scholarly journals Optimal Transport Scenario With Rotary Air Transport for Access to Endovascular Therapy Considering Patient Outcomes and Cost: A Modeling Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Ashlee Wheaton ◽  
Patrick T. Fok ◽  
Jessalyn K. Holodinsky ◽  
Peter Vanberkel ◽  
David Volders ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Patient Outcomes ◽  
Optimal Transport ◽  
Optimal Solution ◽  
Air Transport ◽  
Transport Cost ◽  
Transport Costs ◽  
Vessel Occlusion ◽  
Time To Treatment ◽  
Transport Method

Background and Purpose: For an ischemic stroke patient whose onset occurs outside of the catchment area of a hospital that is capable of Endovascular Treatment (EVT) and whose stroke is suspected to be caused by a large vessel occlusion (LVO), a transportation dilemma exists. Bypassing the nearest stroke hospital will delay Alteplase but expedite EVT. Not bypassing allows for confirmation of an LVO diagnosis before transfer to an EVT-enabled facility, but ultimately delays EVT. Air transport can reduce a patient's overall time to treatment however, it is costly. We expanded on an existing model to predict where Drip-and-Ship vs. Mothership provides better outcomes by including rotary air transport, and we also included prediction of where either the transport method was most cost effective.Methods: An existing model predicts the outcome of patients who screen positive for an LVO in the field based on how they were transported, Drip-and-Ship (alteplase-only facility first, then EVT-enabled facility) or Mothership (direct to EVT-enabled facility). In our model, the addition of rotary wing transportation was conditionally applied to inter-facility transfer scenarios where it provided a time advantage. Both patient outcome and transport cost functions were developed for Mothership and Drip-and-Ship strategies including transfers via either ground or air depending on the conditional probabilities. Experiments to model real world scenarios are presented by varying the driving time between the alteplase-only and EVT-enabled facility, time to treatment efficiencies at the alteplase-only facility, and EVT eligibility for LVO patients. Patient outcome and transport costs were evaluated for Mothership and Drip-and-Ship strategies.Results: The results are presented in temporospatial diagrams that are color coded to indicate which strategy optimizes the objectives. In most regions, there was overall agreement between the optimal solution when considering patient outcomes or transport costs. Small regions exist where outcome and cost are divergent; however, the difference between the divergence in Mothership and Drip-and-Ship in these regions is marginal.Conclusions: The optimal transport method can be optimized for both patient outcomes and transport costs.

Abstract P529: Optimal Transport Scenario for Access to Endovascular Therapy With Consideration of Patient Outcomes and Cost

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ashlee Wheaton ◽  
Peter VanBerkel ◽  
David Volders ◽  
Patrick T Fok ◽  
Jessalyn K Holodinsky ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Optimal Transport ◽  
Transportation Cost ◽  
Air Transportation ◽  
Air Transport ◽  
Cost Functions ◽  
Conditional Probabilities ◽  
Model Probability ◽  
Rotary Wing ◽  
The Brain

Introduction: For an ischemic stroke patient whose onset geographically occurs outside of the catchment area of an EVT enabled facility and whose stroke is suspected to be caused by an occlusion in a large vessel of the brain, a transportation dilemma exists. Bypassing the nearest stroke hospital will delay tPA but expedite EVT. Not bypassing allows for confirmation of an LVO diagnosis before transfer to a CSC, but ultimately delays EVT. Air transportation can reduce a patient’s overall time to treatment. However, air transportation is costly. Methods: In a previously published model probability functions were developed to predict the outcome of a patient who screened positive for an LVO in the field based on how the patient was transported, Drip and Ship (PSC first, then CSC) or Mothership (direct to CSC). The addition of rotary wing transportation was conditionally applied to inter-facility transfer scenarios where it provided a time advantage. Transportation cost functions were created to include both fixed and variable costs as well as probabilities that model the likelihood of air transport providing a time advantage, air-worthy weather, and air resource availability. Both outcome and cost functions were developed for Mothership scenarios and for Drip and Ship scenarios including transfers via either ground or air depending on the conditional probabilities. Results: The figure shows the results of the model for location scenarios with 60 and 90 minutes between the thrombolysis only center and EVT capable center. Three efficiency scenarios are also shown in the figure: 1) both hospitals are efficient; 2) thrombolysis center is inefficient; and 3) both hospitals are inefficient. Conclusions: In some scenarios, both outcome and cost can be optimized to indicate whether Drip and Ship or Mothership is preferred. However, scenarios exist where outcome and cost are divergent. In divergent scenarios cost can be minimized at the expense of patient outcomes.

scholarly journals Efficient heuristic for non-linear transportation problem on the route with multiple ports

2013 ◽  
Vol 20 (4) ◽  
pp. 80-86 ◽  
Author(s):  
Srećko Krile
Keyword(s):  
Optimal Transport ◽  
Cost Minimization ◽  
Transport Cost ◽  
Limited Capacity ◽  
Planning Tool ◽  
Transport Costs ◽  
Efficient Tool ◽  
Computing Power ◽  
Maximal Profit ◽  
Multiple Loading

ABSTRACT We need a better transport planning tool for loading maximization and transport cost minimization on the voyage route with multiple loading/unloading (discharging) ports. The implemented heuristic algorithm is able to find out an appropriate routing sequence with maximal earnings and profit. In the same time it looks for minimal loading/discharging and transshipment costs, but with fulfillment of cargo demands in a number of ports on the route. The efficient algorithm for optimal transport of N cargo loads (e.g. contingent of containers) for ships with limited capacity is being developed. This efficient tool may significantly reduce transport costs and ensure maximal profit to freight forwarders. Also, it can be applied for supply chain management of different goods from numerous vendors. The proposed algorithm shows acceptable complexity that means that such optimization tool can be used in shipping supported with limited computing power.

scholarly journals Optimalisasi Biaya Transportasi Pendistribusian Pupuk Bersubsidi Menggunakan Model Transportasi Metode Modified Distribusition (MODI)

2020 ◽  
Vol 17 (2) ◽  
pp. 160-168
Author(s):  
N Pertiwi ◽  
A I Jaya ◽  
Hajar
Keyword(s):  
Optimal Transport ◽  
Transport Model ◽  
Optimal Solution ◽  
Cost Savings ◽  
Transport Costs ◽  
Cost Of Transport ◽  
Modified Method ◽  
The Cost ◽  
Distribution Cost ◽  
Cost Of Transportation

ABSTRACT This study was conducted to obtain the optimal transport costs in the distribution of subsidized fertilizer in PT. GCS and PT.PPI. This research was done in two steps is to create a transport model of the data obtained and determine its solution initially with Least Cost method, and determine the optimal solution with ModifiedDistribution (MODI) method. Based on research that obtained the initial solution is Rp. 65.040.000 and optimal solution is Rp. 64.950.000. While the cost of transportation from the company is RP. 70.500.000. This shows that both distributors can optimize the total cost of transport for the distribution of subsidized fertilizer in January 2017 with the distribution cost savings of Rp. 5.550.000. Keywords      : Least Cost Method, Modified Method of Distribution, Optimization, Transportation

Quantification of pial collateral pressure in acute large vessel occlusion stroke: basic concept with patient outcomes

2021 ◽  
Author(s):  
Rizwan A. Tahir ◽  
Muhammad Affan ◽  
Horia Marin ◽  
Sameah A. Haider ◽  
Owais Khadem Alsrouji ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Basic Concept ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

scholarly journals Quantified health and cost effects of faster endovascular treatment for large vessel ischemic stroke patients in the Netherlands

2021 ◽  
pp. neurintsurg-2020-017017
Author(s):  
Henk van Voorst ◽  
Wolfgang G Kunz ◽  
Lucie A van den Berg ◽  
Manon Kappelhof ◽  
Floor M E Pinckaers ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Healthcare Costs ◽  
Large Vessel ◽  
Secondary Outcome ◽  
Vessel Occlusion ◽  
Time To Treatment ◽  
Stroke Population ◽  
Life Years ◽  
Mr Clean

BackgroundThe effectiveness of endovascular treatment (EVT) for large vessel occlusion (LVO) stroke severely depends on time to treatment. However, it remains unclear what the value of faster treatment is in the years after index stroke. The aim of this study was to quantify the value of faster EVT in terms of health and healthcare costs for the Dutch LVO stroke population.MethodsA Markov model was used to simulate 5-year follow-up functional outcome, measured with the modified Rankin Scale (mRS), of 69-year-old LVO patients. Post-treatment mRS was extracted from the MR CLEAN Registry (n=2892): costs per unit of time and Quality-Adjusted Life Years (QALYs) per mRS sub-score were retrieved from follow-up data of the MR CLEAN trial (n=500). Net Monetary Benefit (NMB) at a willingness to pay of €80 000 per QALY was reported as primary outcome, and secondary outcome measures were days of disability-free life gained and costs.ResultsEVT administered 1 min faster resulted in a median NMB of €309 (IQR: 226;389), 1.3 days of additional disability-free life (IQR: 1.0;1.6), while cumulative costs remained largely unchanged (median: -€15, IQR: −65;33) over a 5-year follow-up period. As costs over the follow-up period remained stable while QALYs decreased with longer time to treatment, which this results in a near-linear decrease of NMB. Since patients with faster EVT lived longer, they incurred more healthcare costs.ConclusionOne-minute faster EVT increases QALYs while cumulative costs remain largely unaffected. Therefore, faster EVT provides better value of care at no extra healthcare costs.

scholarly journals Transport Cost Estimation Model of the Agroforestry Biomass in a Small-Scale Energy Chain

2020 ◽  
Vol 3 (1) ◽  
pp. 22
Author(s):  
Giulio Sperandio ◽  
Andrea Acampora ◽  
Vincenzo Civitarese ◽  
Sofia Bajocco ◽  
Marco Bascietto
Keyword(s):  
Supply Chain ◽  
Power Plant ◽  
Central Italy ◽  
Biomass Energy ◽  
Transport Cost ◽  
Small Scale ◽  
Economic Sustainability ◽  
Transport Costs ◽  
Energy Chain ◽  
Biomass Power Plant

The delivery of biomass products from the production place to the point of final use is of fundamental importance within the constitution of energy chains based on biomass use as renewable energy source. In fact, transport can be one of the most economically expensive operations of the entire biomass energy production process. In this work, a geographic identification, through remote sensing and photo-interpretation, of the different biomass sources was used to estimate the potential available biomass for energy in a small-scale supply chain. The economic sustainability of transport costs was calculated for different types of biomass sources available close to a biomass power plant of a small-scale energy supply chain, in central Italy. The proposed analysis allows us to highlight and visualize on the map the areas of the territory characterized by greater economic sustainability in terms of lower transport costs of residual agroforestry biomass from the collection point to the final point identified with the biomass power plant. The higher transport cost was around € 40 Mg−1, compared to the lowest of € 12 Mg−1.

Abstract 1122‐000099: Establishing “Code NI” in Addition to “Code Stroke” is Warranted When Mechanical Thrombectomy is Needed

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Kiana Moussavi ◽  
Mohammad Moussavi
Keyword(s):  
Patient Outcomes ◽  
Mechanical Thrombectomy ◽  
Medical Emergency ◽  
Number Needed To Treat ◽  
Insurance Company ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Essential Information ◽  
Bed Management ◽  
Comprehensive Stroke Center

Introduction : Hospital medical emergencies are prone to inefficiencies related to delayed dissemination of information, communication error, role confusion, and delayed decision making. The use of medical codes is intended to convey emergent and essential information quickly while preventing stress and mismanagement. The more complex, critical, and time sensitive an event is, the greater the need to establish a Code. Major mechanical thrombectomy (MT) trials published in 2015 and 2016 proved emergent MT to be more effective compared to IV tPA in stroke patients with large vessel occlusion (LVO). It has been proven that time to reperfusion with MT is directly proportional to severity of patient outcomes, coining the phrase, “save a minute, save a week”. When compared to the use of percutaneous intervention (PCI) in the treatment of STEMI, the number needed to treat for MT is estimated at 5 compared to 16 for PCI. Despite this fact, most hospitals have yet to adopt a code specific to MT. Our Purpose is to emphasize the importance of establishing a dedicated Code NI (Neuro‐Intervention) for stroke patients who require MT by sharing our Methods : After defining the problems, measuring the need, and analyzing the process, we identified the urgency for improvements in our facility. The administration was persuaded to support us in implementation of improvements after realizing the success of MT trials in patient outcomes, length of stay, hospital rankings, Comprehensive Stroke Center Certification, and insurance company compensation. Results : In early 2018, after many presentations and meetings, it was decided to implement “Code NI” for acute stroke patients who met MT criteria. Many teams and individuals including Neurointervention, Neuroradiology, Angio Suite, Anesthesia, ICU, Bed management, and transport were alerted. Following these implementations, from 2018 to 2021, our Door to Puncture Time and Puncture to Recanalization Time has been trending down from 219 to 120; and 261 to 147 minutes respectively. Conclusions : Approximately 70% of stroke patients with LVO have the potential of a meaningful recovery if treated efficiently and effectively. Establishing a “Code NI” for this time sensitive medical emergency helps the patients, their families, hospitals, and society.

On the Historical Relationship between Port (In)Efficiency and Transport Costs in the Developing World

2021 ◽  
Author(s):  
Matías Herrera Dappe ◽  
Tomás Serebrisky ◽  
Ancor Suárez-Alemán
Keyword(s):  
Developing Countries ◽  
Service Provision ◽  
Cost Model ◽  
Transport Cost ◽  
Maritime Transport ◽  
Parametric Approach ◽  
Transport Costs ◽  
Port Efficiency ◽  
Container Ports ◽  
Historical Relationship

Do differences in port performance explain differences in maritime transport costs? How much would improvements in port performance reduce maritime transport costs in developing countries? To answer this question, we use a widely used transport cost model, but we provide a new measure of port efficiency, estimated through a non-parametric approach. Relying on data from the early 2000s, this paper shows that for a sample of 115 container ports in 39 developing countries, becoming as efficient as the country with the most efficient port sector would reduce average maritime transport costs by 5 percent. For the most inefficient country, the reduction in transport costs could reach 15 percent. These findings point out the potential gains that can be achieved from the combination of betterquality investment and more efficient service provision in the port sector. The estimates in this paper cannot be updated because the databases were discontinued and it therefore highlights the need to generate data to evaluate the effectiveness of public policies that are key to competitiveness.

Abstract WP45: Outcomes of Patients With Cerebral Large Vessel Occlusions Undergoing Mechanical Endovascular Revascularization Based on the Quantification of Pial Collateral Perfusion

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Rizwan Tahir ◽  
Horia Marin ◽  
Muhammad Affan ◽  
Ayesha Ahmad ◽  
Michael Bazydlo ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Patient Outcomes ◽  
Perfusion Pressure ◽  
Large Vessel ◽  
Patient Specific ◽  
P Value ◽  
Vessel Occlusion ◽  
Post Procedure ◽  
Endovascular Revascularization ◽  
Unit Increase

Introduction: Patient outcomes after Mechanical Endovascular Revascularization (MER) are dependent on both patient-specific and procedure-specific factors. The pial collateral perfusion to the ischemic penumbra during a cerebral large vessel occlusion (LVO) is one of the most important factors in overall patient outcome. Using our technique of Quantifying of Pial Collateral Perfusion (QPCP) previously described, patient outcomes after MER for cerebral LVO were assessed. Methods: Fifty consecutive patients with proximal middle cerebral artery M1 occlusions for whom QPCP were recorded were included in the study. In addition to patient demographics, the primary outcomes investigated were National Institutes of Health Stroke Scale (NIHSS) scores post-procedure reduction compared to pre-procedure score, and modified Rankin Scale (mRS) score at 30-day and 3-month follow-up. In addition, overall stroke volume, time spent in hospital, and the incidence of hemorrhagic conversion were also assessed. Regression models were used to estimate the association between pial collateral perfusion pressure and the above outcomes. Results: Patients demonstrated for every 5-unit increase in pial collateral perfusion pressure (measured in mmHg) an association with a 0.54-unit decrease in the post-procedure NIHSS score with a P-value of 0.07 (β= -0.54; 95% CI -1.12,0.03). A 5-unit increase in pial collateral perfusion pressure was also associated with 11% lower odds of having a 30-day mRS of 4-5 vs. 0-1 or 2-3 with a P-value of 0.18 (OR=0.89; 95% CI 0.75,1.06). A higher pial collateral perfusion pressure was also associated with a 0.07-unit decrease in the log of the stroke volume (P-value - 0.32). There was no association with higher pial collateral perfusion pressure and incidence of hemorrhagic conversion on post-procedure imaging. Conclusions: The QPCP is an objective measure for predicting patient outcomes after MER for cerebral LVO. Higher pial collateral perfusion pressures are associated with greater improvements in post-reperfusion NIHSS scores and 30-day mRS scores.

A simulation and optimisation procedure to model daily suppression resource transfers during a fire season in Colorado

2017 ◽  
Vol 26 (7) ◽  
pp. 630 ◽  
Author(s):  
Yu Wei ◽  
Erin J. Belval ◽  
Matthew P. Thompson ◽  
Dave E. Calkin ◽  
Crystal S. Stonesifer
Keyword(s):  
Fire Suppression ◽  
Rocky Mountain ◽  
Transport Cost ◽  
Fire Season ◽  
Test Results ◽  
Transport Costs ◽  
Demand Prediction ◽  
Resource Transfers ◽  
Shift Length ◽  
Optimisation Procedure

Sharing fire engines and crews between fire suppression dispatch zones may help improve the utilisation of fire suppression resources. Using the Resource Ordering and Status System, the Predictive Services’ Fire Potential Outlooks and the Rocky Mountain Region Preparedness Levels from 2010 to 2013, we tested a simulation and optimisation procedure to transfer crews and engines between dispatch zones in Colorado (central United States) and into Colorado from out-of-state. We used this model to examine how resource transfers may be influenced by assignment shift length, resource demand prediction accuracy, resource drawdown restrictions and the compounding effects of resource shortages. Test results show that, in certain years, shortening the crew shift length from 14 days to 4 days doubles the yearly transport cost. Results also show that improving the accuracy in predicting daily resource demands decreases the engine and crew transport costs by up to 40%. Other test results show that relaxing resource drawdown restrictions could decrease resource transport costs and the reliance on out-of-state resources. The model-suggested assignments result in lower transport costs than did historical assignments.

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