Knowledge coproduction on the impact of decisions for waterbird habitat in a changing climate.

Scientists, resource managers, and decision makers increasingly use knowledge coproduction to guide the stewardship of future landscapes under climate change. This process was applied in the California Central Valley (USA) to solve complex conservation problems, where managed wetlands and croplands are flooded between fall and spring to support some of the largest concentrations of shorebirds and waterfowl in the world. We coproduced scenario narratives, spatially explicit flooded waterbird habitat models, data products, and new knowledge about climate adaptation potential. We documented our coproduction process, and using the coproduced models, we determined when and where management actions make a difference and when climate overrides these actions. The outcomes of this process provide lessons learned on how to cocreate usable information and how to increase climate adaptive capacity in a highly managed landscape. Actions to restore wetlands and prioritize their water supply created habitat outcomes resilient to climate change impacts particularly in March, when habitat was most limited; land protection combined with management can increase the ecosystem's resilience to climate change; and uptake and use of this information was influenced by the roles of different stakeholders, rapidly changing water policies, discrepancies in decision-making time frames, and immediate crises of extreme drought. Although a broad stakeholder group contributed knowledge to scenario narratives and model development, to coproduce usable information, data products were tailored to a small set of decision contexts, leading to fewer stakeholder participants over time. A boundary organization convened stakeholders across a large landscape, and early adopters helped build legitimacy. Yet, broadscale use of climate adaptation knowledge depends on state and local policies, engagement with decision makers that have legislative and budgetary authority, and the capacity to fit data products to specific decision needs.

Coproducción de información sobre el impacto de las decisiones para el hábitat de las aves acuáticas en un clima cambiante Resumen Hay un incremento del uso que dan los científicos, gestores de recursos y los órganos decisorios a la coproducción de información para guiar la administración de los futuros paisajes bajo el cambio climático. Se aplicó este proceso para resolver problemas complejos de conservación en el Valle Central de California (EE. UU.), en donde los humedales y campos de cultivos manejados se inundan entre el otoño y la primavera para mantener una de las mayores concentraciones de aves playeras y acuáticas del mundo. Coproducimos narrativas de escenarios, modelos espacialmente explícitos de hábitats inundados de las aves acuáticas, productos de datos y conocimiento nuevo sobre el potencial de adaptación climática. Documentamos nuestro proceso de coproducción y usamos los modelos resultantes para determinar cuándo y en dónde marcan una diferencia las acciones de manejo y cuándo el clima anula estas acciones. Los resultados de este proceso proporcionan aprendizaje sobre cómo cocrear información útil y cómo incrementar la capacidad adaptativa al clima en un paisaje con mucha gestión. Las acciones de restauración de los humedales y la priorización del suministro de agua originaron un hábitat resiliente al impacto del cambio climático, particularmente en marzo, cuando el hábitat estaba más limitado; la protección del suelo combinado con el manejo puede incrementar la resiliencia del ecosistema al cambio climático; y la captación y uso de esta información estuvo influenciada por el papel de los diferentes actores, el cambio rápido de las políticas del agua, discrepancias en los marcos temporales de la toma de decisiones y las crisis inmediatas de la sequía extrema. Mientras que un grupo amplio de accionistas contribuyó conocimiento para las narrativas de escenarios y el desarrollo del modelo, para coproducir información útil, los productos de datos fueron adaptados para un conjunto pequeño de contextos decisivos, lo que con el tiempo llevó a una reducción en la participación de los actores. Una organización fronteriza convocó a los actores de todo un paisaje y los primeros adoptantes ayudaron a construir la legitimidad. A pesar de esto, el uso a gran escala de la información sobre la adaptación climática depende de las políticas locales y estatales, la participación de los órganos decisorios que tienen autoridad legislativa y presupuestaria y de la capacidad para ajustar los productos de datos a las necesidades específicas de las decisiones.

Critical land change information enhances the understanding of carbon balance in the United States.

Large-scale terrestrial carbon (C) estimating studies using methods such as atmospheric inversion, biogeochemical modeling, and field inventories have produced different results. The goal of this study was to integrate fine-scale processes including land use and land cover change into a large-scale ecosystem framework. We analyzed the terrestrial C budget of the conterminous United States from 1971 to 2015 at 1-km resolution using an enhanced dynamic global vegetation model and comprehensive land cover change data. Effects of atmospheric CO2 fertilization, nitrogen deposition, climate, wildland fire, harvest, and land use/land cover change (LUCC) were considered. We estimate annual C losses from cropland harvest, forest clearcut and thinning, fire, and LUCC were 436.8, 117.9, 10.5, and 10.4 TgC/year, respectively. C stored in ecosystems increased from 119,494 to 127,157 TgC between 1971 and 2015, indicating a mean annual net C sink of 170.3 TgC/year. Although ecosystem net primary production increased by approximately 12.3 TgC/year, most of it was offset by increased C loss from harvest and natural disturbance and increased ecosystem respiration related to forest aging. As a result, the strength of the overall ecosystem C sink did not increase over time. Our modeled results indicate the conterminous US C sink was about 30% smaller than previous modeling studies, but converged more closely with inventory data.

Effects of 21st-century climate, land use, and disturbances on ecosystem carbon balance in California.

Terrestrial ecosystems are an important sink for atmospheric carbon dioxide (CO2 ), sequestering ~30% of annual anthropogenic emissions and slowing the rise of atmospheric CO2 . However, the future direction and magnitude of the land sink is highly uncertain. We examined how historical and projected changes in climate, land use, and ecosystem disturbances affect the carbon balance of terrestrial ecosystems in California over the period 2001-2100. We modeled 32 unique scenarios, spanning 4 land use and 2 radiative forcing scenarios as simulated by four global climate models. Between 2001 and 2015, carbon storage in California's terrestrial ecosystems declined by -188.4 Tg C, with a mean annual flux ranging from a source of -89.8 Tg C/year to a sink of 60.1 Tg C/year. The large variability in the magnitude of the state's carbon source/sink was primarily attributable to interannual variability in weather and climate, which affected the rate of carbon uptake in vegetation and the rate of ecosystem respiration. Under nearly all future scenarios, carbon storage in terrestrial ecosystems was projected to decline, with an average loss of -9.4% (-432.3 Tg C) by the year 2100 from current stocks. However, uncertainty in the magnitude of carbon loss was high, with individual scenario projections ranging from -916.2 to 121.2 Tg C and was largely driven by differences in future climate conditions projected by climate models. Moving from a high to a low radiative forcing scenario reduced net ecosystem carbon loss by 21% and when combined with reductions in land-use change (i.e., moving from a high to a low land-use scenario), net carbon losses were reduced by 55% on average. However, reconciling large uncertainties associated with the effect of increasing atmospheric CO2 is needed to better constrain models used to establish baseline conditions from which ecosystem-based climate mitigation strategies can be evaluated.

The Role of the Specialist Nurse in Gynaecological Cancer.

PURPOSE OF REVIEW: To explore the role of the specialist nurse within gynaecological cancer. RECENT FINDINGS: There are many different job titles associated with the role of the specialist nurse. Nursing roles are evolving not only to meet the increasing demands on services but also within the ever changing landscape of cancer treatments and improvement in survival. Women and their families need specialist nurses to guide and support them on their cancer journey, along the treatment trajectory and into survivorship. This paper explores specialist nurse roles generally, and within our service which have been adapted to meet service and patient needs within a gynaecological cancer centre. Irrelevant of title, specialist nurses are best suited to meet the patients' needs. The fundamental ethos of the care should always remain having the patients' best interest at heart, acting as their advocate - in essence giving them a voice when they need it.

Spatially explicit modeling of 1992-2100 land cover and forest stand age for the conterminous United States.

Information on future land-use and land-cover (LULC) change is needed to analyze the impact of LULC change on ecological processes. The U.S. Geological Survey has produced spatially explicit, thematically detailed LULC projections for the conterminous United States. Four qualitative and quantitative scenarios of LULC change were developed, with characteristics consistent with the Intergovernmental Panel on Climate Change (IPCC) Special Report on Emission Scenarios (SRES). The four quantified scenarios (A1B, A2, B1, and B2) served as input to the forecasting scenarios of land-use change (FORE-SCE) model. Four spatially explicit data sets consistent with scenario storylines were produced for the conterminous United States, with annual LULC maps from 1992 through 2100. The future projections are characterized by a loss of natural land covers in most scenarios, with corresponding expansion of anthropogenic land uses. Along with the loss of natural land covers, remaining natural land covers experience increased fragmentation under most scenarios, with only the B2 scenario remaining relatively stable in both the proportion of remaining natural land covers and basic fragmentation measures. Forest stand age was also modeled. By 2100, scenarios and ecoregions with heavy forest cutting had relatively lower mean stand ages compared to those with less forest cutting. Stand ages differed substantially between unprotected and protected forest lands, as well as between different forest classes. The modeled data were compared to the National Land Cover Database (NLCD) and other data sources to assess model characteristics. The consistent, spatially explicit, and thematically detailed LULC projections and the associated forest stand-age data layers have been used to analyze LULC impacts on carbon and greenhouse gas fluxes, biodiversity, climate and weather variability, hydrologic change, and other ecological processes.

Increased exposure to community-based education and 'below the line' social marketing results in increased fruit and vegetable consumption.

OBJECTIVE: To determine if localised programmes that are successful in engaging the community can add value to larger fruit and vegetable mass-media campaigns by evaluating the results of the Eat It To Beat It programme. DESIGN: The Eat It To Beat It programme is a multi-strategy intervention that uses community-based education and 'below the line' social marketing to increase fruit and vegetable consumption in parents. This programme was evaluated by a controlled before-and-after study with repeat cross-sectional data collected via computer-assisted telephone interviews with 1403 parents before the intervention (2008) and 1401 following intervention delivery (2011). SETTING: The intervention area was the Hunter region and the control area was the New England region of New South Wales, Australia. SUBJECTS: Parents of primary school-aged children (Kindergarten to Year 6). RESULTS: The programme achieved improvements in knowledge of recommended intakes for fruit and vegetables and some positive changes in knowledge of serving size for vegetables. Exposure to the programme resulted in a net increase of 0.5 servings of fruit and vegetables daily for those who recalled the programme compared with those who did not (P = 0.004). Increased intake of fruit and vegetables was significantly associated with increasing exposure to programme strategies. CONCLUSIONS: The Eat It To Beat It programme demonstrates that an increase in consumption of fruit and vegetables can be achieved by programmes that build on the successes of larger mass-media and social-marketing campaigns.This suggests that funding for localised, community-based programmes should be increased.

The efficacy of a brief, peer-led nutrition education intervention in increasing fruit and vegetable consumption: a wait-list, community-based randomised controlled trial.

OBJECTIVE: The objective of the present research was to test the efficacy of Fruit & Veg $ense sessions in increasing fruit and vegetable consumption. DESIGN: A wait-list randomised controlled trial was conducted (n 292). Intervention participants attended a Fruit & Veg $ense session and received newsletters at weeks 2 and 5 after attending the session. All participants completed an FFQ and a questionnaire measuring knowledge, attitudes, barriers and stage of change for fruit and vegetable consumption at baseline and 6 weeks. SETTING: Hunter region of New South Wales, Australia. SUBJECTS: Two hundred and ninety-two parents with children of primary school age. RESULTS: The intervention group significantly increased its mean consumption of fruit and vegetables by 0·62 servings compared with 0·11 in the control group (difference of 0·51, P = 0·001). Compared with the control group, there were significant increases in intervention participants' knowledge of daily recommended servings (for fruit and vegetables) and serving size (for vegetables), improvement in stage of change for vegetable consumption and a decrease in the number of perceived barriers to fruit and vegetable consumption. CONCLUSIONS: Fruit & Veg $ense is efficacious in increasing fruit and vegetable consumption among parents of primary-school children. The study adds significantly to the limited evidence regarding fruit and vegetable interventions and the feasibility of engaging peer educators to deliver community education sessions. A broader implementation trial to test the effectiveness of Fruit & Veg $ense is recommended.

Estimation of late twentieth century land-cover change in California.

We present the first comprehensive multi-temporal analysis of land-cover change for California across its major ecological regions and primary land-cover types. Recently completed satellite-based estimates of land-cover and land-use change information for large portions of the United States allow for consistent measurement and comparison across heterogeneous landscapes. Landsat data were employed within a pure-panel stratified one-stage cluster sample to estimate and characterize land-cover change for 1973-2000. Results indicate anthropogenic and natural disturbances, such as forest cutting and fire, were the dominant changes, followed by large fluctuations between agriculture and rangelands. Contrary to common perception, agriculture remained relatively stable over the 27-year period with an estimated loss of 1.0% of agricultural land. The largest net declines occurred in the grasslands/shrubs class at 5,131 km2 and forest class at 4,722 km2. Developed lands increased by 37.6%, composing an estimated 4.2% of the state's land cover by 2000.

Hemodialysis graft with blind loop inflow segment treated with stent placement.

We report a case of occlusion of a graft related to residual thrombus collection at the inflow in a blind pouch formed by conversion of a previous brachial cephalic fistula to a graft. The thrombus was unable to be dislodged by conventional methods with the use of a Fogarty balloon and maceration of thrombus with angioplasty. A covered stent was placed at the inflow segment over this thrombus in order to restore the flow through the graft. Angiographic evidence for this case is also reported.

Mediterranean California's water use future under multiple scenarios of developed and agricultural land use change.

With growing demand and highly variable inter-annual water supplies, California's water use future is fraught with uncertainty. Climate change projections, anticipated population growth, and continued agricultural intensification, will likely stress existing water supplies in coming decades. Using a state-and-transition simulation modeling approach, we examine a broad suite of spatially explicit future land use scenarios and their associated county-level water use demand out to 2062. We examined a range of potential water demand futures sampled from a 20-year record of historical (1992-2012) data to develop a suite of potential future land change scenarios, including low/high change scenarios for urbanization and agriculture as well as "lowest of the low" and "highest of the high" anthropogenic use. Future water demand decreased 8.3 billion cubic meters (Bm3) in the lowest of the low scenario and decreased 0.8 Bm3 in the low agriculture scenario. The greatest increased water demand was projected for the highest of the high land use scenario (+9.4 Bm3), high agricultural expansion (+4.6 Bm3), and high urbanization (+2.1 Bm3) scenarios. Overall, these scenarios show agricultural land use decisions will likely drive future demand more than increasing municipal and industrial uses, yet improved efficiencies across all sectors could lead to potential water use savings. Results provide water managers with information on diverging land use and water use futures, based on historical, observed land change trends and water use histories.

Estimating carbon sequestration in the piedmont ecoregion of the United States from 1971 to 2010.

BACKGROUND: Human activities have diverse and profound impacts on ecosystem carbon cycles. The Piedmont ecoregion in the eastern United States has undergone significant land use and land cover change in the past few decades. The purpose of this study was to use newly available land use and land cover change data to quantify carbon changes within the ecoregion. Land use and land cover change data (60-m spatial resolution) derived from sequential remotely sensed Landsat imagery were used to generate 960-m resolution land cover change maps for the Piedmont ecoregion. These maps were used in the Integrated Biosphere Simulator (IBIS) to simulate ecosystem carbon stock and flux changes from 1971 to 2010. RESULTS: Results show that land use change, especially urbanization and forest harvest had significant impacts on carbon sources and sinks. From 1971 to 2010, forest ecosystems sequestered 0.25 Mg C ha-1 yr-1, while agricultural ecosystems sequestered 0.03 Mg C ha-1 yr-1. The total ecosystem C stock increased from 2271 Tg C in 1971 to 2402 Tg C in 2010, with an annual average increase of 3.3 Tg C yr-1. CONCLUSIONS: Terrestrial lands in the Piedmont ecoregion were estimated to be weak net carbon sink during the study period. The major factors contributing to the carbon sink were forest growth and afforestation; the major factors contributing to terrestrial emissions were human induced land cover change, especially urbanization and forest harvest. An additional amount of carbon continues to be stored in harvested wood products. If this pool were included the carbon sink would be stronger.

Obesity is associated with higher 4E-BP1 expression in endometrial cancer.

PURPOSE: Obesity is associated with risk and prognosis of endometrial cancer (EC), and the mammalian target of rapamycin complex 1 (mTORC1) pathway may play an instrumental role. We sought to explore the associations between cellular proliferation, Akt, and 4E binding protein-1 (4E-BP1) (a downstream target of mTORC1), in obese and nonobese women with and without EC. METHODS: Archival tissue-specimens from endometrial biopsies were grouped into two broad categories based on the observed disease behavior and similarities in tissue staining patterns: benign/hyperplasia (without cytologic atypia) (n=18) versus atypia (complex hyperplasia with cytologic atypia)/carcinoma (n=25). The characteristics of the study population, including height and weight to determine body mass index (BMI: kg/m2), were abstracted from medical records. Immunohistochemistry was used to assess the phosphorylated (p)Akt, p4E-BP1, and antigen Ki67. RESULTS: Cytoplasmic and nuclear pAkt were significantly associated with cytoplasmic p4E-BP1 (ρ=+0.48, ρ=+0.50) (P<0.05) and nuclear p4E-BP1 (ρ=+0.40, ρ=+0.44) (P<0.05); cytoplasmic and nuclear p4E-BP1 were significantly associated with Ki67 (ρ=+0.46, ρ=+0.59) (P<0.05). Compared with the benign/hyperplasia group, the women with atypia/carcinoma had significantly higher cytoplasmic and nuclear p4E-BP1 and Ki67. This staining pattern was similar in obese women; however, in nonobese women, neither cytoplasmic nor nuclear p4E-BP1staining differed between benign/hyperplasia versus atypia/carcinoma. CONCLUSION: The activation of 4E-BP1 was higher in the obese women with EC. Adiposity may be a key factor to consider in future studies investigating the role of 4E-BP1 as a biomarker and therapeutic target in EC.