Covid-19 ICU remote-learning course (CIRLC): Rapid ICU remote training for frontline health professionals during the COVID-19 pandemic in the UK

Background The unprecedented increase in critically ill patients due to the COVID-19 pandemic mandated rapid training in critical care for redeployed staff to work safely in intensive care units (ICU). Methods The COVID-19 ICU Remote-Learning Course (CIRLC) is a remote delivery course developed in response to the pandemic. This was a one-day course focused on the fundamentals of Intensive Care. The course used blended learning with recorded lectures and interactive tutorials delivered by shielding and frontline ICU trained professionals. The course was developed within one week and piloted at three NHS Trusts. It was then made publicly available free of charge to redeployed healthcare professionals across the UK and Ireland. An iterative cycle of improvement was used to update the course content weekly. A course confidence questionnaire with quantitative and qualitative questions was used to evaluate effectiveness. Data is reported as n (%), means (SD) and thematic analysis was used for the open questions. Results 1,269 candidates from 171 organisations completed the course, with 99 volunteer trainers. 96% of respondents rated the course as very or extremely useful. 86% rated the online platform as excellent. Overall confidence improved from 2.7/5 to 3.9/5. Qualitative data showed that the course was pitched at the appropriate level, accessible and built clinicians confidence to work in intensive care. Conclusion This model of educational delivery with a rapid iteration cycle was a pragmatic, effective solution to knowledge-based training under social distancing measures. Whilst full course evaluation was not possible, we believe that this work demonstrates practical guidance on educational response in a pandemic as well as highlighting the altruistic nature of the critical care community.

SYSTEM APPROACH TO INFORMATIONAL SUPPORT OF PHARMACEUTICAL DEVELOPMENT OF FINISHED MEDICINAL PRODUCTS

The article considers the application of the system approach for constructing informational support for the life cycle of the production of medicinal products. The principal difficulties of creating a single informational system of the entire life cycle are considered in this article. A brief analysis of the information and computer support of individual links in the life cycle is given. Particular attention is paid to the use of a systematic approach to the creation of information support for the pharmaceutical development of medicines. The principle of QbD - “Quality planned for development” - was taken as a basis. For the implementation the QbD principle on the basis of the system approach, it is proposed to use the Shewhart-Deming iteration cycle to create an information support for a sustainable search for the optimal version (the program) of the conducted studies. The possibility of combining the PDCA cycle and the methodology of the system approach is shown. On its basis, system-theoretic multiple models of nformation support for pharmaceutical development in the graphic-analytical nomination were constructed. The method of applying the criterial approach for the formation of global and local criteria for managing research and the construction of system management models in the Melentiev’s brackets nomination are presented. The information modeling of the stage of pharmaceutical development has been carried out. Functional models have been constructed in the IDEF0 nomination.

Mechanics-Based Interactive Modeling for Medical Flexible Needle Insertion in Consideration of Nonlinear Factors

A mechanics-based model of flexible needle insertion into soft tissue is presented in this paper. Different from the existing kinematic model, a new model has been established based on the quasi-static principle, which also incorporates the dynamics of needle motions. In order to increase the accuracy of the model, nonlinear characteristics of the flexible needle and the soft tissue are both taken into account. The nonlinear Winkler foundation model and the modified Euler–Bernoulli theory are applied in this study, providing a theoretical framework to study insertion and deformation of needles. Galerkin method and iteration cycle analysis are applied in solving a series of deformation control equations to obtain the needle deflection. The parameters used in the mechanics-based model are obtained from the needle force and needle insertion experiment. Sensitivity studies show that the model can respond reasonably to changes in response to variations in different parameters. A 50 mm needle insertion simulation and a 50 mm corresponding needle insertion experiment are conducted to prove the validity of the model. At last, a study on different needle tip bevel demonstrates that the mechanics-based model can precisely predict the needle deflection when more than one parameter is changed. The solution can also be used in optimizing trajectory of the needle tip, enabling the needle to reach the target without touching important physiological structures such as blood vessels with the help of dynamic trajectory planning.

Self-magnetic field calculations in ray-tracing codes

Beam-generated magnetic fields strongly influence the behavior of relativistic electron guns. Existing methods used in ray-tracing codes have limited accuracy and may not correctly represent nonlaminar beams. We describe a technique for the magnetic field calculation in a two-dimensional code based on the assignment of particle currents to the faces of elements in the mesh used for the electrostatic calculation. The balanced calculation of electric and magnetic forces in the same iteration cycle reduces the possibility of numerical filamentation instabilities. With simple rules of assignment on boundary faces, the method also handles field contributions of electrode currents. Several benchmark calculations performed on conformal meshes illustrate the versatility of the technique.

Fast and accurate inclusion of steam properties in two- and three-dimensional steam turbine flow calculations

The Denton time-marching method for turbomachinery flow calculation has been modified for rapid and accurate access to the properties of steam in equilibrium dry and wet states and in the metastable dry region. Transition between metastable dry and equilibrium wet states is accomplished either at the stable equilibrium boundary or by allowing metastable equilibrium expansion followed by a condensation shock whose location depends on the local degree of subcooling of the metastable vapour and the local expansion rate. Steam properties and their derivatives are obtained from a wide-ranging Helmholtz representation of equilibrium (stable and metastable) thermodynamic properties and stored for use in an accurate Taylor series representation. Comparisons have been made of flow development in a low-pressure steam turbine blade row for three expansion assumptions: equilibrium stable and metastable dry, stable equilibrium, dry and wet, and dry expansion prior to a condensation ‘shock’ which is followed by equilibrium wet expansion. Inclusion of real steam properties extends calculation time for one iteration cycle by about 5 per cent and has little effect on the number of cycles required for convergence in the absence of a condensation shock; however, inclusion of the shock may double the time required for convergence.