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Aim: This study examined the impact of therapeutic drug monitoring (TDM) on clinical decision-making for children receiving infliximab for inflammatory bowel disease (IBD).Methods: The medical records of children with IBD who had infliximab trough levels (ITLs) measured between January 2013 and December 2015 at two Canadian tertiary-care centres were examined. The indications for TDM, clinical and laboratory disease activity indices and TDM-driven treatment changes to infliximab therapy were documented.Results: We included 107 consecutive serum measurements of ITLs in 73 children (40 boys), with a median age of 16.1 years, including 52 with Crohn's disease. TDM was performed due to concerns about clinical disease activity in 24/107 (22.4%) measurements and 83 (77.6%) were ordered as routine tests. Of these, 38 (35.5%) ITLs were suboptimal (<3.5 μg/mL) and 36 (34.0%) resulted in more frequent doses of infliximab, with subsequent improvements in disease biomarkers. Interval changes were implemented as a result of 34 (32.0%) ITLs, with shorter intervals in 19 (17.0%) cases, and seven (6.5%) ITLs resulted in adding or increasing doses of immunomodulators. In addition, four children were switched to adalimumab.Conclusion: Therapeutic drug monitoring was helpful in guiding the decision-making process for children with IBD on infliximab. [ABSTRACT FROM AUTHOR]

Long-term monitoring is critical for documenting population and community trends and for management, especially in large river-floodplain ecosystems that provide important services. Levees have reduced active floodplains in most large rivers, but connectivity in some reaches could promote community resilience. Using multivariate tools and regression, we examined spatial and temporal structure in fish community samples from two decades (>1000 samples, >100 sites) in one of the largest relatively intact river-floodplain ecosystems in North America - the Atchafalaya River ( ARB), Louisiana. Assemblages exhibited significant structure temporally and spatially, with most substantial effects of year and hydrologic subdivisions; however, season and water level also influenced community structure. Temporal trends in communities were limited to few areas, while declines in species richness were more widespread; however, rarefied richness trends suggested that declines were slight. Recent and long-term declines in abundance of economically important species (e.g., Black Crappie, Largemouth Bass, Bigmouth Buffalo) and increases in others (e.g., Smallmouth Buffalo, Blue Catfish, Freshwater Drum) drove differences among time periods. Our results suggest that the hydrologic subdivisions of the ARB may be an appropriate scale at which to manage fish populations, hydrology and water quality. Although we could not account for several important factors affecting fish communities in the ARB (e.g., hurricanes, major floods), and were limited by sampling variability, our findings highlight the utility of long-term datasets from large river-floodplain ecosystems for identifying important scales for management, determining species contributions to community change and forming hypotheses about anthropogenic and environmental drivers of variation in fish communities. [ABSTRACT FROM AUTHOR]

Environmental decision-making issues in the Atchafalaya River Basin (ARB), Louisiana require innovative approaches that combine scientific understanding and local stakeholder values. Management of the ARB has evolved from strong federal control to establish the ARB as a primary floodway of the Mississippi River and Tributaries Project to a state and federal collaboration to accommodate fish and wildlife resource promotion, recreational opportunities, and economic development. The management policy has expanded to include a growing number of stakeholders, but the decision-making process has not kept pace. Current conflicts among many local stakeholder groups, due in part to their lack of involvement in the decision-making process, impede restoration efforts. The absence of a long-term collective vision for the ARB by both local stakeholder groups and management agencies further confounds these efforts. This paper proposes a process to apply a structured decision-making framework, a values-based approach that explicitly defines objectives, to promote stakeholder-driven restoration efforts in the ARB and to better prepare for and manage long-term environmental issues. The goals of this approach are: (1) to create a process founded on stakeholder values and supported by rigorous scientific assessment to meet management agency mandates and (2) to establish a transparent process for restoration planning in the ARB that incorporates current and future non-governmental stakeholders into the decision-making process. Similar frameworks have been successful in other river basins; we feel the structure of current restoration efforts in the ARB is well-suited to adopt a values-focused management framework. [ABSTRACT FROM AUTHOR]

Agricultural land in the Midwest is a source of food and fuel, as well as biodiversity. It is also a cause of excess nutrients that make their way to the Mississippi River and the Gulf of Mexico. To address unsustainable changes to biogeochemical cycles and ecosystem functions, a multidisciplinary approach involving social science, natural science, and engineering is often effective. Given the potential of second‐generation biofuels, and capitalizing on the deep‐rooted perennial bioenergy crops capable of thriving in poor soils, we demonstrated an integrated socio‐environmental analysis of the impacts of growing switchgrass within row‐crop landscapes in Illinois. In this study, we model land use scenarios that incorporate switchgrass as a biofuel crop in a Midwest corn‐belt watershed using the Soil Water Assessment Tool coupled with an economic analysis for the Vermilion Basin in Illinois. We estimated the values of ecosystem services under an alternative bioenergy landscape, including commodity and bioenergy crops, changes in biogeochemistry, and recreational services. The estimated annual values of nitrate and sediment reduction attributed to bioenergy crops range from $38 million to $97 million and $16,000 to $197,000, respectively. The annual value of carbon dioxide emission reduction ranges from $1.8 million to $6.1 million based on the initial crop rotation pattern. Estimated average annual values for wildlife viewing, water‐based recreation, and pheasant hunting are $1.24 million, $0.17 million, and $0.3 million, respectively. To our knowledge, this study represents the first effort to comprehensively quantify ecosystem services using a process‐based model, and estimate their value in an alternative bioenergy landscape. The information we generate could aid in understanding the potential for biomass production from marginal land and the total economic value of the landscape at various spatial scales. The framework is useful in fostering alternative bioenergy landscapes with synergies in a food, energy, and conservation nexus. [ABSTRACT FROM AUTHOR]