Logistics Management for Emergency Resource Planning during Covid-19

The following sections are included: • Introduction • Literature Review • Research Methodology and Observations • Distribution Channel in Taiwan • Face Mask Policy in Taiwan • Logistics Network Models by ABC Classification • Strategy for Emergency Resource Stockout • Effect of Waste Face Mask Toward Sustainability • Emergency Resource Controlled by Government • Action Plans • References. © 2023 by World Scientific Publishing Co. Pte. Ltd.

Psychotherapy and Culture: Past, Present, Future

During 2020, the twin pandemics of COVID-19 and social unrest exposed significant socioeconomic and racial/ethnic disparities within the United States. Unfortunately, psychotherapy has often reflected these disparities. If psychotherapy is to remain meaningful and credible it needs to be inclusive of the needs and characteristics of all, not just of a privileged few. However, this does not mean that psychotherapy has not strived to diversify. In fact, significant advances in the field are the results of these efforts. In this article, the intersections between culture and psychotherapy are examined through three distinct types of psychotherapy underscoring their strengths and limitations and using these to propose future areas of cultural psychotherapy research. It is hoped that an enhanced awareness of these distinctions will lead psychologists to more effectively embrace a psychotherapy that is more efficacious and beneficial for all. © 2022 Elsevier Ltd. All rights reserved

Psychosocial Support in the Pandemic: Effects of a Preventive Depression Intervention on Maternal and Infant Outcomes

Background: Perinatal depression is a common and undertreated pregnancy complication. Beginning in January 2020, we implemented “Reach Out, Stay Strong, Essentials for New Moms,” (ROSE) an empirically validated 5-session intervention recommended by the U.S. Preventive Services Task Force to prevent perinatal depression (PPD). Methods: Our integrated evaluation framework helped us to understand the virtual program delivery adapted due to the COVID-19 pandemic. This included semi-structured provider interviews and surveys, patient questionnaires, and a COVID-19 stressor screen. Two controls matched on maternal age, race, delivery date, zip-code, and infant gender were selected per ROSE participant on a quarterly basis, and maternal and infant outcomes were assessed at nine months post-delivery. Results: To date, 68 highrisk pregnant women have been referred, and 57 enrolled in the ROSE program (84% retention, Figure 1). Eight ROSE infants and 16 controls have reached nine months of age and were eligible for review. ROSE participants and controls had similar rates of attendance at a six-week PPD follow-up visit. Participants and controls also attended on average a similar number of well-child visits, had similar rates of screening for PPD at attended visits, and had similar cumulative incidence of positive screens for PPD. ROSE participants and controls had similar rates of initiating breastfeeding. Of those who initiated breastfeeding, ROSE participants had, on average, a longer duration of breastfeeding. Rate of completion of infant vaccination schedules was similar between ROSES participants and controls, with a trend toward reduced vaccination refusal in the ROSE group. Provider stakeholders surveyed feel that the ROSE program is addressing a gap in care by flexibly providing additional mental health services, improving continuity of care through a dedicated program coordinator, and increasing partner engagement. Participants sought out an additional 103 contacts beyond those required by the five sessions of the program. Conclusion: Analysis of preliminary data shows trends toward increased duration of breastfeeding and decreased vaccine hesitancy in the ROSE study population. The majority of records reviewed to date are from initial enrollment, which began in a clinic for pregnant mothers with substance use disorder. Stakeholders feel that ROSE is addressing key care needs, particularly in this clinic population, and participants continue to seek engagement with the program outside of required sessions. Our data suggests that ROSE supports high-risk mothers in caring for themselves and their infants after birth. We will continue to review additional infant and maternal health metrics (Figure 2) as enrollment expands and more of our study population reaches nine months post-delivery.

Palliative care interventions for people who use substances during communicable disease outbreaks: a scoping review

Objectives When resources are strained during communicable disease outbreaks, novel palliative care interventions may be required to optimally support people who use substances with life-limiting illnesses. Therefore, we asked the question, € what is known about communicable disease outbreaks, palliative care and people who use substances?', such as palliative care interventions that can improve the quality of life of patients with life-limiting illnesses. Design We conducted a scoping review that involved comprehensive searches in six bibliographic databases from inception to April 2021 (Medline ALL (Medline and Epub Ahead of Print and In-Process and Other Non-Indexed Citations), Embase Classic+Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trial, PsycInfo all from the OvidSP platform, Scopus from Elsevier) and grey literature searches. We included English and French records about people ≥18 years old with life-limiting illnesses who use substances during communicable disease outbreaks. We identified, summarised and presented the findings about palliative care interventions in figures, tables and narrative descriptions. Results We identified 32 records about palliative care interventions for people who use substances during communicable disease outbreaks. The majority focused on palliative care for people who use substances with AIDS during HIV epidemics (n=27, 84.4%), and approximately half were published in the USA (n=15, 46.9%). Most common substances used were alcohol (n=18, 56.3%), opioids (n=14, 43.8%) and cocaine (n=10, 31.3%). Four groups of palliative care interventions were identified: (1) symptom management (n=20, 62.5%), (2) psychosocial support (n=15, 46.9%), (3) advance care planning (n=8, 25.0%) and (4) healthcare provider training (n=6, 18.8%). Conclusions Beyond studies on HIV epidemics, there is limited knowledge about palliative care interventions for people who use substances during communicable disease outbreaks. Research and guidance are needed about how best to provide palliative care to this population with complex needs including in resource-limited countries. Protocol Buchman DZ, Ding P, Lo S, et al. Palliative care for people who use substances during communicable disease epidemics and pandemics. BMJ Open 2021;11: e053124

IMPACT OF COVID-19 ON THE CLINICAL OUTCOMES AND MANAGEMENT OF IGG4 RELATED DISEASE PATIENTS WITH PANCREATOBILIARY INVOLVEMENT: A MULTICENTER RETROSPECTIVE STUDY

Background: Coronavirus disease 2019 (COVID-19) has affected more than 249 million people worldwide as of November 2021. Patients with chronic immune-mediated inflammatory diseases are at risk of viral infections either related to their underlying immune dysfunction or the immunosuppressive therapy, but little is known about the impact of COVID19 on outcomes and management of pancreatobiliary IgG4 related disease (IgG4 RD) patients. Methods: This was a multicenter retrospective cohort study aiming to investigate the impact of COVID-19 on the clinical outcomes and management of pancreatobiliary IgG4 RD patients in different geographic areas with COVID-19 outbreak. Pancreatobiliary IgG4 RD patients aged 18 years or older from 7 referral centers in Hong Kong, Japan, Thailand, Singapore, the United States and Italy were included. Case definition of IgG4 RD: elevated serum IgG4 serology with typical features of pancreatobiliary involvement on imaging, EUS, ERCP and/ or typical histopathologic features of IgG4 RD. Medical records were reviewed for IgG4 RD status (organ involvement, disease activity, treatment status), COVID-19 infection and outcome. Outcome measures were incidence and severity of COVID-19 in pancreatobiliary IgG4 RD patients, medical treatment for the IgG4 disease during COVID-19 and incidence of postponement or discontinuation of indicated medical treatment for IgG4 RD during COVID-19. Results: 101 pancreatobiliary IgG4 RD patients (mean age 66.4 +/- 12.1 years, male 74.3%) from 7 referral centers were included from January 2020 to November 2020. Major comorbidities of patients: none in 21.8%, diabetes in 45.5%, hypertension in 49.5%, ischemic heart disease in 8.9%, chronic liver disease in 8.9%, chronic kidney disease in 9.9% and cancer in 5.0% of patients. IgG4 RD organ involvement: pancreas only in 36.6%, pancreas and bile duct in 16.8%, bile duct only in 14.9%, pancreatobiliary and other organs in 26.7% of patients. The mean serum IgG4 serology level was 4.72+/-7.31 g/L. In 2020, 27.7% of patients had active IgG4 disease while 72.3% of patients were in remission. In 2020, 65.3% of patients received treatment (steroid in 48.5%, thiopurines in 22.7%, steroid and thiopurines in 25.8%, rituximab in 1.5%), while 30.7% of patients were not on treatment. 2 patients (2.0%) had COVID-19 infection, with 1 patient requiring ICU admission. All infected patients recovered from COVID-19 without flare up of IgG4 RD. In 2020, 6.9% of patients had postponement or discontinuation of indicated medical treatment for IgG4 RD during COVID-19 outbreak due to concern of COVID-19 infection while on immunosuppressive therapy. Conclusion: In this study, low incidence of COVID-19 infection and low rates of postponement or discontinuation of indicated medical treatment were observed in pancreatobiliary IgG4 RD patients during COVID-19 outbreak in 2020. (Table Presented)

Scoring System to Triage Patients for Spine Surgery in the Setting of Limited Resources

INTRODUCTION: As ofMay 04, 2020, the COVID-19 pandemic has affected over 3.5 million people and touched every inhabited continent. Accordingly, it has stressed health systems the world over leading to the cancellation of elective surgical cases and discussions regarding healthcare resource rationing. It is expected that rationing of surgical resources will continue even after the pandemic peak, and may recur with future pandemics, creating a need for a means of triaging emergent and elective spine surgery patients. METHODS: Using a modified Delphi technique, a cohort of 16 fellowship-trained spine surgeons from 10 academic medical centers constructed a scoring system for the triage and prioritization of emergent and elective spine surgeries. Three separate rounds of videoconferencing and written correspondence were used to reach a final scoring system. Sixteen test cases were used to optimize the scoring system so that it could categorize cases as requiring emergent, urgent, high-priority elective, or low-priority elective scheduling. RESULTS: The devised scoring system included 8 independent components: neurological status, underlying spine stability, presentation of a highrisk post-operative complication, patient medical comorbidities, expected hospital course, expected discharge disposition, facility resource limitations, and local disease burden. The resultant calculator was deployed as a freely-available web-based calculator: https://jhuspine3.shinyapps. io/SpineUrgencyCalculator/ CONCLUSION: Here we present the first quantitative urgency scoring system for the triage and prioritizing of spine surgery cases in resource-limited settings. We believe that our scoring system, while not all-encompassing, has potential value as a guide for triaging spine surgical cases during the COVID pandemic and post-COVID period.

A randomized phase II trial of carboplatin with or without nivolumab in metastatic triple-negative breast cancer

Background: Platinum agents induce DNA crosslinking and cause accumulation of genotoxic stress, which leads to immune activation via IFN-γ signaling, making the combination with nivolumab (PD-1 antibody) an attractive strategy to enhance the benefit of either agent alone in metastatic triple-negative breast cancer (mTNBC). Methods: In this phase II open-label, investigator-initiated, multicenter trial, patients with unresectable locally advanced or mTNBC treated with 0-1 prior lines of chemotherapy in the metastatic setting were randomized 1:1 to carboplatin (AUC 6) with or without nivolumab (360 mg) IV every 3 weeks. Stratification factors included: germline BRCA (gBRCA) status, prior neo/adjuvant platinum, and number of prior lines of metastatic therapy. After approval of PD-L1 inhibition for mTNBC, the study was amended to include first-line mTNBC only and PD-L1 status was added as a stratification factor. Patients randomized to carboplatin alone were allowed to crossover at progression to receive nivolumab (+ nab-paclitaxel post-amendment). The primary objective was to compare progression-free survival (PFS) per RECIST 1.1 criteria of carboplatin with or without nivolumab in first-line mTNBC in the S intent-to-treat (ITT) population. Key secondary objectives were objective response rate (ORR), overall survival (OS), clinical benefit rate, and duration and time to objective response. PD-L1 status was confirmed centrally using the SP142 Ventana assay (positive, ≥1% IC). Paired researchbiopsies at baseline, on-treatment and at progression were performed, if safely accessible. The trial closed to accrual prior to reaching target accrual due to approval of PD-1 inhibition in combination with platinum-based chemotherapy for PD-L1+ mTNBC. Results: Between 1/30/2018 and 12/9/2020, 78 patients enrolled. Three patients did not receive protocol treatment, and the safety analysis was conducted among the 75 that received any treatment;37 received carboplatin + nivolumab (Arm A), 38 received carboplatin alone (Arm B). Median age was 59.1 yrs (range: 25.4-75.8). Four patients (5.3%) had a known gBRCA1/2 mutation. Sixty-two (82.7%) patients received 0 prior lines (ITT population) and 13 (17.3%) 1 prior line of metastatic therapy. Sixty-seven patients (89.3%) experienced any grade ≥2 treatment-related adverse event (AE). The most frequent AE were platelet count decrease (n=40;53.3%), anemia (n=36;48.0%), neutrophil count decrease (n=33;44.0%) and fatigue (n=24;32.0%). Grade 3/4 AE were observed in 46 (61.3%) patients, and there was one grade 5 AE (COVID19 pneumonia). Any grade ≥2 immune-related AE (irAE) were observed in 25 of the 37 (67.6%) patients treated with carboplatin + nivolumab. Grade 3/4 irAE were observed in 11 (29.7%) patients. In the ITT population (32 on Arm A;30 on Arm B), median PFS was 4.2 months with carboplatin + nivolumab, and 5.5 months with carboplatin (stratified HR 0.98, 95% CI [0.51-1.88];p=0.95). ORR was 25% vs. 23.3%, respectively. At a median follow-up of 23.5 months, median OS was 17.5 months vs. 10.7 months (stratified HR 0.63, 95% CI [0.32-1.24];p=0.18). In patients with PD-L1+ mTNBC (13 on Arm A;11 on Arm B), median PFS was 8.3 months and 4.7 months, respectively (stratified HR 0.63, 95% CI [0.21-1.89];p=0.41). ORR was 23.1% vs. 27.3%, respectively. Median OS was 17.5 months vs. 9.6 months (stratified HR 0.59, 95% CI [0.20-1.75];p=0.34). Conclusions: Addition of nivolumab to carboplatin in patients with previously untreated mTNBC, unselected by PD-L1 status, did not significantly improve PFS. A trend toward improved PFS and OS was observed in patients with PD-L1+ mTNBC. Tissue, blood and intestinal microbiome biomarker analyses are planned;bulk tumor and single-cell sequencing, and TCR sequencing in peripheral blood are ongoing.

ResSaNet: A Hybrid Backbone of Residual Block and Self-Attention Module for Masked Face Recognition

In recent years, the performances of face recognition have been improved significantly by using convolution neural networks (CNN) as the feature extractors. On the other hands, in order to avoid spreading COVID-19 virus, people would wear mask even when they want to pass the face recognition system. Thus, it is necessary to improve the performance of masked face recognition so that users could utilize face recognition methods more easily. In this paper, we propose a feature extraction backbone named ResSaNet that integrates CNN (especially Residual block) and Self-attention module into the same network. By capturing the local and global information of face area simultaneously, our proposed ResSaNet could achieve promising results on both masked and non-masked testing data.

Introduction of IDEEA (International Design & Engineering Education Association) 2021 Program

IDEEA program provides a platform for academia and industry to meet, exchange ideas, foster collaboration and make new friendships. The IDEEA program, which started in 2019, is on its third year this year. The purpose of this program is for students to find solutions of innovative designs or strategies as potential answers to a given set of requirements. Engineering design tasks for specific purpose drones have been carried out for the past two years, but this year, the development of future mobility was selected as the subject. In order to gain an in-depth understanding of future automobile using C (Connected), A (Autonomous), S (Shared), and E (Electric) as the keywords, 215 engineering and design students from 26 universities around the world form 16 teams. In addition, despite the Covid 19 pandemic environment, various online tools are being used to efficiently cooperate globally. The contents of this project are to design, model, and package an innovative future mobility design and engineering concept. In November of 2020, the program was launched with a general announcement of this year’s assignments. In December, team composition started, and the entire student team formation was completed and the collaboration started in March. It was easier for students to focus on conducting the project during “the team collaboration phase 1”, when all universities around the world were offering classes. The teams had to select a megacity. Then they would develop ideas and define concepts for the future mobility, appropriate for their selected metropolitan area. The midterm presentation took place on May 14th, and the purpose of this presentation was to determine how well cooperation among participating students have been progressing. Students will carry out user-needs research, industrial design and the engineering specifications and develop a “soft” precision mock-up and a CAD model of their final solution. They will present a series of development processes and their virtual mock up on the final presentation, scheduled to be on July 26–27. The IDEEA program faces many challenges due to the wide variety of the participating universities, different majors, semester starting dates and media restrictions in different countries. At the same time, the challenges of the global student teams form the foundation for an important teaching content of the course. The students can experience the collaborative work of engineers and designers in developing real world products in advance. This program will give recommendations for implementing an international, multidisciplinary collaboration course. A structured approach will be documented regarding the organization and project design, the team initiation, teaching concept and the project outcome in terms of quality of the delivered results as well as the learning success of the students. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Incidence of cardiac complications during index hospitalisation with covid-19 in Australia: Aus-covid study

Introduction: Cardiac complications of COVID-19 include acute cardiac injury, myopericarditis, cardiomyopathy and arrhythmias. This study aimed to describe the incidence of cardiac complications in patients admitted to hospital with COVID-19 in Australia. Methods: AUS-COVID is a multicentre observational cohort study across 21 Australian hospitals including all index hospitalisations with laboratory-proven COVID-19 in patients aged 18 years or older. All consecutive patients entered in the AUS-COVID Registry by 28 January 2021 were included in the present study. Results: Six hundred and forty-four hospitalised patients (62.5 ± 20.1 years old, 51.1% male) with COVID-19 were enrolled in the study. Overall in-hospital mortality was 14.3%. Twenty (3.6%) patients developed new atrial fibrillation or flutter during admission and 9 (1.6%) patients were diagnosed with new heart failure or cardiomyopathy. Three (0.5%) patients developed high grade atrioventricular (AV) block. Two (0.3%) patients were clinically diagnosed with pericarditis or myopericarditis. Among the 295 (45.8%) patients with at least one troponin measurement, 99 (33.6%) had a peak troponin above the upper limit of normal (ULN). In-hospital mortality was higher in patients with raised troponin (32.3% vs 6.1%, p<.001). New onset atrial fibrillation or flutter (6.4% vs 1.0%, p=.001) and troponin elevation above the ULN (50.3% vs 16.4%, p<.001) were more common in patients 65 years and older. There was no significant difference in the rate of cardiac complications between males and females. Conclusions: Among patients with COVID-19 requiring hospitalisation in Australia, troponin elevation was common but clinical cardiac sequelae were uncommon. The incidence of atrial arrhythmias and troponin elevation was greatest in patients 65 years and older.

Association of hypertension with mortality in patients hospitalised with covid-19

Introduction: To assess whether hypertension is an independent risk factor for mortality amongst patients hospitalised with COVID-19 and to evaluate the impact of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) on mortality in patients with a background of hypertension. Methods: This observational cohort study included all consecutive index hospitalisations with laboratory proven COVID-19 aged 18 years or older across 21 Australian hospitals entered in the AUS-COVID Registry by 22nd January 2021. Patients were excluded if their past medical or medication history was not available or if they were transferred to another hospital in which case mortality outcomes were not available. Registry data were analysed for in-hospital mortality in patients with comorbidities including hypertension, and baseline treatment with ACE inhibitors or ARBs.Results: 546 consecutive patients (62.9±19.8 years old, 51.8% male) hospitalised with COVID-19 were enrolled. In the multivariable model, significant predictors of mortality were age (aOR 1.09, 95% CI 1.07-1.12, p<.001), heart failure or cardiomyopathy (aOR 2.71, 95% CI 1.13-6.53, p=.026), chronic kidney disease (aOR 2.33, 95% CI 1.02-5.32, p=.044) and chronic obstructive pulmonary disease (aOR 2.27, 95% CI 1.06-4.85, p=.035) (Figure 1). Hypertension was the most prevalent comorbidity (49.5%) but was not independently associated with increased mortality (aOR 0.92, 95% CI 0.48-1.77, p=.81). Amongst patients with hypertension, ACE inhibitors (aOR 1.37, 95% CI 0.61-3.08, p=.61) and ARBs (aOR 0.64, 95% CI 0.27-1.49, p=.30) did not affect mortality. Conclusions: In patients hospitalised with COVID-19, pre-existing hypertension was the most prevalent comorbidity but was not independently associated with mortality. Similarly, the baseline use of ACE inhibitors or ARBs had no independent association with in-hospital mortality.

Consensus guidelines for interventional cardiology services delivery during covid-19 pandemic in Australia and new Zealand.

The global coronavirus disease (COVID-19) pandemic poses an unprecedented stress on healthcare systems internationally. These Health system-wide demands call for efficient utilisation of resources at this time in a fair, consistent, ethical and efficient manner would improve our ability to treat patients. Excellent co-operation between hospital units (especially intensive care unit [ICU], emergency department [ED] and cardiology) is critical in ensuring optimal patient outcomes. The purpose of this document is to provide practical guidelines for the effective use of interventional cardiology services in Australia and New Zealand. The document will be updated regularly as new evidence and knowledge is gained with time. Goals Considerations.