Seasonal facilitative and competitive trade‐offs between shrub seedlings and coastal grasses

Shrub expansion is occurring in grasslands globally and may be impacted by the balance of competition and facilitation with existing grasses. Along the mid‐Atlantic and Gulf coasts, the native shrub Morella cerifera (wax myrtle) is rapidly expanding and displacing other native coastal species. Recent research suggests that much of this expansion is due to warming winter temperatures, as temperatures below −15°C kill M. cerifera. The objective of this project was to understand the importance of species interactions with grasses on the growth and physiology of M. cerifera at the seedling life stage through both field and laboratory experiments. In the field, grasses were removed around seedlings and microclimate and shrub physiology and growth were measured. Seeds and seedlings were experimentally frozen to measure the freeze tolerance at both life stages. We found that grasses provided ~1.3°C insulation to shrubs during winter. A freezing threshold for M. cerifera seedlings was experimentally found between −6°C and −11°C, but seeds remained viable after being frozen to the coldest ecologically relevant temperatures. Seedlings competed for light with grasses during warm months and grew more where grasses were clipped, revealing a trade‐off between winter insulation and summer light competition. Morella cerifera exhibits ecosystem engineering at the seedling stage by significantly reducing summer maximum temperatures. When seedlings are very young (less than one year), grasses appear to improve germination and seedling survival. These phenomena enable rapid expansion of M. cerifera across the landscape and likely inform shrub expansion mechanisms in other systems. Although seedlings are small and relatively vulnerable, this life stage appears to have significant implications for ecosystem trajectory in grasslands undergoing shrub encroachment

Interaction of Seed Dispersal and Environmental Filtering Affects Woody Encroachment Patterns in Coastal Grassland

Encroachment of woody plants into grasslands has occurred worldwide and includes coastal ecosystems. This conversion process is mediated by seed dispersal patterns, environmental filtering, and biotic interactions. As spatiotemporally heterogeneous, harsh environments, barrier islands present a unique set of challenges for dispersal and establishment. Environmental conditions act as filters on dispersed seeds, thereby influencing encroachment and distribution patterns. Seldom have patterns of propagule dispersal been considered in the context of woody encroachment. We quantified dispersal and post‐dispersal processes of an encroaching woody population of Morella cerifera relative to directional rate of encroachment and observed distribution patterns on an Atlantic coastal barrier island with strong environmental filtering. We analyzed historic foredune elevation as a proxy for reduced interior environmental stress. The dispersal kernel was leptokurtic, a common characteristic of expanding populations, but rate of encroachment has slowed since 2005. Expansion pattern was related to foredune elevation, which limits encroachment below a threshold elevation. This difference between dispersal kernel behavior and encroachment rate is due to limited availability of suitable habitat for Morella and temporal variability in chlorides during the time of germination. Our results demonstrate that processes mediating seeds and seedling success must be accounted for to better understand establishment patterns of encroaching woody plants

Implementing chlamydia screening: what do women think? A systematic review of the literature

BACKGROUND: Chlamydia trachomatis is a common sexually transmitted infection that can have serious consequences. It is universally agreed that screening for chlamydia infection should be offered to sexually active young women. We undertook a literature review to document the views, attitudes and opinions of women about being screened, tested and diagnosed with Chlamydia trachomatis. METHODS: Online databases (MEDLINE, Meditext, PsycINFO, Web of Science) and reference lists searched up to August 2005. Search terms: chlamydia, attitude, attitude to health, interview, qualitative, women. Eligibility criteria: about chlamydia, included women, involved interviews/surveys/focus groups, looked at women's views/opinions/attitudes, published in English. Thematic analysis identified the main and recurrent themes emerging from the literature. We compared our thematic analysis with the Theory of Planned Behaviour to provide a model that could assist in planning chlamydia screening programs. RESULTS: From 561 identified articles, 25 fulfilled inclusion criteria and were reviewed. 22: USA, UK; 3: Holland, Sweden, Australia. Major themes identified: need for knowledge and information, choice and support; concerns about confidentiality, cost, fear, anxiety and stigma. Women are more likely to find chlamydia screening/testing acceptable if they think chlamydia is a serious, common condition which can cause infertility and if they understand that chlamydia infection can be asymptomatic. Women want a range of options for chlamydia testing including urine tests, self-administered swabs, pelvic exams and clinician-collected swabs, home-testing and community-based testing. Tests should be free, easy and quick. Women want support for dealing with the implications of a chlamydia diagnosis, they feel chlamydia diagnoses need to be normalised and destigmatised and they want assistance with partner notification. Women need to know that their confidentiality will be maintained. CONCLUSION: Our review found that women from various countries and ethnic backgrounds share similar views regarding chlamydia screening, testing and diagnosis. The acknowledged importance of women's views in planning an effective chlamydia screening program is expanded in this review which details the nature and complexity of such views and considers their likely impact

Cost-effectiveness of adding indoor residual spraying to case management in Afghan refugee settlements in Northwest Pakistan during a prolonged malaria epidemic.

INTRODUCTION: Financing of malaria control for displaced populations is limited in scope and duration, making cost-effectiveness analyses relevant but difficult. This study analyses cost-effectiveness of adding prevention through targeted indoor residual spraying (IRS) to case management in Afghan refugee settlements in Pakistan during a prolonged malaria epidemic. METHODS/FINDINGS: An intervention study design was selected, taking a societal perspective. Provider and household costs of vector control and case management were collected from provider records and community survey. Health outcomes (e.g. cases and DALYs averted) were derived and incremental cost-effectiveness ratios (ICERs) for cases prevented and DALYs averted calculated. Population, treatment cost, women's time, days of productivity lost, case fatality rate, cases prevented, and DALY assumptions were tested in sensitivity analysis. Malaria incidence peaked at 44/1,000 population in year 2, declining to 14/1,000 in year 5. In total, 370,000 malaria cases, 80% vivax, were diagnosed and treated and an estimated 67,988 vivax cases and 18,578 falciparum and mixed cases prevented. Mean annual programme cost per capita was US$0.56. The additional cost of including IRS over five years per case prevented was US$39; US$50 for vivax (US$43 in years 1-3, US$80 in years 4-5) and US$182 for falciparum (US$139 in years 1-3 and US$680 in years 4-5). Per DALY averted this was US$266 (US$220 in years 1-3 and US$486 in years 4-5) and thus 'highly cost-effective' or cost-effective using WHO and comparison thresholds. CONCLUSIONS: Adding IRS was cost-effective in this moderate endemicity, low mortality setting. It was more cost-effective when transmission was highest, becoming less so as transmission reduced. Because vivax was three times more common than falciparum and the case fatality rate was low, cost-effectiveness estimations for cases prevented appear reliable and more definitive for vivax malaria

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Non‐hierarchical competition among co‐occurring woody seedlings in a resource‐limited environment

Abstract Long‐term species persistence in plant communities is contingent in part on the conditions that favor establishment and early survival. In stressful habitats, facilitated seedling establishment can enhance species richness by providing a safe‐site for species unable to establish in open microsites. However, the indirect effects of seedling competition may drive persistence in locations where seedlings occur in high density. This under‐examined dynamic can influence community recovery to stress by favoring competitively dominant species, in particular when stress increases local seedling density in favorable microsites. We present the results of a response surface experiment that examines growth responses among seedlings of Ambrosia dumosa, Eriogonum fasciculatum, and Larrea tridentata that were planted at three densities and four relative frequencies. These species co‐occur at an extensively monitored reference community located in the Colorado Desert, California, USA, where extensive drought caused unprecedented mortality that will require novel recruitment for the community to reach pre‐disturbance composition. Significant, non‐hierarchical competitive responses show that seedling survival is contingent on the species identity and density of neighboring seedlings. This result supports non‐hierarchical competition among these common species. Ambrosia and Eriogonum had faster growth rates than Larrea, but also experienced larger reductions in growth from competition than Larrea. Although drought may intensify seedling competition in favorable locations, the context dependency of competitive outcomes may permit coexistence

Long-Term Community Dynamics Reveal Different Trajectories for Two Mid-Atlantic Maritime Forests

Maritime forests are threatened by sea-level rise, storm surge and encroachment of salt-tolerant species. On barrier islands, these forested communities must withstand the full force of tropical storms, hurricanes and nor’easters while the impact is reduced for mainland forests protected by barrier islands. Geographic position may account for differences in maritime forest resilience to disturbance. In this study, we quantify two geographically distinct maritime forests protected by dunes on Virginia’s Eastern Shore (i.e., mainland and barrier island) at two time points (15 and 21 years apart, respectively) to determine whether the trajectory is successional or presenting evidence of disassembly with sea-level rise and storm exposure. We hypothesize that due to position on the landscape, forest disassembly will be higher on the barrier island than mainland as evidenced by reduction in tree basal area and decreased species richness. Rate of relative sea-level rise in the region was 5.9 ± 0.7 mm yr−1 based on monthly mean sea-level data from 1975 to 2017. Savage Neck Dunes Natural Area Preserve maritime forest was surveyed using the point quarter method in 2003 and 2018. Parramore Island maritime forest was surveyed in 1997 using 32 m diameter circular plots. As the island has been eroding over the past two decades, 2016 Landsat imagery was used to identify remaining forested plots prior to resurveying. In 2018, only plots that remained forested were resurveyed. Lidar was used to quantify elevation of each point/plot surveyed in 2018. Plot elevation at Savage Neck was 1.93 ± 0.02 m above sea level, whereas at Parramore Island, elevation was lower at 1.04 ± 0.08 m. Mainland dominant species, Acer rubrum, Pinus taeda, and Liquidambar styraciflua, remained dominant over the study period, with a 14% reduction in the total number of individuals recorded. Basal area increased by 11%. Conversely, on Parramore Island, 33% of the former forested plots converted to grassland and 33% were lost to erosion and occur as ghost forest on the shore or were lost to the ocean. Of the remaining forested plots surveyed in 2018, dominance switched from Persea palustris and Juniperus virginiana to the shrub Morella cerifera. Only 46% of trees/shrubs remained and basal area was reduced by 84%. Shrub basal area accounted for 66% of the total recorded in 2018. There are alternative paths to maritime forest trajectory which differ for barrier island and mainland. Geographic position relative to disturbance and elevation likely explain the changes in forest community composition over the timeframes studied. Protected mainland forest at Savage Neck occurs at higher mean elevation and indicates natural succession to larger and fewer individuals, with little change in mixed hardwood-pine dominance. The fronting barrier island maritime forest on Parramore Island has undergone rapid change in 21 years, with complete loss of forested communities to ocean or conversion to mesic grassland. Of the forests remaining, dominant evergreen trees are now being replaced with the expanding evergreen shrub, Morella cerifera. Loss of biomass and basal area has been documented in other low elevation coastal forests. Our results indicate that an intermediate shrub state may precede complete loss of woody communities in some coastal communities, providing an alternative mechanism of resilience

Juggling through hoops: Implementing ethics policies in applied language studies

This article reports on a collective effort to position ethics policies within the context of a specific discipline - Applied Language Studies (ALS). Through a discussion of challenges to ALS-specific pedagogical and research practices, this article highlights (1) the need for consistency across institutional Research Ethics Boards in the application of general principles of ethics review, and (2) the recognition of local considerations that are informed by disciplinary approaches not envisioned in current ethics policies. Ethics policies that are driven by substantive ethical intent will recognize pedagogical practices, research methodologies, and epistemological values and traditions that mark a discipline