Social equity-based distribution networks design for the COVID-19 vaccine.

This study aims to investigate the role of social equity in vaccine distribution network design problems. Inspired by the current COVID-19 vaccine allocation in-country context, we capture social equity-based distribution by modeling three theories: Rawls' theory, Sadr's theory, and utilitarianism. We consider various social groups based on degree of urbanization, including inhabitants of cities, towns and suburbs, and rural areas. The distribution problem is subject to, on the one hand, demand-side uncertainty characterized by the daily contamination rate and its space-time propagation that anticipate the in-need population. On the other hand, supply-side uncertainty characterized by the stochastic arrival of vaccine doses for the supply period. To tackle this problem, we propose a novel bi-objective two-stage stochastic programming model using the sample average approximation (SAA) method. We also develop a lexicographic goal programming approach where the social equity objective is prioritized, thereafter reaching an efficiency level. Using publicly available data on COVID-19 in-country propagation and the case of two major provinces in Iran as example of middle-income country, we provide evidence of the benefits of considering social equity in a model-based decision-making approach. The findings suggest that the design solution produced by each social equity theory matches its essence in social science, differing considerably from the cost-based design solution. According to the general results, we can infer that each social equity theory has its own merits. Implementing Rawls' theory brings about a greater coverage percentage in rural areas, while utilitarianism results in a higher allocation of vaccine doses to social groups compared to the Sadr and Rawls theories. Finally, Sadr's theory outperforms Rawls' in terms of both the allocation and cost perspective. These insights would help decision-makers leverage the right equity approach in the COVID-19 vaccine context, and be better prepared for any pandemic crisis that the future may unfold.

A causality analysis of risks to perishable product supply chain networks during the COVID-19 outbreak era: An extended DEMATEL method under Pythagorean fuzzy environment.

In nowadays world, firms are encountered with many challenges that can jeopardize business continuity. Recently, the coronavirus has brought some problems for supply chain networks. Remarkably, perishable product supply chain networks, such as pharmaceutical, dairy, blood, and food supply chains deal with more sophisticated situations. Generally, during pandemic outbreaks, the activities of these industries can play an influential role in society. On the one hand, products of these industries are considered to be daily necessities for living. However, on the other hand, there are many new restrictions to control the coronavirus prevalence, such as closing down all official gatherings and lessening the work hours, which subsequently affect the economic growth and gross domestic product. Therefore, risk assessment can be a useful tool to forestall side-effects of the coronavirus outbreaks on supply chain networks. To that aim, the decision-making trial and evaluation laboratory approach is used to evaluate the risks to perishable product supply chain networks during the coronavirus outbreak era. Feedback from academics was received to identify the most important risks. Then, experts in pharmaceutical, food, and dairy industries were inquired to specify the interrelations among risks. Then, Pythagorean fuzzy sets are employed in order to take the uncertainty of the experts' judgments into account. Finally, analyses demonstrated that the perishability of products, unhealthy working conditions, supply-side risks, and work-hours are highly influential risks that can easily affect other risk factors. Plus, it turned out that competitive risks are the most susceptive risk in the effect category. In other words, competition among perishable product supply chain networks has become even more fierce during the coronavirus outbreak era. The practical outcomes of this study provide a wide range of insights for managers and decision-makers in order to prevent risks to perishable product supply chain networks during the coronavirus outbreak era.

MEDUSA: Multi-Scale Encoder-Decoder Self-Attention Deep Neural Network Architecture for Medical Image Analysis.

Medical image analysis continues to hold interesting challenges given the subtle characteristics of certain diseases and the significant overlap in appearance between diseases. In this study, we explore the concept of self-attention for tackling such subtleties in and between diseases. To this end, we introduce, a multi-scale encoder-decoder self-attention (MEDUSA) mechanism tailored for medical image analysis. While self-attention deep convolutional neural network architectures in existing literature center around the notion of multiple isolated lightweight attention mechanisms with limited individual capacities being incorporated at different points in the network architecture, MEDUSA takes a significant departure from this notion by possessing a single, unified self-attention mechanism with significantly higher capacity with multiple attention heads feeding into different scales in the network architecture. To the best of the authors' knowledge, this is the first "single body, multi-scale heads" realization of self-attention and enables explicit global context among selective attention at different levels of representational abstractions while still enabling differing local attention context at individual levels of abstractions. With MEDUSA, we obtain state-of-the-art performance on multiple challenging medical image analysis benchmarks including COVIDx, Radiological Society of North America (RSNA) RICORD, and RSNA Pneumonia Challenge when compared to previous work. Our MEDUSA model is publicly available.

COVID-Net CXR-S: Deep Convolutional Neural Network for Severity Assessment of COVID-19 Cases from Chest X-ray Images.

The world is still struggling in controlling and containing the spread of the COVID-19 pandemic caused by the SARS-CoV-2 virus. The medical conditions associated with SARS-CoV-2 infections have resulted in a surge in the number of patients at clinics and hospitals, leading to a significantly increased strain on healthcare resources. As such, an important part of managing and handling patients with SARS-CoV-2 infections within the clinical workflow is severity assessment, which is often conducted with the use of chest X-ray (CXR) images. In this work, we introduce COVID-Net CXR-S, a convolutional neural network for predicting the airspace severity of a SARS-CoV-2 positive patient based on a CXR image of the patient's chest. More specifically, we leveraged transfer learning to transfer representational knowledge gained from over 16,000 CXR images from a multinational cohort of over 15,000 SARS-CoV-2 positive and negative patient cases into a custom network architecture for severity assessment. Experimental results using the RSNA RICORD dataset showed that the proposed COVID-Net CXR-S has potential to be a powerful tool for computer-aided severity assessment of CXR images of COVID-19 positive patients. Furthermore, radiologist validation on select cases by two board-certified radiologists with over 10 and 19 years of experience, respectively, showed consistency between radiologist interpretation and critical factors leveraged by COVID-Net CXR-S for severity assessment. While not a production-ready solution, the ultimate goal for the open source release of COVID-Net CXR-S is to act as a catalyst for clinical scientists, machine learning researchers, as well as citizen scientists to develop innovative new clinical decision support solutions for helping clinicians around the world manage the continuing pandemic.

Modelling COVID-19 transmission in a hemodialysis centre using simulation generated contacts matrices.

The COVID-19 pandemic has been particularly threatening to patients with end-stage kidney disease (ESKD) on intermittent hemodialysis and their care providers. Hemodialysis patients who receive life-sustaining medical therapy in healthcare settings, face unique challenges as they need to be at a dialysis unit three or more times a week, where they are confined to specific settings and tended to by dialysis nurses and staff with physical interaction and in close proximity. Despite the importance and critical situation of the dialysis units, modelling studies of the SARS-CoV-2 spread in these settings are very limited. In this paper, we have used a combination of discrete event and agent-based simulation models, to study the operations of a typical large dialysis unit and generate contact matrices to examine outbreak scenarios. We present the details of the contact matrix generation process and demonstrate how the simulation calculates a micro-scale contact matrix comprising the number and duration of contacts at a micro-scale time step. We have used the contacts matrix in an agent-based model to predict disease transmission under different scenarios. The results show that micro-simulation can be used to estimate contact matrices, which can be used effectively for disease modelling in dialysis and similar settings.

Diagnostic and prognostic value of Sepsis-Induced coagulopathy and International Society on Thrombosis and Hemostasis scoring systems in COVID-19-associated disseminated intravascular coagulopathy.

BACKGROUND: The coronavirus disease 2019 (COVID-19) presents various phenotypes from asymptomatic involvement to death. Disseminated intravascular coagulopathy (DIC) is among the poor prognostic complications frequently observed in critical illness. To improve mortality, a timely diagnosis of DIC is essential. The International Society on Thrombosis and Hemostasis (ISTH) introduced a scoring system to detect overt DIC (score ≥5) and another category called sepsis-induced coagulopathy (SIC) to identify the initial stages of DIC (score ≥4). This study aimed to determine whether clinicians used these scoring systems while assessing COVID-19 patients and the role of relevant biomarkers in disease severity and outcome. MATERIALS AND METHODS: An exhaustive search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, using Medline, Embase, Cochrane, CINAHL, and PubMed until August 2020. Studies considering disease severity or outcome with at least two relevant biomarkers were included. For all studies, the definite, maximum, and minimum ISTH/SIC scores were calculated. RESULTS: A total of 37 papers and 12,463 cases were reviewed. Studies considering ISTH/SIC criteria to detect DIC suggested a higher rate of ISTH ≥5 and SIC ≥4 in severe cases and nonsurvivors compared with nonsevere cases and survivors. The calculated ISTH scores were dominantly higher in severe infections and nonsurvivors. Elevated D-dimer was the most consistent abnormality on admission. CONCLUSION: Higher ISTH and SIC scores positively correlate with disease severity and death. In addition, more patients with severe disease and nonsurvivors met the ISTH and SIC scores for DIC. Given the high prevalence of coagulopathy in COVID-19 infection, dynamic monitoring of relevant biomarkers in the form of ISTH and SIC scoring systems is of great importance to timely detect DIC in suspicious patients.

Anticoagulation therapy in COVID-19 patients with chronic kidney disease.

Coagulopathy and derangements in the coagulation parameters are significant features of COVID-19 infection, which increases the risk of disseminated intravascular coagulation, thrombosis, and hemorrhage in these patients, resulting in increased morbidity and mortality. In times of COVID-19, special consideration should be given to patients with concurrent chronic kidney disease (CKD) and COVID-19 (CKD/COVID-19 patients) as renal dysfunction increases their risk of thrombosis and hemorrhage, and falsely affects some of the coagulation factors, which are currently utilized to assess thrombosis risk in patients with COVID-19. Hence, we believe extra attention should be given to determining the risk of thrombosis and bleeding and optimizing the timing and dosage of anticoagulant therapy in this unique population of patients. CKD/COVID-19 patients are considered a high-risk population for thrombotic events and hemorrhage. Furthermore, effects of renal function on paraclinical and clinical data should be considered during the evaluation and interpretation of thrombosis risk stratification. Individualized evaluation of clinical status and kidney function is necessary to determine the best approach and management for anticoagulant therapy, whereas there is a lack of studies about the population of CKD/COVID-19 patients who need anticoagulant therapy now.