FireLossRate: An R package to estimate the loss rate of residential structures affected by wildfires at the Wildland Urban Interface.

To inform proactive management actions supporting community resilience to wildfires, we developed a new software package called FireLossRate. This package in R helps the user to compute wildfire impacts on residential structures at the Wildland Urban Interface (WUI). The package integrates spatial information about exposed structures, empirical equations that estimate the loss rate of structures affected by wildfires as a function of fireline intensity and distance from fire edge with fire growth modeling outputs from fire simulation software and burn probability models. FireLossRate helps to quantify and produce spatially explicit data on structural exposure and loss for single and multiple fires. The package automates post hoc analyses on simulations that include single or multiple wildfires and enables result mapping when combined with other packages available in R. In this paper, we describe the functionality of the FireLossRate package and introduce users to the interpretation of impact indicators of wildfires at the WUI. FireLossRate is available for download at https://github.com/LFCFireLab/FireLossRate.•FireLossRate allows the computation of wildfire impacts indicators on residential structures at the Wildland Urban Interface in support of community fire risk management.

A simulation model for predicting hospital occupancy for Covid-19 using archetype analysis.

COVID-19 pandemic has sent millions of people to hospitals worldwide, exhausting on many occasions the capacity of healthcare systems to provide care patients required to survive. Although several epidemiological research works have contributed a variety of models and approaches to anticipate the pandemic spread, very few have tried to translate the output of these models into hospital service requirements, particularly in terms of bed occupancy, a key question for hospital managers. This paper proposes a tool for predicting the current and future occupancy associated with COVID-19 patients of a hospital to help managers make informed decisions to maximize the availability of hospitalization and intensive care unit (ICU) beds and ensure adequate access to services for confirmed COVID-19 patients. The proposed tool uses a discrete event simulation approach that uses archetypes (i.e., empirical models of trajectories) extracted from empirical analysis of actual patient trajectories. Archetypes can be fitted to trajectories observed in different regions or to the particularities of current and forthcoming variants using a rather small amount of data. Numerical experiments on realistic instances demonstrate the accuracy of the tool's predictions and illustrate how it can support managers in their daily decisions concerning the system's capacity and ensure patients the access the resources they require.

A systematic literature review on the utilization of extended operating room hours to reduce surgical backlogs.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Introduction: Hospital managers address elective patient surgical backlogs with different strategies: increasing installed capacity, managing demand and improving efficiency. Recently, and particularly since the COVID-19 elective surgery suspension, extended operating room hours has been used to reduce waiting lists by taking advantage of empty operating rooms and existing surgical teams. Methods: Two research questions are raised: (1) which are the scientific literature's insights related to the use of extended operating room hours to help reduce surgery backlogs? and (2) provided that a hospital decides to extend its operating room opening time, what are the main challenges and the key aspects to consider in the design and implementation of policies to manage extended operating room hours? A systematic review on Web of Science database was conducted to gather existing literature, published from January 2012 to December 2021, regarding strategies to reduce waiting lists using empty operating rooms outside regular working hours. Results: A total of 12 papers were selected as relevant to address the two research questions. Results were organized according to their main features, namely setting, type of strategy, methodology, and how human resources are handled. Discussion: The review suggests that extended operating room hours might be problematic if current staff is used and that a careful choice of patients should be made. However, its potential to reduce waiting times and its implications are discussed only superficially. Therefore, we analyze the implications of extending operating room hours from four different perspectives (management, staff, patients, and strategy deployment) and define some recommendations for policy makers and healthcare managers when implementing it in practice.

Barriers and facilitators for implementation of a patient prioritization tool in two specialized rehabilitation programs.

INTRODUCTION AND AIMS: Prioritization tools aim to manage access to care by ranking patients equitably in waiting lists based on determined criteria. Patient prioritization has been studied in a wide variety of clinical health services, including rehabilitation contexts. We created a web-based patient prioritization tool (PPT) with the participation of stakeholders in two rehabilitation programs, which we aim to implement into clinical practice. Successful implementation of such innovation can be influenced by a variety of determinants. The goal of this study was to explore facilitators and barriers to the implementation of a PPT in rehabilitation programs. METHODS: We used two questionnaires and conducted two focus groups among service providers from two rehabilitation programs. We used descriptive statistics to report results of the questionnaires and qualitative content analysis based on the Consolidated Framework for Implementation Research. RESULTS: Key facilitators are the flexibility and relative advantage of the tool to improve clinical practices and produce beneficial outcomes for patients. Main barriers are the lack of training, financial support and human resources to sustain the implementation process. CONCLUSION: This is the first study that highlights organizational, individual and innovation levels facilitators and barriers for the implementation of a prioritization tool from service providers' perspective.

A systematic review of patient prioritization tools in non-emergency healthcare services.

BACKGROUND: Patient prioritization is a strategy used to manage access to healthcare services. Patient prioritization tools (PPT) contribute to supporting the prioritization decision process, and to its transparency and fairness. Patient prioritization tools can take various forms and are highly dependent on the particular context of application. Consequently, the sets of criteria change from one context to another, especially when used in non-emergency settings. This paper systematically synthesizes and analyzes the published evidence concerning the development and challenges related to the validation and implementation of PPTs in non-emergency settings. METHODS: We conducted a systematic mixed studies review. We searched evidence in five databases to select articles based on eligibility criteria, and information of included articles was extracted using an extraction grid. The methodological quality of the studies was assessed by using the Mixed Methods Appraisal Tool. The article selection process, data extraction, and quality appraisal were performed by at least two reviewers independently. RESULTS: We included 48 studies listing 34 different patient prioritization tools. Most of them are designed for managing access to elective surgeries in hospital settings. Two-thirds of the tools were investigated based on reliability or validity. Inconclusive results were found regarding the impact of PPTs on patient waiting times. Advantages associated with PPT use were found mostly in relationship to acceptability of the tools by clinicians and increased transparency and equity for patients. CONCLUSIONS: This review describes the development and validation processes of PPTs used in non-urgent healthcare settings. Despite the large number of PPTs studied, implementation into clinical practice seems to be an open challenge. Based on the findings of this review, recommendations are proposed to develop, validate, and implement such tools in clinical settings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018107205.

Accuracy of examination of the long head of the biceps tendon in the clinical setting: A systematic review.

OBJECTIVE: To determine the diagnostic validity of high-resolution ultrasound and orthopaedic special tests in diagnosing long head of the biceps tendon pathologies in patients with shoulder pain. DESIGN: Systematic review with meta-analysis tools. DATA SOURCES: MEDLINE, CINAHL and EMBASE. DATA EXTRACTION: Included studies had to report on the diagnostic validity of orthopaedic special tests or high-resolution ultrasound (HRUS) compared with a reference standard for diagnosing long head of the biceps tendon target conditions (superior labrum anterior and posterior lesions, long head of the biceps tendon tendinopathy, dislocation, effusion or rupture). Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) tool. RESULTS: Of the 30 included studies, 8 focused on high-resolution ultrasound and 22 on orthopaedic special tests. High-resolution ultrasound proved highly specific for the diagnosis of long head of the biceps tendon pathologies. Pooled positive (LR+) and negative (LR-) likelihood ratios were 38.00 and 0.24 for dislocation, respectively, and 35.50 and 0.30 for complete rupture, respectively. The accuracy of orthopaedic special tests varied greatly across studies. The only test of value was Yergason's ma-noeuvre in confirming proximal long head of the biceps tendon pathologies except superior labrum anterior and posterior lesion (high specificity): the summary LR+ and LR- were 2.56 and 0.70, respectively. CONCLUSION: High-resolution ultrasound is reliable to confirm suspected long head of the biceps tendon pathologies. There is insufficient evidence to recommend individual orthopaedic special tests.

Patient prioritization tools and their effectiveness in non-emergency healthcare services: a systematic review protocol.

BACKGROUND: Waiting lists should be managed as fairly as possible to ensure that patients with greater or more urgent needs receive services first. Patient prioritization refers to the process of ranking referrals in a certain order based on various criteria with the aim of improving fairness and equity in the delivery of care. Despite the widespread use of patient prioritization tools (PPTs) in healthcare services, the existing literature on this subject has mainly focused on emergency settings. Evidence has not been synthesized with respect to all the non-emergency services. METHODS: This review aims to perform a systematic synthesis of published evidence concerning (1) prioritization tools' characteristics, (2) their metrological properties, and (3) their effect measures across non-emergency services. Five electronic databases will be searched (Cochrane Library, Ovid/MEDLINE, Embase, Web of Science, and CINAHL). Eligibility criteria guiding data selection will be (1) qualitative, quantitative, or mixed methods empirical studies; (2) patient prioritization in any non-emergency setting; and (3) discussing characteristic, metrological properties, or effect measures. Data will be sought to report tool's format, description, population, setting, purpose, criteria, developer, metrological properties, and outcome measures. Two reviewers will independently screen, select, and extract data. Data will be synthesized with sequential exploratory design method. We will use the Mixed Methods Appraisal Tool (MMAT) to assess the quality of articles included in the review. DISCUSSION: This systematic review will provide much-needed knowledge regarding patient prioritization tools. The results will benefit clinicians, decision-makers, and researchers by giving them a better understanding of the methods used to prioritize patients in clinical settings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018107205.

Novel imprinted transcripts from the Dlk1-Gtl2 intergenic region, Mico1 and Mico1os, show circadian oscillations.

Most of the known imprinted genes are assembled into clusters that share common imprinting control regions (ICRs). Non-coding transcripts are often associated with ICRs and implicated in imprinting regulation. We undertook a systematic search for transcripts originating from the Dlk1-Gtl2 intergenic region that contains the ICR for the chromosome 12 imprinted cluster and identified two overlapping transcripts expressed from opposite strands exclusively from the maternal chromosome. These novel imprinted transcripts most likely represent non-coding RNAs and are located telomeric to the IG DMR, extending the proximal boundary of the region of maternal-specific transcription. Their expression is tissue-specific and shows diurnal and circadian oscillations.Therefore, we named these novel transcripts maternal intergenic circadian oscillating 1 (Mico1) and Mico1, opposite strand (Mico1os).

Expression of clock genes in human peripheral blood mononuclear cells throughout the sleep/wake and circadian cycles.

The rhythmic expression of circadian clock genes in the neurons of the suprachiasmatic nucleus (SCN) underlies the manifestation of endogenous circadian rhythmicity in behavior and physiology. Recent evidence demonstrating rhythmic clock gene expression in non-SCN tissues suggests that functional clocks exist outside the central circadian pacemaker of the brain. In this investigation, the nature of an oscillator in peripheral blood mononuclear cells (PBMCs) is evaluated by assessing clock gene expression throughout both a typical sleep/wake cycle (LD) and during a constant routine (CR). Six healthy men and women aged (mean+/-SEM) 23.7+/-1.6 yrs participated in this five-day investigation in temporal isolation. Core body temperature and plasma melatonin concentration were measured as markers of the central circadian pacemaker. The expression of HPER1, HPER2, and HBMAL1 was quantified in PBMCs sampled throughout an uninterrupted 72 h period. The core body temperature minimum and the midpoint of melatonin concentration measured during the CR occurred 2:17+/-0:20 and 3:24 +/-0:09 h before habitual awakening, respectively, and were well aligned to the sleep/wake cycle. HPER1 and HPER2 expression in PBMCs demonstrated significant circadian rhythmicity that peaked early after wake-time and was comparable under LD and CR conditions. HBMAL1 expression was more variable, and peaked in the middle of the wake period under LD conditions and during the habitual sleep period under CR conditions. For the first time, bi-hourly sampling over three consecutive days is used to compare clock gene expression in a human peripheral oscillator under different sleep/wake conditions.

The circadian regulation of Presenilin-2 gene expression.

Circadian rhythms are generated by a molecular clock composed of clock genes and their protein products. Other genes are regulated in a rhythmic way by this molecular clockwork, but are not themselves constituents of the clock. This study shows that one of these clock-controlled genes encodes the signalling protein Presenilin-2. Indeed, evidence is presented that the promoter of the mouse Presenilin-2 gene is bound and activated by CLOCK and BMAL1, transcription factors of the mammalian circadian clock. Quantification of Presenilin-2 RNA shows that its expression is non-rhythmic in many peripheral tissues (heart, muscle, kidney, spleen, and thymus). Note, though, that careful analysis of the liver data shows that Presenilin-2 RNA exists in distinct isoforms in this tissue, and that rhythmicity is restricted to only a subset of these RNA isoforms. These data indicate a unique mode of regulation of Presenilin-2 transcripts, the circadian control of which appears to happen at the transcriptional and post-transcriptional levels.