The Minnesota Medical Operations Coordination Center: A COVID-19 Statewide Response to Ensure Access to Critical Care and Medical-Surgical Beds

BACKGROUND

COVID-19 led to unprecedented inpatient capacity challenges, particularly in ICUs, which spurred development of statewide or regional placement centers for coordinating transfer (load-balancing) of adult patients needing intensive care to hospitals with remaining capacity.

RESEARCH QUESTION

Do Medical Operations Coordination Centers (MOCC) augment patient placement during times of severe capacity challenges?

STUDY DESIGN AND METHODS

The Minnesota MOCC was established with a focus on transfer of adult ICU and medical-surgical patients; trauma, cardiac, stroke, burn, and extracorporeal membrane oxygenation cases were excluded. The center operated within one health care system's bed management center, using a dedicated 24/7 telephone number. Major health care systems statewide and two tertiary centers in a neighboring state participated, sharing information on system status, challenges, and strategies. Patient volumes and transfer data were tracked; client satisfaction was evaluated through an anonymous survey.

RESULTS

From August 1, 2020, through March 31, 2022, a total of 5,307 requests were made, 2,008 beds identified, 1,316 requests canceled, and 1,981 requests were unable to be fulfilled. A total of 1,715 patients had COVID-19 (32.3%), and 2,473 were negative or low risk for COVID-19 (46.6%). COVID-19 status was unknown in 1,119 (21.1%). Overall, 760 were patients on ventilators (49.1% COVID-19 positive). The Minnesota Critical Care Coordination Center placed most patients during the fall 2020 surge with the Minnesota Governor's stay-at-home order during the peak. However, during the fall 2021 surge, only 30% of ICU patients and 39% of medical-surgical patients were placed. Indicators characterizing severe surge include the number of Critical Care Coordination Center requests, decreasing placements, longer placement times, and time series analysis showing significant request-acceptance differences.

INTERPRETATION

Implementation of a large-scale Minnesota MOCC program was effective at placing patients during the first COVID-19 pandemic fall 2020 surge and was well regarded by hospitals and health systems. However, under worsening duress of limited resources during the fall 2021 surge, placement of ICU and medical-surgical patients was greatly decreased.

Load-Balancing Routing for LEO Satellite Network with Distributed Hops-Based Back-Pressure Strategy

With the expansion of user scale in LEO satellite networks, unbalanced regional load and bursty network traffic lead to the problem of load disequilibrium. A distributed hops-based back-pressure (DHBP) routing is proposed. DHBP theoretically derives a fast solution for the minimum end-to-end propagation hops between satellite nodes in inclined-orbit LEO satellite networks; hence, link weights are determined based on remaining hops between the next hop and destination satellites. In order to control the number of available retransmission paths, the permitted propagation region is restricted to a rectangular region consisting of source-destination nodes to reduce the propagation cost. Finally, DHBP is designed distributedly, to realize a dynamic selection of the shortest link with low congestion and balanced traffic distribution without obtaining the whole network topology. Network simulation results demonstrate that DHBP has higher throughput and lower delay under high load conditions compared with state-of-the-art routing protocols.

Machine-learning assisted scheduling optimization and its application in quantum chemical calculations

Easy and effective usage of computational resources is crucial for scientific calculations, both from the perspectives of timeliness and economic efficiency. This work proposes a bi-level optimization framework to optimize the computational sequences. Machine-learning (ML) assisted static load-balancing, and different dynamic load-balancing algorithms can be integrated. Consequently, the computational and scheduling engine of the ParaEngine is developed to invoke optimized quantum chemical (QC) calculations. Illustrated benchmark calculations include high-throughput drug suit, solvent model, P38 protein, and SARS-CoV-2 systems. The results show that the usage rate of given computational resources for high throughput and large-scale fragmentation QC calculations can primarily profit, and faster accomplishing computational tasks can be expected when employing high-performance computing (HPC) clusters.

Mass Critical Care Surge Response During COVID-19: Implementation of Contingency Strategies - A Preliminary Report of Findings From the Task Force for Mass Critical Care

Background

After the publication of a 2014 consensus statement regarding mass critical care during public health emergencies, much has been learned about surge responses and the care of overwhelming numbers of patients during the COVID-19 pandemic. Gaps in prior pandemic planning were identified and require modification in the midst of severe ongoing surges throughout the world.

Research Question

A subcommittee from The Task Force for Mass Critical Care (TFMCC) investigated the most recent COVID-19 publications coupled with TFMCC members anecdotal experience in order to formulate operational strategies to optimize contingency level care, and prevent crisis care circumstances associated with increased mortality.

Study Design and Methods

TFMCC adopted a modified version of established rapid guideline methodologies from the World Health Organization and the Guidelines International Network-McMaster Guideline Development Checklist. With a consensus development process incorporating expert opinion to define important questions and extract evidence, the TFMCC developed relevant pandemic surge suggestions in a structured manner, incorporating peer-reviewed literature, “gray” evidence from lay media sources, and anecdotal experiential evidence.

Results

Ten suggestions were identified regarding staffing, load-balancing, communication, and technology. Staffing models are suggested with resilience strategies to support critical care staff. ICU surge strategies and strain indicators are suggested to enhance ICU prioritization tactics to maintain contingency level care and to avoid crisis triage, with early transfer strategies to further load-balance care. We suggest that intensivists and hospitalists be engaged with the incident command structure to ensure two-way communication, situational awareness, and the use of technology to support critical care delivery and families of patients in ICUs.

Interpretation

A subcommittee from the TFMCC offers interim evidence-informed operational strategies to assist hospitals and communities to plan for and respond to surge capacity demands resulting from COVID-19.

Relay Positioning for Load-Balancing and Throughput Enhancement in Dual-Hop Relay Networks

In a cellular communication system, deploying a relay station (RS) is an effective alternative to installing a new base station (BS). A dual-hop network enhances the throughput of mobile stations (MSs) located in shadow areas or at cell edges by installing RSs between BSs and MSs. Because additional radio resources should be allocated to the wireless link between BS and RS, a frame to be transmitted from BS is divided into an access zone (AZ) and a relay zone (RZ). BS and RS communicate with each other through the RZ, and they communicate with their registered MSs through an AZ. However, if too many MSs are registered with a certain BS or RS, MS overloading may cause performance degradation. To prevent such performance degradation, it is very important to find the proper positions for RSs to be deployed. In this paper, we propose a method for finding the sub-optimal RS deployment location for the purpose of load-balancing and throughput enhancement. The advantage of the proposed method is the efficiency in find the sub-optimal location of RSs and its reliable tradeoff between load-balancing throughput enhancement. Since the proposed scheme finds the proper position by adjusting the distance and angle of RSs, its computational complexity lower than other global optimization approach or learning-based approach. In addition, the proposed scheme is constituted with the two stages of load-balancing and throughput enhancement. These procedures result in the appropriate tradeoff between load-balancing and throughput enhancement. The simulation results support these advancements of the proposed scheme.

Towards Network Lifetime Enhancement of Resource Constrained IoT Devices in Heterogeneous Wireless Sensor Networks

The participating nodes in Wireless Sensor Networks (WSNs) are usually resource-constrained in terms of energy consumption, storage capacity, computational capability, and communication range. Energy is one of the major constraints which requires an efficient mechanism that takes into account the energy consumption of nodes to prolong the network lifetime. Particularly in the large scale heterogeneous WSNs, this challenge becomes more critical due to high data collection rate and increased number of transmissions. To this end, clustering is one of the most popular mechanisms which is being used to minimize the energy consumption of nodes and prolong the lifetime of the network. In this paper, therefore, we propose a robust clustering mechanism for energy optimization in heterogeneous WSNs. In the proposed scheme, nodes declare themselves as cluster head (CH) based on available resources such as residual energy, available storage and computational capability. The proposed scheme employs the multi criteria decision making technique named as Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) which allows the child nodes to select the optimal CH among several potential CH candidates. Moreover, we also propose mechanisms such as CH-acquaintanceship and CH-friendship in order to prolong the network lifetime. Simulation results show that our proposed scheme minimizes the control overhead, reduces the power consumption and enhances overall lifetime of the network by comparing with the most recent and relevant proposed protocol for WSNs.

A Survey on the Evolution of Opportunistic Routing with Asynchronous Duty-Cycled MAC in Wireless Sensor Networks

Wireless sensor networks (WSNs) have been used for environmental monitoring and reporting for many decades. Energy consumption is a significant research topic because wireless sensor nodes are battery-operated to be highly energy-constrained. Several strategies have been introduced in routing and MAC (Medium Access Control) layer protocols to facilitate energy saving. At the routing layer, an energy-efficient routing protocol, known as opportunistic routing (OR), has been designed to improve efficiency. OR achieves energy efficiency via load-balancing, which forwards packets along multiple routes over WSNs. At the MAC layer, an energy-efficient MAC protocol known as the asynchronous duty-cycled MAC (ADCM) protocol achieves energy saving by turning on and off a sensor node's transmitter and receiver to eliminate unnecessary energy wastage. These protocols each have their own advantages and disadvantages. OR achieves energy efficiency at the routing layer but it raises an issue at the MAC layer. ADCM achieves energy efficiency at the MAC layer, but it hinders the packet forwarding efficiency of the OR. To attain better energy efficiency, a combination of these two ideas led to the development of OR with asynchronous duty-cycled MAC (OR-ADCM). However, even with better energy efficiency, limitations still exist in combining load-balancing and duty-cycling due to conflicts in the inherent properties of OR and ADCM. In this paper, we present a survey of the evolution of OR-ADCM over WSNs to help the reader better understand and appreciate the details of this tradeoff, which we hope will lead to the development of better protocol designs.