ABSTRACT
The continuous transfer of knowledge within an industrial cluster is a key element for the cluster to maintain its long-term competitiveness. In recent years, various shocks have occurred frequently, and issues related to the resilience of regional economies and industrial clusters have attracted attention. These shocks may also hinder the transfer of knowledge within industrial clusters, thereby limiting the development of industrial clusters. However, most of the previous studies have focused on economic performance, and little attention has been paid to how knowledge exchanges within the firms in cluster are affected by shocks. Therefore, this study adopted a resilience perspective, examined the evolution of innovation modes and proximity within industrial clusters, and constructed a four-quadrant analytical framework consisting of two types of proximity and two types of innovation modes, respectively. We attempted to examine whether shocks cause the shift of innovation modes and proximity in the four-quadrant analytical framework to fill the aforementioned gap. In order to further explored its connotation and make future policy advice more valuable, this study used the concept of life cycle development of clusters to analyze evolution. We took the Hsinchu Science Park as the research object, and used the global financial crisis in 2008 and the Covid-19 in 2020 as the shocks to compare the change of innovation modes and proximity at different life cycle stage. © 2021, Chung Hua University. All rights reserved.
ABSTRACT
INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has accelerated the adoption of telemedicine, defined as the real-time, interactive delivery of healthcare information electronically, particularly within urology. However, literature has found that elderly and Black patients are less likely to complete or prefer a tele-health visit. This study aims to understand the impact of various socio-demographic factors on patterns in tele-health usage after the first wave of the COVID-19 pandemic among all surgical specialties and within urology specifically. METHODS: Data on race, ethnicity, type of visit, visit method, language preference, and insurance type was extracted directly from visit information for all surgical specialty visits at the Brigham and Women's Hospital from five three-month time periods in 2019 and 2020. Variables were re-coded to fit a binary outcome for each. Chi-square tests were performed for univariable analysis. A difference-indifferences regression model controlling for time-invariable cofactors was used to examine the effect of each variable on the change in proportion of virtual visits between all possible pairs of time periods. Our exposure variables of interest were Black race, status as Medicare beneficiary, and preference for non-English language with control variables of White race, non-Medicare beneficiary, and primarily English-speaking status, respectively. All analysis was performed in R. RESULTS: Our dataset included a total of 182,074 surgical specialty visits. Although total visits decreased during the pandemic period, total visits before and after the first-wave period were comparable. When compared to White patients, the proportion of virtual visits for Black patients after the first wave was 8.3% higher than expected among all surgical specialties, but 7.3% lower than expected within only urology visits (p<0.01). When compared to non- Medicare beneficiaries, the proportion of virtual visits for Medicare beneficiaries after the first wave was about 6% lower than expected across all surgical specialties and urology only (p<0.01). When compared to English-speaking patients, the proportion of virtual visits for non-English speaking patients after the first wave was 4% less than expected among all specialties and 12% less than expected among urology only (p<0.01). CONCLUSIONS: Usage of tele-health by Black patients, Medicare beneficiaries, and non-English speaking patients is lower than expected in urology. Understanding disparities in tele-health usage may help inform policy that could alleviate inequities in access to urologic care.
ABSTRACT
Background: The COVID-19 pandemic has been associated with a significant disruption in healthcare services including cancer screening and diagnosis. Delays in cancer screening and treatment may lead to increased mortality. We aimed to analyze changes in screening, diagnosis and surgical treatment of common GU malignancies in relation to the COVID-19 pandemic. Methods: We evaluated screening, novel diagnoses, and surgical management modalities of prostate cancer (PCa), urothelial carcinoma (UC) and renal cell carcinoma (RCC) within Massachusetts General Brigham, the largest healthcare system in the Northeastern United States, over four 3-month time periods during the pandemic (March 2020- March 2021). The percentage change in screening, diagnoses and management modalities during pandemic periods as compared to the immediate pre-pandemic period (December 2019-March 2020) was calculated as (Nperiod - Ncontrol)/Ncontrol. The difference in "predicted" versus "observed" diagnoses in each pandemic period was compared to the average of the four preceding 3-month periods (March 2019-March 2020) to account for seasonal variation. Results: The first pandemic peak (March-June 2020) was associated with a significant decline across screening, diagnosis and treatment, ranging from -15.7 to -64.8%, followed by a progressive recovery, ranging from -5.9 to +25.1% in the latest period (December 2020-March 2021) (Table). Although 725 diagnoses were "missed" between March and June 2020 as compared to the previous 12 months, 971 diagnoses were "recovered" between June 2020 and March 2021. Conclusions: A substantial disruption in the screening, diagnosis and treatment of GU malignancies was observed early in the pandemic, followed by a progressive rebound and recovery. The highest declines were observed for PSA screening, and the lowest for cystectomy procedures, reflecting triaging of care based on severity during the pandemic.