Shared morphological consequences of global warming in North American migratory birds

Increasing temperatures associated with climate change are predicted to cause reductions in body size, a key determinant of animal physiology and ecology. Using a four‐decade specimen series of 70 716 individuals of 52 North American migratory bird species, we demonstrate that increasing annual summer temperature over the 40‐year period predicts consistent reductions in body size across these diverse taxa. Concurrently, wing length – an index of body shape that impacts numerous aspects of avian ecology and behaviour – has consistently increased across species. Our findings suggest that warming‐induced body size reduction is a general response to climate change, and reveal a similarly consistent and unexpected shift in body shape. We hypothesise that increasing wing length represents a compensatory adaptation to maintain migration as reductions in body size have increased the metabolic cost of flight. An improved understanding of warming‐induced morphological changes is important for predicting biotic responses to global change.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153188/1/ele13434-sup-0001-Supinfo.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153188/2/ele13434.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153188/3/ele13434_am.pd

Professional agency vs consumer directed care workers: Outcomes in managed care

Direct care workers are a major part of the long-term services and supports (LTSS) needed to address the health of individuals and accounted for $112 billion in United States spending in 2015. Direct care workers are hired within professional agency models (PAMs) or consumer-directed models (CDMs) where workers (including family) are contracted by the individual to obtain services. We sought to identify differences in cost and utilisation outcomes between PAM and CDM participants. Data were obtained from the University of Pittsburgh Medical Center (UPMC) Insurance Services Division from the participants enrolled in UPMC Community HealthChoices in Pennsylvania during 2018. A retrospective, observational cohort study design was performed using claims data. Utilisation outcomes were assessed using multivariate logistic regression and cost outcomes by linear regression. The 3,232 participants met the inclusion criteria. Of these, 69% (N = 2,217) were in a PAM, 23% (N = 752) were in a CDM, and 8% (N = 263) used a combination of services. PAM groups were older (mean 62.4 years vs 54.1 years), more likely to be women (69.0% vs 62.8%), and had more healthcare needs. Hospital utilisation was the same among groups. However, total cost was lower in CDM groups due to differences in LTSS costs between CDM and PAM services. Among dually eligible Medicare and Medicaid beneficiaries receiving LTSS, there are significant differences in age, gender, race and health needs. While hospital utilisation was not different between groups, CDM groups had lower total costs of care compared to PAM. These findings have implications for families, policymakers and insurers in helping to govern community LTSS while supporting member autonomy

Chicago collision data

Records of collisions from McCormick Place (MP) and the rest of Chicago (CHI) used in the analyses in this paper

Data from: Nocturnal flight-calling behaviour predicts vulnerability to artificial light in migratory birds

Understanding interactions between biota and the built environment is increasingly important as human modification of the landscape expands in extent and intensity. For migratory birds, collisions with lighted structures are a major cause of mortality, but the mechanisms behind these collisions are poorly understood. Using 40 years of collision records of passerine birds, we investigated the importance of species’ behavioral ecologies in predicting rates of building collisions during nocturnal migration through Chicago, IL and Cleveland, OH, USA. We found that use of nocturnal flight calls is an important predictor of collision risk in nocturnally migrating passerine birds. Species that produce flight calls during nocturnal migration collided with buildings more than expected given their local abundance, whereas those that do not use such communication collided much less frequently. Our results suggest that a stronger attraction response to artificial light at night in species that produce flight calls may mediate these differences in collision rates. Nocturnal flight calls likely evolved to facilitate collective decision-making during navigation, but this same social behavior may now exacerbate vulnerability to a widespread anthropogenic disturbance. Our results also suggest that social behavior during migration may reflect poorly-understood differences in navigational mechanisms across lineages of birds

A telemedicine bridge clinic improves access and reduces cost for opioid use disorder care

Objective: We evaluated the impact of a telemedicine bridge clinic on treatment outcomes and cost for patients with opioid use disorder. Telemedicine bridge clinics deliver low-barrier rapid assessment of patients with opioid use disorder via audio-only and audiovisual telemedicine to facilitate induction on medication therapy and connection to ongoing care. Methods: A pre-post analysis of UPMC Health Plan member claims was performed to evaluate the impact of this intervention on the trajectory of care for patients with continuous coverage before and after bridge clinic visit(s). Results: Analysis included 150 UPMC Health Plan members evaluated at the bridge clinic between April 2020 and October 2021. At least one buprenorphine prescription was filled within 30 days by 91% of patients; median proportion of days covered by buprenorphine was 73.3%, 54.4%, and 50.6% at 30, 90, and 180 days after an initial visit compared to median of no buprenorphine claims 30 days prior among the same patients. Patients had an 18% decline in unplanned care utilization 30 days after initial Bridge Clinic visit, with a 62% reduction in unplanned care cost per member per month (PMPM), 38% reduction in medical cost PMPM, and 10% reduction in total PMPM (medical + pharmacy cost) at 180 days. Primary care, outpatient behavioral health, and laboratory costs increased while emergency department, urgent care, and inpatient costs declined. Conclusion: Utilization of a telemedicine bridge clinic was associated with buprenorphine initiation, linkage to ongoing care with retention including medication treatment, reduced unplanned care cost, and overall savings

Knee Osteoarthritis and the Risk of Medically Treated Injurious Falls Among Older Adults: A Community‐Based US

ObjectiveThe risk of falls among adults with knee osteoarthritis (OA) has been documented, yet, to our knowledge no studies have examined knee OA and the risk of medically treated injurious falls (overall and by sex), which is an outcome of substantial clinical and public health relevance.MethodsUsing data from the Health Aging and Body Composition Knee Osteoarthritis Substudy, a community-based study of white and African American older adults, we tested associations between knee OA status and the risk of injurious falls among 734 participants with a mean ± SD age of 74.7 ± 2.9 years. Knee radiographic OA (ROA) was defined as having a Kellgren-Lawrence grade of ≥2 in at least 1 knee. Knee symptomatic ROA (sROA) was defined as having both ROA and pain symptoms in the same knee. Injurious falls were defined using a validated diagnosis code algorithm from linked Medicare fee-for-service claims. Cox regression modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs).ResultsThe mean ± SD follow-up time was 6.59 ± 3.12 years. Of the 734 participants, 255 (34.7%) had an incident injurious fall over the entire study period. In the multivariate model, compared with those without ROA or pain, individuals with sROA (HR 1.09 [95% CI 0.73-1.65]) did not have a significantly increased risk of injurious falls. Compared with men without ROA or pain, men with sROA (HR 2.57 [95% CI 1.12-5.91]) had a significantly higher risk of injurious falls. No associations were found for women or by injurious fall type.ConclusionKnee sROA was independently associated with an increased risk of injurious falls in older men, but not in older women

Knee Osteoarthritis and the Risk of Medically Treated Injurious Falls Among Older Adults: A Community‐Based US Cohort Study

ObjectiveThe risk of falls among adults with knee osteoarthritis (OA) has been documented, yet, to our knowledge no studies have examined knee OA and the risk of medically treated injurious falls (overall and by sex), which is an outcome of substantial clinical and public health relevance.MethodsUsing data from the Health Aging and Body Composition Knee Osteoarthritis Substudy, a community-based study of white and African American older adults, we tested associations between knee OA status and the risk of injurious falls among 734 participants with a mean ± SD age of 74.7 ± 2.9 years. Knee radiographic OA (ROA) was defined as having a Kellgren-Lawrence grade of ≥2 in at least 1 knee. Knee symptomatic ROA (sROA) was defined as having both ROA and pain symptoms in the same knee. Injurious falls were defined using a validated diagnosis code algorithm from linked Medicare fee-for-service claims. Cox regression modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs).ResultsThe mean ± SD follow-up time was 6.59 ± 3.12 years. Of the 734 participants, 255 (34.7%) had an incident injurious fall over the entire study period. In the multivariate model, compared with those without ROA or pain, individuals with sROA (HR 1.09 [95% CI 0.73-1.65]) did not have a significantly increased risk of injurious falls. Compared with men without ROA or pain, men with sROA (HR 2.57 [95% CI 1.12-5.91]) had a significantly higher risk of injurious falls. No associations were found for women or by injurious fall type.ConclusionKnee sROA was independently associated with an increased risk of injurious falls in older men, but not in older women