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Similar to national trends, in Illinois, fatal opioid overdoses have risen. Black men (35+) outrank all other racial subgroups for the highest rate of fatal opioid overdoses in the state. To address this, Prevention First and the Illinois Department of Human Services developed a public health education campaign to support increasing enrollment in recovery services, with a focus on Black men (35+). Self-reported Black participants with opioid use disorder (OUD) made up the analytic sample. Study goals were to understand lived experiences of the campaign audience; investigate knowledge, attitudes, and beliefs regarding OUD and treatment; explore perceived barriers and facilitators to treatment; and evaluate messaging that showcased medication-assisted recovery (MAR) as a viable tool for treatment and recovery. Interviews were recorded and transcribed for thematic analysis. Participants shared long and cyclical journeys of use and recovery. Participants had low levels of knowledge of available treatment options and struggled to imagine themselves in recovery because of the fear of cravings and withdrawal. Messaging that was realistic about the cyclical nature of recovery, showed the varying options for MAR, and addressed cravings and withdrawals were well received. These findings illustrate the importance of understanding an audience and involving them in campaign development to create messaging that promotes behavior change and sustained health. Through the Decision Blocks strategic framework, we discovered information gaps, barriers to treatment, and practical solutions to increase access to treatment for Black men with OUD that has been limited due to inequities caused by structural racism., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DJ, DW, PN, and GA are employed by Rescue Agency, which received funding through Prevention First for this study. KZ is employed by Prevention First, which funded this study from a grant administered by the Illinois Department of Human Services Division of Substance Use Prevention and Recovery.

The Hyde Amendment prohibits US federal spending on abortion, including federal Medicaid dollars. Seventeen states cover abortion care in their Medicaid programs, using state funds, but causal evidence on how Medicaid coverage for abortion affects pregnancy outcomes is limited. Using a difference-in-differences design and 2014-21 birth and abortion data from the Centers for Disease Control and Prevention that predate the US Supreme Court's Dobbs decision in 2022, we evaluated a 2018 policy introducing Medicaid coverage for abortion in Illinois. This change increased the number of abortions in the state by 2.43 per 1,000 reproductive-age females, an 18.2 percent increase, and reduced births by 1.66 per 1,000 reproductive-age females, a 2.8 percent decrease, relative to twenty-nine comparison states that did not cover abortion during the study period. Subgroup analyses of birth rates suggested that decreases in birth rates were more pronounced among Black and Hispanic residents, residents in counties with higher poverty rates, and residents closer to an abortion facility. Our finding suggests that Medicaid can play an important role in abortion access.

Introduction: Recovery support workers (RSWs) who provide social support interventions for people who use drugs (PWUD) often face challenges that can jeopardize the well-being, efficacy and sustainability of this essential workforce. To date, little has been reported on the types of implementation strategies used to support RSWs. We describe and evaluate a multifaceted implementation strategy package to support Reducing Opioid Mortality in Illinois (ROMI), a paired peer recovery coach and case manager (PRC-CM) intervention for PWUD with recent criminal-legal involvement in urban and rural settings., Methods: ROMI utilized a remote, hub and spoke-administered multifaceted implementation strategy package to support PRCs-CMs to deliver evidence-based services to PWUD with criminal-legal involvement. The core strategies included: (a) comprehensive training; (b) individual clinical supervision; (c) group consultation; and (d) centralized technical assistance. We evaluated the implementation strategy package using a mixed-methods design including qualitative interviews with the intervention staff to explore their experiences with each strategy component, as well as a quantitative coding of topics discussed during supervision and group consultation meetings to estimate prioritization of issues and balance of topics between strategy type., Results: Between January 2019 and January 2024, the study interviewed 8 PRC-CMs and quantitatively coded 568 sessions (79 group consultations and 489 individual supervisory) for discussion themes. The hub-and-spoke model allowed for centralized access to highly skilled supervisory staff as well as knowledge sharing across geographically remote teams. The therapeutic space to process feelings and emotional support provided during individual supervision was noted to be an essential resource by PRC-CMs. Group consultation facilitated camaraderie, mutual support and continual learning through dynamic and responsive trainings. Frustrations around resource limitations and systemic barriers facing their clients remained a dominant concern for PRCs-CMs, and was incompletely addressed by the technical assistance strategy., Conclusion: Understanding the practical components and individual strengths of the implementation strategies required to support the implementers of complex interventions such as social support and navigation for PWUD with criminal-legal involvement elucidates the organizational and professional capacities that may be required for real world implementation., Trial Registration: NCT04925427., Competing Interests: Declaration of competing interest This work was supported by a grant from the National Institute on Drug AbuseUG1 DA050066. The funder had no role in the design, data collection, analysis, and interpretation of this study., (Copyright © 2024. Published by Elsevier Inc.)

Background: This article presents a model of how farmers choose to custom hire for pest control. The decision-making process is illustrated through a discrete choice experiment conducted via a pilot survey of soybean growers in Michigan, Illinois, and Indiana. Farmers responded to a hypothetical pest infestation by choosing between custom operators, spraying on their own, or leaving the field to its fate., Results: Among farmers who choose to spray, the mean willingness to pay for marginal increases in timeliness (as defined as the chance of late spraying) ranges from 37 to 52 cents per acre. We also find that farmers more averse to risk are more sensitive to custom operator timeliness and that farmers with better-developed social networks are less sensitive to the risk of delay., Conclusion: The results of this study can motivate future research into the drivers of on-farm decision-making, especially as it relates to custom hire behavior in pest control and other field operations. © 2024 The Author(s). Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry., (© 2024 The Author(s). Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.)

Climate adaptation is vital for agriculture to manage the growing risks from more frequent droughts, floods, and extreme heat. Yet, adaptation measures remain underused in some of the most agriculturally productive regions, such as the U.S. Cornbelt. Cover crops represent a growing but still underutilized adaptation measure that offers co-benefits to farmers and society. In this study we examine farmers' perceptions of cover crops as a climate adaptation tool and explore the potential for integrating cover crops into existing crop insurance. We surveyed 1023 farmers in Illinois, Indiana, and Iowa to examine what factors shape cover crop acreage, intensity (percent of farm with cover crops), and farmers' future cover crop plans through negative binomial and ordered logit regression models. In addition, we explored farmers' views on policy changes to incorporate the use of cover crops into crop insurance decisions. We found that farmers largely do not perceive extreme weather as a factor in their cover crop decisions, but they do see cover crops as effective in mitigating some impacts of extreme weather. Nearly twice as many farmers reported neutral or improving cash crop yields following cover crops as those who reported declining cash crop yields. Perceptions of negative cash crop yield responses correlated to fewer acres, lower intensities, and plans for fewer cover crops, while positive yield responses only predicted plans to increase cover crops. Program enrollment, self-efficacy, and reduced tillage were all associated with higher cover crop intensities, acres, and plans. Farm size was positively correlated with more acres of cover crops but also lower intensities. Farmers were interested in crop insurance discounts and carbon markets as policy instruments but ranked cost-share programs as their top option overall. Future research should further explore the link between training, experience, and financial costs to inform what policy instruments will most effectively support scaling up cover crop adoption., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Maternal deaths resulting from opioid use disorder have been increasing across the United States. Opioid use disorder among pregnant persons is associated with adverse pregnancy outcomes, including preterm birth, along with racial disparities in optimal opioid use disorder care., Objective: This study aimed to evaluate whether the Illinois Perinatal Quality Collaborative implementation of the Mothers and Newborns affected by Opioids - Obstetric quality improvement initiative was associated with improvement in opioid use disorder identification, provision of optimal opioid use disorder care for birthing patients, and reduction in racial gaps in optimal opioid use disorder care., Study Design: Using a prospective cohort design, hospitals reported monthly key measures for all patients with opioid use disorder at delivery between July 2018 and December 2020. The Illinois Perinatal Quality Collaborative facilitates collaborative learning opportunities, rapid response data, and quality improvement support. Generalized linear mixed-effects regression models were used to evaluate improvement in optimal opioid use disorder care, including increases in linkages to medication-assisted treatment, recovery treatment services, and naloxone counseling across time, and to determine whether optimal opioid use disorder care was associated with positive outcomes, such as lower odds of preterm birth., Results: A total of 91 hospitals submitted data on 2095 pregnant persons with opioid use disorder. For the primary outcomes, the rates of patients receiving medication-assisted treatment and recovery treatment services improved across the initiative from 41% to 78% and 48% to 67%, respectively. For the secondary outcomes, the receipt of recovery treatment services and both recovery treatment services and medication-assisted treatment provided prenatally before delivery admission was associated with lower odds of preterm birth (adjusted odds ratio: 0.67 [95% confidence interval, 0.50-0.91] and 0.49 [95% confidence interval, 0.31-0.75], respectively). During the first quarter of the initiative, Black patients with opioid use disorder were less likely to be linked to medication-assisted treatment than White patients (23% vs 48%, respectively); however, an increase in medication-assisted treatment rates across the initiative occurred for all patients, with the greatest improvement for Black patients with an associated reduction in this disparity gap with >70% of both Black and White patients linked to medication-assisted treatment., Conclusion: The Mothers and Newborns affected by Opioids - Obstetric initiative was associated with improvement in optimal opioid use disorder care for pregnant patients across Illinois hospitals, additionally racial disparities in opioid use disorder care was reduced across the initiative. Our findings implicate how optimal opioid use disorder care can improve pregnancy outcomes and close persistent racial gaps for pregnant individuals with opioid use disorder., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This study assesses the first statewide program to provide simulation training conducted via videoconference to all new caseworkers. The simulation training in Illinois was conducted at a mock house. A mock family played by standardized clients is physically present, and trainees participate remotely. The program evaluation team implemented a survey that asks trainees to rate their confidence in different skills at multiple timepoints, to appraise the quality of feedback and debriefing of the training team, and to write text responses to the questions regarding their learning experience. Analysis of quantitative data over the course of the training showed statistically significant linear increases in trainees' confidence for all the 14 skills. Their text responses indicated that they received feedback they appreciated and felt they gained ability on a range of different skills. The simulation training makes a valued and effective contribution to the certification training.

Nutrient export of nitrogen and phosphorus from row crop agriculture in the Upper US Midwest is a threat to the structure and function of aquatic systems. To meet Environmental Protection Agency (EPA) nutrient reduction goals, the Upper US Midwest needs to implement strategies to reduce nutrient export from agriculture. Studies demonstrate the potential of cover crops to reduce the export of nitrate-nitrogen from the Upper US Midwest. We investigated the impact of the economically viable winter cash cover crop pennycress (Thlaspi arvense) on soil porewater nutrients and soil nutrients and characteristics. We used nine replicated 0.8 ha plots (n = 3 per treatment) at a production scale research farm over 4 years with pennycress and fertilized pennycress (56 kg ha -1 of urea) treatments compared to a fallow reference. Over the study period, soil porewater nitrate-nitrogen was reduced by 53% in pennycress plots and 34% in fertilized pennycress plots relative to the fallow reference at a depth of 45 cm. Early season establishment was crucial in providing nutrient reduction potential. In 2021, poor pennycress establishment resulted in porewater nitrate-nitrogen concentrations 141% higher than in 2022 with excellent pennycress establishment. Following pennycress termination, soil nitrate-nitrogen was reduced by 24% in pennycress and 26% in fertilized pennycress compared to the fallow reference in the top 30 cm of soil. Following 4 years of pennycress planting, nitrate-nitrogen concentrations were significantly reduced with no broad effect on soil characteristics. We conclude that the novel pennycress crop has potential to reduce nutrient loss from row crop agriculture in the Upper US Midwest., (© 2024 The Author(s). Journal of Environmental Quality published by Wiley Periodicals LLC on behalf of American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America.)

Objectives: This exploratory study aims to: 1) evaluate mental health stigma levels among agricultural youth directors, 2) examine the influence of professional characteristics on stigma, and 3) investigate the relationship between agricultural youth directors' stigma levels and their self-efficacy., Methods: An online survey was administered from March to May 2022 to 642 agricultural youth directors in Illinois who work with youth aged 1-19. Directors' personal and perceived stigmas toward mental illness were measured using the Depression Stigma Scale. Directors' self-efficacy (perceived level of knowledge and confidence) across 19 mental health topics was measured using a 3-point Likert scale. Analyses were conducted by generating descriptive statistics and performing Mann-Whitney U tests on the data., Results: The median personal depression stigma score was 7.57 (SD = 8.02). Our analyses identified significantly higher personal depression stigma scores among men, FFA advisors, agricultural educators, and those lacking personal experience with mental illness. A lack of self-efficacy correlated significantly with increased personal stigma., Conclusions: This study underscores the critical need for targeted educational interventions to reduce stigma among agricultural youth directors and enchance mental health literacy. Anti-stigma and mental health literacy initiatives are essential for fostering a supportive environment that encourages open discussions about mental health issues with youth within the agricultural community.

Pumping surface water from a ditch into a denitrifying woodchip bioreactor could improve nitrate-nitrogen (N) removal by minimizing flow variabilities such as early flow cessation at a given subsurface drainage outlet and flashy drainage hydrographs. Few field-scale subsurface drainage bioreactors with pumping configurations have been assessed. Such evaluations would help better bound reasonable expectations of the benefits and drawbacks at these more advanced bioreactors. An underloaded "ditch diversion" bioreactor constructed in 2018 in Illinois, USA (LW: 4.6 × 9.1 m), was retrofitted with a solar-powered pumping system in 2021 and was then monitored for a 29-d period in 2022 and a 93-d period in 2023. The pumped bioreactor achieved N removal rates averaging 7.5 and 5.2 g N/m 3 -d and N removal efficiencies of 50 and 61% for the monitoring periods in 2022 and 2023, respectively. Pumping generally improved the bioreactor's performance compared to the same monitoring windows from the historic (non-pumped) 2019-2021 periods. Regression analysis indicated the addition of a pump slightly improved N load removal compared to what might be expected for a conventional bioreactor. The somewhat unintended diurnal batch mode operation resulting from the solar-powered pumping system boosted water temperature in the overnight batches. Bioreactor performance can be improved with a pump, especially at underloaded sites, but the additional complexity and cost need to be carefully weighed., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Laura Christianson reports financial support was provided by USDA NRCS. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Monitoring water quality and river ecosystems is vital for maintaining public health and environmental sustainability. Over the past decade, data-driven methods have been extensively used for river water quality modeling, including dissolved oxygen (DO) concentrations. Despite advancements, challenges persist regarding accuracy, scalability, and adaptability of data-driven models to diverse environmental conditions. Previous studies primarily employed singular models or basic combinations of machine learning techniques, lacking advanced integration of adaptive mechanisms to process complex and evolving datasets. The current study introduces innovative hybrid models that integrate temporal pattern attention (TPA) mechanisms with advanced neural networks, including feed-forward neural networks (FFNNs) and long short-term memory networks (LSTMs). This approach leverages the synergistic strengths of individual models, significantly enhancing the accuracy of DO predictions. The models were rigorously tested against water quality data obtained from two distinct riverine environments, the Illinois River (ILL) and Des Plaines River (DP). Daily measured water quality data, including DO, chlorophyll-a, nitrate plus nitrite, water temperature, specific conductance, and pH, from 2017 to 2024 provided a robust foundation for comprehensive analysis of DO dynamics in these rivers. We conducted 10 scenarios with different model inputs, wherein the hybrid TPACWRNN-LSTM-10 model particularly excelled, achieving coefficient of determination values of 0.993 and 0.965, and root mean squared errors of 0.241 mg/L and 0.450 mg/L for DO predictions at the ILL and DP stations, respectively. The model's reliability was further confirmed by Willmott's index values of 0.998 and 0.992 and Nash-Sutcliffe efficiency values of 0.990 and 0.961 at the ILL and DP stations, respectively. Additionally, Shapley additive explanations (SHAP) values were utilized to interpret each predictor's contribution, revealing key drivers of DO predictions. We believe the novel hybrid modeling approach presented in this study could benefit utilities and water resource management systems for predicting water quality in complex systems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background and Objectives: Diet plays critical roles in modulating maternal metabolic health in pregnancy, but is also a source of metabolic-disrupting phthalates and their replacements. We aimed to evaluate whether the effects of better diet quality on favorable maternal metabolic outcomes could be partially explained by lower exposure to phthalates/replacements., Methods: At 13 weeks gestation, 295 Illinois women (enrolled 2015-2018) completed a three-month food frequency questionnaire that we used to calculate the Alternative Healthy Eating Index (AHEI)-2010 to assess diet quality. We quantified 19 metabolites, reflecting exposure to 10 phthalates/replacements, in a pool of five first-morning urine samples collected monthly across pregnancy. We measured 15 metabolic biomarkers in fasting plasma samples collected at 17 weeks gestation, which we reduced to five uncorrelated principal components (PCs), representing adiposity, lipids, cholesterol, inflammation, and growth. We used linear regression to estimate associations of diet quality with [1] phthalates/replacements and [2] metabolic PCs, as well as [3] associations of phthalates/replacements with metabolic PCs. We estimated the proportion of associations between diet quality and metabolic outcomes explained by phthalates/replacements using a causal mediation framework., Results: Overall, every 10-point improvement in AHEI-2010 score was associated with -0.15 (95% CI: -0.27, -0.04) lower adiposity scores, reflecting lower glucose, insulin, C-peptide, leptin, C-reactive protein, but higher adiponectin biomarker levels. Every 10-point increase in diet quality was also associated with 18% (95%CI: 7%, 28%) lower sum of di-2-ethylhexyl terephthalate urinary metabolites (∑DEHTP). Correspondingly, each 18% increase in ∑DEHTP was associated with 0.03 point (95% CI: 0.01, 0.05) higher adiposity PC scores. In mediation analyses, 21% of the inverse relationship between diet quality and adiposity PC scores was explained by lower ∑DEHTP., Conclusions: The favorable impact of diet quality on maternal adiposity biomarkers may be partially attributed to lower metabolite concentrations of DEHTP, a plasticizer allowed to be used in food packaging materials., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Braun served as an expert witness in litigation related to perfluorooctanonic acid contamination in drinking water in New Hampshire. The other authors have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Harm reduction for people who use drugs (PWUD) is an established evidence-based practice that encompasses a wide variety of services, delivery formats, and settings and has been named a priority in US drug policy. Harm reduction is focused on planning with communities and meeting PWUD where they are and encompasses a wide variety of interventions. We describe and report the feasibility, acceptability, and process implementation outcomes for an innovative pilot drug overdose harm reduction intervention, Block-by-Block (BXB), focused on training for and distribution of naloxone and test strips in areas identified as high risk for fatal overdoses., Case Presentation: Beginning operations in 2022, BXB operates in five pilot sites in four Illinois counties. Through partnerships with local organizations, BXB delivers harm reduction services in a private setting (home) or in a setting not specifically focused on serving PWUD (businesses, libraries, faith-based organizations, etc.) to reach PWUD and their friends, family and neighbors living in areas disproportionately affected by opioid overdose death. The intervention theory is based on acknowledgement that harm reduction services that require PWUD to visit a mobile unit, van or community organization, may not reach those in need or their friends, neighbors, and family for a variety of reasons including stigma associated with drug use, lack of awareness about these services, or where to locate them. Services delivered include education and training in the use of naloxone and fentanyl, xylazine and benzodiazepine test strips. Leave behind materials include naloxone, test strips and handouts with information on the intervention and local resources., Conclusions: Results to date indicate that this intervention is feasible -over half (55%) of the doors approached were answered. Acceptability of the intervention as delivered is high --people at 75% of doors that were answered were interested in and received training and/or supplies. BXB is flexible in that it has been quickly adapted to changes in community conditions, the drug supply, and shifting high risk areas as they developed. This is a promising intervention that leverages available data and resources and is readily implementable in communities with support from a central program administrator and access to geo-coded data., Competing Interests: Declarations. Ethics approval and consent to participate: This study was determined reviewed by the Northwestern University Institutional Review Board (STU00218306) and found not to be human research. No consent for participation was obtained. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Importance: Opioid-related overdose accounts for almost 80 000 deaths annually across the US. People who use drugs leaving jails are at particularly high risk for opioid-related overdose and may benefit from take-home naloxone (THN) distribution., Objective: To estimate the population impact of THN distribution at jail release to reverse opioid-related overdose among people with opioid use disorders., Design, Setting, and Participants: This study developed the agent-based Justice-Community Circulation Model (JCCM) to model a synthetic population of individuals with and without a history of opioid use. Epidemiological data from 2014 to 2020 for Cook County, Illinois, were used to identify parameters pertinent to the synthetic population. Twenty-seven experimental scenarios were examined to capture diverse strategies of THN distribution and use. Sensitivity analysis was performed to identify critical mediating and moderating variables associated with population impact and a proxy metric for cost-effectiveness (ie, the direct costs of THN kits distributed per death averted). Data were analyzed between February 2022 and March 2024., Intervention: Modeled interventions included 3 THN distribution channels: community facilities and practitioners; jail, at release; and social network or peers of persons released from jail., Main Outcomes and Measures: The primary outcome was the percentage of opioid-related overdose deaths averted with THN in the modeled population relative to a baseline scenario with no intervention., Results: Take-home naloxone distribution at jail release had the highest median (IQR) percentage of averted deaths at 11.70% (6.57%-15.75%). The probability of bystander presence at an opioid overdose showed the greatest proportional contribution (27.15%) to the variance in deaths averted in persons released from jail. The estimated costs of distributed THN kits were less than $15 000 per averted death in all 27 scenarios., Conclusions and Relevance: This study found that THN distribution at jail release is an economical and feasible approach to substantially reducing opioid-related overdose mortality. Training and preparation of proficient and willing bystanders are central factors in reaching the full potential of this intervention.

Latino/a/x sexual minority men (SMM) and transgender women remain disproportionately impacted by HIV, with higher HIV incidence and lower uptake of pre-exposure prophylaxis (PrEP) than their non-Hispanic White peers. Disparities in PrEP uptake among Latino/a/x populations have been found to be due to structural, social, and personal barriers. Social marketing interventions have been shown to effectively address barriers and increase PrEP uptake in other populations, and thus offer potential as a tool to increase PrEP uptake for Latino/a/x populations. The PrEPárate campaign was developed through community based participatory research and ran from April to September 2022 in Cook County, Illinois. We conducted a mixed methods evaluation through surveys (N = 515) and semi-structured interviews with survey participants and community partners (N = 14). We examined cross-sectional associations of campaign exposure with PrEP awareness and uptake in adjusted multivariable regression models. We used rapid qualitative methods to analyze interviews and assess implementation outcomes following the RE-AIM framework. The campaign reached over 118,000 people on social media, with additional reach over public transit and local events. PrEPárate exposure was associated with increased PrEP awareness (aOR = 5.23; 95% CI [2.58, 10.63]) and PrEP uptake (aOR = 1.69; 95% CI [1.09, 2.62]). Survey respondents expressed that the campaign name, visuals, ambassadors, and distribution were effective in engaging the target audience. Community partners felt the campaign was implemented with fidelity to the original vision and identified future directions for PrEPárate. Social marketing campaigns, anchored in community engagement, may be an effective strategy to increase PrEP awareness and uptake among underserved Latino/a/x populations., Competing Interests: Declarations. Competing interests: The authors have no relevant financial or non-financial interests to disclose., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Aims: Judicious antimicrobial use in companion animal practice is critical for maintaining the effectiveness of antimicrobial agents against bacterial infections and reducing the selection of antimicrobial-resistant bacteria. This study aimed to provide insights into companion animal veterinarians' antimicrobial treatment recommendations for common bacterial infections in dogs and cats and describe the factors influencing their prescription choices., Methods and Results: An online survey using QualtricsXM® software was administered between September and November 2022 to companion animal veterinarians who were Illinois State Veterinary Medical Association members. Descriptive and text analyses were conducted to assess the participants' responses. A total of 78 surveys were included in the analysis. Skin infections were ranked as the most common bacterial infections for which veterinarians prescribed antimicrobial agents, followed by ear, urinary tract, respiratory, and enteric infections. The severity of clinical symptoms and the results of bacterial culture and susceptibility tests were the most influential factors for veterinarians when making antimicrobial prescription choices. Veterinarians were aware of the current antimicrobial prescription guideline recommendations when prescribing antimicrobials empirically to nine hypothetical scenarios of bacterial infections. According to the results of the text analysis that assessed veterinarians' responses to an open-ended question, regarding their challenges when prescribing antimicrobial agents, the pairwise correlation of word frequencies within each response showed the highest correlations between the words 'owner' and 'compliance', 'administration' and 'route', 'cost' and 'culture', and 'patients' and 'acceptance'., Conclusions: The study results can support animal health stakeholders in the development of antimicrobial stewardship programmes to promote appropriate antimicrobial use and limit the emergence of antimicrobial resistance., (© 2024 The Author(s). Zoonoses and Public Health published by Wiley‐VCH GmbH.)

Landfills and wastewater treatment plants (WWTP) are point sources for many emerging contaminants, including microplastics and per- and polyfluoroalkyl substances (PFAS). Previous studies have estimated the abundance and transport of microplastics and PFAS separately in landfills and WWTPs. In addition, previous studies typically report concentrations of microplastics as particle count/L or count/g sediment, which do not provide the information needed to calculate mass balances. We measured microplastics and PFAS in four landfill-WWTP systems in Illinois, USA, and quantified mass of both contaminants in landfill leachate, WWTP influent, effluent, and biosolids. Microplastic concentrations in WWTP influent were similar in magnitude to landfill leachates, in the order of 10 2  μg plastic/L (parts-per-billion). In contrast, PFAS concentrations were higher in leachates (parts-per-billion range) than WWTP influent (parts-per-trillion range). After treatment, both contaminants had lower concentrations in WWTP effluent, although were abundant in biosolids. We concluded that WWTPs reduce PFAS and microplastics, lowering concentrations in the effluent that is discharged to nearby surface waters. However, partitioning of both contaminants to biosolids may reintroduce them as pollutants when biosolids are landfilled or used as fertilizer., Competing Interests: Declaration of competing interest There is no conflict of interest associated with this manuscript., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: This study aims to document the transition from alteplase to tenecteplase within a rural stroke network in the Midwest. It emphasizes the planning and execution of the transition, and evaluates safety and outcomes of tenecteplase compared to alteplase one year after the adoption of the new thrombolytic., Methods: This is a retrospective observational study of patients who were treated with thrombolytic therapy for suspected acute ischemic stroke at Southern Illinois Healthcare rural stroke network between July 2017 and July 2024. For each patient, demographics, past medical history, clinical presentation, National Institutes of Health Stroke Scale (NIHSS), and laboratory values were reviewed. Type of thrombolytic was noted. Door-to-needle time (DTN) and complications of thrombolytic therapy including symptomatic ICH (sICH) were reviewed. The primary outcome was the rate of sICH after administration of thrombolytic therapy. Secondary outcomes included target DTN ≤ 60 minutes and modified Rankin Scale (mRS) 0-2 at 30 days., Results: Out of 279 patients treated with thrombolytics, 215 (77 %) received alteplase, and 64 (23 %) received tenecteplase. The two groups were severity matched, and did not differ in terms of demographics or baseline comorbidities. Median DTN (IQR) was comparable between alteplase and tenecteplase, in minutes ((50 (40-69) vs. 53 (37-65)). In three distinct regression models for each of the predetermined outcomes, accounting for markers of stroke severity, the type of thrombolytic was not associated with development of sICH (OR 1.59, SE 1.445, p = 0.61), target DTN ≤ 60 min (OR 0.996, SE 0.304, p = 0.988), nor mRS 0-2 at 30 days (OR 1.086, SE 0.446, p = 0.842)., Conclusions: In our population, safety and outcome of thrombolytic therapy for acute ischemic stroke did not differ based on the type of thrombolytic used. Our study highlights the planning and execution of the transition from alteplase to tenecteplase, with challenges faced and lessons learned, and supports the use of tenecteplase in real-world rural practice., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: This study explored the cardiac emergency preparedness of school employees in Illinois, as well as their attitudes toward cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) training., Methods: One thousand two hundred seventy-six school employees completed an online survey regarding their school's cardiac emergency preparedness, as well as their access to CPR/AED training, confidence and willingness to perform CPR/AED, and attitudes toward CPR policies and mandates., Results: In total, results from 1273 school employees were analyzed. School employees in Illinois are not prepared to respond to a cardiac emergency, but desire training, plans, and drills. Demographic analyses revealed statistically significant differences in cardiac emergency preparedness between individuals of different personal and school characteristics., Conclusions: School employees in Illinois are not prepared to respond to a cardiac emergency. To increase preparedness for cardiac emergencies at school, schools should implement CPR/AED training for all employees, cardiac emergency response plans, and cardiac emergency response drills., Implications for School Health Policy, Practice, and Equity: Policies should be implemented at the state and local level to support cardiac emergency preparedness in schools, including mandated CPR/AED training for all school employees, cardiac emergency response plans for every building, and required cardiac emergency response drills., (© 2024 The Author(s). Journal of School Health published by Wiley Periodicals LLC on behalf of American School Health Association.)

Triatomine species (kissing bugs) infected with Trypanosoma cruzi are found across the southern United States. The northern limits of Trypanosoma cruzi infected kissing bugs are less understood. The objective of this work was to describe the locations of kissing bugs from Illinois and Missouri based on historical records, submissions to Texas A&M University's (TAMU) Kissing Bug Community Science Program and the Centers for Disease Control and Prevention (CDC), and records from online platforms (iNaturalist, BugGuide, and GBIF) up to and including 2022. A total of 228 records were discovered, including 186 from historical or observation platforms and 42 specimens submitted to TAMU or CDC. Species included Triatoma sanguisuga (221 total records, 9 nymphs) and Triatoma lecticularia (7 records). Notably, nearly all (24/26) records submitted to TAMU were collected indoors. Twelve of the 30 (40%) specimens tested were positive for the presence of T. cruzi, including parasite discrete taxonomic units TcI and TcIV. One triatomine sample had been found in a bed feeding on the submitter; this bug was positive for T. cruzi and had evidence of human blood in its gut. Records suggest a ubiquitous distribution in Missouri and potentially to the northernmost border in Illinois. Further investigations into triatomine distribution and infection status are needed within states assumed to be northern limits in order to create public health and veterinary health messaging and baseline distributional maps from which to measure future range shifts in relation to a changing climate., (© The Author(s) 2023. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Triatoma sanguisuga (Leconte) is one of the most widely distributed kissing bugs in the United States, associated with an extensive zoonotic circulation of Trypanosoma cruzi, the agent of Chagas disease, in a large part of the country. However, the actual risk for human infection in the United States is poorly understood. Here, we further assessed the ecology of T. sanguisuga bugs collected in residents' houses in Illinois and Louisiana, using a metagenomic approach to identify their blood-feeding sources, T. cruzi parasites and gut microbiota. Blood meal analysis revealed feeding on domestic animals (dogs, cats, pigs, goats, and turkeys), synanthropic species (raccoons, opossums, and squirrels), as well as the more sylvatic white-tail deer. Human blood was identified in 11/14 (78%) of bugs, highlighting a frequent vector-human contact. The infection rate with T. cruzi was 53% (8/15), and most infected bugs (6/8) had fed on humans. A total of 41 bacterial families were identified, with significant differences in microbiota alpha and beta diversity between bugs from Louisiana and Illinois. However, predicted metabolic functions remained highly conserved, suggesting important constraints to fulfill their role in bug biology. These results confirmed a significant risk for vector-borne transmission of T. cruzi to humans in Louisiana and Illinois, which warrants more active screening for human infections. Also, while there is broad plasticity in the bacterial composition of T. sanguisuga microbiota, there are strong constraints to preserve metabolic profile and function, making it a good target for novel vector control strategies., (© The Author(s) 2024. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Importance: Most US individuals who access abortion care pay out of pocket due to insurance coverage restrictions on abortion. More research is needed on the financial and psychological burdens of abortion seeking, particularly for those traveling across state lines for care., Objectives: To estimate the proportion of patients seeking abortion who incur abortion-related catastrophic health expenditures (CHEs), assess whether CHE differs between those seeking care in state vs out of state, and examine the association of CHE with mental health symptoms., Design, Setting, and Participants: In this cross-sectional study conducted before the Dobbs v Jackson Women's Health Organization decision, surveys were administered between January and June 2019 among individuals aged 15 to 45 years seeking abortion in 4 clinics located in abortion-supportive states (California, Illinois, and New Mexico). Participants completed self-administered questionnaires while awaiting their abortion appointment. Analyses were conducted from November 2023 to April 2024., Exposure: Travel for abortion care, categorized as either out of state or in state based on participants' state of residence and the clinic location., Main Outcomes and Measures: Self-reported abortion care costs and additional non-health care costs (eg, transportation, accommodation, and missed work), which were considered catastrophic if they were 40% or greater of participants' ability to pay (defined as monthly income remaining after meeting subsistence needs). Multivariable regression analyses were conducted to examine associations between CHE, out-of-state travel for abortion care, and mental health symptoms including stress, anxiety, and depression., Results: Among the 675 participants included in the analytic sample, mean (SD) age was 27.33 (6.27) years; most were in their 20s (374 [55%]), and all but 196 (29%) sought abortion before or at 12 weeks' gestation. A total of 285 participants (42%) were estimated to incur abortion-related CHEs, which was associated with anxiety (APR, 1.13; 95% CI, 1.07-1.19) and depression (APR, 1.25; 95% CI, 1.12-1.39). Of people traveling from out of state (212 [31%]), more were likely to incur CHEs (138 [65%]) compared with those seeking care in state (147 of 463 [32%]) (APR, 2.24; 95% CI, 1.67-3.00)., Conclusions and Relevance: In this cross-sectional study of US patients seeking abortion, many individuals and their households were estimated to incur CHEs, particularly those traveling from out of state. The financial and psychological burdens of abortion seeking have likely worsened after the Dobbs decision, as more people need to cross state lines to reach abortion care. The findings suggest expansion of insurance coverage to ensure equitable access to abortion care, irrespective of people's state of residence, is needed.

This study used Rasch models to evaluate the psychometric properties of a self-efficacy instrument focused on psychosocial aspects of palliative care developed for nursing assistants (NAs). NAs from 6 skilled nursing facilities in Illinois, U.S. (n=102) were divided into intervention and control groups and answered 16 questions at baseline and 1-month follow-up. A total of 84 NAs completed assessments at both times. The rating scale structure improved when 3 instead of 5 response categories were used. After removing 4 items, the instrument demonstrated unidimensionality and local independence. A person-item threshold map indicated a ceiling effect. For the intervention group, 2 items and 1 item became easier and more difficult respectively post-training. With adjustments, the 12-item instrument became an adequate measure of palliative care self-efficacy. By using PCSE-NA as a tool to assess palliative care self-efficacy of NAs, geriatric nurses can identify weaknesses of and ways to improve training for NAs., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Research has repeatedly demonstrated the ability of social networks, interpersonal discussion, and perceived social norms to shape health-related outcomes. There are still substantial gaps, however, in understanding the theoretical mechanism that holds these components together, as well as the boundary conditions of their effects. Employing ego-network analysis with a representative sample of Illinois residents ( N  = 711) and focusing on the context of COVID-19 vaccine adherence, this study constructs a comprehensive framework to examine the direct, indirect, and conditional relationships linking social capital within networks, factual knowledge, and vaccination. Overall, the results point to the ability of tight-knit networks to influence knowledge and behavior for better or worse, depending on the composition of the network and its conversational valence. Theoretical and practical implications are discussed.

Background: Most pregnancy-related deaths in Illinois are preventable. Many of those who died in recent years had at least one emergency department (ED) visit during pregnancy or the postpartum period. This suggests that with the proper training and education, EDs can play an important role in reducing maternal mortality., Methods: A Task Force of 33 interdisciplinary stakeholders from across Illinois met monthly over 1 year to gather and develop educational content focused on obstetric emergency medicine and produce the Maternal Health Emergency Department Toolkit (Toolkit) training. A survey and listening session collected stakeholders' feedback about factors that supported Toolkit development, barriers, and recommendations for similar projects., Results: The Task Force members adapted existing tools and developed novel resources to fill the gaps in maternal health education for the ED setting. The Toolkit consists of five educational modules including didactic information, case-based learning, and resources for additional reading and local implementation. The modules focus on ED recommendations from the Illinois Maternal Mortality Review Committees, triage and management of emergencies in perinatal patients, screening and treatment of mental health and substance use conditions, addressing trauma, performing resuscitation during pregnancy, and conducting safe and coordinated discharge of perinatal patients from the ED. Task Force members described the inclusion of experts with interdisciplinary knowledge, working in small groups, and grounding the educational content in maternal health data as factors contributing to the project's success. They identified scheduling conflicts as a challenge and recommended future projects like this one include more ED providers and staff members., Conclusion: Through promoting cross-disciplinary engagement, education, and collaboration with obstetrics and other service lines, the Toolkit can help fill the gaps in maternal ED education to decrease maternal mortality and morbidity in Illinois., (Copyright © 2024 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.)

Objectives. To describe 4 unique models of operationalizing wastewater-based surveillance (WBS) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in jails of graduated sizes and different architectural designs. Methods. We summarize how jails of Cook County, Illinois (average daily population [ADP] 6000); Fulton County, Georgia (ADP 3000); Middlesex County, Massachusetts (ADP 875); and Washington, DC (ADP 1600) initiated WBS between 2020 and 2023. Results. Positive signals for SARS-CoV-2 via WBS can herald a new onset of infections in previously uninfected jail housing units. Challenges implementing WBS included political will and realized value, funding, understanding the building architecture, and the need for details in the findings. Conclusions. WBS has been effective for detecting outbreaks of SARS-CoV-2 in different sized jails, those with both dorm- and cell-based architectural design. Public Health Implications. Given its effectiveness in monitoring SARS-CoV-2, WBS provides a model for population-based surveillance in carceral facilities for future infectious disease outbreaks. ( Am J Public Health . 2024;114(11):1232-1241. https://doi.org/10.2105/AJPH.2024.307785).

Field-collected specimens were used to obtain nine high-quality genome assemblies from a total of 10 insect species native to prairies and savannas of central Illinois (USA): Mellilla xanthometata (Lepidoptera: Geometridae), Stenolophus ochropezus (Coleoptera: Carabidae), Forcipata loca (Hemiptera: Cicadellidae), Coelinius sp. (Hymenoptera: Braconidae), Thaumatomyia glabra (Diptera: Chloropidae), Brachynemurus abdominalus (Neuroptera: Myrmeleontidae), Catonia carolina (Hemiptera: Achilidae), Oncometopia orbona (Hemiptera: Cicadellidae), Flexamia atlantica (Hemiptera: Cicadellidae) and Stictocephala bisonia (Hemiptera: Membracidae). Sequencing library preparation from single specimens was successful despite extremely small DNA yields (<0.1 μg) for some samples. Additional sequencing and assembly workflows were adapted to each sample depending on the initial DNA yield. PacBio circular consensus (CCS/HiFi) or continuous long reads (CLR) libraries were used to sequence DNA fragments up to 50 kb in length, with Illumina sequenced linked-reads (TellSeq libraries) and Omni-C libraries used for scaffolding and gap-filling. Assembled genome sizes ranged from 135 MB to 3.2 GB. The number of assembled scaffolds ranged from 47 to >13,000, with the longest scaffold per assembly ranging from ~23 to 439 Mb. Genome completeness was high, with BUSCO scores ranging from 85.5% completeness for the largest genome (Stictocephala bisonia) to 98.8% completeness for the smallest genome (Coelinius sp.). The unique content was estimated using RepeatMasker and GenomeScope2, which ranged from 50.7% to 75.8% and roughly decreased with increasing genome size. Structural annotation predicted a range of 19,281-72,469 protein models for sequenced species. Sequencing costs per genome at the time ranged from US$3-5k, averaged ~1600 CPU-hours on a high-performance cluster and required approximately 14 h of bioinformatics analyses with samples using PacBio HiFi data. Most assemblies would benefit from further manual curation to correct possible scaffold misjoins and translocations suggested by off-diagonal or depleted signals in Omni-C contact maps., (© 2024 The Author(s). Molecular Ecology Resources published by John Wiley & Sons Ltd.)

Purpose: We sought to understand how patients and physicians conceptualize uncertainty in the permanent contraception decision-making process., Basic Procedures: In 2022-2023, we interviewed postpartum patients with a documented desire for permanent contraception (n = 81) and their delivering physicians (n = 67). Eligible patients gave birth at one of our four study hospitals in California, Ohio, Illinois, and Alabama. We used rapid content analysis and thematic content analysis to develop and refine themes related to uncertainty in permanent contraceptive decision-making., Main Findings: Most patients reported full certainty in their decision regarding permanent contraception, although some expressed doubts. After receiving permanent contraception, some patients discussed grief but overall affirmed their decision. One patient said they wished they had considered other contraceptive options. Physicians reported using a range of strategies to safeguard from patient regret, including ensuring patients were 100% certain with their decision, inferring certainty based on their characteristics, asking patients to think through all scenarios that could affect decision-making, and repeat counseling during multiple interactions., Principal Conclusions: Patient experiences reveal the depth, fluidity, and nuance of patients' contraceptive decision-making processes. Physicians sometimes failed to grapple with this nuance by centering potential regret in their counseling. Personalized and supportive contraceptive counseling that acknowledges the complexity of contraceptive decision-making is imperative. Shared decision-making can help ensure patients can make informed and autonomous decisions about their reproductive lives., (Copyright © 2024 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.)

Background: Child maltreatment survivors with extensive foster care involvement are tasked with building identities that allow them to make sense of difficult pasts in ways that help them build adult lives., Objective: To use narrative identity theory to explore identities and identity-building challenges of young adults formerly in foster care., Participants and Setting: Twelve young adults who aged out of the foster care system in Illinois., Methods: Participants were interviewed three times with semi-structured protocols that focused on their life stories and the meanings derived from them. Data were analyzed using an adapted grounded theory approach., Results: Many participants forged resistance identities around a fierce sense of agency, motivated to not be another foster care statistic or like their parents. Challenges to identity construction included the scarcity of trusted audiences willing to listen fully to their life stories, missing information about key events, and the senselessness of maltreatment experiences. College and work opportunities provided normative contexts and new audiences where identities shifted, but often at the cost of not revealing their histories, limiting social relations. Temporal coherence was evident in most life stories. Causal and global coherence was more difficult to achieve., Conclusions: Intervention efforts designed to provide willing and helpful audiences for narrative formation work may help young people from foster care find meaning in their pasts that help them forge identities that promote satisfying and successful adult lives. Narrative identity theory may benefit from greater engagement with theories of oppression and marginalization., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: We used human-centered design to explore preferred consumer experiences for obtaining mifepristone for medication abortion care from a pharmacy., Methods: We conducted a two-part virtual workshop series with the same 10 participants in March and April of 2022 to initiate the discovery phase of a human-centered design process. Most participants were residents of Illinois and all participants had uteruses and had either sought abortion care or supported someone who had. Co-developed and co-facilitated with a local abortion fund, workshops engaged participants to provide formative data for the development of recommendations for community health center clinicians and pharmacists. A simulated medication abortion care counseling session grounded group activities and discussions that explored the experience of filling a medication abortion prescription at a pharmacy or by mail. Data were analyzed for key themes and recommendations. Qualitative data were collected from the workshops. Data analysis was conducted in three iterative, parallel stages: 1) virtual whiteboard results from both workshops were analyzed deductively through spreadsheets and visualizations; 2) close reading was conducted for workshop transcripts and participant evaluations; and 3) document analysis was used to triangulate data across formats. Data were discussed periodically among the research team until consensus was reached., Results: Five primary categories of questions and preferences emerged from workshop data concerning: logistics, privacy, cost, pharmacist refusal, and follow-up care. Researchers found that participants desired certain questions and concerns to be answered by specific provider types. Participants indicated a desire for further research and opportunities that prioritize lived experience and use storytelling and/or design methods to collect data., Conclusions: Despite existing patient-oriented medication abortion resources, there is a need for patient resources to support pharmacy dispensing, and a corresponding need for clinician and pharmacist resources. These can help in-person and mail-order pharmacy dispensing to be as consumer friendly as possible., (Copyright © 2024 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.)

Objectives: The study aimed to establish a normative reference value for the agility T-test and Illinois test in football players, on the basis of sex and playing position., Design: Cross-sectional study., Setting: Himachal Pradesh Football Association and Maharishi Markandeshwar Medical College and Hospital-Himachal Pradesh., Participants: 138 football players including 69 male and 69 female players aged 18-25 years were included., Main Outcome Measures: Illinois and agility T-test., Results: Normative values of male and female player's are established for agility T-test 10.06 ± 0.87; 11.27 ± 0.84 and for Illinois test were 15.56 ± 0.80; 17.75 ± 1.37 s, respectively. Mann Whitney U- test was used to compare the agility of both sexes and showed a significant difference (p-value <0.001) in male and female players. Intra-rater reliability was checked for between trials and revealed excellent reliability with greatest single measure ICC (0.972) and average measure ICC (0.936) for Illinois test and single measure ICC (0.891) and average measure ICC (0.903) for agility T-test., Conclusion: Both agility tests concluded that female players are statistically and clinically less agile than male players. Similar results were found when agility was compared according to playing position. On the basis of sex, midfielders are more agile compared with other playing position., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Transition into practice is plagued by personal, work, and patient-related stress leading to burnout and turnover of newly licensed nurses. Leaders must recognize transition shock and moral distress and act immediately. Nursing professional development practitioners at a healthcare organization in Illinois developed the "Flight Risk" Program to recognize, address, and escalate turnover risks as a leadership team. This resulted in retaining 47% of identified "flight risks" and contributed over $3.9 million in cost avoidance., Competing Interests: Vicki Adams and Dana Garcher are employed by Vizient, Inc. Cheryl Nazal and Debbie Rimmele declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Reflecting disparities across the US, in 2015 publicly insured patients of the NorthShore Community Health Center (NSCHC) in Evanston, Illinois had lower breastfeeding rates than commercially insured patients. We used the Replicating Effective Programs framework to describe the design and implementation of a clinically-integrated breastfeeding peer counseling (ci-BPC) program to address these disparities., Study Design: Patient focus groups and surveys informed program design, and a multidisciplinary clinical support team developed workflows that integrated the breastfeeding peer counselor (BPC) into the clinic and the postpartum unit., Results: ci-BPC improved breastfeeding intensity and duration by providing every NSCHC patient with (1) prenatal lactation education; (2) hands on lactation care in the hospital; and (3) on-demand postpartum support. Total cost per patient was $297-386. The program was sustained after demonstrating potential cost-savings., Conclusion: An evidence-based, multidisciplinary collaboration resulted in a sustainable clinically integrated breastfeeding peer counseling program that improved breastfeeding outcomes., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Context: Federal law requires property owners to disclose the presence of known lead-based paint and/or lead hazards to potential home buyers and renters in homes built before 1978., Objective: Using 2015-2016 randomized survey data, we measured lead and radon knowledge, awareness, and exposure avoidance practices., Setting: Home buyers from 4 US states (Illinois, Minnesota, North Carolina, and Ohio)., Participants: 477 recent, single-family pre-1978 dwelling home buyers., Main Outcome Measure(s): Predictors of the home buyer decision to purchase the home during the entire home buying experience based on their understanding of health issues related to lead-based paint and radon exposure., Results: Personal networks (22%) and real estate agents (21%) were the most common sources of health-related lead information. Many home buyers (77%) reported that their awareness of lead did not affect their purchasing decision, and 78% could not confirm that their homes were tested for lead. Respondents who understood lead-related health effects were 5.4 times more likely (95% CI, 1.7-17.5) to have their decision to buy a home affected when their real estate agent discussed lead-based paint issues. Many home buyers reported either they did not remember (37%) or did not sign (20%) the federal law requirement that property owners reveal known lead paint hazards to prospective buyers before a property is sold. Home buyers with awareness of health issues caused by radon were 1.7 times (95% CI, 1.4-2.1) more likely than those who understood lead-related health issues to have their decision to buy the home affected., Conclusion: Real estate agents play an important role to increase awareness of potential lead-based paint health issues when people buy older homes. Home buyer knowledge, awareness, and practice of radon exposure prevention was greater compared to lead exposure prevention. More than half of home buyers did not sign or remember signing lead disclosure paperwork., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: In the United States (US), hepatitis C virus (HCV) screening is not covered by payers in settings outside of primary care. A non-traditional, emergency department (ED)-based HCV screening program can be cost-effective and identify infection in vulnerable populations with a high HCV risk. This study examined the long-term cost-effectiveness of routine HCV screening and linkage-to-care for high-risk patients in the ED from the payer's perspective., Methods: The University of Illinois Hospital and Health Sciences System (UIH) implemented Project HEAL (HIV & HCV Screening, Education, Awareness, Linkage-to-Care). Under this initiative, patients who presented to the ED received opt-out HCV screening if they were at high risk for HCV infection (birth cohort between 1945 and 1964, persons who inject drugs, and HIV infection) with subsequent linkage-to-care if infected. Using the summary data from Project HEAL, a hybrid decision-analytic Markov model was developed based on the HCV screening procedure in the ED and the natural history of HCV. A 30-year time horizon and 1-year cycle length were used. All patients who received the ED-based HCV screening were referred for treatment with direct-acting antiviral (DAA) regardless of their fibrosis stage., Results: When unscreened/untreated patients received DAA treatment at F1, F2, F3, and compensated cirrhosis stages, the incremental cost-effectiveness ratio (ICER) ranged from $6,084 to $77,063 per quality-adjusted life year (QALY) gained. When unscreened/untreated patients received DAA treatment at the decompensated cirrhosis stage, no HCV screening was dominated., Conclusion: ED-based HCV screening and linkage-to-care was cost-effective at the willingness-to-pay (WTP) threshold of $100,000/QALY in all scenarios. A reduction in infected persons in the community may provide additional benefits not evaluated in this study., (© 2024. The Author(s).)

This study evaluated the prevalence rates and risk factors for cyberbullying victimization and perpetration among 7th-12th grade students ( n = 3,396) enrolled in 22 public school districts across Southern Illinois. Risk factors included victimization by traditional bullying, gender identity, cell phone use, and social media usage. We also examined perceptions of school climate and safety. We observed that traditional bullying victimization, gender identity, and social media usage predicted cyberbullying victimization. Similarly, perceptions of school climate and safety were significantly and positively correlated with cyberbullying victimization. In turn, perceptions of school climate and safety predicted cyberbullying perpetration. Rurality was a factor uniquely related to perpetration. Specifically, students from non-rural schools reported higher levels of cyberbullying perpetration than did students from rural schools. Our results underscore the need for intervention and prevention programs to focus on all forms of bullying and parental monitoring of social media accounts., (© 2024 Springer Publishing Company.)

Background: Early diagnostic uncertainty for infection causes delays in antibiotic administration in infected patients and unnecessary antibiotic administration in noninfected patients., Objective: To develop a machine learning model for the early detection of untreated infection (eDENTIFI), with the presence of infection determined by clinician chart review., Derivation Cohort: Three thousand three hundred fifty-seven adult patients hospitalized between 2006 and 2018 at two health systems in Illinois, United States., Validation Cohort: We validated in 1632 patients in a third Illinois health system using area under the receiver operating characteristic curve (AUC)., Prediction Model: Using a longitudinal discrete-time format, we trained a gradient boosted machine model to predict untreated infection in the next 6 hours using routinely available patient demographics, vital signs, and laboratory results., Results: eDENTIFI had an AUC of 0.80 (95% CI, 0.79-0.81) in the validation cohort and outperformed the systemic inflammatory response syndrome criteria with an AUC of 0.64 (95% CI, 0.64-0.65; p < 0.001). The most important features were body mass index, age, temperature, and heart rate. Using a threshold with a 47.6% sensitivity, eDENTIFI detected infection a median 2.0 hours (interquartile range, 0.9-5.2 hr) before antimicrobial administration, with a negative predictive value of 93.6%. Antibiotic administration guided by eDENTIFI could have decreased unnecessary IV antibiotic administration in noninfected patients by 10.8% absolute or 46.4% relative percentage points compared with clinicians., Conclusion: eDENTIFI could both decrease the time to antimicrobial administration in infected patients and unnecessary antibiotic administration in noninfected patients. Further prospective validation is needed., Competing Interests: Dr. Buell is supported by T32 HL007605. Dr. Bhavani is supported by the National Institute of General Medical Sciences GM144867. Dr. Parker is supported by K08HL150291 and R01LM014263. Dr. Churpek is supported by R35GM145330. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)

Rivers are increasingly used as superhighways for the continental-scale transportation of freight goods, but the ecological impact of large vessel traffic on river ecosystems is difficult to study. Recently, the temporary maintenance closure of lock and dam systems on the Illinois Waterway (USA) brought commercial vessel traffic to a halt along the river's length, offering a rare opportunity to study the response of the ecosystem before, during, and after an extended pause of this persistent anthropogenic disturbance. We observed improvements in main- and side-channel water quality and a redistribution of fish habitat-use during a months-long, near-complete reduction of large vessel traffic. Over 3600 water quality and 1300 fish community samples indicate that large vessel traffic reduction coincided with a 33 % reduction in turbidity as well as increased use of sampling strata near vessel navigation corridors by sound-sensitive and rheophilic fishes. Gizzard shad (Dorosoma cepedianum), the most abundant species in the system, also expanded their use of these 'impact' areas. Though inland waterway transport is an economically- and climate-friendly alternative to trucking and rail for the shipment of freight, our data suggest that intense vessel traffic may have profound physical and biological impacts across a large river. Monitoring and mitigation of ecological impacts of the ongoing expansion of inland waterway transport around the world will be critical to balancing large rivers as both useful navigation corridors and functional ecosystems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The US Geological Survey, The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: The purpose of this intervention was to investigate the feasibility, acceptability, and preliminary effectiveness of an online weight loss program, EMPOWER, in rural, underserved communities., Methods: Adults with a body mass index (BMI) ≥ 25 kg/m 2 living in rural counties were recruited through collaboration with University of Illinois Extension. The intervention lasted 1 year including online educations sessions, nutrition and lifestyle coaching, and diet and weight monitoring via a novel web application, MealPlot. Feasibility was measured by enrollment attainment, participant retention, online education session completion, and completion of anthropometric and dietary measures. Acceptability was measured by survey using Likert scales of satisfaction for all program components. Anthropometric measurements, 24-h dietary records, and food frequency questionnaires (FFQs) were measures of program efficacy. Additionally, two interviews were collected for program feedback., Results: Enrollment of 16 participants was attained, however due to higher than anticipated dropout (retention 62.5%, N = 10) at 3-months, 62.5% of the education sessions were completed and 75.0% of anthropometric and dietary measures. The average satisfaction rating for the comprehensive program was 4.2/5 with lowest satisfaction being the MealPlot web application 2.7/5 ( N = 11). On average a clinically significant (≥5% baseline weight) weight loss of 6.2 ± 6.0% body weight or 5.7 ± 5.3 kg and improvements to protein and fiber intake at 12 months ( N = 10) were observed., Conclusions: A novel online weight loss program showed adequate to strong feasibility and acceptability and preliminary results indicating efficacy among a pilot sample of rural residents. Future studies are required to investigate means of improving retention and reducing the burden on program collaborators., Competing Interests: The authors declare that they have no competing interests., (© 2024 Oliveira et al.)

Background: Recovery-oriented systems of care have been a widely supported approach to transforming existing substance treatment programs across different states through developing recovery programs and interagency networks. However, little is known about the facilitators and barriers influencing their development and implementation., Methods: Qualitative study of 5 different recovery-oriented systems of care in Illinois. Nineteen respondents completed individual interviews., Results: A total of 124 codes and 2 themes were identified, reflecting constraints and opportunities. Theme 1 focused on how ROSC programs developed bonding, bridging, and linking social capital. Theme 2 focused on the ROSC coordinator and lead agency's power and accountability., Conclusions: The roles of lead agencies and ROSC coordinators were highlighted in the development and implementation of ROSCs. ROSC membership structures allow for bonding, bridging, and linking social capital. Still, additional technical support is needed to improve accountability, reduce power differentials and turf battles, and ensure greater participation among more diverse stakeholders., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: Asthma reliever medication access is critical, especially in schools. Policies that "stock" reliever inhalers in schools provide failsafe medication access. This research aims to understand barriers and facilitators to Illinois stock inhaler policy implementation., Methods: We conducted 18 semi-structured interviews in 2021-2022 with key school-based and non-school-based partners (school administrators, nurses, governmental agencies, and advocacy leaders). Through Atlas.ti, code frequencies compared (Fisher's exact test), and a thematic analysis performed., Results: Four themes emerged: facilitators, barriers, program rationale, and process considerations. The common facilitators were "Finding a provider," having a "Champion," and "Funding". Barriers included "Not enough school nurses," "Pharmacy refusal to fill prescriptions," and "Feeling overwhelmed." All were supportive of the rationale for stock inhalers. Non-school-based informants (p < .01) were more likely to mention medication donations, while school staff reported having enough nurses as a facilitator (p < .01). School staff reported concerns about children with asthma not having their medication significantly more than other partners (p = .02)., Implications for School Health Policy, Practice, and Equity: Our analysis revealed that school partners recognize the value of stock inhalers. Barrier mitigation to support the funding, prescription access and processing, and training are essential to success of stock inhaler programming. Multilevel collaborative efforts through coalitions could be a potential solution., (© 2024 The Author(s). Journal of School Health published by Wiley Periodicals LLC on behalf of American School Health Association.)

Background: Asthma is a prevalent health concern among Illinois (IL) children, and management is significantly influenced by social determinants. There were 17 states who have adopted stock inhaler laws, but implementation varies widely., Objective: To assess critical barriers to implementation and address sustainability of stock inhaler programming in school-based asthma care in IL., Methods: Semistructured interviews were conducted with high asthma burden school districts in IL to assess barriers in implementing stock inhaler policies and resultant programming. Thematic analysis was performed using Atlas.ti (Scientific Software Development GmbH, Berlin, Germany) to identify and code "threats" to future sustainability. Data were synthesized and presented to stakeholders for barrier mitigation. A schematic flowchart outlining steps to support sustainability was created., Results: A total of 18 interviews were conducted with key community partners across 8 IL school districts, representing rural, urban, and suburban areas. Analysis revealed 25 barriers, with several identified as "threats" to future sustainability, including liability concerns, follow-up care assurance, funding/resources, pharmacy dispensing practices, district-level readiness to change, and nurse staffing. Stakeholders formed a statewide coalition to address these barriers, increase awareness, plan evaluations, and advise on state funding allocation. A national stock inhaler toolkit tailored to school administrative needs was developed to support sustainability efforts., Conclusion: Strategic stakeholder and community engagement are vital for establishing and sustaining stock inhaler programs that adhere to policy mandates. Many districts face challenges initiating and maintaining such programs without critical barrier mitigation and support. Collaborative solutions are necessary to ensure effective school-based asthma management and mitigate persistent pediatric asthma health disparities., (Copyright © 2024 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Context: Cardiovascular disease (CVD) is the leading cause of mortality for US women; lack of health insurance contributes to poor control of risk factors and increased mortality. Health coaching including motivational interviewing can support primary and secondary CVD prevention, but among uninsured women, improving health outcomes is dependent on successfully reaching priority populations., Objective: We evaluated the implementation and reach of health coaching with motivational interviewing among clients in the Illinois WISEWOMAN Program (IWP), a CVD screening and risk-reduction program for uninsured women aged 40 to 64., Intervention: Following CVD screening, motivational interviewing is offered to all IWP clients via four 30-min one-on-one health coaching sessions to offer personalized guidance on setting and achieving health behavior goals., Setting: Our analysis included clients from the eight community-based Illinois agencies that implemented IWP from 2019 to 2023., Design and Measures: We assessed client demographic and baseline health characteristics among all IWP clients, those who participated in health coaching by attending at least one session, and those who completed health coaching by attending at least three of four sessions. We also assessed health coaching participation and completion by agency and examined agency-specific associations between client characteristics and health coaching participation and completion., Results: Among IWP enrollees (n = 3094), 89.7% participated in at least one health coaching session but only 31.4% completed health coaching by attending at least three sessions. Over 90% of IWP clients participated in at least one health coaching session at 4 IWP agencies. Further, over 85% of health coaching participants completed health coaching at four agencies. Across agencies, no client-level characteristics were consistently associated with health coaching participation or completion., Conclusions: High motivational interviewing participation rates support its acceptability among uninsured women, but agency-level community-level barriers likely prevent client engagement in multiple sessions. Reducing CVD risk requires working with partner agencies to address barriers to reaching the priority population., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

Purpose: To describe healthcare experiences and health outcomes among rural LGBTQ + individuals., Design: 2022 cross-sectional survey., Setting: Southern Illinois., Sample: 85 individuals., Measures: Demographics, sexual orientation and gender identity, healthcare experiences, health outcomes., Analysis: Experiences and outcomes were assessed vs orientation and identity. Distribution comparison was by t -test and chi-square, risk prediction by logistic regression, and significance assumed at P < .050., Results: By orientation, participants were: 35.3% gay, 16.5% lesbian, and 45.8% bisexual plus; and by identity they were: 49.4% cisgender, 25.9% transgender, and 24.8% other identity. Survey item responses ranged from 95%-99%. Compared to gay men, lesbians and bisexual plus individuals more frequently reported medical bill payment difficulty (58.3% and 57.9% vs 25.0%; P = .020) and more past month days of poor mental health (19.4 and 15.8 vs 10.6; P = .018). Compared to heterosexual and other identity, transgender individuals less frequently reported having a routine medical provider (72.7% vs 92.7% and 95.0%; P = .037) and more frequently reported past healthcare denial (45.5% vs 17.5% and 18.8%; P = .042). Current health was associated with medical bill payment ability (OR = .33, 95% CI = .13-.86) and respectful treatment by healthcare administrators (OR = 3.90, 95% CI = 1.34-11.35) and clinicians (OR = 3.82, 95% CI = 1.39-10.47). Significance of some findings likely limited due to sample size., Conclusions: Our data describes healthcare experience and health outcome disparities among rural lesbian, gay, bisexual, transgender, queer and other sexual and gender minority individuals, and indicate that clinical experiences directly influence health outcomes., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Asthma is common among the pediatric population. Exacerbations of this chronic condition can lead to emergency department visits and hospitalizations, resulting in time away from school. Children spend the majority of their day at school, where they may need access to quick relief medication to treat respiratory distress. Students' personal asthma medication is not always available in school. School nurses in Illinois collected data and undertook a quality improvement project to increase the number of schools in North Suburban Cook County with undesignated asthma medication. A toolkit was created and shared, helping to remediate barriers associated with obtaining undesignated asthma medication. With access to undesignated asthma medication, school nurses ensure students with asthma receive prompt treatment and coordination of care.

The Virginia opossum ( Didelphis virginiana ) is the only marsupial in North America with a natural range north of Mexico. Its range is widespread throughout the United States, including Illinois. Virginia opossums are opportunistic omnivores that will eat a variety of fruits, grains, insects, and even carrion. They are a ground-foraging species, with frequent soil contact allowing for potential exposure to heavy metal contaminants in terrestrial environments. They are also opportunists that thrive in human-altered ecosystems, including peri-urban environments. Lead is a naturally occurring element and highly toxic metal that is abundant in the soil, primarily due to anthropogenic factors such as fossil fuel use, paint, industrial production waste, and battery recycling. Furthermore, carrion and offal piles containing lead bullet fragments remaining from hunting result in environmental contamination of this heavy metal. Few studies exist on lead exposure in the Virginia opossum. This pilot study evaluates the blood lead burden of 16 free-ranging Virginia opossums presented to a wildlife rehabilitation facility, compared with 16 wild-caught Virginia opossums trapped in grassland, maintained forest, or mixed ecotones. In other species, lead toxicosis has been associated with cognitive dysfunction that may increase the likelihood of trauma or injury in a free-ranging setting. In addition, a high incidence of Virginia opossums presenting for wildlife rehabilitation do so as result of human-animal conflict. Therefore, it was anticipated that individuals presenting for wildlife rehabilitation would have significantly higher blood lead concentrations than their free-roaming counterparts. In this study, every Virginia opossum had measurable blood lead concentrations and the average blood lead concentration of the rehabilitated group was 2.7 times higher than that measured in wild-caught Virginia opossums. These results suggest that Virginia opossums are exposed and susceptible to lead toxicosis due to their diet and foraging behaviors, making them more prone to subsequent injury and presentation to wildlife rehabilitation centers.

Background: Little attention has been placed on language proficiency as a potential variable affecting ACS symptom knowledge, attitudes, and beliefs., Objectives: To compare the ACS symptom knowledge, attitudes, and beliefs of Hispanic and Latina/o/x/e individuals proficient in English and in those only proficient in Spanish. Secondary aims were to determine if there were differences in ACS symptom knowledge, attitudes, or beliefs based on participants' previous exposure to ACS symptom information and to evaluate instrument characteristics of the new Spanish version of the ACS Response Index., Methods: This cross-sectional, comparative study included participants (N = 99) from a community-based clinic in Illinois. Knowledge, attitudes, and beliefs related to ACS symptoms were measured using the ACS Response Index., Results: The average participant was 39.8 (SD 15.6) years of age, female (n = 56, 56.6 %), and had a high school education or less (n = 61, 61.6 %). Participants correctly classified a mean 57.5 % (SD 12.8) of symptoms and had mean attitude and belief scores of 12.1 (SD 3.3) and 17.5 (SD 2.9), respectively. There were no significant differences in knowledge, attitudes, and beliefs based on language proficiency. However, there were some statistically significant differences for knowledge and attitude scores based on exposure to ACS symptom information. The ACS Response Index (Spanish Version) also demonstrated favorable internal consistency., Conclusions: Overall knowledge, attitude, and belief scores were modest in this sample. Higher knowledge and attitude scores were observed for some types of ACS information exposure, supporting the importance of future educational efforts in this population., Competing Interests: Declaration of competing interest This study was supported by a University Research Grant from Illinois State University. There are no other interests to disclose., (Copyright © 2024. Published by Elsevier Inc.)

The leading cause of death in children in the United States is injury caused by firearm violence. States that enact stricter laws related to firearm injury prevention have lower rates of mortality in children. In Illinois, we formed a coalition with medical professionals, medical organizations, community partners, and legislators to craft legislation to reduce the burden of firearm violence on children. These laws can be politically charged. Therefore, we decided to focus on a safe storage education law. We met regularly as a group to draft the bill and an information sheet to support it. Pediatricians and pediatric providers worked with the government relations teams in children's hospitals throughout the state to garner supporting organizations. We also worked to garner cosponsors, provided written and oral testimony to the legislative body, and wrote op-eds to support the bill. Shortly after the bill was passed and signed into law in June of 2022, there was a mass shooting at Highland Park in Illinois. After the shooting, there was a mandate from the Illinois governor to work on passing an assault weapons ban. Pediatricians again provided input into the bill about how the weapons affect children, testified before the House Judiciary Committee, and wrote op-eds. Governor Pritzker signed the Protect Illinois Communities Act into law in January of 2023. Pediatricians actively worked in the passage of both bills, which highlights the importance of medical professionals as experts who can combine powerful stories and evidence based medicine to influence policy., (Copyright © 2024 by the American Academy of Pediatrics.)

Introduction: This study determined the relationship between the emergency nurse work environment and emergency department patient left without being seen rates and lengths of stay., Methods: Cross-sectional analysis of 215 New York and Illinois emergency departments. The work environment (abbreviated Practice Environment Scale of the Nursing Work Index) was measured by emergency nurses in the 2021 RN4CAST-NY/IL survey and linked with outcomes from Hospital Compare. Regression models estimated the relationship between the nurse work environment and emergency department patient left without being seen rates, median length of stay (in minutes), and median behavioral health patient length of stay. Model coefficients were used to estimate expected additional care minutes gained if emergency department work environments improved., Results: "Mixed" work environments had the longest median overall length of stay (3.4 hours) and the highest median left without being seen rates (2.2%), while "poor" work environments had the longest median length of stay for behavioral health patients (6 hours). Improving the emergency department work environment from poor to mixed (and mixed to better) was associated with a 13-minute reduction in overall length of stay (P ≤ .05), a 33-minute reduction in behavioral health length of stay (P ≤ .01), and a 19% reduction in left without being seen rates (P ≤ .01). We estimated 11,824 to 41,071 additional patients could be seen in emergency departments associated with work environment improvements from "poor" to "better," depending on annual patient volumes., Discussion: Hospital administrators should consider investing in nurse work environments as a foundation to improve timely outcomes., (Copyright © 2023 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

The coincidence of rising ozone concentrations ([O 3 ]), increasing global temperatures, and drought episodes is expected to become more intense and frequent in the future. A better understanding of the responses of crop yield to elevated [O 3 ] under different levels of drought and high temperature stress is, therefore, critical for projecting future food production potential. Using a 15-year open-air field experiment in central Illinois, we assessed the impacts of elevated [O 3 ] coupled with variation in growing season temperature and water availability on soybean seed yield. Thirteen soybean cultivars were exposed to a wide range of season-long elevated [O 3 ] in the field using free-air O 3 concentration enrichment. Elevated [O 3 ] treatments reduced soybean seed yield from as little as 5.3% in 2005 to 35.2% in 2010. Although cultivars differed in yield response to elevated [O 3 ] (R), ranging from 17.5% to -76.4%, there was a significant negative correlation between R and O 3 dosage. Soybean cultivars showed greater seed yield losses to elevated [O 3 ] when grown at drier or hotter conditions compared to wetter or cooler years, because the hotter and drier conditions were associated with greater O 3 treatment. However, year-to-year variation in weather conditions did not influence the sensitivity of soybean seed yield to a given increase in [O 3 ]. Collectively, this study quantitatively demonstrates that, although drought conditions or warmer temperatures led to greater O 3 treatment concentrations and O 3 -induced seed yield reduction, drought and temperature stress did not alter soybean's sensitivity to O 3 . Our results have important implications for modeling the effects of rising O 3 pollution on crops and suggest that altering irrigation practices to mitigate O 3 stress may not be effective in reducing crop sensitivity to O 3 ., (© 2024 The Author(s). Global Change Biology published by John Wiley & Sons Ltd.)