Metabolic and other morbid complications in congenital generalized lipodystrophy type 4.

Morbidity and mortality rates in patients with autosomal recessive, congenital generalized lipodystrophy type 4 (CGL4), an ultra-rare disorder, remain unclear. We report on 30 females and 16 males from 10 countries with biallelic null variants in CAVIN1 gene (mean age, 12 years; range, 2 months to 41 years). Hypertriglyceridemia was seen in 79% (34/43), hepatic steatosis in 82% (27/33) but diabetes mellitus in only 21% (8/44). Myopathy with elevated serum creatine kinase levels (346-3325 IU/L) affected all of them (38/38). 39% had scoliosis (10/26) and 57% had atlantoaxial instability (8/14). Cardiac arrhythmias were detected in 57% (20/35) and 46% had ventricular tachycardia (16/35). Congenital pyloric stenosis was diagnosed in 39% (18/46), 9 had esophageal dysmotility and 19 had intestinal dysmotility. Four patients suffered from intestinal perforations. Seven patients died at mean age of 17 years (range: 2 months to 39 years). The cause of death in four patients was cardiac arrhythmia and sudden death, while others died of prematurity, gastrointestinal perforation, and infected foot ulcers leading to sepsis. Our study highlights high prevalence of myopathy, metabolic abnormalities, cardiac, and gastrointestinal problems in patients with CGL4. CGL4 patients are at high risk of early death mainly caused by cardiac arrhythmias.

Socioeconomic representativeness of Australian, Canadian and British cohorts from the paediatric diabetes AdDIT study: comparisons to regional and national data.

BACKGROUND: Given limited data regarding the involvement of disadvantaged groups in paediatric diabetes clinical trials, this study aimed to evaluate the socioeconomic representativeness of participants recruited into a multinational clinical trial in relation to regional and national type 1 diabetes reference populations. METHODS: Retrospective, cross-sectional evaluation of a subset of adolescent type 1 diabetes cardiorenal intervention trial (AdDIT) participants from Australia (n = 144), Canada (n = 312) and the UK (n = 173). Validated national measures of deprivation were used: the Index of Relative Socioeconomic Disadvantage (IRSD) 2016 (Australia), the Material Resources (MR) dimension of the Canadian Marginalisation index 2016 (Canada) and the Index of Multiple Deprivation (IMD) 2015 (UK). Representativeness was assessed by comparing the AdDIT cohort's distribution of deprivation quintiles with that of the local paediatric type 1 diabetes population (regional), and the broader type 1 diabetes population for which the trial's intervention was targeted (national). RESULTS: Recruited study cohorts from each country had higher proportions of participants with higher SES, and significant underrepresentation of lower SES, in relation to their national references. The socioeconomic make-up in Australia mirrored that of the regional population (p = 0.99). For Canada, the 2nd least deprived (p = 0.001) and the most deprived quintiles (p < 0.001) were over- and under-represented relative to the regional reference, while the UK featured higher regional and national SES bias with over-representation and under-representation from the least-deprived and most-deprived quintiles (p < 0.0001). CONCLUSIONS: Significant national differences in trial participation of low SES participants were observed, highlighting limitations in access to clinical research and the importance of reporting sociodemographic representation in diabetes clinical trials. TRIAL REGISTRATION: NCT01581476. Registered on 20 April 2012.

Using spatial video geonarratives to improve nursing care for people who use drugs and experience homelessness: A methodology for nurses.

BACKGROUND: People who are insecurely housed and use drugs are disproportionately affected by drug poisonings. Nurses are uniquely positioned to utilize harm reduction strategies to address the needs of the whole person. Needle debris encompasses drug paraphernalia discarded in public spaces. Studying needle debris provides a strategic opportunity to identify where drugs are being used and target public health strategies accordingly. AIM: Our aim in this article is to illustrate how spatial video geonarratives (SVG) combined GPS technology interviews, and videos of locations with needle debris, can elicit valuable data for nursing research. METHODS: Using SVG required knowledge of how to collect data wearing cameras and practice sessions were necessary. A Miufly camera worn at waist height on a belt provided the stability to walk while interviewing stakeholders. We wore the cameras and conducted go-along interviews with outreach workers, while filming the built environment. Upon completion of data collection, both the interview and GPS information were analysed using Wordmapper software. CONCLUSIONS: This methodology resulted in data presented uniquely in both a visual map and narrative. These data were richer than if a single modality had been used. These data highlighted specific contextual factors that were related to the location of needle debris, which created opportunities for nursing interventions to support people experiencing vulnerability.

Timing of CGM initiation in pediatric diabetes: The CGM TIME Trial.

OBJECTIVE: To determine whether timing of CGM initiation offering low glucose suspend (LGS) affects CGM adherence in children and youth starting insulin pump therapy. METHODS: A 5-site RCT of pump-naïve subjects (aged 5-18 years) with type 1 diabetes (T1D) for at least 1 year compared simultaneous pump and CGM initiation offering LGS vs standard pump therapy with CGM initiation delayed for 6 months. Primary outcome was CGM adherence (hours per 28 days) (MiniMed™ Paradigm™ Veo™ system; CareLink Pro™ software) over 6 months after CGM initiation. Secondary outcome HbA1c was measured centrally. Linear mixed-models and ordinary least squares models were fitted to estimate effect of intervention, and covariates baseline age, T1D duration, HbA1c, gender, ethnicity, hypoglycemia history, clinical site, and association between CGM adherence and HbA1c. RESULTS: The trial randomized 144/152 (95%) eligible subjects. Baseline mean age was 11.5 ± 3.3(SD) years, T1D duration 3.4 ± 3.1 years, and HbA1c 7.9 ± 0.9%. Six months after CGM initiation, adjusted mean difference in CGM adherence was 62.4 hours per 28 days greater in the Simultaneous Group compared to Delayed Group (P = .007). There was no difference in mean HbA1c at 6 months. However, for each 100 hours of CGM use per 28-day period, HbA1c was 0.39% (95% CI 0.10%-0.69%) lower. Higher CGM adherence was associated with reduced time with glucose >10 mmol/L (P < .001). CONCLUSION: CGM adherence was higher after 6 months when initiated at same time as pump therapy compared to starting CGM 6 months after pump therapy. Greater CGM adherence was associated with improved HbA1c.

Fear of hypoglycemia in children with type 1 diabetes and their parents: Effect of pump therapy and continuous glucose monitoring with option of low glucose suspend in the CGM TIME trial.

To determine if pump therapy with continuous glucose monitoring offering low glucose suspend (LGS) decreases fear of hypoglycemia among children with type 1 diabetes and their parents. The CGM TIME trial is a multicenter randomized controlled trial that enrolled 144 children with type 1 diabetes for at least 1 year (mean duration 3.4 ± 3.1 years) starting pump therapy (MiniMed™ Veo™, Medtronic Canada). CGM (MiniMed™ Enlite™ sensor) offering LGS was introduced simultaneously or delayed for 6 months. Hypoglycemia Fear Scale (HFS) was completed by children ≥10 years old and all parents, at study entry and 12 months later. Simultaneous and Delayed Group participants were combined for all analyses. Subscale scores were compared with paired t-tests, and individual items with paired Wilcoxon tests. Linear regression examined association with CGM adherence. 121/140 parents and 91/99 children ≥10 years had complete data. Mean Behavior subscale score decreased from 21.1 (SD 5.9) to 17.2 (SD 6.1) (p < .001) for children, and 20.7 (SD 7.5) to 17.4 (7.4) (p < .001) for parents. Mean Worry subscale score decreased from 17.9 (SD 11.9) to 11.9 (SD 11.4) (p < .001) for children, and 23.1 (SD 13.2) to 17.6 (SD 10.4) (p < .001) for parents. Median scores for 10/25 child items and 12/25 parent items were significantly lower at 12 months (p < .001). Linear regression found no association between HFS scores and CGM adherence. Insulin pump therapy with CGM offering LGS significantly reduced fear of hypoglycemia not related to CGM adherence in children with type 1 diabetes and their parents.

Addressing the data guardian and geospatial scientist collaborator dilemma: how to share health records for spatial analysis while maintaining patient confidentiality.

BACKGROUND: The utility of being able to spatially analyze health care data in near-real time is a growing need. However, this potential is often limited by the level of in-house geospatial expertise. One solution is to form collaborative partnerships between the health and geoscience sectors. A challenge in achieving this is how to share data outside of a host institution's protection protocols without violating patient confidentiality, and while still maintaining locational geographic integrity. Geomasking techniques have been previously championed as a solution, though these still largely remain an unavailable option to institutions with limited geospatial expertise. This paper elaborates on the design, implementation, and testing of a new geomasking tool Privy, which is designed to be a simple yet efficient mechanism for health practitioners to share health data with geospatial scientists while maintaining an acceptable level of confidentiality. The basic premise of Privy is to move the important coordinates to a different geography, perform the analysis, and then return the resulting hotspot outputs to the original landscape. RESULTS: We show that by transporting coordinates through a combination of random translations and rotations, Privy is able to preserve location connectivity among spatial point data. Our experiments with typical analytical scenarios including spatial point pattern analysis and density analysis shows that, along with protecting spatial privacy, Privy maintains the spatial integrity of data which reduces information loss created due to data augmentation. CONCLUSION: The results from this study suggests that along with developing new mathematical techniques to augment geospatial health data for preserving confidentiality, simple yet efficient software solutions can be developed to enable collaborative research among custodians of medical and health data records and GIS experts. We have achieved this by developing Privy, a tool which is already being used in real-world situations to address the spatial confidentiality dilemma.

Social Determinants of Health Are Associated with Modifiable Risk Factors for Cardiovascular Disease and Vascular Function in Pediatric Type 1 Diabetes.

OBJECTIVE: To evaluate the relationship between social determinants of health (SDH) and cardiovascular disease (CVD) risk factors as well as a measure of arterial stiffness in adolescents with type 1 diabetes (T1D). STUDY DESIGN: SDH were measured with the validated Ontario Marginalization Index, derived from deidentified postal code data and stratified by quintile (first = least deprived; fifth = most deprived). SDH dimensions included material deprivation; ethnic concentration; and measures of dependency and residential instability. Metabolic control (hemoglobin A1c), cardiovascular risk metrics, and pulse wave velocity, as a measure of arterial stiffness, were related to SDH. Data were evaluated from a cohort of Canadian adolescents within the Adolescent Diabetes Cardiorenal Intervention Trial, a T1D clinical trial RESULTS: A total of 704 participants were evaluated, and significant differences in hemoglobin A1c were evident at the extremes of material deprivation (8.4% vs 9.1% for least vs most deprived, P < .01). CVD risk factors were analyzed in 199 participants, with the most deprived reporting significantly less exercise (P = .004) and increased rates of smoking (P = .008). Increased material deprivation was associated with fewer metrics of "ideal" cardiovascular health attained. Arterial stiffness, as measured by pulse wave velocity, was associated positively with age, body mass index z score, and material deprivation. CONCLUSION: Increased material deprivation was associated with poorer glycemic control. Modifiable, lifestyle-related risk factors for CVD and early arterial wall change are associated with SDH and represent a target for clinical intervention to reduce future CVD burden in adolescents with T1D.

Breaking Out of Surveillance Silos: Integrative Geospatial Data Collection for Child Injury Risk and Active School Transport.

The preponderance of active school transport (AST) and child injury research has occurred independently, yet they are inherently related. This is particularly true in urban areas where the environmental context of AST may pose risks to safety. However, it can be difficult to make these connections due to the often segregated nature in which these veins of research operate. Spatial video presents a geospatial approach for simultaneous data collection related to both issues. This article reports on a multi-sector pilot project among researchers, a children's hospital, and a police department, using spatial video to map child AST behaviors; a geographic information system (GIS) is used to analyze these data in the environmental context of child pedestrian injury and community violence.

Spatial video geonarratives and health: case studies in post-disaster recovery, crime, mosquito control and tuberculosis in the homeless.

BACKGROUND: A call has recently been made by the public health and medical communities to understand the neighborhood context of a patient's life in order to improve education and treatment. To do this, methods are required that can collect "contextual" characteristics while complementing the spatial analysis of more traditional data. This also needs to happen within a standardized, transferable, easy-to-implement framework. METHODS: The Spatial Video Geonarrative (SVG) is an environmentally-cued narrative where place is used to stimulate discussion about fine-scale geographic characteristics of an area and the context of their occurrence. It is a simple yet powerful approach to enable collection and spatial analysis of expert and resident health-related perceptions and experiences of places. Participants comment about where they live or work while guiding a driver through the area. Four GPS-enabled cameras are attached to the vehicle to capture the places that are observed and discussed by the participant. Audio recording of this narrative is linked to the video via time stamp. A program (G-Code) is then used to geotag each word as a point in a geographic information system (GIS). Querying and density analysis can then be performed on the narrative text to identify spatial patterns within one narrative or across multiple narratives. This approach is illustrated using case studies on post-disaster psychopathology, crime, mosquito control, and TB in homeless populations. RESULTS: SVG can be used to map individual, group, or contested group context for an environment. The method can also gather data for cohorts where traditional spatial data are absent. In addition, SVG provides a means to spatially capture, map and archive institutional knowledge. CONCLUSIONS: SVG GIS output can be used to advance theory by being used as input into qualitative and/or spatial analyses. SVG can also be used to gain near-real time insight therefore supporting applied interventions. Advances over existing geonarrative approaches include the simultaneous collection of video data to visually support any commentary, and the ease-of-application making it a transferable method across different environments and skillsets.

The JDRF CCTN CGM TIME Trial: Timing of Initiation of continuous glucose Monitoring in Established pediatric type 1 diabetes: study protocol, recruitment and baseline characteristics.

BACKGROUND: Continuous glucose monitoring (CGM) has been shown to improve glucose control in adults with type 1 diabetes. Effectiveness of CGM is directly linked with CGM adherence, which can be challenging to maintain in children and adolescents. We hypothesize that initiating CGM at the same time as starting insulin pump therapy in pump naïve children and adolescents with type 1 diabetes will result in greater CGM adherence and effectiveness compared to delaying CGM introduction by 6 months, and that this is related to greater readiness for making behaviour change at the time of pump initiation. METHODS/DESIGN: The CGM TIME Trial is a multicenter randomized controlled trial. Eligible children and adolescents (5-18 years) with established type 1 diabetes were randomized to simultaneous initiation of pump (Medtronic Veo©) and CGM (Enlite©) or to standard pump therapy with delayed CGM introduction. Primary outcomes are CGM adherence and hemoglobin A1C at 6 and 12 months post pump initiation. Secondary outcomes include glycemic variability, stage of readiness, and other patient-reported outcomes with follow-up to 24 months. 144 (95%) of the 152 eligible patients were enrolled and randomized. Allowing for 10% withdrawals, this will provide 93% power to detect a between group difference in CGM adherence and 86% power to detect a between group difference in hemoglobin A1C. Baseline characteristics were similar between the treatment groups. Analysis of 12 month primary outcomes will begin in September 2014. DISCUSSION: The CGM TIME Trial is the first study to examine the relationship between timing of CGM initiation, readiness for behaviour change, and subsequent CGM adherence in pump naïve children and adolescents. Its findings will advance our understanding of when and how to initiate CGM in children and adolescents with type 1 diabetes. TRIAL REGISTRATION: ClinicalTrial.gov NCT01295788. Registered 14 February 2011.

Residential history, the electronic health record, and clinical medicine: A descriptive study in a lung transplant cohort.

Neighborhood level social determinants of health are commonly measured using a patient's most recent residential location. Not accounting for residential history, and therefore missing accumulated stressors from prior social vulnerabilities, could increase misclassification bias. We tested the hypothesis that the electronic health record could capture the residential history of lung transplant patients -a vulnerable population. After applying the Social Vulnerability Index (SVI) to individual residential histories, the most recent SVI equaled the first SVI in only 15.4% (58/374) of patients. There is a need for databases with residential histories to inform place-based determinants of health and applications to patient care.

Bone health in young adults with type 1 diabetes and progressive eGFR decline.

BACKGROUND: Type 1 Diabetes (T1D) is associated with increased risk of fractures, worsened by presence of microvascular complications. This study's objective is to determine the impact of progressive decline in estimated glomerular filtration rate (eGFR) on bone biomarkers and bone microarchitecture in youth with T1D. METHODS: Slopes of eGFR were calculated using measures obtained at four timepoints from adolescence to young adulthood. Participants were identified as eGFR decliners if eGFR decreased ≥ 3ml/min/1.73m2/year. Bone health was assessed in young adulthood by high resolution peripheral quantitative computed tomography (HRpQCT Xtreme CTII) and bone biomarkers; osteocalcin, procollagen 1 intact n-terminal pro-peptide (P1NP), c-terminal telopeptide (CTX), and bone specific alkaline phosphatase. The relationship between diabetes duration, glycated hemoglobin, body mass index (BMI) and vitamin D level on bone biomarkers and microarchitecture was evaluated. Linear regression analysis was used for the statistical analysis in this study. RESULTS: Ninety-nine study participants were studied with longitudinal evaluation of eGFR over 7.4 ± 1.0 years with mean age of 14.7 ± 1.7 years at baseline. Cross sectional evaluation of bone was performed at 21.3 ± 2.1 years. 44% participants had eGFR decline and showed 5% higher cortical porosity diameter than non-decliners (p = 0.035). Greater diabetes duration was associated with higher trabecular separation (p = 0.004) and lower trabecular number (p = 0.01). Higher level of 25 hydroxy-vitamin D was associated with lower trabecular separation (p = 0.01). Elevated glycated hemoglobin (p = 0.0008) and BMI (p = 0.009), were associated with lower markers of bone formation. CONCLUSION: Mild increase in cortical porosity diameter was found in youth with T1D and eGFR decline, however, overall measures of bone microarchitecture on HR-pQCT were similar between both groups and there were no statistically significant changes in bone biomarkers. Hence, skeletal impairments were limited in youth with different eGFR trajectories near peak bone mass. Longitudinal HR-pQCT studies are needed to further understand the impact of eGFR decline on bone microarchitecture. Optimal glycemic control, normal BMI and vitamin D status were supported by this study as important markers for good bone health.

Association of Fructosamine Levels With Glycemic Control in Children With Type 1 Diabetes as Determined by Continuous Glucose Monitoring: Results From the CGM TIME Trial.

OBJECTIVE: Our aim in this study was to determine the correlation between serum fructosamine and average blood glucose, as measured by continuous glucose monitoring (CGM) in children with type 1 diabetes. METHODS: Ninety-seven blood samples were collected from 70 participants in the Timing of Initiation of continuous glucose Monitoring in Established pediatric diabetes (CGM TIME) Trial. Each eligible participant had 3 weeks of CGM data with at least 60% CGM adherence before blood collection. Ordinary least-squares linear regression incorporating restricted cubic splines was used to determine the association between fructosamine levels and mean blood glucose. RESULTS: An association was found between fructosamine and mean blood glucose, with an F statistic of 9.543 (p<0.001). Data were used to create a formula and conversion chart for calculating mean blood glucose from fructosamine levels for clinical use. CONCLUSIONS: There is a complex relationship between average blood glucose, as determined by CGM and fructosamine. Fructosamine levels may be clinically useful for assessing short-term glycemic control when CGM is not available.

Association of School Instructional Mode with Community COVID-19 Incidence during August-December 2020 in Cuyahoga County, Ohio.

Remote and hybrid modes of instruction were employed as alternatives to in-person instruction as part of early mitigation efforts in response to the COVID-19 pandemic. We investigated the impact of a public school district's instructional mode on cumulative incidence and transmission in the surrounding community by employing a generalized estimating equations approach to estimate the association with weekly COVID-19 case counts by zip code in Cuyahoga County, Ohio, from August to December 2020. Remote instruction only (RI) was employed by 7 of 20 school districts; 13 used some non-remote instruction (NRI) (2-15 weeks). Weekly incidence increased in all zip codes from August to peak in late fall before declining. The zip code cumulative incidence within NRI school districts was higher than in those offering only RI (risk ratio = 1.12, p = 0.01; risk difference = 519 per 100,000, 95% confidence interval (123-519)). The mean effect for NRI on emergent cases 2 weeks after mode exposure, controlling for Social Vulnerability Index (SVI), was significant only for high SVI zip codes 1.30, p < 0.001. NRI may be associated with increased community COVID-19 incidence, particularly in communities with high SVI. Vulnerable communities may need more resources to open schools safely.

Using Google Street View for systematic observation of the built environment: analysis of spatio-temporal instability of imagery dates.

BACKGROUND: Recently, Google Street View (GSV) has been examined as a tool for remotely conducting systematic observation of the built environment. Studies have found it offers benefits over in-person audits, including efficiency, safety, cost, and the potential to expand built environment research to larger areas and more places globally. However, one limitation has been the lack of documentation on the date of imagery collection. In 2011, Google began placing a date stamp on images which now enables investigation of this concern. This study questions the spatio-temporal stability in the GSV date stamp. Specifically, is the imagery collected contemporaneously? If not, how frequently and where is imagery from different time periods woven together to represent environmental conditions in a particular place. Furthermore, how much continuity exists in imagery for a particular time period? Answering these questions will provide guidance on the use of GSV as a tool for built environment audits. METHODS: GSV was used to virtually "drive" five sites that are a part of the authors' ongoing studies. Each street in the sites was "driven" one mouse-click at a time while observing the date stamp on each image. Every time the date stamp changed, this "disruption" was marked on the map. Every street segment in the site was coded by the date the imagery for that segment was collected. Spatial query and descriptive statistics were applied to understand the spatio-temporal patterns of imagery dates. RESULTS: Spatio-temporal instability is present in the dates of GSV imagery. Of the 353 disruptions, 82.4% occur close to (<25 m) intersections. The remainder occurs inconsistently in other locations. The extent of continuity for a set of images collected with the same date stamp ranged from 3.13 m to 3373.06 m, though the majority of continuous segments were less than 400 m. CONCLUSION: GSV offers some benefits over traditional built environment audits. However, this investigation empirically identifies a previously undocumented limitation in its application for research. Imagery dates can change often and without warning. Caution should be used at intersections where these disruptions are most likely to occur, though caution should be used everywhere when using GSV as a data collection tool.

The utility of Zip4 codes in spatial epidemiological analysis.

There are many public health situations within the United States that require fine geographical scale data to effectively inform response and intervention strategies. However, a condition for accessing and analyzing such data, especially when multiple institutions are involved, is being able to preserve a degree of spatial privacy and confidentiality. Hospitals and state health departments, who are generally the custodians of these fine-scale health data, are sometimes understandably hesitant to collaborate with each other due to these concerns. This paper looks at the utility and pitfalls of using Zip4 codes, a data layer often included as it is believed to be "safe", as a source for sharing fine-scale spatial health data that enables privacy preservation while maintaining a suitable precision for spatial analysis. While the Zip4 is widely supplied, researchers seldom utilize it. Nor is its spatial characteristics known by data guardians. To address this gap, we use the context of a near-real time spatial response to an emerging health threat to show how the Zip4 aggregation preserves an underlying spatial structure making it potentially suitable dataset for analysis. Our results suggest that based on the density of urbanization, Zip4 centroids are within 150 meters of the real location almost 99% of the time. Spatial analysis experiments performed on these Zip4 data suggest a far more insightful geographic output than if using more commonly used aggregation units such as street lines and census block groups. However, this improvement in analytical output comes at a spatial privy cost as Zip4 centroids have a higher potential of compromising spatial anonymity with 73% of addresses having a spatial k anonymity value less than 5 when compared to other aggregations. We conclude that while offers an exciting opportunity to share data between organizations, researchers and analysts need to be made aware of the potential for serious confidentiality violations.

Prevalence and geographic features of patients eligible for extracorporeal cardiopulmonary resuscitation.

OBJECTIVE: This study sought to identify Out of Hospital Cardiac Arrests (OHCA) eligible for Extracorporeal Cardiopulmonary Resuscitation (ECPR), use Geographic Information Systems (GIS) to investigate geographic patterns, and investigate if correlation between ECPR candidacy and Social Determinants of Health (SDoH) exist. METHODS: This study is of emergency medical service (EMS) runs for OHCA to an urban medical center from January 1, 2016 to December 31, 2020. All runs were filtered to inclusion criteria for ECPR: age 18-65, initial shockable rhythm, and no return of spontaneous circulation within initial defibrillations. Address level data were mapped in a GIS. Cluster detection assessed for granular areas of high concentration. The Center for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI) was overlaid. The SVI ranges from 0-1 with higher values indicating increasing social vulnerability. RESULTS: There were 670 EMS transports for OHCA during the study period. 12.7% (85/670) met inclusion criteria for ECPR. 90% (77/85) had appropriate addresses for geocoding. Three geographic clusters of events were detected. Two were residential areas and one was concentrated over a public use area of downtown Cleveland. The SVI for these locations was 0.79, indicative of high social vulnerability. Nearly half (32/77, 41.5%) occurred in neighborhoods with the highest level of social vulnerability (SVI ≥ 0.9). CONCLUSION: A significant proportion of OHCAs were eligible for ECPR based on prehospital criteria. Utilizing GIS to map and analyze ECPR patients provided insights into the locations of these events and the SDoH that may be driving risk in these places.

Spatial Syndromic Surveillance and COVID-19 in the U.S.: Local Cluster Mapping for Pandemic Preparedness.

Maps have become the de facto primary mode of visualizing the COVID-19 pandemic, from identifying local disease and vaccination patterns to understanding global trends. In addition to their widespread utilization for public communication, there have been a variety of advances in spatial methods created for localized operational needs. While broader dissemination of this more granular work is not commonplace due to the protections under Health Insurance Portability and Accountability Act (HIPAA), its role has been foundational to pandemic response for health systems, hospitals, and government agencies. In contrast to the retrospective views provided by the aggregated geographies found in the public domain, or those often utilized for academic research, operational response requires near real-time mapping based on continuously flowing address level data. This paper describes the opportunities and challenges presented in emergent disease mapping using dynamic patient data in the response to COVID-19 for northeast Ohio for the period 2020 to 2022. More specifically it shows how a new clustering tool developed by geographers in the initial phases of the pandemic to handle operational mapping continues to evolve with shifting pandemic needs, including new variant surges, vaccine targeting, and most recently, testing data shortfalls. This paper also demonstrates how the geographic approach applied provides the framework needed for future pandemic preparedness.