Continuous Coverage Research Articles

Real-World Adherence to and Persistence with Vibegron in Patients with Overactive Bladder: A Retrospective Claims Analysis.

Vibegron is a β3-adrenergic receptor agonist approved for overactive bladder (OAB). This analysis assessed real-world adherence and persistence with vibegron in patients with OAB, along with demographics and clinical characteristics associated with adherence and persistence. This retrospective study used the Optum Research Database to identify patients treated with vibegron from April 2021 to August 2022 (identification period). Patients had ≥ 60days of continuous pharmacy coverage in a commercial or Medicare Advantage plan following the index fill (follow-up). Adherence was assessed as proportion of days covered (PDC) from index to end of follow-up and was defined as PDC ≥ 80%. Persistence was measured as days to discontinuation of therapy (30-day gap) or end of follow-up. Data for adherence and persistence are presented descriptively. Characteristics associated with adherence and persistence were analyzed using multivariable models among patients with medical and pharmacy benefits during the 90days before index (baseline). Overall, 9992 patients had a vibegron claim during the identification period; 9712had ≥ 2months of follow-up. Mean (SD) age was 74.2 (10.7) years; 68.2% were female. Mean (SD) PDC was 0.64 (0.34). Median (95% confidence interval) persistence was 142 (132-153) days. Of the 5073 patients who were ≥ 18years old with continuous baseline pharmacy and medical benefits ≥ 90days before index, 2497 (49.2%) were adherent. Patients were more likely to be adherent and persistent if they received a greater days' supply for the index fill and had baseline medication count ≥ 6. Patients were more likely to discontinue if their index copay was > $45. Nearly half of the patients initiating vibegron were adherent. Factors associated with adherence and persistence were more likely to be related to prescribing practices than patient characteristics. These results suggest it may be best to follow up with patients approximately 4to5months after initiating treatment with vibegron.

Association between nintedanib adherence trajectory and healthcare use among idiopathic pulmonary fibrosis patients

BackgroundAlthough inverse associations have been found between medication adherence and healthcare use and spending outcomes in many clinical settings, no studies to date have examined these relationships for patients with idiopathic pulmonary fibrosis (IPF) initiating nintedanib. We build on our prior study that used group-based trajectory modeling (GBTM) to compare inpatient hospitalization and medical care spending outcomes between groups of patients with different nintedanib adherence trajectories.MethodsThis analysis used 100% Medicare data and included beneficiaries with IPF who initiated nintedanib during 10/01/2014–12/31/2018. The sample consisted of community-dwelling older adults (≥ 66 years) with continuous coverage in Medicare Parts A (inpatient care), B (outpatient care) and D (prescription drugs) for one year before (baseline) and after (follow-up) initiating nintedanib. Patients were assigned to the GBTM-derived adherence trajectory group closest to their own nintedanib adherence experience. All-cause and IPF-related hospitalization events and total medical spending were measured during the follow-up period. Unadjusted and adjusted regression models were estimated to compare outcomes between patients in different nintedanib adherence trajectories.ResultsAmong the 1,798 patients initiating nintedanib, the mean age was 75.4 years, 61.1% were male, and 91.1% were non-Hispanic white. The best-fitting GBTM had five adherence trajectories: high adherence, moderate adherence, high-then-poor adherence, delayed-poor adherence, and early-poor adherence. All-cause hospitalizations and total all-cause medical spending were higher among patients in the high-then-poor, delayed-poor and early-poor adherence trajectories than those in the high adherence trajectory. For example, adjusted total all-cause medical spending was $4,876 (95% CI: $1,470 to $8,282) higher in the high-then-poor adherence trajectory, $3,639 (95% CI: $1,322 to $5,955) higher in the delayed-poor adherence trajectory and $3,907 (95% CI: $1,658 to $6,156) higher in the early-poor adherence trajectory compared with the high adherence trajectory. IPF-related hospitalizations and medical care spending were higher among those in the high-then-poor adherence trajectory compared with those in the high adherence trajectory.ConclusionsPoor adherence to nintedanib was associated with all-cause hospitalizations and medical costs. Therefore, improved adherence programs, such as support programs, can be implemented to reduce economic burden.

Multi-harmonic near-infrared-ultraviolet dual-comb spectrometer.

Dual-comb spectroscopy in the ultraviolet (UV) and visible would enable broad bandwidth electronic spectroscopy with unprecedented frequency resolution. However, there are significant challenges in generation, detection, and processing of dual-comb data that have restricted its progress in this spectral region. In this work, we leverage robust 1550 nm few-cycle pulses to generate frequency combs in the UV-visible. We combine these combs with a wavelength multiplexed dual-comb spectrometer and simultaneously retrieve 100 MHz comb-mode-resolved spectra over three distinct harmonics at 386, 500, and 760 nm. The experiments highlight the path to continuous dual-comb coverage spanning 200-750 nm, offering extensive access to electronic transitions in atoms, molecules, and solids.

A Best-Path Approach to the Design of a Hybrid Space–Ground Quantum Network with Dynamic Constraints

The design and operation of quantum networks are both decisive in the current push towards a global quantum internet. Although space-enabled quantum connectivity has already been identified as a beneficial candidate for long-range quantum channels for over two decades, the architecture of a hybrid space–ground network is still a work in progress. Here, we propose an analysis of such a network based on a best-path approach, where either fiber- or satellite-based elementary links can be concatenated to form a repeater chain. The network consisting of quantum information processing nodes, equipped with both ground and space connections, is mapped into a graph structure, where edge weights represent the achievable secret key rates, chosen as the figure of merit for the network analysis. A weight minimization algorithm allows for identifying the best path dynamically, i.e., as the weather conditions, stray light radiance, and satellite orbital position change. From the results, we conclude that satellite links will play a significant role in the future large-scale quantum internet, in particular when node distances exceed 500 km, and both a constellation of satellites—spanning 20 or more satellites—and significant advances in filtering technology are required to achieve continuous coverage.

Q&A: Continuous Coverage Unwinding and Medicaid Expansion on the Ground in Two North Carolina Counties.

After three years of continuous Medicaid coverage as permitted by COVID-19-related waivers, in 2023 counties had to begin redeterminations of eligibility, "unwinding" this continuous coverage. As unwinding and eligibility determination continues, Medicaid expansion has begun, and county public health leaders are navigating uncertain but exciting waters. Lisa Macon Harrison, MPH, of Granville Vance Public Health, and Joshua Swift, MPH, of Forsyth County Department of Public Health, share their experiences, concerns, and hopes for the future.

From Continuous Coverage to Medicaid Expansion: North Carolina's Changing Public Payer Landscape.

During the COVID-19 pandemic, people who may have otherwise lost Medicaid coverage kept it without the need to reapply annually. In 2023, this continuous coverage began to unwind just as North Carolina prepared to expand Medicaid. This issue of the North Carolina Medical Journal tracks the evolution of the state's public payer landscape in unprecedented times of change, with data, analysis, and personal experiences from public health, philanthropy, clinicians, and Medicaid members.

Keeping People Enrolled During Medicaid Expansion and COVID-19 Continuous Coverage Unwinding.

North Carolina is expanding Medicaid insurance coverage while simultaneously removing coverage from individuals as a result of the end of the COVID-19 emergency. These large-scale eligibility changes have created an opportunity for improved processes. North Carolina chose to build upon the existing Medicaid Family Planning program to maintain access to health care while launching Medicaid expansion.

A telemedicine bridge clinic improves access and reduces cost for opioid use disorder care

ObjectiveWe evaluated the impact of a telemedicine bridge clinic on treatment outcomes and cost for patients with opioid use disorder. Telemedicine bridge clinics deliver low-barrier rapid assessment of patients with opioid use disorder via audio-only and audiovisual telemedicine to facilitate induction on medication therapy and connection to ongoing care. MethodsA pre-post analysis of UPMC Health Plan member claims was performed to evaluate the impact of this intervention on the trajectory of care for patients with continuous coverage before and after bridge clinic visit(s). ResultsAnalysis included 150 UPMC Health Plan members evaluated at the bridge clinic between April 2020 and October 2021. At least one buprenorphine prescription was filled within 30 days by 91% of patients; median proportion of days covered by buprenorphine was 73.3%, 54.4%, and 50.6% at 30, 90, and 180 days after an initial visit compared to median of no buprenorphine claims 30 days prior among the same patients. Patients had an 18% decline in unplanned care utilization 30 days after initial Bridge Clinic visit, with a 62% reduction in unplanned care cost per member per month (PMPM), 38% reduction in medical cost PMPM, and 10% reduction in total PMPM (medical + pharmacy cost) at 180 days. Primary care, outpatient behavioral health, and laboratory costs increased while emergency department, urgent care, and inpatient costs declined. ConclusionUtilization of a telemedicine bridge clinic was associated with buprenorphine initiation, linkage to ongoing care with retention including medication treatment, reduced unplanned care cost, and overall savings.

The Royal Treatment

The Royal Treatment

Expand and extend postpartum Medicaid to support maternal and child health.

Most early maternal deaths are preventable, with many occurring within the first year postpartum (we use the terms "maternal" and "mother" broadly to include all individuals who experience pregnancy or postpartum and frame our recognition of need and policy recommendations in gender-neutral terms. To acknowledge limitations inherent in existing policy and the composition of samples in prior research, we use the term "women" when applicable). Black, Hispanic, and Native American individuals are at the most significant risk of pregnancy-related death. They are more commonly covered by Medicaid, highlighting likely contributions of structural racism and consequent social inequities. State-level length and eligibility requirements for postpartum Medicaid vary considerably. Federal policy requires 60 days of Medicaid continuation postpartum, risking healthcare coverage loss during a critical period of heightened morbidity and mortality risk. This policy position paper aims to outline urgent risks to maternal health, detail existing federal and state-level efforts, summarize proposed legislation addressing the issue, and offer policy recommendations for legislative consideration and future study. A team of maternal health researchers and clinicians reviewed and summarized recent research and current policy pertaining to postpartum Medicaid continuation coverage, proposing policy solutions to address this critical issue. Multiple legislative avenues currently exist to support and advance relevant policy to improve and sustain maternal health for those receiving Medicaid during pregnancy, including legislation aligned with the Biden-Harris Maternal Health Blueprint, state-focused options via the American Rescue Plan of 2021 (Public Law 117-2), and recently proposed acts (HR3407, S1542) which were last reintroduced in 2021. Recommendations include (i) reintroducing previously considered legislation requiring states to provide 12 months of continuous postpartum coverage, regardless of pregnancy outcome, and (ii) enacting a revised, permanent federal mandate equalizing Medicaid eligibility across states to ensure consistent access to postpartum healthcare offerings nationwide.

Risk of mortality in older adults with loss of appetite: An analysis of Medicare fee-for-service data

ObjectivesPrior research suggested that loss of appetite (LOA) among adults with Medicare fee-for-service (FFS) insurance in the United States increased the risk of mortality within 1 year; those findings were not adjusted for risk factors and confounders. The objective of this study was to compare the risk of mortality among Medicare FFS beneficiaries with LOA to a control group without LOA while controlling or adjusting for age, comorbidities, body mass index (BMI), and weight loss. DesignRetrospective and observational analysis of Medicare FFS health insurance claims data from October 1, 2015 to December 31, 2021. SettingClaims from all settings (e.g., hospital inpatient/outpatient, office, assisted living facility, skilled nursing facility, hospice, rehabilitation facility, home) were included in these analyses. ParticipantsThe LOA group included all individuals aged 65–115 years with continuous Medicare FFS medical coverage (Parts A and/or B) for at least 12 months before a claim with ICD-10 diagnosis code “R63.0 Anorexia”. The control group was drawn from individuals aged 65–115 years with continuous Medicare FFS coverage who did not have a diagnosis of R63.0. Individuals with LOA were matched 1:3 to those in the control group based on age, sex, and race/ethnicity. MeasurementsMortality in the LOA group was compared to mortality in the control group using Kaplan–Meier and Cox regression analyses and stratified or adjusted in terms of Charlson Comorbidity Index (CCI), claims-based frailty index (CFI), BMI, and weight loss. ResultsThe study population of 1,707,031 individuals with LOA and 5,121,093 controls without LOA was 61.7% female and 82.2% White. More individuals with LOA compared with the control group had a CCI score 5+ (52.4% vs. 19.4%), CFI score 5+ (31.6% vs. 6.4%), and BMI < 20 kg/m2 (11.2% vs. 2.1%). Median follow-up was 12 months (individuals with LOA) and 49 months (control group). In a matched population, the risk of mortality was significantly higher (unadjusted hazard ratio 4.40, 95% confidence interval 4.39–4.42) for individuals with LOA than the control group. Median survival time was 4 months (individuals with LOA) and 26 months (control group); differences in survival time remained when stratifying by CCI, BMI, and weight loss. ConclusionIndividuals with LOA had a substantially increased risk of death even after matching for age, sex, race/ethnicity, and adjusting for comorbidities. These findings highlight the burden of illness in older adults with LOA and the need for therapies.

Real-world utilization patterns of radium-223 in metastatic prostate cancer in the United States: An administrative claims database study.

79 Background: Radium (Ra)-223 is approved for use in men with symptomatic castration resistant prostate cancer (CRPC) with bone metastases, demonstrating benefits in terms of overall survival and quality of life with a reliable safety profile. In the rapidly evolving treatment landscape for prostate cancer, real-world (RW) data on Ra-223 utilization are limited. We aimed to examine the RW utilization patterns of Ra-223 in patients with metastatic prostate cancer using a large administrative claims database in the US. Methods: A retrospective cohort of men treated with Ra-223 was identified using the closed claims private payor database of the Komodo Research Dataset covering the period from 01/01/2017 to 06/30/2022. The earliest administration of Ra-223 in men with bone metastatic prostate cancer was considered as index date. Individuals were required to have continuous insurance coverage at least 12-month pre-index (baseline) and least 6-month post index or until death if patients survived &lt; 6 months (follow-up). Logistic regression was used to identify baseline demographic, clinical, medications, or healthcare resource use-related factors associated with receiving 5+ cycles of Ra-223. Results: The study cohort comprised of 1,376 men with a median age of 68 years at the time of Ra-223 initiation. Most men were treated by oncologists (52.2%), having bone only metastases (51.5%), having Charlson comorbidity index (CCI) ≥ 1 (76.2%). Diabetes (34.1%), peripheral vascular disease (29.9%), pulmonary disease (25.9%) and mild liver disease (25.1%) were the most common pre-existing comorbidities. Therapies received prior to Ra-223 were androgen receptor pathway inhibitors (75.4%), chemotherapy (32.1%), sipuleucel-T (13.7%) and bone health agents (73.7%). Ra-223 was utilized as a combination therapy by 26.0% of the overall population, predominately with enzalutamide. Nearly 15%, 38%, and 31% received Ra-223 (mono or combination therapy) as 1st, 2nd, and 3rd line therapy, respectively. Approximately 46% of the overall cohort and 54% of those who survived ≥ 6 months had received 5+ cycles, respectively. In regression analysis, men with short survival (&lt;6 month) [Odds ratio, OR: 0.05, 95% confidence interval (CI): 0.03, 0.10], low CCI (0 vs. 4+) (OR: 0.38, 95% CI:0.19, 0.76), and pulmonary disease (OR: 0.71, 95% CI: 0.52, 0.97) had lower likelihood of completion of 5+ cycles. Conclusions: Nearly half of men completed 5+ cycles of Ra-223 therapy in a large US cohort of relatively young mCRPC men with private health insurance. Advanced disease state with short survival and low comorbidity were key factors associated with lower completion of 5+ cycles. The findings highlight the importance of utilizing Ra-223 early after mCRPC diagnosis, when the probability of &gt;6-month survival is higher, to enhance treatment completion that has been shown to result in better outcomes.

Investigating Regional Communication Network Robustness of an Asymmetric String-of-Pearls Satellite Constellation Design Framework

Appropriate selection of a satellite constellation design framework for a particular mission set requires a priori knowledge about the relative merits and shortcomings of different frameworks. Symmetric satellite constellation frameworks exhibit good properties for missions requiring continuous global coverage, whereas asymmetric satellite constellation frameworks benefit missions focusing on regional coverage. This research compares the performance of an asymmetric “string-of-pearls” common repeating ground track constellation design framework against a Walker constellation design framework for maintaining continuous connectivity between regions of interest. Several examples illustrate that the asymmetric string-of-pearls constellation framework appears to require an average of approximately 1.25 fewer satellites than the Walker constellation, whereas the Walker constellation appears approximately 7.86% more robust to satellite failures.

Performance of the double-thin-shell approach for studying nighttime medium-scale traveling ionospheric disturbances using two dense GNSS observation networks in Japan

Electrodynamic coupling between the ionospheric E and F regions is widely recognized as the underlying mechanism for generating medium-scale traveling ionospheric disturbances (MSTIDs) during nighttime at midlatitudes. Recently, the double-thin-shell approach has proven to be a useful tool for studying the E–F coupling. By using total electron content (TEC) measurements, this approach enables the simultaneous reconstruction of electron density perturbations in both the E and F regions with broad and continuous coverage. However, the current reconstruction performance is limited when using only GPS-TEC measurements from GEONET, a dense network of ground-based Global Navigation Satellite System (GNSS) receivers over Japan. The expansion of available data sources and the integration of multi-GNSS observation data are considered important to enhance the double-thin-shell model. Fortunately, SoftBank Corp., a Japanese telecommunications provider, has recently developed a dense independent GNSS observation network to improve positioning services. In this paper, we analyze the potential of the improved double-thin-shell approach and emphasize the importance of incorporating multi-GNSS observation data from both GEONET and SoftBank networks. The solvability analysis, simulation, and observation results collectively indicate a substantial improvement in the spatiotemporal resolution. Specifically, the longitudinal and latitudinal resolution is improved from 0.15° to 0.1° in the E region, and from 0.5° to 0.3° in the F region. The temporal resolution is also improved from 2 to 1 min. In addition, significant improvements have been achieved in the reconstruction performance, particularly for the E region under complex background conditions. Based on these assessments, we conclude that the incorporation of GEONET and SoftBank GNSS observation data holds significant potential for improving the double-thin-shell model and advancing our understanding of MSTIDs.Graphical abstract

Just pass it: NAATP backs both SUPPORT Act versions

The SUPPORT Act reauthorization was passed five years ago, but has yet to be funded. In December before Congress went on vacation for the holiday, the House of Representations passed their version of the new bill, H.R. 4531 (H.R.4531 ‐ Support for Patients and Communities Reauthorization Act). Mark Dunn, lobbyist for the National Association of Addiction Treatment Providers (NAATP), reported back at the end of the year that this version “provides continued coverage for Medicaid individuals who are incarcerated and made positive changes to the IMD [Institution for Mental Diseases] exclusion,” as well as funding the previous programs. In the Senate, two committees advanced that version of the bill (S. 3393 SUPPORT Act). “The Senate bill provides a 70% increase in funding for training of mental health and substance use disorder professionals and a 25% increase in student loan forgiveness for counselors who practice in underserved areas,” Dunn reported. The Senate bill would require the federal government to study whether peer support individuals should be excluded if they have criminal histories, as some states already screen them out, which, as Dunn noted, “eliminates a segment of people in recovery.” NAATP has been advocating for passage and for many of the components included in both bills, Dunn said. “While all our priorities were not included, major advancements were made. We will continue to work with the various congressional leaders as the legislative process continues.” The next steps will be for the full Senate to consider and pass its version of the Support Act reauthorization, and then the two bodies will reconcile the two bills before final passage by both congressional bodies.

Unwinding of Continuous Medicaid Coverage Among Patients at Community Health Centers

This retrospective cohort study uses data from the Accelerating Data Value Across a National Community Health Center Network to assess patterns of Medicaid disenrollment during the first 6 months after the end of continuous enrollment.

Study of assessment and monitoring of pastures land areas in hills based on GIS technologies (case study Southern Uzbekistan)

In this study, we have undertaken a comprehensive exploration of vegetation monitoring and biomass assessment in the mountainous and sub-mountainous regions of southern Uzbekistan, leveraging the capabilities of Geographic Information System (GIS) technologies and remote sensing data. Our research has focused on the critical analysis of biomass levels during the primary plant season, as well as continuous plant monitoring. Our methodology involved the utilization of Landsat 9 satellite image data, further analyzed through the application of two essential vegetation indices, namely the Normalized Difference Vegetation Index (NDVI) and the Soil- Adjusted Vegetation Index (SAVI). One of the key objectives of our investigation was to assess the potential for extrapolating the biomass model for plant cover using GIS technologies. This extrapolation aims to extend our understanding to encompass the period of continuous vegetation coverage monitoring. The combination of GIS, remote sensing data, and advanced vegetation indices serves as a powerful framework for gaining insights into the dynamics of plant growth and biomass variations. Such research not only enhances our understanding of the ecological landscape but also provides valuable information for sustainable land management and agriculture practices in the region

Effects of the Families First Coronavirus Response Act on Coverage Continuity and Access for Medicaid Beneficiaries.

The Families First Coronavirus Response Act (FFCRA) enacted in March 2020 prohibited states from redetermining Medicaid eligibility until March 31st, 2023. However, there has been little direct evidence on how the FFCRA affected coverage continuity, health care access and utilization among Medicaid beneficiaries. In this cross-sectional study, we employ data from the 2015 to 2022 National Health Interview Survey and a difference-in-differences design to study the FFCRA effects by comparing changes in outcomes between Medicaid and privately insured individuals over time. The sample is limited to non-elderly adults aged 19 to 64 years with income below 300% of the federal poverty level. We find that Medicaid beneficiaries experienced a decline in coverage interruptions in 2021 and 2022 relative to privately insured individuals. Additionally, Medicaid beneficiaries had improved access in 2021, with less reporting of unaffordable healthcare needs and delayed medical care due to cost. There were no discernable effects on hospitalizations, ED visits, and doctor/health professional visits. The continuous Medicaid coverage provision under the FFCRA was associated with enhanced coverage stability and improved access to care for Medicaid beneficiaries. Findings highlight potential benefits from new policy initiatives to improve Medicaid coverage continuity.

Data science competition for cross-site individual tree species identification from airborne remote sensing data.

Data on individual tree crowns from remote sensing have the potential to advance forest ecology by providing information about forest composition and structure with a continuous spatial coverage over large spatial extents. Classifying individual trees to their taxonomic species over large regions from remote sensing data is challenging. Methods to classify individual species are often accurate for common species, but perform poorly for less common species and when applied to new sites. We ran a data science competition to help identify effective methods for the task of classification of individual crowns to species identity. The competition included data from three sites to assess each methods' ability to generalize patterns across two sites simultaneously and apply methods to an untrained site. Three different metrics were used to assess and compare model performance. Six teams participated, representing four countries and nine individuals. The highest performing method from a previous competition in 2017 was applied and used as a baseline to understand advancements and changes in successful methods. The best species classification method was based on a two-stage fully connected neural network that significantly outperformed the baseline random forest and gradient boosting ensemble methods. All methods generalized well by showing relatively strong performance on the trained sites (accuracy = 0.46-0.55, macro F1 = 0.09-0.32, cross entropy loss = 2.4-9.2), but generally failed to transfer effectively to the untrained site (accuracy = 0.07-0.32, macro F1 = 0.02-0.18, cross entropy loss = 2.8-16.3). Classification performance was influenced by the number of samples with species labels available for training, with most methods predicting common species at the training sites well (maximum F1 score of 0.86) relative to the uncommon species where none were predicted. Classification errors were most common between species in the same genus and different species that occur in the same habitat. Most methods performed better than the baseline in detecting if a species was not in the training data by predicting an untrained mixed-species class, especially in the untrained site. This work has highlighted that data science competitions can encourage advancement of methods, particularly by bringing in new people from outside the focal discipline, and by providing an open dataset and evaluation criteria from which participants can learn.

CORRIGENDUM: Thermal soaring over the North Sea and implications for wind farm interactions

Seabirds use several flight modes at sea, including thermal soaring, in which thermal uplift is used to gain altitude and save energy. An increase in flight altitude may have consequences for wind farm interactions if it results in birds spending more time within the rotor-swept zone (RSZ). To understand conditions under which thermal soaring occurs and potential implications for wind farm interactions, we investigated thermal soaring in relation to atmospheric conditions in June and July at 2 study areas in the North Sea, west and north of the Dutch coast. We developed algorithms that identified thermal soaring in GPS tracks of lesser black-backed gulls Larus fuscus and radar tracks of seabirds. By combining species-specific 3-dimensional information on flight behaviour from bio-logging with the continuous spatiotemporal coverage of radar positioned at wind parks, we obtained a more comprehensive overview of thermal soaring at sea than either method would obtain alone. Our results showed that birds flew at higher altitudes during thermal soaring than non-soaring flight, increasing the proportion of flight time within the RSZ. Thermal soaring occurred inside offshore wind farms to a similar degree as outside. Thermal soaring was positively correlated with positive temperature differences (ΔT) between sea surface and air (at 2 m above sea level), and north and north-westerly winds. We show that the probability of thermal soaring over the North Sea, inside and outside wind farms, increases with larger temperature differences, resulting in increased time spent within the RSZ and an increased collision risk for seabirds.