ABSTRACT
Global literature have reported that individuals who have recovered from the acute phase of COVID-19 may suffer from persistent symptoms, namely long COVID-19, also known as the post-COVID-19 condition. WHO defines that long COVID-19 occurs in individuals with a history of SARS-CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis. Symptoms of long COVID-19 include fatigue, headache dyspnea and so on, affecting multiple systems such as neurological, psychiatric, respiratory, cardiovascular and gastrointestinal systems. Based on the existing evidence, it is suggested to strengthen scientific research on long COVID-19, persist in a "dynamic COVID-zero strategy" currently to reduce infections,accelerate vaccination coverage, and carry out early monitoring and intervention of long COVID-19, to cope with the long-term disease and economic burden caused by long COVID-19. © 2022, Publication Centre of Anhui Medical University. All rights reserved.
ABSTRACT
The coronavirus disease 2019 (COVID-19) has put enormous pressure on the global supply chain. This work aims to solve supply chain interruption caused by public health emergencies in real life through the resilient supply chain based on digital twins (DTs). The research example used here is the disruption of the supply chain of N95 medical masks under the COVID-19 epidemic. First, the resilient supply chain's emergency decision cost and profit model is established under the manufacturer-supplier shared mode. The supply chain of M company of N95 medical masks in Hubei under the COVID-19 pandemic is selected to discuss the cost of emergency decision-making in the resilient supply chain. Moreover, a product supply chain model is built, including H suppliers, J manufacturers, K distributors, and L retailers. Supply failures result in lower supplier capacity ratios. Accordingly, the supply chain will adopt emergency strategies to reduce operating costs and increase profits. Activating alternative suppliers and distributors can mitigate the loss caused by partial supply chain disruption in emergencies. The elasticity of supply chains based on DTs discussed here is of significant value in helping the automation of critical links of the supply chain. The resilient supply chain combined with the capacity recovery strategy can significantly improve the traditional supply chain's response to supply disruption events.
ABSTRACT
TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: To describe the development, implementation, and learner engagement in a longitudinal international remote critical care continuing medical education program in China. METHODS: Based on the Mayo Clinic Checklist for Early Recognition and Treatment of Acute and Illness and iNjury (CERTAIN) program, we designed and delivered a longitudinal 40-week remote coaching program for a community-based teaching hospital in Shandong Province, China. Based on a mixed-methods needs assessment that included learner feedback using an exploratory sequential design and ICU process and outcomes data, we developed a curriculum that included asynchronous, online learning modules with multiple language captions and weekly remote education sessions using a blend of didactic presentations on common critical care syndromes, virtual simulation, journal club, and case-based discussions. Faculty included a diverse group of critical care experts and bilingual facilitators. The program also included clinical research and quality improvement workshops to facilitate implementation of key concepts identified during these activities. Participants completed a survey using a 5 point anchored Likert scale after each educational activity to provide feedback and guide course improvement. RESULTS: Twenty-two Chinese clinicians (18 physicians, 4 nurses) enrolled in this CERTAIN longitudinal program. Learners completed a total of 163 hours (mean 7.4 hr/learner) asynchronous online learning, and to date have completed 23 weekly education sessions (total 28 hours, including an extended virtual simulation experience). Survey response rate was 56%. Learners reported a high rate of overall satisfaction with the course (112, 61% Excellent;55 (30%) Very Good) and specific topic discussions (110,60% Excellent;57, 31% Very Good), with steady improvement over time. Perceived practice relevance was also high (110, 59% Excellent;55,30% Very Good), and this effort has informed ongoing local performance improvement initiatives. CONCLUSIONS: Remote delivery of longitudinal critical care continuing education program in China using asynchronous learning, case-based discussion, and virtual simulation is feasible, associated with a high rate of learner satisfaction, and increases engagement in quality improvement initiatives. This innovative global education initiative offers an important potential solution to strengthen critical care services in remote, resource-limited settings at low cost, especially during the ongoing COVID-19 pandemic. CLINICAL IMPLICATIONS: The World Health Organization has identified remote education programs as a priority to strengthen international critical care services and better meet growing global clinical demand. The best method to effectively deliver continuing medical education to international healthcare providers with unique cultural, organizational, and practice backgrounds is not well defined. DISCLOSURES: no disclosure on file for Wenjuan Cui;No relevant relationships by Yue Dong, source=Web Response Patent/IP rights for a licensed product relationship with Ambient Clinical Analytics Please note: From 2016 Added 05/23/2021 by Ognjen Gajic, source=Web Response, value=Royalty No relevant relationships by Heyi Li, source=Web Response No relevant relationships by Alexander Niven, source=Web Response no disclosure on file for Lujun Qiao;No relevant relationships by Yuqiang Sun, source=Web Response no disclosure on file for Qingzhong Yuan;
ABSTRACT
Background: To contain the COVID-19 pandemic, laboratory test results are an important reference for making diagnosis whose accuracy is closely associated with the sensitivity and specificity of the detection method.RT-PCR is a general detection method for SARS-CoV-2, but its sensitivity is limited and depends on the content of virus.Optimizing PCR-Time-of-flight mass spectrometry (TOFMS) may improve the sensitivity of low virus content detection, which may be an effective supplement to the existing Methods.Objective: To develop a PCR-TOFMS method for detecting SARS-CoV-2 nucleic acid based on Clin-ToF-II TOFMS system using matrix-assisted laser desorption/ionization(MALDI)principle, and evaluate its practical application value.Methods 186 samples were used as the data for developing a system of PCR-TOFMS, including 121 external quality assessment samples〔47(40 were SARS-CoV-2 positive and 7 were negative)from Shanghai Center for Clinical Laboratory, and 74(41 were SARS-CoV-2 positive and 33 were negative)from National Health Commission of the People's Republic of China〕, and 65(32 positive plasmids and diluted samples, 28 samples of healthy people and 5 of ultrapure water as blank control) bought by our laboratory.Another 100 samples collected during January to February, 2020, were used as the data for testing the performance of our system of PCR-TOFMS, including 80 samples of upper respiratory tract secretions(55 throat swab samples, and 25 sputum samples) of suspected COVID-19 cases collected clinically by Anhui's hospitals and sent to Anhui Provincial Center for Disease Control and Prevention for detection, and 20 throat swab samples of healthy people.The detection procedure for the system was developed, including PCR amplification, SAP digestion, single-base extension and mass spectrometry detection. Based on the positive plasmid, the template quantity was optimized.The diagnostic criterion for SARS-CoV-2 was determined according to the peak signal-to-noise ratio of 186 samples' results. The samples of 80 suspected COVID-19 cases and 20 healthy people were analyzed, and the results were compared with those by RT-PCR.Results By optimizing the template conditions of PCR-TOF MS, the typical mass spectra of PCR-TOFMS was obtained when the template amount was 6 µl.The established RT-PCR reaction system could effectively detect the amplification of ORF1ab gene and nucleocapsid protein (N) gene of SARS-CoV-2 nucleic acid. In this study, the detection rate of PCR-TOFMS for clinically suspected cases was 90.00%, which was higher than 75.00% of RT-PCR. Meanwhile, the results showed that 25.00% of suspicious results were detected by RT-PCR, but no suspicious results were found by PCR-TOFMS. PCR-TOFMS had higher rates of detecting SARS-CoV-2 in sputum samples(100.00% vs 64.00%)and throat swab samples(85.45% vs 43.64%)of suspected COVID-19 cases than RT-PCR, but both of them did not find SARS-CoV-2 in negative samples.Conclusion: The combination of PCR and TOFMS technology makes the detection of SARS-CoV-2 target fragment expand exponentially, thereby improving the detection sensitivity of samples.In addition, MALDI-TOF MS technology has high accuracy and specificity through the detection and analysis of ion molecular weight, which also confirms that sputum sample is better than throat swab sample for detection.This method can be used as a supplement and collaboration of RT-PCR, which can make up for the false negative problem to a certain extent, thus reducing the clinical missed diagnosis rate, improving the detection efficiency, and shortening the time for pandemic situation research and judgment. Copyright © 2020 by the Chinese General Practice.