Bed Capacity Research Articles

Exploring the safety reporting culture among healthcare practitioners in Saudi hospitals: a comprehensive 2022 national study

BackgroundWith the rise in medical errors, establishing a strong safety culture and an effective incident reporting system is crucial. As part of the Saudi National Health Transformation Vision of 2030, multiple projects have been initiated to periodically assess healthcare quality measures and ensure a commitment to continuous improvement. Among these is the Hospital Survey on Patient Safety Culture National Project (HSPSC), conducted regularly by the Saudi Patient Safety Center (SPSC). However, comprehensive tools for assessing reporting culture are lacking. Addressing this gap can enhance reporting, efficiency, and health safety.ObjectiveThis paper aims to investigate the reporting practices among healthcare professionals (HCPs) in Saudi Arabian hospitals and examine the relationship between reporting culture domains and other variables such as hospital bed capabilities and HCPs’ work positions.MethodsThe study focuses on measuring the reporting culture-related items measures and employs secondary data analysis using information from the Hospital Survey on Patient Safety Culture conducted by the Saudi Center for Patient Safety in 2022, encompassing hospitals throughout Saudi Arabia. Data incorporated seven items in total: four items related to the Response to Error Domain, two related to the Reporting Patient Safety Events Domain, and one associated with the number of events reported in the past 12 months.ResultsThe sample for the analyzed data included 145,657 HCPs from 392 hospitals. The results showed that the average positive response rates for reporting culture-related items were between 50% and 70%. In addition, the research indicated that favorable response rates were relatively higher among managerial and quality/patient safety/risk management staff. In contrast, almost half had not reported any events in the preceding year, and a quarter reported only 1 or 2 events. Pearson correlation analysis demonstrates a strong negative correlation between bed capacity and reporting safety events, response to error, and number of events reported (r = -0.935, -0.920, and − 0.911, respectively; p < 0.05), while a strong positive correlation is observed between reporting safety events and response to error (r = 0.980; p < 0.01).ConclusionsAlmost 75% of the HCPs reported fewer safety events over the last 12 months, indicating an unexpectedly minimal recorded occurrence variance ranging from 0 to 2 incidents.

Let's Talk Safety - Data from the Neonatal Intensive Care Unit Safety and Bed Capacity Huddles.

Huddles are brief team meetings designed to communicate essential information. Safety huddles provide a forum to identify and review patient safety events. In a just culture, everyone is accountable for patient safety. The purpose of this project is to discuss safety issues/events at the twice daily bed capacity huddles in a Level IV Neonatal Intensive Care Unit (NICU) utilizing a just culture model. Having daily discussions of patient safety and the escalation process for follow-up promotes a just culture. The aims are to improve the unit's culture of safety and learn from patient safety issues. A just culture model was adopted to promote discussion of safety events during the huddles. A structured checklist of safety events was utilized along with a script of ground rules. Twice a day, a multidisciplinary group gathers to huddle. Nurse leaders facilitate the discussion, track the results, and provide follow-up. The structured safety huddle began in May of 2020 and continues twice daily. All required staff attend. The escalation process is defined and has prevented recurrence of some safety issues. The NICU experienced a 14% increase in favorable results on the Agency for Healthcare Research and Quality (AHRQ) culture of safety survey since the inception of the structured safety huddles. Safety huddle discussions have impacted the culture of safety on this unit. Tracking of discussions can help to identify trends, improve processes, and impact patient safety.

Healthcare professional views about a prehospital redirection pathway for stroke thrombectomy: a multiphase deductive qualitative study

BackgroundMechanical thrombectomy for stroke is highly effective but time-critical. Delays are common because many patients require transfer between local hospitals and regional centres. A two-stage prehospital redirection pathway consisting of...

THE EFFECTS OF LEADERSHIP STYLES OF HEALTHCARE INSTITUTION MANAGERS ON THE JOB SATISFACTION AND ORGANIZATIONAL COMMITMENT OF HEALTHCARE WORKERS

In this study, it is aimed to reveal the effects of the leadership styles of the managers in health institutions on the job satisfaction and organizational commitment of the employees. The data necessary for the research, a survey was conducted among 140 medical professionals working in the administrative departments of hospitals on the Anatolian side of Istanbul with bed capacity of 600 and more. The first section of the study consist of the factor analysis of the measurement instruments of job satisfaction, organizational commitment, and five leadership behaviours. Kaiser-Meyer-Olkin (KMO) test, and the Bartlett’s Sphericity test showed that the study sample was appropriate for the factor analysis. The second section includes multivarite regression model and the univarite analysis. The descriptive statistics of the participant characteristics, and the scales were presented with mean and standard deviation, and frequencies and percentage. The statistical significance was at 0.05 level. The exploratory variables were the participant charactersitics, and the leadership behaviours that found to have statistically significant relationship with the dependent variables. As a result, it is supported by our research findings that the organizational commitment of the personnel working in healthcare institutions is related to the concepts of task-oriented leader and people-oriented leader.

Theoretical investigations of the potential application of PVA-mixed-valent tunnel structured manganese oxide nano-composite in continuous simultaneous removal of multi-contaminants from aqueous waste stream

The potential use of PVA-mixed-valent tunnel structured manganese oxide nano-composite in the removal of multi-contaminants form aqueous solutions was assessed by studying the continuous simultaneous removal of lead, caesium, and cobalt. Within this context, the morphology and the nature of nanoparticle inclusion into the PVA matrix was assessed using SEM–EDX analysis. The nanoparticles are homogenously distributed in the polymeric matrix with some agglomerated inclusions of these particles. The thermal and chemical stability analyses prove the stability of the material up to 180 °C and in slightly acidic to slightly alkaline solutions. The analysis of the gravimetric thermal data shows that the thermal treatment is a feasible end of life management route for this material. The values of percentage uptake and bed capacity indicate the feasibility of the use of this material in the simultaneous removal of lead, caesium and cobalt. The breakthrough curves analyses provide insights into the breakthrough characteristics and underlying removal mechanisms. It was found that the removal reaction follows Langmuir kinetics of adsorption–desorption and that the rate driving forces follow second order reversible reaction kinetics, where the sorption occur at energetically equal sites.

The Alberta Atlas of Healthcare Variation (A-Atlas): A New Clinical Tool

Newly occurring and worsening pressure injuries are a challenge across LTC facilities in Alberta. Despite multiple risk reduction/prevention strategies and early identification and treatment approaches, there is inconsistency with how best practices are utilized across sites. The newly created Alberta Atlas of Healthcare Variation (A-Atlas) reveals the degree of variation by showing weighted median pressure injury rates across provincial zones, adjusted pressure injury rates over time, weighted median pressure injury rates between facilities grouped into different bed capacity ranges and crude pressure injury rates between first and subsequent assessments across sites. The goal of the A-Atlas is to raise awareness of clinical variation and prompt further investigation about why variation is present and whether the variation is warranted or unwarranted. It offers a data driven analysis to enable continuous quality improvement and stimulate action to improve patient outcomes.

Survey and analysis on the resource situation of primary health care institutions in rural China.

China's rural population is immense, and to ensure the well-being of rural residents through healthcare services, it is essential to analyze the resources of rural grassroots healthcare institutions in China. The objective is to examine the discrepancies and deficiencies in resources between rural grassroots healthcare institutions and the national average, providing a basis for future improvements and supplementation of rural healthcare resources. The study analyzed data from 2020 to 2022 on the number of healthcare establishments, the capacity of hospital beds, the number of healthcare professionals, and the number of physicians in both rural and national settings. Additionally, it examined the medical service conditions and ratios of township health centers in rural areas to assess the resource gap between rural areas and the national average. Healthcare establishments: On average, there were 2.2 fewer healthcare institutions per 10,000 persons in rural areas compared to the national average over three years. Hospital beds: On average, there were approximately 36 fewer hospital beds per 10,000 persons in rural areas compared to the national average over three years. Healthcare professionals and physicians: On average, there were about 48 fewer healthcare technical personnel and 10 fewer practicing (including assistant) physicians per 10,000 persons in rural areas compared to the national average over three years. Compared to the national average, there are significant discrepancies and deficiencies in grassroots healthcare resources in rural China. This underscores the necessity of increasing funding to progressively enhance the number of healthcare institutions in rural areas, expand the number of healthcare personnel, and elevate medical standards to better align with national benchmarks. Improving rural healthcare resources will strategically equip these institutions to cater to rural communities and effectively handle public health emergencies. Ensuring that the rural population in China has equal access to healthcare services as the rest of the country is crucial for promoting the well-being of rural residents and achieving health equity.

Closer to Home: A Quality Improvement Initiative to Optimize Satellite Site Bed Capacity.

The coronavirus disease 2019 pandemic resulted in the underutilization of inpatient beds at our satellite location. A lack of clarity and standardized admission criteria for the satellite led to frequent transfers to the main campus, resulting in patients traveling larger distances to receive inpatient care. We sought to optimize inpatient resource use at the satellite campus and keep patients "closer to home" by admitting eligible patients to that inpatient unit (LA4). Our aim was to increase bed capacity use at the satellite from 45% to 70% within 10 months. Our process measure was to increase the proportion of patients needing hospitalization who presented to the satellite emergency department (ED) and were then admitted to LA4 from 76% to 85%. A multidisciplinary team used quality improvement methods to optimize bed capacity use. Interventions included (1) the revision and dissemination of satellite admission guidelines, (2)steps to create shared understanding of appropriate satellite admissions between ED and inpatient providers, (3) directed provider feedback on preventable main campus admissions, and (4) consistent patient and family messaging about the potential for transfer. Data were collected via chart review. Annotated run charts were used to assess the impact of interventions over time. Average LA4 bed capacity use increased from 45% to 69%, which was sustained for 1 year. The average percentage of patients admitted from the satellite ED to LA4 increased from 76% to 84%. We improved bed capacity use at our satellite campus through transparent admission criteria and shared mental models of patient care needs between ED and inpatient providers.

A quality improvement study on how a simulation model can help decision making on organization of ICU wards

BackgroundIntensive Care Unit (ICU) capacity management is essential to provide high-quality healthcare for critically ill patients. Yet, consensus on the most favorable ICU design is lacking, especially whether ICUs should deliver dedicated or non-dedicated care. The decision for dedicated or non-dedicated ICU design considers a trade-off in the degree of specialization for individual patient care and efficient use of resources for society. We aim to share insights of a model simulating capacity effects for different ICU designs. Upon request, this simulation model is available for other ICUs.MethodsA discrete event simulation model was developed and used, to study the hypothetical performance of a large University Hospital ICU on occupancy, rejection, and rescheduling rates for a dedicated and non-dedicated ICU design in four different scenarios. These scenarios either simulate the base-case situation of the local ICU, varying bed capacity levels, potential effects of reduced length of stay for a dedicated design and unexpected increased inflow of unplanned patients.ResultsThe simulation model provided insights to foresee effects of capacity choices that should be made. The non-dedicated ICU design outperformed the dedicated ICU design in terms of efficient use of scarce resources.ConclusionsThe choice to use dedicated ICUs does not only affect the clinical outcome, but also rejection- rescheduling and occupancy rates. Our analysis of a large university hospital demonstrates how such a model can support decision making on ICU design, in conjunction with other operation characteristics such as staffing and quality management.

Analysis of the effect of digital hospital efforts on paper savings in inpatient procedures and on the duration of nursing care services.

This study has two primary objectives. Firstly, it aims to measure the time savings achieved through the digitization of paper forms filled out by nurses in the inpatient care process. Secondly, it seeks to reveal the financial savings resulting from reduced paper consumption due to the digitalization. The Health Information Management System Society (HIMSS)-Electronic Medical Record Adaption Model (EMRAM), which makes stage-based (0-7) evaluations, serves as a tool to measure the rate of technology utilization in public hospitals in Turkey. The study is based on the HIMSS EMRAM criteria for 2018. Bahçelievler State Hospital, a public hospital in Turkey, was chosen as the research facility. In 2017, it was accredited as Stage 6 with HIMSS EMRAM. However, not all its wards have been digitalized. Initially, pilot selected wards were digitized. Therefore, digital and non-digital wards serve together. In this context, 4 wards were randomly selected and time, paper and toner savings before and after digitalization were measured. A table was created in Microsoft Excel,listing the forms used by nurses in inpatient care and the time required to fill them out.The time spent for filling paper-based forms and digital-based forms was measured in randomly selected wards. The analysis showed that digital forms saved more time, paper and toner. For example, filling out the patient history form took 45 min when using paper, compared to 12 min in digital environment. Approximately 27% time savings are achieved only for the patient history form. The total time savings delivered by digitalization for 1,153 inpatients during the year were found as 117 care days, and the savings on total paper consumption was 41.289 pages. For 1,153 inpatients throughout the year, the total time savings from digitalization was 117 care days and the total paper consumption savings was 41,289 pages. In addition, in 4 wards with a total bed capacity of 25, annual paper savings of $1,705.86 and toner savings of $283,736 were achieved. This study reveals the benefits of digitalisation in hospitals for nurses. It saves the time that nurses allocate for filling out paper forms with digitalised forms. Thus, it is a good practice example in terms of using the time allocated for form filling for patient care.When we extend this study to Turkey in general, it can be considered that the time savings achieved by nurses by digitizing inpatient forms varies between 10.8% and 13%. The number of nurses working in public hospitals in Turkey is approximately 160,000. Assuming that 60% of the nurses work in the inpatient ward, it is understood that the annual savings achieved by digitizing the forms corresponds to a range of 398-559 nursing hours.

Utilizing disease transmission and response capacities to optimize covid-19 control in Malaysia

ObjectivesPublic Health Social Measures (PHSM) such as movement restriction movement needed to be adjusted accordingly during the COVID-19 pandemic to ensure low disease transmission alongside adequate health system capacities based on the COVID-19 situational matrix proposed by the World Health Organization (WHO). This paper aims to develop a mechanism to determine the COVID-19 situational matrix to adjust movement restriction intensity for the control of COVID-19 in Malaysia.MethodsSeveral epidemiological indicators were selected based on the WHO PHSM interim guidance report and validated individually and in several combinations to estimate the community transmission level (CT) and health system response capacity (RC) variables. Correlation analysis between CT and RC with COVID-19 cases was performed to determine the most appropriate CT and RC variables. Subsequently, the CT and RC variables were combined to form a composite COVID-19 situational matrix (SL). The SL matrix was validated using correlation analysis with COVID-19 case trends. Subsequently, an automated web-based system that generated daily CT, RC, and SL was developed.ResultsCT and RC variables were estimated using case incidence and hospitalization rate; Hospital bed capacity and COVID-19 ICU occupancy respectively. The estimated CT and RC were strongly correlated [ρ = 0.806 (95% CI 0.752, 0.848); and ρ = 0.814 (95% CI 0.778, 0.839), p < 0.001] with the COVID-19 cases. The estimated SL was strongly correlated with COVID-19 cases (ρ = 0.845, p < 0.001) and responded well to the various COVID-19 case trends during the pandemic. SL changes occurred earlier during the increase of cases but slower during the decrease, indicating a conservative response. The automated web-based system developed produced daily real-time CT, RC, and SL for the COVID-19 pandemic.ConclusionsThe indicators selected and combinations formed were able to generate validated daily CT and RC levels for Malaysia. Subsequently, the CT and RC levels were able to provide accurate and sensitive information for the estimation of SL which provided valuable evidence on the progression of the pandemic and movement restriction adjustment for the control of Malaysia.

The Effect of Neonatal Intensive Care Nurses' Attitudes Towards Palliative Care on Death Anxiety and Burnout: An Analytic Cross-Sectional Study.

This study aimed to determined the effect of neonatal intensive care nurses' attitudes towards palliative care on death anxiety and burnout. This was an analytic cross-sectional study conducted with 215 neonatal intensive care nurses working a children's hospital with Turkey's largest NICU bed capacity. The mean Neonatal Palliative Care Attitude Scale total score was 3.04 ± 0.78, and the mean scores of the organization, resources, and clinician subscales were 3.16 ± 0.86, 2.87 ± 0.80, and 3.10 ± 0.97, respectively. The participants' mean Death Anxiety Scale score was 57.65 ± 21.46, and the mean Burnout Inventory score was 39.21 ± 17.61. The organization subscale explained 17% of the variance in death anxiety, and the organization and resources subscales explained 31% of the variance in burnout. Neonatal intensive care nurses' palliative care attitudes are moderate; they face obstacles in providing and improving their attitudes in this field. The high level of obstacles increases nurses' death anxiety and burnout.

The future of hospital at home: a qualitative interview study of healthcare staff.

Hospital at Home (HaH) services are expanding to provide acute multidisciplinary care in an individual's home. In this pilot study, we interviewed HaH staff to understand challenges and opportunities for service development. We conducted 23 semi-structured interviews with multidisciplinary staff working across three HaH services in Scotland. The questions focussed on service strengths and challenges. Four themes emerged: raising referral awareness, service design and efficiency, staff security on home visits, and sustainability. HaH staff described Emergency Department posters, experience days for non-HaH staff, and daily communication of virtual bed capacity to raise awareness for referrals. Ideas for maximising clinician time were prioritised to improve service efficiency and investment in electric vehicles was strongly supported to mitigate climate impact. We found high job satisfaction and engagement amongst HaH staff. Our interviews suggest enthusiasm for further development of HaH while raising important challenges to address during service expansion.

A robust mixed-integer binary programming model for operating theater scheduling to the patient and the surgeon under uncertainty in an open-heart Surgery Department

In hospitals, the surgical ward is both a cost and revenue center. In this ward, hospitals face challenges such as increasing demand, limited resources, and rising costs. Consequently, the decisions made have an implications effect on the hospital's performance. Therefore, in this paper a robust mixed-integer binary programming model is proposed with three objectives of maximizing the efficiency of available resources, minimizing the patients waiting time, and minimizing surgery costs that are formulated utilizing the augmented epsilon constraint approach. This model allocates the operating room to the patient and the surgeon and then obtains the required bed capacity inside the downstream units for stand-alone cardiac hospitals. This model includes different preferences for hospital, surgeon, and patient: waiting time, patient cancellations, tardiness, uncertainties in surgery durations, the patient operation start times, the overtime per working day, time windows, SICU beds, planning horizon, and the idle times of the surgeons, operating theater, and working day. The proposed model is solved using robust optimization to deal with stochastic. The proposed model is formulated on the stochastic programming method proposed by Bertsimas and Sim. In the proposed model, a rolling horizon method is used to reschedule the program after cancellation. The computational results illustrate that the rolling horizon method reduces waiting time and increases throughput. The results illustrate that the benefit obtained from the introduced model has improvements in reducing the surgery costs, and patient waiting time, and increasing the efficiency of available resources. This study has been performed at Shahid Rajaei Heart Hospital in Iran.

Inpatient Palliative Care and Healthcare Utilization Among Older Patients With Alzheimer's Disease and Related Dementia (ADRD) and High Risk of Mortality in U.S. Hospitals.

Background. Despite the potential of palliative care (PC) to enhance the quality of life for patients with advanced dementia, there is limited knowledge of its inpatient utilization patterns. This study investigated inpatient PC consultation utilization patterns and evaluated its impact on hospital length of stay (LOS) and medical costs among older patients diagnosed with Alzheimer's Disease and Related Dementia who were at a high risk of mortality (ADRD-HRM). Methods. Using the 2016-2019 National Inpatient Sample database, we conducted multivariable logistic regression analyses to identify individual and hospital characteristics influencing PC consultation utilization. We subsequently performed generalized linear models to estimate LOS (using Poisson distribution) and hospital charges (via log-transformation). Results. Our sample encompassed 965,644 hospital discharges (weighted n = 4,828,219) of patients aged 65years and above with ADRD-HRM. Among them, 14.6% received inpatient PC. There was a notable uptrend in PC consultation utilization from 13.3% in 2016 to 16.3% in 2019 (p trend<.001). Factors positively influencing and associated with PC utilization included patients that are older, non-Hispanic White, with higher income, receiving care from teaching hospitals, and facilitated with greater bed capacity (all P < .05). Although patients who received PC were more likely to have 3.0% longer LOS (P < .001), they had 19.2% lower hospital charges (P < .001). Conclusions. PC substantially reduced hospital expenditures for older patients with ADRD-HRM, but the prevalence remained low at 14.6% in the study period. Future studies should explore the unmet needs of patients with lower sociodemographic status and those in rural hospitals to further increase their PC consultation utilization.

The population morbidity with diseases of ear and mastoid and accessibility of otorhinolaryngological care

The article analyses level and dynamics of morbidity of diseases of ear and mastoid in the Sakha Republic (Yakutia) in 2020-2021 and availability of otorhinolaryngological care. The methods of comparative statistics and mathematical analysis were applied to analyze official data provided by the Yakut Republic Medical Information and Analytical Center, the specialized Department of Otorhinolaryngology, the Republic Hospital № 2 - Center for Emergency Medical Care and the Federal State Statistics Service of Russia. The study established increasing trend of increasing morbidity of these diseases in both the adult and child population. In 2021, the growth rate of overall morbidity of adult population reached 17.7% and 8.8% in children, as compared to 2020. The primary morbidity of adults made up to 22.3%, in children - 15.7%. The comparative analysis demonstrated higher rates of general morbidity in the Republic: by 0.5% as compared with the Russian Federation and by 14.1% as compared with the Far Eastern Federal Okrug. The level of primary morbidity was lower than similar indicators of the compared territories by 17.1% and 3.0%, respectively. It is worth noting that analyzed morbidity of diseases of ear and mastoid reflects prevalence of ENT diseases in the region only indirectly, as the statistical data do not allow to estimate separately rate of upper respiratory tract lesions. Meanwhile, respiratory diseases rank first in the structure of population diseases in Yakutia. The growth of disability in children due to diseases of ear and mastoid requires attention. Among children of 0-17 years old, the indicator of primary disability increased from 0.38 to 0.8 per 10,000 of children population (increase of 110.5%); in children 0-3 years old - from 0.9 to 2.3 per 10,000 of the child population (an increase of 155.6%). The analysis of the number of beds in otorhinolaryngology wards established that that the bed capacity per 10,000 population was 0.6 that is significantly lower than the established standards. The article emphasizes need to adjust the Federal standards for hospital bed capacity, taking into account climatic and geographical conditions of the region, which contribute to spread and chronization of ENT diseases.

Analyzing the Capacity of the Healthcare System in Gaza to Address Gaza Residents Needs

The present humanitarian crisis in Gaza has resulted in the devastation of medical facilities and health infrastructure. As of January 2024, the World Health Organization reports that 78% of primary care clinics funded by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA, 2024) have ceased operations, and hospitals’ bed capacity throughout Gaza has decreased by more than 59% (World Health Organization, 2024). Direct military attacks on medical facilities as well as the blockade of medical supplies and humanitarian aid pose the largest obstacles to greater healthcare attainment in Gaza (IRC, 2024). Over the course of the conflict, there has been a surge in the number of people suffering from war injuries, which now totals 71,377 (Shurafa, 2024). The rise in the number of patients who require access to medical services in combination with the limited hospital functionality in the Gaza Strip is putting a massive strain on their already limited healthcare system; before the over 6 month long duration of direct military attacks by the Israeli Defence Forces (IDF) on hospitals in Gaza, data indicated a maximum ratio of 1.55 hospital beds per 1000 individuals across the entire region of the Gaza Strip, while the ratio in the US is around 2.35 hospital beds per 1000 individuals (Taylor, 2024). The already poor living conditions of the demographic–most of whom are housed in temporary structures in severe weather conditions with a lack of access to food and water for sustenance or hygiene–signify a need for a more robust healthcare system. However, triage conditions prioritize treatment of the most severe war injuries, which has forced hospitals to abandon previously established vaccination projects and disease surveillance programs, leaving the remaining population to suffer from preventable diseases such as chickenpox, upper respiratory infections, scabies, and Hepatitis A (Soni, 2024). Individuals who do receive medical care face higher levels of infection due to a lack of adequate sanitation, waste management measures, and basic hygiene supplies (The Economist, 2024).

Desulfurization of Zawia Refinery Diesel Using Adsorption Fixed Bed Process

The study focuses on the dynamic modeling of a fixed-bed adsorber for the adsorption of sulfur compounds in diesel fuel. The model considers non-ideal plug flow behavior and velocity variation along the column, providing a more realistic representation of the adsorption process. Additionally, internal mass-transfer resistances due to pore diffusion mechanisms are incorporated into the model. The study investigates adsorption performance by examining different flow rates (5 cc/min, 10 cc/min, 15 cc/min, and 20 cc/min) and inlet concentrations ranging from 586 to 100 ppm. The bed height is constant at 30 cm. The behavior of various parameters, such as bed utilization, breakpoint time, film mass transfer coefficient, and height of the adsorption zone, is analyzed. The results indicate that a sharp front of the breakthrough curve is observed, followed by the broadening of the tail of the breakthrough curve. The breakthrough curve represents the adsorbate concentration in the effluent stream over time. The investigation reveals that a high flow rate of 20 cc/min and a high inlet concentration yield better overall bed capacity utilization for the adsorption system. This means that the bed is more effectively utilized at higher flow rates and higher inlet concentrations, leading to improved adsorption performance. In conclusion, high flow rates and high inlet concentrations are favorable for enhancing the adsorption system's performance in terms of bed utilization. These results provide valuable insights for optimizing the design and operation of fixed-bed adsorbers that remove sulfur compounds from diesel fuel.

A regionally tailored epidemiological forecast and monitoring program to guide a healthcare system in the COVID-19 pandemic

BackgroundDuring the COVID-19 pandemic, analytics and predictive models built on regional data provided timely, accurate monitoring of epidemiological behavior, informing critical planning and decision-making for health system leaders. At Atrium Health, a large, integrated healthcare system in the southeastern United States, a team of statisticians and physicians created a comprehensive forecast and monitoring program that leveraged an array of statistical methods. MethodsThe program utilized the following methodological approaches: (i) exploratory graphics, including time plots of epidemiological metrics with smoothers; (ii) infection prevalence forecasting using a Bayesian epidemiological model with time-varying infection rate; (iii) doubling and halving times computed using changepoints in local linear trend; (iv) death monitoring using combination forecasting with an ensemble of models; (v) effective reproduction number estimation with a Bayesian approach; (vi) COVID-19 patients hospital census monitored via time series models; and (vii) quantified forecast performance. ResultsA consolidated forecast and monitoring report was produced weekly and proved to be an effective, vital source of information and guidance as the healthcare system navigated the inherent uncertainty of the pandemic. Forecasts provided accurate and precise information that informed critical decisions on resource planning, bed capacity and staffing management, and infection prevention strategies. ConclusionsIn this paper, we have presented the framework used in our epidemiological forecast and monitoring program at Atrium Health, as well as provided recommendations for implementation by other healthcare systems and institutions to facilitate use in future pandemics.

Analysis of the State Archives Republican Archives Documents on Tuberculosis and Fight Against Tuberculosis in the Early Republican Period in Turkiye

Purpose: To share information obtained as a result of examination of archival documents related to tuberculosis and the fight against tuberculosis between 1923-1938. Method: Study, which is a qualitative research, was designed as a document analysis. Previous publications on subject were examined. State Archives Republican Archives Catalogue was scanned. Documents found were analysed. Selected documents were included in study. Study covers the period of Atatürk (1923-1938). Results: In early Republican period, Turkiye gave importance to fight against tuberculosis together with infectious diseases such as malaria, trachoma and syphilis. successful works initiated in Ottoman period were continued and additional works were initiated according to new practices and principles. Tuberculosis and fight against tuberculosis were discussed in "National Turkish Medical Congresses". In following period, main theme of the 11th Congress would be tuberculosis. The Ministry of Health has defined a concept for the fight against infectious diseases and implemented it. Guideline on fight against tuberculosis has started to be published. New dispensaries and sanatoriums were built. Efforts were made to increase existing bed capacity. use of BCG vaccine was introduced. New facilities were built at "Central Institute of Hygine" to start vaccine production. Participation in international exhibitions and congresses was ensured. Arrangements were made regarding the staff and salaries of doctors and nurses, and new civil servant positions were created for the fight against tuberculosis. Conclusion: It would not be wrong to say that works carried out in early Republican period were a stepping stone for the great successes to be achieved in the fight against tuberculosis in future.