As the population of older adults grows, providing high-quality, cost-effective healthcare for those with cognitive impairments is an increasing priority. The COVID-19 pandemic accelerated the shift towards receiving virtual care at home through temporary Medicare flexibilities. However, the uncertainty surrounding the continuing extension of these flexibilities at the federal level and variations in reimbursement policies across the states present challenges for virtual care practices to meet the rising demand for care amid unprecedented workforce shortages. Sustainable, long-term reimbursement at the federal and state levels, a trained and integrated healthcare workforce, and adherence to recognized accreditation standards and guidelines are essential to advance the quality and safety of virtual care for cognitively impaired patients. Furthermore, reimbursement policies that incentivize investments in technology infrastructure and digital literacy outreach are needed to ensure equitable access to virtual care for all patients across the cognitive impairment continuum.

The sources of fine particulate matter (PM2.5, particles with diameter < 2.5 µm) in four monitoring sites in the New York/New Jersey metropolitan statistical area from 2007 to 2017 were apportioned by positive matrix factorization (PMF) of chemical speciation data. Biomass burning, secondary inorganic (i.e., ammonium sulfate and nitrate) and primary traffic exhausts were the predominant PM2.5 sources. The declining trends of PM2.5 mass in all four sites were very well correlated with decreasing secondary sulfate levels due to SO2 emission reductions by coal-fired power plants. The contributions of secondary nitrate, primary traffic exhausts and diesel particles did not change (or slightly increased) over time except for the Queens site, where statistically significant declines were computed. Biomass burning contributions increased in the Queens and Chester sites but declined in the Division Str and Elizabeth Lab sites, although significant interannual variability was observed. Wintertime biomass burning aerosols were most likely due to combustion of contemporary biomass for industrial and domestic heating, and it was linked to the intensity (average minimum temperature) and duration (number of freezing days) of cold weather. The annual summertime biomass burning contributions were correlated with the number of and area burnt by lightning-ignited wildfires. These results indicate that PM2.5 sources in urban environments is changing from anthropogenic secondary sulfate and nitrate to carbonaceous aerosol from local anthropogenic and regional climate-driven biomass burning. This trend may counterbalance emissions controls on anthropogenic activities and modify the biological and toxicological responses and resultant health effects.

Located in the desert of the U.S. Southwest, the City of Tucson and the counties around the metropolitan area have a long history of engaging in heat-related issues. Tucson Water has hosted 14 annual Urban Heat Island workshops, disseminating knowledge on the latest best practices and resources to address extreme heat to city agencies. Leaders in Southern Arizona have also worked with regional and state coalitions to share information and resources on heat management and mitigation. Following the record-breaking heat in the summer of 2023, Arizona Governor, Katie Hobbs, declared an extreme heat emergency and issued an Executive Order to prepare a plan outlining specific lines of action to address extreme heat in the future. The Arizona Department of Health Services (ADHSs) held a summit quickly in the fall of 2023 in Phoenix to understand statewide gaps and prioritize action items. While open to all state participants, the meeting attendance from Southern Arizona partners was limited due to the increased travel distance and limited timing. In response to state-level planning efforts and to advance the city and county’s own ongoing heat planning efforts, the City of Tucson, Pima County Health Department, and the University of Arizona mobilized to organize the Southern Arizona Heat Planning Summit.

The workshop, Developing an Integrated Heat Health Information System for Long-Term Resilience to Climate and Weather Extremes in the El Paso-Juárez-Las Cruces Region, was held in El Paso, Texas, on July 13, 2016. Sponsored by a collaborative of universities and local and federal agencies, the workshop brought together individuals in government, practitioner, and academic communities from Mexico and the United States to discuss the intersection of the region’s climate and weather with factors affecting public health risks related to extreme heat. The region is home to approximately 2.4 million people, most of whom are living in or near the urban centers of Ciudad Juárez (Chihuahua), El Paso, and Las Cruces (New Mexico). These cities share characteristics, such as a high proportion of residents of Hispanic origin, median income below the U.S. national average, and a range of climate related environmental issues that include drought, flooding, air pollution, dust storms, and frequent occurrences of extremely high temperatures during the late spring and early summer. With hotter temperatures and more frequent and persistent heat waves projected for the El Paso-Juárez-Las Cruces region, it is critical to develop more robust systems of institutions, social learning, and partnerships to understand risks and strengthen public health resilience.

Climate influences dengue ecology by affecting vector dynamics, agent development, and mosquito/human interactions. Although these relationships are known, the impact climate change will have on transmission is unclear. Climate-driven statistical and process-based models are being used to refine our knowledge of these relationships and predict the effects of projected climate change on dengue fever occurrence, but results have been inconsistent. We sought to identify major climatic influences on dengue virus ecology and to evaluate the ability of climate-based dengue models to describe associations between climate and dengue, simulate outbreaks, and project the impacts of climate change. We reviewed the evidence for direct and indirect relationships between climate and dengue generated from laboratory studies, field studies, and statistical analyses of associations between vectors, dengue fever incidence, and climate conditions. We assessed the potential contribution of climate-driven, process-based dengue models and provide suggestions to improve their performance. Relationships between climate variables and factors that influence dengue transmission are complex. A climate variable may increase dengue transmission potential through one aspect of the system while simultaneously decreasing transmission potential through another. This complexity may at least partly explain inconsistencies in statistical associations between dengue and climate. Process-based models can account for the complex dynamics but often omit important aspects of dengue ecology, notably virus development and host–species interactions. Synthesizing and applying current knowledge of climatic effects on all aspects of dengue virus ecology will help direct future research and enable better projections of climate change effects on dengue incidence.

Natural resource managers are seeking tools to help them address current and future effects of climate change. We present a model for collaborative planning aimed at identifying ways to adapt management actions to address the effects of climate change in landscapes that cross public and private jurisdictional boundaries. The Southwest Climate Change Initiative (SWCCI) piloted the Adaptation for Conservation Targets (ACT) planning approach at workshops in 4 southwestern U.S. landscapes. This planning approach successfully increased participants’ self-reported capacity to address climate change by providing them with a better understanding of potential effects and guiding the identification of solutions. The workshops fostered cross-jurisdictional and multidisciplinary dialogue on climate change through active participation of scientists and managers in assessing climate change effects, discussing the implications of those effects for determining management goals and activities, and cultivating opportunities for regional coordination on adaptation of management plans. Facilitated application of the ACT framework advanced group discussions beyond assessing effects to devising options to mitigate the effects of climate change on specific species, ecological functions, and ecosystems. Participants addressed uncertainty about future conditions by considering more than one climate-change scenario. They outlined opportunities and identified next steps for implementing several actions, and local partnerships have begun implementing actions and conducting additional planning. Continued investment in adaptation of management plans and actions to address the effects of climate change in the southwestern United States and extension of the approaches used in this project to additional landscapes are needed if biological diversity and ecosystem services are to be maintained in a rapidly changing world.

As part of a regional integrated assessment of climate vulnerability, a survey was conducted from June 1998 to May 2000 of weather, climate, and hydrologic forecasts with coverage of the US Southwest and an emphasis on the Colorado River Basin. The survey addresses the types of forecasts that were issued, the organizations that provided them, and techniques used in their generation. It reflects discussions with key personnel from organizations involved in producing or issuing forecasts, providing data for making forecasts, or serving as a link for communicating forecasts. During the survey period, users faced a complex and constantly changing mix of forecast products available from a variety of sources. The abundance of forecasts was not matched in the provision of corresponding interpretive materials, documentation about how the forecasts were generated, or reviews of past performance. Potential existed for confusing experimental and research products with others that had undergone a thorough review process, including official products issued by the National Weather Service. Contrasts between the state of meteorologic and hydrologic forecasting were notable, especially in the former¹s greater operational flexibility and more rapid incorporation of new observations and research products. Greater attention should be given to forecast content and communication, including visualization, expression of probabilistic forecasts and presentation of ancillary information. Regional climate models and use of climate forecasts in water supply forecasting offer rapid improvements in predictive capabilities for the Southwest. Forecasts and production details should be archived, and publicly available forecasts should be accompanied by performance evaluations that are relevant to users.

Water scarcity is an ever-present fact of life in the arid and increasingly urbanized Southwest. Yet even with the considerable effort expended on drought-proofing urban areas through infrastructure and policy development, droughts of magnitudes found in the historical records of the past 100 yr continue to threaten the region¹s cities. Results of an analysis of the sensitivity of 3 urban areas in Arizona to selected drought scenarios suggest that severe droughts of 1, 5, and 10 yr duration would severely stress existing water supply/demand budgets. The results of the analysis suggest that very considerable conservation efforts would be required to bring demand into balance with existing supply. This article reports on the results of analysis of the sensitivity of urban water systems in the Phoenix and Tucson metropolitan areas as well as in the Sierra Vista subwatershed, which includes the rapidly growing city of Sierra Vista and the adjacent Fort Huachuca Army Base.

This paper summarizes the current state of knowledge of the climate of southwest USA (the 'Southwest'). Low annual precipitation, clear skies, and year-round warm climate over much of the Southwest are due in large part to a quasi-permanent subtropical high-pressure ridge over the region. However, the Southwest is located between the mid-latitude and subtropical atmospheric circulation regimes, and this positioning relative to shifts in these regimes is the fundamental reason for the region¹s climatic variability. Furthermore, the Southwest¹s complex topography and its geographical proximity to the Pacific Ocean, the Gulf of California, and the Gulf of Mexico also contribute to this region¹s high climatic variability. El Niño, which is an increase in sea-surface temperature of the eastern equatorial Pacific Ocean with an associated shift of the active center of atmospheric convection from the western to the central equatorial Pacific, has a well-developed teleconnection with the Southwest, usually resulting in wet winters. La Niña, the opposite oceanic case of El Niño usually results in dry winters for the Southwest. Another important oceanic influence on winter climate of the Southwest is a feature called the Pacific Decadal Oscillation (PDO), which has been defined as temporal variation in sea-surface temperatures for most of the Northern Pacific Ocean. The effects of ENSO and PDO can amplify each other, resulting in increased annual variability in precipitation over the Southwest. The major feature that sets the climate of the Southwest apart from the rest of the United States is the North American monsoon, which in the US is most noticeable in Arizona and New Mexico. Up to 50% of the annual rainfall of Arizona and New Mexico occurs as monsoonal storms from July through September. Instrumental measurement of temperature and precipitation in the Southwest dates back to the middle to late 1800s. From that record, average annual rainfall of Arizona is 322 mm (12.7¹¹), while that of New Mexico is 340 mm (13.4¹¹), and mean annual temperature of New Mexico is cooler (12°C [53°F]) than Arizona (17°C [62°F]). As instrumental meteorological records extend back only about 100 to 120 yr throughout the Southwest, they are of limited utility for studying climate phenomena of long time frames. Hence, there is a need to extend the measured meteorological record further back in time using so-called Œnatural archive¹ paleoclimate records. Tree-ring data, which provide annual resolution, range throughout the Southwest, extend back in time for up to 1000 yr or more in various forests of the Southwest, and integrate well the influences of both temperature and precipitation, are useful for this assessment of climate of the Southwest. Tree growth of mid-elevation forests typically responds to moisture availability during the growing season, and a commonly used climate variable in paleo-precipitation studies is the Palmer Drought Severity Index (PDSI), which is a single variable derived from variation in precipitation and temperature. June-August PDSI strongly represents precipitation and, to a lesser extent, temperature of the year prior to the growing season (prior September through current August). The maximum intra-ring density of higher elevation trees can yield a useful record of summer temperature variation. The combined paleo-modern climate record has at least 3 occurrences of multi-decadal variation (50 to 80 yr) of alternating dry (below average PDSI) to wet (above average PDSI). The amplitude of this variation has increased since the 1700s. The most obvious feature of the temperature record is its current increase to an extent unprecedented in the last 400 yr. Because this warming trend is outside the variation of the natural archives, it is possible that anthropogenic impacts, such as increased atmospheric concentrations of greenhouse trace gases, are playing a role in climate of the Southwest. Accordingly, this pattern merits further research in search of its cause or combination of causes.

For ranchers in the Southwest, unanticipated droughts pose serious management challenges. Social and economic factors combine with the physical impacts of drought to render ranchers more vulnerable to climate variability. Using agricultural census data and interviews with ranchers, we analyze ranchers¹ responses to drought events in 1996 and 1999. From this analysis we develop an initial assessment of the principal factors contributing to the vulnerability of ranching in southeastern Arizona to climatic variability, and we make some preliminary determinations regarding the potential use of climate information in mitigating this vulnerability. During drought, climatic conditions can combine with poor cattle prices and high feed costs to strain ranchers¹ resources. The ability to cope with drought is further complicated by changes in environmental policy and pressure from urban growth. In these circumstances, ranchers reported being tempted to sell their private ranch property to development interests. Although our pilot study identified smaller operations as the most vulnerable to climatic variability in the context of policy and economic uncertainty, these operations reported less utility in climate information. The multidimensional nature of vulnerability suggests that climate information will be most useful to ranching operations of all sizes if it is integrated with market, policy and other economic information and if existing information distribution channels are used to reach ranchers.