Maryland Community Research Articles

Posttraumatic Epilepsy and Dementia Risk

Although both head injury and epilepsy are associated with long-term dementia risk, posttraumatic epilepsy (PTE) has only been evaluated in association with short-term cognitive outcomes. To investigate associations of PTE with dementia risk. The Atherosclerosis Risk in Communities (ARIC) study initially enrolled participants from 1987 to 1989 and this prospective cohort study uses data through December 31, 2019, with a median follow-up of 25 years. Data were analyzed between March 14, 2023, and January 2, 2024. The study took place in 4 US communities in Minnesota, Maryland, North Carolina, and Mississippi. Of 15 792 ARIC study participants initially enrolled, 2061 were ineligible and 1173 were excluded for missing data, resulting in 12 558 included participants. Head injury was defined by self-report and International Classification of Diseases (ICD) diagnostic codes. Seizure/epilepsy was defined using ICD codes. PTE was defined as a diagnosis of seizure/epilepsy occurring more than 7 days after head injury. Head injury, seizure/epilepsy, and PTE were analyzed as time-varying exposures. Dementia was defined using cognitive assessments, informant interviews, and ICD and death certificate codes. Adjusted Cox and Fine and Gray proportional hazards models were used to estimate dementia risk. Participants had a mean (SD) age of 54.3 (5.8) years at baseline, 57.7% were female, 28.2% were of self-reported Black race, 14.4% were ultimately categorized as having head injury, 5.1% as having seizure/epilepsy, and 1.2% as having PTE. Over a median follow-up of 25 (25th to 75th percentile, 17-30) years, 19.9% developed dementia. In fully adjusted models, compared with no head injury and no seizure/epilepsy, PTE was associated with 4.56 (95% CI, 4.49-5.95) times the risk of dementia, while seizure/epilepsy was associated with 2.61 (95% CI, 2.21-3.07) times the risk and head injury with 1.63 (95% CI, 1.47-1.80) times the risk. The risk of dementia associated with PTE was significantly higher than the risk associated with head injury alone and with nontraumatic seizure/epilepsy alone. Results were slightly attenuated in models accounting for the competing risks of mortality and stroke, but patterns of association remained similar. In secondary analyses, the increased dementia risk associated with PTE occurring after first vs second head injury and after mild vs moderate/severe injury was similar. In this community-based cohort, there was an increased risk of dementia associated with PTE that was significantly higher than the risk associated with head injury or seizure/epilepsy alone. These findings provide evidence that PTE is associated with long-term outcomes and supports both the prevention of head injuries via public health measures and further research into the underlying mechanisms and the risk factors for the development of PTE, so that efforts can also be focused on the prevention of PTE after a head injury.

Gauging the stress of long-term care nursing assistants using ecological momentary assessment, wearable sensors and end of day reconstruction.

Nursing assistants working in long-term care (LTC) often report that their job is stressful. To reduce their work stress, a better understanding of their stress profile is needed. We aimed to pilot test methods to identify and understand stressors that LTC nursing assistants experience. We asked each participant to provide wearable sensor/watch data, ecological momentary assessment (EMA) surveys and end of day review data over two eight-hour working shifts. Eight nursing assistants participated. All participants worked in a common continuing care retirement community in Maryland, United States of America. Our stress assessment method revealed 83 stressful events that were classified under 10 categories. Most of the reported events were rated as having a mild to low-moderate intensity. The three most common causes of stress were work demands and pressure (28.35%), heavy workload and staffing (19.69%), and safety issues and COVID-19 concerns (17.32%). We also explored the difference between stress events and intensity among different shifts. Disrespect from residents (22.73%) was the most commonly reported stressor during day shifts. Feeling rushed was the most commonly reported stressor during the evening (22.47%) and the night (38.46%) shifts. We found stress was commonly reported. Stress intensity conflicted with prior literature, and we explored possible explanations. We discuss potential implications for these findings, modification of our methods to increase feasibility, the utility of these data collection methods for future work and suggest next steps.

Assessing suboxone access in community pharmacies: Secret shopper model

ObjectiveTo assess whether Maryland community pharmacies had Suboxone available for dispensing. MethodsThis cross-sectional study used a secret shopper model to contact public-facing community pharmacies in Maryland. The secret shopper, guided by a script, asked whether a prescription for Suboxone was available for the same or next day pick-up. A small convenience sample of pharmacies who did not have Suboxone available received an in-person visit to inquire about medication availability and dispensing barriers. ResultsAfter contacting 99% (n = 1046) of Maryland public-facing pharmacies, Suboxone was confirmed available for immediate pick-up in 31% (n = 326). The remaining did not have, would not disclose, or had limited access (existing patients or specific providers only). Significant differences in Suboxone availability were found for National Capital vs. Baltimore metro region and when pharmacist asked questions vs. no questions. Of the 11 pharmacy visits completed, 10 said they had Suboxone currently in stock, with one clarifying medication was for existing patients only. ConclusionAbout 69% of patients may face challenges when calling to find out whether they can obtain Suboxone in Maryland pharmacies. Better patient education and more thorough pharmacy-level investigation of system and workflow barriers could offer solutions.

P24-097-23 Children's Perceived Social Support and Its Impact on Household Food Insecurity and Obesity Risk Over Time in an Under-Resourced Baltimore, Maryland Community

P24-097-23 Children's Perceived Social Support and Its Impact on Household Food Insecurity and Obesity Risk Over Time in an Under-Resourced Baltimore, Maryland Community

Head Injury and Long-term Mortality Risk in Community-Dwelling Adults

Head injury is associated with significant short-term morbidity and mortality. Research regarding the implications of head injury for long-term survival in community-dwelling adults remains limited. To evaluate the association of head injury with long-term all-cause mortality risk among community-dwelling adults, with consideration of head injury frequency and severity. This cohort study included participants with and without head injury in the Atherosclerosis Risk in Communities (ARIC) study, an ongoing prospective cohort study with follow-up from 1987 through 2019 in 4 US communities in Minnesota, Maryland, North Carolina, and Mississippi. Of 15 792 ARIC participants initially enrolled, 1957 were ineligible due to self-reported head injury at baseline; 103 participants not of Black or White race and Black participants at the Minnesota and Maryland field centers were excluded due to race-site aliasing; and an additional 695 participants with missing head injury date or covariate data were excluded, resulting in 13 037 eligible participants. Head injury frequency and severity, as defined via self-report in response to interview questions and via hospital-based International Classification of Diseases diagnostic codes (with head injury severity defined in the subset of head injury cases identified using these codes). Head injury was analyzed as a time-varying exposure. All-cause mortality was ascertained via linkage to the National Death Index. Data were analyzed between August 5, 2021, and October 23, 2022. More than one-half of participants were female (57.7%; 42.3% men), 27.9% were Black (72.1% White), and the median age at baseline was 54 years (IQR, 49-59 years). Median follow-up time was 27.0 years (IQR, 17.6-30.5 years). Head injuries occurred among 2402 participants (18.4%), most of which were classified as mild. The hazard ratio (HR) for all-cause mortality among individuals with head injury was 1.99 (95% CI, 1.88-2.11) compared with those with no head injury, with evidence of a dose-dependent association with head injury frequency (1 head injury: HR, 1.66 [95% CI, 1.56-1.77]; 2 or more head injuries: HR, 2.11 [95% CI, 1.89-2.37]) and severity (mild: HR, 2.16 [95% CI, 2.01-2.31]; moderate, severe, or penetrating: HR, 2.87 [95% CI, 2.55-3.22]). Estimates were similar by sex and race, with attenuated associations among individuals aged 54 years or older at baseline. In this community-based cohort with more than 3 decades of longitudinal follow-up, head injury was associated with decreased long-term survival time in a dose-dependent manner, underscoring the importance of measures aimed at prevention and clinical interventions to reduce morbidity and mortality due to head injury.

“Backwards Talk” in Smith Island, Maryland

This article presents an exploration of the discourse-level phenomenon known as “backwards talk” (pervasive, highly creative irony) in Smith Island, a small, endangered dialect community in Maryland’s Chesapeake Bay, on the U.S. mid-Atlantic coast. For example, island residents might use the phrase “He’s barefoot!” to indicate someone’s shiny new shoes. The article examines how this phenomenon compares with irony more generally; how it patterns across generations and contexts; how important it is to island residents, who view backwards talk as the defining feature of their dialect; and why the feature has gained such importance in the face of dialect loss—and potential loss of community continuity as well. Because backwards talk is irony, it has important solidarity functions. As playful, nonliteral language, it serves as a symbol of the performed “islandness” that islanders increasingly take up as they come into more and more contact with outsiders. Finally, as a means of offering critical evaluation of outsiders, backwards talk can be seen as a form of antilanguage or counterlanguage, with a central function of resistance against outside forces.

Building a Curriculum to Foster Global Competence and Promote the Public Interest: Social Entrepreneurship and Digital Skills for American Community College Students

ABSTRACT This paper proposes a new approach for combining top-down and bottom-up approaches intended to lead to a curriculum for action in the public interest that builds on social entrepreneurship and digital skills for students at community colleges. This integrated approach requires a collaborative, participatory approach and aims to provide relevant content for students with different cultures and backgrounds, personal values, and sense of identity. The objective is for all participants to engage in the learning process, become more confident, and develop contemporary skills that inspire and enable them to take initiatives to tackle global challenges and to thrive in a multicultural world. A relevant curriculum must enable students to understand the global and local situations in different geographies and, with the increasing demand for digital skills, to access and share information over networks, to develop possible solutions, and to make them happen. This paper proposes ideas for stimulating students to think about what they can do for the public good, starting with local issues, and to generate outcomes valued by the community. The ideas proposed for specific local communities in Maryland can be generalized for understanding and addressing problems for different communities in the United States as well.

My First 51 Years Teaching Microbiology at The Community College of Baltimore County

I have had just one job interview in my life and it was for the position of Biology Instructor at Catonsville Community College. Having just completed my M.S. Degree at Northern Illinois University, I knew I needed employment because I was moving to Maryland prior to September 1970. After enquiring about the possibility of a teaching position at 4 Maryland community colleges, I was granted an interview at Catonsville Community College. On May 4, 1970, I found myself driving from Illinois to Maryland for a real job interview. I remember the date because I was listening on my car radio to the aftermath of the Kent State shooting earlier that day. The interview apparently went well because I was offered the position beginning in September for the amazing salary of $10,000! My professional life had begun. Armed with little more than a love of microbiology and a lot of patience and desire, I began the journey to hopefully become the best microbiology educator of which I am capable. Fifty-one years later I am still striving for that goal.

Mental health care among marginalized populations in the United States

Mental health care among marginalized populations in the United States

125 A forage-based educational needs assessment for equine operations in Maryland

The objective of this project was to collect and formally document information on the forage-based educational needs, preferences, and challenges for equine operations in Maryland. To accomplish this, a needs assessment survey was conducted online using Qualtrics TM during April/May 2020. The survey was open to all equine owners and managers and consisted of 36 questions designed to collect information on educational preferences, management practices, and forage-related challenges or successes. The survey was completed by 47 respondents within the equine industry. Most respondents were female (64%) and 35 to 64 years old (76%). Most respondents owned or managed 1 to 25 equids (90%), and many had been involved in the industry for more than 20 years (44%). The most common grazing method was simple rotational grazing (rotation every 3–10 d; 54%), followed by continuous pasture (no rotation; 38%). Pasture supplied 51 to 75% of their horses’ forage intake for 44% of respondents and 26 to 50% of forage intake for 29% of respondents. Only 17% of respondents had completed a forage analysis within the last 2 years, while 71% of respondents completed regular soil testing (every 3 years or less). Rank-type questions were used to determine preferred educational resources and formats (including both in-person and online options), topics of interest, and forage-related challenges; questions were analyzed on a scale of 1 to 4, with 1 indicating no value/interest or least challenging and 4 indicating a high value/interest or most challenging. Respondents used a variety of resources to obtain forage-related information, with other owners receiving the highest rating (3.11), followed by internet websites (2.94) and local farm suppliers/dealers (2.89). The most preferred formats for receiving information were internet webpages (2.94), online videos (2.89), and newsletters (2.81). Interest was greater for topics pertaining to grazing/pasture management and soil health/fertility compared with forage/hay production. Specifically, respondents showed the greatest interest in education on weed control (3.62), extending the grazing season (3.45), fertilization practices (3.30), and grazing management for utilizing spring growth (3.23) and combating the summer slump (3.23). When asked to identify limitations to improving forage production, a lack of adequate time or labor (2.55) and a lack of machinery or equipment (2.40) were listed as most limiting. The results of this assessment will be used to help Extension educators generate more effective forage-related educational programming to better meet the needs of the equine community in Maryland.

Pharmacogenomic Testing to Inform Prescribing in Patients with Behavioral and Psychiatric Symptoms of Dementia (BPSD): Results from Two Small, Randomized, Controlled Trials

<h3>Introduction</h3> Behavioral and psychiatric symptoms of dementia (BPSD) occur frequently, representing a significant driver of the total costs of dementia in the US. Although antidepressants and atypical antipsychotics are often used in BPSD, they have limited effectiveness and significant toxicity. As a result, recent initiatives have focused on reducing polypharmacy and psychotropic prescribing in this population. Combinatorial pharmacogenomic testing has demonstrated utility in guiding prescribing for psychotropic medications in patients with depression by identifying medications unlikely to be safe or effective due to significant gene-drug interactions. Here we present data from two small, randomized, controlled trials (RCTs) designed to test the hypothesis that combinatorial pharmacogenomic testing could aid in treatment selection for BPSD. <h3>Methods</h3> The first RCT included residents being treated at the Bayleigh Chance retirement community in Maryland (inpatient RCT). The second RCT included patients from the University of Alabama at Birmingham Memory Disorders Clinic (outpatient RCT). Patients were eligible if they had a diagnosis of dementia with psychotic symptoms and/or behavioral disturbance and their condition was severe enough to trigger a consultation with a physician (inpatient RCT) or their physician was considering starting/changing a psychotropic medication (outpatient RCT). For the outpatient RCT, patients were also required to have a caregiver who spends at least 10 hours a week with them. Informed consent was obtained at the screening visit from patients' legally authorized representatives. The inpatient RCT intended to enroll 50 patients and the outpatient RCT intended to enroll 100 patients. Both studies were stopped early due to slow enrollment. Patients were randomized 1:1 to treatment as usual (TAU) or the combinatorial pharmacogenomic-guided care arm. All patients received combinatorial pharmacogenomic testing (GeneSight, Assurex Health). Variants in multiple pharmacokinetic and pharmacodynamic genes were assessed and a weighted combinatorial algorithm categorized medications according to the level of predicted gene-drug interactions (GDI). For patients in the guided-care arm, physicians had access to the test report at the time of the baseline visit. Physicians were blinded to the test report until after the trial for patients in TAU. Assessments were performed at baseline, week 2 (AEs only, inpatient RCT only), week 4 (outpatient RCT only), week 8, and week 12. The primary outcome was the Neuropsychiatric Inventory (NPI), which assesses the presence and severity of BPSD across 12 domains. The nursing home version (NPI-NH) was used for the inpatient RCT and the NPI questionnaire (NPI-Q) was used for the outpatient RCT. A Mixed Model for Repeated Measures (MMRM) was utilized to evaluate NPI and included treatment, week, treatment-by-week interaction, baseline score, baseline score-by-week interaction as fixed effects. The presence of a condition (i.e. depression) was evaluated as a score >0 for the relevant domain on the NPI. Side effects were evaluated using the SA-EPS and MOSES scale (inpatient RCT) or the FIBSER scale (outpatient RCT). Changes in prescribing relative to a pre-test intended medication plan were evaluated in the outpatient RCT. <h3>Results</h3> A total of 12 patients were enrolled in the inpatient RCT (5 in TAU; 7 in guided-care) and 38 patients were enrolled in the outpatient RCT (19 in TAU; 19 in guided-care). At week 12, there were no significant differences in NPI or side effects between guided-care and TAU in either RCT (Table 1). However, the proportion of outpatients experiencing depression at week 12 was significantly lower in the guided-care arm versus TAU (p=0.0479). In the outpatient RCT, the proportion of patients prescribed at least one medication subject to GDI decreased from 58.8% (pre-test) to 25.0% (week 12) in the guided-care arm (Table 2). In contrast, there was an increase in the proportion of patients in TAU taking medications subject to GDI throughout the trial. A significantly higher proportion of patients in the guided-care arm had a reduction in the number of prescribed psychotropic medications by week 12 compared to TAU (Table 2). <h3>Conclusions</h3> Overall, there were no observed differences in overall neuropsychiatric symptoms or side effects among inpatients or outpatients who received pharmacogenomic-guided care compared to TAU. It should be noted that these studies were stopped early due to slow enrollment and were likely underpowered to detect any differences. However, there was a significant reduction in the proportion of outpatients with depression in the guided care arm, which is consistent with the validated use of combinatorial pharmacogenomic testing among patients with depression. There was also evidence that pharmacogenomic-guided care did inform prescribing, with reduced prescribing of medications subject to GDI and reduced psychotropic medication polypharmacy. <h3>Funding</h3> Myriad Neuroscience (Formerly Assurex Health)

COVID-19 Prevalence, Risk Perceptions, and Preventive Behavior in Asymptomatic Latino Population: A Cross-Sectional Study.

AimsTo determine the prevalence, level of coronavirus disease 2019 (COVID-19) risk perception attitude and preventive behavior implemented by the Latino population in the United States of America (USA).MethodsThis cross-sectional study was conducted between July 25 and August 25, 2020, and included asymptomatic Latino participants (n=410) with no current/previous COVID-19 within a religious community in Maryland. Participants answered a questionnaire consisting of three components: patient demographics/socioeconomic status, COVID-19 risk perception, and precautionary behavior. Additionally, a focused history taking and physical examination were performed, and nasal swabs for COVID-19 testing were obtained.ResultsAround 80% of our study population was 35 years and older, considerably healthy, with only about a third reporting history of chronic disease (~80%); most were females (~66%). Of our participants, 90% lived under poverty; only ~6% had made it to college. When asked about the likelihood of acquiring COVID-19, 97.3% stated they have a low risk of getting infected. However, as we asked about the risk of individuals living in their neighborhood, state, and country, the rates changed to moderate to high (78.4%, 86.3%, and 86.6%, respectively). When asked about preventive behavior, 71.2% stated they never wear masks and 85.4% mentioned they never keep social distance. Additionally, 76 (18.5%) tested positive for COVID-19, whereas 64 (84.2%) developed symptoms at follow-up, 57 (75%) were hospitalized, and 4 (5.2%) died.ConclusionsOur study identified inadequate COVID-19 threat perception and lack of engagement in preventive behavior among a group of Latinos living in the USA. We believe that Latino communities across the USA are at markedly high risk of acquiring, spreading, and dying of COVID-19.

Sharing the cure: Building primary care and public health infrastructure to improve the hepatitis C care continuum in Maryland.

In 2014, trained healthcare provider capacity was insufficient to deliver care to an estimated 70 000 persons in Maryland with chronic hepatitis C virus (HCV) infection. The goal of Maryland Community Based Programs to Test and Cure Hepatitis C, a public health implementation project, was to improve HCV treatment access by expanding the workforce. Sharing the Cure (STC) was a package of services deployed 10/1/14-9/30/18 that included enhanced information technology and public health infrastructure, primary care provider training and practice transformation. Nine primary care sites enrolled. HCV clinical outcomes were documented among individuals who presented for care at sites and met criteria for HCV testing including risk factor or birth cohort (born between 1945 and 1965) based testing. Fifty-three providers completed the STC training. STC providers identified 3237 HCV antibody-positive patients of which 2624 (81%) were RNA+. Of those HCV RNA+, 1739 (66%) were staged, 932 (36%) were prescribed treatment, 838 (32%) started treatment, 721 (27%) completed treatment and 543 (21%) achieved cure. Among 1739 patients staged, 693 (40%) patients had a liver fibrosis assessment score<F2, rendering them ineligible for treatment under Maryland Medicaid guidelines. HCV RNA testing among HCV antibody-positive people increased from 40% (baseline) to 95% among STC providers. Of 554 patients with virologic data reported, 543 (98%) achieved cure. Primary care practices can effectively serve as HCV treatment centers to expand treatment access. However, criteria by insurance providers in Maryland were a major barrier to treatment.

Small and Minority Farmers' Knowledge and Resource Sharing Networks, and Farm Sales: Findings from Communities in Tennessee, Maryland, and Delaware

A network analysis can quantify the depth and breadth of a farmer’s relationships with other local farmers, buyers and sellers, or other groups and organizations. Such an analysis can potentially also reveal farmers’ incentives, situations, and behaviors, and it may explain their economic success more generally. This study examines small and minority farmers’ networks using a primary survey in three farming communities. We emphasize networks related to production, marketing, and resource-sharing activities of 127 farmers (nodes) in Tennessee, 46 in Maryland, and 23 in Delaware, and compute three different measures of network importance or “centrality” for each farmer. We then use generalized least squares analysis relating farmer’s age, gender, race, educational attainment, labor use on the farm, and farm location to the farmer’s centrality position or importance in the network, defined by number and strength of links or connections. In additional regression analyses, we find significantly positive effects of the centrality position on farm sales of specialty crops: our model predicts that a farmer who adds one additional link or connection can expect a 19% to 25% increase in sales, all else equal. Our results can potentially be used not only to disseminate information more efficiently, but also to identify farm­ers who would benefit the most from more targeted extension services. See the press release for this article.

Implementing Value-Based Primary Care Delivery in Federally Qualified Health Centers.

Federally Qualified Health Centers (FQHCs), like many health systems, are in transition toward alternative/advanced payment and reimbursement models. Gradually, fee-for-service reimbursements will be replaced by value-based payments with shared accountability for patients' health care outcomes. This article provides a description of an FQHC Primary Care Collaborative (FPCC) model and preliminary outcomes. This collaborative is an advanced payment model resulting from a partnership between Priority Partners Managed Care Organization (PPMCO), Maryland Community Health System, LLP, and 7 Maryland FQHCs. The FPCC model builds on shared measurable health care outcomes to establish an advanced care delivery model that is tailored to the needs of providers and their patients. PPMCO provided prospective payments to the 7 FQHCs based on their patient population size and total historical cost. Each FQHC had specific health outcomes targets for each fiscal year (FY) to maintain funding. Although FQHC implementation approaches varied, the FQHCs used their payments primarily for outreach and care coordination resources, and to develop processes and structures to improve care delivery outcomes. A 3-year assessment of this program revealed a 35% reduction in emergency department visits and an 11% reduction in hospitalizations for Medicaid beneficiaries across all 7 FQHCs. The FPCC 3-year investment of $4.4M yielded a cumulative cost savings of $19.4M, resulting in a cumulative 3:1 return on investment. There is limited evidence for implementation and outcomes of non-state, Medicaid payer-specific, advanced payment models in FQHCs. This article provides a collaborative framework other Medicaid managed care organizations can adopt and build on.

How Can There Be No History?

Many African American communities in Maryland have been free since before emancipation. Members of these communities have been disfranchised through silence, denial, condemnation of properties, and through the use of eminent domain. The Hill Community of Easton, Maryland, was founded shortly after the American Revolution and remains a vital environment into the present. The town of Easton and Talbot County produced Frederick Douglass, aided Harriet Tubman who came from nearby Dorchester County, and also produced many White families who supported the Confederate South and the continuation of slavery. This article uses five summers of archaeological work on the Hill performed in concert with the descendant communities to knit together political needs, historical documentation compiled by local scholars, oral presentations, and members of the University of Maryland’s Archaeology in Annapolis to outline a history and alternative analysis for the remnants of slavery and racism often found on Maryland’s Eastern Shore. We use Slovaj Žižek to find an answer to the question in our title: How can there be no history?

Characterizing the benthic community in Maryland's offshore wind energy areas using a towed camera sled: Developing a method to reduce the effort of image analysis and community description.

Offshore wind farms are a crucial component for the improvement of renewable energy in the United States. The Bureau of Ocean Energy Management (BOEM) designated ~170 km2 of shelf area for wind energy development off the coast of Maryland, USA. In order to understand potential environmental impacts of wind turbine installation on the benthic ecosystem within the designated area, we conducted a study to visually characterize bottom habitats and epibenthic communities in the Mid-Atlantic Outer Continental Shelf blocks of the Maryland wind energy area. Seven 5 km long transects were sampled using a towed camera sled with a downward-facing digital camera that captured images at 5 frames·s-1s. Additional small-mesh beam trawling was also conducted at selected locations complementary for species identification. Image data were analyzed using two image selection methods, random and systematic (i.e. video frames were selected at various intervals). For both methods, estimates of community diversity (Hill’s N2) stabilized with sample sizes ranging from 316 to 398 frames. Our results allowed us to define distinct epibenthic communities and bottom habitats that are associated with offshore wind energy sites and to develop a sampling technique for digital images that can be applied to other research programs.

Management: A Community of Collaboration

Most of us are familiar with the scenario of institutional belt-tightening and the effect that it sometimes has on staffing. Reductions and reallocations of human resources can make it difficult to accomplish our work and can affect morale—but not always. In this column, Andie Craley describes the net positives of that experience at her institution. While still facing the reality of doing more with less, Craley identifies how its inherent challenges can present definite opportunities and foster a community of collaboration.—EditorHaving started as a library technician at Harford Community College Library (HCC Library) just seventeen years ago, I already find myself the third in seniority. Library staff size seems to diminish as additional job functions are assimilated into existing positions, reallocated as new library services are introduced, redeployed to other departments, or completely eliminated as staff retire or resign. The concept of wearing many hats is common, as is the expectation to take on “other duties as assigned.” From networking with colleagues at other Maryland community college libraries, I know this situation is not unique. The current staffing reality both mirrors the evolution of the library’s facilities and demands doing more with less, but it also provides individual and collective opportunities for growth, supporting a community of collaboration.

Slavery and the Early Sulpician Community in Maryland

Slavery and the Early Sulpician Community in Maryland

Primary Care Where Everybody Knows Your Name.

In Maryland communities such as Annapolis, Health Enterprise Zones have spurred investment and experimentation in care delivery.