Challenges and solutions for addressing critical shortage of supply chain for personal and protective equipment (PPE) arising from Coronavirus disease (COVID19) pandemic - Case study from the Republic of Ireland

Efficacy of cleaning, disinfection, and sterilization modalities for addressing infectious drug-resistant fungi: a review

This is a timely and important review that focuses on the appropriateness of established cleaning, disinfection, and sterilization methods to safely and effectively address infectious fungal drug-resistant pathogens that can potentially contaminate reusable medical devices used in healthcare environment in order to mitigate the risk of patient infection. The release of the World Health Organization (WHO) fungal priority pathogen list (FPPL) in 2022 highlighted the public health crisis of antimicrobial resistance (AMR) in clinically relevant fungal species. Contamination of medical devices with drug-resistant fungal pathogens (including those on the FPPL) in healthcare is a rare event that is more likely to occur due to cross-transmission arising from lapses in hand hygiene practices. Established disinfection and sterilization methods decontaminate fungal pathogens on single-use and reusable medical devices; however, there are assumptions that reusable devices destined for semi-critical use are appropriately cleaned and do not harbour biofilms that may undermine the ability to effectively decontamination these type devices in healthcare. International standards dictate that manufacturer's instructions for use must provide appropriate guidance to healthcare facilities to meet safe reprocessing expectations that include addressing drug-resistant fungal pathogens. Increased environmental monitoring and vigilance surrounding fungal pathogens in healthcare is advised, including adherence to hand hygiene/aseptic practices and appropriate cleaning encompassing the simplification of reusable device features for 'ease-of-reach'. There are emereging opportunities to promote a more integrated multiactor hub approach to addressing these sophisticated challenges, including future use of artificial intelligence and machine learning for improved diagnostics, monitoring/surveillance (such as healthcare and wastewater-based epidemiology), sterility assurance, and device design. There is a knowledge gap surrounding the occurrence and potential persistence of drug-resistant fungal pathogens harboured in biofilms, particularly for ascertaining efficacy of high-level disinfection for semi-critical use devices.

The Challenges Experienced by ICU Nurses in Kuwait during the COVID-19 Pandemic

Background

The coronavirus (COVID-19) pandemic presented unprecedented challenges to healthcare systems worldwide, with intensive care unit (ICU) nurses at the forefront of patient care. To date, there is limited evidence into ICU nurses'experiences of the pandemic in Kuwait.

Research question/aims/objectives

To elucidate the challenges faced by ICU nurses in Kuwait during the pandemic, by considering two research questions: "What contributed to intensified pressure for the ICU nurses?" and "How were the nurses affected?".

Research design

This was a qualitative study which utilised semi-structured interviews. Interviews were conducted between January 2021 and June 2022 with ICU nurses who worked during the COVID-19 pandemic. The data were analysed using Charmaz's grounded theory methodology.

Participants and research context

25 nurses from three ICUs in Kuwait.

Ethical considerations

The study was approved by the University Ethics Committee and by the Ministry of Health in Kuwait.

Findings/Results

The analysis identified two themes (the factors contributing to intensified pressure in the ICU, and the impact on the nurses) and seven sub-themes. The pressure in the ICU intensified due to the rise in the number of patients, staff shortages, and the requirement to adhere to unrealistic new procedures for infection control. Restricted and cancelled leave, as well as impaired autonomy at work, impeded the nurses' ability to recover from stress. The heightened stress also contributed to a worsening in interpersonal relationships between the nurses and their colleagues. The nurses' care was compromised by these challenges, leading to moral distress and a range of mental health symptoms (e.g., stress, anxiety, emotional exhaustion).

Conclusions

The study accords with other research conducted during the pandemic in revealing a significant mental health toll among healthcare workers during the pandemic. The stressors were similar to those which have been reported in other studies, although there were also context-specific effects relating to the environment of the ICU and the Kuwaiti context.

Synergistic antimicrobial nanofiber membranes based on metal incorporated silica nanoparticles as advanced antimicrobial layers

In this post-new-normal era, the public prioritizes preventive measures over curing, which is a constructive approach to staying healthy. In this study, an innovative antimicrobial membrane material has been developed, showcasing the promising potential for various applications. The metal-doped silica nanoparticles (Ag, Cu, and Co) were incorporated into a cellulose acetate (CA) polymer-based nanofiber membrane using the electrospinning technique. The metal nanoparticles were doped into a silanol network of silica nanoparticles. The fabricated membranes underwent detailed characterization using a wide range of techniques including PXRD, FTIR, Raman, SEM, TEM, TGA, and tensile testing. These analyses provided compelling evidence confirming the successful incorporation of metal-doped silica nanoparticles (Ag, Cu, and Co) into cellulose-based nanofibers. The band gap energies of the fabricated CA mats lie below 3.00 eV, confirming that they are visible light active. The trimetallic silica nanohybrid exhibited the lowest band gap energy of 2.84 eV, proving the self-sterilizing ability of the CA mats. The DPPH assay further confirmed the best radical scavenging activity by the trimetallic silica nanohybrid incorporated nanofiber mat (91.77 ± 0.88%). The antimicrobial activity was assessed by using the bacterial ATCC strains of Staphylococcus aureus, Streptococcus pneumoniae, MRSA (Methicillin-resistant Staphylococcus aureus), Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa and fungal strains; quality control samples of Trichophyton rubrum, Microsporum gypsium, and Aspergillus niger, as well as the ATCC strain of Candida albicans. The trimetallic silica nanohybrid-incorporated CA membranes demonstrated the most significant inhibition zones. The reported findings substantiate the self-sterilizing mat's viability, affordability, efficacy against a broad spectrum of microbial strains, cost-effectiveness, and biodegradability. Furthermore, the mat serves as a dual-purpose physical and biological barrier against microbes, affirming its potential impact.

The mediation effects of COVID-19-related traumatic stress symptoms and mentalization on the relationship between perceived stress and psychological well-being in healthcare workers transitioning to a post-pandemic world

BACKGROUND

In context of COVID-19 as a collective trauma and the intense involvement of healthcare workers (HCWs) in the pandemic, perceived stress continues to have a tremendous impact on their psychological well-being. However, few studies have attempted to delineate the underlying mechanisms. This study examined whether COVID-19-related traumatic stress symptoms and mentalization act as mediators.

METHODS

A sample of HCWs (N = 2610) from 22 hospitals in Beijing, China participated in this cross-sectional investigation. Data on their perceived stress, psychological well-being, the impact of event, and reflective function during the COVID-19 pandemic were collected using self-report questionnaires. Different mediating models were tested.

RESULTS

COVID-19-related stress symptoms and mentalization independently mediate the association between perceived stress and psychological well-being. These two mediators also compose a serial mediation model. In particular, higher perceived stress inhibits the psychological well-being of HCWs through increased severity of traumatic stress symptoms, which in turn is associated with hypomentalizing.

CONCLUSION

These findings shed light on the mechanisms underlying the relationship between perceived stress and psychological well-being in HCWs. We strongly recommend incorporating a mentalization framework with trauma-informed practice in prevention and intervention work with this population during this and future healthcare crisis.

Impact of infection prevention and control practices, including personal protective equipment, on the prevalence of hospital-acquired infections in acute care hospitals during COVID-19: a systematic review and meta-analysis

BACKGROUND

The COVID-19 pandemic has posed an unprecedented challenge to healthcare systems globally. Personal protective equipment has played a fundamental role in protecting healthcare workers and patients, but its effectiveness in reducing hospital-acquired infections (HAIs) during the pandemic remains a subject of debate.

AIM

To conduct a synthesis and meta-analysis of the best available evidence of the prevalence of HAIs using a before/after approach.

METHODS

A three-step search strategy was undertaken to locate published and unpublished studies. A search was performed in MEDLINE, CINAHL, Embase, PsycINFO, and Google Scholar. Screening of studies, data extraction and critical appraisal were performed by four independent reviewers. Meta-analysis was conducted using Review Manager. The review is reported in accordance with PRISMA and JBI guidelines for systematic reviews.

FINDINGS

Fifteen studies were included in the review. Three studies indicated a statistically significant increase in the number of positive cultures during the COVID-19 period compared to the pre-COVID-19 period. Pooled data showed a non-significant decrease in the number of patients with positive cultures in the COVID-19 period compared to pre-COVID-19. There were no significant differences in various bacterial infections except for a significant decrease in respiratory infections. Pooled data for central line-associated bloodstream infections (CLABSIs) indicated a significant increase during the COVID-19 period, but one study reported an increase in CLABSI incidence.

CONCLUSION

The evidence from this review demonstrates a mixed impact of the COVID-19 pandemic precautions on HAIs.

Development and demonstration of the protective efficacy of a convertible respiratory barrier enclosure: a simulation study

OBJECTIVE

The efficacy of previously developed respiratory barrier enclosures to limit healthcare workers' exposure to aerosols from COVID-19 patients remains unclear; in addition, the design of these devices is unsuitable for transportation or other emergency procedures. Therefore, we developed a novel negative pressure respiratory isolator to improve protection from patient-generated aerosols and evaluated its protective effect in conversion to systemic isolator.

METHODS

This in vitro study simulated droplets by nebulizing 1% glycerol + 99% ethanol solution. We performed cardiopulmonary resuscitation (CPR) and converted a respiratory barrier enclosure into a systemic isolator with a respiratory barrier as well as a respiratory barrier with negative pressure generator (NPG), which were compared with control and room air. During the procedure, particles were counted for 30 seconds and the count was repeated 10 times.

RESULTS

During CPR, the total number of particles in the respiratory barrier with NPG (280,529; interquartile range [IQR], 205,263-359,195; P=0.970) was similar to that in the control (308,789; IQR, 175,056-473,276). Using NPG with a respiratory barrier reduced the number of particles to 27,524 (IQR, 26,703- 28,905; P=0.001). Particle number during conversion of the respiratory barrier into a systemic isolator was also lower than in the control (25,845; IQR, 19,391- 29,772; P=0.001).

CONCLUSION

The novel isolator was converted to a systemic isolator without air leakage. The aerosol-blocking effect of the isolator was quantified using a particle counter during CPR. Further studies comparing the barrier effect of isolators within various pressure differentials are warranted.

Continuous-wave second-harmonic generation in the far-UVC pumped by a blue laser diode

Far-UVC light in the wavelength range of 200-230 nm has attracted renewed interest because of its safety for human exposure and effectiveness in inactivating pathogens. Here we present a compact solid-state far-UVC laser source based on second-harmonic generation (SHG) using a low-cost commercially-available blue laser diode pump. Leveraging the high intensity of light in a nanophotonic waveguide and heterogeneous integration, our approach achieves Cherenkov phase-matching across a bonded interface consisting of a silicon nitride (SiN) waveguide and a beta barium borate (BBO) nonlinear crystal. Through systematic investigations of waveguide dimensions and pump power, we analyze the dependencies of Cherenkov emission angle, conversion efficiency, and output power. Experimental results confirm the feasibility of generating far-UVC, paving the way for mass production in a compact form factor. This solid-state far-UVC laser source shows significant potential for applications in human-safe disinfection, non-line-of-sight free-space communication, and deep-UV Raman spectroscopy.

Contributing to health system resilience during pandemics via purchasing and supply strategies: an exploratory system dynamics approach

BACKGROUND

Health systems worldwide struggled to obtain sufficient personal protective equipment (PPE) and ventilators during the COVID-19 pandemic due to global supply chain disruptions. Our study's aim was to create a proof-of-concept model that would simulate the effects of supply strategies under various scenarios, to ultimately help decision-makers decide on alternative supply strategies for future similar health system related crises.

METHODS

We developed a system dynamics model that linked a disease transmission model structure (susceptible, exposed, infectious, recovered (SEIR)) with a model for the availability of critical supplies in hospitals; thereby connecting care demand (patients' critical care in hospitals), with care supply (available critical equipment and supplies). To inform the model structure, we used data on critical decisions and events taking place surrounding purchase, supply, and availability of PPE and ventilators during the first phase of the COVID-19 pandemic within the English national health system. We used exploratory modelling and analysis to assess the effects of uncertainties on different supply strategies in the English health system under different scenarios. Strategies analysed were: (i) purchasing from the world market or (ii) through direct tender, (iii) stockpiling, (iv) domestic production, (v) supporting innovative supply strategies, or (vi) loaning ventilators from the private sector.

RESULTS

We found through our exploratory analysis that a long-lasting shortage in PPE and ventilators is likely to be apparent in various scenarios. When considering the worst-case scenario, our proof-of-concept model shows that purchasing PPE and ventilators from the world market or through direct tender have the greatest influence on reducing supply shortages, compared to producing domestically or through supporting innovative supply strategies. However, these supply strategies are affected most by delays in their shipment time or set-up.

CONCLUSION

We demonstrated that using a system dynamics and exploratory modelling approach can be helpful in identifying the purchasing and supply chain strategies that contribute to the preparedness and responsiveness of health systems during crises. Our results suggest that to improve health systems' resilience during pandemics or similar resource-constrained situations, purchasing and supply chain decision-makers can develop crisis frameworks that propose a plan of action and consequently accelerate and improve procurement processes and other governance processes during health-related crises; implement diverse supplier frameworks; and (re)consider stockpiling. This proof-of-concept model demonstrates the importance of including critical supply chain strategies as part of the preparedness and response activities to contribute to health system resilience.

Assessing the Disruption Impact on Healthcare Delivery

Health emergency outbreaks such as the COVID-19 pandemic make it challenging for healthcare systems to ration medical resources and patient care. Such disastrous events have been increasing over the past years and are becoming inevitable, necessitating the need for healthcare to be well-prepared and resilient to unpredictable rises in demand. Quantitative and qualitative based decision support systems increase the effectiveness of planning, alleviating uncertainties associated with the crisis. This study aims to understand how the COVID-19 pandemic has affected the performance of healthcare systems in different areas and to address the associated disruption. A cross-sectional online survey was conducted in the Kingdom of Saudi Arabia and the United Arab Emirates among healthcare workers who worked during the pandemic. The pandemic-related disruption and its psychometric properties were assessed using Structural Equations Modeling (SEM) with 5 latent factors: Staff Mental Health, Communication Level, Planning and Readiness, Healthcare Supply Chain, and Telehealth. Responses from highly qualified participants with many years of experience in hospital settings were collected and analyzed. Results show that the model satisfactorily fits the data with a CLI of 0.91 and TLI of 0.88. The model indicates that enhancing supply chain management, planning, telehealth usage, and communication level across the healthcare system can mitigate the disruption. However, the lack of mental health management for healthcare workers can significantly disrupt the quality of delivered care. Staff mental health and healthcare supply chain, respectively, are the highest contributors to varying degrees of disruption in healthcare delivery. This study provides a direction for more research focusing on determinants of healthcare efficiency. It also provides decision-makers insights into the main factors leading to disruptions in healthcare systems, allowing them to shape their outbreak response and better prepare for future health emergencies.

The Efficient Disposal of Biomedical Waste Is Critical to Public Health: Insights from the Central Pollution Control Board Guidelines in India

Biomedical waste (BMW), encompassing hazardous medical materials, poses environmental and public health risks if not correctly managed. The Central Pollution Control Board (CPCB) in India is a statutory organization that oversees BMW disposal standards, aimed at mitigating these hazards. BMW mismanagement is a major problem and potentially poses threats to the environment as well as public health. During the coronavirus disease 2019 (COVID-19) pandemic, increased use of personal protective equipment (PPE) and other medical equipment was witnessed which led to a marked raised BMW generation. To ensure proper and optimized BMW management, CPCB established guidelines and rules to be followed by the medical facilities as well as the common BMW treatment facilities (CBWTFs). The challenges in implementing proper waste management practices were lack of awareness and inadequate infrastructure. Strategies for better BMW management were proposed, including color-coded bins, improved infrastructure, advanced technology, and awareness campaigns. Highlighting CPCB's vital role, this emphasizes healthcare facilities' proactive role in implementing and evolving regulations for sustainable BMW disposal, ensuring both public health and environmental well-being through compliance and responsible waste management partnerships.

Addressing the challenges in implementing airborne infection control guidelines and embracing the policies

Airborne pathogens not only lead to epidemics and pandemics, but are associated with morbidity and mortality. Administrative or managerial control, environmental control and use of personal protective equipments are the three components in airborne infection control. National and international guidelines for ideal airborne infection control (AIC) practices are available for more than a decade; however the implementation of these need to be looked into, challenges identified and addressed for effective prevention of airborne disease transmission. Commitment of multiple stakeholders from policy makers to patients, budget allocation and adequate fund flow, functioning AIC committees at multiple levels with an inbuilt reporting and monitoring mechanism, adaptation of the AIC practices at various health care levels, supportive supervision, training and ongoing education for health care providers, behaviour change communication to patients to adapt the practices at health care facility level, by health care personnel and patients will facilitate health system preparedness for handling any emergencies, but will also help in reducing the burden of persisting airborne diseases such as tuberculosis. Operational research in this least focused area will also help to identify and address the challenges.

Global trends in the research and development of medical/pharmaceutical wastewater treatment over the half-century

The COVID-19 pandemic has severely impacted public health and the worldwide economy. The overstretched operation of health systems around the world is accompanied by potential and ongoing environmental threats. At present, comprehensive scientific assessments of research on temporal changes in medical/pharmaceutical wastewater (MPWW), as well as estimations of researcher networks and scientific productivity are lacking. Therefore, we conducted a thorough literature study, using bibliometrics to reproduce research on medical wastewater over nearly half a century. Our primary goal is systematically to map the evolution of keyword clusters over time, and to obtain the structure and credibility of clusters. Our secondary objective was to measure research network performance (country, institution, and author) using CiteSpace and VOSviewer. We extracted 2306 papers published between 1981 and 2022. The co-cited reference network identified 16 clusters with well-structured networks (Q = 0.7716, S = 0.896). The main trends were as follows: 1) Early MPWW research prioritized sources of wastewater, and this cluster was considered to be the mainstream research frontier and direction, representing an important source and priority research area. 2) Mid-term research focused on characteristic contaminants and detection technologies. Particularly during 2000-2010, a period of rapid developments in global medical systems, pharmaceutical compounds (PhCs) in MPWW were recognized as a major threat to human health and the environment. 3) Recent research has focused on novel degradation technologies for PhC-containing MPWW, with high scores for research on biological methods. Wastewater-based epidemiology has emerged as being consistent with or predictive of the number of confirmed COVID-19 cases. Therefore, the application of MPWW in COVID-19 tracing will be of great interest to environmentalists. These results could guide the future direction of funding agencies and research groups.

Experiences of health professionals in EU institutions during the Covid crisis

We performed a quantitative and a qualitative study, addressing the experiences of health services of 16 European Union institutions during the Covid-19 pandemic. Among the 165 eligible subjects, 114 (69%) participated in the survey. The biggest problem reported was limitation of social contacts (53%). At work, the biggest problems were workload (50%) and shortage of staff (37%). The majority were positive about teamwork. Teleworking was seen positively by 81%. Most participants felt better prepared for future situations by their recent experience (94%). Participants underlined the importance of strengthening the collaboration with the local health systems (80%), as well as with medical services and internal services within their own institution (75%). The qualitative analysis also reported participants' fear of becoming infected, and of their family members getting sick. Similarly reported were the sense of isolation and anxiety, the excessive workload and work complexity, shortage of staff, and the benefits of teleworking. Study findings highlight: i) the need to strengthen mental health support to health personnel, not only during crisis situations; ii) the need for sufficient health workers, with swift recruitment strategies in times of crisis; iii) the importance of clear protocols to ensure no shortages of personal protective equipment (PPE); iv) the importance of teleworking, which represents an opportunity for major reorganisation of work within EU medical services; v) the need to strengthen collaboration with local health systems and the medical services of EU institutions.

Strategies for maintaining and strengthening the health care workers during epidemics: a scoping review

INTRODUCTION

During epidemics such as COVID-19, healthcare workers (HCWs) face several challenges, leading to a shortage and weakening of human resources. To address this issue, employing effective strategies is essential in maintaining and strengthening human resources during outbreaks. This study aimed to gather and classify strategies that could retain and strengthen human health resources during epidemics.

METHODS

In this scoping review, all studies published about strategies for maintaining and strengthening HCWs in epidemics were collected from 4 international databases, including PubMed, Embase, Scopus, and Web of Science. The English language articles published after 2000 up until June 2022 recommended specific strategies regarding the research question. Then, they were analyzed and classified according to thematic analysis based on Braun and Clarke 6 phases protocols.

RESULTS

In total, 9405 records were screened, of which 59 articles were included, and their full texts were reviewed. Fifty factors were identified and classified into five themes: Instruction, Protection, Supporting, Caring, and Communication. Most of the suggestions were conducted in high-income countries and related to the Supporting theme.

DISCUSSION

The majority of strategies discussed in the literature addressed only one or two aspects of human resources. This study provides a holistic perspective on these issues by providing a thematic map of different strategies for strengthening and maintaining HCWs during epidemics. Considering the multidimensionality of human nature, it is suggested that policymakers and managers of health systems provide facilities that simultaneously address a wide range of needs.

It's gone, it's back: A prospective study on the COVID-19 pandemic-related shortages and mental health of Australian families

Our aim was to explore the association between COVID-19 pandemic-related product shortages and symptoms of stress, anxiety, and depression in Australian families, concurrently and longitudinally, while controlling for demographic, health, and psychological characteristics. This prospective study used two waves of data (baseline, Time 0 = April 2020; Time 1 = May 2020) from a longitudinal cohort study of Australian parents of a child aged 0-18 years. Parents were surveyed at baseline about whether they had experienced product shortages related to COVID-19. DASS21 was used to measure symptoms of depression, anxiety, and stress at both waves. The sample included 2,110 participants (N = 1,701, 80.6% mothers). About 68.6% of the respondents reported being impacted by one or more shortages. Product shortages correlated significantly with higher combined and individual scores for anxiety, depression, and stress (r = 0.007 to 0.18, all p < 0.001) at baseline. At Time 1, parental emotion regulation explained 4.0% of the variance (p < .001). Our findings suggest a role for improving parental emotion regulation in coping with stressors, such as shortages and lockdowns.

The Impact of Personal Protective Equipment on Healthcare Workers on COVID-19 Duty in a Tertiary Care Hospital in South India

Context The proper usage of personal protective equipment (PPE) must be prioritised for health care workers (HCWs), where shortages and prolonged use of personal protective equipment can threaten safety in essential health services. Aims To evaluate the effect of personal protective equipment on the health and well-being of HCWs, physicians, nurses, and technicians on duty for COVID-19 rotational postings. Settings and design This cross-sectional study was done by simple random sampling. Methods and materials This study was conducted at a tertiary care centre in South India to assess the utilisation of personal protective equipment (PPE) during the second wave of COVID-19. A physical questionnaire was distributed to a total of 266 healthcare workers, aged 20 to 50, who had worked for a minimum of three consecutive days between May and August 2021. The objective of the study was to evaluate the effectiveness of PPE use among healthcare workers during the second wave of the COVID-19 pandemic. Statistical analysis The data analysis in this study was conducted using IBM Statistical Package for Social Sciences (SPSS) version 19 (IBM Corp., Armonk, New York). The mean and standard deviation, or median, were used to present continuous variables, while frequency and percentage were used to present categorical variables. Furthermore, the minimum sample size required for this study was calculated to be 246 participants. Results The survey included 266 healthcare workers. The mean+/-SD of age was 28.18+/-5.64 and consisted of females (54.51%) and males (45.48%). The postings were in emergency (13.15%), intensive care unit (30.82%), and ward (56.01%), respectively. The HCWs who used PPE for four to seven days reported more symptoms than those who used it for one to three days. Discomforts experienced while wearing PPE were chest suffocation (49.62%), difficulty in performing intubation (36.09%), difficulty in seeing clearly (68.79%), dizziness (49.62%), excessive sweating (75.56%), micturition desire (52.63%), nausea (42.48%), retro-auricular pain (56.76%), stomach burns (27.44%), and thirst or dry throat (78.57%). The symptoms suffered after doffing were tiredness (69.17%), dry mouth (67.29%), dizziness (43.60%), headache (55.63%), chest suffocation (36.46%), dry skin (57.14%), reduced ability to concentrate (48.12%), dark-coloured urine (55.63%), reduced alertness (42.48%), and stomach burns (28.94%). The first thoughts after doffing were to drink water (68.42%), eat something (36.09%), clean yourself (61.27%), urinate (33.08%), and have some rest (29.32%), respectively. 81 (30.45%). The HCWs suffered skin injuries while wearing gloves. The time for restoring after a shift was 12 hours (37.59%), 24 hours (34.21%), 36 hours (11.65%), and 48 hours (16.59%). Pressure sores were reported on the forehead by 53 (19.92%) participants, the nose by 54 (20.30%), the cheek by 31 (11.65%), and behind the ear by 77 (65.71%) participants. The optimal size of PPE was experienced only by 76 (28.57%) participants, while 73 (27.44%) of them felt tight and 117 (43.98%) felt loose. Conclusions To minimise discomfort while managing infectious diseases, HCWs can adopt several practices like taking regular breaks, ensuring humane working hours, utilising high-quality PPE, and wearing properly fitting gear. By implementing these measures, HCWs can enhance their ability to handle infectious diseases effectively while prioritising their comfort and well-being.

A data-driven optimization model to response to COVID-19 pandemic: a case study

COVID-19 is a highly prevalent disease that has led to numerous predicaments for healthcare systems worldwide. Owing to the significant influx of patients and limited resources of health services, there have been several limitations associated with patients' hospitalization. These limitations can cause an increment in the COVID-19-related mortality due to the lack of appropriate medical services. They can also elevate the risk of infection in the rest of the population. The present study aims to investigate a two-phase approach to designing a supply chain network for hospitalizing patients in the existing and temporary hospitals, efficiently distributing medications and medical items needed by patients, and managing the waste created in hospitals. Since the number of future patients is uncertain, in the first phase, trained Artificial Neural Networks with historical data forecast the number of patients in future periods and generate scenarios. Through the use of the K-Means method, these scenarios are reduced. In the second phase, a multi-objective, multi-period, data-driven two-stage stochastic programming is developed using the acquired scenarios in the previous phase concerning the uncertainty and disruption in facilities. The objectives of the proposed model include maximizing the minimum allocation-to-demand ratio, minimizing the total risk of disease spread, and minimizing the total transportation time. Furthermore, a real case study is investigated in Tehran, the capital of Iran. The results showed that the areas with the highest population density and no facilities near them have been selected for the location of temporary facilities. Among temporary facilities, temporary hospitals can allocate up to 2.6% of the total demand, which puts pressure on the existing hospitals to be removed. Furthermore, the results indicated that the allocation-to-demand ratio can remain at an ideal level when disruptions occur by considering temporary facilities. Our analyses focus on: (1) Examining demand forecasting error and generated scenarios in the first phase, (2) exploring the impact of demand parameters on the allocation-to-demand ratio, total time and total risk, (3) investigating the strategy of utilizing temporary hospitals to address sudden changes in demand, (4) evaluating the effect of disruption to facilities on the supply chain network.

Modelling supply chain sustainability challenges in the food processing sector amid the COVID-19 outbreak

The recent COVID-19 pandemic has significantly impacted most businesses and their supply chains. Due to the negative impacts of COVID-19, businesses have been facing numerous challenges. Among them, sustainability challenges are critical for any supply chain. In the literature, several studies have discussed the impacts of the COVID-19 pandemic on supply chains; however, there is a significant research gap in analysing supply chain sustainability challenges amid the COVID-19 outbreak in a particular context. To fill this research gap, this study aims to develop a systematic approach to identifying and analysing COVID-19 outbreak-related supply chain sustainability challenges in the context of the Australian food processing sector. To achieve the aims, this paper develops a mixed-method approach consisting of both qualitative and quantitative techniques, namely online survey and the Best-Worst method. From the online survey among experts from the Australian food processing sector, 22 sustainability challenges were finalised and categorised into four categories, namely, economic, environmental, social and ethical, and operational challenges. The empirical findings from the exploratory investigation reveal that increased food processing cost, lack of transparency and traceability, increase in price of raw materials, lack of capital and physical resources, and spread of fake information are the top five sustainability challenges to the Australian food processing sector due to the impacts of the COVID-19 outbreak. The findings of this study will help decision-makers, practitioners, and policymakers by developing the policies, guidelines, and strategies to overcome the most impactful sustainability challenges to ensure sustainable recovery from the impacts of the COVID-19 outbreak.

Blockchain and COVID-19 pandemic: applications and challenges

The year 2020 has witnessed the emergence of coronavirus (COVID-19) that has rapidly spread and adversely affected the global economy, health, and human lives. The COVID-19 pandemic has exposed the limitations of existing healthcare systems regarding their inadequacy to timely and efficiently handle public health emergencies. A large portion of today's healthcare systems are centralized and fall short in providing necessary information security and privacy, data immutability, transparency, and traceability features to detect fraud related to COVID-19 vaccination certification, and anti-body testing. Blockchain technology can assist in combating the COVID-19 pandemic by ensuring safe and reliable medical supplies, accurate identification of virus hot spots, and establishing data provenance to verify the genuineness of personal protective equipment. This paper discusses the potential blockchain applications for the COVID-19 pandemic. It presents the high-level design of three blockchain-based systems to enable governments and medical professionals to efficiently handle health emergencies caused by COVID-19. It discusses the important ongoing blockchain-based research projects, use cases, and case studies to demonstrate the adoption of blockchain technology for COVID-19. Finally, it identifies and discusses future research challenges, along with their key causes and guidelines.

Challenges and future opportunities to unlock the critical supply chain of personal and protective equipment (PPE) encompassing decontamination and reuse under emergency use authorization (EUA) conditions during the COVID-19 pandemic: Through a reflective circularity and sustainability lens

Severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2), and the resulting coronavirus disease (COVID-19), was declared a public health emergency of global concern by the World Health Organization (WHO) in the early months of 2020. There was a marked lack of knowledge to inform national pandemic response plans encompassing appropriate disease mitigation and preparation strategies to constrain and manage COVID-19. For example, the top 16 "most cited" papers published at the start of the pandemic on core knowledge gaps collectively constitute a staggering 29,393 citations. Albeit complex, appropriate decontamination modalities have been reported and developed for safe reuse of personal and protective equipment (PPE) under emergency use authorization (EUA) where critical supply chain shortages occur for healthcare workers (HCWs) caused by the COVID-19 pandemic. Commensurately, these similar methods may provide solutions for the safe decontamination of enormous volumes of PPE waste promoting opportunities in the circular bioeconomy that will also protect our environment, habitats and natural capital. The co-circulation of the highly transmissive mix of COVID-19 variants of concern (VoC) will continue to challenge our embattled healthcare systems globally for many years to come with an emphasis placed on maintaining effective disease mitigation strategies. This viewpoint article addresses the rationale and key developments in this important area since the onset of the COVID-19 pandemic and provides an insight into a variety of potential opportunities to unlock the long-term sustainability of single-use medical devices, including waste management.

The COVID-19 pandemic and supply chain: international cooperation patterns and influence mechanism

Purpose

The aim of this study is to undertake a systematic analysis of the supply chain literature to uncover the changes and patterns of international cooperation in the context of the COVID-19 pandemic.

Design/methodology/approach

In this study, the information on supply chain-related publications in the Web of Science (WOS) database is analyzed using statistical techniques and visual approaches. The focus is on the five countries with the highest number of supply chain publications, accounting for approximately 70% of global publications. This in-depth analysis aims to provide a clearer understanding of the cooperation patterns and their impact on the supply chain during the COVID-19 pandemic.

Findings

The results of the study reveal that the growth rate of international cooperation in supply chain research during the COVID-19 pandemic is higher compared to the 5-year and 10-year periods before the pandemic. This suggests that the pandemic has not hindered international cooperation in the field, but instead has increased collaboration. In terms of international cooperation patterns, the findings indicate that China and the USA have a strong partnership, with China being the largest partner for the USA and vice versa. The UK's largest partner is China, India's largest partner is the UK and Italy's largest partner is also the UK. This implies that trade, rather than the pandemic, is a determining factor in supply chain research.

Research limitations/implications

This study examines the patterns of international cooperation in supply chain research during the COVID-19 pandemic, providing insights into the changes and mechanisms of international cooperation in this field. Moreover, the results of this study may offer practical benefits for supply chain operators and managers. By providing a deeper understanding of the international cooperation patterns in the field, this research could contribute to the recovery and growth of the global supply chain.

Social implications

This study's analysis of the impact of crisis events, such as the COVID-19 pandemic, on international cooperation in supply chain research contributes to the theoretical development of the field. Additionally, by examining how academia responds to emergencies, it provides valuable insights for operations and supply chain managers in their pursuit of more effective supply chain management.

Originality/value

This study provides a preliminary examination of the international cooperation patterns of supply chain research in the context of the COVID-19 pandemic, representing a novel and early contribution to the existing literature, helping to expand upon current understanding in the field and provide a more comprehensive perspective. Furthermore, this study offers a practical analysis strategy for future supply chain research, fostering progress and growth in the field.

Personal protective equipment availability and accessibility among nurses and midwives in selected urban general hospitals in Lusaka, Zambia: a cross-sectional study

Introduction

the World Health Organization (WHO) declared COVID-19 a pandemic in January 2020, which has spread to many countries, including Zambia. Zambia has had challenges in providing personal protective equipment (PPEs) to nurses and midwives. The study's objective was to assess the availability and accessibility of PPEs among nurses and midwives caring for women in the general hospitals in Lusaka, Zambia.

Methods

a cross-sectional analytical study design was conducted at five general hospitals in Lusaka on 162 nurses and midwives between February and April 2021, selected by purposive sampling of study sites and simple random sampling to select the participants. Data was collected using a semi-structured self-administered questionnaire and analyzed in STATA version 13. Chi-square and Fisher's exact test were used to test associations between the independent variables and the outcome, and a multivariable logistic regression was used to investigate the predictors of accessing PPEs.

Results

out of the 162 who participated in the study, 48.8% were nurses, while 51.2% were midwives. Only 10% (16/160) of the participants reported having enough PPEs at work. Age, marital status, PPE use, employment duration, and protection confidence were associated with accessibility (P<0.05).

Conclusion

overall, there was an inadequate provision of PPEs in the health facilities putting the nurses and midwives at a high risk of acquiring COVID-19. Policymakers need a deliberate move to make the availability and accessibility of PPEs a reality during the pandemic.

Advanced deep learning approaches to predict supply chain risks under COVID-19 restrictions

The ongoing COVID-19 pandemic has created an unprecedented predicament for global supply chains (SCs). Shipments of essential and life-saving products, ranging from pharmaceuticals, agriculture, and healthcare, to manufacturing, have been significantly impacted or delayed, making the global SCs vulnerable. A better understanding of the shipment risks can substantially reduce that nervousness. Thenceforth, this paper proposes a few Deep Learning (DL) approaches to mitigate shipment risks by predicting "if a shipment can be exported from one source to another", despite the restrictions imposed by the COVID-19 pandemic. The proposed DL methodologies have four main stages: data capturing, de-noising or pre-processing, feature extraction, and classification. The feature extraction stage depends on two main variants of DL models. The first variant involves three recurrent neural networks (RNN) structures (i.e., long short-term memory (LSTM), Bidirectional long short-term memory (BiLSTM), and gated recurrent unit (GRU)), and the second variant is the temporal convolutional network (TCN). In terms of the classification stage, six different classifiers are applied to test the entire methodology. These classifiers are SoftMax, random trees (RT), random forest (RF), k-nearest neighbor (KNN), artificial neural network (ANN), and support vector machine (SVM). The performance of the proposed DL models is evaluated based on an online dataset (taken as a case study). The numerical results show that one of the proposed models (i.e., TCN) is about 100% accurate in predicting the risk of shipment to a particular destination under COVID-19 restrictions. Unarguably, the aftermath of this work will help the decision-makers to predict supply chain risks proactively to increase the resiliency of the SCs.

Effectiveness of a low-cost UVGI chamber for decontaminating filtering facepiece respirators to extend reuse

In emergencies like the COVID-19 pandemic, the reuse or reprocessing of filtering facepiece respirators (FFRs) may be required to mitigate exposure risk. Research gap: Only a few studies evaluated decontamination effectiveness against SARS-CoV-2 that are practical for low-resource settings. This study aimed to determine the effectiveness of a relatively inexpensive ultraviolet germicidal irradiation chamber to decontaminate FFRs contaminated with SARS-CoV-2. A custom-designed UVGI chamber was constructed to determine the ability to decontaminate seven FFR models including N95s, KN95, and FFP2s inoculated with SARS-CoV-2. Vflex was excluded due to design folds/pleats and UVGI shadowing inside the chamber. Structural and functional integrity tolerated by each FFR model on repeated decontamination cycles was assessed. Twenty-seven participants were fit-tested over 30 cycles for each model and passed if the fit factor was ≥100. Of the FFR models included for testing, only the KN95 model failed filtration. The 3M™ 3M 1860 and Halyard™ duckbill 46727 (formerly Kimberly Clark) models performed better on fit testing than other models for both pre-and-post decontaminations. Fewer participants (0.3 and 0.7%, respectively) passed fit testing for Makrite 9500 N95 and Greenline 5200 FFP2 and only two for the KN95 model post decontamination. Fit testing appeared to be more affected by donning & doffing, as some passed with adjustment and repeat fit testing. A ≥ 3 log reduction of SARS-CoV-2 was achieved for worn-in FFRs namely Greenline 5200 FFP2. Conclusion: The study showed that not all FFRs tested could withstand 30 cycles of UVGI decontamination without diminishing filtration efficiency or facial fit. In addition, SARS-CoV-2 log reduction varied across the FFRs, implying that the decontamination efficacy largely depends on the decontamination protocol and selection of FFRs. We demonstrated the effectiveness of a low-cost and scalable decontamination method for SARS-CoV-2 and the effect on fit testing using people instead of manikins. It is recognized that extensive experimental evidence for the reuse of decontaminated FFRs is lacking, and thus this study would be relevant and of interest in crisis-capacity settings, particularly in low-resource facilities.

Green Closed-Loop Supply Chain Network Design During the Coronavirus (COVID-19) Pandemic: a Case Study in the Iranian Automotive Industry

This paper presents a new mathematical model of the green closed-loop supply chain network (GCLSCN) during the COVID-19 pandemic. The suggested model can explain the trade-offs between environmental (minimizing CO2 emissions) and economic (minimizing total costs) aspects during the COVID-19 outbreak. Considering the guidelines for hygiene during the outbreak helps us design a new sustainable hygiene supply chain (SC). This model is sensitive to the cost structure. The cost includes two parts: the normal cost without considering the coronavirus pandemic and the cost with considering coronavirus. The economic novelty aspect of this paper is the hygiene costs. It includes disinfection and sanitizer costs, personal protective equipment (PPE) costs, COVID-19 tests, education, medicines, vaccines, and vaccination costs. This paper presents a multi-objective mixed-integer programming (MOMIP) problem for designing a GCLSCN during the pandemic. The optimization procedure uses the scalarization approach, namely the weighted sum method (WSM). The computational optimization process is conducted through Lingo software. Due to the recency of the COVID-19 pandemic, there are still many research gaps. Our contributions to this research are as follows: (i) designed a model of the green supply chain (GSC) and showed the better trade-offs between economic and environmental aspects during the COVID-19 pandemic and lockdowns, (ii) designed the hygiene supply chain, (iii) proposed the new indicators of economic aspects during the COVID-19 outbreak, and (iv) have found the positive (reducing CO2 emissions) and negative (increase in costs) impacts of COVID-19 and lockdowns. Therefore, this study designed a new hygiene model to fill this gap for the COVID-19 condition disaster. The findings of the proposed network illustrate the SC has become greener during the COVID-19 pandemic. The total cost of the network was increased during the COVID-19 pandemic, but the lockdowns had direct positive effects on emissions and air quality.

Effectiveness of front line and emerging fungal disease prevention and control interventions and opportunities to address appropriate eco-sustainable solutions

Fungal pathogens contribute to significant disease burden globally; however, the fact that fungi are eukaryotes has greatly complicated their role in fungal-mediated infections and alleviation. Antifungal drugs are often toxic to host cells and there is increasing evidence of adaptive resistance in animals and humans. Existing fungal diagnostic and treatment regimens have limitations that has contributed to the alarming high mortality rates and prolonged morbidity seen in immunocompromised cohorts caused by opportunistic invasive infections as evidenced during HIV and COVID-19 pandemics. There is a need to develop real-time monitoring and diagnostic methods for fungal pathogens and to create a greater awareness as to the contribution of fungal pathogens in disease causation. Greater information is required on the appropriate selection and dose of antifungal drugs including factors governing resistance where there is commensurate need to discover more appropriate and effective solutions. Popular azole fungal drugs are widely detected in surface water and sediment due to incomplete removal in wastewater treatment plants where they are resistant to microbial degradation and may cause toxic effects on aquatic organisms such as algae and fish. UV has limited effectiveness in destruction of anti-fungal drugs where there is increased interest in the combination approaches such as novel use of pulsed-plasma gas-discharge technologies for environmental waste management. There is growing interest in developing alternative and complementary green eco-biocides and disinfection innovation. Fungi present challenges for cleaning, disinfection and sterilization of reusable medical devices such as endoscopes where they (example, Aspergillus and Candida species) can be protected when harboured in build-up biofilm from lethal processing. Information on the efficacy of established disinfection and sterilization technologies to address fungal pathogens including bottleneck areas that present high risk to patients is lacking. There is a need to address risk mitigation and modelling to inform efficacy of appropriate intervention technologies that must consider all contributing factors where there is potential to adopt digital technologies to enable real-time analysis of big data, such as use of artificial intelligence and machine learning. International consensus on standardised protocols for developing and reporting on appropriate alternative eco-solutions must be reached, particularly in order to address fungi with increasing drug resistance where research and innovation can be enabled using a One Health approach.

Blood plasma supply chain planning to respond COVID-19 pandemic: a case study

The COVID-19 pandemic causes a severe threat to human lives worldwide. Convalescent plasma as supportive care for COVID-19 is critical in reducing the death rate and staying in hospitals. Designing an efficient supply chain network capable of managing convalescent plasma in this situation seems necessary. Although many researchers investigated supply chains of blood products, no research was conducted on the planning of convalescent plasma in the supply chain framework with specific features of COVID-19. This gap is covered in the current work by simultaneous regular and convalescent plasma flow in a supply chain network. Besides, due to the growing importance of environmental problems, the resulting carbon emission from transportation activities is viewed to provide a green network. In other words, this study aims to plan the integrated green supply chain network of regular and convalescent plasma in the pandemic outbreak of COVID-19 for the first time. The presented mixed-integer multi-objective optimization model determines optimal network decisions while minimizing the total cost and total carbon emission. The Epsilon constraint method is used to handle the considered objectives. The model is applied to a real case study from the capital of Iran. Sensitivity analyses are carried out, and managerial insights are drawn. Based on the obtained results, product demand impacts the objective functions significantly. Moreover, the systems' total carbon emission is highly dependent on the flow of regular plasma. The results also reveal that changing transportation emission unit causes significant variation in the total emission while the total cost remains fixed.

Can circular healthcare economy be achieved through implementation of sustainable healthcare supply chain practices? Empirical evidence from Indian healthcare sector

Purpose

Idea of circular economy defies the classical “make-use-dispose” approach of linear economic model. In the context of health-care industry, it relies heavily on the supply chain practices implemented by industry stakeholders. The purpose of this study is to explore such relationships, study their structure and put it across for attaining sustainability at large.

Design/methodology/approach

This study is an empirical research conducted on 145 health-care firms. The collected data is analysed to develop structural and measurement model. The five constructed hypotheses are examined and tested through structural equation modelling.

Findings

The study illustrates the latent relationships that exist among the stakeholders involvement, sustainable supply chain practices, sustainable performance and circular economy for health-care industry. It is found that the adoption of sustainable supply chain practices improves health-care performance, which, in turn, have positive influence on circular economy.

Research limitations/implications

The structural and measurement model is developed in the context of circular health-care economy. It can be validated or improvised by conducting similar research in other industry using different methods. This research work fulfils the long existing gap in research by offering a linkage between various constructs to achieve health-care circular economy. Based on the research results, future researchers can build theories of circular economy and sustainability for health-care industry.

Originality/value

The study attempts to study the supply chain ways to achieve circular economy for Indian health-care sector. It considered latent relationships among the set of constructs, which are needed for theory building at later stage.

Managing COVID-19 in an Australian designated isolation facility: Implications for current and future healthcare crises based on in-depth interviews

Health care workers' (HCWs) lived experiences and perceptions of the pandemic can prove to be a valuable resource in the face of a seemingly persistent Novel coronavirus disease 2019 (COVID-19)-to inform ongoing efforts, as well as identify components essential to a crisis preparedness plan and the issues pertinent to supporting relevant, immediate change. We employed a phenomenological approach and, using purposive sampling, conducted 39 semi-structured interviews with senior healthcare professionals who were employed at a designated COVID-19 facility in New South Wales (NSW), Australia during the height of the pandemic in 2020. Participants comprised administrators, heads of department and senior clinicians. We obtained these HCWs' (i) perspectives of their lived experience on what was done well and what could have been done differently and (ii) recommendations on actions for current and future crisis response. Four themes emerged: minimise the spread of disease at all times; maintain a sense of collegiality and informed decision-making; plan for future crises; and promote corporate and clinical agility. These themes encapsulated respondents' insights that should inform our capacity to meet current needs, direct meaningful and in situ change, and prepare us for future crises. Respondents' observations and recommendations are informative for decision-makers tasked with mobilising an efficacious approach to the next health crisis and, in the interim, would aid the governance of a more robust workforce to effect high quality patient care in a safe environment.

Recent advances in sterilization and disinfection technology: A review

Sterilization and disinfection of pollutants and microorganisms have been extensively studied in order to address the problem of environmental contamination, which is a crucial issue for public health and economics. Various form of hazardous materials/pollutants including microorganisms and harmful gases are released into the environment that enter into the human body either through inhalation, adsorption or ingestion. The human death rate rises due to various respiratory ailments, strokes, lung cancer, and heart disorders related with these pollutants. Hence, it is essential to control the environmental pollution by applying economical and effective sterilization and disinfections techniques to save life. In general, numerous forms of traditional physical and chemical sterilization and disinfection treatments, such as dry and moist heat, radiation, filtration, ethylene oxide, ozone, hydrogen peroxide, etc. are known along with advanced techniques. In this review we summarized both advanced and conventional techniques of sterilization and disinfection along with their uses and mode of action. This review gives the knowledge about the advantages, disadvantages of both the methods comparatively. Despite, the effective solution given by the advanced sterilization and disinfection technology, joint technologies of sterilization and disinfection has proven to be more effective innovation to protect the indoor and outdoor environments.

The Global Impact of COVID-19 on Craniomaxillofacial Surgeons: A Follow-Up Survey After One Year

Study Design

Comparative cross-sectional.

Objective

To measure the impact that COrona VIrus Disease-19 (COVID-19) has had on craniomaxillofacial (CMF) surgeons after 1 year and compare it with 2020 data by (1) measuring access to adequate personal protective equipment (PPE), (2) performance of elective surgery, and (3) the vaccination status. This should be investigated because most CMF surgeons felt that hospitals did not provide them with adequate PPE.

Methods

The investigators surveyed the international AO CMF membership using a 30-item online questionnaire and compared it to a previous study. The primary predictor variable was year of survey administration. Primary outcome variables were availability of adequate personal protective equipment (adequate/inadequate), performance of elective surgery (yes/no), and vaccination status (fully vaccinated/partly vaccinated/not vaccinated). Descriptive and analytic statistics were computed. Binary logistic regression models were created to measure the association between year and PPE availability. Statistical significance level was set at P < .05.

Results

The sample was composed of 523 surgeons (2% response rate). Most surgeons reported access to adequate PPE (74.6%). The most adequate PPE was offered in Europe (87.8%) with the least offered in Africa (45.5%). Surgeons in 2021 were more likely to report adequate PPE compared to 2020 (OR 3.74, 95% CI [2.59-4.39]). Most of the respondents resumed elective surgery (79.5% vs 13.3% in 2020) and were fully vaccinated (59.1%).

Conclusions

Most CMF surgeons now have access to adequate PPE, resumed elective surgery, and are either fully or partly vaccinated. Future studies should investigate the long-term impact of the fast-evolving COVID-19 pandemic on CMF surgeons.

Performance Measurement of the Sustainable Supply Chain During the COVID-19 Pandemic: A real-life case study

This paper aims to introduce a framework to measure the sustainable performance of the supply chain (SC) during the COVID-19 pandemic. The SC stakeholders in this investigation are Suppliers, Production / Remanufacturing / Refurbishing Centers (Factories), Collection / Distribution Centers, Recycling / Landfill Centers, and Customers. The suggested sustainable supply chain (SSC) performance measurement included three pillars with 23 indicators. To evaluate the overall sustainability of the SC understudy, a composite index has been developed that combines all the indicators to reflect the sustainability performance of the SC. Four steps are involved in creating a composite index:1) measuring the value of indicators, 2) weighing indicators, 3) Using the normalization technique, and 4) Evaluating the overall SSC indicator. The real case in Iran is selected as an illustrative case. Our research contributions are: We suggested a novelty indicator of SSC to better show the economic, environmental, and social tradeoffs during the COVID-19 pandemic and lockdowns. We have found and measured the negative and positive impacts of COVID-19 on aspects of sustainability in SC. Based on the achieved data of the real case study, a numerical example is represented to explain how to calculate the composite index. The main contribution of this paper is the development of SSC indicators during the COVID-19 epidemic.

Nurses' duty to care during the COVID-19 pandemic: a cross-sectional survey

Background

Despite the increased demand for nurses worldwide, discussion of nurses’ duty to care is lacking. This study aimed to examine nurses’ duty to care during the coronavirus disease 2019 (COVID-19) pandemic and to identify the influencing factors.

Methods

This was a cross-sectional descriptive research study that used a structured online questionnaire. Registered Korean nurses answered a demographic questionnaire and the Nash Duty to Care Scale.

Results

Age and employment at tertiary hospitals increased nurses’ duty to care. Male sex, a highly educated status, and employment at tertiary hospitals increased the perceived risk. Male sex and employment at tertiary or general hospitals increased confidence in the employer, while a high level of education and a longer total clinical career decreased the same. Age and a higher monthly wage increased perceived obligation. Age, lack of religious beliefs, and clinical experience of 3–7 years increased professional preparedness.

Conclusion

Without enough nursing manpower, the disaster response system could prove to be inefficient. Considering that adequate nurse staffing is essential in disaster management, it is crucial to ensure that nurses have a will to provide care in the case of disaster. In the future, a more active discussion on nurses’ duty to care and additional research on factors that may hinder and facilitate the same are needed.

The role of forecasting in preventing supply chain disruptions during the COVID-19 pandemic: a distributor-retailer perspective

Strengthen the resilience of supply chains was observed to be critical issue by firms to confront disruptions triggered by unprecedented demand and severe disasters. However, the extraordinarily challenging disruptions of COVID-19 pandemic, unlike any disasters seen in recent times. This study aims to provide a practical solution to supply chain (SC) disruptions by estimating the best forecasting models for demand fluctuations in the context of food and beverages. A method is proposed to predict SC disruptions and enhance SC resilience. Double exponential smoothing (DES) and the ARIMA model are adopted as forecasting approaches to estimate demand and optimum inventory quantities during three different periods of disruption associated with the COVID-19 outbreak. A downstream SC involving 2 distributors and 56 retailers is considered to elaborate inventory measurements (optimal inventory levels and total costs). The results demonstrate that distributors can reduce costs by dispensing with some retailers, particularly those who order low quantities and thus incur unjustified expenses. Furthermore, high accuracy is obtained, with minimal differences between the real data and the model’s forecast. Existing research has largely ignored supply disruptions in the distributor-retailer relationship. This study provides distributors and SC managers important knowledge on SC disruptions and identifies appropriate forecasting methods to increase SC resilience. It also provides distributors and other SC managers unprecedented insights on tackling crises of stability like COVID-19.

Mohan D, Karganroudi SS. The Unprecedented Role of 3D Printing Technology in Fighting the COVID-19 Pandemic: A Comprehensive Review

The coronavirus disease 2019 (COVID-19) rapidly spread to over 180 countries and abruptly disrupted production rates and supply chains worldwide. Since then, 3D printing, also recognized as additive manufacturing (AM) and known to be a novel technique that uses layer-by-layer deposition of material to produce intricate 3D geometry, has been engaged in reducing the distress caused by the outbreak. During the early stages of this pandemic, shortages of personal protective equipment (PPE), including facemasks, shields, respirators, and other medical gear, were significantly answered by remotely 3D printing them. Amidst the growing testing requirements, 3D printing emerged as a potential and fast solution as a manufacturing process to meet production needs due to its flexibility, reliability, and rapid response capabilities. In the recent past, some other medical applications that have gained prominence in the scientific community include 3D-printed ventilator splitters, device components, and patient-specific products. Regarding non-medical applications, researchers have successfully developed contact-free devices to address the sanitary crisis in public places. This work aims to systematically review the applications of 3D printing or AM techniques that have been involved in producing various critical products essential to limit this deadly pandemic's progression.

Radio Frequency Heating of Washable Conductive Textiles for Bacteria and Virus Inactivation

The ongoing COVID-19 pandemic has increased the use of single-use medical fabrics such as surgical masks, respirators, and other personal protective equipment (PPE), which have faced worldwide supply chain shortages. Reusable PPE is desirable in light of such shortages; however, the use of reusable PPE is largely restricted by the difficulty of rapid sterilization. In this work, we demonstrate successful bacterial and viral inactivation through remote and rapid radio frequency (RF) heating of conductive textiles. The RF heating behavior of conductive polymer-coated fabrics was measured for several different fabrics and coating compositions. Next, to determine the robustness and repeatability of this heating response, we investigated the textile's RF heating response after multiple detergent washes. Finally, we show a rapid reduction of bacteria and virus by RF heating our conductive fabric. 99.9% of methicillin-resistant Staphylococcus aureus (MRSA) was removed from our conductive fabrics after only 10 min of RF heating; human cytomegalovirus (HCMV) was completely sterilized after 5 min of RF heating. These results demonstrate that RF heating conductive polymer-coated fabrics offer new opportunities for applications of conductive textiles in the medical and/or electronic fields.

Preparing for Future Pandemics: Challenges for Healthcare Leadership

Background

The COVID-19 pandemic is our decade's largest global challenge of health leadership. There is an immediate urge to provide leadership and management with instruction during the extraordinary from before the recovery phase.

Aim

To determine the influence of the COVID-19 disease outbreak on leadership challenges during this difficult time.

Methods

This review of studies includes the work of scientists who have addressed the challenges of leadership at the time of COVID-19 pandemic. Furthermore, the references to the selected studies were used to locate additional research articles related to the topic challenges for leadership.

Conclusion

This new situation of the pandemics needs the leaders in the healthcare system to face many challenges. These challenges are being manager of the care, making decisions, caring for employees, preparing for the unexpected, and updating the community about the situation.

Digital transformation of peatland eco-innovations ('Paludiculture'): Enabling a paradigm shift towards the real-time sustainable production of 'green-friendly' products and services

The world is heading in the wrong direction on carbon emissions where we are not on track to limit global warming to 1.5 °C; Ireland is among the countries where overall emissions have continued to rise. The development of wettable peatland products and services (termed 'Paludiculture') present significant opportunities for enabling a transition away from peat-harvesting (fossil fuels) to developing 'green' eco-innovations. However, this must be balanced with sustainable carbon sequestration and environmental protection. This complex transition from 'brown to green' must be met in real time by enabling digital technologies across the full value chain. This will potentially necessitate creation of new green-business models with the potential to support disruptive innovation. This timely paper describes digital transformation of paludiculture-based eco-innovation that will potentially lead to a paradigm shift towards using smart digital technologies to address efficiency of products and services along with future-proofing for climate change. Digital transform of paludiculture also aligns with the 'Industry 5.0 - a human-centric solution'. However, companies supporting peatland innovation may lack necessary standards, data-sharing or capabilities that can also affect viable business model propositions that can jeopardize economic, political and social sustainability. Digital solutions may reduce costs, increase productivity, improve produce develop, and achieve faster time to market for paludiculture. Digitisation also enables information systems to be open, interoperable, and user-friendly. This constitutes the first study to describe the digital transformation of paludiculture, both vertically and horizontally, in order to inform sustainability that includes process automation via AI, machine learning, IoT-Cloud informed sensors and robotics, virtual and augmented reality, and blockchain for cyber-physical systems. Thus, the aim of this paper is to describe the applicability of digital transformation to actualize the benefits and opportunities of paludiculture activities and enterprises in the Irish midlands with a global orientation.

Exploring factors enabling the spread of COVID-19: Narratives of health professionals in Harare, Zimbabwe

Low- and middle-income countries (LMICs) are affected by an array of health problems ranging from the weak infrastructure health system to the shortage of equipment and qualified personnel in hospitals and other medical facilities. This makes it difficult for health systems in these countries to withstand pandemics like COVID-19 leading to a rapid infection of the population. This research study was set to explore the factors enabling the spread of COVID-19 in the city of Harare. The study utilised an explorative qualitative approach (EQA). The study recruited 40 (N = 40) health professionals who worked for the private sector and the Ministry of Health. One to one semistructured interviews were used to collect data. The data were thematically analysed and presented. Ethical approval was granted by the Joint Research Council of Zimbabwe (JREC). The study found that the shortage of personal protective equipment (PPE), disregard for social distancing, lack of running water, shortage of clinical supplies, overcrowded living houses, selective enforcement of restrictions and corruption were factors that enabled the spread of COVID-19 pandemic in the city of Harare. There is need for more hospitals to be built and fully equipped with the necessary equipment if health delivery and management of people affected by COVID-19 is to be improved. More importantly, the health system needs to be supported by a robust health promotion initiative to enlighten communities on pandemics like COVID-19 and the need to observe utmost hygiene in all spaces.

Impact of coronavirus pandemic litters on microfiber pollution-effect of personal protective equipment and disposable face masks

Coronavirus Pandemic is the current biggest challenge against humanity. Apart from the personal health issues and higher mortality by the coronavirus, recent research works have also reported the environmental impacts of the pandemic. The review aims to analyze the current status of face masks and personal protective equipment littering and subsequent environmental impact in terms of microplastic and microfiber pollution. Recent researches in this domain are collected from the leading databases with relevant keywords and critically analyzed. The review results report a multi-fold increment in the usage of personal protective equipment, particularly face masks after the pandemic. Mismanagement of these items leads them to reach the marine environment through a variety of transportation. The results show a significant amount of increment in plastic and pandemic-related littering after the pandemic. The systematic review shows that the use of synthetic fibers in disposable personal protective equipment and masks leads to release of  fibers that can add-on to microfiber pollution. The results are also true in the case of reusable masks as the repeated laundry and disinfection methods release a significantly higher amount of microfibers. Only very few studies have addressed the release of microfiber from the mask, and no studies have reported the impact of personal protective equipment. The worldwide mass adaptation and improper disposal of these materials increase the seriousness of the problem multiple folds. These findings suggest the immediate requirement of critical analysis of the pandemic-related littering and microfiber release characteristics. The research also urges the need for the implementation of an environmental management plan as a mitigation strategy around the globe.

Operationalizing resilience through collaboration: the case of Sri Lankan tea supply chain during Covid-19

This paper investigates the impact of subcomponents of collaboration: information sharing, connectivity, coordination, integration, and visibility on the tea supply chain resilience of Sri Lanka during the Covid-19 pandemic. This research was carried out with mixed methods. The quantitative approach adopted a systematic random sampling technique to determine the sample size (n = 137), whereas the qualitative study used the purposive sampling technique to determine the sample size (n = 6). Self-administered questionnaires were distributed to tea supply chain professionals and structured interviews were conducted to collect data for the qualitative approach of the study. This study found that all the subcomponents of collaboration positively impacted on tea supply chain resilience during the Covid-19. Moreover, connectivity and coordination have the highest positive impact on tea supply chain resilience while the other three sub-components: information sharing, integration and visibility have significant but relatively less positive impact on supply chain resilience. Thus, tea exporting companies must prioritise, take action steps for enhancing connectivity and coordination when formulating supply chain strategies to enable supply chain resilience. The study being one of the latest empirical studies taking Sri Lankan tea supply chain as a case study, contributes to the knowledge having identified the impact of sub-components of collaboration on tea supply chain resilience during Covid-19. Sri Lanka is one of the most vulnerable middle-income countries and its economy suffered severely during the Covid-19 outbreak. The findings will be supportive in making tea supply chains much stronger, providing a robust contribution to the country's GDP as part of Sri Lanka's national efforts in economic rebuilding.

Exploring the mechanism of action of Xuanfei Baidu granule (XFBD) in the treatment of COVID-19 based on molecular docking and molecular dynamics

Purpose

The Corona Virus Disease 2019 (COVID-19) pandemic has become a challenge of world. The latest research has proved that Xuanfei Baidu granule (XFBD) significantly improved patient’s clinical symptoms, the compound drug improves immunity by increasing the number of white blood cells and lymphocytes, and exerts anti-inflammatory effects. However, the analysis of the effective monomer components of XFBD and its mechanism of action in the treatment of COVID-19 is currently lacking. Therefore, this study used computer simulation to study the effective monomer components of XFBD and its therapeutic mechanism.

Methods

We screened out the key active ingredients in XFBD through TCMSP database. Besides GeneCards database was used to search disease gene targets and screen intersection gene targets. The intersection gene targets were analyzed by GO and KEGG. The disease-core gene target-drug network was analyzed and molecular docking was used for verification. Molecular dynamics simulation verification was carried out to combine the active ingredient and the target with a stable combination. The supercomputer platform was used to measure and analyze the number of hydrogen bonds, the binding free energy, the stability of protein target at the residue level, the solvent accessible surface area, and the radius of gyration.

Results

XFBD had 1308 gene targets, COVID-19 had 4600 gene targets, the intersection gene targets were 548. GO and KEGG analysis showed that XFBD played a vital role by the signaling pathways of immune response and inflammation. Molecular docking showed that I-SPD, Pachypodol and Vestitol in XFBD played a role in treating COVID-19 by acting on NLRP3, CSF2, and relieve the clinical symptoms of SARS-CoV-2 infection. Molecular dynamics was used to prove the binding stability of active ingredients and protein targets, CSF2/I-SPD combination has the strongest binding energy.

Conclusion

For the first time, it was found that the important active chemical components in XFBD, such as I-SPD, Pachypodol and Vestitol, reduce inflammatory response and apoptosis by inhibiting the activation of NLRP3, and reduce the production of inflammatory factors and chemotaxis of inflammatory cells by inhibiting the activation of CSF2. Therefore, XFBD can effectively alleviate the clinical symptoms of COVID-19 through NLRP3 and CSF2.

Improved COVID-19 detection with chest x-ray images using deep learning

The novel coronavirus disease, which originated in Wuhan, developed into a severe public health problem worldwide. Immense stress in the society and health department was advanced due to the multiplying numbers of COVID carriers and deaths. This stress can be lowered by performing a high-speed diagnosis for the disease, which can be a crucial stride for opposing the deadly virus. A good large amount of time is consumed in the diagnosis. Some applications that use medical images like X-Rays or CT-Scans can pace up the time used in diagnosis. Hence, this paper aims to create a computer-aided-design system that will use the chest X-Ray as input and further classify it into one of the three classes, namely COVID-19, viral Pneumonia, and healthy. Since the COVID-19 positive chest X-Rays dataset was low, we have exploited four pre-trained deep neural networks (DNNs) to find the best for this system. The dataset consisted of 2905 images with 219 COVID-19 cases, 1341 healthy cases, and 1345 viral pneumonia cases. Out of these images, the models were evaluated on 30 images of each class for the testing, while the rest of them were used for training. It is observed that AlexNet attained an accuracy of 97.6% with an average precision, recall, and F1 score of 0.98, 0.97, and 0.98, respectively.

Monitoring supply networks from mobile phone data for estimating the systemic risk of an economy

Remarkably little is known about the structure, formation, and dynamics of supply- and production networks that form one foundation of society. Neither the resilience of these networks is known, nor do we have ways to systematically monitor their ongoing change. Systemic risk contributions of individual companies were hitherto not quantifiable since data on supply networks on the firm-level do not exist with the exception of a very few countries. Here we use telecommunication meta data to reconstruct nationwide firm-level supply networks in almost real-time. We find the probability of observing a supply-link, given the existence of a strong communication-link between two companies, to be about 90%. The so reconstructed supply networks allow us to reliably quantify the systemic risk of individual companies and thus obtain an estimate for a country's economic resilience. We identify about 65 companies, from a broad range of company sizes and from 22 different industry sectors, that could potentially cause massive damages. The method can be used for objectively monitoring change in production processes which might become essential during the green transition.

New insights into perceptions of technology claims in greek-style yogurt: A view in the COVID-19 pandemic

The Covid-19 pandemic has strongly impacted people's lives and the food industry. In this sense, food products claiming nutritional and health-promoting benefits due to the presence of bioactive peptides and probiotics, such as Greek-style yogurt, have been in demand. The objective of this work was to investigate, through word association, the perception of the consumers regarding the seven concepts related to Greek-style yogurt (traditional, ultra-creamy, zero fat, high content proteins, zero lactose, light and with no added sugars), in the context of social isolation due to Covid-19. In this online survey, 346 participants completed a questionnaire. The participants were divided according to health concerns (increased, not changed, or decreased) and eating habits (improved, not changed, or worsened) during the Covid-19 pandemic. Chi-square and prototypical analysis were used as statistical tests. During the Covid-19 pandemic, based on self-report, around 66% of the participants had their eating habits and their concerns about health changed. The general associations were related to the categories pleasure, health, creamy, pleasant texture, food restriction, and loss of sensory quality. 'Health' and 'pleasure' were negatively associated with the conceptualization of Greek-style yogurt. For the zero-fat, light, and sugar-free Greek-style yogurts, the terms creamy and ultra-creamy are sensory appealing to the consumers. In general, the price and concerns about health are factors that strongly influence the purchase intention of Greek-style yogurts. The yogurts were associated with sensory and non-sensory characteristics, which can be useful for marketing strategies for of different product concepts.

Supercritical CO2 sterilization: An effective treatment to reprocess FFP3 face masks and to reduce waste during COVID-19 pandemic

The outbreak of COVID-19 pandemic unveiled an unprecedented scarcity of personal protective equipment (PPE) available in sanitary premises and for the population worldwide. This situation fostered the development of new strategies to reuse PPE that would ensure sterility and, simultaneously, preserve the filtering properties of the materials. In addition, the reuse of PPEs by reprocessing could reduce the environmental impact of the massive single-use and disposal of these materials. Conventional sterilization techniques such as steam or dry heat, ethylene oxide, and gamma irradiation may alter the functional properties of the PPEs and/or leave toxic residues. Supercritical CO2 (scCO2)-based sterilization is herein proposed as a safe, sustainable, and rapid sterilization method for contaminated face masks while preserving their performance. The functional (bacterial filtration efficiency, breathability, splash resistance, straps elasticity) properties of the processed FFP3 face masks were evaluated after 1 and 10 cycles of sterilization. Log-6 sterilization reduction levels were obtained for face masks contaminated with Bacillus pumilus endospores at mild operating conditions (CO2 at 39 °C and 100 bar for 30 min) and with low contents of H2O2 (150 ppm). Physicochemical properties of the FFP3 face masks remained unchanged after reprocessing and differences in efficacy were not observed neither in the filtration tests, following UNE-EN 14683, nor in the integrity of FFP3 filtration after the sterilization process. The herein presented method based on scCO2 technology is the first reported protocol achieving the reprocessing of FFP3 masks up to 10 cycles while preserving their functional properties.

COVID-19: Rapid prototyping and production of face shields via flat, laser-cut, and 3D-printed models

The use of personal protective equipment (PPE) has become essential to reduce the transmission of coronavirus disease 2019 (COVID-19) as it prevents the direct contact of body fluid aerosols expelled from carriers. However, many countries have reported critical supply shortages due to the spike in demand during the outbreak in 2020. One potential solution to ease pressure on conventional supply chains is the local fabrication of PPE, particularly face shields, due to their simplistic design. The purpose of this paper is to provide a research protocol and cost implications for the rapid development and manufacturing of face shields by individuals or companies with minimal equipment and materials. This article describes a best practice case study in which the establishment of a local manufacturing hub resulted in the swift production of 12,000 face shields over a seven-week period to meet PPE shortages in the North-West region of Ireland. Protocols and processes for the design, materials sourcing, prototyping, manufacturing, and distribution of face shields are described. Three types of face shields were designed and manufactured, including Flat, Laser-cut, and 3D-printed models. Of the models tested, the Flat model proved the most cost-effective (€0.51/unit), while the Laser-cut model was the most productive (245 units/day). The insights obtained from this study demonstrate the capacity for local voluntary workforces to be quickly mobilised in response to a healthcare emergency, such as the COVID-19 pandemic.