Assessing carrying capacity using demographics, visitor experience and field studies: the case of Hanauma Bay Nature Preserve

The Hanauma Bay Nature Preserve (HBNP) was designated the first Marine Life Conservation District in Hawai'i in 1967. It is the most popular visitor snorkelling experience on the island of O'ahu. A social carrying capacity study was conducted upon reopening, following a nine-month COVID-19 closure due to travel restrictions. Surveys were compared to three prior surveys conducted between 1990 and 2002 to provide a larger historical context of social dynamics and perceived human impacts over time. Demographics, recreational activities, crowding perceptions, and educational availability were assessed. Visitor activity photos and counts were evaluated in context with survey responses. Perceived visitor contact on the reef was compared to in situ snorkelling impact. These quantitative observations reported an average of one reef disturbance for every two individuals. Photographic analysis of breakage of selected baseline corals prior to closure were compared to corals following reopening of the preserve in 2021. Partial mortality occurred in 60% of coral colonies. Successful management policies that include social carrying capacities should align with biological carrying capacities to balance the health of the ecosystem with a positive experience for visitors. These management strategies provide a holistic approach to advance conservation and meet visitor satisfaction goals. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Recruitment of patients to the AVERT DOSE international trial - the Irish experience

Introduction: Mobility training is a complex intervention and recovery post-stroke is multidimensional. AVERT DOSE is the first trial to use an adaptive trial design in stroke rehabilitation and aims to define optimal early intervention regimens for people with mild to moderate ischaemic stroke. Seven Irish sites are participating. Method(s): AVERT DOSE (ACTRN:12619000557134) is a randomised trial that will recruit >2,500 patients internationally. Randomisation is to two groups according to stroke severity. Patients are then randomised to one of four mobility training regimens in each strata and the intervention is delivered for up to 14-days. Primary Outcome: Identification of the intervention regimen that results in higher proportion of favourable outcome at 3-months post-stroke. Seven Irish sites are participating. Result(s): In Ireland, 3 sites are recruiting (SJH, OLOLH, and MMUH) with 4 finalising contracts. Thirteen patients have been recruited to date in Ireland and 265 internationally. Trial set-up has proven complex and variable across Irish sites, with time to ethics approval ranging from 10-37-months. Given the COVID-19 pandemic and international nature of the trial, online training and meetings were necessitated for all Irish sites. Close communication, teamwork and shared responsibilities have supported this process. Flexibility was required with some blinded followup assessments using telehealth. Conclusion(s): Undertaking rehabilitation research requires a dynamic, problem-solving approach, particularly during a pandemic. Irish sites have embraced this opportunity to answer an important stroke research question. In Ireland, shared learning in trial governance should improve future rehabilitation trial readiness. Trial recruitment is expected to gain pace as more Irish and international sites are approved.

A qualitative analysis of radiography students' reflective essays regarding their experience of clinical placement during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic significantly impacted healthcare services and clinical placement for healthcare students. There is a paucity of qualitative research into radiography students' experiences of clinical placement during the pandemic. METHOD: Students in stages three and four of a 4-year BSc Radiography degree in Ireland wrote reflective essays regarding their experience of clinical placement during the COVID-19 healthcare crisis. Permission was granted by 108 radiography students and recent graduates for their reflections to be analysed as part of this study. A thematic approach to data analysis was used, allowing themes to emerge from the reflective essays. Two researchers independently coded each reflective essay using the Braun and Clarke model. RESULTS: Four themes were highlighted; 1) Challenges associated with undertaking clinical placement during the pandemic, such as reduced patient throughput and PPE-related communication barriers; 2) Benefits of clinical placement during the pandemic, in terms of personal and professional development and completing degree requirements to graduate without delay; 3) Emotional impact and 4) Supporting students in clinical practice. Students recognised their resilience and felt proud of their contribution during this healthcare crisis but feared transmitting COVID-19 to family. Educational and emotional support provided by tutors, clinical staff and the university was deemed essential by students during this placement. CONCLUSIONS: Despite the pressure hospitals were under during the pandemic, students had positive clinical placement experiences and perceived these experiences to have contributed to their professional and personal growth. IMPLICATIONS FOR PRACTICE: This study supports the argument for clinical placements to continue throughout healthcare crisis periods, albeit with additional learning and emotional support in place. Clinical placement experiences during the pandemic prompted a deep sense of pride amongst radiography students in their profession and contributed to the development of professional identity.

Survey of Implemented Mitigation Strategies and Further Needs of the U.S. Food Industry to Control COVID-19 in the Work Environment in Early 2021

Our objective was to determine the needs of the U.S. food industry to control COVID-19 in the work environment and what mitigation strategies are being implemented. A Web-based needs assessment survey was distributed in early 2021, targeting professionals in management positions at food industry facilities and operations. Statistical analyses were conducted on the self-reported adoption of mitigation strategies against COVID-19 in the participants' facilities and operations and the perceived needs of the industry regarding COVID-19. A total of 79 usable responses were received (those with data on the participant's industry sector), including 38 (48%) from the dairy, 17 (22%) from the fresh produce, and 24 (30%) from a mixture of other food industry sectors. Two usable responses were from the beef and pork sector, but none were from the poultry sector. Analyses revealed widespread implementation of mitigation strategies in the participants' facilities and oper-ations. Participants perceived that collaboration between the food industry and government agencies, contingency plans and appropriate training, and new technologies are needed to control COVID-19 in the food industry. Subject to limitations associated with low participation, these findings will aid efforts in the represented U.S. food industry sectors to protect workers' health in the event of the emergence of a new SARS-CoV-2 variant or similar future disaster. © 2023, International Association for Food Protection.

Pandemic response and the cost of lockdowns: Global debates from humanities and social sciences

Pandemic Response and the Cost of Lockdowns brings the vast analytical apparatus of the humanities and social sciences to the task of critically analysing the political decisions taken in 2020-21. The global response to the COVID-19 pandemic left little time for critical debate about the impact of lockdowns. Across the world, governments claimed to "follow the science", but they rarely paid attention to the humanities and social sciences. Indeed, the absence of these perspectives is symptomatic of a longer-term trend in the marginalisation of the humanities and social sciences in policymaking and public debate. This book exposes the tragic consequences of this omission in 2020-21 and demonstrates the potential for a different path in the future - a path in which we pay attention to power, complexity, and our biases. The authors establish what these disciplines have to offer in a global emergency and how we can ensure they help us avoid the mistakes of 2020-21 in the future. This original and interdisciplinary book will be of great interest to students, scholars, and researchers throughout the humanities and social sciences, including the fields of philosophy, sociology, anthropology, law, political science, and history, as well as relevant policymakers. © 2023 selection and editorial matter, Peter Sutoris, Sinéad Murphy, Aleida Mendes Borges, and Yossi Nehushtan. All rights reserved.

Evaluating Palin Stammering Therapy for School Children (Palin STSC 8-14): protocol for a feasibility randomised controlled trial comparing Palin STSC(8-14) with usual treatment.

BACKGROUND: Having a stammer can have a significant effect on a child's social, emotional and educational development. With approximately 66,000 children in the UK having a stammer, there is a need to establish an adequate evidence base to inform clinical practice. We describe a feasibility trial to explore the effectiveness of a new therapy programme for children aged 8-14: Palin Stammering Therapy for School Children (Palin STSC(8-14)). Preliminary data from the Michael Palin Centre, where the programme was developed, indicate that Palin STSC(8-14) is effective in reducing stammering frequency and impact for children, with beneficial effects for parents too. We will investigate the feasibility of the methods required for a definitive randomised controlled trial to investigate the application of this therapy by NHS speech and language therapists (SLTs), compared with 'treatment as usual' (TAU), beyond the specialist context in which it was developed. METHODS: This is a two-arm feasibility cluster-randomised controlled trial of Palin STSC(8-14) with TAU control arm, and randomisation at the level of the SLT. Quantitative and qualitative data will be collected to examine the following: the recruitment and retention of therapists and families, the acceptability of the research processes and the therapeutic intervention and the appropriateness of the therapy outcome measures. Assessments will be completed by children and parents at baseline and 6 months later, including measures of stammering severity; the impact of child's stammering on both children and parents; child temperament, behaviour and peer relations, anxiety; quality of life; and economic outcomes. There will also be a qualitative process evaluation, including interviews with parents, children, SLTs and SLT managers to explore the acceptability of both the research and therapy methods. Treatment fidelity will be examined through analysis of therapy session records and recordings. DISCUSSION: The findings of this feasibility trial will inform the decision as to whether to progress to a full-scale randomised controlled trial to explore the effectiveness of Palin STSC(8-14) when compared to Treatment as Usual in NHS SLT services. There is a strong need for an evidence-based intervention for school age children who stammer. TRIAL REGISTRATION: ISRCTN. ISRCTN17058884 . Registered on 18 December 2019.

Orthopaedic Rehabilitation is Associated with Better Outcomes in Orthopaedic Patients with COVID-19

Introduction: The geriatric patient cohort is at high risk of falling and sustaining a fragility fracture, leading to an admission to the orthopaedic rehabilitation ward. Outbreaks of COVID-19 on wards were a common occurrence, with 13% of cases classified as 'healthcare acquired'. This study examines a group in whom these two scenarios coincided, those who sustained a fragility fracture, and later contracted COVID-19 during their rehabilitation stay. The study aims to identify whether access to orthopaedic rehabilitation services during the acute phase of COVID-19 was associated with better patient outcomes. Methods: A retrospective, cohort observational study was carried out. Data from 26 rehabilitation patients aged over 65 years with confirmed COVID-19 at two Irish orthopaedic rehabilitation wards were collected from health records. Symptom profile, COVID-19 severity level based on Irish Thoracic Society guidelines, Clinical Frailty Scale (CFS), Cumulative Illness Rating Scale-Geriatric (CIRS-G) scores and radiological data were reviewed and compared with outcomes from a similar study carried out in the hospital setting. Results: Patient mortality rate was 7.7% (n = 2) in the orthopaedic rehabilitation population compared to 23.2% (n = 16) in the acute hospital orthopaedic population. Median survivor age was 79.5 years (IQR 70-85.5) and 81.5 years (IQR 76.5-86.5), respectively. Mean CFS was 4.15 (SD 1.6) and 5 (SD 1.6), respectively. Mean CIRS-G scores were 10.6 (SD 4.3) and 8.19 (SD 4.4). Most patients were categorised as mild COVID-19 cases (n = 25, 96%), (n = 56, 81.1%). Eight patients (n = 8, 30.8%) in rehabilitation group were asymptomatic compared to five (n = 5, 7%) in the acute hospital group. Atypical symptom presentation was 15.4% (n = 4) and 7% (n = 5) respectively. Delirium was noted in 11.6% (n = 3) of rehabilitation patients compared to 30.4% (n = 21) of acute patients. Non-invasive ventilation was required in 3.8% (n = 1) of rehab patients and 2.9% (n = 2) of acute hospital patients. Conclusion: Orthopaedic rehabilitation patients were younger, less frail, had a milder COVID-19 disease profile and lower mortality rate when compared with orthopaedic patients in the acute hospital setting. Rehabilitation patients had lower rates of reported delirium. Rehabilitation patients' better outcomes may have been associated with an increased accessibility to allied healthcare, increased time between sustaining a fragility fracture and being diagnosed with COVID-19 and a hospital environment more conducive to recuperation.

Multidisciplinary Management of an Outbreak of COVID-19 on an Orthopaedic Rehabilitation Ward: A Description of Outcomes

Introduction: In January 2021, Ireland was undergoing the 'Third Wave' of COVID-19, with almost 2,000 persons hospitalised with COVID-19. Over 50% of all COVID-19-related deaths in the EU have occurred in those aged 80 years and older. The same patient cohort is also at high risk sustaining a fragility fracture, leading to an admission to the orthopaedic rehabilitation ward. This study examines a patient group in whom these two scenarios coincided, describing a patient cohort who having sustained a fragility fracture, later contracted COVID-19. This study aims to describe the characteristics and outcomes of orthopaedic rehabilitation patients with COVID-19 and to examine the response of an orthopaedic rehabilitation ward to an outbreak of COVID-19. Methods: This is a retrospective observational study. Data from 26 hospitalised patients aged over 65 years with COVID-19 at an Irish orthopaedic rehabilitation ward was collected. Symptom profile, degree of COVID-19 severity, Clinical Frailty Scale (CFS), Charleston co-morbidity scores, laboratory and radiological data were reviewed. Individual treatment pathways were recorded for each patient. Infection control records were reviewed to examine the response of the ward to an outbreak of COVID-19. Results: Patient mortality rate was 7.7% (n = 2). Median survivor age was 79.5 years (IQR 70-85.5). Mean CFS and Charleston Co-morbidity scores were 4.15;(SD1.6) and 5.08, respectively. The majority of patients (n = 25, 96%) were categorised as mild COVID-19 cases. Delirium was noted in more than 10% of patients (n = 3, 11.6%). One patient (n = 1, 3.8%) required non-invasive ventilation. In those whose disease was classifies as severe (n = 2, 7.7%), intubation/resuscitation were not deemed appropriate and when they deteriorated, comfort measures were taken. The majority of patients (n = 21, 81%) were able to return home upon discharge. Three patients (11.5%) had increased care needs and required long term care to be arranged. Conclusion: An outbreak of COVID-19 requires a multidisciplinary approach with a focus on not only medical management but also clinical workforce management, patient flow, management of access to the wards and information and communications management. The overall outcomes in this group, including mortality and proportion discharged to long term care, were positive when compared to similar cohorts of elderly hospitalised patients with COVID-19. These outcomes support a multidisciplinary model of care.

Investigating the association between COVID-19 vaccination and care home outbreak frequency and duration.

OBJECTIVES: At the end of 2020, many countries commenced a vaccination programme against SARS-CoV-2. Public health authorities aim to prevent and interrupt outbreaks of infectious disease in social care settings. We aimed to investigate the association between the introduction of the vaccination programme and the frequency and duration of COVID-19 outbreaks in Northern Ireland (NI). STUDY DESIGN: We undertook an ecological study using routinely available national data. METHODS: We used Poisson regression to measure the relationship between the number of RT-PCR confirmed COVID-19 outbreaks in care homes, and as a measure of community COVID-19 prevalence, the Office for National Statistics COVID-19 Infection Survey estimated the number of people testing positive for COVID-19 in NI. We estimated the change in this relationship and estimated the expected number of care home outbreaks in the absence of the vaccination programme. A Cox proportional hazards model estimated the hazard ratio of a confirmed COVID-19 care home outbreak closure. RESULTS: Care home outbreaks reduced by two-thirds compared to expected following the introduction of the vaccination programme, from a projected 1625 COVID-19 outbreaks (95% prediction interval 1553-1694) between 7 December 2020 and 28 October 2021 to an observed 501. We estimated an adjusted hazard ratio of 2.53 of the outbreak closure assuming a 21-day lag for immunity. CONCLUSIONS: These findings describe the association of the vaccination with a reduction in outbreak frequency and duration across NI care homes. This indicates probable reduced harm and disruption from COVID-19 in social care settings following vaccination. Future research using individual level data from care home residents will be needed to investigate the effectiveness of the vaccines and the duration of their effects.

Impact of managing provider type on severe aortic stenosis referral and treatment patterns: An optum electronic medical records analysis

A significant proportion of patients diagnosed with symptomatic severe aortic stenosis (ssAS) do not receive treatment with aortic valve replacement (AVR) despite current ACC/AHA guidelines. Delayed care leads to increased hospitalizations, worsening heart failure and death. Timely referral to a cardiac specialist is a critical step in the treatment pathway. We sought to identify the impact of managing provider type on follow-up care for newly diagnosed patients with severe aortic stenosis (sAS). We analyzed Optum® electronic medical records to identify adults with a new outpatient sAS echo diagnosis in the pre-COVID era (1/2017 - 3/2019). We identified integrated delivery network patients alive 1d post echo excluding those with missing data or AVR within 3d of echo, then selected those managed by a primary care provider (PCP) or a cardiologist (n=5,683). Baseline characteristics were used for covariate-adjusted Cumulative Incidence Function and Fine-Gray subdistribution hazard models. We estimated the impact of managing provider type on the specialist follow-up visit rate (cardiologist, interventional cardiologist and/or cardiothoracic surgeon) for all sAS patients and of surgical or transcatheter AVR for ssAS patients within 1 year of diagnosis. Within 90d of sAS diagnosis, 47% of PCP- vs. 73% of cardiologist-managed patients had a follow-up visit (1-year rates: PCP, 69% vs. cardiologist, 90%;Hazard ratio [HR]=0.54, 95% confidence interval [CI]: 0.49-0.59, p<0.0001). Within 1 year of diagnosis, 36% of PCP- vs. 51% of cardiologist-managed ssAS patients underwent AVR (HR=0.72, CI: 0.63-0.82, p<0.0001) (Figure). Analysis suggests lower referral rates for PCP- than cardiologist-managed patients. In ssAS, 1-year AVR rates were low, particularly for PCPs. These data underscore the importance of timely follow up of all severe AS patients for symptom assessment and appropriate treatment, presenting an opportunity for initiatives to drive behavior change.

Platform Incorporating Patient Navigation, Preparative Guidelines, and Hospital at Home May Improve COVID-19 Outcomes for Patients with Myeloid Malignancies

Background: Patients (pts) with malignancies are at increased risk of morbidity and mortality from COVID-19. Among these pts, some of the higher case fatality ratios (CFR) reported are among pts with myeloid malignancies, ranging from 37 to 50% (Mehta V, Cancer Discov 2020;Ferrara F, Leukemia 2020). Levine Cancer Institute (LCI) has a robust hematologic malignancy and cellular therapy program that serves many pts with myeloid malignancies, seeing nearly 100 new diagnoses of acute myeloid leukemia per year. A strategy to mitigate risks associated with COVID-19 was established at LCI in partnership with Atrium Health's (AH) Hospital at Home (HAH). HAH was a system wide platform using telemedicine and home health services to assess and monitor COVID-19 + pts at high risk of complications. To augment HAH for our medically complex cancer pts, a virtual health navigation process involving expertise from across LCI, including a specialized nurse navigation team, was developed to rapidly identify LCI pts + for SARS-CoV-2, monitor them under physician supervision, and escalate care as needed with AH HAH. Along with the navigation platform, data-driven guidelines for detecting, monitoring, and managing LCI pts + for SARS-CoV-2 were swiftly employed across the extensive LCI network. Herein we report on the outcomes for LCI pts with myeloid malignancies + for SARS-CoV-2 and outline the employed risk mitigation strategies and their potential impact on these outcomes. Methods: An automated daily list of LCI pts + for SARS-CoV-2 was provided by AH Information Services. Each pt's chart was reviewed by a nurse navigator for hematologic or oncologic diagnosis, outpatient or inpatient status, and COVID-19 symptoms. Pts without a cancer diagnosis were not assigned a navigator. If hospitalized, a pt was not assigned a navigator;following discharge, if enrolled in HAH, a navigator was assigned. In collaboration with HAH, an algorithm for directing care was utilized (Figure 1). A diagnosis-specific navigator contacted and screened the pt with an assessment tool, which scored pts for surveillance and treatment needs (Table 1). Documentation was forwarded to the primary hematologist/oncologist. Comprehensive guidelines for testing, scheduling, management of + pts, research, and process changes were created, disseminated, and actively updated through LCI's EAPathways. For outcome analysis for pts with myeloid malignancies, pt vital status was updated through data cutoff (7/3/21). Results: From inception on 3/20/20 to 12/2/20, 974 LCI patients were identified as SARS-CoV-2 + and reviewed for nurse navigation. Of the 974 pts, including pts with benign and malignant diagnoses, 488 were navigated. Among all SARS-CoV-2 + LCI pts, 145 (15%) had a hematologic malignancy, including 37 (4%) pts with myeloid malignancies. Characteristics are shown in Table 2. Of the 37 pts, 18 (49%) were navigated. 70% with myeloid malignancies were on active treatment at the time of + test. Nearly 50% of those on active treatment were navigated. 46% were hospitalized with COVID-19, with this being the main reason for no assigned navigator. 24% of hospitalized pts were eventually assigned a navigator. Only 3 pts had undergone allogeneic stem cell transplantation (allo-SCT) with a median time from transplant to detection of SARS-CoV-2 of 9 months (range, 7-23). 2 out of 3 cases post allo-SCT were asymptomatic. No pt died from COVID-19 following allo-SCT. Among the navigated pts with myeloid malignancies, there was no death related to COVID-19. 4 pts, all of whom were hospitalized, died from COVID-19 (N=2, myelodysplastic syndrome with 1 on azacitidine;N=2, myeloproliferative neoplasm, both on hydrea). A CFR of 11% was demonstrated for LCI pts with myeloid malignancies. Conclusions: A multidisciplinary response strategy liaising between AH HAH and LCI followed, assessed, and assisted cancer pts + for SARS-CoV-2. With our embedded nurse navigation team's specialized attention along with enhanced physician oversight and close collaboration with AH HAH, opportunities f r care escalation or adjustments in cancer-focused care were promptly identified. In this setting, among the high-risk population of pts with myeloid malignancies, a lower CFR than has been reported was observed. A virtual navigation platform with HAH capabilities is a feasible, safe, and effective way to monitor and care for this high-risk population. [Formula presented] Disclosures: Moyo: Seattle Genetics: Consultancy. Chai: Cardinal Health: Membership on an entity's Board of Directors or advisory committees. Avalos: JUNO: Membership on an entity's Board of Directors or advisory committees. Grunwald: Amgen: Consultancy;Agios: Consultancy;Astellas: Consultancy;Daiichi Sankyo: Consultancy;Stemline: Consultancy;Bristol Myers Squibb: Consultancy;PRIME: Other;Trovagene: Consultancy;Blueprint Medicines: Consultancy;AbbVie: Consultancy;Med Learning Group: Other;Pfizer: Consultancy;Sierra Oncology: Consultancy;Janssen: Research Funding;Incyte: Consultancy, Research Funding;Gilead: Consultancy;MDEdge: Other;PER: Other;Cardinal Health: Consultancy;Karius: Consultancy. Copelan: Amgen: Consultancy.

Observations of Volatile Organic Compounds in the Los Angeles Basin during COVID-19

Volatile organic compounds (VOCs) were measured in the Los Angeles (LA) Basin from mid-April to mid-July 2020 during the COVID-19 pandemic, as a part of the Los Angeles Air Quality Campaign (LAAQC). VOCs were quantified in over 450 samples using one- and two-dimensional gas chromatography with different detectors;mixing ratios were determined for 150 compounds associated with on- and off-road mobile, volatile chemical product, and biogenic sources. During the sampling period, traffic counts increased from ∼55% to ∼80% of pre-COVID levels. While the average afternoon combustion-derived VOCs and carbon monoxide (CO) mixing ratios did not change significantly between April-May and June-July, there was a shift in the distribution to higher mixing ratios in June-July, particularly for VOCs associated with gasoline evaporation. Compared to observations made in the last major air quality campaign in the LA Basin (CalNex-2010), emission ratios for 40 compounds relative to acetylene (VOC/acetylene) have remained similar, while emission ratios relative to CO (VOC/CO) have dropped to ∼60% of their 2010 values. This divergence in trends suggests that whereas mobile sources are still the dominant source of the combustion-derived VOCs measured in the LA Basin, there has been a shift in the mobile source sectors, with a growing contribution from sources that have lower CO/acetylene emission ratios, including off-road equipment and vehicles. In addition to the observed shift in source sector contributions, estimated OH exposure was 70-120% higher than in 2010. © 2021 American Chemical Society.

Patient navigation plus hospital at home to improve COVID-19 outcomes for cancer patients

Background: Reports suggested cancer patients were at greater risk for increased morbidity and mortality from COVID-19. A process to mitigate these risks was established at Levine Cancer Institute (LCI) in partnership with Atrium Health's (AH) Hospital at Home (HAH) initiative. This virtual health navigation process employed expertise from the departments of Hematologic Oncology and Blood Disorders, Oncology, and Supportive Oncology, including a specialized nurse navigation team, to rapidly identify COVID-19 positive LCI patients, monitor them under physician supervision, and escalate care as needed with AH HAH program. Methods: AH Information Services created an automated list of LCI COVID-19 positive patients with a daily database. Each patient was reviewed by a nurse navigator. Review included hematologic or oncologic diagnosis, outpatient or inpatient status, and any COVID-19 symptoms. Once a malignant diagnosis was confirmed, a diagnosis-specific navigator contacted and screened the patient with a COVID assessment tool. Documentation was forwarded to the primary oncologist/hematologist. The tool scored patients for surveillance and treatment needs. A score of 0-2 prompted phone assessment every 48-72 hours, and score of 3-5 required every 24-48 hour calls with physician involvement when appropriate. If score of ≥6, care was escalated to LCI nurse/physician for admission to AH acute care HAH or conventional inpatient admission. Results: From inception on 3/20/2020 to data review date of 12/2/2020, 974 LCI patients were identified as COVID-19 positive and reviewed for nurse navigation (Table). Of the 974, 488 were navigated. Given limited resources, patients with benign conditions were not assigned a navigator, though a similar process was created for sickle cell disease. Of the 974, 75 are now deceased. Only 25 are deceased among the 488 navigated. Conclusions: The COVID-19 pandemic presented unprecedented circumstances to our patients and their clinicians. LCI expeditiously put policies and procedures in place to mitigate the intersection of COVID-19 and cancer. The multidisciplinary response strategy liaising between AH HAH and LCI followed, assessed, and assisted LCI COVID19 positive patients. With our embedded nurse navigation team's specialized attention along with enhanced physician oversight and close collaboration with AH HAH, opportunities for care escalation or adjustments in cancerfocused care were promptly identified. Analysis is ongoing to elucidate the lower mortality rate observed among navigated patients.

Variation in immunosuppressant impact onsevere COVID-19 outcome: Preliminary results fromthe COVID-19 Scottish Registry of AutoimmuneRheumatic Diseases (SCAR-19)

Background/AimsThe novel infectious disease COVID-19 is associated with a widespectrum of clinical severity amongst the general population. Patientswith autoimmune rheumatic diseases (ARD) are more likely toexperience serious COVID-19 related events, although risk factorsfor such outcomes have yet to be established. In particular, the riskprofiles of specific ARD therapies are unknown.MethodsA Scottish wide registry was rapidly developed in March 2020. Clinicalcharacteristics and outcomes of infected cases were collated acrossall Scottish health boards, leveraging the Scottish Systemic VasculitisNetwork and Scottish Society for Rheumatology. Eligible patientsincluded any adult ARD patients with a confirmed (clinically or PCR)diagnosis of COVID-19. Simple descriptive statistics were employed toevaluate associations between ARD therapies and a serious COVID-19disease outcome, as defined by a requirement of invasive or noninvasive ventilation, and/or death.ResultsA total of 69 patients (59% female;mean age 65.6, SD15.5) wererecruited to the registry , 92% of which required hospitalisation. Caseswere most commonly diagnosed with rheumatoid arthritis (n = 32, 46.4%) followed by spondyloarthritis (n = 19, 27.5%) and systemicvasculitis (n = 9, 13.0%). Anti-TNF therapy (n = 8, 11.6%) andmethotrexate (n = 31, 44.9%) were the commonest biologic andconventional disease modifying drug (bDMARD and csDMARD) usedrespectively. N = 20 (29%) received background corticosteroid therapy (15.9% prednisolone >5mg, 13% prednisolone 5mg). A severeoutcome was observed in n = 25(31.9%);n = 11 required assistedventilation and n = 19 died. With the exception of Leflunomide, conventional and biologic DMARDs did not appear to confer ahigher risk for severe outcome (table 1). Of note, anti-TNF therapywas associated with a non-serious outcome (p = 0.04) and prednisolone>5mg with a serious outcome (p = 0.08). ConclusionPreliminary data from this Scotland-wide ARD COVID-19 registryevidences variation in the impact of standard ARD therapies on theseverity of COVID-19 outcome. In general, background csDMARD andbDMARD use does not appear to be a risk factor for severe outcomes.However, anti-TNF therapy may confer a favourable outcome, whileleflunomide and corticosteroids may have the opposite effect.Rheumatologists should be aware of these possible risk factors andcontinue to contribute to registries to help establish whether theseputative signals are clinically relevant.

Arterial Roadway Travel Time Reliability and the COVID-19 Pandemic

This paper evaluated the effect of the COVID-19 preventive orders on arterial roadway travel time reliability (TTR). A comparative analysis was conducted to examine average travel time distributions (TTD), and their associated TTR metrics, before and during the COVID-19 pandemic. Travel time data for four urban arterial corridors in Nebraska, disaggregated by peak period and direction, were analyzed. It was found that in 2020, the average TTD mean and standard deviation values for all 16 scenarios were reduced by an average of 14.0% and 43.4%, respectively. The travel time index, the planning time index, the level of travel time reliability (LOTTR), and the buffer index metrics associated with these TTDs were reduced, on average, by 14.0%, 19.7%, 3.5%, and 35.0%, respectively. In other words, whether the test corridors were more reliable during the pandemic was a function of which TTR metric was used. The paper concludes by arguing for a fundamental change in how arterial TTR is measured and reported to different user groups. © 2021 American Society of Civil Engineers.

Non-melanoma skin cancer activity during the COVID-19 pandemic- A single UK tertiary centre experience.

The pandemic caused by SARS-CoV-2 virus, also known as COVID-19, has generated shockwaves in medical and surgical practice. It has necessitated re-deployment of staff and resources to cater for the unpredictable increase in footfall and demand on healthcare systems. This study aimed to investigate how the restructuring of our service altered the triage and management of non-melanoma skin cancer (NMSC) during the pandemic's first wave rise and peak. We retrospectively analysed all patients who underwent a skin excision under local anaesthetic which revealed the presence of a basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) on histopathological analysis between 1st February 2020 - 31st May 2020 compared with the same period in 2019. There was a 158% increase in patients with excision of lesions confirmed on histopathological analysis as a NMSC during the COVID-19 period (168 vs. 65). In 2020, more excisions were performed by consultants (42.9% v 21.5%, p = 0.002) with a lower proportion of excisions with a close margin (27.7% v 17.8%, p = 0.096) and an involved margin (3.1% v 1.8%, p = 0.62). Five of these patients had their further management altered due to service constraints at this time The resource constraints secondary to the pandemic have yielded beneficial service adaptations with the incorporation of a more efficient model for the NMSC service. The sustainability of this model and its impact on training will require further examination when non-urgent and benign elective workload is slowly reinstated and plastic surgery trainees return to their original posts.