Real-world evidence: Patient views on asthma in respiratory specialist clinics in America.

BACKGROUND: Approximately 30% to 50% of patients with moderate/severe asthma have inadequately controlled disease despite adherence to inhaled corticosteroid (ICS)/long-acting ß2-agonist (LABA) therapy. Data on prevalence and burden of uncontrolled asthma in specialty settings are lacking. OBJECTIVE: To evaluate the prevalence and burden of uncontrolled asthma in respiratory specialist clinics in the United States. METHODS: Adults with physician-diagnosed asthma attending pulmonary and allergy clinics with self-reported ICS use in the previous 4 weeks completed an electronic questionnaire including the Asthma Control Test and St George's Respiratory Questionnaire. Additional information was collected using an electronic case report form. RESULTS: Of 774 patients attending 12 pulmonary and 12 allergy clinics, 53% were not well controlled (mean [SD] Asthma Control Test, 14.3 [3.6] vs 22.4 [1.6] in well-controlled patients). Among ICS/LABA users, 56% were not well controlled, which increased with increasing ICS dose (low-dose 45.7%; high-dose 59.7%). The not well-controlled group reported more respiratory illnesses, more comorbidities, and poorer health-related quality of life (mean [SD] St George's Respiratory Questionnaire, 46.1 [18.9] vs 19.8 [12.9] in the well-controlled group). These patients also had more asthma exacerbations (≥1 exacerbation, 68.9% vs 43.1%) and increased health care resource utilization (≥1 asthma-related hospitalization, 10.7% vs 2.7%); 27.3% were also receiving systemic corticosteroids. Approximately 40% of the population were eligible for step-up to ICS/LABA/long-acting muscarinic antagonist triple therapy, and 20% were eligible for biologic therapy. CONCLUSION: Substantial unmet needs exist among patients with inadequately controlled asthma managed in United States specialist settings, which may be addressed by improved patient and physician education, better guideline implementation, and improved adherence.

Disentangling monitoring programs: design, analysis, and application considerations.

Monitoring programs are an essential tool for assessing and informing conservation efforts but the methods used to gather monitoring data directly influence results. This presents a challenge to conservation professionals when deciding on existing data to inform a given question. We illustrate the challenges of using monitoring data by comparing population trends from two large-scale avian monitoring programs in the western United States: the Breeding Bird Survey and Integrated Monitoring in Bird Conservation Regions programs. We used publicly available data to compare trend trajectory between 2008 and 2015 for 148 species across Colorado, Montana, and Wyoming. Trends were inconsistent for 62% of the comparisons, with species having opposite trends in 21 cases. The inconsistencies found within our species comparisons reflect the inherent differences between program sampling design and analytical approach. Periodically revisiting how and why we monitor natural resources is necessary to advance conservation and management as the lessons learned from long-standing programs guide the development of more recent efforts. Our results emphasize that prior to management actions and policy decisions, managers must be aware of both the sampling design and appropriate ecological inference of any monitoring program.

A statistically rigorous sampling design to integrate avian monitoring and management within Bird Conservation Regions.

Monitoring is an essential component of wildlife management and conservation. However, the usefulness of monitoring data is often undermined by the lack of 1) coordination across organizations and regions, 2) meaningful management and conservation objectives, and 3) rigorous sampling designs. Although many improvements to avian monitoring have been discussed, the recommendations have been slow to emerge in large-scale programs. We introduce the Integrated Monitoring in Bird Conservation Regions (IMBCR) program designed to overcome the above limitations. Our objectives are to outline the development of a statistically defensible sampling design to increase the value of large-scale monitoring data and provide example applications to demonstrate the ability of the design to meet multiple conservation and management objectives. We outline the sampling process for the IMBCR program with a focus on the Badlands and Prairies Bird Conservation Region (BCR 17). We provide two examples for the Brewer's sparrow (Spizella breweri) in BCR 17 demonstrating the ability of the design to 1) determine hierarchical population responses to landscape change and 2) estimate hierarchical habitat relationships to predict the response of the Brewer's sparrow to conservation efforts at multiple spatial scales. The collaboration across organizations and regions provided economy of scale by leveraging a common data platform over large spatial scales to promote the efficient use of monitoring resources. We designed the IMBCR program to address the information needs and core conservation and management objectives of the participating partner organizations. Although it has been argued that probabilistic sampling designs are not practical for large-scale monitoring, the IMBCR program provides a precedent for implementing a statistically defensible sampling design from local to bioregional scales. We demonstrate that integrating conservation and management objectives with rigorous statistical design and analyses ensures reliable knowledge about bird populations that is relevant and integral to bird conservation at multiple scales.

A large-scale perspective for managing prairie avifauna assemblages across the western US: influences of habitat, land ownership and latitude.

Future demands for increased food production are expected to have severe impacts on prairie biodiversity and ecosystem integrity. Prairie avifauna of North America have experienced drastic population declines, prompting numerous conservation efforts, which have been informed primarily by small-scale studies. We applied a large-scale perspective that integrates scale dependency in avian responses by analyzing observations of 20 prairie bird species (17 grassland obligates and three sagebrush obligate species) from 2009-2012 in the western prairie region of the United States. We employed a multi-species model approach to examine the relationship of land ownership, habitat, and latitude to landscape-scale species richness. Our findings suggest that patterns and processes influencing avian assemblages at the focal-scale (e.g., inference at the sampling unit) may not function at the landscape-scale (e.g., inference amongst sampling units). Individual species responses to land ownership, habitat and latitude were highly variable. The broad spatial extent of our study demonstrates the need to include lands in private ownership to assess biodiversity and the importance of maintaining habitat diversity to support avian assemblages. Lastly, focal-scale information can document species presence within a study area, but landscape-scale information provides an essential complement to inform conservation actions and policies by placing local biodiversity in the context of an entire region, landscape or ecosystem.

Social cues facilitate habitat selection: American redstarts establish breeding territories in response to song.

For migratory songbirds nesting in northern temperate forests, a short breeding season demands that males rapidly establish territories. Because critical insect and vegetation resources are unavailable during spring arrival, we suggest that conspecifics serve as settlement cues for males new to a local population. To test conspecific attraction, we conducted playback experiments with American redstarts Setophaga ruticilla. Experimental results demonstrate that song playbacks strongly attract conspecifics, recruiting an average of 4.2 additional males per plot; adult males new to our sites increased, while yearling males failed to respond. Yearlings arrived 6 to 10 days later than adults, raising the possibility that yearlings responded to songs of early arriving adults rather than to playbacks. Our work indicates that conspecific attraction is an important mechanism for breeding habitat selection in an established population of a migratory forest songbird, but the effect is moderated by age, reproductive experience and arrival timing.