Evaluation of 3-D printed swabs for respiratory sampling and testing for SARS-CoV-2 during the early pandemic period (preprint)

Appropriate collection of respiratory samples is essential for accurate diagnostic testing of respiratory pathogens such as, SARS-CoV-2. Early in the pandemic, there was a shortage of nasopharyngeal (NP) swabs and difficulty in sampling suspected cases. Therefore, we developed a 3D printed nasal swab for anterior nares, paired with in-house viral transport medium (VTM). The utility of this 3D swab kit was investigated in comparison with the standard NP commercial swab and VTM, in 200 individuals between August and September 2021. Subjects were those presenting for diagnostic testing for SARS-CoV-2 using the RT-PCR (cobas Roche assay) assay. NP samples were taken from each subject using the standard NP and 3D swabs followed by RT-PCR on paired specimens. CT values for amplification of gene targets were evaluated to determine assay parameters based on viral load cut offs of [≤] CT 35 or, [≤] CT 37. For high to medium viral loads, 3D swab based PCR testing had a sensitivity of 93%, specificity of 99%, positive predictive value (PPV) of 98.5% and negative predictive value (NPV) of 96.2% respectively. For low viral loads, 3D swab testing had a sensitivity of 88%, specificity of 99%, with a PPV of 98.5% and NPV of 93.2%.%. 3D swab sampling of anterior nares was comparable with NP sampling using standard swabs for SARS-CoV-2 specimens with a medium to high viral load. Therefore, 3D swab based sampling is a reliable and convenient local solution for collecting respiratory samples for SARS-CoV-2 diagnostic testing.

Application of six sigma and the system thinking approach in COVID-19 operation management: a case study of the victorian aged care response centre (VACRC) in Australia

COVID-19 has posed many unique and critical challenges in various contexts and circumstances. This often led the stakeholders and decision-makers to depart from traditional thinking and the business-as-usual processes and to come up with innovative approaches to tackle various mission-critical situations within a short time frame. In this paper, a real-life case study of COVID-19 operation management following a multi-disciplinary, multi-stakeholder novel integrated approach in aged care facilities in Victoria, Australia, is presented which yielded significant and positive outcomes. The purpose of the intervention was to develop an integrated system performance approach through the application of various quality management tools and techniques to achieve organizational excellence at the aged care centers. The case involved the use of mathematical models along with statistical tools and techniques to address the specific problem scenario. A system-wide management plan was proposed, involving various agencies across several residential aged care facilities during the pandemic. A three-step methodological framework was developed, where Six Sigma, a system thinking approach, and a holistic metric were proposed to manage the value chain of the pandemic management system. The experimental result analyses showed significant improvement in the management process, suggesting the validity and potential of this holistic approach to stabilize the situation and subsequently set the conditions for operations excellence within the sectors. The model offers new insight into the existing body of knowledge and offers an efficient approach to achieving operational excellence in any organization or business regardless of its type, shape and complexity, which can help practitioners in managing complex, mission-critical situations like a pandemic.

Implementation barriers and facilitators to a COVID-19 intervention in Bangladesh: The benefits of engaging the community for the delivery of the programme.

BACKGROUND: BRAC (Bangladesh Rural Advancement Committee), the largest NGO globally, implemented a community-based comprehensive social behavior communication intervention to increase community resilience through prevention, protection, and care for COVID-19. We conducted implementation research to assess fidelity and explore the barriers and facilitators of this intervention implementation. METHODS: We adopted a concurrent mixed-method triangulation design. We interviewed 666 members of 60 Community Corona Protection Committees (CCPCs) and 80 members of 60 Community Support Teams (CSTs) through multi-stage cluster sampling using a structured questionnaire. The qualitative components relied on 54 key informant interviews with BRAC implementers and government providers. RESULTS: The knowledge about wearing mask, keeping social distance, washing hands and COVID-19 symptoms were high (on average more than 70%) among CCPC and CST members. While 422 (63.4%) CCPC members reported they 'always' wear a mask while going out, 69 (86.3%) CST members reported the same practice. Only 247 (37.1%) CCPC members distributed masks, and 229 (34.4%) donated soap to the underprivileged population during the last two weeks preceding the survey. The key facilitators included influential community members in the CCPC, greater acceptability of the front-line health workers, free-of-cost materials, and telemedicine services. The important barriers identified were insufficient training, irregular participation of the CCPC members, favouritism of CCPC members in distributing essential COVID-19 preventive materials, disruption in supply and shortage of the COVID-19 preventative materials, improper use of handwashing station, the non-compliant attitude of the community people, challenges to ensure home quarantine, challenges regarding telemedicine with network interruptions, lack of coordination among stakeholders, the short duration of the project. CONCLUSIONS: Engaging the community in combination with health services through a Government-NGO partnership is a sustainable strategy for implementing the COVID-19 prevention program. Engaging the community should be promoted as an integral component of any public health intervention for sustainability. Engagement structures should incorporate a systems perspective to facilitate the relationships, ensure the quality of the delivery program, and be mindful of the heterogeneity of different community members concerning capacity building. Finally, reaching out to the underprivileged through community engagement is also an effective mechanism to progress through universal health coverage.

Perceptions and Intention of Healthcare Workers’ to Vaccinate Their Children Aged <18 Years against COVID-19 from A Tertiary Care Institute of Eastern Uttar Pradesh (U.P.), India (preprint)

Abstract Background COVID-19 vaccination program among Adults in India is one of the highly successful vaccination drives globally. Indian children aged 15–18 years old became eligible for COVID-19 vaccination on 3rd January, 2022 followed by 12-14 years old children on 16th March, 2022. As parents are primary decision-makers for their children, we aimed to assess parents' perceptions and intentions regarding COVID-19 vaccination for children in India. Aim To assess parental perceptions and intention to get COVID-19 vaccination for their children (aged<18 years), Materials and Methods A cross-sectional anonymous web-based survey was designed. Healthcare workers of a tertiary care institute in Eastern U.P. having any children aged <18 years were the study population. They were recruited through snowball sampling and were sent the study questionnaire in Google form through email and WhatsApp. Cross-tabulation was performed by parents' intention to vaccinate their children against COVID-19 virus with socio-demographic characteristics and their risk perception toward COVID-19, trust in the healthcare system, and their history of vaccine hesitancy behavior routine childhood immunization. Bi-variate analysis was performed to find out the predictors of child vaccination intention among the parents. Results A total of 388 healthcare workers parents (HCWPs) having A child < 18 years of age completed the survey. Mean age of the parents were 40.28 ±11.34 years with majority(97.0%) completing recommended 2 doses of COVIID-19 vaccine. Around 91% of the parents agreed that COVID-19 vaccines are important for child’s health whereas about 89% agreed to the statement that COVID-19 vaccines are effective. A total 356 (91.7%) participants were willing to vaccinate their child against COVID-19, 91.3% of them liked to do so as soon as possible. The factors significantly associated with the stated likelihood of child vaccination among the participants were younger age, female gender, urban residence, absence of any chronic illness, lower monthly income, history of COVID-19 in child and the child/children completed with routine childhood vaccines. Parental concerns mainly centered around vaccine need, safety and side effects. Conclusion The healthcare worker parents(HCWPs) have good knowledge and positive attitude towards COVID-19 vaccination for children. Around 92% of them were willing to vaccinate their children with COVID vaccine currently, which implies very low vaccine hesitancy among the HCWPs . Further longitudinal studies are required to be conducted to assess the trend of parental acceptance of COVID vaccine.

The Most Effective Leadership Style in Pursuit of Resilient Supply Chain: Sequential Mediation of Flexibility and Agile Supply Chain

[...]several organizations faced stock-outs as they were unable to match supplies with demand. The effective leadership style ensures the innovative behaviour of employees (Afsar et al., 2014;Xu et al., 2017) and innovation allow organizations to building SC resilience (Ozdemir et al., 2022). [...]SC resilience literature suggested that strong commitment, decisional flexibility, proactive behavior, learning and innovation are important contributors of SC resilience (Ali & Gölgeci, 2019;Sawyerr & Harrison, 2020;Scholten et al., 2020). [...]the current novel study will address this literature gap as the relationship between leadership styles and resilient SC has not been previously tested. (2020), Ali & Gölgeci (2019), Sawyerr & Harrison (2020) and Remko (2020);all of them suggested to investigate the behavioural aspects of SC managers in pursuit of SC resilience as this phenomena has not been addressed in existing literature. [...]the second objective of this explanatory study is to investigate the most effective leadership style of SC managerial leaders in pursuit of resilient SC through the comparison of transformational and transactional leadership styles.

Effect of increased screen time on eyes during COVID-19 pandemic.

Purpose: The objective of the study was to assess the effect of increased screen time on ocular health during the coronavirus disease (COVID-19) crisis. Materials and Method: An online pretested, self-reported questionnaire with relevant details was generated through Google form and sent to participants. Chi-square or Fisher's exact test was used to investigate the associations between the qualitative variables. The associated risk factors of number and frequency of ocular health problems were analysed by univariate and multivariate logistic regression. Result: A total of 435 responses were considered where 48.5% (N = 211) were female participants and 51.5% (N = 224) were male. Average age of the participants was 35 years. 89% of the participants reported an increase in the screen time during the during the lockdown period. Younger age group reported to have greater screen time than the older participants (p = 0.001) and hence experienced more symptoms of digital eye strain (DES) (p = 0.003). The most common symptoms associated with digital eye strain in our study were eyestrain 52.8% (N = 230) and headache 31.3% (N = 136). In total, 81.37% (354/435) of participants had experienced at least one symptom related to digital screen usage. Conclusion: DES is non-vision-threatening but discomfort caused due to it can have implications on overall physical, mental, and social well-being. The study highlights the increase in digital screen time during the pandemic and the resultant eye strain. There is need of spreading awareness regarding the adverse effects of digital device use and the preventive measures to safeguard our ocular health.

Prevalence and correlates of knowledge and practices regarding infection prevention and control, and triage in primary healthcare settings: A cross-sectional study in Bangladesh.

Background: Despite the high prevalence of healthcare-acquired infection in resource-limited settings, healthcare workers' (HCWs') knowledge and practices of infection prevention and control (IPC) and triage are not well-researched. We examined thisin Bangladesh's primary healthcare facilities (HCFs) during the COVID-19 pandemic. Methods: We surveyed 312 HCWs in 94 community clinics (CCs) and 90 family welfare centres (FWCs) in six districts from February to April 2021. We assessed HCWs' self-reported knowledge and observed practices in four domains: personal hygiene, medical instrument processing, waste management, and triage. We constructed a weighted composite knowledge score and estimated the association between knowledge and background characteristics using a generalised linear mixed effects model. Practices were described through univariate analysis. Findings: On a scale of 100, the mean composite knowledge score was 38.3 (SD: 13.3) overall and 44.0 (SD: 13.1) and 33.8 (SD: 11.6) for FWCs and CCs, respectively. The HCWs of FWCs were more aged, experienced, and educated than those of CCs. Knowledge score was the highest in personal hygiene and the lowest in medical waste segregation. Knowledge was significantly associated with HCWs' designation and education. Concerning practices, not more than one-third of the HCWs or HCFs, on average, followed the recommended protocols, except for wearing face masks while on duty (87.1%) and referring potential COVID-19 patients to higher-level facilities (68.3%). Conclusions: HCWs' capacity in instrument processing, waste management, and triage needs to be improved through formal education and training initiatives. Our study can contribute to the under-researched IPC and triage domains in resource-limited settings.

Application of six sigma and the system thinking approach in COVID-19 operation management: a case study of the victorian aged care response centre (VACRC) in Australia

COVID-19 has posed many unique and critical challenges in various contexts and circumstances. This often led the stakeholders and decision-makers to depart from traditional thinking and the business-as-usual processes and to come up with innovative approaches to tackle various mission-critical situations within a short time frame. In this paper, a real-life case study of COVID-19 operation management following a multi-disciplinary, multi-stakeholder novel integrated approach in aged care facilities in Victoria, Australia, is presented which yielded significant and positive outcomes. The purpose of the intervention was to develop an integrated system performance approach through the application of various quality management tools and techniques to achieve organizational excellence at the aged care centers. The case involved the use of mathematical models along with statistical tools and techniques to address the specific problem scenario. A system-wide management plan was proposed, involving various agencies across several residential aged care facilities during the pandemic. A three-step methodological framework was developed, where Six Sigma, a system thinking approach, and a holistic metric were proposed to manage the value chain of the pandemic management system. The experimental result analyses showed significant improvement in the management process, suggesting the validity and potential of this holistic approach to stabilize the situation and subsequently set the conditions for operations excellence within the sectors. The model offers new insight into the existing body of knowledge and offers an efficient approach to achieving operational excellence in any organization or business regardless of its type, shape and complexity, which can help practitioners in managing complex, mission-critical situations like a pandemic.

Environment and Health: Need to Rebuild and Maintain Balance

Adaptation is one of the most important virtues for the survival of any organism, including humans. During the past few decades, the issue of climate change has been considered one of the most significant problems faced by humanity and has been debated extensively. The surge of pandemic COVID-19 affected virtually every aspect of our life, including the world economy, education, development, etc. to an apparent standstill. It took the life of our near and dear and left several with irreversible damage. COVID-19 reminds us of lessons about responding to climate change and behavioral responses to global challenges. The re-emergence and increasing burden of human Monkeypox cases are also getting global attention. Every disease has its remedy;we just have to decode it. If we want to reverse the degradation of our environment, we must take some difficult actions and modify our habits and behaviors. The required personal changes are at times difficult and sometimes manageable and straightforward. Through proper environmental health engineering, we must concentrate on a different level of prevention. When the environments where we live, work, and play are safe and free of risks that might harm people's health, we are said to be living in good environmental health.

Knowledge and practices related to COVID-19 among mothers of under-2 children and adult males: a cross-sectional study in Bangladesh.

OBJECTIVES: To assess the knowledge and practices related to COVID-19 among Bangladeshi mothers with children aged 2 years or less and adult males. DESIGN: We conducted a cross-sectional study to assess the knowledge and practices using a multistage cluster sampling technique. SETTINGS: Six districts with high COVID-19 infection rates in Bangladesh. PARTICIPANTS: 2185 mothers of under-2 children and 657 adult males were surveyed in December 2020. MAIN OUTCOME MEASURES: We constructed weighted composite knowledge and practice scores and examined associations between composite scores and background characteristics using linear regression models. RESULTS: Knowledge on possible routes of transmission of the novel coronavirus and the critical handwashing and mask-wearing etiquettes was poor. On a scale of 100, the mean composite knowledge scores of mothers and adult males were respectively 33.5 (SD=15; 95% CI 32.9 to 34.1) and 38.2 (SD=14.8; 95% CI 37.1 to 39.4). In contrast to knowledge, adult males obtained lower practice scores than mothers, primarily due to poor physical distancing practices. The mean practice scores of mothers and adult males were 63.0 (SD=18.1; 95% CI 62.3 to 63.8) and 53.4 (SD=17.5; 95% CI 52.0 to 54.7). Moreover, education, household income and access to television and the internet are significantly associated with knowledge. People residing proximal to a city revealed higher knowledge than the relatively distant ones. This was also the case for practice scores; however, the other factors associated with knowledge did not have a significant association with practices. CONCLUSIONS: In general, both mothers and adult males presented with poor knowledge and practices related to COVID-19. While local, national and international institutions should design and implement educational interventions to help improve knowledge, our research shows that mere knowledge may not be enough to ensure practice. Hence, authorities could reinforce positive social norms by setting benchmarks and introducing rewards or sanctions to improve practices.

Attitude, perceptions and willingness to receive COVID-19 vaccine and its associated factors among general population of Uttar Pradesh, Northern India.

Background: Several vaccines have been developed and tested against COVID-19 around the globe. Vaccine hesitancy and misinformation poses major challenges to the achievement of coverage and population immunity. Understanding key determinants that influence the preferences and demands of a COVID-19 vaccine by the community may help to develop strategies for improving coverage. Objectives: To assess willingness to receive coronavirus disease 2019 (COVID-19) vaccine and identify the factors associated with it among the general population of Uttar Pradesh, North India. Material and methods: A web-based cross sectional study was conducted in the month of May 2021 among the unvaccinated general adult population of Uttar Pradesh, Northern India adopting an exponential, non-discriminative snowball sampling technique. A bilingual, self-administered anonymous semi-structured questionnaire in google form was designed and sent to the study participants through social media platform, WhatsApp. Data collected were extracted into excel sheets and was analyzed using SPSS software, version 21.0. Bivariate analysis was performed to identify the key determinants for vaccine acceptance among the participants. Result: Out of 254 participants completing the questionnaire, 219 (86.2%) showed willingness to receive a COVID-19 vaccine, whereas 10 (4.0%) admitted hesitancy and 25 (9.8%) were not sure. Younger age-group (18-44 years), female gender, absence of any co-morbidity, lower education level, current employment status, positive history of confirmed COVID-19 infection in the person and positive history of confirmed COVID-19 infection in any family member/friend were the factors found to be significantly associated with the willingness to receive a COVID-19 vaccine. Conclusion: During the second wave of COVID-19 pandemic in India, high acceptance for COVID-19 vaccination was found among the general population of Uttar Pradesh, whereas concerns about vaccine safety may hinder the actual vaccine uptake.

Artificial Intelligence-Based Portable Bioelectronics Platform for SARS-CoV-2 Diagnosis with Multi-nucleotide Probe Assay for Clinical Decisions.

In the context of the recent pandemic, the necessity of inexpensive and easily accessible rapid-test kits is well understood and need not be stressed further. In light of this, we report a multi-nucleotide probe-based diagnosis of SARS-CoV-2 using a bioelectronics platform, comprising low-cost chemiresistive biochips, a portable electronic readout, and an Android application for data acquisition with machine-learning-based decision making. The platform performs the desired diagnosis from standard nasopharyngeal and/or oral swabs (both on extracted and non-extracted RNA samples) without amplifying the viral load. Being a reverse transcription polymerase chain reaction-free hybridization assay, the proposed approach offers inexpensive, fast (time-to-result: ≤ 30 min), and early diagnosis, as opposed to most of the existing SARS-CoV-2 diagnosis protocols recommended by the WHO. For the extracted RNA samples, the assay accounts for 87 and 95.2% test accuracies, using a heuristic approach and a machine-learning-based classification method, respectively. In case of the non-extracted RNA samples, 95.6% decision accuracy is achieved using the heuristic approach, with the machine-learning-based best-fit model producing 100% accuracy. Furthermore, the availability of the handheld readout and the Android application-based simple user interface facilitates easy accessibility and portable applications. Besides, by eliminating viral RNA extraction from samples as a pre-requisite for specific detection, the proposed approach presents itself as an ideal candidate for point-of-care SARS-CoV-2 diagnosis.

Does market concentration affect wholesale electricity prices? An analysis of the Indian electricity sector in the COVID-19 pandemic context

This study explores whether the market concentration affects the wholesale prices of electricity generation among Indian companies by drawing 15-min frequency data related to electricity production, wholesale prices, and electricity demand in August 2020 during the COVID-19 pandemic. The ARDL model estimates show a positive relationship between market concentration and wholesale energy prices. The study recommends the adoption of policies to reduce market concentration and enhance clean energy development.

Discrepancy between PCR based SARS-CoV-2 tests suggests the need to re-evaluate diagnostic assays (preprint)

Objective: To investigate the possible cause of discrepancy between clinical and RT-PCR based diagnosis of patients with COVID-19.Results: Laboratory records of ten patients with mild to severe COVID-19 were examined. Initially, respiratory samples from the patients were tested using the Roche SARS-CoV-2 Cobas assay and were found to be negative. Further investigation for other viral causes of pneumonia was conducted using the Filmarray RP2.1 assay, which identified SARS-CoV-2 as the pathogen in all ten cases. To investigate whether this could be due to discrepancies between PCR assay, additional testing was conducted using the TaqPath TM COVID19 PCR. Eight of ten samples were positive for SARS-CoV-2 on the TaqPath assay. Further, Spike gene target failures (SGTF) were identified in three of these eight cases. Discrepancy between the three PCR assays could be due to variation in PCR efficiencies of the amplification reactions or, could be due to variation in the primer binding sites. The identification of strains with SGTF identify the possible presence of new SARS-CoV-2 variant strains. Regular modification of gene targets in diagnostic assays may be necessary to maintain robustness and accuracy of SARS-CoV-2 diagnostic assays to avoid reduced case detection, under-surveillance, and missed opportunities for control.

Airway, voice and swallow outcomes following endotracheal intubation and mechanical ventilation for COVID-19 pneumonitis: preliminary results of a prospective cohort study (preprint)

Introduction: The coronavirus pandemic has resulted in unprecedented rates of patients requiring intubation and ventilation over a short period of time. The authors present 3-month data on airway, voice and swallow outcomes for this cohort to better understand the impact of COVID-19 critical illness on laryngotracheal morbidity.  Methods: An observational cohort study was performed on all patients discharged following critical illness at our tertiary institution over a 2-month period (1st March 2020 - 30th April 2020). Patients were stratified on the basis of primary diagnosis: COVID-19 pneumonitis, Non-COVID-19 respiratory failure and non-respiratory. Our primary outcome measure was reported airway, voice, and swallow dysfunction during inpatient admission and on 6-12 week Critical Illness Recovery Clinic follow up. Endoscopic findings of patients referred onward to our Multidisciplinary Laryngology-Speech Therapy Clinic were recorded.Results: 141 patients were included in our study. During inpatient admission there were no statistically significant differences in reported rates of airway, voice, or swallow dysfunction. In Critical Illness Recovery Clinic, there were markedly higher rates of reported airway, voice and swallow dysfunction in the COVID-19 pneumonitis cohort, although these rates only reached statistical significance in respect to airway outcomes (airway p=0.038, voice p=0.064, swallow p=0.240). 100% of patients reviewed to date in the Laryngology-Speech Therapy Clinic following COVID-19 critical illness had clinically significant laryngeal pathology.Conclusion: Our data highlights an impending surge in COVID-19 related laryngotracheal morbidity. Robust, prospective screening and clear referral pathways for all patients following COVID-19 critical illness are essential to identifying and managing this cohort.