"He's a little skinny and he's a little wide.": a mixed design investigation of American Indian student perceptions of healthy bodies.

BACKGROUND: Childhood is a critical developmental time of wellness patterns, yet little is known about what children know and believe. Even less is known about non-majority cultures like American Indian youth. The purpose of this study was to explore American Indian students' understandings of nutrition and physical activity. METHODS: This mixed methods study took place in 10 schools in an American Indian community in the Southwestern U.S. Ninety American Indian students in grades 3-12 (8-19 years old) were interviewed. The interview included an 8-point body size chart. Numerical data were analyzed via t-test statistics while a constant comparison process and analysis was used for the interview data. RESULTS: Students rated approximately 85% of students in Category 5 or smaller on the scale while placing 60% of adults at or above that size. There was a general trend of a larger body type for boys seen as healthy compared to that for girls. Students generally believed that their classmates were larger than the healthy body size. For students, a healthy body was the result of compliance with "eat right and exercise" rules. They exhibited little understanding of nutrition or physical activity and there were few developmental differences in understanding. Health was a corporeal concept and violators of the eat right and exercise rules were seen as lazy. CONCLUSIONS: Students held narrow and corporeal focused notions of health focused on simple rules. People who violated the rules were "lazy", a concept that seemed to underlie multiple constructs and a finding that holds true in other investigations. Students also reported few adult role models, a topic that should be explored with expanded family groups to better represent the multi-generational (e.g. grandparents, uncles, aunts) family housing common in the community. The findings are limited to a single American Indian community and a mixed design of relatively small numbers. This addition to the literature from a non-majority cultural group expands our knowledge of student perspectives on health. These findings can be used to create more effective curricula and interventions. Schools need more effective, but also alternately framed approaches that promote broader views of health.

A qualitative thematic analysis of mentorship for new psychiatric-mental health nurse practitioners.

BACKGROUND: A volume of literature reflects that mentorship is key in producing quality nurse practitioners. Mentoring leads to increased confidence, role clarity, and other benefits improving practice. However, there is little to no research focusing specifically on the impact of mentoring in psychiatric nurse mental health nurse practitioners (PMHNPs). PURPOSE: To explore process of acquiring mentorship and mentoring experiences of newly graduated PMHNPs, all of whom obtained their respective degrees partially or completely online. The study also seeks to describe perceptions of mentoring in PMHNP leaders. METHODS: Nine new graduate PMHNPs and 10 PMHNP leaders were recruited from membership rosters of professional organizations in the Southwestern United States. Informants participated in semi-structured interviews with questions sourced from an interview guide. Interviews were conducted via videoconference or telephone from informants' homes. Data were coded via an in vivo approach and analyzed by thematic methods. RESULTS: New graduates reported that mentoring was dependent on four themes: connectivity, educational stewardship, practice confidence, and luck. Mentor access via work, institutions, or schools was inconsistent. Leaders were concerned about limited educational and professional investment in mentorship because this process is an important component of professional development. CONCLUSION: Mentorship for new graduates is based on a variety of factors, some of which are out of their control. Lack of mentoring may affect practice, which affects patient care. Dialogue between educators, professionals, and organizations may improve mentoring stewardship. IMPLICATIONS: Enhanced communication between educational institutions and professional organizations to create a more fluid process from graduate to mentorship is needed.

Predictions of household water affordability under conditions of climate change, demographic growth, and fresh groundwater depletion in a southwest US city indicate increasing burdens on the poor.

Reduced river flows and groundwater depletion as a result of climate change and population growth have increased the effort and difficulty accessing and processing water. In turn, residential water costs from municipal utilities are predicted to rise to unaffordable rates for poor residential water customers. Building on a regional conjunctive use model with future climate scenarios and 50-year future water supply plans, our study communicates the effects of climate change on poor people in El Paso, Texas, as water becomes more difficult and expensive to obtain in future years. Four scenarios for future water supply and future water costs were delineated based on expected impacts of climate change and groundwater depletion. Residential water use was calculated by census tract in El Paso, using basic needs indoor water use and evaporative cooling use as determinants of household water consumption. Based on household size and income data from the US Census, fraction of household income spent on water was determined. Results reveal that in the future, basic water supply will be a significant burden for 40% of all households in El Paso. Impacts are geographically concentrated in poor census tracts. Our study revealed that negative impacts from water resource depletion and increasing populations in El Paso will lead to costly and difficult water for El Paso water users. We provide an example of how to connect future resource scenarios, including those affected by climate change, to challenges of affordability for vulnerable consumers.

Predicting the northward expansion of tropical lineage Rhipicephalus sanguineus sensu lato ticks in the United States and its implications for medical and veterinary health.

The tropical lineage within the Rhipicephalus sanguineus species complex is cause for growing concern in the U.S. based on its prominent role in creating and perpetuating multiple recently identified outbreaks of Rocky Mountain spotted fever in the southwestern United States and northern Mexico. This lineage is undergoing a northward range expansion in the United States, necessitating the need for enhanced surveillance for Rh. sanguineus. To inform more focused surveillance efforts we use species distribution models (SDMs) to predict current (2015-2019) and future (2021-2040) habitat for the tropical lineage. Models using the MaxEnt algorithm were informed using geolocations of ticks genetically confirmed to be of the tropical lineage, for which data on 23 climatic and ecological variables were extracted. Models predicted that suitability was optimal where temperatures are relatively warm and stable, and there is minimal precipitation. This translated into habitat being predicted along much of the coast of southern states including California, Texas, Louisiana, and Florida. Although the endophilic nature of tropical Rh. sanguineus somewhat violates the assumptions of SDMs, our models correctly predicted known locations of this tick and provide a starting point for increased surveillance efforts. Furthermore, we highlight the importance of using molecular methods to distinguish between ticks in the Rh. sanguineus species complex.

Evidence of likely autochthonous Chagas disease in the southwestern United States: A case series of Trypanosoma cruzi seropositive blood donors.

BACKGROUND: Chagas disease is a parasitic infection that can insidiously cause non-ischemic cardiomyopathy. Given the largely silent nature of this progressive disease, asymptomatic blood donors pose potential blood transfusion risk. Blood donation screening has become an unintentional form of Chagas disease surveillance, with thousands of new cases identified since national surveillance was initiated in 2007. STUDY DESIGN AND METHODS: We recruited T. cruzi-positive blood donors identified from California and Arizona blood centers for confirmatory blood screening and assessment of lifetime infection risk. RESULTS: Among eight suspected cases, we identified four confirmed US autochthonous infections. The current manuscript details the transmission sources, healthcare-seeking behaviors post-blood donation resulting, and clinical course of disease among persons without any history of travel to endemic Latin American countries. DISCUSSION: This manuscript presents four additional US-acquired Chagas disease cases and identifies an opportunity for blood centers to assist in confronting barriers surrounding Chagas disease in the US.

Climatic backdrop for Pueblo cultural development in the southwestern United States.

While climatic triggers for collapse and population migrations of ancestral Pueblo communities have been proposed, little is known about the overall climatic backdrop for the entire pre-Hispanic Pueblo period (ca. 1300 to 460 B2K). Here, we report data from stalagmite HC-1, from Hidden Cave, Guadalupe Mountains, New Mexico, covering the past 3400 years, showing an interval of increased frequency of droughts from 1260 to 370 yr B2K that is coeval with the entire pre-Hispanic Pueblo period. Our record suggests that this puebloan Late Holocene climatic interval was the most arid and highly variable climatic period of the last 3400 years. Climatic conditions favoring the introduction of cultivation existed prior to the Pueblo period during more pluvial-like conditions from at least 3400 to 1260 yr B2K. Hence, the change from the Desert Archaic/Basketmaker to Pueblo cultures was associated with a quick transition to increasing aridity into and through the Pueblo period associated with greater urbanization and the establishment of pueblo population centers.

Severe skin and soft tissue pythiosis acquired in a hot spring in the southwestern United States, a case report and review of North American cases.

BACKGROUND: Human pythiosis, caused primarily by the aquatic oomycete, Pythium insidiosum, is an emerging but uncommon infection in North America. The infection is frequently life-threatening and is often initially unrecognized due to its rarity and similar presentation to certain fungal infections. METHODS: We report a case of skin and soft tissue pythiosis in a patient without significant underlying comorbidities acquired in a New Mexico hot spring and review its successful treatment. We also review all reported pythiosis cases in North America. RESULTS: Eleven confirmed cases of human pythiosis acquired in North America were identified. The majority of cases occurred in children (64%), ten of eleven cases were acquired in the southern U.S., Mexico, Central America or the Caribbean and four of the eleven individuals succumbed to the infection. CONCLUSIONS: With recognition and aggressive surgical and medical treatment good clinical outcomes can be achieved when treating human pythiosis.

Genetic Variation in Rhipicephalus sanguineus s.l. Ticks across Arizona.

Rhipicephalus sanguineus s.l. (Latreille, 1806), the brown dog tick, is the most widely distributed tick species in the world. The two dominant lineages, a temperate group and a tropical group, are recognized as important disease vectors for both dogs and humans. The temperate and tropical lineages overlap in range in some regions of the world, including the southwestern United States, where recent outbreaks of Rocky Mountain spotted fever are linked to R. sanguineus s.l. While it is unclear to what extent they may differ in their capacity to transmit pathogens, finer-scale resolution of temperate and tropical lineage distribution may provide insight into the ecology of these two tick groups and the epidemiology of R. sanguineus s.l.-vectored diseases. Using diagnostic polymerase chain reaction assays, we examined the geospatial trends in R. sanguineus s.l. lineages throughout Arizona. We found the temperate and tropical lineages were well delineated, with some overlap in the eastern part of the state. In one county, tropical and temperate ticks were collected on the same dog host, demonstrating that the two lineages are living in sympatry in some instances and may co-feed on the same host.

Patterns of organic matter accumulation in dryland river corridors of the southwestern United States.

We use Google Earth imagery, drone imagery, and ground-based field measurements to assess the abundance, spatial distribution, and size of accumulations of organic matter in perennial, intermittent, and ephemeral channels in drylands of the southwestern United States. We refer to these accumulations as organic matter jams (OMJs). We examine correlations between OMJ characteristics and indicators of spatial heterogeneity within river corridors. We hypothesize that OMJs occur primarily in association with obstacles such as living woody vegetation and that spatially heterogeneous river corridors have greater numbers of OMJs per surface area of river corridor. Using data from 19 river reaches across four areas in Arizona and Utah, we find that OMJs are preferentially associated with bars in the active channel and with living woody vegetation in the channel and floodplain. We also find that whether greater spatial heterogeneity corresponds to greater spatial density of OMJs can be influenced by downstream distance from major sources of large wood and organic matter and whether the river corridor is supply- or transport-limited with respect to organic matter. Consequently, the strongest influence on OMJ location and abundance can vary between individual reaches of a river corridor and between watersheds. The abundance and size of OMJs in river corridors of sparsely vegetated drylands fall within the ranges of values published for perennial river corridors in wetter climates. We suggest that management of dryland river corridors explicitly include protecting and restoring organic matter accumulations in these environments.

Phylogenetic diversity of two common Trypanosoma cruzi lineages in the Southwestern United States.

Trypanosoma cruzi is the causative agent of Chagas disease, a devastating parasitic disease endemic to Central and South America, Mexico, and the USA. We characterized the genetic diversity of Trypanosoma cruzi circulating in five triatomine species (Triatoma gerstaeckeri, T. lecticularia, T.indictiva, T. sanguisuga and T. recurva) collected in Texas and Southern Arizona using multilocus sequence typing (MLST) with four single-copy loci (cytochrome oxidase subunit II- NADH dehydrogensase subunit 1 region (COII-ND1), mismatch-repair class 2 (MSH2), dihydrofolate reductase-thymidylate synthase (DHFR-TS) and a nuclear gene with ID TcCLB.506529.310). All T. cruzi variants fall in two main genetic lineages: 75% of the samples corresponded to T. cruzi Discrete Typing Unit (DTU) I (TcI), and 25% to a North American specific lineage previously labelled TcIV-USA. Phylogenetic and sequence divergence analyses of our new data plus all previously published sequence data from those four loci collected in the USA, show that TcIV-USA is significantly different from any other previously defined T. cruzi DTUs. The significant level of genetic divergence between TcIV-USA and other T. cruzi DTUs should lead to an increased focus on understanding the epidemiological importance of this DTU, as well as its geographical range and pathogenicity in humans and domestic animals. Our findings further corroborate the fact that there is a high genetic diversity of the parasite in North America and emphasize the need for appropriate surveillance and vector control programs for Chagas disease in southern USA and Mexico.

"They stand in the middle now": Pathways to meeting psychological needs by adolescents who are refugees from sub-Saharan Africa.

OBJECTIVES: This study explored the psychological needs of refugee youth from sub-Saharan Africa resettled in a large city in Southwest United States. We utilized the framework of Basic Psychological Needs Theory (Deci & Ryan, 2000) which proposes that competence, relatedness, and autonomy are universal psychological needs. We examined the challenges to meeting these needs and resolutions to these challenges. Integral to understanding these needs was to place them in the context of a bicultural model of adaptation. Of particular interest was discovering how these young people negotiate and reconcile home and host cultural demands while meeting needs. METHOD: From July 2019 to August 2020, semistructured individual interviews (N = 44) were completed with youth, parents, and cultural experts. Data were analyzed using a hybrid inductive and deductive approach and thematic content analysis. RESULTS: Active engagement, assertion, and self-advocacy were delineated as important pathways to achieve competence. Relatedness needs were served by inclusive ties, and frequently included other "outsiders." Autonomy came from self-sufficiency, agency, and "voice." Altruism was common, extending beyond ethnic community, and promoted competence, relatedness, and empowerment. Conflicts between family and host culture were managed by accepting parental authority. Parents contributed to integrating home and host cultures by flexibly interpreting traditional rules. CONCLUSIONS: Our findings illustrate the strengths of these youth who manage tremendous challenges to meeting their psychological needs. We highlight how in the process of cultural adaptation they retain ties to their home culture. They choose diversity in their relationships and find agency and purpose by supporting others. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Wilderness areas in a changing landscape: changes in land use, land cover, and climate.

Wilderness areas are not immune to changes in land use, land cover, and/or climate. Future changes will intensify the balancing act of maintaining ecological conditions and untrammeled character within wilderness areas. We assessed the quantitative and spatial changes in land use, land cover, and climate predicted to occur in and around wilderness areas by (1) quantifying projected changes in land use and land cover around wilderness areas; (2) evaluating if public lands surrounding wilderness areas can buffer future land-use change; (3) quantifying future climate conditions in and around wilderness areas; and (4) identifying wilderness areas expected to experience the most change in land use, land cover, and climate. We used projections of land use (four variables), land cover (five variables), and climate (nine variables) to assess changes for 707 wilderness areas in the contiguous United States by mid-21st century under two scenarios (medium-low and high). We ranked all wilderness areas relative to each other by summing and ranking decile values for each land use, land cover, and climate variable and calculating a multivariate metric of future change. All wilderness areas were projected to experience some level of change by mid-century. The greatest land-use changes were associated with increases in agriculture, clear cutting, and developed land, while the greatest land cover changes were observed for grassland, forest, and shrubland. In 51.6% and 73.8% of wilderness areas, core area of natural vegetation surrounding wilderness was projected to decrease for the medium-low and high scenarios, respectfully. Presence of public land did not mitigate the influence of land-use change around wilderness areas. Geographically, projected changes occurred throughout the contiguous U.S., with areas in the northeast and upper Midwest projected to have the greatest land-use and climate change and the southwestern U.S. projected to undergo the greatest land cover and climate change. Our results provide insights into potential future threats to wilderness areas and the challenges associated with wilderness stewardship and climate adaptation. Despite the high degree of protection and remoteness of wilderness areas, effective management and preservation of these lands must consider future changes in land use, land cover, and climate.

A latent profile analysis of psychological sense of community and ethnic identity among racial-ethnic minority young adults from the southwestern United States.

Among young adults fof color, both sense of community and ethnic identity, as developmental processes, have been associated with wellness, empowerment, and civic action. Additional research is needed that provides empirical support for the connection between psychological sense of community and ethnic identity on outcomes that relate to human development such as intrapersonal psychological empowerment, civic engagement, and depression symptoms. The current study of young adults of color (N = 243; 70% Hispanic/Chicano(a)/Spanish and 10% American Indian/Native American; 70% female) investigates heterogeneity according to dimensions of psychological sense of community and the ethnic identity construct. Latent profile analyses (LPA) were conducted. Using LPA, five profile groups emerged. Profile group differences were present on reported levels of intrapersonal psychological empowerment, civic engagement, and depression symptoms. Majority of sample participants were classified with moderate to high psychological sense of community and ethnic identity. Findings provide insights for efforts on developing community belongingness based on ethnic group identity and engaging young adults in civic life.

Microbiome stability and structure is governed by host phylogeny over diet and geography in woodrats (Neotoma spp.).

The microbiome is critical for host survival and fitness, but gaps remain in our understanding of how this symbiotic community is structured. Despite evidence that related hosts often harbor similar bacterial communities, it is unclear whether this pattern is due to genetic similarities between hosts or to common ecological selection pressures. Here, using herbivorous rodents in the genus Neotoma, we quantify how geography, diet, and host genetics, alongside neutral processes, influence microbiome structure and stability under natural and captive conditions. Using bacterial and plant metabarcoding, we first characterized dietary and microbiome compositions for animals from 25 populations, representing seven species from 19 sites across the southwestern United States. We then brought wild animals into captivity, reducing the influence of environmental variation. In nature, geography, diet, and phylogeny collectively explained ∼50% of observed microbiome variation. Diet and microbiome diversity were correlated, with different toxin-enriched diets selecting for distinct microbial symbionts. Although diet and geography influenced natural microbiome structure, the effects of host phylogeny were stronger for both wild and captive animals. In captivity, gut microbiomes were altered; however, responses were species specific, indicating again that host genetic background is the most significant predictor of microbiome composition and stability. In captivity, diet effects declined and the effects of host genetic similarity increased. By bridging a critical divide between studies in wild and captive animals, this work underscores the extent to which genetics shape microbiome structure and stability in closely related hosts.

Quantifying contributions of natural variability and anthropogenic forcings on increased fire weather risk over the western United States.

Previous studies have identified a recent increase in wildfire activity in the western United States (WUS). However, the extent to which this trend is due to weather pattern changes dominated by natural variability versus anthropogenic warming has been unclear. Using an ensemble constructed flow analogue approach, we have employed observations to estimate vapor pressure deficit (VPD), the leading meteorological variable that controls wildfires, associated with different atmospheric circulation patterns. Our results show that for the period 1979 to 2020, variation in the atmospheric circulation explains, on average, only 32% of the observed VPD trend of 0.48 ± 0.25 hPa/decade (95% CI) over the WUS during the warm season (May to September). The remaining 68% of the upward VPD trend is likely due to anthropogenic warming. The ensemble simulations of climate models participating in the sixth phase of the Coupled Model Intercomparison Project suggest that anthropogenic forcing explains an even larger fraction of the observed VPD trend (88%) for the same period and region. These models and observational estimates likely provide a lower and an upper bound on the true impact of anthropogenic warming on the VPD trend over the WUS. During August 2020, when the August Complex "Gigafire" occurred in the WUS, anthropogenic warming likely explains 50% of the unprecedented high VPD anomalies.

Improving water scarcity footprint capabilities in arid regions through expansion of characterization factor methods.

Water scarcity footprint (WSF) is a recent addition to life cycle assessment methodology that has advanced the understanding of freshwater environmental impact. The Available Water Remaining (AWARE) method is one approach that has gained significant traction in WSF applications. While an effective method for determining WSF, the methodology has limitations that constrain capabilities for determining freshwater environmental impact in arid regions. The primary limitation is the inability to compare regions when more water demand exists than what is available which typically occurs in arid regions. This limitation reduces resolution and therefore decision-making capabilities. This work proposes a novel method for determining WSF in arid regions by capturing and quantifying scarcity when water demand is greater than availability. The approach presented here, called the demand to availability (DTA) method, is intended to be used for small-scale, or subregion analyses in areas where truncation occurs using standard AWARE methods. With the regional specificity, unique characterization factors can be developed to enhance deterministic resolution and ultimately improve decision-making abilities. The DTA methods are presented universally, allowing for application and implementation to any region. A case study was developed to demonstrate the effectiveness of the DTA method by analyzing characterization factors (CFs) and alfalfa WSFs in the arid Southwestern United States. Using the standard AWARE methods, this region originally truncated 38% of counties resulting in zero resolution or decision-making abilities. Results of the case study that used the proposed DTA method show an improved resolution in 100% of these counties, both within CF and alfalfa WSF. Although the proposed method is an improvement for understanding WSFs in arid regions, limitations and constraints still exist and are discussed.

A PRÉCIS AND CHECKLIST OF HELMINTH PARASITES FOR 14 SPECIES OF WATERFOWL FROM THE CHIHUAHUA DESERT IN THE UNITED STATES AND MEXICO.

A précis of helminth parasite infections and a host-parasite checklist are presented for the following 14 species of waterfowl from the Chihuahua Desert in the United States and Mexico: Chen rossii, Chen caerulescens, Anas platyrhynchos, Anas diazi, Anas acuta, Anas strepera, Anas americana, Anas clypeata, Anas cyanoptera, Anas crecca, Bucephala albeola, Oxyura jamaicensis, Fulica americana, and Podiceps nigricollis. There was a total of 127 species of helminths recovered from the 14 species of waterfowl. Total abundance, which included data available for 12 species of waterfowl, was 134,202 (mean = 11,184, median = 1,376, and 95% confidence limit [CL] = 14,485). Mean species richness ranged from 1.5 in Ross's goose, C. rossii, to 4.3 in the bufflehead, B. albeola. Host mean abundance ranged from 7.5 in the Mexican duck, A. diazi, and green-winged teal, A. crecca, to a high of 811 for the ruddy duck, O. jamaicensis. Ninety-one percent of the helminth species were generalists. Most specialists were associated with the American coot, F. americana (7), and the eared grebe, P. nigricollis (5). Percent helminth species contribution was cestodes 45%, nematodes 25%, trematodes 22%, and acanthocephalans 8%. The most commonly occurring helminth species among the 14 host species were the trematode Notocotylus attenuatus (12), the cestode Cloacotaenia megalops (10), the acanthocephalan Corynosoma constrictum (9), and the nematode Capillaria anatis (6). Low ingestion of invertebrates may have contributed to the lower number of helminth species and abundance in wintering and spring dabbling ducks (Anatini). Wild dabbling ducks ranging in age from 6 mo to 8 yr and 8 mo were infected with helminth parasites. Helminth parasite data from resident and nesting hosts and pre-fledged young birds indicated as many as 43 helminth life cycles may be occurring in the Chihuahua Desert. Host-parasite species checklists are included.

"A Solidarity-Type World": Need-Based Helping among Ranchers in the Southwestern United States.

To better understand risk management and mutual aid among American ranchers, we interviewed and mailed a survey to ranchers in Hidalgo County, New Mexico, and Cochise County, Arizona, focusing on two questions: (1) When do ranchers expect repayment for the help they provide others? (2) What determines ranchers' degrees of involvement in networks of mutual aid, which they refer to as "neighboring"? When needs arise due to unpredictable events, such as injuries, most ranchers reported not expecting to be paid back for the help they provide. When help is provided for something that follows a known schedule or that can be scheduled, such as branding, most ranchers did expect something in return for the help they provide. This pattern makes sense in light of computational modeling that shows that transfers to those in need without expectations of repayment pool risk more effectively than transfers that create debt. Ranchers reported helping other ranchers more often when they belonged to more religious and civic organizations, when they owned larger ranches, when they relied less on ranch vs. other income, and when they had more relatives in the area. Operators of midsize ranches reported helping other ranchers more frequently than did those on smaller and larger ranches. None of our independent variables predicted how many times ranchers reported receiving help from other ranchers. Although ranch culture in the American West is often characterized by an ethic of individualism and independence, our study suggests that this ethic stands alongside an ethic of mutual aid during times of need.

Understanding measures of racial discrimination and microaggressions among American Indian and Alaska Native college students in the Southwest United States.

BACKGROUND: Racial discrimination, including microaggressions, contributes to health inequities, yet research on discrimination and microaggressions has focused on single measures without adequate psychometric evaluation. To address this gap, we examined the psychometric performance of three discrimination/microaggression measures among American Indian and Alaska Native (AI/AN) college students in a large Southwestern city. METHODS: Students (N = 347; 65% female; ages 18-65) completed the revised-Everyday Discrimination Scale, Microaggressions Distress Scale, and Experiences of Discrimination measure. The psychometric performance of these measures was evaluated using item response theory and confirmatory factor analyses. Associations of these measures with age, gender, household income, substance use, and self-rated physical health were examined. RESULTS: Discrimination and microaggression items varied from infrequently to almost universally endorsed and each measure was unidimensional and moderately correlated with the other two measures. Most items contributed information about the overall severity of discrimination and collectively provided information across a continuum from everyday microaggressions to physical assault. Greater exposure to discrimination on each measure had small but significant associations with more substance use, lower income, and poorer self-rated physical health. The Experiences of Discrimination measure included more severe forms of discrimination, while the revised-Everyday Discrimination Scale and the Microaggressions Distress Scale represented a wider range of severity. CONCLUSIONS: In clinical practice, these measures can index varying levels of discrimination for AI/ANs, particularly for those in higher educational settings. This study also informs the measurement of racial discrimination and microaggressions more broadly.

Pediatric Snakebites: Comparing Patients in Two Geographic Locations in the United States.

BACKGROUND: Management of children with snakebites may vary based on subjective criteria, geographic, and climatic factors. We reviewed the incidence and management of snakebite injuries in children at two tertiary referral centers in separate geographic and climatic location to assess differences in management and outcomes of these patients. METHODS: After institutional review board approval, a retrospective chart review was performed for patients ≤18 years with snakebite injuries at emergency departments (ED) of two American College of Surgeons verified trauma centers (2006-2013). One center is in southeast US and experiences a sub-tropical climate whereas the other is in southwest US and experiences a semi-arid climate. Demographic and clinical parameters were extracted. RESULTS: A total of 108 patients (59% male), median age of 9 y (1 y-17 y), were included. Snake type was identified by bystanders in 55.5% cases; copperhead was the most common (37%) subtype. Approximately 30% of patients received antivenom. One quarter of all patients were discharged from the ED. Two patients received surgical intervention in the first 48 hours after presentation. Compared to patients who sustained a snakebite in semi-tropical regions, patients in semi-arid areas had shorter bite-to-ED time, presented directly to the referral center, were more frequently bitten by a rattlesnake, had longer lengths of hospital stay, required antivenom more frequently and at higher doses, and were more frequently admitted to the ICU. No differences were seen in gender, age at presentation, severity of wound, location of bite, abnormalities in coagulation profile or rate of admission to hospital amongst the two sites. CONCLUSIONS: Patients sustaining snakebites in semi-arid climates were more commonly exposed to dangerous snake types, resulting in higher antivenom requirement, as well as longer hospital stays and need for intensive monitoring. Although no fatalities were reported in our study, our data supports early transfer of snakebite victims to higher levels of care, especially in semi-arid or high-risk areas.