Spatial changes in park visitation at the onset of the pandemic

The COVID-19 pandemic disrupted the mobility patterns of a majority of Americans beginning in March 2020. Despite the beneficial, socially distanced activity offered by outdoor recreation, confusing and contradictory public health messaging complicated access to natural spaces. Working with a dataset comprising the locations of roughly 50 million distinct mobile devices in 2019 and 2020, we analyze weekly visitation patterns for 8,135 parks across the United States. Using Bayesian inference, we identify regions that experienced a substantial change in visitation in the first few weeks of the pandemic. We find that regions that did not exhibit a change were likely to have smaller populations, and to have voted more republican than democrat in the 2020 elections. Our study contributes to a growing body of literature using passive observations to explore who benefits from access to nature.

Examining the Remote Learning Experiences of Children Born Very Preterm During the COVID-19 Pandemic

This study examined the remote learning activities children born very preterm (VPT;gestational age <= 30 weeks) received, compared with children born full term (FT;gestational age >= 37 weeks), during the COVID-19 pandemic. Parents of 5- to 6-year-olds born VPT (n = 33) and FT (n = 33) reported on the provision, frequency, and duration of teacher-provided live instruction, educational materials, and homework;and parent-provided educational materials. More kindergarten children born VPT received small group instruction and fewer received large group instruction than FT children. Preschoolers born VPT engaged in parent-provided learning apps, educational videos, and reading activities less frequently or for shorter durations than FT children. Findings suggest that while teachers generally implemented remote learning similarly for children born VPT and FT, parents did not. Children born VPT are at higher risk for educational problems and may benefit from more intensive school- and home-based educational interventions to help offset the impact of school closures.

Work-life balance among health administration faculty before and during the COVID-19 pandemic

This current study examines measures of work-life balance among health administration faculty prior to and during the COVID-19 pandemic. A repeated cross-sectional design is used to analyze data collected from a national survey in 2018 and 2021. Changes in six different outcome measures of work-life balance were examined using multivariable logistic regression, controlling for health administration faculty characteristics. Compared to 2018 respondents, faculty respondents in 2021 were more likely to report that family and personal matters were interfering with their ability to do their job (OR = 1.93, p=0.001). Females more frequently reported that their career had suffered because of personal issues/obligations (OR = 1.82, p=0.003) but were less likely to report having enough time to get their teaching (OR = 0.68, p=0.026). Respondents with children 18 years or younger reported higher rates of regularly having to miss a meeting or event at home (OR = 1.88, p<0.001) and an event at work (OR = 3.74, p<0.001). These faculty also more frequently reported that family or personal matters were interfering with their ability to do their job (OR = 3.04, p<0.001) and that their career suffered because of personal issues/obligations (OR = 2.09, p=0.001). Given the implications of work-life conflicts to organizational outcomes, academic leaders and university decision-makers should consider adopting strategies to mitigate the effects of these disruptions to the work-life equilibrium of academics.

One-Year Neurodevelopmental Outcomes After Neonatal Opioid Withdrawal Syndrome: A Prospective Cohort Study.

Purpose: The aims of this study were, in a cohort of children with neonatal opioid withdrawal syndrome (NOWS), (a) to report 1-year neurodevelopmental outcomes and specifically characterize speech, language, and hearing outcomes and (b) to report the prevalence of cleft lip and/or cleft palate. Method: This prospective observational cohort study includes newborns with confirmed in utero opioid exposure who received pharmacological treatment for NOWS. During 1-year-old developmental visits, we administered standardized assessments (Bayley Scales of Infant and Toddler Development-Third Edition [Bayley-III] or Developmental Assessment of Young Children-Second Edition [DAYC-2]-due to COVID-19 restrictions). We compared Bayley-III scores to standardized population means using one-sample z tests. We report estimates, 95% confidence intervals, and two-sided p values. Results: We enrolled 202 infants (October 2018 to March 2020). Follow-up at 1-year was 80%. Infants with NOWS had lower Bayley-III scores at 1 year compared to published norms for cognitive, language, and motor domains. One infant with NOWS was diagnosed with isolated cleft palate and Pierre Robin sequence. All infants passed the newborn hearing screen, and 7.5% had a formal hearing evaluation after neonatal intensive care unit discharge, with 40% having abnormal or inconclusive results; middle ear effusion was the leading cause of abnormal hearing (66.7%). Ten percent of children received a speech-language pathology referral prior to 2 years of age. Infants born to mothers with mental health conditions were more likely to have Bayley-III or DAYC-2 scores below 95 in language or motor domains. Conclusions: Infants with pharmacologically treated NOWS have significantly lower cognitive, language, and motor scores on standardized developmental testing compared to population means at 1 year of age. Early speech-language pathology referral is frequently necessary to promote optimal development in this population. Supplemental Material: https://doi.org/10.23641/asha.20044403.

THE ETHICS OF GLOBAL COVID-19 VACCINE ALLOCATION

Introduction Policies to increase global vaccine access involve HICs making ethically fraught tradeoffs between saving lives at home or abroad. Such policies should be justifiable to the affected populations. Yet there is little robust data on whether HIC residents endorse their countries' policy choices. Most existing data asks highly simplified questions, without providing background on the ethical tradeoffs involved. These data do not capture the public's informed views, giving policymakers limited guidance on how to craft international vaccine policy. This paper provides the first nuanced data on the informed views of a representative sample of the U.S. public about providing COVID vaccine to poorer countries. Methods This study involved two interventions: a description of ethical arguments for/against providing vaccine to poorer countries and visuals depiction of ethically relevant tradeoffs about providing vaccine to poorer countries at different time points in the US vaccination campaign. A representative sample of 4000 U.S. adults were surveyed, divided evenly into four arms: 1) arguments only;2) tradeoffs only;3) both interventions;4) no interventions. Results Across all four arms, people are more willing to donate vaccines than previously reported, with generosity increasing over time. 43% of respondents were willing to share at an early timepoint when supply was extremely limited, increasing to 54% and 71% at intermediate and current timepoints, respectively. Some specific variables (e.g., political affiliation, age, acceptability of masks) were predictive of willingness to donate and endorsement of specific arguments. Discussion These data can guide policy about providing or keeping U.S. vaccine doses as the world navigates the effects of new variants and the potential need for booster shots in the coming months. Given high levels of willingness to donate, U.S. policy could have initiated global vaccine donations earlier and could be more generous currently.

CEREBRAL VENOUS SINUS THROMBOSIS AND COVID-19: CAUSATION OR COINCIDENCE?

Since early in the pandemic, it has been recognised that coronavirus disease 2019 (COVID-19) is associ-ated with an increased risk of thromboembolic complications. Several recent case reports have identified cases of cerebral venous sinus thrombosis (CVST) occurring in conjunction with COVID-19. Given these patients' increased risk of thromboembolic events, some authors have hypothesised that there may be a causative association between the two conditions. To examine this hypothesis, we collected a retrospective case series of patients with CVST presenting to a large tertiary neurology centre and surrounding trusts in the North West of England between January 2019 and December 2020. The catchment area serves approximately 3.2 million people, of which all confirmed cases of CVST are discussed with tertiary services. We identified 46 cases of CVST during 2020, 5 of which were identified as having been positive for COVID-19 RNA or antibodies at the time of CVST diagnosis (10.87%). A comparative 52 cases of CVST were identified during 2019. We suggest our findings do not provide evidence for an association between CVST and COVID-19 based on overall incidence trends. However, we also suggest that further research should be undertaken regarding this potential association, with particular emphasis on COVID-19 antibody testing.

Economic incentives for the wildlife trade and costs of epidemics compared across individual, national, and global scales

The wildlife trade drives biodiversity loss and zoonotic disease emergence, and the health and economic impacts of COVID‐19 have sparked discussions over stricter regulation of the wildlife trade. Yet regulation for conservation and health purposes is at odds with the economic incentives provided by this multibillion‐dollar industry. To understand why the wildlife trade persists despite associated biodiversity and global health threats, we used a benefit–cost approach using simple calculations to compare the economic benefits of the wildlife trade at the individual, national, and global scales to the costs of COVID‐19, severe acute respiratory syndrome (SARS), and Ebola disease across scenarios of epidemic frequency. For COVID‐19, benefits of the wildlife trade outweigh costs at individual scales, but costs far exceed benefits at national and global scales, particularly if epidemics were to become frequent. For SARS and Ebola, benefits outweigh costs at all scales, except if Ebola‐like epidemics were to become frequent. The wildlife trade produces net benefits for people who depend on wildlife for food and income but incurs net costs on stakeholders at larger scales from increased epidemic risk. While our analysis omits a variety of costs and benefits that are difficult to quantify and contrast, our analysis is meant to illustrate the distributional outcomes across stakeholder groups that could result from increased wildlife trade regulation. Importantly, the feasibility of trade regulatory policies will depend on how these benefits and costs compare across groups and would therefore need to involve accessible and attractive alternative sources of food and livelihoods for those who depend on the wildlife trade. [ FROM AUTHOR] Copyright of Conservation Science & Practice is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

BEDSIDE TEST TO RULE OUT AN ECTOPIC PREGNANCY USING A MODIFIED FDA APPROVED KIT

OBJECTIVE: To evaluate the accuracy of a modified bedside test in ruling out an ectopic pregnancy. The test is based on a lateral flow immunoassay for alpha-fetoprotein (AFP). It has been shown that a high AFP level in vaginal blood indicates the passage of fetal tissue, suggestive of a miscarriage [1].We hypothesized that high AFP levels in sampled intrauterine tissue, assuming non-heterotopic pregnancy, rules out the presence of an ectopic pregnancy. MATERIALS AND METHODS: This is a prospective cohort study. The study included pregnant women undergoing a dilation and curettage (D&C) for pregnancy loss or termination, women with pregnancy loss or an ectopic pregnancy presenting with vaginal bleeding, and non-pregnant women with vaginal bleeding. Vaginal blood was collected on gauzes, sanitary pads, and cotton swabs. Samples were then tested for AFP levels using a commercial kit (ROMplus, Laborie, USA) originally designed to detect leakage of amniotic fluid. This kit contains a lateral flow immunoassay strip capable of detecting the presence of AFP. Positive samples for AFP were retested at a later date (after 3 to 20 days) to ascertain the stability of AFP and reliability of the test. Official sonograms, pregnancy tests, and final pathology results were obtained to confirm pregnancy status as well as the presence or absence of fetal tissue in the vaginal blood. A sensitivity and specificity analysis was performed against these final results to validate the accuracy of the test strip in ruling out an ectopic pregnancy. RESULTS: A total of 30 vaginal blood samples were tested for AFP. All pregnant women who had a miscarriage or D&C had detectible AFP in their vaginal blood (n=13). On retesting the samples 3 to 20 days later, these results remained the same (positive test strip). The remaining 17 vaginal blood samples were from 4 women with ectopic pregnancies and from 13 non-pregnant women with vaginal bleeding. All 4 ectopic pregnancies had no AFP detected in the vaginal blood and only 1 out of 13 non-pregnant patient samples had AFP detected. The ROMplus test strip correctly detected AFP in all samples tested containing fetal tissue (n=13) resulting in a test sensitivity of 100%. ROMplus correctly identified the absence of AFP in 16 out of the 17 samples lacking fetal tissue, a 94% test specificity. CONCLUSIONS: ROMplus has the potential to accurately and reliably detect the presence of AFP, and hence fetal tissue, in vaginal blood samples. This could be a vital non-invasive aid in ruling out an ectopic pregnancy at the bedside (currently off-label use). Furthermore, it could limit the amount of invasive testing and visits needed in cases of pregnancies of unknown location. IMPACT STATEMENT: In light of the recent COVID-19 pandemic, a simple non-invasive bedside test to rule out an ectopic pregnancy is highly desired given its potential for reducing the number of visits, investigations performed, and personnel involved in the workup of a pregnancy of unknown location.

Gauging the happiness benefit of US urban parks through Twitter.

The relationship between nature contact and mental well-being has received increasing attention in recent years. While a body of evidence has accumulated demonstrating a positive relationship between time in nature and mental well-being, there have been few studies comparing this relationship in different locations over long periods of time. In this study, we analyze over 1.5 million tweets to estimate a happiness benefit, the difference in expressed happiness between in- and out-of-park tweets, for the 25 largest cities in the US by population. People write happier words during park visits when compared with non-park user tweets collected around the same time. While the words people write are happier in parks on average and in most cities, we find considerable variation across cities. Tweets are happier in parks at all times of the day, week, and year, not just during the weekend or summer vacation. Across all cities, we find that the happiness benefit is highest in parks larger than 100 acres. Overall, our study suggests the happiness benefit associated with park visitation is on par with US holidays such as Thanksgiving and New Year's Day.

Spatial changes in park visitation at the onset of the pandemic (preprint)

The COVID-19 pandemic disrupted the mobility patterns of a majority of Americans beginning in March 2020. Despite the beneficial, socially distanced activity offered by outdoor recreation, confusing and contradictory public health messaging complicated access to natural spaces. Working with a dataset comprising the locations of roughly 50 million distinct mobile devices in 2019 and 2020, we analyze weekly visitation patterns for 8,135 parks across the United States. Using Bayesian inference, we identify regions that experienced a substantial change in visitation in the first few weeks of the pandemic. We find that regions that did not exhibit a change were likely to have smaller populations, and to have voted more republican than democrat in the 2020 elections. Our study contributes to a growing body of literature using passive observations to explore who benefits from access to nature.

Examination of cataract surgical data: Is access equity improving for Aboriginal and Torres Strait Islander Australians?

Purpose: Persisting inequity in access to eye care for Aboriginal and Torres Strait Islander Australians has been well documented. Over the past decade, a number of frameworks and initiatives have worked towards improving access to eye care, though inconsistent data reporting and availability makes it challenging to form a coherent overview of actual increases in access, and progress towards the population-based needs. The paper will present an improved understanding of access to cataract surgery for Aboriginal and Torres Strait Islander Australians. Method: Publicly available cataract surgical data over the past decade, including Medicare statistics, public hospital data, Australian Institute of Health and Welfare annual Indigenous Eye Health Measures reports, state health data, and past analyses in the literature, is combined and analysed to present an overview of existing surgical delivery and access and a more nuanced consideration of cataract surgery needs for Aboriginal and Torres Strait Islander Australians. Results: Large variance has been identified across jurisdictions, across public and private settings, and across remoteness levels, suggesting significant differences in access. The combined analysis highlights challenges in access for cataract surgeries in metropolitan areas. Finally, impacts of COVID-19 on service provision and the existing backlog is considered. Conclusions: Differing access rates provide an ongoing challenge to organised ophthalmology, as well as the wider eye care sector and national, state and territory-level programs and policies. The shared goal is to best support increasing the cataract surgery rates for Aboriginal and Torres Strait Islander Australians to population-based needs.

Sickle Cell Disease (SCD) As a Risk for COVI19 Compared to Those without SCD Among Patients Admitted in a Large Urban Center, As Estimated By PCR Sars-v-2 Positive Vs Negative Testing

A diagnosis of SCD is considered to be at risk for COVD19. To further define the association between SCD and infection with COVID-19, we estimated risk, by comparing presence or absence of COVID19 infections in individuals with and without SCD admitted concurrently to a large urban health care facility (Grady Memorial Hospital, Atlanta, GA;960 beds, 5th largest public hospital in the US). Primary outcome was a positive or negative COVID-19 diagnosis as defined bySARS-CoV-2 PCR testing. A patient was considered to be COVID-19 positive if tested positive withSARS-CoV-2 PCR for the first time, anytime during the study period, irrespective of number of tests. A patient was considered to be COVID-19 negative if patient had no positive tests during the study period, and had one or moreSARS-CoV-2 PCR negative tests. For COVID19 positive patients, the admission of theSARS-CoV-2 PCR positive test was included in the analysis. For COVID19 negative patients, the first admission with aSARS-CoV-2 PCR negative test was considered for analysis. For this interim analysis, SCD was defined by ICD10 and registry data. Clinical diagnosis such as obesity and respiratory failure were defined by ICD10 coding. Data was obtained from quarterly centralized Epic EMR data extractions. Analysis of outcome of COVID19 positive vs negatives was stratified in four separate analysis: all admissions, ICU admissions, those with respiratory failure and those who died. Multivariate dichotomous logistic regression analyses modeled binary outcome effect of SCD, adjusted for age (<40 vs. > 40 years), sex at birth (females vs. males) and obesity (SAS version 9.4 was used for statistical analyses and overall significance level was set at 0.05). To ensure population homogeneity analysis was conducted on patient ages 20 to 60 years that were Black/African American and admitted from the Emergency Department for a short stay and/or the medicine service (variable interactions at a p<0.01). The study was approved by the institutional review board and by the hospital research oversight committee. Overall, between 3/23/2020 and 6/30/2020, 23697 patients were admitted once or more to Grady Memorial Hospital with one or more PCR sars-cov-2 test, of these 405 were patients with SCD (1.7%). Of the total, 2566 patients (10.8%) tested positive for COVID-19, and 48 patients with SCD (11.8%) were positive. Of 7041 (29.7%) were part of the study population, 332 (4.7%) where patients with SCD (hemoglobin [hb] SS/Sbeta0 =252, hbSC n=55, hbS beta thalassemia+ or hbS beta thalassemia undetermined n=21). Among patients without SCD, 36.3% were female, (n=2557) and among patients with SCD, 53.6% (n=178). The mean age of patients without SCD was: 51.1 years (standard deviation [std]) +/- 19.5 years), and for those with SCD: 35.0 years (std +/- 12.0 years). Results of univariate and multivariate analysis are presented in the table. In conclusion, in a Black/African American patients admitted from the Emergency Room for observation and/or the internal medicine service, when adjusted for age, gender and obesity, with SCD are at a significant increased risk for admissions with COVID-19 infection in general as well as ICU admission or admission with respiratory failures. Further studies can help articulate the risk associated with SCD as well as its potential interaction with other factors, with attention to confounders. [Formula presented] Disclosures: No relevant conflicts of interest to declare.

The Effects of Network Outages on User Experience in Augmented Reality Based Remote Collaboration - An Empirical Study

Augmented Reality (AR) applications can enable geographically distant users to collaborate using shared video feeds or interactive 3D holograms, and may be particularly useful in the socially distant context of the Covid-19 pandemic. However, a good user experience is key for their success and could be negatively impacted by network impairments, which are an inevitable occurrence in today's best-effort Internet. In this paper, we present the findings of an empirical user study, aimed at understanding the effects of network outages, on user experience and behavior, in a collaborative AR task. We highlight how network outages affected users in different ways depending on their role in the collaborative task, and how giving users explicit information about poor network conditions helped them deal with some of these negative effects. Furthermore, we report the strategies that users themselves adopted, to deal with outages, such as batching instructions, or shifting to a different spatial referencing style when communicating with their partners. Lastly, based on our findings, we present some design implications for future remote-collaborative AR applications. © 2021 Owner/Author.

COVIDCampus Game: Making safer choices

This article highlights several game design choices made during the creation of a browser-based game on mitigation strategies for Covid-19. Additionally, it presents a within group comparison of learning gains and self-reported behavioral changes after playing the game. Results show that the short COVIDCampus game has the potential to change college-age players' Covid-19 related mitigation behaviors and it significantly increased players' confidence in asking important health-related questions (Cohen's d=.27). Some implications are discussed. © 2021 Immersive Learning Research Network.

Interactive CovidCampus Simulation Game: Genesis, Design, and Outcomes

We explore how an AR simulation created by a multidisciplinary team evolved into a more interactive, student-centered learning game. The CovidCampus experience was designed to help college students understand how their decisions can affect their probability of infection throughout a day on campus. There were eight decision points throughout the day. Within group comparisons of immediate learning gains and self-reported behavioral changes were analyzed. Results revealed a significant increase in confidence in asking safety-related questions. Post-play, a significant majority of players listed new actions they would take to increase their safety;players were more agentic in their choices. This game allowed players to go back and replay with different choices, but only 7% chose to replay. Short, interactive desktop games may be an effective method for disseminating information about how to stay safer during a pandemic. The game appeared to positively change most players' health behaviors related to mitigation of an infectious disease. Designers of interactive health games should strive to create multi-disciplinary teams, include constructs that allow players to agentically make decisions, and to compare outcomes over time.

Ensuring equity in the management of patients, over 70 years of age, on immunotherapy during the COVID-19 pandemic

Background: Immunotherapy (IO) has transformed the landscape for melanoma. Checkpoint inhibitors (CPI) are now routinely given to older patients. The impact of performance status (PS) and age on the immune response remains unclear. During the COVID-19 pandemic, most older patients elected to continue their cancer therapy. Meta-analysis from trial data thus far has not demonstrated any association with cancer immunotherapy survival. This abstract reports on real -world experience of older patients with melanoma treated during the global pandemic. Methods: Real world data of all patients over 70 years of age receiving IO for melanoma, was collated at a tertiary cancer centre from Oct 2019 - Dec 2020. The objective was to see how these older patients tolerated CPI, in both the adjuvant and palliative settings, during a global pandemic. Information on demographics including age at diagnosis, intention, sites of metastases, PS, co-morbidities, toxicity, impact of COVID-19 and the patient outcomes were collected. During the pandemic the majority of patients on CPI treatment were assessed and followed up by telephone call rather than face to face. Results: Fifty-six patients over 70 years,were identified to have received CPI during the time period. There were 36 male and 22 female patients. Median age was 74 (range 70-88 years). Sixteen patients (29%) were treated with adjuvant intent;the remaining 40 patients (71%) were treated with palliative intent. Most patients with metastatic disease had 1-3 sites. All patients were PS0-1, except for one patient who was PS2. There were 19 patients (34%) who developed significant grade toxicities. No patients were treated on a clinical trial during the pandemic. Three patients (5%) elected to stop treatment during the pandemic. Calls to triage were taken as normal and the majority of patients had toxicity managed as an outpatient. No patients received the vaccine by the end of the study period. Conclusions: Real-world data explored the use of CPI in older patients and the impact of the COVID-19 pandemic on their management. Older patients were able to continue on CPI during the pandemic and it was given safely in adjuvant and palliative settings. Comprehensive geriatric assessments are planned to be integrated however the current demands on medical colleagues has delayed the introduction. However clinicians working in partnership with patients ensured the safe delivery and no patients died from toxicity of therapy or COVID-19 during this time. These findings suggest that shared decision-making during a pandemic with older patients is essential to support patients and optimise outcomes. We suggest cancer therapies should not be restricted to patients based on age and IO can be given safely if precautions are taken during a global pandemic. Patients have now received first COVID-19 vaccinations and ongoing assessement of the impact of the vaccination is in progress.

Maintaining cadaveric dissection in the COVID era: New perspectives in anatomy teaching and medical education

Cadaveric dissection provides a unique learning experience in anatomy teaching that maps well to the required outcomes for medical graduates as prescribed by the General Medical Council (GMC) in the UK. The COVID-19 pandemic has presented new challenges to the maintenance of this method of teaching which is very much dependent on in-person participation. As a result, dissection ceased in many institutions, with anatomy teaching being conducted online. The conviction that hands-on cadaveric dissection offers considerable benefits beyond the imparting of anatomical knowledge has led to the development of strategies to retain the practical element at the core of anatomy teaching. This paper describes the ways in which this has been achieved in the current academic year within a COVID-secure environment. A blended learning curriculum has provided students with both the opportunity for online interaction as well as in-person dissection classes which have become the highlight of the course for students. This paper describes in detail why cadaveric dissection remains key in anatomical education and demonstrates this by mapping its additional benefits to each of the three sets of GMC Outcomes for Graduates (professional values and behaviors, professional skills and professional knowledge). The means by which these were previously achieved as well as how these goals are still being met in our current program during the pandemic are detailed.