Centering the role of community health workers in social risk screening, referral, and follow-up within the primary care setting.

BACKGROUND: Community health workers (CHWs) remain an underutilized resource in social risk diagnostics in the primary care setting. This process evaluation study seeks to assess the role of CHWs in social risk screening, referral, and follow-up through process mapping to identify barriers to the process for future quality improvement efforts. METHODS: Researchers at the Arizona Prevention Research Center (AzPRC) engaged with two Federally Qualified Health Centers (FQHCs) in two of Arizona's major urban areas to evaluate their internal processes for social risk screening and intervention. The Consolidated Framework for Implementation Research (CFIR) was used to direct a process mapping exercise to visually describe the workflow, gaps, and barriers to identifying and addressing social risk. RESULTS: The process unveiled key areas for health system improvements in the community setting, the organizational setting, and in the implementation of social risk screening, referral, and follow-up. Further, process maps highlight the potential resources needed for effective CHW integration to address social risk in the primary care setting. CONCLUSIONS: Our findings demonstrate the importance of organizational tools, such as process mapping, to assist primary care settings in evaluating internal processes for quality improvement in addressing social risk and in effectively integrating the CHW workforce. Subsequent research will evaluate rates of social risk screening, referral, and follow-up within all of Arizona's FQHCs and propose models for CHW integration to address social risk in primary care and strengthen social risk screening reach and effectiveness.

Mesocosm Studies Suggest Climate Change May Release Aedes aegypti (Diptera: Culicidae) Larvae from Cold Inhibition and Enable Year-Round Development in a Desert City.

AbstractGlobal warming trends, human-assisted transport, and urbanization have allowed poleward expansion of many tropical vector species, but the specific mechanisms responsible for thermal mediation of range changes and ecological success of invaders remain poorly understood. Aedes aegypti (Diptera: Culicidae) is a tropical mosquito currently expanding into many higher-latitude regions, including the urban desert region of Maricopa County, Arizona. Here, adult populations virtually disappear in winter and spring and then increase exponentially through summer and fall, indicating that winter conditions remain a barrier to the development of some life stages of A. aegypti. To determine whether cold limits the winter development of A. aegypti larvae in Maricopa County, we surveyed for larval abundance and tested their capacity to develop in ambient and warmed conditions. Aedes aegypti larvae were not observed in artificial aquatic habitats in winter and spring but were abundant in summer and fall, suggesting winter suppression of adults, larvae, or both. Water temperatures in winter months fluctuated strongly; larvae were usually cold paralyzed at night but active during the day. Despite daytime temperatures that allowed activity and achieving similar degree-days as warmed mesocosms, larvae reared under ambient winter conditions were unable to develop to adulthood, perhaps due to repetitive cold damage. However, warming average temperature by 1.7°C allowed many larvae to successfully develop to adults. Because daytime highs in winter will often allow adult flight, it is likely that relatively minor additional winter warming may allow A. aegypti populations to develop and reproduce year-round in Maricopa County.

Seasonal Alternation of Putative Camouflage Wing Morphs of the American Snout Butterfly (Libytheana carinenta).

AbstractIntraspecific variation in camouflage is common in animals. Sexual dimorphism in camouflage is less common and, where observed, attributed to trade-offs between natural selection for predator avoidance and sexual selection for conspicuous mating signals. Here we report on variation in putatively cryptic ventral hindwing patterns in the American snout butterfly, Libytheana carinenta. We use field surveys and crowdsourced data to characterize three morphs. One is found in both sexes, one is male specific, and one is female specific. The sex-specific morphs constitute a sexually dimorphic set whose frequencies change together in time. Field surveys indicate that butterflies in southern Arizona transition from midsummer dominance of the sexually monomorphic pattern to early-fall dominance of the sexually dimorphic set. Crowdsourced data indicate that the sexually dimorphic set dominates in early spring, transitioning later into a mixture of morphs dominated by the monomorphic pattern, with the dimorphic set rising in frequency again in late fall. We discuss this unique pattern of camouflage variation with respect to contemporary theory on animal coloration.

Evaluation of the International Society on Thrombosis and Haemostasis definition of major bleeding in Arizona rattlesnake bites.

INTRODUCTION: In 2023, a group of experts proposed that a definition of major bleeding in pharmaceutically anticoagulated patients be used in all snakebite trials. This includes bleeding that results in death, is life-threatening, causes chronic sequelae, or consumes major healthcare resources, including bleeding into a major area or hemoglobin concentration decrease ≥20 g/L. We hypothesized that a decline in hemoglobin concentration ≥20 g/L is common but rarely clinically significant in our population of Arizona rattlesnake bite patients. METHODS: Poison center records of rattlesnake bites in humans from 2018 through 2022 were retrospectively reviewed and assessed for major bleeding by the above criteria. RESULTS: Four hundred and eighty-one patients met the inclusion criteria, of whom 265 (55.1%) had a hemoglobin concentration decrease ≥20 g/L. No patients died, and there was no evidence of bleeding into a critical organ. Three patients (1.1%) received blood transfusions. A decrease in hemoglobin concentration ≥20 g/L was 100% sensitive for identifying the major bleeding-associated outcomes; however, specificity was only 45.2%. Measures of healthcare utilization and chronic sequelae were somewhat higher in patients with a decrease in hemoglobin concentration ≥20 g/L. DISCUSSION: Laboratory manifestations of hemotoxicity were common in this population, but hemorrhage was rare. While over half of patients met the major bleeding criterion of a decline in hemoglobin concentration ≥20 g/L, only 1.1% had bleeding that was potentially life-threatening as measured by receipt of a red blood cell transfusion. None died or had bleeding into a critical area. While nonspecific for major bleeding, a drop in hemoglobin concentration correlated with worse envenomation severity: these patients received more vials of antivenom, had a higher medical bill, a longer hospital stay, and were less likely to report full recovery at 90 days. CONCLUSIONS: A decrease in hemoglobin concentration ≥20 g/L should not be used as evidence of major bleeding for Arizona rattlesnake envenomation studies, but it may have a role as an indirect marker of envenomation severity.

A framework for integrating wastewater-based epidemiology and public health.

Wastewater-based epidemiology (WBE) is an environmental approach to monitor community health through the analysis of sewage. The COVID-19 pandemic catalyzed scientists and public health professionals to revisit WBE as a tool to optimize resource allocation to mitigate disease spread and prevent outbreaks. Some studies have highlighted the value of WBE programs that coordinate with public health professionals; however, the details necessary for implementation are not well-characterized. To respond to this knowledge gap, this article documents the framework of a successful WBE program in Arizona, titled Wastewater Analysis for Tactical Epidemiological Response Systems (WATERS), detailing the developed structure and methods of communication that enabled public health preparedness and response actions. This communication illustrates how program operations were employed to reduce outbreak severity. The structure outlined here is customizable and may guide other programs in the implementation of WBE as a public health tool.

A mountain pine beetle (Coleoptera: Curculionidae) adult development rate model confirms evolved geographic differences.

Insects live in a wide range of thermal environments and have evolved species- and location-specific physiological processes for survival in hot and cold extremes. Thermally driven dormancy strategies, development rates and thresholds are important for synchronizing cohorts within a population and to local climates and often vary among populations within a species. Mountain pine beetle (MPB), Dendroctonus ponderosae Hopkins (Coleoptera: Curculionidae, Scolytinae), is a widely distributed forest insect native to North America with clinal genetic differentiation in thermally dependent traits. MPB development occurs in Pinus phloem beneath the bark, and its cryptic habitat makes experimentation difficult, particularly for the adult stage. We describe a novel method for modeling MPB adult development following pupation and terminating in emergence from a brood tree. We focus on an Arizona (southern) MPB population with previously described preadult development rates. Field-observed tree attack, adult emergence, and phloem temperature data are combined in a parameterized cohort model and candidate rate curves are evaluated to describe adult emergence timing. Model competition indicates that the Brière rate curve provided the best fit to field data and performed well under cross-validation. Results confirm that the development of Arizona MPB adults is slower than the previously described development rate of more northern Utah adults. Using the estimated adult rate curve in a scenario of increasing mean temperatures, we show that the timing of second-generation adult emergence in the same year would result in cold-intolerant lifestages during winter, limiting the success of bivoltine populations.

De Novo Genome Assemblies From Two Indigenous Americans from Arizona Identify New Polymorphisms in Non-Reference Sequences.

There is a collective push to diversify human genetic studies by including underrepresented populations. However, analyzing DNA sequence reads involves the initial step of aligning the reads to the GRCh38/hg38 reference genome which is inadequate for non-European ancestries. In this study, using long-read sequencing technology, we constructed de novo genome assemblies from two indigenous Americans from Arizona (IAZ). Each assembly included ∼17 Mb of DNA sequence not present [nonreference sequence (NRS)] in hg38, which consists mostly of repeat elements. Forty NRSs totaling 240 kb were uniquely anchored to the hg38 primary assembly generating a modified hg38-NRS reference genome. DNA sequence alignment and variant calling were then conducted with whole-genome sequencing (WGS) sequencing data from 387 IAZ using both the hg38 and modified hg38-NRS reference maps. Variant calling with the hg38-NRS map identified ∼50,000 single-nucleotide variants present in at least 5% of the WGS samples which were not detected with the hg38 reference map. We also directly assessed the NRSs positioned within genes. Seventeen NRSs anchored to regions including an identical 187 bp NRS found in both de novo assemblies. The NRS is located in HCN2 79 bp downstream of Exon 3 and contains several putative transcriptional regulatory elements. Genotyping of the HCN2-NRS revealed that the insertion is enriched in IAZ (minor allele frequency = 0.45) compared to other reference populations tested. This study shows that inclusion of population-specific NRSs can dramatically change the variant profile in an underrepresented ethnic groups and thereby lead to the discovery of previously missed common variations.

Readmission Outcomes in Kidney Transplant Recipients With and Without Delayed Graft Function.

BACKGROUND: Delayed graft function (DGF) is a common post-transplant event associated with increased resource utilization. As a center with experience in DGF, we aimed to assess differences in readmissions and post-transplant outcomes between patients with and without DGF. METHODS: This was a retrospective review of deceased donor kidney transplant recipients at Mayo Clinic Arizona between 2015 and 2020. Recipients with at least one early readmission following kidney transplantation were included in the study. Two groups were identified: (1) recipients with DGF who required early readmission and (2) recipients without DGF who required early readmission. RESULTS: Among recipients with DGF, 43.9% (n = 405) required early readmission compared to 29.1% (n = 179) without DGF (P < .0001). There were no differences in the initial hospital length of stay (P = .08), and most recipients in both groups only required a single readmission (61.7% vs 72.1%, P = .02). Recipients with DGF were more likely to have ≥2 readmissions (P = .02) and a higher total readmission rate (P = .006). Recipients with DGF who required readmission also required more outpatient clinic visits (P = .003). When comparing recipients with and without DGF who required readmission, there were no differences in patient (P = .22) or death-censored (P = .72) graft survival. When comparing patients with and without DGF requiring one versus ≥2 readmissions, there were no differences in patient survival (P = .15), however patients with DGF and ≥2 readmissions had lower death-censored graft survival (P = .001). CONCLUSIONS: Recipients with DGF are at increased risk of readmission. Transplant center-level changes to reduce readmissions and infections could have an important impact on DGF outcomes.

Temperature and time of host-seeking activity impact the efficacy of chemical control interventions targeting the West Nile virus vector, Culex tarsalis.

West Nile virus (WNV) is the leading mosquito-borne disease causing-pathogen in the United States. Concerningly, there are no prophylactics or drug treatments for WNV and public health programs rely heavily on vector control efforts to lessen disease incidence. Insecticides can be effective in reducing vector numbers if implemented strategically, but can diminish in efficacy and promote insecticide resistance otherwise. Vector control programs which employ mass-fogging applications of insecticides, often conduct these methods during the late-night hours, when diel temperatures are coldest, and without a-priori knowledge on daily mosquito activity patterns. This study's aims were to 1) quantify the effect of temperature on the toxicity of two conventional insecticides used in fogging applications (malathion and deltamethrin) to Culex tarsalis, an important WNV vector, and 2) quantify the time of host-seeking of Cx. tarsalis and other local mosquito species in Maricopa County, Arizona. The temperature-toxicity relationship of insecticides was assessed using the WHO tube bioassay, and adult Cx. tarsalis, collected as larvae, were exposed to three different insecticide doses at three temperature regimes (15, 25, and 35°C; 80% RH). Time of host-seeking was assessed using collection bottle rotators with encephalitis vector survey traps baited with dry ice, first at 3h intervals during a full day, followed by 1h intervals during the night-time. Malathion became less toxic at cooler temperatures at all doses, while deltamethrin was less toxic at cooler temperatures at the low dose. Regarding time of host-seeking, Cx. tarsalis, Aedes vexans, and Culex quinquefasciatus were the most abundant vectors captured. During the 3-hour interval surveillance over a full day, Cx. tarsalis were most-active during post-midnight biting (00:00-06:00), accounting for 69.0% of all Cx. tarsalis, while pre-midnight biting (18:00-24:00) accounted for 30.0% of Cx. tarsalis. During the 1-hour interval surveillance overnight, Cx. tarsalis were most-active during pre-midnight hours (18:00-24:00), accounting for 50.2% of Cx. tarsalis captures, while post-midnight biting (00:00-06:00) accounted for 49.8% of Cx. tarsalis. Our results suggest that programs employing large-scale applications of insecticidal fogging should consider temperature-toxicity relationships coupled with time of host-seeking data to maximize the efficacy of vector control interventions in reducing mosquito-borne disease burden.

Digital Storytelling Intervention for Hemoglobin A1c Control Among Hispanic Adults With Type 2 Diabetes: A Randomized Clinical Trial.

Importance: Hispanic adults with type 2 diabetes (T2D) are more likely to develop complications and die from the disease than the US general population. Digital storytelling interventions are narrative-based videos elicited through a community-based participatory research approach to surface the authentic voices of participants overcoming obstacles to health-promoting behaviors that perpetuate health inequities; research on the effect of digital storytelling on T2D outcomes among Hispanic adults is lacking. Objective: To assess the impact of a digital storytelling intervention on glycemic control and its acceptability among Hispanic patients with poorly controlled T2D. Design, Setting, and Participants: This was a multicenter, randomized clinical trial conducted within 2 primary care networks in Minnesota and Arizona among Hispanic adults with poorly controlled T2D (hemoglobin A1c level ≥8%). Enrollment and follow-up were conducted between February 14, 2019, and November 1, 2023. Intervention: The intervention group viewed a 12-minute digital storytelling video. The video included 4 Spanish-language stories that reinforced 4 diabetes self-management behavioral goals (healthful diet for diabetes, physical activity, medication adherence, and glucose self-monitoring). The control group received printed, culturally tailored T2D education materials. Main Outcomes and Measures: The primary outcome was the mean change from baseline to 3 months for hemoglobin A1c levels, adjusting for baseline hemoglobin A1c, age, gender, education, and income. Acceptability and narrative quality of the intervention were assessed through questionnaires. Results: There were 451 study participants, with 227 (mean [SD] age, 54.3 [9.3] years; 158 [69.3%] women) randomized to the intervention group and 224 (mean [SD] age, 54.5 [9.1] years; 156 [69.3%] women) to the control group. Of these, 390 completed 3-month follow-up of the primary outcome (86% retention). There was a small improvement in the mean (SD) hemoglobin A1c level in the intervention group compared with the control group in the adjusted model (9.1% [1.7] to 8.4% [1.6] vs 9.4% [1.8] to 8.8% [2.0]; P = .04] but not in the unadjusted model. Acceptability and narrative quality of the intervention were high. Conclusions and Relevance: In this randomized clinical trial, a digital storytelling intervention developed with and for Hispanic adults with T2D was highly acceptable and feasibly implemented within primary care settings and resulted in a modest improvement of glycemic control. This was a highly scalable intervention that may be integrated into clinical practice as part of a longitudinal diabetes self-management program for Hispanic adults. Trial Registration: ClinicalTrials.gov Identifier: NCT03766438.

Navigating Real-World Randomized Clinical Trials: The 'Parents as Teachers' Experience.

The Parents as Teachers Randomized Controlled Trial (PAT RCT) Case Study investigates the multifaceted impact of implementing the PAT RCT in Arizona, U.S.A., shedding light on both the positive and negative effects. There has been a recent focus on improving the implementation of RCTs in community settings, as this issue has not been fully addressed. This research presents a case study examining the implementation of a community-based RCT in home visitation. This study also addresses the strategies that can be employed to mitigate some of the challenges in the implementation of an RCT, offering valuable insights for future RCTs in the domain of home visiting. The PAT program, aimed at providing parent education and family engagement for children from birth to kindergarten, encompasses a range of services, including personal visits, group connections, child screenings, and community resource linkages. The Parents as Teachers Randomized Controlled Trial (PAT RCT) directly promotes health by educating parents about health and wellness as well as providing early child screenings and heath referrals, all of which enhance health outcomes through timely interventions and improved parental practices. Lessons from the study also aim to improve the implementation of future health-related RCTs, ensuring effective delivery and impactful results.

A case report of mis-snaken identity: When misdiagnosis really bites.

When patients present with an unknown puncture wound, emergency physicians need to consider regional hazards, in addition to standard mechanical injury etiologies. In the Southwestern United States, one such hazard is the rattlesnake. In this report, we present a case in which a rattlesnake envenomation was not considered as a possible cause for a puncture wound of unknown origin, which resulted in an envenomation left untreated for 7 days. A full dry bite observation period of 12 h with serial physical exams and laboratory analysis with guidance from the region poison control center might have led to earlier recognition of an envenomation and antivenom administration. A male patient in his late 70's felt a painon his right ankle while in his backyard in southern Arizona. He did not see the cause and assumed he had sustained an insect bite. He went to the ED that day with minor pain and swelling and was discharged home. One week later, he re-presented severely anemic with edema and ecchymosis to the entire right lower extremity that developed over several days after his first ED visit. He was admitted for antivenom and blood transfusion and discharged on hospital day three. For as long as humans continue to interact with the natural world, venomous creature encounters are going to continue to happen. Rattlesnake envenomation should be included in a physician's differential diagnosis even if one is not witnessed, especially in regions with high rattlesnake activity. In addition to assessing for other potential causes of undifferentiated puncture wounds, serial physical examinations and laboratory testing (with guidance of the regional poison center) are necessary to rule out rattlesnake envenomation.

A longitudinal study on the bacterial quality of baby spinach cultivated in Arizona and California.

In the U.S., baby spinach is mostly produced in Arizona (AZ) and California (CA). Characterizing the impact of growing region on the bacterial quality of baby spinach can inform quality management practices in industry. Between December 2021 and December 2022, baby spinach was sampled after harvest and packaging for microbiological testing, including shelf-life testing of packaged samples that were stored at 4°C. Samples were tested to (i) determine bacterial concentration, and (ii) obtain and identify bacterial isolates. Packaged samples from the Salinas, CA, area (n = 13), compared to those from the Yuma, AZ, area (n = 9), had a significantly higher bacterial concentration, on average, by 0.78 log10 CFU/g (P < 0.01, based on aerobic, mesophilic plate count data) or 0.67 log10 CFU/g (P < 0.01, based on psychrotolerant plate count data); the bacterial concentrations of harvest samples from the Yuma and Salinas areas were not significantly different. Our data also support that an increase in preharvest temperature is significantly associated with an increase in the bacterial concentration on harvested and packaged spinach. A Fisher's exact test and linear discriminant analysis (effect size), respectively, demonstrated that (i) the genera of 2,186 bacterial isolates were associated (P < 0.01) with growing region and (ii) Pseudomonas spp. and Exiguobacterium spp. were enriched in spinach from the Yuma and Salinas areas, respectively. Our findings provide preliminary evidence that growing region and preharvest temperature may impact the bacterial quality of spinach and thus could inform more targeted strategies to manage produce quality. IMPORTANCE: In the U.S., most spinach is produced in Arizona (AZ) and California (CA) seasonally; typically, spinach is cultivated in the Yuma, AZ, area during the winter and in the Salinas, CA, area during the summer. As the bacterial quality of baby spinach can influence consumer acceptance of the product, it is important to assess whether the bacterial quality of baby spinach can vary between spinach-growing regions. The findings of this study provide insights that could be used to support region-specific quality management strategies for baby spinach. Our results also highlight the value of further evaluating the impact of growing region and preharvest temperature on the bacterial quality of different produce commodities.

Twenty-five years of suspected rattlesnake encounters in Arizona.

INTRODUCTION: Rattlesnake (Crotalus spp., Sistrurus spp.) bites in the southwestern United States are associated with significant morbidity. This study aims to describe 25 years of rattlesnake encounters reported to the Arizona Poison and Drug Information Center to identify vulnerable populations and circumstances where encounters occur to create public education to reduce future bites. METHODS: Cases of suspected rattlesnake encounters in Arizona reported to the Arizona Poison and Drug Information Center between 1999 and 2023 were analyzed to identify populations and circumstances associated with encounters. RESULTS: A total of 3,808 cases were analyzed overall and by age subgroups. Most encounters occurred in men (69.9%), during the evening (16:00-21:59; 49.2%), in summer (41.9%), and close to home (38.2%). Most bites occurred to the lower extremity (51%). Children 0 to 12-years-old have more encounters than those 13-years-old and older in rural zip codes (27.7% versus 14.8%; P = 0.005), during spring (31.8% versus 22.3%; P = 0.0005), and during the evening (64.4% versus 48.1%; P < 0.001). DISCUSSION: Rattlesnakes are encountered when rattlesnake and human behavior patterns overlap. Many people spend time outside during evening hours in the summer, and valuable resources like food, water, and shelter can be found near houses where humans spend much of their time. Most age groups have similar encounter circumstances but encounters among children 0 to 12-years-old differ in time of day, season, and urbanization level than encounters of those 13-years-old and older. Limitations of this study include underreporting of encounters, incomplete case details, potential reporting bias, potential snake misidentification, and geographic coverage of the poison center. CONCLUSION: Prevention of rattlesnake bites by reducing encounters is the most effective way to reduce suffering and healthcare costs. Future steps include creating and disseminating targeted public health education using the data collected.

Evaluating the portable X-ray fluorescence reliability for metal(loid)s detection and soil contamination status.

Marginalized communities experience barriers that can prevent soil monitoring efforts and knowledge transfer. To address this challenge, this study compared two analytical methods: portable X-ray fluorescence spectroscopy (pXRF, less time, cost) and inductively coupled plasma mass spectrometry (ICP-MS, "gold standard"). Surface soil samples were collected from residential sites in Arizona, USA (N = 124) and public areas in Troy, New York, USA (N = 33). Soil preparation differed between groups to account for community practice. Statistical calculations were conducted, paired t test, Bland-Altman plot, and a two-way ANOVA indicated no significant difference for As, Ba, Ca, Cu, Mn, Pb, and Zn concentrations except for Ba in the t test. Iron, Ni, Cr, and K were statistically different for Arizona soils and V, Ni, Fe, and Al concentrations were statistically different for New York soils. Zinc was the only element with high R2 and low p value. Pollution load index (PLI), enrichment factors (EF), and geo-accumulation index (Igeo) were calculated for both methods using U.S. Geological Survey data. The PLI were > 1, indicating soil pollution in the two states. Between pXRF and ICP-MS, the Igeo and EF in Arizona had similar degree of contamination for most elements except Zn in garden and Pb in yard, respectively. For New York, the Igeo of As, Cu, and Zn differed by only one classification index between the two methods. The pXRF was reliable in determining As, Ba, Ca, Cu, Mn, Pb, and Zn in impacted communities. Therefore, the pXRF can be a cost-effective alternative to using ICP-MS techniques to screen soil samples for several environmentally relevant contaminants to protect environmental public health.

The moderating role of early-life parental adverse and positive factors in the genetic and environmental contributions to objectively assessed sleep duration in middle childhood.

Early-life positive and adverse parental factors, such as positive parent personality and parental stress, affect the environmental context in which children develop and may influence individual differences in children's sleep health. This study examined the moderating role of early-life parental factors in the heritability (i.e., the extent to which individual differences are due to genetic influences) of objectively assessed childhood sleep duration. A total of 351 families from the Arizona Twin Project were studied. Primary caregivers (95% mothers) reported on multiple dimensions of stress and facets of their own personality when the twins were 12 months old. Seven years later (Mage = 8.43 years, SD = 0.68), families completed a home visit, and twins (51% female; 57% White, 29% Hispanic; 30% monozygotic, 39% same-sex dizygotic, 31% other-sex dizygotic) wore actigraph watches to assess their sleep, with caregivers completing similar assessments on their personality attributes and stress. Early-life positive parent personality moderated the heritability of sleep duration (Δ-2LL [-2 log likelihood] = 2.54, Δdf = 2, p = .28), such that as positive parent personality increased, the heritability of duration decreased. Early-life parental stress also moderated the genetic contribution to sleep duration (Δ-2LL = 2.02, Δdf = 2, p = .36), such that as stress increased, the heritability of duration increased. Concurrent positive parent personality and parental stress composites showed similar patterns of findings. Results highlight the likely contribution of parent positive traits and adverse experiences to the etiology of children's sleep health, with genetic influences on children's sleep more prominent in "riskier" environments. Understanding how genetics and environments work together to influence the etiology of sleep may inform prevention programs.

Impact of a Delirium Protocol on Deliriogenic Medication Use in Hospitalized Older Veterans.

Background The Southern Arizona VA Health Care System (SAVAHCS) implemented a delirium prevention and treatment protocol in 2019. Objective The primary objective of this study was to determine if the implementation of a delirium protocol influenced deliriogenic medication use in hospitalized geriatric veterans. The secondary objectives were to compare the rates of delirium diagnosis, hospital length-of-stay, and rates of newly started deliriogenic medications during admission pre- and post-protocol. Methods This study was a retrospective, secondary data analysis study. Veterans 65 years of age and older who were admitted to an inpatient medical ward at the SAVAHCS for 24 hours or more between January 1, 2018 and December 31, 2018 (pre-protocol) or January 1, 2021 and December 31, 2021 (post-protocol) were included. Patients were excluded if they had a diagnosis of alcohol or benzodiazepine withdrawal upon admission. Results A total of 5491 patients were included in this study; 2940 (53.5%) in the pre-protocol group and 2551 (46.5%) in the post-protocol group. Patients received at least one deliriogenic medication during their admission in the post-protocol group (36.2%) compared with the pre-protocol group (34.1%), but there was no statistically significant difference (P = 0.098). There were also no significant differences in the rates of documentation of delirium as a diagnosis at discharge, hospital length-of-stay, or the rates of newly started deliriogenic medications during admission between the groups. Conclusion Implementation of a delirium prevention and treatment protocol at the SAVAHCS did not significantly impact the use of deliriogenic medications in hospitalized geriatric veterans.

Evidence for human-caused founder effect in populations of Solanum jamesii at archaeological sites: II. Genetic sequencing establishes ancient transport across the Southwest USA.

PREMISE: The domestication of wild plant species can begin with gathering and transport of propagules by Indigenous peoples. The effect on genomic composition, especially in clonal, self-incompatible perennials would be instantaneous and drastic with respect to new, anthropogenic populations subsequently established. Reductions in genetic diversity and mating capability would be symptomatic and the presence of unique alleles and genetic sequences would reveal the origins and ancestry of populations associated with archaeological sites. The current distribution of the Four Corners potato, Solanum jamesii Torr. in the Southwestern USA, may thus reflect the early stages of a domestication process that began with tuber transport. METHODS: Herein genetic sequencing (GBS) data are used to further examine the hypothesis of domestication in this culturally significant species by sampling 25 archaeological and non-archaeological populations. RESULTS: Archaeological populations from Utah, Colorado and northern Arizona have lower levels of polymorphic loci, unique alleles, and heterozygosity than non-archaeological populations from the Mogollon region of central Arizona and New Mexico. Principle components analysis, Fst values, and structure analysis revealed that genetic relationships among archaeological populations did not correspond to geographic proximity. Populations in Escalante, Utah were related to those on the Mogollon Rim (400 km south) and had multiple origins and significant disjunctions with those populations in Bears Ears, Chaco Canyon, and Mesa Verde sites. CONCLUSIONS: Movement of tubers from the Mogollon region may have occurred many times and in multiple directions during the past, resulting in the complex genetic patterns seen in populations from across the Four Corners region.

Methodologies for the collection of parameters to estimate dust/soil ingestion for young children.

Background: Heavy metals, pesticides and a host of contaminants found in dust and soil pose a health risk to young children through ingestion. Dust/soil ingestion rates for young children can be estimated using micro-level activity time series (MLATS) as model inputs. MLATS allow for the generation of frequency and duration of children's contact activities, along with sequential contact patterns. Models using MLATS consider contact types, and transfer dynamics to assign mechanisms of contact and appropriate exposure factors for cumulative estimates of ingestion rates. Objective: The objective of this study is to describe field implementation, data needs, advanced field collection, laboratory methodologies, and challenges for integrating into and updating a previously validated physical-stochastic MLATS-based model framework called the Child-Specific Aggregate Cumulative Human Exposure and Dose (CACHED) model. The manuscript focuses on describing the methods implemented in the current study. Methods: This current multidisciplinary study (Dust Ingestion childRen sTudy [DIRT]) was implemented across three US regions: Tucson, Arizona; Miami, Florida and Greensboro, North Carolina. Four hundred and fifty participants were recruited between August 2021 to June 2023 to complete a 4-part household survey, of which 100 also participated in a field study. Discussion: The field study focused on videotaping children's natural play using advanced unattended 360° cameras mounted for participants' tracking and ultimately conversion to MLATS. Additionally, children's hand rinses were collected before and after recording, along with indoor dust and outdoor soil, followed by advanced mass analysis. The gathered data will be used to quantify dust/soil ingestion by region, sociodemographic variables, age groups (from 6 months to 6 years), and other variables for indoor/outdoor settings within an adapted version of the CACHED model framework. Significance: New innovative approaches for the estimation of dust/soil ingestion rates can potentially improve modeling and quantification of children's risks to contaminants from dust exposure.

Urban house finches are more resistant to the effects of artificial light at night.

Rapid urbanization of habitats alters the physical, chemical, auditory, and photic environments of human and wild animal inhabitants. One of the most widespread transformations is caused by artificial light at night (ALAN), but it is not clear the extent to which individuals acclimate to such rapid environmental change. Here, we tested the hypothesis that urban birds show increased resistance to harmful behavioral, parasitological, and physiological effects of ALAN. We captured house finches (Haemorhous mexicanus), a bird that commonly inhabits cities and their natural surroundings, from two urban and two rural sites in Phoenix, Arizona, USA, which differ by both degree of urbanization and by multiple orders of magnitude in ALAN intensity, and placed them in a common garden laboratory setting. We exposed half of the birds from each habitat type to ecologically relevant levels of night lighting during the subjective night and found that, while ALAN exposure reduced sleep in both urban and rural birds, ALAN-exposed urban birds were able to sleep longer than ALAN-exposed rural birds. We also found that ALAN exposure increased the proliferation rate of an intestinal coccidian parasite (Isospora spp.) in both urban and rural birds, but that the rate of proliferation was lower in urban relative to rural birds. We found that night lighting suppressed titers of feather corticosterone in rural but not urban birds, suggesting that light impairs HPA function through chronic stress or suppression of its circadian rhythmicity, and that urban birds were again resistant to this effect. Mediation analyses show that the effect of ALAN exposure in rural birds was significantly sleep-mediated for feather corticosterone but not coccidiosis, suggesting a diversity of mechanisms by which ALAN alters physiology. We contribute further evidence that animals from night-lit habitats can develop resistance to ALAN and its detrimental effects.