Iowa Counties Research Articles

Evaluating habitat use and relative abundance of Iowa's river otter with harvest data

AbstractThe North American river otter (Lontra canadensis) was extirpated from much of the United States in the early 20th century due to habitat loss, pollution of waterways, and overharvesting. The Iowa Department of Natural Resources began a river otter reintroduction effort in 1985, which placed otters in 14 sites across the state. Otters have since been known to occur in every county in Iowa and appear to have successfully repopulated their former range throughout the state. Our objective was to relate land cover characteristics and otter abundance using harvest data. We used data collected by agency staff to map the locations of otter harvest in Iowa from 2006 to 2016. We mapped otter harvest locations at the subwatershed level (also called 12‐digit Hydrologic Unit Code or HUC‐12). We related otter harvest to land cover variables and predicted otter abundance by land cover type. We found that roads, forests, larger waterways, and Ictaluridae (catfish) presence were negatively correlated with otter harvest. Variables positively correlated with otter harvest were areas with greater land cover diversity, wetland patch density, average stream density, and waterway and wetland areas. The land cover model predicted otters in equal or greater numbers than the harvest data in 62.8% of HUC‐12s. The areas of greatest otter abundance estimates were located near recreation areas and urban areas, indicating the underutilization of these heavy‐trafficked areas by trappers. Areas of fewer predicted otters were not concentrated in a single area of the state but occurred along the Interstate 80 corridor.

Identification of streptomycin-resistant Erwinia amylovora in Iowa.

Erwinia amylovora is a bacterial pathogen that causes fire blight, an important disease in apples and pears. Applying the antibiotic streptomycin during the phenological bloom stage is considered the most effective management tactic for fire blight. Though streptomycin-resistant (SmR) E. amylovora populations have emerged in major U.S. apple-producing regions, antibiotic resistance data for medium to small-sized apple-producing regions like the Midwest is still lacking. This short communication collected symptomatic fire blight samples from Iowa apple orchards during 2022 and 2023, where recent fire blight outbreaks persisted despite streptomycin use. Among E. amylovora isolates from seven counties in central and eastern Iowa, around 90% of them were SmR. All SmR isolates exhibited a single base pair mutation in codon 43 of the rpsL gene, conferring resistance to streptomycin levels exceeding 1,000 μg/mL. Through clustered regularly interspaced short palindromic repeat (CRISPR) analysis, we characterized two E. amylovora genotypes unique to our region. Whole genome sequencing of one representative SmR isolate, IA01, confirmed its CRISPR genotype and subsequent phylogenetic analysis suggested that IA01 is genetically similar to Michigan isolates and distinct from those in eastern and western regions of North America. Furthermore, the disease-causing ability of IA01 was comparable to that of the highly virulent Ea110 strain, a streptomycin sensitive strain isolated from Michigan, in immature pears. Overall, this study underscores the urgent need for regional strategies to address antibiotic resistance and provide insights into its genetic basis and geographic distribution which are crucial for sustainable orchard management.

Distribution trends of bovine Anaplasma marginale in Iowa, based upon veterinary diagnostic lab submissions from 2017-2022

Anaplasma marginale is the common etiological agent of bovine anaplasmosis. Infection results in erythrocyte de­struction leading to the clinical signs of anemia, hypoxia, abortion, jaundice and sudden death. Cattle that survive this acute phase or have lower levels of initial bacteremia become chronic, persistent carriers. Carrier animals serve as reser­voirs for the organism and allow infection to spread via me­chanical or biological vectors, to susceptible herdmates. The objective of this study was to report the distribution trends of A. marginale positive test results during a 5-year period in Iowa. This study evaluated Iowa State University Veterinary Diagnostic Lab (ISU VDL) testing results from bovine cases submitted from January 1, 2017 to January 1, 2022, for molecu­lar and serological detection of all stages of anaplasmosis. Cattle residing in Iowa with positive results for PCR or com­petitive ELISA were included in the analysis. The state was divided into 4 geographical districts (1 = northeast, 2 = south­east, 3 = southwest, and 4 = northwest) and the number of pos­itive tests in each district was determined. Total positive tests by district included: northeast 282; southeast 277; southwest 223; northwest 281. Disease spatial analysis mapping, based upon geographic longitude and latitude location of herds with positive diagnostic tests, illustrate progressive disease expan­sion from the southern counties of Iowa, near the Missouri border, into the northern parts of Iowa. These results suggest that A. marginale has developed a widespread distribution across the state of Iowa.

Motivations and experiences among dentists in rural private practice: A qualitative study.

Despite the critical importance of access to dental care for rural residents and concerns about a shrinking rural dentist workforce, few studies have examined rural dentist motivations to practice in rural areas. The aim of this study was to explore practicing rural dentists' motivations and experiences qualitatively through semi-structured interviews to help inform and guide recruitment and retention efforts in rural areas. Dentists were included in the sample frame if they were general dentists in private practice and had a primary practice located in a rural Iowa county. Rural dentists with publicly available email addresses were contacted by email to participate. Semi-structured interviews were administered to 16 private practice general dentists. All interviews were audio recorded, transcribed, and coded using pre-set and emergent codes. Participants were most commonly male (75%), under age 35 (44%), white (88%), and practiced in a partnership arrangement (44%). The main codes regarding dentists' experiences and motivations to practice in a rural area included familiarity with a rural area, community, financial factors, and clinical care delivery. Having been raised in a rural area was a major influence in most dentists' decisions about where to locate. The importance of rural upbringing in this study underscores the need to consider rural upbringing in dental student admissions. Additional findings, such as financial benefits of a rural practice and other practice-related factors can be used to inform recruitment efforts.

Simulated Ecosystem and Farm-Level Economic Impacts of Conservation Tillage in a Northeastern Iowa County

While the ecological benefits of no-till are largely indisputable, the economic impacts are less certain, and the latter may be partly to blame for lower-than-expected adoption of no-till. In this study, we contribute to a better understanding of the ecosystem and farm-level economic impacts of no-till, with Buchanan County in the northeastern region of the U.S. State of Iowa as the backdrop due to previously established data and model validation efforts in that region. Using the Agricultural Policy Environmental eXtender (APEX) and Farm Economic Model (FEM), we simulated two tillage scenarios—a conservation tillage baseline and no-till—for continuous corn and corn–soybean rotations in Buchanan County using gridded historical climate data. We find that no-till provides clear ecosystem benefits, except that soluble nutrient losses might actually rise. We also find that under current commodity prices for corn and soybeans, no-till is not as profitable as the conservation tillage baseline. For no-till to be at least as profitable as the baseline under current commodity prices, the yield penalty associated with no-till cannot be higher than 1.5% for corn and 0.8% for soybeans, or similar combinations that entail a revenue penalty of about $24,000 for an 809-hectare continuous corn or corn–soybean operation. Given the simulated yield penalties associated with no-till, corn and soybean prices would have to be substantially lower in order for no-till to break even. Consequently, incentives for conservation practice implementation may need to be tied to commodity prices and yield penalties in order to elicit greater adoption rates.

Closure of Labor & Delivery units in rural counties is associated with reduced adequacy of prenatal care, even when prenatal care remains available.

Closure of rural Labor & Delivery (L&D) units can impact timely access to hospital-based obstetrical care. Iowa has lost over a quarter of its L&D units in the previous decade. Assessing the effect of these closures on prenatal care in those rural communities is important to understanding the full effect of unit closures on maternal health care. Using birth certificate data in Iowa from 2017 to 2019, the initiation of prenatal care and adequacy of prenatal visits were assessed for 47 rural counties in Iowa. Of these, 7 experienced a closure of the only L&D unit between 1/1/2018 and 1/1/2019. The impact of these closures is modeled for all birthing parents and compared for Medicaid versus non-Medicaid recipients. All 7 counties that experienced the loss of their only L&D unit continued to have prenatal care services available. Experiencing a closure of an L&D unit was associated with a lower likelihood of overall adequate prenatal care but not significantly associated with a lower rate of first-trimester prenatal care utilization. Among Medicaid recipients of the communities where an L&D unit closed, there was an association of closure with both a lower likelihood of adequate prenatal care and entry to prenatal care after the first trimester. Utilization of prenatal care is lower in rural communities following L&D unit closure, especially among Medicaid recipients. This suggests that the overall maternal health systems were disrupted by the closure of the L&D unit, impacting the utilization of services that remained available to the community.

ACCESS TO HOSPITAL-BASED PALLIATIVE CARE SERVICES FOR OLDER ADULTS IN IOWA

Abstract Background U.S. Medicare covers many palliative services; however, Iowa’s rurality and high rate of older adults (OAs) aged 65 or over make it unclear whether older Iowans have equitable service access. Hospital-based palliative care services (HBPCSs) include curative treatment, whereas other providers of palliative care may not. Thus, this study only examined OAs’ geographic access to HBPCSs in Iowa. Methods This study used the American Hospital Association and U.S. Census Bureau estimate in 2017. The geographical distribution of hospitals and HBPCSs was examined using a county-level approach, considering rural/urban status (using the Office of Management and Budget’s definitions) and OA population proportion. Results Of the 99 counties in Iowa, 89 were rural. Of the 116 hospitals statewide, one urban county and nine rural counties had no hospital. A total of 52 hospitals provided HBPCSs in 43 counties across nine urban and 34 rural counties. HBPCSs were primarily located in central Iowa, with northern and southern Iowa having the lowest access to HBPCSs. The OA population ratio was higher in counties without HBPCSs (19%) than HBPCSs (15.7%). All 54 counties with over a 20% OA population were concentrated in rural counties, while only 37% of these rural counties had HBPCSs. Conclusion This study suggests a regional imbalance of HBPCS providers for OAs in Iowa. Results showed that rural communities with a high ratio of OAs lack HBPCSs and suggest HBPCSs should be expanded at hospitals in northern and southern Iowa counties where many OAs live.

Survey of 226Ra/228Ra and inorganic constituents in Iowa private drinking water wells

AbstractRadium is a naturally‐occurring radioactive element found in Upper Midwest aquifers, yet exposure risks for unregulated water sources in this region are unknown. A survey of 226/228Ra and other inorganic constituents in 94 private wells was conducted in 2019 across 10 Iowa counties. Within private wells, 53% measured below minimum detectable activity whereas 6.3% have 226/228Ra levels above the United States Environmental Protection Agency Maximum Contaminant Level. 226/228Ra occurrence was not associated with well‐depth or chemical surrogates, but were generally consistent with the lithology and historical water quality trends for aquifers. In 2020, 11 of the 226/228Ra‐impacted wells were re‐sampled to assess the efficacy of in‐home water treatment. Water softeners reduced 226/228Ra to non‐detectable activities, but other inorganic constituents persisted and their removal required more advanced treatment. This study suggests that 226/228Ra occurrence in private wells can reasonably be anticipated from public water supply data if reliable information is available to identify the source aquifer.

Patients in Iowa Counties Lacking Hospitals With Labor and Delivery Services Disproportionately Receive Care at Level III Maternal Care Hospitals When Undergoing Cesarean Delivery: A Retrospective Longitudinal Study.

Introduction Many obstetrical patientsfrom rural areas in the United States lack hospitals that provide labor and delivery care. Our objective was to examine the effects of such patientson caseloads of cesarean deliveries at Iowa hospitals withlevel III maternal care, as defined by the Iowa Department of Public Health(e.g., with obstetric anesthesiologists). Methods Thisretrospective longitudinal studyincludedeverydischarge with cesarean delivery in the state of Iowa from October 2015 through June 2021. There were N=60,534 such deliveries from 76 hospitals, of which three were level III, and the rest were level I or II.Poisson regression models with robust variance estimation and controlling for geography, maternal risk factors, and insurance, were used to evaluate the binary outcome of whether patients received care at the university level III hospital in Eastern Iowa, or not. Similar models were also developed for care at the two private level III hospitals in Central Iowa, or not.Differences in the mean probabilities of receiving care at the level III hospitals were then estimated using logistic regression, with results reported in units of changes in cases per week at the hospitals. Results Statewide, the university level III hospital performed 7.4% of the cesarean deliveries, and the two private level III hospitals performed 23.4%.Patients from counties in which nocesarean deliveries were performedduring the quarter of the year when they underwent a cesarean delivery disproportionately received care at level III hospitals versus levels I and II hospitals. Lower 99% confidence limits for incremental risk ratios were 1.46 and 4.20, respectively. Cesarean deliveries among patients residing in counties where no hospital had a labor and delivery ward were distributed unequally between thecounties of the hospitals with level III maternal care. Therewere approximately 1.09 (standard error 0.10) extra cesarean deliveries per week at the university hospital versus 5.81 (standard error 0.11) at the private hospitals. The 1.09 vs 5.81 difference was caused, in part, by the effects of insurance and other hospitals with similar services. Conclusions Patients residing in counties without labor and delivery care disproportionately go to level III hospitals. These results can help anesthesiologists, obstetricians, and analystsat hospitals with large tertiary (level III) programs interpret their annual increases in total obstetric anesthesia activity.

Sexually Transmitted Infection Rates and Closure of Family Planning Clinics Because of Abortion Restrictions in Iowa

This cohort study assesses rates of sexually transmitted infections in Iowa counties before and after closure of family planning health centers and compared with national rates.

Association of distance to gynecologic oncologist and survival in a rural midwestern state (414)

Objectives: Rural ovarian cancer patients experience worse survival outcomes compared to urban patients. We hypothesized that those living farther from gynecologic oncology would have greater mortality because they may be more likely to seek care locally from less specialized providers. Our objective was to assess whether distance to gynecologic oncology providers affects mortality among ovarian cancer patients living in a largely rural midwestern state. Methods: Demographic, tumor, and treatment characteristics were extracted from the Iowa Cancer Registry for patients residing in Iowa diagnosed with malignant primary ovarian cancer from 1990-2018. County-level data from the 2018-19 Area Health Resource File included a number of primary care physicians, surgeons, OB/GYN’s, and hospital beds per 10,000 population. Rurality was categorized using 2013 Rural-Urban Continuum Codes for the patient’s county of residence at the time of diagnosis. Distance to the nearest gynecologic oncologist was calculated from the centroid of the patient’s county of residence to the centroid of the nearest county in Iowa or surrounding states containing a hospital with at least one gynecologic oncologist (n=7). Survival was assessed via Cox proportional hazards models. Results: There were 1,588 patients included, with a mean distance to gynecologic oncology of 45.8 miles and a mean survival of 31 months. Unadjusted models showed those who lived farther from gynecologic oncology had progressively significantly greater risk of death compared to those who lived 0-9 miles: 10-29 (HR: 1.07, 95% CI:1.03-1.12), 30-49 (HR: 1.15, 95% CI:1.05-1.25), 50-69 (HR: 1.23, 95% CI:1.08-1.40), 70+ (HR:1.32, 95% CI:1.11-1.57). In multivariate models that included age, marital status, stage, county-level poverty, and rate of surgeons per 10,000 population, the distance was no longer associated with a higher risk of mortality. Stage II (HR: 3.10, 95% CI: 2.13-4.50), stage III (HR: 7.09, 95% CI: 5.40-9.31), stage IV (HR: 11.59, 95% CI: 8.73-15.38) versus stage I, age 60-69 (HR: 1.47, 95% CI:1.13- 1.90), age 70-79 (HR: 2.08, 95% CI: 1.59-2.71), age 80+ (HR: 4.96, 95% CI: 3.76-6.53) versus <50, unmarried versus married (HR: 1.35, 95% CI: 1.09-1.67) were the strongest predictors for risk of death. Conclusions: Those living farthest from gynecologic oncology care had an increased risk of mortality, but this increase was diminished after controlling for patient/tumor characteristics. Further studies are needed to elucidate reasons contributing to worsened survival for rural women, which could include referral practices of local providers, rates of surgery performed by general OB/GYN’s, and other unknown factors. Objectives: Rural ovarian cancer patients experience worse survival outcomes compared to urban patients. We hypothesized that those living farther from gynecologic oncology would have greater mortality because they may be more likely to seek care locally from less specialized providers. Our objective was to assess whether distance to gynecologic oncology providers affects mortality among ovarian cancer patients living in a largely rural midwestern state. Methods: Demographic, tumor, and treatment characteristics were extracted from the Iowa Cancer Registry for patients residing in Iowa diagnosed with malignant primary ovarian cancer from 1990-2018. County-level data from the 2018-19 Area Health Resource File included a number of primary care physicians, surgeons, OB/GYN’s, and hospital beds per 10,000 population. Rurality was categorized using 2013 Rural-Urban Continuum Codes for the patient’s county of residence at the time of diagnosis. Distance to the nearest gynecologic oncologist was calculated from the centroid of the patient’s county of residence to the centroid of the nearest county in Iowa or surrounding states containing a hospital with at least one gynecologic oncologist (n=7). Survival was assessed via Cox proportional hazards models. Results: There were 1,588 patients included, with a mean distance to gynecologic oncology of 45.8 miles and a mean survival of 31 months. Unadjusted models showed those who lived farther from gynecologic oncology had progressively significantly greater risk of death compared to those who lived 0-9 miles: 10-29 (HR: 1.07, 95% CI:1.03-1.12), 30-49 (HR: 1.15, 95% CI:1.05-1.25), 50-69 (HR: 1.23, 95% CI:1.08-1.40), 70+ (HR:1.32, 95% CI:1.11-1.57). In multivariate models that included age, marital status, stage, county-level poverty, and rate of surgeons per 10,000 population, the distance was no longer associated with a higher risk of mortality. Stage II (HR: 3.10, 95% CI: 2.13-4.50), stage III (HR: 7.09, 95% CI: 5.40-9.31), stage IV (HR: 11.59, 95% CI: 8.73-15.38) versus stage I, age 60-69 (HR: 1.47, 95% CI:1.13- 1.90), age 70-79 (HR: 2.08, 95% CI: 1.59-2.71), age 80+ (HR: 4.96, 95% CI: 3.76-6.53) versus <50, unmarried versus married (HR: 1.35, 95% CI: 1.09-1.67) were the strongest predictors for risk of death. Conclusions: Those living farthest from gynecologic oncology care had an increased risk of mortality, but this increase was diminished after controlling for patient/tumor characteristics. Further studies are needed to elucidate reasons contributing to worsened survival for rural women, which could include referral practices of local providers, rates of surgery performed by general OB/GYN’s, and other unknown factors.

Finding the Community’s Voice: Community-Based Participatory Research in Three Iowa Counties

Engaging all Iowans in building a stronger state, preparing for a thriving future, and solving contemporary problems in research, education, and extension are central to the mission and vision of Iowa State University Extension and Outreach (EO). Achieving these goals will hinge upon EO’s ability to innovate and respond to the needs and interests of Iowa’s diverse residents. Similar to other rural states, the composition of Iowa’s population is evolving in terms of race, nationality, economics, and education. The identities of EO staff do not reflect the communities EO is committed to serving; therefore, programming and activities may lack cultural relevance. In three small studies, Iowa State faculty and research assistants, EO staff, and community consultants (CCs) collaboratively organized local “study circles” and “action forums” in an effort to better understand underrepresented families’ needs in three Iowa counties. The team recruited 98 adults and youth to participate in these group discussions. Often, participants were not aware of EO’s mission, logo, or programs and services. Residents offered ideas for fostering familiarity, trust, and connection. CCs also listened to residents’ barriers to engagement, such as program formats and topics, and documented useful resources to enhance accessibility. Participants shared ideas for programs that they would be motivated to engage in. In this article, the authors outline connections to prior work, recommendations, and limitations.

Assessing adult physical activity and compliance with 2008 CDC guidelines using a Bayesian two-part measurement error model

While there is wide agreement that physical activity is an important component of a healthy lifestyle, it is unclear how many people adhere to public health recommendations on physical activity. The Physical Activity Guidelines (PAG), published by the CDC, provides guidelines to American adults, but it is difficult to assess compliance with these guidelines. The PAG further complicates adherence assessment by recommending activity to occur in at least 10 min bouts. To better understand the measurement capabilities of various instruments to quantify activity, and to propose an approach to evaluate activity relative to the PAG, researchers at Iowa State University administered the Physical Activity Measurement Survey (PAMS) to over 1000 participants in four different Iowa counties. In this paper, we develop a two-part Bayesian measurement error model and apply it to the PAMS data in order to assess compliance with the PAG in the Iowa adult population. The model accurately accounts for the 10 min bout requirement put forth in the PAG. The measurement error model corrects biased estimates and accounts for day-to-day variation in activity. The model is also applied to the nationally representative National Health and Nutrition Examination Survey.

Surveillance and genetic data support the introduction and establishment of Aedes albopictus in Iowa, USA

Aedes albopictus is a competent vector of several arboviruses that has spread throughout the United States over the last three decades. With the emergence of Zika virus in the Americas in 2015–2016 and an increased need to understand the current distributions of Ae. albopictus in the US, we initiated surveillance efforts to determine the abundance of invasive Aedes species in Iowa. Here, we describe surveillance efforts from 2016 to 2020 in which we detect stable and persistent populations of Aedes albopictus in three Iowa counties. Based on temporal patterns in abundance and genetic analysis of mitochondrial DNA haplotypes between years, our data support that Ae. albopictus are overwintering and have likely become established in the state. The localization of Ae. albopictus predominantly in areas of urbanization, and noticeable absence in rural areas, suggests that these ecological factors may contribute to overwintering success. Together, these data document the establishment of Ae. albopictus in Iowa and their expansion into the Upper Midwest, where freezing winter temperatures were previously believed to limit their spread. With impending climate change, our study provides evidence for the further expansion of Ae. albopictus into temperate regions of the United States resulting in increased risks for vector-borne disease transmission.

Using Bayesian Kriging for spatial smoothing of trends in non-normal yield densities

PurposeThe purpose of this paper is to estimate crop yield densities considering time trends in the first three moments and spatially varying coefficients.Design/methodology/approachYield density parameters are assumed to be spatially correlated, through a Gaussian spatial process. This study spatially smooth multiple parameters using Bayesian Kriging.FindingsAssuming that county yields follow skew normal distributions, the location parameter increased faster in the eastern and northwestern counties of Iowa, while the scale increased faster in southern counties and the shape parameter increased more (implying less left skewness) in southwestern counties. Over time, the mean has increased sharply, while the variance and left skewness increased modestly.Originality/valueBayesian Kriging can smooth time-varying yield distributions, handle unbalanced panel data and provide estimates when data are missing. Most past models used a two-stage estimation procedure, while our procedure estimates parameters jointly.

Evaluating the vulnerability of farming communities to winter storms in Iowa, US

Winter storms have been reported as the second-most frequent catastrophe in the Midwest of the United States and can create non-negligible impacts on farming communities that highly rely on climatic-sensitive resources and activities. However, few studies have attempted to assess the vulnerability to winter storms in rural contexts. Focusing on all counties in Iowa, US, as the study area, this research aimed to evaluate the vulnerability of farming communities to winter storms and its major determinants. It first identified both climatic and non-climatic indicators for quantifying winter storm exposure, sensitivity, and adaptive capacity by reviewing previous related studies and examining qualitative interview results. Then, spatial analysis tools were used to quantify and aggregate several indicators, such as winter temperature variation, natural shelter, energy capacity, and facility density. Next, factor analysis was employed to identify latent variables and estimate the index score for adaptive capacity. Finally, the vulnerability of Iowa counties to winter storms was calculated and mapped. The results showed that the determinants of adaptive capacity to winter storms in Iowa could be explained as farming economic status, environmental institutional capital, and innovative capital. Overall, high vulnerability was found in Southeast Iowa due to its low farming economic status and innovative capital, and Northwest Iowa as a result of high exposure and low environmental institutional capital. In a state with dominant farming communities, whether to include its major metropolitan areas to assess winter storm vulnerability seemed to only affect the evaluation of the general pattern of adaptive capacity but not exposure or sensitivity.

An Initiative to Improve 30-Day Readmission Rates Using a Transitions-of-Care Clinic Among a Mixed Urban and Rural Veteran Population.

Hospital readmissions in the United States, especially in patients at high-risk, cost more than $17 billion annually. Although care transitions is an important area of research, data are limited regarding its efficacy, especially among rural patients. In this study, we describe a novel transitions-of-care clinic (TOCC) to reduce 30-day readmissions in a Veterans Health Administration setting that serves a high proportion of rural veterans. In this quality improvement initiative we conducted a pre-post study evaluating clinical outcomes in adult patients at high risk for 30-day readmission (Care Assessment Needs score > 85) discharged from the Iowa City Veterans Affairs (ICVA) Health Care System from 2017 to 2020. The ICVA serves 184,000 veterans across 50 counties in eastern Iowa, western Illinois, and northern Missouri, with more than 60% of these patients residing in rural areas. We implemented a multidisciplinary TOCC to provide in-person or virtual follow-up to high-risk veterans after hospital discharge. The main purpose of this study was to assess how TOCC follow-up impacted the monthly 30-day patient readmission rate. The TOCC resulted in a 19.2% relative reduction in 30-day readmission rates in the 12-month postimplementation period compared to the preimplementation period (9.2% vs 11.4%, P = .04). Virtual visits were more popular than in-person visits among both urban and rural veterans. There was no difference in outcomes between these two follow-up options, and both groups had reduced readmission rates compared to non-TOCC follow-up. A multidisciplinary TOCC within the ICVA featuring both virtual and in-person visits reduced the 30-day readmission rate. This reduction was particularly notable among patients with congestive heart failure.

Quantifying carbon budget, crop yields and their responses to environmental variability using the ecosys model for U.S. Midwestern agroecosystems

As one of the major agricultural production areas in the world, the United States (U.S.) Midwest plays a vital role in the global food supply and agricultural ecosystem services. Although significant efforts have been made in modeling the carbon cycle dynamics over this area, large uncertainty still exists in the previous simulations in terms of reproducing individual components of the carbon cycle and their responses to environmental variability. Here we evaluated the performance of an advanced agroecosystem model, ecosys, in simulating carbon budgets over the U.S. Midwest, considering both the magnitude of carbon flux/yield and its response to environmental (climate and soil) variability. We conducted model simulations and evaluations at 7 cropland eddy-covariance sites as well as over 293 counties of Illinois, Indiana, and Iowa in the U.S. Midwest. The site-level simulations showed that ecosys captured both the magnitude and seasonal patterns of carbon fluxes (i.e., net ecosystem carbon exchange (NEE), ecosystem gross primary production (GPP), and ecosystem respiration (Reco)), leaf area index (LAI), and dynamic plant carbon allocation processes, with R2 equal to 0.92, 0.87, 0.87, and 0.78 for GPP, NEE, Reco, and LAI, respectively across all the sites compared with the observations. For regional scale simulations, ecosys reproduced the spatial distribution and interannual variability of corn and soybean yields with the constraints of observed yields and a new remotely sensed GPP product, with R2 of multi-year averaged simulated and observed yield equal 0.83 and 0.80 for corn and soybean, respectively. The simulated responses of carbon cycle dynamics to environmental variability were consistent with that from the empirical observations at both site and regional scales. Our results demonstrated the applicability of ecosys in simulating the carbon cycle and soil carbon dynamics of the U.S. Midwestern agroecosystems under different climate and soil conditions.

Quantifying nitrogen loss hotspots and mitigation potential for individual fields in the US Corn Belt with a metamodeling approach

The high productivity in the US Corn Belt is largely enabled by the consumption of millions of tons of manufactured fertilizer. Excessive application of nitrogen (N) fertilizer has been pervasive in this region, and the unrecovered N eventually escaped from croplands in forms of nitrous oxide (N2O) emission and N leaching. Mitigating these negative impacts is hindered by a lack of practical information on where to focus and how much mitigation potential to expect. At a large scale, process-based crop models are the primary tools for predicting variables required by decision making, but their applications are prohibited by expensive computational and data storage costs. To overcome these challenges, we built a series of metamodels to learn the key mechanisms regarding the carbon (C) and N cycle from a well-validated process-based biogeochemical model, ecosys. The trained metamodel captures over 98% of the variability of the ecosys simulated outputs for 99 randomly selected counties in Iowa, Illinois, and Indiana. To identify hotspots with high mitigation potential, we introduce net societal benefit (NSB) as an indicator for synthesizing the loss in yield and social benefits through emissions and pollutants avoided. Our results show that reducing N fertilizer by 10% leads to 9.8% less N2O emissions and 9.6% less N leaching at the cost of 4.9% more SOC depletion and 0.6% yield reduction over the study region. The estimated total annual NSB is $395 M (uncertainty ranges from $114 M to $1271 M), including $334 from social benefits (uncertainty ranges from $46 M to $1076 M), $100 M from saving fertilizer (uncertainty ranges from $13 M to $455 M), and −$40 M due to yield changes (uncertainty ranges from −$261 M to $69 M). For the median scenario, we noted that 20% of the study area accounts for nearly 50% of the NSB, and thus represent hotspot locations for targeted mitigation. Although the uncertainty range suggests that developing such a high-resolution framework is not yet settled and the scenario based estimations are not appropriate to inform the management practices for individual farmers, our efforts shed light on the new generation of analytical tools for life cycle assessment.

Local Decision-makers' Perspectives on Roadside Revegetation and Management in Iowa, USA.

Environmental practitioners must understand those they collaborate with to implement programs that are both socially and ecologically effective. Practitioners who understand decision-makers' perspectives are better able to collaborate to lower political, financial, and cultural obstacles. In this study, we surveyed decision-makers involved with a voluntary environmental program in Iowa, USA. Iowa counties can choose to manage their roadside vegetation using an ecological approach, called integrated roadside vegetation management. Key decision-makers who decide whether a county has a roadside program are the county board of supervisors and the county conservation board. We used a mixed-mode design to survey the conservation board directors and chairs of the board of supervisors in each county. Our main goals were to understand the decision-makers' perceived benefits and barriers to having a roadside program in their counties, as well as the key factors influencing their decisions about roadside vegetation management. Safety, maintenance cost savings, and erosion control were the main factors that influenced decision-making, while pollinators and other wildlife received the least consideration. However, decision-makers in counties with a roadside vegetation manager were more influenced by pollinators and other wildlife compared to their counterparts in counties without a roadside vegetation manager. The main barriers to having a program include a lack of resources or other concerns being a higher priority. Emphasizing safety, cost savings, and erosion control benefits of roadside programs, and identifying ways to lower startup costs may increase buy-in with county decision-makers.