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Management literature states that a type of external shock, such as the COVID-19 pandemic, accelerates innovation processes at organisational and societal levels. Furthermore, recent studies stress that this exogenous shock spurred new policies and forced heterogeneous actors of diverse business sectors to reflect on sustainability practices. In this study, the authors concentrate on a specific business industry, such as retail, and overview the main changes during the mentioned pandemic. An appropriate starting point to understand these changes has been to conduct an analysis of the literature, searching for links between the concepts of retail, COVID-19 and sustainability. This research thus provides a snapshot of the latest academic advancements that address issues like the policy framework to recover from COVID-19, retailers’ approach to overcoming this crisis and their approach to corporate social responsibility (CSR). Finally, this chapter lists potential research directions that scholars may consider for a deeper analysis of COVID-19’s impact on retail sustainability practices. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Background: Human SARS-CoV-2 infection can induce a wide spectrum of organ dysfunctions, including microvascular impairment [1]. S1 subunit of viral receptor-binding domain binds to the angiotensin-converting enzyme 2 receptor on endothelium and S2 subunit allows the virus to enter endothelial cells. The resulting breakdown of barrier integrity drives a cascade of infammatory and thrombotic events, that aggravate the course of COVID-19 together with other risk factors [2-4]. Up to date, a lower capillary density has been reported in several distinct body districts, using sublingual video microscopy, ocular optical coherence tomography angiography, skin functional laser Doppler perfusion imaging and nailfold videocapillaroscopy (NVC) [5-8]. NVC examination has been performed in adult COVID-19 patients, however, without a control group [8]. Objectives: To confrm the statistical signifcance of the reduction in capillary density per linear millimeter evaluated by NVC in comparison with primary Ray-naud's phenomenon (PRP) patients and control subjects (CNT) and to evaluate the impact of an aggressive therapy against COVID-19 on the sparing in the number of capillaries. Methods: Sixty-one COVID-19 survivors, thirty-one PRP patients and thirty CNT age and sex-matched underwent NVC analysis. Demographic and clinical data of COVID-19 survivors were collected with special regard to concomitant therapies, that included antivirals, antibiotics, anticoagulants and anti-infamma-tory/immunomodulant drugs (glucocorticoids, hydroxychloroquine, IL-6 receptor antagonist). COVID-19 survivors were divided in two subgroups according to the severity of the active infection: thirty-four survivors with past mild-moderate disease (either unneedy for oxygen supplementation or need for Venturi mask) and twenty-seven survivors with past severe disease (need for Continuous Positive Airways Pressure and/or mechanical ventilation). The same Rheumatologist performed NVC evaluations in all patients and controls, using an optical probe, equipped with a 200x magnifcation lens and connected to a picture analysis software (Videocap, DS Medica, Milan, Italy). Absolute capillary number per linear millimeter was counted. Results: COVID-19 survivors underwent NVC examination after a mean period of 126±53 days from the disease onset. Multivariate analysis showed differences in absolute capillary number per linear millimeter (p<0.001) after adjusting for age, sex, body mass index, comorbidities and concomitant drugs. The mean (± standard deviation) absolute nailfold capillary number per linear millimeter was signifcantly lower in severe (8.2±1.15) and mild-moderate (8.4±0.75) COVID-19 survivors than in both PRP (8.7±0.68) and CNT subjects (9.3±0.53) (p<0.001). The analysis of the impact of treatments on capillary density in the severe COVID-19 patients showed a positive trend (preservation of the capillary number) with antivirals (no: 7.8±1.53;yes: 8.5±0.64;p=0.35) and anti-IL-6 receptor antagonist administration (no: 7.8±1.36;yes: 8.6±0.74;p=0.16), while none of the other drugs was shown to be effective (glucocorticoids p = 0.46;antibiotics = 0.52;anticoagulants not evaluable as they were used in all COVID-19 patients). Conclusion: SARS-CoV-2 infection seems associated to a signifcant capillary loss as distinctive NVC feature and data concerning the comparison of capillary density pre COVID-19 and post COVID-19 are desirable to reinforce this observation. The positive trend in saving the number of capillaries induced by aggressive anti-infammatory therapies in COVID-19 survivors needs larger cohorts of patients.
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This paper explores a modeling and simulation framework in healthcare following a process-centric approach. We focus on an innovative hospital service, Hospital at Home. The framework introduces a business process analysis to detect weakness and bottlenecks, including simulation to perform scenario analysis and the integration to e-Health solutions. The aim is to investigate the role of technological innovations as telemedicine and televisiting in order to explore the impact on both patient well-being and business process management. This work provides an overview of the functioning of the actual process. The outcome of the here proposed framework allows hospital managers to evaluate the extension of this kind of healthcare service, e.g. to other hospital departments or territorial contexts. The direct and positive impact of assistive technologies on the quality of life of patients, has an impact on the overall management of the organizational processes. First, we describe how this kind of service, its presence on the territory, its adaptability and the interaction with telemedicine improves benefits both for patients and operators. Second, we discuss how the approach is suitable to be applied in case of emergency situation, e.g. COVID-19. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Background: Vitamin D regulates the innate and adaptive immune system responses and low vitamin D levels have been associated with the increased risk of respiratory tract infections (1). Vitamin D deficiency has been recently reported to interfere with the prognosis of COVID-19 (2,3). Objectives: The aim of this study was to correlate the 25OH-vitamin D serum levels with lung involvement and disease severity, in a cohort of elderly patients hospitalized for SARS-CoV-2 infection. Methods: Sixty-five COVID-19 patients (mean age 76±13 years) and sixty-five sex-and age-matched control subjects (CNT) were included in the study. Respiratory parameters (PaO2, SO2, PaCO2, PaO2/FiO2), clinical and laboratory parameters (including 25OH-vitamin D, D-dimer, C-reactive protein) and type of radiological pulmonary involvement were collected at hospital admission. Statistical analysis was performed by non-parametric tests. Results: Vitamin D sufficiency (≥30 ng/ml), insufficiency (between 20 and 30 ng/ ml), deficiency (between 10 and 20 ng/ml) and severe deficiency (<10 ng/ml) were observed respectively in 11, 11, 21 and 57 % of COVID-19 patients. Vitamin D serum levels were found significantly lower in COVID-19 patients than in CNT (median 8 vs 16 ng/ml, p=0.001). A statistically significant positive correlation was observed between vitamin D serum levels and SO2 (p=0.05), PaO2 (p=0.03), PaO2/FiO2 (p=0.02). A statistically significant negative correlation was found between vitamin D serum levels and severity of radiologic pulmonary involvement: vitamin D was significantly lower in COVID-19 patients with either diffuse/ severe interstitial lung involvement (p=0.05) or multiple lung consolidations (p=0.0001) than in those with mild radiological lung involvement. Significantly lower vitamin D serum levels were found in COVID-19 patients who died during hospitalization, compared to those who survived (median 3 vs 8 ng/ml, p=0.05). Finally, a statistically significant negative correlation was found between vitamin D serum levels and D-dimer (p=0.04), C-reactive protein (p=0.04) and disease duration (p=0.05). Conclusion: This study confirms that severe vitamin D deficiency is associated with more severe lung involvement, longer disease duration and risk of death in elderly COVID-19 patients.
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Background: COVID-19 is a multifaceted condition with a wide range of clinical manifestations, including microvascular/endothelial dysfunction, that starts in the early phase of the disease and may become dramatically harmful in the late stage, causing a massive pro-thrombotic state. Nailfold videocapillaroscopy (NVC) is the most used tool to identify microvascular status in a large spectrum in a cohort of COVID-19 patients (no controls used) [2]. Objectives: To assess microvascular damage in recovered COVID-19 patients (range of 40-270 days from recovery) by considering the previous severity of the disease, and, as mandatory, the comparison with matched individuals suffering from primary Raynaud's phenomenon (PRP) and healthy volunteers (HV). Methods: NVC investigations were performed during standard clinical assessments in forty-four recovered COVID-19 patients (mean age 58±14 years, mean days from disease onset 129±54, mean days from disease recovery 106±52), twenty-two patients with PRP (mean age 60±15 years, mean years from disease onset 11±10) and twenty-two HV (mean age 60±14 years). COVID-19 patients were divided into two subgroups, according to the need of oxygen supplementation: twenty-two patients with severe lung involvement (need of Continuous Positive Airways Pressure and/or mechanical ventilation, mean age 57±12 years) vs twenty-two patients with mild-moderate lung involvement (need of Venturi mask or no need of oxygen supplementation, mean age 59±15 years). Clinical and demographic data of all the enrolled subjects were collected, during NVC examination. The following capillaroscopic parameters were evaluated: capillary number, dilated capillaries, giant capillaries, microhemorrhages, angiogenesis, disorganization of the microvascular array. A validated semiquantitative scoring (0-3) was adopted for NVC abnormalities [3-5]. Statistical analysis was carried out by non-parametric tests. Results: After COVID-19 recovery, no statistically significant difference was observed between COVID-19 patients and control groups of subjects concerning the score for the following NVC parameters: dilated capillaries, giant capillaries, disorganization of the microvascular array, angiogenesis. However, the capillary number per linear millimeter was significantly lower in COVID-19 patients (8.3±0.9) than in PRP (8.8±0.7, p=0.05) and HV (9.3±0.6, p<0.0001). Surprisingly, recovered COVID-19 patients showed significantly less microhemorrhages (score 0.4±0.3) than subjects of the other groups (PRP 0.6±0.5, p=0.01;HV 0.6±0.6, p=0.05). In particular, recovered patients who had more severe COVID-19 showed less microhemorrhages than patients with mild/moderate disease (score 0.18±0.4 vs 0.36±0.5), but this didn't reach the statistical significance (p=0.18). On the other hand, patients recovered from severe SARS-CoV-2 infection also showed higher rate of angiogenesis (0.18±0.4) than patients with mild/ moderate disease (no case, p=0.04). Conclusion: COVID-19 doesn't seem to significantly induce, in short-term, specific alterations in peripheral microvascular array as evaluated by NVC, despite the severity of the disease, except for a significant reduction of the absolute number of nailfold capillaries. The topic needs longer time of evaluation and larger number of COVID-19 recovered cases to also assess the role of concomitant therapies.
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Background: Coronavirus disease 2019 (COVID-19) outbreak is changing the approach of medical oncologists to cancer management. However, the real impact on cancer care and its potential negative consequences are currently unknown. Methods: A 29-multiple choice question anonymous online survey was shared with members of the Italian Association of Medical Oncology and the Gruppo Italiano Mammella on April 3, 2020. The objectives of the survey were to investigate the attitudes and practice of Italian oncologists before and during COVID-19 outbreak on three relevant areas in breast cancer care: 1) (neo)adjuvant setting;2) metastatic setting;3) research activities. Results: The survey was completed by 165 oncologists, of whom 121 (73.3.%) worked in Breast Units. In the (neo) adjuvant setting, compared to before the emergency, a lower rate of oncologists adopted during COVID-19 outbreak weekly paclitaxel (68.5% vs. 93.9%, P<.001) and dose-dense schedule for anthracycline-based chemotherapy (43% vs. 58.8%, P<.001). In the metastatic setting, compared to before the emergency, a lower number of oncologists adopted during COVID-19 outbreak first-line weekly paclitaxel for HER2-positive disease (41.8% vs. 53.9%, P=.002) or CDK4/6 inhibitors for luminal tumors with less aggressive characteristics (55.8% vs. 80.0%, P<.001). A significant change was also observed in terms of delaying the timing for monitoring CDK4/6 inhibitors therapy, assessing treatment response with imaging and flushing central venous devices. Clinical research and scientific activities were reduced in 80.3% and 80.1% of respondents previously involved in these activities, respectively. Conclusions: Most of the changes in the attitudes and practice of Italian oncologists were reasonable responses to the current health emergency without expected major negative impact on patients' outcomes, although some potentially alarming signals of undertreatment were observed. These data invite developing cautious recommendations to help oncologists ensuring continuous effective and safe cancer care.
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Background: Coronavirus disease 2019 (COVID-19) outbreak is changing the approach of medical oncologists to cancer management. However, the real impact on cancer care and its potential negative consequences are currently unknown. Methods: A 29-multiple choice question anonymous online survey was shared with members of the Italian Association of Medical Oncology and the Italian Breast Cancer Study Group on April 3, 2020. The objectives of the survey were to investigate the attitudes and practice of Italian oncologists before and during COVID-19 outbreak on three relevant areas in breast cancer care: 1) (neo)adjuvant setting;2) metastatic setting;3) research activities. Results: The survey was completed by 165 oncologists, of whom 121 (73.3.%) worked in Breast Units. In the (neo)adjuvant setting, compared to before the emergency, a lower rate of oncologists adopted during COVID-19 outbreak weekly paclitaxel (68.5% vs. 93.9%, P<.001) and dose-dense schedule for anthracycline-based chemotherapy (43% vs. 58.8%, P<.001). In the metastatic setting, compared to before the emergency, a lower number of oncologists adopted during COVID-19 outbreak first-line weekly paclitaxel for HER2-positive disease (41.8% vs. 53.9%, P=.002) or CDK4/6 inhibitors for luminal tumors with less aggressive characteristics (55.8% vs. 80.0%, P<.001). A significant change was also observed in terms of delaying the timing for monitoring CDK4/6 inhibitors therapy, assessing treatment response with imaging and flushing central venous devices. Clinical research and scientific activities were reduced in 80.3% and 80.1% of respondents previously involved in these activities, respectively. Conclusions: Most of the changes in the attitudes and practice of Italian oncologists were reasonable responses to the current health emergency without expected major negative impact on patients’ outcomes, although some potentially alarming signals of undertreatment were observed. These data invite developing cautious recommendations to help oncologists ensuring continuous effective and safe cancer care. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: F. Poggio: Travel/Accommodation/Expenses: Takeda;Honoraria (self), Travel/Accommodation/Expenses: Ely Lilly;Honoraria (self): Merck Sharp & Dohme;Novartis. M. Tagliamento: Travel/Accommodation/Expenses: Roche;Bristol-Myers Squibb;AstraZeneca;Takeda;Honoraria (self): Novartis. M. Di Maio: Research grant/Funding (institution): Tesaro GSK;Honoraria (self), Advisory/Consultancy: AstraZeneca;Janssen;Astellas;Eisai;Pfizer;Merck Sharp & Dohme;Takeda. L. Del Mastro: Advisory/Consultancy: Roche;Novartis;Eisai;Pfizer;AstraZeneca;Ipsen;Eli Lilly;MSD;Seattle Genetics;Genomic Health. M. Lambertini: Advisory/Consultancy: Roche;Honoraria (self): Theramex, Eli Lilly. All other authors have declared no conflicts of interest.