Correction: Differential changes in the onset of spring across US National Wildlife Refuges and North American migratory bird flyways.

[This corrects the article DOI: 10.1371/journal.pone.0202495.].

Provision of Buprenorphine to Pregnant Women by For-Profit Clinics in an Appalachian City.

OBJECTIVES: This study was undertaken to confirm that patient reports on buprenorphine medication-assisted therapy in for-profit buprenorphine clinics in our community were personally costly. We contacted all 17 for-profit clinics in our community and confirmed the patient reports that a significant financial payment of ≤$100 was required for each visit. We also found that tapering of buprenorphine dosage in pregnancy was offered by several of the clinics. METHODS: A telephone survey was conducted with the 17 for-profit buprenorphine clinics located in the Johnson City, Tennessee area. The clinic representative who answered the telephone was asked questions regarding patient costs for therapy and availability of tapering programs for pregnant women. RESULTS: Patient reports that the for-profit clinics are costly were confirmed. None of the clinics accepted insurance reimbursement of any type. The most common weekly costs were $100 per visit. A majority of clinics offered biweekly or monthly visits at significantly increased rates. Clinic representatives stated that a majority of clinics would consider buprenorphine tapering programs for pregnant women. CONCLUSIONS: The high cost of for-profit clinics is a barrier for patient access to medication-assisted therapy with buprenorphine. Tapering of buprenorphine dosage in pregnant women has penetrated buprenorphine management practice in our community. Further research is needed to determine whether elimination of cost barrier would have a positive effect on the rates of neonatal abstinence syndrome.

Differential changes in the onset of spring across US National Wildlife Refuges and North American migratory bird flyways.

Warming temperatures associated with climate change can have indirect effects on migratory birds that rely on seasonally available food resources and habitats that vary across spatial and temporal scales. We used two heat-based indices of spring onset, the First Leaf Index (FLI) and the First Bloom Index (FBI), as proxies of habitat change for the period 1901 to 2012 at three spatial scales: the US National Wildlife Refuge System; the four major bird migratory flyways in North America; and the seasonal ranges (i.e., breeding and non-breeding grounds) of two migratory bird species, Blue-winged Warbler (Vermivora cyanoptera) and Whooping Crane (Grus americana). Our results show that relative to the historical range of variability, the onset of spring is now earlier in 76% of all wildlife refuges and extremely early (i.e., exceeding 95% of historical conditions) in 49% of refuges. In all flyways but the Pacific, the rate of spring advance is generally greater at higher latitudes than at lower latitudes. This differential rate of advance in spring onset is most pronounced in the Atlantic flyway, presumably because of a "warming hole" in the southeastern US. Both FLI and FBI have advanced markedly in the breeding ranges-but not the non-breeding ranges-of the two selected bird species, albeit with considerable intra-range variation. Differences among species in terms of migratory patterns and the location and extent of seasonal habitats, as well as shifts in habitat conditions over time, may complicate predictions of the vulnerability of migratory birds to climate change effects. This study provides insight into how differential shifts in the phenology of disparate but linked habitats could inform local- to landscape-scale management strategies for the conservation of migratory bird populations.