Urgent Requests Research Articles

Telephone counselling in coping with the COVID-19 lockdown consequences: preliminary data.

The direct and indirect stressful effects of COVID-19 lockdown measures adopted to restrict population movements to help curb the epidemic impacted on people’s daily lives. Biella is a small Northern Italy province, historically characterized by the presence of an important and once flourishing textile industry. For decades this province has had suicide rates higher than the Piedmonts and Italian average. In two most recent decades a positive correlation between financial stressors, 2008 economic crisis related, and suicide has been found. As the current economic crisis COVID-19 related is expected to exacerbate again the vulnerability to suicide of this province, during the first lockdown the Crisis Center for Suicide Prevention of Biella set up a telephone counselling service. We aimed to evaluate whether it represented a suitable and useful tool for suicidal crisis prevention. Each phone intervention consisted of four phases: (i) psychoeducation, (ii) emotional stabilization, (iii) personal resources identification/reinforcement, (iv) session ending. This service provided a rapid therapeutic response to urgent requests for care, psychological support, and reassurance. It was able to mitigate stress and reinforce resilience in particularly vulnerable populations. The most innovative element of this project was that it proposed interventions for the emotional stabilization, something that is usually used in face-to-face sessions. Using the right protocols, it proved to offer continuity care and reduce pressure on hospital emergency departments while delivering good outcomes and patient satisfaction. Therefore, the COVID-19 pandemic provided an opportunity to overcome normative, technological, and cultural barriers regarding the use of remote healthcare services.

Ukrainian

Electronic registry systems, established in many European countries, have long proven their eff ectiveness in various areas of the functioning of the state and separate fi rms and in improving the interaction of the population with government and private organizations. Population registers have a special place in the systems of registers. Th ey provide comprehensive and complete personal information, while saving time and eff ort in solving urgent problems, requests and requirements related to health, education, property, employment, pensions, social assistance, etc. Population registers have also proven their eff ectiveness in recent rounds of population and housing censuses. Northern European countries are pioneers in the creation and use of population register systems. Th e relevance of the article for Ukraine is due to: the active development of various registers, which, however, interact poorly with each other and do not constitute a holistic system; the need to take into account the experience of advanced countries in creating a full-fl edged system of registers. Th e purpose of the article is to summarize the experience of northern European countries in the creation and operation of register systems and to determine the role of the central population register as one of the basic registers. Th e novelty of the article lies in a generalized and comparative analysis of the register systems of the Nordic countries, a study of the role of the central population register and other basic and specialized registers as providers of information about the population. Research methods: systems analysis, scientifi c generalization, comparative analysis, methods of research of complex systems. Th e article investigates the general aspects of the creation and use of population registers in Northern Europe. A characteristic feature of northern European countries, in contrast to Ukraine, is the systematic in creation of separate registers, when a certain administrative register immediately determines the place in the general system and the relationship with other, primarily basic, registers. Th e example of two of the most advanced countries in this issue - Denmark and Norway — analyzes the measures to create systems of personal identifi cation numbers and the practice of using these numbers in registry systems. Examples of subsystems of health and education registers, as well as some other registers containing personalized information, are given. Based on the experience of northern European countries, proposals are formulated to create a real functioning system of registers in Ukraine.

Assistance for people with diabetes mellitus during the COVID-19 pandemic. The experience of the TO3 Local Health Care Service in Piedmont

People with diabetes with coronavirus infection have a high likelihood of progression to severe COVID-19. The pandemic has upset our health model; the booking suspension limited access to emergencies, made it difficult to guarantee medical services, with different access priorities, to assist chronic patients, such as diabetics, for whom discontinuity of care could become a risk for and in case of infection. In ASLTO3 we have developed an emergency procedure, in compliance with the lockdown provisions to limit the presence in the clinic, for the provision of services, in presence or at a distance, to people with diabetes blocked at home, or in isolation, hospitalized or quarantined, or to be hospitalized. We have developed a strategy based on the diabetes care pathway PDTA, standard of care in Piedmont, to stratify the risk of loss of access to services and to prepare organizational measures to select, case by case, the relative and deferred urgent requests, direct on the right location for the right answer giving priority to those who still did not know or already knew they had diabetes, even positive for COVID-19, and needed treatment, and uses dedicated telephone lines and e-mails, for a virtual clinic. During the first peak of the pandemic, we assisted over 4000 people with diabetes by providing 7598 services, 244 for endocrinology, 7199 for diabetes, 155 consultations, 431 face-to-face and over 5,000 remotes. Studies produced during the COVID-19 emergency have confirmed that the active resilience of the diabetes care service can help improve patient outcomes and system stability. Experience in the implementation of technologies, such as diabetes PDTA, adapted to the emergency, can help to triage both persons, activities, prevention and assistance, and telemedicine projects to minimize the risk in future events. KEY WORDS pandemic COVID-19; diabetes care pathway; medical services; triage patient; telemedicine.

COVID-19 Needs Assessment and Support for Primary Care Practices in Western North Carolina.

It is critical to ensure that Primary Care Providers (PCPs) have adequate personal protective equipment (PPE), supplies, training, staffing, and contingency planning during pandemics, particularly in rural areas. In March 2020, during the onset of the COVID-19 pandemic, the Mountain Area Health Education Center (MAHEC), in collaboration with the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill, rapidly created and conducted a needs assessment of PCPs in western North Carolina (WNC). A group of twenty volunteers conducted a telephone survey of PCPs in a 16 county region of WNC. Practices were asked about their COVID-19 testing and telehealth offerings, PPE adequacy, and capacity to continue serving patients. The survey's emergency alert feature linked practices to immediate support. Descriptive data were generated to identify regional needs. Out of 110 practices, 48 (43.6%) offered COVID-19 testing, with testing more common in rural counties (56.3% vs 33.9%). Telehealth services, including phone-only visits, were offered by almost all practices (91.8%). PPE needs included N-95 respirators (49.1%), face shields (45.5%), and staff gowns (38.2%). Rural practices were more likely to report the need for PPE. Assistance was requested for staff member childcare (34.5%) and providing or billing for telehealth (31.8%). The most urgent practice requests were related to finances, PPE, and telehealth. MAHEC's Practice Support team linked practices to virtual coaching, tip sheets, case-based video didactics and communication forums, and newsletters. During a pandemic, it is crucial to ensure that PCPs can continue to serve their patients. A rapid needs assessment of PCPs can allow for immediate and ongoing support that matches regional and practice-specific needs. Rural practices may require more assistance than their urban counterparts. Our rapid survey process jumpstarted a statewide system for enhanced communications with PCPs to better prepare for future emergencies.

Unlocking Multiphysics Design Guidelines on Si/C Composite Nanostructures for Next Generation High-Energy-Density and Robust Lithium-Ion Battery Anode

Lithium ion batteries (LIBs) have been one of the most popular energy storage devices in many fields. Along with the development of the LIBs, high energy density becomes one of the most urgent requests in the market. To achieve this goal, high capacity anode materials are attracting more and more research interests, among which the Si related material is one of the most promising candidates for next generation LIBs. The biggest problem of Si related materials is the tremendous volume change during the cycling. Thus, many strategies have been proposed to solve this problem, e.g. nano engineering, composites, etc. The Si/C composite material, is widely adopted because it has the advantage of nanomaterials as well as compensates the weakness of nano-properties. Current material fabrication guidance for novel designs of Si/C composite particle materials for anode only focuses on electrochemical behavior and redox reactions at the nano/micro level; however, they cannot provide detailed information for predicting mechanical deformations of the composite particles especially coupled with electrochemical and thermal fields. Herein, an electro-chemo-mechanical model is established and implemented to quantitatively analyze the multiphysics behavior of five representative Si/C composite nanostructures. Numerical simulation manifests that yolk-shell and dual-shell structures are more robust in terms of particle fractures. With the consideration of electrochemical performance, the yolk-shell structure is the most excellent type among the compared five Si/C composites. Finally, design guidance is mapped to further illustrate quantitative structure-property relations. This study provides novel insights on Si/C composite nanostructure anode material design and further powerful design tools for next-generation high-energy-density lithium-ion batteries.

A cloud priority-based dynamic online double auction mechanism (PB-DODAM)

Double auctions are considered to be effective price-scheduling mechanisms to resolve cloud resource allocation and service pricing problems. Most of the classical double auction models use price-based mechanisms in which determination of the winner is based on the prices offered by the agents in the market. In cloud ecosystems, the services offered by cloud service providers are inherently time-constrained and if they are not sold, the allocated resources for the unsold services are wasted. Furthermore, cloud service users have time constraints to complete their tasks, otherwise, they would not need to request these services. These features, perishability and time-criticality, have not received much attention in most classical double auction models. In this paper, we propose a cloud priority-based dynamic online double auction mechanism (PB-DODAM), which is aligned with the dynamic nature of cloud supply and demand and the agents’ time constraints. In PB-DODAM, a heuristic algorithm which prioritizes the agents’ asks and bids based on their overall condition and time constraints for resource allocation and price-scheduling mechanisms is proposed. The proposed mechanism drastically increases resource allocation and traders’ profits in both low-risk and high-risk market conditions by raising the matching rate. Moreover, the proposed mechanism calculates the precise defer time to wait for any urgent or high-priority request without sacrificing the achieved performance in resource allocation and traders’ profits. Based on experimental results in different scenarios, the proposed mechanism outperforms the classical price-based online double auctions in terms of resource allocation efficiency and traders’ profits while fulfilling the double auction’s truthfulness pillar.

Development of a Quality Indicator to Measure Urgent Requests to the Bedside

ObjectiveTo develop a quality indicator describing the response time to an urgent request for a physician to the bedside of a pregnant or postpartum woman and to identify opportunities for improvement in care timeliness for women with worsening serious clinical conditions. DesignEvidence-based quality improvement project using the Iowa Model–Revised framework to develop a maternal care quality indicator. SettingLabor and delivery, antepartum, and mother/baby units in a large urban safety-net hospital preparing for a state level of maternal care designation survey. ParticipantsAll nurses and physicians caring for hospitalized pregnant and postpartum women participated in implementation. Intervention/MeasurementsPhysician response time was measured as the elapsed time from a nurse’s urgent request for a physician and the presence of a physician at the bedside of a woman in one of the identified units, as recorded in the electronic health record. ResultsPhysician response time to an urgent request to the bedside was documented 179 times during the first 3 months after implementation. Physician presence at the bedside within 30 minutes of a request was recorded in more than 99% of these events. ConclusionPhysicians’ responses to early warning signs within our facility were timely and within the parameters established by the Texas state-mandated criteria for a Level IV maternal care hospital. Response time as documented in the electronic health record provides an important quality indicator of maternal care in the inpatient setting.

A QuESt for speed: rapid qualitative evidence syntheses as a response to the COVID-19 pandemic

BackgroundThe COVID-19 pandemic has created a sense of urgency in the research community in their bid to contribute to the evidence required for healthcare policy decisions. With such urgency, researchers experience methodological challenges to maintain the rigour and transparency of their work. With this in mind, we offer reflections on our recent experience of undertaking a rapid Cochrane qualitative evidence synthesis (QES).MethodsThis process paper, using a reflexive approach, describes a rapid QES prepared during, and in response to, the COVID-19 pandemic.FindingsThis paper reports the methodological decisions we made and the process we undertook. We place our decisions in the context of guidance offered in relation to rapid reviews and previously conducted QESs. We highlight some of the challenges we encountered in finding the balance between the time needed for thoughtfulness and comprehensiveness whilst providing a rapid response to an urgent request for evidence.ConclusionThe need for more guidance on rapid QES remains, but such guidance needs to be based on actual worked examples and case studies. This paper and the reflections offered may provide a useful framework for others to use and further develop.

Evaluation of the Performance and Resource Needs of a Construction Infection Prevention and Control Program

Background: The University Health Network (UHN) is a multisite, academic health sciences center in Toronto, Canada, with 1,300 inpatient beds and ∼126,000 emergency department visits annually. Clinical services include a transplant program, cancer center, dialysis units, and rehabilitation sites. Currently, ∼0.83 km2 (>9 million ft2) of UHN real estate, ∼200 construction, renovation and maintenance projects are underway. The UHN Construction Infection Control Program (CICP) was created in 2012 and has expanded to include 3.5 FTEs to meet the needs of infection prevention oversight during these activities. We describe the performance indicators for the UHN CICP between May 2016 and December 2018 that have informed productivity and resource needs. Methods: Since 2016, construction infection preventionists (CIPs) have prospectively collected data on the frequency of activities reflecting CIP productivity and core job functions: number of meetings (attended and missed), site inspections, responses to breaches in control measures, education hours delivered, urgent requests, and after-hours work. Annual activity rates (frequency of activity divided by CIP months) were analyzed for trends, accounting for additions in CICP personnel over time. Results: Human resources and activities performed in the CICP from 2016 to 2018 are outlined in Table 1. As CICP human resources increased, the number of initiatives supported by the CICP team rose. Activity rates for attended meetings, inspections and hours of education provided increased with higher CIP resources, suggesting an improvement in individual productivity of each CIP (Fig. 1). Concurrently, the rate of missed meetings declined and after-hour requests and breach responses remained stable. Conclusions: An appropriately staffed CICP for the volume and risk level of organization-wide construction, renovation, and maintenance activities is crucial to infection prevention. We developed performance indicators based upon key functions of CIPs to evaluate the productivity of our team and ensure we had adequate human resources to maintain patient safety through our evolving needs.Funding: NoneDisclosures: Susy Hota reports contract research for Finch Therapeutics.

Evaluation and cost estimation of laboratory tests overuse through a CCDSS in a university hospital

Abstract Computerized Clinical Decision Support Systems (CCDSS) are information technology-based systems that use specific patient characteristics and combine them with rule-based algorithms. The aim of this study is to conduct a survey to measure and assess the over-utilization rates of laboratory requests and to estimate the monthly cost of inappropriate requests in inpatients of the “Fondazione Policlinico Universitario A. Gemelli IRCCS” Care Units. This observational study is based on the count of rules violations for 43 different types of laboratory tests requested by the Hospital physicians, for a total of 5,716,370 requests, over a continuous period of 20 months (from 1 July 2016 to 28 February 2018). Requests from all the hospital internal departments (except for Emergency, Intensive Care Units and Urgent requests) were monitored. The software intercepted and counted, in silent mode for the operator, all requests and violations for each laboratory test among those identified. During the observation period a mean of 285,819 requests per month were analyzed and 40,462 violations were counted. The global rate of overuse was 15.2% ± 3.0%. The overall difference among sub-groups was significant (p < 0.001). The most inappropriate exams were Alpha Fetoprotein (85.8% ± 30.5%), Chlamydia trachomatis PCR (48.7% ± 8.8%) and Alkaline Phosphatase (20.3% ± 6.5%). All the exams, globally considered, generated an estimated avoidable cost of 1,719,337€ (85,967€ per month) for the hospital. This study reports rates (15.2%) similar to other works. The real impact of inappropriateness is difficult to assess, but the generated costs for patients, hospitals and health systems are certainly high and not negligible. Key messages It would be desirable for international medical communities to produce a complete panel of prescriptive rules for all the most common laboratory exam. That is useful not only to reduce costs, but also to ensure standardization and high-quality care.

Prospects of Advanced Therapy Medicinal Products–Based Therapies in Regenerative Dentistry: Current Status, Comparison with Global Trends in Medicine, and Future Perspectives

IntroductionRegenerative medicine offers innovative approaches to restore damaged tissues on the basis of tissue engineering (TE). Although research on advanced therapy medicinal products (ATMPs) has been very active in recent years, the number of licensed products remains surprisingly low and restricted to the treatment of severe, incurable diseases. MethodsThis paper provides a critical review of current literature on the regulatory, clinical, and commercial status of ATMP-based therapies in the EU and worldwide and the hurdles to overcome for their broader application in Regenerative Dentistry. ResultsCompetent authorities have focused on developing regulatory pathways to address unmet patient needs. Oncology represents the dominating field, followed by cardiovascular, musculoskeletal, neurodegenerative, immunologic, and inherited diseases. Yet, the status remains in early development, and scientific, regulatory, and cost-effectiveness issues impose considerable hurdles toward marketing authorization, technology adoption, and patient accessibility. In this context, although regenerative dentistry has achieved breakthrough innovations in TE of several dental/oral tissues in preclinical models, it has hardly harnessed research progress to integrate innovative regenerative treatments into clinical practice. ConclusionGlobal demographic changes, which demonstrate a steady increase of the aging population, highlight the societal need for the application of ATMP-based therapies in the treatment of noncommunicable diseases (NCDs). Although oral diseases, as an integral part of NCDs, are not life-threatening and largely preventable, they sustain high prevalence, with severe burden on economy and quality of life. In this perspective, the urgent request to ultimately translate draining research in dental TE conducted during the last decades into innovative treatments brought safely and cost-effectively into society at large still holds the stage. This review provides an overview of the regulatory, clinical, and commercial status of ATMP-based therapies in the European Union and worldwide and the hurdles to overcome for their broader application in regenerative dentistry.

Enterovirus Inhibition by Hinged Aromatic Compounds with Polynuclei.

The modern world has no available drugs for the treatment of enteroviruses (EV), which affect millions of people worldwide each year. The EV71 is a major causative disease for hand, foot, and mouth disease; sometimes it is associated with severe central nervous system diseases. Treatment for enteroviral infection is mainly supportive; treatment for aseptic meningitis caused by enteroviruses is also generally symptomatic. Upon the urgent request of new anti-enterovirus drugs, a series of hinged aromatic compounds with polynulei were synthesized through two different chemical pathways. Among these morpholine–furan/thiophene/pyrrole–benzene–pyrazole conjugates, three new agents exhibited inhibitory activity with EC50 = 2.29–6.16 μM toward EV71 strain BrCr in RD cells. Their selectivity index values were reached as high as 33.4. Their structure–activity relationship was deduced that a thiophene derivative with morpholine and trifluorobenzene rings showed the greatest antiviral activity, with EC50 = 2.29 μM.

Approximate Dynamic Programming for Military Medical Evacuation Dispatching Policies

Military medical planners must consider how aerial medical evacuation (MEDEVAC) assets will be dispatched when preparing for and supporting high-intensity combat operations. The dispatching authority seeks to dispatch MEDEVAC assets to prioritized requests for service, such that battlefield casualties are effectively and efficiently transported to nearby medical-treatment facilities. We formulate and solve a discounted, infinite-horizon Markov decision process (MDP) model of the MEDEVAC dispatching problem. Because the high dimensionality and uncountable state space of our MDP model renders classical dynamic programming solution methods intractable, we instead apply approximate dynamic programming (ADP) solution methods to produce high-quality dispatching policies relative to the currently practiced closest-available dispatching policy. We develop, test, and compare two distinct ADP solution techniques, both of which utilize an approximate policy iteration (API) algorithmic framework. The first algorithm uses least-squares temporal differences (LSTD) learning for policy evaluation, whereas the second algorithm uses neural network (NN) learning. We construct a notional, yet representative planning scenario based on high-intensity combat operations in southern Azerbaijan to demonstrate the applicability of our MDP model and to compare the efficacies of our proposed ADP solution techniques. We generate 30 problem instances via a designed experiment to examine how selected problem features and algorithmic features affect the quality of solutions attained by our ADP policies. Results show that the respective policies determined by the NN-API and LSTD-API algorithms significantly outperform the closest-available benchmark policies in 27 (90%) and 24 (80%) of the problem instances examined. Moreover, the NN-API policies significantly outperform the LSTD-API policies in each of the problem instances examined. Compared with the closest-available policy for the baseline problem instance, the NN-API policy decreases the average response time of important urgent (i.e., life-threatening) requests by 39 minutes. These research models, methodologies, and results inform the implementation and modification of current and future MEDEVAC tactics, techniques, and procedures, as well as the design and purchase of future aerial MEDEVAC assets.

THE APPLICATION OF LUNG MRI IN CASES OF COVID-19 INFECTION

A new coronavirus infection (COVID-19), which epidemic affected almost all states at the beginning of 2020, is also diagnosed radiologically, including computed tomography (CT), which is considered to be the gold standard for this. The lack of awareness among doctors and patients in a number of regions of Russia about the radiology use, need and appropriateness in this infection has led to unreasonable, overly frequent prescribing of chest CT by clinicians, as well as an increase in the chest CT ordering at the urgent request of the patients themselves, despite attempts of radiologists to convince those and others that, most often, this technique is not needed, as not affecting the observation and treatment strategy. The overload of CT units resulting from this has led to its limited availability, which, in addition, can also occur when CT devices get out of order. This publication is dedicated to our experience with magnetic resonance imaging (MRI) for the diagnosis of viral pneumonia. Changes detected on MRI are similar to those visible on CT, it is possible to detect a sign of «ground glass opacity», consolidations, reverse halo sign, fluid in the pleural cavity, air bronchography with an accuracy not less than that of CT, especially if the size of the pathological changes exceeds 1 cm. In addition, MRI allows the differential diagnosis of viral pneumonia and other clinical situations able to simulate it, such as a bron chogenic tumors with retro obstructive pneumonitis, exudative pleurisy, bacterial pneumonia, and bacterial infection inside the viral pneumonia. Given the inaccessibility of CT and/or radiation exposure conserns, MRI can serve as a fairly reliable alternative method for viral pneumonia and other pathological conditions with a nonspecific clinical picture radiological diagnosis and differential diagnosis, provided that anti-epidemic measures are observed and there are no absolute contraindications for MRI.

Numerical simulation and optimization study of the complex fracture network in naturally fractured reservoirs

Multi-fractured horizontal wells are widely used for unconventional reservoir development since the hydraulic fracture (HF) could stimulate natural fractures (NF) to form a complex fracture network (CFN), which will significantly increase the productivity. So accurately characterizing and optimally designing the fracture network configuration are essential to unconventional reservoir development. Facing this urgent request, a numerical study for the complex fracture network is proposed. The displacement discontinuity method (DDM), together with the fluid flow function, is adopted to simulate the HF dynamic propagation which couples the rock and fluid mechanics. A power-law function is adopted to describe the distribution of natural fractures. Then a fracture crossing criterion is used to determine the interaction of HF and NF to simulate the CFN configuration. Based on the CFN numerical model, the effects of different operational and geological parameters, such as the HF spacing and various NF distribution fields, are investigated. Furthermore, a CFN optimization framework is established to achieve the optimal design of CFN under complex geological conditions, in which a clustering-loop method together with a whale optimization algorithm (WOA) is employed to maintain the accuracy while reducing the calculation time. Multiple CFN placement methods are simulated and optimized and the optimal CFN under a complex naturally fractured reservoir is finally obtained. This numerical simulation and optimization approach makes an effort to the study of CFN configuration and unconventional reservoir development.

Signalling cost‐aware routing for green networks

Owing to the environmental impact and potential economic benefits, there is an urgent request for green techniques to reduce energy consumption in telecommunication networks. However, green approaches impose signalling overhead on the network. While most research works in the literature focus on minimisation of energy consumption in green networks, the signalling overhead has largely been unexplored. In this work, the authors tackle the trade-off between energy efficiency and signalling overhead in green routing by formulating an optimisation problem as an integer linear programme (ILP). Their ILP problem minimises signalling overhead with a constraint on the total power consumption of the network. Moreover, their problem introduces the multipath routing feature and takes the flow table sizes of the forwarding devices into account. They prove that the proposed green routing problem is nondeterministic polynomial (NP)-hard and thus propose a polynomial-time heuristic algorithm in addition to analysing its time complexity. They evaluate the performance of the heuristic algorithm by comparing its results with those generated by ILP.

Audit of CT head request appropriateness for patients referred from emergency department

Introduction: Considering the usefulness and relative ease of Computerized Tomography (CT) based diagnosis, the propensity to request it in the Emergency Room setting when at times it is not really indicated can become an issue.
 Objective: To audit use of CT imaging in the emergency department of Rehman Medical Institute by evaluating the clinical practice for CT referral and compliance with clinical guidelines by NICE (National Institute for Health and Care Excellence).
 Materials & Methods: This study was conducted at Radiology Department of Rehman Medical institute Peshawar in Oct-Dec 2019 on 100 patients referred for computed tomography (CT) head scans from the emergency department (ED), mostly performed outside normal working hours. Clinical record and CT reports of patients who had their CT head scans done between 1 January 2018 and September 2019 were reviewed. The imaging record of included patients was reproduced from the Picture Archiving and Communication system (PACS) and laboratory data were reviewed through the Hospital Management Information System (HMIS). Clinical details were reviewed to assess risk factors satisfying NICE criteria for a CT scan in those with head injuries. An urgent CT head scan request was deemed appropriate if it led to an immediate change in patient management. Appropriateness of the requests according to the various guidelines was also evaluated. The NICE guideline 176 was used as a standard of care. Data were entered and analyzed using Microsoft Excel.
 Results: For suspected brain injuries at least one of the NICE criteria was fulfilled by 84 patients, and 3 or more criteria by 16 patients with a history of head injury; 81% scans were both requested and performed in afternoon and night (between 1700 hrs and 0800 hrs). Most (70) patients were males; ages of patients were from 1- 90 years, most being 51-60 years. Most common presenting complaint was altered consciousness (85%); 51% of the advised CT scans were reported normal, 10% had skull fractures (base 2%, vault 8%), 13% extra-axial hemorrhages, 7% contusions, 7% only scalp hematoma, 6% intracerebral hemorrhages. 2% had infarcts and 2% were cerebral abscesses. Common change in patient management included intracranial bleed requiring urgent neurosurgical intervention and hemorrhagic stroke being ruled out. CT head scans also facilitated early discharge of the patients with head injuries and headache from the hospital.
 Conclusion: All (100%) patients had CT head in compliance with NICE guidelines and 81% of these were performed in off hours.
 Keywords: Head; Tomography; Craniocerebral Trauma.

Online University Teaching During and After the Covid-19 Crisis: Refocusing Teacher Presence and Learning Activity

The Covid-19 pandemic has raised significant challenges for the higher education community worldwide. A particular challenge has been the urgent and unexpected request for previously face-to-face university courses to be taught online. Online teaching and learning imply a certain pedagogical content knowledge (PCK), mainly related to designing and organising for better learning experiences and creating distinctive learning environments, with the help of digital technologies. With this article, we provide some expert insights into this online-learning-related PCK, with the goal of helping non-expert university teachers (i.e. those who have little experience with online learning) to navigate in these challenging times. Our findings point at the design of learning activities with certain characteristics, the combination of three types of presence (social, cognitive and facilitatory) and the need for adapting assessment to the new learning requirements. We end with a reflection on how responding to a crisis (as best we can) may precipitate enhanced teaching and learning practices in the postdigital era.

A periodic optimization approach to dynamic pickup and delivery problems with time windows

In dynamic pickup and delivery problems with time windows (PDPTWs), potentially urgent request information is released over time. This gradual data availability means the decision-making process must be continuously repeated. These decisions are therefore likely to deteriorate in quality as new information becomes available. It is still believed that the state of the art for this problem remains far from reaching maturity due to the distinct absence of algorithms and tools for obtaining high-quality solutions within reasonable computational runtimes. This paper proposes a periodic approach to the dynamic PDPTW based on buffering, more specifically a two-step scheduling heuristic which consists of the cheapest insertion followed by a local search. The heuristic’s performance is assessed by comparing its results against those obtained by a mixed integer linear programming model which operates under the assumption that all information is available in advance. Results illustrate how the performance is impacted by urgency levels, the degree of dynamism associated with request arrivals and re-optimization frequency. The findings indicate that increases in dynamism improve solution quality, whereas increases in urgency have the opposite effect. In addition, the proposed approach’s performance is only slightly affected by re-optimization frequency when changing these two characteristics.

Helping others-and myself.

During my first year of grad school, a faculty member asked whether I'd be interested in analyzing data for one of his projects. I enjoyed new computational challenges, so I agreed to do the analyses on top of my normal Ph.D. work. Then, 1 year later, the same faculty member met with me and asked a series of questions posed by reviewers of the paper he had written. I was flustered—I had no idea that a manuscript had even been submitted to a journal—but I answered his questions. Later, though, I got up the courage to drop by his office and find out whether I was listed as a co-author, or even acknowledged, on the manuscript. He said no, acting as though the question itself was inappropriate. The experience led me to rethink my approach to collaborations. > “If you invest time in a project, then you deserve to have your efforts acknowledged.” I started to develop my computational skills when I was working as a pharmacist in Egypt. I had grown tired of my day job, and I was looking for a new challenge. In my spare time, I took online courses that taught me how to write computer code, and I realized that I enjoy programming. Eventually, I decided to quit my pharmacist job and move to the United States, where I started a Ph.D. program in biology. In grad school, I continued to develop my computational skills. Colleagues noticed my expertise and started to ask for help. My dad was always lending a hand to those in need when I was growing up, and he taught me to do the same. So during my first years of grad school, I always said yes when I was asked to assist with data analyses. Once, a fellow grad student came to me with an urgent request. She was leaving for a conference the following week and hadn't analyzed the data for her poster. “Could you help me?” she asked in a desperate tone. Feeling bad for her, I agreed to do some analyses—which took 2 days of my time. My friends often criticized me for saying yes to these requests, pointing out I needed to focus on my own work. They also worried that I was giving people the benefit of my expertise without getting anything substantive, such as authorship or acknowledgment, in return. I understood my friends' concerns. The grad student who needed help with her poster said she'd return the favor someday and buy me a meal, but she never did. And the faculty member I did analyses for never did put my name on his manuscript. In time I realized that although it's OK to lend a helping hand, it's also important to speak up for myself. In the years since, I've made a point of having a conversation about authorship as soon as possible in a collaboration if I'm being asked for a significant contribution to a project. These can be awkward conversations, especially when the collaborator is more senior than I am. But I've learned that they are necessary, because if you invest time in a project, then you deserve to have your efforts acknowledged. These discussions pay off in other ways, too. Ensuring that everyone involved is on the same page alleviates stress during the collaborative process. That frees me to focus on the science, which is the truly fun part. The conversations have also resulted in accomplishments that I could add to my CV. I defended my Ph.D. 3 months ago, and I left grad school as a co-author on 10 manuscripts—with a few more on the horizon. The collaborations I participated in during my time as a Ph.D. student enriched my grad school experience, giving me an opportunity to learn about and contribute to projects apart from my own. I particularly enjoyed helping fellow grad students who were interested in honing their quantitative skills. It was rewarding to see their skills blossom, often to the point where they didn't need my help anymore. But along the way, I learned that in order to maintain my sanity during the collaborative process, I need to be transparent about my expectations. Collaborators can't read my mind, and they may not automatically appreciate how much time it takes to analyze data. So it's my responsibility to tell them.