"It all goes back to trust": a qualitative exploration of extension professionals' perceptions of COVID-19 vaccines in rural Florida

While urban communities experienced high levels of infection at the onset of the COVID-19 pandemic, rural communities experienced an increase of confirmed cases during the fall months of 2020. Rural Americans were also among the most hesitant to receive the COVID-19 vaccine. The purpose of this study was to explore the perceptions of [State] extension professionals related to the COVID-19 vaccines in rural communities. Qualitative methods were utilized to gather data from extension professionals in rural area of [State], where vaccine uptake was below average. Results revealed frustration with the vaccine process, vaccine norms, and skepticism and mistrust to all be contributing factors to vaccine hesitancy in rural communities. Extension professionals discussed not feeling comfortable discussing topics related to public health with their clientele, citing the topic being outside their expertise. Practical recommendations from this study included utilizing a grassroots approach rather than relying on mass media, providing messages related to the COVID-19 vaccine that focus on education, rather than promotion, and testing new messages before they are disseminated.

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.

Occupational health and safety trainees reflect on their education and future careers during COVID-19

Background: The National Institute for Occupational Safety and Health (NIOSH) funded Education and Research Centers (ERCs), located at 18 universities, with the mission to train occupational safety and health (OSH) leaders. The Florida Sunshine ERC has trained hundreds of students since its inception in 1997 through seven programs that collaboratively foster interdisciplinary education and applied research and practice. The COVID-19 pandemic has presented practical challenges for educators, students, and trainees, forcing institutions to move to remote learning. The pandemic also magnifies the importance of public health and OSH. Purpose: This evaluation elicited feedback from ERC trainees early in the pandemic (2020) and again in 2021 on how the pandemic affected their training, professional development, career plans, and wellbeing. Methods: Open-ended surveys were collected and focus groups were held with currently enrolled trainees from seven Sunshine ERC programs. Descriptive statistics were calculated, and qualitative transcripts were analyzed using MAXQDA software. Results: Through survey responses (45 respondents) and focus group discussions (9 participants), ERC trainees shared their perspectives on pandemic impacts in their performance and wellbeing, transition to remote learning, their respective OSH fields, and career plans during the pandemic. Programs should consider enhancing OSH curricula to respond to training needs and issues related to occupational stress and well-being, pragmatism and disaster response, and even more interdisciplinary training to prepare for emerging population-wide threats. Conclusions: OSH training will require shifts in teaching modalities and content to prepare OSH professionals for the future. Evaluation results informed teaching and training modifications to ensure that ERC objectives continue to be met and that trainees are well-prepared and supported.

A framework for determining energy use in rural food delivery services: capturing system interdependencies through an agent-based discrete-event approach

Food e-commerce has seen significant growth over the past decade that accelerated after the onset of the COVID-19 pandemic. Last-mile transportation and logistics are widely considered the most expensive and least efficient portion of the supply chain and have multiple important energy trade-offs such as cargo capacity and consumer density. Last-mile transportation energy use in rural areas is underrepresented in the literature. This study proposes a hybrid agent-based and discrete event model framework for evaluating the last-mile transportation energy use of van- and car-based food delivery services in a rural community, based on meal-kit and grocery delivery operations, respectively. This framework quantifies last-mile energy use in rural areas, and is demonstrated here using a neighborhood outside of Austin, TX as an analytical testbed. The study focuses on the effects of consumer density, cargo limitations, and vehicle speed. For the conditions examined with this framework, diesel delivery vans use more total energy than passenger cars for the same trip, though a van delivering four orders uses less energy per-order than a car delivering one order. However, there are trade-offs between vehicle type and mileage, cargo capacity, route density, and speed that are particularly important for delivery services operating in rural areas. This framework can be used by service providers to assess route-specific trade-offs for each vehicle and gauge which is preferable for given operating conditions or to evaluate the energy, and thus also cost, impact of expanding their services to rural areas.

A pilot study exploring the impacts of COVID-19 on small-scale direct marketing farmers in northwest Arkansas and their responses to the pandemic

The COVID-19 pandemic has led to many disruptions and challenges in local and national food systems in America. Many farms and market gardens were forced to innovate quickly and take action to survive ongoing disruption as these businesses struggled with finances and distribution of products among other challenges. Many small-scale, local farming operations in particular were able to respond to these disruptions in unique ways, which may offer useful insight into how to better prepare small farming communities for public health and other kinds of disasters in the future. This pilot study aims to better understand how COVID-19 affected the local food system in the region of Northwest Arkansas in the mid-southern United States and how small-scale, direct-sales farmers responded to the pandemic, through a survey and interview about their experiences from 2019 to 2021. Participating farmers reported changes in farming procedures and challenges in owning or working on their farms due to ongoing climate-related environmental issues or issues specific to the pandemic, such as distributing products, utilizing financial and other resources of support, and partnering with local supply-chain partners and community members to ensure local businesses' survival during COVID-19. This pilot study can provide insight into how local farming operations and their regional and smaller-scale supply chain partners have built and utilized community resilience strategies to survive COVID-19 challenges in the Northwest region of Arkansas. A statewide follow-up study will be conducted to observe how these producers navigated these challenges on a larger scale, including in different regions of Arkansas following the start of the pandemic.

Programmatic impacts of utilizing various staffing options for COVID-19 contact tracers: recommendations and lessons learned

Background: The rapidly expanding COVID-19 pandemic created an immediate demand for the Department of Health in Hillsborough County (DOH-Hillsborough) Epidemiology Program to supplement its contact tracing workforce;and, because of the long duration of the response, a sustained workforce was needed. The DOH-Hillsborough Epidemiology Program's COVID-19 response, broadly referred to as "contact tracing", included case investigations, outbreaks, and identification and notifications to exposed individuals. To meet contact tracing staffing needs, several staffing options were utilized, including Core Epidemiology Staff, Reassigned DOH-Hillsborough staff (Reassigned Staff), Contracted staffing agency hires (Contract Staff), State of Florida hires (State Level Hires), County hires (DOH-Hillsborough Hires), and college and university faculty and students (University Partners). Purpose: To understand the differences in work output and efficiency across staffing groups (quantitative analysis) and to understand Core Epidemiology Staff recommendations when hiring temporary staff as contact tracers (qualitative analysis). Methods: A mixed-methods approached was used to assess each staffing group hired in Hillsborough County. Quantitative data was analyzed from 3/1/2020 through 1/31/2021, and included data from the state's personnel management system and the state's reportable disease database to represent work output. Qualitative interviews with DOH-Hillsborough Core Epidemiology Staff were conducted and analyzed to understand Core Epidemiology Staff recommendations when hiring surge staffing in the future. Results: During the evaluation period, 199 staff across the staffing groups worked a collective 132,252.50 hours. The number of hours worked per case and contact ranged from 10.16 in Core Epidemiology Staff to 0.67 in University Partners. During qualitative interviews with the Core Epidemiology Staff, five common themes emerged as ideal characteristics for temporary contact tracing staff. These included: communication skills, professionalism, public health knowledge, following official guidance, and flexibility. Two groups who emerged as the "best hires" for their seamless transition into their roles included University Partners and the State Level hires. Discussion: These mixed methods data can be used to develop best practices to inform future surge staffing needs.

Disparities in COVID-19 case counts and incidence in Florida by race and ethnicity at the county and state level

Background: In 2020, as COVID-19 spread across the United States, reports of disparities in COVID-19 incidence and mortality by race and ethnicity soon followed. This study assessed COVID-19 case counts and incidence by race and ethnicity at county and state levels focusing on Florida. Methods: Counts of COVID-19 were collected from June through December 2020. Chi square analyses assessed disparities in case distribution and linear regressions assessed disparities in incidence and potential interaction between predictors. Results: Race and ethnicity were significant predictors of COVID-19 incidence. Mean incidence was 4.9, 6.6, and 14.3 per 1,000 people among White, Black, and Other populations and 10.9 and 5.0 per 1,000 people among Hispanic and non-Hispanic populations. Incidence was greatest among the Other population (P=0.3825), and greater among Hispanic than non-Hispanic populations (P=0.0057). Conclusion: This study illustrates the disproportionate impact of COVID-19 upon racial and ethnic minorities and highlights the need to improve race and ethnicity data collection in disease reporting.

Racial disparities in air pollution burden and COVID-19 deaths in Louisiana, USA, in the context of long-term changes in fine particulate pollution. (Special Issue: Disparities during times of a pandemic and epidemic.)

Black Americans in Louisiana are disproportionately dying from COVID-19, and environmental disparities may be contributing to this injustice. While Black communities in Louisiana's industrialized regions (e.g., Cancer Alley, Calcasieu Parish) have been overburdened with pollution for decades, this disparity has not been evaluated by using recent data. Here, we explore statewide relationships among air pollution burden, race, COVID-19 death rates, and other health/socioeconomic factors. Measures of pollution burden included satellite-derived particulate matter (PM2.5) concentrations and health risks from toxic air pollution (i.e., respiratory hazard [RH] and immunological hazard [IH], estimated by the Environmental Protection Agency). In addition, we evaluate changes in emissions and ambient concentrations of fine PM2.5 in Louisiana over the past few decades. Our overall goal was to better understand Louisiana's burden of air pollution in the context of COVID-19. By all measures, a higher burden of air pollution was associated with larger percentages of Black residents and increased unemployment across Louisiana census tracts. Across parishes, higher COVID-19 death rates were associated with increased RH and IH and larger percentages of Black residents. These associations were not driven by diabetes, obesity, smoking, age, or poverty. Industrial sources comprised more of Louisiana's PM2.5 in 2017 versus 1990, as vehicle contributions declined 75% whereas industrial emissions remained about the same overall (despite variation in the interim). Ambient concentrations of PM2.5 decreased statewide from 2000 to 2015, but subsequently increased in south Louisiana, concurrent with an upward trend in industrial emissions. Our findings highlight the critical need to address Louisiana's pollution disparities and to recognize air pollution exposure as a risk factor for COVID-19.

Collegiate student-athlete psychological distress and counseling utilization during COVID-19

The onset of COVID-19 and cancellation of collegiate sports may have exacerbated student-athletes' psychological distress. Within a national sample of collegiate athletes (N = 5,755;66.7% women), we determined how gender and race related to rates of depression, stress, and counseling use at the beginning of the pandemic (April/May 2020). Overall, 26.5% (n = 1,526) and 10.6% (n = 612) endorsed clinical levels of depression and stress, respectively;25.1% (n = 1,443) and 69.7% (n = 4,014) reported subclinical levels. Few athletes (2.3%-17.1%) reported counseling use before or after the onset of COVID-19;those who did reported higher levels of depression and stress than those who never sought services. The female athletes reported higher rates of depression, stress, and counseling use than the male athletes. There were no race effects. Athletic departments must address their student-athletes' psychological distress by facilitating a higher use of mental health services.

Clinical spectrum of COVID-19 and plasma angiotensin II levels

Angiotensin II levels in COVID-19 are controversial. We studied 12 hospitalized patients, including their baseline levels of peripheral lymphocyte subsets (via flow cytometry) and plasma angiotensin II (via radioimmunoassay). Controls comprised radioimmunoassay's 124 healthy subjects. Angiotensin II levels (pg/ml) were elevated among patients versus controls (Mean +or- standard deviation: 98.8 +or- 146.9 versus 23.7 +or- 15.6, p < 0.0001;Median, interquartile range: 27, 20 to 116 versus 22, 14 to 28). Half the patients had lymphocytopenia (< 1000 cells/mm3), and the CD3+/CD4+ counts were negatively associated with body mass index, viral load, hospital stay and non-home discharge. Angiotensin II imbalance appears to be a biomarker for COVID-19 morbidity and merits further investigation.

Soybean science challenge: growing soybean education beyond our borders

The Soybean Science Challenge (SSC) continues to support Arkansas STEM (science, technology, engineering, and mathematics) educational goals. It aligns with the Next Generation Science Standards (NGSS). Junior high and high-school students are engaged in active learning and the co-creation of knowledge through the support of classroom-based lessons and applied student research. The SSC educates and engages junior high and high school science students and teachers in 'real-world' Arkansas-specific soybean science education through an original NGSS-aligned curriculum in 7E and GRC-3D format and a continuum of educational methods, which include: teacher workshops, online and virtual live stream education, virtual NGSS aligned mini-lessons for the science classroom, community gardens, personal mentoring, student-led research and corresponding award recognition, and partnerships with state and national educators, agencies and the popular media. The COVID19 global pandemic continued to alter the educational landscape in 2021, despite increased in-person instruction. The Soybean Science Challenge (SSC), by nature of its existing design and methodology, launched online Next Generation Science Standards (NGSS) aligned Gathering Reasoning and Communicating (GRC)-3D and 7E lesson plans for teachers. An online course was added, including NGSS-aligned mini-lesson videos for the science classroom, and additional virtual field trips were added to the list on the Soybean Science Challenge website. The Challenge also sponsored the Arkansas Science Teacher Association Conference in October 2021, and the SSC Coordinator Diedre Young conducted a workshop on bringing agriculturally based lessons into the science classroom. The Soybean Science Challenge was also active in science fairs across the state, judging participants at both the regional and state levels. The SSC is in its second year of the junior level award at regional science fairs. Through the SSC, teachers now have access to a plethora of educational instructions that bring real-world agricultural critical thinking into the classroom and students' homes. The SSC has learned that not only do Arkansas teachers and students benefit from these additional resources but teachers and students from other states benefit as well. In 2021, the SSC program reached over 3,000 students and teachers through in-person, digital, virtual, and print methods.

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.

Helping Louisiana's shrimp industry during the pandemic

This article reports on the inclusion of wild-caught shrimp in the USDA Agricultural Marketing Service (AMS) program to help Louisiana's shrimp industry during the COVID-19 pandemic. As a result of a quick Sea Grant mobilization, $50 million in cash from USDA was infused into the shrimping industry, and 7.6 million pounds of Louisiana shrimp were taken out of inventory and distributed nationwide.

Louisiana nurseries: a growing industry dealing with labor shortages

This article presents an overview of the growth of the Louisiana nursery industry and the labour challenges the industry is facing. Labour issues in the nursery industry are not easily solved, considering the nature and seasonality of employment and competition from other industries. Despite the benefits associated with the H-2A guest worker program, particularly securing seasonal workers in times of need, which allows nurseries to cope with labour shortages, few Louisiana nurseries rely on the H-2A program. Moreover, prolonged impact of the COVID-19 pandemic also raises concerns on ways the industry needs may change and how it will affect securing labour.

Failure to respond to a coral disease epizootic in Florida: causes and consequences

Stony coral tissue loss disease (SCTLD) was first observed in September 2014 near Virginia Key, Florida. In roughly six years, the disease spread throughout Florida and into the greater Caribbean basin. The high prevalence of SCTLD and high resulting mortality in coral populations, and the large number of susceptible species affected, suggest that this outbreak is one of the most lethal ever recorded. The initial recognition and management response to this catastrophic disease in Florida was slow, which delayed the start of monitoring programs and prevented coordinated research programs by at least two years. The slow management response was a result of several factors that operated concurrently. First, the Port Miami dredging project was ongoing during the coral disease epidemic and dredging rather than SCTLD was blamed by some managers and local environmental groups for the extreme coral losses reported in the project's compliance monitoring program. Second, this blame was amplified in the media because dredging projects are intuitively assumed to be bad for coral reefs. Third, during this same time State of Florida policy prohibited government employees to acknowledge global warming in their work. This was problematic because ocean warming is a proximal cause of many coral diseases. As a result, the well-known links between warming and coral disease were ignored. A consequence of this policy was that the dredging project provided an easy target to blame for the coral mortality noted in the monitoring program, despite convincing data that suggested otherwise. Specifically, results from the intensive compliance monitoring program, conducted by trained scientific divers, were clear. SCTLD that was killing massive numbers of corals throughout Florida was also killing corals at the dredge site - and in the same proportions and among the same suite of species. While eradication of the disease was never a possibility, early control measures may have slowed its spread or allowed for the rescue of significant numbers of large colonies of iconic species. This coral disease outbreak has similarities to the COVID-19 pandemic in the United States and there are lessons learned from both that will improve disease response outcomes in the future, to the benefit of coral reefs and human populations.

Social determinants of health and COVID-19 infection in North Carolina: a geospatial analysis

Study Objectives: The COVID-19 pandemic has demonstrated that social determinants of health (SDOH) are profoundly linked to the spread and outcomes of COVID-19. However, the relationships between these SDOH and COVID-19 spatial outbreaks have yet to be determined. We conducted spatial analyses with geographic information systems (GIS) mapping of county-level SDOH and regional COVID-19 infection outbreaks to demonstrate the most impactful SDOH and to provide a pragmatic visual guide to prevent future outbreaks.

Rural rates of hepatitis C within an emergency department-based universal screening program

Study Objective: As a consequence of the opioid epidemic, overall Hepatitis C (HCV) infections have increased in the United States. HCV mortality now surpasses more than 60 other infections (eg, HIV, and TB). The CDC now recommends universal HCV screening, for all adults aged =18 years. Several reports highlight the success of large urban EDs to provide screening and linkage to care for HCV but the ability to utilize rural EDs has not been explored. Our objective was to highlight results of an electronic health record (EHR) driven "opt-out," universal HCV screening program in a small rural community ED that serves the economically disadvantaged, rural/mountainous area of SC, including parts of Appalachia.

Anxiety symptoms among extension professionals' during the COVID-19 pandemic with the GAD-2. (Special Issue: Space, place, and COVID-19.)

According to the National Institute of Mental Health, anxiety disorders are a common mental health disorder but often remain undetected and undertreated. During the COVID-19 pandemic, Extension professionals have worked hard to address emerging issues that communities face, possibly impacting the amount of anxiety they experience. This study determined the prevalence of anxiety symptoms among Extension professionals in the United States. Participants from 24 states completed a survey containing the Generalized Anxiety Disorder 2-item (GAD-2) screener. Almost one-quarter of Extension professionals had a GAD-2 score greater than three, an indicator of anxiety with a possibility of generalized anxiety disorder, which is similar to that of the general population. Also, female and male Extension professionals were about equal in the prevalence of anxiety symptoms, which is contrary to the literature. Extension administrators should consider ways to help their employees with this anxiety, especially during and after traumatic events.

Summary of the 31st meeting of the international task force for disease eradication, 20-21 October 2020

This article provides a brief overview of the 31st meeting of the International TaskForce for Disease Eradication (ITFDE) that was convened at The Carter Center in Atlanta, GA, USA on 20-21 October 2020 to discuss "The impact of the COVID-19 pandemic on eradication and elimination programmes and the way forward." It highlights the results of 7 eradication programmes, with specific conclusions and recommendations for each: Guinea Worm Eradication Programme(dracunculiasis;GWEP);Global Polio Eradication Initiative (GPEI);elimination programmes for measles and rubella (MR), malaria, river blindness (onchocerciasis;RB), and lymphatic filariasis (LF);and the program for the Global Elimination of Trachoma.

The effect of metformin use on mortality of COVID-19 patients with diabetes mellitus

Background: COVID-19 is a disease caused by infection with the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). COVID-19 is still a worldwide threat because of its high morbidity and mortality. This is influenced by the occurrence of hypertension, obesity, age and diabetes mellitus. However, currently there is still controversy in the results of research regarding the use of metformin in COVID-19 with type 2 diabetes mellitus (type 2 DM). This study was aimed to analyze the effect of metformin in COVID-19 patients with diabetes mellitus on mortality rates. Subjects and Method: This study was a systematic review and meta-analysis with the following PICO. P: COVID-19 patient with type-2 diabetes mellitus. I: administration of metformin therapy. C: therapy other than metformin and O: mortality. The articles used in this study were obtained from several databases, namely PubMed, Science Direct, Proquest, SpringerLink, Google Scholar and Scopus. The article search keywords were: "COVID-19" OR "coronavirus" AND "diabetes" AND "metformin" AND "mortality". Articles included are full-text English using a cohort study design from 2020 to 2021 and reporting the Odds Ratio in multivariate analysis. The selection of articles was carried out using the PRISMA flow chart. The articles were analyzed using the Review Manager 5.3 application.