The Effect of Fangcang Shelter Hospitals under Resource Constraints on the Spread of Epidemics.

Since the outbreak of the COVID-19 pandemic, Fangcang shelter hospitals have been built and operated in several cities, and have played a huge role in epidemic prevention and control. How to use medical resources effectively in order to maximize epidemic prevention and control is a big challenge that the government should address. In this paper, a two-stage infectious disease model was developed to analyze the role of Fangcang shelter hospitals in epidemic prevention and control, and examine the impact of medical resources allocation on epidemic prevention and control. Our model suggested that the Fangcang shelter hospital could effectively control the rapid spread of the epidemic, and for a very large city with a population of about 10 million and a relative shortage of medical resources, the model predicted that the final number of confirmed cases could be only 3.4% of the total population in the best case scenario. The paper further discusses the optimal solutions regarding medical resource allocation when medical resources are either limited or abundant. The results show that the optimal allocation ratio of resources between designated hospitals and Fangcang shelter hospitals varies with the amount of additional resources. When resources are relatively sufficient, the upper limit of the proportion of makeshift hospitals is about 91%, while the lower limit decreases with the increase in resources. Meanwhile, there is a negative correlation between the intensity of medical work and the proportion of distribution. Our work deepens our understanding of the role of Fangcang shelter hospitals in the pandemic and provides a reference for feasible strategies by which to contain the pandemic.

Methodology to Support the Triage of Suspected COVID-19 Patients in Resource-Limited Circumstances

COVID-19 pandemic has put health systems worldwide under pressure. Thus, establish a triage protocol to support the allocation of resources is important to deal with this public health crisis. In this paper, a structured methodology to support the triage of suspected or confirmed COVID-19 patients has been proposed, based on the utilitarian principle. A decision model has been proposed for evaluating three treatment alternatives: intensive care, hospital stay and home isolation. The model is developed according to multi-attribute utility theory and considers two criteria: the life of the patient and the overall cost to the health system. A screening protocol is proposed to support the use of the decision model, and a method is presented for calculating the probability of which of three treatment is the best one. The proposed methodology was implemented in an information and decision system. The originality of this study is using of the multi-attribute utility theory to support the triage of suspected COVID-19 and implement the decision model in an information and decision system.

Economic policy uncertainty and corporate donation: evidence from private firms in Korea

This study examines the association between economic policy uncertainty (EPU) and private firms' corporate donations. Based on resource constraints and the conservation of resources (COR) theory, we argue that private firms are constantly facing resource constraints and their resource conservation motive becomes apparent when EPU is heightened. Therefore, we expect that corporate donations are negatively related to EPU. Using audited corporate donations from 48,903 private firms in Korea during 2002–2019, we find that private firms' donations are negatively related to EPU. We find that private firms operating in more competitive conditions increase their donations, but this positive association between market competition and donations is moderated by EPU. We find that private firms' donations increased when the progressive party is in power, but this positive relationship is also moderated by EPU. Our results suggest that firms reduce their level of corporate giving to conserve resources as a precautionary saving motive when they face higher EPU. Our paper contributes to the strand of literature on corporate donations and EPU by providing evidence that EPU significantly affects private firms' donations. We also find that firms' strategic motives and political pressure to engage in corporate donations are moderated by EPU.

Risks and opportunities for children's well-being in resource-constrained multigenerational households during COVID-19: Implications for school psychology interventions

The coronavirus disease (COVID-19) pandemic had a global impact on family social and economic well-being. Individuals and families sought alternative living arrangements as a result of the financial crisis, health implications, and housing insecurity, with many joining multigenerational households. However, it is unknown how multigenerational family life affects children's well-being. Therefore, this qualitative study explored risks and resilience-building opportunities for children's psychological and social well-being in resource-constrained multigenerational households during the COVID-19 pandemic in South Africa. Five multigenerational families were selected through snowball sampling and case design. The three generations of participants were grandparents (n = 5), parents (n = 7), and children (n = 4). Data were gathered through a questionnaire and interviews. The study received institutional ethics approval. After thematic analysis, two themes and six sub-themes were identified. Risks were related to interpersonal conflict, family collective fear of COVID-19, and children's multiple other fears. Opportunities were identified as academic support, shared responsibilities, life skills and values acquisition, and family cohesion. Results demonstrated the potential risks and resilience-building opportunities multigenerational households present for children's psychosocial well-being. Multisystemic influences in a multigenerational household contribute to children's adjustment. These outcomes necessitate systemic school psychology interventions. Longitudinal studies are recommended to explore child well-being trends in multigenerational households in varying socioeconomic contexts.

A proposal for selective resuscitation of adult cardiac arrest patients in a pandemic.

Allocation of limited resources in pandemics begs for ethical guidance. The issue of ventilator allocation in pandemics has been reviewed by many medical ethicists, but as localities activate crisis standards of care, and health care workers are infected from patient exposure, the decision to pursue cardiopulmonary resuscitation (CPR) must also be examined to better balance the increased risks to healthcare personnel with the very low resuscitation rates of patients infected with coronavirus disease 2019 (COVID-19). A crisis standard of care that is equitable, transparent, and mindful of both human and physical resources will lessen the impact on society in this era of COVID-19. This paper builds on previous work of ventilator allocation in pandemic crises to propose a literature-based, justice-informed ethical framework for selecting treatment options for CPR. The pandemic affects regions differently over time, so these suggested guidelines may require adaptation to local practice variations.

Doing more with less - How frugal innovations can contribute to improving healthcare systems.

The dominance of an innovation discourse laden with cutting edge and expensive technologies, may be preventing us from recognizing alternative and complementary perspectives, which could help cut healthcare costs while improving worldwide access to health services. One such complementary approach is that of frugal innovation. Frugal innovation, as a way to produce efficacious and affordable products using fewer resources to reach the underserved customers, has received increasing attention in the social sciences literature. Although frugal innovation is commonly associated with emerging economies, there is now a rising interest from healthcare providers in developed countries, to find and apply effective, and lower-cost solutions. Nonetheless, knowledge on frugal innovation and its role in healthcare is dispersed across different literatures which hampers researchers and practitioners to access a fuller, and integrated picture of the phenomenon. In this study, by synthesizing extant knowledge, we tackle the fragmentation of the phenomenon. We elucidate on who the actors are, what is being done, how are such innovations being developed, and what the outcomes are, providing a framework that lays out the underlying mechanisms of frugal innovation in healthcare (FIH). The midrange theory that we develop, provides a conceptual framework for researchers to undertake empirical observation and models to guide managerial practices. Furthermore, by providing a more unified perspective of frugal innovation in healthcare, we hope to initiate conversations on the development, adequacy and adoption of these innovations in healthcare services, which could increase affordability and access for the population while maintaining quality.

A renewal equation model to assess roles and limitations of contact tracing for disease outbreak control.

We propose a deterministic model capturing essential features of contact tracing as part of public health non-pharmaceutical interventions to mitigate an outbreak of an infectious disease. By incorporating a mechanistic formulation of the processes at the individual level, we obtain an integral equation (delayed in calendar time and advanced in time since infection) for the probability that an infected individual is detected and isolated at any point in time. This is then coupled with a renewal equation for the total incidence to form a closed system describing the transmission dynamics involving contact tracing. We define and calculate basic and effective reproduction numbers in terms of pathogen characteristics and contact tracing implementation constraints. When applied to the case of SARS-CoV-2, our results show that only combinations of diagnosis of symptomatic infections and contact tracing that are almost perfect in terms of speed and coverage can attain control, unless additional measures to reduce overall community transmission are in place. Under constraints on the testing or tracing capacity, a temporary interruption of contact tracing may, depending on the overall growth rate and prevalence of the infection, lead to an irreversible loss of control even when the epidemic was previously contained.

COVID-19: Adaptation of a model to predicting healthcare resources needs in Valle del Cauca, Colombia.

BACKGROUND: Valle del Cauca is the region with the fourth-highest number of COVID-19 cases in Colombia (>50,000 on September 7, 2020). Due to the lack of anti-COVID-19 therapies, decision-makers require timely and accurate data to estimate the incidence of disease and the availability of hospital resources to contain the pandemic. METHODS: We adapted an existing model to the local context to forecast COVID-19 incidence and hospital resource use assuming different scenarios: (1) the implementation of quarantine from September 1st to October 15th (average daily growth rate of 2%); (2-3) partial restrictions (at 4% and 8% growth rates); and (4) no restrictions, assuming a 10% growth rate. Previous scenarios with predictions from June to August were also presented. We estimated the number of new cases, diagnostic tests required, and the number of available hospital and intensive care unit (ICU) beds (with and without ventilators) for each scenario. RESULTS: We estimated 67,700 cases by October 15th when assuming the implementation of a quarantine, 80,400 and 101,500 cases when assuming partial restrictions at 4% and 8% infection rates, respectively, and 208,500 with no restrictions. According to different scenarios, the estimated demand for reverse transcription-polymerase chain reaction tests ranged from 202,000 to 1,610,600 between September 1st and October 15th. The model predicted depletion of hospital and ICU beds by September 20th if all restrictions were to be lifted and the infection growth rate increased to 10%. CONCLUSION: Slowly lifting social distancing restrictions and reopening the economy is not expected to result in full resource depletion by October if the daily growth rate is maintained below 8%. Increasing the number of available beds provides a safeguard against slightly higher infection rates. Predictive models can be iteratively used to obtain nuanced predictions to aid decision-making.

INTRODUCCIÓN: Valle del Cauca es el departamento con el cuarto mayor número de casos de COVID-19 en Colombia (>50,000 en septiembre 7, 2020). Debido a la ausencia de tratamientos efectivos para COVID-19, los tomadores de decisiones requieren de acceso a información actualizada para estimar la incidencia de la enfermedad, y la disponibilidad de recursos hospitalarios para contener la pandemia. MÉTODOS: Adaptamos un modelo existente al contexto local para estimar la incidencia de COVID-19, y la demanda de recursos hospitalarios en los próximos meses. Para ello, modelamos cuatro escenarios hipotéticos: (1) el gobierno local implementa una cuarentena desde el primero de septiembre hasta el 15 de octubre (asumiendo una tasa promedio de infecciones diarias del 2%); (2-3) se implementan restricciones parciales (tasas de infección del 4% y 8%); (4) se levantan todas las restricciones (tasa del 10%). Los mismos escenarios fueron previamente evaluados entre julio y agosto, y los resultados fueron resumidos. Estimamos el número de casos nuevos, el número de pruebas diagnósticas requeridas, y el numero de camas de hospital y de unidad de cuidados intensivos (con y sin ventilación) disponibles, para cada escenario. RESULTADOS: El modelo estimó 67,700 casos a octubre 15 al asumir la implementación de una nueva cuarentena, 80,400 y 101,500 al asumir restricciones parciales al 4 y 8% de infecciones diarias, respectivamente, y 208,500 al asumir ninguna restricción. La demanda por pruebas diagnósticas (de reacción en cadena de la polimerasa) fue estimada entre 202,000 y 1,610,600 entre septiembre 1 y octubre 15, a través de los diferentes escenarios evaluados. El modelo estimó un agotamiento de camas de cuidados intensivos para septiembre 20 al asumir una tasa de infecciones del 10%. Conclusión: Se estima que el levantamiento paulatino de las restricciones de distanciamiento social y la reapertura de la economía no debería causar el agotamiento de recursos hospitalarios si la tasa de infección diaria se mantiene por debajo del 8%. Sin embargo, incrementar la disponibilidad de camas permitiría al sistema de salud ajustarse rápidamente a potenciales picos inesperados de infecciones nuevas. Los modelos de predicción deben ser utilizados de manera iterativa para depurar las predicciones epidemiológicas y para proveer a los tomadores de decisiones con información actualizada.

Jugaad Trocar for a 5-mm Laparoscopic Cannula.

When we are practicing, especially in rural India, we often face problems of instrument failure or lost instrument, etc... which may sometimes necessitate abandoning the procedure just because of the lack of a single instrument. We do mobile laparoscopic surgery, carrying all the laparoscopic instruments to far-off places, as far as 60-80 km. On one such occasion, my staff had lost a 5-mm trocar, which had gone unnoticed until I posted a case for laparoscopic cholecystectomy. There was not much time to buy a new one and also it was difficult to procure from the dealer because of the COVID-19 situation. Just because of the lack of one instrument we were facing a situation of postponing laparoscopy!