*3.1. Lung Transplant Recipients*

Steinack et al. reported a 55-year-old woman who underwent a bilateral lung transplantation 5 months prior to infection. The lady was under therapy with tacrolimus, mycophenolate mofefil and prednisolone (Table 1) [19]. The patient presented with gastrointestinal symptoms (nausea, vomiting, diarrhea) and only minor respiratory symptoms (dry cough and rhinorrhea). Initially, she had fever and normal oxygen saturation breathing room air. Stool specimens detected a Norovirus infection, and virus PCR testing of the nasal swab returned positive for SARS-CoV-2. There were only minimal consolidations on chest computed tomography (CT) imaging, without any associated ground-glass opacities. She recovered on empiric intravenous antibiotic treatment without the use of additional antiviral agents, whilst continuing preexisting Cytomegalovirus (CMV)-prophylaxis with valganciclovir. There were no signs of allograft dysfunction in the 6-week follow-up.


**6.1 Recovery framework**

McKinsey [22] has suggested the following three step framework for rapid recovery:

#### **6.2 Recovery sectors**

According to some of the major studies by McKinsey, Economist and others [22–24], the early starters of economy include health care including pharmaceuticals, medtech, diagnostics, hospital and home care services, telehealth/telemedicine, essential items, food and agriculture, FMCG, 3D printing, internet of things (IoT), AI/ML, robotics, smart systems, e-commerce industry. COVID-19 has put the medtech industry at center stage with unparalleled demand for diagnostic test PPE, ventilators, and critical medical supplies. McKinsey [22, 23] has built a detailed model of COVID-19 impact on medical procedures mainly for the United States on the Europe which is used to create a model for predicting the potential impact on medical device sales in consumables and implants. The models consider two broad scenarios for COVID-19 case growth V shape recovery and W shape recovery. In V shape recovery, it is estimated that the material procedures decline by around 70% in the second quarter and up to 45% in third quarter when compared to 2019. It is expected to see a rapid ramp up for the next three forth to catch up on delayed elective procedures. Whereas in W shaped recovery, procedures would decline by 69% and 45% in the second and third quarters respectively.

**Telehealth** potential has been realized after the COVID-19 crisis and telehealth consumer adoption has increased from 11% in 2019 to 76% in 2020 in US along. Approximately \$250 billion or about 20% of all Medicare Medicaid and commercial OP office and home health spend could potentially be virtualized with the help of telehealth. Similar trend has been observed in many countries worldwide.

#### **6.3 Recovery strategies and actions**

It will not be that easy for many organizations to have a detailed analytical understanding of demand variability at local and national level. However, *stress testing* of supply chains with different scenarios with viable product demand and procedures will be very critical for managing the current scenario. Some of the methods suggested to overcome the impact on supply chains [22, 23, 25] includes the following:

Develop a high-risk supply chain disruption-monitoring and response program for countries impacted by the virus and the potential supply chain exposure from Tier 1 and below.

Assign high-risk weighting to suppliers and sub-tiers from emerging and developing countries with less developed healthcare systems that are less prepared.

Conduct a contract review to understand any financial implications of not being able to deliver supplies to manufacturing locations and customers.

Special attention for balancing of supply and demand, building suitable safety stocks are essential for business continuity, particularly with the unpredictable volatility of supply chain functions.

Identify various opportunities at supply side and diversify suppliers to ensure manufacturing capacity and raw material availability.

Establish a robust risk management models to monitor and prepare for shortages in material, manufacturing capacity and work closely with supply chain stakeholders particularly with critical suppliers.

Implement and utilize enhanced risk management, including scenario planning to create preemptive action plans.

Review the New Product Introduction process and utilize design measures to discover or develop alternative sources and routes in order to diversify your value chains. At the same time, analyze cascading implications of changes in volumes, quality and markets.

*Supply Chain Management and Restart of Economy in Post COVID-19 DOI: http://dx.doi.org/10.5772/intechopen.94207*

The most common approach is to use the bill of materials and focus on key components.

Some of the major actions suggested by McKinsey for economy recovery [23] is given below.

Some of the actions suggested for recovery of medtech industry [22] include the following.

*Accelerate capacity* of equipment like PPE, Ventilators, other surgical items etc. that is essential to save the lives of critical COVID-19 patients.

*Maintain capacity* of equipment used in COVID-19 treatment or that requires replacement such as CT machine dialysis equipment or ECMO machines etc.

**D***eprioritisation* of equipment not useful in COVID-19 treatment such as MRI surgical and mammography equipment and etc.

*Supply chain management and reliability:* More than 90% of global annual medical device exports come from countries that are now in some form of quarantine. There for Medtech company should consider activating supply contingency plans repositioning inventory to areas of greatest need and making all reasonable attempts to protect the health and safety of workers on the manufacturing floor.

*Preserving cash*: according to the McKinsey benchmarking analysis the potential for a rapid 3–5% increase in cash flow could be shown additional changes to production like just-in-time inventory pooling and rationalization, and standardization can free up more cash. These initiatives should be rigorously tracked in conjunction with appropriate cash controls and customer considerations.

*Resource relocation and portfolio strategy:* Now is the time to establish processes that can anticipate market demand and shift staffing as needed to quickly accommodate changes this would require increased investment in cross training the employees as well as new processes to rapidly scale up support services.

The company is required to fundamentally rethink the supply chain network and key suppliers as they were already facing pressure to localize in certain markets, after the crisis it will continue to be important for the companies to consider how to balance these pressures that can impact local supplies with potential desires for greater flexibility in capacity. These adaptations could include building more agile organizations, speeding time to market and aspiring to "absolute benchmarks" for product design and development and manufacturing efficiency.

Some of the lessons learned from fast food service organizations like KFC, McDonald etc. include the following which are based on digitalization:

• **Co-creation:** use of user generated content with apps like radio KFC, RJ hunt and design your own bucket challenge.

#### **Strengthening healthcare's supply Chain.**

These are the five specific capabilities that can have a dramatic impact on performance of the healthcare supply chain [26]:

1.Better segmentation of products, markets and customers.

2.Greater agility to reduce cost and increase flexibility.

3.Measurement and benchmarking.

#### **How to address the shortage and improve the safety?**

Supply chain issues create opportunities for counterfeiters and gray market vendors threatening patient safety and cutting into revenues of legitimate companies. Supply chain security breaches are increasing by an average of 33% every year not only in the emerging markets such as China, India & Brazil but also in the developed world. Better supply chain processes are central to increasing patient safety. Therefore, it is recommended that adopting a common global data standard and upgraded grading supply chain processes could/counterfeiting in half returning up to \$15 Billion to \$30 Billion in revenue to legitimate companies to reinvest in further improvements to patient care.

#### **Building a new healthcare supply Chain**

Organizations can learn from the experience of laptop manufacturer in Indian who can accept an order and deliver a customized computers to a European customer in almost a week. Other organizations like pharmaceutical and medical equipment companies can adopt two broad approaches based on internal factors and external factors. Internal factors include – segmentation, agility, measurement while the external factors include- alignment & collaboration [27].

**Segmentation:** Companies such as pharmaceutical and medical device generally follow one size fits all type of supply chains which are proved to be disastrous particularly during pandemic times. Best companies address these problems by segmenting the supply chains according to the nature of product and customers demand and preferences by developing suitable forecasting, production and distribution strategies for each category.

**Agility:** This refers to building and operating supply chains that can better respond to demand shifts due to occurrence of unexpected disruptions in the business. The approaches include cross functional process, understanding of demand and supply scenarios and circumstances, effective communication and transparency across the supply chain.

**Measurement**: Generally, FMCG companies use data driven metrics such as manufacturing index for producing appropriate quantity of stock keeping units (SKUs) across countries and plants. Organizations also uses commercially available benchmarking tools and approaches for guidance and identification of opportunities along with supply chains.

*Supply Chain Management and Restart of Economy in Post COVID-19 DOI: http://dx.doi.org/10.5772/intechopen.94207*

**Alignment**: Refers to building of a cost effective supply chain that could align around global standards that support data interchange processes and capabilities to reduce the errors etc.

**Collaboration**: Many successful organizations collaborate in areas where they have a strength and share the benefits. Collaboration focus on (i) S*election of partners for the potential value of the collaboration; (ii) capabilities and willingness to act as a team; (iii) dedicate resources to collaboration and involve senior leadership in it; (iv) jointly manage performance and measure impact; (v) start out with a long-term perspective.*

According to [25], the supply chains needs a stress test in terms of time to recover (TTR) and time to survive (TTS). TTR is the time it takes for a particular player/stakeholder (supplier, manufacturer, distributor, retailer etc.) in the supply chain to restore full functionality after disruption. TTS is the maximum duration that supply chain can match supply with demand after facility disruption. TTS also estimate each measure under different scenarios of business and Identify its ability to recover from the disaster. Organizations need to have a backup plan when TTR of a stakeholder or facility is greater than its TTS. This helps the organization in quantifying the cost of disruptions and prepare mitigation plans for the most critical parts of the supply chain [25].

At macro level, the economic recovery requires actions such as government stimulus, digitalization, advance technologies like 3D printing, up-skilling/multiskilling of workforce, restructuring of supply chains with better resilience and response, collaboration/alliances, facilitating innovation by start-ups, strengthening research collaboration between government, industry and academia is also very critical for faster recovery.

### **7. Conclusions**

There is a strong relationship between world trade, GDP and supply chain investments around the world during last more than two centuries starting from 1800. As globalization has increased, the world's supply chains have become substantially more interconnected. Moreover, as emerging market economies have steadily come to account for a greater proportion of global GDP, goods often have more stages to pass through before reaching the end consumer.

During last seven decades (starting from 1960s) the economic growth of the world is very significant and also seen many disruptions like Tsunamis, 911 Terrorist attacks, pandemics like COVID-19. Among all the COVID-19 crisis is more significant in terms of health and economy. COVID-19 has led to nearly 5% negative growth of world economy. From national lockdowns to closed airspace and borders, Covid-19 has resulted in unprecedented disruption to the mechanics of most economies, regardless of their size or stage of development. In particular, the erection of these barriers has placed a major strain on the world's supply chains, including essential linkages relating to food and medicines. COVID-19 also created tension between major economies of the world and disrupted global supply chains significantly. Supply chain leaders face pressure to rethink traditional distribution and supplier models. For example, Amazon looks to strengthen its healthcare influence through the expansion of services in the medical supply chain, industry stakeholders are reconsidering traditional hospital-supplier relationships. Data, analytics and technology are playing an increasingly important role in supply chain strategy. A 2018 Global Healthcare Exchange survey [28] showed roughly 60 percent of respondents indicated data and analytics were the highest priority areas for improvement. These changes and trends have pushed the role of supply chain

management into new territory. Now, supply chain leaders are positioned to help lead their organizations to higher levels of customer service with more efficient models [29, 30]. To ensure success amid this changing environment, business leaders including healthcare organizations should place an emphasis on technology, business practices and customer service.


**1. Introduction**

Plastics have been critical in human development. Because of their unique properties including a wide range of temperature use, their resistance to chemicals and light, and their mechanical strength, plastics have brought important advances in health, housing, transportation, science, and education. However, like other man-made materials, when discarded, they accumulate permanently in the natural environment due to their lack of biodegradability. As time goes by and they are exposed to the drag of currents other environmental factors (such as temperature changes, mechanical abrasion, solar irradiation), these polymers break down into microplastics (MPs; 1–5000 m in their longest dimension). The MPs generated in this way are called secondary MPs and are the most abundant type in water bodies [1]. Some MPs are intentionally manufactured for specific applications such as microbeads used in exfoliants or detergents and are called primary MPs [1].

The study of MPs as contaminants began in 2007, and since then many experimental studies have been conducted in which MPs are detected and/or identified. The methodology for the characterization of MPs in water includes sampling, separation from the environmental matrix, quantification, and identification. However, some identification and separation methods work for certain types of MPs while overlooking or damaging others, generating studies that are not comparable with each other and hindering possible solutions such as the estimation of ecological risk assessment (ERA), which can provide the basis for future legislation regarding the use and discharge of MPs.

The ERA is an exposure and dose-response study based on the comparison between the concentration of a chemical of interest found in an ecosystem of interest (in this case water bodies) with the data on the expected effects of this compound for a specific group (flora, fauna, or human). The exposure studies are affected by the lack of standard methods, as described before, as different types and sizes of MPs are collected and identified depending on the used methodology. The dose-response relationship is studied with animal or plant toxicology and then extrapolated for humans with some standard values (see [2]) to obtain a safe concentration level. Quantifying this value is basic for proper risk analysis, and it can be observed linearly and clearly in chemicals since only the species studied and the concentration varies. But for MPs, it is not so simple because there are many other variables that can generate the toxicity of the polymer, such as additives, size, shape, color, and type of the MP. For this reason, toxicological studies are also not standardized and are performed with different types, forms, concentrations, and sizes of MPs as well as different organisms and toxicological endpoints.

Because of the reasons presented above, Gouin et al. [3] identified that the adequate development of an ERA should include the following:

*Microplastics Environmental Risk Assessment: A Review DOI: http://dx.doi.org/10.5772/intechopen.105162*

These key points indicate that standardization and information reporting are essentially the basis of developing an ERA. Therefore, the present review aims to help researchers on plastic pollution in water to observe how the ERAs for MPs have been carried out and improve what other authors have made. Although only eight experimental articles will be analyzed, throughout the paper references to authors proposing a framework for conducting risk analysis for MPs will be found [3–5].

The purpose of the review is to analyze and compare experimental articles that have calculated an environmental risk assessment (ERA) of MPs in a water body. The aspects to be compared are: (a) the criteria used to define a water body as safe or not (PNEC, HI, RI, etc.); (b) which aspects are considered by these criteria; (c) the results of each ERA; (d) the concentration data used in the risk estimation; and finally (e) if the experiments performed comply with the necessary quality in terms of sampling, separation, and identification of MPs in water bodies according to Koelmans et al. [6].


Contents

Preface

This book includes important information for comprehensive treatment planning for a wide variety of dental procedures. Written by internationally recognized oral health specialists, this book offers information on revised concepts of oral diseases and disorders, including insights and diagnostics for each category. Readers will learn about radiology for diagnosis, retrospective studies, and planning considerations for periodontics, endodontics, oral surgery, and restorative dentistry. Additionally, the book includes practical guidelines for detecting child abuse within the dental

practice, as well as the basics of statistical methodologies in dentistry.

section is the use of zirconia as a restorative material.

in the technology linked to the usage of zirconia.

and almost always have nowhere to turn for help.

The first section discusses treatment modalities for impacted molars as well as the radiology of developmental defects. Chapters in this section include a wealth of updated clinical information. The interesting use of radiographs to explore variations in periodontal status among different gender groups is also a focus of this section. The subsequent section provides in-depth coverage of pertinent endodontic and restorative clinical concepts and dental management techniques. Chapters address regenerative endodontic procedures as well as restorations of endodontically treated teeth. Another interesting concept discussed within this

Zirconia has been overlooked as a restorative dental material for many decades. It consists of zirconium dioxide, which has maximum mechanical strength and fracture resistance when compared to all other non-metallic materials. Besides its high strength, zirconia is widely favored for its superior surface smoothness. Despite these beneficial characteristics, zirconia is not as widely used as it could be. This is likely due to cost and knowledge. Most local dental laboratories cannot afford to invest in high-tech, computerized, advanced CAD/CAM systems needed for clinical procedures using zirconia. Additionally, these laboratories do not have enough skilled or knowledgeable personnel to utilize this new technology. However, this has slowly started to change as clinicians learn about this material and begin investing

Another salient point in dentistry is dental trauma. The role of a dental hygienist becomes key in scenarios of dental trauma, as they often are the first points of care in such scenarios. As such, they are key players in emergency treatment modalities that could ensure success of subsequent endodontic or restorative procedures in cases of dental trauma. Dental trauma is not always accidental, however, and this brings us to the role of all oral healthcare professionals in detecting cases of abuse. Cases of abuse usually pertain to young children who have no means of self-defense

It is only recently that society has become increasingly aware of the problem of child abuse across all socioeconomic groups. Abuse often results in immeasurable tragedies involving the emotional, physical, or cognitive impairment of a child that often has far-reaching consequences and impacts on healthy adulthood. The wellbeing and safety of some children across the world are threatened daily by neglect and child abuse. All oral healthcare professionals thus have a key role to play


Preface

With the emergence of the concept of green chemistry, which is defined as the use of a dozen principles that reduce or eliminate hazardous materials in the design, manufacture, and use of chemical products, it is understood that focusing on precautions to reduce or eliminate existing pollution sources is more effective than looking for a cleaning path after exiting. In parallel with increasing and diversifying needs today, with the help of technological developments, production has also increased and diversified. However, in addition to the technical and economic suitability of the processes leading up to the final product, the elimination or reduction of adverse effects that might occur to our health and the environment is now being taken into consideration.

This book describes the principles of green chemistry for clean production in light of the latest technological developments and increasing environmental awareness. As regards industrial applications, in order to minimize wastes at the beginning of production, the book presents research on the development of alternative raw materials, new catalysts for use in the production stage, non-volatile solvents, nonhazardous chemicals, and rapidly renewable and reusable products that are biodegradable in nature by using renewable energy. This book consists of six chapters covering topics such as synthesis and applications of nanomaterials for energy and environmental applications, climate process, alternative green energy sources, and removal of emerging pollutants from water.

> **Murat Eyvaz** Assistant Professor, Department of Environmental Engineering, Gebze Technical University, Turkey

> **Ebubekir Yüksel** Professor, Department of Environmental Engineering, Gebze Technical University, Turkey

**1**

**Chapter 1**

**Abstract**

Applications

environmental remediation

**1. Introduction**

Recent Developments in

**Keywords:** nanocarbon, polymer composite, bio-polymer,

*Nanocarbon-Polymer Composites*

for Environmental and Energy

*Prateek Khare, Ratnesh Kumar Patel and Ravi Shankar*

Advancement in technology is brought up for both the industrialization and urbanization, which imitates the diverse pollutants as by-products to air-water ecosystem. Utilization of carbon is a very well-known age-old practice used for environmental remediation. In recent past years, a tremendous research inclination has been witnessed toward the sustainable development of nanocarbons specifically for environment remediation and energy applications. The new sustainable synthesis approached has been investigated for the development of sustainable nanocarbons. Tailoring the nanocarbon with polymer as a nanocomposite material has spotlighted a new class of environmentally benign bio-compatible materials. Herein, the present perspective is summarizing the basic-advanced research.

Use of chemical products such as, conventional energy reserves, synthetic detergents, pharmaceuticals, dyes, fertilizers, polymers and composites, food additives, agrochemicals, etc., increases over period time across the developing and developed countries and simultaneously is very important for the development of any economy. The society is consuming such products at an exponential rate and thereby generating pollutant in terms of fuel combustion, waste generation in the process operation and waste disposal [1]. Till date, due to their maximum operational, and consumption of the conventional energy reserves including, fossil fuel, and coal are the prime factors of increasing the pollutions to the biosphere at such alarming rate. Moreover, their residue generates unwanted carbon like carbon soot

interact ecosystem imparts their toxic nature and affects the ecology [2–4].

with technology advancement are very necessary and now have become a challenging task for the developing eco-friendly society in the biosphere. The concept of zero-waste production, waste prevention, and with use of efficient materials is the prime concerned for the industries, Therefore, for a healthy society, the role of green chemistry is significant, achieving these targets [5]. As it is a well-known

Developments of the green environmentally benign materials and its competent