Within the context of climate change, there is a pressing need to better understand the ecological implications of changes in the frequency and intensity of climate extremes. Along subtropical coasts, less frequent and warmer freeze events are expected to permit freeze-sensitive mangrove forests to expand poleward and displace freeze-tolerant salt marshes. Here, our aim was to better understand the drivers of poleward mangrove migration by quantifying spatiotemporal patterns in mangrove range expansion and contraction across land-ocean temperature gradients. Our work was conducted in a freeze-sensitive mangrove-marsh transition zone that spans a land-ocean temperature gradient in one of the world's most wetland-rich regions (Mississippi River Deltaic Plain; Louisiana, USA). We used historical air temperature data (1893-2014), alternative future climate scenarios, and coastal wetland coverage data (1978-2011) to investigate spatiotemporal fluctuations and climate-wetland linkages. Our analyses indicate that changes in mangrove coverage have been controlled primarily by extreme freeze events (i.e., air temperatures below a threshold zone of -6.3 to -7.6°C). We expect that in the past 121 yr, mangrove range expansion and contraction has occurred across land-ocean temperature gradients. Mangrove resistance, resilience, and dominance were all highest in areas closer to the ocean where temperature extremes were buffered by large expanses of water and saturated soil. Under climate change, these areas will likely serve as local hotspots for mangrove dispersal, growth, range expansion, and displacement of salt marsh. Collectively, our results show that the frequency and intensity of freeze events across land-ocean temperature gradients greatly influences spatiotemporal patterns of range expansion and contraction of freeze-sensitive mangroves. We expect that, along subtropical coasts, similar processes govern the distribution and abundance of other freeze-sensitive organisms. In broad terms, our findings can be used to better understand and anticipate the ecological effects of changing winter climate extremes, especially within the transition zone between tropical and temperate climates.

SUMMARYAnorexia nervosa is a potentially fatal illness that affects women and a smaller proportion of men. When a patient becomes so severely ill that admission to a medical unit is required, the risk of a poor outcome is high. Most medical services do not have sufficient expertise, without psychiatric help, to manage the nutritional, medical, behavioural and family problems that often appear. These problems interact and this can adversely affect outcome. This article discusses, with reference to the MARSIPAN report, the procedure that should be followed when such a patient presents to an acute medical service. It considers diagnosis, risk assessment, consent, re-feeding syndrome, underfeeding syndrome and treatment-sabotaging behaviours. It stresses the importance of collaboration between expert medical and psychiatric staff, and involvement of the family. When these issues are adequately addressed, the outcome for the patient is more likely to be positive.LEARNING OBJECTIVES•Be confident in diagnosing individuals with anorexia nervosa and identify when urgent in-patient medical treatment is required•Be confident in assessing and managing physical risk in individuals with anorexia nervosa•Be aware of the Royal College of Psychiatrists’ MARSIPAN report and its implications for the management of individuals with eating disorders in medical settingsDECLARATION OF INTERESTNone.

Siever MD (1994) Sexual orientation and gender as factors in socioculturally acquired vulnerability to body dissatisfaction and eating disorders. Journal of Consulting and Clinical Psychology 62 (2) 252-260. Stanford JN & McCabe MP (2002) Body image ideal among males and females. Sociocultural influences and focus on different body parts.

Background: Duration of untreated eating disorder (DUED), that is, the time between illness onset and start of first evidence-based treatment, is a key outcome for early intervention. Internationally, reported DUED ranges from 2.5 to 6 years for different eating disorders (EDs). To shorten DUED, we developed FREED (First Episode Rapid Early Intervention for EDs), a service model and care pathway for emerging adults with EDs. Here, we assess the impact of FREED on DUED in a multi-centre study using a quasiexperimental design.Methods: Two hundred and seventy-eight patients aged 16-25, with first episode illness of less than 3 years duration, were recruited from specialist ED services and offered treatment via FREED. These were compared to 224 patients, of similar age and illness duration, seen previously in participating services (treatment as usual [TAU]) on DUED, waiting times and treatment uptake.Results: FREED patients had significantly shorter DUED and waiting times than TAU patients. On average, DUED was reduced by ∼4 months when systemic delays were minimal. Furthermore, 97.8% of FREED patients took up treatment, versus 75.4% of TAU. Discussion: Findings indicate that FREED significantly improves access to treatment for emerging adults with first episode ED. FREED may reduce distress, prevent deterioration and facilitate recovery.

There is a clear need for greater education of psychiatrists regarding the diagnosis and management of eating disorders. Implementing training programmes and making information readily available could contribute to addressing these issues.