Optimal selection of cruise ship waste disposal ports

As cruise ships call at many ports and passengers come from all over the world, it is very easy to carry viruses on cruise ships. Under the control of the epidemic situation on board, the solid waste generated by them should be scientifically treated to prevent the spread of infectious diseases such as COVID-19 pneumonia. Therefore, Reasonable selection of waste disposal ports and formulation of unloading plans are directly related to the resumption of cruise operations. This study considers the cost and risk of waste disposal, uses robust optimization to deal with waste volume, increases the scenarios of port service interruption due to epidemics and other reasons, and proposes a variety of emergency strategies. Finally, the relevant strategies are selected according to the decision-maker's preference for cost and risk;By solving the relevant examples, the optimal choice of the cruise ship waste disposal port under the epidemic situation is given, which verifies the validity and feasibility of the model. The research helps to improve the management of cruise waste during the post-epidemic period, and has practical value and guiding significance for the normal operation and development of the global cruise market. © 2023 SPIE.

How to Reconcile Pandemic Business Interruption Risk With Insurance Coverage

In the face of major risks, the financial capacities of private (re)insurers are rapidly reached. For major risks such as natural catastrophes, a risk transfer can be operated to the financial markets through securitization. A pandemic is a cat. Unfortunately a nat cat securitization strategy cannot be replicated for a pandemic cat. In this paper, we consider the economic losses that firms are bearing during a pandemic like the COVID-19. We focus on their most important issues: Risk correlation, impact of administrative decisions, moral hazard, and financial liquidity. Then we propose a coverage strategy of the pandemic business interruption risk that combines self-insurance, standard – capped – (re)insurance and new double triggered pandemic business interruption bonds. Lastly, we provide a simple illustration with French data related to the losses borne by the catering sector. © 2023 Editions Dalloz Sirey. All rights reserved.

Providing pandemic business interruption coverage with double trigger cat bonds.

The aim of this paper is to show how qualified investors in cat bonds can offer adequate pandemic business interruption protection in a comprehensive public-private coverage scheme. First, we propose a numerical model to expose how cat bonds can contribute to complement standard re/insurance by improving coverage of cedents even though risks are positively correlated during a pandemic. Second, we introduce double trigger pandemic business interruption cat bonds, which we name PBI bonds, and discuss their precise characteristics to provide efficient coverage. A first trigger should be pulled when the World Health Organization declares a Public Health Emergency of International Concern (PHEIC). The second trigger determines the payout of the bond based on the modelised business interruption losses of an industry in a country. We discuss moral hazard, basis risk, correlation and liquidity issues which are critical in the context of a pandemic. Third, we simulate the life of theoretical PBI bonds in the restaurant industry in France by using data gathered during the COVID-19 pandemic.

An Optimization of Home Delivery Services in a Stochastic Modeling with Self and Compulsory Vacation Interruption

This study presents and discusses the home delivery services in stochastic queuing-inventory modeling (SQIM). This system consists of two servers: one server manages the inventory sales processes, and the other server provides home delivery services at the doorstep of customers. Based on the Bernoulli schedule, a customer served by the first server may opt for a home delivery service. If any customer chooses the home delivery option, he hands over the purchased item for home delivery and leaves the system immediately. Otherwise, he carries the purchased item and leaves the system. When the delivery server returns to the system after the last home delivery service and finds that there are no items available for delivery, he goes on vacation. Such a vacation of a delivery server is to be interrupted compulsorily or voluntarily, according to the prefixed threshold level. The replenishment process is executed due to the (s,Q) reordering policy. The unique solution of the stationary probability vector to the finite generator matrix is found using recursive substitution and the normalizing condition. The necessary and sufficient system performance measures and the expected total cost of the system are computed. The optimal expected total cost is obtained numerically for all the parameters and shown graphically. The influence of parameters on the expected number of items that need to be delivered, the probability that the delivery server is busy, and the expected rate at which the delivery server's self and compulsory vacation interruptions are also discussed.

Stakeholders' solutions to antiretroviral therapy interruption during the COVID-19 pandemic in China: a short report.

Obtaining antiretroviral therapy (ART) was a challenge for people living with HIV (PLHIV) in China during the COVID-19 outbreak. On 26 January 2020, the Chinese Center for AIDS/STD Control and Prevention issued a nationwide directive to relax restrictions on where and when PLHIV could refill ART. This qualitative study explored unexpected barriers under this directive and recommendations to improve future ART delivery. Between February 11 and February 15 2020, in-depth interviews of 4 groups of stake holders related to ART refilling (i.e., PLHIV, community-based organization employees, CDC staff, infectious disease physicians and nurses), were conducted via WeChat. Data were managed by NVivo 11.0 and transcripts were coded using thematic analysis. Sixty-two interviews were conducted. The main barriers to refilling ART included: (1) inconsistent documentation requirements to refill ART, (2) lack of specific protocols on ART refilling, (3) insufficient staffing, and (4) regimen verification and drug shortages. The most common recommendations to improve future ART delivery were: (1) to establish a nationwide system to distribute ART and (2) increase the number of pills delivered with each ART refill. Strengthening protocols and systems to refill ART and improving collaboration is key to preventing interruptions in ART among PLHIV during public health emergencies.

Reinsuring pandemics: the role of government and public-private partnerships between reinsurers and governments.

Pandemic-related business interruption (BI) losses are generally considered 'uninsurable' because, in order to pool sufficient premium revenue to meet valid claims, premiums would be unaffordable for the majority of policyholders. This paper explores whether and how such losses might be made insurable in the U.K. The authors consider post-pandemic governmental responses, including the role of the Financial Conduct Authority (FCA) and the meaning and implications of FCA v Arch Insurance (U.K.) Ltd ([2021] UKSC 1). The central premise of the paper is to highlight the importance of reinsurance in increasing an underwriter's insuring capacity and to illustrate how, with the support of government in the form of a public-private partnership (PPP), 'uninsurable' risks of this type may be made insurable. The authors propose a PPP, 'Pandemic Business Interruption Re', which provides, in their view, a feasible and defensible solution that would confer the benefit of increasing policyholders' faith in the industry's ability to underwrite pandemic-related BI claims and reduce reliance on ex post government aid.

Persistence to long-term PCSK9 inhibitors treatment and its effectiveness in familial hypercholesterolemia: Data from the SAFEHEART study

Background: Most patients with heterozygous familial hypercholesterolemia (FH) do not achieve current LDL-C goals proposed by European guidelines with conventional lipid-lowering therapy (LLT). Chronic use of PCSK9 inhibitors (PCSK9i) have shown to reduce LDL-C levels up to 61% on top of statins. Persistence to chronic LLT is important to reduce the burden of atherosclerotic cardiovascular disease (ASCVD). Purpose(s): To analyze persistence and effectiveness of PCSK9i in clinical practice setting in FH patients from the SAFEHEART register with longterm follow-up. Method(s): SAFEHEART is an open, long-term prospective study of a cohort of subjects with molecular diagnosis of FH. Follow-up is carried out every year through a standardized phone-call to collect clinical conditions, persistence to medications, lipid profile, and cardiovascular events. This study analyses subjects >=18 years of age on stable LLT who have received PCSK9i. Result(s): 696 individuals (46% females), median age 56.4 years (IQR 49- 66) started with PCSK9i (49% alirocumab and 51% evolocumab). Out of them 38% had history of ASCVD, and 89% were on maximum LLT. Median LDL-C at the moment of starting PCSK9i was 145 mg/dL (IQR, 123- 177), representing a poor 2016 & 2019 ESC/EAS guidelines achievement (3% and 0.1% respectively). After a median follow-up of 3.7 years (IQR, 2.3-4.8), 669 patients (96%) remained on PCSK9i treatment during entire follow-up. Only 27 patients (4%) discontinued, 5 temporarily (0.7%) and 22 permanently (3.2%). Most common reasons for PCSK9i treatment interruption were medical decision (n=6), adverse event (AE) (n=5), patient decision not related with AE (n=5) and comorbidity (n=5). Median time to permanent discontinuation was 15 months (IQR, 4-33). Median LDL-C levels observed and % of LDL-C reduction obtained after 1 year of treatment and in the last follow-up visit were: 63 mg/dL (IQR, 43- 88), 61 mg/dL (IQR, 44-82), 57.6% (IQR, 39.5-69) and 58% (IQR, 44-68), respectively. 2016 ESC/EAS guidelines LDL-C goals was achieved by 70% of patients at year 1 and 77% in the last follow-up visit after the introduction of PCSK9i (p<0.001). 2019 ESC/EAS goals were achieved by 44.5% and 48% (p=0.1). Conclusion(s): Long-term persistence to PCSK9i treatment in FH patients is very high (96%) and reasons for discontinuation are diverse. This study shows that COVID-19 pandemic did not affected persistence to treatment. Effectiveness in LDL-C reduction and LDL-C goal achievement improved significantly with introduction of PCSK9i in clinical practice setting.

Factors associated with medication interruption among outpatients with severe mental illness exposed to COVID-19.

Many patients with severe mental illness (SMI) relapsed and deteriorated during the COVID-19 pandemic, as they experienced medication interruption. This study aimed to investigate factors affecting medication interruption in patients with SMI during the COVID-19 pandemic. A total of 2,077 patients with SMI participated in an online survey on medication interruption during the COVID-19 outbreak. The questionnaire comprised six parts: basic demographic information, COVID-19 exposure, state of disease, medication compliance before COVID-19, medication interruption during COVID-19, and the specific impact and needs. A total of 2,017 valid questionnaires were collected. Nearly 50% of patients with SMI have been affected to varying degrees of life expectancy and treatment. Among them, 74 patients stopped taking medicines for more than 14 days without a prescription. Logistic regression analysis showed that cohabitant exposure [OR = 26.629; 95% CI (3.293-215.323), p = 0.002], medication partial compliance and non-compliance pre-COVID-19 [OR = 11.109; 95% CI (6.093-20.251), p < 0.001; OR = 20.115; 95% CI (10.490-38.571), p < 0.001], and disease status [OR = 0.326; 95% CI (0.188-0.564), p < 0.001] were related to medication interruption. More than 50% of the patients wanted help in taking medications, follow-up, and receiving more financial support and protective materials. We found that the daily lives of patients with SMI were much more susceptible to impact during the pandemic. Patients with a history of partial or non-medication compliance before COVID-19 and an unstable disease state are more easily affected by pandemics and epidemics and need extra attention should similar large-scale outbreaks occur in the future.

Interruption of BCG Therapy for NMIBC During COVID-19 Crisis, Dilemma in Its Continuation: a Review of Available Evidence and Suggested Management Strategies.

The COVID-19 disease, caused by SARS-CoV-2 virus, has been one of the worst pandemics ever to hit the human mankind. Undoubtedly the start of the second wave of COVID-19 has literally ripped apart the hearts of millions of people. Cancer patients have been left of the beaten track to their fate, with no access to treatments. Intravesical BCG instillation is the standard of care for patients with non-muscle invasive bladder cancer (NMIBC). Several patients were in the middle of their treatment regimen when this pandemic struck. As slowly the word is recuperating from concussion effect of this pandemic and routine health services are being restored, uro-oncologist will face a unique scenario with respect to intravesical BCG therapy i.e., whether to restart the course of BCG therapy or to continue course from where it was interrupted. There are no studies in literature to directly answer this peculiar question and to resolve this dilemma. So, we in this review article propose to explore the literature for the most appropriate therapeutic regimen for these patients with interruption of intravesical BCG therapy. We plan to divide the patients with interruption to BCG therapy into the following three groups:Group 1: Patients who had interruption during the induction period.Group 2: Patients who completed the induction course but maintenance course could not be started.Group 3: Patients who had interruption during maintenance phase of BCG therapy. We will compile the recent recommendations by NCCN, AUA, and EAU for the administration of intravesical BCG in non-muscle invasive bladder cancer. We herein want to review the literature to propose the most appropriate strategy, its safety profile for these subsets of patients. Supplementary Information: The online version contains supplementary material available at 10.1007/s13193-023-01742-8.

Impact of the COVID-19 pandemic on colorectal cancer screening in New York City.

BACKGROUND: The COVID-19 pandemic significantly impacted the delivery of cancer screening. The resulting decrease in outpatient visits and cancellations of non-urgent procedures have negatively affected colorectal cancer (CRC) screening. We aimed to determine the effect of the pandemic on CRC screening at a safety-net hospital and a private health system based in New York City. METHODS: We identified individuals eligible for CRC screening aged 50 to 75 years presenting for outpatient care at a safety-net public hospital and private health system in April through September of 2019 and 2020. The primary outcome was the proportion of screening-eligible patients seen in primary care who underwent CRC screening. RESULTS: The safety-net hospital had 516 (6.1% of screening-eligible individuals) and 269 (4.3%) screening tests completed in 2019 and 2020, respectively (p < 0.01). Fecal immunochemical tests (FIT) accounted for 69.6% of screening in 2019 and 88.1% in 2020. Colonoscopy accounted for 20.3% of screening in 2019 and 11.9% in 2020. The private health system had 39 (0.7%) and 21 (0.6%) screening tests completed in 2019 and 2020, respectively (p = 0.48). FIT accounted for 61.9% of screening in 2019 and 57.1% in 2020. Colonoscopy accounted for 38.1% of screening in 2019 and 42.9% in 2020. CONCLUSION: Absolute numbers of screening tests decreased for both institutions during the COVID-19 pandemic. We observed a decrease in screening uptake and increase in proportional FIT use in the safety-net hospital but no change in the private health system.

Left Ventricular Recruitment Utilizing Serial Upsizing of Blalock-Taussig-Thomas Shunt to Achieve Successful Biventricular Repair

Background Surgical strategies to achieve biventricular (BiV) repair in children with borderline left ventricle (LV) continue to evolve. We report our innovative strategy of LV recruitment utilizing systemic to pulmonary artery shunt upsizing along with fenestrated atrial septation (FAS). Case The case is a 22mo old with hypoplastic left heart variant with type A aortic arch interruption and bilateral SVC. The LV, aortic and mitral valve were hypoplastic not meeting criteria for BiV repair. He underwent stage 1 palliation (Norwood with 4mm BTT shunt). Frequent COVID infections and over-circulation led to BiV dysfunction and cardiogenic shock requiring ECMO support for 4 days. At 5 months of age cardiac catheterization (CC) revealed good hemodynamic parameters for a stage 2 Glenn. An MRI also revealed growth of the left ventricle. Decision-making A decision was made to engage in a staged LV recruitment process to achieve BiV repair. We elected to avoid a volume offloading procedure in the form of a Glenn. To optimize continued volume loading on the LV, Stage 2 palliation consisted of upsizing to a 5mm BTT shunt with 4mm FAS. MRI at 22 months showed an LV volume of 60ml/m2 associated with CC hemodynamics showing LA pressure of 13mmHg, and LV end-diastolic pressure of 12mmHg. He underwent BiV repair with takedown of DKS, with primary anastomosis of the aorta and the pulmonary artery to their respective circulations. The postoperative echocardiogram illustrated a gradient of 5mmHg and 3mmHg through the mitral and aortic valve respectively. The pt was placed on a beta blocker and discharged on day 5 following BiV conversion. This strategy provides increased pulmonary blood flow with increased bloodflow across the mitral valve and inflow into the LV. In so doing may enhance the rate of LV growth. Furthermore, this strategy avoids the bidirectional Glenn (BDG), a volume offloading operation. Conclusion Shunt upsizing with FAS is well tolerated. It has the potential advantage for fewer operations to achieve BiV circulation due to rapid LV growth in comparison to other staged LV recruitment strategies involving the BDG.Copyright © 2023 American College of Cardiology Foundation

Therapeutic stategies in hospitalised patients with SarsCov-2 hipoxemic pneumonia

Objective: Evaluate the impact of real life use of remdesivir (RDV) as treatment for hypoxemic SarsCoV2 Pneumonia. Method(s): Of 1155 consecutive adult subjects hospitalised with SarsCov2 infection, we selected only those with cumulative evidence of: 1. positive PCR test;2. Radiologically confirmed pneumonia;3. Hypoxemia and need of supplementary O2 (>= 24%). We compared those treated with RDV versus those receiving Standard of Care (SoC), in terms of mortality, length of hospital stay and secondary effects of treatment. Result(s): 843 subjects were treated with RDV and 312 with SoC. In the RDV group, 97.1% patients were also receiving Dexamethasone (DEXA) and mean age was 69.7 (+/-14.4) years with 61.8% male prevalence, as opposed to the SoC group that registered 73.9 (+/-14.5) years and 49.7% male prevalence. Both groups had similar prevalence of Diabetes, Hypertension and Chronic Lung Disease;Overweight was more prevalent in the RDV group whereas Immunosuppressant conditions and Smoking were more frequent in the SoC subjects. Concerning the proposed outcomes: a) RDV patients had a mean Hospital Stay 4.25 days inferior than SOC subjects (p=0.002);b)The relative risk of death during hospital stay in the RDV group was 0.47 [0.38;0.60] when compared to those in the SoC group;c) 9 subjects in the SoC group (0.03%) and 12 patients in the RDV group (0.014%) had secondary effects attributable to treatment drugs, all resolved with treatment interruption. Conclusion(s): The use of RDV with DEXA in SARSCoV-2 Hypoxemic Pneumonia significantly reduced mortality and hospital stay, and registered no significant side effects in a real life cohort of consecutively enrolled patients.

Order for payment procedure and interruption of procedural periods for the pandemic created for the Covid-19. On purpose of the CJEU Judgment of 15 September of 2022 C-18/21, Uniqa Versicherungen AG c. VU

The main purpose of this paper is to analyze the CJEU judgment of September 15, 2022, C-18/21, Uniqa Versicherungen AG v. VU. This resolution is the last that the CJEU has established in relation to Regulation 1896/2006, which regulated the European order for payment process. In response to a prejudicial question referred by the Austrian Supreme Civil and Criminal Court, the CJEU must decide whether an Austrian national Law that interrupted the procedural periods for civil proceedings in Austria could also be applied to the European order for payment procedure. The CJEU, based on the principle of procedural autonomy of the Member States, resolves this issue positively. © 2023, UNIV CARLOSIII MADRID. All rights reserved.

DIVAS - DC Pink Divas Intervening Virtually to Advance Saving Lives: Assessing the impact of digital behavioral health breast cancer education program for Black women

Breast cancer is now the most common cancer. Thirty years of increased awareness, early diagnosis, and treatment access contributed to a 40% decline in breast cancer deaths. Yet, in 2021, more than 281,550 new cases of invasive and 49,290 new cases of non-invasive breast cancer will be diagnosed in U.S. women. Black women are 40% more likely to die of breast cancer - the highest breast cancer death rate across racial and ethnic groups. Today, the Black-white breast cancer mortality gap persists, and Black metastatic breast cancer (MBC) patients have a poorer prognosis. The pandemic exacerbated breast cancer disparities. In 2020, delays and avoidance contributed to an 85% breast cancer screening drop while MBC patients' risk of severe illness and death from COVID-19 elevated. Therapy interruptions and abandonment increased, and conversely, clinical trial enrollment decreased. COVID-19 has accelerated the digital platform shift to telemedicine, online psychosocial support programs, virtual patient navigation, and digital engagement across the oncology care continuum. DC Pink Divas Intervening Virtually to Advance Saving Lives (DIVAS) is an award-winning evidence-based training, outreach, and patient navigation program developed to address the educational needs of Black early-stage, MBC breast cancer patients, survivors, and caretakers and provide strategies to educate, empower and impact women by increasing breast health knowledge, decreasing gaps in screenings and access, increasing awareness of MBC to ensure that where a woman lives, will not determine if she lives through a 1-year commitment of attendance in 8 cohort-based education modules where Black breast cancer mortality is highest. The DIVAS Health Behavioral Change Model adapts the Precaution Adoption Process Model, Health Behavior Model, and Social-Ecological Model. DIVAS implements innovative virtual outreach programs, training, and intervention strategies to empower Advocates to educate peers, providers, and policymakers. 3 Cohorts of Black women impacted by breast cancer trained as Lay Breast Health Advocates from 2011, 2020, and 2021 (N = 57;77.5 % 45 years or younger;36.7% early-stage 0-II, 50% late stage III-IV, 10.3% caretakers) self-reported their lifestyle behaviors, breast cancer diagnosis, breast health education, social media use, and interest in a digital-based lifestyle intervention. Participants completed pre-and post-surveys, interviews, and journaling over 10.5+ hours of education modules to understand their breast health, provider-related challenges, and community-related resources. Findings provide evidence that cohort-tailored education is a successful method of supporting Black women in a behavioral-health intervention. The provision of printed culturally attuned information along with the digital-based instruction from a Black woman health care provider or public health expert is effective in helping Black breast cancer survivors transition into patient empowerment, improve QOL and contribute to better patient outcomes. After the intervention and completion of breast health modules, participants reported increased: self-efficacy in communicating with providers (70%) and self-efficacy in making treatment decisions (70%) self-confidence (85%), and a decrease in lifestyle risk factors (87%). Patient-centric behavioral health interventions in breast cancer education must be advanced digitally to address the pandemic's compounded crisis. DC Pink Divas provides insights to combat rising disparities by educating, empowering, and mobilizing Black lay breast health advocates to improve outcomes. Collaborative digital interventions across the care continuum to improve awareness, access, adherence, infrastructure, culturally attuned training, and support are evidencebased methods for navigating the cancer care transformation accelerated by COVID-19 to advance breast health equity. (Table Presented).

Radiological and clinicopathological findings of breast cancer during the COVID-19 pandemic: a comparative study with the pre-pandemic era.

PURPOSE: The diagnosis and surgical treatment delays that occurred during the coronavirus disease-2019- (COVID-19) pandemic may have affected breast cancer presentation. This study aimed to determine whether there was a difference in the clinicopathological characteristics of breast cancers during the pandemic by comparing them with similar cases from the previous year. The study also aimed to determine the radiological findings of breast cancers during the pandemic. METHODS: A retrospective review was made of patients who underwent surgery for breast cancer between March 11, 2020, and December 11, 2020 (the pandemic group). These patients were compared with similar patients from the previous year (the pre-pandemic group). The postoperative histopathology results of both groups were compared, and the preoperative radiological findings of the pandemic group were defined. RESULTS: There were 71 patients in the pandemic group and 219 patients in the pre-pandemic group. The tumor size was significantly greater, lymph node involvement was more frequent, and waiting time for surgery was longer in the pandemic group (P < 0.001, P = 0.044, P = 0.001, respectively). There was no significant difference between the groups in respect of in situ/invasive tumor distribution, histological type and histological grade of tumor, the presence of lymphovascular/perineural invasion, multifocal/multicentric focus, and Breast Imaging Reporting and Data System Classification (P > 0.15). The radiologic findings of breast cancer during the pandemic typically showed characteristics of malignancy. CONCLUSION: Patients diagnosed with breast cancer during the COVID-19 pandemic had larger tumor sizes, more frequent lymph node involvement and longer waiting time for surgical treatment. Screening programs should be continued as soon as possible by taking necessary precautions.

Business interruption insurance as a means of spreading pandemic-related losses.

This article discusses business interruption insurance as a measure of spreading risk in the context of the COVID-19 pandemic. In drawing a picture of how business interruption insurance has been handled and governed to date by courts and regulators in the U.K., Australia and the U.S., the contribution is specifically concerned with providing tentative answers to two questions: first, whether the design and interpretation of business interruption policies have made it a suitable means of spreading pandemic risks for policyholders; and second, how methods of resolving disputes over pandemic-related losses could improve the position of policyholders in relation to the insurance sector.

Resiliency and reliability of the power grid in the time of COVID-19: An integrated ABC-K-means model for optimal positioning of repair crew

More than one year has passed since the outbreak of a new phenomenon in the world, a phenomenon that has affected and transformed all aspects of human life, it is nothing but pandemic of COVID-19. The field of electrical energy is no exception to this rule and has faced many changes and challenges over the 2020. In this paper, by applying artificial intelligence and the integrated clustering model, by k-means technique, combined with the meta-heuristic artificial bee colony (ABC) algorithm a new methodology is presented in order to optimal positioning of the repair crew based on annual data of power grid under situation of COVID-19 to improve the reliability and resiliency of the network due to the importance of electricity for medical purposes, home quarantine, telecommuting, and electronic services. Current research benefits from real interruption data related to year 2020 in Isfahan Province (Iran), reflexing both the huge changes in patterns of power consumption and dispatching as well as novel geographical distribution of blackouts due to COVID pandemic. The temporal distribution of interruptions is very close to the uniform distribution and the geographical distribution of interruptions relative to the density of subscribers had a normal distribution. Accordingly, proposed model is implemented for clustering the spatial data of blackouts recorded during 2020. The number of clusters is equal to the number of repair teams which in this study is considered equal to three. In the next step, the average spatial coordinates of the points of each cluster are calculated, which after reviewing the geographical conditions in the geo-spatial information system (GIS), indicates the optimal point for the deployment of electrical repair crew related to that cluster. The research findings show that after using the optimal points for a month, system average interruption duration index (SAIDI) decreased by an average of 23% compared to the same period of the 2020.

A pandemic business interruption insurance.

We analyze how pandemic business interruption coverage can be put in place by building on capitalization mechanisms and a portfolio management strategy. As evidenced with COVID-19, pandemics affect economic sectors in differentiated ways: some are very severely affected because their activity is heavily impacted by travel bans and constraints on work organization, while others are more resistant. This opens the door to risk-coverage mechanisms based on a portfolio of financial securities, including long-short positions and options in stock markets. We show that such a strategy allows insurers to offer business interruption coverage in pandemic states, while simultaneously hedging the risks associated with alternating bullish and bearish non-pandemic states. These conclusions contrast sharply with the idea of governments being the only solution to the pandemic insurability problem. They are derived from a theoretical model of corporate risk management, and their practical relevance is illustrated by numerical simulations, using data from the French stock exchange.

Purchase choice of COVID-19 business interruption insurance under different government subsidy models

From the perspective of multiple insurance subjects, this article studies the purchase of COVID-19 business interruption insurance under the government's direct subsidy model and the indirect subsidy model, so as to provide decision support for the collaborative management and control of interruption risks in the supply chain. Research conclusions are as follows: The COVID-19 business interruption insurance can effectively transfer the enterprise interruption risk, and when the manufacturer purchases insurance or joint (manufacturer and seller) purchase insurance, the effect of interruption risk transfer is better than when the seller purchases insurance;The risk transfer effect of the COVID-19 business interruption insurance mainly depends on the three key influencing factors of the interruption penalty coefficient, the government subsidy model and the premium rate. The combined effect of the three factors has caused changes in the decision boundary of the COVID-19 business interruption insurance purchase decision. As a result, joint purchase under the indirect subsidy model, joint purchase under the direct subsidy model, and manufacturer purchase under the direct subsidy model may all become the optimal purchase decision;The value realization and value appreciation paths of the COVID-19 business interruption insurance under different purchasers are different. © 2022 Systems Engineering Society of China. All rights reserved.

Effectiveness assessment of patient-centered measures for chronic disease management during COVID-19 epidemic

Purpose The disruption of routine treatment, including the interruption of medication, might be deteriorating chronic conditions during disasters such as the COVID-19 epidemic. This study aims to assess the effectiveness of patient-centered measures for patients with chronic diseases during the COVID-19 epidemic. Method This was a cross-sectional study to analyze the effectiveness of chronic disease prescriptions issued by hospital-based clinicians, prescription refilling rate, the utilization rate of reservation for picking-up medicine, and the rate of returning to the hospital for refilling prescriptions as scheduled at a tertiary care hospital in Taiwan by using chi-square test. The enrolled outpatients received managed care from January to June of 2019 and 2020. The SAS (v8.2) statistical software was used for analysis. Results The percentage of chronic disease prescriptions issued by physicians out of a total number of outpatient visits increased to 66.0% significantly, and the rate of patients who returned to the hospital to refill chronic disease prescriptions decreased to 52.4%. The utilization rate of reservation service for prescription refills increased significantly from 3.9% to 10.5%. There is a significant difference in age groups and specialties visited by patients who made prescription refill reservations. The top five specialties are cardiovascular medicine, metabolic diseases, and endocrinology, neurology, urology, orthopedics, and rehabilitation. The specialties with the highest increase in reservation rate are psychiatry, gastroenterology, gynecology and pediatrics, and rheumatology. Discussion Most of the chronic disease continuous prescription users are the elderly, but the elderly are at high risk of severe COVID-19. Adopted patient-centered measures for preparedness to go out with medication such as outdoor drug dispensing counters, walk or drive-through pharmacies and online reservations for prescription refilling were effective, which can help elderly with the stable chronic disease obtain medication on schedule and reduce the risk of coronavirus exposure. National Health Insurance Administration should add the prescription refilling records to health insurance cards for further evaluating medicine adherence when prescriptions are revised. © 2022, Gerontechnology. All Rights Reserved.