ABSTRACT
The world has experienced an unprecedented global health crisis since 2020, the COVID-19 pandemic, which inflicted massive burdens on countries' healthcare systems. During the peaks of the pandemic, the shortages of intensive care unit (ICU) beds illustrated a critical vulnerability in the fight. Many individuals suffering the effects of COVID-19 had difficulty accessing ICU beds due to insufficient capacity. Unfortunately, it has been observed that many hospitals do not have enough ICU beds, and the ones with ICU capacity might not be accessible to all population strata. To remedy this going forward, field hospitals could be established to provide additional capacity in helping emergency health situations such as pandemics; however, location selection is a crucial decision ultimately for this purpose. As such, we consider finding new field hospital locations to serve the demand within certain travel-time thresholds, while accounting for the presence of vulnerable populations. A multi-objective mathematical model is proposed in this paper that maximizes the minimum accessibility and minimizes the travel time by integrating the Enhanced 2-Step Floating Catchment Area (E2SFCA) method and travel-time-constrained capacitated p-median model. This is performed to decide on the locations of field hospitals, while a sensitivity analysis addresses hospital capacity, demand level, and the number of field hospital locations. Four counties in Florida are selected to implement the proposed approach. Findings can be used to identify the ideal location(s) of capacity expansions concerning the fair distribution of field hospitals in terms of accessibility with a specific focus on vulnerable strata of the population.
ABSTRACT
Background: Pregnancy is both a risk factor for P. falciparum infection and development of severe malaria and, in Uganda, its control relies heavily in the administration of intermittent preventive treatment with sulfadoxinepyrimethamine (SP-IPTp) during antenatal care visits (ANC). COVID-19 pandemic severely impacted health systems globally. This study aims to assess trends in delivering malaria in pregnancy related healthcare services before and during Covid-19 in thirty health facilities in Northern Uganda. Method(s): Interrupted time series study comparing two periods: I) pre- Covid-19 (January 2018 to February 2020) and II) Covid-19 (from March 2020 to December 2021) period. Data were sourced from the District Health Information Management System II (DHIMS2) routinely collected indicators. Comparisons between the two periods were computed with a jointpoint regression model and Annual Average Percentage Changes (AAPC) were calculated. Result(s): The study involved data collected by 30 health facilities, 30 health facilities in Northern Uganda - including one hospital - with a catchment area of 506,276 inhabitants and an estimated number of pregnancies ranging from 21,440 to 23,315. Covid cumulative cases and deaths for Oyam districs are reported in Figure 1. As shown in Figure 2, during COVID period we found a significant reduction in the number of women accessing to at least 4 antenatal care (ANC) visits and taking at least three doses of intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine. The total number of pregnant women receiving Artemether-Lumefantrine for nonsevere malaria or being hospitalized for severe malaria, along with the total number of institutional deliveries and stillbirths followed kept following the trend recorded prior to the pandemic. Conclusion(s): The present study shows that, despite the international call for prioritization of maternal and reproductive health service delivery during COVID-19 pandemic, in Uganda, the essential care for malaria in pregnancy have been disrupted. This is concerning, as the failure to increase the delivery of SP-IPTp may impact malaria-related mortality.
ABSTRACT
Telehealth has been widely employed and has transformed how healthcare is delivered in the United States as a result of COVID-19 pandemic. While telehealth is utilized and encouraged to reduce the cost and travel burden for access to healthcare, there are debates on whether telehealth can promote equity in healthcare services by narrowing the gap among diverse groups. Using the Two-Step Floating Catchment Area (2SFCA) and Two-Step Virtual Catchment Area (2SVCA) methods, this study compares the disparities of physical and virtual access to primary care physicians (PCPs) in Louisiana. Both physical and virtual access to PCPs exhibit similar spatial patterns with higher scores concentrated in urban areas, followed by low-density and rural areas. However, the two accessibility measures diverge where broadband availability and affordability come to play an important role. Residents in rural areas experience additive disadvantage of even more limited telehealth accessibility than physical accessibility due to lack of broadband service provision. Areas with greater Black population proportions tend to have better physical accessibility, but such an advantage is eradicated for telehealth accessibility because of lower broadband subscription rates in these neighborhoods. Both physical and virtual accessibility scores decline in neighborhoods with higher Area Deprivation Index (ADI) values, and the disparity is further widened for in virtual accessibility compared to than physical accessibility. The study also examines how factors such as urbanicity, Black population proportion, and ADI interact in their effects on disparities of the two accessibility measures.
Subject(s)
Access to Primary Care , COVID-19 , United States , Humans , Pandemics , Health Services Accessibility , COVID-19/epidemiology , LouisianaABSTRACT
Floods are the most commonly occurring natural disaster, with the Centre for Research on the Epidemiology of Disasters 2021 report on "The Non-COVID Year in Disasters" estimating economic losses worth over USD 51 million and more than 6000 fatalities in 2020. The hydrodynamic models which are used for flood forecasting need to be evaluated and constrained using observations of water depth and extent. While remotely sensed estimates of these variables have already facilitated model evaluation, citizen sensing is emerging as a popular technique to complement real-time flood observations. However, its value for hydraulic model evaluation has not yet been demonstrated. This paper tests the use of crowd-sourced flood observations to quantitatively assess model performance for the first time. The observation set used for performance assessment consists of 32 distributed high water marks and wrack marks provided by the Clarence Valley Council for the 2013 flood event, whose timings of acquisition were unknown. Assuming that these provide information on the peak flow, maximum simulated water levels were compared at observation locations, to calibrate the channel roughness for the hydraulic model LISFLOOD-FP. For each realization of the model, absolute and relative simulation errors were quantified through the root mean squared error (RMSE) and the mean percentage difference (MPD), respectively. Similar information was extracted from 11 hydrometric gauges along the Clarence River and used to constrain the roughness parameter. The calibrated parameter values were identical for both data types and a mean RMSE value of ~50 cm for peak flow simulation was obtained across all gauges. Results indicate that integrating uncertain flood observations from crowd-sourcing can indeed generate a useful dataset for hydraulic model calibration in ungauged catchments, despite the lack of associated timing information.
ABSTRACT
Transit-oriented development (TOD) is an urban designed model aimed at attracting more sustainable travellers. However, not all TOD projects succeed in maintaining a high rate of sustainable travel behaviour. To examine the impacts of TOD on residents' travel behaviour, this paper applies binary logistic regression to analyse survey data for 1,298 residents living in the TOD areas in Hangzhou collected in 2020. The results show that socioeconomic characteristics, built environment factors, and travel attitudes play important roles in influencing their travel mode choices. Furthermore, the number of children in households and higher levels of car ownership significantly influence residents' sustainable travel behaviours. However, it appears that only a limited number of factors can convince car users to shift to sustainable modes of travel, such as their workplace being accessible by metro and attitudes towards changes in accessibility. This research study contributes to the existing literature in terms of enhancing the understanding of travel mode choice behaviours, particularly with regard to people who live near public transport infrastructure, as well as formulating evidence-based TOD policies to achieve more sustainable transport systems.
ABSTRACT
Lake eutrophication has become a critical environmental issue due to the global effects of anthropogenic activities and climate change, and has been comprehensively studied for many years. A series of models and indicators have been proposed to assess the trophic state of lakes. The trophic state index (TSI) is a synthetic index that integrates chlorophyll-a, water clarity, and total phosphorus and is widely used to evaluate the trophic state of aquatic environments. In this study, we collected in situ lake samples (N = 431) from typical lakes to match Sentinel-2 MultiSpectral Instrument (MSI) imagery data using the Case 2 Regional Coast Color processor. Then we developed a new empirical model, TSI = -34.04 x (band 4/band 5) - 1.114 x (band 1/band 4) + 97.376. This model is valid for all of China, with good performance and few errors (RMSE = 7.36;MAE = 6.25) for the validation dataset. Recognizing that over 94% of the Chinese population located along eastern watersheds and large lakes have competing water uses, and given the TSI model on the seasonal scales, we further estimated the mean TSI and trophic state in eastern Chinese lakes (> 100 km2) from 2019 to 2020. The results revealed that more lakes were eutrophic in autumn (94.28%) than in spring (> 77.14%), indicating a serious eutrophication of eastern lakes. Although the eastern lakes have been studied in more detail, this study found that eutrophication still has markedly negative impacts on lake ecosystems. In addition, no significant improvement was observed in spring, most likely due to the months of curfew/lockdown from January 2020 onwards due to COVID-19. This may be due to the enrichment of nutrients deposited in sediment or watershed soil, which can be characterized as "autochthonous sources" of lake eutrophication, over decades with high rates of economic development. This study demonstrates the applicability of Sentinel-2 MSI data to monitor lake eutrophication as well as the feasibility of blue/red and red/red edge combinations. The framework and TSI model used bands available on MSI sensors to develop a novel approach for generating historical eutrophication data for large-scale evaluation of and decision-making related aquatic environmental changes, even in poorly studied areas.
ABSTRACT
The COVID-19 pandemic has shifted the paradigm of healthcare delivery within the National Health Service;a focus on virtual care and increasingly limited healthcare resources has led to the use of telemedicine platforms to help streamline referral pathways and deliver care. Within our paediatric dermatology service we have employed the teledermatology platform, Consultant Connect (CC), to deliver advice and guidance, and triage referrals. In addition to improving care and patient outcomes through the platform, its continued development is vital to meet future healthcare requirements. NHS England (NHSE) have outlined expectations for significant reductions in follow-up activity and increased service productivity over the next 2-3 years in their recent priorities and operational planning guidance. We undertook a service evaluation of referrals to the CC platform, which was established in 2019 as a pilot to support general practices outside our catchment area, with advice and guidance for paediatric dermatology. In 2020 this was expanded to cover our local Clinical Commissioning Groups. We aimed to ascertain how well the CC service is achieving its goal, which is to provide rapid response to general practitioners (GPs) and streamline our referrals directing them to either, hospital, community or urgent referral pathways. From July 2019 to January 2021, 2080 referrals were made to CC. In 1540 (74.2%) of cases, onward referral to either community or secondary care was avoided. Further recommendations were as follows: referral to community dermatology (0.4%), routine referrals to secondary care (16.7%), urgent referrals (1.9%) and 2-week wait referrals (2.0%). Insufficient or inadequate clinical information was identified in 0.5% of cases. The average response time was 44.5 min. Since service initiation, the number of referrals per week has increased from seven to 80 (91% rise). The majority of referrals had inflammatory diagnoses (49%), followed by infective dermatoses (20%). Our evaluation demonstrates the growing demand for a teledermatology service and its success in offering timely, high-quality advice to GPs. With defined diagnostics and management plans, GPs are able to initiate treatment in the community, and referrals can be streamlined appropriately. NHSE aims to create two-way digital advice and guidance between clinical teams, ensuring patients are managed safely and referrals triaged according to clinical priority. The CC service not only addresses the immediate task of recovering from the pandemic by clearing waiting lists, but also offers innovative solutions for driving up quality of care for growing numbers of patients.
ABSTRACT
Management, operations, and planning in water resources management are required to respond to a multitude of challenging problems that may arise due to rapid change in climate conditions, extreme weather events, frequent and unforeseen incidents or on the other hand, long-term structured management decisions. This paper reports on deployment of a decision support system (DSS) for Greater Sydney supply systems known as the CARM Greater Sydney Project. Development and deployment of the DSS tool currently being undertaken by WaterNSW is based on integrated hydrological-hydrodynamic water quality models. The system architecture of the tool is underpinned by a set of baseline catchment models developed using eWater's Source modelling suite. Catchment modelling outputs are then fed into reservoir models as input which are housed in the AEM3D (a 3-Dimensional coupled Hydrodynamic- Aquatic Ecosystem Model) platform;providing a set of base cases to represent the fundamental catchment/lake conditions. Mike Workbench - an application developed by DHI is used as the DSS tool. Building on the baseline model, users can generate multiple scenarios with varying complexity by manipulating different parameters of the tool specific to a problem at a scale and level of complexity suited to the problem and needs of decision makers via Mike Workbench. Users can also compare the outcomes between different scenarios, facilitating the decision making for increasingly complex water resources management issues. An integral part of the project is to roll out a suit of comprehensive training on using this tool to different groups of users/stakeholders tailored by their needs and interest. The training and deployment of the new system were started during COVID shutdowns. The paper will provide an overview of the new system and how training was developed as part of the project and embedded through the deployment of the new DSS tool in a fully on-line mode. The lessons learned include providing training specific to user needs, time for practice and one on one support, but also cover planning and integration of the training throughout the project development and deployment. © Hydrology and Water Resources Symposium, HWRS 2022. All rights reserved.
ABSTRACT
Accurate evaluation of the accessibility of medical facilities is a prerequisite for the reasonable allocation of medical resources in a city. The accessibility of medical facilities depends not only on the distance to the supply and demand points, but also on the time spent in the process, and the supply capacity of the supply points. Taking Xi'an City of Shaanxi Province as an example, this paper comprehensively considers the facility supply capacity and introduces the selection probability function based on the two-step floating catchment area (2SFCA) method. In addition, in order to approximate the residents' acceptance of different types of hospitals for long-distance medical treatment in real situations, different levels of search radius were set for the different levels of hospitals, and ArcGIS was used to measure the accessibility and evaluate the spatial layout of medical facilities in the main urban area of Xi'an. The results show that there is a significant difference in the accessibility of medical facilities in the main urban area of Xi'an, and the accessibility tends to decrease gradually from the central city to the periphery. The inequity in the allocation of medical facilities in the main urban area of Xi'an is more obvious, with about 81.64% of people having access to 54.88% of medical resources. The accessibility evaluation model established by the improved 2SFCA method can obtain more accurate and objective evaluation results. This study can provide a reference basis for urban medical facilities' planning and rational spatial layout.
Subject(s)
Health Facilities , Health Services Accessibility , Humans , China , Cities , HospitalsABSTRACT
Water basins characterise both physical and social environmental aspects such as land tenure. As such, the basins extend beyond spatial units of physical resources and human relations analysis to policy research and reform units. The comprehensive view of water basins in research goes along with an observed increase in anthropogenic-driven changes, such as land use and land cover changes, and cases of ineffective remedial measures to the adverse change, such as through applying integrated watershed management approaches. The human-induced land cover changes affect the water basin's biodiversity, for instance, contributing to an increase in zoonotic disease outbreaks like coronaviruses. The Lake Victoria basin exhibits similar patterns of change and effects due to, among other factors, land tenure, whose contribution is less known empirically. Therefore, this paper integrates satellite imagery and catchment survey data to examine the relationship between land tenure and land uses and land cover changes in the Lake Victoria basin of Eastern Africa. Additionally, explore the contextual character and role of three land tenure systems of Customary, Native freehold and Mailo found in the Uganda country segment of the basin in explaining the outcomes. The aim is to provide information that, among other benefits, improves water basin management and governance. The results indicate a statistically significant relationship exists between the perceived extent of land use and land cover change;drivers of change;the extent of adopting sustainable land-use practices, and the prevailing land tenure. Though with different tenure systems, the three case study water catchments experienced adverse land use and cover changes. The changes mainly affected land tenure indicative land use and cover classes, prominently on the Customary, Mailo, and Native freehold land tenure systems. However, marginal differences occur among the land tenure systems, as the systems feature both de jure and de facto systems and an orientation towards customary tenure characters. The situation likely explains the observed closeness in perceptions regarding the role and relationship between land tenure and land use and cover changes, tenure systems character, perceived drivers of change and eventual outcomes, including the sustainable land use practices adoption. In addition to explaining the land use and cover change, land tenure is an essential tool for restoration and sustainable basin development and sustainability. We, thus, recommend land tenure responsiveness in water basin management approaches for sustainable societal development. © 2023 Elsevier Ltd
ABSTRACT
Rivers are undoubtedly the main pathway of waste dispersed in the environment that from land reaches oceans and seas increasing the amount of marine litter. Major cities are a great source of riverine litter as large urbanization can originate pressure on the integrated waste management resulting in litter entering the rivers. Within this study, we aim to investigate the dynamic of floating riverine macrolitter (items >2.5 cm) in the city of Rome before it reaches the sea by assessing the composition, amount, and seasonal trends of litter transported from the urban centre to the main river mouth of Tiber River. Visual surveys for a whole year (March 2021–February 2022) were conducted from two bridges, Scienza Bridge (in the city) and Scafa Bridge (at the main river mouth) and followed JRC/RIMMEL protocol for riverine litter monitoring. Overall, similar litter composition was observed from the city centre to the mouth with a prevalence of plastic material, mainly related to fragmentation process (i.e. plastic pieces) and single use items, mainly in food and beverage sectors. An extrapolated annual loading of 4 × 105 items/year was estimated at the main mouth of Tiber River. The litter flux seems to be influenced by the seasonal variability and hydrometeorological parameters. The frequency of size classes decreases with increasing size in both sites, and more than half of the recorded items were below 10 cm. Specific categories belonging to "other plastics” have been reported related to anti-Covid-19 behaviour such as face masks and beverage sector, e.g. bottle lids and rings. The main colour of plastics was white, suggesting weathering process of floating riverine litter. This study contributes to increasing knowledge of the origin, composition and spatiotemporal dynamics of riverine floating litter from the city and entering the sea. © 2022 Elsevier B.V.
ABSTRACT
Aim/Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is causing coronavirus disease (COVID-19), enters host cells via the angiotensin-converting enzyme 2 receptor. Its expression is higher in thyroid gland than in lungs. In the literature, an association between SARS-CoV-2 infection and subacute thyroiditis has been implicated. Therefore, we aimed to explore the influence of COVID-19 pandemic on the incidence and severity of subacute thyroiditis. Material(s) and Method(s): In our retrospective study we reviewed medical records of all patients who were referred for the first time to our thyroid department from 1 April 2019 to 31 May 2019 (before COVID-19) and from 1 April 2020 to 31 May 2020 (during COVID-19). Our institution has a stable catchment area of 1,000,000 inhabitants. Therefore, number of new cases may be considered the incidence of the disease. In each patient who was referred under suspicion of subacute thyroiditis, thyroid specialists performed clinical examination and thyroid ultrasound. In selected cases, thyroid scintigraphy was performed. Serum levels of free thyroxine (normal range 0.59-4.23 pmol/L) and free triiodothyronine (normal range 11.7-22.5 pmol/L) as well as sedimentation rate were measured. Result(s): In the two months period before COVID-19, we examined 946 patients (224 men/722 women) with the mean age 52.0>19.0 years, and in the two months period during COVID-19, we examined 576 patients (154 men/422 women) with the mean age 53.7>18.3 years. Between the two periods, patients did not differ with respect to sex and age (p=0.201 and p=0.438, respectively). Before COVID-19, we found 8 patients with subacute thyroiditis (0.8% from all in that period), while during COVID-19, we found 10 patients with COVID-19 (1.7% from all in that period). The incidence of subacute thyroiditis did not differ significantly between the two periods (p=0.189). Before COVID-19, patients with subacute thyroiditis had similar level of free thyroxine than during COVID-19 (median, range, 36.0 (7.2-70.4) pmol/L and 34.8 (14.7-70.4) pmol/L, respectively, p=0.929). Before COVID-19, the level of free triiodothyronine was similar than during COVID-19 (median, range, 10.9 (2.6-29.4) pmol/L and 9.5 (4.3-21.7) pmol/L, respectively, p=0.929). Before COVID-9, the sedimentation rate was similar than during COVID-19 (median, range, 65 (5-120) mm/h, and 57 (5-113) mm/h, respectively, p=0.916). Conclusion(s): Although we found absolutely and relatively more patients with subacute thyroiditis during COVID-19 than before, the results were not statistically significant. The same applies to the severity of the disease. A longer observation period would probably yield different results.
ABSTRACT
Aim/Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is causing coronavirus disease (COVID-19), enters host cells via the angiotensin-converting enzyme 2 receptor. Its expression is higher in thyroid gland than in lungs. In the literature, an association between SARS-CoV-2 infection and subacute thyroiditis has been implicated. Therefore, we aimed to explore the influence of COVID-19 pandemic on the incidence and severity of subacute thyroiditis. Material(s) and Method(s): In our retrospective study we reviewed medical records of all patients who were referred for the first time to our thyroid department from 1 April 2019 to 31 May 2019 (before COVID-19) and from 1 April 2020 to 31 May 2020 (during COVID-19). Our institution has a stable catchment area of 1,000,000 inhabitants. Therefore, number of new cases may be considered the incidence of the disease. In each patient who was referred under suspicion of subacute thyroiditis, thyroid specialists performed clinical examination and thyroid ultrasound. In selected cases, thyroid scintigraphy was performed. Serum levels of free thyroxine (normal range 0.59-4.23 pmol/L) and free triiodothyronine (normal range 11.7-22.5 pmol/L) as well as sedimentation rate were measured. Result(s): In the two months period before COVID-19, we examined 946 patients (224 men/722 women) with the mean age 52.0>19.0 years, and in the two months period during COVID-19, we examined 576 patients (154 men/422 women) with the mean age 53.7>18.3 years. Between the two periods, patients did not differ with respect to sex and age (p=0.201 and p=0.438, respectively). Before COVID-19, we found 8 patients with subacute thyroiditis (0.8% from all in that period), while during COVID-19, we found 10 patients with COVID-19 (1.7% from all in that period). The incidence of subacute thyroiditis did not differ significantly between the two periods (p=0.189). Before COVID-19, patients with subacute thyroiditis had similar level of free thyroxine than during COVID-19 (median, range, 36.0 (7.2-70.4) pmol/L and 34.8 (14.7-70.4) pmol/L, respectively, p=0.929). Before COVID-19, the level of free triiodothyronine was similar than during COVID-19 (median, range, 10.9 (2.6-29.4) pmol/L and 9.5 (4.3-21.7) pmol/L, respectively, p=0.929). Before COVID-9, the sedimentation rate was similar than during COVID-19 (median, range, 65 (5-120) mm/h, and 57 (5-113) mm/h, respectively, p=0.916). Conclusion(s): Although we found absolutely and relatively more patients with subacute thyroiditis during COVID-19 than before, the results were not statistically significant. The same applies to the severity of the disease. A longer observation period would probably yield different results.
ABSTRACT
Background. Respiratory syncytial virus (RSV) is a significant cause of hospitalizations in older adults and typically circulates during the fall and winter in the United States. The COVID-19 pandemic and implementation of nonpharmaceutical interventions (NPIs) including masking, improved handwashing, and social distancing likely impacted RSV circulation. To explore the pandemic's impact on RSV seasonality and hospitalizations in adults aged >=18 years, we analyzed laboratory-confirmed RSV-associated hospitalizations through the RSV Hospitalization Surveillance Network (RSV-NET) across four seasons. Methods. RSV-NET is a population-based surveillance system that collects data on RSV-associated hospitalizations across 75 counties in 12 states. An RSV-NET case is a resident of a defined catchment area who tests positive for RSV through a clinician-ordered test within 14 days prior to or during hospitalization. Surveillance was conducted October-April for the 2018-19 and 2019-20 pre-pandemic seasons and October 2020-September 2021 (2020-21 season). Available data October 2021-February 2022 (ongoing 2021-22 season) are presented. Results. 2,536, 3,195, 618, and 1,758 laboratory-confirmed hospitalizations were identified in adults >=18 years in 2018-19, 2019-20, 2020-21, and 2021-22, respectively;case counts were 4.1 and 5.2 times higher in 2018-19 and 2019-20, respectively, than in 2020-2021. Hospitalizations peaked in January for pre-pandemic and 2021-22 seasons and in September for 2020-21 (Figure). For all years combined, 16.2%, 23.4%, 33.3%, and 27.1% of all RSV-associated hospitalizations were among those aged 18-49, 50-64, 65-79 and >=80 years, respectively. Laboratory-confirmed RSV-associated hospitalizations in adults >=18 years, October 2018 - February 2022 Conclusion. Laboratory-confirmed RSV-associated hospitalizations in adults were lower during the 2020-21 and 2021-22 seasons compared with pre-pandemic seasons, with a marked change in seasonal patterns in 2020-21, likely because of NPIs implemented during the pandemic. Continued monitoring of RSV-associated hospitalizations will be critical to understand ongoing changes in RSV circulation that resulted from the COVID-19 pandemic and associated NPIs. (Figure Presented).
ABSTRACT
Background. Universities are interactive communities where frequent contacts between individuals occur, increasing the risk of outbreaks of COVID-19. We embarked upon a real-time wastewater (WW) monitoring program across the University of Calgary (UofC) campus measuring WW SARS-CoV-2 burden relative to levels of disease in the broader surrounding community. Figure 1 The colour scheme shows 6 sewer sub-catchments at the University of Calgary. Auto samplers were deployed at 4 sampling nodes within sub-catchments CR and YA (both residence halls), and UCE and UCS (catchments that include several campus buildings). Figure 2 Log10-transformed abundance (i.e., copies per mL) of nucleocapsid gene (i.e., N1) for SARS-CoV-2 for each sampling location during October 2021 - April 2022. Locations denoted by the same letters (A, B, or C) show no statistical difference (p > 0.05) according to the Wilcoxon rank-sum test. The WWTP sample corresponds to a catchment area covering most of Calgary including the university campus, for which sampling locations CR, UCE, UCS, and UCW are defined in Fig. 1. Methods. From October 2021 - April 2022, WW was collected thrice weekly across UofC campus through 4 individual sewer sampling nodes (Fig. 1) using autosamplers (C.E.C. Analytics, CA). Results from these 4 nodes were compared with community monitoring at Calgary's largest WW treatment plant (WWTP), which received WW from surrounding neighborhoods, and also from UofC. Nucleic acid was extracted from WW for RTqPCR quantification of the N1 nucleocapside gene from SARS-CoV-2 genomic RNA. Qualitative (positive samples defined if cycle threshold < 40) and quantitative statistical analyses were performed using R. Results. Levels of SARS-CoV-2 in WW were significantly lower at all campus monitoring sites relative to the WWTP (Wilcoxon rank-sum test p < 0.05;Fig. 2). The proportion of WW samples that were positive for SARS-CoV-2 was significantly higher for WWTP than at least two campus locations (p < 0.05 for Crowsnest Hall and UCE - University way and campus drive) according to Fischer's exact 2-sided test. The proportion of WW samples with positive WW signals were still higher for WWTP than the other two locations, but statistically not significant (p = 0.216). Among campus locations, the buildings in UCE catchment showed much lower N1 signals than other catchments, likely owing to buildings in this catchment primarily being administration and classroom environments, with lower human-to-human contact and less defecation compared to the other 3 catchments, which include residence hall, a dining area, and/or laboratory spaces. Conclusion. Our results show that SARS-CoV-2 RNA shedding in WW at the U of C is significantly lower than the city-wide signal associated with surrounding neighborhoods. Furthermore, we demonstrate that WW testing at well-defined nodes is a sampling strategy for potentially locating specific places where high transmission of infectious disease occurs.
ABSTRACT
Background. Invasive infection from Group A streptococcus (iGAS) is rising nationally, and we report a significant increase in incidence at an urban, quaternary care health center, which serves the Kensington neighborhood, the epicenter of the opioid crisis in Philadelphia, PA. We examined iGAS infection in the Temple University Health System catchment area Methods. iGAS was defined as an of streptococcus pyogenes cultured from a previously sterile site. Injection drug use (IDU) is a known risk factor for bacterial infection, including iGAS infection. All blood, sterile fluid, and/or tissue cultures that yielded S. pyogenes were identified using the laboratory information system at Temple University Hospital - Main Campus. Two cohorts were compared: January 1, 2021, to December 31, 2021, and January 1, 2019, to December 31, 2019. Electronic health records were reviewed and data pertaining to age, gender, and injection drug use were ed. Descriptive statistics were used to summarize findings. Results. 155 cases of iGAS were identified in 2021 (105 of which involved bacteremia) compared to 69 in 2019 (42 of which involved bacteremia), representing a 224% increase overall. Of the cases in 2021, 130 (84%) were Persons Who Inject Drugs (PWID) compared to only 39 (57%) in 2019. PWID with iGAS were younger (median age 35 vs 54 in 2019, 39 vs 53 in 2021) and more likely to be male (57% vs 43% in 2019, 68% vs 32% in 2021). Male patients also had a higher incidence of PWID than female patients (56% vs 44% in 2019 and 64% vs 36% in 2021). Conclusion. During this same time period, the COVID-19 pandemic added to the ongoing opioid crisis in Philadelphia. The city of Philadelphia publicly reports opioid data, which shows that hospitalizations related to non-fatal opioid overdose have exponentially risen in the past two decades. This also coincides with an increase in the presence of xylazine, an adulterant in the Philadelphia fentanyl supply. Xylazine has been implicated in worsening wounds. Our data supports a concerning association between iGAS and PWID.
ABSTRACT
Background. The Centers for Disease Control and Prevention's Emerging Infections Program (EIP) conducts active laboratory- and population-based surveillance for carbapenem-resistant Enterobacterales (CRE), extended spectrum beta-lactamase-producing Enterobacterales (ESBL-E), and carbapenem-resistant Acinetobacter baumannii (CRAB) in 10 U.S. sites. To describe the impact of the COVID-19 pandemic on the epidemiology of these antibiotic-resistant gram-negative bacteria (AR-GNB), we assessed characteristics of AR-GNB patients with and without a prior SARS-CoV-2 positive (SC2+) viral test. Methods. In 2020 among EIP catchment-area residents, an incident CRAB or CRE case was defined as the first isolation of A. baumannii complex, Escherichia coli, Enterobacter cloacae complex, Klebsiella aerogenes, K. oxytoca, K. pneumonia, or K. variicola in a 30-day period resistant to >=1 carbapenem (excluding ertapenem for CRAB) from a normally sterile site or urine. An incident ESBL-E case was defined as the first isolation of E. coli, K. pneumonia, or K. oxytoca in a 30-day period resistant to any third-generation cephalosporin and non-resistant to all carbapenems from a normally sterile site or urine. Patient charts were reviewed. Results. Of 3904 AR-GNB cases with data available, 163 (4%) had a prior SC2+ test (85 ESBL-E, 70 CRE, and 8 CRAB). Median time from the most recent SC2+ test to AR-GNB culture date was 20 days (IQR 1-48 days). AR-GNB cases with a SC2+ test versus those without were more likely to be Black, non-Hispanic than another race/ ethnicity (31% vs 15%;P< 0.0001), aged >=65 years (62% vs 52%;P=0.0139), and to have prior healthcare exposures (63% vs 49%;P=0.0003) and indwelling devices (51% vs 28%;P< 0.0001). They were also more likely to have bacteremia (24% vs 11%;P< 0.0001), pneumonia (6% vs 1%;P< 0.0001) and be hospitalized around the time of their AR-GNB culture (67% vs 36%;P< 0.0001);median time from SC2 + test to hospital admission was 0.5 day (IQR 0-29.5 days). Conclusion. AR-GNB infections preceded by a SC2+ test were rare but more severe and associated with more healthcare risk factors. This underscores the need for continued infection prevention and control practices and monitoring of these infections during the COVID-19 pandemic.
ABSTRACT
Water basins characterise both physical and social environmental aspects such as land tenure. As such, the basins extend beyond spatial units of physical resources and human relations analysis to policy research and reform units. The comprehensive view of water basins in research goes along with an observed increase in anthropogenic-driven changes, such as land use and land cover changes, and cases of ineffective remedial measures to the adverse change, such as through applying integrated watershed management approaches. The human-induced land cover changes affect the water basin's biodiversity, for instance, contributing to an increase in zoonotic disease outbreaks like coronaviruses. The Lake Victoria basin exhibits similar patterns of change and effects due to, among other factors, land tenure, whose contribution is less known empirically. Therefore, this paper integrates satellite imagery and catchment survey data to examine the relationship between land tenure and land uses and land cover changes in the Lake Victoria basin of Eastern Africa. Additionally, explore the contextual character and role of three land tenure systems of Customary, Native freehold and Mailo found in the Uganda country segment of the basin in explaining the outcomes. The aim is to provide information that, among other benefits, improves water basin management and governance. The results indicate a statistically significant relationship exists between the perceived extent of land use and land cover change;drivers of change;the extent of adopting sustainable land-use practices, and the prevailing land tenure. Though with different tenure systems, the three case study water catchments experienced adverse land use and cover changes. The changes mainly affected land tenure indicative land use and cover classes, prominently on the Customary, Mailo, and Native freehold land tenure systems. However, marginal differences occur among the land tenure systems, as the systems feature both de jure and de facto systems and an orientation towards customary tenure characters. The situation likely explains the observed closeness in perceptions regarding the role and relationship between land tenure and land use and cover changes, tenure systems character, perceived drivers of change and eventual outcomes, including the sustainable land use practices adoption. In addition to explaining the land use and cover change, land tenure is an essential tool for restoration and sustainable basin development and sustainability. We, thus, recommend land tenure responsiveness in water basin management approaches for sustainable societal development.
ABSTRACT
Aims: The ongoing uncertaintyofThe COVID-19 pandemic and recovery to re-establish elective services presents a major challenge to The NHS. Patient flow and bed capacity is now a priority for acute hospitals. We have implemented a new service model aimed at improving patient flow from A&E, where acute surgical patients are triaged and referred directly to The Advanced Nurse Practitioner (ANp) team for assessment and management. A criterion based on The presenting complaint and clinical observations was developed to identify suitable patients. The utilisation of this service was audited for its safety and impact on The Emergency General Surgical provision. Method(s): The setting is a busy University Teaching Hospital with a diverse catchment population of 75,000. A prospective audit identified The number of patients utilising The new care pathway and details of any adverse events or delays in treatment identified. All patients presenting with a General Surgical condition were included. Result(s): Between August and December 2021, 361 patients were referred directly from A&E (81% within first 2 hours of presentation) to The surgical ANp team for assessment. of these, 85 (24%) were admitted for Emergency treatment and 276 (76%) were discharged The same day for either ambulatory or outpatient follow-up, or back to Primary Care. There were no adverse events identified during The audit period. Conclusion(s): Direct streaming of acute surgical patients within a defined criteria to an ANp-led service is safe and effective in helping to improve patient flow and experience within an acute care model.
ABSTRACT
Background: Studying how vaccination hesitancy has changed since the onset of the pandemic and understanding what changed people's opinions could help improve vaccination rate in susceptible populations with high background refusal rates. Method(s): Randomly selected hemodialysis patients in an inner-City Unit were surveyed in 2020 (19 by telephone) and 2021 (31 face to face) about vaccination history and attitudes towards vaccines. In 2020 participants were asked if they would receive a COVID-19 vaccine if available and in 2021 if they had received the vaccine. Respondents who planned to received the vaccine (2020) or received one or both doses (2021) were counted as VACYES while those who were unsure or refused were classified as VACNO. Respondents were also asked their primary reasons for their choice. Result(s): The 2021 group had a mean age of 56.1 +/- 17.9 yrs., mean time on dialysis was 6.2 +/- 7.2 yrs. There were 18 (58%) women and 13 (42%) men, 28 (90%) identified as black. The 2020 and 2021 groups were similar with respect to age, time on dialysis, sex, and race. In 2020, 21% were classified as VACYES compared to 84% of the 2021 sample (p < 0.001). Among VACNO pts the most commonly cited reason was "Safety" (80%). Between vaccinated and unvaccinated patients in 2021, there were no statistically significant differences with respect to age, time on dialysis, sex, race, education, insurance status and presence of diabetes. Among VACYES pts. the three most commonly cited reasons for their choice were "Recommended for people with underlying conditions" (38%), "Trust in healthcare" (45%), and "Safety of the vaccine" (44%). Conclusion(s): In our inner-city population: 1. Although people in our catchment have a low vaccination rate the majority of the dialysis population studied received the vaccine despite initial hesitancy. 2. Recommendations related to underlying conditions, improved confidence in the safety of the vaccine and trust in healthcare were the most important reasons for acceptance. 3. With vaccine efforts still underway, education programs should continue to focus on stressing the importance in people with underlying conditions, improving patient-provider partnering, and disseminating information regarding vaccine safety in order to improve adherence in our kidney disease patients, in whom almost 20% remain unvaccinated.