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The Brew-ty of Small Towns
Get PDFThis paper explores the relationship between breweries and small towns by examining the impacts of breweries in three North Carolina municipalities: Tarboro, Lincolnton, and Hendersonville. In interviewing community stakeholders, business owners, and public officials, this report expounds on the significance of breweries as effective third places in these communities by creating the opportunity for residents to build social capital.Master of City and Regional Plannin
SwinDAF3D: Pyramid Swin Transformers with Deep Attentive Features for Automated Finger Joint Segmentation in 3D Ultrasound Images for Rheumatoid Arthritis Assessment
Get PDFRheumatoid arthritis (RA) is a chronic autoimmune disease that can cause severe joint damage and functional impairment. Ultrasound imaging has shown promise in providing real-time assessment of synovium inflammation associated with the early stages of RA. Accurate segmentation of the synovium region and quantification of inflammation-specific imaging biomarkers are crucial for assessing and grading RA. However, automatic segmentation of the synovium in 3D ultrasound is challenging due to ambiguous boundaries, variability in synovium shape, and inhomogeneous intensity distribution. In this work, we introduce a novel network architecture, Swin Transformers with Deep Attentive Features for 3D segmentation (SwinDAF3D), which integrates Swin Transformers into a Deep Attentive Features framework. The developed architecture leverages the hierarchical structure and shifted windows of Swin Transformers to capture rich, multi-scale and attentive contextual information, improving the modeling of long-range dependencies and spatial hierarchies in 3D ultrasound images. In a six-fold cross-validation study with 3D ultrasound images of RA patients’ finger joints (n = 72), our SwinDAF3D model achieved the highest performance with a Dice Score (DSC) of 0.838 ± 0.013, an Intersection over Union (IoU) of 0.719 ± 0.019, and Surface Dice Score (SDSC) of 0.852 ± 0.020, compared to 3D UNet (DSC: 0.742 ± 0.025; IoU: 0.589 ± 0.031; SDSC: 0.661 ± 0.029), DAF3D (DSC: 0.813 ± 0.017; IoU: 0.689 ± 0.022; SDSC: 0.817 ± 0.013), Swin UNETR (DSC: 0.808 ± 0.025; IoU: 0.678 ± 0.032; SDSC: 0.822 ± 0.039), UNETR++ (DSC: 0.810 ± 0.014; IoU: 0.684 ± 0.018; SDSC: 0.829 ± 0.027) and TransUNet (DSC: 0.818 ± 0.013; IoU: 0.692 ± 0.017; SDSC: 0.815 ± 0.016) models. This ablation study demonstrates the effectiveness of combining a Swin Transformers feature pyramid with a deep attention mechanism, improving the segmentation accuracy of the synovium in 3D ultrasound. This advancement shows great promise in enabling more efficient and standardized RA screening using ultrasound imaging
Host responses to S. pneumoniae in wild type and Mertk mutant mice
Get PDFStreptococcus pneumoniae is the leading cause of community-acquired pneumonia. Mertk is a receptor tyrosine kinase and a member of the TAM family. It serves as an efferocytosis receptor involved in the recognition and removal of apoptotic debris by phagocytic cells, dampening the inflammatory response. Here we show that at 24h post-inoculation with S. pneumoniae, Mertk-/- mice generated through homologous recombination and backcrossed (HRB-Mertk-/- mice) have fewer bacteria present in their pneumonic lung than wild type mice. This enhanced clearance was not observed in Mertk-/- mice generated by CRISPR technology. The enhanced clearance of HRB-Mertk-/- mice was associated with fewer neutrophils and more IFNγ in the bronchoalveolar lavage, but was not prevented by a neutralizing IFNγ antibody. Mertk is highly expressed on alveolar macrophages. Transcriptomic changes observed in HRB-Mertk-/- alveolar macrophages were associated with leukocyte activation, cellular motility, and response to stimulus, suggesting that they are primed for an inflammatory response. HRB-Mertk-/- mice similarly had enhanced host defense pathways in S. pneumoniae-stimulated alveolar macrophages in vitro and in pneumonic lung tissue. However, HRB-Mertk-/- alveolar macrophages demonstrated no defect in phagocytosis and acidification in vivo, and genes and gene sets describing phagocytic pathways were not enriched, suggesting that the enhanced clearance may be through alterations in the lung microenvironment. HRB-Mertk-/- mice are reported to have a long 129P2 DNA insert (~645 genes) in chromosome 2 adjacent to Mertk, as well as other alterations at multiple sites. Thus, while Mertk deficiency may contribute to the enhanced bacterial clearance, it is not solely responsible, because the phenotype is not seen in the CRISPR-Mertk-/- mice. The 129P2 DNA insert in the HRB-Mertk-/- mice must be mediating at least some of this phenotype. Understanding the mechanistic differences and the means by which this 129P2 DNA insert enhances bacterial clearance remains critically important
Selective Influence of Hemp Fiber Ingestion on Post-Exercise Gut Permeability: A Metabolomics-Based Analysis
Get PDFObjectives: This study investigated the effects of 2-week ingestion of hemp fiber (high and low doses) versus placebo bars on gut permeability and plasma metabolite shifts during recovery from 2.25 h intensive cycling. Hemp hull powder is a rich source of two bioactive compounds, N-trans-caffeoyl tyramine (NCT) and N-trans-feruloyl tyramine (NFT), with potential gut health benefits. Methods: The study participants included 23 male and female cyclists. A three-arm randomized, placebo-controlled, double-blind, crossover design was used with two 2-week supplementation periods and 2-week washout periods. Supplement bars provided 20, 5, or 0 g/d of hemp hull powder. Participants engaged in an intensive 2.25 h cycling bout at the end of each of the three supplementation periods. Five blood samples were collected before and after supplementation (overnight fasted state), and at 0 h-, 1.5 h-, and 3 h-post-exercise. Five-hour urine samples were collected pre-supplementation and post-2.25 h cycling after ingesting a sugar solution containing 5 g of lactulose, 100 mg of 13C mannitol, and 1.9 g of mannitol in 450 mL of water. An increase in the post-exercise lactulose/13C mannitol ratio (L:13CM) was used as the primary indicator of altered gut permeability. Other outcome measures included muscle damage biomarkers (serum creatine kinase, myoglobin), serum cortisol, complete blood cell counts, and shifts in plasma metabolites using untargeted metabolomics. Results: No trial differences were found for L:13CM, cortisol, blood cell counts, and muscle damage biomarkers. Orthogonal partial least-squares discriminant analysis (OPLSDA) showed distinct trial differences when comparing high- and low-dose hemp fiber compared to placebo supplementation (R2Y = 0.987 and 0.995, respectively). Variable Importance in Projection (VIP) scores identified several relevant metabolites, including 3-hydroxy-4-methoxybenzoic acid (VIP = 1.9), serotonin (VIP = 1.5), 5-hydroxytryptophan (VIP = 1.4), and 4-methoxycinnamic acid (VIP = 1.4). Mummichog analysis showed significant effects of hemp fiber intake on multiple metabolic pathways, including alpha-linolenic acid, porphyrin, sphingolipid, arginine and proline, tryptophan, and primary bile acid metabolism. Conclusions: Hemp fiber intake during a 2-week supplementation period did not have a significant effect on post-exercise gut permeability in cyclists (2.25 h cycling bout) using urine sugar data. On the contrary, untargeted metabolomics showed that the combination of consuming nutrient-rich hemp fiber bars and exercising for 135 min increased levels of beneficial metabolites, including those derived from the gut in healthy cyclists
Environmental risk and Alpha-gal Syndrome (AGS) in the Mid-Atlantic United States
Get PDFAlpha-gal syndrome (AGS), commonly referred to as the tick bite red meat allergy, has been reported worldwide with the number of suspected cases in the United States increasing from 24 in 2009 to over 34,000 in 2019. Within the US, AGS is associated with the bite of two tick species, Amblyomma americanum and Ixodes scapularis, and has particularly high incidence rates in the mid-Atlantic region. Because AGS is associated with tick bites, the risk of developing AGS is affected by the environment individuals visit. Despite this, as well as the numerous studies associating the environment with Am. americanum, no work to-date has evaluated AGS risk factors associated with the surrounding landscape. We test the hypothesis that AGS risk is associated with habitat fragmentation typically seen in areas classified as open space and low intensity development that are suitable for human-tick interactions, using a combination of generalized linear modeling (GLM), boosted regression trees (BRT), and Maximum Entropy (MaxEnt). We qualitatively compare results from the models, as well as their predictions within the mid-Atlantic region. We found that models mostly agree when determining important environmental variables, with open space development and population density being highly predictive across all models. BRT and GLM predicted a strong east to west gradient of risk across the mid-Atlantic, which largely mirrors the environmental transition from mountains to coastal plains. MaxEnt predicted a much patchier distribution across the region with no discernable patterns. These results provide evidence that AGS is associated with land uses that are associated with habitat fragmentation, the preferred habitat of Am. americanum. This information can be used to inform future education programs aimed at reducing AGS incidence in the region
Methodological Issues of Qualitative Research on End-of-Life Care Among Older Korean Immigrants in the United States
Get PDFQualitative research, rooted in interpretivism, is valuable for studying immigrant populations and understanding cultural influences on health behaviors. However, few studies have explored the methodological challenges of researching older Korean U.S. immigrants, particularly on sensitive topics like end-of-life care, which requires deep cultural understanding. This paper examines the challenges encountered during a pilot study on end-of-life care among older Korean U.S. immigrants. In addition to identifying key methodological obstacles, we highlight strategies to improve future research on sensitive topics within immigrant communities. Our study, informed by existing literature, faced unexpected challenges at every stage—recruitment, data collection, and analysis—each requiring careful adaptation. First, recruitment posed significant challenges. Many participants were hesitant to discuss end-of-life care due to cultural stigma, fearing it might invite misfortune. Some resisted signing consent forms, unfamiliar with Western research protocols and concerned about potential consequences. Others expected structured surveys rather than open-ended interviews, making engagement difficult. Second, conducting interviews brought additional hurdles. The setting needed to feel neutral, as medical or religious environments influenced responses. Language proficiency varied, requiring interpreters and adjusted phrasing. Discussions about end-of-life care sometimes triggered emotional distress, necessitating sensitivity and frequent check-ins. Third, data analysis required careful consideration. Translating nuanced Korean expressions into English was challenging, as some terms lacked direct equivalents. Case vignettes also needed thoughtful adaptation to ensure cultural relevance and avoid bias. Finally, participant feedback led to important revisions, reinforcing the value of involving participants throughout the research process. Engaging them early and reflecting on challenges afterward can improve study design and data quality. By addressing these methodological hurdles, this study provides practical insights for strengthening qualitative research on immigrant populations, particularly when exploring sensitive topics
APPLICATIONS OF MACHINE LEARNING IN UTILITY PLANNING FOR CLIMATE RESILIENCE
Get PDFUtility services are critical infrastructures that shape how urban populations experience the impact of planning policies. Climate change and increasing extreme weather events challenge utilities to maintain service levels while adapting to changing environmental and technological regimes. This dissertation investigates the intersection of utility planning, climate resilience, and applied machine learning through three interconnected papers. The research addresses three critical utility planning challenges: workforce development amid the clean energy transition, water service accessibility for mobile home park residents, and exposure to flooding risk to solar photovoltaic infrastructure. The study pursues two overarching objectives: methodologically, it examines the efficacy of applied machine learning techniques in utility planning applications; substantively, it applies these methods to address specific climate resilience challenges. Paper I uses Natural Language Processing and unsupervised clustering to identify occupational transition pathways for clean energy workforce development, demonstrating the utility of the Occupational Information Network (O*NET) framework as a reconnaissance tool for workforce planning. Paper II employs computer vision to identify 8,460 Mobile Home Parks in North Carolina and characterizes their water utility service accessibility, finding distinct patterns of accessibility inside and outside urban area cluster boundaries. Paper III evaluates flood risk exposure of small and utility scale solar installations in Central and Coastal North Carolina using 100-year digital flood maps and hurricane flood footprints, revealing complementary risk characterizations between the two assessment methods. The dissertation demonstrates how applied machine learning can address utility planning data gaps through information organization, prediction, and structured information extraction. The methods include unsupervised clustering for reorganizing occupational information, computer vision for infrastructure identification, and Large Language Models for information extraction. The research generates datasets to be publicized for use by the climate resilience community of practice. The findings contribute to understanding workforce development pathways, spatial patterns of utility service accessibility, and patterns of exposure to infrastructure risks, while highlighting opportunities for future research in climate resilient utility planning.Doctor of Philosoph
Simulation-based Testing of the Traffic Rules Requirements for Autonomous Vehicles at Intersections
Get PDFTo successfully integrate autonomous vehicles as a mode of transportation, we must test these systems against their end-to-end requirements. When AVs and humans (pedestrians, bicyclists, human-driven vehicles) share the road, they must follow the same traffic rules. Using the common traffic rules (written for human drivers) as an engineering requirement poses a challenge due to the ambiguity of the natural language. On the other hand, an AV is fundamentally different from a human, and a simple road test is not sufficient to assess an AV's compliance and skills. This calls for automated, systematic and scalable testing techniques. The focus of this dissertation is on simulation-based testing of the traffic-rules requirements. This dissertation develops techniques for systematic exploration of the test-case space of autonomous vehicles based on two crucial concepts: complexity and coverage. Here, these concepts are formalized with respect to the traffic rules requirements. The efficiency of finding bugs is improved by incrementally increasing the complexity of a test-case, namely making it harder for an AV to pass a test-case. On the other hand, the diversity of a test-suite is improved by guiding the test-case generation towards increasing the coverage of a test-suite. The framework for formalization of the traffic rules is made more amenable to vetting by the authorities and regulators by narrowing the gap between human intuition and machine language. This is achieved by formalizing traffic rules in first-order logic (FOL) which allows modeling objects and predicates.Doctor of Philosoph
IMPLEMENTATION OF CONTINUOUS GLUCOSE MONITORING PROTOCOL IN PRIMARY CARE
Get PDFDiabetes Mellitus (DM) is a global public health problem, with 537 million adults aged20-79 worldwide diagnosed with DM in 2021 (International Diabetes Federation [IDF], 2021). InNorth Carolina (NC), 12.4% of adults have DM, and 34.6% have pre-diabetes (ADA, 2021).According to the 2019 report from Duplin County Healthy Communities, the rate of DM washigher than the state average at 16.5% (Healthy Communities, 2019). Healthy People's 2030goal is to increase the proportion of adults with DM who use insulin to monitor their blood sugardaily from 86.5% in 2019 in the US to a target of 94.4% by 2030 (Healthy People, 2022). NorthCarolina is below the US average, with only 63.6% of people with DM on insulin checking theirglucose one or more times a day (North Carolina Department of Health and Human Services [NCDHHS], 2022).Continuous glucose monitoring (CGM) provides people with diabetes with a less painful,more frequent glucose reading and improves compliance with monitoring frequent blood sugarlevels (Kieu et al., 2023). The ADA standards of care guidelines for 2025 have recommendedCGM for all patients with type 2 DM (T2DM) who currently use multiple daily injections(MDI), mixed insulin therapies, basal insulin, or documented hypoglycemic events (El Sayed etal., 2023). Primary care providers (PCPs) with specialized training in diabetes technology,coding, billing, and CGM implementation and interpretation are more likely to prescribe CGMs and provide individualized diabetes care to their patients with insulin-dependent DM (Ajjan etal., 2019; Diamond, 2023; Filippi et al., 2023; Martens et al., 2021).The intervention for this quality improvement project was to provide specialized CGMtraining to eight PCPs in eastern NC and monitor the number of CGM prescriptions and thenumber of CGM CPT billing codes over 13 weeks of project implementation. The results showedan increase in CGM prescriptions by 7.29%, with 17 prescriptions from July 1, 2024, toNovember 1, 2024, and an increase of CPT CGM billing codes from zero to 31 from the same time.Doctor of Nursing Practic
Mechanical Leverage of the Foot and Ankle: Aging, Balance and the Future of Super Shoes
Get PDFOlder adults utilize their foot and ankle differently compared to their younger adult counterparts during functional activities such as walking. This difference could be a key factor contributing not only to mobility decline but also to a greater falls risk in our rapidly aging population. As fall rates continue to rise in older adults, better understanding of the morphological changes to the foot with age and the role of the foot and ankle in mitigating falls risk is needed. Requisite foot stiffness and the mechanical leverage it conveys play a critical first line of defense in the successful deployment of neuromuscular strategies to mitigate instability during walking and thereby an unexplored but promising target for low-cost, scalable, and widespread intervention. The goal of this dissertation work is to improve our understanding of age-related differences in the neuromechanical interactions between the foot and ankle and how altering mechanical leverage in the aging foot affects older adults’ ability to respond to greater task demands or instability.The first study found that the dynamic mean ankle moment arm captured task demand changes in foot-ankle control during walking, independent of age, suggesting its potential as a control parameter for assistive devices throughout the lifespan. The second study quantified foot-ankle mechanical transmission, revealing that older adults have a reduced transmission capacity, which may impair effective push-off power during walking. The third study showed that older adults exhibit diminished foot-ankle mechanical leverage, and that better leverage associates with greater stability across age groups, highlighting opportunities for assistive interventions. The fourth study demonstrated that carbon fiber insoles improve foot-ankle mechanical leverage and mitigate instability during habitual walking regardless of age. Collectively, these findings provide pivotal insight into neuromechanics of the foot and ankle with the effect of age, and how some of those age-related deficits may be impacted by the use of a low-cost and clinically feasible solution to mitigate fall risk.Doctor of Philosoph