Category: Ideation

High Oxygen Demand

Due to the COVID-19 pandemic, the high oxygen demand by ventilators and related equipment can create high flow rate demands on a bulk liquid oxygen system, in excess of flow rates for which they were designed. This situation has been reported overseas where increases in flow have in cases exceeded 1000% of design capacity.

Bulk oxygen systems are owned by the medical gas supplier. They consist of a storage tank, a vaporizer, and a gas pressure regulator station as well as a reserve supply.

Illustration of oxygen tank

Bulk oxygen is stored as a cryogenic liquid at approximately -183°C, and then is vaporized to a gas by use of ambient air vaporizer(s), which uses ambient atmospheric heat. Due to the cold liquid temperature, ice does form on the vaporizer (from condensation of atmospheric humidity onto the cold vaporizer surfaces) irrespective of the outdoor conditions. 

The photo on the left illustrates a partially covered surface of a vaporizer; the photo the right shows a vaporizer fully encapsulated with ice (in the middle of the photo). Both photos were taken at different hospitals in southern Ontario during the week of 30 March 2020, when outdoor temperatures were above freezing.   

As ice build-up increases on the vaporizer, the ice acts as an insulator, thereby reducing the available heat transfer surface area; this reduction in surface area reduces the capacity of the system to deliver gaseous oxygen. Vaporizers are sized to allow for certain accumulation and still supply 100% design flow with some degree of safety but, past this flowrate, ice can incrementally accumulate. 

During periods of unusually high oxygen demand, with reduced heat transfer capacity, this can reduce the production rate of gaseous oxygen and can also cause liquid cryogenic oxygen to be introduced into the distribution pipeline downstream of the gas pressure regulators. When this liquid evaporates in the pipeline, the very large change in volume from a liquid to a gas can create significant pressure fluctuations in the pipeline oxygen pressure. 

Removal of Ice from Vaporizers

At all times, but especially at times of unusually high oxygen demand, it is important to keep vaporizers clear of ice. Contact your bulk supplier who will recommend and oversee specialist cleaning companies to perform this maintenance procedure.

Current High Oxygen Demand During COVID-19

It is recommended that a supplemental management plan during this COVID-19 event be established to monitor ice formation on the vaporizer and for ice removal, and to plan for additional high flow rate demand contingencies: 

  • Discuss with your medical oxygen bulk supplier if the LOX tank is being monitored daily by the supplier; if not, monitor the liquid level gauge at least two to three times a day
  • Discuss with your medical oxygen bulk supplier any necessary requirements to deal with a sudden significant step change in flow demand (e.g. keep clear access to the pad for extra deliveries, be ready to support emergency technical service access, etc.) 
  • Discuss with your medical oxygen bulk supplier how much of the surface area can be covered with ice before the evaporator needs to be cleaned; establish response times from the supplier to have a representative on site when the vaporizer(s) need to be cleaned 
  • Do not attempt to remove ice. Contact your bulk supplier who will recommend and oversee specialist cleaning companies to perform this maintenance procedure 
  • Establish daily monitoring of ice build-up; initiate cleaning response as necessary
  • Maintain the area around the evaporator clear of obstructions to airflow, for approximately 3 m if possible
  • Frequently monitor the medical gas pipeline pressure for significant and unusual pressure fluctuations; this may be indicating liquid gas being injected into the pipeline, meaning inadequate vaporizer performance
  • Locate (where provided) the facility emergency oxygen inlet station on the facility façade and verify the shut-off valve is operational.  While the outdoor air temperature is warming, the amount of moisture in the air is also increasing, which can still pose an ice build-up problem over the next few months.

If you would like to learn more about this topic feel free to reach out to:

Ed Hood, P.Eng.,B.Eng.
Mechanical Technical Leader
edward.hood@hhangus.com

Kim Spencer, P.Eng., LEED AP
Principal | Division Director, Health
kim.spencer@hhangus.com

Voir ci-dessous pour des informations en français

In light of the increasing number of cases of COVID-19 in North America and the announcement by the World Health Organization declaring COVID-19 as a pandemic, HH Angus is taking reasonable precautions to ensure the safety and security of our employees, clients, vendors and guests across all our office locations while maintaining a consistent level of client service. We are executing our Business Continuity Plan that covers maintaining office operations, remote working for all our staff, and delivering service to our clients during weather, natural disasters, and other emergency situations where our offices are shut down for extended periods of time. Our Senior Management Team is meeting daily to respond promptly to the latest conditions and to ensure that we continue as best we can to deliver on our commitments to our clients.

Highlights of our plan include:

Remote Working

We have been closely monitoring this situation and have made the decision to instruct our staff to work remotely beginning March 16, 2020 until further notice. We have technology implemented that enables our employees to provide service remotely for all our clients and projects if they are unable to be in our office physically or report to the project site. This includes access to our design software, network, email, audio and video conferencing, and other communications technologies. Our remote working protocols and equipment are being implemented to enable our employees to continue to deliver service to our clients. All our communication channels related to on-going projects remain unchanged. If you have any questions or concerns about a project we are working with you on, please reach out to your HH Angus contact. We will coordinate with you to make arrangements specific to your project including replacing, where possible, in-person meetings with tele/video conferences. If you require information but do not have an existing contact at HH Angus, please email info@hhangus.com, or reach out to one of the key HH Angus contacts listed at the end of this announcement.

Travel
HH Angus has suspended all international and all non-essential domestic travel until further notice. Personal travel is discouraged and any staff returning from travel outside of Canada must self-isolate for 14 days.

Meetings
We have encouraged our employees to not participate in large gatherings such as conferences or networking events and, where possible, to utilize video/teleconferencing or similar communications technologies for external and internal meetings. Our technical staff will continue to visit project sites but will contact the client in advance to ensure that the site is still open and inquire as to health and safety precautions that are in place to ensure that there are no restrictions preventing their visit. We will assess each site meeting on a case-by-case basis to assess compliance with our firm’s existing protocols to protect the health and safety of both HH Angus staff and client staff.

Office Environment
We have intensified cleaning standards for our offices. We have installed hand-washing signage based on best practices in all washrooms and have increased hand sanitizer stations, where products are available, across our properties in order to help minimize the spread infectious agents.

As mentioned previously, we have asked our staff to work remotely as of March 16, 2020. However, certain staff will be on office premises to facilitate deliveries and perform network maintenance. If you require coming to our Toronto office in person, please speak with Reception by telephone (416-443-8200) in advance. Our Vancouver, Montreal, Dallas and Chicago staff will not be available in their respective offices. Please get in touch with your contact in each region for any inquiries, or call Toronto Reception (416-443-8200).

Reporting procedures
We have established a reporting protocol with our employees, should anyone be exposed to coronavirus directly or indirectly, or is feeling unwell for any reason. Any employee travelling out of the country for any reason is required to self-isolate for 14 days upon return to Canada. We will continue to monitor the situation closely, and adjust our response as required.

For more information, we encourage you to review the following resources:

Health Canada
World Health Organization

We will update this information page as the situation evolves. We are committed to helping our staff, clients and communities manage through this crisis to the best of our ability.

Key HH Angus Contacts:

Paul Keenan, President – paul.keenan@hhangus.com | 416 209 4374

Tom Halpenny, Vice President Operations & General Manager – tom.halpenny@hhangus.com | 416 580 0811

Sameer Dhargalkar, Vice President, Marketing & Business Development –sameer.dhargalkar@hhangus.com | 416 904 4592


COVID-19 - Réponse de HH Angus

Compte tenu du nombre croissant de cas de COVID-19 en Amérique du Nord et de l’annonce de l'Organisation mondiale de la santé déclarant la pandémie mondiale de COVID-19, HH Angus prend des précautions raisonnables pour assurer la sûreté et la sécurité de nos employés, clients, fournisseurs et invités dans tous nos bureaux tout en maintenant un niveau de service constant pour nos clients. Nous mettons en œuvre notre Plan de maintien des activités, qui assure le maintien des activités de bureau, le télétravail pour l’ensemble du personnel et la prestation de service à nos clients en cas de désastres météorologiques ou naturels, ou de tout autre situation d’urgence, dans les endroits où nos bureaux sont fermés pour des périodes prolongées. Notre équipe de direction se réunit quotidiennement pour répondre rapidement aux dernières conditions et pour s'assurer que nous continuons du mieux que nous pouvons à respecter nos engagements envers nos clients.

Les points saillants de notre plan comprennent: 

Travail à distance 

Nous suivons de près cette situation et avons pris la décision de charger notre personnel de travailler à distance à partir du 16 mars 2020 jusqu'à nouvel ordre. Nous avons mis en œuvre la technologie qui permet à nos employés de fournir un service à distance pour tous nos clients et projets s'ils ne peuvent pas être physiquement dans nos bureaux ou se présenter sur le site du projet. Cette technologie donne accès à notre logiciel de conception, aux lecteurs réseaux, aux courriels, aux conférence audio-vidéo, de même que d’autres technologies de communication. Nos protocoles et équipements de travail à distance sont mis en œuvre pour permettre à nos employés de continuer à fournir des services à nos clients. Toutes les voies de communication relatives aux projets en cours demeurent les mêmes. Si vous avez des questions ou des préoccupations concernant un projet sur lequel nous travaillons avec vous, veuillez contacter votre contact HH Angus. Nous vous aiderons à prendre les dispositions propres à votre projet, notamment le remplacement, si cela est possible, des réunions en personne par des conférences audio-vidéo. Si vous avez besoin d'informations mais n'avez pas de contact existant chez HH Angus, veuillez envoyer un courriel à info@hhangus.com, ou communiquer avec la personne-ressource de HH Angus donnée à la fin de ce communiqué.

Voyages
HH Angus a suspendu tous les voyages internationaux et nationaux non essentiels jusqu'à nouvel ordre. Les voyages personnels sont déconseillés et tout membre du personnel qui revient de l’Étranger doit s’isoler pendant 14 jours.

Réunions
Nous avons encouragé nos employés à ne pas participer à de grands rassemblements tels que des conférences ou des événements de réseautage et, dans la mesure du possible, à utiliser la vidéo / téléconférence ou des technologies de communication similaires pour les réunions internes ou externes. Notre personnel technique continue de visiter les sites de projet, mais doit d’abord communiquer avec le client pour s’assurer que le chantier est toujours ouvert et s’informer des mesures de prévention mise en place pour la santé et la sécurité afin de s’assurer que rien n’empêche la visite. Nous évaluerons chaque chantier au cas par cas afin de vérifier la conformité aux protocoles existants de notre firme en matière de protection de la santé et de la sécurité du personnel de HH Angus et du client.

Environnement de bureau
Nous avons intensifié les normes de nettoyage de nos bureaux. Nous avons installé une signalisation de lavage des mains basée sur les meilleures pratiques dans toutes les toilettes et avons augmenté les postes de désinfectant pour les mains, où les produits sont disponibles, sur nos propriétés afin de minimiser la propagation d'agents infectieux.

Comme mentionné précédemment, nous avons demandé à notre personnel de travailler à distance à partir du 16 mars 2020. Cependant, certains membres du personnel seront dans le bureau pour faciliter la réception des livraisons et l’entretien du réseau informatique. Si vous avez besoin de venir à notre bureau de Toronto en personne, veuillez parler à la réception par téléphone (416-443-8200) à l'avance. Nos employés de Vancouver, Montréal, Dallas et Chicago ne seront pas disponibles dans leurs bureaux respectifs. Veuillez communiquer avec votre contact dans chaque région pour toute demande de renseignements ou la réception de Toronto (416-443-8200).

Procédures de signalement
Nous avons établi un protocole de signalement avec nos employés, si quelqu'un est exposé directement ou indirectement au coronavirus, ou se sent mal pour une raison quelconque. Tout employé voyageant à l'extérieur du pays pour n’importe quelle raison que ce soit est tenu de s'isoler pendant 14 jours à son retour au Canada. Nous continuerons de surveiller la situation de près et d'ajuster notre réponse au besoin.

Pour plus d'informations, nous vous encourageons à consulter les ressources suivantes :

Santé Canada
Organisation mondiale de la Santé

Nous mettrons à jour cette page d'information à mesure que la situation évolue. Nous sommes engagés à aider notre personnel, nos clients et les collectivités à traverser cette crise au meilleur de nos capacités.

Personne-ressource de HH Angus :

Mohamed Kamel, Directeur du projet – mohamed.kamel@hhangus.com | C 514 863 9202

Consortium Moves on to Bid Stage

Infrastructure Ontario and Metrolinx have announced the shortlist of four approved bidders to participate in the RFP stage for the Go Rail Expansion - Union Station Enhancement Project. HH Angus is a member of the OneUnion Alliance team bidding for this important infrastructure project that is Canada’s busiest inter-city rail service area and the second busiest railway station in North America, serving more than 72 million passengers each year.


OneUnion Alliance is led by constructors Aecon, Modern Niagara and PNR RailWorks and also includes Mott MacDonald, Systra and HH Angus. Shortlisted teams were selected based on their team composition, experience with collaborative project delivery, health and safety, and previous related work.

The project will include:

  • Construction of new platforms, with canopies and vertical access elements, such as stairs and elevators
  • Construction of two new tracks designed to allow for future passenger train speed up to 45mph, with associated signal works
  • Construction of a new concourse area below the new platforms that will connect the York, Bay and Via Concourse, Union Square and the Scotiabank Galleria and both York and Bay Streets
  • Storm water management system and other building systems.

The project is expected to be awarded by summer 2020.

HH Angus’ dedicated Transportation Group has a number of current and recent transit infrastructure projects:

Metrolinx Eglinton Crosstown Light Rail Transit

Toronto York Spadina Subway Extension (Pioneer Village and Finch West)

TTC Sheppard Line Bayview Station

Union Station Revitalization Project

TTC Easier Access

TTC Downtown Relief Line South

You can read more about the Go Rail Expansion Project here.

HH Angus is honoured to once again be named one of Canada’s Best Managed Companies for 2020. This is our second consecutive year being selected for this prestigious honour, and we want to thank our clients and employees for the important part they played in helping us achieve this national recognition. The award, now in its 27th year, distinguishes overall business performance and growth of best-in-class, Canadian-owned companies with revenues of $15 million or more.

Paul Keenan, President of HH Angus

“We are grateful for this acknowledgement of our firm’s forward-looking strategy, as well as the engagement of our employees and their ongoing commitment to technical excellence and innovation,” said Paul Keenan, President of HH Angus. “We were thrilled to be selected for this award in our first submission last year. Being recognized again this year is a testament to the ongoing commitment of our employees, and the confidence of our clients, who place their trust in us year over year. Our expansion to Vancouver underscores our growth strategy, with the opening of a permanent office to support our local and national clients in BC. And as a knowledge-based firm, we are investing in continuous learning for our staff, and in the emerging design and collaboration technologies that will allow us to deliver on our clients’ goals for their built environment.”

Tom Halpenny, General Manager and VP Operations

According to Tom Halpenny, General Manager and VP Operations: “Having just celebrated our 100th anniversary, being recognized as one of Canada’s Best Managed Companies for a second year speaks to the stability of HH Angus, to the strength of our business strategy, and the enduring relationships we have developed with clients over the years.  Those relationships are built largely on the collaborative approach and technical expertise of our staff. This is a team win, and we all share in this award.”

About Canada’s Best Managed Companies

Canada’s Best Managed Companies continues to be the mark of excellence for Canadian-owned and managed companies with revenues over 5 million. Every year since the launch of the program in 1993, hundreds of entrepreneurial companies have competed for this designation in a rigorous and independent process that evaluates their management skills and practices. The awards are granted on four levels:

  1. Canada’s Best Managed Companies new winner (one of the new winners selected each year);
  2. Canada’s Best Managed Companies winner (award recipients that have re-applied and successfully retained their Best Managed designation for two additional years, subject to annual operational and financial review);
  3. Gold Standard winner (after three consecutive years of maintaining their Best Managed status, these winners have demonstrated their commitment to the program and successfully retained their award for 4-6 consecutive years);
  4. Platinum Club member (winners that have maintained their Best Managed status for seven years or more).

Program sponsors are Deloitte Private, CIBC, Canadian Business, Smith School of Business, and TMX Group. For more information, visit:

Deloitte Canada's Best Managed Companies 2020

 

HH Angus Contact:
Sameer Dhargalkar | Vice President, Marketing and Business Development
HH Angus and Associates Ltd.
+l (416) 443 8200
Sameer.dhargalkar@hhangus.com
hhangus.com

In the hospital of the near future, technology plays a key part in streamlining and enhancing the patient’s experience and delivering high quality care: from wireless physiological monitors to virtual reality entertainment to patients’ health information at their fingertips.

Robots roam the hospital—delivering medication, transporting patients and cleaning. Artificial intelligence (AI), predictive analytics and natural language processing automatically transcribe symptoms and diagnose ailments with a high degree of accuracy, while machine learning algorithms constantly improve the system’s ability to detect and treat medical conditions. Human healthcare providers have been all but eliminated from the equation. It’s the perfect healthcare system – or is it?”

“Medicine is both an art and a science. In order to best serve patients, technology needs to support care providers in doing the things that machines cannot do.”

Depending on who you talk to, this is either a futuristic dream or a technological nightmare.  While it is true that our healthcare system could benefit greatly from many of the technologies mentioned above, there is one key element missing: the art of human compassion and caring that is necessary for a truly patient-centric approach to healthcare. Medicine is both an art and a science. In order to best serve patients, technology needs to support care providers in doing the things that machines cannot do. The art of medicine is not just about finding a diagnosis or treating an ailment based on a universally prescribed regimen; it extends into the social realm where human touch, advocacy and empathy are arguably equally important. Medicine is not a one-size-fits-all solution. Cultural norms, family dynamics, genetics, belief systems, and previous experiences all play an important role in patient decision-making. The way in which a provider navigates through these aspects of care greatly influences patients’ autonomy and quality of life. As yet, there is no way to duplicate the complexity of these influences in a machine. There is no such thing as digital compassion.

This isn’t to say that AI doesn’t have tremendous potential to radically transform healthcare for the better. There is no doubt that more accurate diagnoses, fewer medical errors, streamlined documentation, and more nuanced interpretation of large data sets could benefit patients, providers and society as a whole. But maintaining human connection and empathy in a high-tech healthcare system requires careful consideration of how AI and other technologies are implemented – and how they may impact the patient-provider relationship.

Here are several ways AI can support a patient-centered care environment, today and in the future.

Clinical Decision Support

A key way AI can enhance a patient-centered environment is through supporting clinicians rather than replacing them. A great example of this is in providing clinical decision support, highlighting areas of interest or suggesting potential diagnoses or treatment options based on a data set far larger than any human could grasp. While machines are adept at processing large amounts of data, there are many factors that humans are able to account for that machines simply can’t comprehend; on the other hand, humans are barely able to process even a fraction of the data machines can – making a combination of human and machine intelligence the most accurate diagnostic approach. Working together, humans and machines can provide faster and more accurate treatment of conditions to not only address medical issues before they become serious, but also to optimize patients’ health and wellbeing.

Personalized Care

Personalized medicine has been a buzzword since the human genome was first sequenced in 2002 but, unfortunately, reality has not lived up to the hype – yet. Artificial intelligence has the ability to simultaneously analyze far more data points than a human can, and to provide statistical models for potential diagnoses given a particular patient’s unique set of data. There are a number of AI-powered apps on the market which combine AI with medical expertise to interpret a patient’s answers to various questions and respond with a recommended course of action. In some communities where access to high-quality care is limited, this technology is filling the gap and making significant improvements to population health. As an example, Rwanda has a staggering 10,000 residents per doctor, making access to care difficult and expensive; but the introduction of an AI app called Babylon has drastically altered the healthcare landscape. Nearly a third of the population has used the app to access health care advice, dramatically enhancing access to care where providers may not otherwise be available or accessible.

While human involvement in diagnosis and treatment is still critical – all too often AI systems still identify false positives – applications like Babylon can improve the quality of information available to patients, support patient engagement and, ultimately, relieve some of the pressure on overextended healthcare systems around the world.

Patient Data and Privacy

One of the ways AI and machine learning algorithms are trained is to present the system with a large amount of data from which to learn. Unfortunately, this approach is hampered by two challenges particular to healthcare:

  1. there is a lot of data but most of it is not high quality, and
  2. most data is not available to researchers because of strict (and necessary) patient privacy regulations.

These limited data sets have a real impact on the effectiveness of AIs: lack of diversity can lead to incorrect assumptions or bias across different populations, a problem that facial recognition and speech recognition algorithms have already struggled with and been publicly criticized for.

University Health Network (UHN) in Toronto has taken a unique approach to solving the patient privacy problem, by creating a patient-controlled system where blockchain is used to control and track who has access to personal health data. The system also allows patients to grant and revoke access to researchers, enhancing transparency and engagement.  Other AIs are using natural language processing to read increasingly more complex and messy data sets, improving the quality of data which can then be used to train smarter and more accurate medical AIs.

“Explainable” AI Enhances Trust

Clinicians are trained to analyze data to make connections between different symptoms and draw conclusions about diagnoses and patient health, and may often do so unconsciously. But what happens when an AI simply spits out a percentage of risk? Without context, this information may not be useful to a human doctor interpreting the results, and limits the extent to which the data can be used. This problem has led to the development of a new field of “explainable” AI. These systems not only draw conclusions from diverse sets of data, but can also explain the links between different risk factors and outcomes based on evidence – allowing clinicians better insight into the connections between seemingly unrelated data.

Transparency also builds trust in what may otherwise appear to be a vague and arbitrary output. While trust may seem like a superficial benefit, the transparency and explainability of AIs has real-world impact when it comes to reducing bias and errors in the medical system. From an ethical perspective, it is also important to understand how machines draw their conclusions so that we can ensure they are doing so appropriately.

The Doctor is…Automated?

Automation is a nuanced conversation in any industry, no less so in healthcare where organizations are under increasing pressure to treat aging populations with fewer resources. By now it should be clear that automation can never completely replace humans in providing compassionate care, but that doesn’t mean it has no place in the healthcare industry. Studies have shown that both nurses and doctors spend a significant amount of time on tasks unrelated to patient care, such as documentation, billing, reporting and insurance; not only that, but organizations spend tremendous time and resources ensuring compliance with regulatory and accreditation requirements. In the future, many of these repetitive tasks may be automated, leaving clinicians to focus their attention on what machines can’t do: providing compassionate care to their patients.

Implementing Artificial Intelligence in a Patient-Centric Environment

Today’s AI pales in comparison to what we anticipate it will be capable of in the future – the possibilities are both endless and exciting. We are on the cusp of a radical transformation in healthcare, but it is one that needs to be approached with care and consideration to ensure we don’t end up in a technological dystopia where compassion has been traded for clinical efficiency. There is still a tremendous need for human healthcare professionals to provide care to patients, with or without the assistance of medical AIs; in fact, it is very likely that the rise of AI will make skills like empathy and caring even more valued than they are today.

This vision relies upon bringing together people and technology to create a world where clinicians and patients alike benefit from technologies which augment human cognition, automate non-value-added tasks, and help us better understand ourselves. In the end, perhaps that’s what digital compassion is: allowing technology to support the human connection in a way that blends the art with the science, creating a truly patient-centered care environment.

Author: 

Kim Osborne Rodriguez,P.Eng., RCDD
kim.osbornerodriguez@hhangus.com