Geospatial Analyses of Pain Intensity and Opioid Unit Doses Prescribed on the Day of Discharge Following Orthopedic Surgery.

OBJECTIVE: Inappropriate opioid prescribing after surgery contributes to opioid use disorder and risk of opioid overdose. In this cross-sectional analysis of orthopedic surgical patients, we examined the role of patient location on postoperative pain intensity and opioids prescribed on hospital discharge. METHODS: We used geospatial analyses to characterize spatial patterns of mean pain intensity on the day of discharge (PiDoD) and opioid units prescribed on the day of discharge (OuPoD), as well as the effect of regional social deprivation on these outcomes. RESULTS: At a 500-km radius from the surgery site, the Global Moran's I for PiDoD (2.71 × 10-3, variance = 1.67 × 10-6, P = 0.012) and OuPoD (2.19 × 10-3, SD = 1.87, variance = 1.66 × 10-6, P = 0.03) suggested significant spatial autocorrelation within each outcome. Local indicators of spatial autocorrelation, including local Moran's I, Local Indicator of Spatial Autocorrelation cluster maps, and Getis-Ord Gi* statistics, further demonstrated significant, specific regions of clustering both OuPoD and PiDoD. These spatial patterns were associated with spatial regions of area deprivation. CONCLUSIONS: Our results suggest that the outcomes of pain intensity and opioid doses prescribed exhibit varying degrees of clustering of patient locations of residence, at both global and local levels. This indicates that a given patient's pain intensity on discharge is related to the pain intensity of nearby individuals. Similar interpretations exist for OuPoD, although the relative locations of hot spots of opioids dispensed in a geographic area appear to differ from those of hot spots of pain intensity on discharge.

A spatiotemporal natural-human database to evaluate road development impacts in an Amazon trinational frontier.

Road construction and paving bring socio-economic benefits to receiving regions but can also be drivers of deforestation and land cover change. Road infrastructure often increases migration and illegal economic activities, which in turn affect local hydrology, wildlife, vegetation structure and dynamics, and biodiversity. To evaluate the full breadth of impacts from a coupled natural-human systems perspective, information is needed over a sufficient timespan to include pre- and post-road paving conditions. In addition, the spatial scale should be appropriate to link local human activities and biophysical system components, while also allowing for upscaling to the regional scale. A database was developed for the tri-national frontier in the Southwestern Amazon, where the Inter-Oceanic Highway was constructed through an area of high biological value and cultural diversity. Extensive socio-economic surveys and botanical field work are combined with remote sensing and reanalysis data to provide a rich and unique database, suitable for coupled natural-human systems research.

Regional-scale management maps for forested areas of the Southeastern United States and the US Pacific Northwest.

Forests in the United States are managed by multiple public and private entities making harmonization of available data and subsequent mapping of management challenging. We mapped four important types of forest management, production, ecological, passive, and preservation, at 250-meter spatial resolution in the Southeastern (SEUS) and Pacific Northwest (PNW) USA. Both ecologically and socio-economically dynamic regions, the SEUS and PNW forests represent, respectively, 22.0% and 10.4% of forests in the coterminous US. We built a random forest classifier using seasonal time-series analysis of 16 years of MODIS 16-day composite Enhanced Vegetation Index, and ancillary data containing forest ownership, roads, US Forest Service wilderness and forestry areas, proportion conifer and proportion riparian. The map accuracies for SEUS are 89% (10-fold cross-validation) and 67% (external validation) and PNW are 91% and 70% respectively with the same validation. The now publicly available forest management maps, probability surfaces for each management class and uncertainty layer for each region can be viewed and analysed in commercial and open-source GIS and remote sensing software.

Spatial variation in mandibular bone elastic modulus and its effect on structural bending stiffness: A test case using the Taï Forest monkeys.

OBJECTIVES: We investigated how heterogeneity in material stiffness affects structural stiffness in the cercopithecid mandibular cortical bone. We assessed (1) whether this effect changes the interpretation of interspecific structural stiffness variation across four primate species, (2) whether the heterogeneity is random, and (3) whether heterogeneity mitigates bending stress in the jaw associated with food processing. MATERIALS AND METHODS: The sample consisted of Taï Forest, Cote d'Ivoire, monkeys: Cercocebus atys, Piliocolobus badius, Colobus polykomos, and Cercopithecus diana. Vickers indentation hardness samples estimated elastic moduli throughout the cortical bone area of each coronal section of postcanine corpus. For each section, we calculated maximum area moment of inertia, Imax (structural mechanical property), under three models of material heterogeneity, as well as spatial autocorrelation statistics (Moran's I, IMORAN ). RESULTS: When the model considered material stiffness variation and spatial patterning, Imax decreased and individual ranks based on structural stiffness changed. Rank changes were not significant across models. All specimens showed positive (nonrandom) spatial autocorrelation. Differences in IMORAN were not significant among species, and there were no discernable patterns of autocorrelation within species. Across species, significant local IMORAN was often attributed to proximity of low moduli in the alveolar process and high moduli in the basal process. DISCUSSION: While our sample did not demonstrate species differences in the degree of spatial autocorrelation of elastic moduli, there may be mechanical effects of heterogeneity (relative strength and rigidity) that do distinguish at the species or subfamilial level (i.e., colobines vs. cercopithecines). The potential connections of heterogeneity to diet and/or taxonomy remain to be discovered.