Increased Dementia Mortality in West Virginia Counties with Mountaintop Removal Mining?

Atmospheric particulate matter (PM) is elevated in areas of mountaintop removal mining (MTM), a practice that has been ongoing in some counties of West Virginia (WV) USA since the 1970s. PM inhalation has been linked to central nervous system pathophysiology, including cognitive decline and dementia. Here we compared county dementia mortality statistics in MTM vs. non-MTM WV counties over a period spanning 2001–2015. We found significantly elevated age-adjusted vascular or unspecified dementia mortality/100,000 population in WV MTM counties where, after adjusting for socioeconomic variables, dementia mortality was 15.60 (±3.14 Standard Error of the Mean (S.E.M.)) times higher than that of non-MTM counties. Further analyses with satellite imaging data revealed a highly significant positive correlation between the number of distinct mining sites vs. both mean and cumulative vascular and unspecified dementia mortality over the 15 year period. This was in contrast to finding only a weak relationship between dementia mortality rates and the overall square kilometers mined. No effect of living in an MTM county was found for the rate of Alzheimer’s type dementia and possible reasons for this are considered. Based on these results, and the current literature, we hypothesize that inhalation of PM associated with MTM contributes to dementia mortality of the vascular or unspecified types. However, limitations inherent in ecological-type studies such as this, preclude definitive extrapolation to individuals in MTM-counties at this time. We hope these findings will inspire follow-up cohort and case-controlled type studies to determine if specific causative factors associated with living near MTM can be identified. Given the need for caregiving and medical support, increased dementia mortality of the magnitude seen here could, unfortunately, place great demands upon MTM county public health resources in the future.

Effects of MCHM on yeast metabolism

On January 2014 approximately 10,000 gallons of crude 4-Methylcyclohexanemethanol (MCHM) and propylene glycol phenol ether (PPH) were accidentally released into the Elk River, West Virginia, contaminating the tap water of around 300,000 residents. Crude MCHM is an industrial chemical used as flotation reagent to clean coal. At the time of the spill, MCHM's toxicological data were limited, an issue that has been addressed by different studies focused on understanding the immediate and long-term effects of MCHM on human health and the environment. Using S. cerevisiae as a model organism we study the effect of acute exposure to crude MCHM on metabolism. Yeasts were treated with MCHM 550 ppm in YPD for 30 minutes. Polar and lipid metabolites were extracted from cells by a chloroform-methanol-water mixture. The extracts were then analyzed by direct injection ESI-MS and by GC-MS. The metabolomics analysis was complemented with flux balance analysis simulations done with genome-scale metabolic network models (GSMNM) of MCHM treated vs non-treated control. We integrated the effect of MCHM on yeast gene expression from RNA-Seq data within these GSMNM. A total of 215 and 73 metabolites were identified by the ESI-MS and GC-MS procedures, respectively. From these 26 and 23 relevant metabolites were selected from ESI-MS and GC-MS respectively, for 49 unique compounds. MCHM induced amino acid accumulation, via its effects on amino acid metabolism, as well as a potential impairment of ribosome biogenesis. MCHM affects phospholipid biosynthesis, with a potential impact on the biophysical properties of yeast cellular membranes. The FBA simulations were able to reproduce the deleterious effect of MCHM on cellular growth and suggest that the effect of MCHM on ubiquinol:ferricytochrome c reductase reaction, caused by the under-expression of CYT1 gene, could be the driven force behind the observed effect on yeast metabolism and growth.

Assessing tree ring δ15N of four temperate deciduous species as an indicator of N availability using independent long-term records at the Fernow Experimental Forest, WV

Nitrogen deposition in the northeastern US changed N availability in the latter part of the twentieth century, with potential legacy effects. However, long-term N cycle measurements are scarce. N isotopes in tree rings have been used as an indicator of N availability through time, but there is little verification of whether species differ in the strength of this signal. Using long-term records at the Fernow Experimental Forest in West Virginia, we examined the relationship between soil conditions, including net nitrification rates, and wood δ¹⁵N in 2014, and tested the strength of correlation between tree ring δ¹⁵N of four species and stream water NO₃^- loss from 1971 to 2000. Higher soil NO₃^- was weakly associated with higher wood δ¹⁵N across species, and higher soil net nitrification rates were associated with higher δ¹⁵N for Quercus rubra only. The δ¹⁵N of Liriodendron tulipifera and Q. rubra, but neither Fagus grandifolia nor Prunus serotina, was correlated with stream water NO₃^-. L. tulipifera tree ring δ¹⁵N had a stronger association with stream water NO₃^- than Q. rubra. Overall, we found only limited evidence of a relationship between soil N cycling and tree ring δ¹⁵N, with a strong correlation between the wood δ¹⁵N and NO₃^- leaching loss through time for one of four species. Tree species differ in their ability to preserve legacies of N cycling in tree ring δ¹⁵N, and given the weak relationships between contemporary wood δ¹⁵N and soil N cycle measurements, caution is warranted when using wood δ¹⁵N to infer changes in the N cycle.

Initiating Persons into Injection Drug Use in Rural West Virginia, USA

Background: While prior research has explored factors associated with people who inject drugs (PWID) initiating others into drug injection in urban settings, very little work has been done to understand this behavior among rural PWID in Appalachia. Objectives: We aim to identify factors associated with PWID initiating injection-naïve individuals into drug injection in a rural community in West Virginia (WV). Methods: Data were derived from a cross-sectional survey of 420 rural PWID (163 women) in Cabell County, WV in June-July 2018 who indicated recent (past 6 months) injection drug use. Individuals completed a survey that included measures on socio-demographics and injection socialization behaviors. We used logistic regression to identify factors associated with PWID recently initiating someone for their first injection. Results: A minority (17%) reported recently initiating someone for their first injection. In multivariable regression, recent injection initiation was independently associated with number of injections per day (adjusted odds ratio [aOR] 1.16; 95% confidence interval [CI]:1.07,1.25), recent injection in front of an injection-naïve person (aOR 2.75; 95% CI: 1.25,6.04), recent describing how to inject drugs to an injection-naïve person (aOR 5.83; 95% CI: 2.71,12.57), and recent encouragement of an injection-naïve person to inject (aOR 7.13; 95% CI: 2.31,21.87). Conclusion: Injection initiation was independently associated with several injection socialization behaviors involving injection-naïve individuals. PWID who recently initiated injection-naïve individuals had higher odds of frequent injection. Educating rural PWID about how their behaviors can influence others and the importance of engaging in safe injection practices could carry significant public health utility.

Maternal characteristics associated with injury-related infant death in West Virginia, 2010-2014

Although injury-related deaths have been documented among children and adult populations, insufficient attention has been directed towards injury-related infant deaths. The objective of this retrospective study was to investigate maternal and infant characteristics associated with injury-related infant deaths in West Virginia. Birth and infant mortality data for 2010-2014 were sourced from the West Virginia Bureau for Public Health, Charleston. Relative risk was calculated using log-binomial regression utilizing generalized estimating equations. Maternal characteristics associated with injury-related infant mortality in West Virginia were race/ethnicity ([Formula: see text] = 7.48, p = .03), and smoking during pregnancy ([Formula: see text], p < .00). Risk of a Black Non-Hispanic infant suffering an injury-related death was 4.0 (95% CL 1.7, 9.3) times that of infants of other races/ethnicities. Risk of an infant dying from an injury-related cause, if the mother smoked during pregnancy, was 2.9 (95% CL 1.6, 5.0) times the risk of such a death if maternal smoking status during pregnancy is unknown or no smoking, controlling for race/ethnicity. This study provides important information to public health stakeholders at both the state and local levels in designing interventions for partial reduction or prevention of injury-related infant mortality in West Virginia.

Use of high-throughput screening results to prioritize chemicals for potential adverse biological effects within a West Virginia watershed

Organic chemicals from industrial, agricultural, and residential activities can enter surface waters through regulated and unregulated discharges, combined sewer overflows, stormwater runoff, accidental spills, and leaking septic-conveyance systems on a daily basis. The impact of point and nonpoint contaminant sources can result in adverse biological effects for organisms living in or near surface waters. Assessing the adverse or toxic effects that may result when exposure occurs is complicated by the fact that many commonly used chemicals lack toxicity information or water quality standards. To address these challenges, an exposure-activity ratio (EAR) screening approach was used to prioritize environmental chemistry data in a West Virginia watershed (Wolf Creek). Wolf Creek is a drinking water source and recreation resource with documented water quality impacts from point and nonpoint sources. The EAR screening approach uses high-throughput screening (HTS) data from ToxCast as a method of integrating environmental chemical occurrence and biological effects data. Using water quality schedule 4433, which targets 69 organic waste compounds typically found in domestic and industrial wastewater, chemicals were screened for potential adverse biological affects at multiple sites in the Wolf Creek watershed. Cumulative EAR mixture values were greatest at Sites 2 and 3, where bisphenol A (BPA) and pentachlorophenol exhibited maximum EAR values of 0.05 and 0.002, respectively. Site 2 is downstream of an unconventional oil and gas (UOG) wastewater disposal facility with documented water quality impacts. Low-level organic contaminants were found at all sample sites in Wolf Creek, except Site 10, where Wolf Creek enters the New River. The application of an EAR screening approach allowed our study to extend beyond traditional environmental monitoring methods to identify multiple sites and chemicals that warrant further investigation.

A pilot study of minimum operational flow for loose-fitting powered air-purifying respirators used in healthcare cleaning services

The objective of this pilot study was to determine the minimum operational flow for loose-fitting powered air-purifying respirators (PAPR) used in healthcare cleaning services. An innovative respiratory flow recording device was worn by nine healthcare workers to obtain the minute volume (MV, L/min), mean inhalation flow (MIF, L/min), and peak inhalation flow (PIF, L/min) while performing "isolation unit work" (cleaning and disinfecting) of a patient room within 30 min. The MV and PIF were compared with the theoretical values obtained from an empirical formula. The correlations of MV, MIF, and PIF with subjects' age, weight, height, body surface area (A_Du), and body mass index (BMI) were analyzed. The average MV, MIF, and PIF were 33, 74, and 107 L/min, with maximal airflow rates of 41, 97, and 145 L/min, respectively, which are all below the current 170 L/min minimum operational flow for NIOSH certified loose-fitting PAPRs.

The importance of pathophysiology to the understanding of functional limitations in the bioarchaeology of care approach

This article presents a partial bioarchaeology of care case study of a mummified adult female with chronic obstructive pulmonary disease (COPD) from late historic period United States. It examines likely clinical and functional impacts of disease and corresponding need for provision of care, stopping short of Stage 4 Interpretation/analysis. The case study illustrates and argues for the importance of an interdisciplinary research team for achieving a comprehensive understanding of disability and care. The article highlights the necessity of knowledge of pathophysiology for identifying the potential interventions (supports) dictated by the associated functional limitations. inter alia, this case is a powerful illustration of the way analysis of preserved soft tissue can provide insights into disease and likely care that are inaccessible using skeletal analysis alone. The article represents an interesting contribution to the theory and methodology of both the bioarchaeology of care approach and mummy studies.

Synthesis and health-based evaluation of ambient air monitoring data for the Marcellus Shale region

In recent years, there has been a marked increase in the amount of ambient air quality data collected near Marcellus Shale oil and gas development (OGD) sites. We integrated air measurement data from over 30 datasets totaling approximately 200 sampling locations nearby to Marcellus Shale development sites, focusing on 11 air pollutants that can be associated with OGD operations: fine particulate matter (PM_2.5), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), acetaldehyde, benzene, ethylbenzene, formaldehyde, n-hexane, toluene, xylenes, and hydrogen sulfide (H₂S). We evaluated these data to determine whether there is evidence of community-level air quality impacts of potential health concern, making screening-level comparisons of air monitoring data with acute and chronic health-based air comparison values (HBACVs). Based on the available air monitoring data, we found that only a small fraction of measurements exceeded HBACVs, which is similar to findings from integrative air quality assessments for other shale gas plays. Therefore, the data indicate that air pollutant levels within the Marcellus Shale development region typically are below HBACV exceedance levels; however, the sporadic HBACV exceedances warrant further investigation to determine whether they may be related to specific site characteristics, or certain operations or sources. Like any air monitoring dataset, there is uncertainty as to how well the available Marcellus Shale air monitoring data characterize the range of potential exposures for people living nearby to OGD sites. Given the lesser amounts of air monitoring data available for locations within 1,000 feet of OGD sites as compared to locations between 0.2 and 1 miles, the presence of potential concentration hotspots cannot be ruled out. Additional air monitoring data, in particular more real-time data to further characterize short-term peak concentrations associated with episodic events, are needed to provide for more refined assessments of potential health risks from Marcellus Shale development. Implications: While there is now a sizable amount of ambient air monitoring data collected nearby to OGD activities in the Marcellus Shale region, these data are currently scattered among different databases and studies. As part of an integrative assessment of Marcellus Shale air quality impacts, ambient air data are compiled for a subset of criteria air pollutants and hazardous air pollutants that have been associated with OGD activities, and compared to acute and chronic health-based air comparison values to help assess the air-related public health impacts of Marcellus Shale development.

Hypodontia, Oligodontia and Anodontia in West Virginia Appalachia

Purpose: Children in West Virginia have a high prevalence of missing permanent teeth when compared to children in the rest of the nation. The purpose of this study is to determine the prevalence of permanent tooth hypodontia/oligodontia/anodontia in West Virginia children and to compare the prevalence by sex.Methods: Five hundred panoramic radiographs of West Virginia children, ages 6-11 years, were examined for missing permanent tooth buds/permanent teeth. Data analyses included frequency determinations, Chi square analyses, and logistic regression.Results: Sixty children (12.0%, n=500) had at least one missing permanent tooth bud/permanent tooth. There were 15.5% of females and 8.8% of males who had at least one missing permanent tooth bud/permanent tooth. In adjusted logistic regression on at least one missing permanent tooth bud/permanent tooth, females had an adjusted odds ratio of 2.11 [95% Confidence Interval: 1.18, 3.75; p = .011] compared with males. Other variables in the analysis failed to reach significance.Conclusion: In this sample of West Virginia children, females were more likely to have at least one missing permanent tooth bud/permanent tooth compared to males. Early recognition and treatment planning for dental care is needed for children with hypodontia/oligodontia/anodontia.

Water quality perceptions and natural resources Extraction: A matter of geography?

Recent events in the United States have shown the vulnerability of water quality in certain communities. Accordingly, we conducted a survey in a large community in north central West Virginia (US) to explore the factors that influence the perceptions of water quality. We sought to assess whether respondent's proximity to a mine, gas/oil well, or bodies of water would affect their perceived health risks and environmental concern. Additionally, we aimed at understanding how these perceptions were affected by the density of these sites and the presence of these sites within defined distances. As West Virginia is rapidly expanding its natural gas production, there is no research that has objectively associated water quality perceptions with geographic location in regard to oil and gas extraction sites. With small effect sizes, our results add some evidence to the link between unconventional oil and gas extraction, geographic location, and water quality perceptions. This study suggests the need for further water quality monitoring and increased public communication about water management practices in West Virginia.

Nelson-Denny Reading Test Scores as a Predictor of Student Success in Osteopathic Medical Education

Background

Reading skills are crucial in medical school, where students are expected to absorb an onslaught of new and complex material. Studies on reading assessment in osteopathic medical education are lacking.

Objective

To address gaps in the literature related to reading assessment and to investigate the correlation of the Nelson-Denny Reading Test with various performance indicators in osteopathic medical education.

Methods

The West Virginia School of Osteopathic Medicine administered the Nelson-Denny Reading Test to first- and second-year students between 2015 and 2017. Raw scores were translated into the percentile rank, scale score, grade equivalent score, and stanine score based on guidelines supplied with the Nelson-Denny Reading Test. These translated scores were compared with Medical College Admission Test (MCAT) scores, first- and second-year performance on course examinations, Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 scores, and scores provided in a 2002 study by Haught and Walls.

Results

A total of 623 students took the first-year Nelson-Denny Reading Test, and 408 took both the first- and second-year Nelson-Denny Reading Test. Findings showed a large correlation between the Nelson-Denny Reading Test and the verbal reasoning section (r=0.56 for the class of 2020 and 0.46 for the class of 2021) of the old MCAT (before 2015) and the reasoning skills section (r=0.42 for the class of 2020 and 0.49 for the class of 2021) of the new MCAT (released in 2015). There were no correlations with first- and second-year course examination scores or COMLEX-USA Level 1 scores. The Nelson-Denny Reading Test scores reported by Haught and Walls for medical students and health professional students were slightly higher than those found for osteopathic medical students in this study.

Conclusion

The reasoning skills section of the new MCAT could serve as a good proxy for a reading test. There were no correlations between the Nelson-Denny Reading Test and performance in the first 2 years of medical school or COMLEX-USA Level 1 performance. Further research can strengthen the findings and determine whether correlations exist with clinical performance.

Point-of-Care Ultrasonography Integration in Undergraduate Medical Education: A Student-Driven Approach

Background

The importance of medical ultrasonography (US) is well established, but given an already dense curriculum, integration of US into preclinical training can be difficult. Although there is no clear consensus on the best practice for integrating US into medical school curricula, growing student interest in US training demands investigation of potential solutions.

Objective

To investigate whether US integration through peer-assisted learning (PAL) and extracurricular activities during preclinical training is perceived to be valuable by student participants.

Methods

First- and second-year students at the West Virginia School of Osteopathic Medicine (WVSOM) were invited via email to attend 4 monthly PAL extracurricular US sessions on the following point-of-care US topics: (1) basic lung examination to assess pleural sliding, (2) extended focused assessment with sonography for trauma, (3) right upper quadrant biliary examination, and (4) US-guided central venous catheter placement. A brief survey using Likert-style questions inquired about participants' level of agreement with whether the given session was appropriately complex, increased comfort with US, was informative and interactive, and improved confidence in identifying anatomic structures (sessions 2 and 3 only). A final question asked participants whether they would attend more extracurricular US sessions.

Results

Fifty-eight students (36 unique students) attended the peer-led sessions. Of the 58 students, 50 responded to the survey for a response rate of 86.2%. Responses were overwhelmingly positive. All respondents strongly agreed or agreed that these sessions improved their confidence in identifying anatomic structures using US, and 49 (98%) strongly agreed or agreed that they would attend more US sessions.

Conclusion

Respondents strongly endorsed the peer-led US sessions, which has facilitated the formal integration of an elective US course at WVSOM. The peer-led sessions introduced at WVSOM could provide the framework and motivation for similar courses at osteopathic medical schools across the country.

Microbial lipid biomarkers detected in deep subsurface black shales

Evidence for microbes has been detected in extreme subsurface environments as deep as 2.5 km with temperatures as high as 90 °C, demonstrating that microbes can adapt and survive extreme environmental conditions. Deep subsurface shales are increasingly exploited for their energy applications, thus characterizing the prevalence and role of microbes in these ecosystems essential for understanding biogeochemical cycles and maximizing production from hydrocarbon-bearing formations. Here, we describe the distribution of bacterial ester-linked phospholipid fatty acids (PLFA) and diglyceride fatty acids (DGFA) in sidewall cores retrieved from three distinct geologic horizons collected to 2275 m below ground surface in a Marcellus Shale well, West Virginia, USA. We examined the abundance and variety of PLFA and DGFA prior to energy development within and above the Marcellus Shale Formation into the overlying Mahantango Formation of the Appalachian Basin. Lipid biomarkers in the cores suggest the presence of microbial communities comprising Gram (+), Gram (-) as well as stress indicative biomarkers. Microbial PLFA and DGFA degradation in the subsurface can be influenced by stressful environmental conditions associated with the subsurface. The PLFA concentration and variety were higher in the transition zone between the extremely low permeability Marcellus Shale Formation and the more permeable Mahantango Formation. In contrast to this distribution, more abundant and diverse DGFA membrane profiles were associated with the Mahantango Formation. The stress indicative biomarkers like the trans-membrane fatty acids, oxiranes, keto-, and dimethyl lipid fatty acids were present in all cores, potentially indicating that the bacterial communities had experienced physiological stress or nutrient deprivation during or after deposition. The DGFA profiles expressed more stress indicative biomarkers as opposed to the PLFA membrane profiles. These findings suggest the probable presence of indigenous microbial communities in the deep subsurface shale and also improves our understanding of microbial survival mechanisms in ancient deep subsurface environments.

Association Between Breastfeeding and Childhood Cardiovascular Disease Risk Factors

Introduction The immediate benefits of breastfeeding are well-established but the long-term health benefits are less well-known. West Virginia (WV) has a higher prevalence of cardiovascular disease (CVD) and lower breastfeeding rates compared to national averages. There is a paucity of research examining the relationship between breastfeeding and subsequent childhood CVD risk factors, an issue of particular relevance in WV. Methods This study used longitudinally linked data from three cross-sectional datasets in WV (N = 11,980). The information on breastfeeding was obtained retrospectively via parental recall when the child was in the fifth grade. The outcome variables included blood pressure measures [systolic blood pressure (SBP), diastolic blood pressure (DBP)] and lipid profile [total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), non-HDL, and triglycerides (TG)]. Multiple regression analyses were performed, adjusting for childhood body mass index (BMI) and additional covariates. Results Only 43% of mothers self-reported ever breastfeeding. The unadjusted analysis showed that children who were ever vs. never breastfed had significantly lower SBP (b = - 1.39 mmHg; 95% CI - 1.97, - 0.81), DBP (b = - 0.79 mmHg; 95% CI - 1.26, - 0.33), log-TG (b = - 0.08; 95% CI - 0.1, - 0.05), and higher HDL (b = 0.95 mg/dL; 95% CI 0.33, 1.56). After adjustment for the child's BMI, socio-demographic and lifestyle factors, log-TG remained significantly associated with breastfeeding (b = - 0.04; 95% CI - 0.06, - 0.01; p = 0.01). Conclusion The observed protective effect of any breastfeeding on childhood TG level was small but significant. This finding provides some support for a protective effect of breastfeeding on later CVD risk.

Influence of the Agricultural Conservation Easement Program wetland practices on winter occupancy of Passerellidae sparrows and avian species richness

Wetlands enrolled in the Agricultural Conservation Easement Program (ACEP) are established as a means of restoring wetland ecosystems and wildlife habitat on private, agricultural land. In West Virginia, USA, ACEP wetlands have never been evaluated to determine how they function as wildlife habitat in comparison to other available wetland habitat in the state. We measured the wintering occupancy of Passerellidae species and apparent avian species richness on ACEP wetlands and a set of reference wetlands located on public land in West Virginia to evaluate if ACEP wetlands are being used similarly by avian species to other available wetland habitat in the state. Apparent avian species richness and the occupancy probability of four Passerellidae species—song sparrows (Melospiza melodia), dark-eyed juncos (Junco hyemalis), swamp sparrows (Melospiza georgiana), and white-throated sparrows (Zonotrichia albicollis)—did not differ between ACEP and reference sites. In addition to other vegetative and habitat associations for each species, dark-eyed junco occupancy was negatively correlated with wetland size while swamp sparrow occupancy and apparent avian species richness were positively associated with wetland size. These results indicate that ACEP wetlands are providing winter avian habitat as well as another source of wetland habitat in the state. Maintaining and expanding ACEP wetlands in West Virginia would continue to provide wetland systems in areas that are otherwise lacking these habitats.

Longitudinal Ultrasound Curriculum Incorporation at West Virginia University School of Medicine: A Description and Graduating Students' Perceptions

OBJECTIVES

Sonography is a clinical tool being incorporated in multiple medical specialties with evidence of improved patient care and cost. Some schools have begun implementing ultrasound curricula. We hope to build upon that foundation and provide another potential framework of incorporation. There are several barriers, including curricular space, equipment and physical space, adequate faculty, and performing assessment.

METHODS

At West Virginia University, we began a longitudinal ultrasound curriculum in 2012 with incorporation of didactic and practical sessions into gross anatomy, our systems-based second-year curriculum, physical diagnosis course, and clinical rotations. We included both written and practical assessment from the onset. After the initial 4 years, the first graduates were surveyed on their perceptions of the curriculum. Responses were correlated with specialty choice and clinical campus site.

RESULTS

Based on our survey (90% response rate), students felt sonography was useful for anatomical understanding and patient care. Overall, 93% of our respondents reviewed the curriculum favorably. Qualitative feedback was very positive, with students desiring more ultrasound education and more required components, specifically in clinical rotations.

CONCLUSIONS

Based on these results, some changes have already been implemented, including decreased student-to-instructor ratios, more open scan time, and more required components. The breadth of formal assessment has increased. Multiple pilot programs for clinical rotations are being developed. There is an ongoing need for faculty development and continued assessment of ultrasound competency.

Access to Abortion in Central Appalachian States: Examining County of Residence and County-Level Attributes

CONTEXT

Studies of how women's individual characteristics and place of residence are related to variability in gestational age at the time of abortion have not examined county of residence and county-level characteristics. The county level is potentially meaningful, given that county is the smallest geographic unit with policy implications.

METHODS

Data on 38,611 abortions that took place in North Carolina, Virginia and West Virginia in 2012 were used to study the relationship between gestational age and county-level attributes (e.g., metropolitan status and poverty). Three-level hierarchical linear models captured individuals nested in county of residence, clustered by state of residence, and adjusted for individual characteristics and distance traveled to care.

RESULTS

Eight percent of the variation in gestational age at abortion was attributable to county-level characteristics. Residents of counties characterized by persistent poverty obtained abortions 2.3 days later in gestation than those from counties not characterized by that level of economic hardship. Women living in nonmetropolitan counties obtained abortions 1.7 days later than those living in metropolitan counties, even after distance traveled and county-level poverty were controlled for.

CONCLUSION

County of residence is relevant to gestational age at the time of abortion for women in these three states. Evidence that county-level attributes are related to access adds insight to the consequences for women when the landscape of abortion service delivery shifts. Integrating county of residence into research on access to abortion services may be critical to capturing disparities in access.

Rural and urban differences in prenatal exposure to essential and toxic elements

Excess or inadequate levels of inorganic ions may induce significant acute and long-term irreversible dysfunction in humans. The fetus and placenta are particularly vulnerable to toxins due to the immaturity of the blood-brain barrier and diminished biotransformation enzymatic activity. A comparative cross-sectional study was conducted on 172 pregnant women, 79 rural, and 93 urban. Umbilical cord blood was collected at the time of delivery and analyzed for 20 inorganic elements. Significant differences were found between urban and rural samples for two elements where copper (Cu) and molybdenum (Mo) were higher in urban samples. No marked differences between groups occurred for: arsenic, barium, cadmium, calcium, cobalt, lead, lithium, magnesium, manganese, mercury, selenium, strontium, or zinc. All samples were devoid of platinum, silver, thallium or uranium. Data demonstrated significant differences in urban and rural prenatal exposure to Cu and Mo. Further study is needed to determine if there is a causal link between neonatal outcomes and prenatal exposure to these elements.

Unconventional oil and gas chemicals and wastewater-impacted water samples promote adipogenesis via PPARγ-dependent and independent mechanisms in 3T3-L1 cells

Unconventional oil and natural gas (UOG) operations have contributed to a surge in domestic oil and natural gas production in the United States, combining horizontal drilling with hydraulic fracturing to unlock previously inaccessible fossil fuel deposits. >1000 organic chemicals are used in the production process, and wastewater is produced following injection and for the life of the producing well. This wastewater is typically disposed of via injecting into disposal wells for long-term storage, treatment and discharge from wastewater treatment plants, and/or storage in open evaporation pits; however, wastewater spill rates are reported at 2-20% of active well sites across regions, increasing concerns about the environmental impacts of these wastewaters. This study assessed adipogenic activity (both triglyceride accumulation and pre-adipocyte proliferation) for a mixture of 23 commonly used UOG chemicals and a small subset of UOG wastewater-impacted surface water extracts from Colorado and West Virginia, using 3T3-L1 cells and a peroxisome proliferator activated receptor gamma (PPARγ) reporter assay. We report potent and efficacious adipogenic activity induced by both a laboratory-created UOG chemical mixture and UOG-impacted water samples at concentrations below environmental levels. We further report activation of PPARγ at similar concentrations for some samples, suggesting a causative molecular pathway for the observed effects, but not for other adipogenic samples, implicating PPARγ-dependent and independent effects from UOG associated chemicals. Taken together, these results suggest that UOG wastewater has the potential to impact metabolic health at environmentally relevant concentrations.

Veteran-to-Veteran Program

More Veterans are receiving health care outside of the Veterans Health Administration. Over concern for the Veteran's safety and the provider's competency, three progressive steps have been taken within the state of West Virginia. J Contin Educ Nurs. 2018;49(11):493-495.

Implementing Landscape Scale Conservation across Organizational Boundaries: Lessons from the Central Appalachian Region, United States

Natural resources across the United States are increasingly managed at the landscape scale through cooperation among multiple organizations and landowners. United States Department of Agriculture Forest Service (USFS) agency leaders have widely promoted this approach since 2009 when Secretary of Agriculture Vilsack called for "all lands" management. Landscape scale projects have been undertaken to address multiple goals such as single species conservation, resilience to fire, invasive species eradication, and others. The West Virginia Restoration Venture (WVRV)-one of five landscape scale conservation projects funded 2014-2016 across the Northeast and Midwest and known as "Joint Chiefs'" projects-was evaluated by an interdisciplinary team of USFS employees to gain insight into how cross-boundary landscape scale conservation projects are implemented in the region. In this paper, the team used qualitative interview data from project participants to explore processes related to developing a shared vision for the landscape, implementation priorities, and methods to work across institutional and property ownership boundaries. Grounded in the landscape and collaborative resource management literatures, the report shows how established inter-organizational networks, flexible approaches to management, and a "shelf-stock" of ready-to-implement projects led to on-the-ground success. The authors provide insight about factors that constrain and facilitate the implementation of landscape scale conservation projects that have multiple goals, landowners, and organizational partners.