Pausing transplants in the face of a global pandemic: Patient survival implications.

The coronavirus disease 2019 (COVID-19) pandemic has disrupted normal operating procedures at transplant centers. With the possibility that COVID-19 infection carries an overall 4% mortality rate and potentially a 24% mortality rate among the immunocompromised transplant recipients, many transplant centers considered the possibility of slowing down and even potentially pausing all transplants. Many proposals regarding the need for pausing organ transplants exist; however, much remains unknown. Whereas the impact of the COVID-19 pandemic on the overall healthcare system is unknown, the potential impact of pausing organ transplants over a period can be estimated. This study presents a model for evaluating the impact of pausing liver transplants over a spectrum of model for end-stage liver disease-sodium (MELD-Na) scores. Our model accounts for two potential risks of a pause: (1) the waitlist mortality of all patients who do not receive liver transplants during the pause period, and (2) the impact of a longer waiting list due to the pause of liver transplants and the continuous accrual of new patients. Using over 12 years of liver transplant data from the United Network for Organ Sharing and a system of differential equations, we estimate the threshold probability above which a decision maker should pause liver transplants to reduce the loss of patient life months. We also compare different pause policies to illustrate the value of patient-specific and center-specific approaches. Finally, we analyze how capacity constraints affect the loss of patient life months and the length of the waiting list. The results of this study are useful to decision makers in deciding whether and how to pause organ transplants during a pandemic. The results are also useful to patients (and their care providers) who are waiting for organ transplants.

Re-organising wellbeing: Contexts, critiques and contestations of dominant wellbeing narratives

Wellbeing has emerged as an important discourse of management and organisation. Practices of wellbeing are located in concrete organisational arrangements and shaped by power relations built upon embedded, intersecting inequalities and therefore require critical evaluation. Critical evaluation is essential if we are to reorganise wellbeing to move beyond critique and actively contest dominant wellbeing narratives in order to reshape the contexts in which wellbeing can be fulfilled. The COVID-19 pandemic under which this special issue took shape, provides various examples of how practices continue to be shaped by existing narratives of wellbeing. The pandemic also constituted a far-reaching shock that gave collective pause to consider to the extent to which work is really organised to realise wellbeing and opened up potential to think differently. The seven papers included in the special issue reveal the problematic and uneven way in which wellbeing is pursued and examine possibilities to imagine and realise more radical practices of wellbeing that can counter the way in which ill-being is produced by the organisation of labour. © The Author(s) 2023.

Dementia Analytics Research User Group (DARUG) - A Model for meaningful stakeholder engagement in dementia research

BACKGROUND: The importance of involving stakeholders in research is widely recognised but few studies provide details to implementation in practice. The use of real-time technology involving patients, carers and professionals in project design, monitoring, delivery and reporting could maximise contribution. Stakeholder engagement was included as part of a Dementia Analytics Research User Group project which applied machine learning to the Trinity-Ulster-Department of Agriculture (TUDA) data set, identifying clinical and lifestyle factors associated with cognitive health in 5000 community-dwelling older Irish adults.

Excess death rates for Republicans and Democrats during the COVID-19 pandemic

Political affiliation has emerged as a potential risk factor for COVID-19, amid evidence that Republican-leaning counties have had higher COVID-19 death rates than Democrat- leaning counties and evidence of a link between political party affiliation and vaccination views. This study constructs an individual-level dataset with political affiliation and excess death rates during the COVID-19 pandemic via a linkage of 2017 voter registration in Ohio and Florida to mortality data from 2018 to 2021. We estimate substantially higher excess death rates for registered Republicans when compared to registered Democrats, with almost all of the difference concentrated in the period after vaccines were widely available in our study states. Overall, the excess death rate for Republicans was 5.4 percentage points (pp), or 76%, higher than the excess death rate for Democrats. Post- vaccines, the excess death rate gap between Republicans and Democrats widened from 1.6 pp (22% of the Democrat excess death rate) to 10.4 pp (153% of the Democrat excess death rate). The gap in excess death rates between Republicans and Democrats is concentrated in counties with low vaccination rates and only materializes after vaccines became widely available.

A Structured Overview of Insights and Opportunities for Enhancing Supply Chain Resilience

Widespread product shortages during the COVID-19 pandemic and other emergencies have prompted several large studies of how to make supply chains more resilient. In this paper, we leverage these studies, as well as the academic literature, to provide a review of our state of knowledge about supply chain resilience. To do this, we (1) classify the failure modes of a supply chain, (2) quantitatively evaluate the level of resilience needed in a supply chain to achieve desired business or societal outcomes, (3) describe a structured framework of actions to enhance supply chain resilience, and (4) use the resulting conceptual paradigm to review the academic literature on supply chain risk and resilience. In each step, we summarize key insights from our current state of understanding, as well as gaps that present opportunities for research and practice. [ FROM AUTHOR] Copyright of IISE Transactions is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

COVID-19 and lockdown: The highs and lows of general practitioner prescribing

As a result of the global COVID-19 pandemic and subsequent national lockdown, general practices tried to limit unnecessary footfall into surgeries during this period. This paper aims to investigate how General Practice (GP) prescribing changed following the first COVID-19 lockdown by analysing open-source General Practice prescribing data in England and Northern Ireland. Prescribing data was obtained for the calendar years 2019 and 2020 at British National Formulary (BNF) chapter and section levels, aggregated and compared year on year and with each other. Particular attention was given to the change in prescribing between February and March of both years to examine the change in prescribing immediately following the start of the lockdown. Prescribing markedly increased across BNF categories in March 2020 followed by a dip and return to pre-COVID-19 levels in late summer. The rise in the number of items prescribed in England between February and March 2020 was nearly twice that seen in the same period the previous year (14.5% vs 7.6%). Northern Ireland saw a much greater relative increase of 20.7. The “peak, trough and recovery” pattern observed across BNF chapters reflected patients obtaining bigger stocks of prescriptions pre-lockdown. The higher Northern Ireland peak may be part-explained by lack of electronic transfer to pharmacies which exists in England. Increased antimicrobial prescribing, which spiked in March 2020, may relate to issuing “rescue packs” at the outset of the pandemic, with the sustained decline in the following months a possible effect of Covid measures and reduced consulting. © 2021 IEEE

Single use nasal endoscopes - a review of the cost and organisational implications based on department size

Aim: Single use nasal endoscopes have become increasingly popular since the COVID-19 pandemic. By avoiding the risk of cross contamination and reducing exposure by eliminating the need for re-processing, the disposable scopes have clear safety benefits. Despite ENT UK guidelines recommending that disposable nasal endoscopes be available in every department for use in emergencies, they have often been considered prohibitively expensive. The aim of this study was to analyse the costs associated with traditional nasal endoscopes and compare them to the single use scopes. Method: A micro costing exercise was undertaken in three ENT departments: 2 university hospitals, and 1 district general hospital. The outcomes were compared and discussed with relation to the logistics of the departments, as well as organizational considerations. Results: Cost per procedure varied according to the reprocessing methods used in the different departments. The cost of the disposable nasal endoscopes appears high, however there are many hidden costs associated with the traditional scopes, which can be difficult to quantify accurately. Conclusions: Although disposable endoscopes appear costly, reprocessing and frequent repairs required for re-usable scopes account for the comparable cost per procedure. The high risk of COVID-19 transmission from examining the upper aerodigestive tract means that the safety benefits bear more weight in the current climate. However, concerns regarding environmental impact, image quality and storage of examinations also need to be considered.

A Plague on Politics? The COVID Crisis, Expertise, and the Future of Legitimation

Governments rely more and more on experts to manage the increasingly complex problems posed by a growing, diversifying, globalizing world. Surplus technocracy, however, usually comes with deficits of democracy. While especially true in liberal regimes, authoritarian states often face parallel dynamics. Recent trends illustrate how technocratic encroachment on civil society's prerogatives can provoke populist backlash. Such cycles can build toward crises by eroding the legitimacy citizens invest in regimes. Surprisingly, by throwing both the need for and limits of expertise into sharp relief, the politics of COVID-19 create a novel opportunity to disrupt these trends. We assess how this opportunity may be unfolding in two crucial cases, the United States and China, and, more briefly, South Korea. We conclude by sketching some theoretical considerations to guide a geographically expanded and temporally extended research agenda on this important opportunity to slow or reverse a trend plaguing modern governance. © The Author(s), 2021. Published by Cambridge University Press on behalf of the American Political Science Association.

Evaluating an outreach education program to increase uptake and knowledge of hepatitis B testing in Melbourne's Chinese community: CHINA-B study

Background and Aim: Hepatitis B is underdiagnosed in Australia, with an estimated 32% of affected people not aware of their hepatitis status. Australia's Chinese community is among the most at-risk populations for hepatitis B: an estimated 18% of people living with chronic hepatitis B in Australia were born in China. Identified barriers for hepatitis B testing include lack of awareness and limited knowledge about hepatitis B, and stigma associated with the disease. However, limited data are available on effective approaches to engage Chinese people in hepatitis B testing and care. We therefore conducted an evaluation study of an outreach education program among the Chinese community in Melbourne. The primary aim was to assess the efficacy of the education program on hepatitis B testing uptake and compare the efficacy between two educational resources. The secondary aim was to assess the impacts of the education program on hepatitis B-related knowledge. A nested qualitative study was conducted to assess the feasibility and acceptability of the education program. Methods: We conducted a pilot randomized controlled trial in community sites in Melbourne between July 2019 and June 2020. Adults attending the sites who self-identified as having Chinese ethnicity and were unsure of their hepatitis B status were invited to participate. After completing a baseline hepatitis B knowledge questionnaire, participants were randomly assigned to one of two groups to receive educational information (in either English or Chinese): standard hepatitis B information (Arm 1) or liver cancer prevention information focusing on hepatitis B testing (Arm 2). Participants were followed up by telephone after 6 months to determine whether they had a hepatitis B test and to complete a follow-up questionnaire. The follow-up questionnaire repeated the hepatitis B knowledge questions asked at baseline and explored participants' perceived barriers to testing. A before-and-after comparison of hepatitis B-related knowledge was undertaken. Results: Fifty-four participants were recruited from seven community sites. Participants' median age was 33 years (range, 18-90 years), and most (33, 69%) were female. Thirty-three participants (61%) completed follow-up at 6 months, of whom 22 (67%) were female (median age, 29 years). Among participants followed up, 20 (61%) reported visiting a doctor in the 6 months of follow-up and one third of those (n = 7) reported discussing hepatitis B testing at this GP appointment. Four participants (12%) self-reported having had hepatitis B testing: one of 15 (7%) in the standard hepatitis B information group and three of 18 (17%) in the liver cancer prevention information group. Six of 33 participants (18%) reported barriers to having a hepatitis B test, including concerns about accessing health care due to coronavirus disease 2019 and lack of knowledge about how to access health care. Twenty of 33 participants (67%) reported no intention of having a hepatitis B test at follow-up, with the main reason given being do not perceive the risk, do not feel the need. At follow-up after the education program, a significantly lower proportion of participants had the misconception of hepatitis B being transmitted via eating food or sharing eating utensils (8/33, 24%) than at baseline (29/55, 53%) (P < 0.001). The education session was well accepted by participants. Conclusion: A single education session with language-appropriate resources was effective for improving hepatitis B-related knowledge, which was retained at 6 months. However, despite knowledge improvement, a low rate of hepatitis B testing uptake was observed in both groups, with the main barrier being low risk perception in the community.

Masking: Response-ability, in unsteady, broken breaths

A reflection on the "mask," as a question of response and responsibility in the midst of the COVID-19 pandemic. © 2020 Penn State University Press. All rights reserved.