Passive epidemiological surveillance in wildlife in Costa Rica identifies pathogens of zoonotic and conservation importance

Epidemiological surveillance systems for pathogens in wild species have been proposed as a preventive measure for epidemic events. These systems can minimize the detrimental effects of an outbreak, but most importantly, passive surveillance systems are the best adapted to countries with limited resources. Therefore, the present study aims to evaluate the technical and infrastructural feasibility to establish this type of scheme in Costa Rica targeting thedetection of pathogens of zoonotic and conservation importance in wildlife. Between 2018 and 2020, 85 carcasses of free-ranging vertebrates were admitted for post mortem analysis and complementary laboratory analysis, representing a solid basis for the implementation of a passive surveillance system for wildlife diseases in the country. However, we encounter during this research significant constraints that affected the availability of carcasses for analysis, mainly related to the initial identification of cases, detection biases towards events in populated- or easily accessible-areas with nearby located wildlife management centers, further associated with financial disincentives, and limited local logistics capacity. Thus resulting in the exclusion of some geographic regions of the country. This epidemiological surveillance scheme allowed us to estimate the general state of health of the country's wildlife, establishing the cause of death of the analyzed animals as follows: (i) 46 (54.1%) traumatic events, (ii) 23 (27.1%) infectious agents, (iii) two (2.4%) degenerative illness, (iv) three (3.5%) presumably poisoning, and (v) in 11 (12.9%)undetermined. It also allowed the detection of pathogens such as, canine distemper virus, Klebsiella pneumoniae, Toxoplasma gondii, Trypanosoma spp., Angiostrongylus spp., Dirofilaria spp., Baylisascaris spp., among others. As well as recognizing the circulation of these pathogens around national territory and also on those analyzed species. This strategy is crucial in geographical regions defined as critical for the appearance of diseases due to their great biodiversity and social conditions.

Obstacles and opportunities for reducing dwelling size to shrink the environmental footprint of housing: Tenants’ residential preferences and housing choice

The environmental footprint of housing is greatly influenced by the size of a dwelling. Housing size is the result of households’ dwelling selections; accordingly, it is critical to consider residential preferences and choices to inform efforts towards housing sustainability. This study aimed to understand tenants’ preferences for and choices of housing size as one amongst several dwelling characteristics and identify obstacles and opportunities for reducing size in the light of promoting sustainable housing. We employed logistic regression models to analyse a survey with 878 Swiss tenants, and our results identify preference for large dwellings as a major obstacle for reducing dwelling size among affluent tenants. Conversely, tenants with lower income might be forced to move to a smaller dwelling due to financial constraints or attribute higher importance to the financial benefit of lower rents. However, financial disincentives along with substantial non-monetary costs of moving, such as the disruption of local bonds and the difficulty of finding a satisfactory dwelling, can outweigh the benefits of moving to a smaller dwelling. To overcome such obstacles, we suggest offering incentives and other facilitating measures for downsizing moves as well as ensuring an adequate supply of smaller dwellings capable of providing high living quality. We highlight the potential of studying housing functions to conceptualize dwellings fulfilling these requirements.

185. Despite the Availability of Free Testing and Care Testing for Extragenital Sexually Transmitted Infections in a Cohort of Hiv-infected Department of Defense Beneficiaries Is Low and Similar to the Rates Observed Nationwide

Background Background- Current guidelines recommend annual extragenital [EG] testing for all sexually active men who have sex with men (MSM), and every 3−6 months for MSM at risk for sexually transmitted infections (STIs). Compliance with this guideline is low and testing rates among MSM with HIV have ranged between 30–46%. Financial disincentives (such as the lack of reimbursement for EG testing) may contribute to the lower EG testing rates. To examine if access to free testing improves EG testing rates, we used data from the US Military HIV Natural History Study (NHS), a cohort comprised of HIV-infected Department of Defense beneficiaries with access to care and free testing. Methods Methods- Among NHS participants with a follow-up visit between 1/1/2013 and 1/1/2018, genital (primarily urine samples) and EG testing rates (pharyngeal and rectal) were calculated and temporal trends examined. Multivariate logistic regression analysis was used to examine factors associated with EG testing. In a sub-set of participants who answered a risk behavior survey we examined risk-related information. Results Results- Of the 1971 male participants who had a NHS visit during the study period, 1962 (99.5%) had genital and 1419 (72%) had EG testing performed at least once. Annual genital and EG testing rates ranged between 96 - 98% and 33% - 46% respectively. No temporal trends were observed in EG testing rates. EG testing rates were higher in those with a history of gonorrhea, chlamydia or syphilis in the year prior, ranging between 50 and 67%. EG testing was more likely to occur in those who were younger and those with a prior history of STI (Table 1). In a subset of participants with risk behavior information, those who reported being MSM were more likely to be tested [Referent heterosexual; Odds Ratio 2.35 [95% CI 1.60–3.46]. Conclusion Conclusion-Despite the availability of free EG testing, EG testing rates were low in the NHS and similar to those observed nationwide This contrasts with the genital testing rates which were well over 95%, suggesting provider/patient related barriers are likely driving the lower testing rates. To improve testing rates further study is required to fully characterize indications for EG testing and potential provider- and/or patient-related barriers to EG testing. Disclosures All Authors: No reported disclosures

The “Hip Fracture” Bundle—Experiences, Challenges, and Opportunities

Introduction: With growing popularity and success of alternative-payment models (APMs) in elective total joint arthroplasties, there has been recent discussion on the probability of implementing APMs for geriatric hip fractures as well. Significance: Despite the growing interest, little is known about the drawbacks and challenges that will be faced in a stipulated “hip fracture” bundle. Results: Given the varying intricacies and complexities of hip fractures, a “one-size-fits-all” bundled payment may not be an amenable way of ensuring equitable reimbursement for participating physicians and hospitals. Conclusions: Health-policy makers need to advocate for better risk-adjustment methods to prevent the creation of financial disincentives for hospitals taking care of complex, sicker patients. Hospitals participating in bundled care also need to voice concerns regarding the grouping of hip fractures undergoing total hip arthroplasty to ensure that trauma centers are not unfairly penalized due to higher readmission rates associated with hip fractures skewing quality metrics. Physicians also need to consider the launch of better risk-stratification protocols and promote geriatric comanagement of these patients to prevent occurrences of costly adverse events.

Building a Resilient Tomorrow

Even under the most optimistic scenarios, significant global climate change is now inevitable. Although we cannot tell with certainty how much average global temperatures will rise, we do know that the warming we have experienced to date has already caused significant losses, and that the failure to prepare for the consequences of further warming may prove to be staggering. This book does not dwell on overhyped descriptions of apocalyptic climate scenarios, nor does it travel down well-trodden paths surrounding the politics of reducing carbon emissions. Instead, it starts with two central facts: there will be future climate impacts, and we can make changes now to buffer their effects. While squarely confronting the scale of the risks we face, this pragmatic guide focuses on solutions—some gradual and some more revolutionary—currently being deployed around the globe. Each chapter presents a thematic lesson for decision-makers and engaged citizens to consider, outlining replicable successes and identifying provocative recommendations to strengthen climate resilience. Between discussions of ideas as wide-ranging as managed retreat from coastal hot zones to biological solutions for resurgent climate-related disease threats, the authors draw on their personal experiences to tell behind-the-scenes stories of what it really takes to advance progress on these issues. The narrative is dotted with stories of on-the-ground citizenry, from small-town mayors and bankers to generals and engineers, who are chipping away at financial disincentives and bureaucratic hurdles to prepare for life on a warmer planet.

Financial incentives to work: the size of the margin between benefit and in-work incomes

Financial incentives to work are an important consideration for policy makers in the realm of welfare and tax policy. Dominating one corner of the classic ‘iron triangle’ used by policy advisors to illuminate trade-offs between incentives to work, income adequacy and fiscal cost, poor financial disincentives to work can contribute to ‘trapping’ people in poverty. Further, as modern welfare systems have become increasingly ‘active’, with a strong focus on work and increased independence from the state, positive financial incentives have increasingly come to be seen as an important precondition for the effective operation of the welfare safety net.