Intangible capital and reorientation of manufacturing during a pandemic

The COVID-19 pandemic has put enormous pressure on firms to respond to the economic downturn, while also providing opportunities to contribute to the health-care challenges. We investigate firms within the Sharing in Growth (SiG) programme, a government-funded transformation programme in the UK aerospace sector. We evaluate the firms that responded to the UK Ventilator Challenge, to provide equipment to the UK National Health Service (NHS) in order to tackle the pandemic, compared to the firms that did not respond. The study shows that intangible capital in terms of organizational capital is a key capability in responding to opportunities provided by the UK Ventilator Challenge. In particular, we show that the role of leadership in fostering a culture of engagement and empowerment via continuous experimentation and learning is a key capability for firms in responding to sudden and unexpected changes in the environment. Moreover, the study shows that the building and subsequent effectiveness of these forms of organizational capital among the SMEs would not have been possible without the benefits accruing from the SiG programme. We discuss the managerial and policy implications of our findings. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.

SARS-CoV-2 mutations on diagnostic gene targets in the second wave in Zimbabwe: A retrospective genomic analysis.

BACKGROUND: SARS-CoV-2 continues to be a major issue in resource-limited settings, particularly owing to the limited supply of vaccinescaused by inequitable distribution. OBJECTIVE: To monitor diagnostic gene targets to identify potential test failures caused by mutations, which is important for public health. METHODS: Here we analysed the genome sequence of SARS-CoV-2 from the second wave in Zimbabwe. A total of 377 samples weresequenced at Quadram Institute Bioscience. After quality control, 192 sequences passed and were analysed. RESULTS: The Beta variant was dominant during this period, contributing 77.6% (149) of the genomes sequenced and having a total of 2994mutations in diagnostic polymerase chain reaction target genes. Many single nucleotide polymorphism mutations resulted in amino acidsubstitution that had the potential to impact viral fitness by increasing the rate of transmission or evading the immune response to previousinfection or vaccination. CONCLUSION: There were nine lineages circulating in Zimbabwe during the second wave. The B.1.351 was dominant, accounting for >75%.There were over 3 000 mutations on the diagnostic genes and lineage B.1.351, contributing almost two-thirds of the mutations. The S-genehad the most mutations and the E-gene was the least mutated.

Strengthened Pharmacovigilance in France for Monitoring COVID-19 Vaccines and Therapeutics Toward a New Surveillance Era?

Introduction: Following the emergence of SARS-CoV-2, a range of measures have been put in place in France: strengthened surveillance of COVID-19 therapeutics and vaccines, using tools and methods developed to detect promptly any safety issues in order to take appropriate risk minimisation measures [1]. For COVID-19 therapeutics, ANSM has mobilized the French Network of regional pharmacovigilance centers (CRPV) to ensure continuous monitoring and assessment of adverse reaction reports through a specific survey. The results were discussed at an experts' monitoring committee which involves several scientific experts. The members assess collegially the potential safety signals. Then, a specific communication associated with the investigation reports are published on the ANSM website. For COVID-19 vaccines, a similar organization was put in place with additional components. Artificial intelligence and an information system have been used to optimize reports processing and improve specific data collection. Information sheets on adverse events have been made available to patients and healthcare professionals. Finally, pharmaco-epidemiological studies have been conducted in case of a potential signal for confirmation or to quantify the risk. Objective(s): To evaluate the implementation of strengthened monitoring of vaccines and therapeutics used in COVID-19. Method(s): Potential signals detected on vaccines and drugs used in COVID-19 following the implementation of new pharmacovigilance tools and methods were analysed. Result(s): As of March 31th, 2022, more than 140 million doses of COVID-19 vaccines administered with more than 150,000 adverse reactions reports, 45 monitoring committees held and 43 potential signals of COVID-19 vaccines have been transmitted by ANSM to European authorities to reinforce or initiate a signal. As of January 26, 2022, more than 2 300 adverse reactions reports collected for treatment used for patients with COVID-19, 21 monitoring committees held and 3 signals were identified. Conclusion(s): The use of tools and methods in COVID-19 vaccines and medicines monitoring have allowed for early detection of signals and implementation of appropriate risk minimisation measures. This has been made possible thanks to the whole organization of strengthened surveillance which remains agile along the pandemic crisis. Furthermore, facilitation was given to accelerate evaluation, methods to prioritize a large volume of spontaneous reports, and different channels to communicate transparently in order to build trust among stakeholders. There are still challenges to build a new era of surveillance concerning the management of a large number of adverse drug reports, expertise and communication in a daily routine.

Strengthened Pharmacovigilance in France for Monitoring COVID-19 Vaccines and Therapeutics Toward a New Surveillance Era?: An International Journal of Medical Toxicology and Drug Experience

Introduction: Following the emergence of SARS-CoV-2, a range of measures have been put in place in France: strengthened surveillance of COVID-19 therapeutics and vaccines, using tools and methods developed to detect promptly any safety issues in order to take appropriate risk minimisation measures [1]. For COVID-19 therapeutics, ANSM has mobilized the French Network of regional pharmacovigilance centers (CRPV) to ensure continuous monitoring and assessment of adverse reaction reports through a specific survey. The results were discussed at an experts' monitoring committee which involves several scientific experts. The members assess collegially the potential safety signals. Then, a specific communication associated with the investigation reports are published on the ANSM website. For COVID-19 vaccines, a similar organization was put in place with additional components. Artificial intelligence and an information system have been used to optimize reports processing and improve specific data collection. Information sheets on adverse events have been made available to patients and healthcare professionals. Finally, pharmaco-epidemiological studies have been conducted in case of a potential signal for confirmation or to quantify the risk. Objective: To evaluate the implementation of strengthened monitoring of vaccines and therapeutics used in COVID-19. Methods: Potential signals detected on vaccines and drugs used in COVID-19 following the implementation of new pharmacovigilance tools and methods were analysed. Results: As of March 31th, 2022, more than 140 million doses of COVID-19 vaccines administered with more than 150,000 adverse reactions reports, 45 monitoring committees held and 43 potential signals of COVID-19 vaccines have been transmitted by ANSM to European authorities to reinforce or initiate a signal. As of January 26, 2022, more than 2 300 adverse reactions reports collected for treatment used for patients with COVID-19, 21 monitoring committees held and 3 signals were identified. Conclusion: The use of tools and methods in COVID-19 vaccines and medicines monitoring have allowed for early detection of signals and implementation of appropriate risk minimisation measures. This has been made possible thanks to the whole organization of strengthened surveillance which remains agile along the pandemic crisis. Furthermore, facilitation was given to accelerate evaluation, methods to prioritize a large volume of spontaneous reports, and different channels to communicate transparently in order to build trust among stakeholders. There are still challenges to build a new era of surveillance concerning the management of a large number of adverse drug reports, expertise and communication in a daily routine.

Nutritional adequacy and accuracy in long-stay critically ill patients as measured by indirect calorimetry

Introduction: Nutritional optimisation is recognised as having significant impact on clinical and functional outcomes of critically ill patients.1 Clinical recommendations suggest use of indirect calorimetry guided nutrition in the intensive care unit (ICU),2 and a recent systematic review demonstrated improved outcomes from its use.3 The COVID-19 pandemic has seen a greater proportion of patients with prolonged critical illness, a cohort for whom nutritional optimisation is a key unmet need.4 Objectives: To assess rates of over and underfeeding in a tertiary centre ICU and how these relate to markers of catabolism and persistent critical illness. Methods: Serial measurements of REE (resting energy expenditure) and RQ (respiratory quotient) by indirect calorimetry were performed using Q-NRG+ device (COSMED, Rome, Italy). Nutritional intake and estimations of requirements were recorded concurrently together with routine clinical observations, and markers of critical illness, catabolism and over or underfeeding. Results: Across 30 patients, REE was lower than estimated energy requirements, 24.2 (IQR 20.0-28.1) kcal/ day/kg IBW vs. 29.1(IQR 25.4-33.1) kcal/day/kg IBW, p<0.001. 41.8% of measurements showed overfeeding (actual calorie intake >110% of REE), and 23.3% showed underfeeding (actual calorie intake <85% of REE). Obese patients (n=15) were underfed (-98kcal/day deficit) compared to non-obese patients (n=15), who were on average overfed (+256kcal/day surplus), p=0.021. Overfeeding was also associated with greater length of ICU admission (R2 0.159, p<0.005). Median day of ICU admission in overfed patients was 39 days (IQR 24-56), and in underfed patients 21.5 (IQR 7.5-45.25). However, there was no significant association between calorie surplus or deficit, and other markers of overfeeding PaCO2, insulin use, ureacreatinine-ratio. Conclusion: This service evaluation recorded measurements of REE and RQ in critically ill patients with high lengths of ICU stay (up to 66 days). We observed increased rates of overfeeding with increased duration of ICU admission, and increased overfeeding in non-obese patients.

Chelsea Critical Care Physical Assessment scores and tracheostomy weaning in cardiothoracic critically ill patients: A retrospective observational study

Introduction: Chelsea Critical Care Physical Assessment tool (CPAx) is a bedside objective tool designed to measure function in critical illness. CPAx has demonstrated validity, reliability and responsiveness, and is widely used, in the critical care population.1 Martin et al2 looked at responsiveness and construct validity of the Chelsea Critical Care Physical Assessment Tool in a cardiothoracic intensive care unit (ICU). They found that CPAx is able to detect clinically important changes in patients' physical function throughout their hospital stay suggesting good responsiveness. There have been no studies to date that investigate whether there is a relationship between tracheostomy weaning and CPAx score increasing with rehabilitation. Objective: This retrospective study investigates if a relationship exists between an increasing CPAx score and tracheostomy weaning. Secondary aims include whether an increasing CPAx score indicates when a patient may be ready for decannulation. If there is a relationship between CPAx score and tracheostomy weaning, does this relationship change depending on present condition causing critically illness, i.e. medical or surgical admission? Methods: A six month retrospective data collection was completed from June 2020 to December 2020, with data collected from the physiotherapist's electronic notes on Metavision. Inclusion criteria comprised of patients admitted to Royal Papworth Hospital NHS Foundation Trust (RPH) ICU over the 6-month period, requiring tracheostomy insertion. All patients were over 18 years old, had a COVID-19 negative status and must have stayed on ICU for 3 days or more with a tracheostomy (n=28). A negative COVID-19 status was stipulated as the CPAx score has not yet been validated in COVID-19 positive patient group.3 As there is no formalised outcome for tracheostomy weaning a 0-5 scale was created to gain a numerical value of weaning. Results: Of the 28 patients, 23 patients survived RPH ICU stay;5 patients died. 14 of the 28 patients were decannulated during their RPH ICU admission, and 9 patients were repatriated to their local hospital prior to decannulation. Spearman's Rank Correlation Coefficient were applied to the data sets, showing a positive correlation between CPAx score and tracheostomy weaning (CI set at 95%, p = 0.01, r=0.79). Medical cardiothoracic patients e.g. pneumonia and cardiology patients, appear to have a stronger positive correlation (r=0.84) with CPAx and tracheostomy, than surgical cardiothoracic patients (r=0.73). Conclusions: An increasing CPAx score and improvements in tracheostomy weaning have a strong positive correlation, stronger with medical than surgical cardiothoracic critically ill patients. Although a positive correlation is demonstrated, there was inadequate data to indicate that CPAx scores could be used to indicate when a patient may be ready for decannulation. Prospective research is warranted to investigate the relationships further.

From Face-To-Face to the Online Space: The Continued Relevance of Connecting Students With Each Other and Their Learning Post COVID-19

At the time of writing, the largest state in Australia is once more in full lockdown because of surging cases from the new variant strain of COVID-19. During the last lockdown in early 2020, we conducted a study analyzing the efficacy of mapping best-practice face-to-face university teaching into the online space. This article reports on the results of a survey from the perspective of student belonging. Isolation was the most prevalent theme recorded by students despite not being one of the research questions asked. The importance of adopting the model in online university courses in the current/post-COVID-19 world is presented.

"Watch Me Grow- Electronic (WMG-E)" surveillance approach to identify and address child development, parental mental health, and psychosocial needs: study protocol.

BACKGROUND: The COVID-19 pandemic and the associated economic recession has increased parental psychosocial stress and mental health challenges. This has adversely impacted child development and wellbeing, particularly for children from priority populations (culturally and linguistically diverse (CALD) and rural/regional communities) who are at an already increased risk of health inequality. The increased mental health and psychosocial needs were compounded by the closure of in-person preventive and health promotion programs resulting in health organisations embracing technology and online services. Watch Me Grow- Electronic (WMG-E) - developmental surveillance platform- exemplifies one such service. WMG-E was developed to monitor child development and guide parents towards more detailed assessments when risk is identified. This Randomised Controlled Trial (RCT) aims to expand WMG-E as a digital navigation tool by also incorporating parents' mental health and psychosocial needs. Children and families needing additional assessments and supports will be electronically directed to relevant resources in the 'care-as-usual' group. In contrast, the intervention group will receive continuity of care, with additional in-person assessment and 'warm hand over' by a 'service navigator' to ensure their needs are met. METHODS: Using an RCT we will determine: (1) parental engagement with developmental surveillance; (2) access to services for those with mental health and social care needs; and (3) uptake of service recommendations. Three hundred parents/carers of children aged 6 months to 3 years (recruited from a culturally diverse, or rural/regional site) will be randomly allocated to the 'care-as-usual' or 'intervention' group. A mixed methods implementation evaluation will be completed, with semi-structured interviews to ascertain the acceptability, feasibility and impact of the WMG-E platform and service navigator. CONCLUSIONS: Using WMG-E is expected to: normalise and de-stigmatise mental health and psychosocial screening; increase parental engagement and service use; and result in the early identification and management of child developmental needs, parental mental health, and family psychosocial needs. If effective, digital solutions such as WMG-E to engage and empower parents alongside a service navigator for vulnerable families needing additional support, will have significant practice and policy implications in the pandemic/post pandemic period. TRIAL REGISTRATION: The trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819 ) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.

The Artificial University: Decision Support for Universities in the COVID-19 Era

Operating universities under pandemic conditions is a complex undertaking. The Artificial University (TAU) responds to this need. TAU is a configurable, open-source computer simulation of a university using a contact network based on publicly available information about university classes, residences, and activities. This study evaluates health outcomes for an array of interventions and testing protocols in an artificial university of 6,500 students, faculty, and staff. Findings suggest that physical distancing and centralized contact tracing are most effective at reducing infections, but there is a tipping point for compliance below which physical distancing is less effective. If student compliance is anything short of high, it helps to have separate buildings for quarantining infected students, thereby gracefully increasing compliance. Hybrid in-person and online classes and closing fitness centers do not significantly change cumulative infections but do significantly decrease the number of the infected at any given time, indicating strategies for "flattening the curve" to protect limited resources. Supplementing physical distancing with centralized contact tracing decreases infected individuals by an additional 14%;boosting frequency of testing for student-facing staff yields a further 7% decrease. A trade-off exists between increasing the sheer number of infection tests and targeting testing for key nodes in the contact network (i.e., student-facing staff). There are significant advantages to getting and acting on test results quickly. The costs and benefits to universities of these findings are discussed. Artificial universities can be an important decision support tool for universities, generating useful policy insights into the challenges of operating universities under pandemic conditions.