Persistence of genetically engineered canola populations in the U.S. and the adventitious presence of transgenes in the environment.

Feralization of genetically engineered (GE) crops increases the risk that transgenes will become integrated into natural and naturalizing plant populations. A key assumption of the management of GE crops is that populations of escaped plants are short-lived and therefore the risks they pose are limited. However, few populations of escaped crop plants have been tracked over the long term so our understanding of their persistence in ruderal or natural landscapes is limited. We repeated a large-scale road survey of feral GE canola populations in North Dakota, USA, initially conducted in 2010. Our objectives in 2021 were to determine the current distribution of feral canola populations, and to establish the relative frequency of GE and non-GE phenotypes in populations of canola throughout North Dakota. Our results indicate that, although the incidence of feral canola was less in 2021 than 2010, escaped canola populations remain common throughout the state. The prevalence of alternate forms of GE herbicide resistance changed between surveys, and we found an overabundance of non-GE plants compared to the frequency of non-transgenic forms in cultivation. Indirect evidence of persistence includes sampling plants with multiple transgenic traits, and finding populations far from transportation routes. We conclude that feral canola populations expressing transgenic herbicide resistance are established outside of cultivation, that they may be under selection for loss of the transgene, but that they nonetheless pose long-term risks by harboring transgenes in the unmanaged landscape.

Changes in Patterns of Trauma Injuries in the Dakotas Region During the COVID-19 Pandemic.

BACKGROUND: The aim of this study is to compare impact of COVID-19 on trauma volume and characteristics on a set of trauma centers with a rural catchment area. The COVID-19 pandemic has affected different parts of the country quite differently, both in case volume and in local responses. State-wide responses have varied considerably, including variations in local mask mandates, school closures, and social distancing measures. METHODS: This was a retrospective trauma registry review of patients who were admitted to three of the tertiary care trauma centers in North and South Dakota between 2014 through 2022. RESULTS: In the analysis of 36,397 patients, we found a significant increase in trauma patient volume during the COVID-19 pandemic, with an increased percentage of patients presenting with a mechanism of injury secondary to abuse or assault. This increase in patient volume continued to rise during 2021 and 2022. CONCLUSIONS: Our study demonstrates how the COVID-19 pandemic impacted trauma center admissions in the rural and frontier Midwest differently from more urban areas, and the importance of including a variety of settings in trauma research.

Hantavirus Pulmonary Syndrome in an Adolescent from North Dakota.

Hantavirus pulmonary syndrome remains an uncommon yet emerging viral zoonosis that causes respiratory failure and hemodynamic instability in children and adolescents. Due to its acutely progressive course and high mortality rate, clinicians treating hantavirus pulmonary syndrome should understand its epidemiologic risk factors, clinical syndrome and radiographic findings. We present a case of hantavirus pulmonary syndrome in a 14-year-old female from North Dakota who survived the infection without sequelae.

Curious minds to aspiring pharmacists: Impact of high school outreach on pharmacy knowledge and interest.

OBJECTIVE: To analyze the impact of a pharmacy student delivered presentation on prospective rural high school students' interest toward the pharmacy profession and knowledge regarding a career in pharmacy. METHODS: Presentations about applying to pharmacy school, the Doctor of Pharmacy degree, and pharmacist careers were given at ten high schools across North Dakota and Minnesota by third year pharmacy students attending North Dakota State University. Each pharmacy student presenter received training to ensure that all high school students received clear and consistent information. A pre-post survey was used to understand the impact of the presentation on high school student interest and knowledge regarding a career in pharmacy. Data was analyzed using a chi-square test and McNemar's test. RESULTS: Five hundred and eight students consented to the study and completed the pre-post surveys. Of these students, the largest group was high school juniors (number (n) = 239, 47%), followed by sophomores (n = 161, 32%), seniors (n = 104, 20%) and freshmen (n = 3, 1%). The majority of students attended school in North Dakota (n = 469, 92%). Similarly, most students planned to attend a four-year college (n = 451, 89%) and were interested in a medical/healthcare related career (n = 310, 61%). All interest and knowledge questions showed a statistically significant increase in score pre-post. CONCLUSION: Presentations delivered by pharmacy students to prospective rural high school students improved overall interest and knowledge regarding pharmacy school and the profession. Presentations are a useful tool for pharmacy programs to help promote their school and the profession of pharmacy.

COVID-19 Vaccination Rates Among North Dakota Residents Who Gave Birth Between April 1, 2021, and July 15, 2022.

Objectives. To assess COVID-19 vaccination rates among North Dakota residents who gave birth. Methods. We used data from North Dakota Vital Records and the North Dakota Immunization Information System for North Dakota residents who gave birth between April 1, 2021, and July 15, 2022. We evaluated vaccination with 1 dose, primary series, and monovalent booster for timing before and during pregnancy and postpartum. Results. Among North Dakota residents who gave birth, 44% received at least 1 COVID-19 vaccine, 34% received a complete primary series, and 10% received a monovalent booster dose. Among those who received a COVID-19 vaccine, the majority was vaccinated during pregnancy. Obstetrics and gynecology providers administered just 9.2% of COVID-19 vaccine doses. Conclusions. Most persons who gave birth in North Dakota did not receive the primary series of the COVID-19 vaccine while pregnant. Providers have an opportunity to counsel their pregnant and recently pregnant patients on vaccine recommendations. (Am J Public Health. 2024;114(2):237-240. https://doi.org/10.2105/AJPH.2023.307500).

Necrophagous insect species succession on decomposed pig carcasses in North Dakota, USA.

Necrophagous insect species are widely used during death investigations primarily for the estimation of the minimum postmortem interval, since these species use decomposing organic matter for feeding, oviposition, and larval development. The development stages and successional colonization patterns provide important information for shorter or longer postmortem time intervals. Diptera species are the predominant taxa recovered from decomposed bodies. The temperature variance/seasonality is the main factor affecting the time presence and activity of these species. Other factors, such as geographical location, antemortem conditions, and cause of death, can influence the presence and succession of necrophagous entomofauna. Consequently, successional studies and information regarding species colonization patterns are needed for each geographical region to be used as reference data during death investigations. This study addressed the need to collect forensic entomological data for the State of North Dakota, within the first necrophagous entomofauna diversity report for the month of July 2022, using pig carcasses as human analogs. During the experimental period, 18 species of Diptera and Coleoptera were identified, with 10 new state records, while Calliphoridae was found to be the predominant family. The resulted data on necrophagous insect species diversity and dynamics from exposed pig carcasses will strengthen the current knowledge on forensic entomology in North Dakota and will serve as reference data to be used during death investigations in the Great Plains region.

Characterization of Fusarium oxysporum f. sp. pisi Associated with Root Rot of Field Pea in North Dakota and the Effects of Temperature on Aggressiveness.

Fusarium root rot is an important disease of field pea (Pisum sativum var. sativum L.) that occurs everywhere pea is grown, causing yield loss of up to 75%. Fusarium root rot is caused by a complex of Fusarium species, most notably Fusarium solani in the Pacific Northwest of the United States and F. avenaceum in the northern Great Plains of the United States and Canada. F. oxysporum f. sp. pisi (Fop) was frequently isolated from peas exhibiting root rot symptoms in North Dakota during recent surveys. Fop causes wilt (races 1, 5, and 6) and near wilt (race 2) on pea. However, its contribution to pea root rot remains unclear. Fop race was determined for isolates from North Dakota pea root rot surveys. ND Fop isolates were evaluated for root rot pathogenicity and aggressiveness at standard and elevated temperatures. Results from greenhouse wilt assays indicated that all Fop races exist in North Dakota, with race 2 most prevalent among the 25 North Dakota isolates evaluated. Root rot evaluations conducted at 21/18°C and 25/19°C day/night temperatures demonstrated that most Fop isolates were as aggressive or more aggressive than F. solani and F. avenaceum under both temperature regimes. Aggressiveness of Fop isolates tended to increase at elevated assay temperatures. Results from these experiments indicate that Fop may be an important contributor to the root rot complex of field pea in North Dakota and should be considered in integrated pest management strategies, including pea breeding efforts to improve resistance to Fusarium root rot.[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

Adverse Childhood Experiences, Interpersonal Violence, and Racial Disparities in Early Prenatal Care in North Dakota (ND PRAMS 2017-2019).

In North Dakota (ND), American Indian women are more likely to be exposed to adverse childhood experiences (ACEs) and interpersonal violence, and receive late prenatal care (PNC) compared to other racial groups. In a sample of 1,849 (weighted n = 26,348) women from the 2017 to 2019 North Dakota Pregnancy Risk Assessment Monitoring System, we performed a series of logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for AI and Other Racial Identity women compared to White women regarding risk of late PNC (initiated after week 13) and dissatisfaction of PNC timing. Models were adjusted for interpersonal violence (from husband/partner, family member, someone outside of family, ex-husband/partner, or any) to determine if violence accounts for racial/ethnic disparities in PNC. AI women experienced two-fold higher risk of late PNC (OR: 2.25, 95% CI: 1.55, 3.26) and dissatisfaction of PNC timing (OR: 2.34, 95% CI: 1.61, 3.40) than White women. In the analyses for the association between joint ACEs (Higher: ≥4; Lower: <4)/Race and PNC outcomes, odds of late PNC were two-fold among AI women with Higher ACEs (OR: 2.35, 95% CI: 1.41, 3.94) and Lower ACEs (OR: 2.73, 95% CI: 1.69, 4.41), compared to White women with Lower ACEs. Results were similar for dissatisfaction of PNC timing. Accounting for violence did not significantly change odds ratios in any analyses. Thus, interpersonal violence surrounding pregnancy does not explain racial disparities in PNC in ND. To understand disparities in PNC among AI women, risk factors like historic trauma and systemic oppression should be examined.

Evaluating the Ecological Footprint of Landfills: A Framework and Case Study of Fargo, North Dakota.

There is growing interest in better understanding the environmental impacts of landfills and optimizing their operation. Accordingly, we developed a holistic framework to calculate a landfill's Ecological Footprint (EF) and applied that to the Fargo, North Dakota, landfill. Parallelly, the carbon footprint and biocapacity of the landfill were calculated. We calculated the EF for six scenarios (i.e., cropland, grazing land, marine land, inland fishing ground, forest land, and built land as land types) and six operational strategies typical for landfills. Operational strategies were selected based on the variations of landfill equipment, the gas collection system, efficiency, the occurrence of fugitive emissions, and flaring. The annual EF values range from 124 to 213,717 global hectares depending on land type and operational strategy. Carbon footprints constituted 28.01-99.98% of total EF, mainly driven by fugitive emissions and landfill equipment. For example, each percent increase in Fargo landfill's fugitive emissions caused the carbon footprint to rise by 2130 global hectares (4460 tons CO2e). While the landfill has biocapacity as grazing grass in open spaces, it remains unused/inaccessible. By leveraging the EF framework for landfills, operators can identify the primary elements contributing to a landfill's environmental impact, thereby minimizing it.

Grazing management impacts on ecosystem services under contrasting climatic conditions in Texas and North Dakota.

Grazing management is an important factor affecting the delivery of ecosystem services at the watershed scale. Moreover, characterizing the impacts of climate variation on water resources is essential in managing rangelands. In this study, the effects of alternative grazing management scenarios on provisioning, regulating, and supporting services were assessed in two watersheds with contrasting climates; the Lower Prairie Dog Town Fork Red River (LPDTFR) Watershed in North Texas and the Apple Watershed in South Dakota. The impacts of heavy stocking continuous grazing, light stocking continuous grazing, Adaptive Multi-Paddock (AMP) grazing, and an ungrazed exclosure were compared using the Soil and Water Assessment Tool (SWAT) model. Our results indicate that the quantity of snow and timing of snow melt substantially influenced grazing management effects on ecosystem services in the Apple Watershed. In contrast, precipitation was the main factor influencing these effects in the LPDTFR Watershed because it highly affected the variation in water cycling, streamflow, sediment, and nutrient controls. Simulated results indicated that AMP grazing was the optimal grazing management approach for enhancing water conservation and ecosystem services in both watersheds regardless of climatic conditions. The Apple Watershed, which is a snow-dominated watershed, exhibited greater ecosystem service improvements under AMP grazing (50.6%, 58.7%, 74.4%, 61.5% and 72.6% reduction in surface runoff, streamflow, and sediment, total nitrogen (TN) and total phosphorus (TP) losses, respectively as compared to HC grazing) than the LPDTFR Watershed (46.0%, 22.8%, 34.1%, 18.9% and 38.4% reduction in surface runoff, streamflow, and sediment, TN and TP losses, respectively). Our results suggest that improved grazing management practices enhance ecosystem services and water catchment functions in rangeland-dominated areas, especially in colder climates.

Managing the Risk of COVID-19 Using Model Based Predictors: The Case of North Dakota.

OBJECTIVE: North Dakota (ND) had the highest coronavirus disease 2019 (COVID-19) case and mortality rate in the United States for nearly 2 mo. This study aims to compare 3 metrics ND used to guide public health action across its 53 counties. METHODS: Daily COVID-19 case and death totals in North Dakota were evaluated using data from the COVID-tracker website provided by the North Department of Health (NDDoH). It was reported as: active cases per 10,000, tests administered per 10,000, and test positivity rate (the North Dakota health metric). The COVID-19 Response press conferences provided data for the Governor's metric. The Harvard model used daily new cases per 100,000. A chi-squared test was used to compare differences in these 3 metrics on July 1, August 26, September 23, and November 13, 2020. RESULTS: On July 1, no significant difference between the metrics was found. By September 23, Harvard's health metric indicated critical risk while ND's health metric was moderate risk, and the Governor's metric was still low risk. CONCLUSIONS: ND's and the Governor's metric underrepresented the risk of the COVID-19 outbreak in North Dakota. The Harvard metric reflected North Dakota's increasing risk; it should be considered as a national standard in future pandemics. PUBLIC HEALTH IMPLICATIONS: Model-based predictors could guide policy-makers to effectively control spread of infectious disease; proactive models could reduce risk of disease as it progresses in vulnerable communities.

The survival and growth of honey bee (Hymenoptera: Apidae) colonies overwintered in cold storage: the effects of time and colony location.

For over a decade, high percentages of honey bee colonies have been perishing during the winter creating economic hardship to beekeepers and growers of early-season crops requiring pollination. A way to reduce colony losses might be moving hives into cold storage facilities for the winter. We explored factors that could affect the size and survival of colonies overwintered in cold storage and then used for almond pollination. The factors were when hives were put into cold storage and their location prior to overwintering. We found that colonies summered in North Dakota, USA and moved to cold storage in October were larger after cold storage and almond pollination than those moved in November. Colony location prior to overwintering also affected size and survival. Colonies summered in southern Texas, USA and moved to cold storage in November were smaller after cold storage and almond pollination than those from North Dakota. The colonies also were smaller than those overwintered in Texas apiaries. Fat body metrics of bees entering cold storage differed between summer locations. North Dakota bees had higher lipid and lower protein concentrations than Texas bees. While in cold storage, fat bodies gained weight, protein concentrations increased, and lipids decreased. The decrease in lipid concentrations was correlated with the amount of brood reared while colonies were in cold storage. Our study indicates that in northern latitudes, overwintering survival might be affected by when colonies are put into cold storage and that colonies summered in southern latitudes should be overwintered there.

Seasonality of Mosquitoes in North Dakota, 2003-2006, with Four New State Records.

Thirty-seven species and subspecies of mosquitoes were identified from 3,580,610 specimens collected in eastern (Cass, Nelson, and Richland counties) and western (Williams County) North Dakota in 2003-2006. Four species were new state records (Aedes schizopinax, Psorophora ciliata, Ps. ferox, and Ps. horrida). Aedes vexans was dominant (82.9%). Other relatively abundant species were Ae. trivittatus (7.7%), Ae. melanimon (2.7%), Culex tarsalis (2.6%), Ae. dorsalis (1.6%), Ae. sticticus (1.0), and Culiseta inornata (0.9%). The seasonality of the species is presented.

Impacts of the COVID-19 pandemic on landfilling and recycling in the city of Fargo, North Dakota, USA.

The COVID-19 pandemic impacted different aspects of human lifestyle, including waste generation and management. The landfilled and recycled waste volume from the City of Fargo's annual solid waste report between 2019 and 2021 was critically analyzed to understand these impacts. The analysis showed a 4.5% increase in the residential waste volume in 2020 compared to 2019 and 2021, suggesting a pandemic-induced lockdown effect. The monthly residential waste volume was approximately 5-15% greater during the mandatory quarantine period (April - November 2020) than in 2019 and 2021. Commercial waste volume decreased by 12% during 2020 and then sharply increased in 2021 as commercial facilities reopened. The total recycling volume increased slightly by 2.5% in 2020 compared to 2019 and 2021. Cardboard recycling showed a 5.8% increase in 2020 from 2019 and a 13% increase in 2021 compared to 2020. This was presumably caused by the reliance on online shopping during the pandemic and becoming habituated to online shopping. The COVID-19 pandemic did not significantly impact other classes of recycled waste volumes. In summary, COVID-19 affected landfilling and recycling in different capacities in the City of Fargo. The data will contribute to the global understanding of the impact of COVID-19 on solid waste management practices.Implications: The COVID-19 pandemic impacted waste generation and management. In Fargo, USA, the monthly residential waste volume increased by up to 15% during the mandatory quarantine period in 2020 compared to the same period in 2019 and 2021. Conversely, the monthly commercial waste volume decreased during the mandatory quarantine period in 2020. The commercial waste volume increased in 2021 as commercial activities became normal. The cardboard recycling increased significantly because people became used to online shopping during the lockdown, and the practice continues. The findings will contribute to the global understanding of the impact of COVID-19 on solid waste management practices.

Understanding Over-immunization in North Dakota's Adult Population.

CONTEXT: Over-immunization, or administration of excess doses of vaccine, is an understudied topic in immunization. Adult over-immunization is particularly understudied, so building a basic understanding of the sources and scope of over-immunization is necessary to direct action. OBJECTIVE: The aim of this evaluation was to quantify the extent of over-immunization in North Dakota's adult population from 2016 to 2021. DESIGN: Records for all pneumococcal, zoster, and influenza vaccines administered to adults in North Dakota were extracted from the North Dakota Immunization Information System (NDIIS) from January 1, 2016, through December 31, 2021. The NDIIS is a state-wide immunization registry that captures all childhood and most adult immunizations. SETTING: North Dakota. PARTICIPANTS: North Dakotan adults 19 years or older. MAIN OUTCOME MEASURE: The number and percentage of adults identified as over-immunized as well as the number and percentage of doses identified as an extra dose. RESULTS: Frequency of over-immunization was less than 3% for all vaccines over the 6-year period assessed. Pharmacies and private practices were the most common sources of over-immunization of adults. CONCLUSIONS: These data show that over-immunization is still an issue in North Dakota, although the percentage of the adult population impacted is low. Reducing over-immunization is worth pursuing but should be balanced with the importance of improving low immunization coverage rates in the state. Improving utilization of the NDIIS by adult providers can help prevent over-immunization and under-immunization alike.

Evaluation of Wheat Cultivars and Germplasm Lines for Resistance to Pratylenchus neglectus Populations Collected in North Dakota.

Root-lesion nematode (RLN; Pratylenchus neglectus) is a migratory endoparasite and a major soilborne pathogen that affects wheat (Triticum spp.) production worldwide. Genetic resistance is one of the most economical and effective ways to manage P. neglectus in wheat. This study evaluated 37 local cultivars and germplasm lines in seven greenhouse experiments, including 26 hexaploid wheat, six durum wheat, two synthetic hexaploid wheat, one emmer wheat, and two triticale for P. neglectus resistance from 2016 to 2020. North Dakota field soils infested with two RLN populations (350 to 1,125 nematodes per kilogram of soil) were used for resistance screening under controlled greenhouse conditions. The final nematode population density for each cultivar and line was counted under the microscope to categorize the resistance ranking of these entries as resistant, moderately resistant, moderately susceptible, and susceptible. Out of the 37 cultivars and lines, one was classified as resistant (Brennan); 18 were moderately resistant (Divide, Carpio, Prosper, Advance, Alkabo, SY Soren, Barlow, Bolles, Select, Faller, Briggs, WB Mayville, SY Ingmar, W7984, PI 626573, Ben, Grandin, and Villax St. Jose); 11 were moderately susceptible; and seven were susceptible to P. neglectus. The resistant to moderately resistant lines identified in this study could be used in breeding programs after the resistance genes or loci are further elucidated. This research provides valuable information about P. neglectus resistance among wheat and triticale cultivars used in the Upper Midwest region of the United States.

Geographic disparities and temporal changes of COVID-19 hospitalization risks in North Dakota.

Background: Although the burden of the coronavirus disease 2019 (COVID-19) has been different across communities in the US, little is known about the disparities in COVID-19 burden in North Dakota (ND) and yet this information is important for guiding planning and provision of health services. Therefore, the objective of this study was to identify geographic disparities of COVID-19 hospitalization risks in ND. Methods: Data on COVID-19 hospitalizations from March 2020 to September 2021 were obtained from the ND Department of Health. Monthly hospitalization risks were computed and temporal changes in hospitalization risks were assessed graphically. County-level age-adjusted and spatial empirical Bayes (SEB) smoothed hospitalization risks were computed. Geographic distributions of both unsmoothed and smoothed hospitalization risks were visualized using choropleth maps. Clusters of counties with high hospitalization risks were identified using Kulldorff's circular and Tango's flexible spatial scan statistics and displayed on maps. Results: There was a total of 4,938 COVID-19 hospitalizations during the study period. Overall, hospitalization risks were relatively stable from January to July and spiked in the fall. The highest COVID-19 hospitalization risk was observed in November 2020 (153 hospitalizations per 100,000 persons) while the lowest was in March 2020 (4 hospitalizations per 100,000 persons). Counties in the western and central parts of the state tended to have consistently high age-adjusted hospitalization risks, while low age-adjusted hospitalization risks were observed in the east. Significant high hospitalization risk clusters were identified in the north-west and south-central parts of the state. Conclusions: The findings confirm that geographic disparities in COVID-19 hospitalization risks exist in ND. Specific attention is required to address counties with high hospitalization risks, especially those located in the north-west and south-central parts of ND. Future studies will investigate determinants of the identified disparities in hospitalization risks.

Examining the Role of Interpersonal Violence in Racial Disparities in Breastfeeding in North Dakota (ND PRAMS 2017-2019).

BACKGROUND: The 2019 overall breastfeeding initiation rate in the US was 84.1%, yet only 76.6% of American Indian (AI) women initiated breastfeeding. In North Dakota (ND), AI women have greater exposure to interpersonal violence than other racial/ethnic groups. Stress associated with interpersonal violence may interfere with processes important to breastfeeding. We explored whether interpersonal violence partially explains racial/ethnic disparities in breastfeeding in ND. METHODS: Data for 2161 women were drawn from the 2017-2019 ND Pregnancy Risk Assessment Monitoring System. Breastfeeding questions in PRAMS have been tested among diverse populations. Breastfeeding initiation was self-report to "Did you ever breastfeed or pump breast milk to feed your new baby, even for a short period?" (yes/no). Breastfeeding duration (2 months; 6 months) was self-reported how many weeks or months of breastmilk feeding. Interpersonal violence for both 12 months before and during pregnancy based on self-report (yes/no) of violence from a husband/partner, family member, someone else, or ex-husband/partner. An "Any violence" variable was created if participants reported "yes" to any violence. Logistic regression models estimated crude and adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for breastfeeding outcomes among AI and Other Race women compared to White women. Sequential models were adjusted for interpersonal violence (husband/partner, family member, someone else, ex-husband/partner, or any). RESULTS: AI women had 45% reduced odds of initiating breastfeeding (OR: 0.55, 95% CI: 0.36, 0.82) compared to white women. Including interpersonal violence during pregnancy did not change results. Similar patterns were observed for all breastfeeding outcomes and all interpersonal violence exposures. DISCUSSION: Interpersonal violence does not explain the disparity in breastfeeding in ND. Considering cultural ties to the tradition of breastfeeding and the role of colonization may provide a better understanding of breastfeeding among AI populations.

Geographic disparities and temporal changes of COVID-19 incidence risks in North Dakota, United States.

BACKGROUND: COVID-19 is an important public health concern due to its high morbidity, mortality and socioeconomic impact. Its burden varies by geographic location affecting some communities more than others. Identifying these disparities is important for guiding health planning and service provision. Therefore, this study investigated geographical disparities and temporal changes of the percentage of positive COVID-19 tests and COVID-19 incidence risk in North Dakota. METHODS: COVID-19 retrospective data on total number of tests and confirmed cases reported in North Dakota from March 2020 to September 2021 were obtained from the North Dakota COVID-19 Dashboard and Department of Health, respectively. Monthly incidence risks of the disease were calculated and reported as number of cases per 100,000 persons. To adjust for geographic autocorrelation and the small number problem, Spatial Empirical Bayesian (SEB) smoothing was performed using queen spatial weights. Identification of high-risk geographic clusters of percentages of positive tests and COVID-19 incidence risks were accomplished using Tango's flexible spatial scan statistic. ArcGIS was used to display and visiualize the geographic distribution of percentages of positive tests, COVID-19 incidence risks, and high-risk clusters. RESULTS: County-level percentages of positive tests and SEB incidence risks varied by geographic location ranging from 0.11% to 13.67% and 122 to 16,443 cases per 100,000 persons, respectively. Clusters of high percentages of positive tests were consistently detected in the western part of the state. High incidence risks were identified in the central and south-western parts of the state, where significant high-risk spatial clusters were reported. Additionally, two peaks (August 2020-December 2020 and August 2021-September 2021) and two non-peak periods of COVID-19 incidence risk (March 2020-July 2020 and January 2021-July 2021) were observed. CONCLUSION: Geographic disparities in COVID incidence risks exist in North Dakota with high-risk clusters being identified in the rural central and southwest parts of the state. These findings are useful for guiding intervention strategies by identifying high risk communities so that resources for disease control can be better allocated to communities in need based on empirical evidence. Future studies will investigate predictors of the identified disparities so as to guide planning, disease control and health policy.

Development and Assessment of Targeted, Live, and Interactive Continuing Pharmacy Education Workshops in Dementia Care for North Dakota Pharmacists.

Background With the growing US aging population, need for a health care workforce able to provide dementia care will increase. Objective To develop, deliver, and assess interactive live workshops for licensed North Dakota pharmacists in dementia care. Methods Prospective interventional study of impact of free-of-charge, interactive, five-hour workshops for pharmacists providing advanced training in Alzheimer's disease, vascular and Parkinson's disease dementia, dementia with Lewy bodies, and common reversible causes of cognitive impairment. The workshop was offered three times across two different locations in ND: Fargo and Bismarck. Online pre- and postworkshop questionnaires were administered to collect demographics, attendance rationale, perceived ability to provide dementia care, and workshop quality/satisfaction. A 16-item assessment instrument/ test (1 point/item) was developed to assess pre- and postworkshop competency in dementia-related care (ie, knowledge, comprehension, application, and analysis). Descriptive statistics and paired t-test were performed using Stata 10.1. Results Sixty-nine pharmacists were trained and completed the competency test assessments; 95.7% ND pharmacists completed pre-and postworkshop questionnaires. The overall competency test scores improved from 5.7 ± 2.2 to 13.0 ± 2.8 (P < 0.001) and individual scores for each disease/problem also improved significantly (P < 0.001). Increases corresponded with increased self-reported perceived ability to provide dementia care; 95.4 to 100% of participants agreed/strongly agreed learning needs were met, teaching was effective, were satisfied with content and educational material usefulness, and would recommend workshop. Conclusion Workshop had measurable, immediate benefit on knowledge and ability to apply learned information. Structured, interactive workshops are valuable for improving pharmacists' competency in dementia care.