Assessing and addressing social determinants of health in school-based health centers in King County, Washington.

Objective: School-Based Health Centers (SBHCs) can reduce barriers to accessing care for school-aged children and adolescents. However, current practices related to screening for and responding to social determinants of health (SDOH) in SBHCs are unknown. Our study sought to understand SBHC staff's knowledge related to SDOH, and their screening and referral practices for addressing SDOH. Methods: This study was conducted with all SBHCs in King County, Washington (n = 30 clinics operated by n = 8 agencies) between January-March 2022. Data were collected using a web-based questionnaire, distributed to all provider and clinical care staff (n = 222) in these SHBCs. Results: While respondents had strong generalized knowledge regarding SDOH and how they impact health, they were less confident about the specific SDOH impacting the students they serve. Many health limiting and promoting factors are screened for by respondents; however, there was no standardization related to screening and referral practices across SBHCs or agencies. Respondents had suggestions on how to improve screening methodology and ensure that existing practices adequately assess the SDOH impacting student's lives. There was no clearly identified mechanism for making and following up on referrals. Respondents felt that there were either not or only sometimes enough resources available to meet student's needs. Conclusion: SBHCs advance health and educational outcomes for students, yet SDOH are inconsistently assessed and addressed within SBHCs in King County. Standardizing processes for SDOH assessment and referral can help SBHCs develop practices that are in the best service of equity for their student populations.

Human alterations of the global floodplains 1992-2019.

Floodplains provide critical ecosystem services; however, loss of natural floodplain functions caused by human alterations increase flood risks and lead to massive loss of life and property. Despite recent calls for improved floodplain protection and management, a comprehensive, global-scale assessment quantifying human floodplain alterations does not exist. We developed the first publicly available global dataset that quantifies human alterations in 15 million km2 floodplains along 520 major river basins during the recent 27 years (1992-2019) at 250-m resolution. To maximize the reuse of our dataset and advance the open science of human floodplain alteration, we developed three web-based programming tools supported with tutorials and step-by-step audiovisual instructions. Our data reveal a significant loss of natural floodplains worldwide with 460,000 km2 of new agricultural and 140,000 km2 of new developed areas between 1992 and 2019. This dataset offers critical new insights into how floodplains are being destroyed, which will help decision-makers to reinforce strategies to conserve and restore floodplain functions and habitat.

The Social Factors Influencing Cover Crop Adoption in the Midwest: A Controlled Comparison.

Increased funding and resources have become available in recent years for agricultural producers to plant cover crops to improve soil health and prevent nutrient loss and erosion; however, cover crop adoption remains relatively low and has been uneven across different Midwestern counties. This study employed a controlled comparison method to investigate the social factors affecting cover crop adoption in Iowa, Illinois, and Indiana. In each state, the authors compared pairs of neighboring counties, where one county was a relatively higher adopter and the other was a lower adopter of cover crops, while controlling for variations in climate conditions. Results show that there were multiple factors explaining the difference in cover crop adoption among county pairs. Social factors included attitudes toward cover crops; conservation agency influence; presence of cover crop experts, advocates, and/or entrepreneurs; and collaboration between agencies and the private sector. Other important factors included topography, cattle raising, organic production, and local incentive-based programs. Among these, collaborations between agencies and the private sector played the most important role in explaining why some counties had higher rates of cover crop adoption compared to their neighbors.

Encouragement from the right source: Evaluating the impact of the 4R Nutrient Stewardship Certification Program in the Ohio Western Lake Erie Basin.

Harmful algal blooms are a considerable environmental issue predominantly caused by runoff of nutrients from agricultural lands. One high-profile set of practices promoted to combat this threat is the 4Rs of nutrient stewardship that concern using the right source of nutrients at the right rate and right time in the right place. While outreach for agricultural conservation is often undertaken by governmental or nonprofit entities, there is increasing interest in engaging agricultural retailers to leverage the trust that already exists between farmers and their agribusiness professionals. The 4R Nutrient Stewardship Certification Program, implemented in the Western Lake Erie Basin (WLEB) in 2014, certifies crop advising companies and agronomy retailers or Nutrient Service Providers (NSPs) to promote best practices in nutrient management. This program has since grown and now exists in six US states and the province of Ontario and Prince Edward Island in Canada. Using a survey of farmers in the WLEB, we investigate the impact of working with certified NSPs over time on farmers' reported 4R-related behaviors. We find evidence that working with a certified NSP has a positive impact on 4R behaviors that is independent of other potential explanations for this change (e.g., farmer concern about nutrient loss, local regulatory efforts, and exposure to general 4R-related outreach). Overall, these results suggest that the 4R Nutrient Stewardship Certification Program is having an independent, positive impact on farmer behavior, and engaging with agricultural retailers and agronomists can be effective at advancing adoption of environmentally impactful nutrient management practices.

Social, Economic and Overall Health Impacts of COVID-19 on People Living with Disabilities in King County, WA.

The COVID-19 pandemic and the associated mitigation measures to reduce the spread of disease affected the social, economic, and overall health of individuals. Quantitative administrative datasets typically did not contain demographic information that allowed for reporting or analysis of the impacts of COVID-19 on people living with disabilities. Understanding the experiences of this population during the pandemic can inform the design of public health responses that are more robust and better connected to community. This paper describes a qualitative participatory study with a diverse sample of people living with disabilities in King County, WA. Through 2 listening sessions and 35 semi-structured interviews, it examines what impacts COVID-19 brought for people living with disabilities; elucidates the supports that were helpful in addressing COVID-19 impacts; examines inequities faced by the disability community; and sheds light on how to engage with this community to inform the public health emergency response. The process, protocols, findings, and lessons learned are replicable by other local health departments and could be incorporated as part of routine data collection and considered for future public health emergencies.

Five financial incentives to revive the Gulf of Mexico dead zone and Mississippi basin soils.

A central challenge in the Mississippi River Basin is how to continue to support profitable agricultural production, provide water supply, flood control, transportation, and other benefits, while reducing the current burden of environmental degradation. Several practices have been shown to reduce nutrient runoff and water pollution, and improve soil fertility, while often yielding profits for farmers. Yet many of these beneficial practices remain underutilized. Participants at an expert workshop identified five candidate financial mechanisms that could increase adoption of these beneficial farming practices in four focal Midwest states in the next five years: crop insurance premium subsidies, transformation of the private service provider business model, expansion and targeting of 2019 U.S. Farm Bill funding, development of new state funds, and direction of post-disaster federal funds towards habitat restoration, particularly in floodplains. This study provides rough approximations of the change in nutrient runoff and greenhouse gas (GHG) emissions, the annualized costs, and the nutrient and GHG reductions per dollar likely to result from deployment of each financial mechanism. Based upon these approximations, the adoption of these programs could reduce annual nitrate flows at the outlet of the Ohio and Upper Mississippi River Basins by 25%, surpassing the intermediate 2025 target (20% reduction) and achieving more than half of the long-term target (45% reduction) set by the Mississippi River/Gulf of Mexico Hypoxia Task Force. These approximations also illustrate that these five mechanisms could provide the same GHG reductions (∼43 Tg CO2e yr-1) as taking 12 coal-fired energy plants offline. The total cost of these five financial mechanisms is estimated at ∼$2.6 billion, or 64 g of nitrates and ∼17 kg of CO2e per dollar spent. These proposed solutions all face political, financial, cultural or institutional challenges, but with industry support, creative political action, and continued communication of both private and public benefits, they can create meaningful nutrient reductions and rebuild soils by 2022.

Clinical and electrophysiologic variability in amyotrophic lateral sclerosis within a kindred harboring the C9ORF72 repeat expansion.

Our objective was to characterize the motor neuron disease features within a large c9FTD/ALS kindred. We analyzed clinical, electrophysiologic and neuropathologic data in a c9FTD/ALS kindred of Scandinavian ancestry. Results showed that of six family members affected, three had only ALS, two had FTD and one had FTD and ALS. Each patient with motor neuron disease had a different clinical presentation: one patient had only bulbar symptoms, one had bulbar and limb involvement, one had limb symptoms, and one had primarily upper motor neuron disease. Later in the course of disease, all ALS patients developed bulbar involvement and died from respiratory causes. Survival was uniformly short (two to five years). Electrophysiologic studies recorded progressive lower motor neuron dysfunction except in the patient with predominantly upper motor neuron features. In conclusion, this kindred demonstrates that the presentation of ALS within c9FTD/ALS families may vary considerably and electrophysiologic findings reflect this heterogeneity.

Linking water quality and well-being for improved assessment and valuation of ecosystem services.

Despite broad recognition of the value of the goods and services provided by nature, existing tools for assessing and valuing ecosystem services often fall short of the needs and expectations of decision makers. Here we address one of the most important missing components in the current ecosystem services toolbox: a comprehensive and generalizable framework for describing and valuing water quality-related services. Water quality is often misrepresented as a final ecosystem service. We argue that it is actually an important contributor to many different services, from recreation to human health. We present a valuation approach for water quality-related services that is sensitive to different actions that affect water quality, identifies aquatic endpoints where the consequences of changing water quality on human well-being are realized, and recognizes the unique groups of beneficiaries affected by those changes. We describe the multiple biophysical and economic pathways that link actions to changes in water quality-related ecosystem goods and services and provide guidance to researchers interested in valuing these changes. Finally, we present a valuation template that integrates biophysical and economic models, links actions to changes in service provision and value estimates, and considers multiple sources of water quality-related ecosystem service values without double counting.

Reducing greenhouse gas emissions for climate stabilization: framing regional options.

The Intergovernmental Panel on Climate Change (IPCC) has stated that stabilizing atmospheric CO2 concentrations will require reduction of global greenhouse gas (GHG) emissions by as much as 80% by 2050. Subnational efforts to cut emissions will inform policy development nationally and globally. We projected GHG mitigation strategies for Minnesota, which has adopted a strategic goal of 80% emissions reduction by 2050. A portfolio of conservation strategies, including electricity conservation, increased vehicle fleet fuel efficiency, and reduced vehicle miles traveled, is likely the most cost-effective option for Minnesota and could reduce emissions by 18% below 2005 levels. An 80% GHG reduction would require complete decarbonization of the electricity and transportation sectors, combined with carbon capture and sequestration at power plants, or deep cuts in other relatively more intransigent GHG-emitting sectors. In order to achieve ambitious GHG reduction goals, policymakers should promote aggressive conservation efforts, which would probably have negative net costs, while phasing in alternative fuels to replace coal and motor gasoline over the long-term.

Age and apoE associations with complex pathologic features in Alzheimer's disease.

The risk for Alzheimer's disease (AD) is influenced by both age and ApoE status. The present study addresses the associations of age and ApoE status on complex pathologic features in AD (n=81) including coexistent cerebrovascular disease (CVD), argyrophilic grain disease (AGD), and Lewy body disease (LBD). The frequency of coexistent cerebrovascular disease increased with increasing age. Age and ApoE status were differentially associated with atherosclerosis, lacunar infarctions, and microvascular pathology. Coexistent Lewy body pathology was negatively associated with age, dropping off abruptly after age 90. The presence of an ApoE epsilon4 allele was associated with an increased frequency of coexistent LBD. Logistic regression analyses demonstrated both dependent and independent effects of age and ApoE status on the presence of coexistent Lewy body pathology in AD. While the decreasing frequency of LBD in AD after age 90 could be partly accounted for by a lower probability of an ApoE epsilon4 allele, the independent association with age suggests either 1) a survival effect, 2) decreased incidence with advancing age, or 3) both.

Argyrophilic grain disease in demented subjects presenting initially with amnestic mild cognitive impairment.

A previous autopsy study of patients with amnestic-type mild cognitive impairment (MCI) suggested an overrepresentation of argyrophilic grain disease (AGD). We studied 34 patients who had diagnoses of amnestic MCI during progression to dementia and who came to autopsy. Neuropathologic evaluation included routine histochemical and immunohistochemical methods, including a 4-repeat tau-specific marker (ET3). AGD was found in association with a variety of neuropathologic diseases in 18 (53%) cases but was the primary pathologic finding in only one (3%) case. ET3 allowed the detection of AGD in 5 additional cases missed using standard techniques. Cases with AGD were significantly older than those without (mean, 94 vs 84 years; p < 0.004, rank sum test). No significant differences were found between groups for other demographic variables, association of AGD with neuropathologic findings of Alzheimer disease, Lewy body, or cerebrovascular disease, or global measures of cognitive function, although there was a nonsignificant trend towards worsening cognitive status in cases with AGD. AGD is a common pathologic finding in subjects who have been diagnosed with amnestic MCI.

Neuropathologic outcome of mild cognitive impairment following progression to clinical dementia.

BACKGROUND: The pathologic outcome of patients diagnosed with mild cognitive impairment (MCI) following progression to dementia is poorly understood. OBJECTIVE: To determine the pathologic substrates of dementia in cases with prior diagnosis of amnestic MCI. DESIGN AND SETTING: Community-based cohort. PATIENTS: Thirty-four subjects followed up prospectively as part of a community-based study who were diagnosed with amnestic MCI, progressed to clinical dementia, and underwent subsequent postmortem brain analysis. MAIN OUTCOME MEASURES: Neuropathologic analyses resulted in assignment of a primary pathologic diagnosis and included staging of Alzheimer pathologic abnormalities and identification of contributing vascular disease, Lewy bodies, and argyrophilic grains. RESULTS: Although the majority of subjects progressed both clinically and pathologically to Alzheimer disease (AD), 10 (29%) of them developed non-AD primary pathologic abnormalities. All of the cases were found to have sufficient pathologic abnormalities in mesial temporal lobe structures to account for their amnestic symptoms regardless of the cause. Most subjects were found to have secondary contributing pathologic abnormalities in addition to primary pathologic diagnoses. No significant differences between subjects with and without neuropathologically proven AD were detected in demographic variables, apolipoprotein E genotype, or cognitive test measures at onset of MCI, onset of dementia, or last clinical evaluation. CONCLUSIONS: The neuropathologic outcome of amnestic MCI following progression to dementia is heterogeneous, and it includes AD at a high frequency. Complex neuropathologic findings including 2 or more distinct pathologic entities contributing to dementia may be common in community-based cohorts. Neither demographic variables nor cognitive measures had predictive value in determining which patients diagnosed with MCI will develop the neuropathologic features of AD.

Neuropathologic features of amnestic mild cognitive impairment.

BACKGROUND: The neuropathologic substrate of amnestic mild cognitive impairment (aMCI) is not known. OBJECTIVE: To determine the neuropathologic features of patients who died while their clinical classification was aMCI. DESIGN: Cohort study. SETTING: Community based. PARTICIPANTS: Sixty-six individuals, including 15 who had memory impairment beyond that allowed for aging but who were not demented, were studied along with 28 clinically healthy individuals and 23 patients with probable Alzheimer disease (AD) for comparison. MAIN OUTCOME MEASURES: Standard neuropathologic techniques and classification according to Khachaturian, Consortium to Establish a Registry for Alzheimer Disease, and National Institute on Aging-Reagan criteria were used to analyze autopsy tissue from 15 individuals who died while their clinical diagnosis was aMCI. For comparison, autopsy data on age-matched groups of clinically healthy individuals and patients with probable AD were analyzed. RESULTS: Most patients with aMCI did not meet the neuropathologic criteria for AD, but their pathologic findings suggest a transitional state of evolving AD. All the patients with aMCI had pathologic findings involving medial temporal lobe structures, likely accounting for their memory impairment. In addition, there were many concomitant pathologic abnormalities, including argyrophilic grain disease, hippocampal sclerosis, and vascular lesions. CONCLUSIONS: The neuropathologic features of aMCI matched the clinical features and seemed to be intermediate between the neurofibrillary changes of aging and the pathologic features of very early AD.

Variability within individuals of plasma ionic magnesium concentrations.

BACKGROUND: With the invention of the ion-selective electrode (ISE), ionic magnesium (iMg) is a common blood assay. This could be advantageous, as iMg is the biologically active form of Mg. There is some evidence that iMg has considerable within subject variability. RESULTS: Individual ranges averaged.08 mmol/L (range.05 to.14). Coefficients of variation (CV) ranged from 3% to 7% (mean 4%) while analytical variation was determined to be 2.3%. Biological variability thus accounts for almost half of the variability, which is clinically significant, as 9 of the 13 subjects recorded at least one value below a reference range of.46 -.60 mmol/L. A significant within-day variation (p <.001) was noted, with differences between 7:00 and 10:00 as well as 10:00 and 22:00. Between day variations were not significant (p =.56). CONCLUSIONS: A plausible explanation of this data is that iMg has a circadian rhythm. Thus, cautious interpretation of single iMg values is warranted until future research determines the nature of iMg variability.