The Rising Epidemic of Mass Shootings in the US and Its Association with Gun Legislation, Laws, and Sales

Introduction: Mass shootings pose a considerable threat to public safety. This study aims to (1) assess US mass shootings, firearm-related sales, laws, and regional differences from 2015-2021 and (2) investigate changes in mass shootings and firearm sales before and during the Coronavirus Disease 2019 (COVID-19) pandemic. Method(s): A retrospective review of mass shootings, gun sales, and laws regarding the minimum age required to purchase a firearm within the US from 2015-2021. The 10 states/regions with the greatest mean mass shootings/capita from 2015-2021 were selected for further analysis. Result(s): Mass shootings correlated significantly with firearm sales from 2015-2021 nationwide (p< 0.02 for all). The growth in mass shootings, the number killed/injured, and gun sales were greater in 2020 and 2021 compared withthe years prior. The 10 states with the highest mean mass shooting/capita over the study period were Alabama, Arkansas, the District of Columbia, Illinois, Louisiana, Maryland, Mississippi, Missouri, South Carolina, and Tennessee. No significant correlation was found between the number of mass shootings/capita and the minimum age to purchase a firearm. Conclusion(s): Firearm sales correlated significantly with mass shootings from 2015-2021. Mass shootings and gun sales increased at greater rates during the COVID-19 pandemic compared withthe years before the pandemic. Mass shootings exhibited inconsistent trends with state gun laws regarding the minimum age to purchase a firearm. Future studies may consider investigating the methods by which firearms used in mass shootings are obtained to further identify targets for prevention.

Which Telehealth Features Matter Most? Ranking Results from HIV Care Providers and Patients Living with HIV in South Carolina

Objectives: During the COVID-19 pandemic, telehealth was rapidly implemented to mitigate disruptions in HIV care services. However, participation in and benefits from telehealth were not distributed equally among people living with HIV (PWH). The acceptability of alternative telehealth options in HIV care remains understudied. This study aims to assess the relative importance of telehealth features among HIV care providers and PWH. Method(s): We compiled a comprehensive list of 21 telehealth features from the literature and formative research. Telehealth features were grouped into four domains with 4-6 features each: administrative (5), technology (6), visit-related (6), and other (4) features. 22 purposively selected participants (10 HIV care providers, 12 PWH) from South Carolina were asked to rank these features within domains and the domains themselves according to their perceived relative importance. Ranking data was analyzed through count analysis. Result(s): Domain rankings indicated that visit-related features such as a prior relationship with the provider and multidisciplinary virtual visits were most important. Administrative features such as scheduling modalities (e.g., virtual walk-in options) and the waiting time for an appointment were second most important, followed by technological features such as the type of provider (artificial intelligence vs. human provider) and type of telehealth (video, voice-only, or email). Other features such as the availability of technical support and the location where telehealth visits take place were least important to our participants. Across telehealth features, the relationship to the provider was most often ranked first (14 out of 22 participants) followed by out-of-pocket cost (9 out of 22 participants). Conclusion(s): Our findings highlight the importance of visit-related and administrative features of telehealth. A pre-existing relationship with the telehealth provider was particularly important to many providers and patient participants. Findings may inform telehealth HIV care options to meet the needs of PWH and HIV care providers.Copyright © 2023

DOAK 2023 / German-Austrian AIDS Conference

The proceedings contain 115 papers. The topics discussed include: prevention and health promotion regarding sexual transmitted infections among university students in Germany;sexual risk behavior and condom use among Arab men tourists in Pattaya, Thailand;prevalence of individuals with risk for severe COVID-19 in whom ritonavir-containing therapies are contraindicated or may lead to interactions with concomitant medications;therapy adjustment using proviral DNA information among multi-class resistant HIV-1 infected and ART-experienced patients;are we on track to reach the WHO elimination goals for viral hepatitis among HIV+-individuals? updates on HBV prevalence and incidence, 1996-2019;telehealth or in-person HIV care? care continuity drove the decision process during the COVID-19 pandemic. results from a qualitative study in South Carolina;high burden of human papilloma virus infection in people living with HIV;and safety and effectiveness outcomes from the CARISEL study: Phase 3b hybrid-3 implementation study integrating CAB+RPV LA Into European clinical settings.

COVID-19 Testing Practices, Preventive Behaviors, and Factors Associated With Test Positivity: Population-Based Statewide Survey Study.

BACKGROUND: The COVID-19 pandemic has challenged public health efforts globally. Timely population-based surveillance is crucial to support public health programs and policies to limit the spread of COVID-19. The South Carolina (SC) Sampling and Testing Representative Outreach for Novel Coronavirus Guidance (SC STRONG) statewide initiative was established to estimate population-level prevalence and immunity and characterize the transmission dynamics of SARS-CoV-2 using community testing and online surveys. OBJECTIVE: This paper aimed to leverage the survey data collected as part of the initiative to understand risk perceptions, testing practices, and preventive behaviors and identify risk factors for COVID-19 test positivity in SC over time. METHODS: Probability proportionate to size cluster random sampling was used to select SC residents to participate in testing for COVID-19 infection and antibodies and to complete an online survey. This paper focuses on data from the online surveys completed between November 2020 and June 2021. Descriptive statistics were used to describe risk perceptions, attitudes and behaviors, and associated changes over time. Univariate and multivariate logistic regression models were used to identify factors associated with self-reported COVID-19 test positivity. RESULTS: Among the 7170 online survey respondents, 58.7% (4213/7170) self-reported ever testing for COVID-19. The most commonly cited barriers to testing were inconvenient dates, time, and location, as well as discomfort. Overall, 18.7% (790/7170) of respondents reported a history of COVID-19 test positivity. Multivariate logistic regression results indicated that individuals who were aged 50 years or older, self-identified as Black/African American, were obese, and were employed as frontline health care workers or nursing home staff were more likely to self-report COVID-19 test positivity. By contrast, there was a decreased likelihood of test positivity among respondents who were concerned about the burden of COVID-19 in their community and about being infected. CONCLUSIONS: Strategies to remove testing barriers should be implemented to improve access. Our findings provide insights on statewide testing patterns, adoption of prevention behaviors, and risk factors for infection and may inform public health strategies to curb transmission.

A Review of COVID-19 Extracorporeal Membrane Oxygenation Transport

Introduction: Use of extracorporeal membrane oxygenation (ECMO) has been a transport standard of care for cardiovascular and pulmonary compromised patients. However, implementation and associated outcomes for unstable patients diagnosed with SARS-COV-2 infection has not been documented. Method(s): A retrospective chart review was performed examining ECMO transports of patients with SARS-COV-2 infection from April 2020- October 2021 involving one healthcare transport program. Variables of interest included: pH pre-post cannulation, BMI, pre-existing health conditions, medications utilized, and health outcomes. Descriptive statistics was used to analyze the data. Result(s): 21 transports were completed involving North Carolina and South Carolina referral facilities: 15 ground ambulance and 6 EC-145 rotor wing aircraft. All patients were cannulated at outside hospitals, with 2 performed by the transport team. While there were no complications during transport, trends illustrated those patients persistently acidotic (pH< 7.35) after ECMO cannulation were more likely to die.8 of the 10 patients who died had persistently low pH, versus the survivors where only 3 of 11 had persistently low pH after cannulation. This was a statistically significant difference in survival outcomes for those with sustained normal pH after cannulation, p=0.03. BMI had no statistically significant influence on outcomes, p=0.08. Conclusion(s): Transportof patients on ECMO with SARS-COV-2 virus infection is safe and effective with a specialty transport team. The significance between post-ECMO cannulation pH and patient outcomes requires further examination which may aid in patient management.Copyright © 2022

Revealing geographic transmission pattern of COVID-19 using neighborhood-level simulation with human mobility data and SEIR model: A case study of South Carolina.

Direct human physical contact accelerates COVID-19 transmission. Smartphone mobility data has emerged as a valuable data source for revealing fine-grained human mobility, which can be used to estimate the intensity of physical contact surrounding different locations. Our study applied smartphone mobility data to simulate the second wave spreading of COVID-19 in January 2021 in three major metropolitan statistical areas (Columbia, Greenville, and Charleston) in South Carolina, United States. Based on the simulation, the number of historical county-level COVID-19 cases was allocated to neighborhoods (Census block groups) and points of interest (POIs), and the transmission rate of each allocated place was estimated. The result reveals that the COVID-19 infections during the study period mainly occurred in neighborhoods (86%), and the number is approximately proportional to the neighborhood's population. Restaurants and elementary and secondary schools contributed more COVID-19 infections than other POI categories. The simulation results for the coastal tourism Charleston area show high transmission rates in POIs related to travel and leisure activities. The results suggest that neighborhood-level infectious controlling measures are critical in reducing COVID-19 infections. We also found that households of lower socioeconomic status may be an umbrella against infection due to fewer visits to places such as malls and restaurants associated with their low financial status. Control measures should be tailored to different geographic locations since transmission rates and infection counts of POI categories vary among metropolitan areas.

165. Prevalence and Sociodemographic Correlates of Suicidality Among Sexual and Gender Minority Youth Residing in the South

Purpose: Rates of suicidal ideation and attempts among adolescents, especially young sexual and gender minority (SGM) adolescents, have been on the rise over the last several years. The COVID-19 pandemic has only exacerbated risk factors for suicidality and introduced additional barriers to accessing needed medical care and other help-seeking resources. This study sought to estimate the prevalence of suicidal thoughts, plans, and attempts among young SGM adolescents residing in the South, a geographic region with high unmet health needs, greater multi-level experiences of discrimination, and a hostile policy landscape marked by numerous anti-LGBTQ bills and few protections on the basis of sexual and gender identity. Methods: Tailored social media advertising was used between July 2021 and April 2022 to recruit and enroll 384 SGM adolescents aged 13-17 years residing in eight southeastern states (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee). Study staff used multiple authentication procedures to verify the uniqueness and validity of each enrollment. Respondents completed an online cross-sectional survey that assessed prior suicidality (thoughts, plans, attempts). Respondents were provided a number of help-seeking resources at the conclusion of the survey. The mean respondent age was 16.1 years (SD = 1.0), and respondents were primarily female (45.6%, n=175), bisexual (38.0%, n=146), and non-Hispanic White (52.6%, n=202). We used unadjusted and adjusted logistic regression analyses to identify sociodemographic, health, and relationship correlates of prior suicidal ideation and attempts. Results: Overall, 70.6% (n=271) of SGM adolescents reported ever having serious suicidal thoughts. Of these respondents, 74.9% (n=203) had planned and 43.9% (n=119) had attempted suicide. Adjusted analyses showed that the likelihood of prior suicidal ideation was higher among respondents who identified as Hispanic (AOR: 2.7;95% CI: 1.1, 7.0), non-Hispanic Multiracial (AOR: 4.1;95% CI: 1.2, 13.9), and non-Hispanic White (AOR: 3.0;95% CI: 1.4, 6.3) as compared to non-Hispanic Black, and was twice as high among respondents 17 years of age (AOR: 2.3;95% CI: 1.1, 5.0) compared to those 15 years of age. Having a diagnosed disability (AOR: 3.4;95% CI: 1.9, 6.1) and poor parental relationship quality (AOR: 2.3;95% CI: 1.2, 4.1) were also associated with an increased likelihood of prior suicidal ideation. The likelihood of prior attempted suicide was significantly greater among SGM adolescents who reported poor parental relationship quality (AOR: 2.0;95% CI: 1.1, 3.6), a diagnosed disability (AOR: 2.1;95% CI: 1.1, 4.0), and a chronic health condition (AOR: 2.5;95% CI: 1.4, 4.7). Conclusions: The prevalence of lifetime suicidality was quite high among SGM adolescents in the South, even higher than estimates reported by national studies among similarly aged adolescents. The findings suggest the immediate need for tailored efforts to prevent and address suicidality among SGM adolescents, especially given the compounding effects of the COVID-19 pandemic on adolescents' health. The findings also suggest the need to intervene with the parents of SGM adolescents or increase acceptance and connectedness in other close relationships. Sources of Support: This study was funded by the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control (K01CE003226).

"At One Point We Had No Funding for Paper": How Grants and the Covid Crises Have Shaped Service Provision in Child Advocacy Centers

The confluence of the two major challenges has combined to create special challenges for rural nonprofits serving victims of crime: the fluctuation of federal funding, and the Covid-19 pandemic. We discuss the challenges faced by Child Advocacy Centers in northwestern South Carolina in the context of these shifting challenges. From qualitative interviews conducted at 14 centers in this primarily rural region, we explain the challenges they face and the potential effects on the communities they serve interpreted through the lens of Resource Dependence Theory, which predicts that organizations reduce uncertainty of funding through increasing their partnership bonds with cooperative entities.

The impact of COVID-19 pandemic on the dynamic HIV care engagement among people with HIV: real-world evidence

INTRODUCTION: Existing studies examining the impact of the pandemic on engagement in HIV care often capture cross-sectional status, while lacking longitudinal evaluations. This study examined the impact of the pandemic on the longitudinal dynamic change of retention in care and viral suppression status. METHOD(S): The electronic health record (EHR) data of this population-level cohort study were retrieved from the statewide electronic HIV/AIDS reporting system in South Carolina (SC). The study population was people with HIV (PWH) who had at least one year's symmetric follow up observation record before and after the pandemic. Multivariable generalized linear mixed regression models were employed to analyze the impact of the pandemic on these outcomes, adjusting for socio-demographic characteristics and preexisting comorbidities. RESULT(S): In the adjusted models, PWH had a lower likelihood of retention in care (adjusted odds ratio [aOR]: 0.806, 95%CI: 0.769, 0.844) and a higher probability of virological failure (aOR: 1.240, 95%CI: 1.169, 1.316) during the peri-pandemic period than pre-pandemic period. Results from interaction effect analysis from each cohort revealed that the negative effect of the pandemic on retention in care was more severe among PWH with high comorbidity burden than those without any comorbidity;meanwhile, a more striking virological failure was observed among PWH who reside in urban areas than in rural areas. CONCLUSION(S): The COVID-19 pandemic has a negative impact on retention in care and viral suppression among PWH in South Carolina, particularly for individuals with comorbidities and residing in urban areas. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Managing COVID-19 transmission in long-term care: A qualitative study of high performing facilities.

Ever since its emergence, COVID-19 has posed a serious threat to members of the population who are older and have underlying health conditions, with those residing in Long-Term Care Facilities being particularly susceptible. The purpose of this study was to explore initiatives implemented by Long-Term Care Facilities which had lower COVID-19 transmission compared to their regional counterparts. Of the facilities interviewed, the majority implemented a routine testing schedule for residents utilizing both PCR and Rapid Antigen nasal tests, while also separately housing residents who may be at an increased risk. The results of this study could serve as a guidance for other facilities.

SARS-CoV-2 concentration in wastewater consistently predicts trends in COVID-19 case counts by at least two days across multiple WWTP scales.

Wastewater surveillance of SARS-CoV-2 has proven instrumental in mitigating the spread of COVID-19 by providing an economical and equitable approach to disease surveillance. Here, we analyze the correlation of SARS-CoV-2 RNA in influents of seven wastewater plants (WWTPs) across the state of South Carolina with corresponding daily case counts to determine whether underlying characteristics of WWTPs and sewershed populations predict stronger correlations. The populations served by these WWTPs have varying social vulnerability and represent 24% of the South Carolina population. The study spanned 15 months from April 19, 2020, to July 1, 2021, which includes the administration of the first COVID-19 vaccines. SARS-CoV-2 RNA concentrations were measured by either reverse transcription quantitative PCR (RT-qPCR) or droplet digital PCR (RT-ddPCR). Although populations served and average flow rate varied across WWTPs, the strongest correlation was identified for six of the seven WWTPs when daily case counts were lagged two days after the measured SARS-CoV-2 RNA concentration in wastewater. The weakest correlation was found for WWTP 6, which had the lowest ratio of population served to average flow rate, indicating that the SARS-CoV-2 signal was too dilute for a robust correlation. Smoothing daily case counts by a 7-day moving average improved correlation strength between case counts and SARS-CoV-2 RNA concentration in wastewater while dampening the effect of lag-time optimization. Correlation strength between cases and SARS-CoV-2 RNA was compared for cases determined at the ZIP-code and sewershed levels. The strength of correlations using ZIP-code-level versus sewershed-level cases were not statistically different across WWTPs. Results indicate that wastewater surveillance, even without normalization to fecal indicators, is a strong predictor of clinical cases by at least two days, especially when SARS-CoV-2 RNA is measured using RT-ddPCR. Furthermore, the ratio of population served to flow rate may be a useful metric to assess whether a WWTP is suitable for a surveillance program.

COVID-19 Infection Post-Transplant: What is the Collateral Damage to the Graft? A Case for Pre-Transplant Vaccination

Purpose: COVID-19 produces an unpredictable immune reaction and is challenging to manage during active infection and post-infection, in kidney transplant (KTX) recipients. The first peak of the COVID-19 pandemic occurred in South Carolina (SC) starting in May 2020. The aim of this evaluation was to identify the impact of COVID-19 infection on KTX recipient outcomes starting at the peak of the pandemic. Method(s): This was a retrospective, observational evaluation performed as part of the quality assessment performance improvement program. Patients >= 18 years, who underwent a KTX, were managed by our center, and developed a COVID-19 infection in the post-transplant period were included. Patients were further divided into two groups, depending on the time from transplant as of May 2020. Descriptive statistics, including Chi squared, Fischer's Exact, and T-tests, were used to evaluate the data using IBM SPSS Statistics. An immunosuppression (IS) adjustment was defined as a reduction in dose, due to the presence of an acute viral illness. Result(s): From June 2020 to September 2021, 60 patients were identified to have COVID-19. Patients who were <1-year from transplant had a higher incidence of COVID-19 in the first 3 months post-transplant and an increased rate of hospital admission (p = 0.02). 22 patients (79.6%) <1-year from transplant, required an adjustment to IS versus 16 patients (50%) who were >1-year from transplant. 20% (12/60) of patients died post-COVID-19 versus the SC mortality rate of 1.7% as of 11/2021, based on confirmed deaths/cases (12,292/734,555). Rejection post- COVID-19 occurred in 2/60 patients, see Table 2. Conclusion(s): In KTX recipients <1-year post transplant, an earlier diagnosis of COVID-19 in the post-transplant period, increased IS adjustment, and a higher incidence of hospital admission was observed. This data was used to justify the requirement for a COVID-19 vaccine prior to transplant listing and for all patients currently on the waiting list.

Impact of Emergency Remote Teaching on University Students at a Public Institution in the United States

The educational experiences of university students participating in Emergency Remote Teaching (ERT) during the COVID-19 pandemic were evaluated using a survey instrument. Students found ERT stressful (89%) and indicated challenges from inadequate internet (91%), lack of privacy (45%), and increased amount of studying (3 hours more per week). Academic rank correlated with stress level during ERT, with freshmen (42%) reporting the highest stress level and seniors (48%) reporting minimal stress. Lack of face-to-face instruction, missing peer interaction and having to teach the course material to themselves were the top issues that students disliked with ERT. Respondents recognized the need for organization, self-motivati1on, and increased interaction with other students and instructors as key factors for effectiveness and satisfaction of ERT instruction.

The Influence of Seasonal Temperature on Cerebral Venous Thrombosis Before and After the Beginning of the COVID-19 Pandemic

Objective: Assess the relationship of seasonal temperature and COVID-19 infection with the occurrence of cerebral venous thrombosis (CVT). Background: Increased thrombogenicity is associated with COVID-19. Warm environments cause intravascular constriction, promoting CVT. After COVID-19 began, CVT increased during South Carolina's (SC) warmer months. However, the interaction of seasonal temperature and COVID-19 with CVT has not been elucidated. Design/Methods: The Vizient database provided frequency of non-pyogenic CVT, with and without infarction, between 10/2017 and 7/2021. SC's monthly temperatures were obtained from the National Weather Service, and SC DHEC provided COVID-19 cases. This study initially explored the relationship between COVID-19, CVT, and temperature and the effect of COVID-19 on the occurrence of CVT in Greenville, SC. It then expanded to include all SC and nationwide Vizient hospitals. Results: A Pearson correlation assessed the relationship between CVT, temperature, and COVID-19 in Greenville. A significant positive relationship between CVT and both average daily and maximum temperature (r(46) = 0.343, p<0.05;r(46) 0.339, p<0.05, respectively) was identified. There was not a significant relationship between COVID-19 and CVT, even when controlling for temperature. Greenville's independent t-test compared CVT incidence and showed an increase in CVT cases after the COVID-19 pandemic began (t(20)= 2.71, p<0.01). This significance was also demonstrated from the total data from SC and nationwide (t(36) = 2.538, p < .01, t(44) = 4.050, p <.001, respectively). Conclusions: Increased maximum and average daily temperature is significantly correlated to increased CVT hospitalizations. Although COVID-19 cases were insignificantly correlated with CVT, CVT hospitalizations significantly increased from an unknown variable after the COVID19 pandemic. When relating statistics to observed patterns, it is still possible that the conditions surrounding the COVID-19 pandemic complete the increased risk of CVT hospitalizations during warmer months. Future study is needed to elucidate variables' effects and patterns on COVID-19, temperature, and CVT.

Factors Associated with COVID-19 Vaccine Intentions among South Carolina Residents.

Despite evidence of vaccine safety and efficacy, vaccine hesitancy remains a major global health threat. The COVID-19 vaccine has presented unique vaccine hesitancy concerns compared to parental vaccine hesitancy towards childhood vaccines. South Carolina (SC) is home to a largely conservative population and historically has some of the lowest vaccination coverage rates in the United States of America. The goal of the current study was to identify factors associated with COVID-19 vaccine intentions among SC residents. From November 2020 to September 2021, 300,000 invitations to participate in community testing and complete an online survey were mailed to randomly selected SC residents. The survey collected data about behaviors and attitudes towards COVID-19 vaccines, as well as demographic and health characteristics. Of the 10,626 survey participants, 69.9% reported being vaccinated against COVID-19. Among those not vaccinated, 65.5% reported vaccine intentions. Logistic regression analyses were performed to examine factors associated with COVID-19 vaccine intentions. Multivariate logistic regression results indicated that confidence in the safety of the COVID-19 vaccines increased the likelihood of vaccine intentions, while younger age (<60 years) decreased the likelihood of vaccine intentions. To increase vaccine intentions and uptake, public health and government officials in South Carolina and other conservative states should target younger populations and address concerns about COVID-19 vaccine safety.

JUDICIAL HONORS

The Ohio State Bar Association (OSBA) honored Judge MARY JANE TRAPP of Florida's 11th District Court of Appeals with the Ohio Bar Medal. U.S. District Court Judge J. MICHELLE CHILDS of the District of South Carolina received the South Carolina Association for Justice's Outstanding Contribution to Justice Award. Retired Judge LESLIE E. STEIN of the New York Court of Appeals was selected to receive the Ruth G. Schapiro Memorial Award from the New York State Bar Association's Women in Law Section.

Predicting Areas with High Concentration of the Long-Term Uninsured and Their Association with Emergency Department Usage by Uninsured Patients in South Carolina

Background: To predict areas with a high concentration of long-term uninsured (LTU) and Emergency Department (ED) usage by uninsured patients in South Carolina. Methods: American Community Survey data was used to predict the concentration of LTU at the ZIP Code Tabulation Area (ZCTA) level. In a multivariate regression model, the LTU concentration was then modeled to predict ED visits by uninsured patients. ED data came from the restricted South Carolina Patient Encounter data with patients’ billing zip codes. A simulation was conducted to predict changes in the ED visit numbers and rates by uninsured patients if the LTU concentration was reduced to a lower level. Results: Overall, there was a positive relationship between ED visit rates by the uninsured patients and areas with higher concentrations of LTU. Our simulation model predicted that if the LTU concentration for each ZCTA was reduced to the lowest quintile, the ED visit rates by the uninsured would decrease significantly. The greatest reduction in the number of ED visits by the uninsured over a two-year period was for the following primary diagnoses: abdominal pain (15,751 visits), cellulitis and abscess (11,260 visits) and diseases for the teeth and supporting structures (10,525 visits). Conclusions: The provision of primary healthcare services to the LTU could help cut back inappropriate uses of ED resources and healthcare costs.

Needs Assessment of Southeastern United States Vector Control Agencies: Capacity Improvement Is Greatly Needed to Prevent the Next Vector-Borne Disease Outbreak

A national 2017 vector control capacity survey was conducted to assess the United States’ (U.S.’s) ability to prevent emerging vector-borne disease. Since that survey, the southeastern U.S. has experienced continued autochthonous exotic vector-borne disease transmission and establishment of invasive vector species. To understand the current gaps in control programs and establish a baseline to evaluate future vector control efforts for this vulnerable region, a focused needs assessment survey was conducted in early 2020. The southeastern U.S. region was targeted, as this region has a high probability of novel vector-borne disease introduction. Paper copies delivered in handwritten envelopes and electronic copies of the survey were delivered to 386 unique contacts, and 150 returned surveys were received, corresponding to a 39% response rate. Overall, the survey found vector control programs serving areas with over 100,000 residents and those affiliated with public health departments had more core capabilities compared to smaller programs and those not affiliated with public health departments. Furthermore, the majority of vector control programs in this region do not routinely monitor for pesticide resistance. Taken as a whole, these results suggest that the majority of the southeastern U.S. is vulnerable to vector-borne disease outbreaks. Results from this survey raise attention to the critical need of providing increased resources to bring all vector control programs to a competent level, ensuring that public health is protected from the threat of vector-borne disease.

Exploring Secrets by the Sea

Dyjack shares his experience attending and speaking at the American Public Health Association (APHA) state affiliate meeting. He was the sole voice of environmental public health. He had been requested to speak to the contributions of the environmental health profession to public health. This conference was primarily attended by members and supporters of the local APHA affiliate. He reminded the audience that APHA was created in 1872 by a sanitarian, Dr. Stephen Smith, to primarily address water, sanitation, and hygiene. Specifically, much of the work early in APHA's history was focused on environmental health issues such as conditions that exacerbated tuberculosis, contaminated milk, and air pollution. From there he picked up momentum as he described the core functions of public health-assessment, assurance, and policy development. Each of these pillars have environmental health embedded into them. He pointed out that environmental health is the second largest part of the public health workforce. Finally, he shared the 2012 report that describes environmental health as a foundational public health service. Compelling evidence of the centrality of environmental health to public health abounds.

From Strategic Goal to Reality: The Development of the Myrtle Beach Invitational Basketball Tournament

The Myrtle Beach, South Carolina, area was selected to serve as one-time hosts for two tournaments in 2017: the ACC Women's Basketball Tournament and the Puerto Rico Tip-Off Men's College Basketball Tournament, when circumstances required those events to relocate on very short notice. Following the success of these two one-time events, the region sought to become a permanent host of an annual men's college basketball tournament to be played in November or December. This manuscript examines the development process of this tournament and illustrates how tournament organizers addressed the most common elements found in such events.