Protected areas have a mixed impact on waterbirds, but management helps.

International policy is focused on increasing the proportion of the Earth's surface that is protected for nature1,2. Although studies show that protected areas prevent habitat loss3-6, there is a lack of evidence for their effect on species' populations: existing studies are at local scale or use simple designs that lack appropriate controls7-13. Here we explore how 1,506 protected areas have affected the trajectories of 27,055 waterbird populations across the globe using a robust before-after control-intervention study design, which compares protected and unprotected populations in the years before and after protection. We show that the simpler study designs typically used to assess protected area effectiveness (before-after or control-intervention) incorrectly estimate effects for 37-50% of populations-for instance misclassifying positively impacted populations as negatively impacted, and vice versa. Using our robust study design, we find that protected areas have a mixed impact on waterbirds, with a strong signal that areas managed for waterbirds or their habitat are more likely to benefit populations, and a weak signal that larger areas are more beneficial than smaller ones. Calls to conserve 30% of the Earth's surface by 2030 are gathering pace14, but we show that protection alone does not guarantee good biodiversity outcomes. As countries gather to agree the new Global Biodiversity Framework, targets must focus on creating and supporting well-managed protected and conserved areas that measurably benefit populations.

Ecological barriers mediate spatiotemporal shifts of bird communities at a continental scale.

Species' range shifts and local extinctions caused by climate change lead to community composition changes. At large spatial scales, ecological barriers, such as biome boundaries, coastlines, and elevation, can influence a community's ability to shift in response to climate change. Yet, ecological barriers are rarely considered in climate change studies, potentially hindering predictions of biodiversity shifts. We used data from two consecutive European breeding bird atlases to calculate the geographic distance and direction between communities in the 1980s and their compositional best match in the 2010s and modeled their response to barriers. The ecological barriers affected both the distance and direction of bird community composition shifts, with coastlines and elevation having the strongest influence. Our results underscore the relevance of combining ecological barriers and community shift projections for identifying the forces hindering community adjustments under global change. Notably, due to (macro)ecological barriers, communities are not able to track their climatic niches, which may lead to drastic changes, and potential losses, in community compositions in the future.

Temperature niche composition change inside and outside protected areas under climate warming.

Conservation of biodiversity relies heavily on protected areas but their role and effectiveness under a warming climate is still debated. We estimated the climate-driven changes in the temperature niche compositions of bird communities inside and outside protected areas in southern Canada. We hypothesized that communities inside protected areas include a higher proportion of cold-dwelling species than communities outside protected areas. We also hypothesized that communities shift to warm-dwelling species more slowly inside protected areas than outside. To study community changes, we used large-scale and long-term (1997-2019) data from the Breeding Bird Survey of Canada. To describe the temperature niche compositions of bird communities, we calculated the community temperature index (CTI) annually for each community inside and outside protected areas. Generally, warm-dwelling species dominated communities with high CTI values. We modeled temporal changes in CTI as a function of protection status with linear mixed-effect models. We also determined which species contributed most to the temporal changes in CTI with a jackknife approach. As anticipated, CTI was lower inside protected areas than outside. However, contrary to our expectation, CTI increased faster over time inside than outside protected areas and warm-dwelling species contributed most to CTI change inside protected areas. These results highlight the ubiquitous impacts of climate warming. Currently, protected areas can aid cold-dwelling species by providing habitat, but as the climate warms, the communities' temperature compositions inside protected areas quickly begin to resemble those outside protected areas, suggesting that protected areas delay the impacts of climate warming on cold-dwelling species.

Cambios en la composición del nicho térmico dentro y fuera de las áreas protegidas bajo el calentamiento climático Resumen La conservación de la biodiversidad depende mucho de las áreas protegidas, aunque todavía se debate su papel y efectividad bajo el calentamiento climático. Estimamos los cambios causados por el clima en la composición de los nichos térmicos de las comunidades de aves dentro y fuera de las áreas protegidas al sur de Canadá. Supusimos que las comunidades dentro de las áreas protegidas incluyen una proporción mayor de especies de zonas frías que las comunidades fuera de las áreas protegidas. También supusimos que las comunidades cambian a especies de zonas cálidas de forma más lenta dentro de las áreas protegidas que fuera de ellas. Usamos datos de gran escala y largo plazo (1997-2019) del Censo de Aves Reproductoras de Canadá para estudiar los cambios comunitarios. Calculamos el índice anual de temperatura comunitaria (ITC) para cada comunidad dentro y fuera de las áreas protegidas para describir las composiciones del nicho térmico de las comunidades de aves. En general, las especies de zonas cálidas dominaron las comunidades con valores altos del ITC. Simulamos los cambios temporales en el ITC como función del estado de protección mediante modelos lineales de efecto mixto. También determinamos cuáles especies contribuyen más a los cambios temporales en el ITC con un enfoque jackknife. Como lo anticipamos, el ITC fue menor dentro de las áreas protegidas que afuera. Sin embargo, contrario a nuestra hipótesis, el ITC incrementó más rápido con el tiempo dentro de las áreas protegidas y las especies de zonas cálidas contribuyeron más al cambio en el ITC también dentro de las áreas protegidas. Estos resultados resaltan el impacto universal del calentamiento climático. Actualmente, las áreas protegidas pueden auxiliar a las especies de zonas frías al proporcionarles hábitats, pero conforme la temperatura aumenta, las composiciones térmicas de las comunidades dentro de las áreas protegidas se asemejan rápidamente a aquellas fuera de las áreas protegidas, lo que sugiere que las áreas protegidas retrasan el impacto del calentamiento climático sobre las especies de zonas frías.

Conservation cobenefits from air pollution regulation: Evidence from birds.

Massive wildlife losses over the past 50 y have brought new urgency to identifying both the drivers of population decline and potential solutions. We provide large-scale evidence that air pollution, specifically ozone, is associated with declines in bird abundance in the United States. We show that an air pollution regulation limiting ozone precursors emissions has delivered substantial benefits to bird conservation. Our estimates imply that air quality improvements over the past 4 decades have stemmed the decline in bird populations, averting the loss of 1.5 billion birds, ∼20% of current totals. Our results highlight that in addition to protecting human health, air pollution regulations have previously unrecognized and unquantified conservation cobenefits.

Decomposing the spatial and temporal effects of climate on bird populations in northern European mountains.

The relationships between species abundance or occurrence versus spatial variation in climate are commonly used in species distribution models to forecast future distributions. Under "space-for-time substitution", the effects of climate variation on species are assumed to be equivalent in both space and time. Two unresolved issues of space-for-time substitution are the time period for species' responses and also the relative contributions of rapid- versus slow reactions in shaping spatial and temporal responses to climate change. To test the assumption of equivalence, we used a new approach of climate decomposition to separate variation in temperature and precipitation in Fennoscandia into spatial, temporal, and spatiotemporal components over a 23-year period (1996-2018). We compiled information on land cover, topography, and six components of climate for 1756 fixed route surveys, and we modeled annual counts of 39 bird species breeding in the mountains of Fennoscandia. Local abundance of breeding birds was associated with the spatial components of climate as expected, but the temporal and spatiotemporal climatic variation from the current and previous breeding seasons were also important. The directions of the effects of the three climate components differed within and among species, suggesting that species can respond both rapidly and slowly to climate variation and that the responses represent different ecological processes. Thus, the assumption of equivalent species' response to spatial and temporal variation in climate was seldom met in our study system. Consequently, for the majority of our species, space-for-time substitution may only be applicable once the slow species' responses to a changing climate have occurred, whereas forecasts for the near future need to accommodate the temporal components of climate variation. However, appropriate forecast horizons for space-for-time substitution are rarely considered and may be difficult to reliably identify. Accurately predicting change is challenging because multiple ecological processes affect species distributions at different temporal scales.

Protected area characteristics that help waterbirds respond to climate warming.

Protected area networks help species respond to climate warming. However, the contribution of a site's environmental and conservation-relevant characteristics to these responses is not well understood. We investigated how composition of nonbreeding waterbird communities (97 species) in the European Union Natura 2000 (N2K) network (3018 sites) changed in response to increases in temperature over 25 years in 26 European countries. We measured community reshuffling based on abundance time series collected under the International Waterbird Census relative to N2K sites' conservation targets, funding, designation period, and management plan status. Waterbird community composition in sites explicitly designated to protect them and with management plans changed more quickly in response to climate warming than in other N2K sites. Temporal community changes were not affected by the designation period despite greater exposure to temperature increase inside late-designated N2K sites. Sites funded under the LIFE program had lower climate-driven community changes than sites that did not received LIFE funding. Our findings imply that efficient conservation policy that helps waterbird communities respond to climate warming is associated with sites specifically managed for waterbirds.

Las redes de áreas protegidas ayudan a las especies a responder al calentamiento climático. Sin embargo, se sabe muy poco sobre la contribución de las características ambientales y relevantes para la conservación de un sitio a estas respuestas. Investigamos cómo la composición de las comunidades no reproductivas de aves acuáticas (97 especies) en la red (3,018 sitios) Natura 2000 de la Unión Europea (N2K) cambió en respuesta a los incrementos de la temperatura durante más de 25 años en 26 países europeos. Medimos la reorganización comunitaria con base en series temporales de abundancia recolectadas durante el Censo Internacional de Aves Acuáticas en relación con los objetivos de conservación de los sitios N2K, el periodo de asignación de fondos y el estado del plan de manejo. La composición comunitaria de las aves acuáticas en los sitios con planes de manejo y designados explícitamente para su protección cambió más rápidamente en respuesta al calentamiento climático que en otros sitios N2K. Los cambios comunitarios temporales no se vieron afectados por el periodo de asignación a pesar de una mayor exposición al incremento de la temperatura dentro de los sitios N2K de asignación tardía. Los sitios financiados por el programa LIFE tuvieron menos cambios comunitarios causados por el clima que los sitios que no recibieron este financiamiento. Nuestros hallazgos sugieren que la política de conservación eficiente que ayuda a las comunidades de aves acuáticas a responder al calentamiento climático está asociada con sitios específicamente gestionados para las aves acuáticas.

Stakeholders' perceptions of a community-based advanced nurse practitioner-led integrated oncology care model for adults receiving oral anti-cancer medication-A qualitative study.

Oral anti-cancer medications (OAMs) are increasingly prescribed in oncology, and although administered at home, ongoing monitoring generally requires the patient to attend an acute hospital. With the requirement to provide safe yet convenient care and to increase hospital capacity, the potential exists to transition this cohort of patients to the community to be assessed by oncology health care professionals (HCPs). The onset of COVID-19 facilitated this planned transition. OBJECTIVE: The primary objective was to understand stakeholders' perceptions of a community-based advanced nurse practitioner (ANP)-led integrated OAM care model for adults. METHODS: Qualitative data from interviews and focus groups were obtained from 33 individuals; either service users who attended ANP-led OAM clinics or stakeholders involved in OAM care. Data were subsequently analysed using thematic analysis. RESULTS: Four themes were identified and included reflection on pre-COVID-19 system, role of ANP in current OAM care, importance of robust communication and infrastructural requirements for transition to an integrated OAM care model. CONCLUSION: This study demonstrated that patients and HCPs perceived the proposal positively. They identified the ANP as the appropriate HCP to care for this cohort and the importance of communication and strategic planning for transitioning this model of care to the community setting. CLINICAL TRIAL REGISTRATION: ISRCTN10401455.

Characterizing the cultural niches of North American birds.

Efforts to mitigate the current biodiversity crisis require a better understanding of how and why humans value other species. We use Internet query data and citizen science data to characterize public interest in 621 bird species across the United States. We estimate the relative popularity of different birds by quantifying how frequently people use Google to search for species, relative to the rates at which they are encountered in the environment. In intraspecific analyses, we also quantify the degree to which Google searches are limited to, or extend beyond, the places in which people encounter each species. The resulting metrics of popularity and geographic specificity of interest allow us to define aspects of relationships between people and birds within a cultural niche space. We then estimate the influence of species traits and socially constructed labels on niche positions to assess the importance of observations and ideas in shaping public interest in birds. Our analyses show clear effects of migratory strategy, color, degree of association with bird feeders, and, especially, body size on niche position. They also indicate that cultural labels, including "endangered," "introduced," and, especially, "team mascot," are strongly associated with the magnitude and geographic specificity of public interest in birds. Our results provide a framework for exploring complex relationships between humans and other species and enable more informed decision-making across diverse bird conservation strategies and goals.

Mismatch between bird species sensitivity and the protection of intact habitats across the Americas.

Protected areas are highly heterogeneous in their effectiveness at buffering human pressure, which may hamper their ability to conserve species highly sensitive to human activities. Here, we use 60 million bird observations from eBird to estimate the sensitivity to human pressure of each bird species breeding in the Americas. Concerningly, we find that ecoregions hosting large proportions of high-sensitivity species, concentrated in tropical biomes, do not have more intact protected habitat. Moreover, 266 high-sensitivity species have little or no intact protected habitat within their distributions. Finally, we show that protected area intactness is decreasing faster where high-sensitivity species concentrate. Our results highlight a major mismatch between species conservation needs and the coverage of intact protected habitats, which likely hampers the long-term effectiveness of protected areas at retaining species. We highlight ecoregions where protection and management of intact habitats, complemented by restoration, is urgently needed.

Wintering bird communities are tracking climate change faster than breeding communities.

Global climate change is driving species' distributions towards the poles and mountain tops during both non-breeding and breeding seasons, leading to changes in the composition of natural communities. However, the degree of season differences in climate-driven community shifts has not been thoroughly investigated at large spatial scales. We compared the rates of change in the community composition during both winter (non-breeding season) and summer (breeding) and their relation to temperature changes. Based on continental-scale data from Europe and North America, we examined changes in bird community composition using the community temperature index (CTI) approach and compared the changes with observed regional temperature changes during 1980-2016. CTI increased faster in winter than in summer. This seasonal discrepancy is probably because individuals are less site-faithful in winter, and can more readily shift their wintering sites in response to weather in comparison to the breeding season. Regional long-term changes in community composition were positively associated with regional temperature changes during both seasons, but the pattern was only significant during summer due to high annual variability in winter communities. Annual changes in community composition were positively associated with the annual temperature changes during both seasons. Our results were broadly consistent across continents, suggesting some climate-driven restructuring in both European and North American avian communities. Because community composition has changed much faster during the winter than during the breeding season, it is important to increase our knowledge about climate-driven impacts during the less-studied non-breeding season.

Benefits of protected areas for nonbreeding waterbirds adjusting their distributions under climate warming.

Climate warming is driving changes in species distributions and community composition. Many species have a so-called climatic debt, that is, shifts in range lag behind shifts in temperature isoclines. Inside protected areas (PAs), community changes in response to climate warming can be facilitated by greater colonization rates by warm-dwelling species, but also mitigated by lowering extirpation rates of cold-dwelling species. An evaluation of the relative importance of colonization-extirpation processes is important to inform conservation strategies that aim for both climate debt reduction and species conservation. We assessed the colonization-extirpation dynamics involved in community changes in response to climate inside and outside PAs. To do so, we used 25 years of occurrence data of nonbreeding waterbirds in the western Palearctic (97 species, 7071 sites, 39 countries, 1993-2017). We used a community temperature index (CTI) framework based on species thermal affinities to investigate species turnover induced by temperature increase. We determined whether thermal community adjustment was associated with colonization by warm-dwelling species or extirpation of cold-dwelling species by modeling change in standard deviation of the CTI (CTISD ). Using linear mixed-effects models, we investigated whether communities in PAs had lower climatic debt and different patterns of community change than communities outside PAs. For CTI and CTISD combined, communities inside PAs had more species, higher colonization, lower extirpation, and lower climatic debt (16%) than communities outside PAs. Thus, our results suggest that PAs facilitate 2 independent processes that shape community dynamics and maintain biodiversity. The community adjustment was, however, not sufficiently fast to keep pace with the large temperature increases in the central and northeastern western Palearctic. Our results underline the potential of combining CTI and CTISD metrics to improve understanding of the colonization-extirpation patterns driven by climate warming.

Beneficios de las Áreas Protegidas para las Aves Acuáticas No Reproductoras que Están Ajustando su Distribución Debido al Calentamiento Climático Resumen El calentamiento climático está generando cambios en la distribución y en la composición comunitaria de las especies. Muchas de ellas tienen una deuda climática, es decir, los cambios en la distribución se atrasan con respecto a los cambios en las isoclinas térmicas. Dentro de las áreas protegidas (APs), los cambios comunitarios como respuesta al calentamiento climático pueden facilitarse mediante tasas mayores de colonización por especies de climas cálidos, pero también pueden mitigarse al reducir las tasas de extirpación de las especies de climas fríos. Se requiere una evaluación de la importancia relativa de los procesos de colonización-extirpación para orientar las estrategias de conservación que buscan la reducción de la deuda climática y la conservación de las especies. Analizamos las dinámicas de colonización-extirpación que participan en los cambios comunitarios como respuesta al clima dentro y fuera de las APs. Para realizar lo anterior, usamos datos tomados durante 25 años de la presencia de aves acuáticas no reproductoras en el Paleártico occidental (97 especies, 7,071 sitios, 39 países, 1993-2017). Usamos un marco de trabajo del índice de temperatura comunitaria (ITC) basado en las afinidades térmicas de las especies para así investigar la rotación de especies inducida por el incremento en la temperatura. Determinamos si el ajuste térmico en la comunidad estuvo asociado con la colonización por especies de climas cálidos o con la extirpación de especies de climas fríos al modelar el cambio mediante una desviación estándar del ITC (ITCDS ). Con los modelos lineales de efectos mixtos investigamos si las comunidades dentro de las APs tenían una deuda climática más baja y patrones diferentes de cambio comunitario que las comunidades localizadas fuera de las APs. Con la combinación del ITC y deL ITCDS , las comunidades dentro de las APs tuvieron más especies, una mayor colonización, una menor extirpación y una deuda climática más baja (16%) que las comunidades fuera de las APs. Por lo tanto, nuestros resultados sugieren que las APs facilitan dos procesos independientes que moldean las dinámicas comunitarias y mantienen la biodiversidad. Sin embargo, el ajuste comunitario no fue lo suficientemente rápido para mantener el paso de los grandes incrementos en la temperatura de las regiones central y noreste del Paleártico occidental. Nuestros resultados resaltan el potencial que tiene la combinación de las medidas del ITC y del ICTDS para mejorar el entendimiento de los patrones de colonización-extirpación causados por el calentamiento climático.

Regional variation in the impacts of the COVID-19 pandemic on the quantity and quality of data collected by the project eBird.

The COVID-19 pandemic has likely affected natural systems around the world; the curtailment of human activity has also affected the collection of data needed to identify the indirect effects of this pandemic on natural systems. We describe how the outbreak of COVID-19 disease, and associated stay-at-home orders in four political regions, have affected the quantity and quality of data collected by participants in one volunteer-based bird monitoring project, eBird. The four regions were selected both for their early and prolonged periods of mandated changes to human activity, and because of the high densities of observations collected. We compared the months of April 2020 with April in previous years. The most notable change was in the landscapes in which observations were made: in all but one region human-dominated landscapes were proportionally more common in the data in April 2020, and observations made near the rarer wetland habitat were less prevalent. We also found subtler changes in quantity of data collected, as well as in observer effort within observation periods. Finally, we found that these effects of COVID-19 disease varied across the political units, and thus we conclude that any analyses of eBird data will require region-specific examination of whether there have been any changes to the data collection process during the COVID-19 pandemic that would need to be taken into account.

Umbilical hernia repair and recurrence: need for a clinical trial?

INTRODUCTION: Umbilical hernia repair, despite its perceived simplicity, is associated with recurrence between 2.7 and 27%, in mesh repair and non mesh repair respectively. Many factors are recognized contributors to recurrence however multiple defects in the linea alba, known to occur in up to 30% of patients, appear to have been overlooked by surgeons. AIMS: This systematic review assessed reporting of second or multiple linea alba defects in patients undergoing umbilical hernia repair to establish if these anatomical variations could contribute to recurrence along with other potential factors. METHODS: A systematic review of all published English language articles was undertaken using databases PubMed, Embase, Web of Science and Cochrane Library from January 2014 to 2019. The search terms 'Umbilical hernia' AND 'repair' AND 'recurrence' were used across all databases. Analysis was specified in advance to avoid selection bias, was registered with PROSPERO (154173) and adhered to PRISMA statement. RESULTS: Six hundred and forty-six initial papers were refined to 10 following article review and grading. The presence of multiple linea alba defects as a contributor to recurrence was not reported in the literature. One paper mentioned the exclusion of six participants from their study due multiple defects. In all 11 factors were significantly associated with umbilical hernia recurrence. These included: large defect, primary closure without mesh, high BMI in 5/10 publications; smoking, diabetes mellitus, surgical site Infection (SSI) and concurrent hernia in 3/10. In addition, the type of mesh, advanced age, liver disease and non-closure of the defect were identified in individual papers. CONCLUSION: This study identified many factors already known to contribute to umbilical hernia recurrence in adults, but the existence of multiple defects in the linea, despite it prevalence, has evaded investigators. Surgeons need to be consider documentation of this potential confounder which may contribute to recurrence.

Modeling avian full annual cycle distribution and population trends with citizen science data.

Information on species' distributions, abundances, and how they change over time is central to the study of the ecology and conservation of animal populations. This information is challenging to obtain at landscape scales across range-wide extents for two main reasons. First, landscape-scale processes that affect populations vary throughout the year and across species' ranges, requiring high-resolution, year-round data across broad, sometimes hemispheric, spatial extents. Second, while citizen science projects can collect data at these resolutions and extents, using these data requires appropriate analysis to address known sources of bias. Here, we present an analytical framework to address these challenges and generate year-round, range-wide distributional information using citizen science data. To illustrate this approach, we apply the framework to Wood Thrush (Hylocichla mustelina), a long-distance Neotropical migrant and species of conservation concern, using data from the citizen science project eBird. We estimate occurrence and abundance across a range of spatial scales throughout the annual cycle. Additionally, we generate intra-annual estimates of the range, intra-annual estimates of the associations between species and characteristics of the landscape, and interannual trends in abundance for breeding and non-breeding seasons. The range-wide population trajectories for Wood Thrush show a close correspondence between breeding and non-breeding seasons with steep declines between 2010 and 2013 followed by shallower rates of decline from 2013 to 2016. The breeding season range-wide population trajectory based on the independently collected and analyzed North American Breeding Bird Survey data also shows this pattern. The information provided here fills important knowledge gaps for Wood Thrush, especially during the less studied migration and non-breeding periods. More generally, the modeling framework presented here can be used to accurately capture landscape scale intra- and interannual distributional dynamics for broadly distributed, highly mobile species.

Using Semistructured Surveys to Improve Citizen Science Data for Monitoring Biodiversity.

Biodiversity is being lost at an unprecedented rate, and monitoring is crucial for understanding the causal drivers and assessing solutions. Most biodiversity monitoring data are collected by volunteers through citizen science projects, and often crucial information is lacking to account for the inevitable biases that observers introduce during data collection. We contend that citizen science projects intended to support biodiversity monitoring must gather information about the observation process as well as species occurrence. We illustrate this using eBird, a global citizen science project that collects information on bird occurrences as well as vital contextual information on the observation process while maintaining broad participation. Our fundamental argument is that regardless of what species are being monitored, when citizen science projects collect a small set of basic information about how participants make their observations, the scientific value of the data collected will be dramatically improved.

Seasonal associations with novel climates for North American migratory bird populations.

Determining the implications of global climate change for highly mobile taxa such as migratory birds requires a perspective that is spatiotemporally comprehensive and ecologically relevant. Here, we document how passerine bird species that migrate within the Western Hemisphere (n = 77) are associated with projected novel climates across the full annual cycle. Following expectations, highly novel climates occurred on tropical non-breeding grounds and the least novel climates occurred on temperate breeding grounds. Contrary to expectations, highly novel climates also occurred within temperate regions during the transition from breeding to autumn migration. This outcome was caused by lower inter-annual climatic variability occurring in combination with stronger warming projections. Thus, migrants are projected to encounter novel climates across the majority of their annual cycle, with a pronounced peak occurring when juveniles are leaving the nest and preparing to embark on their first migratory journey, which may adversely affect their chances of survival.

Abundance models improve spatial and temporal prioritization of conservation resources.

Conservation prioritization requires knowledge about organism distribution and density. This information is often inferred from models that estimate the probability of species occurrence rather than from models that estimate species abundance, because abundance data are harder to obtain and model. However, occurrence and abundance may not display similar patterns and therefore development of robust, scalable, abundance models is critical to ensuring that scarce conservation resources are applied where they can have the greatest benefits. Motivated by a dynamic land conservation program, we develop and assess a general method for modeling relative abundance using citizen science monitoring data. Weekly estimates of relative abundance and occurrence were compared for prioritizing times and locations of conservation actions for migratory waterbird species in California, USA. We found that abundance estimates consistently provided better rankings of observed counts than occurrence estimates. Additionally, the relationship between abundance and occurrence was nonlinear and varied by species and season. Across species, locations prioritized by occurrence models had only 10-58% overlap with locations prioritized by abundance models, highlighting that occurrence models will not typically identify the locations of highest abundance that are vital for conservation of populations.

Prenatal care in Oregon and Washington: policy and utilization for vulnerable women.

BACKGROUND: In the prenatal period, women can have sustained contact with nurses and other clinicians, forming relationships that are likely to be health enhancing for both the woman and her unborn child. Yet, first trimester care use in Oregon dropped noticeably over the past decade. In comparison with Washington state, Oregon has not shown substantial recovery. OBJECTIVE: The aim of this study was to explore potential reasons for the declining prenatal trend in Oregon. METHODS: We collated county-level birth data from all Oregon and Washington counties from 2000 to 2010. A descriptive, observational, time-series regression analysis for both states assessed the influence of maternal determinants known to impact first trimester care utilization. RESULTS: In Oregon, two factors were significantly associated with declining first trimester care: Medicaid funding (p<.01) and maternal Hispanic ethnicity (p=.02). In Washington, there was no significant association between any assessed determinant and first trimester care. DISCUSSION: In Oregon, over the period of our study, women dependent on Medicaid and women of Hispanic origin were less likely to utilize first trimester care. A similar trend for these variables was not observed in Washington. At the time of our study, both states had different policy approaches, which may explain some of the observable patterns. Amid current healthcare reforms and rising immigration, our findings suggest the need for strong advocacy for those less able to access or utilize care.

Nutritional status, growth and disease management in children with single and dual diagnosis of type 1 diabetes mellitus and coeliac disease.

BACKGROUND: The consequences of subclinical coeliac disease (CD) in Type 1 diabetes mellitus (T1DM) remain unclear. We looked at growth, anthropometry and disease management in children with dual diagnosis (T1DM + CD) before and after CD diagnosis. METHODS: Anthropometry, glycated haemoglobin (HbA1c) and IgA tissue transglutaminase (tTg) were collected prior to, and following CD diagnosis in 23 children with T1DM + CD. This group was matched for demographics, T1DM duration, age at CD diagnosis and at T1DM onset with 23 CD and 44 T1DM controls. RESULTS: No differences in growth or anthropometry were found between children with T1DM + CD and controls at any time point. Children with T1DM + CD, had higher BMI z-score two years prior to, than at CD diagnosis (p < 0.001). BMI z-score change one year prior to CD diagnosis was lower in the T1DM + CD than the T1DM group (p = 0.009). At two years, height velocity and change in BMI z-scores were similar in all groups. No differences were observed in HbA1c between the T1DM + CD and T1DM groups before or after CD diagnosis. More children with T1DM + CD had raised tTg levels one year after CD diagnosis than CD controls (CDx to CDx + 1 yr; T1DM + CD: 100% to 71%, p = 0.180 and CD: 100% to 45%, p < 0.001); by two years there was no difference. CONCLUSIONS: No major nutrition or growth deficits were observed in children with T1DM + CD. CD diagnosis does not impact on T1DM glycaemic control. CD specific serology was comparable to children with single CD, but those with dual diagnosis may need more time to adjust to gluten free diet.