Southwest United States Research Articles

Garbanzos de a libra: The Community Cultural Wealth of Male Bilingual Teachers

Latino males are “effectively vanishing” (Saenz & Ponjuan, 2009, p. 54) from the United States higher education pipeline, a phenomenon clearly evident in the K-12 and postsecondary levels; they have become an ultra-minoritized population. Saenz and Ponjuan (2009) expound various theoretical and socio-cultural explanations for this enduring and distressing trend facing Latino males. In particular, the lack of male teachers as young Latino boys traverse their compulsory education is problematic as representation is critical for persistence and mentoring. As the number of Emergent Bilingual students is now 10% of the U.S. student population, the need for increasing bilingual male teachers is more important than ever. Increasing the representation of Latino male bilingual teachers in primary grade levels, can help ameliorate the leaks that Latino boys, particularly Emergent Bilinguals, encounter in the educational pipeline. Utilizing a narrative inquiry approach this study focused on the experiences of six Latino male bilingual elementary education teachers in the Southwest United States.

P-2152. Strongyloides stercoralis Seroprevalence among Solid Organ Transplant Candidates and Recipients in a Multicenter Hospital System in Arizona

Abstract Background Solid organ transplant (SOT) recipients have a higher risk of Strongyloidiasis associated complications. Universal screening for Strongyloides among SOT candidates and recipients is not well defined in the Southwest United States. We assessed our center’s seropositivity rate for pre- and post-SOT using Strongyloides Ab (strAb) test. Methods We conducted a multicenter, IRB-approved retrospective study. Data were collected from January 2019 to March 2024 for patients ≥18 years old before and after SOT. Most of the testing at our center was performed utilizing the Strongyloides ELISA IgG test kit, Gold Standard Diagnostics, Davis, CA, USA. Results There were 387 patients with a median age of 61 (range 24-85), the majority being white non-Hispanics, 221 (57%) and 241 (62%) males. There were 152 pre-SOT tests performed: kidney (61), liver (54), lung (17), and other (20), in contrast to the 292 post-SOT: kidney (153), liver (45), lung (41), heart (31), and others (22). The majority (248/387) of patients reported historical travel, with 154 (62%) to Strongyloides endemic regions. There were 269 pre-SOT serology, mostly (85%) positive for Epstein Barr virus (EBV), followed by cytomegalovirus (CMV) with 70%, 5% hepatitis C. There was one case of a patient with positive HTLV-I/II serology (negative by confirmatory testing). Of the 283 patients, 24% reported being born outside the US. Of the171 reported gastrointestinal symptoms at the time of strAb testing, 94% were post-SOT. There were 20/387 (5.2%) positive strAb, with 5.3% in pre-SOT and 4.1% in post-SOT. There were 3 cases with negative pre-SOT that seroconverted after transplantation. All of the 93 patients who underwent microscopic stool examinations tested negative. 17/20 patients with a positive strAb received treatment with ivermectin. There was one case of Hyperinfection Syndrome. There was no statistical association between demographics and aforementioned risks, and seropositivity. Conclusion The Strongyloides seropositivity rate in our cohort is comparable to other reports. No associated risk factor was identified. Therefore, universal screening may be needed in similar transplant cohorts, as undetected cases can have devastating outcomes. Disclosures Tirdad Zangeneh, DO, AiCuris.: Grant/Research Support

P-1017. Key Fungal Secreted Proteases in Coccidioidomycosis

Abstract Background Coccidioides, a dimorphic fungus endemic to the Southwest United States, causes unacceptably high morbidity/mortality. Coccidioides’ virulence stems from its unique and poorly understood host form, the spherule. Spores are inhaled by the host and develop into spherules, which mature until they fill with hundreds of endospores and then rupture, disseminating endospores throughout the host. This entire process is known as spherulation. As spherules are unique to Coccidioides, most spherule biology remains unknown. Coccidioides genomes encode 2 expanded families of proteases, subtilases and deuterolysins, that we hypothesize are involved in spherulation and are promising treatment targets. Methods We took 3 approaches to characterize proteases in spherule biology. We studied spherulation by microscopy in the presence of AEBSF (serine protease inhibitor) and 1,10-phenanthroline (metalloprotease inhibitor). We profiled the Coccidioides transcriptome during spherulation, in Converse media, at 39˚C, 10% CO2, or during hyphal growth, in Converse media at room temperature. Using multiplex substrate profiling-mass spectrometry on supernatants from protease deletion mutants or wildtype, we characterized the total amount of secreted protease activity and amino acid preferences around sites of proteolysis. Results Treatment of Coccidioides with a protease inhibitor that blocks subtilase activity prevented spherule formation, indicating a role for subtilases in spherulation. Subtilase and deuterolysin expression is induced upon spherule formation in 4 patterns: 1) during early spherule formation, 2) continuous increase over spherulation, 3) 2 peaks of expression in arthroconidia and endospores, or 4) dramatic increase during endospore release. The subtilase Sub1 fits the 4th pattern and is a top 10 most abundant transcript in spherules during endospore release. Sub1 is a major contributor to secreted protease activity in spherules and exhibits a preference for hydrophobic substrates. Phenotypic characterization of this mutant is underway, including virulence studies. Conclusion By linking protease activity to spherulation, we have demonstrated the importance of further dissecting the role of these 2 expanded protease families in Coccidioides virulence. Disclosures All Authors: No reported disclosures

Mapping species of greatest conservation need and solar energy potential in the arid Southwest for future sustainable development

The need for renewable energy has become increasingly evident in response to the climate change crisis, presenting a paradoxical challenge to biodiversity conservation. The Southwest United States is desirable for large-scale solar energy development (SED) due to its high global horizontal irradiance (GHI) values and vast open landscapes. However, this region is also rich in unique ecological and biological diversity. Several distinct species have garnered special attention as human population growth, habitat alteration, and climate change have accelerated in recent decades (i.e., LeConte’s Thrasher (Toxostoma lecontei), Bendire’s Thrasher (Toxostoma bendirei), Sonoran Desert Tortoise (Gopherus morafkai), Mojave Desert Tortoise (Gopherus agassizii), and the Southwestern population of the Burrowing Owl (Athene cunicularia). As the United States prepares to increase its development in renewable energies, particularly solar energy, there has been a growing concern about how this development will further impact these species. In this study, we propose a novel combined approach to find areas of high habitat suitability for endangered species within areas of high SED potential. Specifically, we employed species distribution modeling (SDM) to identify areas with suitable habitats and likely species presence, and we conducted a site suitability analysis for potential SED locations within the Southwest. As a result, we found significant overlap between potential SED locations and the high-priority habitats of all target species, thus underlining the importance of prioritizing conservation efforts as more solar projects are reviewed in these Southwestern states. Our study aims to inform conservationists and developers in making sustainable decisions for the region’s future development.

How Do Model Biases Affect Large-Scale Teleconnections That Control Southwest U.S. Precipitation? Part II: Seasonal Models

Abstract We explore the skill in predicting southwest United States (SWUS) October–March precipitation and associated large-scale teleconnections in an ensemble of hindcasts from seasonal prediction systems. We identify key model biases that degrade the models’ capability to predict SWUS precipitation. The subtropical jet in the Pacific sector is generally too zonal and elongated. This is reflected in the models’ North Pacific ENSO teleconnections that are generally too weak with exaggerated northwest–southeast tilt, compared to observations. Also, the models are too dependent on tropical, El Niño–like, wave train anomalies for producing high seasonal SWUS precipitation, when in observations there is a larger influence of zonal Rossby wave trains such as the one observed in 2016/17. Overall, this is consistent with biases in the basic-flow-inducing errors in the propagation of zonal wave trains in the North Pacific, which affects SWUS precipitation downstream. Although higher skill may be gained from reducing mean flow biases in the models, a case study of the 2016/17 winter illustrates the great challenge behind skillful seasonal prediction of SWUS precipitation. Unsurprisingly, the almost record-breaking precipitation observed that year in the absence of ENSO is not predicted in the hindcasts, and model perturbation experiments suggest that even a perfect prediction of tropical sea surface temperature and tropical atmospheric variability would not have sufficed to produce a reasonable seasonal precipitation prediction. On a more positive note, our perturbation experiments suggest a potential role for Arctic variability that supports findings from prior studies and suggests reexamining high-latitude drivers of SWUS precipitation.

A Rare Case of Squamous Cell Carcinoma following a Cactus Spine Injury

Squamous Cell Carcinoma (SCC) is the second most common type of skin cancer following basal cell carcinoma (BCC). Risk factors for the development of SCC include exposure to ultraviolet light and trauma such as penetrating wounds. In the Southwest United States, cacti are abundant and can cause minor to serious injury if their spines puncture skin. In this case study, we report an interesting case of the development of well-differentiated squamous cell keratoacanthoma 5 years following a saguaro cactus spine puncture wound.

Evaluation of methotrexate Pharmacogenomic variation to predict acute neurotoxicity in children with acute lymphoblastic leukemia.

Methotrexate is an important component of curative therapy in childhood acute lymphoblastic leukemia (ALL), but the role of genetic variation influencing methotrexate clearance and transport in toxicity susceptibility in children with ALL is not well established. Therefore, we evaluated the association between suspected methotrexate pharmacogenomic variants and methotrexate-related neurotoxicity. This study included children (aged 2-20 years) diagnosed with ALL (2005-2019) at six treatment centers in the southwest United States. Clinical information was abstracted from medical records. Suspected neurotoxic events occurring within 21 days of intravenous and/or intrathecal methotrexate delivered between the end of induction and start of maintenance therapy were independently reviewed by at least two pediatric oncologists. Germline DNA was genotyped and 97 methotrexate pharmacogenomic variants of interest with at least grade 3 evidence were identified using the Pharmacogenomics Knowledge Base. Associations between variants and neurotoxicity were assessed by logistic regression. Data were randomly split (80/20) and random forest was constructed to estimate the ability of the variants to correctly classify neurotoxicity. Of the 763 patients included in the study, 8.2% (n = 63) developed methotrexate-associated neurotoxicity. In logistic models, none of the 97 available pharmacogenomic variants reached adjusted statistical significance. However, two variants, rs17222723 (odds ratio [OR] = 2.83 [ref. = T allele], 95% confidence interval [CI]: 1.20-6.15) in ABCC2 and rs1045642 (OR = 0.66 [ref. = minor A allele], 95% CI: 0.44-0.98) in ABCB1, were nominally associated (p-value < 0.05) with neurotoxicity susceptibility. The addition of pharmacogenomic variants did not improve the predictive performance of random forest model (AUC = 0.73) compared to clinical information alone (AUC = 0.74). Overall, our results suggest that associations between neurotoxicity susceptibility and methotrexate pharmacogenomic variants are generally modest and these variants do not significantly improve neurotoxicity risk stratification among children with ALL.

Student Leader Burnout at Christian Universities: The Protective Roles of Achievement and Awareness of God

Many leaders increase their risk of burnout, the strain from exposure to job-related stress, by neglecting to adequately care for themselves, especially as they experience conflict between the roles they perform and a lack of clarity around the limits of their responsibilities. Resident Assistant (RA) positions are often ambiguous and ill-defined, encompassing roles as helping professionals, administrators, and spiritual leaders for their residents at all hours of the day, navigating conflicting demands placed on them by their myriad responsibilities while also being students themselves. The role conflict and ambiguity they are exposed to have increased in recent years as the scope of RA positions continues to expand, heightening role conflict and ambiguity. This study collected surveys of RAs at a Christian university in the southwest United States to determine the effects of one’s sense of personal accomplishment and spirituality on burnout and its facets of emotional exhaustion, a marked lack of emotional and physical energy, and depersonalization, a dehumanizing perception that distances self from others. Findings indicate that high levels of personal accomplishment, when paired with a strong awareness of God, mitigate the risk of burnout by attenuating the relationship between emotional exhaustion and depersonalization. This extends current understandings of protective factors that can inform efforts to prevent burnout and promote well-being in RAs and other spiritual leaders.

Optimizing in vitro spherulation cues in the fungal pathogen Coccidioides.

Coccidioides spp. are part of a group of thermally dimorphic fungal pathogens, which grow as filamentous cells (hyphae) in the soil and transform to a different morphology upon inhalation into the host. The Coccidioides host form, the spherule, is unique and highly undercharacterized due to both technical and biocontainment challenges. Each spherule arises from an environmental spore (arthroconidium), matures, and develops hundreds of internal endospores, which are released from the spherule upon rupture. Each endospore can then go on to form another spherule in a cycle called spherulation. One of the foremost technical challenges has been reliably growing spherules in culture without the formation of contaminating hyphae and consistently inducing endospore release from spherules. Here, we present optimization of in vitro spherule growth and endospore release, by closely controlling starting cell density in the culture, using freshly harvested arthroconidia, and decreasing the concentration of multiple salts in spherulation media. We developed a minimal medium to test spherule growth on various carbon and nitrogen sources. We defined a critical role for the dispersant Tamol in both early spherule formation and prevention of the accumulation of a visible film around spherules. Finally, we examined how the conditions under which arthroconidia are generated influence their transcriptome and subsequent development into spherules, demonstrating that this is an important variable to control when designing spherulation experiments. Together, our data reveal multiple strategies to optimize in vitro spherulation growth, enabling characterization of this virulence-relevant morphology.IMPORTANCECoccidioides spp. are thermally dimorphic fungal pathogens found in the Southwest United States, Mexico, Central America, and South America. Coccidioides can infect both immunocompetent and immunocompromised people and can cause a devastating disseminated infection, including meningitis, with 30% mortality despite all currently available treatments. In this work, we tackle one of the current largest technical barriers to studying the fungus Coccidioides: reliably growing its host form in vitro. Our work is impactful because we have created a set of foundational tools for the burgeoning field of Coccidioides pathogenesis research. We have carefully optimized conditions that allow the development of Coccidioides in vitro into its pathogenic form. This work will open up many lines of investigation into the molecules that underlie Coccidioides pathogenesis.

Development of a novel patient-reported outcome measure for disseminated coccidioidomycosis (valley fever).

Coccidioidomycosis (Valley Fever) is a dimorphic fungal infection endemic to the southwest United States, Mexico, Central and South America, which can lead to chronic debilitating illness and death. This qualitative study was conducted to develop a bespoke patient-reported outcome measure for patients with chronic disseminated coccidioidomycosis to assess health-related quality of life (HRQoL) impacts. Online, first-person narratives of patient experiences of disseminated coccidioidomycosis were used to create a patient-centred conceptual model of symptoms and impacts of the condition. Interviews were conducted with expert clinicians, followed by concept elicitation interviews with patients, to generate key symptom and impact concepts from which an initial patient-reported outcome measure was developed. The draft measure was reviewed with clinicians for clinical relevance and further assessed in cognitive debriefing interviews with patients to refine the measure and establish content validity. A total of 25 patients were interviewed, which identified impacts relating to physical function, activities of daily living, cognitive function, social/role function and emotional function of disseminated coccidioidomycosis. Twenty items were developed simultaneously in English and Spanish to capture the main impacts across these 5 areas. In general, items were clear and well understood by patients, and clinicians found the measure clinically relevant and appropriate for assessing the burden of disseminated coccidioidomycosis on HRQoL. Once fully validated, the Valley Fever-Patient Reported Outcome measure may be used in interventional studies to assess HRQoL outcomes, and in clinical practice to monitor patients' HRQoL.

The Certification Ranking of Stroke Treatment Centers Is Unclear to the General Public.

BACKGROUND: Certified stroke treatment centers are classified based on their available resources to treat stroke including an Acute Stroke Ready Hospital (ASRH), a primary stroke center (PSC), a Thrombectomy-Capable Stroke Center (TCSC), and comprehensive stroke centers (CSCs). These hospitals all provide varying levels of care with CSCs being the most able to treat all types and complexities of stroke. This undergraduate nursing-led study explored the public's preference for treatment at different certified stroke treatment centers. METHODS: This study was a prospective nonrandomized observational survey of English-speaking adults at a plasma donation center in the Southwest United States. Subjects completed a 2-minute survey asking whether they would drive to the hospital or call 911 during a suspected stroke, and at which type of hospital they would prefer to be treated. RESULTS: Of 249 respondents, 204 (81.9%) indicated that they would call 911 for hospital transport, and 45 (18.1%) would drive their family member to a hospital. Most respondents (95/248, 38.3%) would prefer treatment at a PSC, 90 (36.3%) preferred an ASRH, 52 (21.0%) preferred a CSC, and 11 (4.4%) preferred a TCSC. There was no association between transportation preference and hospital preference dichotomized as CSC or PSC versus ASRH or TCSC (χ2 = 0.021, P = .885), nor CSC versus other (χ2 = 0.944, P = .331). CONCLUSION: Most respondents did not select CSC as the preferred treatment site, and 1 in 5 would drive rather than call 911. This indicates a knowledge gap regarding stroke center classification that warrants increased education.

Burn Period: A Use-Inspired Metric to Track Wildfire Risk across Arizona and New Mexico in the Southwest United States

Abstract Numerous tools and indices exist for wildland fire managers to anticipate and track changes in wildfire risk driven by variability in weather and climate conditions at hourly to seasonal scales. However, in working closely with Southwest U.S. managers, we learned of a simple meteorological metric being informally used, but not widely accessible in existing tools or information products, to gauge short-term changes in wildfire risk. This metric, termed “Burn Period” (BP), is the local count of hours per day with relative humidity values equal to or less than 20%. Our collaboration led to the development of an experimental tool called the “Burn Period Tracker” to ease access and promote the use of BP values for planning and response. This study is a climatological analysis of BP values at 124 fire weather stations across Arizona and New Mexico for the period 2000–22 to aid in interpretation and understanding of this use-inspired metric. BP values reflect the strong seasonality in temperature and moisture deficit–driven wildfire risk across the Southwest United States, with risk climbing through the arid spring season, peaking in June, and then falling rapidly with the onset of the summer monsoon in July. Regression analyses show that short-term variability in BP values is driven by variability in low-level atmospheric moisture in all months with strongest relationships during the summer after the onset of the monsoon. This study highlights the utility of BP as a short-term wildfire planning tool as well as an example of collaborative weather and climate services development.

Kinematics of post-wildfire debris flow initiation mechanism: impact of hydrophobic layer spatial variability and particle size

Post-wildfire debris flow events have been more frequent due to climate change and increased wildfire adversity. Changes in noncohesive soil hydrophobicity, burn, and vegetation removal during wildfires dramatically enhance slopes’ vulnerability to rainfall-induced failure in the arid Southwest USA and similar areas worldwide. This paper contributes to a better understanding the hydrophobic sand slope failure mechanism using experiments and theory. In total, 36 indoor raining experiments use different configurations of fine, medium, and coarse hydrophobic sands subjected to various rain intensities on different slope inclinations. Specific findings contribute to understanding how the spatial variability of the post-wildfire hydrophobic layer, concerning depth and the sand grain size variations, affects the slope failure mechanisms. Clarifying slope failure mechanisms in different layouts is crucial for understanding the initiation and further spatiotemporal debris flow evolution. Results indicate that the surficial hydrophobic layer fails because erosion develops simultaneously from many small failure patches. Erosion pattern, time to failure, water, and sediment overflow temporal dynamics correlate to the dominant sand grain size. Furthermore, seepage-induced shallow infinite slope occurs when the hydrophobic sand layer develops below the surface. Finally, this study identifies the fine sand as the most vulnerable to failure in both configurations.

In Continuation of a ‘Unified Immigration Agenda’: The End of Asylum at the United States Southwest Border

ABSTRACT Through a complementary framework of laws, policies, and practices, the Biden administration has built upon the immigration agendas of previous United States (US) administrations, restricting the right to seek asylum for those arriving at the southwest border almost entirely. Principally, it has expanded certain laws and policies implemented by the Trump administration – some of which it has vigorously defended in court – and implemented new laws and policies, specifically a final rule entitled ‘Circumvention of Lawful Pathways’, which limits asylum but for the most exceptional circumstances. As this article demonstrates, these exceptional circumstances have been interpreted and applied by Customs and Border Protection officers in terms even narrower than the final rule permits. The restriction of asylum has been realized through two specific modifications to US immigration law and, by extension, fundamental precepts of international refugee law: the conflation of asylum seekers and migrants as classes of individuals subject to undifferentiated legal processes, and the qualification of asylum based on the mode of arrival, specifically, arrival by land at the southwest border after having travelled through another Central American State – a condition that applies to all land arrivals by non-Mexican nationals. Through an analysis of quantitative data, and a series of qualitative interviews with legal service providers, shelter providers, independent researchers at US ports of entry, and a former senior US Border Patrol agent, the article demonstrates that the implementation of the Biden administration’s immigration agenda and the practice of Customs and Border Protection officers forms part of a ‘unified immigration agenda’ of multiple sequential US administrations, the purpose of which is to restrict access to asylum, create conditions unconducive to spontaneous arrival at the southwest border, and impose extreme hardships on those who seek to enter the US via the southwest border. The Biden administration has continued to pursue this unified immigration agenda by implementing Circumvention of Lawful Pathways, essentially ending the provision of asylum, even for those who are clearly in need of protection.

Postconcussive symptom severity, risk factors for prolonged recovery, and mental health history: Pathways of influence in a diverse pediatric sample

AbstractIntroductionThe objective of this study was to confirm previous risk factors for concussion recovery in a diverse pediatric sample and to elucidate the pathways by which individual mental health factors influence postconcussive symptom reporting and time to clearance.MethodsSubjects between 13 and 17 years of age (N = 642; mean age = 15.40; 45% female) were analyzed from a prospectively completed database associated with a multidisciplinary TBI/concussion clinic in the southwest United States. Fifty‐four percent of participants identified as Hispanic, 41% received medical coverage through Medicaid, and 54% were injured during participation in an organized sports team. Mediation analysis using a structural equational framework was employed to examine the significance of both direct and indirect effects from preinjury factors (e.g., prior concussions, female gender, history of migraines, anxiety, depression, attention‐deficit/hyperactivity disorder [ADHD], and learning disorders) on postinjury symptom reporting (at baseline and visit 1) and time to clearance.ResultsHigher symptom reporting at baseline was significantly associated with history of anxiety, depression, ADHD, headaches, and female gender. Higher symptom reporting at visit 1 was significantly associated with baseline symptoms, female gender, and history of anxiety. Symptom scores at baseline fully accounted for the relation between history of depression and symptom scores at visit 1 and only partially accounted for the relation between history of anxiety and symptom scores at visit 1. Only history of anxiety indirectly contributed to greater days to clearance through higher symptom scores at visit 1.DiscussionThis study supports the concept that heterogenous experience following injury is influenced by preinjury factors and extends the generalizability of risk factors to a diverse sample of youth in terms of ethnicity, insurance status/type, and mechanism of injury. Anxiety and depression represent important noninjury factors that warrant considerable attention during concussion treatment and management.

A reference genome for Trichogramma kaykai: A tiny desert-dwelling parasitoid wasp with competing sex-ratio distorters.

The tiny parasitoid wasp Trichogramma kaykai inhabits the Mojave Desert of the southwest United States. Populations of this tiny insect variably host up to two different sex-distorting genetic elements: (1) the endosymbiotic bacterium Wolbachia which induces the parthenogenetic reproduction of females, and (2) a B-chromosome, "Paternal Sex Ratio" (PSR), which converts would-be female offspring to PSR-transmitting males. We report here the genome of a Wolbachia-infected Trichogramma kaykai isofemale colony KSX58. Using Oxford Nanopore sequencing we produced a final genome assembly of 203 Mbp with 45x coverage, consisting of 213 contigs with an N50 of 1.9 Mbp. The assembly is quite complete, with 91.41% complete BUSCOs recovered: a very high score for Trichogrammatids that have been previously characterized for having high levels of core gene losses. We also report a complete mitochondrial genome for T. kaykai, and an assembly of the associated Wolbachia, strain wTkk. We identified copies of the parthenogenesis-inducing genes pifA and pifB in a remnant prophage region of the wTkk genome. The Trichogramma kaykai assembly is the highest quality genome assembly for the genus to-date and will serve as a great resource for understanding the evolution of sex and selfish genetic elements.

When Is Teasing Abuse? A Grounded Theory of Teasing Among Mexican American Adolescent Dating Couples

This study examined the use of teasing during observed videotaped interactions of Mexican American adolescent dating couples ( N = 34; 15–17 years old) from an urban area of the Southwest United States. During the interaction task, couples discussed two relationship problems for 14 min and nearly all interactions (88.2%) contained teasing. In turn, we developed a grounded theory of teasing that delineated who initiated the teasing (boys/girls), teasing types, levels of severity of teasing incidents, youth’s motivations for teasing, and the resulting consequences of teasing in real time. We found that most teasing incidents were mild to moderately severe and that girls initiated teasing to a greater extent than boys. Regarding motives, youth used teasing to exert power during the interaction and/or to repair a problem in the relationship. Despite various types of teasing, the resulting consequences were hurt feelings, power struggles, and shame. Participants overtly stated that they desired improved communication. We recommend that socioemotional learning and dating violence prevention programs include teasing as part of conflict resolution skill sets and that these programs be informed by the cultural values of Mexican-origin youth.

Integrating learner-centered design and user-centered design for meaningful instructor onboarding: Supporting large-scale curricular changes to general education

Supporting instructors through large-scale curricular changes to cross-disciplinary programs such as general education is a complex challenge. In this case-based narrative, we describe how one large R1 university in the Southwest United States developed and implemented an instructor support program during a large-scale general education program redesign for a program that had not been substantively revised since 1998. This program typically offers about 500 courses each semester and is taught by roughly 650 instructors. To support the phased rollout of the new program curriculum, we designed and implemented a Quick Start program to support instructors revising courses for the new program, serving over 400 instructors during its first year of implementation. We discuss our integration of learner-centered design principles (McCombs &amp;amp; Whisler, 1997; Weimer, 2013) to guide the development of the Quick Start program and user-centered design principles (Greer &amp;amp; Harris, 2018; Tham, 2022) to create accessible, useful, and context-driven learning content for the instructors. While these frameworks have been integrated in the past to develop learning materials for students (Jones, 2018; Shivers-McNair et al., 2018), our case-based descriptive analysis presents a novel application of this integration for faculty development. We describe how we integrated these principles to design, scale, iterate, and implement instructor onboarding to the new curriculum. Specifically, we offer four guiding pillars: (i) creating an aligned learning experience, (ii) building an instructional community, (iii) foregrounding an asset-based approach, and (iv) creating useful and usable materials to operationalize such an integration of learner-centered and user-centered design approaches for faculty development.

Proportional Trends in Pediatric Opioid Prescribing Between 2005 and 2016 by Age Group, Sex, Ethnicity, Race, Language, and Payer Status from a Large Children's Hospital in the Southwest United States.

Prescription opioid use before adulthood is typically effective for acute pain control and is also associated with adverse short- and long-term consequences. This study examined pediatric opioid prescribing trends over time across different age groups (early childhood, school age, adolescence, young adult) and sociodemographic subgroups (sex, ethnicity, race, language, payer type) from 2005 to 2016. Utilizing 42,020 first outpatient opioid prescriptions for youth aged 0-21 years from a large US children's hospital, this research found notable trends and disparities. Prescription rates increased by 35% from 2005-2007 to 2008-2010, then decreased by 14% from 2008-2010 to 2011-2013, and decreased again by 22% from 2011-2013 to 2014-2016. Chi-squared tests indicated significant changes in prescription rates across all sociodemographic subgroups, though only age group, ethnicity, and payer type (i.e., the party responsible for payment for hospital services) had changes with non-negligible effect sizes (Cramer's V). Specifically, age group showed small to medium effects (V = 0.16), while ethnicity and payer demonstrated small effects (V = 0.10 each). This study highlights variations in opioid prescribing trends, particularly among different age groups, ethnicities, and payer statuses up to 2016. These findings reveal differing trends in pediatric opioid prescribing during the peak of the opioid epidemic, highlighting the importance of considering age and sociodemographic variables for understanding prescribing patterns fully and raising potential concerns about inequities in pain management. Future studies should explore similar trends from 2016 onward.

Disseminated histoplasmosis from western Mexico—rethinking our geographic distribution of endemic fungal species: a case report and review of literature

BackgroundHistoplasma is a fungal pathogen found in many parts of the world. In North America, its distribution is traditionally thought to be endemic to the Ohio and Mississippi River valleys. Development of histoplasmosis after Histoplasma exposure is related to degree of inoculum exposure and susceptibility, for example, immunocompromised status. Most exposed, healthy individuals are asymptomatic and few develop pulmonary symptoms. A limited number of infectious etiologies (that is, Histoplasma, Coccidioides, and Mycobacterium tuberculosis) can cause miliary pattern on chest imaging, and thus, histoplasmosis should be considered whenever a patient presents with pulmonary symptoms and these unique radiographic findings.Case presentationA previously healthy 13-year-old Hispanic male presented as a transfer from an outside hospital with fever and hypoxia in the setting of a progressive, subacute gastrointestinal illness. Given hypoxia, the concern for sepsis, and unclear etiology of his illness, broad-spectrum antimicrobial therapy and noninvasive ventilation were started. Initial evaluation demonstrated miliary pulmonary infiltrates, and travel history raised suspicion for coccidioidomycosis or tuberculosis. After a complete evaluation, lab studies confirmed a diagnosis of histoplasmosis, and the patient made a full recovery after the initiation and completion of antifungal therapy.ConclusionHerein, we present a patient who acquired histoplasmosis from an area of Mexico not currently acknowledged as endemic and review recently published data emphasizing new areas of Histoplasma endemicity in North America, particularly the southwest USA and most states of Mexico. Though limited surveillance data exist, mounting case reports/series and local epidemiologic studies illustrate the expanding worldwide endemicity of Histoplasma and underscore histoplasmosis as a growing global health concern.