Planning for healthcare services during the COVID-19 pandemic in the Southeast of England: a system dynamics modelling approach.

OBJECTIVES: To develop, test, validate and implement a system dynamics model to simulate the pandemic progress and the impact of various interventions on viral spread, healthcare utilisation and demand in secondary care. DESIGN: We adopted the system dynamics model incorporating susceptible, exposed, infection and recovery framework to simulate the progress of the pandemic and how the interventions for the COVID-19 response influence the outcomes with a focus on secondary care. SETTING: This study was carried out covering all the local health systems in Southeast of England with a catchment population of six million with a specific focus on Kent and Medway system. PARTICIPANTS: Six local health systems in Southeast of England using Kent and Medway as a case study. INTERVENTIONS: Short to medium 'what if' scenarios incorporating human behaviour, non-pharmaceutical interventions and medical interventions were tested using the model with regular and continuous feedback of the model results to the local health system leaders for monitoring, planning and rapid response as needed. MAIN OUTCOME MEASURES: Daily output from the model which included number infected in the population, hospital admissions needing COVID-19 care, occupied general beds, continuous positive airway pressure beds, intensive care beds, hospital discharge pathways and deaths. RESULTS: We successfully implemented a regional series of models based on the local population needs which were used in healthcare planning as part of the pandemic response. CONCLUSIONS: In this study, we have demonstrated the utility of system dynamics modelling incorporating local intelligence and collaborative working during the pandemic to respond rapidly and take decisions to protect the population. This led to strengthened cooperation among partners and ensured that the local population healthcare needs were met.

Embedding OR modelling as decision support in health capacity planning: insights from an evaluation.

Literature reviews over five decades have reported the paucity of examples of OR methods being routinely used to support decision-making in health and social care. This paper presents insights from an independent evaluation of a project intended to overcome some of the barriers to implementation by establishing a "community of practice" in Kent (England). The project itself was undertaken by practitioners, and had two main aims: providing training in system dynamics modelling to analysts, and making senior managers aware of the benefits of modelling. The findings largely confirmed previous studies, but also raised issues about style of training delivery and selection of problems to be modelled. Project leaders fully understood the barriers to embedding OR modelling skills, and made considerable efforts to avoid them, but nevertheless the main barrier, pressures on people's time, remained an obstacle. The paper concludes with general reflections and advice.

Can we improve coaches' injury prevention views and implementation practices in the community female Gaelic sport of camogie?

OBJECTIVES: To evaluate the effect of a nationwide coach education workshop on the attitudes towards, willingness and perceived ability of camogie coaches to implement a Camogie Injury Prevention Programme (CIPP) and their implementation of this programme 4 weeks after the workshop. METHODS: Coaches (n=98) from all four provinces in Ireland were recruited and completed a questionnaire prior to and immediately following a developed workshop on the CIPP. Four weeks later 40 of the 98 coaches completed a follow-up questionnaire. Descriptive statistics were completed and a mixed between-within analysis of variance was conducted to examine the differences in willingness and perceived ability to conduct the CIPP over time and between genders. Non-parametric tests examined the differences in attitude scores. The implementation rate of the programme 4 weeks following the workshop was also assessed. RESULTS: Just 13.4% of coaches had previously heard of the CIPP. Significant improvements in attitudes towards, willingness and perceived ability to conduct the CIPP was noted (p<0.001) post-workshop. Ninety-one per cent of coaches reported that implementing the CIPP in a phased approach with their teams would be beneficial. The camogie coaches primarily viewed the CIPP content favourably, finding the exercises important, relevant and mostly enjoyable. However, some coaches reported that the Nordic hamstring curl is too challenging for players to complete (immediately following workshop: 28.7%; 4 weeks later: 53.3%). Four weeks after the workshop, 72.5% of coaches who responded were implementing the CIPP with their teams in the community. CONCLUSIONS: Due to the success of the education workshop, the Camogie Association should incorporate this injury prevention workshop into all mandatory camogie coaching education courses.

A 2-year prospective study of injuries and illness in an elite national junior tennis program.

Objectives: Injury and illness in elite national tennis programs can limit players' current and future performance. This study aimed to prospectively examine injuries and illnesses in an Irish elite national junior tennis program over 2 years. Methods: All injuries and illnesses that led to missed tennis training and match play in the Irish national junior tennis program (n = 82) over 2 years were collected in a prospective cohort study. Injury and illness prevalence and rates were calculated and reported with respect to gender and age group. Descriptive statistics were calculated for the type of illness and the region, location, type, nature, mechanism, and severity of injury. Results: Over the course of the study, 54% of players became injured, with 9.0% receiving more than one injury. Injuries were most frequent in the under-16 age group (12.93 injuries per 1,000 athletic exposures), compared to younger age groups (4.13 [U10], 3.43 [U12], 4.63 [U14] injuries per 1,000 athletic exposures) and seniors (1.98 injuries per 1,000 athletic exposures). Lower (49.5%) and upper limb (35.9%) injuries were frequent and mostly occurred due to overextension (35.9%). No significant differences in males and females injury rates were noted. However, females received a greater proportion of shoulder injuries (23.5% vs 10.9%), with more knee injuries in males (29.1% vs 7.8%). 0.52 illnesses per 1,000 athletic exposures were reported, with respiratory/cardiorespiratory (43.5%) most frequent. Injuries lead to greater average sessions lost (6.77 ± 11.56) than illness (1.83 ± 1.11). Conclusion: These findings can inform injury and illness preventative strategies to minimize absence from tennis play and should be prioritized in the under-16 group. Due to the different injury profiles between males and females, tailored preventative programs should be developed for males and females individually.

Nonsteroidal anti-inflammatory drug use, knowledge, and behaviors around their use and misuse in Irish collegiate student-athletes.

Objectives: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used by athletes to treat injuries but are also reportedly misused as performance or recovery aids. This study aimed to investigate NSAID use, knowledge, and behavior regarding use and misuse of NSAIDs in Irish student-athletes. Methods: One hundred and forty-nine (21.2 ± 3.5 years) student-athletes completed an anonymous questionnaire online. Descriptive statistics were used to summarize the data. Univariate and multivariate regression analyses were utilized to examine whether the associated factors could predict NSAID misuse. Results: Ninety-four per cent of respondents reported using NSAIDs in the past, 63.8% used NSAIDs previously before or after competition  and/or practice, and 13.9% took more than the recommended dosage and this was higher (22.9%) for over-the-counter NSAIDs. More than half were unsure of NSAID side effects. Misuse of NSAIDs was more common in respondents who had more favorable attitudes to the benefits of NSAIDs (odds ratio [OR] = 4.83, 95% confidence interval [CI] = 1.18-19.61), high reported stress (OR = 1.73, 95% CI = 0.58-1.73), or greater behavioral intention to use NSAIDs (OR = 1.89, 95% CI = 0.90-4.53). High perceived athletic identity also significantly predicted behavioral intention (p = 0.01). Conclusion: Education strategies to improve student-athletes' knowledge of appropriate use and side effects of NSAIDs are recommended, particularly for those with high levels of stress and athletic identity.

A dynamic hydrological Monte Carlo simulation model to inform decision-making at Lake Toolibin, Western Australia.

Lake Toolibin, an ephemeral lake in the agricultural zone of Western Australia, is under threat from secondary salinity due to land clearance throughout the catchment. The lake is extensively covered with native vegetation and is a Ramsar listed wetland, being one of the few remaining significant migratory bird habitats in the region. Currently, inflow with salinity greater than 1000 mg/L TDS is diverted from the lake in an effort to protect sensitive lakebed vegetation. However, this conservative threshold compromises the frequency and extent of lake inundation, which is essential for bird breeding. It is speculated that relaxing the threshold to 5000 mg/L may pose negligible additional risk to the condition of lakebed vegetation. To characterise the magnitude of improvement in the provision of bird breeding habitat that might be generated by relaxing the threshold, a dynamic water and salt balance model of the lake was developed and implemented using Monte Carlo simulation. Results from best estimate model inputs indicate that relaxation of the threshold increases the likelihood of satisfying habitat requirements by a factor of 9.7. A second-order Monte Carlo analysis incorporating incertitude generated plausible bounds of [2.6, 37.5] around the best estimate for the relative likelihood of satisfying habitat requirements. Parameter-specific sensitivity analyses suggest the availability of habitat is most sensitive to pan evaporation, lower than expected inflow volume, and higher than expected inflow salt concentration. The characterisation of uncertainty associated with environmental variation and incertitude allows managers to make informed risk-weighted decisions.