Browsing by Subject "North Carolina"
Now showing 1 - 20 of 245
- Results Per Page
- Sort Options
Item Open Access “100 Dollars and Other Valuable Considerations”(2022-04-20) Reneau, OliviaLand and homeownership are topics of much debate, concern, and intervention in modern Black political thought. Discussion of Black land loss, while longitudinal in scope, often places the origins of Black land ownership in the early 1900s. In this paper, I challenge this notion, first placing the origin of Black land ownership in the antebellum period and examining Black land ownership for the following century. To do so, I constructed the narratives of six Black-owned parcels from their acquisition to their status in 1950. My first chapter offers a brief exploration of the history of Black ownership between 1850 and 1950. In my second chapter, I examine the circumstances of the deprivation of that land, inclusive of the political, economic, and white-supremacist tools used to do so. In my third chapter, I consider conceptions of Black land from prominent Black authors like W.E.B. DuBois to the presence of land in abolitionist politics. Then, I offer the complete histories of six formerly Black-owned parcels of land from 1850 to 1950 and the presence of tools of preservation and deprivation of Black ownership in these parcels. I conclude with a brief analysis of the five parcels, an acknowledgment of the limitations of this work, and a discussion of the significance of this work on Black vital records research. By the end of the period, only two parcels were possessed by Black individuals, and only one of those was a direct connection through shared lineage. The chains of title created during this research indicate that wills and end-of-life legal planning best-ensured property were successfully passed from one Black owner to the next, a mechanism that heavily favored families in wealthy, free, Black communities.Item Open Access A Bottom-Up Model of Residential Electricity Demand in North and South Carolina(2017-04-28) Hollis, JohnResidential electricity is a significant component of total electricity use in the United States, and the residential market is also a key demographic for energy efficiency (EE) and distributed generation growth. Uncertainty in residential load growth is driven by the impact of changes in technology, policy, demographic and life-style changes. Using a bottom-up engineering model, we begin the construction of a tool to facilitate analyzing the effects of these factors. We use data from the EIA’s Residential Electricity Consumption Survey (RECS), in conjunction with EnergyPlus and BEopt, publicly available software from NREL, to construct 22 archetypical residential buildings characterizing North and South Carolina’s housing stock. We then model energy use for these buildings, and extrapolate these results to the larger housing stock. Projections are accurate for a benchmark year using actual weather data. We identify a number of potential improvements to the model and ways in which the uncertainty on future projections of energy use can be bound. Our conclusions follow: - The archetypical model is a reasonable solution for regional scale residential electricity modeling which minimizes computational needs. - The model delivers disaggregated energy demand, and hourly demand, estimates which are useful for future analysis of energy policy cost effectiveness. - Weather data is a driving source of uncertainty, and hence input weather data should be carefully considered. Projections should use varied weather data to bound uncertainty. - Despite being less computationally demanding than other methods, this model would benefit from an automated method of archetype alteration to ease sensitivity analysis. BEopt supports this through python and XML input files.Item Open Access A community-based intervention increases physical activity and reduces obesity in school-age children in North Carolina.(Child Obes, 2015-06) Benjamin Neelon, Sara E; Namenek Brouwer, Rebecca J; Østbye, Truls; Evenson, Kelly R; Neelon, Brian; Martinie, Annie; Bennett, GaryBACKGROUND: Community-based interventions are promising approaches to obesity prevention, but few studies have prospectively evaluated them. The aim of this study was to evaluate a natural experiment—a community intervention designed to promote active living and decrease obesity within a small southern town. METHODS: In 2011, community leaders implemented the Mebane on the Move intervention—a community-wide effort to promote physical activity (PA) and decrease obesity among residents of Mebane, North Carolina. We measured child PA and BMI before and after the intervention, using a nearby town not implementing an intervention as the comparison. In total, we assessed 64 children from Mebane and 40 from the comparison community 6 months before, as well as 34 and 18 children 6 months after the intervention. We assessed PA with accelerometers worn for 7 days and calculated BMI z-scores using children's height and weight. We conducted multivariable linear regressions examining pre- to postintervention change in minutes of PA and BMI z-score, adjusting for confounders. RESULTS: At follow-up, children in Mebane modestly increased their moderate-to-vigorous PA (1.3 minutes per hour; 95% confidence interval (CI): 0.2, 2.3; p=0.03) and vigorous activity (0.8 minutes per hour; 95% CI: 0.1, 1.5; p=0.04) more than comparison children. In intervention children, BMI z-scores decreased 0.5 units (kg/m(2); 95% CI: -0.9, -0.02; p=0.045), compared to children in the comparison community. CONCLUSIONS: We observed positive effects on PA level and weight status of children in Mebane, despite high rates of attrition, suggesting that the community-based intervention may have been successful.Item Open Access A digital collection of rare and endangered lemurs and other primates from the Duke Lemur Center.(PloS one, 2019-01) Yapuncich, Gabriel S; Kemp, Addison D; Griffith, Darbi M; Gladman, Justin T; Ehmke, Erin; Boyer, Doug MScientific study of lemurs, a group of primates found only on Madagascar, is crucial for understanding primate evolution. Unfortunately, lemurs are among the most endangered animals in the world, so there is a strong impetus to maximize as much scientific data as possible from available physical specimens. MicroCT scanning efforts at Duke University have resulted in scans of more than 100 strepsirrhine cadavers representing 18 species from the Duke Lemur Center. An error study of the microCT scanner recovered less than 0.3% error at multiple resolution levels. Scans include specimen overviews and focused, high-resolution selections of complex anatomical regions (e.g., cranium, hands, feet). Scans have been uploaded to MorphoSource, an online digital repository for 3D data. As captive (but free ranging) individuals, these specimens have a wealth of associated information that is largely unavailable for wild populations, including detailed life history data. This digital collection maximizes the information obtained from rare and endangered animals with minimal degradation of the original specimens.Item Open Access A Farm-to-School Program Review and Implementation Guide for North Carolina Public School Parents Case Study: E.K. Powe Elementary School | Durham, North Carolina(2010-04-29T18:56:58Z) Shoecraft, KellynFarm to School is a phrase used to describe programs that connect locally-grown foods to schools (Farm to School, 2009). The medium that provides this connection varies, but it is typically made through school gardens, farm field trips, nutrition and culinary education, or serving local foods in the school meals program. Farm to School programs are implemented to provide students with a hands-on learning environment and experiential education, to increase the nutritional quality of food served to students and the amount of time students spend outdoors, and to teach students about the agricultural heritage of their region, among other features. Four approaches are typically utilized in North Carolina and other states to institute Farm to School program: (1)The North Carolina Farm to School Program; (2) Local purchasing through contracted produce vendors; (3) Individual school initiatives; (4) District-wide initiatives. The method that a school or school district uses to implement a Farm to School program depends heavily on stakeholder commitment, funding opportunities, and the support of the school community and the district’s Child Nutrition Services. In this project I have evaluated these four approaches to Farm to School programs, using examples in three North Carolina counties: Durham, Guilford and Wake, and one North Carolina City: Asheville. As a corollary case study, I documented my experiences working with stakeholders from E.K. Powe Elementary School in Durham, North Carolina as they worked to implement a Farm to School program during the 2009-2010 school year. In short, I evaluate Farm to School programs state-wide and determine the strengths, weaknesses, opportunities and threats of each program. Further, I describe a formative process in Durham and use this experience in conjunction with my research to create a Farm to School implementation guide geared to North Carolina public school parents.Item Open Access A Guide to Sustainable Development Down East(2007-05) Korth, JenniferCoastal North Carolina is facing a crisis. Small towns up and down the coast are facing development pressures, population booms, environmental degradation, and loss of the working waterfront and traditional cultures. The cluster of communities known as Down East is especially susceptible to these pressures. These communities are unzoned and unincorporated. Therefore, the Carteret County Commissioners have full decision-making power over the communities of Down East. My masters project serves as a resource document that will educate and guide Down East through its fight for sustainable development, environmental restoration and economic improvement. The necessary information exists, but its not all in one place, its not easy to find and its hard to understand. This includes information on incorporation, smart growth, low impact development and economic renewal. Therefore, this guide pulls together all of the relevant information into one document and includes numerous examples. Information on current activities involving the problems Down East and on future research possibilities is also provided at the end of the resource document. Most importantly, the guide is a neutral and unbiased collection of relevant information. Therefore, I will not be making any recommendations at the end of the guide. I have simply tried to provide an unbiased summary of the information necessary for Down East residents to make an informed decision about their future.Item Open Access A health literacy pilot intervention to improve medication adherence using Meducation® technology.(Patient education and counseling, 2014-05) Zullig, Leah L; McCant, Felicia; Melnyk, S Dee; Danus, Susanne; Bosworth, Hayden BObjective
To determine whether antihypertensive medication adherence could improve using a Meducation® technology health literacy intervention.Methods
We conducted a six-month feasibility study among patients with cardiovascular disease (CVD) risk factors receiving care from hospital-based primary care clinics. All patients received a personalized Meducation® calendar listing CVD-related medications. We evaluated changes in medication adherence and clinical outcomes at six months.Results
There was a 42% enrollment rate (n=23). Forty percent had low health literacy, defined as less than 9th grade reading level. At three months, self-reported medication adherence improved. At six months, medication possession ratio improved 3.2%. Also, at six months there were decreases in patients' average systolic blood pressure (0.5 mmHg), diastolic blood pressure (1.5 mmHg), and body weight (3.6 pounds) (p>0.05).Conclusions
A health literacy intervention may be a feasible mechanism to improve cardiovascular-related medication adherence and outcomes.Practice implications
Health literacy interventions may improve adherence while requiring relatively few resources to implement.Item Open Access A Holistic Approach to Reducing Plastic Marine Debris in Coastal North Carolina(2011-04-29) Ornell, Cassandra; Finn, SarahAffecting waters and coastlines worldwide, plastic marine debris is a pervasive issue that continues to intensify. It threatens wildlife, habitats, and ecosystem functioning, as well as coastal tourism and recreation. This problem can be addressed in ways ranging from local to international in scope, and voluntary to mandatory in implementation. Our objective was to reduce plastic marine debris generation in coastal North Carolina via both voluntary and mandatory approaches; therefore, we used both bottom-up and top-down methods. We focused the bottom-up piece of our project on increasing awareness of the ecological hazards plastic marine debris causes and on encouraging consumers to stop using plastic shopping bags. To this end, we employed a combination of formal and informal education tools, which included presenting in classrooms, leading coastal cleanups, and designing a plastic marine debris exhibit that we displayed at environmentally themed community events. The school presentations targeted students from kindergarten to high school, and are adaptable to a variety of levels and teacher objectives. The coastal cleanups provided community members with an opportunity to see firsthand the local extent of marine debris. Our exhibit enabled us to reach a large and diverse audience, and to show the connection between our decisions and environmental impacts. The top-down component of our project focused on understanding the effectiveness of the Outer Banks plastic bag ban (NC Senate Bill 1018) at reducing plastic marine debris and changing consumer behaviors, as well as its popularity among residents. NC Senate Bill 318, introduced in March 2011, calls for a repeal of this ban, so we composed a policy memo arguing against the repeal and sent it to all state senators. We supported our position with the results we obtained from surveys we conducted of Outer Banks and Carteret County residents. The majority of Outer Banks respondents were in support of the ban, and the majority of Carteret County respondents stated that they would support a plastic bag ban in their county, which lent credence to our argument. Our holistic approach, based on bottom-up and top-down measures, enabled us to test and assess a variety of tools that could reduce plastic marine debris in coastal North Carolina.Item Open Access A MULTICRITERIA FRAMEWORK TO EXTEND THE NORTH CAROLINA NATURAL HERITAGE PROGRAM’S CONSERVATION PLANNING TOOL(2009-04-23T23:22:35Z) Mahoney, PatrickThe protection of natural communities is essential to preserving biodiversity and wildlife habitat across an increasingly developed and fragmented landscape. The North Carolina Natural Heritage Program has produced a scoring of sites across the state using a geospatial tool that ranks sites based upon their importance to biodiversity and wildlife habitat. This scoring uses mostly datasets related to the presence of rare and threatened species. The tool developed in this study extends the rankings produced by the Natural Heritage Program to include other attributes of biodiversity and wildlife habitat, including site context, geometry and variety of abiotic conditions. Dataset measures of these attributes were developed and built into a geospatial tool that produces a ranking of sites. This enables the identification of areas of conservation value that are not well represented in the Natural Heritage Program’s current model. The geospatial datasets used as inputs for the model are structured using multi-attribute utility theory, allowing users to assign utility values to datasets and manipulate the weights received by each dataset in the final scoring. This allows decision-makers to incorporate their own opinions about what contributes to biodiversity value in the ranking of sites, and is transparent in the choices that they have made. This produces a ranking of sites that is representative of a variety of attributes of biodiversity value and explicitly demonstrates the user-specific decisions that were made in its production. This type of ranking is not meant to replace the professional opinions of decision-makers, but can help to guide inquiries into the conservation value of a site where data does not exist on rare and threatened species and help to compare sites that possess similar levels of known biodiversity.Item Open Access A POLICY-ORIENTED ETHNOGRAPHY OF THE WINTER BLUEFIN TUNA FISHERY IN BEAUFORT AND MOREHEAD CITY, NORTH CAROLINA(2005) Brazer, Eric O JrIn the mid-1990s, sport fishermen from the Outer Banks of North Carolina stumbled upon a winter population of bluefin tuna in the shallow waters near shore. Each winter since then, fishermen have braved icy waters and frigid temperatures to capitalize on this resource. In their quest for a commercial share of the U.S. quota, these local fishermen have shown a unique interest in making their voices heard. They now play a significant role in the data collection and management of bluefin tuna, working side-by-side with scientists and forming a non-profit organization. This MP aims to document the cultural system of these fishermen and incorporate recommendations for more effective bluefin tuna management. In an effort to accomplish this goal I produced a policy-oriented ethnography that characterizes the social, economic and regulatory structure of the sport and commercial bluefin tuna fishery in Beaufort and Morehead City, North Carolina.Item Open Access A protocol to evaluate the efficacy, perceptions, and cost of a cholesterol packaging approach to improve medication adherence.(Contemporary clinical trials, 2014-09) Zullig, Leah L; Pathman, Joshua; Melnyk, S Dee; Brown, Jamie N; Sanders, Linda L; Koropchak, Celine; Howard, Teresa; Danus, Susanne; McCant, Felicia; Bosworth, Hayden BPurpose
Elevated low-density lipoprotein cholesterol (LDL-C) is a major modifiable risk factor for cardiovascular disease (CVD), a leading cause of death in the United States. Despite clinical practice guidelines aimed at facilitating LDL-C control, many Veterans do not achieve guideline-recommended LDL-C levels.Methods
We describe a study focused on VA healthcare system users at risk for CVD (i.e., LDL-C level >130 mg/dl and/or <80% cholesterol pill refill adherence in the last 12 months). We are conducting a two and a half year randomized controlled trial (i.e., intervention administered over 12 months) among Veterans with uncontrolled cholesterol receiving care at select VA-affiliated primary care clinics in North Carolina. We anticipate enrolling 250 diverse patients (10% women; 40% African American). Patients are randomized to an educational control group or intervention group. Intervention group participants' medication is provided in special blister packaging labeled for daily use that includes reminders; MeadWestvaco Corporation's pre-filled DosePak® contains standard doses of statins in accordance with the existing prescriptions.Conclusions
Pre-filled blister packaging may provide an inexpensive solution to improve medication adherence. Our study enrolls a diverse sample and provides information about whether an adherence packaging intervention can: 1) improve medication adherence; 2) improve patients' LDL-C levels; 3) be well received by patients and providers; and 4) provide a cost effective solution to improve medication adherence.Item Open Access A randomized controlled trial to evaluate the effectiveness of CouPLES: a spouse-assisted lifestyle change intervention to improve low-density lipoprotein cholesterol.(Preventive medicine, 2013-01) Voils, Corrine I; Coffman, Cynthia J; Yancy, William S; Weinberger, Morris; Jeffreys, Amy S; Datta, Santanu; Kovac, Stacey; McKenzie, Jamiyla; Smith, Rose; Bosworth, Hayden BObjective
This randomized controlled trial evaluated the effectiveness of a telephone-delivered, spouse-assisted lifestyle intervention to reduce patient LDL-C.Method
From 2007 to 2010, 255 outpatients with LDL-C>76 mg/dL and their spouses from the Durham Veterans Affairs Medical Center were randomized to intervention or usual care. The intervention comprised nine monthly goal-setting telephone calls to patients and support planning calls to spouses. Outcomes were assessed at 11 months.Results
Patients were 95% male and 65% White. LDL-C did not differ between groups (mean difference = 2.3 mg/dL, 95% CI = -3.6, 8.3, p = 0.44), nor did the odds of meeting goal LDL-C (OR = 0.95, 95% CI = 0.6, 1.7; p = 0.87). Intakes of calories (p = 0.03), total fat (p = 0.02), and saturated fat (p = 0.02) were lower for the intervention group. Cholesterol and fiber intake did not differ between groups (p = 0.11 and 0.26, respectively). The estimated rate of moderate intensity physical activity per week was 20% higher in the intervention group (IRR = 1.2, 95% CI = 1.0, 1.5, p = 0.06). Most participants did not experience a change in cholesterol medication usage during the study period in the intervention (71.7%) and usual care (78.9%) groups.Conclusion
This intervention might be an adjunct to usual primary care to improve adherence to lifestyle behaviors.Item Open Access A Review of NOAA's Incidental Take Permit (ITP) Process(2021-04-28) Cleary, NikiThe Endangered Species Act is considered the world’s most powerful piece of legislation. The purpose of the Act is to protect and recover imperiled species and the ecosystems they depend on. To achieve these goals, U.S. Fish and Wildlife Service and NOAA’s National Marine Fisheries Service implement many regulations, including one that prohibits almost all takes of listed species. One highly controversial aspect of the Act is the provision allowing non-federal entities to apply for an incidental take permit (ITP). ITPs authorize the incidental take of listed species during otherwise legal activities. I examined the ITP implementation process of listed marine species under NOAA’s jurisdiction. To analyze this process, I conducted a literature review and a case study analysis of the ITP issued to North Carolina Division of Marine Fisheries for sea turtles. I interviewed 13 stakeholders to obtain their perceptions of the process. The literature review revealed that little research has been conducted in regard to marine based ITPs, in contrast to the attention devoted to terrestrial ITPs. The review also revealed shared critiques and shortcomings of ITPs. My case study analysis demonstrated the complexities of the ITP process, which can be lengthy and require scientific data that may not exist. Interviews with stakeholders revealed a host of opinions, which varied considerably among participants. To improve the ITP process for protected species and stakeholders alike, I recommend that NOAA work toward streamlining the ITP process and ensure that all stakeholders are involved.Item Open Access A Roadmap to the New Rural Electric Cooperative Business Model(2017-04-27) Chen, Patrick; Metz, Kerri; Nanavati, Shaina; Way, Jesse; Yang, JingqiIn North Carolina today, rural electric cooperatives provide electricity to 26% of the state’s population. Conducted for the Environmental Defense Fund (EDF), this project aims to assess the services that these cooperatives could offer their members as a means of improving their business model. Through a convenience and snowball sampling approach, we conducted semi-structured interviews with ten organizations. After performing an NVIVO analysis, we identified the criteria of affordability, reliability, and customer satisfaction as the key variables that cooperatives use when assessing service options. Our research revealed continued to reveal the benefits, challenges, and priorities of these cooperatives in offering a range of services to their customers. While each cooperative in North Carolina is unique, we have recommended services they should offer based on their individual priorities and the readiness of each service to be implemented.Item Open Access A School-Based SARS-CoV-2 Testing Program: Testing Uptake and Quarantine Length After In-School Exposures.(Pediatrics, 2022-02) Boutzoukas, Angelique E; Zimmerman, Kanecia O; Mann, Tara K; Moorthy, Ganga S; Blakemore, Ashley; McGann, Kathleen A; Smith, Michael J; Nutting, Boen; Kerley, Karen; Brookhart, M Alan; Edwards, Laura; Rak, Zsolt; Benjamin, Daniel K; Kalu, Ibukunoluwa CObjectives
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related quarantines, which are required after close contact with infected individuals, have substantially disrupted in-person education for kindergarten through 12th grade (K-12) students. In recent recommendations, shortened durations of quarantine are allowed if a negative SARS-CoV-2 test result is obtained at 5 to 7 days postexposure, but access to testing remains limited. We hypothesized that providing access to in-school SARS-CoV-2 testing postexposure would increase testing and reduce missed school days.Methods
This prospective cohort study was conducted in one large public K-12 school district in North Carolina and included 2 periods: preimplementation (March 15, 2021, to April 21, 2021) and postimplementation (April 22, 2021, to June 4, 2021), defined around initiation of an in-school SARS-CoV-2 testing program in which on-site access to testing is provided. Number of quarantined students and staff, testing uptake, test results, and number of missed school days were analyzed and compared between the preimplementation and postimplementation periods.Results
Twenty-four schools, including 12 251 in-person learners, participated in the study. During preimplementation, 446 close contacts were quarantined for school-related exposures; 708 close contacts were quarantined postimplementation. Testing uptake after school-related exposures increased from 6% to 40% (95% confidence interval: 23% to 45%) after implementation, and 89% of tests were conducted in-school. After in-school testing implementation, close contacts missed ∼1.5 fewer days of school (95% confidence interval: -2 to -1).Conclusions
Providing access to in-school testing may be a worthwhile mechanism to increase testing uptake after in-school exposures and minimize missed days of in-person learning, thereby mitigating the pandemic's ongoing impact on children.Item Open Access Accelerated epigenetic age as a biomarker of cardiovascular sensitivity to traffic-related air pollution.(Aging, 2020-12) Ward-Caviness, Cavin K; Russell, Armistead G; Weaver, Anne M; Slawsky, Erik; Dhingra, Radhika; Kwee, Lydia Coulter; Jiang, Rong; Neas, Lucas M; Diaz-Sanchez, David; Devlin, Robert B; Cascio, Wayne E; Olden, Kenneth; Hauser, Elizabeth R; Shah, Svati H; Kraus, William EBackground
Accelerated epigenetic age has been proposed as a biomarker of increased aging, which may indicate disruptions in cellular and organ system homeostasis and thus contribute to sensitivity to environmental exposures.Methods
Using 497 participants from the CATHGEN cohort, we evaluated whether accelerated epigenetic aging increases cardiovascular sensitivity to traffic-related air pollution (TRAP) exposure. We used residential proximity to major roadways and source apportioned air pollution models as measures of TRAP exposure, and chose peripheral arterial disease (PAD) and blood pressure as outcomes based on previous associations with TRAP. We used Horvath epigenetic age acceleration (AAD) and phenotypic age acceleration (PhenoAAD) as measures of age acceleration, and adjusted all models for chronological age, race, sex, smoking, and socioeconomic status.Results
We observed significant interactions between TRAP and both AAD and PhenoAAD. Interactions indicated that increased epigenetic age acceleration elevated associations between proximity to roadways and PAD. Interactions were also observed between AAD and gasoline and diesel source apportioned PM2.5.Conclusion
Epigenetic age acceleration may be a biomarker of sensitivity to air pollution, particularly for TRAP in urban cohorts. This presents a novel means by which to understand sensitivity to air pollution and provides a molecular measure of environmental sensitivity.Item Open Access Adapting to Sea-level Rise: Where North Carolina Stands(2014-04-21) Shipley, KristaIn 2007, the Intergovernmental Panel on Climate Change released their 4th assessment report which provided indisputable evidence that the world climate is warming, leading to changes in sea-level caused by two factors: melting land ice and thermal expansion of the oceans. This report conservatively estimated between 0.18 and 0.59 meters of global mean sea-level rise by 2100. Although sea level rise is a global issue, the specific effects and magnitude felt by different coastal communities are unique. Sea-level at a specific location, relative sea-level, is not influenced solely by GMSL but also by factors such as variations in global land ice which effects the gravitational field of the Earth, local vertical land movements such as sediment compaction and tectonics, as well as changes in coastal currents and local water temperature. The National Oceanic & Atmospheric Administration has identified North Carolina as highly vulnerable to effects of SLR because of its “high wave exposure, low-relief coastal slope, and abundance of barrier islands.” In addition, the Atlantic coast of the United States is experiencing subsidence, a sinking of the Earth’s surface caused by either natural or human-induced causes. In 2010, the North Carolina Coastal Resources Commission’s Science Panel on Coastal Hazards completed the North Carolina Sea-Level Rise Assessment Report, requested by the Coastal Resources Commission to inform sea-level rise policy in the state. The report included a recommendation that North Carolina use of a one meter of rise benchmark for planning purposes. Almost two-and-a-half years later, North Carolina received national and international ridicule for its legislative decision that prohibits factoring a rate of sea-level rise into coastal planning until, at the earliest, July 1, 2016. This masters project will examine how the current law passed despite the recommendation of the Coastal Resources Commission’s Science Panel and will elucidate the future courses of action that the state may execute after the release of a five-year follow-up to the North Carolina Sea-Level Rise Assessment Report in March 2015.Item Open Access Addressing Housing-Related Social Needs Through Medicaid: Lessons From North Carolina's Healthy Opportunities Pilots Program.(Health affairs (Project Hope), 2024-02) Huber, Katie; Nohria, Raman; Nandagiri, Vibhav; Whitaker, Rebecca; Tchuisseu, Yolande Pokam; Pylypiw, Nicholas; Dennison, Meaghan; Van Stekelenburg, Brianna; Van Vleet, Amanda; Perez, Maria Ramirez; Morreale, Madlyn C; Thoumi, Andrea; Lyn, Michelle; Saunders, Robert S; Bleser, William KNorth Carolina Medicaid's Healthy Opportunities Pilots program is the country's first comprehensive program to evaluate the impact of paying community-based organizations to provide eligible Medicaid enrollees with an array of evidence-based services to address four domains of health-related social needs, one of which is housing. Using a mixed-methods approach, we mapped the distribution of severe housing problems and then examined the design and implementation of Healthy Opportunities Pilots housing services in the three program regions. Four cross-cutting implementation and policy themes emerged: accounting for variation in housing resources and needs to address housing insecurity, defining and pricing housing services in Medicaid, engaging diverse stakeholders across sectors to facilitate successful implementation, and developing sustainable financial models for delivery. The lessons learned and actionable insights can help inform the efforts of stakeholders elsewhere, particularly other state Medicaid programs, to design and implement cross-sectoral programs that address housing-related social needs by leveraging multiple policy-based resources. These lessons can also be useful for federal policy makers developing guidance on addressing housing-related needs in Medicaid.Item Open Access Age of first drunkenness and risks for all-cause mortality: A 27-year follow-up from the epidemiologic catchment area study.(Drug and alcohol dependence, 2017-07) Hu, Hui; Eaton, William W; Anthony, James C; Wu, Li-Tzy; Cottler, Linda BEarly-onset drunkenness is associated with an increased risk of developing an alcohol use disorder (AUD), which predicts excess mortality risk. Here, we estimated mortality risk for drinkers with and without early drunkenness.For 14,848 adult participants interviewed about drinking, drunken episodes, and AUD in 1981-83 for the Epidemiologic Catchment Area in New Haven (Connecticut), Baltimore (Maryland), St. Louis (Missouri), and Durham (North Carolina), we linked National Death Index records through 2007.Cox regression modeling estimates showed excess mortality for drinkers with age of first drunkenness earlier than 15 years old (hazard ratio, HR: 1.47, 95% CI: 1.25, 1.72) and when first drunkenness occurred at or after age 15 (HR: 1.20, 95% CI: 1.11, 1.29), as compared with adults who had never been drunk. Consistent results were observed, irrespective of AUD history. That is, early drunkenness signaled excess mortality risk even in absence of AUD.In a large community sample from four cities in the US, early age of onset of drunkenness predicts mortality risk. We discuss experiments to investigate the possible causal significance of this predictive association.Item Open Access Amygdala volume changes in posttraumatic stress disorder in a large case-controlled veterans group.(Arch Gen Psychiatry, 2012-11) Morey, Rajendra A; Gold, Andrea L; LaBar, Kevin S; Beall, Shannon K; Brown, Vanessa M; Haswell, Courtney C; Nasser, Jessica D; Wagner, H Ryan; McCarthy, Gregory; Mid-Atlantic MIRECC WorkgroupCONTEXT: Smaller hippocampal volumes are well established in posttraumatic stress disorder (PTSD), but the relatively few studies of amygdala volume in PTSD have produced equivocal results. OBJECTIVE: To assess a large cohort of recent military veterans with PTSD and trauma-exposed control subjects, with sufficient power to perform a definitive assessment of the effect of PTSD on volumetric changes in the amygdala and hippocampus and of the contribution of illness duration, trauma load, and depressive symptoms. DESIGN: Case-controlled design with structural magnetic resonance imaging and clinical diagnostic assessments. We controlled statistically for the important potential confounds of alcohol use, depression, and medication use. SETTING: Durham Veterans Affairs Medical Center, which is located in proximity to major military bases. PATIENTS: Ambulatory patients (n = 200) recruited from a registry of military service members and veterans serving after September 11, 2001, including a group with current PTSD (n = 99) and a trauma-exposed comparison group without PTSD (n = 101). MAIN OUTCOME MEASURE: Amygdala and hippocampal volumes computed from automated segmentation of high-resolution structural 3-T magnetic resonance imaging. RESULTS: Smaller volume was demonstrated in the PTSD group compared with the non-PTSD group for the left amygdala (P = .002), right amygdala (P = .01), and left hippocampus (P = .02) but not for the right hippocampus (P = .25). Amygdala volumes were not associated with PTSD chronicity, trauma load, or severity of depressive symptoms. CONCLUSIONS: These results provide clear evidence of an association between a smaller amygdala volume and PTSD. The lack of correlation between trauma load or illness chronicity and amygdala volume suggests that a smaller amygdala represents a vulnerability to developing PTSD or the lack of a dose-response relationship with amygdala volume. Our results may trigger a renewed impetus for investigating structural differences in the amygdala, its genetic determinants, its environmental modulators, and the possibility that it reflects an intrinsic vulnerability to PTSD.