What changed in the cyber-security after COVID-19?

This study aimed to evaluate the impact of the prolonged COVID-19 pandemic on outpatient antibiotic prescriptions for pediatric respiratory infections at an acute care hospital in Japan in order to direct future pediatric outpatient antibiotic stewardship. The impact of the COVID-19 pandemic and the FilmArray Respiratory Panel (RP) on outpatient antibiotic prescriptions was assessed from January 2019 to December 2021 using an interrupted time series analysis of children <20 years. The overall antimicrobial prescription rate decreased from 38.7% to 22.4% from the pre-pandemic period to the pandemic. The pandemic (relative risk [RR] level, 0.97 [0.58-1.61]; P = 0.90; RR slope, 1.05 [0.95-1.17] per month; P = 0.310) and FilmArray RP (RR level, 0.90 [0.46-1.75]; P = 0.75; RR slope, 0.95 [0.85-1.06] per month; P = 0.330) had no significant effect on the monthly antibiotic prescription rates. The COVID-19 pandemic was not significantly related to the antibiotic prescription rate, suggesting that it did not impact physicians' behavior toward antibiotic prescriptions. Replacing rapid antigen tests with the FilmArray RP introduced on December 1, 2020, did not affect the magnitude of the reduction in antibiotic prescription rate for pediatric respiratory infections.

This study aimed to assess the impact of the ongoing COVID-19 pandemic on cancer patients, known to be immune-compromised due to the disease itself, oncological treatments and adjuvant medicines use such as steroids. Overall survival was determined for patients with COVID-19 infection and stratification according to known comorbidities and complications was performed. This prospective study included ninety cancer patients with COVID-19 confirmed by PCR testing performed before each cycle of chemotherapy or every two weeks during radiotherapy between May and December 2020 in two tertiary Cancer Centers. Demographic, cancer-related and SARS-CoV-2 infection data were collected and long-term oncologic outcome was assessed. Mean age of cancer patients diagnosed with SARS-CoV-2 was 59.7±12.1 years (range=30-83 years). Fifty-two (57.7%) were women. The most frequent cancer localization was breast (n=28, 31.1%) followed by colorectal (n=11, 12.2%) and lung cancer (n=8, 8.8%). Most patients infected with SARS-CoV-2 were diagnosed in stage IV of the disease (n=44, 48.9%) followed by stage III (n=19, 21.1%) and stage II disease (18.9%). Regarding comorbidities, the most common was hypertension (n=31) followed by cardiac dysfunction (n=23) and type II diabetes (n=13). Of 27 (30%) patients who needed hospitalization, 4 patients developed severe infection, 17 patients had mild symptoms and 6 patients were minimally symptomatic. After a median follow-up of 22.5 months, 5 patients (5.55%) died due to SARS-COV-2 infection, all stages III and IV. Median estimated overall survival was 14 months in patients who died because of COVID infection compared to 98 months in cancer-related mortality analysis (p<0.0001). Three deaths occurred during chemotherapy, 1 death in the chemoradiotherapy radiotherapy group. SARS-CoV-2 infection was associated with an excess mortality in our study population, especially in patients with advanced and metastatic disease and in those receiving immunosuppressive treatment such as chemotherapy and radiotherapy.

Purpose. The research aims to study the effect of the Covid-19 pandemic on aggregate agricultural production and agricultural production per subsector, where the agricultural sector is divided into five subsectors, namely food crops, horticulture, plantations, livestock and fisheries. Methodology / approach. The Autoregressive Distributed Lag (ARDL) method is applied in this work. Using ARDL equations with restricted test cointegration, it generates both short-term and long-term models simultaneously. The analysis moves on to estimate the long-term and short-term models of (i) the impact of the Covid-19 pandemic on total agricultural production and (ii) the impact of the pandemic on agricultural production per subsector. Results. In general, the Covid-19 pandemic had a negative but insignificant effect on Indonesia’s agricultural production. The effect of the Covid-19 pandemic on agricultural production (GDP) varies significantly from one subsector to another. The negative effect was in the food crops, horticulture and fisheries subsectors, but this negative effect was significant only for food crops. The pandemic had a positive effect on the plantation crops and livestock subsectors, but the positive effect was significant only for the livestock subsector. Based on the Error Correction Term (ECT) value, the speed of agricultural subsectors to return to long-run equilibrium is not the same. Originality / scientific novelty. Until now, research on the impact of the Covid-19 pandemic on agriculture has been based on the assumption that the agricultural sector is a homogeneous system. This study examines the agricultural sector by decomposing it into subsectors including food crops, horticulture, plantations, livestock, and fisheries. The results show that each subsector responds differently to shocks (due to the Covid-19 pandemic). As far as we can observe, this study is the first to decompose subsectors for Indonesia. In addition, studies related to the influence of the Covid-19 pandemic on agriculture using a dynamic econometric approach (using time series data) are still limited. Practical value / implications. The Covid-19 pandemic had an impact on production due to an increased unemployment and decreased purchasing power, which reduced demand for products from the food crops, horticulture, and livestock subsector, which in turn caused a decrease in production. Research results help the government in determining the best course of action to support the food crops, horticulture, and fisheries subsectors in the event that the Covid-19 pandemic creates unfavourable conditions. Future research proposals include: (i) a study of how the production function in the agricultural subsector can be used to estimate production in the event of unforeseen circumstances like the Covid-19 pandemic or an economic downturn; and (ii) a study of how the type of fiscal stimulus affects production in agricultural subsectors to determine the type of assistance based on the dominance of subsectors in a particular region.

Aims: In this study, we aim to describe the impact of COVID-19 pandemic on the burden and pattern of hospitalization from the COVID-19-unrelated illnesses among children in Barbados. Materials and Methods: This is a population-based prospective clinical audit. It included children (Age <16 years) admitted for COVID-19-unrelated illnesses to the only tertiary care hospital in this country during the ongoing COVID-19 pandemic. This audit covers the period extending from April to July 2020. The audit data for the corresponding period in 2019 and and 2018, which were also collected prospectively, was used as historical control. Results: There were a total of 178 pediatric medical admissions (PMAs) in this country from April to July 2020. This was a decline of 47.2% (95% confidence interval [CI] = 41.6%, 52.5%) compared to the 336 PMA during the corresponding period in 2019 and 2018. The decline in the number of admissions from asthma phenotypes, respiratory infections, and gastrointestinal infections accounted for 88.0% (95% CI – 78.6%, 94.8%) of the total decline in PMA during the pandemic-related lockdown period when compared with the corresponding period in 2019. The difference in the proportion of children who required transfer to the pediatric intensive care unit during the pandemic and the corresponding period in 2019 and 2018 was statistically not significant (P = 0.8234). Conclusions: A sharp decline in the admissions from asthma phenotypes and those from the respiratory tract and gastrointestinal tract infections resulted in a close to 50% decline in hospitalizations from COVID-19-unrelated illnesses among children in this population.

Firm-level short selling and the local COVID-19 pandemic: Evidence from China

As businesses have embraced more and more technology, cyber risk has become one of the essential components of a risk management initiative that seeks to mitigate and analyze the multitude of new risks. One risk mitigation process is investing in cyber insurance to safeguard the organisations’ assets from cyber threats by transferring them to the insurer. For businesses to decide on cyber insurance, choosing the right insurance plan and policy is crucial. To do so, they need to consider the factors of its implementation. Therefore, this paper aims to investigate the adoption of cyber insurance in Malaysian organisations, thus further exploring the organisations' perceptions of the factors of adopting cyber insurance. A qualitative study is conducted to understand and describe Malaysian organisations’ needs, obstacles, and processes related to cyber insurance adoption by interviewing cybersecurity professionals and cyber insurance personnel to explore valuable insight into the existing knowledge. 30% of the respondents have adopted cyber insurance. While 40% of the respondents were unsure, the other 30% did not adopt cyber insurance in their organisation respectively. These insights include the factors in adopting cyber insurance among Malaysian organisations, which might be crucial for informing future research and practice in the cyber insurance industry. The novelty of this research is the overview of knowledge gaps and perceptions related to the adoption of cyber insurance in Malaysian organisations. Also, this research aims to consider the advantages of the relevant obstacles that influence the decision makers to adopt cyber insurance.

Impact of COVID-19 pandemic on neurology training program in Italy

This study tries to assess the impact of the unexpected COVID-19 pandemic, and the various policy options adopted by different countries to mitigate its effect, on the Malawi economy. The study employs the structural macroeconometric model developed for developing countries by the Economic Commission for Africa. Among others, the results show that the Malawi economy has been severely affected by the pandemic, with GDP growth expected to be below its pre-pandemic projection levels, and with worsened fiscal deficits and debt levels. This calls for a comprehensive policy agenda that tackles the country’s vulnerabilities to generate a transformational and inclusive recovery process. There is a need for the government to enhance its domestic revenue mobilization efforts and public service delivery with fiscal and monetary policy measures that would create an enabling economic environment and strengthen the government’s long-term commitment to structural transformation and long-term growth of the economy.

Background: Our institution has been offering the General inpatient hospice (GIP) services within the premises of our hospital since 2013. Our previous data had suggested increased acceptance of hospice and GIP care with this model. We wanted to study the impact of the current COVID-19 pandemic, on utilization of Hospice with this model of care.Objectives: Compare utilization of GIP at HUMC during the first COVID-19 surge, (3/1/2020–6/30/2020) to pre-COVID period (11/1/2019–2/29/2020).Methods: Using a retrospective chart review was done for GIP admissions from 11/2019 to 6/2020 at Hackensack University Medical Center (HUMC), an academic hospital in New Jersey which was approved by HUMC institutional review board. Data was collected for demographics and comorbidities. Descriptive statistics were reported. Results: The primary findings show increased hospice referrals during the study period (3.02%) compared to the pre-covid time period (2.63%), P = .0592. Furthermore, GIP admissions increased from 122/13 440 (.91%) in the pre-covid period to 146/11 480 (1.27%) during covid, P = .0055. There were 54 patients admitted to GIP with COVID-19. Descriptive statistics showed male and female distribution was almost equal (53.70% vs. 46.30%), and mean age of 82 years. In GIP patients with COVID-19, majority patients were white patients, (66.67%) age group of 76–95 years old and had < 3 comorbidities (85.19%), about half were with hypertension, next chronic condition was diabetes.Conclusions: COVID-19 outbreak increased both hospice referral and admission in our model of care. Availability of GIP in the hospital setting may help acceptance and facilitation of these essential end-of-life care services.

Growth discordance in twin pregnancies is associated with increased perinatal morbidity and mortality, yet the patterns of discordance progression and the utility of Doppler assessments remain underinvestigated. The objective of this study was to conduct a longitudinal assessment of intertwin growth and Doppler discordance to identify possible distinct patterns and to investigate the predictive value of longitudinal discordance patterns for adverse perinatal outcomes in twin pregnancies. This retrospective cohort study included twin pregnancies followed and delivered at a tertiary hospital in London (United Kingdom) between 2010 and 2023. We included pregnancies with at least 3 ultrasound assessments after 18 weeks and delivery beyond 34 weeks' gestation. Monoamniotic twin pregnancies, pregnancies with twin-to-twin transfusion syndrome, genetic or structural abnormalities, or incomplete data were excluded. Data on chorionicity, biometry, Doppler indices, maternal characteristics and obstetrics, and neonatal outcomes were extracted from electronic records. Doppler assessment included velocimetry of the umbilical artery, middle cerebral artery, and cerebroplacental ratio. Intertwin growth discordance was calculated for each scan. The primary outcome was a composite of perinatal mortality and neonatal morbidity. Statistical analysis involved multilevel mixed effects regression models and unsupervised machine learning algorithms, specifically k-means clustering, to identify distinct patterns of intertwin discordance and their predictive value. Predictive models were compared using the area under the receiver operating characteristic curve, calibration intercept, and slope, validated with repeated cross-validation. Analyses were performed using R, with significance set at P<.05. Data from 823 twin pregnancies (647 dichorionic, 176 monochorionic) were analyzed. Five distinct patterns of intertwin growth discordance were identified using an unsupervised learning algorithm that clustered twin pairs based on the progression and patterns of discordance over gestation: low-stable (n=204, 24.8%), mild-decreasing (n=171, 20.8%), low-increasing (n=173, 21.0%), mild-increasing (n=189, 23.0%), and high-stable (n=86, 10.4%). In the high-stable cluster, the rates of perinatal morbidity (46.5%, 40/86) and mortality (9.3%, 8/86) were significantly higher compared to the low-stable (reference) cluster (P<.001). High-stable growth pattern was also associated with a significantly higher risk of composite adverse perinatal outcomes (odds ratio: 70.19, 95% confidence interval: 24.18-299.03, P<.001; adjusted odds ratio: 76.44, 95% confidence interval: 25.39-333.02, P<.001). The model integrating discordance pattern with cerebroplacental ratio discordance at the last ultrasound before delivery demonstrated superior predictive accuracy, evidenced by the highest area under the receiver operating characteristic curve of 0.802 (95% confidence interval: 0.712-0.892, P<.001), compared to only discordance patterns (area under the receiver operating characteristic curve: 0.785, 95% confidence interval: 0.697-0.873), intertwin weight discordance at the last ultrasound prior to delivery (area under the receiver operating characteristic curve: 0.677, 95% confidence interval: 0.545-0.809), combination of single measurements of estimated fetal weight and cardiopulmonary resuscitation discordance at the last ultrasound prior to delivery (area under the receiver operating characteristic curve: 0.702, 95% confidence interval: 0.586-0.818), and single measurement of cardiopulmonary resuscitation discordance only at the last ultrasound (area under the receiver operating characteristic curve: 0.633, 95% confidence interval: 0.515-0.751). Using an unsupervised machine learning algorithm, we identified 5 distinct trajectories of intertwin fetal growth discordance. Consistent high discordance is associated with increased rates of adverse perinatal outcomes, with a dose-response relationship. Moreover, a predictive model integrating discordance trajectory and cardiopulmonary resuscitation discordance at the last visit demonstrated superior predictive accuracy for the prediction of composite adverse perinatal outcomes, compared to either of these measurements alone or a single value of estimated fetal weight discordance at the last ultrasound prior to delivery.

British Journal of NursingVol. 30, No. 16 CommentStoma care services during the COVID-19 pandemicJennie BurchJennie BurchE-mail Address: [email protected]Head of Gastrointestinal Nurse Education, St Mark's HospitalSearch for more papers by this authorJennie BurchPublished Online:11 Sep 2021https://doi.org/10.12968/bjon.2021.30.16.S40AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References COVIDSurg Collaborative. Outcomes from elective colorectal cancer surgery during the SARSCoV-2 pandemic. Colorectal Dis. 2020;00:1–18. https://doi.org/10.1111/codi.15431 Google ScholarD'Antonio D, Pizza F, Tropeano FP, De Palma GD, Marvaso A, Luglio G. COVID-19 outbreak and stoma care on a minor island in Italy: Physically far, virtually near. SN Comprehensive Clinical Medicine. 2020;2(9):1302–1305. https://doi.org/10.1007/s42399-020-00429-3 Crossref, Google ScholarDepartment of Health. New campaign to prevent spread of coronavirus indoors this winter. 2020. https://tinyurl.com/hbdkkfbm (accessed 18 August 2021) Google ScholarFowler A, Abbott TEF, Pearse RM. Can we safely continue to offer surgical treatments during the COVID-19 pandemic? BMJ Qual Saf. 2020;0:1–3. https://doi.org/10.1136/bmjqs-2020-012544 Google ScholarFulham J, Lowther C, Chandler P. Embracing the changes imposed by COVID-19 to shape future stoma care service provision. Br J Nurs. 2020;29(22):S10–S12. https://doi.org/10.12968/bjon.2020.29.22.S10 Link, Google ScholarLancet Oncology (Editorial). Valuing all lives equally: cancer surgery, COVID-19, and the NHS in crisis. Lancet Oncol. 2021;22(2):155. https://doi.org/10.1016/S1470-2045(21)00022-X Crossref, Medline, Google ScholarMarino F, Trompetto M, Gallo G. COVID-19 pandemic: a large boulder on the head of stoma patients. Br J Surg. 2020;107(9):e303. https://doi.org/10.1002/bjs.11754 Crossref, Medline, Google ScholarMorris EJA, Goldacre R, Spata E et al. Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study. Lancet Gastroenterol Hepatol. 2021 Mar;6(3):199-208. doi: https://doi.org/10.1016/S2468-1253(21)00005-4 Crossref, Medline, Google ScholarNational Institute for Health and Care Excellence. When should I suspect coronavirus infection? 2021. https://cks.nice.org.uk/topics/coronavirus-covid-19/diagnosis/diagnosis/ (accessed 13 August 2021) Google ScholarNHS Website. How to avoid catching and spreading coronavirus (COVID-19). https://tinyurl.com/a65uname (accessed 18 August 2021) Google ScholarPata F, Bondurri A, Ferrara F, Parini D, Rizzo G; Multidisciplinary Italian Study group for STOmas (MISSTO). Enteral stoma care during the COVID–19 pandemic: practical advice. Colorectal Dis. 2020;22(9):985–992. https://doi.org/10.1111/codi.15279 Crossref, Medline, Google ScholarVailas M, Sotiropoulou M, Schizas D, Maroulis I. Psychological implications on stoma patients waiting for reversal in the era of COVID-19 pandemic. Br J Surg. 2021;108(4):e181. https://doi.org/10.1093/bjs/znab022 Crossref, Medline, Google ScholarVural F, Özer Özlü. In the COVID-19 Pandemic Living with a Stoma and Being a Stoma Nurse. Turk J Colorectal Dis 2020;30:231-236. https://doi.org/10.4274/tjcd.galenos.2020.2020-10-3 Crossref, Google ScholarWoodhouse F, Yeung T. Impact of COVID-19 on stoma care: the experience of one team in Oxford. Br J Nurs. 2020;29(16):S4–S6. https://doi.org/10.12968/bjon.2020.29.16.S4 Link, Google ScholarWorld Health Organization. Coronavirus disease (COVID-19): How is it transmitted? 2020. https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-how-is-it-transmitted (accessed 13 August 2021) Google ScholarWorld Health Organization. Naming the coronavirus disease (COVID-19) and the virus that causes it. 2021. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it#:~:text=Official%20names%20have%20been%20announced,%2DCoV%2D2) (accessed 13 August 2021) Google ScholarXu Y, Huang ZH, Zheng CZ, Li C, Zhang YQ, Guo TA, Liu FQ, Xu Y. The impact of COVID-19 pandemic on colorectal cancer patients: a single-center retrospective study. BMC Gastroenterol. 2021; 20;21(1):185. https://doi.org/10.1186/s12876-021-01768-8 Crossref, Google Scholar FiguresReferencesRelatedDetailsCited byCaring during and after a pandemicAna González Díaz, Concepción Capilla Díaz2 June 2022 | Gastrointestinal Nursing, Vol. 20, No. Sup4 9 September 2021Volume 30Issue 16ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 11 September 2021 Published in print 9 September 2021 Information© MA Healthcare LimitedPDF download

Whether and how the COVID-19 pandemic affected utilization of routine medical care in areas with low infection risk, such as Taiwan, has not been widely addressed. We aimed to evaluate the impact of the COVID-19 pandemic on access to medical care. Before and after exposure (COVID-19 pandemic) design with a historical control group for comparison of clinical visits based on a retrospective cohort of 6722 customary patients of a community hospital in Zhunan, Taiwan. Repeated measurements of medical utilization in 4-month periods (January to April) of 2019 and 2020 in light of the emerging COVID-19 pandemic were collected. Access to medical care was defined as the mean frequencies of clinical visits. The impacts of the COVID-19 pandemic on access in the overall and specific groups were quantified with a multivariable Poisson regression model. The overall outpatient visits per month declined by 39% (rate ratio [RR], 0.61; P < .0001) after adjusting for demographics. A notable reduction in visits was observed in foreign patients (RR, 0.50; P < .0001). The visits of the elderly (≥ 80 years) were the most frequent before the COVID-19 pandemic but were reduced by 44% (RR, 0.56; P < .0001) after it began. Most disease categories revealed a declining trend, but the size of reduction varied by International Classification of Diseases codes. The COVID-19 pandemic prevented some individuals from keeping regular medical appointments even in an area with a low infection risk. Our findings imply that more research is required to mitigate the effects of delayed medical care for patients who infrequently utilized medical care during and after the long-lasting pandemic period.

PurposeIn recent years, the frequency and severity of cybersecurity incidents have prompted customers to seek out specialized insurance products. However, this has also presented insurers with operational challenges and increased costs. The assessment of risks for health systems and cyber–physical systems (CPS) necessitates a heightened degree of attention. The significant values of potential damages and claims request a solid insurance system, part of cyber-resilience. This research paper focuses on the emerging cyber insurance market that is currently in the process of standardizing and improving its risk analysis concerning the potential insured entity.Design/methodology/approachThe authors' approach involves a quantitative analysis utilizing a Likert-style questionnaire designed to survey cyber insurance professionals. The authors' aim is to identify the current methods used in gathering information from potential clients, as well as the manner in which this information is analyzed by the insurers. Additionally, the authors gather insights on potential improvements that could be made to this process.FindingsThe study the authors elaborated it has a particularly important cyber and risk components for insurance area, because it addresses a “niche” area not yet proper addressed in specialized literature – cyber insurance. Cyber risk management approaches are not uniform at the international level, nor at the insurer level. Also, not all insurers can perform solid assessments, especially since their companies should first prove that they are fully compliant with international cyber security standards.Research limitations/implicationsThis research has concentrated on analyzing the current practices in terms of gathering information about the insured entity before issuing the cyber insurance policy, level of details concerning the cyber security posture of the insured entity and way such information should be analyzed in a standardized and useful manner. The novelty of this research resides in the analysis performed as detailed above and the proposals in terms of information gathered, depth of analysis and standardization of approach made. Future work on the topic can focus on the standardization process for analyzing cyber risk for insurance clients, to improve the proposal based also on historical elements and trends in the market. Thus, future research can further refine the standardization process to analyze in more depth the way this can be implemented and included in relevant legislation at the EU level.Practical implicationsProposed improvements include proposals in terms of the level of detail and the usefulness of an independent centralized approach for information gathering and analysis, especially given the re-insurance and brokerage activities. The authors also propose a common practical procedural approach in risk management, with the involvement of insurance companies and certification institutions of cyber security auditors.Originality/valueThe study investigates the information gathered by insurers from potential clients of cyber insurance and the way this is analyzed and updated for issuance of the insurance policy.

Impact of COVID-19 pandemic on multidrug resistant gram positive and gram negative pathogens: A systematic review

PurposeThis paper presents a cross-sectional study that assessed the impact of the COVID-19 pandemic on rural migrants in Bihar. The primary objective of this study was to evaluate the overall impact of the pandemic on migrants and examine their livelihoods, with a focus on identifying measures that can mitigate the economic consequences.Design/methodology/approachThis study used a telephonic survey to collect primary data from 419 respondents. Descriptive statistics were used to analyze the data, and three indices were constructed: fear and worries, trust and prevention.FindingsThe findings provide insights into the psychological well-being of migrant workers and highlight the challenges they face in sustaining their livelihoods amidst the pandemic. This study concludes by suggesting potential measures to alleviate the economic impact and enhance the resilience of this vulnerable population.Research limitations/implicationsThis study may be limited by the representativeness of the sample as well as the potential for social desirability bias. The study may also be limited by the reliability and validity of the measures used to capture the fear and worries, trust and prevention indices.Originality/valueNumerous studies have examined the impact of the COVID-19 pandemic on rural migrants. However, there are limited studies that estimate the impact of the proposed study based on the challenges faced by rural migrants in Bihar during the pandemic.