Bed Space Research Articles

The effect of types of bed and inter-row spacing on yield and quality of onion at Fogera district of South Gondar zone, Ethiopia

The effect of types of bed and inter-row spacing on yield and quality of onion at Fogera district of South Gondar zone, Ethiopia

Captivity, Life and Death at the Nation’s Edge: Two Christian Visions of the U.S. Immigrant Detention Regime

Contemporary U.S. border enforcement involves more than the exclusion of immigrants. It also involves the extraction of profits from those held captive at the border line. Recast as “bodies” to fill “bed space” in dealings between ICE and private prisons, detained people experience multiple levels of suspension: between nations, between legal statuses, and between states of life and death. The testimonies of two Christian leaders who have ministered to those in detention reveal contrasting visions of life, death, and salvation that alternately occlude and shed light on the material realities of immigrant detention. For Timothy O’Dell, former national Director of Chaplaincy for CoreCivic, incarceration is a transformative experience that can prompt individuals to seek salvation in the hereafter. For Diana Ramos, an asylum-seeker who ministered to her peers while held at CoreCivic’s Eloy Detention Center, the harrowing realities of detention catalyzed moments of this-worldly healing, fueled by imagery of liberation.

1218. Genotypic Investigation of a Rotavirus Cluster at a Pediatric Hospital in 2022

Abstract Background Rotavirus group A (RVA) was the most common cause of infectious gastroenteritis among young children before introduction of rotavirus vaccine in the United States in 2006. Following widespread vaccination, U.S. hospital acquired (HA) rotavirus cases are rare. We describe a cluster of rotavirus infections in a pediatric hospital with a genotype uncommon among U.S. children. Methods Patient cases of HA gastrointestinal (GI) illness were detected through hospital-wide microbiology surveillance, performed by Infection Prevention and Control (IPC) practitioners per state requirements. Cluster procedures were implemented on a unit when 3 cases were identified by symptoms and/or laboratory tests within 48 hours. Due to the current rarity of rotavirus clusters, the hospital partnered with Centers for Disease Control and Prevention (CDC) laboratories to sequence strains in addition to instituting local control measures. RVA strains were genotyped by using the genotype specific qRT-PCR assays for VP7 and VP4 genes. Next Generation Sequencing (NGS) was performed for RVA strain characterization on Illumina MiSeq. Genotypes for all 10 RVA were determined by NCBI’s BLASTN program. Results Epidemiologic surveillance identified a rotavirus cluster of 10 patients aged 10 months to 10 years old, of whom 50% had received rotavirus vaccine. Symptoms included emesis and diarrhea. Cases could not be attributed to vaccine related shedding. All patients had epidemiologic links by contiguous bed spaces or shared care teams. Sequencing was conclusive for 9 of the 10 stool samples to be a G9P[4] genotype, which is rarely detected amongst U.S. children. Local control measures of increased education and cleaning, isolation of positive patients in single rooms, use of soap and water instead of alcohol-based hand sanitizer on room exit, and furlough of symptomatic healthcare workers halted transmission. Conclusion Routine surveillance of HA GI illness identified a cluster; RVA strain genotyping and characterization identified unusual rotavirus genotype G9P[4] as the cause. Partnership between IPC practitioners and laboratorians with CDC demonstrated the need to enhance infection prevention measures to halt transmission and identified a rare rotavirus strain as the likely cause of the cluster. Disclosures Courtney E. Comar, PhD, Pfizer: Stocks/Bonds|Viatris: Stocks/Bonds.

"Open" Covid-19 ICU and the emotional impact on nurses: a qualitative study

The Covid-19 pandemic has led hospitals to introduce restrictions on family visits at all levels of care. Intensive care units have suffered an increase in bed space and workload, closing to family visits. Health care personal, especially nurses, have experienced significant psycho-physical stress during the Covid-19 pandemic waves. To describe and investigate the experiences and the emotional impact of nurses who have experienced the Covid-19 ICU open to family visits. Phenomenological qualitative study through the use of semi-structured interviews. From the interviews made to ten nurses, five themes emerged: reactions to the admission of family members, the active role of the family member, the effect of the visits on hospitalized patients, the return to normality, and the admission of family members as a therapeutic act. After an initial concern about the spread of infection, the nurses have welcomed with satisfaction the opening of ICU Covid-19 to visits. The entry of family members into the Covid-19 ICU was perceived as a facilitating factor for the patient's course and care. The humanization of care is a delicate process: in our study a strong emotional impact has emerged on the nursing staff, which produced joy, satisfaction and contentment, and even more on the impulse and the strength to continue doing their work. This organizational model has restored a kind of normality to patients, their families and health workers, despite the ongoing pandemic.

The spatial distribution characteristics of autogenous medium and its effect on low rank lignite beneficiation in differential-motion dry cascade beneficiation bed

In the mining process, a large amount of inorganic mineral impurities are produced, leading to the grade reduction of lignite. Promoting the efficient separation and utilization of low rank lignite is the key measure to stabilize energy structure. In this paper, differential-motion dry cascade separation bed was used for separation, ash reduction and upgrading for low rank lignite. The spatial distribution characteristics of 1.5–0 mm pulverized coal particles in the differential-motion dry cascade separation bed was emphatically investigated. The influence of selecting 1.5–0 mm pulverized coal particles as autogenous medium on the uniformity and stability of bed density was systematically analyzed. The interlayer distribution law of low rank lignite in differential-motion dry cascade separation bed was dissected. The results shows that the leading particle size fraction and the leading density fraction of autogenous medium particles are d = 0.25–0.125 mm, ρ = 1.8–2.0 g/cm3, respectively and the autogenous medium particles could be diffused uniformly and stably along XOY and XOZ cross section and could form autogenous medium fluidized bed with uniform and stable density. When the pulverized coal particle size d = 0.25–0.125 mm, the average bed density reaches the maximum value of 1.815 g/cm3 and the standard deviation of bed density reaches the minimum value of 0.029, at this time, the stability of bed space density reaches the optimum. When the leading density fraction of pulverized coal is 1.8–2.0 g/cm3, the distribution range of bed density is 1.81–1.82 g/cm3 and the fluctuation amplitude is 0.01 g/cm3, at this time, the density of autogenous medium bed is uniform and stable. The interlayer distribution law of low rank lignite in the separation bed was determined. The ash content of upper layer materials is distributed relatively uniform and the distribution range is 9.44–9.76 % with small fluctuation amplitude. The ash content distribution fluctuation of middle layer materials is large and the distribution range is 18.69–31.02 %. The ash content of lower layer materials is distributed relatively uniformly and the distribution range is 41.22–42.06 %. The low rank lignite was separated and upgraded. The ash content of clean coal is 9.58 % and the yield is 63.14 %. The ash content of gangue is 42.09 % and the yield is 36.86 %. The probable error is 0.11 g/cm3. The separated products are relatively pure and the efficient ash reduction and upgrading for low rank lignite are realized.

Chronic Illness Wisdom is Both/And

This poem reflects on dual tensions that sick and disabled communities have to navigate during ongoing pandemic conditions. In particular, it addresses the chronic illness knowledges that people with post-viral illnesses already possess (the reality of chronic conditions after acute infections, the necessity of solidarity across bed space) in the face of medical and political institutions that refuse to know.

The effect of the COVID-19 pandemic on deceased and living organ donors in the United States of America

A life-saving treatment, solid organ transplantation (SOT) has transformed the survival and quality of life of patients with end-organ dysfunction. The coronavirus disease (COVID-19) pandemic has impacted the practice of deceased and living donations worldwide by various resource shifting, including healthcare personnel and equipment such as ventilators and bed space. Our work explores the COVID-19 pandemic and global transplant data to create a statistical model for deducing the impact of COVID-19 on living donor and deceased donor transplants in the United States of America (USA). In severely impacted regions, transplant centers need to carefully balance the risks and benefits of performing a transplant during the COVID-19 pandemic. In our statistical model, the COVID cases are used as an explanatory variable (input) to living or deceased donor transplants (output). The model is shown to be statistically accurate for both estimation of the correlation structure, and prediction of future donors. The provided predictions are to be taken as probabilistic assertions, so that for each instant where the prediction is calculated, a statistical measure of accuracy (confidence interval) is provided. The method is tested on both low and high frequency data, that notoriously exhibit a different behavior.

A Surgical Approach to Hindlimb Suspension: A Mouse Model of Disuse-Induced Atrophy.

Hindlimb suspension is a well-established rodent model of disuse-induced atrophy and is commonly used to simulate the effects of bed rest and space flight on humans. Over the decades, this method has undergone many changes to reduce the stress response on the animals and improve the reliability of the data. Here, we detail our method of performing hindlimb suspension in mice that minimizes stress, maximizes the replicability of the data, and uses space efficiently.

Abstract 10774: An Ambulatory Syncope Service is a Safe Pathway to Reduce Hospital Admissions

Introduction: Syncope affects up to 50% of people during a lifetime and is a common presentation to Emergency Departments (EDs). The Ambulatory Emergency Care Unit (AECU) Syncope pathway was established at our institution as a route by which low-risk patients presenting with syncope can undergo investigations without requiring hospital admissions as well as reducing length of stay for patients awaiting cardiology input. Hypothesis: The AECU Syncope pathway at Northwick Park Hospital, London, UK is safe and effective in reducing hospital admissions. Methods: We conducted a retrospective study of patients seen via the AECU Syncope pathway in 2020. These were referrals from the Emergency Department, General Practice and Inpatient departments for 24-hour tapes and echocardiograms. Results: A total of 221 patients were referred to the AECU syncope pathway in 2020. Of these, 36 patients (16%) had abnormalities on 24-hour tape. The majority were ectopics (n=12) but patients were also found to have arrhythmias (n=10), bradycardia (n=8) and heart block (n=6). 10 patients had aortic valve dysfunction identified on echocardiogram: 4 had severe aortic stenosis and the rest had milder classifications of aortic valve dysfunction. In total, 42 of the 221 patients had an abnormality on echocardiogram and/or 24-hour tape. Of these 42 patients, 14 were discharged as their abnormalities were insignificant for further cardiology input. 28 were referred to cardiology clinic for review as an outpatient. In terms of readmissions, 6 patients had readmissions within 30 days but only 1 patient had a readmission attributed to syncope, and this was a presyncope episode for which the patient was safety netted for during the previous admission. There were no deaths reported within 30 days of presentation. Within 1 year, there were 2 deaths, but neither were attributed to a major adverse cardiovascular event. Conclusions: The AECU syncope pathway presents a viable, efficient and safe route by which low-risk patients who are under investigation for a presumed syncopal episode can receive cardiology input without requiring a prolonged hospital admission. In doing so, there is a significant benefit to hospitals by reducing strain on bed space and staffing, thereby improving patient flow.

Anisotropy and microcrack-induced failure precursor of shales under dynamic splitting

The dynamic anisotropy and failure mechanism of shales are greatly affected by bedding surfaces. To reveal the influence of beddings on anisotropic characteristics of shales under dynamic impact, the Brazilian splitting tests were conducted by the split Hopkinson pressure bar system. The fracturing process were monitored by the high-speed camera. Meanwhile, to understand crack initiation and propagation mechanism, the stress buildup, stress shadow and stress transfer were modelled based on the digital image processing and the rock failure process analysis method. The effect of dip angle and bedding spacing on crack initiation, propagation and coalescence was analyzed. Simultaneously, the spatial distribution and energy magnitude of crack-induced acoustic emissions were captured numerically. The results show that the shale discs continue to produce parallel cracks and cambered cracks induced by the high stresses at the tips of initial cracks; the tensile strength under dynamic splitting changes in the U-shaped trend with the bedding dip angle increasing; the cracking percentage of bedding surfaces decreases, and the cracking percentage of rock matrix increases with the bedding dip angle increasing. In addition, the acceleration of crack growth and the rapid growth of AE energy can be regarded as the effective precursors of shale failure.

Pyrolysis of forestry biomass and its effect over bed arrangements and thickness for the production of fuels

The present study highlights the performance of forestry biomass namely Babool wood, Chinaberry wood and Catalpa wood in a fixed bed reactor with varied biomass bed thickness and spacing between consecutive beds. Results revealed that several operating parameters including temperature, particle size, and heating rate greatly affected the pyrolysis process. Increasing the operating temperature from 500 °C to 600 °C increased the gaseous yield, while at low temperatures (350–450 °C), the liquid and char yields decreased due to removal of volatile fractions. Further, to improve the efficiency of the reactor, the biomass was placed in different bed arrangements. Results revealed that all the biomass were significant and gave highest yield of liquid products with four-bed arrangement. This study provides the insight of hardwood biomass having good thermal characteristics that makes them suitable for the production of fuels economically with low energy consumption.

18b Comparative Safety and Efficacy of a Hybrid Intravenous and Oral Diltiazem Protocol for Acute Rate Control in the Emergency Department

18b Comparative Safety and Efficacy of a Hybrid Intravenous and Oral Diltiazem Protocol for Acute Rate Control in the Emergency Department

Improving health services for patients with extreme obesity requiring bariatric level care at Wellington Regional Hospital: a clinical audit.

To benchmark the quality of bariatric service delivery against moving and handling and patient care best practice standards, and determine the prevalence of hospitalised patients admitted to Wellington Regional Hospital requiring bariatric level care. A clinical audit consisting of retrospective case-note review and cross-sectional survey was conducted and benchmarked against Accident Compensation Corporation (ACC) national standards. Information recorded included patient demographics, admission planning, patient anthropometric and risk assessments, provider communication, room preparation, mobilisation plan, equipment needs, space and facility design considerations, discharge planning and reportable events. A total of 574 patients were included. The prevalence of hospitalised patients requiring bariatric services was 6.4%. One third of patients (34.3%) were not identified by clinical teams as requiring bariatric support. Most bed (80%) and bathroom (83%) spaces failed to achieve the facility design standard. The majority of patient focused moving and handling hazards were documented whereas environmental hazards or equipment limitations were poorly reported. Only 26.1% of patients had a documented discharge plan. Inadequate identification of patients requiring bariatric support and insufficient documentation of bariatric service delivery were identified. Improving policy adherence will address shortcomings in the provision of a safe environment and high quality care for bariatric patients.

Techno-economic analysis of a recirculating tilapia-lettuce aquaponics system

Recirculating aquaponics systems (RAS) are known to provide an economic alternative for producing healthy foods to address health disparities and food scarcity in abandoned urban areas (food deserts) with limited water and land resources. This study integrated design and operational data into a techno-economic analysis (TEA) to study the profitability of a commercial-scale tilapia-lettuce aquaponics system in the U.S. Midwest. An operational pilot-scale plant was used to obtain the necessary data for the TEA modeling. A mid-size commercial system with a 5300 L fish tank and a 62–63 m 2 plant grow bed space was considered for the analysis. The initial investment cost of the system was $69,230–69,600, with the greenhouse constituting 42% of the cost. The annual operating expense was $33,100 - $33,300, with labor being the major contributor (52%). Sensitivity analysis was performed on land, equipment, feed, utility costs and revenues from fish and lettuce, which identified the labor and greenhouse costs as prime factors controlling the profitability. The market value of the lettuce and its grow space used contributed to the profitability of the studied RAS from the revenue side. A cash flow analysis showed that the system can be profitable, offering a positive net present value (NPV) of $9000 - $12,220. Automated water quality monitoring further reduced labor costs, increasing NPV to $52,220 – $55,545. The TEA, augmented with process data and an uncertainty-based financial performance evaluation identifying key plant parameters, may serve as a framework for evaluating the economic viability of similar food production systems in different locations. • Aquaponics system is a sustainable urban food production alternative. • Techno-economic analysis found aquaponics systems (1400 gal fish tank) are profitable. • Labor and facility costs identified as controlling factors to profitability.

TU7.1 “When Can I Go Home?”- Unplanned Admissions following day case elective surgery

AimDay case surgery is an effective and economical method to manage patients while maintaining quality of care. During the COVID-19 pandemic and the reinstatement of non-cancerous elective surgery, efficient use of bed space capacity has been crucial. Strategies were implemented to reduce unplanned admission rates, including careful patient selection and preoperative assessment. We aimed to review rates of unplanned admissions (UA) following intended day case procedures and to identify methods of future prevention of UA.MethodsA retrospective review was carried out of patients undergoing day case hernia repairs or laparoscopic cholecystectomy in a single district general hospital, between May 2021 and September 2021. Data was collated from an institutional data base with follow up data obtained from an electronic care record.Results53 patients included, with a median age of 76 years (range 23–79), 56.6% male, 23 inguinal hernia repairs and 30 cholecystectomies. 30.2% were unexpectedly admitted post operatively (9 Cholecystectomies and 7 inguinal hernias). Of those admitted, median length of stay was 3.1 days (range2–10). Reason for admission included pain (43.8%), post-operative complications (18.8%) and urinary retention (18.8%). Patients requiring admission were significantly older (mean age 62 vs 49 years old), were more likely to be male (62.5% vs 37.5%) and had a significantly longer theatre time (1.46 vs 1.08 hours, p=0.0001).ConclusionsOur short review has identified older and male patient are more likely to require an overnight admission. Improvement in pain management, theatre planning and streamlining along with optimal discharge planning may reduce the volume of patient requiring UA.

From Agility to Zoom Meetings: Uniting Diverse Teams to Achieve Clinical Excellence During Winter 2020/2021 COVID-19 Surge

Background InformationSince Fall 2020, increased critical care demands from COVID-19 related surges found Augusta University Health System (AUHS) requiring additional staffed ICU and medical-surgical beds to accommodate patient care needs. In response, the Perianesthesia department developed a team staffing model and converted PACU and day surgery space to accommodate the additional patient volume. As the region's only level-1 trauma center, the accommodation of the additional capacity had to include maintaining capacity for urgent, emergent, and medically necessary OR cases.Objectives of ProjectProject objective was to develop and recruit qualified nurses to a new staffing model to expand to 24/7 operations maintaining safe, high-quality care to a mixed population of ICU and medical/surgical level patients while maintaining OR operations for medical necessity.Process of ImplementationA Perioperative Services Surge Plan was developed to balance the needs of the hospital overflow and operative volume. All Perianesthesia bed space was converted to virtual beds that could accommodate ICU, floor, or operative care. An assessment of Perianesthesia and Operative RNs was made to evaluate skill mix and availability to work overnight and weekend hours. Fast track PACU to ICU and medical-surgical skills competency-based orientation was developed which included staff orientation, resources, and documentation skill sets. A unit assessment was completed and supplies and processes to support ICU and floor level of care were obtained and initiated. A schedule was created to support all operations and to provide clear role assignments.Statement of Successful Practice20 ICU beds and 16 medical/surgical beds were successfully opened while maintaining 30-40 OR cases each day. PACU was limited to 11 functional bays for Phase I recovery. Day Surgery was limited to 13 bays to preop and Phase 2 patients.Implications for Advancing the Practice of Perianesthesia NursingThe Perianesthesia elements of the Perioperative Services surge plan, team staffing model and clearly defined unit workflows promoted optimization of resources and capacity to provide high quality care to overflow ICU and medical surgical volume while maintaining necessary OR operations.

Preadmission assessment of extended length of hospital stay with RFECV-ETC and hospital-specific data

BackgroundPatients who exceed their expected length of stay in the hospital come at a cost to stakeholders in the healthcare sector as bed spaces are limited for new patients, nosocomial infections increase and the outcome for many patients is hampered due to multimorbidity after hospitalization.ObjectivesThis paper develops a technique for predicting Extended Length of Hospital Stay (ELOHS) at preadmission and their risk factors using hospital data.MethodsA total of 91,468 records of patient’s hospital information from a private acute teaching hospital were used for developing a machine learning algorithm relaying on Recursive Feature Elimination with Cross-Validation and Extra Tree Classifier (RFECV-ETC). The study implemented Synthetic Minority Oversampling Technique (SMOTE) and tenfold cross-validation to determine the optimal features for predicting ELOHS while relying on multivariate Logistic Regression (LR) for computing the risk factors and the Relative Risk (RR) of ELOHS at a 95% confidence level.ResultsAn estimated 11.54% of the patients have ELOHS, which increases with patient age as patients < 18 years, 18–40 years, 40–65 years and ≥ 65 years, respectively, have 2.57%, 4.33%, 8.1%, and 15.18% ELOHS rates. The RFECV-ETC algorithm predicted preadmission ELOHS to an accuracy of 89.3%. Age is a predominant risk factors of ELOHS with patients who are > 90 years—PAG (> 90) {RR: 1.85 (1.34–2.56), P: < 0.001} having 6.23% and 23.3%, respectively, higher likelihood of ELOHS than patient 80–90 years old—PAG (80–90) {RR: 1.74 (1.34–2.38), P: < 0.001} and those 70–80 years old—PAG (70–80) {RR: 1.5 (1.1–2.05), P: 0.011}. Those from admission category—ADC (US1) {RR: 3.64 (3.09–4.28, P: < 0.001} are 14.8% and 70.5%, respectively, more prone to ELOHS compared to ADC (UC1) {RR: 3.17 (2.82–3.55), P: < 0.001} and ADC (EMG) {RR: 2.11 (1.93–2.31), P: < 0.001}. Patients from SES (low) {RR: 1.45 (1.24–1.71), P: < 0.001)} are 13.3% and 45% more susceptible to those from SES (middle) and SES (high). Admission type (ADT) such as AS2, M2, NEWS, S2 and others {RR: 1.37–2.77 (1.25–6.19), P: < 0.001} also have a high likelihood of contributing to ELOHS while the distance to hospital (DTH) {RR: 0.64–0.75 (0.56–0.82), P: < 0.001}, Charlson Score (CCI) {RR: 0.31–0.68 (0.22–0.99), P: < 0.001–0.043} and some VMO specialties {RR: 0.08–0.69 (0.03–0.98), P: < 0.001–0.035} have limited influence on ELOHS.ConclusionsRelying on the preadmission assessment of ELOHS helps identify those patients who are susceptible to exceeding their expected length of stay on admission, thus, making it possible to improve patients’ management and outcomes.

Moral Distress Amid the Pediatric Behavioral Health Crisis: A Call to Action

Moral Distress Amid the Pediatric Behavioral Health Crisis: A Call to Action

Violence towards health workers in the workplace: exploratory findings in secondary healthcare facilities in Kaduna metropolis, Northern Nigeria

Objective: To determine the prevalence of workplace violence and associated factors in secondary health facilities in Kaduna Metropolis. Methods: This was a cross-sectional study where a semi-structured questionnaire was used to obtain data from 177 health workers who were selected by multistage sampling. The Data was analyzed using SPSS version 23 and results were presented using frequency tables. The Chi-square test was used to test for association between independent and dependent variables. Fisher’s Exact Test was used where more than 20% of the cells had a value less than 5. The level of statistical significance was set at a p-value of &lt;0.05. Results: The results showed that 114 (64.4%) of the respondents had experienced workplace violence; the form which was experienced by most of the respondents was verbal abuse 100 (87.7%). Most (92; 80.7%) of the respondents did nothing following the incident. Most of the respondents believed that lack of bed space 89 (50.3%) and long waiting time 119 (67.3%) are largely responsible for violent situations. There was a statistically significant relationship between the experience of workplace violence and respondents’ age (p=0.001); sex (p=0.00146); cadre (p=0.0012) and work experience (p=0.00483). Conclusion: Most of the respondents had experienced violence in the workplace but did not pursue further action. Training health workers on the means to identify volatile situations and address workplace violence is crucial to ensuring the reduction in the prevalence of harmful incidents. The safety and protection of health workers are integral to the adequate functioning of health systems.

1049 IMPROVING TELEPHONE COMMUNICATION WITH FAMILIES ON A BUSY MEDICAL WARD DURING THE PANDEMIC

Abstract During the pandemic it became critical to reduce visiting to only very specific situations. This resulted in an increase of complaints where a lack of communication from the ward had been recognised as a theme, in spite of the fact that many doctors spent a great deal of time providing updates over the phone to patient’s families. It was noted there were a number of inefficiencies with respect to communicating with families; some families were being contacted repeatedly whereas others were struggling to get in touch. Chronic staffing shortages were also a barrier to effective and timely communication. Qualitative data collected via an online survey demonstrated that junior doctors valued the importance of communicating with families, particularly to provide clinical updates or obtain collateral histories, but found that the extra burden created by the pandemic resulted in far less time to do this efficiently and often resulted in time management difficulties. We introduced a strategy, by way of a magnetic communication board, that provided a flexible, at-a-glance method of ensuring all families had received regular updates from the medical team and collateral histories had been obtained for all relevant patients. We collected weekly data regarding the number of interactions between the medical team and patient relatives’ as a percentage of the total number of bed spaces. An overall improvement was noted: 67% pre-intervention to 76% post, with a maximum of 88% during one particularly successful week. We also were able to demonstrate an increase in ReSPECT form completion (from 40% to 65%). The introduction of an organisational tool such as our communication board resulted in improved patient and relatives’ satisfaction; and an improvement in team performance and overall time management. We are now aiming to build on this and roll it out during the next wave of the pandemic.