Need For Long-term Assessment Research Articles

First description of a Gammaherpesvirus in a common dolphin (Delphinus delphis) from the Eastern Mediterranean Sea.

In September 2020, a male common dolphin (Delphinus delphis) was found dead on a beach near Bat-Yam, Israel. A small, raised, well circumscribed penile lesion (i.e., mass) was identified and removed for histology and molecular characterizations. By histology, the penile mass presented focal keratinization of the squamous epithelium and a mild ballooning of acanthocytes in lower epithelium levels, as well as features compatible with viral plaques, and tested positive for a gammaherpesvirus through molecular characterization analyses. Tissue samples from the lungs, liver, and spleen, however, tested negative for herpesvirus infection. The gammaherpesvirus detected herein is similar to other isolates found in several areas worldwide in different cetacean species. This is the first reported case of gammaherpesvirus infection in dolphins from the eastern Mediterranean Sea, indicative of the need for long-term assessments to create viral infections databases in cetaceans, especially in a climate change context, which is likely to intensify infectious disease outbreaks in marine mammals in the future.

Physiological plasticity in elephants: highly dynamic glucocorticoids in African and Asian elephants

Abstract Slowly reproducing and long-lived terrestrial mammals are often more at risk from challenges that influence fitness and survival. It is, therefore, important to understand how animals cope with such challenges and how coping mechanisms translate over generations and affect phenotypic plasticity. Rapidly escalating anthropogenic challenges may further diminish an animal’s ability to reinstate homeostasis. Research to advance insights on elephant stress physiology has predominantly focused on relative or comparative analyses of a major stress response marker, glucocorticoids (GCs), across different ecological, anthropogenic, and reproductive contexts. This paper presents an extensive review of published findings on Asian and African elephants from 1980 to 2023 (May) and reveals that stress responses, as measured by alterations in GCs in different sample matrices, often are highly dynamic and vary within and across individuals exposed to similar stimuli, and not always in a predictable fashion. Such dynamicity in physiological reactivity may be mediated by individual differences in personality traits or coping styles, ecological conditions, and technical factors that often are not considered in study designs. We describe probable causations under the ‘Physiological Dynamicity Model’, which considers context–experience–individuality effects. Highly variable adrenal responses may affect physiological plasticity with potential fitness and survival consequences. This review also addresses the significance of cautious interpretations of GCs data in the context of normal adaptive stress versus distress. We emphasize the need for long-term assessments of GCs that incorporate multiple markers of ‘stress’ and ‘well-being’ to decipher the probable fitness consequences of highly dynamic physiological adrenal responses in elephants. Ultimately, we propose that assessing GC responses to current and future challenges is one of the most valuable and informative conservation tools we have for guiding conservation strategies.

Persistence of Enrollment Among Commercial Enrollee Populations with Rare Hematologic Diseases: Implications for Long-Term Outcome Assessment and Value-Based Agreements

Background: Innovative therapies, including gene therapies for incurable hematologic conditions, have highlighted the need for long-term assessment of outcomes. Administrative claims are an important source for observing patients over time, but enrollment "churn" across health plans can limit the length of meaningful follow-up analysis. This analysis examined a large, United States (US) dataset with complete enrollment data for health plan members in order to assess continuous enrollment (CE) among commercial populations with and without rare hematologic diseases. Methods: From January 1, 2016 to December 31, 2021 (identification period), a matched-cohort analysis was used to compare enrollment data for commercial members using the Optum Research Database. Members were grouped into the following disease cohorts based on diagnosis codes on non-diagnostic medical claims and/or treatment during the identification period: sickle cell anemia (SCA), beta thalassemia (beta-thal), and hemophilia (HA or HB). SCA was defined using ≥2 claims, on different dates, with an SCA diagnosis code. Beta-thal was defined using ≥1 claim with a beta-thal diagnosis code and ≥2 claims, on different dates, for blood transfusion or luspatercept. Hemophilia was defined using ≥1 claim with a HA/HB diagnosis code and ≥2 claims, on different dates, for on-demand or prophylaxis treatment specific to HA/HB (factor VIII and IX concentrates and emicizumab-kxwh). Members without these rare diseases were eligible for the control cohort if they had at least 1 medical claim during the identification period. The date of the first identifying claim defined the index date. Persistence of CE (medical and pharmacy) was measured in months (30-days), from the index date to the earlier of the disenrollment date or end of data. Rare disease and control cohorts were matched 1:3 without replacement on age, gender, index year, geographic region, fully-insured/administrative services only coverage, and subscriber/dependent status. Member characteristics were descriptively summarized overall, and results were stratified by cohort, index year, and age group (at index). Results: Overall, among ~25.7 million members, 3,459 were identified with a rare hematologic disease of interest (Table 1). Per rare disease cohort, 2,168 with SCA, 422 with beta-thal, and 869 with HA/HB were identified; the average age (standard deviation, SD) was 29.0 (15.1), 36.8 (20.7), and 24.5 (16.0) years in each cohort, respectively. The average (standard deviation [SD]) CE length in months among those with rare disease compared with respective controls was shorter in SCA (19.2 [17.8] vs. 20.4 [18.4]), longer in beta-thal (22.5 [18.1] vs. 20.6 [18.1]), and longer in HA/HB (23.7 [19.4] vs. 21.0 [19.2]) (Table 2). This pattern was consistent across all index years stratifications and among pediatric patients and adults <45 years old. Conclusions/Implications: Continuous enrollment time was overall shorter among members with SCA compared with their controls but longer for those with beta-thal and hemophilia compared with their controls. Even among those with the earliest index year (thus maximum possible follow-up time of ~72 months), average persistence of enrollment ranged from 25-31 months across disease cohorts and their controls. Notably, these findings reflect average enrollment for commercial members, in the setting of no minimum enrollment requirements. By contrast, claims-based research often requires a minimum duration of CE for a particular study population, which often increases the average CE observed. CE varied not only from matched controls, but also across SCA, beta-thal, and HA/HB cohorts, supporting the need to specifically evaluate enrollment in eligible treatment populations. Value-based agreements traditionally have involved commercial populations and have contracted on short-term (6-12 month) outcomes. Providers, payers, and manufactures will need to assess current data assets, available follow-up, and innovative data-sharing solutions that allow for patient portability (e.g., multi-payer platforms) to measure long-term outcomes. These methodological considerations will provide the foundation for aligning risk-sharing interests so that patients may access and benefit from these innovative therapies. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Diabetes Self-Management Education and Support to Improve Outcomes for Children and Young Adults With Type 1 Diabetes: An Umbrella Review of Systematic Reviews.

The objectives of this umbrella review were to describe various aspects of diabetes self-management education and support (DSMES)-related interventions and their effect on clinical, behavioral, and psychosocial outcomes among children and young adults with type 1 diabetes (T1DM) and identify gaps in current DSMES-related research. An umbrella review of systematic reviews on DSMES interventions was conducted in accordance with the PRISMA 2009 statement. Four international medical databases were searched for eligible review articles published in English in the last 10 years that dealt with children and youths with T1DM and were conducted in accordance with a priori protocol. Out of the 234 citations screened, only 8 systematic reviews representing 166 studies were considered eligible for further analysis. Glycemic management (A1C) is the most common outcome variable (108 studies). Common behavioral and psychosocial outcome variables examined are episodes of hypoglycemia (27 studies) and diabetic ketoacidosis (21 studies) and self-care behavior and generic quality of life (20 studies each). Several gaps in DSMES-related research studies are identified, including uneven geographical distribution of study population, methodological weaknesses in study designs, missing important outcome variables, use of nonstandardized assessment tools, and lack of assessment of the sustainability of effects. The effects of DSMES interventions on clinical, behavioral, and psychosocial outcomes are varied. The heterogeneity of implementation and evaluation makes it difficult to draw clear conclusions about elements of DSMES that are most effective. There is a need for long-term assessment of the psychosocial and behavioral outcomes using validated and generalizable instruments.

Short-term lab assessments and microcolonies are insufficient for the risk assessment of insecticides for bees

Risk assessment studies addressing effects of agrochemicals on bumblebees frequently use microcolonies. These are queenless colonies consisting of workers only in which typically one worker will lay unfertilized male-destined eggs. In the first tier of risk assessment for bees, short-term laboratory experiments (e.g. microcolonies) are used, the results of which will determine whether higher tier (semi-)field experiments are needed. To evaluate the suitability of microcolonies for risk assessment, a direct comparison between different assessment methods for the neonicotinoid pesticides acetamiprid and thiacloprid was made: microcolonies and queenright colonies under short-term laboratory conditions, queenright colonies under long-term laboratory conditions, and queenright colonies under field conditions. Here, we demonstrate that results from microcolonies contradict results from queenright colonies. While thiacloprid negatively impacted gyne production in queenright colonies, it had a positive effect on microcolony size. By contrast, thiacloprid had no significant effect on fitness parameters of queenright colonies under short-term laboratory conditions when mostly workers are produced. These results thus highlight both the need for long term assessments, allowing evaluation of gyne production, and the risk of reaching erroneous conclusions when using microcolonies. The negative effect of thiacloprid on colony fitness was confirmed under field conditions, where thiacloprid affected the production of reproductives, colony weight gain, worker weight, and foraging behaviour. For acetamiprid, a negative trend on colony fitness could only be shown in a field setup. Therefore, field-realistic setups, which allow colonies to forage freely, are most appropriate to assess sublethal effects of pesticides affecting behaviour and learning.

A hazardous place to live: spatial and temporal patterns of species introduction in a hot spot of biological invasions

Globally, the spread of non-indigenous species in marine ecosystems is a major ecological and socio-economical concern. The need for long-term assessment on a large scale is a pre-requisite for understanding the drivers associated with their establishment and expansion. Here, the patterns of invasions of subtidal soft-bottom assemblages of shelled molluscs have been quantified based on a unique dataset collected between 2005 and 2012 along the coast of Israel (SE Mediterranean Sea), a hotspot of bioinvasion. Overall, the number of non-indigenous species doubled between 2005 and 2012. Significant differences in terms of species richness and relative abundance were observed in space and time in both native and non-indigenous species. A combination of enduring disturbance regimes related to human activities and site-specific environmental conditions seem to have a critical role in promoting the observed patterns. Our results emphasize the value of long term broad-scale systematic surveys to the development of effective environmental policies for the control of bioinvasions.

The Relationship Between Traumatic Injury in Children and Long-Term Use of Health and Social Services by Children and Their Families.

To increase understanding of relationships between general traumatic injury in children and long-term use of resources in the health care and social services (HSS) sectors by these children and their families 8-10 years after traumatic injury. This study was a cross-sectional retrospective cohort study of prognosis from 2001 to 2003 that quantified recent expenditures on and use of HSS by children and also by their parents. Forty-eight cases of children were selected from the Hamilton Health Sciences pediatric trauma database in the period from January 2001 to December 2003 after incurring a traumatic injury with Injury Severity Score greater than 12. The average total cost to the HSS system per child's family was $4,326.62 during the preceding 6 months. During the same period, average use of HSS was 7 visits. Total service costs incurred by caregivers of injured children increased with severity of the traumatic injury (p= .009). Caregiver HSS use was higher when the injury was caused by a motor vehicle accident than by other types of accidents (p< .001) and increased with the injury severity (p< .001). HSS use by children was related to gender (p< .001), injury mechanism (p< .001), age at accident (p< .001), and time since accident (p= .012), among other factors. Pediatric trauma appears to have long-term effects on expenditures on and use of HSS by the affected children and their families. The findings emphasize the need for long-term assessment and possible delivery of services to the families of the injured children.

Modelling the distribution of four Dioscorea species on the Mahafaly Plateau of south-western Madagascar using biotic and abiotic variables

Wild yam species (Dioscorea spp.) provide important supplementary food and thus contribute directly to the livelihood and well-being of local people in SW Madagascar. Given the ongoing exploitation of this resource, there is a necessity to identify and predict yam species distribution along environmental gradients to improve our understanding of sustainable management of this resource. Therefore, the aims of the current study were to identify predictors for the distribution of important wild yam species and to spatially predict their availability. To this end species abundance and environmental variables were collected in the field using a systematic sampling approach within a yams collection area of four villages (58 plots). A redundancy analysis (RDA) was conducted to investigate the relationship between wild yam species and 12 environmental variables. Species distribution models and species response curves were established for the most abundant wild yam species using nonparametric multiplicative regression (NPMR). These models were subsequently used in conjunction with geospatial data for predictive mapping. RDA depicted a clear pattern of species habitats with D. alatipes occurring in dry spiny forests on calcareous soils at remote places, while D. bemandry and D. fandra were found in forest habitats on sandy soils with high harvest intensities. The NPMR models explained 88% (D. alatipes), 82% (D. bemandry) and 37% (D. fandra) of the variation in species abundance. Sensitivity analysis indicated the importance of vegetation structure, human interventions, and soil characteristics in determining wild yam distribution. Predicted distribution maps showed that the population of wild yam is scarce and mostly located in restricted areas of open spiny forests and dry spiny forest thickets, where harvest intensity is high. This study highlights the need for long-term assessment and public awareness actions on yam harvest practices as well as the importance of anthropogenic factors for the distribution of yam as a key forest resource in SW Madagascar.

Functional outcomes after urinary diversion: The importance of long-term assessment

Radical cystectomy (RC) has been used to treat bladder cancer for over 100 years. Over time, therapy has evolved from a strictly ablative approach to one aimed at preserving health-related quality of life (HR-QOL). Orthotopic lower urinary tract (LUT) diversion represents the most recent form of LUT reconstruction after RC. Despite many advances, the optimal form of urinary diversion after cystectomy has yet to be definitively demonstrated.1 No randomized controlled trial exists comparing existing forms of urinary diversion and no true consensus has been achieved. This may be related in part to the underlying fact that improved health status does not always translate to a demonstrably better quality of life.2 This current article examines both renal and functional outcomes of orthotopic ileal neobladder diversion after RC.3 Using a cohort of 31 patients, Lantz and colleagues describe changes in serum creatinine, continence and reservoir emptying 1-year post-continent diversion. A significant rise in serum creatinine from a normal baseline and a 17.9% rate of uretero-ileal stricture formation were found. Eighty-nine percent of patients developed acceptable daytime continence at 1-year (defined as 0 to 1 pads used per day). Ultimately, patients with a urinary diversion are at risk of upper urinary tract deterioration. Up to 27% of patients with ileal conduit diversion develop renal dysfunction that may continue to worsen in a time-dependent manner. These changes may not become obvious for 10 to 20 years after urinary diversion. Detrimental change in renal function may be due to chronic urinary tract infection, ureteral obstruction or high neobladder pressures. This current study demonstrates a 26.3 μmol/L increase in serum creatinine from baseline 1-year after neobladder creation. A significant change occurred with or without the presence of hydronephrosis. The implications of these early findings highlight the need for meticulous long-term assessment of renal function and routine imaging of the upper urinary tract after urinary diversion. In this study, assessment of continence at 1-year revealed daytime and nighttime continence rates of 89% and 70%, respectively. Although no standard definition of continence or voiding function exists for patients after orthotopic diversion, these early results are encouraging and consistent with most published reports. After 12 months, it is thought that sphincteric function and full neobladder compliance have been achieved. However, deterioration in continence may occur gradually 5 years after orthotopic diversion. It is thought that sphincteric function may actually deteriorate with age and time.4 This further emphasizes the need for long-term assessment even when evaluating voiding function after continent diversion. When reporting functional outcomes after LUT reconstruction, it is also imperative to consider HR-QOL. It is widely assumed patients undergoing orthotopic diversion enjoy a better HR-QOL than those undergoing ileal conduit diversion. Currently, there is no definitive evidence.1 Studying HR-QOL measures in a prospective manner will help determine the ideal form of urinary diversion and further optimize patient outcomes. Implementation of HR-QOL outcomes specific to urology will likely play a large role in the future assessment of all forms of LUTreconstruction. Ultimately, long-term outcomes after orthotopic continent diversion are important to document any potential adverse change in renal function or urinary continence. If long-term continence is not achieved or is achieved at the expense of renal function, orthotopic diversion may not actually preserve HR-QOL. The ideal form of LUT replacement is still unknown, but with prolonged follow-up the ileal neobladder seems most likely to emerge as the gold standard of urinary diversion after RC.

Impacts of Intensive Management on Black Walnut (Juglans nigra L.) Growth and Bole Quality at Mid-Rotation

Abstract High value hardwood species, such as black walnut (Juglans nigra L.), are increasingly planted and intensively managed in the hopes of profitably producing high quality logs. Success or failure of silvicultural practices used to establish these plantations are commonly judged on the basis of early diameter growth response. However, it is generally not known whether treatments judged to be successful when the stand is young translate into mid- and late-rotation bole quality and, ultimately, log value. This study revisits a 35-yr-old experimental black walnut plantation in south-central Illinois (black walnut site index50 = 23m), to evaluate how initial planting density, interplanting with nitrogen-fixing black alder (Alnus glutinosa [L.] Gaertn.), postestablishment weed control, and time of thinning impacted the productivity and bole quality at mid-rotation. Postestablishment weed control conducted at age 6–7 yr did not impact walnut diameter at age 35, but incidence of frost cracks and grade defects in the butt log (lower 2.44 m) were 100% and 30% greater, respectively, on trees receiving the weed control treatment. Time of first thinning of the alder affected walnut quality in the upper log (second 2.44 m log). The higher planting density of walnut and alder reduced the number of defects by 31% in the upper log, but at the expense of stem diameter growth. At a walnut planting density of 7.9 × 7.9 m, interplanting black alder impacted neither walnut diameter growth nor bole quality. The early thinning treatment increased the number of defects on the upper log, but not the butt log. These results suggest that intensive management can have a complex and enduring impact on black walnut plantation growth and development, and elucidate the need for long-term assessment of silvicultural treatments where bole quality is an important component of stand value. For. Sci. 49(4):522–529.

Recognising and responding to the influences of agriculture and other land-use practices on soil fauna in Australia

The abundance and diversity of soil fauna are influenced by a wide range of agricultural and other land use practices. This paper provides three Australian examples of the ways in which land use has affected the different components of the soil fauna and discusses strategies that might be applied to respond to these changes. The paper also discusses an emergent issue (genetic engineering of plants) which may prove to have implications for the soil fauna in future. European settlers dramatically altered the earthworm fauna when they established agriculture on the Australian landscape. This change in the fauna, from native megascolecids to introduced lumbricids, happened by chance, not through thoughtful management. Whilst the most common species now present have the potential to enhance soil properties and plant production significantly, they are patchy in distribution, generally rare in numbers and poor in behavioural diversity. Adoption of the management practices which increase earthworm abundance (e.g. reduced tillage and stubble retention), redistribution of beneficial species to regions lacking them and the introduction of more appropriate taxa from overseas may improve the current fauna's performance. Mediterranean helicid snails are introduced pests of pastures, croplands and vineyards in southern Australia. Their pest status has increased due to the adoption of agricultural practices aimed at soil conservation. Molluscicides are prohibitively expensive to use regularly on a broad-acre basis and environmentally undesirable. Strategic use of such chemicals, as strips to interrupt the seasonal movements of snails or in years when the snail numbers are particularly high, may provide a useful alternative. Fragmentation of native forests is common in Australia but the impact of this fragmentation on the abundance and diversity of soil fauna is poorly understood. Preliminary results are presented for the effects of fragmentation of a Eucalyptus forest on a millipede community. Responses vary between species of soil invertebrates, illustrating that studies need to be focused at population rather than community levels. Responses also vary in time, indicating the need for long-term assessments. Genetically-engineered plants are being developed which incorporate toxins to kill leaf feeding insects. The non-harvested parts of such plants serve as food for the soil fauna which drive nutrient recycling processes. The suitability of this plant material for processing by the soil fauna needs to be researched.

Anogenital warts in childhood

Fifteen children with anogenital warts are presented. Twelve cases were referred for assessment of sexual abuse which was established in six cases, strongly suspected in one, and excluded in three. In two, the source was unclear. Papillomavirus typing was carried out by HPV DNA dot and Southern blot hybridization using mixed HPV 6 11 , 16 18 , and 2 3 DNA probes on 15 specimens from 12 of the children. Seven biopsy specimens were positive for HPV 6 or 11 and one hybridized with both HPV 6 11 and 16 18 mixed sets of probes. Two specimens were positive for HPV 2, and a further two hybridized with both HPV 18 and 2. Three wart specimens could not be typed with the available genital or skin probes. The viruses causing genital tract papillomata are the same for children and adults. The identification of HPV 16 18 raises the concern of potential oncogenicity and stresses the need for longterm assessment. The diagnosis of sexual abuse was made on history rather than examination, as only two cases showed additional physical signs of sexual abuse. It is advocated that the presence of anogenital warts alone be sufficient grounds to pursue the possibility of sexual abuse. Nonsexual transmission, although possible, is far less likely.