Communication in refugee and migrant mental healthcare: A systematic rapid review on the needs, barriers and strategies of seekers and providers of mental health services.

BACKGROUND: Migrants and refugees may not access mental health services due to linguistic and cultural discordance between them and health and social care professionals (HSCPs). The aim of this review is to identify the communication needs and barriers experienced by third-country nationals (TCNs), their carers, and HSCPs, as well as the strategies they use and their preferences when accessing/providing mental health services and language barriers are present. METHODS: We undertook a rapid systematic review of the literature (01/01/2011 - 09/03/2022) on seeking and/or providing mental health services in linguistically discordant settings. Quality appraisal was performed, data was extracted, and evidence was reviewed and synthesised qualitatively. RESULTS: 58/5,650 papers met the inclusion criteria. Both TCNs (and their carers) and HSCPs experience difficulties when seeking or providing mental health services and language barriers are present. TCNs and HSCPs prefer linguistically and culturally concordant provision of mental health services but professional interpreters are often required. However, their use is not always preferred, nor is it without problems. CONCLUSIONS: Language barriers impede TCNs' access to mental health services. Improving language support options and cultural competency in mental health services is crucial to ensure that individuals from diverse linguistic and cultural backgrounds can access and/or provide high-quality mental health services.

Dendrometers challenge the 'moon wood concept' by elucidating the absence of lunar cycles in tree stem radius oscillation.

Wood is a sustainable natural resource and an important global commodity. According to the 'moon wood theory', the properties of wood, including its growth and water content, are believed to oscillate with the lunar cycle. Despite contradicting our current understanding of plant functioning, this theory is commonly exploited for marketing wooden products. To examine the moon wood theory, we applied a wavelet power transformation to series of 2,000,000 hourly stem radius records from dendrometers. We separated the influence of 74 consecutive lunar cycles and meteorological conditions on the stem variation of 62 trees and six species. We show that the dynamics of stem radius consist of overlapping oscillations with periods of 1 day, 6 months, and 1 year. These oscillations in stem dimensions were tightly coupled to oscillations in the series of air temperature and vapour pressure deficit. By contrast, we revealed no imprint of the lunar cycle on the stem radius variation of any species. We call for scepticism towards the moon wood theory, at least as far as the stem water content and radial growth are concerned. We foresee that similar studies employing robust scientific approaches will be increasingly needed in the future to cope with misleading concepts.

The cumulative impacts of droughts and N deposition on Norway spruce (Picea abies) in Switzerland based on 37 years of forest monitoring.

Norway spruce is one of the most important tree species in Central Europe, however, it is facing major problems with recent droughts. In this study we present 37 years (1985-2022) of long-term forest observation data on 82 different forest sites across Switzerland including 134'348 tree observations. The sites consists of managed spruce or mixed forest stands with beech (Fagus sylvatica) and comprise large gradients in altitude (290-1870 m), precipitation (570-2448 mm a-1), temperature (3.6-10.9 °C) or total nitrogen deposition (8.5-81.2 kg N ha-1 a-1). Long-term tree mortality has increased more than fivefold due to the multiple drought years 2019, 2020 and 2022, which is more than double the increase following the 2003 drought. We used a Bayesian multilevel model including three years of lagged drought indicator to predict spruce mortality. Besides stand age, the most important factors were drought and N deposition. Especially under drought conditions spruce mortality was increased on sites with high N deposition. Moreover, N deposition increased the imbalance of foliar phosphorus concentrations, with negative impacts on tree mortality. Mortality was increased by a factor of 1.8 in spruce compared to mixed beech and spruce stands. Stands with high mortality rates showed previously an increased proportion of trees with damaged crowns, especially after the droughts of 2003 and 2018. Taken together, we found evidences of an increase in spruce mortality droughts amplified under high N depositions. The perennial drought of 2018-2020 resulted in a cumulative spruce mortality of 12.1 % (564 dead trees in 82 sites) in only three years. With a Bayesian change-point regression framework we estimated a critical empirical load for nitrogen of 10.9 ± 4.2 kg N ha-1 a-1, which is in line with current thresholds, above which future plantings of spruce in Switzerland may not be a sustainable option due to the observed interaction between drought and nitrogen deposition.

Networking the forest infrastructure towards near real-time monitoring - A white paper.

Forests account for nearly 90 % of the world's terrestrial biomass in the form of carbon and they support 80 % of the global biodiversity. To understand the underlying forest dynamics, we need a long-term but also relatively high-frequency, networked monitoring system, as traditionally used in meteorology or hydrology. While there are numerous existing forest monitoring sites, particularly in temperate regions, the resulting data streams are rarely connected and do not provide information promptly, which hampers real-time assessments of forest responses to extreme climate events. The technology to build a better global forest monitoring network now exists. This white paper addresses the key structural components needed to achieve a novel meta-network. We propose to complement - rather than replace or unify - the existing heterogeneous infrastructure with standardized, quality-assured linking methods and interacting data processing centers to create an integrated forest monitoring network. These automated (research topic-dependent) linking methods in atmosphere, biosphere, and pedosphere play a key role in scaling site-specific results and processing them in a timely manner. To ensure broad participation from existing monitoring sites and to establish new sites, these linking methods must be as informative, reliable, affordable, and maintainable as possible, and should be supplemented by near real-time remote sensing data. The proposed novel meta-network will enable the detection of emergent patterns that would not be visible from isolated analyses of individual sites. In addition, the near real-time availability of data will facilitate predictions of current forest conditions (nowcasts), which are urgently needed for research and decision making in the face of rapid climate change. We call for international and interdisciplinary efforts in this direction.

Understanding Uptake and Experience of Interpreting Services in Primary Care in a South Asian Population in the UK.

This cross-sectional study addresses the evidence gap in uptake of interpretation services and patient experiences among a South Asian population in the UK without English language proficiency.

Hierarchical change-point regression models including random effects to estimate empirical critical loads for nitrogen using Bayesian Regression Models (brms) and JAGS.

The concept of critical loads is used in the framework of the Convention on Long-range Transboundary Air Pollution (UNECE) to define thresholds below which no damaging effects on habitats occur based on the latest scientific knowledge. Change-point regression models applied in a Bayesian framework are useful statistical tools to estimate critical empirical loads. While hierarchical study designs are common in ecological research, previous methods to estimate critical loads using change-point regression did not allow to analyse data collected under such a design. This method update provides an implementation of hierarchical data structure by including random effects such as study sites or as in this example tree species within the Bayesian approach of change-point regression models using two different approaches. The example data set is an European wide gradient study of the impact of climate change and air pollution on forest tree health assessed by foliar nutrient status of nitrogen (N) to phosphorus (P) from 10 different conifer tree species originated from 88 forest sites and 9 countries covering 22 years (1995-2017). Both modelling approaches using JAGS and Bayesian Regression Models using 'Stan' (brms) resulted in reasonable and similar estimations of the critical empirical load for nitrogen (CLempN) for temperate forests. These methodological examples of using different approaches of Bayesian change-point regression models dealing with random effects could prove useful to infer CLempN for other ecosystems and long-term data sets.•Hierarchical change-point regression models are suitable for estimating critical empirical loads.•The Bayesian framework of these models provides the inclusion of the current critical load and various confounding or modifying variables.•Here we present two ways of implementing hierarchical data sets in Bayesian change-point regression models using JAGS and brms.

Characterization of Methicillin-resistant Staphylococcus aureus From Children at Hospital Admission: Experiences From a Hospital in a German Metropolitan Area.

BACKGROUND: Since the 1990s, community-associated Methicillin-resistant Staphylococcus aureus (CA-MRSA) are described as emerging independent of health care. CA-MRSA is associated with the colonization and infection of healthy, immunocompetent younger individuals. While skin and soft tissue infections (SSTI) are predominant, life-threatening syndromes can also occur. METHODS: In this retrospective study, we investigated MRSA stains isolated from community-onset infections and from MRSA screening of children at admission to a tertiary-care hospital in 2012-2018. In total, 102 isolates were subjected to antibiotic susceptibility testing by broth microdilution, spa -typing, multilocus sequence typing, SCC mec typing and virulence/resistance gene detection by polymerase chain reaction. RESULTS: The majority of isolates originated from community-onset infections (80/102), of these primarily from SSTI (70/80). Additional strains were isolated by MRSA screening (22/102). In total 61.8% of the MRSA carried the gene for the Panton-Valentine leukocidin ( lukPV ). Molecular characterization of isolates revealed various epidemic MRSA clones, circulating in both community and hospital settings. Most prevalent epidemic lineages were isolates of the "European CA-MRSA clone" (CC80-MRSA-IV), the "Bengal Bay clone" (ST772-MRSA-V), or the "USA300 NAE clone" (ST8-MRSA-IVa). CONCLUSIONS: Our data highlight the importance of CA-MRSA causing SSTI in children. More frequent microbiological and molecular analysis of these strains is important for targeted treatment and can provide valuable data for molecular surveillance of the pathogen.

Epidemiological Estimate of Growth Reduction by Ozone in Fagus sylvatica L. and Picea abies Karst.: Sensitivity Analysis and Comparison with Experimental Results.

The critical level of ozone flux for forest trees is based entirely on biomass data from fumigation experiments with saplings, mostly in open-top chambers. Extrapolation to mature forests asks, therefore, for validation, which may be performed by epidemiological data analysis. This requires a multivariable regression analysis with a number of covariates to account for potential confounding factors. The present paper analyses the ozone sensitivity of volume increments of mature European beech (Fagus sylvatica) and Norway spruce (Picea abies), with the addition, or removal, of covariates. The comparison of the epidemiological dose-response relationship with experimental data shows very good agreement in beech and a more sensitive relationship in the epidemiological analysis of Norway spruce compared to the experiments. In Norway spruce, there was also a strong interaction between the effects of ozone and temperature; at high July temperatures, the ozone effect was stronger. This interaction may explain the disagreement between the epidemiological study and the experiments, of which the majority were performed in Sweden.

Number of growth days and not length of the growth period determines radial stem growth of temperate trees.

Radial stem growth dynamics at seasonal resolution are essential to understand how forests respond to climate change. We studied daily radial growth of 160 individuals of seven temperate tree species at 47 sites across Switzerland over 8 years. Growth of all species peaked in the early part of the growth season and commenced shortly before the summer solstice, but with species-specific seasonal patterns. Day length set a window of opportunity for radial growth. Within this window, the probability of daily growth was constrained particularly by air and soil moisture, resulting in intermittent growth to occur only on 29 to 77 days (30% to 80%) within the growth period. The number of days with growth largely determined annual growth, whereas the growth period length contributed less. We call for accounting for these non-linear intra-annual and species-specific growth dynamics in tree and forest models to reduce uncertainties in predictions under climate change.

Why trees grow at night.

The timing of diel stem growth of mature forest trees is still largely unknown, as empirical data with high temporal resolution have not been available so far. Consequently, the effects of day-night conditions on tree growth remained uncertain. Here we present the first comprehensive field study of hourly-resolved radial stem growth of seven temperate tree species, based on 57 million underlying data points over a period of up to 8 yr. We show that trees grow mainly at night, with a peak after midnight, when the vapour pressure deficit (VPD) is among the lowest. A high VPD strictly limits radial stem growth and allows little growth during daylight hours, except in the early morning. Surprisingly, trees also grow in moderately dry soil when the VPD is low. Species-specific differences in diel growth dynamics show that species able to grow earlier during the night are associated with the highest number of hours with growth per year and the largest annual growth increment. We conclude that species with the ability to overcome daily water deficits faster have greater growth potential. Furthermore, we conclude that growth is more sensitive than carbon uptake to dry air, as growth stops before stomata are known to close.

Soil solution in Swiss forest stands: A 20 year's time series.

Soil solution chemistry is influenced by atmospheric deposition of air pollutants, exchange processes with the soil matrix and soil-rhizosphere-plant interactions. In this study we present the results of the long-term Intercantonal Forest Observation Program in Switzerland with soil solution measurements since 1998 on a current total of 47 plots. The forest sites comprise two major forest types of Switzerland including a wide range of ecological gradients such as different nitrogen (N) deposition and soil conditions. The long-term data set of 20 years of soil solution measurements revealed an ongoing, but site-specific soil acidification. In strongly acidified soils (soil pH below 4.2), acidification indicators changed only slowly over the measured period, possibly due to high buffering capacity of the aluminum buffer (pH 4.2-3.8). In contrast, in less acidified sites we observed an increasing acidification rate over time, reflected, for example, by the continuous decrease in the ratio of base cations to aluminum (BC/Al ratio). Nowadays, the main driver of soil acidification is the high rate of N deposition, causing cation losses and hampering sustainable nutrient balances for tree nutrition. Mean nitrate leaching rates for the years 2005-2017 were 9.4 kg N ha-1 yr-1, ranging from 0.04 to 53 kg N ha-1 yr-1. Three plots with high N input had a remarkable low nitrate leaching. Both N deposition and nitrate leaching have decreased since 2000. However, the latter trend may be partly explained due to increased drought in recent years. Nonetheless, those high N depositions are still affecting the majority of the forest sites. Taken together, this study gives evidence of anthropogenic soil acidification in Swiss forest stands. The underlying long-term measurements of soil solution provides important information on nutrient leaching losses and the impact climate change effects such as droughts. Furthermore, this study improves the understanding of forest management and tree mortality regarding varying nitrate leaching rates.

Correction: Growth and survival relationships of 71 tree species with nitrogen and sulfur deposition across the conterminous U.S.

[This corrects the article DOI: 10.1371/journal.pone.0205296.].

Growth and survival relationships of 71 tree species with nitrogen and sulfur deposition across the conterminous U.S.

Atmospheric deposition of nitrogen (N) influences forest demographics and carbon (C) uptake through multiple mechanisms that vary among tree species. Prior studies have estimated the effects of atmospheric N deposition on temperate forests by leveraging forest inventory measurements across regional gradients in deposition. However, in the United States (U.S.), these previous studies were limited in the number of species and the spatial scale of analysis, and did not include sulfur (S) deposition as a potential covariate. Here, we present a comprehensive analysis of how tree growth and survival for 71 species vary with N and S deposition across the conterminous U.S. Our analysis of 1,423,455 trees from forest plots inventoried between 2000 and 2016 reveals that the growth and/or survival of the vast majority of species in the analysis (n = 66, or 93%) were significantly affected by atmospheric deposition. Species co-occurred across the conterminous U.S. that had decreasing and increasing relationships between growth (or survival) and N deposition, with just over half of species responding negatively in either growth or survival to increased N deposition somewhere in their range (42 out of 71). Averaged across species and conterminous U.S., however, we found that an increase in deposition above current rates of N deposition would coincide with a small net increase in tree growth (1.7% per Δ kg N ha-1 yr-1), and a small net decrease in tree survival (-0.22% per Δ kg N ha-1 yr-1), with substantial regional and among-species variation. Adding S as a predictor improved the overall model performance for 70% of the species in the analysis. Our findings have potential to help inform ecosystem management and air pollution policy across the conterminous U.S., and suggest that N and S deposition have likely altered forest demographics in the U.S.

The immunopeptidomic landscape of ovarian carcinomas.

Immunotherapies, particularly checkpoint inhibitors, have set off a revolution in cancer therapy by releasing the power of the immune system. However, only little is known about the antigens that are essentially presented on cancer cells, capable of exposing them to immune cells. Large-scale HLA ligandome analysis has enabled us to exhaustively characterize the immunopeptidomic landscape of epithelial ovarian cancers (EOCs). Additional comparative profiling with the immunopeptidome of a variety of benign sources has unveiled a multitude of ovarian cancer antigens (MUC16, MSLN, LGALS1, IDO1, KLK10) to be presented by HLA class I and class II molecules exclusively on ovarian cancer cells. Most strikingly, ligands derived from mucin 16 and mesothelin, a molecular axis of prognostic importance in EOC, are prominent in a majority of patients. Differential gene-expression analysis has allowed us to confirm the relevance of these targets for EOC and further provided important insights into the relationship between gene transcript levels and HLA ligand presentation.

Growth trends of beech and Norway spruce in Switzerland: The role of nitrogen deposition, ozone, mineral nutrition and climate.

Understanding the effects of nitrogen deposition, ozone and climate on tree growth is important for planning sustainable forest management also in the future. The complex interplay of all these factors cannot be covered by experiments. Here we use observational data of mature forests for studying associations of various biotic and abiotic factors with tree growth. A 30year time series on basal area increment of Fagus sylvatica L. and Picea abies Karst. in Switzerland was analyzed to evaluate the development in relation to a variety of predictors. Basal area increment of Fagus sylvatica has clearly decreased during the observation period. For Picea abies no trend was observed. N deposition of more than 26 (beech) or 20-22kgNha-1year-1 (Norway spruce) was negatively related with basal area increment, in beech stronger than in Norway spruce. High N deposition loads and low foliar K concentrations in Fagus were correlated with increased drought sensitivity. High air temperatures in winter were negatively related with basal area increment in Norway spruce in general and in beech at high N:Mg ratio or high N deposition while on an average the relation was positive in beech. Fructification in beech was negatively related to basal area increment. The increase of fructification observed during the last decades contributed thus to the growth decrease. Ozone flux was significantly and negatively correlated with basal area increment both in beech and Norway spruce. The results show clear non-linear effects of N deposition on stem increment of European beech and Norway spruce as well as strong interactions with climate which have contributed to the growth decrease in beech and may get more important in future. The results not only give suggestions for ecological processes but also show the potential of an integral evaluation of observational data.

Epidemiological analysis of ozone and nitrogen impacts on vegetation - Critical evaluation and recommendations.

For human health studies, epidemiology has been established as important tool to examine factors that affect the frequency and distribution of disease, injury, and other health-related events in a defined population, serving the purpose of establishing prevention and control programs. On the other hand, gradient studies have a long tradition in the research of air pollution effects on plants. While there is no principal difference between gradient and epidemiological studies, the former address more one-dimensional transects while the latter focus more on populations and include more experience in making quantitative predictions, in dealing with confounding factors and in taking into account the complex interplay of different factors acting at different levels. Epidemiological analyses may disentangle and quantify the contributions of different predictor variables to an overall effect, e.g. plant growth, and may generate hypotheses deserving further study in experiments. Therefore, their use in ecosystem research is encouraged. This article provides a number of recommendations on: (1) spatial and temporal aspects in preparing predictor maps of nitrogen deposition, ozone exposure and meteorological covariates; (2) extent of a dataset required for an analysis; (3) choice of the appropriate regression model and conditions to be satisfied by the data; (4) selection of the relevant explanatory variables; (5) treatment of interactions and confounding factors; and (6) assessment of model validity.

Multidrug-resistant organisms in refugees: prevalences and impact on infection control in hospitals.

INTRODUCTION: The refugee crisis is a great challenge to the social and healthcare system in European countries, especially in Germany. An abundance of data has been published on the refugees' health problems (infections as well as physical diseases and psychiatric problems) and their prevention (i.e., sanitary and vaccination programs). However, data on prevalences of multidrug-resistant organisms (MDRO) in refugees are scarce, although it is known that most refugees are from or travelled through countries with high prevalences of MDRO. This paper presents current data on MDRO colonization of refugees admitted to hospitals, and the impact of screening upon admission and infection control in hospitals is discussed. METHODS: Anonymous data obtained by screening upon hospital admission were reported by hospitals in the Rhine-Main region of Germany to the local public health department. Screening and microbiological analyses were performed from December 2015 to March 2016 according to standardized and validated methods. RESULTS: 9.8% of the refugees screened (32/325) exhibited colonization with methicillin-resistant Staphylococcus aureus (MRSA), and 23.3% of the refugees (67/290) were colonized with Gram-negative bacteria with extended spectrum beta-lactamases, and/or enterobacteria with resistance against 3 or 4 groups of antibacterials, so-called 3MRGN (multidrug-resistant Gram-negative bacteria with resistance against penicillins, cephalosporins and quinolones) and 4MRGN (with additional resistance against carbapenems). Carbapenem-resistant Gram-negative bacteria (CRGN) were detected in 2.1% (6/290) of the refugees. CONCLUSION: The data confirms the studies published between 2014 and 2016, encompassing refugees tested in Germany, the Netherlands and Israel, with prevalences of MRSA and CRGN up to 13.5% and 5.6%. The MDRO prevalences are higher than those of "risk groups" for MRSA, such as hemodialysis patients and patients depending on outpatient home-nursing care or residing in nursing homes. Therefore, screening and special infection control in hospitals is strongly suggested when refugees are admitted to hospitals, in order to ensure best medical practice and safety for all hospital patients regardless of their country of origin.

Carbapenem-resistant Gram-negative bacteria - analysis of the data obtained through a mandatory reporting system in the Rhine-Main region, Germany, 2012-2015.

BACKGROUND: Multidrug-resistant Gram-negative bacteria (MRGN) and the infections they cause are a serious threat and a challenge to the healthcare system. This particularly applies to carbapenem-resistant Gram-negative bacteria (CRGN). Currently, the introduction of a nationwide mandatory notification system for CRGN in Germany is under consideration. Against this background, this paper presents an analysis of the mandatory reporting system for CRGN in effect since November 2011 in the federal state of Hesse (Germany). MATERIALS AND METHODS: All carbapenem-resistant Gram-negative bacteria and the detected carbapenemases reported to the public health department of the city of Frankfurt am Main, Hesse, Germany, on the basis of the mandatory notification system were analyzed. RESULTS: 827 CRGN cases were reported to the public health department of Frankfurt/Main between April 2012 and December 2015. The following bacterial species were reported: Pseudomonas spp. (n=268), Acinetobacter spp. (n=183), Klebsiella spp. (n=195), Enterobacter spp. (n=77), Escherichia coli (n=75) and others (n=29). Between 2012 and 2015, a reduction of the CRGN reports was noticed, mainly due to changes in the reporting of Pseudomonas spp. Between 2012 and 2015, the total number of notifications decreased slightly, although the number of reported CRGN in screening samples increased, thus giving no indication of a decreased testing frequency. For 10.5% of the patients, the place of residence was not Germany, 18.0% of the patients had previously stayed in hospitals abroad, often in countries with a high CRGN prevalence. CRGN bacteria were reported from all of Frankfurt's hospitals, and 3.9% were reported from out-patient care facilities. Carbapenemases were detected and reported in 251 CRGN bacteria, including 73 OXA-48, 76 OXA-23, 56 NDM subtypes, and 21 KPC subtypes. There have been no major epidemiological signs of outbreak scenarios. DISCUSSION: CRGN bacteria are already widespread in patients from hospitals and out-patient care facilities. Clearly, infection control measurements should therefore not only include hospital patients but also those receiving out-patient care. Screening strategies focused on patients from foreign countries with high MRGN prevalence is not sufficient, as only 10.5% of MRGN patients resided in those countries, and only 18% of the patients had been previously treated in a foreign hospital. In a public health context, infection control measures should therefore encompass broader screening strategies.