Shaping a resilient future in response to COVID-19

Science today defines resilience as the capacity to live and develop with change and uncertainty, which is well beyond just the ability to ‘bounce back' to the status quo. It involves the capacity to absorb shocks, avoid tipping points, navigate surprise and keep options alive, and the ability to innovate and transform in the face of crises and traps. Five attributes underlie this capacity: diversity, redundancy, connectivity, inclusivity and equity, and adaptive learning. There is a mismatch between the talk of resilience recovery after COVID-19 and the latest science, which calls for major efforts to align resilience thinking with sustainable development action. © 2023, Springer Nature Limited.

Balancing Infectious Disease Control and Radiotherapy Risk Management Using a Novel Analytic Approach

To develop an analytic risk management method that uses mathematical models in Failure Modes and Effects Analysis (FMEA) to design mitigation efforts to control pandemic infection, while ensuring safe delivery of radiotherapy. A two-stage FMEA approach is proposed to modify radiotherapy workflow during a pandemic. In stage 1, an Infection Control FMEA (IC-FMEA) is conducted, where risks are evaluated based on environmental parameters, clinical interactions, and modeling of the pandemic infection risk. Occupancy' Risk Index (ORI) is defined as a metric of infection risk probability in each room, based on the degree of occupancy during clinical operations. ORI, in combination with ventilation rate per person (R p), is used to provide a broad infection risk assessment of workspaces. For detailed IC-FMEA of clinical processes, Infection containment failure mode (ICFM) is defined to be any instance of disease transmission within the clinic. Infection risk priority number (IRPN) has been formulated as a function of time, distance, and degree of protective measures. Infection control measures are then systematically integrated into the workflow. In stage 2, a conventional radiotherapy FMEA (RT-FMEA) can be performed on the adjusted workflow. A number of different clinical processes within radiotherapy workflow have been evaluated with this approach. The COVID-19 pandemic was used to illustrate stage 1 IC-FMEA. ORI and R p values were calculated for various workspaces within a radiotherapy clinic. A deep inspiration breath hold (DIBH) CT simulation was used as an example to demonstrate detailed IC-FMEA with ICFM identification and IRPN evaluation. A total of 90 ICFMs were identified in the DIBH process. For minimal protective measures the IRPN values ranged from 2 – 1200, while for increasing degrees of infection control the values decreased to 2-530 and 1-189 corresponding to moderate and enhanced measures respectively. The framework developed in this work provides tools for radiotherapy clinics to analytically assess risks and adjust workflows during a pandemic. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Challenges and Opportunities for Increasing Adoption of Hypofractionated Radiotherapy in Low- and Middle-Income Countries

In the advent of the COVID-19 pandemic, professional societies including the American Society for Radiation Oncology and the National Comprehensive Cancer Network recommended increased adoption of evidence-based hypofractionated radiotherapy (HFRT), with benefits including significantly reducing the number of clinical visits for each patient to minimize potential exposure to infection, and reducing treatment costs and stress on limited workforce, particularly beneficial in Low-and-Middle-Income Countries (LMICs). Despite these benefits, HFRT adoption remains low, especially in LMICs. The purpose of this study is to investigate the challenges and opportunities for increased adoption of evidence-based HFRT in LMICs. An IRB-approved survey was implemented in 18 sample radiotherapy centers in African LMIC to assess the challenges and utilization of HFRT. The experiences of three cancer centers were documented as part of an ongoing multi-center HFRT clinical trial designed to compare results with those reported for clinical trials involving North American and European Populations. Based on the findings assessed, challenges from the survey, and recorded experiences from the three centers, an online education and training program was developed in collaboration with the Global Health Catalyst, Radiation Knowledge and computer-based training tools for treatment planning, contouring, and online learning, with remote support provided by members from the international councils of ASTRO and AAPM. Only 8 of 18 surveyed clinics reported adopting HFRT as a common practice. Analysis of survey data demonstrated a significant need for training on contouring for radiation oncologists, and treatment planning and quality assurance. An education and training program was developed for implementation in the LMICs via a collaborative education model involving ASTRO and AAPM members who are faculty in USA institutions in collaboration with LMIC radiation oncology professionals. The findings demonstrate a need for additional investment in infrastructure and training, as well as better ongoing education of oncology leaders on the benefits of increased adoption of evidence-based HFRT. The project also highlights opportunities and approaches for leveraging information and communication technology for collaborative high-impact global radiation oncology education, with the participation of members across both LMIC and USA institutions and professional societies. The HFRT training program provides a template for continuous education and training to increase the adoption of evidence-based approaches to HFRT that can significantly increase improved access to radiotherapy and reduce disparities in advancing globally the practice of radiation oncology. The impact of such a program and approach will be presented and discussed. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Scoring System to Triage Patients for Spine Surgery in the Setting of Limited Resources

INTRODUCTION: As ofMay 04, 2020, the COVID-19 pandemic has affected over 3.5 million people and touched every inhabited continent. Accordingly, it has stressed health systems the world over leading to the cancellation of elective surgical cases and discussions regarding healthcare resource rationing. It is expected that rationing of surgical resources will continue even after the pandemic peak, and may recur with future pandemics, creating a need for a means of triaging emergent and elective spine surgery patients. METHODS: Using a modified Delphi technique, a cohort of 16 fellowship-trained spine surgeons from 10 academic medical centers constructed a scoring system for the triage and prioritization of emergent and elective spine surgeries. Three separate rounds of videoconferencing and written correspondence were used to reach a final scoring system. Sixteen test cases were used to optimize the scoring system so that it could categorize cases as requiring emergent, urgent, high-priority elective, or low-priority elective scheduling. RESULTS: The devised scoring system included 8 independent components: neurological status, underlying spine stability, presentation of a highrisk post-operative complication, patient medical comorbidities, expected hospital course, expected discharge disposition, facility resource limitations, and local disease burden. The resultant calculator was deployed as a freely-available web-based calculator: https://jhuspine3.shinyapps. io/SpineUrgencyCalculator/ CONCLUSION: Here we present the first quantitative urgency scoring system for the triage and prioritizing of spine surgery cases in resource-limited settings. We believe that our scoring system, while not all-encompassing, has potential value as a guide for triaging spine surgical cases during the COVID pandemic and post-COVID period.

Awareness and likelihood of accepting COVID-19 vaccines among the university students of Bangladesh

Massive vaccination is very important to end the coronavirus disease 2019 (COVID-19) pandemic. This study determined the willingness to receive a COVID-19 vaccine by the university students of Bangladesh and identified their apprehension about the effectiveness and safety of COVID-19 vaccines. Students were invited to complete an online cross-sectional survey (April 3 to June 10, 2021) to explore the intention to receive a COVID-19 vaccine and other factors regarding the responsiveness of the COVID-19 vaccine. Among the 191 respondent students, 52.9% willingly agreed to receive a vaccine, where the remaining was either not decided yet (27.7%) or was not intended to get vaccinated (15.7%). The odd of getting a vaccine were only 1.15. About 83.2% of students were conscious about the severity of COVID-19 and many students responded that they are well-versed about vaccine activity (67.5%) and risk factors (66%). Among the approved vaccines, most students preferred the Oxford-AstraZeneca COVID-19 vaccine ChAdOx1 (38.7%) and Pfizer-BioNTech COVID-19 vaccine BNT162b2 (34%). As some of the students still have lesser intent to accept vaccines, public health officials need to be more proactive to focus on vaccine safety and benefits to enhance vaccine coverage among university students of Bangladesh. © 2022, Intelektual Pustaka Media Utama. All rights reserved.

Epistemological freedom: activating co-learning and co-production to decolonise knowledge production

Purpose The purpose of the paper is to challenge and address the limitations of the traditional system of knowledge production that is embedded in disaster and climate change research studies, and research studies in general. It argues that knowledge production in research processes conforms to colonialist thinking or west-inspired approaches. Such a system often results in the omission of crucial information due to a lack of participation, inclusion and diversity in knowledge production. Design/methodology/approach The paper proposes practices and recommendations to decolonise knowledge production in disaster and climate change research studies, and research studies in general. It provides a brief literature review on the concepts of decolonisation of knowledge and epistemological freedom, and its origins;assesses the need for knowledge decolonisation, emphasising on the integration of local knowledge from grassroots women-led initiatives in instances where disasters and crises are being investigated in vulnerable communities, especially in the Global South;and finally the paper proposes to decolonise knowledge production through activating co-learning and co-production. The practices have been developed from the work of relevant authors in the field and case studies. Findings Through a brief literature review on previous discourses on the topic of knowledge decolonisation and analysis of recent case studies on disaster and crisis management and community resilience, the paper finds that there exists a lack of pluralism and inclusion in epistemology which limits the pursuit to obtain the whole truth in the production of knowledge in research studies. Originality/value This paper adds to the discussion of decolonisation of knowledge in the field of disaster and climate change research studies, and research processes in general. It provides in-depth analyses of recent case studies of emerging community resilience and local practices that were crucial in the face of the coronavirus disease 2019 (COVID-19) crisis.

Regulation, banking competition and risk-taking behavior in the MENA region: policy implications for Islamic banks

Purpose This paper aims to investigate the impact of regulation and market competition on the risk-taking Behaviour of financial institutions in the Middle East and North Africa (MENA) region. Design/methodology/approach The empirical framework is based on panel fixed effects/random effects specification. For robustness purpose, this study also uses the generalized method of moments estimation technique. This study tests the hypothesis that regulatory capital requirements have a significant effect on financial stability of Islamic and conventional banks (CBs) in the MENA region. This study also investigates the moderating effect of market power and concentration on the relationship between capital regulation and bank risk. Findings The estimation results support the view that capital adequacy ratio (CAR) has no significant impact on credit risk of Islamic banks (IBs), whereas market competition does play a significant role in shaping the risk behavior of these institutions. This study report opposite results for CBs - an increase in the minimum capital requirements is followed by an increase in a bank's risk level, which has a negative impact on their financial stability. Furthermore, the results support the notion of a non-linear relationship between banking concentration and bank risk. The findings inform the regulatory authorities concerned with improving the financial stability of banking sector in the MENA region to set their policy differently depending on the level of concentration in the banking market. Research limitations/implications This study contributes to the literature on the effectiveness of regulatory reforms (in this case, capital requirements) and market competition for bank performance and risk-taking. In regard to IBs, capital requirements are less effective in requiring IBs to adjust their risk level according to the Basel III methodology. This study finds that IBs' risk behavior is strongly associated with market competition, and therefore, the interest rates. Moreover, banks operating in markets with high banking concentration (but not necessarily, low competition), will decrease their credit risk level in response to an increase in the minimum capital requirements. As a result, these banks will be more stable compared to their conventional peers. Thus, regulators and policymakers in the MENA region should restrict the risk-taking behavior of IBs through stringent capital requirements and more intense banking supervision. Practical implications The practical implications of these findings are that the regulatory authorities concerned with improving banking sector stability in the MENA region should proceed differently, depending on the level of banking market concentration. The findings inform regulators and policymakers to set capital requirements at levels that would restrict banks from taking more risk to increase their returns. They are also important for bank managers who should avoid risky strategies in response to increased regulatory pressure (e.g. increase in the minimum required capital level of 8%), as they may lead to an increase in the level of non-performing loans, and therefore, a greater probability of bank default. A future extension of this study will focus on testing the effect of bank risk-taking and market competition on the capitalization levels of banks in the MENA countries. More specifically, this study will investigates if banks raise their capitalization levels during the COVID-19 pandemic. Originality/value The analysis of previous research indicates that there is no unambiguous answer to the question of whether IBs perform differently than CBs under different competitive conditions. To fill this gap, this study examines the influence of capital regulation and market competition (both individually and interactively) on bank risk-taking behavior using a large sample of banking institutions in 18 MENA countries over 14 years (2005-2018). For the first time in this line of research, this study shows that the level of market power is positively associated with the level of a bank' insolvency risk. In others words, IBs operating in highly competitive markets are more inclined to take a higher risk than their conventional peers. Regarding the IBs credit risk behavior, this study finds that market power has a limited impact on the relationship between CAR and risk level. This means that IBs are still applying in their operations the theoretical models based on the prohibition of interest.

How do banks' capital regulation and risk-taking respond to COVID-19? Empirical insights of ownership structure

Purpose This study aims to investigate the relationship between capital regulation and risk-taking behavior (financial stability) concerning the impacts of the recent global (COVID-19) crisis and diverse ownership structure. Design/methodology/approach The analysis uses an unbalanced panel data set from 32 commercial banks of Bangladesh for 2000-2020. The authors use the two-step system generalized method of moments and three-stage least squares to produce the study outcomes. Findings The robust results reveal that the relationship between capital regulation and risk (financial stability) is negative (positive) and bi-directional. More significantly, COVID-19 makes banks fragile and demands more capital to absorb risk. However, the effect of COVID-19 is heterogeneous when the authors consider ownership structure. Among the diverse ownership styles, Islamic and active shareholding show their controlling wheel on capital regulation and risk-taking aptitude (financial stability) during the global (COVID-19) crisis. In normal economic conditions, private banks and minority active shareholding can be a good determinant for capital regulation and risk (financial stability). On the other hand, state-owned and large banks have been found as less capitalized and highly risky. Originality/value This study is the pioneer in exploring capital regulation and risk toward the recent global (COVID-19) crisis.

Impact of Comorbidities on Clinical Outcome of Patients with COVID-19: Evidence From a Single-center in Bangladesh

Background: COVID-19 patients with preexisting comorbidities are at increased risk of exacerbated symptoms. Objectives: The current study aimed to firstly assess the impact of predisposed comorbidities on the severity of COVID-19, and secondly investigating the associated clinical outcome of patients with COVID-19 infection in Bangladesh. Methods: In this single-center retrospective study, the medical data of 157 hospitalized COVID-19 patients, including their preexisting comorbidities, from April 30, 2020, to June 15, 2020, are analyzed. Patients' clinical outcomes in moderate-to-critical COVID-19 infections need for Intensive Care Unit (ICU) and mechanical ventilation support, and mortality were evaluated, with emphasis on predisposed chronic diseases. Results: Approximately 40.1 and 7.6% of patients (n = 157) presented severe and critical COVID-19 symptoms, respectively (P = 0.001). The most common comorbidity was diabeties (24.8%), followed by hypertension (23.2). Patients with one or two comorbidities did not present critical symptoms. Most of the critical cases had at least five comorbidities compared to those with 3 or 4 comorbidities (33.3% versus 8.3%;P = 0.038). The highest incidence of critical COVID-19 (41.7%) was among those with 7 comorbidities. Compared to patients with 4 or fewer comorbidities, patients with 5 (n = 15), 6 (n = 4), and 7 (n = 7) comorbidities were more hospitalized at ICU (above 70%, P = 0.025) and had a higher need for intubation support (above 60%, P = 0.038), and presented higher 30-day mortality (6.7, 25, and 28.6%, respectively;P = 0.002), which can be attributed to the declined clinical outcome of patients with 5 or more comorbidities in moderate-to-critical COVID-19 infection. Conclusions: This study demonstrated a positive association between the severity of COVID-19 and the number of predisposed comorbidities, which leads to poor clinical outcomes.