BackgroundThe COVID-19 outbreak has placed the National Health Service under significant strain. Social distancing measures were introduced in the UK in March 2020 and virtual consultations (via telephone or video call) were identified as a potential alternative to face-to-face consultations at this time.Local problemThe Royal National Orthopaedic Hospital (RNOH) sees on average 11 200 face-to-face consultations a month. On average 7% of these are delivered virtually via telephone. In response to the COVID-19 crisis, the RNOH set a target of reducing face-to-face consultations to 20% of all outpatient attendances. This report outlines a quality improvement initiative to rapidly implement virtual consultations at the RNOH.MethodsThe COVID-19 Action Team, a multidisciplinary group of healthcare professionals, was assembled to support the implementation of virtual clinics. The Institute for Healthcare Improvement approach to quality improvement was followed using the Plan-Do-Study-Act (PDSA) cycle. A process of enablement, process redesign, delivery support and evaluation were carried out, underpinned by Improvement principles.ResultsFollowing the target of 80% virtual consultations being set, 87% of consultations were delivered virtually during the first 6 weeks. Satisfaction scores were high for virtual consultations (90/100 for patients and 78/100 for clinicians); however, outside of the COVID-19 pandemic, video consultations would be preferred less than 50% of the time. Information to support the future redesign of outpatient services was collected.ConclusionsThis report demonstrates that virtual consultations can be rapidly implemented in response to COVID-19 and that they are largely acceptable. Further initiatives are required to support clinically appropriate and acceptable virtual consultations beyond COVID-19.RegistrationThis project was submitted to the RNOH’s Project Evaluation Panel and was classified as a service evaluation on 12 March 2020 (ref: SE20.09).
1. The stag beetle, Lucanus cervus is Nationally Scarce in the UK, yet no methods exist for monitoring the abundance of adults or presence of the subterranean larvae.2. Here, we describe the design of an aerial flight interception trap that can be used to catch adults. Various lures were tested and ginger root was found to attract both sexes in equal numbers.3. Road transect surveys of adults killed by vehicles were found to produce reliable estimates of the total abundance of both sexes in areas up to about 12 km from the survey. 4. A novel use of radial diffusive samplers is described to infer the presence of larvae. Both larvae and adult females produce longifolene, which is highly attractive to males.5. Larvae produce a characteristic stridulation pattern, which can be recorded and distinguished from sounds produced by other saproxylic beetles that may co-occur with L. cervus.6. We conclude that aerial traps baited with ginger, combined with road transect surveys can be used to monitor population abundance of adults, while detection of longifolene and the characteristic stridulation pattern can be used to reveal larval presence, without destroying their fragile habitat.
Summary
The development and use of an improved automatic system for the accurate measurement of dissolved organic carbon (D.O.C.) in fresh waters is described. The method, which covers the range 0‐25 mgl−1 D.O.C., is based on the oxidation of organic carbon to carbon dioxide by U.V. radiation. The carbon dioxide produced is measured by a non dispersive infra‐red gas analyser (I.R.G.A.). The I.R.G.A. is also used in the semi‐automatic measurement of particulate organic carbon (P.O.C.) by a combustion method which allows very low concentrations to be measured using samples of 200 ml or less.
Results of surveys of two river systems indicate that D.O.C. concentrations of less than 2.0 mg l−1 are typical in unpolluted chalk streams. D.O.C. concentrations of streams draining acid heathland were found to be significantly higher (3‐5.5 mg l−1).
D.O.C. concentration was found to increase rapidly during a spate, in a river draining areas of mixed underlying geology. The throughput of D.O.C. during the twenty‐five to fifty spates which occur annually in the river could amount to 20‐30% of the annual flux of D.O.C.
P.O.C. concentration in chalk spring waters (0.03–0.04 mg l−1) were found to be higher than expected from preliminary estimates using membrane filtration techniques.
The relevance of the measurement of D.O.C. and P.O.C. flux to estimates of the energy budgets of stream ecosystems is discussed and published methods for the automatic measurement of D.O.C. are reviewed.
1. The quantity of dissolved organic carbon (DOC) released by axenic Lemna minor cultures in the laboratory has been determined by an absolute method and by ' "^C labelling.2. Good agreement was obtained between the two methods and from 1.1% to 2.6% of the total carbon fixed was released.3. The DOC produced by L. minor has been analysed by ultrafiltration and compared with a similar analysis of DOC in natural river water.4. The results of ullrafiltration analyses indicate that the proportion of low molecular weight (<1()(X) Daltons) material in DOM produced by axenic L. minor is significantly greater than is found in its natural habitat.
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