Analysis of a Teleworking Technology Adoption Case: An Agent-Based Model

An agent-based model for teleworking technology adoption is presented, including the risk of office closure in the event of a lockdown. It analyzes an adoption case using simulations and can be adapted to other cases and teleworking promotion strategies to contribute to sustainability. Simulations produce smooth sigmoidal curves that reasonably fit to real adoption curves. The simulation results suggest that the main reason for the observed increase in the adoption rate is the increase in the risk of office closures, the consequent increase in the usefulness of teleworking technology, and the increase in external influence that motivates them.

Monitoring COVID-19 in Colombia during the first year of the pandemic.

Background: COVID-19 cases in Medellín, the second largest city in Colombia, were monitored during the first year of the pandemic using both mathematical models based on transmission theory and surveillance from each observed epidemic phase. Design and Methods: Expected cases were estimated using mandatory reporting data from Colombia's national epidemiological surveillance system from March 7, 2020 to March 7, 2021. Initially, the range of daily expected cases was estimated using a Borel-Tanner stochastic model and a deterministic Susceptible-Infected-Removed (SIR) model. A subsequent expanded version of the SIR model was used to include asymptomatic cases, severe cases and deaths. The moving average, standard deviation, and goodness of fit of estimated cases relative to confirmed reported cases were assessed, and local transmission in Medellin was contrasted with national transmission in Colombia. Results: The initial phase was characterized by imported case detection and the later phase by community transmission and increases in case magnitude and severity. In the initial phase, a maximum range of expected cases was obtained based on the stochastic model, which even accounted for the reduction of new imported cases following the closure of international airports. The deterministic estimate achieved an adequate fit with respect to accumulated cases until the conclusion of the mandatory national quarantine and gradual reopening, when reported cases increased. The estimated new cases were reasonably fit with the maximum reported incidence. Conclusion: Adequate model fit was obtained with the reported data. This experience of monitoring epidemic trajectory can be extended using models adapted to local conditions.

Barriers and facilitators in the implementation of a telemedicine-based outpatient brain tumor surgery program.

OBJECTIVE: Despite growing evidence on the benefits of outpatient oncological neurosurgery (OON), it is only performed in a few specialized centers and there are no previous descriptions of established OON programs in Europe. Moreover, increasing application of telemedicine strategies, especially after the start of the coronavirus disease 2019 (COVID-19) pandemic, is drastically changing neurosurgical management, particularly in the case of vulnerable populations such as neuro-oncological patients. In this context, the authors implemented an OON program in their hospital with telematic follow-up. Herein, they describe the protocol and qualitatively analyze the barriers and facilitators of the development process. METHODS: An OON program was developed through the following steps: assessment of hospital needs, specific OON training, multidisciplinary team organization, and OON protocol design. In addition, the implementation phase included training sessions, a pilot study, and continuous improvement sessions. Finally, barriers and facilitators of the protocol's implementation were identified from the feedback of all participants. RESULTS: An OON protocol was successfully designed and implemented for resection or biopsy of supratentorial lesions up to 3 cm in diameter. The protocol included the patient's admission to the day surgery unit, noninvasive anesthetic monitoring, same-day discharge, and admission to the hospital-at-home (HaH) unit for telematic and on-site postoperative care. After a pilot study including 10 procedures in 9 patients, the main barriers identified were healthcare provider resistance to change, lack of experience in outpatient neurosurgery, patient reluctance, and limitations in the recruitment of patients. Key facilitators of the process were the patient education program, the multidisciplinary team approach, and the HaH-based telematic postoperative care. CONCLUSIONS: Initiating an OON program with telematic follow-up in a European clinical setting is feasible. Nevertheless, it poses several barriers that can be overcome by identifying and maximizing key facilitators of the process. Among them, patient education, a multidisciplinary team approach, and HaH-based postoperative care were crucial to the success of the program. Future studies should investigate the cost-effectiveness of telemedicine to assess potential cost savings, from reduced travel and wait times, and the impact on patient satisfaction.

COVID-19, body weight and the neighbourhood: food system dimensions and consumption associated with changes in body weight of Peruvian adults during first wave lockdowns.

Objective: The objective of this study is to assess changes in the dimensions of the food system and consumption associated with body weight variations during the first month's lockdown in Peruvian adults in Metropolitan Lima. Methods: A cross-sectional study conducted during the first months of lockdowns in Peru. 694 adults completed a web-based survey about changes experienced in the process of acquiring food during lockdown, changes in their intake and self-perceived body weight. A multinomial logistic regression analysis was conducted to evaluate the factors associated with changes in body weight. Results: Weight gain was perceived in 38% of the participants and 22.8% perceived weight loss. 39.2% did not perceive changes in their weight. Risk factors for body weight gain were increased alcohol consumption (OR=4.510, 95% CI 1.764 to 11.531) and decreased fruit consumption (OR=2.129, 95% CI 1.290 to 3.515), while decreasing cereal intake (OR=0.498, 95% CI 0.269 to 0.922) and choosing nutritious food as a driver for purchase (OR=0.512, 95% CI 0.320 to 0.821) were found to be protective against gaining weight. Decreasing food intake during the pandemic (OR=2.188, 95% CI 1.348 to 3.550) and having to miss important foods (OR=2.354, 95% CI 1.393 to 3.978), were associated with weight loss. Conclusions: During confinement, weight gain was mostly associated with food consumption and personal food system factors. Meanwhile, weight loss was associated with external food system factors.

Surrogate test performance for SARS-CoV-2 neutralizing antibodies (nAbs) for convalescent plasma (CCP): How useful could they be?

BACKGROUND: COVID-19 high-titer CCP selection is a concern, because neutralizing antibody (nAb) testing requires sophisticated labs and methods. Surrogate tests are an alternative for measuring nAb levels in plasma bags, including those that are pathogen-reduced. STUDY DESIGN/METHODS: We studied a panel consisting of 191 samples from convalescent donors tested by nAb (CPE-VNT), obtained from 180 CCP donations (collection: March 20-January 21) and 11 negative controls, with a total of 80 and 111 serum and plasma samples (71 amotosalen/UV treated), with nAb titers ranging from negative to 10,240. Samples were blindly tested for several surrogates: one anti-RBD, two anti-spike, and four anti-nucleocapsid tests, either isolated or combined to improve their positive predictive values as predictors of the presence of high-titer nAbs, defined as those with titers ≥160. RESULTS: Except for combined and anti-IgA/M tests, all isolated surrogate tests showed excellent performance for nAb detection: sensitivity (98.3%-100%), specificity (85.7%-100%), PPV (98.9%-100%), NPV (81.3%-100%), and AUC (0.93-0.96), with a variable decrease in sensitivity and considerably lower specificity when using FDA authorization and concomitant nAb titers ≥160. All surrogates had AUCs that were statistically different from CPE-VNT if nAb≥160, including when using combined, orthogonal approaches. CONCLUSIONS: Surrogate tests (isolated or in combination) have an indirect good performance in detecting the presence of nAb, with lower sensitivity and specificity when high nAb titer samples are used, possibly accepting a considerable number of donors whose nAb titers are actually low, which should be evaluated by each laboratory responsible for CCP collection.

A Nature Tourism Route through GIS to Improve the Visibility of the Natural Resources of the Altar Volcano, Sangay National Park, Ecuador

Tourism in natural areas attracts people seeking contact with pristine ecosystems as opposed to a polluted urban habitat and a stressful pace of life. An adequate tourist route and itinerary guarantees a high level of tourist satisfaction. The objective of this study was to focus on the design of a tourist route and itinerary in the Altar Volcano, Sangay National Park, central Ecuador, by integrating tourist attractions and facilities. Within the methodological process, the main tourist attractions of the area were identified and georeferenced;then, a thematic map was elaborated using ArcGIS 10.5® software. Distances were determined by considering the transportation alternatives in relation to the base camps. Finally, the itinerary was structured by considering the possible tourist activities of each place or attraction. As a result, a tourist route was obtained that included 19 attractions and an itinerary that interacts with various activities in the study area. This research will strengthen tourism activities in the Altar Volcano, allowing for an increase in the number of visitors and the development of sustainable tourism thanks to proper planning in the use of a new tourist route.