Tennessee Research Articles

Origin of correlated diffuse scattering in the hexagonal manganites

We use a combination of first-principles density-functional calculations and spin-dynamics simulations to explain the unusual diffuse inelastic neutron scattering in the hexagonal multiferroic yttrium manganite, YMnO3. Using symmetry considerations, we construct a model spin Hamiltonian with parameters derived from our density-functional calculations and show that it captures the measured behavior. We then show that the observed directionality in the structured diffuse scattering in momentum space is a hallmark of the triangular geometry, and that its persistence across a wide range of temperatures, both above and below the Néel temperature TN, is a result of the strong magnetic frustration. We predict that this diffuse scattering exists in a yet-to-be-observed modulated continuum of energies, that its associated spin excitations have distinct in-plane and out-of-plane character, and that vestiges of the magnetic frustration persist into the sub−TN state. Finally, we show that visualizing the magnetic order in terms of composite trimer magnetoelectric monopoles and toroidal moments, rather than individual spins, provides insight into the real-space fluctuations, revealing clusters of emerging order in the paramagnetic state, as well as collective short-range excitations in the ordered antiferromagnetic phase. Our understanding of this directional diffuse scattering in such a wide temperature range, both below and above TN, provides new insight into the magnetic phase transitions in classical frustrated systems. Published by the American Physical Society 2024

Challenges and Opportunities in Providing Academic Library Services to Incarcerated Higher Education Students: A Case Study from a Tennessee State Prison

Challenges and Opportunities in Providing Academic Library Services to Incarcerated Higher Education Students: A Case Study from a Tennessee State Prison

The Effect of Obesity on Postoperative Analgesia Practices and Complications Following Endoscopic Sinus Surgery: A Propensity Score-Matched Cohort Study.

Despite growing concern regarding over-prescription of narcotic pain medication following ambulatory surgery, little is known about the analgesic prescribing practices following endoscopic sinus surgery (ESS) in obese patients in comparison to non-obese patients. To compare the rates of opioid versus non-opioid prescriptions, the need for steroids, and post-operative adverse events between obese and non-obese adult patients undergoing ESS. Using TriNetX Live database, we identified all patients aged ≥18 years who underwent ESS (n = 1303) between 2014 and 2022 across several healthcare institutions across the state of Tennessee. We 1:1 propensity score-matched obese (BMI ≥ 30 kg/m2) and non-obese (18.5 kg/m2 ≤ BMI < 30 kg/m2) cohorts for age, gender, race, and comorbidities including asthma, nicotine dependence, and sleep apnea. Rates of prescriptions and post-operative adverse events between cohorts were analyzed using risk ratios (RR) and confidence intervals (CI). A toal of 532 obese patients were compared to 532 propensity score-matched non-obese patients in the first 14 post-operative days following ESS. The obese cohort was significantly more likely to be prescribed analgesics generally (RR = 1.72; 95% CI = 1.20-2.47), non-opioid analgesics (RR = 1.73; 95% CI = 1.19-2.50), and opioid analgesics (RR = 1.64; 95% CI = 1.14-2.36) than non-obese patients. There was no difference in rates of antibiotic or antiemetic prescription, prednisone/methylprednisolone, dexamethasone, ED visits, critical care service, epistaxis, transfusion, anemia, revision sinus surgery, mechanical ventilation, CPAP, or inhalation airway treatments. Obese patients undergoing ESS were significantly more likely to be prescribed non-opioid and opioid analgesia in the first 14 days post-operatively compared to non-obese patients. There were no differences in post-operative adverse events or other prescriptions. Otolaryngologists should be aware that obese patients are at increased risk of opioid induced airway obstruction and steroid induced hyperglycemia, especially in patients with comorbid sleep apnea or diabetes. Emphasis on non-opioid analgesics and multimodal pain management should be advocated for this population.

Intersecting Disciplines: Should LIS Competencies Include Social Work?

Social work in librarianship is a phenomenon that has gained momentum in public libraries since the first known social worker began working at the San Francisco Public Library in 2009. Few LIS programs offer courses to address this evolving phenomenon, yet librarians and library staff nationwide have expressed the need to have training in social work to help them meet the needs of their users. To date, there are only three universities (Dominican University, University of Michigan and Middle Tennessee State University) that offer dual degree programs and even fewer universities that offer social work librarianship courses. With the concern of librarians not feeling equipped to address the social needs of library users (eg. depression, anxiety, suicide, health issues, substance abuse, poverty) this paper emphasizes the critical need for LIS programs to adapt their curriculum to adequately prepare future librarians for public librarianship.

Optimal Pediatric Outpatient Antibiotic Prescribing

In the US, 50% of all pediatric outpatient antibiotics prescribed are unnecessary or inappropriate. Less is known about the appropriateness of pediatric outpatient antibiotic prescribing. To identify the overall percentage of outpatient antibiotic prescriptions that are optimal according to guideline recommendations for first-line antibiotic choice and duration. This cross-sectional study obtained data on any clinical encounter for a patient younger than 20 years with at least 1 outpatient oral antibiotic, intramuscular ceftriaxone, or penicillin prescription filled in the state of Tennessee from January 1 to December 31, 2022, from IQVIA's Longitudinal Prescription Claims and Medical Claims databases. Each clinical encounter was assigned a single diagnosis corresponding to the lowest applicable tier in a 3-tier antibiotic tier system. Antibiotics prescribed for tier 1 (nearly always required) or tier 2 (sometimes required) diagnoses were compared with published national guidelines. Antibiotics prescribed for tier 3 (rarely ever required) diagnoses were considered to be suboptimal for both choice and duration. Primary outcome was the percentage of optimal antibiotic prescriptions consistent with guideline recommendations for first-line antibiotic choice and duration. Secondary outcomes were the associations of optimal prescribing by diagnosis, suboptimal antibiotic choice, and patient- and clinician-level factors (ie, age and Social Vulnerability Index) with optimal antibiotic choice, which were measured by odds ratios (ORs) and 95% CIs calculated using a multivariable logistic regression model. A total of 506 633 antibiotics were prescribed in 488 818 clinical encounters (for 247 843 females [50.7%]; mean [SD] age, 8.36 [5.5] years). Of these antibiotics, 21 055 (4.2%) were for tier 1 diagnoses, 288 044 (56.9%) for tier 2 diagnoses, and 197 660 (39.0%) for tier 3 diagnoses. Additionally, 194 906 antibiotics (38.5%) were optimal for antibiotic choice, 259 786 (51.3%) for duration, and 159 050 (31.4%) for both choice and duration. Acute otitis media (AOM) and pharyngitis were the most common indications, with 85 635 of 127 312 (67.3%) clinical encounters for AOM and 42 969 of 76 865 (55.9%) clinical encounters for pharyngitis being optimal for antibiotic choice. Only 257 of 4472 (5.7%) antibiotics prescribed for community-acquired pneumonia had a 5-day duration. Optimal antibiotic choice was more likely in patients who were younger (OR, 0.98; 95% CI, 0.98-0.98) and were less socially vulnerable (OR, 0.84; 95% CI, 0.82-0.86). This cross-sectional study found that less than one-third of antibiotics prescribed to pediatric outpatients in Tennessee were optimal for choice and duration. Four stewardship interventions may be targeted: (1) reduce the number of prescriptions for tier 3 diagnoses, (2) increase optimal prescribing for AOM and pharyngitis, (3) provide clinician education on shorter antibiotic treatment courses for community-acquired pneumonia, and (4) promote optimal antibiotic prescribing in resource-limited settings.

Findings and practical guidelines for interim leaders

PurposeInterim leaders often have little advance notice of their new assignments. Yet, they must skillfully lead their organizations, provide stability for staff and continue the direction of the mission and vision in a time of change. In addition, temporary leaders – often termed interim executive directors or interim chief executive officers (CEOs) – are frequently asked to guide the transition for a new and permanent leader.Design/methodology/approachThis qualitative study presents the insights of 24 interim leaders, largely in the Chattanooga, Tennessee (TN) region, who participated in individual virtual interviews and a subsequent virtual focus group to address a protocol of questions concerned with all phases of carrying out the interim position.FindingsThe findings confirmed existing literature on how the interim was selected, the responsibilities of this leader and the costs and benefits for the organization of using an interim and extended findings with guidance for interim over their tenure.Practical implicationsThe findings uncovered new insights into personal and career growth, along with unexpected personal and professional enrichment and satisfaction from the experience. The practical implications include providing detailed guidelines for interim leaders at each stage of their tenure, which can help them navigate the complexities of their roles more effectively. Additionally, the findings highlight the potential for significant personal and professional growth, offering interim leaders unexpected enrichment and satisfaction from their experiences.Social implicationsThe exploratory research validated the existing literature on interim leadership and added additional detail in practical guidance for beginning an interim position, carrying out the interim position and even ending the position. This study delineates practical guidelines at each stage of the interim lifecycle for both the temporary leader and the organization and provides areas for future research. Qualitative findings also identified key characteristics of an interim leader. This study also includes discussion of the political implications of interim CEOs.Originality/valueThe study presents original insights into the role of interim leaders by combining qualitative data from 24 participants in the Chattanooga, TN region with existing literature, thereby enhancing understanding of the challenges and successes these leaders face. It confirms previous findings regarding interim leadership and provides practical guidelines for navigating the interim lifecycle, highlighting aspects of personal growth and satisfaction that have not been extensively explored in prior research.

Coal Ash Triggers an Elevated Temperature Landfill Development: Lessons from the Bristol Virginia Solid Waste Landfill Neighboring Community

Landfills for disposing of solid waste are designed, located, managed, and monitored facilities expected to comply with government regulations to prevent contamination of the surrounding environment. After the average life expectancy of a typical landfill (30 to 50 years), a large investment in the construction, operation, final closure, and 30-year monitoring of a new site is needed. In this case study, we provide a holistic explanation of the unexpected development of elevated temperature landfills (ETLFs), such as that in the city of Bristol (United States) on the border of the states of Virginia and Tennessee, including the initial role played by coal ash. Despite the increasing frequency of ETLF occurrence, there is limited knowledge available about their associated environmental problems. The study uses mixed (qualitative, quantitative, and mapping) methods to analyze (1) the levels of odoriferous reduced sulfur compounds, ammonia, and volatile organic compounds (VOCs) emitted, (2) the ratio of methane to carbon dioxide concentrations in five locations, which dropped from unity (normal landfill) to 0.565, (3) the location of gas well heads with gradients of elevated temperatures, and (4) the correlation of the filling rate (upward of ~12 m y−1) with depth for registered events depositing coal ash waste. The work identifies spatial patterns that support the conclusion that coal ash served as the initiator for an ETLF creation. The case of the city of Bristol constitutes an example of ETLFs with elevated temperatures above the regulatory United States Environmental Protection Agency (EPA) upper threshold (65 °C), having alongside low methane emissions, large production of leachate, land subsidence, and a large production of organic compounds. Such landfills suffer abnormal chemical reactions within the waste mass that reduce the life expectancy of the site. Residents in such communities suffer intolerable odors from fugitive emissions and poor air quality becomes prominent, affecting the well-being and economy of surrounding populations. Conclusive information available indicates that the Bristol landfill has been producing large amounts of leachate and hazardous gases under the high pressures and temperatures developed within the landfill. A lesson learned, which should be used to prevent this problem in the future, is that the early addition of coal ash into the landfill would have catalyzed the process of ETLF creation. The work considers the public health risks and socioeconomic problems of residents exposed to emissions from an ETLF and discusses the efforts needed to prevent further incidents in other locations.

PSX-28 Management of lameness in meat goat herds: A survey of producers in the southeastern US

Abstract Lameness is a persistent animal health concern in the meat goat industry. A survey was developed to describe lameness in commercial meat goat herds in the southeastern US. The survey included 35 multiple-choice questions about general herd attributes, various management practices, and specific herd lameness characteristics. A photo guide of goat hoof lesions was included in the survey package. The survey was sent by postal mail to 629 farms in Tennessee and bordering states with 183 completed surveys returned. The majority of herds managed Kiko (32%), Boer (22%), and Myotonic (19%) goat breeds. Reasons for raising goats included seed stock or breeding stock (78.1%), commercial, market, or slaughter purposes (62.3%), hobby, pets, or show (48.6%), and for brush, vegetation, or weed control (25.7%). Most respondents (90.7%) acquired goats from breeder farms, whereas only 2.7% of respondents purchased goats from sale barns. Most respondents quarantine new animals before adding them to the herd (78.1%), while 19.7% did not quarantine new animals and 1.1% were unfamiliar with the practice. The average monthly lameness rate was estimated to be at 6% with seasonal occurrences identified by respondents as 6% in the fall, 31.4% in the winter, 25.1% in the spring, and 50.5% in the summer. Some respondents indicated no seasonal variation (24.0%) or did not know (3.3%) if seasonal variation existed. Primary causes of lameness identified by respondents were overgrown hooves (50%), foot scald (19%), and foot rot (14%). Other lesions were identified at less than 8%. Sources of lameness treatment information for respondents were other producers (34.9%), veterinarians (30.6%), books (22.4%), online chat groups (19.1%), magazines (8.7%), and the extension service (8.2%). When lame goats were identified, more respondents (56.8%) did not isolate lame goats than those that practiced lame goat isolation (24.0%). Most respondents indicated that they treated lame goats (76.5%), a few did not treat lame goats (4.9%), and notable proportion (19.6%) did not respond to the question. Management approaches to treating lameness identified most frequently by respondents included hoof trimming (85%), topical hoof applications (40%), injectable antibiotics (32%), and footbaths (17%); 4% of respondents noted other methods. As a form of general hoof care management, most producers conducted hoof trimmings two or three times a year (51.9%), compared with trimming hooves once a year (9.8%), monthly (14.2%), or only trim hooves when goats became lame (6.6%). As a culling criterion, 29.5% responded lameness was a cull factor, 45.4% indicated it was not a cull factor, and 25.1% of respondents either did not know or did not response. Survey results showed that lameness is an issue in meat goat herds of the southeastern U.S. and a diversity of management approaches are used by producers to address the concern.

Antimicrobial Prescription Patterns for Acute Sinusitis 2015-2022: A Comparison to Published Guidelines.

Acute rhinosinusitis (ARS) is one of the most encountered conditions in primary care and otolaryngology clinics. However, little is known about how antibiotic prescription practices following a diagnosis of ARS compare to guidelines set forth by the American Academy of Otolaryngology in 2015. To investigate the epidemiology of ARS and the corresponding antibiotic prescribing practices by physicians and compare to published guidelines. Using the TriNetX Live database, we identified all patients diagnosed with ARS using the ICD10 code J01 between April 2015 and December 2022 across the state of Tennessee. After investigating the demographics of this cohort, we compared the first prescribed antibiotic within one day of ARS diagnosis to published guidelines. Antibiotics were grouped into their respective classes. Of 81 310 patients diagnosed with ARS identified in the specified time frame, 66% were Female, 49% were African American, 44% were White, and the mean age was 47 ± 20 years. The six most common initial antibiotics prescribed for ARS were erythromycins/macrolides [14 609 (25.8%)], amoxicillin/clavulanate [14 322 (25.3%)], amoxicillin [9300 (16.4%)], third generation cephalosporins [7733 (13.6%)], quinolones [3648 (6.4%)] and tetracyclines [2235 (3.9%)]. Of this cohort, 56 719 patients (69.8%) of patients were prescribed an antibiotic within one day of diagnosis. Despite published guidelines recommending amoxicillin with or without clavulanic acid as first-line treatment for ARS, only 42.2% of prescribed antibiotics followed this guideline in our cohort. While accounting for patients with penicillin allergy, the second-most represented antibiotics were erythromycins/macrolides, which are specifically recommended against due to high rates of S. Pneumoniae resistance. Our results suggest that further investigation into the causes of erythromycin/macrolide prescriptions as first line treatment for ARS and practices at other institutions should be conducted. In addition, building awareness around published ARS guidelines for physicians may be useful in improving antibiotic stewardship in treatment of ARS.

Tianeptine-involved emergency department visits, fatal overdoses, and substance seizures in Tennessee, 2021–2023

BackgroundTianeptine is an antidepressant that acts as an agonist to the mu-opioid receptor and enhances serotonin reuptake. Tianeptine has been legally sold as an antidepressant in some countries but is not approved for any medical use by the U.S. Food and Drug Administration (FDA). Tianeptine is not a federally controlled substance, but became a schedule II substance in Tennessee on July 1, 2022. This publication aims to describe the prevalence of tianeptine-involved emergency department visits, fatal overdoses, and substance seizures in Tennessee from 2021 to 2023. MethodsWe conducted a study to examine the prevalence of tianeptine-involved emergency department visits and fatal overdoses in Tennessee using data for 2021 to 2023 from the Tennessee Electronic Surveillance System for the Early Notification of Community based Epidemics (ESSENCE) database and the Tennessee State Unintentional Drug Overdose Reporting System (SUDORS). Substance seizure data from National Forensic Laboratory Information System (NFLIS) are included. ResultsOur search of ESSENCE, SUDORS, and NFLIS yielded 50 tianeptine-involved emergency department visits, 6 tianeptine-involved fatal overdoses, and 19 tianeptine substance seizures respectively. Demographic information is provided for the emergency department visits and tianeptine-involved fatal overdoses. Discharge diagnosis and clinical symptomology information are provided for the emergency department visits. ConclusionEmergency department visits and fatal overdoses involving tianeptine have occurred in Tennessee despite tianeptine becoming a schedule II substance. Among emergency department visits, tianeptine use is most commonly associated with gastrointestinal and psychological symptoms. All fatal cases where tianeptine was detected involved other substances, suggesting tianeptine plays a role in polysubstance use.

An Improved 21st Century Judicial System with Environmental Science Expertise is Needed for Resolving Interstate Water Conflicts.

As stresses on groundwater resources increase due to growing population and climate change, water litigation, such as the recently decided Mississippi (MS) vs Tennessee (TN) lawsuit, will become more common. In the United States, lawsuits between states can be heard only by the Supreme Court of the United States (SCOTUS). These lawsuits are expensive and lengthy, often requiring highly specialized technical expertise. In the MS vs TN case, the Court unanimously held that an interstate aquifer is subject to equitable apportionment. Although this appears to be a sound resolution, a careful examination of the SCOTUS hearing transcript revealed that the Justices had several egregious misconceptions about the groundwater system. These misconceptions arose in part due to the failure of technical experts to communicate groundwater concepts in understandable terms and in part due to the Justices' lack of expertise in groundwater science. To address these issues, we first explore methods for improving scientific communication in courtrooms. Second, we propose ideas for reforming the legal system and provide compelling arguments for using the lower courts to hear such cases. We also explore the possibility of creating specialized federal water courts to resolve water disputes.

Enhancing Sustainable Cultivation of Organic Bell Pepper through Fulvic Acid (FA) Application: Impact on Phytochemicals and Antioxidant Capacity under Open-Field Conditions

Fulvic acid (FA) is an eco-friendly solution for reducing the reliance on agrochemicals and enhancing crop quality. The study aimed to investigate the impact of soil and foliar application of FA on the phytochemical content and antioxidant properties of organically grown bell peppers at both the green and red stages. Bell pepper cv. Revolution was grown under open-field conditions at the certified organic farm at Tennessee State University, Nashville, with nine treatments and three replications. FA was applied as a soil drench and foliar spray at four different rates (0, 2.3, 5.5, 7.8, 10.9 mL L−1). The fruits were harvested 55 days (green stage) and 86 days after transplantation (red stage). The study showed significant differences (p ≤ 0.05) between the treatment and maturation stage. The foliar treatment of 7.8 mL L−1 resulted in the highest phenolic content in green bell peppers. The highest total flavonoid content in red bell peppers was achieved with a soil treatment of 7.8 mL L−1. Additionally, the highest level of vitamin C in red bell peppers occurred with a soil concentration of 5.5 mL L−1. In conclusion, applying FA as a biostimulant can enhance the quality of organically grown bell peppers, offering promising opportunities for sustainable agricultural practices.

Age related Antibiotic Prescribing Trends of Clostridioides Difficile Incident Cases within Davidson County TN 2012-2020

Age related Antibiotic Prescribing Trends of Clostridioides Difficile Incident Cases within Davidson County Tennessee 2012-2020 Michael Norris, MSN, Priscilla Pineda, MPH, Malakai Miller, MPH, Raquel Villegas, PhD, MS Background: Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections in the United States. Antibiotic use is considered a predisposing factor for CDI. The State of Tennessee collaborates with the CDC as part of an ongoing Emerging Infections Program (EIP). We sought to better understand the impact of antimicrobial use prior to the date of incident of CDI within the defined age groups of Davidson County, Tennessee. Methods: Surveillance data from the years 2012–2020 were examined for all positive CDI cases within Davidson County. A positive CDI case was defined as a laboratory confirmed case who is ≥ 1 year old living in Davidson County, Tennessee. Antibiotic use was assessed in the 12 weeks prior to CDI. Trends of overall antibiotic use, including the top five antibiotics prescribed by our defined age groups were examined. Analyses were performed using SAS version 9.4. Only fully abstracted cases are included in the study. Results: Among 7,346 positive CDI incident cases identified between 2012–2020, 5,467 (74.4%) received antibiotics 12 weeks prior to a confirmed infection. We looked at the trend of antibiotic prescription over time from 2012-2020 (77.0%, 76.7%, 74.3%, 80.7%, 76.3%, 75.1%, 73.7%, 74.8% and 71.5%) which has decreased since 2015. The prevalence of antibiotic use by age group 1-18 years, 19-44 years, 45-64 years, 65-74 years, and 75+ years was 53.4%, 68.8%, 74.5%, 79.2% and 83.1% respectively. The five most prescribed antibiotics were ceftriaxone ((11.1%), followed by vancomycin IV (10.9%), ciprofloxacin (10.2%), metronidazole (9.1%), and piperacillin (8.6%). Cases in the 45-64 years age group were more likely to be prescribed vancomycin IV, ciprofloxacin, metronidazole, and piperacillin-tazobactam compared to other age groups (p &lt; 0.0001). There was no statistically significant association between ceftriaxone prescription and our defined age groups. Conclusion: In this study, almost three quarters of the CDI cases had received antimicrobial therapy in the 12 weeks prior to infection. Since antibiotic prescription is a potentially modifiable risk factor for CDI, a more in-depth study, combined with an antibiotic stewardship program implementation in all settings would be beneficial to reduce the risk of CDI complications of antibiotic usage.

Candida auris Response in a Tennessee Dialysis Facility, 2023

Background: Candida auris, a multi-drug resistant fungal pathogen, was introduced to Tennessee in 2021. There are limited studies on the spread of C. auris in highly specialized care settings including outpatient dialysis facilities. Facilities are concerned that C. auris transmission is difficult to prevent in this setting due to patient vulnerability, treatment frequency and length, and isolation challenges. As a result, these facilities may reject patients based on their positive colonization status. In 2023, the Tennessee Department of Health (TDH) conducted two containment-driven colonization screenings in response to a colonized patient receiving dialysis treatment for one month without their status being known to the facility. Methods: An initial point prevalence survey (PPS) was conducted to assess for ongoing transmission among dialysis patients. Patient screening was prioritized for the cohort of patients who received dialysis at the same time as the index patient (Cohort A). The screening was broadened to include patients dialyzed directly before Cohort A (Cohort B) by request of the Cohort B patients. A second PPS was conducted 7 weeks later, targeting the same cohorts. Specimens were collected through supervised patient self-collection of a skin swab from the axilla and groin. Flocked Eswabs were used for collection and transferred in Amies transport media to the Tennessee State Public Health Lab. The presence of C. auris was detected via Polymerase Chain Reaction (PCR). Results: Twenty-three patients (12 from Cohort A; 11 from Cohort B) were screened in the first PPS. One patient from Cohort A tested positive. This colonized patient was determined to be a known C. auris case first detected four months prior, but the patient’s status was never communicated to the dialysis facility from the discharging acute care facility. Eleven patients, excluding the previously identified positives, participated (9 from Cohort A; 2 from Cohort B) in the second PPS; no positives were identified. Discussion: The index patient and an additional patient identified by the PPS both received dialysis at this facility for up to 4 months without facility knowledge. These results suggest that the standard infection control practices at this dialysis facility were adequate to prevent the transmission of C. auris among dialysis patients on multiple shifts. Additionally, patient self-collection identified a known C. auris patient. Future TDH work includes further evaluating the risk of C. auris transmission and developing targeted infection prevention and control practices for the outpatient dialysis setting.

Building Workplace Camaraderie Through Library Employee Programming

ABSTRACT Employees at libraries of all types are looking for ways to form and strengthen relationships between colleagues who may be physically and socially disconnected after a period of remote work or staff turnover. At East Tennessee State University’s Sherrod Library, some library faculty and staff formed a committee to plan monthly events to encourage community among library employees. Events have included craft and poetry workshops, music and book discussions, potlucks, and professional development sessions. Recommendations to the reader for planning similar events include considering accessibility and scheduling, drawing from local talent and resources, and experimenting with a variety of activities. The committee’s efforts have strengthened relationships among library employees, improved leadership skills for early career librarians, and inspired new outreach projects to engage the campus community.

The impact of enhanced Milieu teaching with phonological emphasis (EMT + PE) on the speech and language outcomes for toddlers with cleft palate in Brazil and the United States of America

Purpose The purpose of this study was to compare the speech and language outcomes of children with cleft palate with or without cleft lip (CP+/-L) in the USA to children with CP+/-L in Brazil who underwent intervention with enhanced Milieu teaching with phonological emphasis (EMT + PE), as there are few cross-country intervention comparisons for children with CP+/-L. Method This is a retrospective analysis of 29 participants from the USA and 24 participants from Brazil who were matched on age. The US participants were between the ages of 13–35 months (M = 23.76), spoke Standard American English in the home, and were recruited from East Tennessee State University and Vanderbilt University. The Brazilian participants were between the ages of 20–34 months (M = 25.04), spoke Brazilian Portuguese in the home, and were recruited from the Hospital de Reabilitação de Anomalias Craniofaciais–Universidade de São Paulo. All treatment participants received EMT + PE from trained speech-language pathologists in hospital-university clinics. Result The treatment groups demonstrated greater gains than comparison groups in percent consonants correct, number of different words, and expressive/receptive vocabulary. There was no main effect nor interaction by country. Conclusion The application of EMT + PE in a second culture and language is a viable early intervention option for participants with CP+/-L.

Comprehensive Sinkhole Mitigation: A Case Study and Application of Compaction Grouting in Karstic Environments in in the State of Tennessee, USA

Comprehensive Sinkhole Mitigation: A Case Study and Application of Compaction Grouting in Karstic Environments in in the State of Tennessee, USA

Mapping incidence and survival of non-small-cell lung cancers stratified by mutation type in southern Appalachia: A single center retrospective study.

e20568 Background: Non-small cell lung cancer (NSCLC) is often a mutation-driven disease with variability in incidence and survival depending on location as seen in population-based cohort studies. Our study aims to delineate these differences based on molecular testing for these mutations in our study cohort at East Tennessee State University - Quillen College of Medicine, which is based on patients from east Tennessee, western North Carolina, and southwestern Virginia. Methods: We obtained pathology results of 294 patient samples with advanced/metastatic NSCLC from our cancer center/health system database over a 5 year period. PDL-1 was tested in all patients. Fluorescent in-situ hybridization (FISH) testing for common pathogenic driver mutations such as EGFR, ALK, ROS1, RET, MET and PTEN were performed as is standard of care. Molecular sequencing was performed and included over 40 genetic mutations and 2 biomarkers, several of which today are considered targetable for advanced NSCLC, per standard of care. Incidence of different mutations was measured in our patient population. Overall survival was calculated with date of diagnosis available based on pathology report and date of patient expiration obtained from electronic medical records. Data analysis was performed to ascertain which mutations carried an increased risk of death. Results: The TP53 mutation was very common, seen in 85% of squamous cell carcinoma (SCC) histology and 55% of adenocarcinoma. Similarly, incidence of PTEN deletion by FISH was noted to be 52% in SCC and 31% in adenocarcinoma. EGFR mutations were rare, seen in only 3% of tested patients. We had an incidence of KRAS G12C mutations at 11% overall, but it was present in up to 18% of adenocarcinomas. BRAF was seen in 4.8% of all cases, 8% of adenocarcinomas and 2% of SCC. Since there were more than 2 predictors, Cox proportional-hazards regression model was fit. Due to either having all negative values or very few positive values, the variables CCND1, CDKN2B, ERBB2, ERBB4, FGFR, FGFR2, MET, MSI, NRAS, PDGFRA, RET, RS01, SCR were excluded from analysis. A total of 156 samples were used in final analysis. After model building, it was found that BRAF and KRAS G12C mutation were significant predictors of survival by hazard ratios for death. Conclusions: In our unique patient population, there was a greater incidence of deleterious TP53 mutations and PTEN deletions compared to the general North American advanced/metastatic NSCLC population. Although BRAF and KRAS G12C mutations were not at a greater incidence in comparison to the rest of North America, they were notably significant predictors of survival, conferring nearly 3.4 and 2.7 times increased risk of death in our study. [Table: see text]

Human Trafficking Hotline Analysis: Insights from the State of Tennessee

ABSTRACT This exploratory study underscores the value of human trafficking hotlines as an important data source for understanding and responding to trafficking at the micro level. Drawing on data from the Tennessee Statewide Human Trafficking Hotline between 2017 and 2021, 2,316 tips were analyzed and revealed a 219% tip increase over five years, with minimal impact noted due to COVID-19. The most common trafficking tips relate to minors (57%), adult sex trafficking (21%), and labor trafficking (4%). Women and minor victims were overrepresented in tips, and only 3% of victims self-reported to the hotline. Tips were concentrated in counties with larger populations; however, tips also indicated human trafficking presence in rural areas. Multiple victims and trafficking suspects were described in 11.5% of cases, and as the number of victims increased, so did the number of suspected traffickers. When suspects operated together, there tended to be one male and one female in the reported trafficking operations. The findings of this study provide insight into the landscape of human trafficking in Tennessee and can inform policy development and enhanced responses by law enforcement and service providers to human trafficking.

Abstract PO1-15-04: Young Black Women With Triple-Negative Breast Cancer Molecular Subtypes: Population-Specific Patterns and Batch Effect Considerations

Abstract Introduction: While triple-negative breast cancer (TNBC) molecular subtypes have been associated with biological differences and clinical outcomes, studies have overwhelmingly been conducted in populations of European or Asian ancestry. Data collected across diverse populations is required to better leverage clinical directions from translational studies in TNBC. Through females recruited through the Black Women: Etiology and Survival of Triple-Negative Breast Cancers (BEST) study, we sought to characterize subtypes and explore associations. Methods: Our study included Black women diagnosed with early-stage (I-III) invasive TNBC at &amp;lt; = age 50 from 2005 to 2016, with recruitment from Florida and Tennessee state cancer registries. Germline DNA, tumor RNA, clinical outcomes, and risk factor data were collected. TNBC status in the BEST study was based on immunohistochemistry from pathology reports, cancer registry data, and self-reported data. Analyses on banked tumor samples, extracted at multiple time points, were conducted through PAM50 (Nanostring) and whole-transcriptome RNA-seq. TNBC subtype was assessed using TNBCtype-4 (Lehmann et al. 2016). Sources of batch effect were evaluated using PCA and corrected via limma. Genetic ancestry based on OncoArray or MEGA genotyping data was inferred using 1000Genomes continental reference samples. Immune cell characterization was performed via CIBERSORT and ESTIMATE. Statistical significance in comparing differences across subtypes was assessed via Chi-square test. Kaplan-Meier estimates and log-rank test were used for survival analysis. Results: RNA-seq from 114 self-reported Black females with TNBC was analyzed. TNBC subtype distribution in the BEST study cohort included 31.6% basal-like 1 (BL1), 28.9% basal-like 2 (BL2), 16.7% luminal androgen receptor (LAR), and 21.9% mesenchymal (M). While results were largely consistent with prior studies in patients of European or East Asian ancestry, a higher percentage of BL2 subtype was observed (28.9% vs. 21.0%, p=0.053). Based on PAM50 subtyping, 100% of tumors with BL1 and M were basal, whereas 68.8% of LAR and 86.7% of BL2 subtypes were basal. Tumors without subtype decreased from 9.8% to 1.1% after batch correcting for location at which RNA was extracted (Moffitt vs. Vanderbilt) and time between RNA banking and sequencing. All TNBC subtypes in this population demonstrated monocyte/activated dendritic cell predominance, with no significant subtype-specific associations with immune cell patterns. A lower relative proportion of M subtype was found in tumors from BRCA1/2 carriers, but this was not statistically significant due to the small number of carriers (8% vs. 18%; p=0.22). With a median follow-up time of 9 years, there was no significant difference in 10-year overall survival by TNBC subtype (p=0.18). However, patients with M subtype appeared to have worse survival relative to other subtypes combined (p=0.036). Conclusion: Our study is among the largest to date that interrogates TNBC subtypes and associated molecular/clinical data in self-reported Black females with invasive breast cancer. Our findings suggest that established TNBC subtyping can be applied in patients of African ancestry. Furthermore, data to correct for lab-based confounders remains critical; in this study, it enabled us to use many samples that could not be subtyped initially. Several population-specific patterns were observed, including no difference in 10-year overall survival across TNBC subtypes (consistent with prior data), but worse initial outcomes in M subtype; a preliminary association between BRCA1/2 carriers and non-M subtypes (in contrast to prior data); and no significant difference in immune cell distributions (in contrast to prior data mainly from patients of European ancestry). Studies of associations between TNBC subtypes, additional clinical data, and treatment data (type and response rates) are ongoing. Citation Format: Padma Rajagopal, Sonya Reid, Run Fan, Lindsay Venton, Anne Weidner, Mya Roberson, Susan Vadaparampil, Xuefeng Wang, Sean Yoder, Marilin Rosa, Jibril Hirbo, Jennifer Whisenant, Jennifer Pietenpol, Fei Ye, Tuya Pal, Brian Lehmann. Young Black Women With Triple-Negative Breast Cancer Molecular Subtypes: Population-Specific Patterns and Batch Effect Considerations [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-15-04.