Analysis of Oklahoma amputation trends and identification of risk factors to target areas for limb preservation interventions.

OBJECTIVE: Annual trends of lower extremity amputation due to end-stage chronic disease are on the rise in the United States. These amputations are leading to massive expenses for patients and the medical system. In Oklahoma, we have a high-risk population because access to care is low, the number of uninsured is high, cardiovascular health is poor, and our overall health care performance is ranked 50th in the country. But we know little about Oklahomans and their risk of limb loss. It is, therefore, imperative to look closely at this population to discover contemporary rates, trends, and state-specific risk factors for amputation due to diabetes and/or peripheral arterial disease (PAD). We hypothesize that state-specific groups will be identified as having the highest risk for limb loss and that contemporary trends in amputations are rising. To create implementable solutions to limb preservation, a baseline must be set. METHODS: We conducted a 12-consecutive-year observational study using Oklahoma's hospital discharge data. Discharges among patients 20 years or older with a primary or secondary diagnosis of diabetes and/or PAD were included. Diagnoses and amputation procedures were identified using International Classification of Disease-9 and -10 codes. Amputation rates were calculated per 1000 discharges. Trends in amputation rates were measured by annual percentage changes (APC). Prevalence ratios evaluated the differences in amputation rates across demographic groups. RESULTS: Over 5,000,000 discharges were identified from 2008 to 2019. Twenty-four percent had a diagnosis of diabetes and/or PAD. The overall amputation rate was 12 per 1000 discharges for those with diabetes and/or PAD. Diabetes and/or PAD-related amputation rates increased from 8.1 to 16.2 (APC, 6.0; 95% confidence interval [CI], 4.7-7.3). Most amputations were minor (59.5%), and although minor, increased at a faster rate compared with major amputations (minor amputation APC, 8.1; 95% CI, 6.7-9.6 vs major amputation APC, 3.1; 95% CI, 1.5-4.7); major amputations were notable in that they were significantly increasing. Amputation rates were the highest among males (16.7), American Indians (19.2), uninsured (21.2), non-married patients (12.7), and patients between 45 and 49 years of age (18.8), and calculated prevalence ratios for each were significant (P = .001) when compared within their respective category. CONCLUSIONS: Amputation rates in Oklahoma have nearly doubled in 12 years, with both major and minor amputations significantly increasing. This study describes a worsening trend, underscoring that amputations due to chronic disease is an urgent statewide health care problem. We also present imperative examples of amputation health care disparities. By defining these state-specific areas and populations at risk, we have identified areas to pursue and improve care. These distinctive risk factors will help to frame a statewide limb preservation intervention.

Coccidioidomycosis in Oklahoma: A retrospective case series.

BACKGROUND: Coccidioidomycosis is a systemic fungal disease endemic to arid regions of the Western Hemisphere. In the south-western US, Coccidioides spp. may account for up to 20%-25% of all cases of community acquired pneumonia. Clinical manifestations vary widely, from asymptomatic infection to life-threatening disease, especially in immunocompromised hosts. OBJECTIVES: The primary objective of the study was to characterise cases of coccidioidomycosis in an area of the United States not considered traditionally endemic for the disease. METHODS: We performed a single-centre retrospective study of all cases of coccidioidomycosis from 1 January 2000 to 31 December 2020, in the University of Oklahoma Health Sciences Medical Center. RESULTS: A total of 26 patients were included for analysis. The central nervous system (CNS) and the lungs were the sites most frequently involved. Twenty (77%) had travelled to a coccidioidomycosis endemic region. Most were male (81%) with a median age of 42 years (range: 3-78 years). The majority (46%) were Caucasians, 19% were African American, 19% Hispanic, and 12% Native American. The most common comorbidities were diabetes mellitus and acquired immunodeficiency syndrome, identified in 27% and 23% of patients, respectively. Patients on immunosuppressive therapy accounted for 12% of all cases. CONCLUSION: Our study is one of the largest single-centre case series of coccidioidomycosis from a non-endemic area. Diabetes mellitus was the most frequent comorbidity. Compared to other case series of coccidioidomycosis, our patient population had higher rates of immunosuppression and had both a higher rate of disseminated disease and overall mortality.

Changes in alcohol consumption and binge drinking during the COVID-19 pandemic among American Indians residing in California and Oklahoma.

Background: This study explored the increased quantity and frequency of alcohol use in the American Indian (AI) population during the COVID-19 pandemic.Objectives: The aims of this study were to explore possible associations between covariables and both binge drinking and alcohol consumption during COVID-19.Methods: This cross-sectional survey study analyzed data from a sample of AI individuals (63% female) residing in California (n = 411) and Oklahoma (n = 657) between October 2020-January 2021. Analysis included summary statistics and multivariable logistic regression, including a variety of socio-economic, COVID-19 concern, and tobacco and marijuana use variables.Results: One or more alcohol binge episodes were reported between October 2020-January 2021 in 19.3% of participants and elevated overall alcohol consumption was reported by 21.6% of participants. Higher odds of elevated alcohol consumption occurred in women and those following more social distancing measures. The odds of binge drinking or elevated alcohol consumption in those using both marijuana and tobacco (aOR/ adjusted odds ratio:18.9, 95% CI = 8.5, 42.2, and aOR:3.9, 95% CI = 1.7, 8.6, respectively) were higher compared to those using neither. Similarly, the odds of binge drinking or elevated alcohol consumption in those using tobacco only (aOR:4.7, 95% CI = 2.9, 7.7 and aOR: 2.0, 95% CI = 1.1, 3.5, respectively) were higher compared to those using neither.Conclusions: This study found high rates of alcohol use and bingeing during the COVID-19 pandemic. Offering collaborative, culturally sensitive, and affordable support services are important components of intervention and preparation for future stressful events on local, as well as global levels.

Global Genetic Diversity of Tobacco Ringspot Virus Including Newly Reported Isolates from Cotton (Gossypium hirsutum) in Oklahoma.

Cotton is one of the most salient cash crops globally and in the United States. Lately, several virus-like diseases have been reported from cotton in the United States such as the tobacco ringspot virus (TRSV) in Oklahoma. TRSV has been reported from various hosts worldwide with minimal phylogenetic examination. In this study, complete genome sequences of four TRSV isolates from cotton were isolated, and the genetic diversity was investigated along with additional available TRSV isolates retrieved from GenBank. Phylogenetic analysis based on the complete RNA1 and RNA2 sequences distributed all TRSV isolates into three major phylogenetic clades exhibiting a differential clade composition depending on the segment. The TRSV cotton isolates exhibited differential grouping between the RNA1 and RNA2 analyses. Additionally, monophyletic subclades of isolates appeared to be conserved between both segments. Thirty-five recombination events in RNA1 and 23 in RNA2 were identified with implications in the variation of the phylogenetic analyses. Furthermore, multiple hypotheses of TRSV evolution were generated based on the phylogenetic analyses, but to test them, more complete genomes of TRSV will be needed. This study provides the first complete genome analysis of TRSV isolates infecting cotton in the United States and a detailed analysis of global TRSV isolates.

Characterization of hypersaline Oklahoma native microalgae cultivated in flowback and produced water: growth profile and contaminant removal.

This work explores the potential of three hypersaline native microalgae strains from Oklahoma, Geitlerinema carotinosum, Pseudanabaena sp., and Picochlorum oklahomensis, for simultaneous treatment of flowback (FW) and produced wastewater (PW) and the production of algal biomass. The quality of wastewater before and after treatment with these microalgae strains was evaluated and a characterization of algal biomass in terms of moisture, volatile matter, fixed carbon, and ash contents was assessed. The experimental results indicated how all the microalgae strains were able to grow in both FW and PW, revealing their potential for wastewater treatment. Although algal biomass production was limited by nutrient availability both in PW and FW, a maximum biomass concentration higher than 1.35 g L-1 were achieved by the three strains in two of the PWs and one of the FWs tested, with Pseudanabaena sp. reaching nearly 2 g L-1. Interestingly, higher specific growth rates were obtained by the two cyanobacteria strains G. carotinosum and Pseudanabaena sp. when cultivated in both PW and FW, compared to P. oklahomensis. The harvested algal biomass contained a significant amount of energy, even though it was significantly reduced by the very high salt content. The energy content fell within the recommended range of 16-17 MJ kg-1 for biomass as feedstock for biofuels. The algal treatment resulted in the complete removal of ammonia from the wastewater and a significant reduction in contaminants, such as nitrate, phosphate, boron, and micronutrients like zinc, manganese, and iron.

A Comparative Investigation of Equine-Related and Bovine-Related Human Fatalities in Oklahoma.

ABSTRACT: This study examined 71 cases, where 45 cases were equine-related and 26 were bovine-related. Data for this study were collected by examining cases between 2000 and 2022 from the Oklahoma Office of the Chief Medical Examiner database.A majority of the equine-related fatality cases involved males aged 0 to 18 and 60 to 69 years, with sustained injuries of the head, neck, and thoracic regions while being mounted. These injuries were most often inflicted by being kicked or resulted from blunt force of impact. A majority of the bovine-related fatality cases involved males aged 60 to 79 years, with sustained injuries of the head, neck, and thoracic regions while being unmounted. These injuries were most often inflicted by being butted, trampled, or resulted from blunt force of impact. Of the total cases, approximately 42% of the causes of death were blunt force trauma of the head/neck and nearly 34% were multiple blunt force injuries. Only 3 mechanisms of death were discussed.There are distinct similarities in the most prominent gender, cause of sustained injury, and location of injury between equine- and bovine-related fatalities in Oklahoma. This study lends significant support to the need for increased awareness of safe handling practices and safety precaution education for both equine and bovine activities.

Pre-Pandemic Landscape of the Oklahoma Public Health Workforce: A Case Study From the Region 6 Training Needs Assessment Survey, 2019.

CONTEXT: The COVID-19 pandemic highlighted the need for a well-trained public health workforce prior to the public health crisis. Public health training centers regularly assess workforce needs and their pre-pandemic data play vital roles in guiding public health workforce development beyond the crisis. PROGRAM: In 2019, Oklahoma partners of the Region 6 South Central Public Health Training Center (R6SCPHTC) co-conducted an online survey of the public health workforce located in the Health Resources & Services Administration Region 6. IMPLEMENTATION: Between March and April, the R6SCPHTC collected 503 surveys, including 201 surveys from Oklahoma. Questions inquired about demographic and workforce characteristics, work contexts, training needs and interests, training access and logistics, and knowledge of R6SCPHTC online resources. EVALUATION: Key findings included that two-thirds of the pre-pandemic Oklahoma public health workforce consisted of employees age 40 or older with few holding public health or medical degrees. The majority of respondents worked for health departments and Tribes, and almost half were frontline workers. Although at least half of the participants interested in training on public health activities and topics were familiar with them, confidence in their abilities related to these activities and topics was expressed by less than half. Qualitative data provided details on training needs addressed quantitatively and described new training areas. Survey participants expressed interest in diverse training delivery methods and technological devices. Most respondents were not familiar with the free trainings available through the R6SCPHTC. DISCUSSION: Similar to the regional and national public health workforce, Oklahoma's workforce needed training and support already before COVID-19. Time and resources need to be invested into the current and future workforce. While addressing priority public health skills and topics remains important, training on current and emerging topics is needed. Providing accessible trainings with expanded content will prepare Oklahoma's public health workforce for the future.

Evaluation of the Cherokee Nation Hepatitis C Virus Elimination Program - Cherokee Nation, Oklahoma, 2015-2020.

Approximately 2.4 million persons in the United States have hepatitis C virus (HCV) infection, and 66,700 acute HCV infection cases were estimated for 2020 (1,2). American Indian or Alaska Native (AI/AN) persons are disproportionately affected by HCV infection and experienced the highest rates of acute HCV infection (2.1 cases per 100,000 persons) and HCV-associated mortality (10.17 per 100,000 persons) in the United States during 2020 (1). During 2015, Cherokee Nation Health Services (CNHS) in Oklahoma implemented an HCV elimination program, which includes universal HCV screening, primary HCV workforce expansion, and harm reduction services (3). To assess progress 5 years after program initiation, CNHS analyzed deidentified health record data. During November 1, 2015-October 31, 2020, a total of 1,423 persons received a diagnosis of HCV infection. Among these persons, 1,227 (86.2%) were linked to HCV care, and 871 (61.2%) initiated HCV treatment; 702 (49.3%) returned for their 12-week post treatment completion visit, at which time 698 (49.1%) had achieved laboratory-confirmed sustained virologic response (SVR), defined as undetectable HCV RNA at ≥12 weeks after completion of treatment (SVR12). Although CNHS has linked the majority of persons diagnosed with HCV infection to care, and those who returned for the SVR12 visit had high cure rates (99.4%), treatment initiation was lower than expected. Future activities should prioritize addressing gaps in treatment initiation after linkage to care and confirmation of hepatitis C cure with SVR12 testing.

A longitudinal follow-up study of Oklahoma City bombing survivors in the first quarter century after the disaster.

BACKGROUND: This study is one of the longest postdisaster prospective longitudinal studies of disaster-related psychopathology, completed nearly a quarter century after a terrorist bombing, and the longest follow-up study ever conducted using full diagnostic assessment in highly exposed disaster survivors. METHODS: Oklahoma City bombing survivors (87% injured) were randomly selected from a state survivor registry and interviewed approximately 6 months postdisaster (N = 182; 71% participation) and again nearly 25 years later (N = 103; 72% participation). Interviews were conducted using the Diagnostic Interview Schedule (a structured interview assessing full diagnostic criteria) for panic disorder, generalized anxiety disorder, and substance use disorder at baseline and also for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) at follow-up. The Disaster Supplement assessed disaster trauma exposure and subjective experience. RESULTS: At follow-up, 37% of participants exhibited bombing-related PTSD (34% at baseline) and 36% had MDD (23% at baseline). More new cases of PTSD than MDD developed over time. Nonremission rates were 51% for bombing-related PTSD and 33% for MDD. One-third of participants reported long-term nonemployability. CONCLUSIONS: The presence of long-term medical problems among survivors parallels the persistence of psychopathology. Ongoing medical problems might have contributed to psychiatric morbidity. Because no major variables predicted remission from bombing-related PTSD and MDD, all survivors with postdisaster psychopathology likely need access to long-term evaluation and care.

Geographic and social economic disparities in the risk of exposure to ambient air respiratory toxicants at Oklahoma licensed early care and education facilities.

BACKGROUND: Early life exposures to hazardous air pollutants has been associated with adverse asthma-related outcomes. Neighborhood-level social and economic factors play an essential role in the distribution of hazardous air pollutants and children spend a substantial amount of time at early care and education (ECE) facilities. While the indoor air quality of these facilities has been described, particularly for criteria air pollutants such as volatile organic compounds and particulate matter, little is known about the ambient air quality of ECE facilities. OBJECTIVES: We conducted a cross-sectional study to estimate the ambient air quality of Oklahoma licensed ECE facilities and to explore associations between ambient air quality and select geographic predictors. METHODS: We estimated ambient air quality using the total respiratory hazard quotient from the National Air Toxics Assessment according to the geographical location of licensed Oklahoma ECE facilities (N = 3184). We then determined whether urban and rural ECE facilities' air respiratory toxicant exposure risk differed by ECE facilities' neighborhood-level social and economic inequities including: 1) racial-ethnic minority community, 2) neighborhood socioeconomic status, and 3) residential segregation. RESULTS: Urban ECE facilities in Hispanic segregated counties were five times more likely to be at risk of high air respiratory exposure, adjusted for integrated urban counties (p < 0.0001, 95% CI [3.824, 7.699]). Rural ECE facilities in African American segregated counties were nine times more likely to be at risk of high air respiratory toxicant exposure, adjusted for integrated rural counties (p < 0.0001, 95% CI [5.641, 15.928]). CONCLUSION: We found geographically and socially disparate patterns of higher exposures to ambient air respiratory toxicants at Oklahoma ECE facilities. Safer siting policies and interventions are needed to mitigate air respiratory toxicant exposures, which may help to reduce asthma control disparities and improve respiratory health outcomes in Oklahoma ECE facilities.

Collective health behavior and face mask utilization during the COVID-19 pandemic in Oklahoma, USA.

BACKGROUND: Face mask use offers an important public health tool for reducing the spread of coronavirus disease 2019 (COVID-19), yet the politicization of COVID-19 has resulted in uneven adherence. This study assesses the effects of setting characteristics and the sociodemographic composition of crowds on group-level masking rates. METHODS: We conducted 123 site observations of masking behavior at public locations across Oklahoma (USA) between June and September 2020. We used analyses of variance and t-tests to examine variation in masking and ordinary least squares regression to model the effect of setting and sociodemographic characteristics on site-level masking rates. RESULTS: The masking rate across all sites averaged 34% but varied widely. Site-level masking rates were higher at metropolitan sites and sites with a store or municipal masking mandate. The masking rate at sites where women or older adults (60+) were the predominant group did not differ significantly from other sites. Ethnically diverse sites exhibited significantly higher masking rates compared with predominantly white sites. Findings indicate that setting characteristics explained a greater amount of variation in collective masking rates than sociodemographic differences. CONCLUSIONS: This study underscores the importance of place and policy for mask adherence. In the absence of state-level mandates, masking policies at a more local level may be effective.

CATCH-UP vaccines: protocol for a randomized controlled trial using the multiphase optimization strategy (MOST) framework to evaluate education interventions to increase COVID-19 vaccine uptake in Oklahoma.

BACKGROUND: Oklahoma's cumulative COVID-19 incidence is higher in rural than urban counties and higher than the overall US incidence. Furthermore, fewer Oklahomans have received at least one COVID-19 vaccine compared to the US average. Our goal is to conduct a randomized controlled trial using the multiphase optimization strategy (MOST) to test multiple educational interventions to improve uptake of COVID-19 vaccination among underserved populations in Oklahoma. METHODS: Our study uses the preparation and optimization phases of the MOST framework. We conduct focus groups among community partners and community members previously involved in hosting COVID-19 testing events to inform intervention design (preparation). In a randomized clinical trial, we test three interventions to improve vaccination uptake: (1) process improvement (text messages); (2) barrier elicitation and reduction (electronic survey with tailored questions/prompts); and (2) teachable moment messaging (motivational interviewing) in a three-factor fully crossed factorial design (optimization). DISCUSSION: Because of Oklahoma's higher COVID-19 impact and lower vaccine uptake, identifying community-driven interventions is critical to address vaccine hesitancy. The MOST framework provides an innovative and timely opportunity to efficiently evaluate multiple educational interventions in a single study. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05236270, First Posted: February 11, 2022, Last Update Posted: August 31, 2022.

Assessing the Feasibility, Acceptability, and Effectiveness of a Pilot Hepatitis C Screening Program at Food Distribution Sites in Cherokee Nation, Oklahoma.

Compared with other racial and ethnic groups in the United States, American Indian and Alaska Native (AI/AN) people experience the highest incidence of acute hepatitis c (HCV). Cherokee Nation Health Services (CNHS) implemented a pilot health screening program from January through May 2019 to assess whether conducting HCV and other preventive health screenings at food distribution sites is a feasible, acceptable, and effective strategy to increase health screening among underserved community members. Data were collected among 340 eligible participants. Most (76%) participants reported being very comfortable receiving health screenings at food distribution sites and that getting screened at food distribution sites is very easy (75.4%). Most (92.1%, n = 313) participants received HCV screening, with 11 (3.5%) individuals testing positive for HCV antibodies. Of the 11 HCV seropositive individuals, six were confirmed to have active HCV infection of which four initiated treatment. Most (55.7%) participants exhibited a body mass index in the obese range, 33.1% exhibited high hemoglobin A1C (> 6.0), 24.5% exhibited high (> 200) cholesterol, 44.6% exhibited high blood pressure ( > = 140/90), and 54.8% did not have a current primary care provider. This project demonstrated that conducting HCV and other health screenings at food distribution sites within Cherokee Nation was an effective strategy to engage AI/AN people in preventive health screenings. Future programs are needed to scale-up preventive health screenings outside of traditional medical facilities as these types of screenings may help to decrease the HCV disparities among AI/AN people.

Outdoor Medical Cannabis Advertising in Oklahoma: Examining Regulatory Compliance and Social Meanings in Billboard Content.

Background: Medical cannabis currently dominates the U.S. cannabis advertising landscape. The public is increasingly exposed to outdoor cannabis advertising, which increases positive attitudes about and intentions to use cannabis. Research is lacking regarding outdoor cannabis advertising content. This article characterizes the content of outdoor cannabis advertising in Oklahoma, one of the fastest growing U.S. medical cannabis markets. Methods: We conducted a content analysis of cannabis advertising billboard images (n = 73) from Oklahoma City and Tulsa, photographed May 2019-November 2020. We followed a primarily inductive, iterative team approach to thematically analyze billboard content in NVIVO. We reviewed all images, identified a broad coding taxonomy, and then incorporated emergent codes and those related to advertising regulation (e.g. youth/children). We totaled frequencies of code application across billboards and reexamined billboards for final themes. Results: Major themes were social meanings related to cannabis subculture, formal medical systems, and nature, and the presence of company contact information. Minor themes related to convenience, price promotions, store proximity, U.S. affiliation, product quality, and spirituality. State advertising regulation violations were rare, with the exception of content that may promote curative or therapeutic effects (4%) and misrepresentation of product state of origin (1.4%). Conclusion: Outdoor medical cannabis advertising in Oklahoma blurs boundaries between formal medical discourses and cannabis subculture that is suspicious of messaging from authorities and regards cannabis as harmless and natural. Increased monitoring of advertising regulation compliance and greater understanding of social discourses within emerging markets is needed to promote public health within the context of cannabis advertising.

Oklahoma Tobacco Helpline Utilization and Outcomes by Diabetes Status.

CONTEXT: Diabetes and cigarette smoking are major causes of morbidity and mortality. Individuals with type 2 diabetes (T2D) who smoke are at an increased risk of smoking- and diabetes-related morbidity and mortality. OBJECTIVE: We examined utilization patterns, satisfaction, and tobacco cessation outcomes among persons with T2D to determine whether the Oklahoma Tobacco Helpline is an equally effective intervention for tobacco users with T2D compared with those without diabetes. DESIGN: This study was a retrospective cohort design using registration and follow-up data from a state tobacco quitline. SETTING: We examined Oklahoma Tobacco Helpline registration data from July 2015 to June 2021 to compare Helpline utilization among individuals who self-reported a previous diagnosis of T2D compared with those not reporting a diagnosis of diabetes. PARTICIPANTS: Oklahoma Tobacco Helpline registrants enrolled in a call program, either the single- or multiple-call program, who reported diabetes status at baseline. We compared tobacco use history, program enrollment, and services received for individuals self-reporting T2D with those without diabetes. MAIN OUTCOME MEASURES: We compared 30-day point-prevalence abstinence at 7 months and evaluated program satisfaction. RESULTS: Registrants with T2D were more likely to receive a higher intensity of services including the number of coaching calls and the amount of nicotine replacement therapy. At 7-month follow-up, 32.3% of registrants with T2D and 35.1% of those without diabetes reported 30-day point-prevalence abstinence, but the differences were not statistically significant. CONCLUSIONS: While findings demonstrate similar effectiveness, more research is needed to better understand why the prevalence of tobacco use remains high among individuals with T2D and how to improve cessation in this population.

A new isosporan (Apicomplexa: Eimeriidae) from barn swallow, Hirundo rustica (Aves: Passeriformes: Hirundinidae: Hirundininae), in Oklahoma, USA.

Compared to other commonly examined passerine birds for coccidian (Apicomplexa) parasites, little is available on the coccidia of birds of the family Hirundinidae, including barn swallows (Hirundo rustica). Feces was collected in May 2022 from two nesting H. rustica in McCurtain County, Oklahoma, USA; the samples contained oöcysts representing a new species of Isospora. Oöcysts of Isospora zimmermani n. sp. are subspheroidal to ovoidal with a smooth bi-layered wall, measure (L × W) 22.8 × 20.8 µm, and have a length/width (L/W) ratio of 1.1; a micropyle and oöcyst residuum were absent but polar granule(s) are present. Sporocysts are ellipsoidal to ovoidal and measure 15.2 × 9.6 µm, L/W 1.6; a knob-like Stieda body and a rounded sub-Stieda body are present. The sporocyst residuum is composed of compact spheroid with a dense, irregular mass of finer granules lying between and dispersed among the sporozoites. The new species represents only the second isosporan reported from H. rustica but the first from the USA, and fourth species documented from the avian family Hirundinidae. This article was registered in the Official Register of Zoological Nomenclature (ZooBank) as urn:lsid:zoobank.org:pub:1F1E71C3-56E8-4EA7-A9B0-1E585FAA9DE0.

Impacts of heavy metal pollution on the ionomes and transcriptomes of Western mosquitofish (Gambusia affinis).

Our understanding of the mechanisms mediating the resilience of organisms to environmental change remains lacking. Heavy metals negatively affect processes at all biological scales, yet organisms inhabiting contaminated environments must maintain homeostasis to survive. Tar Creek in Oklahoma, USA, contains high concentrations of heavy metals and an abundance of Western mosquitofish (Gambusia affinis), though several fish species persist at lower frequency. To test hypotheses about the mechanisms mediating the persistence and abundance of mosquitofish in Tar Creek, we integrated ionomic data from seven resident fish species and transcriptomic data from mosquitofish. We predicted that mosquitofish minimize uptake of heavy metals more than other Tar Creek fish inhabitants and induce transcriptional responses to detoxify metals that enter the body, allowing them to persist in Tar Creek at higher density than species that may lack these responses. Tar Creek populations of all seven fish species accumulated heavy metals, suggesting mosquitofish cannot block uptake more efficiently than other species. We found population-level gene expression changes between mosquitofish in Tar Creek and nearby unpolluted sites. Gene expression differences primarily occurred in the gill, where we found upregulation of genes involved with lowering transfer of metal ions from the blood into cells and mitigating free radicals. However, many differentially expressed genes were not in known metal response pathways, suggesting multifarious selective regimes and/or previously undocumented pathways could impact tolerance in mosquitofish. Our systems-level study identified well characterized and putatively new mechanisms that enable mosquitofish to inhabit heavy metal-contaminated environments.

Sleep Problems Mediate the Relationship Between Psychosocial Stress and Pain Facilitation in Native Americans: A Structural Equation Modeling Analysis from the Oklahoma Study of Native American Pain Risk.

BACKGROUND: Native Americans (NAs) are more likely to experience chronic pain than non-Hispanic Whites (NHWs); however, the proximate causes predisposing NAs to chronic pain remain elusive. Likely due to centuries of adversity, discrimination, and marginalization, NAs report greater psychological stress than NHWs, which may place them at risk for sleep problems, a well-established risk factor for chronic pain onset. PURPOSE: This study examined the effects of psychological stress and sleep problems on subjective and physiological measures of pain processing in NAs and NHWs. METHODS: Structural equation modeling was used to determine whether ethnicity (NA or NHW) was associated with psychological stress or sleep problems and whether these variables were related to conditioned pain modulation of pain perception (CPM-pain) and the nociceptive flexion reflex (CPM-NFR), temporal summation of pain (TS-pain) and NFR (TS-NFR), and pain tolerance in a sample of 302 (153 NAs) pain-free participants. RESULTS: NAs experienced more psychological stress (Estimate = 0.027, p = .009) and sleep problems (Estimate = 1.375, p = .015) than NHWs. When controlling for age, sex, physical activity, BMI, and general health, NA ethnicity was no longer related to greater sleep problems. Psychological stress was also related to sleep problems (Estimate = 30.173, p = <.001) and psychological stress promoted sleep problems in NAs (indirect effect = 0.802, p = .014). In turn, sleep problems were associated with greater TS-pain (Estimate = 0.714, p = .004), but not other pain measures. CONCLUSIONS: Sleep problems may contribute to chronic pain risk by facilitating pain perception without affecting facilitation of spinal neurons or endogenous inhibition of nociceptive processes. Since psychological stress promoted pain facilitation via enhanced sleep problems, efforts to reduce psychological stress and sleep problems among NAs may improve health outcomes.

Implementation evaluation of a collective impact initiative to promote adolescent health in Oklahoma County, USA.

BACKGROUND: The teenage birth rate in the USA has considerably decreased in recent decades; however, more innovative, collaborative approaches are needed to promote adolescent health and prevent teenage pregnancy at the community level. Despite literature on the promising results of the collective impact (CI) model for health promotion, there is limited literature on the model's ability to reduce teenage pregnancies in a community. The Central Oklahoma Teen Pregnancy Prevention Collaboration is applying the CI model to foster collaboration among multiple stakeholders with the goal of increasing community and organizational capacity to improve adolescent health outcomes. This paper reports the findings from the initiative's implementation evaluation, which sought to understand whether the CI model improved collaboration among organizations and understand barriers and facilitators that affected program delivery. METHODS: Program implementers and evaluators jointly developed research questions to guide the intervention and evaluation design. The Consolidated Framework for Implementation Research (CFIR) was used to assess program components including the intervention characteristics, organization setting, community setting, facilitator characteristics, and the process of implementation. Primary sources of data included performance measures, meeting observations (n = 11), and semi-structured interviews (n = 10). The data was thematically analyzed using CFIR constructs, community capacity domains, and the five constructs of CI. RESULTS: Key findings include the need for shortened meeting times for meaningful engagement, opportunities for organizations to take on more active roles in the Collaboration, and enhanced community context expertise (i.e., those with lived experience) in all Collaboration initiatives. We identified additional elements to the core constructs of CI that are necessary for successful implementation: distinct role identification for partner organizations and incorporation of equity and inclusivity into collaboration processes and procedures. CONCLUSIONS: Results from this implementation evaluation provide valuable insights into implementation fidelity, participant experience, and implementation reach of an innovative, systems-level program. Findings demonstrate the context and requirements needed to successfully implement this innovative program approach and CI overall. Additional core elements for CI are identified and contribute to the growing body of literature on successful CI initiatives.

The role of self-evaluated pain sensitivity as a mediator of objectively measured pain tolerance in Native Americans: findings from the Oklahoma Study of Native American Pain Risk (OK-SNAP).

Native Americans (NAs) are at increased risk for chronic pain. One mechanism contributing to this pain disparity could be personal pain beliefs, which may influence actual pain sensitivity. Thus, we examined whether self-evaluated pain sensitivity (SEPS) mediates the relationship between ethnicity [NAs vs. non-Hispanic Whites (NHWs)] and objectively-measured pain tolerance, and whether catastrophic thinking and pain-related anxiety influence these pain beliefs. 232 healthy, pain-free NAs and NHWs completed questionnaires measuring SEPS, catastrophizing, and anxiety. Objective pain tolerance was also assessed. Results suggested: (1) NAs reported higher levels of SEPS, catastrophizing, and anxiety, (2) catastrophizing may have enhanced anxiety and both catastrophizing and anxiety were associated with higher SEPS, and (3) anxiety and SEPS were associated with lower pain tolerance. A significant bootstrapped mediation analysis suggested NAs experienced higher pain-related anxiety, which may have promoted higher SEPS, that in turn reduced pain tolerance. Longitudinal research is needed to confirm this.