Hospital management and game theory

The COVID-19 pandemic has highlighted that we are stronger when joined around a shared vision. A challenging task in hospitals is to define the scenarios and face change in a manner that benefits the patients, clinical practices and themselves institutions. Game theory provides frames of study for healthcare decision-making at high levels as the government and professional societies. This allows us to study and incorporate this theory to define and approach solutions that can hold the different health systems feasible and wholesome. This chapter presents a conceptual framework that sheds light on medical tutoring in a hospital. Intensive care units are the focus of this study because they have a relevant role in this scenario. The new educational challenges in critical care services must face from a perspective that provides a proper response to changing actuality. This is done through enhanced practice to make decisions using game theory. The principles of this theory predict human behaviour, helping with decision-making and describing how determined results can appear that are not optimal for the entire group. The implementation of critical thinking between an intensive care unit and another service is studied. The results obtained agree with the expected behaviour. The study indicates that game theory provides a framework which manages educational collaboration between clinical units in the hospital. It can get suitable models for strategic interactions that frequently occur in education training and application in medicine. The chapter studies the environments wherein the theory has been applied and the upcoming challenges in this sector. © 2023 Nova Science Publishers, Inc. All rights reserved.

Political Differences in Knowledge and Its Connection with Vaccination during COVID-19

Conservatives in the United States have more negative attitudes toward COVID-19 vaccines and are less likely to be vaccinated than liberals. The present research tests whether political differences in knowledge underlie differences in vaccination. Participants in Study 1 completed a knowledge test about COVID-19 vaccines and indicated whether they had received a COVID-19 vaccine. Republicans had worse knowledge about COVID-19 vaccines than Democrats. Furthermore, political differences in vaccination were significantly mediated by knowledge. Study 2 found that exposure to facts about COVID-19 vaccines led to more favorable perceptions of vaccine effectiveness among Republicans, which in turn was associated with stronger vaccination intentions. These data suggest that knowledge about COVID-19 vaccines may help to explain political differences in vaccination. © 2023 Hogrefe Publishing.

A bibliographical analysis of teamwork in the Web of Science

The purpose of the study is to analyze the development of the scientific production of teamwork, in relation to the performance and productivity of employees, and to distinguish whether the Covid-19 period has affected it. The Web of Science database was used to collect the articles and the methodology used was bibliometric, covering the period from 1993 to December 2021 with 305 articles. Bibliometrix and VOSviewer were used to obtain data for the detailed analysis of results such as world scientific production, areas of knowledge, most cited articles, by language, authors and relevant sources and impact, network of cocitations, keywords, classification of empirical-theoretical methodologies and theories that support the documents. In terms of results, it is highlighted that the predominant area was economic business, the most used methodology was empirical, and in terms of theories supporting the articles, role theory stands out. As for Covid-19, although in previous years the production showed an increase, it can be emphasized that in the last two years there has been a significant increase.

Ensayo clínico aleatorizado en pacientes COVID- 19 sobre el efecto de la fisioterapia precoz en su acondicionamiento físico

Introduction: The WHO recommends early rehabilitation and mobilization interventions in patients hospitalized for COVID-19. The benefits of early physiotherapy, during the hospital stay, have not been proven in clinical trials. Objective: To evaluate the effects of early physiotherapy and health education in hospitalized COVID-19 patients, in relation to the symptoms described in previous studies, analyzing differences between groups regarding their physical conditioning, need for oxygen therapy and hospital stay. Methodology: Randomized clinical trial with two arms, developed in hospitalization and intermediate respiratory care units, with COVID-19 patients. Sixty-four patients included in the experimental group (implementation of an early physiotherapy program after 48–72 h of admission) and 62 patients in the control group (usual treatment of the center). Sociodemographic and clinical variables: mMRC, oxygen therapy, MRC-SS, 30 s-STST, FPM, Tinetti, FRAIL Scale and PCFS. They were evaluated on admission, discharge and two months after discharge. Results: The experimental patients had fewer days of admission and conventional oxygen therapy. At discharge, they present a lower risk of falling (72.9% vs. 95.8%) and less weakness in MRC-SS (2.1% vs. 14.6%). At two months they had less frailty (5.0% vs. 14.5%), greater hand grip strength, less dyspnea, better results in 30s-STST and fewer post-COVID limitations (86.5% vs. 96.4%). Conclusión: The intervention of early physiotherapy in COVID-19 patients and the health education received, prevents muscle weakness during admission, improves physical conditioning at discharge and two months later, and reduces the days of hospital stay. ClinicalTrials.gov (NCT05032885). © 2023 Asociación Española de Fisioterapeutas

Prone positioning in COVID-19 patients with acute respiratory distress syndrome and invasive mechanical ventilation Decúbito prono en pacientes COVID-19 con síndrome de distrés respiratorio agudo y ventilación mecánica invasiva

Objective To identify adverse events related to prone positioning in COVID-19 patients with severe disease and acute respiratory distress syndrome, to analyze the risk factors associated with the development of anterior pressure ulcers, to determine whether the recommendation of prone positioning is associated with improved clinical outcomes. Methods Retrospective study performed in 63 consecutive patients with COVID-19 pneumonia admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning between March and April 2020. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. Results A total of 139 proning cycles were performed. The mean number of cycles were 2 [1–3] and the mean duration per cycle was of 22 h [15–24]. The prevalence of adverse events this population was 84.9 %, being the physiologic ones (i.e., hypo/hypertension) the most prevalent. 29 out of 63 patients (46%) developed prone-related pressure ulcers. The risk factors for prone-related pressure ulcers were older age, hypertension, levels of pre-albumin <21 mg/dl, the number of proning cycles and severe disease. We observed a significant increase in the PaO2/FiO2 at different time points during the prone positioning, and a significant decrease after it. Conclusions There is a high incidence of adverse events due to PD, with the physiological type being the most frequent. The identification of the main risk factors for the development of prone-related pressure ulcers will help to prevent the occurrence of these lesions during the prone positioning. Prone positioning offered an improvement in the oxygenation in these patients.

Challenges of the wine industry of Baja California, Mexico

The Baja California wine industry has developed significantly in recent decades, based on the increase in wine consumption in Mexico and the state government's interest for the development of regional vocations. However, its growth has not been accompanied by an integration of the sector among the producers and with the communities where it is based. This work presents an analysis of the current situation of viticulture in the state from its value chain, to identify the challenges before and after the COVID-19 pandemic, considering the actions carried out from the production of the grape, transformation of the wine, distribution, marketing and commercialization, highlighting the social problems that affect the development of the sector and cultural identity. In this research was used the systematization methodology, which articulates the experiences of key actors related to the industry in the territory. To obtain the information, focus groups organized by activities related to the wine sector in Valle de Guadalupe were held.

Prone positioning in COVID-19 patients with acute respiratory distress syndrome and invasive mechanical ventilation.

OBJECTIVE: To identify adverse events related to prone positioning in COVID-19 patients with severe disease and acute respiratory distress syndrome, to analyze the risk factors associated with the development of anterior pressure ulcers, to determine whether the recommendation of prone positioning is associated with improved clinical outcomes. METHODS: Retrospective study performed in 63 consecutive patients with COVID-19 pneumonia admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning between March and April 2020. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. RESULTS: A total of 139 proning cycles were performed. The mean number of cycles were 2 [1-3] and the mean duration per cycle was of 22h [15-24]. The prevalence of adverse events this population was 84.9 %, being the physiologic ones (i.e., hypo/hypertension) the most prevalent. 29 out of 63 patients (46%) developed prone-related pressure ulcers. The risk factors for prone-related pressure ulcers were older age, hypertension, levels of pre-albumin <21mg/dl, the number of proning cycles and severe disease. We observed a significant increase in the PaO2/FiO2 at different time points during the prone positioning, and a significant decrease after it. CONCLUSIONS: There is a high incidence of adverse events due to PD, with the physiological type being the most frequent. The identification of the main risk factors for the development of prone-related pressure ulcers will help to prevent the occurrence of these lesions during the prone positioning. Prone positioning offered an improvement in the oxygenation in these patients.

[Update of the recommendations of the Pneumonia Zero project]. / Actualización de las recomendaciones del proyecto Neumonía Zero.

The SARS-Cov-2 pandemic has had a negative impact on the implementation of the Zero Pneumonia recommendations and has been accompanied by an increase in rates of ventilator- associated pneumonia (VAP) in intensive care units in Spain. With the aim of reducing the current rates to 7 episodes per 1000 days of MV, the recommendations of the initial project have been updated.Twenty-seven measures were identified and classified into 12 functional measures (semi- sitting position, strict hand hygiene, airway manipulation training, daily assessment of possible extubation, protocolisation of weaning, early tracheostomy, non-invasive ventilation, microbiological surveillance, tubing change, humidification, respiratory physiotherapy, post- pyloric enteral nutrition), 7 mechanical measures (pneumotap pressure control, subglottic suction tubes, subglottic suctioning of tubes, subglottic suctioning of tubes, post-pyloric enteral nutrition, subglottic suction tubes, small-bore/small-bowel tube nutrition, closed/open circuit secretion suctioning, respiratory filters, tooth brushing, negative pressure techniques for secretion suctioning) and 8 pharmacological (selective digestive decontamination, oropharyngeal decontamination, short course of antibiotics, chlorhexidine mouth hygiene, inhaled antibiotics, antibiotic rotation, probiotics, monoclonal antibodies).Each measure was analysed independently, by at least two members of the working group, through a systematic review of the literature and an iterative review of recommendations from scientific societies and/or expert groups.For the classification of the quality of the evidence and strength of the recommendations, the GRADE group proposal was followed. To determine the level of recommendation, each measure was scored by all members of the working group in relation to its effectiveness, tolerability and applicability in Spanish ICUs in the short term. The support of external experts was requested for some of the measures reviewed. Those measures that achieved the highest score were selected.

Implementation of curricular changes at a medical school

The accelerated scientific, technological, and social advances in recent years have posed new challenges for professional training institutions, where universities play a leading role. Medical schools have not been oblivious to this process. This is how Pontificia Universidad Catolica de Chile implemented in 2015 a curricular reform derived from the joint work of academics, students and graduates. For this purpose, a model consisting of stages was followed, including the identification of the problem, general assessment of needs, definition of purpose and learning objectives. We worked with surveys, focus groups and committees of academics and students to identify and map content within the mesh, review terminal learning objectives while creating and reviewing courses for the vertically and horizontally integrated delivery of content and competencies. The first cohort of the new curriculum entered in 2015, consisting of 126 students. The implementation required constant follow-up and monitoring, establishing changes and adjustments according to educational needs and unforeseen conditions such as the COVID-19 pandemic. The implementation process of the new curriculum has been positive, adjusting to the defined strategic planning and responding to unexpected events.

Implementation of curricular changes at a medical school

The accelerated scientific, technological, and social advances in recent years have posed new challenges for professional training institutions, where universities play a leading role. Medical schools have not been oblivious to this process. This is how Pontificia Universidad Católica de Chile implemented in 2015 a curricular reform derived from the joint work of academics, students and graduates. For this purpose, a model consisting of stages was followed, including the identification of the problem, general assessment of needs, definition of purpose and learning objectives. We worked with surveys, focus groups and committees of academics and students to identify and map content within the mesh, review terminal learning objectives while creating and reviewing courses for the vertically and horizontally integrated delivery of content and competencies. The first cohort of the new curriculum entered in 2015, consisting of 126 students. The implementation required constant follow-up and monitoring, establishing changes and adjustments according to educational needs and unforeseen conditions such as the COVID-19 pandemic. The implementation process of the new curriculum has been positive, adjusting to the defined strategic planning and responding to unexpected events. © 2022 Sociedad Medica de Santiago. All rights reserved.

Mentoring Medical Students: Voices from Zoom Rooms during the Pandemic

Even before the COVID-19 pandemic, careers in medicine were challenging, and the academic journey could be a lonely one. The pandemic presented both challenges and opportunities in mentoring such as utilizing technology to transform formal mentorship programs into those that are beneficial for women and minorities because these programs can offer critical engagement, opportunities to hear and express multiple perspectives, expand our capacity to understand and talk about complex social issues, and meaning-making frameworks. Medical schools can utilize innovative and creative mentoring programs to support medical students as they enter the medical profession. © Common Ground Research Networks, Joseph Muñoz et al., All Rights Reserved.

Predictive models of intensive care unit admission in patients with covid-19: systematic review

Background: It is essential to identify the epidemiological and clinical characteristics of patients infected with COVID-19 associated with disease progression leading to ICU admission. The objective was to systematically review the models or scores for predicting admission to the intensive care unit (ICU) available to date for patients with COVID-19. Methods: The study is a systematic review. PubMed, Scopus, Web of Science, Ovid-Medline, and Embase were searched until July 13, 2022. We included studies that have developed and validated a model or scoring system to predict ICU admission in patients with COVID-19. The primary outcome was ICU admission. Risk of bias assessment was performed using the PROBAST tool which is based on four domains: participants, predictors, outcome and analysis. Results: Two studies were included for data extraction and critical appraisal. Predictive models of ICU admission and performance were obtained as primary outcomes. Common predictors for both models were associated with pulmonary compromise (respiratory rate or pulmonary ventilation) and systemic inflammation (C-reactive protein). Conclusions: It is feasible to determine predictor variables for ICU admission in patients hospitalized for COVID-19. However, the studies do not determine a clearly defined score and present a high risk of bias, so it is not feasible to recommend the application of any of these models in clinical practice. © 2022 Publicado por Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo.

AGRINNOVACION 4.0: Methodological classification tool to determine production areas of short-cycle crops

The National Plan for the Improvement of Productivity and Sustainability of the Agricultural Sector aims to be applied in a staggered manner to the entire country, under the name of AGRINNOVACION 4.0 to promote economic recovery and job creation after the COVID-19 pandemic. The objective of this work is to analyze geospatial information of the producers of the AGRINNOVACION 4.0 program using the free Google Earth Engine (GEE) platform, in order to establish the base of the digital agricultural cadastre of the North Zone of Cartago and have a system of geographic information for the application of high-precision technologies, as a basis for the identification model of productive areas with short-cycle crops developed in the North Zone of Cartago. A data acquisition methodology was generated using geographic information systems and machine learning techniques (Random Forest), with good fitting results. For the area under study, it is imperative that the information affected by cloud cover be reduced to make the classification of lands for horticultural use as accurate as possible. The tool is replicable and constitutes a support in the success of the plan for the later stages.

Compressive Goiter with COVID-19: An Unusual Etiology of Respiratory Distress Requiring Endotracheal Intubation with Surgical Resection

Introduction: Gradual enlargement of multinodular goiter (MNG) may compress surrounding structures which may progressively cause complications of tracheal stenosis and airway compromise. Surgical resection remains the gold standard treatment in MNG patients presenting with respiratory distress. In the current global COVID -19 pandemic, compressive goiter should be a differential diagnosis in patients with stable benign thyroid goiter presenting with dyspnea. We present a case of MNG with life threatening airway obstruction during an active COVID-19 infection. Case presentation: A 74-year-old female with a history of hyperthyroidism with multi-nodular goiter and recurrent atrial fibrillation status-post ablation, was transferred to the intensive care unit for treatment after being intubated for respiratory distress at a nearby hospital. She was diagnosed with hyperthyroidism about 40 years ago and managed with methimazole. Over the last two years, thyroid ultrasound and prior imaging showed MNG with patent but moderate tracheal narrowing;fine-needle aspiration (FNA) confirmed benign colloid nodules with cystic degeneration. She was pending cardiac clearance for surgery when symptoms acutely worsened two days before admission. On initial assessment, she was hemodynamically stable, afebrile, with oxygen saturation of 86% on room air. She was alert and able to follow commands. On physical examination, she had stridor and thyromegaly was evident with mild tenderness on palpation. Cardiopulmonary examination was remarkable for coarse breath sounds. Labs showed TSH 4.82 (Normal 0.3 - 4.5 ulU/mL), FT4 0.64 (Normal 0.5- 1.26 ng/dL). Respiratory panel test came back positive for SARS-CoV-2. Racemic epinephrine and albuterol nebulizers were administered to help with her symptoms. CT scan of the neck revealed a severe narrowing and mild rightward shift of the trachea by a large multinodular goiter, prompting the decision to intubate for airway protection. CT scan of the chest with contrast demonstrated the large MNG with tracheal stenosis. Her methimazole dose was adjusted. After cardiac clearance, she underwent thyroidectomy through a transcervical approach. Levothyroxine and calcium supplementation were started post-surgery. She was extubated two days after her thyroidectomy. Pathology results showed no evidence of malignancy. Discussion: Acute airway obstruction by large MNG requiring emergent airway protection is rare. Typically airway compromise from large otherwise stable benign goiters results from sudden hemorrhage into a cyst, upper respiratory tract infection leading to tracheal edema, or worseningcomorbid conditions. During the COVID-19 pandemic, acute respiratory failure and shortness of breath is typical of worsening disease course. This case highlights the importance of maintaining wider differentials of respiratory failure even and we need to consider worsening of tracheal narrowing with a large goiter due to tracheal edema from SARS- CoV-2 Infection. Thyroidectomy before SARS-CoV-2 infection may have reduced her need for emergent intubation for acute respiratory failure by improving pre existing airway compression.Presentation: No date and time listed

Moderate wage increases and flexible labour contracts to protect employment in Colombian manufacturing

Based on conditional and unconditional demands for labour, we exploit the variations of real minimum wage across manufacturing subsectors to present evidence that this variable affects formal employment. The long-term elasticity of labour demand to the minimum wage is around –0.7. Accordingly, increases in the minimum wage lead to job losses for unskilled labour, mainly in plants with fewer than 100;thus, small increases in the minimum wage are desirable to protect employment. Labour demand is highly cyclical: the output elasticity is about 1.7. Thus, some flexibility in labour contracts is desirable to reduce the link between employment and variation of plants’ sales. Open-ended labour contracts might allow reductions of the nominal wage rather than inducing job losses during periods of severe slumps, as has happened during the COVID-19 pandemic. © 2022 The Society for Policy Modeling

Actualización de las recomendaciones del proyecto Neumonía Zero Update of the recommendations of the Pneumonia Zero project

La pandemia por el SARS-Cov-2 ha impactado negativamente en la aplicación de las recomendaciones de Neumonía Zero y se ha acompañado de un incremento de las tasas de Neumonía asociada a ventilación mecánica (NAVM) en las unidades de cuidados intensivos de España. Con el objetivo de disminuir las tasas actuales a 7 episodios por 1000 días de VM, se han actualizado las recomendaciones del proyecto inicial. Se identificaron, 27 medidas que se clasificaron en 12 medidas funcionales (posición semisentada, higiene estricta de manos, entrenamiento para manipular la vía aérea, valoración diaria de posible extubación, protocolización del destete, traqueostomía precoz, ventilación no invasiva, vigilancia microbiológica, cambio de tubuladuras, humidificación, fisioterapia respiratoria, nutrición enteral postpilórica), 7 mecánicas (control de la presión del neumotaponamiento, tubos con aspiración subglótica, nutrición con sondas de bajo calibre/en intestino delgado, aspiración de secreciones con circuitos cerrados/abiertos, filtros respiratorios, cepillado de dientes, técnicas de presión negativa en la aspiración de secreciones) y 8 farmacológicas (descontaminación selectiva digestiva, descontaminación orofaríngea, ciclo corto de antibióticos, higiene de boca con clorhexidina, antibióticos inhalados, rotación de antibióticos, probióticos, anticuerpos monoclonales). Cada medida se analizó de forma independiente, por al menos dos miembros del grupo de trabajo, mediante una revisión sistemática de la literatura y una revisión iterativa de las recomendaciones de las sociedades científicas y/o grupos de expertos. Para la clasificación de la calidad de la evidencia y fuerza de las recomendaciones se siguió la propuesta del grupo GRADE. Para determinar el grado de recomendación, cada medida fue puntuada por todos los miembros del grupo de trabajo en relación con su efectividad, tolerabilidad y aplicabilidad en las UCI españolas a corto plazo de tiempo. Se solicitó el apoyo de expertos externos en alguna de las medidas que se revisaron. Se seleccionaron aquellas medidas que alcanzaron la máxima puntuación.

INNATE IMMUNITY AS PROTECTION AGAINST VIRAL INFECTIONS

Adequate preventive specific and unspecific and therapeutic procedures are urgently required for the new incoming generation of viruses;some strategies approached the infections with chemotherapies adopted from previous antiviral programs or with off label drugs. The optimal goal would be to practice a widespread treatment safe, effective, sustainable, cheap as much as possible. The enhancement of innate immunity defenses and the support of the trained immunity are very helpful aside of the incoming vaccines. Innate immunity is the most ancient ready and quick defense against pathogens of al the living species: it commits phagocytic cells to directly get rid of the infectious agents, while the trained immunity is expressed by the adaptive immunity a late evolutionary phase (2 million years after the innate one): the antibodies producing immunological memory is usually tailored against specific antigens but can be expanded eliciting an immune response against other infecting noxa. This paper deals with the clinical history and revival of C. parvum, a killed commensal bacterium located in the sebaceous glands with strong unspecific antitumoral and antiviral innate immunity enhancing properties that can profitably be updated in hazardous infectious emergencies.

To plan and deliver adjuvant breast radiotherapy over 1 week: 1-week breast workflow implementation

Purpose or Objective To limit hospital visits and transportation of the patients with early breast cancer (BC) especially during the covid-19 pandemic, we aimed to implement a workflow of treatment to prepare and deliver adjuvant breast radiotherapy (RT) within 1 week. Materials and Methods Based on the Fast Forward RT schedule of 5 fractions of 5.2 Gy over 5 days for adjuvant BC, we designed a workflow to perform BC RT over 1 week from the first RT consultation to the end of treatment (figure 1). Patients were seen in consultation on Monday morning. The planning CT was carried out immediately after the consultation. A deep inspiration breath-hold technique was systematically offered to all patients. Automatic delineation using an artificial Intelligence (AI) based model with ART-PlanTM software was first corrected by a junior radiation oncologist (RO) then, independently by a senior RO. As 3D conformal RT failed to achieve dose constraints of the fast forward trial in many cases (due to breast hotspots), we developed a restricted IMRT (rIMRT) technique based on 2 tangential beams (internal and external) using inverse planning restricted optimization parameters to improve the dose homogeneity. Treatment planning was semi-automated by scripting the creation and optimization steps of rIMRT plans. After validation of the reliability of rIMRT treatment delivery by patient-specific quality assurance (PSQA) with gamma index evaluation on 20 patients, we decided to abandon systematic PSQAs. In-vivo dosimetry was validated by end-to-end controls and performed for each patient during the first fraction on Monday afternoon. Daily repositioning was controlled by portal images of the largest segment of each beam. Structured baseline, end of treatment and follow up evaluation forms were used to prospectively collect toxicities and oncological outcomes at each consultation. Patient agreement for data collection and analysis was prospectively obtained. $Φg Results From February 2021 to March 2021, the 1-week breast procedure was proposed to up to 3 patients/week, >65 years, in complete resection after conservative surgery, with pT1-T3 N0 BC, without tumor bed boost or regional lymph nodes irradiation. Six out of seven patients (85.7%) accepted the 1-week breast procedure. All procedures were successfully conducted over 5 days with complete patient and RT team satisfaction. A followup of acute toxicities by online consultation on day 10, structured evaluation forms and management decision trees has been implemented for these patients. No grade >2 acute toxicities (CTACE V4.0) have been reported so far. Conclusion The successful implementation of this comprehensive 1-week breast workflow with AI based delineation and semi-automated rIMRT without PSQA demonstrates the practical feasibility of the whole procedure over 5 days reducing drastically the coming-and-going to the hospital and the overall RT management time per patient. Our work opens the way for further development of comprehensive compact workflows in various settings.

Factors Influencing Success in Advanced Engineering Mathematics Courses: A Case Study

Several studies have been conducted to understand the predictors of academic performance of various levels of high school and undergraduate students as quantified by the grade point average. This study focuses specifically on engineering students as they differ from other undergraduate students in their background and expectations. We focus on quantifying essential predictors of the performance of engineering students in an advanced mathematics course. We collected data from 72 participants recruited from engineering students enrolled in the advanced engineering mathematics (AEM) course in a research university. We chose this course to represent a standard engineering mathematics course covering several essential topics. We consider several factors in our analysis, such as cellphone usage and the academic background, e.g., the academic year, number of minors, and majors, performance in prerequisite courses. We perform several regression analyses to understand the effects of cellphone usage, course schedule, and academic background on performance in the AEM course and its prerequisites. In particular, we use the stepwise regression technique using forward selection and backward elimination procedures. We discovered a few interesting findings in this case study. Firstly, for the participants in this study, we find that the daily average “screen time” on their cellphones is not a statistically significant predictor of student performance. This finding contradicts some prior studies on this participant and may indicate adaption and integration of the technology by the new generation of students in recent years. We also found that the lecturing schedule was not an influential factor for their academic performance. These findings are especially relevant during the COVID-19 pandemic, as they suggest that advanced engineering students have adapted to the use of technology and are flexible concerning lecture schedules. Another unexpected finding is that this study brings new evidence that the number of minors taken by the participants is a negative predictor of their grade in the AEM course. This observation may indicate that course-work from non-major classes may adversely impact their performance in mathematical engineering courses. © Copyright © 2021 Athavale, Mondal and Rivera.