Southern United States Research Articles

Risk Factors for Empiric Treatment Failure in US Female Outpatients with Uncomplicated Urinary Tract Infection: an Observational Study.

Treatment failure (TF) in uncomplicated urinary tract infection (uUTI) increases disease burden and risk of antimicrobial resistance. Identification of risk factors for TF could inform empiric treatment decisions and reduce suboptimal outcomes. To evaluate the incidence of TF to empirically prescribed oral antibiotics and identify risk factors for TF in females with uUTI in the United States (US). This retrospective cohort study used Optum's de-identified Electronic Health Record dataset (January 2017-September 2022). Eligible female patients aged ≥ 12years had ≥ 1 diagnosis of urinary tract infection (UTI) in an outpatient ambulatory/emergency department (ED) setting, ≥ 1 empiric oral antibiotic prescription, and no evidence of complicated UTI (cUTI). TF was defined as having a new/repeat oral antibiotic prescription, IV antibiotic administration or acute UTI diagnosis ≤ 28days following initial empiric oral antibiotic prescription​. Risk factors of TF were selected using LASSO and reported using adjusted risk ratios (aRR) and 95% CIs. Of 376,004 patients with uUTI, 62,873 (16.7%) experienced TF. Incidence of TF was highest in patients with history of antibiotic TF (33.9%) or fosfomycin prescription (30.1%). Significant risk factors of TF included ≥ 3 prior antibiotic prescriptions (aRR [95% CI]: 1.60 [1.56-1.64]); fosfomycin prescription (1.60 [1.38-1.86]); uUTI diagnosis in ED (1.49 [1.46-1.52]), Southern US residence (1.37 [1.35-1.40]), age ≥ 75years (1.35 [1.29-1.41]), recurrent UTI (1.12 [1.10-1.14]) and obesity (1.06 [1.04-1.08]). Incidence of TF to empirically prescribed oral antibiotics for uUTI is considerable. Prior infections requiring antibiotic prescription and location of care are key risk factors for TF in female outpatients with uUTI. Knowledge of these TF risk factors can inform shared-decision making and supplement existing guidance on uUTI treatment.

The Impact of Environmental and Housing Factors on the Distribution of Triatominae (Hemiptera, Reduviidae) in an Endemic Area of Chagas Disease in Puebla, Mexico.

Chagas disease (CD), a Neglected Tropical Disease caused by Trypanosoma cruzi, affects millions of people in Latin America and the southern US and spreads worldwide. CD results from close interactions between humans, animals, and vectors, influenced by sociodemographic factors and housing materials. This study aimed to evaluate how these factors, along with seasonal changes, affect the distribution of CD vectors in an endemic community near Puebla, Mexico, using a cross-sectional survey. A total of 383 people from this area, known for the presence of major vectors such as Triatoma barberi and Triatoma pallidipennis, were surveyed. As a result of the survey, it was found that only 27.4% of respondents knew about CD, and 83.3% owned potential reservoir pets; additionally, the quality of the wall, roof, and floor significantly influenced vector sightings, while the seasonal pattern showed less of an association. Chi-square tests confirmed these associations between vector sightings and housing materials (p < 0.001); vector sightings versus seasonal patterns showed less of an association (p = 0.04), and land use changes did not show an association (p = 0.27). Construction materials play an important role in the sighting of triatomines in homes, so important actions should be taken to improve homes. However, further experimental or longitudinal studies are needed to establish causality.

Multiphase Reactions of Hydrocarbons Into an Air Quality Model With CAMx‐UNIPAR: Impacts of Humidity and NOx on Secondary Organic Aerosol Formation in the Southern USA

AbstractSecondary organic aerosol (SOA) mass in the Southern USA during winter‐spring 2022 was simulated by integrating Comprehensive Air quality Model with extensions (CAMx) with the UNIfied Partitioning‐Aerosol phase Reaction (UNIPAR) model, which predicts SOA formation via multiphase reactions of hydrocarbons. UNIPAR streamlines multiphase partitioning of oxygenated products and their heterogeneous reactions by using explicitly predicted products originating from 10 aromatics, 3 biogenics, and linear/branched alkanes (C9‐C24). UNIPAR simulations were compared with those using Secondary Organic Aerosol Partitioning (SOAP) model, which uses simple surrogate products for each precursor. Both UNIPAR and SOAP showed similar tendencies in SOA mass but slightly underpredicted against observations at given five ground sites. However, SOA compositions and their sensitivity to environmental variables (sunlight, humidity, NOx, and SO2) were different between two models. In CAMx‐UNIPAR, SOA originated predominantly from alkanes, terpenes, and isoprene, and was influenced by humidity, showing high SOA concentrations with wet‐inorganic salts, which accelerated aqueous reactions of reactive organic products. NO2 was positively correlated with biogenic SOA because elevated levels of nitrate radicals and hygroscopic nitrate aerosol effectively oxidized biogenic hydrocarbons at night and promoted SOA growth via organic heterogeneous chemistry, respectively. Anthropogenic SOA, which formed mainly via daytime oxidation with OH radicals, was weakly and negatively correlated with NO2 in cities. In CAMx‐UNIPAR, the sensitivity of SOA to aerosol acidity (neutral vs. acidic aerosol at cation/anion = 0.62) was dominated by isoprene SOA. The reduction of NOx emissions could effectively mitigate SOA burdens in the Southern USA where biogenic hydrocarbons are abundant.

A Qualitative Study of Transportation-Related Barriers to HIV Care in South Carolina.

Addressing structural barriers to care for people living with human immunodeficiency virus (HIV) in the southern United States is critical to increase rates of viral suppression and to reduce existing HIV disparities. This qualitative study aimed to describe transportation-related barriers experienced by people living with HIV in South Carolina, understand perceived effects of transportation vulnerability on HIV care, and explore strategies used by individuals to overcome transportation-related challenges. We conducted semistructured interviews with 20 people living with HIV from South Carolina who were either reengaging in HIV care after a prolonged absence (>9 months) or in care but with a detectable viral load (ie, >200 copies/mL). All people living with HIV reported transportation vulnerability. A deductive/inductive approach was used to identify transportation-related barriers perceived to negatively affect HIV care. We also identified strategies and resources described by people living with HIV as helpful in addressing transportation challenges. Participants described a range of transportation-related barriers to HIV care, including lack of access to reliable, safe, and affordable transportation, as well as stigma due to HIV and socioeconomic statuses. These barriers were reported to negatively affect engagement in care and worsen both physical and mental health. Participants indicated flexible clinic policies and instrumental support from family and friends were useful in overcoming barriers. This study offers insight for the development of transportation interventions to improve equitable access to HIV care for people living with HIV in South Carolina. It also calls attention to the ways in which transportation vulnerability, HIV-related stigma, and disability status intersect to create unique challenges for some people living with HIV.

Fracturing a Female Identity

As a white woman raised in a rural community in a heteropatriarchal, evangelical Christian family whose tradition is hard work and family values, the author lived within the boundaries of those archetypal, stereotypical roles until tragedy struck, shaking the foundation of her self-concept as mother, wife, woman. This crisis invited a deterritorialization of self-concepts that imprisoned her, exposing her gendered existence, which she chronicled in journals over the period of this reimagining of self. Reflection on this personal writing reveals its role in developing not only the identity of a writer but the identity of a woman in the shattering and reimagining of facets of her “self” when a spouse’s moral undoing threatens her sense of being. In this autoethnographic study, the author’s Deleuzian approach to reflecting on identity through journal dipping into her own writing in a time of trauma and self-examination explores the possibilities for applying hermeneutics to personal texts to free the potential for rhizomatic expansion of feminine becoming born when the cultural expectations of feminine being in the United States South are fractured.

“Why Should We Care?”: Motivations of Public Librarians in the American South to Expand Civic Engagement for Racial Justice

ABSTRACTAn important aspect of human information behavior research is to understand the motivations of people as they interact with information and technologies to make a difference. This paper presents exploratory findings of a qualitative study of public librarians' motivations to expand civic engagement for racial justice in the American South. The geographical region is stereotypically characterized historically as being solely racially intolerant in public perceptions, scholarly discourse, political networks, and news media. This research challenges such limited notions, highlighting public librarian's logic‐based motivations to further civic engagement for racial justice in context of the nation's historical/contemporary racialized political climate. In the process, the authors acknowledge the voices/perspectives of public librarians, an often‐underrepresented group in privileged academic information behavior research. Thematic narrative analysis is explored as a strategic mode of presenting the findings.

Experiences of Older Adults with Heart Failure Using Telemedicine During the COVID-19 Pandemic: A Qualitative Study.

Background: Telemedicine (TM) usage increased rapidly during the COVID-19 pandemic. This study is part of a larger mixed-methods study comparing TM and in-person visits of older adults with heart failure (HF) and describes patient's TM experiences during the pandemic. Methods: This study employed qualitative design using survey responses and individual interviews. Study eligibility requirements included >55 years old, HF diagnosis, and TM visit between September 1, 2020 and May 31, 2021, at one of two participating health systems in the southern United States. Results: Twenty-two TM recipients completed qualitative interviews, and 91 of 125 online survey respondents answered open-ended questions. Data were gathered, sorted, and revealed five themes. Discussion: Interview respondents identified benefits, e.g., convenience, inclusion, decreased exposure, and problems, e.g., connectivity issues, inadequate equipment, and medical conditions impacting use. Recommendations included allocating sufficient appointment time, tailoring visits, and increasing written communication. This study was part of a larger clinical trial registered at ClinicalTrials.gov: NCT04304833.

Diversity Analysis in Brinjal (Solanum melongena L.) Genotypes Using Microsatellite Markers

Brinjal (Solanum melongena L.) is commonly called as eggplant or aubergine. It is one of the most important commercial solanaceous vegetable crops grown widely in Asian and African countries. It is popular among people of all social strata and is rightly called a vegetable of masses [1, 2]. It is of substantial economic importance in Asia, Africa, and the subtropics (India, Central America), and it is also grown in some warm temperate regions (Mediterranean area, Southern USA) [3, 4]. It is an old world species and native to Indo-Chinese centre of origin [5]. The genus Solanum is morphologically hypervariable and highly diverse in number of species [6] and ecogeographical distribution [7]. Despite the economic and nutritional importance of eggplant, breeding efforts in this crop have been limited compared to other solanaceous crops, such as tomato and potato [8, 9]. In the present study 30 solanaceae specific microsatellite markers were used of which 29 showed good amplification in the 4 checks used viz state check for round and oblong to long fruit, national check for round fruit and national check for oblong to long fruit. Of these 29, primer set emi04J02 and emk03O04 did show amplification in the other genotypes. Finally, 27 markers were used for analysis. Of these 23 showed monomorphic pattern (85.1%) whereas only 4 showed some polymorphism (14.8 %). The most informative marker was eme01D03 which showed presence of 3 alleles. The low degree of polymorphism indicated a high degree of homogeneity in the genotypes which could be due to a narrow genetic base.

Associations of Minority Stressors, Alcohol Use Disorder, Resilience, and HIV Testing Self-Efficacy Among Community-Based Black Men Who Have Sex with Men in a Southern U.S. City: A Causal Mediation and Moderation Analysis

Background: Black men who have sex with men (BMSM) face multiple minority stressors (e.g., homophobia, racism, and presumed HIV status) that may indirectly erode their confidence in pursuing HIV testing uptake through exacerbating alcohol use disorder (AUD). Objectives: Using cross-sectional data from 203 community-based BMSM (71.4% as homosexual with a mean age of 26 years) living in a Southern US city, we conducted a causal mediation and moderation analysis to investigate in/direct pathways linking minority stressors, AUD risk, and self-efficacy of HIV testing, including how resilience may moderate these associations. Results: Our mediation analysis revealed that AUD risk accounted for 32.1% of the total effect of internalized homonegativity (βtotal effect = -0.424; SE=0.071; p<0.001), 28.6% of the total effect of experienced homophobia (βtotal effect = -0.684; SE=0.122; p<0.001), and 15.3% of the total effect of perceived HIV stigma (βtotal effect = -0.361; SE=0.164; p<0.05) on HIV testing self-efficacy. Resilience significantly moderated the associations of experienced homophobia (β = -0.049; SE=0.011; p<0.001), internalized homonegativity (β = -0.065; SE=0.027; p<0.01), and perceived HIV stigma (β = -0.034; SE=0.013; p<0.05) with AUD risk. Resilience also significantly moderated the associations of experienced homophobia (β = -0.073; SE=0.021; p<0.01), internalized homonegativity (β = -0.082; SE=0.012; p<0.001), perceived HIV stigma (β = -0.037; SE=0.039; p<0.05), and AUD risk (β = -0.021; SE=0.015; p<0.05) with HIV testing self-efficacy. Conclusions: Our study provides important implications in identifying multilevel sources for building resilience among BMSM to buffer the effects of minority stress on AUD risk and improve HIV testing outcomes.

Labour Relations and Modes of Production under Russia's Institutional Development

The article contributes to a discussion on the taxonomy of labour relations and its relationships with modes of production in the paradigm of post-Marxian historical institutionalism in the tradition by D.C. North and R.M. Nureev. From this perspective the author provides an outline of the concept of labour relations in Russia/ USSR, with the focus on transition processes. The author traces the transitions from kin-ordered and tributary slavery to serfdom, from tributary and commodified serfdom to wage commodified labour, then to tributary and commodified labour under socialism. The outline is based primarily on the quantitative and qualitative evidence from the previous research literature. From the cross-country comparative perspective the author highlights that the cases of slavery during the early modern capitalism, inherited by the Antebellum Southern United States during the Industrial Revolution, as well as mass use of penall abour during the Soviet industrialization effort, moderately replicated in the pre-reform China, demonstrate resumption of institutions of forced labour on the path to modern economy and society. The evidence indicates that this is associated with the processes of military modernization and expansion of the war economy. In its turn, the weakening of the military threat created the possibility of commodified labour relations development. From this perspective, the trend towards expanding their share was formed in the USSR in the 1950s, and Russia’s transition to market relations in the late 1980s – 1990s appeared to be a new stage in the development of this process.

A new species of alien land flatworm in the Southern United States.

Specimens of a flat and dark brown land planarian were found in a plant nursery in North Carolina, USA in 2020. On the basis of examination of photographs of the live specimens only, the specimens were considered as belonging to Obama nungara, a species originally from South America, which has now invaded a large part of Europe. Unexpectedly, a molecular analysis revealed that the specimens did not belong to this species, neither to the genus Obama. We then undertook its histological study, which finally confirmed that the species is a member of the genus Amaga: the species is herein described as a new species, Amaga pseudobama n. sp. The species has been found in three locations in North Carolina and some infested plants were from Georgia. We reinvestigated specimens collected in Florida in 2015 and found that they also belong to this species. Citizen science observations suggest its presence in other states. Therefore, it is likely that A. pseudobama has already invaded a part of south-east USA and that the invasion took place more than ten years ago. The complete 14,909 bp long mitochondrial genome was obtained. The mitogenome is colinear with those of other Geoplanidae and it was possible to find and annotate a tRNA-Thr, which has been reported missing in several geoplanids. Amaga pseudobama shares with other Geoplaninae the presence of alternative start codons in three protein-coding genes of its mitogenome. The availability of this new genome helped us to improve our annotations of the ND3 gene, for which an ATT start codon is now suggested. Also, the sequence of the ATP6 gene raised questions concerning the use of genetic code 9 to translate the protein-coding genes of Geoplanidae, as the whole translated protein would not contain a single methionine residue when using this code. Two maximum likelihood phylogenies were obtained from genomic data. The first one was based on concatenated alignments of the partial 28S, Elongation Factor 1-alpha (EF1) and cox1 genes. The second was obtained from a concatenated alignment of the mitochondrial proteins. Both strictly discriminate A. pseudobama from O. nungara and instead associate it with Amaga expatria. We note that the nine species currently accepted within Amaga can be separated into two groups, one with extrabulbar prostatic apparatus, including the type species A. amagensis, and one with intrabulbar prostatic apparatus, including the new species A. pseudobama. This suggests that species of the latter group should be separated from Amaga and constitute a new genus. This finding again illustrates the possible emergence of new invasive species in regions naturally devoid of large land planarians, such as North America. Amaga pseudobama thus deserves to be monitored in the USA, although its superficial resemblance to O. nungara and Geoplana arkalabamensis will complicate the use of photographs obtained from citizen science. Our molecular information provides tools for this monitoring.

Abstract B058: Preliminary findings of a multilevel community-based clinical trials and genomic navigation program implemented in the southern United States

Abstract Introduction: Advances in genomics have increased our understanding of the interplay between genetics, environment, behavior, and disease. However, these scientific advances are hampered by the inadequate representation of African American (AA) and Hispanic populations in genomic studies and clinical trials; thus, it is important to identify effective engagement and navigation strategies. The goal of the MSM/TU/UAB OCCC Partnerships to Advance Cancer Health Equity (PACHE) Outreach Core is to implement and evaluate an evidence-based, theory-informed, multi-level, clinical trial and cancer genomics education program (CTC-GEP) to address the determinants for AA and Hispanic participation in clinical trials and genomic research. The program consists of a clinical and genomic navigator and a high and low-tech toolkit. We will present preliminary data characterizing the feasibility phase of this two-arm behavioral trial. Methods: The Attitudes and Intentions to Enroll in a Therapeutic Trial (AIET) questionnaire and a culturally tailored social and demographic questionnaire were used by navigators to obtain participants information. Cumulative logistic regression was used to assess the correlation of age, race, education, and type of health insurance with attaining a higher score on the Likert scale used in AIET survey questions at pre- and post-test. Results: Younger participants (18-49 years) were significantly more likely than older participants (ages 50 and above) to hold several positive views about participating in clinical trials. Specifically, they were 3.6 times as likely to believe that participating in a clinical trial could help advance science to improve community health (P-value = 0.0393); 4.6 times as likely to think there are benefits for others like them (P-value = 0.25); 5.6 times as likely to trust that clinical trial centers have rules to protect their records (P-value = 0.024); and 3.9 times as likely to trust health workers (P-value = 0.002). Additionally, participants with a high school education or less were 3.2 times as likely to consider themselves at risk of cancer compared to those with a college education or higher (P- value = 0.0015). Medicare &amp; Medicaid recipients, compared to those with private insurance, viewed privacy as a major concern when participating in research (P-value = 0.008). Furthermore, Black/AA participants were more likely than White participants to believe that Blacks are used in research without their knowledge (P-value = 0.005). Conclusions: CTC- GEP was demonstrated to be feasible and acceptable among study participants. Findings from the AIET survey highlight privacy concerns are more pronounced among Medicare &amp; Medicaid recipients, indicating a need for better communication about privacy protections. As well, age and racial disparities exist in trust regarding the ethical conduct of research, with older and AA participants expressing significant concern about being used in research inappropriately and without their knowledge. Citation Format: Mohamed Mubasher, Osato Eke, Victoria Churchill, Vivian Carter, Yu-Mei Schoenberger, Desiree Rivers, Jamirah Chevrin, Stephen Sodeke, Christina Wilkerson, Makeeta Rayton, Teresa Hall, Illeana Barrios Zermeno, Angela Morris, Jennifer Culbertson, Roland Matthews, Brian Rivers. Preliminary findings of a multilevel community-based clinical trials and genomic navigation program implemented in the southern United States [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B058.

Abstract B119: Evaluation of a navigator training program to increase clinical trials and genomic research participation among adult African Americans and Hispanics residing in the Southern United States

Abstract Introduction: Patient Navigators (PNs) have have proven to be effective along the cancer care continuum. However, emerging data suggest that the scope of patient navigation should be expanded to include other contexts such as the recruitment of racial/ethnic minorities for cancer clinical trials. Because the processes of recruitment and retention are often linked, the same barriers hindering minority recruitment often hinder minority retention. The potential benefits of studying generalizability and statistical power for subgroup analyses may be lost with disproportionately high attrition among the enrolled minorities. The dual focus of the training curriculum on both recruitment and retention distinguishes it from the few previous efforts focused on the traditional PN model for minority recruitment in clinical trials and genomic research studies. Methods: A two-phased navigator training program was implemented. Components of the training program was adapted in collaboration, with the Joint Cancer Advisory Council and Bioethics Co-Leaders, from the existing UAB IMPACT Patient Navigation Training Curriculum. A systematic literature review will be conducted to identify the most salient genomic educational and resource needs and concerns of AAs and Hispanic populations regarding participation in genomic-focused research and clinical trials. These findings informed the adaptation of the training curriculum based on principles of adult education. Results: We conducted a joint training for the Clinical Trials and Genomic Navigators at each Partnership institution (MSM, TU, UAB) for the proposed project. The Co-Leaders from the Partnership Outreach Cores, the Bioethics Shared Resource, and the Joint Cancer Advisory Council planned and assigned responsibilities and dates for completion of the training activities. The initial training was the GW Navigator On-line Training Program. A supplemental training was held at one of the partnering sites, a safety-net hospital (Grady Cancer Center for Excellence). The in-person training featured an overview presentation on Genetic Risk Assessment in Oncology by a licensed genetic counselor, followed by a case study approach to enrollment and the implementation of a research study with training materials such as tablets provided by the training conductors. An evaluation was completed by the team for training conductors. The third training was held at Tuskegee University and ttopics included the importance of consent training. For this presentation, we will present the qualitative and quantitative findings. Conclusions: The training outcomes were standardized and included input from the Bioethics Co-Leaders and JCAR members. We measured changes over time (pre vs. posttest) in: 1) knowledge and skills of clinical trials and genomic research; 2) ability to identify barriers and solutions to participation in research, 3) ability to implement the two toolkits, and 4) level of ease in identifying open protocol research studies and clinical trials. Citation Format: Osato Eke, Makeeta Rayton, Teresa Hall, Lleana Barrios-Zermeno, Jennier Culbertson, Angela Morris, Vivian Carter, Yu-Mei Schoenberger, Victoria Churchill, Desiree Rivers, Stephen Sodeke, Mohamed Mubasher, Roland Matthews, Brian Rivers. Evaluation of a navigator training program to increase clinical trials and genomic research participation among adult African Americans and Hispanics residing in the Southern United States [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B119.

Abstract B127: Providers and survivors’ perspectives on affordability challenges for gastrointestinal cancer Black and White patients living in socioeconomically disadvantaged US states

Abstract Background: Affordability challenges for gastrointestinal (GI) cancer care may be numerous and complex in socioeconomically disadvantages states of the southern US, like Alabama (AL) and Mississippi (MS). Given that a large share of the African American US population lives in the southern US, these challenges may be contributing to observed racial disparities in GI cancer. Methods: Semi-structured interviews were conducted with purposefully selected AL and MS GI cancer providers, other staff, and survivors. Interview guides were developed based on access to care conceptual frameworks to identify barriers and facilitators to surgical and overall cancer care along 5 domains: Availability, Accessibility, Affordability, Acceptability, and Accommodation. Transcripts were analyzed by 3 coauthors using an inductive thematic and content analysis qualitative approach with NVivo 12 Plus software. Intercoder agreement was reached at 91%. This analysis focuses on the Affordability domain. Results: Providers (N=27) were 11 surgeons, 4 medical and radiation oncologists, 1 primary care provider, 6 nurses, and 5 patient navigators, 22% practiced in rural areas, 78% in urban areas. Survivors (N=36) were 44-87 years of age, 42% female, 70% white, 30% African-American, 53% colorectal, 19% pancreatic, 28% esophageal cancer. Providers and survivors discussed affordability challenges at the patient and system level. Patient-level challenges were: 1) High cost burden besides payments to providers (e.g., transportation, ostomy bags, nutritional supplements, non-antineoplastic drugs, feeding tubes, deductibles), and 2) Spending priorities outside of health care (e.g., patients prioritizing what to spend limited incomes on, which bills to pay). System-level affordability barriers included: 1) Care impacted by insurance processes (e.g., delays due to preauthorization or hospital out-of-network, surgery scheduled around deductible), and 2) Logistical burdens to access resources to help patients afford care (e.g., applying for grants). Two additional themes emerged from the providers’ interviews only: 1) Added costs due to scarcity of quality medical services (e.g., cost of repeating imaging procedures that were of poor quality), and 2) Poverty making it unfeasible to deliver guideline-concordant care (e.g., providers unable to provide recommended radiation treatment if patients need to travel long distances and have no money for gas). One more theme emerged from the survivors’ interviews only related to the burden of a confusing billing system (e.g., repeat billing for the same doctor). Conclusions: Many affordability-related challenges exist for the care of GI patients from disadvantaged states of the Deep South, and impact survivors and providers’ decision making about treatment and other needs. Future research should quantify the extent of these challenges and determine how they contribute to observed racial disparities in GI cancer surgery and other treatment. Citation Format: Maria Pisu, Nataliya V. Ivankova, Jessica Morgan, Yu-Mei M. Schoenberger, Nathan C. English, Burkely P. Smith, Ivan I. Herbey, Courtney Williams, Bayley A. Jones, Wendelyn M. Oslock, Daniel I. Chu. Providers and survivors’ perspectives on affordability challenges for gastrointestinal cancer Black and White patients living in socioeconomically disadvantaged US states [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B127.

Implementation of a heart failure disease management program in the rural southern United States: a best practice implementation project.

Heart failure affects thousands of patients annually, often resulting in hospitalization, emergency room visits, and decreased quality of life. The scientific evidence indicates that disease management programs using a multidisciplinary approach improve outcomes for heart failure patients. The overarching aim of this evidence implementation project was to establish a disease management program for heart failure patients. Specifically, the project sought to promote compliance with best practices for the early identification of heart failure exacerbation symptoms to prevent emergency room visits and hospitalizations, thereby reducing morbidity and mortality. This project was guided by the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit strategy. A baseline audit was conducted, revealing the need for a heart failure disease management program. A policy was developed to implement a disease management program and virtual relationships were established to create a multidisciplinary team. A follow-up audit was conducted to determine whether the implemented interventions closed the gap in practice identified by the baseline audit. The baseline audit revealed 0% compliance with best practices for the management of patients with heart failure, while the follow-up audit revealed 93.3% compliance. This project enhanced best practices by implementing a protocol in a rural health clinic to ensure that all heart failure patients were enrolled in a disease management program. Recommendations include using the electronic health record to quickly identify heart failure patients and their status in a disease management program. Chart audits should be performed every 6 months to ensure the program's sustainability and to determine heart failure patients' enrollment status. http://links.lww.com/IJEBH/A270.

Montelukast deprescribing in outpatient specialty clinics: A single center cross-sectional study

ObjectiveTo identify and evaluate montelukast deprescribing in outpatient specialty clinics. MethodsThis was a single-center, retrospective, cross-sectional study conducted at an academic health system in the southern US including 21 specialty clinics. Subjects included adults ≥18 years with an active prescription for montelukast who attended at least one appointment in pulmonology, otolaryngology, or neurology outpatient specialty clinics between January 1, 2021 to December 31, 2022. Patients <18 years and those with diagnoses of uncontrolled asthma or allergic rhinitis were excluded. Outcomes assessed included the frequency and period prevalence of montelukast deprescribing, defined by a documented montelukast discontinuation within the medical record, and evaluation of reasoning for discontinuation mentioned in visit notes. ResultsThere were 1152 patients who met inclusion criteria. Of these, 43 (3.7 %) experienced a montelukast deprescribing event: 18 (41.9 %) in neurology, 13 (30.2 %) in otolaryngology, and 12 (27.9 %) in pulmonology. Documented reasons for deprescribing were only available for 11 patients (25.6 %); reasons for deprescribing included patient-provider shared decision-making regarding the Black Box Warning [n = 5 (11.6 %)], inadequate treatment response [n = 3 (7.0 %)], suicidal thought development [n = 1 (2.3 %)], adverse drug event [n = 1 (2.3 %)], and pregnancy planning [n = 1 (2.3 %)]. ConclusionMontelukast deprescribing rates were less than 5 % in outpatient specialty clinics. Factors associated with montelukast deprescribing beget further investigation.

Drive time to care and retention in HIV care: Rural-urban differences among Medicaid enrollees in the United States South.

Less than 50% of people with HIV (PWH) in the United States are retained in care, a key step along the HIV care continuum. We examined the impact of geographic access to care on retention in care for urban and rural PWH. We used Medicaid claims and clinician data (Medicaid Analytic eXtract and MAX Provider Characteristics, 2009-2012) for 13 Southern states plus the District of Columbia. We calculated drive time from the enrollees' ZIP Code Tabulation Area to their usual source of care. We used generalized estimating equations to examine the association between drive time to care >30 min (versus ≤30 min) and retention in care, overall and stratified by rurality. In sensitivity analysis, we examined the definition of retention in care, states included in the analysis, and enrollee- and care-related characteristics. The sample included 49,596 PWH. Overall, the association between drive time >30 min and retention was significant, but small (adjusted odds ratio [aOR] 1.01, 95% confidence interval [CI] 1.00, 1.01) and was not significant in urban areas; however, the significance and direction of the association differed in sensitivity analysis. In rural areas, driving >30 min to care was associated with 7% higher odds of retention in care (aOR 1.07, 95% CI 1.05, 1.08) and this association remained significant and positive in nearly all sensitivity analyses. For PWH in rural areas, greater drive time is consistently associated with greater retention in care. Disentangling the mechanisms of this relationship is a future research priority.

The changing South in presidential elections

We examine presidential elections in the American South. Our empirical starting point is the 2008 election of Democrat Barack Obama. We discuss political dynamics leading up to this historic contest but focus our analysis on the last four elections concluding with the defeat of President Trump in 2020. Tapping into recent southern politics scholarship emphasizing partisan patterns that differ based on population growth (or lack thereof), we show how this factor affects presidential voting with an assemblage of data collected at the state-, county-, and individual-level. We first consider the prominence of presidential Republicanism across the 11 southern states. Next, we delve into these states’ counties to further assess two-party competition in presidential contests. Finally, drawing on Cooperative Election Study (CES) data, controlling for a host of factors, we examine whether varying population rates at the state- and county-level affect presidential preferences. The U.S. South is forever changing, and in presidential politics substantial alterations to its electorate generally favor an emerging Democratic Party.

PSIV-14 Short-term heat stress affects the plasma metabolome of Florida Cracker sheep

Abstract Florida Cracker sheep is a heritage sheep breed and an endangered species that was developed under natural selection in Florida, US. The objective of this study was to evaluate the effect of short-term heat stress on the plasma metabolome of Florida Cracker ewes (2 yr). A total of fourteen ewes were allocated to heat stress (HT, n = 7) or cooling (CTL, n = 7) conditions for 6 wk during the summer season. Treatment groups were grouped in covered concrete floor pens with similar dimensions and characteristics and had access to shelter, feed, and freshwater ad libitum. The HT pen was exposed to regular ambient temperatures, and for the cooling pen, an evaporative cooling fan was used. Data for ambient temperature and relative humidity of HT and CTL pens were recorded every week to estimate the temperature humidity index (THI). Blood samples were collected from each experimental ewe 1 wk before the start of the experiment (baseline) and at wk 1, 2, 3, 4, 5, and 6 post-treatment. Plasma was extracted from the blood and processed for targeted metabolomics. Targeted metabolomics was performed using Nuclear Magnetic Resonance spectroscopy to quantify a total of 50 metabolites, including organic acids, amino acids, hexoses, lipids, and carnitines. Statistical analysis for biomarker and pathway enrichment was performed using Metaboanalyst 5.0. The THI values for the HT and THI groups ranged from 81.3 to 89.5 and from 73.5 to 75.6, respectively. A total of 19 differentially abundant metabolites were identified between HT and CTL. The pathway enrichment analysis showed upregulation of fatty acid and primary bile biosynthesis, and glutathione, porphyrin, glycine, serine, and threonine metabolism (P ≤ 0.05) in HT compared with CTL sheep. These metabolic pathways could have a role in the response of the ewes to short-term HT. Our findings highlight that short-term HT alters the plasma metabolome of Florida Cracker ewes. Understanding these changes can contribute to the development of effective management strategies to mitigate the detrimental impact of HT on sheep operations in the Southern US.

Culturally Adapted Lifestyle Intervention for South Asian Adults With Cardiovascular Risk Factors

South Asian adults in the US experience excess cardiovascular disease (CVD) compared with other racial and ethnic groups. The effectiveness and reach of guideline-recommended lifestyle interventions have not been evaluated in this population. To evaluate whether a culturally adapted, group lifestyle intervention will improve CVD risk factors more effectively than written health education materials among US South Asian adults. This single-blind randomized clinical trial was conducted from March 6, 2018, to February 11, 2023 at community sites in the Chicago, Illinois, metropolitan area. South Asian adults aged 18 to 65 years who were overweight or obese, had no history of CVD events, and had at least 1 additional CVD risk factor (hypertension, dyslipidemia, prediabetes, or diabetes) were eligible for inclusion. A 16-week, culturally adapted, group-based lifestyle intervention led by community health coaches. Lifestyle modification counseling was delivered in English, Gujarati, Hindi, and Urdu. Participants tracked their diet and physical activity (PA) and received 4 optional group maintenance sessions between months 5 and 11 of follow-up. The intervention was delivered in person prior to the onset of the COVID-19 pandemic and via videoconference starting in March 2020. The control group received written health education materials, delivered monthly. Primary outcomes were the between-group differences in CVD risk factor changes from baseline to 12 months, including weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), glycated hemoglobin (HbA1c), and total cholesterol, estimated using multivariate mixed-effects regression models. Secondary outcomes were self-reported diet quality, PA, and self-efficacy, estimated using univariate mixed-effects regression models. Among 549 randomized participants, 318 (57.9%) were women, and mean (SD) participant age was 49.2 (9.5) years. Mean differences in CVD risk factor changes from baseline to 12 months in the intervention vs control group were calculated for weight (mean difference, -0.07 kg; 95% CI, -0.55 to 0.42), SBP (mean difference, 0.47 mm Hg; 95% CI, -1.85 to 2.79), DBP (mean difference, 0.44 mm Hg; 95% CI, -1.06 to 1.95), cholesterol (mean difference, -2.47 mg/dL; 95% CI, -8.51 to 3.57), and HbA1c (mean difference, -0.07%; 95% CI -0.20% to 0.07%). Intervention participation was associated with greater improvements in dietary quality, PA, and self-efficacy than control. In the SAHELI randomized clinical trial, a culturally adapted, group lifestyle intervention was not more effective than written health education materials for CVD risk factor reduction among US South Asian adults, but the intervention was associated with small improvements in self-reported health behaviors. Effective CVD prevention interventions for this elevated-risk population require further investigation. ClinicalTrials.gov Identifier: NCT03336255.