Geographic variation in risk of blacklegged tick-borne coinfections in the eastern United States.

Ticks and tick-borne diseases pose a significant public health threat in the United States, particularly in the Northeast and Upper Midwest. Tick control operations are predominately focused on private residential properties. Surveys of publicly funded vector control programs have indicated that high use public lands may be viable targets for future tick control activities if funding is available. However, little is known about the feasibility of implementing tick control activities on these properties. We administered a survey to understand current tick control and tick bite prevention educational practices and potential barriers to future tick control on public lands. The survey was distributed to public land managers in Minnesota, New York, Pennsylvania, and Wisconsin and we received 129 responses. The responses indicated that tick control was undertaken on only 10% of the public lands that respondents managed. Landscape management was the most common intervention. Some (40%) of the public land managers indicated interest in using tick control methods in the future, again with landscape management being the preferred intervention. Respondents indicated that there may be significant barriers for the use of acaricides and host-targeted interventions. Currently, tick bite prevention education appears to be the primary protective measure utilized on public land, with 63% of responding land managers offering education to staff or visitors. Our survey indicates that high use public lands may present potential targets for limited tick control operations, but the potential barriers must be addressed and additional evaluation of these interventions on high use public land is required.

Abstract In the U.S. Upper Midwest, early soybean planting is becoming more common, but the implications for soil residual herbicide dissipation and optimal application time remain unclear. Earlier planting extends the interval between soil-residual herbicide application at planting and the onset and peak of weed emergence, potentially reducing efficacy through an extended window for dissipation. This study aimed to evaluate the dissipation and weed control efficacy of soil residual herbicides applied at different timings in early-planted soybean systems under varying soil conditions. At Arlington (silt loam soil), herbicide concentrations at soil sampling, 21 d after the fourth and final application time, which followed a series of treatments from planting to V1, were similar across application times, while at Brooklyn (sandy loam soil), herbicide concentrations were usually higher in later applications. Despite these differences, weed density at POST was similar across application times within each site. However, an additional late POST herbicide application was necessary at Brooklyn following the earliest application times in 2022, indicating more rapid herbicide dissipation. Herbicide dissipation and efficacy varied by soil texture. In sandy soils, early applications may lead to reduced control of late-emerging weeds due to rapid dissipation. In contrast, finer-textured soils may allow for more flexible application timing. These insights support site-specific residual herbicide application strategies in early-planted soybean systems.

BackgroundDetailed studies of foraging behavior are needed for scientific management of the endangered rusty-patched bumblebee (Bombus affinis) in the disjunct and ecologically differentiated habitats it presently occupies. Current knowledge gaps hinder recovery planning but are challenging to redress through direct observation of rare interactions in the field.MethodsWe used genetic metabarcoding to characterize the taxonomic composition of pollen collected by B. affinis workers in the Appalachian mountains of Virginia and West Virginia from 2021–2023. We developed a custom sequence database of the regional flora and compared results for two independent genetic loci, internal transcribed spacer 1 and internal transcribed spacer 2 (ITS1 and ITS2).ResultsWhile ITS2 consistently detected more plant diversity, results from the two loci were broadly concordant with a few notable exceptions. The plant genera Hydrangea, Actaea, Rhododendron, Tilia, and (unexpectedly) Laportea were prominent in midsummer samples, with Rubus a consistent contributor in late spring and early summer. Pea flowers (family Fabaceae) were relatively infrequent but the genera Securigera and Trifolium were detected before the Hydrangea bloom and again in late summer afterwards. The diversity of forage plants was highest in late summer, driven primarily by various genera of Asteraceae. Comparing the current data with previous work indicates regional differentiation in forage plants between Appalachia and the upper Midwest, but also allows ‘consensus’ forage sources that are supported by multiple lines of evidence and shared between regions to be tabulated. These results should help managers focus survey efforts for this endangered species and plan habitat enhancements.

Abstract Background Cardiac implantable electronic device infection (CIEDI) is a serious complication, occurring in approximately 1% of implantations. In addition to antimicrobial therapy, complete device extraction is considered essential for definitive cure. However, this may not always be feasible due to a variety of factors. In select cases, long-term chronic antibiotic suppression (CAS) has been used, yet clinical characteristics and outcomes of patients who received CAS have scarcely been reported. Methods A descriptive study analyzing all adult (age > 18) patients with definite CIEDI who received CAS between 2016 and 2023 across the Mayo Clinic Enterprise (Arizona, Florida, Minnesota, and Upper Midwest) was conducted. Patients with either ventricular assist devices or fungal infection were excluded. Results A total of 321 patients were diagnosed with definite CIEDI during the study period. A total of 37 (8.7%) patients received CAS due to device retention. The median age was 77.5 [IQR 70.5, 87.5] with 32.4% female. Permanent pacemakers were involved in most (64.9%) infections. Approximately one-third (32.4%) of patients had a prosthetic valve. The median time from initial device implantation to CIEDI was 10.6 years [IQR 4.8, 18.1]. CIED-related infective endocarditis was present in 70.3% of cases and 67.6% had lead involvement. The most commonly isolated organisms were Staphylococcus aureus (29.7%), coagulase-negative staphylococci (27%), Enterococcus faecalis (13.5%) and Streptococci (13.5%). Other pathogens or culture-negative cases comprised 16.3%. The primary reason for device retention and CAS was poor surgical candidacy. Doxycycline was the most commonly used agent for CAS, accounting for 37.8% of cases. The average length of suppression was 469.0 days [IQR158.0, 1264.0]. The rate of relapse was 8.1% with all occurring within 90 days of diagnosis. One year mortality was 27.0%. Conclusion CAS may be a feasible option for patients with device retention, although a small proportion experience CIEDI relapse. Unexpectedly, the pathogen distribution among CAS recipients differed from that seen in a general CIED infection population, highlighting selection bias and the distinct clinical characteristics of patients managed with CAS. Disclosures Larry M. Baddour, MD, UpToDate, Inc.: Royalty payments (authorship duties).

BackgroundAccording to CDC, vancomycin should be a key-target for ASP; and high negative-predictive-value of nasal MRSA PCR screening (nMP) for pneumonia has been shown.MethodsInformatics-based ASP interventions were implemented at a tertiary-care-center serving the tristate area in Upper Midwest as current state/ Fishbone analyses showed that vancomycin-use for pneumonia is high and nMP are not being done as not easy to remember/order. SMART aim was to reduce vancomycin-use by 20% for pneumonia by 3/15/25. Automated Default nMP order was incorporated in Pneumonia order-set in EMR (Epic) while ordering vancomycin for Hospital Acquired pneumonia/Ventilator associated pneumonia on 10/7/24 and for Severe Community Acquired pneumonia meeting criteria for vancomycin on 11/4/24.Vancomycin-use during pre-intervention-period(P1: 4/1/24-9/30/24) was compared with intervention-period(P2: 10/15/24-3/15/2025).ResultsOutcome measures (vancomycin duration; cost) showed a significant decline on XmR SPC charts (Figures 1 and 2). Average vancomycin use decreased by 49.5% (from 72.2 DOT/1000 patient days in P1 to 36.3 DOT/1000 patient days in P2, p< 0.01). Average Vancomycin drug inventory cost decreased by 50% (from 1089.5 USD/1000 patient days in P1 to 546.3 USD/1000 patient days in P2; p< 0.05). All Process measures showed a significant, sustained change: proportion of nMP ordering increased to 100% in P2 (p< 0.0001); proportion of negative PCR results leading to discontinuation of vancomycin increased by 84% (p< 0.01) and time to discontinuation of vancomycin declined by >50% (p< 0.05); balancing measures [readmissions and total time from order to PCR results] remained unchanged.ConclusionInformatics-based ASP interventions were highly transformative leading to a significant decline in total vancomycin utilization, considerable healthcare-cost savings and significant increase in nMP screening among patients hospitalized with pneumonia; and should be considered for implementation on a wider scale.DisclosuresAll Authors: No reported disclosures

BackgroundDespite using CDC diagnostic criteria and Antimicrobial stewardship interventions we witnessed an increase in local CDI.MethodsMultifaceted IPC QI-interventions were implemented at our tertiary-care-center ICU Rehabilitation serving tristate-area of upper Midwest: manual-auditing, real-time observations for HCP hand-hygiene compliance; soap/sanitizer usage; education, hand-hygiene reminders in medical staff lounge, patient-rooms, nursing-stations, provider coaching and huddles focusing on nursing education. Pre-intervention-period (P1:4/1/2023- 9/30/2023) was compared with Intervention-period (P2:10/1/2023-3/31/2024). Additionally, *observation of automated hand hygiene system and a pilot Cross-sectional comparison was done for overall hand-hygiene compliance and CDI in our health-system (with manual auditing/monitoring) with a health-system with automated hand-hygiene monitoring [Spaulding Rehabilitation Center (Harvard Medical School, Boston, MA), using automated hand-hygiene system (Biovigil®) with inbuilt signaling/recording if improper hand-hygiene performed] (*supported by CDC PFL IPC Ambassador grant)ResultsHand-hygiene compliance rates for HCP increased from 69% [191/277 (compliant/observations)] during P1 to 91% (463/510) during P2 (P< 0.0001); with physicians increasing from 70% to 89% (p< 0.05); nurses 71% to 93% (p< 0.001); midlevel- providers 69% to 88% (p< 0.05); ancillary-staff 61% to 87% (p< 0.01)]. Hand-soap usage increased from 43% to 74% in P2 (p< 0.05). C. difficile SIR (Standardized Infection Ratio) decreased from 1.6 during P1 to 0.4 during P2 (p< 0.05). Comparatively, Spaulding Rehabilitation Center with automated hand-hygiene system had overall hand-hygiene compliance rates of 97% from 10/1/2023-3/31/24 (compared to 91% in our system) and C. difficile SIR of 0 compared with 0.4 in our system (p< 0.0001).ConclusionWith interventions, we observed improved hand-hygiene compliance and decreased CDI at our institution, however, greater hand- hygiene compliance and lower SIR were noted with an automated system. Next steps would be to continue auditing/interventions and further evaluate applicability of automated-systems including cost-benefit analysisDisclosuresAll Authors: No reported disclosures

BackgroundLyme disease is a tick borne disease transmitted through the bite of infected blacklegged ticks. It can cause a Bull's-eye rash at the site of the bite, fever, headache, fatigue, muscle and joint pain. If left untreated, Lyme disease can lead to severe complications such as arthritis, atrioventricular block, neurological problems, and chronic fatigue. Lyme disease is most common in the northeastern, mid-Atlantic, and upper Midwest regions of the United States. Northeastern Pennsylvania is an endemic area for Lyme diseases.Figure 1peak incidence of Lyme disease is observed in July.Lyme disease occurs throughout the year. The incidence begins to rise in the spring, peaks in July and then decreases in the fall.Figure 2Increased trend of Lyme disease over the yearsWe observed increased trend of Lyme disease in The Wright Center Community Health Clinics from 2016 to 2023.MethodsData was collected from The Wright Center community health clinics from 2015 to 2024. ICD-10 code A69.20 was used to extract cases with diagnosis of Lyme disease. RStudio was applied for data analysis. We modified the CDC Lyme disease prevention poster with a QR code for patient education. The poster was uploaded to the TV screens in the clinics.Figure 3peak distribution of Lyme disease between age 50-60.Incidence of Lyme disease has an age difference with peak distribution between age 50-60 in The Wright Center Community Health Clinics.ResultsSeasonal prevalence of Lyme disease was observed in our study, similar to CDC data. Lyme disease occurs throughout the year. The incidence begins to rise in the spring, peaks in July and then decreases in the fall (Figure 1). We observed an increased trend of Lyme disease over the years in our community (Figure 2). Our data showed the incidence of Lyme disease nearly doubled in 2023 compared with 2016. Incidence of Lyme disease has an age difference with peak distribution between age 50-60 (Figure 3). Peak distribution is different from CDC data which has a bimodal peak distribution in age 5-9 and age 65-69. Lack of the peak distribution in early age is likely due to different patient populations. Majority of the patients in our community health center are above 18 years old, only 20% of the patients are less than 18. Sex difference was also investigated in this study. 55.7% of the cases are female while 44.3% are male. However demographic data showed more female patients than male patients in our clinics. There is no significant sex difference when data is normalized with total female and total male patients respectively.ConclusionLyme disease surveillance is crucial for monitoring disease trends and identifying at-risk populations. Prevention is important to reduce the incidence of Lyme disease and improve community health in endemic areas.DisclosuresAll Authors: No reported disclosures

Analysis of Factors Associated with More Than a Decade of Graft Survival in Kidney Recipients at a Single Center in the Upper Midwest

Listener perceptions of word-final /l/: Effects of listener dialect.

The demographic and geographic representation of participants in myasthenia gravis (MG) trials has yet to be systematically reviewed. The goal of this study was to explore potential disparities in MG interventional clinical trial enrollment. We included completed interventional clinical trials from January 2002 to December 2021 that enrolled participants with MG within the United States and Canada. Twenty-eight trials meeting these criteria were identified at Clinicaltrials.gov, and 16 trials contributed data. Study sponsors provided data for age, sex/gender, race, ethnicity, and state/province of site enrollment. Pooled data showed the following participant ethno-racial composition across trials: White = 79.9%, Black = 11.9%, Asian = 3.3%, Native American = 1.2%, "Other" race = 3.7%; 10.5% of participants identified as Hispanic ethnicity. Male participation was approximately 53%. Average participant age was 55.0 ± 17.0 years. The three highest enrolling US states were Texas, California, and Florida, and the highest enrolling Canadian province was Ontario. There was no enrollment in several Upper Midwest, Northern Rocky Mountain, and Southern US states. Total enrollment among White, Black, and Native American participants was proportional to the US population, whereas Hispanic and Asian participants were under-enrolled. The geographic distribution of enrollment suggests a possible concern that many patients do not have convenient access to trial centers. Strategies are needed to facilitate greater clinical trial participation among underrepresented and underserved communities that will improve generalization of study results to the overall MG population.

Our AIDS Walks Are Only Beginning: A Commentary and Call to Increase HIV Advocacy Efforts in the Rural Upper Midwestern United States From Nurses With Lived Experience.

BackgroundThe COVID-19 pandemic caused substantial mortality in the United States with impacts unevenly distributed across the country. Official COVID-19-related death counts, however, almost certainly underrepresent the true impact of the pandemic due to underreporting, misclassification, and, particularly in the early stages of pandemic, limited testing and diagnosis [1]. Excess death rates, deaths above expected levels based on historical trends, arguably provide a more comprehensive measure of COVID-19 impacts by capturing both direct COVID-19 deaths and indirect fatalities related to pandemic disruptions. The goal of the study is to examine spatial and temporal disparities in COVID-19 excess mortality in 2020–2021 and 2021–2022 across the U.S., distinguishing between quantifiable sociodemographic influences and unmeasurable place-based factors through Multiscale Geographically Weighted Regression (MGWR).MethodsExcess mortalities are examined in 2020–2021 and 2021–2022 to capture temporal and spatial shifts in COVID-19-related excess mortality patterns. MGWR is used to identify localized variations in the determinants of excess death rates using data on socioeconomic conditions, political affiliation, demographic factors, health status, and healthcare access.ResultsWe present the results of calibrating both a global and a local model of excess death rates during two phases of the COVID-19 pandemic. In terms of the global results, in both time periods excess death rates were significantly higher in counties with high percentages of people below the poverty line, Republican-leaning residents, high proportions of elderly population, high levels of deprivation, high unemployment, and relatively high proportions of residents with diabetes. Rates were also significantly higher in counties with relatively high proportions of residents without health insurance, where there were more females than males, and where there were fewer younger adults, although these effects were not as strong as the previous associations. However, these macro-level conditioned associations can hide important local variations in the determinants of severe COVID-19-related health outcomes. Because COVID-19-related excess death rates exhibit strong spatial patterns, any covariate sharing a similar spatial distribution, even if coincidental, might spuriously be reported to have a significant impact on excess dates rates when examined globally. To examine this possibility, a local statistical model is calibrated which suggests some alternative views on the determinants of COVID-19-relates deaths. For instance, although excess death rates were strongly linked to Republican party support across the whole country in the first phase of the pandemic, this relationship was limited to the eastern seaboard and the Deep South in the second phase. There was a significant conditioned relationship between excess deaths and the elderly only across the southern half of the country in both phases of the pandemic. The impacts of being without health insurance were only severe in the western half of the country and only in the first phase of the pandemic. In contrast to the global finding, the positive association with diabetes was only found along the east coast and only in the first phase of the pandemic. In the first phase of the pandemic, excess mortality was only significantly positively associated with the proportion of Hispanics in the Southwest and was insignificant elsewhere, In the second phase of the pandemic, there were no significant positive relationships reported locally but there were significant negative relationships across the upper Midwest, the Northeast, and in Texas. In distinct contrast to the global results, the local conditioned relationship between excess death rates and percentage Black population was significantly positive across the country in both phases of the pandemic. In the first phase of the pandemic, conditioning on all the covariates in the model, excess deaths from COVID-19 were lower than expected in most parts of the country except for a cone-shaped set of states from Nebraska to Texas; in the second phase the unseen benefits of location were only experienced in the upper Midwest. The results support the use of local models to better understand the nature of pandemics and also that COVID-19 impacts arose from a complex interaction between both measurable factors and localized, often unobservable, influences.ConclusionsDisparities in excess deaths during the COVID-19 pandemic reflect a combination of structural vulnerabilities and unmeasured local influences. To effectively reduce mortality gaps and strengthen preparedness for future health crises, public health interventions must be geographically tailored, targeting both region-specific risk factors and the contextual conditions that shape local outcomes.

The impact of heat exposure on patients with end-stage kidney disease (ESKD) is of growing concern in the context of climate change. In this study, we investigated the association of heat exposure with hospitalization and mortality, and how the risk of these adverse health outcomes varied by climate region in the US. We obtained hospitalization and mortality data for patients with ESKD receiving in-center hemodialysis treatment between 2012 and 2018 at Fresenius Kidney Care facilities located within the contiguous US. We used the treatment facility location to assign heat exposure using maximum universal thermal climate index temperature data. We conducted a space-time-stratified case-crossover study using conditional Poisson regression with distributed lag nonlinear models to examine the effects of heat exposure at the 95th percentile of the region-specific temperature distribution for lags of three days. Stratified analyses were run to assess differences in associations across nine climate regions and three latitude bands. The cumulative lag 0-3 risk of hospitalization associated with heat exposure was highest in the West (rate ratio [RR]: 1.099; 95% confidence interval [CI]: 1.041, 1.160), whereas the highest risk of mortality was observed in the Northwest region (RR: 1.097; 95% CI: 1.007, 1.195). We observed significant increases in the risk of hospitalization at the low- and mid-latitude bands and a significant increase in the risk of mortality in the mid-latitude band. We observed spatial heterogeneity across US climate regions. The strongest effects of heat exposure were observed in the Ohio Valley, South, and West regions for hospitalization and the Upper Midwest, Southeast, and Northwest regions for mortality. Findings may be used to inform targeted interventions to patients with ESKD residing in areas with higher risks of adverse health outcomes following heat exposure.

The emergence of tick-borne pathogens depends on ecological opportunity and barriers to persistence within vectors and hosts. Borrelia burgdorferi is firmly entrenched in the mid-Atlantic, whereas Babesia microti and Anaplasma phagocytophilum remain patchily distributed. Five years of integrated surveillance (2020–2024) at three Maryland sites allowed us to track B. microti and A. phagocytophilum establishment by screening questing Ixodes scapularis nymphs, Peromyscus-fed nymphs, and Peromyscus leucopus by qPCR, then contextualizing results with paired county-level human case data. B. burgdorferi was consistently detected in all sites and sample types, with prevalence stable at approximately 5–20% in questing nymphs and exceeding 30% in hosts, confirming long-term enzootic maintenance. By contrast, B. microti and A. phagocytophilum were initially sporadic but increased in prevalence, particularly in rodents and Peromyscus-fed ticks. Over time A. phagocytophilum prevalence significantly increased to above 20% in some Peromyscus-fed nymphal collections despite much lower prevalence in questing ticks, highlighting the early-warning value of bloodmeal-associated surveillance. Coinfections were rare, though enrichment of B. burgdorferi + A. phagocytophilum in Peromyscus-fed ticks suggests possible facilitation during early establishment. These results indicate that B. microti and A. phagocytophilum are actively emerging in Maryland, following their entrenchment in the Northeast and Upper Midwest. Combining surveillance from questing nymphal ticks, Peromyscus-fed nymphal ticks, and P. leucopus reservoir hosts provides a framework for detecting enzootic cycles before they appear in questing populations or human case counts, offering critical early-warning capacity for public health preparedness.

Firms today struggle to recruit and attract talent. One recruitment approach is showing students advertisements to attract them to a profession. We investigated high school and college business student responses to a pair of professional recruiting messages. Professionals from smaller urban and rural markets of the upper Midwest described accounting features they found attractive. Their report generated almost twenty themes. High school students enrolled in business courses in their junior and senior years, along with first- and second-year college students, ranked those themes from most to least desirable. We constructed one recruiting message using the most desirable themes and another using the least desirable. These messages were tested with another group of high school and college students to assess their persuasiveness. The results showed that college students found the messages more persuasive than high school students and that females were slightly more receptive than males. Consequently, college students should be targeted to persuade candidates to pursue careers in accounting.

BackgroundHealthcare disparities often cause rural BIG 1 TBI patients to be transferred to a higher level of care due to a fear of clinical decline.MethodsWe conducted a retrospective cohort study from 2020 to 2022 that compared patients with the principal diagnosis of BIG1 TBI who were transferred from rural critical access facilities in the upper Midwest to a tertiary care center vs those who were admitted directly to the same tertiary care center. The primary outcomes were cost and mortality. Statistical significance in mortality rates and length of stay was determined using Pearson's Chi Squared and Kruskal-Wallis tests, with significance thresholds set at α = 0.05.Results62 BIG1 patients were examined in the study and 18 were excluded. Of the 44 patients studied, there were no deaths in either group, and length of stay was not significant (P = .36). Transferred patients also underwent more head CT scans when compared to directly admitted patients (mean 2.5 vs 2.1, P = .003). For in-network costs, the average cost of transferred patients was $13,956 and the average cost for direct admissions was $9216 (P = .0003). For out-of-network costs, the average cost of transferred patients was $20,041 and the average cost for direct admission was $13,789 (P = .02).ConclusionCompared to patients who are directly admitted, transfer patients have an increased cost of care while having no difference in clinical outcomes. Technological advances in telemedicine and protocolized care may assist with decreasing the cost while increasing efficiency of care for these patients.

Abstract Historically, the Veterans Health Administration (VHA/VA) has provided access to skilled home health (e.g., rehabilitation, nursing) and home health aide services through contract community agencies. In 2022, VA began piloting VA-delivered home health (VA-HH) at 4 sites in the upper Midwest. Program goals were to improve access to care and care coordination. In 2024, we conducted semi-structured interviews with VA-HH nurses (n = 18) and nursing assistant/aides (n = 13) to understand motivations for joining VA-HH, resources needed to address Veterans’ complex care needs, and overall job satisfaction. Most nurses (60%) and aides (85%) joined VA for their VA-HH positions. Motivations included commitment to the philosophy of home health, desire to give back to Veterans, and appreciation for flexibility and autonomy in their roles. Both groups noted the need for clear guidelines and procedures, supplies (e.g., for wound care), and technology (e.g., for in-home charting) to effectively deliver home health to Veterans with complex care needs. Whereas nurses discussed the importance of inter-team collaboration (e.g., with social work, primary care), aides focused more on collaboration within the VA-HH team. Aides described needing strong communication with nurses, plus nurse and management support related to complex care (e.g., dementia, mental health) and safety concerns. Most staff expressed high job satisfaction. Aides, particularly those with prior non-VA experience, noted being valued and included in the overall healthcare team. Moving forward, VA-HH could be expanded to serve more Veterans. Further enhancing inter- and intra-team collaboration, safety protocols, and leadership support could promote ongoing job satisfaction and high-quality care.

Abstract Previous seminal studies on US flood hydroclimatology have recognized large‐scale seasonal precipitation water from the lower atmosphere as a significant factor influencing flood patterns and have identified potential moisture delivery pathways associated with seasonal flooding across the conterminous United States (CONUS). Given the changing climate, however, an update of these studies is warranted, leveraging the more extensive and longer series of data sets currently available on floods and exogenous climate drivers. Using a Lagrangian particle tracking model (HYSPLIT), this study explores the large‐scale moisture delivery pathways associated with monthly floods during the winter season across the CONUS. The contributions of various moisture sources (i.e., land, extratropical Pacific, tropical Pacific, extratropical Atlantic, tropical Atlantic, and Arctic) to winter floods are summarized for each hydrologic region (HUC02) based on the moisture delivery pathways identified by the HYSPLIT model. Our results show that major oceanic sources are the primary contributors to winter floods in coastal regions, whereas land remains a significant source for hydrologic regions over the Midwest. Humidity profiles along the trajectories further indicate that air masses from the Pacific lose substantial moisture when crossing western mountain ranges and subsequently gain over east of the Rockies, making land a key contributor to floods over the upper Midwest. We also find substantial variability in moisture source contributions depending on flood severity in specific regions. In addition, the circulation patterns associated with extreme flood trajectories reveal consistent large‐scale features, typically involving a deep low‐pressure system delivering moisture to hydrologic regions.

West Nile virus (WNV) is a mosquito-borne flavivirus endemic to the United States. Several regions, including parts of the Midwest, experience sustained WNV transmission with annual local and regional outbreaks. In the upper Midwest, Culex pipiens Linnaeus and Culex restuans Theobold, play key roles in WNV circulation, with Cx. pipiens considered the primary epidemic vector responsible for human cases and Cx. restuans linked to early-season enzootic amplification. These species share ecological niches, have similar host preferences, and are morphologically difficult to distinguish. Both are implicated in WNV transmission, but species-level differentiation is not routinely prioritized for many surveillance and control programs due to logistical challenges and limited evidence to support the effort. This narrative review investigates the role of Cx. restuans in WNV transmission in the upper Midwest, focusing on distribution, morphology, vector competence, population dynamics, and vector control. We synthesize current evidence and identify knowledge gaps that may inform vector surveillance practices and contribute to more targeted WNV control strategies.