An Alternative Food Pantry Responds to the Pandemic: A Case Study on Service Redesign

This article provides a teaching case study detailing the reaction of an alternative food pantry to the Coronavirus. The alternative food pantry provided produce, dairy, meat, and cereals to around 150 families each week before the virus. Due to social distancing and concerns about spreading infection, the food distribution process needed to be quickly modified. This paper examines the enterprise's procurement, transportation, and distribution operations before and during the virus crisis. This juxtaposition highlights the changes that the unfolding pandemic necessitated and the various ways food pantries can organize their distribution. This presents an excellent opportunity to illustrate service process redesign and service blueprinting to students in addition to highlighting the operational issues that the redesign presented. The case can be used in core undergraduate classes on operations and supply chains, specialized undergraduate courses on service management, and graduate-level classes on supply chain and service management. © 2022 NeilsonJournals Publishing.

On the Design of Integrated Tele-Monitoring/Operation System for Therapeutic Devices in Isolation Intensive Care Unit

We design a central controller system (CCS) and a tele-controlled system (TCS) with an aim of developing the integrated tele-monitoring/operation system that can enable the medical staff to tele-monitor the state of therapeutic devices utilized in the isolation intensive care unit (ICU) and to tele-operate its user interfaces. To achieve this aim, we survey the medical staff for medical requirements first and define the design guideline for tele-monitoring/operation functionality and field applicability. In designing the CCS, we focus on realizing the device having intuitive and user-friendly interfaces so that the medical staff can use the device conveniently without pre-training. Further, we attempt to implement the TCS capable of manipulating various types of user interfaces of the therapeutic device (e.g., touch screen, buttons, and knobs) without failure. As two core components of the TCS, the precision XY-positioner having a maximum positioning error of about 0.695 mm and the end-effector having three-degrees-of-freedom motion (i.e., pressing, gripping, and rotating) are applied to the system. In the experiment conducted for assessing functionality, it is investigated that the time taken to complete the tele-operation after logging into the CCS is less than 1 minute. Furthermore, the result of field demonstration for focus group shows that the proposed system could be applied practically to the medical fields when the functional reliability is improved. IEEE

Stressors Experienced by Primary Caregivers of Severe Acute Brain Injury Patients Recovering from Coma in Neurointensive Care Units: Preliminary Findings from a Multicenter Qualitative Study

Objective: To understand the psychosocial stressors reported by caregivers of severe acute brain injury (SABI) patients recovering from coma in neuroICUs. Background: Caregivers of SABI patients are at risk of developing long-term adverse psychological outcomes following neuroICU discharge, particularly those of patients admitted in a comatose state and remaining disabled. Understanding the top psychosocial stressors reported by these caregivers is critical for design of interventions to improve psychological outcomes. Design/Methods: At the time of neuroICU discharge, we conducted semi-structured, recorded interviews with 15 primary caregivers of SABI patients, all of whom were comatose for greater than 24 hours and needed tracheostomy and/or feeding tube placement. Participants were recruited as a convenience sample from 6 US centers. A codebook for psychosocial stressors was developed from open coding of the first 5 interview transcripts amongst 9 study team members. Using NVivo software, two team members then independently coded each transcript, refined the codebook, and resolved coding discrepancies. Results: Fourteen of 15 caregivers provided demographic data: 13 (92.9%) were female, 5 (35.7%) were racial minorities, and 9 (64.3%) reported fewer than 4 years of college. Six of the 15 (40.0%) patients had recovered to a Glasgow Coma Scale of 9 or higher at the time of interview. The psychosocial stressors most commonly reported by participants were: navigation of the healthcare system, including hospital visitor restrictions due to COVID-19;uncertainty about prognosis;communication with healthcare providers;juggling of practical matters beyond the hospitalization;and navigation of social relationships. Caregivers also referenced challenges with direct caregiving responsibilities, changes to the relationship dynamic with the hospitalized patient, and loss of normality. Conclusions: Across multiple US centers, caregivers of SABI patients in various stages of coma recovery at time of neuroICU discharge share a wide variety of psychosocial stressors. Interventions designed to improve psychological outcomes will need to acknowledge these stressors directly.

A follow-up on quantitative and qualitative olfactory dysfunction and other symptoms in patients recovering from COVID-19 smell loss.

BACKGROUND: Sudden smell loss is a specific early symptom of COVID-19, which, prior to the emergence of Omicron, had estimated prevalence of ~40% to 75%. Chemosensory impairments affect physical and mental health, and dietary behavior. Thus, it is critical to understand the rate and time course of smell recovery. The aim of this cohort study was to characterize smell function and recovery up to 11 months post COVID-19 infection. METHODS: This longitudinal survey of individuals suffering COVID-19-related smell loss assessed disease symptoms and gustatory and olfactory function. Participants (n=12,313) who completed an initial survey (S1) about respiratory symptoms, chemosensory function and COVID-19 diagnosis between April and September 2020, were invited to complete a follow-up survey (S2). Between September 2020 and February 2021, 27.5% participants responded (n=3,386), with 1,468 being diagnosed with COVID-19 and suffering co-occurring smell and taste loss at the beginning of their illness. RESULTS: At follow-up (median time since COVID-19 onset ~200 days), ~60% of women and ~48% of men reported less than 80% of their pre-illness smell ability. Taste typically recovered faster than smell, and taste loss rarely persisted if smell recovered. Prevalence of parosmia and phantosmia was ~10% of participants in S1 and increased substantially in S2: ~47% for parosmia and ~25% for phantosmia. Persistent smell impairment was associated with more symptoms overall, suggesting it may be a key marker of long-COVID illness. The ability to smell during COVID-19 was rated slightly lower by those who did not eventually recover their pre-illness ability to smell at S2. CONCLUSIONS: While smell ability improves for many individuals who lost it during acute COVID-19, the prevalence of parosmia and phantosmia increases substantially over time. Olfactory dysfunction is associated with broader persistent symptoms of COVID-19, and may last for many months following acute COVID-19. Taste loss in the absence of smell loss is rare. Persistent qualitative smell symptoms are emerging as common long-term sequelae; more research into treatment options is strongly warranted given that even conservative estimates suggest millions of individuals may experience parosmia following COVID-19. Healthcare providers worldwide need to be prepared to treat post COVID-19 secondary effects on physical and mental health.

Approaching ICU families in person versus by phone for organ donation authorization

INTRODUCTION: COVID-19 forced conversations between ICU patients' families and organ procurement organizations (OPOs) by phone, as opposed to in-person. We hypothesized that a phone approach of a patient's family would be a negative predictor of donation authorization success. METHODS: We conducted a retrospective observational study of a database of ICU patients from 2017-2020 whose families had been approached by New England Donor Services for organ donation. We excluded approaches of registered potential donors after brain death because authorization was already secured. In addition to whether OPO approach occurred in person or by phone, we extracted data on patient and surrogate demographics, OPO representative training, and ICU-to-OPO transitions. The outcome of interest was successful donation authorization. Univariate and multivariate analyses were conducted to determine predictors of successful authorization. RESULTS: Among 2240 approaches of potential organ donors, OPO approaches by phone constituted 221/1282 (17%) of successful authorizations, as opposed to 134/958 (14%) of failed attempts (p=0.04). No significant betweengroup differences were observed amongst racial subgroups. Amongst all successful authorization approaches, mean patient age was lower (43.3 vs. 45.1, p=0.008);and higher percentages of white/non-Hispanic patients (75.8 vs. 63.3, p< 0.001), previously registered potential DCD donors (78.2 vs. 21.8, p< 0.001), parents as the key family surrogate (43.6 vs. 33.8, p< 0.001), OPO representatives being specially trained in authorization approach (91.2 vs. 79.5, p< 0.001), and ICU-OPO collaborative donation processes (85.4 vs. 72.7, p< 0.001) were seen. Fewer unplanned mentions of donation by ICU staff were seen among successful authorizations (12.3 vs. 22.3, p< 0.001). In a multivariate model, phone approach, patient age, and unplanned hospital mentions no longer had significant associations with successful authorization, but the other variables above were all strong predictors. CONCLUSIONS: OPO approach by phone is not a barrier to successful organ donation. Strategies for successful approaches should focus instead on cultivating a collaborative process between ICU teams and OPOs and prioritizing the involvement of OPO representatives with special training for discussing authorization.

Isolation and genomic analyses of an early sars-cov-2 strains from the 2020 epidemic in gwangju, south korea

Since the first identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in China in late December 2019, the coronavirus disease 2019 (COVID-19) has spread fast around the world. RNA viruses, including SARS-CoV-2, have higher gene mutations than DNA viruses during virus replication. Variations in SARS-CoV-2 genome could contribute to efficiency of viral spread and severity of COVID-19. In this study, we analyzed the locations of genomic mutations to investigate the genetic diversity among isolates of SARS-CoV-2 in Gwangju. We detected non-synonymous and frameshift mutations in various parts of SARS-CoV-2 genome. The phylogenetic analysis for whole genome showed that SARS-CoV-2 genomes in Gwangju isolates are clustered within clade V and G. Our findings not only provide a glimpse into changes of prevalent virus clades in Gwangju, South Korea, but also support genomic surveillance of SARS-CoV-2 to aid in the development of efficient therapeutic antibodies and vaccines against COVID-19. © This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License.

Tweet Sentiment Analysis for Predicting the Symptoms Effect Level Regarding COVID-19

From the end of 2019, numerous comments and opinions relating to the COVID-19 pandemic have been posted on Twitter. The number of opinions rapidly increased since the countries began implementing social isolation and reduction. In these comments, users often express different emotions regarding COVID-19 signs and symptoms, the majority of which are sadness and fear sentiments. It is important to determine the symptom effect level for the emotions of symptomatic persons based on their opinions. However, no study analyzes the tweets' sentiment related to the COVID-19 topic to predict the symptoms effect level. Therefore, in this study, we present a method to predict the symptoms effect level based on the sentiment analysis of symptomatic persons according to the following steps. First, the sentiments in tweets are analyzed by using a combination of the text representation model and convolutional neural network. Second, a topic modeling model is built based on the latent Dirichlet allocation algorithm to group symptoms into small clusters that conform to sadness and fear sentiments. Finally, the symptom effect level is predicted based on the probability distribution of the symptoms in each sentiment cluster. Experiments using tweets promise that the proposed method achieves significant results toward the accuracy and obtained information.

Low-Field, Portable Magnetic Resonance Imaging at the Bedside to Assess Brain Injury in Patients with Severe COVID-19

Objective: To obtain neuroimaging on patients with COVID-19 using a low-field, portable magnetic resonance imaging (MRI) device. Background: Neuroimaging is a key step in the clinical evaluation of brain injury. Conventional MRI systems operate at high-strength magnetic fields (1.5-3T) that require patient transportation to access-controlled environments. During the COVID-19 pandemic, critically ill patients have had limited neuroimaging due to infection control and safety concerns. We report neuroimaging in patients with severe COVID-19 using a portable MRI device. Design/Methods: A 64mT point-of-care (POC) MRI was used to acquire neuroimaging in Yale New Haven Hospital ICUs from April 2020 through August 2020. COVID-19 patients with neurological symptoms and no MRI contraindications were scanned. Exams were acquired using a standard 110V/15A power outlet. Hospital rooms included vital signs monitors, ventilators, dialysis machines, and intravenous infusion pumps. Images were acquired by trained research staff, without the need for an MRI technician. POC MRI exams were interpreted by two boardcertified physicians (one neuroradiologist and one neurologist). Results: POC MRI exams were obtained on 22 ICU COVID-19 patients (19% female, ages 42-74 years, 86% mechanically ventilated). Glasgow Coma Scale and Richmond Agitation-Sedation Scale at time of scan were 7±3 and-3±2, respectively. T1-weighted (T1W), T2-weighted (T2W), fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI) sequences were obtained for all patients. Axial scan times were 4:54 minutes, 7:03 minutes, 9:31 minutes, and 9:04 minutes, respectively. Examination time was 35:40 minutes. Abnormal neuroimaging findings were observed in 10 patients: Intracranial hemorrhage (n=2), cerebral infarction (n=4), diffuse cerebral edema (n=1), and leukoencephalopathy (n=3). The device did not interfere with ICU equipment, and no significant adverse events occurred. Conclusions: We report the acquisition of neuroimaging using a low-field, portable MRI at the bedside of patients with severe COVID-19. This approach may hold promise for bedside assessment of neurological injury in settings with imaging access constraints.

Impact of obstructive sleep apnea and positive airway pressure therapy on COVID-19 outcomes

Introduction: We explore the impact of obstructive sleep apnea (OSA) and positive airway pressure (PAP) therapy on novel coronavirus (COVID-19) infection rate and severity. Methods: Retrospective analysis was performed utilizing a database of patients evaluated by Kaiser Permanente Southern California sleep medicine between 2015-2020 (includes sleep study, daily PAP, and electronic health record data.) Adult patients were analyzed if: on March 1, 2020 patient was alive, had ≥1 month health-plan enrollment, and had sleep diagnostic or PAP data. PAP adherence was calculated between March 1, 2020 to COVID-19 confirmation, death, disenrollment or study end date (July 31, 2020), whichever came earlier. COVID-19 outcomes were evaluated based on OSA status and PAP adherence: patients with PAP <2 hours/ night were considered “untreated”;≥2 hours/night were “treated”;2-3.9 hours/night were “moderately-treated”;≥4 hours/night were “well-treated”. Apnea hypopnea index (AHI) defined OSA severity. Multiple logistic regression evaluated the association of various demographic/clinical factors. Results: Of 81,932 patients (39.8% female, age 54.0±14.9 years) analyzed, 1493 (1.8%) had COVID-19 with 224 (0.3%) hospitalizations and 61 (0.07%) resulting in intensive care or death. Increased severity of “Untreated” OSA was associated with higher COVID-19 rate and lower when “treated” [No OSA 1.7%;Mild 2%;Moderate 2%;Severe 2.4%;OSA unknown severity 2%;Treated 1.4%;p<0.0001]. Better PAP adherence was associated with reduced infection rate [“untreated” 2.1%;“moderately-treated” 1.7%, “well-treated” 1.3%, No OSA 1.7%;p=<0.0001]. Multivariable analysis confirmed increased infection rate with OSA versus no OSA [OR 0.82(0.70,0.96)] and the benefit of good PAP adherence versus “untreated” [“moderately-treated” OR 0.82 (0.65, 1.03);“well-treated” OR (0.69 (0.59, 0.80)]. Increased infection rate was also associated with obesity, higher Charlson Comorbidity score, Black and Hispanic ethnicities, and Medicaid enrollment;increasing age was associated with reduced infection rate. Separate multivariable analysis showed dose-response association of OSA severity on infection rate [Mild OR 1.21 (1.01,1.44 95%CI);Moderate- Severe OR 1.27 (1.07,1.51) versus no OSA]. Neither OSA presence nor PAP adherence significantly impacted rate of hospitalization nor intensive care or death. Conclusion: Significant associations emerged with OSA increasing and PAP therapy reducing COVID-19 infection rate. Findings support continued PAP use during the pandemic.

Dynamic phenotype learning: A novel machine learning approach to develop and discover new osa sub-types

Introduction: Current approach to processing polysomnography is labor intensive and produces metrics that are poor at identifying obstructive sleep apnea (OSA) phenotypes necessary to enhance personalized care. We describe our approach to utilize Dynamic Phenotype Learning (DPL) as an innovative machine learning technique to identify OSA subtypes that can better predict clinical risk and success with therapies. Methods: This study is a collaboration between Kaiser Permanente Southern California (KPSC), a large integrated health system, and EnsoData Research, which specializes in applied A.I. analysis of physiologic waveforms. KPSC sleep medicine compiled a database of N=5,368-234,250 subjects that include Types I, II, III, or IV sleep study data, daily PAP data, patient reported data, and comprehensive electronic health record information, with present research applications to study the relationship between OSA and PAP adherence with cardiovascular outcomes, health economic impacts, novel coronavirus (COVID-19) outcomes, and predictive PAP adherence and OSA severity clinical decision tools. DPL is a machine learning method for studying known and new biomarkers and care-pathway indices, including personalized screening, diagnostic, treatment, adherence, and outcomes predictors, that can be rooted in physiologic data. DPL processes waveform signal data without scoring, annotations, or expert synthesis, by applying a novel machine learning mechanism that blurs supervised and unsupervised deep learning paradigms, to find relationships between physiome dynamics expressed in waveforms and phenotypes and endotypes of interest. Results: We demonstrate DPL method with an illustrative study on known indices, to explain its ability to (1) lift theoretical-empirical predictive accuracy ceilings and (b) reduce several sources of bias and variance. We show DPL exceeds the ROC-AUC and PRC-AUC of equivalent deep learning models in N=30,000 Report-Demographic (ODI, PLMSI, Weight), Scoring (REM, OSA), and Waveform (EEG, PPG) datasets respectively to predict AHI, TST, Brain Age, and OSAInsomnia. We present our current collaboration advancing DPL to identify specific phenotypes that better predict: (a) cardiovascular risk;(b) neurocognitive outcomes;(c) response to PAP and alternative therapies. Conclusion: DPL methods are being applied to large and comprehensive patient dataset to identify phenotypic indices and biomarkers with potential to take us beyond the AHI, and uncover relationships between OSA sub-types, treatments, and health outcomes.

Innovative solutions to improve protection from airborne pathogens during retinal imaging and examination

Purpose : To develop and evaluate custom solutions for ophthalmologists when performing retinal examination on patients with airborne communicable disease. Methods : Two solutions were developed for viewing and imaging patients with airborne communicable disease. The first solution was a custom indirect ophthalmoscope barrier shield consisting of a 3D printed bracket and laser cut shield. The shields were mounted using a rubber band fastening device to allow easy removal and cleaning. The bracket spaced the shield from the user to prevent fogging and heat generation. The central aperture allowed an unobstructed view of the retina. The second solution was a hand-held off the shelf portable fundus camera used with a Controlled Air-Purifying Respirator (CAPR) for providers examining patients in negative pressure rooms. Clinical viability was assessed with a survey completed by providers. Results : Providers completed the survey after use. No fogging obscured view of the retina. Ergonomically, the provider was able to maneuver and perform indirect ophthalmoscopy to the periphery. Spacing of the shield allowed use with a N95 and prevented heat buildup. The portable fundus camera was used with a CAPR successfully allowing the user to maintain full PPE while taking fundus photos of patients on airborne precautions. It was possible to use an N95 mask with the CAPR to prevent transmission of airborne particles from the user. Conclusions : There is a need for improved personal protective equipment due to the spread of COVID-19. Both solutions allowed ophthalmologists to maintain airborne precautions when examining patients. The first solution was compatible with a N95 mask and provided an additional face shield. This solution allowed viewing of the macula as well as far periphery. The second solution allowed use of a CAPR, making it suitable for providers who do not fit N95 masks. Photographs of the macula and mid-peripheral retina were possible with this option and dilation was not needed for examination. However, peripheral retinal viewing was more limited compared with the first option.

Icu visitor restriction policies and approaches to family engagement during the COVID-19 pandemic

INTRODUCTION: Communication with family members of ICU patients has changed dramatically during the COVID-19 pandemic. To investigate these changes, we interviewed site project leaders among ICUs that had participated in the Family Engagement Collaborative (FEC), a shared learning experience begun by SCCM in September 2019 that promoted ICU family engagement projects among participating sites before being cancelled in March 2020 due to COVID-19. METHODS: We developed a structured set of survey questions regarding the impact of COVID-19 on ICU family visitation and engagement and assessed content validity via an iterative process amongst FEC leadership. From June 9 to July 17, we contacted the site leader of all 27 ICUs that had participated in the FEC and administered the survey by phone. We also asked site leaders to provide a copy of their current visitor restriction policy. RESULTS: 22/27 (81.5%) site leaders participated. When asked about the peak of the pandemic in their respective ICUs, 2 sites (9.1%) reported having had a strict no-visitor policy without any exceptions. The remaining sites all reported a variety of exceptions, with a majority allowing visitation for patients at the end-of-life. Regarding current policies, all sites now have some visitor restriction exceptions in place, but with significant variability;at least half (12, 54.5%) of sites now permit at least 1 visitor for non-COVID patients during defined visitor hours. Four sites (21.1%) reported that their hospital did not provide PPE to visitors. 16 sites (84.2%) were unclear of their hospital's timeline for further relaxing visitor restrictions. All but 1 site (95.5%) reported now using video conferencing with families;however, 10 sites (47.6%) reported clinicians' using their own personal devices for conferencing. Among hospitals providing devices for staff, approximately 1 device had been provided on average for every 13 ICU beds. CONCLUSIONS: While ICU visitor policies have somewhat relaxed since the peak of the pandemic, there is considerable uncertainty about how policies might change moving forward. ICUs need additional resources to provide PPE for visitors and to ensure adequate video conferencing capabilities on hospital devices.

Lessons learned from the sccm family engagement collaborative prior to the COVID-19 pandemic

INTRODUCTION: The Family Engagement Collaborative (FEC) was a year-long shared learning experience begun by SCCM in September 2019 that utilized educational webinars, conference calls, listserv communications, and centralized family and clinician data collection to promote ICU family engagement projects among participating sites. We describe lessons learned from the FEC up to the point at which it was cancelled due to COVID-19, at a time when most sites had just begun local project implementation. METHODS: During an orientation period, sites reported on their selected local projects via scheduled conference calls and an online listserv. All sites also planned individual methods of assessing project impact via pre- and postimplementation data collection, with the option of utilizing an SCCM REDCap database for FS-ICU 24R and IPFCC Clinician Survey data starting in January 2020. After the FEC was cancelled in March 2020, each site leader was contacted to participate in a structured phone exit interview. RESULTS: Among 27 actively participating ICUs, the most common projects were creating ICU orientation videos, packets, or educational programs (12, 44.4%) promoting structured family care conferences (6, 22.2%), and implementing ICU diaries (5, 18.5%). 212 FS-ICU 24R surveys and 346 IPFCC Clinician Surveys collected across sites before project implementation highlighted a broad need for improving family support. After cancellation, 22 site leaders (81.5%) completed an interview. 20 sites (90.1%) reported stopping their project implementation due to the pandemic. The only 2 sites that continued projects were implementing (1) a standardized palliative extubation protocol and (2) daily written summaries for families of non-decisional patients. When all site leaders were asked to rate how helpful the FEC had been from a scale of 0-10, mean response was 8.0 (SD 2.5). Seven leaders (25.9%) suggested that a future FEC could benefit by focusing more on sites implementing a specific standardized project, as opposed to promoting a variety of different ideas. CONCLUSIONS: While the pandemic had a profound impact on sites' implementation of family-centered care projects that are of clear need, participants found value in the FEC's educational and communication model and provided actionable feedback for future iterations.

3D printing novel PPE for response to covid-19 related shortages

COVID-19 disruptions to the global supply chain have caused a shortage of personal protective equipment (PPE) at healthcare facilities world-wide. Traditional manufacturers are unable to fill the demand for equipment. Additive manufacturing has been able to help slacken the need by creating novel PPE. Over 8000 reusable filtered masks, over 10,000 face shields, and testing equipment were created with the combined efforts of healthcare organizations, academic institutions, community maker organizations, and creative industry partners. © 2020 SPIE