Location selection of field hospitals amid COVID-19 considering effectiveness and fairness: A case study of Florida.

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.

Impact of the Covid-19 Pandemic on Malaria Services in Uganda: A Time Series Analysis

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.

Disparities in spatial accessibility of primary care in Louisiana: From physical to virtual accessibility.

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.

A 3-year review of an innovative teledermatology service in paediatric dermatology delivering results in the face of a pandemic backlog

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.

Spatial Accessibility and Equity Evaluation of Medical Facilities Based on Improved 2SFCA: A Case Study in Xi'an, China.

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.

From city to sea: Spatiotemporal dynamics of floating macrolitter in the Tiber River

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.

Characteristics of Subacute Thyroiditis during COVID-19 Pandemic

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.

Characteristics of Subacute Thyroiditis during COVID-19 Pandemic

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.

RSV-associated Hospitalizations in Adults Aged >=18 Years and the Impact of the COVID-19 Pandemic in the United States, October 2018 - February 2022

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).

Comprehensive, longitudinal wastewater surveillance for SARS-CoV-2 across a university campus, demonstrates low levels of SARS-CoV-2 activity relative to the surrounding community

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.

Dramatic Increase in Invasive Group A Streptococcal Infection in Persons Who Inject Drugs in an Urban Philadelphia Hospital

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.

Antibiotic-resistant gram-negative bacterial infections among persons with or without a prior positive test for SARS-CoV-2 in 10 U.S. sites, 2020

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.

Direct streaming of acute surgical patients to an advanced nurse practitioner-led service: A prospective audit of a pilot service to improve patient flow

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.

Improvement in COVID-19 Vaccine Hesitancy Rates Between 2020-2021 in an Inner-City Dialysis Population and Associated Factors

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.

Evaluating the poison prevention and medicine safety program for English as a Second Language (ESL) instructors and students

Background: English as a Second Language (ESL) classes provide an ideal environment to provide health education and collaboration. The PCC developed a Poison Prevention and Medicine Safety Program for ESL Instructors and Students. Each lesson promotes skills-based learning along with literacy development based on goals and measurable objectives. The lessons incorporated PCC-related vocabulary words, role playing (calling the PCC, asking questions about medicines), word development activities, and using PCC materials. Discussion sections provided an opportunity for the students to familiarize themselves with the PCC materials and content. Guided comprehension questions and answers illustrated the teaching material and objectives for the lesson. Although initially in-person, due to the COVID-19 outbreak, ESL classes were moved to remote formats. As a result, the PCC ESL Program was also formatted in an electronic version. Our goals were to learn how the program was utilized, the comfort of the participants with the material, and the perceived interest and comfort of participants with the curriculum. Method(s): One-hour webinar training sessions for ESL instructors were offered to present the program components. ESL instructors throughout the PCC catchment area were invited to participate via email. After the training session, each participant was emailed the electronic version of the program and instructor's guide to use for teaching online classes. Participants were able to request the manual if needed for in-person teaching. Follow-up surveys were sent via email 1 month after each training using Survey Gizmo. The participants were asked to rate program content, PCC materials, and student reactions to the topics. Three email attempts were made to complete the follow-up survey. Result(s): Between September 2021 and January 2022, 10 training sessions were provided to a total of 154 participants. Follow-up surveys were collected from training participants in October 2020, January, June, and November 2021, and February 2022. A total of 61 participants completed 80 follow-up surveys (12 participants completed more than one survey). Of the 61 participants, 29 surveys (completed by 20 participants) reported using the PCC ESL program. Most (26;90%) used the content online, two in person and one used it with another lesson. The activity sheets used most often were role playing activities: Calling the PCC (21/22;95%) and Asking Questions about Medicines (14/22;64%). Most responses rated the brochures (16/29;55%), fact sheets (17/29;59%) and instructor's guide (20/29;69%) as "very helpful." All responses (23/23;100% indicated they were "comfortable" or "very comfortable" presenting the material. Participants that felt most of students they taught would be either "extremely" or "somewhat comfortable" (22/29;76%) calling the PCC after the lessons. It was also reported that students were more interested in the topic of medicine safety (23/29;79%) compared to poison prevention (18/26;69%). All responses (29;100%) indicated they would recommend the PCC program to other ESL instructors. Conclusion(s): Offering a PCC ESL program focusing on poison prevention and medicine safety combines authentic learning with health information. Follow-up surveys showed that participants were comfortable presenting the content and would recommend the program. Future steps include an evaluation of the training once classes are fully back to in-person.

Impact of the COVID-19 Pandemic on Neurosurgical Transfers: A Single Tertiary Center Study.

OBJECTIVE: Interfacility transfers represent a large proportion of neurosurgical admissions to tertiary care centers each year. In this study, the authors examined the impact of the COVID-19 pandemic on the number of transfers, timing of transfers, demographic profile of transfer patients, and clinical outcomes including rates of surgical intervention. METHODS: A retrospective review of neurosurgical transfer patients at a single tertiary center was performed. Patients transferred from April to November 2020 (the "COVID Era") were compared with an institutional database of transfer patients collected before the COVID-19 pandemic (the "Pre-COVID Era"). During the COVID Era, both emergent and nonemergent neurosurgical services had resumed. A comparison of demographic and clinical factors between the 2 cohorts was performed. RESULTS: A total of 674 patients were included in the study (331 Pre-COVID and 343 COVID-Era patients). Overall, there was no change in the average monthly number of transfers (P = 0.66) or in the catchment area of referral hospitals. However, COVID-Era patients were more likely to be uninsured (1% vs. 4%), had longer transfer times (COVID vs. Pre-COVID Era: 18 vs. 9 hours; P < 0.001), required higher rates of surgical intervention (63% vs. 50%, P = 0.001), had higher rates of spine pathology (17% vs. 10%), and less frequently were admitted to the intensive care unit (34% vs. 52%, P < 0.001). Overall, COVID-Era patients did not experience delays to surgical intervention (3.1 days vs. 3.6 days, P = 0.2). When analyzing the subgroup of COVID-Era patients, COVID infection status did not impact the time of transfer or rates of operation, although COVID-infected patients experienced a longer time to surgery after admission (14 vs. 2.9 days, P < 0.001). CONCLUSION: The COVID-19 pandemic did not reduce the number of monthly transfers, operation rates, or catchment area for transfer patients. Transfer rates of uninsured patients increased during the COVID Era, potentially reflecting changes in access to community neurosurgery care. Shorter time to surgery seen in COVID-Era patients possibly reflects institutional policies that improved operating room efficiency to compensate for surgical backlogs. COVID status affeted time to surgery, reflecting the preoperative care that these patients require before intervention.

Bringing experimental therapeutics clinical trials network (ETCTN) to underrepresented population

Background: Access to health care including clinical trials (CT) leading to paradigm-changing cancer treatments are critical for high quality cancer care and equity in society. In this report, we highlight methods in accruing to ETCTN wherein underrepresented rural, low-income, and racial minorities comprise >50% of enrollment. Methods: University of Kansas Cancer Center (KUCC) is one of eight National Cancer Institute (NCI) designated cancer centers awarded CATCH-UP.2020 (CATCH-UP), a congressionally mandated P30 supplement to enhance access for minority/underserved populations to ETCTN precision medicine CT. KUCC catchment area is 23% rural by Rural Urban Continuum Codes (RUCC);almost 90 % of counties are designated primary care HPSA's (Health Professional Shortage Areas). KUCC Early Phase and Masonic Cancer Alliance (rural outreach network) partnered to operationalize CATCH-UP. We engaged disease-focused champion investigators in disease working groups and MCA physicians who selected scientifically sound CT that fit catchment area needs. Patient and Investigator Voices Organizing Together, a patient research advocacy group provided practical feedback. MCA navigator coordinated recruitment. Telehealth was used for rural patients that would have a significant distance to travel just to be screened. Results: CATCH-UP was initiated in September 2020. Twenty-eight CT were activated, many in community sites. Average activation time was 81 days. Delays were mainly from CT amendments. KUCC enrolled the first patient in the CATCH-UP program. In 6 months, we met accrual requirements (24/year, 50% minorities). During first year, we enrolled 47 (>50% minorities), an increase of 680% from our average accrual of 6/year (>50% minorities) in ETCTN through Early Drug Development Opportunity Program (2016-2020). To date, we have enrolled 61, 54% from rural, HPSA, race and other minorities. Although the proportion of minorities did not change but remained high, this funding allowed us to substantially increase the number of patients from a catchment area with high proportion of geographically and socioeconomically underserved minorities given access to early phase CT through ETCTN. Conclusions: Amid COVID-19 pandemic, the NCI CATCH-UP program and methods we used allowed access to novel therapies for rural, medically underserved, and other minority groups.

Telehealth cognitive-behavioral therapy for cancer-related cognitive impairment: A model for remote clinical trial participation

Background: Cancer-related cognitive impairment (CRCI) can include persistent memory symptoms, and affects many cancer survivors. Memory and Attention Adaptation Training (MAAT) is an evidencebased cognitive behavioral therapy (CBT) that improves CRCI with demonstrated efficacy in telehealth delivery. MAAT consists of 8 weekly (45-minute) video visits. The aims of this study are to confirm MAAT telehealth efficacy in a phase III RCT (MAAT versus Supportive Therapy;ST) across large catchment areas of two comprehensive cancer centers. A secondary aim is to evaluate treatment-induced brain activation as assessed by functional MRI (fMRI) in a subset of participants. We present remote treatment and data capture methods of this open NCI-sponsored (R01CA244673) randomized clinical trial (NCT 04586530). These methods have high success in participant accrual despite COVID-19 pandemic conditions, and can be readily adopted to other clinical trials to enhance rural/underserved enrollment. Methods: We are enrolling 200 adult, stage I-III breast cancer survivors 1-5 years post-chemotherapy with cognitive complaints. Individuals with CNS disease, previous brain injury, dementia or psychiatric disorder are excluded. All study procedures are completed from the participant's home (except fMRI). Eligibility screening is a semi-structured phone interview followed by detailed informed consent online (Research Electronic Data Capture: REDCap) with staff phone guidance. Consented participants complete baseline brief phone-based neurocognitive assessment and validated patient-reported outcome measures (PROs) of cognition and quality of life via REDCap. Participants are randomized to MAAT or ST and assigned treating clinicians at respective cancer centers. All 8 visits are completed through secure telehealth platforms, followed by repeat phone/online assessment posttreatment and again at 6 months. Enrollment began in 3/2021. As of 1/2022 (9 months), 56 participants are enrolled (28% of the planned sample), 47 randomized (MAAT 24;ST 23), with 24 completing post-treatment assessments. If all assessments and treatment visits were in person, travel burden per participant is 968 miles/20.5 hours driven, and $542 (US 2021 Federal rate). Thus, study travel savings to date are $30,352. Participant feedback indicates telehealth makes participation possible, similar to previous MAAT research. The current RCT demonstrates utility, efficiency and cost-savings of telehealth and remote data capture technology in the conduct of cancer control research. Elements of methods described can also be adopted for cancer therapeutic trials. Comprehensive cancer centers, where most clinical trials are based, can enhance participation of remote and/or underserved populations that have higher rates of cancer, more disease burden and less opportunity for trial participation.

Improving access to cancer clinical trials for patients from CALD backgrounds whose preferred language is not English - Results of a National Survey in Australia (Current Resources)

INTRODUCTION AND OBJECTIVES: Despite Australia having an extremely diverse population, research demonstrates that cancer patients from culturally and linguistically diverse ('CALD') communities are underrepresented in clinical trials. To inform future policy and strategy to address this inequity, we completed a national survey of the Australian clinical trials workforce evaluating current resources to address this issue, identified barriers and preferred solutions. This reports current resources in place. METHODS: An online survey was created using Redcap comprising a mix of 15 closed and open-ended items with an estimated completion time of 20 minutes. The survey was emailed to members of two peak bodies for oncology clinicians in Australia, the Clinical Oncology Society of Australia (COSA) and the Medical Oncology Group of Australia (MOGA) and all major cancer cooperative trial groups (12) in Australia. The survey was also promoted by the study team to relevant individuals and online via Twitter. Quantitative analysis was performed using Microsoft Excel and qualitative analysis of free text entries was performed using NVivo. RESULTS: 91 respondents completed the questionnaire, with representatives from each state - the majority of respondents were from NSW (53%) and Victoria (31%). 68% were clinicians and 16% were clinical trial coordinators. 55% of respondents reported that their trial catchment was comprised of over 20% patients from a CALD background - however, 62% reported that less than 20% of their trials had included CALD participants in the previous 12 months. 74% of respondents reported that their units do not routinely collect data on preferred language or ethnic background of trial patients. Qualitative analysis showed that the only resource routinely available to sites are in person interpreters used in standard of care, which additionally, have been difficult to access during the COVID pandemic leading to only phone interpreters. CONCLUSIONS: This representative survey of the Australian cancer clinical trials workforce confirms an ongoing inequity with disproportionately lower numbers of CALD patients on enrolled in cancer clinical trials compared to the catchments served. Most respondents stated that CALD data is not routinely collected, which inhibits ongoing monitoring of this issue. We did not find evidence of existing specific resources in place to support recruitment of CALD populations, apart from standard of care interpreters.

Neighbourhood-scale wastewater-based epidemiology for COVID-19: opportunities and challenges

Auckland is New Zealand's largest city and is the main international entry point to New Zealand, with most of the nation's Managed Isolation and Quarantine Facilities. Consequently, it is the place most likely for a COVID-19 outbreak to occur and, accordingly, has been the focus of efforts to monitor SARS-CoV-2 via wastewater-based epidemiology. Historically, wastewater-based epidemiology has mainly been applied at the catchment or sewershed scale, with samples collected at wastewater treatment plants. COVID-19 has necessitated a re-evaluation of this broad-scale approach to wastewaterbased epidemiology in New Zealand, where there is a need for more detailed information to better target the public health response. Using Auckland as a case study, this paper assesses the spatial and temporal extent of the city's wastewater network to inform the selection of strategic neighbourhoodscale sampling sites for wastewater-based epidemiology. Sample site selection criteria included topology and connectivity of the sewer network, the capacity to record sewer flow, limited rain infiltration, resident population, and accessibility. Six sites were identified that provide an immediate opportunity for neighbourhood-scale monitoring. Reflecting on the analysis required for selecting appropriate monitoring locations, the paper moves to critically discuss the key unknowns and research needs associated with conducting neighbourhoodscale wastewater-based epidemiology. Population mobility poses challenges for estimating population size and for capturing a positive SARS-CoV-2 signal in wastewater at this scale. There is a need to determine the full spectrum of residence times within the sewer network to design representative sampling and the implications of disregarding residence times in the current sampling regimes are poorly understood. Hydraulic models require refinement to accurately account for variable residence times and topological features in the network (e.g., holding tanks and pumping stations). Addressing these challenges is urgent and ongoing to realise the benefits of neighbourhood-scale wastewater-based epidemiology in response to COVID-19 and beyond.