Community-based response to the COVID-19 pandemic: case study of a home isolation centre using flexible surge capacity.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) has consumed many available resources within contingency plans, necessitating new capacity surges and novel approaches. This study aimed to explore the possibility of implementing the concept of flexible surge capacity to reduce the burden on hospitals by focussing on community resources to develop home isolation centres in Bangkok, Thailand. STUDY DESIGN: A qualitative study consisted of observational and semi-structured interview data. METHODS: The development and activities of home isolation centres were observed, and interviews were conducted with leaders and operational workforces. Data were deductively analysed and categorised based on the practical elements necessary in disaster and emergency management. RESULTS: Data were categorised into the seven collaborative elements of the major incident medical management and support model. The command-and-control category demonstrated four subcategories: (1) coordination and collaboration; (2) staff engagement; (3) responsibility clarification; and (4) sustainability. Safety presented two subcategories: (1) patients' information privacy and treatment; and (2) personnel safety and privacy. Communication showed internal and external communications subcategories. Assessment, triage, treatment and transport followed the processes of the COVID-19 treatment protocols according to the World Health Organisation (WHO) guidelines and hospital operations. Several supply- and patient-related challenges were identified and managed during centre development. CONCLUSIONS: The use of community resources, based on the flexible surge capacity concept, is feasible under restricted circumstances and reduced the burden on hospitals during the COVID-19 pandemic. Continuous education among multidisciplinary volunteer teams facilitated their full participation and engagement. The concept of flexible surge capacity may promote an alternative community-based care opportunity, irrespective of emergencies' aetiology.

Traumatic work related mortality among seafarers employed in British merchant shipping, 1976-2002.

AIMS: To establish the causes and circumstances of all traumatic work related deaths among seafarers who were employed in British merchant shipping from 1976 to 2002, and to assess whether seafaring is still a hazardous occupation as well as a high risk occupation for suicide. METHODS: A longitudinal study of occupational mortality, based on official mortality files, with a population of 1,136,427 seafarer-years at risk. RESULTS: Of 835 traumatic work related deaths, 564 were caused by accidents, 55 by suicide, 17 by homicide, and 14 by drug or alcohol poisoning. The circumstances in which the other 185 deaths occurred, including 178 seafarers who disappeared at sea or were found drowned, were undetermined. The mortality rate for 530 fatal accidents that occurred at the workplace from 1976 to 2002, 46.6 per 100,000 seafarer-years, was 27.8 times higher than in the general workforce in Great Britain during the same time period. The fatal accident rate declined sharply since the 1970s, but the relative risk of a fatal accident was 16.0 in 1996-2002. There was no reduction in the suicide rate, which was comparable to that in most high risk occupations in Britain, from 1976 to 1995; but a decline since 1995. CONCLUSIONS: Although there was a large decline in the fatal accident rate in British shipping, compared to the general workforce, seafaring has remained a hazardous occupation. Further prevention should focus on improvements in safety awareness among seafarers and shipping companies, reductions in hazardous working practices, and improvements in care for seafarers at risk of suicide.

Evidence for rhythms of mitotic activity in normal and adenocarcinoma cells of the renal tubules of Rana pipiens.

Kidneys were studied from 1,111 leopard frogs (Rana pipiens) after exposures to a 12-hour light-12-hour dark environment. Circadian mitotic rhythms were observed in cells of normal and spontaneous adenocarcinomatous proximal convoluted tubules from these animals. Student's t-tests verified the existence of two distinct cell populations, normal and adenocarcinomatous, in the proximal tubules. Both the mitotic variations and the t-test values were significant with P values of 0.05 or less. Mean mitotic values for the normal and spontaneous adenocarcinomatous proximal tubule epithelia were generally lower during the light-phase and higher during the dark-phase periods of the control day. The mitotic rhythm of the cancerous epithelium was almost always superimposable in outline over that of the normal epithelium during the same experimental period; i.e., the correspondence of phases of the normal and cancerous mitoses was almost identical in a single graph, although the amplitude of the cancerous mitoses was always higher. In addition to the reproducible circadian rhythms, the data demonstrated evidence for the existence of ultradian, as well as circannual rhythms.