Pandemic Response: Risk Planning in Times of a Crisis

The COVID-19 crisis caught many economic players unprepared and unable to act. Little research has been conducted on its impacts and reasons for the lack of appropriate countermeasures. This paper investigates the progress of the crisis and analyzes potential reasons for the emergence of unsatisfactory risk management. It gives advice for companies on how to cope with the situation best. In addition to the current situation, two past crises as well as the contrary strategies of two companies were examined with the aim of drawing sensible conclusions towards their strategies of managing risk. Modern methods with a strong focus on data-driven examination lead to one-dimensional approaches that are unable to reflect complex interrelations. The paper concludes that existing risk management systems are already set up in a comprehensive way and that the main issue lies within behavioral patterns of individuals who are either unable or unwilling to see existing risks. This leads to situations in which risks are identified, though concurrently ignored in subsequent decision-making processes

Future skills: Developing skills for jobs that do not yet exist in sectors that have not yet been invented

In this paper, the author reconsiders the question of whether compulsory education systems are ‘fit for purpose’, when the purpose is to provide adequately educated people with the Knowledge, Skills, and Attributes (KSAs) that allow them to be useful and productive members of society. By the use of structural unemployment rates, the author shows that even though the populations were increasing, unemployment remained the same over a long period suggesting that the right KSAs were being provided. The author then considers the changes to compulsory education that occurred in the last two decades of the 20th century in medium and high-income societies, and how this has, potentially, broken the link between the KSAs provided and the KSAs needed. He ends with a call for action to rethink the provision of tertiary education so as to ensure those experiencing it are fitted with the skills needed for the future. This paper was delivered as the keynote opening speech at the iCiTRA conference in Malaysia in September 2021, the text itself is taken from the author’s 2017 paper Unfit for Purpose? Graduate business education and the real world: a reflective and evidence-based discussion about education, jobs and unemployment

GEN1 from a thermophilic fungus is functionally closely similar to non-eukaryotic junction-resolving enzymes

AbstractProcessing of Holliday junctions is essential in recombination. We have identified the gene for the junction-resolving enzyme GEN1 from the thermophilic fungus Chaetomium thermophilum and expressed the N-terminal 487-amino-acid section. The protein is a nuclease that is highly selective for four-way DNA junctions, cleaving 1nt 3′ to the point of strand exchange on two strands symmetrically disposed about a diagonal axis. CtGEN1 binds to DNA junctions as a discrete homodimer with nanomolar affinity. Analysis of the kinetics of cruciform cleavage shows that cleavage of the second strand occurs an order of magnitude faster than the first cleavage so as to generate a productive resolution event. All these properties are closely similar to those described for bacterial, phage and mitochondrial junction-resolving enzymes. CtGEN1 is also similar in properties to the human enzyme but lacks the problems with aggregation that currently prevent detailed analysis of the latter protein. CtGEN1 is thus an excellent enzyme with which to engage in biophysical and structural analysis of eukaryotic GEN1

COVID-19 during the index hospital admission confers a 'double-hit' effect on hip fracture patients and is associated with a two-fold increase in 1-year mortality risk

PURPOSE: The aims were to: (1) determine 1‐year mortality rates for hip fracture patients during the first UK COVID‐19 wave, and (2) assess mortality risk associated with COVID‐19. METHODS: A nationwide multicentre cohort study was conducted of all patients presenting to 17 hospitals in March‐April 2020. Follow‐up data were collected one year after initial hip fracture (‘index’) admission, including: COVID‐19 status, readmissions, mortality, and cause of death. RESULTS: Data were available for 788/833 (94.6%) patients. One‐year mortality was 242/788 (30.7%), and the prevalence of COVID‐19 within 365 days of admission was 142/788 (18.0%). One‐year mortality was higher for patients with COVID‐19 (46.5% vs. 27.2%; p < 0.001), and highest for those COVID‐positive during index admission versus after discharge (54.7% vs. 39.7%; p = 0.025). Anytime COVID‐19 was independently associated with 50% increased mortality risk within a year of injury (HR 1.50, p = 0.006); adjusted mortality risk doubled (HR 2.03, p < 0.001) for patients COVID‐positive during index admission. No independent association was observed between mortality risk and COVID‐19 diagnosed following discharge (HR 1.16, p = 0.462). Most deaths (56/66; 84.8%) in COVID‐positive patients occurred within 30 days of COVID‐19 diagnosis (median 11.0 days). Most cases diagnosed following discharge from the admission hospital occurred in downstream hospitals. CONCLUSION: Almost half the patients that had COVID‐19 within 365 days of fracture had died within one year of injury versus 27.2% of COVID‐negative patients. Only COVID‐19 diagnosed during the index admission was associated independently with an increased likelihood of death, indicating that infection during this time may represent a ‘double‐hit’ insult, and most COVID‐related deaths occurred within 30 days of diagnosis

Cerebrospinal fluid cortisol levels are higher in patients with delirium versus controls

<p>Abstract</p> <p>Background</p> <p>High plasma cortisol levels can cause acute cognitive and neuropsychiatric dysfunction, and have been linked with delirium. CSF cortisol levels more closely reflect brain exposure to cortisol, but there are no studies of CSF cortisol levels in delirium. In this pilot study we acquired CSF specimens at the onset of spinal anaesthesia in patients undergoing hip fracture surgery, and compared CSF and plasma cortisol levels in delirium cases versus controls.</p> <p>Findings</p> <p>Delirium assessments were performed the evening before or on the morning of operation with a standard battery comprising cognitive tests, mental status assessments and the Confusion Assessment Method. CSF and plasma samples were obtained at the onset of the operation and cortisol levels measured. Twenty patients (15 female, 5 male) aged 62 - 93 years were studied. Seven patients were diagnosed with delirium. The mean ages of cases (81.4 (SD 7.2)) and controls (80.5 (SD 8.7)) were not significantly different (p = 0.88). The median (interquartile range) CSF cortisol levels were significantly higher in cases (63.9 (40.4-102.1) nmol/L) than controls (31.4 (21.7-43.3) nmol/L; Mann-Whitney U, p = 0.029). The median (interquartile range) of plasma cortisol was also significantly higher in cases (968.8 (886.2-1394.4) nmol/L, than controls (809.4 (544.0-986.4) nmol/L; Mann Whitney U, p = 0.036).</p> <p>Conclusions</p> <p>These findings support an association between higher CSF cortisol levels and delirium. This extends previous findings linking higher plasma cortisol and delirium, and suggests that more definitive studies of the relationship between cortisol levels and delirium are now required.</p

TGF-β mimic proteins form an extended gene family in the murine parasite Heligmosomoides polygyrus

We recently reported the discovery of a new parasite-derived protein that functionally mimics the immunosuppressive cytokine transforming growth factor (TGF)-β. The Heligmosomoides polygyrus TGF-β Mimic (Hp-TGM) shares no homology to any TGF-β family member, however it binds the mammalian TGF-β receptor and induces expression of Foxp3, the canonical transcription factor of both mouse and human regulatory T cells. Hp-TGM consists of five atypical Complement Control Protein (CCP, Pfam 00084) domains, each lacking certain conserved residues and 12–15 amino acids longer than the 60–70 amino acids consensus domain, but with a recognizable 3-cysteine, tryptophan, cysteine motif. We now report on the identification of a family of nine related Hp-TGM homologues represented in the secreted proteome and transcriptome of H. polygyrus. Recombinant proteins from five of the nine new TGM members were tested for TGF-β activity, but only two were functionally active in an MFB-F11 reporter assay, and by the induction of T cell Foxp3 expression. Sequence comparisons reveal that proteins with functional activity are similar or identical to Hp-TGM across the first three CCP domains, but more variable in domains 4 and 5. Inactive proteins diverged in all domains, or lacked some domains entirely. Testing truncated versions of Hp-TGM confirmed that domains 1–3 are essential for full activity in vitro, while domains 4 and 5 are not required. Further studies will elucidate whether these latter domains fulfill other functions in promoting host immune regulation during infection and if the more divergent family members play other roles in immunomodulation

Developing prediction models for symptom severity around the time of discharge from a tertiary-care program for treatment-resistant psychosis

Antipsychotics are the only therapeutic class indicated in the symptomatic management of psychotic disorders. However, individuals diagnosed with schizophrenia or schizoaffective disorder may not always benefit from these first-line agents. This refractoriness to conventional treatment can be difficult to address in most clinical settings. Therefore, a referral to a tertiary-care program that is better able to deliver specialized care in excess of the needs of most individuals may be necessary. The average outcome following a period of treatment at these programs tends to be one of improvement. Nonetheless, accurate prognostication of individual-level responses may be useful in identifying those who are unlikely to improve despite receiving specialized care. Thus, the main objective of this study was to predict symptom severity around the time of discharge from the Refractory Psychosis Program in British Columbia, Canada using only clinicodemographic information and prescription drug data available at the time of admission. To this end, a different boosted beta regression model was trained to predict the total score on each of the five factors of the Positive and Negative Syndrome Scale (PANSS) using a data set composed of 320 hospital admissions. Internal validation of these prediction models was then accomplished by nested cross-validation. Insofar as it is possible to make comparisons of model performance across different outcomes, the correlation between predictions and observations tended to be higher for the negative and disorganized factors than the positive, excited, and depressed factors on internal validation. Past scores had the greatest effect on the prediction of future scores across all 5 factors. The results of this study serve as a proof of concept for the prediction of symptom severity using this specific approach

Efficiency improvement of vertical axis wind turbines with an upstream deflector.

The suitability of using an upstream deflector to improve the efficiency of a vertical axis wind turbine is presented in this study. A two-dimensional vertical axis wind turbine (VAWT) was modelled and simulated using ANSYS Fluent 14.0 computational fluid dynamics (CFD) software to solve the k-epsilon (RNG) turbulence model. Firstly, the open rotor design was optimised by varying orientation and pitch angle, prior to analysing the effect increasing wind speed had on the turbine performance. A maximum efficiency of 19.101% was achieved and was used as the open rotor design. A series of curved upstream deflectors were then evaluated in terms of efficiency improvements against the original open rotor design. Installation of the deflector resulted in a redirection of the fluid flow from the returning turbine blade, therefore reducing the negative torque induced on the system. Additionally, deflector width angles of 45o and 36o were found to improve the turbine performance by 1.266%. Finally, a scale model of the wind turbine was constructed and experimentally tested using a wind tunnel. No correlation between the CFD and experimental results was found due to variations in the wind speed tested by both methods. However, the VAWT design operated at a reasonably efficient level during the experimental testing, even under suboptimal conditions

Epidemiology of emergency ambulance service calls related to mental health problems and self harm: a national record linkage study.

Background: People experiencing a mental health crisis receive variable and poorer quality care than those experiencing a physical health crisis. Little is known about the epidemiology, subsequent care pathways of mental health and self-harm emergencies attended by ambulance services, and subsequent all-cause mortality, including deaths by suicide. This is the first national epidemiological analysis of the processes and outcomes of people attended by an ambulance due to a mental health or self-harm emergency. The study aimed todescribe patient characteristics, volume, case-mix, outcomes and care pathways following ambulance attendance in this patient population.Methods: A linked data study of Scottish ambulance service, emergency department, acute inpatient and death records for adults aged ?16 for one full year following index ambulance attendance in 2011.Results: The ambulance service attended 6802 mental health or self harm coded patients on 9014 occasions. This represents 11% of all calls attended that year. Various pathways resulted from these attendances. Most frequent were those that resulted in transportation to and discharge from the emergency department (n =4566/9014; 51%). Some patients were left at home (n = 1003/9014 attendances, 11%). Others were admitted to hospital (n = 2043/9014, 23%). Within 12 months of initial attendance, 279 (4%) patients had died, 97 of these were recorded as suicide.Conclusions: This unique study finds that ambulance service and emergency departments are missing opportunities to provide better care to this population and in potentially avoidable mortality, morbidity and service burden. Developing and testing interventions for this patient group in pre-hospital and emergency department settings could lead to reductions in suicide, patient distress, and service usag