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The outbreak of multiple disaster sites during the coronavirus disease 2019 (COVID-19) pandemic has presented challenges due to varying access time intensity, population density, and medical resources at each site. To address these issues, this study focuses on 13 districts and counties in Wuhan, China. The importance of each research area is analyzed using the improved PageRank and TOPSIS algorithms to determine the optimal site selection plan. Additionally, a particle swarm algorithm is used to construct an emergency material dispatching model that targets both distribution and site selection costs to solve the multi-distribution center dispatching problem. The results suggest that constructing 10 distribution centers can satisfy the demand for epidemic prevention and control in Wuhan city while saving costs associated with site selection and material distribution. Compared to the previous optimal solution, the distribution and site selection costs under the optimal solution decreased by 27.9% and 17.82%, respectively. This approach can serve as a basis for dispatching emergency materials during public health emergencies.
ABSTRACT
The outbreak of multiple disaster sites during the coronavirus disease 2019 (COVID-19) pandemic has presented challenges due to varying access time intensity, population density, and medical resources at each site. To address these issues, this study focuses on 13 districts and counties in Wuhan, China. The importance of each research area is analyzed using the improved PageRank and TOPSIS algorithms to determine the optimal site selection plan. Additionally, a particle swarm algorithm is used to construct an emergency material dispatching model that targets both distribution and site selection costs to solve the multi-distribution center dispatching problem. The results suggest that constructing 10 distribution centers can satisfy the demand for epidemic prevention and control in Wuhan city while saving costs associated with site selection and material distribution. Compared to the previous optimal solution, the distribution and site selection costs under the optimal solution decreased by 27.9% and 17.82%, respectively. This approach can serve as a basis for dispatching emergency materials during public health emergencies. © 2023 by the authors.
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For the purpose of solving the problems of missing edges and low segmentation accuracy in medical image segmentation, a medical image segmentation network (EAGC_UNet++) based on residual graph convolution UNet++ with edge attention gate (EAG) is proposed in the study. With UNet++ as the backbone network, the idea of graph theory is introduced into the model. First, the dropout residual graph convolution block (DropRes_GCN Block) and the traditional convolution structure in UNet++ are used as encoders. Second, EAGs are adopted so that the model pays more attention to image edge features during decoding. Finally, aiming at the imbalance problem of positive and negative samples in medical image segmentation, a new weighted loss function is introduced to enhance segmentation accuracy. In the experimental part, three datasets (LiTS2017, ISIC2018, COVID-19 CT scans) were used to evaluate the performances of various models;multiple groups of ablation experiments were designed to verify the effectiveness of each part of the model. The experimental results showed that EAGC_UNet++ had better segmentation performance than the other models under three quantitative evaluation indicators and better solved the problem of missing edges in medical image segmentation. © 2023 The Authors. IET Image Processing published by John Wiley & Sons Ltd on behalf of The Institution of Engineering and Technology.
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BACKGROUND: People with serious mental illness (SMI) and intellectual disabilities and/or developmental disabilities (ID/DD) living in group homes (GHs) and residential staff are at higher risk for COVID-19 infection, hospitalization, and death compared with the general population. METHODS: We describe a hybrid type 1 effectiveness-implementation cluster randomized trial to assess evidence-based infection prevention practices to prevent COVID-19 for residents with SMI or ID/DD and the staff in GHs. The trial will use a cluster randomized design in 400 state-funded GHs in Massachusetts for adults with SMI or ID/DD to compare effectiveness and implementation of "Tailored Best Practices" (TBP) consisting of evidence-based COVID-19 infection prevention practices adapted for residents with SMI and ID/DD and GH staff; to "General Best Practices" (GBP), consisting of required standard of care reflecting state and federal standard general guidelines for COVID-19 prevention in GHs. External (i.e., community-based research staff) and internal (i.e., GH staff leadership) personnel will facilitate implementation of TBP. The primary effectiveness outcome is incident SARS-CoV-2 infection and secondary effectiveness outcomes include COVID-19-related hospitalizations and mortality in GHs. The primary implementation outcomes are fidelity to TBP and rates of COVID-19 vaccination. Secondary implementation outcomes are adoption, adaptation, reach, and maintenance. Outcomes will be assessed at baseline, 3-, 6-, 9-, 12-, and 15-months post-randomization. CONCLUSIONS: This study will advance knowledge on comparative effectiveness and implementation of two different strategies to prevent COVID-19-related infection, morbidity, and mortality and promote fidelity and adoption of these interventions in high-risk GHs for residents with SMI or ID/DD and staff. CLINICAL TRIAL REGISTRATION NUMBER: NCT04726371.
Subject(s)
COVID-19 , Adult , Child , Humans , COVID-19/prevention & control , SARS-CoV-2 , Group Homes , COVID-19 Vaccines , Developmental Disabilities , Randomized Controlled Trials as TopicABSTRACT
Background: While the COVID-19 pandemic has reshaped how oncology is practiced, we sought to understand itseffects on treatment decision-making and care experiences amongst cancer patients at the Tom BakerCancer Centre in Calgary, Canada. METHODS: A 24 item, cross-sectional survey was developed based on literature review and iterative feedback fromoncology physicians, nurses, and a patient advisor. Survey domains included fear of COVID-19 andperceived risk, uptake of COVID-19 public health measures, cancer treatment decision-making duringthe pandemic, and cancer care experiences during the pandemic. Demographic, cancer and treatment-related information was obtained from the electronic medical record for patients who consented andcompleted the survey. In the first quarter of 2021, 161 patients accrued including 44 breast cancerpatients. The cohort characteristics and survey responses were summarized using descriptive statistics. RESULTS: For the 44 participants with breast cancer, all were female and the median age was 59 years (range 35-83 years). Our breast cancer cohort was almost evenly split between those with stage I-III (45.5%) andthose with metastatic disease (54.5%). Time since diagnosis was as follows: less than 1 year (17patients), 1-3 years (10 patients), 3-5 years (5 patients), and more than 5 years (9 patients). Treatmentsreceived since declaration of the pandemic Sincluded: surgery (21 patients), radiation (17 patients), chemotherapy (25 patients), endocrine therapy (25 patients), and other systemic therapies such as boneand anti-HER2 agents (15 patients). Just over half of the participants (54.5%) agreed or strongly agreedthat they were at increased risk of contracting COVID19;however, fewer patients expressed beinguncomfortable thinking about COVID-19 (45.4%), afraid of COVID-19 (38.6%), or fearful of dying fromCOVID19 (31.8%). The vast majority (>93%) of patients followed public health recommendations formitigating the risk of contracting COVID-19 (i.e. masking, frequent hand washing/sanitization, and socialdistancing) and 70.4% expressed a willingness to receive the vaccine when available. Of therespondents, 19 had undergone testing for COVID-19 at least once and 3 tested positive. Only 2 patientsreported that their surgical course was altered due to the pandemic and no patients declinedtreatments or perceived delays or modifications in therapies otherwise. Of 25 breast participants whohad experienced a cancer-related telehealth appointment during the pandemic, 21 (84%) agreed orstrongly agreed with being satisfied with the encounter. CONCLUSION: The COVID-19 pandemic caused minimal perceived disruption to care amongst a small cohort of breastcancer patients being treated at our centre. While experience with a cancer-related telehealthappointment was not universal, our findings support acceptability of its use.
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Background: The pandemic has presented professional and personal challenges for the MO workforce. CAMO sought to examine the temporal effects of C19 on MOs and care practices across Canada. Methods: Three serial multiple-choice, web-based surveys were conducted in 2020 – from Mar 30th to April 4th (S1), May 6th to May 15th (S2) and Dec 10th to 18th (S3). The surveys were distributed by email to MOs identified through CAMO and the Royal College of Physicians and Surgeons directory (n=618). Participation was voluntary with no compensation. Descriptive analyses with frequency distributions are reported. Results: The timing for S1 and S3 coincided with the 1st and 2nd C19 waves in Canada. Response rates decreased slightly: 26% S1, 25% S2 and 20% S3. Per table, demographics were similar across surveys: majority of respondents were from a comprehensive cancer centre and in practice for < 15 years. Concerns regarding PPE access and C19 personal risk decreased over time. A high rate of telemedicine was observed in S1 but this notably decreased by S3, despite the 2nd wave. A similar decreasing trend was observed in the proportion of altered chemotherapy plans due to C19. Similar levels of anxiety, depression, lack of focus and concerns for personal wellness were maintained over time. In S3, respondents noted delayed cancer diagnoses and oncologist burnout as the top 2 post-pandemic challenges, and 87% believed their workload would increase. [Formula presented] Conclusions: As the pandemic continues, positive trends can be observed in concerns around PPE access and C19 risk. A high level of telemedicine adoption was observed early in the pandemic but is decreasing, and chemotherapy plans remained unchanged for most patients. Concerns regarding personal wellness remained high across all 3 surveys. Proactive strategies to support physician wellness, mitigate burnout and manage MO workload are needed. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
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Objectives: In the integrated management of gestational diabetes mellitus (GDM), health education plays an important role and directly affects patients' blood glucose level control, pregnancies, and neonatal outcomes. The rapid growth of the internet has ushered in an era of big data and the rational use of the internet. Meanwhile, due to the COVID-19 epidemic, onsite education has been forced to adapt to online programs, including the health education of GDM. Methods: We developed an innovative mobile application (app) that combines a teaching model of the flipped classroom and GDM management, which allows pregnant women to learn knowledge about GDM and prevent GDM to a certain degree. It turns passive learners into active learners, leads them to preview before class, and takes the lead in the classroom, mobilizing learners' enthusiasm to achieve good teaching results. Results: The implementation of the online gestational diabetes flipped classroom is an innovative attempt in this field. The described approach is especially relevant in the context of the ongoing global pandemic, accelerates knowledge transfer, improves patients' learning motivation, has a health promotion effect, and boosts patients' self-management efficiency. This app can overcome the treatment barriers for those patients that cannot go to the hospital, enhance health promotion efforts, and improve GDM management. Mobile healthcare promotes doctor-patient interaction, facilitates the monitoring of and feedback on conditions, and facilitates the adjustment of patient treatment plans. Conclusions: This model of combining gestational diabetes health education with a mobile app is an exemplary approach now, and it can be promoted to other disciplines.
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Background: Available data suggest that cancer patients who contract COVID-19 may have worse outcomes, including a higher mortality compared to noncancer patients. In an effort to inform and guide our clinicians in theongoing management of cancer patients during the COVID-19 pandemic, CancerControl Alberta (CCA)implemented targeted fast-track testing for symptomatic, immunocompromised cancer patients in the ambulatorysetting. We report the results of the first 7 weeks of testing at the Tom Baker Cancer Centre (TBCC), acomprehensive tertiary cancer center serving southern Alberta (population approximately 2 million). Methods: Referral for prioritized COVID-19 testing (results within 24 hours) was intended for ambulatory cancerpatients who were identified to have symptoms consistent with an influenza-like illness and confirmed to meet atleast one of the following criteria: stem cell transplant recipient, hematologic malignancy, cancer diagnosis receiving>0.5 mg/kg/day of prednisone or equivalent, patients on immunotherapy treatment, patients on active chemotherapy within the last 3 weeks, neutropenia (ANC <500), lung cancer, chronic lung disease (e.g., COPD), or patientsreceiving curative radiation. Testing occurred on site at the TBCC at a designated drive-through testing area wherestaff, using PPE, tested patients who remained in their cars. The assay for COVID-19 was nucleic acid-based test, and patients were also tested for a standard respiratory virus panel. Patients received either a nasopharyngeal orthroat swab, for hematologic and solid tumors diagnoses, respectively. Descriptive analyses were performed. Results: Between April 15th and June 1st, 2020, 80 patients received prioritized testing at the Tom Baker CancerCentre. Patients who were tested for COVID-19 had the following characteristics: median age of 60.5 years (range19, 85) and 31% were male. The majority of tested patients (80%) met the criteria as outlined to prioritize testing.Patients with the following tumor types comprised over 80% of those tested: breast (n=22), hematologic (n=16), lung(n=9), gynecologic (n=9), and GI (n=9). The average time from screening to testing was 26.5 hours, and theaverage time from test to result was 12.8 hours. At the time of reporting, only one breast cancer patient, who justfinished chemotherapy, tested positive via the fast-track testing process;this patient received repeat clearancetesting, undergoing a total of 6 tests over one month before achieving 2 negative tests. Conclusions: Our experience demonstrates that prioritized testing for COVID-19 among those who are potentiallythe most susceptible, namely immunocompromised cancer patients, is feasible. Very few (1%) positive cases ofCOVID-19 were identified, among 80 patients tested in the first 47 days of operationalizing the fast-track testingprocess. Expedited testing should be considered as an ongoing strategy to provide guidance to clinicians inmanaging cancer patients during the COVID-19 pandemic.
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Background: The first case of COVID-19 (SARS-CoV-2, C19) was reported to Health Canada on Jan 25th, 2020.By March 18th, states of emergency were declared across multiple provinces. The pandemic has presentedprofessional and personal challenges for the medical oncology workforce and cancer care. Under the auspices ofthe Canadian Association of Medical Oncology (CAMO), we sought to examine the temporal effects of C19 onmedical oncologists and care practices across Canada. Methods: Two serial multiple-choice, web-based national surveys were conducted in 2020from March 30th toApril 4th (S1) and May 6th to May 15 , 2020 (S2). The surveys were distributed by email to medical oncologistsidentified through CAMO and the Royal College of Physicians and Surgeons Medical Oncology directory (n=618).Participation was voluntary with no compensation. Descriptive analyses with frequency distributions are reported. Results: A total of 157 completed responses were received for S1 and 159 responses for S2 (25% response rate).Demographics were similar between S1/S2: from comprehensive cancer centre (87%/86%), greater than 15 years inpractice (41%/46%), CAMO member (60%/65%). Moderate to extreme concern of C19 exposure decreased overtime for self (79%/54%), for family (82%/65%), and for patient (pt) (71%/54%). Routine use of PPE increased(67%/100%) with less concern around PPE access (69%/28%). Frequent anxiety (54%/32%) and depression(19%/14%) lessened while frequent lack of interest (18%/17%) and lack of focus (33%/31%) were unchanged. Useof telemedicine for >50% of pts remained high (82%/86%), and confidence in adequate health care access for ptsincreased (39%/59%). Centre accrual activity to clinical trials increased (46%/67%). Change in chemotherapy for>20% of pts was reported infrequently (33%/23%). Cancer prognosis and treatment benefit remained the primarydeterminant in treatment decision-making (rank score: 7.50/7.95) while resource access (6.19/5.68) and pt risk ofC19 (6.05/5.72) became less important. Conclusions: As the pandemic curve flattens and Canadian medical oncologists adjust to a new normal, positivetrends can be observed in concerns around C19 exposure, frequency of anxiety and depression, concerns aboutPPE access, confidence in health care access, and accrual to clinical trials. Chemotherapy plans remainedunchanged for the majority of pts. A high rate of early adoption of telemedicine was observed and maintained. Serialfollow-up is valuable to understand changing perceptions and practices.
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Coronavirus disease 2019 (COVID-19) is still a global epidemic. Several studies of individuals with severe COVID-19 regard convalescent plasma (CP) transfusion as an effective therapy. However, no significant improvements are found in randomized clinical trials of CP treatment. Until now, data for individuals with mild COVID-19 transfused CP were lacking. This study recruited eight individuals with mild COVID-19 who received at least one dose of CP transfusion. After CP therapy, the clinical symptoms of all individuals improved. Lymphocyte counts tended to increase, and lactate dehydrogenase, creatine kinase and aspartate aminotransferase tended to decrease. However, C-reactive protein increased transiently in three individuals. The median time for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid test to become negative was 2.5 days after CP transfusion. The study shows the potential benefits of CP. Meanwhile, CP probably enhances the inflammatory response to SARS-CoV-2 temporarily in people with insufficient antiviral immunity. However, the effects of CP are not permanent.
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Background: The covid-19 pandemic has presented unprecedented professional and personal challenges for the oncology community. Under the auspices of the Canadian Association of Medical Oncologists, we conducted an online national survey to better understand the impact of the pandemic on the medical oncology community in Canada. Methods: An English-language multiple-choice survey, including questions about demographics, covid-19 risk, use of personal protective equipment (ppe), personal challenges, and chemotherapy management was distributed to Canadian medical oncologists. The survey was open from 30 March to 4 April 2020, and attracted 159 responses. Results: More than 70% of medical oncologists expressed moderate-to-extreme concern about personally contracting covid-19 and about family members or patients (or both) contracting covid-19 from them. Despite that high level of concern, considerable variability in the use of ppe in direct cancer care was reported at the time of this survey, with 33% of respondents indicating no routine ppe use at their institutions and 69% indicating uncertainty about access to adequate ppe. Of the respondents, 54% were experiencing feelings of nervousness or anxiety on most days, and 52% were having feelings of depression or hopelessness on at least some days. Concern about aging parents or family and individual wellness represented the top personal challenges identified. The management of cancer patients has been affected, with adoption of telemedicine reported by 82% of respondents, and cessation of clinical trial accrual reported by 54%. The 3 factors deemed most important for treatment decision-making wereâ cancer prognosis and anticipated benefit from treatment,â risk of treatment toxicity during scarce health care access, andâ patient risk of contracting covid-19. Conclusions: This report describes the results of the first national survey assessing the impact of the covid-19 on Canadian medical oncologists and how they deliver systemic anticancer therapies. We hope that these data will provide a framework to address the challenges identified.