Southern West Virginia Research Articles

Pine woodland fire dynamics mirror industrial history at New River Gorge National Park and Preserve, West Virginia, USA

Fire is an important biophysical process in pine (Pinus) and mixed pine-oak (Quercus) forests and woodlands across the Central Appalachian Mountains. Decades of fire exclusion, however, particularly on public lands, have resulted in a well-documented homogenization of species composition and forest structure. Our objective was to inform management and restoration efforts by expanding on previous dendroecological research at New River Gorge National Park and Preserve and adjacent Babcock State Park in southern West Virginia. Specifically, we assessed pine woodland fire activity in the context of local industrial history, land management, and regional drought. Samples cut from 110 fire-scarred pine trees, distributed across four sites, were used to develop a fire-scar record that spans the period 1842–2010; however, sample depth diminishes rapidly before the 1860s. Fires occurred frequently and extensively in the early–mid 20th century, coinciding with peak coal production and population density. Eleven major fires, or years when at least two trees and 25 % of samples recorded a fire scar at an individual site, were documented in the tree-ring record, but none occurred during the federal land management era (1978–present). Synchronous fire events recorded at two or more sites were associated with drier than average September–May (‘dormant season’) climate conditions. Our results indicate that, since the late 19th century, fire activity in pine woodlands at the New River Gorge has been driven primarily by human ignitions associated with industrial activities, and that periods of drought have amplified landscape-scale fire occurrence. Land managers should consider these historical fire patterns when developing restoration strategies that may include prescribed fire, thinning treatments, and managed wildfires.

Female black bear home range and resource selection in relation to West Virginia mine lands

AbstractWildlife space use is a key component to consider when determining effective conservation and management practices. Home range size and resource selection can vary temporally and spatially depending on mortality risks in the area and access to food resources. Lands used for coal mining can contain unique mortality risks and food resources for American black bears (Ursus americanus) relative to surrounding landscapes due to hunting restrictions, vegetation planted as part of the reclamation process, and other anthropogenic food resources. We examined the influence of mining sites on resource selection of female black bears in southern West Virginia, USA, during 2007 and 2008. We estimated home range size with Brownian Bridge movement models and evaluated variation in home range size with mixed‐effects linear regression. We evaluated resource selection with mixed‐effects Poisson point process models. On mine sites, the mean 95% home range for female black bears was 1,996 ha (SD = 2,633) in the autumn and 544 ha (SD = 238) in the spring, and on non‐mine sites the mean 95% home range was 1,926 ha (SD = 1,292) in the autumn and 771 ha (SD = 480) in the spring. Our resource selection model indicated black bears used nonhunting zones associated with mine lands much greater than their availability, and that black bears in mine areas disproportionately used areas in close proximity to anthropogenic structures. Interannual variation in home range size was likely associated with mast conditions, because smaller home ranges were associated with high mast production. Our data suggest black bears may be using non‐hunting zones within mine lands as refugia from hunting and are using anthropogenic food sources available at refuse sites on mine lands, which may increase regional black bear populations in areas with high mining activity.

Effect of Coal Mining on Health Outcomes Between Male and Female Miners in Southern West Virginia: A Brief Report.

There is evidence of an association between coal mining and an increased prevalence of respiratory and cardiovascular disease (CVD). Mining is significantly associated with elevated chronic CVD mortality rates. Research is limited and looks at the differences between specific health outcomes between male and female coal miners. The aim of this study was to compare the long-term health outcomes of male and female coal miners in southern West Virginia. We used the Charleston Area Medical Center (CAMC) data registry to look at specific health outcomes of coal miners. We queried the data warehouse from September 1, 2016, to January 1, 2023, to identify any coal miners coming to CAMC for any treatment. We identified adult patients aged 18-90 years with at least one visit to a clinic in the CAMC system. We identified (n=2,460) cases of coal miners, comprising of 2,280 males and 180 females. Overall, we found higher mortality rates as well as higher rates of ischemic heart disease, heart failure, cancer, and mental health disorders among male coal miners. Additional research is needed to further examine possible contributing factors that explain the differences in health outcomes between male and female coal miners. Clinicians and policymakers need to address health disparities and occupational hazards that impact the health outcomes of coal miners living in southern West Virginia.

Faucet-mounted point-of-use drinking water filters to improve water quality in households served by private wells

Approximately 13 % of Americans rely on private wells for household potable water. As private wells are not regulated beyond initial construction and often employ limited or no treatment, source water from wells can be vulnerable to contamination. While several studies have assessed applications of point-of-use (POU) filters in improving municipal tap water quality, few have investigated their use with private well water. This effort aims to build on previous examinations of POU treatment as a strategy to reduce adverse household drinking water exposures by: 1) assessing the effectiveness of commercially available faucet-mounted POU filters for improving microbial and chemical water quality in homes with private wells; and 2) documenting household ease of use and satisfaction with the filters. Faucet-mounted POU filters were distributed to 21 homes reliant on private wells in southern West Virginia and southwestern Virginia. Study participants were asked to collect water samples from two taps in their homes pre-filter installation, and again two-weeks and four-weeks post-installation. Participants filled out surveys about perceptions of their drinking water and the filter. Concentrations of Total Coliform, Ba, Cd, Cr, U, Cu, Pb, Al, Fe, Mn, Zn, and Sr were significantly lower (p < 0.05, Wilcoxon Rank Sum) in filtered water samples compared to paired unfiltered samples (n = 42) for the study period. However, concentrations of certain contaminants in filtered samples from homes with high levels of source water contamination still exceeded drinking water standards. Less than half of study participants reported that they intended to keep using the filters, citing issues of flowrate. Our findings suggest that faucet-mounted POU filters, while effective in reducing contaminants, might not be an appropriate intervention to improve water quality for all homes on private well water. Future investigation is required to improve filter user satisfaction and better assess appropriate source water chemistries for implementation.

Revisiting the petrology of lower Pennsylvanian (Namurian and Langsettian) coals in southern West Virginia and southwestern Virginia, USA

Namurian and Langsettian coals representing a vertical span of about 650 m were sampled from cores in southern West Virginia and western Virginia. The coal rank ranges from medium through low volatile bituminous. Historically, a significant portion of the production from the region has been for smokeless steam coals and for metallurgical coal. Despite the presence of thrust faults and the potential for fault-induced movement of mineralizing fluids, a depth-of-burial/geothermal-gradient model, as proposed earlier, appears to be sufficient to describe the increase of rank with depth. The coals generally have >70% total vitrinite (mineral-free basis) and a telovitrinite/(telovitrinite + detrovitrinite) ratio exceeding 0.75. Fusinite dominates the inertinite group macerals. An unnamed Langsettian coal had a high liptinite content but, otherwise, in part owing to the difficulty of detecting liptinites in medium and low volatile bituminous coals, liptinite appears to be sparse. Among the coals in the study, not all of them have been extensively mined. The Pocahontas coals represent the most significant economic resource.

A crowdsource approach to documenting users' preferences for landscape attributes in the proposed Appalachian Geopark Project in West Virginia, United States

This study demonstrated the potential utility of crowdsource photographs to investigate users' (residents and visitors) preferences for landscape features in the proposed Appalachian Geopark Project in southern West Virginia, United States, assuming that a photographic choice implies a preference. The study used photographs from Flickr crowdsource. Our method combined existing technologies of crowdsourcing, geographic information system (GIS), machine learning (ML) and added a new metrics generation capability to provide a novel approach to classifying users' preferences. First, spatial distribution of the photographs was assessed. Second, the amount of area in pixels covered by each feature was calculated to quantify the different landscape features contained in the photographs. The results revealed that the photographs were congregated in specific locations of the study region showing clustered patterns of distribution. The content analysis revealed that the forest was the predominant landscape feature, followed by rock, antrhopogenic (anthro), sky, water, grass and road that were captured in the photographs. This approach is an indirect approach that help understand what landscape features are captured in the photographs by the users. The ability to provide statistics for pixel-by-pixel classification in the ML output represents a new functionality that can be useful in other studies such as in a single landscape type (e.g., urban, agriculture, etc.) and temporal data (e.g., date taken).

Remembering Herbert Gutman's Work, Culture, and Society Fifty Years On

Remembering Herbert Gutman's <i>Work, Culture, and Society</i> Fifty Years On

African American Workers and the Appalachian Coal Industry

African American Workers and the Appalachian Coal Industry

A 10-Year Epidemiologic Overview of Firearm Injuries in Southern West Virginia

The firearm mortality rate in West Virginia (WV) increased over the past four years and is currently 50% higher than the national rate. These alarming statistics, combined with the urban-to-rural shift in firearm injuries, prompted this 10-year epidemiologic overview. To the best of the authors' knowledge, the current study stands alone as the only report of its kind on firearm injuries in the rural setting of southern WV. Firearm injuries were common in White males within the age range of 20-49 years. Assault, which is typically identified as an urban problem, was found to be the most common injury in the study population. In our data series, injury severity score was the strongest predictor of mortality, followed by self-inflicted cause of injury and trauma to the neck/head region.

Characteristics of Pediatric Celiac Disease in Southern West Virginia

Purpose Celiac disease (CD) is a disorder in which gluten ingestion triggers an autoimmune response causing inflammation and damage to the small intestine. With improved awareness and screening availability, prevalence and variation in clinical presentation have subsequently increased. Thus, our study identified the disease characteristics and presentation patterns of pediatric CD in southern West Virginia. Methods We retrospectively reviewed charts for pediatric patients (age &lt;18 years) diagnosed with CD during a 10-year period at a tertiary care hospital. Results A total of 59 patients met inclusion criteria. The mean age of diagnosis was 10.0+4.6 years, with 61% of patients being female. One-third of cases were asymptomatic and diagnosed from screenings of patients with hypothyroidism or type 1 diabetes mellitus. In symptomatic patients (n=40), abdominal pain was the most common presenting symptoms (78%), followed by constipation (30%). Classical symptoms of diarrhea and failure to thrive/unexplained weight loss were less common (n=9). At diagnosis, anti-tissue transglutaminase (tTG) IgA antibodies and deamidated gliadin peptide IgG antibodies were both positive in 88% of cases, and endomysial antibodies were positive in 70% cases. One-year post-diagnosis clinic follow-up rate was 63%. A gluten-free diet improved symptoms and tTG IgA serology levels in all patients with follow-up. Conclusion Our data fills in the gap of the paucity of information available about CD in children from Appalachia. A high index of suspicion is required to screen and diagnose CD as many patients are either asymptomatic or lack classical findings. A gluten-free diet is a highly effective treatment, although follow-up after initial diagnosis remains a challenge.

African American Workers and the Appalachian Coal Industry by Joe William Trotter, Jr.

Reviewed by: African American Workers and the Appalachian Coal Industry by Joe William Trotter, Jr. Cicero M. Fain (bio) African American Workers and the Appalachian Coal Industry. By Joe William Trotter, Jr. (Morgantown: West Virginia University Press, 2022. Pp. 176. $34.99 cloth; ebook $34.99) Joe William Trotter, Jr., ranks among the pantheon of America's most influential historians. For more than forty years, beginning with his 1985 work Black Milwaukee: The Making of an Industrial Proletariat, 1915–1945, he has chronicled the African American experience, most profoundly on the centrality of the Black working class to America's economic, industrial, cultural, and political development. His pioneering and provocative work examining the intersections of race, class, labor, urbanization, and gender within diverse urban- and rural-industrial settings has challenged prevailing historiography and expanded our understanding of Black migration, labor relations, and community formation. It has also added important dimensionality, complexity, and agency to Black workers, families, and communities within the historical narrative. Arguably, Trotter's most enduring contribution to our understanding of the African American urban experience was his employment of the proletarianization model in Black Milwaukee as an alternative theoretical framework to the long-standing "ghetto synthesis" model. That study animated important dialog and debate in its prioritization of class over racial identification as the defining consciousness of the Black working-class experience. In a 2007 Journal of Urban [End Page 67] History essay, Trotter acknowledges some of the limitations of his proletarianization model. In it, he concludes, "were I to write Black Milwaukee today, I would seek to synthesize past and present intellectual currents in African American urban and labor historiography, pay closer attention to the relationship between different eras in the transformation of African American life, and offer a broader and more comprehensive case study of the Black urban experience."1 The culmination of these objectives are the five essays comprising his most recent book, African American Workers and the Appalachian Coal Industry. Encompassing nearly thirty years of research on the African American experience, class, and race relations, in the Appalachian coal fields, the collection reiterates the continuing relevancy of the proletarianization model as an analytical tool—in this instance, primarily in its examination of the working-class experience of Black coal miners within his homeplace of the southern West Virginia coal mining region. Here, as a boy, Trotter experienced the disproportional impact of technological, social, and political changes on Black workers, families, and communities after World War II, which caused unemployment and out-migration. This reassessment of the field since Black Milwaukee's publication embraces innovations in scholarship on racial, class, and gender dynamics of working-class formation as ways to reformulate the proletarianization model. In presenting the coronavirus as one of the rationales for its publication, the essays historicize the continuing vulnerability of poor and working-class Blacks and people of color who work and live in dangerous, racialized, and unhealthy environments. This collection cement's Trotter's status as the foremost historian on U.S. labor and working-class studies. Its summary of the history and historiography of Black coal miners in Appalachia posits the continuing theoretical applicability of the proletarianization model in the twenty-first century, points to new pathways to pursue to explore its utility, and underscores the continuing resonance of his [End Page 68] southern West Virginia upbringing on his scholarship. Highly readable, meticulously researched, and skillfully rendered, African American Workers is a worthy addition to Trotter's remarkable legacy. Cicero M. Fain CICERO M. FAIN, III is visiting diversity scholar at Marshall University and the author of Black Huntington: An Appalachian Story. His current book project is entitled Buffalo Soldier, Deserter, Criminal: The Remarkably Complicated Life of Charles Ringo. Footnotes 1. Joe William Trotter, Jr. "Black Milwaukee: Reflections on the Past Twenty Years," Journal of Urban History 33 (May 2007): 567. Copyright © 2022 Kentucky Historical Society

The Activism of Dance Performance in Appalachia: Utilizing the Arts to Address Social and Environmental Crisis and Injustice in the Mountains

Abstract For well over a century, the human and more-than-human of Central Appalachia have endured oppression and exploitation, primarily due to natural resource extraction. In spring 2008, the author led a dark touri to a mountaintop removal coalmining site in Southern West Virginia for colleagues, which included Dance Professor Deborah McLaughlin. As a result, the two collaborated on three evening-length dance/theater works highlighting social and environmental crises and injustices in the region. The performances incorporated contemporary dance, poetry, the spoken word, and the visual arts, as well as contemporary and traditional music. The first, Eating Appalachia: Selling Out to the Hungry Ghost, focused on mountaintop removal coalmining and its environmental and cultural destruction. With Sounds of Stories Dancing, the duo paid homage to millions of mountain residents forced to leave the region to find stable employment, despite longing to remain. In the final piece, The Shadow Waltz, they honored the lives of coalminers with black lung disease, as well as their families. This essay discusses the challenges of creating art that critiques socially constructed messages portrayed as given truths, as well as the educational and social successes of daring to dance truth to power.

Blind Alfred Reed: Appalachian Visionary

Atlanta-based indie record label Dust-to-Digital has released the complete recorded works of Blind Alfred Reed, one of the largely unsung heroes of the early days of recorded country music, and one of the earliest recorded songwriters in the genre. Reed is not exactly obscure—he recorded at the famed Bristol Sessions, and his songs have been recorded by Bruce Springsteen, Ry Cooder, and others, so enthusiasts of old-time music will recognize his name and perhaps his sound. His complete recordings have not been available in one place until now. Producer and liner note author Ted Olson, who has, in the last decade, produced landmark box set collections on the Bristol, Johnson City, and Knoxville Sessions among others, considers Reed a sage. He writes in the notes that Reed possessed in his songwriting “an intense and fearless social vision” and that Reed's songs “seek to venture beyond the shadowy world of injustices, hypocrisies, and lies.”Reed was a singer and fiddler from southern West Virginia, whose main occupation was music and who managed to eke out a living as a performer, a music teacher, and for a short time in the late 1920s, a recording artist. His sound was sparse and unembellished, using only fiddle, guitar, and one or two voices. Many fiddlers of his time played and sang at the same time, but Reed had a more direct and conservative approach than most—he played the same notes he sang, often in a measured, sauntering cadence—and his voice and fiddle both resonated deeply and clearly. As a singer, Reed was emotive in a manner similar to the old ballad singers—he did not try to shape how listeners interpreted the lyrics; rather, he sang in a neutral way that invited them in to sort things out for themselves. Reed recorded all of his songs with his son Arville, except for one solo number recorded in Bristol and three more with neighbor Arthur Wyrick. I find the recordings of Arville singing with his father among the most enjoyable on the set.The songs deal with religious virtues or economic conditions, or they provide some kind of social commentary, often having to do with the roles and behavior of men and women in relationships, albeit offered from varying, sometimes opposing viewpoints. His perspective was in no small way shaped by the Church, and about one-third of the twenty-two songs on this collection reference religious life in some manner. There are also topical songs about real-life events of the day, a common songwriting practice at that time, and several lighthearted social songs that may be off-putting if taken out of context. In “Woman's Been After Man Ever Since,” he sings: “What a shame it is that women try to be so much like men, they will run for office if they get the chance.” Other songs are social and religious statements on rural Appalachian religious morals of the time, addressing short skirts, bobbed hair, and young men who wear fine shoes but carry a bottle in their pocket. Reed's best-known composition “How Can a Poor Man Stand Such Times and Live?” is indicative of yet another strain of Reed's songwriting: economic hardship.This is a hardy collection that shows the breadth of Reed's songwriting, but to some ears, the music itself may sound monotonous. Indeed, with the exception of a single track recorded by Arville, the songs are either in the key of G major or C major—and all of the nineteen songs Reed sings begin with a simple, single-string fiddle intro. The melodies are pleasant and at times nuanced, including a waltz, but I must admit that for many years, Reed's songs tended to run together for me. This set helped me connect the music itself with its historical context and importance, and to realize more keenly that the real impact of Reed's music is as a songwriter who was ahead of his time. In the notes, Olson compares him to Woody Guthrie.As we have come to expect from Dust-to-Digital, the eighty-four-page hardcover book accompanying the CD is original, tidy, and beautiful. It contains unreleased photos and documents, studio sheets, and complete lyrics, in addition to an essay by Olson, who is becoming a household name in historical releases (he has been nominated multiple times for Grammy awards for his work as a music producer and songwriter). The notes here contain new research into Reed's life and music and are a friendly read—at once affectionate and informative. Since the release of this collection in 2016, Olson has continued to research the Reed family and has assembled an even more nuanced account. An updated and revised version of his liner notes was published in June 2022 on the Music of Our Mountains website. See https://musicofourmountains.com for more information.

Fire history and vegetation data reveal ecological benefits of recent mixed-severity fires in the Cumberland Mountains, West Virginia, USA

BackgroundWithout periodic fire, fire-adapted plant communities across the Central Hardwood Forest Region (CHF) in the USA have undergone significant changes in forest structure and species composition, most notably a decrease in oak regeneration and herbaceous diversity and an increase in shade-tolerant, fire-sensitive tree species. In this study, we conducted a comparative analysis of two mixed pine-oak (Pinus-Quercus) forests with different land management histories in the Cumberland Mountains of southern West Virginia where fire ecology and fire effects are understudied. We reconstructed the fire history of both sites from fire-scarred shortleaf pine (Pinus echinata Mill.) and pitch pine (Pinus rigida Mill.) trees to describe variation in the fire regimes over time. We also made plant community measurements that spatially coincided with fire-scarred pines to assess present-day plant community structure in relation to recent fire history.ResultsBefore 1970, fires at Hite Fork and Wall Fork occurred frequently and almost exclusively in the dormant season, every 7–8 years on average. The fire regimes diverged in the Post-Industrial era (1970–2020), during which there was a single fire at Wall Fork, while six major fires, scarring more than 40% of sampled trees, occurred between 1985 and 2017 at Hite Fork. Four of these dormant-season fires correspond to late fall incendiary fires in the observational record. These differences in recent fire history had large effects on plant community structure. Recent mixed-severity fires at Hite Fork likely caused mortality of pole-sized trees and opened the canopy, creating conditions favorable for pine recruitment and resulted in significantly higher species richness in the herbaceous layer compared to Wall Fork, which exhibited the effects of mesophication.ConclusionsOur results suggest that frequent mixed-severity fire in pine-oak forests of the Cumberland Mountains can meet management objectives by reducing mesophytic tree abundance, increasing herbaceous diversity and pine recruitment, and generally promoting forest heterogeneity.

Provider Perspectives on Sleep Apnea from Appalachia: A Mixed Methods Study.

: BackgroundWest Virginia (WV) has the highest rates of obesity and cardiopulmonary disease in the United States (U.S.). Recent work has identified a significant care gap in WV for obstructive sleep apnea (OSA). This OSA care gap likely has significant health implications for the region given the high rates of obesity and cardiopulmonary disease. The purpose of this mix methods study was to identify barriers that contribute to the rural OSA care disparity previously identified in WV. Methods: This study used mixed methods to evaluate the barriers and facilitators to management of OSA at Federally Qualified Health Centers serving communities in southern WV. Focus groups were conducted at federally qualified health centers with providers serving Appalachian communities. Participants also completed the validated Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) questionnaire to gain insight into provider knowledge and beliefs regarding OSA. EMR analysis using diagnostic codes was completed at the sites to assess OSA prevalence rates. The same individual served as the interviewer in all focus group sessions to minimize interviewer variability/bias. Our team checked to ensure that the professional transcriptions were correct and matched the audio via spot checks. Results: Themes identified from the focus groups fell into three broad categories: (1) barriers to OSA care delivery, (2) facilitators to OSA care delivery, and (3) community-based care needs to optimize management of OSA in the targeted rural areas. Questionnaire data demonstrated rural providers feel OSA is an important condition to identify but lack confidence to identify and treat OSA. Evaluation of the electronic medical record demonstrates an even larger OSA care gap in these rural communities than previously described. Conclusion: This study found a lack of provider confidence in the ability to diagnose and treat OSA effectively and identified specific themes that limit OSA care in the communities studied. Training directed toward the identified knowledge gaps and on new technologies would likely give rural primary care providers the confidence to take a more active role in OSA diagnosis and management. An integrated model of care that incorporates primary care providers, specialists and effective use of modern technologies will be essential to address the identified OSA care disparities in rural WV and similar communities across the U.S. Community engaged research such as the current study will be essential to the creation of feasible, practical, relevant and culturally competent care pathways for providers serving rural communities with OSA and other respiratory disease to achieve health equity.

Spatial Cases of Endocarditis in Southern West Virginia

Spatial Cases of Endocarditis in Southern West Virginia

Sites of Ambivalence? Conflicting Attitudes Toward Coal in Southern West Virginia

Sites of Ambivalence? Conflicting Attitudes Toward Coal in Southern West Virginia

0565 Examining obstructive sleep apnea knowledge and attitudes of providers in southern West Virginia

Abstract Introduction Obstructive sleep apnea (OSA) syndrome is a common but underdiagnosed clinical problem with multiple health implications. The rising prevalence of OSA has been linked to increasing obesity. Because the obesity rate of West Virginia (WV) is almost 40%, successful identification and treatment of OSA is essential to improving the health of WV communities. Our previous work demonstrated that OSA is ineffectively managed in our rural communities. This study aimed to evaluate OSA knowledge and attitudes of primary care providers (PCPs) practicing at Federally Qualified Health Centers (FQHC) serving rural communities with significant health disparity in southern WV. Methods We assessed OSA knowledge and attitudes of 14 PCPs in southern WV (n=6 physicians and 8 mid-level providers; 53.2 + 12.2 years of age; 78% female) practicing at FQHC. The OSA Knowledge and Attitudes (OSAKA) questionnaire assesses providers’ knowledge via 18 true-false statements and importance and attitude via five Likert. OSA attitudes are assessed via two items for importance of OSA and three items for confidence in identifying and treating OSA. Results No respondents answered the 18-knowledge portion with 100% accuracy (mean = 14.3). Mann Whitney U tests were then used to compare Physicians’ and mid-level providers’ years in practice and OSAKA responses. Knowledge scores in physicians (Mdn = 16) significantly differed from mid-level providers scores (Mdn = 13.5) in our sample (U = 5.5, p &amp;lt; 0.05, r = -0.66). OSAKA Importance and Confidence questions revealed that PCPs felt OSA identification was important, but were not confident in their ability to manage OSA. Conclusion Our results demonstrate that rural PCPs have fairly good knowledge of OSA in general but lack knowledge in specific domains. Interestingly, providers feel OSA is an important disease and were fairly knowledgeable with the disease, but lacked confidence to manage OSA. Further explanatory studies are warranted to more robustly examine these findings. Our prior work demonstrates sleep apnea is ineffectively managed in the region. Thus, targeted training and further engagement with rural providers may well address disparity in OSA management for Appalachian communities. Support (If Any) (NIH/NIGMS 5U54GM104942-03).

Richard L. Trumka: A Labor Leader in Troubled Times

Richard L. Trumka: A Labor Leader in Troubled Times

Impact of the 24/7 nurse practitioner model on emergency department stay at a level 1 trauma center: A retrospective study.

The aim of the study was to assess the impact of 24/7 trauma nurse practitioner service model on the emergency department patient flow. Seamless transition of trauma patients through the emergency department to inpatient hospital care is crucial for coordination of care, clinical safety and positive health outcomes. A level 1 trauma centre located in Southern West Virginia, USA expanded their trauma nurse practitioner service covering the emergency department 24/7. Retrospective cohort study conducted in accordance with the Strengthening the Reporting of Observational studies in Epidemiology guidelines. Patients admitted to the trauma centre between March 2019 and February 2020 were divided into two groups: trauma patients managed by trauma nurse practitioners versus the hospitalist service. The hospital service group was chosen as the comparator group because any admission prior to night coverage by the trauma nurse practitioners were managed by the hospitalist service. The emergency department length of stay was significantly lower in trauma nurse practitioners' patients by an average of 300min (772.25±831.91 vs. 471.44±336.65, p=<.001). Similarly, time to place emergency department discharge order was shorter by 49min (277.76±159.69 vs. 228.27±116.04, p=.001) for this group. Moreover, trauma nurse practitioners on an average placed one less consultation (1.06±0.23 vs. 1.46±0.74, p<.001). The patient care provided by trauma nurse practitioners aided in the reduction of strain felt by their emergency department. They were able to help facilitate patient flow thus lessening the pressure of boarding in an overcrowded emergency department. The study institution hopes to sustain the current service model and continue to review outcomes and processes managed by trauma nurse practitioners to ensure consistency and quality. Similar trauma centres should evaluate the structure of their trauma service that includes the role of trauma nurse practitioner service and work towards allowing them to manage patient care from the emergency department 24/7.