Comparison of Emergency Medical Services Duration amid Routine Service for COVID-19 Patients

BACKGROUND: Concerning the COVID-19 outbreak in Thailand, the number of patients has been increasing. Emergency medical services (EMS) operating duration differs from normal services due to equipment preparation, number of personnel, and on-board ambulance procedures. Notably, there have been no studies examining EMS duration regarding COVID-19 patients. AIM: The aim of this study was to compare the EMS time for COVID-19 patients and routine services. METHODS: This cross-sectional study was conducted in a tertiary university hospital in Khon Kaen, Thailand. Information gathering was carried out by employing the Srinagarind Hospital EMS database throughout January 1, 2020, and February 10, 2021. RESULTS: A total of 2420 EMS operations were examined, of which five tested positive for COVID-19 (0.21%). The mean age of the COVID-19 patients was 35.6 ± 7.2 years, with the activation interval for COVID-19 and routine services at 64.20 ± 10.14 and 1.42 ± 0.42 min, respectively (p < 0.001). The on-scene time for COVID-19 and routine services was 3.20 ± 0.44 and 5.20 ± 2.20 min, respectively. CONCLUSIONS: EMS operating time amid the activation interval for COVID-19 patients was significantly longer than in the normal group. However, on-scene time for COVID-19 patients was less time than in normal operations.

An Opportunity During Antenatal Services to Strengthen Nurturing Care: Global and National Recommendations for Routine Ultrasound Before 24 Weeks Gestation

Introduction: The Healthy Pregnancy, Healthy Baby study (HPHB) augments a routine service (pregnancy ultrasound) with information about fetal and infant development and the importance of parent wellbeing and infant care, to assess whether it will improve child development and growth, parent-infant attachment, parental wellbeing and routine clinic attendance. This paper outlines the process of intervention development and implementation in a complex environment with multiple stakeholders.Methods: Study participants were recruited from pregnant women attending fetal ultrasound (US) at Chris Hani Baragwanath Hospital (CHBH), Soweto, South Africa. Partners were invited to attend all sessions. The HPHB intervention, a novel combination of a health and a parenting intervention that augments a routine service (US), is being tested through a randomized controlled trial with outcome assessments at 6 weeks and 6 months follow-up. The current study outlines the process of moving from intervention design to full implementation in a high-risk clinical setting.Results: Formative research informed the design and content of the intervention materials. Implementation is monitored through weekly reports and team meetings as well as formal and informal feedback received from staff and participants. Close collaborations with clinicians enhanced recruitment practices and provided clinical oversight of the trial procedures. Ongoing stakeholder engagement informed intervention procedures and strategies to address challenges that arise during implementation.Conclusion: This study emphasizes the importance of dynamic, inclusive and interactive approaches to intervention development and implementation, as well as the purposeful use of varied information from diverse sources in decision-making for effective implementation.

Rapid response and learning for later: establishing high quality information networks and evaluation frameworks for the National Ambulance Service response to COVID-19 – the ENCORE COVID Project Protocol

Background: The National Ambulance Service (NAS) is at the forefront of Ireland’s response to the COVID-19 pandemic. As directed in Ireland’s National Action Plan, NAS significantly expanded prehospital services, including provision of a novel COVID-19 testing service. Additionally, other health services rely on NAS’s capacity to assess, transport and/or treat COVID-19 patients. In a climate of innovation and adaptation, NAS needs to learn from international ambulance services and share experience. Evaluation of the NAS response to COVID-19 is required to facilitate evidence-based planning for subsequent waves or future pandemics, and to identify innovative practice for mainstreaming into routine service provision. Aims: This project aims to test the utility of novel information networks and develop a tool that is tailored to evaluating pandemic-imposed change in an emergency medical service. Methods: The first aim will be to introduce and measure the impact of ambulance-specific research and information updates for NAS. Secondly, the usefulness to members of an international network of senior ambulance and research personnel (‘AMBULANCE+COVID19’ network), and the clarity and feasibility of a short-survey instrument, the Emergency Medical Services Five Question Survey (EMS-5QS), will be assessed. Finally, an evaluation framework for assessing pandemic-imposed change will be developed to enable NAS determine innovations: (1) for reactivation in another wave or new pandemic; (2) to be sustained as part of routine service. The framework will be developed in collaboration with NAS and the National Quality Improvement Team. The Research Team includes expertise from academia, ambulance services and the National Public Health Emergency Team. Conclusions: This project will facilitate the prompt introduction of information sharing processes to an emergency medical service and assess the impact of those processes. By developing a process for evaluating pandemic-imposed change in NAS, this project will add to the toolbox for future pandemic planning in emergency medical services internationally.

Ламинарная обмотка тороидального поля для термоядерной электростанции типа Токамак

There are described some alternatives to traditional technical solutions used in the designs of experimental Tokamak thermonuclear installations. The proposals must significantly reduce capital costs of the construction of toroidal field windings for thermonuclear power plants of this type. Cost reduction may be achieved by choosing a coil design that excludes degradation of the properties of a superconducting cable, significant simplifications of the cable design, cooling the winding with thermosyphon, avoiding the occurrence of high voltages due to using a quench back method for the winding protection, A procedure is described for the reliable selection of the operating current of the cable and the maximum permissible values of the electric field in it. It is considered also a facility of access to the thermonuclear unit of the power plant for routine service without dismantling the toroidal field winding and its vacuum shell.

Access and Waiting Time Standard for Early Intervention in Psychosis: At Risk Mental State Identification and Interventions Accepted within a Routine Service

Aim: Following the introduction of an access and waiting time standard for Early Intervention in Psychosis (EIP) services, the identification and treatment of people experiencing an At-Risk Mental State (ARMS) for psychosis has become a national priority. However, there is a dearth of literature concerning what is offered to and accepted by ARMS service users within routine services. Methods: This descriptive evaluation reports upon the assessment and treatment of people with an at-risk mental state identified during the first year of a routine service operating in line with the EIP standard. The paper details referral sources, referral to treatment times, socio-demographic characteristics, ARMS subgroups and the interventions accepted by these service users. Results: A total of 138 ARMS cases were identified over the evaluation period, with 73% (n=101) aged between 18-34 years and 86% (n=118) meeting attenuated psychotic symptoms criteria. The majority (64%) of service users engaged in multiple interventions; 54% (n=75) accepted psychoeducation and coping skills enhancement work, 42% (n=58) participated in a sleep programme, 33% (n=45) undertook coping with voices and visions work and 28% (n=39) engaged in individual psychological therapy. Conclusion: The findings indicate that the majority of ARMS service users presenting to the EIP service were aged 18-34 and experienced attenuated psychotic symptoms. A range of NICE and CBT informed interventions as well as individual psychological therapies appear to be acceptable to ARMS service users and many engaged in multiple interventions offered.

The comprehensive framework for integrated healthcare implementation: a realist evaluation of positive parenting in rural primary care in the US

PurposeThis study aimed to develop a comprehensive framework that encompasses contextual determinants of integrated care implementation. The initial framework was developed based on literature and was refined based on contexts and mechanisms that facilitated or interfered with integrating a pilot parenting intervention, Behavior Checker (BC), into the routine service delivery in a rural primary care clinic in the USA.Design/methodology/approachThis study was a single organizational case study informed by the realist evaluation methodology. Data collection methods included key informant interviews, healthcare staff surveys, a focus group and direct observation of meetings. Data analysis focused on identifying the context-mechanism-outcome (CMO) frameworks, a heuristic used in a realist evaluation to map pathways of the interactions between program inputs and contextual conditions leading to intended and/or unintended outcomes.FindingsThe identified CMOs and antecedent contexts identified informed the process of revising the initial Comprehensive Framework for Integrated Healthcare Development and Implementation (CF-IHDI). The revised CF-IHDI contained six parent domains of outer setting, basic structures, people and value, intervention characteristics, organizational capabilities for change and key processes.Research limitations/implicationsThe CMOs and core characteristics of contextual conditions that activated facilitating mechanisms can inform future studies examining healthcare integration efforts.Practical implicationsThe CF-IHDI can guide primary care clinics in identifying factors and strategies to consider when integrating parenting or other psychosocial interventions into primary care routine service delivery.Originality/valueThe CF-IHDI developed in this study contributes to the knowledge of contexts and mechanisms that facilitate and interfere with integrated care implementation.

Rapid response and learning for later: establishing high quality information networks and evaluation frameworks for the National Ambulance Service response to COVID-19 – the ENCORE COVID Project Protocol

Background: The National Ambulance Service (NAS) is at the forefront of Ireland’s response to the COVID-19 pandemic. As directed in Ireland’s National Action Plan, NAS significantly expanded prehospital services, including provision of a novel home and community COVID-19 testing service. Additionally, other health services rely on NAS’s capacity to assess, transport and/or treat COVID-19 patients. In a climate of innovation and adaptation, NAS needs to learn from international ambulance services and share experience. Evaluation of the NAS response to COVID-19 is required to facilitate evidence-based planning for subsequent waves or future pandemics, and to identify innovative practice for mainstreaming into routine service provision. Aims: This project aims to provide information networks and evaluation tools that will help NAS meet these requirements. Methods: The first aim will be to produce ambulance-specific research and information updates for NAS. Secondly, an international network of senior ambulance and research personnel will be established (‘AMBULANCE+COVID19’ network) and a short-survey instrument, the Emergency Medical Services Five Question Survey (EMS-5QS), will be developed. The EMS-5QS will enable AMBULANCE+COVID19 participants to nominate a topic for which they would like to hear about the experience and practice of other ambulance services. Multiple surveys covering a range of topics will be carried out. Finally, an evaluation framework will be developed to enable NAS determine innovations: (1) for reactivation in another wave or new pandemic; (2) to be sustained as part of routine service. The framework will be developed in collaboration with NAS and the Health Service Executive National Quality Improvement Team. The Research Team includes expertise from academia, ambulance services and the National Public Health Emergency Team. Conclusions: Ability to mobilise resources quickly and utilise ready-made international networks will ensure a successful project than can inform future information sharing methodologies and pandemic planning for ambulance services internationally.

Breakthrough on Routine Service Cycle Time Improvement – Leap Frog Concept, Duri Field, Indonesia

Leap frog concept was created to address the loss of single joint rig agility and drive the cycle time average lower than ever. The idea is to move the preparation step into a background activity that includes moving the equipment, killing the well, dismantling the wellhead and installing the well control equipment/BOP before the rig came in. To realize the idea, a second set of equipment is provided along with the manpower. By moving the preparation step, the goal is to eliminate a 50% portion of the job from the critical path. The practice is currently performed in tubing pump wells on land operations. However, the work concept could be implemented for other type of wells, especially ESP wells. After implementation, the cycle time average went down from 18 hours to 11 hours per job, or down by ~40%. The toolpusher also reports more focused operations due to reduced scope and less crew to work with, making the leap frog operation safer and more reliable. Splitting the routine services into 2 parts not only shortened the process but it also reduces noise that usually appear in the preparation process. The team are rarely seen waiting on moving support problems that were usually seen in the conventional process. Having the new process implemented, the team had successfully not only lowered cycle time, but also eliminated several problems in one step. Other benefits from leap frog implementation is adding rig count virtually to the actual physical rig available on location, and also adding rig capacity and completing more jobs compared to the conventional rig. In other parts, leap frog faced some limitation and challenges, such as: limited equipment capability for leap frog remote team to work on stuck plunger, thus hindering its leap frog capability, and working in un-restricted/un-clustered area which disturb the moving process and operation safety.

Use of Rubber Mat to Improve Deformation Behaviors of Ballastless Tracks Laid on Bridges

The deformation behaviors of ballastless tracks have an important influence on their service performance. In this work, rubber mats commonly used in metro traffic were employed in ballastless tracks laid on bridges to improve their deformation behaviors. In order to research the effect of rubber mat for deformation behaviors, a series of static loading tests were carried out based on two full-scale ballastless tracks with different types of isolation layers. Main conclusion include that, for ballastless track with geotextile isolation layers, gaps and voids are formed at interlayers with the increasing static load. However, for ballastless track with rubber mat isolation layer, the maximum tensile deformation in the thickness direction unexceeds the precompression of rubber mat under the deadweight of its upper structures. Interlayer gaps and voids can be eliminated due to the precompression of rubber mat. Besides, the rubber mat isolation layer is still in the linear elasticity stage under the routine service condition, and the interlayer behaviors of the ballastless tracks perform well. It is a feasible way to use a rubber mat isolation layer to improve the deformation behaviors of ballastless tracks laid on bridges.