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One-third of transgender individuals report having at least one negative health care experience related to being transgender and nearly a quarter report that they have delayed seeking health care due to fear of being mistreated. Objective: To assess medical providers’ experiences with, attitudes towards, and knowledge of transgender health care in the Northeast Tennessee region. Study Design: Cross-sectional survey. Setting: Academic and community health care clinics in Northeast Tennessee. Participants: Physicians, nurse practitioners, and physician assistants practicing emergency medicine, family medicine, internal medicine, obstetrics & gynecology, or pediatrics (n=154). Main and Secondary Outcome Measures: Descriptive statistics and multiple regression models were used to determine relationships between provider characteristics and three sets of dependent variables (practices, attitudes, and knowledge). Results: The majority of providers (65%) had not received training in transgender healthcare. Over 90% perceived they had treated fewer than five trans-identified patients in the last year. The majority of respondents (69.3%) felt comfortable providing health care to transgender patients, yet only 38% felt competent treating this population. Providers indicated it was important to know their patients’ sexual practices, gender identity and sexual orientation; however, the majority of providers never or rarely asked patients their gender identity (75.4%), sexuality (57.2%), or desired pronouns (84.4%). Having formal training in transgender health was the only significant predictor of knowledge, sexual orientation and gender history taking, and competence/comfort with transgender patient care. Conclusions: Results demonstrate a contradiction between ideology and practice. Most participants responded they felt comfortable providing care to the transgender population, yet their responses indicated a lack of training and absence of inclusivity in their health care practices. As formal training was the only significant predictor of outcomes, this suggests that additional medical education and training is needed on transgender health care.

In 2016, Tennessee Governor Bill Haslam signed into law the “Counseling Discrimination Bill,” which allows a licensed counselor in a private practice to use personal (i.e., religious) beliefs as an reason to terminate care or refer away LGBT+ clients, as long as they refer the client to another counselor. In that same year, the state legislature and governor defunded the University of Tennessee, Knoxville’s Office for Diversity and Inclusion, which had spearheaded a number of LGBT+ activities and initiatives around campus. In this interactive discussion, scholars from different Tennessee institutions (and/ or who were raised and educated in Tennessee) will discuss how their scholarship and activism has been shaped by, and is helping to inform, LGBT+ policy in Tennessee, and how these lessons might be applied in other state/local contexts. The panelists will speak to a number of questions, including: How can my scholarship inform LGBT+ policy in my state? How do I connect with policymakers, practitioners, and organizations that could benefit from my expertise? How can I contribute to local advocacy efforts, and what might be my appropriate role in those efforts? How do I get involved in this arena at different stages of my career? and How can I help interested students get involved?

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Various methods exist for measuring and analyzing dental wear patterns in mam-mals, and these patterns have been extensively studied in ungulates. Mesowear has proven useful as a method to compare large numbers of individuals, particularly fossil individuals, observe trends through time or between groups, and estimate paleoenvi-ronmental conditions. Levels of attrition (tooth-on-tooth wear) and abrasion (tooth-on-food wear) can be readily compared by observing the shape of the cusp and relative crown height of the tooth. This study uses a modified method of mesowear analysis, examining actual cusp angles of the population of Tapirus polkensis from the Gray Fossil Site, a densely canopied, hickory and oak dominated forest located in Gray, Tennes-see. Crown height and cusp angle were measured for 38 specimens arranged into eruption series from young juveniles to old adults. Results found a strong correlation between eruption series and cusp angle with a steady increase in mean angle as the individuals increase in age. A strong correlation between cusp angle and crown height was also found. Overall, the population showed relatively low wear rates, as would be expected of a forest-dwelling browser. As a mesowear analysis across all age groups for a population has not been conducted before, this study could be useful for measuring relative wear rates at different life stages and could be applied across other com-munities.

The National Flood Insurance Program (NFIP) provides federally-backed insurance for properties in Special Flood Hazard Areas, yet many property owners do not enroll in the program. I compared flood losses and flood insurance enrollment for three Tennessee communities: Chattanooga, Elizabethton and Pigeon Forge, to investigate the relationship between flooding and NFIP enrollment. Normalized flood losses and insurance purchases were cross-correlated using lags of zero through nine years to investigate the relationship between flood losses in one year and NFIP enrollment in subsequent years. The correlation between flood losses and NFIP enrollment is significant (r = 0.39 and 0.42 respectively, p<0.05) in the year in which flood losses occurred for Chattanooga and Elizabethton. In Pigeon Forge, flood losses correlate to NFIP enrollment in the following year (r=0.43, p=0.02).

Background: In the United States, cases of human blastomycosis are largely described in defined geographic areas, with Mississippi reporting the highest prevalence of disease in the southeast region. The infection is uncommonly recognized in mountainous areas, and our previous report of blastomycosis in the southern Appalachian mountains of northeast Tennessee appeared to be an exception to the usual disease distribution. Methods: Our current retrospective study was undertaken to determine whether blastomycosis has persisted as an endemic fungal infection in our northeast Tennessee geographic area and whether epidemiologic features have changed over a 25-year time period. Results: Results show that clinical aspects of the disease have remained fairly constant with few exceptions; mass-type pulmonary lesions have become more common, and itraconazole has emerged as the therapy of choice. Most notably, however, are the observations that blastomycosis persists as a major endemic fungal infection in our mountain region, more than half of all cases occurring during the period from 1996 to 2005 were found in a core area centered on two counties, Washington and Unicoi; three of five counties surrounding the core counties experienced rate increases compared to our previous study. Conclusions: These findings suggest a further expansion of this endemic fungal disease beyond the core region.

BACKGROUND: Little research has been conducted to observe the impact that rural settings have on the structure and function of hospital ethics committees. Additionally, studies need to focus on ethics committees, as it is often the body which protects the values of the community as globalization increases. The purpose of this study is to provide an overview of ethics committees in rural hospitals in East Tennessee. METHODS: From a list of fifteen hospitals in East Tennessee, eleven hospitals in communities of 15,000 people or less were contacted, ten of which had functioning ethics committees. Phone calls were made to identify members of the ethics committee and interviews were set up with nine of the hospitals. A structured interview format was used to address the range of topics. Hospital size ranged from 6 to 230 beds. RESULTS: The most unique trait afforded to small hospital ethics committees was their ability to communicate effectively and efficiently due to their small size. The culture of the area subtly impacted the type of issues the committees faced as did the hospital network affiliation. CONCLUSIONS: While connection to a network provides abundant resources, small hospital size reduces the inefficiency created by the bureaucracy of larger hospitals and enhances communication. Ethics committees in rural hospitals are variably effective and contain a level of organization comparable to that of larger hospitals.

No scale provided. Researched by Dr. Nat E. Hyder and Midred Kozsuch. Cartography and illustration by Alan Park in 1980. Overmountain Press. Indicates mills, forges, and places of interest. / https://dc.etsu.edu/rare-maps/1120/thumbnail.jpg