A novel separate chance-constrained programming model to design a sustainable medical ventilator supply chain network during the Covid-19 pandemic

Providing new models or designing sustainable networks in recent studies represents a growing trend. However, there is still a gap in the simultaneous modeling of the three dimensions of sustainability in the electronic medical device supply chain (SC). In this paper, a novel hybrid chance-constrained programming and cost function model is presented for a green and sustainable closed-loop medical ventilator SC network design. To bring the problem closer to reality, a wide range of parameters including all cost parameters, demands, the upper bound of the released co2, and the minimum percentage of the units of product to be disposed and collected from a customer and to be dismantled and shipped from DCs are modeled as uncertain along with the normal probability distribution. The problem was first formulated into the framework of a bi-objective stochastic mixed-integer linear programming (MILP) model;then, it was reformulated into a tri-objective deterministic mixed-integer nonlinear programming (MINLP) one. In order to model the environmental sustainability dimension, in addition to handling the total greenhouse gas emissions, the total waste products were also controlled. The efficiency and applicability of the proposed model were tested in an Iranian medical ventilator production and distribution network. For sensitivity analyses, the effect of some critical parameters on the values of the objective functions was carefully examined. Finally, valuable managerial insights into the challenges of companies during the COVID-19 pandemic were presented. Numerical results showed that with the increase in the number of customers in the COVID-19 crisis, social responsibility could improve cost mean by up to 8%.

Analysis and Performance of Solar Photovoltaic Energy System in India: Case Study

There are seven types of renewable energy, of which only five will generate electricity. The most extensively utilized renewable energy source for residential usage is solar photovoltaic energy. With over 486GW of generation capacity, solar PV remains as the third largest renewable power source, with advanced photovoltaic (PV) innovation. The United States and China have the most solar plant installations. India holds the third place as the country's solar area is expected to recover completely after the COVID-19 epidemic, wherein the energy from solar PV is expected to overtake coal before 2040. To examine and observe the various processes carried out by solar PV, several experimental studies have been carried out. This research article presents the different case studies of solar PV systems and observes the characteristics of voltage and current or voltage and power for different solar radiations and temperature, respectively. Secondly, the proposed study has observed and analyzed the performance of PV module in series or parallel connections concerning I-V and V-P characteristics. In third section, the shading effects on solar PV module output power is observed. In the fourth and fifth sections, methods to solve the shading module's output power constraint has been studied and finally the MPP is observed by varying the duty cycle of the converter. In the sixth and seventh section, the performance of SEPIC converter is evaluated based on the open and closed-loop systems, and the challenges in buck-boost converter are solved. © 2022 IEEE.

Closed-Loop Systems in Neuromodulation: Electrophysiology and Wearables.

Most currently available neuromodulation techniques for pain work through an open-loop system. The distance between the epidural space and the target of the stimulation in a dynamic body can change because of physiologic conditions. The closed-loop system in spinal cord neuromodulation consists of an integrated system that records real-time electrophysiological activity in the form of evoked compound action potentials and uses it in a feedback mechanism to adjust stimulus output. Wearables represent newly developed technologies that have gained traction in recent years. Their application in pain management is still developing but promising.

Letting the World See through Your Eyes: Using Photovoice to Explore the Role of Technology in Physical Activity for Adolescents Living with Type 1 Diabetes

This paper qualitatively explores how technologies and physical activity are experienced by adolescents with type 1 diabetes. Type 1 diabetes is a life-threatening autoimmune condition, which is highly prevalent in young children. Physical activity is underutilised as part of treatment goals due to multifactorial challenges and lack of education in both the family setting and across society as a whole. Using photovoice methodology, 29 participants (parents and adolescents), individually or as dyads, shared and described in reflective journal format examples of technology and physical activity in their lives. In total, 120 personal photographs with accompanying narratives were provided. The data were thematically coded by the researcher and then collaboratively with participants. Four key themes (and 12 subthemes) were generated including: (i) benefits of technology;(ii) complexity and difficulty;(iii) emotional impact;(iv) reliance and risk. Findings demonstrate that current technology does not address the complex needs of adolescents with type 1 diabetes to enable participation in physical activity without life risk. We conclude from our findings that future technologies for supporting engagement in physical activity as part of diabetes management need to be: more interoperable, personalised and integrated better with ongoing education and support.

Closed-Loop Insulin Therapy in Older Adults with Type 1 Diabetes: Real-World Data.

Objective: To assess the impact of initiation of closed-loop control (CLC) on glycemic metrics in older adults with type 1 diabetes (T1D) in the real world. Methods: Retrospective analysis of electronic health records from a single tertiary diabetes center of older adults prescribed CLC between January and December 2020. Results: Forty-eight patients (mean age 70 ± 4 years, T1D duration 42 ± 14 years) were prescribed CLC and 39/48 started on the CLC. Among the CLC starters, 97.5% and 95% were prior pump and continuous glucose monitoring (CGM) users, respectively. CGM metrics showed an increase in time-in-range (62% ± 13% to 76% ± 9%; P < 0.001), a reduction in both time spent <70 mg/dL [2% (1%-3%) to 1% (1%-2%); P = 0.03] and >180 mg/dL (30% ± 11% to 20% ± 9%; P < 0.001) at 3 months. Conclusion: In this real-world data most of the older patients with T1D initiating CLC were prior pump and CGM users. Initiation of CLC improved glycemic control and reduced time spent in hypoglycemia compared with prior therapy.

Sensory Integration Balance Deficits in Complex mTBI: Can Early Initiation of Rehabilitation With Wearable Sensor Technology Improve Outcomes?

Objectives: 1) To determine the role of timing in rehabilitation of balance deficits in people with mTBI 2) To determine if home monitoring improves outcomes 3) To develop a novel feedback system using wearable sensors to provide physical therapists with real-time information about quality of head and trunk movement during exercise. Plan: This is an interventional study on people with mTBI. Aim I examines whether initiating interventional physical therapy earlier rather than later improves outcomes. Aim II, nested within Aim I, examines whether home monitoring of vestibular rehabilitation improves outcomes. Aim III develops a system capable of delivering real-time feedback on quality to improve outcomes.

A Virtual Training Program for the Tandem t:slim X2 Insulin Pump: Implementation and Outcomes.

Insulin pump training has traditionally been performed in-person. The coronavirus disease 2019 (COVID-19) pandemic necessitated vast increases in the number of virtual pump trainings for Tandem t:slim X2 insulin pump starts. A customized structured pump training curriculum specifically tailored to virtual learning was deployed in early 2020, and included (1) preparation for training with use of the t:simulator app, (2) use of the teach-back method during video training, and (3) automating data uploads for follow-up. Retrospective analysis from >23,000 pump training sessions performed from January 1, 2020 to July 28, 2020 showed sensor time-in-range for up to 6 months after training was 72% (60%-81%) for virtual training versus 67% (54%-78%) for in-person training. Higher user satisfaction (4.78 ± 0.52 vs. 4.64 ± 0.68; P < 0.01) and higher user confidence (4.61 ± 0.75 vs. 4.47 ± 0.0.85; P < 0.01) were reported after the virtual sessions. Virtual pump training was well received and proved safe and effective with the new virtual training curriculum.

The Effectiveness of Virtual Training on the MiniMed™ 670G System in People with Type 1 Diabetes During the COVID-19 Pandemic.

Background: The coronavirus disease 2019 (COVID-19) pandemic has challenged the ability to do face-to-face training on advanced diabetes management technologies. In the United States, Medtronic Diabetes shifted from occasional to 100% virtual training on all diabetes devices in mid-March 2020. We studied the outcomes of virtual training on the MiniMed™ 670 G hybrid closed-loop system in type 1 diabetes. Methods: From March 20, 2020, to April 22, 2020 (intra-COVID-19), virtual training on the MiniMed 670 G system was completed using Zoom with satisfaction captured through online post-training surveys. Training efficiency was measuring by the days between the date of product shipment and the date of the first and final trainings. Patient satisfaction with training on the MiniMed 670 G was determined by Net Promotor Score® (NPS®). Uploads from CareLink™ Personal and CareLink Professional and calls to the Medtronic 24-h technical support team requesting educational/software assistance and/or help with health care provider telehealth visits were recorded. Continuous glucose monitoring (CGM) results were measured using the CareLink Personal database. All results except for the Zoom satisfaction survey were compared with data from January 20, 2020, to February 22, 2020, (Pre-COVID-19) when training was performed in-person. Results: The CGM metrics were comparable between pre- and intra-COVID-19 training. The Zoom video conferencing application had 98% satisfaction. The NPS rose from 78 to 84. The time between the pump shipment and the first and last (automode) training was significantly reduced from 14 ± 7 days to 11 ± 5 days (P < 0.001) and from 19 ± 7 days to 15 ± 15 days (P < 0.01), respectively. There was a decrease in the calls for educational assistance to the technical support team but an increase in requests for login and software installation support. Conclusions: Virtual training of individuals with diabetes on the MiniMed 670 G system resulted in high satisfaction and short-term glycemic results comparable with in-person training.

Successful Initiation of Hybrid Closed-Loop System Using Virtual Pump Training Program in a Teenager With Type 1 Diabetes Previously Treated with Multiple Daily Injections.

Due to the coronavirus disease 2019 restrictions in providing diabetes services, we have developed an innovative pump training program, which consisted of technical session, pump training, one in-person practical session, and four consecutive online sessions (Skype Meet Now).A 13-year-old female patient with a 4-year history of type 1 diabetes (T1D) on multiple daily injections (MDI) with glycated hemoglobin 8.9%; 74 mmol/mol) initiated Minimed 670G system using the program. Time in range (70-180 mg/dL) of 39% and sensor glucose (SG) of 214±91 mg/dL (MDI with continuous glucose monitoring) increased to 69% in the first 2 weeks and reached 86% and SG of 140±40 mg/dL in the first month of auto mode initiation, without severe hypoglycemia or hyperglycemia. Virtual pump training program can be an effective tool to initiate a hybrid closed-loop system and to improve glycemic control in people with T1D on MDI.