Conditions Of Scarce Resources Research Articles

Is 1 Day of Focused Training in Echocardiographic Assessment Using Subxiphoid-Only (EASy) Examination Enough? A Tertiary Hospital Response to the COVID-19 Crisis and the Use of the EASy Examination to Support Unit-Wide Image Acquisition.

We assessed the efficacy of 1-day training in echocardiography assessment using subxiphoid-only (EASy) followed by supervised image interpretation and decision-making during patient rounds as a novel approach to scaling up the use of point-of-care ultrasound (POCUS) in critically ill patients. Retrospective analysis of medical records and EASy examination images. Tertiary care academic hospital. A total of 14 adults (> 18 yr old) with COVID-19-associated respiratory failure under the care of Albany Medical Center's surge response team from April 6-17, 2020 who received at least one EASy examination. Residents (previously novice sonographers) were trained in EASy examination using 1 day of didactic and hands-on training, followed by independent image acquisition and supervised image interpretation, identification of hemodynamic patterns, and clinical decision-making facilitated by an echocardiography-certified physician during daily rounds. We recorded the quality of resident-obtained EASy images, scanning time, and frequency with which the supervising physician had to repeat the examination or obtain additional images. A total of 63 EASy examinations were performed; average scanning time was 4.3 minutes. Resident-obtained images were sufficient for clinical decision-making on 55 occasions (87%), in the remaining 8 (13%) the supervising physician obtained further images. EASy examination is an efficient, valuable tool under conditions of scarce resources. The educational model of 1-day training followed by supervised image interpretation and decision-making allows rapid expansion of the pool of sonographers and implementation of bedside echocardiography into routine ICU patient management.

493. ENDURANCE - EffectiveNess of Evusheld for COVID-19 Pre-exposUre PRophylAxis iN ImmunoCompromised PatiEnts – A Pilot Study

Abstract Background In December 2021, Evusheld, a cocktail of 2 monoclonal antibodies (mAB), was granted EUA for COVID-19 pre-exposure prophylaxis (PrEP) of immunocompromised patients (Table 1). The EUA was updated June 2022 to recommend repeating a dose every 6 months for patients needing ongoing protection. However, EUA was revoked in January 2023 due to identified resistance of Omicron lineage. Clinical trials about a new mAB for PrEP are continuing. Real-world data on the effectiveness of Evusheld may help develop strategies for the administration of new mAB. ENDURANCE is a complex retrospective study to assess Evusheld's effectiveness by evaluating and comparing treatment outcomes among 4 groups of patients classified based on the timing of treatment and the number of repeated Evusheld treatments (Figure 1). This pilot study describes treatment outcomes in the first analyzed group (gr. A) treated before Omicron development. Table 1 EUA criteria for Evusheld use, used as inclusion criteria for our study. * Patients with moderate to severe immunosuppression due to a medical condition or receipt of immunosuppressive medications and may not mount an adequate immune response to COVID-19 vaccination. Figure 1 ENDURANCE Study design. 459 patients who received the initial dose of Evusheld were followed for 180 days (group A, n=151, and group B, n=308). Patients who received repeated treatment (group A’, n=151) were followed for 180 days following an additional dose while patients who did not receive repeated treatment (group B’, n=308) were followed for an additional 180 days (181 till 360 days after the initial dose). Primary outcome is defined as confirmed symptomatic COVID-19 infection. We hypothesize a significantly lower rate of COVID-19 infections in the period before Omicron emergence (Groups A and B), disregarding if patients received repeated doses of Evusheld (Group A’) or not (Group B’). A Pilot Study describes the treatment outcomes in group A. Methods We conducted a retrospective chart review of patients treated with Evusheld under EUA between January 18 and June 21, 2022, to assess their response to treatment by evaluating outcomes listed in Figure 2. Patients were classified in tiers based on the degree of underlying immunosuppression (Table 2). In addition, COVID-19 anti-Spike antibodies were requisitioned before treatment. Figure 2 Evaluated outcomes. Primary outcome was positive COVID test at any point during the study period. Secondary outcomes were measured through the number of all-cause ED visits, hospitalizations, ICU admissions and deaths within 30 days from the positive COVID-19 test. Table 2 Tiered system for prioritizing patients based on severity of immunosuppression should resources be scarce. Results From 151 patients, the majority were vaccinated (95%), seropositive (66%), and classified as Tier 1 at the time of treatment (58%) (Table 3). All seronegative patients (39) were vaccinated (Figure 3). 16/159 (11%) developed symptomatic COVID-19 infection within 180 days from treatment (mean 119.8 days); 10/16 patients received antiviral treatment outpatient (Table 4). None visited ED, were hospitalized, or died. Table 3 Patients’ vaccination status and anti-Spike antibody (serology) results per tiers. *All seronegative patients were vaccinated; unvaccinated patients (8) were either seropositive (5) or with unknown serology (3). Figure 3 Serum anti-Spike antibody results in vaccinated and unvaccinated patients. All seronegative patients (n=39) were vaccinated. Unvaccinated patients were either seropositive (n=5) or with unknown serology results. Table 4 Characteristics of COVID-19 positive patients, compared to patients not diagnosed with COVID-19. Conclusion Our pilot data suggests that Evusheld may be effective against susceptible strains, as demonstrated by the low number of symptomatic infections, which all were mild and did not require ED or hospital utilization (Figure 4). A tier system may help prioritize patients in scarce resource conditions. Further studies are needed to identify risk factors for severe COVID in immunocompromised patients and understand their immunological response to vaccines and natural infection to create the most helpful tier system. Figure 4 Treatment outcomes. 10% (16/151) of Evusheld recipients developed mild symptomatic COVID-19. Number of all cause ED visits, hospitalizations, and deaths within 30 days from testing positive for COVID-19 was 0, suggesting possible beneficial effect of Evusheld use in immunocompromised population. Disclosures All Authors: No reported disclosures

Evaluation of the effect of JSC RZD transportation infrastructure availability on the risks of losses in the process of transportation

Aim. The availability of transportation infrastructure facilities affects the quality of the transportation services provided by JSC RZD. At the same time, this effect may significantly differ depending on the operating conditions of the transportation infrastructure or a specific railway line and can cause various degrees of risk of damage to the transportation process. Such risks are defined as risks of train-hour losses due to transportation infrastructure failures. Planning dependability management activities under conditions of scarce resources requires targeted identification of the transportation infrastructure facilities whose availability most significantly affects the magnitude of the risks of damage to the transportation process. The aim of the paper is to develop a method for evaluating daily availability and identifying its correlation with the risk of train-hour losses. Methods. The authors used the methods of risk management, probability theory and mathematical statistics, correlation and regression analysis. Results. The paper suggests representing the daily availability indicator of JSC RZD’s transportation infrastructure facilities as a two-parameter gamma distribution and describing its effect on the risks of the transportation process with a regression model. Conclusions. The paper’s findings can be used as part of transportation infrastructure dependability planning and targeted allocation of resources, as well as for substantiating the dependability indicator when evaluating the practical capacity of railway lines and utilization ratio and in a number of other operational tasks.

Lean readiness assessment model – a tool for Humanitarian Organizations' social and economic sustainability

Purposepurpose of this study is to present a Lean Readiness Assessment Model (LRAM) for assessing the readiness of Humanitarian Organizations (HO) for adopting Lean Management (LM) (Johanson et al.) practices. Literature reveals that implementation of LM itself is a cost and most organizations have failed to adopt LM techniques due to a non-readiness status and a non-supportive organizational culture. This situation indicates that the assessment of organizations' readiness before implementation of lean techniques is necessary.Design/methodology/approachThis was an empirical quantitative study. Based on a synthesis of the literature, a conceptual model was developed by identifying seven critical success factors (CSFs). The CSFs were validated by HO professionals via a questionnaire-based survey. The data from the responses were analysed by applying partial least square structured equation modelling (PLS-SEM) using the SmartPLS3 software.FindingsA proven LRAM was constructed that consists of CSFs (independent and mediating variables), which have reflected positive coefficients and significant t >1.96 and p < 0.05 values. The CSFs that are significant include process management, planning and control management, customer relationship management, human resource management, communication and coordination management and a positive organizational culture. The CSFs of supplier relationship and top management and leadership had insignificant t and p values and were dropped from the final LRAM.Originality/valueThis is a unique and rare study in its nature which developed LRAM for HO sector. The contribution of this model is to improve the efficiency and sustainability (economic and social aspects) of an HO under scarce resource conditions.

Pragmatic ex-ante evaluation using an innovative conceptual framework: The case of a high-tech entrepreneurship program for women

Program designers at local project level usually design interventions under conditions of scarce resources and bounded rationality lacking sufficient information about the process and impact mechanisms of the complex social programs they design and implement. This paper proposes a model for pragmatic ex ante evaluation using an innovative conceptual framework for practitioners working in the field to improve gender equality in research and innovation.The presented and applied model is pertinent to the theory-oriented evaluation tradition using a logic frame and a theory of change approach adapted to the special requirements of ex-ante evaluation. The model is illustrated by the case study of a program for the promotion of women entrepreneurship in the STEM fields.It is concluded that in a setting with limited resources and information, ex-ante evaluations should aim at defining clear conditions of proportionality and need to take into account the extent to which contextual factors hinder or facilitate the implementation of a program, and the specific institutional and system mechanisms at play, in order to enable proactive risk management from the beginning.

The Dissociated Manufacture of the 21st Century Public Administration: in Search of Integration in an Environment of Change

This article aims to provide an answer on how to create a public administrative system that ties together the requirement of legitimacy and effectiveness of the government under conditions of scarce resources and in an environment of change. First, an outlook of the last forty years of changes in public administration is provided, which are titled as “the administration of efficiency-effectiveness”, “the administration of legitimacy-legality” and “the administration of interdependencies” (both governmental and social-governmental) and that respectively refer to the New Public Management, the Democratic Transition and the New Public Governance. The causes that drove these three reforms and its essential characteristics are summarized, focusing particularly on the disconnection of the reforms and their effects on public administration. The need for further integration is pointed out as a mean to strengthen the directive effectiveness of the democratic government and to restore social confidence on its competence and efficacy. Regardless of the value of the reforms, the limits of the efficiency-effectiveness and the legitimacy-legality as dissociated approaches are highlighted, as well as its consequences in the functioning of the public administration. Based on the structural interdependence of relations between the actors of contemporary society, including the government, the New Public Governance is explained as the steering process of current social and political interactions. Secondly, and according to the New Public Governance principles, a proposal for the integration of the three administrative reforms is offered in order to revaluate the significance and effectiveness of the public administration work.

Make economics your friend

In this essay I define the discipline of economics and say why it's useful. I review methods for measuring economic outcomes relevant to those working to prevent infections, and review how decision-makers should use the information to help choose the best among competing programmes. I finish by arguing that good economics can improve the amount of health gained from an infection prevention service working under conditions of scarce resources.

Оценка эффективности инвестиционных проектов по критерию их качества

Under conditions of scarce resources the firm is facing challenge of selection most effective investment projects. In order to make reasonable managerial decisions comprehensive analysis is needed that will show value for investor as well as influence of investments on future development and competitive performance of the firm. The article provides an overview of existing methods of evaluating the effectiveness of investment projects, that allowed to indicate and classify their main advantages and disadvantages. Author presents new approach to evaluation of investment projects effectiveness by the criteria of quality of the industrial system, which forms the basis of investment project. It is shown that its usage helps to essentially lower disadvantages of existing methods.

Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response.

Catastrophic disasters occurring in 2011 in the United States and worldwide--from the tornado in Joplin, Missouri, to the earthquake and tsunami in Japan, to the earthquake in New Zealand--have demonstrated that even prepared communities can be overwhelmed. In 2009, at the height of the influenza A (H1N1) pandemic, the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services, along with the Department of Veterans Affairs and the National Highway Traffic Safety Administration, asked the Institute of Medicine (IOM) to convene a committee of experts to develop national guidance for use by state and local public health officials and health-sector agencies and institutions in establishing and implementing standards of care that should apply in disaster situations-both naturally occurring and man-made-under conditions of scarce resources. Building on the work of phase one (which is described in IOM's 2009 letter report, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations), the committee developed detailed templates enumerating the functions and tasks of the key stakeholder groups involved in crisis standards of care (CSC) planning, implementation, and public engagement-state and local governments, emergency medical services (EMS), hospitals and acute care facilities, and out-of-hospital and alternate care systems. Crisis Standards of Care provides a framework for a systems approach to the development and implementation of CSC plans, and addresses the legal issues and the ethical, palliative care, and mental health issues that agencies and organizations at each level of a disaster response should address. Please note: this report is not intended to be a detailed guide to emergency preparedness or disaster response. What is described in this report is an extrapolation of existing incident management practices and principles. Crisis Standards of Care is a seven-volume set: Volume 1 provides an overview; Volume 2 pertains to state and local governments; Volume 3 pertains to emergency medical services; Volume 4 pertains to hospitals and acute care facilities; Volume 5 pertains to out-of-hospital care and alternate care systems; Volume 6 contains a public engagement toolkit; and Volume 7 contains appendixes with additional resources.

The Art of Enduring Contradictory Goals: Challenges in the Institutional Co-construction of a ‘good death’

ABSTRACTThis paper focuses on the normative notion of ‘good death’, its practical relevance as a frame of reference for ‘death work’ procedures in institutional elder care in Switzerland and the ways in which it may be challenged within migrant ‘dying trajectories’. In contemporary palliative care, the concept of ‘good death’ focuses on the ideal of an autonomous dying person, cared for under a specialised biomedical authority. Transferred to the nursing home context, characterised by long-term basic care for the very old under conditions of scarce resources, the notion of ‘good death’ is broken down into ready-to-use, pragmatic elements of daily routines. At the same time, nursing homes are increasingly confronted with socially and culturally diversified populations. Based on ethnographic findings, we give insight into current practices of institutional ‘death work’ and tensions arising between contradicting notions of a ‘good death’, by referring to decision-making, life-prolonging measures, notions on food/feeding and the administration of sedative painkillers.

Optimization of surgical treatment of skull base juvenile angiofibroma under the conditions of scarce resources

The authors suggest temporary ligation of external carotid artery before the excision of tumour on the lesion side in patients with juvenile angiofibroma of the skull base (JASB). Based on the suggested method, the patients were divided into two groups: group 1 – control group (n = 27) – without the preliminary temporary ligation of the external carotid artery (the traditional method) and group 2 – the main group (n = 20) – with the preliminary temporary ligation of the external carotid artery. The intraoperative blood loss in patients of the group 1 was 600.0–1500.0 ml, which, in turn, complicated the surgical view and necessitated the similar group blood and plasma transfusion. Recurrence of the disease in this group was observed in 4 patients. Bleeding during the surgery in the group 2 patients ranged from 250.0 to 550.0 ml, i.e. 2.0 and 2.5 times lower than in group 1, which provided better surgical view and did not require blood components transfusion. In this group relapse was observed in 1 patient. The comparative analysis has shown the efficacy of the proposed JASB surgical treatment method, therefore it can be used as an alternative to embolization of the external carotid artery basin, in all the regions, i.e., in the places where no high – tech equipment is available.

The main directions of zemstvo healthcare development in Kazan governorate in XIX century

The Zemstvo reform has set a start of changes in a number of spheres of the country’s life, including health-care. The development of zemstvo healthcare in Kazan Governorate took the way of increasing the number of healthcare workers and consolidating the healthcare facilities network. Kazan Governorate zemstvo managed to create a promoted healthcare in conditions of scarce resources and lack of medical professionals. At this period, a new form of medical and sanitary attendance — medical district — was created, replacing the old patrolling system. One of the advantages of zemstvo healthcare was introduction of free drug supplies. At the end of XIX century, a developed network of pharmacies was established. Almost in all uyezds of Kazan Governorate, medical depots were functioning, providing local pharmacies with the required medicines. At the beginning of zemstvo healthcare functioning, obstetrics was singled out as a separate branch of medicine. In XIX century, special maternity beds appeared in a number of zemstvo healthcare units. At the beginning of XX century, special maternity ward for obstetric aid appeared in zemstvo hospitals, maternity clinics opened. By the early XX century, a rural healthcare system, its legal groundwork, operations and funding were established. As a result of zemstvo self-government institutions functioning, an extensive network of uyezd hospitals, paramedic stations was established, providing medical aid to rural population; stationary zonal system of medical aid was created.

News content online: Patterns and norms under convergence dynamics

The article investigates evolutionary trends in online news presentation and delivery in the light of convergence dynamics. The case study of Greece is an example of how convergence ideas are ‘normalised’ in the actual content due to countering forces exercised by the dominant professional culture and organisational models in the news business. The findings provide evidence that the outcomes of this new culture of high interconnectivity that come along with convergence cannot be ignored even in countries with no advanced employment of its potentialities. At the same time, questions on whether, under conditions of scarce resources and a weak journalistic culture, convergence affordances actually create spaces for a more open and inclusive journalism or are used mainly as vehicles for economic survival, smothering any other potential, are raised.

Ernst Chain: a great man of science

This paper is a tribute to the scientific accomplishments of Ernst Chain and the influence he exerted over the fields of industrial microbiology and biotechnology. Chain is the father of the modern antibiotic era and all the benefits that these therapeutic agents have brought, i.e., longer life spans, greater levels of public health, widespread modern surgery, and control of debilitating infectious diseases, including tuberculosis, gonorrhea, syphilis, etc. Penicillin was the first antibiotic to become commercially available, and its use ushered in the age of antibiotics. The discovery of penicillin's bactericidal action had been made by Alexander Fleming in London in 1928. After publishing his observations in 1929, no further progress was made until the work was picked up in 1939 by scientists at Oxford University. The group was headed by Howard Florey, and Chain was the group's lead scientist. Chain was born and educated in Germany, and he fled in 1933 as a Jewish refugee from Nazism to England. Other important members of the Oxford research team were Norman Heatley and Edward Abraham. The team was able to produce and isolate penicillin under conditions of scarce resources and many technical challenges. Sufficient material was collected and tested on mice to successfully demonstrate penicillin's bactericidal action on pathogens, while being nontoxic to mammals. Chain directed the microbiological methods for producing penicillin and the chemical engineering methods to extract the material. This technology was transferred to US government facilities in 1941 for commercial production of penicillin, becoming an important element in the Allied war effort. In 1945, the Nobel Prize for medicine was shared by Fleming, Florey, and Chain in recognition of their work in developing penicillin as a therapeutic agent. After World War II, Chain tried to persuade the British government to fund a new national antibiotic industry with both research and production facilities. As resources were scarce in postwar Britain, the British government declined the project. Chain then took a post in 1948 at Rome's Instituto Superiore di Sanitá, establishing a new biochemistry department with a pilot plant. During that period, his department developed important new antibiotics (including the first semisynthetic antibiotics) as well as improved technological processes to produce a wide variety of important microbial metabolites that are still in wide use today. Chain was also responsible for helping several countries to start up a modern penicillin industry following World War II, including the Soviet Union and the People's Republic of China. In 1964, Chain returned to England to establish a new biochemistry department and industrial scale fermentation pilot plant at Imperial College in London. Imperial College became the preeminent biochemical department in Europe. Chain was also a pioneer in changing the relationship between government, private universities, and private industry for collaboration and funding to support medical research. Ernst Chain has left a lasting impact as a great scientist and internationalist.

Cosmopolitanism and Transnational Private Law

As a legal mechanism for doing justice between individuals under conditions of scarce resources, private law derives its legitimacy from both national governmental institutions that pursue a particular scheme of social justice and to a lesser and often overlooked extent from cosmopolitan principles of civil law. The cosmopolitan view of private law suggests that it is in an important sense found, not made, discovered by the exercise of reason, moral argument, and logical thought. It is not tied to any particular political structure, whether state, village or empire. European Union private law relies for its legitimacy almost entirely on its pursuit of a thin theory of justice concerning the enhancement of individual choice, which inevitably brings it into conflict with national private law systems that pursue broader schemes of social justice. Transnational commercial law (or the new lex mercatoria) also relies upon the narrow justification of the enhancement of cross-border trade, but its creation by private actors increases its efficacy and efficiency. Both European Union private law and transnational commercial law lack, however, adequate links to cosmopolitan principles of law and broad conceptions of social justice, with the effect that their legitimacy is weaker than that of national private law systems. The principal conclusion of this analysis is the contention is that the cosmopolitan strand of legitimacy, if it is to provide adequate support for transnational law, must realign itself with concerns about social justice.

Accounting at the London School of Economics: Opportunity lost?

Given the aims of the founders of the London School of Economics, it is not surprising that accounting should have been taught at the School from soon after its establishment. An early focus on teaching practical accounting, with professional practitioners as teachers, was gradually supplanted by approaches informed by the economics of decision-making in conditions of scarce resources. By the 1930s, the Department of Business Administration provided an intellectual basis for thinking about financial reporting and costing that challenged taken-for-granted practices. After World War II, the “LSE Triumvirate” of William Baxter, Harold Edey and David Solomons took forward ideas of opportunity cost and value to the owner as core theoretical concepts, while developing undergraduate and later postgraduate programmes that provided rigorous education for future accountants, administrators, business people and academics. However, the focus on education, and the weak infrastructure for accounting research in the UK had the unintended consequence that, by the early 1970s, the Department of Accounting did not have the opportunity of responding to changes in research focus in North America, which were influenced by developments in financial economics.

Accounting at the London School of Economics: Opportunity Lost?

Given the aims of the founders of the London School of Economics, it is not surprising that accounting should have been taught at the School from soon after its establishment. An early focus on teaching practical accounting, with professional practitioners as teachers, was gradually supplanted by approaches informed by the economics of decision-making in conditions of scarce resources. By the 1930s, the Department of Business Administration provided an intellectual basis for thinking about financial reporting and costing that challenged taken-for-granted practices. After World War II, the “LSE Triumvirate” of William Baxter, Harold Edey and David Solomons took forward ideas of opportunity cost and value to the owner as core theoretical concepts, while developing undergraduate and later postgraduate programmes that provided rigorous education for future accountants, administrators, business people and academics. However, by the late 1960s, the Department of Accounting missed the opportunity of responding to changes in research focus in North America, which were influenced by developments in financial economics. The outcome was an erosion of research leadership, with other UK universities becoming the main centres of quantitative and critical accounting research.

Sex differences in children's formation of exclusionary alliances under scarce resource conditions

Conclusions that human males behave more competitively than females have been tempered by recent findings that the two sexes use differing competitive strategies. Theoretically, mammalian males generally gain more than females from using riskier strategies, whereas females have more to lose. Females therefore should compete using less risky strategies. Research with humans suggests that one of these may involve alliance and coalition formation. These diminish risk yet exact a cost in terms of payoffs, suggesting that they may elicit sex-differentiated patterns of use. We examined the hypothesis that early sex-differentiated patterns would appear in which human females would form exclusionary alliances under scarce resource conditions more than males would, whereas males would use individualistic strategies more than females would. To test the hypothesis, 15 female and 14 male triads of 4-year-old children were observed under plentiful and scarce resource conditions. Under scarce resource conditions only, females formed more exclusionary alliances than males did, whereas males engaged in more individualistic competition than females did. Discussion focuses on factors that should predict sex differences in the use of coalitions.

A Test of Two Skew Models to Explain Cooperative Breeding

Two competing models, reproductive skew and skew selection, have been constructed to explain the evolution of cooperation among unrelated breeders. Reproductive skew is a trade-off model that assumes breeding occurs under scarce resource conditions. One breeder gains units of fecundity at the expense of other breeders during aggressive, altruistic or tug-of-war transactions. After joining, the distribution of fecundity among breeders shifts from symmetrical to asymmetrical. In contrast, skew selection is a surplus model that assumes breeding occurs during a springtime glut. Skew selection assumes that fecundity among breeders is initially asymmetrical and that joining reduces the asymmetry of fecundity. This paper reports findings from a breeding experiment on the fire ant, Solenopsis invicta, which supported skew selection rather than reproductive skew. Joining was a win-win strategy for alpha and beta breeders; beta breeders gained within-group survival benefits; alpha breeders gained between-group survival benefits. In summary, skew selection extends Darwin’s theory of natural selection by revealing the self-interested core of cooperative breeding.

THE IMPACT OF ADDING AN EXTERNAL RATER ON INTERDEPARTMENTAL COOPERATIVE BEHAVIORS OF WORKERS

Prior research has illustrated the benefits of cooperation across groups. This study sought to identify methods to induce cooperation across groups. Three laboratory studies showed modifying performance appraisals to include intergroup behavior, and including an external supervisor evaluation, led to greater frequencies of helping behavior and more positive attitudes towards cooperating under scarce resource conditions.