FEASIBILITY of LINKING UNIVERSAL WELL-CHILD HEALTHCARE and FINANCIAL COUNSELLING: FINDINGS from the AUSTRALIAN HEALTHIER WEALTHIER FAMILIES (HWF) PILOT RANDOMISED CONTROLLED TRIAL

Background: We pilot-tested the feasibility and short-term impacts of "Healthier Wealthier Families" (HWF), which seeks to reduce financial hardship by developing a referral pathway between universal child and family health (CFH) services and financial counselling. Method(s): Setting: CFH services in five sites (Victoria, New South Wales), coinciding with the COVID-19 pandemic. Participant(s): Caregivers of children aged 0-5 years. Eligible clients disclosed financial hardship using a study-designed screening tool. Design(s): Pilot randomised controlled trial (RCT). With mixed progress in Sites 1-3, we conducted an implementation evaluation and adapted the protocol to a simplified RCT (Site 4) and direct referral with pre-post evaluation (Site 5). Intervention(s): Financial counselling. The comparator was usual care. Measures: Feasibility was assessed via proportions of clients screened, enrolled, followed-up, and who accessed financial counselling. Impacts (quantitative surveys, qualitative interviews) included finances to 6 months post-enrolment. Result(s): 72%-100% of clients across sites answered the financial screen. In RCT sites (1-4), less than one-quarter enrolled. In Site 5, n = 44/64 (64%) clients were eligible and engaged with financial counselling. Common challenges facing these clients were utility debts (73%), obtaining government entitlements (43%) and material aid/emergency relief (27%). On average, their household income increased $250 per fortnight ($6504 annually), and families received average single payments of $784. Caregivers identified benefits including reduced stress, practical help, increased knowledge and empowerment. Conclusion(s): Financial hardship screening via CFH, and direct referral, were acceptable to caregivers. Individual randomisation was infeasible. Matching between populations and CFH practice is necessary to incorporate a HWF model of care.

An analysis of Residents' Willingness to Pay for Domestic Nature-Based Tourism in Botswana During and Post the COVID-19 Pandemic

The COVID-19 pandemic halted tourism leading to job losses, loss of livelihoods and revenue losses at national and international levels. The pandemic has reinforced the need to develop strong domestic tourism bases. The overall aim of this study is to estimate domestic tourists' willingness to pay for domestic tourism packages during and post the COVID-19 pandemic. To achieve the overall aim, this study seeks to estimate the residents' willingness to pay (WTP) for a standard two-day domestic nature-based tourism package and analyse factors influencing residents' WTP for domestic nature-based tourism. The study relied on primary data sourced from an online questionnaire administered randomly to residents aged 18 years and older. The contingent valuation method (CVM) was used to analyse the average level of the residents' WTP for domestic tourism. On average, the respondents were willing to pay for a standard two-day domestic nature-based tourism experience package valued at BWP3 340.66 per person sharing. Some camps charge as high as BWP72 097.62 for a similar package. There is a need to develop plans that promote pricing and product offerings that accommodate domestic tourists without having an impact on the sustainability of natural resources and the integrity of the natural environment © 2023 AJHTL /Author(s)

The 4Cs of academic language and literacy: Facilitating structured discussions in remote classrooms

This chapter describes how teachers have used structured discussions and digital tools to transition from traditional classrooms to remote, online instruction during the COVID-19 pandemic. With emphasis on culturally and linguistically diverse students, the chapter includes examples of how teachers reinforce literacy while supporting 21st century skills such as collaboration, communication, critical thinking, and creativity. Tools and strategies are presented along with examples teachers can use to facilitate student learning across content areas in virtual classrooms. © 2021, IGI Global.

In the covid aftermath, using an innovative collaborative approach to improve wait times for skin cancer patients

COVID-19 led to drastic reductions in non-urgent medical visits and cancer care. Surgical patient backlogs mean new strategies are required to decrease wait times and administrative costs whilst improving patient outcomes. We review the impact of combined speciality Plastic Surgery and Dermatology 2 week-wait (2ww) clinics on wait times and hospital attendances and associated cost implications when compared to the single speciality clinics. Retrospective analysis comparing Plastic surgery (PS) and Dermatology (DM) 2ww clinics against combined Dermatology and Plastic surgery (DP) clinics across the same 3-month period in 2018 and 2019 at a single UK tertiary centre. 283 patients reviewed across the same 3-month period in 2018 and 2019 (PS n=53, DM n=158, PD n=72). PD reviewed most patients per clinic (Averages: PD n=18.0, PS n=8.8, DM n=12.1). Hospital attendance decreased from 1.84 to 1.51 visits. 42.9% of excisional biopsies were performed on the same day as initial assessment compared to 18.0% in PS/DM clinics. Referral to surgery time decreased from 67.7days to 50.4 days, and tertiary assessment to surgery from 49.5days to 36.9days. PD attracted tariffs of up to £29.78 more per patient. Combined clinics see more patients and attract higher tariffs per patient, whilst reducing outpatient attendances and wait times to surgery. This has significant cost-saving implications whilst optimising cancer care.

Characteristics and Outcomes of COVID-19 in Hospitalized Native American Patients: A Single-Site Retrospective Analysis

Background. COVID-19 continues to threaten public health, particularly in Native American (NA) communities, which experienced some of the highest rates of COVID-19 infection and mortality in the US. Although the risk factors and clinical characteristics of COVID-19 are well documented in the general population, there has been little research on NA patients. Methods. We present descriptive data based on chart reviews of COVID-19 patients hospitalized between April 1 and July 31, 2020 at the Whiteriver Service Unit (WRSU), an Indian Health Service site on the Fort Apache Reservation. Results. Of the 2,262 COVID-19 cases during the observation period, 490 (22%) were hospitalized and 35 (1.6%) died within 28 days. Compared to previous reports, hospitalized patients at WRSU were younger (median age 54), more likely to be female (55% female), and more likely to have comorbidities (92% at least 1, median 2). Patients under 50 (n=200) often had a history of alcohol abuse (51%) or polysubstance abuse (20%). One third of hospitalized patients (34%) were monitored at home and referred for treatment through a high-risk outreach program. Patients were admitted much earlier at WRSU than in other locations, with a median interval of 4 days from symptom onset to hospitalization compared to 7 days reported elsewhere, but over half were still transferred to higher care. Although WRSU patients had higher rates of comorbidities, the 28-day hospital mortality rate from COVID-19 was nearly half of what has been previously reported (35/490, 7% vs 15-20% reported elsewhere, p < 0.001). This trend persisted after controlling for age. Multivariate logistic regression showed that increasing age, male sex, and high BMI were significantly associated with higher risk of death from COVID-19 (overall model p < 0.001). Characteristics and outcomes of hospitalized COVID-19 patients at WRSU Conclusion. Hospitalized patients at WRSU tended to be younger but with more comorbidities than previous studies. This may reflect the fact that NAs tend to acquire comorbidities at younger ages than the general population. This may also reflect the high rates of substance abuse in younger patients, which could be an additional risk factor for severe COVID-19. We believe that the low mortality rates at WRSU are a result of our outreach program, which likely decreased the interval between symptom onset and medical treatment.

THE IMPACTS OF COVID-19 ON NATURE-BASED TOURISM IN BOTSWANA: IMPLICATIONS FOR COMMUNITY DEVELOPMENT

COVID-19 has had significant impacts on industries and individuals globally. Due to restrictions put in place to reduce the spread of the disease, it has affected the travel and tourism industry. Using the concepts of ecotourism and sustainable tourism, a systematic qualitative document analysis of available literature was carried out to determine the impacts of the COVID-19 pandemic on nature-based tourism and its implications on community development, using Botswana as a case study. Results indicate that due to the unsustainable and predominant dependence on the international market, the tourism sector in Botswana has come to a standstill. Furthermore, the promotion of domestic tourism to nature-based attractions may lead to conservation issues. COVID-19 has also had an impact on community development through abrupt losses of employment and income. However, several positive environmental impacts have also been experienced. This article calls for a transformation of the tourism sector to make it more resilient. As a response measure, it is necessary to assess whether there is a need to call for a change in policy from high-value low-volume to low-cost high-volume, which may have negative impacts on conservation. However, as an adaptive response, we assert the need to diversify tourism products to consider the needs of both domestic and regional markets so that the focus is not just on nature-based tourism and international clientele. © 2021. All Rights Reserved.

Diagnosis and Management of Osteoporosis During COVID-19: Systematic Review and Practical Guidance.

It is acknowledged that the COVID-19 pandemic has caused profound disruption to the delivery of healthcare services globally. This has affected the management of many long-term conditions including osteoporosis as resources are diverted to cover urgent care. Osteoporosis is a public health concern worldwide and treatment is required for the prevention of further bone loss, deterioration of skeletal micro-architecture, and fragility fractures. This review provides information on how the COVID-19 pandemic has impacted the diagnosis and management of osteoporosis. We also provide clinical recommendations on the adaptation of care pathways based on experience from five referral centres to ensure that patients with osteoporosis are still treated and to reduce the risk of fractures both for the individual patient and on a societal basis. We address the use of the FRAX tool for risk stratification and initiation of osteoporosis treatment and discuss the potential adaptations to treatment pathways in view of limitations on the availability of DXA. We focus on the issues surrounding initiation and maintenance of treatment for patients on parenteral therapies such as zoledronate, denosumab, teriparatide, and romosozumab during the pandemic. The design of these innovative care pathways for the management of patients with osteoporosis may also provide a platform for future improvement to osteoporosis services when routine clinical care resumes.

Blood donor surveillance of SARS-CoV-2 seroreactivity

Background/Case Studies: Blood donor based serosurveillance is a convenient and cost-effective strategy to monitor the extent of the COVID-19 pandemic and allows the detection of asymptomatic and recovered cases. The RESPONSE (REDS-IV-P Epidemiology, Surveillance and Preparedness of the Novel SARS-CoV-2 Epidemic) study conducted monthly cross-sectional serosurveys of 1000 routinely obtained donor samples in 6 metropolitan regions (see table). Study Design/Methods: Samples were captured monthly from March or April through June 2020. Siteswere selected based on reports of epidemic activity or as low prevalence control regions. Donations from COVID- 19 convalescent plasma donors were excluded. Coded samples, with routinely collected demographic data and zip code of residence, were tested for SARS-CoV-2 antibodies using the Ortho VITROS anti-SARS-CoV-2 S1 Total Ig (data reported below) with planned confirmation of reactivity on Roche Elecsys® NC Anti-SARS-CoV-2 and a pseudovirus-based neutralization assay. Results/Findings: Table 1 shows donor seroreactivity with 95% CI. For all sites, seroreactivity was <1.0% (range 0.1%-0.9%) at the beginning of the surveillance period. Donor seroreactivity in New York City (NYC) was about 10-fold higher in April through June as compared to March and was much higher than in other locations. There were modest increases in seroreactivity over the study timeframe for all other sites. Conclusions: Modest increases in seroreactivity from baseline were found in all sites, with the largest increase in NYC. SARS-CoV-2 antibody testing of routinely obtained blood donor samples allows for detection of asymptomatic and recovered COVID-19 cases and enables future estimation of infection incidence by geographic and other demographic parameters. This approach will be used in a significantly expanded CDC National serosurveillance study involving all 50 states over 18 months.

Qualification of COVID-19 convalescent plasma donations by SARS-CoV-2 antibody testing utilizing a wide-dynamic range Antigen-Sandwich S1-antigen immunoassay and reflex neutralizing antibody testing

Background/Case Studies: The efficacy of COVID-19 convalescent plasma (CCP) to treat COVID-19 is hypothesized to be associated with the concentration of neutralizing antibodies (nAb) to SARS-CoV-2. While high capacity, automated serologic assays to detect binding antibodies (bAb) have been developed, complex nAb assays are not easily adaptable to high-throughput testing. We sought to determine the effectiveness of using surrogate bAb signalto- cutoff ratio (S/CO) in predicting nAb titers using a pseudovirus reporter viral neutralization (RVPN) assay. Study Design/Methods: CCP donor serum collected by 3 large US blood collectors was tested with a bAb assay (Ortho Diagnostic VITROS® Anti-SARS-CoV-2 Total, CoV2T) and a nAb RVPN assay. Although EUA approved as a qualitative assay, CoV2T reports a semi-quantitative S/CO. The RVPN assay uses a pseudovirus construct with native S-protein and target cell lines overexpressing ACE2 receptor and TMPRSS2 protease. Serially diluted serum is mixed with SARS-CoV-2 pseudovirus to assess inhibition of viral entry in culture and reported as titers resulting in 50% neutralization of virus infectivity (NT50) by nonlinear regression analysis. CoV2T prediction effectiveness at several S/CO thresholds was evaluated for various RVPN nAb NT50 titers using receiver operating characteristic analysis. Results/Findings: 753 CCP donations were tested with median CoV2T S/CO of 71.2 (range 0.1-919) and median NT50 of 527.5 (range <40 to >10,240). The prevalence of CCP donors with NT50 over various target n-Ab titers were 86% >80, 76% >160, and 45% >640. Increasing CoV2T reactivity threshold reduces sensitivity to predict the target NT50 titer while specificity to identify those below nAb threshold increases for all targeted NT50s (Table 1). As the targeted NT50 is increased from >80 to >640, the positive predictive value falls dramatically while the negative predictive value increases, thus S/CO thresholds are less able to predict donors who have the target NT50 titer but more able to predict those donors who do not meet it. Conclusions: The selection of targeted nAb titer for clinical use will significantly impact availability of CCP for transfusion. Product release with CoV2T assay S/CO thresholds must balance the risk of releasing products below minimum target nAb titer and the cost of false negatives (CCP units below the threshold with adequate nAb titers). A two-step testing scheme may be optimal, with nAb testing performed on CoV2T reactive samples with S/CO values below the release threshold.

Information management in the early stages of the COVID-19 pandemic

Purpose: This paper aims to review the information management aspects of the early months of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coronavirus 19 outbreak. It shows that the transition from epidemic to the pandemic was caused partly by poor management of information that was publicly available in January 2020. Design/methodology/approach: The approach combines public domain epidemic data with economic, demographic, health, social and political data and investigates how information was managed by governments. It includes case studies of early-stage information management, from countries with high and low coronavirus disease 2019 impacts (as measured by deaths per million). Findings: The reasons why the information was not acted upon appropriately include “dark side” information behaviours (Stone et al., 2019). Many errors and misjudgements could have been avoided by using learnings from previous epidemics, particularly the 1918-1919 flu epidemic when international travel (mainly of troops in First World War) was a prime mode of spreading. It concludes that if similar outbreaks are not to turn into pandemics, much earlier action is needed, mainly closing borders and locking-down. Research limitations/implications: The research is based on what was known at the time of writing, when the pandemic’s exact origin was uncertain, when some statistics about actions and results were unavailable and when final results were unknown. Practical implications: Governments faced with early warning signs or pandemics must act much faster. Social implications: If the next virus is as infectious as SARS-CoV-2 but much more fatal, the world faces disastrous consequences if most governments act as slowly as this time. Originality/value: This is one of the first analyses of information management practices relating to the pandemic’s early stages. © 2020, Emerald Publishing Limited.

Minipool testing for SARS-CoV-2 RNA in US blood donors

Background/Case Studies: SARS-CoV-2 RNA has been detected by PCR in plasma, serum or whole blood specimens from hospitalized patients in studies from multiple countries. For asymptomatic individuals, several reports have described detection of SARS-CoV-2 RNA in plasma in a small number of blood donors, whereas other reports showed no detection of SARS-CoV-2 RNA in whole blood, serum or plasma from asymptomatic individuals including blood donors. No cases of transfusion-transmission of SARS-CoV-2 (or other human coronaviruses) have been reported, nor has virus been isolated from blood samples by tissue culture. We tested residual volumes of donor plasma from mini-pools (MPs) used for routine nucleic acid testing (NAT) screening to determine the frequency of SARS-CoV-2 RNAemia in blood donors in six US metropolitan regions (New York, Seattle, San Francisco, Los Angeles, Boston, Minneapolis). Study Design/Methods: Blood donations collected from 7 March 2020 to 30 June 2020 were tested for SARS-CoV-2 RNA. Donations were tested in plasma MPs of 6 or 16 donations (MP16 format for five regions and MP6 format for Seattle), targeting 500 MPs per region per month, using the Grifols Procleix SARS-CoV-2 transcriptionmediated amplification (TMA) assay on the Procleix Panther system. The test has a 95% limit of detection (LOD) of 16.5 copies/mL (95% CI, 12.8 to 23.6 copies/mL) by probit analysis. A confirmed positive result was defined by the detection of viral RNA upon repeat testing using the same assay and an alternate target region TMA assay (Grifols SARS-CoV-2 confirmatory TMA assay) with comparable sensitivity. Positive MPs were further tested using the Ortho VITROS anti-SARS-CoV-2 Total Ig test to detect antibodies and diluted 4-fold and tested using the Procleix SARS-CoV-2 TMA assay to determine whether the viral load was close to the 95% LOD. Results/Findings: A total of 8,496 MPs16 and 1,998 MPs 6, corresponding to ∼147,000 blood donations, were tested for SARS-CoV-2 RNA. One confirmed positive MP16 sample from a March donation in San Francisco was identified (0.0007% [95% CI 0.000035-0.004%]). The MP was negative for antibody and nonreactive when diluted 4-fold, suggesting a viral load below 1,000 RNA copies/mL in the individual donation. Conclusions: Blood donation MP-NAT indicated that SARS-CoV-2 RNAemia is rare, and when detected the RNA was at low concentration. Although future studies to determine the infectivity of RNA-positive plasma are warranted and in progress, these findings are reassuring with respect to transfusion safety and support current recommendations from WHO and regulatory agencies to not screen donors by NAT.