Programs and Communities

An increase in population and need to protect the planet has created many initiatives and research goals in developing alternatives methods of fueling. Federal and state policies have provided a push for industries to find ways to of reducing their impact on the environment while maintaining competitiveness. In the sector of alternative fuels, large policies such as the Renewable Fuel Standards (RFS) in the United States are making goals to reduce vehicular fuel from coal and oil, and focus on alternative fuels such as ethanol and biodiesel. Along with the RFS and other federal policies, states are introducing independent initiatives to promote the use of alternative fuels.

Research has shown that other crops besides corn can feasibly be used to produce ethanol for fuel use. One of the major crops of interest currently is switchgrass (Panicum Virgatum L.) because of its ability to grow under a variety of weather conditions and soil types. Switchgrass does not require as much maintenance as corn and is a perennial grass that can have high yielding fields for up to 9 years.

This report focuses on the impacts from using switchgrass-derived ethanol to meet the state of Arizona’s policy to have government fleet vehicles operating on alternative fuels. The study uses a life cycle assessment (LCA) approach to evaluate 22 million gallons of ethanol produced in Arizona and stored at fueling stations for use. Impacts in land use, global warming, and water quality are evaluated using software tools and databases in Ecoinvent and Simapro.

The results of the study indicate that the cultivation and harvest phase of the process will contribute the most to negative environmental impacts. According to the study, application of heavy nutrient fertilizer and the machinery needed for the additional agriculture have the potential to contribute over 36 million moles of hydrogen and 89 million CTU eq. to the air, soil, and water.

Diabetes, a common chronic condition, effects many individuals causing poor quality of life, expensive medical bills, and devastating medical complications. While health care providers try to manage diabetes during short office visits, many patients still struggle to control their diabetes at home. Lack of diabetes self-management (DSM) is a potential barrier for people with diabetes having to maintain healthy hemoglobin A1cs (HgA1c).

In hopes of addressing this concern, an evidenced-based intervention; diabetic education and phone calls, using the chronic care model as its framework was implemented. The intervention targeted people with type II diabetes at a transitional care setting. Measured variables included HgA1c and DSM. Statistically significant improvements were seen in reported physical activity. Average improvements were seen in HgA1c and DSM after three months of diabetes self-management education (DSME). Attrition, cultural sensitivity, and increasing DSME hours should be further evaluated for future projects.

Background and Purpose: Over 30 million people in the United States (U.S.) have diabetes mellitus, which comprises about 9% of the population, and about 90% of individuals with diabetes have type 2 diabetes (Centers for Disease Control and Prevention [CDC], 2017). Adults with type 2 diabetes at a local internal medicine clinic were consistently having high glycated hemoglobin (HbA1C) levels, demonstrated by data collected from the electronic health record (EHR), and there was no ordering process for referring patients to diabetes management education and support (DSMES) services. The purpose of this project was to improve glycemic control, demonstrated by lower HbA1C levels, and reach a diabetes education attendance rate of 62.5% at an internal medicine clinic in Chandler, Arizona.

Methods: An electronic health record (EHR) template was created and brief staff training was completed to connect patients with diabetes in the community to a local formal diabetes education program. HbA1C levels were measured before and three months after adults with education program. HbA1C levels were measured before and three months after adults with type 2 diabetes mellitus (T2DM) received physicians’ orders for a DSMES program, and rates of attendance to the program were calculated. Data was collected through the EHR and through feedback from the DSMES program. Descriptive statistics were used in data analysis.

Outcomes: The participants’ results did not demonstrate significant differences in pre-referral and post-referral HbA1C results after they were ordered DSMES services (p = .506). The proportion of education attendance (30%) was lower than the project goal of 62.5%, but increased from the clinic baseline.

Conclusions: EHR template implementation for referral to DSMES may increase rates of formal diabetes education and improve glycemic control. Larger sample sizes, longer project periods, alternative methods of communication, and increased follow-up of participants may be required to produce significant results.

Background: The global prevalence of all types of diabetes increased from 108 million in 1980 to 422 million in 2014 (Nazir et al., 2018). The Centers for Disease Control and Prevention (2017) ranks diabetes as the 7th leading cause of death in the United States with an estimated annual expense of $327 billion. Within the rural setting, patients typically have less resources available for the treatment and self-management of their diseases. It is important to explore self-management techniques that can be utilized by patients with type 2 diabetes living in rural areas. Research demonstrating the importance of education, exercise, diet, glucose monitoring, medications, and supportive measures is prominent throughout the literature.

Objective: The purpose of this Doctor of Nursing Practice (DNP) applied project is to investigate the effects of delivering biweekly text messages containing diabetes self-management education (DSME) materials to patients in an effort to support successful self-care.

Methods: During an 8 week period, DSME was provided via text messaging, bi-weekly (Sunday and Wednesday), to 23 rural participants with type 2 diabetes, in a family clinic in Payson, Arizona. Participants were asked to complete the Skills, Confidence, and Preparedness Index both pre- and post-intervention to evaluate their knowledge of diabetes self-management.

Results: Twenty-three adults aged 52 to 78 years (M = 64.91) participated in the project. Of the participants, 57% (13/23) were female. The majority of participants had T2DM diagnosis less than 10 years (M=13.8 years). There was a statistical difference between the pre- and post-Skills, Confidence and Preparedness Index questionnaire (p < .001) indicating an improvement in self-efficacy scores post- intervention.

Conclusion: DSME delivered via text message is a cost-effective way to increase patients' self-efficacy and potentially improve their ability to successfully self-manage their disease.

The coronavirus (COVID-19) pandemic has affected employment and food security globally and in the United States. To understand the impacts of COVID-19 on food security in Arizona, a representative survey of Arizona households was launched online from July 1 to August 10, 2020. This brief provides an overview of changes in food security rate, perceived worries and challenges about food security, as well as behavioral changes and strategies adopted since the pandemic. Additional briefs from the Arizona survey covering topics on economic consequences, food access, and participations in food assistance programs during the pandemic are also available.

The coronavirus (COVID-19) pandemic led to disruptions in the food supply and high rates of unemployment and under-employment, both in Arizona and nationally. These emergencies required food assistance programs to adapt quickly and in unprecedented ways by relaxing eligibility criteria, improvising on delivery modalities, and increasing benefits. To examine food assistance program participation during the pandemic, we collected data from a representative sample of 620 Arizona households. The sample was drawn from across Arizona in July-August 2020 using an online survey. This brief provides the summary for participation in key food assistance programs, namely, the Supplementary Nutrition Assistance Program (SNAP), the Special Supplemental Program for Women Infants and Children (WIC), School Food Programs, and the emergency food assistance provided through food pantries.

Diabetes is a leading cause of morbidity in the world. About 42 million people worldwide have
diabetes. Poorly managed diabetes leads to long term complications and mortality. Diabetes self-management education (DSME) has been effective in preventing or delaying complications.The purpose of this project is to implement a diabetes self-management education (DSME)
program in primary care and to evaluate its impact on glycemic control and diabetes knowledge in a selected group of adults 18 years or older in a community-based practice.

Interprofessional collaboration (IP) is an approach used by healthcare organizations to improve the quality of care. Studies examining effects of IP with patients with type 2 diabetes mellitus (T2DM) have shown improvement in A1C, blood pressure, lipids, self-efficacy and overall greater knowledge of disease process and management. The purpose of this project was to evaluate the impact of IP with attention to identifying and addressing social needs of patients with T2DM. Participants at least 18 years of age with an A1C >6.5% were identified; Spanish speaking patients were included in this project. The intervention included administration of Health Leads questionnaire to assess social needs. Monthly in person or phone meetings were conducted during a 3-month period.

The patient had the option to meet with the doctor of nursing practice (DNP) student as well as other members of the team including the clinical pharmacist and social work intern. Baseline A1C levels were extracted from chart at 1st monthly meeting. Post A1C levels were drawn at the 3 month follow up with their primary care provider. Study outcomes include the difference in A1C goal attainment, mean A1C and patient satisfaction. Pre A1C levels in participants ranged from 7.1% to 9.8% with a mean of 8.3%. Post A1C levels ranged from 6.9% to 8.6% with a mean of 7.7%. Two cases were excluded as they did not respond to the intervention. A paired-samples t test was calculated to compare the mean pre A1C level to the post A1C level. The mean pre A1C level was 8.24 (sd .879), and the post A1C level was 7.69 (sd .631). A significant decrease from pre to post A1C levels was found (t (6) = 2.82, p<.05).

The prevalence of Type 2 Diabetes is on the rise, as are the costs. This nation’s healthcare system must promote interprofessional collaboration and do a better job of addressing SDOH to more effectively engage patients in the management of their disease.

With more than 19 million confirmed COVID-19 cases across the United States1 and over 500,000 in Arizona as of December 2020, the ongoing pandemic has had devastating impacts on local, national, and global economies. Prior to the pandemic (February 2020), based on U.S. Bureau of Labor Statistics data, the unemployment rate in Arizona was 6.5%, compared to 4.9% at the national level.3 Since the beginning of the COVID-19 pandemic (March 2020), the United States has experienced striking increases in the unemployment rate, reaching 13.2% in April. Similarly, in Arizona, the unemployment rate jumped to over 13.5% in April. The unemployment rates have since declined both nationally and in Arizona but remain higher compared to February 2020. In November 2020 (the most recent data available), the national unemployment rate was 6.7%, while in Arizona the rate was 7.8%—the 10th highest unemployment rate among all U.S. states.