American Indian and Alaska Native Accessibility to Comprehensive Cleft Lip and Palate Treatment.

American Indians and Alaska Natives (AI/AN) have the highest incidence of cleft lip and palate (orofacial clefts [OFCs]) when compared to other ethnic groups. We aim to determine the AI/AN populations' proximity and accessibility to American Cleft Palate-Craniofacial Association accredited centers (ACPA centers) for treatment of OFCs. Our hypothesis is an unacceptable proportion of the AI/AN population lacks reasonable accessibility to ACPA centers and comprehensive craniofacial care.A cross-sectional study of ACPA centers and AI/AN populations were analyzed for possible disparities.ACPA centers were mapped using Geographic Information Systems (GIS) and compared with 2018 census population data and 2017 Tribal Census Tract data to visually display possible disparities. Total annual potential pediatric cleft care need for selected high-density AI/AN populated lands were estimated.GIS mapping demonstrates geographical isolation of AI/AN populations from ACPA centers. Two states with high AI/AN populated lands (ND, WY) have no ACPA centers. 47.1% of ACPA centers in high AI/AN populated lands have no craniofacial trained surgeons versus 78.9% craniofacial staffed ACPA centers nationally. The potential unmet cleft and craniofacial care need in selected high-density AI/AN populated lands is 1042 children.AI/AN populations are likely underserved by ACPA centers and by craniofacial fellowship-trained staffed centers. Not addressing OFCs with comprehensive care can lead to worsened outcomes and further marginalization of these children. With future studies, we will be capable of making data-driven, informed decisions to more effectively ensure AI/AN access to comprehensive cleft and craniofacial care.

Belowground interactions with aboveground consequences: Invasive earthworms and arbuscular mycorrhizal fungi.

A mounting body of research suggests that invasive nonnative earthworms substantially alter microbial communities, including arbuscular mycorrhizal fungi (AMF). These changes to AMF can cascade to affect plant communities and vertebrate populations. Despite these research advances, relatively little is known about (1) the mechanisms behind earthworms' effects on AMF and (2) the factors that determine the outcomes of earthworm-AMF interactions (i.e., whether AMF abundance is increased or decreased and subsequent effects on plants). We predict that AMF-mediated effects of nonnative earthworms on ecosystems are nearly universal because (1) AMF are important components of most terrestrial ecosystems, (2) nonnative earthworms have become established in nearly every type of terrestrial ecosystem, and (3) nonnative earthworms, due to their burrowing and feeding behavior, greatly affect AMF with potentially profound concomitant effects on plant communities. We highlight the multiple direct and indirect effects of nonnative earthworms on plants and review what is currently known about the interaction between earthworms and AMF. We also illustrate how the effects of nonnative earthworms on plant-AMF mutualisms can alter the structure and stability of aboveground plant communities, as well as the vertebrate communities relying on these habitats. Integrative studies that assess the interactive effects of earthworms and AMF can provide new insights into the role that belowground ecosystem engineers play in altering aboveground ecological processes. Understanding these processes may improve our ability to predict the structure of plant and animal communities in earthworm-invaded regions and to develop management strategies that limit the numerous undesired impacts of earthworms.

SEnDAE: A resource for expanding research into social and environmental determinants of health.

BACKGROUND AND OBJECTIVE: Social and Environmental Determinants of Health (SEDoH) are of increasing interest to researchers in personal and public health. Collecting SEDoH and associating them with patient medical record can be challenging, especially for environmental variables. We announce here the release of SEnDAE, the Social and Environmental Determinants Address Enhancement toolkit, and open-source resource for ingesting a range of environmental variables and measurements from a variety of sources and associated them with arbitrary addresses. METHODS: SEnDAE includes optional components for geocoding addresses, in case an organization does not have independent capabilities in that area, and recipes for extending the OMOP CDM and the ontology of an i2b2 instance to display and compute over the SEnDAE variables within i2b2. RESULTS: On a set of 5000 synthetic addresses, SEnDAE was able to geocode 83%. SEnDAE geocodes addresses to the same Census tract as ESRI 98.1% of the time. CONCLUSION: Development of SEnDAE is ongoing, but we hope that teams will find it useful to increase their usage of environmental variables and increase the field's general understanding of these important determinants of health.

The changing PM2.5 dynamics of global megacities based on long-term remotely sensed observations.

Satellite observations show that the rapid urbanization and emergence of megacities with 10 million or more residents have raised PM2.5 concentrations across the globe during the past few decades. This study examines PM2.5 dynamics for the 33 cities included on the UN list of megacities published in 2018. These megacities were classified into densely (>1500 residents per km2), moderately (300-1500 residents per km2) and sparsely (<300 residents per km2) populated areas to examine the effect of human population density on PM2.5 concentrations in these areas during the period 1998-2016. We found that: (1) the higher population density areas experienced higher PM2.5 concentrations; and (2) the megacities with high PM2.5 concentrations in these areas had higher concentrations than those in the moderately and sparsely populated areas of other megacities as well. The numbers of residents experiencing poor air quality is substantial: approximately 452 and 163 million experienced average annual PM2.5 levels exceeding 10 and 35 µg/m3, respectively in 2016. We also examined PM2.5 trends during the past 18 years and predict that high PM2.5 levels will likely continue in many of these megacities in the future without substantial changes in their economies and/or pollution abatement practices. There will be more megacities in the highest PM2.5 pollution class and the number of megacities in the lowest PM2.5 pollution class will likely not change. Finally, we analyzed how the PM2.5 pollution burden varies geographically and ranked the 33 megacities in terms of PM2.5 pollution in 2016. The most polluted regions are China, India, and South Asia and the least polluted regions are Europe and Japan. None of the 33 megacities currently fall in the WHO's PM2.5 attainment class (<10 µg/m3) while 9 megacities fall into the PM2.5 non-attainment class (>35 µg/m3). In 2016, the least polluted megacity was New York and most polluted megacity was Delhi whose average annual PM2.5 concentration of 110 µg/m3 is nearly three times the WHO's non-attainment threshold.

An estimate of avian mortality at communication towers in the United States and Canada.

Avian mortality at communication towers in the continental United States and Canada is an issue of pressing conservation concern. Previous estimates of this mortality have been based on limited data and have not included Canada. We compiled a database of communication towers in the continental United States and Canada and estimated avian mortality by tower with a regression relating avian mortality to tower height. This equation was derived from 38 tower studies for which mortality data were available and corrected for sampling effort, search efficiency, and scavenging where appropriate. Although most studies document mortality at guyed towers with steady-burning lights, we accounted for lower mortality at towers without guy wires or steady-burning lights by adjusting estimates based on published studies. The resulting estimate of mortality at towers is 6.8 million birds per year in the United States and Canada. Bootstrapped subsampling indicated that the regression was robust to the choice of studies included and a comparison of multiple regression models showed that incorporating sampling, scavenging, and search efficiency adjustments improved model fit. Estimating total avian mortality is only a first step in developing an assessment of the biological significance of mortality at communication towers for individual species or groups of species. Nevertheless, our estimate can be used to evaluate this source of mortality, develop subsequent per-species mortality estimates, and motivate policy action.