A qualitative study on pharmacy policies toward over-the-counter syringe sales in a rural epicenter of US drug-related epidemics

Background Expanding access to sterile syringes in rural areas is vital, as injection-related epidemics expand beyond metropolitan areas globally. While pharmacies have potential to be an easily accessible source of sterile syringes, research in cities has identified moral, legal and ethical barriers that preclude over-the-counter (OTC) sales to people who inject drugs (PWID). The current study builds on prior urban-based research by elucidating (1) pharmacy OTC policies and (2) pharmacists’ rationale for, and barriers and facilitators to, OTC syringe sales in a US rural area hard hit by drug-related epidemics. Methods We conducted 14 semi-structured interviews with pharmacists recruited from two Eastern Kentucky health districts. Interview domains included experiences with, and attitudes toward, selling OTC syringes to PWID. Constructivist grounded theory methods were used to analyze verbatim transcripts. Results Most pharmacists operated “restrictive OTC” pharmacies (n = 8), where patients were required to have a prescription or proof of medical need to purchase a syringe. The remainder (n = 6) operated “open OTC” pharmacies, which allowed OTC syringe sales to most patients. Both groups believed their pharmacy policies protected their community and pharmacy from further drug-related harm, but diverging policies emerged because of stigma toward PWID, perceptions of Kentucky law, and belief OTC syringe sales were harmful rather than protective to the community. Conclusion Our results suggest that restrictive OTC pharmacy policies are rooted in stigmatizing views of PWID. Anti-stigma education about substance use disorder (SUD), human immunodeficiency virus (HIV), and Hepatitis C (HCV) is likely needed to truly shift restrictive pharmacy policy.

Diet of the southern ravine salamander Plethodon richmondi

The diets of many small North American Plethodon species are poorly studied despite their important roles in forest ecosystems. Using a non lethal gastric lavage method, we examined the spring-season diet of 31 southern ravine salamanders (Plethodon richmondi) from a second-growth forest in south-eastern Kentucky (USA). We recovered and identified a total of 452 prey items from 14 different prey groups. The three most important prey groups were Formicidae (ants), Acari (mites and ticks), and Collembola (springtails). Together, these groups accounted for more than 80 % of all prey items. Examining the diets of terrestrial salamanders may help us better understand their roles in the regulation of invertebrate communities and the transfer of accessible nutrients back to the soil.

Eastern Kentucky and Northwestern Virginia, 1861–1862

From May 1861 through 1862, Appalachian eastern Kentucky and northwestern Virginia stood at the forefront of many decisions by the governments of the United States and the Confederate States. These regions, with their topographical challenges, provided the perfect cover for guerrilla activity. Poor roads and isolated communities holding populaces with divided loyalties encouraged small-unit tactics. The contest for northwestern Virginia grew out of the want of control of the Baltimore and Ohio Railroad. Quick and sharp, the war in northwestern Virginia ultimately resulted in the formation of a new Union state. It provided the fields for many important figures who would grow to prominence in the coming war, including Gen. Robert E. Lee and Maj. Gen. George B. McClellan. In eastern Kentucky, the armies competed for the important road connecting the Cumberland Gap to the Bluegrass region. The Battle of Mill Springs settled the question of who would control the region.

First Records of Freckled Madtom (Noturus nocturnus) in Ohio, USA

Two new Ohio localities for the Freckled Madtom (Noturus nocturnus Jordan and Gilbert, 1886) were recently discovered. These are the first, and currently only, Freckled Madtom collected in Ohio waters. A single individual was collected in the Scioto River in Scioto County by the Midwest Biodiversity Institute (MBI) and a previously misidentified specimen was collected in the Ohio River at the Hannibal Locks and Dam by the Ohio River Valley Water Sanitation Commission (ORSANCO). The closest historical records are from the Little Sandy River and Big Sandy River drainages in eastern Kentucky. Other Ohio River collections have been made near the border of Kentucky and Indiana. The origins of the recent Ohio specimens are unknown; whether they emanate from other known populations or have been overlooked altogether is unclear.

Development of Mine Soils in a Chronosequence of Forestry-Reclaimed Sites in Eastern Kentucky

Surface mining for coal has contributed to widespread deforestation and soil loss in coal mining regions around the world, and particularly in Appalachia, USA. Mined land reforestation is of interest in this and other regions where forests are the dominant pre-mining land use. This study evaluated mine soil development on surface-mined sites reforested according to the Forestry Reclamation Approach, representing a chronosequence of time ranging from 0 to 19 years after reclamation. Soils were sampled in depth increments to 50 cm and analyzed for a suite of soil physical and chemical characteristics. Overall, soil fines (silt + clay) tended to increase over time since reclamation (17% silt at year 0 increasing to 35% at year 11; 3.2% clay at year 0 increasing to 5.7% at year 14) while concentrations of metals (e.g., Al, Mg, Mn, Na) demonstrated varied relationships with time since reclamation. Concentrations of organic carbon (OC) tended to increase with time (0.9% OC at year 0 increasing to 2.3% at year 14), and were most enriched in near-surface soils. Some soil characteristics (e.g., Na, OC, Ca) demonstrated patterns of increasing similarity to the forest control, while others were distinct from the forest control throughout the chronosequence (e.g., Al, clay, Mn, gravel). Future surveys of these soils over time will elucidate longer-term patterns in soil development, and better characterize the time scales over which these soils might be expected to approximate forest soil conditions.