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1.
J Nurs Adm ; 50(2): 85-89, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31977945

RESUMEN

OBJECTIVE: The aim of this study was to examine program effectiveness in changing Caritas leadership, self-caring behaviors, and perceptions of coworkers of participants who completed the Caritas Coach Education Program (CCEP). BACKGROUND: The CCEP has been a highly successful education program for individuals who wish to intellectually and experientially learn to teach, live, and practice human caring theory. METHODS: A pretest-posttest descriptive design was used to evaluate changes in perceptions of self-caring, caritas leadership, and coworker behaviors after completion of CCEP. RESULTS: The mean scores of all measures improved significantly. CONCLUSIONS: After completion of CCEP, participants demonstrated statistically significant changes in 3 caritas measures: leadership, coworker, and self-rating. Caritas Coach participants exhibited the greatest change in their self-caring scores.


Asunto(s)
Actitud del Personal de Salud , Educación en Enfermería/organización & administración , Empatía , Personal de Enfermería en Hospital/educación , Personal de Enfermería en Hospital/psicología , Filosofía en Enfermería , Adulto , Arizona , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud
3.
mSphere ; 5(1)2020 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-31996418

RESUMEN

The vast majority of microbes inhabiting oligotrophic shallow subsurface soil environments have not been isolated or studied under controlled laboratory conditions. In part, the challenges associated with isolating shallow subsurface microbes may persist because microbes in deeper soils are adapted to low nutrient availability or quality. Here, we use high-throughput dilution-to-extinction culturing to isolate shallow subsurface microbes from a conifer forest in Arizona, USA. We hypothesized that the concentration of heterotrophic substrates in microbiological growth medium would affect which microbial taxa were culturable from these soils. To test this, we diluted cells extracted from soil into one of two custom-designed defined growth media that differed by 100-fold in the concentration of amino acids and organic carbon. Across the two media, we isolated a total of 133 pure cultures, all of which were classified as Actinobacteria or Alphaproteobacteria The substrate availability dictated which actinobacterial phylotypes were culturable but had no significant effect on the culturability of Alphaproteobacteria We isolated cultures that were representative of the most abundant phylotype in the soil microbial community (Bradyrhizobium spp.) and representatives of five of the top 10 most abundant Actinobacteria phylotypes, including Nocardioides spp., Mycobacterium spp., and several other phylogenetically divergent lineages. Flow cytometry of nucleic acid-stained cells showed that cultures isolated on low-substrate medium had significantly lower nucleic acid fluorescence than those isolated on high-substrate medium. These results show that dilution-to-extinction is an effective method to isolate abundant soil microbes and that the concentration of substrates in culture medium influences the culturability of specific microbial lineages.IMPORTANCE Isolating environmental microbes and studying their physiology under controlled conditions are essential aspects of understanding their ecology. Subsurface ecosystems are typically nutrient-poor environments that harbor diverse microbial communities-the majority of which are thus far uncultured. In this study, we use modified high-throughput cultivation methods to isolate subsurface soil microbes. We show that a component of whether a microbe is culturable from subsurface soils is the concentration of growth substrates in the culture medium. Our results offer new insight into technical approaches and growth medium design that can be used to access the uncultured diversity of soil microbes.


Asunto(s)
Actinobacteria/aislamiento & purificación , Alphaproteobacteria/aislamiento & purificación , Medios de Cultivo/química , Microbiología del Suelo , Actinobacteria/crecimiento & desarrollo , Alphaproteobacteria/crecimiento & desarrollo , Arizona , Técnicas Bacteriológicas , Centrifugación , Bosques , Filogenia , ARN Ribosómico 16S/genética
4.
Viruses ; 12(2)2020 Jan 26.
Artículo en Inglés | MEDLINE | ID: mdl-31991902

RESUMEN

The Sonoran Desert tortoise Gopherus morafkai is adapted to the desert, and plays an important ecological role in this environment. There is limited information on the viral diversity associated with tortoises (family Testudinidae), and to date no DNA virus has been identified associated with these animals. This study aimed to assess the diversity of DNA viruses associated with the Sonoran Desert tortoise by sampling their fecal matter. A viral metagenomics approach was used to identify the DNA viruses in fecal samples from wild Sonoran Desert tortoises in Arizona, USA. In total, 156 novel single-stranded DNA viruses were identified from 40 fecal samples. Those belonged to two known viral families, the Genomoviridae (n = 27) and Microviridae (n = 119). In addition, 10 genomes were recovered that belong to the unclassified group of circular-replication associated protein encoding single-stranded (CRESS) DNA virus and five circular molecules encoding viral-like proteins.


Asunto(s)
Virus ADN/aislamiento & purificación , Heces/virología , Tortugas/virología , Animales , Arizona , Virus ADN/clasificación , Virus ADN/genética , ADN Circular , ADN de Cadena Simple/genética , Genoma Viral , Microviridae/clasificación , Microviridae/genética , Microviridae/aislamiento & purificación , Microvirus/clasificación , Microvirus/genética , Microvirus/aislamiento & purificación , Filogenia , Recombinación Genética , Proteínas Virales/genética
5.
J Surg Res ; 245: 367-372, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31425877

RESUMEN

BACKGROUND: Statins have been shown to improve outcomes in traumatic brain injury (TBI) in animal models. The aim of our study was to determine the effect of preinjury statins on outcomes in TBI patients. METHODS: We performed a 4-y (2014-2017) review of our TBI database and included all patients aged ≥18 y with severe isolated TBI. Patients were stratified into those who were on statins and those who were not and were matched (1:2 ratio) using propensity score matching. The primary outcome was in-hospital mortality. The secondary outcomes were skilled nursing facility disposition, Glasgow Outcome Scale-extended score, and hospital and intensive care unit length of stay (LOS). RESULTS: We identified 1359 patients, of which 270 were matched (statin: 90, no-statin: 180). Mean age was 55 ± 8y, median Glasgow Coma Scale was 10 (8-12), and median head-abbreviated injury scale was 3 (3-5). Matched groups were similar in age, mechanism of injury, Glasgow Coma Scale, Injury Severity Score, neurosurgical intervention, type and size of intracranial hemorrhage, and preinjury anticoagulant or antiplatelet use. The overall in-hospital mortality rate was 18%. Patients who received statins had lower rates of in-hospital mortality (11% versus 21%, P = 0.01), skilled nursing facility disposition (19% versus 28%; P = 0.04), and a higher median Glasgow Outcome Scale-extended (11 [9-13] versus 9 [8-10]; P = 0.04). No differences were found between the two groups in terms of hospital LOS (6 [4-9] versus 5 [3-8]; P = 0.34) and intensive care unit LOS (3 [3-6] versus 4 [3-5]; P = 0.09). CONCLUSIONS: Preinjury statin use in isolated traumatic brain injury patients is associated with improved outcomes. This finding warrants further investigations to evaluate the potential beneficial role of statins as a therapeutic drug in a TBI. LEVEL OF EVIDENCE: Level III Therapeutic.


Asunto(s)
Lesiones Traumáticas del Encéfalo/mortalidad , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Arizona/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
6.
J Am Acad Psychiatry Law ; 47(4): 538, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31811082
7.
Zootaxa ; 4668(3): zootaxa.4668.3.1, 2019 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-31716615

RESUMEN

Paraleucopidae Wheeler fam. nov. is proposed for the previously unplaced New World genera Paraleucopis Malloch, Mallochianamyia Santos-Neto and Schizostomyia Malloch and undescribed Australian species. A key to genera of Paraleucopidae is provided. Paraleucopis is revised and includes nine species: P. auripes Wheeler Sinclair sp. nov. (type locality: Andalgala, Argentina); P. bispinosa Wheeler Sinclair sp. nov. (type locality: Socos, Coquimbo, Chile); P. boharti Wheeler Sinclair sp. nov. (type locality: Andalgala, Argentina); P. boydensis Steyskal (type locality: nr. Palm Desert, California, USA); P. corvina Malloch (type species of genus; type locality: New Mexico, USA); P. mexicana Steyskal (type locality: Kino Bay, Mexico); P. nigra Wheeler Sinclair sp. nov. (type locality: Portal, Arizona, USA); P. paraboydensis Wheeler Sinclair sp. nov. (type locality: Willis Palms Oasis, California, USA); P. saguaro Wheeler Sinclair sp. nov. (type locality: Usery Mtn Park, Arizona, USA). A key to the species of Paraleucopis is provided. The distribution of Paraleucopis is disjunct, with six species in the western United States and northwestern Mexico and three species in northern Chile and northern Argentina.                The sister group and superfamilial assignment of the Paraleucopidae cannot be established based on current knowledge although the family has affinities to some families of the Asteioinea sensu J.F. McAlpine. A well-supported hypothesis on the relationships of the families of the Acalyptratae will be required before the sister group relationships of Paraleucopidae can be determined.


Asunto(s)
Dípteros , Distribución Animal , Estructuras Animales , Animales , Argentina , Arizona , Australia , Tamaño Corporal , California , Chile , México , New Mexico , Tamaño de los Órganos
8.
Zootaxa ; 4695(5): zootaxa.4695.5.1, 2019 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-31719332

RESUMEN

The robber fly genus Wilcoxia is revised based on external morphological features of adults. For each species the following is provided: type specimen information, diagnostic features, description, natural history including associated prey data, and geographical distribution (derived from georeferenced localities for both examined specimens and literature records). A key to adults of Wilcoxia, supplemented with photographs of habitus and selected morphological features, is included. The genus comprises eight species, distributed primarily in the southwestern United States. Three new species are described: W. apache (type locality: New Mexico, Quay County, Apache Canyon), W. flavipennis (type locality: Arizona, Pima County, Organ Pipe Cactus National Monument), and W. forbesi (type locality: New Mexico, Doña Ana County, 1 mi. NW Tortugas Mt.). There appear to be two reasonably well-defined species groups (cinerea and martinorum groups, with four species in each), based on structural features, seasonality and natural history. Identified prey items (for W. apache, W. forbesi and W. martinorum) include representatives from Hemiptera (eight families), Coleoptera (one family), Hymenoptera (five families) and Diptera (10 families). A discussion on the structural heterogeneity of Wilcoxia and a history of its classification are provided.


Asunto(s)
Escarabajos , Dípteros , Animales , Arizona , New Mexico , Sudoeste de Estados Unidos
9.
Zootaxa ; 4688(4): zootaxa.4688.4.4, 2019 Oct 24.
Artículo en Inglés | MEDLINE | ID: mdl-31719427

RESUMEN

The tarantula spider genus Aphonopelma Pocock, 1901 has received considerable attention in recent years but the group's diversity remains poorly understood in Mexico, particularly in the pine-oak woodlands of the Sierra Madre Occidental and associated Madrean "Sky Islands". A pair of tarantulas discovered from an unsampled region in the Sierra de Bacadéhuachi (the westernmost range of the Sierra Madre Occidental) in northeastern Sonora was found to be closely related to four species from the Madrean "Sky Islands" in Arizona and New Mexico. An integrative approach for delimiting species (incorporating data from molecular phylogenetics, morphology, distributions, and breeding periods) suggests that the specimens from Sierra de Bacadéhuachi belong to an undescribed species that is herein named Aphonopelma bacadehuachi sp. nov. This new species adds to our knowledge of an increasingly diverse assemblage of Aphonopelma from the Madrean Pine-Oak Woodlands Hotspot. Collaborations between Mexican and American researchers are needed to accelerate discovery and description of the group's remaining diversity, particularly in light of the many threats facing the ecoregion including habitat degradation and climate change.


Asunto(s)
Quercus , Arañas , Animales , Arizona , Bosques , Islas , México , New Mexico
10.
Accid Anal Prev ; 133: 105289, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31586824

RESUMEN

In recent years, the popularity of all-terrain vehicles (ATVs) in the United States (US) has increased, and the number of ATV driver and passenger deaths have also increased substantially in the last few decades. Riders or occupants of ATVs as well as golf carts are particularly vulnerable to injury, not only due to the lack of protection and safety equipment offered by their vehicles, but also the propensity for ejection in the event of a crash. Given the vulnerability of these road users, it's critical to understand factors which may affect injury severity to plan effective countermeasures aimed at reducing these injuries and fatalities. To better understand factors affecting the injury severity of ATV and golf cart riders or occupants involved in police-reported crashes, this study presents an analysis using six years of crash data from the US state of Arizona. Over the analysis period, there were 1769 drivers/passengers of these vehicle types involved in police-reported crashes. Of these occupants/riders, 67.7% were injured or killed as a result of the crash; a proportion significantly higher than police-reported crashes involving most other vehicle types, exhibiting the need to examine factors leading to these injuries and fatalities. In order to analyse factors affecting the injury severity of ATV and golf cart occupants/riders, a random parameters (RP) ordered logit statistical model was developed, which was most appropriate given the ordered nature of injury-severity data. Several person- vehicle- roadway- and environmental-related variables were found to significantly affect the injury severity of riders or occupants of ATVs and golf carts. Given the vulnerability of these road users, it's important for transportation agencies to explore effective countermeasures aimed at reducing the severity of crashes involving these vehicle types. The results of this study provide important insights which can assist in developing effective engineering-, enforcement-, education, or policy-related countermeasures.


Asunto(s)
Accidentes de Tránsito/mortalidad , Vehículos a Motor Todoterreno , Heridas y Traumatismos/mortalidad , Accidentes de Tránsito/prevención & control , Adulto , Arizona/epidemiología , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Modelos Logísticos , Masculino , Persona de Mediana Edad , Equipos de Seguridad/estadística & datos numéricos , Adulto Joven
11.
Prev Vet Med ; 172: 104779, 2019 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-31557686

RESUMEN

Leptospirosis, caused by Leptospira spp., is a zoonotic bacterial disease important to both human and animal health. Six pathogenic serovars are currently known to commonly infect and cause disease in dogs in the United States. While canine leptospirosis infection is historically rare in Arizona (≤5 cases reported annually) (ADHS unpublished data) several clusters were reported in Maricopa County (MC) during February 2016-January 2017. Public health initiated an outbreak response and developed a knowledge, attitudes, and practices survey for veterinarians. The goals were to determine awareness and general attitudes about canine leptospirosis and to identify gaps in veterinarians' knowledge in treatment and prevention. We distributed a 40-question self-administered online survey to 1058 Arizona Veterinary Medical Association members, made available during February 9-May 15, 2017. We analyzed the results using Pearson's Chi-squared or Fisher's exact test; a P-value <0.05 was considered statistically significant. We analyzed 202 complete responses. Veterinarians from 10 (66%) of 15 Arizona counties were represented. MC practices were more likely to stock leptospirosis vaccine (80%) than other counties combined (58%) (P = 0.004). The average composite knowledge score was 24.4 out of 38 (range 12-37, median 24); 49% of respondents demonstrated higher knowledge as defined by authors, largely in identification of leptospirosis risk factors (86%) and routes of exposure (73%). Fewer than half (45%) of respondents correctly identified the length of time bacteria can be shed in dogs' urine. Eighty-one percent of respondents demonstrated lower knowledge about clinical signs associated with leptospirosis; only 47% of respondents identified eight clinical signs commonly associated with leptospirosis. Sixty-one percent of MC respondents agreed that leptospirosis is an important canine disease in their geographic area, while only 40% of other county respondents agreed (P=0.03). Seventy percent of respondents identified diagnostic testing options. The majority correctly selected infection-control practices in line with recommendations from 2 national clinical guidelines. More respondents would recommend leptospirosis vaccination if dogs traveled or lived in rural areas (87-96%) than if dogs attended day care or were boarded (63%). We identified opportunities for education, including the local epidemiology of leptospirosis, transmission prevention strategies, vaccine safety, testing, clinical identification, and emerging risk factors. Our findings will help guide the design of educational materials for small animal veterinarians in Arizona regarding recommendations for prevention of animal and human leptospirosis infections; these efforts could also shift the culture of reporting companion animal diseases to improve future One Health collaborations.


Asunto(s)
Brotes de Enfermedades/veterinaria , Enfermedades de los Perros/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Leptospirosis/veterinaria , Veterinarios/estadística & datos numéricos , Animales , Arizona , Perros , Leptospirosis/epidemiología , Veterinarios/psicología
12.
Artículo en Inglés | MEDLINE | ID: mdl-31370179

RESUMEN

The geologic profile of the western United States lends itself to naturally elevated levels of arsenic and uranium in groundwater and can be exacerbated by mining enterprises. The Navajo Nation, located in the American Southwest, is the largest contiguous Native American Nation and has over a 100-year legacy of hard rock mining. This study has two objectives, quantify the arsenic and uranium concentrations in water systems in the Arizona and Utah side of the Navajo Nation compared to the New Mexico side and to determine if there are other elements of concern. Between 2014 and 2017, 294 water samples were collected across the Arizona and Utah side of the Navajo Nation and analyzed for 21 elements. Of these, 14 elements had at least one instance of a concentration greater than a national regulatory limit, and six of these (V, Ca, As, Mn, Li, and U) had the highest incidence of exceedances and were of concern to various communities on the Navajo Nation. Our findings are similar to other studies conducted in Arizona and on the Navajo Nation and demonstrate that other elements may be a concern for public health beyond arsenic and uranium.


Asunto(s)
Arsénico/análisis , Agua Subterránea/química , Indios Norteamericanos , Uranio/análisis , Contaminantes Químicos del Agua/análisis , Contaminación Química del Agua/estadística & datos numéricos , Calidad del Agua , Arizona , Regulación Gubernamental , Agua Subterránea/análisis , Humanos , Minería , New Mexico , Utah , Contaminación Química del Agua/análisis
13.
Environ Sci Technol ; 53(17): 10139-10145, 2019 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-31389234

RESUMEN

Heterogeneous oxidation of SO2 on mineral dust is a significant source of sulfate in the atmosphere. Given that a large fraction of nitrate is deposited on the mineral aerosols, the determination of the effect of nitrate on the SO2 oxidation on mineral dust and its in-depth mechanism are much desired. In this work, we report nitrate-enhanced SO2 oxidation on authentic mineral dust. By comparing the SO2 uptake behaviors on Arizona test dust (ATD, a typical proxy of mineral dust) with or without nitrate, we found that although nitrate hinders the initial SO2 uptake, it substantially accelerates SO2 uptake and oxidation after a pronounced induction period. In other words, a hindering-then-accelerating feature in the SO2 uptake profile was observed on nitrate-containing ATD (N-ATD) particles. In addition, HONO was released in the accelerating period as the reduction product of nitrate. The accumulation of protons (H+) from SO2 oxidation during the induction period plays a key role in the acceleration of SO2 oxidation. Our work suggests that the nitrate-participating SO2 oxidation on mineral dust can be one of the important contributions of the sulfate source in the atmosphere.


Asunto(s)
Polvo , Minerales , Aerosoles , Arizona , Protones
14.
J Surg Res ; 243: 531-538, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31377494

RESUMEN

BACKGROUND: Although New York's Medicaid expansion increased coverage in 2001, little is known regarding changes in surgical care utilization among patients with vascular disease. We sought to measure the impact of expansion on the rates of both vascular procedures and amputations. MATERIALS AND METHODS: A retrospective analysis was performed using the State Inpatient Databases of New York and Arizona, 1998-2006. Patients aged 18-64 who underwent lower extremity vascular surgery procedures or amputations between 1998 and 2006 were included. Outcomes included rates of total vascular, open vascular, and endovascular procedures, in addition to rates of amputation. A difference-in-difference analysis measured changes in the rates of procedure types, while adjusting for temporal trends in both states. RESULTS: In this cohort (n = 112,624), Medicaid expansion was not associated with a change in mortality (odds ratio 0.92, P = 0.5). Expansion was associated with a lower incidence of total vascular procedures (incidence rate ratio [IRR] 0.65, P < 0.001) and open vascular procedures (IRR 0.92, P = 0.002), but a higher incidence of endovascular procedures (IRR 1.13, P < 0.001). There was no change in the rate of amputations (IRR 1.02, P = 0.58). In patients with chronic limb-threatening ischemia (n = 12,668), expansion was associated with a lower incidence of total procedures (IRR 0.59, P < 0.001) and endovascular procedures (IRR 0.59, P < 0.001) but a higher incidence of amputations (IRR 1.43, P = 0.001) and higher odds of mortality (odds ratio 2.21, P = 0.032). CONCLUSIONS: After Medicaid expansion, the rates of total vascular procedures decreased, with no impact on amputations rates. Furthermore, the utilization of limb-saving procedures in patients with chronic limb-threatening ischemia did not increase.


Asunto(s)
Amputación/estadística & datos numéricos , Procedimientos Endovasculares/estadística & datos numéricos , Recuperación del Miembro/estadística & datos numéricos , Arizona , Femenino , Humanos , Masculino , Medicaid , Persona de Mediana Edad , New York , Estudios Retrospectivos , Estados Unidos
15.
Emerg Infect Dis ; 25(9): 1745-1747, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31441755

RESUMEN

Tucson, Arizona, USA, is a highly coccidioidomycosis-endemic area. We conducted a retrospective review of 815 patients in Tucson over 2.7 years. Of 276 patients with coccidioidomycosis, 246 had a delay in diagnosis; median delay was 23 days. Diagnosis delay was associated with coccidioidomycosis-related costs totaling $589,053 and included extensive antibacterial drug use.


Asunto(s)
Coccidioidomicosis/epidemiología , Diagnóstico Tardío/economía , Enfermedades Pulmonares Fúngicas/epidemiología , Arizona/epidemiología , Coccidioidomicosis/diagnóstico , Coccidioidomicosis/economía , Costos y Análisis de Costo , Femenino , Humanos , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/economía , Masculino , Registros Médicos , Persona de Mediana Edad , Estudios Retrospectivos
16.
Sr Care Pharm ; 34(8): 514-519, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31462355

RESUMEN

OBJECTIVE: The aim of this study was to evaluate prescribing practices for elderly patients started on apixaban in multiple practice settings.
DESIGN: Retrospective, chart review.
SETTING: One outpatient and three inpatient settings in Arizona and Massachusetts.
PATIENT, PARTICIPANTS: Patients who received a new order for apixaban between July 1, 2015, and December 31, 2016. Inclusion criteria included adults 65 years of age and older who were receiving apixaban for atrial fibrillation or venous thromboembolism (VTE) at a current treatment dose.
There were 1,045 patients included, the average age was 78 years, 52% were male, and 90% had atrial fibrillation.
MAIN OUTCOME MEASURE: Appropriate prescribing of apixaban based on Food and Drug Administration (FDA)-labeling (age, weight, serum creatinine).
RESULTS: Six patients who were on hemodialysis were excluded from the analysis, leaving 1,039 patients to be analyzed. 16.2% (168/1,039) of patients had an incorrect dose of apixaban prescribed based on their indication. Of those, 75% (126/168) were taking the medication for atrial fibrillation and 25% (42/168) for VTE. For those with atrial fibrillation (n = 126), the majority of inappropriate orders resulted from doses that were lower than indicated (113/126).
CONCLUSION: This research suggests that elderly patients may receive inappropriately lower doses of apixaban than indicated, which may decrease the effectiveness of the medication. This research supports the fact that pharmacists can play a vital role in anticoagulation stewardship by verifying apixaban doses for accuracy.


Asunto(s)
Pirazoles/efectos adversos , Piridonas/efectos adversos , Anciano , Anticoagulantes , Arizona , Femenino , Humanos , Masculino , Massachusetts , Estudios Retrospectivos
17.
Pediatrics ; 144(3)2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31451609

RESUMEN

BACKGROUND: Cannabis concentrates, which are cannabis plant extracts that contain high concentrations of Δ-9-tetrahydrocannbinol (THC), have become increasingly popular among adults in the United States. However, no studies have reported on the prevalence or correlates of cannabis concentrate use in adolescents, who, as a group, are thought to be particularly vulnerable to the harms of THC. METHODS: Participants are a racially and ethnically diverse group of 47 142 8th-, 10th-, and 12th-grade students recruited from 245 schools across Arizona in 2018. Participants reported on their lifetime and past-month marijuana and cannabis concentrate use, other substance use, and risk and protective factors for substance use problems spanning multiple life domains (ie, individual, peer, family, school, and community). RESULTS: Thirty-three percent of all 8th-, 10th-, and 12th-graders reported lifetime cannabis use, and 24% reported lifetime concentrate use. Seventy-two percent of all lifetime cannabis users had used concentrates. Relative to adolescent cannabis users who had not used concentrates, adolescent concentrate users were more likely to use other substances and to experience more risk factors, and fewer protective factors, for substance use problems across numerous life domains. CONCLUSIONS: Most adolescent cannabis users have used concentrates. Based on their risk and protective factor profile, adolescent concentrate users are at higher risk for substance use problems than adolescent cannabis users who do not use concentrates. Findings raise concerns about high-risk adolescents' exposure to high-THC cannabis.


Asunto(s)
Dronabinol , Abuso de Marihuana/epidemiología , Fumar Marihuana/epidemiología , Extractos Vegetales , Adolescente , Arizona/epidemiología , Humanos , Prevalencia , Factores de Riesgo , Autoinforme , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/epidemiología
18.
Am Surg ; 85(6): 611-619, 2019 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-31267902

RESUMEN

The Medicare Severity Diagnosis Related Group (MS-DRG) weight, as derived from the MS-DRG assigned at discharge, is in part determined by the physician-documented diagnoses. However, the terminology associated with MS-DRG determination is often not aligned with typical physician language, leading to inaccurate coding and decreased hospital reimbursements. The goal of this study was to evaluate the impact of a diagnosis picklist within a paper-based history and physical examination (H&P) on the average MS-DRG weight and the Case-mix index (CMI). Our trauma center implemented a paper H&P form for trauma patients featuring picklist diagnoses aligned with the MS-DRG terminology and arranged by the physiologic system. To evaluate its impact, we conducted a cohort study using data from our trauma registry between July 2015 and November 2017. Our cohort included 442 (26.0%) paper and 1,261 (74.0%) dictated H&Ps. Average CMI (2.56 vs 2.15) and expected patients ($25,057 vs $19,825) were higher for the paper group (P < 0.001, P = 0.002). Adjusted regression models demonstrated paper coding to be associated with 0.265 CMI points, translating to an average increase in expected payment of 6.5 per cent per patient. Utilization of a standardized, paper-based H&P template with picklist diagnoses was associated with a higher trauma service CMI and higher expected payments. Preprinted diagnoses that align with the MS-DRG terminology lead to clinical documentation improvement.


Asunto(s)
Grupos Diagnósticos Relacionados/tendencias , Documentación/tendencias , Alta del Paciente/tendencias , Mejoramiento de la Calidad , Centros Traumatológicos/organización & administración , Heridas y Traumatismos/diagnóstico , Centros Médicos Académicos/organización & administración , Arizona , Intervalos de Confianza , Bases de Datos Factuales , Grupos Diagnósticos Relacionados/normas , Documentación/métodos , Femenino , Humanos , Masculino , Medicare/economía , Admisión del Paciente/normas , Admisión del Paciente/tendencias , Alta del Paciente/normas , Alta del Paciente/estadística & datos numéricos , Examen Físico/normas , Examen Físico/tendencias , Sistema de Pago Prospectivo/normas , Sistema de Pago Prospectivo/tendencias , Análisis de Regresión , Estudios Retrospectivos , Estados Unidos , Heridas y Traumatismos/clasificación
19.
BMC Public Health ; 19(1): 875, 2019 Jul 04.
Artículo en Inglés | MEDLINE | ID: mdl-31272444

RESUMEN

BACKGROUND: Hearing loss is among the leading causes of disability in persons 65 years and older worldwide and is known to have an impact on quality of life as well as social, cognitive, and physical functioning. Our objective was to assess statewide prevalence of self-reported hearing ability in Arizona adults and its association with general health, cognitive decline, diabetes and poor psychosocial health. METHODS: A self-report question on hearing was added to the 2015 Behavioral Risk Factor Surveillance System (BRFSS), a telephone-based survey among community-dwelling adults aged > 18 years (n = 6462). Logistic and linear regression were used to estimate the associations between self-reported hearing loss and health outcomes. RESULTS: Approximately 1 in 4 adults reported trouble hearing (23.2, 95% confidence interval: 21.8, 24.5%), with responses ranging from "a little trouble hearing" to being "deaf." Adults reporting any trouble hearing were at nearly four times higher odds of reporting increased confusion and memory loss (OR 3.92, 95% CI: 2.94, 5.24) and decreased odds of reporting good general health (OR = 0.50, 95% CI: 0.40, 0.64) as compared to participants reporting no hearing difficulty. Those reporting any trouble hearing also reported an average 2.5 more days of poor psychosocial health per month (ß = 2.52, 95% CI: 1.64, 3.41). After adjusting for sex, age, questionnaire language, race/ethnicity, and income category the association between diabetes and hearing loss was no longer significant. CONCLUSIONS: Self-reported hearing difficulty was associated with report of increased confusion and memory loss and poorer general and psychosocial health among Arizona adults. These findings support the feasibility and utility of assessing self-reported hearing ability on the BRFSS. Results highlight the need for greater inclusion of the full range of hearing disability in the planning process for public health surveillance, programs, and services at state and local levels.


Asunto(s)
Pérdida Auditiva/epidemiología , Pérdida Auditiva/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Arizona/epidemiología , Sistema de Vigilancia de Factor de Riesgo Conductual , Cognición , Personas con Discapacidad/psicología , Personas con Discapacidad/estadística & datos numéricos , Femenino , Estado de Salud , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Prevalencia , Autoinforme , Adulto Joven
20.
Ecol Appl ; 29(8): e01979, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31332869

RESUMEN

Higher tree density, more fuels, and a warmer, drier climate have caused an increase in the frequency, size, and severity of wildfires in western U.S. forests. There is an urgent need to restore forests across the western United States. To address this need, the U.S. Forest Service began the Four Forest Restoration Initiative (4FRI) to restore four national forests in Arizona. The objective of this study was to evaluate how restoration of ~400,000 ha under the 4FRI program and projected climate change would influence carbon dynamics and wildfire severity from 2010 to 2099. Specifically, we estimated forest carbon fluxes, carbon pools and wildfire severity under a moderate and fast 4FRI implementation schedule and compared those to status quo and no-harvest scenarios using the LANDIS-II simulation model and climate change projections. We found that the fast-4FRI scenario showed early decreases in ecosystem carbon due to initial thinning/prescribed fire treatments, but total ecosystem carbon increased by 9-18% over no harvest by the end of the simulation. This increased carbon storage by 6.3-12.7 million metric tons, depending on the climate model, equating to removal of carbon emissions from 55,000 to 110,000 passenger vehicles per year until the end of the century. Nearly half of the additional carbon was stored in more stable soil pools. However, climate models with the largest predicted temperature increases showed declines by late century in ecosystem carbon despite restoration. Our study uses data from a real-world, large-scale restoration project and indicates that restoration is likely to stabilize carbon and the benefits are greater when the pace of restoration is faster.


Asunto(s)
Cambio Climático , Fuego , Arizona , Carbono , Ecosistema , Sudoeste de Estados Unidos , Árboles
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