Ohio Counties Research Articles

Evaluating fentanyl test strips as a harm reduction strategy in rural and urban counties: study protocol for a randomized controlled trial

BackgroundOpioid-related fatalities are a leading cause of death in Ohio and nationally, with an increasing number of overdoses attributable to fentanyl. Rapid fentanyl test strips can identify fentanyl and some fentanyl analogs in urine samples and are increasingly being used to check illicit drugs for fentanyl before they are used. Fentanyl test strips are a promising harm reduction strategy; however, little is known about the real-world acceptability and impact of fentanyl test strip use. This study investigates fentanyl test strip distribution and education as a harm reduction strategy to prevent overdoses among people who use drugs.MethodsThe research team will recruit 2400 individuals ≥ 18 years with self-reported use of illicit drugs or drugs purchased on the street within the past 6 months. Recruitment will occur at opioid overdose education and naloxone distribution programs in 16 urban and 12 rural Ohio counties. Participating sites will be randomized at the county level to the intervention or non-intervention study arm. A brief fentanyl test strip educational intervention and fentanyl test strips will be provided to participants recruited from sites in the intervention arm. These participants will be eligible to receive additional fentanyl test strips for 2 years post-enrollment. Participants recruited from sites in the non-intervention arm will not receive fentanyl test strip education or fentanyl test strips. All participants will be followed for 2 years post-enrollment using biweekly, quarterly, and 6-month surveys. Primary outcomes include (1) identification of perceived barriers and facilitating factors associated with incorporating fentanyl test strip education and distribution into opioid overdose education and naloxone distribution programs; (2) differences in knowledge and self-efficacy regarding how to test drugs for fentanyl and strategies for reducing overdose risk between the intervention and non-intervention groups; and (3) differences in non-fatal and fatal overdose rates between the intervention and non-intervention groups.DiscussionFindings from this cluster randomized controlled trial will contribute valuable information about the feasibility, acceptability, and impact of integrating fentanyl test strip drug checking in rural and urban communities in Ohio and help guide future overdose prevention interventions.Trial registrationClinicalTrials.gov NCT05463341. Registered on July 19, 2022. https://clinicaltrials.gov/study/NCT05463341

Influences of social networks, demographics, and evacuation duration on evacuation decisions: Insights from Ohio and Pennsylvania

Understanding post-hazard evacuation decisions poses challenges due to the complex interplay between individual behaviors and community influences. This study investigates the evacuation decisions made by residents from three counties of Ohio and Pennsylvania, correlating their choices with various sociodemographic and behavioral factors. By analyzing diverse evacuation durations—spanning a week, two months, and a permanent period—the research identifies patterns in distance preference, influenced by attributes such as gender, race, social networks, and travel habits. Evacuation duration emerged as a significant predictor of the distance traveled, with prolonged durations leading to farther evacuations. The research highlights the importance of leveraging local social networks for effective communication during hazards and informs policy recommendations for tailored evacuation advisories and inter-state evacuation collaborations.

Community-Engaged Data Science (CEDS): A Case Study of Working with Communities to Use Data to Inform Change

Data-informed decision making is a critical goal for many community-based public health research initiatives. However, community partners often encounter challenges when interacting with data. The Community-Engaged Data Science (CEDS) model offers a goal-oriented, iterative guide for communities to collaborate with research data scientists through data ambassadors. This study presents a case study of CEDS applied to research on the opioid epidemic in 18 counties in Ohio as part of the HEALing Communities Study (HCS). Data ambassadors provided a pivotal role in empowering community coalitions to translate data into action using key steps of CEDS which included: data landscapes identifying available data in the community; data action plans from logic models based on community data needs and gaps of data; data collection/sharing agreements; and data systems including portals and dashboards. Throughout the CEDS process, data ambassadors emphasized sustainable data workflows, supporting continued data engagement beyond the HCS. The implementation of CEDS in Ohio underscored the importance of relationship building, timing of implementation, understanding communities’ data preferences, and flexibility when working with communities. Researchers should consider implementing CEDS and integrating a data ambassador in community-based research to enhance community data engagement and drive data-informed interventions to improve public health outcomes.

Comments: Pore Space Leasing: Insights From a Bakken Surface Owner’s Perspective

During a trip to western North Dakota last month to visit my family, I met with a long-time friend, Dick, who holds subsurface mineral rights and surface rights in the Bakken area. Over coffee, German sausage, and kuchen, our conversation naturally turned to the leasing of pore space. Dick has lately been approached by landmen with what they describe as “great deals” for purchasing the underlying pore space associated with his surface rights. They hesitate to provide specific offers. Instead, he described the initial interactions as “like making a deal for a new car or tractor.” The landmen reply, “I’ll need to go back to the client [my boss or manager] with your questions.” Sound familiar? Like most US states, pore space ownership correlates with surface ownership in North Dakota. In August 2022, the North Dakota Supreme Court clarified the rights of surface owners and the need for compensation for pore space use. It also created uncertainty for oil and gas operators who previously had more latitude in using pore space without compensation. Dick knows his way around the dealmaking involved in oil and gas rights leasing, having been involved in many landmen inquiries in the days of the Bakken boom and subsequent wheeling and dealing. However, pore space leasing is relatively nascent and faces similar unknowns like the early days of Bakken pitches. During his research, he came up against the same walls I have over the years while writing about pore space leasing for carbon sequestration. Becoming more apparent as deals gain momentum is the lack of specifics for comparable deals. As when purchasing a home, identifying “comps” for similar properties is a necessary part of the process. But the amounts paid for pore space are closely held, generally not publicly available. It’s impossible to determine if a deal is good or bad. Is the compensation fair? And individual surface owners and landowners rights associations (and/or their attorneys) are aware of the 45Q tax credit of $85/tonne of CO2 captured and stored available to the project developer/operator under the 2022 US Inflation Reduction Act. How should this be factored into the determination of fair compensation? For example, the Ohio River Valley Institute (ORVI), a think tank focused on the Appalachian region, in March described a proposal by Tenaska Inc. to lease underground pore space across seven counties (approximately 80,000 acres) in Ohio, Pennsylvania, and West Virginia for the sequestering of 150 million tons of CO2. In a document proposing terms for the acquisition of nearly 1,400 acres of pore space in county parklands in Washington County, Pennsylvania, Tenaska offered about $4 million for the county’s 2.6-million-metric-ton share of the CO2 between 2027 and 2056, or about $1.50 per metric ton. The ORVI called the deal “ridiculous and borderline insulting.” It supports this declaration by highlighting a comp available from August 2023. Mountaineer GigaSystem LLC offered the state of West Virginia a royalty of $3.35 per metric ton to sequester CO2 on public land in Mason County—more than two times what Tenaska is offering Washington County. It also made the point that the ultimate cost of capturing and sequestering the CO2 will not be borne by Tenaska or its customers. The 45Q tax credit will provide Tenaska $423 million annually for sequestering 5 million tons of CO2 annually. The region’s lease revenue will be $7.5 million. To align with the available comp, ORVI said Tenaska’s offer should at least match Mountaineer’s $3.35 instead of the proposed $1.50 per metric ton. In the western US, ExxonMobil is seeking to pay the US Bureau of Land Management (BLM) to inject 150 million tons of CO2 over the course of 20 years into 100,000 subsurface acres of pore space on federal lands. The proposed Snowy River CO2 project in Carter County, Montana, is still in the environmental assessment and public comment phase, and the BLM’s compensation for the use of the land is not yet publicly disclosed or finalized. Our takeaway after finishing the sausage and kuchen? As pore space leasing evolves, landowners like Dick face a complex landscape of uncertain deals and opaque compensation. With legal clarifications and potential tax credits in play, navigating these new frontiers requires keen insight and vigilance to ensure fair and beneficial agreements for all involved.

The cost of doing nothing: Preventable premature births for at-risk women

Background: The effects of poverty in the United States are growing, and the impacts are most severe for the already vulnerable populations. This analysis looks at the cost of doing nothing for at-risk pregnant women in one county in NE Ohio. Most of these women are living at or below the poverty level, lack safe, affordable, and stable housing, and often do not receive recommended levels of prenatal care. This examination uses data from Mahoning County, Ohio, where one program has provided wrap-around support for any at-risk pregnant mother since 2016. Objective: Examine the cost/savings of providing wrap-around support services to at-risk pregnant women. Methods: Data was provided by the Mahoning County Pathway HUB (MCPH) regarding all births since its 2016 inception. Data was extracted from the Ohio Department of Health, the CDC, and other sources regarding the cost of births and specifically premature births. These sources of data were analyzed using causal-comparative methods, in order to understand the frequency of premature births, with, and without the support services provided by the MCPH. Conclusion: The results of these causal-comparative analyses suggest that the cost of doing nothing for at-risk pregnant women is substantial for all stakeholders. Results demonstrate a savings of 2.45 million dollars for the five years included in the analysis. Because most of the services provided by the MCPH are billable to public health insurance, this model of supporting pregnant mothers who are at risk is important. The cost of doing nothing can lead to a lifetime of avoidable suffering and financial hardship for the women and infants who are born premature. The results from the MCPH suggest that this model of support and service delivery is making a difference, based on the lower-than-expected pre-term births over their tenure of operation.

Age of first dental visits: A benefit of the pediatric medical home.

This retrospective cohort study compared differences in age one dental visit use and age at first dental visit according to fluoride varnish receipt at the pediatric medical home. Enrollment and claims data were used from Partners For Kids, a pediatric accountable care organization covering Medicaid-enrolled children living in 47 of 88 counties in Ohio. The main outcomes were having an age one dental visit and the mean age at first dental visit. Descriptive statistics and bivariate comparisons were applied. Among 17,675 children, 2.8% had an age one dental visit. The mean age at first dental visit was 4.8 years. Children who received fluoride varnish from their medical home (12% of study population) were significantly younger at their first dental visit (4.1 vs. 4.9 years, p < 0.001). Despite longstanding recommendations for the age one dental visit, very few Medicaid-enrolled children in Ohio had one. The pediatric medical home lowered the age of first dental visit.

Extreme Weather Disruptions and Emergency Preparedness Among Older Adults in Ohio: An Eight-County Assessment

The disproportionate risks and impacts of climate change and extreme weather on older adults are increasingly evident. While especially true in disaster-prone areas, human-caused climate change introduces an element of uncertainty even in previously identified “safe” regions such as the Midwestern United States. Using a cumulative disadvantage and vulnerability-informed framework and descriptive statistics from multiple data sources, this article provides an overview of climate impacts, vulnerabilities, and county-level characteristics, focusing on older adults living in Central Ohio. A comparative multiple-case study methodology was used to triangulate regionally representative primary and secondary data sources to examine state and county-level measures of vulnerability, emergency preparedness, and disruptions caused by extreme weather among older adults across eight counties in Central Ohio. Seventy-eight percent of older adults in the sample reported being prepared for emergencies per Federal Emergency Management Agency guidelines. Older adults in Union County reported the highest rates of preparedness, while those in Fayette County reported the lowest. County-level rates of disruption of life activities by extreme weather ranged widely. Among the most rural in the region, Fayette County emerged as uniquely disadvantaged, with the lowest median income, the most vulnerable across multiple social vulnerability dimensions, and the most reported disruptions to life activities from extreme weather. County profiles offer a snapshot of existing vulnerabilities, socioeconomic conditions, special needs, preparedness, and current disruptions among older adults in the region and can inform resource mobilization across community and policy contexts.

Primary care professionals' perspectives on tailoring buprenorphine training for rural practice.

Buprenorphine is a highly effective medication for opioid use disorder (OUD) that remains substantially underutilized by primary care professionals (PCPs). This is particularly true in rural communities, which have fewer prescribers and significant access disparities. The Drug Enforcement Administration removed the X-waiver requirement in December 2022, yet many rural clinicians still report barriers to prescribing buprenorphine. In this study, we examined rural PCPs' experiences with buprenorphine to identify tailored training strategies for rural practice. Physicians, nurse practitioners, and physician associates practicing in rural Ohio counties were recruited through contacts at statewide health associations and health professions training programs. Twenty-three PCPs were interviewed about their perspectives on prescribing buprenorphine, including their training history. PCPs self-reported being motivated to respond to OUD. However, they also reported that current training efforts failed to equip them with the knowledge and resources needed to prescribe effectively, and that urban-focused training often alienated rural clinicians. Participants suggested tailoring training content to rural settings, using rural trainers, and bolstering confidence in navigating rural-specific barriers, such as resource deficits and acute opioid fatigue. Our study found that current training on buprenorphine prescribing is inadequate for meeting the needs of rural PCPs. Tailored buprenorphine training is needed to improve accessibility and acceptability, and to better support the clinical workforce in communities disproportionately impacted by the opioid epidemic.

Spatial Patterns of Nonprofit Founding: Toward a Local Ecology

Nonprofit organizations are vital to the implementation of social policy and provide myriad benefits to those nearby, yet few studies consider founding patterns in small areas. Conceptualizing ecological processes at the local level and in the context of developmental regimes, this article investigates nonprofit founding events among neighborhoods with a unique data set aggregated by census tract from 2010 to 2016 in one northeast Ohio county (United States) using a hierarchical Bayesian model. The results broadly support the density dependence hypothesis, however, suggest high density is required to reduce founding rates in small areas. The results indicate nonprofit founding rates are lower in tracts with higher levels of economic disadvantage and higher shares of Latino residents. The paper calls for further research into nonprofit population dynamics among small areas and for policymakers to closely consider nonprofit founding events, as founding determines the future of a region’s nonprofit infrastructure.

An Application of Social Vulnerability Index to Infant Mortality Rates in Ohio Using Geospatial Analysis- A Cross-Sectional Study

BackgroundOhio ranks 43rd in the nation in infant mortality rates (IMR); with IMR among non-Hispanic black infants is three times higher than white infants.ObjectiveTo identify the social factors determining the vulnerability of Ohio counties to IMR and visualize the spatial association between relative social vulnerability and IMR at county and census tract levels.MethodsThe social vulnerability index (SVICDC) is a measure of the relative social vulnerability of a geographic unit. Five out of 15 social variables in the SVICDC were utilized to create a customized index for IMR (SVIIMR) in Ohio. The bivariate descriptive maps and spatial lag model were applied to visualize the quantitative relationship between SVIIMR and IMR, accounting for the spatial autocorrelation in the data.ResultsSoutheastern counties in Ohio displayed highest IMRs and highest overall SVIIMR; specifically, highest vulnerability to poverty, no high school diploma, and mobile housing. In contrast, extreme northwestern counties exhibited high IMRs but lower overall SVIIMR. Spatial regression showed five clusters where vulnerability to low per capita income in one county significantly impacted IMR (p = 0.001) in the neighboring counties within each cluster. At the census tract-level within Lucas county, the Toledo city area (compared to the remaining county) had higher overlap between high IMR and SVIIMR.ConclusionThe application of SVI using geospatial techniques could identify priority areas, where social factors are increasing the vulnerability to infant mortality rates, for potential interventions that could reduce disparities through strategic and equitable policies.

Recovery Support and Capacity Assessment Using the Calculating an Adequate System Tool: Two Case Studies.

There are multiple, reliable, and authoritative federally managed data sources for understanding the incidence and prevalence of substance use disorder (SUD) and its sequela. However, there remains a gap in metrics representing the need and capacity for treatment and related supports within local communities. To address this challenge, Calculating an Adequate System Tool (CAST) was developed in 2016 by an interdisciplinary group of researchers at the Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality to assess the capacity of the SUD care system within a defined geographic area. It allows for risk assessment of local social and community determinants of substance abuse, as well as an assessment of local service needs across the continuum of SUD care. This article describes the application of the CAST to 2 counties in Ohio and 1 county in Montana. The purpose of using CAST for each area, results of the application, and experiences in utilizing the tool are described. Application of the CAST demonstrated unique findings within each of the geographic areas. In Ohio, recovery support services were lacking in both counties assessed, while differences in crime rate and alcohol outlet density were attributed to varying rates of drug-related hospitalization. Notable findings in Montana included an oversaturation of coalitions focused on substance use prevention and gaps in the areas of detoxification services, partial day treatment, recovery residences, and peer support specialists. CAST is a useful tool for guiding decision-making relative to substance use care needs and capacities for local geographic areas. Findings should be interpreted thoughtfully and in the context of data availability. CAST continues to be enhanced and further expanded for assessing capacity of local and statewide substance use care systems.

IDENTIFYING THE RELATIONSHIP BETWEEN ALZHEIMER’S DISEASE PREVALENCE AND CURRENT SERVICE USE IN OHIO’S 88 COUNTIES

Abstract Recently released data reveals that over 235,000 people over the age of 65 have Alzheimer’s disease and related dementia (ADRD) in Ohio. Using 2020 data from the National Center for Health Statistics, county-level specific ADRD prevalence estimates for Ohio’s 88 counties were also prepared (Range: 9.4-13.4 per 1000 individuals 65+). Researchers, practitioners, and policy-makers can use these estimates to better understand the reach and impact of ADRD in local communities. Nationally and in Ohio, care and support for older adults and specifically older adults with ADRD typically falls to family caregivers, home- and community-based service (HCBS) providers, and residential care providers such as nursing homes. This study pairs the county-level ADRD prevalence data with county-level data on available services (e.g., Memory Care Units, nursing home beds) and service users (e.g., HCBS users). The 10 counties in Ohio with the highest prevalence rates are home to nearly 60% of the 65+ population statewide. Additionally, these counties had a significantly higher proportion of older Black/Hispanic individuals than the other counties (10.8 versus 2.9). When looking at capacity, the top 10 counties contained just 12% of all nursing home beds, but 54% of nursing homes memory care units for the entire state. When considering service use, these 10 counties served a smaller percentage of the state’s HCBS users (13%). For Ohio and other states, it is important to explore available services and current service usage when faced with the increasing estimates of people living with ADRD.

Abstract C099: Take CARE: An implementation science initiative to reduce the cervical cancer burden in Appalachia

Abstract Appalachia has a higher burden of cervical cancer than other regions of the United States. Cervical cancer risk factors and causes are largely known, so evidence-based interventions in health systems addressing those factors and causes can improve cervical cancer incidence and mortality rates. Take CARE (Clinical Avenues to Reach Health Equity) is designed to address three factors strongly associated with cervical cancer and is made up of three evidence-based complementary initiatives focused on HPV vaccination, smoking cessation, and cervical cancer screening: I Vaccinate, Break Free, and The HOME Initiative, respectively. The overall goal is to use implementation science designs to provide an integrated approach to reduce cervical cancer risk among patients of 39 health centers from ten participating systems. The project was implemented in two phases: formative and trial. In the formative phase, community profiles were developed to better understand the cancer burden and resources available. Community members and clinic staff were interviewed about barriers to cervical cancer screening and HPV vaccination and norms about screening, vaccination, and tobacco cessation. Findings informed study materials. Clinic champions were identified, and implementation teams were formed to support the champion role. Details were gathered about facility processes, staffing, patient load, and existing cervical cancer-related activities. Waiting room seating, availability of digital displays, number of exam rooms, and locations for promotional materials and staff trainings were documented through environmental scans. The trial phase was introduced as a delayed group implementation design in ten health systems located in Appalachian counties of Kentucky, Ohio, Virginia, and West Virginia from October 2020 to June 2022. Five systems were assigned to an Early Group and five to a Late Group that would receive the intervention 12 months after Early systems. I Vaccinate was first to be implemented, promoting HPV vaccination in 9–45-year-olds. Health systems receive education materials and providers select strategies and set goals to improve vaccination rates. Break Free was introduced six to eight weeks later and identifies eligible smokers who want to quit in the next six months, providing free smoking cessation counseling and medication to patients. Systems received education on the Ask, Advise, Refer model and could select staff to be trained as Tobacco Treatment Specialists. HOME was the final initiative introduced and focuses on improving cervical cancer screening in underscreened female patients via a mail-based HPV self-sampling program. One year after the first initiative launched, health systems were taught to bundle the initiatives as one program, Take CARE. After this, the Early systems entered a sustainability phase for two years. The process will occur similarly for Delayed health systems but with only one year of sustainability. Analyses will focus on changes in HPV vaccination, smoking cessation, and cervical cancer screening over time. Citation Format: Ryan D. Baltic, Roger Anderson, Mark B. Dignan, Amy K. Ferketich, Mira L. Katz, Stephenie Kennedy, Paul L. Reiter, Electra D. Paskett. Take CARE: An implementation science initiative to reduce the cervical cancer burden in Appalachia [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C099.

Improving Patient Access and Provider Availability in Classical Hematology: The Development of an Advanced Practice Provider Led Virtual Anemia Consult Clinic

Background: Classical hematology entails the diagnosis and treatment of many complex disease processes. The growing volume of referrals to classical hematology is challenged by staff hematology provider shortages. Our institutional goal for new patient access is to be seen within 7 days of the scheduling request. In Q2 of 2022, the leadership team identified the average wait time for a hematology consult was greater than 3 weeks and anemia consults comprised over 2/3 of these consultation requests. To address this need, a taskforce was developed to utilize trained classical hematology advanced practice providers (APPs) to see anemia consults virtually for initial work up and management. To optimize APP consult utilization, a centralized virtual anemia consult clinic (VACC) was developed to address patient access issues and improve staff physician consult availability for more complex hematologic diseases. VACC strived to provide greater access to local metropolitan areas as well as reaching those in-state several hours away, breaking down barriers in transportation and access. Methods: In September 2022, a centralized VACC was launched and staffed by hematology APPs to provide availability for patients with an anemia diagnosis. APPs performed triage, assessment, diagnosis, and provided treatment for anemia diagnoses. VACC is staffed Monday-Friday with 5 new consults per day (40 minutes for each consult) for a total of 25 anemia consults per week. Common diagnoses such as iron deficiency and nutritional anemias were seen in VACC (Figure 1A). A staff hematologist and APPs huddled once weekly to discuss complex patients to triage, diagnose, and treat appropriately. Results: APPs in VACC saw a total of 610 in-state virtual consults between September 2022 and May 2023. The median wait for a virtual anemia consult was 4 days. APPs were able to see virtual anemia consults in 31 Ohio counties, reaching counties at the northern most part of the state, to the southern most tip (Figure 1B). This provided patients with flexibility to be evaluated at home without driving hours for a consult. Of patients seen, 82% were female, 17.9% male and 0.1% non-binary. Racial demographics included 29.8% black, 1.7% Asian, 0.7% American Indian, 4.4% multiracial, and 60.7% white patients. Classical hematology APP revenue increased 276%. VACC slot utilization during this time averaged 91%. Overall classical hematology access for physicians and APPs improved from its peak of 20 days just before VACC started, to 8 days in May 2023. The majority of patients (73%) seen for initial consultation were incorporated into the APP practice for follow up visits and further treatment, increasing slot utilization and productivity for hematology APP practice. Conclusions: Collaboration between hematology physicians and hematology APPs within our institute led to an initiative increasing patient access for hematology diagnoses through the development of an APP staffed VACC. VACC led to a decrease in days wait for patients to be seen with an anemia diagnosis and provided increased consult slots to our staff hematologists to see more complex hematologic cases. Barriers such as transportation and limited scheduling options were removed through the option of scheduling anemia consults into VACC centralized clinic. Weekly huddles between staff hematologist and APPs led to collaborative relationships, mentoring, education, and increased expertise of colleagues to better serve patients and provide quality care in assessment, diagnosis, and treatment of patients with anemia diagnoses. Recommendations: APP led virtual consult clinics in classical hematology clinics are valuable tools to increase patient access and APP productivity, improve scheduling workflows, and decrease barriers related to patient inconveniences and social barriers. Hematology physician shortages call for an increase in education and collaboration with hematology APPs to execute comprehensive care to hematology patients. Future efforts for this clinic will focus on patient outcomes, addressing further social barriers identified to hematology patients, and consideration of expanding diagnoses seen in virtual consult clinic, such as thrombocytopenia, to expand timely access to care.

Opiate Use Disorder and Exercise: A Systematic Review

Background: The opiate epidemic continues to cause hardship to American communities, including in all counties in Ohio, and resulted in 100 000 drug overdoses in 2021. Medications such as buprenorphine have helped people affected by opiate use disorder (OUD) to continue through recovery, although medication assisted therapy (MAT) has shown limited retention rates, calling for complimentary interventions to be implemented. Exercise has potential to reduce cardiovascular risk, lower obesity, and improve mental health. The aim of this study is to systematically review the literature on OUD and exercise as an adjunct to MAT. The authors hypothesize that there is a gap in the knowledge as to whether this modality has been thoroughly researched to aid in OUD recovery.Methods: A database literature search of PubMed, CINHAL, and PsychInfo returned a total of 458 abstracts. Four sets of exclusion criteria were implemented resulting in a total of 26 articles. After further review, 8 more articles were excluded by the authors.Results: Eighteen articles including participants with OUD were systematically reviewed. Only 1 article solely fo-cused on participants with OUD and exercise as an adjunct to treatment.Conclusion: Exercise as an adjunct to treatment for OUD is an area of addiction treatment that warrants further investigation. Incorporating exercise into a recovery program for people with substance use disorders (SUD) specifically has been touted as a promising modality, however, limitations in OUD only studies and lack of control groups make it difficult to draw a conclusion to support our hypothesis.

Strains of Anaplasma phagocytophilum from horses in Ohio are related to isolates from humans in the northeastern USA.

The tick-borne obligatory intracellular bacterium Anaplasma phagocytophilum infects granulocytes of humans as well as domesticated and wild animals, causing a febrile disease collectively called granulocytic anaplasmosis. The host species specificity and zoonotic potential of A. phagocytophilum strains remain unclear. In the USA, human granulocytic anaplasmosis (HGA) is primarily reported in Wisconsin and Minnesota, the northeastern coastal states, and northern California. In horses, A. phagocytophilum causes equine granulocytic anaplasmosis (EGA). Although EGA has been reported in the same US regions as HGA, horses with a definitive diagnosis of EGA have not been reported in Ohio, where the incidence of HGA is low. In this study, samples from archived blood smears or whole blood from three horses from three different counties in Ohio that presented in 2018, 2020, and 2021 with clinical signs and laboratory findings consistent with EGA were evaluated by PCR and sequencing. Sequences of ankA (encoding ankyrin A) of the three A. phagocytophilum strains were identical and related to strains isolated from humans in the northeastern USA yet distinct from those in California or Europe based on phylogenetic analysis. Each Ohio strain contains unique A. phagocytophilum p44 genes encoding the immunodominant major outer membrane proteins, underscoring the antigenic diversity of A. phagocytophilum strains that cause EGA in Ohio. From 2018 to 2023, 14 additional cases of EGA were identified by serodiagnosis in Ohio and nearby locations in Pennsylvania, pointing to a heretofore unrecognized prevalence of EGA and the risk of transmission of anaplasmosis to humans and animals in this region.IMPORTANCEThe tick-borne obligatory intracellular bacterium Anaplasma phagocytophilum infects humans as well as domesticated and wild animals, causing a febrile disease collectively called granulocytic anaplasmosis. The epidemiology and the host species specificity and zoonotic potential of A. phagocytophilum strains remain unclear. In this study, ankA (encoding ankyrin A) and p44 gene sequences of A. phagocytophilum were determined in clinical specimens from horses in Ohio and compared with those found in A. phagocytophilum strains from various hosts and geographic regions. With increasing numbers of seropositive horses, the study points out the unrecognized prevalence and uncharacterized strains of A. phagocytophilum infection in horses and the importance of A. phagocytophilum molecular testing for the prevention of equine and human granulocytic anaplasmosis.

Hollowing out of middle‐pay jobs in Ohio: An exploratory analysis

AbstractHollowing out is a term that refers to the decline in the share of middle‐pay and middle‐skilled jobs relative to low‐pay and high‐pay jobs. This study employs county‐level occupational data at the place of employment to document hollowing out of middle‐pay jobs across regions in Ohio. The county‐level data with occupational information allow us to study how regions' economic heterogeneity contributes to the decline of middle‐paying jobs in Ohio over the 2001–2019 period. Of 88 counties in Ohio, 77 counties experienced declines in the shares of middle‐paying jobs. On average, Appalachian Ohio counties experienced higher hollowing out rates than other counties. We found that the hollowing out of middle‐paying jobs in Ohio is associated with the declines in the shares of manufacturing and mining jobs.

Crime and Features of the Built Environment Predicting Risk of Fatal Overdose: A Comparison of Rural and Urban Ohio Counties with Risk Terrain Modeling

Crime and Features of the Built Environment Predicting Risk of Fatal Overdose: A Comparison of Rural and Urban Ohio Counties with Risk Terrain Modeling

Turning the Page on Breast Cancer in Ohio: Lessons learned from implementing a multilevel intervention to reduce breast cancer mortality among Black women.

Turning the Page on Breast Cancer (TPBC) uses a multilevel approach to reduce breast cancer (BC) mortality among Black women. TPBC intervenes by (1) improving health care facilities' ability to conduct effective BC screening, follow-up, and treatment; (2) involving community-based organizations; and (3) providing education and personal risk information through a culturally relevant website. Ohio has among the worst BC mortality rates in the United States for Black women. TPBC is in its third year of providing targeted interventions in 12 Ohio counties with particularly high BC rates among Black women. TPBC enrolls health care facilities, collects organizational and patient data, and conducts key informant interviews to inform the provision of appropriate evidence-based interventions. TPBC engages Black communities through community-based organizations and social media advertising. The TPBC website offers BC information, connects Black women to community BC resources, and provides access to a risk-assessment tool. TPBC has provided tailored information packets, evidence-based interventions, and systematic support for improving the tracking and follow-up of breast health care among patients in 10 clinical partnerships. The project has provided education at community events monthly since mid-2021. The TPBC website (http://endbreastcancerohio.org) is promoted through social media (primarily Facebook) and community events to reach Black women aged 25-70 years. To date, 4108 unique users have visited the website, of whom 15.9% completed the risk assessment. Novel strategies are needed to address persistent disparities in BC outcomes among Black women. TPBC demonstrates the potential effectiveness of multiple methods of community-based, clinic-based, and web-based engagement. Turning the Page on Breast Cancer (TPBC) aims to reduce breast cancer mortality among Black women in Ohio by conducting multilevel, community-engaged interventions in 12 counties. Women are provided risk information and education at virtual and in-person community events and through a community-friendly website that was launched in November 2020. Almost 4000 women have visited the website, which offers community-targeted information, urges screening for individuals at elevated risk, and offers access to patient navigation services; 655 users have used a breast cancer risk-assessment tool on the site. Community-based organizations conduct educational efforts. TPBC partners with health care facilities, which are taught to improve their ability to conduct effective breast cancer screening, follow-up, and treatment. So far, TPBC has provided educational information, evidence-based intervention lists, tailored information packets, and ongoing quarterly support to partners in 10 counties. Evaluation will focus on aggregated data for screening and genetic testing referral at the clinic level.

Quantification of natural gas and other hydrocarbons from production sites in northern West Virginia using tracer flux ratio methodology.

Tracer flux ratio (TFR) methodology performed downwind of 15 active oil and natural gas production sites in Ohio County, West Virginia sought to quantify air pollutant emissions over two weeks in April 2018. In coordination with a production company, sites were randomly selected depending on wind forecasts and nearby road access. Methane (CH4), ethane (C2H6), and tracer gas compounds (acetylene and nitrous oxide) were measured via tunable infrared direct absorption spectroscopy. Ion signals attributed to benzene (C6H6) and other volatile gases (e.g., C7 - C9 aromatics) were measured via proton-transfer reaction time-of-flight mass spectrometry. Short-term whole facility emission rates for 12 sites are reported. Results from TFR were systematically higher than the sum of concurrent on-site full flow sampler measurements, though not all sources were assessed on-site in most cases. In downwind plumes, the mode of the C2H6:CH4 molar ratio distribution for all sites was 0.2, which agreed with spot sample analysis from the site operator. Distribution of C6H6:CH4 ratios was skew but values between 1 and 5 pptv ppbv-1 were common. Additionally, the aromatic profile has been attributed to condensate storage tank emissions. Average ratios of C7 - C9 to C6H6 were similar to other literature values reported for natural gas wells.