Remote maintenance activities in ITER will be performed by a unique set of hardware systems, supported by an extensive software kit. A layer of middleware will manage and control a complex set of interconnections between teams of operators, hardware devices in various operating theatres, and databases managing tool and task logistics. The middleware is driven by constraints on the amounts and timing of data like real-time control loops, camera images, and database access. The Remote Handling Study Centre (RHSC), located at FOM Institute DIFFER, has a 4-operator work cell in an ITER-relevant RH control room setup which connects to a virtual hot cell back-end. The Centre is developing and testing flexible integration of the Control Room components, resulting in proof-of-concept tests of this middleware layer. SW components studied include generic human-machine interface software, a prototype of an RH operations management system, and a distributed virtual reality system supporting multi-screen, multi-actor, and multiple independent views. Real-time rigid body dynamics and contact interaction simulation software supports the simulation of structural deformation, "augmented reality" operations and operator training. The paper presents generic requirements and conceptual design of middleware components and Operations Management Systems in the context of an RH Control Room work cell. The simulation software is analyzed for real-time performance and it is argued that it is critical for middleware to have complete control over the physical network to be able to guarantee bandwidth and latency to the components.
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Background: The COVID-19 pandemic taught us how to rethink care delivery. It catalyzed creative solutions to amplify the potential of personnel and facilities. This paper presents and evaluates a promptly introduced triaging solution that evolved into a tool to tackle the ever-growing waiting lists at an academic ophthalmology department, the TeleTriageTeam (TTT). A team of undergraduate optometry students, tutor optometrists, and ophthalmologists collaborate to maintain continuity of eye care. In this ongoing project, we combine innovative interprofessional task allocation, teaching, and remote care delivery. Objective: In this paper, we described a novel approach, the TTT; reported its clinical effectiveness and impact on waiting lists; and discussed its transformation to a sustainable method for delivering remote eye care. Methods: Real-world clinical data of all patients assessed by the TTT between April 16, 2020, and December 31, 2021, are covered in this paper. Business data on waiting lists and patient portal access were collected from the capacity management team and IT department of our hospital. Interim analyses were performed at different time points during the project, and this study presents a synthesis of these analyses. Results: A total of 3658 cases were assessed by the TTT. For approximately half (1789/3658, 48.91%) of the assessed cases, an alternative to a conventional face-to-face consultation was found. The waiting lists that had built up during the first months of the pandemic diminished and have been stable since the end of 2020, even during periods of imposed lockdown restrictions and reduced capacity. Patient portal access decreased with age, and patients who were invited to perform a remote, web-based eye test at home were on average younger than patients who were not invited. Conclusions: Our promptly introduced approach to remotely review cases and prioritize urgency has been successful in maintaining continuity of care and education throughout the pandemic and has evolved into a telemedicine service that is of great interest for future purposes, especially in the routine follow-up of patients with chronic diseases. TTT appears to be a potentially preferred practice in other clinics and medical specialties. The paradox is that judicious clinical decision-making based on remotely collected data is possible, only if we as caregivers are willing to change our routines and cognitions regarding face-to-face care delivery.
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This article draws on findings of an international study of social workers’ ethical challenges during COVID-19, based on 607 responses to a qualitative survey. Ethical challenges included the following: maintaining trust, privacy, dignity and service user autonomy in remote relationships; allocating limited resources; balancing rights and needs of different parties; deciding whether to break or bend policies in the interests of service users; and handling emotions and ensuring care of self and colleagues. The article considers regional contrasts, the ‘ethical logistics’ of complex decision-making, the impact of societal inequities, and lessons for social workers and professional practice around the globe.
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