Burkholderia pseudomallei Laboratory Exposure, Arizona, USA.

We describe an incidental Burkholderia pseudomallei laboratory exposure in Arizona, USA. Because melioidosis cases are increasing in the United States and B. pseudomallei reservoirs have been discovered in the Gulf Coast Region, US laboratory staff could be at increased risk for B. pseudomallei exposure.

Genomic Sequencing Surveillance to Identify Respiratory Syncytial Virus Mutations, Arizona, USA.

We conducted surveillance of respiratory syncytial virus (RSV) genomic sequences for 100 RSV-A and 27 RSV-B specimens collected during November 2022-April 2023 in Arizona, USA. We identified mutations within prefusion F-protein antigenic sites in both subtypes. Continued genomic surveillance will be critical to ensure RSV vaccine effectiveness.

Detection of Hantavirus during the COVID-19 Pandemic, Arizona, USA, 2020.

We identified 2 fatal cases of persons infected with hantavirus in Arizona, USA, 2020; 1 person was co-infected with SARS-CoV-2. Delayed identification of the cause of death led to a public health investigation that lasted ≈9 months after their deaths, which complicated the identification of a vector or exposure.

Limited Cutaneous Leishmaniasis as Ulcerated Verrucous Plaque on Leg, Tucson, Arizona, USA1.

We report a 34-year-old man who had a nonhealing, verrucous plaque with central ulceration on the lower leg. This case-patient is a rare example of endemic limited cutaneous leishmaniasis in Tucson, Arizona, USA. Clinicians should be aware of this disease because its manifestations can vary for individual patients.

Measurement invariance of the Arizona Sexual Experience Scale by sexual orientation: comparing the sexual functioning of gay and heterosexual individuals.

BACKGROUND: The assessment of sexual functioning requires accurate and reliable measures as well as short and easy to apply. The Arizona Sexual Experience Scale (ASEX), which provides a quick, easy, and nonintrusive assessment of sexual functioning in men and women, is a clear example of a commonly used scale that satisfies these qualities. AIM: The study sought to examine measurement invariance and differential item functioning (DIF) by sexual orientation of the Spanish version of the ASEX. METHODS: A confirmatory factor analysis was performed on a sample of 1600 adults (800 gay and 800 heterosexual individuals), testing measurement invariance of the ASEX by sexual orientation in men and women separately, and calculating its reliability and DIF. OUTCOMES: The measure provided by the Spanish version of the ASEX is reliable and valid for assessing the sexual functioning of gay men and lesbians, but comparisons by sexual orientation are not recommended for men. RESULTS: The results of the confirmatory factor analysis confirmed the unidimensional structure of the ASEX already found in the Spanish validation with heterosexual people. Measurement invariance showed that, in the men's sample, the factor structure of the ASEX only reached the weak level of invariance, whereas in the women's sample, strict invariance by sexual orientation was reached. The internal consistency reliability was adequate, with better coefficients in women than in men. No significant DIF was observed in either men or women. CLINICAL IMPLICATIONS: Clinicians should further their training in sexual and gender diversity as approaches such as affirmative LGBT psychotherapy gain popularity, and they must have access to assessment instruments that are psychometrically robust enough to be used with this population. STRENGTHS AND LIMITATIONS: This research has some limitations. Because the distribution was administered solely through social media platforms, those without access to social media were unable to participate. Beyond these restrictions, however, the findings are thought to be significant from a research and clinical perspective since measurement invariance is a step that is often excluded when using an instrument validated in a mostly heterosexual sample. CONCLUSION: Validating assessment tools in gay men and lesbians is essential because sexual functioning is a crucial concept in sexual health. The findings of this study suggest that the Spanish version of the ASEX offers valid and reliable measures of sexual functioning for both heterosexual and gay people, though there would be bias in comparing men of both orientations.

Pre-contact Agave domesticates - living legacy plants in Arizona's landscape.

BACKGROUND AND SCOPE: Agaves played a central role as multi-use plants providing food, fibre and beverage to pre-contact and historical Mesoamerican cultures. However, their importance to Indigenous Peoples in the Southwest USA and northern Mexico, where they occur because of adaptations such as CAM photosynthesis, is less well known. Archaeological research indicates the Hohokam and other pre-contact Southwestern agrarian people increased agricultural potential in this region by engineering riverine terraces and bajadas for agave dry farming. Agricultural features such as terraces and rock piles were especially characteristic of post-1000 CE with the increase of dense, aggregated populations. We present an overview of six pre-contact agave domesticates (PCADs) the Hohokam and other cultures cultivated, and their ecological and cultural attributes. These PCADs are Agave murpheyi, A. delamateri, A. phillipsiana, A. sanpedroensis, A. verdensis and A. yavapaiensis. CONCLUSION: Pre-contact agriculturists cultivated at least six once cryptic domesticated agave species in the modern Arizona landscape associated with pre-contact agricultural features, such as rock structures. Because of the longevity and primarily asexual reproduction of these agaves, relict clones have persisted to the present day, providing an opportunity to study pre-contact nutrition, trade, migration and agricultural practices. Taxonomic data imply that pre-contact farmers selected desirable attributes, initiating domestication processes that resulted in discrete lineages. These agaves are morphologically and genetically distinct from Southwest US and northern Mexico wild agaves and Mesoamerican wild and domesticated species. Additionally, the remnant clones present a rare opportunity to examine domesticates virtually unchanged since they were last cultivated prehistorically. These discoveries underline the need to view landscapes and some plant species from a cultural, rather than 'natural', perspective and discern potential cryptic species veiled by traditional taxonomic treatments. Protecting and understanding the distribution, and ecological and cultural roles of these plants require interdisciplinary collaboration between botanists, archaeologists, federal agencies and Indigenous Peoples.

Sexual Dysfunction in Parkinson's Disease: A Systematic Review of the Arizona Sexual Experience Scale Sexual Dysfunction in Parkinson Disease: A Systematic Review of the Arizona Sexual Experience Scale.

OBJECTIVE: Parkinson's disease (PD) affects older individuals and can cause sexual dysfunction (SD). SD is a determinant of general well-being; but is infrequently assessed in professionally. The Arizona Sexual Experience Scale (ASEX) measures SD; unlike other scales, it is minimally invasive and requires little time to complete. This review aimed to assess the prevalence of SD in patients with PD using ASEX. METHODS: Were searched the keywords, "sexual dysfunction," "Parkinson's disease" and "ASEX" in 9 databases. RESULTS: The prevalence of SD ranged from 65%-90%. SD was associated with older age at disease onset, higher Unified Parkinson Disease Rating Scale scores, age and depression (p ranged from .001 to <.05). The most observed SD was erectile dysfunction in men. CONCLUSION: SD is common among patients with PD. ASEX, although not specific to PD, is an easy and quickly applied tool that can help evaluate SD and guide treatments in PD.

Genetic characterization and description of Leishmania (Leishmania) ellisi sp. nov.: a new human-infecting species from the USA.

In a 2018 report, an unusual case of cutaneous leishmaniasis was described in a 72-year-old female patient residing in Arizona, United States of America (USA). Preliminary analysis of the 18S rDNA and glyceraldehyde-3-phosphate dehydrogenase genes supported the conclusion that the Leishmania strain (strain 218-L139) isolated from this case was a novel species, though a complete taxonomic description was not provided. Identification of Leishmania at the species level is critical for clinical management and epidemiologic investigations so it is important that novel human-infecting species are characterized taxonomically and assigned a unique scientific name compliant with the ICZN code. Therefore, we sought to provide a complete taxonomic description of Leishmania strain 218-L139. Phylogenetic analysis of several nuclear loci and partial maxicircle genome sequences supported its position within the subgenus Leishmania and further clarified the distinctness of this new species. Morphological characterization of cultured promastigotes and amastigotes from the original case material is also provided. Thus, we conclude that Leishmania (Leishmania) ellisi is a new cause of autochthonous cutaneous leishmaniasis in the USA.

Experimental Analysis of Various Blockage Performance for LiDAR Sensor Cleaning Evaluation.

Autonomous driving includes recognition, judgment, and control technologies, and is implemented using sensors such as cameras, LiDAR, and radar. However, recognition sensors are exposed to the outside environment and their performance may deteriorate because of the presence of substances that interfere with vision, such as dust, bird droppings, and insects, during operation. Research on sensor cleaning technology to solve this performance degradation has been limited. This study used various types and concentrations of blockage and dryness to demonstrate approaches to the evaluation of cleaning rates for selected conditions that afford satisfactory results. To determine the effectiveness of washing, the study used the following criteria: washer, 0.5 bar/s and air, 2 bar/s, with 3.5 g being used three times to test the LiDAR window. The study found that blockage, concentration, and dryness are the most important factors, and in that order. Additionally, the study compared new forms of blockage, such as those caused by dust, bird droppings, and insects, with standard dust that was used as a control to evaluate the performance of the new blockage types. The results of this study can be used to conduct various sensor cleaning tests and ensure their reliability and economic feasibility.

Cross-Sectional Study of Clinical Predictors of Coccidioidomycosis, Arizona, USA.

Demographic and clinical indicators have been described to support identification of coccidioidomycosis; however, the interplay of these conditions has not been explored in a clinical setting. In 2019, we enrolled 392 participants in a cross-sectional study for suspected coccidioidomycosis in emergency departments and inpatient units in Coccidioides-endemic regions. We aimed to develop a predictive model among participants with suspected coccidioidomycosis. We applied a least absolute shrinkage and selection operator to specific coccidioidomycosis predictors and developed univariable and multivariable logistic regression models. Univariable models identified elevated eosinophil count as a statistically significant predictive feature of coccidioidomycosis in both inpatient and outpatient settings. Our multivariable outpatient model also identified rash (adjusted odds ratio 9.74 [95% CI 1.03-92.24]; p = 0.047) as a predictor. Our results suggest preliminary support for developing a coccidioidomycosis prediction model for use in clinical settings.

University-Associated SARS-CoV-2 Omicron BA.2 Infections, Maricopa County, Arizona, USA, 2022.

We investigated a university-affiliated cohort of SARS-CoV-2 Omicron BA.2 infections in Arizona, USA. Of 44 cases, 43 were among students; 26 persons were symptomatic, 8 sought medical care, but none were hospitalized. Most (55%) persons had completed a primary vaccine series; 8 received booster vaccines. BA.2 infection was mild in this young cohort.

Severe Combined Immunodeficiency (SCID) Screening in Arizona: Lessons Learned from the First 2 Years.

PURPOSE: The incidence of severe combined immunodeficiency (SCID) in the USA was reported as 1 in 58,000 live births. In Arizona, it was anticipated that newborn screening would identify two to four cases of SCID per year. This estimate did not consider ethnic nuances in Arizona, with higher percentages of Native American and Hispanic populations compared to national percentages. The true incidence of SCID and non-SCID T cell lymphopenia has not previously been reported in Arizona. METHODS: A retrospective chart review was performed on all abnormal SCID newborn screening (NBS) tests in Arizona from January 1, 2018, to December 31, 2019, using data from the Arizona Department of Health Services and the Phoenix Children's Hospital's electronic medical record [IRB# 20-025]. RESULTS: Seven infants were diagnosed with SCID, yielding an incidence of 1 in 22,819 live births. Four of these infants had Artemis-type SCID. Thirteen infants were identified with an abnormal initial NBS which ultimately did not lead to a diagnosis of SCID. Four of these infants were diagnosed with congenital syndromes associated with T cell lymphopenia. Infants of Hispanic ethnicity were over-represented in this cohort. CONCLUSION: Over 2 years, NBS in Arizona confirmed an incidence more than 2.5 times that reported nationally. This increased incidence is likely reflective of Arizona's unique population profile, with a higher percentage of Native American population. The findings in our non-SCID cohort are in alignment with previously published data, except for an increased percentage of infants of Hispanic/Latino ethnicity, possibly reflecting Arizona's increased percentage of Hispanic/Latino population compared to the general US population.

Forest restoration treatments increased growth and did not change survival of ponderosa pines in severe drought, Arizona.

We report on survival and growth of ponderosa pines (Pinus ponderosa Douglas ex P. Lawson & C. Lawson) 2 decades after forest restoration treatments in the G. A. Pearson Natural Area, northern Arizona. Despite protection from harvest that conserved old trees, a dense forest susceptible to uncharacteristically severe disturbance had developed during more than a century of exclusion of the previous frequent surface-fire regime that ceased upon Euro-American settlement in approximately 1876. Trees were thinned in 1993 to emulate prefire-exclusion forest conditions, accumulated forest floor was removed, and surface fire was re-introduced at 4-years intervals (full restoration). There was also a partial restoration treatment consisting of thinning alone. Compared with untreated controls, mortality of old trees (mean age 243 years, maximum 462 years) differed by <1 tree ha-1 and old-tree survival was statistically indistinguishable between treatments (90.5% control, 92.3% full, 82.6% partial). Post-treatment growth as measured by basal area increment of both old (pre-1876) and young (post-1876) pines was significantly higher in both treatments than counterpart control trees for more than 2 decades following thinning. Drought meeting the definition of megadrought affected the region almost all the time since the onset of the experiment, including 3 years that were severely dry. Growth of all trees declined in the driest 3 years, but old and young treated trees had significantly less decline. Association of tree growth with temperature (negative correlation) and precipitation (positive correlation) was much weaker in treated trees, indicating that they may experience less growth decline from warmer, drier conditions predicted in future decades. Overall, tree responses after the first 2 decades following treatment suggest that forest restoration treatments have led to substantial, sustained improvement in the growth of old and young ponderosa pines without affecting old-tree survival, thereby improving resilience to a warming climate.

Sexual Dysfunction Among Egyptian Idiopathic Parkinson's Disease Patients.

BACKGROUND: One of the non-motor features of idiopathic Parkinson's disease (IPD) is sexual dysfunction (SD) which is under-recognized and, consequently, undertreated. This study aimed to evaluate SD in patients with IPD. PATIENTS AND METHODS: The study was conducted on 67 IPD patients; 30 healthy subjects with age and gender matching with the patients served as the control group. All participants were subjected to sexual function assessment using the Arabic version of Arizona Sexual Experience Scale (ASEX), Mini-Mental State Examination (MMSE), and Beck Depression Inventory (BDI), while the severity of IPD was assessed using the modified Hoehn and Yahr scoring scale and MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). RESULTS: There were no statistically significant differences between patients with IPD and the control group regarding MMSE, hypertension, diabetes mellitus, or dyslipidemia. However, BDI scores were significantly higher in patients with IPD. The rate of SD among our patients was 64% compared to 30% in the control group. The total score and subscales of ASEX were significantly higher in IPD patients than in controls. SD showed a significant correlation with the severity of the IPD irrespective of other variables, including patient age, sex, disease duration, hypertension, diabetes, dyslipidemia, smoking, and dose of L-dopa. CONCLUSION: SD is a commonly underrated feature in patients with IPD; it should be investigated carefully as it is an important non-motor symptom that correlates with disease severity.

The power of local research to inform adverse childhood experiences in substance use prevention in adolescents and adults.

BACKGROUND: The impact of adverse childhood experiences on substance use has been well reported, however, less well documented is looking at the comparison of youth and adult substance use and their respective adverse childhood experiences. This study leveraged local data sources to support prevention efforts inside a state-level working group and examined research questions that explored the relationship between reported adverse childhood experiences and substance use for youth and adult samples at the state level. METHODS: This study conducted a series of logistic regression models (95% CI) between substance use outcomes with different age group populations to investigate the relationship between adverse childhood experiences and substance use for each group. Adverse childhood experiences scores and substance use were examined using two Arizona datasets: 1) Arizona Youth Survey (n = 42,009) and 2) the Behavioral Risk Factor Surveillance System (n = 5328). RESULTS: The results of youth and adult datasets were consistent: users with adverse childhood experiences scores of 4 to 6 had a positive association with more substance use. When the variables were examined, showing the entire sample of youth and adult groups compared to those subgroups with a score of zero, a score of 1 to 3, and a score of 4 to 6, the overall pattern was the same; the more frequent use of substances was directly associated to the group with higher scores. Additionally, findings support increased attention on prevention and intervention efforts with higher reports of adverse childhood experiences as well as substance use. CONCLUSIONS: These findings demonstrate how local research can help prioritize prevention resources and increase the value of data-based decision-making. Policy-makers and providers can examine youth and adult data to compare priorities and assess for planning purposes. Specifically, it is possible to replicate known research findings, identify the most impacted subpopulations, and forecast the community's future needs.

"They say it's fentanyl, but they honestly look like Perc 30s": Initiation and use of counterfeit fentanyl pills.

BACKGROUND: Worsening of the overdose crisis in the USA has been linked to the continuing proliferation of non-pharmaceutical fentanyl (NPF). The recent wave of NPF spread in the USA has been fueled by an increased presence of counterfeit pills that contain NPF. This qualitative study aims to characterize the motivation and practices of counterfeit NPF pill initiation and use among individuals using illicit opioids in Arizona. METHODS: Between October 2020 and May 2021, semi-structured interviews were conducted with 22 individuals meeting the following eligibility criteria: (1) 18 years or older; (2) residence in Arizona; and (3) use of illicit opioids in the past 30 days and/or opioid use disorder treatment in the past 12 months. Participants were recruited through referrals by a harm reduction organization, craigslist ads, and referrals by other participants. Interviews were conducted virtually via Zoom. Qualitative interviews were transcribed and analyzed thematically using NVivo. RESULTS: Out of 22 participants, 64% were male, and 45% were ethnic minorities. Age ranged between 25 and 51 years old. Participants noted significant recent increases in the availability of counterfeit NPF pills ("blues," "dirty oxys") that were most commonly used by smoking. The majority indicated first trying NPF pills in the past year, and the first use often occurred in situations of reduced access to heroin or pharmaceutical opioids. Participant decisions to switch over to more frequent NPF pill use or to maintain some levels of heroin use were shaped by local drug availability trends and personal experiences with NPF effects. They were also influenced by conflicting views of social acceptability of pharmaceutical-like drugs, perceived harms of NPF in terms of overdose risks and increased difficulty of quitting, and perceived benefits of switching to the non-injection route of opioid administration (e.g., from injecting heroin to smoking NPF pills). CONCLUSION: Our findings highlight the need for the implementation of novel policy, treatment, and harm reduction approaches to address the growing unpredictability of drug supply and NPF pill-specific risks, attitudes, and behaviors.

Cutaneous Leishmaniasis Caused by an Unknown Leishmania Strain, Arizona, USA.

We investigated an autochthonous case of cutaneous leishmaniasis caused by a genetically different Leishmania sp. in a patient in Arizona, USA. This parasite was classified into the subgenus Leishmania on the basis of multilocus DNA sequence and phylogenetic analyses of the rRNA locus and 11 reference genes.

Coccidioidomycosis and COVID-19 Co-Infection, United States, 2020.

We review the interaction between coronavirus disease (COVID-19) and coccidioidomycosis, a respiratory infection caused by inhalation of Coccidioides fungal spores in dust. We examine risk for co-infection among construction and agricultural workers, incarcerated persons, Black and Latino populations, and persons living in high dust areas. We further identify common risk factors for co-infection, including older age, diabetes, immunosuppression, racial or ethnic minority status, and smoking. Because these diseases cause similar symptoms, the COVID-19 pandemic might exacerbate delays in coccidioidomycosis diagnosis, potentially interfering with prompt administration of antifungal therapies. Finally, we examine the clinical implications of co-infection, including severe COVID-19 and reactivation of latent coccidioidomycosis. Physicians should consider coccidioidomycosis as a possible diagnosis when treating patients with respiratory symptoms. Preventive measures such as wearing face masks might mitigate exposure to dust and severe acute respiratory syndrome coronavirus 2, thereby protecting against both infections.

Genomic Sequencing of SARS-CoV-2 E484K Variant B.1.243.1, Arizona, USA.

Genomic surveillance can provide early insights into new circulating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. While conducting genomic surveillance (1,663 cases) from December 2020-April 2021 in Arizona, USA, we detected an emergent E484K-harboring variant, B.1.243.1. This finding demonstrates the importance of real-time SARS-CoV-2 surveillance to better inform public health responses.

Water and nitrogen shape winter annual plant diversity and community composition in near-urban Sonoran Desert preserves.

Increased nitrogen (N) deposition threatens global biodiversity, but its effects in arid urban ecosystems are not well studied. In addition to altered N availability, urban environments also experience increases in other pollutants, decreased population connectivity, and altered biotic interactions, which can further impact biodiversity. In deserts, annual plant communities make up most of the plant diversity, support wildlife, and contribute to nutrient cycling and ecosystem processes. Functional tradeoffs allowing coexistence of a diversity of annual plant species are well established, but maintenance of diversity in urban conditions and with increased availability of limiting nutrients has not been explored. We conducted a 13-year N and phosphorus (P) addition experiment in Sonoran Desert preserves in and around Phoenix, AZ, to test how nutrient availability interacts with growing season precipitation, urban location, and microhabitat to affect winter annual plant diversity. Using structural equation modeling and generalized linear mixed modeling, we found that annual plant taxonomic diversity was significantly reduced in N-enriched and urban plots. Water availability in both current and previous growing seasons impacted annual plant diversity, with significant interaction effects showing increased diversity in wetter years and greater responsiveness of the community to water following a wet year. However, there were no significant interactions between N enrichment and water availability, urban location, or microhabitat. Lowered diversity in urban preserves may be partly attributable to increased urban N deposition. Changes in biodiversity of showy species like annual wildflowers in urban preserves can have important implications for connections between urban residents and nature, and reduced diversity and community restructuring with N enrichment represents a challenge for future preservation of aridland biodiversity.