Misdiagnosis of Clostridioides difficile Infections by Standard-of-Care Specimen Collection and Testing among Hospitalized Adults, Louisville, Kentucky, USA, 2019-20201.

Although Clostridioides difficile infection (CDI) incidence is high in the United States, standard-of-care (SOC) stool collection and testing practices might result in incidence overestimation or underestimation. We conducted diarrhea surveillance among inpatients >50 years of age in Louisville, Kentucky, USA, during October 14, 2019-October 13, 2020; concurrent SOC stool collection and CDI testing occurred independently. A study CDI case was nucleic acid amplification test‒/cytotoxicity neutralization assay‒positive or nucleic acid amplification test‒positive stool in a patient with pseudomembranous colitis. Study incidence was adjusted for hospitalization share and specimen collection rate and, in a sensitivity analysis, for diarrhea cases without study testing. SOC hospitalized CDI incidence was 121/100,000 population/year; study incidence was 154/100,000 population/year and, in sensitivity analysis, 202/100,000 population/year. Of 75 SOC CDI cases, 12 (16.0%) were not study diagnosed; of 109 study CDI cases, 44 (40.4%) were not SOC diagnosed. CDI incidence estimates based on SOC CDI testing are probably underestimated.

Lessons learned from COVID-19: provider suggestions for improving service delivery in sexual violence resource centers and children's advocacy centers in Kentucky

The COVID-19 pandemic has presented unique challenges for human service providers, especially as face-to-face services were limited by both formal and informal efforts to protect public health. Telehealth has emerged as a main strategy to ensure continuity of care. This study explored adaptations to services in child advocacy centers (CACs) and sexual violence resource centers (SVRCs) across the Commonwealth of Kentucky, particularly using telehealth. This study highlights respondents' suggestions about improving these service delivery systems and the particular emphasis on challenges and strengths of telehealth for reaching those in rural areas.

Serving the low-income consumer in a rich economy: Dollar General racks up sales

PurposeThe conceptualization of the Base of Pyramid (BOP) proposes that low-income markets can lead to profitable opportunities for businesses. The purpose of this study is to identify key success factors of a BOP business strategy based on a case study of the discount retailer, Dollar General, in the USA.Design/methodology/approachThe research design used in this research is an in-depth case study of Dollar General in the USA. Qualitative methods are applied in both the primary and secondary data collection and during the follow-on data analysis of Dollar General.FindingsDollar General's strategic profile is achieved through the combination of the following four actions which are tailored to compete effectively at the BOP in the USA: creating the neighborhood discounter, raising aspirational appeal, reducing service and eliminating internationalization.Research limitations/implicationsThe case is specific to Dollar General in a US cultural context.Practical implicationsThe case of Dollar General demonstrates how a discounter retailer should not only follow a low-cost strategy to compete at the BOP. Its ability to craft a distinctive strategy is coherent with meeting the logistical, rational and emotional needs of the low-income consumer in the USA.Social implicationsMany businesses have neglected rural areas of the USA as being unprofitable. The ability for businesses such as Dollar General to serve the BOP segment can foster the socio-economic well-being of communities.Originality/valueThe overwhelming body of the BOP literature is based on emerging markets. To the best of the authors' knowledge, this is one of the few studies to investigate BOP business strategy in the USA.

"Whoever Needs Food We'll Feed Them One Way or the Other": COVID-19 and Food Aid in Appalachian Kentucky

In one eastern Kentucky county, the COVID-19 pandemic and related economic downturn ushered in increases in federal and corporate aid. In response, families with school-aged children distributed excess food to friends and neighbors and donated food back to pantries they had previously utilized. In-depth, semi-structured interviews illuminate how public-private food aid amidst the COVID-19 pandemic was distributed to and within rural Kentucky communities and who was left out. I introduce the concept of networks of care, which comprise local systems of distribution among family, friends, and neighbors that challenge reliance on market labor for subsistence while demanding constant work to maintain. This paper argues that networks of care demonstrate the need and an extent infrastructure for large-scale distributive politics that compensate for this ongoing care work.

Healthcare Providers' Experience Using Telehealth During the Onset of the COVID-19 Pandemic in a Predominantly Rural Patient Base: An Online Survey.

INTRODUCTION: COVID-19 led to the rapid adoption of telemedicine with a significant spike in the literature concerning the patients' perspective of its use. The providers' perspective has been less well studied. Med Center Health is a healthcare network that provides services in 10 southern Kentucky counties that are home to over 300,000 people with approximately 61% of this population living in areas defined as rural. The goal of this article was to compare the experience of providers serving a predominantly rural population to their patients and compare the experience of providers between each other based on the obtained demographic data. METHODS: An online electronic survey was developed and sent out from July 13th, 2020 to July 27th, 2020 for completion to the 176 physicians of the Med Center Health Physician group. The survey gathered basic demographic information, telemedicine use during COVID-19, and perceptions of telemedicine use during and the role of telemedicine after COVID-19. Perceptions of telemedicine were gauged using Likert and Likert-style questions. Cardiology provider responses were compared to the previously published patient responses. Differences between providers were also analyzed based on the demographic data obtained. RESULTS: Fifty-eight providers responded to the survey with nine providers indicating that they did not use telemedicine during COVID-19. Significant differences between eight cardiologists' and cardiology patients' perceptions of telemedicine visits were seen for internet connectivity (p < 0.001), privacy (p = 0.01), and clinical exam (p < 0.001) with cardiologists ranking these as more concerning or worse in all instances. These results continued when comparing perceptions of patients' in-person experience and providers' perception of telemedicine visits with significant differences observed with clinical exam (p < 0.001), communication (p = 0.048), and overall experience (p = 0.02). No statistically significant differences were seen between cardiologists and other providers. Providers who indicated more than 10 years of practice rated their experience with telemedicine significantly lower in the domains of effective communication (p = 0.004), level of care provided (p = 0.02), thoroughness of clinical exam (p = 0.047), patient comfort discussing concerns (p = 0.04), and overall experience (p = 0.048). Despite this, only three providers indicated that they would not use telemedicine post-pandemic with a majority indicating that they would feel comfortable using telemedicine for follow-up visits and medication refill visits. CONCLUSION: This is the first study to our knowledge to compare patient and provider satisfaction concerning telemedicine across a wide array of topics using Likert-style and Likert scale questions and the first to investigate the perception of providers who serve a predominantly rural patient base during the COVID-19 pandemic. Similar results have been found in a few previous studies concerning telemedicine being less favorably rated by more experienced providers. Further studies need to be conducted to identify and correct the barriers that exist for providers and the adoption of telemedicine.

Optimizing the Interdisciplinary Design of Adaptive Platform Trials

Adaptive platform trials (APTs) are often complex clinical trials that, ideally, are well suited to answer the motivating clinical questions effectively and efficiently, with the motivating clinical questions and associated treatment arms expected to evolve over time as evidence accumulates. Recently, APTs have played a pivotal role in informing public health policy by efficiently generating compelling evidence regarding the effectiveness of therapies for COVID-19. For APTs to be maximally effective in informing future public health policy, they must be carefully tailored to address the right clinical questions, with the right balance of size, scope, rigor, and flexibility. The design process requires input from clinical and statistical domain experts and often includes input from trial implementation personnel, ethicists, and patient representatives. The design process is inherently iterative, with proposed designs evaluated through trial simulation, the identification of strengths and weaknesses of the proposed design, and revision by the team to address weaknesses. This iterative design process requires effective communication and collaboration between the statistical and clinical domain experts. This session is intended to present a current best practice in facilitating and enhancing the collaborative design process for APTs, including how best to present simulation-based trial performance to the design team and ensure effective interdisciplinary communication. The speakers have extensive experience in leading the design of APTs across multiple therapeutic areas, in both academic and industry settings. The session will begin with a brief presentation by Dr. Lewis on the basic structure of an APT and the tasks and challenges associated with the multidisciplinary design process. The subsequent discussion will be organized by the following themes: (1) considerations in the selection of the study population and primary outcome metric;(2) selecting treatment domains and factors to be compared;(3) trial simulation and communication of performance metrics to both statistical and non-statistical team members;and (4) defining and calibrating interim decision rules. Each of the 4 panel members will outline a recommended approach to facilitating 1 of the 4 design tasks, with examples drawn from their experience. The remaining time (15 min) will be available for a panel question-and-answer period. At the end of the session, the audience will have an understanding of the general organization of, and a process for facilitating, the design process for an adaptive platform trial. Panel Members Roger J Lewis, MD, PhD, is a Senior Physician in the Los Angeles County Department of Health Services, Professor of Emergency Medicine at the David Geffen School of Medicine at UCLA, and the Senior Medical Scientist at Berry Consultants, LLC, a group that specializes in innovative clinical trial design. He is also the former Chair of the Department of Emergency Medicine at Harbor-UCLA Medical Center. Dr. Lewis' expertise centers on adaptive and Bayesian clinical trials, including platform trials;translational, clinical, health services and outcomes research methodology;data and safety monitoring boards, and the oversight of clinical trials. Dr. Lewis was elected to membership in the National Academy of Medicine in 2009. He has authored or coauthored over 270 original research publications, reviews, editorials, and chapters. Dr. Lewis is a Past President of the Society for Academic Emergency Medicine (SAEM) and served on the Board of Directors for the Society for Clinical Trials. He is a fellow of the American College of Emergency Physicians, the American Statistical Association, and the Society for Clinical Trials. Juliana Tolles, MD, MHS, is an Assistant Professor of Emergency Medicine at the Harbor-UCLA Medical Center and the David Geffen School of Medicine at UCLA, and a Medical and Statistical Scientist at Berry Consultants, LLC. Her academic research interests include emergency medical services, resuscitation medicine, and trau a care. She has authored several reviews for Journal of the American Medical Association (JAMA) on statistical methodology and has lectured nationally on research methodology for the Society for Academic Emergency Medicine Advanced Research Methodology Evaluation and Design (ARMED) course. She is also a co-investigator for the Strategies to Innovate Emergency Clinical Care Trials (SIREN) network Southern California site. Kert Viele, PhD, is a Director and Senior Statistical Scientist with Berry Consultants, where he leads Berry Consultants' research enterprise. He is a leader in clinical trial implementation of Bayesian hierarchical modeling, with expertise in platform and basket trials as well as clinical trials incorporating the use of historical information. Prior to joining Berry Consultants in 2010, he was a faculty member at the University of Kentucky, where he received the Provost's Award for Outstanding Teaching and was an investigator for NSF and NIH-funded research. He has developed over 100 custom Bayesian adaptive clinical trials for clients in industry, government, and academia, and currently serves on several data safety monitoring boards for randomized clinical trials. A former editor of the journal Bayesian Analysis, Dr. Viele is also an author of FACTS (Fixed and Adaptive Clinical Trial Simulator), clinical trial simulation software currently licensed to multiple pharmaceutical, academic, and government organizations. William Meurer, MD, MS, is an Associate Professor of Emergency Medicine and Neurology at the University of Michigan Health System. In addition, he serves as a Medical and Statistical Scientist for Berry Consultants, LLC. He works to improve the care of patients with acute neurological disease both through his work on the acute stroke team and as a researcher. His work in the field focuses on the design of clinical trials with adaptive and flexible components. In addition, he is a principal investigator of the National Institutes of Neurological Disorders and Stroke (NINDS) Clinical Trials Methodology Course (http:// neurotrials.training) and a co-investigator in the clinical coordinating center of the Strategies to Innovate Emergency Care Clinical Trials (SIREN) network- also funded by NIH). He was a co-investigator on the Adaptive Designs Accelerating Promising Treatments into Trials (ADAPT-IT) project, as part of the FDA Advancing Regulatory Science initiative with NIH.

The Impact of the COVID-19 Pandemic on Citizens' Attitudes and Behaviors in the Use of Peri-Urban Forests: An Experience from Italy

Peri-urban forests are complex systems capable of providing amenity and scenic values as well as recreational opportunities for citizens. From early 2020, national governments have promulgated restrictions, requiring citizens to adopt a new lifestyle to counter the COVID-19 outbreak. This study aimed to understand if citizens' behaviors and attitudes in the use of peri-urban forests are changing due to COVID-19 restrictions. Methodologically, a questionnaire survey was carried out, adopting a systematic sampling method. Two peri-urban forests were chosen as study areas: the first one was close to the town of Trento in the Alps (Monte Marzola), and the second one was in the proximity of the city of Florence (Monte Morello). At the end of data collection, 281 questionnaires were collected and processed. The results showed an increase in visits to peri-urban forests during the COVID-19 pandemic (36.4% of visitors in Monte Marzola and 17.1% in Monte Morello, respectively) with the aim of satisfying the need for relaxation and contact with nature. However, the use of peri-urban forests in times of crisis has been quite different in the two contexts: the visitors of Monte Marzola evidenced the role of a forest as a place where they can satisfy their need to play sports (mean value 4.53 in a five-point Likert scale), while Monte Morello forest was considered by visitors to be a place where the demand for companionship was fulfilled (mean value 4.27). © 2023 by the authors.

SARS-CoV-2 RNA abundance in wastewater as a function of distinct urban sewershed size

During the COVID-19 pandemic, wastewater-based epidemiology has emerged as a promising approach for monitoring SARS-CoV-2 prevalence on a community-level. Despite much being known about the utility of making these measurements in large wastewater treatment plants, little is known about the correlation with finer geographic resolution, such as those obtained through sewershed sub-area catchments. This study aims to identify community wastewater surveillance characteristics between sewershed areas that affect the strength of the association of SARS-CoV-2 RNA detection in a metropolitan area. For this, wastewater from 17 sewershed areas were sampled in Louisville/Jefferson County, Kentucky (USA), from August 2020 to April 2021 (N = 727), which covered approximately 97% of the county's households. Solids were collected from the treatment plants from November 2020 to December 2020 (N = 42). Our results indicate that the sewersheds differ in SARS-CoV-2 trends;however, high pairwise correlation spatial trends were not observed, and the mean SARS-CoV-2 RNA concentrations of smaller upstream community sewershed areas did not differ from their respective treatment centers. Solid samples could only be collected at treatment plants, therefore not allowing us to evaluate SARS-CoV-2 abundance as a function of the sewershed scale. The population size sensitivity of SARS-CoV-2 concentration detection is non-linear: at low population levels the measures are either too sensitive and generate a high level of variability, or at high population levels the estimates are dampened making small changes in community infection levels more difficult to discern. Our results suggest selecting sampling sites that include a wide population range. This study and its findings may inform other system-wide strategies for sampling wastewater for estimating non-SARS-CoV-2 targets.

What do patients with asthma want to know? Google Trends insights into U.S. general population interest between 2004 and 2022 can help structure patient education initiatives

Rationale: The aim of this study is to use the research tool Google Trends to analyze U.S. general population interest in asthma. Methods: The research tool Google Trends (trends.google.com) was used to access data sets for the searched term "asthma” between 2004 and 2022 (English language, U.S. location). Data were normalized and adjusted to make comparisons between search terms substantiated. Each data point was divided by the total searches of the geography and time range it represented. Results: Searches for asthma detected have remained stable in terms of volume between 2004 and 2022 apart from a spike during February-May 2020 which corresponded with one of the peaks of the COVID pandemic. Top 5 states for asthma searches in 2022 were Kentucky, Tennessee, Connecticut, Mississippi, Maryland. The list of the top states is dynamic and has changed since 2004.Top search terms in the U.S. in 2022 were: allergy, allergy asthma, asthma and allergy, asthma symptoms, asthma attack. Searches for allergy have consistently been present in the top 5 terms when patients searched for asthma during the last 18 years, between 2004 and 2022. Conclusions: Asthma-related Google searches reveal topics of high interest that could supplement the understanding about general population interest. Searches for allergy have consistently been present in the top 5 terms when patients searched for asthma during the last 18 years, emphasizing the role of allergists/immunologists in asthma care. Knowledge of variability in search patterns and specific topics could help allergy organizations and practicing allergists focus their educational programs towards patients' interests.

Using Case Method to Address Equity-Related Gaps in Principal Aspirants' Learning Experiences

Case method as an andragogical approach connects theory and practice in numerous fields: law, medicine, business, and education. With the recent COVID-19 pandemic and lockdowns faced by public schools, higher education institutions faced challenges in how to address learning that had previously occurred within field experiences. The authors, working in the field of educator preparation, were able to shift some learning from field experiences to case method. With this shift, they were able to purposefully address issues of equity that students inconsistently encountered through field experiences. This self-study focuses on the implementation of a case study that had been previously published in a peer-reviewed journal by the authors. This case study became part of the culminating assessment for a course in the principal preparation program. Student responses indicated that case method instruction offered an opportunity to consider decisions involving equity in a low stake environment.

Burnout and Well-Being of Triple Board and Post Pediatric Portal Alumni

Objectives: The first graduates from the integrated Pediatrics, Adult Psychiatry, and Child and Adolescent Psychiatry, or Triple Board (TB), began their careers in 1991. The last survey of career outcomes occurred in 2009. Since that time, another pathway to child and adolescent psychiatry was developed, the Post Pediatric Portal Program (PPPP). We surveyed TB and PPPP graduates regarding their satisfaction with their training, current burnout, and wellness. Method(s): Participants were invited to participate via email snowball recruitment. Validated surveys measured both burnout and well-being, including the Oldenburg Burnout Inventory (OLBI) and the Psychological Well-Being (SPARQ) Scale. Participants were also asked about their professional satisfaction and demographics. All study protocols were reviewed and approved by the University of Kentucky IRB. Result(s): There were 104 eligible participants who completed the survey between September and December 2021. Most respondents (56.7%) were under age 44 years;70.2% identified as male, 76.9% were White, and 6.7% were PPPP graduates. Ninety-eight percent reported satisfaction with their decision to train in TB or PPPP. Mean burnout was 2.4 on a scale of 1 to 4. Mean psychological well-being was 6.0 on a scale of 1 to 7. There was a significant and negative correlation between well-being and burnout. Females experienced a significantly higher level of burnout than males. Individuals aged 25 to 44 years reported a significantly higher level of burnout than those aged 45 to 74. Conclusion(s): The majority of graduates report satisfaction with their training in TB or PPPP and high levels of well-being. Burnout among TB and PPPP graduates is similar to those of other specialties, including that women and younger physicians have higher burnout. Limitations include the sample size and low representation from PPPP graduates, although it is currently unknown how many TB/PPPP graduates there are in the United States. Recruitment was limited to email and word of mouth, which may not reflect TB or PPPP graduates as a whole. This is also a cross-sectional sample at 1 time point during the COVID-19 pandemic, which may have impacted burnout. Future studies may compare the rates of burnout, well-being, and satisfaction with those of other specialties, especially categorical psychiatry and pediatrics. AC, WL, CAD Copyright © 2022

Surgical Technologist Apprentice Program: An Innovative Approach to Improve Staffing: The Official Voice of Perioperative Nursing

Along with surgeons, anesthesia professionals, and RN circulators, surgical technologists are essential members of the perioperative team. Despite a partnership with a local community college that offered a surgical technologist degree program, Norton Healthcare in Louisville, Kentucky, continued to experience a shortage of surgical technologists. To meet demands, the clinical educators at the facility developed an in-house Surgical Technologist Apprentice Program (STAP). The STAP consists of six weeks of didactic learning and hands-on training in an OR simulation laboratory, followed by a six-month preceptorship in the OR. This program has proven invaluable, particularly as the COVID-19 pandemic increased the need for personnel who are not only skilled in the OR but also can provide essential frontline patient care when needed. Together, the STAP and the college partnership offer a career-building opportunity for those in entry-level positions who may not otherwise be able to afford to train for this specialized role.

An Overview of Legal Issues and Regulations Affecting CBD-Based Franchise Systems

[...]in Oregon and Florida, consumers can purchase CBD in their coffee.2 Following declassification of hemp as a Schedule I drug, a recent Gallup poll found that one in seven Americans use hemp-derived CBD products (although CBD derived from marijuana is still illegal under federal law and will not be addressed here). "3 CBD products are available at a variety of mainstream retailers including CVS, Walgreens, GNC, Kroger, Ulta Beauty, Abercrombie & Fitch, and American Eagle Outfitters.4 Industry research firms estimate that by 2024, CBD sales will exceed twenty billion dollars in the United States.5 Another study projects a twenty-five percent compound annual growth rate in the CBD edible market between 2020 and 2027.6 Many consumers rely on CBD to treat anxiety, pain, and insomnia.7 Other common usages include over-the-counter treatment for depression, muscle contractions, skin conditions, and digestive concerns.8 A third of pet owners have purchased CBD-infused treats, food, or other items for their cats and dogs, and purchases of CBD pet products are rapidly increasing as pet owners begin to return to the office following the nationwide lifting of COVID-19 restrictions.9 Considering this clear market demand and the likelihood that states will continue to ease restrictions on sale of CBD and other hemp-derived related products, franchisors may find entering the CBD market an irresistible opportunity-either through creating a new franchised system that primarily sells CBD products or by adding them as a new or additional product line in an existing system. [...]Section IV addresses many of the unique challenges associated with franchises selling CBD and proposes best practices for both franchisors and franchisees. "25 Guy believed a cannabis product with low levels of THC but high levels of CBD would be appealing for these users.26 By the late 1990s, several Northern California cannabis growers were cultivating high CBD/low THC strains and distributing both the seeds and their research about its effects at marijuana shops and fairs on the West Coast.27 In 2010, a group of medical marijuana researchers and cannabis growers founded Project CBD, a nonprofit corporation with the goal of collecting and promoting medical research regarding the benefits of CBD.28 In August 2013, CNN aired Dr. Sanjay Gupta's documentary Weed, which contained a segment describing the successful use of a CBD oil developed by the Stanley Brothers, called "Charlotte's Web," to reduce seizures in fiveyear old Charlotte Figi.29 After the segment, the wait list for the oil grew to 15,000 people, families moved to Colorado with the hope of using the oil, and the Food and Drug Administration fast-tracked trials of GW Pharmaceutical's CBD-based medication, Epidiolex.30 Popular culture acceptance and demand for CBD has continued to increase in the last decade.

INTRODUCTION FROM THE EDITORIAL TEAM

The American South has the highest rate of COVID-19 mortality relating to "unhealthy lifestyle behaviors" that persist in this region, especially among the areas where historically marginalized populations are concentrated (e.g., https://www.cdc.gov/physicalactivity/physical -activity-and-COVID-19.html,<https://www.cdc.gov/physicalactivity/data/inactivity -prevalence-maps/index.html>). Schmitz and McCreary evaluate the influence of the U.S. Army Corps of Engineers in the Apalachicola-Chattahoochee-Flint (ACF) river basin regarding the Florida v. Georgia Supreme Court case. [...]the authors note that the Florida v. Georgia case provides insight for others, particularly geographers, studying the ACF river basin or other transboundary river basins from either analytical or political perspectives.

Mitigating an Infodemic: Can The Professions Still Regulate Themselves?

[...]the World Health Organization (WHO) defines infodemic as "too much information including false or misleading information in digital and physical environments during a disease outbreak. While there are several resources with statistics related to mortality and morbidity, various issues, such as a lack of testing, raise questions about the reliability of these numbers. Dr. Paul is licensed in Kentucky and Dr. Oz is licensed in New York. Because of their notoriety, their comments are reported across many of the better-known news organizations. [...]the following quote is taken from the Mission Statement on the web site: "We The People with independent information from the world's top experts in medicine and law, so you can be empowered with facts, protect your health, and .."

Survey of State Laws Governing Fees Associated With Late Payment of Rent

The information used in developing this survey was obtained through an exhaustive review of each state's relevant statute and court rules, as well as a thorough review of appellate court opinions interpreting a relevant statute or providing guidance in the absence of statutory directive. In most instances, tenants are provided the lease on a take-it-or-leave-it basis with no opportunity to negotiate any of its terms, including provisions related to late fees.1 States that impose late fee maximums vary greatly on the amount and form of the limitation. In most of these states, the reasonableness requirement is established by courts rather than through legislation. * Arizona: For residential tenancies, it is implied within its eviction statutes that late fees must be reasonable. * California: Must be reasonably related to costs the landlord faces as a result of rent being late. * Connecticut: Fees must bear a reasonable relationship to the actual damage that the landlord sustains, and the court may void if excessive. * Illinois: Must be a reasonable forecast of damage caused by the breach. * Kentucky: Must be reasonable;$20 or 20 percent of the rental fee for each month is deemed reasonable. * Ohio: Must be reasonable in proportion to the rental rate and have a rational basis supporting the imposition of the charge. * Oklahoma: Must be reasonably related to actual costs incurred. * Pennsylvania: Late fees must be reasonable. * Texas: Must be reasonable;presumed reasonable if not more than 12 percent of the amount of rent for a dwelling located in a structure that contains no more than four units or 10 percent for a structure that contains more than four units. * Vermont: Late fee allowed if reasonably related to costs incurred. * Washington: Presumably must be reasonable. * West Virginia: Presumably must be reasonable. Most of these moratoriums were expired as of the date of the initial publication of this survey. * California: Renters who have submitted a declaration of COVID-19-related financial distress cannot be charged a late fee for the late payment of rental payments (no expiration date). * Colorado: Executive order prohibited landlords and lenders from charging late fees for any rent incurred between May 1, 2020, and April 27, 2021, due to the pandemic (expired). * Connecticut: Executive order 7X granted tenants an automatic 60-day grace period for April 2020 rent and made a 60-day grace period for May 2020 rent available upon request.

SURFACE TENSION-MEDIATED PROCESSING OF WASTEWATER SAMPLES FOR SARS-CoV-2

Wastewater testing for SARS-CoV-2 has emerged as a promising tool for disease surveillance in aggregate populations. We present a novel method to rapidly extract, concentrate, and amplify viral RNA from wastewater using Exclusion-based Sample Preparation (ESP) and RT-PCR. This technology identified potential outbreaks of SARS-CoV-2 at University of Kentucky dormitories, resulting in targeted clinical testing and quarantine procedures. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.

Impact of COVID-19 Pandemic Healthcare Restrictions on Utilization and Diagnostic Yield of Outpatient Transthoracic Echocardiograms

Background: In 2014, appropriate use criteria (AUC) were introduced for initial outpatient pediatric transthoracic echocardiograms (TTEs). These criteria classified common indications for echocardiograms as appropriate (A), may be appropriate (M), and rarely appropriate (R). In 2020, a subsequent AUC guideline provided further direction regarding utilization of TTE in longitudinal follow-up of congenital heart disease (CHD). In response to the COVID-19 pandemic, a Kentucky executive order prohibited elective medical procedures from 3/18/2020-4/27/2020. Simultaneously, the American Society of Echocardiography recommended limiting rarely appropriate studies. Our primary objective was to determine if the cessation of elective medical procedures in Kentucky during the COVID-19 pandemic resulted in a decrease in the proportion of rarely appropriate outpatient TTEs interpreted at the open echocardiography lab at Norton Children's Hospital. Differences in appropriateness of echocardiogram orders by provider type were evaluated, and diagnostic yield of outpatient pediatric TTEs prior to and during this time period were compared. Methods: A retrospective chart review was conducted comparing proportions of rarely appropriate outpatient pediatric TTEs performed pre-COVID (3/21/2019-4/28/2019) and during COVID (3/19/2020-4/27/2020). All outpatient TTEs interpreted at our institution performed on subjects <=18yrs of age in Kentucky facilities during the relevant time periods were eligible for inclusion. Studies performed outside of Kentucky were excluded. TTE indication was determined by chart review and echocardiogram reports. Appropriateness of indication was evaluated using pediatric AUC guidelines for initial outpatient TTE or CHD follow-up. Variables collected included study date, indication, findings, referring provider type, and prior known cardiac diagnosis when relevant. The statistical analyses used for the data consisted of descriptive, bivariate, and logistic regression modeling. Results: Of 767 TTEs reviewed, 486 met inclusion criteria: 364 pre-COVID vs. 122 during COVID. TTE indication was classifiable in 354 (72.8%) of studies. Of TTEs preCOVID, 100 (37.7%) were rarely appropriate vs. 18 (20.2%) during COVID (p=0.002, Table 1.) Pediatric cardiologists tended to order fewer rarely appropriate TTEs than pediatricians pre-COVID (35.9% vs. 46.4%), although this difference was not statistically significant. Cardiologists ordered the majority of outpatient TTEs during COVID (77/89 TTEs, 86.5%), limiting the ability to compare TTE indications by provider type. There was no significant difference in diagnostic yield of initial outpatient TTEs with 32 (8.9%) abnormal studies pre-COVID vs. 12 (10.9%) during COVID (p=0.574, Figure 1). Conclusion: The executive order prohibiting elective procedures during the COVID-19 pandemic in Kentucky resulted in a decrease in the proportion of rarely appropriate outpatient pediatric TTEs. There was no significant difference in diagnostic yield of initial outpatient TTEs between time periods, suggesting that clinically significant echocardiogram findings were still detected despite more prudent utilization of echocardiography during this time. Diagnostic yield classification of initial outpatient pediatric transthoracic echocardiograms (TTEs) performed pre-COVID and during COVID elective procedure restrictions at Norton Children's Hospital.

Assessing the Intention, Attitudes, and Social Influences on COVID-19 Preventive Behaviors Among Non-rural Black and Rural Appalachian White Populations: A Faith-Based Community Study

Introduction: The COVID-19 pandemic has had detrimental impacts in non-rural Black and rural Appalachian populations. Yet despite the pandemic’s magnitude, there is a scarcity of research exploring potential influences of attitudes and social influences within these populations on their adherence to COVID-19 public health preventive behaviors. Purpose: This study examines the intention, attitudes, and social influences to adhere to COVID-19 preventive behaviors among non-rural Black and rural Appalachian congregants in Kentucky by integrating the Theory of Planned Behavior (TPB). Methods: Secondary analysis of cross-sectional data was used to assess the association between the TPB constructs and four key public health behaviors: obeying a stay-at-home order, social distancing, good hygiene practices, and wearing a mask in public. Generalized estimating equation-type logistic regression models were fit for all binary outcomes. Results: A total of 942 respondents completed the survey. Eighty-nine per cent were older than 36 years, and 73% were female. Of the respondents who were White, 97.7% lived in rural Appalachia Kentucky, and of those who were Black, 93.5% lived in non-rural Kentucky. Attitude towards the behavior was negatively associated with the stay-at-home order (p=0.003). Both attitude toward the behavior (p<0.001) and the subjective norm (p=0.025) were negatively associated with mask wearing. Perceived behavioral control was positively associated with mask wearing (p=0.023) with non-rural respondents more likely to wear a mask than rural ones (p<0.001). None of the TPB constructs showed significant association with hygiene practices or with social distancing. Implications: This study provides further insight into the cultural and societal influences that intersect during a global pandemic. The intention to comply with public health recommendations may vary at favorable and unfavorable levels. The results lend support to the importance of designing effective, culturally tailored communication for future public health preparedness.

SARS-CoV-2 (COVID-19) Vaccine Intentions in Kentucky

Background: At the time of our writing, the COVID-19 pandemic continues to cause significant disruption to daily lives. In Kentucky, the burdens from this disease are higher, and vaccination rates for COVID-19 are lower, in comparison to the U.S. as a whole. Understanding vaccine intentions across key subpopulations is critical to increasing vaccination rates. Purpose: This study explores COVID-19 vaccine intentions in Kentucky across demographic subpopulations and also investigates the influences on vaccine intention of attitudes and beliefs about COVID-19. Methods: A population-based survey of 1,459 Kentucky adults was conducted between January 26 and March 20, 2021, with over-sampling of black/African American and Latino/a residents, using online and telephonic modalities. Descriptive statistics characterize the sample and overall vaccine intentions and beliefs. Multivariable linear regression models probed relationships between demographics and vaccination intentions, as well as relationships between vaccination beliefs and vaccination intention. Results: Of the 1,299 unvaccinated respondents, 53% reported intent to get vaccinated, 16% had not decided, and 31% felt they would not get vaccinated. Lower vaccination intention was independently associated with age, lower educational attainment, black/African American race, lower income, Republican political affiliation, rural residence, and several beliefs: low vaccine safety, low vaccine efficacy, the rapidity of vaccine development, and mistrust of vaccine producers. Implications: Increasing COVID-19 vaccination rates will help end this pandemic. Findings from this study can be used to tailor information campaigns aimed at helping individuals make informed decisions about COVID-19 vaccination.