Horsley Medical Practice

Abstract Gas developments are required to facilitate energy transition from carbon intensive energy to a sustainable balance of green and blue energy. The next decade will focus on exploiting gas fields globally to support this. A significant number of these fields are located in deepwater and /or are long distances from existing gas processing / LNG plants. Transporting large volumes of gas from remote gas fields over longer distances and in deeper waters remains technologically and economically challenging. Conventional and near-term development options include subsea compression, floating vessels with topside compression and pipeline tie-back to shore, or floating liquefied natural gas vessels. This paper and study are supported by The Oil & Gas Technology Centre (OGTC) and UK Oil and Gas Authority. It examines development options for a 200 km long 1700 m water depth tie back using integrated production modeling linked to power demands, along with installed steel tonnages. The Scope 1 and 2 emissions per unit of gas produced are analysed via a life cycle assessment using ISO 14044 as guidance for a long-distance gas tieback to the point of sale (inclusive of processing to sales specification). The major power intensive equipment used to develop these fields will be presented showing their proportion of the power consumption compared with the total; these include compression either onshore, offshore or subsea as well as the efficiency of the power generation devices in these environments. The paper will highlight the economics of each option and how varying the carbon price changes the commercial position of each option. The paper will show that by understanding what drives emissions, and how emissions relate to the amount of gas produced, that concept selection can drive upwards of 50% reduction in life cycle carbon emissions whilst improving project economic performance. This paper examines multiple innovative technologies, providing technology readiness of new concepts based on the benchmarked study focusing both economic and carbon emission aspects. Finally, the paper will show that better economic outcomes with the decarbonisation of gas gathering systems is technically possible and can be deployed subsea to help meet the energy transition and allow the development of remote and deeper gas fields.

Abstract Thermally insulated hot buried pipelines pose a unique set of challenges. This paper discusses those challenges and how they were met during design and construction of the 150 km long Husky LLB Direct Pipeline, the longest thermally insulated oil pipeline in Canada. Thermal insulation materials are soft and can be easily damaged during construction and backfilling, and by large restraining forces at bends when the pipeline is operating at high temperatures. The large temperature difference between pipeline installation temperature and maximum operating temperature leads to large axial compressive forces that can cause movement at bends, crush insulation, increase temperatures at ground surface, cause loss of restraint, and in the worst case, lead to upheaval buckling and loss of containment. Special design and construction features to deal with these challenges, including insulation specifications, insulation of pipe bends, pipeline pre-straining, long radius bends, deeper burial, and pipeline roping, were therefore necessary. After pipe has been insulated with polyurethane foam it cannot be bent in standard field bending machines used for uninsulated pipes because the foam is too soft. The induction bends and cold bends that are shop insulated after bending are expensive. The Project minimized the number of these expensive insulated bends by using an engineered ditch bottom profile. This meant that shop bends were only needed to reduce excavation depth at sharp changes in ground surface elevation where the roped profile required excessive grading. Care was therefore necessary in the selection and development of specifications for the insulation system and shop fabricated bends, and to design and construct a ditch profile to minimize forces on the insulation and control upheaval buckling. Close co-ordination with vendors and the construction contractor was crucial for a successful and timely completion.

Background:Refugee health professionals belong to a particularly vulnerable group in the host country's labour market as their foreign education is not recognised and they face barriers re-entering their original occupations.International studies indicate that early interventions can increase the employability of refugees.They can thus resume work and the European staff shortage in health care can be reduced.The purpose of this review is to identify and analyse the effectiveness of international qualification programmes for the labour market integration of refugee health professionals.Methods: Six international databases were systematically searched.The search terms were identified using the PICOS-categories and adapted to each database.Because of a lack of evidence-based programmes for refugees the search was extended to qualification programmes for immigrant health professionals.Out of 8451 findings, 102 articles in German and English were included in the final full-text screening.The studies included in the final synthesis will be assessed with the Mixed Method Appraisal Tool.Results: Results are preliminary.There was only one unevaluated programme addressing refugee health professionals.Other programmes addressed immigrant health professionals and were qualitatively evaluated.They primarily focused on (medical) language professionalisation.Within these communication training related to patient-centred care and courses explaining the health care system of the host country were part of the programme. Conclusion:This review highlights the lack of systematically evaluated qualification programmes for refugee health professionals.Based on this review and a needs assessment, an evidencebased qualification programme will be implemented at a German hospital. Main messages:There is a strong need for evidence-based qualification programmes for refugee health professionals.The qualification programme that will be implemented as a consequence of this review can be applied to other hospitals across Europe and may help reduce the staff-shortage in health care.

Effective interprofessional collaborative practice is critical to maximizing patient safety and providing quality patient care; incorporating these strategies into the curriculum is an important step toward implementation. This study assessed whether TeamSTEPPS training using simulation could improve student knowledge of TeamSTEPPS principles, self-efficacy toward interprofessional collaborative practice, and team performance. Students (N = 201) demonstrated significant improvement in all of the targeted measurements.

This study aimed to evaluate changes in voiding with age in women with different urodynamic diagnoses. Correlation was used to analyse the association between age and voiding parameters (maximum flow rate, voided volume, flow rate centile and maximum detrusor pressure – PdetMax) in 896 datasets. Multivariate analysis was used to analyse the data further by age group and diagnosis – urodynamic stress incontinence (USI); detrusor overactivity (DO); mixed USI and DO; no urodynamic abnormality. Results showed that diagnosis accounts for a significant amount of variation in all four of the dependent variables Age group shows a significant effect on voiding volume but does not show significant effects on any other variable studied. There is no significant interaction term in any of the analyses, meaning that age and diagnosis do not appear to function together, e.g. age does not relate to flow rate centile, maximum flow rate or PdetQMax. It was concluded that the data suggest that there is no significant change in voiding function related to age. In the elderly, the main alteration in voiding is due to a higher prevalence of DO.

Observed variation in hospital costs may be attributable to differences in patients' health outcomes. Previous studies have resorted to inherently incomplete outcome measures such as mortality or re-admission rates to assess this claim. This study makes use of a novel dataset of routinely collected patient-reported outcome measures (PROMs) linked to inpatient records to (i) access the degree to which cost variation is associated with variation in patients' health gain and (ii) explore how far judgement about hospital cost performance changes when health outcomes are accounted for. We use multilevel modelling to address the clustering of patients in providers and isolate unexplained cost variation. We find some evidence of a U-shaped relationship between risk-adjusted costs and outcomes for hip replacement surgery. For three other procedures (knee replacement, varicose vein and groin hernia surgery), the estimated relationship is sensitive to the choice of PROM instrument. We do not observe substantial changes in cost performance estimates when outcomes are explicitly accounted for.

ABSTRACT This paper describes the problems involved in selecting a control system for a floating production system. The more commonly used control system options are defined and described at component level. Design criteria are reviewed indicating the effect of field size and layout. Functional requirements of the control system are described and related to their impact on the maintenance requirements. Conclusions are drawn about the solutions available and their impacts on production system efficiency. INTRODUCTION Any floating production system may be classified according to a number of major system parameters such as production system size (single well, multi well) maintenance philosophy (divers, remote retrieval) and functional requirements. It is the intention of this paper to investigate the impact of these parameters and the selection and design of a suitable control system for a floating production system. In preparing this paper the authors have addressed the problem of writing a detailed specification for a control system. Initially a number of questions would be asked about the floating production system and the specification developed. It is proposed to describe these initial questions and the resultant trade-offs. As background to these discussions, a brief review is given of the principles behind subsea control systems. For the purposes of these discussions it is assumed that the specification being developed represents the most cost effective solution. Classification of Control Systems The problems of controlling a subsea valve can be solved in a number of ways, the choice being driven by the overall production system configurations and requirements. The simplest solution is a direct hydraulic system (see fig. 1) where hydraulic fluid is pumped through a supply line to the valve actuator causing the actuator to move. As the length of supply line increases the energy required to move the fluid through the line becomes larger and the time taken to move the actuator increases. The advantages of a direct system are its simplicity, reliability and hence, low maintenance costs. The disadvantage is a poor response time as the range increases. An obvious way to overcome the disadvantages of a direct system is to keep the hydraulic supply close to the actuator and use a signal to control the supply. Three principal solutions of this sort are commonly used, discrete, sequenced and multiplexed electro-hydraulic. A discrete hydraulic control system, as shown in fig. 2, uses a hydraulic signal to operate a pilot valve that allows hydraulic fluid from an accumulator to operate the actuator. The accumulator is trickle charged between operations at a rate greater than the average rate of discharge of the accumulator.

The paper discusses the application of self-elevating platforms (jack-up rigs) to offshore production.Particular emphasis is placed on South East Asia, where marginal field development of short life fields in relatively shallow water depth is a prime consideration.Cost comparison between a jack-up rig and a fixed platform are discussed using an actual estimate of installed costs for σ specific field development. The technical features and limitations of the jack-up rig are also dealt with.

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