Prioritization Of Resources Research Articles

Acute medical units during the first wave of the COVID-19 pandemic: a cross-national exploratory study of impact and responses

The COVID-19 pandemic represents one of the greatest ever challenges for healthcare. In the UK and beyond, acute medical units (AMUs) are the first point of assessment and care for the majority of medical inpatients. By their design and systems, they inevitably played an important role in the COVID-19 response but to date little has been published on how the COVID-19 pandemic has affected how AMUs have reorganised their resources, processes and structure. This retrospective study in August 2020 of 10 AMUs across Europe and Australasia used a standardised questionnaire to investigate existing practice and structure of AMUs, the national context of local hospital experience, changes to practice during the COVID-19 pandemic and views regarding future practice. Changes to AMU structure, process and organisation are described in two contexts: preventing and controlling the spread of COVID-19 and adding value to the patient's acute care journey in the local context. We describe novel practices that have arisen and highlight areas of concern. The AMUs were able to adapt to meet the demands of acute care delivery during the first wave of the COVID-19 pandemic. Operational planning and prioritisation of resources must be optimised to ensure sustainability of these services for future waves.

Long COVID-19 Syndrome: A Comprehensive Review of Its Effect on Various Organ Systems and Recommendation on Rehabilitation Plans.

The majority of people infected with SARS-CoV-2 fully recovered within a few weeks. However, a considerable number of patients of different ages still suffer from long-lasting problems similar to the multi-organ damage in its acute phase of infection, or experience symptoms continuously for a longer term after the recovery. The severity of the primary infection seems not to be associated with the possibility and severity of long-term symptoms. Various unresolved symptoms have been reported in COVID-19 survivors months after hospital discharge. Long COVID-19 Syndrome refers to survivors 4 months after initial symptoms onset. It is important to understand the systemic effects of Long COVID-19 Syndrome, its presentations, and the need for rehabilitations to restore functional recovery in survivors. Government, healthcare workers, and survivor groups should collaborate to establish a self-sustaining system to facilitate follow-up and rehabilitations, with prioritization of resources to more severely Long COVID-19 Syndrome survivors. This review looks into the systemic effects of Long COVID-19 Syndrome in various aspects: respiratory, cardiovascular, hematological, renal, gastrointestinal, neurological, and metabolic effects of Long COVID-19 Syndromes. Recommendations for follow-up and rehabilitations details have been explored to cope with the tremendous Long COVID-19 Syndrome patients.

Administrative Groupings and Equality in Public Service Provision

Abstract Scarcity in public service agencies requires a prioritization of resources, and inherent to all prioritizations is a comparison of the cases. Despite the amount of research that has been conducted on the prioritization process, surprisingly little attention has been paid to the underlying comparison. Drawing on insight from the street-level bureaucracy literature, this study suggests that the administrative grouping of citizens in public service agencies influences the comparison so that the allocation of public services not only depends on a citizen’s need, but also on the needs of the other citizens assigned to the same agency. In a fixed effects analysis, based on registry data on more than 300,000 students, this study exploits the as-good-as-random assignment of students to classes within schools to analyze the influence of classroom composition on referrals to special education in Danish primary school. The result shows that students with better-performing peers are considerably more likely to be referred to special education than equally low-achieving students in lower-performing classes. This finding substantiates the argument of frame of reference effects in street-level bureaucracy and illustrates an unwarranted distributive consequence of the administrative grouping of citizens, thereby initiating a theoretical discussion of how such an influence can be mitigated.

Comparing 911 and emergency hotline calls for domestic violence in seven cities: What happened when people started staying home due to COVID-19?

Research Summary: We examine changes in help‐seeking for domestic violence (DV) in seven U.S. cities during the COVID‐19 pandemic. Using Bayesian structural time‐series modeling with daily data to construct a synthetic counterfactual, we test whether calls to police and/or emergency hotlines varied in 2020 as people stayed home due to COVID‐19. Across this sample, we estimate there were approximately 1030 more calls to police and 1671 more calls to emergency hotlines than would have occurred absent the pandemic. Policy Implications: Interagency data sharing and analysis holds great promise for better understanding localized trends in DV in real time. Research‐practitioner partnerships can help DV coordinated community response teams (CCRTs) develop accessible and sustainable dashboards to visualize data and advance community transparency. As calls for drastic changes in policing are realized, prioritization of finite resources will become critical. Data‐driven decision‐making by CCRTs provides an opportunity to work within resource constraints without compromising the safety of DV victims.

Machine Learning Approaches to Identify Patient Comorbidities and Symptoms That Increased Risk of Mortality in COVID-19.

Providing appropriate care for people suffering from COVID-19, the disease caused by the pandemic SARS-CoV-2 virus, is a significant global challenge. Many individuals who become infected may have pre-existing conditions that may interact with COVID-19 to increase symptom severity and mortality risk. COVID-19 patient comorbidities are likely to be informative regarding the individual risk of severe illness and mortality. Determining the degree to which comorbidities are associated with severe symptoms and mortality would thus greatly assist in COVID-19 care planning and provision. To assess this we performed a meta-analysis of published global literature, and machine learning predictive analysis using an aggregated COVID-19 global dataset. Our meta-analysis suggested that chronic obstructive pulmonary disease (COPD), cerebrovascular disease (CEVD), cardiovascular disease (CVD), type 2 diabetes, malignancy, and hypertension as most significantly associated with COVID-19 severity in the current published literature. Machine learning classification using novel aggregated cohort data similarly found COPD, CVD, CKD, type 2 diabetes, malignancy, and hypertension, as well as asthma, as the most significant features for classifying those deceased versus those who survived COVID-19. While age and gender were the most significant predictors of mortality, in terms of symptom–comorbidity combinations, it was observed that Pneumonia–Hypertension, Pneumonia–Diabetes, and Acute Respiratory Distress Syndrome (ARDS)–Hypertension showed the most significant associations with COVID-19 mortality. These results highlight the patient cohorts most likely to be at risk of COVID-19-related severe morbidity and mortality, which have implications for prioritization of hospital resources.

Extraction, Utilization Pattern and Prioritization of Fuel Resources for Conservation in Hydro-electric Power Project Areas in Kullu District, Himachal Pradesh, Northwestern Himalaya

In hilly areas, fuelwood is the major source of the energy and it provides almost all of the cooking energy requirements. There are millions of people living inside the protected and unprotected areas with dependencies on these areas for essential services. Among these, fuelwood and fodder are two important and critical components of the village economy especially in the hills and the annual wood consumption is very high. Information on fuelwood resources, their extraction and availability are very scanty. Therefore, the present study was carried out to study the diversity of fuelwood species, annual collection, preference, and availability of fuel species in the forests. Forty six species (33 Trees and 13 Shrubs) were extracted for fuel by the inhabitants. Species preference ranged from 0.05-0.55 Probability Use (PU) and was highest for Cedrus deodara (0.55), followed by Picea smithiana, Pinus wallichiana and Quercus leucotrichophora (0.50, each), Alnus nitida, Quercus floribunda and Ulmus wallichiana (0.45, each) and Ulmus villosa (0.40). Use pressure ranged from 1.35-826.65 Resource Use Index (RUI and was highest for Cedrus deodara (826.65), followed by Picea smithiana (675.00), Quercus leucotrichophora (630.00), Pinus wallichiana (558.00) and Quercus floribunda (348.30). Therefore, immediate actions are suggested to sustain the current and future demand for fuelwood. Awareness among the villagers and mass multiplication through conventional and in-vitro methods for the species facing high anthropogenic pressures and their establishment and maintenance in the in-situ and ex-situ conditions may help in the conservation and management of these species.

A global dataset of inland fisheries expert knowledge

Inland fisheries and their freshwater habitats face intensifying effects from multiple natural and anthropogenic pressures. Fish harvest and biodiversity data remain largely disparate and severely deficient in many areas, which makes assessing and managing inland fisheries difficult. Expert knowledge is increasingly used to improve and inform biological or vulnerability assessments, especially in data-poor areas. Integrating expert knowledge on the distribution, intensity, and relative influence of human activities can guide natural resource management strategies and institutional resource allocation and prioritization. This paper introduces a dataset summarizing the expert-perceived state of inland fisheries at the basin (fishery) level. An electronic survey distributed to professional networks (June-September 2020) captured expert perceptions (n = 536) of threats, successes, and adaptive capacity to fisheries across 93 hydrological basins, 79 countries, and all major freshwater habitat types. This dataset can be used to address research questions with conservation relevance, including: demographic influences on perceptions of threat, adaptive capacities for climate change, external factors driving multi-stressor interactions, and geospatial threat assessments.

Understanding junior doctors\u2019 experiences of teaching on the acute take: a qualitative study

BackgroundNew medical graduates are significantly unprepared to manage acutely unwell patients due to limited first-hand clinical exposure in the undergraduate curriculum. Supporting undergraduate learning in the acute setting can be challenging for junior doctors when balancing teaching and clinical responsibilities. Our aim was to explore junior doctors’ first-hand experiences of supporting undergraduate education in the acute admissions environment(take).MethodsFourteen junior doctors in one teaching hospital in South West England took part in semi-structured focus groups (4–6 participants in each) which were audio-recorded, transcribed, and thematically analysed.ResultsJunior doctors described their educational role as comprising: teaching, demonstrating, coaching, and supervising. They perceived the acute take as a highly variable, unpredictable setting that offered a broad scope for learning. Tensions between doctors’ clinical and educational roles were described, influenced by internal and external factors. Clinical work was prioritised over teaching and participants lacked confidence in supervisory and clinical skills. Doctors felt pressured to meet students’ expectations and lacked understanding of their educational needs. Senior colleagues were highly influential in establishing an educational culture and were often a source of pressure to deliver timely clinical care. Organisations were perceived not to value teaching due to the lack of provision of dedicated teaching time and prioritisation of limited resources towards patient care. Participants managed tensions by attempting to formally separate roles, demoting students to passive observers, and they sought greater continuity in placements to better understand students’ abilities and expectations.ConclusionsEducational opportunities for undergraduate students on the acute take are varied and highly valuable. This study provides insight into the provision of workplace education and its challenges from junior doctors’ perspectives. We highlight areas for improvement of relevance to educational providers.

A Practical Assessment of Modern IT Project Complexity Management Tools

Complexity is ubiquitous in modern engineering and project management. It is traditionally associated with failure. Also, complexity works! It delivers functionality, creativity, innovation. Complexity management contributes to the success of high-risk IT projects, helps better project understanding, allows for better prioritization and planning of resources. Managing negative complexity reduces project risk. Positive and appropriate complexity are catalysts for opportunities. This paper is a qualitative longitudinal study based on multiple industry project cases, consisting in the repeated evaluation of a set of complexity management tools. The tools were deployed in a classical process framework: plan, identify, analyze, plan responses, monitor, and control. The evaluated tools red-flag and measure complexity, analyze its sources and effects, and plan mitigation strategies. The study aims to provide project managers with methods for increasing project success rates and reducing failure in complex IT project environments.

Farm Suicides in Wisconsin, 2017–2018: Preliminary Findings and a Call for Future Research

Studies across the last few decades have consistently found farmers and farmworkers at an elevated risk of death by suicide compared to other occupational groups in the United States. Still, there is currently no comprehensive national surveillance system for agricultural-related injuries or suicides. For this study, we analyzed Wisconsin death certificate data from 2017 and 2018 to identify the burden of suicide among farmers and farmworkers. In 2017 and 2018, 44 farm-related suicides were identified, or 14.3 per 100,000 farmers and farmworkers. The median age of victims was 51.5 ± 20, and six (13.6%) were female. As these suicide cases were cross-checked, we found that none were identifiable solely from previously published news media or obituaries, indicating: (1) a clear need for a multi-sourced suicide data approach and inter-agency collaborations for future research, and (2) the need for a deeper investigation into the reporting of farm-related suicides. These data are necessary for informing state and local level policy, resource prioritization, and the evaluation of intervention efforts.

Adult diet in England: Where is more support needed to achieve dietary recommendations?

BackgroundSmall-area estimation models are regularly commissioned by public health bodies to identify areas of greater inequality and target areas for intervention in a range of behaviours and outcomes. Such local modelling has not been completed for diet consumption in England despite diet being an important predictor of health status. The study sets out whether aspects of adult diet can be modelled from previously collected data to define and evaluate area-level interventions to address obesity and ill-health.MethodsAdults aged 16 years and over living in England. Consumption of fruit, vegetables, and sugar-sweetened beverages (SSB) are modelled using small-area estimation methods in English neighbourhoods (Middle Super Output Areas [MSOA]) to identify areas where reported portions are significantly different from recommended levels of consumption. The selected aspects of diet are modelled from respondents in the National Diet and Nutrition Survey using pooled data from 2008–2016.ResultsEstimates indicate that the average prevalence of adults consuming less than one portion of fruit, vegetables or 100% juice each day by MSOA is 6.9% (range of 4.3 to 14.7%, SE 0.06) and the average prevalence of drinking more than 330ml/day of SSB is 11.5% (range of 5.7 to 30.5%, SE 0.03). Credible intervals around the estimates are wider for SSB consumption. The results identify areas including regions in London, urban areas in the North of England and the South coast which may be prioritised for targeted interventions to support reduced consumption of SSB and/or an increase in portions of fruit and vegetables.ConclusionThese estimates provide valuable information at a finer spatial scale than is presently feasible, allowing for within-country and locality prioritisation of resources to improve diet. Local, targeted interventions to improve fruit and vegetable consumption such as subsidies or voucher schemes should be considered where consumption of these foods is predicted to be low.

Attributable hospital costs, home care costs and risk of long-term sickness benefits following traffic injuries by road user type

BackgroundTraffic injuries involving vulnerable road users tend to be forgotten in the political prioritisation in many countries. The underreporting of traffic crashes in vulnerable road users is much higher than that of crashes involving cars. Sometimes, it is even argued that underreported crashes in vulnerable road users are costless. In this study, we aimed to estimate the hospital and home care costs, as well as the risk of long-term sickness benefits, associated with a traffic injury by road user type in the first year after the injury. MethodsThe study used a complete sample of traffic injuries treated in emergency rooms and hospitals in Denmark. We applied a nationwide case-crossover design to the data, comprising 47,242 hospital-registered traffic injuries, of which 14,246 were cyclist injuries and 17,193 were pedestrian injuries, including pedestrian falls. We estimated the attributable hospital and home care costs following the traffic injuries in a two-part model and the excess risk of long-term sickness benefits beyond four weeks in a binomial regression model, taking into account that the data originated from a case-crossover design. ResultsWe found that cyclist injuries were as costly as car injuries. Comparing all road users, we found that the most expensive traffic injuries were those of motorcyclists, moped drivers and pedestrians involved in multiparty crashes. ConclusionTraffic injuries involving vulnerable road users reach a price level similar to that of car injuries. The underreporting of crashes in vulnerable road users can, however, imply that road authorities choose safety measures that prevent car–car crashes instead of those that prevent crashes involving vulnerable road users, such as single-bicycle crashes or pedestrian falls. The outcome of this lack of knowledge and recognition is a biased prioritisation of the limited resources for road safety work.

Geo-spatial technology application for prioritization of land resources in Udham Singh Nagar District of Uttarakhand, India

A loss of soil resources by prolific watersheds is a frequent problem confronting hydrologists and watershed managers. Soil erosion is a major factor in losses of soil. Different models are used for prediction of the amount of soil loss by erosion. In the present study, modelling using Revised Universal Soil Loss equation (RUSLE) is integrated with Remote Sensing (RS) and Geographical Information Systems (GIS) techniques and employed to estimate soil erosion and prioritization of watersheds of Udham Singh Nagar district of Uttarakhand, India. The results showed that Udham Singh Nagar district’s major portion (38.66%) is covered with agriculture land and only 17.57% area is covered with forest. Water-bodies have occupied 2.18% area of US Nagar district. A large variation has been noticed in case of built-up land which has been recorded as 5.71%. US Nagar has more agricultural land. Udham Singh Nagar is having plane topography hence the range of soil erosion is from 0 to 40 ton/ha/year. However, most region of Udham Singh Nagar district falls under the category of 0-2 ton/ha/year soil erosion. The value of soil losses in most of cases is less than 1 t/ha/yr except in case of 11 watersheds,where it is slightly higher than 1 t/ha/yr. Moreover, it has been concluded that major portion of Udham Singh Nagar districtwere slight prone category of soil erosion, and therefore, no major plan/activity is required for reducing soil losses. Only checking large amount of runoff and enhancing organic matter build up in the soil will suffice the purpose.

Valuing recreational fishery attributes, opportunities and associated activities in China from the tourists’ satisfaction perspectives

Recreational fishery (RF) integrates the primary, secondary, and tertiary industries, which has been playing an irreplaceable role in protecting fishery ecological system, conserving fishing resources and creating employment opportunities for local fishery farmers in China. Unfortunately, due to the lack of economic value information, makes current RF management strategies problematic, especially in terms of resource allocation and prioritization of management tasks. To fill such a gap, we employ the tourist satisfaction approach (TSA) to estimate the value of RF resources. In particular, IV-OProbit is used to solve the endogenous issue of the impact of travel costs on travel satisfaction. The results show that travel cost has a significant negative effect on tourist satisfaction. Other attributes, such as the number of RF activities, size of fishing area, water clarity, vegetation coverage, as well as the number of fishing spots all have significant positive effects on tourist satisfaction, and their average MWTP is ¥372.21 ($56.24), ¥123.04 ($18.59), ¥67.47 ($10.19), ¥47.19 ($7.13), and ¥10.14 ($1.53), respectively. Besides, we also find that non-local female tourists with higher income and younger age seem to have higher WTP to improve attributes quality compared to local male tourists with lower income and older age. Furthermore, the local and non-local tourists also show divergent preferences where the locals prefer a large fishing area, while the non-locals prioritize their preference on the diversity of leisure activities. Accordingly, we put forward the general measures and specific measures to protect and enhance the development of recreational fishery.

Nurses’ Moral Distress in Caring for COVID-19 Patients

Dear Editor romoting the principles of professional practice is an approach to build trust among individuals concerning the medical profes sion. Individuals’ trust in nurses plays a cru cial role in patient care; thus, is of signifi cant importance. The main cornerstone in nursing care is the existence of nurses with professional ethics. Due to the epidemic of Coronavirus Disease 2019 (COVID-19), numerous patients have been hospital ized in the Intensive Care Unit (ICU) and some have expired in Iran and around the world. COVID-19 high lighted various difficult ethical issues encountered by healthcare providers in caring for patients and families. Nurses, as frontline healthcare workers, spend most of their time with patients; therefore, it is essential to ad dress the ethical concerns they face [1]. Attention to safety in nurses In the fight against COVID-19, ensuring the safety of nurses and other forefront healthcare workers is an important ethical concern. Nurses have to work under conditions that pose fundamental and uncertain risks to their health. Although nurses often voluntarily care for patients in high-risk situations, deficiencies and inappro priate conditions (e.g. the lack of protective facilities), prolonged presence in the wards to compensate for staff shortages, and patient care threaten their health; accord ingly, such conditions jeopardize more effective patient care. Due to these limitations, nurses cannot provide ef fective care and experience moral distress, psychological distress, and Post-Traumatic Stress Disorder (PTSD) [2]. Providing healthcare resources for patients COVID-19-induced conditions have necessitated more serious (and ethical) attention to the prioritization of care and resources in different care units. Making the right decision about the patient is among the ethical as pects that nurses encounter in special wards; it imposes a great moral burden on the healthcare staff. Nurses must provide care, justice, transparency, and protection in a way that does not incur legal and conscientious re sponsibilities. Patients with COVID-19 are admitted to hospital wards with different care needs. They require adequate medical care, beds, ventilators and oxygen therapy, medicine, and so on. When nurses are unable to provide effective care due to a large number of hospital ized patients and the lack of facilities, they face moral contradictions. Even in the UK, due to a large number of patients, the situation changed; normally, in the ICU, the ratio of nurses to patients was 1: 1, i.e., altered to 1: 6. Consequently, it affected care and caused ethical

Training needs assessment: tool utilization and global impact

BackgroundGlobal demand for standardized assessment of training needs and evaluation of professional continuing education programs across the healthcare workforce has led to various instrumentation efforts. The Hennessy-Hicks Training Needs Analysis (TNA) questionnaire is one of the most widely used validated tools. Endorsed by the World Health Organization, the tool informs the creation of tailored training to meet professional development needs. The purpose of this project was to describe TNA tool utilization across the globe and critically appraise the evidence of its impact in continuous professional development across disciplines and settings.MethodsA systematic integrative literature review of the state of the evidence across PubMed, Scopus, CINAHL, and Google Scholar databases was carried out. Full-text, peer reviewed articles and published dissertations/theses in English language that utilized the original, adapted or translated version of the TNA tool were included. Selected articles were appraised for type and level of evidence.ResultsA total of 33 articles were synthesized using an inductive thematic approach, which revealed three overarching themes: individual, team/interprofessional, and organizational level training needs. Included articles represented 18 countries, with more than two thirds involving high-income countries, and one third middle-income countries. Four studies (12.1%) used the original English version instrument, 23 (69.7%) adapted the original version, and 6 (18.2%) translated and culturally adapted the tool. Twenty-three studies targeted needs at the individual level and utilized TNA to determine job roles and responsibilities. Thirteen articles represented the team/interprofessional theme, applying the TNA tool to compare training needs and perceptions among professional groups. Last, three articles used the tool to monitor the quality of care across an institution or healthcare system, demonstrating the organizational training needs theme.ConclusionsOverall evidence shows that the TNA survey is widely used as a clinical practice and educational quality improvement tool across continents. Translation, cultural adaptation, and psychometric testing within a variety of settings, populations, and countries consistently reveals training gaps and outcomes of targeted continuous professional development. Furthermore, it facilitates prioritization and allocation of limited educational resources based on the identified training needs. The TNA tool effectively addresses the “know-do” gap in global human resources for health by translating knowledge into action.

Moral Distress and Resilience Associated with Cancer Care Priority Setting in a Resource-Limited Context.

BackgroundMoral distress and burnout are highly prevalent among oncology clinicians. Research is needed to better understand how resource constraints and systemic inequalities contribute to moral distress in order to develop effective mitigation strategies. Oncology providers in low‐ and middle‐income countries are well positioned to provide insight into the moral experience of cancer care priority setting and expertise to guide solutions.MethodsSemistructured interviews were conducted with a purposive sample of 22 oncology physicians, nurses, program leaders, and clinical advisors at a cancer center in Rwanda. Interviews were recorded, transcribed verbatim, and analyzed using the framework method.ResultsParticipants identified sources of moral distress at three levels of engagement with resource prioritization: witnessing program‐level resource constraints drive cancer disparities, implementing priority setting decisions into care of individual patients, and communicating with patients directly about resource prioritization implications. They recommended individual and organizational‐level interventions to foster resilience, such as communication skills training and mental health support for clinicians, interdisciplinary team building, fair procedures for priority setting, and collective advocacy for resource expansion and equity.ConclusionThis study adds to the current literature an in‐depth examination of the impact of resource constraints and inequities on clinicians in a low‐resource setting. Effective interventions are urgently needed to address moral distress, reduce clinician burnout, and promote well‐being among a critical but strained oncology workforce. Collective advocacy is concomitantly needed to address the structural forces that constrain resources unevenly and perpetuate disparities in cancer care and outcomes.Implications for PracticeFor many oncology clinicians worldwide, resource limitations constrain routine clinical practice and necessitate decisions about prioritizing cancer care. To the authors’ knowledge, this study is the first in‐depth analysis of how resource constraints and priority setting lead to moral distress among oncology clinicians in a low‐resource setting. Effective individual and organizational interventions and collective advocacy for equity in cancer care are urgently needed to address moral distress and reduce clinician burnout among a strained global oncology workforce. Lessons from low‐resource settings can be gleaned as high‐income countries face growing needs to prioritize oncology resources.

Satellite remote sensing to assess cyanobacterial bloom frequency across the United States at multiple spatial scales

Cyanobacterial blooms can have negative effects on human health and local ecosystems. Field monitoring of cyanobacterial blooms can be costly, but satellite remote sensing has shown utility for more efficient spatial and temporal monitoring across the United States. Here, satellite imagery was used to assess the annual frequency of surface cyanobacterial blooms, defined for each satellite pixel as the percentage of images for that pixel throughout the year exhibiting detectable cyanobacteria. Cyanobacterial frequency was assessed across 2,196 large lakes in 46 states across the continental United States (CONUS) using imagery from the European Space Agency’s Ocean and Land Colour Instrument for the years 2017 through 2019. In 2019, across all satellite pixels considered, annual bloom frequency had a median value of 4% and a maximum value of 100%, the latter indicating that for those satellite pixels, a cyanobacterial bloom was detected by the satellite sensor for every satellite image considered. In addition to annual pixel-scale cyanobacterial frequency, results were summarized at the lake- and state-scales by averaging annual pixel-scale results across each lake and state. For 2019, average annual lake-scale frequencies also had a maximum value of 100%, and Oregon and Ohio had the highest average annual state-scale frequencies at 65% and 52%. Pixel-scale frequency results can assist in identifying portions of a lake that are more prone to cyanobacterial blooms, while lake- and state-scale frequency results can assist in the prioritization of sampling resources and mitigation efforts. Satellite imagery is limited by the presence of snow and ice, as imagery collected in these conditions are quality flagged and discarded. Thus, annual bloom frequencies within nine climate regions were investigated to determine whether missing data biased results in climate regions more prone to snow and ice, given that their annual summaries would be weighted toward the summer months when cyanobacterial blooms tend to occur. Results were unbiased by the time period selected in most climate regions, but a large bias was observed for the Northwest Rockies and Plains climate region. Moderate biases were observed for the Ohio Valley and the Southeast climate regions. Finally, a clustering analysis was used to identify areas of high and low cyanobacterial frequency across CONUS based on average annual lake-scale cyanobacterial frequencies for 2019. Several clusters were identified that transcended state, watershed, and eco-regional boundaries. Combined with additional data, results from the clustering analysis may offer insight regarding large-scale drivers of cyanobacterial blooms.

Cancer care in the time of COVID-19: A conceptual framework to improve cancer outcomes during a pandemic.

e18628 Background: At the start of the COVID-19 pandemic, a plan for cancer management during a pandemic did not exist. It soon became clear that without proper planning, cancer outcomes would worsen. Cancer patients are at increased risk of COVID-19 infection, morbidity, and mortality. Health sectors internationally reduced or paused non-urgent cancer care to protect cancer patients from COVID-19. However, disproportionate delays in screening, diagnosis, and treatment can unduly impact cancer outcomes, and backlogs can further burden a strained health system. Tailored approaches to cancer management are required which balance health resource availability along with the risks of exposure and benefits of treatment. Australia’s relatively low COVID-19 case numbers afforded Cancer Australia an opportunity to proactively plan for optimal cancer management during this, and future, pandemics. Methods: Cancer Australia’s Cancer care in the time of COVID-19: A conceptual framework for the management of cancer during a pandemic (the framework) maps evidence-based cancer care considerations in relation to a health system’s capacity across acute and recovery pandemic phases, in relation to steps of the cancer care pathway. The framework promotes infection control and resource prioritisation in the context of innovative care models, triaging approaches and individualised treatment plans, underpinned by effective communication and shared decision-making. Results: The framework supports health system planning and risk-stratified approaches to guide decision-making and improve cancer outcomes. Many aspects of cancer care are recommended to continue (to varying degrees) in most pandemic phases, with modifications or pauses in some aspects of care as the pandemic curve approaches or exceeds health system capacity. Principles of the framework were employed during the second wave of COVID-19 in the Australian state of Victoria, with continuation of cancer screening programs, diagnostic investigations, and treatments wherever it was safe to do so. This resulted in reductions in cancer services and treatment being relatively smaller than in the first wave. Conclusions: Cancer management in a pandemic is not a one-size-fits-all. Countries and jurisdictions need to tailor cancer care according to the risk of the health system becoming overwhelmed. The framework guides optimal cancer care to improve outcomes for people with cancer, while minimising COVID-19 infection. As further evidence becomes available from this pandemic or in future pandemics, this framework can be refined to inform ongoing and future pandemic health system planning.

Information sharing, collaboration, and decision-making during disease outbreaks: the experience of Fiji

ABSTRACT With disease outbreaks rising, responsive and resilient systems are needed. Understanding how disease outbreaks are managed, and how governments, non-governmental organisations (NGOs), and international governmental organisations (IGOs) work together to respond is essential. Fifteen key informant interviews and one group interview were conducted with individuals in water and health sectors from the Fijian government, NGOs, and IGOs at the water catchment, divisional, and national levels about decision-making during outbreaks. Thematic analysis found changes in communication, collaboration, and coordination during an outbreak. Communication becomes open, transparent, frequent, and utilises informal pathways including social media. Collaboration increases and becomes more flexible, leading to changes in roles, responsibilities and decision-making. The flexibility helps resource and fund redistribution. Coordination guided by government priorities, funding, laws, adaptability, and flexibility, enables targeted actions including resource prioritisation. Maximising the communication, collaboration, and coordination amongst sectors during disease outbreaks and non-outbreak periods can strengthen system resilience and responsiveness.