Mapping mitonuclear epistasis using a novel recombinant yeast population.

Genetic variation in mitochondrial and nuclear genomes can perturb mitonuclear interactions and lead to phenotypic differences between individuals and populations. Despite their importance to most complex traits, it has been difficult to identify the interacting mitonuclear loci. Here, we present a novel advanced intercrossed population of Saccharomyces cerevisiae yeasts, called the Mitonuclear Recombinant Collection (MNRC), designed explicitly for detecting mitonuclear loci contributing to complex traits. For validation, we focused on mapping genes that contribute to the spontaneous loss of mitochondrial DNA (mtDNA) that leads to the petite phenotype in yeast. We found that rates of petite formation in natural populations are variable and influenced by genetic variation in nuclear DNA, mtDNA and mitonuclear interactions. We mapped nuclear and mitonuclear alleles contributing to mtDNA stability using the MNRC by integrating a term for mitonuclear epistasis into a genome-wide association model. We found that the associated mitonuclear loci play roles in mitotic growth most likely responding to retrograde signals from mitochondria, while the associated nuclear loci with main effects are involved in genome replication. We observed a positive correlation between growth rates and petite frequencies, suggesting a fitness tradeoff between mitotic growth and mtDNA stability. We also found that mtDNA stability was correlated with a mobile mitochondrial GC-cluster that is present in certain populations of yeast and that selection for nuclear alleles that stabilize mtDNA may be rapidly occurring. The MNRC provides a powerful tool for identifying mitonuclear interacting loci that will help us to better understand genotype-phenotype relationships and coevolutionary trajectories.

Variation in the timing and duration of autumn leaf phenology among temperate deciduous trees, native shrubs and non-native shrubs.

The timing and duration of autumn leaf phenology marks important transitions in temperate deciduous forests, such as, start of senescence, declining productivity and changing nutrient cycling. Phenological research on temperate deciduous forests typically focuses on upper canopy trees, overlooking the contribution of other plant functional groups like shrubs. Yet shrubs tend to remain green longer than trees, while non-native shrubs, in particular, tend to exhibit an extended growing season that confers a competitive advantage over native shrubs. We monitored leaf senescence and leaf fall (2017-2020) of trees and shrubs (native and non-native) in an urban woodland fragment in Wisconsin, USA. Our findings revealed that, the start of leaf senescence did not differ significantly between vegetation groups, but leaf fall started (DOY 273) two weeks later in shrubs. Non-native shrubs exhibited a considerably delayed start (DOY 262) and end of leaf senescence (DOY 300), with leaf-fall ending (DOY 315) nearly four weeks later than native shrubs and trees. Overall, the duration of the autumn phenological season was longer for non-native shrubs than either native shrubs or trees. Comparison of the timing of spring phenophases with the start and end of leaf senescence revealed that when spring phenology in trees starts later in the season senescence also starts later and ends earlier. The opposite pattern was observed in native shrubs. In conclusion, understanding the contributions of plant functional groups to overall forest phenology requires future investigation to ensure accurate predictions of future ecosystem productivity and help address discrepancies with remote sensing phenometrics.

Characterizing spring phenology in a temperate deciduous urban woodland fragment: trees and shrubs.

Phenological research in temperate-deciduous forests typically focuses on upper canopy trees, due to their overwhelming influence on ecosystem productivity and function. However, considering that shrubs leaf out earlier and remain green longer than trees, they play a pivotal role in ecosystem productivity, particularly at growing season extremes. Furthermore, an extended growing season of non-native shrubs provides a competitive advantage over natives. Here, we report spring phenology, budburst, leaf-out, and full-leaf unfolded (2017-2021) of a range of co-occurring species of tree (ash, American basswood, red oak, white oak, and boxelder) and shrub (native species: chokecherry, pagoda dogwood, nannyberry, American wild currant and Eastern wahoo, and non-native species: buckthorn, honeysuckle, European privet, and European highbush cranberry) in an urban woodland fragment in Wisconsin, USA, to determine how phenology differed between plant groups. Our findings show that all three spring phenophases of shrubs were 3 weeks earlier (p < 0.05) than trees. However, differences between shrubs groups were only significant for the later phenophase; full-leaf unfolded, which was 6 days earlier (p < 0.05) for native shrubs. The duration of the spring phenological season was 2 weeks longer (p < 0.05) for shrubs than trees. These preliminary findings demonstrate that native shrubs, at this site, start full-leaf development earlier than non-native species suggesting that species composition must be considered when generalizing whether phenologies differ between vegetation groups. A longer time series would be necessary to determine future implications on ecosystem phenology and productivity and how this might impact forests in the future, in terms of species composition, carbon sequestration, and overall ecosystem dynamics.

Fostering effective and sustainable scientific collaboration and knowledge exchange: a workshop-based approach to establish a national ecological observatory network (NEON) domain-specific user group.

The decision to establish a network of researchers centers on identifying shared research goals. Ecologically specific regions, such as the USA's National Ecological Observatory Network's (NEON's) eco-climatic domains, are ideal locations by which to assemble researchers with a diverse range of expertise but focused on the same set of ecological challenges. The recently established Great Lakes User Group (GLUG) is NEON's first domain specific ensemble of researchers, whose goal is to address scientific and technical issues specific to the Great Lakes Domain 5 (D05) by using NEON data to enable advancement of ecosystem science. Here, we report on GLUG's kick off workshop, which comprised lightning talks, keynote presentations, breakout brainstorming sessions and field site visits. Together, these activities created an environment to foster and strengthen GLUG and NEON user engagement. The tangible outcomes of the workshop exceeded initial expectations and include plans for (i) two journal articles (in addition to this one), (ii) two potential funding proposals, (iii) an assignable assets request and (iv) development of classroom activities using NEON datasets. The success of this 2.5-day event was due to a combination of factors, including establishment of clear objectives, adopting engaging activities and providing opportunities for active participation and inclusive collaboration with diverse participants. Given the success of this approach we encourage others, wanting to organize similar groups of researchers, to adopt the workshop framework presented here which will strengthen existing collaborations and foster new ones, together with raising greater awareness and promotion of use of NEON datasets. Establishing domain specific user groups will help bridge the scale gap between site level data collection and addressing regional and larger ecological challenges.

Species conservation in the era of genomic science.

The exponential increase in the availability of genomic data, derived from sequencing thousands of loci or whole genomes, provides exciting new insights into the diversity of life. However, it can also challenge established species concepts and existing management regimes derived from these concepts. Genomic data can help inform decisions about how to manage genetic diversity, but policies that protect identified taxonomic entities can generate conflicting recommendations that create challenges for practitioners. We outline three dimensions of management concern that arise when facing new and potentially conflicting interpretations of genomic data: defining conservation entities, deciding how to manage diversity, and evaluating the risks and benefits of management actions. We highlight the often-underappreciated role of values in influencing management choices made by individuals, scientists, practitioners, the public, and other stakeholders. Such values influence choices through mechanisms such as the Rashomon effect, whereby management decisions are complicated by conflicting perceptions of the causes and consequences of the conservation problem. To illustrate how this might operate, we offer a hypothetical example of this effect for the interpretation of genomic data and its implications for conservation management. Such value-based decisions can be challenged by the rigidity of existing management regimes, making it difficult to achieve the necessary flexibility to match the changing biological understanding. We finish by recommending that both conservation geneticists and practitioners reflect on their respective values, responsibilities, and roles in building a more robust system of species management. This includes embracing the inclusion of stakeholders in decision-making because, as in many cases, there are not objectively defensible right or wrong decisions.

Integrating Community Health Workers' Dual Clinic-Community Role in Safety-Net Primary Care: Implementation Lessons from a Pragmatic Diabetes-Prevention Trial.

BACKGROUND: Over a third of US adults carry a diagnosis of prediabetes, 70% of whom may progress to type 2 diabetes mellitus ("diabetes"). Community health workers (CHWs) can help patients undertake healthy behavior to prevent diabetes. However, there is limited guidance to integrate CHWs in primary care, specifically to address CHWs' dual clinic-based and community-oriented role. OBJECTIVE: Using evidence from CHWs' adaptations of a diabetes-prevention intervention in safety-net hospitals in New York City, we examine the nature, intent, and possible consequences of CHWs' actions on program fidelity. We propose strategies for integrating CHWs in primary care. DESIGN: Case study drawing on the Model for Adaptation Design and Impact (MADI) to analyze CHWs' actions during implementation of CHORD (Community Health Outreach to Reduce Diabetes), a cluster-randomized pragmatic trial (2017-2022) at Manhattan VA and Bellevue Hospital. PARTICIPANTS: CHWs and clinicians in the CHORD study, with a focus in this analysis on CHWs. APPROACH: Semi-structured interviews and focus group discussion with CHWs (n=4); semi-structured interviews with clinicians (n=17). Interpretivist approach to explain CHWs' adaptations using a mix of inductive and deductive analysis. KEY RESULTS: CHWs' adaptations extended the intervention in three ways: by extending social assistance, healthcare access, and operational tasks. The adaptations were intended to improve fit, reach, and retention, but likely had ripple effects on implementation outcomes. CHWs' focus on patients' complex social needs could divert them from judiciously managing their caseload. CONCLUSIONS: CHWs' community knowledge can support patient engagement, but overextension of social assistance may detract from protocolized health-coaching goals. CHW programs in primary care should explicitly delineate CHWs' non-health support to patients, include multiprofessional teams or partnerships with community-based organizations, establish formal communication between CHWs and clinicians, and institute mechanisms to review and iterate CHWs' work to resolve challenges in their community-oriented role.

Implementation fidelity to a behavioral diabetes prevention intervention in two New York City safety net primary care practices.

BACKGROUND: It is critical to assess implementation fidelity of evidence-based interventions and factors moderating fidelity, to understand the reasons for their success or failure. However, fidelity and fidelity moderators are seldom systematically reported. The study objective was to conduct a concurrent implementation fidelity evaluation and examine fidelity moderators of CHORD (Community Health Outreach to Reduce Diabetes), a pragmatic, cluster-randomized, controlled trial to test the impact of a Community Health Workers (CHW)-led health coaching intervention to prevent incident type 2 Diabetes Mellitus in New York (NY). METHODS: We applied the Conceptual Framework for Implementation Fidelity to assess implementation fidelity and factors moderating it across the four core intervention components: patient goal setting, education topic coaching, primary care (PC) visits, and referrals to address social determinants of health (SDH), using descriptive statistics and regression models. PC patients with prediabetes receiving care from safety-net patient-centered medical homes (PCMHs) at either, VA NY Harbor or at Bellevue Hospital (BH) were eligible to be randomized into the CHW-led CHORD intervention or usual care. Among 559 patients randomized and enrolled in the intervention group, 79.4% completed the intake survey and were included in the analytic sample for fidelity assessment. Fidelity was measured as coverage, content adherence and frequency of each core component, and the moderators assessed were implementation site and patient activation measure. RESULTS: Content adherence was high for three components with nearly 80.0% of patients setting ≥ 1 goal, having ≥ 1 PC visit and receiving ≥ 1 education session. Only 45.0% patients received ≥ 1 SDH referral. After adjusting for patient gender, language, race, ethnicity, and age, the implementation site moderated adherence to goal setting (77.4% BH vs. 87.7% VA), educational coaching (78.9% BH vs. 88.3% VA), number of successful CHW-patient encounters (6 BH vs 4 VA) and percent of patients receiving all four components (41.1% BH vs. 25.7% VA). CONCLUSIONS: The fidelity to the four CHORD intervention components differed between the two implementation sites, demonstrating the challenges in implementing complex evidence-based interventions in different settings. Our findings underscore the importance of measuring implementation fidelity in contextualizing the outcomes of randomized trials of complex multi-site behavioral interventions. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov on 30/12/2016 and the registration number is NCT03006666 .

Disparities in routine healthcare utilization disruptions during COVID-19 pandemic among veterans with type 2 diabetes.

BACKGROUND: While emerging studies suggest that the COVID-19 pandemic caused disruptions in routine healthcare utilization, the full impact of the pandemic on healthcare utilization among diverse group of patients with type 2 diabetes is unclear. The purpose of this study is to examine trends in healthcare utilization, including in-person and telehealth visits, among U.S. veterans with type 2 diabetes before, during and after the onset of the COVID-19 pandemic, by demographics, pre-pandemic glycemic control, and geographic region. METHODS: We longitudinally examined healthcare utilization in a large national cohort of veterans with new diabetes diagnoses between January 1, 2008 and December 31, 2018. The analytic sample was 733,006 veterans with recently-diagnosed diabetes, at least 1 encounter with veterans administration between March 2018-2020, and followed through March 2021. Monthly rates of glycohemoglobin (HbA1c) measurements, in-person and telehealth outpatient visits, and prescription fills for diabetes and hypertension medications were compared before and after March 2020 using interrupted time-series design. Log-linear regression model was used for statistical analysis. Secular trends were modeled with penalized cubic splines. RESULTS: In the initial 3 months after the pandemic onset, we observed large reductions in monthly rates of HbA1c measurements, from 130 (95%CI,110-140) to 50 (95%CI,30-80) per 1000 veterans, and in-person outpatient visits, from 1830 (95%CI,1640-2040) to 810 (95%CI,710-930) per 1000 veterans. However, monthly rates of telehealth visits doubled between March 2020-2021 from 330 (95%CI,310-350) to 770 (95%CI,720-820) per 1000 veterans. This pattern of increases in telehealth utilization varied by community type, with lowest increase in rural areas, and by race/ethnicity, with highest increase among non-hispanic Black veterans. Combined in-person and telehealth outpatient visits rebounded to pre-pandemic levels after 3 months. Despite notable changes in HbA1c measurements and visits during that initial window, we observed no changes in prescription fills rates. CONCLUSIONS: Healthcare utilization among veterans with diabetes was substantially disrupted at the onset of the pandemic, but rebounded after 3 months. There was disparity in uptake of telehealth visits by geography and race/ethnicity.

Ten best practices for effective phenological research.

The number and diversity of phenological studies has increased rapidly in recent years. Innovative experiments, field studies, citizen science projects, and analyses of newly available historical data are contributing insights that advance our understanding of ecological and evolutionary responses to the environment, particularly climate change. However, many phenological data sets have peculiarities that are not immediately obvious and can lead to mistakes in analyses and interpretation of results. This paper aims to help researchers, especially those new to the field of phenology, understand challenges and practices that are crucial for effective studies. For example, researchers may fail to account for sampling biases in phenological data, struggle to choose or design a volunteer data collection strategy that adequately fits their project's needs, or combine data sets in inappropriate ways. We describe ten best practices for designing studies of plant and animal phenology, evaluating data quality, and analyzing data. Practices include accounting for common biases in data, using effective citizen or community science methods, and employing appropriate data when investigating phenological mismatches. We present these best practices to help researchers entering the field take full advantage of the wealth of available data and approaches to advance our understanding of phenology and its implications for ecology.

Self-Assessed Severity as a Determinant of Coronavirus Disease 2019 Symptom Specificity: A Longitudinal Cohort Study.

Coronavirus disease 2019 symptom definitions rarely include symptom severity. We collected daily nasal swab samples and symptom diaries from contacts of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) case patients. Requiring ≥1 moderate or severe symptom reduced sensitivity to predict SARS-CoV-2 shedding from 60.0% (95% confidence interval [CI], 52.9%-66.7%) to 31.5% (95% CI, 25.7%- 38.0%) but increased specificity from 77.5% (95% CI, 75.3%-79.5%) to 93.8% (95% CI, 92.7%-94.8%).

National Health Policy Leadership Program for General Internists.

INTRODUCTION: Early or mid-career physicians have few opportunities to participate in career development programs in health policy and advocacy with experiential and mentored training that can be incorporated into their busy lives. AIM: The Society of General Internal Medicine (SGIM) created the Leadership in Health Policy (LEAHP) program, a year-long career development program, to prepare participants with a sufficient depth of knowledge, skills, attitudes, and behaviors to continue to build mastery and effectiveness as leaders, advocates, and educators in health policy. We sought to evaluate the program's impact on participants' self-efficacy in the core skills targeted in the curriculum. SETTING/PARTICIPANTS: Fifty-five junior faculty and trainees across three scholar cohorts from 2017 to 2021. PROGRAM DESCRIPTION: Activities included workshops and exercises at an annual meeting, one-on-one mentorship, monthly webinars and journal clubs, interaction with policy makers, and completion of capstone projects. PROGRAM EVALUATION: Self-administered, electronic surveys conducted before and following the year-long program showed a significant improvement in mean self-efficacy scores for the total score and for each of the six domains in general knowledge, teaching, research, and advocacy in health policy. Compared to the baseline scores, after the program the total mean score increased from 3.1 to 4.1, an increase of 1.1 points on a 5-point Likert scale (95% CI: 0.9-1.3; Cohen's D: 1.7), with 61.4% of respondents increasing their mean score by at least 1 point. Responses to open-ended questions indicated that the program met scholars' stated needs to improve their knowledge base in health policy and advocacy skills. DISCUSSION: The LEAHP program provides an opportunity for mentored, experiential training in health policy and advocacy, can build the knowledge and amplify the scale of physicians engaged in health policy, and help move physicians from individual patient advocacy in the clinic to that of populations.

Primary Care Practice Transformation in the Era of COVID-19 and Beyond: Key Principles for General Internal Medicine Practitioners.

As members of the Clinical Practice Committee (CPC) of the Society for General Internal Medicine (SGIM), we support practice innovation and transformation to achieve a more just system by which all people can achieve and maintain optimal health. The COVID-19 pandemic has tested the US healthcare delivery system and sharpened our national awareness of long-standing and ingrained system shortcomings. In the face of crisis, SGIM members innovated and energetically mobilized to focus on the immediate needs of our patients and communities. Reflecting on these experiences, we are called to consider what was learned from the pandemic that applies to the future of healthcare delivery. CPC members include leaders in primary care delivery, practice finance, quality of care, patient safety, hospital practice, and health policy. CPC members provide expertise in clinical practice, serving as primary care doctors, hospitalists, and patient advocates who understand the intensity of care needed for those with severe COVID-19 infections, the disproportionate impact of the pandemic on Black and Brown communities, the struggles created for those with poor access to care, and the physical and emotional impact it has placed on patients, families, and clinicians. In this consensus statement, we summarize lessons learned from the 2020-2021 pandemic and their broader implications for reform in healthcare delivery. We provide a platform for future work by identifying many interactive elements of healthcare delivery that must be simultaneously addressed in order to ensure that care is accessible, equitably provided, patient-centered, and cost-effective.

Impact of land use and food environment on risk of type 2 diabetes: A national study of veterans, 2008-2018.

BACKGROUND: Large-scale longitudinal studies evaluating influences of the built environment on risk for type 2 diabetes (T2D) are scarce, and findings have been inconsistent. OBJECTIVE: To evaluate whether land use environment (LUE), a proxy of neighborhood walkability, is associated with T2D risk across different US community types, and to assess whether the association is modified by food environment. METHODS: The Veteran's Administration Diabetes Risk (VADR) study is a retrospective cohort of diabetes-free US veteran patients enrolled in VA primary care facilities nationwide from January 1, 2008, to December 31, 2016, and followed longitudinally through December 31, 2018. A total of 4,096,629 patients had baseline addresses available in electronic health records that were geocoded and assigned a census tract-level LUE score. LUE scores were divided into quartiles, where a higher score indicated higher neighborhood walkability levels. New diagnoses for T2D were identified using a published computable phenotype. Adjusted time-to-event analyses using piecewise exponential models were fit within four strata of community types (higher-density urban, lower-density urban, suburban/small town, and rural). We also evaluated effect modification by tract-level food environment measures within each stratum. RESULTS: In adjusted analyses, higher LUE had a protective effect on T2D risk in rural and suburban/small town communities (linear quartile trend test p-value <0.001). However, in lower density urban communities, higher LUE increased T2D risk (linear quartile trend test p-value <0.001) and no association was found in higher density urban communities (linear quartile trend test p-value = 0.317). Particularly strong protective effects were observed for veterans living in suburban/small towns with more supermarkets and more walkable spaces (p-interaction = 0.001). CONCLUSION: Among veterans, LUE may influence T2D risk, particularly in rural and suburban communities. Food environment may modify the association between LUE and T2D.

Who is Responsible for Discharge Education of Patients? A Multi-Institutional Survey of Internal Medicine Residents.

BACKGROUND: Safely and effectively discharging a patient from the hospital requires working within a multidisciplinary team. However, little is known about how perceptions of responsibility among the team impact discharge communication practices. OBJECTIVE: Our study attempts to understand residents' perceptions of who is primarily responsible for discharge education, how these perceptions affect their own reported communication with patients, and how residents envision improving multidisciplinary communication around discharges. DESIGN: A multi-institutional cross-sectional survey. PARTICIPANTS: Internal medicine (IM) residents from seven US residency programs at academic medical centers were invited to participate between March and May 2019, via email of an electronic link to the survey. MAIN MEASURES: Data collected included resident perception of who on the multidisciplinary team is primarily responsible for discharge communication, their own reported discharge communication practices, and open-ended comments on ways discharge multidisciplinary team communication could be improved. KEY RESULTS: Of the 613 resident responses (63% response rate), 35% reported they were unsure which member of the multidisciplinary team is primarily responsible for discharge education. Residents who believed it was either the intern's or the resident's primary responsibility had 4.28 (95% CI, 2.51-7.30) and 3.01 (95% CI, 1.66-5.71) times the odds, respectively, of reporting doing discharge communication practices frequently compared to those who were not sure who was primarily responsible. To improve multidisciplinary discharge communication, residents called for the following among team members: (1) clarifying roles and responsibilities for communication with patients, (2) setting expectations for communication among multidisciplinary team members, and (3) redefining culture around discharges. CONCLUSIONS: Residents report a lack of understanding of who is responsible for discharge education. This diffusion of ownership impacts how much residents invest in patient education, with more perceived responsibility associated with more frequent discharge communication.

Conservation lessons from taboos and trolley problems.

Governments pass conservation laws, adopt policies, and make plans yet frequently fail to implement them. Implementation of conservation, however, often requires costly sacrifice: people foregoing benefit for the benefit of biodiversity. Decisions involve trade-offs with outcomes that depend on the values at stake and people's perceptions of those values. Psychology, ethics, and behavioral science have each addressed the challenge of making difficult, often tragic, trade-off decisions. Based on these literatures, values can be classified as secular or sacred, where sacred values are those for which compensation may be unthinkable (e.g., freedom). Taboo trade-offs emerge when secular values are pitted against sacred ones. These are difficult to discuss, much less negotiate. Confronting taboo trade-offs in conservation may require discursive approaches to better understand particular attributes of decisions that place sacred human values at risk. Tragic trade-offs emerge when sacred values are pitted against one another. The trolley problem-a forced choice between 2 unthinkable outcomes-is a simple heuristic illustrating ethical challenges of tragic trade-offs. Behavior studies illustrate that people have a strong aversion to losses where an active choice was made, resulting in a bias toward status quo decisions. Faced with tragic, trolley-problem-like choices, people tend to avoid taking responsibility for action, defer decisions, evade opinions on painful choices, and regret unfortunate outcomes of actions. To help close the implementation gap, conservation actors may need to directly address the psychological, ethical, and behavioral barriers created by the remorse, regret, and moral residue of implementing conservation choices that have tragic outcomes. Recognition of these predictable features of the human psyche may foster better administrative structures to support action with durable outcomes as well as new research directions.

Lecciones sobre Conservación a Partir de los Tabúes y el Dilema del Tranvía Resumen Los gobiernos aprueban leyes, adoptan políticas y elaboran planes para la conservación, pero con frecuencia fallan en implementar todo lo anterior. La implementación de la conservación, sin embargo, requiere con frecuencia un sacrificio muy costoso: que la gente renuncie a un beneficio para beneficiar a la biodiversidad. Las decisiones involucran compensaciones con resultados que dependen de los valores que están en juego y la percepción que tiene la gente de esos valores. La Psicología, la Ética y las Ciencias del Comportamiento han abordado el reto de la toma de decisiones difíciles, con frecuencia trágicas, relacionadas con las compensaciones. Con base en la literatura de estas disciplinas, podemos clasificar los valores como seculares o sagrados, donde los últimos son aquellos para los cuales una compensación puede ser inimaginable (p. ej.: la libertad). Las compensaciones tabúes emergen cuando se confrontan los valores seculares contra los sagrados y es difícil discutirlas y mucho menos negociarlas. La confrontación de las compensaciones tabú dentro del esquema de la conservación puede requerir de estrategias discursivas para entender de mejor manera los atributos particulares de las decisiones que colocan los valores humanos sagrados que están en riesgo. Las compensaciones trágicas surgen cuando se confrontan entre sí los valores sagrados. El dilema del tranvía - una elección forzada entre dos resultados impensables - es un heurístico simple que ilustra los retos éticos que representan las compensaciones trágicas. Los estudios sobre el comportamiento demuestran que las personas tienen una fuerte aversión hacia las pérdidas en las que se realizó una elección activa, lo que resultó en un sesgo hacia las decisiones del orden establecido. Cuando las personas se enfrentan a elecciones trágicas del estilo del dilema del tranvía tienden a evitar responsabilizarse por la acción, aplazar las decisiones, evadir opiniones sobre elecciones dolorosas y arrepentirse por los resultados desafortunados de las acciones. Para ayudar a reducir la brecha de la implementación, los actores de la conservación podrían necesitar abordar directamente las barreras psicológicas, éticas y de comportamiento creadas por el remordimiento, el arrepentimiento y el residuo moral de la implementación de las elecciones de conservación que tienen resultados trágicos. El reconocimiento de estos rasgos predecibles de la psique humana puede promover de mejor manera las estructuras administrativas para respaldar las acciones con resultados duraderos, así como nuevas directrices para la investigación.

Improving inferences about private land conservation by accounting for incomplete reporting.

Private lands provide key habitat for imperiled species and are core components of function protectected area networks; yet, their incorporation into national and regional conservation planning has been challenging. Identifying locations where private landowners are likely to participate in conservation initiatives can help avoid conflict and clarify trade-offs between ecological benefits and sociopolitical costs. Empirical, spatially explicit assessment of the factors associated with conservation on private land is an emerging tool for identifying future conservation opportunities. However, most data on private land conservation are voluntarily reported and incomplete, which complicates these assessments. We used a novel application of occupancy models to analyze the occurrence of conservation easements on private land. We compared multiple formulations of occupancy models with a logistic regression model to predict the locations of conservation easements based on a spatially explicit social-ecological systems framework. We combined a simulation experiment with a case study of easement data in Idaho and Montana (United States) to illustrate the utility of the occupancy framework for modeling conservation on private land. Occupancy models that explicitly accounted for variation in reporting produced estimates of predictors that were substantially less biased than estimates produced by logistic regression under all simulated conditions. Occupancy models produced estimates for the 6 predictors we evaluated in our case study that were larger in magnitude, but less certain than those produced by logistic regression. These results suggest that occupancy models result in qualitatively different inferences regarding the effects of predictors on conservation easement occurrence than logistic regression and highlight the importance of integrating variable and incomplete reporting of participation in empirical analysis of conservation initiatives. Failure to do so can lead to emphasizing the wrong social, institutional, and environmental factors that enable conservation and underestimating conservation opportunities in landscapes where social norms or institutional constraints inhibit reporting.

La incorporación de las tierras privadas a la planeación de la conservación regional y nacional ha sido un reto a pesar de su importancia como hábitat para especies en peligro y como componentes nucleares de las redes funcionales de áreas protegidas. La identificación de las localidades en donde sea probable que los propietarios privados participen en las iniciativas de conservación puede ayudar a evitar conflictos costosos y a aclarar las compensaciones entre los beneficios ecológicos y los costos sociopolíticos. La evaluación empírica y espacialmente explícita de los factores asociados con la conservación en tierras privadas es una herramienta emergente usada para la identificación de oportunidades de conservación en el futuro. Sin embargo, la mayoría de los datos sobre la conservación en tierras privadas es reportada voluntariamente y está incompleta, lo cual complica realizar estas evaluaciones. Usamos una aplicación novedosa de los modelos de ocupación para analizar la presencia de la mitigación por conservación en tierras privadas. Comparamos diferentes formulaciones de los modelos de ocupación con un modelo de regresión logística para predecir las localidades de la mitigación por conservación con base en un marco de trabajo de un sistema socioecológico espacialmente explícito. Combinamos un experimento de simulación con un estudio de caso sobre datos de mitigación en Idaho y Montana (Estados Unidos) para ilustrar la utilidad del marco de trabajo de ocupación para el modelado de la conservación en tierras privadas. Los modelos de ocupación que consideraron explícitamente la variación en los reportes produjeron estimados de los predictores que estuvieron sustancialmente menos sesgados que los estimados producidos por la regresión logística bajo todas las condiciones simuladas. Los modelos de ocupación produjeron estimaciones para seis predictores que evaluamos en nuestro estudio de caso, los cuales fueron mayores en magnitud pero menos certeros que aquellos producidos por la regresión logística. Estos resultados sugieren que los modelos de ocupación tienen como resultado inferencias cualitativamente diferentes a la regresión logística con respecto a los efectos de los predictores sobre la presencia de mitigación por conservación y resaltan la importancia de la integración de los reportes variables e incompletos sobre la participación dentro del análisis empírico de las iniciativas de conservación. Si se falla en lo anterior se puede terminar enfatizando el factor social, institucional y ambiental equivocado que permite la conservación, además de subestimar las oportunidades de conservación en paisajes en donde las normas sociales o las restricciones institucionales inhiben el reporte de datos.

Integrating Community Health Workers into Safety-Net Primary Care for Diabetes Prevention: Qualitative Analysis of Clinicians' Perspectives.

BACKGROUND: Evidence shows community health workers (CHWs) can effectively deliver proven behavior-change strategies to prevent type 2 diabetes mellitus (diabetes) and enhance preventive care efforts in primary care for minority and low-income populations. However, operational details to integrate CHWs into primary care practice remain less well known. OBJECTIVE: To examine clinicians' perceptions about working with CHWs for diabetes prevention in safety-net primary care. SETTING: Clinicians are primary care physicians and nurses at two New York City safety-net hospitals participating in CHORD (Community Health Outreach to Reduce Diabetes). CHORD is a cluster-randomized trial testing a CHW intervention to prevent diabetes. DESIGN: Guided by the Consolidated Framework for Implementation Research, we studied how features of the CHW model and organizational context of the primary care practices influenced clinicians' perspectives about the acceptability, appropriateness, and feasibility of a diabetes-prevention CHW program. Data were collected pre-intervention using semi-structured interviews (n = 18) and a 20-item survey (n = 54). APPROACH: Both survey and interview questions covered clinicians' perspectives on diabetes prevention, attitudes and beliefs about CHWs' role, expectations in working with CHWs, and use of clinic- and community-based diabetes- prevention resources. Survey responses were descriptively analyzed. Interviews were coded using a mix of deductive and inductive approaches for thematic analysis. KEY RESULTS: Eighty-seven percent of survey respondents agreed CHWs could help in preventing diabetes; 83% reported interest in working with CHWs. Ninety-one percent were aware of clinic-based prevention resources; only 11% were aware of community resources. Clinicians supported CHWs' cultural competency and neighborhood reach, but expressed concerns about the adequacy of CHWs' training; public and professional emphasis on diabetes treatment over prevention; and added workload and communication with CHWs. CONCLUSIONS: Clinicians found CHWs appropriate for diabetes prevention in safety-net settings. However, disseminating high-quality evidence about CHWs' effectiveness and operations is needed to overcome concerns about integrating CHWs in primary care.

Why don't phenophase dates in the current year affect the same phenophase dates in the following year?

Examining whether a phenophase occurrence date in the current year affects the same phenophase occurrence date in the following year is crucial for developing cross-year phenological prediction models. Here, we carried out correlation analyses between leaf unfolding start (LUS)/leaf fall end (LFE) dates in the current and following years for four dominant tree species in temperate northern China from 1981 to 2012. Then, we calculated the recurrence intervals of LUS and LFE between two adjacent years for each species. Moreover, we investigated temperature effects on LUS/LFE dates, growing season and non-growing season lengths. Results show that correlation coefficients between LUS/LFE dates in the current and following years are nonsignificant at most stations. The recurrence interval of a phenophase has slight interannual variation and correlates significantly (and negatively) with the phenophase occurrence date of the current year. Further analyses indicate that LUS dates correlate significantly (and negatively) with spring mean temperatures, while LFE dates correlate significantly (and positively) with autumn mean temperatures, but negatively with growing season mean temperatures. In addition, spring mean temperatures can influence growing season length by controlling LUS date but cannot influence the following non-growing season length. Similarly, autumn mean temperatures and growing season mean temperatures can influence the subsequent non-growing season length but cannot influence the growing season length of the following year. Our study highlights that recurrence interval and time restrictions in the effects of seasonal temperatures on phenophase dates are the main environmental causes of nonsignificant correlations between phenophase occurrence dates in the current and following years.

Evaluating autumn phenology derived from field observations, satellite data, and carbon flux measurements in a northern mixed forest, USA.

Common approaches currently used to monitor forest phenology include direct field observation and indirect approaches such as satellite remote sensing and carbon flux measurements. However, differences in both temporal and spatial scales of these methods make direct comparison challenging. In order to evaluate the reliability of indirect measures of autumn phenology in estimating direct observations, we compared the timing of three transition dates and the rate of autumn progression derived from (i) satellite data (MOD13Q1 006 enhanced vegetation index (EVI) and normalized difference vegetation index (NDVI) products, 2000-2017), (ii) carbon flux measurements (net ecosystem exchange (NEE) and gross primary production (GPP), 1997-2016), and (iii) field observation (2010, 2012 for the north site and 2010, 2012, and 2013 for the south site) from a mixed forest in northern Wisconsin, USA. Overall, the transition dates and progression rates derived from NDVI were closest to that of field observations. Furthermore, the start of autumn derived from satellite data was earlier than directly observed leaf coloration (LC), which resulted from species-specific canopy senescence patterns and the sensitivity of the vegetation indices. Even after full leaf fall was reached, EVI continued to detect coloring which was likely due to the presence of understory plant species. Finally, NEE and GPP changes tended to start before LC as a result of tree physiological and environmental changes and continued after full leaf fall possibly due to understory and coniferous activity. These results highlight the need for long-term field observations of both trees and understory species, information on species-specific canopy senescence patterns, and species composition in understanding the efficiency of indirect approaches in estimating autumn forest phenology.

How well do the spring indices predict phenological activity across plant species?

The spring indices, models that represent the onset of spring season biological activity, were developed using a long-term observational record from the mid-to-late twentieth century of three species of lilacs and honeysuckles contributed by volunteer observers across the nation. The USA National Phenology Network (USA-NPN) produces and freely delivers maps of spring index onset dates at fine spatial scale for the USA. These maps are used widely in natural resource planning and management applications. The extent to which the models represent activity in a broad suite of plant species is not well documented. In this study, we used a rich record of observational plant phenology data (37,819 onset records) collected in recent years (1981-2017) to evaluate how well gridded maps of the spring index models predict leaf and flowering onset dates in (a) 19 species of ecologically important, broadly distributed deciduous trees and shrubs, and (b) the lilac and honeysuckle species used to construct the models. The extent to which the spring indices predicted vegetative and reproductive phenology varied by species and with latitude, with stronger relationships revealed for shrubs than trees and with the Bloom Index compared to the Leaf Index, and reduced concordance between the indices at higher latitudes. These results allow us to use the indices as indicators of when to expect activity across widely distributed species and can serve as a yardstick to assess how future changes in the timing of spring will impact a broad array of trees and shrubs across the USA.