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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.
Background: Healthcare providers are encouraged to prepare their practice to effectively manage the care of mild to moderate adolescent depression. Cost-effective screening, diagnostic, and newly developed pediatric primary care depression management guidelines have been established. To integrate guidelines into practice, primary care providers (PCPs) must document effectively to ensure a complete treatment plan is in place in the patient’s electronic health record (EHR).
Intervention: Elements from a flowsheet were implemented into the EHR to promote thorough assessment and documentation of care delivered to adolescents with depression.
Methods: An initial chart review was completed on patients diagnosed with depression. An updated depression template was implemented within the EHR for six weeks. A follow-up chart review was completed post-intervention to determine if documentation of elements from the adolescent depression guidelines improved after the EHR update. Pre-intervention and post- intervention surveys were delivered to PCP’s to understand their perspective on adolescent depression management.
Outcomes: The chart review revealed that baseline PHQ-9 screenings were documented in 91% (n=43) of the charts reviewed in the pre-intervention timeframe. Only 78% (n=7) of the charts reviewed during post-intervention included PHQ-9 screenings. Early intervention treatment options documented in the pre-intervention timeframe included education 100% (n=47), medication prescriptions 53% (n=25), and psychotherapy referrals 18% (n=18). During post- intervention, education 100% (n=9), medication prescriptions 78% (7), and psychotherapy referrals 22% (n=7) were documented by the PCPs.
Recommendation: The quality improvement project focused heavily on documentation completed over a one year pre-intervention timeframe compared to a six-week post-intervention timeframe. Further evaluation and chart review over the next year will provide a more adequate comparison of documentation within primary care practice.
Methods: At an urban primary care pediatric office located in the southwestern US, an educational quality improvement project for healthcare practice providers and front office staff was conducted to increase the utilization of the existing EMR-linked patient portal. The healthcare providers were asked to complete a pre- and post- survey evaluation of their knowledge and usage of the patient portal. Provider and patient portal data usage was collected over a five-month period, September 2019 to January 2020.
Results: Data was analyzed using the Intellectus Statistics softwareTM. Significant results were found at the conclusion of the project in the number of active patient portal users, web-enabled, portal logins, labs published/viewed, messages sent, appointment reminders and Santovia utilization. At the end of the project no significance was found with messages received by the healthcare providers or staff through the patient portal. Survey results found significant differences between pre- and post- portal usage. No significance was found on providers’ knowledge on how to web-enable patients. Providers’ also demonstrated no significant change in their perceptions of the benefit in utilizing the portal in patient care after the educational intervention. Survey results allowed for additional analysis of commonly utilized portal functionalities, disease or health topics utilized in Santovia, and suggestions on how to make the use of the patient portal easier for providers.
Implications for Health Care Providers: This quality improvement project found that implementation an EMR-linked patient portal requires a comprehensive practice approach with structured education sessions. Including all employees can improve patient portal utilization. This educational project resulted in significant increases in most portal functionalities within 5 months. Further practice change evaluations are needed to evaluate how to improve patient portal utilization with a larger group of participants in a variety of outpatient settings.
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.