Abstract 357: Statewide Collaboration in Rural STEMI System Development in Resource Limited Environments- Where You Live Shouldn't Determine If You Live: North Dakota Mission: Lifeline

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Thomas Haldis ◽  
Jeffrey Sather ◽  
Karthik Reddy ◽  
Robert Oatfield ◽  
Yassar Almanaseer ◽  
...  
Keyword(s):  
Population Density ◽  
North Dakota ◽  
System Development ◽  
State Level ◽  
Aggregate Data ◽  
Medically Underserved ◽  
Multidisciplinary Teams ◽  
Resource Limited ◽  
Data Feedback ◽  
Reperfusion Strategy

Background: Mission: Lifeline is a strategic initiative to save lives and reduce disability by improving emergency readiness and response to heart attack patients. Heart disease is the number one killer in North Dakota and nationally. North Dakota consists of 53 counties over 69,001 square miles with a population of 680,000. Thirty-four entire counties are designated medically underserved areas and 13 counties have some part of them designated medically underserved. A large number of residents reside in the 36 frontier counties 21% (142,800/680,000) with a population density of < 6 people/mile, and 9 rural counties 15% (102,000 of 680,000): < 5000 residents Population density of > 6/mile together making up just over one third of the state population and 85% (45 of 53) of the physical territory. Eight urban counties with a city of at least 15,000 make up the remaining population at 63% (428,400 of 680,000). In 2011, ND M:L received a $7.1 million grant to bridge gaps in disparities in access to care by streamlining statewide STEMI systems. Methods: A statewide initiative was implemented for pre-hospital recognition, education, triage, and treatment of STEMI patients to the most appropriate reperfusion strategy. • Ninety eight percent (123 of 125) licensed ground EMS received funding to enable pre-hospital 12 lead ECG acquisition and transmission to both referral and receiving hospitals • In person facilitated education were provided to each EMS agency in 3 rounds with focus on acquisition, recognition and triaging of STEMI patients utilizing the ACC/AHA guidelines. • PCI receiving hospital physician and nurse educator teams facilitated a standardized in person clinical STEMI education session at each of the 38 referring hospitals focused on utilizing a state recommended referring hospital STEMI protocol, EMS transport guideline, and a STEMI feedback process • Six of six PCI receiving hospitals collected data utilizing the ACTION GWTG Registry Results: • In ND aggregate data from Quarter 3 2012 to Quarter 3 2013 there have been marked improvements in several measures. The ND Mission: Lifeline composite score 93% (557/ 596) to 97% (471/482) 1ST EKG obtained Pre-hospital 46% (56/122) to 76% (92/121) ED Arrival to First In-Hosp ECG % within 10 minutes 66.% (81/122) to 84% (103/122) Arrival to Primary PCI <= 90 min. from 86% (32/37) to 100% (43/43) Conclusions: To sustain STEMI system of care for patients in ND, collaboration with regional partners, care standardization, aggregate data sharing and feedback have been identified as vital. Regional champions committed to systemization are central to EMS and referral hospital engagement and state level process improvement. PCI receiving hospitals lead the way in convening regional multidisciplinary teams meetings, and facilitating data feedback on STEMI systems at a state level to support a unified platform of sustainability.

scholarly journals Come and Charge It

2020 ◽  
Vol 6 (3) ◽  
Author(s):  
Matthew A. Arth
Keyword(s):  
Energy Storage ◽  
System Development ◽  
Storage System ◽  
State Level ◽  
Energy Storage System ◽  
The United States ◽  
Battery Energy Storage ◽  
Current State ◽  
Battery Energy ◽  
Solar Resource

Affordable, reliable battery energy storage has long been the holy grail of the electric grid. From avoiding expensive transmission build-out to smoothing out fluctuations inherent to wind and solar resource output, batteries hold the promise of providing the solution to an ever more intermittent and distributed grid. Across the United States and particularly in Texas, that futuristic vision is beginning to approach reality as battery costs decline and favorable regulatory policy is implemented. This Article addresses the current state of battery energy storage system development and notes recent contributory policy developments at both the national and state level.

scholarly journals Effects of Government Mandated Social Distancing Measures on Cumulative Incidence of COVID-19 in the United States and its Most Populated Cities

2020 ◽  
Author(s):  
Bhuma Krishnamachari ◽  
Alexander Morris ◽  
Diane Zastrow ◽  
Andrew Dsida ◽  
Brian Harper ◽  
...  
Keyword(s):  
United States ◽  
Population Density ◽  
Cumulative Incidence ◽  
Negative Binomial ◽  
State Level ◽  
The United States ◽  
Reverse Causality ◽  
Social Distancing ◽  
School Closing ◽  
Adjusted Rate

AbstractCOVID-19, caused by the SARS-CoV-2 virus, has quickly spread throughout the world, necessitating assessment of the most effective containment methods. Very little research exists on the effects of social distancing measures on this pandemic. The purpose of this study was to examine the effects of government implemented social distancing measures on the cumulative incidence rates of COVID-19 in the United States on a state level, and in the 25 most populated cities, while adjusting for socio-demographic risk factors. The social distancing variables assessed in this study were: days to closing of non-essential business; days to stay home orders; days to restrictions on gathering, days to restaurant closings and days to school closing. Using negative binomial regression, adjusted rate ratios and 95% confidence intervals were calculated comparing two levels of a binary variable: “above median value,” and “median value and below” for days to implementing a social distancing measure. For city level data, the effects of these social distancing variables were also assessed in high (above median value) vs low (median value and below) population density cities. For the state level analysis, days to school closing was associated with cumulative incidence, with an adjusted rate ratio of 1.59 (95% CI:1.03,2.44), p=0.04 at 35 days. Some results were counterintuitive, including inverse associations between cumulative incidence and days to closure of non-essential business and restrictions on gatherings. This finding is likely due to reverse causality, where locations with slower growth rates initially chose not to implement measures, and later implemented measures when they absolutely needed to respond to increasing rates of infection. Effects of social distancing measures seemed to vary by population density in cities. Our results suggest that the effect of social distancing measures may differ between states and cities and between locations with different population densities. States and cities need individual approaches to containment of an epidemic, with an awareness of their own structure in terms of crowding and socio-economic variables. In an effort to reduce infection rates, cities may want to implement social distancing in advance of state mandates.

scholarly journals Effectiveness of COVID-19 shelter-in-place orders varied by state

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0245008
Author(s):  
Yevgeniy Feyman ◽  
Jacob Bor ◽  
Julia Raifman ◽  
Kevin N. Griffith
Keyword(s):  
Population Density ◽  
Study Design ◽  
Regression Discontinuity ◽  
State Level ◽  
County Level ◽  
Opportunities To Learn ◽  
Mobility Data ◽  
Percentage Points ◽  
Reduced Mobility ◽  
The U.S

State “shelter-in-place” (SIP) orders limited the spread of COVID-19 in the U.S. However, impacts may have varied by state, creating opportunities to learn from states where SIPs have been effective. Using a novel dataset of state-level SIP order enactment and county-level mobility data form Google, we use a stratified regression discontinuity study design to examine the effect of SIPs in all states that implemented them. We find that SIP orders reduced mobility nationally by 12 percentage points (95% CI: -13.1 to -10.9), however the effects varied substantially across states, from -35 percentage points to +11 percentage points. Larger reductions were observed in states with higher incomes, higher population density, lower Black resident share, and lower 2016 vote shares for Donald J. Trump. This suggests that optimal public policies during a pandemic will vary by state and there is unlikely to be a “one-size fits all” approach that works best.

scholarly journals Pediatric Intensive Care Unit Admissions for COVID-19: Insights Using State-Level Data

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Rohit S. Loomba ◽  
Enrique G. Villarreal ◽  
Juan S. Farias ◽  
Ronald A. Bronicki ◽  
Saul Flores
Keyword(s):  
Intensive Care ◽  
Population Density ◽  
Multivariate Analyses ◽  
Pediatric Intensive Care ◽  
State Level ◽  
The United States ◽  
Respiratory Support ◽  
Level Data ◽  
Beta Coefficient

Introduction. Intensive care has played a pivotal role during the COVID-19 pandemic as many patients developed severe pulmonary complications. The availability of information in pediatric intensive care units (PICUs) remains limited. The purpose of this study is to characterize COVID-19 positive admissions (CPAs) in the United States and to determine factors that may impact those admissions. Materials and Methods. This is a retrospective cohort study using data from the COVID-19 Virtual Pediatric System (VPS) dashboard containing information regarding respiratory support and comorbidities for all CPAs between March and April 2020. The state-level data contained 13 different factors from population density, comorbid conditions, and social distancing score. The absolute CPA count was converted to frequency using the state’s population. Univariate and multivariate regression analyses were performed to assess the association between CPA frequency and admission endpoints. Results. A total of 205 CPAs were reported by 167 PICUs across 48 states. The estimated CPA frequency was 2.8 per million children in a one-month period. A total of 3,235 tests were conducted of which 6.3% were positive. Children above 11 years of age comprised 69.7% of the total cohort and 35.1% had moderated or severe comorbidities. The median duration of a CPA was 4.9 days (1.25–12.00 days). Out of the 1,132 total CPA days, 592 (52.2%) involved mechanical ventilation. The inpatient mortalities were 3 (1.4%). Multivariate analyses demonstrated an association between CPAs with greater population density (beta coefficient 0.01, p < 0.01 ). Multivariate analyses also demonstrated an association between pediatric type 1 diabetes mellitus with increased CPA duration requiring advanced respiratory support (beta coefficient 5.1, p < 0.01 ) and intubation (beta coefficient 4.6, p < 0.01 ). Conclusions. Inpatient mortality during PICU CPAs is relatively low at 1.4%. CPA frequency seems to be impacted by population density. Type 1 DM appears to be associated with increased duration of HFNC and intubation. These factors should be included in future studies using patient-level data.

scholarly journals APLIKASI PENCARIAN PARKIR JAKARTA BERBASIS ANDROID MENGGUNAKAN RESTFUL API

2019 ◽  
Vol 1 (2) ◽  
pp. 1-13
Author(s):  
Muhammad Adam Dzulqarnain ◽  
Muhammad Luthfi Aziz ◽  
Muhammad Fauzi Rachman ◽  
Aldy Rialdy Atmadja
Keyword(s):  
Population Density ◽  
System Development ◽  
The State ◽  
Android Application ◽  
Development Method ◽  
Metropolitan Cities

Jakarta is one of the metropolitan cities in Indonesia. The increasing number of vehicles entering Jakarta has resulted in the difficult to find parking area. Moreover, the population density occurred in there also resulted in the difficulty of finding parking area. Each parking area have its own capacity, the driver must directly check the state of the parking area. According to a survey conducted by VIVA, it takes 21 minutes to find parking in Jakarta (Viva, 2017). Based on the background of the problem, it can be conclude, the focus of the research is how to implement RESTFul API on an android application , so it will be ease to find a parking area in Jakarta. The system development method uses Scrum, the implementation results in the form of an android-based application using the RESTFul API.

scholarly journals A practical approach for geographic prioritization and targeting of insecticide-treated net distribution campaigns during public health emergencies and in resource-limited settings

2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Alyssa J. Young ◽  
Will Eaton ◽  
Matt Worges ◽  
Honelgn Hiruy ◽  
Kolawole Maxwell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Score ◽  
Value Added ◽  
State Level ◽  
Risk Scores ◽  
Analytic Hierarchy ◽  
Use Of Resources ◽  
Resource Limited ◽  
Geographic Prioritization ◽  
Using Data

Abstract Background The use of data in targeting malaria control efforts is essential for optimal use of resources. This work provides a practical mechanism for prioritizing geographic areas for insecticide-treated net (ITN) distribution campaigns in settings with limited resources. Methods A GIS-based weighted approach was adopted to categorize and rank administrative units based on data that can be applied in various country contexts where Plasmodium falciparum transmission is reported. Malaria intervention and risk factors were used to rank local government areas (LGAs) in Nigeria for prioritization during mass ITN distribution campaigns. Each factor was assigned a unique weight that was obtained through application of the analytic hierarchy process (AHP). The weight was then multiplied by a value based on natural groupings inherent in the data, or the presence or absence of a given intervention. Risk scores for each factor were then summated to generate a composite unique risk score for each LGA. This risk score was translated into a prioritization map which ranks each LGA from low to high priority in terms of timing of ITN distributions. Results A case study using data from Nigeria showed that a major component that influenced the prioritization scheme was ITN access. Sensitivity analysis results indicate that changes to the methodology used to quantify ITN access did not modify outputs substantially. Some 120 LGAs were categorized as ‘extremely high’ or ‘high’ priority when a spatially interpolated ITN access layer was used. When prioritization scores were calculated using DHS-reported state level ITN access, 108 (90.0%) of the 120 LGAs were also categorized as being extremely high or high priority. The geospatial heterogeneity found among input risk factors suggests that a range of variables and covariates should be considered when using data to inform ITN distributions. Conclusion The authors provide a tool for prioritizing regions in terms of timing of ITN distributions. It serves as a base upon which a wider range of vector control interventions could be targeted. Its value added can be found in its potential for application in multiple country contexts, expediated timeframe for producing outputs, and its use of systematically collected malaria indicators in informing prioritization.

scholarly journals The Influence of Contextual Factors on the Initial Phases of the COVID-19 Outbreak across U.S. Counties

2020 ◽  
Author(s):  
Wolfgang Messner ◽  
Sarah E Payson
Keyword(s):  
Air Pollution ◽  
Population Density ◽  
Contextual Factors ◽  
Statistical Significance ◽  
State Level ◽  
Ethnic Composition ◽  
Personal Health ◽  
Policy Makers ◽  
Black African ◽  
Exponential Growth Model

Objectives: To examine the influence of county- and state-level characteristics on the initial phases of the COVID-19 outbreak across U.S. counties up to April 14, 2020. Methods: We used a statistical exponential growth model for the outbreak. Contextual factors at county- and state-level were simultaneously tested with a multilevel linear model. All data was publicly available. Results: Collectivism was positively associated with the outbreak rate. The racial and ethnic composition of counties contributed to outbreak differences, affecting Black/African and Asian Americans most. Counties with a higher median age had a stronger outbreak, as did counties with more people below the age of 18. Higher income, education, and personal health were generally associated with a lower outbreak. Obesity was negatively related to the outbreak. Smoking was negatively related, but only directionally informative. Air pollution was another significant contributor to the outbreak, but population density did not give statistical significance. Conclusions: Because of high intrastate and intercounty variation in contextual factors, policy makers need to target pandemic responses to the smallest subdivision possible, so that countermeasures can be implemented effectively.

scholarly journals Disparities in Case Frequency and Mortality of Coronavirus Disease 2019 (COVID-19) Among Various States in the United States

2020 ◽  
Author(s):  
Rohit S. Loomba ◽  
Gaurav Aggarwal ◽  
Saurabh Aggarwal ◽  
Saul Flores ◽  
Enrique G. Villarreal ◽  
...  
Keyword(s):  
Population Density ◽  
State Level ◽  
The United States ◽  
Testing Frequency ◽  
Level Data ◽  
The Us ◽  
Mortality Case ◽  
Percent Mortality ◽  
Beta Coefficient ◽  
Reported Data

Objective: To utilize publicly reported, state-level data to identify factors associated with the frequency of cases, tests, and mortality in the US. Materials & Methods: Retrospective study using publicly reported data collected included the number of COVID-19 cases, tests, and mortality from March 14th through April 30th, 2020. Publicly available state-level data was collected which included: demographics comorbidities, state characteristics and environmental factors. Univariate and multivariate regression analyses were performed to identify the significantly associated factors with percent mortality, case and testing frequency. All analyses were state-level analyses and not patient-level analyses. Results: A total of 1,090,500 COVID-19 cases were reported during the study period. The calculated case and testing frequency were 3,332 and 19,193 per 1,000,000 patients. There were 63,642 deaths during this period which resulted in a mortality of 5.8%. Factors including to but not limited to population density (beta coefficient 7.5, p< 0.01), transportation volume (beta coefficient 0.1, p< 0.01), tourism index (beta coefficient -0.1, p=0.02) and older age (beta coefficient 0.2, p=0.01) are associated with case frequency and percent mortality. Conclusions: There were wide variations in testing and case frequencies of COVID-19 among different states in the US. States with higher population density had a higher case and testing rate. States with larger population of elderly and higher tourism had a higher mortality.

scholarly journals TOWARDS EFFECTIVE MULTIDISCIPLINARY ENGINEERING EDUCATION: THE MULTIDISCIPLINARY DESIGN STREAM AT QUEEN'S UNIVERSITY - PART II

2011 ◽  
Author(s):  
David S. Strong
Keyword(s):  
Engineering Design ◽  
System Development ◽  
Multidisciplinary Design ◽  
Multidisciplinary Teams ◽  
Perceived Need ◽  
Funding Policies ◽  
Practical Design ◽  
Queen's University ◽  
Design Skills ◽  
Engineering Schools

Professional engineers not only have to work frequently with those from other disciplines and professions, but often have to develop working skills and knowledge beyond their original discipline due to the requirements of their employment. Engineering accreditation bodies have accordingly begun to include the ability to function in multidisciplinary teams as a demonstrable requirement for accreditation of engineering schools. Similarly, engineering design skills are also important attributes for professional engineers, particularly those working in product, process or system development. Although long required by many engineering accreditation bodies, it is perceived by industry that most engineering graduates, although technically competent, have minimal practical design skills. There are many factors in most Canadian engineering schools that may limit student’s development of multidisciplinary and design skills. These include separate engineering departments, departmental funding policies, schedules based on individual disciplines, and heavy core course loads based on the perceived need for more math, science and computer courses. As a result, practical design experiences may be limited to one final year, discipline specific course. In an effort to address the need for both multidisciplinary and design engineering skills, a Multidisciplinary Design Stream has been developed at Queen’s University. Beginning with a course designed to develop a broad range of fundamental engineering design knowledge, skills and attitudes, the stream culminates with a full academic year experience working on industry based design projects in multidisciplinary teams. The first paper in this series, presented at the 2005 CDEN conference, discussed the first course in this stream and laid out the plans for the successive multidisciplinary industry-based design project. This paper will extend that discussion to review the industry project phase and reflect on the overall results of the first full offering of the multidisciplinary design stream.

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