Effects of Rurality on Distance and Time Traveled to Receive Vaccination Against Mpox-New Mexico and Idaho 2022-2023.

ABSTRACT: We compared mpox vaccination access between urban and rural residents who received ≥1 JYNNEOS dose using immunization data in Idaho and New Mexico. Rural residents traveled 5 times farther and 3 times longer than urban residents to receive mpox vaccination. Increasing mpox vaccine availability to health care facilities might increase uptake.

Cross-scale analysis reveals interacting predictors of annual and perennial cover in Northern Great Basin rangelands.

Exotic annual grass invasion is a widespread threat to the integrity of sagebrush ecosystems in Western North America. Although many predictors of annual grass prevalence and native perennial vegetation have been identified, there remains substantial uncertainty about how regional-scale and local-scale predictors interact to determine vegetation heterogeneity, and how associations between vegetation and cattle grazing vary with environmental context. Here, we conducted a regionally extensive, one-season field survey across burned and unburned, grazed, public lands in Oregon and Idaho, with plots stratified by aspect and distance to water within pastures to capture variation in environmental context and grazing intensity. We analyzed regional-scale and local-scale patterns of annual grass, perennial grass, and shrub cover, and examined to what extent plot-level variation was contingent on pasture-level predictions of site favorability. Annual grasses were widespread at burned and unburned sites alike, contrary to assumptions of annual grasses depending on fire, and more common at lower elevations and higher temperatures regionally, as well as on warmer slopes locally. Pasture-level grazing pressure interacted with temperature such that annual grass cover was associated positively with grazing pressure at higher temperatures but associated negatively with grazing pressure at lower temperatures. This suggests that pasture-level temperature and grazing relationships with annual grass abundance are complex and context dependent, although the causality of this relationship deserves further examination. At the plot-level within pastures, annual grass cover did not vary with grazing metrics, but perennial cover did; perennial grasses, for example, had lower cover closer to water sources, but higher cover at higher dung counts within a pasture, suggesting contrasting interpretations of these two grazing proxies. Importantly for predictions of ecosystem response to temperature change, we found that pasture-level and plot-level favorability interacted: perennial grasses had a higher plot-level cover on cooler slopes, and this difference across topography was starkest in pastures that were less favorable for perennial grasses regionally. Understanding the mechanisms behind cross-scale interactions and contingent responses of vegetation to grazing in these increasingly invaded ecosystems will be critical to land management in a changing world.

Exploring healthcare provider retention in a rural and frontier community in Northern Idaho.

BACKGROUND: A shortage of healthcare providers, particularly in primary care and mental health, exists in the predominately rural state of Idaho. There are also barriers to retaining healthcare providers to work in rural and remote communities. Limited research using U.S. samples has explored factors that may affect the retention of healthcare providers in rural areas. Additionally, due to differences between communities, it is important to conduct community-level investigations to better understand how these factors may affect retention in rural areas. Therefore, the purpose of this study was to explore factors affecting healthcare provider retention in a rural community in Northern Idaho. METHODS: A modified version of the Nursing Community Apgar Questionnaire (NCAQ) was completed by 30 healthcare providers in a rural and frontier community in Northern Idaho to assess factors influencing healthcare provider retention. Factors were classified into classes including geographic, economic, scope of practice, medical support, and facility and community support classes. Retention factors were assessed on their perceived importance to retention as well as whether they were perceived as an advantage or challenge to retention based on Likert scales. A "Community Apgar" score was also created by combining the importance and advantage/challenge factors. RESULTS: Overall, items in the medical support group had the highest importance of any other class and included factors such as nursing workforce. Additionally, the facility and community support class, which included factors such as televideo support, was rated the highest advantage class and had the highest Apgar score, indicating it contained the factor that healthcare providers identified as the most important advantage (i.e., medical reference resources). CONCLUSION: Our study identified multiple factors that healthcare providers deemed as important advantages or disadvantages to retaining healthcare providers in rural areas. Overall, facility and community support factors were found to have the highest advantage in the retention of rural providers. Rural healthcare organizations looking to increase healthcare provider retention should target retention efforts towards these factors. Additional research should also be conducted on other rural samples across the U.S. to make comparisons of findings.

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.

Observed face mask use outside retail chain stores during the COVID-19 pandemic in two cities in the state of Idaho, USA.

During the COVID-19 pandemic, public health authorities have encouraged the use of face masks to minimize transmission within the community. To assess mask wear during a COVID-19 surge and guide public health response efforts, including public messaging on mask recommendations, we compared observed mask use in the largest city in each of Idaho's 2 most populous counties, both without a current mask mandate. We recorded mask usage by every third person exiting stores of 5 retail chains in Boise and Nampa during November 8-December 5, 2021. Observations were conducted during three time periods (morning, afternoon, and evening) on weekday and weekend days. A multivariable model with city, retail chain, and city-chain interaction was used to assess mask wear differences by city for each chain. Of 3021 observed persons, 22.0% wore masks. In Boise, 31.3% (430/1376) of observed persons wore masks; in Nampa, 14.3% (236/1645) wore masks. Among all persons wearing masks, > 94% wore masks correctly; cloth and surgical masks were most common. By retail chain, observed individuals at Boise locations were 2.3-5.7 times as likely to wear masks than persons at respective Nampa locations. This study provided a rapid, nonconfrontational assessment of public use of mitigation measures in 2 Idaho cities during a COVID-19 surge.

An exploration of patient and pharmacist willingness to utilize a food insecurity screening tool in supermarket-based pharmacies.

BACKGROUND: Food insecurity (FI) is a disturbance of eating patterns due to lack of resources, preventing consistent access to healthy foods. FI negatively impacts health outcomes and increases care cost. OBJECTIVES: The primary objective was to (a) explore patient willingness to screen with the 2-question Hunger Vital Sign tool and (b) accept education regarding food assistance programs at their community pharmacy. The secondary objective was to gauge pharmacy personnel's comfort with utilizing the screener and providing education. PRACTICE DESCRIPTION: Screenings occurred from February to May 2023 at supermarket-based pharmacies in counties above state average FI prevalence. PRACTICE INNOVATION: This study evaluated responses to a 9-item FI screening questionnaire that was offered to patients presenting to the pharmacy. Personnel offered patients education about resources and documented responses. Pharmacies provided survey responses to detail their experiences. EVALUATION METHODS: This mixed-methods observational pilot study received approval from Idaho State University's institutional review board. Objective 1(a) was assessed by recording the number of patients agreeing or declining to participate. Objective 1(b) was evaluated by recording the number of patients who accepted education. The secondary objective was appraised by gathering survey responses from personnel. Results were analyzed with descriptive statistics. RESULTS: Of patients asked to participate, 163 (73.1%) agreed. Forty-one agreed but did not submit responses. Of patients agreeing, 123 (75.5%) accepted education. Of patients submitting responses, 56 (49.5%) screened as at-risk for FI. Regarding comfort engaging in the innovation, 4 pharmacies (50.0%) reported being comfortable, 3 (37.5%) neither comfortable nor uncomfortable, and 1 (12.5%) uncomfortable. Qualitative information collected from personnel highlighted meaningful interactions and how this will change their approach to pharmacy practice. CONCLUSION: Supermarket-based pharmacists may be able to detect and educate on FI. Patients in the study screened at a higher rate of at-risk for FI than their counties reported. Many patients accepted education regardless of screening results.

How to implement a "standard of care" regulatory model for pharmacists.

National pharmacy associations have increasingly explored regulation according to a "standard of care." In such a model, pharmacists can provide a wide range of clinical services aligned with their education and training. Based on Idaho's experience implementing this model, there are five critical steps states must take to enact a standard of care: 1) Adopt a broad definition of "practice of pharmacy;" 2) Allow elasticity for practice innovation over time; 3) Decide which limited instances still necessitate prescriptive regulation; 4) Eliminate all unnecessary regulations; and 5) Strengthen accountability for deviations from the standard of care. States wishing to adopt a standard of care approach can follow this five-step process to enhance patient care and mitigate the lag that is otherwise constant between laws and practice.

Nutrient leaching potential along a time series of forest water reclamation facilities in northern Idaho.

Forest water reclamation is a decades-old practice of repurposing municipal reclaimed water using land application on forests to filter nutrients and increase wood production. However, long-term application may lead to nutrient saturation, leaching, and potential impairment of ground and surface water quality. We studied long-term effects of reclaimed water application on nutrient leaching potential in a four-decade time series of forest water reclamation facilities in northern Idaho. Our approach compared reclaimed water treated plots with untreated control plots at each of the forest water reclamation facilities. We measured soil nitrifier abundance and net nitrification rates and used tension lysimeters to sample soil matrix water and drain gauges to sample from a combination of matrix and preferential flow paths. We determined nutrient leaching as the product of soil water nutrient concentrations and model-estimated drainage flux. There was more than 450-fold increase in nitrifier abundance and a 1000-fold increase in net nitrification rates in treated plots compared with control plots at long-established facilities, indicating greater nitrate production with increased cumulative inputs. There were no differences in soil water ammonium, phosphate, and dissolved organic nitrogen concentrations between control and effluent treatments in tension lysimeter samples. However, concurrent with increased nitrifier abundance and net nitrification, nitrate concentration below the rooting zone was 2 to 4-fold higher and nitrate leaching was 4 to 10-fold higher in effluent treated plots, particularly at facilities that have been in operation for over two decades. Thus, net nitrification and nitrifier abundance assays are likely indicators of nitrate leaching potential. Inorganic nutrient concentrations in drain gauge samples were 2 to 11-fold higher than lysimeter samples, suggesting nutrient losses occurred predominantly through preferential flow paths. Nitrate was vulnerable to leaching during the wet season under saturated flow conditions. Although nitrogen saturation is a concern that should be mitigated at long-established facilities, these forest water reclamation facilities were able to maintain average soil water nitrate concentrations to less than 2 mg L-1, so that nitrogen and phosphorous are effectively filtered to below safe water standards.

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.

Misleading Statements About "Life of the Mother" Exceptions in Pro-life Laws Require Correction.

Misleading statements in a recent Obstetrics & Gynecology article require correction. No state has an abortion law that is a total ban on abortion. Every state law permits abortion when necessary to save a mother's life. Texas law does not require an "imminent" risk and allows a doctor to use his "reasonable medical judgment" to determine if an abortion is necessary to prevent a "risk" of maternal death. Similarly, Idaho allows a doctor to use his "good faith medical judgment" to determine when to intervene, without need for "immediacy".

Cluster of Carbapenemase-Producing Carbapenem-Resistant Pseudomonas aeruginosa Among Patients in an Adult Intensive Care Unit - Idaho, 2021-2022.

Treatment of carbapenemase-producing carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) infections is challenging because of antibiotic resistance. CP-CRPA infections are highly transmissible in health care settings because they can spread from person to person and from environmental sources such as sink drains and toilets. During September 2021-January 2022, an Idaho hospital (hospital A) isolated CP-CRPA from sputum of two patients who stayed in the same intensive care unit (ICU) room (room X), 4 months apart. Both isolates had active-on-imipenem metallo-beta-lactamase (IMP) carbapenemase gene type 84 (blaIMP-84) and were characterized as multilocus sequence type 235 (ST235). A health care-associated infections team from the Idaho Division of Public Health visited hospital A during March 21-22, 2022, to discuss the cluster investigation with hospital A staff members and to collect environmental samples. CP-CRPA ST235 with blaIMP-84 was isolated from swab samples of one sink in room X, suggesting it was the likely environmental source of transmission. Recommended prevention and control measures included application of drain biofilm disinfectant, screening of future patients who stay in room X (e.g., the next 10 occupants) upon reopening, and continuing submission of carbapenem-resistant P. aeruginosa (CRPA) isolates to public health laboratories. Repeat environmental sampling did not detect any CRPA. As of December 2022, no additional CP-CRPA isolates had been reported by hospital A. Collaboration between health care facilities and public health agencies, including testing of CRPA isolates for carbapenemase genes and implementation of sink hygiene interventions, was critical in the identification of and response to this CP-CRPA cluster in a health care setting.

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.

Opportunities for pharmacist prescriptive authority of buprenorphine following passage of the Mainstreaming Addiction Treatment (MAT) Act.

In December 2022, Congress passed the Mainstreaming Addiction Treatment Act, which removed the federal legal barrier to pharmacist buprenorphine prescribing. As a result, each state can now decide whether or not to allow pharmacists to prescribe buprenorphine as an additional access point to reduce fatal opioid overdoses. At least 10 states allow pharmacists to prescribe controlled substances under collaborative practice agreements. Two states (California and Idaho) have also created pathways for independent prescribing of buprenorphine by pharmacists. Additional states should seek to enable pharmacists to prescribe buprenorphine to increase access to a proven beneficial treatment and help reduce fatal opioid overdoses.

Aroma Profile Development in Beer Fermented with Azacca, Idaho-7, and Sultana Hops.

Hops are among the most costly and environmentally impactful raw materials used in brewing, yet they play a crucial role in the aroma of beer. However, predicting beer aroma based on hop variety or hopping method remains arduous. This is partly because hop oils are unique for each hop variety, and they may be biotransformed by yeast enzymes during fermentation. Even slight molecular structure modifications can dramatically affect the organoleptic properties of beer. Through combined chemical and sensory analysis of dry-hopped beers prepared with different hop varieties (Azacca, Idaho-7, and Sultana), this work aimed to profile the aromas and the overall biotransformation processes taking place during fermentation. A total of 51 volatile organic compounds (VOCs) were semi-quantified and monitored: 19 esters, 13 sesquiterpenes, 7 ketones, 7 alcohols, 4 monoterpenes, and 1 volatile acid. There were significant similarities in the measured analytes and perceived aromas of these beers, but one hop variety (Sultana) delivered an increased quantity of unique aromas and an increased concentration of volatiles in the headspace for the same quantity of hop pellets added. This work provides practical information to brewers who utilize hops in beer production.

Gymnosperms of Idaho: Chemical Compositions and Enantiomeric Distributions of Essential Oils of Abies lasiocarpa, Picea engelmannii, Pinus contorta, Pseudotsuga menziesii, and Thuja plicata.

Conifers are of great economic value in terms of lumber production, important for construction and other uses such as pulp and paper. They are also important sources of essential oils. Conifer species have been vital to the ethnobotany and traditional herbal medicine of many different Native American groups. The objective of this work was to obtain and analyze the essential oils of several conifer species (Abies lasiocarpa, Picea engelmannii, Pinus contorta, Pseudotsuga menziesii, and Thuja plicata) growing in Idaho. The foliar essential oils were obtained by hydrodistillation and then analyzed by gas chromatographic methods, including GC-MS, GC-FID, and chiral GC-MS. The essential oils were obtained in varying yields from 0.66% up to 4.70%. The essential oil compositions were largely dominated by monoterpene hydrocarbons and oxygenated monoterpenoids. The chiral monoterpenoids were generally rich in the (-)-enantiomers for members of the Pinaceae, but the (+)-enantiomers predominated in the Cupressaceae. The essential oil compositions obtained in this work are qualitatively similar, but quantitatively different, to previously reported compositions and confirm and complement the previous reports. However, this is the first comprehensive analysis of the chiral terpenoid components in these conifer species. Additional research on essential oils of the Pinaceae and Cupressaceae is needed to describe the chemical profiles, chemical compositions, and enantiomeric distributions more reliably in the various species and infraspecific taxa of these two families.

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).

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.

Increasing Incidence of Invasive Group A Streptococcus Disease, Idaho, USA, 2008-2019.

We investigated invasive group A Streptococcus epidemiology in Idaho, USA, during 2008-2019 using surveillance data, medical record review, and emm (M protein gene) typing results. Incidence increased from 1.04 to 4.76 cases/100,000 persons during 2008-2019. emm 1, 12, 28, 11, and 4 were the most common types, and 2 outbreaks were identified. We examined changes in distribution of clinical syndrome, patient demographics, and risk factors by comparing 2008-2013 baseline with 2014-2019 data. Incidence was higher among all age groups during 2014-2019. Streptococcal toxic shock syndrome increased from 0% to 6.4% of cases (p = 0.02). We identified no differences in distribution of demographic or risk factors between periods. Results indicated that invasive group A Streptococcus is increasing among the general population of Idaho. Ongoing surveillance of state-level invasive group A Streptococcus cases could help identify outbreaks, track regional trends in incidence, and monitor circulating emm types.

Household Transmission of SARS-CoV-2 from Humans to Pets, Washington and Idaho, USA.

SARS-CoV-2 likely emerged from an animal reservoir. However, the frequency of and risk factors for interspecies transmission remain unclear. We conducted a community-based study in Idaho, USA, of pets in households that had >1 confirmed SARS-CoV-2 infections in humans. Among 119 dogs and 57 cats, clinical signs consistent with SARS-CoV-2 were reported for 20 dogs (21%) and 19 cats (39%). Of 81 dogs and 32 cats sampled, 40% of dogs and 43% of cats were seropositive, and 5% of dogs and 8% of cats were PCR positive. This discordance might be caused by delays in sampling. Respondents commonly reported close human‒animal contact and willingness to take measures to prevent transmission to their pets. Reported preventive measures showed a slightly protective but nonsignificant trend for both illness and seropositivity in pets. Sharing of beds and bowls had slight harmful effects, reaching statistical significance for sharing bowls and seropositivity.

Fruit and Vegetable Prescription Program for Diabetes Control Among Community Health Centers in Rural Idaho and Oregon.

A Fruit and Vegetable Prescription program (12-16 weeks, 2018-2020) was implemented at community health centers serving rural communities in the northwestern United States. The impact of the program on type 2 diabetes control was evaluated. Reductions in mean hemoglobin A1C were statistically significant (P < .01). The percentage of participants with critically high blood glucose levels (A1C > 9%) decreased from 76% (114/151) to 41% (62/151; P < .01). The findings mirror those of similar programs. The sustainability of these beneficial interventions, however, relies on improved access to preventive care. (Am J Public Health. 2022;112(7):975-979.https://doi.org/10.2105/AJPH.2022.306853).