Proximity to Hospital-Based Obstetric Care in a Maternity Desert in the Deep South.

Objectives. To examine the accessibility of hospital facilities with maternity care services in 1 rural county in Alabama in preparation for the initiation of prenatal care services at a federally qualified health center. Methods. We analyzed driving distance (in miles) from maternal city of residence in Conecuh County, Alabama to hospital of delivery, using 2019-2021 vital statistics data and geographic information system (GIS) software. Results. A total of 370 births to mothers who have home addresses in Conecuh County were reported, and 368 of those were in hospital facilities. The majority of deliveries were less than 30 miles (median = 23 miles) from the maternal city of residence. Some women traveled more than 70 miles for obstetrical care. Conclusions. Pregnant patients in Conecuh County experience significant geographic barriers related to perinatal care access. Using GIS for this analysis is a promising approach to better understand the unique challenges of pregnant individuals in this rural population. Public health policy efforts need to be geographically tailored to address these disparities. (Am J Public Health. 2024;114(S4):S330-S333. https://doi.org/10.2105/AJPH.2024.307692).

Exploration of sub-field microclimates and winter temperatures: Implications for precision agriculture.

The field of precision agriculture has brought the concept for "big data" to farming by bringing sensor technology into the field allowing growers to make more efficient management decisions. However much of the research and practice of precision agriculture has focused on soil-related issues while sub-field microclimates have been mostly unstudied despite their known importance to crop production. This study sought to explore the differences in temperature at a sub-field level during an entire season using weather microsensors recording data every minute from 11 Dec 2017 to 11 Apr 2018. Twenty-two cost-effective sensors were placed within a ~ .5 ha area satsuma orange (Citrus unshiu) grove along the Gulf Coast on Baldwin County, Alabama. The sensors were placed in aerated housings in a vertical column on the west face of eleven trees at a height of 1 and 2 m off the ground. We focus on several events where temperatures hovered near 0 °C or near - 7 °C, a temperature known to damage satsuma trees and find that temperatures can vary by as much as 1.5 to 2 °C at the same moment in the same grove. Extreme cold events were also found to be non-uniform within the grove, and the response was seen on a tree-by-tree basis where increased exposure to < - 7 °C temperatures led to increase defoliation (r2 = 0.92) and lower fruit count in the following year (r2 = 0.71). We discuss the implication of these differences in temperature and what it may mean for the future of precision agriculture.

Impacts of Pre-bloom Leaf Removal on Wine Grape Production and Quality Parameters: A Systematic Review and Meta-Analysis.

Wine grape (Vitis vinifera L.) is the most widely cultivated fruit crop in the world. However, the climactic characteristics in some growing regions are suboptimal for grape production, including short season length and excess precipitation. Grape growers can utilize an array of methods to mitigate these issues, including "early leaf removal," a management practice involving the removal of leaves from selected basal nodes along shoots around bloom. This meta-analysis reviews the extensive literature on this practice, with specific regards to application at "pre-bloom" (PB). One hundred seventy-five publications on the topic of "early leaf removal" were identified using key terms and subsequently narrowed via eight data curation steps. The comparison between treated (PB) and control plants in these studies revealed two important results. First, PB lowered bunch rot disease (-61%), partially through reducing the compactness of clusters. Second, PB promoted a significant increase in fruit total soluble solids (°Brix, +5.2%), which was related to the increase in the leaf-to-fruit ratio. Furthermore, cultivar and rootstock were found to have a large influence on the success of PB, while the contribution of climate was smaller. In conclusion, PB significantly lowers yield and bunch rot disease and increases °Brix, both of which improve grape and wine quality.

Demographic and spatial trends in diabetes-related virtual nursing examinations.

Diabetes currently affects nearly 30 million Americans, but the distribution of cases is not uniform across all demographics or every state. In the course of their education, nurses learn how to become important conduits for information on diabetes management during their eventual interactions with patients. Exploring the status and trends of diabetes-related knowledge in nursing students is one method to explore the idea that one's community affects how one sees disease. However, they are not yet experts, which places them in a period of transition. This study used data mined from the Shadow Health Digital Clinical Experience™ virtual patient exams conducted by nursing students between the years of 2012 and 2015 to find any potential demographic or spatial trends within simulation performance results from nursing students who examined a virtual patient with self-managed diabetes. Findings of the analysis indicated that age and experience affected the way in which an examination was conducted, where older and more experienced nursing students asked 8% fewer examination questions, yet showed 32% more empathy and offered 76% more educational statements than their younger counterparts. Spatial trends were less pronounced, although deeper analysis revealed that students in states closer to the national mean for population rate with diabetes perform better, show more empathy, and offer more educational statements during examinations compared to states well above or well below the national mean. This suggests that targeted information may be preferable to "one-size-fits-all" public health awareness and education programs for diabetes programs used uniformly across the country.

Effects of a warming trend on cool climate viticulture in Michigan, USA.

Historically, Michigan's climate had mainly three challenges for grape production: growing season temperatures were too low, the growing season was too short and there was too much rain near harvest. However, climate change in the past decades has led to a vastly different landscape that is evolving to meet the new climate. Recently, there has been a significant move from Vitis labrusca (North American) grape plantings to Vitis vinifera (wine grapes) as a consequence of Michigan's shifting climate. The goal of this study was to analyze the historical shift in climate and its potential future impact on the grape industry. We obtained data climate model projection data from two greenhouse gas (GHG) emission scenarios. First, a multi-linear regression model was built to predict future grape yields (t/ac) using data from the climate model projections. Second, trends in the severity of the three challenges (temperature, season length, precipitation timing) were analyzed. In both GHG scenarios grape yields are seen to improve, but to different extents. The improvement is likely a response to warmer season temperatures canceling out losses to early season frost. Model projections recommend that Michigan's future climate will be more accommodating for all varieties of grapes. This suggests that grape production will continue to grow, but the landscape will continue to evolve with more emphasis on varieties that are more climatically sensitive to cold temperatures. Climate change has greatly affected Michigan's viticultural landscape, and will continue to do so in the coming decades.