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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]

Research Summary: Public mass shootings in the United States have become substantially more deadly over time. We document this increase, offer a model to explain it, review supporting evidence for the model, and present new findings on offenders from 1966 to 2019. It appears that societal changes have led to more public mass shooters who are motivated to kill large numbers of victims for fame or attention, as well as to more shooters who have been directly influenced by previous attackers. They often spend extended time planning their attacks and are increasingly likely to acquire powerful weapons and develop specific strategies to enhance their lethality. Policy Implications: New policies should be aimed at addressing the aforementioned factors. For instance, the deadliest public mass shooters' desires for fame and attention might be countered by a change in media coverage policies. Additionally, the deadliest perpetrators' lengthy planning periods have been associated with more warning signs being reported to police, so that type of information could justify denying many potential attackers access to firearms through extreme risk protection orders and red flag laws. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Clinical care often requires referrals, but many referrals never result in completed evaluations. We determined the extent to which referral-based consultations were completed in a US medical institution. Factors associated with completion were identified. Method In a cross-sectional analysis, we analysed billing records and electronic and paper-based medical records for patients aged 65 years or older receiving health care between July 2000 and June 2002 in an integrated, urban, tax-supported medical institution on an academic campus. All referrals in ambulatory care, scheduling of consultation within 180 days, and completion were assessed. We conducted a multivariate survival analysis to identify factors associated with completion. Results We identified 6785 patients with encounters. Mean age was 72 years, and, of the participants, 66% were women, 55% were African-American and 32% were Medicaid eligible. Of the 81% with at least one primary-care visit in ambulatory care, 63% had at least one referral. About 8% of referrals required multiple orders before an appointment was scheduled. Among 7819 orders for specialty consultation in ambulatory care, 71% led to appointments, and 70% of appointments were kept (completed = 0.71*0.70 or 50%). Scheduling of consultations varied (12% to 90%) by specialty. Medicare, singular orders, location of referral and lack of hospitalization were independently significantly associated with scheduling of appointments. Conclusions Among older adults studied, half of medical specialty referrals were not completed. Multiple process errors, including missing information, misguided referrals and faulty communications, likely contribute to these results. Information systems offer important opportunities to improve the referrals process. [ABSTRACT FROM AUTHOR]

Focuses on the evidence against a constant-difference effect in concurrent-chains schedules in the U.S. Increase of terminal link durations; Difference between terminal links; Concept of delay-reduction theory.

The author focuses on the performance of administrative drug-scheduling processes in dealing with drugs examined by C. Coulson and J. P. Caulkins. The author mentions that four possible Type II errors were discovered by the researchers and found that legislative action is responsible for one probable Type I error. He adds that the single class of benefit from the use of any drug recognized in the conventions and the Controlled Substances Act was noted by the researchers.

Featured here is the program schedule of the Thirty-fifth Annual International Reading Association Convention held in Atlanta, Georgia during May 6-11, 1990. The convention program features an "official" Chapter 1 series of meetings selected by a committee of submitted by Chapter 1 Directors from proposals submitted by Chapter 1 programs. The 77 sessions composing the series are listed below. They also appear in chronological order in the program beginning at 9.00 a.m., Tuesday, May 8, 1990.