Service Men Research Articles

DRG payment for major pancreatic surgery: analysis of resource consumption and suggestions from a tertiary hospital in China.

To investigate the cost homogeneity within the Diagnosis-Related Group (DRG) "major operation of pancreas and liver, with general complications or comorbidities" (HB13), its cost-influencing factors, and to propose suggestions for better grouping efficacy. Medical and insurance settlement data of inpatients covered by the DRG payment system at the author's institution were collected from March 15, 2022 to December 31, 2023. The cost homogeneity of group HB13 was assessed using the coefficient of variation (CV). Clinical factors that may have an impact on hospitalization cost for patients undergoing pancreatic surgery were identified through a semi-structured interview administered to the pancreatic surgeons in author's department, their significance was analyzed using multiple linear regression, along with their impact on the cost of different service categories. A proposal to subdivide HB13 was made and evaluated by CV and t-test. The CV of the HB13 group was 0.4. Robotic-assisted surgery and pancreaticoduodenectomy were two independent factors that significantly affected the total cost. Patients undergoing robotic-assisted surgery have an average increase of 41,873 CNY in total cost, primarily derived from operation fee. Patients undergoing pancreaticoduodenectomy have an average increase of 37,487 CNY in total cost, with significant increases across all service categories. HB13 was subdivided based on whether pancreaticoduodenectomy was performed. The newly formed groups exhibited lower CVs than the original HB13. The cost homogeneity of HB13 was lower than that of other DRG groups in author's department. It is recommended to introduce a supplementary payment for patients requiring robotic-assisted surgery, to guarantee their access to this advanced technology. It is recommended to establish a new group with higher payment standard for patients undergoing pancreaticoduodenectomy. A tiered CV criterion for the evaluation of grouping efficacy is recommended to increase intra-group homogeneity, facilitating a better allocation of health insurance funds, and the prevention of unintended negative outcomes such as service cuts and cherry-picking.

Policing and public health interventions into sex workers’ lives: necropolitical assemblages and alternative visions of social justice

Abstract While extensive literature documents how criminalisation harms sex workers’ health and rights, limited research has critically examined how interactions between criminal-justice, health, and other systems shape support and justice for and by people who sell sex. We attend to this question by drawing on participatory, qualitative research with a diverse group of sex workers and other stakeholders in East London, UK. In addition to directly and structurally-violent enforcement practices, we identified wider, necropolitical assemblages and practices – across police, local and immigration authorities, health and social services – that disciplined sex workers’ lives, responsibilised them for their health, and defunded specialist services grounded in lived realities, amid tensions over sex-work governance. These effects – grounded in notions of community and vulnerability that often privileged residents’ concerns over threats to sex workers’ safety and health – impacted marginalised and minoritised cis and trans women the most. Those who worked on the street and used drugs, were migrants, and/or women of colour were particularly targeted for enforcement, discounted when reporting violence and impacted by service cuts. Yet participants’ appeals for redirection of funds from enforcement towards respectful, peer-led services reflected claims to social justice on their own terms. We recommend (re)commissioning health and support services that respond to sex workers’ diverse realities, with and by them, alongside concerted efforts to end policies and practices that criminalise, punish, and blame. This would help to alleviate the health and social harms that we document, in support of inclusive participation in health and broader social justice goals.

Transit Board Diversity and Pandemic Service Cuts in Vulnerable Communities

Despite its primary role in shaping policy and service characteristics, board governance is an understudied topic in the field of urban transit. Existing research on board management and representative bureaucracy theory suggests that the race and gender diversity of boards has a significant impact on organizational activity but that these relationships are highly dependent on the cultural context and industry analyzed. In this paper, we evaluate how the diversity of transit boards (with respect to race, gender, and disability) in the U.S.A. correlates with service changes authorized by these boards during the COVID-19 pandemic. Utilizing a database on board governance and general transit feed specification data for 36 agencies, we find a positive relationship between the presence of women on transit boards and vertically equitable service cuts, defined as increasing or maintaining transit service in more vulnerable neighborhoods. Overall, transit agencies with more female board members had more equitable service cuts, on average, during the COVID-19 pandemic.

If You Cut It Will They Ride? Longitudinal Examination of the Elasticity of Public Transport Ridership in the Post-Pandemic Era

In the past two years, public transport ridership has declined because of COVID-19 pandemic health measures and new working from home policies. This decline in ridership has caused major financial stress on public transport agencies around the world. Several agencies have responded to this financial stress by reducing services. The extent to which these service cuts will affect transit ridership is unknown because of the changing operational environment in the post-pandemic world. Our study uses a longitudinal panel data from Montréal, Quebec, Canada, to explore the relationship between route-level ridership and operational factors over time. We find that public transport ridership demand at the route level is highly elastic when compared to trip frequency and has become more elastic after the COVID-19 pandemic. Our findings imply that agencies cutting service in the post-pandemic era run a much more significant risk of creating a “doom spiral,” where service reductions spur greater declines in ridership, forcing further reductions. Demand was found to be most elastic on more frequent routes, so agencies should prioritize maintaining services on their core routes in the post-pandemic era. This study can be of use to public transit planners and policymakers considering making service changes to attract more riders or trying to respond to post-COVID-19 financial stress.

Impacts of pandemic service adaptations on job accessibility: A case study of the Bay Area Rapid Transit

The COVID-19 pandemic highlighted transit's crucial role as a social service, ensuring access to essential destinations. Despite this, unprecedented ridership lows forced agencies to implement service cuts, disproportionately affecting essential workers and vulnerable populations. However, the full extent of these impacts remains underexplored. While existing literature examines transit agency responses during the pandemic, much of the focus has been on public health and safety measures, overlooking the specifics of service adjustment strategies implemented. This study contributes to our understanding of transit agency pandemic responses throughout the pre-, peak-, and post-pandemic phases by 1) characterizing patterns in transit service adjustments and 2) extending pandemic accessibility literature by examining job-specific impacts. The framework integrates time series clustering, qualitative review of agency press releases, and transit accessibility analysis, using only publicly available data. Through a case study of Bay Area Rapid Transit, we find distinct clusters of stations characterized by patterns in weekday morning peak service restoration and station area demographics. While impacts to accessibility varied by time of day, the relative ordering of accessibility levels across income and race/ethnicity remained consistent throughout the pandemic. These findings contribute to our understanding of service adaptation impacts and inform equitable response strategies for future service planning and disruptions.

The Impact of Quantitative Easing on The U.S. Economy

Quantitative easing has had a profound impact on various aspects of the US economy, including social welfare and wealth disparities, education reforms, changes in government fiscal strategies and financial regulation, alterations in consumption savings and investment patterns, as well as corporate strategy adjustments. Additionally, this policy has significantly influenced academia, policymaking, and public discourse. The recession was not limited to the financial markets but affected all sectors of society. In a low-interest-rate environment, capital seeking higher returns flooded into the stock and real estate markets leading to soaring prices. While excessive borrowing and spending may stimulate short-term economic growth; it could trigger a credit crunch that would further depress growth in the long run. In the current global low-interest rate environment, higher education institutions have the option of obtaining funds through debt financing; however, they must remain vigilant to fluctuations in tuition and educational burden. Collaboration between governments, educational institutions, employers and students is crucial for mitigating this crisis. Vocational education has become a more cost-effective and adaptable alternative due to its lower tuition fees. Furthermore, quantitative easing may impose constraints on future government policymaking regarding debt-related issues. The government should closely monitor changes in inflationary pressures, take measures to contain the threat of high inflation to economic stability, and prevent long-term debt accumulation from leading to fiscal deficits and cuts in public services.

Generation Expansion Planning considering environmental impact and sustainable development for an Indian state using the LEAP platform

GEP (Generation Expansion Planning) is one of the most complex tasks in which planning is done to find the best possible distinct solutions to install new generating units to meet future load demands. This paper uses the Low Emission Analysis Platform (LEAP) software environment to analyse the GEP for the AP Power sector from 2021 to 2050. In recent years, the AP power sector has faced several issues, such as frequent service cuts due to power shortages. In this paper, five scenarios such as Business As Usual (BAU), Low Demand Growth (LDG), High Demand Growth (HDG), Least Cost Optimization (LCO) and Climate Mitigation Scenarios, have been analysed with environmental, technical, and economic parameters. This study has estimated the total environmental emissions and total cost of all scenarios. At present, Andhra Pradesh has a total installed capacity of 25.4 GW. The best scenarios can be selected based on environmental impact, cost-effectiveness, efficiency, and reliability. The results show that the LDG scenario will be an optimal choice for AP due to the state's economic crisis, and the government should also focus on energy conservation and limit demand growth to 4.5%. While presenting a general GEP, the study presents comprehensive system performance scenarios from which planners can choose.

Measuring the impacts of disruptions on public transit accessibility and reliability

Public transit systems are facing higher risk of system degradation from external disruptions, affecting their ability to deliver reliable accessibility to transit users. Therefore, resilience, the ability to maintain functions during a disruption, becomes a crucial assessment of public transit systems. In this paper, we calculate two space-time prism-based measures with General Transit Feed Specification real-time (GTFS-RT) data: realizable real-time accessibility, a conservative real-time accessibility measure that can be achieved by users subject to delays, and scheduled accessibility, accessibility based on schedule. We also define accessibility unreliability, the deviation between realizable accessibility and scheduled accessibility, to measure the reliability of delivered accessibility. We use the two measures to gauge the resilience of public transit systems and conduct two case studies of short- and long-term disruptions, namely Ohio State football games and the COVID-19 pandemic, on the Central Ohio Transit Authority (COTA) bus system in Columbus, Ohio. We find there are two peaks of high unreliability before and after each football games, with the stadium as the geographic center of the disruption. The after-game peaks are shorter and more intense than the before-game. We also find COVID-19 had persistent negative impacts on accessibility and reliability: Realizable accessibility universally declined during the pandemic, but only part of cities experienced unreliability increase, primarily in urban perimeters and suburbs. Improved traffic conditions during the pandemic may help to reduce unreliability, but the later service cuts increased unreliability. The two case studies prove the effectiveness of the method to detect system disturbances and provide important guidance for public transit system operation and planning.

The "Colored American Asiatic Traveler": Peter K. L. Cole and American Empire in Japan

Abstract: This article examines African Americans' participation in US empire-building in the nineteenth-century Pacific World. It uses the life story of Peter K. L. Cole, a Black world traveler and a resident of Yokohama, Japan, to explore how notions of race, empire, modernity, and citizenship circulated around the Pacific Ocean from the 1850s to the 1870s. Cole deployed the intertwined discourses of Black settler colonialism and Black orientalism to stake claims to African American equality in the post-Civil War United States. His efforts to build equal citizenship on the basis of Black men's service to American empire abroad gained little traction as the white supremacist logics of the US settler state excluded Black people from national belonging and erased their participation in imperial expansion.

Active Duty to Veteran: Challenges Faced by Service Men and Women Reintegrating to Civilian Life in the South Carolina Lowcountry

Objective: One in 4 active-duty US military personnel report needing support for mental health issues. This proportion increases to 41% of all US military veterans, suggesting mental health status may worsen by the transition from active duty to civilian life. In this study, we explore the lived experiences of veterans in the South Carolina Lowcountry as they transition from active service to civilian life, with an emphasis on identifying services and support for this population. Methods: We used a qualitative design employing a grounded theory approach. We conducted semi-structured interviews with 20 veterans in the first year of reintegration to civilian life that examined the following areas: (1) social isolation; (2) physical isolation; and (3) self-reported levels of mental distress. Results: Thematic saturation was reached with the following emerging themes: (1) perceived mental distress due to social and physical isolation, (2) difficulty transitioning from the military “family” to one’s actual family, (3) confusion regarding identity and place in society, and an expressed (4) need for services to support this critical period in a veteran’s life. Conclusions: Our interview data provide insight about the experiences of military veterans as they return to civilian life and offer evidence for the need for better integration into the social and physical fabric of the population using both existing and enhanced community-based support programs

A New Working Class: The Legacies of Public-Sector Employment in the Civil Rights Movement

A New Working Class: The Legacies of Public-Sector Employment in the Civil Rights Movement

"How Did Local Governments Recover Their Financial Condition? Lessons from Citizen Participation"

This study offers lessons for overcoming future economic crises by examining whether democratic management helped local governments recover their financial condition. During the Great Recession, local governments were forced to make painful decisions regarding increased taxes and user charges, and cuts in public services. Several case studies provide evidence that citizen participation allows localities to increase property taxes as well as cut public services. However, broader, systematic empirical research is lacking. This study found that local governments with participatory budgeting were more likely to improve their financial condition during the Great Recession. The results allow us to identify the role of citizens in fiscal decision-making, offering lessons on how local governments can overcome possible fiscal crises in the future.

STATE OF CARDIOVASCULAR SYSTEM IN MILITARIES OF UKRAINE ARMED FORCES UNDER THE WAR WITH RUSSIA.

To study the state of cardiovascular system in servicemen (SM) of Ukraine Armed Forces (UAF), who took part in the fight against russian military aggression, and the factors of military service that could cause the occurrence of circulatory system diseases. The study included 110 men of UAF, who were undergoing examination and treatment at the NRCRM. The average age of the examinees was (46.4 ± 8.8) years. The checkup included an examination by a cardiologist and different diseases experts (as indicated), electrocardiography, Doppler echocardiography, daily monitoring of the electrocardiogram and other necessary studies. Hypertensive heart disease (HHD) was diagnosed in 83.6 % of patients, coronary heart disease (CHD) in 52.8 % ones, including 7.3 % of persons who survived an acute myocardial infarction, heart failure (HF) in 80.9 % of patients. Before the war, 51.8 and 7.3 % of SM suffered from HHD and CHD, respectively. Seven SM sustained a missile wound of extremities and subsequently developed HHD, suggesting a possible association between the two events (Pearson's χ2 = 4.148 with р = 0.042, but р = 0.081 using Fisher's exact test). Out of 18 SM without signs of HHD, 8 had normal body weight and 10 had obesity, when in SM with HHD it was 7 and 15 persons, respectively.Obesity I degree discovered in 10, and II degree in 2 SM. Excess body weight and the degree of obesity had a significant relationship with HHD development (χ2 = 8.995; р = 0.029). The age of patients with CHD (50 persons) was significantly greater than that of patients without CHD (52 persons): (50.1 ± 5.4) vs. (42.0 ± 9.5) years at р = 0.000. Among circulatory system diseases in SM of UAF HHD and CHD were the most common ones. More than half of the SM were sick with HHD before being drafted into the army. During the period of taking part in the war the development of HHD new cases was observed in 35 SM, and CHD in 50 SM. The onset of HHD new cases can be associated with missile wound of extremities and obesity, and new CНD cases with age factor.

Policing and public health interventions into sex workers’ lives: necropolitical assemblages and alternative visions of social justice

ABSTRACT While extensive literature documents how criminalisation harms sex workers’ health and rights, limited research has critically examined how interactions between criminal-justice, health, and other systems shape support and justice for and by people who sell sex. We attend to this question by drawing on participatory, qualitative research with a diverse group of sex workers and other stakeholders in East London, UK. In addition to directly and structurally-violent enforcement practices, we identified wider, necropolitical assemblages and practices – across police, local and immigration authorities, health and social services – that disciplined sex workers’ lives, responsibilised them for their health, and defunded specialist services grounded in lived realities, amid tensions over sex-work governance. These effects – grounded in notions of community and vulnerability that often privileged residents’ concerns over threats to sex workers’ safety and health – impacted marginalised and minoritised cis and trans women the most. Those who worked on the street and used drugs, were migrants, and/or women of colour were particularly targeted for enforcement, discounted when reporting violence and impacted by service cuts. Yet participants’ appeals for redirection of funds from enforcement towards respectful, peer-led services reflected claims to social justice on their own terms. We recommend (re)commissioning health and support services that respond to sex workers’ diverse realities, with and by them, alongside concerted efforts to end policies and practices that criminalise, punish, and blame. This would help to alleviate the health and social harms that we document, in support of inclusive participation in health and broader social justice goals.

Transit Price Elasticities and Cross-Elasticities

This article summarizes price elasticities and cross-elasticities for use in public transit planning. It describes elasticities and how they are used, and examines previous research on transit elasticities. Commonly used transit elasticity values are largely based on studies of short- and medium-run impacts performed decades ago when real incomes where lower and a larger portion of the population was transit dependent. As a result, they tend to be lower than appropriate to model long-run impacts. Analysis based on these elasticity values tends to understate the potential of transit fare reductions and service improvements to reduce problems, such as traffic congestion and vehicle pollution, and understates the long-term negative impacts that fare increases and service cuts will have on transit ridership, transit revenue, traffic congestion, and pollution emissions.

Public transit cuts during COVID-19 compound social vulnerability in 22 US cities.

The COVID-19 pandemic has severely impacted public transit services through plummeting ridership during the lockdown and subsequent budget cuts. This study investigates the equity impacts of reductions in accessibility due to transit service cuts during COVID-19 and their association with urban sprawl. We evaluated transit access to food and health care services across 22 US cities in three phases during 2020. We found stark socio-spatial disparities in access to basic services and employment in food and health care. Transit service cuts worsened accessibility for communities with multiple social vulnerabilities, such as neighborhoods with high rates of poverty, low-income workers, and zero-vehicle households, as well as poor neighborhoods with high concentrations of black residents. Moreover, sprawled cities experienced greater access loss during COVID-19 than compact cities. Our results point to policies and interventions to maintain social equity and sustainable urban development while benefiting diverse social groups during disruptions.

The Year Without Tourism: Hawai‘i’s FY2022 Pandemic Budget

Hawai‘i’s economy was devastated by the COVID-19 pandemic.  The effective closure of the tourism industry created an unemployment crisis and led to a dramatic decline in tax revenues.  Nevertheless, Hawai‘i managed to avoid mass layoffs of public employees and draconian cuts in public services because of federal relief funds.  The $15.9 billion budget for FY2022 restored funding to most departments, but the state’s dependence on the visitor industry has left it particularly vulnerable to future pandemic travel restrictions. &nbsp

Mechanism for Financing the Accumulated Debt of Utility Services Water, Electricity and Gas as a Result of the COVID-19

The effects associated with the pandemic of COVID-19 have left several consequences. The large confinements have caused formal and independent job losses. Therefore, families have been forced to prioritize their monthly utility bills. Most countries have decided on suspending cuts in utility services and give them payment arrangements for the future instead. In this article, the actions taken in Latin America and Europe are presented. Additionally, for the Chilean case, a mechanism for financing the accumulated debt is proposed. The main objective of this is to establish a procedure that allows users to regain the habit of paying for public utilities (water, electricity and piped gas).

Trends in Medicare Reimbursement within Dermatology: 2011-2021

Introduction: Recently, the Centers for Medicare and Medicaid services have emphasized increased reimbursement for evaluation and management services with compensatory cuts in procedural services. A paucity of data exists examining reimbursement for evaluation and management and procedural services within dermatology. Methods: This was a retrospective analysis of databases maintained by the Centers for Medicare and Medicaid Services which aimed at assessing if Medicare reimbursement rates in dermatology followed other specialties studied over time. The Physician/Supplier Procedure Summary File, a total summary of Medicare Part B carrier claims, was queried to find the 20 most common Healthcare Common Procedure Coding System codes performed by dermatologists as well as 10 common evaluation and management codes billed by dermatologists in 2019. The Medicare Physician Fee Schedule look-up tool was queried to extract reimbursement rates for all these codes for the years 2011 through 2021, inclusive. Reimbursements were adjusted for inflation. Results: For both procedural and evaluation and management codes, an average decline in reimbursement of 9.57% was seen from 2011 to 2021 when adjusted for inflation in healthcare costs. Seven out of ten E/M codes experienced a decline in reimbursement when adjusted for inflation with an average decrease of 8.34%. Fifteen out twenty procedural codes experienced a decline when adjusted for inflation with an average decrease of 10.8%. Conclusion: The decrease in reimbursement here parallels other specialties in trend but is smaller in magnitude of decline. Future studies may reveal the impact of these trends on providers, practices, and patients.

Bad government performance and citizens’ perceptions: A quasi-experimental study of local fiscal crisis

The link between actual government performance and citizens’ performance perceptions has been controversial. Given the prevalence of negativity bias, however, the link between bad performance and citizens’ perceptions could appear to be strong. To explore this theoretically unconfirmed link, this study uses a quasi-experiment that contrasts a Japanese town in fiscal crisis, involving tax increases and service cuts, with a control village not in fiscal crisis. Using a difference-in-differences analysis with a careful retrospective pretest, it finds negative effects of the fiscal crisis on citizens’ process perception, while it shows no effects on citizens’ service satisfaction and trust in the mayor, council, and administrators. The study further finds positive associations between citizens’ performance perceptions and civic engagement. It discusses these findings to identify the boundary conditions in which a bad performance–negative perception link is likely to appear. Points for practitioners Psychology literature on negativity bias suggests that the causal links and mechanisms between bad performance and negative perceptions are stronger than those between good performance and positive perceptions. Not only citizens, but also politicians and administrators, hold negativity bias. Their blame-avoidance strategies could alleviate the growth of citizens’ negative perceptions with bad performance. Participatory governance might moderate the bad performance–negative perception link by placing citizens in a performance-improvement process and promoting their interaction with government officials.