Search Results (382)

Background: As the U.S. population ages, the need for gastrointestinal (GI) care and procedures grows. Medicare is a significant payer for these procedures, but declining reimbursements raise concerns about the availability of GIs and thus equitable access to care. This study examines the relationship between Medicare reimbursements for GI procedures and the regional supply and demand of GI physicians. Methods: This study analyzed the Medicare facility and non-facility setting physician reimbursements for the top 10 GI procedures for 2003, 2013, and 2023. Facility reimbursements were compared across four regions (Northeast, Midwest, South, and West) and compared to regional GI physician supply and demand data for 2013 and 2025 projections. Linear regression and mixed-effects models were used to evaluate relationships between reimbursements, physician supply, and demand. Results: The national average adjusted facility setting physician reimbursements for the top 10 GI procedures declined by 45.6% from 2003 to 2023. In 2013 and projected for 2025, the South had the highest GI physician supply and demand, but consistently lower facility setting physician reimbursements compared to the Northeast and West. Associations between supply, demand, and reimbursements were observed, though regional patterns showed paradoxical trends, such as similar low reimbursements in the South and Midwest despite differing supply levels. Conclusions: Regional inconsistencies between physician supply and reimbursements highlight the complexity of economic and healthcare dynamics. Declining Medicare reimbursements for GI procedures are multifactorial and, as the aging population grows, these reductions may widen disparities. Further investigation is needed to address barriers and ensure equitable access to GI care. Full article

Although student evaluations of teaching (SET) in higher education have recently gained considerable interest, little is known about whether course level influences these evaluations. Accordingly, two datasets, obtained from a large public university in the U.S. Midwest, were analyzed to investigate whether course level makes a difference in SET. The first dataset included 25,306 evaluations across eight course levels collected using the SET questionnaire. A one-way multivariate analysis of variance (MANOVA), followed by univariate analyses of variance (ANOVAs), was conducted to test whether course level makes a difference in SET scores. To cross-validate the results and ensure generalizability, the same analyses were conducted using a second, smaller dataset (N = 444). MANOVA results revealed a statistically significant effect for course level on the combined SET dimensions across both campuses. All univariate ANOVAs were also significant across both campuses. Follow-up post hoc comparisons, with level 1 as the reference group, were statistically significant, especially for level 8. Overall, these results underscore the importance of accounting for course level when interpreting SET and encourage researchers to include key covariates (e.g., class size, discipline, instructor experience, and student composition) to identify the factors driving course-level differences. Full article

Calonectria ilicicola (anamorph: Cylindrocladium parasiticum) is a globally important soil-borne fungal pathogen, causing Cylindrocladium black rot (CBR) in peanuts (Arachis hypogaea) and red crown rot (RCR) in soybeans (Glycine max), two legume crops central to global food security. Under favorable conditions, these diseases can cause yield losses of 15–50%, with severe epidemics causing substantial economic damage. A defining feature of C. ilicicola is its production of melanized microsclerotia that persist in soil for up to seven years, complicating long-term disease management across major production regions worldwide. The recent spread of RCR into the U.S. Midwest highlights the adaptive potential of the pathogen and underscores the urgency of updated, integrated control strategies. This review synthesizes current knowledge on disease symptoms, pathogen biology, the life cycle, isolation techniques, and molecular diagnostics, with particular emphasis on recent genomic and multiomics advances. These approaches have identified key virulence-associated genes and core pathogenicity factors, providing new insights into host–pathogen interactions and enabling more targeted resistance breeding through marker-assisted selection and the use of wild germplasm. We critically evaluate integrated disease management strategies, including host resistance, chemical and biological control, cultural practices, and physical interventions, highlighting their complementarities and limitations. By integrating classical pathology with emerging molecular and ecological innovations, this review provides a comprehensive background for developing more effective and sustainable management approaches for CBR and RCR. Full article

Agro-industrial facilities host processes and products that are highly sensitive to thermal fluctuations. Given the projected increase in air temperatures in tropical regions due to climate change, improving indoor thermal conditions in these facilities has become critically important. Conventional cooling systems are widely used to maintain adequate indoor temperatures; however, they are associated with high energy consumption. In this context, Ground Source Heat Pump (GSHP) technology emerges as a promising alternative to reduce cooling loads by exchanging heat with the ground. This study evaluates the reductions in cooling energy consumption and the return on investment of a GSHP system integrated with conventional cooling system, considering a prototype agro-industrial room located in two ecotones of the Brazilian Midwest: the Amazon Forest (AF) and Brazilian Savanna (BS). Building energy simulations were performed using EnergyPlus software v. 9 under current climate conditions and climate change scenarios for 2050 and 2080. Initially, the prototype room was conditioned using a conventional HVAC system; subsequently, a GSHP system was integrated to enhance energy efficiency and reduce energy demand. Under current conditions, cooling energy demand in the BS and AF ecotones is projected to increase by 16.5% and 18.3% by 2050, and by 24.5% and 23.5% by 2080, respectively. The payback analysis indicates that the average return on investment improves under future climate scenarios, decreasing from 14.5 years under current conditions to 10.13 years in 2050 and 9.86 years in 2080. The findings contribute to understanding the thermal resilience and economic feasibility of ground-coupled heat exchangers as a sustainable strategy for mitigating climate change impacts in the agro-industrial sector. Full article

The Frontal Area Index (FAI) is a commonly used, cost-effective preliminary screening tool for identifying the Least Cost Path (LCP) of urban ventilated corridors and mitigating the Urban Heat Island (UHI) effect, particularly in situations where data and budget availability are limited. Although its theoretical basis and simulation studies have been extensively examined, empirical validation through field measurements remains limited. This study assesses the FAI method’s applicability in two representative U.S. Midwest cities—St. Louis and Chicago—and proposes key modifications based on field-measurement validation. FAI simulations were conducted to identify optimal ventilation corridors, and the results were subsequently compared with in situ field measurements. Our findings indicated a strong correlation between FAI predictions and field data in St. Louis. In contrast, significant discrepancies were observed in Chicago, where simulated ventilation performance did not align with measured conditions, revealing the standard method’s limitations in complex urban topographies. To address these shortcomings, this study proposes four modifications to enhance the model’s accuracy for U.S. Midwest cities: (1) adjusting the model for varying urban morphologies, (2) limiting the calculation scope, (3) implementing a distinct approach for riverine areas, and (4) adopting a plot-based division for areas with large-scale buildings. This research verifies and refines the FAI method, creating a more reliable tool for diverse urban contexts. The optimized approach provides robust support for wind environment analysis, ventilation corridor planning, and UHI mitigation strategies. Full article

Background/Objectives: Low-income compared to high-income women have a higher incidence of and mortality from cervical cancer (CC) due to lower screening rates (under/never-screened). Home-based screening for CC via mailed “self-collection” for human papillomavirus (HPV) testing is an alternative to traditional, provider-collected screening that may be more acceptable to low-income women. Theoretically, adoption of a recent technology, in this case, mailed return of self-collection, is related to the Diffusion of Innovations concepts of advantages and complexity. The purpose of this study was to develop and psychometrically test scales to measure advantages and complexity of self-collection in a low-income, under/never-screened population. Methods: Low-income women (n = 168) were recruited in person from food pantries and online using Facebook in the Midwest U.S. After a baseline survey, women were mailed a self-collection kit. We assessed reliability with item analysis and Cronbach’s α and evaluated validity with exploratory factor analysis and t-tests, using mailed kit return as the independent variable. Results: Two scales were developed: (1) advantages (Cronbach’s α = 0.84), item–total correlation = 0.51 to 0.69, and (2) complexity (Cronbach’s α = 0.82), item–total correlation = 0.45 to 0.64. Exploratory factor analysis supported items factoring on their respective scales, and t-tests supported a relationship between each scale and mailed return of kits. Conclusions: Both the advantages and complexity scales demonstrated reliability and validity among low-income women. Future studies should evaluate these scales in a larger, more diverse population. Nurses could use these scales to assess preferences and difficulties associated with self-collection and aid patients with CC screening decision-making. Full article

La Crosse virus (LACV) is a mosquito-borne virus (family Peribunyaviridae) that can result in severe human infection in children under sixteen. Historically, LACV comprised two lineages, predominantly in the Midwest and Appalachian regions of the US. In 2005, a virus of a third lineage was detected in the Northeast; however, this and subsequently isolated strains of lineage III have not, to date, been implicated in human disease. One hypothesis for this discrepancy is that vector mosquitoes have a reduced vector competency for LACV lineage III, thus preventing horizontal transmission and clinical cases. Here, we utilized two mosquito species, Aedes triseriatus, the native vector, and Aedes albopictus, an invasive potential vector, each from both a historic LACV range (Virginia) and from the region of lineage III (Connecticut). Utilizing oral feeding and intrathoracic inoculation methods of viral exposure, rates of LACV infection, dissemination, and transmission (proxied via salivary secretion) and capability for vertical transmission (proxied via virus-positive ovaries) were determined by harvesting mosquito bodies, legs, saliva, and ovaries, respectively. Overall, we did not detect consistent differences in transmission between any lineage, species, or state of origin, at day 14 post-infection. However, we highlight the transmission potential of LACV lineage III in all mosquito populations tested here, representing the first evidence of lineage III competency in Aedes triseriatus and Aedes albopictus, indicating the potential for human disease. We thus suggest that the absence of human cases of LACV lineage III is not modulated by a lack of vector competency in mosquitoes. Full article

Background: Colorectal cancer (CRC) incidence and mortality have declined in the United States over the past two decades, yet disparities persist by age, sex, race/ethnicity, and geography. To characterize population-level survival signals, we examined trends in age-adjusted incidence rates (AAIR), mortality rates (AAMR), and the mortality-to-incidence ratio (AAMIR) from 1999 to 2021, stratified by key subgroups. Methods: This retrospective analysis utilized de-identified data from the CDC WONDER United States Cancer Statistics database, encompassing incident CRC cases (SEER codes 21041–21052) and deaths (ICD-10 codes C18–C20) in adults aged 20 years and older. Age-adjusted rates (per 100,000, 2000 U.S. standard population) and AAMIR were calculated using Stata 17.0. Joinpoint regression identified trends (annual or average annual percent change [APC/AAPC], p < 0.05). Results: Among 3,489,881 cases and 1,225,986 deaths, AAIR decreased from 78.24 (1999) to 50.79 (2021; AAPC: −2.20%, 95% CI: −2.52 to −1.89), AAMR decreased from 29.34 to 17.92 (AAPC: −2.33%, −2.46 to −2.20), and AAMIR from 0.375 to 0.353 (AAPC: −0.08%, −0.47 to 0.30; p = 0.669). Women showed a significant AAMIR decline (AAPC: −0.29%), unlike men (AAPC: 0.07%). Young adults (20–39 years) had rising AAIR (AAPC: 2.42%) and AAMR (0.87%) but improving AAMIR (AAPC: −1.71%). Non-Hispanic Black individuals had the highest AAMIR (0.400 in 2021; AAPC: −0.54%). The Northeast had the most favorable AAMIR trend (AAPC: −0.40%), while the Midwest, South, and West were stable. States like New Jersey and Massachusetts achieved low AAMIR (0.292 and 0.304 in 2021), contrasting with Nebraska and Arizona (0.402 in both). Conclusions: Although colorectal cancer incidence and mortality have declined substantially in the United States from 1999 to 2021, the mortality-to-incidence ratio improved only marginally and remained markedly uneven across subgroups. Targeted interventions—enhancing screening and treatment access for men, racial/ethnic minorities, younger adults, and high-burden regions and states—can promote equitable outcomes. Full article

Background/Objectives: HPV vaccination uptake among adolescents and young adults in the US remains low, and coverage in the Midwest falls short of the Healthy People 2030 goal of 80%. Methods: A cross-sectional survey of adolescents and young adults was conducted to identify facilitators and barriers to HPV vaccination uptake among adolescents and young adults in the Midwest. Results: Out of 1306 individuals aged 13–26 years, 397 (30.4%) were fully vaccinated (2–3 doses), 124 (9.5%) had received one dose, 324 (24.8%) were unvaccinated, and 461 (35.3%) were unsure of their vaccination status. Awareness of HPV vaccines (OR: 2.4, 95% CI: 1.6, 3.6), beliefs about vaccine effectiveness (OR: 1.8, 95% CI: 1.1, 2.9), family support (OR: 2.3 95% CI: 1.4, 3.8) and knowing someone with cervical cancer (OR: 1.8, 95% CI: 1.2, 2.7) were associated with increased odds of full vaccination. Beliefs in vaccine safety (OR: 2.0, 95%CI: 1.0, 3.9) and having health insurance coverage (OR: 1.9, 95% CI: 1.0, 3.5) were associated with increased odds of initiated vaccination (i.e., receiving at least one dose). Concerns about vaccine side effects (OR: 0.5, 95% CI: 0.3, 0.8) and not receiving recommendations from doctors were significantly associated with decreased odds of full vaccination (OR: 0.5, 95% CI: 0.3, 0.8) or initiated vaccination (OR: 0.5% CI: 0.2, 0.9). Clinician recommendations and awareness also reduced the likelihood of unknown vaccination status. Race-stratified analyses suggested heterogeneity in predictors across racial/ethnic groups. Conclusions: Our findings support the need for multi-level interventions aimed at increasing HPV vaccination initiation and completion in the Midwest. Full article

Quinoa (Chenopodium quinoa Willd) is a nutrient-rich multipurpose crop. Its grains are used as a cereal, green leaves as a vegetable for humans, and the whole green plant as an alternate forage for livestock. Recently, whole-plant quinoa forage has been evaluated in several countries in Asia and Europe for its potential use as an alternative forage for livestock; however, this has not been performed in the United States. We investigated forage yield and related agronomic traits, nutritional composition, and feed quality-related traits in 60-day-old quinoa whole plants of four quinoa lines over a two-year period. The goal was to evaluate the feasibility of quinoa forage production in Missouri, a drought-prone midwestern state of the USA. Morphological traits (height and fresh and dry weight per plant), chemical composition (fiber contents), and nutritive quality (digestible nutrient contents) of forages were affected by quinoa genotype and year of planting. The crude protein content of quinoa forage averaged 16.23% and fiber 22.08%, which was similar to the values reported in Asia and Europe, but was slightly lower than that of alfalfa. Calcium (1.26%) and phosphorus (0.47% dry weight) were significantly higher than those reported in published quinoa forage results and are comparable to those in published alfalfa minerals. Lysine (0.98%) and methionine (0.25%) were higher than the published results for quinoa and alfalfa. Neutral detergent fiber (34.10%) and acid detergent fiber (25.01%) were lower than those of alfalfa, indicating better digestibility of the quinoa forage. The calculated digestible dry matter (69.40%), dry matter intake (3.56%), relative food value (192%), and total digestible nutrient (70.33%) were higher than those of alfalfa and comparable with published results for quinoa forage. Our preliminary results indicate that the quinoa lines evaluated in this study have excellent potential to be used as a non-traditional alternative forage, especially in environmentally stressed areas where the production of other forage crops is limited. Further research should explore the full multipurpose benefits of quinoa, including its use as grains, leafy green, and whole-plant forage. Full article

Although the atmospheric boundary layer height (ABLH) is a highly relevant parameter for various meteorological studies, the analysis of its behavior remains undersampled in South America, especially in Brazil. In this context, this work presents a monthly characterization of the ABLH during the convective period (Convective Boundary Layer Height-CBLH) using radiosonde data and a comparison between the monthly patterns obtained from ERA5 and COSMIC-2 data. The results demonstrate that, based on radiosonde data, the CBLH can be grouped into six regions (Northern Amazon, North, Northeast, Midwest, Southeast, and South), with seasonality varying according to the continentality and the climate to which they are exposed. The ERA5 and COSMIC-2 data show considerable agreement for most of the year [average absolute difference of [362 ± 182] m] and demonstrate the same seasonality observed in radiosondes for the North Amazon, North, Northeast, Southeast, and South regions. The highest discrepancies between ERA5 and COSMIC-2 occur during the fire season, mainly at Midwest region, reaching 802 m in July, likely linked to the sensitivity of the COSMIC-2 to fire plumes. Full article

Cryptosporidiosis is a zoonotic disease of medical and veterinary importance caused by Cryptosporidium spp. This study conducted a systematic review to assess the occurrence and distribution of Cryptosporidium spp. in humans in Brazil, with emphasis on C. parvum. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol and using five databases, 3689 articles were screened, and 48 met the inclusion criteria. Most studies were concentrated in the Southeast Region, particularly São Paulo, while major gaps were identified in the North and Midwest Regions. The mean prevalence was 8.9% using direct methods and 52.2% using indirect methods, with the highest positivity reported in the Northeast Region. Microscopy was the most frequently employed diagnostic tool, although it showed limited ability to differentiate species. When combined with molecular approaches, C. parvum and C. hominis were identified as the predominant species. Infection was most common among children and immunocompromised individuals, especially those with HIV and kidney diseases. Overall, the findings highlight substantial research gaps regarding cryptosporidiosis in Brazil and its disproportionate impact on vulnerable populations. Expanding regional studies, integrating molecular methods for species characterization, and implementing targeted public health strategies are essential to improve epidemiological knowledge and guide prevention and control measures. Full article

Rapid biofuel expansion has significantly reshaped agricultural land use in the United States, raising concerns about the conversion and long-term sustainability of marginal croplands. Understanding how policy incentives influence these land-use changes remains a key challenge in sustainable land management. This study aims to quantify the effects of the Renewable Fuel Standard on cropland expansion and subsequent abandonment in the U.S. Midwest using a probabilistic and spatially explicit framework. The analysis integrates geospatial datasets from USDA, USGS, gridMET, and the U.S. Energy Information Administration, combining indicators of soil productivity, slope, precipitation, temperature, and market accessibility. Bayesian logistic regression models were developed to estimate pre-policy baseline probabilities of corn cultivation and to generate counterfactual scenarios—hypothetical conditions representing land-use patterns in the absence of policy incentives. Results show that over one-quarter of marginal land cultivated in 2016 would likely not have been planted without biopower policy-related incentives, indicating that policy-driven expansion extended into less suitable areas. A second-stage analysis identified regions where such lands were later abandoned, revealing the role of climatic and economic constraints in shaping long-term sustainability. These findings demonstrate the effectiveness of integrating probabilistic modelling with high-resolution spatial data to evaluate causal policy effects and quantify counterfactual impacts—that is, the measurable differences between observed and simulated land-use outcomes. Full article

Despite existing biosecurity frameworks, there is limited empirical evidence on how US swine producers’ beliefs, behaviors, and risk perceptions influence enhanced biosecurity implementation. We conducted an online survey among US swine producers to understand their biosecurity beliefs, behaviors, and practices. We used descriptive, unsupervised machine learning, and Factor Analysis for Mixed Data (FAMD). Of fifty-four respondents, 48.1% reported implementing some biosecurity measures, and 72.2% valued having enhanced biosecurity protocols. Majority (53.7%) considered their veterinarian’s biosecurity opinion most important, and 37% were not concerned about African swine fever. Almost all (90.7%) felt confident they could contain an outbreak on their farms. However, none practiced enhanced biosecurity. The cluster analysis identified four distinct producer profiles (K = 4). Cluster A had young, inexperienced producers operating breeding facilities, with moderate biosecurity adoption. Cluster B included young, small-farm producers with variable biosecurity practices and low mortality rates. Cluster C comprised farms with moderate experience, higher mortality rates, and the lowest biosecurity adoption. Cluster D was composed of older, experienced, educated producers with the highest biosecurity standards and lowest mortality rates. FAMD revealed clustering along human capital and resource availability dimensions. Regular biosecurity assessments, tailored recommendations, and training would improve biosecurity in the swine industry. Full article

In the context of an increasingly hostile national political environment and federal cuts to refugee resettlement programs in the United States, advocates often highlight the economic contributions of immigrants and refugees to garner local support, especially in regions with histories of economic and population decline. While these narratives continue to be a centerpiece of pro-immigrant and -refugee advocacy, in practice advocates and refugees themselves use a diverse set of frames to promote belonging. In this paper, we examine pro-refugee advocacy frames in a small, nontraditional destination in the Midwest. We draw on survey and focus group research with young adult refugees and nonprofit advocates and content analysis of online stories about refugees. We found that pro-refugee values frames (humanitarian and faith-based) and contributions frames (economic, cultural and civic) coexisted across the local landscape and were used by not only nonprofit advocates and local officials, but also by refugees themselves. While advocacy groups emphasized the dominant frame highlighting refugees’ economic contributions, they were also strategic in using overlapping frames to highlight a less public frame, refugees’ contributions to civic engagement through community service and volunteering. Advocates tended to reproduce the economic contributions frame to appeal to key stakeholders, which consequently obscures refugees’ diverse contributions, but we argue that refugee self-advocates’ use of the civic engagement frame pushes back against economic and other frames that limit their contributions and helps them to create spaces of belonging. Full article