Predicting pharmacy naloxone stocking and dispensing following a statewide standing order, Indiana 2016

BACKGROUND: While naloxone, the overdose reversal medication, has been available for decades, factors associated with its availability through pharmacies remain unclear. Studies suggest that policy and pharmacist beliefs may impact availability. Indiana passed a standing order law for naloxone in 2015 to increase access to naloxone. OBJECTIVE: To identify factors associated with community pharmacy naloxone stocking and dispensing following the enactment of a statewide naloxone standing order. METHODS: A 2016 cross-sectional census of Indiana community pharmacists was conducted following a naloxone standing order. Community, pharmacy, and pharmacist characteristics, and pharmacist attitudes about naloxone dispensing, access, and perceptions of the standing order were measured. Modified Poisson and binary logistic regression models attempted to predict naloxone stocking and dispensing, respectively. RESULTS: Over half (58.1%) of pharmacies stocked naloxone, yet 23.6% of pharmacists dispensed it. Most (72.5%) pharmacists believed the standing order would increase naloxone stocking, and 66.5% believed it would increase dispensing. Chain pharmacies were 3.2 times as likely to stock naloxone. Naloxone stocking was 1.6 times as likely in pharmacies with more than one full-time pharmacist. Pharmacies where pharmacists received naloxone continuing education in the past two years were 1.3 times as likely to stock naloxone. The attempted dispensing model yielded no improvement over the constant-only model. CONCLUSIONS: Pharmacies with larger capacity took advantage of the naloxone standing order. Predictors of pharmacist naloxone dispensing should continue to be explored to maximize naloxone access

Estimating Atrazine Leaching in the Midwest

Data from seven Management Systems Evaluation Areas (MSEM) were used to test the sensitivity of a leaching model, PRZM-2, to a variety of hydrologic settings common in the Midwest. Atrazine leaching was simulated because the use of atrazine was prevalent in the MSEA studies and it frequently occurs in the region\u27s groundwater. Results of long-term simulations using regional and generalized input parameters produced ranks of leaching potential similar to those based on measurements. Short-term simulations used site-specific soil and chemical coefficients

Climate Change Sensitivity Assessment on Upper Mississippi River Basin Streamflows Using SWAT

The Soil and Water Assessment Tool (SWAT) model was used to assess the impacts of potential future climate change on the hydrology of the Upper Mississippi River Basin (UMRB). Calibration and validation of SWAT were performed on a monthly basis for 1968-87 and 1988-97, respectively; R2 and Nash-Sutcliffe simulation efficiency (E) values computed for the monthly comparisons were 0.74 and 0.65 for the calibration period and 0.81 and 0.75 for the validation period. The impacts of eight 20-year (1971- 90) scenarios were then analyzed, relative to a scenario baseline. A doubling of atmospheric CO2 concentrations was predicted to result in an average annual flow increase of 35 percent. An average annual flow decrease of 15 percent was estimated for a constant temperature increase of 4°C. Essentially linear impacts were predicted among precipitation change scenarios of -20, -10, 10, and 20 percent, which resulted in average annual flow changes at Grafton, Illinois, of -51, -27, 28, and 58 percent, respectively. The final two scenarios accounted for variable monthly temperature and precipitation changes obtained from a previous climate projection with and without the effects of CO2 doubling. The resultant average annual flows were predicted to increase by 15 and 52 percent in response to these climatic changes. Overall, the results indicate that the UMRB hydrology is very sensitive to potential future climate changes and that these changes could stimulate increased periods of flooding or drought

Evaluation of EPIC for Three Minnesota Cropping Systems

The Erosion Productivity Impact Calculator (EPIC) model was tested using four years of field data collected at a site near Lamberton, Minnesota, under three different crop rotations: continuous corn (Zea mays L.) or CC, soybean (Glycine max L.)-corn (SC), continuous alfalfa (Medicago sativa L.) or CA. The model was evaluated by comparing measured versus predicted subsurface drainage flow (tile flow), nitratenitrogen (NO3-N) loss in tile flow, residual NO3-N in the soil profile, crop N uptake, and yield. Initially, EPIC was run using standard Soil Conservation Service (SCS) runoff curve numbers (CN2) suggested for the soil type at the site. Two different SC runs were performed with a nitrogen fixation parameter denoted as parm(7) set at either 1.0 or 0.3, reflecting uncertainty for this parameter. Under this scenario, EPIC accurately tracked monthly CC and SC variations of tile flow (r2 = 0.86 and 0.90) and NO3- N loss (r2 = 0.69 and 0.52 or 0.62). However, average annual CC and SC tile flows were under-predicted by 32 and 34 percent, and corresponding annual NO3-N losses were under-predicted by 11 and 41 or 52 percent. Predicted average annual tile flows and NO3-N losses improved following calibration of the CN2; CC and SC tile flow under-predictions were -9 and -12 percent while NO3-N losses were 0.6 and -54 or -24 percent. In general, EPIC reliably replicated the impacts of different crop management systems on nitrogen fate; e.g., greater N loss under CC and SC than CA, and less residual soil N under CA as compared to the other cropping systems. The simulated CA monthly tile flows and NO3-N losses also compared poorly with observed values (r2 values of 0.27 and 0.19). However, the predicted CA annual drainage volumes and N losses were of similar magnitude to those measured, which is of primary interest when applying models such as EPIC on a regional scale

Validation of EPIC for Two Watersheds in Southwest Iowa

The Erosion Productivity Impact Calculator (EPIC) model is validated using long-term data collected for two southwest Iowa watersheds that have been cropped in continuous corn under two different tillage systems. The annual hydrologic balance was calibrated during 1988-94 by adjusting the runoff curve numbers and residue effects on soil evaporation. Model validation was performed for 1976-87 using both summary statistics and parametric and nonparametric statistical tests. Overall, results show that EPIC was able to replicate the long-term relative differences between the two tillage systems

The Economics of Dead Zones: Linking Externalities from the Land to their Consequences in the Sea

The purpose of this review and analysis is to provide a basic understanding of the issues related to worldwide hypoxic zones and the range of economic questions sorely in need of answers. We begin by describing the causes and extent of hypoxic zones worldwide, followed by a review of the evidence concerning ecological effects of the condition and impacts on ecosystem services. We describe what is known about abatement options and cost effective policy design before turning to an analysis of the large, seasonally recurring hypoxic zone in the Gulf of Mexico. We advance the understanding of this major ecological issue by estimating the relationship between pollutants (nutrients) and the areal extent of the hypoxic zone. This “production function” relationship suggests that both instantaneous and legacy contributions of nutrients contribute to annual predictions of the size of the zone, highlighting concerns that ecologists have raised about lags in the recovery of the system and affirms the importance of multiple nutrients as target pollutants. We conclude with a discussion of critical research needs to provide input to policy formation

Climate Change Sensitivity Assessment on Upper Mississippi River Basin Streamflows using SWAT

The Soil and Water Assessment Tool (SWAT) model was used to assess the effects of potential future climate change on the hydrology of the Upper Mississippi River Basin (UMRB). Calibration and validation of SWAT were performed using monthly stream flows for 1968–1987 and 1988–1997, respectively. The R2 and Nash-Sutcliffe simulation efficiency values computed for the monthly comparisons were 0.74 and 0.69 for the calibration period and 0.82 and 0.81 for the validation period. The effects of nine 30-year (1968 to 1997) sensitivity runs and six climate change scenarios were then analyzed, relative to a scenario baseline. A doubling of atmospheric CO2 to 660 ppmv (while holding other climate variables constant) resulted in a 36 percent increase in average annual streamflow while average annual flow changes of −49, −26, 28, and 58 percent were predicted for precipitation change scenarios of −20, −10, 10, and 20 percent, respectively. Mean annual streamflow changes of 51,10, 2, −6, 38, and 27 percent were predicted by SWAT in response to climate change projections generated from the CISRO-RegCM2, CCC, CCSR, CISRO-Mk2, GFDL, and HadCMS general circulation model scenarios. High seasonal variability was also predicted within individual climate change scenarios and large variability was indicated between scenarios within specific months. Overall, the climate change scenarios reveal a large degree of uncertainty in current climate change forecasts for the region. The results also indicate that the simulated UMRB hydrology is very sensitive to current forecasted future climate changes

Effects of Training on Social Work, Nursing and Medical Trainees' Knowledge, Attitudes and Beliefs Related to Screening and Brief Intervention for Alcohol Use

Indiana University's Schools of Social Work, Nursing and Medicine formed a consortium to advance education for Screening Brief Intervention and Referral to Treatment (SBIRT). Trainees participated in SBIRT training and completed data collection before, immediately after, and 30 days after a face-to-face training. The study explored participants' perceptions about the training and the likelihood of implementing SBI in practice, including attitudes and beliefs that may be predictive of SBIRT utilization in clinical practice. Results show the training targeting SBI and MI behaviors may improve participants' self-reported competence with SBI. This improvement was consistent and strong in all programs. The study results also provided a preliminary indication that the training affected participants' perception of time utilization and compensation for performing SBI