Supporting Staff in Southern Family Planning Clinics: Challenges and Opportunities

Objectives The aim of this study was to identify key challenges and opportunities to better support non-clinician clinic staff at family planning centers in Southern US states. Methods We conducted qualitative interviews with 15 individuals in clinic staff and leadership positions at family planning centers in seven Southern states. Results Turnover had negative impacts on both clinic functioning as well as patient care. Participants identified several challenges related to recruitment and retention in family planning health centers in the South, including the conservative contextual landscape, the perceived value of support staff, gaps in communication, and rural locations. In response to these challenges, staff also identified key strategies to better support and retain health center workers. These included prioritizing investment in management, creating career advancement opportunities, prioritizing staff retention, and creating space for self-care. Health center staff and leadership who used these strategies to support and retain staff noted improvements in the effectiveness of staff work as well as increases in patient volume. Conclusions for Practice Study findings provide key areas for intervention including providing development opportunities, commitment from leadership to recognize and invest in staff and supporting self-care. Focusing on ensuring internal organizational justice for staff may also facilitate resilience to external challenging environments. Better supporting clinic staff is likely also important for quality services and ensures the full workforce involved in providing family planning care can work at full capacity.

Sustainability at Auburn University: Assessing Rooftop Solar Energy Potential for Electricity Generation with Remote Sensing and GIS in a Southern US Campus

Achieving sustainability through solar energy has become an increasingly accessible option in the United States (US). Nationwide, universities are at the forefront of energy efficiency and renewable generation goals. The aim of this study was to determine the suitability for the installation of photovoltaic (PV) systems based on their solar potential and corresponding electricity generation potential on a southern US university campus. Using Auburn University located in the southern US as a case study, freely available geospatial data were utilized, and geographic information system (GIS) approaches were applied to characterize solar potential across the 1875-acre campus. Airborne light detection and ranging (lidar) point clouds were processed to extract a digital surface model (DSM), from which slope and aspect were derived. The area and total solar radiation of campus buildings were calculated, and suitable buildings were then determined based on slope, aspect, and total solar radiation. Results highlighted that of 443 buildings, 323 were fit for solar arrays, and these selected rooftops can produce 27,068,555 kWh annually. This study demonstrated that Auburn University could benefit from rooftop solar arrays, and the proposed arrays would account for approximately 21.07% of annual electricity requirement by buildings, equivalent to 14.43% of total campus electricity for all operations. Given increasing open and free access to high-resolution lidar data across the US, methods from this study are adaptable to institutions nationwide, for the development of a comprehensive assessment of solar potential, toward meeting campus energy goals.

Social isolation and psychological distress among southern US college students in the era of COVID-19

Objective: To examine the prevalence of psychological distress and its association with social isolation among University of North Carolina Chapel Hill (UNC-CH) students. Methods A cross-sectional survey was emailed to all students in June 2020. Students reported self-isolating none, some, most, or all of the time and were screened for clinically significant symptoms of depression (CSSD). Data were weighted to the UNC-CH population. Results: 7,012 students completed surveys-64% reported self-isolating most or all of the time and 64% reported CSSD. Compared to those self-isolating none of the time, students self-isolating some of the time were 1.78 (95% CI 1.37-2.30) times as likely to report CSSD, and students self-isolating most and all of the time were 2.12 (95% CI 1.64-2.74) and 2.27 (95% CI 1.75-2.94) times as likely to report CSSD, respectively. Conclusions: Universities should prioritize student mental health and prepare support services to mitigate mental health consequences of the pandemic.

Genetic diversity and aggressiveness of Fusarium virguliforme isolates across the Midwestern United States

Sudden death syndrome (SDS) of soybean is a damaging disease caused by the fungus Fusarium virguliforme. Since this pathogen was first reported in the southern US state of Arkansas in 1971, it has spread throughout the Midwestern U.S. The SDS pathogen primarily colonizes roots but also produces toxins that translocate to and damage leaves. Previous studies detected little to no genetic differentiation among isolates, suggesting F. virguliforme in North America has limited genetic diversity and a clonal population structure. Yet, isolates vary in virulence to roots and leaves. We characterized a set of F. virguliforme isolates from the Midwestern U.S. representing a south to north latitudinal gradient from Arkansas to Minnesota. Ten previously tested microsatellite loci were used to genotype isolates and plant assays were conducted to assess virulence. Three distinct population clusters were differentiated across isolates. Although isolates ranged in virulence classes from low to very high, little correlation was found between virulence phenotype and cluster membership. Similarly, population structure and geographic location were not highly correlated. However, the earliest diverging cluster had the lowest genetic diversity and was detected only in southern states, while the other two clusters were distributed across the Midwest and were predominant in Minnesota. One of the Midwestern clusters had the greatest genetic diversity and was found along the northern edge of the known distribution. The results support three genetically distinct population clusters of F. virguliforme in the U.S., with two clusters contributing most to spread of this fungus across the Midwest.

Recurring Spatiotemporal Patterns of COVID-19 in the United States

We analyzed the waxing and waning patterns ('surges') of reported SARS-CoV-2 cases from January 1, 2020 through Oct 31, 2021 in all states and provinces (n = 93) in the USA, Mexico, and Canada, and across all counties (N = 3142) in the USA. A correlation matrix of the 576 x 576 daily case incidence rates in the 50 US states generates a distinctive 'checkerboard' pattern showing that the epidemic has consisted of seven distinct internally coherent spatiotemporal wave patterns, four in the first year of the epidemic, and three thus far in the second year. Geoclustering of state case rate trajectories reveals three dominant co-varying spatial clusters of similar case rate trajectories, in the northeastern, southeastern and central/western regions of the USA. The spatiotemporal patterns of epidemic year 1 have thus far been repeated (p<.001) in epidemic year 2. The 'checkerboard' pattern of the correlation matrix of case trajectories can be closely simulated as three sets of interacting sine waves with annual frequencies of 1:1:2 major cycles per year, corresponding to the northeastern, central/western, and southeastern state clusters. Case incidence patterns in Mexico and Canada have been similar to nearby regions in the southern US and the northern US, respectively. Time lapse videos allow visualization of the wave patterns. These highly structured geographical and temporal patterns, coupled with emerging evidence of annual repetition of these same patterns, show that SARS-CoV-2 case rates are driven at least in part by predictable seasonal factors.

Cotton Leafroll Dwarf Virus US Genomes Comprise Divergent Subpopulations and Harbor Extensive Variability

Cotton leafroll dwarf virus (CLRDV) was first reported in the United States (US) in 2017 from cotton plants in Alabama (AL) and has become widespread in cotton-growing states of the southern US. To investigate the genomic variability among CLRDV isolates in the US, complete genomes of the virus were obtained from infected cotton plants displaying mild to severe symptoms from AL, Florida, and Texas. Eight CLRDV genomes were determined, ranging in size from 5865 to 5867 bp, and shared highest nucleotide identity with other CLRDV isolates in the US, at 95.9–98.7%. Open reading frame (ORF) 0, encoding the P0 silencing suppressor, was the most variable gene, sharing 88.5–99.6% and 81.2–89.3% amino acid similarity with CLRDV isolates reported in cotton growing states in the US and in Argentina and Brazil in South America, respectively. Based on Bayesian analysis, the complete CLRDV genomes from cotton in the US formed a monophyletic group comprising three relatively divergent sister clades, whereas CLRDV genotypes from South America clustered as closely related sister-groups, separate from US isolates, patterns reminiscent of phylogeographical structuring. The CLRDV isolates exhibited a complex pattern of recombination, with most breakpoints evident in ORFs 2 and 3, and ORF5. Despite extensive nucleotide diversity among all available CLRDV genomes, purifying selection (dN/dS < 1) was implicated as the primary selective force acting on viral protein evolution.

1394. Autochthonous Leprosy in Missouri

Background Introduction: Leprosy (Hansen’s disease) is a chronic granulomatous infection of the skin/peripheral nerves caused by Mycobacterium leprae. Of 216 new cases reported in the US in 2019, 70% were in FL, LA, TX, HI, CA, GA and NY. Leprosy is considered a zoonosis in the southern US with the nine-banded armadillo as a reservoir. There have been no reported autochthonous leprosy cases in Missouri. Methods Case: 55 y/o previously healthy male noted a new rash on his arm 2 years ago. Over time it spread to his extremities/torso. Skin biopsy showed a granulomatous infiltrate, suspected granuloma annulare, but it progressed despite appropriate therapy. He noted progressive numbness of the affected areas of skin and several regional nerve distributions. In the weeks prior to his initial visit he noted facial swelling, eyelid and ear induration, worsening fatigue, diffuse arthralgia, and some vision changes. His travel history is limited to Canada, Colorado and a brief vacation to the Texas/Mexico border (no notable outdoor exposure during the latter trip; no travel outside the country). He lives in rural Missouri where he is exposed to armadillos. His dogs frequently kill them and often bring them into the yard, rolling around on/in the dead carcasses which he disposes of. He typically wears gloves when handling them and has never consumed them. On exam he had diffuse purplish-red nummular infiltrated anesthetic papules and plaques diffusely distributed over the trunk and extremities. Distinct left ulnar neuropathy was noted. He exhibited leonine facies and infiltration of the bilateral helices. Repeat biopsy showed a granulomatous infiltrate with abundant acid-fast bacilli. DNA sequencing confirmed M. leprae. He was preventatively treated with prednisone and methotrexate to minimize immune reaction, and two weeks later began a regimen of monthly rifampin, minocycline, and moxifloxacin with an anticipated duration of 24 months. Results Diagnosis lepromatous leprosy with pre-treatment immune reaction. This is potentially the first case of autochthonous leprosy in Missouri. Providers should include Hansen’s disease in the differential diagnosis of patients with dermal eruption and cutaneous neurological symptoms to avoid delays in diagnosis/care. Disclosures All Authors: No reported disclosures