Critical Capacity Research Articles

Beyond empowerment and inspiration: towards a critical program for multicultural youth leadership

ABSTRACT This article examines the ways in which multicultural youth leadership programs reflect a model of participatory citizenship and individual empowerment that risks affirming white institutional worlds. Drawing on data from a national study of migrant and refugee youth in Australia, it suggests that while these activities offer useful forms of civic and vocational training for its participants, leadership programs can burden migrant youth with forms of cultural labor that other young people are not expected to perform. Programs of multicultural youth leadership make young migrants responsible for their communities, while also obscuring these communal attachments and responsibilities via an emphasis on individual achievement. It is argued that such programs form part of a wider discourse of neoliberal nationhood and youth futurity, where ideas about the productive potential of migrant youth are shaped by normative ideas about what the nation should be. These programs could instead be reoriented to emphasize the critical and creative capacities of migrant youth. Strategies of co-production can enable young people to take up a more flexible range of positions through which they share their expertise, and contribute to collective forms of cultural citizenship that can challenge, rather than affirm, the white institutional worlds through which they are governed.

The experiences of NHS hospital acute medicine departments in England during the first wave of the COVID-19 pandemic

We conducted a survey exploring the experiences of NHS hospital acute medicine services in England during the 1st wave of the COVID-19 pandemic. Responses were collected from 26th May to 8th July 2020. The results of 91 sites are presented. The total number of patients referred to the medical take for assessment and admitted from the medical take decreased from pre-pandemic levels compared to peak COVID-19 activity. The total number of acute medical beds decreased, however critical care beds increased by 162%. We report the median timeline from first admission of COVID-19 to when baseline critical care capacity was reached. We found regional variation across the results. These findings can assist healthcare leaders prepare for future pandemics.

Technology and Disasters: The Evolution of the National Emergency Tele-Critical Care Network.

Technology and Disasters: The Evolution of the National Emergency Tele-Critical Care Network.

Controversies in an information technology startup: A critical actor-network analysis of the entrepreneurial process

This article critically investigates the controversies involved in the entrepreneurial process of an IT venture using the Actor-Network Theory (ANT). While ANT and other processual approaches have been used to assess entrepreneurship, little emphasis has been placed on addressing the controversies involved in the entrepreneurial process. To overcome this bias, we used the Cartography of Controversies (CC), an ANT's applied method, to highlight the impacts of conflictual relationships on the organizing process of an IT venture. We based our analysis on a pluralistic corpus of primary data, including interviews, focus groups, field journals, and other documents. We found five main critical issues related to the entrepreneurial process, being them: sociodemographic biases, reproduction of economic and cultural inequalities, conflicts among organizational elites, disputes between owners and workers, and overdependence of startups on larger technological firms. In line with the ‘ANT and After’ literature, we demonstrated how the critical use of ANT sociological approach avoids excessively aggregated categories often present on other critical studies. Finally, we conclude that the critical use of ANT can contribute to more sophisticated and well-built forms of criticism, orienting the research empirically and considering the critical capacities of the actants themselves.

The Critical Bearing Capacity of Beams in Steel Grillages

The paper reports results of investigations into the effect produced by elastic action of the nodes of the beam grillage on an increase in the critical moment of lateral torsional buckling. Also, the effectiveness of the use of closed section ribs in the grillage nodes for increase in critical load capacity of the coupling beam was examined and compared with that of flat ribs.

Contextualising evidence-based recommendations for the second wave of the COVID-19 pandemic in India

Contextualising evidence-based recommendations for the second wave of the COVID-19 pandemic in India

P.43 Impact of the COVID-19 pandemic on obstetric anaesthesia: A service evaluation

Introduction: The first wave of the COVID-19 pandemic, between March and May 2020, affected provision of anaesthetic services across the country. At its peak, critical care capacity exceeded 300% at Royal Gwent Hospital (RGH). Anaesthetic rotas were upscaled, trainees worked a 1 in 5 rota, and there was 24-h resident consultant anaesthetist cover. An obstetric COVID-19 contingency plan was introduced from 15 March 2020. We explored the impact of the pandemic on the provision of obstetric anaesthesia in RGH.

Participatory Nutrition Capacity Assessment and Capacity Development in Six Regions of Ethiopia

Abstract Objectives The multi-faceted causes of malnutrition make capacity development in nutrition complex. Defining capacity development actions requires an understanding of the landscape actors utilize to address the determinants. Thus, six regional health bureaus (RHB) in Ethiopia, in collaboration with Alive & Thrive (A&T), conducted participatory capacity assessments to identify capacity strengths and gaps, and co-developed appropriate maternal, infant, and young child nutrition (MIYCN) capacity development plans linked to achieving targets outlined in the national nutrition program. Methods From April to June 2019, 143 nutrition practitioners in six regions of Ethiopia conducted rapid participatory assessments of their respective regional capacity. They used an adapted assessment tool based on WHO's six system building blocks, and a four-level scoring guide to identify MIYCN capacity strengths and gaps on 87 statements of excellence. Validated by RHB's leadership, the assessors and A&T co-developed region-specific MIYCN capacity development plans for areas rated ‘poor’ and ‘fair’. Results An aggregate assessment score for six regions revealed presence of adequate MIYCN implementation capacity – excellent (25.3%), moderate capacity with basic ones in place or in use – good (37.9%), low capacity needing attention – ‘fair’ (23.6%), and no capacity or critical capacity limitation needing urgent attention – ‘poor’ (9.4%). Using a prioritization matrix, MIYCN-focused performance strengthening plans were designed, tailored to each region's context. Beginning in July 2019, the six RHBs incorporated key MIYCN improvement action items targeted towards ‘poor’ and ‘fair’ performance areas with relevant indicators into their annual plans, budget structure, and M&E framework. A&T and other partners provided technical assistance and coordinated their efforts with RHBs to spirally build regional MIYCN implementation capacities. Conclusions The participatory capacity assessment served to establish a baseline of existing MIYCN implementation capability; and create a strong and shared commitment within the health sector identifying areas for improvement that can be addressed by the government, with little or no external assistance. Funding Sources The Bill & Melinda Gates Foundation.

Two-year single centre results with covered endovascular reconstruction of aortic bifurcation (CERAB) in the treatment of extensive aorto-iliac occlusive disease.

To report the results of a single-centre in the treatment of extensive aorto-iliac occlusive disease (AIOD) by the covered endovascular reconstruction of aortic bifurcation (CERAB) technique. A retrospective analysis was conducted on data obtained from the review of medical charts of all consecutive patients treated with CERAB technique for AIOD between January 2016 and December 2019 in San Giovanni-Addolorata Hospital (Rome, Italy). Clinical examination, duplex ultrasound with ankle-brachial index measurement and contrast-enhanced computed tomography angiography were performed preoperatively. A clinical and ultrasound follow-up was carried out at one month and then half yearly after the intervention to evaluate patients' clinical status, limb salvage, target lesion revascularization rate, primary and secondary patency rate. During the study period, 24 patients (14 men, 58.3%; 10 women, 41.7%; median age 59 years, range 37-79 years) underwent CERAB for AIOD (TASC II C 29.2%, TASC II D 70.8%). Indications for treatment were: intermittent claudication in 18 patients (75%) and critical limb ischemia in 6 (25%). Technical success was achieved in all cases. Perioperative minor complications occurred in three cases (12.5%). One patient reported an intraoperative iliac rupture requiring adjunctive covered stenting. Median hospital length of stay was two days (range 1-9). No patient died perioperatively nor at the last follow-up. At a median follow-up of 18 months (range 6-48 months), mean ankle-brachial index increased significantly (from 0.62 ± 0.15 before the procedure to 0.84 ± 0.18) (P < 0.001) and target lesion revascularization rate was 12.5%. At two years, the limb salvage rate was 100%, and primary and secondary patency rates were 87.5% and 100%, respectively. CERAB technique demonstrated to be effective at the mid-term follow-up with low rate of complications and short length of stay. Long-term results and more robust data are needed to affirm this technique as the first-line treatment for extensive AIOD. However, it could become the preferred option especially in fragile patients and during contemporary COVID-19 pandemic due to the current limitations in vascular and critical care bed capacity.

COVID-19 highlights the need to optimize critical care resource use: The role of a respiratory-led multidisciplinary team.

COVID-19 highlights the need to optimize critical care resource use: The role of a respiratory-led multidisciplinary team.

Critical temperatures, pressures, heat capacities, and thermal diffusivities of three furanic biofuels

The critical temperatures, pressures, heat capacities, and thermal diffusivities of 2-methylfuran, 2,5-dimethylfuran, and 2-methyltetrahydrofuran have been measured. Heat capacities and thermal diffusivities have been measured at atmospheric pressure in the temperature ranges from 298.00 to 473.15 K and from 289.15 to 303.15 K, respectively. The temperature dependencies of heat capacities have been approximated by third-order polynomials. The coefficients of these polynomials are given. Experimental critical constants have been compared with those calculated using the group contribution methods of Wilson and Jasperson, Nannoolal et al., Marrero and Gani, and Hukkerikar et al. The thermal conductivities of the compounds under study have been calculated using experimental data and estimated by the group contribution methods of Govender et al. and Liu et al.

Urgent needs to accelerate the race for COVID-19 therapeutics.

Urgent needs to accelerate the race for COVID-19 therapeutics.

Reduced critical care demand with early CPAP and proning in COVID-19 at Bradford: A single-centre cohort.

Guidance in COVID-19 respiratory failure has favoured early intubation, with concerns over the use of CPAP. We adopted early CPAP and self-proning, and evaluated the safety and efficacy of this approach. This retrospective observational study included all patients with a positive COVID-19 PCR, and others with high clinical suspicion. Our protocol advised early CPAP and self-proning for severe cases, aiming to prevent rather than respond to deterioration. CPAP was provided outside critical care by ward staff supported by physiotherapists and an intensive critical care outreach program. Data were analysed descriptively and compared against a large UK cohort (ISARIC). 559 patients admitted before 1 May 2020 were included. 376 were discharged alive, and 183 died. 165 patients (29.5%) received CPAP, 40 (7.2%) were admitted to critical care and 28 (5.0%) were ventilated. Hospital mortality was 32.7%, and 50% for critical care. Following CPAP, 62% of patients with S:F or P:F ratios indicating moderate or severe ARDS, who were candidates for escalation, avoided intubation. Figures for critical care admission, intubation and hospital mortality are lower than ISARIC, whilst critical care mortality is similar. Following ISARIC proportions we would have admitted 92 patients to critical care and intubated 55. Using the described protocol, we intubated 28 patients from 40 admissions, and remained within our expanded critical care capacity. Bradford's protocol produced good results despite our population having high levels of co-morbidity and ethnicities associated with poor outcomes. In particular we avoided overloading critical care capacity. We advocate this approach as both effective and safe.

The repurposed use of anesthesia machines to ventilate critically ill patients with coronavirus disease 2019 (COVID-19)

BackgroundThe surge of critically ill patients due to the coronavirus disease-2019 (COVID-19) overwhelmed critical care capacity in areas of northern Italy. Anesthesia machines have been used as alternatives to traditional ICU mechanical ventilators. However, the outcomes for patients with COVID-19 respiratory failure cared for with Anesthesia Machines is currently unknow. We hypothesized that COVID-19 patients receiving care with Anesthesia Machines would have worse outcomes compared to standard practice.MethodsWe designed a retrospective study of patients admitted with a confirmed COVID-19 diagnosis at a large tertiary urban hospital in northern Italy. Two care units were included: a 27-bed standard ICU and a 15-bed temporary unit emergently opened in an operating room setting. Intubated patients assigned to Anesthesia Machines (AM group) were compared to a control cohort treated with standard mechanical ventilators (ICU-VENT group). Outcomes were assessed at 60-day follow-up. A multivariable Cox regression analysis of risk factors between survivors and non-survivors was conducted to determine the adjusted risk of death for patients assigned to AM group.ResultsComplete daily data from 89 mechanically ventilated patients consecutively admitted to the two units were analyzed. Seventeen patients were included in the AM group, whereas 72 were in the ICU-VENT group. Disease severity and intensity of treatment were comparable between the two groups. The 60-day mortality was significantly higher in the AM group compared to the ICU-vent group (12/17 vs. 27/72, 70.6% vs. 37.5%, respectively, p = 0.016). Allocation to AM group was associated with a significantly increased risk of death after adjusting for covariates (HR 4.05, 95% CI: 1.75–9.33, p = 0.001). Several incidents and complications were reported with Anesthesia Machine care, raising safety concerns.ConclusionsOur results support the hypothesis that care associated with the use of Anesthesia Machines is inadequate to provide long-term critical care to patients with COVID-19. Added safety risks must be considered if no other option is available to treat severely ill patients during the ongoing pandemic.Clinical trial numberNot applicable.

Caring for critically ill adults in paediatric intensive care units in England during the COVID-19 pandemic: planning, implementation and lessons for the future

ObjectiveTo describe the experience of paediatric intensive care units (PICUs) in England that repurposed their units, equipment and staff to care for critically ill adults during the first wave of...

Evidence and rationale for a pragmatic approach to pre-operative isolation prior to elective urological surgery during the de-escalation phase of COVID-19

Introduction: In response to the COVID-19 pandemic elective operating decreased to meet critical care capacity demands at the Royal Berkshire Hospital. As this demand fell elective operating subsequently increased. This saw the introduction of the ‘Cold Pathway’ at the Royal Berkshire Hospital in line with Public Health England guidelines; the first urology patients being admitted on 14 May 2020. This requires patients to undergo a 14-day self-isolation period, which many find difficult, with a negative COVID-19 swab 48 h prior to their operation. Aims: This article examines whether any differences exist in patient outcomes related to COVID-19 since implementation of the Cold Pathway and the significance of this to the 14-day self-isolation rule. Methods: Urology patients electively operated on between 23 March 2020–3 July 2020 were included. A combination of electronic records and telephone consultations were used to obtain data regarding a pre-selected set of questions. Results: One hundred and ninety-six patients were included. Seventy-eight patients were admitted prior to the introduction of the Cold Pathway and 118 after this point. Of patients analysed prior to the implementation of the Cold Pathway, one required ongoing hospital treatment as a result of potentially obtaining COVID-19 from in-patient admission. Of the 78 patients, 14 isolated prior to their procedure. Post-implementation, 118 patients were examined. Despite claiming to have complied with self-isolation instructions at admission, 45 patients admitted retrospectively to not complying at all or only partially. One patient developed COVID-19 3 weeks post-operatively. Discussion: We have shown no difference in outcomes, in relation to COVID-19, when comparing those admitted pre- and post-Cold Pathway implementation. Many patients describe difficulty in following this isolation period. In conjunction with falling national and local levels of COVID-19 positive cases, we have therefore adopted a more pragmatic approach to patient isolation with the ability to perform operations based on clinical need and individual patient circumstances. Level of evidence: This is a cohort study of patients undergoing elective urological surgery at the Royal Berkshire Hospital.

A mixed methods protocol to evaluate the effectiveness and acceptability of COVID-19 Community Assessment Hubs.

Background: Ireland's health system has been under significant strain due to staff shortages and inadequate capacity. Critical care bed capacity per capita in Ireland is among the lowest in Europe, thus, the coronavirus disease 2019 (COVID-19) pandemic has put additional strain on an over-stretched system. COVID-19 Community Assessment Hubs (CAHs) were established to mitigate unnecessary admission to acute hospitals, and reduce infection spread by supporting COVID-19 positive or suspected positive patients to isolate at home, or in isolation facilities. There is some evidence that similar assessment centres may be a successful triage strategy to reduce burden on hospital and acute care. Aim : The aim of this study is to evaluate the impact of COVID-19 Community Assessment Hubs on service delivery in two regions in Ireland during the pandemic. Methods: A mixed-methods approach will be used, incorporating co-design to engage stakeholders and ensure informed data capture and analysis. Online surveys will assess CAH patients' experiences of access to and quality of care. Clinical patient data from CAHs will be collected and analysed using multinomial logistic regression to check for association with patient demographics and COVID-19 symptoms, and CAH early warning scores and outcomes (Transfer to Emergency Department, Transfer to isolation unit, Sent home with care plan). Semi-structured interviews will be conducted with: patients to elicit an in-depth understanding of experiences and acceptability of attending CAHs; and staff to understand challenges, benefits, and effectiveness of CAHs. Interview data will be analysed using thematic analysis. Discussion: This study will provide valuable insights from both patient and staff perspectives on the operation of CAHs. We will evaluate the effectiveness and acceptability of CAHs and propose areas for improvement of the service. This will contribute to international literature on the use of community assessment centres during infectious disease pandemics.

A Protocol for Carotid Artery Stenting in COVID Times. A Single Canadian Centre Experience.

The COVID-19 pandemic has resulted in huge disruption to healthcare delivery worldwide. There is a need to balance the urgent needs of the neurovascular patient population with the desire to preserve critical inpatient hospital capacity. It is incumbent on neurointerventionalists to advocate for their patients to minimise future disability. Patients still require semiurgent carotid revascularisation after ischaemic embolic events. We present a review of a novel protocol for expediting patient flow through the carotid stenting process, in accordance with government directives to minimise nonessential inpatient admissions, ensure its efficacy, and evaluate its safety. We also evaluate the literature regarding complications with attention to the timing of these related to the procedure. A retrospective review of 45 consecutive carotid stenting cases performed at London Health Sciences Centre between March 2020 and March 2021 for symptomatic extracranial internal carotid artery stenosis utilising a default same-day discharge policy was performed. Complications were plotted as a function of time. Twenty-four patients underwent carotid artery stenting with same-day discharge and 21 patients underwent stenting with an overnight inpatient stay. A single stent occlusion occurred 27 h post stenting. Simple modification of protocol for symptomatic carotid artery stenting during the COVID-19 outbreak with radial access as first approach appears to provide safe, efficacious care.

815 The Impact and Implications for The Workload for Vascular Surgery as A Result of the COVID-19 Lockdown

IntroductionThe emergence of the coronavirus pandemic and subsequent UK lockdown resulted in a significant reduction in elective vascular surgery to increase critical care capacity. We aimed to ascertain the impact of lockdown on the workload of a busy vascular surgical unit.MethodData on all major vascular procedures performed between March 2020 and June 2020 were collected prospectively. Comparison to the same time period over the last 6 years was performed using a prospectively maintained database.Results92 major cases were performed, a reduction of 30% compared with cases performed during similar periods (803 cases total, mean 133), with an increased proportion of unplanned & emergency cases(35.9% & 31.5% vs 31.4% & 20.5%).There was a significant reduction in aortic procedures (19 vs mean 36). Despite the reduction in cases there was a similar number of amputations performed (9 vs mean 10).ConclusionsThe lockdown period resulted in a 30% reduction in cases performed with far fewer aortic procedure performed and a similar number of amputations. These pending cases will need consideration, especially with critical care capacity to ensure they are completed within a timely period. Considerations for capacity are also pertinent given the approach of winter and the possibility of a second wave.

Long-term trends in critical care admissions in Wales*.

As national populations age, demands on critical care services are expected to increase. In many healthcare settings, longitudinal trends indicate rising numbers and proportions of patients admitted to ICU who are older; elsewhere, including some parts of the UK, a decrease has raised concerns with regard to rationing according to age. Our aim was to investigate admission trends in Wales, where critical care capacity has not risen in the last decade. We used the Secure Anonymised Information Linkage Databank to identify and characterise critical care admissions in patients aged ≥ 18 years from 1 January 2008 to 31 December 2017. We categorised 85,629 ICU admissions as youngest (18-64 years), older (65-79 years) and oldest (≥ 80 years). The oldest group accounted for 15% of admissions, the older age group 39% and the youngest group 46%. Relative to the national population, the incidence of admission rates per 10,000 population in the oldest group decreased significantly over the study period from 91.5/10,000 in 2008 to 77.5/10,000 (a relative decrease of 15%), and among the older group from 89.2/10,000 in 2008 to 75.3/10,000 in 2017 (a relative decrease of 16%). We observed significant decreases in admissions with high comorbidity (modified Charlson comorbidity index); increases in the proportion of older patients admitted who were considered 'fit' rather than frail (electronic frailty index); and decreases in admissions with a medical diagnosis. In contrast to other healthcare settings, capacity constraints and surgical imperatives appear to have contributed to a relative exclusion of older patients presenting with acute medical illness.