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Background Significant uncertainty has existed about the safety of reopening college and university campuses before the COVID-19 pandemic is better controlled. Moreover, little is known about the effects that on-campus students may have on local higher-risk communities. Objective We aimed to estimate the range of potential community and campus COVID-19 exposures, infections, and mortality under various university reopening plans and uncertainties. Methods We developed campus-only, community-only, and campus × community epidemic differential equations and agent-based models, with inputs estimated via published and grey literature, expert opinion, and parameter search algorithms. Campus opening plans (spanning fully open, hybrid, and fully virtual approaches) were identified from websites and publications. Additional student and community exposures, infections, and mortality over 16-week semesters were estimated under each scenario, with 10% trimmed medians, standard deviations, and probability intervals computed to omit extreme outliers. Sensitivity analyses were conducted to inform potential effective interventions. Results Predicted 16-week campus and additional community exposures, infections, and mortality for the base case with no precautions (or negligible compliance) varied significantly from their medians (4- to 10-fold). Over 5% of on-campus students were infected after a mean of 76 (SD 17) days, with the greatest increase (first inflection point) occurring on average on day 84 (SD 10.2 days) of the semester and with total additional community exposures, infections, and mortality ranging from 1-187, 13-820, and 1-21 per 10,000 residents, respectively. Reopening precautions reduced infections by 24%-26% and mortality by 36%-50% in both populations. Beyond campus and community reproductive numbers, sensitivity analysis indicated no dominant factors that interventions could primarily target to reduce the magnitude and variability in outcomes, suggesting the importance of comprehensive public health measures and surveillance. Conclusions Community and campus COVID-19 exposures, infections, and mortality resulting from reopening campuses are highly unpredictable regardless of precautions. Public health implications include the need for effective surveillance and flexible campus operations. 

The U.S. is in the grips of a devastating opioid and heroin co-epidemic affecting nearly all socio-economic populations at great human (~7,800 new users/day) and financial ($78.5 billion/year) costs but with no obvious solution. We describe recent work and challenges to develop, integrate, and use several analytic multi-scale simulation models of these epidemics to develop insight into the epidemic’s complex underlying dynamics, generate causal hypotheses, and inform effective policy interventions. We developed preliminary agent-based, differential equation, network spread, and cellular automata models that reasonably replicate at multiple scales the past 17 years of this epidemic’s growth and spread at town, county, state, and national levels. Results suggest that some current approaches are unlikely to be very effective, some in fact may worsen the epidemic, and ultimately only certain combinations and sequences of policies are likely to have value, with important implications on both model architecture and policy optimization. 

To identify significant patient and system access barriers and facilitators to dermatology care in one rural health system with limited dermatology appointment availability.

Mixed methods study using data from electronic medical records, patient surveys, stakeholder semi‐structured interviews, and service area dermatologist demographics. Retrospective data were collected between 1 January 2017–1 March 2018, and interviews and surveys were conducted between June 1–August 31, 2018. Participants were recruited from two primary care practices in one rural Maine regional health system.

Findings from thematic analyses, descriptive statistics, and statistical modelling were integrated using Chi‐square tests for homogeneity to develop a unified understanding. Statistical modelling using odd‐ratio logistic and linear regression were performed for each outcome variable of interest.

Urgent referrals by primary care increased the likelihood of dermatology care overall (OR: 6.771;p = .007) and at nearby sites with limited availability (OR: 4.024;p = .024), but not at geographically further sites with higher capacities (p = .844). Referral under‐diagnosis occurred in 20.8% of those biopsied. Older (p = .041) or non‐working (p = .021) patients were more likely to remain unevaluated than seek more available but geographically further care.

In rural areas with scarce appointment availability, primary care provider diagnostic accuracy may be an important barrier of dermatology care receipt and health outcomes, especially among at‐risk populations.

Although melanoma mortality rates are decreasing throughout the US, little is known about why rates in Maine continue to rise. This study applied a comprehensive approach to identify several patient and system access barriers to dermatology care in one underserved rural regional health system. While specific to this population and large service area, these findings will inform improvement efforts here and support broader future research efforts aimed at understanding and improving health outcomes in this rural state.