Impact on glycaemic outcomes of transitioning from in-person to virtual FreeStyle Libre onboarding during the Covid-19 pandemic

Background and aims: Onboarding of the FreeStyle Libre, an intermittently scanned continuous glucose monitoring (isCGM) device, was pre-dominantly conducted in-person prior to the Covid-19 pandemic. However, onboarding rapidly become virtual due to enforced social distancing restrictions. This audit aimed to determine if onboarding method impacted on glycaemic outcomes and engagement statistics in people living with diabetes (pwD). Method(s): PwD who started FreeStyle Libre between January 2019 and March 2022, had their mode of onboarding recorded and had >=70% data were identified and included within the audit. Glycaemic indices and engagement statistics (previous 90 day averages) were obtained from LibreView (Abbott, USA) three months after the last person was onboarded, and compared using linear models, adjusting for FreeStyle Libre duration, %active (where appropriate), age and sex. Result(s): From 1007 eligible participants (in-person 44% [n = 445];virtual 56% [n = 562]), FreeStyle Libre usage duration was greater for those onboarded in-person vs. virtually (974[891,1101) vs. 420[280,564] days [p < 0.001]). There were no significant differences in glycaemic or engagement indices between in-person and virtual onboarding methods: average glucose (10[9,11]) vs. 10[9,11])mmol/l), %time very-low (<3.0mmol/l, 0[0,1]) vs. 0[0,1]%), %time low (3.0-3.8mmol/ l, 2[1,4] vs. 2[1,4]), %time in range (3.9-10.0mmol/ l, 54[+/-17] vs. 53[+/-19]%), %time high (10.1-13.9mmol/ l, 27[21,31]) vs. 26[21,31]%), %time very-high (>13.9mmol/l, 14[6,24] vs. 15[7,26]%), %active (96[90,100] vs. 94[87,99]%) or scans/day (11[8,15] vs. 10[7,14]). Conclusion(s): There were no differences in glycaemic outcomes or engagement indices between pwD between onboarding methods. Virtual onboarding using online videos for isCGM is as equally effective as face to face.

Inhibition of SARS-CoV2 Replication Regulated by NSP3 through Ayurveda Phytoconstituents of Indian Traditional Medicine

With Covid-19, a significant proportion of the population who are already vaccinated have tested positive. Therefore, there is a need for better medicines that act against the virus rigorously without causing any side effects. We aim to achieve the same through molecular docking and further simulations for bioactive phytochemicals of ayurvedic medicinal plants. The target for this study has been considered the NSP3 protein of the viral RNA that actively takes part in both replication and immune evasion pathways of the virus. Ligand libraries consisting of bioactive phytochemicals of aswasgandha and analogues of curcumin and piperine are curated. The libraries, along with the NSP3 protein moiety are docked onto two active sites. With the best-scored complexes further taken up for molecular dynamics simulation, the study resulted in favourable outcomes for three such ligands (compound ID 5469426, 69501714, ZINC000003874317). © 2023 Bharati Vidyapeeth, New Delhi.

Bibliometric analysis and systematic review of green human resource management and hospitality employees' green creativity

Purpose: The study aims to work on two objectives, first to provide a theoretical foundation along with ongoing trend in the field of green human resource management (GHRM) and employee green creativity (EGC) in the hospitality and tourism industry. Second, the study also proposes a conceptual research model to understand the dynamics of the relationship between GHRM and EGC for future studies. Design/methodology/approach: The study uses multi-method approach, systematic literature review and bibliometric analysis is performed on published work on GHRM and EGC. This study initially shortlisted 52 publications from multiple databases, which was refined to 11 Scopus-indexed papers, which discussed both GHRM and EGC attributes in a hospitality context. VOSviewer and advance excel software's are being used to perform the analysis. Findings: The systematic literature review concluded that very limited studies have been conducted on GHRM and EGC in the hospitality context and it has recently gained prominence during the covid pandemic. While bibliometric analysis also identified h-index authors with their co-authorship network, citations and keywords matrix and the changing trends in the domain of GHRM and EGC in hospitality and tourism industry. The analysis also highlights the individual and organisational factors influencing the relation between GHRM and EGC. Originality/value: This study is the first to conduct a systematic literature review and bibliometric analysis on GHRM and EGC in hospitality and tourism sector. Moreover the paper also provides researchers with an in-depth summary of the available literature and a blue print for future studies on GHRM and EGC. © 2023, Emerald Publishing Limited.

Flash glucose monitoring: The story so far and the journey ahead

Just a few years ago FreeStyle Libre (FSL) was a rarely encountered device, used only by a select few people with type 1 diabetes who could afford to self-fund it. This small disc has a small cannula under the skin which allows for interstitial glucose measurements and remains in situ for 14 days. Over the last 4 years the number of people with access to this life-changing technology on the National Health Service (NHS) has increased rapidly. Although there were barriers to implementing access and encouraging uptake of this technology, including systems, healthcare professionals and the users themselves, innovative interventions from NHS England and diabetes organisations ensured those who stood to gain the most benefit were not impeded in their access, with a particular emphasis on enabling FSL use in those who are often the hardest to reach. This article reviews the impact of FSL on type 1 diabetes care in England, the key events to date and the lessons learnt that can be applied in the future for newer diabetes technologies. Copyright © 2022 BMJ Publishing Group. All rights reserved.

Arterio-Venous Fistula Creation by Nephrologists and Its Outcome in a Tertiary Level Hospital over Two Years Including Covid-19 Pandemic Period

BACKGROUND: Currently, AVFs are created by vascular surgeons urologists and nephrologists. Nephrologists may be better placed to create AVFs and conduct follow-up as they re well versed with the usage of AVF. AIM OF THE STUDY: This observational prospective study aims to find the outcome of AVFs created by nephrologists over two years in a tertiary level hospital. METHOD(S): All the patients in whom an AVF was created by nephrologists between March 2020 and August 2022 were included. On the day of surgery vitals were recorded and vein mapping was done. Side-to-side anastomosis with 6-0 proline between artery and vein were performed under local anesthesia in a single sitting. Patients were observed for post-op complications. During the COVID-19 pandemic, RT PCR was only performed in suspected in suspected patients indentified during screening. All patients staff and surgeons wore N-95 masks in addition to usual sterile measures. Patients were followed up at 6th week and 12th week post-AVF construction to do clinical examination and evaluate blood flow diameter of AVF by high-quality Doppler. Patients were asked to use AVF for dialysis after 6th week of creation after they have matured. AVF maturation was defined radiologically as a combination of blood flow of 600 ml/min and diameter of 6 mm or more and clinically usable. Else it was considered immature. Primary failure was defined as AVFs that had not matured till 12th week of creation. All the data were analyzed by appropriate statistical tools using the SPSS software RESULTS: A total of 1323 fistulae (including 376 during COVID-19 pandemic) were created in 1102 patients. Of them 928 (84.21%) were males, and 537 (48.72%) of the patients were having underlying diabetes mellitus. A total of 1008 (76.19%) were radio-cephalic while 262 (19.8%), 19 (1.43%) were brachio-cephalic, and brachio-basilic respectively. 1013 (76.56%) fistulae were left sided. 944 (85.66%) were already on hemodialysis while 158 (14.33%) were planned for elective initiation after fistula maturation. Of the 1102 patients, 150 patients required fistula creation twice, 17 patients thrice, and 4 patients underwent fistula creation four times. Out of 556 (50.45%) patients who completed three months follow-up, 65 patients (11.69%) expired. Primary failure was observed in 107 (19.21%) fistulae and 24 (4.30%) patients developed local site infection. 8 (1.43%) and 4 (0.71%) patients developed fistula rupture and aneurysms respectively requiring admission for AVF closure. Mean AVF blood flow and diameter were 674.92 +/- 317.40 and 5.42 +/- 1.33 at 6th week and 983.60 +/- 289.41 and 9.36 +/- 54.58 at 12th week respectively. During the COVID-19 pandemic, out of 376, 15 (7.1%) patients were found to be COVID-19 positive during follow-up, and only 2 out of 18 staff and 4 nephrologists were found to COVID-19 positive. CONCLUSION(S): Nephrologists are well positioned to create AVFs successfully. However, collaboration with vascular surgeons and radiologists will further improve the success rate and management of complications. AVF creation is safe during pandemics and should be continued.

System Dynamics Based Analysis of Oil & Gas Supply Chain Disruptions During COVID-19

COVID-19 has shocked global humanity and forced the world for continued lockdown and sudden economic turmoil. The oil and gas (O&G) sectors has experienced a nearly catastrophic besides undergoing supply-demand stalemate and free fall of crude price. Such an unbalance has impacted the supply chain of the O&G industry, having diverse ‘Hotspots.’Besides the growth of green energy, the oil sector contributes significantly to the energy security for the majority of the countries. Hence, the O&G sector needs to consider resilience strategies against such hotspots critically. This research has identified such critical hotspots and analyzed their moderation by developing a STELLA software model with system dynamics (SD) approach. The SD model is simulated with the data input of crude price, forecast demand, and strategy for the upcoming fiscal years. The Indian O&G sector is chosen as a case study;however, globally, the uniformity of the oil and gas supply chain could be effectively applied. The results indicate a drastic decline in production, revenue, sustainability, and net profits, though the critical resilience strategies are suggested. Despite a comprehensive exhibit of difficulties, the oil industry is expected to stay innovative, resilient, and compelling and eventually balances the slump as economic situations improve. IEEE

LESSONS LEARNT FROM COVID-19 FOR HEALTH SYSTEMS: THE USE CASE OF DIABETES REMOTE MONITORING

Background and Aims: The goal of increased telemedicine as part of diabetes care has been intensified and accelerated as a consequence of the COVID-19 pandemic. Made possible since the advent of cloud-connected technologies for diabetes management, such as continuous glucose monitoring systems, the development of telemedicine as part of the standard of care for people with diabetes still faces significant challenges in Europe. Methods: A group of multidisciplinary experts from across Europe participated in an in-depth needs assessment and review of the benefits and challenges to wider access and implementation of telemedicine and telemonitoring in the post-pandemic future. Results: Challenges include: 1) a fragmented approach to healthcare technology assessment and reimbursement;2) lack of eHealth education and literacy, amongst healthcare professionals and patients;3) lack of data integration with electronic health records;4) patient consent, privacy and data protection. To meet these challenges, the following actions were identified: 1) investment in telemedicine and technology that allows remote monitoring;2) bridge health inequities;3) protect patient data and privacy;4) incentivize broad adoption by patients, providers and health systems;5) ensure a true measure of the value these technologies bring. Conclusions: There is a strong consensus among experts on the challenges that must be overcome to secure access to telemonitoring and telemedicine for the diabetes community. There is a significant need for action across European health policymakers, to move forward in establishing digital competencies and developing sustainable solutions that support wider implementation of digital technologies and telemedicine in diabetes care.

Automated COVID-19 detection using Deep Convolutional Neural Network and Chest X-ray Images

COVID-19 was previously identified as 2019-nCoV, however it was reclassified as severe acute respiratory syndrome coronavirus 2 by the International Committee on Taxonomy of Viruses (ICTV) (SARS-CoV-2). It was first discovered in Wuhan, China's Hubei Province, and has since spread all over the world. The scientific community is working to develop COVID-19 detection technologies that are both quick and accurate. Chest x-ray imaging can aid in the early diagnosis of COVID-19 patients. In COVID-19 individuals, chest x-rays can indicate a variety of lung abnormalities, including lung consolidation, ground-glass opacity, and others. The COVID-19 biomarkers, however, must be identified by qualified and experienced radiologists. Each report must be inspected by the radiologist, which is a time-consuming procedure. The medical infrastructure is currently overburdened due to the huge volume of patients. In this study, we propose automatic COVID-19 identification in chest x-rays using a deep learning technique. COVID-19, pneumonia, and healthy x-rays are included in the dataset for the studies. The proposed model had an average accuracy and sensitivity of 97 percent. The obtained findings demonstrate that the model can compete with existing state-of-the-art models. © 2021 IEEE.

A System for Remote Monitoring of Patient Body Parameters

In today's world, life without technology is not possible. Continuous advancement in patient health monitoring techniques, medical equipment's or machines and other enhancing technologies is ongoing as per recent trends in specifically healthcare sector in order to reduce human efforts. Taking into consideration the serious nature of the above aforementioned problem, it is necessary to make some major improvements in the communication devices and systems with application-based technology in order to enhance their performance thereby saving medical costs and achieve other major advantages. The principal objective of this paper is to provide a system for remote and secure monitoring of healthcare information of patient suffering from virus and utilizing a mobile device as per the patient requirements. In this paper, a proposed model measure the temperature of the body, respiratory system especially lung sound and breathing activity, which are the main source of symptoms to understand the actual health condition of a person. And data sensed by the IoT sensor device used for measuring the real-time data body temperature, lung sounds, respiratory data, pulse rate and heartbeat. © 2021 IEEE.

Delivering evidence-based interventions for type 1 diabetes in the virtual world - A review of UK practice during the SARS-CoV-2 pandemic.

AIMS: This review considers the impact of the SARS-CoV-2 pandemic on access to interventions for those living with type 1 diabetes and discusses the solutions which have been considered and actioned to ensure ongoing access care. METHODS: We performed a focussed review of the published literature, and the guidelines for changes that have been effected during the pandemic. We also drew from expert recommendations and information about local practice changes for areas where formal data have not been published. RESULTS: Evidence based interventions which support the achievement of improved glucose levels and/or reduction in hypoglycaemia include group structured education to support self-management, insulin pump therapy and continuous glucose monitoring. The SARS-CoV-2 pandemic had impacted the ability of diabetes services to deliver these intervention. Multiple adaptations have been put in place - transition to online delivery of education and care, and usage of diabetes technology. CONCLUSIONS: Although various adaptations have been made during the pandemic that have positively influenced uptake of services, there are many areas of delivery that need immediate improvement in the UK. We recommend a proactive approach in recognising the digital divide and inequity in distribution of these changes and we recommend introducing measures to reduce them.

Technology Adoption in Tourism and Hospitality Pedagogy: Analysis of Teacher Readiness Amidst of COVID-19 Lockdown in India

Sudden rise in the pandemic has also revolutionized the teaching practices amidst of lock down practices which have led the universities and institutions to adopt technology systems as a source of connectivity to students and impart education. However the haphazard implementation of technological practices has levied a stress upon deliverability by faculties especially in tourism and hospitality which is more a practical based concept. Keeping in view the current scenario of teaching and learning practices, the current study examines factors associated with the technological adoption in tourism and hospitality faculty. Where the technological acceptance model describes the adoption for technology in teaching practices, results for structural constraints associated with it cannot be neglected. So to understand how to sustain technology use, there is a requirement for understanding what influences adoption process among teachers and how such factors determine their future intentions. Accordingly an online survey was conducted from faculties of tourism and hospitality of various universities and institutes in India. About 355 responses which were found reliable were used for final analysis. SEM analysis revealed that the relationship between self-efficacy, perceived ease of use at one hand have direct significant impact on intentions for future use, the structure constraints also mediates the relationship between the self-efficacy and intention to use thereby reflecting a significant role in technology adoption practices. The research will help in filling up the theoretical as well as implications for tourism education system and technological adoption practices where while technological training and digital familiarity programs needs to be implemented play as structural factors induces a significant impression on online pedagogical system in India. © 2021 Publishing India Group. All rights reserved.

COVID 19 Presentation and Effect of Associated Co-morbidities on Severity of Illness at a Dedicated COVID Hospital in North India

Background: Corona virus (SARS-Cov-2) belongs to coronaviridiae family, first identified in December 2019 in Wuhan, China, thus named as corona virus disease-19 (COVID-19). Later on the World Health Organization declared the outbreak as Public Health Emergency of International Concern on 30 January 2020 and the pandemic on 11 March. Material and methods: A total of 332 patients, diagnosed with COVID-19 by Reverse transcription polymerase chain reaction (RT-PCR), admitted in level iii, dedicated COVID hospital were evaluated for presenting symptoms and various comorbidities by detail history, body mass index, random blood sugar, x-ray chest, electrocardiography and kidney function test. Severity of disease was stratified as mild, severe, critical and mortality. Results: Of 332 patients, 205 (61%) were males and 127(38.3%) were females with average age 40.21 +/- 16.15.298 (89.8%) from urban area and 34 (10.2%) from rural area. Most common symptom was fever, in 192 (578%) patients, followed by cough, 136 (41.0%), sore throat, 95 (28.6%). The least common symptoms were rhinorrhoea (11%) and vomiting (11%). As per severity of disease, 251 (75.6%) were mild, 45 (13.6%) severe, 11 (3.3%) critical, and 12 (3.6%) expired. Conclusion: Older cases were at a risk of developing severe and critical illness. Males were found to have a more severe illness. Smokers have severe illness, compared to non-smokers, and the association between severity and smoking was significant. There was a fair and significant correlation between number of comorbidities and severity of illness. Among the comorbidities, chronic kidney disease has strongest association with mortality.

The transCampus Metabolic Training Programme Explores the Link of SARS-CoV-2 Virus to Metabolic Disease.

Currently, we are experiencing a true pandemic of a communicable disease by the virus SARS-CoV-2 holding the whole world firmly in its grasp. Amazingly and unfortunately, this virus uses a metabolic and endocrine pathway via ACE2 to enter our cells causing damage and disease. Our international research training programme funded by the German Research Foundation has a clear mission to train the best students wherever they may come from to learn to tackle the enormous challenges of diabetes and its complications for our society. A modern training programme in diabetes and metabolism does not only involve a thorough understanding of classical physiology, biology and clinical diabetology but has to bring together an interdisciplinary team. With the arrival of the coronavirus pandemic, this prestigious and unique metabolic training programme is facing new challenges but also new opportunities. The consortium of the training programme has recognized early on the need for a guidance and for practical recommendations to cope with the COVID-19 pandemic for the community of patients with metabolic disease, obesity and diabetes. This involves the optimal management from surgical obesity programmes to medications and insulin replacement. We also established a global registry analyzing the dimension and role of metabolic disease including new onset diabetes potentially triggered by the virus. We have involved experts of infectious disease and virology to our faculty with this metabolic training programme to offer the full breadth and scope of expertise needed to meet these scientific challenges. We have all learned that this pandemic does not respect or heed any national borders and that we have to work together as a global community. We believe that this transCampus metabolic training programme provides a prime example how an international team of established experts in the field of metabolism can work together with students from all over the world to address a new pandemic.

Time in range: A best practice guide for UK diabetes healthcare professionals in the context of the COVID-19 global pandemic.

The emergence of continuous glucose monitoring has driven improvements in glycaemic control and quality of life for people with diabetes. Recent changes in access to continuous glucose monitoring systems within UK health services have increased the number of people able to benefit from these technologies. The COVID-19 pandemic has created an opportunity for diabetes healthcare professionals to use continuous glucose monitoring technology to remotely deliver diabetes services to support people with diabetes. This opportunity can be maximized with improved application and interpretation of continuous glucose monitoring-generated data. Amongst the diverse measures of glycaemic control, time in range is considered to be of high value in routine clinical care because it is actionable and is visibly responsive to changes in diabetes management. Importantly, it is also been linked to the risk of developing complications associated with diabetes and can be understood by people with diabetes and healthcare professionals alike. The 2019 International Consensus on Time in Range has established a series of target glucose ranges and recommendations for time spent within these ranges that is consistent with optimal glycaemic control. The recommendations cover people with type 1 or type 2 diabetes, with separate targets indicated for elderly people or those at higher risk from hypoglycaemia, as well as for women with type 1 diabetes during pregnancy. The aim of this best practice guide was to clarify the intent and purpose of these international consensus recommendations and to provide practical insights into their implementation in UK diabetes care.