Public Opinion on Priorities Toward Fair Allocation of Ventilators During COVID-19 Pandemic: A Nationwide Survey

Background: The rapidly growing imbalance between supply and demand for ventilators during the COVID-19 pandemic has highlighted the principles for fair allocation of scarce resources. Failing to address public views and concerns on the subject could fuel distrust. The objective of this study was to determine the priorities of the Iranian public toward the fair allocation of ventilators during the COVID-19 pandemic.Methods: This anonymous community-based national study was conducted from May 28 to Aug 20, 2020, in Iran. Data were collected via the Google Forms platform, using an online self-administrative questionnaire. The questionnaire assessed participants' assigned prioritization scores for ventilators based on medical and non-medical criteria. To quantify participants' responses on prioritizing ventilator allocation among sub-groups of patients with COVID-19 who need mechanical ventilation scores ranging from −2, very low priority, to +2, very high priority were assigned to each response.Results: Responses of 2,043 participants, 1,189 women, and 1,012 men, were analyzed. The mean (SD) age was 31.1 (9.5), being 32.1 (9.3) among women, and 29.9 (9.6) among men. Among all participants, 274 (13.4%) were healthcare workers. The median of assigned priority score was zero (equal) for gender, age 41–80, nationality, religion, socioeconomic, high-profile governmental position, high-profile occupation, being celebrities, employment status, smoking status, drug abuse, end-stage status, and obesity. The median assigned priority score was +2 (very high priority) for pregnancy, and having <2 years old children. The median assigned priority score was +1 (high priority) for physicians and nurses of patients with COVID-19, patients with nobel research position, those aged <40 years, those with underlying disease, immunocompromise status, and malignancy. Age>80 was the only factor participants assigned −1 (low priority) to.Conclusions: Participants stated that socioeconomic factors, except for age>80, should not be involved in prioritizing mechanical ventilators at the time of resources scarcity. Front-line physicians and nurses of COVID-19 patients, pregnant mothers, mothers who had children under 2 years old were given high priority.

Handling of The Environmental Drainage System In Jembrana District, Bali Province

The rapid growth of the urban population should be followed by the provision of basic infrastructure and facilities inadequate residential areas. One of them is the facilities and infrastructure for the environmental drainage system in residential areas to be free from standing water, especially during the rainy season. In Jembrana Regency, especially in Negara city and its surroundings, there are fourteen inundation points spread over 3 (three) districts. Drainage treatment is carried out by ranking priority scales based on inundation parameters. The parameters are inundation of height, length, frequency, and also the loss parameters due to inundation of economic facilities, public facilities, transportation facilities, housing, and casualties. With limited funds available, detailed planning is carried out on three inundation points with the highest priority score. The analysis shows that three inundation points receive priority for handling, namely Baler Bale Agung village’s environmental drainage system, Dauh Waru village, and environmental drainage Loloan Timur village. The drainage construction system uses an open channel with a U-ditch type and a box culvert with freecast concrete’s quality value of K-350.

Feasibility of a surveillance programme based on gargle samples and pool testing to prevent SARS-CoV-2 outbreaks in schools

School closures have a negative impact on physical and mental well-being, and education, of children and adolescents. A surveillance programme to detect asymptomatic SARS-CoV-2 infection could allow schools to remain open, while protecting the vulnerable. We assessed the feasibility of a programme employing gargle samples and pool testing of individually extracted RNA using rRT-qPCR in a primary and a secondary school in Germany, based on programme logistics and acceptance. Twice a week, five participants per class were selected to provide samples, using an algorithm weighted by a risk-based priority score to increase likelihood of case detection. The positive response rate was 54.8% (550 of 1003 pupils). Logistics evaluation revealed the rate-limiting steps: completing the regular pre-test questionnaire and handing in the samples. Acceptance questionnaire responses indicated strong support for research into developing a surveillance programme and a positive evaluation of gargle tests. Participation was voluntary. As not all pupils participated, individual reminders could lead to participant identification. School-wide implementation of the programme for infection monitoring purposes would enable reminders to be given to all school pupils to address these steps, without compromising participant anonymity. Such a programme would provide a feasible means to monitor asymptomatic respiratory tract infection in schools.

A novel approach: Simulating multiple simultaneous encounters to assess multitasking ability in emergency medicine

Study objective The purpose of this feasibility study is to develop and validate a new assessment tool and scoring system for multitasking competency for physicians in-training in a timed simulated setting. The multitasking competency includes ability to appropriately prioritize and implement tasks for different patients who present simultaneously. Methods We designed three single task stations with different levels of difficulty and priority. These skill stations were then combined to create a multitasking simulation scenario. Skill checklists and the global rating scale were utilized to assess the participants’ performance. A multitasking score, multitasking index, and priority score were developed to measure the multitasking ability of participants. Results Thirty-three first-year postgraduate physicians were recruited for this prospective study. The total performance scores were significantly higher for the single-tasking stations than for the multitasking scenario. In terms of the time needed to complete the tasks, the participants spent more time on the multitasking scenario than on the single-tasking scenario. There were significant correlations between the global rating scale and the multitasking score (rho = 0.693, p < 0.001) and between the global rating scale and the multitasking index (rho = 0.515, p < 0.001). The multitasking score, multitasking index, and priority score did not have any significant correlations with the total single-tasking score. Conclusion We demonstrated that the use of a simulated multitasking scenario could be an effective method of assessing multitasking ability and allow assessors to offer better quality feedback.

Pediatric Observational Priority Score and Early Warning Scoring System to Predict Admission Status in Pediatric Patients in Haji Adam Malik General Hospital

Background: Doctors must be able to quickly and accurately assess clinical condition of patients, especially in the emergency rooms. An easy scoring system but producing meaningful clinical conclusions is the reason for creating various scoring systems. Includes a scoring system for predicting the admission status of patients. Aim: To determine the diagnostic value of POPS and EWSS to predicting admission status of pediatric patients in the emergency department. Methods: Diagnostic tests for POPS and EWSS were done to predict the admission status of pediatric patients in the emergency department of Haji Adam Malik general hospital from May to October 2020. Subjects aged 1 month to 18 years were excluded if they left the emergency department prior to assessment, had trauma cases, died, inpatients due to social indications, and patients who came only to continue therapy were also excluded. POPS and EWSS assessments were carried out by the researcher and the admission status of the patients were determined by the doctor in charge in the emergency department. Results: There were 119 children meeting the inclusion and exclusion criteria. POPS score ≥3 had sensitivity 82.65%, specificity 85.71%, and AUC 0.88 (p <0.001). EWSS score ≥2 had sensitivity 83.67%, specificity 71.43%, and AUC 0.83 (p <0.001). Conclusion: POPS and EWSS had good diagnostic values in predicting the admission status of pediatric patients in the emergency department. POPS has a slightly higher diagnostic value than EWSS.

Development of an android application to compute priority score for road sections

The quality of roads dictates the development of the country as well as the quality of lives of its citizens. To maintain the road sections at the desired level of service, adequate and timely maintenance works are necessary. But maintaining all the road sections every year is not possible for developing countries like India. These works get constrained by limited budget and hence utilization of the budget becomes crucial for the concerned government department. Out of hundreds of road sections, the department can select only a few at a time. But most of the times, the procedure of filtering out these few sections is not scientific and hence gets influenced by some undue external factors. Looking at these problems, the authors perceived an urgent need of an accessible and user-friendly mobile application that does the prioritization process. The works in this paper describes the development of an android based application which considers the four important domains of any road section viz. pavement functional distress, roughness, social importance and pavement structural strength. From the user inputs related to these four domains, the application accordingly computes and displays a priority score, on the basis of which the user can select the road sections for maintenance works. The validation of the application results has been performed and some test results will be added in the full-length paper.

The Right to Urban Streams: Quantitative Comparisons of Stakeholder Perceptions in Defining Adaptive Stream Restoration

Assuring healthy streams in the urban environment is a major goal for restoration scientists, urban planners, and city practitioners around the globe. In South Korea, many urban stream restoration efforts are designed to provide safe water to society and enhance ecological functions. We examined the extent to which the individual interests and different values of multiple stakeholders were considered in previous decision-making in two urban stream restoration projects. The relevant data on stream restoration were collected through the nominal group technique (NGT) and the analytic hierarchy process (AHP) for the two stream cases of a populated inland area and a coastal region in South Korea. The AHP results provide information about the comparative weights of the values of ecological restoration (priority score: 0.487), social restoration (priority score: 0.231), and landscape revitalization (priority score: 0.279) of the Ahn-Yang stream and ecological restoration (priority score: 0.527), social restoration (priority score: 0.182), and landscape revitalization (priority score: 0.290) of the Sahn-Jee stream. The stakeholders of the populated metropolitan area had a relatively high awareness of their role in environmental restoration, thus it was natural for them to place a high value on social restoration.

Strategic planning approach to the development of contract farming in the Egyptian sugar industry

The strategies required to develop contract farming in the Egyptian sugar industry were examined by applying the Strength-Weakness-OpportunitiesThreats (SWOT) approach in combination with an analytic hierarchy process. Data were collected from sugar beet farmers, extension workers, experts, and employees of the Dakhalia Sugar and Refining Company in Egypt. Market risk has the highest overall priority score among the strengths. Noncommitment of farmers to harvest time received the highest overall priority score among the weaknesses, while valorization of sugar industry wastes had the highest overall priority score among the opportunities, and accumulation of large reserves of sugar at the factory was perceived as the most important threat to the sugar industry. These findings can be used to formulate strategies based on current situation analysis and create suitable conditions for successful contract farming in the sugar sector. Keywords: strategies; SWOT-AHP; contract farming; sugar industry; Egypt

Development of a tool for identifying and addressing prioritised determinants of quality improvement initiatives led by healthcare professionals: a mixed-methods study

Background Several frameworks have been developed to identify essential determinants for healthcare improvement. These frameworks aim to be comprehensive, leading to the creation of long lists of determinants that are not prioritised based on being experienced as most important. Furthermore, most existing frameworks do not describe the methods or actions used to identify and address the determinants, limiting their practical value. The aim of this study is to describe the development of a tool with prioritised facilitators and barriers supplemented with methods to identify and address each determinant. The tool can be used by those performing quality improvement initiatives in healthcare practice. Methods A mixed-methods study design was used to develop the tool. First, an online survey was used to ask healthcare professionals about the determinants they experienced as most facilitating and most hindering during the performance of their quality improvement initiative. A priority score was calculated for every named determinant, and those with a priority score ≥ 20 were incorporated into the tool. Semi-structured interviews with implementation experts were performed to gain insight on how to analyse and address the determinants in our tool. Results The 25 healthcare professionals in this study experienced 64 facilitators and 66 barriers when performing their improvement initiatives. Of these, 12 facilitators and nine barriers were incorporated into the tool. Sufficient support from management of the department was identified as the most important facilitator, while having limited time to perform the initiative was considered the most important barrier. The interviews with 16 experts in implementation science led to various inputs for identifying and addressing each determinant. Important themes included maintaining adequate communication with stakeholders, keeping the initiative at a manageable size, learning by doing and being able to influence determinants. Conclusions This paper describes the development of a tool with prioritised determinants for performing quality improvement initiatives with suggestions for analysing and addressing these determinants. The tool is developed for those engaged in quality improvement initiatives in practice, so in this way it helps in bridging the research to practice gap of determinants frameworks. More research is needed to validate and develop the tool further.