Impact of pharmacists as immunizers on vaccination rates: A systematic review and meta-analysis.

BACKGROUND: Underutilization of vaccination programs remains a significant public health concern. Pharmacists serve as educators, facilitators, and in some jurisdictions, as administrators of vaccines. Though pharmacists have been involved with immunizations in various ways for many years, there has yet to be a systematic review assessing the impact of pharmacists as immunizers in these three roles. OBJECTIVE: To complete a systematic review of the literature on the impact of pharmacists as educators, facilitators, and administrators of vaccines on immunization rates. METHODS: We identified 2825 articles searching the following databases from inception until October 2015: PubMed, EMBASE, Cochrane Libraries, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, Google Scholar. Grey literature was identified through use of the Canadian Agency for Drugs and Technology in Health "Grey Matters" search tool. Content from relevant journals and references of included studies were also searched. Inclusion criteria were clinical or epidemiologic studies in which pharmacists were involved in the immunization process. Studies were excluded if no comparator was reported. Two reviewers independently completed data extraction and bias assessments using standardized forms. RESULTS: Thirty-six studies were included in the review, 22 assessed the role of pharmacists as educators and/or facilitators and 14 assessed their role as administrators of vaccines. All studies reviewed found an increase in vaccine coverage when pharmacists were involved in the immunization process, regardless of role (educator, facilitator, administrator) or vaccine administered (e.g., influenza, pneumococcal), when compared to vaccine provision by traditional providers without pharmacist involvement. Limitations of the results include the large number of non-randomized trials and the heterogeneity between study designs. CONCLUSIONS: Pharmacist involvement in immunization, whether as educators, facilitators, or administrators of vaccines, resulted in increased uptake of immunizations. PROSPERO Registration: CRD42013005067.

Stem respiration in a closed-canopy upland oak forest.

Stem respiration was measured throughout 1993 on 56 mature trees of three species (Quercus alba L., Quercus prinus L., and Acer rubrum L.) in Walker Branch Watershed, Oak Ridge, Tennessee. A subset of the trees was remeasured during 1994. Diameter increments, stem temperatures and soil water were also monitored. Respiration rates in the spring and summer of 1993 tracked growth rate increments, except during a drought when growth dropped to zero and respiration increased to its highest rate. During the dormant season, rates of total stem respiration (R(t)) tended to be greater in large trees with thick sapwood but no such trend was observed during the growing season. Before and after the growing season, respiration rates correlated well with stem temperatures. Estimated values of Q(10) were 2.4 for the two oak species and 1.7 for red maple. The Q(10) values were used along with baseline respiration measurements and stem temperatures to predict seasonal changes in maintenance respiration (R(m)). In red maple, annual total R(m) accounted for 56 and 60% of R(t) in 1993 and 1994, respectively. In chestnut oak, R(m) accounted for 65 and 58% of R(t) in 1993 and 1994, respectively. In white oak, R(m) accounted for 47 and 53% of R(t) in 1993 and 1994, respectively. Extrapolating these data to the stand level showed that woody tissue respiration accounted for 149 and 204 g C m(-2) soil surface year(-1) in 1993 and 1994, respectively.

Biochemical composition of loblolly pine reflects pollutant exposure.

Under experimental conditions, the growth of loblolly pine (Pinus taeda L.) is often responsive to ozone at near-ambient concentrations. However, little is known of the biochemical changes associated with this or other pollutants. Loblolly pine seedlings in open-top chambers were exposed to combinations of ozone (sub-ambient, ambient, or twice-ambient), acidic precipitation (pH 3.8 or pH 5.2) and soil magnesium (0.15 or 0.32 microg g(-1) exchangeable Mg) for three growing seasons. The effects of these treatments were greater in foliage than in stems or roots. The largest treatment effect was a 50% decrease in the starch concentration of current-year foliage from the twice-ambient ozone treatment compared with current-year foliage from the sub-ambient ozone treatment. Responses to ozone were consistent with the hypothesis that ozone-induced growth reductions are associated with depletion of carbohydrate reserves resulting from injury compensation and repair processes or reduced carbon fixation or both. Addition of acidic precipitation, and to a small extent Mg, decreased sugar concentrations of tissues; however, this effect appeared to be mediated by nutrient addition rather than by acidity per se. Given the role of carbohydrates in plant resistance to environmental stress, the sensitivity of carbohydrates to experimental treatments demonstrates the potential for indirect effects of ozone, acidic precipitation, and soil properties on stress resistance. Noncarbohydrate constituents were largely unresponsive to the experimental treatments. These findings imply that tissue carbohydrate analysis may be useful for assessing the impacts of pollutants in forest ecosystems.

Ozone, acidic rain and soil magnesium effects on growth and foliar pigments of Pinus taeda L.

Height and diameter growth, biomass accumulation and leaf pigment concentrations were measured in loblolly pine (Pinus taeda L.) seedlings grown in soil containing 12 or 35 microg Mg g(-1) and exposed from May to October to subambient, ambient, or twice-ambient ozone (O(3)), and to simulated acidic rain with a pH of either 4.0 or 5.3. At the end of one growing season, height and diameter growth of seedlings exposed to twice-ambient O(3) were not statistically different from those of seedlings exposed to subambient O(3). Biomass of all plant parts was reduced by 7 to 16% in response to increasing O(3) concentration. No statistically significant growth responses to rain chemistry or soil magnesium status were observed, and there were no statistically significant interactive treatment effects. Needle pigment concentrations were not significantly affected by rain chemistry or soil Mg status and there were no visible signs of injury to needles that could be attributed to O(3) stress or Mg deficiency. Concentrations of chlorophyll a and b, and carotenes were 23, 30 and 21% higher (P

Pine needle holders for use in gas exchange measurements.

Simple holders for positioning pine needles in a gas exchange cuvette are described. The holders make it easy to enclose a standard length of needles in the cuvette in a single plane without mutual shading. The holders also make it possible, following gas exchange measurements, to harvest for further analysis just those needle portions that were enclosed in the leaf chamber. Field observations, which were made with a gas exchange cuvette incorporating the needle holders, on the relationship between carbon exchange rate and photon flux density in loblolly pine (Pinus taeda L.) needles are reported.

The effects of stem girdling on biogeochemical cycles within a mixed deciduous forest in eastern Tennessee : I. Soil solution chemistry, soil respiration, litterfall and root biomass studies.

Studies on the effects of stem girdling of a tulip poplar (Liriodendron tulipifera L.) dominated mixed deciduous forest revealed that trees continued to grow above the point of girdling for more than two years after girdling. Soil core samples showed that root biomass was not significantly reduced until two years after trees were girdled. Litterfall during the fall of 1977 from trees girdled in Semptember 1975 and allowed to develop stump sprouts (plot no. 1) was 72% of the control plot. Litterfall during the same time from trees girdled in May 1976 but with stump sprouts removed (plot no. 2) was 82% of the control. Diameter growth during the growing season of 1977 was 53% of control in plot no. 1 and 68% of control in plot no. 2. No significant differences (P>0.05) in forest floor CO2 efflux rates were observed between plots in the field. However, respiration rates were found to be higher in the girdled plot soil than in the control soil when roots and litter were removed by sieving and CO2 efflux from just the mineral soil and associated detritus was measured.Increased leaching rates of nutrients revealed the effects of girdling on biogeochemical cycles of the forest. The most pronounced effect was increased concentrations of NO3 ions in the soil water of the girdled plots, resulting in losses of NO3 ions below the root zone (>60 cm) during the second year. These losses amounted to 25.4 kg ha-1 in plot no. 2 and 9.0 kg ha-1 in plot no. 1 as compared to 0.15 kg/ha-1 from the control plot. Calcium losses below the root zone during the second year were ≃10 kg ha-1 greater in plot no. 2 than the control plot, while losses from plot no. 1 were about equal to the control. Calcium and nitrogen uptake by the sprouts in plot no. 1 offset the slightly reduced uptake by the girdled trees and in fact uptake in plot no. 1 may have exceeded the control during the first year. Differences in uptake could account for only a portion of the differences in NO3 ion concentrations based on litterfall and diameter growth in girdled plots.

The effects of stem girdling on biogeochemical cycles within a mixed deciduous forest in eastern Tennessee : II. Soil nitrogen mineralization and nitrification rates.

Nitrogen mineralization and net nitrification rates were 3-7 times greater in soil incubations from a girdled Liriodendron tulipifera (L.) stand than in a control stand. Neither litter nor root extracts had an inhibitory effect on nitrogen mineralization or nitrification rate. A lack of nitrification inhibitors also was demonstrated by the fact that ammonium added to the control stand was completely converted to nitrate upon incubation. Additions of sucrose increased CO2 evolution and decreased nitrogen mineralization and nitrification rates in the girdled plot soil, suggesting that nitrification could be effectively controlled by competition for NH 4+ supplies by heterotrophic soil organisms. CO2 evolution rates during incubation showed that heterotrophic as well as nitrifier activities were greater in the girdled plot soil than in the ungirdled plot soil, but the ratio of C to N mineralized was lower in the girdled plot soil. These results collectively indicate that nitrification is regulated by the availability of NH 4+ in these stands, and that the latter is strongly regulated by heterotrophic demand for N.