Risk factors for poor health-related quality of life in patients with colon cancer include stoma and smoking habits.

BACKGROUND: Previous studies have shown that health-related quality of life (HRQoL) is associated with the prognosis of cancer patients. The aim of this study was to investigate risk factors for poor HRQoL in patients with colon cancer. METHODS: This was a prospective population-based study of patients with colon cancer included between 2012 and 2016. HRQoL was measured using the cancer-specific European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30. Multiple linear regression analysis adjusted for age, sex, body mass index, smoking habits, American Society of Anesthesiologists physical status classification, emergency/elective surgery, resection with/without a stoma and tumour stage was used. RESULTS: A total of 67% (376/561) of all incident patients with colon cancer (196 [52.1%] females) was included. Mean (range) age was 73 (30-96) years. Patients with worse health (American Society of Anesthesiologists physical status 3 and 4), those with higher body mass index, smokers and those planned to undergo surgical treatment with a stoma were at a higher risk for poor HRQoL than the other included patients at baseline and 6-month follow-up. CONCLUSIONS: Patient characteristics such as smoking, high body mass index and worse physical health as well as treatment with a stoma were associated with lower HRQoL. Health care for such patients should focus on social and lifestyle behavioural support and stoma closure, when possible. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03910894).

Hazards in Motion: Development of Mobile Geofences for Use in Logging Safety.

Logging is one of the most hazardous occupations in the United States. Real-time positioning that uses global navigation satellite system (GNSS) technology paired with radio frequency transmission (GNSS-RF) has the potential to reduce fatal and non-fatal accidents on logging operations through the use of geofences that define safe work areas. Until recently, most geofences have been static boundaries. The aim of this study was to evaluate factors affecting mobile geofence accuracy in order to determine whether virtual safety zones around moving ground workers or equipment are a viable option for improving situational awareness on active timber sales. We evaluated the effects of walking pace, transmission interval, geofence radius, and intersection angle on geofence alert delay using a replicated field experiment. Simulation was then used to validate field results and calculate the proportion of GNSS error bearings resulting in early alerts. The interaction of geofence radius and intersection angle affected safety geofence alert delay in the field experiment. The most inaccurate alerts were negative, representing early warning. The magnitude of this effect was largest at the greatest intersection angles. Simulation analysis supported these field results and also showed that larger GNSS error corresponded to greater variability in alert delay. Increasing intersection angle resulted in a larger proportion of directional GNSS error that triggered incorrect, early warnings. Because the accuracy of geofence alerts varied greatly depending on GNSS error and angle of approach, geofencing for occupational safety is most appropriate for general situational awareness unless real-time correction methods to improve accuracy or higher quality GNSS-RF transponders are used.

The Science of Firescapes: Achieving Fire-Resilient Communities.

Wildland fire management has reached a crossroads. Current perspectives are not capable of answering interdisciplinary adaptation and mitigation challenges posed by increases in wildfire risk to human populations and the need to reintegrate fire as a vital landscape process. Fire science has been, and continues to be, performed in isolated "silos," including institutions (e.g., agencies versus universities), organizational structures (e.g., federal agency mandates versus local and state procedures for responding to fire), and research foci (e.g., physical science, natural science, and social science). These silos tend to promote research, management, and policy that focus only on targeted aspects of the "wicked" wildfire problem. In this article, we provide guiding principles to bridge diverse fire science efforts to advance an integrated agenda of wildfire research that can help overcome disciplinary silos and provide insight on how to build fire-resilient communities.

Divergence in an obligate mutualism is not explained by divergent climatic factors.

Adaptation to divergent environments creates and maintains biological diversity, but we know little about the importance of different agents of ecological divergence. Coevolution in obligate mutualisms has been hypothesized to drive divergence, but this contention has rarely been tested against alternative ecological explanations. Here, we use a well-established example of coevolution in an obligate pollination mutualism, Yucca brevifolia and its two pollinating yucca moths, to test the hypothesis that divergence in this system is the result of mutualists adapting to different abiotic environments as opposed to coevolution between mutualists. We used a combination of principal component analyses and ecological niche modeling to determine whether varieties of Y. brevifolia associated with different pollinators specialize on different environments. Yucca brevifolia occupies a diverse range of climates. When the two varieties can disperse to similar environments, they occupy similar habitats. This suggests that the two varieties have not specialized on distinct habitats. In turn, this suggests that nonclimatic factors, such as the biotic interaction between Y. brevifolia and its pollinators, are responsible for evolutionary divergence in this system.

Climate change, woodpeckers, and forests: Current trends and future modeling needs.

The structure and composition of forest ecosystems are expected to shift with climate-induced changes in precipitation, temperature, fire, carbon mitigation strategies, and biological disturbance. These factors are likely to have biodiversity implications. However, climate-driven forest ecosystem models used to predict changes to forest structure and composition are not coupled to models used to predict changes to biodiversity. We proposed integrating woodpecker response (biodiversity indicator) with forest ecosystem models. Woodpeckers are a good indicator species of forest ecosystem dynamics, because they are ecologically constrained by landscape-scale forest components, such as composition, structure, disturbance regimes, and management activities. In addition, they are correlated with forest avifauna community diversity. In this study, we explore integrating woodpecker and forest ecosystem climate models. We review climate-woodpecker models and compare the predicted responses to observed climate-induced changes. We identify inconsistencies between observed and predicted responses, explore the modeling causes, and identify the models pertinent to integration that address the inconsistencies. We found that predictions in the short term are not in agreement with observed trends for 7 of 15 evaluated species. Because niche constraints associated with woodpeckers are a result of complex interactions between climate, vegetation, and disturbance, we hypothesize that the lack of adequate representation of these processes in the current broad-scale climate-woodpecker models results in model-data mismatch. As a first step toward improvement, we suggest a conceptual model of climate-woodpecker-forest modeling for integration. The integration model provides climate-driven forest ecosystem modeling with a measure of biodiversity while retaining the feedback between climate and vegetation in woodpecker climate change modeling.

[Self-expanding stent in obstructing colorectal cancer. A new technique to avoid abdominal surgery]. / Vinster med självexpanderande stent vid obstruerande kolorektal cancer. Ny teknik för att undvika bukoperation.

Emergency operations for obstructing colorectal cancer are associated with high morbidity and mortality rates and often result in a temporary or permanent colostomy. A colorectal stent can be used both for palliation and as a "bridge to surgery". Twenty-three patients with obstructive sigmoid or rectal cancer were selected for stenting. Self-expanding metal mesh stents were placed under endoscopic and flouroscopic guidance. Stent placement was technically successful in 19 patients and clinical success was seen in 18. There were only three minor complications, no major and no procedure related mortality. Four patients were later resected without a diverting stoma, two with rectal cancer had preoperative MRI and radiotherapy. In 15 patients the procedure was regarded as palliative. Stent migration was noted in four patients but symptomatic reobstruction did not occur, no patient needed later surgery. Colorectal stenting procedure is effective and safe and can be used in obstructing cancers both as a temporary relief before elective resection and as a definitive treatment in palliative cases.

Comparative phylogeography of a coevolved community: concerted population expansions in Joshua trees and four yucca moths.

Comparative phylogeographic studies have had mixed success in identifying common phylogeographic patterns among co-distributed organisms. Whereas some have found broadly similar patterns across a diverse array of taxa, others have found that the histories of different species are more idiosyncratic than congruent. The variation in the results of comparative phylogeographic studies could indicate that the extent to which sympatrically-distributed organisms share common biogeographic histories varies depending on the strength and specificity of ecological interactions between them. To test this hypothesis, we examined demographic and phylogeographic patterns in a highly specialized, coevolved community--Joshua trees (Yucca brevifolia) and their associated yucca moths. This tightly-integrated, mutually interdependent community is known to have experienced significant range changes at the end of the last glacial period, so there is a strong a priori expectation that these organisms will show common signatures of demographic and distributional changes over time. Using a database of >5000 GPS records for Joshua trees, and multi-locus DNA sequence data from the Joshua tree and four species of yucca moth, we combined paleaodistribution modeling with coalescent-based analyses of demographic and phylgeographic history. We extensively evaluated the power of our methods to infer past population size and distributional changes by evaluating the effect of different inference procedures on our results, comparing our palaeodistribution models to Pleistocene-aged packrat midden records, and simulating DNA sequence data under a variety of alternative demographic histories. Together the results indicate that these organisms have shared a common history of population expansion, and that these expansions were broadly coincident in time. However, contrary to our expectations, none of our analyses indicated significant range or population size reductions at the end of the last glacial period, and the inferred demographic changes substantially predate Holocene climate changes.

Abdominoperineal excision with partial anterior en bloc resection in multimodal management of low rectal cancer: a strategy to reduce local recurrence.

PURPOSE: Total mesorectal excision is the gold standard in the performance of an abdominoperineal resection but little has changed in the way the perineal operation is performed. A frequent problem is anterior dissection. The aim of this study was to present the results of abdominoperineal resection using selected partial anterior en bloc resection to reduce recurrence. METHODS: The data were population-based and prospectively registered. Two experienced surgeons performed the operations. In selected cases, depending on clinical and magnetic resonance imaging findings, parts of the vagina or prostate close to the tumor were resected. All specimens were examined according to Quirke. RESULTS: Sixty-three patients underwent abdominoperineal resection with total mesorectal excision; 56 received preoperative radiotherapy. The tumors involved the anterior bowel wall in 40 cases and in 23 (58 percent) of them, en bloc resections were performed. The distance from the tumor to the conventional resection margin (without en bloc resection) was 0 mm in ten cases. The median follow-up period was 37 months. So far, one (1.7 percent) local recurrence has been detected in 58 (92 percent) curative and indeterminate cases. The cancer-specific five-year survival in these cases was 87 percent (Kaplan-Meier). CONCLUSION: A multimodal management regimen in patients with low rectal cancer, including preoperative radiotherapy and abdominoperineal resection with a high frequency of partial en bloc resection of the vagina or prostate, resulted in excellent local control and survival. In some male patients, excenteration with urinary stoma can be avoided.