Intercrisis learning in disaster response network: experience of Korea from MERS and COVID-19

This paper critically reviews whether the hierarchical system or intercrisis learning can be sufficient to understand Korea's COVID-19 responses. Our case study suggests that a Korean response system is a hybrid form that uses a hierarchical structure together with a network approach. To unveil theoretical models of how learning may occur and evolve during a crisis, we employ a policy learning model combining the network perspective and the four Cs model (cognition, communication, coordination, and control). We analyse the change in government manuals, response policies, and agenda streams observed in government documents. This analysis reveals far more complex interactions among actors and policies, both flexible and rigid at different phases of COVID-19. On top of policy learning, we conclude that it is necessary to rediscover the power of citizen voluntary responses and collaboration among actors of the response network through value change.

A flexible framework for intervention analysis applied to credit-card usage during the coronavirus pandemic.

We develop a variant of intervention analysis designed to measure a change in the law of motion for the distribution of individuals in a cross-section, rather than modeling the moments of the distribution. To calculate a counterfactual forecast, we discretize the distribution and employ a Markov model in which the transition probabilities are modeled as a multinomial logit distribution. Our approach is scalable and is designed to be applied to micro-level data. A wide panel often carries with it several imperfections that complicate the analysis when using traditional time-series methods; our framework accommodates these imperfections. The result is a framework rich enough to detect intervention effects that not only shift the mean, but also those that shift higher moments, while leaving lower moments unchanged. We apply this framework to document the changes in credit usage of consumers during the COVID-19 pandemic. We consider multinomial logit models of the dependence of credit-card balances, with categorical variables representing monthly seasonality, homeownership status, and credit scores. We find that, relative to our forecasts, consumers have greatly reduced their use of credit. This result holds for homeowners and renters as well as consumers with both high and low credit scores.

Optimized nerve block techniques while performing percutaneous hepatic ablation: Literature review and practical use.

Percutaneous image guided thermal ablation has become a cornerstone of therapy for patients with oligometastatic disease and primary liver malignancies. Evolving from percutaneous ethanol injection (PEI), thermal ablation utilizing radiofrequency ablation (RFA) and microwave ablation (MWA) have become the standard approach in the treatment of isolated lesions that fit within the size criteria for curative intent therapy (typically 3-4cm). With the evolution of more intense thermal ablation, such as MWA, the dramatic increase in both the size of ablation zone and intensity of heat generation have extended the limits of this technique. As a result of these innovations, intra-procedural and post-procedural pain have also significantly increased, requiring either higher levels of intravenous sedation or, in some institutions, general anesthesia. In addition to the increase in therapeutic intensity, the use of intravenous sedation during aggressive ablation procedures carries the risk of over-sedation when the noxious insult (i.e. the ablation) is removed, adding further difficulty to post-procedural recovery and management. Furthermore, high subdiaphragmatic lesions become challenging in this setting due to issues relating to sedation and compliance with breath hold/breathing instructions. Although general anesthesia may mitigate these complications, the added resources associated with providing general anesthesia during ablation is not cost effective and may result in substantial delays in treatment. The reduction of Aerosol Generating Medical Procedures (AGMP), such as intubation due to the COVID-19 Pandemic, must also be taken into consideration. Due to the potential increased risk of infection transmission, alternatives to general anesthesia should be considered when safe and possible. Upper abdominal regional nerve block techniques have been used to manage pain related to trauma, surgery, and cancer; however, blocks of this nature are not well described in the interventional radiology literature. The McGill University group has developed experience in using such blocks as splanchnic, celiac and hepatic hilar nerve blocks to provide peri-procedural pain control [1]. Since incorporating these techniques (along with hydrodissection with tumescent anesthesia), we have also observed in our high volume ablation center a dramatic decrease in the amount of sedatives administered during the procedure, a decrease in patient discomfort during localization and ablation, as well as decreased pain post-procedure. Faster time to discharge and overall reduction in room procedural time serve as added benefits. The purpose of this publication is to outline and illustrate the practical application and use of nerve block/regional anesthesia techniques with respect to percutaneous hepatic thermal ablation.