The Graduate School's annual Graduate Education Advancement Board Impact Awards recognize graduate students for contributions they are making to our state. These awards are possible thanks to the unwavering support of the Graduate Education Advancement Board (GEAB).
Dental disease is the most common disease of childhood and disproportionately affects low-income minority children. The N.C. Department of Health and Human Services (DHHS) has reported that children with cavities in their "baby teeth" are three times more likely to develop cavities in their permanent teeth.
Doctoral student Jacqueline Burgette, D.M.D., examined how an early education program for children of diverse low-income families might influence children's use of dental care. Burgette's study included 479 families enrolled in Early Head Start (EHS) and 699 families with similar characteristics but not enrolled in EHS. As part of this study, 400 EHS teachers were trained in implementing the EHS early childhood oral health program guidelines through a collaboration between the N.C. Division of Public Health and DHHS. Communication training also was provided for staff members in every EHS program.
In Burgette's study, parents were interviewed about their children's dental visits over two years. She found that children enrolled in EHS had 2.5 times the odds of having an overall dental visit and 2.6 times the odds of having a preventive dental visit, compared to the children not enrolled in EHS. Her findings suggest that EHS efforts may be contributing to better oral health for young children at high risk for tooth decay.
"Jackie's study informs state strategies for extending effective oral health services to children attending private early education and childcare programs in addition to the publicly funded Early Head Start program, thus potentially reaching thousands of preschool-aged children in the state," said adviser Gary Rozier, D.D.S.
Duplin County has the highest hog population density of any county in the United States. Liquid manure from concentrated animal feeding operations (CAFOs) is stored in open-air lagoons and sprayed onto sprayfields as fertilizer. The state regulates hog CAFOs by requiring nutrient management plans to demonstrate that crops are absorbing the nutrients being sprayed and that the fertilizer is not being over-applied. These plans, though public, are not easily accessible.
Recent master's degree graduate Elizabeth Christenson reviewed all nutrient management plans for Duplin County—managing a team of 15 undergraduate volunteers to scan more than 1,300 plans for all of North Carolina that are stored as paper files. From that effort, she created the first open-source sprayfield spatial database for swine CAFOs in North Carolina, for Duplin County.
Christenson also created a method to improve the time scale of sprayed nutrient data because the nutrient management plans are only submitted every five years and do not distinguish by year. She helped create a new method of identifying crops grown on sprayfields using annual remotely sensed crop data, so that she could then approximate nutrient application on a finer scale. Christenson's research has implications for watershed protection, and human and environmental health in communities with CAFOs.
"The result of Elizabeth's work is the first comprehensive spatial database of swine farms and their sprayfields. This database will be made available to the public, so that any stakeholder can have access to it," said adviser Marc Serre, Ph.D.
An estimated 36,000 state residents are living with HIV, according to the N.C. Department of Health and Human Services, of whom 20 percent are unaware of their status and approximately 30 percent are diagnosed late in the course of the disease.
Anna Cope, Ph.D., examined the diagnosis, care and treatment status of potential transmitting partners to inform innovative HIV prevention strategies in North Carolina. Her findings indicate that most HIV transmission in the state appears to result from contact with people who are aware of their infection and most of these previously diagnosed partners had not achieved viral suppression. Early diagnosis of HIV is crucial for protecting both individual-level and public health.
Cope assessed the geographic patterns of early diagnosis in North Carolina to locate populations and areas of the state most likely to benefit from targeted programs promoting HIV testing and status awareness. She identified that despite the wide availability of HIV testing services, delays in diagnosis were apparent among individuals who live near testing sites, but choose to travel longer distances than geographically necessary to test. Cope has shared her finding with state public health officials and her findings have implications for new interventions to prevent HIV transmission and improve the lives of those impacted by the disease in North Carolina.
"From the moment I met Anna, she expressed an interest in research opportunities to help identify successful strategies to improve the health of people living with HIV in North Carolina," said adviser William Miller, M.D., Ph.D.
North Carolina is home to more than 775,000 military veterans, according to the U.S. Department of Veterans Affairs, and an estimated 100,000-plus active military personnel. That's close to 900,000 powerful narratives of military experience in North Carolina alone.
Gregory DeCandia, a master of fine arts student, and his colleagues conducted interviews with members of North Carolina Vietnam Veterans Inc., UNC-Chapel Hill's ROTC and veterans throughout the nation. From these narratives, DeCandia's team created Silhouettes of Service, a solo theater performance piece. The interviews totaled 268 pages of transcript, edited to 29 script pages.
The finished piece incorporates a rotating aluminum cube framework, created by technical production graduate student Jacob Walton; the elements of the frame move to allow images to be projected and accommodate other storytelling elements. Silhouettes of Service was highlighted in a set of three UNC Process Series works focused on veterans and their families. Downrange: Voices from the Homefront, by 2004 GEAB Impact Award recipient Mike Wiley, also was featured. All Silhouettes of Service readings and performances have offered feedback sessions with members of the creative team and local veterans' organizations to provide a supportive environment for the audiences to share their own experiences.
"It is Greg's intention, using the tools of theater, to bring to the stage the voices of veterans of the armed forces so that their particular stories may be told. Silhouettes of Service promises to be the capstone on an exceptional record of achievement for this outstanding student," said adviser Ray Dooley, M.F.A.
Oyster reefs are a critical ecological, economic and cultural resource for North Carolina—the estimated monetary value of an unharvested oyster reef, alone, is tens of thousands of dollars per acre annually.
Luke Dodd, Ph.D., assessed the impact of ocean acidification and other threats to oyster reefs. In testing shell growth rates for more than 500 juvenile oysters raised in differing levels of ocean acidification, he found good news: In high-salinity areas, oysters grow even in extreme acidity. Additionally, acidification will also disrupt the predatory behavior of mud crabs that feed upon young oysters. His findings indicate that as ocean acidification increases, reef restorations may need to be targeted toward areas of higher salinity such as Core Sound or the mouths of the White Oak and New rivers.
Dodd also studied the state's stone crab population, which is increasing within the Pamlico Sound. Little is known of this species' influence on oyster reefs, and Dodd's work determined how crab size affects their ability to consume oyster prey. Additionally, Dodd discovered that unlike many other bivalves, oysters do not stop filtering when predators are nearby to avoid becoming prey. This means that reefs can be managed as nurseries for valuable fisheries species without reducing their impact on water quality. This new knowledge of oyster reefs can be directly used to enhance the health and prosperity of the state's coastal ecosystems.
"Luke's graduate work has already yielded both high-impact scientific contributions and information that is critically important to coastal decision-making," said adviser Michael Piehler, Ph.D.
The housing market collapse and the "Great Recession" have led some to question the wealth-building effects of affordable homeownership. Doctoral student Ahmed Rachid El-Khattabi tested whether homeownership is a way for lower-income people to create and preserve wealth. He used 2005-2012 data from the Community Advantage Program (CAP), a secondary mortgage market program founded as a joint initiative among the Ford Foundation, Fannie Mae and Self-Help (a nonprofit lender based in Durham) to promote home lending to low-income families; between 25 percent and 30 percent of the households in this dataset live in North Carolina.
Preliminary results suggest that low- and moderate-income homeowners, on average, had more liquid assets, measured as a combination of bank holdings and CDs, throughout the sample period than their renter counterparts. Homeowners in the study also were five times more likely than renters to have investment accounts and 30 times more likely to have retirement accounts. CAP homeowners had greater assets, but also greater liabilities: Homeowners had higher student loan debt and credit card debt than the renters. Even considering differing compositions of net wealth, the decline in housing values during the recession and the costs of homeownership, homeowners still had higher net wealth than their renter counterparts.
El-Khattabi's findings can help policymakers understand potential benefits of homeownership to low- and moderate-income homeowners—and to the state in which these households live.
"The recent financial crisis has called into question whether homeownership provides the financial security that has long been associated with it. Rachid's research sheds light on this timely question and shows that, even during the crisis years, homeownership provided a financial cushion for low-income households," said adviser Lutz Hendricks, Ph.D.
Forty-three percent of middle school students and 19 percent of high school students in North Carolina have been bullied in school, according to 2013 Youth Risk Behavior Survey data. North Carolina signed the School Violence Prevention Act into law in 2009. This law applies to more than 2,500 public schools (K-12), with the goal of protecting nearly 1.5 million students.
Will Hall, Ph.D., examined whether or not the law is being implemented consistently. He recruited 664 educators employed in 93 of the state's 115 school districts, and participants completed an online survey. His findings suggest considerable variability in the law's implementation. For almost every policy component, scores ranged from 0 percent to 100 percent.
Participant responses indicated that educator training about the policy in general and related to the eight protected student populations was largely not implemented. Implementation was reported as higher when related to reporting and investigating incidents of bullying. Reporting, investigating and remediating bullying behavior were highest for bullying based on race and then disability, and lowest for bullying based on sexual orientation and gender identity. Participant responses indicated greater implementation in high schools than in elementary schools. Higher levels of teacher protection were reported in elementary schools. Hall's findings provide policymakers and school officials with crucial information in their efforts to protect all students from bullying.
"His findings from teachers and administrators across North Carolina demonstrate that implementation as intended is rare and that many teachers are not fully informed on who should be protected by the law and how to protect them," said adviser Mimi Chapman, Ph.D.
North Carolina is the second largest producer of hogs nationwide, with the majority of hogs raised in industrial hog operations (IHOs). In these facilities, low doses of antibiotics are administered to hogs to prevent disease and promote growth. Research suggests that this practice can lead to the emergence of antibiotic-resistant Staphylococcus aureus within IHOs, and that workers can be exposed.
Sarah Hatcher, Ph.D., investigated whether or not living with an IHO worker is associated with carrying antibiotic-resistant S. aureus in children under 7 years of age. The study was conducted in partnership with the Rural Empowerment Association for Community Help, UNC-Chapel Hill and Johns Hopkins University, and it included 198 IHO worker-child household pairs and 202 community referent household pairs in which the adult was not employed in livestock production.
Among the team's findings, a greater percentage of children living with IHO workers carried S. aureus, methicillin-resistant S. aureus (MRSA) and multidrug-resistant S. aureus (MDRSA). Fourteen percent of children in the IHO group and 6 percent of children in the community referent group carried MRSA, and 23 percent of children in the IHO group and 8 percent of children in the community group carried MDRSA. A greater percentage of IHO workers carried S. aureus characteristic of livestock sources compared to adults in the community referent group, representing possible IHO workplace exposure and warranting further investigation.
"Sarah's research is highly significant to the global study of antibiotic-resistant bacteria while contributing to the well-being of communities in rural North Carolina," said adviser Jill Stewart, Ph.D.
North Carolina is the ninth most diabetic state in the nation, according to the N.C. Department of Health and Human Services. Current medical practices require diabetics to painfully inject themselves with medicine daily, but a sticker-like patch, called a microneedle patch, uses needles so small that they painlessly insert into the skin to deliver medicine. These microneedle patches have potential to increase comfort and reduce dosing frequency—increasing medication compliance in the process. An emerging 3-D printing technique called Continuous Liquid Interface Production, or CLIP, has been used to manufacture microneedles 400 times faster than current techniques with improved control over shape.
Doctoral student Ashley Johnson tested and performed troubleshooting of early CLIP printers in collaboration with the startup company Carbon3D to improve the capacity to print parts at a very small scale. These tests resulted in a 10-fold improvement in printer resolution to enable small microneedles, close to the width of a human hair, to be fabricated using 3-D printing.
Ultimately, CLIP has potential to alleviate manufacturing hurdles that have plagued the commercialization of microneedle technology, such as poor control, lack of scalability and high cost. While there are currently no commercially available microneedle systems to treat illnesses, the technology has tremendous promise to improve therapeutic outcomes for diabetes and a variety of other diseases through increased patient comfort and compliance.
"Ashley collaborated with my startup company Carbon3D, providing key insights for biomedical engineering applications and demonstrating the ability of this new approach to 3-D printing to have a resolution 10 times better than traditional technologies," said adviser Joseph DeSimone, Ph.D.
North Carolina has made major progress in reducing the formation of the air pollutant ozone; however, some counties still exceed the current air pollution standards set by the U.S. Environmental Protection Agency. Ground level ozone has been extensively investigated for its harmful pulmonary health effects and recently has been suggested as a contributor to diabetes. Doctoral student Desinia Miller examined if and how ozone exposure may change metabolism and contribute to insulin resistance, which can lead to type 2 diabetes.
In rodent studies, Miller and colleagues observed that ozone exposure was associated with marked changes in glucose, fat and protein metabolism. Further, Miller and her colleagues have shown that rodents exposed to ozone also had elevated blood stress hormones. Importantly, a clinical ozone exposure study in North Carolina showed that humans present similar effects to rodents, especially in stress hormone increase and fat metabolism. These ozone-related changes in metabolism and in stress response are thought to contribute to insulin resistance.
Overall, Miller and colleagues showed for the first time that air pollutants can produce several metabolic effects throughout the body by activating a stress response pathway that can hinder insulin production. These new findings could directly inform future research, and guide regulatory decisions and interventions focused on preventing diabetes.
"The incidence of diabetes has been rising in the U.S., and especially in North Carolina. Her research will have paramount impact on identifying the contribution of environment in growing crises of diabetes, obesity and cardiovascular disease," said adviser Urmila Kodavanti, Ph.D.
Systemic lupus erythematosus (SLE) is an autoimmune disorder that affects an estimated 45,000 people in North Carolina. Since SLE symptoms can mimic other illnesses, it can take many years for an accurate diagnosis, in part because there is no single conclusive laboratory test that identifies this disease in its early stages. There is no cure for SLE and the current treatments use powerful immunosuppressants that create side effects including osteoporosis, muscle weakness, cataracts and increased risk for diabetes and infection.
Doctoral student Andrew Monteith, working in collaboration with the UNC Rheumatology Clinic, has identified that white blood cells called macrophages malfunction in lupus-prone mice and SLE patients. Macrophages normally destroy "debris" from dead cells by using a specialized cellular compartment called the lysosome. Maturation of the lysosome fails in lupus-prone macrophages, promoting the accumulation of debris on the cell's surface. This buildup is vital in the autoimmune process and occurs prior to the development of SLE symptoms, making it a potential biomarker for disease flares.
By focusing on the underlying mechanism that prevents lysosome maturation, Monteith and his colleagues also hope to design a targeted therapeutic with potentially fewer side effects than traditional immunosuppressants.
"Genetic manipulations by Andrew showed that events not previously associated with lupus have a profound effect on the disease, making this defect a good target for therapeutics," said adviser Barbara Vilen, Ph.D.
Studies indicate that consumption of sugary beverages is high among N.C. children, contributing to the risk of becoming overweight or obese in childhood. Doctoral student Brooke Nezami's Smart Moms study tested the effectiveness of an innovative smartphone-based intervention to reduce child and maternal sugar-sweetened beverage intake and maternal weight.
The six-month trial included overweight and obese mothers within driving distance of the Raleigh-Durham area and their children ages 3-to-5. Mother-child pairs were assigned to the intervention or a waitlist control group. Nezami delivered content to mothers in the intervention through one face-to-face group session, smartphone-optimized website lessons (weekly for the first three months and biweekly for the final three months) and between three and four text messages weekly. Each mother was asked to track certain behaviors and submit the information via text message. They received personalized feedback on their progress.
At six months, children in the Smart Moms group had reduced their sugar-sweetened beverage intake significantly more than children in the control group, and mothers in the Smart Moms group lost significantly more weight than mothers in the control group. Additionally, participation levels were high. The Smart Moms program shows how approaches that incorporate technology may prevent weight gain in children.
"Brooke's work has had a positive and significant impact on the families who participated, and because the intervention she developed uses innovative technology, it has the potential to impact significantly more mothers, children and families upon dissemination," said adviser Deborah Tate, Ph.D.
The quadriceps muscles are important because they absorb impact forces that occur in the course of walking. If these muscles don't function properly, greater force is placed on the knee joint during walking, and this can contribute to joint damage and knee osteoarthritis, a disease which is a leading cause of disability. Nearly one in two individuals is at risk of developing symptomatic knee osteoarthritis by age 85, according to the U.S. Centers for Disease Control and Prevention. Improving quadriceps function is critical for prevention and treatment of knee osteoarthritis, yet difficult to achieve.
Derek Pamukoff, Ph.D., focused his research on an innovative rehabilitation method called vibration therapy. The purpose of his study was to determine how two types of muscle vibration, whole body (WBV) and local muscle vibration (LMV), affect quadriceps function. Sixty healthy individuals and 20 individuals with anterior cruciate ligament (ACL) reconstruction, a group that is five to seven times more likely to develop knee osteoarthritis compared to healthy individuals, participated in the study.
The results indicated that both WBV and LMV improved quadriceps function in both groups. Furthermore, WBV and LMV produced similar improvements in quadriceps function. This is of great importance due to the enhanced portability and substantially lower cost of LMV compared to WBV. Further research is necessary, but both vibration therapies show promise for improving quadriceps function and reducing osteoarthritis-related disability.
"In addition to reducing the cost of rehabilitation, the portable nature of this new technology could have substantial implications for individuals with osteoarthritis in rural areas who have limited access to health care facilities," said adviser Troy Blackburn, Ph.D.
North Carolina has experienced a dramatic loss of oyster populations during the past century, prompting the N.C. Division of Marine Fisheries (DMF) to direct massive efforts toward restoring a multi-million dollar fishery. Unfortunately, this initiative has had trouble producing prolific oyster reefs.
Previously, oyster-reef growth has only been measured in terms of oyster density or shape, height and complexity. Doctoral student Justin Ridge developed a model for measuring fine-scale growth by examining a selection of reefs with a terrestrial laser scanner. The laser scanner maps surfaces at centimeter scale, creating a digital model of a reef at a given point in time. He also surveyed the tops of additional reefs, creating GPS-informed digital maps for comparison at different times, and measured oyster density at different elevations of constructed and natural reefs.
By using these methods, Ridge determined that in the lower parts of estuaries that have high salinity, oyster reefs grow best under a specific range of tidal exposures and fail in settings that are always submerged. Essentially, this defines the areas along the N.C. coast where oyster reefs will form or persist. In related work, he determined that armoring marshes with oyster reefs is effective in preventing shoreline erosion that has been naturally occurring since the mid-1800s. The conclusions from his research are already being incorporated in several oyster restoration efforts, including a DMF project in southeastern North Carolina.
"Justin presents centimeter-scale digital elevation models that show exactly where different parts of the reef grow or erode through time across areas with different tidal regimes. No other research group is collecting these types of data," said adviser Antonio B. Rodriguez, Ph.D.
Neighborhoods may provide vital support for healthy and unhealthy lifestyles. Doctoral student Pasquale Rummo studied neighborhood factors and created valuable new knowledge that can shape better health outcomes for low-income households, older adults and Latinos. Obtaining valid, reliable measures of food environments in Latino communities is important for understanding barriers to healthy diet behaviors in this population at high risk for cardiovascular disease.
Rummo investigated retail food outlet data and conducted his own field-based census of Durham County, N.C., food outlets, finding that only 56 percent of food stores characterized as Latino were identified in two commercial databases, making it difficult to study access to healthy foods in this vulnerable population. He also investigated neighborhood convenience stores' influence on diet quality, using data gathered over 13 years in four U.S. cities. Rummo found that greater neighborhood availability of convenience stores is linked to poorer diet quality, especially among low-income individuals. In reviewing 25 years of data in four U.S. cities, he also found that higher community-level fast food prices are linked to lower fast food consumption—but only within neighborhoods with a high proportion of low-income households.
Rummo also studied whether neighborhoods in urban locations support healthy aging and found that areas with growing older adult populations were less dense and less walkable than areas with younger populations. These findings can help officials find ways to create policies that bring healthier eating, and lifestyles, to North Carolina's neighborhoods.
"Pasquale is drawing attention to critical barriers faced by low-income individuals, minority subpopulations, particularly Latinos, and older adults. His work will ultimately help find policy targets that could be used in policy-level efforts to reduce health disparities by income, race and ethnicity, and age," said adviser Penny Gordon-Larsen, Ph.D.
Native to other regions of the world, invasive plants can disrupt the ecology of natural areas where they are introduced. They affect nearly every area of North Carolina, and the autumn olive and Chinese privet, in particular, have escaped cultivation and increased in frequency and density.
To determine the effects of these invasive shrubs on the state's forests, doctoral student Dennis Tarasi sampled forested plant communities in North Carolina with varying levels of autumn olive or Chinese privet dominance. His findings showed that the dominance of these shrubs correlated with significant changes in the forests, including the overall loss of native species and a significant decline in young trees. Chinese privet "invasions" corresponded to greater native species loss and structural changes than those by autumn olive. Many invasive species also have been documented as negatively affecting soil and available light.
Tarasi assessed changes in soil moisture levels, air temperature and light availability, emphasizing locations that were heavily invaded compared to those with little invasion. He found that the heavily invaded sites were more shaded and cooler across the entire summer. Soil moisture did not appear affected. Tarasi then removed invasive shrubs from several sites in his study; this action increased light availability and air temperature with little effect on soil moisture. Land managers, scientists, policymakers and many others can apply Tarasi's research and methods to manage ongoing invasions.
"Dennis is providing comprehensive and compelling evidence as to the impacts of exotic plant species and the pattern of these impacts across the Carolina landscape. This is work that advances our conceptual framework regarding the impacts of invasive species and, in addition, helps inform managers as to where and how to focus their efforts to control invasive exotics," said adviser Robert Peet, Ph.D.
Medicaid covers prenatal care and delivery for about half of N.C. births, according to the State Center for Health Statistics. Community Care of North Carolina (CCNC) manages care for Medicaid recipients. In partnership with the N.C. Division of Medical Assistance, CCNC launched a Pregnancy Medical Home (PMH) program in 2011 that screens and refers patients for pregnancy care management to address modifiable risk factors with the goal of improving maternal health and birth outcomes.
Christine Tucker, Ph.D., used extensive risk screening data from the PMH program, linked to birth certificates, to determine which combination of risk factors from the screening form best predicts preterm birth. Her analysis indicated that the maternal risk factors that were most strongly associated with preterm birth were multiple gestation, previous preterm delivery, cervical insufficiency, diabetes, renal disease and hypertension. Additional predictors were non-Hispanic black race, low maternal body mass (a maternal body mass index below 18), smoking during pregnancy, asthma, other chronic conditions, no previous delivery and a history of low birth weight or death of the fetus/loss of the fetus in the second trimester.
Tucker also identified risk factors for vulnerable subgroups, allowing for better targeting of preterm delivery prevention interventions. She has shared her findings widely, in North Carolina and beyond. Her analysis provides valuable insights into how the PMH program can best focus allocated state funding to help women at highest risk of preterm birth.
"North Carolina is confronted with high rates of preterm birth (12 percent), higher than the national average. In a time of increasing mandates for efficiency and effectiveness of state dollars, Christine's work will help to address North Carolina's high rate of preterm birth by ensuring that patients with highest risk are prioritized for pregnancy care management," said adviser Carolyn Halpern, Ph.D.
