Satellite data reveal differential responses of Swiss forests to unprecedented 2018 drought

Extreme events such as the summer drought of 2018 in Central Europe are projected to occur more frequently in the future and may cause major damages including increased tree mortality and negative impacts on forest ecosystem services. Here, we quantify the response of >1 million forest pixels of 10 × 10 m across Switzerland to the 2018 drought in terms of resistance, recovery, and resilience. We used the Normalized Difference Water Index (NDWI) derived from Sentinel-2 satellite data as a proxy for canopy water content and analyzed its relative change. We calculated NDWI change between the 2017 pre-drought and 2018 drought years (indicating resistance), 2018 and the 2019 post-drought (indicating recovery), and between 2017-2019 (indicating resilience). Analyzing the data from this large natural experiment, we found that for 4.3% of the Swiss forest the NDWI declined between 2017 and 2018, indicating areas with low resistance of the forest canopy to drought effects. While roughly 50% of this area recovered, in 2.7% of the forested area NDWI continued to decline from 2018 to 2019, suggesting prolonged negative effects or delayed damage. We found differential forest responses to drought associated with site topographic characteristics and forest stand characteristics, and to a lesser extent with climatic conditions and interactions between these drivers. Low drought resistance and high recovery were most prominent at forest edges, but also on south-facing slopes and lower elevations. Tree functional type was the most important driver of drought resilience, with most of the damage in stands with high conifer abundance. Our results demonstrate the suitability of satellite-based quantification of drought-induced forest damage at high spatial resolution across large areas. Such information is important to predict how local site characteristics may impact forest vulnerability to future extreme events and help in the search for appropriate adaptation strategies.

Preliminary Data on the Occurrence of Anisakis spp. in European Hake (Merluccius merluccius) Caught Off the Portuguese Coast and on Reports of Human Anisakiosis in Portugal

Parasitic nematodes of the genus Anisakis are among the most important biological hazards associated with seafood. A survey of Anisakis spp. in European hake (Merluccius merluccius) was undertaken as this species is a staple of the Portuguese diet. Moreover, a literature review of cases of anisakiosis reported from Portugal, a country with one of the highest levels of fish consumption in the world, was also carried out. Seventy-five European hake caught in the Atlantic Ocean off the northern coast of Portugal were analyzed to determine the infection levels and site distribution of Anisakis spp. Isolated nematode larvae were identified to species level by molecular analysis. Two sets of samples were collected. Firstly, a total of 46 Anisakis spp. L₃ larvae were collected with a prevalence of 76.7% (95% CI 61.5–91.8%) and intensity (mean ± SD, range) of 2.0 ± 1.2 (1–5). Most larvae were found on the liver (45.7%) and on the gonads (32.6%), but none in the muscle. The molecular analysis showed the presence of both A. simplex s.s. (70%) and A. pegreffii (30%). For the second sample, analyzed using the UV-Press method, a total of 473 Anisakis spp. were found, with a prevalence of 95.6% (95% CI 89.5–100.0%), intensity (mean ± SD, range) of 11.3 ± 9.7 (1–41), density of 0.05 ± 0.04 (0–0.16) worms/muscle weight in g, and density of 0.54 ± 0.50 (0–2.53) worms/viscera weight in g. Surprisingly, only three very recent cases of human anisakiosis in Portugal have been reported in the literature. Data from this study contribute towards an updating of the existing epidemiological picture in an area characterized by very high seafood consumption and changing eating habits.

Antigonon leptopus invasion is associated with plant community disassembly in a Caribbean island ecosystem

Invasions by non-native plant species are widely recognized as a major driver of biodiversity loss. Globally, (sub-)tropical islands form important components of biodiversity hotspots, while being particularly susceptible to invasions by plants in general and vines in particular. We studied the impact of the invasive vine A. leptopus on the diversity and structure of recipient plant communities on the northern Caribbean island St. Eustatius. We used a paired-plot design to study differences in species richness, evenness and community structure under A. leptopus-invaded and uninvaded conditions. Community structure was studied through species co-occurrence patterns. We found that in plots invaded by A. leptopus, species richness was 40–50% lower, and these plots also exhibited lower evenness. The magnitude of these negative impacts increased with increasing cover of A. leptopus. Invaded plots also showed higher degrees of homogeneity in species composition. Species co-occurrence patterns indicated that plant communities in uninvaded plots were characterized by segregation, whereas recipient plant communities in invaded plots exhibited random co-occurrence patterns. These observations suggest that invasion of A. leptopus is not only associated with reduced species richness and evenness of recipient communities in invaded sites, but also with a community disassembly process that may reduce diversity between sites. Given that A. leptopus is a successful invader of (sub-)tropical islands around the globe, these impacts on plant community structure highlight that this invasive species could be a particular conservation concern for these systems.

Composite versus Amalgam Restorations Placed in Canadian Dental Schools

OBJECTIVES

To investigate the latest teaching policies of posterior composite placement versus amalgam and to determine the actual numbers of posterior composites versus amalgam restorations placed in Canadian dental schools, over the years from 2008 to 2018.

METHODS

Emails were sent to Chairs/Heads of Restorative Departments and Clinic Directors of all 10 Canadian dental schools to collect data in the forms of: 1) Questionnaire on current teaching policies of posterior composite and amalgam restorations; 2) data entry form to collect the actual numbers of posterior composite and amalgam restorations placed in their clinics.

RESULTS

For the teaching questionnaire, the response rate was 90% (n=9). Seven (78%) of the responding schools reported that they assign 25%-50% of their preclinical restorative teaching time towards posterior composite placement. While, three (33%) of the responding schools allocated 50%-75% of their restorative teaching towards amalgam placement. Data entry response rate was 80% (n=8). Amalgam material was dominant in the restoration distribution from 2008 to 2012. While from 2013 to 2018, resin composite material was dominant in all eight responding schools. Linear regression analysis revealed a significant increasing trend in placing posterior composites in all the responding schools over time (p<0.05).

CONCLUSIONS

Data analysis revealed a clear trend towards an increase of posterior composite restoration placement and a decrease in the number of amalgam restorations placed. However, the teaching time assigned for posterior composite is not aligned with quantity placed. Review and adjustment of time allocated for teaching and training of each material are recommended.

Forests buffer against variations in precipitation

Atmospheric moisture recycling effectively increases the amount of usable water over land as the water can undergo multiple precipitation-evapotranspiration cycles. Differences in land cover and climate regulate the evapotranspiration flux. Forests can have deep roots that access groundwater facilitating transpiration throughout the dry season independent of precipitation. This stable transpiration buffers the forest against precipitation variability. However, it is not known whether the buffering effect, already modeled for tropical forests, is common to all forests globally. Here we apply a state-of-the-art Lagrangian moisture tracking model (UTrack) to study whether forest land cover in the upwind precipitationshed can lead to a reduction in monthly precipitation variability downwind. We found a significant buffering effect of forests in the precipitation variability of 10 out of 14 biomes globally. On average, if 50% of precipitation originates from forest, then we find a reduction in the coefficient of variation of monthly precipitation of 60%. We also observed that a high fraction of precipitation from non-forest land sources tends to have the opposite effect, that is, no buffering effect. The average variation of monthly precipitation was 69% higher in areas where 50% of precipitation originates from non-forest land sources in the precipitationshed. Our results emphasize the importance of land cover composition in the precipitationshed to buffer precipitation variability downwind, in particular forest cover. Understanding the influence of land cover in a precipitationshed on atmospheric moisture transport is key for evaluating an area's water-climate regulatory ecosystem services and may become increasingly important due to continued changes in land cover and climate change.

Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry

OBJECTIVES

To determine factors associated with COVID-19-related death in people with rheumatic diseases.

METHODS

Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category.

RESULTS

Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death.

CONCLUSION

Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.

Morphological and molecular characterization of a novel Myxobolus species from the gastrointestinal tract of brown trout (Salmo trutta) in Spain

The genus Myxobolus Bütschli, 1882 is the largest group within the class Myxosporea and includes 905 nominal species, 18 of which have been found to infect fish belonging to the family Salmonidae. In the present study, microscopic analysis enabled detection of myxospores in 43 of 613 (7.0%) gastrointestinal tracts from brown trout (Salmo trutta) captured in several rivers in the northwest of the Iberian Peninsula. Measurement of the whole myxospores, polar capsules and other morphological characteristics, together with identification of the site of infection, has led us to propose a novel salmonid-myxobolid species, Myxobolus compostellanus n. sp. Molecular analysis of the small subunit ribosomal RNA (SSU-rRNA) gene yielded the same consensus sequence of 2039 bp in 14 fish specimens. A BLAST search indicated 97.6% similarity to Myxobolus neurobius. Phylogenetic analysis revealed that M. compostellanus n. sp. is clustered with other salmonid-infecting myxobolids. The present findings contribute to the existing knowledge about the genus Myxobolus, providing both morphological and molecular data on a novel species of Myxobolus found to infect the gastrointestinal tract of salmonids, M. compostellanus n. sp. in the brown trout (S. trutta).

rasterdiv-An Information Theory tailored R package for measuring ecosystem heterogeneity from space: To the origin and back

Ecosystem heterogeneity has been widely recognized as a key ecological indicator of several ecological functions, diversity patterns and change, metapopulation dynamics, population connectivity or gene flow.In this paper, we present a new R package-rasterdiv-to calculate heterogeneity indices based on remotely sensed data. We also provide an ecological application at the landscape scale and demonstrate its power in revealing potentially hidden heterogeneity patterns.The rasterdiv package allows calculating multiple indices, robustly rooted in Information Theory, and based on reproducible open-source algorithms.

Spatially explicit removal strategies increase the efficiency of invasive plant species control

Effective management strategies are needed to control expansion of invasive alien plant species and attenuate economic and ecological impacts. While previous theoretical studies have assessed optimal control strategies that balance economic costs and ecological benefits, less attention has been paid to the ways in which the spatial characteristics of individual patches may mediate the effectiveness of management strategies. We developed a spatially explicit cellular automaton model for invasive species spread, and compared the effectiveness of seven control strategies. These control strategies used different criteria to prioritize the removal of invasive species patches from the landscape. The different criteria were related to patch size, patch geometry, and patch position within the landscape. Effectiveness of strategies was assessed for both seed dispersing and clonally expanding plant species. We found that, for seed-dispersing species, removal of small patches and removal of patches that are isolated within the landscape comprised relatively effective control strategies. For clonally expanding species, removal of patches based on their degree of isolation and their geometrical properties comprised relatively effective control strategies. Subsequently, we parameterized the model to mimic the observed spatial distribution of the invasive species Antigonon leptopus on St. Eustatius (northern Caribbean). This species expands clonally and also disperses via seeds, and model simulations showed that removal strategies focusing on smaller patches that are more isolated in the landscape would be most effective and could increase the effectiveness of a 10-yr control strategy by 30-90%, as compared to random removal of patches. Our study emphasizes the potential for invasive plant species management to utilize recent advances in remote sensing, which enable mapping of invasive species at the high spatial resolution needed to quantify patch geometries. The presented results highlight how this spatial information can be used in the design of more effective invasive species control strategies.

Zschokkella epinepheli n. sp. (Myxosporea: Myxidiidae) infecting the gallbladder of the white grouper Epinephelus aeneus (Serranidae) from Tunisian waters

A new coelozoic myxosporean species, Zschokkella epinepheli n. sp., collected from the gallbladder of the white grouper Epinephelus aeneus (Perciformes: Serranidae) from the bay of Bizerte, Tunisia, is described based on morphological and molecular characteristics. Myxospores and plasmodia were observed floating free in the bile. Mature plasmodia were polysporic and subspherical in shape, measuring 85.0-94.0 μm long and 70.0-82.0 μm wide. Mature myxospores were ovoid in valvular view, measuring 10.0 ± 1.7 (8.0-11.0) μm in length and 7.0 ± 0.3 (6.6-7.5) μm in width. Polar capsules were pyriform and equal in size, measuring 3.0 ± 0.2 (2.8-3.6) μm in length and 2.3 ± 0.3 (1.8-2.7) μm in width. Myxospore valves had 12-14 longitudinal striations. Based on the small subunit rDNA, the new species Z. epinepheli n. sp. differs from all other Zschokkella species for which there is a DNA sequence deposited in GenBank. Phylogenetic analysis revealed that Z. epinepheli n. sp. clustered in the marine subclade of Zschokkella species within the biliary tract IV clade. This is the first report of a Zschokkella species from the gallbladder of an epinephelin fishes.

Locked-in and living delta pathways in the Anthropocene

Delta systems are fundamental to the persistence of large human populations, food systems and ecosystem processes. Structural changes in natural and social components of deltas, emerging from past land-use changes, have led deltas to become locked-in loosing the ability to transform back into living deltas, and making them more at risk. We propose a framework to assess whether deltas become locked-in by changes in natural or social infrastructure, by examining the dynamic coupling between population and land-use development over 300 years for 48 deltas globally. We find that 46% of the deltas are defined as living, where population, irrigation, and cropland are correlated. Of the 54% locked-in deltas, 21% show changes in natural infrastructure to cropland (n = 6) or irrigation (n = 4), and 33% (n = 16) show changes in social infrastructure. Most locked-in deltas are in Europe but also in other continents due to decoupled development of population and cropland. While, locked-in deltas due to changes in natural infrastructure have highest average risks, those with changes in social infrastructure and the living deltas have highest risks from future relative sea level rise. These results show that deltas have varying natural and social components derived from a 300 years historical perspective, which are not taken into account in risk assessments for global deltas.

Catch-quota matching allowances balance economic and ecological targets in a fishery managed by individual transferable quota

Fishers with individual catch quota, but limited control over the mix of species caught, depend on trade and catch-quota balancing allowances to fully utilize their quota without discarding. However, these allowances can theoretically lead to overfishing if total allowable catches (TACs) are consistently exceeded. This study investigates usage of balancing allowances by the Icelandic demersal fleet over 2001-2017, for over 1,900 vessels. When a vessel's demersal catch exceeds owned and leased quota for a given species, the gap can be bridged by borrowing quota from the subsequent fishing period or transforming unutilized quota in other species, restricted by limits. Conversely, excess quota can be saved or transformed into quota for species where there is a shortfall. We found evidence that balancing behavior is frequently similar across the fleet. Transformations are consistent with indicators of a general quota shortage and potential for arbitrage caused by differences in conversion ratios used for transformation and lease prices. Larger companies contribute more to these patterns. Nevertheless, TAC overages are generally modest especially in recent years-key reasons appear to be the tightening of vessel transformation limits and the central role of Atlantic cod, which is the main target species but cannot be persistently overfished due to a specific prohibition on positive transformations into the species. These results show how the tailored design of the Icelandic catch-quota balancing system has helped in balancing economic and ecological goals of management. We suggest policy changes that could further reduce ecological risks, e.g., prioritizing between-year transfers over transformations.

Hepatitis C treatment outcome in former or current intravenous drug users coinfected with HIV, with or without directly observed therapy

BACKGROUND

Intravenous drug users (IDUs) with hepatitis C virus (HCV)/human immunodeficiency virus (HIV)-coinfection are recognised as a high-risk, vulnerable group.

METHODS

Between February 2015 and April 2018, a single-centre, non-interventional cohort study was conducted in an outpatient setting, to evaluate the sustained virologic response (SVR12) and assess treatment uptake models. The study included 385 former or recent IDUs divided into two groups: A-without use of opioid substitution treatment (OST) and B-patients taking opioid substitution; patients in group B received OST and self-administered therapy (B1) or OST and therapy under DOT (B2). Patients were characterised by demographic and clinical features and compared for treatment response. Correlations between SVR12 and independent variables were determined by logistic regression.

RESULTS

Patients were mostly males (88.3%) with a mean age of 46 ± 5 years and HCV genotype 1a (63.7%). Approximately 28% were treatment-experienced and 84.9% received sofosbuvir/ledipasvir. The mean CD4⁺T count was 649 cells/mm³, and most individuals were on antiretroviral therapy with undetectable viral loads (97.4%). SVR12 was achieved in 94.8%, and only eight patients relapsed. No significant differences were found in treatment effect between individuals taking opioid substitutes under different treatment models. Correlations were found between HCV viral response and both HIV suppression and albumin levels.

CONCLUSIONS

IDU with HCV/HIV coinfection, including individuals on self-administration of HCV therapy and opioid substitution treatments or in DOT programmes, are no longer considered a difficult-to-treat group, as they achieve high rates of SVR12.

Modelling the distribution of Mustela nivalis and M. putorius in the Azores archipelago based on native and introduced ranges

The aims of this study were to predict the potential distribution of two introduced Mustelidae, Mustela nivalis and M. putorius in the Azores archipelago (Portugal), and evaluate the relative contribution of environmental factors from native and introduced ranges to predict species distribution ranges in oceanic islands. We developed two sets of Species Distribution Models using MaxEnt and distribution data from the native and introduced ranges of the species to project their potential distribution in the archipelago. We found differences in the predicted distributions for the models based on introduced and on native occurrences for both species, with different most important variables being selected. Climatic variables were most important for the introduced range models, while other groups of variables (i.e., human-disturbance) were included in the native-based models. Most of the islands of the Azorean archipelago were predicted to have suitable habitat for both species, even when not yet occupied. Our results showed that predicting the invaded range based on introduced range environmental conditions predicted a narrower range. These results highlight the difficulty to transfer models from native to introduced ranges across taxonomically related species, making it difficult to predict future invasions and range expansion.

Morphology, seasonality and molecular characterization of Ceratomyxa draconis n. sp. parasite of Trachinus draco (L.) from the Bay of Bizerte, Tunisia

The specimens of Trachinus draco collected from the Bay of Bizerte were found to be infected with a new Ceratomyxa species described as Ceratomyxa draconis n. sp. The sequence of small subunit ribosomal RNA gene obtained in this study differs from other Ceratomyxa sequences available in GenBank. Mature spores of this species were elongated and crescent-shaped in sutural view, measuring 7.4 ± 0.77 (6.4-8.0) μm in thickness and 30.8 ± 1.65 (28.8-32.8) μm in width. The polar capsules were spherical, equal in size, and measuring 3.3 ± 0.2 (3.6-4.0) μm in diameter. The Ceratomyxa draconis n. sp. showed a clearly seasonal variation of prevalence with highest prevalence noted during summer months.

Reuma.pt/vasculitis - the Portuguese vasculitis registry

Background

The vasculitides are a group of rare diseases with different manifestations and outcomes. New therapeutic options have led to the need for long-term registries. The Rheumatic Diseases Portuguese Register, Reuma.pt, is a web-based electronic clinical record, created in 2008, which currently includes specific modules for 12 diseases and > 20,000 patients registered from 79 rheumatology centres. On October 2014, a dedicated module for vasculitis was created as part of the European Vasculitis Society collaborative network, enabling prospective collection and central storage of encrypted data from patients with this condition. All Portuguese rheumatology centres were invited to participate. Data regarding demographics, diagnosis, classification criteria, assessment tools, and treatment were collected. We aim to describe the structure of Reuma.pt/vasculitis and characterize the patients registered since its development.

Results

A total of 687 patients, with 1945 visits, from 13 centres were registered; mean age was 53.4 ± 19.3 years at last visit and 68.7% were females. The most common diagnoses were Behçet’s disease (BD) (42.5%) and giant cell arteritis (GCA) (17.8%). Patients with BD met the International Study Group criteria and the International Criteria for BD in 85.3 and 97.2% of cases, respectively. Within the most common small- and medium-vessel vasculitides registered, median [interquartile range] Birmingham Vasculitis Activity Score (BVAS) at first visit was highest in patients with ANCA-associated vasculitis (AAV) (17.0 [12.0]); there were no differences in the proportion of patients with AAV or polyarteritis nodosa who relapsed (BVAS≥1) or had a major relapse (≥1 major BVAS item) during prospective assessment (p = 1.00, p = 0.479). Biologic treatment was prescribed in 0.8% of patients with GCA, 26.7% of patients with AAV, and 7.6% of patients with BD. There were 34 (4.9%) deaths reported.

Conclusions

Reuma.pt/vasculitis is a bespoke web-based registry adapted for routine care of patients with this form of rare and complex diseases, allowing an efficient data-repository at a national level with the potential to link with other international databases. It facilitates research, trials recruitment, service planning and benchmarking.

Effect of governance structure on conservation land acquisition in California over the last 100 years

The process of expanding a network of conservation areas includes identifying valuable areas for conservation, devising policies and implementing conservation actions on the ground. While the first two components are often analyzed in conservation science, the literature seldom focuses on the implementation process, particularly, how the governance structure acts as driver of conservation outcomes. In this paper, we analyze the process of development of the conservation network in California between 1910 and 2010 to test whether governance structure explains the variation in the attribution of land for conservation over time. We find that governance structure does play an important role in the development of the conservation network over the century. We find evidence that polycentric and diverse governance structures result in better conservation outcomes (i.e. more area of land acquired for conservation). Arrangements that included multiple levels of agencies (e.g. Federal, State, and County) better predict the area of conservation land per decade. Location of conservation action per county had an effect on conservation outcomes over the last decades, and we also find a strong negative effect of per capita income in the implementation of conservation actions. These results suggest that it is possible to leverage governance structure to meet future conservation challenges through the maintenance of a diverse and polycentric governance structure.

Ceratomyxa mennani n. sp. (Myxosporea: Bivalvulida) parasitizing the gallbladder of the dusky grouper Epinephelus marginatus (Serranidae) from Tunisian waters

Ceratomyxa mennani n. sp. is a new coelozoic Ceratomyxa species found in the gallbladder of Epinephelus marginatus from the Gulf of Tunis, Tunisia. Mature plasmodia were disporic, ovoid in shape measuring 9-12 μm in width and 11-14 μm in length. Mature myxospores were slightly crescent-shaped with almost straight posterior margin, measuring 5.8 ± 0.2 (5.4-6.1) μm in length and 12.7 ± 0.3 (11.9-13.0) μm in thickness. The two valves were unequal with rounded ends. Polar capsules were spherical, equal in size with 2.1 ± 0.2 (1.9-2.6) μm in diameter. The binucleated sporoplasm filled the entire cavity of the myxospore. Molecular analysis of SSU rDNA sequences indicated that C. mennani n. sp. was distinct from all other Ceratomyxa sequences in GenBank. Phylogenetic analysis revealed that C. mennani n. sp. clustered with Ceratomyxa species infecting Epinephelinae fishes. Seasonal prevalence of infection over one year was significantly higher in winter and the lowest in autumn. This is the third report of Ceratomyxa species infecting the gallbladder of Epinephelus marginatus from Tunisia and the first study to include molecular data.

Influence of livelihood assets, experienced shocks and perceived risks on smallholder coffee farming practices in Peru

Smallholder farmers might adopt different farming practices to cope with multiple stressors depending on their livelihood assets, and with varying environmental and economic outcomes. Ongoing global change is triggering stronger and different stressors that threaten conventional farming practices; however, this could be resolved if livelihood assets that drive decision making are actionable and thus can be modified. This study assessed the influence of farmers' livelihood assets, risk perception, and shocks on the choice of non-conventional farming practices for smallholder coffee farmers in San Martín, Peru. Using household survey data, we collected data on 162 coffee plantations along an elevation gradient. We operationalized the sustainable livelihoods framework for the adoption of shade and input coffee farming strategies and explored farmers' motives to change them. Despite associated high risks with pest and disease pressure, coffee price volatility and climate change, these risks did not explain the current shade and input farming strategies. While in the past five years, farmers adapted shade and input management in response to pest and disease and climate change pressures, these occurred in diverging directions: we found higher human and social assets associated with higher shade levels, and a trend for higher physical and financial assets associated with higher input use. These findings illustrate that two main factors affect decisions on farming practices related to shade and input management and they relate to different livelihood capitals. This suggests a potential for conflicting decision-making, push-and-pulling decisions in different directions. Further the disconnect between livelihood assets and perceptions suggests that perception of risk and shocks might not be sufficient to motivate decision making under changing conditions. Such insights in decision-making typologies and drivers can inform the development of farming practices that enhance resilience and sustainability of smallholder coffee production in Peru and elsewhere in the tropics.

Drug retention of biological DMARD in rheumatoid arthritis patients: the role of baseline characteristics and disease evolution

Objective

To examine the association of the evolution in physician-reported and patient-reported outcomes with decision to stop biological DMARDs (bDMARDs) in RA. The contribution of baseline characteristics is well established, but little is known about how the disease evolution influences the decision to discontinue therapy.

Methods

RA patients who initiated a bDMARD treatment from 2009 and with information on date of visit were pooled from seven European RA registers. Each outcome was divided into baseline assessments (capturing the inter-individual differences at drug initiation) and changes from baseline at subsequent visits (capturing the individual evolution). Cox regression models were used to examine their association with drug discontinuation, adjusting for baseline patient and co-therapy characteristics and stratifying by register and calendar year of drug initiation.

Results

A total of 25 077 patients initiated a bDMARDs (18 507 a TNF-inhibitor, 3863 tocilizumab and 2707 abatacept) contributing an amount of 46 456.8 patient-years. Overall, drug discontinuation was most strongly associated with a poor evolution of the DAS28, with a hazard ratio of 1.34 (95% CI 1.29, 1.40), followed by its baseline value. A change of Physician Global Assessment was the next strongest predictor of discontinuation, then the Patient Global Assessment.

Conclusions

The decision to discontinue treatments appears to be mostly influenced by DAS28 and particularly its evolution over time, followed by Physician Global Assessment evolution, suggesting that the decision to stop bDMARDs relies more on the physician’s than on the patient’s global assessment.