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As with many infectious diseases throughout history, stigma is a part of the trajectory of the HIV disease process. HIV-related stigma impedes women from being tested for HIV. Once infected, HIV-related stigma hinders women from disclosing their HIV status to sexual partners and health care providers, engaging in medical care, effectively self-managing the disease after infection, and adhering to anti-retroviral therapy. After three decades of the HIV epidemic, no evidenced-based, culturally relevant, gender-specific interventions exist to help women infected with HIV manage the stigma associated with HIV infection. This manuscript reports the feasibility of using an iPod touch device and acceptability of a stigma reduction intervention with HIV-infected women in the Deep South in a mixed-method, randomized clinical trial. Results from the study demonstrate that it is feasible to utilize an iPod touch device to deliver an HIV-related stigma intervention to women. Further, women report that the HIV-related stigma intervention is acceptable and meaningful.

Background A recent American Heartworm Society (AHS) survey on the incidence of adult heartworm infections in dogs in the United States of America showed a 21.7% increase in the average cases per veterinary clinic from 2013 to 2016. The analysis reported here was performed to see if heartworm testing results available via the Companion Animal Parasite Council (CAPC) aligned with the AHS survey and whether changes in heartworm preventive dispensing accounts for the increased incidence. The resistance of Dirofilaria immitis to macrocyclic lactones (MLs) has been previously reported. Methods An analysis of 7–9 million heartworm antigen tests reported annually to the Companion Animal Parasite Council (CAPC) from 2013 to 2016 was conducted and compared to the 2016 AHS survey. A state-by-state analysis across the southeastern USA was also performed. National heartworm preventive dispensing data were obtained from Vetstreet LLC and analyzed. All oral, topical and injectable heartworm preventives were included in this analysis, with injectable moxidectin counting as six doses. Results Positive antigen tests increased by 15.28% from 2013 to 2016, similar to the 21.7% increase reported by the AHS survey. Incidence in the southeastern USA increased by17.9% while the rest of USA incidence increased by 11.4%. State-by-state analysis across the southeastern USA revealed an increased positive test frequency greater than 10% in 9 of 12 states evaluated. During this time, the overall proportion of dogs receiving heartworm prophylaxis remained relatively unchanged. Approximately 2/3 of the dogs in the USA received no heartworm prevention each year. Conclusion These CAPC data show the rate of positive heartworm tests increasing significantly ( P  <  0.0001) in the USA from 2013 to 2016, with a higher rate of increase in the southeastern USA than nationally. Only 1/3 of dogs in the USA were dispensed one or more doses of heartworm prevention annually by veterinarians, averaging 8.6 monthly doses/year. Veterinarians and pet owners should work together to follow CAPC and AHS guidelines to protect dogs from infection with D. immitis . Lack of preventive use and the emergence of heartworm resistance to MLs could both be impacting the increased rate of positive heartworm tests in dogs.

Atmospheric moisture budget and its regulation of the summer (June–July–August) precipitation over the Southeastern United State (SE U.S.) were examined during 1948–2007 using PRECipitation REConstruction over Land and multiple reanalysis datasets. The analysis shows that the interannual variation of SE U.S. summer precipitation can be largely explained by the leading Empirical Orthogonal Function mode showing a spatially homogenous sub-continental scale pattern. Consequently, areal-averaged precipitation was investigated to focus on the large-scale rainfall changes over the SE U.S. The wavelet analysis identifies an increased 2–4 year power spectrum in recent 30 years (1978–2007), suggesting an intensification of the interannual variability. Analysis of the atmospheric moisture budget indicates that the increase in precipitation variability is mainly caused by moisture transport, which exhibits a similar increase in the 2–4 year power spectrum for the same period. Moisture transport, in turn, is largely controlled by the seasonal mean component rather than the subseasonal-scale eddies. Furthermore, our results indicate that dynamic processes (atmospheric circulation) are more important than thermodynamic processes (specific humidity) in regulating the interannual variation of moisture transport. Specifically, the North Atlantic Subtropical High western ridge position is found to be a primary regulator, with the ridge in the northwest (southwest) corresponding to anomalous moisture divergence (convergence) over the SE U.S. Changes in moisture transport consistent with the increased frequency of these two ridge types in recent 30 years favor the intensification of summer precipitation variability.

The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study is a national, population-based, longitudinal study of 30,000 African-American and white adults aged ≧45 years. The objective is to determine the causes for the excess stroke mortality in the Southeastern US and among African-Americans. Participants are randomly sampled with recruitment by mail then telephone, where data on stroke risk factors, sociodemographic, lifestyle, and psychosocial characteristics are collected. Written informed consent, physical and physiological measures, and fasting samples are collected during a subsequent in-home visit. Participants are followed via telephone at 6-month intervals for identification of stroke events. The novel aspects of the REGARDS study allow for the creation of a national cohort to address geographic and ethnic differences in stroke.

This study characterizes the intraseasonal variability (ISV) in the Southeastern United States (SE US) rainfall in boreal summer and delineates the associated dynamical processes featuring three-way interactions among the SE US rainfall, the central US low-level jet (LLJ), and the North Atlantic subtropical high (NASH). The analysis reveals that the ISV of the SE summer rainfall peaks at the 10‒20-day timescales. The physical mechanisms for the three-way interactions on the 10‒20-day timescales are proposed. When the NASH attains a minimum strength, the reduced size of the NASH is accompanied with an eastward retreat of the western ridge of the NASH, leading to a decrease in the zonal pressure gradient and consequently a weakening of the LLJ 1 day after. The weakened LLJ and the eastward-shifted NASH western ridge induces anomalous cyclonic circulation over the SE US, moves preferred regions of moisture convergence from central US to the SE US, and 3 days later the SE US rainfall attains its maximum strength. The excessive latent heating associated with the enhanced SE US rainfall excites an anomalous anticyclone northeast of the rainfall region, resulting in an increase in the NASH intensity that peaks 2 days after the maximum SE US rainfall. The NASH subsequently expands with its western ridge moving westward, zonal pressure gradient restored, and LLJ strength recovered. An anomalous anticyclone then emerges over the SE US and suppresses rainfall, marking the shift from an intraseasonal wet phase to dry phase in this region. A more rigorous proof of these causalities demand carefully designed numerical experiments and further statistical analysis in future. Our results suggest that improved prediction of SE US summer rainfall across intraseasonal scales depends critically on the model representation of the three-way coupling among the NASH, the central US LLJ, and the SE US rainfall.

Eastern equine encephalitis virus (EEEV; family Togaviridae, genus Alphavirus) is a mosquito-borne pathogen found in eastern North America that causes severe disease in humans and horses. The mosquito Culiseta melanura (Coquillett) (Diptera: Culicidae) is the primary enzootic vector of EEEV throughout eastern North America while several mosquito species belonging to diverse genera serve as bridge vectors. The ecology of EEEV differs between northern and southern foci, with respect to phenology of outbreaks, important vertebrate hosts, and bridge vector species. Active transmission is limited to roughly half of the year in northern foci (New York, New Hampshire, Massachusetts, Connecticut), while year-round transmission occurs in the southeastern region (particularly Florida). Multiple phylogenetic analyses indicate that EEEV strains circulating in northern foci are likely transported from southern foci by migrating birds. Bird species that overwinter or migrate through Florida, are bitten by Cs. melanura in late spring, and arrive at northern breeding grounds in May are the most likely candidates to disperse EEEV northward. Available data indicate that common yellowthroat and green heron satisfy these criteria and could serve as virus dispersers. Understanding the factors that drive the phenology of Cs. melanura reproduction in the south and the timing of avian migration from southern foci could provide insight into how confluence of these biological phenomena shapes outbreaks of EEE throughout its range. This information could be used to develop models predicting the likelihood of outbreaks in a given year, allowing vector control districts to more efficiently marshal resources necessary to protect their stakeholders.

Buruli ulcer (BU) is a chronic and debilitating skin disease caused by the environmental pathogen, (MU). The primary virulence determinant is mycolactone, a cytotoxic lipid compound unique to MU and its other mycolactone producing mycobacteria (MPM) ecological variants. Although BU prevalence is highest in West Africa and Australia, little is known about MU and other MPM distribution in non-endemic regions such as the Southeastern United States (US). In this study, environmental samples (water filtrand, plant biofilm, soil, aquatic invertebrates) were collected from nine freshwater sites across Louisiana, Mississippi and Alabama over three sampling periods (August 2020, November 2020, March 2021). Samples were screened for MU and MPM presence and abundance by PCR and genotyped using variable number tandem repeat (VNTR) profiling. All nine sites were positive for MU or other MPM DNA in at least one substrate, except invertebrates. Overall, mean concentrations were 4.3 × 10 genome units (GU)/sample in August 2020, 1.26 GU/sample in November 2020, and 55.5 GU/sample in March 2021. Profiling by VNTR identified four MU (designated A-D) and one genotype(s), among environmental samples, with genotype frequencies varying by site and sampling time. Detection of MU and genotypes in Southeastern US aquatic environments, matching those from BU endemic regions, provides rationale for ongoing surveillance. Our findings broaden the known geographic range of MU and MPMs and offer baseline data to help predict and prevent and predict the possibility of zoonotic transmission in Southeastern US.

Objectives. We examined the impact of smoking cessation on weight change in a population of women prisoners. Methods. Women prisoners (n = 360) enrolled in a smoking cessation intervention; 250 received a 10-week group intervention plus transdermal nicotine replacement. Results. Women who quit smoking had significant weight gain at 3- and 6-month follow-ups, with a net difference of 10 pounds between smokers and abstainers at 6 months. By the 12-month follow-up, weight gain decreased among abstainers. Conclusions. We are the first, to our knowledge, to demonstrate weight gain associated with smoking cessation among women prisoners. Smoking cessation interventions that address postcessation weight gain as a preventative measure may be beneficial in improving health and reducing the high prevalence of smoking in prisoner populations.

• Premise of the study: Whereas population genetic studies have examined allopolyploids, comparable studies of naturally occurring autopolyploids remain rare. To address fundamental questions regarding autopolyploidy, we undertook a detailed population genetic study of one of the classic examples of autopolyploidy, Galax urceolata (Diapensiaceae), which comprises diploid, triploid, and autotetraploid cytotypes. Galax is endemic to the Appalachian Mountains, the adjacent piedmont, sandhills, and coastal plain and represents perhaps the most widely known example of autopolyploidy in nature. • Methods: Flow cytometry was used to diagnose ploidal level of ~1000 individuals across 71 populations. We used 10 microsatellite markers to examine genetic variation across the geographic range of Galax and assessed multiple origins though comparisons of diploid, triploid, and tetraploid accessions using multiple analytical approaches. • Key results: Tetraploids had higher levels of heterozygosity than diploids did. Genetic variation in diploid and tetraploid Galax is geographically structured among the ecoregions of the southeastern United States. Autotetraploidy in Galax urceolata has occurred independently at least 46 times, with triploidy having occurred a minimum of 31 times. • Conclusions: Genetic differentiation among ecoregions suggests historical patterns of local adaptation. The numerous independent origins of tetraploid Galax reported here are among the highest frequencies of independent polyploidizations ever reported for any polyploid (auto- or allopolyploid).

Objective To characterize the clinical, demographic, and socioeconomic profile of childhood systemic lupus erythematous (cSLE) in the Black Belt of the Southern United States in comparison to the current literature of predominantly Caucasian cohorts. Methods This is a cross-sectional study characterizing patients with cSLE from two centers in the Southeastern United States– University of Mississippi Medical Center (UMMC) and University of Alabama at Birmingham (UAB). Demographic, social, and clinical data was retrospectively collected by medical chart review for prevalent and incident cSLE patients via electronic medical records for UMMC and the Childhood arthritis and rheumatology research alliance (CARRA) registry database for UAB. The data was combined and analyzed using SPSS statistical software. Results Of the 45 patients,82.2%were female, 82.2% were of AA ethnicity, and 66.7% had Medicaid insurance. Mean age at diagnosis was 13.5 years (+/- 2.8). Mean American College of Rheumatology (ACR) score at diagnosis was 5.1 (+/- 1.27), the Systemic Lupus International Collaborating Clinics (SLICC score) was 8.4 (+/- 2.5). Average baseline Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was 13.06 (+/- 9.3), SLEDAI at 6 months and 1 year respectively was 7.4 and 4.7. Average distance traveled to see a rheumatologist was 74.83 miles compared to a national average of 42.8 miles. 37/45 patients (82%) belonged to medium-high or high Social Vulnerability Index (SVI) group based on zip code. Conclusion Compared to previously described multiethnic cohorts of cSLE, this predominantly AA patient population in the Southern United States has significantly higher disease activity and greater damage accrual. Social risk factors for this population include a higher SVI, longer distance from an academic pediatric rheumatology center, and having Medicaid insurance. The effect of these factors on disparity of disease outcomes needs to be further explored with larger cohorts. Significance and innovations • There is limited literature on childhood systemic lupus erythematosus (cSLE) in Black patients from the Southern United States. This descriptive cohort focuses on patients from two states in the geographical Black Belt of the United States, a region that has not been previously explored in this context. • This study examines the potential association between adverse socioeconomic factors and disparities in outcomes in cSLE, an area that remains understudied.