Metal-Coordinated, Dual-Crosslinked PIM Polymer Membranes for Upgraded CO2 Separation: Aging and Plasticization Resistance.

The practical use of polymers of intrinsic microporosity (PIMs) in CO2 separation is often hindered by their moderate selectivity, performance instability over time, and pressure constraints. To address these limitations, a straightforward approach is presented to enhance the CO2 separation capability of PIM-1 by incorporating metal ions into uniformly hydrolyzed PIM-1 (cPIM). This dual linking strategy, achieved via ionic and coordination bonding of metal ions with the polymeric side chains including ─COOH and ─CONH2, restructures the polymer, disrupting hydrogen bonds between cPIM chains and creating active sites for CO2 via π-complexation. This modification enhances gas permeability while maintaining high selectivity. The optimized zinc-coordinated membrane achieves an impressive CO2 permeability of ≈2,500 Barrer with CO2/N2 and CO2/CH4 selectivities of 27.1 and 23, respectively, outperforming pristine cPIM (700 Barrer; CO2/N2 = 27; CO2/CH4 = 19). Notably, this performance surpasses the 2008 Robeson upper-bound limits for both gas pairs. Additionally, the metal-coordinated membranes exhibit remarkable long-term stability, resisting aging effects for up to 20 days and maintaining anti-plasticization properties at pressures up to 20 bar. These dual-crosslinked membranes demonstrate promising potential for mixed gas separation, indicating their suitability for real-world industrial applications.

Co-created improvement goals and strategies for implementing SBIRT and MAUD in primary care settings in a facilitator-supported, tailored implementation study.

Evidence-based approaches to screening and treatment for unhealthy alcohol use have the potential to reduce morbidity and mortality but are currently underutilized in primary care settings. To support implementation of screening, brief intervention, and referral to treatment (SBIRT) and medication-assisted treatment for alcohol use disorder (MAUD) by identifying goals co-developed by clinics and practice facilitators in a flexible implementation study. In a pragmatic implementation study, we used practice facilitation to support the implementation of SBIRT and MAUD in 48 clinical practices across Oregon, Washington, and Idaho. Our study used a tailored approach, in which facilitators and clinics co-identified implementation goals based on clinic needs. We used clinic contact logs, individual interviews, group periodic reflections with practice facilitators, and exit interviews with clinic staff to inform qualitative analysis. With support from practice facilitators, clinics identified goals spanning SBIRT, MAUD, reporting, targeted patient outreach, and quality improvement capacity. Goals addressed both the technical (e.g. data tracking) and social (e.g. staff training) aspects of SBIRT and MAUD. A decision tree summarizes emergent findings into a tool to support future implementation of SBIRT in primary care settings. A facilitator-supported, tailored approach to SBIRT implementation enabled clinics to identify a variety of goals to improve SBIRT and MAUD implementation. These identified priorities, along with a decision tree describing the hierarchical structure of these goals, could support future implementation efforts.

Evidence shows that certain approaches to screening and treating unhealthy alcohol use, such as screening, brief, intervention, and referral to treatment (SBIRT) and medication-assisted treatment for alcohol use disorder (MAUD), can improve health outcomes. However, these practices are not used widely enough in primary care settings. Practice facilitators­professionals who support clinical practice change­can help clinics improve how they provide care. Our study used a flexible model in which practice facilitators and clinics worked together to identify goals for improving SBIRT and MAUD. We interviewed clinic staff and facilitators and made note of clinic communications to identify goals and the experience of clinic partners and facilitators. Identified goals included SBIRT, MAUD, reporting, targeted patient outreach, and quality improvement capacity. The facilitator-supported, tailored implementation model allowed for flexibility to meet clinic needs, but this flexibility sometimes led to confusion. Involvement of experienced facilitators and mentoring opportunities for novice staff is recommended for future studies utilizing this approach.

Experimental species removal reveals species contributions to positive pollinator-mediated reproductive interactions.

Pollinator-mediated reproductive interactions among co-flowering plant species provide a canonical example of how biotic factors may contribute to species coexistence, yet we lack understanding of the exact mechanisms. Flowering-dominant and unusually attractive "magnet species" with disproportionate contributions to pollination may play key roles in such reproductive interactions, but their relative roles within the same community have rarely been assessed. We experimentally removed either a flowering-dominant or a highly attractive magnet species and compared effects on visitation frequency, pollinator richness, and seed set of co-flowering plants. Removal of either the flowering-dominant species or the magnet species reduced community-level pollinator visitation. Removal of the magnet species had the most consistent effect, including reduced pollinator visitation and richness, and reduced seed set of most co-flowering plants. These results suggest that the magnet species, which interacts with a wider range of pollinator species than does the dominant species, promotes the visitation and reproductive fitness of most other species. Removal of the flowering-dominant species affected only certain species, perhaps because these plants had floral traits similar to the dominant species. Our results highlight the role of attractive magnet species within a community in structuring reproductive interactions and identify potential mechanisms involved in coexistence facilitated by reproductive interactions.

Champions to enhance implementation of clinical and community-based interventions in cancer: a scoping review.

BACKGROUND: Champions are integral across research in cancer, yet studies exploring their roles are limited and have produced mixed results. The current review examines and synthesizes descriptions of how champions emerged and the types of activities they most often performed. By examining evidence from across the translational research continuum, this scoping review aims to characterize the role of champions and strategies that facilitate their involvement in the implementation of cancer care interventions in both clinical and community-based settings. METHODS: This scoping review was designed and implemented in compliance with PRISMA-ScR. The review focused on peer-reviewed articles in English-language journals. We searched five databases: PubMed (including MEDLINE), Scopus (including EMBASE), CINAHL, PsycINFO, and the Cochrane Library. Articles published from 1971 to 2022 were included. Two members of the team reviewed in duplicate each article and then a single member of the team extracted the data in Covidence, with a second member comparing the extraction to the original article. Qualitative and quantitative data were extracted and then synthesized. These data were used to summarize core champion activities and implementation strategies and to characterize barriers and facilitators to using champions in research. RESULTS: A total of 74 articles were included in the review. The qualitative synthesis highlighted facilitators and barriers to the effective use of champions. Facilitators included consideration of an individual's characteristics when identifying champions, time spent planning for the specific responsibilities of champions, working within a supportive environment, and identifying champions embedded in the target setting. Major barriers included constrained time, low self-efficacy among champions, inadequate training, high turnover rates of champions, and a lack of buy-in from organizational leadership toward the intervention. Champions also were mostly assigned their roles, had varied core activities, and used complementary strategies to empower their target populations. Champions' most frequent core activities include facilitation, outreach/promotion, and recruitment of participants into studies. CONCLUSIONS: Champions were used in research of many cancer types and often serve similar roles regardless of where they are located within the translational research process. Despite their critical role, evidence is lacking on the impact of champions specifically on outcomes of many of the research studies that include them. Future research is needed to understand the nuances of champion-driven approaches across diverse cancer care settings.

The microclimatic effects of the native shrub Ephedra californica (Mormon tea) in California drylands.

Introduction: The impacts of climate change can be profound in many ecosystems worldwide, including drylands such as arid and semi-arid scrublands and grasslands. Foundation plants such as shrubs can provide microclimatic refuges for a variety of taxa. These shrubs can directly influence micro6 environmental measures, and indirectly increase the local environmental heterogeneity as a result. We examined the hypothesis that, in comparison to an open gap, foundation shrubs improve the microclimate beneath their canopy and that microclimate is in turn a significant predictor of annual vegetation. The following predictions were made: 1) mean air temperature (NSAT), ground temperature (SGT), and vapour pressure deficit (VPD) will be significantly lower under the shrubs than in the open microsites; 2) shrub canopy size predicts microclimate; 3) site-level aridity estimates and percent shrub cover influence annual plant abundance and richness; and 4) the site13 level mean of NSAT and VPD predict annual plant abundance and richness. Methods: Our study took place in Southwestern California, U.S.A. We used a handheld device with a probe to measure microclimatic variables such as near-surface air temperature (NSAT), near-surface relative humidity (NSRH), and surface ground temperature (SGT) at the shrub species Ephedra californica and in the open gap, across six sites in California, United States. Air temperature and RH were then used to calculate VPD. The mean number of vascular plant species across each site was also recorded. Results & discussion: Only SGT was significantly reduced under shrub canopies. Canopy volume was not a significant predictor of all three microclimatic variables, demonstrating that even small, low-stature shrubs can have facilitative effects. Furthermore, total shrub cover and aridity at sites significantly predicted mean plant richness and abundance. There were significantly more plants associated with shrubs and there were significantly more species associated with the open. Mean air temperature and VPD at the site-level significantly predicted vegetation abundance and richness, though microsite-level differences were only significant for richness. Foundation shrubs are a focal point of resiliency in dryland ecosystems. Understanding their impact on microclimate can inform us of better management, conservation, and restoration frameworks.

Evaluating a virtual facilitation workshop with antimicrobial stewardship teams within a cluster randomized stepped-wedge trial.

BACKGROUND: Antimicrobial stewardship programs (ASP) often function naturally as facilitators within clinical hospital settings, by working with individuals and teams to reduce unnecessary antibiotics. Within implementation science, facilitation has been studied and evaluated as an implementation strategy that can accelerate and improve fidelity to implementation efforts. This study describes a novel, virtual facilitation strategy developed and served as an intervention within the optimizing perioperative antibiotics for children trial (OPERATIC trial). This paper: (1) describes ASP team's preferences for and use of a facilitation workshop and (2) describes sustained use of facilitation skills throughout the study period. METHODS: Study participants included antimicrobial stewardship team members from the nine children's hospitals that participated in this study and completed facilitation training. All individuals who completed facilitation training were asked to evaluate the training through an online survey. Additionally, site leads were interviewed by the site coordinator every other month and asked about their team's use of facilitation skills throughout the rest of the study period. Survey data were managed and coded in R, and qualitative interview data were analyzed using rapid methodology. RESULTS: 30 individuals, including both physicians and pharmacists, completed the evaluation. Individuals largely rated themselves as novice facilitators (53%). Individuals reported satisfaction with virtual facilitation and identified different components of the workshops as valuable. An additional 108 interviews were performed throughout the study period. These interviews found that facilitators reported using all skills throughout the study period and described varied use of skills over time. All nine sites applied facilitation strategies, team building techniques, and communication/conflict skills at some point during the intervention phase. CONCLUSION: We describe the use of virtual facilitation as an acceptable and appropriate strategy to enhance facilitation skills for ASP teams working to reduce unnecessary postoperative antibiotics. Participants reported different useful components of facilitation training and described using differing facilitation skills throughout the trial. Overall, the use of facilitation skills continued throughout the duration of the study period. This paper outlines how facilitation training can be conducted virtually in a way that is feasible and acceptable to clinicians. TRIAL REGISTRATION: NCT04366440, April 24, 2020.

Population monitoring and conservation implications of intra- and interspecific nest occupation rates in swallows.

With the exception of a few groups of birds, such as large raptors and colonial seabirds, direct counts of nests cannot be conducted over very large areas for most of the abundant and widely distributed species, and thus indirect methods are used to estimate their relative abundances and population sizes. However, many species of the Family Hirundinidae (swallows and martins) build their mud nests in discrete, predictable and accessible sites, which are reused across years. Therefore, the direct count of active nests could constitute a reliable method for estimating breeding population sizes and their changes at large spatial and temporal scales. We illustrate the feasibility of this monitoring approach through a single year survey of >2700 nests of three coexisting Old-World species, the barn swallow (Hirundo rustica), the red-rumped swallow (Cecropis daurica), and the crag martin (Ptyonoprogne rupestris), distributed across Portugal and Spain. Our results revealed changes in the use of nesting substrates and increases in interspecific nest usurpation rates over recent decades. While 56% of the nests of C. daurica were located in rocks five decades ago, almost 100% are nowadays located in anthropogenic substrates such as bridges, road culverts, and abandoned buildings, which could have favored the range expansion of this species. Nest occupation rates were surprisingly low (12% in C. daurica, 21% in H. rustica, and 37% in P. rupestris), and the proportion of abandoned nesting sites was very high (65% in C. daurica, 50% in H. rustica, and 27% in P. rupestris). Abandonment rates reflect the population decline reported for H. rustica. Notably, the usurpation of nests of C. daurica by house sparrows Passer domesticus, which is the main cause of breeding failure, has increased from 2.4% in 1976-1979 to 34.7% of the nests nowadays. The long-term monitoring of nests may constitute a reliable and affordable method, with the help of citizen science, for assessing changes in breeding population sizes and conservation threats of these and other mud-nest building hirundines worldwide.

Generalization in perceptual learning across stimuli and tasks.

Perceptual learning, known to improve visual perception, demonstrates the plasticity of brain processes underlying vision. Early studies, using the backward-masked texture discrimination task (TDT), focused on the lack of generalizing learning to stimulus features, relating learning specificity to the selectivity of the brain networks involved in the visual task. Learning was found to be highly specific to the stimulus features, as expected from the processing selectivity found in early visual areas as well as to the task employed in training, pointing to top-down effects. More recent studies demonstrate the generalization of learning to untrained features under specifically designed training procedures. Here we suggest that transfer of learning takes place when the trained and untrained stimuli and task activate overlapping brain processes. We tested the effect of TDT learning, under conditions with and without visual adaptation, on the contrast detection (CD) of localized Gabor targets, either alone or backward masked (BM). At the TDT peripheral-target location, we found that the transfer of learning between TDT to CD and BM occurs under the TDT adaptation condition, but not under the no-adaptation condition, whereas at the TDT center-target location we found that transfer occurs for both conditions. Our results suggest that learning generalization across experimental conditions depends on overlapping neural processes within brain networks, here dominated by the inhibitory effects involved in adaptation and in spatiotemporal masking. Importantly, increased adaptation during training, due to increased stimulus consistency, enabled the transfer of learning to other tasks limited by sensory adaptation.

Positive interactions and interdependence in communities.

Facilitative interactions play crucial roles in community organization, and the stress gradient hypothesis (SGH) provides a simple conceptual framework for the context-dependency of competitive and facilitative interactions. The idea is that positive interactions are more common under high physical and consumer stress, where species benefit from stress-tolerant neighbors, than in benign environments. We explore insights from the SGH into ecological generality, niche theory, community assembly, and diversity effects on ecosystem function and discuss how the SGH can inform our understanding of rapid evolution, mutualisms, exotic invasions, and facilitation cascades. We suggest that, with escalating global stresses, the SGH may provide a conceptual template for an interdependent perspective in ecology that can contribute to conservation and restoration efforts.

A neural circuit from thalamic paraventricular nucleus via zona incerta to periaqueductal gray for the facilitation of neuropathic pain.

Top-down projections transmit a series of signals encoding pain sensation to the ventrolateral periaqueductal gray (vlPAG), where they converge with various incoming projections to regulate pain. Clarifying the upstream regulatory hierarchy of vlPAG can enhance our understanding of the neural circuitry involved in pain modulation. Here, we show that a in a mouse model of spared nerve injury (SNI), activation of a circuit arising from posterior paraventricular thalamic nucleus CaMKIIα-positive neurons (PVPCaMKIIα) projects to gamma-aminobutyric acid neurons in the rostral zona incerta (ZIrGABA) to facilitate the development of pain hypersensitivity behaviors. In turn, these ZIrGABA neurons project to CaMKIIα-positive neurons in the vlPAG (vlPAGCaMKIIα), a well-known neuronal population involved in pain descending modulation. In vivo calcium signal recording and whole-cell electrophysiological recordings reveal that the PVPCaMKIIα→ZIrGABA→vlPAGCaMKIIα circuit is activated in SNI models of persistent pain. Inhibition of this circuit using chemogenetics or optogenetics can alleviate the mechanical pain behaviors. Our study indicates that the PVPCaMKIIα→ZIrGABA→vlPAGCaMKIIα circuit is involved in the facilitation of neuropathic pain. This previously unrecognized circuit could be explored as a potential target for neuropathic pain treatment.

Factors influencing patient engagement in decision making for catheter ablation of atrial fibrillation: a cross-sectional survey.

AIMS: Patient engagement in decision making could improve healthcare quality and health outcome, which has been emphasized in atrial fibrillation (AF) management guidelines. However, patients report relatively low level of engagement in decision making for catheter ablation (CA). Therefore, this study aims to explore the influencing factors of AF patient engagement in decision making for CA. METHODS AND RESULTS: A cross-sectional study was conducted. A total of 836 patients were recruited from six tertiary hospitals in Shanghai. Adapted version of the Control Preferences Scale, Chinese version of the All Aspects of Health Literacy Scale, Chinese version of the Facilitation of Patient Involvement Scale and the Atrial Fibrillation Knowledge Questionnaire were used to measure patient engagement in decision making, health literacy, perception of physician facilitation and AF knowledge, respectively. Of the 750 patients who returned valid questionnaires, 20.2% of the patients reported active engagement in decision making, 39.5% reported collaborative engagement, and 40.3% reported passive engagement. Compared with patients perceiving passive engagement, those with collaborative or active engagement were more likely to be female, have higher income, moderate EHRA class (II and III), higher perception of physician facilitation, higher health literacy and higher AF knowledge (P＜0.05 for all). The collaborative engagement group exhibited a shorter AF duration. CONCLUSION: The degree of patient engagement in CA decision making varied, with most perceiving passive engagement. Patient engagement in decision making was influenced by gender, income, duration of AF, EHRA class, perception of physician facilitation, health literacy and AF knowledge.

Facilitating Family Carer Dementia Education: We All Need to Learn.

BACKGROUND/OBJECTIVES: The importance of family carer dementia education is highlighted in research, practice guidance, and policy. Less attention is paid to how facilitators learn and prepare for their role. This research aimed to explore and describe facilitator learning experiences within a bespoke Scottish Carers' Academy designed around a theory-guided approach called Care Empathia. A healthcare and university partnership ensured integration with services and the fusion of dementia higher education know-how with clinical practice expertise. METHODS: Nineteen facilitator questionnaires were completed from two Carer Academy hubs; thirteen participated in online focus groups. RESULTS: The questionnaire findings highlighted the learning gained from being a facilitator, observing expert facilitators in action, and listening to the testimonies of family carers. The framework analysis of the focus group data identified six themes, including safe learning approaches, the art of facilitation, emotional work, team learning, and leadership. These findings highlight the importance of facilitator preparation and the advantages of co-delivery models that combine clinical and practice education expertise. CONCLUSION: Facilitators need to understand how to walk the talk of theory-guided educational models, be open to reciprocity in learning, and be prepared for the emotional work of delivering trauma-informed practical dementia care education to family carers.

Remembering change: Interdependence between change awareness and meaningful connection in achieving proactive facilitation.

Two experiments investigated proactive facilitation (PF) or proactive interference (PI) in the recall of recently learned targets, under conditions of assessing the detection and recollection of target changes across two learning phases (with A-B/A-D word pairs). Some changes established meaningful connections across the phases; others did not. Task instructions on the subsequent cued-recall test (Experiment 1) or during Phase 2 study (Experiment 2) guided participants (university students) to monitor and report the changes. Accuracy in cued recall conditionalized on measures of change awareness replicated previous findings in establishing conditions for PF and PI. However, PF was much reduced for unconnected materials. Moreover, when change recollection failed, PI occurred even under conditions of meaningful connections (Experiment 1). Discussion emphasizes this interdependence of meaningfulness of connections and change awareness in influencing whether and how memory for earlier events affects memory for more recent ones.

Root puppet masters: Infauna shift trait-productivity relationships in submerged aquatic vegetation communities.

Submerged aquatic vegetation (SAV) growth can be limited by light and nutrient availability. Infauna are common inhabitants of SAV meadows. Their activity increases nutrient mobility, and they can positively affect plant growth, but we do not know their role in plant trait-biomass production relationships. We approached this problem using a 15-week in situ transplant experiment in the Baltic Sea with experimental additions of Macoma balthica, a sedentary bivalve, to experimental SAV communities. Experimental plant communities were tricultures with varying species composition, compiled from a pool of six different species, to create an experimental gradient of trait community weighted means that allowed us to detect changes more clearly in plant trait-biomass production relationships in response to the M. balthica treatment. We evaluated the relationships between plant height, leaf area, maximum root length (MMRL), specific root length (SRL), and SAV biomass production, then compared M. balthica condition index (soft tissue biomass [WW, mg]/valve length [mm]) to plant community leaf tissue nutrient concentrations (N (%DW), δ15N). Community biomass production was significantly related to plant height in the control treatment, but this relationship was decoupled in the M. balthica treatment, where community biomass production was instead significantly related to MMRL and SRL. This suggested a shift in the predominant SAV growth strategy, from height-related to root-related community biomass production. Leaf tissue δ15N was significantly related to M. balthica condition index. The growth of one species, Potamogeton perfoliatus, was significantly inhibited by the M. balthica treatment. Our results show that infauna have an important role in the plant traits related to community biomass production, and they have the potential to shape plant community structure via selective influences on different plant species.

The Impact of Microbial Interactions on Ecosystem Function Intensifies Under Stress.

A major challenge in ecology is to understand how different species interact to determine ecosystem function, particularly in communities with large numbers of co-occurring species. We use a trait-based model of microbial litter decomposition to quantify how different taxa impact ecosystem function. Furthermore, we build a novel framework that highlights the interplay between taxon traits and environmental conditions, focusing on their combined influence on community interactions and ecosystem function. Our results suggest that the ecosystem impact of a taxon is driven by its resource acquisition traits and the community functional capacity, but that physiological stress amplifies the impact of both positive and negative interactions. Furthermore, net positive impacts on ecosystem function can arise even as microbes have negative pairwise interactions with other taxa. As communities shift in response to global climate change, our findings reveal the potential to predict the biogeochemical functioning of communities from taxon traits and interactions.

A community-based peer-facilitated psychological and social support model to improve retention in care among Cameroonian adolescents perinatally infected with human immunodeficiency virus: A randomized controlled trial.

BACKGROUND: Psychological and social support for adolescents living with HIV remains undocumented and unaddressed in Central Africa. This study aimed at assessing effectiveness of a peer-facilitated community-based support model in improving retention in care among adolescents living with HIV and attending care in Chantal Biya Foundation, Yaounde, Cameroon. MATERIALS AND METHODS: We conducted an analysis of adolescents aged 10-19 years old, perinatally infected with HIV, on follow-up in the Day Care Unit of a reference hospital in Yaounde, Cameroon, and enrolled in the IAS-CIPHER-2021/1214-ATE-SMAVI, a individually randomized controlled trial. While the control arm only received routine care in the health facility, the intervention arm, in addition, was assigned to an HIV association for sustained support model, including support groups, leisure workshops and home visits. Structured questionnaires, including validated French versions of mental health scales, were quarterly administered to the study participants in both study arms by trained healthcare providers. The main outcome was maintaining retention in care beyond the first 15-month period of the study start. Kaplan-Meier and Cox regression models were fitted to assess association between intervention and outcome. Hazard Ratio (HR) across categories of exposure variables were compared using Wald's test. p-value <0.05 was considered significant. RESULTS: In total, 305 adolescents were recruited in the study at a median age of 15.2 years old, including 162 (53.1 %) females and 153 individuals in the intervention arm. Mental health troubles were prevalent: severe depression (26.9 %), high or very high anxiety (28.9 %), and low self-esteem (84.9 %). Noteworthy, all of the baseline characteristics were balanced irrelevant to the study arm. Probability of maintaining good retention in care beyond the first 15-month period of study start remained higher in the intervention arm (82.0 % [95 %CI: 73.7 %-88.4 %]) versus the control arm (71.0 % [95 %CI: 63.2 %-78.1 %]), [cHR (95 %CI): 2.0 (1.1-3.3), p=0.044]. CONCLUSIONS: Capacity should be built in terms of implementing community-based peer-facilitated support groups in local organizations providing care to adolescents living with HIV.

Virtual practice facilitation as an implementation strategy for launching opioid safety committees for quality improvement in primary care: feasibility, acceptability, and intervention fidelity.

BACKGROUND: Practice facilitation (PF) is an evidence-based multicomponent in-person implementation strategy. COVID-19-related lockdowns caused many implementation initiatives to rapidly shift to virtual settings, but there is limited evidence on PF deployed exclusively using virtual meeting platforms. Our objective was to assess the feasibility and acceptability of virtual PF used in a primary care setting to implement interdisciplinary opioid safety committees (OSCs) to improve care for patients using opioid medicines for persistent pain and reduce high-dose opioid prescribing. We also describe alignment of virtual PF with the core functions of PF and fidelity of participating clinics to the OSC intervention. METHODS: We applied qualitative and quantitative methods to evaluate virtual PF used to implement a quality improvement project at Kaiser Permanente Washington, an integrated health system in Washington State. We established interdisciplinary OSCs in primary care clinics using virtual PF. OSCs were tasked with promoting opioid safety and high-quality pain care through population management and chart reviews. We used administrative data to calculate feasibility measures including attendance and retention. Acceptability data came from interviews with OSC members conducted by evaluators. Measures of fidelity to the OSC intervention were abstracted from meeting notes and administrative data. We used qualitative methods to assess the adherence of virtual PF to the core functions of PF. RESULTS: Facilitators carried out a comprehensive PF approach virtually and demonstrated adherence to the core functions of PF. We established OSCs in eight clinics and conducted an average of 17.5 virtual PF meetings over eight months of PF for each clinic. Average attendance was 75% and we had 84% retention. OSC members were highly satisfied with virtual PF. Facilitators effectively supported teams through implementation and technical challenges and OSC members gained skills through virtual PF. We implemented OSCs with high fidelity, suggesting virtual PF is an effective implementation strategy. CONCLUSIONS: We found virtual PF is a feasible and acceptable implementation strategy for this intervention and identified strategies to support care teams through challenges. Our findings can help inform future implementation efforts, especially those hoping to engage geographically dispersed clinics or remote clinical staff. TRIAL REGISTRATION: Not applicable.

Phenology mediates direct and indirect interactions among co-occurring invasive plant species.

Why nonnative invasive plant species commonly co-occur, despite their competitive superiority and propensity to displace native species, remains a paradox in invasion biology. Negative interactions among competitively dominant invaders are potentially alleviated by two understudied mechanisms: seasonal priority effects, where phenological separation weakens the effect of competition on species with early phenology; and indirect facilitation, where competition between two species is mitigated by a third species. Although phenological separation has been speculated as a mechanism for explaining co-occurrence patterns of invasive plants, it has never been directly tested. In a greenhouse experiment, we tested the effect of phenological separation on direct and indirect interactions between three co-occurring invasive plant species found in the riparian forests of North America. These species have distinct natural phenological separation with reproduction in early spring (Ficaria verna), mid-spring (Alliaria petiolata), and late summer (Microstegium vimineum). When phenology was experimentally synchronized, direct pairwise interactions among invasive species were overwhelmingly negative, asymmetric, and unlikely to promote co-occurrence. However, increasing phenological separation generated seasonal priority effects, which weakened the effect of competition on species with early phenology. Furthermore, the addition of a third species generated indirect facilitative effects, which balanced competitive outcomes among the two weakest competitors. Based on these findings, we conclude that phenological separation modulates the strength of both seasonal priority effects and indirect facilitation within species interaction networks and may promote the co-occurrence of three common invasive species within this study system. We articulate how future studies can test the external validity of these findings in more complex environmental conditions and with a larger range of invasive plants.

Topographic heterogeneity triggers complementary cascades that enhance ecosystem multifunctionality.

Topographic heterogeneity sets the stage for community assembly, but its effects on ecosystem functioning remain poorly understood. Here, we test the hypothesis that topographic heterogeneity underpins multiple cascading species interactions and functional pathways that indirectly control multifunctionality. To do so, we combined experimental manipulation of a form of topographic heterogeneity on rocky shores (holes of various sizes) with a comprehensive assessment of naturally assembled communities and multifunctionality. Structural equation modeling indicated that heterogeneity: (1) enhanced biodiversity by supporting filter feeder richness; (2) triggered a facilitation cascade via reef-forming (polychaete) and biomass-dominant (macroalga) foundation species, which in turn broadly supported functionally diverse epibiotic and understory assemblages; and (3) inhibited a key consumer (limpet). The model supported that these mechanisms exerted complementary positive effects on individual functions (e.g., water filtration, ecosystem metabolism, nutrient uptake) and, in turn, collectively enhanced multifunctionality. Topographic heterogeneity may therefore serve as a cornerstone physical attribute by initiating multiple cascades that propagate through ecological communities via foundation species, ultimately manifesting disproportionate effects on ecosystem multifunctionality.