Why Am I Here? Choristers' Perception of the University-Community Choir: An Abstract

Pre-COVID-19 pandemic years have seen an increase in experience-related services such as travel, events, or creative pursuits. Spending on such services increased four times faster than those on goods, signaling shifts in consumer behavior (Goldman et al., 2017). Due to COVID-19, nations restricted mass gatherings, limiting group activities. Large group musical performance activities, such as choral singing, were severely affected by public health restrictions. Meanwhile, leisure activities were found to be essential for participants' well-being (Jacob et al., 2009). As restrictions lift, the question remains: will large group activities regain their place amongst leisure activities in the post-pandemic world? We examine the motivations and perceived benefits of choir membership to evaluate the practices and strategies for chorister recruitment and retention in the pre- and post-pandemic environment within the context of a Northern Ontario-based university-community choir-Near North Voices (NNV) (North Bay, ON). Data was collected via online survey through NNV's email list and member-only Facebook page. The study is comprised of two stages. In Stage 1 (Fall 2015), we examined choristers' perceived benefits, motivation, and involvement in the choir. The results, derived from the final sample of 55 participants (RR: 44.7%), revealed a range of personal and community benefits that affected participants' decisions to join the choir. Positive emotions, physical health, sense of belonging, personal challenge, and self-accomplishment were the strongest perceived benefits. The choristers were strongly motivated by love for singing, music, and/or performance, as well as personal connections, need for belonging, and personal challenge. In Stage 2 (Spring 2022), we examined the impact of the COVID-19 imposed suspension on choristers' perceptions of benefits of choral participation, on their well-being, and the anticipated challenges of recruitment and retention for the post-COVID resumption of choral activities. The results, based on the final sample of 34 respondents (RR: 41.9%), indicate that almost half the sample (47.1%) undertook new leisure activities (e.g., TV streaming, virtual church and community choirs, yoga, skiing, cooking/baking). The suspension of choral activities had a major/severe impact on 39.3% and moderate impact on 36.3% of the participants. ‘Feeling of loss', absence of social contact, and ‘missing singing with others' were among the most frequently mentioned impacts of the suspension, which also helped the participants appreciate ‘how much they were benefitting' from choir participation. When asked about their well-being two weeks prior to the survey, 30.3% fell into the lower end of the WHO-5 Well-Being Index (Topp et al., 2015), while 27.3% reported the best imaginable well-being. The majority (72.7%) indicated that they would rejoin NNV rehearsals once restrictions are lifted. Fear of infection, availability of safe and appropriate venues to ensure distancing and air circulation were among frequently cited concerns for recruitment and retention in the post-pandemic environment. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Emergency remote instruction in 2020: Differential impacts on science, technology, engineering, and mathematics students' confidence and belonging, by gender, race/ethnicity, and socioeconomic status

The COVID-19 pandemic forced higher education into emergency remote instruction in 2020. Impacts of this modality shift on undergraduates of different identities are important to document, for both current students who need support now and future students who may face other crises. A large survey in the United States asked students in science, technology, engineering, and mathematics (STEM) to report the impact of emergency remote instruction on their confidence to succeed and sense of belonging in STEM. Using those data, we find that the impact varies by gender, race/ethnicity, and socioeconomic status (SES). For instance, 63.3% of lower SES women identifying as underrepresented racial/ethnic minorities (URM) reported a decrease in their confidence to succeed, compared to 38.9% of non-URM, higher SES men who reported a decrease. On the other hand, 35.3% of URM, lower SES men reported that emergency remote instruction increased their sense of belonging, compared to 15.9% of non-URM, higher SES women. The large percentage reporting increased belonging was unexpected and adds to calls for more research into the experiences of URM men. Our results suggest researchers, instructors, and administrators working to mitigate shocks to higher education must consider multiple identities and take an intersectional view, because impacts of these crises are not neutral with respect to gender, race/ethnicity, and SES.

Comparing the Delta and Omicron waves - are calmer waters ahead?

Introduction: The SARS-CoV-2 pandemic has disproportionately affected obstetric patients, with outcomes differing between viral variants. The Delta variant was associated with more severe disease than previous variants [1]. The Omicron variant exhibits increased transmissibility and became predominant by mid-December 2021 [2]. We aimed to compare outcomes between women presenting in Delta and Omicron waves at our tertiary obstetric centre. Methods: Caldicott Guardian approval was obtained and ethical approval waived. All women admitted to Princess Royal Maternity, Glasgow, between 01/05/2021–30/11/2021 (Delta) and 01/12/2021– 27/01/2022 (Omicron) with a positive SARS-CoV-2 test were included. Womenwere assigned a primary diagnosis of COVID-19 if admitted for >24 h due to symptoms of SARS-CoV-2 infection. Advanced respiratory support was defined as continuous positive airway pressure, high flow nasal oxygen or ventilation. Results: Forty-eight women had confirmed SARS-CoV-2 infection during the 7-month Delta wave, compared with 29 in the 2-month Omicron wave. Women were more likely have COVID-19 as a primary diagnosis in the Delta compared with Omicron wave (Table). Patients admitted during the Omicron compared with Delta wave were less likely to require advanced respiratory support or be admitted to critical care. There were two emergent deliveries performed in critical care during the Delta wave, and none in the Omicron wave. (Table Presented) Discussion:We observed reduced disease severity during the Omicron wave: women admitted during this time were more likely to have SARS-CoV-2 as an incidental diagnosis, with reduced requirements for advanced respiratory support and critical care. The increased number of cases likely reflects the high transmissibility of this variant, having implications for resource management and service provision. Our data are from a single centre, and we await further data on the effect of the Omicron variant in obstetric patients.

Vaccine uptake in the obstetric population - too little too late?

Introduction: Since April 2021, UK guidance recommends pregnant women should be vaccinated against SARS-CoV-2. Vaccine uptake in this population is low, though reasons for this remain poorly understood [1,2]. We aimed to characterise uptake of SARS-CoV-2 vaccines in patients admitted to two inner-city maternity units (∼8500 deliveries per year). Methods: Caldicott Guardian approval was obtained and formal ethical review was waived. All obstetric patients admitted to Princess Royal Maternity, Glasgow, and Royal Alexandra Hospital, Paisley, between 1 May 2021 and 23 January 2022 and who tested positive for SARS-CoV-2 were included. Results: There were 98 women (median [IQR] age 29.5 [26–34] years, white ethnicity 74/98 [76%], most deprived socioeconomic quintile 56/ 98 [57%]). 19/98 women (19%) had received any SARS-CoV-2 vaccine prior to infection with 9/19 receiving their first vaccine pre-pregnancy and 10/19 during pregnancy at median (IQR) 22.3 (13.8–25.0) weeks gestation. 11/98 women (11%) had received two vaccines before infection. Oxygenwas required in 32/79 (41%) of unvaccinatedwomen and 3/19 (16%) women who had received any vaccine prior to infection. No double-vaccinated women required oxygen or critical care admission. 24 women (25%) received a first vaccine after delivery and 56 women (57%) remain unvaccinated. Discussion: Vaccine uptake was poor in this inner-city cohort, with only 19% and 11% having received any or two vaccines respectively prior to SARS-CoV-2 infection. Of those who had received any vaccine before infection, just over half received this during pregnancy. In a Scottish population study, 42.8% of all women giving birth in October 2021 had received any dose and 32.3% of women had received two doses [1]. The lower rates in our cohort may reflect our population being skewed towards more deprived groups. Our data supports the need for two vaccines for effective protection against severe COVID-19. Barriers to vaccination require urgent attention. (Figure Presented)

Impact of imaging modality choices on emergency department length of stay for patients with renal colic

Introduction & Objectives: Renal colic is a common presentation to emergency departments. Non-contrast CT is the gold standard for diagnosing ureteric stones. Ultrasound (USS) is also commonly used, however has lower sensitivity and specificity. Uncertainty in imaging findings can delay diagnosis and thereby prolong the length of stay (LoS) in the emergency department. The aim of this study was to assess the current imaging practices for assessment renal colic in the emergency department setting and the impact of imaging modality choices on patient flow. Methods: Patient presentations were identified from Emergency Department Information System for renal colic and urinary calculus diagnosis codes from October 2019 to September 2020. This was correlated with radiology departmental records for imaging modalities used. Clinical records were reviewed for demographics, LoS, disposition, imaging findings and radiation dose. Results: 590 presentations were identified, with 431 first presentations, 86 re-presentations (within 30 days) and 73 interhospital transfers. Imaging was performed in 74.7% of presentations (n = 441). Patients had a median age of 46 years and were mostly male (69%). 73.3% of first presentations had CT as first-line imaging. Those who had USS as first-line imaging were predominantly female (59%) and younger (mean 31.1 vs 46.6 years, p<0.01). They had longer total LOS when compared to CT for first presentations (mean 604 vs 443 minutes, p < 0.01) and all presentations (mean 599 vs 440 minutes, p<0.01). Compared to CT +/- abdominal x-ray, patients having USS were more likely to be admitted to the short stay unit (71.4% vs 43.7%) for longer periods (mean 511 vs 401 minutes, p = 0.05). 17% of patients who initially had USS subsequently had a CT, with this group having the longest mean LoS (total 713 minutes, short stay 720 minutes). Conclusions: USS is more likely to be used in younger and female patients. Compared to CT, first-line USS in renal colic correlated with longer time spent in ED, more admissions to short stay and longer LoS in short stay. Given constraints on hospital resources with the Covid-19 pandemic, renal colic imaging pathways should be examined for opportunities to improve patient flow.

Strategies for teaching idea generation for project-based learning and adapting these approaches to an on-line environment

Problem solving is a key skill for engineers and innovative problem solving relies on effective idea generation. Over several years a blended learning approach to teach idea generation has been developed at Massey University, Palmerston North, New Zealand. This article describes the approach which includes an on-line pre-workshop module followed by an in-person workshop. In the workshop students work in teams and generate ideas for a given scenario using different idea generation methods. Ideas are then shared, and students reflect on the methods they have used. In 2021 the in-person workshop was moved on-line due to a Covid-19 lockdown. The workshop was redesigned to use breakout rooms in Zoom and Google Docs were used to enable students within the team to share their ideas in a safe environment, while at the same time allowing staff to monitor progress and offer assistance when needed. While the on-line workshop was successful at teaching idea generation techniques, it was not possible to replicate the same environment as the in-person workshop. © WIETE 2022

Impact of the Covid pandemic on health care equity in NHS General Dental Practice.

INTRODUCTION: Oral health inequalities existed before Covid, but the pandemic presented an unprecedented challenge for health services. Our aim was to determine whether patient groups at risk of health care inequality due to the pandemic could be identified from NHS dental claims. METHODS: Secondary analysis of routinely collected NHS Business Services Authority data for patients treated by General Dental Practitioners in England and Wales between April 2019 and January 2022 to assess the effect of the Covid pandemic on claims for patients attending general dental practices. Data for treatment items claimed after the start of the first lockdown were compared to the pre-lockdown period. RESULTS: The proportion of claims for child fillings, child extractions and child fluoride varnish application after March 2020 were lower than equivalent proportions for adults, in both England and Wales. Similarly, there were consistently fewer claims for fillings and extractions for patients claiming pension credit guarantee credit than all pensioners in both England and Wales. CONCLUSION: The Covid pandemic may have caused health care inequality for children and patients claiming pension credit guarantee credit. This may compound the inequality in oral health for these patients.

A retrospective analysis of Klebsiella bloodstream infections in critically ill patients over a five-year period

Introduction: This study aimed to identify Klebsiella spp. bloodstream infections (KBSIs) in critically ill patients, characterising potential risk factors and targets for intervention. Methods: A retrospective analysis of blood cultures submitted to the Clinical Microbiology and Public Health Laboratory between 2015 and 2020, together with data from the Public Health England Data Capture System, was performed to identify KBSIs. Electronic patient records were reviewed for potential sources and risk factors. Results: Klebsiella spp. were the second leading cause of Gram-negative BSIs in critically ill patients, after E. coli (82 KBSIs over five years). Almost two-thirds (62.2%) were nosocomial. Median age was 64.3 years (IQR: 50.2–71.2), 62.2% were male and case fatality rate was 22%. Comorbidities included ‘Cardiovascular’ (48.8%), ‘Respiratory’ (37.8%), ‘Gastrointestinal’ (37.8%), ‘Endocrine’ (35.4%) and ‘Surgery’ (35.4%). Common sources were ‘Line’ (36.6%), ‘Urinary Tract’ (25.6%) and ‘Gastrointestinal’ (11.0%). 54.3% of sputum/BAL, 33.3% of line and 14.9% of urine cultures grew Klebsiella within 2 weeks of a KBSI. Ventilator use (76.5%) and pneumonia (51.0%) were common prior to hospital-onset KBSIs. KBSIs numbers peaked in April-June 2020, coinciding with the first wave of COVID-19. Discussion: This study presents a current overview of characteristics of KBSIs in critically ill patients. We speculate that the high rates of positive sputum/BAL and line cultures associated with nosocomial infections, signify pneumonia and subsequent line contamination as a potential cause of KBSIs. This could have important consequences in context of the COVID-19 pandemic and highlights the importance of intravascular catheter care in the prevention of KBSIs.

Prescriber Perceptions on Utilization of the Antibiotic Self-Stewardship Time Out Program (SSTOP) at Veterans Affairs Medical Centers (VAMC): A Strategy for Improved Antibiotic Use

Background. Evidence is lacking on how to implement effective and sustainable antibiotic stewardship strategies. The Antibiotic Self-Stewardship Time Out Program (SSTOP) evaluated the implementation at VAMCs of an "Antibiotic Timeout" 3 days after the initiation of antibiotics to encourage providers to review continued use of broad-spectrum antibiotics. Methods. Sites launched the SSTOP note templates in a rolling fashion from June 2019-March 2020. Clinical pharmacists largely drove the implementation. The vancomycin note template was implemented at 6 of 8 sites and the antipseudomonal note template across 4 of 8 sites. Two sites were unable to launch the note templates due to lack of resources, however they utilized SSTOP principles/guided tools. From Sept 2019-Nov 2020 we conducted post-launch qualitative interviews with Antibiotic Stewardship Program (ASP) champions involved in implementation across the 8 VAMCs. Interviews were transcribed and analyzed for thematic content. Results. Feedback from ASP providers suggests prescribers had mixed reviews on the note template, but overall liked the process and deemed it to be straightforward. Many valued the algorithm, indicating it was helpful in both thinking about antibiotics prior to initiation, and identification of appropriate antibiotics. Barriers included staffing (e.g., rotating residents/turnover), surgery service, information technology (IT) support, COVID-19, and the need to remind providers to use the template. Facilitators consisted of strong stewardship, local champions (e.g., ID Fellow), medicine service, and SSTOP data feedback reports. Recommendations largely centered on improvements to the note template usability and to SSTOP feedback reports (e.g., inclusion of patient/provider-level data). Conclusion. Overall, the SSTOP note templates were considered acceptable and straightforward. By guiding providers to prescribe more appropriate antibiotics, they act as influencers for practice change, and may strengthen provider/ASP relations. Plans for continued utilization of the note templates after the project concludes suggest SSTOP may serve as a way to achieve sustainable promotion of antibiotic use improvements.

Teaching Structures in an (Almost) Empty Room: An Assessment of Strategies for Student Engagement in Mixed-mode and Remote Classes

Newly imposed educational delivery modalities such as mixed-mode or fully remote instruction due to the Covid-19 pandemic have resulted in creative, innovative instructional approaches to undergraduate engineering education. However, given the unique circumstances caused by the pandemic and the constraints it placed on students, some instructional techniques have been more successful than others. It is crucial for future efforts in remote and hybrid teaching environments to use this opportunity to document the realized benefits, unforeseen negative consequences, and student perceptions of various teaching strategies. This paper traces lessons learned through mixed-mode and remote instruction of structural engineering courses for three different courses and student populations: (1) introduction to steel design and (2) indeterminate analysis for structural engineering concentrators, and (3) steel and concrete design for engineering concentrators in other sub-disciplines. Across these courses, initial teaching strategies included a mixture of flipped classroom, traditional lectures, and interactive group problem solving. Collectively, the instructors determined through ongoing formal and informal student surveys, as well as additional unstructured feedback, that proposed teaching strategies required adjustments as the semester progressed. Some technological limitations were discovered after rigorous testing with live students, while successful technological strategies included digital problem sessions with document cameras, and chat-based questions with discussions. Furthermore, depending on course size and student population, students tended to engage more readily compared to verbal questions directed to the instructor during remote live classes. This engagement varied among written e-mails and chats, discussion boards, and Teaching Assistant (TA) office hours. To build on initial findings from individual course feedback, all three classes were evaluated using a common mid-term and end-of-term survey soliciting student reactions to content delivery, technology aides, and interactions with instructors/TAs. Overall, lessons learned through mixed-mode and remote instruction in structural engineering can inform future educators in this field, reducing time spent surveying available technologies and pointing towards strategies shown to be effective in this context. © American Society for Engineering Education, 2021

Demand for regional level III neonatal services is not reduced during national COVID lockdowns.

Following the first peak of the COVID-19 pandemic, reports from around the world suggested a reduction in preterm deliveries during lockdown periods. We reviewed preterm admissions to a large tertiary neonatal unit in inner North East London during two United Kingdom (UK) national lockdowns in 2020 and 2021. We found no evidence of difference in admissions during two national lockdowns compared to previous years. Based on these findings, we recommend that neonatal services remain as vigilant and prepared as ever for the unpredictable nature of preterm birth, and their staff protected to provide this highly specialist care.

Comparison of all-cause mortality in England with Europe and the USA: January 2020 to February 2021

Background Assessing mortality during the COVID-19 pandemic is vital for informing public health strategies and policy decision making. All-cause excess mortality provides an objective measure of the impact of the pandemic including both the direct and indirect effects. Our study considers the burden of mortality in the UK, Europe and the USA. We examine variation between countries, by age and sex. We explore the extent to which this variation is associated with COVID-19 case rates and other population characteristics. Methods The study is a secondary analysis of routine administrative population and mortality data. Weekly death occurrences and population estimates were obtained from Eurostat and national statistical agencies. Contextual information on COVID-19 case rates, population-level risk factors and healthcare were obtained from various open-source databases. Weekly age-standardised mortality rates (ASMRs) were calculated and presented relative to a baseline average from the preceding 5-year period. Relative cumulative (rc) ASMRs were then calculated to provide a comparable assessment of excess mortality at a point in time. Results Preliminary results show that, by end of the analysis period, England had an overall rcASMR of 10.09%. Higher excess mortality was identified for some countries (eg USA 14.58%) and lower - even below average mortality - for others (eg Norway -6.8%). Under 65 rcASMR showed substantial variation between countries. Cumulative COVID-19 case rates showed a moderate effect size (R2 = 0.51) when used to explain the proportion of variation observed between rcASMRs. Other population factors showed a smaller effect. Conclusions The burden of mortality experienced between countries and populations over the COVID-19 pandemic period has shown significant variation. Factors which may have contributed to the position of some countries should be further explored in order to inform ongoing management of Covid-19 and future pandemic events. Key messages Significant variation in all-cause excess mortality has been identified across the COVID-19 pandemic period between nations and particularly in younger age groups. COVID-19 case rates are associated with relative cumulative all-cause excess mortality among the nations assessed.

Quality improvement project: Improving documentation and junior doctor confidence on covid-19 ward rounds using a ward round pro forma

Introduction.: Templates and checklists have improved patient outcomes in multiple settings.1,2 There are barriers in junior doctors scribing complete entries using blank sheets;patient care might suffer due to incomplete records. This project implemented a ward round proforma across three wards of a tertiary hospital containing high risk COVID-19 patients, aiming to improve both documentation rates and subsequent ease in finding pertinent information. Methods.: Respiratory consultants determined 11 key parameters that should be documented daily for COVID-19 patients. Baseline objective data collection analysed all high-care ward round entries (n=15), recording parameters as present or absent. Multidisciplinary team (MDT) opinions were collected via questionnaire. The pro-forma was trialled for two-weeks;repeated subjective and objective analysis was performed. All (n=12) inpatient notes on the COVID-19 high-care ward were analysed. Results/Discussion.: Pro-forma compliance was 100%. The mean number of key parameters documented per ward round entry increased by 80%, from 5 to 9. Eleven (100%) of the key parameters showed increased completion rates (fig.1). Junior doctor confidence increased 1-Likert point: 'average' to 'confident' (fig.2). 97% of respondents (n=31) reported the pro forma saved time. Information finding and swab tracking both increased by 1-Likert point: 'average' to 'easy' (fig.2). From a medico-legal perspective, documentation of basic information (date, time) improved by 13%. This project shows not only a 60% increase in ceiling of care documentation, but also improved ease in accessing such information. Conclusion.: This pro-forma is a simple and acceptable intervention to improve documentation rates and information accessibility, giving junior doctors more confidence.

Stock market reactions to favorable and unfavorable information security events: A systematic literature review

The rapid digital transformations across every industry sector, accelerated partly due to the COVID-19 pandemic, have increased organizations’ use of information systems for operational and strategic purposes. These organizational responses have led to a confluence of digital, biological, and physical technologies that are revolutionizing business practices and workflows. But accompanying the pervasive use of digital technologies and the evolutionary nature of digital assets, is a shifting world of cyberattacks and information security (ISec) cybercrimes. Dynamic cybercrimes make it increasingly difficult for managers and researchers to anticipate the types, magnitude, and severity of future information security (ISec) breaches. Thus, we perform a systematic literature review (SLR) that explores, gathers, and categorizes event studies to examine the influence of favorable and unfavorable ISec events on stock markets. We extend the research conducted by Spanos and Angelis (2016) and provide a comprehensive understanding of the market's efficiency to process public information released about ISec events, ISec contingency factors, and the influence of ISec events on stock prices and factors other than price. Our systematic search reveals 58 relevant papers that include 80 studies. We find that in 75% of the studies ISec events can significantly affect a company's stock market performance, and that such effects are primarily exhibited within two days before and after the event day. Further, the magnitude of abnormal returns is higher in studies examining unfavorable ISec events, such as ISec breaches, compared to abnormal returns from favorable events, such as ISec investments and ISec certifications. In the end, our SLR serves as a foundation for ISec and management communities to build upon to keep industry and academia apprised of continually developing trends, new attack vectors and types of data breaches, protective ISec behaviors and programs, and their subsequent influences on stock market values and returns. © 2021 Elsevier Ltd

P.19 Characteristics of SARS-CoV-2 positive obstetric patients within one UK health board

Introduction: The obstetric impact of COVID-19 remains undetermined, with case series scarce and reported outcomes variable. The UK Obstetric Surveillance System (UKOSS) recently reported on a national cohort of pregnant women who required hospital admission due to COVID-19 between March and April 2020.1 We aimed to assess the demographics and outcomes for obstetric patients with COVID-19 infection within our Scottish, inner-city health board and compare this against that reported by UKOSS. Methods: Caldicott Guardian approval was obtained and the requirement for ethical approval waved by the local research ethics service. All female patients of child-bearing age (age 16–49) with a positive SARS-CoV-2 test between 16 March – 3 June 2020 were identified by the local Infection Prevention and Control team. These data were cross-referenced with local electronic notes systems to identify pregnant or recently pregnant women (within 6 weeks post-partum). Collected data were de-identified prior to analysis and analyses performed using R statistical software. Descriptive statistics are reported with results expressed as mean (SD), median [IQR], or n (%). Results: In total, 741 eligible women tested positive for SARS-CoV-2 within the study period. Twenty-three (3%) were pregnant or recently pregnant, with 14 of these women (60%) requiring hospital admission (representing 5.1 cases per 1000 maternities). All identified patients of Black or Asian ethnicity were admitted to hospital (5 in total), whilst only 47% of women of white ethnicity were admitted. The most common symptoms in admitted patients were cough (present in 64% of cases) and fever (present in 57% of cases). Amongst admitted patients, median age was 31.5 [29.3–34.0], median gestation at diagnosis 30.5 [24.3–37.5] weeks and 6 patients (43%) had a booking BMI [Formula presented]0 kg/m2. Three hospitalised patients (21.4%) required oxygen therapy and one required post-operative ICU monitoring. Two fetal losses occurred before 22 weeks gestation. No neonatal deaths occurred and no infants tested positive for SARS-CoV-2. Discussion: During this “first wave” of the pandemic, rates of COVID-19 were in keeping with those reported by UKOSS. This may reflect local adherence to shielding advice, or that testing was performed only on symptomatic patients. Also in keeping with results from UKOSS, patients from minority ethnic groups (and those with high BMIs) were over represented in hospital admission rates. All patients studied have subsequently been discharged home and mainly required level 1 care during admission. Numbers for neonatal outcomes are low and further conclusions cannot be made from these data.

O.9 Going viral: enhanced recovery after planned caesarean delivery during a global pandemic

Introduction: The Enhanced Recovery after Obstetric Surgery in Scotland (EROSS) programme aims to reduce variation in care for women undergoing planned caesarean delivery (CD) and optimise patient experience, facilitating timely hospital discharge.1 In four years since its introduction, compliance with bundles of care has improved with day 1 discharge increasing from 5% to 32% Scotland-wide (unpublished data). The initial wave of coronarivus infections saw a predominantly consultant-delivered service, limited antenatal education and restrictions on hospital visitors. We assessed the impact of the pandemic on adherence to EROSS bundles and hospital discharge. Methods: Caldicott Guardian approval was obtained to review data regarding planned CD across three maternity units in our health board over two time periods: 18 March – 14 July 2019 (“baseline”) and 16 March – 12 July 2020 (“COVID”). Data were extracted from electronic patient records (Badgernet) and cross-referenced with theatre data (Opera). Patient characteristics, EROSS bundle adherence and postoperative length of stay (LoS) were compared. Results: A total of 1306 planned CD were reviewed. Patient characteristics were similar. Bundle adherence, where recorded, was variable. LoS was recorded in all cases – median LoS was reduced in the COVID cohort, and day 1 discharge rates increased significantly. [Formula presented] Discussion: Despite challenges posed by the coronavirus pandemic, a planned CD service was successfully maintained in our region. Continuing the trend established over the preceding 4 years, median LOS was reduced. Day 1 discharges were significantly increased despite variable bundle compliance. Are these changes a natural continuation of the embedded EROSS pathway, or have perceived barriers to discharge (eg staff shortages, limited antenatal education, non-compliance with care bundles) been superseded by concerns around exposure to coronavirus while in hospital? Further qualitative research with staff and patient surveys may provide greater insight.

Approaching democracy: American government in times of challenge

From unsubstantiated 2020 election fraud claims and the storming of the US Capitol to the rampage of COVID-19 and racial injustice, this book covers the foundations, institutions, and processes of “the great American experiment” with a clear and resonant theme: Democracy cannot be taken for granted, whether at home or internationally, and eternal vigilance (along with civic intelligence) is required to protect it. Approaching Democracy provides students with a framework to analyze the structure, process, and action of US government, institutions, and social movements. It also invites comparison with other countries. This globalizing perspective gives students an understanding of issues of governance and challenges to democracy here and elsewhere. At a moment of growing domestic terrorism, political hyper-partisanship, populism, identity politics, and governmental dysfunction, there is no better time to bring Approaching Democracy--a textbook based on Vaclav Havel’s powerful metaphor of democracy as an ideal and the American experiment as the closest approach to it--to a new generation of political science undergraduate students. NEW TO THE NINTH EDITION •Two new authors, Nadia E. Brown and Sarah Allen Gershon, who bring refreshing intellectual and diverse perspectives to the text. •Includes the tumultuous political context surrounding the Trump presidency, the 2020 elections, the 116th Congress, the Supreme Court, the COVID-19 crisis, and the fight for social and racial justice. •Figures and tables reflect the latest available data and surveys. •Two new features--Diversity and Democracy, highlighting the experiences of America’s diverse social groups and the role of identity politics?and Discussion Questions at the end of each chapter, assessing critical thinking skills. •Critical contemporary events are explored throughout the book, including the attempted coup following the 2020 elections, the Trump administration’s handling of the COVID-19 pandemic, Black Lives Matter, protests in American cities that come to the epicenter of America’s approach to democracy, the changes in the Supreme Court and the federal court system, the growth of LGBTQ+ legal rights, and the alteration in American Federalism. New and updated data on public attitudes toward police brutality, DACA, voter suppression, healthcare, and the global climate movement are also covered. © 2021 Larry Berman, Bruce Allen Murphy, Nadia E. Brown, and Sarah Allen Gershon.