Demonstration of Remote Control of Critical Care Ventilators and the Integrated Clinical Environment

Introduction: The COVID-19 pandemic posed numerous challenges to patient care, including extensive PPE use, patient care in isolation rooms, inadequate numbers of intensivists particularly in rural communities, use of unfamiliar ventilators that would be partially remedied by the ability to remotely control lung ventilation. The goals of the project were to study the intended use, risk management, usability, cybersecurity for remote control of ventilators and demonstrate the use of a single interface for several different ventilators. Method(s): Clinical scenarios were developed including remote control of the ventilator from an antechamber of an isolation room, nursing station within the same ICU, and remote control from across the country. A risk analysis and was performed and a risk management plan established using the AAMI Consensus Report--Emergency Use Guidance for Remote Control of Medical Devices. A cybersecurity plan is in progress. Testing was done at the MDPNP laboratory. We worked with Nihon Kohden OrangeMed NKV-550, Santa Ana, CA, and Thornhill Medical MOVES SLC, Toronto, Canada. Both companies modified their devices to allow remote control by and application operating on DocBox's Apiary platform. Apiary is a commercially available ICE solution, DocBox Inc, Waltham, MA. An expert panel was created to provide guidance on the design of a single common, simple to use graphical user interface (GUI) for both ventilators. Manufacturers' ventilation modes were mapped to ISO 19223 vocabulary, data was logged using ISO/IEEE 11073-10101 terminology using AAMI 2700-2-1, Medical Devices and Medical Systems - Essential safety and performance requirements for equipment comprising the patient-centric integrated clinical environment (ICE): Part 2-1: Requirements for forensic data logging. Result(s): We demonstrated that both ventilators can be controlled and monitored using common user interface within an institution and across the country. Pressure and flow waveforms were available for the NKV-550 ventilator, and usual ventilator measurements were displayed in near-real time. The interface allowed changing FiO2, ventilation mode, respiratory rate, tidal volume, inspiratory pressure, and alarm settings. At times, increased network latency negatively affected the transmission of waveforms. Conclusion(s): We were able to demonstrate remote control of 2 ventilators with a common user interface. Further work needs to be done on cybersecurity, effects of network perturbations, safety of ventilator remote control, usability implications of having a common UI for different devices needs to be investigated.

Work-from-home and the risk of securities misconduct

In the wake of the global pandemic, a challenge for CEOs and boards is to set a stakeholder-acceptable organizational balance between remote and traditional office working. However, the risks of work-from-home are not yet fully understood. We describe competing theories that predict the effect on misconduct of a corporate shift to work-from-home. Using internal bank data on securities traders we exploit lockdown variation induced by emergency regulation of the Covid-19 pandemic. Our difference-in-differences analysis reveals that working from home lowers the likelihood of securities misconduct;ultimately those working from home exhibit fewer misconduct alerts. The economic significance of these changes is large. Our study makes an important step toward understanding the link between the balance of work locations and the risk that comes with this tradeoff. © 2023 The Authors. European Financial Management published by John Wiley & Sons Ltd.

Global Pandemic and Human Security: Using Health-EDRM Risk Assessment Framework to Enhance Technology Support for DRR

‘Biological hazard' is regarded as a major human security threat to people's well-being and development. In the era of globalisation and rapid technological development, COVID-19 pandemic once again revealed how an emerging communicable disease might impact not only health but also the socioeconomic ecology of people globally, while the related health risk can be mitigated by the employment of appropriate technology. The chapter examines how the latest World Health Organization Health-EDRM framework (2019) may inform the conceptualisation and assessment of health risks and proposes a Health-EDRM assessments framework for biological hazard. A case study of how health risks and vulnerability associated with home care may be reduced by employing technology in non-standard living context during pandemic and a case study of community resilience and community engagement are also included. The discussion also puts Health-EDRM framework into a human security perspective. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer 2022.

Analysis Of the Effectiveness of Risk- Based Internal Audit Implementation: A Case Study: Acces la Success

Background: Risk Based internal audit is a control and supervision activity carried out by internal auditors using the output of risk management. Purpose: The purpose of this study was to obtain a comprehensive understanding of the implementation of risk based internal audit at BPJS Ketenagakerjaan. Internal auditors need to know about risk management and risk maturity to identify key areas that require immediate supervision and follow-up. Method: This research is a case study qualitative research with a descriptive approach. Data was collected by means of interviews, observation and documentation. The analysis technique using triangulation is to collect data, reduce and draw conclusions. Results and findings: Researchers found that Social Security Agency while in Indonesian term is Badan Penyelenggara Jaminan Sosial (BPJS) Ketenagakerjaan as an institution that is mandated to manage labor social security membership fees and implement good governance and manage business risks. The risk management output is then used as the basis for conducting an internal audit. Discussion: BPJS Ketenagakerjaan carries out risk management to identify risks, identify areas that have potential risks and carry out risk profiling. This makes it easier for internal auditors to carry out the internal audit process. Impact: The results of risk management make it easier for auditors to identify risks and identify specific areas so that internal audits can run effectively and efficiently.

Reevaluating the risk minimization utility of Islamic stocks and bonds (Sukuk) in international financial markets

We examine the risk minimization utility of Islamic stock and Sukuk (bond) indices by studying their linkages against traditional global counterparts. We first employ an asymmetric power ARCH-based ADCC model on an extended dataset employed by Kenourgios et al. (2016). Our sample ranges from July 2007 to June 2021 covering the Global Financial Crisis (GFC), the European Sovereign Debt Crisis (ESDC), and the COVID-19 pandemic. Econometric tests suggest strong evidence of coupling in the bulk of Islamic equity indices. A handful of emerging market indices constitute exceptions. Qualitatively similar results emerge from time–frequency analysis via wavelet tools, revealing pervasive coupling in both returns and volatility series. The linkages are scale-dependent in only a few pairs. In contrast, Sukuk indices are uncoupled from their global fixed income counterparts and relevant risky debt portfolios. In sum, the risk-return characteristics of Islamic equities (especially in developed economies) remain coupled to major global benchmarks and therefore are unlikely to appeal as safe haven candidates. The converse applies to Sukuk, which promises potential portfolio diversification benefits and safe haven status in ‘normal' and crisis periods.

Global Pandemic and Human Security: Technology and Development Perspective

This book highlights how the human security aspect has been affected by the global pandemic, based on the specific case study, field data, and evidence. COVID-19 has exemplified that the pandemic is global, but its responses are local. The responses depend on national governance and policy framework, use of technology and innovation, and people's perceptions and behavior, among many others. There are many differences in how the pandemic has affected the rich and the poor, urban and rural sectors, development and fiscal sectors, and developed and developing nations and communities. Echoing human security principles, the 2030 Agenda emphasized a "world free of poverty, hunger, disease and want… free of fear and violence… with equitable and universal access to quality education, health care, and social protection….to safe drinking water and sanitation… where food is sufficient, safe, affordable and nutritious… where habitats are safe, resilient and sustainable…and where there is universal access to affordable, reliable and sustainable energy.” These basic human security [PA1] principles and development agenda are highly affected by the global pandemic worldwide, irrespective of its development and economic status. Thus, the book highlights the nexus between human security and development issues. It has two major pillars, one is the development and the other is technology issues. These two inter-dependent topics are discussed in the perspective of the global pandemic, making this the most important feature of this book. While the world is still in the middle of a pandemic, and possibly other natural and biological hazards may affect peoples' lives and livelihoods in the future, this book provides some key learning, which can be used to cope with future uncertainties, including climate risks. Thus, the book is timely and relevant to wider readers. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer 2022.

Coupling Tracer Derived ACH with Risk Calculators to Calculate Risk of COVID-19 Infection

Risk calculators have been utilised to predict the risk of infection from SARS-CoV-2. Inputs include the dimensions of the indoor space, number of infected persons and activity, and inhalation rate of susceptible persons. The compartment model requires an estimate of the Air Changes per Hour (ACH) in the space, as the concentration is changing as a result of the dynamic balance between the generation and removal of exhaled quanta. ACH can be estimated using CO2, engineering drawings, or airflow measurements, but these estimates are often incorrect due to mechanical anomalies and mixing inefficiencies, or in the case of CO2, an absence of continuous occupancy for a sufficient amount of time. SF6 as a tracer gas to establish ACH has been used extensively for many decades to measure air exchange. This approach was utilised to assist a school in managing risk of infection in their facility during an exam period. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.

China: The Bankable State

The volume on China: The Bankable State rejects neoliberal consensus and focuses on crucial contributions of the Chinese state in shaping Chinese economy. This book makes crucial theoretical contributions to the study of local political economy of China. This book engages with Chinese state responses to challenges China faces in the processes of reform, transition and development of both commercial and non-commercial banks. This book explores Chinese economic growth and development policy processes and its uniqueness in the wider world economy. The book examines Chinese financial policy praxis and offers an insightful account of its successes for the wider resurgence of alternative political economy of local development. Additionally, this book also showcases state led entrepreneurship in China. The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021.

Privacy Preserving based Personal Health Records Sharing Using Rail Fence Data Encryption (RFDE) for Secure Cloud Environment

The prevalence cloud security has privacy preserving problems that major challenges due to humanity's need protect the sensitive and non-sensitive data to decision-making and resolve data leakage problems. One of the most difficult aspects is the reuse and sharing of accurate and detailed clinical data about PHR collected via Personal Health Records (PHRs) cloud transition is difficult. PHRs are often privacy preserving patient-centric models for exchanging medical information outsourced to third parties, such as Cloud Service Providers (CSP). A unique PHR patient information to ensure security with encryption before storage in the cloud. But still, issues such as security issues, flexible access and a valid user privacy risk management, efficiency and remain an important challenge to achieve better data access sensitive and non-sensitive imposition of control in cloud storage. To achieve high efficiency of PHR and modular data access control, Rail Fence Data Encryption (RFDE) algorithm provided to encrypt the PHR file to make high privacy standards. RFDE is also a form of transposition cipher called zigzag encryption, and the unauthorized user can't access the information. The proposed algorithm encrypts the PHR information it generates the secret key. The receiver decrypts the PHR information using the private key. The proposed algorithm provide efficient performance compared with previous algorithm. © 2023 IEEE.

Energy Resilience and Climate Protection: Energy systems, critical infrastructures, and sustainability goals

The increasingly interconnected, fast-moving, unmanageable and unpredictable world brings with it an unprecedented variety of known and as yet unknown challenges and risks. Some of the global risks have a direct impact on critical infrastructures as well as those of energy supply in particular. A high level of functionality of critical infrastructures (CRITIS), which include the sectors of energy, information technology and telecommunications, transportation and traffic, health, water, food, finance and insurance, government and administration, as well as media and culture, is indispensable for a modern industrial society. In the context of the Corona crisis of 2020/2021, the worldwide inadequate preparation for pandemics became obvious, although the probability of epidemic outbreaks and their global spread has increased significantly in recent decades and was thus predictable to a certain extent. Moreover, it has been shown that in a globally interconnected world, complex crisis phenomena can mutually amplify and thus escalate within a short period of time. In particular, the deficits in preparedness for major risks that became apparent in the course of the Corona pandemic cannot be managed by nation states alone, especially since the probability of such events has risen continuously in recent decades and will continue to increase with growing globalization and urbanization and, in particular, as a result of climate change and its consequences. This publication addresses the challenges of energy resilience and climate protection, which will require immense attention in the future. © Springer Fachmedien Wiesbaden GmbH, part of Springer Nature 2022. All rights reserved.

SAFETY INCIDENTS CLASSIFIED AS CLINICAL PROCESS/ PROCEDURE IN HOSPITALIZED PATIENTS DURING THE COVID-19 PANDEMIC

Objective: Compare reported patient safety incidents related to a clinical process/ procedure among patients with laboratory-confirmed COVID-19 diagnosis and with Severe Acute Respiratory Syndrome (SARS) caused by another infectious or undetermined agent and the other patients. Results and discussion: retrospective, documentary study approved by the ethics committee in a public teaching hospital in southern Brazil. In the study, 2,191 notifications and records of COVID-19 between March and September 2020 were used. The data were submitted to descriptive analysis with frequencies of the variables in the data set, Fisher's test to determine the associations between outcomes (classification/process/ problem) and calculation of relative risk to measure its strength. The incidence of pressure ulcers was almost 3.7 times higher in patients with SARS. In the others, various tube-related incidents and events associated to the surgical process predominated. Conclusion: Intensive nursing care for patients with SARS, risk management and strengthening of good practices for the safety of all patients were relevant. © 2023, Universidade Federal do Parana. All rights reserved.

External validation of triage tools for adults with suspected COVID-19 in a middle-income setting: an observational cohort study.

BACKGROUND: Tools proposed to triage ED acuity in suspected COVID-19 were derived and validated in higher income settings during early waves of the pandemic. We estimated the accuracy of seven risk-stratification tools recommended to predict severe illness in the Western Cape, South Africa. METHODS: An observational cohort study using routinely collected data from EDs across the Western Cape, from 27 August 2020 to 11 March 2022, was conducted to assess the performance of the PRIEST (Pandemic Respiratory Infection Emergency System Triage) tool, NEWS2 (National Early Warning Score, version 2), TEWS (Triage Early Warning Score), the WHO algorithm, CRB-65, Quick COVID-19 Severity Index and PMEWS (Pandemic Medical Early Warning Score) in suspected COVID-19. The primary outcome was intubation or non-invasive ventilation, death or intensive care unit admission at 30 days. RESULTS: Of the 446 084 patients, 15 397 (3.45%, 95% CI 34% to 35.1%) experienced the primary outcome. Clinical decision-making for inpatient admission achieved a sensitivity of 0.77 (95% CI 0.76 to 0.78), specificity of 0.88 (95% CI 0.87 to 0.88) and the negative predictive value (NPV) of 0.99 (95% CI 0.99 to 0.99). NEWS2, PMEWS and PRIEST scores achieved good estimated discrimination (C-statistic 0.79 to 0.82) and identified patients at risk of adverse outcomes at recommended cut-offs with moderate sensitivity (>0.8) and specificity ranging from 0.41 to 0.64. Use of the tools at recommended thresholds would have more than doubled admissions, with only a 0.01% reduction in false negative triage. CONCLUSION: No risk score outperformed existing clinical decision-making in determining the need for inpatient admission based on prediction of the primary outcome in this setting. Use of the PRIEST score at a threshold of one point higher than the previously recommended best approximated existing clinical accuracy.

What is needed to effectively communicate risk during a health crisis? A qualitative study with international experts based on the COVID-19 pandemic.

OBJECTIVE: To identify a framework for risk communication during health crises by using the current pandemic as a case study. DESIGN: A qualitative study based on individual interviews. SETTING: Different countries with diverse levels of perceived success on risk communication during the COVID-19 health crisis. PARTICIPANTS: International experts with experience in health crisis management or risk communication. ANALYSIS: A thematic analysis was performed supported by Atlas.ti. RESULTS: Four men and six women took part in the study (three from Europe, two from Latin America, two from North America, one from Asia and two from Oceania). Three major themes emerged from the data: (1) institutionalising the communication strategy; (2) defining the problem that needs to be faced; (3) developing an effective communication strategy. CONCLUSION: Risk communication during a health crisis requires preparation of governments and of health teams in order to produce and deliver effective messages as well as to help communities to make informed and healthy decisions. This is particularly relevant for slow disasters, such as COVID-19, as the strategy must innovate to avoid information fatigue of the audience. The findings of this article could inform guidelines to best equip countries for a clear communication strategy for future crises. PROSPERO REGISTRATION NUMBER: CRD42021234443.

Factors associated with recognition at work among nurses and the impact of recognition at work on health-related quality of life, job satisfaction and psychological health: a single-centre, cross-sectional study in Morocco.

OBJECTIVES: To describe the sociodemographic, occupational and health factors that influence nurses' recognition at work and to examine a recognition pathway model to assess the relationship between recognition at work and health-related quality of life (HRQOL), job satisfaction, anxiety and depression. DESIGN: This is a cross-sectional observational study with prospective data collection based on a self-report questionnaire. SETTING: University hospital centre in Morocco. PARTICIPANTS: The study included 223 nurses with at least 1 year of practice at the bedside in care units. MEASURES: We included the sociodemographic, occupational and health characteristics of each participant. The Fall Amar instrument was used to measure job recognition. HRQOL was measured using the Medical Outcome Study Short Form 12. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression. Job satisfaction was measured using a rating scale (ranging from 0 to 10). Path analysis was used to examine the nurse recognition pathway model to assess the relationship between nurse recognition at work and key variables. RESULTS: The participation rate in this study was 79.3%. Institutional recognition was significantly correlated with gender, midwifery specialty and normal work schedule: ß=-5.10 (-8.06, -2.14), ß=-5.13 (-8.66, -1.60) and ß=-4.28 (-6.85, -1.71), respectively. Significant correlations were found between recognition from superiors and gender, mental health specialisation and normal work schedule: ß=-5.71 (-9.39, -2.03), ß=-5.96 (-11.17, -0.75) and ß=-4.04(-7.23, -0.85), respectively. Recognition from coworkers was significantly associated with mental health specialisation: ß=-5.09 (-9.16, -1.01). The trajectory analysis model found that supervisor recognition had the best impact on anxiety, job satisfaction and HRQOL. CONCLUSIONS: Recognition from superiors is important in maintaining nurses' psychological health, HRQOL and job satisfaction. Therefore, managers in hospitals should address the issue of recognition at work as a potential personal, professional and organisational lever.