Design of Folate-Containing Liposomal Nucleic Acid Delivery Systems for Antitumor Therapy

The outbreak of multiple disaster sites during the coronavirus disease 2019 (COVID-19) pandemic has presented challenges due to varying access time intensity, population density, and medical resources at each site. To address these issues, this study focuses on 13 districts and counties in Wuhan, China. The importance of each research area is analyzed using the improved PageRank and TOPSIS algorithms to determine the optimal site selection plan. Additionally, a particle swarm algorithm is used to construct an emergency material dispatching model that targets both distribution and site selection costs to solve the multi-distribution center dispatching problem. The results suggest that constructing 10 distribution centers can satisfy the demand for epidemic prevention and control in Wuhan city while saving costs associated with site selection and material distribution. Compared to the previous optimal solution, the distribution and site selection costs under the optimal solution decreased by 27.9% and 17.82%, respectively. This approach can serve as a basis for dispatching emergency materials during public health emergencies.

Emergency Material Scheduling Optimization Method Using Multi-Disaster Point Distribution Approach

The outbreak of multiple disaster sites during the coronavirus disease 2019 (COVID-19) pandemic has presented challenges due to varying access time intensity, population density, and medical resources at each site. To address these issues, this study focuses on 13 districts and counties in Wuhan, China. The importance of each research area is analyzed using the improved PageRank and TOPSIS algorithms to determine the optimal site selection plan. Additionally, a particle swarm algorithm is used to construct an emergency material dispatching model that targets both distribution and site selection costs to solve the multi-distribution center dispatching problem. The results suggest that constructing 10 distribution centers can satisfy the demand for epidemic prevention and control in Wuhan city while saving costs associated with site selection and material distribution. Compared to the previous optimal solution, the distribution and site selection costs under the optimal solution decreased by 27.9% and 17.82%, respectively. This approach can serve as a basis for dispatching emergency materials during public health emergencies. © 2023 by the authors.

Innovations in Ambulatory Stewardship

Ambulatory antibiotic use accounts for most of the global consumption of antibiotics leading to selection pressure, multidrug resistance, and significant healthcare costs (https://www.cdc.gov/antibiotic-use/community/pdfs/16_268900-A_CoreElementsOutpatient_508.pdf) The Centers for Disease Control and Prevention established the Core Elements of outpatient antimicrobial stewardship in 2016 as a framework to develop, expand, and evaluate ambulatory stewardship programs, which must address overuse in multiple settings (e.g., urgent care centers, adult and pediatric outpatient practices, dental practices, and retail clinics). As such, we present examples of innovative yet adaptable outpatient stewardship initiatives encompassing a variety of settings. We also address patterns of ambulatory antibiotic prescribing and novel stewardship initiatives implemented during the novel coronavirus disease 2019 (COVID-19) pandemic. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Impact of Time-Motion Patient Flow Analysis on the Productivity of an Endoscopy Unit in a Large Safety-Net Health Center

Introduction: The COVID-19 pandemic disrupted health care delivery, particularly for high-volume procedural areas. To improve productivity in the Los Angeles County 1 University of Southern California Medical Center (LAC + USC) Endoscopy Unit, we initiated an iterative rapid cycle quality improvement process to identify inefficiencies and implement changes to our workflow. Method(s): A time-motion analysis of patient flow through the LAC + USC Endoscopy Unit was used to construct a time-tracked flow sheet to track individual patients as they moved through the Unit. Data were collected weekly over 3 9-10 week phases, and intervening plan-do-study-act (PDSA) cycles were conducted to direct interventions for subsequent phases. Following phase 1 (9/1/21 to 11/9/21) we implemented targeted interventions at the start of phase 2 (12/1/21 to 2/1/22) and phase 3 (3/15/22 to 5/31/22). Phase 2 was focused on our anesthesia supported endoscopy room which requires greater resource coordination. Metrics were compared to published benchmarks. Linear regression was used to compare outcome parameters for the lean process flow improvement project. Result(s): Our phase 1 analysis showed operational delays in room turnover time for all procedures and pre-operative assessment and first-case on time start percentage for procedures supported by anesthesia, when compared to published benchmarks (Table 1). In phase 2 we implemented an intervention of combining pre-anesthesia visits with endoscopy teaching visits for patients designated to have anesthesia support. This significantly improved both turnover time and throughput for the anesthesia room (Table 1). In phase 3 we initiated a policy of preparing the first patient of the day in the procedure room which dramatically increased first-case on time start percentage. We further streamlined inter-procedure processes by simultaneously consenting, placingmonitoring equipment and documenting in the time between procedures, leading to a greater than 20% increase in total procedure volume (Table 1). Procedure throughput for the anesthesia supported procedure room increased from 4.5 to 7 to 9 procedures per room per day for phases 1, 2, and 3 respectively (Table 1). EndoscopyUnit staffing remained unchanged throughout the study period. Conclusion(s): Time-motion analysis of patient flow may be used to perform targeted interventions with significant improvements in Endoscopy Unit efficiency. This may be achieved without costly interventions such as hiring additional support staff or faculty. (Table Presented).

A Multicenter Study of Covid-19 Infection in Pediatric Intensive Care Units in the Us

Background: To describe characteristics of COVID-19 infection among patients requiring admission to pediatric intensive care units (PICU) in the USA. Method(s): Observational surveillance study of COVID-19 infected patients admitted to PICUs in 27 US states between April 1, 2020 - May 1, 2021. Result(s): Four hundred fifty-three patients were included;the majority were from institutions in the South and Midwest regions (40% and 34%). The population was mainly male (57%) and Hispanic (36%), with a median age of 10 years (IQR 4-15). 76% had 1 or more comorbidity. Patient's or caregiver's reported sources for COVID-19 infection were household and community contacts (31% and 24%). One hundred sixty-seven (40%) individuals were diagnosed with the multisystem inflammatory syndrome in children (MISC) within 7 days of PICU admission. Compared to COVID-19 cases without MISC, gastrointestinal, mucocutaneous, and neurological signs and symptoms were more frequent at PICU admission. Nasal cannula (20%) and high-flow oxygen (12.4%) were the most common respiratory support strategies at day 1 of admission, and mechanical ventilation by day 7. Overall, 104 (23%) and 8 (1.8%) individuals were placed on mechanical ventilation and extracorporeal membrane oxygenation (ECMO) within the interval of observation. Steroids and remdesivir were the most delivered COVID-19 targeted therapies (60% and 33%), and only 3% of the patients received convalescent plasma;IVIG (86.8%) and anakinra (61%) were commonly used among individuals with MISC. The overall mortality proportion (MP) was 2.65 (n= 12), and mortality was more frequent among individuals > 2 years old. Of the 167 children with MISC, only 1 died, MP (0.6). Conclusion(s): Mortality associated with pediatric COVID-19 infection is less frequent than in critically ill COVID-19-infected adults. Among pediatric/ adolescent patients, children > 2 years are the most vulnerable to adverse COVID-19-associated outcomes. MISC cases were frequent, yet mortality was low.

Vaccine Uptake in a Predominantly Black and Latinx Cohort Hospitalized for Covid-19

Background: Vaccine uptake has been notably lower in minoritized populations in the United States. The impact of previous infection with SARSCoV- 2, disease severity, and persistent symptoms on the uptake of COVID-19 vaccines and boosters in predominantly Black and Latinx communities has not been examined. We aimed to describe correlates of vaccine uptake in a minoritized cohort hospitalized for COVID-19 during the first pandemic wave in New York City, and investigate whether those with more severe initial COVID-19 and persistent symptoms would be less likely to get vaccinated. Method(s): This retrospective cohort study included the electronic medical records of the first 894 consecutive adult patients who survived hospitalization for COVID-19 at a large quaternary care medical center in Northern Manhattan between 1 March and 8 April 2020. We ed data regarding demographics, comorbidities, oxygen requirements during hospitalization, persistence of symptoms at 3- and 6-months after admission, COVID-19 vaccinations through November 2022, and influenza vaccination during the 2018-2019 through 2021-2022 seasons. Unadjusted and adjusted logistic regression analyses were conducted to describe the predictors of COVID-19 vaccination, delayed vaccination (first dose after 6 May 2021), and receipt of a booster vaccine. Statistical analyses were performed using R V.4.2.1. Result(s): The cohort of 894 patients was predominantly Latinx (54%) and Non- Hispanic Black (15%). 41% received at least one influenza vaccine pre-COVID, and 67% had at least one comorbidity. 22% (199/894) remained COVID-19 unvaccinated. Of the individuals who received at least one dose of COVID-19 vaccine, 57% (397/695) received at least one booster. Exactly 31% (212/695) delayed vaccination. 25% (27/106) of unvaccinated individuals reported persistent generalized symptoms compared to 18% (78/436) of vaccinated individuals. Multiple logistic regression showed that Hispanic/Latinx ethnicity, age 35-64, and concurrent influenza vaccination were associated with increased COVID-19 vaccine uptake. No association was found between vaccine uptake and disease severity or persistence of symptoms. Conclusion(s): Achieving a deeper understanding of the factors driving vaccine hesitancy is critical to increasing and sustaining acceptance of COVID-19 vaccination especially in communities with historically low uptake of annual vaccines.

Identification of shared genes and possible therapeutic target between systemic lupus erythematosus and COVID-19

Background/purpose: Coronavirus disease 2019 (COVID-19) has led to a rapid increase in mortality worldwide. Systemic lupus erythematosus (SLE) was a high-risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) infection, Whereas the molecular mechanisms underlying SLE and CVOID-19 are not well understood. This study aims to discover the common molecular mechanisms and genetic biomarkers of SLE and COVID-19, providing new ideas for the treatment of COVID-19. Method(s): RNA sequencing data of peripheral blood mononuclear cells (PBMC) from 6 SLE datasets and 8 COVID-19 datasets were obtained from the GEO database. Highly related modular genes associated with COVID-19 and SLE were identified by weighted gene co-expression network analysis (WGCNA). The differentially expressed genes (DEGs) between patients and healthy controls (HCs) were identified by the limma package. Common shared DEGs from COVID-19 and SLE were identified. Cytoscape and MCODE plugin were utilized for exploring the protein-protein interaction network (PPI) and identifying shared hub genes. Potential biological functions and pathways were also explored from the common DEGs. For better analysis of detailed biological mechanisms, both xCell algorithm and the cMap in CLUE (https://clue.io/) were utilized for discovering immune cell infiltration and predicting potential drugs that negatively regulate the highly expressed genes. Result(s): With identified 498 up-regulated common DEGs in SLE and COVID-19 related genes, total 11 and 13 gene modules of SLE and COVID-19 were identified espectively After overlapping differential genes, the final intersection gene set contains 218 genes. The PPI, especially the functional subnet module consists of upregulated genes by MCODE showed a great deal IFN related genes involved in the regulation of immunity. GO biological processes also showed possible functions were defense response to virus and mitotic cell cycle. Moreover, changes of most immune cells were strongly consistent between SLE and COVID-19. CDK inhibitors identified may be more likely to inhibit two diseases. Conclusion(s): Our study examined in detail the common molecular mechanisms of SLE and COVID-19, in which cellular response to cytokine stimulus, like regulating IFN, which might be the key target of both diseases. CDK is associated with the progression of SLE and COVID-19, which may be the potential therapeutic drug for SLE patients with COVID-19 infection.

Molecular mechanisms underlying regulatory T cell deficiency and potential drugs in COVID-19

Background/Purpose: The 2019 outbreak of coronavirus disease COVID-19 causes immune system disruption. Recent studies reported that the decrease or depletion of regulatory T cell (Treg) may be responsible for overstimulation of the immune system and lung damage in patients with severe COVID-19. This study aims to find the molecular mechanisms and genetic biomarkers associated with Tregs in COVID-19, providing new ideas for the treatment of COVID-19. Method(s): RNA sequencing data of peripheral blood mononuclear cells (PBMC) from 252 COVID-19 infected patients and 69 healthy controls (HC) were obtained from the GEO database. The Tregs composition of COVID-19 samples was quantified using the CIBERSORT deconvolution method. The differential genes (DEGs) were identified by the limma R package. Gene co-expression network analysis (WGCNA) was used to identify the gene. Differentially expressed Tregs-related genes (DETregRGs) were obtained by intersecting DEGs with the highly related modular genes obtained in the previous step. The potential biological functions and pathways of DETregRGs were then explored. Protein-protein interaction (PPI) networks were subsequently constructed to identify hub genes. In addition, the prediction of small molecule drugs for the potential treatment of COVID-19 was made using the CMap database. Result(s): After the weighted gene co-expression network analysis (WGCNA), the turquoise module was highly correlated with Treg expression and a total of 134 DEGs was identified as DETregRGs. These genes were mainly involved in GO biological processes, such as the inflammatory response, and T cell differentiation of thymus. Then, 11 hub genes (including RPS12, RPL21, RPS3A, CD8B, CD3D, TRAT1, RPS6, CD3E, CD28, RPL3, and CD4) were ranked based on Molecular Complex Detection (MCODE) analysis. The TregRG score of COVID-19 patients showed significantly lower than HC, calculated by the 'singscore' algorithms. After the signature query of the CMap database, the KU-0063794, an mTOR inhibitor ranked second in the negative enrichment score, may restore immune system dysregulation caused by increased Th17 differentiation and decreased Treg differentiation during SARS-CoV- 2 infection. Conclusion(s): Our study examined in detail the molecular mechanisms underlying the inadequacy of Tregs in patients with COVID-19 infection. mTOR inhibitors may improve COVID-19 symptoms by expanding Tregs which may be one of the potential therapeutic methods that need further investigation. (Figure Presented).

Characteristics and Outcomes of Patients with SARS-CoV-2 Reinfections Requiring Treatment in a COVID-19 Ambulatory Treatment Program

Background. Montefiore Medical Center (MMC), Bronx, NY, established an ambulatory program to offer COVID-19 treatments (monoclonal antibodies [mAB] and oral antivirals) to patients with mild-moderate illness according to emergency use authorization criteria. Given multiple pandemic waves in the area, several patients have been reinfected and were treated twice. The objective of this analysis is to identify clinical characteristics and outcomes in patients with repeated COVID-19 infections and treatments. Methods. Electronic health records were reviewed to identify patients between December 1, 2020 and April 28, 2022 who received COVID-19 treatment on more than one occasion at MMC. Data collected included demographics, risk factors for progression to severe illness, name and date of COVID-19 treatments received, vaccination status, and clinical outcomes of 30-day emergency department (ED) presentation or hospital admission following each treatment. Results. Out of 3,042 total treated patients, 13 (0.4%) received multiple treatments with either mAB or oral antivirals for COVID-19 reinfection during the study period. Median age of reinfected patients requiring treatment was 50 years. Median days between first and second treatments was 298 days (range 91-468 days). The most common risk factor for progression to severe disease were cardiovascular disease (54%) and immunocompromised status (62%) (Table 1). Ten patients had received at least two doses of vaccine (77%) with Pfizer (54%) or Moderna (23%) vaccines prior to reinfection. No patients reported any adverse reactions to either treatment. Four patients presented to the ED or were hospitalized following treatment of reinfection, three of which were for COVID-related symptoms. Of these, two had two risk factors for progression and the third had been hospitalized previously for initial COVID-19 infection. Conclusion. Though COVID-19 reinfection has been described, especially during Omicron surges, there were relatively few reinfected patients requiring treatment in our cohort. Patients with risk factors for disease progression may also be at increased risk for reinfection, especially the immunocompromised.

Factors Predicting Bacterial Coinfection in Hospitalized COVID-19 Patients

Background. Despite multiple studies indicating a low prevalence of bacterial coinfection in coronavirus disease 2019 (COVID-19) patients, the majority of hospitalized COVID-19 patients receive one or more antibiotics. Patients with coinfection usually have multiple risk factors and poor clinical outcomes. Methods. A retrospective case control study was conducted comparing clinical characteristics and antimicrobial use in hospitalized adult COVID-19 patients with bacterial co-infections vs. randomly selected patients without co-infections (matched on month of admission). The study was conducted at three hospitals within the Montefiore Medical Center, Bronx, NY between March 1, 2020 and October 31, 2020. A multivariable logistic regression model was developed to assess the relationship of each predictor variable with coinfection status. Secondary outcomes included hospital mortality, antibiotic days of therapy (DOT), and C. difficile infection. Results. A total of 150 patients with coinfection and 150 patients without coinfection were included in the analysis. Table 1 summarized baseline characteristics and risk factors. The multivariable logistic regression model indicated that presence of a central line (OR=5.4, 95% CI: 2.7-11.1), prior antibiotic exposure within 30 days (OR=5.3, 95% CI: 2.8-10.0), prior ICU admission (OR=3.6, 95% CI: 1.7-7.6), steroid use (OR=2.7, 95% CI: 1.4-4.9), and any comorbid condition (OR=2.7, 95% CI: 1.4-5.2) were significantly associated with the development of coinfection (table 2). Mortality was higher in patients with coinfection (56% vs. 11%, p < 0.0001) (table 3). Average antibiotic DOT was 10.5 in coinfected patients compared to 4 in noncoinfected patients, (p < 0.0001). Forty-one percent of coinfected patients had a multidrug resistant organism isolated. C. difficile rate was higher in coinfected patients (4% vs. 0%, p=0.03). Conclusion. As the healthcare community contends with a 3rd year of COVID-19 pandemic, understanding risk factors most predictive of bacterial coinfection can guide empiric antimicrobial therapy and targeted stewardship interventions. Ideally, co-infection risk scores are developed which may be useful for future inpatient surges.

Similarity-Principle-Based Machine Learning Method for Clinical Trials and Beyond

With recent success in supervised learning, artificial intelligence (AI) and machine learning (ML) can play a vital role in precision medicine. Deep learning neural networks have been used in drug discovery when larger data is available. However, applications of machine learning in clinical trials with small sample size (around a few hundreds) are limited. We propose a Similarity-Principle-Based Machine Learning (SBML) method, which is applicable for small and large sample size problems. In SBML, the attribute-scaling factors are introduced to objectively determine the relative importance of each attribute (predictor). The gradient method is used in learning (training), that is, updating the attribute-scaling factors. We evaluate SBML when the sample size is small and investigate the effects of tuning parameters. Simulations show that SBML achieves better predictions in terms of mean squared errors for various complicated nonlinear situations than full linear models, optimal and ridge regressions, mixed effect models, support vector machine and decision tree methods. Copyright © 2022 American Statistical Association.

The moderating effect of managerial discretion on cross-border knowledge search and the innovation quality of high-tech firms in a global health emergency: evidence from China

Purpose>This study aims to analyze the moderating effect of managerial discretion on the relationship between cross-border knowledge search and the high-tech firms' innovation quality in a global health emergency and addresses the following issues: the influence mechanism of different types of cross-border knowledge search on the high-tech firms' innovation quality in a global health emergency;and the moderating role of different dimensions of manager discretion on the above relationship.Design/methodology/approach>Based on the firms' strategy selection methods, the authors divided cross-border knowledge search into three aspects, namely, breadth, depth and balance, and analyzed the impact of cross-border knowledge search on the innovation quality of high-tech firms in a global health emergency, taking managerial discretion as the moderating variable, and divided it into position rights, pay rights and operation rights according to the key rights of firms' strategic management. Furthermore, the authors constructed a theoretical model, and for an analysis sample, the authors collected data from Chinese high-tech firms from 2013 to 2021.Findings>The empirical results show that there is an inverted U-shaped relationship between cross-border knowledge search breadth, depth and balance and the innovation quality of high-tech firms. The position rights, pay rights and operation rights of managerial discretion have partially significant moderating effects on the relationship between cross-border knowledge search breadth, depth and balance and the high-tech firms' innovation quality.Originality/value>Considerable literature has grown around the theme of the impact of knowledge search on the firms' innovation quality. Nevertheless, only a few studies draw on the combination of global health emergency, cross-border knowledge search and the innovation quality;in particular, no literature has analyzed the relationship between the three from the managerial discretion perspective. Exploring the above relationships has great theoretical value for enriching and improving knowledge management and innovation management theories and provides a theoretical basis and practical support for high-tech firms to face challenges of a global health emergency and to break through the innovation dilemma.

Fighting Fires from Crisis to Crisis: The Evolution of Central Banking in Europe

The year 2019 ushered in the end of an era for the European Central Bank when Mario Draghi stepped down as ECB President. The financial crisis left a legacy of central banks as “the only game in town”. The COVID-19 pandemic reinforced the role of central banks as critical firefighters during crises, in contrast to earlier periods. This contribution examines the evolution of central banking in Europe. First, it evaluates the ideational shifts that allowed for a more expansive interpretation of the role of a central bank. Second, it looks at the ECB’s response to the Covid-19 crisis and assesses the underlying reasons why the use of the bank’s balance sheet is here to stay. Third, it looks at these issues in a comparative perspective, contrasting the issues and policy responses faced by the ECB to those of the Bank of England and the US Federal Reserve. The final section concludes. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The COVID-19 Pandemic Response System at University Level: The Case of Safe Campus Model at Ewha Womans University

In response to the changes in the Coronavirus disease 2019 (COVID-19) epidemic situation, Ewha Womans University established Ewha Safe Campus (ESC), an on-campus infection outbreak management system, to allow students and faculty members to safely resume face-to face classes in 2022. The COVID-19 testing station, Ewha Safe Station, is the core element of ESC. Symptomatic students and faculty members perform a combo swab self-PCR test or receive a nasopharyngeal swab PCR test from experts to prevent the spread of COVID-19 through early detection and management. ESC is significant in that it detects infection risks and proactively implements preemptive measures in a university. The COVID-19 health response system model at the university level was applied for the first time in South Korea, reaching a milestone in the history of university health in South Korea. In particular, it is highly valuable that the test was free of charge, as it enabled all of the examinees to have easy access to the test through joint cooperation with the Seegene Medical Foundation. This is a successful example of cooperation between schools and private institutions for public health improvement. In the future, the direct and indirect effects of the establishment and implementation of ESC need to be evaluated and confirmed, and areas requiring improvements need to be identified in preparation for another infectious disease outbreak in the future.

Disparities in telemedicine satisfaction among older and nonwhite dermatology patients: A cross-sectional study

Background: Telemedicine use has expanded rapidly during the COVID-19 pandemic. There is limited data on patient satisfaction with teledermatology;therefore, we examined patient teledermatology experiences at a large academic center. Methods: After Weill Cornell Medicine Institutional Review Board approval, patients scheduled for teledermatology visits (1/2021-4/2021) were enrolled and sent pre/postconsultation questionnaires about telemedicine satisfaction, expectations, and concerns (5-point Likert scale) (82% response rate). Results: Of 202 participants, 120 (59%) were female with mean age 49 years. Participants were largely White (78%) and non-Hispanic (86%). The majority had at least a college degree (94%) and were employed (66%). Younger patients (21-40) were more satisfied with telemedicine (P =.016), and its convenience (P =.001), compared with older participants (>66) (P =.001, P =.019). Those with shorter travel times (<30 min) preferred in-person visits (P =.031). Nonwhite race was associated with greater concerns for conversation privacy and inappropriate information access (both P =.004). White race was associated with greater confidence in telemedicine diagnosis (P =.032). Participants had less trouble hearing and seeing than anticipated (P ≤.001 and P =.005). Patients were more interested in using telemedicine and preferred it over in-person appointments post- vs. preconsultation (P<.001 both). Conclusion: Our study demonstrates overall positive attitudes towards teledermatology. However, decreased satisfaction and confidence were found amongst older and nonwhite patients. Patients with longer vs. shorter clinic proximity preferred telemedicine to in-person visits, which may improve access to care in areas without dermatologists. Our study clarified specific concerns that may be used to devise strategies to encourage universal utilization of teledermatology where appropriate.

Rethinking the Immune Regulatory Role of Platelets during the COVID-19 Pandemic

Since the start of the COVID-19 pandemic, the recognition and management of thrombotic complications has become a clinical challenge, either in severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) patients or in those receiving vector-based COVID-19 vaccination. In addition to blood clot formation, platelets can also respond to a variety of inflammatory cytokines and act in concert with circulating leukocytes to prevent pathogen infection. Herein, we review the basic biological roles of platelets in infection/inflammation, tools for assessment, and mechanisms of platelet activation to elucidate their immune regulatory roles. Copyright (C) 2022, Taiwan Society of Geriatric Emergency & Critical Care Medicine.

The impact of COVID-19 on the hot food takeaway planning regulatory environment: perspectives of local authority professionals in the North East of England.

BACKGROUND & AIMS: Planning regulations have been used to prevent the over-proliferation of hot food takeaways, minimising the impact of local obesogenic environments. To help mitigate the effects of lockdown, the UK government introduced temporary changes in March 2020 to Planning Regulations for England, allowing food retailers to open for takeaway services beyond 'ancillary' level without needing to apply for planning permission through permitted development rights (PDR). Businesses are required to notify their local authority (LA) when they implement PDRs. To better understand the impact of regulations on the policy and practice of key professional groups, Public Health England commissioned Teesside University to undertake scoping research in the North East of England. METHODS: A focus group and interviews were conducted with 15 professionals from 7 of 12 North East LAs. Professions included Planners, Public Health Leads, Environmental Health Officers and Town Centre Managers. Data were analysed using a codebook thematic analysis approach. An interpretation meeting with some participants was conducted. RESULTS: LAs were not aware of most businesses notifying them of new regulation adherence despite taking up PDRs, but were considered low-priority with many lacking formal recording procedures. There were concerns about health consequences of the changes, and consensus relating to ongoing issues with capacity across all professional groups, largely due to the continuing pandemic and absence of a strategy out of temporary measures. Concerns existed around ensuring cessation of restaurants trading as takeaways, and hygiene inspections backlog. Many (personally) saw new takeaways as a lifeline, offering broader menus and preserving local economies. CONCLUSION: Lack of information around the number of restaurants/pubs using PDR to trade as takeaway services, ongoing capacity issues of LAs and, at the time, the absence of a strategy post regulation changes, meant there were high levels of uncertainty regarding the impacts of these temporary measures.

AN OPERATIONS MANAGEMENT APPROACH TO A CRITICAL ENDOSCOPIC BACKLOG

Background: The COVID-19 pandemic introduced unprecedented disruptions to healthcare delivery, particularly for ambulatory services such as gastrointestinal endoscopy. At the peak of the pandemic in our region between December 2020 to February 2021, ambulatory endoscopy services were suspended at the Los Angeles County + University of Southern California Medical Center (LAC+USC). While endoscopy services resumed in March 2021, the operational challenges introduced by COVID-19 led to a mounting backlog of patients awaiting endoscopic procedures reaching 1,035 by June 2021. As part of our solution to this crisis, we used the principles of operations management to perform a process flow analysis to identify inefficiencies and develop targeted interventions to enhance the operational performance of our endoscopy unit. Methods: A time-motion analysis of patient flow through the LAC+USC Endoscopy Unit was used to construct a comprehensive time-tracked flow sheet to track individual patients as they moved through the unit from check-in to discharge on random dates over a 6-week period (Figure 1). Simultaneously, a qualitative stakeholder survey on perceived operational inefficiencies was distributed to all faculty, staff, and fellows in the endoscopy unit. At the end of 6 weeks, collected data were compared to both published benchmarks and stakeholder survey responses, and inefficiencies identified for intervention. Results: Data were collected for 214 procedures (179 moderate sedation, 35 monitored anesthesia care) in the endoscopy unit. When compared to established benchmarks, we found operational delays in 1) check-in to procedure start time, 2) room turnover time, and 3) first-case on-time start percentage (Table 1). Results from the stakeholder survey aligned with these data. Targeted interventions (Table 1) developed by a multi-disciplinary group of faculty, nursing staff, and trainees from both Gastroenterology and Anesthesiology departments were then implemented, including 1) preparation of the first patient of the day in the procedure room, 2) pre-operative clinic visits for all patients designated to require anesthesia during endoscopy, 3) implementation of a brief-operative note and 4) a time study to encourage first-case on-time start. In combination with maneuvers to streamline the pre-procedure process, this resulted in a reduction of the backlog to 430 by November 2021. Conclusion: Granular analysis of data tracking process flow times through the LAC+USC Endoscopy Unit aligned with stakeholder perceptions regarding operational inefficiencies. The combination of objective and subjective data allowed us to rapidly implement targeted interventions to increase the throughput of the endoscopy unit and address the backlog of endoscopy procedures caused by the COVID-19 pandemic. (Figure Presented) (Table Presented)

Guillain–Barré syndrome with weakness confined to the bilateral upper extremities after ChAdOx1-S/ nCoV-19 vaccination

Currently, vaccination against coronavirus disease (COVID-19) is being conducted worldwide, and studies on its side effects are required to evaluate its safety. We report a case of Guillain-Barré syndrome (GBS) after vaccination with ChAdOx1/nCoV-19. A healthy 32-year-old man presented with mild weakness in his bilateral upper extremities 19 days after the vaccination. At 24 days after the vaccination, nerve conduction study showed demyelinating neuropathy in the bilateral upper and lower extremities. Intravenous immunoglobulin (IVIg) was administered over 5 days, and at the 2-week follow-up after finishing IVIg treatment, the weakness in the upper extremities was fully resolved. Although GBS is an uncommon side effect after COVID-19 vaccination, clinicians should be aware of its possible occurrence. When a patient complains of weakness after COVID-19 vaccination, clinicians should consider the possibility of GBS development. © 2022, ASEAN Neurological Association. All rights reserved.

The Effectiveness of an Outpatient Personalized Multidisciplinary Intervention Model, Guided by Comprehensive Geriatric Assessment, for Pre-Frail and Frail Elderly

Background: Our study evaluates the efficacy of an outpatient personalized multidisciplinary intervention model guided by comprehensive geriatric assessment (CGA), for pre-frail and frail elderly. Methods: A single-arm self-controlled study was conducted at the outpatient departments (OPD) of a medical center in Taiwan. Subjects received personalized multidisciplinary intervention, including physical therapy, psychotherapy, a nutritional consultation, precise medicine, and social resource linkage, as determined by the results of their CGAs. After 3 months of interventions, change in the proportions of the frail status (frail, pre-frail and robust), functional scores, depressive status, cognition, nutritional status, percentage of inappropriate medication used and social resource usage were analyzed. A logistic regression model was applied to determine the predictive factors associated with an improvement in frail severity. Results: A significant improvement in frail status was found (proportion of frail: 44.5% versus 23.1%, p < 0.001). Physical function, depressive and nutritional status were also significantly improved. 18.5% of participants used inappropriate medications, with benzodiazepine hypnotics the most common (40.9%). 24.2% of subjects were successfully linked to social resources. The presence of the frail phenotypes exhaustion was significantly associated with an improvement in frail severity (odds ratio (OR) = 2.77, 95% confidence interval (CI) = 1.15–6.66, p = 0.023). There was a significant dose response relationship between the improvement of frail status and physical training times (proportion of improved frail status: 23.7%, 40.5% and 47.9% for 0, 1–3, and 4–6 times of physical training, p = 0.03). Conclusion: The reported CGA-based, personalized multidisciplinary intervention model was effective at improving frail severity among pre-frail and frail elderly in OPDs.