scholarly journals Advanced Virtual Support for Operational Forces: A 3-Year Summary

2021 ◽  
Author(s):  
Robert D McLeroy ◽  
Michael T Kile ◽  
Daniel Yourk ◽  
Sean Hipp ◽  
Jeremy C Pamplin
Keyword(s):  
Critical Care ◽  
Return On Investment ◽  
Demographic Data ◽  
Financial Return ◽  
Telemedicine System ◽  
Military Health ◽  
Medical Specialties ◽  
Patient Disposition ◽  
The Government ◽  
Virtual Support

ABSTRACT Introduction The Military Health System mission is to provide medical care throughout the globe to service members and beneficiaries. To achieve this mission in the most austere of locations, telemedical support is an essential force multiplier when robust in-person medical support is not feasible. This led to the development of a telemedical solution initially known as the Virtual Critical Care Consultation service which provided tele-critical care assistance to downrange providers. The VC3 system then expanded to include multiple medical specialties available for consultation. The current version of this telemedical solution is the ADvanced VIrtual Support for OpeRational Forces (ADVISOR) program which is a synchronous and asynchronous telemedicine system that was developed to provide 24/7 remote expert support to military clinicians engaged in casualty care in austere and operational environments. Materials and Methods This manuscript reviews the ADVISOR program data collected from 2017 to 2020 and provides a rough order of magnitude for return on investment. We reviewed data collected by Operational Virtual Health Reports and Operational Virtual Health Evaluations following synchronous consultations. Part of the data reviewed was available patient demographic data, local caregiver information, the purpose of the consult, recommendations made during the consult, the technology used during the consult, and the patient disposition. They also recorded the evacuation plan for the patient and whether a medical evacuation was escalated (e.g. changed from routine to urgent, or from urgent to critical care air transport), downgraded (e.g. urgent to routine), or avoided altogether based on the telephonic consultation. Results There were a total of 156 real-world calls during the evaluation period. The total cost savings for these calls was $1,097,027 (3-year program costs of $909,973 less an average of $87,261+/- $28,633 per call or $2,007,000 total) from downgrading or avoidance of planned evacuations. The unmeasured value associated with ADVISOR consultations should also be commented on. For example, when evacuation plans are escalated based on remote expert consultation, it is probable that the escalation increases patient safety and may avoid medical complications that would result in longer term medical costs to the government. Conclusions Based on the collected information, the financial return on investment has exceeded costs and the system is perceived as being valued added for both local caregivers and remote experts. The system appears to help optimize evacuation planning, specifically by downgrading or eliminating unnecessary evacuations.

Demographic changes and savings behavior: the experience of a developing country

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ebrahim Rezaei
Keyword(s):  
Time Series ◽  
Demographic Data ◽  
Calculated Data ◽  
The Other ◽  
Demographic Changes ◽  
Savings Behavior ◽  
Content Type ◽  
Household Level ◽  
Savings Rate ◽  
The Government

PurposeThis paper aims to disclose the savings behavior of Iran's economy in the context of demographic transition.Design/methodology/approachEmploying a version of Ramsey-Cass-Koopmans growth model, this paper benefits from a broad range of data and variables which are mainly taken from the Central Bank of Iran's database. The study uses actual and calculated data to produce analogous simulated data. The data cover the 1970–2015 period. This long period provides an opportunity to simulate more valid time series. It is worth noting that due to the severe economic sanctions imposed on the Iran's economy, particularly after 2017, some most recent data have been obliterated from the sample.FindingsThe results, stemming from the simulated model, hint that; firstly, the population variable is a notable determinant of the savings rate. Secondly, the effects of a slump in the population growth rate would attenuate the savings level significantly. Thirdly, other pragmatic steps could be taken to redress the fallout of the demographic changes.Research limitations/implicationsThere are some limitations in providing broad data related to economic sectors in Iran. The savings data, for instance, are available as an aggregated time series, and if the authors had wide data of household level, they would have been able to build more detail-based model. Similar to this issue of lack of households’ income-based data, some measures such as high or low levels as well as detailed demographic data could be helpful in sophisticated household level resulting. In addition, the complex relationship between the government and social security (pension) funds, in terms of financing part of government's budget deficit by these funds, thwarts a typical researcher in using comprehensive and transparent government expenditure data in their research. In other words, the possible positive or negative role of the funds, as a related issue to the demographic changes, cannot simply be determined in the model. It might be possible after necessary corrections are carried out in the mentioned relations.Originality/valueIn fact, the problem statement in this paper is to discern how the population aging can impact the saving rates on the one hand, and to what extent its repercussion can be modified by the other theoretical-based determinants on the other. In fact, the underlying argument of the present research arises from the stylized facts concerning prognosticates of the future evolutions of the world's population. To that end, the study will use Iran's economic and demographic data.

scholarly journals Emergency medicine as a career choice: a descriptive study of Canadian medical students

CJEM ◽  
2009 ◽  
Vol 11 (03) ◽  
pp. 196-206 ◽  
Author(s):  
Ian M. Scott ◽  
Riyad B. Abu-Laban ◽  
Margot C. Gowans ◽  
Bruce J. Wright ◽  
Fraser R. Brenneis
Keyword(s):  
Emergency Medicine ◽  
Family Medicine ◽  
Medical School ◽  
Career Choice ◽  
Demographic Data ◽  
School Entry ◽  
Social Orientation ◽  
Scope Of Practice ◽  
Medical Specialties ◽  
Hospital Orientation

ABSTRACTBackground:Studies indicate that a student's career interest at medical school entry is related to his or her ultimate career. We sought to determine the level of interest in emergency medicine among students at the time of medical school entry, and to describe characteristics associated with students primarily interested in emergency medicine.Methods:We surveyed students in 18 medical school classes from 8 Canadian universities between 2001 and 2004 at the commencement of their studies. Participants listed their top career choice and the degree to which a series of variables influenced their choices. We also collected demographic data.Results:Of 2420 surveys distributed, 2168 (89.6%) were completed. A total of 6.1% (95% confidence interval 5.1%–7.1%) of respondents cited emergency medicine as their first career choice. When compared with students primarily interested in family medicine, those primarily interested in emergency medicine reported a greater influence of hospital orientation and a lesser influence of social orientation on their career choice. When compared with students primarily interested in the surgical specialties, those primarily interested in emergency medicine were more likely to report medical lifestyle and varied scope of practice as important influences. When compared with students primarily interested in the medical specialties, those who reported interest in emergency medicine were more likely to report that a hospital orientation and varied scope of practice were important influences, and less likely to report that social orientation was important.Conclusion:Students primarily interested in emergency medicine at medical school entry have attributes that differentiate them from students primarily interested in family medicine, the surgical specialties or the medical specialties. These findings may help guide future initiatives regarding emergency medicine education.

scholarly journals Does Gender Impact Intensity of Care Provided to Older Medical Intensive Care Unit Patients?

2010 ◽  
Vol 2010 ◽  
pp. 1-8
Author(s):  
Kathleen M. Akgün ◽  
Terrence E. Murphy ◽  
Katy L. B. Araujo ◽  
Peter H. Van Ness ◽  
Margaret Pisani
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Demographic Data ◽  
University Teaching ◽  
Explanatory Variables ◽  
Health Differences ◽  
Medical Intensive Care ◽  
Gender Based

Introduction. Women receive less aggressive critical care than men based on prior studies. No documented studies evaluate whether men and women are treated equally in the medical intensive care unit (MICU). The Therapeutic Intervention Scoring System-28 (TISS-28) has been used to examine gender differences in mixed ICU studies. However, it has not been used to evaluate equivalence of care in older MICU patients. We hypothesize that given nonsignificant, baseline health differences between genders at MICU admission, the level of care provided would be equivalent.Methods. Prospective cohort of 309 patients≥60 years old in the MICU of an urban university teaching hospital. Explanatory variables were demographic data and baseline measures. Primary outcomes were TISS-28 scores and MICU interventions. We compare TISS-28 scores by gender using a statistical test of equivalence.Results. Women were older and had more chronic respiratory failure at MICU admission. Using equivalence limits of±15% on gender-based scores of TISS-28, MICU interventions were equivalent. Supplementary analysis showed no statistically significant association between gender and mortality.Conclusions. In contrast with other reports from the cardiac critical care literature, as measured by the TISS-28, gender-based care delivered to older MICU patients in this cohort was equivalent.

scholarly journals Ease of Doing Business Index: An Analysis of Investors Practical View

2021 ◽  
Vol 17 (1) ◽  
pp. 101-123
Author(s):  
Shakirat Adepeju Babatunde ◽  
Mohammed Kayode Ajape ◽  
Kabir Dandago Isa ◽  
Owolabi Kuye ◽  
Eddy Olajide Omolehinwa ◽  
...  
Keyword(s):  
Private Sector ◽  
World Bank ◽  
Return On Investment ◽  
Government Procurement ◽  
Cross Sectional ◽  
Procurement Process ◽  
Chamber Of Commerce ◽  
Doing Business ◽  
Ease Of Doing Business ◽  
The Government

Abstract: This study investigates the effect of Ease of Doing Business Index (EDBI) on Return on Investment (ROI). The study employs a cross-sectional survey design covering five years from 2015 to 2019. The sample is 47 registered companies with the Lagos Chamber of Commerce and Industry, which is the most representative of the organised private sector group in Nigeria. The study adopts descriptive and linear regression statistical analysis. Findings show a statistically significant negative effect of Government policy continuity. The government procurement process, Raw materials availability and Quality of workforce show adverse effects. Traffic and transportation management, power supply and Security infrastructure show insignificant effect on ROI. Hence, findings indicate that Government procurement process is inimical to ease of doing business in Nigeria despite the government improvement efforts. Since government efforts are insufficient, the World Bank should incorporate private sector ideals into EDBI to create a synergy a robust EDBI. Keywords: Ease of Doing Business, ease of doing business index, return on investment, investors, World Bank.      Ease of Doing Business Index: Sebuah Analisis terhadap Pandangan Praktis InvestorAbstrak: Penelitian ini menginvestigasi pengaruh Ease of Doing Business Index (EDBI) terhadap Return on Investment (ROI). Penelitian ini menggunakan desain survei cross-sectional dari tahun 2015 sampai dengan tahun 2019. Sampel penelitian ini adalah 47 perusahaan yang terdaftar di Lagos Chamber of Commerce and Industry. Penelitian ini menggunakan analisis deskriptif dan statistik regresi linear. Dari berbagai elemen EDBI, temuan dari penelitian ini menunjukkan adanya pengaruh negatif yang signifikan antara keterlanjutan kebijakan pemerintah terhadap ROI. Proses pengadaan pemerintah, ketersediaan bahan mentah, dan kualitas tenaga kerja menunjukkan pengaruh berkebalikan dengan ROI. Lalu lintas dan manajemen transportasi, supply listrik, dan infrastruktur keamanan menunjukkan pengaruh tidak signifikan terhadap ROI. Usaha pemerintah dalam meningkatkan proses pengaadaan pemerintah masih belum memadai karena masih kecilnya pengaruh terhadap EDBI Nigeria. World Bank sebaiknya memasukkan pengaruh sektor privat dalam indikator EDBI sebagai upaya menciptakan sinergi antara pemerintah dan sektor privat untuk peningkatan EDBI dan dampaknya pada ekonomi. Kata kunci: Ease of Doing Business, indeks kemudahan berbisnis, pengembalian investasi, investor, Bank Dunia

Return on investment of Canadian tobacco control policies implemented between 2001 and 2016

2021 ◽  
pp. tobaccocontrol-2021-056473
Author(s):  
Jean-Eric Tarride ◽  
Gord Blackhouse ◽  
G. Emmanuel Guindon ◽  
Michael O Chaiton ◽  
Lynn Planinac ◽  
...  
Keyword(s):  
Tobacco Control ◽  
Return On Investment ◽  
Economic Benefits ◽  
Sensitivity Analyses ◽  
Control Policies ◽  
Productivity Costs ◽  
Tobacco Policies ◽  
Tobacco Control Policies ◽  
Life Years ◽  
The Government

ObjectivesTo determine the return on investment (ROI) associated with tobacco control policies implemented between 2001 and 2016 in Canada.MethodsCanadian expenditures on tobacco policies were collected from government sources. The economic benefits considered in our analyses (decrease in healthcare costs, productivity costs and monetised life years lost, as well as tax revenues) were based on the changes in smoking prevalence and attributable deaths derived from the SimSmoke simulation model for the period 2001–2016. The net economic benefit (monetised benefits minus expenditures) and ROI associated with these policies were determined from the government and societal perspectives. Sensitivity analyses were conducted to check the robustness of the result. Costs were expressed in 2019 Canadian dollars.ResultsThe total of provincial and federal expenditures associated with the implementation of tobacco control policies in Canada from 2001 through 2016 was estimated at $2.4 billion. Total economic benefits from these policies during that time were calculated at $49.2 billion from the government perspective and at $54.2 billion from the societal perspective. The corresponding ROIs were $19.8 and $21.9 for every dollar invested. Sensitivity analyses yielded ROI values ranging from $16.3 to $28.3 for every dollar invested depending on the analyses and perspective.ConclusionsThis analysis has found that the costs to implement the Canadian tobacco policies between 2001 and 2016 were far outweighed by the monetised value associated with the benefits of these policies, making a powerful case for the investment in tobacco control policies.

scholarly journals Evolution of the United States Military Extracorporeal Membrane Oxygenation Transport Team

2020 ◽  
Vol 185 (11-12) ◽  
pp. e2055-e2060
Author(s):  
Matthew D Read ◽  
Jason J Nam ◽  
Mauer Biscotti ◽  
Lydia C Piper ◽  
Sarah B Thomas ◽  
...  
Keyword(s):  
Critical Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Demographic Data ◽  
The United States ◽  
Published Data ◽  
Medical Treatment Facility ◽  
Membrane Oxygenation ◽  
Transport Distance ◽  
Primary Indication ◽  
The U.S

Abstract Introduction The use of extracorporeal membrane oxygenation (ECMO) for the care of critically ill adult patients has increased over the past decade. It has been utilized in more austere locations, to include combat wounded. The U.S. military established the Acute Lung Rescue Team in 2005 to transport and care for patients unable to be managed by standard medical evacuation resources. In 2012, the U.S. military expanded upon this capacity, establishing an ECMO program at Brooke Army Medical Center. To maintain currency, the program treats both military and civilian patients. Materials and methods We conducted a single-center retrospective review of all patients transported by the sole U.S. military ECMO program from September 2012 to December 2019. We analyzed basic demographic data, ECMO indication, transport distance range, survival to decannulation and discharge, and programmatic growth. Results The U.S. military ECMO team conducted 110 ECMO transports. Of these, 88 patients (80%) were transported to our facility and 81 (73.6%) were cannulated for ECMO by our team prior to transport. The primary indication for ECMO was respiratory failure (76%). The range of transport distance was 6.5 to 8,451 miles (median air transport distance = 1,328 miles, median ground transport distance = 16 miles). In patients who were cannulated remotely, survival to decannulation was 76% and survival to discharge was 73.3%. Conclusions Utilization of the U.S. military ECMO team has increased exponentially since January 2017. With an increased tempo of transport operations and distance of critical care transport, survival to decannulation and discharge rates exceed national benchmarks as described in ELSO published data. The ability to cannulate patients in remote locations and provide critical care transport to a military medical treatment facility has allowed the U.S. military to maintain readiness of a critical medical asset.

The Role of Online Privacy Concern as a Mediator between Internet Self-Efficacy and Online Technical Protection Privacy Behavior

2017 ◽  
Vol 9 (3-2) ◽  
Author(s):  
Wan Ying Lee ◽  
Chee-Seng Tan ◽  
Poh Chua Siah
Keyword(s):  
Internet Addiction ◽  
Self Efficacy ◽  
Demographic Data ◽  
Study Data ◽  
Online Privacy ◽  
Privacy Concern ◽  
Internet Users ◽  
The Government ◽  
Questionnaire Surveys ◽  
The Impact

Online risks may result in unnecessary harm but these risks can be minimized by being online privacy concerned and by taking privacy protective actions. Few studies examined the impact of privacy concern and internet self-efficacy on the online technical protection privacy behavior. Therefore, this research aims to investigate the effect of privacy concern and internet self-efficacy on technical protection. Quantitative and purposive sampling methods were used in this study. Data were gathered via questionnaire surveys from 235 undergraduates from six universities in Malaysia. The questionnaire includes participants’ demographic data, internet addiction test, web user self-efficacy scale, privacy concern, and technical protection scale. Hierarchical multiple regression analyses were conducted to examine the effect of internet self-efficacy and privacy concern on technical protection, while controlling for gender, course type, and internet addiction. Results showed that both privacy concern and internet self-efficacy were significant predictors of technical protection. Moreover, mediation analysis showed that there was an indirect effect of internet self-efficacy on technical protection through privacy concern. The results contribute to literature by revealing how internet self-efficacy and privacy concern increase technical protection. The government and policy makers can design intervention and prevention programs that aim to boost privacy concern and internet self-efficacy, so that internet users are more capable of safeguarding their online privacy.  

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