Background: The COVID-19 pandemic resulted in reduced patient access and deferral of medical services. Long wait times for patients to access specialized medical care became a challenge to health care systems. Baycrest is an academic health sciences centre in Toronto, Canada, that specializes in post-acute and ambulatory care for older adults. As a result of deferred care, wait times for the mental health services increased significantly. This compelled the ambulatory mental health program to apply quality improvement Methods to identify and prioritize care for the most unwell people on the waitlist, while avoiding duplication of referrals between hospitals. This study aimed to assess the utility and feasibility of this new process.

Methods: The quality process involved a Rapid Design Event approach, where the mental health programs created inclusion and exclusion eligibility criteria and established a priority system to assign patients to one of three categories based on need: high priority, routine, and decline. Identification of high priority referrals was meant to allow the most unwell patients to be seen sooner. The central navigation process was refined through quality improvement huddles and standard feedback mechanisms. After three weeks of trialing the process, a sustainability plan to move to operations was applied, and results were continuously monitored through reports and improvement board huddles.

Results: In the first 3 months of implementation, the percentage of patients receiving meaningful clinical contact within 14 days of referral increased from 3.8% to 82.3%, with contact by a clinician within an average of 4 days. Across the ambulatory mental health programs, wait times for psychogeriatric assessment for high priority patients improved from 141 days to 31.8days. Factors leading to the improvement will bediscussed.

Conclusions: The central navigation and extended triage processes were found to be feasible and of great utility. The high priority patients who needed to be assessed sooner were identified through an extended triage process. Meaningful clinical contact was made within days and wait times reduced for those most in need. This demonstrated how a quality improvement process can lead to significant improvements in health care delivery.

Background: Data regarding the effects of the SARS-COV-2 (COVID-19) pandemic on healthcare-associated infections (HAIs) in Canadian acute-care hospitals are limited. We examined the impact of the COVID-19 pandemic on HAIs and antimicrobial resistant organisms in hospitals participating in the Canadian Nosocomial Infection Surveillance Program. Methods: We analyzed 13,406 HAIs including adult mixed intensive care unit (ICU) central-line–associated bloodstream infections (CLABSIs), and healthcare-associated (HA) Clostridioides difficile infection (CDI), methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI), vancomycin-resistant Enterococcus (VRE) BSI, and carbapenemase-producing Enterobacterales (CPE) infections collected using standardized case definitions and questionnaires from 29–64 hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) from January 2018 to December 2021. We used a generalized linear mixed model with quasi-Poisson distribution to assess step and slope changes in monthly HAI rates between the pre–COVID-19 pandemic period (January 1, 2018–February 29, 2020; 26 time points) and the COVID-19 pandemic period (March 1, 2020–December 31, 2021; 22 time points). Results were reported as incidence rate ratios (IRRs) with 95% confidence intervals (CIs) and adjusted for seasonality, hospital clustering, and hospital characteristics of interest. Results: In the CNISP network, 7,352 (55%) HAIs were reported in the prepandemic period and 6,054 (45%) in the pandemic period. Median age was significantly younger during the pandemic period compared to the prepandemic period among patients with HA-CDI, HA-MRSA BSI, and adult mixed ICU CLABSIs, and more than half of cases among all reported HAIs were male (range, 52%–65%). The 30-day all-cause in-hospital mortality rate did not significantly change between the prepandemic and pandemic periods for all reported HAIs and was highest among HA-VRE BSIs (34%). Modeling results indicated that the COVID-19 pandemic was associated with an immediate increase in HA-CDI and adult mixed ICU CLABSI rates whereas HA-MRSA BSI, HA-CPE and HA-VRE BSI rates immediately decreased. However, pandemic status did not have a statistically significant lasting impact on monthly rate trends for all reported HAIs after adjusting for seasonality, clustering, and hospital covariates (Fig. 1 and 2). Adjusted IRRs for all HAIs ranged from 1.00 to 1.01 (95% CI, 0.94–0.99 to 1.01–1.05).

Conclusions: Although the COVID-19 pandemic placed a significant burden on the Canadian healthcare system, the immediate impact on monthly rates of HAIs in Canadian acute-care hospitals was not sustained over time. Understanding the epidemiological effects of the COVID-19 pandemic in the context of changing patient populations, and clinical and infection control practices, are essential to inform the continued management and prevention of HAIs in Canadian acute-care settings.

Disclosures: None

In a survey of infection prevention programs, leaders reported frequent clinical and infection prevention practice modifications to avoid coronavirus disease 2019 (COVID-19) exposure that exceeded national guidance. Future pandemic responses should emphasize balanced approaches to precautions, prioritize educational campaigns to manage safety concerns, and generate an evidence-base that can guide appropriate infection prevention practices.

A global ageing population presents opportunities and challenges to designing urban environments that support ageing in place. The World Health Organization's Global Age-Friendly Cities movement has identified the need to develop communities that optimise health, participation and security in order to enhance quality of life as people age. Ensuring that age-friendly urban environments create the conditions for active ageing requires cities and communities to support older adults’ rights to access and move around the city (‘appropriation’) and for them to be actively involved in the transformation (‘making and remaking’) of the city. These opportunities raise important questions: What are older adults’ everyday experiences in exercising their rights to the city? What are the challenges and opportunities in supporting a rights to the city approach? How can the delivery of age-friendly cities support rights to the city for older adults? This paper aims to respond to these questions by examining the lived experiences of older adults across three cities and nine neighbourhoods in the United Kingdom. Drawing on 104 semi-structured interviews with older adults between the ages of 51 and 94, the discussion centres on the themes of: right to use urban space; respect and visibility; and the right to participate in planning and decision-making. These themes are illustrated as areas in which older adults’ rights to access and shape urban environments need to be addressed, along with recommendations for age-friendly cities that support a rights-based approach.

We evaluated the QX200 Droplet Digital PCR (ddPCR™, Bio-Rad) system and protocols for the detection of the tick-borne pathogens Borrelia burgdorferi and Borrelia miyamotoi in Ixodes scapularis nymphs and adults collected from North Truro, Massachusetts. Preliminary screening by nested PCR determined positive infection levels of 60% for B. burgdorferi in these ticks. To investigate the utility of ddPCR as a screening tool and to calculate the absolute number of bacterial genome copies in an infected tick, we adapted previously reported TaqMan®-based qPCR assays for ddPCR. ddPCR proved to be a reliable means for detection and absolute quantification of control bacterial DNA with precision as low as ten spirochetes in an individual sample. Application of this method revealed the average carriage level of B. burgdorferi in infected I. scapularis nymphs to be 2291 spirochetes per nymph (range: 230–5268 spirochetes) and 51 179 spirochetes on average in infected adults (range: 5647–115 797). No ticks naturally infected with B. miyamotoi were detected. The ddPCR protocols were at least as sensitive to conventional qPCR assays but required fewer overall reactions and are potentially less subject to inhibition. Moreover, the approach can provide insight on carriage levels of parasites within vectors.

Recent archaeological investigations at Pueblo Bonito in Chaco Canyon reveal that residents constructed a large diversion channel during the eleventh century A.D. as dramatic growth resulted in the expansion of the building onto the main valley floor. Sediments in the diversion channel reflect repeated episodes of flooding, rather than slow moving water typically found in irrigation canals, and archaeobotanical data indicate deposition during late summer or early fall. Although an agricultural function is possible, the channel may have been built primarily to divert floodwaters away from Pueblo Bonito while providing a nearby water source for construction and domestic use. The diversion channel was destroyed by the entrenchment of the “Bonito paleo-channel” in the late A.D. 1000s, and then buried by a combination of cultural debris and valley flooding. Although the canyon stream system changed throughout the occupation of Pueblo Bonito, there is no evidence that the formation of a deep natural channel in the floodplain had any negative effect on the growth of the great house

This article describes a form of agricultural labor intensification common in the postwar Soviet Union that shares some important similarities to Clifford Geertz's notion of agricultural involution, first devised to describe Javanese wet rice agriculture. Using the examples of hog farming and cotton production, this paper describes the phenomenon of postwar agricultural involution, and explores its limits and possibilities. The most important divergence from Geertz's original model is that in the Soviet cases, agricultural involution did not attain any form of environmental equilibrium; in fact, because of agricultural involution, the Soviet Union was forced to confront the environmental limits of agricultural intensification. The concept of agricultural involution provides a way of thinking about the relative flexibility or rigidity of agroecological health in the face of labor intensification. This quality—how much additional labor and how many extra humans an agricultural ecosystem is able to support—is critical in evaluating how robust or fragile a landscape is.

The purpose of the present study was to determine the influence of the glycaemic index (GI) and glycaemic load (GL) on the ratio of tryptophan (TRP) relative to other large neutral amino acids (LNAA). Ten healthy men (age 22·9 (sd 3·4) years; BMI 23·5 (sd 1·6) kg/m2) underwent standard GI testing, and later consumed each of a mixed-macronutrient (1915 kJ; 66·5 % carbohydrate (CHO), 17 % protein and 16·5 % fat) high-GI (MHGI), an isoenergetic, mixed-macronutrient low-GI (MLGI) and a CHO-only (3212 kJ; 90 % CHO, 8 % protein, 2 % fat) high-GI (CHGI) meal on separate days. The GI, GL and insulin index values (e.g. area under the curve) were largest after the CHGI meal (117, 200, 158), followed by the MHGI (79, 59, 82) and MLGI (51, 38, 56) meals, respectively (all values were significantly different, P < 0·05). After the MHGI and MLGI meals but not after the CHGI meal, TRP was elevated at 120 and 180 min (P < 0·05). After the CHGI, LNAA was lower compared with the MLGI (P < 0·05); also the rate of decline in LNAA was higher after CHGI compared with MHGI and MLGI (both comparisons P < 0·05). The percentage increase from baseline in TRP:LNAA after CHGI (23 %) was only marginally higher than after the MHGI meal (17 %; P = 0·38), but it was threefold and nearly significantly greater than MLGI (8 %; P = 0·05). The present study demonstrates that the postprandial rise in TRP:LNAA was increased by additional CHO ingestion and higher GI. Therefore, the meal GL appears to be an important factor influencing the postprandial TRP:LNAA concentration.

Objectives: The UK National Institute for Health and Clinical Excellence (NICE) has been widely hailed as an international leader in health technology assessment. The objectives of its guidance are to ensure uniformity in healthcare provision, and promote a systematic and accountable way to allocate resources. However, research relating to the implementation of guidance is limited, and little is known about how it influences decision making at the consultation level or how useful it is to individual patients.

Methods: In-depth interviews were undertaken with professionals involved in healthcare provision at the community level, and with clinical professionals and patients providing or receiving care for morbid obesity and breast cancer (n = 52).

Results: Although NICE guidance was generally well-regarded, in practice it was of more importance and usefulness to managerial than clinical professionals. Clinicians used a patchy approach to implementation depending on whether recommendations accorded with their personal interpretation of the evidence available, and whether funding was available locally. Many patients had not heard of NICE, and clinical professionals did not alert them to its existence. Even where patients knew about relevant guidance, they were rarely able to use it to assert their right to treatment.

Conclusions: These findings challenge the perception that NICE guidance results in consistent and accountable decision making, and the limited accessibility and usefulness of guidance to patients suggests more information and support is needed at the point of provision if these objectives are to be achieved.

Health and pleasure resorts constitute a distinctive, numerous and important kind of industrial town. But they, and the service industries which are central to their economies, have hardly been studied from a social conflict and industrial relations perspective. This paper opens out this theme by analysing a strike in the catering trades in San Sebastián, at the time Spain's largest and most prestigious seaside resort, at the height of the holiday season in August. The course of the strike is charted in its economic and political context, and the reasons for its outbreak, and for an ensuing attempt to escalate it into a local general strike, are analysed. Particular attention is paid to the status in the labour market of the camareros or hotel, restaurant and café waiters who withdrew their labour, and to reactions to the strike among local media who were deeply conscious of the importance to San Sebastián's staple industry of sustaining a carefully-constructed image of tranquillity and security. Comparisons are made with British resort experiences in the turbulent years between 1916 and 1921, and further work on this theme is urged, especially for this important period.