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A comparison of computer-extracted and facility-reported counts of hospitalized COVID-19 patients for public health reporting at 36 hospitals found 42% of days with matching counts between the data sources. Mis-categorization of suspect cases was a primary driver of discordance. Clear reporting definitions and data validation facilitate emerging disease surveillance.
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PurposeThe architecture, engineering and construction (AEC) industry encounter substantial risks and challenges in its evolution towards sustainable development. International businesses, multinational AEC organisations, technical professionals, project and portfolio management organisations face global connectivity challenges between business units, especially during the outbreak of novel coronavirus pandemic, to manage construction megaprojects (CMPs). That raises the need to manage global connectivity as a main strategic goal of global organisations. This paper aims to investigate barriers to integrating lean construction (LC) practices and integrated project delivery (IPD) on CMPs towards the global integrated delivery (GID) transformative initiatives and develop future of work (FOW) global initiatives in contemporary multinational AEC organisations.Design/methodology/approachA two-stage quantitative and qualitative research approach is adopted. The qualitative research methodology consists of a literature review to appraise barriers to integrating LeanIPD&GID on CMPs. Barriers are arranged into six-factor clusters (FCs), with a conceptualisation of LeanIPD&GID, GID strategy placements and FOW global initiatives with multiple validations. This analysis also involved semi-structured interviews and focus group techniques. Stage two consisted of an empirical questionnaire survey that shaped the foundation of analysis and findings of 230 respondents from 23 countries with extensive cosmopolitan experience in the construction of megaprojects. The survey examined a set of 28 barriers to integrating LeanIPD&GID on CMPs resulting from a detailed analysis of extant literature after validation. Descriptive and inferential statistical tests were exploited for data analysis, percentage scoring analysis, principal component analysis (PCA) and eigenvalues were used to elaborate on clustered factors.FindingsThe research conceptualised LeanIPD&GID principles and proposed GID strategy placements for LeanIPD&GID transformative initiatives and FOW global initiatives. It concluded that the most significant barriers to integration of LeanIPD&GID on CMPs are "lack of mandatory building information modelling (BIM) and LC industry standards and regulations by governments”, "lack of involvement and support of governments”, "high costs of BIM software licenses”, "resistance of industry to change from traditional working practices” and "high initial investment in staff training costs of BIM”. PCA revealed the most significant FCs are "education and knowledge-related barriers”, "project objectives-related barriers” and "attitude-related barriers”. Awareness of BIM in the Middle East and North Africa (MENA) region is higher than LC and LC awareness is higher than IPD knowledge. Whilst BIM adoption in the MENA region is higher than LC;the second is still taking its first steps, whilst IPD has little implementation. LeanBIM is slightly integrated, whilst LeanIPD integration is almost not present.Originality/valueThe research findings, conclusion and recommendation and proposed GID strategy placements for LeanIPD&GID transformative initiatives to integrating LeanIPD&GID on CMPs. This will allow project key stakeholders to place emphasis on tackling LeanIPD&GID barriers identified in this research and commence GID strategies. The study has provided effective practical strategies for enhancing the integration of LeanIPD&GID transformative initiatives on CMPs.
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PurposeBuilt environment encounters substantial risks and challenges in its evolution towards sustainable development. International businesses and multinational engineering organisations face global connectivity challenges between business units, especially during the outbreak of the novel coronavirus pandemic (COVID-19), which has profoundly disrupted the construction industry throughout the world. That raises the need to manage global connectivity as a main strategic goal of multinational architecture, engineering and construction (AEC) organisations. This study aims to develop a strategic framework managing challenges of integrating lean construction (LC) and integrated project delivery (IPD) on construction megaprojects (CMPs) towards global integrated delivery (GID) transformative initiatives in multinational AEC organisations.Design/methodology/approach"Mixed research methods” involving a two-stage quantitative and qualitative research approach is adopted. The qualitative research methodology consists of a literature review to assess challenges to integrate LeanIPD&GID on CMPs. There is an assessment of conceptualisation of LeanIPD&GID and GID strategy placements, development of LeanIPD&GID integration framework and future of work (FOW) global initiatives with multiple validations. The analysis involved semi-structured interviews and focus group techniques. Stage 2 consisted of an empirical questionnaire survey that shaped the foundation of analysis and findings of 190 respondents from 23 countries with an extensive cosmopolitan experience of megaprojects in construction. The survey examined a set of 20 challenges to integrate LeanIPD&GID on CMPs resulting from a detailed analysis of extant literature after validation. Descriptive and inferential statistical tests were exploited for data analysis and percentage score analysis.FindingsThe research conceptualised LeanIPD&GID principles, proposed GID strategy placements, a framework for managing challenges of LeanIPD&GID transformative initiatives, FOW global initiatives and key performance indicators (KPIs). It concluded that the most significant challenges to integrate of LeanIPD&GID on CMPs are "lack of governmental incentives, policies, regulations or legal frameworks”, "lack of client's awareness and IPD experience amongst key stakeholders”, "lack of organisation's senior-management and client's commitment to IPD approaches”, "resistance of industry to change from traditional procurement to IPD” and "lack of integrated synergies between LC, IPD working towards LeanIPD&GID”. Awareness of building information modelling (BIM) in the Middle East and North Africa (MENA) region is higher than LC, and LC awareness is higher than IPD knowledge. While BIM adoption in the MENA region is higher than LC, LC is still taking its first steps, and IPD has little implementation. LeanBIM is slightly integrated, while LeanIPD integration is almost not present.Originality/valueThe research findings, conclusions and recommendations provide a proposed framework for implementation, KPIs and GID strategy placements for LeanIPD&GID transformative initiatives to integrate LeanIPD&GID on CMPs and FOW global initiatives. This will allow project key stakeholders to place emphasis on managing LeanIPD&GID challenges identified in this research and commence GID strategies. The study has provided effective practical strategies for enhancing integration of LeanIPD&GID transformative initiatives on CMPs.
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OBJECTIVE: To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on healthcare-associated infections (HAIs) reported from 128 acute care and 132 long-term care Veterans Affairs (VA) facilities. METHODS: Central line-associated bloodstream infections (CLABSIs), ventilator-associated events (VAEs), catheter-associated urinary tract infections (CAUTIs), and methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile infections and rates reported from each facility monthly to a centralized database before the pandemic (February 2019 through January 2020) and during the pandemic (July 2020 through June 2021) were compared. RESULTS: Nationwide VA COVID-19 admissions peaked in January 2021. Significant increases in the rates of CLABSIs, VAEs, and MRSA all-site HAIs (but not MRSA CLABSIs) were observed during the pandemic period in acute care facilities. There was no significant change in CAUTI rates and C. difficile rates significantly decreased. There were no significant increases in HAIs in long-term care facilities. CONCLUSIONS: The COVID-19 pandemic had a differential impact on HAIs of various types in VA acute care with many rates increasing. The decrease in CDI HAIs may be due, in part, to evolving diagnostic testing. The minimal impact of COVID-19 in VA long-term facilities may reflect differences in patient numbers and acuity and early recognition of the impact the pandemic had on nursing home residents leading to increased vigilance and optimization of infection prevention and control practices in that setting. These data support the need for building and sustaining conventional infection prevention and c ontrol strategies before and during a pandemic.
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The diversity of the cutaneous manifestations of syphilis and the ability of the spirochete to evade diagnosis have been well documented by medical literature. However, what triggers the onset of secondary syphilis is not yet clear because of difficulties studying the bacterium. Our case describes the onset of a heterogeneous rash (or coexisting rashes) that presented the day after vaccination with the Moderna mRNA-1273 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. The potential etiologies of the patient's rash: A vaccine reaction, reactivation of chronic spontaneous urticaria, or a physical sign of syphilis itself are then reviewed. The potential for the Moderna coronavirus disease 2019 (COVID-19) vaccine to be the catalyst of this patient's cutaneous manifestations of his immune system responses is also hypothesized.
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Background and Aims: COVID-19 vaccines are vital tools for infection prevention and control of the pandemic. However, coronavirus immunization requires acceptance among healthcare workforces and by the community. In Ethiopia, studies focused on determinants of vaccine acceptance, knowledge, attitude, and prevention practices (KAP) contrary to the novel coronavirus among healthcare staff are limited. Hence, closing this gap requires research. Methods: A cross-sectional study was conducted on 844 governmental healthcare workers. A stratified, simple random sampling technique was used to select the respondents. Data were collected using a structured questionnaire. Binary and multivariable logistic regression statistical models were used to analyze the data. Results: This study indicated that only 57.9% of the participants had good COVID-19 vaccine acceptance, meaning they took at least a dose of the vaccine themselves. We found that 65%, 60.9%, and 51.3% of the participants had good knowledge, prevention practices, and attitude against the pandemic. The novel coronavirus vaccine acceptance rate was 2.19 times more likely among females (adjusted odds ratio [AOR] = 2.19 with 95% confidence interval [CI]: 1.54-3.10) than among male participants. Further, respondents who did not report having any chronic diseases were 9.40 times higher to accept COVID-19 vaccines (AOR = 9.40 with 95% CI: 4.77, 18.53) than those who reported having a chronic condition. However, healthcare workers who had a habit of chewing khat at least once per week were 4% less likely to take the vaccine (AOR = 0.04 with 95% CI: 0.01, 0.32) than those who had no habit of chewing khat. Conclusion: Many core factors influencing COVID-19 vaccine acceptance were identified. A significant number of participants had poor vaccine acceptance, KAP against COVID-19. Therefore, the government should adopt urgent and effective public health measures, including public campaigns to enhance public trust in COVID-19 vaccines. In addition, continuous, timely, and practical training should be provided to healthcare workers.
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Background and Aims COVID‐19 vaccines are vital tools for infection prevention and control of the pandemic. However, coronavirus immunization requires acceptance among healthcare workforces and by the community. In Ethiopia, studies focused on determinants of vaccine acceptance, knowledge, attitude, and prevention practices (KAP) contrary to the novel coronavirus among healthcare staff are limited. Hence, closing this gap requires research. Methods A cross‐sectional study was conducted on 844 governmental healthcare workers. A stratified, simple random sampling technique was used to select the respondents. Data were collected using a structured questionnaire. Binary and multivariable logistic regression statistical models were used to analyze the data. Results This study indicated that only 57.9% of the participants had good COVID‐19 vaccine acceptance, meaning they took at least a dose of the vaccine themselves. We found that 65%, 60.9%, and 51.3% of the participants had good knowledge, prevention practices, and attitude against the pandemic. The novel coronavirus vaccine acceptance rate was 2.19 times more likely among females (adjusted odds ratio [AOR] = 2.19 with 95% confidence interval [CI]: 1.54–3.10) than among male participants. Further, respondents who did not report having any chronic diseases were 9.40 times higher to accept COVID‐19 vaccines (AOR = 9.40 with 95% CI: 4.77, 18.53) than those who reported having a chronic condition. However, healthcare workers who had a habit of chewing khat at least once per week were 4% less likely to take the vaccine (AOR = 0.04 with 95% CI: 0.01, 0.32) than those who had no habit of chewing khat. Conclusion Many core factors influencing COVID‐19 vaccine acceptance were identified. A significant number of participants had poor vaccine acceptance, KAP against COVID‐19. Therefore, the government should adopt urgent and effective public health measures, including public campaigns to enhance public trust in COVID‐19 vaccines. In addition, continuous, timely, and practical training should be provided to healthcare workers.