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As a result of the digital transition, planned or imposed, it is important that companies introduce control tools that allow measuring, validating, and improving the operations performed automatically, by the various technologies involved in the processes. For SMEs the challenge is increased by the lack of available resources. The additional benefits that the introduction of these tools can bring are several and diversified, but there are also several challenges to their implementation. One of the main obstacles will be the time factor, which in this case covers several dimensions. We intend to demonstrate that in the first stage of the implementation process, the ChatGPT technology can be important in presenting these benefits and challenges to managers of SMEs as well as higher education institutions, increasing the training of future managers in business intelligence and data analysis platforms that are mostly open source and low/no code for cost reduction. We focus our attention on a small Portuguese company where the advances in the digital transition were imposed by the pandemic but now faces the challenges of uncertainty in the quality of its process data and has to make choices between the visible and invisible costs of implementing business intelligence tools.
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Researchers have found that women who deliver babies in the midst of a pandemic are more likely to have mental health consequences, including postpartum depression, and their infants are likely to suffer as well, if the stressors are not mitigated. The cohort study of 318 mothers in the United States, Australia, and the United Kingdom found that COVID‐related stress was significantly associated with poor postpartum mental health and increased negative affectivity among infants.
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OBJECTIVES: This study aimed to provide real-world evidence on coronavirus disease 2019 vaccine effectiveness (VE) against symptomatic infection and severe outcomes caused by Omicron in children aged 5 to 11 years. METHODS: We used the test-negative study design and linked provincial databases to estimate BNT162b2 vaccine effectiveness against symptomatic infection and severe outcomes caused by Omicron in children aged 5 to 11 years between January 2 and August 27, 2022 in Ontario. We used multivariable logistic regression to estimate VE by time since the latest dose, compared with unvaccinated children, and we evaluated VE by dosing interval. RESULTS: We included 6284 test-positive cases and 8389 test-negative controls. VE against symptomatic infection declined from 24% (95% confidence interval [CI], 8% to 36%) 14 to 29 days after a first dose and 66% (95% CI, 60% to 71%) 7 to 29 days after 2 doses. VE was higher for children with dosing intervals of ≥56 days (57% [95% CI, 51% to 62%]) than 15 to 27 days (12% [95% CI, - 11% to 30%]) and 28 to 41 days (38% [95% CI, 28% to 47%]), but appeared to wane over time for all dosing interval groups. VE against severe outcomes was 94% (95% CI, 57% to 99%) 7 to 29 days after 2 doses and declined to 57% (95%CI, -20% to 85%) after ≥120 days. CONCLUSIONS: In children aged 5 to 11 years, 2 doses of BNT162b2 provide moderate protection against symptomatic Omicron infection within 4 months of vaccination and good protection against severe outcomes. Protection wanes more rapidly for infection than severe outcomes. Overall, longer dosing intervals confer higher protection against symptomatic infection, however protection decreases and becomes similar to shorter dosing interval starting 90 days after vaccination.
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BACKGROUD: COVID-19 has led to a reduction in operating efficiency. We aim to identify these inefficiencies and possible solutions as we begin to pursue a move to planned surgical care. METHODS: All trauma and orthopaedic emergency surgery were analysed for May 2019 and May 2020. Timing data was collated to look at the following: anaesthetic preparation time, anaesthetic time, surgical preparation time, surgical time, transfer to recovery time and turnaround time. Data for 2019 was collected retrospectively and data for 2020 was collected prospectively. RESULTS: A total of 222 patients underwent emergency orthopaedic surgery in May 2019 and 161 in May 2020. A statistically significant increase in all timings was demonstrated in 2020 apart from anaesthetic time which demonstrated a significant decrease. A subgroup analysis for hip fractures demonstrated a similar result. No increase in surgical time was observed in hand and wrist surgery or for debridement and washouts.Although the decrease in anaesthetic time is difficult to explain, this could be attributed to a reduction in combined anaesthetic techniques and possibly the effect of fear. The other increases in time demonstrated can largely be attributed to the PPE required for aerosol generating procedures and other measures taken to reduce spread of the virus. These procedures currently form a large amount of the orthopaedic case load. CONCLUSION: COVID-19 has led to significant reductions in operating room efficiency. This will have significant impact on waiting times. Increasing frequency of regional anaesthesia concurrently with non-aerosol generating surgeries may improve efficiency.
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Student persistence in the first year of studies is a crucial concern in online higher education. Recent accelerated growth in online programs due to the COVID pandemic has increased concerns over higher dropout rates, which are often connected to students' time challenges--time poverty, juggling multiple commitments, and fitting studies into busy lives. However, research seldom focuses on students' perceptions of time issues related to persistence. This study addresses this gap by exploring how 20 second-year students retrospectively viewed their experiences of time challenges and how they impacted their persistence in their first year at an online open university. Content analysis of in-depth interviews demonstrated that time pressure and time-conflicts were crucial barriers for success in the foundational semester, the main barrier was juggling study with multiple priorities. Most persisters had good time management and high levels of intrinsic motivation, satisfaction, and self-determination. However, even procrastinators with heavy work-family duties managed to persevere due to their resilience and personal motivation. Lastly, recommendations and strategies for effective student-based interventions to foster persistence are suggested.
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Even prior to the COVID-19 pandemic, high school students across the United States were enrolling in online courses at increasing rates. As a result of pandemic related school closures, even more schools enrolled students in supplementary online courses as a method for delivering instruction during emergency remote learning. Despite enrollment increases in online courses for high school students, many questions remain about how to provide effective instruction virtually and the structures and supports that facilitate student success in their online courses. While previous studies have examined predictors of student success in online courses, there is less research on the influence of the enrollment process (e.g., which students enroll, who enrolls them, and when they are enrolled) on student outcomes. To fill this gap, this correlational study examines when students enroll in supplemental online high school courses and whether the timing of enrollment in an online course (i.e., prior to a semester, at the start of a semester, or during a semester already in progress) relates to students' subsequent course outcomes. The findings suggest that students who enroll on-time are more likely to complete their online courses than students who enroll late.
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The ability of a company to prioritize work orders is an essential part of managing work which in turn is vital when it comes to delivering maintenance services. The authors have drafted a tutorial paper that outlines a real‐world application of practices which determine asset criticality and work order prioritization. The paper initially provides a background on the estate of the featured facilities department. An approach is then provided to determine asset criticality across an asset register which factors in the importance of each site in relation to the overall mission of the estate. The final step is to use asset criticality, work urgency and a time factor to address work order prioritization. If a company wishes to adopt the approach in this paper but does not possess a Computerized Maintenance Management System (CMMS) with the required functionality, they could instead utilize a spreadsheet‐based approach incorporating data exports from their resident CMMS. While this paper features data from the facilities management industry, the approach is agnostic and can be implemented by maintenance departments regardless of the industry.
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BACKGROUND: Cardiovascular diseases ranked first in terms of the number of deaths in Serbia in 2019, with 52,663 deaths. One fifth of those were from ischemic heart disease (IHD), and half of IHD deaths were from acute coronary syndrome (ACS). We present the ACS mortality time trend in Serbia during a 15-year period using the latest available data, excluding the COVID-19 pandemic. METHODS: The data on patients who died of ACS in the period from 2005 to 2019 were obtained from the National Statistics Office and processed at the Department of Prevention and Control of Non-communicable Diseases of the Institute of Public Health of Serbia. Number of deaths, crude mortality rates (CR) and age-standardized mortality rates (ASR-E) for the European population were analyzed. Using joinpoint analysis, the time trend in terms of annual percentage change (APC) was analyzed for the female and male population aged 0 to 85+. Age-period-cohort modeling was used to estimate age, cohort and period effects in ACS mortality between 2005 and 2019 for age groups in the range 20 to 90. RESULTS: From 2005 to 2019 there were 90,572 deaths from ACS: 54,202 in men (59.8%), 36,370 in women (40.2%). Over the last 15 years, the number of deaths significantly declined: 46.7% in men, 49.5% in women. The annual percentage change was significant: -4.4% in men, -5.8% in women. Expressed in terms of APC, for the full period, the highest significant decrease in deaths was seen in women aged 65-69, -8.5%, followed by -7.6% for women aged 50-54 and 70-74. In men, the highest decreases were recorded in the age group 50-54, -6.7%, and the age group 55-59, -5.7%. In all districts there was significant decline in deaths in terms of APC for the full period in both genders, except in Zlatibor, Kolubara and Morava, where increases were recorded. In addition, in Bor and Toplica almost no change was observed over the full period for both genders. CONCLUSIONS: In the last 15 years, mortality from ACS in Serbia declined in both genders. The reasons are found in better diagnostic and treatment through an organized network for management of ACS patients. However, there are districts where this decline was small and insignificant or was offset in recent years by an increase in deaths. In addition, there is space for improvement in the still-high mortality rates through primary prevention, which at the moment is not organized.
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Acute Coronary Syndrome , COVID-19 , Myocardial Ischemia , Humans , Female , Male , Serbia/epidemiology , Acute Coronary Syndrome/epidemiology , Pandemics , Cohort Studies , Registries , Myocardial Ischemia/epidemiologyABSTRACT
The article mentions the anniversary of the Managing Adult Malnutrition in the Community program to address malnutrition in the United Kingdom (UK) that was launched 10 years ago as of September 2022.
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Breastfeeding is a natural act, but it is also a learned behaviour. This year’s theme for World Breastfeeding Week 2022 is ‘Step up for breastfeeding: Educate and support.’ Organizations like Mumbai Breastfeeding Promotion Committee (MBPC) Mumbai Obstetric & Gynecological Society (MOGS) and Federation of Obstetrics & Gynecologic Societies of India (FOGSI) have been holding activities, webinars and competitions to focus on this important topic. This has been a wonderful way to partner with neonatologists, pediatricians, community medicine and mother support groups. The aim of all these activities is to highlight the physiological importance of breastfeeding, promote exclusive breastfeeding, and make the general population aware about its multiple benefits. This article provides a few key points for practicing physicians to impart knowledge of the evidence-based advantages of breastfeeding to their patients, friends and relatives.
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BACKGROUND: Critically ill COVID-19 patients may develop acute respiratory distress syndrome and the need for respiratory support, including mechanical ventilation in the intensive care unit. Previous observational studies have suggested early tracheotomy to be advantageous. The aim of this parallel, multicentre, single-blinded, randomized controlled trial was to evaluate the optimal timing of tracheotomy. METHODS: SARS-CoV-2-infected patients within the Region Västra Götaland of Sweden who needed intubation and mechanical respiratory support were included and randomly assigned to early tracheotomy (≤ 7 days after intubation) or late tracheotomy (≥ 10 days after intubation). The primary objective was to compare the total number of mechanical ventilation days between the groups. RESULTS: One hundred fifty patients (mean age 65 years, 79% males) were included. Seventy-two patients were assigned to early tracheotomy, and 78 were assigned to late tracheotomy. One hundred two patients (68%) underwent tracheotomy of whom sixty-one underwent tracheotomy according to the protocol. The overall median number of days in mechanical ventilation was 18 (IQR 9; 28), but no significant difference was found between the two treatment regimens in the intention-to-treat analysis (between-group difference: - 1.5 days (95% CI - 5.7 to 2.8); p = 0.5). A significantly reduced number of mechanical ventilation days was found in the early tracheotomy group during the per-protocol analysis (between-group difference: - 8.0 days (95% CI - 13.8 to - 2.27); p = 0.0064). The overall correlation between the timing of tracheotomy and days of mechanical ventilation was significant (Spearman's correlation: 0.39, p < 0.0001). The total death rate during intensive care was 32.7%, but no significant differences were found between the groups regarding survival, complications or adverse events. CONCLUSIONS: The potential superiority of early tracheotomy when compared to late tracheotomy in critically ill patients with COVID-19 was not confirmed by the present randomized controlled trial but is a strategy that should be considered in selected cases where the need for MV for more than 14 days cannot be ruled out. Trial registration NCT04412356 , registered 05/24/2020.
Subject(s)
COVID-19 , SARS-CoV-2 , Aged , Critical Illness/epidemiology , Critical Illness/therapy , Female , Humans , Male , Respiration, Artificial/methods , Tracheotomy/methods , Treatment OutcomeABSTRACT
Each shipping line is expected to establish a reliable operating model, and the design of ship schedules is a key operational consideration. Long-term profits for shipping lines can be expected from a well-designed ship schedule. In today’s liner service design, managing the time factor is critical. Shipping schedules are prone to different unexpected disruptions. Such disruptions would necessitate a near-real-time analysis of port capacity and re-design of the original ship schedule to offset the negative externalities. Ship schedule recovery strategies should be implemented to mitigate the effects caused by disruptions at ports or at sea, which may include, but are not limited to, ship sailing speed adjustment, handling rate adjustment at ports, port skipping, and port skipping with container diversion. A proper selection of ship schedule recovery strategies is expected to minimize deviations from the original ship schedule and reduce delays in the delivery of cargoes to the destination ports. This article offers a thorough review of the current liner shipping research primarily focusing on two major themes: (1) uncertainties in liner shipping operations;and (2) ship schedule recovery in response to disruptive events. On the basis of a detailed review of the available literature, the obtained results are carefully investigated, and limitations in the current state-of-the-art are determined for every group of studies. Furthermore, representative mathematical models are provided that could be further used in future research efforts dealing with uncertainties in liner shipping and ship schedule recovery. Last but not least, a few prospective research avenues are suggested for further investigation.
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The article discusses research which examined the association of intrauterine device (IUD) insertion timing and breastfeeding to IUD expulsion, conducted by Mary Anne Armstrong and published in an issue of "JAMA Network Open" journal. Topics explored include the risk of uterine perforation in postpartum IUD insertion in breastfeeding women, the incidence rates recorded among breastfeeding and nonbreastfeeding women, and the acknowledgment of IUD expulsion risk in pre-insertion counseling.
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Background and Aim: In December 2019, a new type of Coronavirus (SARS-CoV-2) pneumonia (COVID-19) was reported in Wuhan and quickly spread worldwide. This study was designed to investigate the clinical symptoms of the COVID-19 patients. Materials and Methods: In this retrospective study, we collected data of 132 COVID-19 dead patients. Demographic, epidemiological, and clinical data and laboratory test results were analyzed on days 1, 3, and 6 of admission. Results: Most cases were in the 66-75 age group, 64.39% of which were males. Three days after admission, 55.3% of patients died. The most frequent clinical manifestations were dry cough (70.45%) and fever (54.54%), which increased during hospitalization. Diabetes and blood pressure were reported as the most prevalent underlying diseases. Lymphopenia and an increase in leucocyte number were observed in most patients. ESR (92.5%) and LDH (94.64%) levels were above normal. Furthermore, 42.85% and 44.73% of patients had elevated ALT and AST levels, respectively. Conclusion: The results of this study revealed that males are more likely to be infected with SARS-CoV-19. Underlying diseases were common among patients and clinical and laboratory symptoms aggravated with a rise in hospitalization time.
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Objectives:Some people who contract severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) experience one or more signs and symptoms that persist for several weeks to several months following infection. Given the number who have contracted the virus, the still-active transmission of the infection, and the impact of these signs and symptoms on quality of life and functional capacities, post-COVID-19 conditions could place additional strain on Québec’s health-care system. To support its reflection on the offer of services to be recommended to adequately meet these needs, the Ministère de la Santé et des Services sociaux asked the Institut national d'excellence en santé et en services sociaux (INESSS) to prepare a state-of-knowledge report on the models of care and service organization currently in use or under development for preventing the persistence of COVID-19 symptoms and managing post-COVID-19 conditions. Conclusions:RESULTS: From the available literature, together with its uncertainties, the contextual information and the consultations, INESSS arrives at the following findings: • The models that focus on preventing the persistence of COVID-19 symptoms that were found in the literature are intended for individuals who have been hospitalized during the acute phase of the infection and are initiated during the hospital stay or at discharge. They are aimed at preventing the complications associated with the acute phase of the infection and the long-term sequelae. On the other hand, the more general management models that were found are intended for anyone with persistent symptoms of SARS-CoV-2 infection, regardless of the infection’s initial presentation. These models are aimed mainly at reducing persistent symptoms and their impact on the patient’s quality of life. • The models described in the literature for preventing COVID-19 symptom persistence and managing post-COVID-19 conditions have evolved since the beginning of the pandemic. However, whether focused on symptom persistence prevention or symptom management, these models and those recommended by learned societies and technology assessment agencies have several points in common, such as the need to evaluate the patient, individualized management, the involvement of professionals with different areas of expertise, referring the patient to the appropriate services, and considering at least three areas of intervention, namely, physical health, mental health, functional disabilities or social support. However, there are few data available for assessing the impact of the current models on patients, clinicians and the health-care system. • In Canada, the organization of care and services for post-COVID-19 conditions varies from province to province. While Ontario seems to focus on integrating the management of patients with functional disabilities directly into the current health-care system, Alberta and British Columbia are relying on a few dedicated post-COVID-19 clinics. In Québec, the services available for individuals with post-COVID-19 conditions differ from one facility to another. • Many of the models identified and described in the literature are based on centralizing the overall evaluation of patients and then referring them to the services that will meet their needs. • In Québec, the services currently available for individuals with a post-COVID condition are focused mainly on rehabilitation. According to the consultations, these services only partially meet their needs, mainly because the capacity of these services falls short of the demand and the areas of intervention do not cover all the aspects of post-COVID-19 conditions, and because of the lack of knowledge about these conditions and the difficulty or time it takes to access a health professional with expertise in rehabilitation, mental health or social support. Some of the other issues raised were staff shortages, the connections between the levels of care and services, the required consult time, and regional differences in demand volume and resource availability. • Various strategies for optimizing the management of Quebecers with post-COVID conditions were brought up, including addressing the issues mentioned above and providing financial support. In addition, according to the stakeholders consulted, it would be desirable if the government drafted clear guidelines to facilitate the organization of care and services in the different health and social services regions. • Equity of access to care and services for individuals with complex conditions unrelated to COVID-19 and the costs associated with a new offer of care and services raise some concerns and merit consideration when putting it together. • According to the stakeholders consulted, setting up a certain number of dedicated clinics would help meet the needs of persons with a post-COVID-19 condition. If this is done, these clinics should be able to rely on professionals with expertise in the different intervention areas mentioned above and be integrated into a defined care and services pathway. In addition, they should be supported by a strong front line, in other words, one that is equipped, trained and supported. CONCLUSION: Current knowledge about the optimal models of care and service organization for individuals with post-COVID-19 conditions is limited. However, the assessment of all the information found has revealed certain components common to the models in place in other jurisdictions, certain weaknesses in the current offer of services, elements that might be applicable and relevant to Québec practice, and issues that need to be considered. This information will be used to guide reflection on the organization of care and services in Québec for the prevention of COVID-19 symptoms and the management of post-COVID-19 conditions. INESSS will take into account the information presented in this report, particularly the needs and expectations of Québec clinicians and patients, when updating its support tool for the clinical management of individuals with a post-COVID-19 condition. Methods:We conducted a systematic review of publications containing scientific and nonscientific data, information, positions and clinical recommendations from the literature on models of care and service organization for preventing the persistence of COVID-19 symptoms and managing post-COVID-19 conditions. Contextual information was also collected from the websites of Canadian governmental and paragovernmental bodies. To gather information on the organization of services in Québec, those in charge of institutions, regional departments of general medicine and specific post-COVID-19 services in the health and social services system were invited to complete a questionnaire designed to identify service organization initiatives in progress or in preparation, and the issues and needs perceived by the system's different sectors. All of the results of the information gathering from the literature were discussed with a committee consisting of representatives from various professional bodies, clinicians with different types of expertise, and two individuals with a post-COVID-19 condition.
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Objectives:Post‒COVID-19 condition, also referred to as long COVID or post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC), among other names, is a condition characterized by new or persisting symptoms beyond the acute phase of the disease (e.g., for more than 4 or 12 weeks following an initial COVID-19 infection, clinical definition pending). People with post‒COVID-19 may experience a range of heterogenous symptoms including fatigue, shortness of breath, muscle aches, and cognitive and mental health challenges. Although the clinical pathophysiology of the condition is not yet well-defined, it is increasingly being recognized that is affects multiple organs and may have severe impacts to a person’s well-being and quality of life. CADTH, in consultation with its customers, is undertaking a Condition Level Review on post‒COVID-19. A Condition Level Review is an assessment of the evidence on a range of health technologies and emerging issues on all aspects of the condition, including prevention, identification, treatment, and management.