Georgia Region Research Articles

Evaluating the hypoxic tolerance of two maturity stages of Antarctic krill (Euphausia superba) at its range edge

AbstractThe South Georgia region of the Southern Ocean represents the northernmost range edge for Antarctic krill. Of concern is the extent to which rapid warming of surface water temperatures and reduced oxygen contents around this region might challenge the physiological tolerance of krill, particularly the later maturity stages. Hypoxia is generally considered to be less than 30 to 20% of air saturation, hereafter as threshold hypoxia, while less than 10% of air saturation would qualify as severe hypoxia. These levels are unlikely to occur in the Southern Ocean but might happen in the middle of dense krill swarms. We investigated gene expression and biochemical markers related to aerobic metabolism, antioxidant defence, and heat-shock response under 6-h threshold (4 kPa; TH) and 1-h severe (0.6 kPa; SH) hypoxia exposure, to understand how hypoxia might alter respiratory and biochemical pathways in adult and subadult krill. After 6-h TH, subadults induced expression of citrate synthase (CS), and mitochondrial superoxide dismutase (also after 1-h SH) over normoxic expression levels. The maturity stages responded differently in glutathione peroxidase (1-h SH; lower in subadults and higher in adults), and CS (6-h TH; higher in subadults and lower in adults) activities as for the oxidative damage marker to lipids (6-h TH; lower in subadults and higher in adults). Subadults had a greater capacity than adults to deal with hypoxic conditions. This may be a strategy allowing them to exist in larger swarms to reduce predation pressure before reaching reproductive condition.

Colorectal cancer survival disparities in the five regions of Georgia.

The objective of this study was to examine 5-year colorectal cancer survival rates. We also determined whether demographics, tumor characteristics, and treatment modality were associated with 5-year CRC survival in the Clayton, West Central, East Central, Southeast, and Northeast Georgia regions because the significant higher CRC mortality rates in these regions in comparison to the overall rates in the State of Georgia. We conducted a retrospective cohort analysis using data from the 1975-2016 Surveillance, Epidemiology, and End Results program aggregated CRC patients to these five regions. Five-year CRC survival was calculated and stratified by the five regions of Georgia, using the Kaplan-Meier method with log-rank test. Cox proportional hazard regression was used to examine the mentioned association in these five regions. Among 11,023 CRC patients, 5-year CRC survival was lowest in Clayton (65.9%) compared to the West Central (69.0%), East Central (68.2%), Southeast (70.5%), and Northeast regions (69.5%) (p-value = 0.02). In multivariable analysis, greater risk of CRC death was found in the Clayton region compared to the West Central (HR, 1.12; 95%, 1.00-1.25) region when adjusting for demographics, tumor characteristics, and treatment modality. Among Clayton Georgians, age of 75+ years (HR, 2.13; 95%, 1.56-2.89), grade 3 & 4 tumors (HR, 2.22; 95%, 1.64-3.00), and distant stage (HR, 20.95; 95%, 15.99-27.45) were negatively associated with CRC survival. We observed place-based differences in CRC survival with significantly lower survival rates in the Clayton region. Factors associated with higher risk of CRC death include older age at diagnosis, high-grade tumors, and distant stage CRC among Clayton Georgians. Our study provides important evidence to all relevant stakeholders in furthering the development of culturally tailored CRC screening interventions aimed at CRC early detection and improved outcomes.

Abstract A100: Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia

Abstract Background: Significantly higher colorectal cancer (CRC) mortality exists in the five public health districts of Georgia including the Clayton, West Central, East Central, Southeast, and Northeast Georgia. Particularly, CRC outcomes are poorer among patients living in low socioeconomic (SES) areas with predominantly Black population in Georgia. We sought to examine 5-year CRC survival rates between White and Black/Other patients and determine whether regional SES status associated with 5-year CRC survival within different race groups in these five regions of Georgia. Methods: We performed a retrospective cohort analysis using data from the 1975-2016 Surveillance, Epidemiology, and End Results program. The 2015 United State Department of Agriculture Economic Research Services (USDA ERS) county typology codes were used to identify region-level SES with persistent poverty, low employment, and low education. A county is classified by the USDA ERS as a persistent poverty by using 1980, 1990, 2000 censuses and 2007-11 American Community Survey. Five-year CRC survival rates were compared by using Kaplan-Meier method. Cox proportional hazard regression was used to examine the aforementioned associations in different race groups adjusted for demographics (gender, age at diagnosis, marital status, and five Georgia regions) and tumor features (stage, grade, and primary site). Results: Among 11,023 CRC patients (31.9% Black/Other patients), 5-year CRC survival rates were lower among Black/Other patients compared to White patients (65.9% vs. 69.9%; p-value<0.001). Black/Other patients living in low education, low employment, and persistent poverty regions appeared to have lower 5-year survival rates compared to those not living in those regions (59.6% vs. 67.8%, p-value<0.001; 65.4% vs. 66.2%, p-value=0.385; 64.4% vs. 66.5%, p-value=0.089 respectively). In the adjusted analysis, we found that White patients living in regions with persistent poverty were 1.12-fold of increased risk of CRC death (HR, 1.12; 95% CI, 1.00-1.25; p-value=0.043) compared to those living in non-persistent poverty regions. Among Black/Other patients, those living in regions with low education were 1.19-fold of increased risk of CRC death (HR, 1.19; 95% CI, 1.01-1.40; p-value=0.033) compared to those living in non-low education regions. Other factors, such as older age at diagnosis, distant stage, and high-grade tumors, were positively associated with CRC death among the entire cohort, regardless of racial groups. Conclusion: In Georgia, we found that Black/Other patients demonstrated the lower CRC survival rates. Region-level SES was associated with CRC survival among White and Black/Other patients. White patients living in regions with persistent poverty, and Black/Other patients living in regions with low education had an increased risk of CRC death. Our findings provide important evidence to relevant stakeholders in furthering the development of culturally tailored CRC screening interventions aimed at CRC early detection by considering patient’s regional SES status in Georgia. Citation Format: Meng-Han Tsai, Shaoyong Su, Marlo Vernon, Yanbin Dong. Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia [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 A100.

Academic Outreach and Collaboration with Community Oncology Practices to Enhance Referrals and Reduce Disparities in Hematological Malignancies

Introduction: Disparities in cancer care are widely reported with the reasons being multifactorial. Delays in referral and distance to travel along with lack of public transportation are common structural barriers that further exacerbate the racial and income related disparities in the care of hematological malignancies. A lower proportion of black patients receive transplants, both autologous (AutoSCT) and allogeneic (AlloSCT) for similar indications as compared to white populations. Racial disparities are evident in transplant utilization for hematologic malignancies. When offered similar therapy, the outcomes might be better in black patients as compared to White populations underscoring the effect of biology of the disease. South Georgia region has a very high poverty rate with many counties having a median income much less than the national average. We report our efforts to increase access for hematological malignancies for patients in predominantly rural and minority focused settings. Methods: We reviewed charts of all patients referred to our center from 01/2014 to 12/2022. We divided patients into three groups. Cohort A. 36 months from 1/14 to 06/2017. Cohort B, 36 months from 07/19 to 12/22. The intervening two years were utilized for outreach development. Physicians visited all the community centers and created an easy access physician to physician referral system. In addition, in partnership with community oncology, two clinics were established at 65 miles and 89 miles to our center. Referrals from these sites were seen at these outreach clinics. The total number of Auto and Allo SCT and clinical trial enrollment data were obtained from databases. Outcomes data is from that reported on the SCT patients to the national databases. Statistics are descriptive. Results: Post outreach activity showed a significant increase in volumes. (Figure 1) Patients' referrals for heme-malignancies were up to 1725 compared to 632 (170% increase). The median distance travelled in these groups was 52.7 vs 17.8 miles (range 0-525 vs 2342) demonstrating the larger area covered from outreach activity. Considering our metro area radius of 20 miles, 62% of patients were outside our immediate area. Excluding the patients withing the 20-mile radius between the two groups, median distance travelled by patients in cohort B being 99 miles vs 60 miles in cohort A. The increase was consistent across all races. There was an increase from 254 to 588 in black population and 355 to 1028 in the white populations. The outreach clinics set up in partnership with the community practices added a significant new patient population with numbers increasing from under 25 in the initial cohort to above 250 in cohort B. Overall this increase translated to higher number of transplants with 146 transplants in cohort A compared to 347 in cohort B, a 137% increase. The alloSCT increased from 51 to 85 and autoSCT from 95 to 262 between the two cohorts respectively. In addition, the addition of CAR-T further expanded the cellular therapy program with a total of 131 cellular therapy products in fiscal year 2023 compared to 39 in fiscal year 2015, a 235% increase. Our outcomes have consistently improved as well with the most recent CIBMTR 1 year survival of 74% while the predicted was 68%. Similarly, the increase in referrals translated to an increase in clinical trial enrollment with the most recent 3-year period having an accrual of 216 as compared to 56, a 285% increase overall and 185% in black patients, compared to the initial 3 years. Age is another commonly noted factor that results in lower access to care. Our model resulted in a significant increase in elderly patients as well with > 60 years of age patients increasing from 326 to 1017 while those above 70 increased from 149 to 549 in the respective cohorts. Conclusions: Our model is easily reproducible and shows a substantial increase in the number of referrals for hematological malignancies. The recent approvals of complex therapies like CAR-T and other T cell engaging therapies necessitate a close collaboration between academic and community practices. Similar models if developed at other academic centers can significantly reduce structural barriers and might improve outcomes further in all patient populations.

სამხრეთ საქართველოს ვულკანური ლავებით ჩახერგილი მდინარეების დაგუბებული უბნების ეკოლოგიური საფრთხეები

The article describes the blocking of river valleys caused by volcanic activity in the Southern georgia region. As a result of them, the origin of the volcanic relief and the flooded areas and lakes which are of great importance for the natural territorial development of South Georgia. Damped lakes do not represent a danger of breakthrough, but Their preservation in nature is under threat due to climatic, geomorphological and anthropogenic influences. For this, it is important to monitor and protect them. These works will protect the unique lakes of the region from ecological threats.

Ocean Recreation and the Economic Contributions of Visitation in and around Gray’s Reef National Marine Sanctuary

Providing demonstrable and quantifiable evidence to substantiate the value of Marine Protected Areas like National Marine Sanctuaries is important for understanding their role in the blue economy, as well as gaining management and financial support for their protection. This study employs economic contribution analysis to estimate the economic contributions of ocean recreation spending of visitors to Gray’s Reef National Marine Sanctuary (GRNMS) and the coastal Georgia region. Employing economic contribution analysis is found to be more useful in influencing stakeholder decisions, and can therefore be a useful tool in providing inputs for management decisions related to marine protected areas. This study shows that visitors to coastal Georgia spent about USD 1.4 billion on ocean recreation activities in a single year. This translates to a total economic contribution of 18,950 jobs, USD 603 million labor income, USD 938 million value added, and USD 1.8 billion output. About USD 123 million of the total visitor spending can be attributed to GRNMS, contributing 1702 total jobs, USD 54 million in total labor income, USD 84 million in total value added, and USD 159 million in total output. This study highlights the importance of coastal Georgia and GRNMS as economic drivers of the region’s economy, supporting the need for continued management and investment in the Sanctuary and its resources.

Abstract 123: Bystander Cpr Usage In Out-of-hospital Cardiac Arrest During The Covid-19 Pandemic: Results From The Northeast Georgia Cardiac Arrest Registry

Background: During the COVID-19 pandemic, a higher incidence of out-of-hospital cardiac arrest (OHCA) has been reported but rates of bystander CPR usage have not been studied. Due to the COVID-19 pandemic, bystanders may be reluctant to perform CPR due to risk of infection and due to social isolation measures, there may be less bystanders present to perform CPR.Objective: The purpose of the study was to study rates of bystander CPR usage in out-of hospital cardiac arrest (OHCA) during the COVID-19 pandemic and to evaluate for any association between bystander CPR usage and increasing COVID-19 infection during 2020 and 2021. Methods: We performed a retrospective study of the Northeast Georgia Cardiac Arrest Registry to compare bystander CPR usage for all patients presenting to Northeast Georgia Medical Center in Gainesville, Georgia with OHCA from 14 surrounding counties of northeast Georgia from March 2019 to December 2021. Results: A total of 18,421 and 18,678 COVID-19 infections were reported in Hall County between Mar-Dec 2020 and Jan-Dec 2021, respectively. A total of 228 cardiac arrests occurred in 2019, 273 in 2020, and 268 in 2021. Overall bystander CPR usage was 44% in 2019, 43% in 2020, and 47% in 2021, p = .64. Before COVID-19 the bystander CPR usage was 43% and 46% during, p = 0.44. There was no significant correlation between bystander CPR usage and COVID-19 infections in Hall County (r = 0.06, p = 0.79). Multivariable logistic regression model demonstrated that initial shockable rhythm (p < 0. 001) was the strongest predicator of bystander CPR (table 1). Conclusions: Bystander CPR usage in OHCA in the northeast Georgia region remained constant despite the COVID-19 pandemic. There were no significant differences in bystander CPR usage in OHCA prior to or during COVID-19 pandemic. Additional studies are needed to evaluate for possible variables which may be contributing to initial shockable rhythm as the strongest predicator of bystander CPR.

“WOW Them and Show Them How Exciting Social Studies Can Be”: Exploring a Self-Sustaining Social Studies Summer Camp for Young Learners Led by Teacher Candidates

The Junior Knight Camp is an annual summer program that specifically supports elementary school students in an effort to increase knowledge of social studies using an interdisciplinary thematic approach. This interdisciplinary approach includes STEM, the arts, literacy, and physical education. The camp operates on multiple campuses of the university led by teacher candidates under the guidance of education faculty. In addition to meeting the needs of young children in the Middle Georgia region, this annual camp also serves as an experiential learning opportunity for rising seniors in the dual elementary education and special education degree program. The authors believe that this self-sustaining model can be replicated by many education preparatory programs.

The Association between High Body Mass Index and Mortality Risk in Hospitalized Patients Diagnosed with COVID-19: A Meta-Analysis

Background : COVID-19, caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), emerged as a global pandemic with confirmed death cases of more than 1.27 million worldwide. Since the past pandemic, several studies discovered the adverse effects of excess fat accumulation on the severity of viral infections. This study aimed to investigate the association between high body mass index (BMI) and mortality risk in hospitalized COVID-19 patients based on four categories of high BMI ranges. Subjects and Method : A systematic review and Meta-Analysis was conducted using search articles from electronic databases including PubMed, Google Scholar, and Scopus, published from 2019 to 2021. The keywords used to retrieve articles were "Body Mass Index" OR BMI OR Obesity OR Overweight) AND (Mortality OR Death) AND COVID-19 OR SARS-CoV-2. The included studies were full-text articles published in the English language, reporting adjusted odds ratios from multivariate analysis. The eligibility criteria were defined using PICO model. The article selection was conducted using PRISMA flow chart. The included studies were analyzed by the Review Manager 5.3 application. Results : A total of nine cohort studies involving 12,907 COVID-19 patients with high BMI conducted from America, Europe, and Georgia regions was included in qualitative synthesis and Meta-Analysis. The pooled estimate showed hospitalized COVID-19 patients with morbid/ class III obesity had a higher risk of mortality (aOR= 1.77; 95% CI= 1.27 to 2.47; p= 0.001) than overweight (aOR= 1.10; 95% CI= 1.00 to 1.21; p= 0.060), class I (aOR= 1.16; 95% CI= 0.87 to 1.55; p= 0.300), and class II obesity (aOR= 1.54; 95% CI= 1.11 to 2.13; p= 0.009). Conclusion : High BMI increases the risk of mortality in hospitalized COVID-19 patients. A potential dose-response relationship may exist between different categories of high BMI range and mortality risk in COVID-19 patients. Keywords : BMI, obesity, mortality, COVID-19, SARS-CoV-2 Correspondence : Yuzana Maung. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: yuzmg5699@gmail.com. Mobile: +6281295346614. Journal of Epidemiology and Public Health (2021), 06(01) https://doi.org/10.26911/jepublichealth.2021.06.01.08

Modeling the Impact of Ocean Circulation on Chlorophyll Blooms Around South Georgia, Southern Ocean

AbstractThe northeast periphery of the Scotia Sea hosts one of the largest chlorophyll‐a blooms of the Southern Ocean. This bloom peaks to the northwest of the island of South Georgia, extending eastward for hundreds of kilometers. Although the Southern Ocean has many islands of similar size, South Georgia is ecologically one of the most significant: It not only sustains one of the Southern Ocean's largest and most diverse ecosystems but also constitutes its single most important region for biological carbon sequestration. While the exceptional nature of South Georgia's blooms has been recognized widely, both the physical processes that contribute to their fertilization and the reasons why these blooms are larger than those of other similar regions (e.g., Kerguelen or Crozet Islands) are poorly understood. We use the results of a high‐resolution ocean model to investigate the physical processes that mediate the entrainment of deep, iron‐rich waters into the surface layers of the South Georgia region. We show that the Southern Antarctic Circumpolar Current Front, the southernmost jet of the Antarctic Circumpolar Current (ACC), pumps iron‐enriched waters from the deep ocean onto the bottom layers of South Georgia's shelf. These waters are upwelled along the northern coast of the island and are then exported into the Georgia Basin, where topographically steered circulation shields them from the dispersive effects of local currents and eddies, thus allowing the bloom development.

Seasonal gene expression profiling of Antarctic krill in three different latitudinal regions.

The Antarctic krill, Euphausia superba, has evolved seasonal rhythms of physiology and behaviour to survive under the extreme photoperiodic conditions in the Southern Ocean. However, the molecular mechanisms generating these rhythms remain far from understood. The aim of this study was to investigate seasonal differences in gene expression in three different latitudinal regions (South Georgia, South Orkneys/Bransfield Strait, Lazarev Sea) and to identify genes with potential regulatory roles in the seasonal life cycle of Antarctic krill. The RNA-seq data were analysed (a) for seasonal differences between summer and winter krill sampled from each region, and (b) for regional differences within each season. A large majority of genes showed an up-regulation in summer krill in all regions with respect to winter krill. However, seasonal differences in gene expression were less pronounced in Antarctic krill from South Georgia, most likely due to the milder seasonal conditions of the lower latitudes of this region, with a less extreme light regime and food availability between summer and winter. Our results suggest that in the South Orkneys/Bransfield Strait and Lazarev Sea region, Antarctic krill entered a state of metabolic depression and regressed development (winter quiescence) in winter. Moreover, seasonal gene expression signatures seem to be driven by a photoperiodic timing system that may adapt the flexible behaviour and physiology of Antarctic krill to the highly seasonal environment according to the latitudinal region. However, at the lower latitude South Georgia region, food availability might represent the main environmental cue influencing seasonal physiology.

Georgia Library Spotlight - Middle Georgia Regional Library

Georgia Library Spotlight - Middle Georgia Regional Library

Show us your beaks and we tell you what you eat: Different ecology in sympatric Antarctic benthic octopods under a climate change context

Show us your beaks and we tell you what you eat: Different ecology in sympatric Antarctic benthic octopods under a climate change context

The Effect of Peer Support on Colorectal Cancer Patients' Adherence to Guideline-Concordant Multidisciplinary Care.

Multidisciplinary care is critical for the successful treatment of stage III colorectal cancer, yet receipt of adjuvant chemotherapy remains unacceptably low. Peer support, or exposure to others treated for colorectal cancer, has been proposed as a means to improve patient acceptance of cancer care. The purpose of our study was to evaluate the effect of peer support on the attitudes of patients with colorectal cancer toward chemotherapy and their adherence to it. We conducted a population-based survey of patients with sage III colorectal cancer and compared demographics and adjuvant chemotherapy adherence after patient-reported exposure to peer support. Patients were identified by using Surveillance, Epidemiology, and End Results Program cancer registries and were recruited 3 to 12 months after cancer resection. All patients with stage III colorectal cancer who underwent colorectal resection between 2011 and 2013 and were located in the Detroit and Georgia regions were included. The main outcome measure was adjuvant chemotherapy adherence. Exposure to peer support was an intermediate outcome. Among 1301 patient respondents (68% response rate), 48% reported exposure to peer support. Exposure to peer support was associated with younger age, higher income, and having a spouse or domestic partner. Exposure to peer support was significantly associated with receipt of adjuvant chemotherapy (OR, 2.94; 95% CI, 1.89-4.55). Those exposed to peer support reported positive effects on attitudes toward chemotherapy. This study has limitations inherent to survey research including the potential lack of generalizability and responses that are subject to recall bias. Additionally, the survey results do not allow for determination of the temporal relationship between peer support exposure and receipt of chemotherapy. Our study demonstrates that exposure to peer support is associated with higher adjuvant chemotherapy adherence. These data suggest that facilitated peer support programs could positively influence patient expectations and coping with diagnosis and treatment, thereby affecting the uptake of postoperative chemotherapy. See Video Abstract at http://links.lww.com/DCR/A587.

Cross-comparison and evaluation of air pollution field estimation methods

Accurate estimates of human exposure is critical for air pollution health studies and a variety of methods are currently being used to assign pollutant concentrations to populations. Results from these methods may differ substantially, which can affect the outcomes of health impact assessments. Here, we applied 14 methods for developing spatiotemporal air pollutant concentration fields of eight pollutants to the Atlanta, Georgia region. These methods include eight methods relying mostly on air quality observations (CM: central monitor; SA: spatial average; IDW: inverse distance weighting; KRIG: kriging; TESS-D: discontinuous tessellation; TESS-NN: natural neighbor tessellation with interpolation; LUR: land use regression; AOD: downscaled satellite-derived aerosol optical depth), one using the RLINE dispersion model, and five methods using a chemical transport model (CMAQ), with and without using observational data to constrain results. The derived fields were evaluated and compared. Overall, all methods generally perform better at urban than rural area, and for secondary than primary pollutants. We found the CM and SA methods may be appropriate only for small domains, and for secondary pollutants, though the SA method lead to large negative spatial correlations when using data withholding for PM2.5 (spatial correlation coefficient R = −0.81). The TESS-D method was found to have major limitations. Results of the IDW, KRIG and TESS-NN methods are similar. They are found to be better suited for secondary pollutants because of their satisfactory temporal performance (e.g. average temporal R2 > 0.85 for PM2.5 but less than 0.35 for primary pollutant NO2). In addition, they are suitable for areas with relatively dense monitoring networks due to their inability to capture spatial concentration variabilities, as indicated by the negative spatial R (lower than −0.2 for PM2.5 when assessed using data withholding). The performance of LUR and AOD methods were similar to kriging. Using RLINE and CMAQ fields without fusing observational data led to substantial errors and biases, though the CMAQ model captured spatial gradients reasonably well (spatial R = 0.45 for PM2.5). Two unique tests conducted here included quantifying autocorrelation of method biases (which can be important in time series analyses) and how well the methods capture the observed interspecies correlations (which would be of particular importance in multipollutant health assessments). Autocorrelation of method biases lasted longest and interspecies correlations of primary pollutants was higher than observations when air quality models were used without data fusing. Use of hybrid methods that combine air quality model outputs with observational data overcome some of these limitations and is better suited for health studies. Results from this study contribute to better understanding the strengths and weaknesses of different methods for estimating human exposures.

Plantation Houses of North Florida

<p>The concept of Plantation conjures an image that identifies the North Florida / South Georgia region of the U. S. Leon County attracted many cotton planters from Georgia, Virginia, Maryland, North and South Carolina in the 1820’s to the 1850’s. Up to the beginning of the Civil War, Leon County was the 5th largest producer of cotton counting all counties from Florida and Georgia. The Civil War brought the plantation culture to a standstill.</p><p>The plantations transformed the environment based on their need for open fields in which to cultivate different crops, or raise a variety of animals with the help of slaves. From the 1900’s many plantations abandoned their land to nature producing a deep change in the local landscape. Today plantations are not used as much for planting crops but more for hunting or as tree farms. The hunting plantations do not grow crops but provide good conditions for the hunting of animals and birds. Other plantations were torn apart, sold and now are part of the Tallahassee urban fabric. In other words, they disappeared.</p><p>The transformation of the plantations has been slow and steady, and has become the image of the area, even the region. The paper shows five plantations that represent five different evolutions of these traditional landscapes. The landscapes have evolved to accommodate the very local but fluid definition of place. It is this transformation, this evolving identity which helped preserve some of the traditional landscapes and the traditional architecture on them.</p><p>The most prominent feature of the plantation is the “Big House” or plantation house. The house embodies all aspects of the plantation life style. The construction materials and methods reflected the times, the technologies and the available resources.</p><p>The research has been done mainly in the archives of the Tallahassee Trust for Historic Preservation. The results, still pending, explain the land typology as it evolved from the golden decades of the plantation culture to the present day land use.</p>

Evans v Georgia Regional Hospital

Evans v Georgia Regional Hospital

News - West Georgia Regional LIbrary

News - West Georgia Regional LIbrary

Performance of Multiple Alternatives to Reduce Carbon Emissions for Transit Fleets: A Real-world Perspective

Transit agencies are always seeking opportunities to reduce fuel consumption, which typically provides simultaneous emissions reductions. However, the effectiveness and efficiency of fuel conservation and emission reduction alternatives differ as a function of local transit operating characteristics. The fact that emissions reductions from multiple alternatives are not necessarily additive further complicates these analyses. In selecting a set of alternatives, transit agencies need to evaluate multiple options simultaneously, and under agency-specific operating parameters. This paper presents the analysis of emissions reduction alternatives of eco-driving and purchasing new fleet with compressed natural gas, utilizing real-world operating data collected from the Metropolitan Atlanta Rapid Transit Authority (local transit) and the Georgia Regional Transportation Authority (express bus) fleets. Each individual emissions reduction alternative was first investigated for effectiveness individually and then in combination to assess cumulative impacts. The results show that the comparative performance of emissions reductions alternatives is highly dependent on vehicle operating characteristics, and thus the preferred alternatives, differ between different fleets. The analysis conducted for the Atlanta, Georgia region in the United States provides insight to how such modeling techniques can assist planning for future fleets given each agency's unique local conditions.

Obstetric Provider Maldistribution: Georgia, USA, 2011

Objectives In 2010, Georgia had the nation's highest maternal mortality rate, sixteenth highest infant mortality rate, and a waning obstetrician/gynecologist (ob/gyn) workforce. Statewide ob/gyn workforce data, however, masked obstetric-specific care shortages and regional variation in obstetric services. The Georgia Maternal and Infant Health Research Group thereby assessed each Georgia region's obstetric provider workforce to identify service-deficient areas. Methods We identified 63 birthing facilities in the 82 Primary Care Service Areas (PCSAs) outside metropolitan Atlanta and interviewed nurse managers and others to assess the age, sex, and expected departure year of each delivering professional. Using accepted annual delivery rates of 155 per obstetrician (OB), 100 per certified nurse midwife (CNM), and 70 per family medicine physician (FP) we converted obstetric providers into "OB equivalents" to standardize obstetric services available in any given area. Using facility births and computed OB equivalents (contemporary and 2020 estimates), we calculated current and projected average annual births per provider (AABP) for each PCSA, categorizing its obstetric provider workforce as "adequate" (AABP<144), "at risk" (144≤AABP≤166), or "deficient" (AABP>166). We mapped results using ArcGIS. Results Of 82 surveyed PCSAs, 52% (43) were deficient in obstetric care; 16% (13) had a shortage and 37% (30) lacked obstetric providers entirely. There were no delivering FPs in 89% (73) of PCSAs and no CNMs in 70% (56). If Georgia fails to recruit delivering providers, 72% (58/77) of PCSAs will have deficient or no obstetric care by 2020. Conclusions Obstetric provider shortages in Georgia hinder access to prenatal and delivery services. Care-deficient areas will expand if recruitment and retention of delivering professionals does not improve.