Community Medicine Clerkship amidst COVID-19 Pandemic: Re-designing, Implementation, and Evaluation

Clerkship on primary care and family medicine is multi-elemental and was very challenging during the COVID-19 pandemic. Some medical students postponed their graduation because the clerkship at the health center could not be carried out in a pandemic situation. This article aims to describe the community medicine clerkship (CMC) module and its implementation amidst the COVID-19 pandemic. This module was delivered by online and offline activities from 10th August to 13th September 2020. A total of forty students, twelve faculty mentors, and fifteen Primary Health Care (PHC) preceptors from ten PHCs in the Tangerang District, Indonesia were involved. Students could carry out activities and fulfil assignments given in the midst of a pandemic with a re-designing of the CMC module. The one-sample t-tests were employed to compare the difference between the study values and the values before the COVID-19 pandemic. The study showed that the scores of students participating in CMC module during the COVID-19 pandemic were significantly different from the scores before the pandemic in terms of both individual and group scores. The findings of the study clearly indicated that all clinical clerkship modules must be redesigned to suit the current conditions. Modifications and variations of various learning methods, guidance techniques, monitoring and coordination are all factors that must be considered in implementing changes to these modules. © 2023 Dwi Tyastuti, Risahmawati Risahmawati, Marita Fadhillah, Fika Ekayanti, Sity Kunarisasia & Ahmad A. Habibi.

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.

Critical discourse studies and 'times of crisis': a proposal for re-existences based on Critical Aquilombage and Pragmatic Networks perspectives

The purpose of this reflection is to contribute to the debate on Critical Discourse Studies, through the presentation of original theoretical-methodological possibilities of anti-colonial nature, attentive and committed to the citizen struggle. Therefore, as a scenario of reflection and potential epistemological and methodological application, the concept of Critical Aquilombage – CA – (SANTOS, 2019;2021;2022) is described and applied in intersection with the concept of Pragmatic Networks – PR – (SANTOS, 2017;2019);the 'discourse of crisis' (located in the context of the Covid-19 pandemic in Brazil) is used as illustration for the analysis. In the text, theoretical-methodological understandings related to discourse are developed, as well as the critical discourse analysis (FAIRCLOUGH, 2003;2010;RESENDE, 2019) oriented to the consolidation of reexistence movements (SOUZA, 2009;2011). In this way, a critical reflection and potential application of the epistemological-methodological-ontological enterprise CA-PR are presented, approaching them to the problematization of the term 'crisis'. Finally, it is possible to argue that the term ‘crisis' has been strategically used by social representants of symbolic and material power to operate the existential emptiness of Black People, operating the non-existence process (that is, sophisticated discursive movements in which existences are affected and erased, to the detriment of few others – which ones, for centuries, have continued to manipulate language and society in order to maintain places of social privilege and prestige): on the other hand, the critical-reflective use of texts can point to new modes of resistance. © 2022 Thesaurus Editora de Brasilia Ltda.. All rights reserved.

Moderating effect of project size on the relationship between COVID-19 safety protocols and economic performance of construction projects

PurposeThe COVID-19 health crisis has brought about a set of extra health and safety regulations, and procedures to the construction industry which could influence projects' economic performance (EP). The aim of this paper is to examine the effect of adopting COVID-19 safety protocols on construction sites on the economic performance (EP) of construction projects.Design/methodology/approachEmploying the survey method using a structured questionnaire, data were collected from small- and large-sized construction projects in Nigeria and analysed using partial least squares structural equation modelling (PLS-SEM) technique.FindingsThe findings reveal that job re-organization and sanitization have negative significant effects on EP, while social distancing and specific training have no effect on EP. Furthermore, project size moderates the relationship between job re-organization, sanitization, specific training and EP with the stronger effect on the relationships observed in big projects, except for the relationship between sanitization and EP where the moderating relationship is stronger in small projects. However, there is no significant moderating effect of project size on the relationship between social distancing and EP.Practical implicationsAs construction project sites continue to operate amidst strict safety protocols, this study offers theoretical and practical insights on how construction projects can adhere to the safety protocols while performing economically.Originality/valueThe originality of this study's findings stems from the fact that it is among the first to provide greater insight on how construction projects have fared economically considering the impact of the various COVID-19 protocols.

How Can Conspicuous Omni-Signaling Fulfil Social Needs and Induce Re-Consumption?

This study investigated consumer behaviors in conspicuous omni-signaling—its internal motivations and its consequences on social needs fulfilment and re-consumption intention in the context of luxury fashion. A phenomenon of conspicuous consumption is identified with the consumption and display of conspicuous goods to signal status, wealth, and prestige. Digital development has made conspicuous signaling radically emerge in social media through the posting of photos, videos, or stories of luxury goods. This drives an emerging phenomenon of conspicuous omni-signaling, the use of both offline and online media to signal conspicuous consumption hybridlike. As a new phenomenon, little is known of consumer behaviors related to conspicuous omni-signaling. To facilitate the investigation, an online survey was conducted to collect data from 474 valid respondents across eight cities representing various conspicuous consumption characteristics of Indonesian consumers. Veblen's conspicuous consumption and Maslow's hierarchy of needs theories were employed as the main lens for analysis. PLS-SEM technique was employed as the research model uses mixed reflective and formative constructs. WarpPLS 7.0 was then used for data analysis. The results indicated that luxury values and fashion consciousness positively affect conspicuous omni-signaling. This study also found that conspicuous omni-signaling affects conspicuous re-consumption both directly and indirectly through social needs fulfilment. This study contributes to extend the concept of conspicuous offline consumption and conspicuous online consumption to conspicuous omni-signaling. This study also confirms conflicting results in the effect of conspicuous consumption on social needs fulfilment, and conflicting results in the effect of conspicuous consumption on conspicuous re-consumption.

Understanding the Contribution of the A4A Approach to Higher Education

This chapter aims to explore the actor-for-actor (A4A) logic supporting recent changes occurred within higher education institutions (HE), in light of the changes brought about by the recent digital revolution underway, partly accelerated by the recent Pandemic of COVID-19. The work starts from an analysis of recent advances in the literature on the theme of relationships between actors, and on a possible contribution coming from a systems perspective to identify what are the distinctive elements of a digital re-configuration of HE as inspired by A4A. The key elements of A4A are defined herein and applied to the new HE value proposal with evidence of aspects related to contents, conditions, opportunities, fulfilment, embeddedness, exchanges, self-feeding development. The HE Management can take advantage of the considerations set out here and also know how to look at mixed, perhaps modular, solutions that can respond to the changing needs of the varied users. © Springer Nature Switzerland AG 2022.

Multi-omics blood atlas reveals unique features of immune and platelet responses to SARS-CoV-2 Omicron breakthrough infection.

Although host responses to the ancestral SARS-CoV-2 strain are well described, those to the new Omicron variants are less resolved. We profiled the clinical phenomes, transcriptomes, proteomes, metabolomes, and immune repertoires of >1,000 blood cell or plasma specimens from SARS-CoV-2 Omicron patients. Using in-depth integrated multi-omics, we dissected the host response dynamics during multiple disease phases to reveal the molecular and cellular landscapes in the blood. Specifically, we detected enhanced interferon-mediated antiviral signatures of platelets in Omicron-infected patients, and platelets preferentially formed widespread aggregates with leukocytes to modulate immune cell functions. In addition, patients who were re-tested positive for viral RNA showed marked reductions in B cell receptor clones, antibody generation, and neutralizing capacity against Omicron. Finally, we developed a machine learning model that accurately predicted the probability of re-positivity in Omicron patients. Our study may inspire a paradigm shift in studying systemic diseases and emerging public health concerns.

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.

The Role of Greenery in Stress Reduction among City Residents during the COVID-19 Pandemic.

Cities, as places of social interactions and human relationships, face new challenges, problems, and threats, which are sources of stress for residents. An additional cause of stress in recent years has been the COVID-19 pandemic; it was urban dwellers who were most exposed to the virus and most affected by it. Chronic stress has led to the serious erosion of physical health and psychophysical well-being among urban dwellers, and so there is a need to seek new solutions in terms of building the resilience of cities and their residents to stress. This study aims to verify the hypothesis that greenery reduced the level of stress among urban dwellers during the pandemic. The verification of this hypothesis was achieved based on a literature analysis and the results of geo-questionnaire studies conducted involving 651 residents of Poznan-among the largest of Polish cities, where the share of green areas in the spatial structure is more than 30%. According to the analysis, the interviewees experienced above-average stress levels that went up during the pandemic, and the source was not so much the virus but the restrictions imposed. Green areas and outdoor activities helped in reducing this stress (being surrounded by and looking at greenery, garden work, or plant cultivation). Residents perceive a post-pandemic city as one that is more green, in which priority is given to unmanaged green areas. It has also been pointed out that a response to the reported need for urban re-construction towards stress resilience may be a biophilic city.

A COVID-19 Infection Model Considering the Factors of Environmental Vectors and Re-Positives and Its Application to Data Fitting in Japan and Italy.

COVID-19, which broke out globally in 2019, is an infectious disease caused by a novel strain of coronavirus, and its spread is highly contagious and concealed. Environmental vectors play an important role in viral infection and transmission, which brings new difficulties and challenges to disease prevention and control. In this paper, a type of differential equation model is constructed according to the spreading functions and characteristics of exposed individuals and environmental vectors during the virus infection process. In the proposed model, five compartments were considered, namely, susceptible individuals, exposed individuals, infected individuals, recovered individuals, and environmental vectors (contaminated with free virus particles). In particular, the re-positive factor was taken into account (i.e., recovered individuals who have lost sufficient immune protection may still return to the exposed class). With the basic reproduction number R0 of the model, the global stability of the disease-free equilibrium and uniform persistence of the model were completely analyzed. Furthermore, sufficient conditions for the global stability of the endemic equilibrium of the model were also given. Finally, the effective predictability of the model was tested by fitting COVID-19 data from Japan and Italy.

Poverty Reduction through Growth, Redistribution and Social Inclusion in Times of COVID-19: Kenyan Evidence on the Underlying Mechanisms

The paper looks at the nexus between growth, poverty, inequality and redistribution in Africa, using Kenya as a case study. The existing literature shows a strong causal link from growth to poverty reduction. This link is the basis for the pro-poor poverty reduction strategy. There is evidence from the AERC studies that, poverty reduction in a given period is associated with higher growth rates in successive periods that are inequality-reducing and conceptually long lasting. This virtuous spiral of poverty reduction, higher growth and less inequality over time, is the basis for the pro-growth poverty reduction strategy that has recently been emphasized in the literature (Thorbecke and Ouyang, 2022). The two poverty reduction strategies, a pro-poor strategy and a pro-growth poverty reduction one, complement each other, sustaining household escapes from poverty over time. The paper provides evidence from Kenya showing that human capital formation is the key mechanism underlying the virtuous spiral of lower poverty, higher growth and less inequality as the economy progresses through time. A perspective on robustness of the virtuous spiral in the context of COVID-19 and other pandemics is offered in the concluding section of the paper.

THE CONTAGION NUMBER: HOW FAST CAN A DISEASE SPREAD?

The overall purpose of this paper is to define a new metric on the spreadability of a disease. Herein, we define a variant of the well-known graph-theoretic burning number (BN) metric that we coin the contagion number (CN). We aver that the CN is a better metric to model disease spread than the BN as the CN concentrates on first time infections. This is important because the Centers for Disease Control and Prevention report that COVID-19 reinfections are rare. This paper delineates a novel methodology to solve for the CN of any tree, in polynomial time, which addresses how fast a disease could spread (i.e., a worst-cast analysis). We then employ Monte Carlo simulation to determine the average contagion number (ACN) (i.e., a most-likely analysis) of how fast a disease would spread. The latter is analyzed on scale-free graphs, which are specifically designed to model human social networks (sociograms). We test our method on some randomly generated scale-free graphs and our findings indicate the CN to be a robust, tractable (the BN is NP-hard even for a tree), and effective disease spread metric for decision makers. The contributions herein advance disease spread understanding and reveal the importance of the underlying network structure. Understanding disease spreadability informs public policy and the associated managerial allocation decisions. © 2023 by the authors.

Impact of COVID-19 on Nepal's Labour Migration

For many years, Nepal has relied on the import of labour by foreign countries to sustain its economy with income from remittances having approached 30% of the national gross domestic product for close to a decade. Besides being the most valuable source of hard currency, earnings by labour migrants have also contributed to reducing poverty levels drastically in recent years while also providing the impetus for rapid urbanization and rising consumerism. All of that has now been put in jeopardy as the result of the COVID-19 pandemic that has led to tens of thousands of Nepali workers being laid off in the Gulf Cooperation Council countries, the major destination for Nepalis in foreign employment. This chapter explores how the pandemic has affected the foreign employment sector with a particular focus on the number of Nepalis returning home, how the government plans to deal with a large number of unemployed young men and women, the expected reduction in remittances, and the possible social dislocations as a result of sudden loss of inflow of cash in the rural hinterlands of the economy. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Predictive Accuracy of the Breathing Frequency-Ratio of Oxygen Saturation Index for Re-Intubation in Mechanically Ventilated Subjects With COVID-19.

BACKGROUND: Several studies have suggested that high-flow nasal cannula (HFNC) is useful for respiratory support after extubation in subjects with COVID-19 pneumonia, whereas 18.2% subsequently needed to undergo re-intubation. This study aimed to evaluate whether the breathing frequency (f)-ratio of oxygen saturation (ROX) index, which has been shown to be useful for predicting future intubation, is also useful for re-intubation in subjects with COVID-19. METHODS: We retrospectively analyzed mechanically ventilated subjects with COVID-19 who underwent HFNC therapy after extubation at 4 participating hospitals between January 2020-May 2022. We evaluated the predictive accuracy of ROX at 0, 1, and 2 h for re-intubation until ICU discharge and compared the area under the receiver operating characteristic (ROC) curve of the ROX index with those of f and SpO2 /FIO2 . RESULTS: Among the 248 subjects with COVID-19 pneumonia, 44 who underwent HFNC therapy after extubation were included. A total of 32 subjects without re-intubation were classified into the HFNC success group, and 12 with re-intubation were classified into the failure group. The overall trend that the area under the ROC curve of the ROX index was greater than that of the f and SaO2 /FIO2 was observed, although there was no statistical significance at any time point. The ROX index at 0 h, at the cutoff point of < 7.44, showed a sensitivity and specificity of 0.42 and 0.97, respectively. A trend of positive correlation between the time until re-intubation and ROX index at each time point was observed. CONCLUSIONS: The ROX index in the early phase of HFNC therapy after extubation was useful for predicting re-intubation with high accuracy in mechanically ventilated subjects with COVID-19. We may need close observation for subjects with < 7.44 ROX index just after extubation because of their high risk for re-intubation.

Analyzing factors affecting charter flight service demand: A case of Taiwan

Global charter flight demand remined relatively stable over the last decades, and international charter flight is an integrated product of the aviation and tourism industries. To better understand charter flight tourism in Asia, this study analyses key reasons affected Taiwan's charter flight demand from Japan, South Korea, Malaysia, and Singapore during the period 2009‒2018, with a consideration of aviation- and tourism-related variables. Empirical results show that the reduction in scheduled flight aircraft size stimulated new charter flight demand to Taiwan, offsetting the negative effects caused by scheduled seat increment to a certain degree. This study contributes to literature by exploring the impact of scheduled flight service availability on charter flight demand, and further enriches our understanding of the impact of scheduled flight services on international tourist arrivals in terms of aircraft size. Importantly, it has implications for policymakers and stakeholders involved in charter business, assisting them in facilitating aviation and tourism recovery during the post-COVID-19 era.

Seizing the COVID-19 Conjuncture: Re-positioning Higher Education Beyond the Pandemic

This chapter argues that, whilst the exact parameters of COVID-19-inspired futures remain unknown, the pandemic has accelerated various incipient trends and has heightened disruption and complexity, and many aspects of the status quo ante will change. The chapter contends that, for universities, the ultimate priority is not to cope with the short-term effects of the pandemic, but to think carefully of how to re-position for long-term resilience and to ensure readiness to meet the challenges of the twenty-first century. Accordingly, surviving and thriving in the post-pandemic environment calls for re-assessment, re-thinking and adapting strategy by universities. To this end, the chapter maps possible key pathways for re-thinking or adapting higher education strategy for a post-COVID-19 world, and identifies innovative response possibilities with regard to teaching and learning, research, sustainability, and societal impact. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Adenovirus vector vaccines

Recently, importance of vaccines for treatment and prevention of emerging and re-emerging infectious diseases has been re-recognized. A replication-incompetent adenovirus（Ad） vector vaccine expressing virus antigen proteins is one of the most advanced platforms as a novel vaccine because an Ad vector vaccine can be rapidly applicable to pandemic. In this review, we describe the basic properties of an Ad vector for vaccine, in addition to the summary of the development of an Ad vector vaccine for emerging and re-emerging infectious diseases, including Coronavirus disease 2019（COVID-19）, worldwide.Alternate :抄録非増殖型アデノウイルスベクターは、in vivoへの直接投与において優れた遺伝子導入活性を示すことから、病原体由来の抗原タンパク質を発現させることにより、新興・再興感染症に対するワクチンベクターとして積極的な開発が進められてきた。最近では、新型コロナウイルス感染症（COVID-19）に対するワクチンとして、欧米中露において迅速な実用化がなされた。本稿では、アデノウイルスベクターの特性、COVID-19に対するアデノウイルスベクターワクチンの特徴、およびアデノウイルスベクターワクチンの可能性について解説する。

Disassembly, Re-Engineering, Mobilization and Re-Assembly Journey of the First Lift Boat from Gulf of Mexico to the Caspian Sea

The Cheleken field offshore Turkmenistan is going through brown field development and challenges with retaining and enhancing production increase every day. Well Interventions are deemed to be a daily necessity to maintain production. Coiled Tubing, Wireline and other rigless interventions have been used directly on platforms resulting in occupying critical spaces, logistic and marine congestion (one Coiled Tubing Move comprises of over twenty lifts), structure integrity limitations, crane and lifting limitation, and a lot more. The need for a self-elevating platform arose and operator search for a proper one within the Caspian Sea ended with disappointments. This paper details the innovative and out of the box solution that was put in place to mobilize the first Lift Boat to the Caspian Sea. A lift boat was identified in the USA in the Gulf of Mexico which was underutilized after the pandemic and oil recession. The Class 230 specifications met the end user's requirements but the challenge was how to mobilize it to the Caspian. In addition, there were a handful of modifications that were requested for the Caspian operation that were not necessarily required in the Gulf. Mobilization of the lift boat must be carried out through the Volga-Don canal locking system which has a width of 57 feet 9 inch (maximum allowable beam for vessels is 56 feet 5 inches). The beam of the lift boat was 78 feet which is too wide to fit through the Volga-Don shipping canal. Hence, it was necessary to disassemble and transport the lift boat in sections. This paper describes the following: • Disassembly requirements necessary to prepare the lift boat for mobilization • The mobilization of the lift boat • • Installation of well service and intervention equipment • Technology and methodology adopted The reassembly requirements once the lift boat reached the shipyard at Caspian Sea The Lift boat was disassembled into three major sections for transportation: a) the center hull module b) the port wing module, and c) the starboard wing module. The wing modules, miscellaneous equipment and containers were loaded onto a barge and sea-fastened for transportation. The center hull module was wet towed to the shipyard located in the Caspian where the lift boat was reassembled, and the well service equipment was installed. The mobilization and assembly happened during the Covid-19 era, and the vessel was hit by Hurricane Ida which impacted the disassembly schedule. Challenges on mobilizing the personnel, equipment, machinery, port clearance, etc. were all extremely tough due to Covid-19. The paper will also cover technical implications on conducting this task by complying with the classification and flag state requirements as per Turkmenistan authority. The main lesson of the paper is the identification of gaps on mobilization and how the improved techniques can be utilized for executing the task on a fast-track manner. © 2023, Offshore Technology Conference.

A totally implantable venous access device (TIVAD) abandoned for 5 years is re-accessed normally: A case report and literature review.

Regular flushing and locking of totally implantable venous access devices (TIVADs) is recommended to maintain their patency when not in use. In this case report, a 73-year-old male patient received radical resection for rectal carcinoma in January 2010. A TIVAD was implanted in 2014 and a total of 12 rounds of chemotherapy of FOLFIRI was completed in 2015. During the period from 2015 to 2020, the patient never used or conducted the monthly infusion port flushing because of the inconvenience, the COVID-19 pandemic, and so on. On 18th April 2020, the patient was admitted to the radiotherapy department of Yiwu Central Hospital. The nurse evaluated the TIVAD upon admission, finding that the skin around the reservoir was normal without any sign of infection as erythema or induration of the skin overlying the implantable port but there was intraluminal occlusion of the devices. In order to re-access the catheter, discussion of a MDT was performed and several days of unremitting efforts were tried. Gratifyingly, the patient's port was re-accessed successfully without any adverse reactions. This is a rare infusion port that has not been used and maintained for 5 years. For the port that has not been used and maintained for a long time up to 5 years, the medical staff should not give up easily. During the COVID-19 pandemic, prolonging the flushing interval of TIVADs can be an optimal clinical strategy without negative outcomes.

Needs Assessment and Best Practices for Digital Trainings for Health Professionals in Ethiopia Using the RE-AIM Framework: COVID-19, Case Study.

OBJECTIVES: To assess the implementation science outcomes of a COVID-19 e-health educational intervention in Ethiopia targeting healthcare workers via the RE-AIM (Reach, Effectiveness, Adaption, Implementation, Maintenance) framework. METHODS: A series of three one-hour medical seminars focused on COVID-19 prevention and treatment education were conducted between May-August 2020. Educational content was built from medical sites previously impacted by COVID-19. Post-seminar evaluation information was collected from physician and other participants by a survey instrument. Cross-sectional evaluation results are reported here by RE-AIM constructs. RESULTS: The medical seminars reached 324 participants. Key success metrics include that 90% reporting the information delivered in a culturally sensitive/tailored manner (effectiveness), 80% reporting that they planned to share the information presented with someone else (adoption and implementation), and 64% reporting using information presented in their daily clinical responsibilities 6 months after the first medical seminars (maintenance). CONCLUSION: Grounded in a theoretical framework and following evidenced-based best practices, this intervention advances the field of dissemination and implementation science by demonstrating how to transition healthcare training and delivery from an in-person to digital medium in low-resource settings like Ethiopia.