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Aquifer Characterization Techniques To Evaluate Coal Combustion Residuals Sources, Vincent Buening, Wenbo Xie

World of Coal Ash Proceedings

Aquifer Characterization Techniques to Evaluate Coal Combustion Residuals Sources Authors Mr. Vincent Buening - United States - TRC Mr. Wenbo Xie - United States - TRC Abstract Many of the constituents monitored in groundwater for CCR Rule compliance occur naturally in the environment. Sorting through natural and anthropogenic sources often requires additional in-depth analysis beyond the routine groundwater monitoring program. TRC’s practical application of several aquifer characterization tools and strategies can be used to evaluate potential sources of CCR constituents in groundwater. These strategies include the use of stable isotopes such as boron (δ11B), lithium (δ7Li), and strontium (δ87Sr); age …

Beneficially Using Bottom Ash As Landfill Protective Cover, Ryan Doyle

World of Coal Ash Proceedings

The Overall Process of Beneficially Using Bottom Ash as Landfill Protective Cover, an Engineer’s Perspective Authors Mr. Ryan Doyle - United States - AECOM Abstract Using bottom ash as protective cover along the base of a landfill is one way to beneficially use coal combustion residuals (CCR). The bottom ash serves as a filter to prevent finer particles (e.g. fly ash) from clogging the geocomposite liner which transports leachate to the sump of the landfill cell. Understanding the gradation of the bottom ash and the material properties of the geocomposite are imperative to finding the right combination for an effective …

Tricky Constituents- Issues With Leachate And Groundwater Constituents Of Concern, William Kennedy

World of Coal Ash Proceedings

Tricky Constituents – Issues with Leachate and Groundwater Constituents of Concern Authors Mr. William Kennedy - United States - Stantec Abstract Certain parameters in wastewater are more problematic to treat than others. Some constituents of concern such as arsenic and mercury are amenable to chemical precipitation, given the correct conditions. Others such as lithium, boron, and molybdenum are much more problematic – both in terms of cost and complexity. For waters from pump and treat systems that produce discharges to surface waters, it is important to correctly identify the appropriate discharge concentrations. Certain groundwater or leachate constituents of concern do …

Attenuation Of Metals And Inorganics- Insights From Laboratory Testing Approaches, Larissa Smith, Michael Healey, Jeff Roberts, Allison Kreinberg

World of Coal Ash Proceedings

Natural Attenuation of Metals and Inorganics: Insights from Laboratory Testing Approaches Authors Ms. Larissa Smith - Canada - SiREM Mr. Michael Healey - Canada - SiREM Mr. Jeff Roberts - Canada - SiREM Ms. Allison Kreinberg - United States - Geosyntec Consultants, Inc. Ms. Crystal Wilson - United States - Geosyntec Consultants, Inc. Mr. Lane Dorman - United States - Geosyntec Consultants, Inc. Mr. Andrzej Przepiora - Canada - Geosyntec Consultants, Inc. Abstract Laboratory treatability studies can be used to evaluate and optimize groundwater treatment options for contaminants found at coal combustion residual (CCR) sites. An important consideration in groundwater …

Paper_Attenuation Of Metals And Inorganics: Insights From Laboratory Testing Approaches, Larissa Smith, Michael Healey, Jeff Roberts, Allison Krienberg

World of Coal Ash Proceedings

Laboratory treatability studies can be used to evaluate and optimize groundwater treatment options for contaminants of concern (COCs) found at coal combustion residual (CCR) sites. An important consideration in groundwater treatment selection is the suitability of monitored natural attenuation (MNA) as a treatment component or as a stand-alone passive treatment. This presentation will focus on the use of treatability testing to evaluate natural and enhanced attenuation treatment options for redox sensitive metals in CCR-impacted groundwater. In one demonstration, a comprehensive laboratory program was performed based upon the USEPA’s tiered approach to identify the natural attenuation processes, rates, attenuation capacities, and …

Groundwater Corrective Action Implementation Issues, Jeremy Hurshman, Dennis Connair

World of Coal Ash Proceedings

Implementation Issues, Groundwater Corrective Action, Laramie River Station, Basin Electric Power Cooperative Authors Mr. Jeremy Hurshman - United States - AECOM Mr. Dennis Connair - United States - AECOM Abstract Groundwater monitoring of an ash pond and landfill complex at the subject site identified the presence of lithium and molybdenum at statistically significant levels (SSLs) above the site-specific groundwater protection standards (GWPSs). Groundwater impact in the sandstone aquifer was delineated and found to be limited to an area of less than 10 acres. An assessment of corrective measures (ACM) was conducted and a public meeting open to interested and affected …

Epa’S Value Engineering Approach For Gypsum Stack Closure, Michael Ayers, Craig Zeller

World of Coal Ash Proceedings

EPA’s Value Engineering Approach for Gypsum Stack Closure Authors Mr. Michael Ayers - United States - Watershed Geo Mr. Craig Zeller - United States - US EPA Abstract In February 2017, US EPA Region 4 assumed responsibility for water treatment and daily operations for an unlined and open 350-acre gypsum stack located in Pascagoula, Mississippi. The gypsum stack contains approximately 15M cubic yards of phosphogypsum with elevated levels of nutrients and acidic pH. To the immediate east of the facility is one of the most biologically productive estuarine ecosystems in the Gulf of Mexico region. An uncontrolled and untreated release …

Ucc’S Innovative Ccr Dewatering, Morgan French

World of Coal Ash Proceedings

An Innovative and Economical Approach To Ash Dewatering Authors Mr. Morgan French - United States - UCC Environmental Abstract This paper presents an innovative and cost-effective approach for fly ash dewatering that is specifically designed to address a major challenge in coal ash pond closure projects. Fly ash dewatering is particularly difficult because of its fine particle size, typically less than 40 microns, and its hydrophilic nature, which makes it difficult to separate from water. The new technique employs a combination of chemical treatment and mechanical dewatering to achieve a significant reduction of fly ash moisture content. The chemical treatment …

Paper_Capping & Closure For Two Pennsylvania Landfills Subject To U.S. Epa’S Ccr Rule Promulgated Under 40 Cfr 257 Subpart D, Ron Harris, Cory White, John Klamut

World of Coal Ash Proceedings

This project consisted of capping two coal combustion residuals (CCR) landfills with geosynthetic capping systems consisting of 24-inches of final cover soil over eight ounce per square yard filter/separation geotextile over Super Gripnet geomembrane with drainage studs along top and friction spikes along the bottom over a prepared subgrade consisting of in-place cover soil. Approximately 20 acres were capped at each landfill in 2023. Closure plans addressing CCR Rule requirements were prepared and posted to the stations’ CCR Rule websites. Per those plans, the stations intend to cease coal combustion and residual waste disposal by year-end 2028. To comply with …

Next-Generation High-Resolution Methods For Site Characterization, Pj Nolan, Cole Mayer, Dawn Prell, Rens Verburg

World of Coal Ash Proceedings

Next-Generation High-Resolution Methods for Site Characterization Authors Dr. PJ Nolan - United States - WSP USA Mr. Cole Mayer - United States - WSP USA Ms. Dawn Prell - United States - WSP USA Dr. Rens Verburg - United States - WSP USA Abstract The requirements from regulatory agencies and other stakeholders to provide more robust site characterization when entering remedial action or developing alternative source demonstrations (ASDs) at Coal Combustion Product (CCP) sites have increased in recent years. In many cases, the current mainstream site characterization methods used for these efforts fail to meet those requirements. Here, we demonstrate …

Fly Ash And Lime Stabilization Of Sewage Sludge- Changes To Phosphorous Solubility And Bioavailability, Yaniv Freiberg, Shahar Baram, Michael Borisover, Pinchas Fine

World of Coal Ash Proceedings

Fly Ash and Lime Stabilization of Sewage Sludge: Changes to Phosphorous Solubility and Bioavailability Authors Dr. Yaniv Freiberg - United States - University of Illinois at Urbana-Champaign Dr. Shahar Baram - Israel - Institute of Soil, Water, and Environmental Sciences, Volcani Center Dr. Michael Borisover - Israel - Institute of Soil, Water, and Environmental Sciences, Volcani Center Dr. Pinchas Fine - Israel - Institute of Soil, Water, and Environmental Sciences, Volcani Center Abstract Biosolids application to agricultural soils offers an alternative source of essential macro and micro plant nutrients that replace industrial products. In addition, the alkaline treatment of sludge …

A Comparative Evaluation Of Portable X-Ray Fluorescence (Pxrf) Analysis On Fly Ash, Christopher Frishcosy, Ashley Manning-Berg, Linen Cooper, Robert Hageman

World of Coal Ash Proceedings

An Evaluation of On-Site X-Ray Fluorescence (XRF) Analysis on Coal Combustion Residuals Authors Mr. Christopher Frishcosy - United States - University of Tennessee at Chattanooga Dr. Ashley Manning-Berg - United States - University of Tennessee at Chattanooga Ms. Linen Cooper - United States - University of Tennessee at Chattanooga Mr. Robert Hageman - United States - Tennessee Valley Authority Mr. Timothy Moyers - United States - Tennessee Valley Authority Ms. Tara Masterson - United States - Tennessee Valley Authority Mr. Nicholas McClung - United States - Tennessee Valley Authority Abstract As coal-fired fossil plants are retiring and less Coal Combustion …

Paper_A Comparative Evaluation Of Portable X-Ray Fluorescence (Pxrf) Analysis On Fly Ash, Christopher Frishcosy, Ashley Manning-Berg, Eric Hageman, Timothy Moyers

World of Coal Ash Proceedings

As coal-fired fossil plants are retiring and lower volumes of Coal Combustion Products (CCPs) are being produced, the generators of Coal Combustion Residual (CCR) producers across the nation are focused on harvesting landfilled and ponded coal ash to maintain the supply for beneficial use markets such as those volumes needed by the concrete mixing industry. To aid in the development of more efficient harvesting strategies, research performed in the emerging Geomaterials Testing and Research Laboratory (GTRL) at the University of Tennessee at Chattanooga College of Engineering and Computer Science and the College of Biology, Geology, and Environmental Science (UTC – …

Managing Ash Pond Closure Waters, Philip Benson

World of Coal Ash Proceedings

Managing Ash Pond Closure Waters: Technology Selection and Design Considerations Authors Mr. Philip Benson - United States - Geosyntec Consultants, Inc. Abstract The water management issues created by ash pond closure are complex. Dewatering activities can produce large volumes of water that require treatment. Pore water can contain high constituent concentrations due to the long- term contact with ash. Dewatering and stormwater management practices significantly impact the quantity and quality of water that must be treated. The ash has been deposited in the basin over years or even decades, often from diverse sources of coal. The diverse coal sources and …

Coal Ash Constituents And Treatment Options, Christine Harris, Rob Orlando

World of Coal Ash Proceedings

Coal Ash Constituents and Treatment Options Authors Mrs. Christine Harris - United States - Groundwater Treatment and Technology, LLC (GWTT) Mr. Rob Orlando - United States - Groundwater Treatment and Technology, LLC (GWTT) Abstract This presentation will open with a review of the information required to design a water treatment system to meet discharge requirements, including how the constituents may change as the ash is dewatered. Attendees will then be invited to spin the wheel of constituents. Based on water samples results, there are many potential constituents in coal ash. This presentation will cover the eight (8) most common constituents …

Removal Of Selenium From Difficult-To-Treat Wastewaters Using An Innovative Reductive-Adsorptive Media, Patrick Mckeown, Madan Tandukar, Steve Woodard, Mike Nickelsen

World of Coal Ash Proceedings

Removal of Selenium from Difficult-to-treat Wastewaters Using an Innovative Reductive-adsorptive Media Authors Mr. Patrick McKeown - United States - ECT2 Dr. Madan Tandukar - United States - ECT2 Dr. Steve Woodard - United States - ECT2 Mr. Mike Nickelsen - United States - ECT2 Abstract Selenium is one of the more difficult-to-treat emerged contaminants, and is mostly prevalent in mining and power wastewater. In water and wastewater, selenium generally exists as soluble oxyanions, selenite (SeO32−) and selenate (SeO42−). Out of these, selenate is the more mobile and prevalent species, which also is more difficult to remove. With increasing focus on …

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 …

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 …

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 …