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At the hillslope profile and/or field scale, a simple Windows graphical user interface (GUI) is available to easily specify the slope, soil, and management inputs for application of the USDA Water Erosion Prediction Project (WEPP) model. Likewise, basic small watershed configurations of a few hillslopes and channels can be created and simulated with this GUI. However, as the catchment size increases, the complexity of developing and organizing all WEPP model inputs greatly increases due to the multitude of potential variations in topography, soils, and land management practices. For these types of situations, numerical approaches and special user interfaces have been developed to allow for easier WEPP model setup, utilizing either publicly available or user-specific geospatial information, e.g., digital elevation models (DEMs), geographic information system (GIS) soil data layers, and GIS land use/land cover data layers. We utilize the Topographic Parameterization (TOPAZ) digital landscape analysis tool for channel, watershed, and sub-catchment delineation and to derive slope inputs for each of the subcatchment hillslope profiles and channels. A user has the option of specifying a single soil and land management for each subcatchment or utilizing the information in soils and land use/land cover GIS data layers to automatically assign those values for each grid cell. Once WEPP model runs are completed, the output data are analyzed, results interpreted, and maps of spatial soil loss and sediment yields are generated and visualized in a GIS. These procedures have been used within a number of GIS platforms including GeoWEPP, an ArcView/ArcGIS extension that was the first geospatial interface to be developed in 2001. GeoWEPP allows experienced GIS users the ability to import and utilize their own detailed DEM, soil, and/or land use/land cover information or to access publicly available spatial datasets. A web-based GIS system that used MapServer web GIS software for handling and displaying the spatial data and model results was initially released in 2004. Most recently, Google Maps and OpenLayers technologies have been integrated into the web WEPP GIS software to provide significant enhancements. This article discusses in detail the logic and procedures for developing the WEPP model inputs, the various WEPP GIS interfaces, and provides example real-world geospatial WEPP applications. Further work is ongoing in order to expand these tools to allow users to customize their own inputs via the internet and to link the desktop GeoWEPP with the web-based GIS system. [ABSTRACT FROM AUTHOR]

Background: Spinal muscular atrophy (SMA) is a rare genetic disease characterized by progressive muscular weakness and atrophy resulting from motor neuron degeneration. Limited information is available on disease progression among older SMA patients, particularly adults., Objective: This study sought to characterize the natural history of SMA among adult patients in US hospital settings through the assessment of symptoms, complications, costs, and healthcare resource utilization (HRU) over 3 years before the availability of disease-modifying therapies., Methods: The study population included adult (≥18 years) patients with inpatient and/or hospital-based outpatient discharge records and ≥2 primary or secondary SMA ICD-9 codes ≥30 days apart in the Premier Healthcare Database during the main study period (2007-2014). Index date was the date of the first SMA ICD-9 code. The frequency of SMA-related symptoms and complications was assessed 1 year preindex through 2 years postindex to characterize disease progression. Costs and HRU were also assessed across the study period., Results: A total of 446 adult patients from 337 US hospitals met inclusion criteria for these analyses. All evaluated SMA-related symptoms and complications increased steadily over time, from 1 year preindex to 2 years postindex both overall and in each age group. Adult patients with SMA had increasing total costs and HRU over the 3-year study period: total costs were $1,759 preindex and $12,308 by 2 years postindex., Conclusions: Findings are consistent with increasing disease burden over time and support the progressive nature of SMA for adult patients with hospital interactions.

The challenges of integrating behavioral healthcare delivery and the demand for better management of behavioral healthcare benefits require corporate risk managers to focus on issues of quality and outcomes. A strategic partnership between the employer and a managed care organization is one tool for reducing risk and improving the quality of services for beneficiaries, using the techniques of total quality management. The following article describes a six-step process for launching such a strategic partnership, along with some potential pitfalls.