Ecological strategies and disturbance response of tropical forest trees: insight from functional trait variation

Tropical forests store 40% of terrestrial carbon, process six times as much carbon as is released through fossil fuel use, and are epicenters of biodiversity. Despite all that we know about tropical forests, there remains much to discover about variation in ecological strategies, differences in the way species acquire limited resources through dissimilarities in construction and allocation patterns. We also know little as to how this variation shapes the resilience of tropical tree communities to disturbance. These forests are increasingly threatened by global change stressors, such as anthropogenic land-use and climate change. Recent advances in ecological literature show that more insight into differences in ecological strategies among tropical forest species can be gained by going beyond species distributions to also examine functional trait variation. Functional traits are morphological and physiological traits that reflect allocation strategies thought to be important determinants of fitness. In the first two chapters of my dissertation, I quantified wood density and anatomical variation at multiple scales, and related this variation to ecological strategies of tropical forest tree species. The last two chapters examined effects of historical disturbance on the composition and temporal dynamics of tropical forest communities. In addition to wood density, other traits studied in these later chapters were maximum height and diameter. Across my dissertation, the scales spanned ranged from intra-individual, intra-specific, interspecific, community and temporal levels, across two tropical forests, the 50 ha CTFS plot in BCI, Panama, and the 5.2 ha long-term forest plots in Kibale National Park, Uganda. With the functional trait approach, my dissertation demonstrated several novel patterns, including 1) linear radial increases in wood density are typical of fast-growth high mortality tropical tree species, while slow-growth low mortality species show a range of radial changes in wood density including non-linear trends 2) greater variation in ecological strategies when wood density is decomposed into anatomical components, with functional consequences for species growth and mortality of saplings but not adult trees, 3) persistence of the effects of selective logging on the taxonomic and structural composition but not functional composition of a tropical forest 45 years after, and 4) inadequacy of classical successional models that assume recovery to pre-disturbance conditions for predicting the effects of selective logging on tropical forest dynamics

There's Much Yet to be Done: Diverse Perspectives on HPV Vaccination

It has been over 10 y since the first HPV vaccines were licensed and introduced in a number of countries around the world. As only the second vaccine (after hepatitis B) that prevents an infection that can lead to the development of cancer, HPV vaccine occupies an important position in our armamentarium of vaccines yet remains underutilized. The number of national HPV vaccination programs has increased steadily; as of June 2017, 91 countries had introduced national HPV vaccination programs,1 with that number now over 100. Over the past 10+ y, several modifications have been made to the vaccination regimen (e.g., moving from three to two doses if the first dose is administered before age 15 y), in the type of vaccine available (e.g., introduction of the 9-valent vaccine), and in the target of vaccination (e.g., many countries have shifted from female-only to gender-neutral vaccination). There is great variability across the globe in terms of HPV vaccination policies and accompanying barriers to the implementation and/or sustainability of programs. It is well known, for instance, that Japan’s initial success with vaccination was undermined by several factors, leading to a precipitous drop in vaccination rates, with little subsequent recovery.2 Other countries, such as the U.S.,3 have struggled to achieve vaccination goals, and still others have faced setbacks but with good recovery (e.g., Denmark and Ireland).4,5 At the same time, many countries, including China,6 still have not implemented national vaccination programs, with the cost of vaccines presenting a significant obstacle, particularly for those countries that are not eligible for reduced pricing through Global Alliance for Vaccines and Immunisation (GAVI) or other mechanisms. Other countries, such as Malaysia, Rwanda, Australia, and the U.K., have achieved sustained high levels of vaccination.7–10 Unwarranted fears about HPV vaccine and the proliferation of misinformation, particularly via social media, have proven to be significant and widespread obstacles to achieving and maintaining high vaccination rate

Association of state Medicaid expansion status with rates of suicide among US adults

Importance: In the US, suicide is the 10th leading cause of death and a serious mental health emergency. National programs that address suicide list access to mental health care as key in prevention, and more large-scale policies are needed to improve access to mental health care and address this crisis. The Patient Protection and Affordable Care Act (ACA) Medicaid Expansion Program was implemented in several states with the goal of increasing access to the health care system. Objective: To compare changes in suicide rates in states that expanded Medicaid under the ACA vs states that did not. Design, Setting, and Participants: In this cross-sectional study, state-level mortality rates were obtained from the National Center for Health Statistics for US individuals aged 20 to 64 years from January 1, 2000, to December 31, 2018. Data analysis was performed from April 18, 2021, to April 15, 2022. Exposures: Changes in suicide mortality rates among nonelderly adults before and after Medicaid expansion in expansion and nonexpansion states were compared using adjusted difference-in-differences analyses via hierarchical bayesian linear regression. Main Outcomes and Measures: Suicide rates using death by suicide as the primary measure. Results: Of the total population at risk for suicide, 50.4% were female, 13.3% were Black, 79.5% were White, and 7.2% were of other races. The analytic data set contained suicide mortality data for 2907 state-age-year units covering the general US population. A total of 553 912 deaths by suicide occurred during the study period, with most occurring in White (496 219 [89.6%]) and male (429 580 [77.6%]) individuals. There were smaller increases in the suicide rate after 2014 in Medicaid expansion (2.56 per 100 000 increase) compared with nonexpansion states (3.10 per 100 000 increase). In adjusted difference-in-differences analysis, a significant decrease of -0.40 (95% credible interval, -0.66 to -0.14) suicides per 100 000 individuals was found, translating to 1818 suicides that were averted in 2015 to 2018. Conclusions and Relevance: In this cross-sectional study, although suicide rates increased in both groups, blunting of these rates occurred among nonelderly adults in the Medicaid expansion states compared with nonexpansion states. Because this difference may be linked to increased access to mental health care, policy makers should consider suicide prevention as a benefit of expanding access to health care

Diverse community energy futures in Saskatchewan, Canada

Abstract: This research explores peoples’ place attachment and context surrounding power production and energy futures. Facilitated, deliberative focus groups were conducted as comparative case studies in three fossil fuel-dependent cities in Saskatchewan Canada: Estevan (situated next to the provincial centers of coal, oil and gas production), Saskatoon (situated more northerly and furthest from coal, oil and gas production) and the capital city of Regina. (situated between the other two communities). This study supports the conclusions: (1) participants believed the focus groups improved their knowledge surrounding power production; (2) although there is strong support for wind and solar power production, there is a gap in implementation; and (3) place-based location impacts perceptions of power production sources. Participants were surveyed before and after focus group meetings to explore the perceptions and preferences of power productions sources. All three communities favored renewables in the order of solar and wind. Estevan, supported carbon capture and sequestration (CCS) to a greater degree and perceived much lower risk surrounding CCS than the other two communities. This may be explained by information gaps in this community. Participants were far less likely to believe a climate crisis is occurring, and while recognizing health concerns surrounding coal, they spent considerably more time discussing the loss of coal and its impact on their economy. Saskatoon, the community furthest from coal oil and gas production, spent considerable time discussing renewables, and when asked about coal, oil and gas identified the need to transition and retrain dependent workers. Although the uranium sector is present in Saskatchewan and in closer proximity to Saskatoon, there was little knowledge or support for new small modular nuclear reactors. Graphic abstract

Self-reported occupational visual and hearing impairment among dental professionals in Nigeria

Objective: To determine the prevalence of occupational visual and hearing impairment among dental professionals in Edo State, Nigeria. Materials and Methods: A questionnaire based cross-sectional survey of dental surgeons, dental surgery assistants (DSA), dental therapists and dental technologists was conducted in four government owned dental centers in Edo state which included: University of Benin Teaching Hospital, Specialist Hospital, Benin City, Irrua specialist hospital and General hospital, Fugar. Results: The response rate was 78.1%. Majority (77.3%) of the respondents were dentists, others were dental nurses (10.7%), dental technologists (9.3%) and dental therapists (2.7%). The prevalence of hearing impairment was 4.0% while visual impairment was 12.0%. The prevalence of hearing impairment was higher among dental technologists, however this was not statistically significant (P>0.05).The regular use of safety practices among the dental professionals was low ranging from12.0% to 50.7%. Conclusion: Visual impairment was more common than hearing impairment among dental professionals. Noise level and hazards to the eyes in dental clinic should be evaluated by occupational health and safety advisors with a view of making useful recommendation to reduce their adverse impact on dental professionals. Further investigations using objective auditory and visual assessment tools are also recommended.Keywords: Occupational health, visual impairment, hearing impairment, dental professionals, health hazard

State public assistance spending and survival among adults with cancer

IMPORTANCE: Social determinants of health contribute to disparities in cancer outcomes. State public assistance spending, including Medicaid and cash assistance programs for socioeconomically disadvantaged individuals, may improve access to care; address barriers, such as food and housing insecurity; and lead to improved cancer outcomes for marginalized populations. OBJECTIVE: To determine whether state-level public assistance spending is associated with overall survival (OS) among individuals with cancer, overall and by race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included US adults aged at least 18 years with a new cancer diagnosis from 2007 to 2013, with follow-up through 2019. Data were obtained from the Surveillance, Epidemiology, and End Results program. Data were analyzed from November 18, 2021, to July 6, 2023. EXPOSURE: Differential state-level public assistance spending. MAIN OUTCOME AND MEASURE: The main outcome was 6-year OS. Analyses were adjusted for age, race, ethnicity, sex, metropolitan residence, county-level income, state fixed effects, state-level percentages of residents living in poverty and aged 65 years or older, cancer type, and cancer stage. RESULTS: A total 2 035 977 individuals with cancer were identified and included in analysis, with 1 005 702 individuals (49.4%) aged 65 years or older and 1 026 309 (50.4%) male. By tertile of public assistance spending, 6-year OS was 55.9% for the lowest tertile, 55.9% for the middle tertile, and 56.6% for the highest tertile. In adjusted analyses, public assistance spending at the state-level was significantly associated with higher 6-year OS (0.09% [95% CI, 0.04%-0.13%] per $100 per capita; P \u3c .001), particularly for non-Hispanic Black individuals (0.29$100 per capita; P = .01) and non-Hispanic White individuals (0.12% [95% CI, 0.08%-0.16%] per $100 per capita; P \u3c .001). In sensitivity analyses examining the roles of Medicaid spending and Medicaid expansion including additional years of data, non-Medicaid spending was associated with higher 3-year OS among non-Hispanic Black individuals (0.49$100 per capita when accounting for Medicaid spending; 0.17% [95% CI, 0.02%-0.31%] per $100 per capita Medicaid expansion effects). CONCLUSIONS AND RELEVANCE: This cohort study found that state public assistance expenditures, including cash assistance programs and Medicaid, were associated with improved survival for individuals with cancer. State investment in public assistance programs may represent an important avenue to improve cancer outcomes through addressing social determinants of health and should be a topic of further investigation

Diverse community energy futures in Saskatchewan, Canada

Abstract: This research explores peoples’ place attachment and context surrounding power production and energy futures. Facilitated, deliberative focus groups were conducted as comparative case studies in three fossil fuel-dependent cities in Saskatchewan Canada: Estevan (situated next to the provincial centers of coal, oil and gas production), Saskatoon (situated more northerly and furthest from coal, oil and gas production) and the capital city of Regina. (situated between the other two communities). This study supports the conclusions: (1) participants believed the focus groups improved their knowledge surrounding power production; (2) although there is strong support for wind and solar power production, there is a gap in implementation; and (3) place-based location impacts perceptions of power production sources. Participants were surveyed before and after focus group meetings to explore the perceptions and preferences of power productions sources. All three communities favored renewables in the order of solar and wind. Estevan, supported carbon capture and sequestration (CCS) to a greater degree and perceived much lower risk surrounding CCS than the other two communities. This may be explained by information gaps in this community. Participants were far less likely to believe a climate crisis is occurring, and while recognizing health concerns surrounding coal, they spent considerably more time discussing the loss of coal and its impact on their economy. Saskatoon, the community furthest from coal oil and gas production, spent considerable time discussing renewables, and when asked about coal, oil and gas identified the need to transition and retrain dependent workers. Although the uranium sector is present in Saskatchewan and in closer proximity to Saskatoon, there was little knowledge or support for new small modular nuclear reactors. Graphic abstract: [Figure not available: see fulltext.].Funding is gratefully acknowledged from the Sylvia Fedoruk Canadian Centre for Nuclear Innovation, University of Saskatchewan, Canada. DMR was funded by the International Research Collaboration Fund of the UK Carbon Capture and Storage Research Centre, supported by UK Engineering and Physical Sciences Research Council (EPSRC) grant EP/ K000446/2

Accurate forest projections require long-term wood decay experiments because plant trait effects change through time.

Whether global change will drive changing forests from net carbon (C) sinks to sources relates to how quickly deadwood decomposes. Because complete wood mineralization takes years, most experiments focus on how traits, environments and decomposer communities interact as wood decay begins. Few experiments last long enough to test whether drivers change with decay rates through time, with unknown consequences for scaling short-term results up to long-term forest ecosystem projections. Using a 7 year experiment that captured complete mineralization among 21 temperate tree species, we demonstrate that trait effects fade with advancing decay. However, wood density and vessel diameter, which may influence permeability, control how decay rates change through time. Denser wood loses mass more slowly at first but more quickly with advancing decay, which resolves ambiguity about the after-life consequences of this key plant functional trait by demonstrating that its effect on decay depends on experiment duration and sampling frequency. Only long-term data and a time-varying model yielded accurate predictions of both mass loss in a concurrent experiment and naturally recruited deadwood structure in a 32-year-old forest plot. Given the importance of forests in the carbon cycle, and the pivotal role for wood decay, accurate ecosystem projections are critical and they require experiments that go beyond enumerating potential mechanisms by identifying the temporal scale for their effects

Medical students\u27 knowledge of HPV, HPV vaccine, and HPV-associated head and neck cancer

On the basis of their training, medical students are considered the best case scenario among university students in knowledge of the human papillomavirus (HPV). We evaluated differences in knowledge of HPV, HPV vaccine, and head and neck cancer (HNC) among medical students. A previously validated questionnaire was completed by 247 medical students at a Midwestern university. Outcomes of interest were knowledge score for HPV and HPV vaccine, and HNC, derived from combining questionnaire items to form HPV knowledge and HNC scores, and analyzed using multivariate linear regression. Mean scores for HPV knowledge were 19.4 out of 26, and 7.2 out of 12 for HNC knowledge. In the final multivariate linear regression model, sex, race, and year of study were independently associated with HPV and HPV vaccine knowledge. Males had significantly lower HPV vaccine knowledge than females (β = -1.53; 95% CI: -2.53, -0.52), as did nonwhite students (β = -1.05; 95% CI: -2.07, -0.03). There was a gradient in HPV vaccine knowledge based on the year of study, highest among fourth year students (β = 6.75; 95% CI: 5.17, 8.33). Results were similar for factors associated with HNC knowledge, except for sex. HNC knowledge similarly increased based on year of study, highest for fourth year students (β = 2.50; 95% CI: 1.72, 3.29). Among medical students, gaps remain in knowledge of HPV, HPV vaccine, and HPV-linked HNC. Male medical students have significantly lower knowledge of HPV. This highlights the need to increase medical student knowledge of HPV and HPV-linked HNC

Association of Inventory to Measure and Assess imaGe Disturbance - Head and Neck Scores With Clinically Meaningful Body Image-Related Distress Among Head and Neck Cancer Survivors

Objective: The Inventory to Measure and Assess imaGe disturbance - Head and Neck (IMAGE-HN) is a validated patient-reported outcome measure of head and neck cancer-related body image-related distress (BID). However, the IMAGE-HN score corresponding to clinically relevant BID is unknown. The study objective is to determine the IMAGE-HN cutoff score that identifies head and neck cancer patients with clinically relevant BID. Methods: We conducted a cross-sectional study at six academic medical centers. Individuals ≥18 years old with a history of head and neck cancer treated with definitive intent were included. The primary outcome measure was the IMAGE-HN. A Receiver Operating Characteristic curve analysis was performed to identify the IMAGE-HN score that maximized sensitivity and specificity relative to a Body Image Scale score of ≥10 (which indicates clinically relevant BID in a general oncology population). To confirm the validity of the IMAGE-HN cutoff score, we compared the severity of depressive [Patient Health Questionnaire-9 (PHQ-9)] and anxiety symptoms [Generalized Anxiety Disorder-7 (GAD-7)], and quality of life [University of Washington-QOL (UW-QOL)] in patients with IMAGE-HN scores above and below the cutoff. Results: Of the 250 patients, 70.4% were male and the mean age was 62.3 years. An IMAGE-HN score of ≥22 was the optimal cutoff score relative to a Body Image Scale score of ≥10 and represents a clinically relevant level of head and neck cancer-related BID. Relative to those with an IMAGE-HN score of \u3c22, patients with IMAGE-HN scores of ≥22 had a clinically meaningful increase in symptoms of depression (mean PHQ-9 score difference = 5.8) and anxiety (mean GAD-7 score difference = 4.1) as well as worse physical (mean UW-QOL score difference = 18.9) and social-emotional QOL (mean UW-QOL score difference = 21.5). Using an IMAGE-HN cutoff score ≥22, 28% of patients had clinically relevant BID. Conclusion: An IMAGE-HN score of ≥22 identifies patients with clinically relevant head and neck cancer-related BID. This score may be used to detect patients who could benefit from strategies to manage their distress, select patients for studies evaluating interventions to manage head and neck cancer-related BID, and improve our understanding of the underlying epidemiology of the disorder