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1.
Sustain Cities Soc ; 97: 104702, 2023 Oct.
Article in English | MEDLINE | ID: mdl-37360282

ABSTRACT

The excessive traffic congestion in vehicles lowers the service quality of urban bus system, reduces the social distance of bus passengers, and thus, increases the spread speed of epidemics, such as coronavirus disease. In the post-pandemic era, it is one of the main concerns for the transportation agency to provide a sustainable urban bus service to balance the travel convenience in accessibility and the travel safety in social distance for bus passengers, which essentially reduces the in-vehicle passenger congestion or smooths the boarding-alighting unbalance of passengers. Incorporating the route choice behavior of passengers, this paper proposes a sustainable service network design strategy by selecting one subset of the stops to maximize the total passenger-distance (person × kilometers) with exogenously given loading factor and stop-spacing level, which can be captured by constrained non-linear programming model. The loading factor directly determines the in-vehicle social distance, and the stop-spacing level can efficiently reduce the ridership with short journey distance. Therefore, the sustainable service network design can be used to help the government minimize the spread of the virus while guaranteeing the service quality of transport patterns in the post-pandemic era. A real-world case study is adopted to illustrate the validity of the proposed scheme and model.

2.
Int J Public Health ; 68: 1605015, 2023.
Article in English | MEDLINE | ID: mdl-36926284

ABSTRACT

Objective: This study assesses a multi-period capacitated maximal-covering location-allocation model for healthcare services, taking interservice referral as well as equity access into account. Methods: A two-stage optimization strategy is used to formulate the model. In the first stage, facilities are located to maximize covered demand, and in the second stage, patients are allocated to capacitated facilities based on their radius of coverage over multiple time periods. The problem, which belongs to the NP-hard class of optimization problems, is solved using a linear mixed-integer programming (MILP) model. Results: A numerical example is presented to evaluate the efficiency of the proposed model. In addition, to identify near-optimal solutions for large instances, a hybrid genetic-sequential quadratic programming approach (GA-SQP) is developed. To examine the performance and efficiency of the GA-SQP, we employed several randomly generated test instances of various sizes and compared them to those obtained using the exact method. Conclusion: The proposed model has demonstrated an excellent ability in locating healthcare facilities and allocating health services while taking shortage and equity into account during each time period.


Subject(s)
Health Facilities , Models, Theoretical , Humans , Delivery of Health Care , Algorithms
3.
Sensors (Basel) ; 22(23)2022 Nov 26.
Article in English | MEDLINE | ID: mdl-36501890

ABSTRACT

The transmission of satellite payload data is critical for services provided by aerospace ground networks. To ensure the correctness of data transmission, the TCP data transmission protocol has been used typically. However, the standard TCP congestion control algorithm is incompatible with networks with a long time delay and a large bandwidth, resulting in low throughput and resource waste. This article compares recent studies on TCP-based acceleration algorithms and proposes an acceleration algorithm based on the learning of historical characteristics, such as end-to-end delay and its variation characteristics, the arrival interval of feedback packets (ACK) at the receiving end and its variation characteristics, the degree of data packet reversal and its variation characteristics, delay and jitter caused by the security equipment's deep data inspection, and random packet loss caused by various factors. The proposed algorithm is evaluated and compared with the TCP congestion control algorithms under both laboratory and ground network conditions. Experimental results indicate that the proposed acceleration algorithm is efficient and can significantly increase throughput. Therefore, it has a promising application prospect in high-speed data transmission in aerospace-ground service networks.


Subject(s)
Algorithms , Computer Communication Networks , Feedback , Acceleration
4.
Front Bioeng Biotechnol ; 10: 865130, 2022.
Article in English | MEDLINE | ID: mdl-35445001

ABSTRACT

In this paper, a multidisciplinary cross-fusion of bionics, robotics, computer vision, and cloud service networks was used as a research platform to study wide-field bionic compound eye target recognition and detection from multiple perspectives. The current research status of wide-field bionic compound-eye target recognition and detection was analyzed, and improvement directions were proposed. The surface microlens array arrangement was designed, and the spaced surface bionic compound eye design principle cloud service network model was established for the adopted spaced-type circumferential hierarchical microlens array arrangement. In order to realize the target localization of the compound eye system, the content of each step of the localization scheme was discussed in detail. The distribution of virtual spherical targets was designed by using the subdivision of the positive icosahedron to ensure the uniformity of the targets. The spot image was pre-processed to achieve spot segmentation. The energy symmetry-based spot center localization algorithm was explored and its localization effect was verified. A suitable spatial interpolation method was selected to establish the mapping relationship between target angle and spot coordinates. An experimental platform of wide-field bionic compound eye target recognition and detection system was acquired. A super-resolution reconstruction algorithm combining pixel rearrangement and an improved iterative inverse projection method was used for image processing. The model was trained and evaluated in terms of detection accuracy, leakage rate, time overhead, and other evaluation indexes, and the test results showed that the cloud service network-based wide-field bionic compound eye target recognition and detection performs well in terms of detection accuracy and leakage rate. Compared with the traditional algorithm, the correct rate of the algorithm was increased by 21.72%. Through the research of this paper, the wide-field bionic compound eye target recognition and detection and cloud service network were organically provide more technical support for the design of wide-field bionic compound eye target recognition and detection system.

5.
BMC Cancer ; 22(1): 26, 2022 Jan 03.
Article in English | MEDLINE | ID: mdl-34980028

ABSTRACT

BACKGROUND: Breast cancer incidence in Northern Thailand has shown a continuous increase since records began in 1983. In 2002 the urgency of the situation prompted Maharaj Nakorn Chiang Mai Hospital to initiate the Suandok Breast Cancer Network (SBCN). METHODS: The SBCN is a not-for-profit organization in the university hospital which serves as a training and education center and provides highly specialized medical care for patients in Chiang Mai and in 5 provinces of northern Thailand, with the key mission of improving breast cancer care. The short-term goal was to overcome the barriers to engagement with breast cancer and its treatment and the long-term goal was to increase the overall survival rate of breast cancer patients in our region. RESULTS: We enrolled breast cancer patients treated at Maharaj Nakorn Chiang Mai Hospital between January 2006 and December 2015 and divided into 2 cohorts: 1485 patients who were diagnosed from 2006 to 2009 (cohort 1: early implementation of SBCN) and 2383 patients who were diagnosed from 2010 to 2015 (cohort 2: full implementation of SBCN). Criteria to measure improved cancer waiting time (CWT) would include: time to diagnosis, time to surgery, and time to radiotherapy. The 5-year overall survival (OS) of the cohort 2 was higher than that in cohort 1, at 73.8 (72.0-75.5) compared to 71.5 (69.2-73.7) (p-value = 0.03). CONCLUSIONS: Reasons behind the success of project include the uniformity of care encouragement, service network development and timely access to each step of breast cancer management. The model used in SBCN could be adopted as a learning guide to improve healthcare access and outcome for breast cancer patients in low- to middle-income countries.


Subject(s)
Breast Neoplasms/therapy , Community Networks , Delivery of Health Care/methods , Health Plan Implementation , Health Services Accessibility/organization & administration , Adult , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Developing Countries , Female , Hospitals, University , Humans , Incidence , Middle Aged , Retrospective Studies , Survival Rate , Thailand/epidemiology , Time-to-Treatment/statistics & numerical data
6.
Ann Oper Res ; 319(1): 463-516, 2022.
Article in English | MEDLINE | ID: mdl-34024978

ABSTRACT

Despite the fact that medical responses are crucial for saving precious lives during any humanitarian crisis (e.g., the COVID-19 pandemic), healthcare infrastructure in many communities are partially covered or are not covered yet. In order to strengthen the health system response to such crisis, especially in low- to middle-income communities, this paper extends a novel multi-objective model for designing a health service network under uncertainty which simultaneously considers efficiency, social responsibility, and network cost. For efficiency, a modified data envelopment analysis model is introduced and inserted into the proposed model to decrease the inefficiency of healthcare facilities belonging to the different tiers of the health system. For social responsibility, two measures of job creation and balanced development are incorporated into the extended model. This is not only considered to cope with the increased numbers of patients and disaster victims to healthcare facilities but also to deal with the challenge of the economy and the livelihoods of people during the crisis. Moreover, a novel mixed possibilistic-flexible robust programming (MPFRP) approach is developed to protect the considered network against uncertainty. To show the applicability of the extended model, a real-world case study is presented. The results reveal that contrary to fuzzy programming models, the MPFRP performs well in terms of social responsibility (72%), cost (8%), and efficiency (28%) and is able to make a trade-off between these three measures. In this study, the resilience level of the designed network is not addressed while disregarding any short-term stoppage owing to internal or external sources of disruption in designing may bring about a considerable loss.

7.
IFAC Pap OnLine ; 55(10): 2914-2919, 2022.
Article in English | MEDLINE | ID: mdl-38620794

ABSTRACT

The advent of the Covid-19 pandemic has posed severe challenges to health care networks in various countries. The overcrowding of hospitals and the lack of medical staff and beds in multiple wards are among the main problems of governments. A new virus wave also exacerbates these problems. Also, the lack of information and the variability of the incidence rate and severity of the disease in different waves make it difficult to estimate the number of patients accurately. In this respect, this study develops a mixed-integer linear programming model to reorganize the medical service network. A fuzzy approach is employed to estimate the number of patients in each period. The result obtained from the model, apart from preventing the shortage of hospital beds, demonstrates a 60% reduction in visits to these centers.

8.
Aletheia ; 54(1): 126-135, jan.-jun. 2021. ilus, tab
Article in Portuguese | LILACS-Express | LILACS, Index Psychology - journals | ID: biblio-1285027

ABSTRACT

RESUMO A violência contra a mulher é considerada mundialmente como um problema de saúde pública e a América Latina tem sido apontada como a região de maior incidência deste tipo de violação. Esta revisão sistemática objetivou investigar a produção científica latino-americana sobre serviços de atendimento à mulher vítima de violência que incluam psicólogos em suas equipes. Foram realizadas buscas nas bases de dados Scielo, Lilacs, e Portal Capes, com os descritores "violência contra a mulher", "violência doméstica contra a mulher", "psicologia", "psicología", "violencia contra las mujeres", "violencia doméstica contra la mujer". Considerou-se apenas artigos publicados na América Latina, nos idiomas português e espanhol, durante os últimos 5 anos. No total, 10 estudos foram analisados na íntegra. Esta revisão permitiu constatar que ainda há lacunas na rede de atendimento, que dizem respeito não apenas à atuação do psicólogo, mas também às diferentes áreas que compõem as redes de acolhimento à mulher.


ABSTRACT Violence against women is considered worldwide as a public health problem and Latin America has been identified as the region with the highest incidence of this type of violation. This systematic review aims to investigate the Latin American scientific production on care services that include Psychology professionals in their teams for women who have been victims of violence. Searches were carried out in the databases of Scielo, Lilacs and Portal Capes, with the descriptions "violence against women", "domestic violence against women", "psychology", "psicología", "violencia contra las mujeres", "violencia doméstica contra la mujer". Only articles published in Latin America, in Portuguese and Spanish, in the last 5 years, have been considered. In total, 10 studies were analyzed in their entirety. This review showed that there are still gaps in the care network of these cases, which concern not only the role of the psychologist, but also the different areas that make up the networks for the support of women.

9.
J Gastrointest Surg ; 25(3): 593-602, 2021 03.
Article in English | MEDLINE | ID: mdl-32500419

ABSTRACT

BACKGROUND: While there have been many outcome studies on paraesophageal hernia repair in the civilian population, there is sparse recent data on the veteran population. This study analyzes the mortality and morbidities of veterans who underwent paraesophageal hernia repair in the Veterans Affairs Surgical Quality Improvement Program database. METHODS: Veterans who underwent paraesophageal hernia repair from 2010 to 2017 were identified using Current Procedural Terminology codes. Multivariable analysis was used to compare laparoscopic and open, including abdominal and thoracic approaches, groups. The outcomes were postoperative complications and mortality. RESULTS: There were 1607 patients in the laparoscopic group and 366 in the open group, with 84.1% men and mean age of 61 years. Gender and body mass index did not influence the type of surgical approach. The mortality rates at 30 and 180 days were 0.5% and 0.7%, respectively. Postoperative complications, including reintubation (2.2%), pneumonia (2.0%), intubation > 48 h (2.0%), and sepsis (2.0%) were higher in the open group (15.9% versus 7.2%, p < 0.001). The laparoscopic group had a significantly shorter length of stay (4.3 versus 9.6 days, p < 0.001) and a lower percentage of return to surgery within 30 days (3.9% versus 8.2%, p < 0.001) than the open group. The ratio of open versus laparoscopic paraesophageal hernia repairs varied significantly by different Veterans Integrated Services Network regions. CONCLUSIONS: Veterans undergoing laparoscopic paraesophageal hernia repair experience similar outcomes as patients in the private sector. Veterans who underwent laparoscopic paraesophageal hernia repair had significantly less complications compared to an open approach even after adjusting for patient comorbidities and demographics. The difference in open versus laparoscopic practices between various regions requires further investigation.


Subject(s)
Hernia, Hiatal , Laparoscopy , Veterans , Female , Hernia, Hiatal/surgery , Herniorrhaphy/adverse effects , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Quality Improvement , Treatment Outcome
10.
Health Equity ; 2(1): 174-181, 2018.
Article in English | MEDLINE | ID: mdl-30283865

ABSTRACT

Background: Artificial intelligence (AI) is a rapidly developing computer technology that has begun to be widely used in the medical field to improve the professional level and efficiency of clinical work, in addition to avoiding medical errors. In developing countries, the inequality between urban and rural health services is a serious problem, of which the shortage of qualified healthcare providers is the major cause of the unavailability and low quality of healthcare in rural areas. Some studies have shown that the application of computer-assisted or AI medical techniques could improve healthcare outcomes in rural areas of developing countries. Therefore, the development of suitable medical AI technology for rural areas is worth discussing and probing. Methods: This article reviews and discusses the literature concerning the prospects of medical AI technology, the inequity of healthcare, and the application of computer-assisted or AI medical techniques in rural areas of developing countries. Results: Medical AI technology not only could improve physicians' efficiency and quality of medical services, but other health workers could also be trained to use this technique to compensate for the lack of physicians, thereby improving the availability of healthcare access and medical service quality. This article proposes a multilevel medical AI service network, including a frontline medical AI system (basic level), regional medical AI support centers (middle levels), and a national medical AI development center (top level). Conclusion: The promotion of medical AI technology in rural areas of developing countries might be one means of alleviating the inequality between urban and rural health services. The establishment of a multilevel medical AI service network system may be a solution.

11.
Psicol. ciênc. prof ; 37(4): 939-955, out.- dez. 2017. tab
Article in Portuguese | LILACS, Index Psychology - journals | ID: biblio-884028

ABSTRACT

A violência nas relações conjugais tem sido alvo de diferentes políticas públicas, em dispositivos organizados na perspectiva do trabalho em rede. O presente estudo, exploratório e qualitativo, buscou conhecer a percepção de psicólogos(as) que trabalham nestes dispositivos, acerca do fenômeno da violência conjugal, das políticas públicas na área e inserção de psicólogos(as) na rede de atendimento. Participaram oito profissionais que responderam a uma entrevista semiestruturada. Identificou-se o predomínio da compreensão feminista sobre o fenômeno. Ademais, a violência conjugal foi considerada complexa e influenciada por questões socioeconômicas. Os participantes aferiram aspectos sobre manifestações da violência e seu ciclo, referindo que se trata de uma demanda pouco atendida em seus locais de trabalho. No que tange às políticas públicas, foram consideradas insuficientes para o atendimento da demanda e permeada por dificuldades de delimitação dos papéis e funções nos serviços. Consideram que ocorrem sobreposições de intervenções na rede de atendimento, que se mostra fragmentada e pouco articulada. Propõem-se reflexões acerca das potencialidades da Psicologia para fortalecimento da rede de atendimento e garantia de direitos para pessoas que vivenciam violência conjugal....(AU)


Violence in conjugal relationships has been addressed by different public policies through social assistance devices organized from a network perspective. This exploratory qualitative study aimed to know how psychologists who work in these devices perceive conjugal violence, related public policies and the psychologist's insertion in the service network. Eight professionals responded to a semi-structured interview. We identified predominant feminist comprehension towards the phenomenon. Conjugal violence was considered complex and influenced by socioeconomic issues. Participants evaluated aspects on manifestations of violence and its cycle, reporting that this demand is not frequently met in their workplace. Concerning public policies, they were considered insufficient to meet the demands and permeated by difficulties in delimitating roles and functions in the services. Participants indicated overlapping interventions in the service network, which appears to be fragmented and scarcely articulated. We propose reflections on the potentiality of psychology to strengthen the network and guarantee the rights of people experiencing conjugal violence....(AU)


La violencia en las relaciones de pareja ha sido objeto de políticas públicas, organizadas en la perspectiva de dispositivos en redes. Este estudio, de carácter exploratorio y cualitativo, tuvo como objetivo conocer la percepción de los psicólogos que trabajan en estos dispositivos, sobre el fenómeno de la violencia doméstica, las políticas públicas en el área y la inserción de los psicólogos en la red de servicios. Los participantes fueron ocho profesionales que respondieron a una entrevista semiestructurada. Se identificó el dominio de la comprensión feminista del fenómeno. Por otra parte, la violencia doméstica fue considerada compleja e influenciada por cuestiones socioeconómicas. Los participantes han evaluado aspectos de las manifestaciones de la violencia y su ciclo, señalando que es poca la demanda en sus lugares de trabajo. Las políticas públicas fueron consideradas insuficientes para satisfacer a la demanda y permeadas por las dificultades en la definición de los roles y funciones de los servicios. Los entrevistados consideran que las intervenciones se sobreponen en la red de servicios, que aparece fragmentada y mal articulada. Se proponen reflexiones sobre las posibilidades de la psicología para el fortalecimiento de la red de servicios y garantía de derechos a las personas que sufren violencia doméstica....(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Professional Practice , Psychology , Violence
12.
Child Abuse Negl ; 70: 53-64, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28558323

ABSTRACT

The aim of this study was to present the dynamics of sexual violence against boys. Interviews were conducted with four male victims of sexual abuse between the ages of six and 10, as well as four psychologists employed in the health care system and involved in the treatment of sexually abused boys. Results were examined using thematic content analysis, based on six deductively identified themes corresponding to the following stages of sexual violence against children and adolescents: preparation, episodes, silencing, narratives, repression and overcoming. The results suggested that proximity between victims and offenders, who were mostly adolescent boys, was a facilitator of abuse. The interviews also revealed that victims faced significant levels of disbelief and discrimination. Lastly, the findings pointed to the importance of protective actions and of the system itself, though all practitioners perceived the latter as flawed and unprepared to handle cases involving sexually abused boys. These findings underscore the social invisibility of sexual violence against boys, due to the low number of referrals as well as the disbelief and discrimination, which permeates the management of these cases.


Subject(s)
Child Abuse, Sexual , Sex Factors , Social Discrimination , Brazil , Child , Child Abuse, Sexual/statistics & numerical data , Family , Humans , Male , Psychology
13.
J Community Health ; 42(2): 358-368, 2017 Apr.
Article in English | MEDLINE | ID: mdl-27896504

ABSTRACT

As of October 2016, use of federal Older Americans Act funds for health promotion and disease prevention will be restricted to the Administration on Aging's criteria for high-level evidence-based health promotion programs. Dissemination of these programs to rural communities remains limited. Therefore a strong need exists to identify strategies that facilitate program implementation and sustainability. The objective of this study was to compare organizational readiness and implementation strategies used by rural communities that achieved varying levels of success in sustaining evidence-based health promotion programs for older adults. We utilized a qualitative multi-site case study design to analyze the longitudinal experiences of eight rural sites working to implement evidence-based health promotion program over 3 years (8/2012-7/2015). Multiple sources of data (interviews, documents, reports, surveys) from each site informed the analysis. We used conventional content analysis to conduct a cross-case comparison to identify common features of rural counties that successfully implemented and sustained their target evidence-based health promotion program. Readiness to implement evidence-based programs as low at baseline as all site leaders described needing to secure additional resources for program implementation. Sites that successfully utilized six essential resources implemented and sustained greater numbers of workshops: (1) External Partnerships, (2) Agency Leadership Commitment, (3) Ongoing Source of Workshop Leaders, (4) Health Promotion Coordination Tasks Assigned to Specific Staff, (5) Organizational Stability, and (6) Change Team Engagement. The six essential resources described in this study can help rural communities assess their readiness to implement health promotion programs and work secure the resources necessary for successful implementation.


Subject(s)
Health Promotion/organization & administration , Aged , Education , Evidence-Based Practice/methods , Evidence-Based Practice/organization & administration , Health Promotion/methods , Humans , Local Government , Longitudinal Studies , Organizational Case Studies , Program Development , Program Evaluation , Wisconsin
14.
Rev. Kairós ; 19(4): 343-361, mar. 2016. tab
Article in Portuguese | LILACS, Index Psychology - journals | ID: biblio-948069

ABSTRACT

Este trabalho tem como objetivo investigar a rede de atendimento comunitário a idosos em Florianópolis (SC), por meio da estratégia dos Grupos de Convivência para Idosos (GCI), apresentando seu processo de criação e de desenvolvimento histórico e sociocultural, assim como a evolução no número de grupos e de idosos participantes. Realizou-se uma pesquisa bibliográfica, descritivo-exploratória e de levantamento, com abordagens qualitativa e quantitativa dos dados. Aplicaram-se entrevistas semiestruturadas com quatro assistentes sociais que participaram do processo de implementação da estratégia de GCI na cidade. Constatou-se a criação formal desses grupos, vinculada e impulsionada, principalmente, por órgãos governamentais da área da assistência social, sendo que, ao longo dos anos, o número de GCI e de participantes aumentou expressivamente em Florianópolis (SC).


This study aims to investigate the community service network for the elderly in Florianópolis (SC), through the strategy of Community Centers for the Elderly (CCEs), presented their process of creation and history and socio-cultural development, including also the increase in the number of groups and elderly participants. We conducted a literature search, descriptive and exploratory and survey with qualitative and quantitative approaches to data. They were applied semi-structured interviews with four social workers who participate in the implementation process of CCEs strategy in the city. the formal establishment was found these groups, bound and driven mainly by government agencies of the social assistance area, and, over the years, the number of CCEs and participants increased significantly in Florianópolis (SC).


Este trabajo tiene como objetivo investigar la red de atención comunitaria a ancianos en Florianópolis (SC), a través de la estrategia de los Grupos de Convivencia para los ancianos (GCI), presentando su proceso de creación y de desarrollo histórico y sociocultural, así como la evolución en el número de grupos y de ancianos participantes. Se realizó una investigación bibliográfica, descriptiva-exploratoria y de levantamiento, con abordajes cualitativo y cuantitativo de los datos. Se aplicaron entrevistas semiestructuradas con cuatro asistentes sociales que participaron en el proceso de implementación de la estrategia de GCI en la ciudad. Se constató la creación formal de estos grupos, vinculada e impulsada, principalmente, por organismos gubernamentales del área de la asistencia social, siendo que a lo largo de los años, el número de GCI y de participantes aumentó expresivamente en Florianópolis (SC).


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Social Participation/psychology , Senior Centers/organization & administration , Policy Making , Public Policy , Qualitative Research
15.
Chinese Hospital Management ; (12): 26-28, 2016.
Article in Chinese | WPRIM (Western Pacific) | ID: wpr-512523

ABSTRACT

Objective To analyze the coordination and continuity of service delivery for hypertension patients in rural health network,so as to provide references for improving integrated service utilization.Methods Self-developed questionnaire of service coordination and continuity delivery according to the research literature at home and abroad was used as the tool,and the data was analyzed by descriptive statistics.Results 49.6% patients were accompanied by one or more diseases.About 73.0% had seeking care experience in township health centers.Patients with seeking care to two or more medical institutions accounted for 51.3%.Recommending referral institutions for patients with poor therapeutic effect by grassroots doctors were the biggest proportion with 28.4% and 68.7% respectively.The proportion that superior doctors treating patients according to the related information from subordinate institutions was less than 43.0%,the proportion that junior doctors continuing to treat referral patients according to early diagnosis and treatment information was just over 40%.Easier upward referral but harder downward referral also existed among medical settings of different levels.Conclusion The disease characteristics of rural patients increased the possibility of seeking care among vertical medical institutions,but the level of continuity and coordination service delivery was not high in this network.So all-sided service integration to rural tertiary health institutions should be strengthened.

16.
Prehosp Disaster Med ; 30(3): 233-8, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25783663

ABSTRACT

PROBLEM: Hospital-evacuation decisions are rarely straightforward in protracted advance-warning events. Previous work provides little insight into the decision-making process around evacuation. This study was conducted to identify factors that most heavily influenced the decisions to evacuate the US Department of Veterans Affairs (VA) New York Harbor Healthcare System's (NYHHS; New York USA) Manhattan Campus before Hurricane Irene in 2011 and before Superstorm Sandy in 2012. METHODS: Semi-structured interviews with 11 senior leaders were conducted on the processes and factors that influenced the evacuation decisions prior to each event. RESULTS: The most influential factor in the decision to evacuate the Manhattan Campus before Hurricane Irene was New York City's (NYC's) hospital-evacuation mandate. As a federal facility, the Manhattan VA medical center (VAMC) was exempt from the city's order, but decision makers felt compelled to comply. In the case of Superstorm Sandy, corporate memory of a similar 1992 storm that crippled the Manhattan facility drove the decision to evacuate before the storm hit. CONCLUSIONS: Results suggest that hospital-evacuation decisions are confounded by political considerations and are influenced by past disaster experience. Greater shared situational awareness among at-risk hospitals, along with a more coordinated approach to evacuation decision making, could reduce pressure on hospitals to make these high-stakes decisions. Systematic mechanisms for collecting, documenting, and sharing lessons learned from past disasters are sorely needed at the institutional, local, and national levels.


Subject(s)
Cyclonic Storms , Decision Making, Organizational , Emergency Shelter , Hospitals , Politics , Transportation of Patients , Disaster Planning , Humans , Interviews as Topic , New York City , Public Opinion
17.
Vaccine ; 31 Suppl 10: K88-97, 2013 Dec 30.
Article in English | MEDLINE | ID: mdl-24331079

ABSTRACT

PURPOSE: To review algorithms used to identify uveitis in administrative and claims databases. METHODS: We searched the MEDLINE database via PubMed from 1991 to September 2012 using vocabulary and key terms related to uveitis. We also searched the reference lists of included studies. Two investigators independently assessed studies against pre-determined inclusion criteria. The same two investigators independently extracted data regarding participant and algorithm characteristics and assessed a study's methodological rigor using a pre-defined approach. RESULTS: Seven studies met inclusion criteria. Variability exists among algorithms employed in these studies for finding cases of uveitis and related conditions as well as in use and implementation of validation methods. Of the seven included studies, three involved case validation. One used a narrow algorithm in addition to text mining of electronic medical records to identify incident cases and found a positive predictive value of 52.1%. The other two, which used broader uveitis definitions and included both incident and prevalent cases, found positive predictive values of 24.8% and 52.6%. CONCLUSIONS: Further research, with case as well as individual code validation, is needed to determine appropriate uveitis algorithms for purposes of active surveillance in administrative data. Decisions about which algorithm to use will depend on the desired balance of sensitivity and specificity.


Subject(s)
Databases, Factual/statistics & numerical data , Epidemiologic Methods , Insurance Claim Review/statistics & numerical data , International Classification of Diseases/statistics & numerical data , Uveitis/epidemiology , Algorithms , Humans , Incidence
18.
Ciênc. Saúde Colet. (Impr.) ; 16(3): 1671-1680, mar. 2011. tab
Article in Portuguese | LILACS | ID: lil-582466

ABSTRACT

Este trabalho versa sobre a construção das redes interfederativas de saúde, compostas pelos entes federativos que, conjuntamente, devem gerir, de maneira coordenada e compartilhada, um sistema de saúde único, de âmbito nacional. Discorre ainda sobre os elementos necessários à construção da rede e à sua operacionalização, como os colegiados, os consensos interfederativos e os contratos administrativos organizativos.


The present paper deals with the construction of health interfederal networks, composed by each federate organization that together will manage nationwide the Unified Health System in a shared and coordinated way. It also ranks the necessary conceptual elements to the network construction and adequate operation like local management boards, interfederal board of trustees and administrative organizational contracts.


Subject(s)
Humans , Community Networks , Delivery of Health Care/organization & administration , Public Health Administration , Brazil
19.
Article in Chinese | WPRIM (Western Pacific) | ID: wpr-412432

ABSTRACT

Through the analysis of the problems of health service delivery system in rural areas and the causes of the abnormal operation of the three-tier rural health service network, this article probed into the continuity of health service in rural China. These issues are observed from the aspects of continuity of disciplines, institutions, relationship and health information. Policy recommendations include remolding the institutional relations in the three-tier rural health service network, constructing reasonable supporting environment and improving the health delivery quality.

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