Many affected counties have had experienced a shortage of personal protective equipment (PPE) during the coronavirus disease (COVID-19) pandemic. We aimed to investigate the needs of healthcare ...professionals and the technical difficulties faced by them during the initial outbreak. A cross-sectional web-based survey was conducted among the healthcare workforce in the most populous cities from three Latin American countries in April 2020. In total, 1,082 participants were included. Of these, 534 (49.4%), 263 (24.3%), and 114 (10.5%) were physicians, nurses, and other professionals, respectively. At least 70% of participants reported a lack of PPE. The most common shortages were shortages in gown coverall suits (643, 59.4%), N95 masks (600, 55.5%), and face shields (569, 52.6%). Professionals who performed procedures that generated aerosols reported shortages more frequently (p<0.05). Professionals working in the emergency department and primary care units reported more shortages than those working in intensive care units and hospital-based wards (p<0.001). Up to 556 (51.4%) participants reported the lack of sufficient knowledge about using PPE. Professionals working in public institutions felt less prepared, received less training, and had no protocols compared with their peers in working private institutions (p<0.001). Although the study sample corresponded to different hospital centers in different cities from the participating countries, sampling was non-random. Healthcare professionals in Latin America may face more difficulties than those from other countries, with 7 out of 10 professionals reporting that they did not have the necessary resources to care for patients with COVID-19. Technical and logistical difficulties should be addressed in the event of a future outbreak, as they have a negative impact on healthcare workers. Clinical trial registration: NCT04486404.
Outbreaks of transmission of infection related to endoscopy despite reported adherence to reprocessing guidelines warrant scrutiny of all potential contributing factors. Recent reports from ...ambulatory surgery centers indicated widespread significant occult damage within endoscope working channels, raising concerns regarding the potential detrimental impact of this damage on the adequacy of endoscope reprocessing.
We inspected working channels of all 68 endoscopes at our academic institution using a novel flexible inspection endoscope. Inspections were recorded and videos reviewed by 3 investigators to evaluate and rate channel damage and/or debris. Working channel rinsates were obtained from all endoscopes, and adenosine triphosphate (ATP) bioluminescence was measured.
Overall endoscope working channel damage was rated as minimal and/or mild and was consistent with expected wear and tear (median 1.59 on our 5-point scale). Our predominant findings included superficial scratches (98.5%) and scratches with adherent peel (76.5%). No channel perforations, stains, or burns were detected. The extent of damage was not predicted by endoscope age. Minor punctate debris was common, and a few small drops of fluid were noted in 42.6% of endoscopes after reprocessing and drying. The presence of residual fluid predicted higher ATP bioluminescence values. The presence of visualized working channel damage or debris was not associated with elevated ATP bioluminescence values.
The flexible inspection endoscope enables high-resolution imaging of endoscope working channels and offers endoscopy units an additional modality for endoscope surveillance, potentially complementing bacterial cultures and ATP values. Our study, conducted in a busy academic endoscopy unit, indicated predominately mild damage to endoscope working channels, which did not correlate with elevated ATP values.
To investigate community and health-care workers' perspectives on the coronavirus disease 2019 (COVID-19) pandemic and on early pandemic responses during the first 2 weeks of national lockdown in ...Zimbabwe.
Rapid qualitative research was carried out between March and April 2020 via phone interviews with one representative from each of four community-based organizations and 16 health-care workers involved in a trial of community-based services for young people. In addition, information on COVID-19 was collected from social media platforms, news outlets and government announcements. Data were analysed thematically.
Four themes emerged: (i) individuals were overloaded with information but lacked trusted sources, which resulted in widespread fear and unanswered questions; (ii) communities had limited ability to comply with prevention measures, such as social distancing, because access to long-term food supplies and water at home was limited and because income had to be earned daily; (iii) health-care workers perceived themselves to be vulnerable and undervalued because of a shortage of personal protective equipment and inadequate pay; and (iv) other health conditions were sidelined because resources were redirected, with potentially wide-reaching implications.
It is important that prevention measures against COVID-19 are appropriate for the local context. In Zimbabwe, communities require support with basic needs and access to reliable information to enable them to follow prevention measures. In addition, health-care workers urgently need personal protective equipment and adequate salaries. Essential health-care services and medications for conditions other than COVID-19 must also continue to be provided to help reduce excess mortality and morbidity.
The COVID-19 pandemic has caused a dramatic shortage in the medical supplies needed to treat the virus due to a massive surge in demand as the disease circled the globe during the first half of 2020. ...Prior to the crisis, there was an interdependence of trade and production for medical supplies, with advanced industrial countries like the United States and Germany specializing in the relatively high-tech medical devices sector, while low-cost production hubs such as China and Malaysia were leading producers of less technologically sophisticated personal protective equipment (PPE) products such as face masks, surgical gloves, and medical gowns. After the COVID-19 outbreak, global shortages of PPE products emerged as many affected countries imposed export controls and sought ways to boost domestic output. A case study of the face mask value chain in the United States shows misalignments between the priorities of U.S. federal government officials and the strategies of leading U.S. multinational producers of face masks, which resulted in exceptionally costly policy delays in terms of health outcomes. On balance, the U.S. shortage of N95 respirators during the COVID-19 pandemic is more a policy failure than a market failure. The global value chain framework highlights strategic options that could lead to more resilient supply chains and diversified sourcing patterns.
If memory hierarchy is stopping your microprocessor from performing at the highest level it should be, then this book will show how to resolve that problem. This book provides the reader with ...everything they need to know about the logical design and operation, physical design and operation, performance characteristics and resulting design trade-offs, and the energy consumption of modern memory hierarchies. You learn how to tackle the challenging optimization problems that result from the side-effects that can appear at any point in the entire hierarchy. As a result you will be able to design and emulate the entire memory hierarchy. As a reference, this book is targeted toward both academics and practicing engineers in microarchitecture and computer system design, embedded system design, and low power design.
A rapidly increasing selection of laboratory equipment can be fabricated with open-source three-dimensional printers at low cost.
Most experimental research projects are executed with a combination ...of purchased hardware equipment, which may be modified in the laboratory and custom single-built equipment fabricated inhouse. However, the computer software that helps design and execute experiments and analyze data has an additional source: It can also be free and open-source software (FOSS) (
1
). FOSS has the advantage that the code is openly available for modification and is also often free of charge. In the past, customizing software has been much easier than custom-building equipment, which often can be quite costly because fabrication requires the skills of machinists, glassblowers, technicians, or outside suppliers. However, the open-source paradigm is now enabling creation of open-source scientific hardware by combining three-dimensional (3D) printing with open-source microcontrollers running on FOSS. These developments are illustrated below by several examples of equipment fabrication that can better meet particular specifications at substantially lower overall costs.
Rotating machinery is one of the most typical types of mechanical equipment and plays a significant role in industrial applications. Condition monitoring and fault diagnosis of rotating machinery has ...gained wide attention for its significance in preventing catastrophic accident and guaranteeing sufficient maintenance. With the development of science and technology, fault diagnosis methods based on multi-disciplines are becoming the focus in the field of fault diagnosis of rotating machinery. This paper presents a multi-discipline method based on image-processing for fault diagnosis of rotating machinery. Different from traditional analysis method in one-dimensional space, this study employs computing method in the field of image processing to realize automatic feature extraction and fault diagnosis in a two-dimensional space. The proposed method mainly includes the following steps. First, the vibration signal is transformed into a bi-spectrum contour map utilizing bi-spectrum technology, which provides a basis for the following image-based feature extraction. Then, an emerging approach in the field of image processing for feature extraction, speeded-up robust features, is employed to automatically exact fault features from the transformed bi-spectrum contour map and finally form a high-dimensional feature vector. To reduce the dimensionality of the feature vector, thus highlighting main fault features and reducing subsequent computing resources, t-Distributed Stochastic Neighbor Embedding is adopt to reduce the dimensionality of the feature vector. At last, probabilistic neural network is introduced for fault identification. Two typical rotating machinery, axial piston hydraulic pump and self-priming centrifugal pumps, are selected to demonstrate the effectiveness of the proposed method. Results show that the proposed method based on image-processing achieves a high accuracy, thus providing a highly effective means to fault diagnosis for rotating machinery.
•GVCs in medical industries were subject to intense public controversy and state intervention during the initial phase of the COVID-19 pandemic.•We move beyond simplistic ‘success or failure’ of GVCs ...by differentiating GVC ‘adaptation’ and ‘effectiveness’ during two phases of the crisis: first, a localized crisis in China, and later, a global systemic crisis.•It shows how different types of state policies, beyond just GVC facilitation, interact with GVCs to produce mixed outcomes of PPE provision.•It advances the literature on the state-GVC nexus by showing deeper ‘mutual constraints’ between states and GVCs, which goes beyond states as external shapers of GVCs.•While states influence GVCs, two structural features of GVCs – geography of production and technological complexity – set limits on state policy, even among ‘strong’ states and during a crisis.
Shortages of critical medical supplies during the COVID-19 pandemic have turned global value chains (GVCs) in personal protective equipment (PPE) into a political lightning rod. Some blame excessive outsourcing and foreign dependency for causing shortages, thus urging greater state intervention; others applaud GVCs for their flexibility and scaling up of production, while blaming states for undermining GVC operations. Using policy process-tracing and monthly trade data of seven PPE products across the US, Europe, China and Malaysia, this paper goes beyond the binary debate of either the ‘failure’ or ‘success’ of GVCs to show when and under what conditions states interacted with GVCs to produce mixed outcomes in provisioning countries with PPEs. We identify interactions between the type of state intervention and two key structural features of GVCs – geographic distribution of production and technological attributes of the product. Conceptually, the paper demonstrates the mutual constraints of states and GVCs, and highlights structural factors involved in the relationship. Looking to the future of GVCs, we caution against wholesale declarations that GVCs should be abandoned or maintained, instead concluding that paying attention to GVC structure, states and their interactions are crucial.
During the course of the Novel Coronavirus (SARS-CoV-2) pandemic, Italy has reported one of the highest number of infections. Nearly ten percent of reported coronavirus infections in Italy occurred ...in healthcare workers. This study aimed to understand physicians' access to personal protective equipment (PPE) and to information about their use, risk perception and strategies adopted to prevent contracting the infection.
We undertook a cross-sectional, online self-reported survey implemented between March 31 and April 5 2020 of Italian physicians.
Responses were received from 516 physicians, only 13% of which reported to have access to PPE every time they need them. Approximately half of the physicians reported that the information received about the use of PPE was either clear (47%) or complete (54%). Risk perception about contracting the infection was influenced by receiving adequate information on the use of PPE. Access to adequate information on the use of PPE was associated with better ability to perform donning and doffing procedures OR = 2.2 95% C.I. 1.7-2.8 and reduced perception of risk OR = 0.5, 95% C.I. 0.4-0.6.
Results from this rapid survey indicate that while ramping up supplies on PPE for healthcare workers is certainly of mandatory importance, adequate training and clear instructions are just as important.
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