Resilient Services Research Articles

Reducing the bullwhip effect to enhance maritime service resilience: The power of blockchain technology for cutting down the market uncertainty in the maritime supply chain

In order to enhance the maritime service resilience due to the uncertain environment, our study use the game-theoretical model to find the optimal scheme based on the hypothesis of rational participants, involves a port and a carrier. The results show three aspects. Specifically, firstly, through using the technical superiority of blockchain and changing the influence rate of market disturbance, the negative effects of market uncertainty and bidirectional bullwhip effect can be reduced under the different conditions. Secondly, the ability improvement of maritime service can improve the maritime resilience. Moreover, the blockchain can empower the traditional service in order to improve the traditional ability of the maritime supply chain. Finally, we reveal the relationship between the bidirectional bullwhip effect and product quantity by investigating the degree of market fluctuation of heterogeneous supply and demand. It needs to be highlighted that if you pay little attention to the fluctuation of the market demand, it's more likely to produce a bidirectional bullwhip effect. Based on these results, the conclusion shows that the stakeholder can enhance maritime service resilience by reducing the bullwhip effect, such as improving service level or adopting the blockchain technology based on the specific conditions.

Understanding the use of telemedicine across different opioid use disorder treatment models: A scoping review.

The COVID-19 pandemic has instigated the development of telemedicine-mediated provision of medications for opioid use disorder such as buprenorphine and methadone, referred to as TMOUD in this study. As services start to return to pre-pandemic norms, there is a debate around the role of TMOUD as addition to or replacement of the conventional cascade of care for people with opioid use disorder (PWOUD). This scoping review is designed to characterize existing TMOUD services and provide insights to enable a more nuanced discussion on the role of telemedicine in the care of PWOUD. The literature search was conducted in OVID Medline, CINAHL, and PsycINFO, from inception up to and including April 2023, using the Joanna Briggs Institute methodology for scoping reviews. The review considered any study design that detailed sufficient descriptive information on a given TMOUD service. A data extraction form was developed to collect and categorize a range of descriptive characteristics of each discrete TMOUD model identified from the obtained articles. A total of 45 articles met the inclusion criteria, and from this, 40 discrete TMOUD services were identified. In total, 33 services were US-based, three from Canada, and one each from India, Ireland, the UK, and Norway. Through a detailed analysis of TMOUD service characteristics, four models of care were identified. These were TMOUD to facilitate inclusion health, to facilitate transitions in care, to meet complex healthcare needs, and to maintain opioid use disorder (OUD) service resilience. Characterizing TMOUD according to its functional benefits to PWOUD and OUD services will help support evidence-based policy and practice. Additionally, particular attention is given to how digital exclusion of PWOUD can be mitigated against.

Assessment of Impacts and Resilience of Online Food Services in the Post-COVID-19 Era

The expansion of the online food services (collectively referred to as ‘OFS’) sector has been accelerating at high rates worldwide over the last few years. This sector is widely acknowledged, especially by urban consumers, for making life more convenient. During the strict lockdown following the breakout of the COVID-19 pandemic, the OFS sector saw major growth, as many restaurants and grocery stores turned to the delivery format. Conversely, the sector has also been facing many challenges, which have lasting social, economic, and environmental impacts. Considering this situation, this study carried out a review of existing literature on the social, environmental, and economic impacts of OFS and explored the resilience gaps of this fast-growing food service business. To achieve this, relevant literature was collected through Elsevier’s SCOPUS database and other sources. The authors have documented specific social, environmental, and economic impacts of OFS on consumers and providers. Furthermore, various changes in this sector following the pandemic have also been underlined in this study. A combination of policy actions at the national, local, private sector, and individual levels is crucial to mitigate the adverse impact of OFS; hence, greater resilience will be ensured.

Estimating 5G Network Service Resilience Against Short Timescale Traffic Variation

5G networks are designed to create a new ecosystem for vertical industries such as health care, energy, and public transport. These novel applications, on the other hand, bring new challenges to network resilience. Among them, traffic variation is one of the most vital threats to the 5G network. With tens of thousands of devices connected to the network, network service resilience is threatened by the heavy traffic change induced by the end users or malicious attacks. While long timescale traffic variation can be easily predicted based on historical data, short timescale abnormal traffic is hard to forecast yet can significantly violate the service requirements. The impact of short timescale traffic variation can be mitigated by 5G management and control systems. However, the complexity and dynamics of the virtualized 5G system make it hard to estimate its resilience. This paper provides a 5G network model that captures the data traffic changes and network dynamic management mechanism. The model is able to evaluate the performance of different network services with different requirements under traffic variation events. We analyze the effectiveness of auto-scaling and compare different isolation strategies for traffic congestion. The simulation results on service resilience estimation can become strong supporting information for 5G network deployment and configuration.

A Quantitative Assessment of the Impact of Automated Incident Response on Cloud Services Availability

Abstract In the rapidly evolving landscape of cloud computing, ensuring high service availability is paramount for organizations reliant on digital infrastructure. This study conducts a quantitative assessment of the impact of Automated Incident Response Systems (AIRS) on the availability of cloud services. Utilizing a dataset derived from multiple cloud service providers over a twelve-month period, we analyze key performance metrics, including incident response times, resolution rates, and service uptime statistics, both pre- and post-AIRS implementation. The results indicate a statistically significant improvement in service availability following the deployment of AIRS, characterized by reduced incident resolution times and enhanced operational uptime. Furthermore, we present a comparative analysis of traditional incident response methodologies versus automated systems, demonstrating the superior efficiency and reliability of AIRS. The findings underscore the necessity for organizations to embrace automation in incident management to bolster service resilience and optimize customer satisfaction. This study concludes with practical recommendations for organizations considering the integration of AIRS into their operational frameworks. In the rapidly evolving landscape of cloud computing, ensuring high service availability has become a critical concern for organizations that depend heavily on digital infrastructures. This study conducts a comprehensive quantitative assessment of the impact of Automated Incident Response Systems (AIRS) on the availability of cloud services. As cloud environments become increasingly complex, the potential for service disruptions due to incidents—such as hardware failures, security breaches, or configuration errors—poses significant risks to businesses. Through a detailed analysis of incident response metrics obtained from a diverse dataset comprising five leading cloud service providers, this research evaluates key performance indicators including incident response times, resolution rates, and service uptime statistics over a twelve-month period. Employing rigorous statistical methods, the study investigates the relationship between the implementation of AIRS and enhancements in service availability, offering insights into the effectiveness of automation in incident management. The results reveal a statistically significant improvement in service availability post-AIRS deployment, characterized by a dramatic reduction in average incident response times—from 30 minutes to just 10 minutes—and an increase in resolution rates from 75% to 95%. Furthermore, the average service uptime improved from 90% to an impressive 99.5%, demonstrating the potential for organizations to achieve greater operational resilience through the integration of automated systems. The findings also include a comparative analysis of traditional versus automated incident response methodologies, highlighting the superior efficiency and reliability of AIRS. This study emphasizes the necessity for organizations to adopt automated solutions in their incident management frameworks to mitigate the risks associated with downtime and enhance customer satisfaction. The conclusions drawn from this research provide practical recommendations for businesses considering AIRS integration, making a compelling case for the strategic implementation of automated incident response mechanisms in the pursuit of optimal service availability.

Effects of Communicable Diseases on Maternity services in selected MNCH priority counties’ Public Health facilities in Kenya: A Case of COVID-19.

Covid-19 is a rapidly evolving pandemic which has affected both developed and developing countries. Maternity services in low resource countries are adapting to provide antenatal and postnatal care midst a rapidly shifting health system environment due to the COVID-19 pandemic. Over the years there has been progress in reducing maternal and new-born mortality and stillbirths in Kenya and the globe. However, in the wake of covid-19 pandemic, perinatal women and their frontline health services providers especially nurses and midwives have been cited to bear the brunt of the pandemic. This has largely been linked to the limited access to Personal Protective Equipment (PPE) requirements and the fear of contracting the disease within health services delivery points. There have been adverse effects of maternal and new-born care outcomes due to coronavirus disease. The objective of this study was to determine the effect of coronavirus disease (COVID 19) to maternity services in selected levels III and IV public health facilities within five (5) Counties in Kenya. The five MNCH priority counties selected included Nairobi, Migori, Kilifi, Isiolo and Garissa. A two-stage sampling approach was used to select health facilities in the 5 MNCH priority counties with the sampling frame comprising all MNCH priority counties in Kenya. The study employed cross-sectional and observational retrospective approaches. Data was collected from the midwifery managers and maternity registers in a total of 28 levels III and IV facilities. Open Data Kit (ODK) formatted tools were used to collect data from maternity services facility managers and maternity registers in the selected facilities. Data collected from maternity registers covered the period of four months before covid-19 pandemic and four months during the covid-19 pandemic. A two-days training programme comprising of introduction to study objectives and instruments as well as review of the instruments, practice interviews and data collection was conducted. Data was analysed using STATA Version 15. Descriptive statistics and measures of central tendencies were used to analyse the demographic details of the respondents and health related variables of interests. Chi-square test and fishers exact test were used to find association between facilities that had diagnosed COVID-19 cases and their demographic characteristics. For all tests, a p-value < 0.05 was taken as statistically significant. A total of 31 midwifery managers were interviewed and a total of 801 maternity records (400 before COVID and 401 during COVID-19 pandemic) were obtained from levels 3 III (66%) and IV (34%) facilities across 5 MNCH priority counties in Kenya [Nairobi (27%), Garissa (10%), Isiolo (20%), Kilifi (23%) and Migori (20%)]. On Overall representation, Level III facilities were slightly over half (51.6%) and level IV facilities had 48.4% representation. Most of the maternity services managers interviewed (48.4%) had worked for less than 3 years in their respective stations and the majority (67.7%) had a diploma in either Nursing or midwifery as their highest level of professional education. Overall, the managers indicated that ANC visits had reduced (67.9%), referrals of mothers with complications got delayed (29%), mothers feared delivering in hospitals (64.5%) and possibly some mothers were delivering with the assistance of TBAs (45.2%). The managers reported that New-born care services were the most affected by the pandemic (54.8%) followed by ANC services (45.2%). Immunization services were the least affected (35.5%). The managers (41.9%) reported reduced uptake of FP commodities and a reduction in exclusive breastfeeding (12.9%). Majority (51.6%) of the managers confirmed there was an increase of unplanned pregnancies (90.4) during the pandemic period with limited opportunity to educate ANC clients (74.2%). It was observed that 48% of the facilities surveyed had diagnosed a covid-19 case yet only 61.3% and 54.8% of the facilities had access to masks and hand sanitizers respectively. Facility records indicated a 19% higher ANC attendance before COVID than during COVID-19 pandemic period. Neonatal deaths increased significantly during Covid-19 period ((P=0.010) by 38%. Live births significantly increased by 15% during the pandemic (p<0.0001). Other significant increases were observed in mothers with labour complications (p=0.0003) and number of mothers that underwent caesarean sections(p<0.001) during the pandemic period. There was no sufficient statistical evidence on whether the uptake of FP commodities, post-partum complications, immunizations and maternal mortalities were affected by the covid-19 pandemic. The Covid-19 pandemic caught maternity service providers and the local health systems unaware. The fear of the pandemic had a cross-cutting effect on utilisation of maternity services. Continuous training of health services providers on emergency response to pandemics and health system preparedness is vital in order to have resilient service delivery points.

Spatial Heterogeneity of Watershed Ecosystem Health and Identification of Its Influencing Factors in a Mountain–Hill–Plain Region, Henan Province, China

A watershed ecosystem is a compound ecosystem composed of land and rivers, and its health is closely related to the sustainable development of the region it is located in. The Yihe River Basin (YRB) in central China’s Henan province, which is located in the north–south transition zone and has a mountain–hill–plain landscape from the upstream to the downstream, is adopted as the research area in this study. A watershed ecosystem health assessment system is constructed based on an ecosystem vigor–organization–resilience–service supply and demand harmony (EVORSH) framework and utilized to assess the ecosystem health in the YRB by taking a 3 km × 3 km grid as the evaluation unit. Thirteen factors are selected from natural and human social factors, and from them, the factors that influence watershed ecosystem health through the generation of spatial heterogeneity are identified using the geographical detector model. The following findings are obtained. (1) The mean value of ecosystem health levels in the YRB is 0.65 and at the good level. The ecosystem health has considerable spatial heterogeneity. The areas with high–high concentration are distributed in the mountains in the upper reaches of the YRB, and the areas with low–low concentration are mainly distributed in the plain areas in the middle reaches of the YRB. (2) The geographical detector result shows that 9 of 13 factors have a considerable impact on the spatial distribution of the YRB’s ecosystem health. The interaction between two factors is enhanced synergically. The decisive power of population density, rainfall, and potential evapotranspiration are more than 0.5, so these three are the main factors that influence the distribution of ecosystem health in the YRB. (3) The EVORSH framework is suitable for the measurement of ecosystem health in the YRB. The evaluation result is consistent with the actual situation in the YRB. A 3 km × 3 km grid is used as the basic research unit, and it can more accurately and scientifically express the spatial heterogeneity of ecosystem health in the YRB compared with the macro evaluation unit. This study can provide a scientific basis for ecological protection and high-quality development planning in the YRB. By integrating multi-dimensional data and methods, the EVORSH framework proposed in this study can quickly and scientifically assess the status of ecosystem health, identify the influencing factors of spatial heterogeneity, and could be applied in other similar watersheds.

Sustainable procurement of medical devices in an international context

Background and Objectives Sustainability is a working principle included in the United Nations (UN) procurement processes with the adoption of the Sustainable Development Goals (SDGs) in 2015. In the context of internationally funded projects in developing countries for procuring health-related goods during and following the COVID-19 pandemic, this article further investigates what sustainable procurement means when applied to purchasing medical devices (MDs), considering its impact on health services. It also proposes a reflection on the concepts of sustainability and quality assurance as guiding principles for technical teams during the process of MD procurement. Material and Methods This article aims to identify how sustainability can be implemented during the execution of a project based on the analysis of principles that guide procurement actions in the four UN agencies with the highest volume of MD procurement. The concept of sustainability is also explored from a macrosystemic point of view as the ratio between the impact of a procurement project on healthcare services and its investment. Its implications for population health and wealth is also discussed. Based on the experience of the authors in implementing purchasing processes of MDs, a framework for the specific technical activity is then proposed. Results In the UN system, sustainable procurement focuses on the social, economic, and environmental quality of the equipment and on the conditions of its production to guarantee that a sustainable good is procured. Not being enough, the focus should also be on the benefit of a procurement project, not as the possession of a new MD, but as the utility of the device: an instrument to provide healthcare services of the beneficiary country. Procuring sustainable goods should include planning their future use as an essential component for a sustainable positive impact on the health and wealth of the beneficiary population. Thus, the intended use of the procured devices should be defined, planned, and measured. In the proposed framework, sustainability is a ratio between an MD’s social, economic, and environmental costs and the benefits of its use. When neglecting the essential factor of sustainable use of MDs, the risk of purchasing equipment that will not be properly and efficiently used is relevant. To guarantee the sustainable use of a MD, it is essential to assess the needs, the local conditions, and the conditions for its lifelong use. Further evolution of the concept of sustainability is developed towards the possibility of modulating the project’s objective from procuring sustainable MDs to improving the sustainability of the health services by procuring MDs. Conclusion Sustainable procurement of MDs is a key factor in supporting the sustainable development of health services and health systems toward the SDGs. Post-pandemic investments to strengthen the resilience of health services in developing countries shall consider sustainable procurement, including the essential quality assurance process. This process, led by an expert clinical engineer, shall be centered on the future use of the equipment and not be limited to its quality as a material good.

Evaluating infection prevention and control structure of Indonesian COVID-19 referral hospitals.

This study demonstrates the necessity to improve hospital IPC structures to increase the resilience of health services to natural hazards and public health emergencies.

Resilience services from battery energy storage degradation

Resilience services from battery energy storage degradation

Exploring resilience in public services within marginalised communities during COVID-19: The case of coal mining regions in Colombia

This paper examines the impact of COVID-19 on marginalised communities and its effects on the provision of public services. Focusing on two coal mining regions in Colombia during the pandemic crisis, and examining Indigenous and Afro-Colombian communities, we analyze the provision of public services at a local level, identifying both shortcomings and resilience. Findings show that the lack of resilient public services amplified the effects of COVID-19 and its containment measures, exacerbating existing structural inequalities within local marginalised communities. It also reinforced the control exercised by coal mining companies within local economies. However, the substantial lack of public service provision also provided space for the development and strengthening of several resilience strategies among local communities, such as solidarity networks and schemes and the revitalization of local environmental knowledge. The study identifies multiple shortcomings in how the national and local administrations handled the COVID-19 outbreak and highlights the potential of enhancing resilience in public services to support marginalised communities in times of crisis.

Disparities in disruptions to public drinking water services in Texas communities during Winter Storm Uri 2021

Winter Storm Uri of February 2021 left millions of United States residents without access to reliable, clean domestic water during the COVID19 pandemic. In the state of Texas, over 17 million people served by public drinking water systems were placed under boil water advisories for periods ranging from one day to more than one month. We performed a geospatial analysis that combined public boil water advisory data for Texas with demographic information from the 2010 United States Census to understand the affected public water systems and the populations they served. We also issued a cross-sectional survey to account for people’s lived experiences. Geospatial analysis shows that the duration of boil water advisories depended partly on the size of the public water system. Large, urban public water systems issued advisories of intermediate length (5–7 days) and served racially diverse communities of moderate income. Small, mostly rural public water systems issued some of the longest advisories (20 days or more). Many of these systems served disproportionately White communities of lower income, but some served predominantly non-White, Hispanic, and Latino communities. In survey data, “first-generation” participants (whose parents were not college-educated) were more likely to be placed under boil water advisories, pointing to disparate impacts by socioeconomic group. The survey also revealed large communication gaps between public water utilities and individuals: more than half of all respondents were unsure or confused about whether they were issued a boil water advisory. Our study reinforces the need to improve resilience in public water services for large, diverse, urban communitiesandsmall, rural communities in the United States and to provide a clear and efficient channel for emergency communications between public water service utilities and the communities they serve.

Does ridesourcing respond to unplanned rail disruptions? A natural experiment analysis of mobility resilience and disparity

Urban rail transit networks provide critical access to opportunities and livelihood in many urban systems. Ensuring that these services are resilient (that is, exhibiting efficient responses to and recovery from disruptions) is a key economic and social priority. Increasingly, the ability of urban rail systems to cope with disruptions is a function of a complex patchwork of mobility options, wherein alternative modes can complement and fill occurring service gaps. This study analyzes the role of ridesourcing in providing adaptive mobility capacity that could be leveraged to fill no-notice gaps in rail transit services, addressing the question of distributional impacts of resilience. Using a natural experiment, we systematically identify 28 major transit disruptions over the period of one year in Chicago and match them, both temporally and spatially, with ridesourcing trip data. Using multilevel mixed modeling, we quantify variation in the adaptive use of on-demand mobility across the racially and economically diverse city of Chicago. Our findings show that the gap-filling potential of adaptive ridesourcing during rail transit disruptions is significantly influenced by the station-, community-, and district-level factors. Specifically, greater shifts to ridesourcing occur during weekdays, nonholidays, and more severe disruptions, in community areas that have higher percentages of white residents and transit commuters, and in the more affluent North district of the city. These findings suggest that while ridesourcing appears to provide adaptive capacity during rail disruptions, its benefits do not appear to be equitable for lower-income communities of color that already experience limited mobility options. Research implications for mobility operator collaborations to support mobility as a service are discussed. This study builds a more comprehensive understanding of transit service resilience, variation in vulnerability, and the complementarity of ridesourcing to existing transport networks during disruptions.

Liberia health system's journey to long-term recovery and resilience post-Ebola: a case study of an exemplary multi-year collaboration.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict' Liberia is one of the three countries worst hit by the 2014-2016 West Africa Ebola Virus disease (EVD) outbreak, during which it recorded over 10,000 cases, including health workers. Estimates suggest that the non-EVD morbidity and mortality resulting from the collapse of the health system exceeded the direct impact of EVD. Lessons from the outbreak were clear, not only for Liberia but also for the regional and global communities: that building health system resilience through an integrated approach is an investment in population health and wellbeing, as well as economic security and national development. It is therefore no surprise that Liberia made recovery and resilience a national priority from the time the outbreak waned in 2015. The recovery agenda provided the platform for stakeholders to work toward the restoration of the pre-outbreak baseline of health system functions while aiming to build a higher level of resilience, informed by lessons from the Ebola crises. Based on the co-authors' experiences of on-the-ground country-support work, this study sought to provide an overview of the Liberia Health Service Resilience project (2018-2023) funded by KOICA, and propose a set of recommendations for national authorities and donors, derived from the authors' perceptions of best practices and key challenges associated with the project. We used both quantitative and qualitative approaches to generate the data represented in this study by reviewing published and unpublished technical and operational documents, and datasets derived through situational and needs assessments and routine monitoring and evaluation activities. This project has contributed to the implementation of the Liberia Investment Plan for Building a Resilient Health System and the successful response to the COVID-19 outbreak in Liberia. Although limited in scope, the Health Service Resilience project has demonstrated that health system resilience could be operationalized by applying a catchment and integrated approach and encouraging multi-sectoral collaboration, partnership, local ownership, and promoting the Primary Health Care approach. Principles applied in this pilot could guide the operationalization of health system resilience efforts in other resource-limited settings similar to Liberia and beyond.

Online and reliable SFC protection scheme of distributed cloud network for future IoT application

The implementation of intelligent device-free sensing (IDFS) necessitates a substantial number of edge IoT devices to extend the service coverage. Prior to deploying these IoT applications on a large scale, a reliable service provision scheme is imperative. In recent years, network function virtualization (NFV) technologies enable fast and convenient service provision by instantiating service function chain (SFC) in the distributed cloud network. However, ensuring resilient service provision is a challenge in NFV environment due to the vulnerability of software-defined network functions. Furthermore, the sequential arrangement of virtual network functions (VNFs) in SFC exacerbates the situation, as the malfunction of any VNFs within the SFC could result in the collapse of the associated service. In this paper, we firstly built a mathematical model for SFC online reliability protection and resource consumption optimization. We then propose a multi-mode VNF backup scheme to guarantee the different reliability requirements for various services. Furthermore, a novel SFC Online Reliability Protection (SORP) scheme is introduced to handle the dynamic SFC requests in distributed cloud network. The simulation results evince the efficacy of the SORP scheme in mitigating service failures and achieving a superior request acceptance ratio, while concurrently reducing average bandwidth consumption, which is particularly noteworthy in high latency scenarios.

The "Let's Talk about Children" intervention in a Finnish school context: fidelity, parents' experiences, and perceived benefits.

The Let's Talk about Children intervention is a tool for parents and professionals to work together to promote children's positive development, resilience, and psychosocial well-being in social and healthcare services, at school, and in day care. The aim of this study was to evaluate the fidelity, parents' experiences, and perceived benefits of using the Let's Talk about Children intervention in a school context. Participants (N = 65 first-grader parents) completed an online questionnaire after the intervention. The results show that the intervention was delivered as designed and conducted with high fidelity. Parents' experiences of the Let's Talk about Children discussions were positive, parents felt that the atmosphere was good during the discussion, and the participants reported benefits from the intervention. Clinical trial registration:ClinicalTrials.gov, identifier NCT05038280.

Mobility operator service capacity sharing contract design to risk-pool against network disruptions

We propose a new mechanism to design risk-pooling contracts between operators to improve service resilience during disruptions. We formulate a novel two-stage stochastic multicommodity flow model to determine the cost savings of a coalition under different disruption scenarios and solve it using L-shaped method along with sample average approximation. Computational tests are conducted for network instances with up to 1024 scenarios. The proposed model is applied to a regional multi-operator network in the Randstad area of the Netherlands, for four operators, 40 origin-destination pairs, and over 1400 links where disruption data is available. Using the proposed method, we identify stable cost allocations that could yield a 66% improvement in overall network performance over not having any risk-pooling contract in place. We illustrate the sensitivity of the HTM operator's bargaining power to different network structures and disruption scenarios.

Patient and public co-creation of healthcare safety and healthcare system resilience: The case of COVID-19.

Healthcare system resilience is a conceptual approach that seeks to explore how health services adapt and respond to variability in demand and resources. As has been witnessed since the beginning of the COVID-19 pandemic, healthcare services have undergone many reconfigurations. One understudied aspect of how the 'system' is able to adapt and respond is the contribution of key stakeholders-patients and families, and in the context of the pandemic, the general public as a whole. This study aimed to understand what people were doing during the first wave of the pandemic to protect the safety of their health, and the health of others from COVID-19, and the resilience of the healthcare system. Social media (Twitter) was used as a method of recruitment due to its ability for social reach. Twenty-one participants took part in 57 semistructured interviews over three time points from June to September 2020. The included an initial interview and invitation to two follow-up interviews after 3 and 6 weeks. Interviews were conducted virtually using Zoom-an encrypted secure video conferencing software. A reflexive thematic analysis approach to analysis was used. Three themes, each with its own subthemes were identified in the analysis: (1) A 'new safety normal'; (2) Existing vulnerabilities and heightened safetyand (3) Are we all in this together? This study found that the public had a role in supporting the resilience of healthcare services and systems during the first wave of the pandemic by adapting their behaviour to protect themselves and others, and to avoid overwhelming the National Health Service. People who had existing vulnerabilities were more likely to experience safety gaps in their care, and be required to step in to support their safety, despite it being more difficult for them to do so. It may be that the most vulnerable were previously required to do this extra work to support the safety of their care and that the pandemic has just illuminated this issue. Future research should explore existing vulnerabilities and inequalities, and the heightened safety consequences created by the pandemic. The National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC), Patient and Public Involvement and EngagementResearch Fellowand NIHR Yorkshire and Humber PSTRC Patient Involvement in Patient Safety theme lay leader are involved in the preparation of a lay version of the findings within this manuscript.

Evaluating remnant vegetation management practices adjacent to apple orchards to support native bee pollinators

SummaryMaintenance of a diverse pollinator community helps ensure resilience in pollination services. Fragments of woody and grassy vegetation in the vicinity of croplands have been shown to encourage the presence of crop‐pollinating bees. However, to date, little attention has been given to the management practices that may enhance the presence of bees in such fragments. We investigated how the maintenance of remnant forest fragments adjacent to apple orchards in South Australia affects floral resources and native bee communities. The fragments had been subject to either (a) fire (assessments three years post‐burn), (b) cattle grazing under trees and (c) low maintenance management (>20 years not grazed or burnt). Plant communities were sampled along transects in plots. Bee communities were sampled using hand netting. We fitted generalised linear mixed models to investigate differences in plant and bee diversity between treatments and to elucidate the effect of plant diversity on bee diversity. We compared plant and bee community composition among treatments using non‐metric multidimensional scaling and conducted network analysis to measure the robustness of plant‐pollinator interactions to the removal of species. Both floral resource abundance and bee diversity were higher in burnt and low‐maintenance fragments than in grazed fragments. Bee species richness was positively associated with plant species richness. The species richness of bees that visit apple flowers was positively associated with flower abundance but not with floral species richness. Plant‐pollinator networks in grazed sites had fewer links per species and a higher proportion of realised links than those under other management practices. However, the resilience of pollinator networks did not differ significantly between management practices. Thus, controlled burns or low‐maintenance management of forest fragments appear to be the most suitable landscape management practices to support apple pollinating bees. Burning requires consideration of additional ecological consequences, such as the conservation of fire‐sensitive species and specialist woodland fauna. Cattle grazing adjacent to orchards results in simplified bee communities and pollination networks and is not recommended if pollination services are required for adjacent land uses. This information can benefit orchardist as well as managers of fragments of native vegetation adjacent to orchard crops.

The resiliency of noncommunicable diseases services during the public health crisis: a lesson from Bangkok, Thailand

BackgroundThe healthcare services for non-communicable diseases (NCD) are commonly affected by public health crises like the COVID-19 pandemic. During the pandemic, all healthcare facilities in Bangkok had been overwhelmed by the extreme caseload of COVID-19. Health service resiliency is crucial for the continued service of healthcare facilities post pandemic. This study aims to explore the impacts of COVID-19 on NCD service disruption and addressed the resilience of healthcare services at the operational level.MethodsHealthcare facility-based surveys and in-depth interviews were conducted among representatives of the facilities in Bangkok from April 2021 to July 2021. The web-based, self-administered questionnaire, was sent to directors or authorities of all healthcare facilities in Bangkok Thailand (n = 169). Two healthcare facilities from three levels of health services were purposively selected. The directors or medical doctors and nurses who are in charge of the NCD service, and working at the six selected health facilities, were invited to participate in the in-depth interviews. Descriptive statistics were used to analyze the survey data, and thematic analysis was used to analyze the data from the in-depth interviews.ResultsThe impact of COVID-19 on NCD service disruption in the second wave (2021) was more severe than in the first wave (2020). The main reasons for NCD service disruptions are insufficient staff, and the closure of some services offered by the healthcare facilities. Surprisingly, both the budget and medical supply for healthcare facilities in Bangkok are less affected by the COVID-19 pandemic. Our study revealed resilience capability i.e. absorptive, adaptive, and transformative capabilityamong the healthcare facilities that provide a continuum of care by increasing availability and accessibility to healthcare services for chronic illness as DM. The service disruption in Bangkok may alter from other provinces because of variations in COVID-19 incidence and health services contexts.ConclusionDuring the public health crisis, using affordable and common digital technologies to ensure DM patients can access a continuum of care and providing alternative services such as mobile medical laboratories, medication delivery, and medical refill at drug stores can increase consistent monitoring of glycemic levels and use of prescribed medication.