Mountain West Research Articles

Geospatial Hot Spots and Cold Spots in US Cancer Disparities and Associated Risk Factors, 2004-2008 to 2014-2018.

Despite declining cancer death rates in the US, cancer remains the second deadliest disease and disparities persist. Although research has focused on identifying risk factors for cancer deaths and associated disparities, few studies have examined how these relationships vary over time and space. The primary objective of this study was to identify cancer mortality hot spots and cold spots - areas where cancer death rates decreased less than or more than neighboring areas over time. A secondary objective was to identify risk factors of cancer mortality hot spots and cold spots. We analyzed county-level cancer death rates from 2004 through 2008 and 2014 through 2018, exploring disparities in changes over time for socioeconomic and demographic variables. We used hot spot analysis to identify areas with larger decreases (cold spots) and smaller decreases (hot spots) in cancer death rates and random forest machine learning analysis to assess the relative importance of risk factors associated with hot spots and cold spots. We mapped spatial clustering areas. Geospatial analysis showed hot spots predominantly in the Plains states and Midwest and cold spots in the Southeast, Northeast, 2 Mountain West states (Utah and Idaho), and a portion of Texas. Factors with the strongest influence on hot spots and cold spots were unemployment, preventable hospital stays, mammography screening, and high school education. Geospatial disparities in changes in cancer death rates point out the critical role of access to care, socioeconomic position, and health behaviors in persistent cancer mortality disparities. Study results provide insights for interventions and policies that focus on addressing health care access and social determinants of health.

Understanding Community-Specific Health Behaviors to Prevent Type 2 Diabetes and Depression in Rural Adolescents: A Qualitative Study.

Type 2 diabetes (T2D) and depression co-occur, and rates are on the rise in adolescents, disproportionately affecting teenagers in rural communities and those who identify as members of historically disadvantaged racial/ethnic groups. Addressing the promotion of health behaviors is important for prevention of these comorbid health concerns; however, disparities in their prevalence highlight that a healthy lifestyle is not equally accessible for all individuals. Thus, holistic and multi-level approaches that address structural inequities, leverage cultural and family assets, and are effectively integrated into the community are critically needed. This project is an initial phase of a broader community-academic collaboration that aims to address preventable chronic diseases and mental health in adolescents living in the rural Mountain West by tailoring an evidence-based health behavior and lifestyle intervention for these communities. Interviewers conducted semi-structured interviews with N = 19 individuals (n = 11 adolescents, 11-17years, n = 8 mothers) who lived in neighboring counties in the rural Mountain Western USA and had a family history of T2D. Interview schedules were developed by an interdisciplinary team, with community input, and covered topics such as food and staying active, stress, T2D risk, and community and culture. Using thematic analysis, data were reduced through coding, categorization, and development of themes. Data revealed three major themes: "Families Face Systemic Barriers to Health," "Family Routines Support Health," and "Connection is Crucial to Holistic Health." Findings reveal opportunities for addressing health inequities and developing effective, integrated T2D and depression prevention strategies within this specific community. They also potentially contain insights that may be applicable to others interested in adapting interventions for diverse groups.

Expanded geographic distribution for two Legionella pneumophila sequence types of clinical concern.

Legionella pneumophila serogroup 1 sequence types (ST) 213 and 222, a single-locus variant of ST213, were first detected in the early 1990s in the Midwest United States (U.S.) and the late 1990s in the Northeast U.S. and Canada. Since 1992, these STs have increasingly been implicated in community-acquired sporadic and outbreak-associated Legionnaires' disease (LD) cases. We were interested in understanding the change in LD frequency due to these STs and identifying genetic features that differentiate these STs from one another. For the geographic area examined here (Mountain West to Northeast) and over the study period (1992-2020), ST213/222-associated LD cases identified by the Centers for Disease Control and Prevention increased by 0.15 cases per year, with ST213/222-associated LD cases concentrated in four states: Michigan (26%), New York (18%), Minnesota (16%), and Ohio (10%). Additionally, between 2002 and 2021, ST222 caused at least five LD outbreaks in the U.S.; no known outbreaks due to ST213 occurred in the U.S. during this time. We compared the genomes of 230 ST213/222 isolates and found that the mean of the average nucleotide identity (ANI) within each ST was high (99.92% for ST222 and 99.92% for ST213), with a minimum between ST ANI of 99.50% and a maximum of 99.87%, indicating low genetic diversity within and between these STs. While genomic features were identified (e.g., plasmids and CRISPR-Cas systems), no association explained the increasing geographic distribution and prevalence of ST213 and ST222. Yet, we provide evidence of the expanded geographical distribution of ST213 and ST222 in the U.S.IMPORTANCESince the 1990s, cases of Legionnaires' disease (LD) attributed to a pair of closely related Legionella pneumophila variants, ST213 and ST222, have increased in the U.S. Furthermore, between 2002 and 2021, ST222 caused at least five outbreaks of LD in the U.S., while ST213 has not been linked to any U.S. outbreak. We wanted to understand how the rate of LD cases attributed to these variants has changed over time and compare the genetic features of the two variants. Between 1992 and 2020, we determined an increase of 0.15 LD cases ascribed to ST213/222 per year in the geographic region studied. Our research shows that these STs are spreading within the U.S., yet most of the cases occurred in four states: Michigan, New York, Minnesota, and Ohio. Additionally, we found little genetic diversity within and between these STs nor could specific genetic features explain their geographic spread.

Expert insights on managing harmful algal blooms

Freshwater harmful algal blooms (HABs) are a global environmental, economic, social, and public health hazard. While there is an increasing understanding of the ecological considerations of HABs, there is limited understanding of human dimensions and management needs. We conducted semi-structured key informant interviews with 28 water managers and researchers to better understand how they perceive current management and to identify future management priorities in regard to HABs. For this study, we interviewed 31 key informants from three regions of the United States (New England, Ohio, and the Mountain West). We solicited insights across aspects of HABs management, including prevention, forecasting, monitoring, response, and communication. Nutrient management was the main consideration for the prevention of HAB events. Key informants noted that forecasting has the potential to be a valuable tool in the future but is not yet accurate enough at a local scale for widespread use. Monitoring was found to be implemented in varying ways across and even within the states and regions, with a need for more funding and standardization. HAB event responses vary greatly from chemical and physical treatments that suppress toxins to no-swim advisories, all with a mix of strengths and weaknesses. Finally, an increase in and improvement of communication efforts was identified as critical for reducing public health risks. These findings provide perceptions of current management practices and future plans while including opportunities to improve current freshwater HAB management efforts.

Pre-licensure nursing students' experiences of psychological safety: A longitudinal qualitative study

BackgroundPrevious studies have explored the concept of psychological safety among pre-licensure nursing students; however, the literature is notably sparse on personal descriptions of pre-licensure nursing students' experiences of psychological safety in clinical settings. Individual descriptions of psychological safety will provide added insight and understanding about the elements that shape psychological safety in pre-licensure nursing students. AimThis research aimed to explore pre-licensure nursing students' experiences of psychological safety during clinical rotations and how these experiences change over time. DesignA longitudinal, qualitative, descriptive design was used for this study. SettingsParticipants were recruited from a nursing program in the Mountain West region. ParticipantsFifty-four students from three cohorts were enrolled in the study at the time of this data collection and analysis. MethodsEach participant completed a semi-structured telephone interview after finishing their first academic term involving a clinical rotation. Participants completed additional interviews after each subsequent semester. Individual waves of data were analyzed using thematic analysis, and multiple waves of data were analyzed using a simplified trajectory approach. ResultsFive themes emerged from the data: “Who I Am,” “Where I Am,” “Who I Am With,” “Responding in the Moment,” and “Anticipating the Future.” ConclusionsThe psychological safety of pre-licensure nursing students in clinical settings is fundamental to their learning and future practice within the nursing profession. The development of psychological safety is dynamic and multifaceted. It is interpersonal but also shaped by organizational factors. Any one person can make an outsized difference in a student's experience. Understanding these themes can help clinical preceptors and nursing faculty understand and better fulfill their respective roles in fostering psychological safety in clinical settings. Additional insights are expected as the longitudinal study continues.

Trends in pre-biopsy MRI usage for prostate cancer detection, 2007-2022.

Clinical guidelines favor MRI before prostate biopsy due to proven benefits. However, adoption patterns across the US are unclear. This study used the Merative™ Marketscan® Commercial & Medicare Databases to analyze 872,829 prostate biopsies in 726,663 men from 2007-2022. Pre-biopsy pelvic MRI within 90 days was the primary outcome. Descriptive statistics and generalized estimating equations assessed changes over time, urban-rural differences, and state-level variation. Pre-biopsy MRI utilization increased significantly from 0.5% in 2007 to 35.5% in 2022, with faster adoption in urban areas (36.1% in 2022) versus rural areas (28.3% in 2022). Geographic disparities were notable, with higher utilization in California, New York, and Minnesota, and lower rates in the Southeast and Mountain West. The study reveals a paradigm shift in prostate cancer diagnostics towards MRI-guided approaches, influenced by evolving guidelines and clinical evidence. Disparities in access, particularly in rural areas and specific regions, highlight the need for targeted interventions to ensure equitable access to advanced diagnostic techniques.

Implementation of a rural emergency department-initiated buprenorphine program in the mountain west: a study protocol

BackgroundOpioid related overdose morbidity and mortality continue to significantly impact rural communities. Nationwide, emergency departments (EDs) have seen an increase in opioid use disorder (OUD)-related visits compared to other substance use disorders (SUD). ED-initiated buprenorphine is associated with increased treatment engagement at 30 days. However, few studies assess rural ED-initiated buprenorphine implementation, which has unique implementation barriers. This protocol outlines the rationale and methods of a rural ED-initiated buprenorphine program implementation study.MethodsThis is a two-year longitudinal implementation design with repeated qualitative and quantitative measures of an ED-initiated buprenorphine program in the rural Mountain West. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework outlines intervention assessments. The primary outcome is implementation measured by ED-initiated buprenorphine protocol core components. Reach, adoption, and maintenance are secondary outcomes. External facilitators from an academic institution with addiction medicine and prior program implementation expertise partnered with community hospital internal facilitators to form an implementation team. External facilitators provide ongoing support, recommendations, education, and academic detailing. The implementation team designed and implemented the rural ED-initiated buprenorphine program. The program includes OUD screening, low-threshold buprenorphine initiation, naloxone distribution and administration training, and patient navigator incorporation to provide warm hand off referrals for outpatient OUD management. To address rural based implementation barriers, we organized implementation strategies based on Expert Recommendations for Implementing Change (ERIC). Implementation strategies include ED workflow redesign, local needs assessments, ED staff education, hospital leadership and clinical champion involvement, as well as patient and community resources engagement.DiscussionMost ED-initiated buprenorphine implementation studies have been conducted in urban settings, with few involving rural areas and none have been done in the rural Mountain West. Rural EDs face unique barriers, but tailored implementation strategies with external facilitation support may help address these. This protocol could help identify effective rural ED-initiated buprenorphine implementation strategies to integrate more accessible OUD treatment within rural communities to prevent further morbidity and mortality.Trial RegistrationClinicalTrials.gov National Clinical Trials, NCT06087991. Registered 11 October 2023 – Retrospectively registered, https://clinicaltrials.gov/study/NCT06087991.

"A Different Kind of Hardship": Landscapes of Japanese American Resettlement During World War II

abstract: At the beginning of World War II, the United States illegally imprisoned 120,000 Japanese Americans and placed them in concentration camps for the duration of the war. What is less known about the incarceration is that more than one-quarter of the camp population, or approximately thirty-five thousand individuals, was encouraged to leave the camps and relocate to rural communities, small towns, and cities largely in the Mountain West, Midwest, and East Coast. This article focuses on the living conditions and experiences of Japanese Americans during this wartime resettlement period as they adjusted to life outside the camps and encountered a wide range of housing types, including tent camps, rooming houses, college dormitories, hostels, and, often, crowded and substandard apartments located in urban areas. Many Japanese Americans faced numerous challenges in these new environments, notably a discriminatory real estate industry and limited job opportunities. This discussion of the physical landscapes encountered during the resettlement period helps provide a more complete and richer understanding of the imprisonment of Japanese Americans during the war.

Patterns of parent media use: The influence of parent media use profiles on parental mediation, technoference, and problematic media use

Mothers play an important role in setting the overall media culture within the home. Research suggests that children model parental behavior in many ways, including in media use habits. The current study explores profiles or patterns of maternal media use and associations between these patterns and parenting behaviors surrounding media use and parent and child problematic media use two years later. In our sample of 268 mothers of young children in a large Mountain West city, latent profile analysis was utilized, and four distinct profiles of media users were identified. Results suggest that mothers in a low media use profile set limits around their child's media use and report low levels of both technoference and parent problematic media use. Conversely, mothers in a higher social use profile exhibit high levels of parent and child problematic media use compared to other profiles. We encourage mothers to be mindful users of media, remembering that their media use behaviors can impact the overall media use climate in the home.

Mortality due to falls by county, age group, race, and ethnicity in the USA, 2000–19: a systematic analysis of health disparities

Fall-related mortality has increased rapidly over the past two decades in the USA, but the extent to which mortality varies across racial and ethnic populations, counties, and age groups is not well understood. The aim of this study was to estimate age-standardised mortality rates due to falls by racial and ethnic population, county, and age group over a 20-year period. Redistribution methods for insufficient cause of death codes and validated small-area estimation methods were applied to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual fall-related mortality. Estimates from 2000 to 2019 were stratified by county (n=3110) and five mutually exclusive racial and ethnic populations: American Indian or Alaska Native (AIAN), Asian or Pacific Islander (Asian), Black, Latino or Hispanic (Latino), and White. Estimates were corrected for misreporting of race and ethnicity on death certificates using published misclassification ratios. We masked (ie, did not display) estimates for county and racial and ethnic population combinations with a mean annual population of less than 1000. Age-standardised mortality is presented for all ages combined and for age groups 20-64 years (younger adults) and 65 years and older (older adults). Nationally, in 2019, the overall age-standardised fall-related mortality rate for the total population was 13·4 deaths per 100 000 population (95% uncertainty interval 13·3-13·6), an increase of 65·3% (61·9-68·8) from 8·1 deaths per 100 000 (8·0-8·3) in 2000, with the largest increases observed in older adults. Fall-related mortality at the national level was highest across all years in the AIAN population (in 2019, 15·9 deaths per 100 000 population [95% uncertainty interval 14·0-18·2]) and White population (14·8 deaths per 100 000 [14·6-15·0]), and was about half as high among the Latino (8·7 deaths per 100 000 [8·3-9·0]), Black (8·1 deaths per 100 000 [7·9-8·4]), and Asian (7·5 deaths per 100 000 [7·1-7·9]) populations. The disparities between racial and ethnic populations varied widely by age group, with mortality among younger adults highest for the AIAN population and mortality among older adults highest for the White population. The national-level patterns were observed broadly at the county level, although there was considerable spatial variation across ages and racial and ethnic populations. For younger adults, among almost all counties with unmasked estimates, there was higher mortality in the AIAN population than in all other racial and ethnic populations, while there were pockets of high mortality in the Latino population, particularly in the Mountain West region. For older adults, mortality was particularly high in the White population within clusters of counties across states including Florida, Minnesota, and Wisconsin. Age-standardised mortality due to falls increased over the study period for each racial and ethnic population and almost every county. Wide variation in mortality across geography, age, and race and ethnicity highlights areas and populations that might benefit most from efficacious fall prevention interventions as well as additional prevention research. US National Institutes of Health (Intramural Research Program, National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; Intramural Research Program, National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research).

Revisiting the evolution of downhill thunderstorms over Beijing: a new perspective from a radar wind profiler mesonet

Abstract. Downhill thunderstorms frequently occur in Beijing during the rainy seasons, leading to substantial precipitation. The accurate intensity prediction of these events remains a challenge, partly attributed to insufficient observational studies that unveil the thermodynamic and dynamic structures along the vertical direction. This study provides a comprehensive methodology for identifying both enhanced and dissipated downhill thunderstorms. In addition, a radar wind profiler (RWP) mesonet has been built in Beijing to characterize the pre-storm environment downstream of the thunderstorms at the foothill. This involves deriving vertical distributions of high-resolution horizontal divergence and vertical motion from the horizontal wind profiles measured by the RWP mesonet. A case study of an enhanced downhill thunderstorm on 28 September 2018 is carried out for comparison with a dissipated downhill thunderstorm on 23 June 2018, supporting the notion that a deep convergence layer detected by the RWP mesonet, combined with the enhanced southerly flow, favors the intensification of thunderstorms. Statistical analyses based on radar reflectivity from April to September 2018–2021 have shown that a total of 63 thunderstorm events tend to be enhanced when entering the plain, accounting for about 66 % of the total number of downhill thunderstorm events. A critical region for intensified thunderstorms lies on the downslope side of the mountains west to Beijing. The evolution of a downhill storm is associated with the dynamic conditions over the plain compared to its initial morphology. Strong westerly winds and divergence in the middle of troposphere exert a critical influence on the enhancement of convection, while low-level divergence may lead to dissipation. The findings underscore the significant role of an RWP mesonet in elucidating the evolution of a downhill storm.

County Characteristics and Veteran Suicide in the United States, 2011–2018

IntroductionFew studies have examined county-level hotspots of veteran suicide and associated place-based contributors, limiting development of targeted community-level prevention strategies. The objectives of this national spatial analysis of all veteran suicides were to identify areas of the United States (U.S.) with higher-than-expected veteran suicide rates and determine county-level social and economic characteristics associated with areas of higher risk. MethodsUsing Bayesian hierarchical modeling, county-level standardized mortality ratios for veteran suicide deaths were estimated for time periods 2011-2018, 2011-2014, and 2015-2018. Adjusted relative risk, accounting for community characteristics, for each county was then estimated and associations between community characteristics and veteran suicide risk were examined. Analyses were conducted in 2023-2024. ResultsRisk of veteran suicide is predominantly concentrated in the Mountain West and West. Significant predictors of risk across all time periods were per capita number of firearm retailers (2011-2018 RR=1.065 [95%CI 1.030-1.102]), the proportion of residents who moved in the past year (2011-2018 RR=1.060 [95%CI 1.039-1.081]), the proportion of residents who live alone (2011-2018 RR=1.067 [95%CI 1.046-1.089]), the proportion of residents in rental housing (2011-2018 RR=1.041 [95%CI 1.018-1.065]), and the proportion of married residents (2011-2018 RR=0.915 [95%CI 0.890-0.941]). ConclusionsThis study contributes to a comprehensive public health approach to veteran suicide prevention by identifying where resources are needed most, and which place-based intervention targets have the largest potential for impact. Findings suggest that public health efforts to address suicide among veterans should address community level firearm access and identify ways to alleviate deleterious effects of social fragmentation.

How story problems strengthen arithmetic problem-solving strategy sophistication: Evidence from a learning trajectory teaching experiment in kindergarten

BackgroundThe sophistication of young children's arithmetic problem-solving strategies can be influenced through experience and instructional intervention. One potential pathway is through encountering story problems where the location of the unknown quantity varies. AimsThe goal of the present study is to characterize how arithmetic problem-solving strategy sophistication can evolve through opportunities to solve story problems. SampleWe used microgenetic principles to guide the coding of arithmetic problem-solving behavior (8843 attempts) across three timescales (time within-session, attempt to solve, and between sessions) for nine story problem structures (N = 40, 19 girls). Data come from a teaching experiment conducted in a Mountain West US state in Spring 2018. MethodsWe employed a Bayesian hierarchical ordinal regression with a nine-level response variable. The model contained fixed effects for session, attempt, story problem structure; a smooth time within session effect; and random effects for student, instructor, and equation. ResultsOur analysis indicates which transitions from less to more sophisticated strategies are better supported by additional attempts to solve the same problem vs. additional instructional sessions. Strategy sophistication also varied by the location of the unknown quantity (result unknown, find difference, start unknown), but not operation (join, separate, part-whole). ConclusionsIf confirmed by other studies, including experiments, what teachers offer children in terms of learning opportunities (more attempts within the same problem or more problems across work sessions) should vary based on the transition they are making.

WS09.04 Airway microbial dynamics and inflammation: insights from the Mountain West CF Consortium’s research findings

WS09.04 Airway microbial dynamics and inflammation: insights from the Mountain West CF Consortium’s research findings

Detection of Beet curly top virus in Solanum jamesii, Artemisia tridentata, Helianthus annuus, and Cannabis sativa in Utah.

Historically, beet curly top virus (BCTV; Geminiviridae, Curtovirus) is known for destroying the sugar beet industry in Utah and has been a persistent problem in the state since then (Ball, 1917). Starting in June of 2022, we began identifying plants in San Juan County, Utah with chlorosis and leaf curling. Of note, Solanum jamesii, the Four Corners potato, Artemisia tridentata, big sagebrush, and Helianthus annuus, common sunflower, were found with general chlorosis, severe leaf curling and in the case of the sage brush, completely lacking in smell whereas nearby sage plants without the yellowing were intensely fragrant. In August 2023, Cannabis sativa plants for hemp production were found with severe leaf curling in Juab County, Utah. Samples were collected and stored at -80°C for future work. DNA was extracted using the IBI Genomic Plant DNA kit (IBI Scientific, Dubuque, IA) and subjected to rolling circle amplification using Phi29 polymerase (NEB, Ipswich, MA). The primer set BCTV2 (Strausbaugh et al. 2008) for BCTV detection was then used on a subset of the RCA-positive samples for either one (A. tridentata, H. annus, and S. jamesii) or two (C. sativa) plants displaying classic BCTV symptoms, to amplify a 518 bp region. This amplicon was then sequenced by the Sanger method to a 4x coverage. The resulting sequences (accession nos. OR698900 to OR698904) share 98.94 to 99.80% nucleotide identity to the Worland strain (accession no. KU892789.1) for all samples. To confirm the detection, a triple antibody sandwich ELISA kit from Nano Diagnostics (San Jose, CA) was used on these, and other plants of similar species and symptoms from across the state. Samples that tested positive include 3/3 symptomatic H. annuus plants, 1/1 symptomatic S. jamesii, 3/3 symptomatic A. tridentata. The A. tridentata samples were collected from Juab, San Juan, and Utah Counties. None of three asymptomatic A. tridentata plants tested were ELISA positive. Of the C. sativa plants tested by ELISA, 9/9 of the plants displaying classic BCTV symptoms in that host were positive and 6/6 of the plants without classic BCTV symptoms were ELISA positive. The findings of these novel hosts indicate the need for increased testing and analysis of economically relevant crops and native flora across the state. These findings represent a concern for conservation in the case of S. jamesii and a potential threat to the growing hemp industry in the state due to the severity of BCTV symptoms on these plants. Additionally, the finding of A. tridentata as a host may represent a significant finding for the epidemiology of BCTV in the Mountain West region as A. tridentata is distributed from Mexico to Canada along the Rocky Mountain range and is found in much of the Western US in arid regions. This is the first report, to our knowledge, of S. jamesii and A. tridentata as hosts for BCTV and the first peer reviewed reports for H. annuus and C. sativa as hosts for BCTV in Utah.

A phenomenological understanding of the intersectionality of ageism and racism among older adults: Interpersonal experiences

Summary This qualitative, phenomenological study explored the lived experience of the intersectionality of ageism and racism among older adults, with a focus on interpersonal experiences. Fifteen participants 60+ years of age (M = 67, SD = 7.45) in the U.S. Mountain West identifying as Black, Latino(a), Asian-American/Pacific Islander, or Indigenous engaged in a 1-hour interview. A three-cycle, inductive coding process involved five coders who independently coded interviews and engaged in critical discussion to resolve disagreements. An audit trail, member checking, and peer debriefing enhanced credibility. Findings The results detail four umbrella themes and nine subthemes. The subthemes demonstrate experiences of the intersectionality of ageism with racism reflected through (1) increased disrespect, (2) cultural differences in respect for elders, (3) tokenization, (4) physical appearance, (5) being ignored or discriminated against due to others’ discomfort, (6) intersecting experiences of pity, hate, and violence, (7) unspoken bias (including racial profiling), (8) microaggressions: questioning intelligence/ability, and (9) microaggressions: slurs. Multiple themes highlighted how ageism may be racialized through stereotypes related to mental (in)capability. Applications Social work practitioners and researchers can apply the findings from this study to explore interventions aimed at reducing interpersonal, racialized ageist microaggressions related to mental incapability. At the community level, anti-racism and anti-ageism initiatives should collaborate by applying an enhanced understanding of the ways ageism and racism intersect through pity, hate, and violence particularly in public settings such as shopping centers. The findings from this study can also help shape policies aimed at reducing racial profiling and hate crimes toward older adults of color.

The use of Groasis Waterboxx devices to improve mineland reclamation efforts by increasing transplant survival and growth of five native woody species

The reclamation of disturbed lands worldwide is a difficult and increasing problem. In the Mountain West region of the United States, mining activities commonly occur in zones dominated by native woody plants. The restoration of woody plants in these areas is challenging, and direct seeding efforts result in poor seedling emergence and establishment. Therefore, seedling transplants are often used, but they frequently experience high mortality during the first year, particularly due to summer stresses. We evaluated if the Groasis Waterboxx device could be used to mitigate drought stress on seedling transplants and improve their establishment on a reclaimed waste rock dump. The Waterboxx device collects precipitation into a polypropylene reservoir and slowly dispenses water onto the soil next to the seedling. To test such a hypothesis, 400 seedlings from five native woody plants (Atriplex canescens, Cercocarpus ledifolius, Pinus edulis, Purshia tridentata, and Rhus glabra) were planted with and without a Waterboxx. The Waterboxx device improved soil water potential, at 40 cm, it took 1 month longer to go below −1 MPa under a Waterboxx. Survival increased 30–65% in four of the five species, and seedling vigor increased for three of the five species. Vigor was higher with all plant species at both planting times and was significantly better in 50% of comparisons. Results support the use of the Waterboxx for improving seedling establishment on mineland overburden sites in the semiarid mountain west. The effectiveness of the Waterboxx device provides merit for future testing where drought challenges seedling establishment.

Understanding Reductions of PM2.5 Concentration and Its Chemical Composition in the United States: Implications for Mitigation Strategies.

Motivated by the recent tightening of the US annual standard of fine particulate matter (PM2.5) concentrations from 12 to 9 μg/m3, there is a need to understand the spatial variation and drivers of historical PM2.5 reductions. We evaluate and interpret the variability of PM2.5 reductions across the contiguous US using high-resolution estimates of PM2.5 and its chemical composition over 1998-2019, inferred from satellite observations, air quality modeling, and ground-based measurements. We separated the 3092 counties into four characteristic regions sorted by PM2.5 trends. Region 1 (primarily Central Atlantic states, 25.9% population) exhibits the strongest population-weighted annual PM2.5 reduction (-3.6 ± 0.4%/yr) versus Region 2 (primarily rest of the eastern US, -3.0 ± 0.3%/yr, 39.7% population), Region 3 (primarily western Midwest, -1.9 ± 0.3%/yr, 25.6% population), and Region 4 (primarily the Mountain West, -0.4 ± 0.5%/yr, 8.9% population). Decomposition of these changes by chemical composition elucidates that sulfate exhibits the fastest reductions among all components in 2720 counties (76% of population), mostly over Regions 1-3, with the 1998-2019 mean sulfate mass fraction in PM2.5 decreasing from Region 1 (29.5%) to Region 4 (11.8%). Complete elimination of the remaining sulfate may be insufficient to meet the new standard for many regions in exceedance. Additional measures are needed to reduce other PM2.5 sources and components for further progress.

Isolated Optic Neuritis: Etiology, Characteristics, and Outcomes in a US Mountain West Cohort.

The diagnosis and treatment of autoimmune optic neuritis (ON) has improved with the accessibility and reliability of aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibody testing, yet autoantibody-negative ON remains common. This study describes the demographic, clinical, and outcome data in patients with isolated ON across the pediatric and adult cohort. A retrospective chart review of University of Utah Health patients with the International Classification of Diseases (ICD) code of ICD-9 377.30 (ON unspecified), ICD-9 377.39 (other ON), or ICD-10 H46 (ON) and at least 2 ophthalmologic evaluations were conducted between February 2011 and July 2023. Only isolated cases of ON without other brain or spinal demyelinating lesions were evaluated. Differences in demographic and clinical characteristics between AQP4, MOG, and Other-ON were determined. Of the 98 patients (15 children and 83 adults), 9 (9.2%) were positive for AQP4-IgG and 35 (35.7%) tested positive for MOG-IgG. Fifty-four were classified into Other-ON, of which 7 (13.0%) had recurrence or new demyelinating lesions during a median follow-up of 12.5 months-2 were ultimately diagnosed with recurrent isolated ON (RION), 1 with chronic relapsing inflammatory ON (CRION), 2 with multiple sclerosis, 1 with collapsin response-mediator protein (CRMP)-5-ON, and 1 with seronegative neuromyelitis optica spectrum disorder. Four patients were treated with long-term immunosuppressive therapy. No patients with RION or CRION had preceding infections; they had first recurrences of ON within 2 months. At presentation, AQP4-ON (75%) and MOG-ON (48.8%) had more severe vision loss (visual acuity <20/200) than Other-ON (23.2%, P = 0.01). At the 1-month follow-up, 93.0% of patients with MOG-ON and 89.3% of patients with Other-ON demonstrated a visual acuity ≥20/40, compared with only 50% of patients with AQP4-ON (P < 0.01). By the last follow-up, 37.5% of the AQP4-ON still exhibited visual acuity <20/40, including 25% who experienced severe vision loss (visual acuity <20/200). By contrast, over 95% of patients with MOG-ON and Other-ON maintained a visual acuity of ≥20/40. In our cohort, over a quarter of pediatric cases presented with simultaneous bilateral ON, 40% had a preceding infection, and 44.4% initially presented with a visual acuity <20/200. Two pediatric cases had recurrence, and both were MOG-ON. By their last follow-up, all pediatric cases had achieved a visual acuity of 20/40 or better. In addition, pediatric cases were more likely to exhibit disc edema compared with adult cases (100% vs 64%, P < 0.01). Despite recent advances in identification and availability of testing for AQP4-IgG and MOG-IgG, over half of patients who presented with isolated ON remained with an "idiopathic" diagnostic label. As more than 1 in 10 patients with AQP4-IgG and MOG-IgG negative ON experienced recurrence or develop new demyelinating lesions, clinicians should provide anticipatory guidance and closely monitor for potential long-term outcomes. In addition, it is crucial to re-evaluate the diagnosis in cases of poor recovery, ON recurrence, and the emergence of new neurological symptoms, as ON can often be the initial presentation of other conditions.

A Mixed Method Study to Explore How Maintenance Personnel Can Enhance Wildfire Smoke Resilience at Long-Term Care Facilities in the US Mountain West

Wildfire activity is increasing around the world, concurrent with climate change, and mitigation strategies for protecting vulnerable populations are desperately needed. Because inhaled particles are deleterious to respiratory health, particularly among older adults with co-morbidities, we engaged maintenance personnel working in long term care facilities located in the Western US. Our objective was to identify opportunities to build resilience during wildfire smoke events. We implemented a virtual workshop that addressed wildfire smoke health impacts as well as strategies to assess and maintain indoor air quality. A total of 24 maintenance personnel attended the virtual workshop and 14 participated in a quantitative survey. Workshop attendees found value in the material and there was enthusiasm for educational resources and enhancing indoor air quality. Four months later, four maintenance staff participated in a follow-up interview. Our qualitative assessment revealed the following themes: awareness and prioritization, application of knowledge, barriers, and educational resources. Access to real-time actionable air quality data was a consistent feature across these themes. Maintenance personnel could play a key role in a facility’s ability to prepare for and respond to wildfire smoke events, and this study highlights potential challenges and opportunities to involving them in resilience building strategies.