Decision Analysis on the Financial Performance of Companies Using Integrated Entropy-Fuzzy TOPSIS Model

Sustainable economic development plans have been shattered by the devastating COVID-19 crisis, which brought about an economic recession. The companies are suffering from financial losses, leading to financial distress and disengagement from sustainable economic goals. Many companies fail to achieve considerable financial performances, which may lead to unachieved organizational goal and a loss of direction in decision-making and investment. According to the past studies, there has been no comprehensive study done on the financial performance of the companies based on liquidity, solvency, efficiency, and profitability ratios by integrating the entropy method and fuzzy technique for order reference based on similarity to the ideal solution (TOPSIS) model in portfolio investment. Therefore, this paper aims to propose a multi-criteria decision-making (MCDM) model, namely the entropy-fuzzy TOPSIS model, to evaluate the financial performances of companies based on these important financial ratios for portfolio investment. The fuzzy concept helps reduce vagueness and strengthen the meaningful information extracted from the financial ratios. The proposed model is illustrated using the financial ratios of companies in the Dow Jones Industrial Average (DJIA). The results show that return on equity and debt-to-equity ratios are the most influential financial ratios for the performance evaluation of the companies. The companies with good financial performance, such as the best HD company, have been determined based on the proposed model for portfolio selection. A mean-variance (MV) model is used to validate the proposed model in the portfolio investment. At a minimum level of risk, the proposed model is able to generate a higher mean return than the benchmark DJIA index. This paper is significant as it helps to evaluate the financial performance of the companies and select the well-performing companies with the proposed model for portfolio investment. © 2023 by the authors.

The unseen frontlines: Perceptions and challenges of ancillary staff in the emergency department during COVID-19 pandemic

Background and objectives: The COVID-19 pandemic has shed some light on healthcare workers (HCW), their safety, and their well-being. Although medical and nursing teams are traditionally perceived as the faces of healthcare, ancillary staff are also integral to the effective operations of the frontline of the pandemic and can be exposed to occupational hazards in their line of duty. Despite this, few studies have focused on their experience during the pandemic. This study explores the perceptions and challenges faced by ancillary staff working in an emergency department (ED) in Singapore during the first year of the pandemic. Methods: Fourteen participants were recruited via stratified random sampling from administration, portering, housekeeping, and security personnel from the ED. Data were collected from July 2020 to December 2020 through in-depth, semi-structured interviews until data saturation. Interviews were audio-recorded and transcribed verbatim. Codes were identified independently then iteratively by three research members and analyzed using thematic analysis. Results: The results centered on a total of seven main themes. Three themes were identified as challenges: "adapting to changes," "exhaustion and insufficient rest," and "increased manpower demands." Four themes were related to perceptions: "fear and uncertainty," "safety and preparedness at work," "team communication and support," and "motivation for work." Foreign staff (71.4% of the respondents) faced additional stress from travel restrictions and being away from family;35.7% of the respondents do not feel recognized as a healthcare hero. Conclusion: This study highlighted the different challenges faced by ancillary staff and their perceptions of working during a pandemic. It is important to provide open and clear communication channels between management, the staff, and the public and to provide rationales for change. Regular training sessions, disease outbreak simulations, and knowledge of the disease boosted the confidence of staff in their safety. Practical implications include reviewing the work contract obligations to provide adequate rest for ancillary staff.

Single-amplicon, Multiplex Real-time RT-PCR with Tiled Probes to Detect SARS-CoV-2 spike Mutations Associated with Variants of Concern

Background. Detection and surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants is of great public health importance. Broadly accessible and inexpensive assays are needed to enhance variant surveillance and detection globally. We developed and validated a single-reaction multiplex real-time RT-PCR (the Spike SNP assay) to detect specific mutations associated with variants of concern (VOC). Methods. A single primer pair was designed to amplify a 348 bp region of spike. Probes were initially designed with locked nucleic acids (LNAs) to increase probe melting temperature, shorten probe length, and specifically detect 417K, E484K, and N501Y (Figure). The assay was optimized and evaluated using characterized variant sample pools. Clinical evaluation was performed on a convenience set of residual nasopharyngeal swabs, and variant calls were confirmed by SARS-CoV-2 genomic sequencing in a subset of samples. Following the initial evaluation, unmodified probes (without LNAs) were designed to detect L452R, L452Q, and E484Q. Figure. Spike SNP distinguishes mutations occurring in different lineages (A-C). Representative results of variant detection a single Spike SNP run are shown for mutations in the codons for 4177K (A) and mutations that encode 484K (B) and 501Y (C). Curves show dilutions of the following variants: blue, BEI 52286 (wild type);pink B.1.1.7;purple, B1.525;and green, P.1. Variant pools were used for B.1.17, B.1.525, and P.1 strains. Curves are displayed for a given dilution in each channel and result interpretation is shown (D). Results. The lower limit of 95% detection was 2.46 to 2.48 log10 GE/mL for the three targets (~1-2 GE/reaction). Among 253 nasopharyngeal swabs with detectable SARS-CoV-2 RNA, the Spike SNP assay was positive in 238 (94.1%), including all samples with Ct values < 30 (220/220) for the N2 target and 18/33 samples with N2 Ct values ≥ 30. Results were confirmed by SARS-CoV-2 genomic sequencing in 50/50 samples (100%). Subsequent addition of the 452R probe did not affect performance for the original targets, and probes for 452Q and 484Q performed similarly to LNAmodified probes. Conclusion. The Spike SNP assay provides fast, inexpensive and sensitive detection of specific mutations associated with SARS-CoV-2 VOCs, and the assay can be quickly modified to detect new mutations in the receptor binding domain. Similar analytical performance of LNA-modified and unmodified probes presents options for future assay customization that balance the shorter probe length (LNAs) and increased accessibility (unmodified). The Spike SNP assay, if implemented across laboratories offering SARS-CoV-2 testing, could greatly increase capacity for variant detection and surveillance globally.

ATG and Post-Transplant Cyclophosphamide Predisposes to Inferior Outcome When Using Cryopreserved Stem Cell Grafts

Background During 2020, the novel COVID-19 pandemic lead to cryopreservation of allogeneic hematopoietic stem cell (HSCT) grafts based on NMDP and EBMT recommendations, to secure grafts before start of conditioning chemotherapy. We examined the impact of this change in practice on patient outcomes. Methods We retrospectively analyzed the outcomes of 483 patients who received HSCT between Aug 2017 and Aug 2020, at Princess Margaret Cancer Centre, Canada, comparing the outcomes between those who received cryopreserved (CRYO, n=135) or fresh peripheral blood stem cell grafts (FRESH, n=348). Median follow-up: 12.3 months. Probability of overall survival (OS) was calculated using the Kaplan-Meier product-limit method and heterogeneity of time-to-event distribution functions were compared by the log-rank test. Cumulative incidences of aGvHD and cGvHD, relapse, and non-relapse mortality (NRM) were estimated using the cumulative incidence method considering competing risk, and groups were compared using Gray's test. Death was considered as a competing event for relapse, aGvHD and cGvHD, and relapse was considered a competing event for NRM, aGvHD and cGvHD. Results Median age was 58y;54.5% were males. Acute myeloid leukemia was commonest HSCT indication (n=248, 49.1%). Donors: MUD 10/10 n=233;MUD 9/10 (MMUD) n=48, matched related donor (MRD) n=112, Haploidentical n=88. Transplant conditioning: 79 (23%) and 23 (17%) patients received myeloablative conditioning (MAC) in the FRESH and the CRYO groups, respectively (p ns). In the FRESH group, 253 (73%) patients and 114 (84%) patients in the CRYO group received ATG followed by posttransplant cyclophosphamide (PTCy) and Cylosporine GvHD prophylaxis. OS at the 2y timepoint, FRESH group (n=348), was 67.0% (61.1-72.3%), compared to 48.7% (38.1-58.4%) for patients in the CRYO group (n=135), p=0.002, Figure 1a. This was mainly due to MRD cohort outcomes: 2y OS in MRD FRESH group (n=65), was 85.2% (73.3-92.0%), compared to 45.1% (29.9-59.1%) in MRD CRYO group (n=47), p<0.001, Figure 2a. Multivariate analysis (MVA) for OS, significant factors were increasing patient age, DRI high/v.-high, HCT-CI ≥ 3, Donors: Haplo and MMUD, cryopreservation, Table 1. NRM at 1y for FRESH (n=348) 17% (13.2-21.2) vs CRYO (n=135) 22.1 % (14.8-30.4), p ns. However, in the MRD cohort, NRM at 1y for FRESH group (n=65), was 1.5% (0.1-7.4%), compared to 15.4% (6.6-27.4%) for CRYO group (n=47), p=0.003, Figure 2b. On MVA, NRM adverse significant factors were patient age, DRI high/v.-high, Donors: Haplo and MMUD, Table 1. Cumulative incidence (CI) of relapse at 2y for FRESH 22.4% (17.5-27.7) vs CRYO 27.0 % (18.8-35.9) p=0.07. The CI of moderate-severe cGvHD at 1y for FRESH group (n=315) was 21.5% and 10.8% in the CRYO group, p=0.027, Figure 1c. Patients with FRESH 10/10 MUDs (n=180), had CI of moderate-severe cGvHD at 1y of 20.6%, compared to CRYO 10/10 MUDs (n=35), 6.0% p ns for MUDs;FRESH MRD (n=64) CI was 30.1%;and CRYO MRD (n=43) 10.3%, p=0.008 for MRD, Figure 1d. On MVA, significant adverse factors for chronic GvHD were increasing donor age, male recipient/female donor, whilst graft CRYO was protective, Table 1. GvHD-and Relapse free Survival (GRFS) at 2y for FRESH 54.0% (47.9-59.6) vs CRYO 43.4% (33.4-53.0) p<0.05, Figure 1b. However, in the MRD cohort, GRFS at 2y in FRESH group (n=65), was 74.2% (61.3-83.4%), compared to 40.7% (26.3-54.6%) for CRYO group (n=47), p=0.001;other donor types no difference, Figure 1c. On MVA, significant factors correlated with worse GRFS were: DRI high and very-high, cryopreservation, Donors: Haplo and MMUD, Table 1. Compared to FRESH group, CRYO group experienced reduced cGvHD, delay in neutrophil engraftment, higher graft failure and increased CMV reactivation, with no difference in relapse incidence or acute GvHD. Conclusion Cryopreservation was associated with inferior outcomes post-HSCT particularly in the MRD cohort, possibly due to combination ATG and post-transplant cyclophosphamide impacting differential tolerance to cryopreservation on components of the stem ce l graft;further studies are warranted to elucidate mechanisms for this observation. [Formula presented] Disclosures: Law: Novartis: Consultancy;Actinium Pharmaceuticals: Research Funding. Lipton: Bristol Myers Squibb, Ariad, Pfizer, Novartis: Consultancy, Research Funding. Kim: Bristol-Meier Squibb: Research Funding;Paladin: Honoraria, Research Funding;Pfizer: Honoraria, Research Funding;Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Mattsson: MattssonAB medical: Current Employment, Current holder of individual stocks in a privately-held company.

A mixed-equilibrium model of individual and household activity–travel choices in multimodal transportation networks

This paper develops a novel household-oriented activity-based mixed-equilibrium model for estimating individual and household activity–travel choices in multimodal transportation networks with interactions between private car and public transit modes. In the novel model, household members with heterogeneous errors of perception on the time-dependent utility of different activity types make daily joint/solo activity–travel choices in a mixed-equilibrium manner, which maximizes either perceived household utility or perceived individual utility. A logit-based stochastic choice model is developed to capture the mixed equilibrium with heterogeneous errors of perception and used to predict the choices of alternative joint activity–travel paths (JATPs) on a supernetwork platform. Based on this stochastic JATP choice model, the mixed-equilibrium model is formulated as an equivalent variational inequality (VI) problem and solved using a modified diagonalization method. This converts the time-dependent activity–travel scheduling problem into an equivalent static traffic assignment problem on JATPs. The conditions required for the existence and uniqueness of a solution to the equivalent VI problem in terms of a JATP flow pattern are also identified. Numerical examples are provided to illustrate the model's merits and its applications for examining the effect of the coronavirus disease 2019 (COVID-19) pandemic. © 2021 Elsevier Ltd

Evaluation and Improvement of the Efficiency of Logistics Companies with Data Envelopment Analysis Model

The performance of global trade depends on the logistics industry to move products, information, finances, technology and human resources along the supply chain. The current situation during the pandemic relies on the logistics industry particularly in the courier, parcel and express service providers to deliver daily essentials. Product customization, customer demand, technological sophistication, threat of new entrants, border closure, compliance to Covid-19 regulations and global economic crisis have taken the logistics industry by storm. For the sustainment and growth of these companies, strategic decision making shall take place. A huge determinant of these decisions is the financial efficiency of the companies. Therefore, this paper aims to determine the efficiency of the logistics companies in Malaysia by analyzing their financial performances using current ratio, debt to assets ratio, debt to equity ratio, earnings per share, return on assets and return on equity with data envelopment analysis model. The results of this study found that five companies, COMPLET, GDEX, MISC, SURIA and WPRTS are efficient. This study fills the research gap by determining the efficiency scores of these companies and suggesting potential improvements for inefficient companies to enhance and optimize their financial positions.

Severe COVID-19 Is an Acquired Red Cell Disease- Potential Mechanisms Underlying Endothelialitis

Rationale As the SARS-CoV-2 pandemic continues, there is an imperative to understand the pathophysiology underlying the associated critical illness. Evidence exists that COVID-19 is a systemic vasculopathy associated with a hypercoaguable state and recent meta analyses have shown that standard inflammatory biomarkers in critically ill COVID-19 patients are not significantly elevated when compared with similarly ill patients with non-SARS-CoV-2- related sepsis. Leveraging our novel microvasculature-on-a-chip microfluidics platform which permits tight biomechanical control, we investigate how physical interactions between the endothelium and COVID-19 patient red blood cells (RBCs) may directly cause endothelialitis. Methods In a single ICU, we enrolled patients with sepsis (SOFA score ≥3), and categorized as either resultant from COVID-19 (n=14) or alternative infection (n=15), collecting clinical data and whole blood. These samples were perfused through our systems comprising microchannels of 2 distinct diameters (40μm and 60μm) to approximate the size of postcapillary venules at physiologic shear rates (200 s-1 to 1000 s-1). Mean and peak velocity measurements as well as red cell aggregation were recorded using cell tracking with high resolution video microscopy. Plasma was prepared from these collections for measurement of syndecan-1 via ELISA to examine endothelial disturbance. Results Comparing demographic and clinical data, no significant differences were measured in co-morbidities, SOFA score or 30 day mortality between the two patient populations whereas there was a higher incidence of vasopressor use in the non-COVID sepsis group. There was no difference in mean or maximum velocity, however, blood from COVID-19 sepsis patients demonstrated increased red cell aggregation under dynamic conditions at lower shear rates (200 s-1- 400 s-1) when compared with patients with sepsis from non-COVID-19 causes (Figure, right panel). This effect was more pronounced in the smaller channel size. Additionally, syndecan-1 levels in patients with COVID-19 were elevated compared with patients with non-COVID-19 related sepsis, (812±357 ng/mL vs 469 ±193, p=0.15, Figure, left panel). Conclusions Our data support the hypothesis that COVID-19 results in an acquired RBC membrane pathology leading to aggregation. To our knowledge, this is the first study that proposes such a mechanism. We theorize this phenomenon directly disrupts the endothelial glycocalyx as the aggregates "rub" against it. Further work to isolate effects of red cell aggregation, cytokines and proteinases in plasma on endothelium and to demonstrate hypercoagulability in our microvasculature-on-chip system are underway. We believe our work suggests that therapies specifically targeting RBC aggregation may be beneficial for COVID-19 patients.

Surgical consent during the COVID-19 pandemic.

BACKGROUND AND AIMS: During the COVID-19 pandemic, surgical practice may deviate with operative and non-operative management considered. Appropriate discussion of options with patients is paramount to quality surgical care. Intercollegiate and EAES guidelines recommend discussing and documenting risk of COVID-19 exposure in the consent process for patients undergoing surgery. MATERIALS AND METHODS: Closed-loop audit of consent forms for patients undergoing emergency and elective surgical procedures. Interventions implemented included education of wider surgical teams. Data was collected during a one-week period for each cycle and analysed using Chi-squared test. RESULTS: In cycle 1, 6/17 (35.3%) case notes documented discussion of COVID-19 risk. Following intervention, compliance improved to 23/29 (79.3%) cases in cycle 2 and 33/45 (73.3%) cases in cycle 3. CONCLUSION: Pre-intervention, our consenting practice was non-compliant. Our interventions led to significant and sustained improvements in practice. We recommend provision of wider surgical team education to facilitate good consenting practice.