West US Research Articles

Ecohydrological Variables Underlie Local Moisture Recycling in Mediterranean‐Type Climates

AbstractMediterranean areas are projected to face increased water scarcity due to global changes. Because a relatively large fraction of the precipitation in Mediterranean areas originates locally, changes at the land surface may further dampen local precipitation. Here, we study the contribution of evaporation to local precipitation for the first time on a scale of approximately 50 km using local evaporation recycling (ELMR) and local precipitation recycling (PLMR), and make a comparison among five Mediterranean climate regions: South West Australia, South West US, central Chile, the Mediterranean Basin, and the Cape region of South Africa. Specifically, this study aims to understand the effects of ecohydrological (dependent on vegetation or the hydrological cycle) and non‐ecohydrological variables on ELMR and PLMR. We find that (a) on average, ecohydrological variables correlate more frequently and more strongly to ELMR and PLMR than non‐ecohydrological variables; (b) ELMR is large over wet areas and PLMR is large over dry areas; and (c) there are differences in underlying factors of ELMR and PLMR among the regions due to differences in wetness, topography, and land cover. The results suggest that in Mediterranean regions, changes in vegetation cover or the hydrological cycle may strengthen the local water cycle through enhancing ELMR. Finally, ELMR and PLMR help to identify where in Mediterranean regions we might enhance the local water cycle through land cover changes.

How story problems strengthen arithmetic problem-solving strategy sophistication: Evidence from a learning trajectory teaching experiment in kindergarten

BackgroundThe sophistication of young children's arithmetic problem-solving strategies can be influenced through experience and instructional intervention. One potential pathway is through encountering story problems where the location of the unknown quantity varies. AimsThe goal of the present study is to characterize how arithmetic problem-solving strategy sophistication can evolve through opportunities to solve story problems. SampleWe used microgenetic principles to guide the coding of arithmetic problem-solving behavior (8843 attempts) across three timescales (time within-session, attempt to solve, and between sessions) for nine story problem structures (N = 40, 19 girls). Data come from a teaching experiment conducted in a Mountain West US state in Spring 2018. MethodsWe employed a Bayesian hierarchical ordinal regression with a nine-level response variable. The model contained fixed effects for session, attempt, story problem structure; a smooth time within session effect; and random effects for student, instructor, and equation. ResultsOur analysis indicates which transitions from less to more sophisticated strategies are better supported by additional attempts to solve the same problem vs. additional instructional sessions. Strategy sophistication also varied by the location of the unknown quantity (result unknown, find difference, start unknown), but not operation (join, separate, part-whole). ConclusionsIf confirmed by other studies, including experiments, what teachers offer children in terms of learning opportunities (more attempts within the same problem or more problems across work sessions) should vary based on the transition they are making.

Oral Anticoagulant (OAC) Use Among Medicare Patients Newly Diagnosed with Venous Thromboembolism (VTE): Factors Associated with Treatment Status

Introduction Clinical guidelines recommend initial treatment with OACs, such as direct-acting oral anticoagulants (DOACs; apixaban, dabigatran, edoxaban, rivaroxaban) or warfarin, for at least 3 months after an initial venous thromboembolism (VTE) event. Early OAC use is associated with improved clinical outcomes and helps prevent VTE recurrence. Purpose To estimate the proportion of Medicare beneficiaries newly diagnosed with VTE with and without OAC treatment within the month from first VTE and identify factors associated with being untreated in that period. Additionally, to identify factors associated with treatment with DOACs or warfarin among OAC-treated patients. Methods Data from 1/1/2014-12/31/2019 of Medicare beneficiaries aged ≥65 years with a new diagnosis of VTE in the inpatient or ambulatory (including emergency room [ER]) setting from 1/1/2015 to 12/31/2019 were included. Additional eligibility criteria included continuous Medicare Parts A, B and D enrollment ≥12 months before and ≥30 days after first VTE diagnosis (index VTE), no diagnosis for atrial fibrillation, inferior vena cava filter, pregnancy or cancer, and no OAC treatment prior to index VTE. VTE patients with ≥1 outpatient pharmacy claims for a DOAC or warfarin within 30 days from index VTE were considered OAC-treated; otherwise, they were classified as untreated. Patients in the OAC-treated cohort were further classified into the DOAC or warfarin subgroups based on the first OAC treatment observed from index VTE (index OAC). Factors associated with being untreated with OACs (vs. treated) and with receiving treatment with DOACs (vs. warfarin) were assessed using multivariable logistic regressions. Results A total of 169,928 patients (49.7% OAC-treated; 50.3% untreated) were identified. In the OAC-treated cohort, 62,528 (74.0%) had DOACs (mainly apixaban [51.9%] and rivaroxaban [46.9%]), and 29,324 (26.0%) warfarin as index OAC. Within the OAC-treated and untreated cohorts respectively, mean age was 76.2 and 77.3 years, 62.9% and 66.4% were female, 82.6% and 75.4% were Non-Hispanic White, mean CCI score was 2.0 and 3.0, 51.8% and 70.3% had DVT only, and 48.2% and 29.7% had PE. Factors associated with being untreated with OACs (odds ratio; 95% confidence interval) included Hispanic ethnicity (vs. White) (1.35; 1.29-1.42), congestive heart failure (1.44; 1.39-1.48), cerebrovascular disease (1.36; 1.32-1.39), anemia (1.25; 1.22-1.28), and peripheral vascular disease (1.22; 1.19-1.25). Having part D low-income subsidy was also associated with being untreated with OACs (1.14; 1.07, 1.20). Index VTE diagnosis setting being ER (vs. outpatient) (0.38; 0.36-0.39) and pulmonary embolism (vs. DVT) (0.45; 0.44-0.46) were associated with increased odds of being treated with OAC, as was being diagnosed by a radiologist (0.62; 0.60-0.64), emergency medicine physician (0.52; 0.49-0.56) or hematologist (0.56; 0.50-0.63) (vs. primary care) ( Figure 1). Among the OAC-treated cohort, factors associated with being treated with DOACs vs. warfarin included diagnosis in more recent years, VTE in ER setting (1.22; 1.15-1.30). VTE in inpatient setting (0.74; 0.70-0.78) and renal disease (0.73; 0.70-0.76) were associated with increased odds of being treated with warfarin, as were Northeast (0.79; 0.76-0.83), Midwest (0.52; 0.50-0.54), and West US census regions (0.56; 0.53-0.59), respectively ( Figure 2). Conclusions In this study of Medicare patients, nearly half of the patients with ICD codes for VTE were not treated with OAC in the first month from initial diagnosis. Among OAC-treated patients, a higher proportion of patients were treated with DOAC vs. warfarin, consistent with more recent guideline recommendation. Factors associated with being untreated might reflect challenges associated with VTE management among disadvantaged populations and in the presence of certain comorbidities.

A Large National Study on Racial Disparities among Asian American, Native Hawaiian, and Other Pacific Islander Cancer Patients Who Refuse Radiation Therapy and Surgery

Asian Americans (AAs) are the only race for whom cancer is the leading cause of death in the US. Despite radiation therapy (RT) and surgery being curative treatments, prior work demonstrated AAs refuse RT/surgery at a higher rate than other races. Given AAs are often aggregated with Native Hawaiians and other Pacific Islanders (NHPIs), rates of RT/surgery refusal within this community are poorly understood. We aimed to 1) assess RT/surgery refusal on overall survival (OS) using propensity-score (PS) matched groups, 2) identify AA and NHPI populations that refuse RT/surgery and 3) determine predictors of refusing RT/surgery. A US hospital-based retrospective cohort study of the National Cancer Database was conducted. Patients included were ≥18 years old, AA by ethnogeographic region (South AA, East AA, and Southeast AA) or NHPI race, with a confirmed diagnosis of 1 of the 10 most common US cancers during 2004-2017 who were recommended for RT/surgery. Cox proportional hazard models with adjusted Hazard Ratios (aHR) assessed propensity-score matched groups (1:10) based on age, race, cancer stage, comorbidity index, rurality, facility type, facility location, and year of diagnosis. Adjusted odds ratios (aOR) were calculated and 95% confidence intervals (95% CI) for treatment refusal using logistic regression. Population heterogeneity for treatment refusal by race was assessed with likelihood ratio tests (p-heterogeneity). The cohort of 147,685 patients who met the inclusion criteria were predominantly East AA (43%), diagnosed with breast cancer (42%), and had a <2 comorbidity index (99%). Median age was 61 years. Median follow-up was 58 months. Overall, 2,888 (5%) patients refused RT, and 1,073 (1%) refused surgery. RT refusal by race was 5.7% (East AA), 7.9% (NHPI), 4.6% (South AA), and 4.6% (Southeast AA). Surgery refusal rates were 1.5% (East AA), 1.9% (NHPI), 1.1% (South AA) and 1.2% (Southeast AA). RT refusal significantly predicted poorer OS (aHR = 1.15, 95% CI = 1.06-1.25) whereas surgery refusal did not. Compared to East AA, NHPIs had a higher risk of RT refusal (aOR = 1.44, 95% CI = 1.27-1.62), whereas South AA (aOR = 0.85, 95% CI = 0.75-0.95) and Southeast AA (aOR = 0.82, 95% CI = 0.75-0.90) had a significantly lower risk (p-heterogeneity<.0001). Predictors of RT refusal were older patient age, high comorbidity index, oral cavity cancer, urban-rural residence, Midwest or West US region, and diagnosis 2011-2017. Among AA and NHPI patients with cancers in the US, RT refusal predicted poorer OS. NHPI had the highest risk of RT refusal. Given AA and NHPI are not monolithic groups, data disaggregation is necessary to understand racial/ethnic disparities for treatment refusal. Sociocultural and historical contexts of AA and NHPI populations on treatment refusal are necessary to improve cancer outcomes among these populations.

Associations of Cost Sharing With Rheumatoid Arthritis Disease Burden.

To evaluate the regional variation of cost sharing and associations with rheumatoid arthritis (RA) disease burden in the US. Patients with RA from rheumatology practices in Northeast, South, and West US regions were evaluated. Sociodemographics, RA disease status, and comorbidities were collected, and Rheumatic Disease Comorbidity Index (RDCI) score was calculated. Primary insurance types and copay for office visits (OVs) and medications were documented. Univariable pairwise differences between regions were conducted, and multivariable regression models were estimated to evaluate associations of RDCI with insurance, geographical region, and race. In a cohort of 402 predominantly female, White patients with RA, most received government versus private sponsored primary insurance (40% vs. 27.9%). Disease activity and RDCI were highest for patients in the South region, where copays for OVs were more frequently more than $25. Copays for OVs and medications were less than $10 in 45% and 31.8% of observations, respectively, and more prevalent in the Northeast and West patient subsets than in the South subset. Overall, RDCI score was significantly higher for OV copays less than $10 as well as for medication copays less than $25, both independent of region or race. Additionally, RDCI was significantly lower for privately insured than Medicare individuals (RDCI -0.78, 95% CI [-0.41 to -1.15], P < 0.001) and Medicaid (RDCI -0.83, 95% CI [-0.13 to -1.54], P = 0.020), independent of region and race. Cost sharing may not facilitate optimum care for patients with RA, especially in the Southern regions. More support may be required of government insurance plans to accommodate patients with RA with a high disease burden.

Climate-driven trends in agricultural water requirement: an ERA5-based assessment at daily scale over 50 years

The impact of climate variability on the water requirements of crops is a key issue in a globalized world with unprecedented population and unevenly distributed water resources. Changes of hydro-climatic forcings may have significant impacts on water resources use, considering the possible effects on irrigation requirements and crop water stress. In this work, a comprehensive estimation of crop water requirements over the 1970–2019 period is presented, considering 26 main agricultural products over a 5 arcmin resolution global grid. The assessment is based on a daily-scale hydrological model considering rainfed and irrigated scenarios, driven by hydro-climatic forcings derived from ERA5, the most recent climate reanalysis product within the Climate Change Service of the Copernicus Programme. Results show the heterogeneous impact of climate variability on harvested areas of the world, quantified by water stressed days and irrigation requirement rates. Increases of irrigation requirement rates were found on more than 60% of irrigated lands, especially in regions like South Europe, North-East China, West US, Brazil and Australia, where the mean rate increased more than 100 mm yr−1 from 1970s to 2010s. The daily analysis of water requirements shows that crops require significantly more days of irrigation per season, especially in Europe, Africa and South-East Asia. Statistically significant trends of water stress duration were found over 38% of rainfed croplands, while only 6% of croplands has been affected by negative trends and shorter stress duration, mainly in India, Malaysia, North Europe and coastal regions of central western Africa.

Identifying predictors of opioid use among older United States' adults with pain.

To identify the strongest predictors of opioid use among older United States' (US) adults (≥50 years) with pain. Cross-sectional retrospective database design. 2017 Medical Expenditure Panel Survey data. Civilian, noninstitutionalized sample of US adults aged ≥50 years alive for the calendar year with pain in the past 4 weeks. Hierarchical logistic regression models assessed significant predictors of opioid use, which included: predisposing, enabling, need, personal health practices, and external environmental factors. Opioid use status (opioid user vs. nonopioid user). Among 51,372,861 civilian, noninstitutionalized US adults alive aged ≥50 years with pain in 2017, the opioid use prevalence was 27.4 percent (95 percent confidence interval = 25.8-29.0). Predictors of opioid use included: white versus other race (adjusted odds ratio, AOR = 1.430), Hispanic versus non-Hispanic ethnicity (AOR = 0.648), up to high school versus higher than high school education (AOR = 1.259), functional limitation versus no limitation (AOR = 1.580), lit-tle/moderate versus quite a bit/extreme pain (AOR = 0.422), good versus fair/poor perceived mental health status (AOR = 1.429), smokers versus nonsmokers (AOR = 1.523), and residing in the northeast versus west US (AOR = 0.646). This study of 51 million older US adults with pain indicated that several factors including race, ethnicity, education, functional limitations, pain severity, mental health status, smoking status, and region of the country were pre-dictors of opioid use. Future research is needed in additional clinical populations and to investigate where these findings diverge from previous studies.

Psychedelic Mushrooms in the USA: Knowledge, Patterns of Use, and Association With Health Outcomes.

Introduction: Popular media coverage of psychedelics use, growing research into this class of compounds for psychiatry and decriminalization initiatives, are transforming the public perception of psychedelics. However, little is known about levels of knowledge and psychedelic mushroom (PM) use among American adults.Methods: We examined PM use and various measures of health status, quality of life, and self-reported mental health outcome measures obtained through a national on-line, cross-sectional survey of adults with a demographic composition representative of the US adult population by region, gender, age, and race (weighted N = 251,297,495) from November 2020–March 2021.Results: General mental health and well-being were popular reasons for PM use (63.6%), although use for medically-diagnosed (31.8%) and self-diagnosed (19.0%) conditions was also common. PM users reported more depression and anxiety as reflected in higher GAD-7 and PHQ-9 scores. Factors predictive of PM use included being male [OR 1.54 95%CI 1.09–2.15] and having higher Charlson Comorbidity Index scores [OR 1.42; 95%CI 1.22–1.65]. Self-reported PM use was less likely among participants with health insurance [OR = 0.50 (0.35–0.72)], increased age [OR = 0.92 (0.90–0.93)] and, relative to those living in the west US census region, living in the northeast [OR = 0.27 (0.15–0.50)], midwest [OR = 0.34 (0.20–0.56)], and south [OR = 0.38 (0.26–0.55)].Discussion and Conclusions: A significant number of Americans are already “self-medicating” with PM and as growing positive media coverage of psychedelics drives public interest in the health benefits of PM, this number will increase. The association between PM use and poor mental health requires further research to inform policy.

Species mixture effects and climate influence growth, recruitment and mortality in Interior West USA Populus tremuloides‐conifer communities

Abstract Tree‐species mixture effects (e.g. complementarity and facilitation) have been found to increase individual‐tree productivity, lessen mortality and improve recruitment in forests worldwide. By promoting more efficient and complete resource use, mixture effects may also lessen individual‐tree‐level water stress, thus improving drought resistance. We investigated the influence of mixture effects on tree productivity, mortality and recruitment across broad compositional and moisture gradients in high‐elevation Interior West US mixed‐conifer communities, where Populus tremuloides (trembling aspen) is the major contributor to functional diversity. Our goal was to provide a more complete scientific foundation for managing these drought‐prone, fire‐excluded systems under an uncertain climate. We used landscape‐scale national forest inventory data to examine mixture effects on P. tremuloides and the major associated conifer species, Pseudotsuga menziesii, Pinus contorta, Abies lasiocarpa and Picea engelmannii. Using generalized linear mixed modelling, we isolated the influences of P. tremuloides relative density and climate on tree‐level (stems ≥ 12.7 cm DBH) growth, mortality and stand‐level recruitment (presence/absence of new trees). Cold‐season precipitation (PPT) and warm‐season vapour pressure deficit (VPD) served to represent soil moisture supply and demand, respectively. Populus tremuloides growth declined as interspecific density increased. In contrast, Pinus contorta and A. lasiocarpa growth increased with P. tremuloides density. For all species except A. lasiocarpa and P. menziesii, growth increased under higher PPT and VPD. Populus tremuloides mortality increased under high VPD but not with interspecific relative density. We found limited evidence that A. lasiocarpa mortality decreased as P. tremuloides density increased. Populus tremuloides recruitment declined steeply above 25% interspecific relative density. We found a decline in conifer recruitment odds as P. tremuloides density increased, ranging from strong in P. contorta to insubstantial in P. engelmannii. Synthesis. Our findings have implications for sustaining mixed‐conifer communities impacted by climate change and historical fire exclusion. Mixtures of P. tremuloides and conifers may improve conifer growth while adversely impacting P. tremuloides growth relative to pure stands. Higher conifer productivity combined with lower P. tremuloides recruitment at high conifer relative density may accelerate succession.

Trends in Incidence of Nicotine Use Disorder Among Adolescents in the Pediatric Hospital, 2012-2019.

To assess trends in the incidence of nicotine use disorder (NUD) and describe associated factors among adolescents in the pediatric emergency department (ED) and inpatient settings. We conducted a retrospective cohort study of all adolescents (11-18 years) with a hospital encounter (inpatient, observation, or ED) in the Pediatric Health Information System between January 1, 2012, and September 30, 2019. After excluding adolescents with a previous International Classification of Diseases, Ninth Revision, and International Classification of Diseases, Tenth Revision, NUD diagnosis in the past 2 years, adolescents with new NUD diagnosis (ie, NUD incidence) were identified. A multivariable generalized liner mixed model was used to assess adjusted NUD incidence and investigate the relationship of NUD with patient characteristics and any interactions between characteristics and time. Spearman's correlation coefficient was used to assess the correlation between NUD incidence and e-cigarette use reported among youth. Of 3 963 754 adolescents, 15 376 (0.4%) had a new diagnosis of NUD. Between 2012 and 2019, NUD incidence increased from 0.3% to 0.4% (P < .001). Findings from the time interaction effect analysis revealed increasing NUD incidence among certain subpopulations, including boys, those with a commercial or other insurance type, adolescents seen in the ED, those from the lowest and highest median household income quartile, and those in the South and West US Census regions. The correlation between NUD incidence and e-cigarette use among high school students was ρ = 0.884 (P = .006). The incidence of NUD among adolescents is increasing. Efforts to increase the screening and treatment of NUD among adolescents in the hospital, particularly among the at-risk populations identified, are needed.

Variation in Treatment Practices for Subclinical Hypothyroidism in Pregnancy: US National Assessment.

Although thyroid hormone replacement may improve outcomes in pregnant women with subclinical hypothyroidism (SCH), the extent to which they receive treatment is unknown. To describe levothyroxine (LT4) treatment practices for pregnant women with SCH. Retrospective cohort study. Large US administrative claims database. Pregnant women with SCH defined by untreated TSH 2.5 to 10 mIU/L. Initiation of LT4 as a function of treating clinician specialty (endocrinology, obstetrics/gynecology, primary care, or other), baseline TSH, patient clinical and demographic factors, and US region. We identified 7990 pregnant women with SCH; only 1214 (15.2%) received LT4. Treatment was more likely in patients with higher TSH, obesity, recurrent pregnancy loss, thyroid disease, and cared for by endocrinologists. Proportion of treated women increased over time; LT4 treatment was twice as likely in 2014 as in 2010. Women in Northeast and West US were more likely to receive LT4 compared with other regions. Asian women were more likely, whereas Hispanic women were less likely, to receive LT4 compared with white women. Endocrinologists started LT4 at lower TSH thresholds than other specialties, and treated women who were more likely to have had recurrent pregnancy loss and thyroid disease than women treated by other clinicians. We found large variation in the prescription of LT4 to pregnant women with SCH, although most treatment-eligible women remained untreated. Therapy initiation is associated with geographic, clinician, and patient characteristics. This evidence can inform quality improvement efforts to optimize care for pregnant women with SCH.

First-order estimates of the costs, input-output energy analysis, and energy returns on investment of conventional and emerging biofuels feedstocks

Here we report on a static, algebraic, spreadsheet-implemented modeling approach to estimate the costs, energy inputs and outputs, and global warming potential of biomass feedstocks. Inputs to the model included literature sourced data for: environmental factors, crop physiological-parameters such as radiation use efficiency and water use efficiency, and crop cost components. Using an energy-input-output life-cycle-assessment approach, we calculated the energy associated with each cost component, allowing an estimate of the total energy required to produce the crop and fuel alongside the energy return on investment. We did this for crop scenarios in the upper Midwest US and Far West US (for algae). Our results suggested that algae are capable of the highest areal biomass production rates of 120 MG/(ha·a), ten times greater than Maize. Algal fuel systems had the highest costs, ranging from 28 to 65 US $/GJ, compared to 17 US $/GJ for Maize ethanol. Algal fuel systems had the lowest energy returns on investment, nearly 0, compared to 25 for Switchgrass to ethanol. The carbon equivalent emissions associated with the production schemes predictions ranged from 40 (Maize) to 180 (algae PBR) CO2eq/GJnet. The promise of low cost fuel and carbon neutrality from algae is demonstrated here to be extremely challenging for fundamental reasons related to the capital-intensive nature of the cultivation system.

Fishing and temperature effects on the size structure of exploited fish stocks

Size structure of fish stock plays an important role in maintaining sustainability of the population. Size distribution of an exploited stock is predicted to shift toward small individuals caused by size-selective fishing and/or warming; however, their relative contribution remains relatively unexplored. In addition, existing analyses on size structure have focused on univariate size-based indicators (SBIs), such as mean length, evenness of size classes, or the upper 95-percentile of the length frequency distribution; these approaches may not capture full information of size structure. To bridge the gap, we used the variation partitioning approach to examine how the size structure (composition of size classes) responded to fishing, warming and the interaction. We analyzed 28 exploited stocks in the West US, Alaska and North Sea. Our result shows fishing has the most prominent effect on the size structure of the exploited stocks. In addition, the fish stocks experienced higher variability in fishing is more responsive to the temperature effect in their size structure, suggesting that fishing may elevate the sensitivity of exploited stocks in responding to environmental effects. The variation partitioning approach provides complementary information to univariate SBIs in analyzing size structure.

Multi-scale enhancement of climate prediction over land by increasing the model sensitivity to vegetation variability in EC-Earth

The EC-Earth earth system model has been recently developed to include the dynamics of vegetation. In its original formulation, vegetation variability is simply operated by the Leaf Area Index (LAI), which affects climate basically by changing the vegetation physiological resistance to evapotranspiration. This coupling has been found to have only a weak effect on the surface climate modeled by EC-Earth. In reality, the effective sub-grid vegetation fractional coverage will vary seasonally and at interannual time-scales in response to leaf-canopy growth, phenology and senescence. Therefore it affects biophysical parameters such as the albedo, surface roughness and soil field capacity. To adequately represent this effect in EC-Earth, we included an exponential dependence of the vegetation cover on the LAI. By comparing two sets of simulations performed with and without the new variable fractional-coverage parameterization, spanning from centennial (twentieth century) simulations and retrospective predictions to the decadal (5-years), seasonal and weather time-scales, we show for the first time a significant multi-scale enhancement of vegetation impacts in climate simulation and prediction over land. Particularly large effects at multiple time scales are shown over boreal winter middle-to-high latitudes over Canada, West US, Eastern Europe, Russia and eastern Siberia due to the implemented time-varying shadowing effect by tree-vegetation on snow surfaces. Over Northern Hemisphere boreal forest regions the improved representation of vegetation cover tends to correct the winter warm biases, improves the climate change sensitivity, the decadal potential predictability as well as the skill of forecasts at seasonal and weather time-scales. Significant improvements of the prediction of 2 m temperature and rainfall are also shown over transitional land surface hot spots. Both the potential predictability at decadal time-scale and seasonal-forecasts skill are enhanced over Sahel, North American Great Plains, Nordeste Brazil and South East Asia, mainly related to improved performance in the surface evapotranspiration.

Outpatient Antibiotic Prescribing Practices for Uncomplicated Urinary Tract Infection in Women in the United States, 2002-2011.

Background. Urinary tract infection (UTI) is one of the most common diagnoses leading to an antibiotic prescription for women seeking ambulatory care. Understanding current national outpatient antibiotic prescribing practices will help ongoing stewardship efforts to optimize antibiotic use; however, information on recent national outpatient antibiotic prescribing trends for UTI is limited. Methods. We analyzed the National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Survey datasets from 2002 to 2011. Outpatient visits of women aged ≥18 years with a diagnosis of uncomplicated UTI were included for analysis. We conducted weighted descriptive analyses, examined time trends in antibiotic prescribing, and used multivariable logistic regression to identify patient and provider factors associated with fluoroquinolone prescribing. Results. A total of 7111 visits were identified. Eighty percent of visits resulted in an antibiotic prescription; fluoroquinolones were the most frequently prescribed antibiotics throughout the study period (49% overall). Older patients (adjusted odds ratio [AOR] for adults aged ≥70 years = 2.5; 95% confidence interval [CI], 1.6-3.8) and patients treated by internists (AOR = 2.0; 95% CI, 1.1-3.3) were more likely than younger patients and those treated by family practitioners to receive fluoroquinolones. Outpatient visits in the West US Census region were less likely to be associated with fluoroquinolone prescribing (AOR = 0.6; 95% CI, .4-1.0) compared with visits in the Northeast. Conclusions. Fluoroquinolones were the most frequently selected antibiotic treatment for uncomplicated UTI in women during the study period. Outpatient antibiotic stewardship initiatives should include efforts to reduce overuse of fluoroquinolones for uncomplicated UTI.

Cost analysis for high-volume and long-haul transportation of densified biomass feedstock

Using densified biomass to produce biofuels has the potential to reduce the cost of delivering biomass to biorefineries. Densified biomass has physical properties similar to grain, and therefore, the transportation system in support of delivering densified biomass to a biorenery is expected to emulate the current grain transportation system. By analyzing transportation costs for products like grain and woodchips, this paper identifies the main factors that impact the delivery cost of densified biomass and quantifies those factors’ impact on transportation costs. This paper provides a transportation-cost analysis which will aid the design and management of biofuel supply chains. This evaluation is very important because the expensive logistics and transportation costs are one of the major barriers slowing development in this industry.Regression analysis indicates that transportation costs for densified biomass will be impacted by transportation distance, volume shipped, transportation mode used, and shipment destination, just to name a few. Since biomass production is concentrated in the Midwestern United States, a biorefinery’s shipments will probably come from that region. For shipments from the Midwest to the Southeast US, barge transportation, if available, is the least expensive transportation mode. If barge is not available, then unit trains are the least expensive mode for distances longer than 161km (100miles). For shipments from the Midwest to the West US, unit trains are the least expensive transportation mode for distances over 338km (210miles). For shorter distances, truck is the least expensive transportation mode for densified biomass.

The influence of the inter-decadal Pacific oscillation on US precipitation during 1923–2010

Precipitation over the contiguous United States exhibits large multi-decadal oscillations since the early twentieth century, and they often lead to dry (e.g., 1946–1976 and 1999-present) and wet (e.g., 1977–1998) periods and apparent precipitation trends (e.g., from the 1950s to 1990s) over most of the western and central US. The exact cause of these inter-decadal variations is not fully understood. Using observational and reanalysis data and model simulations, this paper examines the influence of the Inter-decadal Pacific Oscillation (IPO) on US precipitation. The IPO is a leading mode of sea surface temperatures (SSTs) seen mostly in the Pacific Ocean. It is found that decadal precipitation variations over much of the West and Central US, especially the Southwest, closely follow the evolution of the IPO (r = 0.85 during 1923–2010 for the Southwest US), and the dry and wet periods are associated, respectively, with the cold and warm phases of the IPO. In particular, the apparent upward trend from the 1950s–1990s and the dry decade thereafter in precipitation over much of the West and Central US are largely caused by the IPO cycles, which switched to a warm phase around 1977 and back to a cold phase around 1999. An atmospheric model forced with observed SSTs reproduces much of this association of US precipitation with the IPO (r = 0.95 between smoothed observed and simulated Southwest US precipitation during 1950–2009 and r = 0.88 between the simulated Southwest US precipitation and the IPO). Atmospheric reanalysis and model data both show a strong high (low) pressure center and anti-cyclonic (cyclonic) anomaly circulation over the North Pacific in the lower troposphere during cold (warm) phases of the IPO, which lead to dry and cold northwesterly and northerly winds and below-normal precipitation over much of the West US during IPO cold periods. The IPO induced changes are most pronounced during the boreal cold season. The results reinforce the notion that tropical Pacific SSTs (and the accompanying SST anomalies in the North Pacific) have large impacts on US precipitation and highlight the need to understand and simulate the IPO for decadal prediction of US precipitation.

Patterns of chemotherapy (CT) use in a U.S.-wide population-based cohort of patients (pts) with metastatic colorectal cancer (mCRC).

3537 Background: Few population studies have examined treatment regimens and duration in mCRC since the introduction of biologic therapies in 2004. Methods: We assessed 4,877 consecutive mCRC pts who received CT between Jan 2004 and Mar 2011 at academic, private, and community hospital-based practices participating in a US-wide CT order entry (COE) system that captures patient demographics, stage and treatment data. Multivariate analyses of prospectively recorded patient and provider characteristics identified significant predictors of specific therapeutic approaches. Results: Among all pts, median age was 64; 55% male; (ECOG PS 0/1/2+) (56%/33%/11%). In first-line CT, 17% of pts received fluoropyrimidine (FU) only, while 16% received FU and irinotecan and 65% received FU and oxaliplatin. Older pts, those with poorer ECOG PS, and those treated in private practices were significantly more likely to receive FU only (all p ≤0.05). 53% of all pts received treatment in line 2, 28% in line 3, and 13% in line 4. Mean duration of treatment was 170 days (line 1), 139 (line 2), 135 (line 3) and 126 (line 4). Bevacizumab (bev) was administered to 65% of pts at some point in their treatment. Among the 51% who received bev in line 1, 33% continued bev beyond progression (BBP) in line 2. Pts treated at academic centers, pts who received longer duration of line 1 therapy, and pts whose providers had greater CRC pt volume were significantly more likely to continue BBP. Overall, 23% of pts received cetuximab (cet) (4% of all line 1 pts, 17% of line 2, 31% of line 3, and 29% of line 4). Mean duration of cet use was 168 days (line 1), 125 (line 2), 133 (line 3) and 129 (line 4). Pts treated at academic centers, pts who received longer duration of line 1 therapy, and pts treated in the West US were significantly more likely to ever receive cet. Cet use decreased by 18% following FDA label change restricting use to KRAS wt pts in Jun 2009 (p &lt;0.001). Of all pts, 6% received panitumumab at some point. Of those, 39% had previously received cet. Conclusions: This population-based study provides insight into treatment patterns of mCRC in the US. Usage of biologic agents varies significantly according to patient, practice, and provider characteristics.

ENSO regulation of MJO teleconnection

The extratropical teleconnections associated with Madden–Julian Oscillation (MJO) are shown to have an action center in the North Pacific where the pressure anomalies have opposite polarities between the Phase 3 (convective Indian Ocean) and Phase 7 (convective western Pacific) of the MJO. The teleconnection in the same phase of MJO may induce opposite anomalies over East Asia and North America between El Nino and La Nina years. During MJO Phase 3, a gigantic North Pacific anticyclonic anomaly occurs during La Nina, making coastal northeast Asia warmer/wetter than normal, but the west US colder/drier; whereas during El Nino the anticyclonic anomaly is confined to the central North Pacific, hence the northwest US experiences warmer than normal weather under influence of a downstream cyclonic anomaly. During Phase 7, an extratropical cyclonic anomaly forms over the northwest Pacific during La Nina due to convective enhancement over the Philippine Sea, causing bitter winter monsoon over Japan; whereas during El Nino, the corresponding cyclonic anomaly shifts to the northeast Pacific due to enhanced convection over the equatorial central Pacific, which causes warm and wet conditions along the west coast of US and Canada. Further, the presence of ENSO-induced seasonal anomalies can significantly modify MJO teleconnection, but the aforementioned MJO teleconnection can still be well identified. During Phase 3, the MJO teleconnection pattern over North Pacific will be counterbalanced (enhanced) by El Nino (La Nina)-induced seasonal mean anomalies. During Phase 7, on the other hand, the MJO teleconnection anomalies in the northeastern Pacific will be enhanced during El Nino but reduced during La Nina; thereby the impacts of MJO teleconnection on the North America is expected to be stronger during El Nino than during La Nina.

Women who abuse prescription opioids: Findings from the Addiction Severity Index-Multimedia Version ® Connect prescription opioid database

Background Evidence suggests gender differences in abuse of prescription opioids. This study aimed to describe characteristics of women who abuse prescription opioids in a treatment-seeking sample and to contrast gender differences among prescription opioid abusers. Methods Data collected November 2005 to April 2008 derived from the Addiction Severity Index Multimedia Version Connect (ASI-MV ® Connect) database. Bivariate and multivariable logistic regression examined correlates of prescription opioid abuse stratified by gender. Results 29,906 assessments from 220 treatment centers were included, of which 12.8% ( N = 3821) reported past month prescription opioid abuse. Women were more likely than men to report use of any prescription opioid (29.8% females vs. 21.1% males, p < 0.001) and abuse of any prescription opioid (15.4% females vs. 11.1% males, p < 0.001) in the past month. Route of administration and source of prescription opioids displayed gender-specific tendencies. Women-specific correlates of recent prescription opioid abuse were problem drinking, age <54, inhalant use, residence outside of West US Census region, and history of drug overdose. Men-specific correlates were age <34, currently living with their children, residence in the South and Midwest, hallucinogen use, and recent depression. Women prescription opioid abusers were less likely to report a pain problem although they were more likely to report medical problems than women who abused other drugs. Conclusions Gender-specific factors should be taken into account in efforts to screen and identify those at highest risk of prescription opioid abuse. Prevention and intervention efforts with a gender-specific approach are warranted.