Global mapping of ecosystem services and conservation priorities.

Global efforts to conserve biodiversity have the potential to deliver economic benefits to people (i.e., "ecosystem services"). However, regions for which conservation benefits both biodiversity and ecosystem services cannot be identified unless ecosystem services can be quantified and valued and their areas of production mapped. Here we review the theory, data, and analyses needed to produce such maps and find that data availability allows us to quantify imperfect global proxies for only four ecosystem services. Using this incomplete set as an illustration, we compare ecosystem service maps with the global distributions of conventional targets for biodiversity conservation. Our preliminary results show that regions selected to maximize biodiversity provide no more ecosystem services than regions chosen randomly. Furthermore, spatial concordance among different services, and between ecosystem services and established conservation priorities, varies widely. Despite this lack of general concordance, "win-win" areas-regions important for both ecosystem services and biodiversity-can be usefully identified, both among ecoregions and at finer scales within them. An ambitious interdisciplinary research effort is needed to move beyond these preliminary and illustrative analyses to fully assess synergies and trade-offs in conserving biodiversity and ecosystem services.

Mapping socio-economic scenarios of land cover change: a GIS method to enable ecosystem service modelling.

We present a GIS method to interpret qualitatively expressed socio-economic scenarios in quantitative map-based terms. (i) We built scenarios using local stakeholders and experts to define how major land cover classes may change under different sets of drivers; (ii) we formalized these as spatially explicit rules, for example agriculture can only occur on certain soil types; (iii) we created a future land cover map which can then be used to model ecosystem services. We illustrate this for carbon storage in the Eastern Arc Mountains of Tanzania using two scenarios: the first based on sustainable development, the second based on 'business as usual' with continued forest-woodland degradation and poor protection of existing forest reserves. Between 2000 and 2025 4% of carbon stocks were lost under the first scenario compared to a loss of 41% of carbon stocks under the second scenario. Quantifying the impacts of differing future scenarios using the method we document here will be important if payments for ecosystem services are to be used to change policy in order to maintain critical ecosystem services.

Evaluating the impacts of protected areas on human well-being across the developing world.

Protected areas (PAs) are fundamental for biodiversity conservation, yet their impacts on nearby residents are contested. We synthesized environmental and socioeconomic conditions of >87,000 children in >60,000 households situated either near or far from >600 PAs within 34 developing countries. We used quasi-experimental hierarchical regression to isolate the impact of living near a PA on several aspects of human well-being. Households near PAs with tourism also had higher wealth levels (by 17%) and a lower likelihood of poverty (by 16%) than similar households living far from PAs. Children under 5 years old living near multiple-use PAs with tourism also had higher height-for-age scores (by 10%) and were less likely to be stunted (by 13%) than similar children living far from PAs. For the largest and most comprehensive socioeconomic-environmental dataset yet assembled, we found no evidence of negative PA impacts and consistent statistical evidence to suggest PAs can positively affect human well-being.

Techniques for precise energy calibration of particle pixel detectors.

We demonstrate techniques to improve the accuracy of the energy calibration of Timepix pixel detectors, used for the measurement of energetic particles. The typical signal from such particles spreads among many pixels due to charge sharing effects. As a consequence, the deposited energy in each pixel cannot be reconstructed unless the detector is calibrated, limiting the usability of such signals for calibration. To avoid this shortcoming, we calibrate using low energy X-rays. However, charge sharing effects still occur, resulting in part of the energy being deposited in adjacent pixels and possibly lost. This systematic error in the calibration process results in an error of about 5% in the energy measurements of calibrated devices. We use FLUKA simulations to assess the magnitude of charge sharing effects, allowing a corrected energy calibration to be performed on several Timepix pixel detectors and resulting in substantial improvement in energy deposition measurements. Next, we address shortcomings in calibration associated with the huge range (from kiloelectron-volts to megaelectron-volts) of energy deposited per pixel which result in a nonlinear energy response over the full range. We introduce a new method to characterize the non-linear response of the Timepix detectors at high input energies. We demonstrate improvement using a broad range of particle types and energies, showing that the new method reduces the energy measurement errors, in some cases by more than 90%.

Evaluating organizational design to assure technology transfer: the case of the Community Clinical Oncology Program.

Current theories of organizational performance are used to guide researchers at the Health Services Research Center of the University of North Carolina at Chapel Hill and the University of Illinois Survey Research Laboratory in the evaluation of the National Cancer Institute's Community Clinical Oncology Program (CCOP) and to derive policy options to enhance program operations. CCOP represents an innovative mechanism designed to improve the accrual of patients to phase III clinical trials, involve community-based oncologists in clinical research, and potentially to disseminate new information on the state-of-the-art cancer treatment to areas distant from cancer centers and research-oriented medical centers. Examined in this evaluation of the second phase of the CCOP are the ability of the 52 currently funded CCOPs and 17 research bases to accrue patients to cancer treatment and cancer control research protocols, their influence on the patterns of practice for cancer treatment in CCOP communities, and their influence on cancer control awareness and activity among primary care physicians. The evaluation applies selected organizational perspectives to describe the intraorganizational and interorganizational characteristics of the CCOPs, research bases, and the Institute that may affect the performance of the CCOP. This organizational approach relates the accrual and influence of the CCOP to controllable aspects of the program's design and management strategies that can be changed through policies directed by the National Cancer Institute. These policies include the criteria used to select CCOPs, the role of research bases in the development and implementation of treatment and cancer control research protocols, and the use of accrual credits.

Addition of Cardiorespiratory Fitness Within an Obesity Risk Classification Model Identifies Men at Increased Risk of All-Cause Mortality.

OBJECTIVE: Guidelines for identification of obesity-related risk which stratify disease risk using specific combinations of body mass index and waist circumference. Whether the addition of cardiorespiratory fitness, an independent predictor of disease risk, provides better risk prediction of all-cause mortality within current body mass index and waist circumference categories is unknown. The study objective was to determine whether the addition of cardiorespiratory fitness improves prediction of all-cause mortality risk classified by the combination of body mass index and waist circumference. METHODS: We performed a prospective observational study using data from the Aerobics Center Longitudinal Study. A total of 31,267 men (mean age, 43.9 years; standard deviation, 9.4 years) who completed a baseline medical examination between 1974 and 2002 were included. The main outcome measure was all-cause mortality. Participants were grouped using body mass index- and waist circumference-specific threshold combinations: normal body mass index: 18.5 to 24.9 kg/m(2), waist circumference threshold of 90 cm; overweight body mass index: 25.0 to 29.9 kg/m(2), waist circumference threshold of 100 cm, and obese body mass index: 30.0 to 34.9 kg/m(2), waist circumference threshold of 110 cm. Participants were classified using cardiorespiratory fitness as unfit or fit, where unfit was the lowest fifth of the age-specified distribution of maximal exercise test time on the treadmill among the entire Aerobics Center Longitudinal Study population. RESULTS: A total of 1399 deaths occurred over a follow-up of 14.1 ± 7.4 years, for a total of 439,991 person-years of observation. Men who were unfit and had normal body mass index with waist circumference <90 cm and ≥90 cm had 95% (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.34-2.83) and 163% (HR, 2.63; 95% CI, 1.58-4.40) higher mortality risk than men who were fit, respectively (P <.05). Men who were unfit and overweight had 41% (HR, 1.41; 95% CI, 1.04-1.90) higher mortality risk with a waist circumference <100 cm (P <.05), but were at no greater risk (HR, 1.30; 95% CI, 0.92-1.84) if their waist circumference was ≥100 cm (P = .14). Men who were unfit and obese were not at increased mortality risk (HR, 1.37; 95% CI, 0.90-2.09) with a waist circumference <110 cm (P = .14), but were at 111% (HR, 2.11; 95% CI, 1.31-3.42) increased risk with a waist circumference ≥110 cm (P <.05). CONCLUSIONS: For most of the body mass index and waist circumference categories, inclusion of cardiorespiratory fitness allowed for improved identification of men at increased mortality risk.

Leukaemia Research Fund Data Collection Survey: descriptive epidemiology of chronic myeloid leukaemia.

This paper describes the recent epidemiology of chronic myeloid leukaemia occurring in selected parts of England and Wales. The overall rates for the pooled sexes is 1.0/10(5) per year and the geographical distributions described in this paper show remarkable homogeneity at county, district and electoral ward level. The implication of these observations is discussed.

The leukaemia research fund data collection survey: the incidence and geographical distribution of acute myeloid leukemia.

This paper reports on the 2,362 cases of acute myeloid leukemia (AML) accumulated by the Leukaemia Research Fund Data Collection Survey between January 1, 1984, and June 30, 1988 providing the recent geographical distribution and descriptive epidemiology of the AML group of conditions. Statistical approaches to this data set are described. The study shows sex differences in distribution for those aged under 55 years compared to older age groups, with variable male: female incidence in different age bands and a male excess in those over 55 years. A nonsignificant excess of females was noted in those under 5 years. The rates presented for 1984-1986 are higher than those previously described for England and Wales. Statistically significant variation in incidence was seen both between counties and districts. At electoral ward level regression analyses were suggestive of links between AML and higher social class and living close to estuaries.

The Leukaemia Research Fund Data Collection Study: descriptive epidemiology of acute lymphoblastic leukemia.

This paper reports on cases of acute lymphoblastic leukemia (ALL) recorded by a specialist registry of hematopoietic malignancies. The cases have been diagnosed since January 1, 1984, and originate from certain parts of the United Kingdom. The information is analyzed by age, sex, and area of residence at diagnosis. The age distribution shows a childhood peak but fails to show an adult peak previously reported in literature from abroad. At a broad geographic level the county of Cumbria is shown to display the highest rates of ALL in all ages both in the 3 years of formal analyses (1984-1986) and in the 2 recent years. The administrative districts of Copeland, Sedgemoor, and North Devon also show excesses in all ages with Copeland having the highest SRR and level of statistical significance. This is a new observation for Copeland, the district containing the Sellafield nuclear reprocessing facility in that the high rates are for all ages of ALL. These new data were not considered in earlier official reports about that area. A regression analysis at electoral ward level shows no statistically significant association but excesses of cases, which are mirrored in a larger "all leukemias" data set, occur in wards near estuaries (a new observation) and in the upper socioeconomic groups.

Calpain inhibition mediates autophagy-dependent protection against polyglutamine toxicity.

Over recent years, accumulated evidence suggests that autophagy induction is protective in animal models of a number of neurodegenerative diseases. Intense research in the field has elucidated different pathways through which autophagy can be upregulated and it is important to establish how modulation of these pathways impacts upon disease progression in vivo and therefore which, if any, may have further therapeutic relevance. In addition, it is important to understand how alterations in these target pathways may affect normal physiology when constitutively modulated over a long time period, as would be required for treatment of neurodegenerative diseases. Here we evaluate the potential protective effect of downregulation of calpains. We demonstrate, in Drosophila, that calpain knockdown protects against the aggregation and toxicity of proteins, like mutant huntingtin, in an autophagy-dependent fashion. Furthermore, we demonstrate that, overexpression of the calpain inhibitor, calpastatin, increases autophagosome levels and is protective in a mouse model of Huntington's disease, improving motor signs and delaying the onset of tremors. Importantly, long-term inhibition of calpains did not result in any overt deleterious phenotypes in mice. Thus, calpain inhibition, or activation of autophagy pathways downstream of calpains, may be suitable therapeutic targets for diseases like Huntington's disease.

The matrix matters: effective isolation in fragmented landscapes.

Traditional approaches to the study of fragmented landscapes invoke an island-ocean model and assume that the nonhabitat matrix surrounding remnant patches is uniform. Patch isolation, a crucial parameter to the predictions of island biogeography and metapopulation theories, is measured by distance alone. To test whether the type of interpatch matrix can contribute significantly to patch isolation, I conducted a mark-recapture study on a butterfly community inhabiting meadows in a naturally patchy landscape. I used maximum likelihood to estimate the relative resistances of the two major matrix types (willow thicket and conifer forest) to butterfly movement between meadow patches. For four of the six butterfly taxa (subfamilies or tribes) studied, conifer was 3-12 times more resistant than willow. For the two remaining taxa (the most vagile and least vagile in the community), resistance estimates for willow and conifer were not significantly different, indicating that responses to matrix differ even among closely related species. These results suggest that the surrounding matrix can significantly influence the "effective isolation" of habitat patches, rendering them more or less isolated than simple distance or classic models would indicate. Modification of the matrix may provide opportunities for reducing patch isolation and thus the extinction risk of populations in fragmented landscapes.

Community lifestyle characteristics and lymphoid malignancies in young people in the UK.

Data from a specialist registry of haematopoietic malignancies in England and Wales (1984-1988) have been analysed to investigate variations of incidence by age and diagnostic subtype of lymphoid malignancies in young people (aged 0-24 years). Attention has been focussed on the role of community lifestyle indicators for small areas, derived from routine sources, in an ecological analysis. The predominant conditions were acute lymphoblastic leukaemia (ALL)--42.4%, and Hodgkin's disease (HD)--37.5%. Lowest overall incidence at approximately 8 years of age corresponded to the termination of the childhood peak for ALL. Opposite trends of incidence rates with distance from urban centres (urban distance) were observed for the two age groups: odds ratios (OR) for areas greater than 20 km from towns and cities were 1.46 (95% confidence interval 1.01-2.12) for ages 0-7 and 0.75 (95% confidence interval 0.56-0.99) for ages 8-24. For the younger group this was entirely attributable to ALL. HD, which was dominant in the older group, had highest incidence in connurbations but the gradient of risk for older onset ALL followed the overall pattern for this age group. A positive relationship with socioeconomic status was evident for both age groups but this was considerably stronger for the older cases (OR = 1.16, 95% confidence interval 1.01-1.33) than for the younger for whom it was not independent of urban distance. These results display an association between expression of lymphoid malignancies in young people and urban distance which is not attributable to socioeconomic status; for urban distances the distribution is shifted towards ALL and towards younger age at onset.

Epidemiological evidence for the 'two-disease hypothesis' in Hodgkin's disease.

This study relates to 1803 newly diagnosed cases of Hodgkin's Disease (HD) registered between 1984 and 1988 by a specialist leukaemia-lymphoma registry covering approximately half of England and Wales. In addition to registration data the analyses use routine census data. Rye classification is available for the majority of cases with only 7% being unclassified. The data confirm that the young adult peak in HD occurrence is attributable to the nodular sclerosing subtype (NS), and there is some evidence that NS has a different geographical distribution by county to the other Rye subtypes. Because of possible geographical biases in the classification, subsequent spatial analyses are disaggregated by age at diagnosis with particular emphasis being placed on the two age groups 0-34 and 50-79 years. For these, trends of risk by areal socioeconomic status are in opposite directions and the effects of urban-rural status while in the same direction also differ significantly. Allowance for these does not, however, explain the significant difference between the county distributions of the two groups. Patterns of spatial clustering are quite distinct with evidence for local spatial aggregation amongst younger cases.

Investigation of spacial clustering of rare diseases: childhood malignancies in North Humberside.

STUDY OBJECTIVE: The aims of the study were (1) to test for uniformity of distribution of childhood leukaemias and other malignancies; and (2) to consider the aetiological implications of unusual distributions. DESIGN: A test for spacial clustering was applied using a method which allows for unequal distribution of the population at risk and avoids using census data to provide population denominators. When clustering was identified, four possible aetiological links which had already been suggested to the Leukaemia Research Fund Centre were examined in a local area. SETTING: The study was carried out in the Yorkshire Health Region in the north of England. PATIENTS: 144 children under 15 years of age with a diagnosis of malignant disease known to the Yorkshire Regional Childhood Tumour Registry between 1974 and 1986 were included in the analysis. Of these 53 had leukaemias and nine had lymphomas. MEASUREMENTS AND RESULTS: Significant localised clustering was found in North Humberside, though not in the whole of the Yorkshire Health Region. A number of clustered cases were identified, some of whom were in a post code sector, Hull 10, to the west of Kingston-upon-Hull, about which concern had been expressed since 1985. There was however no evidence that disease clustering was confined to this area. Four previously suggested hypotheses about causation in this particular area were examined but the results were negative or inconclusive. CONCLUSIONS: The identification of spacial clustering must be seen as only the first step in a series of investigations; it can only rarely lead to aetiological conclusions by itself, but it can motivate and target other investigations.

Competitive behavior in local physician markets.

Competition often is viewed as a mechanism for controlling cost. Competition may work well in urban areas with many providers; competition may not exist in rural areas with few providers. The authors use the empirical framework developed by Bresnahan and Reiss to analyze the entry behavior of physicians into local markets to determine the level of physician supply consistent with competitive behavior. The study estimates entry patterns for total and specialty physicians located in nonmetropolitan health service areas using longitudinal data. The authors find a surprising drop in the population increments necessary for entry by the second provider, possibly due to the unattractiveness of being the solo physician in an area. Subsequent population increments stabilize at three to five physicians. Since more than 93 percent of the U.S. population lives in areas that can support three to five physicians, competition between physicians through mechanisms such as managed care may be feasible.

Primary health care in rural areas: an agenda for research.

The confluence of forces slowing the growth of the physician supply despite a continued shortage of primary care physicians, the encouragement of competitive medical practices that centralize resources in larger places, and the changing of the rural population's character to one of more dependence on medical care may bring on another "rural health crisis" in the decade ahead.

The hospital and medical practice: a study of physician staff appointments among specialists and generalists.

The names, specialties, and appointment status of physicians with privileges in 161 North Carolina hospitals were obtained and compared to the file of licensed, active, patient-care physicians practicing in the State for the year 1978. The listings were examined to determine the number of physicians without a hospital privilege by age, race, sex, specialty, and geographic location. Overall, only 11 percent of all active physicians did not have some form of hospital appointment. Among family and general practitioners, 29 percent had either a restricted hospital privilege or no hospital appointment at all. A greater number of nonwhite and female physicians were also without privileges. These data have implications for the training of physicians in a system that emphasizes hospital care and includes inpatient treatment within the purview of primary care.

Medical education and the retention of rural physicians.

OBJECTIVE: This study inquires whether retention in rural practice settings is longer for graduates of public medical schools and community hospital-based residencies, and for those who participated in rural rotations as medical students and residents. These questions are addressed separately for "mainstream" rural physicians and physicians serving in the National Health Service Corps (NHSC). DESIGN: Design is a prospective cohort study. PARTICIPANTS: Study subjects were 202 primary care physicians who graduated from U.S. allopathic medical schools from 1970-1980, and who in 1981 were working in a nationally representative sample of externally subsidized rural practices. Nearly half were serving in the NHSC. Physicians were first identified in 1981 as part of an earlier study. INTERVENTION: In 1990, study subjects were re-located and sent a follow-up mail survey inquiring about their medical training backgrounds and their careers from the time of graduation until 1990. We examined associations between four features of physicians' medical training and their subsequent retention in rural practice settings. RESULTS: Among those not in the NHSC, rural retention duration did not differ for those from public versus private medical schools, those who trained in community hospitals versus university hospital-based residencies, or for those who completed versus did not complete rural rotations as students or residents. Among NHSC physicians, no retention duration differences were noted for those with rural experiences as students or residents, or for those trained in community hospital residencies. Contrary to common wisdom, public school graduates in the NHSC remained in rural areas for shorter periods than private school graduates. CONCLUSIONS: These findings call into question whether current rural-focused medical education initiatives prepare rural physicians in ways able to influence their retention in rural settings. For purposes of enhancing the rural practice retention of its alumni, the NHSC should not selectively award scholarships to students from public medical schools.

Patterns of health maintenance organization service areas in rural counties.

This study analyzes the 1993 National Directory of HMOs to determine the extent to which rural counties are included in health maintenance organization (HMO) service areas. Two specific questions are addressed: (1) How do the patterns of service areas differ across HMO model types? (2) What are the characteristics that distinguish rural counties served by HMOs from those that are not? Although a majority of rural counties are in HMO service areas, substantially fewer are served by non-individual practice association (non-IPA) models. Access to HMO services is found to decrease with county population density, and adjacency to metropolitan areas is an important predictor of inclusion in service areas.