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Association of Surgeons in Training Surgical Summit, online, 17 Oct 2020 - 17 Oct 2020 2021 Virtual Annual Meeting / Surgical Research Society, online, 24 Mar 2021 - 25 Mar 2021, National Research Collaborative Meeting, online, 10 Dec 2020 - 10 Dec 2020, Royal Australasian College of Surgeons Annual Academic Surgery Conference, online, 5 Nov 2020 - 5 Nov 2020; The British journal of surgery : BJS 108(12), 1448-1464 (2021). doi:10.1093/bjs/znab336 Published by Wiley, New York, NY [u.a.]

The purpose of this report is to outline the evaluation and comparison approach and the knowledge obtained through a detailed data collection process, in order to examine the implementation and application of the Half Double Methodology (HDM) at Forsvarsministeriets Material- og Indkøbsstyrelse (FMI), as well as compare and contrast pilot and reference projects. State-owned FMI is the Danish Ministry of Defence Acquisition and Logistics Organization (English abbreviation: DALO), and thus a unit under the Ministry of Defence and the Danish public sector. It is likely that the Half Double Methodology has had a positive impact on FMI and their team collaboration. The procurement process is faster, which especially is evident in pilot case 3, but also the initial versions of pilot case 1 and 2. However, here, the cases were subject to external conditions which increased the duration. FMI experiences satisfaction from stakeholders involved in the procurement. This satisfaction is also present in most of the team members engaging with the methodology. Hence overall, integrating the Half Double Methodology in FMI’s team collaboration is perceived as a success in FMI and continues to be applied. However, there is still room for improvements in the procurement process and team configuration. This relates to the application of HDM, but also other constraints in FMI, which is related to a lack of resources to develop interdisciplinary teams, as well as challenges from covid-19 restrictions. The purpose of this report is to outline the evaluation and comparison approach and the knowledge obtained through a detailed data collection process, in order to examine the implementation and application of the Half Double Methodology (HDM) at Forsvarsministeriets Material- og Indkøbsstyrelse (FMI), as well as compare and contrast pilot and reference projects. State-owned FMI is the Danish Ministry of Defence Acquisition and Logistics Organization (English abbreviation: DALO), and thus a unit under the Ministry of Defence and the Danish public sector. It is likely that the Half Double Methodology has had a positive impact on FMI and their team collaboration. The procurement process is faster, which especially is evident in pilot case 3, but also the initial versions of pilot case 1 and 2. However, here, the cases were subject to external conditions which increased the duration. FMI experiences satisfaction from stakeholders involved in the procurement. This satisfaction is also present in most of the team members engaging with the methodology. Hence overall, integrating the Half Double Methodology in FMI’s team collaboration is perceived as a success in FMI and continues to be applied. However, there is still room for improvements in the procurement process and team configuration. This relates to the application of HDM, but also other constraints in FMI, which is related to a lack of resources to develop interdisciplinary teams, as well as challenges from covid-19 restrictions.

AbstractFew data are available on the incidence of deep vein thrombosis (DVT) in critically ill COVID-19 with thrombosis prophylaxis. This study retrospectively included 88 patients in the ICU with critically ill COVID-19 at Jinyintan Hospital in Wuhan, China. All patients underwent compression ultrasonography for identifying DVT. Firth logistic regression was used to examine the association of DVT with sex, age, hypoalbuminemia, D-dimer, and SOFA score. The median (interquartile range [IQR]) age and SOFA score of 88 patients were 63 (55–71) years old and 5 (4–6), respectively. Despite all patients receiving guideline-recommended low-molecular-weight heparin (LMWH) thromboprophylaxis, the incidence of DVT was 46% (95% CI 35–56%). Proximal DVT was recognized in 9% (95% CI 3–15%) of the patients, while 46% (95% CI 35–56%) of patients had distal DVT. All of the proximal DVT combined with distal DVT. Risk factors of DVT extension occurred in all distal DVT patients. As Padua score ≥ 4 or IMPROVE score ≥ 2, 53% and 46% of patients had DVT, respectively. Mortality was higher in patients with acute DVT (30%) compared with non-DVT (17%), but did not reach statistical significance. Hypoalbuminemia (odds ratio [OR], 0.17; 95% CI 0.06–0.05, P = 0.001), higher SOFA score (OR per IQR, 2.07; 95% CI 1.38–3.39, P = 0.001), and elevated D-dimer (OR per IQR, 1.04; 95% CI 1.03–1.84, P = 0.029) were significant DVT risk factors in multivariable analyses. High incidence of DVT was identified in patients with critically ill COVID-19, despite the use of guideline-recommended pharmacologic thromboprophylaxis. The presence of hypoalbuminemia, higher SOFA score, and elevated D-dimer were significantly independent risk factors of DVT. More effective VTE prevention and management strategies may need to be addressed.

Three key transitions leading to a “safe and just” operating space, with a focus on food systems, emerged during the development of a Foresight study promoted by SCAR (Standing Committee on Agricultural Research1): (a) sustainable and healthy diets for all; (b) full circularity in the use of resources; (c) diversity as a key component of stable systems. As consequence of COVID-19, food emerged again as a central element of life, along with health, after decades in which food security was taken for granted, at least in most developed countries. The COVID-19 outbreak offered the opportunity for a reflection on the importance of resilience in emergencies. Sustainable and healthy diets for all, was shown, during the pandemic, to depend much more on social and economic conditions than on technical aspects of food production and processing. Agriculture and the agro-industry have now a potential to absorb, at least temporarily, workers laid out in other sectors; the pandemic could be an opportunity to re-think and re-value labor relationships in the sector as well as local productions and supply chains. A full circularity in food systems also would benefit from stronger links established at the territorial level and increase the attention on the quality of the environment, leading to the adoption of benign practices, regenerating rather than impoverishing natural resources. Diversity is a key component of a resilient system, both in the biophysical sphere and in the social sphere: new business models, new knowledge-sharing networks, new markets. The three transitions would operate in synergy and contribute to the resilience of the whole food system and its preparation for a possible next emergency. Science can support policy making; however, science needs to be better embedded in society, to have a clear direction toward the grand challenges, to address the social, economic, behavioral spheres, to aim clearly at the common good. We need to re-think the conundrum between competition and cooperation in research, devising ways to boost the latter without sacrificing excellence. We need to improve the way knowledge is generated and shared and we need to ensure that information is accessible and unbiased by vested interests.

Abstract Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population. The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous.

This paper explores the rising tensions between efficiency and resilience in global value chains (GVCs) in the post-COVID-19 world and discusses their potential implications for managing and coordinating GVCs. It considers efficiency and resilience in GVCs in relation to each other and explores the possibility of tensions between the two concepts. Particularly, it is argued that, while efficiency and resilience in GVCs may be at odds with each other in the short-term, they are not necessarily mutually exclusive in the long run. The paper adds to the discussions of trade-offs involved in managing contemporary GVCs and offers a new perspective on the interplay between efficiency and resilience. Embedded in the discussion of resilience vis-à-vis efficiency, we also provide a long-term perspective to prepare for and deal with global pandemics – or other risks – in an increasingly interconnected world. We lay out decisions and steps involved in finding the balance between efficiency and resilience, as both need to be maintained concurrently over longer periods.

Objective To determine the incidence of hospital admissions and associated mortality rates for non-covid medical conditions during the covid-19 pandemic.Design Nationwide, population based cohort study.Setting Denmark from 13 March 2019 to 27 January 2021.Participants All Danish residents gt;1 year of age.Main outcomes measures Population based healthcare registries that encompass the entire Danish population were used to compare hospital admission and mortality rates during the covid-19 pandemic (from 11 March 2020 to 27 January 2021) with the prepandemic baseline data (from 13 March 2019 to 10 March 2020). Hospital admissions were categorised as covid-19 when patients were assigned a diagnosis code for covid-19 within five days of admission. All patients were followed until migration, death, or end of follow-up, whichever came first. Rate ratios for hospital admissions were computed using Poisson regression and were directly standardised using the Danish population on 1 January 2019 as reference. 30 day mortality rate ratios were examined by Cox regression, adjusted for age and sex, and covid-19 diagnosis was used as a competing risk.Results 5 753 179 residents were identified during 567.8 million person weeks of observation, with 1 113 705 hospital admissions among 675 447 people. Compared with the prepandemic baseline period (mean hospital admission rate 204.1 per 100 000/week), the overall hospital admission rate for non-covid-19 conditions decreased to 142.8 per 100 000/week (rate ratio 0.70, 95.66 to 0.74) after the first national lockdown, followed by a gradual return to baseline levels until the second national lockdown when it decreased to 158.3 per 100 000/week (0.78, 0.73 to 0.82). This pattern was mirrored for most major diagnosis groups except for non-covid-19 respiratory diseases, nervous system diseases, cancer, heart failure, sepsis, and non-covid-19 respiratory infections, which remained lower throughout the study period. Overall 30 day mortality rates were higher during the first national lockdown (mortality rate ratio 1.28, 95.23 to 1.32) and the second national lockdown (1.20, 1.16 to 1.24), and these results were similar across most major diagnosis groups. For non-covid-19 respiratory diseases, cancer, pneumonia, and sepsis, the 30 day mortality rate ratios were also higher between lockdown periods.Conclusions Hospital admissions for all major non-covid-19 disease groups decreased during national lockdowns compared with the prepandemic baseline period. Additionally, mortality rates were higher overall and for patients admitted to hospital with conditions such as respiratory diseases, cancer, pneumonia, and sepsis. Increased attention towards management of serious non-covid-19 medical conditions is warranted. Objective: To determine the incidence of hospital admissions and associated mortality rates for non-covid medical conditions during the covid-19 pandemic. Design: Nationwide, population based cohort study. Setting: Denmark from 13 March 2019 to 27 January 2021. Participants: All Danish residents >1 year of age. Main outcomes measures: Population based healthcare registries that encompass the entire Danish population were used to compare hospital admission and mortality rates during the covid-19 pandemic (from 11 March 2020 to 27 January 2021) with the prepandemic baseline data (from 13 March 2019 to 10 March 2020). Hospital admissions were categorised as covid-19 when patients were assigned a diagnosis code for covid-19 within five days of admission. All patients were followed until migration, death, or end of follow-up, whichever came first. Rate ratios for hospital admissions were computed using Poisson regression and were directly standardised using the Danish population on 1 January 2019 as reference. 30 day mortality rate ratios were examined by Cox regression, adjusted for age and sex, and covid-19 diagnosis was used as a competing risk. Results: 5 753 179 residents were identified during 567.8 million person weeks of observation, with 1 113 705 hospital admissions among 675 447 people. Compared with the prepandemic baseline period (mean hospital admission rate 204.1 per 100 000/week), the overall hospital admission rate for non-covid-19 conditions decreased to 142.8 per 100 000/week (rate ratio 0.70, 95% confidence interval 0.66 to 0.74) after the first national lockdown, followed by a gradual return to baseline levels until the second national lockdown when it decreased to 158.3 per 100 000/week (0.78, 0.73 to 0.82). This pattern was mirrored for most major diagnosis groups except for non-covid-19 respiratory diseases, nervous system diseases, cancer, heart failure, sepsis, and non-covid-19 respiratory infections, which remained lower throughout the study period. Overall 30 day mortality rates were higher during the first national lockdown (mortality rate ratio 1.28, 95% confidence interval 1.23 to 1.32) and the second national lockdown (1.20, 1.16 to 1.24), and these results were similar across most major diagnosis groups. For non-covid-19 respiratory diseases, cancer, pneumonia, and sepsis, the 30 day mortality rate ratios were also higher between lockdown periods. Conclusions: Hospital admissions for all major non-covid-19 disease groups decreased during national lockdowns compared with the prepandemic baseline period. Additionally, mortality rates were higher overall and for patients admitted to hospital with conditions such as respiratory diseases, cancer, pneumonia, and sepsis. Increased attention towards management of serious non-covid-19 medical conditions is warranted.

Restructuring of healthcare services during the COVID-19 pandemic has led to lockdown of Epilepsy Monitoring Units (EMUs) in many hospitals. The ad-hoc taskforce of the International League Against Epilepsy (ILAE) and the International Federation of Clinical Neurophysiology (IFCN) highlights the detrimental effect of postponing video-EEG monitoring of patients with epilepsy and other paroxysmal events. The taskforce calls for action to continue functioning of Epilepsy Monitoring Units during emergency situations, such as the COVID-19 pandemic. Long-term video-EEG monitoring is an essential diagnostic service. Access to video-EEG monitoring of the patients in the EMUs must be given high priority. Patients should be screened for COVID-19, before admission, according to the local regulations. Local policies for COVID-19 infection control should be adhered to during the video-EEG monitoring. In cases of differential diagnosis where reduction of antiseizure medication is not required, consider home video-EEG monitoring as an alternative in selected patients.

Ultrafine particles (UFP; particulate matter <0.1 μm diameter) emitted from motorized traffic may be highly detrimental to health. Active mobility (walking, bicycling) is increasingly encouraged as a way to reduce traffic congestion and increase physical activity levels. However, it has raised concerns of increased exposure to UFP, due to increased breathing rates in traffic microenvironments, immediately close to their source. The recent Coronavirus Disease 2019 (COVID-19) societal closures reduced commuting needs, allowing a natural experiment to estimate contributions from motorized traffic to UFP exposure while walking or bicycling. From late-March to mid-July 2020, UFP was repeatedly measured while walking or bicycling, capturing local COVID-19 closure (‘Phase 0’) and subsequent phased re-opening (‘Phase 1, 2, 2.1 & 3’). A DiSCmini continuously measured particle number concentration (PNC) in the walker/bicyclist’s breathing zone. PNC while walking or bicycling was compared across phased re-openings and the effect of ambient temperature, wind speed and direction, was determined using regression models. Approximately 40 repeated 20-minute walking and bicycling laps were made over 4 months during societal re-opening phases related to the COVID-19 pandemic, from late March to mid July 2020 in Copenhagen. Highest median PNC exposure of both walking (13,170 pt/cm3, standard deviation (SD): 3560 pt/cm3) and bicycling (21,477 pt/cm3, SD: 8964) was seen during societal closures (Phase 0) and decreased to 5,367 pt/cm3 (SD: 2949) and 8,714 pt/cm3 (SD: 4309) in Phase 3 of re-opening. These reductions in PNC were mainly explained by meteorological conditions, with most of the deviation explained by wind speed (14–22%) and temperature (13–10%). Highest PNC was observed along major roads and intersections. In conclusion, we observed decreases in UFP exposure while walking and bicycling during societal re-opening phases related to the COVID-19 pandemic, due largely to meteorological factors (e.g., wind speed and temperature) and seasonal variations in UFP levels. Graphical abstract Unlabelled Image