Photochemical Action Plots Map Orthogonal Reactivity in Photochemical Release Systems.

The wavelength-by-wavelength resolved photoreactivity of two photo-caged carboxylic acids, i. e. 7-(diethylamino)-coumarin- and 3-perylene-modified substrates, is investigated via photochemical action plots. The observed wavelength-dependent reactivity of the chromophores is contrasted with their absorption profile. The photochemical action plots reveal a remarkable mismatch between the maximum reactivity and the absorbance. Through the action plot data, the study is able to uncover photochemical reactivity maxima at longer and shorter wavelengths, where the molar absorptivity of the chromophores is strongly reduced. Finally, the laser experiments are translated to light emitting diode (LED) irradiation and show efficient visible-light-induced release in a near fully wavelength-orthogonal, sequence-independent fashion (λLED1 = 405 nm, λLED2 = 505 nm) with both chromophores in the same reaction solution. The herein pioneered wavelength orthogonal release systems open an avenue for releasing two different molecular cargos with visible light in a fully orthogonal fashion.

Using the R package popharvest to assess the sustainability of offtake in birds.

The R package popharvest was designed to help assess the sustainability of offtake in birds when only limited demographic information is available. In this article, we describe some basics of harvest theory and then discuss several considerations when using the different approaches in popharvest to assess whether observed harvests are unsustainable. Throughout, we emphasize the importance of distinguishing between the scientific and policy aspects of managing offtake. The principal product of popharvest is a sustainable harvest index (SHI), which can indicate whether the harvest is unsustainable but not the converse. SHI is estimated based on a simple, scalar model of logistic population growth, whose parameters may be estimated using limited knowledge of demography. Uncertainty in demography leads to a distribution of SHI values and it is the purview of the decision-maker to determine what amounts to an acceptable risk when failing to reject the null hypothesis of sustainability. The attitude toward risk, in turn, will likely depend on the decision-maker's objective(s) in managing offtake. The management objective as specified in popharvest is a social construct, informed by biology, but ultimately it is an expression of social values that usually vary among stakeholders. We therefore suggest that any standardization of criteria for management objectives in popharvest will necessarily be subjective and, thus, hard to defend in diverse decision-making situations. Because of its ease of use, diverse functionalities, and a minimal requirement of demographic information, we expect the use of popharvest to become widespread. Nonetheless, we suggest that while popharvest provides a useful platform for rapid assessments of sustainability, it cannot substitute for sufficient expertise and experience in harvest theory and management.

Measures of Referral vs Receipt of Social Services Among Patients With Health-Related Social Needs.

This cohort study compares measures of referral vs receipt in evaluating social resource platform outcomes among patients with health-related social needs.

Photochemical Action Plots Reveal Red-shifted Wavelength-dependent Photoproduct Distributions.

Photochemical action plots are a powerful tool for mapping photochemical reaction outcomes wavelength-by-wavelength. Typically, they map either the depletion of a reactant or the formation of a specific product as a function of wavelength. Herein, we exploit action plots to simultaneously map the formation of several photochemical products from a single chromophore. We demonstrate that the wavelength-resolved mapping of two reaction products formed during the irradiation of a chalcone species not only shows wavelength dependence - exhibiting the typical strong red-shift of the photochemical reactivity compared to the absorbance spectrum of the chromophore - but also a strong wavelength selectivity with remarkably different product distributions resulting from different irradiation wavelengths.

Residential Structural Racism and Prevalence of Chronic Health Conditions.

Importance: Studies elucidating determinants of residential neighborhood-level health inequities are needed. Objective: To quantify associations of structural racism indicators with neighborhood prevalence of chronic kidney disease (CKD), diabetes, and hypertension. Design, Setting, and Participants: This cross-sectional study used public data (2012-2018) and deidentified electronic health records (2017-2018) to describe the burden of structural racism and the prevalence of CKD, diabetes, and hypertension in 150 residential neighborhoods in Durham County, North Carolina, from US census block groups and quantified their associations using bayesian models accounting for spatial correlations and residents' age. Data were analyzed from January 2021 to May 2023. Exposures: Global (neighborhood percentage of White residents, economic-racial segregation, and area deprivation) and discrete (neighborhood child care centers, bus stops, tree cover, reported violent crime, impervious areas, evictions, election participation, income, poverty, education, unemployment, health insurance coverage, and police shootings) indicators of structural racism. Main Outcomes and Measures: Outcomes of interest were neighborhood prevalence of CKD, diabetes, and hypertension. Results: A total of 150 neighborhoods with a median (IQR) of 1708 (1109-2489) residents; median (IQR) of 2% (0%-6%) Asian residents, 30% (16%-56%) Black residents, 10% (4%-20%) Hispanic or Latino residents, 0% (0%-1%) Indigenous residents, and 44% (18%-70%) White residents; and median (IQR) residential income of $54 531 ($37 729.25-$78 895.25) were included in analyses. In models evaluating global indicators, greater burden of structural racism was associated with greater prevalence of CKD, diabetes, and hypertension (eg, per 1-SD decrease in neighborhood White population percentage: CKD prevalence ratio [PR], 1.27; 95% highest density interval [HDI], 1.18-1.35; diabetes PR, 1.43; 95% HDI, 1.37-1.52; hypertension PR, 1.19; 95% HDI, 1.14-1.25). Similarly in models evaluating discrete indicators, greater burden of structural racism was associated with greater neighborhood prevalence of CKD, diabetes, and hypertension (eg, per 1-SD increase in reported violent crime: CKD PR, 1.15; 95% HDI, 1.07-1.23; diabetes PR, 1.20; 95% HDI, 1.13-1.28; hypertension PR, 1.08; 95% HDI, 1.02-1.14). Conclusions and Relevance: This cross-sectional study found several global and discrete structural racism indicators associated with increased prevalence of health conditions in residential neighborhoods. Although inferences from this cross-sectional and ecological study warrant caution, they may help guide the development of future community health interventions.

Community-based organizations' perspectives on piloting health and social care integration in North Carolina.

BACKGROUND: Community-based organizations (CBOs) are key players in health and social care integration initiatives, yet little is known about CBO perspectives and experiences in these pilot programs. Understanding CBO perspectives is vital to identifying best practices for successful medical and social care integration. METHODS: From February 2021 to March 2021, we conducted surveys with 12 CBOs that participated in the North Carolina COVID-19 Social Support Program, a pre-pilot for North Carolina's Medicaid Sect. 1115 demonstration waiver program that addresses social drivers of health. RESULTS: CBO participants preferred communication strategies that involved direct communication and felt clear communication was vital to the program's success. Participants expressed varied experiences regarding their ability to handle a changing volume of referrals. Participants identified their organizations' strengths as: strong organizational operations, past experiences with and understanding of the community, and coordination across organizations. Participants identified challenges as: difficulty communicating with clients, coping with capacity demands for scaling services, and lack of clear processes from external organizations. Almost all CBO participants expressed enthusiasm for participating in similar social care transformation programs in the future. CONCLUSIONS: CBO participants in our study had broadly positive experiences in the pilot program and almost all would participate in a similar program in the future. Participants provided perspectives that can inform health and social care integration initiatives, including strengths and challenges in such programs. To build and sustain health and social care integration programs, it is important to: (1) support CBOs through regular, direct communication that builds trust and power-sharing between CBO and health care entities; (2) leverage CBO community expertise; and (3) pursue an individualized assessment of CBO capacity and identify CBO capacity-building strategies that ensure program success and sustainability.

Rapid formation of new migration route and breeding area by Arctic geese.

Many Arctic-breeding animals are at risk from local extirpation associated with habitat constriction and alterations in phenology in their Arctic environment as a result of rapid global warming.1 Migratory species face additional increasing anthropogenic pressures along their migratory routes such as habitat destruction, droughts, creation of barriers, and overexploitation.2,3 Such species can only persist if they adjust their migration, timing of breeding, and range.4 Here, we document both the abrupt (∼10 years) formation of a new migration route and a disjunct breeding population of the pink-footed goose (Anser brachyrhynchus) on Novaya Zemlya, Russia, almost 1,000 km away from the original breeding grounds in Svalbard. The population has grown to 3,000-4,000 birds, explained by intrinsic growth and continued immigration from the original route. The colonization was enabled by recent warming on Novaya Zemlya. We propose that social behavior of geese, resulting in cultural transmission of migration behavior among conspecifics as well as in mixed-species flocks, is key to this fast development and acts as a mechanism enabling ecological rescue in a rapidly changing world.

The gut signals to AGRP-expressing cells of the pituitary to control glucose homeostasis.

Glucose homeostasis can be improved after bariatric surgery, which alters bile flow and stimulates gut hormone secretion, particularly FGF15/19. FGFR1 expression in AGRP-expressing cells is required for bile acids' ability to improve glucose control. We show that the mouse Agrp gene has 3 promoter/enhancer regions that direct transcription of each of their own AGRP transcripts. One of these Agrp promoters/enhancers, Agrp-B, is regulated by bile acids. We generated an Agrp-B knockin FLP/knockout allele. AGRP-B-expressing cells are found in endocrine cells of the pars tuberalis and coexpress diacylglycerol lipase B - an endocannabinoid biosynthetic enzyme - distinct from pars tuberalis thyrotropes. AGRP-B expression is also found in the folliculostellate cells of the pituitary's anterior lobe. Mice without AGRP-B were protected from glucose intolerance induced by high-fat feeding but not from excess weight gain. Chemogenetic inhibition of AGRP-B cells improved glucose tolerance by enhancing glucose-stimulated insulin secretion. Inhibition of the AGRP-B cells also caused weight loss. The improved glucose tolerance and reduced body weight persisted up to 6 weeks after cessation of the DREADD-mediated inhibition, suggesting the presence of a biological switch for glucose homeostasis that is regulated by long-term stability of food availability.

Open removal models with temporary emigration and population dynamics to inform invasive animal management.

Removal sampling data are the primary source of monitoring information for many populations (e.g., invasive species, fisheries). Population dynamics, temporary emigration, and imperfect detection are common sources of variation in monitoring data and are key parameters for informing management. We developed two open robust-design removal models for simultaneously modeling population dynamics, temporary emigration, and imperfect detection: a random walk linear trend model (estimable without ancillary information), and a 2-age class informed population model (InfoPM, closely related to integrated population models) that incorporated prior information for age-structured vital rates and relative juvenile availability. We applied both models to multiyear, removal trapping time-series of a large invasive lizard (Argentine black and white tegu, Salvator merianae) in three management areas of South Florida to evaluate the effectiveness of management programs. Although estimates of the two models were similar, the InfoPMs generally returned more precise estimates, partitioned dynamics into births, deaths, net migration, and provided a decision support tool to predict population dynamics under different effort scenarios while accounting for uncertainty. Trends in tegu superpopulation abundance estimates were increasing in two management areas despite generally high removal rates. However, tegu abundance appeared to decline in the Core management area, where trapping density was the highest and immigration the lowest. Finally, comparing abundance predictions of no-removal scenarios to those estimated in each management area suggested significant population reductions due to management. These results suggest that local tegu population control via systematic trapping may be feasible with high enough trap density and limited immigration; and highlights the value of these trapping programs. We provided the first estimates of tegu abundance, capture probabilities, and population dynamics, which is critical for effective management. Furthermore, our models are applicable to a wide range of monitoring programs (e.g., carcass recovery or removal point-counts).

Aqueous electrochemically-triggered atom transfer radical polymerization.

Simplified electrochemical atom transfer radical polymerization (seATRP) using CuII-N-propyl pyridineimine complexes (CuII(NPPI)2) is reported for the first time. In aqueous solution, using oligo(ethylene glycol) methyl ether methacrylate (OEGMA), standard electrolysis conditions yield POEGMA with good control over molecular weight distribution (D m < 1.35). Interestingly, the polymerizations are not under complete electrochemical control, as monomer conversion continues when electrolysis is halted. Alternatively, it is shown that the extent and rate of polymerization depends upon an initial period of electrolysis. Thus, it is proposed that seATRP using CuII(NPPI)2 follows an electrochemically-triggered, rather than electrochemically mediated, ATRP mechanism, which distinguishes them from other CuIIL complexes that have been previously reported in the literature.

Evaluating the effect of expert elicitation techniques on population status assessment in the face of large uncertainty.

Population projection models are important tools for conservation and management. They are often used for population status assessments, for threat analyses, and to predict the consequences of conservation actions. Although conservation decisions should be informed by science, critical decisions are often made with very little information to support decision-making. Conversely, postponing decisions until better information is available may reduce the benefit of a conservation decision. When empirical data are limited or lacking, expert elicitation can be used to supplement existing data and inform model parameter estimates. The use of rigorous techniques for expert elicitation that account for uncertainty can improve the quality of the expert elicited values and therefore the accuracy of the projection models. One recurring challenge for summarizing expert elicited values is how to aggregate them. Here, we illustrate a process for population status assessment using a combination of expert elicitation and data from the ecological literature. We discuss the importance of considering various aggregation techniques, and illustrate this process using matrix population models for the wood turtle (Glyptemys insculpta) to assist U.S. Fish and Wildlife Service decision-makers with their Species Status Assessment. We compare estimates of population growth using data from the ecological literature and four alternative aggregation techniques for the expert-elicited values. The estimate of population growth rate based on estimates from the literature (λmean = 0.952, 95% CI: 0.87-1.01) could not be used to unequivocally reject the hypotheses of a rapidly declining population nor the hypothesis of a stable, or even slightly growing population, whereas our results for the expert-elicited estimates supported the hypothesis that the wood turtle population will decline over time. Our results showed that the aggregation techniques used had an impact on model estimates, suggesting that the choice of techniques should be carefully considered. We discuss the benefits and limitations associated with each method and their relevance to the population status assessment. We note a difference in the temporal scope or inference between the literature-based estimates that provided insights about historical changes, whereas the expert-based estimates were forward looking. Therefore, conducting an expert-elicitation in addition to using parameter estimates from the literature improved our understanding of our species of interest.

Setting population-size targets for geese causing socio-economic conflicts.

Most European goose populations have increased exponentially, and this has increasingly brought them into conflict with human activities. To manage this conflict, we used multi-criteria decision analysis to help set population targets for a super-abundant population of greylag geese (Anser anser). We relied on expert elicitation to assess the consequences of varying goose abundance on nine ecological, economic, and societal objectives. Representatives from national governments and from non-governmental organizations then weighted the objectives based on their perceived relative importance, and we used a consensus-convergence model to reach stakeholder agreement on the tradeoffs among objectives. The preferred population targets for two management units represent about a 20% reduction from current abundances, which from a management perspective would require considerable effort above and beyond current population-control measures. We believe that multi-criteria decision analysis can provide a systematic and transparent framework for building consensus among diverse stakeholders in a wide array of human-wildlife conflicts.

popharvest: An R package to assess the sustainability of harvesting regimes of bird populations.

Bird harvest for recreational purposes or as a source for food is an important activity worldwide. Assessing or mitigating the impact of these additional sources of mortality on bird populations is therefore crucial issue. The sustainability of harvest levels is however rarely documented, because knowledge of their population dynamics remains rudimentary for many bird species. Some helpful approaches using limited demographic data can be used to provide initial assessment of the sustainable use of harvested bird populations, and help adjusting harvest levels accordingly. The Demographic Invariant Method (DIM) is used to detect overharvesting. In complement, the Potential Take Level (PTL) approach may allow setting a level of take with regard to management objectives and/or to assess whether current harvest levels meet these objectives. Here, we present the R package popharvest that implements these two approaches in a simple and straightforward way. The package provides users with a set of flexible functions whose arguments can be adapted to existing knowledge about population dynamics. Also, popharvest enables users to test scenarios or propagate uncertainty in demographic parameters to the assessment of sustainability through easily programming Monte Carlo simulations. The simplicity of the package makes it a useful toolbox for wildlife managers or policymakers. This paper provides them with backgrounds about the DIM and PTL approaches and illustrates the use of popharvest's functionalities in this context.

A Multiarmed Bandit Approach to Adaptive Water Quality Management.

Nonpoint source water quality management is challenged with allocating uncertain management actions and monitoring their performance in the absence of state-dependent decision making. This adaptive management context can be expressed as a multiarmed bandit problem. Multiarmed bandit strategies attempt to balance the exploitation of actions that appear to maximize performance with the exploration of uncertain, but potentially better, actions. We performed a test of multiarmed bandit strategies to inform adaptive water quality management in Massachusetts, USA. Conservation and restoration practitioners were tasked with allocating household wastewater treatments to minimize N inputs to impaired waters. We obtained time series of N monitoring data from 3 wastewater treatment types and organized them chronologically and randomly. The chronological data set represented nonstationary performance based on recent monitoring data, whereas the random data set represented stationary performance. We tested 2 multiarmed bandit strategies in hypothetical experiments to sample from the treatment data through 20 sequential decisions. A deterministic probability-matching strategy allocated treatments with the highest probability of success regarding their performance at each decision. A randomized probability-matching strategy randomly allocated treatments according to their probability of success at each decision. The strategies were compared with a nonadaptive strategy that equally allocated treatments at each decision. Results indicated that equal allocation is useful for learning in nonstationary situations but tended to overexplore inferior treatments and thus did not maximize performance when compared with the other strategies. Deterministic probability matching maximized performance in many stationary situations, but the strategy did not adequately explore treatments and converged on inferior treatments in nonstationary situations. Randomized probability matching balanced performance and learning in stationary situations, but the strategy could converge on inferior treatments in nonstationary situations. These findings provide evidence that probability-matching strategies are useful for adaptive management. Integr Environ Assess Manag 2020;16:841-852. © 2020 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Incorporating uncertainty and risk into decision making to reduce nitrogen inputs to impaired waters.

This article aims to understand decision making under uncertainty and risk, with a case study on Cape Cod, Massachusetts. Decision makers need to consider imperfect information on the cost and effectiveness of advanced nitrogen-removing on-site wastewater treatment systems as options to mitigate water quality degradation. Research included modeling nitrogen load reduction to impaired coastal waters from seven treatment system technologies and eliciting expert knowledge on their costs. Predictions of nitrogen load removal and cost for each technology incorporated variation in effectiveness and uncertainty in household water use, costs, and expert confidence in costs. The predictions were evaluated using the Pareto efficiency concept to reveal tradeoffs between cost and effectiveness. The stochastic dominance index was used to identify preferred technologies for risk-averse decision making, assuming no further learning is possible. Lastly, the predictions were combined into a cost-effectiveness metric to estimate the expected payoff of implementing the best treatment system in the face of uncertainty and the expected payoff of learning which treatment systems are most cost-effective over time. The expected value of perfect information was calculated as the difference between the expected payoffs. Three technologies revealed Pareto efficient tradeoffs between cost and effectiveness, whereas one technology was the preferred risk-averse option in the absence of future learning. There was a high expected value of perfect information, which could motivate adaptive management on Cape Cod. This research demonstrated decision analysis methods to guide future research and decision making toward meeting water quality objectives and reducing uncertainty.

Spatial conservation planning under uncertainty: adapting to climate change risks using modern portfolio theory.

Climate change and urban growth impact habitats, species, and ecosystem services. To buffer against global change, an established adaptation strategy is designing protected areas to increase representation and complementarity of biodiversity features. Uncertainty regarding the scale and magnitude of landscape change complicates reserve planning and exposes decision makers to the risk of failing to meet conservation goals. Conservation planning tends to treat risk as an absolute measure, ignoring the context of the management problem and risk preferences of stakeholders. Application of risk management theory to conservation emphasizes the diversification of a portfolio of assets, with the goal of reducing the impact of system volatility on investment return. We use principles of Modern Portfolio Theory (MPT), which quantifies risk as the variance and correlation among assets, to formalize diversification as an explicit strategy for managing risk in climate-driven reserve design. We extend MPT to specify a framework that evaluates multiple conservation objectives, allows decision makers to balance management benefits and risk when preferences are contested or unknown, and includes additional decision options such as parcel divestment when evaluating candidate reserve designs. We apply an efficient search algorithm that optimizes portfolio design for large conservation problems and a game theoretic approach to evaluate portfolio trade-offs that satisfy decision makers with divergent benefit and risk tolerances, or when a single decision maker cannot resolve their own preferences. Evaluating several risk profiles for a case study in South Carolina, our results suggest that a reserve design may be somewhat robust to differences in risk attitude but that budgets will likely be important determinants of conservation planning strategies, particularly when divestment is considered a viable alternative. We identify a possible fiscal threshold where adequate resources allow protecting a sufficiently diverse portfolio of habitats such that the risk of failing to achieve conservation objectives is considerably lower. For a range of sea-level rise projections, conversion of habitat to open water (14-180%) and wetland loss (1-7%) are unable to be compensated under the current protected network. In contrast, optimal reserve design outcomes are predicted to ameliorate expected losses relative to current and future habitat protected under the existing conservation estate.

Value of sample information in dynamic, structurally uncertain resource systems.

Few if any natural resource systems are completely understood and fully observed. Instead, there almost always is uncertainty about the way a system works and its status at any given time, which can limit effective management. A natural approach to uncertainty is to allocate time and effort to the collection of additional data, on the reasonable assumption that more information will facilitate better understanding and lead to better management. But the collection of more data, either through observation or investigation, requires time and effort that often can be put to other conservation activities. An important question is whether the use of limited resources to improve understanding is justified by the resulting potential for improved management. In this paper we address directly a change in value from new information collected through investigation. We frame the value of information in terms of learning through the management process itself, as well as learning through investigations that are external to the management process but add to our base of understanding. We provide a conceptual framework and metrics for this issue, and illustrate them with examples involving Florida scrub-jays (Aphelocoma coerulescens).

Dynamic minimum set problem for reserve design: Heuristic solutions for large problems.

Conversion of wild habitats to human dominated landscape is a major cause of biodiversity loss. An approach to mitigate the impact of habitat loss consists of designating reserves where habitat is preserved and managed. Determining the most valuable areas to preserve in a landscape is called the reserve design problem. There exists several possible formulations of the reserve design problem, depending on the objectives and the constraints. In this article, we considered the dynamic problem of designing a reserve that contains a desired area of several key habitats. The dynamic case implies that the reserve cannot be designed in one time step, due to budget constraints, and that habitats can be lost before they are reserved, due for example to climate change or human development. We proposed two heuristics strategies that can be used to select sites to reserve each year for large reserve design problem. The first heuristic is a combination of the Marxan and site-ordering algorithms and the second heuristic is an augmented version of the common naive myopic heuristic. We evaluated the strategies on several simulated examples and showed that the augmented greedy heuristic is particularly interesting when some of the habitats to protect are particularly threatened and/or the compactness of the network is accounted for.

Changing CHANGE: adaptations of an evidence-based telehealth cardiovascular disease risk reduction intervention.

Relatively few successful medication adherence interventions are translated into real-world clinical settings. The Prevention of Cardiovascular Outcomes in African Americans with Diabetes (CHANGE) intervention was originally conceived as a randomized controlled trial to improve cardiovascular disease-related medication adherence and health outcomes. The purpose of the study was to describe the translation of the CHANGE trial into two community-based clinical programs. CHANGE 2 was available to Medicaid patients with diabetes and hypertension whose primary care homes were part of a care management network in the Northern Piedmont region of North Carolina. CHANGE 3 was available to low-income patients receiving care in three geographical areas with multiple chronic conditions at low or moderate risk for developing cardiovascular disease. Adaptations were made to ensure fit with available organizational resources and the patient population's health needs. Data available for evaluation are presented. For CHANGE 2, we evaluated improvement in A1c control using paired t test. For both studies, we describe feasibility measured by percentage of patients who completed the curriculum. CHANGE 2 involved 125 participants. CHANGE 3 had 127 participants. In CHANGE 2, 69 participants had A1c measurements at baseline and 12-month follow-up; A1c improved from 8.4 to 7.8 (p = .008). In CHANGE 3, interventionists completed 47% (n = 45) of calls to enroll participants at the 4-month encounter, and among those eligible for a 12-month call (n = 52), 21% of 12-month calls were completed with participants. In CHANGE 2, 40% of participants (n = 50) completed all 12 encounters. Thoughtful adaptation is critical to translate clinical trials into community-based clinic settings. Successful implementation of adapted evidence-based interventions may be feasible and can positively affect patients' disease control.

Evaluating the Effectiveness of Community and Hospital Medical Record Integration on Management of Behavioral Health in the Emergency Department.

This study evaluated the correlation of an emergency department embedded care coordinator with access to community and medical records in decreasing hospital and emergency department use in patients with behavioral health issues. This retrospective cohort study presents a 6-month pre-post analysis on patients seen by the care coordinator (n=524). Looking at all-cause healthcare utilization, care coordination was associated with a significant median decrease of one emergency department visit per patient (p < 0.001) and a decrease of 9.5 h in emergency department length of stay per average visit per patient (p<0.001). There was no significant effect on the number of hospitalizations or hospital length of stay. This intervention demonstrated a correlation with reducing emergency department use in patients with behavioral health issues, but no correlation with reducing hospital utilization. This under-researched approach of integrating medical records at point-of-care could serve as a model for better emergency department management of behavioral health patients.