scholarly journals How should hospitals manage the backlog of patients awaiting surgery following the COVID-19 pandemic? A demand modelling simulation case study for carotid endarterectomy

2020 ◽  
Author(s):  
Guy Martin ◽  
Jonathan Clarke ◽  
Sheraz Markar ◽  
Alexander W Carter ◽  
Sam Mason ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Quality Care ◽  
Surgical Care ◽  
Surgical Capacity ◽  
Case Scenario ◽  
Worst Case ◽  
Health Crisis ◽  
Demand Modelling ◽  
The Impact

Background The COVID-19 pandemic presents unparalleled challenges for the delivery of safe and effective care. In response, many health systems have chosen to restrict access to surgery and reallocate resources; the impact on the provision of surgical services has been profound, with huge numbers of patient now awaiting surgery at the risk of avoidable harm. The challenge now is how do hospitals transition from the current pandemic mode of operation back to business as usual, and ensure that all patients receive equitable, timely and high-quality surgical care during all phases of the public health crisis. Aims and Methods This case study takes carotid endarterectomy as a time-sensitive surgical procedure and simulates 400 compartmental demand modelling scenarios for managing surgical capacity in the UK for two years following the pandemic. Results A total of 7,69 patients will require carotid endarterectomy. In the worst-case scenario, if no additional capacity is provided on resumption of normal service, the waiting list may never be cleared, and no patient will receive surgery within the 2-week target; potentially leading to >1000 avoidable strokes. If surgical capacity is doubled after 1-month of resuming normal service, it will still take more than 6-months to clear the backlog, and 30.8% of patients will not undergo surgery within 2-weeks, with an average wait of 20.3 days for the proceeding 2 years. Conclusions This case study for carotid endarterectomy has shown that every healthcare system is going to have to make difficult decisions for balancing human and capital resources against the needs of patients. It has demonstrated that the timing and size of this effort will critically influence the ability of these systems to return to their baseline and continue to provide the highest quality care for all. The failure to sustainably increase surgical capacity early in the post-COVID-19 period will have significant long-term negative impacts on patients and is likely to result in avoidable harm.

scholarly journals The impact of spousal violence on the children: A pastoral care approach

2014 ◽  
Vol 70 (2) ◽  
Author(s):  
Luvuyo G. Sifo ◽  
Maake J. Masango
Keyword(s):  
Pastoral Care ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Spousal Violence ◽  
Post Traumatic Stress ◽  
Case Scenario ◽  
Care Approach ◽  
Post Traumatic ◽  
The Impact

This article investigates the impact of spousal violence on children. Spousal violence in the home affects children negatively and its impact goes beyond their childhood years into adulthood. Some children become dysfunctional in life as a result of their exposure to violence between their parents. These children may exhibit symptoms associated with post-traumatic stress disorder (PTSD) later on in life. A case study of a family exposed to violence was undertaken. Findings from this case scenario were measured against existing literature. A pastoral care method of responding to the victims is proposed in order for them to be healed.

scholarly journals Assessing storm surge hazard and impact of sea level rise in the Lesser Antilles case study of Martinique

2017 ◽  
Vol 17 (9) ◽  
pp. 1559-1571 ◽  
Author(s):  
Yann Krien ◽  
Bernard Dudon ◽  
Jean Roger ◽  
Gael Arnaud ◽  
Narcisse Zahibo
Keyword(s):  
Sea Level Rise ◽  
Sea Level ◽  
Storm Surge ◽  
Numerical Models ◽  
Lesser Antilles ◽  
Adaptation Measures ◽  
Worst Case ◽  
Mitigation And Adaptation ◽  
The Impact

Abstract. In the Lesser Antilles, coastal inundations from hurricane-induced storm surges pose a great threat to lives, properties and ecosystems. Assessing current and future storm surge hazards with sufficient spatial resolution is of primary interest to help coastal planners and decision makers develop mitigation and adaptation measures. Here, we use wave–current numerical models and statistical methods to investigate worst case scenarios and 100-year surge levels for the case study of Martinique under present climate or considering a potential sea level rise. Results confirm that the wave setup plays a major role in the Lesser Antilles, where the narrow island shelf impedes the piling-up of large amounts of wind-driven water on the shoreline during extreme events. The radiation stress gradients thus contribute significantly to the total surge – up to 100 % in some cases. The nonlinear interactions of sea level rise (SLR) with bathymetry and topography are generally found to be relatively small in Martinique but can reach several tens of centimeters in low-lying areas where the inundation extent is strongly enhanced compared to present conditions. These findings further emphasize the importance of waves for developing operational storm surge warning systems in the Lesser Antilles and encourage caution when using static methods to assess the impact of sea level rise on storm surge hazard.

scholarly journals SPATIOTEMPORAL VISUALIZATION OF TSUNAMI WAVES USING KML ON GOOGLE EARTH

2017 ◽  
Vol XLII-2/W7 ◽  
pp. 1291-1299 ◽  
Author(s):  
H. Mohammadi ◽  
M. R. Delavar ◽  
M. A. Sharifi ◽  
M. D. Pirooz
Keyword(s):  
Decision Making ◽  
Disaster Management ◽  
Google Earth ◽  
Disaster Mitigation ◽  
Case Scenario ◽  
Worst Case ◽  
Tsunami Waves ◽  
Spatiotemporal Visualization ◽  
Virtual Globes ◽  
The Impact

Disaster risk is a function of hazard and vulnerability. Risk is defined as the expected losses, including lives, personal injuries, property damages, and economic disruptions, due to a particular hazard for a given area and time period. Risk assessment is one of the key elements of a natural disaster management strategy as it allows for better disaster mitigation and preparation. It provides input for informed decision making, and increases risk awareness among decision makers and other stakeholders. Virtual globes such as Google Earth can be used as a visualization tool. Proper spatiotemporal graphical representations of the concerned risk significantly reduces the amount of effort to visualize the impact of the risk and improves the efficiency of the decision-making process to mitigate the impact of the risk. The spatiotemporal visualization of tsunami waves for disaster management process is an attractive topic in geosciences to assist investigation of areas at tsunami risk. In this paper, a method for coupling virtual globes with tsunami wave arrival time models is presented. In this process we have shown 2D+Time of tsunami waves for propagation and inundation of tsunami waves, both coastal line deformation, and the flooded areas. In addition, the worst case scenario of tsunami on Chabahar port derived from tsunami modelling is also presented using KML on google earth.

scholarly journals The impact of the COVID-19 pandemic on digital globalization

2021 ◽  
Vol 129 ◽  
pp. 06008
Author(s):  
Maria Loredana Popescu ◽  
Svetlana Platagea Gombos ◽  
Sorin Burlacu ◽  
Amza Mair
Keyword(s):  
Global Economy ◽  
World Economy ◽  
Value Added ◽  
Digital Transformation ◽  
Lessons Learned ◽  
Health Crisis ◽  
Main Research ◽  
Documentary Analysis ◽  
The Impact

Research background: After more than a year of the Covid-19 pandemic, we can investigate whether it caused a shock to the global economy, pushing for deglobalization, or on the contrary, it was a challenge for digital globalization and digital transformation of economies. Through this research we join the research contributions that examine the process towards digital globalization that characterizes the world economy, its impact on businesses, consumers, and governments. We also discuss the challenges posed by the crisis caused by the coronavirus pandemic to globalization and perhaps the acceleration of the digital transformation of economies. Purpose of the article: The aim of this research is to highlight the impact of the COVID-19 pandemic in the age of digital globalization. Methods: Documentary analysis, as the main research method, is doubled by a case study that allows us to highlight the specific characteristics of digital globalization. Findings & Value added: The findings of the research allowed us to highlight the essential aspects of digital globalization that were perhaps exacerbated by the Covid-19 pandemic, but which contribute greatly to understanding the phenomenon of globalization. Our research also reveals four lessons learned in the COVID-19 pandemic. We also present some considerations regarding the globalization after the health crisis.

A Case Study - Life Extension of Offshore Bridge Bearings

2021 ◽  
Author(s):  
Ahmed Abdelkhalek ◽  
Govindavilas Sudhesh ◽  
Anjan Sarkar ◽  
Mohammed Eissa
Keyword(s):  
Cost Savings ◽  
Holistic Approach ◽  
Life Extension ◽  
Case Scenario ◽  
Worst Case ◽  
Maintenance And Repair ◽  
Seasonal Monitoring ◽  
The Impact ◽  
Bridge Bearings

Abstract Structural bearings of 47 offshore platform-link bridges with average age of 40 years were inspected and recommended for replacements due to their poor condition. Replacement of bridge bearings involves major risk and production interruptions given the structural modifications, and critical piping and E&I disconnections required for safe jacking-lifting activities required during the process. This paper presents the approach adopted to assure the integrity of the bridges and extend their lives without the need to replace the bearings. The approach employed failure mode and effect analysis to identifying and narrowing down areas that need focused efforts while tackling the problem. Scenario based structural assessments were carried out to examine the impact of the level of movement-allowing bearings functionality on the integrity of the bridge and its supporting structures; identify critical locations to be targeted during focused inspections; and establish envelopes for monitoring thermal expansion and contraction of the bridges. Guidelines were developed and implemented for integrated inspection-maintenance and repair campaign, which aimed to tackle corrosion issues and to install movement-monitoring indicators. Indicator seasonal monitoring is employed to establish the functionality of bearings on the long-term. The what-if structural assessments revealed that even in the worst-case scenario (in which the bearing are completely jammed) the option of local strengthening of the bridge and its supporting elements is more attractive than bearing replacement. The integrated inspection-maintenance and repair campaigns revealed that excessive corrosion levels observed from historic visual inspections on external non-critical bearing components (e.g: guide plates, angles, etc.) is not indicative of the condition of the internal load-bearing components (pedestals) which experienced much lower corrosion levels. The seasonal monitoring of bridge movements revealed that the 40+ years old Teflon pads are still functional and allow the bridges expansion and contraction. The developed holistic approach enabled demonstration of the fitness for service of the bearings, and provided means for assuring their long-term performance through monitoring. The results assured safety, integrity and delivered significant cost savings through aversion brownfield modifications, and production loss associated with bridge jacking and bearing replacement operations.

scholarly journals Imported dengue in Spain: a nationwide analysis with predictive time series analyses

2019 ◽  
Vol 26 (8) ◽  
Author(s):  
Lidia Redondo-Bravo ◽  
Claudia Ruiz-Huerta ◽  
Diana Gomez-Barroso ◽  
María José Sierra-Moros ◽  
Agustín Benito ◽  
...  
Keyword(s):  
Time Series ◽  
Control Measures ◽  
Severe Dengue ◽  
Vector Surveillance ◽  
Case Scenario ◽  
Worst Case ◽  
Temporal Behaviour ◽  
The Impact ◽  
Near Future ◽  
Local Transmission

Abstract Background Of febrile illnesses in Europe, dengue is second only to malaria as a cause of travellers being hospitalized. Local transmission has been reported in several European countries, including Spain. This study assesses the evolution of dengue-related admissions in Spain in terms of time, geographical distribution and individuals’ common characteristics; it also creates a predictive model to evaluate the risk of local transmission. Methods This is a retrospective study using the Hospital Discharge Records Database from 1997 to 2016. We calculated hospitalization rates and described clinical characteristics. Spatial distribution and temporal behaviour were also assessed, and a predictive time series model was created to estimate expected cases in the near future. Figures for resident foreign population, Spanish residents’ trips to endemic regions and the expansion of Aedes albopictus were also evaluated. Results A total of 588 dengue-related admissions were recorded: 49.6% were women, and the mean age was 34.3 years. One person died (0.2%), 82% presented with mild-to-moderate dengue and 7–8% with severe dengue. We observed a trend of steady and consistent increase in incidence (P < 0.05), in parallel with the increase in trips to dengue-endemic regions. Most admissions occurred during the summer, showing significant seasonality with 3-year peaks. We also found important regional differences. According to the predictive time series analysis, a continuing increase in imported dengue incidence can be expected in the near future, which, in the worst case scenario (upper 95% confidence interval), would mean an increase of 65% by 2025. Conclusion We present a nationwide study based on hospital, immigration, travel and entomological data. The constant increase in dengue-related hospitalizations, in combination with wider vector distribution, could imply a higher risk of autochthonous dengue transmission in the years to come. Strengthening the human and vector surveillance systems is a necessity, as are improvements in control measures, in the education of the general public and in fostering their collaboration in order to reduce the impact of imported dengue and to prevent the occurrence of autochthonous cases.

Assembly System Configuration Design for Reconfigurability Under Uncertain Production Evolution

2019 ◽  
Vol 141 (7) ◽  
Author(s):  
Zhengqian Jiang ◽  
Hui Wang ◽  
Maxim A. Dulebenets ◽  
Junayed Pasha
Keyword(s):  
System Throughput ◽  
Assembly System ◽  
Configuration Design ◽  
System Configuration ◽  
Case Scenario ◽  
Worst Case ◽  
Design Evolution ◽  
Product Evolution ◽  
Concurrent Optimization ◽  
The Impact

Assembly system configuration determines the topological arrangement of stations with defined logical material flow among them. The design of assembly system configuration involves (1) subassembly planning that defines subassembly tasks and between-task material flows and (2) workload balancing that determines the task-station assignments. The assembly system configuration should be flexibly changed and updated to cope with product design evolution and updating. However, the uncertainty in future product evolution poses significant challenges to the assembly system configuration design since the higher cost can be incurred if the assembly line suitable for future products is very different from that for the current products. The major challenges include (1) the estimation of reconfiguration cost, (2) unavailability of probability values for possible scenarios of product evolution, and (3) consideration of the impact of the subassembly planning on the task-station assignments. To address these challenges, this paper formulates a concurrent optimization problem to design the assembly system configuration by jointly determining the subassembly planning and task-station assignments considering uncertain product evolution. A new assembly hierarchy similarity model is proposed to estimate the reconfiguration effort by comparing the commonalities among different subassembly plans of current and potential future product designs. The assembly system configuration is chosen by maximizing both assembly hierarchy similarity and assembly system throughput under the worst-case scenario. A case study motivated by real-world scenarios demonstrates the applicability of the proposed method including scenario analysis.

scholarly journals Assessing storm surge hazard and impact of sea level rise in Lesser Antilles-Case study of Martinique

2017 ◽  
Author(s):  
Yann Krien ◽  
Bernard Dudon ◽  
Jean Roger ◽  
Gaël Arnaud ◽  
Narcisse Zahibo
Keyword(s):  
Sea Level Rise ◽  
Sea Level ◽  
Storm Surge ◽  
Numerical Models ◽  
Lesser Antilles ◽  
Adaptation Measures ◽  
Worst Case ◽  
Mitigation And Adaptation ◽  
The Impact

Abstract. In the Lesser Antilles, coastal inundations from hurricane-induced storm surges cause great threats to lives, properties, and ecosystems. Assessing current and future storm surge hazard with sufficient spatial resolution is of primary interest to help coastal planners and decision makers develop mitigation and adaptation measures. Here, we use wave-current numerical models and statistical methods to investigate worst case scenarios and 100-year surge levels for the case study of Martinique, under present climate or considering a potential sea-level rise. Results confirm that the wave setup plays a major role in Lesser Antilles, where the narrow island shelf impedes the piling-up of large amounts of wind-driven water on the shoreline during extreme events. The radiation stress gradients thus contribute significantly to the total surge, up to 100 % in some cases. The non-linear interactions of sea level rise with bathymetry and topography are generally found to be relatively small in Martinique, but can reach several tens of centimeters in low-lying areas where the inundation extent is strongly enhanced compared to present conditions. These findings further emphasize the importance of waves for developing operational storm surge warning systems in the Lesser Antilles, and encourage caution when using static methods to assess the impact of sea level rise on storm surge hazard.

The Impact of Flexbarrier Ingress on Flexlok Stress

2009 ◽  
Author(s):  
Jing Lu ◽  
Frank Ma ◽  
Zhimin Tan ◽  
Terry Sheldrake
Keyword(s):  
Internal Pressure ◽  
Structural Function ◽  
Analysis Model ◽  
Flexible Pipe ◽  
Case Scenario ◽  
Element Analysis ◽  
Worst Case ◽  
Ongoing Research ◽  
Nominal Size ◽  
The Impact

An unbonded flexible pipe typically consists of multiple metallic and thermoplastic layers, where each layer is designed to provide a specific structural function. The burst resistance against the internal pressure in an unbonded flexible pipe is provided mainly by its Flexlok layer. The Flexlok is made by helically-wound steel wires, with neighbouring wires interlocking each other. Beneath the Flexlok is the Flexbarrier, a polymer layer, acting as the boundary for conveyed fluids. The internal pressure is passed onto the Flexlok through the Flexbarrier layer. Under internal pressure, the Flexbarrier can creep into the gaps between Flexlok wires. Theoretically, the polymer material ingress could reduce the flexibility of the Flexlok due to premature lock-up between Flexlok wires and subsequently increase the stress levels. This study presents a 3D finite element analysis model developed to quantify the stress elevation in the Flexlok wire, caused by the Flexbarrier layer ingress. In terms of Flexlok gap size distribution, both nominal and worst case scenarios are studied. In the nominal scenario, the Flexlok gap sizes are evenly distributed. In the worst case scenario, the Flexlok gap is assumed to be completely closed at one position while the gaps at the neighbouring positions are twice the nominal size. Flexbarrier ingress with different temperatures is also studied. Conclusions are obtained by analyzing the simulation results. The work presented is part of an ongoing research and development project.

scholarly journals Impact of Xylella fastidiosa subspecies pauca in European olives

2020 ◽  
Vol 117 (17) ◽  
pp. 9250-9259 ◽  
Author(s):  
Kevin Schneider ◽  
Wopke van der Werf ◽  
Martina Cendoya ◽  
Monique Mourits ◽  
Juan A. Navas-Cortés ◽  
...  
Keyword(s):  
Xylella Fastidiosa ◽  
Plant Diseases ◽  
Disease Spread ◽  
Economic Damage ◽  
Climatic Suitability ◽  
Case Scenario ◽  
Worst Case ◽  
Ongoing Research ◽  
Phytosanitary Measures ◽  
The Impact

Xylella fastidiosa is the causal agent of plant diseases that cause massive economic damage. In 2013, a strain of the bacterium was, for the first time, detected in the European territory (Italy), causing the Olive Quick Decline Syndrome. We simulate future spread of the disease based on climatic-suitability modeling and radial expansion of the invaded territory. An economic model is developed to compute impact based on discounted foregone profits and losses in investment. The model projects impact for Italy, Greece, and Spain, as these countries account for around 95% of the European olive oil production. Climatic suitability modeling indicates that, depending on the suitability threshold, 95.5 to 98.9%, 99.2 to 99.8%, and 84.6 to 99.1% of the national areas of production fall into suitable territory in Italy, Greece, and Spain, respectively. For Italy, across the considered rates of radial range expansion the potential economic impact over 50 y ranges from 1.9 billion to 5.2 billion Euros for the economic worst-case scenario, in which production ceases after orchards die off. If replanting with resistant varieties is feasible, the impact ranges from 0.6 billion to 1.6 billion Euros. Depending on whether replanting is feasible, between 0.5 billion and 1.3 billion Euros can be saved over the course of 50 y if disease spread is reduced from 5.18 to 1.1 km per year. The analysis stresses the necessity to strengthen the ongoing research on cultivar resistance traits and application of phytosanitary measures, including vector control and inoculum suppression, by removing host plants.

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