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1.
mBio ; 11(5)2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32887735

RESUMO

In December of 2019, a novel coronavirus, SARS-CoV-2, emerged in the city of Wuhan, China, causing severe morbidity and mortality. Since then, the virus has swept across the globe, causing millions of confirmed infections and hundreds of thousands of deaths. To better understand the nature of the pandemic and the introduction and spread of the virus in Arizona, we sequenced viral genomes from clinical samples tested at the TGen North Clinical Laboratory, the Arizona Department of Health Services, and those collected as part of community surveillance projects at Arizona State University and the University of Arizona. Phylogenetic analysis of 84 genomes from across Arizona revealed a minimum of 11 distinct introductions inferred to have occurred during February and March. We show that >80% of our sequences descend from strains that were initially circulating widely in Europe but have since dominated the outbreak in the United States. In addition, we show that the first reported case of community transmission in Arizona descended from the Washington state outbreak that was discovered in late February. Notably, none of the observed transmission clusters are epidemiologically linked to the original travel-related case in the state, suggesting successful early isolation and quarantine. Finally, we use molecular clock analyses to demonstrate a lack of identifiable, widespread cryptic transmission in Arizona prior to the middle of February 2020.IMPORTANCE As the COVID-19 pandemic swept across the United States, there was great differential impact on local and regional communities. One of the earliest and hardest hit regions was in New York, while at the same time Arizona (for example) had low incidence. That situation has changed dramatically, with Arizona now having the highest rate of disease increase in the country. Understanding the roots of the pandemic during the initial months is essential as the pandemic continues and reaches new heights. Genomic analysis and phylogenetic modeling of SARS-COV-2 in Arizona can help to reconstruct population composition and predict the earliest undetected introductions. This foundational work represents the basis for future analysis and understanding as the pandemic continues.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Arizona/epidemiologia , Betacoronavirus/classificação , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/virologia , Evolução Molecular , Genoma Viral/genética , Humanos , Incidência , Mutação , Pandemias , Filogenia , Pneumonia Viral/virologia , Proteínas Virais/genética
2.
Front Health Serv Manage ; 37(1): 45-48, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842089

RESUMO

For populations experiencing the preexisting conditions of poverty and all its related social inequalities, the COVID-19 pandemic further complicates the delivery of healthcare. Two members of the American College of Healthcare Executives-Tim Egan, president and CEO of Roseland Community Hospital on the South Side of Chicago, Illinois, and Lynette Bonar, RN, FACHE, CEO of Tuba City Regional Health Care Corporation on the Navajo and Hopi reservations in Arizona-deal with those complications daily. Presented here together, their perspectives show resilience, cultural sensitivity, and commitment to protect the well-being of their diverse communities.


Assuntos
Adaptação Psicológica , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Assistência à Saúde/organização & administração , Assistência à Saúde/estatística & dados numéricos , Pessoal de Saúde/psicologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Adulto , Arizona , Atitude do Pessoal de Saúde , Betacoronavirus , Chicago , Cidades/estatística & dados numéricos , Feminino , Humanos , Índios Norte-Americanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , População Rural , População Urbana
3.
MMWR Morb Mortal Wkly Rep ; 69(32): 1070-1073, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32790662

RESUMO

Alcohol-based hand sanitizer is a liquid, gel, or foam that contains ethanol or isopropanol used to disinfect hands. Hand hygiene is an important component of the U.S. response to the emergence of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). If soap and water are not readily available, CDC recommends the use of alcohol-based hand sanitizer products that contain at least 60% ethyl alcohol (ethanol) or 70% isopropyl alcohol (isopropanol) in community settings (1); in health care settings, CDC recommendations specify that alcohol-based hand sanitizer products should contain 60%-95% alcohol (≥60% ethanol or ≥70% isopropanol) (2). According to the Food and Drug Administration (FDA), which regulates alcohol-based hand sanitizers as an over-the-counter drug, methanol (methyl alcohol) is not an acceptable ingredient. Cases of ethanol toxicity following ingestion of alcohol-based hand sanitizer products have been reported in persons with alcohol use disorder (3,4). On June 30, 2020, CDC received notification from public health partners in Arizona and New Mexico of cases of methanol poisoning associated with ingestion of alcohol-based hand sanitizers. The case reports followed an FDA consumer alert issued on June 19, 2020, warning about specific hand sanitizers that contain methanol. Whereas early clinical effects of methanol and ethanol poisoning are similar (e.g., headache, blurred vision, nausea, vomiting, abdominal pain, loss of coordination, and decreased level of consciousness), persons with methanol poisoning might develop severe anion-gap metabolic acidosis, seizures, and blindness. If left untreated methanol poisoning can be fatal (5). Survivors of methanol poisoning might have permanent visual impairment, including complete vision loss; data suggest that vision loss results from the direct toxic effect of formate, a toxic anion metabolite of methanol, on the optic nerve (6). CDC and state partners established a case definition of alcohol-based hand sanitizer-associated methanol poisoning and reviewed 62 poison center call records from May 1 through June 30, 2020, to characterize reported cases. Medical records were reviewed to abstract details missing from poison center call records. During this period, 15 adult patients met the case definition, including persons who were American Indian/Alaska Native (AI/AN). All had ingested an alcohol-based hand sanitizer and were subsequently admitted to a hospital. Four patients died and three were discharged with vision impairment. Persons should never ingest alcohol-based hand sanitizer, avoid use of specific imported products found to contain methanol, and continue to monitor FDA guidance (7). Clinicians should maintain a high index of suspicion for methanol poisoning when evaluating adult or pediatric patients with reported swallowing of an alcohol-based hand sanitizer product or with symptoms, signs, and laboratory findings (e.g., elevated anion-gap metabolic acidosis) compatible with methanol poisoning. Treatment of methanol poisoning includes supportive care, correction of acidosis, administration of an alcohol dehydrogenase inhibitor (e.g., fomepizole), and frequently, hemodialysis.


Assuntos
Higienizadores de Mão/envenenamento , Metanol/envenenamento , Adulto , Idoso , Arizona/epidemiologia , Ingestão de Alimentos , Feminino , Higienizadores de Mão/química , Humanos , Masculino , Metanol/análise , Pessoa de Meia-Idade , New Mexico/epidemiologia , Envenenamento/epidemiologia , Envenenamento/mortalidade , Adulto Jovem
6.
Public Health Rep ; 135(5): 631-639, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687733

RESUMO

OBJECTIVES: Maricopa County, Arizona (2017 population about 4.3 million), is located in the Sonoran Desert. In 2005, the Maricopa County Department of Public Health (MCDPH) established a heat-associated mortality surveillance system that captures data on circumstances of death for Maricopa County residents and visitors. We analyzed 2006-2016 surveillance system data to understand the characteristics and circumstances of heat-associated deaths. METHODS: We classified heat-associated deaths based on International Classification of Diseases, Tenth Revision codes (X30, T67.X, and P81.0) and phrases (heat exposure, environ, exhaustion, sun, heat stress, heat stroke, or hyperthermia) in part I or part II of the death certificate. We summarized data on decedents' demographic characteristics, years lived in Arizona, location of death (indoors vs outdoors), presence and functionality of air conditioning, and whether the decedent had been homeless. We examined significant associations between variables by using the Pearson χ2 tests and logistic regression. RESULTS: During 2006-2016, MCDPH recorded data on 920 heat-associated deaths, 912 of which included location of injury. Of 565 (62%) heat-associated deaths that occurred outdoors, 458 (81%) were among male decedents and 243 (43%) were among decedents aged 20-49. Of 347 (38%) heat-associated deaths that occurred indoors, 201 (58%) were among decedents aged ≥65. Non-Arizona residents were 5 times as likely as Arizona residents to have a heat-associated death outdoors (P < .001). Of 727 decedents with data on duration of Arizona residency, 438 (60%) had resided in Arizona ≥20 years. CONCLUSIONS: Ongoing evaluation of interventions that target populations at risk for both outdoor and indoor heat-associated deaths can further inform refinement of the surveillance system and identify best practices to prevent heat-associated deaths.


Assuntos
Transtornos de Estresse por Calor/epidemiologia , Transtornos de Estresse por Calor/mortalidade , Mortalidade/tendências , Vigilância da População/métodos , Saúde Pública/estatística & dados numéricos , Saúde Pública/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arizona/epidemiologia , Criança , Pré-Escolar , Feminino , Previsões , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
J Environ Radioact ; 220-221: 106266, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32560894

RESUMO

Radon (Rnair) was monitored in open air in publicly accessible areas surrounding the Pinenut uranium (U) mine during mining and reclamation activities in 2015-16 to address concerns about mining related effects to areas surrounding Grand Canyon National Park (GCNP) in Arizona, USA. During July 2015, Rnair concentrations associated with the ore storage pile monitoring site were larger than those at the mine vent monitoring site and likely resulted from the relatively large amount of ore stored on site during this period. Higher wind velocities at the ore pile monitoring site generally resulted in lower Rnair concentrations; however, wind velocity did not appear to be an important factor in controlling Rnair concentrations at the mine vent monitoring site. Physical disturbances of the ore pile by heavy equipment did not coincide with elevated Rnair concentrations at the ore storage pile or mine vent monitoring sites. The relative size of the ore storage pile showed a positive trend with the daily mean Rnair concentration measured at the ore pile monitoring site. Principal component analysis (PCA) was applied to the ore pile and mine vent multivariate data sets for simultaneous comparison of all measured variables during 230 days of the study period. A significant positive coefficient for Rnair was associated with a significant negative coefficient for wind speed for principal component (PC) 2ore pile. Significant, positive PC2mine vent coefficients included Rnair, wind direction, and relative ore pile size indicating that Rnair variations at the mine vent monitoring site may be affected by Rn sourced from the ore pile. The ore pile is located about 200 m south of the mine vent Rn monitor with the prevalent wind direction coming from the south. All data generated during the field study and laboratory verification tests were published by Naftz et al. (2018) and are available online at: https://doi.org/10.5066/F79Z946T.


Assuntos
Monitoramento de Radiação , Arizona , Mineração , Radônio , Urânio
9.
Plant Dis ; 104(7): 1994-2004, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32441578

RESUMO

Leaf spot diseases have become a major concern in spinach production in the United States. Determining the causal agents of leaf spots on spinach, their prevalence and pathogenicity, and fungicide efficacy against these pathogens is vital for effective disease management. Spinach leaves with leaf spots were collected from Texas, California, Arizona, and South Carolina from 2016 to 2018, incubated in a moist chamber, and plated on potato dextrose and tryptic soy agar media. Fungal and bacterial colonies recovered were identified based on morphology and sequence analysis of the internal transcribed spacer rDNA and 16S rRNA, respectively. Two predominant genera were isolated: (i) Colletotrichum spp., which were identified to species based on sequences of both introns of the glutamate synthetase (GS-I) and glyceraldehyde-3-phosphate dehydrogenase (gapdh-I) genes; and (ii) Stemphylium spp., identified to species based on sequences of the gapdh and calmodulin (cmdA) genes. Anthracnose (Colletotrichum spinaciae) and Stemphylium leaf spot (Stemphylium vesicarium and S. beticola) were the predominant diseases. Additional fungi recovered at very limited frequencies that were also pathogenic to spinach included Colletotrichum coccodes, C. truncatum, Cercospora beticola, and Myrothecium verrucaria. All of the bacterial isolates were not pathogenic on spinach. Pathogenicity tests showed that C. spinaciae, S. vesicarium, and S. beticola caused significant leaf damage. The fungicides Bravo WeatherStik (chlorothalonil), Dithane F-45 (mancozeb), Cabrio (pyraclostrobin), and Merivon (fluxapyroxad and pyraclostrobin) were highly effective at reducing leaf spot severity caused by an isolate of each of C. spinaciae and S. vesicarium, when inoculated individually and in combination.


Assuntos
Spinacia oleracea , Arizona , RNA Ribossômico 16S , South Carolina , Texas , Estados Unidos
10.
Clin Infect Dis ; 71(15): 807-812, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32240285

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) causes a range of illness severity. Mild illness has been reported, but whether illness severity correlates with infectivity is unknown. We describe the public health investigation of a mildly ill, nonhospitalized COVID-19 case who traveled to China. METHODS: The case was a Maricopa County resident with multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive specimens collected on 22 January 2020. Contacts were persons exposed to the case on or after the day before case diagnostic specimen collection. Contacts were monitored for 14 days after last known exposure. High-risk contacts had close, prolonged case contact (≥ 10 minutes within 2 m). Medium-risk contacts wore all US Centers for Disease Control and Prevention-recommended personal protective equipment during interactions. Nasopharyngeal and oropharyngeal (NP/OP) specimens were collected from the case and high-risk contacts and tested for SARS-CoV-2. RESULTS: Paired case NP/OP specimens were collected for SARS-CoV-2 testing at 11 time points. In 8 pairs (73%), ≥ 1 specimen tested positive or indeterminate, and in 3 pairs (27%) both tested negative. Specimens collected 18 days after diagnosis tested positive. Sixteen contacts were identified; 11 (69%) had high-risk exposure, including 1 intimate contact, and 5 (31%) had medium-risk exposure. In total, 35 high-risk contact NP/OP specimens were collected for SARS-CoV-2 testing; all 35 pairs (100%) tested negative. CONCLUSIONS: This report demonstrates that SARS-CoV-2 infection can cause mild illness and result in positive tests for up to 18 days after diagnosis, without evidence of transmission to close contacts. These data might inform public health strategies to manage individuals with asymptomatic infection or mild illness.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Adulto , Arizona , Betacoronavirus/patogenicidade , China , Técnicas de Laboratório Clínico , Busca de Comunicante/métodos , Infecções por Coronavirus/virologia , Humanos , Masculino , Pandemias , Pneumonia Viral/virologia , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/virologia , Manejo de Espécimes/métodos , Viagem
11.
Plant Dis ; 104(6): 1811-1816, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32282277

RESUMO

Fusarium wilt of lettuce, caused by Fusarium oxysporum f. sp. lactucae, is now found in all major lettuce producing regions in California and Arizona. The population structure of F. oxysporum f. sp. lactucae in California and Arizona was characterized based on somatic compatibility and sequences of the translation elongation factor 1-α gene (EF-1α) and rDNA intergenic spacer region (IGS). In this study, 170 isolates were tested for somatic compatibility based on heterokaryon formation, using complementary nitrate nonutilizing (nit) mutants. Five subgroups (A to E) of somatic compatibility group 0300 were identified. Isolates associated with the same subgroup had a strong complementation reaction, whereas reactions between isolates of different subgroups were weak or delayed. An isolate from the first known infestation of Fusarium wilt of lettuce in California was associated with subgroup A, which predominated among isolates in our collection. Isolates representative of each subgroup were confirmed to be associated with race 1, based on the reaction of differential lettuce cultivars. It is possible that somatic compatibility subgroups B to E of F. oxysporum f. sp. lactucae were derived from subgroup A, as a consequence of somatic mutations affecting compatibility. If so, subgroups of F. oxysporum f. sp. lactucae may represent an intermediate step in divergence that will lead to clearly separable compatibility groups. Sequences of EF-1α and IGS were both identical for 58 isolates of F. oxysporum f. sp. lactucae that represented all somatic compatibility subgroups and locations from which isolates were obtained, indicating that subgroups were derived from the same clonal lineage (VCG 0300).


Assuntos
Fusarium , Arizona , California , DNA Ribossômico , Alface
12.
PLoS One ; 15(4): e0231170, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32267885

RESUMO

Bats are among the most widespread mammals on Earth, and are subject to habitat change, loss, and other disturbances such as fire. Wildfire causes rapid changes in vegetation that affect habitat use. However, the spatial scale at which these changes affect bats depends on their use of habitat elements. Three years post wildfire, we assessed how burn severity, water, landform type, elevation, vegetation type, and roads affected use by bats of a forest landscape at multiple spatial scales. We deployed acoustic detectors at randomly selected locations within a 217,712 ha wildfire boundary in Arizona. We classified echolocation calls to species or group and calculated an activity index by adjusting the calls per hour. We conducted a multi-scale analysis of landscape structure and composition around each location from a 90 to 5760 m radius. No scale was selected preferentially by any species or group. Stream density and elevation range were more important predictors for species groups than burn severity. When burn severity was a predictor, agile species had higher activity in areas that were unburned or had low severity burn. A heterogeneous landscape composed of high, medium, and low burn severity patches within a forest altered by large wildfires provided habitat for different bat species, but water density and range in elevation were more important for predicting bat habitat use than fire severity in this arid landscape. More than one spatial scale, representing local to landscape levels, should be considered in managing habitat for bats. In arid areas, such as the western United States, maintaining reliable water sources is important for bats. Managing these factors at multiple spatial scales will benefit bat species with different wing morphologies, echolocation call types, and habitat selections.


Assuntos
Distribuição Animal , Quirópteros/fisiologia , Monitorização de Parâmetros Ecológicos/estatística & dados numéricos , Rios , Incêndios Florestais , Animais , Arizona , Ecolocação , Monitorização de Parâmetros Ecológicos/instrumentação , Feminino , Voo Animal , Florestas , Comportamento de Retorno ao Território Vital , Masculino , Análise Espacial
13.
J Zoo Wildl Med ; 51(1): 232-235, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32212569

RESUMO

This study presents the gross and histopathological findings of adenoviral hemorrhagic disease (AHD) in two yearling and one adult mule deer (Odocoileus hemionus). These cases represent the first known outbreak of deer adenovirus (Odocoileus adenovirus 1) in Arizona. Over the span of a month, three female captive mule deer were submitted to Midwestern University's Animal Health Institute for postmortem examination. All of these deer were from the same deer farm and historical findings were similar, consisting of acute presentation of hemorrhagic diarrhea and sudden death. Grossly and histopathologically, all cases had severe pulmonary edema and hemorrhagic enteritis. Additionally, two of the three cases had low numbers of large amphophilic intranuclear inclusions expanding endothelial cells within the small intestine and lungs. Viral PCR of pooled small intestine, lung, and spleen from each of the three cases were positive for deer adenovirus and negative for blue tongue and epizootic hemorrhagic disease.


Assuntos
Infecções por Adenoviridae/veterinária , Atadenovirus/isolamento & purificação , Cervos , Diarreia/veterinária , Hemorragia Gastrointestinal/veterinária , Infecções por Adenoviridae/diagnóstico , Infecções por Adenoviridae/patologia , Animais , Animais de Zoológico , Arizona , Diarreia/diagnóstico , Diarreia/patologia , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/patologia
14.
Wilderness Environ Med ; 31(1): 82-86, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32008950

RESUMO

Treating skin disorders in wilderness settings is often challenging. In this report we describe common skin conditions affecting the feet of river runners on the Colorado River in Grand Canyon National Park. These conditions are frequently referred to by river runners with a catchall term, "tolio." Several skin disorders have been identified as components of tolio, with the most prevalent currently being pitted keratolysis. We present a case of pitted keratolysis in a river guide occurring during a multiday river trip, where treatment can be difficult. Prevention is often more important.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Pododermatite Necrótica dos Ovinos/diagnóstico , Pododermatite Necrótica dos Ovinos/terapia , Pé de Imersão/terapia , Esportes Aquáticos , Animais , Arizona , Traumatismos em Atletas/etiologia , Pododermatite Necrótica dos Ovinos/etiologia , Humanos , Pé de Imersão/diagnóstico , Pé de Imersão/etiologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
15.
J Dent Educ ; 84(6): 681-687, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32068258

RESUMO

PURPOSE: To survey A. T. Still University, Arizona School of Dentistry & Oral Health (ATSU-ASDOH) graduates and evaluate the impact of completing a Master of Public Health (MPH) degree during dental school on a dentist's practice behaviors, volunteerism, and attitudes toward dental education, practice preparedness, and the dental profession. METHODS: In 2018, a 35-question survey was emailed to 637 (ATSU-ASDOH) graduates from 2007 to 2017. Questions were related to demographics, obtaining an MPH, postgraduate education, practice setting, and attitudes regarding dental education on practice preparedness and the dental profession. RESULTS: One hundred and seven dentists completed the survey for a response rate of 16.8%. Of those, 40 respondents received an MPH from (ATSU-ASDOH) at the same time as graduating with a DMD or within 5 years following graduation. Dentists with an MPH were more likely to practice in public health settings (P = 0.028). However, the MPH did not appear to influence attitudes toward the dental profession. CONCLUSION: Dentists from (ATSU-ASDOH) who obtained an MPH and those who entered dental school wanting to work with the underserved are more likely to practice within public health settings. This study begins to paint a picture of a dual degree graduate. Future studies should explore which variables are more likely to result in a graduate working within a public health setting.


Assuntos
Faculdades de Odontologia , Universidades , Arizona , Atitude do Pessoal de Saúde , Educação em Odontologia , Saúde Pública
16.
PLoS One ; 15(2): e0228537, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32049986

RESUMO

Urbanization modifies land surface characteristics with consequent impacts on local energy, water, and carbon dioxide (CO2) fluxes. Despite the disproportionate impact of cities on CO2 emissions, few studies have directly quantified CO2 conditions for different urban land cover patches, in particular for arid and semiarid regions. Here, we present a comparison of eddy covariance measurements of CO2 fluxes (FC) and CO2 concentrations ([CO2]) in four distinct urban patches in Phoenix, Arizona: a xeric landscaping, a parking lot, a mesic landscaping, and a suburban neighborhood. Analyses of diurnal, daily, and seasonal variations of FC and [CO2] were related to vegetation activity, vehicular traffic counts, and precipitation events to quantify differences among sites in relation to their urban land cover characteristics. We found that the mesic landscaping with irrigated turf grass was primarily controlled by plant photosynthetic activity, while the parking lot in close proximity to roads mainly exhibited the signature of vehicular emissions. The other two sites that had mixtures of irrigated vegetation and urban surfaces displayed an intermediate behavior in terms of CO2 fluxes. Precipitation events only impacted FC in urban patches without outdoor water use, indicating that urban irrigation decouples CO2 fluxes from the effects of infrequent storms in an arid climate. These findings suggest that the proportion of irrigated vegetation and urban surfaces fractions within urban patches could be used to scale up CO2 fluxes to a broader city footprint.


Assuntos
Ciclo do Carbono/fisiologia , Dióxido de Carbono/química , Poaceae/fisiologia , Chuva , Solo , Urbanização , Arizona , Dióxido de Carbono/análise , Cidades , Clima Desértico , Humanos , Estações do Ano , Solo/química , Fatores de Tempo , Emissões de Veículos/análise , Ciclo Hidrológico/fisiologia
17.
J Nurs Adm ; 50(2): 85-89, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31977945

RESUMO

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.


Assuntos
Atitude do Pessoal de Saúde , Educação em Enfermagem/organização & administração , Empatia , Recursos Humanos de Enfermagem no Hospital/educação , Recursos Humanos de Enfermagem no Hospital/psicologia , Filosofia em Enfermagem , Adulto , Arizona , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde
19.
Proc Natl Acad Sci U S A ; 117(3): 1596-1605, 2020 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-31907313

RESUMO

Hybrid-poplar tree plantations provide a source for biofuel and biomass, but they also increase forest isoprene emissions. The consequences of increased isoprene emissions include higher rates of tropospheric ozone production, increases in the lifetime of methane, and increases in atmospheric aerosol production, all of which affect the global energy budget and/or lead to the degradation of air quality. Using RNA interference (RNAi) to suppress isoprene emission, we show that this trait, which is thought to be required for the tolerance of abiotic stress, is not required for high rates of photosynthesis and woody biomass production in the agroforest plantation environment, even in areas with high levels of climatic stress. Biomass production over 4 y in plantations in Arizona and Oregon was similar among genetic lines that emitted or did not emit significant amounts of isoprene. Lines that had substantially reduced isoprene emission rates also showed decreases in flavonol pigments, which reduce oxidative damage during extremes of abiotic stress, a pattern that would be expected to amplify metabolic dysfunction in the absence of isoprene production in stress-prone climate regimes. However, compensatory increases in the expression of other proteomic components, especially those associated with the production of protective compounds, such as carotenoids and terpenoids, and the fact that most biomass is produced prior to the hottest and driest part of the growing season explain the observed pattern of high biomass production with low isoprene emission. Our results show that it is possible to reduce the deleterious influences of isoprene on the atmosphere, while sustaining woody biomass production in temperate agroforest plantations.


Assuntos
Atmosfera , Hemiterpenos/biossíntese , Hibridização Genética , Populus/crescimento & desenvolvimento , Populus/metabolismo , Poluição do Ar , Arizona , Biocombustíveis , Biomassa , Butadienos , Dióxido de Carbono/metabolismo , Carotenoides/metabolismo , Clima , Oregon , Fotossíntese , Folhas de Planta/metabolismo , Brotos de Planta/genética , Brotos de Planta/crescimento & desenvolvimento , Plantas Geneticamente Modificadas/metabolismo , Populus/genética , Proteoma , Interferência de RNA , Estações do Ano , Estresse Fisiológico , Terpenos/metabolismo , Termotolerância/fisiologia , Madeira
20.
Comput Inform Nurs ; 38(6): 294-302, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31929354

RESUMO

Preoperative care is a critical, yet complex, time-sensitive process. Optimization of workflow is challenging for many reasons, including a lack of standard workflow analysis methods. We sought to comprehensively characterize electronic health record-mediated preoperative nursing workflow. We employed a structured methodological framework to investigate and explain variations in the workflow. Video recording software captured 10 preoperative cases at Arizona and Florida regional referral centers. We compared the distribution of work for electronic health record tasks and off-screen tasks through quantitative analysis. Suboptimal patterns and reasons for variation were explored through qualitative analysis. Although both settings used the same electronic health record system, electronic health record tasks and off-screen tasks time distribution and patterns were notably different across two sites. Arizona nurses spent a longer time completing preoperative assessment. Electronic health record tasks occupied a higher proportion of time in Arizona, while off-screen tasks occupied a higher proportion in Florida. The contextual analysis helped to identify the variation associated with the documentation workload, preparation of the patient, and regional differences. These findings should seed hypotheses for future optimization efforts and research supporting standardization and harmonization of workflow across settings, post-electronic health record conversion.


Assuntos
Registros Eletrônicos de Saúde , Recursos Humanos de Enfermagem no Hospital , Assistência Perioperatória , Análise e Desempenho de Tarefas , Fluxo de Trabalho , Arizona , Documentação , Florida , Humanos , Gravação em Vídeo
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