Western North Carolina Research Articles

The geography of wild American ginseng in North Carolina, USA: a comparative study of four capability analysis methods

Wild American ginseng is the root component of a family of plants called Panax, and it grows mainly in the understory of the eastern deciduous forests in North America. The growing market for wild American ginseng in Asia along with the scarcity of this plant in the wild due to rising illegal harvest have been simultaneously pushing up the price of American ginseng in the market, increasing incentives further for illegal harvest of this soon-to-be-extinct species. This paper studies the geography of wild American ginseng to identify the spatial distribution of the suitable habitat of this plant in the wild and provides advice on what conditions are required and what regions are suitable for cultivating it in farms, introducing an alternative to the wild American ginseng to decrease the harvesting pressure on its wild counterpart. By employing four popular geospatial methods, including the Binary Screening method, the Ordinal Ranking method (both Graduated Screening and Addition-of-Factors methods), and the Weighted Linear Combination method, this paper carries out a capability analysis and mapping for wild American ginseng in North Carolina (NC). After building the models, they are validated by using the data of the known locations of wild American ginseng plants in NC. Developing these models helps in gaining a more comprehensive understanding of where the plant naturally grows and sheds light on how government agencies can more effectively and more efficiently plan for law enforcement activities to better protect this plant from illegal harvest. The general pattern of our results suggests that western NC counties such as Jackson, Haywood, Transylvania, Henderson, Cherokee, and Ash are some of the most suitable geographical areas for wild American ginseng to grow. The results of our model validation analysis, along with the comparison of our models' predictions to the observed occurrences of wild American ginseng in nature, indicate that the Binary Screening method’s predictions align with almost 96% of the reported observations in nature. This suggests that the influential natural factors necessary for wild American ginseng are more of complementary factors to each other than being substitutes, meaning that they all must exist in the environment for it to grow, and it could not be that the lack of one natural factor can be compensated by the abundance of another natural factor.

Accessing perinatal substance use disorder care in your local community: A case study of an innovative hub and spoke network in western North Carolina

IntroductionThe incidence of substance use disorders (SUD) in the general population and in the pregnant person population has risen over the last 20 years. Concurrently, both perinatal and SUD care in rural areas is laden with access barriers including but not limited to geographical distance from potential treatment and stigma. An integrated outpatient perinatal substance use disorder (PSUD) clinic in an urban area in western North Carolina (WNC) found that patients who traveled further for prenatal care were less likely to continue seeking care in the postpartum period. Acknowledging that the risk of overdose increases in the postpartum period, the PSUD clinic utilized a hub and spoke model to promote healthcare accessibility. MethodsThe clinic adapted the Vermont hub and spoke model and the CHARM (Children and Recovering Mothers) collaborative. The urban hub in WNC has now developed eight spokes in rural communities. The hub provides education and technical assistance to the rural spokes, and the two engage in bidirectional referral pathways. This manuscript details the model and analyzes the existing strengths and barriers at two spokes, a family medicine Federally Qualified Health Center and a hospital affiliated obstetrics and gynecology practice and analyzes their process of implementation of integrated outpatient perinatal substance use care. ResultsBoth spokes found coaching relationships and the sharing of resources such as clinical guidelines useful to begin prescribing buprenorphine for PSUD. Their context led one spoke to begin prescribing within one year while the other took two years. ConclusionComparing and contrasting these spokes serves to demonstrate that across many contexts, a hub and spoke model is a replicable intervention for rural perinatal substance use access to care barriers. Comparing the two spokes emphasizes the need for adaptation as well as standardization of the model to improve evidence-based PSUD care most effectively.

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

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

Focus groups revealed how community health workers in North Carolina find, verify, and process health information for migrant and seasonal farmworkers.

Community health workers (CHWs) bridge the gap in health and social services delivery for marginalized communities, providing critical health information to those with limited access to health resources. The purpose of our study was to understand CHWs' approaches to identifying salient and credible health information for migrant and seasonal farmworkers in rural North Carolina (NC). Two focus group discussions were held with CHWs in eastern NC and one in western NC in February 2020. CHWs seek health information on chronic health conditions disproportionately experienced by farmworkers such as diabetes and high blood pressure. They search for information from existing resources in their possession, via the internet, and through consultation with health professionals. CHWs also verify the information and transform the content into resources that are accessible to farmworkers. Our findings suggest that CHWs possess a strong set of information literacy skills that could be enhanced through additional training in crediting sources, creating new materials, and organization and storage. This study adds to the very limited body of knowledge about how CHWs seek and transmit information to their communities and sheds light on their information need and literacy abilities.

Exploring community members' perceptions to adopt a Tele-COPD program in rural counties

BackgroundPatients diagnosed with COPD residing in rural areas report a lower quality of life. Telehealth addresses geographic barriers by offering routine, technology-based visits, and remote patient monitoring. ObjectiveThe study objective was to explore adoption perceptions of a tele-COPD program among community members in rural Western North Carolina (WNC) counties. MethodsA convenience sample of 17 community members were recruited to participate in one of five 45-min focus groups. Before the focus group, all participants completed a brief demographic survey. Focus groups were digitally recorded, transcribed verbatim, imported into MAXQDA v10, and analyzed thematically using established qualitative coding procedures. SPSS v22 was used to calculate descriptive statistics. ResultsParticipants were primarily Non-Hispanic White (100%), male (59%), insured (100%), and had at least a high school education (80%). Only 25% of participants had any prior knowledge of telehealth programs. The majority (94%) of participants expressed interest in receiving a tele-COPD program due to convenience factors. Yet, most participants expressed a lack of interest and comfort in using Internet-capable devices (e.g., mobile devices, tablets, computers). Participants noted that to be successful, telehealth visits must be described and shown to them by their own provider or other trusted individual(s), such as a pharmacist. Privacy and cost were also expressed as telehealth concerns. ConclusionInterest in a tele-COPD program was high among community residents in rural WNC. However, to increase patient willingness to adopt a tele-COPD program, patients' providers must overcome challenges, such as patients' awareness and knowledge of telehealth, privacy and cost concerns, and access to and comfort with using new technologies. Pharmacists may mitigate these challenges by increasing patients' trust and comfort with telehealth programs.

COVID-19 Needs Assessment and Support for Primary Care Practices in Western North Carolina.

It is critical to ensure that Primary Care Providers (PCPs) have adequate personal protective equipment (PPE), supplies, training, staffing, and contingency planning during pandemics, particularly in rural areas. In March 2020, during the onset of the COVID-19 pandemic, the Mountain Area Health Education Center (MAHEC), in collaboration with the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill, rapidly created and conducted a needs assessment of PCPs in western North Carolina (WNC). A group of twenty volunteers conducted a telephone survey of PCPs in a 16 county region of WNC. Practices were asked about their COVID-19 testing and telehealth offerings, PPE adequacy, and capacity to continue serving patients. The survey's emergency alert feature linked practices to immediate support. Descriptive data were generated to identify regional needs. Out of 110 practices, 48 (43.6%) offered COVID-19 testing, with testing more common in rural counties (56.3% vs 33.9%). Telehealth services, including phone-only visits, were offered by almost all practices (91.8%). PPE needs included N-95 respirators (49.1%), face shields (45.5%), and staff gowns (38.2%). Rural practices were more likely to report the need for PPE. Assistance was requested for staff member childcare (34.5%) and providing or billing for telehealth (31.8%). The most urgent practice requests were related to finances, PPE, and telehealth. MAHEC's Practice Support team linked practices to virtual coaching, tip sheets, case-based video didactics and communication forums, and newsletters. During a pandemic, it is crucial to ensure that PCPs can continue to serve their patients. A rapid needs assessment of PCPs can allow for immediate and ongoing support that matches regional and practice-specific needs. Rural practices may require more assistance than their urban counterparts. Our rapid survey process jumpstarted a statewide system for enhanced communications with PCPs to better prepare for future emergencies.

98 Rural Population at Risk of Delayed Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction in North Carolina

Emergent reperfusion by percutaneous coronary intervention (PCI) is indicated in patients with ST-elevation myocardial infarction (STEMI) and should be performed within 90-minutes of first medical contact (FMC), although long transport times make meeting this goal difficult in many parts of rural North Carolina (NC). Early fibrinolytic therapy is recommended in cases where PCI is not possible within 120-minutes of FMC and out-of-hospital fibrinolytics may improve outcomes in cases with long transport times. The objectives of this study were to determine the number of NC residents with prolonged transport times to the nearest 24/7 primary PCI (PPCI) center and to map this population. We analyzed transport time to the nearest PPCI center using the ArcGIS Pro geographical information system (GIS). To identify those at risk of a >120-minute FMC-to-device time, a 60-minute transport time cutoff was selected. This cutoff is based on an estimated 15-minute scene time (national median in STEMI) and a 45-minute door-to-device time (NC median with EMS pre-arrival notification). US Census Data (2010) were used to cohort NC residents by time to PPCI. Counties with potential benefit from out-of-hospital fibrinolytics were identified as those with >10% of their population living >60 minutes from PPCI. We identified 28 PPCI centers in NC and 9 in bordering areas of adjacent states. The percentage of NC residents who have greater than a 60-minute transport time to PPCI is 7.5% (718,141/9,535,483). We found that 25 of 100 counties have more than 50% of their population in a long transport area and 15 of those have more than 90% of their population in long transport areas (Figure 1). The longest transport times are found in extreme western and eastern NC. A large percentage of rural NC residents are at risk for delayed PCI. Emergency medical services medical directors should consider these data in conjunction with on-scene times and door-to-device times in their counties to guide decision-making about out-of-hospital fibrinolytic protocols.

Mitigating the Risk of Infectious Diseases Among Rural Drug Users in Western North Carolina: Results of the Southern Appalachia Test, Link, Care (SA-TLC) Health Care Provider Survey.

To characterize how health care providers in western North Carolina (NC) manage patients with substance use disorders and to inform strategies for preventing injection drug use (IDU)-associated outbreaks of bloodborne infectious diseases. We collected data on practice characteristics, provider sociodemographics, and attitudes and beliefs about hepatitis C virus (HCV), human immunodeficiency virus (HIV), opioid use, and IDU via online survey. Providers in 8 counties of western NC were invited to participate by email. Results were analyzed using descriptive and bivariate statistics. Of 84 respondents participating between 30 July and 3 December 2018, 81% were practicing clinicians and 46% served a county identified as being vulnerable to IDU-associated outbreaks of HCV or HIV. A substantial proportion was unsure about injecting behaviors among patients. Scores reflected comfort working with opioid users, though this varied by medical specialty. One-quarter of respondents "never" discussed harm reduction or HCV treatment with patients known to inject drugs; 22% "never" discussed HIV screening with injectors; and 1 in 3 referred at-risk patients out for HCV or HIV testing rather than ordering a test themselves. Scores indicated low levels of stigma toward persons living with HCV or HIV. Respondents identified HIV treatment, HCV treatment, and liver disease management as training needs. Our findings provide insights to inform health infrastructure improvement, with the goal of preventing HCV or HIV outbreaks in southern Appalachia. Rural health care workers are willing to receive additional training if it can improve care for patients affected by substance use disorders.

Geographic multi-criteria evaluation and validation: A case study of wildfire vulnerability in Western North Carolina, USA following the 2016 wildfires

In 2016, an intense drought occurred in the southeastern U.S. Dry conditions resulted in unprecedented wildfires throughout the southern Appalachian Mountains, especially in western North Carolina (WNC). Future climate change is expected to increase temperatures, alter precipitation, and stress water resources in the region, which could lead to more frequent drought and wildfire. The increasing threat of destructive wildfires combined with a growing wildland-urban interface indicate a need for a comprehensive assessment of wildfire vulnerability in WNC, while recent wildfires offer an opportunity to evaluate assessment accuracy. The study identifies locations vulnerable to wildfire in WNC based on wildfires from 1985 through 2016. By combining tract-level socioeconomic and physical data in a geographic information system, specific locations of vulnerability were identified and validated using wildfire perimeters from 2016. Unlike previous vulnerability research, this study integrates novel methods in GIS, including analytical hierarchical processing, validation, and GIS multi-decision criteria decision making to ensure vulnerability is accurately calculated. The vulnerability index indicates that social vulnerability varies greatly throughout the region, while physical and overall wildfire vulnerability is greatest in rural, mountainous portions of the region, which are less equipped for mitigation. Based on the results, the impacts of future wildfires on quality of life will vary across the region, so targeted responses are needed. The vulnerability index provides transparency to vulnerable communities, enabling policymakers to identify opportunities to prepare for resilience by targeting vulnerability hotspots.

Understanding Key-Informant Experiences and Perceptions of the 2016 Drought and Wildfires in Western North Carolina

Abstract In 2016, an exceptional drought and subsequent wildfires devastated the southeastern United States. Western North Carolina (WNC), a socioeconomically growing region that is dependent on revenue from tourism and agriculture, was particularly impacted by the events. The Southeast is not typically considered to be water vulnerable, and few studies have explored drought and wildfire in WNC. However, the region is projected to experience elevated water vulnerability as a result of rapid population growth and increased climatic variability. The recent events highlight the need for better understanding of water-related experiences and perceptions to inform proactive policies for risk mitigation in WNC. To evaluate stakeholder experiences and perceptions relating to the events in 2016, the authors conducted telephone interviews with key informants from a variety of sectors in two counties (Buncombe and Watauga) and then subjected their responses to content analysis. Informants frequently discussed themes relating to the “Natural Resources and Environment” code group, with responses revealing concerns about the health effects of smoke exposure, as well as water quantity. Other common topics of discussion for informants include water management, public awareness, and disaster severity. The prevalence of other themes varied by county, demonstrating the importance of local context. Surprisingly, informants rarely discussed risk in the context of increasing population and development, suggesting that current policies may inadequately address future risks. Stakeholders across all sectors placed substantial emphasis on information dissemination both within agencies and to the public. With a better understanding of key-informant experiences and perceptions, policymakers will be better equipped to address policy shortcomings as well as to prepare for future hazards.

Latinx child farmworkers in North Carolina: Study design and participant baseline characteristics.

Although children as young as 10 years can work in agriculture, little research has addressed their occupational health. This paper describes a large, multicomponent study of hired Latinx child farmworkers, and the characteristics of children participating in this study. Survey interviews were conducted in 2017 with 202 Latinx children aged 10-17 years employed in agriculture across North Carolina (NC). Most (81.2%) participants were born in the United States, 37.6% were female, and 21.3% were aged 10-13 years. Most (95.1%) were currently enrolled in school. Thirty-six (17.8%) were migrant workers. 34.7% had worked in agriculture for 1 year; 18.3% had worked 4+ years. 33.7% worked piece rate. 57.4% worked in tobacco. Participants in western NC differed in personal and occupational characteristics from those in eastern NC. This study has enrolled a large and diverse child farmworker sample. This overview indicates several important issues for further analysis.

Standardization and Scaling of a Community-Based Palliative Care Model

Although limited, the descriptions of Community-Based Palliative Care (CBPC) demonstrates variability in team structures, eligibility, and standardization across care settings. In 2014, Four Seasons Compassion for Life, a nonprofit hospice and palliative care (PC) organization in Western North Carolina (WNC), was awarded a Centers for Medicare and Medicaid Services Health Care Innovation (CMMI) Award to expand upon their existing innovative model to implement, evaluate, and demonstrate CBPC in the United States. The objective of this article is to describe the processes and challenges of scaling and standardizing the CBPC model. Four Season's CBPC model serves patients in both inpatient and outpatient settings using an interdisciplinary team to address symptom management, psychosocial/spiritual care, advance care planning, and patient/family education. Medicare beneficiaries who are ≥65 years of age with a life-limiting illness were eligible for the CMMI project. The CBPC model was scaled across numerous counties in WNC and Upstate South Carolina. Over the first two years of the project, scaling occurred into 21 counties with the addition of 2 large hospitals, 52 nursing facilities, and 2 new clinics. To improve efficiency and effectiveness, a PC screening referral guide and a risk stratification approach were developed and implemented. Care processes, including patient referral and initial visit, were mapped. This article describes an interdisciplinary CBPC model in all care settings to individuals with life-limiting illness and offers guidance for risk stratification assessments and mapping care processes that may help PC programs as they develop and work to improve efficiencies.

Occurrence of Brown Marmorated Stink Bug (Hemiptera: Pentatomidae) on Wild Hosts in Nonmanaged Woodlands and Soybean Fields in North Carolina and Virginia.

Nonmanaged plants occurring along forest edges and in suburban settings were sampled for brown marmorated stink bug, Halyomorpha halys (Stål), in North Carolina (NC) and Virginia (VA) over the course of three growing seasons. Commercial soybeans (Glycine max), an attractive cultivated host, were also sampled in 2014 in NC and in VA from 2010-2014. Very few H. halys were found on nonmanaged plants or soybean fields in the coastal plain region of either state, but substantial populations were recorded in the piedmont and mountain regions. From 2011 to 2013, H. halys comprised from 51 to 97% of all stink bug species observed on nonmanaged plants in the piedmont and mountain regions. In VA, the distribution expanded from detection in 12 counties in 2010 to 53 counties in 2014, with economically damaging levels occurring in the piedmont region. During these studies, H. halys were observed to complete one and a partial second generation per year in western NC and southwestern VA, similar to that previously observed in regions farther north. Several plants were identified as preferred hosts, with tree of heaven, catalpa, yellowwood, paulownia, cherry, walnut, redbud, and grape having consistently high numbers of H. halys. Knowing that these plants are preferred by H. halys during certain stages of the insects' development will aid in the search for H. halys in new areas, as well as serve as one predictor of the likelihood of a certain area to attract and sustain large H. halys populations.

Cyber-Fundraising and North Carolina Public Libraries

In February 2002, Governor Michael F. Easley announced that NorthCarolina was suffering from a $900 million budget deficit. TheGovernor’s solution to this problem was to withhold $209 million instate payments to local governments, which in turn forced many toslash local budgets.1 Because public libraries are heavily subsidizedthrough these revenues, budget cuts loomed ominously over NorthCarolina public libraries and their leaders. Libraries in western NorthCarolina were faced with losing as much as 50 percent of their funding.2

First-responder preparedness in western North Carolina: A preliminary analysis

The need for well-prepared emergency response agencies has become more evident since the natural disaster of Hurricane Katrina and the terrorist attack on 9/11. While political and public attention has focused on the needs of urban areas, the state of preparedness among rural first-responder agencies has not been sufficiently addressed. Rural areas are home to nearly 59 million US citizens and are the sites of critical infrastructure and military facilities. An assessment of emergency-related resources in rural areas is necessary not only to protect these assets but also to support disasters in neighboring urban areas. To better understand the level of preparedness in rural western North Carolina (WNC), this survey measures perceptions of emergency preparedness for natural disasters and terrorist attacks among representatives from first-responder agencies in 18 counties.

Temporal and Spatial Epidemiology of Phytophthora Root Rot in Fraser Fir Plantations.

In 1999, 19 plots of Fraser fir (Abies fraseri) with a disease focus were established in commercial plantings grown for Christmas tree production in the mountains of five western North Caro-lina counties. Progress of Phytophthora root rot caused by Phytophthora cinnamomi as estimated by mortality was followed in each plot over 3 to 4 years in an attempt to understand dispersal of inoculum. Slope, aspect, and field production age at the time plots were established were recorded. Rainfall estimated from National Weather Service stations each growing season also was recorded. The relationship of site parameters and rainfall to dispersal and disease was investigated. Disease incidence and mortality were assessed in June and September each year for 3 or 4 years depending on plot. Phytophthora root rot as estimated by mortality counts over time in a logistic regression model progressed in only five of 19 plots over 3 years. None of the site parameters correlated with mortality data, although slightly more disease was found in plots with a north aspect. Rainfall was below normal in the 3 years of the study and did not correlate with mortality in any year. Lack of disease progress in the majority of plots was attributed to drought conditions in the region. In the five plots where mortality increased over time, spatial analysis suggested an aggregated pattern of diseased plants. Aggregation was apparent but not very strong among nearest neighbors, but was considerably stronger among groups of trees within a local area. This aggregation within groups was stronger when larger group sizes were examined by beta-binomial analysis. A spatial analysis by distance indices method (SADIE) indicated the presence of secondary clusters occurring several meters away from the main focus. A stochastic model also was employed that indicated a combination of spatial processes were likely involved, specifically a tendency toward spread within a local area, but not necessarily to the nearest neighboring trees, combined with an influence of background inoculum that could not be accounted for within local areas and may have come from external sources. Thus, all sources of inoculum including infected planting stock, inoculum in soil, infected trees, and contaminated equipment were equally important in epidemics of Phytophthora root rot in Fraser fir and dispersal of P. cinnamomi.

Searching for Hereditary Hemochromatosis

To detect hereditary hemochromatosis (HH) in low-income residents of a medically underserved region through free screening and confirmatory laboratory testing and to raise awareness of HH in the general population. Two-tiered reflexive laboratory testing was used to screen for HH. Participants evaluated the project by written survey upon its conclusion. Data were analyzed by descriptive techniques. Local public health departments in 18 counties in western North Carolina (WNC). PARTICIPANTS/SUBJECTS: Phase 1: adult volunteers age > or = 20 without previous diagnosis of HH; Phase 2: Phase 1 participants with elevated screening results and adult family members of Phase 2 participants found to have HFE mutations; Phase 3: randomly-selected Phase 1 participants (Survey A) and all Phase 2 participants with HFE mutations (Survey B). Phase 1 (initial screening): non-fasting blood collection by venipuncture with testing for transferrin saturation (TS). Phase 2 (confirmatory testing): fasting blood collection by venipuncture for TS, serum ferritin (SF), and cheek swab for DNA analysis for two HFE mutations (C282Y and H63D). Phase 3: written Surveys A and B. Total number participants screened for HH; prevalence of elevated TS in Phase 1 participants; prevalence of HFE genotypes consistent with HH (C282Y/C282Y and C282Y/H63D) in Phase 2 participants; prevalence of elevated SF in subjects with HFE mutations; number of family members tested; number of participants being treated for HH as a result of screening; increase in awareness of HH among Phase 1 participants. 2,034 total subjects participated in screening events and/or family member testing. Of the 1,976 Phase 1 participants, 130 (6.6%) had elevated TS (> or = 45%). Twenty of 130 (15.4%) Phase 2 subjects were homozygotes for C282Y. The prevalence of the C282Y/C282Y genotype among the Phase 1 participants who were tested in Phase 2 was 20/1976 (1.0%). Fourteen of 20 (70%) C282Y homozygotes had elevated SE Eleven of 130 (8.5%) Phase 2 subjects were compound heterozygotes for C282Y and H63D, and none had elevated SE Of 58 family members tested, two (3.4%) were homozygotes for C282Y and eight (13.8%) were compound heterozygotes for C282Y and H63D. One of two (50%) family members homozygous for C282Y had an elevated SE No compound heterozygotes had elevated SE Sixty-four of 120 (54.2%) Phase 1 subjects responded to Survey A. 53.1% of respondents were unaware of HH prior to the screening event. 92.1% of respondents told their family and friends about HH after participating. 73.4% discussed their laboratory results with their healthcare provider. Twenty of 41 participants (48.8%) found to have HFE mutations associated with HH responded to Survey B. Eleven of 20 (55.0%) stated that they were being treated for HH. The prevalence of the major genetic mutation, C282Y/C282Y, associated with HH among Phase 1 study participants in WNC was 1%, more than three times the national prevalence of approximately 0.33%. Results suggest that free screening using laboratory tests in a two-tiered reflexive approach may be an effective means of detecting HH, especially in high-risk populations. Early detection through free laboratory screening tests may reduce morbidity and, ultimately, healthcare costs for low-income individuals. Awareness of HH as a health concern may increase as a result of publicity generated by screening events.

A Guide to the Historic Architecture of Piedmont North Carolina by Catherine W. Bishir, Michael T. Southern, and: A Guide to the Historic Architecture of Western North Carolina by Catherine W. Bishir et al, and: A Guide to the Historic Architecture of Eastern North Carolina by Catherine W. Bishir, Michael T. Southern

BOOK REVIEWS The creation of the college had its own drama. Mter six years of planning (1923-1930) and at the moment that construction was about to begin, the site had to be changed because of a proposed state highway. The new site was the dramatic cliffside wooded area on the banks of the Mississippi that still marks the special character ofthe school. Then, when all the money was raised, the Depression caused other disruptions.There was even fundraising competition with the Mother Church that made for some uncomfortable moments and further delays. But what emerged in the end was an essay in romantic design that evoked a medieval English village. All of this is laid out in meticulous detail and amazing imagery. Many of the photographs are by Rob Craig himself and demonstrate his talent as an artist, as well as an historian. But there are also Maybeck's drawings, sketches, and plans, along with period photographs. This is a large and heavy book, but read it yo~ should.This book is essential for anyone interested in Maybeck and the period. PAMELA H SIMPSON Washington and Lee University Guide/{) JJ,t HlSTORlC i\RC Hrl ·LTU RE d PLEDMONT NORT H . CAROLINA ~ . ,, , ., ... ..... t ~ .......... ~ -~~=! Guide to the HISTORIC ARCH IT EC fU RE 1'WESTERN NORTH CAROLINA Catherine W. Bishir and Michael T. Southern. A Guide to the Historic Architecture of Piedmont North Carolina. The Richard Hampton Jenrette Series in Architecture and the Decorative Arts. Chapel Hill and London: University of North Carolina Press, 2003, xxiii + 596 pp., 53 maps, 536 illus., hardcover, $39.95, ISBN 0-8078-2772-x, paperback, $22.50, ISBN 0-8078-5444-1. CatherineW.Bishir,MichaelT.Southern,andJennifer F. Martin.A Guide to the HistoricArchitecture of Western North Carolina. The Richard Hampton Jenrette Series in Architecture and the Decorative Arts. Chapel Hill and London: University of North Carolina Press, 1999, xxi + 471 pp., 30 maps, 313 illus., hardcover, $37.95, ISBN 0-80782465 -8, paperback, $22.50, ISBN 0-8078-4767-4. Catherine W. Bishir and Michael T. Southern. A Guide to the Historic Architecture of Eastern North Carolina. The Richard Hampton Jenrette Series in Architecture and the Decorative Arts. Chapel Hill and London: University of North Carolina Press, 1996, xvi + 483 pp., 34 maps, 428 illus., hardcover, $39.95, ISBN 0-8078-2285-x, paperback, $22.50, ISBN 0-8078-4594-9. T he three-volume guide to the historic architecture of North Carolina may top the list of guide books. These three books provide what is surely the most comprehensive, historically and culturally informative, and easyto -use set of guides to any state in the nation. They not only open our eyes to great architecture, but they also teach us how that architecture is the very story of our past. Moreover, they demonstrate the larger patterns of place and the connections between diverse elements of the built environment. The multi-volume format includes general introductions to each of the three geographical divisions of the state, as well as numerous maps that provide an overall orientation to the entire area covered in that volume. The Piedmont volume has sixteen county groupings and twentythree town and city maps, in addition to the nine maps that show historical or geographical features, such as river basins, ethnic settlement patterns, or principal industries. The other volumes are similar, with nineteen county group maps and fourteen city maps for the Eastern, and fifteen county groups, thirteen city maps, and seven maps of historical or geographical features for the Western. Individual sections include a 84 ARRIS Volume Sixteen BOOK REVIEWS general introduction to the county and focus on the county seat, towns and neighborhoods (with particular buildings highlighted), and various isolated buildings. Each entry contains d::tte, architect or builder, and specific location, followed by description and analysis. Each volume concludes with a glossary, a selected bibliography, and a section on additional sources of information. These guides are excellent in part because the architectural fabric of the state is so strong. With the Cupula House and Tryon Palace to the east, Old Salem and the fine academic buildings of the University of North Carolina and Duke in the Piedmont and...

Influence of drainage basin topography and elevation on carbon dioxide and methane supersaturation of stream water

The partial pressures of CO2 (pCO2) andCH4 (pCH4) in streams are not only governed byinstream processes, but also by transformations occurring in soil andgroundwater ecosystems. As such, stream water pCO2 andpCH4 can provide a tool to assess ecosystem respiration andanaerobic metabolism throughout drainage basins. We conducted three surveyssampling the gas content of streams in eastern Tennessee and western NorthCarolina to assess factors regulating ecosystem metabolism in catchmentswith contrasting geomorphologies, elevations and soil organic matterstorage. In our first survey, the influence of drainage basin geomorphologyon ecosystem respiration was examined by sampling streams drainingcatchments underlain by either shale or dolomite. Geomorphology isinfluenced by geology with shale catchments having shallower soils, broader,unconstrained valley floors compared with dolomite catchments.pCO2 varied little between catchment types but increased froman average of 3340 ppmv in spring to 9927 ppmv in summer or 9.3 and 28 timesatmospheric equilibrium (pCO2(equilib)), respectively. Incontrast, pCH4 was over twice as high in streams drainingshale catchments (306 ppmv; pCH4(equilib) = 116) compared withmore steeply incised dolomite basins (130 ppmv; pCH4(equilib)= 51). Using the ratio of pCH4:pCO2 as an indexof anaerobic metabolism, shale catchments had nearly twice as muchanaerobiosis (pCH4:pCO2 = 0.046) than dolomitedrainages (pCH4:pCO2 = 0.024). In our secondsurvey, streams were sampled along an elevational gradient (525 to 1700 m)in the Great Smoky Mountains National Park, USA where soil organic matterstorage increases with elevation. pCO2 did not vary betweenstreams but increased from 5340 ppmv (pCO2(equilib) = 15) to8565 ppmv (pCO2(equilib) = 24) from spring to summer,respectively. During spring pCH4 was low and constant acrossstreams, but during summer increased with elevation ranging from 17 to 2068ppmv (pCH4(equilib) = 10 to 1216). The contribution ofanaerobiosis to total respiration was constant during spring(pCH4:pCO2 = 0.017) but during summer increasedwith elevation from 0.002 at 524 m to 0.289 at 1286 m. In our last survey,we examined how pCO2 and pCH4 changed withcatchment size along two rivers (ca. 60 km stretches in both riverscorresponding to increases in basin size from 1.7–477km2 and 2.5–275 km2). pCO2and pCH4 showed opposite trends, with pCO2decreasing ca. 50% along the rivers, whereas pCH4roughly doubled in concentration downstream. These opposing shifts resultedin a nearly five-fold increase of pCH4:pCO2along the rivers from a low of 0.012 in headwaters to a high of 0.266 65-kmdownstream. pCO2 likely declines moving downstream asgroundwater influences on stream chemistry decreases, whereaspCH4 may increase as the prevalence of anoxia in riversexpands due to finer-grained sediments and reduced hydrologic exchange withoxygenated surface water.

Boone — A new variety of potato resistant to late blight and adapted to western north carolina

Boone (U.S.D.A. B 880-4) is a late-maturing, high-yielding variety. The tubers are medium oblong, very smooth and shallow-eyed. They do not sprout in storage until late in the spring. Boone is highly resistant to, if not immune from, the common race of the late blight fungus.