Optimization of process parameter for theaflavin extraction from black tea (Camellia sinensis) as an inhibitor potential of rdrp SARS-CoV-2 using response surface methodology

Theaflavins and their derivatives such as theaflavin gallate have shown a broad spectrum of antiviral activity against several viruses, including influenza A B and hepatitis C viruses. Theaflavins could inhibit RdRp activity through blocking the active site in the catalytic pocket of RdRp in SARS-CoV-2, SARS-CoV and MERS-CoV. The extraction process is carried out using distilled water as solvent. The effect of three independent variabels: temperature (70-90°C), time (5-25 minutes), and solvent-solid ratio (30:1 - 50:1) on the extraction process of theaflavin from black tea were investigated. Response Surface Methodology was applied for optimization of the three process parameters and expressed at the second-order polynomial. The research showed that temperature was the most influencing variable for the theaflavin extraction from black tea (Camellia sinesis). The optimal condition for the extraction of theaflavin from black tea were performed at temperature of 90°C, 25 minutes and solvent: solid ratio 50:1 (ml/g). © 2023 Author(s).

Clinical Profile, Immunosuppressive Managment and Outcome in Adult Renal Allograft Recipients with Covid-19 Infection: A Case Series from Single Centre in Bangladesh

Introduction: The Novel Coronavirus disease 2019 (COVID-19), a respiratory infection has become a global concern. Given to the extent of the COVID-19 pandemic, it has been explored that Renal Allograft Recipients are considered high risk group for unfavourable outcome due to multiple comorbidities, long term immunosuppressive medications and residual CKD. This case series demonstrates clinical characteristics and outcome of COVID-19 infection in Renal Allograft Recipients. Method(s): Here we present 20 adult Renal Allograft Recipients admitted with moderate to severe symptom and RT PCR confirmed COVID-19 infection at united hospital limited from August 2020 to December 2021. We assessed demographic characteristics, comorbidities, clinical and laboratory parameters, radiological findings, immunosuppressive management and outcome. Result(s): Among all,15 patients were male with median age 55 years (range,34-75years). Mean time interval between renal transplantation were 90 months (24-132 months). Common comorbidities were hypertension (n=19), DM (n=18), lung diseases (n=13), IHD (n=9). Fever (100%) was most common symptom followed by cough(80%), sore throat(75%), and diarrhoea(60%). Nine (45%) patients who presented with dyspnoea during admission further progressed to poor outcome. During admission mean baseline creatinine was 1.51mg/dl(0.66-3.1 mg/dl), 15 patients had lymphopenia and 11 patients had higher inflammatory markers like high ferritin level, CRP, procalcitonin, LDH and D-dimer. Total 15 patients had abnormal HRCT findings and most common finding was unilateral or bilateral Ground glass opacity followed by consolidation, pleural effusion and interlobular septal thickening with mean TSS scoring being 8 (range 4-16). All patients were on triple immunosuppressive regimen (antimetabolites, CNI, low dose steroid).After admission antimetabolites were withdrawn in all patients, CNI were continued in 10 patients, 50% reduction in 2 patients, complete cessation of CNI in 8 patients and low dose steroids were switched to dexamethasone 6mg/ day. Other treatments included antiviral (Favipiravir, Remdisivir), antibiotics, LMWH followed by Rivaroxaban. Total 3 patients received Tocilizumab and Convalescent plasma was administered in 2 patients. Among all, 18 patients received different form of oxygen therapy, 9 patients were transferred to ICU, 7 patients required mechanical ventilation and 4 patients developed ARDS. 8 patients had other bacterial or fungal coinfection. six patients developed AKI and 2 of them needed Renal replacement therapy (RRT). Total 4 patients of AKI and 1 patient who required RRT finally expired. Total 6 patients died and after a median 18 days of admission. Conclusion(s): In this case series we describe 30% mortality rate. Older age, severe symptom specially dyspnoea during presentation, multiple comorbidities, high inflammatory markers, high baseline creatinine developing AKI, high TSS score at HRCT and requirement of mechanical ventilation were associated with high risk of death. No conflict of interestCopyright © 2023

European Dendroecological Fieldweek (EDF) 2021 in Val Müstair, Switzerland: International education and research during the pandemic

The European Dendroecological Fieldweek (EDF) is a one-week course that takes place every year at varying locations in Europe according to the principle "Bring tree-ring research to the people”. The EDF welcomes early-career to advanced researchers, but also forest service and other federal agency employees and private people interested in tree-ring sciences from all over the world. It encompasses a large spectrum of dendrochronological field, laboratory and data analysis methods and scientific fields including climatology, ecology, physiology, geomorphology and archaeology. Multiple scales of observations from the individual cell to the ecosystem level and from seasonal to multi-centennial periods are covered. Work on mini research projects in topic groups alternates with keynote lectures and individual participants' presentations. As one of the first in-person tree-ring meetings since the start of the COVID-19 pandemic the 31st EDF was held in summer 2021 in Val Müstair, Switzerland. Topics included i) Tree age and climate sensitivity of a relict, old-growth Scots pine stand, ii) Blue intensity-based climate sensitivity of Norway spruce growth, iii) Tree rings as indicators of grey larch budmoth outbreaks, iv) Growth of larch trees along an abandoned irrigation channel, v) Wood anatomical characteristics of two alpine creeping shrub species, and vi) Historical dating of a stable and a residential house. Alongside with their educational value these projects allowed novel insight into the age structure and growth dynamics of the sub-alpine forests and beyond in the valley and provided valuable outcome to the local stakeholders such as the Nature Park Biosfera Val Müstair, the local forest service and the public of Val Müstair. Under hindered conditions due to the pandemic, the 31st EDF still demonstrated its strength as an international educational and interdisciplinary scientific field and lab course, combining teaching with the application of cutting-edge technologies. © 2023

Analyzing the Barriers to Building a 3-D Printing Enabled Local Medical Supply Chain Ecosystem

Building a local supply chain requires separating the regions and creating alliances with local partners and customers, resulting in a new business model. In local supply chains, the factory procures material, parts, and preassembled elements from local suppliers and sells the final products to local customers. Three-dimensional printing (3DP) has the potential to enable a more local, globally connected, and efficient supply chain through reduced inventory and transportation costs transforming the make-to-stock to the make-on-demand production cycle. In this study, we use an integrated Interpretive Structural Model and Decision-making Trial and Evaluation Laboratory technique to explore and assess the challenges faced by the 3DP companies to become enabling partners in the localized supply chains. The scope of the study, which was limited to 3DP of medical parts and components, identified that regulatory compliance, stringent quality standards, and lack of design expertise are significant barriers to developing localized three-dimensional printing ecosystems. Furthermore, the study identified immediate support from the local government, the high collaboration between the stakeholders, and the need for change in business approach as the key drivers for developing 3DP-enabled localized supply chain ecosystems. IEEE

MACROGLOSSIA IN THE SETTING OF COVID-19

SESSION TITLE: COVID-19 Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Macroglossia is a rare but life-threatening symptom that disrupts a person's ability to talk, swallow, and can also compromise their airway. Although not very well studied, there are several case reports describing a possible association between COVID-19 infection and macroglossia in people with African ancestry. We present an African American man who developed significant macroglossia several days after testing positive for COVID-19. CASE PRESENTATION: A 59 y/o African American male with a history of chronic bronchitis and tobacco use presented with 4 days of dyspnea. Sars-Cov-2 PCR was positive. Chest x-ray revealed bilateral, diffuse lung infiltrates. He had an elevated CRP of 295 and a d-dimer of 265. He became lethargic and hypercapnic requiring intubation which was nontraumatic. He was sedated, paralyzed, and proned. He received steroid therapy, broad spectrum antibiotics and a dose of Sarilumab. About a week later, he developed macroglossia that worsened over the course of days. Side effect profiles of each of his medications did not reveal any increased likelihood of macroglossia. C1Q complement cascade was mildly elevated and C1 esterase inhibitor level was normal. Diagnosis and treatment was necessary at this point as concerns for tongue central necrosis were raised and baseline tongue size would be required for proper evaluation and surgical intervention if necessary. He was given 4 units of FFP for possible angioedema with no improvement. CT Neck W/ contrast revealed edema and protrusion of the tongue without a discrete mass. Workup for acromegaly, sarcoidosis, amyloidosis, and hypothyroidism were negative. A pressure ulcer developed on his tongue due to the endotracheal tube and so he underwent tracheostomy. His tongue was draped in Chlorhexidine soaked gauze as well as Vashe wound solution. As he recovered from COVID-19 pneumonia, his respiratory status improved as well as his macroglossia. His tracheostomy was decannulated and his tongue returned to its baseline size. DISCUSSION: Macroglossia can lead to complications including airway compromise, dysphagia, or speech difficulties. It has been heavily proposed in the literature that COVID-19 infection can lead to postinfectious inflammatory peripheral nerve injury secondary to immune driven mechanisms. It was also previously proposed in literature based on immune-histochemical analysis of a tongue tissue sample taken from a COVID-19 patient that tongue muscle atrophy occurs as well as macrophage infiltration similar to that of nerve injury repair which can eventually lead to macroglossia. CONCLUSIONS: As the effects of COVID-19 are becoming better studied overtime, macroglossia, especially in those with African ancestry, is increasingly coming under the radar. This case report seeks to educate clinicians on this possible sequela and encourage supportive treatment in hopes that the tongue will recover. Reference #1: McCrossan S, Martin S, Hill C. Tongue Reduction for Macroglossia. J Craniofac Surg. 2021;32(5):1856-1859. doi:10.1097/SCS.0000000000007276 Reference #2: Colombo D, Del Nonno F, Nardacci R, Falasca L. May macroglossia in COVID-19 be related not only to angioedema?. J Infect Public Health. 2022;15(1):112-115. doi:10.1016/j.jiph.2021.10.026 Reference #3: Fernandez CE, Franz CK, Ko JH, et al. Imaging Review of Peripheral Nerve Injuries in Patients with COVID-19. Radiology. 2020;298 (3). https://doi.org/10.1148/radiol.2020203116 DISCLOSURES: No relevant relationships by Megan Devine No relevant relationships by Devin Haney No relevant relationships by Es-Haq Hassanin No relevant relationships by Nadim Islam No relevant relationships by Alyssa Weyer

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.)

Association of comorbidities with the COVID-19 severity and hospitalization: A study among the recovered individuals in Bangladesh

Objectives: We aimed at the identification of the association of comorbidities with the COVID-19 severity and hospitalization. Methods: It is a retrospective cross-sectional study to investigate the variation in age, sex, dwelling, comorbidities, and medication with the COVID-19 severity and hospitalization by enrolling 1025 recovered individuals while comparing their time of recovery with or without comorbidities. Results: COVID-19 patients mostly suffered from fever. The predominant underlying medical conditions in them were hypertension (HTN) followed by diabetes mellitus (DM). Patients with cardiovascular disease (CVD) (54.3%) and hepatic disorders (HD) (43.6%) experienced higher severity. The risk of symptomatic cases was higher in aged (odds ratio, OR = 1.04, 95% CI = 1.02-1.06) and comorbid (OR = 1.87, 95% CI = 1.34-2.60) patients. T-test confirmed the differences between the comorbid and non-comorbid patients' recovery duration. The presence of multiple comorbidities increased the time of recovery (15-27 days) and hospitalization (20-40%). Increased symptomatic cases were found for patients having DM+HTN whereas CVD+Asthma patients were found with higher percentage of severity. Besides, DM+CKD (chronic kidney disease) was associated with higher hospitalization rate. Higher odds of severity were found for DM+CVD (OR = 4.42, 95% CI = 1.81-10.78) patients. Hospitalization risk was also increased for them (OR = 5.14, 95% CI = 2.02-13.07). Moreover, if they had HTN along with DM+CVD, they were found with even higher odds (OR = 6.82, 95% CI = 2.37-19.58) for hospitalization. Conclusion: Our study indicates that people who are aged, females, living in urban area and have comorbid conditions are at a higher risk for developing COVID-19 severity. Clinicians and health management authorities should prioritize these high-risk groups to reduce mortality attributed to the disease.

Corona Virus Disease 2019 (COVID-19) Diagnostic Tests: A Glimpse.

Mass testing for COVID-19 infection is one of the core measures in tackling the global spread of the disease. Testing is vital to diagnose and estimate cases, attack rates and case fatality rates- critical data for policy-making. As COVID-19 continues to spread globally, the demand for more extensive laboratory testing and innovative technology increases. However, countries around the world have been struggling to keep up pace with the worldwide demand to expand testing strategy. The pandemic evolves, so does our knowledge and understanding of diagnostic tests of COVID-19. Here we aim to review major challenges related to COVID-19 diagnostic tests and future development. So, the ongoing urgency and demand for tests would certainly steer the rapid uptake of novel techniques, which in turn would boost our understanding of diagnostic tests for COVID-19.

Relationship of Workload, Work-Family Conflict, and Work Stress on Workers in The Java Island During the COVID-19 Pandemic in 2020

The COVID-19 pandemic has an impact on all levels of society, including workers. Around 80% of workers experience symptoms of stress during the COVID-19 pandemic. Workload and work-family conflict (multiple role conflicts) can trigger work stress. This study aimed to determine the relationship between workload and work-family conflict with work stress on workers on Java during the COVID-19 pandemic in 2020. This study used a cross-sectional study design. There were 436 respondents, obtained through the accidental sampling method. Data collection was carried out online using google form in October 2020. Multivariate analysis was carried out using multiple logistic regression tests. The results showed that 47.2% of workers experienced high levels of stress. The results of multivariate analysis that have been controlled with variables of age, marital status, type of work, length of work, and average income indicate that the workload (AOR = 2.55, 95% CI = 1.71-3.80) and work-family conflict (AOR=7.33, 95% CI = 4.72-11.37) was significantly associated with the incidence of work stress during the COVID-19 pandemic. The conclusion in this study is that workload and work-family conflict are related to the stress level of workers. The high level of work-family conflict is the most dominant factor related to the stress level of workers during the COVID-19 pandemic. This study recommends the importance of stress management for workers during a pandemic to prevent work stress.

A Proposed Framework for Developing User-Centred Mobile Healthcare Applications for the Biggest Annual Mass Gathering (Hajj) Post COVID-19

The Hajj pilgrimage being the largest annual mass gathering globally with two to three million participants from over 180 counties, will remain a high priority for diseases surveillance for future epidemics or any other international public health emergencies with rapid scalability. This paper highlights the importance of monitoring mass gatherings during a pandemic and how mHealth applications can reduce the burden on health facilities during a mass gathering and tackle future infectious diseases outbreaks. The paper also highlights the importance of developing a user-centred application when designing for a diverse group of users with a shared purpose. As a result, a framework has been proposed to update the current applications or design and develop future mobile health applications. The framework has been developed based on the rationale and evidence found in the literature. © Islam et al. Published by BCS Learning and Development Ltd.

mVote: A Mobile Voting System to Conduct Election during COVID-19 Pandemic

Over years, the voting system has been a democratic way to make a collective decision to express an opinion or selecting a leader. In organizations, voting can occur to elect members of the committee or to choose the roles of candidates. At present, in this era of technological advancement, the voting process became a major issue in order to avoid vulnerabilities like missing votes, multiple voting, and miscount in an election. The manual or semi-automated systems of voting are quite a time consuming, inefficient and unfortunately lack security. Moreover, for COVID-19, physical manual vote taking has become colossal. In this paper, a secure android based mobile voting system named 'mVote' is developed for conducting vote at different institutes and organizations during and post-pandemic situation. The usability and usefulness of the 'mVote' mobile application were evaluated through the System Usability Scale (SUS) which was replicated with 75 participants. The findings of the evaluation study showed that the developed 'mVote' application is usable and will help different organizations and institutes to improve the voting experience during and post-pandemic situation.

Association of working shifts, inside and outside of healthcare, with severe COVID-19: an observational study.

BACKGROUND: Health and key workers have elevated odds of developing severe COVID-19; it is not known, however, if this is exacerbated in those with irregular work patterns. We aimed to investigate the odds of developing severe COVID-19 in health and shift workers. METHODS: We included UK Biobank participants in employment or self-employed at baseline (2006-2010) and with linked COVID-19 data to 31st August 2020. Participants were grouped as neither a health worker nor shift worker (reference category) at baseline, health worker only, shift worker only, or both, and associations with severe COVID-19 investigated in logistic regressions. RESULTS: Of 235,685 participants (81·5% neither health nor shift worker, 1·4% health worker only, 16·9% shift worker only, and 0·3% both), there were 580 (0·25%) cases of severe COVID-19. The odds of severe COVID-19 was higher in health workers (adjusted odds ratio: 2·32 [95% CI: 1·33, 4·05]; shift workers (2·06 [1·72, 2·47]); and in health workers who worked shifts (7·56 [3·86, 14·79]). Being both a health worker and a shift worker had a possible greater impact on the odds of severe COVID-19 in South Asian and Black and African Caribbean ethnicities compared to White individuals. CONCLUSIONS: Both health and shift work (measured at baseline, 2006-2010) were independently associated with over twice the odds of severe COVID-19 in 2020; the odds were over seven times higher in health workers who work shifts. Vaccinations, therapeutic and preventative options should take into consideration not only health and key worker status but also shift worker status.

Pandemic Now and Then: A Historical Perspective of Non-Pharmaceutical Interventions Adopted In Covid-19

The coronavirus disease 2019 (COVID-19), first reported in Wuhan, China is now a major global health threat - a pandemic. Public health control measures are the cornerstones in the fight against COVID-19 in the absence of an effective vaccine or proven treatment. The aim of this review was to explore the historical use case of various public health measures adopted today to tackle COVID-19 spread. Although our knowledge about this novel coronavirus transmission is evolving over time, the fundamental non-pharmaceutical interventions e.g., handwashing, wearing a mask, physical distancing, isolation, quarantine and border control which are adopted globally at present are not new. This review highlighted that historically and religiously similar approaches were practised in the medieval past for controlling disease outbreaks. The successful implementation of the public health control measures largely depends on health systems resilience, community engagement and changes in population behaviour. Combined global efforts are essential to strengthen health systems, improve the capability of research and transparent information sharing with both public and international bodies to combat the pandemic.

Hepatology outpatient clinics in the COVID-19 era: Is virtual better?

Background and Aim: The rapid spread of coronavirus disease 2019 (COVID-19) warranted a change in service delivery in our tertiary hospital from face-to-face contact at outpatient clinics to predominantly telephone and video consultations. The constraints of remote consultations on clinical examination and reduced access for patients to pathology and radiology present challenges in patient care. We aimed to measure the impact of telephone and video consultations on patient care and clinic efficiency. Methods: Face-to-face outpatient clinic appointments were converted to telephone or video consultations from March 2020. Patient events were taken from our general hepatology and viral hepatitis clinics, comparing a 4-week period in May 2020 to May 2019. Hospital electronic health records (BOSSnet;Core Medical Solutions), pathology (iSOFT;DXC Technology), and radiology (IMPAX;Agfa HealthCare) databases were used to record the following outcomes: mode of service delivery;did-not-attend (DNA) or patient uncontactable rate;absence of required pathology or radiology results;and follow-up outcomes, including standard follow-up, general practitioner, chart review in clinic, results review out of clinic time, and early clinic follow-up. Events with inadequate documentation were excluded from the study. Episodes of care where the clinician detailed that clinical decisions could not be made or were delayed due to the nature of the consultation were recorded. Fisher's exact test was used to compare the years, with P < 0.05 used for significance. Results: We reviewed a total of 267 and 306 clinic appointments in 2019 and 2020, respectively, over the 4-week period each May. After excluding patients with no documentation, there remained 249 patients in 2019 and 284 patients in 2020. The mean age of patients was 55 years in both year groups, with male patients making up 53.5% of patients in 2019 and 50.6% in 2020. As per the change in hospital policy for management of COVID-19, most appointments in 2020 were conducted virtually, with only 3.3% of patients seen face to face. This is in contrast to 2019, when virtual consultations were the minority (Table 1). Compared with 2019, the DNA rate was significantly higher in 2020 (18.89% vs 25.35%;P = 0.017). There was no significant difference in the rate of patients who came to clinic without having had the required investigations (26.0% in 2019 vs 31.1% in 2020;P = 0.32). A significantly larger number of patients required earlier clinic follow-up in 2020 (5% in 2019 vs 13.1% in 2020;P = 0.01). In 20.4% of consultations in 2020, clinical decisions were delayed as determined by the treating clinician. This is in contrast to 2019, when there were only 2% of patients who had clinical care delayed (P < 0.001). Conclusion: Virtual consultations over telephone and video call are convenient for patients. In 2020, there was a higher rate of DNAs and a greater proportion of patients who did not have the required investigations to allow further patient management. These factors lead to delays in clinical care and inefficient service delivery due to the requirement for results to be followed up outside of clinic time. A greater number of clinic appointments are required to achieve similar progression in patient management, due to clinical need for examination or face-to-face discussion. Virtual clinics are potentially useful in maintaining a limited level of patient contact during the COVID-19 pandemic. However, this study raises concerns about patient care and system efficiencies if remote care is provided long term. Further studies are required to identify specific patient cohorts who may be more suited to a remote style of clinic review.

Examining the predictors of unit price of a readymade garment in Bangladesh

Purpose- The prime objective of the present research study was to determine the antecedents of unit price for a readymade garment 'XYZ' and to investigate the influence of three variable- raw material, quality labor cost, quality cost on per unit price. Design/methodology/approach- In this study a simple random sample has been drawn constituting production manager as the sample unit. The present study used a sample of 50 RMG companies. Further, the influences of predictor variables on the per unit price has been assessed using multiple linear regression analysis. Findings-The findings in this paper supports the two variables;raw material and quality because result revealed that both are significant whereas, labor cost is insignificant. It implies that labour cost is not influencing the unit price. Research limitations/implications- The paper leads to a research question for future researchers-why labor cost is non-significant predictor of unit price? despite being very much important theoretically. Limitations of the paper include the data that is specific to Bangladesh RMG industry, therefore it cannot be generalised, further the economic meltdown due to COVID-19 pandemic might have influenced the results. Originality/value - The paper's prime contribution is based on the assessment of predictor variables and their influence on unit price of readymade garment XYZ. It is based on the estimates provided by the production manager. © 2020 Universidade do Minho. All rights reserved.

Big data analytics in healthcare: a systematic literature review

The current study performs a systematic literature review (SLR) to synthesise prior research on the  applicability of big data analytics (BDA) in healthcare. The SLR examines the outcomes of 41 studies, and presents them in a comprehensive framework. The findings from this study suggest that applications of BDA in healthcare can be observed from five perspectives, namely, health awareness among the general public, interactions among stakeholders in the healthcare ecosystem, hospital management practices, treatment of specific medical conditions, and technology in healthcare service delivery. This SLR recommends actionable future research agendas for scholars and valuable implications for theory and practice. © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.