American Indians travel great distances for obstetrical care: Examining rural and racial disparities.

Rural, American Indian/Alaska Native (AI/AN) people, a population at elevated risk for complex pregnancies, have limited access to risk-appropriate obstetric care. Obstetrical bypassing, seeking care at a non-local obstetric unit, is an important feature of perinatal regionalization that can alleviate some challenges faced by this rural population, at the cost of increased travel to give birth. Data from five years (2014-2018) of birth certificates from Montana, along with the 2018 annual survey of the American Hospital Association (AHA) were used in logistic regression models to identify predictors of bypassing, with ordinary least squares regression models used to predict factors associated with the distance (in miles) birthing people drove beyond their local obstetric unit to give birth.

Impacts of the US southeast wood pellet industry on local forest carbon stocks.

We assessed the net impacts of a wood-dependent pellet industry of global importance on contemporaneous local forest carbon component pools (live trees, standing-dead trees, soils) and total stocks. We conducted post-matched difference-in-differences analyses of forest inventory data between 2000 and 2019 to infer industrial concurrent and lagged effects in the US coastal southeast. Results point to contemporaneous carbon neutrality.

Nested-Solution Facility Location Models.

Classical facility location models can generate solutions that do not maintain consistency in the set of utilized facilities as the number of utilized facilities is varied. We introduce the concept of nested facility locations, in which the solution utilizing facilities is a subset of the solution utilizing facilities, for all ≤ < ≤ , given some lower limit and upper limit on , the number of facilities that will be utilized in the future. This approach is demonstrated with application to the -median model, with computational testing showing these new models achieve reductions in both average regret and worst-case regret when ≠ facilities are actually utilized.

Evaluating disparities in access to obstetric services for American Indian women across Montana.

Purpose: Pregnant women across the rural United States have increasingly limited access to obstetric care, especially specialty care for high-risk women and infants. Limited research focuses on access for rural American Indian/Alaskan Native (AIAN) women, a population warranting attention given persistent inequalities in birth outcomes.

Methods: Using Montana birth certificate data (2014-2018), we examined variation in travel time to give birth and access to different levels of obstetric care (i.

Assessment of the Effect of Urban Agriculture on Achieving a Localized Food System Centered on Chicago, IL Using Robust Optimization.

In this work, nonrobust (average yield) and robust (varying yield) optimization techniques were applied to find the minimum radius required from the center of Chicago, Illinois, United States (U.S.) and land area by type to meet the population's nutritional needs given yield data for conventional and urban agricultural products.

Expansion of US wood pellet industry points to positive trends but the need for continued monitoring.

Implementation of the European Union Renewable Energy Directive has triggered exponential growth in trading of pelletized wood fibers. Over 18 million tons of wood pellets were traded by EU member countries in 2018 of which a third were imported from the US. Concerns exist about negative impacts on US forests but systematic assessments are currently lacking.

Diabetes management at community health centers: Examining associations with patient and regional characteristics, efficiency, and staffing patterns.

A major source of primary health care for millions of Americans, community health centers (CHCs) act as a key point of access for diabetes care. The ability of a CHC to deliver high quality care, that supports patients' management of their diabetes, may be impacted by the unique set of resources and constraints it faces, both in terms of characteristics of its patient population and aspects of operations. This study examines how patient and regional characteristics, staffing patterns, and efficiency were associated with diabetes management at CHCs (percentage of patients with uncontrolled diabetes, HbA1C > 9%).

Operational efficiency, patient composition and regional context of U.S. health centers: Associations with access to early prenatal care and low birth weight.

Community health centers (CHCs) provide comprehensive medical services to medically under-served Americans, helping to reduce health disparities. This study aimed to identify the unique compositions and contexts of CHCs to better understand variation in access to early prenatal care and rates of low birth weights (LBW). Data include CHC-level data from the Uniform Data System, and regional-level data from the US Census American Community Survey and Behavioral Risk Factor Surveillance System.

Measuring efficiency of community health centers: a multi-model approach considering quality of care and heterogeneous operating environments.

Over 1300 federally-qualified health centers (FQHCs) in the US provide care to vulnerable populations in different contexts, addressing diverse patient health and socioeconomic characteristics. In this study, we use data envelopment analysis (DEA) to measure FQHC performance, applying several techniques to account for both quality of outputs and heterogeneity among FQHC operating environments. To address quality, we examine two formulations, the Two-Model DEA approach of Shimshak and Lenard (denoted S/L), and a variant of the Quality-Adjusted DEA approach of Sherman and Zhou (denoted S/Z).