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The Legacy Ash Rule- ​ Can Beneficial Reuse Be A Solution, Tom Kierspe

World of Coal Ash Proceedings

THE LEGACY ASH RULE: CAN BENEFICIAL REUSE BE A SOLUTION? Authors Mr. Tom Kierspe - United States - The SEFA Group, LLC Abstract Tom Kierspe, P.E.1 1The SEFA Group, 219 Cedar Road, Lexington, SC 29073 KEYWORDS: Coal Ash Beneficiation, Beneficial Reuse, Encapsulated Reuse, Coal Ash Recycling, Thermal Beneficiation, Pond Reclamation, STAR Process, Stakeholders, CCP Impoundments, Characterization ABSTRACT On May 18, 2023, EPA proposed changes to the CCR regulations for inactive surface impoundments at inactive electric utilities, referred to as “legacy CCR surface impoundments”. With the final rule currently proposed to be issued April 2024, utilities are reevaluating these sites. Much …

Dewatering Optimization Strategies In Support Of Closure By Removal (Cbr) To Accelerate Groundwater Cleanup At Coal Combustion Residual Sites (Ccr) With Case Study, Sean Larkin, Jacob Chu

World of Coal Ash Proceedings

Dewatering Optimization Strategies in Support of Closure by Removal (CBR) to Accelerate Groundwater Cleanup at CCR Sites with Case Study Authors Mr. Sean Larkin - United States - Haley & Aldrich Inc. Dr. Jacob Chu - United States - Haley & Aldrich Inc. Abstract This presentation is focused on coal combustion residual (CCR) sites in corrective action that are performing closure-by-removal (CBR) in support of an overall groundwater remedy. CBR is often coupled with a variety of groundwater treatment options, including (but not limited to), monitored natural attenuation and/or contingent active or passive treatment of areas within the plume where …

Beneficial Use Of​ Harvested Ponded Fly Ash And Landfilled Fgd Materials For High-Volume Surface Mine Reclamation, Tarunjit Butalia

World of Coal Ash Proceedings

Use of Harvested Fly Ash and LandfilledFGD Materials for Mine Reclamation Authors Dr. Tarunjit Butalia - United States - The Ohio State University Abstract In this work, The Ohio State University will present a full-scale demonstration project at the now-defunct Conesville power plant in Ohio, at which fly ash was harvested from a closed-out ash pond and stabilized FGD material recovered from a closed-out landfill to reclaim an abandoned surface mine. Site monitoring results will be presented.

Inchi Isotopologue And Isotopomer Specifications, Hunter N. B. Moseley, Philippe Rocca-Serra, Reza M. Salek, Masanori Arita, Emma L. Schymanski

Markey Cancer Center Faculty Publications

This work presents a proposed extension to the International Union of Pure and Applied Chemistry (IUPAC) International Chemical Identifier (InChI) standard that allows the representation of isotopically‑resolved chemi‑ cal entities at varying levels of ambiguity in isotope location. This extension includes an improved interpretation of the current isotopic layer within the InChI standard and a new isotopologue layer specification for representing chemical intensities with ambiguous isotope localization. Both improvements support the unique isotopically‑ resolved chemical identification of features detected and measured in analytical instrumentation, specifically nuclear magnetic resonance and mass spectrometry.

Scientific contribution

This new extension to the InChI standard …

Chemically Induced Cone Degeneration In The 13-Lined Ground Squirrel, Hannah M. Follett, Emma Warr, Jenna Grieshop, Ching Tzu Yu, Mina Gaffney, Owen R. Bowie, Jong Won Lee, Sergey Tarima, Dana K. Merriman, Joseph Carroll

Biostatistics Faculty Publications

Animal models of retinal degeneration are critical for understanding disease and testing potential therapies. Inducing degeneration commonly involves the administration of chemicals that kill photoreceptors by disrupting metabolic pathways, signaling pathways, or protein synthesis. While chemically induced degeneration has been demonstrated in a variety of animals (mice, rats, rabbits, felines, 13-lined ground squirrels (13-LGS), pigs, chicks), few studies have used noninvasive high-resolution retinal imaging to monitor the in vivo cellular effects. Here, we used longitudinal scanning light ophthalmoscopy (SLO), optical coherence tomography, and adaptive optics SLO imaging in the euthermic, cone-dominant 13-LGS (46 animals, 52 eyes) to examine retinal structure …

A Mind-Body Intervention To Improve Physical Activity For Patients With Chronic Hip-Related Pain: Protocol For A Mixed Methods Study., Kate N Jochimsen, Kristin R Archer, Robin A Pollini, Robert A Parker, Nomin Enkhtsetseg, Cale A Jacobs, Ana Maria Vranceanu

Psychiatry Faculty Publications

BACKGROUND: Pain and dysfunction persist for most patients following hip-related pain treatment. Additionally, individuals with hip-related pain are typically less physically active than individuals without hip pain, despite evidence that regular physical activity reduces chronic musculoskeletal pain. Poor psychological health is common in patients with hip-related pain and further reinforces low physical activity. Mind-body interventions can improve psychological health and activity levels but have yet to be integrated to provide comprehensive, psychologically informed care for patients with hip-related pain. Thus, we are using the NCCIH intervention development framework to develop Helping Improve PSychological Health (HIPS), a novel, multimodal mind-body intervention …

Fasting And Glucose Metabolism Differentially Impact Peripheral Inflammation In Human Type 2 Diabetes, Gabriella H. Kalantar, Shubh Saraswat, Sara Santacruz-Calvo, Fatemeh Gholamrezaeinejad, Aida Javidan, Madhur Agrawal, Rui Liu, Philip A. Kern, Xiaohua Douglas Zhang, Barbara S. Nikolajczyk

Biostatistics Faculty Publications

Cytokines produced by peripheral T-helper 1/17 cells disproportionately contribute to the inflammation (i.e., metaflammation) that fuels type 2 diabetes (T2D) pathogenesis. Shifts in the nutrient milieu could influence inflammation through changes in T-cell metabolism. We aimed to determine whether changes in glucose utilization alter cytokine profiles in T2D. Peripheral blood mononuclear cells (PBMCs), CD4+ T-cells, and CD4+CD25- T-effector (Teff) cells were isolated from age-matched humans classified by glycemic control and BMI. Cytokines secreted by CD3/CD28-stimulated PBMCs and Teff were measured in supernatants with multiplex cytokine assays and a FLEXMAP-3D. Metabolic activity of stimulated CD4+ T-cells was measured by a Seahorse …

Protein Oxidation In Aging And Alzheimer’S Disease Brain, Rukhsana Sultana, D. Allan Butterfield

Markey Cancer Center Faculty Publications

Proteins are essential molecules that play crucial roles in maintaining cellular homeostasis and carrying out biological functions such as catalyzing biochemical reactions, structural proteins, immune response, etc. However, proteins also are highly susceptible to damage by reactive oxygen species (ROS) and reactive nitrogen species (RNS). In this review, we summarize the role of protein oxidation in normal aging and Alzheimer’s disease (AD). The major emphasis of this review article is on the carbonylation and nitration of proteins in AD and mild cognitive impairment (MCI). The oxidatively modified proteins showed a strong correlation with the reported changes in brain structure, carbohydrate …

Predicting The Pathway Involvement Of Metabolites Based On Combined Metabolite And Pathway Features, Erik D. Huckvale, Hunter N. B. Moseley

Markey Cancer Center Faculty Publications

A major limitation of most metabolomics datasets is the sparsity of pathway annotations for detected metabolites. It is common for less than half of the identified metabolites in these datasets to have a known metabolic pathway involvement. Trying to address this limitation, machine learning models have been developed to predict the association of a metabolite with a “pathway category”, as defined by a metabolic knowledge base like KEGG. Past models were implemented as a single binary classifier specific to a single pathway category, requiring a set of binary classifiers for generating the predictions for multiple pathway categories. This past approach …

Barriers To Buprenorphine Dispensing By Medicaid-Participating Community Retail Pharmacies, Patricia R Freeman, Lindsey R Hammerslag, Katherine A Ahrens, Michael Sharbaugh, Adam J Gordon, Anna E Austin, Julie M Donohue, Lindsay D Allen, Andrew J Barnes, Jeffery C Talbert

Biostatistics Faculty Publications

IMPORTANCE: Controlled substances have regulatory requirements under the US Federal Controlled Substance Act that must be met before pharmacies can stock and dispense them. However, emerging evidence suggests there are pharmacy-level barriers in access to buprenorphine for treatment for opioid use disorder even among pharmacies that dispense other opioids.

OBJECTIVE: To estimate the proportion of Medicaid-participating community retail pharmacies that dispense buprenorphine, out of Medicaid-participating community retail pharmacies that dispense other opioids and assess if the proportion dispensing buprenorphine varies by Medicaid patient volume or rural-urban location.

DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study included Medicaid pharmacy claims (2016-2019) …

Optimization, Characterization, And Comparison Of Two Luciferase-Expressing Mouse Glioblastoma Models, Louis Rodgers, Julia A. Schulz Pauly, Bryan J. Maloney, Anika M. S. Hartz, Bjoern Bauer

UK CARES Faculty Publications

Glioblastoma (GBM) is the most aggressive brain cancer. To model GBM in research, orthotopic brain tumor models, including syngeneic models like GL261 and genetically engineered mouse models like TRP, are used. In longitudinal studies, tumor growth and the treatment response are typically tracked with in vivo imaging, including bioluminescence imaging (BLI), which is quick, cost-effective, and easily quantifiable. However, BLI requires luciferase-tagged cells, and recent studies indicate that the luciferase gene can elicit an immune response, leading to tumor rejection and experimental variation. We sought to optimize the engraftment of two luciferase-expressing GBM models, GL261 Red-FLuc and TRP-mCherry-FLuc, showing differences …

Influence Of Four Veterinary Antibiotics On Constructed Treatment Wetland Nitrogen Transformation, Matthew Russell, Tiffany L. Messer, Deborah A. Report, Richard L. Smith, Shannon L. Bartelt-Hunt, Daniel D. Snow, Ariel P. Reed

UK CARES Faculty Publications

The use of wetlands as a treatment approach for nitrogen in runoff is a common practice in agroecosystems. However, nitrate is not the sole constituent present in agricultural runoff and other biologically active contaminants have the potential to affect nitrate removal efficiency. In this study, the impacts of the combined effects of four common veterinary antibiotics (chlortetracycline, sulfamethazine, lincomycin, monensin) on nitrate-N treatment efficiency in saturated sediments and wetlands were evaluated in a coupled microcosm/mesocosm scale experiment. Veterinary antibiotics were hypothesized to significantly impact nitrogen speciation (e.g., nitrate and ammonium) and nitrogen uptake and transformation processes (e.g., plant uptake and …

Family-Centered Care For Lgbtq+ Parents Of Infants In The Neonatal Intensive Care Unit: An Integrative Review, Olivia S. Yinger, Aubrey E. Jones, Keisa Fallin-Bennett, Chelsea Gibbs, Rachel H. Farr

UK CARES Faculty Publications

Background: Having an infant in the Neonatal Intensive Care Unit (NICU) can disrupt parent well-being, the transition to parenthood, and the typical trajectories of infant and child health. For lesbian, gay, bisexual, transgender, queer, or other sexual and gender minority identity (LGBTQ+) parents, this stress may be compounded by health disparities and fear of stigma and discrimination; however, research is lacking about LGBTQ+ parents of infants in the NICU. Objectives: The purpose of this integrative review was to better understand the experiences of LGBTQ+ parents of NICU infants, with a focus on experiences of stigma and discrimination, sources of strength …

Addressing Multimodal Transportation Needs Through Complete Streets Implementation, Eirini Stavropoulou, Nikiforos Stamatiadis, William Staats, Teng Wang, Reginald Souleyrette

Kentucky Transportation Center Research Report

Since the early 2000s, over 1,600 transportation agencies in the United States have adopted Complete Streets policies. Recently, the Kentucky Transportation Cabinet (KYTC) published its Complete Streets, Roads, and Highways Manual, which aims to implement a safe and equitable transportation system throughout the state, as well as a Complete Streets policy. The manual and policy offer guidance on integrating Complete Streets principles into road design, however, KYTC currently lacks tools or methods to evaluate how well specific projects address Complete Streets goals. This is problematic because systematic assessments are needed to effectively prioritize projects and allocate scarce funding. Based …

Estimation Of Benefits From Pedestrian And Bicycle Improvements, Dionysios Tzamakos, Nikiforos Stamatiadis, William Staats, Teng Wang, Reginald Souleyrette

Kentucky Transportation Center Research Report

Delivering safe mobility for all users of the transportation system is a key priority of the Kentucky Transportation Cabinet (KYTC). Because many system users rely on pedestrian and bicycle facilities, it is critical for KYTC to balance pedestrian and bicycle facility accommodations with those for motorized users. Currently, the Strategic Highway Investment Formula for Tomorrow (SHIFT) — the Cabinet’s systematic approach to scoring and prioritizing proposed roadway projects — awards up to five points (out of a possible total of 100) for pedestrian and bicycle projects. But the agency lacks a robust method for estimating the benefits of pedestrian and …

Are “10 Grams Of Protein” Better Than “Ten Grams Of Protein”? How Digits Versus Number Words Influence Consumer Judgments, Marisabel Romero, Adam W. Craig, Milica Mormann, Anand Kumar

Marketing & Supply Chain Faculty Publications

Numerical information can be communicated using different number formats, such as digits (“5”) or number words (“five”). For example, a battery product may claim to last for “5 hours” or “five hours.” And while these two formats are used interchangeably in the marketplace, it is not clear how they influence consumer judgments and behavior. Via six experimental studies, two online ad campaigns, and one large secondary dataset analysis, we find that digits, compared to number words, positively affect consumer behavior. We refer to this phenomenon as the number format effect. We further show that the number format effect occurs because …

Matching Study Design To Prescribing Intention, Bethany L. Diprete, Gyeon Oh, Daniela C. Moga, Nabarun Dasgupta, Svetla Slavova, Emily Slade, Chris Delcher, Brian W. Pence, Shabbar I. Ranapurwala

Biostatistics Faculty Publications

Purpose: In drug studies, research designs requiring no prior exposure to certain drug classes may restrict important populations. Since abuse-deterrent formulations (ADF) of opioids are routinely prescribed after other opioids, choice of study design, identification of appropriate comparators, and addressing confounding by “indication” are important considerations in ADF post-marketing studies. Methods: In a retrospective cohort study using claims data (2006–2018) from a North Carolina private insurer [NC claims] and Merative MarketScan [MarketScan], we identified patients (18–64 years old) initiating ADF or non-ADF extended-release/long-acting (ER/LA) opioids. We compared patient characteristics and described opioid treatment history between treatment groups, classifying patients as …

Quantifying Image Quality In Aoslo Images Of Photoreceptors, Brea D. Brennan, Heather Heitkotter, Joseph Carroll, Sergey Tarima, Robert F. Cooper

Biostatistics Faculty Publications

The use of “quality” to describe the usefulness of an image is ubiquitous but is often subject to domain specific constraints. Despite its continued use as an imaging modality, adaptive optics scanning light ophthalmoscopy (AOSLO) lacks a dedicated metric for quantifying the quality of an image of photoreceptors. Here, we present an approach to evaluating image quality that extracts an estimate of the signal to noise ratio. We evaluated its performance in 528 images of photoreceptors from two AOSLOs, two modalities, and healthy or diseased retinas. The algorithm was compared to expert graders’ ratings of the images and previously published …

Identification Of Rnai-Related Genes And Transcriptome Assembly Of Loblolly Pine (Pinus Taeda, L.) Seedlings Exposed To Insect-Specific Dsrna, Zachary Bragg, Lynne K. Rieske

Entomology Faculty Publications

Considerable research has focused on gene silencing in tree-feeding insects, but how trees recognize and process double-stranded RNA (dsRNA) engineered to target plant pests is unknown. We performed transcriptomic assembly, preliminary differential expression analysis, and in silico annotation on loblolly pine (Pinus taeda, L.) seedlings exposed to southern pine beetle-specific dsRNA. This pilot study sought to elucidate the baseline response of seedlings challenged with insect-specific dsRNA. Treated and untreated seedlings were sequenced and following transcriptome assembly 20 RNAi-related proteins (RRPs) were annotated. Differential gene expression analysis conducted using DESeq2 followed by pathway enrichment revealed 7131 differentially expressed transcripts, of which …

Plant Model Of Α-Synucleinopathy: Expression Of Α-Synuclein A53t Variant In Hairy Root Cultures Leads To Proteostatic Stress And Dysregulation Of Iron Metabolism, Jasmina Kurepa, Kristen A. Bruce, Greg A. Gerhardt, Jan A. Smalle

Neurology Faculty Publications

Synucleinopathies, typified by Parkinson’s disease (PD), entail the accumulation of α- synuclein (αSyn) aggregates in nerve cells. Various αSyn mutants, including the αSyn A53T variant linked to early-onset PD, increase the propensity for αSyn aggregate formation. In addition to disrupting protein homeostasis and inducing proteostatic stress, the aggregation of αSyn in PD is associated with an imbalance in iron metabolism, which increases the generation of reactive oxygen species and causes oxidative stress. This study explored the impact of αSyn A53T expression in transgenic hairy roots of four medicinal plants (Lobelia cardinalis, Artemisia annua, Salvia miltiorrhiza, and Polygonum multiflorum). In all …

Regulation Of Rorα Stability Through Prmt5-Dependent Symmetric Dimethylation, Gaofeng Xiong, Brynne Obringer, Austen Jones, Elise Horton, Ren Xu

Markey Cancer Center Faculty Publications

Retinoic acid receptor-related orphan receptor alpha (RORα), a candidate tumor suppressor, is prevalently downregulated or lost in malignant breast cancer cells. However, the mechanisms of how RORα expression is regulated in breast epithelial cells remain incompletely understood. Protein arginine N-methyltransferase 5 (PRMT5), a type II methyltransferase catalyzing the symmetric methylation of the amino acid arginine in target proteins, was reported to regulate protein stability. To study whether and how PRMT5 regulates RORα, we examined the direct interaction between RORα and PRMT5 by immunoprecipitation and GST pull-down assays. The results showed that PRMT5 directly bound to RORα, and PRMT5 mainly symmetrically …

A Cautionary Tale About Properly Vetting Datasets Used In Supervised Learning Predicting Metabolic Pathway Involvement, Erik D. Huckvale, Hunter N. B. Moseley

Markey Cancer Center Faculty Publications

The mapping of metabolite-specific data to pathways within cellular metabolism is a major data analysis step needed for biochemical interpretation. A variety of machine learning approaches, particularly deep learning approaches, have been used to predict these metabolite-to-pathway mappings, utilizing a training dataset of known metabolite-to-pathway mappings. A few such training datasets have been derived from the Kyoto Encyclopedia of Genes and Genomes (KEGG). However, several prior published machine learning approaches utilized an erroneous KEGG-derived training dataset that used SMILES molecular representations strings (KEGG-SMILES dataset) and contained a sizable proportion (~26%) duplicate entries. The presence of so many duplicates taint the …

Effect Of Simulated Gastrointestinal Digestion On Antioxidant, And Anti-Inflammatory Activities Of Bioactive Peptides Generated In Sausages Fermented With Staphylococcus Simulans Qb7, Hongying Li, Hongbing Fan, Zihan Wang, Qiujin Zhu, Jianping Wu

Animal and Food Sciences Faculty Publications

Dry-fermented sausages are a good source of bioactive peptides, whose stability against gastrointestinal (GI) digestion determines their bioaccessibility. This study focused on evaluating the effect of peptide extracts from sausages fermented with Staphylococcus simulans QB7 during in vitro simulated GI digestion, including peptide profi les and antioxidant and anti-infl ammatory activities. Peptides present in sausages were degraded during digestion, with molecular weight reduced from > 12 kDa to < 1.5 kDa. Besides, the content of amino acids increased from 381.15 to 527.07 mg/g, especially tyrosine being found only after GI digestion. The anti-infl ammatory activities were increased after GI digestion, however, the changes in antioxidant activities were the opposite. A total number of 255, 252 and 386 peptide sequences were identified in undigested, peptic-digested and GI-digested samples, respectively. PeptideRanker, BIOPEP-UWM and admetSAR were used to further predict the functional properties and intestinal absorption of the identified peptide sequences from GI digestion. Finally, 18 peptides were discovered to possess either antioxidant or anti-infl ammatory capacities.

Ensuring Equitable Application Of Interventions To Vulnerable Subpopulations In The Kentucky Consortium For Accountable Health Communities (Kc-Ahc), Jing Li, Jessica M. Clouser, Akosua Adu, Aiko Weverka, Nikita Vundi, Terry D. Stratton, Mark V. Williams

Journal of Appalachian Health

Introduction: The Centers for Medicare and Medicaid Services (CMS) has funded the Accountable Health Communities (AHC) model to test whether systematically identifying and addressing the health-related social needs (HRSNs) of individuals would impact healthcare utilization and total cost of care for Medicare and Medicaid beneficiaries. Toward this effort, AHCs implement screening, referral, and community navigation services in their local areas. There are 28 CMS-funded AHCs nationwide, including the Kentucky Consortium for Accountable Health Communities (KC-AHC).

Purpsoe: This study aims to assess the equity of KC-AHC model activities in three vulnerable sub-populations: dual enrollees, disabled individuals, and women.

Methods: Twenty-eight primary …

Maternal Age And Inadequate Prenatal Care In West Virginia: A Project Watch Study, Madelin Gardner, Amna Umer, Brian Hendricks, Toni Marie Rudisill, Candice Lefeber, Collin John, Christa Lilly

Journal of Appalachian Health

Introduction: Adequate prenatal care (PNC) is essential to the overall health of mother and infant. Teen age and advanced maternal age (AMA) are known risk factors for poor birth outcomes. However, less is known about whether these age groups are associated with inadequate PNC.

Purpose: This study sought to determine the potential association between maternal age (in groups, aged 20–24, 25–29, 30–34, 35–39, and >40) and inadequate PNC (visits).

Methods: West Virginia (WV) Project WATCH population-level data (May 2018–March 2022) were used for this study. Multiple logistic regressions were performed on inadequate PNC (less than 10 visits) with maternal age …

Trilogies: Lessons From 50 Years Facilitating Community-Based Health Assessments And Planning In Appalachia, Bruce Behringer

Journal of Appalachian Health

Involvement of community and organizational groups is fundamental to most public ventures. Most social, health, economic, and educational improvements in Appalachia have been characterized by successfully integrating community input and finding ways to encourage organizational change and collaboration.

Managing group process and related facilitation skills are fundamental competencies for public health professionals and others guiding change efforts. Groups from communities and organizations can get stalled in their deliberations; a facilitator frequently must think quickly to diagnose the situation and propose alternative approaches. Creative and flexible approaches, learned through practice experiences, can blend with theories and frameworks learned in academic preparation …

Overexpression Of Fatty Acid Synthase Upregulates Glutamine–Fructose-6-Phosphate Transaminase 1 And O-Linked N-Acetylglucosamine Transferase To Increase O-Glcnac Protein Glycosylation And Promote Colorectal Cancer Growth, James Drury, Mariah E. Geisen, Josiane Weber Tessmann, Piotr G. Rychahou, Courtney O. Kelson

Markey Cancer Center Faculty Publications

Fatty acid synthesis has been extensively investigated as a therapeutic target in cancers, including colorectal cancer (CRC). Fatty acid synthase (FASN), a key enzyme of de novo lipid synthesis, is significantly upregulated in CRC, and therapeutic approaches of targeting this enzyme are currently being tested in multiple clinical trials. However, the mechanisms behind the pro- oncogenic action of FASN are still not completely understood. Here, for the first time, we show that overexpression of FASN increases the expression of glutamine–fructose-6-phosphate transaminase 1 (GFPT1) and O-linked N-acetylglucosamine transferase (OGT), enzymes involved in hexosamine metabolism, and the level of O-GlcNAcylation in vitro …

Treatment At An Academic Medical Center Eliminates Survival Disparities For Appalachian Kentuckians With Pancreatic Ductal Adenocarcinoma, Emily Cassim, Hannah Mcdonald, Megan Harper, Quan Chen, Miranda Lin, Reema Patel, Michael Cavnar, Prakash Pandalai, Bin Huang, Pamela C. Hull, Joseph Kim, Erin Burke

Journal of Appalachian Health

Introduction: Rates of cancer mortality in Appalachian Kentucky is among the highest in the nation. It is unknown whether geographic location of treatment for pancreatic ductal adenocarcinoma (PDAC), one of the deadliest cancers worldwide, influences survival in Appalachian Kentuckians.

Purpose: This study compares outcomes among Appalachian Kentuckians with PDAC who received treatment at an academic medical center (AMC) or community facility (CF).

Methods: Using the Kentucky Cancer Registry, patients diagnosed with PDAC between 2003 and 2018 were identified. Patients were categorized according to treatment location (AMC v. CF) and county of residence (Appalachian v. non-Appalachian). Kaplan-Meier curves were constructed to …

Conscientious Objection: Understanding When And Why Primary Care Physicians Object To Providing Health Care To Transgender And Gender-Diverse Patients In An Appalachian Medical Center, Mili S. Patel, Kelley A. Jones, Laura Davisson, Elizabeth Miller, Nicole Kahn, Pamela J. Murray, Kacie M. Kidd

Journal of Appalachian Health

Introduction: Transgender and gender-diverse (TGD) individuals face barriers to accessing primary and gender-affirming care, especially in rural regions where a national shortage of medical providers with skills in caring for TGD people is further magnified. This care may also be impacted by individual providers’ strongly held personal or faith beliefs and associated conscientious objection to care.

Purpose: This study assesses the prevalence of conscientious objection to providing care and gender-affirming hormone (GAH) therapy to TGD individuals among physicians in an Appalachian academic medical center.

Methods: An anonymous, online, cross-sectional survey of physicians was distributed to resident and faculty physicians in …

Check With The Intended Audience First! Content Validation As A Method For Inclusive Research For Primary Care Engagement In Rural Appalachia, Sydeena E. Isaacs, Jennifer Schroeder Tyson, Ashley Parks, Danielle Adams

Journal of Appalachian Health

Introduction: To date, referral practices based on social determinants of health (SDOH) among primary care providers (PCPs) and clinic staff in rural regions, including Appalachian North Carolina (NC), are not well understood.

Purpose: This study aims to develop and content validate a primary care engagement (PCE) survey to assess (1) engagement and burnout; (2) referral practices; and (3) self-efficacy and confidence in making referrals based on SDOH among PCPs and clinic staff in Appalachian NC.

Methods: Using the Social-Ecological Model as a theoretical framework, researchers developed a 37-item PCE survey. Content validation was completed by a panel of experts recruited …