Central Appalachian Region Research Articles

Cyclical uncertainty: Healthcare providers and gender affirming care in Central Appalachia

Purpose An estimated 1.4–2.3 million transgender and gender nonbinary (TGNB) adults live in the United States. Very few studies have explored TGNB healthcare delivery from the perspectives of primary care providers in the Southeast region broadly, and even fewer have focused on the Central Appalachian region in particular. This project explores the perspectives of providers in the area to better understand the needs of this population. Methods Healthcare providers in community health organizations within Central Appalachia participated in sixteen in-depth interviews. Researchers performed a qualitative thematic analysis to identify major themes in experiences of providing gender affirming care (GAC) for TGNB in the region. Results Data analysis revealed four major themes: 1) practitioners’ baseline knowledge of GAC influences their perception of providing care for TGNB patients, 2) practitioners report a lack of certainty in providing care to TGNB patients, 3) practitioners show interest in and recognize the need for educational resources and support in providing GAC, and 4) colleagues and patients are a useful source of knowledge for providing GAC. Conclusion Participants held inconsistent definitions for what Gender Affirming Care means, but did not express confusion or uncertainty about the importance of providing GAC as part of primary care. Hesitation to treat was most often associated with a lack of self-confidence in a provider’s ability to provide appropriate care to patients. This suggests a misunderstanding or lack of education related to the health needs of this population, and specifically a lack of awareness that providing GAC goes beyond the provision of transition related medicine.

Alzheimer’s Disease and related dementias prevalence higher in Appalachian counties within Central Appalachia

AbstractBackgroundAlzheimer’s disease and related dementias (ADRD) prevalence varies geographically in the US. The Appalachian region has lower educational attainment and health care access barriers compared to non‐Appalachian regions. The objective of this proposal is to assess whether the geographic variation of ADRD in Central Appalachia is explained by county‐level sociodemographic factors or access to care.MethodsCenters for Medicare and Medicaid Services Public Use Files from 2015‐2018 were used to estimate county‐level ADRD prevalence among all fee‐for‐service beneficiaries in Central Appalachia (Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia). Negative binomial regression was used to estimate prevalence overall, by Appalachian Regional Commission’s Appalachian/non‐Appalachian designation, and by rural/urban (Rural‐Urban Continuum Codes) classification. Models were then adjusted for: (1) county‐level demographics including age, gender, Medicaid eligibility, and comorbidities (atrial fibrillation, chronic kidney disease, depression, diabetes, heart failure, hyperlipidemia, hypertension, ischemic heart disease, schizophrenia/other psychotic disorders, and stroke); (2) sociodemographics (race/ethnic distribution, education, aging population distribution, and renter‐occupied housing); and (3) diagnostic access (PCP visits, neurology visits, and imaging scans).ResultsA total of 592 counties comprise the Central Appalachian region where 43% (n = 255) are Appalachian and 45% (n = 267) are rural counties. The prevalence of ADRD did not vary over the time period but was higher for Appalachian counties both overall (PR: 1.03; 95% CI: 1.02, 1.04) and after adjustment (PR: 1.02; 95% CI: 1.00, 1.03) compared to non‐Appalachian counties. This difference was similar among rural and urban counties (p = 0.326). These differences did vary across the states in the region (p = 0.0040). In North Carolina and Tennessee, Appalachian counties had higher ADRD prevalence, while in Ohio and Tennessee, rural counties have lower ADRD prevalence.ConclusionThere is a consistent difference between Appalachian and non‐Appalachian counties, with Appalachian counties having relatively higher ADRD prevalence (in the range of 2.0‐3.0% times higher) than non‐Appalachian counties. These differences persisted even after considering age, education, other sociodemographic factors and access to care measures.

Geographic Variation of Prevalence of Alzheimer's Disease and Related Dementias in Central Appalachia.

Alzheimer's disease and related dementias (ADRD) prevalence varies geographically in the United States. To assess whether the geographic variation of ADRD in Central Appalachia is explained by county-level sociodemographics or access to care. Centers for Medicare and Medicaid Services Public Use Files from 2015- 2018 were used to estimate county-level ADRD prevalence among all fee-for-service (FFS) beneficiaries with≥1 inpatient, skilled nursing facility, home health agency, hospital outpatient or Carrier claim with a valid ADRD ICD-9/10 code over three-years in Central Appalachia (Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia). Negative binomial regression was used to estimate prevalence overall, by Appalachian/non-Appalachian designation, and by rural/urban classification. Models were then adjusted for county-level: 1) FFS demographics (age, gender, and Medicaid eligibility), comorbidities; 2) population sociodemographics (race/ethnicity, education, aging population distribution, and renter-occupied housing); and 3) diagnostic access (PCP visits, neurology visits, and imaging scans). Across the 591 counties in the Central Appalachian region, the average prevalence of ADRD from 2015- 2018 was 11.8%. ADRD prevalence was modestly higher for Appalachian counties both overall (PR: 1.03; 95% CI: 1.02, 1.04) and after adjustment (PR: 1.02; 95% CI: 1.00, 1.03) compared to non-Appalachian counties. This difference was similar among rural and urban counties (p = 0.326) but varied by state (p = 0.004). The relative variation in ADRD prevalence in the Appalachian region was smaller than hypothesized. The case mixture of the dual eligible population, accuracy of the outcome measurement, and impact of educational attainment in this region may contribute to this observation.

Clean innovation ecosystems: Lifting distressed communities in Appalachia with clean energy

The U.S. government has invested in distressed communities in the 21st century but with minimal effect. Regarding income, poverty, joblessness, and vacancy rates, the average distressed zip code in 2018 showed no improvement compared to its standing relative to the average prosperous zip code in 2000. We have discovered the formation of unique business clusters funded by public-private partnerships have the potential to make a difference in lifting distressed communities. Our research of literature and artifacts (photographs, videos, documents, digital media - websites or social media posts) suggests the discovery of a Clean Innovation Ecosystem (CIE). CIE refers to the network of social entrepreneurs, organizations, institutions, and individuals that work together to promote sustainable technologies and practices. As of the 4th quarter of 2023, manufacturing annual run rate construction spending has skyrocketed to over $200 billion. There are another $600 billion of Voltage Valley projects announced that have not yet been built. Over the past two decades, private investment has been between $20 billion and $100 billion annually in U.S. manufacturing infrastructure. Governments are making unprecedented investments in clean energy - which include approximately $400 billion in funding from the Inflation Reduction Act (IRA), $8 billion to establish 6–10 regional Hydrogen Hubs in the U.S., investments in carbon capture, renewable energy technologies, and other investments in clean energy sectors and technologies. All these investments come with the condition that the investment lifts distressed communities. This article explains why investing in Appalachia and geographic regions with similar characteristics will maximize the social benefit of public investment in a Clean Innovation Ecosystem. Our case study covers the Greater Central Appalachian Voltage Valley (GCAVV) – the states of Kentucky, West Virginia, Ohio, Upstate New York, and Michigan, as well as the Central Appalachian region as defined by 56 of the 85 distressed communities of Appalachia.

Wetland Creation and Reforestation of Legacy Surface Mines in the Central Appalachian Region (USA): A Potential Climate-Adaptation Approach for Pond-Breeding Amphibians?

Habitat restoration and creation within human-altered landscapes can buffer the impacts of climate change on wildlife. The Forestry Reclamation Approach (FRA) is a coal surface mine reclamation practice that enhances reforestation through soil decompaction and the planting of native trees. Recently, wetland creation has been coupled with FRA to increase habitat available for wildlife, including amphibians. Our objective was to evaluate the response of pond-breeding amphibians to the FRA by comparing species occupancy, richness, and abundance across two FRA age-classes (2–5-year and 8–11-year reclaimed forests), traditionally reclaimed sites that were left to naturally regenerate after mining, and in mature, unmined forests in the Monongahela National Forest (West Virginia, USA). We found that species richness and occupancy estimates did not differ across treatment types. Spotted Salamanders (Ambystoma maculatum) and Eastern Newts (Notophthalmus viridescens) had the greatest estimated abundances in wetlands in the older FRA treatment. Additionally, larger wetlands had greater abundances of Eastern Newts, Wood Frogs (Lithobates sylvaticus), and Green Frogs (L. clamitans) compared to smaller wetlands. Our results suggest that wetland creation and reforestation increases the number of breeding sites and promotes microhabitat and microclimate conditions that likely maximize the resilience of pond-breeding amphibians to anticipated climate changes in the study area.

Loneliness and Alcohol use among College Students During the COVID-19 Pandemic in Rural Appalachia

Objective Binge drinking and heavy alcohol use are highly prevalent among college students. During the COVID-19 pandemic, due to lockdown restrictions and other challenges, many college students were burdened with loneliness, which can contribute to chronic stress, and substance use. The current study explores the association between loneliness and various levels of alcohol use among college students in the rural, underserved region of Central Appalachia, USA. Methods Data were collected from a regional sample (n = 320) of college age adults, age 18-25 in the Central Appalachian region. The UCLA-3 item Loneliness Scale (UCLA-3) was used in the study to evaluate loneliness. Logistic regression analysis was conducted to assess the association between levels of loneliness and three separate outcomes, including past year binge drinking, past year heavy alcohol use, and past year weekly alcohol use. Results Overall, 25.5% of the participants reported severe loneliness, 33.6% reported moderate, and 40.9% reported low levels of loneliness. Results of the adjusted models revealed that severe loneliness was associated with higher odds of heavy alcohol use (AOR = 1.89, 95% CI [1.02, 3.50]) and binge drinking (AOR = 2.96, 95% CI [1.16, 7.51]), and not associated with weekly alcohol use. Conclusion The study found that higher levels of loneliness were linked to both binged drinking and heavy alcohol use. Further efforts for counseling and treatment among college students who are burdened with severe loneliness should be considered. The chronic stress associated with severe loneliness needs to be further addressed, particularly among emerging adults.

Geographic variation of prevalence of Alzheimer’s Disease and related dementias in the Central Appalachian region of the United States

AbstractBackgroundAreas within the Appalachian region may have a greater burden of under diagnosed Alzheimer’s disease and related dementias (ADRD). As rural areas have lower reported ADRD prevalence compared to urban areas in spite of lower educational attainment (which should lead to higher ADRD prevalence) this argues that the true burden of ADRD is likely underestimated in areas without adequate detection resources. There is need to understand if ADRD prevalence is truly lower in rural areas, or if this is a disease detection difference. The objective of this proposal is to assess the burden of ADRD in Central Appalachia.MethodsCenters for Medicare and Medicaid Services Public Use Files from 2015‐2018 were used to estimate county‐level ADRD prevalence among all fee‐for‐service beneficiaries in Central Appalachia (Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia). Negative binomial regression was used to estimate prevalence overall, by Appalachian Regional Commission’s Appalachian/non‐Appalachian designation, and by rural/urban (Rural‐Urban Continuum Codes) classification. Models were then adjusted for county‐level demographics including age, gender, Medicaid eligibility, and comorbidities (atrial fibrillation, chronic kidney disease, depression, diabetes, heart failure, hyperlipidemia, hypertension, ischemic heart disease, schizophrenia/other psychotic disorders, and stroke).ResultsThe prevalence of ADRD did not vary over the time period but was higher for Appalachian counties both overall (12.0% vs. 11.6%; p = 0.001; Figure 1) and among both urban (p<0.001) and rural counties (p = 0.024; Figure 2). Urban Appalachian counties had 2‐4% higher prevalence compared to urban non‐Appalachian counties with this difference reaching statistical significance in 2017 and 2018. While a similar trend was observed in rural counties (Appalachian counties having 1‐3% higher prevalence), these yearly ratios did not reach statistical significance. After adjustment, the associations attenuated in urban counties, but over the entire study period, rural Appalachian counties had 2.2% higher prevalence than rural non‐Appalachian counties (Figure 3).ConclusionThere is a consistent difference between Appalachian and non‐Appalachian counties, demonstrated overall and by rural status, with Appalachian counties having ADRD prevalence in the range of 1.0‐4.5% higher than non‐Appalachian counties. However, while county‐level demographics and comorbidities explained the difference in urban counties, the elevated prevalence in rural‐Appalachian counties persisted.

Fire exclusion vs. a fire-free interval following repeated prescribed fire: Consequences for forest stand structure and species composition in an upland oak forest

In the Central Appalachian forest region, oaks (Quercus L.) and other disturbance-dependent tree species are experiencing widespread regeneration failure after decades of fire suppression. Managers use prescribed fire to decrease basal area with the aim of facilitating oak regeneration and shifting species composition toward pyrophytic species that dominate the overstory. Although fire may set the stage for improved oak regeneration, a fire-free period is necessary for oak seedlings to develop into fire-resistant stems. The effects of prescribed fire have been amply investigated across the region, but few studies have examined changes to stand structure and oak regeneration after cessation of burning. We followed the effects of three treatments, fire-excluded, 3x-burned, and 4x-burned, for 20 years. After a fire-free interval of approximately ten years, burned treatments had significantly lower total basal area and greater relative density of oaks in the subcanopy (10–20 cm DBH) than the fire-excluded treatment. The 4x-burned, which had the greatest reduction in basal area, also had greater relative density of midstory oaks (2–10 cm DBH), and higher stem density of oak regeneration (<2 cm DBH) than the fire-excluded. Despite these trends towards increased regeneration of oaks and other pyrophytes, red maple (Acer rubrum L.) stem density also increased in the midstory of burned treatments, suggesting a legacy effect of decades of fire suppression and the concomitant mesophication that has occurred. We also examined the effects of continued fire exclusion on the fire-excluded reference treatment. Additional evidence of mesophication on this treatment was demonstrated by increased overstory (≥20 cm DBH) and subcanopy red maple stem density as well as midstory (2–10 cm DBH) eastern white pine (Pinus strobus L.) stem density, a prominent mesophyte on these sites. This study supports the idea that repeated prescribed burning followed by a 10-year fire-free interval can alter stand structure and lead to improved oak regeneration by increasing canopy openness. However, the results were variable across burned treatments (3x vs. 4x) and the ingrowth of red maple and other mesophytes after only 10 years of fire exclusion will require additional control measures. Successful maintenance of oak-dominated forests on upland sites in the Central Appalachian hardwoods region may be contingent on a subsequent canopy disturbance that further increases light availability followed by a fire-free interval. Importantly, in the absence of burning or other disturbance, red maple and other mesophytic species will continue to increase in relative stem density.

Receiver Function Analysis Reveals Lateral Variations in Temperature and Water Content in the Mantle Transition Zone Beneath Eastern North America

AbstractUsing recently collected high‐resolution seismic data along a dense linear transect across Ohio, West Virginia, and Virginia (called Mid‐Atlantic Geophysical Integrative Collaboration (MAGIC) profile), we analyze P‐to‐S receiver functions to investigate the undulations of the mantle transition zone (MTZ) discontinuities (410‐ and 660‐km) beneath the central Appalachian region. Our results incorporating the effects of local crustal and mantle structures suggest shallowing of both the 410‐ and the 660‐km discontinuities from the northwest (inland) to the southeast (coast) along MAGIC profile. Hydro‐thermal upwelling beneath the eastern U.S. coastal plain due to a hydrated MTZ and hot upwelling return flow associated with the descending lower mantle Farallon slab is consistent with our observations of MTZ structure considering 3D velocity heterogeneity. The inferred hydrous hot upwelling rising into the upper mantle may trigger dehydration melting atop the 410‐km discontinuity, which may help to explain the presence of a low velocity upper mantle anomaly beneath the region today.

Setting Patient-Centered Priorities for Cardiovascular Disease in Central Appalachia: Engaging Stakeholder Experts to Develop a Research Agenda.

The disproportionate burden of cardiovascular diseases (CVD) and associated risk factors continues to exist in the Central Appalachian Region (CAR) of the United States. Previous studies to gather data about patient-centered care for CVD in the region were conducted through focus group discussions. There have not been any studies that used a collaborative framework where patients, providers, and community stakeholders were engaged as panelists. The objective of this study was to identify patient-centered research priorities for CVD in the CAR. We used a modified Delphi approach to administer questionnaires to forty-two stakeholder experts in six states representing the CAR between the fall of 2018 and the summer of 2019. Their responses were analyzed for rankings and derived priorities by research gaps. Six of the fifteen research priorities identified were patient-centered. These patient-centered priorities included shorter wait times for appointments; educating patients at their level; empowering patients to take responsibility for their health; access to quality providers; heart disease specialists for rural areas; and lifestyle changes. The participants' commitments to identify patient-centered research priorities indicate the potential to engage in community-based collaboration to address the burden of CVD in the CAR.

“We flew under the radar:” examining the influence of stigma on community engagement strategies among harm reduction practitioners in Central Appalachia

BackgroundThe rise in opioid overdoses has disproportionately affected the Central Appalachian region of the United States. Stigma towards people who use drugs (PWUD) has limited access to life-saving harm reduction services in the region. Previous research has emphasized the need to engage communities to reduce stigma, yet these efforts can lead to backlash. The purpose of this study was to explore how stigma affects harm reduction practitioners’ approaches to community engagement. MethodsWe analyzed qualitative interviews with harm reduction practitioners (n ​= ​35) in Central Appalachia. We used deductive and inductive coding, as well as narrative summaries, to identify harm reduction practitioners’ descriptions of stigma and their resulting approaches to community engagement. We identified three in vivo codes that encapsulated the main community engagement strategies, “flying under the radar,” “spreading the word,” and “damage control,” and assessed how each strategy influenced program operations. ResultsMost participants (n ​= ​18) “spread the word,” or conducted community engagement activities to combat social stigma about harm reduction services. While many were able to gain approval in the community, some experienced pushback from certain stakeholders. Eleven participants “flew under the radar,” or decided not to engage stakeholders about their program, after perceiving that social and enacted stigma were too great to overcome. While they did not experience backlash, they could not access some funding sources or partner with state-sanctioned organizations. Finally, a few participants (n ​= ​6) did not proactively choose an engagement approach and instead had to conduct “damage control” to assuage community concerns about their services. ConclusionTo determine the most appropriate engagement strategy, harm reduction practitioners may benefit from evaluating the levels of stigma within their community. Federal, state, and local funding and policy interventions are needed to augment stigma reduction efforts within Central Appalachia.

Prevalence and Factors of Self-medication with Antibiotics in Claiborne County, Tennessee.

Antimicrobial resistance (AMR) is a serious concern to public health, causing an estimated 35,000 deaths annually in the U.S. Misuse of antimicrobials increases the rate of AMR. Self-medication with antibiotics (SMA) is a primary contributor to AMR that can be addressed through education. SMA has been reported at rates of 3% to 66% in the U.S. but has not been evaluated in Appalachia.1 Low health literacy and barriers to accessing care have been correlated with SMA and are common in many areas of Appalachia. This study aims to assess factors associated with SMA, demographic differences in knowledge of / beliefs about SMA, and describe practices and beliefs of those who self-medicate in the Cumberland Gap region. Structured interviews were conducted in a rural health clinic and in a dental office to ascertain demographic information, knowledge of appropriate antibiotic use, and behaviors associated with self-medication. Inferential statistics (chi-squared, Fisher's exact, and ANOVA tests) were conducted. In the last 3 years, 41% of the 78 respondents had practiced SMA. A higher percentage of those who believed that antibiotics are used to treat viral infections have self-treated compared to those who did not hold that belief. Of those who SMA, convenience was the most common reason, while the common symptoms treated were congestion and fever. The current study provides a first estimate of SMA in the Central Appalachian Region and finds the prevalence to be higher than previously reported in other regions of the U.S. Future studies could include larger, more representative samples and longitudinal study designs to confirm these findings.

Multi-objective planning for food production in a mountainous region: Strategic land utilization for meeting food demand and economic revitalization

• Multi-objective planning leads to increased food production in a mountainous region • Land grading criteria are used to conserve crop diversity with limited land • Land accessibility analysis suggests potential for expandable crop production • Surplus horticultural production showed immense economic revitalization potential The mountainous landscapes and significant decline of predominate industries have made the North Central Appalachian (NCA) region vulnerable to economic shocks. Given the rugged terrain that hinders large-scale industrialization, community-supported food production can be a sustainable solution to help meet food demand and revitalize regional economy. This study evaluated the potential of strategic utilization of arable land in a mountainous region to increase niche crops production and revenue. Using West Virginia as a study area, current food production shortages were estimated to be -47% to -100% for all 30 crops. A novel multi-objective planning function that considers land slope, crop diversity, yield and sale price was developed and applied to reallocate existing and expandable arable lands for increased food production. Accessibility, a numeric measure determined by the land slope and traversable road networks, was used to delineate availability of arable lands, and the accessibility values (0.816-0.999) of the expandable arable land suggests high accessibility. Results showed that demand for horticultural crops can be extensively met (potential/demand = ∼39) by restructuring the cropland; whereas field crop gaps can be slightly ( i.e ., 0.6%) reduced with the addition of expandable land. The analyses yielded a surplus production of horticultural foods while increasing crop diversity, and showed immense potential for economic revitalization. The methodology developed in this study and the results could be used to leverage regional policymaking to significantly reduce food shortage and to enhance economic revival in the NCA and similar regions.

Climate Change Migration and the Economic Rebirth of Central Appalachia

This research examines the potential economic rebirth of the Central Appalachian Region as persons from the southwestern and southeastern parts of the United States seek a safe and livable environment for their families and businesses. Central Appalachia is projected to be the largest habitable area in the continental United States by the year 2050. However, mined land remediation, water control efforts, and hydro-electric energy generation units will be required to support the incoming population.

Impacts of the COVID-19 Pandemic on a Rural Opioid Support Services Program.

During 2020, Kentucky saw the third highest increase in overdose deaths in the U.S. Employment issues, inadequate housing, transportation problems, and childcare needs present barriers to accessing treatment in rural areas. These barriers and others (e.g., technology) arose during the pandemic negatively affecting individuals in recovery and service providers as they adjusted services to provide primarily telehealth and remote services. This study examines the impact of COVID-19 in its early stages on an opioid use disorder (OUD) support services program in a nonprofit located in rural eastern Kentucky, part of the central Appalachia region. A qualitative design was applied, employing semi-structured interviews in early fall 2020. Participants were associated with one OUD support services program, including service recipients, program coordinators, and business vendors. Guided by the Social Determinants of Health framework, two-cycle coding–descriptive coding and pattern coding–was utilized. Codes were sorted into three patterns: changes to daily life; financial impacts; and service access and provision. Overall, early stages of COVID-19 brought increased stress for individuals in recovery, as they were taking on more responsibility and navigating a changing environment. Coordinators were under pressure to provide services in a safe, timely manner. Vendors vocalized their struggles and successes related to finances. These findings can help organizations make realistic adjustments and policymakers set reasonable expectations and consider additional financial support.

Fe-Bound Organic Carbon and Sorption of Aromatic Dissolved Organic Carbon in Surface Soil: Comparing a Forest, a Cropland, and a Pasture Soil in the Central Appalachian Region, West Virginia, U.S.A

The essential roles of Fe oxides in stabilizing long-term soil organic carbon (SOC), especially aromatic dissolved organic carbon (DOCaro), are well-established in forest soils and sediments. We chose to focus on these processes in agricultural soils in which the input and translocation of native DOC to deeper soils are impacted by management practices. We quantified SOC, Fe oxide bound SOC (Fe-bound OC), and the DOCaro sorption in a forest, a cropland, and a pasture soil at 0–10 and 10–25 cm. Significantly larger amounts of Fe oxides in the cropland soil were observed compared to the forest and pasture soils at both depths (p &lt; 0.05). Land management practices and depth both significantly influenced the Fe-bound OC percentage (p &lt; 0.05). Larger maximum sorptions of DOC in the cropland (315.0 mg kg−1) and pasture (395.0 mg kg−1) soils than the forest soil (96.6 mg kg−1) at 10–25 cm weres found. DOCaro sorption decreased in the three soils at 0–10 cm (slope of −0.002 to −0.014 L2 mg−2 m−1) as well as the forest soil at 10–25 cm (−0.016 L2 mg−2 m−1) with increasing equilibrium DOC concentration. Conversely, the cropland and pasture soils at 10–25 cm increased (0.012 to 0.014 L2 mg−2 m−1). The different sorption behaviors of DOCaro in these surface soils indicate that the forest, cropland, and pasture-managed soils may have more complex and various sorption behaviors in stabilizing DOCaro and non-DOCaro.

Rainstorms Inducing Shifts of River Hydrochemistry during a Winter Season in the Central Appalachian Region

Rainstorms rapidly change catchment conditions which can alter river flow and water constituents due to the transport and fate of suspended and dissolved solids and the river water chemistry. To understand river water chemistry changes, this investigation relies on field data collected during a winter season. The Kanawha River in West Virginia was monitored using grab water samples and continuous readings from two water quality stations (Q1 and Q2) separated by 23.5 km. Water samples allowed the identification of water chemistry, whereas the two stations retrieved hourly measurements of temperature, turbidity, NO3−, Cl− and pH to capture transient rainstorm responses. It was found through the Piper diagram that water type was mainly calcium-chloride, whereas the Gibbs diagram identified that the dominant geochemical process was rock weathering. On the other hand, during transient rainstorms responses, we found that concentrations of HCO3−, NO3− and Cl− changed from bicarbonate type to no dominant type. Furthermore, hysteretic effects of rainstorms were influenced by the soil moisture of the catchment area. Additionally, HCO3− and NO3− had different hysteretic loop directions between Q1 and Q2. This approach proved that river water chemistry adjustments caused by rainstorms were successfully identified by relying on grab water samples and continuous measurements.

Maternal proximity to mountain-top removal mining and birth defects in Appalachian Kentucky, 1997-2003.

Extraction of coal through mountaintop removal mining (MTR) alters many dimensions of the landscape. Explosive blasts, exposed rock, and coal washing have the potential to pollute air and water. Previous research suggests that infants born to mothers living in areas with MTR have a higher prevalence of birth defects. In this cross-sectional study, we further examine the relationship between MTR activity and several types of birth defects. Maternal exposure to MTR was assessed using remote sensing data from Skytruth, which captures MTR activity in the Central Appalachian region of the United States. Active MTR area was quantified within a five-kilometer buffer surrounding geocoded maternal address captured on birth records for live births to Appalachian Kentucky mothers between 1997 and 2003 (N = 95,581). We assigned high, medium, and low exposure based on the tertile of total MTR area within 5-km, and births with no MTR within this buffer were assigned zero exposure. The presence or absence of a birth defect grouped into six major organ systems was identified using birth records alone. Finally, we applied conditional multiple imputation for variables with missing values before conducting separate multivariable log-binomial regression models for each birth defect group. Prevalence ratio (PR) estimates were adjusted for individual level covariates from birth records. The prevalence of gastro-intestinal defects was significantly higher in birth records with high and low active MTR exposure compared to records with no exposure. (High exposure: PR = 1.99, 95% CI = 1.14–3.47; low exposure PR = 1.88, 95% CI = 1.06–3.31). This study supports some of the existing findings of previous ecological studies. Research addressing the relationship between gastro-intestinal birth defects and MTR coal mining is warranted but should carefully consider temporal dimensions of exposure.

Thermogravimetric Analysis of Respirable Coal Mine Dust for Simple Source Apportionment

ABSTRACT Resurgence of coal mine dust lung diseases in the central Appalachian region of the United States and elsewhere has spurred a range of efforts to better understand respirable coal mine dust (RCMD) exposures and sources. Thermogravimetric analysis (TGA) of RCMD samples can enable the dust mass to be fractionated into three main components: coal, non-carbonate minerals, and carbonates. These are expected to approximate, respectively, the three primary dust sources in many underground mines: the coal seam being mined, the surrounding rock strata (i.e., typically dominated by non-carbonate minerals) being drilled or mined along with the coal, and the rock dust products (i.e., typically made from carbonate-rich limestone or dolostone) being applied in the mine to mitigate explosibility hazards. As proof of concept, TGA was applied to respirable dust samples that were laboratory-generated from real source materials representing 15 mines. Except in the case of two mines, compositional results were generally consistent with expectations. TGA was also applied to RCMD samples collected in standard locations of 23 mines (including the 15 mines represented by the dust source materials). Results showed significantly different compositions with respect to sampling location and geographic region (i.e., within and outside of central Appalachia). To further interpret the RCMD results, a simple source apportionment model was built using the dust compositions yielded from the source materials analysis. Model results indicated that, on average, about twice as much dust was sourced from mining into rock strata than from mining the target coal seam. This finding is particularly important for mines extracting relatively large amounts of rock along with the coal or for mines that frequently encounter high-silica rock strata.

The Economic Impact of a Renewable Biofuels/Energy Industry Supply Chain Using the Renewable Energy Economic Analysis Layers Modeling System

The University of Tennessee’s (UT) Department of Agricultural and Resource Economics models supply chains for both liquid and electricity generating technologies currently in use and/or forthcoming for the bio/renewable energy industry using the input–output model IMPLAN®. The approach for ethanol, biodiesel, and other liquid fuels includes the establishment and production of the feedstock, transportation of the feedstock to the plant gate, and the one-time investment as well as annual operating of the facility that converts the feedstock to a biofuel. This modeling approach may also include the preprocessing and storage of feedstocks at depots. Labor/salary requirements and renewable identification number (RIN) values and credits attributable to the conversion facility, along with land-use changes for growing the feedstock are also included in the supply chain analyses. The investment and annual operating of renewable energy technologies for electricity generation for wind, solar, and digesters are modeled as well. Recent modeling emphasis has centered on the supply chain for liquid fuels using the Bureau of Economic Analysis’s 179 economic trading areas as modeling regions. These various data layers necessary to estimate the economic impact are contained in UT’s renewable energy economic analysis layers (REEAL) modeling system. This analysis provides an example scenario to demonstrate REEAL’s modeling capabilities. The conversion technology modeled is a gasification Fischer–Tropsch biorefinery with feedstock input of 495,000 metric tons per year of forest residue transported to a logging road that is less than one mile in distance. The biorefinery is expected to produce sustainable aviation fuel (SAF), diesel, and naphtha. An estimated one million tons of forest residue are required at fifty percent moisture content. Based on a technical economic assessment (TEA) developed by the Aviation Sustainability Center (ASCENT) and the quantity of hardwood residues available in the Central Appalachian region, three biorefineries could be sited each utilizing 495,000 dry metric tons per year. Each biorefinery could produce 47.5 million liters of SAF, 40.3 million liters of diesel, and 23.6 million liters of naphtha. Annual gross revenues for fuel required for the biorefineries to break even are estimated at $193.7 million per biorefinery. Break-even plant gate fuel prices when assuming RINs and 12.2 percent return on investment are $1.12 per liter for SAF, $1.15 per liter for diesel, and $0.97 per liter for naphtha. Based on IMPLAN, an input–output model, and an investment of $1.7 billion, the estimated economic annual impact to the Central Appalachian region if the three biorefineries are sited is over a half a billion dollars. Leakages occur as investment dollars leaving the region based on the regions local purchase coefficients (i.e., LPPs), which totals $500 million. This results in an estimated $2.67 billion in economic activity with a multiplier of 1.7, or for every million dollars spent, an additional $0.7 million in economic activity is generated in the regional economy. Gross regional product is estimated at $1.28 billion and employment of nearly 1,200 jobs are created during the construction period of the biorefineries, which results in $700 million in labor income with multiplier effects. Economic activity for the feedstock operations (harvesting and chipping) is estimated at slightly more than $16.8 million resulting in an additional $30 million in the economic impact. The stumpage and additional profit occurring from the harvest of the forest residues result in $40 million directly into the pockets of the resource and logging operation owners. Their subsequent expenditures resulted in a total economic activity increase of $71.4 million. These operations result in creating an estimated 103 direct jobs for a total of 195 with multiplier effects. Direct feedstock transportation expenditures of more than $36.7 million provide an estimated increase in economic activity of almost $68 million accounting for the multiplier effects.