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ABSTRACTChronic wasting disease (CWD) is a fatal transmissible spongiform encephalopathy that affects both free-ranging and farmed cervid species, including mule deer, white-tailed deer, and elk (Odocoileus hemionus, Odocoileus virginianus, and Cervus canadensis). Due to the long incubation period and variability of clinical signs, CWD can expand and spread to new areas before they reach diagnostically detectable levels. Antemortem testing methods currently available can be difficult to obtain and to be applied to the large numbers required for adequate surveillance. However, key volatile biomarkers could be harnessed for non-invasive antemortem surveillance. Detection dogs are the most effective tool currently available for volatile detection; dogs can effectively complete wildlife surveys at rates surpassing that of humans. This study is the first to demonstrate that trained detection dogs can be used as an antemortem test for CWD. First, we trained three dogs to differentiate between CWD-positive and CWD-negative white-tailed deer faeces in a laboratory setting. Dogs spent significantly more time at the positive sample than the negative samples, suggesting that they differentiated between the positive and negative volatile signatures. We then trained the same dogs to search for CWD-positive faecal samples in a more naturalistic field setting. In the field, dogs found 8/11 CWD-positive samples and had an average false detection rate of 13%. These results suggest that dogs can be trained to differentiate CWD-positive faeces from CWD-negative faeces in both laboratory and field settings. Future studies will compare canine accuracy to other antemortem methods, as well as improved canine training methods.

AbstractRefugee maternal health is an under-studied area in health science research since refugee women have complex health histories that consistently change throughout their resettlement journey. This study examined setting-based maternal health understanding among Bhutanese refugee women resettled in Greensboro, NC. We utilized qualitative case-study methods to examine n = 12 interviews within three different cases based on birth settings. Themes around women’s experiences of familial support, impact of setting-based maternal health access, and quality of care experienced were significant findings. Study aims were to help providers improve patient-provider interaction in relaying adequate care information and assess women’s pre-settlement health history for appropriate care.

PurposeTo explore the caregiving dynamic between NICU nurses and mothers with a substance-exposed pregnancy (SEP) by examining how nurses view these mothers compared to mothers without an SEP.DesignA qualitative design using interviews with NICU nurses who care for infants and families with an SEP.SampleThe sample (n = 9) was all female, with an average of approximately 10 years of nursing experience in the NICU, with two-thirds having achieved a Bachelor of Science in Nursing (BSN) or higher.Main outcome variablePerceptions of nurses working with families affected by an SEP.ResultsStigmatized views and trust issues shaped nurses' views of mothers with an SEP as different from other mothers. Empathy levels toward mothers differed related to nurses' views of substance use as either a moral decision or chronic disease. These viewpoints shaped the nurse's judgment of the mother's potential to provide a safe environment and independently care for the infant at home. Nurses described personal distress when caring for these families.

Participation in recreation can produce health benefits for all college students and open pathways to inclusion for individuals with intellectual and/or developmental disabilities (IDD). Despite the growing number of college students with IDD on over 260 college campuses across the United States, there is a dearth of literature exploring their inclusion within campus recreation. This study examined how organizational culture of campus recreation departments and inclusive postsecondary education (IPSE) programs support and inhibit inclusion of college students with IDD. A constructivist qualitative case study design, which was instrumental and collective, was used with two universities in the Eastern Time Zone and one university in the Central Time Zone of the United States. A document review and individual interviews with administrative and frontline staff were conducted with each campus recreation department. An iterative and comparative process of analysis was utilized and included the use of poetic analysis. The results of this study revealed a critical need to assess and examine the inclusion of these students within campus life at large.

People who are diagnosed with a substance use disorder can experience stigmatizing interactions with health and social service providers, which may decrease both quality and continuity of care. For women with a substance-exposed pregnancy (SEP), this stigma can increase exponentially. Stigmatizing interactions can be difficult to identify due to social sanctions against expressing stigmatizing attitudes, beliefs, and behaviors and because stigma often resides in accepted cultural norms. Examining discourses around care provision can serve to identify instances of social stigma as well as illuminate the cultural norms in which they are embedded. Using data from a seven-year grounded theory study on perinatal substance use service provision, this paper reports on the perceptions and experiences of service providers working with mothers who have an SEP and illustrates complexities behind stigmatizing patient-provider interactions. Data collected included observations at meetings, workshops, and conferences addressing best practices across the continuum of care for perinatal substance use as well as interviews and focus groups with providers. The construct of “good mothering,” or hegemonic motherhood, was identified as an important cultural norm that supported social stigma and was embedded in providers’ interactions with mothers with an SEP. Discursive elements found in providers’ descriptions of perinatal substance use service work are presented and highlight the role of hegemonic motherhood as a stigmatizing agent.

ABSTRACTChronic wasting disease (CWD) continues to spread in both wild and captive cervid herds in North America and has now been identified in wild reindeer and moose in Norway, Finland and Sweden. There is limited knowledge about the variety and characteristics of isolates or strains of CWD that exist in the landscape and their implications on wild and captive cervid herds. In this study, we evaluated brain samples from two captive elk herds that had differing prevalence, history and timelines of CWD incidence. Site 1 had a 16-year history of CWD with a consistently low prevalence between 5% and 10%. Twelve of fourteen naïve animals placed on the site remained CWD negative after 5 years of residence. Site 2 herd had a nearly 40-year known history of CWD with long-term environmental accrual of prion leading to nearly 100% of naïve animals developing clinical CWD within two to 12 years. Obex samples of several elk from each site were compared for CWD prion strain deposition, genotype in prion protein gene codon 132, and conformational stability of CWD prions. CWD prions in the obex from site 2 had a lower conformational stability than those from site 1, which was independent of prnp genotype at codon 132. These findings suggest the existence of different CWD isolates between the two sites and suggest potential differential disease attack rates for different CWD strains.

One of the fastest emerging global public health crises is the rapid increase in the population of forcibly displaced people, known as refugees. Refugee women, particularly, are at a greater disadvantage due to their social positioning related to gender norms, language barriers, and lack of resources. They are also more likely to experience structural and situational stressors. Despite myriad negative factors, studies show refugee women employ resilient strategies to overcome their stressors. This study uses a narrative analysis approach to understand how a Bhutanese refugee woman’s experiences throughout her journey of birth, double displacement, and resettlement were expressed through her resiliency and independence and culminated into a community leadership role once she was resettled in the United States. Data were collected using extensive observational field notes and multiple formal and informal interviews. The story was co-constructed with the participant through an iterative process of developing, verifying, and refining to increase accuracy. Implications for social work practice emphasize the need to identify and support women as leaders in the community, to connect refugee communities with organizational resources, and to preserve and promote the voices of women leaders and empower their position in their communities.

The concept of assemblage has a long history in both the arts and social sciences. Assemblage thinking is particularly useful for critical scholars to engage with complex phenomena, such as drug use and stigma. Analytic methods that support assemblage thinking through the construction, deconstruction, and reconstruction of data-based assemblages are needed. This paper describes a qualitative analytic method, poetic assemblage, that merges the arts and social sciences to support assemblage thinking. I demonstrate its utility by presenting its application to data gathered on the stigma associated with perinatal drug use. Poetic assemblage, a form of poetic inquiry, uses disparate data sources to create temporary constructions that allow the researcher to make and remake connections and relationships across human, nonhuman, and discursive agents. The aim of this paper is to demonstrate how this method can be used to support assemblage thinking and mid-level theorizing around complex and dynamic phenomena. The method involves the evolvement of constructed, deconstructed, and reconstructed research poems. This process creates a liminal space for the researcher to engage with multiple possibilities and allows for a focus on emergent questions rather than on identifying simple answers. Using a series of studies on how healthcare and social services are provided to pregnant and parenting people who use drugs (PPPWUD), I describe my initial use of poetic inquiry in data analysis and my subsequent recognition of its limitations in supporting assemblage thinking. I then demonstrate both the construction and reconstruction of assemblage poems as well as provide examples of analytic insights on structural stigma that were illuminated from the process. While I demonstrate its application to a specific form of stigma, I am proposing the method's utility for imagining new possibilities, identifying emergent questions, and deepening theorizing for any complex social issue.

ABSTRACTChronic wasting disease (CWD) is a naturally occurring infectious, fatal, transmissible spongiform encephalopathy of cervids. Currently, disease confirmation relies on post-mortem detection of infectious prions in the medial retropharyngeal lymph nodes or obex in the brain via immunohistochemistry (IHC). Detection of CWD in living animals using this method is impractical, and IHC and other experimental assays are not reliable in detecting low concentrations of prion present in biofluids or faeces. Here, we evaluate the capability of faecal volatile organic compound analysis to discriminate between CWD-positive and -exposed white-tailed deer located at two positive cervid farms, and two groups of CWD-negative deer from two separate disease-free farms.

Despite decreases in infants born premature and at low birth weight in the United States (U.S.), racial disparities between Black and White women continue. In response, the purpose of this analysis was to examine associations between both traditional and novel indicators of county-level structural racism and birth outcomes among Black and White women. We merged individual-level data from the California Birth Statistical Master Files 2009–2013 with county-level data from the United States (U.S.) Census American Community Survey. We used hierarchical linear modeling to examine Black-White differences among 531,170 primiparous women across 33 California counties. Traditional (e.g., dissimilarity index) and novel indicators (e.g., Black to White ratio in elected office) were associated with earlier gestational age and lower birth weight among Black and White women. A traditional indicator was more strongly associated with earlier gestational age for Black women than for White women. This was the first study to empirically demonstrate that structural racism, measured by both traditional and novel indicators, is associated with poor health and wellbeing of infants born to Black and White women. However, findings indicate traditional indicators of structural racism, rather than novel indicators, better explain racial disparities in birth outcomes. Results also suggest the need to develop more innovative approaches to: (1) measure structural racism at the county-level and (2) reform public policies to increase integration and access to resources.

ABSTRACTPrion diseases are transmissible spongiform encephalopathies (TSEs) characterized by fatal, progressive neurologic diseases with prolonged incubation periods and an accumulation of infectious misfolded prion proteins. Antemortem diagnosis is often difficult due to a long asymptomatic incubation period, differences in the pathogenesis of different prions, and the presence of very low levels of infectious prion in easily accessible samples. Chronic wasting disease (CWD) is a TSE affecting both wild and captive populations of cervids, including mule deer, white-tailed deer, elk, moose, muntjac, and most recently, wild reindeer. This study represents a well-controlled evaluation of a newly developed real-time quaking-induced conversion (RT-QuIC) assay as a potential CWD diagnostic screening test using rectal biopsy sections from a depopulated elk herd. We evaluated 69 blinded samples of recto-anal mucosa-associated lymphoid tissue (RAMALT) obtained from USDA Veterinary Services. The results were later un-blinded and statistically compared to immunohistochemical (IHC) results from the USDA National Veterinary Services Laboratories (NVSL) for RAMALT, obex, and medial retropharyngeal lymph node (MRPLN). Comparison of RAMALT RT-QuIC assay results with the IHC results of RAMALT revealed 92% relative sensitivity (95% confidence limits: 61.52–99.8%) and 95% relative specificity (95% confidence limits: 85.13–99%). Collectively, our results show a potential utility of the RT-QuIC assay to advance the development of a rapid, sensitive, and specific prion diagnostic assay for CWD prions.

This case study examines implications of a university’s culture on advocating for supportive policies and programs for parenting students. Four themes illuminated several key tensions within the institution that affected support for parenting students: the lack of formal policy, an emphasis on faculty practices around accommodations, concerns about differential treatment, and the problematization of parenting students. Findings are used to suggest future avenues for investigation and advocacy strategies that incorporate organizational culture.

ABSTRACTChronic wasting disease (CWD), the only known wildlife prion disease, affects deer, elk and moose. The disease is an ongoing and expanding problem in both wild and captive North American cervid populations and is difficult to control in part due to the extreme environmental persistence of prions, which can transmit disease years after initial contamination. The role of exogenous factors in CWD transmission and progression is largely unexplored. In an effort to understand the influence of environmental and dietary constituents on CWD, we collected and analyzed water and soil samples from CWD-negative and positive captive cervid facilities, as well as from wild CWD-endozootic areas. Our analysis revealed that, when compared with CWD-positive sites, CWD-negative sites had a significantly higher concentration of magnesium, and a higher magnesium/copper (Mg/Cu) ratio in the water than that from CWD-positive sites. When cevidized transgenic mice were fed a custom diet devoid of Mg and Cu and drinking water with varied Mg/Cu ratios, we found that higher Mg/Cu ratio resulted in significantly longer survival times after intracerebral CWD inoculation. We also detected reduced levels of inflammatory cytokine gene expression in mice fed a modified diet with a higher Mg/Cu ratio compared to those on a standard rodent diet. These findings indicate a role for dietary Mg and Cu in CWD pathogenesis through modulating inflammation in the brain.

ABSTRACTIn this study, we examined factors that influenced doula use among adolescent mothers in a community-based childbirth education and doula program. We used a qualitative case study approach to gather perspectives from adolescent mothers and doulas through semistructured interviews, field observations, and a focus group. These women collectively revealed multiple themes related to doula use among adolescent mothers, including relationship development and barriers to doula use at the individual and structural levels. Effective training and support for doulas that serve adolescent clients can improve these mothers’ birth experiences, and program planners in the United States and other countries can use process evaluations to improve doula programs for adolescent mothers.

Abstract:Black mothers provide a disproportionate share of unpaid and informal health care support to others, internal and external to their households. In addition, black women experience a disproportionate burden of chronic disease and health-related risk factors. Despite these trends, few studies have examined the impact of daily mothering on women’s self-care practices. Embodiment, an ecosocial theory applied to health disparities research, describes a process by which individuals may biologically incorporate their material and social environments. Black women and mothers have historically managed their own well-being in the context of the care of others, as well as popular images and perceptions that characterize this population as stronger, less feminine, and deviant relative to white women. In this study, we examine how black mothers understand and report their self-care as they simultaneously manage obligations to others and popular messages about black women and motherhood. Findings were based on qualitative data collected from 16 black women. Overall, we found the women reported feelings of stress. This stress seemed to be a consequence of conflicting demands of (1) maternal sacrifice, which is a component of the expectations of a “strong black woman” stereotype, and (2) self-care as it is defined and promoted by healthism.

ABSTRACTChronic wasting disease (CWD) is a geographically expanding prion disease of wild and captive cervids in North America. Disease can be transmitted directly, animal to animal, or indirectly via the environment. CWD contamination can occur residually in the environment via soil, water, and forage following deposition of bodily fluids such as urine, saliva, and feces, or by the decomposition of carcasses. Recent work has indicated that plants may even take up prions into the stems and leaves. When a carcass or gut pile is present in the environment, a large number of avian and mammalian species visit and consume the carrion. Additionally, predators like coyotes, likely select for disease-compromised cervids. Natural cross-species CWD transmission has not been documented, however, passage of infectious prion material has been observed in the feces of crows. In this study we evaluated the ability of CWD-infected brain material to pass through the gastrointestinal tract of coyotes (Canis latrans) following oral ingestion, and be infectious in a cervidized transgenic mouse model. Results from this study indicate that coyotes can pass infectious prions via their feces for at least 3 days post ingestion, demonstrating that mammalian scavengers could contribute to the translocation and contamination of CWD in the environment.

The purpose of our study was to describe the progressive accumulation of the abnormal conformer of the prion protein (PrPCWD) and spongiform degeneration in a single section of brain stem in Rocky Mountain elk (Cervus elaphus nelsoni) with chronic wasting disease (CWD). A section of obex from 85 CWD-positive elk was scored using the presence and abundance of PrPCWDimmunoreactivity and spongiform degeneration in 10 nuclear regions and the presence and abundance of PrPCWDin 10 axonal tracts, the subependymal area of the fourth ventricle, and the thin subpial astrocytic layer (glial limitans). Data was placed in a formula to generate an overall obex score. Data suggests that PrPCWDimmunoreactivity and spongiform degeneration has a unique and relatively consistent pattern of progression throughout a section of obex. This scoring technique utilizing a single section of obex may prove useful in future work for estimating the presence and abundance of PrPCWDin peripheral tissues and the nervous system in elk with CWD.

Research poetics, a form of arts-based research methods, has been underutilized in the field of health promotion. Poetic methods have most commonly been used as a form of re/presentation of the lived experience in qualitative research. For the community-engaged researcher, re/presenting findings through poetry offers unique opportunities for engaging the reader and reaching diverse communities. However, this approach also has implications as an analytic method and allows the analyst to have a more meaningful and personal engagement with participants' stories. Perhaps most importantly, this approach acknowledges and brings to the forefront the co-construction of qualitative findings and de-centers the authority of the researcher by preserving and promoting the participant's voice. Using examples from the authors' own research, this article describes opportunities for incorporating research poetics into health promotion research and argues for its applicability for community-engaged health promotion researchers.Figurative language can give shape to the difficult and the painful. It can make visible and “felt” that which is invisible and “unfeelable.” Imagery, more than anything else, can take us out of our own existence and let us stand in the condition of another instance, or another life. It can make the subject of the poem, whatever it is, as intimate as honey—or ashes—in the mouth. Use it responsibly [1, p. 108].

The aim of this study was to understand adolescent mothers’ childbirth experiences. Semistructured interviews were conducted with participants recruited from a community-based program for adolescent mothers. Fourteen mothers described their birth experiences. Using a narrative analytic approach, responses were reconstructed into birth stories. Stories, condensed into poetic form, were compared and contrasted. Four unique categories emerged: connected births, surreal births, disconnected births, and disempowered births. Categories differed by agency, support, and emotional tone. Positive support was found in stories that portrayed high agency and positive affect, whereas problematic support was apparent in stories that conveyed passivity, frustration, and disappointment. This study has implications for tailoring childbirth education for adolescent mothers and can inform health-care professionals working with this population.

Mechanisms for the spread of transmissible spongiform encephalopathy diseases, including chronic wasting disease (CWD) in North American cervids, are incompletely understood, but primary routes include horizontal and environmental transmission. Birds have been identified as potential vectors for a number of diseases, where they ingest or are exposed to infected material and later shed the disease agent in new areas after flying substantial distances. We recently identified American crows (Corvus brachyrhynchos) as having the potential to translocate infectious prions in their feces. Our results suggest that this common, migratory North American scavenger is capable of translocating infectious prions to disease-free areas, potentially seeding CWD infection where no other initial source of pathogen establishment is forthcoming. Here we speculate on the role avian scavengers, like American crows, might play in the spatial dissemination of CWD. We also consider the role mammalian scavengers may play in dispersing prions.

Cerebrospinal fluid (CSF) has been examined as a possible source for preclinical diagnosis of prion diseases in hamsters and sheep. The present report describes the detection of chronic wasting disease (CWD) in the CSF of elk and evaluates its usefulness as an antemortem test for CWD. The CSF from 6 captive and 31 free-ranging adult elk was collected at necropsy and evaluated for the presence of the abnormal isoform of the prion protein that has been associated with CWD (PrPCWD) via protein misfolding cyclic amplification. Additionally, the obex from each animal was examined by immunohistochemistry (IHC). Four out of 6 captive animals were CWD-positive and euthanized due to signs of terminal CWD. The remaining 2 were CWD negative. None of the 31 free-range animals showed overt signs of CWD, but 12 out of 31 tested positive for CWD by IHC. Protein misfolding cyclic amplification detected PrPCWDfrom 3 of the 4 captive animals showing clinical signs of CWD and none of the nonclinical animals that were CWD positive by IHC. The data suggests that CWD prions can be detected in the CSF of elk, but only relatively late in the course of the disease.

Effective treatment of substance-exposed pregnancies requires gender-responsive care coordinated across agencies and systems. A deeper understanding of the perspectives, experience, and practices of professionals providing these services is needed to improve care. This study examines service provision for perinatal substance use through the perspectives and experiences of healthcare and social service professionals. Using a constructivist grounded theory design, data were collected over a 7-year period. Data collection consisted of interviews and focus groups with professionals as well as observations of professional meetings and workshops where practices and procedures were discussed. A multi-level model of service delivery is described. The role of affect, particularly around issues of custody, is discussed along with structural level actions that develop in the absence of integrated treatment. Structural support both within and across systems of care is crucial to developing coordinated and compassionate care and to increasing engagement in care services.

Violence is an important public health problem among adolescents in the United States. Substance use and violence tend to co-occur among adolescents and appear to have similar etiologies. The present study examined the extent to which a comprehensive prevention approach targeting an array of individual-level risk and protective factors and previously found effective in preventing tobacco, alcohol, and illicit drug use is capable of decreasing violence and delinquency. Schools (N=41) were randomly assigned to intervention and control conditions. Participants in the 20 intervention schools received the Life Skills Trainingprevention program including material focusing on violence and the media, anger management, and conflict resolution skills. Survey data were collected from 4,858 sixth grade students prior to the intervention and three months later after the intervention. Findings showed significant reductions in violence and delinquency for intervention participants relative to controls. Stronger prevention effects were found for students who received at least half of the preventive intervention. These effects include less verbal and physical aggression, fighting, and delinquency. The results of this study indicate that a school-based prevention approach previously found to prevent tobacco, alcohol, and illicit drug use can also prevent violence and delinquency.

Early onset of substance use among adolescents has been found to be associated with later risky sexual behaviors. This study examined long-term follow-up data from a large randomized school-based drug prevention trial to (1) investigate the long-term impact of the prevention program on drug use and sexual behaviors that put one at elevated risk for HIV infection; and (2) use growth modeling procedures to examine potential mechanisms of intervention effects. Self-report survey data were collected from students in the 7th grade, prior to the intervention in 1985, and in grades 8, 9, 10, and 12. Participants in the intervention condition received a 30-session drug prevention program in 7th through 9th grades. Follow-up surveys were completed by 2042 young adults (mean age = 24) in 1998. As young adults, participants were considered to be engaging in high-risk behavior for HIV infection if they reported having multiple sex partners, having intercourse when drunk or very high, and recent high-risk substance use. The intervention had a direct protective effect on HIV risk behavior in the overall sample in young adulthood. Furthermore, among participants receiving 60% or more of the prevention program, analyses showed that the intervention significantly reduced growth in alcohol and marijuana intoxication over the course of adolescence, which in turn was associated with a reduction in later HIV risk behavior. The behavioral effects of competence-enhancement drug prevention programs can extend to risk behaviors including those that put one at risk for HIV infection.

This study examined long-term follow-up data from a large-scale randomized trial to determine the extent to which participation in a school-based drug abuse prevention program during junior high school led to less risky driving among high school students. Self-report data collected from students in the 7th, 10th, and 12th grades were matched by name to students' department of motor vehicles (DMV) records at the end of high school. The DMV data included the total number of violations on students' driving records as well as the number of “points” that indicate the frequency and severity of the violations. A series of logistic regression analyses revealed that males were more likely to have violations and points on their driving records than females, and regular alcohol users were more likely to have violations and points than those who did not use alcohol regularly. Controlling for gender and alcohol use, students who received the drug prevention program during junior high school were less likely to have violations and points on their driving records relative to control group participants that did not receive the prevention program. Findings indicated that antidrinking attitudes mediated the effect of the intervention on driving violations, but not points. These results support the hypothesis that the behavioral effects of competence-enhancement prevention programs can extend to risk behaviors beyond the initial focus of intervention, such as risky driving.

Purpose:The authors determine if specific features of the clinical presentation of acute postoperative endophthalmitis correlate with the microbiologic culture results.