An assessment of the Midwest climate adaptation network: A call for improved coordination and collaboration.

Climate adaptation and the management of climate impacts require cross-sectoral and regional coordination and collaboration, but presently there is no thorough assessment of the adaptation network in the Midwest United States to evaluate how well it achieves such collaboration. We investigated the climate adaptation network across the Midwest to inform the strategic agenda for a climate adaptation boundary organization in Minnesota - the University of Minnesota Climate Adaptation Partnership (MCAP). We identified 150 organizations and more than 500 unique connections between them. About ten organizations with more than 25 connections each link the existing Midwest climate adaptation network, but most organizations have fewer than five connections. This asymmetry can affect the flow of resources such as information, technical assistance, and financial support. It can also hinder coordination and collaboration as called for by the Intergovernmental Panel on Climate Change (IPCC et al., 2019). The Midwest adaptation network is not well-balanced with respect to the adaptation cycle: many organizations focus on understanding or planning for climate change, with few organizations focused on problem identification, plan implementation, or monitoring. The gaps identified here suggest that MCAP and other regional adaptation organizations can (1) improve cross-sectoral and intraregional coordination and collaboration, and (2) fill gaps in the adaptation cycle, particularly implementation and monitoring. As more communities and jurisdictions move beyond climate planning toward adaptation implementation and management, and as an increasing number of state, federal and private sector funds become available to support implementation, climate service providers such as MCAP should evaluate their services and capacities and adapt alongside the communities they support.

Assessing long-term impacts of cover crops on soil organic carbon in the central US Midwestern agroecosystems.

Cover crops have been reported as one of the most effective practices to increase soil organic carbon (SOC) for agroecosystems. Impacts of cover crops on SOC change vary depending on soil properties, climate, and management practices, but it remains unclear how these control factors affect SOC benefits from cover crops, as well as which management practices can maximize SOC benefits. To address these questions, we used an advanced process-based agroecosystem model, ecosys, to assess the impacts of winter cover cropping on SOC accumulation under different environmental and management conditions. We aimed to answer the following questions: (1) To what extent do cover crops benefit SOC accumulation, and how do SOC benefits from cover crops vary with different factors (i.e., initial soil properties, cover crop types, climate during the cover crop growth period, and cover crop planting and terminating time)? (2) How can we enhance SOC benefits from cover crops under different cover crop management options? Specifically, we first calibrated and validated the ecosys model at two long-term field experiment sites with SOC measurements in Illinois. We then applied the ecosys model to six cover crop field experiment sites spanning across Illinois to assess the impacts of different factors on SOC accumulation. Our modeling results revealed the following findings: (1) Growing cover crops can bring SOC benefits by 0.33 ± 0.06 MgC ha-1  year-1 in six cover crop field experiment sites across Illinois, and the SOC benefits are species specific to legume and non-legume cover crops. (2) Initial SOC stocks and clay contents had overall small influences on SOC benefits from cover crops. During the cover crop growth period (i.e., winter and spring in the US Midwest), high temperature increased SOC benefits from cover crops, while the impacts from larger precipitation on SOC benefits varied field by field. (3) The SOC benefits from cover crops can be maximized by optimizing cover crop management practices (e.g., selecting cover crop types and controlling cover crop growth period) for the US Midwestern maize-soybean rotation system. Finally, we discussed the economic and policy implications of adopting cover crops in the US Midwest, including that current economic incentives to grow cover crops may not be sufficient to cover costs. This study systematically assessed cover crop impacts for SOC change in the US Midwest context, while also demonstrating that the ecosys model, with rigorous validation using field experiment data, can be an effective tool to guide the adaptive management of cover crops and quantify SOC benefits from cover crops. The study thus provides practical tools and insights for practitioners and policy-makers to design cover crop related government agricultural policies and incentive programs for farmers and agri-food related industries.

Rurality Impacts Mammography Screening Adherence Among Mid-life Women in the Kansas Region.

OBJECTIVE: The gold standard for breast cancer screening and prevention is regular mammography; thus, understanding what impacts adherence to this standard is essential in limiting cancer-associated costs. We assessed the impact of various understudied sociodemographic factors of interest on adherence to the receipt of regular mammograms. METHODS: A total Nc = 14,553 mammography-related claims from Nw = 6,336 female Kansas aged between 45 and 54 were utilized from insurance claim databases furnished by multiple providers. Adherence to regular mammography was quantified continuously via a compliance ratio, used to capture the number of eligible years in which at least one mammogram was received, as well as categorically. The relationship between race, ethnicity, rurality, insurance (public/private), screening facility type, and distance to nearest screening facility with both continuous and categorically defined compliance were individually assessed via Kruskal-Wallis one-way ANOVAs, chi-squared tests, multiple linear regression models, and multiple logistic regression, as appropriate. Findings from these individual models were used to inform the construction of a basic, multifaceted prediction model. RESULTS: Model results demonstrated that all factors race and ethnicity had at least some bearing on compliance with screening guidelines among mid-life female Kansans. The strongest signal was observed in the rurality variable, which demonstrated a significant relationship with compliance regardless of how it was defined. CONCLUSION: Understudied factors that are associated with regular mammography adherence, such as rurality and distance to nearest facility, may serve as important considerations when developing intervention strategies for ensuring that female patients stick to prescribed screening regimens.

STEMI: Considerations for Left Main Culprit Lesions.

PURPOSE OF REVIEW: There is a paucity of data regarding the prevalence, clinical characteristics, and outcomes of patients presenting with ST elevation myocardial infarction (STEMI) due to left main (LM) culprit vessel. RECENT FINDINGS: LM culprit STEMI (LMCSTEMI) is an uncommon, but frequently catastrophic event. Prior meta-analyses and registries have described a varying prevalence of LMCSTEMI, associated cardiogenic shock, and in-hospital mortality among those surviving to hospital presentation. These observed clinical discrepancies may be partially attributable to diverse clinical and angiographical subsets among this STEMI population. STEMI due to LM culprit artery disease represents a clinically high-risk subset of patients with substantial in-hospital mortality. In this paper, we summarize the available clinical data pertaining to STEMI with LM culprit, discuss unique ECG characteristics, and discuss contemporary revascularization therapy. We also report the preliminary findings from a contemporary, STEMI database describing clinical characteristics and angiographically defined subsets of LM culprit STEMI.

Coxiella burnetii in 3 Species of Turtles in the Upper Midwest, United States.

Coxiella burnetii, the causative bacterium of the zoonotic disease Q fever, has been documented in many different species. We describe documented turtles that were PCR positive for C. burnetii from multiple locations in Illinois and Wisconsin, USA. Assessing the conservation implications, reservoir potential, and zoonotic risk requires further research.

Lengthening of maize maturity time is not a widespread climate change adaptation strategy in the US Midwest.

Increasing temperatures in the US Midwest are projected to reduce maize yields because warmer temperatures hasten reproductive development and, as a result, shorten the grain fill period. However, there is widespread expectation that farmers will mitigate projected yield losses by planting longer season hybrids that lengthen the grain fill period. Here, we ask: (a) how current hybrid maturity length relates to thermal availability of the local climate, and (b) if farmers are shifting to longer season hybrids in response to a warming climate. To address these questions, we used county-level Pioneer brand hybrid sales (Corteva Agriscience) across 17 years and 650 counties in 10 Midwest states (IA, IL, IN, MI, MN, MO, ND, OH, SD, and WI). Northern counties were shown to select hybrid maturities with growing degree day (GDD°C) requirements more closely related to the environmentally available GDD compared to central and southern counties. This measure, termed "thermal overlap," ranged from complete 106% in northern counties to a mere 63% in southern counties. The relationship between thermal overlap and latitude was fit using split-line regression and a breakpoint of 42.8°N was identified. Over the 17-years, hybrid maturities shortened across the majority of the Midwest with only a minority of counties lengthening in select northern and southern areas. The annual change in maturity ranged from -5.4 to 4.1 GDD year-1 with a median of -0.9 GDD year-1 . The shortening of hybrid maturity contrasts with widespread expectations of hybrid maturity aligning with magnitude of warming. Factors other than thermal availability appear to more strongly impact farmer decision-making such as the benefit of shorter maturity hybrids on grain drying costs, direct delivery to ethanol biorefineries, field operability, labor constraints, and crop genetics availability. Prediction of hybrid choice under future climate scenarios must include climatic factors, physiological-genetic attributes, socio-economic, and operational constraints.

Greenhouse gases drove the increasing trends in spring precipitation across the central USA.

The central USA experienced major flooding during spring 2019, with both the Missouri and Mississippi Rivers at major flood stage at several locations, causing levees to breach and widespread flooding. Here, we examine the total precipitation responsible for the spring 2019 flooding across the central USA from the perspective of weather types. We focus on the weather type (referred to as 'Midwest Water Hose' (MWH) (Zhang and Villarini. 2019 Climate Dynamics 53, 4217-4232. (doi:10.1007/s00382-019-04783-4))) that contributes the most to the total precipitation across the central USA. This weather type contributed to more than 70% of the total precipitation received across much of this region during January-May 2019, and it has been occurring increasingly frequently over the past 40 years. Furthermore, we found that climate model experiments with the historical change of greenhouse gas concentration can well reproduce the observed rising trend, while this is not the case for the natural forcing experiments. Therefore, the rising trend and the high frequency of the MWH can be mainly attributed to the rising greenhouse gases caused by human activities, rather than natural forcing. This article is part of a discussion meeting issue 'Intensification of short-duration rainfall extremes and implications for flash flood risks'.

Contextual influences on Latino men's sexual and substance use behaviors following immigration to the Midwestern United States.

Objectives: Latinos in the United States experience a disproportionate number of HIV and other sexually transmitted infections (STIs) and higher use of alcohol and illegal drugs, which has been attributed to increases in risk behaviors following immigration. Whereas substantial research documents these behavioral changes, little is known about how immigrants increase their risk or why some immigrants increase their risk and other immigrants do not. This study explored how the social and normative context affects sexual and substance use behaviors among Latino immigrant men in a midsized Midwestern city of the United States.Methods: We interviewed 64 Latino immigrant men recruited from community sites in Milwaukee, Wisconsin (mean age = 32.6 years). Participants reported the social and normative contexts preceding and following immigration, including social networks and support, perceptions of the law, and familiar and peer normative influences.Results: Immigrants attributed changes in their sexual and substance use behaviors to their immigration goals, social support, peer and familial normative influences, and restrictions related to their immigrant status. Immigration for economic and personal advancement was generally protective from behaviors that would interfere with those goals as were extended familial networks that could provide support, resources, and normative control. The need to stay under the radar of authorities, the proportion of Latinos in the community, the social and normative changes associated with immigrants' age, and the higher perceptions of risk for HIV in the United States compared with their home countries also influenced immigrants' sexual and substance use behaviors.Conclusions: Changes in risk behavior after immigration to the United States reflect a combination of social and normative factors and personal goals. Interventions and policies aiming to prevent HIV and substance use among Latino immigrants should understand the contextual conditions that decrease or increase their risk behaviors in the United States.

Active surveillance of ticks in peri-domestic areas of Indiana, Midwest United States.

BACKGROUND & OBJECTIVES: The incidence of Borreliosis, Anaplasmosis, Babesiosis and other tick-borne diseases acquired from private residential/peri-domestic areas has increased over the decades. However, tick activity and proportion of private residential properties with established tick populations remain unknown. The purpose of the current study was to determine the predictors of tick activity in peri-domestic areas. METHODS: In a cross-sectional study design, we used snowball-sampling with cold-calling techniques to collect free-living ticks, sociodemographic, and microclimatic data from June to November 2018 from a total of 96 private residential areas in south-central Indiana, USA. RESULTS: Thirty-eight percent of peri-domestic areas sampled had tick activity, and of these, 50% had established tick populations. Nymphal ticks were the most abundant life stage. Self-reported TBD diagnosis was 16%. Amblyomma americanum [Linnaeus (lone star tick)] was the most abundant tick species collected. Other tick species identified include: Ixodes scapularis [Say (black-legged/deer tick)] and Dermacentor variabilis [Say (American dog tick)]. Increasing temperature was positively associated with tick activity, while elevation was negatively associated with tick abundance. INTERPRETATION & CONCLUSION: Our study results reveal that the proportion of peri-domestic areas in Indiana with established tick populations is high. Amblyomma americanum tick is the most predominant tick species in peri-domestic areas of south-central Indiana. Active surveillance of ticks in peri-domestic areas is necessary for informing decisions by households and communities about where to target tick exposure and tick-borne disease prevention efforts.

Proceedings of the 43nd Annual Upper Midwest Neuro-Ophthalmology Group Meeting, July 23, 2021 and Second Virtual Upper Midwest Neuro-Ophthalmology Group Meeting.

The 43rd meeting of the Upper Midwest Neuro-Ophthalmology Group (UMNOG) took place on July 23, 2021. For the second sequential year, the meeting was held virtually due to the COVID-19 pandemic. The meeting was held in the honour of the late Ivy Dreizin MD. Ninety people attended virtually marking the highest UMNOG meeting attendance on record. There were 23 podium presentations interspersed with numerous personal testimonials recognising Dr Dreizin and her immense contributions to the UMNOG community.

Parasitism of Adult Pentatomidae by Tachinidae in Soybean in the North Central Region of the United States.

Stink bugs (Hemiptera: Pentatomidae) are agricultural pests of increasing significance in the North Central Region of the United States, posing a threat to major crops such as soybean. Biological control can reduce the need for insecticides to manage these pests, but the parasitism of stink bugs by Tachinidae (Diptera) is poorly characterized in this region. The objective of this study was to evaluate the rate of parasitism of stink bugs by tachinids over 2 yr from nine states across the North Central Region. Parasitism was assessed by quantifying tachinid eggs on the integument of stink bug adults. Parasitism rates (i.e., percent of adult stink bugs with tachinid eggs) were compared across stink bug species, states, stink bug sex, and years. The mean percent parasitism of stink bugs by tachinids was about 6% across the region and did not differ among stink bug species. Mean percent parasitism was significantly higher in Missouri than in northern and western states. In addition, male stink bugs had significantly higher mean percent parasitism than females. Stink bug species commonly found in soybean in the region showed some parasitism and are therefore potentially vulnerable to oviposition by these parasitoids. This is the first study to characterize the level of parasitism of stink bugs by tachinids across the North Central Region.

Health Care Professionals' Awareness of a Child's Impending Death.

Health care professionals' (HCPs) experiences during early pediatric end-of-life care were explored using a theory-building case study approach. Multiple data collection methods including observation, electronic medical record review, and semi-structured interviews were collected with 15 interdisciplinary HCPs across four cases. Within- and across-case analyses resulted in an emerging theory. HCPs' initial awareness of a child's impending death is fluid, ongoing, and informed through both relational and internal dimensions. Initial cognitive awareness is followed by a deeper focus on the child through time-oriented attention to the past, present, and future. HCPs engage in a "delicate dance of figuring out" key issues. Awareness was exemplified through four themes: professional responsibility, staying connected, grounded uncertainty, and holding in. The emerging theoretical model provides a framework for HCPs to assess their ongoing awareness, identify personal assumptions, and inform gaps in understanding when facilitating early end-of-life care discussions with families.

Identifying Perspectives About Health to Orient Obesity Intervention Among Urban, Transitionally Housed Indigenous Children.

Drawing from a socioecological framework of health, this community-based participatory research study examined key cultural health perspectives of transitionally housed, food insecure Indigenous children (aged 8-12 years) by utilizing talking circles and a 4-day photovoice (PV) curriculum. In total, 18 Indigenous children portrayed their health perceptions by taking photographs of their living environment and categorizing photos as healthy, unhealthy, or mixed. And, 10 of the 18 children completed pre- and post-evaluations, where data elucidated that urban Indigenous children experiencing food and housing insecurity demonstrate unique holistic and socioecological perceptions about health. Healthy themes included nutrition, gardening, interpersonal relationships, food sovereignty, water quality, and natural and built environments. Unhealthy themes included cumulative stress, food insecurity, access and cost, screen time, smoking, and violence. We found that implementing these robust insights into urban Indigenous obesity prevention interventions could significantly drive success. This approach may benefit children with similar socioecological strengths and vulnerabilities.

Qualitative Assessment of Bad News Delivery Practices during Miscarriage Diagnosis.

Miscarriage is one of the most common pregnancy complications health care providers discuss with patients. Previous research suggests that women's distress is compounded by ineffective communication with providers, who are usually not trained to deliver bad news using patient-centered dialogue. The purpose of this study was to use a patient-centered approach to examine women's experiences with and perspectives of communication during a miscarriage to assist in the development of communication training tools for health care providers. During focus groups, 22 women who had experienced miscarriage discussed video-recorded standardized patient-provider interactions and recalled communication during their own miscarriages. Results of a pragmatic iterative analysis of the transcripts suggest training techniques and communication behaviors that should guide education for providers to deliver the diagnosis of and treatment options for early pregnancy loss, such as demonstrating empathy, creating space for processing, checking for understanding, and avoiding medical jargon and emotionally charged language.

Sex Trafficking Knowledge and Training: Implications From Environmental Scanning in the American Midwest.

Large gaps exist in our knowledge about the effectiveness of sex trafficking training. This study surveyed knowledge and training regarding sex trafficking among service providers (N = 66; i.e., social workers, law enforcement offers, and medical providers) in one Midwestern state. The study aimed to: (a) determine the goodness-of-fit between respondents' agency criteria for victim identification and established trafficking definitions, (b) assess training desired and received, and (c) examine group differences in knowledge and training by profession and position. Results suggest confusion exists in defining sex trafficking among aftercare providers despite nearly all respondents indicating they had received training on definition, identification, and vulnerability. Training gaps regarding service coordination, case development, and the legal, mental health, and medical needs of victims remain.

"It feels like home": Transgender youth in the Midwest and conceptualizations of community climate.

Community climate toward sexual and gender minority (SGM) youth is associated with higher rates of victimization and poorer health and wellbeing-related outcomes such as depression and suicidal ideation. However, this field of research has underemphasized the experiences of transgender youth, particularly within the Midwestern context which is marked by vast rurality and characterized as sociopolitically conservative. Using qualitative and community-based methods, this study identified factors that impact community climate from the perspective of transgender youth (n = 19) in the Midwest and situated them within the Ecological Systems Theory (EST). Thematic analysis of interviews revealed four themes: resources, visibility, policies, and ideologies. Themes often crossed levels within the EST, indicating the complexity and interrelated nature of climate across local, regional, and national contexts. Implications for theory, research, and practice are discussed.

Does early childhood education enhance parental school involvement in second grade?: Evidence from Midwest Child-Parent Center Program.

This paper examines the impact on parent involvement in second grade in the Midwest Child-Parent Centers (MCPC), a high-quality preschool-to-third-grade school reform model. A new focus of research on early childhood programs is understanding how early childhood learning gains can be sustained. Two-generation programs that provide diverse family services may be one approach. The MCPC expansion was implemented for a cohort of over 2000 Chicago and Saint Paul students beginning in preschool. Based on a comparison of the program and usual-service comparison groups matched at the school level via propensity scores, ratings were obtained for a subset of the sample by teachers and parents on parent involvement in school in second grade. After accounting for potential attrition bias via multiple imputation and propensity score weighting, results indicated that MCPC participation was associated with significantly higher parent involvement in school at the end of second grade both in the aggregate sample (Effect Size = 0.19 SD) and in Chicago (ES = 0.24). Differences in Saint Paul, however, were small (ES = 0.15) and not statistically significant. Robustness testing using different model specifications revealed similar results. Implications for assessing and sustaining early childhood learning gains are discussed with a focus on recognizing that parental involvement is an integral component of high-quality programs.

Proceedings of the 42nd Annual and First Virtual Upper Midwest Neuro-Ophthalmology Group Meeting, 24 July 2020.

The 42nd meeting of the Upper Midwest Neuro-Ophthalmology Group (UMNOG) took place on 24 July 2020 in an inaugural virtual format due to COVID-19 precautions. Eighty-seven people attended virtually, including 25 trainees, which marked the highest UMNOG meeting attendance on record. We present a synopsis of the meeting presentations.

Observation of irrigation-induced climate change in the Midwest United States.

Irrigated agriculture alters near-surface temperature and humidity, which may mask global climate change at the regional scale. However, observational studies of irrigation-induced climate change are lacking in temperate, humid regions throughout North America and Europe. Despite unknown climate impacts, irrigated agriculture is expanding in the Midwest United States, where unconfined aquifers provide groundwater to support crop production on coarse soils. This is the first study in the Midwest United States to observe and quantify differences in regional climate associated with irrigated agricultural conversion from forests and rainfed agriculture. To this end, we established a 60 km transect consisting of 28 stations across varying land uses and monitored surface air temperature and relative humidity for 31 months in the Wisconsin Central Sands region. We used a novel approach to quantify irrigated land use in both space and time with a database containing monthly groundwater withdrawal estimates by parcel for the state of Wisconsin. Irrigated agriculture decreased maximum temperatures and increased minimum temperatures, thus shrinking the diurnal temperature range (DTR) by an average of 3°C. Irrigated agriculture also decreased the vapor pressure deficit (VPD) by an average of 0.10 kPa. Irrigated agriculture significantly decreased evaporative demand for 25% and 66% of study days compared to rainfed agriculture and forest, respectively. Differences in VPD across the land-use gradient were highest (0.21 kPa) during the peak of the growing season, while differences in DTR were comparable year-round. Interannual variability in temperature had greater impacts on differences in DTR and VPD across the land-use gradient than interannual variability in precipitation. These regional climate changes must be considered together with increased greenhouse gas emissions, changes to groundwater quality, and surface water degradation when evaluating the costs and benefits of groundwater-sourced irrigation expansion in the Midwest United States and similar regions around the world.

Color, chlorophyll a, and suspended solids effects on Secchi depth in lakes: implications for trophic state assessment.

Secchi depth (SD), a primary metric to assess trophic state, is controlled in many lakes by algal densities, measured as chlorophyll-a (chl-a) concentration. Two other optically related water quality variables also directly affect SD: non-algal suspended solids (SSNA ) and colored dissolved organic matter (CDOM, expressed as the absorption coefficient at 440 nm, a440 ). Using a database of ~1,460 samples from ~625 inland lake basins in Minnesota and two other Upper Midwest states, Wisconsin and Michigan, we analyzed relationships among these variables, with special focus on CDOM levels that influence SD values and the Minnesota SD standards used to assess eutrophication impairment of lakes. Log-transformed chl-a, total suspended solids (TSS), and SD were strongly correlated with each other; log(a440 ) had major effects on log(SD) but was only weakly correlated with log(chl-a) and log(TSS). Multiple regression models for log(SD) and 1/SD based on the three driving variables (chl-a, SSNA , and CDOM) explained ~80% of the variance in SD in the whole data set, but substantial differences in the form of the best-fit relationships were found between major ecoregions. High chl-a concentrations (> 50 µg/L) and TSS (> 20 mg/L) rarely occurred in lakes with high CDOM (a440  > ~4 m-1 ), and all lakes with a440  > 8 m-1 had SD ≤ 2.0 m despite low chl-a values (<10 µg/L) in most lakes. Further statistical analyses revealed that CDOM has significant effects on SD at a440 values > ~ 4 m-1 . Thus, SD is not an accurate trophic state metric in moderately to highly colored lakes, and Minnesota's 2-m SD criterion should not be the sole metric to assess eutrophication impairment in warm/cool-water lakes of the Northern Lakes and Forest ecoregion. More generally, trophic state assessments using SD in regions with large landscape sources of CDOM need to account for effects of CDOM on SD.