ABSTRACT
Objectives: To evaluate how payers utilize Institute for Clinical and Economic Review (ICER) assessments to inform coverage or formulary decisions. Method(s): Double-blinded, web-based survey was fielded through Xcenda's research panel, the Managed Care Network, from June to July 2022. Result(s): A total of 51 payers from health plans (n=27), integrated delivery networks (n=12), and pharmacy benefit managers (n=12) participated in the survey. When assessing the usefulness of ICER's value assessment framework (VAF) to inform formulary decisions within their organizations, 57% of payers indicated it was extremely/very useful, 33% indicated somewhat useful, and 10% indicated not at all/not very useful. Most respondents (73%) agreed that ICER assessments are aligned with their organization's internal assessment. Utilization of ICER's VAF was most prevalent in high-cost drug or disease states (78%), rare/orphan disease states (71%), and oncology/hematology disease states (67%). Payers reported less use in primary care disease states (29%), COVID-19 (8%), and digital therapeutics (4%). In the last 24 months, 20% of payers reported ICER's recommendations often influenced coverage decisions, 59% indicated occasional influence, and 22% indicated no influence. In the last 24 months, payers indicated the top 5 ICER assessments that influenced their coverage decisions included high cholesterol (38%), Alzheimer's disease (36%), atopic dermatitis (33%), multiple myeloma (31%), and chemotherapy-induced neutropenia (28%). ICER assessments that were less impactful included beta thalassemia (3%), digital health technologies (3%), and supervised injection facilities (3%). Payers reported using ICER assessments to inform both expanded and restricted coverage decisions. Conclusion(s): Payers find ICER's VAF useful to inform their organization's formulary decisions. ICER's assessments often align with payers' internal assessments and are most frequently utilized for high-cost drugs or disease states. Payers indicate ICER assessments have affected both expansion and restriction in their coverage policies.Copyright © 2023
ABSTRACT
This paper investigates the role of global confidence cycles, measured as the common factor across a wide range of survey-based business or consumer confidence indicators in global macroeconomic fluctuations over 1985–2019. We estimate a factor-augmented vector autoregression model, where global confidence shocks are identified through recursive restrictions. We report three main results. First, the global confidence cycles—in particular, that of consumer confidence—have played a key role in global business cycle fluctuations, explaining over a third of total variations. Second, while global business confidence shocks are in nature demand driven, global consumer confidence seems to reflect both demand and supply shocks, in line with "animal spirit” and "news” views on the relationship between confidence and economic activities. Third, the shifts in global confidence are not necessarily accounted for by uncertainty shocks. Instead, confidence acts as an important channel in the transmission of uncertainty shocks. The results are robust to alternative identification using a novel set of external instruments, alternative variable orderings, and different uncertainty measures. © 2023, European Central Bank. All rights reserved.
ABSTRACT
The ongoing COVID-19 pandemic has forced the fashion industry to digitalize the conventional work system. Fashion designers were required to work from home, and textile trade shows were held online. However, fabric suppliers were unable to present their fabrics in a manner that enabled their properties to be easily understood. Visual information, such as photographs, videos, and the brief explanations provided by fabric suppliers were insufficient for fashion designers to comprehend the fabric's properties. Thus, this research aims to identify the critical information for fashion designers in their digital fabric search and to discover effective ways to present this information. The current state of online tactile information was analyzed by conducting content analysis on several online fabric retailers. Then, semi-structured one-on-one in-depth interviews with 25 fashion designers were conducted to identify the strengths and weaknesses of the existing types of visual and textual information. Results revealed the most effective ways to present fabrics online. Specific guidelines were established for photographing or writing each type of information. Finally, a conceptual framework for fabric tactile communication in digital environments was developed. This study can contribute to the improvement of a designer's experience in online fabric markets and can be used as a fundamental guide on designer's tactile perception of fabrics, which can support technologies, such as haptic devices and 3D clothing simulation software. © 2022, The Author(s).
ABSTRACT
Purpose: This study aimed to measure the influence of infection control fatigue and compassion competence on disaster nursing core competencies of nurses at COVID-19 designated hospitals. Methods: A descriptive survey was conducted among 128 nurses from two COVID-19 designated hospitals. Data were collected from June 1 to 14, 2022 and analyzed using the t-test, one-way analysis of variance, Pearson correlation coefficients, and hierarchical multiple regression with SPSS for Windows version 26.0. Results: Disaster nursing core competencies had a significant correlation with compassion competence (r=.50, p<.001), but not with infection control fatigue. Multiple regression analysis for disaster nursing core competencies revealed that the most powerful predictor was communication (β=.31, p<.001). Communication, insight and having children explained approximately 30% of the variance in disaster nursing core competencies. Conclusion: The compassion competence of nurses at COVID-19 designated hospitals was a major factor influencing disaster nursing competence. Communication was the most important sub-factor of compassion competence. It will be necessary to develop and implement a program to enhance nurses' compassion competence to improve nurses' disaster nursing core competencies. © 2022 Korean Academy of Fundamentals of Nursing.
ABSTRACT
Introduction: Ischemic necrosis of dermal flaps is a devastating complication of reconstructive surgery. The increasing prevalence of diabetes, obesity, and an aging population adds to this concern. Hypoxia-inducible factor-1alpha (HIF-1alpha), a master regulator of the adaptive response to hypoxia, controls the expression of angiogenic growth factors. The development of biologically active, gene-specific mRNAs, especially in COVID-19 vaccines, has shown the ability for intracellular protein expression. We sought to express HIF-1alpha through mRNA transfection and determined its biological activity by measuring the upregulation of selected downstream targets. Method(s): 5'-methyl-capped poly-A tailed mRNA was generated using T7 RNA polymerase and verified by gel electrophoresis. Predominant and variant HIF-1alpha mRNA were transfected into primary human dermal fibroblasts via Lipofectamine in triplicate, and RNA levels were assessed using RT-qPCR. All gene expression levels were normalized to beta-actin expression levels Results: At one day after transfection, the levels of HIF-1alpha transcript were significantly higher in the cells transfected with predominant (p = 0.0104) and variant (p = 0.0007) HIF-1alpha transcripts relative to the control. Additionally, the expression of HIF-1alpha transcription product genes VEGF (p = 0.0274) and ANG-1 (p = 0.05) were significantly higher in the cells transfected with the HIF-1alpha transcripts than the control. Conclusion(s): Our approach led to the successful transfection of HIF-1alpha mRNA into human fibroblasts, resulting in upregulation of HIF-1alpha downstream angiogenic targets. Thus, the use of biologically active HIF-1alpha mRNA transfection offers a promising approach to inhibit ischemic necrosis.
ABSTRACT
Since early 2020, the number of COVID-19 cases has continued its rise and fall worldwide, greatly impacting sectors such as health outcomes, economics, housing, and transportation. To mitigate the spread of the pandemic, governments implemented various measures to reduce the mobility of the population, restricting international travel, hierarchical lockdowns, stay-at-home mandates, and work-from-home orders. In this aspect, early studies in the transportation field showed large changes in travel behaviour. However, we know less about the long-term impact of COVID-19 on people's travel behaviour. This paper explores the change in commute behaviour during the pandemic, focusing on the resilience index of transit users and its determining factors. The hist gradient boosting model was the most precise when compared with linear and other machine learning models (considering R2, MSE, MAE). The results suggested the following: (1) commuters' trips decreased unevenly in Seoul. Through machine learning algorithms, social-economic factors, and accessibility, 50% of the heterogeneity can be explained. (2) Consumer and Service Industry and Foreigner Tourism were impacted negatively continually. Neighbourhoods with higher car ownership and a higher percentage of female residents show long term weak public transit resilience. (2) Short distance commuters (less than 20 minutes) and commuters visiting city centres, returned to public transport in the second year after avoiding it during the first year of the pandemic. Considering the uneven negative results of COVID-19, this research can be a reference for policy design and effective decision making.
ABSTRACT
Background: Due to COVID pandemic, there have been increased needs for ECMO circuits to support patients with respiratory failure1. Unfortunately, due to pharmacokinetics alteration of commonly used sedative and psychotropic medications by the ECMO circuits2,new sedation approaches to manage delirium and agitation is required. We present a case of COVID pneumonia patient on ECMO support, whose delirium symptoms were managed with a novel psychopharmacotherapy protocol. Case: Mr. M is a 57-year-old male patient with past medical history of obesity, hypertension, admitted to Stanford Hospital due to COVID pneumonia, complicated by respiratory failure, required to be on Veno-Venous ECMO support with bridge to transplant. He had significant hyperactive delirium with Richmond Agitation-Sedation Scale (RASS) score of +3 and ICDSC score of 7 for most of the days, despite heavy conventional pharmacological sedation. We observe the same problems with most patients placed on the ECMO system, leading to an investigation and development of a new protocol. Discussion: Patient on ECMO support requires adequate sedation to prevent clinical deterioration that can result from hyperactive delirium (ie., chugging, blood clots or decannulation)2. Nevertheless, ECMO circuit’s significant alterations of drug pharmacokinetics, such as increased volume of distribution and sequestration of lipophilic and protein bound medications, with no clear guidelines on managing sedation/delirium in patients with ECMO support at this time2, we conducted an extensive literature search and developed a novel protocol. This new sedation approach includes alpha-2 agonists, opioids, barbiturates and calcium channel modulators with the lowest lipophilicity and protein binding potential of each medication in its class4,5,thus overcoming the challenges introduced by ECMO circuits. The new protocol allowed the patient to participate in lung transplant work-up, physical therapy, and eventually facilitated receiving bilateral lung transplantation. Conclusion/Implications: ECMO is a life saving device that can help patient with cardiac-respiratory failure, and its use has been increasing in clinical practice. However, there needs to be an improvement in successful sedation/delirium management to minimize adverse events, and optimize the success of this lifesaving technologies. References: 1. Cho HJ, et al. ECMO use in COVID-19: lessons from past respiratory virus outbreaks-a narrative review. Crit Care. 2020 Jun 6;24(1):301 2. deBacker J, et al. Sedation Practice in Extracorporeal Membrane Oxygenation-Treated Patients with Acute Respiratory Distress Syndrome: A Retrospective Study. ASAIO J. 2018 Jul/Aug;64(4):544-551 3. Lemaitre F, et al. Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood. Crit Care. 2015;19(1):40 4. Hansch C, et al. Hydrophobicity and central nervous system agents: on the principle of minimal hydrophobicity in drug design. J Pharm Sci. 1987 Sep;76(9):663-87 5. Bockbrader HN, et al. A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. Clin Pharmacokinet. 2010 Oct;49(10):661-9
ABSTRACT
The ongoing COVID-19 pandemic has caused a recession in the fashion industry. Therefore, this study aims to assess the influence of face masks on the selection of fashion products by Korean women in their twenties and thirties. This is highly relevant as the mandatory donning of face masks becomes a social norm. To this end, an in-depth interview and a survey were conducted. The results indicate that wearing a face mask affects consumers' fashion selection criteria in regard to styles, materials, colors, and types. Face masks have gradually contributed to the unification and simplification of fashion styles due to the atmosphere and wearing of the mask itself, which has led to a decline in the overall interest in fashion. Most consumers in this study felt a dis-connect between face masks and fashion products, since the former have not been established within most fashion styles. Consequently, consumers had difficulty naturally aligning face masks with various fashion styles, which eventually led to a decreased interest in fashion. This study is significant in that it provides objective data that can be utilized to establish strategies in the fashion industry regarding the integration of face masks © 2022. The Korean Society of Clothing and Textiles. All rights reserved.
ABSTRACT
The COVID-19 pandemic has brought unprecedented growth to the e-commerce industry, triggering widespread digital service transformation across various business segments in Vietnam. A pressing concern for both businesses and policymakers is whether the sudden peak in customer interest in e-commerce can be sustained in the future. This research seeks to address this concern by considering whether and how customers' motivations to participate in e-commerce activities have changed. We collected primary data from a self-administered survey to empirically examine how health and safety concerns influence customers' online shopping behavior during the pandemic, alongside other known determinants for e-commerce participation, namely technology readiness and connectedness. The results confirm that health and safety concerns have a positive influence on customers' usage of e-commerce after controlling for technology readiness and connectedness. Furthermore, customers in age groups with higher risks of severe COVID-19 symptoms and mortality are more likely to increase e-commerce usage during the social distancing and isolation period. Our results support the idea that the customer base for e-commerce and digital services have expanded beyond the typical tech-savvy and young customers in their twenties. These are promising signs for postpandemic recovery and even expansion, as firms may leverage the momentum of change in customers' motivations and start tailoring their public relation campaigns to address a wider age range of potential consumers.
ABSTRACT
Background/Objectives: This study investigated nurse-related keywords which were presented together with nurse on phrase, clauses or sentence of documents or conversations in the Korea online newspaper articles. Methods/Statistical analysis: Text mining, which is a common method of analysis for large datasets, was used to analyze the changes in nurses’ image before and after COVID-19. A total of the linking words with nurse were calculated by the number of presentation on online newspaper article in Naver before and after COVID-19. In order to identify the meaning of the words, clustering of the collected linking words by categories was analysed and the characteristics of each cluster were classified. Over 5,000 articles were identified as targets for a keyword analysis. Findings: The most frequently presenting words were hospital, medical and patient. Before COVID-19, the words related to ‘workplace bullying’ were highly presented and after COVID-19, the words related to ‘care’ were highly presented. Improvements/Applications: With analyzing the trends of changes and characteristics of words by COVID-19 and clusters, we attempted to investigate the image of nurse that the public think and feel about nurse.
ABSTRACT
Objectives: To assess the healthcare utilization (HCRU) among the patients who received care via telehealth during the COVID-19 pandemic. Methods: A retrospective 6-month pre-post analyses was conducted utilizing HealthJump data. Adult patients with incident telehealth visit (index date) between Feb 1st–April 30th, 2020 were identified, using the CMS CPT codes in conjunction with the description of encounters. Patients were required to be continuously enrolled in the baseline and follow-up period and should have zero telehealth visit in the baseline period. Age, gender and diagnosis on the index date were summarized for the sample. During the baseline and follow-up period, proportion of patients having >=1 visits for the following HCRU visits were evaluated and compared using McNemar’s test: (a) Office visits, (b) Inpatient visits, (c) Consultations, (d) Emergency Department visits, (e) Critical Care, (f) Nursing Facility, (g) Home Services, (f) Preventive care, (g) Mental Health (h) Non-face to Face (F2F) services. A subset analyses was conducted among patients with COVID-19 diagnosis. Results: 27,169 patients with a mean(SD) age of 50.15(17.11) and predominantly female (62.4%) were included in study. Hypertension, hyperlipidemia, anxiety disorder, type 2 diabetes mellitus and chronic obstructive pulmonary disorder were the top diagnoses associated with the index telehealth visit. Compared to baseline period, patients had a significant increase in outpatient (18 percentage points, p<0.0001) and non-F2F (13 percentage points, p<0.0001) visits and significant decrease in inpatient, consultation, emergency room, nursing facility and preventive visits during the follow-up period. Of the sample, 534 patients had COVID-19 diagnosis with a mean(SD) age of 49.9(16.04) and were predominantly female (61.6%). Similar decrease and increase in HCRU were observed in the subset of COVID-19 patients in our study. Conclusions: During COVID-19 pandemic, patients utilizing telehealth experienced similar shift in the HCRU, especially in outpatient & non-F2F visits, irrespective of the COVID diagnosis.
ABSTRACT
Background: Ascites is a common, painful, and dangerous complication of cirrhosis Body weight is a reliable proxy for ascites volume Therefore, daily weight monitoring is recommended to optimize ascites management Methods: In this feasibility study, cirrhotic patients requiring ascites management were enrolled in the inpatient or outpatient setting Patients were given a Bluetooth-connected scale, which transmitted weight data to the PGHD Connect Smartphone App, and then via the cloud to the electronic medical record (EMR) Weights were monitored every weekday In the event of a weight change 5lbs in 1 week, patients were called and administered a short symptom questionnaire, and providers received an email alert The primary outcomes were percentage of enrolled days during which weight data was successfully transmitted to the EMR, and the percentage of weight alerts which prompted a response by the provider Results: 37 patients were enrolled from January 2019 to June 2020: 19 (51%) male, mean MELD score of 15 8 (SD 5 6), mean age 61 years (range 35-81), and 22 (59%) were enrolled as inpatients Cirrhosis etiology was non-alcoholic steatohepatitis in 32%, alcohol in 32%, and viral in 11% Seven patients (19%) patients were on a single diuretic at enrollment, 24 (65%) were on two diuretics, and 6 (16%) were on no diuretics Weight data was successfully transmitted to the EMR during 71% of study enrollment days, with technology issues reported on 10% of days Patients were more likely to weigh themselves in the morning, with 1067 weights transmitted before noon and 142 transmitted after noon Of 111 weight alerts to date, 57 (51%) were triggered by weight loss and 54 (49%) by weight gain Providers responded in some way to 96 (79%) weight alerts, and actively intervened in response to 53 (43%), for example by contacting the patient, scheduling clinic or paracentesis appointments, modifying the diuretic dose or requesting laboratory workup 17 of 37 (46%) patients prompted both weight increase and weight decrease alerts during the study period, 10 (27%) prompted only weight decrease alerts, 5 (13%) prompted only weight increase alerts, and 5 (13%) patients prompted no alerts There were 22 readmissions for any reason over the course of the study period 24 (65%) patients opted to extend their participation beyond the initial 28-day study period Conclusion: We demonstrate feasibility of a telemonitoring system to facilitate ascites management We report excellent rates of patient and provider engagement, including during the COVID-19 era This innovation could enable early therapeutic intervention, decreasing the burden of morbidity and mortality among cirrhotic patients.