Louisiana Research Articles

Identifying and filling critical knowledge gaps can optimize financial viability of blue carbon projects in tidal wetlands

One of the world’s largest “blue carbon” ecosystems, Louisiana’s tidal wetlands on the US Gulf of Mexico coast, is rapidly being lost. Louisiana’s strong legal, regulatory, and monitoring framework, developed for one of the world’s largest tidal wetland systems, provides an opportunity for a programmatic approach to blue carbon accreditation to support restoration of these ecologically and economically important tidal wetlands. Louisiana’s coastal wetlands span ∼1.4 million ha and accumulate 5.5–7.3 Tg yr−1 of blue carbon (organic carbon), ∼6%–8% of tidal marsh blue carbon accumulation globally. Louisiana has a favorable governance framework to advance blue carbon accreditation, due to centralized restoration planning, long term coastal monitoring, and strong legal and regulatory frameworks around carbon. Additional restoration efforts, planned through Louisiana’s Coastal Master Plan, over 50 years are projected to create, or avoid loss of, up to 81,000 ha of wetland. Current restoration funding, primarily from Deepwater Horizon oil spill settlements, will be fully committed by the early 2030s and additional funding sources are required. Existing accreditation methodologies have not been successfully applied to coastal Louisiana’s ecosystem restoration approaches or herbaceous tidal wetland types. Achieving financial viability for accreditation of these restoration and wetland types will require expanded application of existing blue carbon crediting methodologies. It will also require expanded approaches for predicting the future landscape without restoration, such as numerical modeling, to be validated. Additional methodologies (and/or standards) would have many common elements with those currently available but may be beneficial, depending on the goals and needs of both the state of Louisiana and potential purchasers of Louisiana tidal wetland carbon credits. This study identified twenty targeted needs that will address data and knowledge gaps to maximize financial viability of blue carbon accreditation for Louisiana’s tidal wetlands. Knowledge needs were identified in five categories: legislative and policy, accreditation methodologies and standards, soil carbon flux, methane flux, and lateral carbon flux. Due to the large spatial scale and diversity of tidal wetlands, it is expected that progress in coastal Louisiana has high potential to be generalized to similar wetland ecosystems across the northern Gulf of Mexico and globally.

Abstract A126: Cancer screening trends in Louisiana’s sexual gender minority population

Abstract Cancer screenings in Louisiana (LA) have been consistently lower than the national average. Sexual and gender minorities (SGM) are more likely to be non-compliant with cancer screening guidelines and consistently do not meet cancer screening recommendations. This study compares compliance to cervical, breast, and colorectal cancer (CRC) screening guidelines over time between SGM and the non-SGM population in LA. Data were obtained from the LA 2014, 2016, 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System (BRFSS). The sample was divided into gay (including lesbian, gay, bisexual, or other sexual orientation other than straight) and straight. Three primary outcomes of interest were used to measure breast, cervical, and CRC cancer screening adherence based on the U.S. Preventive Services Task Force (USPSTF) screening recommendation at the time of each survey. Descriptive analysis and chi-square tests were conducted using sample weights. CRC had the lowest compliance rate in the entire population and across sexual orientation groups. Twenty-five percent of both populations had never received any CRC screening test. Comparatively, 3.6% of straight and 5.3% of gay populations had never received a mammogram while 6.6% of straight and 13.6% of the population had never received a pap smear. Significant improvements in compliance to breast, cervical, and CRC cancer screenings guidelines was observed among those who identified as straight over the survey years until 2020. Decreases in screening compliance were observed in this population from 2020 to 2022, likely due to the effects of the COVID pandemic. Screening compliance in those who identified as gay showed more variation over time in all three cancers. Screening compliance for CRC and cervical cancer were at its highest in 2016, declined to its lowest point in 2020, but increased in 2022. In 2016, there was a significant decline in breast cancer screening compliance in this population to the lowest ever observed in both groups. The initial increases in colorectal and cervical cancer screening observed from 2014 to 2016 among the gay population may be attributed to significant decreases in uninsured rates following the passage of the Affordable Care Act. Additionally, this population saw increased access to the private insurance market following the Obergefell decision and the Marriage Equality Act of 2015, which extended employer-sponsored coverage to same-sex couples. While breast cancer screenings declined from 2014-2016 in the gay population, there was a sharp increase from 2016 to 2018, which aligns with the 2016 expansion of Medicaid in Louisiana. Despite increases in access to insurance coverage, SGM individuals report being in fair or poor health and having negative experiences with healthcare providers at higher rates than their non-SGM counterparts. More research is needed to understand the healthcare landscape and experiences of SGM Louisianans. This will help to inform targeted interventions to increase screenings and improve cancer outcomes among this population. Citation Format: Bilikisu Elewonibi, Carleigh Baudoin, Ashely Fenton. Cancer screening trends in Louisiana’s sexual gender minority population [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A126.

The state of Louisiana’s freshwater commercial fishery: a study of fishermen’s attitudes towards fishing and their future

As an important contributor to Louisiana’s economy, the commercial freshwater fisheries have been the subject of growing attention in recent years by resource managers as the industry appears to be on the brink of collapse. Fewer participants are entering the field, fish buyers and processors are closing, and market prices remain stagnant. To better understand this industry, we conducted a study to characterize the commercial freshwater fisheries in Louisiana including the fishermen, the fishing operations, the effort across the state, local knowledge on management issue and barriers and opportunities for the future of the industry. We completed structured interviews at fish houses across Louisiana. The average full-time fisherman was 56 years old with about 34 years of commercial fishing experience, and catfish (Ictaluridae spp.) and buffalo (Ictobius spp.) appear to be the most sought-after finfish; however, this slightly differs by region. Overall, this study provides in-depth insight into the trends, problems, and successes of Louisiana’s freshwater commercial fisheries. This information will allow managers and other groups like cooperative extension to identify and design opportunities for the industry and utilize their information in management across the state.

Health Service Utilization Patterns Among Medicaid Enrollees With Intellectual and Developmental Disabilities Before and During the COVID-19 Pandemic: Implications for Pandemic Response and Recovery Efforts.

To assess the impact of COVID-19 on health service utilization of adults with intellectual and developmental disabilities (IDDs) through an analysis of Medicaid claims data. Retrospective cohort study of Medicaid claims. Medicaid members aged 25 to 64years from January 1, 2018, to March 31, 2021, from the states of Louisiana, Pennsylvania, and Wyoming. We analyzed data from two 12-month time periods (pre-COVID-19 and during COVID-19) and assessed the potential impact of the COVID-19 pandemic on health service utilization and service intensity for 3 cohorts: (1) IDD with preexisting mental health diagnoses, (2) IDD without mental health diagnoses, and (3) all other Medicaid members. Health service utilization determined by specific claims data classifications. The analysis showed reduced utilization for nonmental health service types with differing utilization patterns for IDD with preexisting mental health diagnoses, IDD without mental health diagnoses, and all other Medicaid members. Change in utilization varied, however, for mental health service types. Measures of service intensity showed decreased numbers of members utilizing services across most service types and increased Medicaid claims per person across most mental health service categories but decreased Medicaid claims per person for most nonmental health services. Results suggest a need for mental health services among all Medicaid members during the COVID-19 pandemic. By anticipating these needs, communities may be able to expand outreach to Medicaid members through enhanced case management, medication checks, and telemedicine options.

Investigating older driver crashes on high-speed roadway segments: a hybrid approach with extreme gradient boosting and random parameter model

Older drivers are often more susceptible to crashes due to age-related physical and cognitive limitations, particularly in complex driving environments. Considering the limited research in this area, this study focuses on investigating crashes involving older drivers on high-speed roadways (≥ 45 mph). The analysis is based on data collected from Louisiana State, encompassing 18,300 older driver-involved crashes (2017-2021). For analysis, a two-step hybrid modelling approach is employed: a) Extreme Gradient Boosting (XGBoost) is used to classify top variable features and b) Correlated Random Parameter Ordered Probit with Heterogeneity in Means (CRPOP-HM) is used to predict the likelihood of crash injury severity. . Some of the critical factors increasing the likelihood of fatal-severe or injury crashes involving older drivers on high-speed segments include the manner of collision (rear-end, right-angle, single-vehicle), primary contributing factor (violation, pedestrian action), presence of passenger (s), location type (open country, residential, business with mixed residential), and weekend.

Quantifying air quality co-benefits to industrial decarbonization: the local Air Emissions Tracking Atlas

IntroductionMany decarbonization technologies have the added co-benefit of reducing short-lived climate pollutants, such as particulate matter (PM), nitrogen oxides (NOx), and sulfur dioxide (SO2), creating a unique opportunity for identifying strategies that promote both climate change solutions and opportunities for air quality improvement. However, stakeholders and decision-makers may struggle to quantify how these co-benefits will impact public health for the communities most affected by industrial air pollution.MethodsTo address this problem, the LOCal Air Emissions Tracking Atlas (LOCAETA) fills a data availability and analysis gap by providing estimated air quality benefits from industrial decarbonization options, such as carbon capture and storage (CCS). These co-benefits are calculated using an algorithm that connects disparate datasets that separately report greenhouse gas emissions and other pollutants at U.S. industrial facilities.ResultsVersion 1.0 of LOCAETA displays the estimated primary PM2.5 emission reduction co-benefits from additional pretreatment equipment for CCS on industrial and power facilities across the state of Louisiana, as well as the potential for VOC and NH3 generation. The emission reductions are presented in the tool alongside facility pollutant emissions information and relevant air quality, environmental, demographic, and public health datasets, such as air toxics cancer risk, satellite and in situ pollutant measurements, and population vulnerability metrics.DiscussionLOCAETA enables regulators, policymakers, environmental justice communities, and industrial and commercial users to compare and contrast quantifiable public health benefits due to air quality impacts from various climate change mitigation strategies using a free and publicly-available tool. Additional pollutant reductions can be calculated using the same methodology and will be available in future versions of the tool.

Battle of the Bites: The Effect of Sewage Effluent Exposure on Mosquitofish Biocontrol of Mosquitoes in Residential Louisiana.

Mosquitofish, Gambusia affinis, are eponymous larval mosquito predators. Their ability to colonize and survive in habitats that are uninhabitable by other potential predators allows them to naturally manage larval mosquito populations in most ground pools they are present in. However, effluent from residential onsite wastewater treatment systems (OWTSs) appears to limit the presence of fish predators. This is especially problematic in Louisiana, where regulations allow the discharge of OWTS effluent into open drainage conveyances. To determine the effect of effluent on the capacity of mosquitofish for biocontrol in contaminated areas, we assessed the body condition metrics of populations from two effluent-exposed sites and two sites not exposed to effluent, determined the lethal effect of effluent-contaminated drainage water on fish, and measured the prey consumption rates in the presence of effluent. Female fish collected from effluent-impacted sites had a reduced somatic body condition and most females examined displayed masculinized anal fins resembling the male gonopodium structure. This trait was not seen in fish collected from the control sites and has not yet been documented in association with OWTSs or in the state of Louisiana. Fish from the control sites survived at effluent-contaminated water levels < 70%, and the prey clearance rates increased with dilution. Onsite wastewater treatment system effluent has significant effects on both the short- and long-term persistence of mosquitofish, their body composition, reproductive health, and larval mosquito consumption. These effects likely release mosquito larvae from suppression and may increase the threat of mosquito-transmitted pathogens in effluent-contaminated locations.

Abstract 4968: Discovery of cancer-associated factors in 293.5 million diagnosis records using statistical machine learning analysis

Abstract Cancer, a leading global public health issue, ranks as the second leading cause of death in the United States, with projections indicating 1,958,310 new cases and 609,820 deaths in 2023. Accurately quantifying specific pre-disease diagnosis factors associated with cancer, as well as predicting cancer through disease trajectories and imaging modalities, presents a complex and formidable challenge. A comprehensive temporal trajectory analysis of cancer diseases, using disease trajectories as an insight within large cohorts in the USA, has not yet been developed. Our analysis used a comprehensive EHR dataset stretching back to 1999, encompassing 293,501,891 records and involving 3,019,978 patients within Ochsner Health, a large integrated health system across the State of Louisiana. According to our investigation, those diagnosed at the ICD chapter level with diseases of the genitourinary system (genitourinary diseases, ICD-10 Chapter 14, relative risk (RR=1.65)) or endocrine nutritional and metabolic diseases (obesity, ICD-10 Chapter 4, RR=1.35) have an elevated risk of being diagnosed with cancer in the subsequent five years. The top four individual diagnosis ICD-10 codes associated with increased risk are N60 (Benign Mammary dysplasia, RR=7.80), M34 (Systemic sclerosis, RR=7.72), R43 (Disturbances of smell and taste, RR=6.93), and R92 (Abnormal and inconclusive findings on diagnostic imaging of the breast, RR=6.59). Furthermore, in our investigation of specific types of cancer risk across 17 cancer types (Breast, Skin, Prostate, Lung, Pancreatic, etc.), we observed that the most common diseases associated with breast and skin cancer involved immune mechanisms (RR=8.35 and 8.68), genitourinary issues (RR=4.13 and 2.48), obesity (RR=3.42 , 3.35), and cardiovascular conditions (ICD-10 Chapter 9, RR=1.73 and 2.19). For prostate cancer, associations were found with obesity (RR=3.50), human immunodeficiency virus (HIV, ICD-10 Chapter 1, RR=2.39). Across lung cancer, involvement with chronic viral hepatitis (ICD-10 Chapter 1, RR=4.00), cardiovascular issues (RR=3.52), genitourinary problems (RR=4.13), and obesity (RR=3.42) were indicated. Our comprehensive analysis has the potential to contribute to the early detection, diagnosis trajectories, and improved understanding of the pathological processes underlying cancer in patients worldwide. Citation Format: Md Ashad Alam, Nick Duesbery, Daniel Daniel Fort. Discovery of cancer-associated factors in 293.5 million diagnosis records using statistical machine learning analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4968.

Managing Feral Swine: Thoughts of Private Landowners in the West Gulf Region

Feral swine (Sus scrofa) have extensive harmed private landowners throughout the southern United States, especially in the West Gulf Region. Managing feral swine on private land is becoming increasingly critical and challenging to reduce both ecological and economic damage. To better understand private landowners’ experience and preferences for various feral swine management measures, we surveyed private landowners across the West Gulf Region (WGR) including Arkansas (AR), Louisiana (LA), and East Texas (ETX) in 2021. A total of 4500 surveys were mailed across the three states, with 2000 questionnaires sent in AR, 1500 in LA, and 1000 in ETX. Using descriptive analysis and principal components analysis (PCA), we analyzed private landowners’ experiences and preferences in feral swine management across this region. The tesults revealed that most private landowners (&gt;85%) in the region were familiar with feral swine, and over 80% of them had ever seen the intrusion of feral swine onto their properties. Regarding the potential management measures, these landowners strongly supported lethal control methods such as capture and kill; in addition, they expressed a strong desire to receive education on and technical assistance with controlling feral swine. These findings provide a better understanding of private landowners’ familiarity and experiences with feral swine presence on their properties and their preference and support for various feral swine control measures, aiding in developing more effective feral swine management and control policies and programs in the West Gulf Region and beyond.

Scales of Diversity Affecting Ecosystem Function across Agricultural and Forest Landscapes in Louisiana

Current land use and extensive modifications of natural ecosystems across the state of Louisiana are generally similar to those across the southeastern USA where rainfall supports forest ecosystems. Both intentional and unintentional consequences of ecosystem modifications from the scales of water and sediment movement across a field edge to state-wide loss of functional grasslands are legacies from previous development across the state. While major investments and large-scale, long-term plans are aspects of some continuing ecological issues across the state, small-scale, volunteer-led restoration of native grassland plant communities in the Louisiana Coastal Prairie illustrates the value associated with the restoration of natural ecosystem function in drastically disturbed environments. As is now becoming increasingly recognized, Louisiana grasslands represent less obvious components of forest, woodland, and wetland landscapes across the state, where they have contributed essential wildlife habitat, and ecosystem functions. These are now largely missing from many landscapes across the state and region. The strategic restoration of grassland functions combining novel native grass pastures and fully functional native grassland plant communities as landscape components could provide both economic and ecosystem benefits. Specific native grassland seed resources are needed for various restoration activities to enhance ecosystem function at a range of scales across the state and region.

Hessian fly (Diptera: Cecidomyiidae) virulence in Louisiana: assessment of field populations from 2023 to efficacy of 27 Hessian fly resistance genes in wheat.

The Hessian fly, Mayetiola destructor (Say), is one of the most important insect pest plaguing wheat (Triticum aestivum, L) producers across the United States and around the world. Genetic resistance is the stalwart for control of Hessian fly. However, new genotypes (biotypes) arise in deployment of wheat containing resistance genes, so field populations must be evaluated periodically to provide information on the efficacy of those deployed genes. Louisiana (LA), with its diverse agricultural landscape, is not exempt from the challenges posed by this destructive pest. We previously documented the resistance response of wheat lines harboring Hessian fly resistance (H) genes against field populations collected in 2008 from across the southeastern United States, including Iberville Parish, LA. In the spring of 2023, we reevaluated the resistance response of 27 H genes from the field populations collected from Iberville Parish, LA, and compared the results with those observed in 2008. Sixteen H genes showed comparable resistance to the field populations from both years. While 3 of the H genes, H11, H23, and H24, showed a significant decrease in resistance, 2 genes, H16 and H31, had marked increase in resistance. Furthermore, 6 additional H genes were evaluated in 2023, with 4 showing >70% resistance. Our results clearly identify a total of 20 H genes that are moderate to highly effective against the 2023 Hessian fly population from Iberville Parish, LA. The resistance response documented in this study offers valuable information to wheat breeders in the region for effective management of this insect pest.

BARRIERS AND SOCIETAL FACTORS SURROUNDING LONG-STAY RESIDENT DISCHARGE TO THE COMMUNITY IN LOUISIANA

Abstract The focus of this study is to determine the resident characteristics and societal factors that prevent long-stay residents (LSR) from discharging to the community based on the LSR in Louisiana (LA) compared to the United States (US). This study will also explore solutions that can assist LSR in successfully discharging to the community. Discharge to the community from a skilled nursing facility is influenced by functional status, health of the resident, and the availability of community-based services. About 20% of LSR (&amp;gt;100 days) discharge to the community from skilled nursing facilities (SNF), while that number is more than doubled for short-stay residents. Current data provides little information about the odds of a LSR returning to the community. CMS data shows that LSR in LA have higher rates of Activities of Daily Living Decline (ADL) (LA-18.83%/US-14.68%), Antipsychotic Use (LA-16.9%/US-14.58%), and Pressure Ulcers (LA-9.4%/US-2.4%) than the national average. LSR exhibiting these characteristics are less likely to be discharged to the community. Additional characteristics of this population include high levels of comorbid chronic conditions that are difficult to manage outside of the facility, and having Medicaid (LA-71.5%/US-61.1%) as their payer status, a known barrier to community discharge. States should increase the availability of home health and community-based services that cater to the Medicaid population. Assisted living facilities are a great alternative to living “at home”. Additional research should be conducted to examine affordable assisted living options in more states for long-stay Medicaid residents who desire to live independently in the community.

Survey of Vaccine Hesitancy in Patients Visiting Three Tertiary-care Emergency Departments in Southeast Louisiana.

Vaccine hesitancy has been a barrier to achieving herd immunity during the coronavirus 2019 (COVID-19) pandemic. Having low socioeconomic status and education levels, and being a person of color, are associated with higher COVID-19 infection risk and worse outcomes. These same groups are associated with higher vaccine hesitancy. The state of Louisiana has one of the lowest vaccination rates in the country. In this study we aimed to identify demographic, perspective, and health behavior factors associated with vaccine hesitancy in emergency departments (ED) in Southeast Louisiana. A cross-sectional survey was distributed at three tertiary-care hospital EDs. Patients >18years old and not in acute distress were recruited between April-July 2021. The 37-item questionnaire addressed socioeconomic demographics, social determinants of health, COVID-19 safety practices, thoughts and perceptions on COVID-19 and vaccines, sources of COVID-19 and vaccine information, and trust in the healthcare system. Overall, 247 patients completed our survey. Of those, 29.6% reported they were vaccine hesitant. These respondents were significantly more likely, when compared to vaccine-acceptant respondents, to never have married, to have some college education, make less than <$25,000 in household earnings yearly, be unsure whether vaccines prevent disease, not have discussed the COVID-19 vaccine with their primary care doctor, and to prefer to do their own research for COVID-19 vaccine information. We observed no statistically significant differences based on gender, race/ethnicity, parental status, area of living, or their perceived risk of needing hospitalization for treatment or dying from the virus. Vaccine hesitancy was associated with multiple socioeconomic factors, perspectives, and beliefs. Vaccine-hesitant individuals were more uncertain about the safety of the COVID-19 vaccine, the feasibility of obtaining the vaccine, and its efficacy. Public health interventions aimed at these findings and improving public trust in healthcare systems are needed to increase vaccine acceptance.

Development of a Hypertension Electronic Phenotype for Chronic Disease Surveillance in Electronic Health Records: Key Analytic Decisions and Their Effects.

Modernizing chronic disease surveillance with electronic health record (EHR) data may provide better data to improve hypertension prevention and control, but no consensus exists for an EHR-based surveillance definition for hypertension. The Multi-State EHR-Based Network for Disease Surveillance (MENDS) pilot surveillance system was used to develop and test an electronic phenotype for hypertension. We used MENDS data from 1,671,279 patients in Louisiana to examine the effect of different analytic decisions on estimates of hypertension prevalence. Decisions included 1) whether to restrict surveillance to patients with recent blood pressure measurements, 2) varying the number and recency of encounters to define the population at risk of hypertension, 3) how to define hypertension (diagnosis codes, antihypertensive medication, blood pressure measurements, or combinations of these), and 4) how to handle multiple blood pressure measurements on the same day. Results were compared with independent estimates of hypertension prevalence in Louisiana from the Behavioral Risk Factor Surveillance System (BRFSS). Applying varying criteria resulted in hypertension prevalence estimates ranging from 19.7% to 59.3%. A hypertension surveillance strategy that includes a population with at least 1 clinical encounter with measured blood pressure in the previous 2 years and identifies hypertension using all available data (≥1 diagnosis code, ≥1 antihypertensive medication, and ≥2 elevated blood pressure values ≥140/90 mm Hg on separate days) generated estimates in line with population-based survey data. This definition estimated the crude 2019 hypertension prevalence in the state of Louisiana as 43.4% (age-adjusted, 41.0%), comparable with the crude BRFSS estimate of 39.7% (age adjusted, 37.1%). Applying different criteria to define hypertension using EHR data has a large effect on hypertension prevalence estimates. The proposed electronic phenotype generates hypertension prevalence estimates that align with independent estimates from BRFSS.

Optimal application of dextranase in a Louisiana sugarcane factory to mitigate severe processing problems after a freeze

A Louisiana (LA) state-wide severe freeze occurred from 23–26 December 2022, which was followed by warm weather and occasional fog causing severe deterioration of all sugarcane varieties in the fields. Dextranase was applied to break down dextran (glucose polysaccharide) into smaller, more manageable molecules, which can improve processing. The efficiency of dextranase application depends on the pH, dry solids content rds (Brix), temperature, retention time, and agitation, type, activity and dosage of the applied dextranase as well as the enzyme/substrate ratio. Dextranase applications to juice are more efficient and economical than adding to syrup because the high temperature and dry solids content of syrups impede its action. Heating juice to 50 °C and pre-liming to pH 5.9 is optimal for dextranase application, but after 50 °C the activity falls off quickly. One LA factory built a new juice liming system that was quickly modified for optimal dextranase application after the freeze. Optimum conditions for concentrated dextranase (92700 DU/mL) applied were: rds &lt;25%, temperature 50 °C, juice pH = 5.90, 1:10 working solution of concentrated dextranase up to 5 mg/L dosage; retention time = 10 min; 0.624 s–1 agitation. These conditions were successful with &gt;80% breakdown of Haze dextran and minimized processing problems associated with the freeze. Retention time was not as important as temperature and the pH of the juice. The use of dextranase allowed this factory to (i) process all the field sugarcane from the growers even when sucrose concentrations were very low (down to ~56% juice purities on the last day of cane delivery), (ii) continue to crystallize sugar at acceptable crystallization rates, (iii) keep crystal elongation factors to only 2.3 and largely prevent needle formation, and (iv) allow the production of raw sugar with no dextran penalties from the refinery.

Lessons learned from 30-years of operation of the Caernarvon Freshwater Diversion, Louisiana USA

Wetland loss is a worldwide issue with estimates of loss ranging from 50% to 71% in the 20th century. Louisiana's coastal zone lost approximately 4,830 km2, or 25% of the land area between 1932 and 2016 due to a variety of natural and anthropogenic forces that both erode and prevent the growth or maintenance of existing land. Freshwater diversions were constructed along the Mississippi River to convey freshwater, nutrients, and sediment from the Mississippi River to Louisiana's coastal basins to combat saltwater intrusion, nourish the marshes, and stimulate fisheries. The Caernarvon Freshwater Diversion (CFD) was authorized by the Flood Control Acts of 1928 and 1965, the 1974 Water Resources Development Act, and a 1984 Environmental Impact Statement, with construction completed and operations started in 1991. The CFD has been largely successful from the standpoint of the project's authorized goals. Early on in the project, the CFD helped combat saltwater intrusion in a 2,730 km2 basin and re-established the gradient from fresh to salt marsh, by creating conditions favorable to fresh marsh species. Although not a specific project goal, the CFD also built more than 700 acres of new emergent wetland between 1991 and 2016. By critically assessing 30 years of CFD governance, operations, monitoring, and adaptive management, lessons learned are developed that provide valuable information for making the operations and governance of current and future diversions more effective, transparent, adaptive, and trusted by the basin communities. Louisiana's Coastal Master Plan pivots to the use of river diversions to focus on land building and large-scale ecosystem restoration by mimicking natural processes that originally built the Louisiana deltaic landscape, rather than the more common small-scale restoration that has occurred over the past decades. However, large-scale restoration projects, by their nature, impact a wide variety of stakeholders and tend to cross political boundaries. Lessons learned from the CDF highlight the need for flexibility in the long-term and specificity in the short term in governing the operations of a large-scale coastal project. Recommendations developed for modernizing project implementation into the future given changing estuaries and climate will help increase effective implementation of larger-capacity river sediment diversions and other ecosystem-scale projects. It is time for big and bold action to restore south Louisiana and other coastal environments worldwide, and critical to success is using results from numerous past studies, applying lessons learned from existing projects like the CFD, and projections of future conditions.

NO2 emissions from oil refineries in the Mississippi Delta

Of the >17,943 thousand barrels per calendar day (bbl/d) of oil refining capacity located in the US, the Petroleum Administration for Defense District 3 (PADD-3) region has the largest number of refineries and accounts for >53 % (or 9607 tbbl/d) of all US oil refining capacity. Processing facilities in this area are mainly located on the Gulf of Mexico coast in Texas and Louisiana. This study selected a sub-region for analysis within the Mississippi River delta in the state of Louisiana between the cities of New Orleans and Baton Rouge. This region is characterized by intensive industrial activity connected with oil refining and related activities. The TROPOspheric Monitoring Instrument (TROPOMI) detected highly localized NO2 vertical column densities (VCDs) over the two largest US refineries in Baton Rouge (503,000 bbl/d) and Garyville (578,000 bbl/d). TROPOMI NO2 VCD over these stations were 100 μmol/m2 and 80 μmol/m2, respectively. A high correlation coefficient (r = 0.65, p < 0.05) was also found between TROPOMI NO2 and population density. Data from the National Emissions Inventory (NEI) showed high NOx emissions from refineries and other industries including coal-fired power generation, chemical, and aluminum processing plants. The results of the NO2 analysis are of practical interest for a comparative assessment of air pollution, as well as for the exchange of best practices in the field of low-waste fuel combustion technologies.

Erosion and Culture

Erosion and Culture

Food insecurity among households with children during the early months of the COVID-19 pandemic

Understanding impacts of the COVID-19 pan­demic among households with children is neces­sary to design appropriate public health responses that protect food and nutrition security. The objec­tive of this research was to understand predictors of food insecurity during the COVID-19 pandemic among households with at least one child (&lt;18 years), including whether foods reported as out-of-stock were associated with the likelihood of food insecurity. An online survey using validated measures and open-ended questions was distrib­uted to a convenience sample in five states—Louisiana, Montana, North Carolina, Oregon, and West Virginia—during the early months of the COVID-19 pandemic (April through September of 2020). Predictors of food insecurity (race/ethnicity, age, marital status, education, federal nutrition assistance program participation, number of adults and children in the household, rurality, and missing foods when shopping) among households with children during the COVID-19 pandemic were modeled using logistic regression (p &lt; 0.05, a priori). To further illuminate household experiences during this time, two researchers independently coded open-ended survey question data using inductive and deductive approaches to construct themes. Households with children had increased odds of experiencing food insecurity during the COVID-19 pandemic if they had the following characteristics: Hispanic ethnicity; age between 25 and 44 years; additional adult household members; economic hardship; SNAP/WIC participation; being widowed, divorced, or separated; and report­ing foods not available when shopping. Partici­pants described mainly negative changes to dietary patterns and practices as a result of the COVID-19 pandemic. They also described food security chal­lenges and ideas for improving food security. Con­sistent with other data collected and analyzed dur­ing the height of the COVID-19 pandemic, this study contributes findings that emphasize the need for enhanced public health responses and emer­gency preparedness measures that protect food and nutrition security. Because of the increased short- and long-term consequences including exposure to adverse circumstances, impaired learning, risks to mental health, and poor health outcomes, ensuring an adequate food supply is especially important for households with children.

CAR-T therapy access with Louisiana Medicaid: A single institution retrospective analysis.

e18580 Background: Chimeric antigen receptor (CAR)-T therapy has revolutionized the treatment of hematologic malignancies over the past few years. Axicabtagene-ciloleucel was initially approved by the food and drug administration in October 2017 for relapsed/refractory diffuse large B cell lymphoma (DLBCL) after 2 or more lines of systemic therapy. In April 2022, it was approved as second-line therapy for DLBCL that is refractory to first-line or relapses within 12 months of chemoimmunotherapy. Studies have reported complete responses in 50-60% and prolongation of overall survival by 12-18 months. However, CAR-T remains an expensive therapy that can cost up to 1 million USD. Accessibility to CAR-T is governed by various socioeconomic factors including insurance status. The state of Louisiana currently does not have any institution which offers CAR-T therapy. Our Medicaid population is further disadvantaged by the fact that their insurance does not cover out-of-state services. Hence, we conducted this institutional study to evaluate the accessibility to CAR-T and the factors associated with it. Methods: Our retrospective study included adult patients with a diagnosis of DLBCL treated at LSU Shreveport between January 2018 to December 2022. We excluded all other types of B-cell lymphomas, prisoners, and pregnant women. Our primary objective was to evaluate whether the lack of access to CAR-T due to insurance status affected mortality. Our secondary objective was to examine the various demographic factors associated. Analysis was conducted using SAS. Descriptive statistics, Chi-square tests were used to report the results. Results: Our study included a total of 84 patients with a mean age of 59 years. 58% were Caucasian and 38% were African American. 65% were male. 33% had Medicaid coverage and 31% had Medicare. 60% had advanced-stage DLBCL, and 40% had early-stage (Stages I and II). 6% had either double-hit or triple-hit lymphomas. 17% of patients were considered eligible for CAR-T at relapse as per clinician discretion. 33% of patients who were eligible could not get a referral for CAR-T due to factors like insurance status and costs associated with out-of-state living. This led to an increased mortality of 60% in that cohort vs 0% in those who got referrals (p-value of 0.02). Medicaid was the predominant insurance (67%) among those who were unable to get referrals for CAR-T, thus strengthening our hypothesis. Conclusions: Through our study, we aim to bring to light the disparity faced by Louisiana Medicaid patients wherein they don’t have access to a potentially curative therapy for DLBCL. While we do recognize the expenses associated with CAR-T, we wish to highlight that not all states have direct access to this therapy. Seeing how our patients must already uproot their lives temporarily to get CAR-T, their decision could be made easier if insurance can cover the cost at least on a case-to-case basis.