap™ to house staff routinely involved in fluoroscopic cases, including urology, orthopedic surgery, neurosurgery, radiology, general surgery, anesthesia, plastic surgery, cardiology, vascular surgery, and gastroenterology residents and fellows. RESULTS: Of 218 participants 61 (28%) responded during the 3-week study period. Overall 57% reported learning fluoroscopic radiation safety informally, with 28% receiving informal as well as formal education. Concerning directional x-ray travel and exposure only 20% answered correctly. In terms of conditions potentially related to radiation exposure 86% selected infertility, 87% cataracts, 87% leukemia and lymphoma, 59% central nervous system tumors and 71% birth defects. Twenty percent wear lead lined glasses, 23% dosimeters, 92% thyroid shields, 2% lead gloves, 92% lead apron, 48% lead shield and 1.6% nothing. Of the respondents 49% were unsure if the machine was set to continuous or pulse. Ninety-eight percent knew decreasing time and 100% knew wearing protective materials were ways to decrease exposure. However, concerning distance and exposure only 56% answered correctly. The majority of respondents believe radiation safety is important and would like more formal education. CONCLUSIONS: Fluoroscopic radiation safety knowledge is low among house staff routinely exposed to fluoroscopy. Further study and likely increased formal education are warranted.

Willingness to Pay for Conservation of Transborder Migratory Species: A Case Study of the Mexican Free-Tailed Bat in the United States and Mexico.

We estimated U.S. and Mexican citizens' willingness to pay (WTP) for protecting habitat for a transborder migratory species, the Mexican free-tailed bat (Tadarida brasiliensis mexicana), using the contingent valuation method. Few contingent valuation surveys have evaluated whether households in one country would pay to protect habitat in another country. This study addresses that gap. In our study, Mexican respondents were asked about their WTP for conservation of Mexican free-tailed bat habitat in Mexico and in the United States. Similarly, U.S. respondents were asked about their WTP for conservation in the United States and in Mexico. U.S. households would pay $30 annually to protect habitat in the United States and $24 annually to protect habitat in Mexico. Mexican households would pay $8 annually to protect habitat in Mexico and $5 annually to protect habitat in the United States. In both countries, these WTP amounts rose significantly for increasing the size of the bat population rather than simply stabilizing the current bat population. The ratio of Mexican household WTP relative to U.S. household WTP is nearly identical to that of Mexican household income relative to U.S. household income. This suggests that the perceived economic benefits received from the bats is similar in Mexico and the United States, and that scaling WTP by relative income in international benefit transfer may be plausible.

Recreation economics to inform migratory species conservation: Case study of the northern pintail.

Quantification of the economic value provided by migratory species can aid in targeting management efforts and funding to locations yielding the greatest benefits to society and species conservation. Here we illustrate a key step in this process by estimating hunting and birding values of the northern pintail (Anas acuta) within primary breeding and wintering habitats used during the species' annual migratory cycle in North America. We used published information on user expenditures and net economic values (consumer surplus) for recreational viewing and hunting to determine the economic value of pintail-based recreation in three primary breeding areas and two primary wintering areas. Summed expenditures and consumer surplus for northern pintail viewing were annually valued at $70M, and annual sport hunting totaled $31M (2014 USD). Expenditures for viewing ($42M) were more than twice as high than those for hunting ($18M). Estimates of consumer surplus, defined as the amount consumers are willing to pay above their current expenditures, were $15M greater for viewing ($28M) than for hunting ($13M). We discovered substantial annual consumer surplus ($41M) available for pintail conservation from birders and hunters. We also found spatial differences in economic value among the primary regions used by pintails, with viewing generally valued more in breeding regions than in wintering regions and the reverse being true for hunting. The economic value of pintail-based recreation in the Western wintering region ($26M) exceeded that in any other region by at least a factor of three. Our approach of developing regionally explicit economic values can be extended to other taxonomic groups, and is particularly suitable for migratory game birds because of the availability of large amounts of data. When combined with habitat-linked population models, regionally explicit values could inform development of more effective conservation finance and policy mechanisms to enhance environmental management and societal benefits across the geographically dispersed areas used by migratory species.

Interaction between the RNA-dependent ATPase and poly(A) polymerase subunits of the TRAMP complex is mediated by short peptides and important for snoRNA processing.

The RNA exosome is one of the main 3' to 5' exoribonucleases in eukaryotic cells. Although it is responsible for degradation or processing of a wide variety of substrate RNAs, it is very specific and distinguishes between substrate and non-substrate RNAs as well as between substrates that need to be 3' processed and those that need to be completely degraded. This specificity does not appear to be determined by the exosome itself but rather by about a dozen other proteins. Four of these exosome cofactors have enzymatic activity, namely, the nuclear RNA-dependent ATPase Mtr4, its cytoplasmic paralog Ski2 and the nuclear non-canonical poly(A) polymerases, Trf4 and Trf5. Mtr4 and either Trf4 or Trf5 assemble into a TRAMP complex. However, how these enzymes assemble into a TRAMP complex and the functional consequences of TRAMP complex assembly remain unknown. Here, we identify an important interaction site between Mtr4 and Trf5, and show that disrupting the Mtr4/Trf interaction disrupts specific TRAMP and exosome functions, including snoRNA processing.

Engaging primary care patients to use a patient-centered personal health record.

PURPOSE: Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most patients receive their care. METHODS: We conducted a mixed methods assessment of a proactive implementation strategy for a patient portal (an interactive preventive health record [IPHR]) offered by 8 primary care practices. The practices implemented a series of learning collaboratives with practice champions and redesigned workflow to integrate portal use into care. Practice implementation strategies, portal use, and factors influencing use were assessed prospectively. RESULTS: A proactive and customized implementation strategy designed by practices resulted in 25.6% of patients using the IPHR, with the rate increasing 1.0% per month over 31 months. Fully 23.5% of IPHR users signed up within 1 day of their office visit. Older patients and patients with comorbidities were more likely to use the IPHR, but blacks and Hispanics were less likely. Older age diminished as a factor after adjusting for comorbidities. Implementation by practice varied considerably (from 22.1% to 27.9%, P <.001) based on clinician characteristics and workflow innovations adopted by practices to enhance uptake. CONCLUSIONS: By directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems.

Market forces and technological substitutes cause fluctuations in the value of bat pest-control services for cotton.

Critics of the market-based, ecosystem services approach to biodiversity conservation worry that volatile market conditions and technological substitutes will diminish the value of ecosystem services and obviate the "economic benefits" arguments for conservation. To explore the effects of market forces and substitutes on service values, we assessed how the value of the pest-control services provided by Mexican free-tailed bats (Tadarida brasiliensis mexicana) to cotton production in the southwestern U.S. has changed over time. We calculated service values each year from 1990 through 2008 by estimating the value of avoided crop damage and the reduced social and private costs of insecticide use in the presence of bats. Over this period, the ecosystem service value declined by 79% ($19.09 million U.S. dollars) due to the introduction and widespread adoption of Bt (Bacillus thuringiensis) cotton transgenically modified to express its own pesticide, falling global cotton prices and the reduction in the number of hectares in the U.S. planted with cotton. Our results demonstrate that fluctuations in market conditions can cause temporal variation in ecosystem service values even when ecosystem function--in this case bat population numbers--is held constant. Evidence is accumulating, however, of the evolution of pest resistance to Bt cotton, suggesting that the value of bat pest-control services may increase again. This gives rise to an economic option value argument for conserving Mexican free-tailed bat populations. We anticipate that these results will spur discussion about the role of ecosystem services in biodiversity conservation in general, and bat conservation in particular.

Economic value of instream flow for non-commercial whitewater boating using recreation demand and contingent valuation methods.

Whitewater river kayaking and river rafting require adequate instream flows that are often adversely affected by upstream water diversions. However, there are very few studies in the USA of the economic value of instream flow to inform environmental managers. This study estimates the economic value of instream flow to non-commercial kayakers derived using a Travel Cost Method recreation demand model and Contingent Valuation Method (CVM), a type of Contingent Behavior Method (CBM). Data were obtained from a visitor survey administered along the Poudre River in Colorado. In the dichotomous choice CVM willingness to pay (WTP) question, visitors were asked if they would still visit the river if the cost of their trip was $Y higher, and the level of $Y was varied across the sample. The CVM yielded an estimate of WTP that was sensitive to flows ranging from $55 per person per day at 300 Cubic Feet per Second (CFS) to a maximum $97 per person per day at flows of 1900 CFS. The recreation demand model estimated a boater's number of trips per season. We found the number of trips taken was also sensitive to flow, ranging from as little as 1.63 trips at 300 CFS to a maximum number of 14 trips over the season at 1900 CFS. Thus, there is consistency between peak benefits per trip and number of trips, respectively. With an average of about 100 non-commercial boaters per day, the maximum marginal values per acre foot averages about $220. This value exceeds irrigation water values in this area of Colorado.

Designing a patient-centered personal health record to promote preventive care.

BACKGROUND: Evidence-based preventive services offer profound health benefits, yet Americans receive only half of indicated care. A variety of government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records, but current systems may not utilize the technology's full potential. METHODS: Using a previously described model to make information technology more patient-centered, we developed an interactive preventive health record (IPHR) designed to more deeply engage patients in preventive care and health promotion. We recruited 14 primary care practices to promote the IPHR to all adult patients and sought practice and patient input in designing the IPHR to ensure its usability, salience, and generalizability. The input involved patient usability tests, practice workflow observations, learning collaboratives, and patient feedback. Use of the IPHR was measured using practice appointment and IPHR databases. RESULTS: The IPHR that emerged from this process generates tailored patient recommendations based on guidelines from the U.S. Preventive Services Task Force and other organizations. It extracts clinical data from the practices' electronic medical record and obtains health risk assessment information from patients. Clinical content is translated and explained in lay language. Recommendations review the benefits and uncertainties of services and possible actions for patients and clinicians. Embedded in recommendations are self management tools, risk calculators, decision aids, and community resources--selected to match patient's clinical circumstances. Within six months, practices had encouraged 14.4% of patients to use the IPHR (ranging from 1.5% to 28.3% across the 14 practices). Practices successfully incorporated the IPHR into workflow, using it to prepare patients for visits, augment health behavior counseling, explain test results, automatically issue patient reminders for overdue services, prompt clinicians about needed services, and formulate personalized prevention plans. CONCLUSIONS: The IPHR demonstrates that a patient-centered personal health record that interfaces with the electronic medical record can give patients a high level of individualized guidance and be successfully adopted by busy primary care practices. Further study and refinement are necessary to make information systems even more patient-centered and to demonstrate their impact on care. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT00589173.

Non-market valuation of off-highway vehicle recreation in Larimer County, Colorado: Implications of trail closures.

Few economic studies are available to measure off-highway vehicle recreation benefits foregone when trails must be closed to protect the environment. This paper estimates the non-market benefits associated with off-highway vehicle (OHV) recreation on National Forest lands in Larimer County, Colorado. We use a contingent valuation model (CVM) to estimate benefits to OHV users, which includes dirt bike riders, all terrain vehicle (ATV) riders, and 4-wheel drive (4x4) users. Using CVM we find the mean consumer surplus estimates to be $78 per person per day. These results are consistent with the few previous estimates of OHV recreation benefits. This equates to a per trail per summer consumer surplus of at least between $219,467 and $296,876, and a county level surplus per summer to be at least between $796,447 and $1,077,367. These benefits can be compared to environmental costs to obtain a more complete picture of the effects of trail closure, as well as the negative spillovers to non-motorized users.

Mountain substitutability and peak load pricing of high alpine peaks as a management tool to reduce environmental damage: a contingent valuation study.

High alpine peaks throughout the world are under increasing environmental pressure from hikers, trekkers, and climbers. Colorado's "Fourteeners", peaks with summits above 14,000 feet are no exception. Most of these peaks have no entrance fees, and reach ecological and social carrying capacity on weekends. This paper illustrates how a series of dichotomous choice contingent valuation questions can be used to evaluate substitutability between different alpine peaks and quantify the price responsiveness to an entrance fee. Using this approach, we find that peak load pricing would decrease use of popular Fourteeners in Colorado by 22%. This reduction is due almost entirely to substitution, rather than income effects. There is also price inelastic demand, as 60% of the hikers find no substitution for their specific Fourteener at the varying cost increases posed in the survey. The no substitute group has a mean net benefit of $294 per hiker, per trip, considerably higher than visitor net benefits in most recreational use studies.

A model for predicting daily peak visitation and implications for recreation management and water quality: evidence from two rivers in Puerto Rico.

Visitor use surveys and water quality data indicates that high visitor use levels of two rivers in Puerto Rico does not appear to adversely affect several water quality parameters. Optimum visitor use to maximize visitor defined satisfaction is a more constraining limit on visitor use than water quality. Our multiple regression analysis suggests that visitor use of about 150 visitors per day yields the highest level of visitor reported satisfaction, a level that does not appear to affect turbidity of the river. This high level of visitor use may be related to the gregarious nature of Puerto Ricans and their tolerance for crowding on this densely populated island. The daily peak visitation model indicates that regulating the number of parking spaces may be the most effective way to keep visitor use within the social carrying capacity.

Wildfire effects on hiking and biking demand in New Mexico: a travel cost study.

We use a travel cost model to test the effects of wild and prescribed fire on visitation by hikers and mountain bikers in New Mexico. Our results indicate that net benefits for mountain bikers is $150 per trip and that they take an average of 6.2 trips per year. Hikers take 2.8 trips per year with individual net benefits per trip of $130. Both hikers' and mountain bikers' demand functions react adversely to prescribed burning. Net benefits for both groups fall as areas recover from prescribed burns. Because both visitation and annual recreation benefits decrease to these two types of visitors, this gives rise to multiple use costs associated with prescribed burning. With respect to wildfire, hikers and mountain bikers both exhibit decreased visitation as areas recover from wildfires, however, only hikers indicate an increase in per trip net benefits. Bikers' demand effectively drops to zero. These results differ from previous findings in the literature and have implications for efficient implementation of the National Fire Plan and whether prescribed burning is a cost effective tool for multiple use management of National Forests. Specifically, that fire and recreation managers cannot expect recreation users to react similarly to fire across recreation activities, or different geographic regions. What is cost effective in one region may not be so in another.