"Victims of the System”: Anti-Government Discourse and Political Influencers Online

Since the beginning of the COVID-19 pandemic, several online movements converged in reaction to health measures enacted by governments internationally and in Quebec, Canada. This chapter examines the confluence of microcelebrity and far-right populism via a portrait of Quebec-based influencers against mask, vaccination, and health measures. It employs mixed methods to analyze two popular anti-mask influencers in Quebec, Daniel Pilon and the Stéphane Blais's Foundation for the defense of the rights and liberties of the people (FDDLP). As a counterpoint, the FDDLP represents itself as a defender against governmental overreach mounting legal challenges to the emergency health measures taken by the Quebec government. Blais's videos present a counterpoint that resembles Pilon's subject matter and rhetorical appeals. Given that the FDDLP presents itself as a populist defense of the people's rights, it is notable that Blais's videos move from rights-oriented discourse to more conspiracy-oriented themes over the course of the pandemic. © 2023 selection and editorial matter, Victoria Kannen and Aaron Langille;individual chapters, the contributors.

Queering public health: a critical examination of healthcare access and gender expression among trans, nonbinary, and other gender nonconforming people during COVID-19

Research documenting the impact of COVID-19 on Two-Spirit, lesbian, gay, bisexual, transgender, and queer (2SLGBTQ+) populations in Canada is limited. Our objectives were to investigate the impact of COVID-19 lockdown measures on the lives of trans, nonbinary, and other gender nonconforming (TGNC) people. Engage COVID-19 is a mixed methods study examining the impact of COVID-19 on gay, bisexual, queer, and other men who have sex with men (GBQM) living in Vancouver, Toronto, and Montreal, Canada. Using purposive sampling, we conducted in-depth qualitative interviews (between November 2020-February 2021 and June-October 2021) with 93 participants who discussed the impact of COVID-19 on their lives. Seventeen participants were identiAed as TGNC. TGNC participants reported barriers to trans healthcare during the initial months of the COVID-19 pandemic. Several participants indicated that some public health interventions during COVID-19 (i.e., lockdowns) eased the pressure to "perform" gender due to fewer in-person interactions. During lockdowns, TGNC participants increasingly cultivated community networks online. Nevertheless, participants reported longing for the social support that was available to them during pre-COVID. Lack of access to community spaces during lockdowns had a negative impact on participants' mental health, despite reduced pressure to perform gender and opportunities for social engagement in online spaces.

Social determinants of health and COVID-19: An evaluation of racial and ethnic disparities in attitudes, practices, and mental health

Previous evaluations have reported racial minorities feel they are at greater risk of contracting COVID-19, but that on average, they have better preventative practices, such as wearing face masks and avoiding large gatherings. In this study, we explored associations between social determinants of health (SDOH), race and ethnicity, COVID-19 practices and attitudes, and mental health outcomes during the pandemic. We examined associations between SDOHs and practices, attitudes, and mental health symptoms by race and ethnicity using multivariable linear and logistic regressions in 8582 Arkansan pulse poll respondents (September—December, 2020). Compared to White respondents, mean attitude and practice scores were greater (indicating safer) among Black (4.90 vs. 3.45 for attitudes;2.63 vs. 2.41 for practices) and Hispanic respondents (4.26 vs. 3.45 for attitudes;2.50 vs. 2.41 for practices). Respondents' SDOH scores by race/ethnicity were: White (3.65), Black (3.33), and Hispanic (3.22). Overall, attitude and practice scores decreased by 0.35 and 0.09, respectively, for every one-point increase in SDOH. Overall, a one-point increase in SDOH was associated with 76% and 85% increased odds of screening negative for anxiety and depression, respectively. To conclude, underlying social inequities are likely driving safer attitudes, practices, and worse anxiety and depression symptoms in Black and Hispanic Arkansans. In terms of policy implications, our study supports the urgency of addressing SDOHs for rural states similar to Arkansas.

Efficacy of detergent-based cleaning and wiping against SARS-CoV-2 on high-touch surfaces.

Efficacy of cleaning methods against SARS-CoV-2 suspended in either 5% soil load (SARS-soil) or simulated saliva (SARS-SS) was evaluated immediately (hydrated virus, T0) or 2 hours post-contamination (dried virus, T2). Hard water dampened wiping (DW) of surfaces, resulted in 1.77-3.91 log reduction (T0) or 0.93-2.41 log reduction (T2). Incorporating surface pre-wetting by spraying with a detergent solution (D + DW) or hard water (W + DW) just prior to dampened wiping did not unilaterally increase efficacy against infectious SARS-CoV-2, however, the effect was nuanced with respect to surface, viral matrix, and time. Cleaning efficacy on porous surfaces (seat fabric, SF) was low. W + DW on stainless steel (SS) was as effective as D + DW for all conditions except SARS-soil at T2 on SS. DW was the only method that consistently resulted in > 3-log reduction of hydrated (T0) SARS-CoV-2 on SS and ABS plastic. These results suggest that wiping with a hard water dampened wipe can reduce infectious virus on hard non-porous surfaces. Pre-wetting surfaces with surfactants did not significantly increase efficacy for the conditions tested. Surface material, presence or absence of pre-wetting, and time post-contamination affect efficacy of cleaning methods.

THE IMPACT OF CENTRAL COORDINATION ON ENDOSCOPY EFFICIENCY

Background: The impacts of the COVID-19 pandemic have been far reaching and have necessitated many changes to healthcare delivery. At the QEII Health Sciences Center physical space limitations for patient check-in and recovery have restricted outpatient endoscopy to 3 of 4 available endoscopy suites. On June 1, 2020 a new system of central endoscopy triage and coordination for the Division of Digestive Care and Endoscopy (DC&E) was implemented in an effort to increase efficiency and maintain patient access to endoscopy. The components of the RESET (Re-introduce Endoscopy Safely and EfficienTly) Plan included a) a new endoscopy coordinator role to manage a common endoscopy waitlist, endoscopist schedules, and booking clerks, b) a modified triage system to improve waitlist consistency, c) a common endoscopy waitlist with patients booked in the next available appointment regardless of endoscopist, d) discontinuation of fixed endoscopy slots for endoscopists, and e) appointment scheduling no sooner than 4-weeks in advance to minimize no-shows and last-minute cancellations. Aims: The aim of this study is to evaluate the impact of the RESET Plan on the efficiency of DC&E endoscopy. Methods: A retrospective pre- and post-implementation study evaluating the volume and efficiency of outpatient endoscopy before and after implementation of the RESET Plan. The Pre-RESET period included all procedures performed from June 1, 2019 to October 31, 2019. The Post-RESET period included all procedures performed from June 1, 2020 to October 31, 2020. A separate endoscopy suite and triage system is used for endoscopic retrograde cholangiopancreatography (ERCP) and these cases were excluded. Early effectiveness outcomes were reported including a comparison of the number of endoscopic procedures per week and per list, pre- and post- implementation. Data analysis was primarily descriptive with data expressed as frequencies, means (SD), and proportions (%). Exploratory group comparisons were performed using independent-samples T-Test. Results: During the 5-month Pre-RESET period, 2203 endoscopic procedures were performed. During the Post-RESET period a total of 1920 procedures were performed. Due to pandemic restrictions, there was a 29% decrease in available endoscopy lists from 2019 to 2020. There was a 24% increase in the number procedures performed per endoscopy list, from 6.4 to 8.0 (p=0.004, 95% CI 0.52- 2.53), pre- and post-RESET. Conclusions: While the COVID-19 pandemic has disrupted healthcare delivery, it has also provided an opportunity to implement health system structure and process changes. The RESET Plan resulted in significant gains in efficiency which largely offset losses in endoscopy throughput imposed by COVID-19 pandemic restrictions. Future research will determine what patient and health system factors most significantly impact system efficiency as well as the cost-effectiveness of the RESET Plan.

LINKING PRIMARY AND SPECIALTY CARE FOR THE MANAGEMENT OF DIGESTIVE HEALTH CONDITIONS: AN EVALUATION OF GUT LINK IMPLEMENTATION

Background: Severe restrictions on in-person encounters and endoscopic procedures for digestive care have occurred as a result of the COVID-19 pandemic. This has exacerbated pre-existing barriers in access to gastroenterology (GI) care across Nova Scotia (NS) for patients and primary healthcare providers (PHCPs). In response, a provincial PHCP-GI consultative service (GUT LINK) was implemented at a single tertiary care center with the goal of supporting PHCPs in the management of non-urgent GI referral conditions. Aims: To implement and evaluate the acceptability, feasibility, appropriateness, and early effectiveness of the GUT LINK PHCP-GI consultation service. Methods: This is an ongoing prospective observational cohort study. All referrals received through the EMR-based referral and triage management system between May and November 2020 that were deemed to be amenable to management within primary care with specialist support were returned to the PHCP with the suggestion to arrange a GUT LINK telephone consultation. GUT LINK appointments were scheduled through an administrative support telephone line with the PHCP and a GI specialist. A post-consultation e-questionnaire was distributed to PHCPs who consented to participate. Feasibility (number of and indication for referrals, PHCP participation rates), acceptability and appropriateness (satisfaction, future use, likelihood to recommend) metrics and outcomes (case resolution, re-referrals, proportion requiring endoscopic investigations) were recorded. Patient charts were reviewed to determine whether the patient ultimately required GI speciality care. Analyses were descriptive and expressed as frequencies, means (+/-SD), medians (+/-SE), and proportions (%). Results: A total of 45 GUT LINK consultations were completed between May and November 2020. Of these, 20% required GI specialist care and 80% have remained within primary care, with a median follow-up of 101 (+/-9.1) days. The indications for GUT LINK consultation included lower GI symptoms (64%), abnormal imaging or investigations (17%), and upper GI symptoms (19%). been completed. All PHCPs reported that GUT LINK consultation was easy to access, while 90% found the advice helpful and 80% reported that that it resolved the issue. Following the GUT LINK appointment, 80% felt they would not need to refer their patient to GI. Conclusions: The implementation of GUT LINK was acceptable, feasible, and improved access to specialist support for management of undifferentiated GI symptoms. Future research will focus on comprehensive stakeholder engagement in order to design, implement, and evaluate GUT LINK PHCP care pathways.

IMPROVING ACCESS TO URGENT GASTROENTEROLOGICAL CONSULTATION: A POSITIVE PANDEMIC IMPACT

Background: The global COVID-19 pandemic has resulted in a dramatic re-alignment of clinical service delivery. In mid-March 2020 the Division of Digestive Care and Endoscopy at Dalhousie University leveraged eHealth technology to rapidly implemented a new referral management and triage system and established a new rapid outpatient consultation service to facilitate urgent virtual and face-to-face appointments. Standardized procedures for triaging, booking, and staffing the urgent gastroenterology consultation service were implemented. Aims: The aim of this study was to evaluate the impact of the implementation of a standardized triage and consultation process on access to urgent gastroenterology consultative services at a single tertiary care center during the COVID-19 pandemic. Methods: We performed a pre- and post-implementation study comparing efficiency metrics for urgent triage and urgent consultation. The pre-implementation cohort included all patients referred and triaged to an urgent clinic appointment between April 1, 2019 to September 30, 2019. The post-implementation cohort included all patients referred and triaged to an urgent clinic appointment between April 1, 2020 to September 30, 2020. Healthcare efficiency data was extracted through electronic record review with specific dates and times for referral receipt (a), triage completion (b), appointment wait-listing (c), and clinic appointment (d). The time to triage (TT), time to visit (TV), and total time to consult (TC) were calculated (TT = c - a;TV = d - c;TC = TT + TV) for each patient. The Mann-Whitney U test was used to compare TT, TV, CT between patient cohorts. Results: A total of 429 patients were booked for urgent clinic consultation, 176 during the pre-implementation period and 253 in the post-implementation period. The mean TT for the pre-and post-implementation cohorts was 4.8 days and 3.3 days, respectively (U=18,149, p=0.001). Mean TV was decreased from 16.2 days for the pre-implementation cohort to 3.6 days for the post-implementation cohort (U=6095, p=0.000). The mean time from a referral being received to the patient being seen in consultation (TC) decreased by 67% from 21 days to 6.9 days, Figure 1 (U=6,419, p=0.000). Conclusions: The COVID-19 pandemic has had a dramatic impact on healthcare delivery in Nova Scotia. One positive result is that it facilitated the motivation and alignment needed to make a large health system change that may not have otherwise been possible. This study demonstrates that a standardized pathway for urgent outpatient gastroenterology assessment improves the timeliness of care delivery.

RAPID IMPLEMENTATION OF AN EVIDENCE-BASED, VIRTUAL COVID-19 VACCINE EDUCATION CLINIC AT THE NOVA SCOTIA COLLABORATIVE INFLAMMATORY BOWEL DISEASE CLINIC (NSCIBD)

Background The COVID-19 global pandemic has been associated with significant morbidity and mortality. Rapid adaptation of approaches to clinical management as well as policy decisions in relation to implementation of vaccination programs for persons living with IBD has been required throughout the pandemic. To meet the sudden demand of large scale public health-mandated COVID-19 vaccine education for patients living with IBD in Nova Scotia a novel, evidence-based, virtualCOVID-19 vaccine educational intervention was developed, implemented, and evaluated. Methods This was a prospective, observational, cross sectional, implementation-effectiveness study conducted at the NSCIBDprogram between April-July 2021. The educational intervention consisted of a standardized email outlining evidence relating to risks and benefits of COVID-19 vaccinations. The intervention was offered to all patients contacting the NSCIBD program with questions or concerns about the vaccine. During one-on-one virtual visits, standardized and evidence-basedinformation was provided by a gastroenterologist or IBD nurse practitioner. Following the session, an anonymous questionnaire (NoviSurvey) evaluated key implementation metrics including satisfaction, appropriateness, usefulness, perceived impact on knowledge and vaccine hesitancy, willingness to participate in future sessions, and recommendations for improvement. Descriptive analyses were conducted, with group means expressed as proportions for categorical variables and means for numerical variables. Results A total of 265 patients were invited to participate in the online survey, with a response rate of 49% (131/265). Before the session, 48.9% (64/131) expressed COVID-19 vaccine hesitancy and 26% (35/131) expressed concerns relating to risks versus benefits of COVID-19 vaccines. Ninety-one percent (119/ 131) of respondents found the education program to be helpful and 92% (121/131) indicated there was no information perceived to be lacking from the session. Following the intervention, the proportion of those willing to get vaccinated rose from 61% to 86.3%. Only 1.5% (2/ 131) indicated that they would likely not get vaccinated. Most participants (77%, 101/131) found the written and virtually administered educational content to be satisfactory and 88% (115/131) were willing to participate in similar virtual education offerings in the future. Conclusion Implementation of an evidence-based, multidisciplinary COVID-19 vaccination education intervention delivered using a virtual platform was perceived to be feasible, acceptable, and effective by IBD patients. Further research on innovative, evidence-based, multidisciplinary educational interventions and the impact of these interventions on IBD clinical outcomes are needed.

Evaluation of surface disinfection methods to inactivate the beta coronavirus Murine Hepatitis Virus.

The list of EPA-approved disinfectants for coronavirus features many products for use on hard, non-porous materials. There are significantly fewer products registered for use on porous materials. Further, many common, high-touch surfaces fall in between non-porous materials such as glass and porous materials such as soft fabrics. The objective of this study was to assess the efficacy of selected commercially available disinfectant products against coronaviruses on common, high-touch surfaces. Four disinfectants (Clorox Total 360, Bleach solution, Vital Oxide, and Peroxide Multi-Surface Cleaner) were evaluated against Murine Hepatitis Virus A59 (MHV) as a surrogate coronavirus for SARS-CoV-2. MHV in cell culture medium was inoculated onto four materials: stainless steel, latex-painted drywall tape, Styrene Butadiene rubber (rubber), and bus seat fabric. Immediately (T0) or 2-hr (T2) post-inoculation, disinfectants were applied by trigger-pull or electrostatic sprayer and either held for recommended contact times (Spray only) or immediately wiped (Spray and Wipe). Recovered infectious MHV was quantified by median tissue culture infectious dose assay. Bleach solution, Clorox Total 360, and Vital Oxide were all effective (>3-log10 reduction or complete kill of infectious virus) with both the Spray Only and Spray and Wipe methods on stainless steel, rubber, and painted drywall tape when used at recommended contact times at both T0 and T2 hr. Multi-Surface Cleaner unexpectedly showed limited efficacy against MHV on stainless steel within the recommended contact time; however, it showed increased (2.3 times greater efficacy) when used in the Spray and Wipe method compared to Spray Only. The only products to achieve a 3-log10 reduction on fabric were Vital Oxide and Clorox Total 360; however, the efficacy of Vital Oxide against MHV on fabric was reduced to below 3-log10 when applied by an electrostatic sprayer compared to a trigger-pull sprayer. This study highlights the importance of considering the material, product, and application method when developing a disinfection strategy for coronaviruses on high-touch surfaces.

The impact of coronavirus disease 2019 on the head and neck cancer pathway in the West of Scotland.

OBJECTIVE: The coronavirus disease 2019 pandemic has greatly disrupted head and neck cancer services in the West of Scotland. This study aimed to assess the impact of the first wave of the pandemic on cancer waiting times. METHODS: A retrospective review of multidisciplinary team records was undertaken between March and May in 2019 and the same months in 2020. Time-to-diagnosis and time-to-treatment for new cancers treated with curative intent were compared between the study periods, and subclassified by referral pathway. RESULTS: A total of 236 new cancer patients were included. During the pandemic, pathways benefitted from reduced diagnostic and treatment times resulting from the restructuring of service provisions. A 75 per cent reduction in secondary care referrals and a 33 per cent increase in urgent suspicion of cancer referrals were observed in 2020. CONCLUSION: Head and neck cancer pathway times did not suffer because of the coronavirus pandemic. Innovations introduced to mitigate issues brought about by coronavirus benefitted patients, led to a more streamlined service, and improved diagnostic and treatment target compliance.

Secure electronic document signing uptake in biologic prescribing for immune mediate diseases

Background: The COVID-19 pandemic drastically impacted workflows in gastroenterology practice. Physicians managing immune-mediated diseases (IMDs) must complete special authorization (SA) and prescription renewal (Rx) forms for patients on biologic therapy. This adds significant administrative burden potentially leading to delays in therapy initiation and care continuity. Historically, document completion has largely been paper-based, with forms faxed between patient support programs (PSPs) and physician offices. The use of secure electronic document signing (SEDS) platforms during the pandemic has allowed physicians to receive and complete documents digitally. The aim of the project was to evaluate the impact of SEDS-based biologic documentation on clinical practice in order to 1) Determine if the use of SEDS platforms increased timeliness of document returns compared to traditional workflows 2) Assess whether SEDS usage is acceptable and sustainable and 3) Assess MD satisfaction with SEDS platforms. Methods: This was a retrospective audit of SEDS and paper-based biologic document workflows from a single PSP (Abbvie Care). Outcomes of interest were the number of documents completed monthly using SEDS, new monthly users, and the number of active monthly users between April 1, 2020-March 31, 2021. Time (days) to SEDS completion (vs. paper process) was determined by reviewing timepoint data for SA and Rx documents from May 2019-January 2020 ('pre- SEDS') and for SEDS documents from May 2020-January 2021('SEDS'). The return time (RT) was defined as the time between date sent to a physician's office by the PSP to the date returned to the PSP. Documents in the pre- SEDS cohort with a RT exceeding 30 days were excluded. Results: In total, 5573 SA and Rx documents were completed by 383 physicians using the SEDS platform from April 2020-March 2021. A mean of 14.6 (sd 21.8) documents were signed per physician. The number of monthly electronic documents processed increased from 104 in April 2020 to 800 in March 2021. Active monthly users increased from 24 in April 2020 to 213 in March 2021 (31 new users monthly). A total of 19,387 paper documents were processed during the 'pre-SEDS' period and 3,317 electronic documents processed in the 'SEDS' period. The mean RT in the 'pre- SEDS' period was 8.03 days (sd 8.2) and the 'SEDS' period was 1.11 days (sd 2.6). Conclusion: This data demonstrates acceptability, appropriateness, and improved processing efficiency of an SEDS platform improving timeliness of patient care. Next steps in this research include surveying physicians to understand the work-flow impact of SEDS, functionality, long-term sustainability, satisfaction and impacts on disease related outcomes.

Rapid implementation of an evidence-based, virtual COVID-19 vaccine education clinic at the nova scotia collaborative inflammatory bowel disease clinic (NSCIBD) Program

Background: The COVID-19 global pandemic has been associated with significant morbidity and mortality. Rapid adaptation of approaches to clinical management as well as policy decisions in relation to implementation of vaccination programs for persons living with IBD has been required throughout the pandemic. To meet the sudden demand of large scale public health-mandated COVID-19 vaccine education for patients living with IBD in Nova Scotia a novel, evidence-based, virtual COVID-19 vaccine educational intervention was developed, implemented, and evaluated. Methods: This was a prospective, observational, cross sectional, implementation-effectiveness study conducted at the NSCIBD program between April-July, 2021. The educational intervention consisted of a standardized email outlining evidence relating to risks and benefits of COVID-19 vaccinations. The intervention was offered to all patients contacting the NSCIBD program with questions or concerns about the vaccine. During one-on-one virtual visits, standardized and evidence-based information was provided by a gastroenterologist or IBD nurse practitioner. Following the session, an anonymous questionnaire (NoviSurvey) evaluated key implementation metrics including satisfaction, appropriateness, usefulness, perceived impact on knowledge and vaccine hesitancy, willingness to participate in future sessions, and recommendations for improvement. Descriptive analyses were conducted, with group means expressed as proportions for categorical variables and means for numerical variables. Results: A total of, 265 patients were invited to participate in the online survey, with a response rate of, 49% (131/265). Before the session, 48.9% (64/131) expressed COVID-19 vaccine hesitancy and, 26% (35/131) expressed concerns relating to risks versus benefits of COVID- 19 vaccines. Ninety-one percent (119/131) of respondents found the education program to be helpful and, 92% (121/131) indicated there was no information perceived to be lacking from the session. Following the intervention, the proportion of those willing to get vaccinated rose from, 61% to, 86.3%. Only, 1.5% (2/131) indicated that they would likely not get vaccinated. Most participants (77%, 101/131) found the written and virtually administered educational content to be satisfactory and, 88% (115/131) were willing to participate in similar virtual education offerings in the future. Conclusion: Implementation of an evidence-based, multidisciplinary COVID-19 vaccination education intervention delivered using a virtual platform was perceived to be feasible, acceptable, and effective by IBD patients. Further research on innovative, evidence-based, multidisciplinary educational interventions and the impact of these interventions on IBD clinical outcomes are needed.

A mixed methods study to evaluate physiotherapy student preferences in digital teaching for achieving effective learning of practical skills

Keywords: Undergraduate;On-line learning;Practical skills Purpose: Due to the hands-on nature of physiotherapy effective teaching and learning of practical skills is an essential component of student education in preparation for clinical practice. The COVID-19 pandemic, has led to the increasing use of digital resources and the need for more effective evaluation of the use of video tutorials in student education. This study evaluates whether first year undergraduate physiotherapy students have a preference for in class teaching or video tutorials. Methods: This mixed methods study comprised the collection of qualitative and quantitative data. Forty-eight first year undergraduate physiotherapy students were first exposed to a video tutorial which taught a skill prior to performing it in a classroom setting. This was followed by a second practical class, this time adopting a traditional live demonstration of a different skill by the same teacher. Students were then required to perform this skill in the classroom. Student preference for the two approaches of teaching was determined and ability to achieve the two skills were graded. Results: A significant number of students preferred the traditional teaching method to the use of video tutorials stating that it made learning easier. However, student grades were consistently higher following the video tutorial. Due to varying levels of participant uptake for undergoing grading and the limited number of participants graded, the results were not generalisable. Conclusion(s): Students preferred the traditional teaching method because it allowed them more interaction with the teacher and the opportunity to ask questions throughout the demonstration. The research suggests video tutorials have a role as an adjunct to practical teaching but not an alternative to traditional live demonstrations. Impact: The research suggests video tutorials have a role as an adjunct but not an alternative to traditional live demonstrations. Students stated that they prefer traditional live demonstrations, however, students level of skill increased following the use of video tutorials. Further research is required to ascertain the value of using interactive on-line tutorials as an alternative to face to face classroom teaching and the influence of learning via video tutorials on students future clinical practice and service user care. Funding acknowledgements: None.

RAPID IMPLEMENTATION OF AN EVIDENCE-BASED, VIRTUAL COVID-19 VACCINE EDUCATION CLINIC AT NOVA SCOTIA COLLABORATIVE INFLAMMATORY DISEASE CLINIC (NSCIBD)

Background Rapid adaptation of clinical management as well as policy decisions in relation to implementation of COVID-19 vaccination programs for persons living with IBD has been required throughout the pandemic. Aims To meet the need for public health-mandated COVID-19 vaccine education for patients living with IBD in Nova Scotia a novel, evidence-based, virtual COVID-19 vaccine educational intervention was developed, implemented, and evaluated. Methods An observational, cross sectional, implementation-effectiveness study was conducted at the NSCIBD program between April and July, 2021. The educational intervention consisted of a standardized evidence-based letter describing risks and benefits of COVID-19 vaccine emailed to patients in advance of a virtual clinic appointment. Virtual appointments were offered to all patients contacting the NSCIBD program with questions or concerns about vaccination. During these virtual visits standardized, evidence-based information was provided by a gastroenterologist (n=2) or IBD nurse practitioners (n=2) and patients were provided with an opportunity to address specific disease and treatment related concerns. Following the session, a link to an anonymous questionnaire was distributed via email to evaluate key implementation metrics including satisfaction, appropriateness, usefulness, perceived impact on knowledge and vaccine hesitancy, and recommendations for improvement. Data analysis was descriptive. Group means were expressed as proportions for categorical variables and means for numerical variables. Results A total of 298 patients participated in a virtual patient education session of which 265 provided a valid email address and invited to participate in the on-line survey. The response rate was 49% (131/265). Before the session, 48.9% (64/131) expressed vaccine hesitancy. Twenty-six percent (35/131) expressed concerns relating to risks versus benefits of COVID-19 vaccines. Ninety-one percent (119/131) of respondents found the education program helpful. The proportion of those willing to get vaccinated rose from 61% (pre) to 86.3% (post). Only 1.5% (2/131) indicated they would not get vaccinated. Seventy-seven percent (101/131) found the written and virtually administered educational content to be satisfactory. Eighty-eight percent (115/131) of respondents were willing to participate in similar types of virtual education offerings in the future. Conclusions Implementation of an evidence-based, multidisciplinary, virtual COVID-19 vaccination education intervention was perceived to be feasible, acceptable, and effective by IBD patients. Further research on innovative, evidence-based, multidisciplinary educational interventions and the impact of these interventions on IBD clinical outcomes are needed. Funding Agencies None

SECURE ELECTRONIC DOCUMENT SIGNING UPTAKE IN BIOLOGIC PRESCRIBING FOR IMMUNE MEDIATED DISEASES

Background: The COVID-19 pandemic drastically impacted workflows in gastroenterology practice. Physicians managing immune-mediated diseases (IMDs) must complete special authorization (SA) and prescription renewal (Rx) forms for patients on biologic therapy. This adds significant administrative burden potentially leading to delays in therapy initiation and care continuity. Historically, document completion has largely been paper-based, with forms faxed between patient support programs (PSPs) and physician offices. Disruption of normal office processes during the pandemic necessitated the movement of existing paper-based workflows online. The use of secure electronic document signing (SEDS) platforms has allowed physicians to receive and complete documents digitally. Aims: To evaluate the impact of SEDS-based biologic documentation on clinical practice. Objectives were 1) to determine if the use of SEDS platforms increased timeliness of document returns compared to traditional workflows 2) assess whether SEDS usage is acceptable and sustainable and 3) assess MD satisfaction with SEDS platforms. Methods: This was a retrospective audit of SEDS and paper-based biologic document workflows from a single PSP (Abbvie Care). Outcomes of interest were the number of documents completed monthly using SEDS, new monthly users, and the number of active monthly users between April 1, 2020-March 31, 2021. Time (days) to SEDS completion (vs. paper process) was determined by reviewing timepoint data for SA and Rx documents from May 2019-January 2020 (‘pre- SEDS’) and for SEDS documents from May 2020-January 2021(‘SEDS’). The return time (RT) was defined as the time between date sent to a physician’s office by the PSP to the date returned to the PSP. Documents in the pre-SEDS cohort with a RT exceeding 30 days were excluded Results: In totally, 5573 SA and Rx documents were completed by 383 physicians using the SEDS platform from April 2020-March 2021. A mean of 14.6 (sd 21.8) documents were signed per physician. The number of monthly electronic documents processed increased from 104 in April 2020 to 800 in March 2021. Active monthly users increased from 24 in April 2020 to 213 in March 2021 (31 new users monthly). A total of 19,387 paper documents were processed during the ‘pre-SEDS’ period and 3,317 electronic documents processed in the ‘SEDS’ period. The mean RT in the ‘pre-SEDS’ period was 8.03 days (Sd 8.2) and the ‘SEDS’ period was 1.11 days (sd 2.6). Conclusion: This data demonstrates acceptability, appropriateness, and improved processing efficiency of an SEDS platform improving timeliness of patient care. Next steps in this research include surveying physicians to understand the work-flow impact of SEDS, functionality, long-term sustainability, satisfaction and impacts on disease related outcomes.

Synthesis and Evaluation of Ammonia Borane: A Modular, Multifaceted Approach Introducing Experimental Design through Guided Inquiry

A practical focusing on the synthesis, isolation, and hydrolysis of ammonia borane (AB), H3N·BH3, was developed for first-year undergraduate students. By requiring students to propose their own experimental setup to measure the amount of gas produced upon hydrolysis, experimental design skills were introduced and developed during the practical. As a result of the COVID-19 pandemic, remote and face-to-face versions of the practical were created to enable inclusivity in which experimental design skills were a key feature. Students identified and reported an appreciable increase in their experimental design skills. The multifaceted nature of the practical allows for flexibility in its implementation, dependent on students' prior knowledge, local logistical considerations, and the learning objectives of an institution. © 2021 American Chemical Society and Division of Chemical Education, Inc.

Defending Weapons Inspections from the Effects of Disinformation

The intentional spread of disinformation is not a new challenge for the scientific world. We have seen it perpetuate the idea of a flat earth, convince communities that vaccines are more dangerous than helpful, and even suggest a connection between the "5G" communication infrastructure and COVID-19. Nor is disinformation a new phenomenon in the weapons inspection arena. Weapons inspectors themselves are often forced to sift through alternative narratives of events and inconsistent reporting, and they regularly see their credibility and conclusions questioned in the face of government politics or public biases. But certain recent disinformation campaigns have become so overwhelmingly comprehensive and effective that they constitute a new kind of threat. By preventing accountability for clear violations of international law, these campaigns have created a challenge to the survival of arms control treaties themselves. If weapons inspectors cannot regain the trust of the international community in the face of this challenge, it will be increasingly difficult to ensure compliance with arms control and disarmament treaties going forward. In this essay, I will briefly discuss one of the most comprehensive disinformation efforts of the past decade: the disinformation campaign used to prevent accountability for Syria's repeated use of chemical weapons. After this discussion, I will propose one possible approach to help protect the credibility of disarmament experts and weapons inspectors in the face of pervasive disinformation. This approach will require a concerted effort to connect and support compliance experts and to understand and explain their expertise across cultural, political, national, economic, and religious divides.

What lies ahead for energy and carbon emissions post covid-19

Energy supply and demand patterns changed as the response to the COVID-19 pandemic evolved and remained uncertain. The outbreak has been a one-of-a-kind situation unlike anything seen in the last one hundred years. As a result of various measures put in place by governments, travel was vastly reduced, and air travel diminished to near zero. Consumption and the price of fossil fuels decreased significantly and hundreds of millions of metric tons of CO2 emissions were prevented. The impact of Covid-19 on the worldwide energy industry and greenhouse gas emissions has been drastic but seemingly temporary. In 2020, wildfires in western United States more than made up for the reduction in global emissions in the first half of 2020 due to the pandemic. Renewable energy has made major advances recently, but fossil fuels still supply 84% of the global energy. Advancements in aircraft efficiency and extensive utilization of electric vehicles charged with renewable sources of electricity offer remarkable opportunities for improving our environment. Without major changes in the energy and transportation industries, greenhouse gas emissions are likely to return to their 2019 levels before long. © 2021, European Association for the Development of Renewable Energy, Environment and Power Quality (EA4EPQ). All rights reserved.