Implementation and outcomes of a statewide TBI screening program for underserved populations.

The purpose of this paper is to describe the implementation and outcomes of a unique traumatic brain injury (TBI) screening initiative serving the community, with a focus on underserved populations. Idaho's definition of underserved populations includes people living in rural/frontier areas, people experiencing homelessness or intimate partner violence, people with co-occurring disorders, and people with cultural and/or linguistically diverse backgrounds. The goals of screenings are to help participants gain awareness about the likelihood of having experienced a TBI, bridge the gap in TBI reporting, and provide needed support to underserved populations in a rural state. Our work represents a cross-sectional study. Beginning in 2014, TBI screenings were conducted by the Institute of Rural Health within a public health university with several internal and external partners, as well as grant funding for work. Trained interprofessional health students and/or members of the Institute of Rural Health performed TBI screenings using the Ohio State University TBI Identification Method-Interview Form. Those who screened as likely experiencing a TBI received resources for care and follow-up telephone calls. Data were collected on the number of individuals screened and their results and reported using descriptive statistics. From 2014 to 2022, a total of 1333 individuals were screened at 23 different community events across Idaho. Over 30% of screened individuals reported a history of head or neck injury, primarily due to falls and being hit by objects. The majority of identified cases of TBI were characterized by no loss of consciousness or <30 min of unconsciousness. Screenings targeting underserved populations showed higher TBI prevalence. Targeting underserved populations proved valuable in identifying TBI cases. The collaborative and interprofessional approach of this screening is unique and highlights the potential to address complex health issues effectively. These findings offer valuable insights for others implementing TBI screening programs in community settings.

The Ability of Primary Care Practices to Measure and Report on Care Quality.

BACKGROUND: Creating useful clinical quality measure (CQM) reports in a busy primary care practice is known to depend on the capability of the electronic health record (EHR). Two other domains may also contribute: supportive leadership to prioritize the work and commit the necessary resources, and individuals with the necessary health information technology (IT) skills to do so. Here we describe the results of an assessment of the above 3 domains and their associations with successful CQM reporting during an initiative to improve smaller primary care practices' cardiovascular disease CQMs. METHODS: The study took place within an AHRQ EvidenceNOW initiative of external support for smaller practices across Washington, Oregon and Idaho. Practice facilitators who provided this support completed an assessment of the 3 domains previously described for each of their assigned practices. Practices submitted 3 CQMs to the study team: appropriate aspirin prescribing, use of statins when indicated, blood pressure control, and tobacco screening/cessation. RESULTS: Practices with advanced EHR reporting capability were more likely to report 2 or more CQMs. Only one-third of practices were "advanced" in this domain, and this domain had the highest proportion of practices (39.1%) assessed as "basic." The presence of advanced leadership or advanced skills did not appreciably increase the proportion of practices that reported 2 or more CQMs. CONCLUSIONS: Our findings support previous reports of limited EHR reporting capabilities within smaller practices but extend these findings by demonstrating that practices with advanced capabilities in this domain are more likely to produce CQM reports.

The Essential Oil Compositions of Ambrosia acanthicarpa Hook., Artemisia ludoviciana Nutt., and Gutierrezia sarothrae (Pursh) Britton & Rusby (Asteraceae) from the Owyhee Mountains of Idaho.

As part of our interest in the volatile phytoconstituents of aromatic plants of the Great Basin, we have obtained essential oils of Ambrosia acanthicarpa (three samples), Artemisia ludoviciana (12 samples), and Gutierrezia sarothrae (six samples) from the Owyhee Mountains of southwestern Idaho. Gas chromatographic analyses (GC-MS, GC-FID, and chiral GC-MS) were carried out on each essential oil sample. The essential oils of A. acanthicarpa were dominated by monoterpene hydrocarbons, including α-pinene (36.7-45.1%), myrcene (21.6-25.5%), and ß-phellandrene (4.9-7.0%). Monoterpene hydrocarbons also dominated the essential oils of G. sarothrae, with ß-pinene (0.5-18.4%), α-phellandrene (2.2-11.8%), limonene (1.4-25.4%), and (Z)-ß-ocimene (18.8-39.4%) as major components. The essential oils of A. ludoviciana showed wide variation in composition, but the relatively abundant compounds were camphor (0.1-61.9%, average 14.1%), 1,8-cineole (0.1-50.8%, average 11.1%), (E)-nerolidol (0.0-41.0%, average 6.8%), and artemisia ketone (0.0-46.1%, average 5.1%). This is the first report on the essential oil composition of A. acanthicarpa and the first report on the enantiomeric distribution in an Ambrosia species. The essential oil compositions of A. ludoviciana and G. sarothrae showed wide variation in composition in this study and compared with previous studies, likely due to subspecies variation.

Are National Breast and Cervical Cancer Early Detection Program Recipients Providing Services in Counties Heavily Burdened by Breast and Cervical Cancer?

INTRODUCTION: Alignment of National Breast and Cervical Cancer Early Detection Program (NBCCEDP) clinical services with the spatial distribution of breast and cervical cancer burden is essential to maximizing programmatic impact and addressing cancer disparities. This study identified spatial clustering of breast and cervical cancer burden scores and assessed whether and to what extent NBCCEDP clinical services were associated with clusters for the 5-year period, 2015-2019. METHODS: We examined burden scores for spatial clustering using Local Indicators of Spatial Association (LISA) tests in GeoDA. We then used t-tests to compare the NBCCEDP 5-year average percentage of eligible women served clinical breast and cervical cancer services between hotspot (high burden) and coolspot clusters. RESULTS: There was statistically significant spatial clustering in the pattern of breast and cervical cancer burden scores across counties, with hotspot clusters mostly observed in the Southern region, Idaho and Nevada. For both breast and cervical cancer, higher percentages of eligible women received breast and cervical cancer clinical services in coolspot clusters compared to hotspot clusters during each year from 2015-2019. CONCLUSION: NBCCEDP clinical services can help reduce breast and cervical cancer burden. Yet, during 2015-2019, increased service delivery was not aligned with the spatial distribution of counties with greater breast and cervical cancer burdens. NBCCEDP recipients may improve their impact on breast and cervical cancer burden by prioritizing and consistently increasing service delivery in cancer burden hotspot clusters if they have not already maximized their resources in these areas.

Crop bromide concentrations following methyl bromide fumigation for pale cyst nematode in southeastern Idaho.

Methyl bromide (MeBr) is a sterilizing fumigant used to control quarantine pests that is restricted due to its detrimental atmospheric effects. The degradation of injected MeBr produces crop-available Br- . Up to five applications of MeBr were used in southeastern Idaho fields to combat the pale cyst nematode (Globodera pallida). Data regarding the uptake and partitioning of Br- in crops following MeBr application in the region were unavailable. Research determined background concentrations of Br- in alfalfa (Medicago sativa L.), barley (Hordeum vulgare L.), corn (Zea mays L.), potato (Solanum tuberosum L.), and wheat (Triticum aestivum L.) compared to MeBr-treated fields. Background Br- concentrations ranged from nondetectable (ND) to 33.0 mg Br- kg-1 ; vegetative tissue concentrations were greater than reproductive, except corn where there was no difference. Nearly all crops grown in MeBr-treated fields had greater Br- concentrations than background. Background-baled-alfalfa tissue Br- concentration was 33.0 mg kg-1 compared to 117.8 mg Br- kg-1 from a MeBr-treated field. Br- concentration in green alfalfa decreased from 79.8 to 36.5 mg Br- kg-1 at the final cutting in a MeBr-treated field, where time after application decreased crop Br- concentrations. Small grains had low Br- concentrations in reproductive tissue (1.7 mg Br- kg-1 ) compared to vegetative tissue (106.5 mg Br- kg-1 ). Corn stover concentration (12.7 mg Br- kg-1 ) was low relative to small-grain straw, but corn ear (5.8 mg Br- kg-1 ) was greater than small-grain reproductive tissue in the MeBr-treated field. Crop selection following MeBr applications should consider the likelihood of elevated Br- concentration for the plant fractions intended end use.

Grapevine Endophyte Endornavirus and Two New Endornaviruses Found Associated with Grapevines (Vitis vinifera L.) in Idaho, USA.

Five virus genomes, ranging between 12.0 and 12.3 kb in length and identified as endornaviruses, were discovered through a high-throughput sequencing (HTS) analysis of the total RNA samples extracted from two wine grape cultivars collected in the State of Idaho. One was found in a declining Chardonnay vine and was determined to be a local isolate of grapevine endophyte endornavirus (GEEV), and four others represented two novel endornaviruses named grapevine endornavirus 1 (GEV1) and grapevine endornavirus 2 (GEV2). All three virus genomes span a large, single open reading frame encoding polyproteins with easily identifiable helicase (HEL) and RNA-dependent RNA polymerase (RdRP) domains, while the GEV2 polyprotein also contains a glycosyltransferase domain. The GEV1 genome found in an asymptomatic Cabernet franc vine was related to, but distinct from, GEEV: the 5'-proximal, 4.7 kb segment of the GEV1 genome had a 72% identical nucleotide sequence to that of GEEV, while the rest of the genome displayed no significant similarity to the GEEV nucleotide sequence. Nevertheless, the amino acid sequence of the RdRP domain of GEV1 exhibited the closest affinity to the RdRP of GEEV. GEV2 was found in declining Chardonnay and asymptomatic Cabernet franc vines as three genetic variants exhibiting a 91.9-99.8% nucleotide sequence identity among each other; its RdRP had the closest affinity to the Shahe endorna-like virus 1 found in termites. In phylogenetic analyses, the RdRP and HEL domains of the GEV1 and GEV2 polyproteins were placed in two separate clades inside the large lineage of alphaendornaviruses, showing an affinity to GEEV and Phaseolus vulgaris endornavirus 1, respectively.

Essential Oil Composition of Grindelia squarrosa from Southern Idaho.

Grindelia squarrosa is an arid lands herb that has been used in Native American traditional medicine, is a potential source of pharmacologically active compounds, and has been explored as a source of biofuel. The purpose of this work was to examine the essential oil composition of G. squarrosa from southern Idaho. Gas chromatographic methods revealed the essential oil of G. squarrosa var. serrulata to be rich in monoterpenoids, α-pinene (21.9%), limonene (17.1%), terpinolene (10.6%), and borneol (6.5%). The essential oil composition of G. squarrosa from Idaho is similar to that previously reported from specimens collected from Montana and confirms the volatile phytochemistry of plants growing in North America. The major essential oil components were screened for antimicrobial activity against respiratory and dermal pathogens. (-)-ß-Pinene showed strong antibacterial activity against Streptococcus pneumoniae (MIC 39.1 µg/mL) and (-)-borneol showed strong activity against Staphylococcus aureus (MIC 78.1 µg/mL).

Resistance and Tolerance Screening of Spring Wheat Cultivars to Cereal Cyst Nematode (Heterodera avenae) in Southeastern Idaho.

Increased populations of Heterodera avenae in southeastern Idaho are associated with increased planting of susceptible cereal cultivars and lack of crop rotation. Identifying high-yield, resistant spring wheat cultivars with tolerance requires testing new genotypes and susceptibility assessments of marketed cultivars. We conducted two experiments to determine whether cultivars with putative resistance could maintain acceptable yield in the presence of H. avenae. We also evaluated the tolerance response in relation to previously tested cultivars. Seven spring wheat cultivars were planted in two irrigated commercial fields that were naturally infested with high populations of H. avenae. Measures of resistance, tolerance, and grain yield were assessed in aldicarb-treated versus nontreated plots. In aldicarb-treated plots in both years, grain yield of the susceptible cultivars Snow Crest, WestBred 936, WB9411, Patwin-515, and WB9668 was significantly increased. The expected yield increase with aldicarb was limited for the moderately susceptible Expresso due to water stress. 'WB-Rockland', carrying the Cre5 resistance gene, maintained its standard yield, while none of the other cultivars in the experiment showed resistance or tolerance. Our results indicated that aldicarb improves wheat grain yield in irrigated crop production systems, and although removed from the market, it is effective and has utility for research. The results also support the hypothesis that high yield susceptible cultivars can mask the effect of H. avenae on grain yield when managed appropriately.

Promising Interventions to Prevent Liver Cancer in Idaho.

INTRODUCTION: The Idaho Comprehensive Cancer Control Program (ICCCP) collaborated with the Idaho Immunization Program (IIP) to plan and implement activities to increase knowledge and awareness of liver cancer prevention through tailored hepatitis B immunization messaging to the Idaho community and health care providers. PURPOSE AND OBJECTIVES: In this article, we report findings from an evaluation of these activities. INTERVENTIONS APPROACH: The two programs implemented liver cancer prevention activities between May 2017 and December 2017; strategies included a social media vaccination awareness campaign and health care provider education. EVALUATION METHODS: Facebook Insights was used to report, and descriptive statistics were used to analyze, data from the social media campaign. Descriptive statistics were used to analyze data collected from a retrospective pre-post survey for the health care provider presentations and paired t-tests were conducted to detect differences between pre- and postexposure. RESULTS: For the social media campaign, ICCCP and IIP posted a total of 32 liver cancer and hepatitis B vaccination posts on their respective Facebook pages, which reached 42,804 unique users. For the health care provider presentations, there was a statistically significant increase in awareness, knowledge, ability, and intention among health care providers. IMPLICATIONS FOR PUBLIC HEALTH: Our evaluation serves as an example of how public health social media can reach consumers and how educating providers can raise awareness on the importance of hepatitis B vaccination as a means of preventing liver cancer.

Lost in the woods: Forest vegetation, and not topography, most affects the connectivity of mesh radio networks for public safety.

Real-time data- and location-sharing using mesh networking radios paired with smartphones may improve situational awareness and safety in remote environments lacking communications infrastructure. Despite being increasingly used for wildland fire and public safety applications, there has been little formal evaluation of the network connectivity of these devices. The objectives of this study were to 1) characterize the connectivity of mesh networks in variable forest and topographic conditions; 2) evaluate the abilities of lidar and satellite remote sensing data to predict connectivity; and 3) assess the relative importance of the predictive metrics. A large field experiment was conducted to test the connectivity of a network of one mobile and five stationary goTenna Pro mesh radios on 24 Public Land Survey System sections approximately 260 ha in area in northern Idaho. Dirichlet regression was used to predict connectivity using 1) both lidar- and satellite-derived metrics (LIDSAT); 2) lidar-derived metrics only (LID); and 3) satellite-derived metrics only (SAT). On average the full network was connected only 32.6% of the time (range: 0% to 90.5%) and the mobile goTenna was disconnected from all other devices 18.2% of the time (range: 0% to 44.5%). RMSE for the six connectivity levels ranged from 0.101 to 0.314 for the LIDSAT model, from 0.103 to 0.310 for the LID model, and from 0.121 to 0.313 for the SAT model. Vegetation-related metrics affected connectivity more than topography. Developed models may be used to predict the connectivity of real-time mesh networks over large spatial extents using remote sensing data in order to forecast how well similar networks are expected to perform for wildland firefighting, forestry, and public safety applications. However, safety professionals should be aware of the impacts of vegetation on connectivity.

A Novel Rhabdovirus Associated with the Idaho Population of Potato Cyst Nematode Globodera pallida.

Globodera pallida, a potato cyst nematode (PCN), is a quarantine endoparasitic pest of potato (Solanum tuberosum) in the US due to its effects on yield and quality of potato tubers. A new rhabdovirus, named potato cyst nematode rhabdovirus (PcRV), was revealed and characterized in the G. pallida populations collected in Idaho through use of high-throughput sequencing (HTS) and RT-PCR and found to be most closely related to soybean cyst nematode rhabdovirus (ScRV). PcRV has a 13,604 bp long, single-stranded RNA genome encoding five open reading frames, including four rhabdovirus-specific genes, N, P, G, and L, and one unknown gene. PcRV was found present in eggs, invasive second-stage juveniles, and parasitic females of G. pallida, implying a vertical transmission mode. RT-PCR and partial sequencing of PcRV in laboratory-reared G. pallida populations maintained over five years suggested that the virus is highly persistent and genetically stable. Two other Globodera spp. reproducing on potato and reported in the US, G. rostochiensis and G. ellingtonae, tested negative for PcRV presence. To the best of our knowledge, PcRV is the first virus experimentally found infecting G. pallida. Based on their similar genome organizations, the phylogeny of their RNA-dependent RNA polymerase domains (L gene), and relatively high identity levels in their protein products, PcRV and ScRV are proposed to form a new genus, provisionally named "Gammanemrhavirus", within the family Rhabdoviridae.

Improving Quality Improvement Capacity and Clinical Performance in Small Primary Care Practices.

PURPOSE: We undertook a study to assess whether implementing 7 evidence-based strategies to build improvement capacity within smaller primary care practices was associated with changes in performance on clinical quality measures (CQMs) for cardiovascular disease. METHODS: A total of 209 practices across Washington, Oregon, and Idaho participated in a pragmatic clinical trial that focused on building quality improvement capacity as measured by a validated questionnaire, the 12-point Quality Improvement Capacity Assessment (QICA). Clinics reported performance on 3 cardiovascular CQMs-appropriate aspirin use, blood pressure (BP) control (<140/90 mm Hg), and smoking screening/cessation counseling-at baseline (2015) and follow-up (2017). Regression analyses with change in CQM as the dependent variable allowed for clustering by practice facilitator and adjusted for baseline CQM performance. RESULTS: Practices improved QICA scores by 1.44 points (95% CI, 1.20-1.68; P <.001) from an average baseline of 6.45. All 3 CQMs also improved: aspirin use by 3.98% (average baseline = 66.8%; 95% CI for change, 1.17%-6.79%; P = .006); BP control by 3.36% (average baseline = 61.5%; 95% CI for change, 1.44%-5.27%; P = .001); and tobacco screening/cessation counseling by 7.49% (average baseline = 73.8%; 95% CI for change, 4.21%-10.77%; P <.001). Each 1-point increase in QICA score was associated with a 1.25% (95% CI, 0.41%-2.09%, P = .003) improvement in BP control; the estimated likelihood of reaching a 70% BP control performance goal was 1.24 times higher (95% CI, 1.09-1.40; P <.001) for each 1-point increase in QICA. CONCLUSION: Improvements in clinic-level performance on BP control may be attributed to implementation of 7 evidence-based strategies to build quality improvement capacity. These strategies were feasible to implement in small practices over 15 months.

Time from breast cancer diagnosis to treatment among Idaho's National Breast and Cervical Cancer Early Detection Program population, 2011-2017.

PURPOSE: Idaho's Women's Health Check (WHC) Program provides breast and cervical cancer screening to under- and uninsured women via funding from the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Because WHC serves populations with less access to health care, this study evaluated time from breast cancer diagnosis to treatment for women enrolled in the WHC program and linked to Cancer Data Registry of Idaho (CDRI) case data (WHC-linked) and the remainder of female Idaho resident breast cases. METHODS: Among Idaho residents aged 50-64 years diagnosed during 2011-2017 with ductal carcinoma in situ or invasive breast cancer, we assessed differences in the median time from definitive diagnosis to treatment initiation overall and by demographic and tumor characteristics, and differences in the distribution of demographic and tumor-related variables between 231 WHC-linked and 3,040 non-linked breast cancer cases. RESULTS: WHC-linked cases were significantly less likely to be non-Hispanic white, and more likely to live in poorer census tracts, be diagnosed at a later stage, and be treated with mastectomy. Most WHC-linked (92%) and non-linked women (94%) began treatment within 60 days of diagnosis; no differences in time to treatment were observed. CONCLUSION: Disparities in the interval from definitive diagnosis to breast cancer treatment initiation were not observed for women enrolled in the WHC program relative to other Idaho women.

Improving Central Cancer Registry Surveillance through Interstate Data Exchange of Electronic Pathology Reports.

When a cancer case is diagnosed or treated in one US state, but the patient resides in another, the case report abstract is shared with the central cancer registry in the state of residence through interstate data exchange. However, the records shared may not include pathology reports. Cases diagnosed in another state that would be ascertained only from pathology reports may thus be missed. Utah Cancer Registry received many electronic pathology (e-path) records for nonresident cases that were not being shared. In 2019, Utah Cancer Registry implemented workflow changes and created a novel data extract process to share e-path records in a North American Association of Central Cancer Registries (NAACCR) HL7 format. Utah Cancer Registry shared e-path records for an estimated 2,773 cases with other states for the diagnosis year 2018. Of these cases, both an e-path record and NAACCR-format abstract were shared for 1,709 (61.6%), whereas e-path record only was shared for 1,064 (38.4%). The largest number of e-path records went to 2 adjacent states: Idaho (n = 1,084) and Wyoming (n = 621). Receiving registries reported success importing the files. The e-path data stream resulted in ascertainment of 96 new cases for Idaho and 89 for Wyoming for diagnosis year 2018. Whereas most shared e-path records represented cases already known to the receiving registry, registry staff provided feedback that it was beneficial to obtain the additional documentation. Linking and reviewing the shared e-path records did represent additional workload. Central cancer registries can adopt this process for sharing e-path records via interstate data exchange to support complete case ascertainment in collaborating states.

Cancer among Refugees Resettled to Idaho during 2008-2019: A Proof-of-Concept Study.

BACKGROUND: Disparities in cancer burden and outcomes according to socioeconomic characteristics have been extensively characterized for US populations. The cancer experience of refugees, who may share characteristics of other socioeconomically disadvantaged populations and also experience distinct barriers to care, has not been described previously. We conducted a proof-of-concept study evaluating our ability to characterize cancer incidence in refugees resettled to Idaho via a novel linkage of cancer data and administrative data characterizing refugee arrivals to Idaho. METHODS: In July 2021, the Cancer Data Registry of Idaho probabilistically linked cancer surveillance data and refugee arrival data (2008- 2019 diagnosis and arrival years) collected through the Centers for Disease Control and Prevention's Electronic Disease Notification (EDN) System. We used SEER*Stat to calculate standardized incidence ratios (SIR) for malignant tumors and benign/borderline malignant brain and other nervous system (ONS) tumors using Idaho-specific and Surveillance, Epidemiology, and End Results (SEER) Program referent incidence rates. RESULTS: 60 malignant and 7 benign brain and ONS tumors were diagnosed among 9,499 refugees resettled to Idaho. Refugees had fewer than expected malignant tumors overall (57 observed vs 96.0 expected; SIR, 0.60; 95% CI, 0.45-0.77). An excess of tumors of the esophagus were diagnosed among Southeast Asian refugees (4 observed vs 0.64 expected; SIR, 6.3; 95% CI, 1.7-16.0). We also used EDN data to update country of birth for linked persons. CONCLUSIONS: Linking EDN refugee data to cancer surveillance data presented unique challenges. However, we used a novel data source to augment cancer data and characterize incidence in refugees, potentially improving our ability to serve this vulnerable population.

US Rural Surgeons Leading During COVID-19: Where Are They Now?

Rural surgeons from disparate areas of the United States report on the effects of the COVID-19 pandemic in their communities as the virus has spread across the country. The pandemic has brought significant changes to the professional, economic, and social lives of the individual surgeons and their communities.

The Evolution of Sex is Tempered by Costly Hybridization in Boechera (Rock Cress).

Despite decades of research, the evolution of sex remains an enigma in evolutionary biology. Typically, research addresses the costs of sex and asexuality to characterize the circumstances favoring one reproductive mode. Surprisingly few studies address the influence of common traits that are, in many organisms, obligately correlated with asexuality, including hybridization and polyploidy. These characteristics have substantial impacts on traits under selection. In particular, the fitness consequences of hybridization (i.e., reduced fitness due to interspecific reproductive isolation) will influence the evolution of sex. This may comprise a cost of either sex or asexuality due to the link between hybridity and asexuality. We examined reproductive isolation in the formation of de novo hybrid lineages between 2 widespread species in the ecological model system Boechera. Seventeen percent of 664 crosses produced F1 fruits, and only 10% of these were viable, suggesting that postmating prezygotic and postzygotic barriers inhibit hybrid success in this system. The postmating prezygotic barrier was asymmetrical, with 110 of 115 total F1 fruits produced when Boechera stricta acted as maternal parent. This asymmetry was confirmed in wild-collected lineages, using a chloroplast phylogeny of wild-collected B. stricta, Boechera retrofracta, and hybrids. We next compared fitness of F2 hybrids and selfed parental B. stricta lines, finding that F2 fitness was reduced by substantial hybrid sterility. Multiple reproductively isolating barriers influence the formation and fitness of hybrid lineages in the wild, and the costs of hybridization likely have profound impacts on the evolution of sex in the natural environment.

Direct patient care services by community and ambulatory care pharmacists in Idaho.

Background Pharmacists are one of the most accessible but unoptimized healthcare providers in the community. They are medication experts and have authority to independently prescribe in Idaho. Through the provision of direct patient care services (i.e., those distinct from traditional prescription dispensing functions), pharmacists have a greater opportunity to impact chronic disease prevention and management across the state. This can be done by filling gaps in community care (e.g., prescribing recommended therapy) and directly managing and preventing chronic diseases. However, current practices surrounding pharmacist-provided direct patient care services are unknown. Objective To characterize direct patient care services provided by Idaho community and ambulatory care pharmacists as well as to assess individual pharmacists' and their work sites' capacity and barriers in providing and expanding services. Setting Community and ambulatory care pharmacists' work sites in Idaho. Method We administered a cross-sectional, electronic, 20-min survey to Idaho community and ambulatory care pharmacists. Main outcome measure The survey focused on collecting data on current practices, capacity, and barriers related to pharmacist-provided direct patient care services. Results The survey was completed by 280 eligible community and ambulatory care pharmacists with the majority of respondents (n = 250) offering pharmacist-provided direct patient care services. Pharmacists most often prescribed therapy for tobacco cessation (nicotine replacement, bupropion, varenicline), naloxone, and devices for patients with diabetes. Top barriers to individual pharmacists providing services were dispensing load and workload while top barriers to work sites (e.g., environment) were reimbursement/billing, number of available staff, and workflow. Conclusion Idaho community and ambulatory care pharmacists currently offer direct patient care services to patients across the state, but face barriers in providing and increasing services offered.

Outcomes Associated With a Nurse-Driven Palliative Care Screening Tool in the Intensive Care Unit.

BACKGROUND: Access to specialty palliative care delivery in the intensive care unit is inconsistent across institutions. The intensive care unit at the study institution uses a screening tool to identify patients likely to benefit from specialty palliative care, yet little is known about outcomes associated with the use of screening tools. OBJECTIVE: To identify outcomes associated with specialty palliative care referral among patients with critical illness. METHODS: Records of 112 patients with positive results on palliative care screening were retrospectively reviewed to compare outcomes between patients who received a specialty palliative care consult and those who did not. Primary outcome measures were length of stay, discharge disposition, and escalation of care. RESULTS: Sixty-five patients (58%) did not receive a palliative care consult. No significant differences were found in length of hospital or intensive care unit stay. Most patients who experienced mechanical ventilation did not receive a palliative care consultation (χ2 = 5.14, P = .02). Patients who were discharged to home were also less likely to receive a consult (χ2 = 4.1, P = .04), whereas patients who were discharged to hospice were more likely to receive a consult (χ2 = 19.39, P < .001). CONCLUSIONS: Unmet needs exist for specialty palliative care. Understanding the methods of identifying patients for specialty palliative care and providing them with such care is critically important. Future research is needed to elucidate the factors providers use in their decisions to order or defer specialty palliative care consultation.

The Unknown Human Health Legacy of Nuclear Weapons Testing.

For nearly half a century, the United States and the Soviet Union were locked in a fierce battle although no shots were actually fired. Starting in the 1940s, both started developing their arsenal of nuclear weapons, in preparation for an all-out nuclear war. The U.S. government primarily used a patch of land in Nye, NV, that was formerly a military base, to conduct their tests. It was flat with few animals nearby. It seemed far from civilization and wasn't adjacent to any water streams, which the government thought would minimize the spread of contamination that would be generated from the above-ground blasts. In other words, the site seemed to be perfect.