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The concentration of insulin-like growth factor I (IGF-I) was determined in paired specimens of liquid plasma and of plasma that had been applied to a filter paper disk, dried, and eluted; the measurements were performed by an immunochemiluminometric assay (ICMA). The 129 paired assays showed good correlation: y = 1.04x + 4.99; R2 = 0.934, where y is the result on dried samples and x is that on liquid samples. In 18 patients with acromegaly who lived on an island off the West Pacific Rim, plasma specimens were collected, applied to filter paper, dried, and mailed to a laboratory in the Upper Midwest of the United States. IGF-I was eluted from the filter paper disks and measured by ICMA. IGF-I concentrations ranged from 101 to 254 ng/ml in 11 patients with newly diagnosed but untreated acromegaly, 138 to 503 ng/ml in 4 patients with recurrent acromegaly, and 27 to 88 ng/ml in 3 patients with surgically cured acromegaly. These data demonstrate that plasma specimens of patients with acromegaly can be collected on filter paper disks and mailed to a laboratory on a distant continent for measurement of IGF-I. Such use of laboratory resources in one continent to help another continent, "Laboratories Without Borders," is somewhat analogous to the program "Doctors Without Borders."

Identifying tobacco use status is essential to address use and provide resources to help patients quit. Being able to collect this information in an electronic format will become increasingly important, as the Centers for Medicare and Medicaid Services has included the assessment of tobacco use as part of its Stage 1 Meaningful Use criteria. The objective was to compare the accuracy of online vs. paper assessment methods to ascertain cigarette smoking status using a face-to-face structured interview as the gold standard. This was a retrospective analysis of a stratified opportunity sample of consecutive patients, reporting in 2010 for a periodic health evaluation, who completed either a scannable paper-based form or an online questionnaire and underwent a standardized rooming interview. Compared with face-to-face structured interview, the overall observed agreement and kappa coefficient for both methods combined (paper and online) were 97.7% and 0.69 (95% confidence interval (CI) 0.51-0.86) . For the online form they were 97.4% and 0.61 (95% CI 0.33-0.90), and for the paper form they were 97.9% and 0.75 (95% CI 0.54-0.96). There was no statistically significant difference in agreement between the online and paper-based methods (P=0.76) compared with a face-to-face structured interview. Online assessment of tobacco use status is as accurate as a paper questionnaire, and both methods have greater than 97% observed agreement with a face-to-face structured interview. The use of online assessment of tobacco use status has several advantages and more widespread use should be explored.

In the study presented here, we describe our efforts to develop and validate a new measurement tool for perimenopausal menstrual blood loss. We validate this simple-to-use, subjective pencil-and-paper scale, the Mansfield-Voda-Jorgensen Menstrual Bleeding Scale (MVJ), against an objective measure, the weight of used menstrual products. Thirty-one women from the Minneapolis-St. Paul, MN region saved all their used products over three menstrual cycles, storing them in airtight zip bags, and rated their menstrual fluid volume loss using the MVJ. The overall correlation between MVJ scores and log discharge rate was quite high (r = 0.683); all MVJ categories were statistically unique with the exception of categories "1" and "2." The overall fit, then, was particularly good at the heavy bleeding end of the scale. When five women with poor performance were removed, the correlations ranged from 0.480-0.894. The MVJ is a promising tool for identifying women with excessive menstrual bleeding. It is a simple-to-use, pencil-and-paper scale that offers an inexpensive and practical method to clinicians who work with perimenopausal women, the group most vulnerable to unnecessary worry and/or interventions when menorrhagia is incorrectly diagnosed.

Urinary homovanillic (HVA) and vanillylmandelic (VMA) acids were analyzed on 200 random urine samples from patients with neuroblastoma and controls, after the samples had been dried onto absorbent filter paper. The acids were determined quantitatively by gas chromatography (GC) and qualitatively by thin layer chromatography (TLC). The results were analyzed for correlation between liquid urine samples and urine dried on filter paper and between TLC and GC methods. A high overall correlation for HVA and VMA (99%) was found between liquid and dried filter samples analyzed by GC. The correlations were more significant for samples with elevated levels of these acids than for those with normal levels. Normalization of the results to the urinary creatinine concentration (UCr) is indicated due to variations in urine concentration. Results from TLC analysis showed a false positive rate of 3.5% and a false negative rate of 0.5% compared to GC analysis. This work suggests that a combination of a sensitive TLC method with a rapid quantitative GC method would be suitable for mass neuroblastoma screening in infants.

Poleward and uphill range shifts are a common-but variable-response to climate change. We lack understanding regarding this interspecific variation; for example, functional traits show weak or mixed ability to predict range shifts. Characteristics of species' ranges may enhance prediction of range shifts. However, the explanatory power of many range characteristics-especially within-range abundance patterns-remains untested. Here, we introduce a hypothesis framework for predicting range-limit population trends and range shifts from the internal structure of the geographic range, specifically range edge hardness, defined as abundance within range edges relative to the whole range. The inertia hypothesis predicts that high edge abundance facilitates expansions along the leading range edge but creates inertia (either more individuals must disperse or perish) at the trailing range edge such that the trailing edge recedes slowly. In contrast, the limitation hypothesis suggests that hard range edges are the signature of strong limits (e.g. biotic interactions) that force faster contraction of the trailing edge but block expansions at the leading edge of the range. Using a long-term avian monitoring dataset from northern Minnesota, USA, we estimated population trends for 35 trailing-edge species and 18 leading-edge species and modelled their population trends as a function of range edge hardness derived from eBird data. We found limited evidence of associations between range edge hardness and range-limit population trends. Trailing-edge species with harder range edges were slightly more likely to be declining, demonstrating weak support for the limitation hypothesis. In contrast, leading-edge species with harder range edges were slightly more likely to be increasing, demonstrating weak support for the inertia hypothesis. These opposing results for the leading and trailing range edges might suggest that different mechanisms underpin range expansions and contractions, respectively. As data and state-of-the-art modelling efforts continue to proliferate, we will be ever better equipped to map abundance patterns within species' ranges, offering opportunities to anticipate range shifts through the lens of the geographic range., (© 2024 The Author(s). Journal of Animal Ecology © 2024 British Ecological Society.)

Maintaining healthy forests requires multiple individuals, including foresters who develop timber sale silvicultural prescriptions and loggers who implement those prescriptions, resulting in the transplantation of forest health science into workable management plans. However, data on the experiences, attitudes, and opinions of these two groups are often missing when developing or refining forest health treatment strategies. To explore the role that these groups play in sustaining forest health, we examined timber sale administrators' and loggers' perspectives on treatment approaches for eastern spruce dwarf mistletoe (Arceuthobium pusillum) (ESDM), a parasitic plant native to Minnesota that increases mortality and reduces growth rate and regeneration success of black spruce (Picea mariana). While ESDM has been managed for decades in black spruce stands in Minnesota, little is known about the effectiveness of the management approaches. Data were gathered through interviews and focus groups with loggers, as well as an online survey and focus groups with foresters who administer timber sales. Study participants identified a range of field-based barriers, knowledge gaps, and uncertainties that hamper the ability to effectively implement ESDM treatment strategies as designed, including financial, administrative, informational, policy-related, and environmental factors. These factors have a significant bearing on the ability to effectively implement ESDM treatment approaches; yet may be factors that were not known or considered when developing treatment strategies. This case study underscores the value of nurturing a science-management partnership to ensure that a broad set of voices are considered when developing or revising forest health treatment strategies., (© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

Purpose: With decreasing access to rural obstetrical care, this study aimed to identify factors that contribute to the ability of Minnesota's rural communities to continue to offer obstetrical services locally. The study also sought to characterize attributes that differentiate rural communities that continue to offer obstetrical care from those that do not., Methods: Family medicine physicians practicing in communities of fewer than 20,000 people were interviewed through a phone survey that included multiple choice and open-ended questions. Quantitative and qualitative analyses were performed on data collected from the responses., Findings: Within the Minnesota communities represented (N = 25), prenatal care was provided broadly, regardless of whether labor and delivery services were available. For the communities providing local labor and delivery (N = 17), several factors seemed to be key to sustaining these services: having a sufficient cohort of delivering providers, having surgical backup, having accessible confident nurses and nurse anesthetists, sustaining a sufficient annual birth volume at the hospital, and having organizational and administrative support. In addition, supporting anesthesia and analgesic services, access to specialist consultation, having resources for managing and referring both newborn and maternal complications, and sustaining proper equipment were also requisite., Conclusions: Rural Minnesota family medicine physicians practicing in communities providing local labor and delivery care emphasized several essential components for sustainable provision of these services. With awareness of these essential components, rural health care providers, administrators, and policy makers can focus resources and initiatives on efforts that are most likely to support a sustainable and coordinated rural labor and delivery program., (© 2020 National Rural Health Association.)

Minnesota has the largest Somali diaspora in the world. Uniquely, the Minnesotan Somali diaspora utilizes traditional healing practices along with Western medicine. Therefore, medical providers who regularly interact with Somali patients must be aware of traditional healing practices. A scoping review inclusive of three databases (Embase Classic + Embase, Ovid MEDLINE, PsychINFO) was conducted. Fifty-eight studies met established criteria. Traditional medicine is performed with conventional medicine. Illnesses are acknowledged to be caused by a malfunctioning body, evil eye, and/or zar (possession). Examples of the utilization of dawo dhaqmeed (traditional practices) included ilko dacowo (dental enucleation), khat (catha edulis), guboow (use of a fire-heated object), cupping, xoq (scraping), xidhayn (female genital mutilation), duugto (massage), baan (nutrition), herbs, caano geel (camel milk), Qur'anic healing, prayer, zam zam (holy water), tahliil liquid (blessed water), and amulets. Practices ranged from benign to harmful. Identifying Somali traditional healing practices is the first step in understanding the health of the Somali community in Minnesota., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To assess the effectiveness of coronavirus disease 2019 (COVID-19) prevention strategies used during sports participation., Design: To analyze prospective reports of student-athletes with COVID-19-positive tests to assess prevention strategies and risk factors by sports and seasons., Setting: Minnesota high schools., Participants: Fall 2020 (August 24-October 30) and winter 2021 (January 2-March 12) student-athletes., Assessment of Risk Factors: Sports, indoor location, mask use, physical distancing, and season., Main Outcome Measures: COVID-19-positive test rates., Methods: Self-selected schools voluntarily reported, in 2-week intervals, the number of student-athletes with COVID-19-positive tests in each sport and the number of athletes participating in each sport during the fall and winter sports seasons. The positive testing rates per 100 000 athletes were calculated for participants in each sport and compared by sports type and risk variables., Results: The high school age community-positive testing rate was 1298 per 100 000 students in the fall and 2396 in the winter. The student-athlete positive testing rate was 1500 per 100 000 athletes during the fall and 2800 during the winter (χ2 = 1.98, df = 1, P = 0.350). Positive tests per 100 000 athletes ranged from 197 (girls alpine skiing) to 4151 (wrestling). The incidence rates comparing indoor with outdoor sports (P = 0.001) and close-contact with physically distanced sports (P = 0.023) were significantly different, but the incidence rates comparing indoor masked with unmasked sports (P = ns) were not different., Conclusion: Athletes competing in outdoor individual sports have less risk of a COVID-19-positive test compared with age-matched individuals in the community and indoor sports participants either wearing or not wearing masks during competition. Unmasked athletes in close proximity have the highest positive test rates, and unenforced masking is not associated with lower positive testing rates. More study is needed to understand mask effectiveness., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

This article poses a response to one argument supporting the force feeding of political prisoners. This argument assumes that prisoners have moral autonomy and thus cannot be force fed in the early stages of their hunger strike. However, as their fasting progresses, their cognitive competence declines, and they are no longer autonomous. Since they are no longer autonomous, force feeding becomes justified. This article questions the recurrent citation of a paper in empirical support of the claim that hunger strike causes mental disorders or cognitive impairments. The paper, written by Daniel Fessler, partially relies on the Minnesota Starvation Experiment conducted in 1944 to 1945 for scientific support. Using widely accepted criteria for assessing the ethical acceptability of clinical research, we argue that the Minnesota Starvation Experiment had significant scientific shortcomings and is a case of unethical research. From this, we question the appropriateness of citing the Minnesota Starvation Experiment and consequently Fessler's paper. If Citing Fessler's paper becomes problematic, this particular argument for the force feeding of prisoners loses much of its strength., (© 2021. Journal of Bioethical Inquiry Pty Ltd.)

Zizania palustris L. (northern wild rice, NWR) is an aquatic grass native to North America that is notable for its nutritious grain. This is an important species with ecological, cultural and agricultural significance, specifically in the Great Lakes region of the USA. Using flow cytometry, we first estimated the NWR genome size to be 1.8 Gb. Using long- and short-range sequencing, Hi-C scaffolding and RNA-seq data from eight tissues, we generated an annotated whole-genome de novo assembly of NWR. The assembly was 1.29 Gb in length, highly repetitive (approx. 76.0%) and contained 46 421 putative protein-coding genes. The expansion of retrotransposons within the genome and a whole-genome duplication (WGD) after the Zizania-Oryza speciation event have both led to an increase in the genome size of NWR in comparison with Oryza sativa L. and Zizania latifolia. Both events depict a genome rapidly undergoing change over a short evolutionary time. Comparative analyses revealed the conservation of large syntenic blocks between NWR and O. sativa, which were used to identify putative seed-shattering genes. Estimates of divergence times revealed that the Zizania genus diverged from Oryza approximately 26-30 million years ago (26-30 MYA), whereas NWR and Z. latifolia diverged from one another approximately 6-8 MYA. Comparative genomics confirmed evidence of a WGD in the Zizania genus and provided support that the event occurred prior to the NWR-Z. latifolia speciation event. This genome assembly and annotation provides a valuable resource for comparative genomics in the Oryzeae tribe and provides an important resource for future conservation and breeding efforts of NWR., (© 2021 Society for Experimental Biology and John Wiley & Sons Ltd.)

Purpose The International Classification of Functioning, Disability and Health (ICF) Comprehensive Core Set for Vocational Rehabilitation (CSVR) is a shortlist of functioning domains developed for use with people of working age that experience limitation in their work-related functional capacity. Functional capacity can be measured by, for example, Spinal Function Sort pictorial questionnaire and Functional Capacity Evaluation tests such as the: Complete Minnesota Dexterity Test, grip strength test, pushing, pulling, progressive iso-inertial lifting and carrying. However, these tests have not yet been linked to the CSVR. The objective of this study was to evaluate the extent to which the Spinal Function Sort and Functional Capacity Evaluation tests could be mapped to the ICF categories of the CSVR. Methods Two raters independently performed the linking of the Spinal Function Sort and the Functional Capacity Evaluation related tests to the CSVR according to established ICF linking rules. If an item could not accurately be linked to a CSVR category, the item was linked to the most fitting ICF category. Disagreements were resolved in a consensus meeting. Interrater agreement between raters was expressed in percentage agreement. Results The Spinal Function Sort and Functional Capacity Evaluation tests described a total of 39 unique ICF categories, out of which only six (15%) came from the CSVR. Interrater agreement ranged between 17 and 91%. Conclusions The study found six categories including vestibular functions, muscle power functions, writing, lifting and carrying objects, fine hand use and hand and arm use within the CSVR using the Spinal Function Sort and The Complete Minnesota Dexterity Test. With the rest of the items, the CSVR was considered too broad.

The mere threat of predation may incite behavioral changes in prey that lead to community-wide impacts on productivity, biodiversity, and nutrient cycling. The paucity of experimental manipulations, however, has contributed to controversy over the strength of this pathway in wide-ranging vertebrate systems. We investigated whether simulated gray wolf (Canis lupus) presence can induce behaviorally-mediated trophic cascades, specifically, whether the 'fear' of wolf olfactory cues alone can change deer foraging behavior in ways that affect plants and soils. Wolves were recently removed from the Cedar Creek Ecosystem Science Reserve (Minnesota, USA), such that consumptively mediated predator effects were negligible. At 32 experimental plots, we crossed two nested treatments: wolf urine application and herbivore exclosures. We deployed camera traps to quantify how white-tailed deer (Odocoileus virginianus) adjusted their spatiotemporal habitat use, foraging, and vigilance in response to wolf cues and how these behavioral changes affected plant productivity, plant communities, and soil nutrients. Weekly applications of wolf urine significantly altered deer behavior, but deer responses did not cascade to affect plant or soil properties. Deer substantially reduced crepuscular activity at wolf-simulated sites compared to control locations. As wolves in this area predominantly hunted during mornings and evenings, this response potentially allows deer to maximize landscape use by accessing dangerous areas when temporal threat is low. Our experiment suggests that prey may be sensitive to 'dynamic' predation risk that is structured across both space and time and, consequentially, prey use of risky areas during safe times may attenuate behaviorally-mediated trophic cascades at the predator-prey interface.

Background: Early care and education settings (ECE) are potential venues for young children to develop healthy lifestyle habits. The study assesses training needs and associations with relevant practices of licensed ECE providers across Minnesota and Wisconsin., Methods: A random sample of 823 providers completed a 97-item survey assessing nutrition and physical activity (PA) practices and training needs. Logistic regression, adjusted for program type (center- and family home-based), and location (urban/rural) examined associations between the top 3 selected training needs and provider practices., Results: Top training needs: (1) ways to effectively engage parents about healthy eating and PA, (2) low-cost ways to serve healthy foods, and (3) fun and easy nutrition education curricula. Providers who reported being not happy/somewhat happy vs happy/very happy with parent communication were more likely to need training to engage parents. Among providers who prepared food on-site, shopping at Farmer's Market had lower odds of needing training for serving healthy meals on a budget. Not having completed nutrition training in the past year providers were more likely to need training for fun and easy nutrition education curricula., Conclusions: Providers need additional training to improve communication with parents, healthy food shopping practices, and nutrition-related games., (© 2020 American School Health Association.)

Despite representing a sizeable fraction of the canopy, very little is known about leaf sheath gas exchange in grasses. Specifically, estimates of sheath stomatal conductance, transpiration and photosynthesis along with their responses to light, CO 2 and vapour pressure deficit (VPD) are unknown. Furthermore, the anatomical basis of these responses is poorly documented. Here, using barley as a model system, and combining leaf-level gas exchange, whole-plant gravimetric measurements, transpiration inhibitors, anatomical observations, and biophysical modelling, we found that sheath and blade stomatal conductance and transpiration were similar, especially at low light, in addition to being genotypically variable. Thanks to high abaxial stomata densities and surface areas nearly half those of the blades, sheaths accounted for up to 17% of the daily whole-plant water use, which -surprisingly- increased to 45% during the nighttime. Sheath photosynthesis was on average 17-25% that of the blade and was associated with lower water use efficiency. Finally, sheaths responded differently to the environment, exhibiting a lack of response to CO 2 but a strong sensitivity to VPD. Overall, these results suggest a key involvement of sheaths in feedback loops between canopy architecture and gas exchange with potentially significant implications on adaptation to current and future climates in grasses., (© 2020 John Wiley & Sons Ltd.)

Lois Jovanovič (1947-2018) was a trailblazing and relentless clinical endocrinologist and researcher whose innovative approaches to diabetes and pregnancy changed the lives of thousands of women and their babies. Of her many accomplishments, she is best known for devising the diabetes and pregnancy protocols of intensive insulin delivery and glucose control that have made it possible for thousands of women with diabetes to deliver healthy babies and for pioneering the use of insulin analogues in pregnancy. Her research also paved the way for the development of the artificial pancreas. This biographical portrait describes her personal involvement with diabetes, her beginnings as a medical doctor, and highlights her main contributions to the field of diabetes.

Objective: With advancements in surgical equipment and procedures, human-system interactions in operating rooms affect surgeon workload and performance. Workload was measured across surgical specialties using surveys to identify potential predictors of high workload for future performance improvement., Summary Background Data: Surgical instrumentation and technique advancements have implications for surgeon workload and human-systems interactions. To understand and improve the interaction of components in the work system, NASA-Task Load Index can measure workload across various fields. Baseline workload measurements provide a broad overview of the field and identify areas most in need of improvement., Methods: Surgeons were administered a modified NASA-Task Load Index survey (0 = low, 20 = high) following each procedure. Patient and procedural factors were retrieved retrospectively., Results: Thirty-four surgeons (41% female) completed 662 surgery surveys (M = 14.85, SD = 7.94), of which 506 (76%) have associated patient and procedural data. Mental demand (M = 7.7, SD = 5.56), physical demand (M = 7.0, SD = 5.66), and effort (M = 7.8, SD = 5.77) were the highest rated workload subscales. Surgeons reported difficulty levels higher than expected for 22% of procedures, during which workload was significantly higher (P < 0.05) and procedural durations were significantly longer (P > 0.001). Surgeons reported poorer perceived performance during cases with unexpectedly high difficulty (P < 0.001)., Conclusions: When procedural difficulty is greater than expected, there are negative implications for mental and physical demand that result in poorer perceived performance. Investigations are underway to identify patient and surgical variables associated with unexpected difficulty and high workload. Future efforts will focus on re-engineering the surgical planning process and procedural environment to optimize workload and performance for improved surgical care.

Reed canary grass (Phalaris arundinacea L.) is an invasive, cool-season grass commonly dominating wetlands with high nutrient loads. Its impact on nitrogen removal via denitrification in wetlands is unknown. Most studies of denitrification in treatment wetlands have focused on the effects of physical or chemical variables and not on the effects of plant roots on the soil environment. The purpose of this study was to measure effects of plant type on denitrification rates in typical wetland soils of the midwestern United States by comparing wet prairie mix, switchgrass-dominated, and reed canary grass plant communities. Nitrate (NO 3 ) removal and other parameters were measured in miniature wetlands, or mesocosms, containing each plant community transplanted from a small agricultural treatment wetland in southern Minnesota. Quantitative polymerase chain reaction analysis was used to quantify the total bacteria population (measured with 16S rRNA genes) and denitrifying gene abundance (measured with nosZ genes) from the rhizosphere of each plant community. The wet prairie mix mesocosms on average removed the most NO - ) removal and other parameters were measured in miniature wetlands, or mesocosms, containing each plant community transplanted from a small agricultural treatment wetland in southern Minnesota. Quantitative polymerase chain reaction analysis was used to quantify the total bacteria population (measured with 16S rRNA genes) and denitrifying gene abundance (measured with nosZ genes) from the rhizosphere of each plant community. The wet prairie mix mesocosms on average removed the most NO 3 - in each test (p = .01 and .08). Whereas the wet prairie mix removed the most NO 3 - from the surface water (p < .01), reed canary grass removed more from the subsurface (p < .01). Ratios of denitrifying to total bacteria were higher in the wet prairie mix than in the other communities' root zones (p < .05). Results suggest that reed canary grass invasion could reduce denitrification in wetlands, especially during the spring and fall when it is growing but other plants are dormant., (© 2020 The Authors. Journal of Environmental Quality © 2020 American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America.)

As part of ongoing epidemiological studies for assessing the association between exposure to dust from taconite operations and the development of respiratory diseases, the goal of this study was to reconstruct the exposures of workers to elongate mineral particle (EMP) in the Minnesota taconite mining industry from 1955-2010. Historical NIOSH-7400 and equivalent EMP personal exposure data were extracted from two sources: (1) the Mine Safety and Health Administration (MSHA) online database recorded for all inspection results since 1978 with 655 EMP monitoring records from 1978-2010 for 13 MSHA Mine IDs associated with this study; and (2) the mining companies' internal monitoring reports contained 96 personal EMP exposure records. NIOSH-7400 EMP personal exposures were measured for workers in different jobs in all active mines in 2010 by obtaining 1,285 personal samples. After data treatment, all data were grouped into seven mines and eight departments. Within each mine-department, the yearly EMP mean concentration in f/cc for each year of operation was predicted using two approaches. The performance of two approaches varied by situation. The assumptions underlying each approach described in this article have limitations. A linear regression based on limited historical measurements and those made in 2010-2011 (Approach 1) does not yield reasonable and plausible values of the slope. Approach 2 assumes that the EMP and the respirable dust in the same department share the same historical time trend. This approach allowed us to avail of the more reasonable slope estimates from the historical respirable dust data set and yielded more plausible historical exposure estimates for most locations. This work with two different job exposure matrix (JEMs) provides a unique research opportunity to study the potential impact of exposure assessment to epidemiological results. Both JEMs are being used to assess associations between EMP and respiratory disease in epidemiological studies.

Rationale, Aims and Objectives: Checklists have been adopted by various institutions to improve patient outcomes. In particular, readmission prevention checklists may be of potential value to improve patient care and reduce medical costs. As a result, a prior quality improvement study was conducted to create an intensive care unit readmission prevention checklist. The previous pilot demonstrated zero readmissions when the readmission prevention checklist was utilized but yielded low compliance (30%). Thus, a subsequent quality initiative was undertaken to refine the readmission prevention checklist with the primary aim of improved compliance while maintaining a reduced readmission rate that was observed with the original quality improvement study., Method: A single-centre, cross-sectional study for assessing baseline data and a prospective observational study to assess the effectiveness of a refined readmission prevention checklist tool in a 20-bed tertiary medical-surgical intensive care unit at an academic medical centre in Rochester, MN was conducted. Medical patients admitted through the emergency department, upon direct transfer from outside facility, and post-operative surgical patients at our institution were included. A refined readmission prevention checklist tool was administered during an 8-week pilot period for medical and post-operative surgical patients., Results: The refined readmission prevention checklist resulted in an even lower compliance (10.5%) from the initial phase likely resulting from utilization of a paper readmission prevention checklist in an electronic medical environment. Moreover, the refined readmission prevention checklist demonstrated a 22% unplanned readmission rate for patients in which the tool was utilized., Conclusions: In conclusion, the findings of the current quality improvement study may serve to rethink the process of health care delivery that applies paper tools in an electronic medical environment., (© 2014 John Wiley & Sons, Ltd.)

The objective of this study was to evaluate biosecurity practices related to chronic wasting disease (CWD) transmission pathways and prevention in active cervid herds in Minnesota in 2019 by species, size and location of herds. A self-administered questionnaire was sent to all cervid producers in Minnesota to gather demographic, management, and biosecurity practices. Among producers (N=136), 63.2 % raised predominantly deer species and 36.8 % raised predominantly elk or reindeer. Survey responses were analyzed by herd species (deer or elk/reindeer), herd size (<20 or ≥20 animals), and location (southeast Minnesota or rest of the state) to determine statistical differences between strata. In terms of CWD transmission risks from other farmed cervids, 40.4 % (95 % Confidence Intervals (CI) 32.1-48.8) of Minnesota producers stated they introduced new cervids to the operation in the previous 3 years, though there were minimal other forms of direct contact. A higher percentage of larger sized elk/reindeer herds reported practices that indicate potential for indirect contact with other farmed cervids. Vehicles or trailers that entered the farm were used to transport other live cervids, cervid carcasses, or cervid body parts in past 3 years in 64.3 % (95 % CI 46.3-82.3) of larger elk/reindeer herds compared to 13.6 % (95 % CI 4.7-22.4) of smaller deer herds. For CWD transmission risks from wild cervids, limited potential direct contact was reported. Among all producers, 9.6 % (95 % CI 4.6-14.6) reported farmed cervid escapes in the past 3 years (even temporarily) and 0.7 % (95 % CI 0.0-2.2) of producers reported wild white-tailed deer (WTD) inside perimeter fencing. Additionally, 24.3 % (95 % CI 17.0-31.6) of producers observed wild WTD near the perimeter fencing in the past 12 months and 18.7 % (95 % CI 12.0-25.3) reported use of double perimeter fencing, indicating frequent proximity to wild deer and potential for direct and/or indirect contact exposures. Further, 14.3 % (95 % CI 6.7-21.9) of deer herds and 30.0 % (95 % CI 17.1-42.9) of elk herds reported potential access of wild cervids to hay/silage while stored on the farm, with similar results comparing smaller and larger size strata (13.8 % (95 % CI 6.1-21.4) and 29.6 % (95 % CI 17.3-42.0), respectively). Contact through hunting or taxidermy practices occurred infrequently, with the exception of 20.1 % (95 % CI 13.3-27.0) of producers reporting bringing outside hunted cervid parts/carcasses onto property in the past 3 years. Overall, results identified direct and indirect contact exposures from both farmed and wild cervids to Minnesota herds, with many producers reporting potential contact with wild cervids through direct and multiple indirect pathways. Many of these indirect exposures to wild and farmed cervids varied by herd size and species strata. Better understanding of these potential CWD transmission pathways and how differences between herd size and species affect these pathways will facilitate development of more effective biosecurity programs for cervid herds., Competing Interests: Declaration of Competing Interest The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Zebra mussels (Dreissena polymorpha) are invasive species that alter ecosystems and food webs with the potential to affect aquatic mercury cycling and bioaccumulation in fishes, although the effect of zebra mussels on fish tissue mercury has not been tested in inland lakes. We assessed differences in fish tissue mercury concentrations and food webs in Minnesota lakes with and without zebra mussels while controlling for other lake and watershed characteristics. Mercury concentrations in adult walleye (Sander vitreus) and yellow perch (Perca flavescens) were 72 % and 157 % higher, respectively, in lakes containing zebra mussels compared to uninvaded lakes. Mercury in young of year (age-0) fish was also elevated, with mercury concentrations 97 % and 82 % higher in age-0 walleye and yellow perch, respectively, in zebra mussel lakes. Walleye mercury concentrations exceeded 0.22 ppm - a threshold triggering more restrictive human consumption advisories for sensitive populations - at a 23 % smaller size, and average-sized walleye (420 mm) exceeded this threshold at a rate of 77 % in invaded lakes, compared to 35 % in uninvaded lakes. Walleye and yellow perch relied more on littoral resources in lakes with zebra mussels but did not feed at meaningfully higher trophic levels. Increased fish tissue mercury in lakes invaded by zebra mussels have consequential implications for fisheries and human health., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Gretchen Hansen reports financial support was provided by Minnesota Environment and Natural Resources Trust Fund as recommended by the Minnesota Aquatic Invasive Species Research Center (MAISRC) and the Legislative-Citizen Commission on Minnesota Resources (LCCMR). Gretchen Hansen reports financial support was provided by the U.S. Geological Survey (USGS) in cooperation with the National Institutes for Water Resources. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Angiographic evidence of the anatomy of coronary arteries and the type of coronary artery lesions in women with a history of hypertensive disorders of pregnancy (HDP) are poorly documented., Objectives: This study sought to determine the role of a history of HDP as a unique risk factor for early coronary artery disease (CAD) and type of acute coronary syndrome (ACS) (ie, atherosclerotic vs myocardial infarction with nonobstructive coronary arteries [MINOCA]) in women who underwent coronary angiography., Methods: This study used a population-based cohort of parous female patients with incident CAD who underwent coronary angiography and age-matched control subjects. The SYNTAX (Synergy between PCI [percutaneous coronary intervention] with TAXUS [Boston Scientific] and Cardiac Surgery) score was assessed to determine the complexity and degree of CAD; MINOCA was diagnosed in the presence of clinical acute myocardial infarction in the absence of obstructive coronary disease., Results: A total of 506 parous female Olmsted County, Minnesota (USA) residents had incident CAD and angiographic data from November 7, 2002 to December 31, 2016. Women with HDP were younger than normotensive women at the time of the event (median: 64.8 years vs 71.8 years; P = 0.030). There was a strong association between HDP and ACS (unadjusted P = 0.018). Women with HDP compared with women with normotensive pregnancies were more likely to have a higher SYNTAX score (OR: 2.28; 95% CI: 1.02-5.12; P = 0.046), and MINOCA (OR: 2.08; 95% CI: 1.02-4.25; P = 0.044)., Conclusions: A history of HDP is associated with CAD earlier in life and with a future risk for myocardial infarction with both obstructive and nonobstructive coronary arteries. This study underscores the need for timely detection and treatment of nonobstructive disease, in addition to traditional risk factors., Competing Interests: Funding Support and Author Disclosures This study used the resources of the Rochester Epidemiology Project (REP) medical records-linkage system, which is supported by the National Institute on Aging (grant AG 058738), by the Mayo Clinic Research Committee, and by fees paid annually by REP users. The content of this article is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health (NIH) or the Mayo Clinic. Dr Garovic has received support from NIH grant R01HL136348. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: Children with childhood absence epilepsy (CAE) are deemed to be at higher risk of attention deficit hyperactivity disorder (ADHD), however the magnitude of that risk has not been assessed in a population-based study., Methods: The Rochester Epidemiology Project database was used to identify children with a new diagnosis of CAE while resident in Olmsted County, MN between 1980-2018. For each case, four age- and sex-matched controls without epilepsy were identified. Records of cases and controls screening positive for ADHD were reviewed to confirm this diagnosis. Those with comorbid ADHD and CAE were further assessed to determine if the ADHD diagnosis preceded or followed the epilepsy diagnosis, as well as the impact of ADHD treatment on possible seizure exacerbation and long-term epilepsy course., Results: Forty-one cases of CAE were identified and matched to 164 controls. ADHD was diagnosed in 17 children (41.5 %) with CAE and 12 controls (7.3 %) (p < 0.001). Compared to those without epilepsy, the diagnosis of ADHD in CAE was more likely to be made by a mental health professional than a primary care provider (p = 0.047). ADHD in CAE typically followed the diagnosis of CAE and in 7/17 cases, was diagnosed after remission of epilepsy and discontinuation of antiseizure medication. There was no difference in the proportion of cases or controls treated with ADHD medication (16/17 cases and 12/12 controls). Both groups had high likelihood of favorable response to ADHD medication and no child with CAE experienced seizure exacerbation with ADHD treatment., Conclusions: ADHD was 5.7-fold more common in CAE then in children without epilepsy in our population-based study. Treatment with stimulants is highly effective and not associated with worsening of seizures. Primary care providers must be vigilant to carefully screen this population for ADHD., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To decrease the number of inappropriate pages after-hours by 50%., Methods: Over 9 weeks, after-hours pages to the on-call resident at University of Minnesota Department of Urology were documented. Pages were deemed "appropriate" or "inappropriate" by 3 independent reviewers. The source of each page was reviewed and after several plan-do-study-act (PDSA) cycles, 3 separate interventions were created, directed at floor nursing, patient phone calls, and the call triage center. After a 6-week implementation period, data were re-collected for 9 weeks. Descriptive statistics were generated, and a Mann-Whitney U test was used to compare inappropriate pages pre- and post- interventions., Results: In phase I, 48 shifts were recorded. The mean number of pages per shift was 8.9 (range 1-27), with 52.7% of pages considered "inappropriate." Most pages came from the wards (48.9%) followed by the emergency department (20.4%), patient phone calls (19.4%), and the call center (2.6%). From these domains, the call center had the highest proportion of inappropriate pages (90.9%). In phase II, 39 shifts were recorded. The mean number of pages per shift decreased to 6.0 (range 1-20), and inappropriate pages per shift decreased by 68.4%, (P <.0001)., Conclusion: By improving communication to nurses, patients, and call center personnel, inappropriate after-hours pages decreased by 68.4%-exceeding our aim. Future studies are needed to assess if the impact was sustainable over time., Competing Interests: Declaration of Competing Interest Rachel A. Mann: Boston Scientific—consultant/advisor; the remaining authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

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., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

This consensus statement emerges from collaborative efforts among leading figures in critical care cardiology throughout the United States, who met to share their collective expertise on issues faced by those active in or pursuing contemporary critical care cardiology education. The panel applied fundamentals of adult education and curriculum design, reviewed requisite training necessary to provide high-quality care to critically ill patients with cardiac pathology, and devoted attention to a purposeful approach emphasizing diversity, equity, and inclusion in developing this nascent field. The resulting paper offers a comprehensive guide for current trainees, with insights about the present landscape of critical care cardiology while highlighting issues that need to be addressed for continued advancement. By delineating future directions with careful consideration and intentionality, this Expert Panel aims to facilitate the continued growth and maturation of critical care cardiology education and practice., Competing Interests: Funding Support and Author Disclosures Dr Elliott is the director of the Critical Care Cardiology Education Summit; has received grant funding from the American College of Cardiology; and has received educational honoraria from Zoll. Dr Bartos has received grant funding from the National Institutes of Health and the Leona M. and Harry B. Helmsley Charitable Trust. Dr Barnett has received research funding from Merck; and has received educational honorarium from Zoll. Drs Barnett, Alviar, Gage, Horowitz, and Katz are co-course directors of the NYU Langone Critical Care Cardiology Symposium, and the course has received industry support. Dr Roswell is the chair of the American College of Cardiology Critical Care Cardiology member section; and chair-elect of the American Board of Internal Medicine Board of Directors. Dr Alviar has received research funds from Baxter; and has served on the Speakers Bureau for Zoll and Abiomed. Drs Bennett and Jentzer are co-course directors of Heart to Heart: Advances in Cardiovascular Critical Care and Resuscitation. Dr Berg has received institutional grants to Brigham & Women’s Hospital from AstraZeneca and Pfizer; has received honoraria from the Medical Education Speakers Network and USV Private Limited; has received consulting fees from AstraZeneca, MobilityBio, Pfizer, and Youngene Therapeutics; and has served on clinical endpoint committees for studies sponsored by Beckman Coulter, Kowa Pharmaceuticals, and Tosoh Biosciences. Dr Bohula has received personal consulting fees from Novo Nordisk, Servier, and Esperion; has served on an events adjudication committee for Kowa; and has received research support from Regeneron. Drs Dahiya and Senman are the founders of www.ccc1stop.com and CCCEnthusiasts, LLC, which has received unrestricted funding support from Zoll and CardioNerds. Dr Gage has served on the Speakers Bureau (historic) and received honoraria from Abiomed; and has received educational honoraria from Zoll. Dr Higgins has received educational honoraria from Abbott. Dr Horowitz has received research funds from Inari and Penumbra. Dr Katz has served on the data safety monitoring board member for the Abiomed RECOVER IV trial; has received research support from Abbott Corporation; and has received speaker honoraria from Zoll. Dr Lee has received educational honoraria from Getinge. Dr Metkus has received consulting fees/honoraria from TelaDoc, BestDoctors, and Oakstone-EBIX; and receives textbook royalties from McGraw-Hill. Dr Solomon has received intramural research funds from the National Institutes of Health Clinical Center; and is the chair-elect of the American College of Cardiology Critical Care Cardiology member section. Dr Dudzinski is course director of 5C: Concepts in Contemporary Critical Care Cardiology, and this course has received educational grants from Abbott, Abiomed, and Zoll. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Seven public water systems in Minnesota, USA were analyzed from one to five times over a two-year period to assess temporal changes in the concentrations of total bacteria, Legionella spp., and Legionella pneumophila from source (i.e., raw water) through the water treatment process to the end water user. Bacterial biomass was collected by filtering large volumes of raw water (12 to 425 L, median: 38 L) or finished and tap water (27 to 1205 L, median: 448 L) using ultrafiltration membrane modules. Quantitative PCR (qPCR) was then used to enumerate all bacteria (16S rRNA gene fragments), all Legionella spp. (ssrA), and Legionella pneumophila (mip). Total coliforms, Escherichia coli, and L. pneumophila also were quantified in the water samples via cultivation. Median concentrations of total bacteria and Legionella spp. (ssrA) in raw water (8.5 and 4.3 log copies/L, respectively) decreased by about 2 log units during water treatment. The concentration of Legionella spp. (ssrA) in water collected from distribution systems inversely correlated with the total chlorine concentration for chloraminated systems significantly (p = 0.03). Although only 8 samples were collected from drinking water distribution systems using free chlorine as a residual disinfectant, these samples had significantly lower concentrations of Legionella spp. (ssrA) than samples collected from the chloraminated systems (p = 5 × 10 -4 ). There was considerable incongruity between the results obtained via cultivation-independent (qPCR) and cultivation-dependent assays. Numerous samples were positive for L. pneumophila via cultivation, none of which tested positive for L. pneumophilia (mip) via qPCR. Conversely, a single sample tested positive for L. pneumophilia (mip) via qPCR, but this sample tested negative for L. pneumophilia via cultivation. Overall, the results suggest that conventional treatment is effective at reducing, but not eliminating, Legionella spp. from surface water supplies and that residual disinfection is effective at suppressing these organisms within drinking water distribution systems., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Timothy M. LaPara and Raymond M. Hozalski report financial support was provided by Minnesota Environment and Natural Resources Trust Fund. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Study Objective: The aim of this quality improvement (QI) project was to assess postoperative narcotic use after pediatric gynecologic surgeries and establish standard postoperative opioid dosing. Through standard dosing, we hoped to decrease variability in postoperative opioid prescriptions and decrease excess opioid doses in the community., Methods: This quality improvement project was approved by the Children's Minnesota institutional review board. Counseling on postoperative pain management was provided pre- and postoperatively. At the 2-week postoperative visit, patients were asked about the number of opioid doses used and pain control satisfaction. Baseline data were collected for 6 months, with surgeons prescribing the number of opioid doses on the basis of their personal preference. After reviewing the prescribing practices and number of doses used, standard opioid doses were established, and data collection was repeated., Results: Complete data were recorded for 30 cases before implementation of standard doses and for 29 cases after implementation. Standardized opioid dosing resulted in a 30% decrease in total opioid doses in circulation (252 to 176 doses; P = .014) and a 15% reduction in excess doses in circulation (162 to 137 doses). Forty-three percent of patients did not use any opioid doses. There was no significant difference (P = .8818) in patient pain control satisfaction rating., Conclusion: Standard opioid dose prescribing is feasible for common pediatric gynecologic surgeries without affecting patient pain control satisfaction. Opioid dose standardization may decrease opioid circulation within the community. Approximately 2 of every 5 patients used 0 opioid doses, which suggests that a further reduction in the standard dose prescriptions is possible., Competing Interests: Conflicts of Interest The authors of this paper have nothing to disclose., (Copyright © 2024. Published by Elsevier Inc.)

Background: African Americans (AAs) face cardiovascular health (CVH) disparities linked to systemic racism. The 2020 police killing of Mr. George Floyd in Minneapolis, Minnesota, alongside the COVID-19 pandemic, exacerbated adverse psychosocial factors affecting CVH outcomes among AAs. This manuscript describes the study protocol and participant characteristics in an ancillary study exploring the relationship between biopsychosocial factors and CVH among AAs., Methods: Using a community-based participatory approach, a mixed-methods ancillary study of 58 AA participants from an overarching randomized control trial (RCT) was conducted. Baseline RCT health assessments (November 2020) provided sociodemographic, medical, and clinical data. Subsequent health assessments (February-December 2022) measured sleep quality, psychosocial factors (e.g., high-effort coping), biomarkers (e.g., cortisol), and cardiovascular diagnostics (e.g., cardio-ankle vascular index). CVH was assessed using the American Heart Association Life's Simple 7 (LS7) (range 0 to 14, poor to ideal) and Life's Essential 8 (LE8) scores (range 0 to 100, low to high). Correlations between these scores will be examined. Focus group discussions via videoconferencing (March to April 2022) assessed psychosocial and structural barriers, along with the impact of COVID-19 and George Floyd's killing on daily life., Results: Participants were predominantly female (67%), with a mean age of 54.6 [11.9] years, high cardiometabolic risk (93% had overweight/obesity and 70% hypertension), and moderate LE8 scores (mean 57.4, SD 11.5)., Conclusion: This study will enhance understanding of the associations between biopsychosocial factors and CVH among AAs in Minnesota. Findings may inform risk estimation, patient care, and healthcare policies to address CVD disparities in marginalized populations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Mitral annular calcification (MAC) is a progressive degenerative process associated with comorbidities and increased mortality. A staging system that considers extramitral cardiac damage in MAC may help improve patient selection for mitral valve interventions., Objectives: This study sought to develop a transthoracic echocardiogram (TTE)-based cardiac staging system in patients with MAC and significant mitral valve dysfunction and assess its prognostic utility., Methods: We retrospectively evaluated all adults who underwent TTE over 1 year at Mayo Clinic with MAC and significant mitral valve dysfunction defined as mitral stenosis and/or at least moderate mitral regurgitation. Patients were categorized into 5 stages according to extramitral cardiac damage by TTE. All-cause mortality and heart failure hospitalization were assessed., Results: For the 953 included patients, the mean age was 76.2 ± 10.7 years, and 54.0% were women. Twenty-eight (2.9%) patients were classified in stages 0 to 1, 499 (52.4%) in stage 2, 115 (12.1%) in stage 3, and 311 (32.6%) in stage 4. At the 3.8-year follow-up, mortality was significantly higher in patients in stages 2 to 4 compared to stages 0 to 1 and increased with each stage. Survival differences were maintained after adjustment for age, diabetes mellitus, and glomerular filtration rate. The rate of heart failure hospitalization was significantly higher in stages 3 and 4 compared to stages 0 to 1. Similar results were observed in subgroup analysis in patients with moderate or severe MAC, predominant mitral stenosis, or predominant mitral regurgitation., Conclusions: Using the proposed extramitral cardiac damage staging system in patients with MAC and significant mitral valve dysfunction, more advanced stages are associated with higher mortality., Competing Interests: Funding Support and Author Disclosures Dr Guerrero has received institutional research grant support from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

The role of the Nurse Scientist in clinical settings represents a relatively new career path that has garnered attention in recent literature. Although there is considerable variability in how this role is operationalized across institutions, Mayo Clinic stands out as one of the few health systems in the United States employing nurse scientists who are fully and exclusively engaged in their own programs of research. Given the need for practical information to guide development and implementation of a research-focused nurse scientist role, the purpose of this paper is to describe the infrastructure and resources supporting Mayo Clinic nurse scientists, share role expectations and metrics for success, discuss both the facilitators of success and ongoing challenges, and compare our current practices to those found in the literature., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Climate change will shift the composition of northern Minnesota forests from boreal to temperate by the end of the century. This shift in forest composition will likely affect outdoor recreation, a valuable ecosystem service and a key economic driver for the region. In this context, the objective of our paper is to empirically examine the relationship between forest composition and recreation. We analyze the effect of changes in forest composition for seven forest types on seven types of recreation using a lognormal pooled panel regression model for Minnesota's Laurentian Mixed Forest Province. Earlier research showed forest composition affected recreation at the level of broad groups of broadleaved or coniferous species. We find a statistically significant empirical association between forest composition and recreation at the forest type level (forest types within those broad groups). This relationship varies across forest types and recreation categories. For example, big game hunting is positively related to elm-ash-cottonwood and white-red-jack pine and negatively associated with aspen-birch. We find individual forest types within broad groups of broadleaved or coniferous forests, have different relationships with recreation, so that these broad groups are not sufficient in capturing the effect of forest composition on recreation. Our results are of interest in the context of current shifts in forest composition caused by climate change, which could also affect recreation. Our findings suggest adding a forest composition lens to existing policies could facilitate strategies for more effective recreation management and climate change adaptation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Objective: The Non-Opioid Pain Alleviation Information Network (NOPAINMN) project was designed to identify, consolidate, and map evidence-based non-opioid and non-pharmacological pain management complementary and integrative health (CIH) modalities for chronic pain management across Minnesota into a searchable and informational website (www.nopainmn.org ). Methods: The Academic Consortium for Integrative Medicine & Health's Pain Task Force White Paper identifying evidence-based research of non-pharmacological pain practice (NPPC) was reviewed and referenced. National and state certifying boards and accrediting organizations for NPPC modalities were accessed to identify Minnesota-based NPPC providers' name, business/health-system affiliation, address, contact information, and credentials. The NOPAINMN website displays these data in a consumer-facing website with searchable fields such as NPPC modality type, and location with varying distances. The website was β-tested by practitioners and stakeholders for optimization. Eight main NPPC modalities and their respective subcategories were identified and mapped: Acupuncture; Integrative Medical Care (Functional medicine consultation and Integrative medicine consultation); Massage Therapy; Mind-Body Therapies (Biofeedback, Clinical Hypnosis, Mindfulness-Based Stress Reduction, and Music Therapy); Movement Therapies (Tai Chi, qigong , and Yoga Therapy); Psychology (Cognitive Behavioral Therapy); Rehabilitative Therapies (Physical and Occupational Therapy); and Spinal Manipulation. Results: All information compiled resulted in 17,155 providers/practitioners. Physical Therapy had the greatest number of reported providers ( n  = 5224), followed by Occupational Therapy ( n  = 3792), Psychology ( n  = 3324), Chiropractic ( n  = 3033), Acupuncture ( n  = 591), and Massage Therapy ( n  = 544). The Resource Map included 56 major health systems, 686 facilities, 2651 solo or private group practices, and 14 academic training schools. With web-based cross-referencing, providers and facilities were affiliated and linked with health systems to produce an interconnected mapping system. β-Testing with patients found that the website was reported as relatively easy to use and informative. Conclusion: The website was created to assist individuals, health care providers, insurance carriers, and health care facilities in finding evidence-based information and resources on NPPC to guide, support, and proactively manage and engage chronic pain patients across Minnesota.

Purpose: The Child Friendly Cities Initiative (CFCI) is a UNICEF framework based on the UN Convention on the Rights of the Child (CRC). CFCI was launched globally in 1996 to protect children's rights throughout the world. There are child friendly cities in over 44 countries around the globe, but none presently in the United States. The purpose was to establish a Child Friendly City in the United States., Description: Child friendly cities are a child-rights and equity-based approach designed to ensure all children in a community reach their full potential for optimal health, development, and well-being. The paper discusses the development of the guiding principles of the CFCI-Minneapolis Model as well as a community needs assessment., Assessment: The assessment consisted of a digital survey of 60 questions on the SurveyMonkey platform. The sample included 173 Minneapolis youth 10-18 years of age and 85 parents with children less than five years of age. The participants were drawn from four of the 83 Minneapolis neighborhoods that had the highest concentration of children and youth, communities of color, and immigrant families that have historically been under resourced., Conclusion: The results of the community assessment guided the development of four programmatic initiatives. These included child rights learning & awareness, emergency preparedness & planning, community safety, and youth participation in decision making. The paper concludes with the lesson learned to date in the implementation of the CFCI-Minneapolis Model. These include partnership, dedication, leadership, community engagement, coalition building, and celebrating success. CFCI-Minneapolis received full designation from UNICEF USA as a child friendly city in February 2024., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: To determine factors associated with intention to receive recommended COVID-19 booster vaccines in 2023-2024., Methods: A cross-sectional study of 1,256 individuals at Minnesota State and County fairs was conducted to assess their intention to receive a COVID-19 booster vaccine in the coming year if recommended. The association between booster intention and multiple factors believed to influence willingness to receive the vaccine, including perceived vaccine safety, perceived risk of COVID-19, public health knowledge, fear of future pandemics, and political affiliation, were analyzed using ordinal logistic regression and adjusted odds ratios (aOR)., Results: Intention to receive a COVID-19 booster vaccine was high among our participants with 56% reporting they were extremely likely to receive the vaccine this year and another 15% reporting that they were likely to do the same. A strong association with getting a booster vaccine was found between perceived vaccine safety (aOR: 15.3, 95% CI: 10.6-22.2), perceived COVID-19 risk (aOR: 3.5, 95% CI: 2.4-5.1), pandemic fear (aOR: 3.4, 95% CI: 2.4-4.8), public health knowledge (aOR: 1.3, 95% CI: 0.9-1.8), and democrat political affiliation (aOR: 2.8, 95%CI: 1.8-4.4)., Conclusions: Our study emphasizes the importance of perceived vaccine safety as a predictor of intention to accept COVID-19 vaccines and highlights the continued need to effectively communicate with the public about the safety of vaccines., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: As of 2020, 20% of people residing in the United States of America (U.S.) lived in rural communities. Despite rural residents tending to be older, poorer, and having greater disease burden than their urban counterparts, the number of rural primary care providers continues to decline. Nearly 66% of U.S. Primary Care Health Professional Shortage Areas are designated as rural. Pharmacists can help address this shortage of rural primary care providers, often serving as providers of first-contact care; however, only 12% of U.S. pharmacists practice in rural communities. To help address this gap, in 2022 an elective Rural Pharmacy course was created at the University of Minnesota College of Pharmacy by a faculty member who has rural practice experience., Methods: The course combines formal lectures, guest presentations by rural pharmacists and student interviews with additional rural pharmacists. For the 42 students enrolled in the course in 2022 and 2023, non-parametric statistics were used to compare the percentage of students who were raised in rural communities or who otherwise had extensive exposure to rural, and compare student interest ratings (1 to 7) about practicing/living rural at the beginning and end of the course. Students also wrote end-of-course reflection papers, commenting on the course and their interviews with rural pharmacists., Results: Across both years, 45% of the enrolled students had previous experience in rural communities. The net change in Rural Interest scores among students completing both questionnaires was + 5 in 2022 and + 2 in 2023, both non-significant differences. The largest shifts in student interest were from "Not Sure" at the start of the course to "Interested" or "Not Interested" at the end of the course, and from "Interested" to "Very Interested." In their reflection papers nearly 60% of students reported being most impressed by their interviews with rural pharmacists., Conclusions: A course addressing the benefits and challenges of practicing pharmacy in rural communities was well-received by pharmacy students. Even students who have little interest in living in a rural community can benefit from being introduced to rural culture, enabling them to provide more culturally-responsive care for patients from rural communities., (© 2024. The Author(s).)

Excess non-point nutrient loading continues to impair urban surface waters. Because of the potential contribution of tree litterfall to nutrient pollution in stormwater, street sweeping is a promising management tool for reducing eutrophication in urban and suburban regions. However, nutrient concentrations and loads of material removed through street sweeping have not been well characterized, impeding the development of pollution reduction credits and improvement of models for stormwater management. We evaluated the role of canopy cover over streets, street sweeper type, season, and sweeping frequency in contributing to variation in concentrations and loads of nitrogen (N), phosphorus (P), and solids recovered in street sweepings, using analyses of samples collected during regular street sweeping operations in five cities in the Minneapolis-St. Paul Metropolitan Area, Minnesota, USA. We expected that nutrient concentrations and loads would be highest in seasons and places of higher tree litterfall. We also expected that regenerative-air sweepers would recover higher loads compared to mechanical broom sweepers. Total N and P concentrations in sweepings increased most strongly with canopy cover in June, October, and November. Total N and P recovered in street sweepings similarly increased with canopy cover in June, October, and November, and peaked in early summer and autumn, times of high litterfall. In contrast, total dry mass in sweepings was greatest in early spring, following winter snowmelt. However, nutrient loads and concentrations did not differ between sweeper types. Our results add to growing evidence of the importance of street trees in contributing nutrient pollution to urban surface waters. Street sweeping focused on high-canopy streets during early summer and autumn is likely an effective management tool for stormwater nutrient pollution., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Increased awareness of oral health disparities in the United States has highlighted the need to expand the workforce and access to both primary and preventive dental care. Achieving oral health equity will require new dental team members with appropriate clinical skills dedicated to reaching historically marginalized populations through intra and interprofessional practice. Collective efforts by health care advocates in Minnesota led to legislation that created a dental hygiene-based workforce model inspired by the vision and foresight of the American Dental Hygienists' Association's "Advanced Dental Hygiene Practitioner." In July 2023, there were 141 licensed dental therapists and 99 certified advanced dental therapists, with the majority being dual-licensed dental hygienists/dental therapists, providing primary care services in a variety of settings throughout the state. Current data confirm their contributions to increasing access to primary oral health care services for Minnesotans across the lifespan. While surmountable challenges remain, new opportunities are emerging for dental therapists within Minnesota's transforming health care system. The purpose of this paper is to describe the implementation of this new workforce model in Minnesota, its challenges and successes to assist other states in developing new models for intraprofessional dental team members., (Copyright © 2023 The American Dental Hygienists’ Association.)

Objectives: This study characterized variation in e-cigarette use patterns and related protective factors by ethnicity among Asian American adolescents., Methods: Multivariable logistic regressions modelled associations between ethnic group, 6 protective factors (college aspirations, internal developmental assets, positive teacher engagement, family caring, and peer and parent anti-smoking norms), and past 30-day e-cigarette use, adjusting for covariates among 10,482 8th, 9th, and 11th grade Asian American respondents to the 2019 Minnesota Student Survey. Interaction terms (protective factor × ethnic group) were used in 6 subsequent regression models to examine whether the association between each protective factor and e-cigarette use differed as a function of ethnic group., Results: Respondents included 9.0% Indian, 0.3% Burmese, 7.9% Chinese, 2.5% Filipino, 25.0% Hmong, 3.2% Karen, 4.6% Korean, 2.7% Laotian, 8.2% Vietnamese, 7.5% other, 7.5% multi-ethnic, and 21.6% multi-racial adolescents. E-cigarettes were the predominant form of tobacco use. Laotian and multi-racial groups reported the highest e-cigarette use (16.6% and 16.3%), whereas Chinese and Asian Indians reported the lowest (4.7% and 5.0%). Strong peer anti-smoking norms, higher internal developmental assets scores, and positive teacher engagement were associated with lower odds of e-cigarette use across groups, with significant interactions for internal developmental assets by ethnicity., Conclusions: E-cigarettes are the most prevalent tobacco product used by Asian adolescents in Minnesota, with notable heterogeneity by ethnicity. While most established protective factors appeared to function similarly for Asian adolescents, others differed, underscoring the importance of disaggregating data by ethnicity to inform the tailoring of prevention and control strategies for these ethnic groups., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The objective of this study was to evaluate risks related to introduction of Chronic Wasting Disease (CWD) to farmed cervid herds in Minnesota (MN), Pennsylvania (PA), and Wisconsin (WI). This was the first study to evaluate risk factors related to multiple pathways of CWD transmission to farmed cervid herds. Participating herds in this case-control study included 22 case and 49 control herds identified through participation in the respective mandatory State CWD herd program. Data was voluntarily collected from white-tailed deer (WTD) study herds using a questionnaire and state animal health agency databases. Univariable analyses identified associations between CWD-positive herds and variables representing different transmission pathways, including direct contact with infected farmed cervids (imported from a herd that later tested positive for CWD) odds ratio (OR):7.16, 95 % confidence intervals (CI):1.64-31.21 and indirect contact with infected wild cervids (access of domestic cats to pens or feed storage area) OR:4.07, 95 % CI:1.35-12.26, observed evidence of mammalian scavengers inside or outside of fenceline in the previous 12 months OR:6.55, 95 % CI:1.37-31.32, ≤ 5 km distance to nearest detected CWD-positive wild cervid OR:3.08, 95 % CI:1.01-9.39, forested area crosses the perimeter fenceline OR:3.54, 95 % CI:1.13-11.11, ≤ 0.3 m distance of water source to fenceline OR:4.71, 95 % CI:1.60-13.83, and water source shared with wild cervids (running or standing water) OR:4.17, 95 % CI:1.34-12.92. Three variables from univariable analyses that represented different biological transmission pathways were placed in a Firth's penalized maximum likelihood multivariable logistic regression to evaluate associations between transmission pathway and CWD herd infection status. For the issue of low sample size and overfitting, 95 % CIs for estimated coefficients for the three variables were computed via bootstrapping of 10,000 independent bootstrap samples. The three biological variables were significantly associated with herd CWD infection status: imported cervids from a herd that later tested positive for CWD (OR:5.63; 95 % CI:1.1-28.2), ≤ 0.3 m distance of cervid water source to perimeter fenceline (OR:4.83; 95 % CI:1.5-16.1), and ≤ 5 km distance to nearest detected CWD-positive wild cervid (OR:4.10; 95 % CI:1.1-15.2). The risk factors associated with CWD herd status identified in this study indicated the importance of transmission through direct contact pathways with infected cervid herds (introduction of cervids from herds later identified as CWD-infected) and indirect contact pathways with infected wild cervids that could be related to other animals through the perimeter fence. Further studies are needed to confirm and clarify understanding of indirect pathways to allow development of improved biosecurity practices to prevent CWD introduction to cervid herds., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)