Kentucky Research Articles

Prognostic Significance and Treatment Response Associations of Genetic Mutations in Chronic Myelomonocytic Leukemia: A Retrospective Cohort Study

Background: This retrospective cohort study investigates the prognostic significance of genetic mutations in Chronic Myelomonocytic Leukemia (CMML) and their association with treatment responses among patients treated at a single institution, juxtaposed with a statewide dataset from Kentucky. Methods: The study includes 51 patients diagnosed with CMML under the World Health Organization criteria from January 2005 to December 2023. It examines their genomic profiles and subsequent survival outcomes. The analysis also categorizes patients into CMML-1 and CMML-2 subtypes and assesses survival differences between transformed and non-transformed cases. Results: Mutations in TET2, ASXL1, and SRSF2 were found to significantly influence survival, establishing their roles as critical prognostic markers. Additionally, the cohort from the University of Kentucky exhibited distinct survival patterns compared to the broader Kentucky state population, suggesting that demographic and treatment-related factors could underlie these variances. Conclusions: This research underscores the pivotal role of targeted genetic profiling in deciphering the progression of CMML and refining therapeutic strategies. The findings emphasize the necessity for advanced genetic screening in managing CMML to better understand individual prognoses and optimize treatment efficacy, thereby offering insights that could lead to personalized treatment approaches.

An LSTM deep learning framework for history-based tornado prediction using meteorological data and damage assessment using NDVI anomalies

Extreme weather patterns can affect ground and satellite sensors before and after their occur. This study focused on tornadoes that occurred on December 10 and 11, 2021 in the state of Kentucky. The main goal of this research was to develop a deep learning algorithm based on history to predict this phenomenon. Four scenarios were created based on temperature, air pressure, wind speed and their combination. The temperature-based scenario shows high accuracy and shows the time series of temperature rise several degrees before the tornado. In the second step, the normalized difference vegetation index (NDVI) anomaly was calculated and classified for Mayfield city. Severe NDVI anomalies showed high consistency with enhanced Fujita scale and ultra-high-resolution satellite imagery, with a correlation greater than 0.9.

A qualitative study of end-stage liver disease and liver transplant referral practices among primary care providers in nonurban America.

In rural America, the road to obtaining a liver transplant (LTX) often starts at the primary care provider's (PCP's) office. Patients with end-stage liver disease (ESLD) in rural communities experience lower rates of wait-listing and higher mortality. This study identifies issues related to the knowledge and perceptions of ESLD and LTX referral among PCPs in rural Kentucky (KY). The study protocol involved relying upon a semistructured outline to explore the knowledge, attitude, and perceptions of PCPs toward ESLD and LTX referral among PCPs in rural KY. Inductive thematic analysis was utilized to identify, analyze, and report themes. From the focus group interviews, three themes were identified: medical culture, gaps in knowledge, and bias against those with self-induced causes of ESLD. Each theme illuminated barriers to referral for transplant evaluation. Knowledge gaps, attitudes in medical culture, and biases surrounding ESLD and LTX referral exist in community medicine practice. This highlights the importance of education, resources, and facilitation of LTX referral processes for PCPs.

Clean innovation ecosystems: Lifting distressed communities in Appalachia with clean energy

The U.S. government has invested in distressed communities in the 21st century but with minimal effect. Regarding income, poverty, joblessness, and vacancy rates, the average distressed zip code in 2018 showed no improvement compared to its standing relative to the average prosperous zip code in 2000. We have discovered the formation of unique business clusters funded by public-private partnerships have the potential to make a difference in lifting distressed communities. Our research of literature and artifacts (photographs, videos, documents, digital media - websites or social media posts) suggests the discovery of a Clean Innovation Ecosystem (CIE). CIE refers to the network of social entrepreneurs, organizations, institutions, and individuals that work together to promote sustainable technologies and practices. As of the 4th quarter of 2023, manufacturing annual run rate construction spending has skyrocketed to over $200 billion. There are another $600 billion of Voltage Valley projects announced that have not yet been built. Over the past two decades, private investment has been between $20 billion and $100 billion annually in U.S. manufacturing infrastructure. Governments are making unprecedented investments in clean energy - which include approximately $400 billion in funding from the Inflation Reduction Act (IRA), $8 billion to establish 6–10 regional Hydrogen Hubs in the U.S., investments in carbon capture, renewable energy technologies, and other investments in clean energy sectors and technologies. All these investments come with the condition that the investment lifts distressed communities. This article explains why investing in Appalachia and geographic regions with similar characteristics will maximize the social benefit of public investment in a Clean Innovation Ecosystem. Our case study covers the Greater Central Appalachian Voltage Valley (GCAVV) – the states of Kentucky, West Virginia, Ohio, Upstate New York, and Michigan, as well as the Central Appalachian region as defined by 56 of the 85 distressed communities of Appalachia.

Single institution retrospective review of patients with metastatic hormone receptor positive breast cancer receiving first line therapy of CDK4/6 inhibitors.

e13090 Background: Breast cancer continues to be the most commonly diagnosed cancer in women. The majority of these cancers are estrogen positive (ER+) and about 6% of new cases are stage 4 at time of diagnosis. The current standard of care for postmenopausal women with stage 4 ER+ breast cancer is a combination of an aromatase inhibitor (AI) with a cyclin-dependent kinase (CDK) 4/6 inhibitor. Based on Medicare data claim analysis from IQVIA, CDK 4/6 inhibitors are being used nationally in the first line setting in 56% of cases where 24% of cases were treated with AI monotherapy. The state of Kentucky currently lies below this national average by using this treatment regimen in 38% of cases where 47% of cases are treated with AI monotherapy. The reason for this discrepancy between the national average and Kentucky is currently unknown. To further understanding, we have conducted an internal review of adherence to the guidelines. Methods: This is a single center retrospective study done at University of Louisville, Brown Cancer Center. Data was collected on patients who had biopsy proven metastatic hormone positive breast cancer from July 2021 until May 2023 (n=41). Collected characteristics include age on diagnosis, tumor grade, sites of metastatic disease, first line treatment received, choice of CDK4/6 inhibitor if received, and prior exposure to chemotherapy or anti-estrogen therapy. Results: In our cohort of 41 patients, we found that 63.4% (n=26) of patients received an AI and CDK4/6 inhibitor in the first line. There were 4.88% (n=2) of patients who received AI monotherapy, 21.9% (n=9) received Fulvestrant and CDK4/6 inhibitor, 4.88 % (n=2) received AI and Fulvestrant and 4.88% (n=2) received Fulvestrant alone. In total, patients who received estrogen therapy plus CDK4/6 inhibitor totaled 85% of new patients (n=35). Conclusions: This internal review showed our institution to be compliant with endocrine therapy and CDK 4/6 inhibitor in front-line treatment for the majority of metastatic ER+ patients. Given the supportive data for use of CDK 4/6 inhibitors in front-line treatment, the compliance is expected to be much higher. We recommend continued discussion amongst oncology providers to help identify barriers to treatment and determine the causes for poor compliance in the state of Kentucky.

Utilization of long-acting injectable monthly depot buprenorphine for opioid use disorder (OUD) in Kentucky, before and after COVID-19 related buprenorphine access policy changes

IntroductionLong-acting injectable buprenorphine (LAI-bup) formulations have advantages over transmucosal buprenorphine (TM-bup), but barriers may limit their utilization. Several policies shifted during the COVID-19 pandemic to promote buprenorphine access. The federal government expanded telemedicine treatment for opioid use disorder and Kentucky (KY) Medicaid lifted prior authorization requirements (PAs) for LAI-bup (i.e., Sublocade®). This retrospective cohort study evaluated changes in LAI-bup access, utilization, and retention before and after these policy changes in KY. MethodsIndividual-level TM-bup and LAI-bup dispensing record data from KY's prescription drug monitoring program examined LAI-bup utilization and retention, without a >30-day gap in coverage, for patients starting a new episode of LAI-bup treatment. Two key time periods were examined: pre-policy changes (Apr 1, 2019 – Dec 31, 2019) and post-policy changes (Apr 1, 2020 – Dec 31, 2020). Data on PA requests among Medicaid managed care organizations and availability of LAI-bup Risk Evaluation and Mitigation Strategy (REMS)-certified pharmacies were also obtained. A multivariable Cox proportional hazard regression model analysis compared pre- versus post-policy period treatment discontinuation. ResultsThe number of patients initiating LAI-bup increased from 211 to 481 over the two periods. By the end of the post-policy period, 24.3 % of eligible patients were retained on LAI-bup, versus 12.5 % in the pre-policy change period. The adjusted hazard ratio, comparing discontinuation during the post- versus pre-policy change periods, was 0.70 (95 % confidence interval: 0.55–0.89). There were also more REMS-certified pharmacies and providers in the post-policy change period. ConclusionsLAI-bup access, utilization, and retention increased after several policy changes.

Cost of start-up activities to implement a community-level opioid overdose reduction intervention in the HEALing Communities Study

BackgroundCommunities That HEAL (CTH) is a novel, data-driven community-engaged intervention designed to reduce opioid overdose deaths by increasing community engagement, adoption of an integrated set of evidence-based practices, and delivering a communications campaign across healthcare, behavioral-health, criminal-legal, and other community-based settings. The implementation of such a complex initiative requires up-front investments of time and other expenditures (i.e., start-up costs). Despite the importance of these start-up costs in investment decisions to stakeholders, they are typically excluded from cost-effectiveness analyses. The objective of this study is to report a detailed analysis of CTH start-up costs pre-intervention implementation and to describe the relevance of these data for stakeholders to determine implementation feasibility.MethodsThis study is guided by the community perspective, reflecting the investments that a real-world community would need to incur to implement the CTH intervention. We adopted an activity-based costing approach, in which resources related to hiring, training, purchasing, and community dashboard creation were identified through macro- and micro-costing techniques from 34 communities with high rates of fatal opioid overdoses, across four states—Kentucky, Massachusetts, New York, and Ohio. Resources were identified and assigned a unit cost using administrative and semi-structured-interview data. All cost estimates were reported in 2019 dollars.ResultsState-level average and median start-up cost (representing 8–10 communities per state) were $268,657 and $175,683, respectively. Hiring and training represented 40%, equipment and infrastructure costs represented 24%, and dashboard creation represented 36% of the total average start-up cost. Comparatively, hiring and training represented 49%, purchasing costs represented 18%, and dashboard creation represented 34% of the total median start-up cost.ConclusionWe identified three distinct CTH hiring models that affected start-up costs: hospital-academic (Massachusetts), university-academic (Kentucky and Ohio), and community-leveraged (New York). Hiring, training, and purchasing start-up costs were lowest in New York due to existing local infrastructure. Community-based implementation similar to the New York model may have lower start-up costs due to leveraging of existing infrastructure, relationships, and support from local health departments.

Mourning the greatest: “unforgivably black” and peacefully Muslim Muhammad Ali

ABSTRACT When Muhammad Ali died in June 2016, media were filled with remembrances of the boxer. Some memories focused on what he meant to his home state of Kentucky, or how an individual had bonded with their father while watching Ali in the ring. Others focused on what Ali’s status as a celebrity Black Muslim man meant to them. The boxer who called himself “the Greatest” joined the Nation of Islam after his first fight with Sonny Liston in 1964 and later became a Sufi Muslim. Islam, in its many forms, is viewed with suspicion in the United States and Ali was likely the most visible Muslim American during his lifetime. This research examines how writers remembered Ali in the week after his death and identifies three themes which seemed most prominent: Ali as the proud Black Muslim man, Ali as freedom fighter, and Ali as an embodiment of peace.

Abstract 1103: Molecular signature for treatment-responsive and recurrent Wilms tumors

Abstract Wilms tumor is the most common solid renal malignancy in children. To better understand the biology of Wilms tumors and develop drugs especially against tumors that relapse, we sought to identify mutations in the exome, differential gene expression patterns, and tumor suppressor expression status of Wilms tumors in Kentucky. The Kentucky Cancer Registry (KCR) Virtual Tissue Repository identified 29 cases of Wilms tumor diagnosed between 2015 and 2021 at hospitals across the Commonwealth of Kentucky. The Markey Cancer Center Biospecimen Procurement and Translational Pathology Facility prepared tumor microarrays (TMAs) using Wilms tumor and matching normal tissue cores for immunohistochemistry (IHC) analysis. RNA-Seq analysis performed at the Markey Cancer Center Oncogenomics Facility identified a gene signature that was further validated by IHC and reverse-transcription quantitative-PCR (RT-qPCR). Outcome data provided by KCR indicated that increased expression of an anti-apoptotic protein in the tumor counter-intuitively provided better prognosis and outcome to treatment, indicating that the treatments either directly or indirectly targeted this protein. Loss of function of the tumor suppressor proteins in Par-4/PAWR, WT1 and p53 did not explain the higher expression of the cell survival protein. Our multidisciplinary team approach involves basic science/translational researchers, population scientists, biomedical informaticists, and clinicians and has resulted in well-characterized, Wilms tumor tissue microarrays. The next phase of the study is generating patient derived xenografts (PDXs) for a better understanding of Wilms tumor biology in children. Citation Format: Jieyun Jiang, Derek B. Allison, Ravshan Burikhanov, Saptadwipa Ganguly, Ryan A. Goettl, Jinpeng Liu, Chi Wang, Amanda F. Saltzman, Thomas Tucker, Peter H. Spielmann, Eric B. Durbin, John A. D’Orazio, Vivek M. Rangnekar. Molecular signature for treatment-responsive and recurrent Wilms tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1103.

Abstract P246: Geographical Mapping and Cluster Analysis of Ischemic Stroke in Kentucky

Background: Stroke death is the third leading cause of death in the United States, the sixth leading cause of death in Kentucky (KY), and ischemic stroke (IS) is the most prevalent type in adults (~85%). Small area estimates of stroke incidence can help identify local interventions to lower the burden of vascular risk factors and risk of recurrent IS in these areas. Therefore, the goals of this study are to calculate small area IS incidence rates, examine clusters, and understand the distribution of IS in KY. Methods: Data was obtained from the Kentucky Hospital Inpatient Discharge and Outpatient Services Databases (HIDOSD) from 2012 to 2021; and the Kentucky Cabinet for Health and Family Services. HIDOSD represents KY emergency department discharges, inpatient data, and ambulatory facility services. We linked 5-digit Zip codes to (n=759) zip code tabulation areas (ZCTA) available from the US Census Bureau. The annualized IS rate per 100,000 was calculated by dividing the mean number of IS hospitalizations from 2012 to 2021 by the ZCTA 2020 population. We categorized IS rates by quartiles and calculated box plots in descriptive analyses. We tested for significant spatial clusters using the Local Moran’s I with Empirical Bayes rate smoothing in GeoDa. Results: From 2012-2021, 90,840 IS hospitalizations were reported in KY. The median IS rate was 226.5 per 100,000. The median rate in the highest quartile was 290.8 (IQR 171.7 - 290.8) vs 171.7 (IQR 171.7 - 290.8) in the lowest quartile. An area of high IS rate clusters (n=20) was identified in southeastern KY with lower clusters dispersed throughout the state. Figure. Conclusions: This 10-year analysis of IS hospitalizations across KY identified areas of potential intervention. Future efforts are needed to identify the social and medical contributors driving burden of IS in these areas and to design interventions targeted to improve health outcomes.

The Productivity and Carbon Exchange of an Intensively Managed Pasture in Central Kentucky

Intensive pasture management that aims at providing season-long forage while minimizing soil degradation is increasingly becoming an important grazing strategy in Kentucky. Typically, it involves the use of high-yielding warm and cool season forage species that are well suited to local soil and climate conditions, meeting the dual-purpose provision of high nutritional value while remaining resilient to grazing pressure and changing climate. Monitoring carbon exchange is a crucial component for effective pasture management to promote sustainable pastureland management practices. We hypothesized that pasturelands, when intensively managed, would exhibit a small but important CO2 cumulative uptake year-round. We used the Eddy covariance method to measure the net ecosystem exchange of CO2 (NEE) and productivity of an intensively managed pastureland at Kentucky State University Research and Demonstration station from 2015 to 2020. The study has two objectives: to quantify interannual variability in net ecosystem exchange, and examine the controlling environmental factors, in particular temperature, sunlight, and precipitation of NEE. Diurnal and seasonal fluctuations followed typical patterns of carbon uptake and release. Overall, the pasture site consistently was carbon sink except for 2016, in part due to a warmer winter season than usual, sequestering 1394 gCm−2 over the study period. Precipitation and temperature were critical environmental factors underpinning seasonal CO2 uptake and release. Of critical importance was the net carbon uptake during the non-growing season.

Assessing Tornado Impacts in the State of Kentucky with a Focus on Demographics and Roadways Using a GIS-Based Approach

Although the literature provides valuable insight into tornado vulnerability and resilience, there are still research gaps in assessing tornadoes’ impact on communities and transportation infrastructure, especially in the wake of the rapidly changing frequency and strength of tornadoes due to climate change. In this study, we first investigated the relationship between tornado exposure and demographic-, socioeconomic-, and transportation-related factors in our study area, the state of Kentucky. Tornado exposures for each U.S. census block group (CBG) were calculated by utilizing spatial analysis methods such as kernel density estimation and zonal statistics. Tornadoes between 1950 and 2022 were utilized to calculate tornado density values as a surrogate variable for tornado exposure. Since tornado density varies over space, a multiscale geographically weighted regression model was employed to consider spatial heterogeneity over the study region rather than using global regression such as ordinary least squares (OLS). The findings indicated that tornado density varied over the study area. The southwest portion of Kentucky and Jefferson County, which has low residential density, showed high levels of tornado exposure. In addition, relationships between the selected factors and tornado exposure also changed over space. For example, transportation costs as a percentage of income for the regional typical household was found to be strongly associated with tornado exposure in southwest Kentucky, whereas areas close to Jefferson County indicated an opposite association. The second part of this study involves the quantification of the tornado impact on roadways by using two different methods, and results were mapped. Although in both methods the same regions were found to be impacted, the second method highlighted the central CBGs rather than the peripheries. Information gathered by such an investigation can assist authorities in identifying vulnerable regions from both transportation network and community perspectives. From tornado debris handling to community preparedness, this type of work has the potential to inform sustainability-focused plans and policies in the state of Kentucky.

Impact of real-time weather conditions on crash injury severity in Kentucky using the correlated random parameters logit model with heterogeneity in means

The present study investigated the impact of real-time weather (air temperature, relative humidity, precipitation, wind speed, and solar radiation) on crash injury severity. Recent crash data (January 2016 to April 2021) on Interstate-75 in the state of Kentucky were merged with real-time weather information (retrieved from Kentucky Mesonet stations) at the 1-hour level. The severity index “SI” (i.e., the ratio of percent severe crashes to percent exposure of a specific weather state during the crash period) was introduced to evaluate the impact of different real-time weather states on fatal and severe injury crashes. Furthermore, the standard mixed logit (MXL), correlated mixed logit (CMXL), and correlated mixed logit with heterogeneity in means (CMXLHM) models were fitted and compared to identify the risk factors contributing to crash injury severity while accounting for unobserved heterogeneity. The results showed that the CMXLHM model was statistically superior to the CMXL and MXL models based on various goodness-of-fit measures (e.g., Akaike information criterion “AIC” and McFadden pseudo R-squared). Results from the SI analysis and CMXLHM model showed that real-time weather-related factors (e.g., air temperature ≥ 70 0F and relative humidity ≥ 90 %) were significantly associated with higher severe injury likelihood. Further, driving under the influence (DUI), young drivers, and vehicle travel speed were associated with greater injury severities. On the other hand, presence of horizontal curve, passenger cars, and hourly traffic volume were associated with lower injury severity likelihood. The study outcomes can help in incident management by suggesting specific real-time weather-related states to feed to dynamic message signs (DMS) to enhance travelers’ safety along the interstates.

Comparing the Demographic Characteristics of Victims of Sexual Assault in Rural Versus Urban Areas.

In 2019, over 459,000 persons in the United States survived sexual assault, and 21%-26% sought medical treatment. Ideally, trained medical professionals who understand the unique physical and mental health needs of this patient population, such as forensic nurses, would provide care. Yet, the care that forensic nurses and other healthcare providers can offer to sexual violence/abuse survivors is hindered by the lack of understanding of the demographics of those who seek care. With the delineation of highly affected demographic groups, barriers to care can be addressed. This study compared rates, demographic characteristics, acuity, and codes for sexual violence/abuse encounters experienced by those patients residing in rural versus urban counties of Kentucky (KY). This included encounters before and after SARS-CoV-2. Deidentified claims data were extracted for patient encounters billed with the International Classification of Diseases, 10th Revision, Clinical Modification for sexual violence/abuse seen at a university healthcare center serving the Northeastern, Southeastern, and Central regions of KY from October 2015 to February 2021. Analysis comprised descriptive statistics, independent samples t tests, and chi-square tests of association. Significant demographic differences were identified between the two groups. The mean age of those residing in rural areas was significantly younger than those living in urban areas. Similarly, the percentage of male survivors was significantly higher in the rural population. The racial composition also differed, with higher percentages of survivors being Black and Hispanic in the urban population, relative to rural dwellers. Findings suggest that rural youth (especially boys aged 10 years and younger) and urban minorities are at a higher risk for sexual violence/abuse in KY when compared with their counterparts (i.e., urban youth and rural minorities).

Trends in Infective Endocarditis Mortality in the United States: 1999 to 2020: A Cause for Alarm.

Data on national trends in mortality due to infective endocarditis (IE) in the United States are limited. Utilizing the multiple causes of death data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database from 1999 to 2020, IE and substance use were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. Between 1999 and 2020, the IE-related age-adjusted mortality rates declined. IE-related crude mortality accelerated significantly in the age groups 25-34 years (average annual percentage change, 5.4 [95% CI, 3.1-7.7]; P<0.001) and 35-44 years (average annual percentage change, 2.3 [95% CI, 1.3-3.3]; P<0.001), but remained stagnant in those aged 45-54 years (average annual percentage change, 0.5 [95% CI, -1.9 to 3]; P=0.684), and showed a significant decline in those aged ≥55 years. A concomitant substance use disorder as multiple causes of death in those with IE increased drastically in the 25-44 years age group (P<0.001). The states of Kentucky, Tennessee, and West Virginia showed an acceleration in age-adjusted mortality rates in contrast to other states, where there was predominantly a decline or static trend for IE. Age-adjusted mortality rates due to IE in the overall population have declined. The marked acceleration in mortality in the 25- to 44-year age group is a cause for alarm. Regional differences with acceleration in IE mortality rates were noted in Kentucky, Tennessee, and West Virginia. We speculate that this acceleration was likely due mainly to the opioid crisis that has engulfed several states and involved principally younger adults.

Rural disparities in emergency department utilization for migraine care.

To evaluate differences in emergency department (ED) utilization and quality of care for migraine in patients with rural and nonrural residences. Migraine is a significant problem in the United States with direct health-care utilization cost amounting to US $4.2 billion annually. A considerable portion of this cost is attributed to more than 4 million annual ED visits for migraine and headache. Previous research has documented health disparities among rural populations in other disease states, which can be influenced by factors such as socioeconomic status and health-care access. Given these associations, it was hypothesized that patients with rural residence in a national sample would have increased ED utilization for migraine compared to patients with nonrural residence. This was a cross-sectional epidemiologic study to evaluate rural disparities in ED utilization and quality of care for migraine in the United States in 2019. ED encounter data were collected from the Healthcare Cost and Utilization Project (HCUP) Nationwide Emergency Department Sample (NEDS) and Kentucky State Emergency Department Database (KY-SEDD). The primary outcome was crude and age-adjusted rates of ED encounters for migraine per 10,000 population. ED encounters were included if they had a primary International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code of G43.xx. ED encounters lacking sufficient data to classify into a geographic group were excluded. Secondary outcomes examined differences in quality of care, including mean ED charges and the proportion of encounters with medication administration, imaging, and nerve block service codes between groups. One hundred eighty-three thousand two hundred eleven national ED discharges were classified as rural patient encounters and 627,176 were classified as nonrural. The rural group had significantly higher crude and age-adjusted rates of ED utilization for migraine (crude: rural 39.8, 95% confidence interval [CI] 36.9-42.7; nonrural 22.2, 95% CI 21-23.5 and age-adjusted: rural 41.8, 95% CI 38.8-44.8; nonrural 23.4, 95% CI 22.1-24.7). Opioid utilization was higher in rural encounters (rural n = 26,764, 14.6%; nonrural n = 50,367, 8%; p < 0.001). A Kentucky sub-analysis found 5210 ED discharges were classified as Appalachian and 12,551 as non-Appalachian. The Appalachian group had significantly higher ED utilization rates for migraine compared to the non-Appalachian and national rural groups (crude: Appalachian 44.9, 95% CI 43.7-46.2; age-adjusted: Appalachian 47.4, 95% CI 46.1-48.8). The Kentucky Appalachian group also demonstrated significantly higher opioid analgesia use compared to the national rural group (Appalachian n = 1031, 19.8%; p < 0.001). This study suggests rural populations, particularly in Appalachia, may experience significantly higher ED utilization for migraine compared to nonrural patients. Moreover, rural populations were more likely to receive suboptimal migraine management with opioid analgesia. Multimodal health-care interventions should be developed to improve access to outpatient migraine care and further investigate potential risk factors in the rural population. With high ED utilization, the Appalachian population may benefit most from such an intervention.

Bystander preference for naloxone products: a field experiment

BackgroundBystander administration of naloxone is a critical strategy to mitigate opioid overdose mortality. To ensure bystanders’ willingness to carry and administer naloxone in response to a suspected overdose, it is critical to select products for community distribution with the highest likelihood of being utilized. This study examines bystanders’ preference for and willingness to administer three naloxone products approved by the FDA for bystander use and identify product features driving preference.MethodsThe population was a convenience sample of individuals who attended the Kentucky State Fair, August 18–28, 2022, in Louisville, Kentucky. Participants (n = 503) watched a standardized overdose education and naloxone training video, rated their willingness to administer each of three products (i.e., higher-dose nasal spray, lower-dose nasal spray, intramuscular injection), selected a product to take home, and rated factors affecting choice.ResultsAfter training, 44.4% chose the higher-dose nasal spray, 30.1% chose the intramuscular injection, and 25.5% chose the lower-dose nasal spray. Factors most influencing choice on a 10-point Likert scale were ease of use (9 [7–10]), naloxone dose (8 [5–10]), and product familiarity (5 [5–9]).ConclusionsBystanders expressed high willingness to administer all studied formulations of naloxone products. Product choice preference varied as a function of product features. As the number and variety of available products continue to increase, continuous evaluation of formulation acceptability, in addition to including individuals with lived experience who are receiving and administering overdose reversal agents, is critical to support adoption and save lives.

1529. Factors Associated With HIV-positive Test Results in People Who Inject Drugs

Abstract Background Syringe Services Programs (SSP) are essential for harm reduction among persons who inject drugs (PWID). The Kentucky Income Reinvestment Program (KIRP), a statewide program funded through the Ryan White HIV/AIDS Program, provides comprehensive early intervention services targeting those at highest risk for HIV infection. As KIRP provides testing at SSPs and at other venues serving PWID, we sought to compare factors associated with a positive HIV test result between SSP sites and community testing sites. Methods We conducted a cross-sectional study across the state of Kentucky from January 2022 to March 2023. We compared the demographic characteristics of PWID tested across 54 SSPs versus PWID tested at KIRP outreach events (substance abuse treatment centers, correctional facilities, shelters, etc.); and factors associated with an HIV-positive test result. Study data were collected and managed using a REDCap database. The statistical analyses, including logistic regression, were performed with Stata 17 (College Station, TX: Stata Corp LLC). Results In the study period, 20,397 PWID were tested for HIV, 10,058 in the outreach events, and 10,339 at SSPs. The median age was 39 (IQR 32 – 46) years; 11,075 (54.3%) were male, 18,905 (92.7%) were white, and 550 (6.7%) reported MSM behavior. Outreach events were superior in reaching racial and ethnic minority groups. (Table 1). The HIV-positive rate was higher in the outreach group (0.37% vs. 0.15%; p=0.003). In a multivariate model, PWID not engaged with an SSP were significantly associated with higher HIV incidence when adjusted by gender, race, and sexual risk factors for HIV acquisition.Table 1.Demographic characteristics of the PWID tested for HIV by test location.Table 2.Factors associated with an HIV-positive test in PWID. Conclusion SSPs provide comprehensive harm reduction services, and, in our study, reduced HIV incidence amongst participants. We were able to reach more underrepresented populations with testing at outreach sites, which also serve PWID. To end the HIV epidemic, and increase prevention services, enrollment of underrepresented populations into SSP services is paramount. Disclosures All Authors: No reported disclosures

Antimicrobial IV to PO switch practices at 9 institutions in Kentucky with Established Antimicrobial Stewardship Programs

Context Intravenous (IV) to oral (PO) transition of antimicrobial therapy is a common antimicrobial stewardship activity. Inpatient institutions seeking to create new IV to PO switch services or enhance existing services may benefit from a review of practices utilized at other institutions. Objective The objective of this review is to summarize IV to PO switch practices utilized by healthcare institutions with established antimicrobial stewardship programs across Kentucky. Methods The Kentucky Antimicrobial Stewardship Innovation Consortium (KASIC) invited pharmacists on the Advisory Board to share current IV to PO switch practices utilized at their institutions. The submitted documents were evaluated in a systematic approach and summarized. Results Nine of ten institutions represented by the Advisory Board submitted an IV to PO switch practice document for analysis. All institutions utilized pharmacist-driven protocols to allow automatic conversion from IV to PO for select antimicrobials based on specific patient criteria. All protocols included the following antimicrobials eligible for conversion: azithromycin, doxycycline, fluconazole, levofloxacin, linezolid, and metronidazole. Majority of protocols also had inclusion and exclusion criteria based on patient specific factors such as ability to use the enteral route, clinical stability, and infection type. There was variation in the level of restriction placed on conversion eligibility criteria among protocols. Conclusion IV to PO switch practices for antimicrobials vary across the state of Kentucky. Institutions should tailor protocols based on specific needs, clinical leadership support, and feasibility of implementation.

Spatial effort displacement in Florida commercial reef fisheries after red tides

Red tides have affected marine and coastal communities for centuries. The effects of red tides on commercial capture fisheries have rarely been evaluated, owing in part to a lack of appropriate data. Leveraging modeled maps of red tide severity, vessel monitoring systems data, and logbook records, we investigated the commercial fisheries impacts of red tide events in Florida during the period 2008–2019. We focused on the bottom longline and vertical line fisheries targeting reef fishes. Red tides were punctuated events peaking at the end of summer, with 2018 and 2019 the most intense years. The total area affected by intense red tides (concentrations> 1,000 cells/L) was 103,483 km2, about the size of the state of Kentucky. Red tides did not have negative effect on fleet-level fisheries metrics such as number of fishing vessels, trips, fishing effort or revenue (generalized mixed effect models, p > 0.5). Fishing effort was, however, displaced from the red tide areas, and fishers avoided areas characterized by intense blooms (zero-inflated negative binomial model, p < 0.001). Follow up of the long-term likely responses of the resource and the catch are needed to fully understand the consequences of red tide events in commercial fisheries in the Gulf of Mexico.