Hurricanes pose a substantial risk to New England forest carbon stocks

Nature-based climate solutions (NCS) are championed as a primary tool to mitigate climate change, especially in forested regions capable of storing and sequestering vast amounts of carbon. New England is one of the most heavily forested regions in the United States (>75% forested by land area), and forest carbon is a significant component of climate mitigation policies. Large infrequent disturbances, such as hurricanes, are a major source of uncertainty and risk for policies relying on forest carbon for climate mitigation, especially as climate change is projected to alter the intensity and extent of hurricanes. To date, most research into disturbance impacts on forest carbon stocks has focused on fire. Here, we show that a single hurricane in the region can down between 121 and 250 MMTCO2e or 4.6%-9.4% of the total aboveground forest carbon, much greater than the carbon sequestered annually by New England's forests (16 MMTCO2e year-1). However, emissions from hurricanes are not instantaneous; it takes approximately 19 years for downed carbon to become a net emission and 100 years for 90% of the downed carbon to be emitted. Reconstructing hurricanes with the HURRECON and EXPOS models across a range of historical and projected wind speeds, we find that an 8% and 16% increase in hurricane wind speeds leads to a 10.7- and 24.8-fold increase in the extent of high-severity damaged areas (widespread tree mortality). Increased wind speed also leads to unprecedented geographical shifts in damage, both inland and northward, into heavily forested regions traditionally less affected by hurricanes. Given that a single hurricane can emit the equivalent of 10+ years of carbon sequestered by forests in New England, the status of these forests as a durable carbon sink is uncertain. Understanding the risks to forest carbon stocks from disturbances is necessary for decision-makers relying on forests as a NCS.

Eelgrass (Zostera marina L.) populations are threatened by high sea-surface temperatures and impaired waters on Nantucket Island, USA

Eelgrass (Zostera marina L.) is a key foundation species that provides multiple ecosystem services to shallow coastal and estuarine systems in the Northern Hemisphere. It is estimated that, over the last century, up to 50 % of all Z. marina habitat has been lost along the east coast of the USA due to factors including light reduction, eutrophication, and physical disturbance. Warming sea surface temperatures are also believed to be exacerbating losses and the future of this ecosystem is unclear. Here, we assess Z. marina meadows on Nantucket, an island system located 50 km off-shore of Massachusetts, by using common indicators of seagrass plant health and environmental quality. Our results show that Z. marina meadows on Nantucket Island are thermally stressed and light-limited during parts of their peak growing season. This suggests that sea-surface temperatures are a pivotal factor, along with cultural eutrophication, in observed large-scale losses of Z. marina and that further degradation could be expected in the future as the climate continues to warm. Methods from this study may be used by managers as a guide to assess seagrass ecosystem status in degrading systems.

Mechanical power and 30-day mortality in mechanically ventilated, critically ill patients with and without Coronavirus Disease-2019: a hospital registry study

BACKGROUND

Previous studies linked a high intensity of ventilation, measured as mechanical power, to mortality in patients suffering from "classic" ARDS. By contrast, mechanically ventilated patients with a diagnosis of COVID-19 may present with intact pulmonary mechanics while undergoing mechanical ventilation for longer periods of time. We investigated whether an association between higher mechanical power and mortality is modified by a diagnosis of COVID-19.

METHODS

This retrospective study included critically ill, adult patients who were mechanically ventilated for at least 24 h between March 2020 and December 2021 at a tertiary healthcare facility in Boston, Massachusetts. The primary exposure was median mechanical power during the first 24 h of mechanical ventilation, calculated using a previously validated formula. The primary outcome was 30-day mortality. As co-primary analysis, we investigated whether a diagnosis of COVID-19 modified the primary association. We further investigated the association between mechanical power and days being alive and ventilator free and effect modification of this by a diagnosis of COVID-19. Multivariable logistic regression, effect modification and negative binomial regression analyses adjusted for baseline patient characteristics, severity of disease and in-hospital factors, were applied.

RESULTS

1,737 mechanically ventilated patients were included, 411 (23.7%) suffered from COVID-19. 509 (29.3%) died within 30 days. The median mechanical power during the first 24 h of ventilation was 19.3 [14.6-24.0] J/min in patients with and 13.2 [10.2-18.0] J/min in patients without COVID-19. A higher mechanical power was associated with 30-day mortality (OR_adj 1.26 per 1-SD, 7.1J/min increase; 95% CI 1.09-1.46; p = 0.002). Effect modification and interaction analysis did not support that this association was modified by a diagnosis of COVID-19 (95% CI, 0.81-1.38; p-for-interaction = 0.68). A higher mechanical power was associated with a lower number of days alive and ventilator free until day 28 (IRR_adj 0.83 per 7.1 J/min increase; 95% CI 0.75-0.91; p < 0.001, adjusted risk difference - 2.7 days per 7.1J/min increase; 95% CI - 4.1 to - 1.3).

CONCLUSION

A higher mechanical power is associated with elevated 30-day mortality. While patients with COVID-19 received mechanical ventilation with higher mechanical power, this association was independent of a concomitant diagnosis of COVID-19.

Highly Pathogenic Avian Influenza A(H5N1) Virus Outbreak in New England Seals, United States

We report the spillover of highly pathogenic avian influenza A(H5N1) into marine mammals in the northeastern United States, coincident with H5N1 in sympatric wild birds. Our data indicate monitoring both wild coastal birds and marine mammals will be critical to determine pandemic potential of influenza A viruses.

Gathered from the Vine: A Survey of Seven Grapevine Viruses Within New England Vineyards

Vineyards in the Southeastern New England American Viticultural Area were surveyed for the incidence of seven major viruses: grapevine leafroll-associated viruses (GLRaV-1, GLRaV-2, GLRaV-3, and GLRaV-4), grapevine fanleaf virus (GFLV), tomato ringspot virus (ToRSV), and tobacco ringspot virus (TRSV). Viruses were detected by DAS-ELISA and confirmed by RT-PCR and Sanger sequencing. Multiple viruses were present in 19 out of the 25 vineyards surveyed between 2018 and 2020. GLRaV-3 (27.59%) was the most prevalent virus followed by GLRaV-4 (14.90%), GLRaV-1 (13.52%), GLRaV-2 (11.03%), ToRSV (6.34%), GFLV (5.24%), and TRSV (2.62%). Furthermore, phylogenetic analyses of the viral partial genome sequences acquired in this study revealed that the grapevine viruses present in this area are diverse, indicating that they may have been introduced from different sources. Our findings stress the need for improving the sanitary status of planting materials to avoid the introduction and dissemination of viruses to vineyards in this important wine-producing region of New England.

Radical shift in the genetic composition of New England chicory populations

Human activities have been altering the flora and fauna across the planet. Distributions and the diversity of species, and the phenotypes of individuals in those species are changing. New England with its rapidly changing human demographics is an ideal place to investigate these temporal changes in the habitat. The flora of New England consists of both native and nonnative species. Non-indigenous plant species have been introduced since the first Europeans arrived in North America in the 15th century. Cichorium intybus (chicory), native to Eurasia, was first recorded in North America in 1774. Subsequently, chicory spread and became naturalized throughout much of the continent.In this study, we used chloroplast DNA sequences and 12 microsatellite nuclear markers to assess the temporal genetic changes in New England populations of chicory. We analysed 84 herbarium specimens and 18 contemporary extant populations (228 individuals in total).Three chloroplast DNA haplotypes were detected and all were present in New England prior to 1890; however, Hap3 was rare prior to the 1950s. The nuclear DNA markers showed a major shift in the genetic diversity and composition, with all historical herbarium collections belonging to a single genetic cluster and 16 out of 18 contemporary chicory populations belonging to different genetic clusters. This change occurred regionally and also on a local scale with contemporary populations being very different from herbarium specimens collected previously in the corresponding localities. Synthesis. Our results indicate that the genetic diversity and structure of Cichorium intybus populations have changed substantially since the founding populations in New England. These changes may have contributed to the success of this nonnative species and helped to fuel its rapid expansion and adaptation to the changing landscapes in both New England and the rest of North America.

"I've been to more of my friends' funerals than I've been to my friends' weddings": Witnessing and responding to overdose in rural Northern New England

PURPOSE

Overdose is a leading cause of death among people who use drugs (PWUDs), but policies to reduce fatal overdose have had mixed results. Summaries of naloxone access and Good Samaritan Laws (GSLs) in prior studies provide limited information about local context. Witnessing overdoses may also be an important consideration in providing services to PWUDs, as it contributes to post traumatic stress disorder (PTSD) symptoms, which complicate substance use disorder treatment.

METHODS

We aim to estimate the prevalence and correlates of witnessing and responding to an overdose, while exploring overdose context among rural PWUD. The Drug Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE) mixed-methods study characterized substance use and risk behaviors in 11 rural Massachusetts, Vermont, and New Hampshire counties between 2018 and 2019. PWUD completed surveys (n = 589) and in-depth interviews (n = 22).

FINDINGS

Among the survey participants, 84% had ever witnessed an overdose, which was associated with probable PTSD symptoms. Overall, 51% had ever called 911 for an overdose, though some experienced criminal legal system consequences despite GSL. Although naloxone access varied, 43% had ever used naloxone to reverse an overdose.

CONCLUSIONS

PWUD in Northern New England commonly witnessed an overdose, which they experienced as traumatic. Participants were willing to respond to overdoses, but faced barriers to effective overdose response, including limited naloxone access and criminal legal system consequences. Equipping PWUDs with effective overdose response tools (education and naloxone) and enacting policies that further protect PWUDs from criminal legal system consequences could reduce overdose mortality.

Coastal Recreation in Southern New England: Results from a Regional Survey

This paper presents a summary of coastal recreation of New England residents from a survey conducted in the summer of 2018. The management of New England's coasts benefits from understanding the value of coastal recreation and the factors influencing recreational behavior. To address this need, the survey collected the geographic location and trip details for both day and overnight visits to any type of location on the New England coast for a range of water recreation activities, providing a comprehensive view of coastal recreation in the region. This paper summarizes participation in various types of water recreation activities, including beachgoing, swimming, fishing, wildlife viewing, boating, and other coastal recreation activities. We quantify demand for coastal recreation using participation and effort models that disaggregate the dimensions of recreational behavior over space and census demographics. This provides insights on the scale and location of beneficiaries of this important human use of the natural environment. We found that 71% of people in the surveyed region participate in coastal recreation and engage in a wide range of coastal recreation activities at varied locations from open-ocean-facing coastal beaches to sheltered, estuarine ways to water. On average, people in the region take 37 trips to recreate on the coast of New England in a year, spending 167 hours per year visiting recreation sites and 66 hours traveling. This adds up to nearly 170.5 million trips from our sample region, 772.4 million hours of recreation time, and 304.6 million hours of travel time. Distance to the coast, demographics, and recreational activities affect how often people go and how much time they spend on coastal recreation.

Frequency and Geographic Distribution of Borrelia miyamotoi, Borrelia burgdorferi, and Babesia microti Infections in New England Residents

BACKGROUND

Borrelia miyamotoi is a relapsing fever spirochete that relatively recently has been reported to infect humans. It causes an acute undifferentiated febrile illness that can include meningoencephalitis and relapsing fever. Like Borrelia burgdorferi, it is transmitted by Ixodes scapularis ticks in the northeastern United States and by Ixodes pacificus ticks in the western United States. Despite reports of clinical cases from North America, Europe, and Asia, the prevalence, geographic range, and pattern of expansion of human B. miyamotoi infection are uncertain. To better understand these characteristics of B. miyamotoi in relation to other tickborne infections, we carried out a cross-sectional seroprevalence study across New England that surveyed B. miyamotoi, B. burgdorferi, and Babesia microti infections.

METHODS

We measured specific antibodies against B. miyamotoi, B. burgdorferi, and B. microti among individuals living in 5 New England states in 2018.

RESULTS

Analysis of 1153 serum samples collected at 11 catchment sites showed that the average seroprevalence for B. miyamotoi was 2.8% (range, 0.6%-5.2%), which was less than that of B. burgdorferi (11.0%; range, 6.8%-15.6%) and B. microti (10.0%; range, 6.5%-13.6%). Antibody screening within county residence in New England showed varying levels of seroprevalence for these pathogens but did not reveal a vectoral geographical pattern of distribution.

CONCLUSIONS

Human infections caused by B. miyamotoi, B. burgdorferi, and B. microti are widespread with varying prevalence throughout New England.

COVID-19's Perceived Impact on Primary Care in New England: A Qualitative Study

BACKGROUND

COVID-19 impacted primary care delivery, as clinicians and practices implemented changes to respond to the pandemic while safely caring for patients. This study aimed to understand clinicians' perceptions of the positive and negative impacts of COVID-19 on primary care in New England.

METHODS

This qualitative interview study was conducted from October through December 2020. Participants included 22 physicians and 2 nurse practitioners practicing primary care in New England. Data were thematically coded and analyzed deductively and inductively using content analysis.

RESULTS

Through qualitative content analysis, 4 areas were identified in which clinicians perceived that COVID-19 impacted primary care: 1) bureaucracy, 2) leadership, 3) telemedicine and patient care, and 4) clinician work-life. Our findings suggest that the positive impacts of COVID-19 included changes in primary care delivery, new leadership opportunities for clinicians, flexible access to care for patients via telemedicine, and a better work-life balance for clinicians. Respondents identified negative impacts related to sustaining pandemic-inspired changes, the inability for some populations to access care via telemedicine, and the rapid implementation of telemedicine causing frustration for clinicians.

CONCLUSIONS

Understanding clinician perspectives on how primary care transformed to respond to COVID-19 helps to identify beneficial pandemic-related changes that should be sustained and ideas for improvement that will support patient care and clinician engagement.

Spectacles of Settler Colonial Memory: Archaeological Findings from an Early Twentieth-Century "First" Settlement Pageant and Other Commemorative Terrain in New England

In 1923, rural New England mill town Dover, New Hampshire, staged a Tercentenary pageant of extraordinary proportions to celebrate its "first" settlement. This public spectacle memorialized a specific, and deeply exclusionary, narrative of English settler colonialism, shaped by social anxieties of the post-First World War United States. Recent archaeological research has found possible remnants from this spectacle on a seventeenth-century site. In disturbing this site, the Tercentenary pageant appears to have disregarded actual significant material traces from the very era it aimed to memorialize--traces that offer distinct, fuller understandings of deeply nuanced Native-settler interactions in the Piscataqua River region. Dover's pageant is situated in a regional analysis of Native and Euro-colonial commemorative place-making of the early twentieth century, exploring how different communities pursued multivocal, monovocal, or other approaches in their performative engagements with the seventeenth century.

Comparing fruiting phenology across two historical datasets: Thoreau's observations and herbarium specimens

BACKGROUND AND AIMS

Fruiting remains under-represented in long-term phenology records, relative to leaf and flower phenology. Herbarium specimens and historical field notes can fill this gap, but selecting and synthesizing these records for modern-day comparison requires an understanding of whether different historical data sources contain similar information, and whether similar, but not equivalent, fruiting metrics are comparable with one another.

METHODS

For 67 fleshy-fruited plant species, we compared observations of fruiting phenology made by Henry David Thoreau in Concord, Massachusetts (1850s), with phenology data gathered from herbarium specimens collected across New England (mid-1800s to 2000s). To identify whether fruiting times and the order of fruiting among species are similar between datasets, we compared dates of first, peak and last observed fruiting (recorded by Thoreau), and earliest, mean and latest specimen (collected from herbarium records), as well as fruiting durations.

KEY RESULTS

On average, earliest herbarium specimen dates were earlier than first fruiting dates observed by Thoreau; mean specimen dates were similar to Thoreau's peak fruiting dates; latest specimen dates were later than Thoreau's last fruiting dates; and durations of fruiting captured by herbarium specimens were longer than durations of fruiting observed by Thoreau. All metrics of fruiting phenology except duration were significantly, positively correlated within (r: 0.69-0.88) and between (r: 0.59-0.85) datasets.

CONCLUSIONS

Strong correlations in fruiting phenology between Thoreau's observations and data from herbaria suggest that field and herbarium methods capture similar broad-scale phenological information, including relative fruiting times among plant species in New England. Differences in the timing of first, last and duration of fruiting suggest that historical datasets collected with different methods, scales and metrics may not be comparable when exact timing is important. Researchers should strongly consider matching methodology when selecting historical records of fruiting phenology for present-day comparisons.

Factors Influencing Carbon Stocks and Accumulation Rates in Eelgrass Meadows Across New England, USA

Increasing the protection of coastal vegetated ecosystems has been suggested as one strategy to compensate for increasing carbon dioxide (CO₂) in the atmosphere as the capacity of these habitats to sequester and store carbon exceeds that of terrestrial habitats. Seagrasses are a group of foundation species that grow in shallow coastal and estuarine systems and have an exceptional ability to sequester and store large quantities of carbon in biomass and, particularly, in sediments. However, carbon stocks (C_org stocks) and carbon accumulation rates (C_org accumulation) in seagrass meadows are highly variable both spatially and temporally, making it difficult to extrapolate this strategy to areas where information is lacking. In this study, C_org stocks and C_org accumulation were determined at 11 eelgrass meadows across New England, representing a range of eutrophication and exposure conditions. In addition, the environmental factors and structural characteristics of meadows related to variation in C_org stocks were identified. The objectives were accomplished by assessing stable isotopes of δ¹³C and δ¹⁵N as well as %C and %N in plant tissues and sediments, measuring grain size and ²¹⁰Pb of sediment cores, and through assessing site exposure. Variability in C_org stocks in seagrass meadows is well predicted using commonly measured environmental variables such as grain size distribution. This study allows incorporation of data and insights for the northwest Atlantic, where few studies on carbon sequestration by seagrasses have been conducted.

Co-designed Land-use Scenarios and their Implications for Storm Runoff and Streamflow in New England

Landscape and climate changes have the potential to create or exacerbate problems with stormwater management, high flows, and flooding. In New England, four plausible land-use scenarios were co-developed with stakeholders to give insight to the effects on ecosystem services of different trajectories of socio-economic connectedness and natural resource innovation. With respect to water, the service of greatest interest to New England stakeholders is the reduction of stormwater and flooding. To assess the effects of these land-use scenarios, we applied the Soil and Water Assessment Tool to two watersheds under two climates. Differences in land use had minimal effects on the water balance but did affect high flows and the contribution of storm runoff to streamflow. For most scenarios, the effect on high flows was small. For one scenario-envisioned to have global socio-economic connectedness and low levels of natural resource innovation-growth in impervious areas increased the annual maximum daily flow by 10%, similar to the 5-15% increase attributable to climate change. Under modest population growth, land-use decisions have little effect on storm runoff and high flows; however, for the two scenarios characterized by global socio-economic connectedness, differences in choices regarding land use and impervious area have a large impact on the potential for flooding. Results also indicate a potential interaction between climate and land use with a shift to more high flows resulting from heavy rains than from snowmelt. These results can help inform land use and development, especially when combined with assessments of effects on other ecosystem services.

The strength of green ties: Massachusetts cranberry grower social networks and effects on climate change attitudes and action

The cranberry, a commodity of social, cultural, and economic importance to New England, is under threat due to climatic change in this region of the United States. Yet, previous research reveals that cranberry growers have mixed attitudes about the anthropogenic roots of climate change, with many being skeptical. Building on the researchers' analysis of the personal and ecological conditions that affect climate change attitudes among cranberry growers, this paper examines the effect that key actors in the growers' social networks have on those attitudes. Through statistical analysis of survey data and content analysis of two important cranberry newsletters, the paper finds that cranberry growers' perceived importance of two key cranberry growing institutions, the "sociopolitically focused" Cape Cod Cranberry Growers' Association and the "technically focused" University of Massachusetts Cranberry Station, as well as connections to other cranberry growers, is associated in nuanced ways with growers' climate change attitudes. Drawing on the sociological theory of "social capital," the paper examines how these social ties to key actors/institutions may result in greater threat perception or worry about climate change. It then considers how "green ties," if harnessed and supported by these important actors in the cranberry grower network, might significantly mitigate climate change in the future.

Change in opioid policies in New England emergency departments, 2014 vs 2018

OBJECTIVE

The U.S. opioid epidemic persists, yet it is unclear if opioid-related emergency department (ED) policies have changed. We investigated: 1) the prevalence of opioid use disorder (OUD) prevention and treatment policies in New England EDs in 2018, and 2) how these policies have changed since 2014.

METHODS

Using the National Emergency Department Inventory-USA, we identified and surveyed all New England EDs in 2015 and 2019 about opioid-related policies in 2014 and 2018, respectively. The surveys assessed OUD prevention policies (to use a screening tool, access the Prescription Drug Monitoring Program [PDMP], notify primary care providers, prescribe/dispense naloxone) and treatment policies (to refer to recovery resources, prescribe/dispense buprenorphine).

RESULTS

Of 194 EDs open in 2018, 167 (86 %) completed the survey. Of 193 EDs open in 2018 and 2014, 147 (76 %) completed both surveys. In 2018, the most commonly-reported policy was accessing the PDMP (96 %); the least commonly-reported policy was prescribing/dispensing buprenorphine to at risk patients (37 %). EDs varied in prescribing/dispensing naloxone: 35 % of EDs offered naloxone to ≥80 % of patients at risk of opioid overdose versus 33 % of EDs to <10 % of patients at risk. Most EDs (74 %) reported prescribing/dispensing buprenorphine to <10 % of patients with OUD. Comparing 2018 to 2014, the greatest difference in policy use was in prescribing/dispensing naloxone (+55 %, p < 0.001).

CONCLUSION

Implementation of opioid-related ED policies increased between 2014 and 2018. Continued effort is needed to understand the extent to which policy implementation translates to clinical care, and to best translate evidence-based policies into clinical practice.

Effects of Mowing and Prescribed Fire on Plant Community Structure and Function in Rare Coastal Sandplains, Nantucket Island, MA, USA

Coastal sandplains provide habitat for a suite of rare and endangered plant and wildlife species in the northeastern United States. These early successional plant communities were maintained by natural and anthropogenic disturbances including salt spray, fire, and livestock grazing, but over the last 150 years, a decrease in anthropogenic disturbance frequency and intensity has resulted in a shift towards woody shrub dominance at the expense of herbaceous taxa. This study quantified the effects of more than a decade of dormant season disturbance-based vegetation management (mowing and prescribed fire) on coastal sandplain plant community composition on Nantucket Island, Massachusetts, USA. We used time-series plant cover data from two similar sites to evaluate the effectiveness of disturbance management for restoring herbaceous species cover and reducing woody shrub dominance. Our results indicate that applying management outside of the peak of the growing season has not been effective in maintaining or increasing the cover of herbaceous species. While management activities resulted in significant (P < 0.01) increases in herbaceous species immediately after treatment, woody species recolonized and dominated treated sites within 3-years post treatment at the expense of graminoids and forbs. These results highlight the difficulties associated with directing ecological succession using disturbance-based management to maintain rare, herbaceous species in coastal sandplain systems that were once a prevalent landscape component under historically chronic anthropogenic disturbance. Further experimentation with growing season disturbance-based management and different combinations of management techniques could provide insights into management alternatives for maintaining herbaceous conservation targets in coastal sandplains.

Climate variability reduces employment in New England fisheries

Beyond their value as a natural resource, marine fisheries employ an estimated 18.4 million commercial harvesters worldwide. Previous research describes how climate change can affect fish populations, but how it will impact fishing employment and communities is not yet understood. New England, which employs 34,000 commercial harvesters, has a well-documented management history and some of the world’s fastest-warming waters. This paper provides empirical evidence that fluctuations in a regional climate index reduced county-level fishing employment in New England by an average of 16% between 1996 and 2017. The findings cannot be extrapolated to other regions without further study, but they demonstrate how climate can be linked to fishing employment at a regional level via a biophysical pathway.

Climate change is already affecting fish productivity and distributions worldwide, yet its impact on fishing labor has not been examined. Here I directly link large-scale climate variability with fishery employment by studying the effects of sea-surface pressure changes in the North Atlantic region, whose waters are among the world’s fastest warming. I find that climate shocks reduce not only regional catch and revenue in the New England fishing sector, but also ultimately county-level wages and employment among commercial harvesters. Each SD increase from the climatic mean decreases county-level fishing employment by 13%, on average. The South Atlantic region serves as a control due to its different ecological response to climate. Overall, I estimate that climate variability from 1996 to 2017 is responsible for a 16% (95% CI: 10% to 22%) decline in county-level fishing employment in New England, beyond the changes in employment attributable to management or other factors. This quantitative evidence linking climate variability and fishing labor has important implications for management in New England, which employs 20% of US commercial harvesters. Because the results are mediated by the local biology and institutions, they cannot be directly extrapolated to other regions. But they show that climate can impact fishing outcomes in ways unaccounted by management and offer a template for study of this relationship in fisheries around the world.

The opioid epidemic in rural northern New England: An approach to epidemiologic, policy, and legal surveillance

The opioid crisis presents substantial challenges to public health in New England's rural states, where access to pharmacotherapy for opioid use disorder (OUD), harm reduction, HIV and hepatitis C virus (HCV) services vary widely. We present an approach to characterizing the epidemiology, policy and resource environment for OUD and its consequences, with a focus on eleven rural counties in Massachusetts, New Hampshire and Vermont between 2014 and 2018. We developed health policy summaries and logic models to facilitate comparison of opioid epidemic-related polices across the three states that could influence the risk environment and access to services. We assessed sociodemographic factors, rates of overdose and infectious complications tied to OUD, and drive-time access to prevention and treatment resources. We developed GIS maps and conducted spatial analyses to assess the opioid crisis landscape. Through collaborative research, we assessed the potential impact of available resources to address the opioid crisis in rural New England. Vermont's comprehensive set of policies and practices for drug treatment and harm reduction appeared to be associated with the lowest fatal overdose rates. Franklin County, Massachusetts had good access to naloxone, drug treatment and SSPs, but relatively high overdose and HIV rates. New Hampshire had high proportions of uninsured community members, the highest overdose rates, no HCV surveillance data, and no local access to SSPs. This combination of factors appeared to place PWID in rural New Hampshire at elevated risk. Study results facilitated the development of vulnerability indicators, identification of locales for subsequent data collection, and public health interventions.

Assessing the local economic impacts of land protection

Land protection, whether public or private, is often controversial at the local level because residents worry about lost economic activity. We used panel data and a quasi-experimental impact-evaluation approach to determine how key economic indicators were related to the percentage of land protected. Specifically, we estimated the impacts of public and private land protection based on local area employment and housing permits data from 5 periods spanning 1990-2015 for all major towns and cities in New England. To generate rigorous impact estimates, we modeled economic outcomes as a function of the percentage of land protected in the prior period, conditional on town fixed effects, metro-region trends, and controls for period and neighboring protection. Contrary to narratives that conservation depresses economic growth, land protection was associated with a modest increase in the number of people employed and in the labor force and did not affect new housing permits, population, or median income. Public and private protection led to different patterns of positive employment impacts at distances close to and far from cities, indicating the importance of investing in both types of land protection to increase local opportunities. The greatest magnitude of employment impacts was due to protection in more rural areas, where opportunities for both visitation and amenity-related economic growth may be greatest. Overall, we provide novel evidence that land protection can be compatible with local economic growth and illustrate a method that can be broadly applied to assess the net economic impacts of protection.

Early Questing by Lone Star Tick Larvae, New York and Massachusetts, USA, 2018

Subtropical lone star tick larvae typically emerge in late summer. We found clusters of host-seeking lone star tick larvae during early June 2018 in New York and Massachusetts, USA. Invasion and persistence of this tick in more northern locations may have been promoted by adaptation to an accelerated life cycle.

Prevalence of alopecia in gray seals Halichoerus grypus atlantica in Massachusetts, USA, 2004-2013

There has been an increase in the presence of alopecia among gray seals Halichoerus grypus atlantica in Massachusetts, USA. To understand the prevalence and describe the presentation of this condition, data records and photographs of 10070 gray seals from 2004-2013 were reviewed; there were sufficient data to confidently assess the presence or absence of alopecia in 2134 seals. Mild hair loss presented in multifocal patches with minimal to no skin lesions or erythema. In severe cases, alopecia was concentrated over the dorsal head, neck, and shoulders and extended down the ventrum, affecting >50% of the body. Associated skin lesions and erythema were often present. Alopecia was documented in 7.1% of the surveyed seals, and was centered in Nantucket. Alopecia was more prevalent in stranded/sighted animals in spring and summer, with 81% of cases documented from April to July. There was no sex bias, and weanlings were the most affected age class (38%). The etiology for alopecia in Massachusetts gray seals is unknown. Possible causes of alopecia in wildlife are infectious disease, nutritional deficiencies, endocrinopathies, or chronic physiologic stress. High population density around Nantucket may escalate intraspecific competition for resources, which may indirectly lead to stress-induced immunosuppression or nutritional deficiencies. Crowded haul-out sites increase the opportunity for disease transmission. The weanling age class may be prone to alopecia due to naïve immune systems and inexperienced foraging capabilities. Diagnostic sample collection from gray seals will be required to characterize the etiology, pathogenesis, and significance of alopecia in this population.

An assessment of the microbial community in an urban fringing tidal marsh with an emphasis on petroleum hydrocarbon degradative genes

Small fringing marshes are ecologically important habitats often impacted by petroleum. We characterized the phylogenetic structure (16S rRNA) and petroleum hydrocarbon degrading alkane hydroxylase genes (alkB and CYP 153A1) in a sediment microbial community from a New Hampshire fringing marsh, using alkane-exposed dilution cultures to enrich for petroleum degrading bacteria. 16S rRNA and alkB analysis demonstrated that the initial sediment community was dominated by Betaproteobacteria (mainly Comamonadaceae) and Gammaproteobacteria (mainly Pseudomonas), while CYP 153A1 sequences predominantly matched Rhizobiales. 24 h of exposure to n-hexane, gasoline, dodecane, or dilution culture alone reduced functional and phylogenetic diversity, enriching for Gammaproteobacteria, especially Pseudomonas. Gammaproteobacteria continued to dominate for 10 days in the n-hexane and no alkane exposed samples, while dodecane and gasoline exposure selected for gram-positive bacteria. The data demonstrate that small fringing marshes in New England harbor petroleum-degrading bacteria, suggesting that petroleum degradation may be an important fringing marsh ecosystem function.

Metrics for comparing stand structure and dynamics between Ecological Reserves and managed forest of Maine, USA

A data set of common forest metrics was prepared using inventory data from Ecological Reserves in Maine, northeastern USA. An Ecological Reserve is generally defined as an area where timber harvesting does not occur and natural disturbance events are allowed to proceed without significant human influence. Beginning in the early 2000s, permanent, long term monitoring plots were established in Reserves across Maine. To date, 50 Reserves occupying approximately 70,820 ha with a total of 1,103 monitoring plots comprise Maine's Ecological Reserve System. A goal of the Ecological Reserve Monitoring program is to remeasure plots every 10 years and about half of the plots have been remeasured since the initial inventory. Stand metrics were calculated for both monitoring rounds and include: live tree basal area, live tree density, large (diameter at breast height, dbh ≥40 cm) and very large (dbh ≥51 cm) live tree density, standing dead tree density, large (dbh ≥40 cm) and very large (dbh ≥51 cm) standing dead tree density, total and large (diameter at transect intersect ≥40 cm) downed coarse woody debris volume, as well as various stand dynamic metrics. For comparison, the same metrics were computed for managed forests in Maine using permanent plot data from the US Department of Agriculture, Forest Service, Forest Inventory and Analysis (FIA) Program. Information on Ecological Reserve monitoring plots includes Ecological Reserve name, forest-type group, geographic location, elevation, slope, aspect, and harvest history. This data should prove invaluable for assessing and evaluating long-term changes in Ecological Reserves across the broad ecological/climate zones that are present in Maine. No copyright or proprietary restrictions are associated with the use of this data set other than citation of this Data Paper. These data are freely available for non-commercial scientific use.

Spartina alterniflora δ15N as an indicator of estuarine nitrogen load and sources in Cape Cod estuaries

δ¹⁵N values of coastal biota have been used as indicators of land-derived N-loads and sources to estuarine systems and should respond predictably to differences in nitrogen and be sensitive to changes in nitrogen, preferably at the low end of eutrophication. We evaluated Spartina alterniflora as an indicator species of N-loads and sources of δ¹⁵N throughout the growing season, and compared the average δ¹⁵N to estuarine nitrogen loads and sources for several estuaries receiving different watershed N-loads. δ¹⁵N of S. alterniflora differed among estuaries, and these differences were maintained even as δ¹⁵N declined during the end of the growing season. δ¹⁵N values increased with increasing nitrogen loads to the subestuaries and with increasing percent wastewater-derived nitrogen load. The response of δ¹⁵N of S. alterniflora to increased N loads was greater at low N-loads, and decreased as N-loads increased, suggesting that S. alterniflora is a good indicator of incipient nitrogen load.

Top-down and bottom-up controls on southern New England salt marsh crab populations

Southern New England salt marsh vegetation and habitats are changing rapidly in response to sea-level rise. At the same time, fiddler crab (Uca spp.) distributions have expanded and purple marsh crab (Sesarma reticulatum) grazing on creekbank vegetation has increased. Sea-level rise and reduced predation pressure drive these changing crab populations but most studies focus on one species; there is a need for community-level assessments of impacts from multiple crab species. There is also a need to identify additional factors that can affect crab populations. We sampled crabs and environmental parameters in four Rhode Island salt marshes in 2014 and compiled existing data to quantify trends in crab abundance and multiple factors that potentially affect crabs. Crab communities were dominated by fiddler and green crabs (Carcinus maenas); S. reticulatum was much less abundant. Burrow sizes suggest that Uca is responsible for most burrows. On the marsh platform, burrows and Carcinus abundance were negatively correlated with elevation, soil moisture, and soil percent organic matter and positively correlated with soil bulk density. Uca abundance was negatively correlated with Spartina patens cover and height and positively correlated with Spartina alterniflora cover and soil shear strength. Creekbank burrow density increased dramatically between 1998 and 2016. During the same time, fishing effort and the abundance of birds that prey on crabs decreased, and water levels increased. Unlike in other southern New England marshes where recreational overfishing is hypothesized to drive increasing marsh crab abundance, we propose that changes in crab abundance were likely unrelated to recreational finfish over-harvest; instead, they better track sea-level rise and changing abundances of alternate predators, such as birds. We predict that marsh crab abundance will continue to expand with ongoing sea-level rise, at least until inundation thresholds for crab survival are exceeded.

Statistical Models to Predict and Assess Spatial and Temporal Low-Flow Variability in New England Rivers and Streams

In the northern hemisphere, summer low flows are a key attribute defining both quantity and quality of aquatic habitat. I developed one set of models for New England streams/rivers predicting July/August median flows averaged across 1985 to 2015 as a function of weather, slope, % imperviousness, watershed storage, glacial geology and soils. These models performed better than most USGS models for summer flows developed at a statewide scale. I developed a second set of models predicting interannual differences in summer flows as a function of differences in air temperature, precipitation, the North Atlantic Oscillation Index (NAO), and lagged NAO. Use of difference equations eliminated the need for transformations and accounted for serial autocorrelations at lag 1. The models were used in sequence to estimate time series for monthly low flows and for two derived flow metrics (tenth percentile (Q10) and minimum 3-in-5 year average flows). The first metric is commonly used in assessing risk to low flow conditions over time while the second has been correlated with increased probability of localized extinctions for brook trout. The flow metrics showed increasing trends across most of New England for 1985-2015. However, application of summer flow models with average and extreme climate projections to the Taunton River, MA, a sensitive watershed undergoing rapid development, projected that low flow metrics will decrease over the next 50 years.

Thirty-Three Years of Ocean Benthic Warming Along the U.S. Northeast Continental Shelf and Slope: Patterns, Drivers, and Ecological Consequences

The U.S. Northeast Continental Shelf is experiencing rapid warming, with potentially profound consequences to marine ecosystems. While satellites document multiple scales of spatial and temporal variability on the surface, our understanding of the status, trends, and drivers of the benthic environmental change remains limited. We interpolated sparse benthic temperature data along the New England Shelf and upper Slope using a seasonally dynamic, regionally specific multiple linear regression model that merged in situ and remote sensing data. The statistical model predicted nearly 90% of the variability of the data, resulting in a synoptic time series spanning over three decades from 1982 to 2014. Benthic temperatures increased throughout the domain, including in the Gulf of Maine. Rates of benthic warming ranged from 0.1 to 0.4°C per decade, with fastest rates occurring in shallow, nearshore regions and on Georges Bank, the latter exceeding rates observed in the surface. Rates of benthic warming were up to 1.6 times faster in winter than the rest of the year in many regions, with important implications for disease occurrence and energetics of overwintering species. Drivers of warming varied over the domain. In southern New England and the mid-Atlantic shallow Shelf regions, benthic warming was tightly coupled to changes in SST, whereas both regional and basin-scale changes in ocean circulation affect temperatures in the Gulf of Maine, the Continental Shelf, and Georges Banks. These results highlight data gaps, the current feasibility of prediction from remotely sensed variables, and the need for improved understanding on how climate may affect seasonally specific ecological processes.

Qualitative Comparison of Barriers to Antiretroviral Medication Adherence Among Perinatally and Behaviorally HIV-Infected Youth

Medication adherence among youth living with HIV (28%-69%) is often insufficient for viral suppression. The psychosocial context of adherence barriers is complex. We sought to qualitatively understand adherence barriers among behaviorally infected and perinatally infected youth and develop an intervention specific to their needs. We conducted in-depth interviews with 30 youth living with HIV (aged 14-24 years) and analyzed transcripts using the constant comparative method. Barriers were influenced by clinical and psychosocial factors. Perinatally infected youth barriers included reactance, complicated regimens, HIV fatigue, and difficulty transitioning to autonomous care. Behaviorally infected youth barriers included HIV-related shame and difficulty initiating medication. Both groups reported low risk perception, medication as a reminder of HIV, and nondisclosure, but described different contexts to these common barriers. Common and unique barriers emerged for behaviorally infected and perinatally infected youth reflecting varying HIV experiences and psychosocial contexts. We developed a customizable intervention addressing identified barriers and their psychosocial antecedents.

High Elevation Refugia for Bombus terricola (Hymenoptera: Apidae) Conservation and Wild Bees of the White Mountain National Forest

Many wild bee species are in global decline, yet much is still unknown about their diversity and contemporary distributions. National parks and forests offer unique areas of refuge important for the conservation of rare and declining species populations. Here we present the results of the first biodiversity survey of the bee fauna in the White Mountain National Forest (WMNF). More than a thousand specimens were collected from pan and sweep samples representing 137 species. Three species were recorded for the first time in New England and an additional seven species were documented for the first time in the state of New Hampshire. Four introduced species were also observed in the specimens collected. A checklist of the species found in the WMNF, as well as those found previously in Strafford County, NH, is included with new state records and introduced species noted as well as a map of collecting locations. Of particular interest was the relatively high abundance of Bombus terricola Kirby 1837 found in many of the higher elevation collection sites and the single specimen documented of Bombus fervidus (Fabricius 1798). Both of these bumble bee species are known to have declining populations in the northeast and are categorized as vulnerable on the International Union for Conservation of Nature's Red List.

Measuring Down: Evaluating Digital Storytelling as a Process for Narrative Health Promotion

Digital storytelling (DST) engages participants in a group-based process to create and share narrative accounts of life events. We present key evaluation findings of a 2-year, mixed-methods study that focused on effects of participating in the DST process on young Puerto Rican Latina's self-esteem, social support, empowerment, and sexual attitudes and behaviors. Quantitative results did not show significant changes in the expected outcomes. However, in our qualitative findings we identified several ways in which the DST made positive, health-bearing effects. We argue for the importance of "measuring down" to reflect the locally grounded, felt experiences of participants who engage in the process, as current quantitative scales do not "measure up" to accurately capture these effects. We end by suggesting the need to develop mixed-methods, culturally relevant, and sensitive evaluation tools that prioritize process effects as they inform intervention and health promotion.

Concussion Care Practices and Utilization of Evidence-Based Guidelines in the Evaluation and Management of Concussion: A Survey of New England Emergency Departments

Evidence-based clinical practice guidelines can facilitate proper evaluation and management of concussions in the emergency department (ED), often the initial and primary point of contact for concussion care. There is no universally adopted set of guidelines for concussion management, and extant evidence suggests that there may be variability in concussion care practices and limited application of clinical practice guidelines in the ED. This study surveyed EDs throughout New England to examine current practices of concussion care and utilization of evidence-based clinical practice guidelines in the evaluation and management of concussions. In 2013, a 32-item online survey was e-mailed to 149/168 EDs throughout New England (Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Maine). Respondents included senior administrators asked to report on their EDs use of clinical practice guidelines, neuroimaging decision-making, and discharge instructions for concussion management. Of the 72/78 respondents included, 35% reported absence of clinical practice guidelines, and 57% reported inconsistency in the type of guidelines used. Practitioner preference guided neuroimaging decision-making for 57%. Although 94% provided written discharge instructions, there was inconsistency in the recommended time frame for follow-up care (13% provided no specific time frame), the referral specialist to be seen (25% did not recommend any specialist), and return to activity instructions were inconsistent. There is much variability in concussion care practices and application of evidence-based clinical practice guidelines in the evaluation and management of concussions in New England EDs. Knowledge translational efforts will be critical to improve concussion management in the ED setting.

Emerging Cases of Powassan Virus Encephalitis in New England: Clinical Presentation, Imaging, and Review of the Literature

BACKGROUND

Powassan virus (POWV) is a rarely diagnosed cause of encephalitis in the United States. In the Northeast, it is transmitted by Ixodes scapularis, the same vector that transmits Lyme disease. The prevalence of POWV among animal hosts and vectors has been increasing. We present 8 cases of POWV encephalitis from Massachusetts and New Hampshire in 2013-2015.

METHODS

We abstracted clinical and epidemiological information for patients with POWV encephalitis diagnosed at 2 hospitals in Massachusetts from 2013 to 2015. We compared their brain imaging with those in published findings from Powassan and other viral encephalitides.

RESULTS

The patients ranged in age from 21 to 82 years, were, for the most part, previously healthy, and presented with syndromes of fever, headache, and altered consciousness. Infections occurred from May to September and were often associated with known tick exposures. In all patients, cerebrospinal fluid analyses showed pleocytosis with elevated protein. In 7 of 8 patients, brain magnetic resonance imaging demonstrated deep foci of increased T2/fluid-attenuation inversion recovery signal intensity.

CONCLUSIONS

We describe 8 cases of POWV encephalitis in Massachusetts and New Hampshire in 2013-2015. Prior to this, there had been only 2 cases of POWV encephalitis identified in Massachusetts. These cases may represent emergence of this virus in a region where its vector, I. scapularis, is known to be prevalent or may represent the emerging diagnosis of an underappreciated pathogen. We recommend testing for POWV in patients who present with encephalitis in the spring to fall in New England.

Deciduous forest responses to temperature, precipitation, and drought imply complex climate change impacts

Changes in spring and autumn phenology of temperate plants in recent decades have become iconic bio-indicators of rapid climate change. These changes have substantial ecological and economic impacts. However, autumn phenology remains surprisingly little studied. Although the effects of unfavorable environmental conditions (e.g., frost, heat, wetness, and drought) on autumn phenology have been observed for over 60 y, how these factors interact to influence autumn phenological events remain poorly understood. Using remotely sensed phenology data from 2001 to 2012, this study identified and quantified significant effects of a suite of environmental factors on the timing of fall dormancy of deciduous forest communities in New England, United States. Cold, frost, and wet conditions, and high heat-stress tended to induce earlier dormancy of deciduous forests, whereas moderate heat- and drought-stress delayed dormancy. Deciduous forests in two eco-regions showed contrasting, nonlinear responses to variation in these explanatory factors. Based on future climate projection over two periods (2041-2050 and 2090-2099), later dormancy dates were predicted in northern areas. However, in coastal areas earlier dormancy dates were predicted. Our models suggest that besides warming in climate change, changes in frost and moisture conditions as well as extreme weather events (e.g., drought- and heat-stress, and flooding), should also be considered in future predictions of autumn phenology in temperate deciduous forests. This study improves our understanding of how multiple environmental variables interact to affect autumn phenology in temperate deciduous forest ecosystems, and points the way to building more mechanistic and predictive models.

Borrelia miyamotoi sensu lato seroreactivity and seroprevalence in the northeastern United States

Serum from �%^4% of residents was positive for infection, compared with �%^9% for B. burgdorferi.

Borrelia miyamotoi sensu lato, a relapsing fever Borrelia sp., is transmitted by the same ticks that transmit B. burgdorferi (the Lyme disease pathogen) and occurs in all Lyme disease�?"endemic areas of the United States. To determine the seroprevalence of IgG against B. miyamotoi sensu lato in the northeastern United States and assess whether serum from B. miyamotoi sensu lato�?"infected persons is reactive to B. burgdorferi antigens, we tested archived serum samples from area residents during 1991�?"2012. Of 639 samples from healthy persons, 25 were positive for B. miyamotoi sensu lato and 60 for B. burgdorferi. Samples from �%^10% of B. miyamotoi sensu lato�?"seropositive persons without a recent history of Lyme disease were seropositive for B. burgdorferi. Our resultsA suggest thatA human B. miyamotoiA sensu latoA infection may be common in southern New England and that B. burgdorferi antibody testing is not an effective surrogate for detecting B. miyamotoi sensu lato infection.

Monitoring human babesiosis emergence through vector surveillance New England, USA

Human babesiosis is an emerging tick-borne disease caused by the intraerythrocytic protozoan Babesia microti. Its geographic distribution is more limited than that of Lyme disease, despite sharing the same tick vector and reservoir hosts. The geographic range of babesiosis is expanding, but knowledge of its range is incomplete and relies exclusively on reports of human cases. We evaluated the utility of tick-based surveillance for monitoring disease expansion by comparing the ratios of the 2 infections in humans and ticks in areas with varying B. microti endemicity. We found a close association between human disease and tick infection ratios in long-established babesiosis-endemic areas but a lower than expected incidence of human babesiosis on the basis of tick infection rates in new disease-endemic areas. This finding suggests that babesiosis at emerging sites is underreported. Vector-based surveillance can provide an early warning system for the emergence of human babesiosis.

Determining past leaf-out times of New England's deciduous forests from herbarium specimens

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PREMISE OF THE STUDY

There is great interest in studying leaf-out times of temperate forests because of the importance of leaf-out in controlling ecosystem processes, especially in the face of a changing climate. Remote sensing and modeling, combined with weather records and field observations, are increasing our knowledge of factors affecting variation in leaf-out times. Herbarium specimens represent a potential new source of information to determine whether the variation in leaf-out times observed in recent decades is comparable to longer time frames over past centuries.•

METHODS

Here we introduce the use of herbarium specimens as a method for studying long-term changes in leaf-out times of deciduous trees. We collected historical leaf-out data for the years 1834-2008 from common deciduous trees in New England using 1599 dated herbarium specimens with young leaves.•

KEY RESULTS

We found that leaf-out dates are strongly affected by spring temperature, with trees leafing out 2.70 d earlier for each degree C increase in mean April temperature. For each degree C increase in local temperature, trees leafed out 2.06 d earlier. Additionally, the mean response of leaf-out dates across all species and sites over time was 0.4 d earlier per decade. Our results are of comparable magnitude to results from studies using remote sensing and direct field observations.•

CONCLUSIONS

Across New England, mean leaf-out dates varied geographically in close correspondence with those observed in studies using satellite data. This study demonstrates that herbarium specimens can be a valuable source of data on past leaf-out times of deciduous trees.

Spatial and temporal distributions of lung cancer histopathology in the state of Maine

Maine has among the highest rates of lung cancer in the United States (US). Maine serves as a geographical representation of US rural communities, and their associated health disparities. As the key risks of tobacco use decrease and radon abatement increases, previously obscured environmental exposures may measurably contribute to the attributable risk fraction of lung cancer. To generate hypotheses of novel environmental exposures associated with lung cancer, we investigated if there was non-random spatial distribution of lung cancer in Maine. Case data (n = 14,038) between 1995 and 2006 were obtained from the Maine Cancer Registry. Population data were obtained from the 2000 US Census. We assessed the spatial distribution of lung cancers among white cases by histopathology subtype [non-small cell lung carcinoma (NSCLC): adenocarcinoma (n = 3680), squamous cell (n = 2801) and large cell (n = 1195); and small cell lung carcinoma (SCLC) (n = 1994)], using spatial scan statistic, assuming a discrete Poisson distribution adjusted for age and population density. Because of time-dependent trends in lung cancer differential diagnostic criteria, we repeated our analyses, limiting it to 2002-2006. While SCLC rates were equivalent across the state, we identified discrete regions with elevated rates of adenocarcinoma among females and squamous cell carcinoma among males. Independent of gender, the most striking geospatial observation was elevated large cell lung cancer specifically in one of the poorest counties in the US. A selective spatial distribution of large cell lung cancer has not been previously reported. More research is needed to identify factors inducing large cell carcinoma pathology, and to determine if in rural communities health disparities are associated with increased risk for this diagnosis.