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Field of bones : a Brady novel of suspense
This time Sheriff Joanna Brady may expect to see her maternity leave through to completion, but the world has other plans when a serial homicide case surfaces in her beloved Cochise County. Rather than staying home with her newborn and losing herself in the cold cases to be found in her father's long unread diaries, Joanna instead finds herself overseeing a complex investigation involving multiple jurisdictions.
Book
Effect of Self-Measuring Blood Pressure Program on Hypertension Control: Analysis by Diabetes Status, Age, Gender, and Race in Rural Arizona
Background: Rural areas face numerous health challenges, including workforce shortages, limited training opportunities, and delayed care. These disparities can be mitigated by self-management interventions for diseases such as hypertension. This study assessed the implementation of a Self-Measuring Blood Pressure (SMBP) program in rural Arizona, documenting its barriers and patient experiences. Methods: In this before-after study, participants were loaned a digital device which they used to self-measure and record blood pressure (BP) over 1 week or more for hypertension diagnosis or 4 weeks or more for monitoring. Blood pressure (BP) control was assessed per the guidelines of the American Heart Association and American Diabetes Association. BP changes between baseline and post-program were assessed using paired-Student t tests. Effect modification by diabetes was analyzed using stratification. Results: Among 740 participants, significant associations were found with gender, age, and controlled BP among non-diabetic patients. Post-intervention, 63.4% of diabetic patients showed controlled BP, and 25.7% of non-diabetic patients had controlled BP, with higher control rates among females and older age groups (60–79 years). Baseline mean SBP was 148.3 ± 19.6 mmHg, improving to 133.9 ± 14.6 mmHg; baseline DBP was 88.5 ± 33.6 mmHg, improving to 83.4 ± 9.6 mmHg. Conclusions: The SMBP program effectively controlled BP, highlighting the value of combining clinical care with telemonitoring.
Journal Article
Microplastics in Lake Mead National Recreation Area, USA: Occurrence and biological uptake
Microplastics are an environmental contaminant of growing concern, but there is a lack of information about microplastic distribution, persistence, availability, and biological uptake in freshwater systems. This is especially true for large river systems like the Colorado River that spans multiple states through mostly rural and agricultural land use. This study characterized the quantity and morphology of microplastics in different environmental compartments in two large reservoirs along the Colorado River: Lakes Mead and Mohave, within Lake Mead National Recreation Area. To assess microplastic occurrence, surface water and surficial sediment were sampled at a total of nine locations. Sampling locations targeted different sub-basins with varying levels of anthropogenic impact. Las Vegas Wash, a tributary which delivers treated wastewater to Lake Mead, was also sampled. A sediment core (33 cm long, representing approximately 19 years) was extracted from Las Vegas Bay to assess changes in microplastic deposition over time. Striped bass (Morone saxatilis), common carp (Cyprinus carpio), quagga mussels (Dreissena bugensis), and Asian clams (Corbicula fluminea) were sampled at a subset of locations to assess biological uptake of microplastics. Microplastic concentrations were 0.44-9.7 particles/cubic meter at the water surface and 87.5-1,010 particles/kilogram dry weight (kg dw) at the sediment surface. Sediment core concentrations were 220-2,040 particles/kg dw, with no clear increasing or decreasing trend over time. Shellfish microplastic concentrations ranged from 2.7-105 particles/organism, and fish concentrations ranged from 0-19 particles/organism. Fibers were the most abundant particle type found in all sample types. Although sample numbers are small, microplastic concentrations appear to be higher in areas of greater anthropogenic impact. Results from this study improve our understanding of the occurrence and biological uptake of microplastics in Lake Mead National Recreation Area, and help fill existing knowledge gaps on microplastics in freshwater environments in the southwestern U.S.
Journal Article
High-Risk Outreach for COVID-19 Mortality Reduction in an Indigenous Community
Indigenous populations have been disproportionally affected by COVID-19, particularly those in rural and remote locations. Their unique environments and risk factors demand an equally unique public health response. Our rural Native American community experienced one of the highest prevalence outbreaks in the world, and we developed an aggressive management strategy that appears to have had a considerable effect on mortality reduction. The results have implications far beyond pandemic response, and have reframed how our community addresses several complicated health challenges. (Am J Public Health. 2021;111(11):1939–1941. https://doi.org/10.2105/AJPH.2021.306472 )
Journal Article
Promoting Equitable Access to COVID-19 Vaccinations in Rural and Underserved Arizona: Experiences From Three County Health Departments
By population, Arizona has the seventh highest percentage of people who report their race as Native American or American Indian.11 Tribal areas, rural and urban geographies, binational communities in US-Mexico border counties, and rapid population growth over the preceding two decades were important factors that affected Arizona's COVID-19 public health responses. Faced with these challenges, Cochise County Health & Social Services (CCHSS) engaged public and private health care providers in vaccine delivery efforts. Local health providers, critical access hospitals, Federally Qualified Health Centers, the media, fire and law enforcement departments, and community organizations engaged in significant outreach efforts including two mass mailings in English and Spanish. Early on, there was high interest in vaccines among the Native American population and a high level of cooperation between NNHD and CCHHS. Because the county received vaccines through the state allocation earlier than the Navajo Nation received vaccines from the federal government, many tribal members accessed vaccination via county services.
Journal Article
DID THE 2007 LEGAL ARIZONA WORKERS ACT REDUCE THE STATE'S UNAUTHORIZED IMMIGRANT POPULATION?
We test for an effect of Arizona's 2007 Legal Arizona Workers Act (LAWA) on the proportion of the state's population characterized as noncitizen Hispanic. We use the synthetic control method to select a group of states against which Arizona's population trends can be compared. We document a notable and statistically significant reduction in the proportion of the Hispanic noncitizen population in Arizona. The decline observed matches the timing of LAWA's implementation, deviates from the time series for the synthetic control group, and stands out relative to the distribution of placebo estimates for other states in the nation.
Journal Article
Urban soil carbon and nitrogen converge at a continental scale
In urban areas, anthropogenic drivers of ecosystem structure and function are thought to predominate over larger-scale biophysical drivers. Residential yards are influenced by individual homeowner preferences and actions, and these factors are hypothesized to converge yard structure across broad scales. We examined soil total C and total δ13C, organic C and organic δ13C, total N, and δ15N in residential yards and corresponding reference ecosystems in six cities across the United States that span major climates and ecological biomes (Baltimore, Maryland; Boston, Massachusetts; Los Angeles, California; Miami, Florida; Minneapolis-St. Paul, Minnesota; and Phoenix, Arizona). Across the cities, we found soil C and N concentrations and soil d15N were less variable in residential yards compared to reference sites supporting the hypothesis that soil C, N, and δ15N converge across these cities. Increases in organic soil C, soil N, and soil δ15N across urban, suburban, and rural residential yards in several cities supported the hypothesis that soils responded similarly to altered resource inputs across cities, contributing to convergence of soil C and N in yards compared to natural systems. Soil C and N dynamics in residential yards showed evidence of increasing C and N inputs to urban soils or dampened decomposition rates over time that are influenced by climate and/or housing age across the cities. In the warmest cities (Los Angeles, Miami, Phoenix), greater organic soil C and higher soil δ13C in yards compared to reference sites reflected the greater proportion of C₄ plants in these yards. In the two warm arid cities (Los Angeles, Phoenix), total soil δ13C increased and organic soil δ13C decreased with increasing home age indicating greater inorganic C in the yards around newer homes. In general, soil organic C and δ13C, soil N, and soil δ15N increased with increasing home age suggesting increased soil C and N cycling rates and associated 12C and 14N losses over time control yard soil C and N dynamics. This study provides evidence that conversion of native reference ecosystems to residential areas results in convergence of soil C and N at a continental scale. The mechanisms underlying these effects are complex and vary spatially and temporally.
Journal Article
Ecological-niche modeling reveals current opportunities for Agave dryland farming in Sonora, Mexico and Arizona, USA
For centuries, humans occupying arid regions of North America have maintained an intricate relationship with Agave (Agavoideae, Asparagaceae). Today Agave cultivation, primarily for beverage production, provides an economic engine for rural communities throughout Mexico. Among known dryland-farming methods, the use of rock piles and cattle-grazed areas stand out as promising approaches for Agave cultivation. Identifying new cultivation areas to apply these approaches in Arizona, USA and Sonora, Mexico warrants a geographic assessment of areas outside the known ranges of rock piles and grasslands. The objective of this study was to predict areas for dryland-farming of Agave and develop models to identify potential areas for Agave cultivation. We used maximum entropy (MaxEnt) ecological-niche-modeling algorithms to predict suitable areas for Agave dryland farming. The model was parameterized using occurrence records of Hohokam rock piles in Arizona and grassland fields cultivated with Agave in Sonora. Ten environmental-predictor variables were used in the model, downloaded from the WorldClim 2 climate database. The model identified potential locations for using rock piles as dryland-farming methods from south-central Arizona to northwestern Sonora. The Agave -grassland model indicated that regions from central to southern Sonora have the highest potential for cultivation of Agave , particularly for the species Agave angustifolia . Results suggest that there are many suitable areas where rock piles can be used to cultivate Agave in the Sonoran Desert, particularly in the border of southeastern Arizona and northwest Sonora. Likewise, cattle-grazing grasslands provide a viable environment for cultivating Agave in southern Sonora, where the expanding bacanora-beverage industry continues to grow and where different Agave products (e.g., syrups, fructans, saponins, and medicinal compounds) can potentially strengthen local economies.
Journal Article
Integrating Behavioral and Primary Health Care in Rural Clinics: What Does Culture Have to Do with It?
Successful integration of health care in rural and underserved communities requires attention to power structures, trust, and disciplinary boundaries that inhibit team-based integration of behavioral and primary health care. This paper reports on perceived successes and ongoing challenges of integrating primary and behavioral health care from the perspectives of providers, community leaders, and community members. Data collection consisted of semi-structured qualitative interviews and focus groups conducted as part of a regional health equity assessment in northern Arizona. The authors explore barriers and successes in integrating health care in rural clinics using the perspective of a social ecological framework and the mediating role of culture. Differing expectations, differing professional areas, and interpersonal interactions were primary factors challenging movement toward integrated health care. Results suggest that providers and policymakers working toward health care integration should consider culture and interpersonal interaction as dynamic mediators, particularly in underserved and rural health care contexts.
Journal Article
Decreases in Suicide Deaths and Attempts Linked to the White Mountain Apache Suicide Surveillance and Prevention System, 2001–2012
Objectives. We evaluated the impact of a comprehensive, multitiered youth suicide prevention program among the White Mountain Apache of Arizona since its implementation in 2006. Methods. Using data from the tribally mandated Celebrating Life surveillance system, we compared the rates, numbers, and characteristics of suicide deaths and attempts from 2007 to 2012 with those from 2001 to 2006. Results. The overall Apache suicide death rates dropped from 40.0 to 24.7 per 100 000 (38.3% decrease), and the rate among those aged 15 to 24 years dropped from 128.5 to 99.0 per 100 000 (23.0% decrease). The annual number of attempts also dropped from 75 (in 2007) to 35 individuals (in 2012). National rates remained relatively stable during this time, at 10 to 13 per 100 000. Conclusions. Although national rates remained stable or increased slightly, the overall Apache suicide death rates dropped following the suicide prevention program. The community surveillance system served a critical role in providing a foundation for prevention programming and evaluation.
Journal Article