Future Lyme disease risk in the south-eastern United States based on projected land cover.

Lyme disease is the most significant vector-borne disease in the United States, and its southward advance over several decades has been quantified. Previous research has examined the potential role of climate change on the disease's expansion, but no studies have considered the role of future land cover upon its distribution. This research examines Lyme disease risk in the south-eastern U.S. based on projected land cover developed under four Intergovernmental Panel on Climate Change Scenarios: A1B, A2, B1, and B2. Land cover types and edge indices significantly associated with Lyme disease in Virginia were incorporated into a spatial Poisson regression model to quantify potential land cover suitability for Lyme disease in the south-eastern U.S. under each scenario. Our results indicate an intensification of potential land cover suitability for Lyme disease under the A scenarios and a decrease of potential land cover suitability under the B scenarios. The decrease under the B scenarios is a critical result, indicating that Lyme disease risk can be decreased by making different land cover choices. Additionally, health officials can focus efforts in projected high incidence areas.

A mid-century ecological forecast with partitioned uncertainty predicts increases in loblolly pine forest productivity.

Ecological forecasting of forest productivity involves integrating observations into a process-based model and propagating the dominant components of uncertainty to generate probability distributions for future states and fluxes. Here, we develop a forecast for the biomass change in loblolly pine (Pinus taeda) forests of the southeastern United States and evaluate the relative contribution of different forms of uncertainty to the total forecast uncertainty. Specifically, we assimilated observations of carbon and flux stocks and fluxes from sites across the region, including global change experiments, into a forest ecosystem model to calibrate the parameter distributions and estimate the process uncertainty (i.e., model structure uncertainty revealed in the residuals of the calibration). Using this calibration, we forecasted the change in biomass within each 12-digit Hydrologic (H12) unit across the native range of loblolly pine between 2010 and 2055 under the Representative Concentration Pathway 8.5 scenario. Averaged across the region, productivity is predicted to increase by a mean of 31% between 2010 and 2055 with an average forecast 95% quantile interval of ±15 percentage units. The largest increases were predicted in cooler locations, corresponding to the largest projected changes in temperature. The forecasted mean change varied considerably among the H12 units (3-80% productivity increase), but only units in the warmest and driest extents of the loblolly pine range had forecast distributions with probabilities of a decline in productivity that exceeded 5%. By isolating the individual components of the forecast uncertainty, we found that ecosystem model process uncertainty made the largest individual contribution. Ecosystem model parameter and climate model uncertainty had similar contributions to the overall forecast uncertainty, but with differing spatial patterns across the study region. The probabilistic framework developed here could be modified to include additional sources of uncertainty, including changes due to fire, insects, and pests: processes that would result in lower productivity changes than forecasted here. Overall, this study presents an ecological forecast at the ecosystem management scale so that land managers can explicitly account for uncertainty in decision analysis. Furthermore, it highlights that future work should focus on quantifying, propagating, and reducing ecosystem model process uncertainty.

Use of self-monitoring tools in a clinic sample of adults with type 2 diabetes.

Self-monitoring is an effective strategy for chronic disease management; many readily available mobile applications allow tracking of diabetes-related health behaviors but their use has not yet been integrated into routine clinical care. How patients engage with these applications in the real world is not well understood. The specific aim of this study is to survey adults with type 2 diabetes (T2D) regarding self-monitoring behaviors, including mobile application use. In 2015, we surveyed an adult diabetes clinic population (n = 96) regarding self-monitoring behaviors: diet, physical activity, weight, and blood glucose. Self-monitoring with any method ranged from 20-90 %. About half of the participants owned smartphones; few had mobile applications. The most common app-tracked behavior was physical activity, then weight and diet. Despite numerous available mobile health-tracking applications, few T2D adults from our sample used them, though many reported self-monitoring with other methods.

A comparative study of two methods of large loop excision of the transformation zone.

OBJECTIVE: To determine whether the conventional large loop excision of the transformation zone (CLLETZ) and the "top-hat" technique (THLLETZ) differ in (a) completeness of excision of the cervical lesion, (b) depth of cervical tissue excised and (c) adequacy of follow up by cytology and colposcopy. DESIGN: Retrospective case review. SETTING: University Teaching Hospital, London. SAMPLE: Five hundred and thirteen consecutive patients matched for age, parity, smoking history and referral cytology who had either CLLETZ (286-5%) or THLLETZ (227-44%) for cervical intraepithelial neoplasia (CIN). METHODS: All procedures were performed or supervised by BSCCP-accredited colposcopists. All cytology and histology were reviewed by two specialist cytohistopathologists. Cervical stenosis was defined as difficulty in or inability in obtaining an endocervical brush smear. MAIN OUTCOME MEASURES: Depth of cervical tissue excised, histology of endocervical margins, post-LLETZ cytologic and colposcopic findings. RESULTS: The mean depth of excision in the CLLETZ group was 12.1 mm (SD = 4.4 mm) and 20.8 mm (SD = 6.4 mm) in the THLLETZ group. The incidence of involved endocervical margins was 2.8% in the CLLETZ group and 5.2% in the THLLETZ group (P= 0.1). There was CIN in the "top-hat specimen" of 10 THLLETZ cases (4.4%, CI = 95%). The first post-treatment cervical smear was inadequate in 5 (4.1%) cases in the CLLETZ group and 20 (11.7%) in the THLLETZ group (P= 0.022). Cervical stenosis was found in 21 (7.7%) cases in the CLLETZ group and in 64 (30.9%) cases in the THLLETZ group (P < 0.0001). Eleven (4%) patients in the CLLETZ group had cytological and/or colposcopic evidence of residual CIN compared with 12(5.8%) patients in THLLETZ group (P= 0.4). In the first follow-up assessment, 21.7% of the CLLETZ group had incomplete colposcopy compared with 48.7% in the THLLETZ group (P < 0.0001). CONCLUSIONS: Compared with the CLLETZ, the THLLETZ (1) removed more cervical tissue but did not have a lower incidence of involved endocervical margins, and (2) resulted in significantly higher incidence of inadequate post-treatment colposcopic and cytological follow up. These data indicate that there is no justification to performing a "top-hat" LLETZ routinely.

Comparative genomic hybridization analysis of bilateral hyperplasia of usual type of the breast.

Hyperplasia of usual type (HUT) is part of the spectrum of benign proliferative disease in the breast and confers an increased risk of developing invasive cancer. Its role as a putative precursor of invasive ductal carcinomas in the breast is, however, controversial. HUT is occasionally seen bilaterally but it is not clear whether there is a genetic predisposition to the process. This study has analysed 14 cases of bilateral HUT in the breast (28 independent lesions) by comparative genomic hybridization (CGH) analysis to define DNA copy number changes and to investigate any commonality in these genetic alterations. The mean number of alterations seen was 1.6 (46/28) in all lesions, with common losses at chromosomes 1p, 16p, 17q, and 22q. Bilaterally, only five alterations were seen in common across both lesions in both breasts, but no single locus was altered preferentially. These data indicate that a proportion of HUT in the breast are indeed clonal, neoplastic proliferations which exhibit genetic alterations in common with invasive breast cancer, albeit at very low levels. The limited data from these experiments do not reveal a specific predisposition locus.