ABSTRACT
Although the popularity of protected areas for recreation has been increasing, short term changes in visitation occurred during the COVID-19 pandemic. To examine how volunteer geographic information data can be used to monitor such often rapid changes in visitation across multiple locations, data from online fitness platforms for mountain biking (Trailforks) and remote area hiking (Wikiloc) were analysed before (2019) and during (2020-2021) the COVID-19 pandemic for 40 protected areas in Queensland, Australia. Mountain biking was popular with a total of 93,311 routes on Trailforks, with 26,936 routes in 2019, increasing to 37,406 in 2020, and then decreasing to 28,969 in 2021. Approximately 66% of all the routes were from just three urban protected areas out of the 12 with route data. There were 4367 routes for remote area hiking on Wikiloc across 36 protected areas, which increased slightly from 1081 in 2019, to 1421 in 2020 and to 1865 in 2021. Across 18 factors, distance from urban areas and networks of mountain biking trails best predicted popularity for mountain biking based on Generalised Linear Models. In contrast, average slope and large networks of hiking trails best predicted hiking, with similar results for each year. The two sources of online data were correlated with trail counter data, although not consistently. The results highlight how external factors affect visitation, but also how the same types of protected areas remained popular, and that the impacts of COVID-19 pandemic on visitation in South-East Queensland protected areas was less dramatic than for other regions. This study further highlights how volunteered geographic information can be used to assess the popularity of protected areas, including in rapidly changing conditions. Management implications Rapid changes in visitation can be challenging to monitor and manage, as occurred with the COVID-19 pandemic. The impacts of the COVID-19 pandemic on mountain biking and hiking and factors predicting protected area popularity were examined across different parks. Visitation increased at different stages of the pandemic, with mountain bikers' preferring urban parks with networks of mountain bike trails while some hikers preferred more remote large parks. Managers can expand on traditional methods of visitor monitoring by using volunteered geographic information to monitor rapid and longer-term trends of visitation to protected areas.
ABSTRACT
The COVID-19 pandemic revealed that many countries have failed to provide the general population with the cognitive tools to thoroughly understand and cope with a global health crisis. While scientists and leaders worldwide have struggled to discover ways to contain the spread of the virus, this difficult task has become overwhelming due to the limited ability of many citizens to grasp the urgency of the situation. Although in today’s digitized world we have endless access to data and more ways to represent information and statistics than ever before, numerous incidents have demonstrated that the frequent misapprehension of data can cause confusion rather than clarity. This opinion paper examines how issues such as the misunderstanding of large quantities, fractions, probabilities, and mathematical modeling may be affecting the way people view the current pandemic. Finally, we also discuss how numeracy can act as a protective factor against motivated reasoning, which often affects how we consume information related to the pandemic. © 2022 Informa UK Limited, trading as Taylor & Francis Group.
ABSTRACT
Background: Several international guidelines have highlighted the importance of ensuring the energy and protein intake of people with COVID- 19, but little is known about the nutritional risks for patients in critical conditions. There is still controversy if the modified Nutric score (mNUTRIC) is associated with higher mortality in patients with COVID-19 in the intensive care unit (ICU). Therefore, this study aims to investigate the applicability of the mNUTRIC score to assess nutritional risks and mortality in these critically ill patients with COVID-19 to improve prognosis and clinical results. Methods: This is a retrospective, observational study carried out in three ICU specially equipped for COVID-19 at the Hospital Clinica San Francisco, Guayaquil, Ecuador. Critically ill COVID-19 patients admitted in these ICUs between March and May 2020 were the study population. The exclusion criteria were those under 18 years of age or with a length of stay in the ICU of less than 24 hours. The nutritional risk of each patient was assessed upon admission to the ICU using the mNUTRIC score, and a score ≥of 5 indicates a high nutritional risk. Mortality was calculated according to the results of the patients after 30 days of ICU hospitalization. The results were presented by descriptive statistical analysis. Results: A total of 97 COVID-19 patients were admitted to the ICU with a median age of 64 years, 68 men (70%). Based on the mNutric score at ICU admission, a low nutritional risk (< 4 points) was observed in 65% of critically ill patients with COVID-19, while a high nutritional risk (≥5 points) was observed in 34%. The ICU mortality at 30 days was significantly higher in the high nutritional risk group than the survivors (40% vs. 15%) Also this group was associated with more days in mechanical ventilation (median 11 days) and more days in ICU w(mean 13 days). Furthermore, it was observed that the patients who survived the ICU had a much higher nutritional risk than those who did not survive (84% vs 59%). Conclusion: A large percentage of critically ill COVID-19 patients were at low nutritional risk, as evidenced by the mNUTRIC score. However, patients at high nutritional risk at ICU admission showed significantly higher ICU mortality at 30 days than those who survived. Therefore, the mNUTRIC score may be an appropriate tool for assessing nutritional risk and prognosis for critically ill COVID-19 patients.
ABSTRACT
Study Objectives: Amid the US opioid epidemic, emergency providers and patients are searching for non-opioid or nonpharmacologic pain treatment options. The challenge of managing pain without opioids was escalated by the COVID-19 pandemic with opioid related overdoses and deaths increasing by 20-40%. Most healthcare professionals have limited knowledge, resources or time for pain education, especially in the emergency department (ED). To address these needs a novel pain coaching program was designed including a menu of nonpharmacologic patient discharge toolkit materials. Study objectives were to determine descriptive patient and toolkit utilization data and challenges in the first 4 months of a novel pain program. Methods: Target population consisted of patients ≥14 years of age seen by a new ED Pain Coaching staff from January 4, 2021- April 30, 2021. The two ED sites consisted of an urban, academic center with trauma center, pediatric ED, etc. and an affiliated community ED. Patients were determined by ED rounding, ED census review and consultation by ED staff, physicians, physical therapy, palliative care and pharmacy. Summary statistics for patient demographics, pain type, REALM-SF score, educational topics, toolkit materials, challenges and other data were ed from coaching and patient notes on a daily basis using a REDCap database for analysis. Upon request, there were select inpatient and repeat coaching encounters. Results: During this 4-month pilot, 296 coaching sessions were completed on 276 unique patients;20 screen outs for severe pain, procedures, violent behavior or other obstacles. Average age was 43 with 85% between 20-70 years of age;62% female;60% African American. Pain was 46% acute, 50% acute on chronic and 4% chronic with patients often having multiple pain etiologies: musculoskeletal (74%), inflammatory (71%), post-trauma (15%), headache (14%), post-surgical (4%) and neuropathic (3%). Education topics provided with accompanying toolkit items: hot/cold gel packs (90%), car with 4 flat tires analogy (90%), pain neuroscience education (88%), aromatherapy inhalers (82%), breathing techniques (69%), virtual reality (51%), exercise (38%), stretching (35%), diet (20%), acupressure (11%). The majority of patients were seen in 2 EDs or associated trauma center (87%);however, the coach received referrals for selected inpatients (13%). Seventeen educational brochures were made available to patients with aromatherapy, managing pain, pain and stress, and nonpharmacologic management being most utilized. Challenges to coaching included medical condition (14%), too much pain (11%), time constraints (7%);52% had no challenges. Regarding patient feedback, 61% indicated the session was helpful and 39% were unsure at the time. Conclusion: Results from this novel ED pain coach and discharge toolkit model provide valuable insights for development of a national pain coach model. Coaching scripts, note template, brochures, videos, inventory and other programmatic materials will be published for further implementation. Future plans include longitudinal patient follow-up, staff satisfaction assessment and addition of new modalities.