The COVID-19 pandemic decreased the in-person outpatient visits and accelerated the use of telehealth services among mental health patients. Our study investigated the sociodemographic and clinical correlates of the intensity of telehealth use among mental health patients residing in rural Louisiana, United States. The study sample included 7069 telehealth visits by 1115 unique patients encountered from 1 April 2020 to 31 March 2021 at six mental health outpatient clinics managed by the Northeast Delta Human Services Authority (NEDHSA). We performed a negative binomial regression analysis with the intensity of service use as the outcome variable. Being younger, female, and more educated were associated with a higher number of telehealth visits. The prevalence of other chronic conditions increased telehealth visits by 10%. The telehealth service intensity varied across the nature of mental health diagnoses, with patients diagnosed with the schizophrenia spectrum and other psychotic disorders utilizing 15% fewer telehealth visits than patients diagnosed with depressive disorders. The promotion of telehealth services among mental health patients in the rural setting might require the elimination of the digital divide with a particular focus on the elderly, less educated, and those with serious mental health illnesses such as schizophrenia and psychotic disorders.

Elevation gradients are used as a proxy to simulate climate change effects. A field study was conducted along an elevational gradient in Nepal to understand the effects of abiotic conditions on agriculturally important insect herbivore populations (tobacco caterpillar: Spodoptera litura, tomato fruit worm: Helicoverpa armigera, and South American leaf miner, Tuta absoluta) and herbivory damage on tomatoes. Elevation ranged from 100 m to 1400 m above sea level, representing different climatic zones where tomatoes are grown. Contrary to our hypothesis, natural herbivore populations and herbivory damage significantly increased at higher elevations. Individual insect species responses were variable. Populations of S. litura and T. absoluta increased at higher elevations, whereas the H. armigera population was highest at the mid-elevational range. Temperature variations with elevation also affected insect catch numbers and the level of plant damage from herbivory. In the context of climate warming, our results demonstrate that the interactive effects of elevation and climatic factors (e.g., temperature) will play an important role in determining the changes in insect pest populations and the extent of crop losses.

Missed appointments, or no-shows, can affect patients’ health due to delays in receiving timely care and result in inefficient use of health care resources. Telehealth has generally been considered effective and is widely implemented to treat behavioral health conditions. Although knowledge about no-shows is critical to inform health care institutions for effective management of resources and better health outcomes,¹ a limited body of literature has compared no-shows between telehealth and in-person care in behavioral health clinics in rural settings that cater to patients with relatively low income.

Integrated care addresses the fragmentation of patient health services and potentially improves the experience of care, reduces healthcare costs, and improves health outcomes. This study assessed the improvements in mental health and physical health outcomes among patients living with mental health challenges and treated in an integrated care setting. The longitudinal retrospective cohort study evaluated anxiety (GAD-7), depression (PHQ-9), systolic blood pressure, and glycated hemoglobin levels from baseline to the next three assessments recorded from October 1, 2018, to December 31, 2023. At baseline, 239 participants responded to mental health outcome measures, 344 to systolic blood pressure, and 164 to glycated hemoglobin level. The Generalized Estimating Equations analysis showed an improvement in GAD-7 (-1.28 [95% CI, -1.71 to -0.85]) and PHQ-9 (-1.37 [95% CI, -1.73 to -0.92]) scores in successive assessments. The physical health outcomes (Systolic blood pressure (-0.004 [95% CI, -1.34 to 1.35]) and glycated hemoglobin (0.04 [95% CI, -0.07 to 0.15])) remained stable. This study demonstrates that patients with mental health challenges treated in integrated care experience improvements in depression and anxiety symptoms, with stable physical health outcomes.

Overextraction of groundwater reduces groundwater height, increases the energy cost, and may threaten an aquifer's economic life. Water‐intensive crops, corn, and soybean, dominate the agricultural land in the Mississippi River Alluvial Aquifer (MRAA) region of the United States, thus stressing this confined aquifer. Groundwater conservation policy or the adoption of efficient irrigation technology could save both water and energy. This study aims to estimate the future returns from the irrigated land under the scenarios of 30%, 20%, 10%, 5%, and no groundwater conservation from 2020 to 2022. An accurate model to predict the crop choice decision is important to estimate the impact of groundwater policies. We develop a crop choice model where an individual farmer has a crop planting or land fallowing choice each year. We use the random forest, boosted regression trees, and support vector machine for the crop choice prediction. Boosted regression trees perform the best in our classification problem with 75.5% out of sample accuracy. The prediction model shows that the numbers of corn growers increase in the future. Our results show that the profit of 2572 farmers increased cumulatively by 0.14% when they conserve groundwater by 30% for 3 years. From a policy perspective, providing financial and technical assistant to farmers for making investments to conserve groundwater could save energy costs and sustain the economic life of the MRAA. Recommendations for Resource Managers Land allocations to water‐intensive crops such as corn and soybeans will expand in Louisiana. More efficient irrigation technology may reduce the groundwater extraction volume. Groundwater extraction volume using a choice prediction model gives a more accurate account of water use compared to the status quo crop choice decision scenario. Since efficient irrigation measures do not reduce crop yield, profit from the irrigated land is higher as it reduces the extraction cost. Government cost‐share to adopt efficient irrigation measures may help conserve groundwater resources.