Marketing strategies to maintain and attract customers during the COVID-19 pandemic in gyms of Ribeirao Preto-SP, Brazil

Introduction: Brazil is ranked third in the world in fitness service billing, with 34,509 registered gyms. However, the COVID-19 pandemic brought challenges and a drop in this revenue. Consequently, the gyms were forced to adopt new management and marketing strategies to stay in the market facing the contemporary context. Background: To identify the sports marketing strategies used by gym managers in Ribeirao Preto, SP, Brazil, to keep and attract new customers during the COVID-19 pandemic. Methods: A qualitative study was performed through semi-structured interviews, conducted through the Google Meet tool, recorded to be transcribed and analyzed. Results: Among the strategies used by the six managers interviewed stand out: gym safety and cleanliness as marketing;the prioritization of the relationship with customers as the main form of retention;the overuse of bonus marketing;packages and more attractive monthly fees to keep and at the same time attract new customers;and, also the use of social networks as the main form of attraction. The problems were similar among the managers, with at least 1/3 indicating the lack of a specific budget for marketing, centralized campaigns in other locations or franchises, inefficient live broadcasts, and traditional marketing with a very high cost. Final words: The managers needed to overcome the pandemic obstacles to plan and promote marketing strategies for gyms with different objectives, public, and size. There are still few studies on the relationship between marketing and Brazil's fitness market, highlighting the importance of more studies that address this theme.

Impacts of a fraction of inspired oxygen adjustment protocol in COVID-19 patients under mechanical ventilation: A prospective cohort study.

OBJECTIVE: We examined weather a protocol for fraction of inspired oxygen (FiO2) adjustment can reduce hyperoxemia and excess oxygen use in COVID-19 patients mechanically ventilated. DESIGN: Prospective cohort study. SETTING: Two intensive care units (ICUs) dedicated to COVID-19 patients in Brazil. PATIENTS: Consecutive patients with COVID-19 mechanically ventilated. INTERVENTIONS: One ICU followed a FiO2 adjustment protocol based on SpO2 (conservative-oxygen ICU) and the other, which did not follow the protocol, constituted the control ICU. MAIN VARIABLES OF INTEREST: Prevalence of hyperoxemia (PaO2>100mmHg) on day 1, sustained hyperoxemia (present on days 1 and 2), and excess oxygen use (FiO2>0.6 in patients with hyperoxemia) were compared between the two ICUs. RESULTS: Eighty two patients from the conservative-oxygen ICU and 145 from the control ICU were included. The conservative-oxygen ICU presented lower prevalence of hyperoxemia on day 1 (40.2% vs. 75.9%, p<0.001) and of sustained hyperoxemia (12.2% vs. 49.6%, p<0.001). Excess oxygen use was less frequent in the conservative-oxygen ICU on day 1 (18.3% vs. 52.4%, p<0.001). Being admitted in the control ICU was independently associated with hyperoxemia and excess oxygen use. Multivariable analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FiO2 use and adverse clinical outcomes. CONCLUSIONS: Following FiO2 protocol was associated with lower hyperoxemia and less excess oxygen use. Although those results were not associated with better clinical outcomes, adopting FiO2 protocol may be useful in a scenario of depleted oxygen resources, as was seen during the COVID-19 pandemic.

Lung Ventilation and Perfusion SPECT in long-COVID-19

Aim/Introduction: Knowledge about COVID-19's physiopathology is still scarce, mainly with respect to the recovery phase. Nonetheless, its association with an increased incidence of thromboembolic phenomena is well established. Ventilation/Perfusion single-photon emission computed tomography (VP-SPECT) plays a major role in the evaluation of pulmonary embolism (PE) and microvascular disease, given its high sensibility and low radiation burden. We aim, with this study, to review the contribution of VP-SPECT in these patients' follow-up, with a particular focus on those with long-COVID-19. Material(s) and Method(s): We performed a retrospective study with COVID-19 patients that underwent VP-SPECT in our Department, until march-2022. Functional impairment of global pulmonary perfusion (FIGPP) was quantified by assigning points for each segment with a mismatch defect (a total of 36 points in 18 segments). PE was defined by the presence of segmental or subsegmental pleural-based mismatch defect(s) assessed at least 2 points. All relevant demographic/clinical data were collected. Result(s): Sixty patients (mean age 54.8+/-12.8 years, 51.3% female) with a history of COVID-19 underwent VP-SPECT on average 285.6+/-127.2 days after infection. There was a high prevalence of severe infections (58%, N=29) and admitted patients (64.9%, N=37), with a mean length of stay in the hospital of 22.5+/-17.2 days. Six patients (10.2%) had acute PE associated. The main reason for VPSPECT was post-infection fatigue/dyspnoea (71.7%;N=43). Only 6.9% of patients underwent VP-SPECT during acute disease (N=4). Median FIGPP was 6% (0-47). Patients who were hospitalized (p=0.066) or who had severe disease (p=0.161) showed no statistically significant differences in FIGPP. Management change after VP-SPECT occurred in 11.9% (N=7). Patients who did not start anticoagulant therapy (N=46) showed a median FIGPP of 6% (0-18). Conclusion(s): Our findings suggest that, although clinically relevant, persistent post-COVID-19 fatigue/dyspnoea symptoms do not appear to be justified by a FIGPP associated with significant thromboembolism and are unrelated to disease severity and need for hospitalisation. However, VP-SPECT played an important role both in excluding serious sequelae of thromboembolism and in identifying patients at higher risk of developing pulmonary hypertension.

Lung Ventilation and Perfusion SPECT in long-COVID-19

Aim/Introduction: Knowledge about COVID-19's physiopathology is still scarce, mainly with respect to the recovery phase. Nonetheless, its association with an increased incidence of thromboembolic phenomena is well established. Ventilation/Perfusion single-photon emission computed tomography (VP-SPECT) plays a major role in the evaluation of pulmonary embolism (PE) and microvascular disease, given its high sensibility and low radiation burden. We aim, with this study, to review the contribution of VP-SPECT in these patients' follow-up, with a particular focus on those with long-COVID-19. Material(s) and Method(s): We performed a retrospective study with COVID-19 patients that underwent VP-SPECT in our Department, until march-2022. Functional impairment of global pulmonary perfusion (FIGPP) was quantified by assigning points for each segment with a mismatch defect (a total of 36 points in 18 segments). PE was defined by the presence of segmental or subsegmental pleural-based mismatch defect(s) assessed at least 2 points. All relevant demographic/clinical data were collected. Result(s): Sixty patients (mean age 54.8+/-12.8 years, 51.3% female) with a history of COVID-19 underwent VP-SPECT on average 285.6+/-127.2 days after infection. There was a high prevalence of severe infections (58%, N=29) and admitted patients (64.9%, N=37), with a mean length of stay in the hospital of 22.5+/-17.2 days. Six patients (10.2%) had acute PE associated. The main reason for VPSPECT was post-infection fatigue/dyspnoea (71.7%;N=43). Only 6.9% of patients underwent VP-SPECT during acute disease (N=4). Median FIGPP was 6% (0-47). Patients who were hospitalized (p=0.066) or who had severe disease (p=0.161) showed no statistically significant differences in FIGPP. Management change after VP-SPECT occurred in 11.9% (N=7). Patients who did not start anticoagulant therapy (N=46) showed a median FIGPP of 6% (0-18). Conclusion(s): Our findings suggest that, although clinically relevant, persistent post-COVID-19 fatigue/dyspnoea symptoms do not appear to be justified by a FIGPP associated with significant thromboembolism and are unrelated to disease severity and need for hospitalisation. However, VP-SPECT played an important role both in excluding serious sequelae of thromboembolism and in identifying patients at higher risk of developing pulmonary hypertension.

Studies on covid-19 and health reflections in vulnerable territories and in favels: a systematic review

The covid-19 pandemic has had various social impacts globally, however, the favelas and their communities are considered groups with greater vulnerability. In the absence of basic sanitation, precarious residences, low income or poverty, and unemployment are factors that differ in the impacts generated by covid-19 on this specific public, compared to other localities. I have these parameters established as of great concern, determined the question that is the focus of this research: What is being produced by researchers on the subject of COVID-19 in vulnerable territories and in favelas? In order to answer the research question and considering that there have been no studies that address this issue from a systematic review, this article aims to analyze the scientific production in journals indexed in the Web of Science collection on COVID-19 and favelas. As results, it is highlighted the amount of studies produced in India and in Brazil, despite few cited, and that the co-occurrence map allows to focus on the potential of the receptivity of thematic studies on populations and their local reality of vulnerability.

Emergency Surgery in a Large Urban Area Community Hospital During SARS-CoV-2 Pandemic: An Analysis on Acute Appendicitis

Background: The literature highlights a decrease in surgical treated appendicitis with an increased severity during the COVID-19 pandemic. The aim of this study was to analyze the effect of COVID lockdown on the population with appendicitis comparing clinical-pathologic data and outcome in two matching period (prepandemic and pandemic era). Methods: A retrospective analysis of patients admitted to two community urban hospital in Rome with diagnosis of acute appendicitis (AA) before and after the COVID-19 pandemic was performed. We compared patients patients with acute appendicitis in three groups named A (pre-COVID), B (early pandemic), and C (late pandemic). We evaluate the differences between the three groups in terms of onset of symptoms and severity, procedure difficulty, conversion rate, and short-term outcome. Results: A total of 310 patients were identified. The time interval from onset of symptoms to arrival in the emergency department was significantly longer in both pandemic group;there was also a significantly longer time to surgery comparing to group A. The risk of complicated AA was higher in both pandemic groups. A significantly higher grade of difficulty was detected in both COVID-groups. However, no differences were observed in conversion rate. Postoperative complications rate showed no significant difference among all three groups. No patients was tested positive for SARSCoV-2 postoperatively. Conclusion: AA treatment was comparable to pre-COVID period in-hospital presurgery stay and early postoperative outcome. With an accurate respect of pandemic protocol is possible to maintain a high and safe standard of care for patients with acute appendicitis. Copyright © 2022 The Authors. Published by on behalf of the Associazione Chirurghi Ospedalieri Italiani and Wolters Kluwer.

Comparativo De Diagnostico E Mortalidade Em Idosos Por Leucemias No Estado Do Parana Antes E Depois Da Pandemia De Covid-19

Introducao: A pandemia de COVID-19, causada pelo SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) trouxe um desafio para a populacao geral, sem condicoes de qualquer tipo de planejamento, porem sendo evidente o maior impacto em paises subdesenvolvidos como o Brasil, que apresentava capacidade mais limitada para lidar com casos criticos, levando ao colapso dos sistemas de saude em varias localidades. Entao, considerando que a febre e um dos principais sintomas de COVID-19 e tambem um sintoma comum nas leucemias e tambem considerando que a populacao idosa envolve uma maior complexidade devido sua fragilidade e multicomorbidades, e valido a analise no diagnostico e na mortalidade pelas leucemias comparando com ano pre-pandemico. Objetivos: Analisar, atraves dos dados disponiveis publicamente no Departamento de Informatica do Sistema Unico de Saude (DATASUS) e no Sistema de Informacao de Mortalidade (SIM), do ano de 2020, o impacto da pandemia de COVID-19 no diagnostico e mortalidade de leucemias no estado do Parana e comparar com o mesmo periodo de 2019, ultimo ano antes da pandemia. Material e Metodos: Constituiu-se de estudo transversal e descritivo. A populacao alvo foi de pacientes, de faixa etaria maior que 60 anos, com diagnostico de leucemia, firmado no estado do Parana, no periodo de 2019, ano pre-pandemia, e no ano seguinte, em 2020, primeiro apos a pandemia de COVID-19. Resultados: Em 2019, o estado do Parana registrou 198 novos casos de leucemia em idosos, sendo a maioria dado na faixa etaria entre 60 e 64 anos. No mesmo ano, foram registrados 303 obitos tendo como causa a leucemia, a maioria deles em pacientes com 80 anos ou mais. Ja em 2020, o Estado registrou 171 novos casos de leucemia, novamente com a maioria entre 60 e 64 anos. Os obitos foram contabilizados em 305, sendo a maioria na faixa etaria de 70 a 79 anos. Discussao: O numero de diagnosticos no estado do Parana reduziu apos o inicio da pandemia de COVID-19, semelhante a outros lugares do mundo com mesmo comportamento, tendo explicacao baseada talvez no respeito dos pacientes ao isolamento social e ao colapso dos sistemas de saude que necessitaram realocar recursos e funcionarios para o atendimento direto das sindromes respiratorias. A mortalidade parece nao ter sido afetada no Estado, apesar de pacientes idosos serem mais vulneraveis as complicacoes de COVID-19 e a um maior numero de internacoes, motivos pelos quais os pacientes mais idosos poderiam ter um atraso no inicio da terapia ou aumento na mortalidade por leucemias no periodo apos inicio da pandemia. Conclusao: Faz-se necessario, entao, manutencao da atencao com o diagnostico de leucemias na populacao idosa, mas tambem cautela em relacao a morbidade causada por esta, considerando maior vulnerabilidade dessa classe e maior susceptibilidade ao virus de COVID-19, que pode levar a atrasos e suspensao de esquemas de tratamento. Copyright © 2022

O Impacto Da Pandemia De Covid-19 No Diagnostico De Neoplasias Hematologicas No Estado Da Paraiba: Um Comparativo De Tres Anos

Introducao: Os canceres sao doencas geneticas cujo fenotipo maligno resulta de uma alteracao que e transmitida da celula alterada para suas celulas filhas, rompendo uma serie de barreiras fisiologicas para perpetuar. Atualmente, o cancer e encarado como um problema de saude publica em nivel global e, como outras doencas de curso menos agudo, o diagnostico e o tratamento do cancer tambem foram afetados pela pandemia de COVID-19 (coronavirus disease). Objetivos: Analisar, atraves dos dados disponiveis publicamente no Departamento de Informatica do Sistema Unico de Saude (DATASUS), dos anos de 2020 e 2021, o impacto da pandemia de COVID-19 no diagnostico de neoplasias malignas no estado da Paraiba e comparar com os mesmos periodos de 2019, ultimo ano antes da pandemia. Material e Metodos: Constituiu-se de estudo transversal e descritivo. A populacao alvo foi de pacientes, de todas as faixas etarias, com diagnostico de neoplasia hematologica, firmado no estado da Paraiba, no periodo de 2019, ano pre-pandemia, e no bienio 2020-2021, anos apos a pandemia de COVID-19. Resultados: Em 2019 a Paraiba registrou 403 novos casos de neoplasias hematologicas, sendo 213 no sexo masculino (52,8%). Os tipos mais comuns foram os linfomas nao-Hodgkin, correspondendo a 28,53%, seguido pelas leucemias (24,56%). Quanto ao estadiamento, a maioria dos diagnosticos foi no estagio II (11,6%), com o campo "Ignorado" correspondendo a 59,8%. O tempo medio entre o diagnostico e o inicio do tratamento foi menor que 30 dias (36,22%). Ja em 2020, o Estado registrou 439 novos casos, sendo 234 no sexo masculino (53,3%). Neste ano, os tipos mais comuns foram novamente os linfomas nao-Hodgkin, correspondendo a 32,11%, seguido pelas leucemias (28,7%). O estadiamento se deu no estagio 1 em sua maioria, correspondendo a 14,57%, com o campo ignorado neste ano tendo atingido a marca de 57,4%. O tempo medio entre o diagnostico e o inicio do tratamento foi menor que 30 dias (34,39%). No segundo ano apos a pandemia, em 2021, a Paraiba registrou 450 novos casos de neoplasias hematologicas, sendo 280 no sexo masculino (62,22%). Neste ano, o tipo mais comum foram as leucemias (32,44%) seguido dos linfomas nao-Hodgkin (29,33%). A maioria dos diagnosticos se deu no estagio III (10,66%) e o tempo medio entre o diagnostico e o inicio do tratamento foi maior que dois meses na maioria dos casos, correspondendo a 42,88%. Discussao: A pandemia de COVID-19 trouxe diversas repercussoes para a area da saude, mais do que aquelas implicadas tao somente pela infeccao que o virus SARS-CoV-2 traz em si, porem nao afetou o numero dos diagnosticos de neoplasias hematologicas no estado da Paraiba. Cabe pontuar que aumentou o tempo entre o diagnostico e o inicio do tratamento, bem como houve mais diagnosticos em estagios mais avancados da doenca, talvez pela realocacao de recursos e infraestrutura redirecionados para atendimento das sindromes respiratorias agudas. Conclusao: Apesar de nao haver impactado no numero de diagnosticos, a pandemia de COVID-19 trouxe impactos prognosticos, com maior tempo ate inicio do tratamento e com diagnosticos em estagios mais avancados de doenca. Tambem cabe destacar a quantidade de dados computados nos campos dados como "Ignorado", "Nao aplica" ou "Outros", o que dificulta a analise fidedigna dos dados epidemiologicos. Copyright © 2022

Can we optimize d-dimer cut off value to predict pulmonary embolism in covid-19 patients?

Background: Covid-19 is associated with an increased risk of pulmonary embolism (PE) therefore, should the cut off d-dimer value be adjusted for these patients? Material(s) and Method(s): Retrospective and observational study to understand if there is a d-dimer cut-off that could guide clinics to perform a thoracic computed tomography angiography (CTA) in patients with covid-19. The population was covid-19 patients admitted to covid-19 dedicated wards of a University Hospital Centre for one year. Result(s) and Conclusion(s): 725 (52%) patients with covid-19 had a d-dimer value dosed during the first 5 days of the disease. Those, 63 (9%) did a CTA with a diagnosis of 16 (25%) PE. Gender was equally represented, median age was 70 years (ID=3.49) and the majority (94%) survived. Thirteen (81%) patients with PE had a d-dimer value above 2500 ng/mL (OR=9.244, 95% CI 2.248-9.837), with 7 (54%) with values over 10000 ng/mL, but in 3 (9%) it was under 1500 ng/mL. Seventy-three (63%) of patients with a d-dimer over 1500 ng/mL did not had a thoracic CTA performed. In our population PE was not a frequent outcome. The results are influenced by the low number of thoracic CTA performed because, even tough the cut-off d-dimer value used at our hospital to perform a thoracic CTA to exclude PE is 1500 ng/mL, most patients with that d-dimer value did not take the exam and so PE could not be excluded. Although in most PE cases the d-dimer value was above 2500 ng/mL, the results of our study cannot verify if that is a better cut-off value.

BS Team: Finding Competence Gaps

The academy form competences to work in the routine, without worries, without unknown hazards. The rules and objectives in routine activities are clear and require operational discipline to control the cost of production and product quality. The current educational model does not prepare society and groups for an emergency or even for decisions in a crisis, where resources are scarce mainly because the necessary knowledge about danger and its mechanism of action is lacking. What really happens in the chain event scenario when the danger is unknown? What are the typical models of action of the emergency leader and his team? What are the required actions in crisis management required for a BS type event considering the scarce resources, the high level of stress and the direction of the danger energy? Which models are indicated for the situation of unknown danger and its intense energy flow with high impacts during these events? What is the appropriate mind map of those who lead and execute the actions considering the low level of visibility in the events and the dynamic of geopolitics in the BS scenario where, depending on the preparation for emergency, in case of intense demand for attention and action, possible modifications may occur in the map mental for decisions? This work intends to review the discussions already performed about new concepts and tools to be used in the crisis prevention area. Between this works we will understand the effect of the stress level on emergency decisions valuating human error and observing team response using LODA tool. The Human elements designed in the organizational culture, can stop the high danger energy that can flow from some industries. The principal aspects to be constructed and monitored are technology (risk and complexity);management (leadership and stress);and behavior (cooperation, commitment, competence, and communication). By the other hand, human factors are analyzed to avoid situations which hazard energy carriers during top events, as the effect of cultural aspects to chain reaction until the occurrence of disaster. Decision models for the emergency brigade (leader and team) indicate the motor and cognitive gaps that cause lack of control during contingencies. Finally, the analysis of simulation types, by rotating observation of field simulation allow find the deficiencies of the emergency team in a real situation in the future. The methodology divided in following steps are dynamic: first, rescue the discussions about stress and the BS events and, in second step, recognize the intense hazard energy flow through failure events, antecedents, elements and human factors. In third step, we try to locate the gaps and environmental conflicts influencing losses from accidents. Finally, we assess the current event of covid-19 pandemics to suggest correct emergency preparedness actions in the preparation of leaders and their teams regarding cognitive and motor characteristics in situations of high demand. When comparing the characteristics already described by TALEB about BS with the event COVID-19, we intend to carry out a case study to indicate the possible causes this global impact crisis, or even, understand the technological disaster causes where uncontrolled events from chemical, nuclear, and oil industry begins chain reactions until the disaster. Unfortunately, a Crisis situation can be caused from several intricated dimensions, making difficult the contingency and mitigation actions. © 36th Center for Chemical Process Safety International Conference, CCPS 2021 - Topical Conference at the 2021 AIChE Spring Meeting and 17th Global Congress on Process Safety.

Impact of COVID-19 pandemic on inequalities in mortality: an analysis in Piedmont and Emilia-Romagna : Elena Strippoli

Background Italy was heavily hit by the COVID-19 pandemic. According to official statistics, during 2020 there were more than 75,000 excess deaths compared to the average expected mortality in 2015-2019. General mortality (GM) is a good measure of both the direct and indirect effects of the pandemic because it's exempt from potential bias due to misclassification of events. Evidence shows a greater burden of disease and mortality attributable to COVID-19 among disadvantaged populations, with the risk of an exacerbation of existing health inequalities. We aim to analyse the trend of social inequalities in mortality during the first pandemic year in two Italian regions (Piedmont and Emilia-Romagna) using data from Administrative Population Registries (APR) and statistical databases. Methods Data on deaths occurred between Jan 2015 and Jan 2021 in subjects ≥65, stratified by educational level, were obtained from Regional APR and the Census. Using a time series approach, we computed Standardized Mortality Rates (SMR), Relative Index of Inequalities (RII) and Slope Index of Inequalities (SII), adjusted by age, gender, month and region. SMR, RII and SII from March 2020 were forecasted using Holt-Winters method and compared to the observed values in the same period. Results SMRs were higher than expected during the two 2020 epidemic waves (Mar-Apr, Oct-Dec) in both regions. RII didn't increase significantly. Absolute inequalities instead rose in Piedmont during both pandemic waves, mostly among women, and in Emilia-Romagna in March among men. Conclusions The impact of the pandemic on inequalities in GM has been at least of the same size of the impact of other mechanisms of unequal mortality. APR coupled with sociodemographic data are a quick and reliable source for assessing the unequal impact of the COVID-19 pandemic on health. Further research is needed to explore mechanisms underlying these effects e.g. inequalities in cause-specific mortality and access to health services. Key messages The unequal impact of the pandemic on mortality was confirmed. Administrative data linked with Census and health data are efficient and reliable sources for a timely monitoring of health inequalities.

Impacts of a fraction of inspired oxygen adjustment protocol in COVID-19 patients under mechanical ventilation: A prospective cohort study Impactos de un protocolo de ajuste de la fracción de oxígeno inspirado en pacientes con COVID-19 sometidos a ventilación mecánica: un estudio de cohorte prospectivo

Objective We examined weather a protocol for fraction of inspired oxygen (FiO2) adjustment can reduce hyperoxemia and excess oxygen use in COVID-19 patients mechanically ventilated. Design Prospective cohort study. Setting Two intensive care units (ICUs) dedicated to COVID-19 patients in Brazil. Patients Consecutive patients with COVID-19 mechanically ventilated. Interventions One ICU followed a FiO2 adjustment protocol based on SpO2 (conservative-oxygen ICU) and the other, which did not follow the protocol, constituted the control ICU. Main variables of interest Prevalence of hyperoxemia (PaO2 >100 mmHg) on day 1, sustained hyperoxemia (present on days 1 and 2), and excess oxygen use (FiO2 > 0.6 in patients with hyperoxemia) were compared between the two ICUs. Results Eighty two patients from the conservative-oxygen ICU and 145 from the control ICU were included. The conservative-oxygen ICU presented lower prevalence of hyperoxemia on day 1 (40.2% vs. 75.9%, p < 0.001) and of sustained hyperoxemia (12.2% vs. 49.6%, p < 0.001). Excess oxygen use was less frequent in the conservative-oxygen ICU on day 1 (18.3% vs. 52.4%, p < 0.001). Being admitted in the control ICU was independently associated with hyperoxemia and excess oxygen use. Multivariable analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FiO2 use and adverse clinical outcomes. Conclusions Following FiO2 protocol was associated with lower hyperoxemia and less excess oxygen use. Although those results were not associated with better clinical outcomes, adopting FiO2 protocol may be useful in a scenario of depleted oxygen resources, as was seen during the COVID-19 pandemic.

Logistics Management for Competitiveness of a MSE of the balanced food industry against Covid-19

The objective of the research was to design a logistics management model for the competitiveness of an SME in the balanced food industry to the year2021. The methodology used has a mixed, applied and prospective approach. Validated instruments were applied according to experts, identifying nine root causes demonstrating inadequate logistical management and low competitiveness. A logistics management model was developed by means of eight strategies to improve the processes: supply, storage, inventory and distribution. Diagrams were restructured increasing 6% the total activitiesand 16% the automated activitiesby means of information technologies, annual savings of S/16 920 have been estimated in salaries and 80% in merchandise acquisition costs, likewise, the numberof operatorswasreduced by 50% anda recovery of 5% of merchandise is achieved. Implementation costs were estimated at S/61 103 and finally;the environmental impact was determined using the 3 R's, being a precedent for companiesin the same industry that want to increase their competitiveness. © 2022 Latin American and Caribbean Consortium of Engineering Institutions. All rights reserved.

Bibliometric Analysis: Nanotechnology and COVID-19

Background: COVID-19 pandemic information is critical to study it further, but the virus has still not been confined. In addition, even if there is no longer any threat, more knowledge may be gathered from these resources. Methods: The data used in this study was gathered from several scientific areas and the links between them. Since the COVID-19 pandemic has not been fully contained, and additional information can be gleaned from these references, bibliometric analysis of it is important. Results: A total of 155 publications on the topic of "COVID-19" and the keyword "nanotechnology" was identified in the Scopus database between 2020 and 2021 in a network visualization map. Conclusion: As a result, our analysis was conducted appropriately to provide a comprehensive understanding of COVID-19 and nanotechnology and prospective research directions for medicinal chemistry.

Ofatumumab subcutaneous injection for the treatment of relapsing forms of multiple sclerosis.

INTRODUCTION: In recent years, different studies have highlighted the importance of B cells in the pathophysiology of multiple sclerosis (MS): they secrete cytokines to modulate the inflammatory environment, present antigens for the activation of T lymphocytes, and they secrete antibodies contributing to the destruction of the myelin sheath. Combined, these findings have lead to new possible means for treating MS. AREAS COVERED: In this review, we provide an up-to-date overview of the characteristics of ofatumumab (aka Kesimpta), and the differences between this drug and the other anti-CD20 monoclonal antibodies used to treat MS. EXPERT OPINION: The evolution of disease-modifying treatment algorithms in MS underlines the importance of starting treatment as soon as the diagnosis is defined, and with adequate 'treatment intensity.' Monoclonal antibodies and other aggressive treatments are now considered as an option at the clinical presentation of the disease, based to the prognostic profile emerging through clinical and paraclinical investigations. The recent adoption of new diagnostic criteria allows for the early diagnosis of MS. This, together with the availability of disease-modifying therapies (DMTs), such as ofatumumab, with a good efficacy/safety profile and which are easy to administer, could contribute to significant improvements in the long-term prognosis of MS.

BS Team: Finding Competence Gaps

The academy form competences to work in the routine, without worries, without unknown hazards. The rules and objectives in routine activities are clear and require operational discipline to control the cost of production and product quality. The current educational model does not prepare society and groups for an emergency or even for decisions in a crisis, where resources are scarce mainly because the necessary knowledge about danger and its mechanism of action is lacking. What really happens in the chain event scenario when the danger is unknown? What are the typical models of action of the emergency leader and his team? What are the required actions in crisis management required for a BS type event considering the scarce resources, the high level of stress and the direction of the danger energy? Which models are indicated for the situation of unknown danger and its intense energy flow with high impacts during these events? What is the appropriate mind map of those who lead and execute the actions considering the low level of visibility in the events and the dynamic of geopolitics in the BS scenario where, depending on the preparation for emergency, in case of intense demand for attention and action, possible modifications may occur in the map mental for decisions? This work intends to review the discussions already performed about new concepts and tools to be used in the crisis prevention area. Between this works we will understand the effect of the stress level on emergency decisions valuating human error and observing team response using LODA tool. The Human elements designed in the organizational culture, can stop the high danger energy that can flow from some industries. The principal aspects to be constructed and monitored are technology (risk and complexity);management (leadership and stress);and behavior (cooperation, commitment, competence, and communication). By the other hand, human factors are analyzed to avoid situations which hazard energy carriers during top events, as the effect of cultural aspects to chain reaction until the occurrence of disaster. Decision models for the emergency brigade (leader and team) indicate the motor and cognitive gaps that cause lack of control during contingencies. Finally, the analysis of simulation types, by rotating observation of field simulation allow find the deficiencies of the emergency team in a real situation in the future. The methodology divided in following steps are dynamic: first, rescue the discussions about stress and the BS events and, in second step, recognize the intense hazard energy flow through failure events, antecedents, elements and human factors. In third step, we try to locate the gaps and environmental conflicts influencing losses from accidents. Finally, we assess the current event of covid-19 pandemics to suggest correct emergency preparedness actions in the preparation of leaders and their teams regarding cognitive and motor characteristics in situations of high demand. When comparing the characteristics already described by TALEB about BS with the event COVID-19, we intend to carry out a case study to indicate the possible causes this global impact crisis, or even, understand the technological disaster causes where uncontrolled events from chemical, nuclear, and oil industry begins chain reactions until the disaster. Unfortunately, a Crisis situation can be caused from several intricated dimensions, making difficult the contingency and mitigation actions. © 2021 American Institute of Chemical Engineers. All rights reserved.

Prevalence and impact of dysrhythmias in COVID-19 intensive care patients

Background: The COVID-19 pandemic has had a dramatic impact on clinical practice, amounting to more emergency department and intensive care unit (ICU) admissions. Due to their frequent multiple comorbidities, management in the ICU is challenging. Early studies suggest that cardiac injury is frequent in hospitalized patients with COVID-19, and it is plausible that these patients have a higher risk of cardiac dysrhythmias. Purpose: To determine the prevalence of dysrhythmias in ICU patients with COVID-19 pneumonia, identify major predictors and determine the impact on in-hospital mortality. Methods: A retrospective study of 98 consecutive patients with COVID-19 Pneumonia admitted to the ICU of a tertiary hospital in 2020. The main outcome was dysrhythmias (including significant bradycardia, high/slow ventricular rate or new-onset atrial fibrillation (AF) or atrial flutter, other supraventricular tachycardias, ventricular tachycardia and ventricular fibrillation). Significant bradycardia was defined as heart rate lower than 40 or need of treatment. Sociodemographic variables and clinical data were retrieved for each patient, severity scores at admission (Apache II, SOFA and SAPS II), number of days on mechanical ventilation or high-flow oxygen and placement on Venovenous Extracorporeal Membrane Oxygenation (ECMO) or prone position were recorded. Statistical comparison was made between groups, including logistic regression adjusting for confounding variables. Results: The most frequent arrhythmia was significant sinus bradycardia (28, 28.5%) followed by high ventricular rate AF (14, 14.2%). Patients who had dysrhythmias were older (66.24 ± 10.13 vs 60.85 ± 12.69 years, p 0.024), more severe (SAPS II score 42.55 ± 11.08 vs 35.98 ± 11.26, p 0.006), had more atrial fibrillation (AF) (p 0.022), had higher maximum C-reactive protein (mCRP) (6.56 ± 2.68 vs 6.24 vs 2.86, p 0.009), were mechanically ventilated for a longer time (15.64 ± 13.18 vs 8.92 ± 8.85 days, p 0.004), had longer intubation time (14.52 ± 9.39 vs 8.70 ± 8.21 days, p 0.002) and had higher usage of dexamethasone (p 0.042) and prone position (p 0.016). When adjusted for confounding variables, prone was the most significant predictor (OR 2.800;95% CI 1.203-6.516) followed by use of dexamethasone (OR 2.484;95% CI 1.020-6.050). Days intubated, days on mechanical ventilation, age, mCRP and SAPS II on admission were also predictors of dysrhythmia. Regarding mortality, patients with arrhythmic events had a tendency for greater in-hospital death (OR 2.440;95% CI 0.950-6.310;p 0.065). Conclusions: COVID-19 ICU patients are a subset of patients at risk of cardiac arrhythmias. Use of prone position was the main contributor to these events, but clinical history, severity and treatment may also play an important role. Efforts must be made to optimize ventilatory support and treatment in order to reduce the risk of dysrhythmias. (Figure Presented).