Modelling vaccination capacity at mass vaccination hubs and general practice clinics

COVID-19 population vaccination programs are underway globally. In Australia, the federal government has entered into three agreements for the supply of vaccines, with roll-out beginning for the highest priority groups in February 2021. Expansion of the vaccination program throughout February and March failed to meet government targets and this has been attributed to international supply issues. However, Australia has local capacity to manufacture one million doses of the AstraZeneca vaccine weekly and once fully operational this will greatly increase the national vaccination capacity. Under current plans, these vaccine doses will be distributed primarily through a network of general practices, to be joined in later phases by community pharmacies. It remains unclear whether these small distribution venues have the logistical capacity to administer vaccines at the rate they will become available. To inform this discussion, we applied stochastic queue network models to estimate the capacity of vaccination sites based on assumptions about appointment schedules, service times and available staff numbers. We specified distinct queueing models for two delivery modes: (i) mass vaccination hubs located in hospitals or sports arenas and (ii) smaller clinics situated in general practices or community pharmacies. Based on our assumed service times, the potential daily throughput for an eight hour clinic at a mass vaccination hub ranged from around 500 vaccinations for a relatively small hub to 1,400 vaccinations a day for a relatively large hub. For GP vaccination clinics, the estimated daily throughput ranged from about 100 vaccinations a day for a relatively small practice to almost 300 a day for a relatively large practice. Stress tests showed that for both delivery modes, sites with higher staff numbers were more robust to system pressures, such as increased arrivals or staff absences, and mass vaccination sites were more robust that GP clinics. Our analysis is accompanied by an interactive web-based queue simulation applet, which allows users to explore queue performance under their own assumptions regarding appointments, service times and staff availability. Different vaccine delivery modes offer distinct benefits and may be particularly appealing to specific population segments. A combination of expanded mass vaccination hubs and expanded GP vaccination is likely to achieve mass vaccination faster than either mode alone.

Rehearsal rooms in the context of norwegian standard ns 8178:2014

Music school students spend much more time rehearsing than performing in concert halls. Individual and small ensemble exercises are a major part of daily practice. The aim of the article is to verify whether the areas of rehearsal rooms given in functional programs attached to architectural contests for music schools, are sufficient to provide required acoustic conditions inside the chamber such as sound power level (SPL) and reverberation time (RT) which is preferred by musicians. The Norwegian Standard NS 8178:2014 was used to calculate the sound level generated by instruments. In this paper, the author will focus on small rehearsal rooms dedicated to individual practice and small practice groups of two or three members.

Small Practices, Big (QI) Dreams: Customizing QI Efforts for Under-resourced Primary Care Practices to Improve Diabetes Disparities (Preprint)

UNSTRUCTURED Electronic health record quality improvement (QI) initiatives hold great promise in improving adoption of clinical practice guidelines, including those related to diabetes. QI initiatives implemented in under-resourced primary care settings that primarily serve racial/ethnic minority populations have potential to improve quality of care and ultimately improve diabetes disparities. The “Screen at 23” campaign was launched in 2011 to increase screening for prediabetes and diabetes at lower body mass index (BMI) thresholds (i.e., 23 kg/m2) for Asian Americans, in line with the new guidelines put forth by the American Diabetes Association. Here, we describe the implementation of a customized electronic health record QI initiative in under-resourced practices that primarily serve low-income South Asian populations in New York City, designed to increase diabetes screening using updated BMI guidelines and in alignment with the “Screen at 23” campaign. The customization involved the implementation of an innovative, semi-manual alternate solution to automated clinical decision support systems (CDSS) alerts in order to address the restrictions on customizing CDSS alerts in electronic health record platforms used in small practice settings. We also discuss challenges and strategies with this customized QI effort. Our experience suggests that multi-sector partnership engagement, user-centered approaches, and relationship-building with key stakeholders are even more critical in under-resourced, and small practice settings. Relatively simple technological solutions can be greatly beneficial in enhancing small practice capacity to engage in larger-scale QI initiatives. Tailored, context-driven approaches for implementation of equity-focused QI initiatives such as the one we describe can increase adoption of clinical practice guidelines, improve diabetes-related outcomes, and improve health disparities among under-served populations. INTERNATIONAL REGISTERED REPORT RR2-https://doi.org/10.1186/s13063-019-3711-y

Practice Effects and Test–Retest Reliability of the Continuous Performance Test, Identical Pairs Version in Patients with Schizophrenia over Four Serial Assessments

Objective The purposes of this study were to examine the practice effects and test–retest reliability of the Continuous Performance Test, Identical Pairs version (CPT-IP) over four serial assessments in patients with schizophrenia. Method Fifty-six patients with schizophrenia were assessed with the CPT-IP four times, once per week. The CPT-IP contains four indices: “2-digit score,” “3-digit score,” “4-digit score,” and “total score.” Results The four indices showed trivial-to-small practice effects (Cohen’s d = −0.13–0.24), good-to-excellent test–retest reliability (ICC = 0.62–0.88), and unacceptable random measurement error (MDC% = 33.8%–110.8%). Conclusions The total score had the best reliability among the four indices. Although practice effects of the four indices all appeared cumulative, all four CPT-IP indices reached a plateau after the second assessment. These results indicate that clinicians should interpret the change scores of the CPT-IP conservatively and use the total-score index in their routine repeated assessments.

Helping Bodies in Motion Stay in Motion Through a Unique Model of Care

There are many inherent challenges associated with the development of an effective lifestyle medicine practice that is financially viable. There exist numerous proposed practice models, many of which show promise. Inertia Medical represents a model of combined care through which services related to musculoskeletal and lifestyle medicine are offered in a part-time, self-pay, solo practice. Central to the framework of Inertia Medical is simplicity. The small practice structure allows patients to feel closely connected to the provider and directly involved in their own health care. Minimal overhead costs and limited administrative tasks allow more time, energy, and resources to be focused on what matters most—delivering high-quality patient care. The simple design has become a distinguishing characteristic of this practice and could allow other health care providers to adopt a similar model.