Non-summer Months Research Articles

Seasonal Patterns of Living Kidney Donation in the United States From 1995 to 2019.

The number of living kidney donors in the United States has declined since 2005, with variations based on the donor-recipient relationship. The reasons for this decline are unclear, and strategies to mitigate declined donations remain elusive. We examined the change in donor number monthly (within-year) versus annually (between-years) to inform potentially modifiable factors for future interventions. In this registry-based cohort analysis of 141759 living kidney donors between 1995 and 2019, we used linear mixed-effects models for donor number per month and year to analyze between-year and within-year variation in donation. We used Poisson regression to quantify the change in the number of donors per season before and after 2005, stratified by donor-recipient relationship and zip-code household income tertile. We observed a consistent summer surge in donations during June, July, and August. This surge was statistically significant for related donors (incidence rate ratio [IRR] range: 1.12-1.33) and unrelated donors (IRR range: 1.06-1.16) across donor income tertiles. Our findings indicate lower rates of living kidney donation in non-summer months across income tertiles. Interventions are needed to address barriers to donation in non-summer seasons and facilitate donations throughout the year. Since the Organ Donor Leave Law provides a solid foundation for supporting year-round donation, extending the law's provisions beyond federal employees may mitigate identified seasonal barriers.

Urinary benzophenone-3 concentrations and ovarian reserve in a cohort of subfertile women

ObjectiveTo evaluate the association between urinary benzophenone-3 concentrations and measures of ovarian reserve (OR) among women in the Environment and Reproductive Health (EARTH) Study seeking fertility treatment at Massachusetts General Hospital in Boston, Massachusetts. DesignProspective cohort study. MethodsWomen from the EARTH cohort contributed spot urine samples before assessment of OR outcomes. Antral follicle count (AFC) and day-3 follicle stimulating hormone (FSH) levels were evaluated as part of standard infertility workups during unstimulated menstrual cycles. Quasi-Poisson and linear regression models were used to evaluate the association of specific gravity (SG)-adjusted urinary benzophenone-3 concentrations with AFC and FSH, respectively, with adjustment for age and physical activity. In secondary analyses, models were stratified by age. Sensitivity analyses assessed for confounding by season by restricting to women with exposure and outcome measured in the same season and stratifying by summer vs. non-summer months and for confounding by sunscreen use by restricting to women who filled out product questionnaires and adjusting for and stratifying by average sunscreen use score. ResultsThe study included 142 women (mean age ± SD, 36.1 ± 4.6; range, 22-45 years) enrolled between 2009 and 2017 with both urinary benzophenone-3 and AFC and 57 women with benzophenone-3 and FSH measurements. Most women were white (78%) and highly educated (49% with a graduate degree). Women contributed a mean of 2.7 urine samples (range, 1-10) with 37% contributing 2 or more samples. Benzophenone-3 was detected in 98% of samples. Geometric mean (GM) SG-corrected urinary benzophenone-3 concentration was 85.9 μ g/L (geometric standard deviation 6.2). There were no associations of benzophenone-3 with AFC and day-3 FSH in the full cohort. In stratified models, a 1-unit increase in log GM benzophenone-3 was associated with AFC 0.91 (95% CI, 0.86, 0.97) times lower among women ≤35 years old and was associated with FSH 0.73 (95% CI, 0.12, 1.34) IU/L higher among women >35 years old. Effect estimates from models stratified by season and sunscreen use were null. ConclusionIn main models, urinary benzophenone-3 was not associated with OR. However, younger may be vulnerable to potential effects of benzophenone-3 on AFC. Further research is warranted.

Estimating Residential Water Demand Under Systematic Shifts Between Uniform Price (UP) and Increasing Block Tariffs (IBT)

AbstractWe evaluate whether changing from a uniform price (UP) to an increasing block tariff (IBT) changes people's behavior. We exploit a unique setting in which the price scheme moves back and forth yearly from UP to IBT. We discuss the effectiveness of IBT in reducing summer consumption. This issue is relevant to many countries and policymakers interested in designing tariff structures. There is no evidence of how the same consumer may react to systematically switching from one tariff structure to another yearly. We estimate the residential water demand and its price elasticity using a generalized least squared random effect model for the UP and the discrete/continuous choice model for the IBT. In addition, we split the sample between low and high‐consumption groups. For the low consumption group unaffected by the tariff change, the elasticity in the nonsummer months is higher (more elastic) than in the summer. Consumers in this group reduce their elasticity from nonsummer to summer months (−0.299 vs. −0.071, respectively) and increase their consumption by 13%. The high consumption group increased its summer consumption, but only by 8.7%, and contrary to the first group, its elasticity increased significantly (from −0.299 to −0.568). The high‐consumption group is indeed affected by the change in tariff. From a policy perspective, this implies that the IBT structure is relevant. However, if the policy seeks to promote conservation, it needs to be adjusted to a lower decile of the water consumption distribution to affect a more significant portion of the population.

Solar-enhanced freshwater generation in arid coastal environments: A double basin stepped solar still with vertical wick assistance study in northern Gujarat

Harnessing solar energy for water distillation is a significant method for obtaining freshwater from saline and seawater, especially in remote areas. The primary objective of this research is to assess the performance of a novel double basin stepped-type solar still combined with the vertical wick-assisted unit in the northern part of Gujarat. Experiments were conducted during non-summer months at Central Salt and Marine Chemical Research Institute, (Location −21°45′32″N 72°8′39″E). The set-up was designed, fabricated, and investigated for freshwater production, efficiency analysis, and exergy analysis. Accordingly, in-depth thermal analysis was carried out for the entire unit in terms of predicted water generation and efficiency of the system. The maximum potable water production as 5.2 kg/m2 and 1.9 kg/m2 was attain from double basin stepped solar still and vertical wick unit respectively followed by cumulative overnight productivity of 1 kg/m2. This being said that the average freshwater production from the system is realized to be 8 kg/m2 day which was a significant output in the domain of solar still. Furthermore, 48 % and 26 % maximum thermal efficiencies were pursued for the double basin set-up and wick-assisted set-up respectively. Accordingly, 30 % and 21 % average exergy efficiency for double basin and vertical wick units respectively. The customer end cost for one litre of fresh water from the designed set-up is 0.0048$/L, this effective evidence is built-up to suggest an efficient and superior option to implement this kind of set-up near coastal and salt farming regions where scarcity of potable water is observed.

The summer parental investment gap? Socioeconomic gaps in the seasonality of parental expenditures and time with school-age children

Inequalities in parental investments can shape inequalities in children’s outcomes and life chances. Scholars have theorized how socioeconomic status (SES) may moderate how parents use parental investments to respond to the loss of the provision of public schooling during the summer. We investigate the seasonality of SES gaps in parental investments of both money and time in the United States using the 1996–2019 Consumer Expenditure Survey and the 2003–2019 American Time Use Survey. We find SES gaps in parental investments of both money and time during the summer, and that SES gaps in expenditures are larger in the summer than during non-summer months. We find little evidence that any of these gaps have grown substantially over time. Finally, we find evidence that SES gaps in summer paternal investments of time are driven by investments in younger rather than older school-aged children. Our findings contribute to our understanding of the link between public and parental investments in children, address a key mechanism in the debate about the summer learning gap, and provide new evidence on how parents may target investments in children towards the ages when they are most consequential.

Pretreatment Vitamin D Concentrations Do Not Predict Therapeutic Outcome to Anti-TNF Therapies in Biologic-Naïve Patients With Active Luminal Crohn's Disease.

Vitamin D has a regulatory role in innate and adaptive immune processes. Previous studies have reported that low pretreatment vitamin D concentrations are associated with primary non-response (PNR) and non-remission to anti-TNF therapy. This study aimed to assess whether pretreatment 25-hydroxyvitamin D concentrations predicted PNR and non-remission to infliximab and adalimumab in patients with active luminal Crohn's disease. 25-Hydroxyvitamin D concentrations were measured in stored baseline samples from 659 infliximab- and 448 adalimumab-treated patients in the Personalised Anti-TNF Therapy in Crohn's disease (PANTS) study. Cut-offs for vitamin D were deficiency <25 nmol/L, insufficiency 25-50 nmol/L, and adequacy/sufficiency >50 nmol/L. About 17.1% (189/1107; 95% CI, 15.0-19.4) and 47.7% (528/1107; 95% CI, 44.8-50.6) of patients had vitamin D deficiency and insufficiency, respectively. 22.2% (246/1107) of patients were receiving vitamin D supplementation. Multivariable analysis confirmed that sampling during non-summer months, South Asian ethnicity, lower serum albumin concentrations, and non-treatment with vitamin D supplementation were independently associated with lower vitamin D concentrations. Pretreatment vitamin D status did not predict response or remission to anti-TNF therapy at week 14 (infliximab Ppnr = .89, adalimumab Ppnr = .18) or non-remission at week 54 (infliximab P = .13, adalimumab P = .58). Vitamin D deficiency was, however, associated with a longer time to immunogenicity in patients treated with infliximab, but not adalimumab. Vitamin D deficiency is common in patients with active Crohn's disease. Unlike previous studies, pretreatment vitamin D concentration did not predict PNR to anti-TNF treatment at week 14 or nonremission at week 54.

The Impact of the COVID-19 Pandemic on the Experiences and Operations of Sponsors of the Summer Food Service Program in Maryland, USA: A Multiphase Mixed Methods Study.

During the COVID-19 pandemic, the Summer Food Service Program (SFSP) was allowed to operate in untraditional non-summer months to ensure children did not lose access to free and reduced-priced nutritious meals when schools were mandated to close in the United States. This study assessed the impact of the pandemic on the operations and experiences of Summer Food Service Program (SFSP) sponsors in the state of Maryland during the COVID-19 pandemic in 2020 (Phase I) and 2021 (Phase II). This study used a multiphase explanatory sequential mixed methods design with qualitative prioritization. Maryland SFSP sponsors completed an online survey (Phase I: n = 27, Phase II: n = 30), and semi-structured in-depth interviews were conducted with a subset of sponsors who completed the survey (Phase I: n = 12, Phase II: n = 7). Inductive and deductive analyses were used for qualitative data, and descriptive statistics were used for quantitative data. The COVID-19 pandemic caused SFSP sponsors to change their operations. Sponsors were primarily concerned about staff safety/burnout and decreased participation. Sponsors perceived waivers implemented by the United States Department of Agriculture to be crucial in enabling them to serve meals to children during the pandemic. The findings from our study support advocacy efforts to permanently implement waivers and provide free school meals for all children.

Genetic Factors Associated with Absolute and Relative Plasma Concentrations of Calcitriol.

Little is known regarding factors associated with calcitriol and a relative measure of calcitriol, the calcitriol-24,25-dihydroxyvitamin D3-calcifediol proportion ratio (C24CPR). Using a cross-sectional study design, healthy young adults of African and European descent, matched (1:1) on age (±5 years) provided a blood sample in non-summer months (N = 376). Vitamin D metabolites were measured in plasma with HPLC/MS-MS. West African genetic ancestry proportion (WGA) was estimated using STRUCTURE modeling of genetic ancestry-informative markers. Multivariable regression models were used to estimate the association of WGA and vitamin D-pathway gene variants with calcitriol and C24CPR, controlling for days from summer solstice, age, sex, blood pressure, body mass index, dietary vitamin D intake, oral contraceptive/medroxyprogesterone acetate use, smoking, tanning bed use, and time of day. Calcitriol and C24CPR were not highly correlated (rho = 0.14), although both were significantly, positively, and monotonically associated with WGA (Ptrend 0.025 and <0.001, respectively). In fully adjusted models, genetic factors explained a greater proportion of variability in C24CPR (R2 = 0.121 and 0.310, respectively). Variants in genes with associated with calcitriol (CALB1, CYP27B1, GC, and PPARGC1A) differed from those associated with C24CPR (CYP3A43, FGF23, KL, and VDR). Both absolute and relative measures of calcitriol were significantly higher among African Americans. Otherwise, these biomarkers appear to be genetically distinct. C24CPR may be better suited to personalized medicine, due to a higher proportion of population variability explained by genetic variation and a less skewed distribution.

Investigating the vertical and spatial extent of radon-based classification of the atmospheric mixing state and impacts on seasonal urban air quality

A recently-developed radon-based method for combined classification of both diurnal and synoptic timescale changes in the atmospheric mixing state is applied to 1-year of observations in Ljubljana (capital of Slovenia). Five diurnal-timescale mixing classes (#1 to #5) were defined for each season along with an additional mixing class (#6) in non-summer months, representative of synoptic-timescale changes of the atmospheric mixing state associated with “persistent temperature inversion” (PTI) events. Seasonal composite radiosonde profiles and mean sea level pressure charts within each mixing class are used to demonstrate the link between prevailing synoptic conditions and the local mixing state, which drives changes in urban air quality. Diurnal cycles of selected pollutants (BC, NO2, CO, PM10, SO2 and O3) exhibited substantial seasonality as a result of changing mixing conditions, source types and strengths. For the more well-mixed conditions (classes #2 to #3), surface wind speeds were 3 times higher than during class #6 (PTI) conditions, resulting in a 3-fold reduction of primary pollutant accumulation. Daily-mean PM10 concentrations only exceeded EU and WHO guideline values in winter and autumn for two of the radon-defined mixing classes: (i) class #5 (strongly stable near-surface conditions associated with passing synoptic anti-cyclone systems), and (ii) class #6 (PTI conditions driven by regional subsidence in the presence of the “Siberian High”). Both mixing states were associated with low mean wind speeds (∼0–0.7 m s−1) and strong thermal stratification, as indicated both by pseudo-vertical temperature gradients (∆T/∆z) and radiosonde profiles. Diurnal ∆T/∆z values indicated limited opportunity for convective mixing of pollutants from the basin atmosphere under these conditions. The demonstrated consistency in atmospheric mixing conditions (vertically and spatially) across the diurnal cycle within each of the defined mixing classes suggests the radon-based classification scheme used in conjunction with 3-D urban sensor networks could be well suited to evaluate mitigation schemes for urban pollution and urban climate.

Assessment of using spaceborne LiDAR to monitor the particulate backscatter coefficient on large, freshwater lakes: A test using CALIPSO on Lake Michigan

The Cloud-Aerosol LiDAR and Infrared Pathfinder Satellite Observation (CALIPSO) satellite was launched in 2006 with the primary goal of measuring the properties of clouds and aerosols in Earth’s atmosphere using LiDAR. Since then, numerous studies have shown the viability of using CALIPSO to observe day/night differences in subsurface optical properties of oceans and large seas from space. To date no studies have been done on using CALIPSO to monitor the subsurface optical properties of large, freshwater-lakes. This is likely due to the limited spatial resolution of CALIPSO, which makes the mapping of subsurface properties of regions smaller than large seas impractical. Still, CALIPSO does pass over some of the world’s largest, freshwater-lakes, yielding important information about the water. Here we use the entire CALIPSO data record (approximately 15 years) to measure the particulate backscatter coefficient (bbp, m−1) across Lake Michigan. We then compare the LiDAR derived values of bbp to optical imagery values obtained from MODIS and to in situ measurements. Critically, we find that the LiDAR derived bbp aligns better in non-summer months with in situ values when compared to the optically imagery. However, due to both high cloud coverage and high wind speeds on Lake Michigan, this comes with the caveat that the CALIPSO product is limited in its usability. We close by speculating on the roll that spaceborne LiDAR, including CALIPSO and other satitlites, have on the future of monitoring the Great Lakes and other large bodies of fresh water.

P662 Pre-treatment vitamin D concentrations do not predict therapeutic outcome to anti-TNF therapies in biologic-naïve patients with active luminal Crohn’s disease

Abstract Background Vitamin D has a regulatory role in innate and adaptive immune processes. Previous small studies have reported that low pre-treatment vitamin D concentrations are associated with primary non-response and shorter drug persistence to anti-TNF therapy. We sought to assess whether pre-treatment 25-hydroxyvitamin D concentrations predicted primary non-response and non-remission to infliximab and adalimumab in patients with Crohn’s disease recruited to the PANTS (Personalised Anti-TNF Therapy in Crohn’s disease) study. Methods We used composite endpoints using the Harvey Bradshaw Index (HBI) in adults and the short paediatric Crohn’s disease activity index (sPCDAI) in children, corticosteroid use, and C-reactive protein (CRP) to define primary non-response (Figure 1). Remission was defined as CRP of ≤3 mg/L and HBI of ≤4 points (short paediatric Crohn’s disease activity index ≤15 in children), without corticosteroid therapy or exit for treatment failure. 25-hydroxyvitamin D concentrations were measured in stored baseline serum samples and cut-offs for vitamin D status were: deficiency &amp;lt; 25nmol/L, insufficiency 25-50nmol/L and adequacy/sufficiency &amp;gt; 50nmol/L. Results Samples from 659/898 infliximab (526 Remicade; 133 biosimilar CT-P13) and 448/605 adalimumab (448 Humira) treated patients included in the effectiveness analysis of the PANTS study were included. Overall, 17.1% (189/1107; 95% confidence interval [CI] 15.0 - 19.4%) and 47.7% (528/1107; 95% CI 44.8 - 50.6%) patients had vitamin D deficiency and insufficiency, respectively. At baseline, 22.2% (246/1107) patients were receiving some form of vitamin D supplementation. Multivariable linear regression analysis confirmed that baseline sampling during non-summer months (Figure 2), South Asian ethnicity, lower serum albumin concentrations, higher HBI and nontreatment with vitamin D supplements were independently associated with lower vitamin D concentrations (Figure 3). Primary non-response at week 14 and non-remission at week 54 occurred in 19.3% (116/600; 95% CI 16.4 - 22.7%) and 58.8% (351/597; 95% CI 54.8- 62.7%) patients treated with infliximab and 25.3% (100/396; 95% CI 21.2- 29.8%) and 65.3% (246/377; 95% CI 60.3- 69.9%) of patients treated with adalimumab, respectively. Pre-treatment vitamin D status did not predict response or remission status to anti-TNF therapy at week 14 (infliximab Ppnr = 0.87, adalimumab Ppnr = 0.18) or non-remission at week 54 (infliximab P = 0.12, adalimumab P = 0.59) (Figure 4). Conclusion Vitamin D deficiency is common in patients with active Crohn’s disease. Unlike previous studies, pre-treatment serum 25-hydroxyvitamin D concentration did not predict primary non-response to anti-TNF treatment at week 14 or non-remission at week 54.

Understanding the relationship between weather variables and intake in beef steers.

The relationship between weather variables and dry matter intake (DMI) in beef steers was examined using daily intake data from 790 beef steers collected through a computer-controlled feeding system in nonsummer months. Daily data were condensed into weekly averages (N = 13,895 steer-weeks). The variables considered to predict DMI (2.50 to 23.60 kg/d) were body weight (197 to 796 kg), dietary net energy for maintenance (NEm; 0.79 to 2.97 Mcal/kg), ambient temperature (-23.73 °C to 21.40 °C), range of temperature (2.79 °C to 19.43 °C), dew point (-27.84 °C to 14.34 °C), wind speed (2.08 to 6.49 m/s), solar radiation (30.8 to 297.1 W/m2), and 2-wk lag (average of previous 2 wk's values) and monthly lag (average of previous 4 wk's values) of each weather variable. Toeplitz variance-covariance structure for repeated measures was used to determine the model to predict DMI, while accounting for the effects of body weight, dietary NEm, and other variables in the model. Two-week lag of ambient temperature interacted (P ≤ 0.005) with 2-wk lag of range of temperature, monthly lag of wind speed, 2-wk lag of solar radiation, and dew point to predict DMI. Interactions (P = 0.0001) between 2-wk lag of range of temperature vs. dew point and monthly lag of wind speed vs. 2-wk lag of solar radiation were also detected. This study reports important weather variables associated with differences in DMI of growing and finishing steers and will help improve the accuracy of DMI prediction equations for beef cattle. Improvements in the accuracy of predicting DMI should give producers better tools to plan and execute efficient feeding management programs. The R2 of the overall model was 0.8891.

Contribution of Tibetan Plateau ecosystems to local and remote precipitation through moisture recycling.

The ecosystems of the Tibetan Plateau (TP) provide multiple important ecosystem services that benefit both local populations and those beyond, such as through climate regulation services on precipitation for East Asia and China. However, the precipitation regulation service of the TP ecosystems for supplying moisture and maintaining precipitation is yet to be evaluated. In this study, we used the moisture recycling framework and a moisture tracking model to quantify the precipitation regulation services of TP ecosystems for their contribution to precipitation. We found TP ecosystems contributed substantially to local and downwind precipitation, with a contribution of 221 mm/year for the TP and neighboring areas through evapotranspiration (ET) (104 mm/year through transpiration), declined to <10 mm/year for eastern China and other surrounding countries. Among ecosystem types, grassland contributed most to precipitation, followed by barren and snow lands, forests, and shrublands. In terms of seasonality, precipitation contribution from TP ecosystems was greater in summer months than in non-summer months for western China, while the opposite was true for eastern China-although the magnitude was much smaller. Over the past two decades, the significant ET increases in TP translated to a widespread increase in precipitation contribution for TP and downwind beneficiary regions from 2000 to 2020. Our study provides a quantitative way to understand the precipitation regulation services of TP ecosystems through moisture recycling, substantiating their key role to maintain precipitation and the water cycle for downwind regions-effectively acting as an ecological safeguard that could be perceived by the public.

Energetic Comparison of Vertical Bifacial to Tilted Monofacial Solar

In this article, a vertical bifacial + reflector configuration is presented as a candidate for solar canals and other applications that allow dual use of the land. Modeling with weather data from Merced, CA shows output to be competitive with fixed 20° tilt systems, with south-facing vertical orientation showing 117% and 87% of annual output of south-facing 20° systems with and without a reflector, respectively. Repetition with weather data from Houston, Denver, and Miami produces similar results, with values ranging from 112%–121% and 82%–94%, which serve as conservative estimates due to lack of modeled soiling on tilted systems in the latter comparison. South-facing vertical orientations have better performance in nonsummer months relative to other systems, resulting in a flatter seasonal curve, with useful implications for load balancing and energy storage. East- and west-facing vertical orientations outperform their fixed tilt defaults, even without a reflector, and tolerate higher dc/ac inverter ratios than similar south-facing vertical orientations before appreciable clipping effects are seen.

Seasonal Trends for Environmental Illness Incidence in the U.S. Army.

The incidence of and risk factors for exertional heat illness (EHI) and cold weather injury (CWI) in the U.S. Army have been well documented. The "heat season", when the risk of EHI is highest and application of risk mitigation procedures is mandatory, has been arbitrarily defined as May 1 through September 30, while the "cold season" is understood to occur from October 1 to April 30 each year. The proportions of EHI and CWI that occur outside of the traditional heat and cold seasons are unknown. Additionally, it is unknown if either of the seasonal definitions are appropriate. The primary purpose of this study was to determine the proportion of EHI and of CWI that occur within the commonly accepted seasonal definitions. We also report the location-specific variability, seasonal definitions, and the demographic characteristics of the populations. The U.S. Army installations with the highest frequency of EHI and of CWI from 2008 to 2013 were identified and used for analysis. In total there were 15 installations included in the study, with five installations used for analysis in both the EHI and CWI projects. In- and out-patient EHI and CWI data (ICD-9-CM codes 992.0 to 992.9 and ICD codes 991.0 to 991.9, respectively) were obtained from the Defense Medical Surveillance System. Installation-specific denominator data were obtained from the Defense Manpower Data Center, and incidence rates were calculated by week, for each installation. Segmental (piecewise) regression analysis was used to determine the start and end of the heat and cold seasons. Our analysis indicates that the heat season starts around April 22 and ends around September 9. The cold season starts on October 3 and ends on March 24. The majority (n = 6,445, 82.3%) of EHIs were diagnosed during the "heat season" of May 1 to September 30, while 10.3% occurred before the heat season started (January1 to April 30) and 7.3% occurred after the heat season ended (October 1 to December 31). Similar to EHI, 90.5% of all CWIs occurred within the traditionally defined cold season, while 5.7% occurred before and 3.8% occurred after the cold season. The locations with the greatest EHI frequency were Ft Bragg (n = 2,129), Ft Benning (n = 1,560), and Ft Jackson (n = 1,538). The bases with the largest proportion of CWI in this sample were Ft Bragg (17.8%), Ft Wainwright (17.2%), and Ft Jackson (12.7%). There were considerable inter-installation differences for the start and end dates of the respective seasons. The present study indicates that the traditional heat season definition should be revised to begin ∼3 weeks earlier than the current date of May 1; our data indicate that the current cold season definition is appropriate. Inter-installation variability in the start of the cold season was much larger than that for the heat season. Exertional heat illnesses are a year-round problem, with ∼17% of all cases occurring during non-summer months, when environmental heat strain and vigilance are lower. This suggests that EHI mitigation policies and procedures require greater year-round emphasis, particularly at certain locations.

The climate response to increased cloud liquid water over the Arctic in CESM1: a sensitivity study of Wegener–Bergeron–Findeisen process

The surface radiative imbalance has large impacts on the long-term trends and year-to-year variability of Arctic sea ice. Clouds are believed to be a key factor in regulating this radiative imbalance, whose underlying processes and mechanisms, however, are not well understood. Compared with observations, the Community Earth System Model version 1 (CESM1) is known to underestimate Arctic cloud liquid water. Here, the following hypothesis is proposed and tested: this underestimation is caused by an overactive Wegener–Bergeron–Findeisen (WBF) process in model as too many supercooled liquid droplets are scavenged by ice crystals via deposition. In this study, the efficiency of the WBF process in CESM1 was reduced to investigate the Arctic climate response, and differentiate the responses induced by atmosphere–ocean–sea ice coupling and global warming. By weakening the WBF process, CESM1 simulated liquid cloud fractions increased, especially in winter and spring. The cloud response resulted in increased downwelling longwave flux and decreased shortwave flux at the surface. Arctic clouds and radiation in simulations with reduced WBF efficiency show a better agreement with satellite retrievals. In addition, both coupling and global warming amplify the cloud response to a less efficient WBF process, due to increased relative humidity and enhanced evaporation, respectively. As a response, the sea ice tends to melt over the North Atlantic Ocean, most likely caused by a positive feedback process between clouds, radiation and sea ice during non-summer months. These results improve our understanding of large-scale effects of the WBF process and the role of cloud liquid water in the Arctic climate system.

1428. Lyme Disease Treatment in the United States: Prescribing Patterns from a Nationwide Commercial Insurance Database, 2016-2018

BackgroundLyme disease (LD) is the most common vector-borne disease in the United States and is a significant public health problem. The use of non-standard antibiotic treatment regimens for LD has been associated with adverse effects; however, the overall landscape of treatment has not been described previously. We aimed to describe real-world antibiotic prescribing patterns for LD.MethodsWe performed a retrospective analysis of the MarketScan commercial claims database of outpatient encounters from 2016-2018 in the United States. We identified all individuals with a visit that included an LD diagnosis code and a prescription within 30 days of the visit for one or more of 12 antibiotics that may be prescribed for LD. We then categorized each individual as having received either standard or non-standard treatment during the two-year period. Standard treatment was defined as treatment with a first, second or third-line antibiotic for LD, for no longer than 30 days, and for no more than two episodes during the study period. Descriptive and multivariable analyses were performed to compare characteristics of people who received standard vs non-standard treatment for LD.ResultsA total of 84,769 prescriptions met criteria for inclusion, written for 45,926 unique patients. The mean duration of prescriptions was 21.4 days (SD 10.8). Most individuals (84.5%) treated for LD received standard treatment during the study period. Female gender (OR 1.5, p< 0.0001) and age 19-45 (p=0.0003) were significantly associated with being prescribed non-standard LD treatment. Treatment in low-incidence states (OR 2.2 compared to high-incidence states, p< 0.0001) and during non-summer months (OR 2.2, p< 0.0001) was more likely to be non-standard.Age distribution of patients receiving treatment for Lyme disease, by gender and age at first prescription Seasonality of standard versus non-standard treatment of Lyme disease ConclusionIn this population of employed, young, and insured patients, young and middle-aged women were at the highest risk of receiving non-standard LD treatment. Treatments prescribed in states with low incidence of LD or during non-summer months were also more likely to be non-standard, a trend which likely reflects misdiagnosis or overtreatment of LD. Future studies are needed to further define prescriber and patient factors associated with non-standard LD treatment and related adverse outcomes.Disclosures All Authors: No reported disclosures

Increases in Biogenic Volatile Organic Compound Concentrations Observed after Rains at Six Forest Sites in Non-Summer Periods

Since biogenic volatile organic compounds (BVOCs) are important precursors of ozone, the monitoring of the BVOC concentration distributions is needed. In general, forest BVOC concentrations increase in summer as well as in other seasons. This study aims to detect temporally sporadic increases in BVOC concentrations in the non-summer months and to analyze the occurring climatic conditions. Using a uniform sampling system and shared gas chromatography–mass spectrometry, the concentrations of isoprene and monoterpenes in six Japanese forests were observed approximately once a month for 3 years. Using the observed data, the relations between the BVOC concentration increases and meteorological factors were evaluated. Twenty instances of temporal increases in BVOC concentrations were observed. These mainly occurred in spring for isoprene and in autumn for monoterpenes. Most of the increases in the non-summer months were observed after a rainfall event, when the daily temperature range was large, suggesting that wind, rain, and a rapid diurnal temperature rise could be factors in the non-summer months. Thus, the network monitoring of BVOC concentrations might be effective for understanding the effects of factors other than temperature, and the mechanisms and frequency of the temporal increases, on the BVOC concentrations in various forests.

Pediatric Mental Health Boarding

The growing prevalence of pediatric mental and behavioral health disorders, coupled with scarce psychiatric resources, has resulted in a substantial increase in the number of youth waiting in emergency departments (EDs) and medical units for inpatient psychiatric care. To characterize the prevalence of pediatric mental health boarding and identify associated patient and hospital factors. Medline and PsycINFO. All studies describing frequencies, durations, processes, outcomes, and/or risk factors associated with pediatric mental health boarding in youth ≤21 years of age. Publications meeting inclusion criteria were charted by 2 authors and critically appraised for quality. Eleven studies met inclusion criteria; 10 were retrospective cohort studies and 9 were conducted at single centers. All of the single-center studies were conducted at children's hospitals or pediatric EDs in urban or suburban settings. Study sample sizes ranged from 27 to 44 328. Among youth requiring inpatient psychiatric care, 23% to 58% experienced boarding and 26% to 49% boarded on inpatient medical units. Average boarding durations ranged from 5 to 41 hours in EDs and 2 to 3 days in inpatient units. Risk factors included younger age, suicidal or homicidal ideation, and presentation to a hospital during nonsummer months. Care processes and outcomes were infrequently described. When reported, provision of psychosocial services varied widely. Boarding definitions were heterogeneous, study sample sizes were small, and rural regions and general hospitals were underrepresented. Pediatric mental health boarding is prevalent and understudied. Additional research representing diverse hospital types and geographic regions is needed to inform clinical interventions and health care policy.

The Comprehensive Fire Information Reconciled Emissions (CFIRE) inventory: Wildland fire emissions developed for the 2011 and 2014 U.S. National Emissions Inventory

ABSTRACT Wildland fire emissions from both wildfires and prescribed fires represent a major component of overall U.S. emissions. Obtaining an accurate, time-resolved inventory of these emissions is important for many purposes, including to account for emissions of greenhouse gases and short-lived climate forcers, as well as to model air quality for health, regulatory, and planning purposes. For the U.S. Environmental Protection Agency’s 2011 and 2014 National Emissions Inventories, a new methodology was developed to reconcile the wide range of available fire information sources into a single coherent inventory. The Comprehensive Fire Information Reconciled Emissions (CFIRE) inventory effort utilized satellite fire detections as well as a large number of national, state, tribal, and local databases. The methodology and results for CONUS and Alaska were documented and compared against other fire emissions databases, and the efficacy of the overall effort was evaluated. Results show the overall spatial pattern differences and relative seasonality of wildfires and prescribed fires across the country. Prescribed burn emissions occurred primarily in non-summer months were concentrated in the Southeast, Northwest, and lower Midwest, and were relatively consistent year to year. Wildfire emissions were much more variable but occurred primarily in the summer and fall. Overall, CFIRE represents a third of total emitted PM2.5 across all sources in the National Emissions Inventory, with prescribed fires accounting for nearly half of all CFIRE emissions. Compared with other wildland fire emissions inventories derived solely from satellite detections, the CFIRE inventory shows markedly increased emissions, reflecting the importance of the multiple national and regional databases included in CFIRE in capturing small fires and prescribed fires in particular. Implications: Wildland fire emissions inventories need to incorporate multiple sources of fire information in order to better represent the full range of fire activity, including prescribed burns and smaller fires. For the 2011 and 2014 U.S. National Emissions Inventory, a methodology was developed to collect, associate, and reconcile fire information from satellite data as well as a large number of national, regional, state, local, and tribal fire information databases across the country. The resulting emissions inventory shows the importance of this type of integration and reconciliation when compared against other emissions inventories for the same period.