Supply Chain, Material Management, and Finance

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2, created a worldwide need for supplementary PPE to protect frontline workers who were working tirelessly to save the lives of those exhibiting symptoms. At the same time, supply chains were interrupted due to mass reductions in their workforce who were affected by the disease. Factories producing additional PPE were hampered by these workforce reductions and were increasingly challenged to increase operations in order to meet the international demand. Local distributors were left with minimal supplies and supply chains experienced rapidly diminishing supplies of critical items, meaning they were unable to meet the needs of logarithmic increases in sick patients. This chapter details the changes that a small hospital-based supply chain team, responsible for supplying one of the hospitals at the epicenter of the COVID-19 crisis in New York City, made in the face of this crisis and how they effectively organized delivery and disbursement of PPE and critical supplies in less than 3 weeks. Lessons learned are included in this chapter as a guide for success of supply chain management during a large-scale, worldwide shortage in essential materials and equipment. © SBH Health System 2022.

Computational Fluid Dynamics-Based Optimization of Face Mask Filter Media Using Micro-Computed Tomography Scans

During the COVID-19 pandemic, face masks have become an important protective measure for reducing the spread of potentially infectious aerosol particles emitted while speaking, coughing, or simply breathing. In this work, a voxel-based numerical model obtained from micro-computed tomography (microCT) scans of a medical mask was validated by comparing fractional filtration efficiency and net pressure loss to values measured at an in-house mask test bench after discharging the mask in isopropanol. Varying mean fiber diameter, solid volume fraction, and thickness of the filter medium, parametric studies based on a digital twin of the mask sample were carried out. It is demonstrated that face masks can be designed where filtration efficiency, pressure drop, and material consumption is improved compared to the base case. © 2023 The Authors. Chemical Engineering Technology published by Wiley-VCH GmbH.

Delayed Diagnosis of Pediatric Sternoclavicular Joint Infections and Clavicular Osteomyelitis During the COVID-19 Pandemic: A Report of 3 Cases

Sternoclavicular joint infections and osteomyelitis of the clavicle are extremely rare infections, especially in the pediatric population. Early signs of these infections are nonspecific and can be mistaken for common upper respiratory infections such as COVID-19 and influenza. Rapid diagnosis and treatment are critical for preventing potentially fatal complications such as mediastinitis. We present three cases of sternoclavicular joint infections in the past year during the COVID-19 pandemic. All three patients had delayed diagnoses likely secondary to COVID-19 workup. Each patient underwent surgical irrigation and débridement. Two of three patients required multiple surgeries and prolonged antibiotic courses. Placement of antibiotic-impregnated calcium sulfate beads into the surgical site cleared the infection in all cases where they were used. All three patients made a full recovery;however, the severity of their situations should not be overlooked. Children presenting to the hospital with chest pain, fever, and shortness of breath should not simply be discharged based on a negative COVID-19 test or other viral assays. A higher index of suspicion for bacterial infections such as clavicular osteomyelitis is important. Close attention must be placed on the physical examination to locate potential areas of concentrated pain, erythema, or swelling to prompt advanced imaging if necessary.

Digital Media in Schools During the Covid-19 Lockdown: Teachers’ Experiences with Choosing Teaching Strategies

The Covid-19 pandemic unexpectedly led school teachers to exclusively using digital technologies. Few insights exist so far on how teachers choose, in such situations, digitally supported teaching strategies to actively engage their students in the learning process. We explored these choices by conducting semi-structured interviews with eight secondary school teachers from a large city in southern Germany during school closures. Relaying on the ICAP framework, we found that, for instance, teachers used websites with hypertexts to engage students actively, playful programming platforms to engage them constructively, or online group discussions to engage them interactively. Teachers’ choice had to take technical constrains into account, such as the limits of available mobile data volumes, students’ digital literacy, and the purpose for which new material was presented. Our findings suggest that categorizing learning activities according to students’ ICAP levels of cognitive engagement can help teachers make decisions about their use of educational technologies. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Chronic Pain Patients During COVID-19: Machine Learning Reveals Attributes Leading to Pandemic Susceptibility and Resilience

Introduction: The novel coronavirus has disrupted chronic pain patients’ care, on-going clinical studies, interrupted daily routines and pain management plans, as well as halted social/extracurricular activities. These disturbances may contribute to increased pain intensity, worsening disability, and deteriorating mood in a population with mental and physical health comorbidities. COVID-19 presented a unique opportunity to observe patients’ pain experience, including quality-of-life (QoL) and daily activities, as well as identify and characterize individuals who are potentially susceptible to changes during a substantial stressor. Methods: As part of on-going multi-site Boston Scientific studies prospectively observing up to 1700 chronic leg and back pain patients’ responses to spinal cord stimulation (SCS), we used smartphones to collect daily self-reported pain intensity, mood, sleep, medications, and activities. We also obtained in-clinic questionnaires and objective measures from smartwatches, sleep sensors, weekly voice recordings, and SCS usage. To evaluate changes during COVID-19, we defined two 6-week periods: “COVID” (03/6/2020—04/17/2020), “Pre-COVID” (12/20/2019- 01/30/2020). Since patients may be differentially impacted, we performed multivariate analyses integrating changes in self-reported variables between periods, which were normalized and K-means clustered to identify sub-cohorts. We also administered questions to assess patients’ emotional state during the pandemic, analyzed with natural language processing (NLP). Results: In our results (Figures 1-4), we found no differences in self-reports between pre-COVID and COVID for the entire cohort (n=70/159). However, clustering identified 3 sub-cohorts: individuals whose pain worsened (pain-susceptible), whose activities decreased (ADLsusceptible), and whose mood, sleep, medication, and activities remained the same or improved (QoL-resilient) during COVID. Partial correlations between changes in self-reports also showed differences as a function of period and sub-cohort. Sensor data indicated that NLP-identified fear related speech content during COVID was lower for the QoL-resilient group, who also had greater watch step counts during pre-COVID, supporting the idea that they had the best overall wellbeing or initial behaviors of the 3 groups. There were no differences in clinical assessments or SCS usage between sub-cohorts or periods. Conclusion: Our results indicate the existence of 3 patient sub-cohorts that diverge in their behaviors during COVID-19. We find each sub-cohort has a characteristic signature that allows us to predict the response an individual patient had to the pandemic. These findings demonstrate the importance of multi-dimensional digital monitoring with important implications for telemedicine, clinical trials and neuromodulation system management. Disclosure: Richard Rauck, MD: Boston Scientific: Contracted Research: Self, Medtronic: Contracted Research: Self, Mainstay: Contracted Research: Self, Saluda: Contracted Research: Self, Stimwave: Contracted Research: Self, SPR Therapeutics: Contracted Research: Self, Nevro: Contracted Research: Self, Neuros: Contracted Research: Self, Sara Berger, PhD: IBM: Employee:, Guillermo Cecchi, PhD: IBM: Employee:, Carla Agurto, PhD: IBM: Employee:, Elif Eyigoz, PhD: IBM: Employee:, Kristen Lechleiter, MS: Boston Scientific: Employee:, Dat Huynh, PhD: Boston Scientific: Employee:, Brad Hershey, BS: Boston Scientific: Employee:, Eric Loudermilk, MD: None, Julio Paez, MD: None, Louis Bojrab, MD: None, John Noles, MD: None, Todd Turley, MD: None, Mohab Ibrahim, MD: None, Amol Patwardhan, MD: None, James Scowcroft, MD: Nevro: Contracted Research:, Boston Scientific: Contracted Research:, Saluda: Contracted Research:, Rene Przkora, MD: Boston Scientific, Abbott, Nevro, Medtronic: Contracted Research:, Nathan Miller, MD: None, Gassan Chaiban, MD: Boston Scientific: Consulting Fee:, Matt McDonald, MS: Boston Scientific: Salary/Employee: Self, Jeffrey Rogers, PhD: IBM: Employee: [Formul presented] [Formula presented] [Formula presented]

Digital Social Interaction in Older Adults during the COVID-19 Pandemic

Throughout the COVID-19 pandemic, older adults have been encouraged to stay indoors and isolated, leading to potential disruptions in their social activities and interpersonal relationships. This interview study ($N=24$) provides a close examination of older adults' communication technology adoption and usage in light of the pandemic. Our interviews revealed that the pandemic motivated many older adults to learn new technology and become more tech-savvy in an effort to stay connected with others. However, older adults also reported challenges related to the pandemic that were major impediments to technology adoption. These were: (1) lack of access to in-person technology support under physical distancing mandates, (2) lack of opportunities for online participation due to negative age stereotypes and assumptions, and (3) increased apprehension to seek help from family members and friends who were suffering from pandemic-related stresses. This study extends technology adoption literature and contributes an up-to-date examination of the "grey digital divide"(the gap between older adults who use technology and those who do not). Our findings demonstrate that despite the rapidly increasing number of tech-savvy seniors, a digital divide not only persists, but has been exacerbated by the transition to virtual-only offerings. We reveal the challenges and coping strategies of older adults who remain separated from technology and propose actionable solutions to increase digital access during the COVID-19 pandemic and beyond. © 2021 ACM.

Pulmonary interstitial glycogenosis: A manifestation of pulmonary growth disorder in an infant with trisomy 21 and congenital pulmonary airway malformation

Introduction Pulmonary interstitial glycogenosis (PIG) is a distinct interstitial lung disease of infancy, considered within the spectrum of alveolar simplification disorders. Diagnosis can be challenging and is confirmed by lung biopsy showing glycogen granules within interstitial spindle-shaped cells. The overall prognosis is encouraging but therapeutic interventions lack standardization. This case report describes a 10 month-old male with Trisomy 21, hybrid congenital pulmonary lesion, and congenital heart disease, who was also found to have PIG on lung biopsy. Description A full-term male baby with antenatal concerns for Trisomy 21, left-sided chest mass, suspected to be congenital pulmonary airway malformation (CPAM) and atrial septal defect (ASD) presented with neonatal respiratory distress requiring noninvasive positive pressure ventilation for the first 24 hours of life. A left pneumothorax developed on the second day and was managed conservatively. Post-natal echocardiography confirmed the ASD and showed a large bidirectional patent ductus arteriosus (PDA). A chest CT scan confirmed the large left lower lobe CPAM with additional findings of left intra-lobar bronchopulmonary sequestration, a large right aorto-pulmonary collateral, bilateral ground-glass opacities and peripheral clustering of cysts. Due to persistent tachypnea and hypoxemia, left lower lobe resection of mass was performed at 4 weeks. Pathology surprisingly demonstrated findings consistent with PIG in addition to CPAM type 2. He remained oxygen dependent at discharge with feeding via both nasogastric tube and oral trials. There were several subsequent admissions for respiratory distress in the absence of viral infections. At 3 months, echocardiography revealed increased pulmonary arterial pressure and chest-x-ray showed pulmonary vascular congestion. A trans-catheter PDA closure and right aorto-pulmonary collateral ligation were performed, with insignificant improvement in his respiratory status. He further showed poor weight gain. During an admission at 7 months, oral feeding was stopped due to aspiration concerns. At 9 months, due to persistent respiratory signs, he received pulse dose of IV steroids. A gastrostomy tube was concurrently placed given aspiration demonstrated on swallow evaluation. After a second dose of IV pulse steroids a month later, his respiratory status has dramatically improved with no tachypnea and minimal nocturnal oxygen requirement. Discussion To the best of our knowledge this is the first description of PIG associated with multiple pulmonary and cardiac anomalies. Treatment with steroids remains controversial. Benefits and side effects of steroids treatment needed to be weighed in this case in the light of the Covid-19 pandemic. The patient's respiratory status improved dramatically after two steroid pulses.

Evaluation of Dental Practices Changes During the COVID-19 Pandemic in Brazil

Dentists are healthcare professionals who are at high risk of infection and transmission of the coronavirus disease-19 (COVID-19). The primary objective of the present study was to evaluate the changes in clinical practice made by Brazilian dentists during the COVID-19 pandemic. From June 22 to July 13, 2020, an online questionnaire was sent to dentists using Google Forms. After providing consent, 1,178 dentists answered questions regarding their knowledge and clinical experiences related to COVID-19. Data were analyzed using Chi-square, Fisher's exact, or Kruskal-Wallis tests, with a significance level of 5%. Brazilian dentists significantly changed their routine dental practices. Biosafety measures were added in their offices by 98% of the dentists, increasing operating costs for 88.3% of dentists. Greater discomfort due to the increase in personal protection equipment (PPE) worn during the pandemic was reported by 58.6%. Furthermore, 84.2% reduced heir hours of service. It was found that the dentists decreased their workload, used additional PPE, and took additional biosafety measures.