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Due to the outbreak of COVID-19, increasing attention has been paid to designing a cold chain logistics mechanism to ensure the quality of vaccine delivery. In this study, a cold chain digital twins-based risk analysis model is constructed to handle and monitor the vaccine delivery process with a high level of reliability and traceability. The model integrates the Internet of Things (IoT) and digital twins to acquire data on environmental conditions and shipment movements and connect physical cold chain logistics to the digital world. Through the simulation of cold chain logistics in a virtual environment, the risk levels relating to physical operations at a certain forecast horizon can be predicted beforehand, to prevent a 'broken' cold chain. The result of this investigation will reshape the cold chain in the digital age, benefit society in terms of sustainability and environmental impact, and hence contribute to the development of cold chain logistics in Hong Kong. © 2023 IEEE.
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Autistic young adults are at a higher risk of experiencing elevated mental and psychological distress during times of isolation, such as the COVID-19 pandemic, due to the challenges related to uncertainty and abrupt changes in every aspect of daily life. In this research, we aim to develop participant-centric interventions for assisting autistic young adults in addressing their anxiety and stress during times of isolation. We first conducted an exploratory literature review to gather the design requirements for an effective stress management technology. Based on our findings, we designed our initial high-fidelity prototype, MindBot, a mindfulness and AI-based chatbot application. We conducted an in-depth qualitative study (semi-structured interviews with 15 autistic young adults and a cognitive walkthrough with 20 participants who have training in HCI and usability evaluation techniques) to identify the design and usability issues to improve the effectiveness of MindBot. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Background: Venetoclax (Ven) in combination with hypomethylating agents, such as azacitidine (Aza) and low dose cytarabine (LDAC) has been shown to be effective therapy in acute myeloid leukaemia (AML) and has become standard of care for newly-diagnosed patients unfit for intensive chemotherapy (DiNardo et al., 2020;Wei et al., 2019;Pollyea et al., 2020). Efficacy has also been shown in the relapsed/refractory (R/R) setting in more limited data sets (Báez-Gutiérrez et al., 2021;Pollyea et al., 2020, Stahl et al., 2020;DiNardo et al., 2019). Ven combination therapy has become widely used in newly-diagnosed patients in the UK since its approval during the COVID-19 pandemic as an alternative to intensive chemotherapy and subsequently for patients unfit for intensive therapy. Aims: We describe the characteristics and outcomes of patients with AML or high risk myelodysplastic syndrome (HRMDS) receiving Ven combinations in frontline and R/R settings to provide real-world insight into their use in UK clinical practice. Methods: A retrospective analysis was performed of all patients with AML or HR-MDS who received Ven combination therapy at University College London Hospital between April 2020 and September 2021. Patient demographics, treatment history and bone marrow results were obtained from electronic health care and laboratory records. Disease stratification and response assessments were made as per European LeukemiaNet (ELN) criteria (Döhner et al., 2017). Results: At the time of analysis, 95 patients received Ven combinations (61 as frontline treatment and 34 for R/R AML), with a median follow up of 14 months. The majority of patients in both groups had adverse risk ELN classification (70.5% of frontline patients, 64.7% of R/R) and received Ven-Aza (100% frontline and 91.1% R/R) (Table 1). The median ages were 72 and 59 years respectively. The incidence of composite CR/CRi was 70.5% in the frontline setting, with median duration of response (DoR) of 8.3 months and overall survival (OS) of 7.1 months. In R/R AML, the CR/CRi rate was 64.7%, median DoR 10.5 months and median OS 9.8 months. Four out of the 43 patients who achieved CR/CRi (9.3%) following frontline treatment and 9 of the 22 R/R (40.9%) patients proceeded to allogeneic stem cell transplant (alloSCT) post induction. The median survival for all patients who underwent alloSCT is not reached in this analysis. The highest CR/CRi rates were observed in intermediate risk patients (90.9% in frontline treatment, 71.4% in R/R), with lower rates in both favourable (80% and 66.7%) and adverse risk patients (65.1% and 59.1% respectively). The presence of NPM1 and IDH1/2 mutations were associated with high CR/CRi rates in both the frontline (85.7% and 84.6% respectively) and R/R groups (100% and 81.8%), with below average response rates seen in TP53 mutated AML (62% in frontline, 40% in R/R). Notable responses were seen in patients with RUNX1 mutations in both settings (77.8% frontline, 66.6% R/R). Summary/Conclusion: Our data describes real world effectiveness for venetoclax combinations as both frontline and salvage therapy in UK clinical practice, similar to that seen in clinical trials. This further contributes to our understanding of these therapies, in particular their use as a viable treatment option in R/R patients and as a bridge to alloSCT, and highlights the importance of further characterisation of genetic predictors of response to inform treatment decisions in real-world practice.
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Vaccines that elicit mucosal immune responses against SARS-CoV-2 could potent ially be of exceptional importance in providing first line defence at the site of viral entry. In order to understand the mucosal immune response profiles of SARS-CoV-2 vaccines, we examined both the mucosal and systemic responses of subjects vaccinated by two different vaccination platforms: mRNA (Comirnaty) and inactivated virus (CoronaVac). Nasal epithelial lining fluid (NELF) and peripheral blood samples were collected in subjects who had received two doses of CoronaVac or Comirnaty. We quantified IgA and IgG specific to SARS-CoV-2 S1 protein, neutralisation antibody by ELISA in NELF and plasma samples. Only Comirnaty induced nasal S1-specific IgA and IgG responses, which were evident as early as on 14±2 days after the first dose. The NELF samples of 72% of subjects became IgA+IgG+, while in 62.5% of subjects the samples were neutralising by 7±2 days after the second dose. In 45% of the subjects their NELF remained neutralising 50 days after the booster. In plasma, 91% and 100% Comirnaty subjects possessed S1-specific IgA+IgG+ on 14±2 days after the first dose and 7±2 days after booster, respectively. The plasma collected on 7±2 days after booster was 100% neutralising. The induction of S1-specific antibody by CoronaVac was IgG dominant, and 70% of the subjects possessed specific IgG by 7±2 days after booster and were all neutralising. This study reveals that Comirnaty is able to induce S1-specific IgA and IgG r esponse with neutralising activity in the nasal mucosa in addition to a consistent systemic response.
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Background. Donning personal protective equipment (PPE) and performing cardiopulmonary resuscitation (CPR) are stressful tasks for healthcare professionals, particularly during the COVID-19 pandemic. This study aimed to assess the effectiveness of simulation training on donning PPE and performing CPR with PPE put on for nurses at a geriatric step-down hospital. Methods. A lecture and simulation training on donning PPE and performing CPR were provided for nurses. Confidence in donning PPE and performing CPR, knowledge of CPR, and satisfaction of participants were assessed before training (baseline), after the lecture, and after the simulation training. Results. 50 nurses (33 women and 17 men) attended both the lecture and simulation training, accounting for 90% of nurses in the department. Self-rated confidence in donning PPE and performing CPR improved significantly after the lecture (both p<0.001) and again after the simulation training (both p<0.001). Knowledge of CPR improved significantly after the lecture (p<0.001). Self-rated satisfaction of participants was high (9.3±0.3). Conclusion. Simulation training on donning PPE and performing CPR with PPE put on significantly improves the knowledge and confidence of nurses in a geriatric step-down hospital. This may contribute to improved patient outcomes, particularly during the COVID-19 pandemic. © 2022 The Hong Kong Geriatrics Society and Hong Kong Association of Gerontology.
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Sudden periods of extreme and persistent changes in the distribution of medical emergencies can trigger resource planning inefficiencies for Emergency Medical Services, causing delayed responses and increased waiting times. Predicting such changes and reacting adaptively can alleviate these adversarial impacts. In this paper, we propose a simple framework to enhance historically calibrated call volume models, the latter a focus of study in the arrival estimation literature, to give more accurate short-term prediction by refitting their residuals into time series. We discuss some justification of our framework from the perspective of doubly stochastic Poisson processes. We illustrate our methodology in predicting the hourly call volume to the 911 call center during the Covid-19 pandemic in NYC, showing how it could improve the performance of baseline historical estimators by close to 50% measured by the out-of-sample prediction error for the next hour. © 2021 IEEE.
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In most emergency medical services (EMS) systems, patients are transported by ambulance to the closest most appropriate hospital. However, in extreme cases, such as the COVID-19 pandemic, this policy may lead to hospital overloading, which can have detrimental effects on patients. To address this concern, we propose an optimization-based, data-driven hospital load balancing approach. The approach finds a trade-off between short transport times for patients that are not high acuity while avoiding hospital overloading. In order to test the new rule, we build a simulation model, tailored for New York City's EMS system. We use historical EMS incident data from the worst weeks of the pandemic as a model input. Our simulation indicates that 911 patient load balancing is beneficial to hospital occupancy rates and is a reasonable rule for non-critical 911 patient transports. The load balancing rule has been recently implemented in New York City's EMS system. © 2021 IEEE.
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Introduction: Epstein-Barr virus (EBV) is a globally prevalent herpesvirus with an estimated 90-95% seropositivity rate worldwide. It is most known for causing infectious mononucleosis characterized by the classic triad of fever, pharyngitis, and lymphadenopathy. Hepatitis is a common manifestation seen in 90% of cases;however, isolated acute hepatitis in the absence of infectious mononucleosis is a rare clinical presentation. Case Description/Methods: An 18-year-old female with no medical history presented with fevers, fatigue, myalgia, and headache ongoing for one week. She had been evaluated previously with recommendations for supportive care for an unspecified viral illness. Workup at the time had been negative for urine hCG, COVID-19, heterophile antibody, Lyme disease, and bacteremia. However, symptoms worsened with the development of nausea, vomiting, and darkening of her urine. Prior to this, patient had been in her normal state of health without sick contacts, travel history, animal exposures, risky sexual practices, or substance use. Exam revealed cervical lymphadenopathy and hepatosplenomegaly. Labs showed normal leukocyte count 8.4 thou/cmm with differential significant for reactive lymphocytosis 19% and bandemia 8%. Liver function tests were abnormal with elevated total bilirubin 3.8 mg/dL, AST 366 U/L, ALT 460 U/L, ALP 562 U/L. Synthetic function was intact. Hepatic ultrasound was unrevealing. Extensive infectious workup revealed acute EBV infection with serologies showing positive VCA IgM Ab 74.3 U/mL, negative VCA IgG Ab 11.9 U/mL, negative EA Ab < 5 U/mL, negative EBNA Ab < 3 U/mL. Patient was managed supportively with improved symptoms. She was instructed to avoid physical contact sports for one month upon discharge. Discussion: Clinically significant EBV induced hepatitis is a rare entity seen in < 5% of cases. Nevertheless, it is important to consider EBV as a causative pathogen of acute hepatitis. Heterophile antibody or Monospot test is the diagnostic test of choice with a sensitivity of 85% and a specificity of 100%;however, false negatives can occur especially early in the disease course. EBV serology has an improved sensitivity of 97% with a comparable specificity of 94%. As such, follow-up serology is necessary especially if clinical suspicion is high. While no specific EBV targeted therapies exist, it is important to identify it given the potential complications, including splenic rupture, airway obstruction, malignancies, lymphoproliferative disorders, among others.
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Purpose Although there have been considerable discussions on the business value of adopting blockchain in supply chains, it is unclear whether such blockchain-enabled supply chains (BESCs) can help firms mitigate the negative impact resulting from the recent COVID-19 pandemic. This study aims to answer this important question. Design/methodology/approach The authors conduct an event study to quantify the financial effects of the COVID-19 pandemic and compare the differences in such effects between treatment firms that have adopted BESCs and matched control firms that have not adopted BESCs. The authors also perform a regression analysis to examine how the role of BESCs in mitigating COVID-19's negative impact varies across firms with different levels of supply chain leanness and complexity. The analysis is based on 88 treatment firms and 88 matched control firms, all of which are publicly listed on the US stock markets. Findings The test results suggest that although both the treatment and control firms are negatively affected by the COVID-19 pandemic, the effect is less negative for the treatment firms compared to the control firms, demonstrating the role of BESCs in mitigating the negative impact caused by the COVID-19 pandemic. Moreover, the mitigating role of BESCs is more pronounced for firms with lean and complex supply chains. Originality/value This study is among the first to provide empirical evidence on the mitigating role of BESCs during the COVID-19 pandemic, highlighting the importance of adopting blockchain in supply chains with high uncertainties and disruption risks.
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Purpose Under the impact of Coronavirus disease 2019 (COVID-19), this paper contributes in the deployment of the Artificial Intelligence of Things (AIoT)-based system, namely AIoT-based Domestic Care Service Matching System (AIDCS), to the existing electronic health (eHealth) system so as to enhance the delivery of elderly-oriented domestic care services. Design/methodology/approach The proposed AIDCS integrates IoT and Artificial Intelligence (AI) technologies to (1) capture real-time health data of the elderly at home and (2) provide the knowledge support for decision making in the domestic care appointment service in the community. Findings A case study was conducted in a local domestic care centre which provided elderly oriented healthcare services to the elderly. By integrating IoT and AI into the service matching process of the mobile apps platform provided by the local domestic care centre, the results proved that customer satisfaction and the quality of the service delivery were improved by observing the key performance indicators of the transactions after the implementation of the AIDCS. Originality/value Following the outbreak of COVID-19, this is a new attempt to overcome the limited research done on the integration of IoT and AI techniques in the domestic care service. This study not only inherits the ability of the existing eHealth system to automatically capture and monitor the health status of the elderly in real-time but also improves the overall quality of domestic care services in term of responsiveness, effectiveness and efficiency.
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Background and Aim: Hepatitis B is underdiagnosed in Australia, with an estimated 32% of affected people not aware of their hepatitis status. Australia's Chinese community is among the most at-risk populations for hepatitis B: an estimated 18% of people living with chronic hepatitis B in Australia were born in China. Identified barriers for hepatitis B testing include lack of awareness and limited knowledge about hepatitis B, and stigma associated with the disease. However, limited data are available on effective approaches to engage Chinese people in hepatitis B testing and care. We therefore conducted an evaluation study of an outreach education program among the Chinese community in Melbourne. The primary aim was to assess the efficacy of the education program on hepatitis B testing uptake and compare the efficacy between two educational resources. The secondary aim was to assess the impacts of the education program on hepatitis B-related knowledge. A nested qualitative study was conducted to assess the feasibility and acceptability of the education program. Methods: We conducted a pilot randomized controlled trial in community sites in Melbourne between July 2019 and June 2020. Adults attending the sites who self-identified as having Chinese ethnicity and were unsure of their hepatitis B status were invited to participate. After completing a baseline hepatitis B knowledge questionnaire, participants were randomly assigned to one of two groups to receive educational information (in either English or Chinese): standard hepatitis B information (Arm 1) or liver cancer prevention information focusing on hepatitis B testing (Arm 2). Participants were followed up by telephone after 6 months to determine whether they had a hepatitis B test and to complete a follow-up questionnaire. The follow-up questionnaire repeated the hepatitis B knowledge questions asked at baseline and explored participants' perceived barriers to testing. A before-and-after comparison of hepatitis B-related knowledge was undertaken. Results: Fifty-four participants were recruited from seven community sites. Participants' median age was 33 years (range, 18-90 years), and most (33, 69%) were female. Thirty-three participants (61%) completed follow-up at 6 months, of whom 22 (67%) were female (median age, 29 years). Among participants followed up, 20 (61%) reported visiting a doctor in the 6 months of follow-up and one third of those (n = 7) reported discussing hepatitis B testing at this GP appointment. Four participants (12%) self-reported having had hepatitis B testing: one of 15 (7%) in the standard hepatitis B information group and three of 18 (17%) in the liver cancer prevention information group. Six of 33 participants (18%) reported barriers to having a hepatitis B test, including concerns about accessing health care due to coronavirus disease 2019 and lack of knowledge about how to access health care. Twenty of 33 participants (67%) reported no intention of having a hepatitis B test at follow-up, with the main reason given being do not perceive the risk, do not feel the need. At follow-up after the education program, a significantly lower proportion of participants had the misconception of hepatitis B being transmitted via eating food or sharing eating utensils (8/33, 24%) than at baseline (29/55, 53%) (P < 0.001). The education session was well accepted by participants. Conclusion: A single education session with language-appropriate resources was effective for improving hepatitis B-related knowledge, which was retained at 6 months. However, despite knowledge improvement, a low rate of hepatitis B testing uptake was observed in both groups, with the main barrier being low risk perception in the community.
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COVID-19 pandemic has been making significant changes to every aspect of human life. As a country of high trade openness, having extensive trade relations with many economic partners, Vietnam's export and import are severely affected by the wave of the epidemic. Therefore, this paper focuses on analyzing the impacts of COVID-19 outbreak on Vietnam's foreign trade, apart from that proposing some prospects and solutions for this branch to overcome this global pandemic.
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Background/Case Studies: To date, convalescent plasma for the treatment of SARS-CoV-2 has shown effectiveness in severely ill patients in reducing mortality. While studies have demonstrated a low risk of serious adverse events, the comprehensive incidence and nature of the spectrum of transfusion reactions to convalescent plasma is unknown. Here, we retrospectively examine 427 inpatient convalescent plasma transfusions to determine incidence and types of reactions, as well as clinical parameters and risk factors associated with transfusion reactions. Study Design/Methods: Retrospective analysis was performed for 427 transfusions to 215 COVID-19 patients within the Mount Sinai Health System (MSHS), through eIND and EAP approval pathways by the FDA. Transfusions were blindly evaluated by two reviewers and adjudicated by a third reviewer in discordant cases. Patient demographics, clinical, and laboratory parameters were compared and analyzed. Statistical analysis was performed determine the significance of these parameters and univariate logistic regression analysis was performed to assess which independent variables were correlated with a transfusion reaction. Results/Findings: Fifty-five reactions from 427 transfusion events were identified (12.9% incidence), thirteen of which were attributed to transfusion (3.1% incidence). Reactions were classified as underlying COVID-19 (76%), febrile non-hemolytic (10.9%), transfusion-associated circulatory overload (9.1%), allergic (1.8%), and hypotensive (1.8%) reactions. Statistical analysis identified increased transfusion reaction risk for ABO blood group B, Sequential Organ Failure Assessment scores of 12-13, or a cancer diagnosis. A decreased risk was identified for patients in the age group of 80-89 years. Conclusions: Our findings support the use of convalescent plasma as a safe therapeutic option from a transfusion reaction perspective, in the setting of COVID-19. Further studies are needed to confirm the clinical significance of ABO group B, cancer diagnosis, age, and predisposing disease severity in the incidence of transfusion reaction events.
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Infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may lead to a disease spectrum named COVID-19, including a severe form of pneumonia characterized by an intense inflammatory response similar to acute respiratory distress syndrome. Current management guidelines in pregnancy have been limited. In the setting of severe COVID-19 in pregnancy, including in the periviability period, combination multitargeted therapy should be strongly considered. We report a case of severe COVID-19 pneumonia in a periviable pregnancy treated with concurrent combination of remdesivir, corticosteroids, and convalescent plasma therapy, leading to rapid maternal pulmonary improvement. © Wolters Kluwer Health, Inc. All rights reserved.
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SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: The SARS-CoV2 virus is well known for causing atypical pneumonia in addition to other symptoms. Various neurological symptoms have been reported including anosmia, headaches, and stroke like symptoms. Here we report a case of a critically ill patient who developed encephalopathy with evidence of multiple bilateral acute strokes. CASE PRESENTATION: 68-year-old African American male with no significant past medical history presented with shortness of breath, cough, and fever. He was tested positive for COVID-19. Patient quickly desaturated after admission requiring intubation and ICU care. During his hospital course, he developed severe renal injury which required hemodialysis. Despite daily dialysis in attempt to correct uremia and cessation of all sedations, patient remained minimally responsive. CT head without contrast was unremarkable for any acute process. Despite improvement in his respiratory status and azotemia, patient remained encephalopathic, unable to be extubated. He was subsequently treated empirically with Keppra for possible subclinical seizures and methylphenidate for neurostimulation, no improvement was seen. Due to the hospital protocol to limit exposure, our patient was one of the first in our hospital to receive a brain MRI after 29 days of hospitalization, which revealed numerous small areas of restricted diffusion throughout the centrum semiovale bilaterally compatible with extensive small acute infarct. There was also an acute infarct adjacent to the frontal horn. Based on the locations of the infarcts, they were determined to be most likely ischemic in nature. The patient remained intubated in the ICU with guarded prognosis without improvement in his status, he later entered hospice care as per family’s wishes. DISCUSSION: The neurological manifestations of SARS-CoV2 virus vary. According to a series of 13 cases studied showed 2 of 13 patients with brain MRI had single acute ischemic strokes. (3) Our case showed multiple bilateral infarcts on MRI, which has scarcely been reported. It was concluded that his encephalopathy was related to these cerebral infarcts. The varied coagulopathy features seen in COVID patients is well known and cases of microthrombi have been reported. Our patient was given full dose anticoagulation after admission but, altered mentation made extubating impossible. CONCLUSIONS: Our patient was able to fight COVID pneumonia but incurred extra pulmonary consequences. This presentation emphasizes early MRI should be done as reversible causes may be ruled out. Acute CVA should be a top differential in unexplained encephalopathy. This case brings to light that although it is possible for patients, even the most severe cases who require intubation, to fight this atypical pneumonia, they can rapidly develop extra-pulmonary complications which if goes unrecognized can leave lethal penalties. Reference #1: Avula A, Nalleballe K, Narula N, et al. COVID-19 presenting as stroke [published online ahead of print, 2020 Apr 28]. Brain Behav Immun. 2020;S0889-1591(20)30685-1. doi:10.1016/j.bbi.2020.04.077 Reference #2: Pleasure SJ, Green AJ, Josephson SA. The Spectrum of Neurologic Disease in the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic Infection: Neurologists Move to the Frontlines. JAMA Neurol. Published online April 10, 2020. doi:10.1001/jamaneurol.2020.1065 Reference #3: Helms J, Kremer S, Merdji H, et al. Neurologic Features in Severe SARS-CoV-2 Infection. New England Journal of Medicine. 2020. doi:10.1056/nejmc2008597. DISCLOSURES: No relevant relationships by Padmini Giri, source=Web Response No relevant relationships by Gloria Hong, source=Web Response No relevant relationships by Han Lam, source=Web Response No relevant relationships by DANYAL TAHERI ABKOUH, source=Web Response