Catalysing innovation and digital transformation in combating the Covid-19 pandemic: Whole-of government collaborations in ICT, R&D, and business digitization in Singapore

IMPACTThis article illustrates how collaborative partnerships between the public and private sectors played a critical role in developing and deploying innovative practices in Singapore to manage the Covid-19 crisis. The study provides some important lessons for the international community to reduce the impact of emergencies by leveraging collaborative partnerships for innovation.Alternate :Collaborative partnerships between the public and private sectors played a critical role in developing and deploying innovative practices to overcome Covid-19 in Singapore. The extant literature has not paid adequate attention to the determinants for managing collaborative partnerships in the emergency context. Using the case of digital transformation and ICT deployment in Singapore, the authors show how and why rapid reactions and responses to pandemics and other emergencies can be achieved through public–private partnerships for collaborative innovation.

Necessity of mandatory postoperative intensive care unit management after clipping surgery for unruptured intracranial aneurysms.

OBJECTIVE: Many neurosurgeons routinely perform postoperative intensive care unit (ICU) management after clipping of unruptured intracranial aneurysms (UIAs). However, whether routine postoperative ICU care is necessary remains a clinical question. Therefore, we investigated which factors acted as risk factors that actually required ICU care after microsurgical clipping of unruptured aneurysms. METHODS: We included a total of 532 patients who underwent clipping surgery for UIA between January 2020 and December 2020. The patients were divided into two groups: those who really required ICU care (41 patients, 7.7%) and those who did not (491 patients, 92.3%). A backward stepwise logistic regression model was used to identify factors that were independently associated with ICU care requirement. RESULTS: The mean hospital stay duration and the operation time were significantly longer in the ICU requirement group than in the no ICU requirement group (9.9 ± 10.7 vs. 6.3 ± 3.7 days, p = 0.041), (259.9 ± 128.4 vs. 210.5 ± 46.1 min, p = 0.019). The transfusion rate was significantly higher (p = 0.024) in the ICU requirement group. Multivariable logistic regression analysis identified male sex (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.15-4.76; p = 0.0195), operation time (OR, 1.01; 95% CI, 1.00-1.01; p = 0.0022), and transfusion (OR, 2.35; 95% CI, 1.00-5.51; p = 0.0500) as independent risk factors for requiring ICU care after clipping. CONCLUSIONS: Postoperative ICU management may not be mandatory after clipping surgery for UIAs. Our results suggest that postoperative ICU management may be more required in the male sex, patients with longer operation times, and those who received a transfusion.

Centralized basic orthopaedic surgery virtual examinations - assessment of examination environment

Background: Centralized examinations are key to competency-based curricula as they are carried out by neutral assessors who are not involved in teaching the learner and allow for evaluation of trainees against their peers. The COVID-19 pandemic has limited the ability to gather to perform in-person evaluations. We sought to assess the effectiveness and end-user experience of virtual centralized Objective Structured Clinical Examination (OSCE) for basic orthopedic surgery modules. Methods: A virtual evaluation process including assessor training followed by online OSCE for basic orthopaedic surgery modules (arthroplasty and trauma) were developed. Surveys were used to assess the effectiveness of the assessor training and the overall examination environment. Results: All 14 assessors completed the post-training survey and agreed that the training session was useful and should be repeated prior to all virtual centralized examinations. Seventy-four percent of residents (n = 17) responded to the survey. Most trainees (59%) recommend that some, but not all, examinations be conducted virtually. The online platform generally did not alter trainees' preparation, comfort levels, stress levels prior to or during the examination, or ability to demonstrate their skills. Technical difficulties were rare, though when they did occur, the trainees perceived it to negatively impact their score. Conclusion: Most residents wished for increased frequency of formative examinations, which is in keeping with the Competence by Design education framework. Given the minimal perceived difference between the virtual and in-person assessment environments, and with the added convenience of virtual examinations, the virtual platform may be a useful tool to facilitate increased frequency of formative assessments for any learner.

Educational impact of the COVID-19 third wave on a competency- based orthopedic surgery program

Background: The COVID-19 third wave in Ontario from April to June 2021 led to a province-wide cancellation of elective surgeries and the development of policies to minimize in-person patient encounters. We aimed to assess the educational impact of the third wave on the orthopedic surgical trainees in a competency-based program. Methods: Qualitative post-third-wave surveys were distributed to residents in postgraduate years (PGY) 1-4 in a competency-based orthopedic training program in Ontario (n = 48). Results: Thirty-one residents (64.5%) responded to the survey. Overall average work hours per week were reduced from 79.3 to 73.3 hours among the junior residents (n = 16) and from 79.7 to 72.5 hours among the senior residents (n = 15). More than half of the residents saw their overall patient encounter volume either decrease or significantly decrease. More senior residents (66.7%, n = 10) reported significant decreases in their operating volume than the junior residents (43.8%, n = 7). Five senior residents (33.3%) and 6 junior residents (37.5%) did not receive credits for their rotation. Of those residents, 4 senior residents (80%) and 2 junior residents (33.3%) perceived that they achieved all expected competencies to pass the rotation. Conclusion: Several residents, especially residents in PGY3 and PGY4, perceived that they achieved the necessary competencies to progress to the next level of training despite seeing reduced work hours, decreased patient encounters, and reduced operating volume during the COVID-19 third wave in Ontario. Further studies on identifying and managing discrepancies pertaining to assessment of residents' performance and faculty's perception of their competence in orthopedic surgery training may be warranted.

Off-the-Shelf Partial HLA Matching SARS-CoV-2 Antigen Specific T Cell Therapy: A New Possibility for COVID-19 Treatment.

BACKGROUND: Immunological characteristics of COVID-19 show pathological hyperinflammation associated with lymphopenia and dysfunctional T cell responses. These features provide a rationale for restoring functional T cell immunity in COVID-19 patients by adoptive transfer of SARS-CoV-2 specific T cells. METHODS: To generate SARS-CoV-2 specific T cells, we isolated peripheral blood mononuclear cells from 7 COVID-19 recovered and 13 unexposed donors. Consequently, we stimulated cells with SARS-CoV-2 peptide mixtures covering spike, membrane and nucleocapsid proteins. Then, we culture expanded cells with IL-2 for 21 days. We assessed immunophenotypes, cytokine profiles, antigen specificity of the final cell products. RESULTS: Our results show that SARS-CoV-2 specific T cells could be expanded in both COVID-19 recovered and unexposed groups. Immunophenotypes were similar in both groups showing CD4+ T cell dominance, but CD8+ and CD3+CD56+ T cells were also present. Antigen specificity was determined by ELISPOT, intracellular cytokine assay, and cytotoxicity assays. One out of 14 individuals who were previously unexposed to SARS-CoV-2 failed to show antigen specificity. Moreover, ex-vivo expanded SARS-CoV-2 specific T cells mainly consisted of central and effector memory subsets with reduced alloreactivity against HLA-unmatched cells suggesting the possibility for the development of third-party partial HLA-matching products. DISCUSSION: In conclusion, our findings show that SARS-CoV-2 specific T cell can be readily expanded from both COVID-19 and unexposed individuals and can therefore be manufactured as a biopharmaceutical product to treat severe COVID-19 patients. ONE SENTENCE SUMMARY: Ex-vivo expanded SARS-CoV-2 antigen specific T cells developed as third-party partial HLA-matching products may be a promising approach for treating severe COVID-19 patients that do not respond to previous treatment options.

Plasmonic heating-based portable digital PCR system.

A miniaturized polymerase chain reaction (PCR) system is not only important for medical applications in remote areas of developing countries, but also important for testing at ports of entry during global epidemics, such as the current outbreak of the coronavirus. Although there is a large number of PCR sensor systems available for this purpose, there is still a lack of portable digital PCR (dPCR) heating systems. Here, we first demonstrated a portable plasmonic heating-based dPCR system. The device has total dimensions of 9.7 × 5.6 × 4.1 cm and a total power consumption of 4.5 W, allowing for up to 25 dPCR experiments to be conducted on a single charge of a 20 000 mAh external battery. The dPCR system has a maximum heating rate of 10.7 °C s-1 and maximum cooling rate of 8 °C s-1. Target DNA concentrations in the range from 101 ± 1.4 copies per µL to 260 000 ± 20 000 copies per µL could be detected using a poly(dimethylsiloxane) (PDMS) microwell membrane with 22 080 well arrays (20 µm diameter). Furthermore, the heating system was demonstrated using a mass producible poly(methyl methacrylate) PMMA microwell array with 8100 microwell arrays (80 µm diameter). The PMMA microwell array could detect a concentration from 12 ± 0.7 copies per µL to 25 889 ± 737 copies per µL.