The incidence of refeeding syndrome and the nutrition management of severely malnourished inpatients with eating disorders: An observational study.

OBJECTIVE: Nutritional rehabilitation and weight restoration are often critical for the treatment of eating disorders (ED), yet are restricted by the potential risk of refeeding syndrome (RFS). The primary objective was to determine the incidence of RFS. Secondary objectives were to explore predictive factors of RFS and describe its impact on treatment goals for patients with ED. METHOD: This retrospective observational study reviewed the nutrition management for patients admitted to a quaternary hospital for ED treatment from 2018 to 2020. Data were collected during the first 4 weeks of admission and included anthropometry, energy prescription, incidence and severity of RFS, and electrolyte and micronutrient prescription. Outcomes included incidence of RFS, energy prescription and advancement, and weight change. RESULTS: Of 423 ED admissions, 217 patients (median [interquartile range, IQR] age 25 [21-30.5] years; 210 [97%] female) met inclusion criteria. Median (IQR) body mass index (BMI) on admission was 15.5 (14.1-17.3) kg/m2 . The mean (standard deviation) length of admission was 35 (7.3) days. Median (IQR) initial energy prescription was 1500 (930-1500) kcal/day. Seventy-three (33%) patients developed RFS; 34 (16%) mild, 27 (12%) moderate, and 12 (5%) severe. There was no association between RFS severity and admission BMI, energy prescription, or prescription of prophylactic electrolytes or micronutrients. Lower admission weight was associated with RFS (odds ratio 0.96, 95% confidence interval [0.93-1.00], p = .035). Less than half of the participants met the weight gain target (>1 kg per week) in the first 3 weeks of admission. DISCUSSION: The incidence of severe RFS was low in this cohort and was associated with lower admission weight. PUBLIC SIGNIFICANCE: This study is one of the largest studies to utilize consensus-defined criteria to diagnose RFS among adult patients admitted for treatment of an ED. This population is still considered to be at risk of RFS and will require close monitoring. The results add to the growing body of research that restriction of energy prescription to prevent RFS may not require the level of conservatism traditionally practiced.

Wildfire facilitates upslope advance in a shade-intolerant but not a shade-tolerant conifer.

Wildfires may facilitate climate tracking of forest species moving upslope or north in latitude. For subalpine tree species, for which higher elevation habitat is limited, accelerated replacement by lower elevation montane tree species following fire may hasten extinction risk. We used a dataset of postfire tree regeneration spanning a broad geographic range to ask whether the fire facilitated upslope movement of montane tree species at the montane-to-subalpine ecotone. We sampled tree seedling occurrence in 248 plots across a fire severity gradient (unburned to >90% basal area mortality) and spanning ~500 km of latitude in Mediterranean-type subalpine forest in California, USA. We used logistic regression to quantify differences in postfire regeneration between resident subalpine species and the seedling-only range (interpreted as climate-induced range extension) of montane species. We tested our assumption of increasing climatic suitability for montane species in subalpine forest using the predicted difference in habitat suitability at study plots between 1990 and 2030. We found that postfire regeneration of resident subalpine species was uncorrelated or weakly positively correlated with fire severity. Regeneration of montane species, however, was roughly four times greater in unburned relative to burned subalpine forest. Although our overall results contrast with theoretical predictions of disturbance-facilitated range shifts, we found opposing postfire regeneration responses for montane species with distinct regeneration niches. Recruitment of shade-tolerant red fir declined with fire severity and recruitment of shade-intolerant Jeffrey pine increased with fire severity. Predicted climatic suitability increased by 5% for red fir and 34% for Jeffrey pine. Differing postfire responses in newly climatically available habitats indicate that wildfire disturbance may only facilitate range extensions for species whose preferred regeneration conditions align with increased light and/or other postfire landscape characteristics.

Productivity modifies the effects of fire severity on understory diversity.

High severity fire may promote or reduce plant understory diversity in forests. However, few empirical studies have tested long-standing theoretical predictions that productivity may help to explain observed variation in post-fire plant diversity. Support for the influence of productivity on disturbance-diversity relationships is found predominantly in experimental grasslands, while tests over large areas with natural disturbance and productivity gradients are few and have yielded inconsistent results. Here, we measured the response of post-fire understory plant diversity to natural gradients of fire severity and productivity in a large-scale observational study in California's subalpine forests. We found that plant species richness increased with increasing fire severity and that this trend was stronger at high productivity. We used plant traits to investigate whether release from competition might contribute to increasing diversity and found that short-lived and far-dispersing species benefited more from high severity fire than their long-lived and near-dispersing counterparts. For far-dispersing species only, the benefit from high severity fire was stronger in high productivity plots where unburned species richness was lowest. Our results support theoretical connections between fire severity, productivity and plant communities that are key to predicting the consequences of increasing fire severity and frequency on diversity in the coming decades.

Facultative pupal mating in Heliconius erato: Implications for mate choice, female preference, and speciation.

Mating systems have broad impacts on how sexual selection and mate choice operate within a species, but studies of mating behavior in the laboratory may not reflect how these processes occur in the wild. Here, we examined the mating behavior of the neotropical butterfly Heliconius erato in the field by releasing larvae and virgin females and observing how they mated. H. erato is considered a pupal-mating species (i.e., males mate with females as they emerge from the pupal case). However, we observed only two teneral mating events, and experimentally released virgins were almost all mated upon recapture. Our study confirms the presence of some pupal-mating behavior in H. erato, but suggests that adult mating is likely the prevalent mating strategy in this species. These findings have important implications for the role of color pattern and female mate choice in the generation of reproductive isolation in this diverse genus.