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Objective: To characterize the experience of people with epilepsy and aligned healthcare workers (HCWs) during the first 18 months of the COVID‐19 pandemic and compare experiences in high‐income countries (HICs) with non‐HICs. Methods: Separate surveys for people with epilepsy and HCWs were distributed online in April 2020. Responses were collected to September 2021. Data were collected for COVID‐19 infections, the effect of COVID‐related restrictions, access to specialist help for epilepsy (people with epilepsy), and the impact of the pandemic on work productivity (HCWs). The frequency of responses for non‐HICs and HICs were compared using non‐parametric Chi‐square tests. Results: Two thousand one hundred and five individuals with epilepsy from 53 countries and 392 HCWs from 26 countries provided data. The same proportion of people with epilepsy in non‐HICs and HICs reported COVID‐19 infection (7%). Those in HICs were more likely to report that COVID‐19 measures had affected their health (32% vs. 23%; p < 0.001). There was no difference between non‐HICs and HICs in the proportion who reported difficulty in obtaining help for epilepsy. HCWs in non‐HICs were more likely to report COVID‐19 infection than those in HICs (18% vs 6%; p = 0.001) and that their clinical work had been affected by concerns about contracting COVID‐19, lack of personal protective equipment, and the impact of the pandemic on mental health (all p < 0.001). Compared to pre‐pandemic practices, there was a significant shift to remote consultations in both non‐HICs and HICs (p < 0.001). Significance: While the frequency of COVID‐19 infection was relatively low in these data from early in the pandemic, our findings suggest broader health consequences and an increased psychosocial burden, particularly among HCWs in non‐HICs. Planning for future pandemics should prioritize mental healthcare alongside ensuring access to essential epilepsy services and expanding and enhancing access to remote consultations. Plain Language Summary: We asked people with epilepsy about the effects of COVID‐19 on their health and healthcare. We wanted to compare responses from people in high‐income countries and other countries. We found that people in high‐income countries and other countries had similar levels of difficulty in getting help for their epilepsy. People in high‐income countries were more likely to say that their general health had been affected. Healthcare workers in non‐high‐income settings were more likely to have contracted COVID‐19 and have the care they deliver affected by the pandemic. Across all settings, COVID‐19 associated with a large shift to remote consultations. [ABSTRACT FROM AUTHOR]

Objectives: As part of the COVID‐19 and Epilepsy (COV‐E) global study, we aimed to understand the impact of COVID‐19 on the medical care and well‐being of people with epilepsy (PWE) in the United States, based on their perspectives and those of their caregivers. Methods: Separate surveys designed for PWE and their caregivers were circulated from April 2020 to July 2021; modifications in March 2021 included a question about COVID‐19 vaccination status. Results: We received 788 responses, 71% from PWE (n = 559) and 29% (n = 229) from caregivers of persons with epilepsy. A third (n = 308) of respondents reported a change in their health or in the health of the person they care for. Twenty‐seven percent (n = 210) reported issues related to worsening mental health. Of respondents taking ASMs (n = 769), 10% (n = 78) reported difficulty taking medications on time, mostly due to stress causing forgetfulness. Less than half of respondents received counseling on mental health and stress. Less than half of the PWE reported having discussions with their healthcare providers about sleep, ASMs, and potential side effects, while a larger proportion of caregivers (81%) reported having had discussions with their healthcare providers on the same topics. More PWE and caregivers reported that COVID‐19‐related measures caused adverse impact on their health in the post‐vaccine period than during the pre‐vaccine period, citing mental health issues as the primary reason. Significance: Our findings indicate that the impact of the COVID‐19 pandemic in the US on PWE is multifaceted. Apart from the increased risk of poor COVID‐19 outcomes, the pandemic has also had negative effects on mental health and self‐management. Healthcare providers must be vigilant for increased emotional distress in PWE during the pandemic and consider the importance of effective counseling to diminish risks related to exacerbated treatment gaps. [ABSTRACT FROM AUTHOR]

This paper assesses the relationship between gridded (5 × 5°) monthly North Atlantic (10-70°N, 80°W-20°E) sea-surface temperature anomalies (SSTAs) and concurrent, one-monthly and two-monthly lagged rainfall totals for four coherent Icelandic precipitation regions over the period 1961-2002. Monthly correlation fields are derived and tested for field-significance at the 0.1 level. Stepwise multiple linear regression models are then constructed to predict one-monthly ( t + 1) and two-monthly ( t + 2) lagged rainfall from SSTA variations for those months and regions with field-significant correlation patterns. Most of the field-significant correlation patterns are for concurrent relationships and for precipitation during the winter months in northern Iceland at the t + 1 and t + 2 timesteps. The t + 1 and t + 2 predictor patterns of northern Icelandic precipitation in February are field-significant. For this month, above-average precipitation in northern Iceland in February is linked to a pool of warm water that tracks eastwards from the eastern Atlantic (40-55°N, 5-40°W) in December into northern European sea areas (e.g. North Sea, Norwegian Sea) by January. Study results also reveal that December precipitation in northern Iceland is also potentially predictable from SE North Atlantic SST (10-40°N, 5-45°W) in the preceding October and November. The models' skill is assessed retrospectively by re-deriving the forecasting algorithms over training periods A (1961-1990) and B (1971-2002), and then evaluating the models' performance over validation periods A (1991-2002) and B (1961-1970). Coefficients of determination ( R2) between observed and modelled t + 1 and t + 2 February and December precipitation in northern Iceland range from 4 to 49%, indicating some utility of these forecasting models for seasonal predictions of Icelandic precipitation. Copyright © 2006 Royal Meteorological Society. [ABSTRACT FROM AUTHOR]

Rationale, Aims and Objectives: A learning health system model can be used to efficiently evaluate and incorporate evidence‐based care into practice. However, there is a paucity of evidence describing key organizational attributes needed to ensure a successful learning health system within primary care. We interviewed stakeholders for a primary care learning health system in Ontario, Canada (the Alliance for Healthier Communities) to identify strengths and areas for improvement. Method: We conducted a qualitative descriptive study using individual semistructured interviews with Alliance stakeholders between December 2019 and March 2020. The Alliance delivers community‐governed primary healthcare through 109 organizations including Community Health Centres (CHCs). All CHC staff within the Alliance were invited to participate. Interviews were audio‐recorded and transcribed verbatim. We performed a thematic analysis using a team approach. Results: We interviewed 29 participants across six CHCs, including Executive Directors, managers, healthcare providers and data support staff. We observed three foundational elements necessary for a successful learning health system within primary care: shared organizational goals and culture, data quality and resources. Building on this foundation, people are needed to drive the learning health system, and this is conditional on their level of engagement. The main factors motivating staff member's engagement with the learning health system included their drive to help improve patient care, focusing on initiatives of personal interest and understanding the purpose of different initiatives. Areas for improvement were identified such as the ability to extract and use data to inform changes in real‐time, better engagement and protected time for providers to do improvement work, and more staff dedicated to data extraction and analysis. Conclusions: We identified key components needed to establish a learning health system in primary care. Similar primary care organizations in Canada and elsewhere can use these insights to guide their development as learning health systems. [ABSTRACT FROM AUTHOR]

The empirical relationship between total phosphorus and chlorophyll has guided lake management decisions for decades, but imprecision in this relationship in individual lakes limits the utility of these models. Many environmental factors that potentially affect the total phosphorus‐chlorophyll relationship have been studied, but here we hypothesize that imprecision can be reduced by considering differences in the proportions of phosphorus bound to three different "compartments" in the water column: phosphorus bound in phytoplankton, phosphorus bound to suspended sediment that is not associated with phytoplankton, and dissolved phosphorus. We specify a hierarchical Bayesian network model that estimates phosphorus associated with each compartment using field measurements of chlorophyll, total suspended solids, and total phosphorus collected from reservoirs in Missouri, United States. We then demonstrate that accounting for these different compartments yields accurate predictions of total phosphorus in individual lakes. Results from this model also yield insights into the mechanisms by which lake morphometric and watershed characteristics affect observed relationships between total phosphorus and chlorophyll. [ABSTRACT FROM AUTHOR]