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Rajaram Govindarajan Department of Operations Management, Innovation and Data Sciences at the ESADE Business School and Govisystem, Barcelona, SpainCorrespondence: Rajaram GovindarajanDepartment of Operations Management, Innovation and Data Sciences at the ESADE Business School and Govisystem, Barcelona, SpainEmail raja@govisystem.orgAbstract: The lockdown strategy used to prevent the spread of COVID-19 (coronavirus disease 2019) has disrupted the global economy. Some countries have started reopening their economies under the threat of a second wave because studies show that only 4% of the population is infected so far and more waves will be needed to achieve herd immunity. Lockdowns have been used with a primary purpose of regulating the demand for healthcare while ignoring the economic consequences. Contrary to the lockdown strategy, some countries such as Brazil have given priority to their economy leading to very high infection and mortality rates. After a first wave of the pandemic, we now know something critically important—those who are likely to become seriously ill and potentially die if SARS-CoV-2 infection is not prevented. That information cannot be ignored in our strategy and is used to control the pandemic. The paper proposes to focus on managing the risk of the virus being transmitted to the vulnerable rather than focusing on controlling all who can potentially transmit it. It argues that only 4% of the global population is at high risk of severe COVID-19 and would require hospital admission if infected. We propose to target this 4% of the population for preventive efforts. Protecting the vulnerable via lockdowns and other measures will be more effective and efficient than locking down the entire population and destroying their economies that are equally critical to life. We hypothesize that such “targeted prevention” strategies are more likely to help achieve our goals: 1) reduce mortality by preventing the infection reaching its potential victims, 2) spend the resources efficiently by knowing the “target” of our preventive efforts, and 3) achieve effective and efficient control of the pandemic without causing disruption to the socio-economic activities until an effective vaccine is available.Keywords: COVID-19, lockdown, targeted prevention, infection control, SARS-CoV-2, coronavirus

Rajaram GovindarajanOperations Management, Innovation and Data Sciences, ESADE Business School, 08001 Barcelona, SpainBackground: The functional role of Comprehensive Unit-based Safety Program (CUSP) teams was extended to empower them and make them a part of the organizational management. Purpose: These improvements in the functional roles of CUSP were made with the objective of solving two structural issues, namely, departmentalization and compartmentalization present in health care organizations. Methods: The following were three improved functional roles: 1) instead of just being a reactive mechanism to implement improvements based on real safety issues, they also carried out risk analysis and implemented preventive actions proactively; 2) instead of focusing only on safety, they controlled all results such as safety, quality, treatment effectiveness and timeliness of their respective process units, using a series of Key Performance Indicators; and 3) instead of being a supplementary multidisciplinary team parallel to the organization´s departmentalized management structure, they were made to participate in the decision-making structure, representing their respective process units. These teams represented different process units and were named as Comprehensive Unit-based Process (CUP) teams. Results: The CUP structural design changed the dynamics of the organization: 1) it integrated members of different disciplines, especially physicians and nurses, and integrated them into a team with a shared goal, making internal communication and teamwork a “systemic” requirement; 2) it disabled the middle-level managers to represent the interests of specific knowledge-based groups such as physician departments or nursing areas while making decisions; and 3) it reassigned middle-level managers the task of representing different CUPs, making each manager responsible for a process unit, thus ensuring control over the results of multidisciplinary activities.Conclusion: The new organizational structure put burden on the system, not on its people, as it made multidisciplinary communication and teamwork to be the rule of the game, allowing patient-centered health care.Keywords: process management, CUSP, CUP, multidisciplinary teamwork, lean management, patient safety

Abby Holt,1 Muhammad A Khan,2 Swetha Gujja,3 Rangaswmy Govindarajan31Arkansas Department of Health, Little Rock, 2White River Health System, Batesville, 3Division of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USABackground: Prostate cancer subjects with prostate-specific antigen (PSA) relapse who are treated with androgen deprivation therapy (ADT) are recommended to have baseline and serial bone densitometry and receive bisphosphonates. The purpose of this community population study was to assess the utilization of bone densitometry and bisphosphonate therapy in men receiving ADT for non-metastatic prostate cancer.Methods: A cohort study of men aged 65 years or older with non-metastatic incident diagnoses of prostate cancer was obtained from the Surveillance Epidemiology End Results (SEER)-linked Medicare claims between 2004 and 2008. Claims were used to assess prescribed treatment of ADT, bone densitometry, and bisphosphonates.Results: A total of 30,846 incident prostate cancer cases receiving ADT and aged 65 years or older had no bone metastases; 87.3% (n=26,935) on ADT did not receive either bone densitometry or bisphosphonate therapy. Three percent (n=931) of the cases on ADT received bisphosphonate therapy without ever receiving bone densitometry, 8.8% (n=2,702) of the cases on ADT received bone densitometry without receiving intravenous bisphosphonates, while nearly 1% (0.90%, n=278) of the cases on ADT received both bone densitometry and bisphosphonates. Analysis showed treatment differed by patient characteristics.Conclusion: Contrary to the recommendations, bone densitometry and bisphosphonate therapy are underutilized in men receiving ADT for non-metastatic prostate cancer.Keywords: prostatic neoplasms, androgen antagonists, bone densitometry, gonadotropin-releasing hormone, osteoporosis

Facile transmetalation is observed from a d8 metal, platinum(II), to indium and gallium leading to the extrusion of methylated gallate and indate anions representing a rare case of the "reverse" transmetalation from a d8 metal to a main group metal. The Pt–Ga and Pt–In bonding in the bimetallic complexes was analyzed through bosonic and fermionic potentials, QTAIM, and NBO. [ABSTRACT FROM AUTHOR]