Adaptive Manufacturing for Healthcare During the COVID-19 Emergency and Beyond.

During the COVID-19 pandemic, global health services have faced unprecedented demands. Many key workers in health and social care have experienced crippling shortages of personal protective equipment, and clinical engineers in hospitals have been severely stretched due to insufficient supplies of medical devices and equipment. Many engineers who normally work in other sectors have been redeployed to address the crisis, and they have rapidly improvised solutions to some of the challenges that emerged, using a combination of low-tech and cutting-edge methods. Much publicity has been given to efforts to design new ventilator systems and the production of 3D-printed face shields, but many other devices and systems have been developed or explored. This paper presents a description of efforts to reverse engineer or redesign critical parts, specifically a manifold for an anaesthesia station, a leak port, plasticware for COVID-19 testing, and a syringe pump lock box. The insights obtained from these projects were used to develop a product lifecycle management system based on Aras Innovator, which could with further work be deployed to facilitate future rapid response manufacturing of bespoke hardware for healthcare. The lessons learned could inform plans to exploit distributed manufacturing to secure back-up supply chains for future emergency situations. If applied generally, the concept of distributed manufacturing could give rise to "21st century cottage industries" or "nanofactories," where high-tech goods are produced locally in small batches.

Implementing powered stretcher and load systems was a cost effective intervention to reduce the incidence rates of stretcher related injuries in a paramedic service.

Paramedic services are considering moving towards the use of powered stretcher and load systems to reduce stretcher related injuries, but cost is perceived as a barrier. This study compared injury incidence rates, days lost, and compensation costs between Niagara Emergency Medical Service (NEMS) and Hamilton Paramedic Service (HPS) pre- (four years) and post- (one year) implementation of powered stretcher and load systems in NEMS. Prior to the intervention stretcher related musculoskeletal disorder (MSD) incidence rates averaged 20.0 (±6.8) and 17.9 (±6.4) per 100 full time equivalent (FTE), in NEMS and HPS respectively. One-year post intervention rates decreased to 4.3 per 100 FTE in NEMS, a 78% reduction. Rates modestly increased to 24.6 per 100 FTE in HPS in same period. Cost-benefit analysis estimated that the added cost to purchase powered stretcher and load systems would be recovered within their expected 7-year service life due to the reduction in compensation costs.

Evaluating factors influencing groundwater vulnerability to nitrate pollution: developing the potential of GIS.

The 1991 EU Nitrate Directive was designed to reduce water pollution from agriculturally derived nitrates. England and Wales implemented this Directive by controlling agricultural activities within their most vulnerable areas termed Nitrate Vulnerable Zones. These were designated by identifying drinking water catchments (surface and groundwater), at risk from nitrate pollution. However, this method contravened the Nitrate Directive because it only protected drinking water and not all waters. In this paper, a GIS was used to identify all areas of groundwater vulnerable to nitrate pollution. This was achieved by constructing a model containing data on four characteristics: the quality of the water leaving the root zone of a piece of land; soil information; presence of low permeability superficial (drift) material; and aquifer properties. These were combined in a GIS and the various combinations converted into a measure of vulnerability using expert knowledge. Several model variants were produced using different estimates of the quality of the water leaving the root zone and contrasting methods of weighting the input data. When the final models were assessed all produced similar spatial patterns and, when verified by comparison with trend data derived from monitored nitrate concentrations, all the models were statistically significant predictors of groundwater nitrate concentrations. The best predictive model contained a model of nitrate leaching but no land use information, implying that changes in land use will not affect designations based upon this model. The relationship between nitrate levels and borehole intake depths was investigated since there was concern that the observed contrasts in nitrate levels between vulnerability categories might be reflecting differences in borehole intake depths and not actual vulnerability. However, this was not found to be statistically important. Our preferred model provides the basis for developing a new set of groundwater Nitrate Vulnerable Zones that should help England and Wales to comply with the EU Nitrate Directive.

Rapid carbohydrate loading after a short bout of near maximal-intensity exercise.

PURPOSE: One limitation shared by all published carbohydrate-loading regimens is that 2-6 d are required for the attainment of supranormal muscle glycogen levels. Because high rates of glycogen resynthesis are reported during recovery from exercise of near-maximal intensity and that these rates could in theory allow muscle to attain supranormal glycogen levels in less than 24 h, the purpose of this study was to examine whether a combination of a short bout of high-intensity exercise with 1 d of a high-carbohydrate intake offers the basis for an improved carbohydrate-loading regimen. METHODS: Seven endurance-trained athletes cycled for 150 s at 130% VO2peak followed by 30 s of all-out cycling. During the following 24 h, each subject was asked to ingest 12 g.kg-1 of lean body mass (the equivalent of 10.3 g.kg-1 body mass) of high-carbohydrate foods with a high glycemic index. RESULTS: Muscle glycogen increased from preloading levels (+/- SE) of 109.1 +/- 8.2 to 198.2 +/- 13.1 mmol.kg-1 wet weight within only 24 h, these levels being comparable to or higher than those reported by others over a 2- to 6-d regimen. Densitometric analysis of muscle sections stained with periodic acid-Schiff not only corroborated these findings but also indicated that after 24 h of high-carbohydrate intake, glycogen stores reached similar levels in Type I, IIa, and IIb muscle fibers. CONCLUSION: This study shows that a combination of a short-term bout of high-intensity exercise followed by a high-carbohydrate intake enables athletes to attain supranormal muscle glycogen levels within only 24 h.