Region Of Kentucky Research Articles

Snakebites Reported to the Kentucky Regional Poison Control Centers for the Years 2012-2016.

Snake envenomations cause significant morbidity and mortality. The goals of this study were to assess the epidemiology of snakebites in Kentucky and treatment strategies used by physicians reporting to the Kentucky Regional Poison Control Centers. This was a descriptive epidemiologic study compiling clinical data on snakebites reported to the Kentucky Regional Poison Control Centers from 2012 to 2016. We built a database of the patient demographics, treatment, and clinical course of each snakebite reported in the study period. Attention was paid to all antivenom interventions and use of contraindicated therapies. We compiled 674 total records. Patient age was 34±18 y (mean±SD), with males (71%) predominating. Most (97%) bites were to a distal upper or lower extremity. The majority (78%) occurred at a private residence. Most reports came between May and September (88%). Of the 674 patients, 24% (n=159) were classified as moderate or severe. Two hundred thirty (34%) patients were admitted to the hospital. Forty-six patients (7%) received surgical consultation, and 12 (2%) underwent surgical intervention. One hundred fifty-three patients received antivenom, with 6±3 vials used per patient. Length of stay was 3±2 d when antivenom was administered and 2±2 d when not administered. Six cases of coagulopathy were noted. Multiple contraindicated therapies were noted. Snake envenomations are a prevalent public health concern for residents of Kentucky, chiefly during summer months. Significant medical intervention is being performed for many patients, with a high prevalence of contraindicated therapies. More data are needed to fully characterize the epidemiologic impact and appropriateness of the interventions being applied.

Mapping Fundamental-Mode Site Periods and Amplifications from Thick Sediments: An Example from the Jackson Purchase Region of Western Kentucky, Central United States

ABSTRACTV S 30 is currently used as a key proxy to parameterize site response in engineering design and other applications. However, it has been found that VS30 is not an appropriate proxy, because it does not reliably correlate with site response. Therefore, the VS30-based National Earthquake Hazards Reduction Program site maps may not capture regional site responses. In earthquake engineering, site resonance, which can be characterized by the fundamental mode with a site period (Tf) and its associated peak amplification (A0), is the primary site-response concern. Mapping Tf and A0 is thus essential for accurate regional seismic hazard assessment. We developed a 3D shear-wave velocity model for the Jackson Purchase Region of western Kentucky, based on shear-wave velocity profiles interpreted from seismic reflections and refractions, mapped geologic units, and digital-elevation-model datasets. We generated shear-wave velocity profiles at grid points with 500 m spacing from the 3D model and performed 1D linear site-response analyses to obtain Tf and A0, which we then used to construct contour maps for the study area. Our results show that Tf and A0 maps correlate with the characteristics of regional geology in terms of sediment thicknesses and their average shear-wave velocities. We also observed a strong dependency of A0 on bedrock shear-wave velocities. The mapped Tf and A0 are consistent with those estimated from borehole transfer functions and horizontal-to-vertical spectral ratio analyses at broadband and strong-motion stations in the study area. Our analyses also demonstrate that the depth to bedrock (Zb) is correlated to Tf, and the average sediment shear-wave velocity (VS-avg) is correlated to A0. This implies that Zb and VS-avg may be considered as paired proxies to parameterize site resonance in the linear-elastic regime.

Oxygen isotope (δ18O) trends measured from Ordovician conodont apatite using secondary ion mass spectrometry (SIMS): Implications for paleo-thermometry studies

Abstract The oxygen isotopic compositions (δ18O) of minimally altered phosphate minerals and fossils, such as conodont elements, are used as a proxy for past ocean temperature. Phosphate is thermally stable under low to moderate burial conditions and is ideal for reconstructing seawater temperatures because the P-O bonds are highly resistant to isotopic exchange during diagenesis. Traditional bulk methods used to measure conodont δ18O include multiple conodont elements, which can reflect different environments and potentially yield an aggregate δ18O value derived from a mixture of different water masses. In situ spot analyses of individual elements using micro-analytical techniques, such as secondary ion mass spectrometry (SIMS), can address these issues. Here we present 108 new δ18O values using SIMS from conodont apatite collected from four Lower to Upper Ordovician stratigraphic successions from North America (Nevada, Oklahoma, and the Cincinnati Arch region of Kentucky and Indiana, USA). The available elements measured had a range of thermal alteration regimes that are categorized based on their conodont alteration index (CAI) as either low (CAI = 1–2) or high (CAI = 3–4). Though individual spot analyses of the same element yield δ18O values that vary by several per mil (‰), most form a normal distribution around a mean value. Isotopic variability of individual spots can be minimized by avoiding surficial heterogeneities like cracks, pits, or near the edge of the element and the precision can be improved with multiple (≥4) spot analyses of the same element. Mean δ18O values from multiple conodonts from the same bed range between 0.0 and 4.3‰ (median 1.0‰), regardless of low or high CAI values. Oxygen isotopic values measured using SIMS in this study reproduce values similar to published trends, namely, δ18O values increase during the Early–Middle Ordovician and plateau by the mid Darriwilian (late Middle Ordovician). Twenty-two of the measured conodonts were from ten sampled beds that had been previously measured using bulk analysis. SIMS-based δ18O values from these samples are more positive by an average of 1.7‰ compared to bulk values, consistent with observations by others who attribute the shift to carbonate- and hydroxyl-related SIMS matrix effects. This offset has implications for paleo-temperature model estimates, which indicate that a 4 °C temperature change corresponds to a 1‰ shift in δ18O (‰). Although this uncertainty precludes precise paleo-temperature reconstructions by SIMS, it is valuable for identifying spatial and stratigraphic trends in temperature that might not have been previously possible with bulk approaches.

Water Quality Monitoring for the Central Appalachian Coalfields Crayfish

Primary economic drivers over the years in the central Appalachian coalfields include coal mining, timbering, fossil fuel extraction, and all-terrain vehicle tourism. These industries cause impacts such as sedimentation, elimination of headwater streams (resulting from valley fills), destruction of riparian vegetation, and increased physiochemical pollution in montane streams. As a result of this significant habitat destruction, two species of endemic crayfishes, Cambarus callainus and Cambarus veteranus, were both federally listed in April 2016. This study will sample 12 selected sites – four degraded streams, four medium-impacted streams, and four reference condition streams – within the coalfields region of Kentucky, Virginia, and West Virginia. Sampling will occur for one year, alternating monthly between two sets of six sites. General crayfish sampling will occur at each site to document the crayfish community present. Water quality monitoring will be split into four categories: long-term, point-source, photometer, and water samples analyzed for heavy metal content. Understanding the chemical composition of the target species’ habitat will enable us to properly and efficiently aid C. callainus and C. veteranus conservation efforts.

The Journal of Clinical Pharmacology Adds 2 Associate Editors

Drs. Bertino (Editor-in-Chief) and Reed (Associate Editor), Ms. Marshall (Managing Editor), and The Journal of Clinical Pharmacology (JCP) are pleased to announce the addition of 2 associate editors: Joan Korth-Bradley, PharmD, PhD, received her BSc at the University of Toronto and completed a residency in hospital pharmacy at Ottawa General Hospital. She then received her PharmD from the University of Minnesota, completed a clinical pharmacy fellowship at the University of Texas at Austin, and then completed a PhD under Dr. Tom Ludden in the Division of Pharmaceutics at the University of Texas at Austin. After a brief career in academia and hospital pharmacy, Dr. Korth-Bradley joined Wyeth-Ayerst in 1991 and then Pfizer Inc. (which acquired Wyeth-Ayerst) in 2009. She is currently a Senior Director in Clinical Pharmacology at Pfizer Inc. Dr. Korth-Bradley is a Fellow of the American College of Clinical Pharmacology, the American College of Clinical Pharmacy, and the American Association of Pharmaceutical Scientists. She has served on numerous ACCP committees and is currently an ACCP Regent. She has also been a member of the Editorial Board of JCP. She has an extensive track record of publications and presentations in clinical pharmacology. Janice E. Sullivan, MD, started her career in nursing (as a nurse practitioner) and then received her MD from the University of Minnesota. She completed a pediatric residency at the University of Arkansas and a Fellowship in Pediatric Pharmacology and Critical Care from Case Western Reserve University. Dr. Sullivan is currently a Professor at the University of Louisville, the Vice Chair of Research in the Department of Pediatrics at the University of Louisville, and a consultant at the Kentucky Regional Poison Center of Norton Children's Hospital. She has recently stopped her many years of pediatric critical care work to focus on her research activities. Dr. Sullivan is board-certified in Pediatrics, Pediatric Critical Care, and Clinical Pharmacology. She holds fellowships in the American Academy of Pediatrics and the Society of Critical Care Medicine. She has an extensive record of extramural research funding as well as a long record of publications and presentations. We welcome Drs. Korth-Bradley and Sullivan as Associate Editors for The Journal of Clinical Pharmacology.

Abstract P593: Association Between Troponin and Ischemic Stroke Recurrence in the Greater Cincinnati/Northern Kentucky Stroke Study

Introduction: Elevations in troponin (cTn) are common in patients with acute ischemic stroke, yet their significance remains uncertain. Hypothesis: Elevated cTn at the time of acute ischemic stroke is associated with ischemic stroke recurrence. Methods: We included all adult patients with acute ischemic stroke who were residents of the Greater Cincinnati/Northern Kentucky region and who presented to an emergency department (ED) in 2015 and who had a cTn measured within 24 hours of ED arrival. Our exposure variable was an elevated cTn, defined as a value exceeding the laboratory’s 99 th percentile. Our primary outcome was ischemic stroke recurrence, defined as a new ischemic stroke with radiographic confirmation in the 3 years following the index ischemic stroke event. Cox proportional hazards model was used to evaluate the association between elevated cTn and ischemic stroke recurrence while adjusting for demographics, vascular risk factors, and stroke severity. In a secondary analysis, we excluded patients with a concomitant adjudicated myocardial infarction (MI) at the time of the index ischemic stroke. Results: Among 2,334 patients with acute ischemic stroke, 1,992 (85%) had a cTn assay within 24 hours of ED arrival and were included in the analysis. 402 (20%) patients had an elevated cTn and 259 (13%) patients had a recurrent ischemic stroke. 66 (3%) patients had an elevated cTn and a concomitant acute MI and 336 (17%) patients had an elevated cTn without a concomitant acute MI. After adjustment for demographics, vascular risk factors, and stroke severity, we found an association between elevated cTn and recurrent ischemic stroke (hazards ratio [HR], 1.5; 95% CI, 1.1-2.0). Our results were unchanged after excluding patients with a concomitant adjudicated MI (HR 1.4; 95% CI, 1.03-2.0). Conclusions: Among patients with acute ischemic stroke, elevated cTn even in the absence of concomitant adjudicated MI, was associated with ischemic stroke recurrence. Further mechanistic studies are necessary to explore the underlying etiology of hypertroponinemia among patients with acute ischemic stroke in order to guide targeted therapies to reduce stroke recurrence.

Hal Rogers’s Kentucky Kingdom

This year marks Harold “Hal” Rogers’s twenty-first consecutive electoral victory in Kentucky’s Fifth Congressional District, making him the secondlongest-serving Republican in Congress. He rode into office on the wave of the Reagan Revolution in 1980, and the governing style he’s employed in the Fifth District—which covers the rural, mountainous, Appalachian region of southeastern Kentucky—can mostly be described as Reaganite: pro–War on Drugs, pro–prison expansion, anti-regulation of extractive industries, and pro-family. The congressman has had to improvise a little over the years in response to changes in the economy and political system, but he’s wellpositioned to do so: as a former chairman of the House Appropriations Committee, the elite “College of Cardinals” that manages the government’s budget, and the ranking member of the House Appropriations Subcommittee on State and Foreign Operations, he’s one of the most influential men in Washington. Rogers has extraordinary discretion over where and how the government exercises power domestically and overseas, especially within the border regions; he can coerce other lawmakers to support his policies by withholding funding; and, crucially, he can funnel tons of “pork” back to his home district

Through space and time: Predicting numbers of an eruptive pine tree pest and its predator under changing climate conditions

Forest biotic populations and communities are undergoing irreversible changes due to climatic perturbations, and these effects may be exacerbated by insect pests. In the southeastern United States (U.S.), Dendroctonus frontalis is one of the most important forest pests that can cause substantial tree mortality over large geographic areas. As life-history of D. frontalis is dependent on environmental conditions, our objective was to determine the effects of climatic variables on the species occurrence of D. frontalis and their main predator, Thanasimus dubius. U.S. Department of Agriculture - Forest Service beetle trapping data (proxy for true abundance) for 2014–2018 were assessed with nine climatic variables including: (1) average monthly minimum, maximum, and mean temperatures; (2) mean winter temperature; (3) minimum, maximum and mean annual temperature; and (4) cumulative winter and annual precipitation. Variable selection was performed using least absolute selection and shrinkage operator (LASSO), and selected variables were fit to varying coefficient generalized additive models (GAMs). Minimum temperatures for February and March and maximum temperatures for January and prior year August were found to have a significant effect on D. frontalis numbers, and model accuracy was ~89%. Beetle suitability was assessed for 1981–2100 under three different shared socioeconomic pathways (SSP). The model indicated that the suitability of D. frontalis has increased from 1981 to 2019 in certain regions of Alabama, Mississippi, and Georgia, while Arkansas, Kentucky, Louisiana, North Carolina, Tennessee, East Texas, and Virginia had low suitability. Future projections indicated comparable D. frontalis numbers to current numbers under the lowest SSP of 2.1 °C by year 2100, but D. frontalis may decrease under higher warming projections. The same climatic predictors influenced T. dubius, except average September maximum temperature replaced August maximum temperatures in the model. Understanding how these abiotic factors influence forest pest populations may better guide prevention and management practices aimed at identifying high risk areas and reducing pest outbreaks.

Abstract PO-253: Increasing colorectal cancer screening in rural underserved communities with multilevel interventions: Formative evaluation of accelerating colorectal cancer screening and follow-up through implementation science in Appalachia

Abstract Background: Colorectal cancer (CRC) screening is lower in Appalachian regions of Kentucky and Ohio than in their non-Appalachian counterparts, with lower screening contributing to increased CRC incidence and mortality. To address CRC disparities in these underserved regions, researchers from the University of Kentucky and The Ohio State University partnered with two federally qualified health centers (FQHCs) to develop and implement multilevel interventions (MLIs) during year one of a 5-year National Cancer Institute funded Cancer Moonshot project to increase CRC screening and follow-up in Appalachian Kentucky and Ohio. Methods: Drawing from the Model for the Analysis of Population Health and Health Disparities and using a social determinants of health framework, researchers selected and partnered with Community Advisory Boards (CAB) to guide project formation in two Appalachian counties, one in Kentucky and one in Ohio. These formative activities included creating community profiles, conducting key informant interviews with clinic and community champions, and completing data inventories to assess clinic capacity, ultimately resulting in two primary care clinics being selected for pilot year implementation activities. Results: Key informant interviews revealed barriers to CRC screening at multiple levels: patient (e.g., fear of screening results), provider (e.g., competing priorities), clinic (e.g., lack of reminder or tracking systems), and community (e.g., cultural norms). Clinic champions were provided with menus of evidence-based interventions (EBIs) to address barriers at each level and were encouraged to select locally relevant, implementable EBIs. Clinics chose to implement the following EBIs: improved patient education materials (patient-level), additional provider education (provider-level), improvement of electronic health record (EHR) reporting and creation of clinic-wide screening protocols (clinic-level), and provision of interactive screening education at community events (community- level). Conclusion: Results from pilot year activities were used to refine the project approach for years two through five. Project activities will be expanded to 10 more Appalachian counties in Kentucky and Ohio using a design wherein counties will be paired by participating clinic patient volume. As in pilot year activities, clinic/community champions will be encouraged to select EBIs appropriate to their patients, providers, clinics, and communities. To measure clinical outcomes, self- reported screening will be monitored using data from county-wide telephone surveys with additional data from clinic EHRs. Using an MLI approach may be well- received in underserved rural Appalachian communities and may ultimately be successful at reducing CRC screening disparities. Citation Format: Aaron J. Kruse-Diehr, Jill M. Oliveri, Mira L. Katz, Mark Cromo, Robin C. Vanderpool, Michael L. Pennell, Darrell M. Gray II, Paul L. Reiter, Bin Huang, Gregory S. Young, Darla Fickle, Melinda Rogers, David Gross, Sue Russell, Electra D. Paskett, Mark Dignan. Increasing colorectal cancer screening in rural underserved communities with multilevel interventions: Formative evaluation of accelerating colorectal cancer screening and follow-up through implementation science in Appalachia [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-253.

Exceptional Survival Among Kentucky Stage IV Non-small Cell Lung Cancer Patients: Appalachian Versus Non-Appalachian Populations.

To determine differences in exceptional survival (ES)-survival of 5 years or more past diagnosis-between stage IV non-small cell lung cancer (NSCLC) patients residing in the Appalachian versus non-Appalachian regions of Kentucky. This was a population-based, retrospective case-control study of Kentucky patients, diagnosed with stage IV NSCLC between January 1, 2000, and December 31, 2011. The data were drawn from the Kentucky Cancer Registry. Findings from the multivariable logistic regression revealed no significant differences in the odds of ES between patients who resided in Appalachian versus non-Appalachian Kentucky. Being female and undergoing surgery only as the first course of treatment were associated with higher odds of ES. Increasing age, unspecified histology, having poorly differentiated or undifferentiated carcinomas, and receiving radiation therapy only as the first course of treatment were associated with decreased odds of ES. Differences in the odds of ES among stage IV NSCLC patients were not related to residence in Appalachian versus non-Appalachian Kentucky. ES was associated with other nongenetic and treatment factors that warrant further investigations.

A conceptual model of epikarst processes across sites, seasons, and storm events

The epikarst is an area of complex interactions and processes and is an important component of the critical zone. Understanding how processes in the epikarst are similar and different between sites is of the utmost importance in determining how information about these systems can be used to understand broader concepts and implications in the unsaturated zone of karst systems. We looked at two sites in separate karst regions of Kentucky, USA, to assess patterns in storm response of epikarst systems. Using discharge and analytes including pH, temperature, specific conductance, and turbidity as markers of epikarst processes, we assessed how each of these parameters responded to storm pulses, comparing between sites and seasons (leaf-on vs. leaf-off). Our results show that hysteresis patterns vary between analyte and season, but there are consistent patterns between sites. Regression modeling of cross-correlation results show that storm intensity drives the timing of storm responses, whereas precipitation total drives how strongly the analytes correlate to discharge response. Across both sites, analytes respond similarly, with the lag in response likely tied to the size of the basin. The similarity in response of the study sites suggests that the processes controlling transport through the epikarst are consistent across sites. The influence of a storm event and season on these responses highlight the importance of further study of soil and near-surface processes on controlling geochemical responses in the epikarst.

Examining Factors Associated with Non-Fatal Overdose among People Who Inject Drugs in Rural Appalachia

Background Overdose (OD) deaths have continued to rise in the United States posing a critical public health challenge. Various factors have been associated with increased likelihood of OD, including history of injection drug use. Purpose: This study examined multi-level factors associated with non-fatal OD among current people who inject drugs (PWID) in Appalachian Kentucky. Methods: This cross-sectional study utilized data from 324 PWID recruited via Respondent-Driven Sampling techniques in three Appalachian counties. The analysis focused on correlates of overdose history among people who inject drugs (PWID). Findings: Approximately 36.7% of our sample reported having overdosed in their lifetime, with only 21.4% currently having access to a naloxone kit for OD reversal. Respondents who had injected fentanyl alone or in combination with another drug (OR = 4.26, 95% CI= 2.31,7.86) had 4 times higher odds of an OD than those who did not. Our study found those who injected buprenorphine as primary drug (OR = 0.29, 95% CI = 0.10,0.81) had lower odds of OD compared to those who injected heroin. Conclusions/Importance: Given an increase in OD prevalence among PWID in the U.S, and especially among people living in the Appalachian region of Kentucky, assessing factors associated with OD is critical in development of tailored public health interventions to address the disparate rates of non-fatal OD in this vulnerable population.

Abstract B100: Reported barriers to colorectal cancer screening in Appalachian Kentucky

Abstract Background: Appalachian Kentucky residents suffer significant colorectal cancer (CRC) disparity, in part related to low utilization of CRC screening. Reducing or removing potential barriers to CRC screening uptake may increase utilization of CRC screening in this population. The purpose of this study was to identify barriers to CRC screening in adults aged 50 years and older in rural Appalachian Kentucky. Methods: This study reports the analysis of baseline data from a randomized controlled trial designed to promote CRC screening in rural Appalachian Kentucky among individuals who have not been screened for CRC recruited from two Emergency Departments at St. Claire Regional Medical Center in Morehead, Kentucky, and Appalachian Regional Healthcare in Hazard, Kentucky. The survey used for this study assessed CRC screening status, barriers, susceptibility, and benefits related to CRC screening, sociodemographic characteristics, and other health-related information such as health care utilization including the reason for ED visit, insurance coverage, and health care access. Descriptive and bivariate analyses are reported. Results: Questionnaires were completed by 191 adults aged 50 and over, waiting for nonurgent care or with a family member in the ED of rural Appalachian hospitals. Participants were mostly Caucasian (98%), female (57%), aged 58 ± 8 years, who had household income < $20,000 (56%), and 95% had never undergone CRC screening. Fear of CRC result (51%), perceived pain (50%), and cost (49%) were the most salient barriers to CRC screening test. The following four demographic variables were significantly associated with barriers to CRC screening; education, marital status, income, and age. Conclusions: Rural Appalachian Kentucky residents do not screen for CRC according to guidelines, partly due to perceived barriers to CRC screening. Education and income level were associated with the perception of painful and costly CRC screening in this population, suggesting that they do not have adequate knowledge or access to CRC screening resources available in the communities. Considering the cultural norms peculiar to Appalachian Kentucky, this population will benefit from a community health worker-led educational intervention to promote CRC screening through short video messages about the CRC screening process, other less invasive screening options, and benefits of CRC screening. This intervention may be able to address the barriers identified in this group, including the perception of painful screening procedure and the fear of screening result. Additionally, appropriate navigation program to affordable and accessible CRC screening resources within the local community would be beneficial to addressing the dismal use of screening resources among individuals in this population. Citation Format: Adaeze Aroh, Adebola Adegboyega, Jennifer Hatcher. Reported barriers to colorectal cancer screening in Appalachian Kentucky [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B100.

Entrepreneurial Orientation, Collaborative Engagement, and Performance: Evidence From Rural Economic Development Organizations

This study examines the role of entrepreneurial orientation (EO) and collaborative engagement on the performance of rural economic development organizations. The authors theorize that an organization’s EO and collaborative engagement, determined by levels of active engagement within a regional collaboration network, impact its ability to accomplish its goals, satisfy its stakeholders, and influence regional economic development. The authors’ analysis of data from 98 collaborating economic development organizations operating in the economically distressed region of eastern Kentucky shows that EO and collaborative engagement are positively associated with performance. This study provides actionable insights for leaders of economic development organizations seeking to improve their operations.

Using machine learning to identify karst sinkholes from LiDAR-derived topographic depressions in the Bluegrass Region of Kentucky

Information about the distribution and characteristics of existing sinkholes is critical for understanding karst aquifer systems and evaluating sinkhole hazards. LiDAR provides accurate and high-resolution topographic information and has been used to improve delineation of sinkholes in many karst regions. LiDAR data also reveal many topographic depressions, however, and identifying sinkholes from these depressions through manual visual inspection can be slow and laborious. To improve the efficiency of the identification process, we applied six machine learning methods (logistic regression, naive Bayes, neural network, random forests, RUSBoost, and support vector machine) to a dataset of morphometric characteristics of LiDAR-derived topographic depressions. Sinkhole data from Bourbon, Woodford, and Jessamine Counties in the Bluegrass Region of Kentucky were used to derive the dataset for training and testing the machine learning methods. The dataset consisted of 22,884 records with 10 variables for each record. For each method, a random subset of 80% of the records was used for training and the remaining 20% was used for testing. The test receiver operating characteristic curves showed that all six methods were applicable to the dataset, as demonstrated by all area under the curves (AUCs) being greater than 0.87. Neural network emerged as the method that performed best, with an AUC of 0.95 and a testing average accuracy of 0.85. To further improve the sinkhole mapping process, we subsequently developed a two-step process that combined the trained neural network classifier and manual visual inspection and applied the process to Scott County, also in the Bluegrass region. We were able to locate 97% of the sinkholes in the county by manually inspecting only 27% of the topographic depressions the neural network classified as having relatively high probabilities of being sinkholes. This study showed that machine learning is a promising method for improving sinkhole identification efficiency in karst areas in which high-resolution topographic information is available.

Descriptive analysis of long-term monitoring sites for Cambarus callainus and Cambarus veteranus.

Cambarus callainus and Cambarus veteranus are two federally listed crayfish species endemic to the coalfields region of Kentucky, Virginia, and West Virginia. These crayfishes are impacted by anthropogenic changes in their environment, namelysuch as sedimentation, which eliminates the interstitial spaces these species use as shelter. An investigation was initiated to examine environmental factors of streams with populations of C. callainus and C. veteranus in southern West Virginia, eastern Kentucky, and northern Virginia. Environmental data were collected at long term monitoring sites for C. callainus and C. veteranus within the Big Sandy and Guyandotte River basins, with 56 site localities chosen based on a quantitative assessment of their habitat. 100 m transects were divided into 10 m subsections that were seined for 10 minutes or until all available microhabitats were sampled. Subsections were analyzed for habitat density, substrate coarseness, embeddedness, and heterogeneity. Data collected from this project can be used for comparing historic localities lacking these species to assess viability for reintroductions.

Prescribed fire and natural canopy gap disturbances: Impacts on upland oak regeneration

Across the central and eastern U.S., decades of fire exclusion have coincided with upland oak (Quercus spp.) regeneration problems and a compositional shift toward shade-tolerant, fire-sensitive species like red maple (Acer rubrum L.) and American beech (Fagus grandifolia Ehrh.). Because oaks are fire-adapted and moderately shade-intolerant, prescribed fire is commonly used as a management tool to decrease competition, increase light, and promote oak regeneration. However, prescribed fire alone often fails to sufficiently open the canopy and improve oak competitive status, suggesting the combination of fire and canopy gaps may be necessary for oak success. To better understand the effects of single and multiple prescribed fires alone and combined with naturally-formed canopy gaps on tree regeneration, we measured tree densities (both seed and resprout origin) in five height size classes (small seedlings: ≤0.5 m, large seedlings (>0.5–1.0 m), saplings (1.1–4.0 m), midstory (4.1–7.0 m), and poles (7.1–12 m)) within gaps and non-gap areas treated with no fire, single fire, or multiple fires (2–3) across six sites within the Knobs Region of Kentucky (U.S.A.) in 2017. Oaks were common as small and large seedlings without fire, especially within gaps, but they were largely absent from larger size classes. Instead, red maples and American beech dominated sapling and midstory size classes without fire, regardless of gap treatment. Single and multiple fires reduced both absolute and relative density of American beech saplings and red oaks (Q. velutina Lam., Q. coccinea Munchh. and Q. rubra L.) of all sizes, but single fires, both within and outside of gaps, increased red maple large seedling, sapling, and midstory dominance. Multiple fires, both within and outside of gaps, reduced red maple abundance, and this coincided with increased relative density of white (Q. alba L.) and chestnut oaks (Q. montana Willd.), but not of red oaks. Red oak small and large seedlings were the only oaks where absolute density increased in the small (~300 m2), relatively old (20–30 yr), naturally-formed canopy gaps in this study. Our findings suggest that management techniques that include multiple prescribed fires and large canopy gaps (>300 m2) created relatively soon after fire will likely be necessary to reduce competing species, increase oak density, and allow oaks to reach sapling and midstory size classes.

SOAR—the solution to the high prevalence of heart disease in Appalachian Kentucky

Many diseases affect the population of Appalachian Kentucky, but none more than heart disease. The purpose of this article is to address the alarmingly high prevalence of heart disease in the Appalachian region of Kentucky and to provide evidence-based methods for reducing its incidence and management. This is an issue of astronomical importance as people living in Appalachian Kentucky have the worst cardiovascular risk profile in the USA. The first section of this article provides succinct clarification of how heart disease afflicts this region and the area-specific variables affecting it. The second section illustrates a more in-depth background of heart disease through a social and economic perspective. Research shows many promising benefits of utilizing a comprehensive strategic initiative for reducing heart disease; therefore, the third section will evaluate the proposed solution, the Shaping Our Appalachian Region (SOAR) strategic model, for reducing the incidence of heart disease in Appalachian Kentucky. The significant need for change within this underserved region is imperative and must be recognized and addressed immediately.

Abstract WMP51: Ischemic Stroke Rates in Those With Diabetes in the Black and White Population: An Update

Background: We previously reported an increased incidence of stroke in the population with diabetes. This was particularly pronounced in those under 65 years of age. With guidelines now including glycemic monitoring during hospitalization, we examined incidence attributable to diabetes in 2010 and 2015. Methods: Ischemic strokes in the 5-county Greater Cincinnati/Northern Kentucky region were ascertained, then physician verified, at all 15 area hospitals using ICD-9 codes 430 to 436 or ICD10 codes I60 to I68. First ever ischemic strokes in patients aged 20 years and older were included in this analysis. Population age-specific rates of diabetes were estimated using the 2009-2010 and 2015-2016 NHANES databases, then applied to local population numbers, extracted from the US Census Bureau website, to estimate the denominator for calculation of incidence rates. Incidence rates were adjusted by age race and sex, as appropriate, to the 2010 US population. Diabetes was defined as reported in the electronic medical record or glycohemoglobin A1c &gt 6.4% during hospitalization. Results: There were a total of 4141 ischemic strokes; 55% female and 22% black. Stroke rates continue to be substantially higher in those with diagnosed diabetes, than those without diabetes overall and for those less than 65 years in both time periods, as well as those 65 years and older except for the black population in 2010. Racial disparities continue in both the less than 65 and 65 years and older age groups. Stroke rates were higher for Blacks in the less than 65 year age group for those both with and without diabetes; with risk ratios ranging from 1.3 to 2.7. Of note the stroke rate has decreased between 2010 and 2015 for those with diabetes <65 years of age. (Table) Conclusions: The population with diabetes continues to be at increased risk of stroke, especially in those less than 65 years of age and those of black race.

A spatial genomic approach identifies time lags and historical barriers to gene flow in a rapidly fragmenting Appalachian landscape

The resolution offered by genomic data sets coupled with recently developed spatially informed analyses are allowing researchers to quantify population structure at increasingly fine temporal and spatial scales. However, both empirical research and conservation measures have been limited by questions regarding the impacts of data set size, data quality thresholds and the timescale at which barriers to gene flow become detectable. Here, we used restriction site associated DNA sequencing to generate a 2,140 single nucleotide polymorphism (SNP) data set for the copperhead snake (Agkistrodon contortrix) and address the population genomic impacts of recent and widespread landscape modification across an ~1,000-km2 region of eastern Kentucky, USA. Nonspatial population-based assignment and clustering methods supported little to no population structure. However, using individual-based spatial autocorrelation approaches we found evidence for genetic structuring which closely follows the path of a historically important highway which experienced high traffic volumes from c. 1920 to 1970 before losing most traffic to a newly constructed alternative route. We found no similar spatial genomic signatures associated with more recently constructed highways or surface mining activity, although a time lag effect may be responsible for the lack of any emergent spatial genetic patterns. Subsampling of our SNP data set suggested that similar results could be obtained with as few as 250 SNPs, and a range of thresholds for missing data exhibited limited impacts on the spatial patterns we detected. While we were not able to estimate relative effects of land uses or precise time lags, our findings highlight the importance of temporal factors in landscape genetics approaches, and suggest the potential advantages of genomic data sets and fine-scale, spatially informed approaches for quantifying subtle genetic patterns in temporally complex landscapes.