Geriatric trauma triage: optimizing systems for older adults-a publication of the American Association for the Surgery of Trauma Geriatric Trauma Committee.

Background: Geriatric trauma patients are an increasing population of the United States (US), sustaining a high incidence of falls, and suffer greater morbidity and mortality to their younger counterparts. Significant variation and challenges exist to optimize outcomes for this cohort, while being mindful of available resources. This manuscript provides concise summary of locoregional and national practices, including relevant updates in the triage of geriatric trauma in an effort to synthesize the results and provide guidance for further investigation. Methods: We conducted a review of geriatric triage in the United States (US) at multiple stages in the care of the older patient, evaluating existing literature and guidelines. Opportunities for improvement or standardization were identified. Results: Opportunities for improved geriatric trauma triage exist in the pre-hospital setting, in the trauma bay, and continue after admission. They may include physiologic criteria, biochemical markers, radiologic criteria and even age. Recent Trauma Quality Improvement Program (TQIP) Best Practices Guidelines for Geriatric Trauma Management published in 2024 support these findings. Conclusion: Trauma systems must adjust to provide optimal care for older adults. Further investigation is required to provide pertinent guidance.

Using economic analysis to inform health resource allocation: lessons from Malawi.

Despite making remarkable strides in improving health outcomes, Malawi faces concerns about sustaining the progress achieved due to limited fiscal space and donor dependency. The imperative for efficient health spending becomes evident, necessitating strategic allocation of resources to areas with the greatest impact on mortality and morbidity. Health benefits packages hold promise in supporting efficient resource allocation. However, despite defining these packages over the last two decades, their development and implementation have posed significant challenges for Malawi. In response, the Malawian government, in collaboration with the Thanzi la Onse Programme, has developed a set of tools and frameworks, primarily based on cost-effectiveness analysis, to guide the design of health benefits packages likely to achieve national health objectives. This review provides an overview of these tools and frameworks, accompanied by other related analyses, aiming to better align health financing with health benefits package prioritization. The paper is organized around five key policy questions facing decision-makers: (i) What interventions should the health system deliver? (ii) How should resources be allocated geographically? (iii) How should investments in health system inputs be prioritized? (iv) How should equity considerations be incorporated into resource allocation decisions? and (v) How should evidence generation be prioritized to support resource allocation decisions (guiding research)? The tools and frameworks presented here are intended to be compatible for use in diverse and often complex healthcare systems across Africa, supporting the health resource allocation process as countries pursue Universal Health Coverage.

Impact of the COVID-19 pandemic on mechanical ventilation cases and mortality rates in non-SARS-CoV-2 patients: A nationwide analysis in Spain.

BACKGROUND: The COVID-19 pandemic has presented unprecedented challenges for healthcare systems globally, impacting critical care resources and patient outcomes. Understanding its multifaceted effects is crucial for future crisis response. OBJECTIVE: Analyze the repercussions of the COVID-19 pandemic on mechanical ventilation cases and mortality among non-SARS-CoV-2 patients. METHODS: A nationwide database encompassing all patients receiving mechanical ventilation in Spain was used to compare the number of cases and clinical outcomes during COVID-19 (March 2020 - December 2021) to pre-pandemic cases (May 2018 - February 2020). Univariate and multivariate analyses were employed. RESULTS: COVID-19 significantly reduced access to ventilation for non-COVID-19 patients. A 16 % decrease (12,099 fewer patients) was observed during the pandemic compared to pre-pandemic times. This reduction affected all analyzed conditions except self-inflicted injuries, coinciding with a rise in overall mortality risk (34.5% vs 35.6 %, OR 1.09, 95 %CI 1.06-1.12). The increased mortality was consistent across diverse admission types, including cancer (37.1% vs. 41.5 %, OR 1.18, 95 %CI 1.09-1.29), hemorrhagic strokes (55.4% vs. 56.6 %, OR 1.07, 95 %CI 1.02-1.20), acute myocardial infarction (35.6% vs. 38 %, OR 1.11, 95 %CI 1.01-1.21), non-SARS-CoV-2 pneumonia (44.5% vs. 45.8 %, OR 1.12, 95 %CI 1.02-1.24), septic shock (54.7% vs. 56.3 %, OR 1.10, 95 %CI 1.06-1.15), and prolonged ventilation (≥96 h) (37% vs. 38.2 %, OR 1.10, 95 %CI 1.06-1.10). CONCLUSIONS: The findings underscore the profound impact of the COVID-19 pandemic on critical care utilization and patient outcomes among non-SARS-CoV-2 patients. As healthcare systems strive to mitigate future crises, these insights emphasize adaptable strategies for equitable access to life-saving treatments.

Spatial Access to Continuous Maternal and Perinatal Health Care Services in Low-Resource Settings: Cross-Sectional Study.

BACKGROUND: Maternal and perinatal health are fundamental to human development. However, in low-resource settings such as sub-Saharan Africa (SSA), significant challenges persist in reducing maternal, newborn, and child mortality. To achieve the targets of the sustainable development goal 3 (SDG3) and universal health coverage (UHC), improving access to continuous maternal and perinatal health care services (CMPHS) has been addressed as a critical strategy. OBJECTIVE: This study aims to provide a widely applicable procedure to illuminate the current challenges in ensuring access to CMPHS for women of reproductive age. The findings are intended to inform targeted recommendations for prioritizing resource allocation and policy making in low-resource settings. METHODS: In accordance with the World Health Organization guidelines and existing literature, and taking into account the local context of CMPHS delivery to women of reproductive age in Mozambique, we first proposed the identification of CMPHS as the continuum of 3 independent service packages, namely antenatal care (ANC), institutional delivery (ID), and postnatal care (PNC). Then, we used the nearest-neighbor method (NNM) to assess spatial access to each of the 3 service packages. Lastly, we carried out an overlap analysis to identify 8 types of resource-shortage zones. RESULTS: The median shortest travel times for women of reproductive age to access ANC, ID, and PNC were 2.38 (IQR 1.38-3.89) hours, 3.69 (IQR 1.87-5.82) hours, and 4.16 (IQR 2.48-6.67) hours, respectively. Spatial barriers for women of reproductive age accessing ANC, ID, and PNC demonstrated large variations both among and within regions. Maputo City showed the shortest travel time and the best equity within the regions (0.46, IQR 0.26-0.69 hours; 0.74, IQR 0.47-1.04 hours; and 1.34, IQR 0.83-1.85 hours, respectively), while the provinces of Niassa (4.07, IQR 2.41-6.63 hours; 18.20, IQR 11.67-24.65 hours; and 7.69, IQR 4.74-13.05 hours, respectively) and Inhambane (2.69, IQR 1.49-3.91 hours; 4.43, IQR 2.37-7.16 hours; and 10.76, IQR 7.73-13.66 hours, respectively) lagged behind significantly in both aspects. In general, more than 51% of the women of reproductive age, residing in 83.25% of Mozambique's land area, were unable to access any service package of CMPHS in time (within 2 hours), while only about 21%, living in 2.69% of Mozambique's land area, including Maputo, could access timely CMPHS. CONCLUSIONS: The spatial accessibility and equity of CMPHS in Mozambique present significant challenges in achieving SDG3 and UHC, especially in the Inhambane and Niassa regions. For Inhambane, policy makers should prioritize the implementation of a decentralization allocation strategy to increase coverage and equity through upgrading existing health care facilities. For Niassa, the cultivation of well-trained midwives who can provide door-to-door ANC and PNC at home should be prioritized, with an emphasis on strengthening communities' engagement. The proposed 2-step procedure should be implemented in other low-resource settings to promote the achievement of SDG3.

Examining geographical inequalities for malaria outcomes and spending on malaria in 40 malaria-endemic countries, 2010-2020.

BACKGROUND: While substantial gains have been made in the fight against malaria over the past 20 years, malaria morbidity and mortality are marked by inequality. The equitable elimination of malaria within countries will be determined in part by greater spending on malaria interventions, and how those investments are allocated. This study aims to identify potential drivers of malaria outcome inequality and to demonstrate how spending through different mechanisms might lead to greater health equity. METHODS: Using the Gini index, subnational estimates of malaria incidence and mortality rates from 2010 to 2020 were used to quantify the degree of inequality in malaria burden within countries with incidence rates above 5000 cases per 100,000 people in 2020. Estimates of Gini indices represent within-country distributions of disease burden, with high values corresponding to inequitable distributions of malaria burden within a country. Time series analyses were used to quantify associations of malaria inequality with malaria spending, controlling for country socioeconomic and population characteristics. RESULTS: Between 2010 and 2020, varying levels of inequality in malaria burden within malaria-endemic countries was found. In 2020, values of the Gini index ranged from 0.06 to 0.73 for incidence, 0.07 to 0.73 for mortality, and 0.00 to 0.36 for case fatality. Greater total malaria spending, spending on health systems strengthening for malaria, healthcare access and quality, and national malaria incidence were associated with reductions in malaria outcomes inequality within countries. In addition, government expenditure on malaria, aggregated government and donor spending on treatment, and maternal educational attainment were also associated with changes in malaria outcome inequality among countries with the greatest malaria burden. CONCLUSIONS: The findings from this study suggest that prioritizing health systems strengthening in malaria spending and malaria spending in general especially from governments will help to reduce inequality of the malaria burden within countries. Given heterogeneity in outcomes in countries currently fighting to control malaria, and the challenges in increasing both domestic and international funding allocated to control and eliminate malaria, the efficient targeting of limited resources is critical to attain global malaria eradication goals.

Equality of healthcare resource allocation between impoverished counties and non-impoverished counties in Northwest China: a longitudinal study.

BACKGROUND: The Health and Medical Assistance Program for Poverty Alleviation is part of China's targeted poverty elimination strategy, which aims to protect poor people's right to health and prevent them from becoming trapped in or returning to poverty because of illness. Many tasks have been defined in this program, including raising the medical insurance level, providing a triage system, improving medical and health services, and enhancing people's health. One pivotal aspect of this initiative involves equitable health resource allocation, a key measure aimed at bolstering medical and health services. This study aimed to analyze and compare health resource allocations in different counties in Northwest China after the implementation of the program. METHODS: The Gini coefficient quantifies the level of distributional equality, the Theil index assesses the sources of inequality, and the Health Resource Agglomeration Degree gauges the accessibility of health resources. RESULTS: 1) The health resource allocation distributed based on population(Gini Coefficient < 0.45) was more equitable than that distributed based on area(Gini Coefficient > 0.35) among counties in Northwest China. 2) The contribution rate within non-impoverished counties is higher than that of impoverished counties, which means the inequality within non-impoverished counties. 3) The allocation of beds in medical institutions by area in non-impoverished counties was better than that in impoverished counties, and accessibility to health services for residents in non-impoverished counties was better than that in impoverished counties. CONCLUSION: The analysis of health resource allocation among the five provinces in Northwest China revealed significant differences in equality among the five provinces in Northwest China, and the differences were mainly derived from the non-impoverished counties. Although the equality is gradually improving, the number of health resources in impoverished counties remain lower than that in non-impoverished counties.Subsequently, it is essential to ensure equitable distribution of healthcare resources while also taking into account their utilization and quality.

Quantitative and qualitative management of water resources with the use of treated wastewater in agriculture.

The principled utilization of treated wastewater can reduce the pollution load on the environment. Because on the one hand, treated wastewater can be a suitable fertilizer substitute, and on the other hand, using treated wastewater in irrigation prevents the discharge of polluted surface water into water sources. In the south of Tehran province, polluted surface water is used for irrigation in the agricultural sector, and this has led to environmental problems. To solve this problem, it has been decided to implement a plan to build surface water treatment plants and an irrigation and drainage network to transfer treated wastewater to farms. Therefore, the present study aimed to investigate the economic and environmental effects of this project in the region. A hydro-economic model has been used to achieve this goal. According to the results, in the case of the application of environmental constraints in the optimization model, the cultivation area and the farmers' profit will be reduced by about 5% and 36%, respectively, compared with the noncompliance of environmental constraints. However, this decline in profit can be compensated by adopting solutions such as improving the irrigation system, the application of treated wastewater, or using the fertilizer potential of water sources in the agricultural sector. PRACTITIONER POINTS: In the optimal economic-environmental situation, farmers' profit is reduced compared with the optimal economic situation. In the case of implementing the treated wastewater application, the farmers' profit will increase despite environmental constraints. In the optimal economic-environmental situation, fewer lands are cultivated with diverse crops than in optimal economic conditions.

Will urban scale affect health services inequity? The empirical evidence from cities in China.

Background: The equity of public resources triggered by city shrinkage is a global challenge. Significantly, the impact of city shrinkage on the allocation of health service resources needs to be better understood. This study explores the impact of population change on government investment and health service delivery in shrinking cities. Data and method: Using data from China's Urban Statistical Yearbook (2010-2020), we employ regression discontinuity (RD) and fixed-effect models to examine the causal relationship between city shrinkage and health service provision. Result: Shrinking cities show significant disparities in health resources, particularly in bed numbers (-1,167.58, p < 0.05) and doctor availability (-538.54, p < 0.05). Economic development (p < 0.01) and financial autonomy (p < 0.01) influence hospital bed distribution. Investments in public services (primary schools and teachers, p < 0.01) affect health resource delivery. Robustness tests support our results. Conclusion: This study reveals how city shrinkage disrupts health service provision and equity, establishing a causal relationship between city shrinkage/expansion and health resource allocation, emphasizing the imbalance caused by urban population changes. City expansion intensifies competition for health resources, while shrinking cities struggle to provide adequate resources due to government reluctance. Policymakers should adapt health resource allocation strategies to meet patient demands in changing urban landscapes.

Impact of Ambient Temperature on Mortality Burden and Spatial Heterogeneity in 16 Prefecture-Level Cities of a Low-Latitude Plateau Area in Yunnan Province: Time-Series Study.

Background: The relation between climate change and human health has become one of the major worldwide public health issues. However, the evidence for low-latitude plateau regions is limited, where the climate is unique and diverse with a complex geography and topography. objectives: This study aimed to evaluate the effect of ambient temperature on the mortality burden of nonaccidental deaths in Yunnan Province and to further explore its spatial heterogeneity among different regions. Methods: We collected mortality and meteorological data from all 129 counties in Yunnan Province from 2014 to 2020, and 16 prefecture-level cities were analyzed as units. A distributed lagged nonlinear model was used to estimate the effect of temperature exposure on years of life lost (YLL) for nonaccidental deaths in each prefecture-level city. The attributable fraction of YLL due to ambient temperature was calculated. A multivariate meta-analysis was used to obtain an overall aggregated estimate of effects, and spatial heterogeneity among 16 prefecture-level cities was evaluated by adjusting the city-specific geographical characteristics, demographic characteristics, economic factors, and health resources factors. Results: The temperature-YLL association was nonlinear and followed slide-shaped curves in all regions. The cumulative cold and heat effect estimates along lag 0-21 days on YLL for nonaccidental deaths were 403.16 (95% empirical confidence interval [eCI] 148.14-615.18) and 247.83 (95% eCI 45.73-418.85), respectively. The attributable fraction for nonaccidental mortality due to daily mean temperature was 7.45% (95% eCI 3.73%-10.38%). Cold temperature was responsible for most of the mortality burden (4.61%, 95% eCI 1.70-7.04), whereas the burden due to heat was 2.84% (95% eCI 0.58-4.83). The vulnerable subpopulations include male individuals, people aged <75 years, people with education below junior college level, farmers, nonmarried individuals, and ethnic minorities. In the cause-specific subgroup analysis, the total attributable fraction (%) for mean temperature was 13.97% (95% eCI 6.70-14.02) for heart disease, 11.12% (95% eCI 2.52-16.82) for respiratory disease, 10.85% (95% eCI 6.70-14.02) for cardiovascular disease, and 10.13% (95% eCI 6.03-13.18) for stroke. The attributable risk of cold effect for cardiovascular disease was higher than that for respiratory disease cause of death (9.71% vs 4.54%). Furthermore, we found 48.2% heterogeneity in the effect of mean temperature on YLL after considering the inherent characteristics of the 16 prefecture-level cities, with urbanization rate accounting for the highest proportion of heterogeneity (15.7%) among urban characteristics. Conclusions: This study suggests that the cold effect dominated the total effect of temperature on mortality burden in Yunnan Province, and its effect was heterogeneous among different regions, which provides a basis for spatial planning and health policy formulation for disease prevention.

Modeling defensive resource allocation in multilayered systems under probabilistic and strategic risks.

Confronting the continuing risk of an attack, security systems have adopted target-hardening strategies through the allocation of security measures. Most previous work on defensive resource allocation considers the security system as a monolithic architecture. However, systems such as schools are typically characterized by multiple layers, where each layer is interconnected to help prevent single points of failure. In this paper, we study the defensive resource allocation problem in a multilayered system. We develop two new resource allocation models accounting for probabilistic and strategic risks, and provide analytical solutions and illustrative examples. We use real data for school shootings to illustrate the performance of the models, where the optimal investment strategies and sensitivity analysis are presented. We show that the defender would invest more in defending outer layers over inner layers in the face of probabilistic risks. While countering strategic risks, the defender would split resources in each layer to make the attacker feel indifferent between any individual layer. This paper provides new insights on resource allocation in layered systems to better enhance the overall security of the system.

Cost Evaluation of the Ontario Virtual Urgent Care Pilot Program: Population-Based, Matched Cohort Study.

BACKGROUND: In 2020, the Ministry of Health (MoH) in Ontario, Canada, introduced a virtual urgent care (VUC) pilot program to provide alternative access to urgent care services and reduce the need for in-person emergency department (ED) visits for patients with low acuity health concerns. OBJECTIVE: This study aims to compare the 30-day costs associated with VUC and in-person ED encounters from an MoH perspective. METHODS: Using administrative data from Ontario (the most populous province of Canada), a population-based, matched cohort study of Ontarians who used VUC services from December 2020 to September 2021 was conducted. As it was expected that VUC and in-person ED users would be different, two cohorts of VUC users were defined: (1) those who were promptly referred to an ED by a VUC provider and subsequently presented to an ED within 72 hours (these patients were matched to in-person ED users with any discharge disposition) and (2) those seen by a VUC provider with no referral to an in-person ED (these patients were matched to patients who presented in-person to the ED and were discharged home by the ED physician). Bootstrap techniques were used to compare the 30-day mean costs of VUC (operational costs to set up the VUC program plus health care expenditures) versus in-person ED care (health care expenditures) from an MoH perspective. All costs are expressed in Canadian dollars (a currency exchange rate of CAD $1=US $0.76 is applicable). RESULTS: We matched 2129 patients who presented to an ED within 72 hours of VUC referral and 14,179 patients seen by a VUC provider without a referral to an ED. Our matched populations represented 99% (2129/2150) of eligible VUC patients referred to the ED by their VUC provider and 98% (14,179/14,498) of eligible VUC patients not referred to the ED by their VUC provider. Compared to matched in-person ED patients, 30-day costs per patient were significantly higher for the cohort of VUC patients who presented to an ED within 72 hours of VUC referral ($2805 vs $2299; difference of $506, 95% CI $139-$885) and significantly lower for the VUC cohort of patients who did not require ED referral ($907 vs $1270; difference of $362, 95% CI 284-$446). Overall, the absolute 30-day costs associated with the 2 VUC cohorts were $18.9 million (ie, $6.0 million + $12.9 million) versus $22.9 million ($4.9 million + $18.0 million) for the 2 in-person ED cohorts. CONCLUSIONS: This costing evaluation supports the use of VUC as most complaints were addressed without referral to ED. Future research should evaluate targeted applications of VUC (eg, VUC models led by nurse practitioners or physician assistants with support from ED physicians) to inform future resource allocation and policy decisions.

Does government environmental attention drive green total factor productivity? Evidence from China.

Based on city-level panel data spanning 2008 to 2021, this study investigates the impact of government environmental attention (GEA) on green total factor productivity (GTFP). The findings suggest that increased GEA substantially enhances the growth of GTFP. After conducting robustness and endogeneity tests, the study's results consistently show reliability and robustness. Further analysis elucidates several mechanisms through which GEA influences GTFP, including fostering green technology innovation, optimizing resource allocation, and promoting upgrades in industrial structure. Heterogeneity analyses reveal that the impact of GEA on GTFP is notably pronounced in eastern cities, as well as in cities characterized by low resource dependency, mature industrial development, and high market competition. Conversely, the influence of GEA on GTFP is less discernible in cities prioritizing economic development goals, possibly due to differing policy orientations and resource allocation strategies. This study offers a novel perspective on understanding how GEA shape green development and provides empirical support for policy formulation.

What does "urgency" mean when prioritizing cancer treatment? Results from a qualitative study with German oncologists and other experts during the COVID-19 pandemic.

PURPOSE: Cancer care in Germany during the COVID-19 pandemic was affected by resource scarcity and the necessity to prioritize medical measures. This study explores ethical criteria for prioritization and their application in cancer practices from the perspective of German oncologists and other experts. METHODS: We conducted fourteen semi-structured interviews with German oncologists between February and July 2021 and fed findings of interviews and additional data on prioritizing cancer care into four structured group discussions, in January and February 2022, with 22 experts from medicine, nursing, law, ethics, health services research and health insurance. Interviews and group discussions were digitally recorded, transcribed verbatim and analyzed using qualitative content analysis. RESULTS: Narratives of the participants focus on "urgency" as most acceptable criterion for prioritization in cancer care. Patients who are considered curable and those with a high level of suffering, were given a high degree of "urgency." However, further analysis indicates that the "urgency" criterion needs to be further distinguished according to at least three different dimensions: "urgency" to (1) prevent imminent harm to life, (2) prevent future harm to life and (3) alleviate suffering. In addition, "urgency" is modulated by the "success," which can be reached by means of an intervention, and the "likelihood" of reaching that success. CONCLUSION: Our analysis indicates that while "urgency" is a well-established criterion, its operationalization in the context of oncology is challenging. We argue that combined conceptual and clinical analyses are necessary for a sound application of the "urgency" criterion to prioritization in cancer care.

Reproductive biology of Hawaiian lava crickets.

Insects have spread across diverse ecological niches, including extreme environments requiring specialized traits for survival. However, little is understood about the reproductive traits required to facilitate persistence in such environments. Here, we report on the reproductive biology of two species of endemic Hawaiian lava crickets (Caconemobius fori and Caconemobius anahulu) that inhabit barren lava flows on the Big Island. We examine traits that reflect investment into reproduction for both male and female lava crickets and compare them to the non-extremophile Allard's ground cricket (Allonemobius allardi) in the same sub-family. Lava cricket females possessed fewer, but much larger eggs than ground crickets, while males do not provide the costly nuptial gifts that are characteristic of the Nemobiinae subfamily. Lava crickets also have longer ovipositors relative to their body length than related Caconemobius species that occupy cave habitats on the Hawaiian islands. The differences in reproduction we report reveal how these little-known cricket species may increase survival of their offspring in the resource-deprived conditions of their hot, dry environments.

The Tumor Risk Score (TRS) - next level risk prediction in head and neck tumor surgery.

PURPOSE: Head and neck cancer surgery often requires postoperative monitoring in an intensive care unit (ICU) or intermediate care unit (IMC). With a variety of different risk scores, it is incumbent upon the investigator to plan a risk-adapted allocation of resources. Tumor surgery in the head and neck region itself offers a wide range of procedures in terms of resection extent and reconstruction methods, which can be stratified only vaguely by a cross-disciplinary score. Facing a variety of different risk scores we aimed to develop a new Tumor Risk Score (TRS) enabling anterograde preoperative risk evaluation, resource allocation and optimization of cost and outcome measurements in tumor surgery of the head and neck. METHODS: A collective of 547 patients (2010-2021) with intraoral tumors was studied to develop the TRS by grading the preoperative tumor size and location as well as the invasiveness of the planned surgery by means of statistical modeling. Two postoperative complications were defined: (1) prolonged postoperative stay in IMC/ICU and (2) prolonged total length of stay (LOS). Each parameter was analyzed using TRS and all preoperative patient parameters (age, sex, preoperative hemoglobin, body-mass-index, preexisting medical conditions) using predictive modeling design. Established risk scores (Charlson Comorbidity Index (CCI), American Society of Anesthesiologists risk classification (ASA), Functional Comorbidity Index (FCI)) and Patient Clinical Complexity Level (PCCL) were used as benchmarks for model performance of the TRS. RESULTS: The TRS is significantly correlated with surgery duration (p < 0.001) and LOS (p = 0.001). With every increase in TRS, LOS rises by 9.3% (95%CI 4.7-13.9; p < 0.001) or 1.9 days (95%CI 1.0-2.8; p < 0.001), respectively. For each increase in TRS, the LOS in IMC/ICU wards increases by 0.33 days (95%CI 0.12-0.54; p = 0.002), and the probability of an overall prolonged IMC/ICU stay increased by 32.3% per TRS class (p < 0.001). Exceeding the planned IMC/ICU LOS, overall LOS increased by 7.7 days (95%CI 5.35-10.08; p < 0.001) and increases the likelihood of also exceeding the upper limit LOS by 70.1% (95%CI 1.02-2.85; p = 0.041). In terms of predictive power of a prolonged IMC/ICU stay, the TRS performs better than previously established risk scores such as ASA or CCI (p = 0.031). CONCLUSION: The lack of a standardized needs assessment can lead to both under- and overutilization of the IMC/ICU and therefore increased costs and losses in total revenue. Our index helps to stratify the risk of a prolonged IMC/ICU stay preoperatively and to adjust resource allocation in major head and neck tumor surgery.

Medical Triage: Ethical Implications and Management Strategies.

Natural or man-made medical disasters have repeatedly affected human communities. The impact on health care resources may vary depending on the magnitude of each crisis, catastrophe or pandemic, and the resources available. Medical triage protocols serve as invaluable tools to address clinical needs, particularly when resources, including supplies, equipment, and personnel, are limited. Although resources should be allocated to maximize the benefit, resource allocations need to be ethically sound. Existing triage protocols have inherent limitations.

Monitoring resilience in bursts.

The possibility to anticipate critical transitions through detecting loss of resilience has attracted attention in many fields. Resilience indicators rely on the mathematical concept of critical slowing down, which means that a system recovers more slowly from external perturbations when it gets closer to tipping point. This decrease in recovery rate can be reflected in rising autocorrelation and variance in data. To test whether resilience is changing, resilience indicators are often calculated using a moving window in long, continuous time series of the system. However, for some systems, it may be more feasible to collect several high-resolution time series in short periods of time, i.e., in bursts. Resilience indicators can then be calculated to detect a change of resilience between such bursts. Here, we compare the performance of both methods using simulated data and showcase the possible use of bursts in a case study using mood data to anticipate depression in a patient. With the same number of data points, the burst approach outperformed the moving window method, suggesting that it is possible to downsample the continuous time series and still signal an upcoming transition. We suggest guidelines to design an optimal sampling strategy. Our results imply that using bursts of data instead of continuous time series may improve the capacity to detect changes in resilience. This method is promising for a variety of fields, such as human health, epidemiology, or ecology, where continuous monitoring can be costly or unfeasible.

Coupling coordination degree of healthcare resource supply, demand and elderly population change in China.

OBJECT: To analyze the trend of the coupling and coordination of the supply and demand of healthcare resources between the elderly population and healthcare resources in China during the period of 2012-2022, to reveal the impact of the growth of the elderly population on the relationship between the supply and demand of healthcare resources, and to put forward suggestions to improve the coupling and coordination between the supply and demand of healthcare resources and the elderly population, in order to cope with the challenges of an aging society. METHODS: By obtaining relevant data from authoritative data sources such as China Statistical Yearbook, Health and Health Statistics Yearbook, and the Chinese government website from 2012 to 2022, we constructed a comprehensive measurement index for the three systems of elderly population, healthcare resource supply, and healthcare resource demand; Using the entropy value method to assign weights to the indicators, combined with the coupling coordination degree model, to reveal the changes of the elderly population change and the supply and demand of medical and health resources; using ArcGIS technology, to study the spatial characteristics of the elderly population change and the supply and demand of medical and health resources. RESULTS: From 2012 to 2022, the supply and demand of healthcare resources and the variation of the elderly population in China show a continuous growth trend, and the comprehensive development level of the system gradually climbs from a low level to a high level. The fluctuation of coupling degree and coordination degree rises, although the coordination degree has always been lower than the coupling degree, but the distance between the coordination degree and the coupling degree gradually narrows with the passage of time. The coordination degree between population aging and medical and health resources development shows spatial heterogeneity in China, with the eastern region significantly higher than the western region/. CONCLUSIONS: The coupling degree between population aging and healthcare resource supply and demand in China from 2012 to 2022 shows a general upward trend from low coupling to medium-high coupling, but it is worth noting that even though the degree of coupling increases, the degree of coordination is still relatively lagging behind, suggesting that the government and relevant departments need to pay more attention to coordinated allocation and management of healthcare resources. At the same time, the spatial differences in the degree of coordination among provinces suggest that future policymakers should take regional differences into full consideration in policymaking and sustainable development.

Predictor Selection for Case Complexity Based on Routine Data for Needs-Based and Competence-Based Staff Planning.

Due to nursing staff shortage and growing nursing care demand, resource allocation and optimal task distribution have become primary concerns of nursing management. Grade mix analysis based on nursing interventions and nurse qualifications from routine patient documentation can support this. Case complexity is a key linking factor of nursing interventions, workload, and grade mix. This study determined case complexity predictors based on one year of routine patient documentation (n = 3,373 cases) from a Swiss hospital and predicted the patient clinical complexity level via weighted cumulative logistic regression models. Significant predictors were sex, age, pre-admission residence, admission type, self- care index, pneumonia risk, and number of nursing interventions. The models' accuracy is limited yet appropriate for applications such as needs- and competence- based staff-planning. After calibration via in-hospital data it could support nursing management in these tasks. The next step is now to test the model in a clinical setting.

Extreme functional specialization of fertile leaves in a widespread fern species and its implications on the evolution of reproductive dimorphism.

Resource allocation theory posits that organisms distribute limited resources across functions to maximize their overall fitness. In plants, the allocation of resources among maintenance, reproduction, and growth influences short-term economics and long-term evolutionary processes, especially during resource scarcity. The evolution of specialized structures to divide labor between reproduction and growth can create a feedback loop where selection can act on individual organs, further increasing specializaton and  resource allocation. Ferns exhibit diverse reproductive strategies, including dimorphism, where leaves can either be sterile (only for photosynthesis) or fertile (for spore dispersal). This dimorphism is similar to processes in seed plants (e.g., the production of fertile flowers and sterile leaves), and presents an opportunity to investigate divergent resource allocation between reproductive and vegetative functions in specialized organs. Here, we conducted anatomical and hydraulic analyses on Onoclea sensibilis L., a widespread dimorphic fern species, to reveal significant structural and hydraulic divergences between fertile and sterile leaves. Fertile fronds invest less in hydraulic architecture, with nearly 1.5 times fewer water-conducting cells and a nearly 0.5 times less drought-resistant xylem compared to sterile fronds. This comes at the increased relative investment in structural support, which may help facilitate spore dispersal. These findings suggest that specialization in ferns-in the form of reproductive dimorphism-can enable independent selection pressures on each leaf type, potentially optimizing spore dispersal in fertile fronds and photosynthetic efficiency in sterile fronds. Overall, our study sheds light on the evolutionary implications of functional specialization and highlights the importance of reproductive strategies in shaping plant fitness and evolution.