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North Carolina's colonial assembly emitted its own paper money and maintained some amount in public circulation during its entire history as a separate colony. No systematic or statistical analysis of North Carolina's paper money regime exits in the literature. We correct that here. We model and estimate how the market value of this money was determined. We compare the quantity theory of money with an asset-pricing model to see which explains the observed market value of the paper money better. Finally, we explore counterfactual redemption architectures to show how redemption affected monetary performance in periods of value collapse. [ABSTRACT FROM AUTHOR]

Understanding how to make the world a better place requires interdisciplinary knowledge. Public policy analysis helps policymakers arrive at informed policy decisions. The policy analysis process involves public problem definition and data collection, stakeholder identification, a rationale for government involvement, evaluation criteria, identification and analysis of policy alternatives, and a recommendation. Economics informs not only the identification of market failures but also how we think about public problems, evaluate relevant research, identify policy alternatives, weigh objective criteria (costs, benefits, equity), and select optimal solutions. Students of policy analysis gain experience through in-class examples of contemporary topics and an iterative policy paper, where each student selects a public problem, conducts research, and writes an analysis. Students become effective consumers and beginning producers of policy analysis.

This pair of papers examines and describes the state action necessary to make markets function as environmental policy instruments and as strategies of governance. We do this through a detailed look at the mechanics of environmental credit compliance markets in the US states of Oregon, Ohio, and North Carolina in which stream credits are privately created and sold to developers who have impacted protected stream systems. In this paper, we observe that the governance of streams as water resources requires the state to create a scalar hierarchy that fixes certain characteristics of streams at certain scales of state action. These fixes attempt to resolve, bracket, or ignore the temporal and spatial variability of streams that can confound governance; however, these variabilities are essential to the scientific study of streams. At each of the four distinct scales, four different operations crucial to market function were observed; at each scale, elements of natural variability were fixed or confined to be expressed only within the given scale. These observations reveal principles of how scale functions within environmental governance, as well as failures where gaps and resistances appear that create unforeseen outcomes in market-led policy. In three different state settings, the establishment of a fixed scale of governance is made in different ways that depend on the local institutional and social context. However, they all act to render an unruly set of temporal and spatial flows as instead occurring within certain fixed scalar boundaries, and thus amenable to governance with markets. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the intersection of cultural processes and immigration in parental understanding of adolescent mental health and mental health seeking behaviors among African immigrants in Western countries. The present study examines the perspectives of Congolese immigrant parents on adolescent mental health in Brussels, Belgium, and Raleigh, North Carolina, USA – two geographic regions with relatively large Congolese migrant populations. This study highlights a needed understanding of cultural and acculturative context in shaping the beliefs of Congolese immigrants and explores potential barriers of seeking health services. Additionally, it recognizes health issues among this underrepresented and underserved population. Design/methodology/approach: Fifteen Congolese immigrant parents, eight in the USA and seven in Belgium, participated in structured qualitative interviews using an adapted version of Kleinman Questions and behavioral scenarios on depression, post-traumatic stress disorder and oppositional defiant disorder. Interviews were audio recorded, and participants were assigned pseudonyms to de-identify responses. English interviews were transcribed verbatim by a trained team of undergraduate research assistants, and French interviews were transcribed verbatim by the first author and a graduate research assistant. Following transcription, the first and second authors used a rapid analytic approach (Hamilton, 2013). The first and second authors conducted a matrix analysis to observe thematic patterns. Findings: Parents interpreted adolescent behavior to be more problematic when the scenarios were overtly outside of their cultural realm of values and beliefs. Parents preferred methods of intervention through religious practices and/or family and community efforts rather than seeking mental health services in their host countries as a secondary option. The authors' findings provide an understanding of the values and beliefs of this underrepresented demographic, which may be useful to guide health professionals on how to support this community in a culturally responsive way. Research limitations/implications: Limitations to the current study include the structured nature of the interview guide that did not allow for in-depth qualitative exploration. Interviewed participants had lived in their host countries for more than 10+ years. Thus, the authors' findings are not reflective of new immigrants' experiences. Parents' perspectives were likely shaped by exposure to Western beliefs related to support for mental health (e.g. knowledge of psychologists). Future studies should focus on recent refugees due to exposure to traumatic events and experiences reflective of the Democratic Republic of Congo's (DRC's) current socio-political situation, and how these are understood in the context of adolescent mental health. Further, due to the hypothetical nature of the scenarios, the authors cannot be sure that participants would engage in the identified approaches with their children. Additionally, hearing from the youth's perspective would provide a clearer insight on how mental health and seeking professional help is viewed in a parent–child relationship. Finally, the data for this study were collected in 2019, prior to the COVID-19 pandemic. Although the authors cannot speak directly to Congolese refugee and immigrant experiences during this significant historical period, given the rise in mental health concerns in refugee populations more broadly (Logie et al., 2022), the authors' findings speak to how parents may have responded to increased mental health symptoms and point to additional barriers that these populations may have faced in accessing support. The authors' study emphasizes the need for dedicating resources and attention to this population, especially the development of culturally tailored messaging that invites community members to support the mental health needs of their community. Practical implications: The authors' findings provide important implications for mental health professionals. This study provides a clearer understanding of how Congolese immigrant parents view mental health and help-seeking within their cultural frame. Although parents may seek professional help, a distrust of mental health services was expressed across both cohorts. This suggests that mental health professionals should acknowledge potential distrust among this population and clarify their role in supporting the mental health of adolescent immigrants. Clinicians should inquire about familial cultural beliefs that are parent- and child-centered and modify their interventions to fit these belief structures. Originality/value: This paper addresses the gap in knowledge about mental health perspectives of Sub-Saharan African immigrant populations, specifically those from the DRC. [ABSTRACT FROM AUTHOR]

While the literature on entrepreneurial support organizations (ESOs) proliferates, we still do not understand whether local ESOs benefit some founders more than others. Drawing on organizational sponsorship and inclusive ecosystems literatures, this paper empirically examines whether founder characteristics of gender, immigrant, and racial minority group membership moderate the relationship between participation in different types of ESO services (incubator, mentoring, and education programs) and funding received from state, federal, and venture capital (VC) sources. Relying on a detailed database of life sciences firms founded in North Carolina's Research Triangle region, the paper uncovers how funding outcomes differ depending on the funding source and the moderating ESO and founder traits. The paper concludes with practical implications for how women, immigrant, and minority founders may be better supported by ESOs for broader, inclusive ecosystem building. Plain English Summary: Do entrepreneurial support organizations (ESOs) have different benefits for different founders? This paper finds the answer is yes, which has implications for how to create a more inclusive entrepreneurial ecosystem. While the literature continues to reveal more about the role of organizations like accelerators, business incubators, and mentoring programs for entrepreneurial success, we lack understanding of the different roles these organizations might play in fostering more inclusive entrepreneurial regions. This research analyzes whether women, immigrant, and racial minority founders benefit differently from participating in different types of mainstream entrepreneurial support organization programs including incubation, education, and mentoring. Results show great variation in how founders benefit from these programs with implications for inclusive ecosystem building. Since these organizations are often publicly funded or supported, the findings have implications for policy and economic development practice as well as for entrepreneurial firm strategy. [ABSTRACT FROM AUTHOR]

This pair of papers examines and describes the state action necessary to make markets function as environmental policy instruments and as strategies of governance. They do this through a detailed look at the mechanics of environmental credit compliance markets in the US states of Oregon, Ohio, and North Carolina in which stream credits are privately created and sold to developers who have impacted protected stream systems. In this paper, we examine the tools, techniques, and people involved in the creation of a value-bearing stream credit out of a physical stream or river site. These observations reveal important principles of how science functions within governance, as well as where gaps and resistances appear that create unforeseen outcomes in market-led policy. We examine the construction and use of instruments that define natural processes as objects with value; these techniques and tools include databases and spreadsheets, algorithms, and field scoring tools that have been scavenged from a wide range of scientific and governance practices and are not themselves inherently capitalist or developed for capitalist purposes. In three different state settings, the move from measure to value is made in different ways that depend on the local institutional and social context. However, they all act to render a network of interacting ecological forces as a field of discrete ecosystem objects amenable to governance with markets. [ABSTRACT FROM AUTHOR]

The present study is a single-site quality improvement project within pediatric primary care involving the implementation of a digital version of the Modified Checklist for Autism in Toddlers–Revised. We evaluated the impact of the digital screener on the likelihood of physician referral for a developmental evaluation or autism diagnosis, and the age of the patients at the time of the event. Patients were children 16–30 months old seen for 18 and 24 months' well-child visits (1279 encounters), who screened positive for risk for autism spectrum disorder on the Modified Checklist for Autism in Toddlers–Revised without a previously documented autism spectrum disorder diagnosis. Comparisons were made between a cohort of children screened with the paper and pencil version of the Modified Checklist for Autism in Toddlers–Revised before the digital version was implemented and a cohort of children screened during the intervention period. Patients were followed until 48 months and referrals were obtained from electronic health records. Patients screened with the digital Modified Checklist for Autism in Toddlers–Revised were five times more likely to be referred for a developmental evaluation. The automatic scoring, risk assessment, and referral decision support features helped to improve screening outcomes. In this clinic, process change to a digital screening method with automatic guidance for next steps improved adherence to evidence-based clinical care. This was a project in primary care for young children (1–2 years old). We tested a parent questionnaire on a tablet. This tablet questionnaire asked questions to see whether the child may have autism. We compared the paper and pencil version of the questionnaire to the tablet questionnaire. We read the medical charts for the children until they were 4 years old to see whether they ended up having autism. We found that doctors were more likely to recommend an autism evaluation when a parent used the tablet questionnaire. We think that the tablet's automatic scoring feature helped the doctors. We also think that the doctors benefited from the advice the tablet gave them. [ABSTRACT FROM AUTHOR]

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Local sales tax bases are determined by factors including businesses, residential populations, and nonresidential visitors. This paper capitalizes on the COVID‐19 pandemic, using the sudden absence of in‐commuters, tourists, and college students to estimate the contributions these populations have on the sales tax base in North Carolina's 100 counties. The findings suggest that losing one in‐commuter results in a loss of roughly $1000 a month in taxable sales. Similarly, the loss of one hotel night booking results in a loss in taxable sales of approximately $525. This translates, for the median county, to exporting 17% to in‐commuters and 12% to tourists. The impact on the loss of a residential college student is less clear. Key Takeaways: Nonresidents, such as commuters, tourists, and college students, are important components to many local governments' sales tax base.A single in‐commuter is estimated to contribute approximately $1000 to the local sales tax base, which translates to about 17% of the tax base for the median county in our sample.The contribution to local sales for a hotel night stay, our proxy for tourism, is estimated to be approximately $525 to the local sales tax base, which translates to about 12% of the tax base for the median county in our sample.We do not find evidence that college students contribute meaningfully to the local sales tax base.This paper informs policy conversations around tax leakage, revenue‐raising capacity, and the benefits and costs of local sales taxes. [ABSTRACT FROM AUTHOR]

This research delves into the intricate dynamics of landslides, emphasizing their consequences on transportation infrastructure, specifically highways and roadway bridges in North Carolina. Based on a prior investigation of bridges in Puerto Rico after Hurricane Maria, we found that bridges above water and situated in valleys can be exposed to both landslide and flooding risks. These bridges faced heightened vulnerability to combined landslides and flooding events due to their low depth on the water surface and the potential for raised flood heights due to upstream landslides. Leveraging a dataset spanning more than a century and inclusive of landslide and bridge information, we employed logistic regression (LR) and random forest (RF) models to predict landslide susceptibility in North Carolina. The study considered conditioning factors such as elevation, aspect, slope, rainfall, distance to faults, and distance to rivers, yielding LR and RF models with accuracy rates of 76.3% and 82.7%, respectively. To establish that a bridge's location is at the bottom of a valley, data including landform, slope, and elevation difference near the bridge location were combined to delineate a bridge in a valley. The difference between bridge height and the lowest river elevation is established as an assumed flooding potential (AFP), which is then used to quantify the flooding risk. Compared to traditional flood risk values, the AFP, reported in elevation differences, is more straightforward and helps bridge engineers visualize the flood risk to a bridge. Specifically, a bridge (NCDOT ID: 740002) is found susceptible to both landslide (92%) and flooding (AFT of 6.61 m) risks and has been validated by field investigation, which is currently being retrofitted by North Carolina DOT with slope reinforcements (soil nailing and grouting). This paper is the first report evaluating the multi-hazard issue of bridges in valleys. The resulting high-fidelity risk map for North Carolina can help bridge engineers in proactive maintenance planning. Future endeavors will extend the analysis to incorporate actual flooding risk susceptibility analysis, thus enhancing our understanding of multi-hazard impacts and guiding resilient mitigation strategies for transportation infrastructure. [ABSTRACT FROM AUTHOR]

The share of students attending charter schools has been rising. There is evidence that charter school growth has increased socioeconomic segregation of students between schools. In this paper, we assess whether charter school growth affects how students are organized within nearby traditional public schools (TPS). We use administrative data from North Carolina to estimate the impact of charter school openings on segregation by income within nearby TPS. Our models exploit variation in the presence and location of charter schools over time between 2007 and 2014 for students in Grades 3 to 8. We find limited evidence that the segregation of students by income at the classroom level increases when charters open nearby. We find some evidence of increasing segregation in third grade and fourth grade math and third grade ELA classrooms at TPS within 2 miles of new charters in large urban districts schools. Our results vary somewhat depending on how we control for underlying trends and measure segregation. We find no effect of charter school growth on income segregation in higher grades. [ABSTRACT FROM AUTHOR]

Regional weather networks—also referred to as mesonets—are imperative for filling in the spatial and temporal data gaps between nationally supported weather stations. The North Carolina Environment and Climate Observing Network (ECONet) fills this regional role; it is a mesoscale network of 44 (as of 2023) automated stations collecting 12 environmental variables every minute across North Carolina. Measured variables include air temperature, precipitation, relative humidity, barometric pressure, wind speed, wind direction, total solar radiation, photosynthetically active solar radiation, soil temperature, soil moisture, leaf wetness index, and black globe temperature. All data undergo quality control procedures and are made freely available to the public via data portals hosted by the State Climate Office of North Carolina at North Carolina State University. This paper provides a technical overview of ECONet, including a description of the siting criteria, station maintenance procedures, data quality control procedures, and data availability. We also summarize unique aspects of ECONet data collection as well as innovative research and applications that rely on ECONet data. ECONet data are used by many sectors including, but not limited to, emergency management, natural resources management, public health, agriculture, forestry, science education, outdoor recreation, and research. ECONet data and data-powered applications offer valuable insights to local, regional, and federal partners, yet opportunities to expand ECONet research and applications remain. Significance Statement: This paper explains the ongoing and emerging impacts of a statewide weather station network called the North Carolina Environment and Climate Observing Network (ECONet). ECONet consists of 44 (as of 2023) automated stations located across the state. Each station collects 12 environmental variables every minute. ECONet data and data-powered applications offer valuable insights to local, regional, and federal partners. There are many opportunities to expand ECONet-based research and applications. [ABSTRACT FROM AUTHOR]

Driver characteristics have been linked to the frequency and severity of car crashes. Among these, age and gender have been shown to impact both the possibility and severity of a crash. Previous studies have used standard ordered probit (OP) models to analyze crash data, and some research has suggested heteroskedastic ordered probit (HETOP) could provide improved model fit. The objective of this paper is to evaluate potential improvements of the heteroskedastic ordered probit (HETOP) model compared to the standard ordered probit (OP) model in crash analysis, by examining the effect of gender across age on injury severity among drivers. This paper hypothesizes that the HETOP model can provide a better fit to crash data, by allowing heteroskedasticity in the distribution of injury severity across driver age and gender. Data for 20,222 crashes were analyzed for North Carolina from 2016 to 2018, which represents the state with the highest number of fatalities per 100 million vehicle miles traveled amongst available crash data from the Highway Safety Information System. Darker lighting conditions, severe road surface conditions, and less severe weather were associated with increased injury severity. For driver demographics, the probability of severe injuries increased with age and for male drivers. Moreover, the variance of severity increased with age disproportionately within and across genders, and the HETOP was able to account for this. The results of the two applied approaches revealed that HETOP model outperformed the standard OP model when measuring the effects of age and gender together in injury severity analysis, due to the heteroskedasticity in injury severity within gender and age. The HETOP statistical method presented in this paper can be more broadly applied across other contexts and combinations of independent variables for improved model prediction and accuracy of causal variables in traffic safety. [ABSTRACT FROM AUTHOR]

The nationwide shortage of psychiatric providers delays patients from receiving vital mental health (MH) treatments. Mental Health clinical pharmacist practitioners (CPPs) are qualified to provide comprehensive medication management (CMM) services and expand care; however, many MH interdisciplinary teams have not incorporated MH CPPs or have not optimized their role. The purpose of this paper is to highlight how MH CPPs leveraged telemedicine to provide CMM to outpatient MH clinics requiring provisional coverage for other prescribing providers. This paper also reviews supplemental services and barriers to implementation. The Veterans Integrated Services Network (VISN) 6 Clinical Resource Hub‐Telemental Health (CRH‐TMH) is a centralized interdisciplinary team that provides telemental health services to veterans through coordination with their local Veterans Health Administration Health Care Systems located in North Carolina and Virginia. The MH CPPs serve as advanced practice providers with a scope of practice that authorizes prescriptive authority including controlled substances. The VISN 6 CRH‐TMH program was initiated in 2020 and expanded from one MH CPP to include three MH CPPs and a MH CPP supervisor. Since initiation, the MH CPPs have supported 10 outpatient MH clinics. From October 2021 to March 2023, the MH CPPs have completed 5080 clinical encounters. The MH CPPs decreased phone appointments and increased the percentage of video‐to‐home encounters from 56% in fiscal year 2021 to 91% by March fiscal year 23. Virtual same‐day access was implemented at three locations and the substance use disorder program provided timely access to life‐saving treatments. The joint intake clinic optimized veterans' intake into the MH clinic by the therapist providing diagnostic services and the CPP performing CMM during the same appointment. The telehealth learning experience increased training opportunities for residents. The success of this initiative further supports the expansion of MH CPPs as advanced practice providers. [ABSTRACT FROM AUTHOR]

South Africa's Just Energy Transition (JET) from coal to renewable energy in response to climate change mitigation policies comes packaged with social costs that these mitigation policies tend to overlook, considering their focus on carbon emission reduction. The paper argues that Social Impact Assessments (SIAs), a component of Environmental Impact Assessments (EIAs) focused on social impact mitigation, can be a long-term approach to closing the social cost gap. Against this backdrop, the paper's arguments were informed by a literature analysis on SIAs and the Just Energy Transition, semi-structured interviews, and surveys with 230 participants, including experts, from Kriel and Carolina in Mpumalanga, South Africa. The findings point to skills development barriers such as poor school attendance, a lack of alignment between existing curriculum design and labour markets, and students' low aptitude for STEM subjects. It also identifies community sustainability issues linked to poor public participation, gender inequalities in land reform and economic participation, and culturally disruptive displacements that will intensify as the energy shift unfolds. The paper submits that SIAs, if incorporated into mainstream energy transition planning, might be a long-term approach to mitigating societal costs and can support socially responsible policies. [ABSTRACT FROM AUTHOR]

The floods caused by Hurricane Matthew in 2016 affected Lumberton, a socioeconomically diverse city in North Carolina with 729 public housing units. Public housing residents face unique challenges in accessing resources and post-disaster temporary accommodations, further delaying their recovery compared to other survivors. This paper investigates the obstacles to public housing recovery and the residents' recovery challenges using descriptive statistics, mapping, and qualitative analysis in Lumberton. Findings show the dependency of public housing units' recovery on assistance policies and decisions of various organizations, including local housing authorities. Multiple changes in recovery plans and limited, uncertain, delayed funding and bureaucratic obstacles to funding allocation slow the units' recovery and prolong the residents' displacement, adversely affecting their recovery. Hence, pre-disaster resilience initiatives should address these vulnerabilities and the recovery policy's limitations to support public housing units and residents' recovery. Moreover, affordable housing recovery must become a priority in national housing recovery policies. [ABSTRACT FROM AUTHOR]

Background: Hysterectomy is a common surgery among reproductive-aged U.S. patients, with rates highest among Black patients in the South. There is limited insight on causes of these racial differences. In the U.S., electronic medical records (EMR) data can offer richer detail on factors driving surgical decision-making among reproductive-aged populations than insurance claims-based data. Our objective in this cohort profile paper is to describe the Carolina Hysterectomy Cohort (CHC), a large EMR-based case-series of premenopausal hysterectomy patients in the U.S. South, supplemented with census and surgeon licensing data. To demonstrate one strength of the data, we evaluate whether patient and surgeon characteristics differ by insurance payor type. Methods: We used structured and abstracted EMR data to identify and characterize patients aged 18–44 years who received hysterectomies for non-cancerous conditions between 10/02/2014–12/31/2017 in a large health care system comprised of 10 hospitals in North Carolina. We used Chi-squared and Kruskal Wallis tests to compare whether patients' socio-demographic and relevant clinical characteristics, and surgeon characteristics differed by patient insurance payor (public, private, uninsured). Results: Of 1857 patients (including 55% non-Hispanic White, 30% non-Hispanic Black, 9% Hispanic), 75% were privately-insured, 17% were publicly-insured, and 7% were uninsured. Menorrhagia was more prevalent among the publicly-insured (74% vs 68% overall). Fibroids were more prevalent among the privately-insured (62%) and the uninsured (68%). Most privately insured patients were treated at non-academic hospitals (65%) whereas most publicly insured and uninsured patients were treated at academic centers (66 and 86%, respectively). Publicly insured and uninsured patients had higher median bleeding (public: 7.0, uninsured: 9.0, private: 5.0) and pain (public: 6.0, uninsured: 6.0, private: 3.0) symptom scores than the privately insured. There were no statistical differences in surgeon characteristics by payor groups. Conclusion: This novel study design, a large EMR-based case series of hysterectomies linked to physician licensing data and manually abstracted data from unstructured clinical notes, enabled identification and characterization of a diverse reproductive-aged patient population more comprehensively than claims data would allow. In subsequent phases of this research, the CHC will leverage these rich clinical data to investigate multilevel drivers of hysterectomy in an ethnoracially, economically, and clinically diverse series of hysterectomy patients. [ABSTRACT FROM AUTHOR]

This paper describes a human-centered design approach to investigate unmet adolescent sexual health wants and needs among youth of color in low-income and rural communities in Texas, North Carolina, and Connecticut (n = 149). The approach involved gathering qualitative data through in-depth interviews and other human-centered design activities between April 2016 and August 2016. Data were analyzed using thematic content analysis after each round of data collection. Themes were triangulated across multiple data sources to identify key insights. Results highlighted several important unmet wants and needs. Participants shared that schools were not the preferred place to learn about sexual health and healthy relationships, due to uncomfortable and sometimes even hostile environments. When discussing the potential to use internet- and technology-based sexual health resources, participants expressed concerns over privacy, safety, and credibility of information available. Similarly, participants preferred mobile apps over websites due to the privacy of the experience. Most importantly, key emotions impacting adolescents' access to and use of sexual health resources were identified. Results indicated a preference for consuming story-based information in a text message format that described diverse experiences related to sexual health topics. Together, these findings led to the development of an innovative, mobile health intervention for adolescents, the Real Talk mobile app. This human-centered approach can support researchers and practitioners in strengthening intervention development efforts to improve the reach, adoption, and implementation of sexual health interventions. [ABSTRACT FROM AUTHOR]

In the wake of the 2008 Great Recession, a section of the Dodd–Frank Act (DFA) ostensibly provided greater protection to low-income borrowers by capping bank charges on small dollar mortgages (defined here as less than $100,000) and requiring more bank oversight by outside auditors. Previous research has shown that both actions had the perverse consequence of reducing the availability of mortgage credit to low-income borrowers. Building on these findings, we investigate the following question: Did the decline in access to credit lead to a decrease in demand for homes in high poverty census tracts, and a corresponding decline in property values in these areas? Using an OLS regression model of home values and census tract data in Forsyth County, North Carolina from 2007 to 2020, we calculate that nominal home values dropped by over 40% in the county's lowest income census tracts after the institution of the DFA, relative to the rest of the county. Our paper offers evidence that DFA has harmed those that the Act was intended to help. [ABSTRACT FROM AUTHOR]

Background: The onset of the COVID-19 pandemic challenged healthcare providers to adapt their models of care and leverage technology to continue to provide necessary care while reducing the likelihood of exposure. One setting that faced a unique set of challenges and opportunities was free and charitable clinics. In response to the emerging pandemic, The North Carolina Association for Free and Charitable Clinics (NCAFCC) offered their 66 member clinics access to a telehealth platform, free of charge. Objective: This paper explores the varied perspectives of leaders in the NCAFCC member clinics regarding the implementation of telehealth services to facilitate continuity of care for patients during the height of the pandemic. Design: This qualitative study is part of a broader research effort to understand and contextualize the experience of implementing and using telehealth services by North Carolina free and charitable clinics during and after the COVID-19 pandemic. The research team conducted 13 key informant interviews and employed thematic analysis and grounded theory to explore critical themes and construct a model based on the CFIR to describe the use of telehealth in free and charitable clinics. Results: Twelve clinic managers and executive directors from free and charitable clinics across the state participated in the key informant interviews providing their unique perspective on the experience of implementing telehealth services in a free and charitable clinic environment during the COVID-19 pandemic. When examined within the lens of the consolidated framework for implementation research (CFIR), 3 key themes emerged from the key informant interviews: mission driven patient centered care, resilience and resourcefulness, and immediate implementation. Conclusions: This study aligns with existing literature regarding telehealth implementation across other safety net provider settings and highlights the key implementation factors, organizational elements, provider perspectives, and patient needs that must collectively be considered when implementing new technologies, especially in a low-resource, high need healthcare setting. The study showcases the implementation climate, resourcefulness, and mission driven approach that allowed many NCAFCC clinics to respond to an emergent situation by adopting and implementing a telehealth platform in a period of 2 weeks or less. [ABSTRACT FROM AUTHOR]

Transportation agency personnel gain valuable knowledge through their work, but such knowledge is lost if it is not documented properly after the worker leaves the organization. The risk of losing institutional knowledge is a current problem at state departments of transportation, including the North Carolina Department of Transportation (NCDOT), due to high personnel turnover. State transportation agencies have implemented knowledge repositories in the form of lessons learned/best practices databases to address this problem. However, motivating end-users to use such databases is challenging. This paper addresses this challenge through novel artificial intelligence technology whereby a neural network–based language model is implemented as part of the NCDOT's new knowledge management program: Communicate Lessons, Exchange Advice, Record (CLEAR). The CLEAR program encompasses a database of lessons learned/best practices and a website to access and search the database. The developed methodology involves training a language model on transportation construction texts and using that trained model in a novel algorithm enabling users to search the CLEAR database easily. The developed language-processing model provides an easily accessible interface to suggest the most relevant CLEAR data based on the end-user's searched keywords. The model learns an inference model of construction domain–specific vocabulary extracted from various sources, such as contract documents, textbooks, and specifications, to make meaningful connections between lessons learned/best practices in the CLEAR database and project-specific knowledge. The developed model has been validated by project managers for projects at various life cycle stages. The automation of information retrieval is intended to encourage NCDOT personnel to use and embrace the CLEAR program as part of their routine work to improve project workflow. In the long run, the NCDOT will benefit from consistent usage of the CLEAR program and its high quality content, thereby leading to enhanced institutional knowledge and organizational innovation. The construction industry, with a particular emphasis on transportation construction, currently faces tremendous challenges in retaining and retraining existing personnel to ensure business continuity on projects. Knowledge gained on projects by project personnel can be lost forever if not properly documented. While knowledge repositories are effective toward ensuring the storing and retrieving of past knowledge, extant literature underlines the need to ensure continued participation by the end-users for the success of such repositories. This research effort uses natural language processing, a subfield artificial intelligence that deals specifically with text sources, as a means to quickly and accurately enhance the quality of search results being displayed to the end-users within the North Carolina Department of Transportation's recently commissioned knowledge management program called CLEAR. As a result, end-users can stay motivated and embrace the CLEAR program, thereby ensuring its long-term success. In the long run, the consistent usage of the CLEAR program and the high quality content that is input to the CLEAR database by the NCDOT end-users will lead to enhanced institutional knowledge and internal organizational innovation. [ABSTRACT FROM AUTHOR]

As a widespread vector of disease with an expanding range, the mosquito Aedes albopictus Skuse (Diptera: Culicidae) is a high priority for research and management. A. albopictus has a complex life history with aquatic egg, larval and pupal stages, and a terrestrial adult stage. This requires targeted management strategies for each life stage, coordinated across time and space. Population genetics can aid in A. albopictus control by evaluating patterns of genetic diversity and dispersal. However, how life stage impacts population genetic characteristics is unknown. We examined whether patterns of A. albopictus genetic diversity and differentiation changed with life stage at a spatial scale relevant to management efforts. We first conducted a literature review of field‐caught A. albopictus population genetic papers and identified 101 peer‐reviewed publications, none of which compared results between life stages. Our study uniquely examines population genomic patterns of egg and adult A. albopictus at five sites in Wake County, North Carolina, USA, using 8425 single nucleotide polymorphisms. We found that the level of genetic diversity and connectivity between sites varied between adults and eggs. This warrants further study and is critical for research aimed at informing local management. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bisphenol A (BPA) is a high-production-volume chemical associated with a wide range of health outcomes in animal and human studies. BPA is used as a developer in thermal paper products, including cash register receipt paper; however, little is known about exposure of cashiers to BPA and alternative compounds in receipt paper. OBJECTIVE: We determined whether handling receipt paper results in measurable absorption of BPA or the BPA alternatives bisphenol S (BPS) and 4-hydroxyphenyl 4-isoprooxyphenylsulfone (BPSIP). METHODS: Cashiers (n = 77) and non-cashiers (n = 25) were recruited from the Raleigh-Durham-Chapel Hill region of North Carolina during 2011-2013. Receipts were analyzed for the presence of BPA or alternatives considered for use in thermal paper. In cashiers, total urine and serum BPA, BPS, and BPSIP levels in post-shift samples (collected ≤ 2 hr after completing a shift) were compared with pre-shift samples. Levels of these compounds in urine from cashiers were compared to levels in urine from non-cashiers. RESULTS: Each receipt contained 1-2% by weight of the paper of BPA, BPS, or BPSIP. The post-shift geometric mean total urinary BPS concentration was significantly higher than the pre-shift mean in 33 cashiers who handled receipts containing BPS. The mean urine BPA concentrations in 31 cashiers who handled BPA receipts were as likely to decrease as to increase after a shift, but the mean post-shift concentrations were significantly higher than those in non-cashiers. BPSIP was detected more frequently in the urine of cashiers handling BPSIP receipts than in the urine of noncashiers. Only a few cashiers had detectable levels of total BPA or BPS in serum, whereas BPSIP tended to be detected more frequently. CONCLUSIONS: Thermal receipt paper is a potential source of occupational exposure to BPA, BPS, and BPSIP. [ABSTRACT FROM AUTHOR]

This paper analyzes usage data from Hunter Library's digital collections using Google Analytics for a period of twenty-seven months from October 2013 through December 2015. The authors consider this data analysis to be important for identifying collections that receive the largest number of visits. We argue this data evaluation is important in terms of better informing decisions for building digital collections that will serve user needs. The authors also study the benefits of harvesting to sites such as the Digital Public Library of America, and they believe this paper will contribute to the literature on Google Analytics and its use by libraries. [ABSTRACT FROM AUTHOR]

Like other minoritized populations, American Indian/Alaska Native (AI/AN) females experience disparate morbidity and mortality outcomes to that of the general US population. This study identified discrepancies in reporting of AI/AN female decedents between the North Carolina Violent Death Reporting System (NC-VDRS) and an online, user-generated database. Female AI/AN decedent data of all ages were collected from the NC-VDRS and compared against that of the publicly available North Carolina Missing and Murdered Indigenous Women (MMIW NC) database for the study period, 2004–2019. Twenty-four of the 72 cases matched between data systems (33.3%). Substantive differences between the NC-VDRS and the MMIW NC database were found. Future efforts should be directed towards supporting Indigenous communities with the comprehensive data the NC-VDRS can provide. This paper highlights statewide public health systems like the NC-VDRS supporting community efforts to understand, advocate for, and disseminate information on MMIW. [ABSTRACT FROM AUTHOR]

Purpose: Many older adults engage in volunteer activities, drawing meaning and purpose through such efforts. Social distancing restrictions, put in place during Covid-19 surges to reduce the risk of transmission, disrupted older adult volunteers' lives and volunteer experiences. Social distancing measures provide a unique opportunity to explore what happened when the choices around pausing or stopping volunteering were not entirely within the control of older adults. This paper aims to explore the experiences of older adult volunteers as they navigated uncertainties and made difficult decisions around balancing their safety and their desire to continue volunteering. Design/methodology/approach: The authors conducted interviews with 26 community-dwelling older adults, age 50+, who had engaged in volunteer activities for at least 1 h a week prior to the start of the pandemic. The interviews were conducted on the phone or via Zoom. The authors used thematic analysis to help us analyze the data and identify patterns from participants' experiences. Findings: Despite the risk presented by Covid-19, most participants volunteered during the pandemic. They continued some or all of their previous activities with safety-related adjustments, with some seeking new or different opportunities. Participants' discussions highlight the challenges of volunteering during the pandemic and the importance of engagement to their resiliency and subjective well-being. Originality/value: This paper provides original contributions to understanding how and why older adults volunteered during the Covid-19 pandemic. The social distancing measures provide a novel opportunity to enrich our understanding of the meaningfulness and value of volunteerism to older adults' lives and subjective well-being. [ABSTRACT FROM AUTHOR]

In the wake of the COVID-19 pandemic, many districts sought digital learning solutions to recover from learning loss, improve equity, and prepare for future interruptions. With this paper, we aim to provide information to policymakers and legislators regarding the value of resources needed to successfully implement comprehensive digital learning programing. We focus on the policies and resource allocation decisions made in North Carolina, one of the first states to launch a statewide digital learning initiative. First, we demonstrate the effects of state policy on school practices, then we turn the focus of the paper to how districts and schools allocated resources to implement digital learning. We apply the ingredients method to examine the costs of digital learning during the 2018–2019 school year. We close with recommendations for future policy and resource allocation. [ABSTRACT FROM AUTHOR]

All professional decisions prepared for a specific stakeholder can and must be explained. The primary role of explanation is to defend and reinforce the proposed decision, supporting stakeholder confidence in the validity of the decision. In this paper we present the methodology for explaining results of the evaluation of alternatives for water quality protection for a real-life project, the Upper Neuse Clean Water Initiative in North Carolina. The evaluation and comparison of alternatives is based on the Logic Scoring of Preference (LSP) method. We identify three explainability problems: (1) the explanation of LSP criterion properties, (2) the explanation of evaluation results for each alternative, and (3) the explanation of the comparison and ranking of alternatives. To solve these problems, we introduce a set of explainability indicators that characterize properties that are necessary for verbal explanations that humans can understand. In addition, we use this project to show the methodology for automatic generation of explainability reports. We recommend the use of explainability reports as standard supplements for evaluation reports containing the results of evaluation projects based on the LSP method. [ABSTRACT FROM AUTHOR]

Agricultural labor is extremely hazardous, yet young children are legally permitted to work on farms. This paper contextualizes and describes Latinx hired child farmworkers' stated reasons for working. We conducted a mixed-methods study using in-depth interviews (n = 30) and survey interviews (n = 202) with Latinx child farmworkers aged 10 to 17 in North Carolina. Our qualitative thematic analysis identified children's salient reasons for working, including supporting family, contextual factors that lead to farm work, and occupying summer time. Statistical analysis showed that children's primary reasons for working included buying clothes (91.1%) and school supplies (64.7%), with few differences by gender, age, or other characteristics. The findings demonstrate that most Latinx children view farm work as a necessary but temporary experience that financially supports their families. We discuss the implications for protecting Latinx child workers by reducing their structural vulnerability in order to facilitate healthy development. [ABSTRACT FROM AUTHOR]

A relevant, well-crafted emergency plan can help schools most optimally return to normal following a disaster. During this time, educators find themselves facing unintended responsibilities like operating on the front lines of providing social-emotional support for their students. Researchers conducted 115 interviews with educators impacted by Hurricanes Harvey and Matthew in Texas and North Carolina to assess their mental health and their school's role in returning to normal. Findings suggest that emergency plans often did not take into account the social-emotional factors of recovery. This paper seeks to provide insight into the experiences of educators following a disaster and propose elements to consider in revising school emergency plans. [ABSTRACT FROM AUTHOR]

This paper introduces an approach to evaluate the performance of a previously implemented or proposed hurricane evacuation plan that describes where and when official evacuation orders are issued. The approach involves use of the new integrated scenario-based evacuation (ISE) decision support tool to define a best track evacuation plan as a reference point and measure the performance of other plans in relation to that according to their ability to meet multiple stated objectives: minimizing risk to the population, travel time, and time people are away from their homes. Using North Carolina in Hurricane Florence (2018) as a case study, we demonstrate the process by evaluating performance of both the actual set of orders as executed and the orders that would have been recommended if the new ISE decision support tool had been used during the event. All three plans were evaluated for two cases—assuming the hurricane unfolds as it actually did, and if the hurricane had instead evolved like one of 21 other realistic scenarios. Results suggest the actual evacuation was quite good, and the ISE tool could have resulted in improved evacuation performance. This paper introduces a comprehensive, replicable approach to evaluating the performance of a previously implemented or proposed hurricane evacuation plan (i.e., a plan that describes where and when official evacuation orders are issued). Currently, there is no formal way to do so. The method presented defines as a reference point the evacuation plan that would minimize the stated aims if there was no uncertainty in the hurricane behavior, that is, if we had a crystal ball so that at the time the hurricane formed we could know the eventual track, intensity, and associated wind, rain, and flooding hazards exactly. The approach then measures the performance of other plans in relation to that reference, with performance based on their ability to meet multiple objectives: minimizing risk to the population, travel time, and time people are away from their homes. This new method can be of practical use to (1) provide after-the-fact evaluation of past evacuations to facilitate learning, (2) support planning through comparison of alternative strategies and decision support tools for hypothetical future hurricanes, and (3) gauge expectations about what performance can be reasonably expected in different circumstances. [ABSTRACT FROM AUTHOR]

While the plastics pollution crisis has remained on the wider global radar, a more recent and seemingly more pervasive type of pollution, known as microplastic pollution, has gained attention by environmentalists. However, there are large gaps in the research of microplastic pollution, especially in freshwater ecosystems. This study seeks to address this gap by investigating the prevalence of microplastics in the Catawba River Basin of North Carolina. The Catawba River Basin is an ideal study location due to its use for recreation, energy, and drinking water for the nearby metropolis of Charlotte, NC. Eighty water samples were collected from five different sites. These sites were characterized by recreated versus non-recreated areas and upstream versus downstream locations. Each sample was vacuum filtered through micron filter paper and then analyzed under a compound microscope for microplastics. Notably, the presence of microplastics in every water sample collected was found. The results showed a 45% increase in prevalence of microplastics in recreated areas compared with less recreated areas, and 25% increase in microplastics downstream of Wastewater Treatment Plants compared with upstream locations. More research is necessary to identify and understand the possible human health and ecological implications of microplastics in the North Carolina area. [ABSTRACT FROM AUTHOR]

Community health workers are responsible for finding, processing, and transferring health information to communities with limited access to health‐related resources, including farmworkers. This paper is the culmination of an undergraduate student research project to explore the learning processes and preferences of farmworker‐serving community health workers in the USA. The project was designed for students from farmworker or agricultural backgrounds at two North Carolina universities and was supported by a North Carolina Department of Health and Human Services workforce development grant. Semi‐structured interviews were conducted, in person and virtually, with a convenience sample of 17 current and former community health workers. The interview data were analysed thematically and identified a preference for a combination of learning styles, with visual and hands‐on learning being the most preferred. Community health workers also identified the importance of learning preferences in relation to their responsibilities as health educators. This study provides librarians, along with public health and medical professionals, with useful information about learning preferences to inform the creation of new and varied learning materials for community health workers. [ABSTRACT FROM AUTHOR]

Over the last decade, the Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been transitioning to electronic food-benefits (eWIC). The North Carolina Appalachian Region was among the last to implement this transition, yet little is known about how eWIC influenced experiences in rural areas. This study examined potential differences in maternal shopping characteristics (MSC), perceptions, barriers, and dietary intakes by type of food-benefits used (paper food-benefits (PB) versus eWIC) among pregnant women and/or mothers in three rural counties in Western North Carolina. Our findings suggest eWIC has a positive impact on MSC and overall satisfaction in this region. [ABSTRACT FROM AUTHOR]

This paper empirically investigates how sentences to be assigned at trial impact plea bargaining. The analysis is based on the model of bargaining with asymmetric information by Bebchuk, 1984. I provide conditions for the nonparametric identification of the model, propose a consistent nonparametric estimator, and implement it using data on criminal cases from North Carolina. Employing the estimated model, I evaluate how different sentencing reforms affect the outcome of criminal cases. My results indicate that lower mandatory minimum sentences could greatly reduce the total amount of incarceration time assigned by the courts, but may increase conviction rates. In contrast, the broader use of non-incarceration sentences for less serious crimes reduces the number of incarceration convictions, but has a very small effect over the total assigned incarceration time. I also consider the effects of a ban on plea bargains. Depending on the case characteristics, over 20 percent of the defendants who currently receive incarceration sentences would be acquitted if plea bargains were forbidden. [ABSTRACT FROM AUTHOR]

Misalignment between the different levels of complex societal systems (e.g. socio-technical, socio-ecological) are often a barrier to transitioning these systems toward more sustainable behavior. One way to understand alignment is through the Multilevel Perspective Theory of sustainable transitions in sociotechnical systems (MLP) which posits that when a regime (the current "ways of doing" something) exhibits behavior that negatively impacts its surrounding economic, social and environmental landscape, that landscape will exert pressure on the regime to change. This in turn opens the window of opportunity for niche developments such as novel technology adoption or policy changes. Therefore, understanding the relationships between the landscape, the regime and emerging niches can help align these different levels of perspective to facilitate a successful transition toward more sustainable practices. This paper describes a methodology for mapping complex systems such as agricultural systems based on MLP theory, and incorporates a fourth "user" level (e.g. the farm) into this multilevel framework (MLP+ F). The methodology is illustrated with a case study example of North Carolina's lagoon and sprayfield swine waste management regime. By integrating well-established techniques for data collection and analysis, the case study engages a diverse panel of local experts through a modified Delphi approach to identify the relevant concepts and their cause-effect relationships for the current regime. These concepts and relationships are then categorized and organized into a multilevel, multi-perspective conceptual model using fuzzy cognitive maps. The conceptual model identifies how stakeholder groups align in their perception of the system, and provides a foundation for future qualitative, semi-quantitative, and visual analyses of the system and how it can be changed through alternative scenarios. Although this methodology was initially developed for agricultural applications, it has potential for application to other complex societal issues where understanding stakeholder alignment and the potential for sustainability transitions through change are needed. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the utility of electronic tablets and their capacity to increase hospital floor productivity, efficiency, improve patient care information safety, and to enhance resident education and resource utilization on a busy Otolaryngology - Head & Neck Surgery inpatient service. This was a prospective cohort study with a 2-week pre-implementation period with standard paper census lists without mobile tablet use, and a 2-week post-implementation period followed with electronic tablets used to place orders, look up pertinent clinical data, educate patients as appropriate, and to record daily to-dos that would previously be recorded on paper. The setting for the study was Duke University Medical Center in Durham, North Carolina, with 13 Otolaryngology residents comprising the study population. The time for inpatient rounding was shorter with the use tablets ( p = 0.037). There was a non-significant trend in the number of times a resident had to leave rounds to look up a clinical query on a computer, with less instances occurring in the post-implementation study period. The residents felt that having a tablet facilitated more detailed and faster transfer of information, and improved ease of documentation in the medical record. Seventy percent felt tablets helped them spend more time with patients, 70 % could spend more time directly involved in rounds because they could use the tablet to query information at point-of-care, and 80 % felt tablets improved morale. The utility of a mobile tablet device coupled with the electronic health record appeared to have both quantitative and qualitative improvements in efficiency, increased time with patients and attendance at academic conferences. Tablets should be encouraged but not mandated for clinical and educational use. [ABSTRACT FROM AUTHOR]

Historically, swimming pools have been a source of inequity when it comes to the distribution of recreation services in the United States. Many of the problems that correlate with the inequitable allocation of recreation resources including public swimming pools began with ideas about race, geography, poor planning practices and faulty policymaking (Rothstein, 2017). Moreover, one of the primary outcomes of engaged, inclusive planning is equity in the provision of recreation programs and facilities. In this essay, we offer a summary of key legal cases that help address questions related resource allocation related to public swimming pools. Finally, we present a short case study on the Winston Water Works Project in Winston-Salem, North Carolina. This case illustrates the power of grassroots level advocacy, engaged community planning, and policymaking that protects the recreation infrastructure in a community and moves the needle of social justice toward equity. Our principle interest in this paper is in the equitable provision and distribution of aquatics programming and facilities. [ABSTRACT FROM AUTHOR]

Background. Health equity impact assessments (HEIAs) inform the reduction of health inequities by evaluating programs or policies that affect target populations. Local health departments (LHD) receiving funding through the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) Program conducted HEIAs for evidence-based strategies (EBSs). This paper describes the impact of HEIAs on the implementation of EBSs and highlights lessons learned during implementation of HEIA modifications. Methods. We conducted a content analysis using data from the HEIA Modification Tracker and focus groups to identify themes and lessons learned. Results. Fifteen HEIAs were conducted by five LHDs between 2016 and 2020. The most common modifications to EBS implementation were 1) increasing education and training for community members and 2) altering messaging mediums and language to reach intended audiences. Discussion. Health equity impact assessments serve as a systematic and tangible way to center health equity, reflect on past processes, and inform improvements. [ABSTRACT FROM AUTHOR]

The floodplains of the Southeast's stream network once hosted immense brakes of rivercane (Arundinaria gigantea), a disturbance-dependent native bamboo with both cultural and ecological significance. Ecologically, rivercane alters its local environments, boosts biodiversity and biomass, and protects streambanks from erosion and storm damage. Indigenous peoples of the Southeast have used rivercane for millennia, for material and cultural purposes, and formerly maintained its health and extent through harvesting and fire. Settler-colonial incursions largely destroyed rivercane, through the more intense disturbance of different land management practices, and brakes now exist mainly in relatively small areas. While numerous rivercane restoration projects are in process throughout its natural range, no comprehensive inventory of living rivercane exists. In this paper, we present both human context and the results of LiDAR analysis that identifies canebrakes based on the physical characteristics of the plant and brake. In our study area on the Little Tennessee River in western North Carolina, we found rivercane on about 9 percent of the floodplain area, based on QL1 LiDAR data available from the state of North Carolina. The technique can be applied in any part of rivercane's range, and the resulting inventory used in support of both cultural and ecological goals. [ABSTRACT FROM AUTHOR]

Objectives: To describe how the UNC Horizons program, a comprehensive women-centered program for pregnant and parenting women with substance use disorders, and its patient population have changed over time and summarize basic neonatal outcomes for infants born to women in treatment at Horizons. Methods: Yearly Annual Reports from fiscal years of 1994 to 2017 were abstracted. Patient characteristics and infant outcomes compared to normative North Carolina data were examined. Results: Highlights of findings include: The percentage of women for whom opioids were the primary substance of use increased from 0% in 1995–1996 to 62% in 2016–17, while cocaine decreased from 66 to 12%. Intravenous substance use history increased from 7% in 1994–1995 to 41% in 2016–2017. The number of women reporting a history of incarceration rose from 10–20% in the early years to 40%-50% beginning in 2007–2008. The proportion of women reporting a desire to hurt themselves rose from 20% in 2004–2005 to 40% in 2016–2017. Self-reported suicide attempt history remained consistent at 32% across years. While reporting of childhood physical abuse remained at 38% across years, reporting of sexual abuse and domestic violence trended upward. Horizons did not differ from North Carolina in the likelihood of patients giving birth prematurely [χ2(13) = 20.6,p =.082], or the likelihood of a patient giving birth to a low birthweight infant [χ2(13) = 14.7,p =.333]. Conclusions for Practice: Breaking the cycle of addiction for women and children must focus on helping women with substance use problems develop a sense of hope that their lives can improve, and a sense of feeling safe and nurtured. Significance: Systematic examinations of programs that provide treatment services to pregnant and parenting women with substance use disorders have typically been focused on a limited set of outcomes and have been cross-sectional in nature. The current paper presents a detailed examination of the patient populations over a 23-year period, with particular attention to the changes over time in the women served. The birth weight and prematurity of infants born to the women in this program were likewise examined over time, and in comparison to state-level data. [ABSTRACT FROM AUTHOR]

In this qualitative study, the experiences of students of color at a predominantly white university in North Carolina are used to expose the ways in which white homogeneity and white normativity work to maintain hidden white privileges in various campus settings. Through the counternarratives obtained during nine focus group meetings with a total of thirty-one selfidentified students of color, these students are able to expose and describe a host of unnoticed burdens associated with being Brown and Black in white campus settings. They experience racial othering, extreme visibility, and stereotypes associated with their race and gender, and they explain ways they have devised to navigate through the university in the face of daily and routine manifestations of racism. Their voices effectively counter the ideologies of majoritarian stories that consistently deny the existence and effects of racism, to reveal some of the ways in which college life is in an unequal, racialized experience. The paper concludes by acknowledging limitations of this research as well as by discussing implications for the use of experiential knowledge through counterstories of those affected by injustice to help oppose false ideologies that work to promote racialized college experiences and outcomes. [ABSTRACT FROM AUTHOR]

The public policy innovation and adoption processes are dynamic and complex. This is no exception for the adoption of hazard mitigation policies by localities prone to natural hazards. This paper synthesizes theories about policy innovation and adoption, and literature about hazards mitigation, and proposes a theoretical framework for understanding the factors driving hazard mitigation policy adoption at the local level. Our goal is to identify the key elements and parameters of the hazard mitigation policy adoption construct as well as the relationship between them. Using the property buyout program as an example, we present case studies in the states of North Carolina and New Jersey to illustrate a proposed theoretical framework and outline the directions for future research. The case studies show promising evidence consistent with the proposed framework, covering five categories—hazard problem, social context, institutional capacity, cross-sector collaboration, and policy diffusion. In particular, as for institutional capacity, three aspects influence the uptake of buyouts, including individual capacity [e.g., geographic information system (GIS) and technical skills], organizational capacity (e.g., reducing the negative financial impact on the tax base of buyouts and encouraging an innovative culture of flood mitigation strategies), and system capacity (e.g., cooperation among local organizations). To further validate the framework, systematic research of localities with diverse characteristics of policy adopters and nonadopters is needed. Flood hazard mitigation is a policy issue with great significance for governments and thousands of flood-prone communities in the US. Local governments bear the primary responsibility of initiating actions for managing flood hazard. Our theorization exercise and the case studies on the property buyout program highlight the importance of several internal and external factors that influence decisions to pursue this hazard mitigation measure at the local level. For local floodplain managers, disaster resilience officers, and policy entrepreneurs, these findings offer pointers as to where they should focus their effort to maximize the possibility of success. Within the community, developing a comprehensive appreciation of the local flood hazard, GIS, and technical skills of local officials as well as cooperation between local organizations are essential in cultivating a culture that encourages innovative flood mitigation strategies. Externally, coordination and communication between the federal, state, and local levels, as well as learning and emulation of practices in peer communities are key for local success. In this regard, the training workshops and outreach programs of FEMA, FEMA regional offices, and its state counterparts are critical. These programs will elevate the issue on the local agenda, disseminate best practices, demystify the process, and incentivize more mitigation policy adoption. [ABSTRACT FROM AUTHOR]

Introduction: Social insecurity, a form of deprivation of social amenities, if present among patients presenting in a rural emergency department (ED) can be a source of medical burden and poor health outcomes. Although knowledge and understanding of the insecurity profile of such patients is necessary for targeted care that improves their health outcomes, the concept has not been comprehensively quantified. In this study we explored, characterized, and quantified the social insecurity profile of ED patients at a rural teaching hospital in southeastern North Carolina with a large Native American population. Methods: A paper survey questionnaire was administered by trained research assistants between May– June 2018 to patients who presented to the ED and consented to participate in this cross-sectional, singlecenter study. The survey was anonymous with no identifying information collected on the respondents. A general demographic section and questions derived from the literature capturing sub-constructs of social insecurity—communication access, access to transportation, housing insecurity and home environment, food insecurity, and exposure to violence–were captured in the survey. We assessed the factors included in the index of social insecurity based on a rank ordering using the magnitude of their coefficient of variation and the Cronbach’s alpha reliability index of the constituent items. Results: Overall, we collected 312 surveys from the approximately 445 administered and included them in the analysis, representing a response rate of about 70%. The average age of the 312 respondents was 45.1 (±17.7) years with a range of 18.0-96.0. More females (54.2%) than males participated in the survey. Native Americans (34.3%), Blacks (33.7%), and Whites (27.6%) comprised the three major racial/ethnicity groups of the sample, which are representative of the study area’s population distribution. Social insecurity was observed among this population regarding all the subdomains and an overall measure (P <.001). We identified three key determinants of social insecurity—food insecurity, transportation insecurity, and exposure to violence. Social insecurity significantly differed overall and among the three of its key constituent domains by patients’ race/ethnicity and gender (P <.05). Conclusion: Emergency department visits in a rural North Carolina teaching hospital are characterized by a diverse patient population, including patients with some degree of social insecurity. Historically marginalized and minoritized groups including Native Americans and Blacks demonstrated overall higher rates of social insecurity and higher indexes on exposure to violence than their White counterparts. Such patients struggle with basic needs such as food, transportation, and safety. As social factors play a critical role in health outcomes, supporting the social well-being of a historically marginalized and minoritized rural community would likely help build the foundation for safe livelihood with improved and sustainable health outcomes. The need for a more valid and psychometrically desirable measurement tool of social insecurity among ED populations is compelling. [ABSTRACT FROM AUTHOR]