Search

Snowfall in the central United States has been shown to be highly variable at interannual timescales and subjected to long‐term linear trends. However, limited understanding is available about the intra‐annual variations and trends in snowfall within this region. Using a selection of GHCN daily snowfall observations and statistical analyses, this study develops a monthly climatology of snowfall characteristics in the central United States from 1948 to 2021. Here we find larger magnitude snowfall events have a greater relative frequency to seasonal snowfall late in the snow season, have increased in frequency in the western and northern regions of the basin, and contribute to a bimodal distribution of monthly snowfall in these sub‐regions. While snowfall has significantly increased over time within the northern and western regions of the domain by as much as 83%, snowfall has significantly decreased by much as 46% in the southern and eastern regions. Further, March snowfall totals and event frequencies have declined across the vast majority of the study domain, with maximum decreases in eastern IA of approximately 50%. When coupled with increases in snowfall and snowfall events in February, this suggests a shift in the snowfall season with time in this portion of the study region. Such results may be of particular interest to snow and water resource managers where integration of the nonstationarity of snowfall events and totals with time into management plans may yield better solutions. [ABSTRACT FROM AUTHOR]

Background: Infusion therapy refers to the intravenous administration of medicines and fluids for the treatment of status migrainosus, severe persistent headaches, or chronic headache. Headache practices and centers offer this treatment for patients as an alternative to the emergency department (ED) setting. However, little information is available in the literature on understanding the operations of an infusion center. Objective: We sought to survey the Inpatient Headache & Emergency Medicine specialty section and the Academic Program Directors listserv of the American Headache Society (AHS) to better understand current practices. Methods: A survey was advertised and distributed to the listservs of both the Inpatient Headache & Emergency Medicine specialty section and the Academic Program Directors, which combined included both academic and private practices. In addition, the survey was available on laptops at related events at an annual AHS meeting in Scottsdale. Results: Of the 127 members of the combined group of both listservs, 50 responded with an overall survey response rate of 39%. Ten out of fifty were from programs with more than one responder completing the survey, leaving 40 unique headache programs. Academic programs made up the majority of programs (85%, 34/40). The total of 40 participating programs is comparable with the 47 academic headache programs listed on the American Migraine Foundation website at the time of the survey. Of the academic programs surveyed, most were hospital based (n = 23) compared with a satellite location (n = 11). Of all programs surveyed, 68% (27/40) offered infusion therapy. Of those that did not have an infusion practice (n = 13), the most common reason cited was insufficient staffing (n = 8). Key highlights of the survey included the following: The majority of programs offering infusions obtain prior authorization before scheduling (70%, 19/27) and offer patient availability 5 days/week (78%, 21/27) typically only during business hours (81%, 22/27). Programs reported that they typically give three to four medications during each infusion session (72%, 18/25). Treatment paradigms varied between programs. Programs surveyed were concentrated in the Northeast and Midwest regions of the United States. Conclusion: The limited number of headache infusion centers overall may contribute to the limited ability of headache infusion centers to prevent ED migraine visits. Headache patients can have unpredictable headache onset, and most of the infusion practices surveyed appeared to adapt to this by offering infusions most days during a work week. However, this need for multiple days per week may also explain the most common reason for not having an infusion practice, which is insufficient staffing. Various treatment paradigms are implemented by different practitioners, and future studies will have to focus on investigation of best practice. [ABSTRACT FROM AUTHOR]