The early bud gets the cold: Diverging spring phenology drives exposure to late frost in a Picea mariana [(Mill.) BSP] common garden.

Under climate change, the increasing occurrence of late frost combined with advancing spring phenology can increase the risk of frost damage in trees. In this study, we tested the link between intra-specific variability in bud phenology and frost exposure and damages. We analysed the effects of the 2021 late frost event in a black spruce (Picea mariana (Mill.) BSP) common garden in Québec, Canada. We hypothesised that the timing of budbreak drives the exposure of vulnerable tissues and explains differences in frost damage. Budbreak was monitored from 2015 to 2021 in 371 trees from five provenances originating between 48° and 53° N and planted in a common garden at 48° N. Frost damages were assessed on the same trees through the proportion of damaged buds per tree and related to the phenological phases by ordinal regressions. After an unusually warm spring, minimum temperatures fell to -1.9°C on May 28 and 29, 2021. At this moment, trees from the northern provenances were more advanced in their phenology and showed more frost damage. Provenances with earlier budbreak had a higher probability of damage occurrence according to ordinal regression. Our study highlights the importance of intra-specific variability of phenological traits on the risk of frost exposure. We provide evidence that the timings of bud phenology affect sensitivity to frost, leading to damages at temperatures of -1.9°C. Under the same conditions, the earlier growth reactivation observed in the northern provenances increases the risks of late frost damage on the developing buds.

Phytochemicals Involved in Plant Resistance to Leporids and Cervids: a Systematic Review.

Non-nutritive phytochemicals (secondary metabolites and fibre) can influence plant resistance to herbivores and have ecological impacts on animal and plant population dynamics. A major hindrance to the ecological study of these phytochemicals is the uncertainty in the compounds one should measure, especially when limited by cost and expertise. With the underlying goal of identifying proxies of plant resistance to herbivores, we performed a systematic review of the effects of non-nutritive phytochemicals on consumption by leporids (rabbits and hares) and cervids (deer family). We identified 133 out of 1790 articles that fit our selection criteria (leporids = 33, cervids = 97, both herbivore types = 3). These articles cover 18 species of herbivores, on four continents. The most prevalent group of phytochemicals in the selected articles was phenolics, followed by terpenes for leporids and by fibre for cervids. In general, the results were variable but phenolic concentration seems linked with high resistance to both types of herbivores. Terpene concentration is also linked to high plant resistance; this relationship seems driven by total terpene content for cervids and specific terpenes for leporids. Tannins and fibre did not have a consistent positive effect on plant resistance. Because of the high variability in results reported and the synergistic effects of phytochemicals, we propose that the choice of chemical analyses must be tightly tailored to research objectives. While researchers pursuing ecological or evolutionary objectives should consider multiple specific analyses, researchers in applied studies could focus on a fewer number of specific analyses. An improved consideration of plant defence, based on meaningful chemical analyses, could improve studies of plant resistance and allow us to predict novel or changing plant-herbivore interactions.

Rapid response to a college outbreak of meningococcal serogroup B disease: Nation's first widespread use of bivalent rLP2086 vaccine.

OBJECTIVE: To outline the reasoning behind use of bivalent rLP2086 in a Rhode Island college meningococcal B disease outbreak, highlighting the timeline from outbreak declaration to vaccination clinic, emphasizing that these two time points are <3 days apart. PARTICIPANTS: Staff, faculty, and students at College X eligible for vaccination. METHODS: An outbreak response was initiated, advantages/disadvantages of available MenB vaccines were discussed, and a vaccination clinic was coordinated. RESULTS: Bivalent rLP2086 was chosen as the vaccination intervention. We achieved a 94% coverage rate for the first dose. To date, this intervention has prevented further cases of Neisseria meningitidis serogroup B disease at College X. CONCLUSIONS: The close, efficient collaboration of public health stakeholders and College X led 94% of the eligible population to be safely vaccinated with at least one dose of bivalent rLP2086. This outbreak marked the first time bivalent rLP2086 was effectively used as an intervention response.

Current initiatives to protect Rhode Island adolescents through increasing HPV vaccination.

This commentary provides an overview of recent initiatives in Rhode Island to promote human papillomavirus (HPV) vac-30 cination with the goal of protecting Rhode Island adolescents against vaccine-preventable HPV-associated cancers. With the exception of the introduction of a recent school entry requirement, most of the initiatives and related activities described were conducted as part of a cooperative agreement between 35 RIDOH and CDC, and were supported by the Prevention and Public Health Fund. (1).

Evaluation of the impact of the 2012 Rhode Island health care worker influenza vaccination regulations: implementation process and vaccination coverage.

CONTEXT: In October 2012, the Rhode Island Department of Health (HEALTH) amended its health care worker (HCW) vaccination regulations to require all HCWs to receive annual influenza vaccination or wear a surgical mask during direct patient contact when influenza is widespread. Unvaccinated HCWs failing to wear a mask are subject to a fine and disciplinary action. OBJECTIVE: To describe the implementation of the 2012 Rhode Island HCW influenza vaccination regulations and examine their impact on vaccination coverage. DESIGN: Two data sources were used: (1) a survey of all health care facilities subject to the HCW regulations and (2) HCW influenza vaccination coverage data reported to HEALTH by health care facilities. Descriptive statistics and paired t tests were performed using SAS Release 9.2. SETTING AND PARTICIPANTS: For the 2012-2013 influenza season, 271 inpatient and outpatient health care facilities in Rhode Island were subject to the HCW regulations. MAIN OUTCOME MEASURE: Increase in HCW influenza vaccination coverage. RESULTS: Of the 271 facilities, 117 facilities completed the survey (43.2%) and 160 facilities reported vaccination data to HEALTH (59.0%). Between the 2011-2012 and 2012-2013 influenza seasons, the proportion of facilities having a masking policy, as required by the revised regulations, increased from 9.4% to 94.0% (P < .001). However, the proportion of facilities implementing Advisory Committee on Immunization Practices-recommended strategies to promote HCW influenza vaccination did not increase. The majority of facilities perceived benefits to collecting HCW influenza vaccination data, including strengthening infection prevention efforts (83.2%) and improving patient and coworker safety (75.2%). Concurrent with the new regulations, influenza vaccination coverage among employee HCWs in Rhode Island increased from 69.7% in the 2011-2012 influenza season to 87.2% in the 2012-2013 season. CONCLUSION: Rhode Island's experience demonstrates that statewide HCW influenza vaccination requirements incorporating mask wearing and moderate penalties for noncompliance can be effective in improving influenza vaccination coverage among HCWs.

Qualitative evaluation of Rhode Island's healthcare worker influenza vaccination regulations.

OBJECTIVE: To evaluate Rhode Island's revised vaccination regulations requiring healthcare workers (HCWs) to receive annual influenza vaccination or wear a mask during patient care when influenza is widespread. DESIGN: Semi-structured telephone interviews conducted in a random sample of healthcare facilities. SETTING: Rhode Island healthcare facilities covered by the HCW regulations, including hospitals, nursing homes, community health centers, nursing service agencies, and home nursing care providers. Participants Staff responsible for collecting and/or reporting facility-level HCW influenza vaccination data to comply with Rhode Island HCW regulations. METHODS: Interviews were transcribed and individually coded by interviewers to identify themes; consensus on coding differences was reached through discussion. Common themes and illustrative quotes are presented. RESULTS: Many facilities perceived the revised regulations as extending their existing influenza vaccination policies and practices. Despite variations in implementation, nearly all facilities implemented policies that complied with the minimum requirements of the regulations. The primary barrier to implementing the HCW regulations was enforcement of masking among unvaccinated HCWs, which required timely tracking of vaccination status and additional time and effort by supervisors. Factors facilitating implementation included early and regular communication from the state health department and facilities' ability to adapt existing influenza vaccination programs to incorporate provisions of the revised regulations. CONCLUSIONS: Overall, facilities successfully implemented the revised HCW regulations during the 2012-2013 influenza season. Continued maintenance of the regulations is likely to reduce transmission of influenza and resulting morbidity and mortality in Rhode Island's healthcare facilities.

Efficacy and tolerance of sodium phosphates oral solution after diet liberalization.

Bowel cleansing regimens commonly require adherence to liquid diets for 24 to 48 hours before examination, which often leads to poor compliance, reduced cleansing, and ultimately inadequate examinations. The authors investigated the efficacy and tolerability of diet liberalization before bowel cleansing with sodium phosphates oral solution. Two hundred patients were randomized into two treatment groups. One group received the standard light breakfast followed by clear liquids the day before colonoscopy; the second had a normal breakfast followed by a low-residue lunch the day before colonoscopy. Both groups had the same bowel preparation with sodium phosphates oral solution (2 x 45-mL, 7 p.m./6 a.m.). There was no difference in clinical efficacy between the two diet regimens (excellent/good in 93% standard, 95% low-residue). Fewer patients receiving the low-residue diet reported hunger, and more patients receiving the low-residue regimen reported energy to perform usual activities. This study supports offering patients a regular breakfast and a low-residue lunch before bowel cleansing with sodium phosphates oral solution.

Gender disparity in the practice of gastroenterology: the first 5 years of a career.

BACKGROUND: Despite an unprecedented demand for gastroenterology services, the number of gastroenterology trainees has decreased over 50% since 1993. Women comprise nearly 50% of the U.S. medical school student population; yet only occupy 16% of gastroenterology fellowship positions. In order to recruit the best candidates to gastroenterology we must be able to demonstrate the attractiveness of a career in the field. A prospective study was performed to identify the career choices of graduates from gastroenterology fellowship programs using a prospective study model and to identify whether gender differences exist in the practice of gastroenterologists up to 5 yr after completion of training. METHODS: A survey gathering information on demographics, practice pattern, and income was mailed to two cohorts of gastroenterology fellows 3 and 5 yr after graduation. RESULTS: A total of 247 subjects completed the 3 yr and 220 subjects responded to the 5-yr survey. At 3 yr, men reported higher income (p < 0.001), worked longer hours per week (p < 0.002), and were more likely to be part owner of the practice (p= 0.027). Females reported fewer children (p < 0.007), lower board certification rates (p < 0. 002), worked for larger, multispecialty practices (p < 0.001), and practiced more internal medicine. These differences were still present at 5 yr into gastroenterology practice. CONCLUSIONS: Significant differences in practice type, earnings, board certification, professional standing, and alterations in family planning are noted between male and female gastroenterologists in the initial 5 yr of their practice.

Gastroenterology training and career choices: a prospective longitudinal study of the impact of gender and of managed care.

OBJECTIVE: We aimed to determine if gender differences exist in the selection and training of female and male gastroenterology fellows. METHODS: One hundred seventy-six of 218 training program directors returned an 18-question survey about their programs, including leave policies, training, and prevalence of female faculty. Two cohorts of graduating trainees from 1993 and 1995 (N = 393) returned anonymous surveys regarding their training program experiences, demographics, and business training. RESULTS: Female gastroenterology trainees are more likely to choose programs according to parental leave policies (p < 0.05), female faculty (0.2990 correlation coefficient), and "family reasons" (p < 0.04) than the male trainees. Female trainees were more likely to remain childless (p < 0.001) or have fewer children at the end of training despite marital status not unlike their male colleagues. Female trainees altered their family planning because of training program restrictions (20% vs 7%, p < 0.001). They perceived gender discrimination (39%) and sexual harassment (19%) during gastroenterology training. Trainees of both sexes had mentorship during training (65% vs 71%, ns); female trainees were more likely to have an opposite sex mentor (71% vs 3.4%) despite an almost 50% prevalence of female full-time and clinical faculty. Female trainees were apt to be less trained in advanced endoscopy (p < 0.005). Trainees of both sexes were influenced by the changing health care environment in career choice (49% vs 42%, ns); neither gender felt adequately prepared for the business aspects of gastroenterology. CONCLUSION: Alterations in gastroenterology training are needed to attract qualified female applicants. New graduates of both sexes lack practice management education.