Relaxation Of Restrictions Research Articles

Analysis by simulation of process improvement at the entrance of a primary care unit

Este artigo analisa uma proposta de redesenho de processos da porta de entrada de uma unidade de atenção primária em saúde no Município do Rio de Janeiro. O principal redesenho proposto foi a unificação das filas dos guichês, deixando de estratificar usuários de acordo com sua equipe. Dados coletados em visitas de campo foram usados para construir um modelo de simulação de eventos discretos. Foram analisados os impactos do redesenho sobre o tempo médio de espera em fila, sobre o tamanho médio da fila e sobre a taxa de ocupação dos guichês. Os resultados da simulação apontam para uma redução de 89,9% do tempo médio em fila, passando de 465,5 segundos para 47,2 segundos. Correspondentemente, o tamanho médio da fila foi reduzido de 0,9 usuários para 0,6 usuários. Ainda, houve a redução de um guichê e aumento na taxa média de utilização dos guichês, de 56,9% para 67,4%, aumentando a produtividade sem geração de sobrecarga. Estudos futuros poderão explorar o relaxamento de restrições nas premissas do modelo e a replicabilidade dos resultados em unidades de saúde semelhantes.

Strategies to reduce risk perception among grocery shoppers in the US: A survey study.

During the COVID-19 lockdown in the US, many businesses were shut down temporarily. Essential businesses, most prominently grocery stores, remained open to ensure access to food and household essentials. Grocery shopping presents increased potential for COVID-19 infection because customers and store employees are in proximity to each other. This study investigated shoppers’ perceptions of COVID-19 infection risks and put them in context by comparing grocery shopping to other activities outside home, and examined whether a proactive preventive action by grocery stores influence shoppers’ perceived risk of COVID-19 infection. Our data were obtained via an anonymous online survey distributed between April 2 and 10, 2020 to grocery shoppers in New York State (the most affected by the pandemic at the time of the study) and Washington State (the first affected by the pandemic). We found significant factors associated with high levels of risk perception on grocery shoppers. We identified some effective preventive actions that grocery stores implement to alleviate anxiety and risk perception. We found that people are generally more concerned about in-store grocery shopping relative to other out-of-home activities. Findings suggest that a strict policy requiring grocery store employees to use facemasks and gloves greatly reduced shoppers’ perceived risk rating of infection of themselves by 37.5% and store employees by 51.2%. Preventive actions by customers and businesses are critical to reducing the unwitting transmission of COVID-19 as state governments prepare to reopen the economy and relax restrictions on activities outside home.

Roadmap out of lockdown underscores positive UK story

▀ The government's roadmap for exiting lockdown takes a gradual approach to relaxing restrictions. Combined with other factors, including the rapid rollout of vaccinations and the extension of fiscal support in March's Budget, the plan reinforces our view that the UK economy will outperform its peers in 2021. ▀ Under the roadmap, and Covid numbers allowing, the economy will exit partial hibernation in stages, beginning with the reopening of schools on March 8 and concluding with all legal limits on social contact ending on June 21. ▀ The extension of support measures in the Budget, including the furlough scheme, will help maintain the base of the economy as normality returns. Growth will also benefit from headwinds in 2020 becoming tailwinds this year.

The Temptation of War: How Alcohol Affected the Canadian First World War Experience in Hastings, 1917

ABSTRACT This article analyses the consumption of alcohol amongst Canadian soldiers based in the East Sussex town of Hastings in 1917. It shows that more relaxed restrictions on alcohol in Britain to those in Canada, all provinces and eventually the federal government had prohibited alcohol by 1918, proved too much of a temptation for some Canadians, who were caught up in instances of drunkenness, disorder and petty crime. The wide availability of alcohol in the town coupled with poor administration and scattered billets provided a fertile environment for ill-discipline. This caused tension between some in the community and the Canadians. Another theme which started to emerge in Hastings was that Canada was more socially advanced than Britain. The motherland’s reluctance to completely ban alcohol was viewed as archaic and backwards. For some Canadians, this warranted a loosening of the attachment to Britain and the Empire in favour of Canada. The Canadian’s experience of alcohol in Hastings may, therefore, point to how Canada was moving away from Britain and the Empire and strengthening its own sense of self. This aspect warrants further research.

Visitation After Vaccination: Ethics, Risks, and Benefits Must Be Considered

Visitation After Vaccination: Ethics, Risks, and Benefits Must Be Considered

Monitoring Sound and Its Perception during the Lockdown and De-Escalation of COVID-19 Pandemic: A Spanish Study.

The lockdown measures in Spain due to the SARS-CoV-2 or COVID-19 (Coronavirus disease 2019) pandemic from 13 March to 21 June 2020 had extensive social and environmental implications. This study aims to understand how the measures of lockdown have influenced noise levels, as well as people’s perception of sound quality before and after lockdown, including de-escalation. For this purpose, an online survey was carried out. Moreover, the noise linked to the Global Positioning System (GPS) position of each individual respondent was recorded aiming to correlate the noise level with the result of the survey. An average reduction of over 30 dB was observed compared with the sound pressure level before lockdown. Furthermore, it was found that the loudness parameter, together with the overall level, increased as the country started relaxing restrictions. Additionally, results showed that the perception of noise quality changed depending on the phase of de-escalation (p < 0.01), the type of property (p < 0.05), and the outside noise (p < 0.01). Moreover, noise annoyance was determined considering age (p < 0.01), gender (p < 0.05), type of property (p < 0.001), and home refurbishment (p < 0.05). It may be concluded that the most important measure to decrease noise levels is the reduction of traffic noise, through using eco-friendly public transportation or bicycles and limiting nightlife hours.

Explaining the Voluntary Compliance to COVID-19 Measures: An Extrapolation on the Gender Perspective

The discourse of gender amidst the COVID-19 pandemic had been a big fuss. Amongst the discussions is the gender-related responses to COVID-19 that generally assume females to better respond to COVID-19 than males. Despite the converging assumptions, previous studies tend to conceptualize gender as binary biological sex, and consequently, there is little understanding of the gender-COVID-19 measures compliance relationship. By taking gender as a multidimensional perspective, this research aims to examine the relationship between sex, gender psychology, and gender-role with voluntary compliance to COVID-19 measures as well as the moderating role of situational aspects that can activate individuals' responses toward COVID-19. A survey had been conducted in Indonesia, as Indonesia represents a country with relaxed COVID-19 restrictions making voluntary compliance is deemed important. Consistent with our predictions and previous studies, females tend to better comply with COVID-19 when gender is treated as dichotomous sex. However, a closer look at the gender dimensions revealed that gender psychology (feminine vs masculine) and gender-role (traditional vs egalitarian) provide a better explanation of the specific compliance behaviour toward COVID-19 measures. Interestingly, although situational pathogen avoidance (SPA) directly leads to adherence to several compliance behaviours, it does not moderate the four compliance behaviour of COVID-19 measures. Theoretical and practical contributions are further discussed.

Programs cite improved access under telehealth initiation to buprenorphine

Two New York primary care programs that offer buprenorphine treatment for opioid use disorder (OUD) are reporting dramatically reduced wait times and other benefits from temporarily relaxed restrictions allowing initiation to treatment after a telemedicine visit. Leaders of the programs say persons exiting the criminal justice system and clients of syringe services programs have been among the main beneficiaries of an exception that was enacted to maintain access to care for OUD during the COVID‐19 crisis.

Overview of the characteristics of and responses to the three waves of COVID-19 in Japan during 2020-2021.

The first case of COVID-19 in Japan was reported on 16 January 2020. The total number of the infected has reached 313,844 and the number of deaths has reached 4,379 as of 16 January 2021. This article reviews the characteristics of and responses to the three waves of COVID-19 in Japan during 2020-2021 in order to provide a reference for the next step in epidemic prevention and control. The Japanese Government declared a state of emergency on 7 April 2020, which suppressed the increase in the number of the infected by curtailing economic activity. The first wave peaked at 701 new cases a day and it decreased to 21 new cases on May 25 when the state of emergency was lifted. However, the number of the infected increased again due to the resumption of economic activity, with a peak of 1,762 new cases a day during the second wave. Although the situation was worse than that during the first wave, the government succeeded in limiting the increase without declaring a state of emergency again, and that may be attributed to a decrease in crowd activities and an increase in the number of inspections. During the third wave, the number of the infected continued to exceed the peak during previous waves for two months. Major factors for this rise include the government's implementation of further policies to encourage certain activities, relaxed immigration restrictions, and people not reducing their level of activity. An even more serious problem is the bed usage for patients with COVID-19; bed usage exceeds 50% not only in major cities but also in various areas. On 7 January 2021, 5,953 new cases were reported a day; this greatly exceeded the previous peak, and the state of emergency was declared again. Although Japan has been preparing its medical system since the first wave, maintaining that system has imposed a large economic burden on medical facilities, hence stronger measures and additional support are urgently needed to combat COVID-19 in the coming few months.

Broiler growth and efficiency in response to relaxed maternal feed restriction

Broiler growth performance can be influenced by maternal BW, maternal age, and sex. The present study evaluated broiler growth and efficiency in response to increased maternal BW (relaxed level of maternal feed restriction). It was hypothesized that BW and fatness would increase, and efficiency would be reduced as maternal BW increased. Ten BW trajectories were applied to precision-fed Ross 708 female broiler breeders (n = 30) from 2 to 42 wk of age. Trajectories varied in prepubertal and pubertal growth phases from 2.5 to 22.5% above the recommended BW target. Additional unrestricted breeders (n = 6) were not limited to a maximum BW (fed ad libitum). Two 35 d experiments were conducted with precision-fed broilers from these breeders at 35 and 42 wk of age. Two analyses (full and restricted analysis scopes) were performed to evaluate broiler BW, feed conversion ratio (FCR) and carcass traits with maternal BW at photostimulation (22 wk of age) as a continuous effect, and maternal age and sex as discrete effects. The full scope included broilers from all hens (feed restricted and unrestricted). The restricted scope excluded broilers from unrestricted hens. Differences were reported at P ≤ 0.05. For every kilogram increase in maternal BW, cumulative FCR increased by 0.235 and 0.471 g:g for broilers from all and feed restricted hens, respectively. Proportional gut weight of broilers from feed restricted hens decreased by 0.8244% per kilogram increase in maternal BW. Males were heavier than females on day 28 and 35, and broilers from 42-wk-old breeders were heavier than broilers from 35-wk-old breeders on day 0 and 35. Males from all hens were more feed efficient (1.318 g:g) than females (1.335 g:g) from day 29 to 35. Females from all and feed restricted hens had a greater proportional fat pad and breast muscle weight than males, and proportional breast muscle yield of broilers from 42-wk-old breeders was on average 1.04 times greater than that of broilers from 35-wk-old breeders. Maternal BW did not affect offspring BW, reduced cumulative FCR, and reduced gut weight in the restricted analysis scope.

Medication-assisted Treatment for Opioid Use Disorder in Rhode Island: Who Gets Treatment, and Does Treatment Improve Health Outcomes?

Since the early 2000s Rhode Island has been among the states hardest hit by the opioid crisis. In response, the state has made it a priority to expand access to medication-assisted treatment (MAT) for opioid use disorder (OUD), which refers to the use of the FDA-approved medications methadone, buprenorphine, and/or naltrexone in conjunction with behavioral therapy. MAT is strongly supported by scientific evidence and endorsed by US public health officials and yet fails to reach many OUD patients. Using administrative data covering medical treatments and selected health outcomes for more than three-quarters of the Rhode Islanders covered by health insurance from mid-2011 through mid-2019, this report considers MAT’s efficacy in preventing opioid overdoses in Rhode Island and sheds light on the barriers to receiving MAT. The authors find evidence that MAT, as practiced in Rhode Island, appears to reduce the risk of opioid overdose: Among patients who had an initial (nonfatal) overdose, those who had received MAT in the preceding three months were less likely to experience a second overdose. In addition, federal policies that allowed a broader set of health-care providers to prescribe buprenorphine for OUD and enabled each prescriber to treat more patients with that drug are shown to have had some success in expanding the set of patients receiving MAT in Rhode Island.Unfortunately, we observe significant disparities in access to MAT across different groups within Rhode Island. Among individuals diagnosed with opioid dependence, those living in places with elevated poverty rates are less likely to receive buprenorphine, but they are also somewhat more likely to receive methadone. Because a treatment regimen involving methadone is much less convenient for the patient compared with one involving buprenorphine, ideally patients should have similar access to both drugs. Having Medicaid insurance as opposed to some other form of insurance is associated with a much greater chance of receiving methadone treatment, a finding that supports policies that would incentivize the expansion of Medicaid in states that have not yet done so. Women are somewhat less likely than men to receive either methadone or buprenorphine.This research demonstrates that recent federal policies helped to increase the number of Rhode Islanders who were prescribed buprenorphine for OUD. Raising patient-number limits enabled select prescribers to serve more patients and expand the total patient pool; however, more people could be helped if more prescribers took full advantage of their prescribing limits. This research and similar findings from other states reveal that the typical buprenorphine prescriber has a caseload that is well below the maximum number of patients they could treat. A separate policy that enabled mid-level practitioners (such as physician assistants) to train to prescribe buprenorphine was also found to draw in new patients, particularly those in high-poverty Zip codes. The research also underscores the urgency of helping more OUD patients receive methadone and/or buprenorphine treatment quickly following an overdose (in hospitals, for example) and to maintain that treatment over time for a sufficient duration.Some additional policies that could promote greater access to MAT include allowing pharmacists to prescribe buprenorphine, relaxing restrictions on the use of telehealth for obtaining buprenorphine prescriptions, and revisiting the rules about allowing take-home doses of methadone. Additional research is required on these interventions before specific recommendations can be made, but consideration of further policy adjustments is critically important given the ongoing scourge of opioid abuse and the proven ability of MAT to help those suffering from opioid use disorder. In response to the COVID-19 pandemic there has in fact been a temporary loosening of policies related to MAT in order to minimize patients’ exposure to the virus while helping them to get on or stay on medications, thus offering an opportunity to evaluate the efficacy and safety of the revised measures.

A proposed framework to limit post-lockdown community transmission of COVID-19 in Africa.

As of March 11, 2021, 3,992,044 coronavirus disease 2019 (COVID-19) cases and 106,615 deaths (case fatality rate 2.67%) have been reported on the African continent. In March 2020, even before the first case of COVID-19 was registered, some African countries implemented total lockdown measures, which limited movement of people, banned mass gatherings, and closed schools and borders. However, these control measures, which affect individuals and society's well-being, cannot be implemented for a long time. There is an urgent need for a robust framework to guide African countries to make evidence-based decisions on easing these restrictive measures and reapply them when the infection rates increase significantly. This article presents a proposed framework to guide lockdown easing while limiting the community spread of COVID-19 in Africa. Due to lack of information on the impact of relaxing restrictions on peoples' movement on the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the causative agent for COVID-19) and how businesses will respond, it is almost clear that there is no single grand lockdown exit strategy. African governments should develop flexible, iterative lockdown exit plans based on epidemiological disease data, economic indicators, and peoples' views to inform decisions, all of which are paramount for success. A phased approach of changes and willingness to adapt methods will allow governments to minimize the pandemic's adverse impact and respond accordingly as new control tools become available.

We won't slow down

Team Pharmacy enters 2021 on a roll. In the face of our lifetimes' most formidable public health emergency, the federal government relaxed restrictions on pharmacists' patient-care authorities andfreed pharmacy compounders to mitigate drug shortages. These policies give pharmacists a chance to prove the value of their contributions to health care, in good times and bad. In 2021, we'll fight to expand and make permanent regulations that improve patient outcomes and keep communities safe. In December, the U.S. Supreme Court ruled 8–0 in favor of patients over pharmacy benefit manager (PBM) greed. By upholding an Arkansas law that requires the drug middlemen to reimburse all pharmacies fairly, the Court empowered other states looking to end shady PBM business practices that starve pharmacies and rob patients of access to care. This year, APhA will keep pushing for PBM transparency at the federal and state levels. National media attention to pharmacy workplace conditions that threaten patient safety opened the door for a real conversation on where the system has gone wrong, and how we can make it right. Preventing potentially deadly medication errors requires nothing less than an overhaul of payment models that disincentivize patient care and lead to burnout and despair for pharmacists. There are ways to make quality care profitable, and we'll pull out all the stops to make them happen. We've got your back. In 2021, APhA launches a new strategic agenda that includes preserving the testing and immunizing authorities the federal government granted during the pandemic, as well as pursuing other authorities necessary to meet our patients' and communities' needs; ensuring that pharmacists' well-being and patients' safety are prioritized over volume and speed; securing reimbursement for pharmacist-provided services for Medicare Part B beneficiaries at the federal level and for beneficiaries of public and private plans at the state level; and advancing payment reform that sustains patient access to pharmacy products and services. We'll also unveil enhanced engagement structures to keep our members connected, supported, and active. Pharmacy is on the move, but we've still got a lot of ground to cover. Setbacks and successes are a package deal, and it's up to us to press on no matter what obstacles lay in our path. I have every reason to believe we'll make it. I'm blown away by what APhA staff and members were able to achieve under 2020's unreal circumstances. Thank you for all you do and have done. We will tackle whatever lies ahead together—and we'll win. From all of us at APhA, have a healthy and happy new year.

Выявление неисправностей в группах мобильных роботов с использованием скользящих наблюдателей

The paper studies the emerging trends in advanced computing and information technology for efficient solutions of fault identification problem for mobile robot groups under the unmatched disturbances. The sliding mode observers are considered for mentioned problem solution. It facilitates the concept of Smart everything inside the considered robotic group during its generalized control: smart surrounding sensing, communication, processing, and scanned data storing. The suggested novel approach to sliding mode observer design is based on obtaining the reduced order model of the initial system. This allows reduce the complexity of sliding mode observer and relax restrictions imposed on the initial system.

Underdetection of cases of COVID-19 in France threatens epidemic control.

As countries in Europe gradually relaxed lockdown restrictions after the first wave, test-trace-isolate strategies became critical to maintain the incidence of coronavirus disease 2019 (COVID-19) at low levels1,2. Reviewing their shortcomings can provide elements to consider in light of the second wave that is currently underway in Europe. Here we estimate the rate of detection of symptomatic cases of COVID-19 in France after lockdown through the use of virological3 and participatory syndromic4 surveillance data coupled with mathematical transmission models calibrated to regional hospitalizations2. Our findings indicate that around 90,000 symptomatic infections, corresponding to 9 out 10 cases, were not ascertained by the surveillance system in the first 7 weeks after lockdown from 11May to 28June 2020, although the test positivity rate did not exceed the 5% recommendation of the World Health Organization (WHO)5. The median detection rate increased from 7% (95% confidence interval, 6-8%) to 38% (35-44%) over time, with large regional variations, owing to a strengthening of the system as well as a decrease in epidemic activity. According to participatory surveillance data, only 31% of individuals with COVID-19-like symptoms consulted a doctor in the study period. This suggests that large numbers of symptomatic cases of COVID-19 did not seek medical advice despite recommendations, as confirmed by serological studies6,7. Encouraging awareness and same-day healthcare-seeking behaviour of suspected cases of COVID-19 is critical to improve detection. However, the capacity of the system remained insufficient even at the low epidemic activity achieved after lockdown, and was predicted to deteriorate rapidly with increasing incidence of COVID-19 cases. Substantially more aggressive, targeted and efficient testing with easier access is required to act as a tool to control the COVID-19 pandemic. The testing strategy will be critical to enable partial lifting of the current restrictive measures in Europe and to avoid a third wave.

Exponential stability of nonlinear systems involving partial unmeasurable states via impulsive control

Abstract This paper investigates the stability problem of partial unmeasurable nonlinear systems under impulsive control. Some sufficient conditions are given to guarantee exponential stability of systems using transition matrix method coupled with dimension expansion technique, where the possibility of the effects of partial unmeasurable states is fully considered. In our proposed method, we not only allow systems to have incomplete states, but also relax restrictions on measurable states, which has a wider range of applications in practice. Finally, two illustrative examples are presented, with their numerical simulations, to demonstrate the effectiveness of main results.

Another silver lining?: Anthropological perspectives on the promise and practice of relaxed restrictions for telemedicine and medication-assisted treatment in the context of COVID-19.

As a response to the COVID-19 pandemic, the United States Drug Enforcement Administration (DEA) has temporarily relaxed restrictions to serve people who are opioid dependent during social distancing mandates. Changes include allowing patients to take home more doses of methadone and buprenorphine rather than coming to the clinic every day (for methadone) or weekly (for buprenorphine) and relaxed restrictions on telehealth delivery. Telemedicine Program representatives have described the relaxing of federal regulations as a "silver lining" to the COVID-19 pandemic. Drawing from medical anthropology approaches to epidemic surveillance and understandings of risk, we critically evaluate media representations of recent changes to telemedicine, prescribing, and opioid treatment delivery. Ethnographic research with providers and stakeholders in Arizona from 2017 to the present add insight to our analysis of media reports on these topics. Our findings demonstrate that media portrayal of access to medication-assisted treatment (MAT) as the key to preventing both COVID-19 and overdose among people who are opioid dependent misses important risks and potential inequities. Applied social science questions raised by the new guidelines include: who receives take-home doses of methadone and buprenorphine and why; and how media representations of risk and benefit rationales shape real-world policy and practice.

Fault Identification in Mobile Robot Groups Using Sliding Mode Observers

The paper studies the emerging trends in advanced computing and information technology for efficient solutions of fault identification problem for mobile robot groups under the unmatched disturbances. The sliding mode observers are considered for mentioned problem solution. It facilitates the concept of Smart everything inside the considered robotic group during its generalized control: smart surrounding sensing, communication, processing, and scanned data storing. The suggested novel approach to sliding mode observer design is based on obtaining the reduced order model of the initial system. This allows reduce the complexity of sliding mode observer and relax restrictions imposed on the initial system.

Hard, not early: putting the New Zealand Covid-19 response in context

A popular narrative that New Zealand’s policy response to Coronavirus was ‘go hard, go early’ is misleading. While restrictions were the most stringent in the world during the Level 4 lockdown in March and April, these were imposed after the likely peak in new infections. I use the time path of Covid-19 deaths for each OECD country to estimate inflection points. Allowing for the typical lag from infection to death, new infections peaked before the most stringent policy responses were applied in many countries, including New Zealand. The cross-country evidence shows that restrictions imposed after the inflection point in infections is reached are ineffective in reducing total deaths. Even restrictions imposed earlier have just a modest effect; if Sweden’s more relaxed restrictions had been used, an extra 310 Covid-19 deaths are predicted for New Zealand – far fewer than the thousands of deaths in some widely reported mathematical simulations.

Estimated Association of Construction Work With Risks of COVID-19 Infection and Hospitalization in Texas

Policy makers have relaxed restrictions for certain nonessential industries, including construction, jeopardizing the effectiveness of social distancing measures and putting already at-risk populations at greater risk of coronavirus disease 2019 (COVID-19) infection. In Texas, Latinx populations are overly represented among construction workers, and thus have elevated rates of exposure that are compounded by prevalent high-risk comorbidities and lack of access to health care. To assess the association between construction work during the COVID-19 pandemic and hospitalization rates for construction workers and the surrounding community. This decision analytical model used a mathematical model of COVID-19 transmission, stratified by age and risk group, with construction workers modeled explicitly. The model was based on residents of the Austin-Round Rock metropolitan statistical area, with a population of 2.17 million. Based on 500 stochastic simulations for each of 15 scenarios that varied the size of the construction workforce and level of worksite transmission risk, the association between continued construction work and hospitalizations was estimated and then compared with anonymized line-list hospitalization data from central Texas through August 20, 2020. Social distancing interventions, size of construction workforce, and level of disease transmission at construction worksites. For each scenario, the total number of COVID-19 hospitalizations and the relative risk of hospitalization among construction workers was projected and then compared with relative risks estimated from reported hospitalization data. Allowing unrestricted construction work was associated with an increase of COVID-19 hospitalization rates through mid-August 2020 from 0.38 per 1000 residents to 1.5 per 1000 residents and from 0.22 per 1000 construction workers to 9.3 per 1000 construction workers. This increased risk was estimated to be offset by safety measures (such as thorough cleaning of equipment between uses, wearing of protective equipment, limits on the number of workers at a worksite, and increased health surveillance) that were associated with a 50% decrease in transmission. The observed relative risk of hospitalization among construction workers compared with other occupational categories among adults aged 18 to 64 years was 4.9 (95% CI, 3.8-6.2). The findings of this study suggest that unrestricted work in high-contact industries, such as construction, is associated with a higher level of community transmission, increased risks to at-risk workers, and larger health disparities among members of racial and ethnic minority groups.