Treating an Epidemic During a Pandemic: Experience Treating Opioid Use Disorder at the Baltimore Convention Center Field Hospital.

During the COVID-19 pandemic, access to addiction treatment has plummeted. At the same time, patients with opioid use disorder are at higher risk of COVID-19 infection and experience worse outcomes. The Baltimore Convention Center Field Hospital (BCCFH), a state-run COVID-19 disaster hospital operated by Johns Hopkins Medicine and the University of Maryland Medical System, continues to operate 14 months into the pandemic to serve as an overflow unit for the state's hospitals. BCCFH staff observed the demand for opioid use disorder care and developed admission criteria, a pharmacy formulary, and case management procedures to meet this need. This article describes generalized lessons from the BCCFH experience treating substance use disorder during a pandemic.

Late spring freezes coupled with warming winters alter temperate tree phenology and growth.

Spring phenology is advancing with warming but late spring freezes may not advance at the same rate, potentially leading to an increase in freezes after trees initiate budburst. Research suggests warming winters may delay budburst through reduced chilling, which may cause plants to leafout more slowly, thus decreasing spring freeze tolerance. Here, we assessed the effects of late spring freezes and reduced over-winter chilling on sapling phenology, growth and tissue traits, across eight temperate tree and shrub species in a laboratory experiment. We found that spring freezes delayed leafout - extending the period of greatest risk for freeze damage - increased damage to the shoot apical meristem, and decreased leaf toughness and leaf thickness. Longer chilling accelerated budburst and leafout, even under spring freeze conditions. Thus, chilling compensated for the adverse effects of late spring freezes on phenology. Despite the effects of spring freezes and chilling on phenology, we did not see any major reordering in the sequence of species leafout. Our results suggest climate change may impact forest communities not through temporal reassembly, but rather through impacts on phenology and growth from the coupled effects of late spring freezes and decreased over-winter chilling under climate change.

Climate change reshapes the drivers of false spring risk across European trees.

Temperate forests are shaped by late spring freezes after budburst - false springs - which may shift with climate change. Research to date has generated conflicting results, potentially because few studies focus on the multiple underlying drivers of false spring risk. Here, we assessed the effects of mean spring temperature, distance from the coast, elevation and the North Atlantic Oscillation (NAO) using PEP725 leafout data for six tree species across 11 648 sites in Europe, to determine which were the strongest predictors of false spring risk and how these predictors shifted with climate change. All predictors influenced false spring risk before recent warming, but their effects have shifted in both magnitude and direction with warming. These shifts have potentially magnified the variation in false spring risk among species with an increase in risk for early-leafout species (i.e. Aesculus hippocastanum, Alnus glutinosa, Betula pendula) compared with a decline or no change in risk among late-leafout species (i.e. Fagus sylvatica, Fraxinus excelsior, Quercus robur). Our results show how climate change has reshaped the drivers of false spring risk, complicating forecasts of future false springs, and potentially reshaping plant community dynamics given uneven shifts in risk across species.

Seasonal fluctuation of nonstructural carbohydrates reveals the metabolic availability of stemwood reserves in temperate trees with contrasting wood anatomy.

Nonstructural carbohydrates (NSCs) play a critical role in plant physiology and metabolism, yet we know little about their distribution within individual organs such as the stem. This leaves many open questions about whether reserves deep in the stem are metabolically active and available to support functional processes. To gain insight into the availability of reserves, we measured radial patterns of NSCs over the course of a year in the stemwood of temperate trees with contrasting wood anatomy (ring porous vs diffuse porous). In a subset of trees, we estimated the mean age of soluble sugars within and between different organs using the radiocarbon (14C) bomb spike approach. First, we found that NSC concentrations were the highest and most seasonally dynamic in the outermost stemwood segments for both ring-porous and diffuse-porous trees. However, while the seasonal fluctuation of NSCs was dampened in deeper stemwood segments for ring-porous trees, it remained high for diffuse-porous trees. These NSC dynamics align with differences in the proportion of functional sapwood and the arrangement of vessels between ring-porous and diffuse-porous trees. Second, radial patterns of 14C in the stemwood showed that sugars became older when moving toward the pith. The same pattern was found in the coarse roots. Finally, when taken together, our results highlight how the radial distribution and age of NSCs relate to wood anatomy and suggest that while deeper, and likely older, reserves in the stemwood fluctuated across the seasons, the deepest reserves at the center of the stem were not used to support tree metabolism under usual environmental conditions.

Rethinking false spring risk.

Temperate plants are at risk of being exposed to late spring freezes. These freeze events-often called false springs-are one of the strongest factors determining temperate plants species range limits and can impose high ecological and economic damage. As climate change may alter the prevalence and severity of false springs, our ability to forecast such events has become more critical, and it has led to a growing body of research. Many false spring studies largely simplify the myriad complexities involved in assessing false spring risks and damage. While these studies have helped advance the field and may provide useful estimates at large scales, studies at the individual to community levels must integrate more complexity for accurate predictions of plant damage from late spring freezes. Here, we review current metrics of false spring, and how, when, and where plants are most at risk of freeze damage. We highlight how life stage, functional group, species differences in morphology and phenology, and regional climatic differences contribute to the damage potential of false springs. More studies aimed at understanding relationships among species tolerance and avoidance strategies, climatic regimes, and the environmental cues that underlie spring phenology would improve predictions at all biological levels. An integrated approach to assessing past and future spring freeze damage would provide novel insights into fundamental plant biology and offer more robust predictions as climate change progresses, which are essential for mitigating the adverse ecological and economic effects of false springs.

Disclosure of "nonharmful" medical errors and other events: duty to disclose.

An estimated 98 000 patients die in the United States each year because of medical errors. One million or more total medical errors are estimated to occur annually, which is far greater than the actual number of reported "harmful" mistakes. Although it is generally agreed that harmful errors must be disclosed to patients, when the error is deemed to have not resulted in a harmful event, physicians are less inclined to disclose it. Little has been written about the handling of near misses or "nonharmful" errors, and the issues related to disclosure of such events have rarely been discussed in medicine, although they are routinely addressed within the aviation industry. Herein, we elucidate the arguments for reporting nonharmful medical errors to patients and to reporting systems. A definition of what constitutes harm is explored, as well as the ethical issues underpinning disclosure of nonharmful errors. In addition, systematic institutional implications of reporting nonharmful errors are highlighted. Full disclosure of nonharmful errors is advocated, and recommendations on how to discuss errors with patients are provided. An argument that full error disclosure may improve future patient care is also outlined.