Interacting ecological filters influence success and functional composition in restored plant communities over time.

A trait-based community assembly framework has great potential to direct ecological restoration, but uncertainty over how traits and environmental factors interact to influence community composition over time limits the widespread application of this approach. In this study, we examined how the composition of seed mixes and environment (north- vs. south-facing slope aspect) influence functional composition and native plant cover over time in restored grassland and shrubland communities. Variation in native cover over 4 years was primarily driven by species mix, slope aspect, and a species mix by year interaction rather than an interaction between species mix and slope aspect as predicted. Although native cover was higher on wetter, north-facing slopes for most of the study, south-facing slopes achieved a similar cover (65%-70%) by year 4. While community-weighted mean (CWM) values generally became more resource conservative over time, we found shifts in particular traits across community types and habitats. For example, CWM for specific leaf area increased over time in grassland mixes. Belowground, CWM for root mass fraction increased while CWM for specific root length decreased across all seed mixes. Multivariate functional dispersion remained high in shrub-containing mixes throughout the study, which could enhance invasion resistance and recovery following disturbance. Functional diversity and species richness were initially higher in drier, south-facing slopes compared to north-facing slopes, but these metrics were similar across north- and south-facing slopes by the end of the 4-year study. Our finding that different combinations of traits were favored in south- and north-facing slopes and over time demonstrates that trait-based approaches can be used to identify good restoration candidate species and, ultimately, enhance native plant cover across community types and microhabitat. Changing the composition of planting mixes based on traits could be a useful strategy for restoration practitioners to match species to specific environmental conditions and may be more informative than using seed mixes based on growth form, as species within functional groups can vary tremendously in leaf and root traits.

Embedding Chaplaincy Services in Primary Care for Immigrants, Refugees and Asylum Seekers: A Boston Pilot Intervention.

This Boston-based pilot research was an exploratory study that integrated outpatient chaplaincy into a refugee and immigrant health primary care clinic. Patients were screened for spiritual distress and offered a meeting with chaplaincy interns. Forty-eight patients were seen in clinic, 28 were screened, and 9 met with a chaplain. Most frequent domains of spiritual distress were grief (n = 8), feelings of abandonment (n = 5), guilt (n = 4), betrayal (n = 4), fear of death (n = 3), shame (n = 3), and trust (n = 3). Faith was relevant to treatment decision-making for 6 patients. It was found that outpatient chaplaincy services are a feasible intervention to address spiritual distress in immigrant and refugee patients.

A Logic Model Framework for Planning an International Refugee Health Research, Evaluation, and Ethics Committee.

Collaborative approaches to supporting the health of refugees and other newcomer populations in their resettlement country are needed to address the complex medical and social challenges they may experience after arrival. Refugee health professionals within the Society of Refugee Healthcare Providers (SRHP)-the largest medical society dedicated to refugee health in North America-have expressed interest in greater research collaborations across SRHP membership and a need for guidance in conducting ethical research on refugee health. This article describes a logic model framework for planning the SRHP Research, Evaluation, and Ethics Committee. A logic model was developed to outline the priorities, inputs, outputs, outcomes, assumptions, external factors, and evaluation plan for the committee. The short-term outcomes include (1) establish professional standards in refugee health research, (2) support evaluation of existing refugee health structures and programs, and (3) establish and disseminate an ethical framework for refugee health research. The SRHP Research, Evaluation, and Ethics Committee found the logic model to be an effective planning tool. The model presented here could support the planning of other research committees aimed at helping to achieve health equity for resettled refugee populations.

Forensic evaluation of alleged wrist restraint/handcuff injuries in survivors of torture utilizing the Istanbul Protocol.

Despite being a common form of abuse, there is a paucity of literature describing shackling and wrist restraint injuries among survivors of torture. Forensic evaluation of alleged wrist restraint/handcuff injuries in survivors of torture presents challenges to the evaluator, especially if the injuries are remote and do not leave lasting marks nor neurologic deficits. Thorough history-taking and physical examination are critical to effective forensic documentation. Guidance is provided in The Manual on Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (Istanbul Protocol), the gold standard for the medicolegal documentation of torture. This guidance relies primarily on physical findings, with less direction provided on how to interpret historical evidence or when historical evidence provided by the patient can be interpreted as highly consistent with alleged injury in the absence of current physical findings. Through a case-based review, we present diagnostic strategies for the evaluation of alleged abuse involving wrist restraints/handcuffs, focusing on skin, neurologic, and osseous injuries. We highlight key findings from both the history and physical examination that will allow the evaluator to improve the accuracy of their expert medical opinion on the degree to which medical findings correlate with the patient's allegations of wrist restraint injuries.

Lymphedema Incidence After Axillary Lymph Node Dissection: Quantifying the Impact of Radiation and the Lymphatic Microsurgical Preventive Healing Approach.

BACKGROUND: Axillary surgery and radiotherapy are important aspects of breast cancer treatment associated with development of lymphedema. Studies demonstrate that Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) may greatly reduce the incidence of lymphedema in high-risk groups. The objective of this study is to summarize the evidence relating lymphedema incidence to axillary lymph node dissection (ALND), regional lymph node radiation (RLNR) therapy, and LYMPHA. METHODS: We performed a literature search to identify studies involving breast cancer patients undergoing ALND with or without RLNR. Our primary outcome was the development of lymphedema. We analyzed the effect of LYMPHA on lymphedema incidence. We chose the DerSimonian and Laird random-effects meta-analytic model owing to the clinical, methodological, and statistical heterogeneity of studies. RESULTS: Our search strategy yielded 1476 articles. After screening, 19 studies were included. Data were extracted from 3035 patients, 711 of whom had lymphedema. The lymphedema rate was significantly higher when RLNR was administered with ALND compared with ALND alone (P < 0.001). The pooled cumulative incidence of lymphedema was 14.1% in patients undergoing ALND versus 2.1% in those undergoing LYMPHA and ALND (P = 0.029). The pooled cumulative incidence of lymphedema was 33.4% in those undergoing ALND and RLNR versus 10.3% in those undergoing ALND, RLNR, and LYMPHA (P = 0.004). CONCLUSION: Axillary lymph node dissection and RLNR are important interventions to obtain regional control for many patients but were found to constitute an increased risk of development of lymphedema. Our findings support that LYMPHA, a preventive surgical technique, may reduce the risk of breast cancer-related lymphedema in high-risk patients.

Within-and among-year germination in Sonoran Desert winter annuals: bet hedging and predictive germination in a variable environment.

In variable environments, organisms must have strategies to ensure fitness as conditions change. For plants, germination can time emergence with favourable conditions for later growth and reproduction (predictive germination), spread the risk of unfavourable conditions (bet hedging) or both (integrated strategies). Here we explored the adaptive value of within- and among-year germination timing for 12 species of Sonoran Desert winter annual plants. We parameterised models with long-term demographic data to predict optimal germination fractions and compared them to observed germination. At both temporal scales we found that bet hedging is beneficial and that predicted optimal strategies corresponded well with observed germination. We also found substantial fitness benefits to varying germination timing, suggesting some degree of predictive germination in nature. However, predictive germination was imperfect, calling for some degree of bet hedging. Together, our results suggest that desert winter annuals have integrated strategies combining both predictive plasticity and bet hedging.

Altered water and nitrogen input shifts succession in a southern California coastal sage community.

Vegetation-type conversions between grasslands and shrublands have occurred worldwide in semiarid regions over the last 150 years. Areas once covered by drought-deciduous shrubs in Southern California (coastal sage scrub) are converting to grasslands dominated by nonnative species. Increasing fire frequency, drought, and nitrogen deposition have all been hypothesized as causes of this conversion, though there is little direct evidence. We constructed rain-out shelters in a coastal sage scrub community following a wildfire, manipulated water and nitrogen input in a split-plot design, and collected annual data on community composition for four years. While shrub cover increased through time in all plots during the postfire succession, both drought and nitrogen significantly slowed recovery. Four years after the fire, average native shrub cover ranged from over 80% in water addition, ambient-nitrogen plots to 20% in water reduction, nitrogen addition plots. Nonnative grass cover was high following the fire and remained high in the water reduction plots through the third spring after the fire, before decreasing in the fourth year of the study. Adding nitrogen decreased the cover of native plants and increased the cover of nonnative grasses, but also increased the growth of one crown-sprouting shrub species. Our results suggest that extreme drought during postfire succession may slow or alter succession, possibly facilitating vegetation-type conversion of coastal sage scrub to grassland. Nitrogen addition slowed succession and, when combined with drought, significantly decreased native cover and increased grass cover. Fire, drought, and atmospheric N deposition are widespread aspects of environmental change that occur simultaneously in this system. Our results imply these drivers of change may reinforce each other, leading to a continued decline of native shrubs and conversion to annual grassland.

Appendicitis as the presenting manifestation of Kawasaki disease.

In cases of Kawasaki's disease (KD) presenting as acute surgical abdomen, rarely has the presence of acute appendicitis been found. We report two cases of histologically confirmed acute appendicitis in the presence of KD and a review of the literature as it pertains to acute abdomen and atypical presentations of KD.

Guiding Principles for Writing About Immigrants and Immigrant Health.

This perspective identifies harmful phrasing and frames in current clinician and researcher work relating to immigrant health and provides equity-centered alternatives. Recommendations are organized within two broad categories, one focused on shifting terminology toward more humanizing language and the second focused on changing frames around immigration discourse. With regards to shifting terminology, this includes: 1) avoiding language that conflates immigrants with criminality (i.e., "illegal"); 2) using person-first language (i.e., "person applying for asylum" or "detained person" rather than "asylum-seeker" or "detainee"); 3) avoiding comparisons to "native" populations to mean non-foreign-born populations, as this contributes to the erasure of Native Americans and indigenous people; 4) avoiding hyperbolic and stigmatizing "crisis" language about immigrants; and 5) understanding inherent limitations of terms like "refugee," "asylum seeker," "undocumented" that are legal not clinical terms. With regards to challenging dominant frames, recommendations include: 6) avoiding problematization of certain borders compared to others (i.e., U.S.-Mexico versus U.S.- Canada border) that contributes to selectively subjecting people to heightened surveillance; 7) recognizing the heterogeneity among immigrants, such as varying reasons for migration along a continuum of agency, ranging from voluntary to involuntary; 8) avoiding setting up a refugee vs. migrant dichotomy, such that only the former is worthy of sympathy; and 9) representing mistrust among immigrants as justified, instead shifting focus to clinicians, researchers, and healthcare systems who must build or rebuild trustworthiness. Ensuring inclusive and humanizing language use and frames is one critical dimension of striving for immigrant health equity.

Hepatitis C treatment outcomes among people who inject drugs experiencing unstable versus stable housing: Systematic review and meta-analysis.

BACKGROUND: The prevalence of hepatitis C virus (HCV) among people who inject drugs (PWID) is between 50-70%. Prior systematic reviews demonstrated that PWID have similar direct acting antiviral treatment outcomes compared to non-PWID; however, reviews have not examined treatment outcomes by housing status. Given the links between housing and health, identifying gaps in HCV treatment can guide future interventions. METHODS: We conducted a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched six databases for articles from 2014 onward. Two reviewers conducted title/abstract screenings, full-text review, and data extraction. We extracted effect measures for treatment initiation, adherence, completion, success, and reinfection by housing status. Studies underwent quality and certainty assessments, and we performed meta-analyses as appropriate. RESULTS: Our search yielded 473 studies, eight of which met inclusion criteria. Only the treatment initiation outcome had sufficient measures for meta-analysis. Using a random-effects model, we found those with unstable housing had 0.40 (0.26, 0.62) times the odds of initiating treatment compared to those with stable housing. Other outcomes were not amenable for meta-analysis due to a limited number of studies or differing outcome definitions. CONCLUSIONS: Among PWID, unstable housing appears to be a barrier to HCV treatment initiation; however, the existing data is limited for treatment initiation and the other outcomes we examined. There is a need for more informative studies to better understand HCV treatment among those with unstable housing. Specifically, future studies should better define housing status beyond a binary, static measure to capture the nuances and complexity of housing and its subsequent impact on HCV treatment. Additionally, researchers should meaningfully consider whether the outcome(s) of interest are being accurately measured for individuals experiencing unstable housing.

COVID-19 vaccination uptake and determinants of booster vaccination among persons who inject drugs in New York City.

BACKGROUND: Persons who inject drugs (PWID) may be unengaged with healthcare services and face an elevated risk of severe morbidity and mortality associated with COVID-19 due to chronic diseases and structural inequities. However, data on COVID-19 vaccine uptake, particularly booster vaccination, among PWID are limited. We examined COVID-19 vaccine uptake and factors associated with booster vaccination among PWID in New York City (NYC). METHODS: We recruited PWID using respondent-driven sampling from October 2021 to November 2023 in a survey that included HIV and SARS-CoV-2 antibodies testing. The questionnaire included demographics, COVID-19 vaccination and attitudes, and drug use behaviors. RESULTS: Of 436 PWID, 80% received at least one COVID-19 vaccine dose. Among individuals who received at least one COVID-19 vaccine dose, 95% were fully vaccinated. After excluding participants recruited before booster authorization for general adults started in NYC, and those who had never received an initial vaccination, 41% reported having received a COVID-19 booster vaccine dose. COVID-19 booster vaccination was significantly associated with having a high school diploma or GED (adjusted odds ratio (aOR) 1.93; 95% confidence interval (CI) 1.09, 3.48), ever received the hepatitis A/B vaccine (aOR 2.23; 95% CI 1.27, 3.96), main drug use other than heroin/speedball, fentanyl and stimulants (aOR 14.4; 95% CI 2.32, 280), number of non-fatal overdoses (aOR 0.35; 95% CI 0.16, 0.70), and mean vaccination attitude score (aOR 0.94; 95% CI 0.89, 0.98). CONCLUSIONS: We found a suboptimal level of COVID-19 booster vaccination among PWID, which was consistent with the rates observed in the general population in NYC and the U.S. Community-based interventions are needed to improve COVID-19 booster vaccination access and uptake among PWID. Attitudes towards vaccination were significant predictors of both primary and booster vaccination uptake. Outreach efforts focusing on improving attitudes towards vaccination and educational programs are essential for reducing hesitancy and increasing booster vaccination uptake among PWID.

Long-term drought promotes invasive species by reducing wildfire severity.

Anthropogenic climate change has increased the frequency of drought, wildfire, and invasions of non-native species. Although high-severity fires linked to drought can inhibit recovery of native vegetation in forested ecosystems, it remains unclear how drought impacts the recovery of other plant communities following wildfire. We leveraged an existing rainfall manipulation experiment to test the hypothesis that reduced precipitation, fuel load, and fire severity convert plant community composition from native shrubs to invasive grasses in a Southern California coastal sage scrub system. We measured community composition before and after the 2020 Silverado wildfire in plots with three rainfall treatments. Drought reduced fuel load and vegetation cover, which reduced fire severity. Native shrubs had greater prefire cover in added water plots compared to reduced water plots. Native cover was lower and invasive cover was higher in postfire reduced water plots compared to postfire added and ambient water plots. Our results demonstrate the importance of fuel load on fire severity and plant community composition on an ecosystem scale. Management should focus on reducing fire frequency and removing invasive species to maintain the resilience of coastal sage scrub communities facing drought. In these communities, controlled burns are not recommended as they promote invasive plants.

Phenotypic selection favors missing trait combinations in coexisting annual plants.

Trade-offs among traits are important for maintaining biodiversity, but the role of natural selection in their construction is not often known. It is possible that trade-offs reflect fundamental constraints, negative correlational selection, or directional selection operating on costly, redundant traits. In a Sonoran Desert community of winter annual plants, we have identified a trade-off between relative growth rate and water-use efficiency among species, such that species with high relative growth rate have low water-use efficiency and vice versa. We measured selection on water-use efficiency, relative growth rate, and underlying traits within populations of four species at two study sites with different average climates. Phenotypic trait correlations within species did not match the among-species trade-off. In fact, for two species with high water-use efficiency, individuals with high relative growth rate also had high water-use efficiency. All populations experienced positive directional selection for water-use efficiency and relative growth rate. Selection tended to be stronger on water-use efficiency at the warmer and drier site, and selection on relative growth rate tended to be stronger at the cooler and wetter site. Our results indicate that directional natural selection favors a phenotype not observed among species in the community, suggesting that the among-species trade-off could be due to pervasive genetic constraints, perhaps acting in concert with processes of community assembly.

Understanding past, contemporary, and future dynamics of plants, populations, and communities using Sonoran Desert winter annuals.

Global change requires plant ecologists to predict future states of biological diversity to aid the management of natural communities, thus introducing a number of significant challenges. One major challenge is considering how the many interacting features of biological systems, including ecophysiological processes, plant life histories, and species interactions, relate to performance in the face of a changing environment. We have employed a functional trait approach to understand the individual, population, and community dynamics of a model system of Sonoran Desert winter annual plants. We have used a comprehensive approach that connects physiological ecology and comparative biology to population and community dynamics, while emphasizing both ecological and evolutionary processes. This approach has led to a fairly robust understanding of past and contemporary dynamics in response to changes in climate. In this community, there is striking variation in physiological and demographic responses to both precipitation and temperature that is described by a trade-off between water-use efficiency (WUE) and relative growth rate (RGR). This community-wide trade-off predicts both the demographic and life history variation that contribute to species coexistence. Our framework has provided a mechanistic explanation to the recent warming, drying, and climate variability that has driven a surprising shift in these communities: cold-adapted species with more buffered population dynamics have increased in relative abundance. These types of comprehensive approaches that acknowledge the hierarchical nature of biology may be especially useful in aiding prediction. The emerging, novel and nonstationary climate constrains our use of simplistic statistical representations of past plant behavior in predicting the future, without understanding the mechanistic basis of change.

Water-use efficiency and relative growth rate mediate competitive interactions in Sonoran Desert winter annual plants.

PREMISE OF THE STUDY: A functional approach to investigating competitive interactions can provide a mechanistic understanding of processes driving population dynamics, community assembly, and the maintenance of biodiversity. In Sonoran Desert annual plants, a trade-off between relative growth rate (RGR) and water-use efficiency (WUE) contributes to species differences in population dynamics that promote long-term coexistence. Traits underlying this trade-off explain variation in demographic responses to precipitation as well as life history and phenological patterns. Here, we ask how these traits mediate competitive interactions. • METHODS: We conducted competition trials for three species occupying different positions along the RGR-WUE trade-off axis and compared the effects of competition at high and low soil moisture. We compared competitive effect (ability to suppress neighbors) and competitive response (ability to withstand competition from neighbors) among species. • KEY RESULTS: The RGR-WUE trade-off predicted shifts in competitive responses at different soil moistures. The high-RGR species was more resistant to competition in high water conditions, while the opposite was true for the high-WUE species. The intermediate RGR species tended to have the strongest impact on all neighbors, so competitive effects did not scale directly with differences in RGR and WUE among competitors. • CONCLUSIONS: Our results reveal mechanisms underlying long-term variation in fitness: high-RGR species perform better in years with large, frequent rain events and can better withstand competition under wetter conditions. The opposite is true for high-WUE species. Such resource-dependent responses strongly influence community dynamics and can promote coexistence in variable environments.

Immigration-related Legal Collaboration in Primary Care: Evaluating Impact on Knowledge and Well-being.

OBJECTIVES: To evaluate the impact of embedding an immigration attorney in a primary care clinic to address immigration-related legal needs. METHODS: We conducted a mixed-methods study of 42 legal clinic participants from May 2019-February 2020. Measures included psychological distress, understanding of legal options, and self-rated general health collected prior to, following, and 60-90 days after consultation. RESULTS: There was significant improvement in participants' understanding of their legal immigration options pre- (4.9, SD 2.9) and post-consult (8.6, SD 2.1), and 60 days later (7.0, SD 2.8) (F=11.0, p<.05), but self-rated health scores and distress did not significantly improve, although there was a high loss-to-follow up rate at 60 days (42.8%). Qualitative results underscored the interconnectedness of immigration status and health. DISCUSSION: Embedding immigration legal services in primary care improved patients' understanding of immigration-related legal options, although successfully mitigating the health impacts of vulnerable immigration status may take broader societal interventions.