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COVID-19 has caused not only unprecedented health crises but also economic crises among individuals across the world. White-collar (salaried-class) employees with a fixed salary face financial insecurity due to job loss, pay cuts and uncertainty in retaining a job. This study examines the financial behavior of Indian white-collar salariedclass investors to their cognitive biases. In addition, the mediating effect of financial self-efficacy on cognitive biases and financial behavior is examined. Respondents were given structured questionnaires (google forms) through emails and WhatsApp for data collection. SPSS and R-PLS are used to analyze the data. Conservatism (r = -.603, p < 0.05) and herding bias (r = -.703, p < 0.05) have a significant negative correlation with financial behavior. Financial self-efficacy has a significant positive correlation (r =.621. p < 0.050). Conservatism and herding predicted 60.5% and 62.2% of the variance, respectively. The direct and indirect paths between conservatism bias, financial self-efficacy, and financial behavior are significant. The paths between herding, financial self-efficacy and financial behavior are also significant. © Ankita Mulasi, Jain Mathew, Kavitha Desai, 2022.
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The requirement for remote examination had emerged along with remote learning during the COVID-19 pandemic as the unprecedented situation had brought the world to halt. The pandemic had forced many educational institutions to move towards the online mode of assessment to assess the caliber of the students. This paper focuses on the ways that an online examination system can be prepared and can be used for conducting exams remotely in a secure way. It also emphasizes on various test cases that are essential for an efficient and useful examination system that can benefit both students and faculty by saving them time and effort. Due to the challenges in the existing mode of online assessment such as the use of digital forms that are usually used for conducting surveys, scanning and uploading answer sheets using phone with poor camera quality, the problem of engaging in the different kinds of misconduct, it was important to understand the user requirements at an examiner and examinee level and prepare a web application that addresses them and makes it convenient to conduct and attempt. We propose different methodologies that can be implemented in a Python based web application with the help of JavaScript such as switching the browser window to full-screen in order to restrict access to other applications, limited exits from full-screen, easy management of examiner and candidate data along with visualization of exam data that help to better understand and draw quick conclusions at the time of exam. It is also focused on the continuously evolving distance education system and finding the best software solution possible for online examinations. Additionally, an automated grading system may help to reduce human error and declare results easily reducing fatigue. © 2022 IEEE.
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Modern manufacturing enterprises must be agile to cope with sudden demand changes arising from increased global competition, geopolitical factors, and unforeseen circumstances such as the Covid-19 pandemic. Small- and Medium-Sized Enterprises (SMEs) in the manufacturing sector lack agility due to lower penetration of Information Technology (IT) and Operational Technology (OT), the inability to employ highly skilled human capital, and the absence of a formal innovation ecosystem for new products or solutions. In recent years, Cloud-based Design and Manufacturing (CBDM) has emerged as an enabler for product realization by integrating various service-based models. However, the existing framework does not thoroughly support the innovation ecosystem from concept to product realization by formally addressing economic challenges and human skillset requirements. The present work considers the augmentation of the Design-as-a-Service (DaaS) model into the existing CBDM framework for enabling systematic product innovations. The DaaS model proposes to connect skilled human resources with enterprises interested in transforming an idea into a product or solution through the CBDM framework. The model presents an approach for integrating human resources with various CBDM elements and end-users through a service-based model. The challenges associated with successfully implementing the proposed model are also discussed. It is established that the DaaS has the potential for rapid and economical product discovery and can be readily accessible to SMEs or independent individuals. [ FROM AUTHOR] Copyright of Journal of Mechanical Design is the property of American Society of Mechanical Engineers and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Background: The impact of clinician burnout on patient care is pervasive across medical delivery systems. The effects are also felt in preventive care where cancer screening efforts rely on clinician referrals through the electronic medical records (EMRs). Though designed to support healthcare, EMRs are a significant source of clinician burnout given the number of clicks or navigation time needed to refer a patient. This is a barrier to Patient Navigation (PN) when ordered tests do not materialize into screenings or when clinicians order labs/imaging and the pending orders are not created. This causes frustration for all clinical staff involved, delays the workflow processes, and leads to missed opportunities for PN. We implemented an 'order set' intervention to reduce the click burden linked to colorectal cancer (CRC) screening referral among clinicians in South Georgia. Methods: The 'order set' intervention was developed to facilitate PN for a Colorectal Cancer Control Program (CRCCP) aimed at implementing Evidence- Based Interventions to increase CRC screening rates in Georgia. The 'order set' was designed to address workflow issues by consolidating steps associated with CRC screening. This reduced typing input and the need to click between multiple windows within the EMR while making a referral to PN. The intervention was piloted in the Albany Area Primary Health Care (AAPHC) system after modifications were made to the EMR and clinician workflows. The monthly CRC screening rates continue to be generated and tracked post-implementation. Results: The use of the 'order set' reduced the click burden from 78 to 7 inputs and clinician EMR interaction time from 110 seconds to 29 seconds. Providers from 4/7 clinics have adopted the 'order sets' when making referrals for CRC screening. Two clinics provided post-implementation screening data. The pre-implementation screening rates for one clinic were comparable (August = 59.3%, September = 57.6%) to post-implementation (October = 56.3%, November = 56.6%, December = 57.2%), while the second clinic showed some increase (August = 58.6%, September = 60%) vs. (October = 61%, November = 62.1%, December = 62.8%). Conclusions: The 'order sets' intervention reduced the time clinicians spent creating referrals for CRC screening, including fecal immunochemical tests (FIT) and colonoscopies. Additional follow-up and rollout to clinics participating in the program is underway to evaluate further the impact of the order sets on CRC screening outcome and process measures, including qualitative interviews with clinicians. There is significant potential in the application of order sets to various workflow processes to aid in preventative health efforts. Challenges linked to the COVID-19 pandemic and staff turnover affected acquisition of patient referral data.
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Objective: NA Background: Chronic inflammatory demyelinating polyneuropathy (CIDP) is characterized on nerve conduction study (NCS) by prolonged distal latencies, slowed conduction velocities, prolonged late responses, conduction blocks, and temporal dispersion. Unmyelinated fibers typically conduct action potentials at speeds of 0.5-10 m/s;myelinated fibers conduct an order of magnitude faster, e.g. 50-70 m/s. While very slow conduction velocities < 25 m/s are typically associated with the genetic neuropathies as in the Charcot-Marie Tooth neuropathies, CIDP can manifest with slow conduction velocities. Prompt recognition of CIDP is crucial for the timely initiation of immunotherapy. Design/Methods: NA Results: This case series of three CIDP patients demonstrates very slow conduction velocities and prolonged distal latencies. An 81-year-old woman with history of multiple sclerosis and chronic myelogenous leukemia presented with inability to walk over a few months with diffuse sensory loss. NCS showed absent motor responses in the leg, partial conduction blocks in the arm, prolonged ulnar motor distal latency 7.9 ms (normal ≤3.4ms), and very slow conduction velocities < 15 m/s. A 50-year-old woman with prior history of COVID-19 presented with diffuse weakness. NCS showed ulnar motor distal latency of 23.2 ms, slowed motor conduction velocities < 30 m/s. After treatment initiation with intravenous immunoglobulin, sensory responses improved, and conduction velocities increased to > 30 m/s. A 49-year-old woman presented with 3 months of bilateral weakness and sensory symptoms two weeks after a COVID-19 vaccination. NCS showed ulnar motor distal latency of 14 ms and slowed motor conduction velocities < 30 m/s. Conclusions: Very slow conduction velocities are a feature not just of the genetic neuropathies but also of acquired demyelination as seen in CIDP, and the latter is distinguished by abnormal temporal dispersion and conduction blocks. Astute electrophysiologists should modify sweep speed and gain to increase sensitivity for delayed or dispersed responses.
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SARS-CoV-2- Severe acute respiratory syndrome- coronavirus-2 is one of the most infectious diseases, leading to a pandemic. COVID-19 has extensive involvement in the lower respiratory tract causing acute respiratory syndrome disease (ARDS). No exact treatment is available, so strategies for developing treatment include repurposing of drugs. Pathogenesis of COVID-19 is associated with a cytokine storm in lung alveoli, leading to extensive inflammation and hemorrhage in lung tissue (1). Excessive pro-inflammatory cytokine production contributes to the progression of ARDS, additional tissue damage, multi-organ failure, and death. As there is a correlation between cytokine storm and COVID-19, early management of cytokine storm can improve survival rate and reduce mortality. The authors of this article presented similarities in the pathophysiology of COVID-19 and other inflammatory diseases like rheumatoid arthritis, an overview of the common cytokines associated with both the diseases and their inhibitory molecules that can be repurposed for the treatment of COVID-19. © The Electrochemical Society
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Objectives: Cardiac rehabilitation (CR) exercise classes in Singapore were either cancelled or suspended due to the ongoing COVID-19 pandemic. In response, a hybrid CR programme utilising telehealth was created to reduce reliance on in-person sessions. Our study aimed to assess early patients' impressions of this novel CR delivery method. Methods: Each hybrid CR programme comprises: (a) one CR orientation session via the Zoom video conferencing platform where patients interact with CR nurses and physiotherapists, (b) two 6-minute walk test fitness assessments (at baseline and upon completion), (c) five in-person supervised exercise classes and (d) two teleconsultation sessions (scheduled after exercise sessions 2 and 4) where CR physiotherapists review symptoms and discuss exercise prescriptions with patients over the phone. Upon programme completion, patients filled 2 anonymous online questionnaires - one assessing the videoconferencing component and another assessing the teleconsultation component and overall programme. Results: Seven patients underwent the hybrid CR programme. The majority were male (n=6, 86%), aged between 51 to 65 years (n=4, 57%) and had previously used a wide range of mobile applications (n=6, 86%). 100% of patients either agreed or strongly agreed that both videoconferencing and teleconsultation were: (a) easy to use, (b) as valuable as in-person sessions, (c) saved time and (d) had lower infection risk compared to in-person sessions (Figure). The overall ratings for videoconferencing, teleconsultation and the hybrid programme were 9.3, 9.6 and 9.6 (out of 10) respectively. All patients would definitely recommend the programme to others. Conclusion: Responses by participants of a novel hybrid CR programme utilising telehealth are highly encouraging. From a patient perspective, incorporation of telehealth to enable remote CR is feasible, acceptable and should be considered as an alternative CR delivery method.
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Background: The COVID-19 pandemic created numerous challenges for graduate medical education, including defining the role of asynchronous virtual education in general cardiovascular (CV) fellowship training. The CardioNerds podcast introduced the CardioNerds Case Report (CNCR) series to provide continued high-quality cardiovascular education during the pandemic. Moving forward, the role and value of asynchronous education, and specifically medical podcasts, remain unknown. Methods: The CNCR series included a wide range of case-based episodes involving cardiology fellows, content experts, and program leadership from participating programs. Every accredited general cardiology fellowship program in the United States was invited. A survey assessing attitudes on a likert scale towards cased-based cardiology podcasts and medical podcasts was administered to all participating programs. Results: 44 cardiology fellowship programs participated in the CNCR series representing 137 fellows and 59 program directors and leaders (PDs). At this time, 76% of fellows and 63% of program directors have responded. 90% of both fellows and PDs agreed that the CNCR series was an effective way to teach core CV concepts and 74% of fellows felt that contributing to the CNCR series improved their clinical reasoning skills. 70% of PDs and 94% of fellows felt that medical podcasts in general added to their knowledge base. Fellows were more likely to strongly agree that medical podcasts changed their clinical practice compared to PDs (46% vs 8%, p = 0.02). Conclusion: Medical podcasts are becoming increasingly popular in cardiovascular education and training. Specifically, the CNCR platform has been well received by fellowship programs and has potentially influenced clinical practice. CV training programs and professional societies should invest in ensuring high quality medical podcasts are incorporated into CV training moving forward to supplement traditional CV education.
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Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods. Background: The COVID-19 pandemic led to widespread repercussions on the delivery of health care worldwide. Design/Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by ICD-10 codes and/or classifications in stroke center databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI,-11.7 to-11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI,-13.8 to-12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI,-13.7 to-10.3, p=0.001). There were greater declines in primary compared to comprehensive stroke centers (CSC) for stroke hospitalizations (-17.3% vs-10.3%, p<0.0001) and IVT (-15.5% vs-12.6%, p=0.0001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) months of the pandemic, with greater recovery in hospitals with lower COVID-19 hospitalization volume, high volume stroke center, and CSC. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months, with greater recovery in hospitals with lower COVID-19 hospitalizations, high volume stroke centers, and CSCs.
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Introduction and Objectives The COVID-19 pandemic brought new challenges to the healthcare system, with every patient contact a potential risk to staff. This required rapid changes to traditional working methods in order to protect healthcare staff from virus exposure, reduce staff anxiety, and manage limited Personal Protective Equipment (PPE) supplies. We aimed to rapidly implement a new strategy for ward working, which would maintain high-quality patient care while reducing staff virus exposure and PPE consumption. Methods We developed an integrated team working concept called SPACES (Shared Patient Assessments Cuts Exposure for Staff) to gain maximum benefit from every staff-patient contact, regardless of the individual's team role. For example, a doctor undertaking a ward round would also perform observations, deliver meals, drinks and medication, and undertake procedures such as venesection, at one single visit saving patient contacts by other healthcare colleagues. All staff applied the same principle for each patient contact. We recorded individual staff entries into each bay (n=5) and side room (n=7) over 24 hours using the SPACES approach, and compared this to pre-SPACES estimates. We also reviewed Ward patient and staff feedback pre- A nd post-SPACES. Results We estimated that pre-SPACES there were 97 individual staff entries into a bay of 4 patients, and 36 into each side room, per 24 hours. Using SPACES, we reduced this to a median [IQR] of 20 [12-22] entries per bay and 11 [10-16] entries per side room (p=0.06 and 0.02 respectively). This decreased PPE consumption by approximately 75%. Patient satisfaction survey responses before and after implementing SPACES were unchanged. Staff feedback on SPACES reflected high levels of satisfaction, increased sense of teamwork, and reduced anxiety of contracting COVID-19. Conclusions We showed that using the SPACES initiative in a COVID-19 ward decreased staff exposure to highly infectious patients, with resultant PPE use reductions, while maintaining a high standard of patient care and strengthening team spirit and staff morale. Following our successful trial period, SPACES received support from the British Thoracic Society and the Royal Colleges of Physicians and Nursing. It has been adopted throughout our trust, and by many centres internationally.
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P2 Figure 1Number of staff entries into bays and side-rooms over 24 hours with SPACES compared to estimates without. Median with inter-quartile range shown for 5 bays and 7 side rooms surveyed. P-value is Wilcoxon signed rank test[Figure omitted. See PDF]ConclusionsWe showed that using the SPACES initiative in a COVID-19 ward decreased staff exposure to highly infectious patients, with resultant PPE use reductions, while maintaining a high standard of patient care and strengthening team spirit and staff morale. Following our successful trial period, SPACES received support from the British Thoracic Society and the Royal Colleges of Physicians and Nursing. It has been adopted throughout our trust, and by many centres internationally.
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Background: Numerous descriptive studies of COVID-19 have been undertaken in countries around the world describing local experiences including China, Italy and America. Aims: To better understand the impact of the first UK peak of the COVID-19 pandemic on the local population, and whether findings of international data were applicable to the population served by a large London NHS Trust. Methods: We performed a retrospective cohort study from 10/03/20-26/04/20 of 215 adult patients with confirmed/clinically suspected COVID-19 admitted to 3 acute respiratory wards, collecting patient demographics, laboratory and imaging findings, progress during admission and outcome including discharge or death. Results: 209 patients were included in the final analysis. Most patients were male (66.0%). Median age was 66 years and increasing age decreased survival probability (p<0.001). Median length of stay was 9 days (IQR 5-15). Most patients were of white ethnicity (57%);36% (n=75) were from BAME groups and 8% from other (n=16). The severity of bilateral opacification of chest X ray on admission trended with mortality (p = 0.0248). 64 (33%) had diabetes, 30 (15%) were obese and 36% (n=70) had underlying lung disease. A high number of patients had a clinical frailty score >5 (64.6%). 29% (n=44) of patients required non-invasive ventilation, of which 45% required transfer to ITU. Conclusion: Our cohort of patients with severe disease mirrors existing data that older, more comorbid, male patients were more likely to be affected. Severity of radiological findings correlated with mortality. The higher proportion of patients of white ethnicity highlights the need for ongoing study into local variation of disease.
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Background: There is a growing body of literature on COVID-19 suggesting decreased survival with increasing age, in black and minority ethnic patients (BAME), and with comorbidities such as diabetes mellitus and obesity. Aims: To evaluate whether these risk factors were relevant in a cohort of COVID-19 patients admitted to a large North East London NHS trust serving 3 boroughs with a highly diverse population. Method: Data was collected for 215 patients from 10/03/2020-26/04/2020 for retrospective analysis. 209 patients with confirmed or clinically suspected COVID-19 admitted to 3 respiratory wards were included in the final analysis. Results: Most patients were male (66.0%). 77 patients died during the data collection period (32%). 32.4% of patients had pre-existing diabetes, and 14.4% had pre-existing obesity. 118 patients were of White ethnicity (56.5%), 43 Asian (20.6%), 28 Black (13.4%), 4 Mixed (1.9%) and 16 Other (7.7%). In a Cox proportional hazards model, there was a significant difference in survival for patients >65 years old (HR 6.12, 2.20-17.1, p < 0.001). There was a no significant difference in survival for patients based on sex, pre-existing diabetes, obesity or ethnicity. Conclusion: In contrast to international data and despite serving a population with rich ethnic diversity, COVID-19 infection in our cohort was most prevalent in white patients. The unchanged survival between white and BAME groups may reflect the high measures of deprivation in the local population. To better understand these findings continued investigation into the local demographics and variations are critical to stratify risk and to help plan for further peaks in the pandemic.