North Carolina State Research Articles

Effects of Shallow Surface Drainage Ditches With Controlled Subsurface Drainage Management on Crop Yields in North Carolina

Highlights Shallow surface ditches with controlled subsurface drainage (SD) increased corn and soybean yields in eight of nine growing seasons compared to conventional drainage. The SD system increased corn yields on average by 0.4 Mg/ha, or 4% (0.7 Mg/ha, or 6.6%, excluding 2016). The SD system increased soybean yields on average by 0.5 Mg/ha, or 14.3%. Abstract. Agricultural drainage in the coastal areas of North Carolina (NC) is commonly achieved through large trapezoidal-shaped ditches. The coastal region of NC has limited topographic relief (slopes < 1%) with poorly drained soils that can cause substantial issues with surface water ponding during high-intensity or long-duration precipitation events without some form of surface drainage. Installation of large free flowing surface ditches (FD) with field crowning improves the drainage intensity but can create negative consequences such as over drainage and side slope scouring within the ditch. Large open ditches remove tillable land from production and serve as a primary transport pathway for pollutants. An alternative drainage design (SD) has been implemented that decreases the size of the surface ditches, limiting their drainage effect to only surface water and potentially improving equipment trafficability. The smaller ditches, installed with precision grade equipment, are placed on a grade sufficient to direct surface flow while keeping soil movement to a minimum. Lateral subsurface drainage tiles are installed to provide subsurface drainage and are connected to a main tile line operated with an outlet control structure for controlled drainage (CD). This study evaluates the crop yield and water table effects of the SD system compared to FD over nine crop seasons from 2014-2022. The SD treatment increased yield in eight of the nine crop seasons overall, four of five corn (Zea mays L.) crops, and all four soybean (Glycine max L.) crops. Overall, SD increased corn yields by 0.4 Mg/ha or 4% (0.7 Mg/ha or 6.6% with the exclusion of 2016) and soybean yields by 0.5 Mg/ha (14.3%). The effects of SD on crop yield and water table show that the system can be utilized to improve crop health and provide better management of cropland for producers. Keywords: Corn Yield, Drainage Water Management, Soybean Yield, Surface Drainage, Water Table.

Effect of S-metolachlor and flumioxazin herbicides on sweetpotato treated with and without activated charcoal applied through transplant water

Abstract Flumioxazin and S-metolachlor are widely used in conventional sweetpotato production in North Carolina and other states; however, some growers have recently expressed concerns about potential effects of these herbicides on sweetpotato yield and quality. Previous research indicates that activated charcoal has the potential to reduce herbicide injury. Field studies were conducted in 2021 and 2022 to determine whether flumioxazin applied preplant and S-metolachlor applied before and after transplanting negatively affect sweetpotato yield and quality when activated charcoal is applied with transplant water. The studies evaluated five herbicide treatments and two activated charcoal treatments. Herbicide treatments included two flumioxazin rates, one S-metolachlor rate applied immediately before and immediately after transplanting, and no herbicide. Charcoal treatments consisted of activated charcoal applied at 9 kg ha−1, and no charcoal. No visual injury from herbicides or charcoal was observed. Likewise, no effect of herbicide or charcoal treatment on no. 1, marketable (sum of no. 1 and jumbo grades), or total yield (sum of canner, no. 1, and jumbo grades) was observed. Additionally, shape analysis conducted on calculated length-to-width ratio (LWR) for no. 1 sweetpotato roots found no effect from flumioxazin at either rate on sweetpotato root shape. However, both S-metolachlor treatments resulted in lower LWR of no. 1 sweetpotato roots in 2021. Results are consistent with prior research and indicate that flumioxazin and S-metolachlor are safe for continued use on sweetpotato at registered rates.

Spanish Translation and Cultural Adaptations of Physical Therapy Parent Educational Materials for Use in Neonatal Intensive Care.

A paucity of Spanish language, culturally relevant parent education materials in the healthcare setting results in suboptimal care for Latinx families and further perpetuates health disparities. The purpose of this article is to describe the process for Spanish translation and cultural adaptations to parent education materials of a parent-centered physical therapy program designed to support maternal mental health and infant development during Neonatal Intensive Care (NICU). Two bilingual physical therapy (PT) students translated educational materials from English to Spanish and were proofread by a professional translator. Next, we conducted a materials review with 5 members of the Latine Community Review Board (CRB), a "standing" advisory group of natively Spanish-speaking, Latine North Carolinians who contract with research teams under the coordination of the Inclusive Science Program (ISP) of the North Carolina Translational and Clinical Sciences Institute (NC TraCS). Review session recruitment, facilitation, and data analysis were conducted by bilingual NC TraCS project managers and the primary investigator for the main feasibility study. Readability analyses were performed at the final stage of translation and adaptation. Themes from CRB review sessions for improvement included to 1) use parent-friendly language, 2) use the plural masculine form of gendered language for caregivers to include all gender identities in this neonatal context, 3) address challenges with direct translation, and 4) use written education materials to supplement in-person, hands-on training with parents and their infants.All translated materials received a grade level of 5 on the Crawford grade-level index. Based on CRB feedback and readability analysis, the translation and cultural-adaptation process resulted in comprehensible written parent education materials for Spanish-speaking families. Review meetings with the CRB reinforced the need for Spanish materials in the healthcare setting. Further assessment of these materials with Spanish-speaking families in the NICU setting is needed.

Trends in Pediatric Emergency and Inpatient Healthcare Use for Mental and Behavioral Health Among North Carolinians During the Early COVID-19 Pandemic.

Widespread school closures and health care avoidance during the COVID-19 pandemic led to disruptions in access to pediatric mental health care. We conducted a retrospective study of emergency and inpatient administrative claims from privately insured children aged 6-20 years in North Carolina between January 2019 and December 2020. We compared rates of emergency department (ED) visits (per 100 000 person-days) and risks of hospitalizations (per 100 000 persons) with diagnosis codes in each category (mental/behavioral health; suicidal ideation, suicide attempt, and intentional self-harm [SI/SA/ISH]; and social issues) across 3 time periods (pre-pandemic, lockdown, and reopening). We calculated the proportion and 95% confidence intervals (CI) of total ED visits and total hospitalizations attributable to mental/behavioral health and SI/SA/ISH across the 3 time periods. Rates of all categories of ED visits decreased from pre-pandemic to the lockdown period; from pre-pandemic to the reopening period, mental/behavioral health visits decreased but rates of SI/SA/ISH visits were unchanged. The proportion of ED visits attributable to mental/behavioral health increased from 3.5% (95% CI 3.2%-3.7%) pre-pandemic to 4.0% (95% CI 3.7%-4.3%) during reopening, and the proportion of SI/SA/ISH diagnoses increased from 1.6% (95% CI 1.4%-1.8%) pre-pandemic to 2.4% (95% CI 2.1%-2.7%) during the reopening period. Emergency care use for social issues and hospital admissions for mental/behavioral health and SI/SA/ISH diagnoses were unchanged across the study periods. In the early pandemic, pediatric mental health care and acute suicidal crises accounted for increased proportions of emergency care. During pandemic recovery, understanding the populations most impacted and increasing access to preventative mental health care is critical.

Potential demand for and access to medication abortion among North Carolina college students

Objective To estimate demand for medication abortion (MAB) among North Carolina (NC) college students and describe access to nearest clinics offering MAB to each campus. Methods We calculated demand using 2019-2020 campus demographics and NC abortion statistics. We used a mystery client technique to gather MAB cost and appointment wait times at the closest clinics and calculated travel distances and times. Results We estimated that 2,517 NC students seek MAB annually. Twenty-one clinics were closest to NC’s 111 colleges and universities, including five in neighboring states. Mean cost was $450, with an average wait time of six days to appointment. The average round-trip travel distance was 58 miles and time to the nearest clinic was 84 min by car. Conclusions Many NC college students likely obtain MAB every year and face high costs, long wait times and distances to care, which has likely worsened after the overturning of Roe v. Wade.

Wood properties of mature loblolly pine grown in Hawaii, North Carolina, and Mississippi: impacts of climate conditions on specific gravity and chemical composition

Higher productivities for loblolly pine (Pinus taeda L.) growing at exotic locations (e.g., Hawaii, Brazil) indicate that the full growth potential of this southern pine species has yet to be reached in plantations across the southeastern United States (US). The higher productivity of Hawaii-grown loblolly pine has been attributed to more favorable climate conditions. To date, physical, anatomical, and chemical property data for loblolly pine wood from exotic locations are scarce. Mid-infrared spectroscopy coupled with multivariate analysis was used to screen for chemical differences between wood samples from Hawaii (HI), North Carolina (NC), and Mississippi (MS). The principal component analysis scores plot showed that the MS samples formed a distinct cluster apart from overlapping clusters for the other two sites. Using standard wet chemistry procedures, we found that the mean lignin content for the MS site (30.1%) was significantly lower than that determined for the NC (34.5%) and HI (33.9%) sites; said lower lignin value was offset by significantly higher glucose and mannose contents. Results on the US mainland were seemingly consistent with the greater formation of latewood at sites with longer growing seasons, and the lower lignin content of latewood relative to earlywood shown for pines. Given the low percent latewood for the HI site (37.2%) relative to both mainland sites (MS, 54.8%; NC, 53.1%), yet similar lignin contents between the NC and HI sites, it appears that the relative lignin value for these exotically-grown loblolly pine trees cannot be solely attributed to the proportion of latewood.

Proton Radiation Effect on Iron Thermal Oxides: Point Defects, Microstructure & Corrosion Electrochemistry

Iron(Fe)-based alloys, such as austenitic stainless steels, form protective surface oxide layers when exposed to oxygen, aqueous electrolyte, and water vapor, which effectively inhibit corrosion [1]. One attribute that underpins the electrochemical reactivity of surface oxide layers is the presence and properties of charged point defects (e.g. vacancies and interstitials charge compensated by electrons or holes), which govern the rate and mechanism of ionic transport when exposed to an oxidizing environment such as an aqueous electrolyte [2,3,4]. However, the effect of radiation on the relationship between point defects, oxide microstructure, and oxidation behavior is poorly understood. Structural materials used in nuclear applications are particularly susceptible to radiation damage, which can degrade the underlying surface oxides. To investigate this phenomenon, thermally oxidized pure Fe was selected as a model material system to study radiation-induced defects in iron oxide scales [3]. Iron oxides were fabricated by thermal oxidation of pure Fe metal in air at 400°C, 600oC, and 800°C for 1 hour. Each oxides layer exhibits an outer hematite (α-Fe2O3) and inner magnetite (Fe3O4)/wüstite (FeO) layers with varying thickness depending on the oxidation conditions. These oxides were then irradiated with 200 keV, 0.03 dpa protons at room temperature. The oxide microstructure and phase compositions were characterized with transmission electron microscopy (TEM) coupled with electron energy loss spectroscopy (EELS). These results were corroborated with X-Ray diffraction (XRD) and Raman spectroscopy analysis. The relative vacancy concentrations and size distributions in the oxide layers were investigated using positron annihilation spectroscopy (PAS) and positron annihilation lifetime spectroscopy (PALS) techniques. Lastly, these oxides were exposed to a 0.1 M borate buffer solution (pH 9.2) at applied potential where corrosion reactivity was governed by interfacial reactions and ionic defects to regulate the growth processes observed. The potentials were cycled over the ranges where oxides growth and reduction occurred involving Fe/Fe(II)/Fe(III) reactions at a pH which suppressed chemical reactions at the oxide/electrolyte interface and would lead to solubilization of Fe species. The subsequent oxidation, reduction, and semiconductor properties of the oxides were evaluated using AC and DC electrochemical methods, both with and without prior irradiation. Current results demonstrate that radiation damage can manifest itself in the form of vacancy clustering and possible maghemite (γ-Fe2O3) formation. These phenomena were corroborated with donor density and diffusivity values calculated using Mott-Schottky analysis and electrochemical impedance spectroscopy (EIS) analysis and equivalent circuit model (ECM) interpretation, respectively. Radiation damages to the outer rate-regulating α-Fe2O3 layer correlates with enhanced anodic current density corresponding to Fe/Fe(II)/Fe(III) reactions. However, proton radiation may also interact with the metal/oxide and oxide/oxide interfaces depending on the oxide structure and H+ beam penetration depth, leading to either degradation or improvement in the Fe-oxide corrosion responses. Nevertheless, the damage persists and can continue to impact corrosion mechanisms long after the irradiation source is removed. The multiple techniques adopted, each characterizing a material property of a different length scale (from meso-, micro-, to macroscopic) enable us to hypothesize the roles that point defects played after irradiation and during corrosion and how the radiation-induced changes in the defect characteristics influence corrosion electrochemistry. Acknowledgment Research primarily supported as part of the fundamental understanding of transport under reactor extremes (FUTURE), an Energy Frontier Research Center funded by the U.S. Department of Energy, Office of Science, Basic Energy Sciences. Utilization of the Malvern-Panalytical Empyrean diffractometer were supported by Nanoscale Materials Characterization Facility with National Science Foundation under award CHE-2102156. The TEM sample preparation and characterization was performed at the Analytical Instrumentation Facility at North Carolina State University, which is supported by the State of North Carolina and the National Science Foundation (award number ECCS-1542015). LANL is operated by Triad National Security, LLC, for the National Nuclear Security Administration of the U.S. DOE (Contract No. 89233218CNA000001).

USING COLLECTIVE IMPACT TO ASSESS HOME AND COMMUNITY-BASED SERVICES WORKER TRAINING AND CREDENTIALING

Abstract Older adults and people living with disabilities receive home- and community-based services (HCBS) from approximately 120,000 often poorly paid and inadequately supported direct care workers in North Carolina (NC). The demand for these workers is increasing rapidly, with NC projected to add almost 23,000 new direct care jobs from 2020 to 2030. With the goal of optimizing the workforce pipeline to prepare for the high need for HCBS across NC, we conducted a Medicaid-funded landscape analysis of direct care training/credentialing using Collective Impact (CI). CI is used for diverse collaborations through forming a common agenda, shared measurement, mutually reinforcing activities, continuous communication, and “backbone” support (dedicated coordination team). Engaging with lived experiences is crucial in CI as it leads to sustainable decision-making informed by those affected by policy change. With input from long-term services and support agencies, licensing bodies, advocates, and those with lived experience, we characterized NC HCBS training/credentialing landscape, generating a first-of-its-kind comprehensive crosswalk resource for the state. Findings reveal the complexity of training/requirements, limited portability, lack of flexibility, and a need for more person-centered and relational core competencies. In addition, funding and incentives for additional training are lacking, which limits opportunities for professional development and career advancement. CI is an effective method to analyze direct care worker training/credentialing, it allowing researchers to harness the wisdom of community partners and incorporate lived experiences of the people most impacted by potential policy changes - workers, HCBS recipients, and families.

LEVERAGING THE COMMUNITY AS PARTNERS TO ADVANCE CANCER RESEARCH IN SOCIALLY DIVERSE OLDER ADULT POPULATIONS

Abstract Older Black adults with cancer suffer a “double disadvantage” to their health due to the compounding effects of ageism and racism. This “double disadvantage” further fuels the disparities in cancer-related mortality observed for this population. For example, multiple myeloma (MM) is an incurable and debilitating blood cancer that predominantly affects older Black adults. Despite overall improvements in MM-related survival observed following the introduction of novel therapies, older Black persons with MM continue to die at twice the rate of their White counterparts. This survival gap is largely driven by differential healthcare access and disappears when older Black adults are given equal access to care. Using MM as a chronic disease model, we are partnering with a community advisory board to design and pilot test a community lay navigator program that seeks to address some of the upstream determinants of healthcare access that limit how older Black adults newly diagnosed with MM perceive the need for, seek, reach and engage with the healthcare system. Through our foundational qualitative work focused on older North Carolinians (patients and caregivers) affected by MM, we have identified the following multilevel (individual, interpersonal, and community level) intervention targets: trust, knowledge and health beliefs, availability and adequacy of social support, and patient empowerment. In addition, we are leveraging the resources of an established core (Rapid Case Ascertainment) housed within our Comprehensive Cancer Center and linked to the statewide N.C. Central Cancer Registry to facilitate early identification of eligible participants (within 4-8 weeks of diagnosis) and patient outreach.

When Life Gives You Lemons, Do Outreach! A Program for University Professors to Virtually Connect to K-12 Students during the COVID-19 Pandemic and beyond

At the beginning of the coronavirus pandemic in the Spring of 2020, North Carolina (NC) public schools moved to distance education in which all students attended classes on video conferencing programs. During this time, NC State University faculty offered virtual guest talks to NC K-12 students. Eighty-eight faculty from three NC State colleges volunteered and 161 teachers requested talks, with approximately 5,400 students. Overall, significantly more teachers from the NC Piedmont region requested speakers (p<.0001); significantly more urban teachers requested talks (p<.0001); and, significantly more elementary school teachers requested speakers than middle (p<.0001) or high school (p<.0001) teachers. The program was beneficial to teachers and students, exposing them to real-world research. In the future, the program should be

Endocarditis, drug use and biological sex: A statewide analysis comparing sex differences in drug use-associated infective endocarditis with other drug-related harms

ObjectivesHospitalizations for drug use-associated infective endocarditis (DUA-IE) have risen sharply across the United States over the past decade. The sex composition of DUA-IE remains less clear, and studies have indicated a possible shift to more females. We aimed to compare more recent statewide hospitalization rates for DUA-IE in females versus males and contextualize them among other drug-related harms in North Carolina (NC). MethodsThis study was a retrospective analysis using public health datasets of all NC hospital discharges for infective endocarditis from 2016 to 2020. Drug use-related hospitalizations were identified using ICD-10-CM codes. Discharge rates by year and sex for DUA-IE and non-DUA-IE were calculated and compared to fatal overdoses and acute hepatitis C (HCV). Temporal, demographic, and pregnancy trends were also assessed. ResultsHospitalizations rates for DUA-IE were 9.7 per 100,000 over the five-year period, and 1.2 times higher among females than males. Females composed 57% of DUA-IE hospitalizations over the period. Conversely, fatal overdose, acute HCV, and non-DUA-IE hospitalization rates were higher among males. Age, county of residence, and pregnancy status did not explain the higher DUA-IE among females. ConclusionFemales now comprise the majority of DUA-IE hospitalizations in NC, unlike other drug-related harms. No clear demographic or geographic associations were found, and further research is needed to explain this phenomenon. Preventing invasive infections among females who inject drugs should be prioritized.

Influence of Genetic Selection on Rearing Parameters and Production Performance of Two Leghorn Type Pullets, 1940 Random-Bred Control Versus W-36 (2016) Commercial Strain Grown under the Same Regimen

The aim of this study was to expand the period of selection history by evaluating the pullet growth characteristics of two genetic stocks of Leghorns reared under identical conditions 1940 Leghorn Strain (WL40) from the University of Arkansas and a 2016 Commercial Hy-Line W-36 (WLCC) from Hy-Line were housed in the same environment, comparing rearing production characteristics from the day of hatch until 16 weeks of age. All chicks were hatched at the Prestage Department of Poultry Science at North Carolina State University and raised in the same cage-rearing facility, with 14 birds per brooding cage then reduced to 10 birds per cage. Pullets were weighed bi-weekly, and feed weigh-backs were concurrent to determine body growth, feed consumption, and utilization. Pullet starter was fed from 0-6 weeks, a grower from 6-12 weeks, and a developer from 12-16 weeks. Diets were provided ad libitum, and mortality was recorded daily. The experiment was a randomized block design using a 2 ×3 factorial design, 2 genetic strains, and 3 dietary phase regimens and all data were statistically analyzed using a one-way ANOVA. Both strains responded similarly, showing an increase in body weights with the 2016 commercial strain exhibiting heavier weights with no significant differences (P>0.05) in all feed phases. Results from this data suggest that layer selection over the years had neutral adverse effects on body weights or feed conversion reared in the same environment and current commercial diet. This indicated that selection preferences for desirable traits such as body weights and feed conversion have been successfully implemented for optimal performance benefiting the 2016 pullet.

Hematologic Abnormalities and Diseases Associated with Moderate-to-Marked Basophilia in a Large Cohort of Dogs.

Basophilia is a rare hematologic finding in dogs. This research aimed to describe the hematologic and clinical characteristics of dogs with moderate-to-marked basophilia. CBC reports with blood smear examinations from dogs presented to the North Carolina State University Veterinary Teaching Hospital were retrospectively reviewed for basophilia (>193 cells/µL). We classified basophilia as moderate when counts were ≥500 cells/µL and marked when they reached ≥1000 cells/µL. We compared the hematologic and clinical profiles of dogs with moderate-to-marked basophilia (the basophilia group) to those without basophilia, serving as our control group. In addition, we investigated differences between dogs with marked basophilia versus those with moderate basophilia, as well as between dogs in the basophilia group with and without concurrent eosinophilia. Diseases associated with moderate-to-marked basophilia included eosinophilic lung disease (p < 0.0001), leukemia/myeloproliferative neoplasms (p = 0.004), parasitic infection (p = 0.004), mast cell tumor (p = 0.005), and inflammatory bowel disease (p = 0.02). Overall, dogs with marked basophilia had a lower frequency of inflammatory diseases (51% vs. 70%, p = 0.009) and a higher frequency of neoplastic diseases (48% vs. 26%, p = 0.003) compared to those with moderate basophilia. In the basophilia group, concurrent eosinophilia was only seen in 36% of dogs. Dogs with concurrent eosinophilia were more often diagnosed with inflammatory diseases (77% vs. 58%, p = 0.006), with fewer diagnoses of neoplasia (19% vs. 40%, p = 0.001), compared to dogs without concurrent eosinophilia. The findings of this study offer veterinary clinicians valuable guidance in determining diagnostic priorities for dogs with moderate-to-marked basophilia.

Calculation of body surface area of corn snakes (Pantherophis guttatus) utilizing computed tomography.

To determine the K-constant for body surface area calculation from body weight in corn snakes (Pantherophis guttatus) through the use of computed tomography (CT) measurements. 12 adult corn snakes held by North Carolina State University for research purposes underwent CT between November 2022 and January 2023. Each snake had a CT scan, physical examination, and body weight measurement. CT images were uploaded into software able to perform 3-D reconstruction and measure body surface area. The species-specific K-constant was determined using nonlinear regression analysis between body surface area and (body weight in grams)2/3. The mean body weight of the 12 adult corn snakes was 228 g, with a mean body surface area of 505.1 cm2. The calculated K-constant was 13.6 (P < .001). The resulting formula for body surface area in corn snakes is BSA in cm2 = 13.6 X (body weight in grams)2/3. The body surface area formula developed for corn snakes will allow for improved dosing accuracy for medications with low therapeutic safety margins. Additional pharmacokinetic and pharmacodynamic studies are necessary to determine the safety and efficacy of individual medications.

Assessing pharmacists’ knowledge, attitudes, and practices of opioid management within different patient populations

BackgroundRacial disparities in drug overdose exist, with black, indigenous, and Hispanic individuals experiencing higher rates of opioid overdose deaths. Opioid use disorder prevention services, such as opioid deprescribing and naloxone dispensing, have been identified as ways to prevent opioid overdose. Pharmacists can help use these strategies, but racial disparities in use exist. ObjectiveThis study aimed to evaluate North Carolina (NC) pharmacist knowledge, attitudes, and practices (KAP) of opioid management practices, including opioid deprescribing and naloxone dispensing, across different racial and ethnic groups. MethodsThis was a prospective, cross-sectional study conducted through a Web-based KAP survey distributed via e-mail to all NC pharmacists using a modified Dillman’s method. Descriptive statistics were used to analyze demographics and pharmacist KAP data. Attitudes data were further analyzed using one-way analysis of variance tests and Tukey’s post hoc analyses. ResultsAfter applying exclusion criteria, 527 participants were eligible for analysis; 254 of these individuals completed the entire survey. The survey response rate was 15.3% and respondents were mostly female (59.1%) and white (86.6%). Approximately half of pharmacists knew the correct opioid morphine milliequivalent cutoffs considered to be high risk (47.7%) and not to be exceeded (51.9%). When asked about chronic opioid statistics within the United States, respondents overestimated that 23.70% of patients on chronic opioid therapy receive naloxone (SD = 18.93%). Pharmacists believed that black patients were more likely to adhere to an opioid taper than any other race or ethnicity and Hispanic patients were more likely to adhere to naloxone treatment than any other race or ethnicity. Finally, 91% of pharmacists knew what an opioid taper was, but 77% of pharmacists had never designed one. ConclusionsGaps in knowledge may contribute to further disparities in opioid management. Pharmacists’ attitudes may contribute to biases in opioid management practices and practices related to opioid deprescribing may limit the pharmacists’ current role. More education is needed so pharmacists can play an increased role in opioid management across all patient populations.

Abstract B106: Assessing racial disparities in the receipt of quality care in the most prevalent cancers in American Indians

Abstract INTRODUCTION Previous SEER-Medicare analyses reported lower receipt of guideline concordant care for American Indian (AI) compared with White (WH) patients across several cancers. While large scale assessments are informative, there is a need to assess cancer outcomes and develop interventions at a level closer to communities. To address this gap, we assessed measures of quality care in AI and WH breast, prostate, and colorectal cancer patients. METHODS We assembled novel cohorts of AI and WH patients from the North Carolina (NC) cancer registry, the state with the largest AI population east of the Mississippi River. Eligible patients were diagnosed with breast, prostate, and colorectal cancers who linked to public and private insurance claims with continuous enrollment (2003-2019). Measures were assessed within 1 year of diagnosis unless stated otherwise. Breast cancer measures included receipt of: (1) HER2 testing within 3 months of diagnosis [NQF #1878]; (2) Tamoxifen/Aromatase Inhibitors for Stage I-III ER/PR+ [NQF #220]; (3) radiation among stage I-III breast conserving surgery or mastectomy patients [NQF #0219]. Stage II-III colorectal cancer measures included receipt of: (1) carcinoembryonic antigen (CEA) testing; (2) surveillance colonoscopy; and (3) computed tomography (CT) among resected patients [NCCN 2.2023 COL-8]. We assessed receipt of prostate-specific antigen (PSA) testing in the first 15 months after prostate cancer diagnosis to monitor disease recurrence. Poisson regression adjusting for sex, urbanicity, insurance type, and age at diagnosis was used to estimate risk ratios (RR) and 95% confidence intervals (CI) comparing the receipt of care between AI and WH patients. RESULTS The sample sizes of AI patients differed across measures, ranging from 104 colorectal to 554 prostate cancer patients. Evidence of disparity was mixed for the breast cancer measures. AI breast cancer patients less frequently received HER2 testing within 3 months of diagnosis (AI=61% vs WH=71%), although adjustment attenuated this association (RR=0.90; CI: 0.81-1.01). Among stage I-III breast cancer patients, AIs more frequently received radiation within 1 year of surgery (AI=75% vs WH=71%) compared with WH patients (RR=1.11; CI: 1.01-1.21). Across colorectal cancer measures, AI patients performed as well or better than WH patients. Notably, AI patients more frequently received CEA testing (AI=71% vs WH=59%), a difference that persisted after adjustment (RR=1.17; CI: 1.03-1.32). AI prostate cancer patients received PSAs less often in the 15 months following diagnosis (AI=82% vs WH=88%) than WH patients (RR=0.96; CI: 0.93-1.00). CONCLUSIONS The magnitude and direction of AI/WH disparities in receipt of quality cancer care differed across measures. Racial misclassification is a challenge in AI health outcomes research, which may misrepresent the experience of AIs. Nevertheless, our findings provide insight into specific areas of breast, prostate, and colorectal cancer care where local tailored interventions can be focused to improve care equity. Citation Format: Bradford E. Jackson, Marc E. Emerson, Lisa P. Spees, Chris D. Baggett, Hayley N. Morris, Ana I. Salas, Angelo Moore, Yadurshini Raveendran, Clare Meernik, Tomi Akinyemiju, Rachel Denlinger-Apte, Ronny A. Bell, Stephanie B. Wheeler. Assessing racial disparities in the receipt of quality care in the most prevalent cancers in American Indians [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 B106.

Assessing Barriers to Human Papillomavirus (HPV) Vaccination in At-Risk Rural Communities of Western North Carolina, United States.

Human papillomavirus (HPV) vaccination among adolescents in rural, western North Carolina (NC) remains suboptimal. Data are needed to understand the barriers to HPV vaccination in these communities. We conducted a cross-sectional pilot study of parental attitudes and provider practices regarding HPV vaccination in rural western NC counties with lower HPV vaccination rates. Eight health department clinics were enrolled in the study. Further, 29 provider and 32 parent surveys were analyzed along with environmental scans. Median provider comfort regarding knowledge of HPV-associated diseases was 85% (IQR = 75-95), on a scale of 0-100% (100% representing complete comfort). Median parental comfort level regarding knowledge of HPV-associated diseases and the HPV vaccine was 75% (IQR = 50-89) and 75% (IQR = 49-96), respectively. Less than 25% of parents rated the HPV vaccine as 'extremely effective' against genital (16.7%) and anal cancers (17.9%). Parents were more likely to rate the vaccine as 'extremely effective' to 'very effective' if their child was female. There was no significant difference between parental- and provider-reported comfort with knowledge about HPV-associated diseases (p = 0.0725) and the HPV vaccine (p = 0.167). This study identified multiple opportunities to increase HPV vaccine coverage among unvaccinated adolescents at parental, provider, and clinic levels. Health education of rural NC residents and providers in public health settings may identify future interventions to increase HPV vaccine uptake.

Prevalence and Proportion of Transcranial Doppler Screenings in a Population Children with Sickle Cell Disease and Association with Hydroxyurea Adherence

Sickle cell disease (SCD) is an inherited or genetic hemoglobinopathy in the United States and approximately 100,000 Americans are affected. The prevalence of stroke in unscreened children with sickle cell anemia (SCA) is 10% and can begin at infancy. National guidelines strongly recommend annual Transcranial Doppler (TCD) screenings as well as hydroxyurea (HU) administration in children with SS and Sβ o thalassemia (SCA) genotypes. The purpose of this project was to examine the prevalence and proportion of TCD screenings in North Carolina (NC) Medicaid enrollees and to identify associations with sociodemographic factors (age, sex, and rurality) and HU adherence. A longitudinal analysis of NC Medicaid claims data (2016-2019) was conducted for children with SCD ages 2-16 years. Prevalence of TCD screening claims was calculated to determine the number of children with TCD claims for each of the three, 12-month enrollment periods. The proportion of TCD screening claims was calculated based on NC Medicaid enrollees who had increasing TCD claims (0, 1, 2, or 3+) for 12, 24, and 36 months of Medicaid enrollment. HU adherence was measured using Proportion of Days Covered (PDC). HU PDC is a measure of HU prescription fills over 365 days within a 12-month period. HU PDC was used to categorize enrollees into good (≥80%), moderate (60-79%), or poor (&amp;lt;60%) adherence categories. Age (years) was declared as the age in years of each participant during each study observation period and was categorized into three groups: preschoolers (2-5 years), school aged (6-11 years), and adolescents (12-16 years). Rurality was identified by converting residential zip codes to rural/urban county codes (RUCC). An adjusted multivariable Poisson regression model was fit to assess the rate of TCD screenings by HU adherence while controlling for age, sex, and rurality. The prevalence of children with annual TCD screening claims ranged from 39.5% to 40.1%. The percentage of children with 2 or more TCD claims increased when they had extended months of NC Medicaid enrollment (10.5% at 12 months, 33.7% at 24 months, and 52.6% at 36 months). Overall, children with Good HU adherence were 2.48 (95% CI 2.00, 3.06) times more likely to have TCD claims than children with poor HU adherence. In conclusion, the prevalence of TCD screenings of children with SCD on NC Medicaid was extremely low. Children with better HU adherence and extended NC Medicaid enrollment time were associated with higher number of TCD screenings.

U.S. Hydrodynamic Dredging Challenges and Opportunities

The issue of sedimentation in navigable waterways continually confronts maritime authorities. Regular maintenance dredging, a costly and arduous exercise, is necessary to ensure safe navigation is achievable throughout the year. Private industry and the U.S. Army Corps of Engineers (USACE) combined to remove roughly 230 million cubic yards of maintenance volume at an estimated cost of $1.7 billion in 2020. The handling and disposal of dredged material are practices affected by numerous regulatory constraints. Once a local or national organization has established the most efficient, lowest-cost dredging alternative with the most flexibility, the next step is identifying and addressing permitting concerns and seeking permits to use the technology. Innovative water injection dredging (WID) has been approved in various locations throughout the U.S.A., including providing a reliable means for the North Carolina State Ports Authority (NCSPA) to provide access to its berths, removing sediment over the Chesapeake Bay Bridge–Tunnel to minimize potential harm to the existing tunnel structure, and maintaining federal navigational depth in the Mississippi River. This paper aims to provide a summary overview of the current state of WID in U.S. waterways, including the discussion of a successful permitting and procurement effort by the NCSPA that secured a custom-built WID vessel for North Carolina. Recent literature has identified parameters correlated with WID performance, such as median grain size, hydrology of the waterway, Richardson number, and the liquidity index, which are explored.

Fatal occupational injuries in North Carolina, 1992–2017

ObjectivesAfter declining for several decades, fatal occupational injury rates have stagnated in the USA since 2009. To revive advancements in workplace safety, interventions targeting at-risk worker groups must be implemented....