Uptake of vaccination in older Indian patients with cancer: A cross-sectional observational study

Background: Older patients with cancer are at a higher risk of invasive infections. Vaccination is an effective approach to decrease the mortality and morbidity associated with infections. Objective(s): Our primary objective was to evaluate the proportion of older patients with cancer who had received routine vaccinations against pneumococcal, influenza, and coronavirus disease 2019 (COVID-19). Our secondary objective was to identify the factors associated with vaccine uptake such as age, sex, education, marital status, comorbidities, and place of residence. Material(s) and Method(s): This cross-sectional observational study was conducted in the geriatric oncology outpatient clinic of the Department of Medical Oncology at the Tata Memorial Hospital, a tertiary care cancer hospital in Mumbai, India, from February 2020 to January 2023. We included all patients aged >=60 years who were evaluated in the geriatric oncology clinic during the study period and for whom the immunization details were available. The uptake of COVID-19 vaccine was calculated from March 2021 onwards, which was when the COVID-19 vaccine became available to patients aged >=60 years in India. Result(s): We enrolled 1762 patients;1342 (76.2%) were male. The mean age was 68.4 (SD, 5.8) years;795 (45%) patients were from the west zone of India. Only 12 (0.68%) patients had received the pneumococcal vaccine, and 13 (0.7%) had received the influenza vaccine. At least one dose of the COVID-19 vaccine had been taken by 1302 of 1562 patients (83.3%). On univariate logistic regression, education, marital status, geographic zone of residence, and primary tumor site were correlated with the uptake of COVID-19 vaccine. Factors associated with a greater COVID-19 vaccine uptake included education (up to Std 10 and higher vs. less than Std 10: Odds Ratio [OR], 1.46;95% confidence interval [CI], 1.07-1.99;P = 0.018, and illiterate vs. less than Std 10: OR, 0.70;95% CI, 0.50-0.99;P = 0.041), marital status (unmarried vs. married: OR, 0.27;95% CI, 0.08-1.08;P = 0.046, and widow/widower vs. married: OR, 0.67;95% CI, 0.48-0.94;P = 0.017), lung and gastrointestinal vs. head-and-neck primary tumors (lung cancer vs. head-and-neck cancer: OR, 1.60;95% CI, 1.02-2.47;P = 0.038, and gastrointestinal vs.head-and-neck cancer: OR, 2.18;95% CI, 1.37-3.42;P < 0.001), and place of residence (west zone vs. central India: OR, 0.34;95% CI, 0.13-0.75;P = 0.015). Conclusion(s): Fewer than 1 in 100 older Indian patients with cancer receive routine immunization with influenza and pneumococcal vaccines. Hearteningly, the uptake of COVID-19 vaccination in older Indian patients with cancer is over 80%, possibly due to the global recognition of its importance during the pandemic. Similar measures as those used to increase the uptake of COVID-19 vaccines during the pandemic may be beneficial to increase the uptake of routine vaccinations.Copyright © 2023 Cancer Research, Statistics, and Treatment.

Megaregions and COVID-19: a call for an innovative governing structure in the United States

In the United States, megaregions, which are networks of urban centres and their hinterlands, have a greater prevalence of COVID-19, but have been overlooked as a geographical unit for multi-jurisdictional governance for pandemic response. Existing multi-metropolitan planning organization (MPO) collaborations and state-level COVID-19 coalitions in the United States demonstrate the utility of the megaregion as an effective framework for regional collaboration and operations. Using multilevel modelling, we explore the significance of megaregions in explaining disease occurrence. The results suggest that the megaregion can be an appropriate geographical scale for multi-jurisdictional operations, governance and pandemic response. © 2023 Regional Studies Association.

Digital Value Chain Strategies and its Impact on Organizational Productivity: The Mediating Role of Government Digital Initiatives to Achieve 5 Trillion US$ Economy by 2025. A Case Study of Select Automobile Firms in Delhi NCR Region

The unprecedented COVID-19 pandemic has severely affected the Automobile sector in the Delhi NCR region with Supply chain disruptive innovations and periodic travel restrictions imposed by the government. The present study investigates the influence of the digital value chain on organisational productivity. The study analyses the data collected from Logistics and Supply chain managers working in allied areas of value chain operations in the automobile sector. The target respondents selected for the study are 200, and purposeful sampling is used to identify the target respondents with expertise in the areas of supply chain and marketing. Partial least squares regression is used to analyse the collected data and establish relationships among the variables and explanatory variables. The study contributes to the understanding of value chain strategies and their significance in enhancing organisational productivity in the automobile sector.

A Survey on Diagnosing Pulmonary Diseases

Due to the increase in world population, a lot of research is being done in the medical sciences. Pandemics and epidemics have multiple outbreaks in many regions of the world. In order to solve the issue, creative probing is being used. Most of the illnesses in the group are obstructive and may result in a loss of life. Heart and lung conditions make up a large portion of the obstructive illnesses in this group. More than 5 lakh people die each year from lung illnesses, generally known as pulmonary disorders, with an equal proportion of men and women affected. Each disease has unique symptoms that are connected to it in the fields of medicine and healthcare. There are several new tests that are being developed to identify each of the dangerous diseases that are on the rise. This results from the necessity for quick illness prediction. This paper examines numerous studies and experiments carried out over a variety of timelines and approaches selected by various experiments, carefully examining the benefits and drawbacks of the approaches in order to construct an appropriate model for the cause. It focuses on the study of diagnosing pulmonary disorders and making the user's task easy in understanding the scanned images obtained. © 2023 IEEE.

Immunogenicity and safety of Biological E's CORBEVAX™ vaccine compared to COVISHIELD™ (ChAdOx1 nCoV-19) vaccine studied in a phase-3, single blind, multicentre, randomized clinical trial.

Optimum formulation of Biological-E's protein subunit CORBEVAX™ vaccine was selected in phase-1 and -2 studies and found to be safe and immunogenic in healthy adult population. This is a phase-3 prospective, single-blinded, randomized, active controlled study conducted at 18 sites across India in 18-80 year-old subjects. This study has two groups; (i) immunogenicity-group, participants randomized either to CORBEVAX™ (n = 319) or COVISHIELD™ arms (n = 320). (ii) Safety-group containing single CORBEVAX™ arm (n = 1500) and randomization is not applicable. Healthy adults without a history of COVID-19 vaccination or SARS-CoV-2 infection were enrolled into immunogenicity arm and subjects seronegative to SARS-CoV-2 infection were enrolled into the safety arm. The safety profile of CORBEVAX™ vaccine was comparable to the comparator vaccine COVISHIELD™. Majority of reported AEs were mild in nature in both arms. The CORBEVAX™ to COVISHIELD™ GMT-ratios at day-42 time-point were 1·15 and 1·56 and the lower limit of the 95% confidence interval for the GMT-ratios was determined as 1·02 and 1·27 against Ancestral and Delta strains of SARS-COV-2 respectively. Both COVISHIELD™ and CORBEVAX™ vaccines showed comparable seroconversion post-vaccination against anti-RBD-IgG response. The subjects in CORBEVAX™ cohort also exhibited higher interferon-gamma secreting PBMC's post-stimulation with SARS-COV-2 RBD-peptides than subjects in COVISHIELD™ cohort.

Assessment of mental workload and stress levels during the COVID19 outbreak among doctors catering to industrial workforce

Introduction: Health care providers are vital resources for every country. Their health and safety are crucial not only for continuous and safe patient care, but also for control of any outbreak. Mental workload is a broad multidimensional construct. It refers to a subjective experience of the costs incurred by a physician in performing patient. Mental demand, physical demand, temporal demand, effort, performance and frustration levels are the important dimensions on workload. Recognizing the degree to which we are affected and making strategies to make life better is important. Objective(s): To assess the mental workload status of doctors who are catering to mainly industrial workforce and what is its dimension which is putting a toll on them and the degree of stress they are experiencing, and to correlate between workload and stress levels. Material(s) and Method(s): A cross sectional study was carried out in ESIC Medical College and Hospital, from September 1 to December 31 ,2020. Both online and offline survey questionnaires were used to collect the data from doctors working in ESIC hospital, which was started after clearance from IEC and consent from participants. Workload was assessed using NASA task load index which contains 6 dimensions. This was assessed using a scale graded from 0 to 10 and stress levels were assessed using perceived stress scale. Result(s): A total of 104 participants responded to the survey of which 40(38.5%) were female and 64(61.5%) were male. The proportion of participants with high mental demand were 68(65.4%), physical demand 44(42.3%), effort demand 74(71.2%), frustration 40(38.5%), performance demand 8(7.7%) and temporal demand 44(42.3%). The proportion of participants with higher levels of workload were 90(86.5%), among whom, females were 37.8 % and males were 62.2 %. The perceived stress scale showed 2(1.9%) of participants were in low stress (score 0-13) And 80(76.9%) were in moderate stress (score 14-26) and 22(21.2%) were in high stress (score 27-40). Among participants with high stress levels 45.5 % were females and 54.5% were males. The calculated overall workload mean scores was 66.23+15.383 and perceived stress was 22.01+5.55 which is positively correlated and statistically significant. Conclusion(s): A considerate proportion of doctors' experience high workload and stress levels. Doctors being frontline workers are more vulnerable for mental health problems which are still underreported and is expected to be very considerate. There is a need to implant ways to decrease the stress levels of doctors and for better patient care.

A survey of student motivations for enrolling in engineering and technology undergraduate programs

Despite many efforts to attract and retain students in STEM programs in U.S. universities, it has proven to be a significant challenge. The ongoing COVID-19 pandemic has added to the struggles of students and educational institutions. At the same time, there is significant interest among funding agencies, including the National Science Foundation and philanthropic organizations to encourage enrollment in minority populations. This requires that we need to better understand the student population. Many national surveys and data sources including the Integrated Postsecondary Education System (IPEDS) provide a macro-level view across the entire country. This is insufficient for producing classroom-level changes. We need detailed information at the micro-level such as student surveys across multiple institutions to probe student motivations and ensure that their expectations are met and nurtured. We present the results of conducting a survey among 32 STEMs students enrolled in an introductory engineering course at Fairleigh Dickinson University. This is the first semester after the pandemic that courses were taught in person. We found significant differences along gender and racial lines. For the male students, 38% chose their STEM major due to parental or social influence, whereas for females it was 12.5%. For whites, parental/social influence accounted for 28% of STEM choices, whereas for African Americans, it was 0%. Across all students, 50% chose a STEM major due to an early interest in the field, or due to self-realization that they were good at STEM-related activities such as problem-solving. Our results indicate the importance of hands-on STEM exposure to students at the K-12 level and the role of mentors. Due to the recency of the data collected, we expect our findings to be valuable to the STEM education community. © 2022 IEEE.

Delayed IBD diagnosis leads to worse outcomes over years, with multiple implications on service delivery

Background: Delays in diagnosis can be patient and health-system related. Such delays have been reported to increase overall complications in Inflammatory Bowel Diseases (IBD). The aim of our study was to report on the impact of delays on IBD-related adverse outcomes (AOs), as hospitals currently face challenges with long waiting lists in the post-COVID-19 era. Method(s): New patients referred for suspected IBD to a single tertiary care centre between Jan 2013 to Dec 2017 were identified using EMR. A cut-off time was set for each delay-type based on best average hospital waiting times. Reasons for delays until start of treatment and data on pre-defined AOs (steroid & other rescue therapies, hospitalisations, surgery) were recorded for each patient until end of June 2021. Data was analysed using multiple Pearson correlations and Cox proportional Hazard model to determine if there was a difference in survival without AOs between patients with and without delay. Result(s): 105 patients were identified using strict criteria (M=58;median age=32y) with a median follow-up of 55 months. The most frequent presenting complaints were abdominal pain (44, 41.9%), loose stools (40, 38.1%), bloody diarrhoea (37, 35.2%) and bleeding perrectum (33, 31.4%). 65, 27 and 13 patients had a final diagnosis of Ulcerative colitis, Crohn's disease and Unclassified colitis respectively, and were analysed jointly. The longest delay-types noted: Patients seeking medical attention (median= 4 months;range 1 to 84 months);arranging gastroenterology clinic review after GP referral (median=5 weeks;1 to 30 weeks);and waiting for index endoscopy (median=3 weeks;1 to 36 weeks). Patient stratification based on delay-type, using specific cut-off times for each showed a statistically significant difference in survival without AOs for all (when comparing delay vs no delay). - delay in seeking medical attention (cut-off=1m;p=0.004) (Fig 1A) - delay in GP referral to specialty review (cut-off=1w;p=0.048) - delay in index endoscopy (cut-off=4w;p=0.01) (Fig 1B) - delay in starting treatment (cut-off=4w;p=0.03) Conclusion(s): Several bottlenecks of delays increase AOs in IBD over the follow-up period. A delay as short as a week, between GP referral to specialty review, is significant in determining AOs, relevant for specialist IBD centres particularly in the post-Covid period. Endoscopy units should prioritise suspected IBD patients to reduce AOs, which is likely to have implications on service delivery and planning. Long delays observed in patients seeking medical attention highlights the need for better patient education in the community.

Screening tool to improve patient referral to acute surgical care from accident and emergency

IntroductionThis study aimed, first, to audit the appropriateness of surgical referrals to an acute surgical unit for urgent assessment and, second, to devise a screening tool for use in the emergency department to categorise patients into those who need an urgent surgical review and those who can be seen in an ambulatory setting within the next few days.MethodsThe first phase of the study was an audit of surgical referrals between 1 and 18 February 2020 to check the appropriateness of the surgical referral. In the second phase, a tool was designed to screen patients who did not require urgent surgical review and could be seen in the ambulatory clinic. A prospective questionnaire study was conducted from 1 February to 24 March 2020 with patients who were admitted to an acute surgical ward. Based on responses to the screening tool, patients were given the outcome of whether they can be discharged and seen in an ambulatory clinic. The accuracy of the screening tool outcome was assessed and compared with actual patient discharge outcomes by the surgical team evaluating patients' electronic medical records.ResultsIn the first audit of referrals to the acute surgical ward, 206 patients were referred to the acute surgical unit and seen by the senior surgeon. Of these, 142 (68.9%) were discharged on the same day with or without follow-up in the ambulatory surgical clinic. In the prospective questionnaire phase of the study, 98 patients completed the questionnaire. The most common presentation was abdominal pain (n=60) followed by urological symptoms (n=11), symptoms of hernia complication (n=10), abscess (n=7), testicular pain (n=2) and trauma (n=2). Of the patients discharged on the same day, 50% were given ambulatory care appointments and 50% were discharged with no further follow-up. The sensitivity and specificity of the screening tool were 100% and 60.7%, respectively;the overall accuracy was 88.4%.ConclusionA large proportion of patients who are referred to the acute surgical unit can be deferred and seen in the ambulatory clinic. The screening tool used for acute surgical referral had reasonable sensitivity and high specificity to screen patients who can be seen in ambulatory clinics. At the same time, it identified patients who were unwell and required urgent surgical admission.

A Real Time Monitoring System for Home Isolated COVID-19 Patients

During this Covid-19-time number of patients in hospital are increased. The covid-19 patients are mainly of two types one who has a serious condition and the other who has a mild covid-19 symptom. On the other way, the patients who have very serious conditions generally have all facilities, they have doctors around them and other medical staff also there to take care of the situation, but the patients who have not very serious conditions are generally isolated in their home, a problem with this home isolated patients are they do not consult with doctor day to day and what happens if patients condition become serious basically this paper is going to solve this two problem and also monitoring the patients while getting different data like a heartbeat, SpO2, body temperature, etc. along with that we used a location sharing and nearest hospitals identification. Here we design IoT, GSM/GPS-based system through which we send the patients' health data directly to the hospital and if the patients' conduction becomes serious then it sends an alert to the hospital along with the patient's location and it also sends the hospital location to the patients. © 2022 IEEE.

Analysis of the Regulatory Development Cryptocurrencies for Trading in Business with Deep Learning Techniques

As the number of people infected with COVID-19 continues to rise, a number of nations have implemented state wide quarantines. This has resulted in a global financial crisis that is having severe impacts on countries all around the world. As a direct consequence of the epidemic, unemployment rates have increased in a number of different regions, which has a substantial and detrimental effect on trade across the globe. In light of the current state of the economy, Artificial Intelligence (AI) is causing a shift in the manner in which businesses evaluate their bitcoin holdings. The application of AI in a commercial setting has the potential to produce a wide range of beneficial results. We are spared from completing as much manual labour as a direct result of the favourable effects that AI has had on technology. These consequences can be noticed in our day-to-day lives. In the event that there is a pandemic, having knowledge of AI and the various strategies it employs, such as the classifier model, could be beneficial. Humans will be better suited to make decisions if they have rapid access to the analyses and projections that are created by AI and big data. In order to be prepared for the arrival of the new world, the company is putting in more effort, in collaboration with small and medium-sized enterprises (SMEs) and start-ups, to improve the administration of virtual enterprises by having a presence on a variety of different e-trade systems. Artificial intelligence (AI) is currently being utilised in a variety of settings to assist with the process of identifying and implementing workable solutions to a variety of problems that can develop in the workplace. AI is being used to improve business operations in a wide variety of spheres, including marketing, fraud detection, algorithmic trading, customer assistance, portfolio management, and product recommendations based on customer preferences. These are just few of the sectors. These are just a few examples of the kinds of problems that artificial intelligence might be able to solve in the future. Given the present worth of cryptocurrencies, technological developments may also be made in order to improve the performance of the rules that have been provided and produce the most accurate conclusion that is possible. © 2022 IEEE.

A study on the utilization of Ayushman Bharat arogya scheme among patients admitted to a tertiary care hospital during Covid pandemic

Introduction and Aim: In India, most of the households face financial hardships due to catastrophic health care expenses. In response to covid-19 pandemic, the government launched the Ayushman Bharat Arogya Karnataka program, which offered health insurance for the coverage of covid-19 treatment costs and prevent families from undergoing financial hardships and incurring healthcare costs. The purpose of this study was to investigate and compare the utilization of the Ayushman Bharat insurance scheme among covid-19 positive and non-covid patients admitted to a tertiary care hospital in the Karnataka district of Dakshina Kannada. Methodology: Data was collected from medical records of a tertiary care hospital in the Dakshina Kannada District of Karnataka for this cross-sectional study. The data collected was analyzed using the Microsoft Excel program, and the results subjected to statistical analysis using IBM SPSS software ver.20. Result(s): The study found that there was a significant association between utilization of ABArK among patients (Covid and non-Covid) admitted to the hospital. While the utilization of ABArK among covid patients was found to be 51.3%, the utilization among non-covid patients was only 14.1% (chi2= 1242.32, p value <0.001). Conclusion(s): To improve the utilization of this scheme, public awareness activities must be conducted. As a result, less out-of-pocket expenditure would be incurred and access to healthcare facilities made easier. Copyright © 2022, Indian Association of Biomedical Scientists. All rights reserved.

The Use Of Social Media In Indian Elections: An Overview

This paper studies the use of social media in the Indian Lok Sabha and assembly elections. This study focuses on using social media in the 2014 and 2019 Lok Sabha elections and its impact on voters. Besides, the paper also discusses the extensive use of social media in last assembly elections held in different Indian states during the COVID-19 pandemic. The onset of the pandemic has forced politicians and political parties to turn to social media for virtual campaigning. This paper covers the role of social media in the assembly elections in UP, Uttarakhand, Punjab, Goa, West Bengal, and Kerala. In recent years, Indian politicians have significantly relied on social media for campaigning during elections. As a result of the COVID-19 pandemic and the Election Commission's temporary restriction on rallies, the use of social media in assembly elections grew considerably. This paper also highlights social media usage in the recent 2022 assembly elections in Gujarat and Himachal Pradesh.

STUDY ON GENDER DIFFERENCE IN ACUTE CORONARY SYNDROME IN YOUNG ADULTS IN TERTIARY HEALTH CENTER OF RURAL TELANGANA

Acute coronary syndrome is no more a disease of elderly as before. Many young people are developing ACS. There is also difference among genders in terms of prevelance, risk factors and demographic features. To study the difference among both gender study was carried out. This is a retrospective study of young adults <46 yrs of age in our medical college from rural central India over a period from March 2020 to March 2021. This consists of comprehensive data of management, risk factors & clinical features of young acute coronary syndrome. METHODS: 108 patients who presented with chest pain and other symptoms who underwent coronary angiogram diagnosed as ACS were included in this study. This is a retrospective, record based cross sectional study of patients with acute coronary syndrome of less than 45 years age group at RVM Institute of medical sciences and research center during March 2020 to March 2021. RESULTS: Number of patients in both gender were proportionate in all age groups. The difference between genders was not statistically significant. Proportion of people consuming alcohol and smoking was high among males compared to females and this difference was statistically significant. Similarly raised TROP I and CKMB was found more among men compared to women and the difference was statistically significant. Men showed lower ejection fraction and severe LV dysfunction. Male's shows more STEMI > Unstable angina > NSTEMI. As the disease was more severe among males they were managed predominantly by PTCA. CONCLUSION: Females have milder disease compared to males. Presence of risk factors is low. ECHO and angiographic findings show milder form of disease in females compared to males and hence managed more commonly by medical management. Our study period is in COVID 19 period but patients were negative for COVID19, 23.4% of total ACS admissions were in young. [ FROM AUTHOR]

Livelihood, Employment and Health of Migrant Workers in the Context of COVID-19 Pandemic

This chapter discusses some of the important issues of migrant population in the context of COVID-19 pandemic. Most of the unskilled/semi-skilled workers earn subsistence levels of wages, and no social protection is available. Central and state governments and society did not take any concrete measures to address their concerns related to livelihood and health, especially during the nationwide lockdown and phased unlocking period. This qualitative study was conducted to understand the impact of COVID-19 pandemic on their lives and livelihood. We also explored the common vulnerabilities that migrants faced across the states and the type of assistance they received from various stakeholders. Health care and health-seeking behaviour during COVID times were other important areas that we focused upon. © 2022 selection and editorial matter, S. Irudaya Rajan;individual chapters, the contributors.

DELAYED IBD DIAGNOSIS LEADS TO WORSE OUTCOMES OVER YEARS, WITH MULTIPLE IMPLICATIONS ON SERVICE DELIVERY

Background Delays in diagnosis could be patient-related and health-system related. It has been reported that such delays increase overall complications in Inflammatory Bowel Diseases (IBD). The aim of our study was to report on the impact of delays on IBD-related adverse outcomes (AOs), as most hospitals currently face challenges with long waiting lists in the post-Covid-19 era. Methods New patients referred for suspected IBD to a single tertiary care centre between Jan 2013 to Dec 2017 were identified using EMR. For purposes of the study, a cut-off time was set by investigators for each delay-type based on best average hospital waiting times. The reasons for delays in patient journey until start of treatment and data on predefined AOs (steroid & other rescue therapies, hospitalisations, surgery) were recorded for each patient until end of June 2021. The data were analysed using multiple Pearson correlations and Cox proportional Hazard model to determine whether there is a difference in survival without AOs between patients with and without a delay. Results Total of 105 patients were identified using stringent criteria (M=58 ;median age=32y) with a long median followup of 55 months. The most frequent presenting complaints were abdominal pain (44, 41,9%), loose stools (40, 38,1%), bloody diarrhoea (37, 35,2%) and bleeding per-rectum (33, 31,4%) and only 16% declared a family history. 65, 27 and 13 patients had final diagnosis of Ulcerative colitis, Crohn's disease and Unclassified colitis respectively, and analysed collectively. In our cohort, the longest delay-types noted were - patients seeking medical attention (median= 4 months;range 1 to 84 months), arranging gastroenterology clinic review after referral from primary care (median=5 weeks;range 1 to 30 weeks), and waiting for index endoscopy (median=3 weeks;1 to 36 weeks). Patient stratification based on delay-type, using specific cutoff times for each showed a statistically significant difference in survival without AOs for all (when comparing delay v/s no delay). 1. delay in seeking medical attention (cut-off=1m;p=0.004) (figure 1A) . delay in GP referral specialty review (cut-off=1w;p=0.048) . delay in index endoscopy (cut-off= 4w;p=0.01) (Fig 1B) . delay in starting treatment (cut-off= 4w;p=0.03) Conclusion . Several bottlenecks of delays increase AOs in IBD over the follow-up period. . A delay as short as a week, between GP referral specialty review, is significant in determining AOs;this has implications on specialist IBD centres particularly in the post-Covid period. . Endoscopy units should prioritise suspected IBD patients to reduce AOs, which is likely to have implications on service delivery and planning. . Long delays observed in patients seeking medical attention highlights the need for both primary and secondary care to undertake patient education in the community.

A conceptual framework for identifying sustainable business practices of small and medium enterprises

Purpose The purpose of the current paper is to identify the factors responsible for achieving business sustainability. This paper further attempts to develop a conceptual framework that can help SMEs to achieve viable business growth through improved sustainable performance. Design/methodology/approach The study follows a methodical examination of literature published on SMEs during COVID-19. Specifically, the combination of keywords has primarily centred on SMEs, Business Practices, COVID-19 and Pandemic. The 155 research papers identified for the analysis have been classified as per geographical spread, type of papers, central theme, and theoretical foundations, which finally is followed by rigourous thematic analysis. Findings This research contributes to the SME literature by providing methodological, conceptual and practical rigour. The framework proposed by the research covers all the relevant areas which can be useful in preparing sustainable business trajectory for SMEs. It outlines the required directives for designing sustainable business practices for SMEs and includes macro and micro determinants. It also opens up future research avenues in different areas identified in the research. Future research can be performed on comparing business practices of SMEs across the emerging and developed economies. Practical implications In this study, we propose a framework that enables the design of sustainable business practices and thereby supports SMEs to combat any uncertain events or shocks. SMEs that can work on adopting sustainable business practices may sculpt novel avenues for growth and competitive advantage for their business. Originality/value The study is distinctive in nature as it is based on the examination of literature published during a phenomenological event (COVID-19) which depicts the sudden and unaccounted disruptions faced by SMEs and thereby strategies formulated around the significant glitches.

Evaluation of safety and immunogenicity of receptor-binding domain-based COVID-19 vaccine (Corbevax) to select the optimum formulation in open-label, multicentre, and randomised phase-1/2 and phase-2 clinical trials.

BACKGROUND: We assessed the efficacy of a receptor-binding domain (RBD)-based protein subunit COVID-19 vaccine. METHODS: A randomised Phase-1/2 trial followed by a Phase-2 trial were conducted to assess the safety and immunogenicity of the COVID-19 vaccine Corbevax and select to an optimum formulation. Healthy adults (n=460) without COVID-19 vaccination or SARS-CoV-2 infection in the Phase-1/2 study were randomly divided into four vaccine formulation groups. FINDINGS: A low incidence of adverse events was reported post-vaccination. All formulations showed similar profiles of humoral and cellular immune responses that were associated with the content of CpG1018 adjuvant in the vaccine. In the Phase-2 study, 750 µg of CpG1018 showed significant improvement (> 4-fold increase from baseline) in immune responses, including the titres of anti-RBD IgG and neutralising antibody (nAb), and cellular immune responses, while maintaining the safety profile. Antibodies persisted consistently for 12 months after the second dose of vaccine. INTERPRETATIONS: Corbevax (two-dose schedule with 28 days of interval between doses) was well tolerated with no observed safety concerns. Previous observations from efficacy studies by Moderna and AstraZeneca and the correlation between nAb titres post-vaccination and a human convalescent serum panel showed that Corbevax induced significantly high nAb titres. These studies were prospectively registered with the Clinical Trial Registry of India (CTRI/2021/06/034014 and CTRI/2020/11/029032). FUNDING: Bill & Melinda Gates Foundation, BIRAC-Division of Department of Biotechnology, Govt of India, and the Coalition for Epidemic Preparedness Innovations funded this study.

A 1-year longitudinal study: Change in mental health outcomes of frontline emergency department healthcare workers in this COVID-19 pandemic

Background: There are ample cross-sectional data demonstrating association of COVID-19 pandemic with depression and anxiety in frontline healthcare workers (HCWs). However, there is a lack of longitudinal studies among frontline HCWs to quantify the change in depression and anxiety in this pandemic. Objectives: We aim to (1) quantify the change in depression and anxiety symptoms in our cohort of frontline emergency department (ED) HCWs over a 1-year period, and (2) identify factors associated with this change. Methods: This is a prospective longitudinal single-center study carried out over a 1-year period in June 2020 and June 2021. A paper-based survey questionnaire was administered to ED HCWs and participation was voluntary. Depression and anxiety were measured using Depression, Anxiety and Stress Scale-21 Items (DASS-21). No specific intervention was implemented by the study team over the year. The overall response rate was 93.5%. In all, 241 HCWs were matched based on last 4 digits of their phone number, gender, ethnicity, and occupation. Logistic regressions were performed to identify factors associated with depression and anxiety. Results: HCWs were mainly females (71.8%), nurses (71.4%), or Chinese (38.6%). There was a significant increase in median depression score among doctors (2020: 1 (0-3) vs 2021: 3 (0-5), p=0.018). HCWs ≥41 years (odds ratio (OR), 10.6;95% confidence interval (CI), 1.5-75.9)), living with elderly (OR, 4.3;1.3-14.4), and with greater Concerns in Workload (OR, 2.5;1.5-4.2) had higher risk of depression. HCWs with more years of work experience (OR, 0.9;0.8-1.0) and who perceived better workplace support (OR, 0.3;0.2-0.6) had lower risk of depression. There was significant reduction in median anxiety score among all HCWs (2020: 2 (0-4) vs 2021: 2 (0-4), p=0.045) and in prevalence of anxiety (2020: 30.7% vs 2021: 21.6%, p=0.023). HCWs living with elderly (OR, 5.9;1.8-19.2), with greater Concerns in COVID-19 Infection Risk (OR, 2.0;1.1-3.3), and with Workload (OR, 1.6;1.0-2.6) had higher risk of anxiety, while those living with young children (OR, 0.1;0.02-0.5) had lower risk of anxiety. Conclusion: Our longitudinal study showed that mental health outcomes in frontline ED HCWs continued to be poor after a year. Several factors have been identified, which will allow for targeted interventions to optimize and prevent deterioration of our frontline HCWs' well-being.