ABSTRACT
Introduction: Acute kidney injury (AKI) is a severe complication of coronavirus disease-2019 (COVID-19). kidney damage linked to COVID-19 could take on specific characteristics by genetic, environmental and socio-cultural factors. This study aims to evaluate incidence, risk factors and case-fatality rate of AKI in COVID-19 patients at Centre Medical de Kinshasa (CMK). Method(s): In a prospective cohort study carried out at the Kinshasa Medical Center (KMC), consecutive patients admitted to the ICU were screened for the presence of AKI from March 1st, 2020 to January 1st, 2022 period covered the first 4 waves of the Covid-19 pandemic. We included all adult inpatients (>=18 years old) with a positive COVID-19 PCR result. Patients on chronic dialysis (hemodialysis or peritoneal dialysis) and those with less than two creatinine measurements were excluded. Aki was defined according KDIGO guidelines. Univariate and multivariate analysis were performed by Cox regression to identify risk factors for AKI and association between AKI and in-hospital mortality. The significance level of p value was set at 0.05. Result(s): A total of 217 patients were included in the study of which most were males (77.0%) and blacks (80.2%). AKI was diagnosed in 63 out of 217 (29%) COVID-19 patients after a median time of 2 days (0-7). Stages 1, 2, or 3 AKI accounted for 39.7%, 11.1% and 49.2%, respectively. Hemodialysis was performed in 7.8% of the subjects and 69.8% of the survivors did not recover kidney function after AKI. Risk factors for kidney injury were first COVID-19 wave (HR: 3.1 [1.2-8.4] p=0.022), obesity (HR: 1.2 [1.02-6.7] p=0.046), higher SOFA score (HR: 6.1 [2.1-17.3] p=0.001) and CRP at day 7 (HR: 1.9 [1.1-10.0] p=0.023). Patients with AKI had a mortality rate of 57.1%. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (HR:2.96 [1.93-4.65] p=0.013) compared to non-AKI patients. Conclusion(s): AKI was present in three out of ten COVID-19 patients. The most significant risk factors for AKI were first wave, obesity, higher SOFA score and CRP. Despite dialysis, AKI has been associated with almost threefold increase in overall mortality and seven out of ten survivors did not recover kidney function after AKI. No conflict of interestCopyright © 2023
ABSTRACT
Disruptive events such as natural disasters become increasingly frequent, demonstrating the need for resilient supply systems. Additive manufacturing (AM) is an emerging technology which can help to solve supply bottlenecks as seen during SARS-CoV-2. AM was able to mitigate supply bottlenecks of medical spare parts, in times when globally arranged traditional supply sources failed. This chapter presents and discusses how AM can help to increase resilience. For this purpose, our contribution examines modern portfolio theory and the interplay of a hedged sourcing approach (traditional, formative with AM). This is assessed by using a single case study. The results indicate that using AM as a hedged source of supply to traditional supply sources increases the overall resilience of the supply system. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
The vulnerability of supply chains is more evident during crises. Recently, the COVID-19 pandemic, container ship blockades, and marine traffic jams in the Suez Canal have caused severe supply disruptions. Additive manufacturing (AM) often referred to as 3D printing, at demand sites, can solve supply disruptions. This study investigates how AM in different configurations affects supply availability. To this end, we simulate a healthcare supply chain. The simulation considers daily business demand and operational and disruptive supply risks. We measure demand, orders, stock levels, and availability indicators and compare them across supply configurations. The simulation allows identifying the most effective resilience configuration related to the cost-per-availability ratio. Overall, simulations support using AM as a risk-mitigation strategy. Copyright © 2022 Inderscience Enterprises Ltd.
ABSTRACT
Purpose In the context of the COVID-19 pandemic, this study investigates a variety of approaches to supply disruption risk management for achieving effective responses for resilience at the supply management subunit level (e.g. category of items). Drawing on the attention-based view of the firm, the authors model the attentional antecedents of supply resilience as (1) attentional perspectives and (2) attentional selection. Attentional perspectives focus on either supply risk sources or supply network recoverability, and both are hypothesised to have a direct positive association with supply resilience. Attentional selection is top down or bottom up when it comes to disruption detection, and these are hypothesised to moderate the association between disruption risk management perspectives and resilience. Design/methodology/approach Conducted at the early phases of the COVID-19 pandemic, this study employs a hierarchical regression analysis on a multicountry survey of 190 procurement professionals, each responding from the perspective of their own subunit area of supply responsibility. Findings Both attentional disruption risk management perspectives are needed to achieve supply resilience, and neither is superior in terms of achieving supply resilience. Both the efficiency of the top down and exposure to the unexpected with the bottom up are needed - to a balanced degree - for improved supply resilience. Practical implications The results encourage firms to purposefully develop their supply risk management practices, first, to include both perspectives and, second, to avoid biases in attentional selection for disruption detection. Ensuring a more balanced approach may allow firms to improve their supply resilience. Originality/value The results contribute to the understanding of the microfoundations that underpin firms' operational capabilities for supply risk and disruption management and possible attentional biases.
ABSTRACT
Purpose - The SARS-CoV-2 pandemic has had severe effects on economies worldwide and, in particular, on public institutions that must keep their operations running while supply chains are interrupted. The purpose of this study is to examine how public institutions act during a pandemic to ensure the security of supply. Design/methodology/approach - The distinct focus is if, why and how public institutions have adopted additive manufacturing (AM) - a production technology colloquially known as three-dimensional printing in which a product is created by joining raw material layer by layer based on a digital model (computer-aided design [CAD] file) of the product - in reaction to supply disruptions caused by the SARS-CoV-2 pandemic. For this purpose, four cases within the context of the pandemic supply disruption are used as the units of analysis. Findings - The findings are twofold: public institutions reacted, on the one hand, with a behavioral solution approach, trying to solve the supply disruption with new or changed forms of cooperation and collaboration. On the other hand, public institutions used a technical solution approach (TSA) as a supply disruption response and intensified their use of AM. Research limitations/implications - This research derives an implications model that focuses on the TSA. Considering the ex ante and ex post phases of the disruption, several effects of AM on resilience are identified. The most relevant is the long-term learning effect (i.e. AM data created during this disruption might also help in a new disruption). Practical implications - Practitioners who act under extreme pressure and uncertainty are informed by cases that have managed to close bottleneck situations with either a behavioral or TSA. Specific strategies are given for how public buyers could use AM within a pandemic situation to mitigate supply bottlenecks, such as increasing their robustness by localizing sourcing and increasing agility by combining traditional and additive supply sources. Additionally, insights are provided into how public organizations can increase their level of preparedness by including disruption paragraphs, establishing CAD databases, in contract clauses and keeping reserve contracts with AM service providers. Originality/value - This research contrasts behavioral and technical solution concepts for a pandemic in the public sector. Thus, it provides insights into the relative benefits of AM and causes and effect with regard to how AM affects supply robustness and agility.