The differential impact of nicotine replacement therapy sampling on cessation outcomes across established tobacco disparities groups

Cigarette smoking is increasingly concentrated among marginalized populations with limited access to evidence-based cessation treatment. This includes racial/ethnic minorities, lower income individuals, those with lower educational attainment, and residents of rural areas. To reach Healthy People 2020 objectives, successful cessation interventions must narrow these disparities. Nicotine replacement therapy (NRT) sampling is an easily translatable and scalable intervention that could enhance treatment access and thus narrow disparities. The present study examined individual-level demographic moderators of the impact of NRT sampling on cessation-related behaviors including: 1) use of a cessation medication, 2) making a 24-hour quit attempt, 3) floating abstinence, and 4) 7-day point prevalence abstinence at 6-months. Study participants included N = 1245 adult smokers enrolled in the Tobacco Intervention in Primary Care Treatment Opportunities for Providers (TIP TOP) study, a recently concluded large-scale clinical trial of NRT sampling relative to standard care within 22 primary care clinics across South Carolina. Generalized linear models examined individual-level demographic moderators of treatment effect. Results suggest that NRT sampling may be more effective among some of the most disadvantaged groups of smokers, including smokers with lower income and education, as well those who live in more rural areas. The effects of NRT sampling did not differ by race. In sum, NRT sampling is a low-cost, low-burden intervention that could be disseminated broadly to reach large numbers of smokers and potentially narrow cessation disparities.

Legacy Contaminants in Aquatic Biota in a Stream Associated with Nuclear Weapons Material Production on the Savannah River Site

Former nuclear weapons material production at the U.S. Department of Energy's Savannah River Site (SRS) has resulted in contamination of certain terrestrial and aquatic ecosystems on site with legacy wastes such as radiocesium (¹³⁷Cs), tritium (³H), and metals. We collected fish and invertebrates from five beaver ponds (sites) above, adjacent, and downgradient of three SRS facilities (H-, F-, and C-Areas) to evaluate whether the accumulation of metals and radionuclides in biota were associated with specific facility operations and if the measured levels could pose risks to aquatic organisms. We compared concentrations of various metals, ¹³⁷Cs, and ³H in fish, as well as in water (³H only), among sites along the stream gradient. Fish collected from sites adjacent to H-Area had significantly higher ¹³⁷Cs concentrations compared to fish from other sites. Both biota and water samples indicated significantly greater levels of ³H in sites adjacent to and downstream of C-Area. Concentrations of zinc (Zn), copper (Cu), and mercury (Hg) in some samples exceeded effects levels reported for fish and may pose a risk to fish populations. This study reported fish tissue concentrations of ¹³⁷Cs and ³H, which have not been documented extensively in ecotoxicological studies. Our results suggested that industrial operations such as nuclear material production at SRS could have long-lasting impact on the aquatic ecosystem via the release of radionuclides and metals, and long-term monitoring of physiological effects and population level impact in biota exposed to these contaminants are recommended.

Expanding access to HPV vaccination in South Carolina through community pharmacies: A geospatial analysis

OBJECTIVE

Human papillomavirus (HPV)-associated cancer rates are higher in rural areas. Despite the preventive benefits of HPV vaccination, uptake is lower among rural populations. Community-based pharmacies with a strong presence in rural communities may be ideal for improving HPV vaccination access. Our objective was to determine whether spatial access to pharmacies among adolescents and young adults in South Carolina varied by rurality and geographic access to primary care providers.

METHODS

Geographic information systems methods were used to evaluate spatial access to community-based pharmacies among persons aged 10-24 years in South Carolina census tracts (CTs). CTs were categorized as metropolitan, micropolitan, or small-town and isolated rural CTs using rural-urban commuting area codes and as health provider shortage areas (HPSAs) or not. Descriptive and spatial statistics were calculated to compare access across CT groupings and to evaluate geospatial clustering.

RESULTS

Areas of highest access clustered among the metropolitan CTs. Whereas spatial access was higher in metropolitan than micropolitan CTs, there was no difference in spatial access between metropolitan and small-town and rural CTs. In general, HPSA-designated areas had lower spatial access to pharmacies than non-HPSA-designated areas. However, in micropolitan areas, there was no difference in spatial access to pharmacies based on HPSA designation.

CONCLUSION

Spatial access to pharmacies among small town and rural areas was comparable to urban areas as was HPSA-designated micropolitan areas and non-HPSA micropolitan areas. This suggests that pharmacies are equally accessible to both urban and rural populations in South Carolina, but additional research is needed to identify effective strategies to promote the uptake of and the availability of HPV vaccination in pharmacies (e.g., insurance coverage) and to ensure patients are educated on the benefits of HPV vaccinations and its availability in nonprimary care settings.

Healthy Eating Policy Improves Children's Diet Quality in Early Care and Education in South Carolina

Policies to promote healthy foods in early care and education (ECE) in the United States exist, but few have been prospectively evaluated. In South Carolina, a statewide program serving low-income children in ECE enacted new policies promoting healthy foods. We conducted an evaluation to measure changes in dietary intake among children in ECE exposed and not exposed to the new policy. Using direct observation, we assessed dietary intake in 112 children from 34 ECE centers in South Carolina and 90 children from 30 ECE centers in North Carolina (a state with no policy). We calculated Healthy Eating Index-2015 (HEI) scores to measure diet quality consumed before and after the policy was enacted. We fit mixed-effects linear models to estimate differences in HEI scores by state from baseline to post-policy, adjusting for child race, number of children enrolled, director education, center years in operation, participation in the Child and Adult Care Food Program (CACFP), and center profit status. The policy increased HEI scores for whole fruits, total fruits, and lean proteins, but decreased scores for dairy. Thus, the policy was associated with some enhancements in dietary intake, but additional support may help improve other components of diet.

The Venom Compound N-(3-methylbutyl)acetamide Attracts Several Polistes (Fuscopolistes) Species (Hymenoptera: Vespidae)

Polistes paper wasps in the Fuscopolistes subgenus (Hymenoptera: Vespidae) can be serious pests when they swarm at tall man-made structures. Chemical attractants may be useful to trap such paper wasps when they achieve pest status. Polistes venom has been shown to elicit a variety of behavioral responses in congeneric wasps, making it a source for potential chemical attractants. The compound N-(3-methylbutyl)acetamide is a principal volatile component in the venom of many female vespid wasps, including numerous Polistes species. We report the presence of N-(3-methylbutyl)acetamide in autumn gynes of Polistes metricus Say, Polistes bellicosus Cresson, and Polistes dorsalis (F.), as well as workers of Polistes aurifer (Saussure), P. bellicosus, P. metricus, and P. dorsalis. In field tests conducted in Florida, Georgia, South Carolina, and Washington, N-(3-methylbutyl)acetamide attracted male and female P. aurifer and P. metricus, as well as male P. dorsalis and P. bellicosus. Thus, N-(3-methylbutyl)acetamide may be a useful lure for trapping these paper wasps in pest situations.

Trophodynamics of Per- and Polyfluoroalkyl Substances in the Food Web of a Large Atlantic Slope River

Per- and polyfluoroalkyl substances (PFASs) have attracted scientific and regulatory attention due to their persistence, bioaccumulative potential, toxicity, and global distribution. We determined the accumulation and trophic transfer of 14 PFASs (5 short-chain and 9 long-chain) within the food web of the Yadkin-Pee Dee River of North Carolina and South Carolina, US. Food web components and pathways were determined by stable isotope analyses of producers, consumers, and organic matter. Analyses of water, sediment, organic matter, and aquatic biota revealed that PFASs were prevalent in all food web compartments. Biofilm, an aggregation of bacteria, fungi, algae, and protozoans and a basal resource for the aquatic food web, showed high PFAS accumulation (in 10 of 14 compounds), particularly for perfluorooctanoic acid, with the greatest mean concentration of 463.73 ng/g. The food web compartment with the most detections and greatest concentrations of PFASs was aquatic insects; all 14 PFASs were detected in individual aquatic insect samples (range of <limit of detection [<LOD] to 1670.10 ng/g of wet weight [WW]). These findings may suggest a trophic link between biofilm PFASs and aquatic insect PFASs. Individual fish tissue samples ranged from <LOD to 797.00 ng/g of WW, where perfluorooctanesulfonate (PFOS) was the dominant PFAS among all samples (64%). The ova of an imperiled fish, the robust redhorse (Moxostoma robustum), had concentrations of 10 PFASs (range of <LOD to 482.88 ng/g of WW) and the highest PFOS concentration (482.88 ng/g of WW), indicating a likely maternal transfer. The trophic magnification factors (TMFs) calculated in this study showed that various taxa accumulated PFAS compounds differently. PFBS, a short-chain PFAS compound that would presumably exhibit lesser TMFs, had nine values among our compartments and organisms >1.0 (range of 0.57 to 2.33); it is possible that an unmeasured PFBS precursor may be accumulating in biota and metabolizing to PFBS, leading to a higher than expected TMFs for this compound. Our findings demonstrate the prevalence of PFASs in a freshwater food web with potential implications for ecological and human health.

Detection and quantification of engineered particles in urban runoff

Urban runoff conveys contaminants including titanium dioxide (TiO₂), widely used as engineered nanoparticles (e.g., 1-100 nm) and pigments (e.g., 100-300 nm) in the urban environment, to receiving surface waters. Yet, the concentrations of TiO₂ engineered particles (e.g., engineered nanoparticles and pigments) in urban runoff has not been determined due to difficulties in distinguishing natural from engineered TiO₂ particles in environmental matrices. The present study examines the occurrence and estimates the concentrations of TiO₂ engineered particles in urban runoff under wet- and dry-weather conditions. Urban runoff was collected from two bridges in Columbia, South Carolina, USA under wet-weather conditions and from the Ballona Creek and Los Angeles (LA) River in Los Angeles, California, USA under dry-weather conditions. The concentrations of TiO₂ engineered particles were determined by mass balance calculations based on shifts in elemental concentration ratios in urban runoff relative to natural background elemental ratios. Elemental ratios of Ti to Nb in urban runoff were higher than the natural background ratios, indicating Ti contamination. The occurrence of TiO₂ engineered particles was further confirmed by transmission electron microscopy coupled with energy dispersive spectroscopy. The concentration of TiO₂ engineered particles in urban runoff was estimated to be in the range of 5-150 μg L^-1. Therefore, this study identifies urban runoff as a previously unaccounted source of TiO₂ engineered particle release to the environment, which should be included in engineered nanoparticle fate modeling studies and in estimating environmental release of engineered nanoparticles.

Modeling and monitoring riparian buffer zones using LiDAR data in South Carolina

Functional riparian areas protect water quality and conserve aquatic systems, plants, and wildlife. Laser-based remote sensing technology offers a high-resolution approach to both characterize and document changes in riparian buffer zones (RBZs). The objectives of this study were to demonstrate a rapid method and model to calculate riparian buffer widths on both sides of a stream using a LiDAR-derived slope variable, to classify riparian buffers and determine their quality, and to evaluate the appropriateness of using LiDAR in riparian buffer assessment. For this purpose, RBZs were delineated for Hunnicutt and King Creek, which are located in Oconee and Pickens counties, in South Carolina. Results show that LiDAR was effective in delineating required riparian buffer widths based on the topography slope of upstream areas, and in calculating the ratio of tree cover. This LiDAR-based assessment methodology could be applied to a wide-range of environments.

Community capacity coach: Embedded support to implement evidenced-based prevention

Given the pervasive nature of child abuse and neglect, multilevel public health approaches are necessary. Implementation science can help in understanding the most effective ways to build infrastructure and support delivery of such approaches. In this theoretical paper, we describe the implementation of the Positive Parenting Program (Triple P), an evidence-based population-level parenting program in South Carolina. While implementation science has informed how to move population-level efforts to scale, we discuss challenges that persist in practice, such as when there is a need for multiple stakeholders to understand, support, and apply implementation best practices in a systematic and consistent way. To address this challenge, we introduce the role of a Community Capacity Coach, who lives in the local community and works towards the implementation of Triple P. The Coach is responsible for bridging gaps between the local community and statewide support systems. We detail the ways in which the Coach's role aligns with key intermediary functions, and how the Coach is embedded within the larger Triple P statewide support system. We then discuss the assessment of the Coach's impact; and conclude with future directions and next steps for this role within Triple P South Carolina.

Geomorphology and Species Interactions Control Facilitation Cascades in a Salt Marsh Ecosystem

Facilitation cascades are chains of positive interactions that occur as frequently as trophic cascades and are equally important drivers of ecosystem function, where they involve the overlap of primary and secondary, or dependent, habitat-forming foundation species [1]. Although it is well recognized that the size and configuration of secondary foundation species' patches are critical features modulating the ecological effects of facilitation cascades [2], the mechanisms governing their spatial distribution are often challenging to discern given that they operate across multiple spatial and temporal scales [1, 3]. We therefore combined regional surveys of southeastern US salt marsh geomorphology and invertebrate communities with a predator exclusion experiment to elucidate the drivers, both geomorphic and biotic, controlling the establishment, persistence, and ecosystem functioning impacts of a regionally abundant facilitation cascade involving habitat-forming marsh cordgrass and aggregations of ribbed mussels. We discovered a hierarchy of physical and biological factors predictably controlling the strength and self-organization of this facilitation cascade across creekshed, landscape, and patch scales. These results significantly enhance our capacity to spatially predict coastal ecosystem function across scales based on easily identifiable metrics of geomorphology that are mechanistically linked to ecological processes. Replication of this approach across vegetated coastal ecosystems has the potential to support management efforts by elucidating the multi-scale linkages between geomorphology and ecology that, in turn, define spatially explicit patterns in community assembly and ecosystem functioning.

Evaluation of Insecticide Thresholds in Late-Planted Bt and Non-Bt Corn for Management of Fall Armyworm (Lepidoptera: Noctuidae)

The fall armyworm, Spodoptera frugiperda (J. E. Smith), is a major pest of corn in North and South America. It is managed primarily with transgenic corn-producing insecticidal proteins of Bacillus thuringiensis (Bt), but the development of resistance threatens their durability and necessitates the use of alternative management strategies. We conducted late-planted field trials during 2016 and 2017 in South Carolina using natural infestations. We evaluated the use of Bt and non-Bt corn hybrids in combination with foliar applications of chlorantraniliprole at varying infestation thresholds to protect field corn from infestation and damage and determine effects on grain yield. All Bt hybrids were more effective at reducing fall armyworm infestation rates and leaf injury than multiple insecticide sprays, and no Bt hybrid reached the lowest infestation threshold (20%) to require supplemental insecticide treatments, despite infestations in non-Bt corn reaching >68% in each year. The only Bt and/or insecticide treatment to significantly reduce ear feeding or the proportion of ears injured (mainly by Helicoverpa zea [Boddie]) was the Bt hybrid pyramid producing Vip3A. However, significant protection of yield was detected only in the Bt hybrids producing Cry1A.105 + Cry2Ab2. All Bt traits tested in this study were effective in reducing infestation and feeding damage from fall armyworm, although this did not always result in significant protection of yield. Our results demonstrate the potential and limitations of using chlorantraniliprole with Bt (when resistance is present) and non-Bt corn to manage this pest.

Moving Oral Contraceptives over the Counter: Theory-based Formative Research to Design Communication Strategy

The American College of Obstetricians and Gynecologists (ACOG) recommends that oral contraceptives (OC) should be available over the counter (OTC). This study explored women's attitudes toward OC OTC in rural South Carolina. In-depth, individual interviews were conducted with 52 women ages 18-44 years old. Data analysis was informed by a reproductive justice theoretical framework and included an inductive, constant-comparative approach using HyperRESEARCH 3.7.5. Participants self-identified as either Black (62%) or White (28%). Participants believed that OC OTC would prevent unintended pregnancy by improving anonymity, convenience, and access to contraception. Many participants faced barriers to receiving a prescription, including time, transportation, cost, stigma, embarrassment, and clinician refusal based on religious reasons. Participants believed OC OTC would improve women's control over their fertility and emphasized the importance of health insurance coverage for OC OTC. Some participants expressed concerns about the risk of side effects, contraindications, and the potential for abuse. Some participants believed women, especially adolescents, required physician guidance and an annual exam to use OC. Findings suggest that a lack of knowledge and misinformation about the risks of OC serve as a barrier among some women in rural areas. Widespread acceptance of OC OTC will require messaging strategies to dispel safety concerns about OC OTC and empower women.

Core strategies, social processes, and contextual influences of early phases of implementation and statewide scale-up of group prenatal care in South Carolina

This mixed-methods process evaluation examined a state-wide, interagency collaborative in South Carolina that expanded CenteringPregnancy group prenatal care from two to five additional healthcare practices from 2012 to 2015. The evaluation focused on delineating core processes, strategies, and external contextual elements of group prenatal care implementation and scale-up. Success of this scale-up was enhanced by the effective use and creation of windows of opportunity, which allowed stakeholders to pursue actions consistent with their own values, at both state and organizational levels. Most importantly, strong political advocacy and state-level financial commitment for group prenatal care made it possible for clinics throughout South Carolina to begin providing CenteringPregnancy to their patients. Improved understanding of the processes involved in scaling-up pilot interventions may enhance the effectiveness and efficiency of future expansion efforts.

Efficacy and Profitability of Insecticide Treatments for Tomato Spotted Wilt Management on Peanut in South Carolina

Tomato spotted wilt (TSW) is a common and serious disease of peanut (Arachis hypogaea L.) caused by Tomato spotted wilt virus (TSWV; family Tospoviridae, genus Orthotospovirus). Management frequently uses an integrated approach, with cultivar resistance and application of in-furrow insecticide as two critical components. In-furrow insecticides help suppress thrips, which can injure and stunt young growing plants and transmit TSWV, with postemergent application of acephate capable of providing additional thrips control. To examine effects of systemic insecticides (imidacloprid, imidacloprid plus fluopyram, phorate, and acephate) on TSW management, yield, and economic return across cultivar susceptibilities (susceptible, moderately susceptible, and resistant) in South Carolina, a meta-analysis was used to synthesize results from 32 studies conducted between 2009 and 2018. Although efficacy and magnitude of individual treatments varied with susceptibility, imidacloprid increased, whereas phorate generally decreased TSW incidence relative to nontreated controls. In-furrow treatments followed by acephate further reduced TSW incidence and increased profitability. All examined treatments improved yield compared with untreated peanuts except for susceptible cultivars treated with imidacloprid. Imidacloprid plus fluopyram increased yield more than imidacloprid alone for the susceptible group, although there was little difference between these treatments in association with moderately susceptible cultivars. When comparing individual applications, phorate was overall the most profitable option across susceptibilities, although imidacloprid plus fluopyram exhibited analogous profitability for susceptible cultivars. Results from this study can be used to assist producer selection of management options for TSW in peanut.

Treating Systemic Lupus Erythematosus (SLE): The Impact of Historical Environmental Context on Healthcare Perceptions and Decision-Making in Charleston, South Carolina

INTRODUCTION

Over 400,000 slaves were taken from Africa and brought to Charleston, South Carolina, as part of the transatlantic slave trade during the 18th and 19th centuries. Due to these negative historical events, the healthcare of African Americans in Charleston may be compromised in regard to chronic illnesses and other conditions affecting minorities, such as lupus.

MATERIALS AND METHODS

The current study used an ethnographic approach to obtain the perspectives of lupus patients with the goal of identifying gaps within current research. In addition to patient perspectives, the geographical location of Charleston, South Carolina was considered through inquiries around culture, community, advocacy, and client/patient interaction to establish a narrative for the themes that emerged.

RESULTS

The eleven major themes identified were connectedness, knowledge, experience with lupus, compliance, clinical trial participation, career and planning for the future, visits, access to resources, lifestyle, transition from child to adult care, and an overarching theme of self-management.

CONCLUSION

Understanding healthcare perceptions and decision-making among culturally diverse populations, particularly those who have been defined by centuries of substandard care, marginalization, exploitation, and distrust, is critical to the development of culturally tailored interventions designed to improve patient outcomes and reduce health disparities.

Effects of industrial disturbances on biodiversity of carrion-associated beetles

Energy production systems such as nuclear reactors and coal-burning power plants produce a multitude of waste contaminants including radionuclides, trace elements, and heavy metals. Among invertebrates, much of the effort to understand the impact of these contaminants has focused in aquatic environments, while relatively less attention has been on terrestrial communities. We investigated the effects of trace element and radionuclide contamination on assemblages of beetles that are drawn to vertebrate carrion. Samples were collected from riparian sites at the Savannah River Site in South Carolina to compare trap catches (i.e., measure of relative abundance) of beetles and species diversity along a habitat gradient (0-300 m) away from an aquatic habitat and between uncontaminated and contaminated sites. We collected 17,800 carrion-associated beetles representing 112 species in nine families, which were classified as either scavenger or predatory beetles. Beetle catches and species diversity were generally higher at contaminated than uncontaminated sites. These trends were likely driven by scavenger species, which showed similar patterns between sites, whereas patterns of catches and species diversity were variable between sites for predatory beetles. Species compositions of contaminated and uncontaminated sites were generally distinct, however habitat edges appeared to substantially affect beetle assemblages. Overall, our study suggests carrion beetle assemblages are sensitive to edge effects and may exhibit variable responses to the presence of anthropogenic contaminants or disturbances associated with energy production systems. Such results reflect the inherent variability among individual beetle species, populations, and communities to local environmental conditions, and underscores the need for multi-taxa approach in environmental impact assessments.

First record of Piscicapillaria bursata (Nematoda: Capillariidae), a parasite of hammerhead sharks Sphyrna spp., in the western Atlantic Ocean

Examination of 32 spiral valves from neonate specimens of hammerhead shark Sphyrna spp. (Carcharhiniformes: Sphyrnidae) captured between June and August 2018 off the Atlantic coast of South Carolina, USA, revealed the presence of the capillariid nematode Piscicapillaria bursata (Capillariidae) in the Carolina hammerhead S. gilberti, the scalloped hammerhead S. lewini, and their hybrids. This is the second find of this parasite originally described from hammerhead sharks off Australia, its first record from the western Atlantic Ocean, and its first record in a new host species and in hybrids.

Meconium identifies high levels of metals in newborns from a mining community in the U.S

BACKGROUND

This pilot study was conducted to determine if we could identify intrauterine exposure to metals in meconium, as a measure of exposure for mother-child pairs living in proximity to a mining operation.

OBJECTIVES

We used meconium as a means to measure metal exposure in utero. We set out to quantify the exposure to selected metals that are currently being mined and also are found in the Superfund site in Butte, Montana, and to compare it to that of Columbia, South Carolina, US, where mining is not occurring.

METHODS

This cross-sectional study was conducted between May and November 2018. We received Institutional Review Board approval and we consented women following the birth of their newborns, and collected meconium within 24 h of birth, without any identifiers. Each laboratory used the same protocol for collection, transport, and storage; and the same laboratory protocol was used for the analysis of all samples. Samples were digested using standard acid/peroxide digestion methods and measured by inductively coupled plasma mass spectroscopy.

RESULTS

We collected meconium specimens from 17 infants in Columbia, South Carolina and 15 infants in Butte, Montana. The concentrations found in Columbia were in the low μg kg^-1 range (or less) and were similar to the low levels that have been identified in other studies of meconium. The magnitude of the differences in concentrations found in Butte compared to Columbia was 1792 times higher for Cu, 1650 times higher for Mn, and 1883 times higher for Zn.

CONCLUSION

Using meconium to measure exposure of newborns has implications for risk assessment in a mining-exposed population. This approach was inexpensive and thorough. The magnitude of the differences in the metal levels identified from the two study sites suggests there is an urgent need for further research to learn if there are health consequences to these highly exposed infants.

Nonlinear patterns in mercury bioaccumulation in American alligators are a function of predicted age

Mercury is a widespread, naturally occurring contaminant that biomagnifies in wetlands due to the methylation of this element by sulfate-reducing bacteria. Species that feed at the top trophic level within wetlands are predicted to have higher mercury loads compared to species feeding at lower trophic levels and are therefore often used for mercury biomonitoring. However, mechanisms for mercury bioaccumulation in sentinel species are often poorly understood, due to a lack of long-term studies or an inability to differentiate between confounding variables. We examined mercury bioaccumulation patterns in the whole blood of American alligators (Alligator mississippiensis) from a long-term mark-recapture study (1979-2017) in South Carolina, USA. Using a growth model and auxiliary information on predicted age at first capture, we differentiated between age- and size-related variation in mercury bioaccumulation, which are often confounded in alligators due to their determinate growth pattern. Contrary to predictions that the oldest or largest individuals were likely to have the highest mercury concentrations, our best-supported model indicated a peak in mercury concentration at 30-40 years of age, depending on the sex, and lower concentrations in the youngest and oldest animals. To evaluate the robustness of our findings, we re-analyzed data from a previously published study of mercury in alligators sampled at Merritt Island National Wildlife Refuge in Florida. Unlike the South Carolina data, the data from Florida contained minimal auxiliary information regarding age, yet the best supported model similarly indicated a peaked rather than increasing relationship between mercury and body size, a less-precise indicator of age. These findings highlight how long-term monitoring can differentiate between confounding variables (e.g., age and size) to better elucidate complex relationships between contaminant exposure and demographic factors in sentinel species.

Impact of Natural Organic Matter on Plutonium Vadose Zone Migration from an NH4Pu(V)O2CO3(s) Source

We investigated the influence of natural organic matter (NOM) on the behavior of Pu(V) in the vadose zone through a combination of the field lysimeter and laboratory studies. Well-defined solid sources of NH₄Pu(V)O₂CO₃(s) were placed in two 5-L lysimeters containing NOM-amended soil collected from the Savannah River Site (SRS) or unamended vadose zone soil and exposed to 3 years of natural South Carolina, USA, meteorological conditions. Lysimeter soil cores were removed from the field, used in desorption experiments, and characterized using wet chemistry methods and X-ray absorption spectroscopy. For both lysimeters, Pu migrated slowly with the majority (>95%) remaining within 2 cm of the source. However, without the NOM amendment, Pu was transported significantly farther than in the presence of NOM. Downward Pu migration appears to be influenced by the initial source oxidation state and composition. These Pu(V) sources exhibited significantly greater migration than previous studies using Pu(IV) or Pu(III) sources. However, batch laboratory experiments demonstrated that Pu(V) is reduced by the lysimeter soil in the order of hours, indicating that downward migration of Pu may be due to cycling between Pu(V) and Pu(IV). Under the conditions of these experiments, NOM appeared to both enhance reduction of the Pu(V) source as well as Pu sorption to soils. This indicates that NOM will tend to have a stabilizing effect on Pu migration under SRS vadose zone field conditions.

Church Leaders' Views of Obesity Prevention Efforts for Children and Youth

OBJECTIVE

To examine church leaders' views on the role of faith-based organizations in promoting healthy eating and physical activity in children.

DESIGN

Qualitative research using semi-structured in-depth interviews.

SETTING

South Carolina.

PARTICIPANTS

Leaders (n = 26) from United Methodist churches (n = 20).

PHENOMENON OF INTEREST

Perceptions of health promotion efforts for children in faith-based settings, including primary health concerns, perceived opportunities, partnerships, and the relationship of these efforts to the overall church mission.

ANALYSIS

Interviews were transcribed verbatim and coded using a constant comparative method.

RESULTS

Five themes emerged related to (1) multiple concerns about health issues facing children; (2) existing church structures influencing health behaviors; (3) potential partnerships to address children's health; (4) importance of role models; and (5) the need for a tailored approach.

CONCLUSIONS AND IMPLICATIONS

Church leaders viewed childhood health behaviors as an important area of concern for the church and identified links between physical and spiritual health. They identified multiple existing and potential organizational and community structures as important in improving healthy eating and physical activity. Faith-based organizations can play an important role in developing and delivering health programming for children but desired assistance through partnerships with subject matter experts.

Impact of bromide exposure on natural organochlorine loss from coastal wetland soils in the Winyah Bay, South Carolina

Naturally formed halogenated organic compounds are common in terrestrial and marine environments and play an important role in the halogen cycle. Among these halogenated compounds, chlorinated organic compounds are the most common halogenated species in all soils and freshwater sediments. This study evaluated how a previously observed phenomenon of bromination of organic matter in coastal soils due to salt-water intrusion impacts the stability and fate of natural organochlorine (org-Cl) in coastal wetland soils. The reacted solid and liquid samples were analyzed using X-ray spectroscopy (in cm and at micron scales for solids) and ion chromatography. We find that introduction of Br^- species and their subsequent reactions with organic carbon are associated with an average of 39% loss of org-Cl species from leaf litter and soil. The losses are more prominent in org-Cl hotspots of leaf litter, and both aliphatic and aromatic organochlorine compounds are lost from all samples at high Br^- concentrations. The combination of solid and aqueous phase analysis suggests that org-Cl loss is most likely largely associated with volatilization of org-Cl. Release of labile org-Cl compounds has detrimental environmental implications for both ecosystem toxicity, and stratospheric ozone. The reactions similar to those observed here can also have implications for the reactions of xenobiotic chlorinated compounds in soils.

Microbial community structure shows differing levels of temporal stability in intertidal beach sands of the grand strand region of South Carolina

Studies of microbial community structure in intertidal and supratidal beach sands along the California and Gulf of Mexico coasts have begun to reveal geographical patterns in microbial diversity through the use of next generation sequencing technology. Only a few studies have targeted communities along the Eastern seaboard, leaving a variety of microbial ecosystems uncharacterized. In this study, we examine the microbial community structure within three South Carolina beaches along the Grand Strand via sequencing of the V4 region of the 16S rRNA gene to discern relationships between diversity and temporal or regional factors. Gammaproteobacteria, Planctomycetes, Acidobacteria, and Actinobacteria dominated the composition of these beaches. Diversity analyses revealed that highly diverse communities were similar in overall composition and diversity but showed different levels of community structure stability over time. The community structure in Pawleys Island sands showed no significant change over time, while Garden City experienced significant shifts between each sampling date. Community structure also differed between beaches and, to a lesser degree, sampling date. These data provide evidence of the high microbial diversity within these beach sands and suggest that even though beaches of the same geographic region can show similarity in composition and diversity at a particular timepoint, the nature of their community structure and underlying diversity may differ comparatively and over time.

Soybean Host Plant Resistance to Megacopta cribraria (Hemiptera: Plataspidae) and the Potential Role of Leaf Trichome Density

Megacopta cribraria (F.) (Hemiptera: Plataspidae) is an invasive pest of soybean that has spread across the southeastern United States since its initial discovery in 2009 in Georgia. Previous studies in the southeastern states have documented both the population dynamics of this pest and host plant resistance (HPR) among soybean varieties, although the specific mechanisms of HPR remain unknown. The objectives of this study were, therefore, to 1) quantify field resistance to M. cribraria in multiple soybean varieties in two states previously affected by severe M. cribraria infestations, North Carolina (NC) and South Carolina (SC); and 2) study the role of soybean trichome density in imparting resistance against M. cribraria. Soybean variety 'Camp' was least attractive to M. cribraria, through time and locations, suggesting consistent resistance. Other varieties showed variable performance among the locations and sampling dates. A significant difference in trichome density was evident. However, there was no correlation between trichome density and M. cribraria infestation. Compared to a previously published study in the same location, when M. cribraria adults emerging from overwintering dispersed into soybeans, in our study only first-generation adults dispersed into soybeans. Considering the current trend of significantly lower M. cribraria infestation rates in North and South Carolina, this pest may be finally succumbing to indigenous natural enemies and should be managed by incorporating integrated pest management tactics, such as HPR, that help conserve natural enemy populations.

A comparison of cost and quality of three methods for estimating density for wild pig (Sus scrofa)

A critical element in effective wildlife management is monitoring the status of wildlife populations; however, resources to monitor wildlife populations are typically limited. We compared cost effectiveness of three common population estimation methods (i.e. non-invasive DNA sampling, camera sampling, and sampling from trapping) by applying them to wild pigs (Sus scrofa) across three habitats in South Carolina, U.S.A where they are invasive. We used mark-recapture analyses for fecal DNA sampling data, spatially-explicit capture-recapture analyses for camera sampling data, and a removal analysis for removal sampling from trap data. Density estimates were similar across methods. Camera sampling was the least expensive, but had large variances. Fecal DNA sampling was the most expensive, although this technique generally performed well. We examined how reductions in effort by method related to increases in relative bias or imprecision. For removal sampling, the largest cost savings while maintaining unbiased density estimates was from reducing the number of traps. For fecal DNA sampling, a reduction in effort only minimally reduced costs due to the need for increased lab replicates while maintaining high quality estimates. For camera sampling, effort could only be marginally reduced before inducing bias. We provide a decision tree for researchers to help make monitoring decisions.

Mercury bioaccumulation in Tilefish (Lopholatilus chamaeleonticeps) from offshore waters of South Carolina, USA

Mercury (Hg) concentrations in Tilefish (Lopholatilus chamaeleonticeps) have been reported to be one of the highest of all fish species, resulting in advisories that, historically, have recommended zero consumption. The current study assesses Hg bioaccumulation in Tilefish targeted by the commercial fisheries operating off the coast of South Carolina, USA. We provide results for an under-sampled region and explore how life history potentially impacts Hg uptake in Tilefish. Mercury concentration in Tilefish muscle tissue ranged from 0.10 to 0.99 ppm, with a mean of 0.23 ppm (n = 63). The majority of Tilefish samples (95%) were within the "Good Choices" range for consuming at least one serving per week, with 62% being within the range considered best for eating two meals a week", per suggestion by the US EPA and US FDA (2017). The present study of Tilefish from the western Atlantic further substantiates the importance of monitoring Hg in commercial fish species regionally.

Examining maternal and environmental transfer of mercury into American alligator eggs

American alligators are exposed to mercury (Hg) throughout their natural range and may maternally transfer Hg into their eggs. Wildlife species are highly sensitive to Hg toxicity during embryonic development and neonatal life, and information on Hg transfer into eggs is critical when attempting to understand the effects of Hg exposure on developing oviparous organisms. To examine Hg transfer in alligators, the objectives of the present study were to 1) determine Hg concentrations in yolk (embryonic and neonatal food source) from wild alligator eggs collected from three locations - Yawkey Wildlife Center SC (YWC), Lake Apopka FL (LA), and Lake Woodruff FL (LW); 2) examine the relationship between THg concentrations in wild alligator nest material and egg yolk at Merritt Island National Wildlife Refuge, FL; 3) examine the Hg concentrations in wild maternal female alligators (blood) and the THg in corresponding egg yolks and embryos across three nesting seasons at a single location (YWC), and evaluate the relationship between nesting female THg concentrations (blood) and their estimated age and number of nesting years (YWC); and 4) assess the transfer of biologically-relevant Hg concentrations (based on Hg measured in maternal female blood) into embryos using an egg-dosing experiment. Mean total Hg (THg) concentrations observed at each site were 26.3 ng/g ± 11.0 ng/g (YWC), 8.8 ng/g ± 5.1 ng/g (LA), and 22.6 ng/g ± 6.3 ng/g (LW). No relationship was observed between THg in alligator nest material and corresponding yolk samples, nor between THg in maternal alligator blood and estimated age and number of nesting years of these animals. However, significant positive relationships were observed between THg in blood of nesting female alligators and THg in their corresponding egg yolk. We observed that 12.8% of the maternal blood THg is found in the corresponding egg yolk, and a highly significant correlation was observed between the two sample types (r = 0.66; p < 0.0001). The egg dosing experiment revealed that Hg did not transfer through the eggshell at developmental stage 19. Overall, this study provides new information regarding Hg transfer in American alligators which can improve biomonitoring efforts and may inform ecotoxicological investigations and population management programs in areas of high Hg contamination.

Understanding Community-based HIV/AIDS Service Organizations: An Invaluable Source of HPV-related Cancer Information for At-risk Populations

To describe non-clinical HIV service providers (NCHSPs) as surrogate seekers and health information mavens for people living with HIV (PLWH), men who have sex with men (MSM), and other vulnerable populations.In May/June 2016, we recruited 30 NCHSPs from three community-based HIV/AIDS service organizations. NCHSPs completed a 118-item self-administered, paper-and-pencil survey about HPV, cancer, and health communication. Data were analyzed using Stata/SE 14.1.Almost all (97%) NCHSPs were surrogate seekers and had looked for HIV/AIDS (97%), STD (97%), and cancer (93%) information. Most (60%) cancer information seekers had looked for information about HPV. The Internet (97%) and healthcare providers (97%) were health information sources almost all NCHSPs trusted. Nearly all NCHSPs (93%) were completely or very confident about their ability to find health information. The mean health information mavenism score (17.4 ± 2.1) was significantly higher than the scale's high-score cutoff (15.0) (p < 0 .001).NCHSPs look for and share health information with the vulnerable populations (e.g., PLWH, MSM) they serve. More research is needed to understand what NCHSPs' know and think about the health information they are sharing with vulnerable populations.

The potential of a year-round school calendar for maintaining children's weight status and fitness: Preliminary outcomes from a natural experiment

Purpose

To evaluate the potential of a year-round school calendar (180-day school year distributed across 12 months) as an intervention compared to a traditional school calendar (180-day school year distributed across 9 months) for mitigating children's weight gain and fitness loss via a natural experiment.

Methods

Height, weight, and cardiorespiratory fitness (CRF) (i.e., Fitnessgram Progressive Aerobic Cardiovascular Endurance Run) were measured in children (5-12 years old) in 3 schools (2 traditional, 1 year-round, n = 990 students, age = 8.6 ± 2.4 years, 53.1% male, 68.9% African American) from 1 school district. Structure (represented by the presence of a school day) was the independent variable. Changes in body mass index (BMI), age- and sex-specific BMI z-scores (zBMI), BMI percentile, percent of overweight or obese children, and CRF (Progressive Aerobic Cardiovascular Endurance Run laps completed) were assessed for summer 2017 (May-August 2017), school year 2017/2018 (August 2017-May 2018), and summer 2018 (May-August 2018). Primary analyses examined the overall change in weight and CRF from summer 2017 until summer 2018 via multilevel mixed effects regression, with group (traditional vs. year-round calendar), time, and a group-by-time interaction as the independent variables. Secondary regression analyses estimated differences in change within and between groups during each time period, separately.

Results

Year-round students gained less BMI (difference in ∆ = -0.44, 95% confidence interval (CI): -0.67 to -0.03) and less CRF (difference in ∆ = -1.92, 95%CI: -3.56 to -0.28) than students attending a traditional school overall. Compared with traditional students, during both summers, year-round students gained less BMI (summer 2017 difference in ∆ = -0.15, 95%CI: -0.21 to -0.08; summer 2018 difference in ∆ = -0.16, 95%CI: -0.24 to -0.07) and zBMI (summer 2017 difference in ∆ = -0.032, 95%CI: -0.050 to -0.010; summer 2018 difference in ∆ = -0.033, 95%CI: -0.056 to -0.009), and increased CRF (summer 2017 difference in ∆ = 0.40, 95%CI: 0.02-0.85; summer 2018 difference in ∆ = 0.23, 95%CI: -0.25 to 0.74). However, the opposite was observed for the school year, with traditional students gaining less BMI and zBMI and increasing CRF compared with year-round students (difference in BMI ∆ = 0.05, 95%CI: 0.03-0.07; difference in zBMI ∆ = 0.012, 95%CI: 0.005-0.019; difference in Progressive Aerobic Cardiovascular Endurance Run laps ∆ = -0.43, 95%CI: -0.58 to -0.28).

Conclusion

The year-round school calendar had a small beneficial impact on children's weight status but not CRF. It is unclear if this benefit to children's weight would be maintained because gains made in the summer were largely erased during the school year. Trajectories of weight and CRF gain/loss were consistent with the structured days hypothesis.

A characterization of personal care product use among undergraduate female college students in South Carolina, USA

Some chemicals used in personal care products (PCPs) are associated with endocrine disruption, developmental abnormalities, and reproductive impairment. Previous studies have evaluated product use among various populations; however, information on college women, a population with a unique lifestyle, is scarce. The proportion and frequency of product use were measured using a self-administered survey among 138 female undergraduates. Respondents were predominately Caucasian (80.4%, reflecting the college's student body), and represented all years of study (freshman: 24.6%; sophomore: 30.4%; junior: 18.8%; senior: 26.1%). All respondents reported use of at least two PCPs within 24 h prior to sampling (maximum = 17; median = 8; IQR = 6-11). Compared with studies of pregnant and postpartum women, adult men, and Latina adolescents, college women surveyed reported significantly higher use of deodorant, conditioner, perfume, liquid soap, hand/body lotion, sunscreen, nail polish, eyeshadow, and lip balm (Chi Square, p < 0.05). More study is needed to understand the magnitude and racial disparities of PCP chemical exposure, but given the potential effects on reproduction and fertility, our findings of abundant and frequent product use among these reproductive-aged women highlight opportunities for intervention and information on endocrine disrupting chemical (EDC)-free alternative products and behaviors.

Temporal Trends in Per- and Polyfluoroalkyl Substances in Bottlenose Dolphins (Tursiops truncatus) of Indian River Lagoon, Florida and Charleston, South Carolina

Temporal trends in plasma concentrations of per- and polyfluoroalkyl substances (PFAS) in free-ranging bottlenose dolphins (Tursiops truncatus) inhabiting two geographic areas: Indian River Lagoon, Florida over the years 2003-2015 and the waters surrounding Charleston, South Carolina over 2003-2013, were examined. Nine PFAS met the inclusion criteria for analysis based on percent of values below level of detection and sampling years. Proportionate percentiles parametric quantile regression assuming lognormal distributions was used to estimate the average ratio of PFAS concentrations per year for each chemical. Plasma concentrations decreased over time for perfluorodecanoate (PFDA), perfluorohexane sulfonate (PFHxS), perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS), and perfluoroundecanoate (PFUnDA) in both locations. Perfluorononanoate (PFNA) decreased with time in Indian River Lagoon dolphins. Perfluorododecanoate (PFDoDA) concentrations significantly increased over time among female Indian River Lagoon dolphins. Regulation and phaseout of specific PFAS groups may have led to the decreasing levels of those PFAS and increasing levels of other replacement PFAS.

Effects of construction-related land use change on streamflow and sediment yield

Observations from four small watersheds by the Reedy River in upstate South Carolina, USA, were used to evaluate the effects of urban development due to residential construction on streamflow and sediment yield, and to assess the effectiveness of Best Management Practices (BMPs). Paired watershed studies were used to quantify changes in flow magnitudes and sediment outputs at the watershed scale. A novel method based on the Revised Universal Soil Loss Equation was developed to quantify the contribution from each land use to watershed sediment yield. Area-normalized stormflows and peak flows in developed watersheds were 2-9 times greater than those from an undeveloped reference watershed. Sediment yield (SY) and event mean concentration (EMC) were 6 times greater in a developed watershed that had no ongoing construction. In actively developing watersheds, however, SY and EMC were 60-90 times greater compared to the reference. Sediment contribution factor (10^-2 kg h MJ^-1 mm^-1), defined as SY per unit rainfall erosivity, for each land use with 95% confidence interval was: Forest = 4 ± 2, Pasture = 2 ± 2, Full Development = 18 ± 11, Active Development = 440 ± 120. These values can be used to predict long-term change in sediment yield due to a future land-use change. Significant increases in flow and sediment occurred despite the use of BMPs, so improvements to their implementation and/or proper maintenance may be necessary to ensure that their protective goals are met.

Blood lead levels in children in urban and rural areas: Using multilevel modeling to investigate impacts of gender, race, poverty, and the environment

Many studies of children's exposure to lead (Pb) are carried out in urban and industrialized environments. This study analyzed blood lead level (BLL) data collected from 2011 to 2016 from approximately 140,000 children ages <1 to 6 years across South Carolina (SC), including urban and rural areas. Individual-level characteristics included children's age, and race/ethnicity. Block group variables examined included population by race and ethnicity, households below the poverty level, median year homes built, urban/rural classification, and percent road coverage. BLL were higher in urban compared to rural children but increased to a greater extent in rural children from age < 1 year to 2 years. Road coverage was strongly associated with higher BLL in urban areas, and with home age more weakly, but neither road coverage nor home age was associated with BLL in rural areas. Young urban children may receive greater exposure to Pb from house dust and outdoor legacy Pb contamination, and young rural children through diet and drinking water. Black children had higher BLL in urban areas than white children, and the converse was true in rural areas. Population data indicated that rural areas had more poverty than urban areas, but strong associations between increased children's BLL and either ethnicity or socio-economic status (SES) at the block group level was not observed, likely due to distinct characteristics of poverty and geographic distribution by ethnicity in urban as compared to rural areas of SC. Individual demographics and environmental characteristics may be more closely associated with BLL than geographically aggregated SES and race/ethnicity characteristics. Interventions to reduce children's exposure to Pb should occur at as early an age as possible, and differences between rural and urban areas should be considered as interventions are developed to reduce children's BLL.

Basins, beaver ponds, and the storage and redistribution of trace elements in an industrially impacted coastal plain stream on the Savannah River Site, SC, USA

Accumulation of eleven trace elements in sediment was evaluated throughout an industrially disturbed headwater stream on the Savannah River Site, SC, USA. Sampling began at upstream sedimentation basins at the margins of industrial areas, continued longitudinally downstream to a beaver pond representing a potential sink in the mid-reaches, and ended in downstream reaches. Additionally, sediment from beaver impacted areas in another industrially disturbed stream and a reference stream were analyzed to assess the natural tendency of these depositional features to settle out trace elements. We further compared trace element accumulation in sediment and biota from downstream reaches before and after an extreme rainy period to evaluate the potential redistribution of trace elements from sink areas. Trace elements accumulated in the headwater basins from which elements were redistributed to downstream reaches. The mid-reach beaver affected area sediments accumulated elevated concentrations of most analyzed elements compared to the free-flowing stream. The elevated accumulation of organic matter in these sink areas illustrated the effectiveness of reduced water velocity areas to settle out materials. The natural tendency of beaver ponds to accumulate trace elements and organic matter was further illustrated by sediments from the reference beaver pond accumulating higher concentrations of several elements than sediments from the free flowing section the stream impacted by industrial activity. However, concentrations in sediment from sedimentation basins and the beaver impacted area of the disturbed stream were highest. Trace elements and organic matter appeared to be redistributed from the sinks after the record rainy period resulting in increased trace element concentrations in both sediment and biota. These data suggest that assessments of contaminants in stream systems should include such slow-water, extreme depositional zones such as beaver impacted areas or basins to verify what contaminants may be pulsing through the stream.

Gender Disparities in Traumatic Life Experiences and Antiretroviral Therapy Adherence Among People Living with HIV in South Carolina

People living with HIV are at increased risk for experiencing trauma, which may be linked to reduced adherence to antiretroviral therapy (ART), making it more difficult to achieve and maintain viral suppression. The current study sought to assess whether traumatic life experiences were associated with lower ART adherence among a diverse sample of people living with HIV in South Carolina. A cross-sectional survey was completed by 402 individuals receiving HIV care from a large immunology center. Principal component analysis revealed three primary categories of trauma experience (extreme violence/death-related trauma, physical and sexual assault, and accidental/disaster-related trauma). Multivariable logistic regression models using complete case analysis and multiple imputation were used to determine the associations between experiencing each trauma category and ART adherence. Complete case analysis showed that overall, participants who reported exposure to any trauma were 58% less likely to be adherent to their ART (adjusted OR 0.42; 95% CI 0.21-0.86) compared to respondents who did not experience trauma. Participants exposed to extreme violence/death-related trauma were 63% less likely to be adherent to their ART (adjusted OR 0.37; 95% CI 0.15-0.95) compared to respondents who did not experience trauma. Participants exposed to physical and sexual assault were 65% less likely (adjusted OR 0.35; 95% CI 0.16-0.77) and those who reported experiencing accidental/disaster-related trauma were 56% less likely (adjusted OR 0.44; 95% CI 0.21-0.93) to report being ART adherent compared to participants who did not experience trauma. Analyses with multiple imputation yielded similar findings as the complete case analyses. When the data were analyzed separately by gender, the associations between overall trauma, extreme violence/death-related trauma, and physical and sexual assault were statistically significant for men using complete case and multiple imputation analyses. There were no statistically significant associations between trauma and ART adherence among women. Findings highlight the need to adopt trauma-informed approaches and integrate trauma- and gender-specific interventions into HIV clinical care in the Southern United States.

Paying for Palliative Care in Medicare: Evidence From the Four Seasons/Duke CMMI Demonstration

CONTEXT

Palliative care improves patient and family outcomes and may reduce the cost of care, but this service is underutilized among Medicare beneficiaries.

OBJECTIVES

To describe enrollment patterns and outcomes associated with the Center for Medicare and Medicaid Innovation expansion of a multisetting community palliative care program in North and South Carolina.

METHODS

This observational study characterizes the Center for Medicare and Medicaid Innovation cohort's care and cost trajectories after enrollment. Program participants were age-eligible Medicare fee-for-service beneficiaries living in Western North Carolina and South Carolina who enrolled in a palliative care program from September 1, 2014, to August 31, 2017. End-of-life costs were compared between enrolled and nonenrolled decedents. Program administrative data and 100% Medicare claims data were used.

RESULTS

A total of 5243 Medicare beneficiaries enrolled in the program from community (19%), facility (21%), small hospital (27%), or large hospital (33%) settings. Changes in Medicare expenditures in the 30 days after enrollment varied by setting. Adjusted odds of hospice use were 60% higher (OR = 1.60; CI = 1.47, 1.75) for enrolled decedents relative to nonenrolled decedents. Participants discharged to hospice vs. participants not had 17% (OR = 0.83 CI = 0.72, 0.94) lower costs. Among enrolled decedents those enrolled for at least 30 days vs. <30 days had 42% (OR = 0.58, CI = 0.49, 0.69) lower costs in the last 30 days of life.

CONCLUSIONS

Expansion of community palliative care programs into multiple enrollment settings is feasible. It may improve hospice utilization among enrollees. Heterogeneous program participation by program setting pose challenges to a standardizing reimbursement policy.

Pharmacy students' intentions to utilize pharmacoeconomics, pharmacoepidemiology, and health outcomes in future jobs

INTRODUCTION

The objectives of this study were to explore factors associated with pharmacy students' intentions to utilize health outcomes by: (1) understanding opinions on health outcomes, (2) understanding the likelihood of using health outcomes in different settings, and (3) predicting pharmacy students' intentions to utilize health outcomes in future jobs.

METHODS

This study surveyed second-year pharmacy students over two years. The survey contained four components: the theory of planned behavior, opinions on health outcomes, the likelihood of using health outcomes in different settings, and demographics. To predict pharmacy students' intentions to utilize health outcomes in future jobs, a multiple linear regression model was used with behavioral intention as the dependent variable.

RESULTS

Of the 376 second-year pharmacy students surveyed, 229 responded (60.90%). Pharmacy students had a positive attitude (mean: 0.77, SD: 0.16), high level of subjective norm (mean: 0.75, SD: 0.18), high level of perceived behavioral control (mean: 0.74, SD: 0.15), and high level of behavioral intention (mean: 0.74, SD: 0.21). They thought health outcomes were important for their future jobs (mean: 0.76, SD: 0.22), and equally important as other courses in the doctor of pharmacy curriculum (mean: 0.49, SD: 0.23). Significant predictors of utilizing health outcomes in future jobs were attitude (0.21; 95% CI: 0.03, 0.40), subjective norm (0.38; 95% CI: 0.23, 0.54), and perceived behavioral control (0.45, 95% CI: 0.27, 0.63).

CONCLUSIONS

The second-year pharmacy students in the program studied had positive opinions and expressed high likelihood of applying their health outcomes knowledge and skill after graduation.

Gamification of a Mobile Applications Lecture in a Pharmacy Course

This report describes a librarian's development of an interactive and competitive trivia game using Poll Everywhere, an audience response system software. The trivia game was implemented during a live lecture session on drug information mobile applications taught to first-year pharmacy students. To add a fun and engaging reference for students, the librarian decided to model the game after HQ, a free trivia gaming app. Development of the session, student response, changes to future iterations, and lessons learned by the librarian are described.

Understanding women's postpartum sexual experiences

This study aimed to understand women's sexual health experiences, specifically knowledge, attitudes and norms related to sexual behaviour resumption during the postpartum period. Semi-structured, reproductive health-focused interviews (N = 70) were conducted among women aged 18 years or older (range: 19-78) residing in South Carolina. Findings demonstrated that women identified clinicians as most influential concerning when they should and could resume sexual activity. Some women noted returning to sex earlier than anticipated due to personal and partner desire and indicated achieving considerable sexual satisfaction during the postpartum period. However, other participants noted difficulties resuming sexual activity, including pain and exhaustion from caring for a new baby. Findings provide practical recommendations for health professionals to further develop tailored, timely health messaging related to safe and healthy postpartum sexual behaviours. We discuss recommendations for health professionals to bring further awareness to varied postpartum sexual experiences.

Mercury Concentrations in the Two-Toed Amphiuma (Amphiuma means) and the Lesser Siren (Siren intermedia): Validating Non-lethal Sampling Methods in Southeastern Aquatic Salamanders

The global decline of amphibians is a major conservation issue. Many stressors are recognized for this decline including exposure to environmental contaminants. Mercury (Hg) is an environmental contaminant that bioaccumulates in wildlife and can cause a variety of negative impacts across taxa, including amphibians. Amphiuma and Siren spp. can comprise a large portion of biomass within their respective ecosystems, and thus, likely serve as important predators or prey in wetland communities. However, due to their cryptic nature, little is known about their ecology, diet, and accumulation potential. We sought to validate a nonlethal sampling method to quantify total mercury (THg) in two enigmatic species of aquatic salamanders: the two-toed amphiuma (Amphiuma means) and the lesser siren (Siren intermedia). We examined relationships between THg content in lethal (whole-body) and nonlethal (tail clip) samples. Tail clips were statistically significant predictors of whole-body THg (all p < 0.001), explaining 84-89% of variation in whole-body THg. Average whole-body THg (mg/kg) did not significantly differ between the two species (p = 0.97), and overall, they had similar whole-body THg content (S. intermedia = 0.330 ± 0.04, n = 18; A. means = 0.333 ± 0.07, n = 11). To our knowledge, these data represent the first reported Hg burdens in A. means and S. intermedia.

Expectations and reality: perceptions of support among African American breast cancer survivors

Objective: The experience of an illness such as breast cancer is not a static event. Just as physiological needs change as a patient transitions through diagnosis, treatment, to long-term survivorship, so too will their needs for social support. We applied a transitions theory framework to explore how African American women with breast cancer conceptualized and experienced support along their breast cancer journey. Design: We recruited 16 African American women with breast cancer from a regional cancer center in South Carolina to complete qualitative, semi-structured interviews. We iteratively examined verbatim transcripts using thematic analysis. Results: Three core themes emerged: 'I guess she was supposed to': When support meets patient expectations; 'I wasn't expecting that and that just made me feel so good': When reality exceeds expectations; and 'Don't try to make an invalid out of me': When support given wasn't what was desired. Survivors shared how their family, friends and clergy met their needs for emotional (e.g. prayer, sharing affirmations about God) and instrumental support (e.g. cooking meals, house cleaning). They emphasized how receiving emotional support from their healthcare providers was a pleasant surprise. However, survivors also described unexpected disappointments when family members offered support that was un-needed or un-desired. Conclusions: Applying transitions theory, we found that social support is a process of bidirectional negotiation where African American women with breast cancer perceive support as helpful and acceptable depending on who offers support, what type of support is offered, and when it is offered. Members of their social support network (e.g. family, friends, providers) should periodically assess the survivor's evolving needs to ensure the social support harmonizes with the needs and expectations of the survivor.

Factors Influencing Adherence to Recommended Colorectal Cancer Surveillance: Experiences and Behaviors of Colorectal Cancer Survivors

The number of colorectal cancer (CRC) survivors in the USA is increasing and factors associated with CRC surveillance require attention. This study examined the role of personal, provider, and practice-level factors on CRC survivor care surveillance experiences and outcomes. A telephone survey, informed by the Chronic Care Model, was conducted over a 1-year period with 150 CRC survivors identified via the South Carolina Central Cancer Registry. Participants were ages ≥ 21 years and diagnosed with stages I-III CRC within 1.5 years of study enrollment. Data were analyzed using descriptive statistics and logistic regression. Adherence was defined as receipt of surveillance colonoscopy at 13 months post-CRC surgery, as recommended by evidence-based guidelines. The majority of participants were male (55%) and white (86%), with a median age of 65 years (range 25-89). Almost half (43%) had attained a high school degree or less. Cancer stage was fairly evenly distributed, and 58% had received treatment by surgery alone (provider-level factor). Few participants (56%) received a survivorship care plan (practice-level factor), and adherence to surveillance colonoscopy was lowest (36%) among participants with more than one comorbidity (personal-level factor). Logistic regression models showed that the only significant effect of personal, provider, or practice-level factors on CRC surveillance adherence was related to type of health insurance coverage (private/HMO vs. other; p = 0.04). This is one of the first studies to evaluate CRC surveillance in a socioeconomically diverse sample. The only associations found among the examined factors and adherence were related to type of health insurance coverage. Participants with private/HMO health insurance were significantly more likely than participants with "other" health insurance coverage types (i.e., none, Medicare without supplement, Medicare with supplement) to be adherent to the 13-month colonoscopy. Therefore, future education strategies and patient navigation interventions could focus on identifying and overcoming multi-level barriers to CRC surveillance services.

Statewide Longitudinal Progression of the Whole-Patient Measure of Safety in South Carolina

Meaningful improvement in patient safety encompasses a vast number of quality metrics, but a single measure to represent the overall level of safety is challenging to produce. Recently, Perla et al. established the Whole-Person Measure of Safety (WPMoS) to reflect the concept of global risk assessment at the patient level. We evaluated the WPMoS across an entire state to understand the impact of urban/rural setting, academic status, and hospital size on patient safety outcomes. The population included all South Carolina (SC) inpatient discharges from January 1, 2008, through to December 31, 2013, and was evaluated using established definitions of highly undesirable events (HUEs). Over the study period, the proportion of hospital discharges with at least one HUE significantly decreased from 9.7% to 8.8%, including significant reductions in nine of the 14 HUEs. Academic, large, and urban hospitals had a significantly lower proportion of hospital discharges with at least one HUE in 2008, but only urban hospitals remained significantly lower by 2013. Results indicate that there has been a decrease in harm events captured through administrative coded data over this 6-year period. A composite measure, such as the WPMoS, is necessary for hospitals to evaluate their progress toward reducing preventable harm.

Ecotoxicoparasitology of mercury and trace elements in semi-aquatic mammals and their endoparasite communities

Many contaminants persist in the environment for decades or more, influencing ecosystem health. Environmental contamination with mercury (Hg) is a particular concern due to its ability to biomagnify in food webs and its lethal and sub-lethal effects in exposed organisms. Despite the known impacts of anthropogenic contamination, there remains a need for data on wildlife exposure to Hg and other contaminants, and the effects of exposure on wildlife health. The objectives of this study were to: 1) quantify differences in concentrations of mercury and other trace elements among three sympatric semiaquatic mammals of different assumed trophic position: North American river otter (Lontra canadensis), raccoon (Procyon lotor), and North American beaver (Castor canadensis), 2) compare trace element concentrations between animals captured on the Savannah River Site (SRS) in South Carolina, USA, where known inputs of Hg and other trace elements have occurred, and reference sites in South Carolina (SC) and Georgia (GA), USA, and 3) investigate the relationship between host trace element concentrations and endoparasite communities. River otters, beavers, and raccoons were sampled from the SRS, SC, and GA to quantify trace element concentrations in liver tissue and quantify endoparasite communities. Both species and sampling location were important factors determining hepatic trace element concentration, however, there was no consistent trend of elevated trace element concentrations among animals sampled on the SRS. Only Hg demonstrated biomagnification based on assumed trophic position, with river otters having the highest Hg concentrations among the sampled species. Additionally, the results suggest a possible relationship between host hepatic mercury concentration and endoparasite abundance, while hepatic selenium concentration may be related to endoparasite diversity. These findings further demonstrate how wildlife can accumulate anthropogenic contamination, although future research is needed to determine the mechanisms contributing to patterns observed between endoparasite communities and the contaminant concentrations of their mammalian hosts.

Genetics, morphology and diet of introduced populations of the ant-eating Texas Horned Lizard (Phrynosoma cornutum)

Introduced species can diverge from their source population when they become established in a new ecosystem. The Texas Horned Lizard (Phrynosoma cornutum) is native to the western United States (US) and was historically introduced to several locations in the southeastern US. We studied three introduced populations in South Carolina, US to determine if they exhibit dietary, morphological and genetic divergence from the native western US populations. We expected little divergence from western populations because P. cornutum is a specialist whose biology is largely shaped by its diet of Pogonomyrmex harvester ants. We show that the introduced populations have mixed ancestry between south Texas and more northern areas and experienced founder effects and genetic bottlenecks resulting in decreased genetic diversity. South Carolina lizards primarily consume ants (94%), but surprisingly, they did not eat harvester ants. Introduced lizards primarily eat Dorymyrmex ants, but each introduced population complements Dorymyrmex with significantly different amounts of other species of ants, insects and plant matter. Introduced populations have smaller body size and have different limb and head shapes compared to western populations. This study demonstrates successful persistence of an introduced vertebrate that may be attributed to phenotypic change, even in the face of reduced genetic diversity.

Susceptibility of Corn Earworm (Lepidoptera: Noctuidae) to Cry1A.105 and Cry2Ab2 in North and South Carolina

The corn earworm, Helicoverpa zea (Boddie), is managed in corn and cotton in the United States primarily using transgenic cultivars that produce insecticidal proteins from the bacterium Bacillus thuringiensis (Bt). However, increasing reports of resistance to one or more Bt proteins threaten the continued efficacy of Bt traits. To better understand the development of resistance of H. zea to Bt corn and cotton in the southeastern United States, we monitored for resistance to Cry1A.105 and Cry2Ab2 among 22 field populations of H. zea collected in non-Bt and Bt corn expressing Cry1A.105 + Cry2Ab2 during 2017 and 2018. Colonies were established in the laboratory and progeny were screened in diet-overlay bioassays to purified Cry1A.105 and Cry2Ab2 proteins. Compared with two susceptible laboratory colonies, all 14 field colonies tested with Cry1A.105 were highly resistant, with resistance ratios (RRs) ranging from 13.5 to >4,000. For Cry2Ab2, 19 colonies were tested and RRs ranged from 0.26 to 33.7. Field populations were significantly more susceptible to Cry2Ab2 than Cry1A.105. We documented variability in F0 and F1 pupal weight and developmental rates of natural populations of H. zea, but observed no significant correlation with susceptibility to either Cry1A.105 or Cry2Ab2. Our results expand on the recent reports of H. zea resistance to Cry1A and Cry2A proteins and will aid in the design and deployment of future pyramided crops in the United States.

Process and Product Innovations from a Statewide Capacity-Building Initiative for Substance Use Treatment and Recovery

Statewide behavioral health collaborative capacity-building initiatives are designed to support substance use agencies in strengthening their behavioral health services delivery and implementing evidence-supported practices. This study explored the types of innovations resulting from one such statewide behavioral health initiative, as well as the facilitators and barriers to implementing these innovations, from the perspective of the substance use agencies involved in the initiative. Data were collected through semistructured interviews with 67 agency stakeholders and 93 agency progress reports. Results indicated that 161 innovations emerged through this project for the substance use agencies, including staffing; policy, procedure, and technology; partnerships; training and media products; and service innovations. Agency facilitators included collaboration/partnership, project buy-in, and quality of agency staff. Barriers to implementation included lack of collaboration or partnerships, agency infrastructure or climate, lack of project buy-in, and funding and billing issues. The article concludes with a discussion on implications for social work practice in behavioral health.

Delay discounting and reward sensitivity in a 2 × 2 study of bipolar disorder and alcohol dependence

BACKGROUND AND AIMS

Separate studies have shown increased delay discounting in people with bipolar disorder (BD) and people with alcohol dependence (AD) relative to people without mental health problems. Delay discounting was compared in people with no mental health problems, AD, BD and AD plus BD. Associations of delay discounting with self-reported impulsivity and reward sensitivity were also assessed.

DESIGN

The study was a two-by-two factorial comparative observational design.

SETTING

Data were collected at baseline diagnostic visits as part of a neuroimaging study at a medical university in South Carolina, USA.

PARTICIPANTS

Twenty-two BD + AD, 33 BD, 28 AD and 27 people without mental health problems participated.

MEASUREMENTS

Diagnostic and clinician-rated symptom measures, self-report questionnaires and a computerized delay discounting task were administered. Two-by-two general linear univariate models were tested to examine between-group differences on discounting rates, and bivariate correlations and hierarchical regression analyses were performed to examine associations between discounting rates and self-reported reward sensitivity and impulsivity.

FINDINGS

There was a significant main effect of AD (P = 0.006, η2  = 0.068). The main effect of BD and the BD × AD interaction terms were non-significant (P ≥ 0.293, η2  ≤ 0.010). Reward sensitivity and impulsivity were not significantly associated with discounting rates after adjustment for the other (P ≥ 0.089).

CONCLUSIONS

People with alcohol dependence appear to have higher delay discounting, while previously found associations between bipolar disorder and delay discounting may be secondary to alcohol use disorder.

Occurrence of tire wear particles and other microplastics within the tributaries of the Charleston Harbor Estuary, South Carolina, USA

Microplastics (<5 mm) are ubiquitous in the marine environment, occurring in both sediments and surface waters worldwide. However, few studies have documented the presence of microplastics and tire wear particles in coastal rivers. A survey of microplastics and low-density tire wear particles (≥63 μm) in the sediment and surface water of the three major tributaries within the Charleston Harbor estuary was conducted. Intertidal sediment, subtidal sediment, and sea surface microlayer concentrations ranged from 0 to 652 microplastics/m², 3-4,375 microplastics/kg wet weight, and 3-36 microplastics/L, respectively. Blue fibers and tire wear particles were the two most abundant microplastic types observed, constituting 26.2% and 17.1%, respectively, of total microplastics. Tire wear particles were primarily identified by morphology, and ATR-FTIR analysis was conducted for a small subset (n = 5) of larger particles (≥500 μm). The present study provides the first microplastic field assessment of low-density tire wear particles in estuarine tributaries.