Department Resources Research Articles

Emergency department resource optimisation for improved performance: a review

Emergency departments (EDs) have been becoming increasingly congested due to the combined impacts of growing demand, access block and increased clinical capability of the EDs. This congestion has known to have adverse impacts on the performance of the healthcare services. Attempts to overcome with this challenge have focussed largely on the demand management and the application of system wide process targets such as the “four-hour rule” intended to deal with access blocks. In addition, EDs have introduced various strategies such as “fast tracking”, “enhanced triage” and new models of care such as introducing nurse practitioners aimed at improving throughput. However, most of these practices require additional resources. Some researchers attempted to optimise the resources using various optimisation models to ensure best utilisation of resources to improve patient flow. However, not all modelling approaches are suitable for all situations and there is no critical review of optimisation models used in hospital EDs. The aim of this article is to review various analytical models utilised to optimise ED resources for improved patient flow and highlight benefits and limitations of these models. A range of modelling techniques including agent-based modelling and simulation, discrete-event simulation, queuing models, simulation optimisation and mathematical modelling have been reviewed. The analysis revealed that every modelling approach and optimisation technique has some advantages and disadvantages and their application is also guided by the objectives. The complexity, interrelationships and variability of ED-related variables make the application of standard modelling techniques difficult. However, these models can be used to identify sources of flow obstruction and to identify areas where investments in additional resources are likely to have most benefit.

The effect of multidisciplinary colorectal center development on short-term hospital readmissions for patients with anorectal malformations or Hirschsprung disease

IntroductionHospital readmissions have become a quality metric for both hospital systems and individual surgeons. The medical literature is replete with studies describing readmission rates and factors contributing to readmissions following surgical procedures. Relatively little, however, has been done to define potential solutions to these problems. Over the past decade there has been a movement toward the development of multidisciplinary colorectal centers at high volume children's hospitals. We hypothesized that the development of a colorectal center at our children's hospital decreased readmissions in our colorectal surgery population. Materials and methodsA retrospective review was performed including all patients with the diagnosis of anorectal malformation (ARM) or Hirschsprung disease (HD) at our institution between the years of 2005–2017. Patient level outcomes were compared between the cohort treated prior to (2005–2010) and the cohort treated after the development of the colorectal center (2012–2017). ResultsA total of 354 patients were identified. One hundred seventy-eight patients (113 ARM, 65 HD) were treated prior to and 176 patients (110 ARM, 66 HD) were treated after the development of the colorectal center. Forty-five (25.3%) patients underwent neonatal repair prior to development of the center compared to 15 (8.5%) after. 111 (62.4%) patients underwent colostomy prior to the colorectal center comparted to 95 (54%) after. The rate of readmission within 120 days of discharge in the early group was 63% compared to 52% in those managed in the multidisciplinary colorectal center (p = 0.04). Conversely, the rate of emergency room visits increased from 8.4% to 27.3% (p = 0.01). The decrease in readmission rates was more pronounced in the ARM group, while the HD cohort had similar readmission rates before and after the establishment of the center. Multivariate logistic regression revealed an odds ratio of 0.59 (95% CI 0.37–0.92) for readmission following the development of the multidisciplinary colorectal center. DiscussionThe development of a multidisciplinary colorectal center at our institution was associated with decreased hospital readmissions, but an increase in emergency department resource utilization. These findings suggest improved efficiency in patient care with the implementation of a multispecialty, patient centered approach while also identifying areas of focus for future quality improvement initiatives. Level of EvidenceLevel III, retrospective comparative study.

PulseNet and the Changing Paradigm of Laboratory-Based Surveillance for Foodborne Diseases.

PulseNet, the National Molecular Subtyping Network for Foodborne Disease Surveillance, was established in 1996 through a collaboration with the Centers for Disease Control and Prevention; the US Department of Agriculture, Food Safety and Inspection Service; the US Food and Drug Administration; 4 state public health laboratories; and the Association of Public Health Laboratories. The network has since expanded to include 83 state, local, and food regulatory public health laboratories. In 2016, PulseNet was estimated to be helping prevent an estimated 270 000 foodborne illnesses annually. PulseNet is undergoing a transformation toward whole-genome sequencing (WGS), which provides better discriminatory power and precision than pulsed-field gel electrophoresis (PFGE). WGS improves the detection of outbreak clusters and could replace many traditional reference identification and characterization methods. This article highlights the contributions made by public health laboratories in transforming PulseNet's surveillance and describes how the transformation is changing local and national surveillance practices. Our data show that WGS is better at identifying clusters than PFGE, especially for clonal organisms such as Salmonella Enteritidis. The need to develop prioritization schemes for cluster follow-up and additional resources for both public health laboratory and epidemiology departments will be critical as PulseNet implements WGS for foodborne disease surveillance in the United States.

Common Current Procedural Terminology Codes in Breast Imaging.

This article reviews the common Current Procedural Terminology (CPT) codes for frequently performed breast imaging procedures. The CPT codes for breast radiology services, including the revised codes for mammography, computer-assisted detection (CAD), breast ultrasound, breast magnetic resonance imaging (MRI), and imaging-guided breast interventional procedures and the new codes for digital breast tomosynthesis (DBT) and marker placement in axillary lymph nodes are outlined. The application of basic CPT coding principles, such as the use of modifiers and the different structure of code families in breast radiology services, is also discussed. CPT codes are updated on an ongoing basis to reflect the evolution of medical practice, and the CPT codes for breast imaging procedures have changed significantly in the past 5 years. These modifications can affect the distribution of work and utilization of resources in radiology departments. A working knowledge of coding practices will facilitate compliance with billing regulations and help ensure breast radiologists are appropriately paid for their work.

Highlighting the rules between diagnosis types and laboratory diagnostic tests for patients of an emergency department: Use of association rule mining.

Diagnostic tests are widely used in emergency departments to make detailed investigations on diagnosis and treat patients correctly. However, since these tests are expensive and time-consuming, ordering correct tests for patients is crucial for efficient use of hospital resources. Thus, understanding the relation between diagnosis and diagnostic test requirement becomes an important issue in emergency departments. Association rule mining was used to extract hidden patterns and relation between diagnosis and diagnostic test requirement in real-life medical data received from an emergency department. Apriori was used as an association rule mining algorithm. Diagnosis was grouped into 21 categories based on International Classification of Disease, and laboratory tests were grouped into four main categories (hemogram, biochemistry, cardiac enzyme, urine and human excrement related). Both positive and negative rules were discovered. Since the nature of the data had the dominance of negative values, higher number of negative rules with higher confidences were discovered compared to positive ones. The extracted rules were validated by emergency department experts and practitioners. It was concluded that understanding the association between patient's diagnosis and diagnostic test requirement can improve decision-making and efficient use of resources in emergency departments. Association rules can also be used for supporting physicians to treat patients.

New Administrative Practice: The Organizational Identity Operation of Teacher Departments

This study evaluated the organizational identity perceptions of teachers in teacher departments. Based on a literaturereview, this research regards organizational identity as being composed of mind identity, behavior identity, and visualidentity. Fieldwork was conducted, and 180 students in teacher departments were asked to participate in the study.After valid questionnaires were received, SPSS 22.0 was used for analysis. Importance and performance analysis(IPA) is a strategic tool that was used in this study to capture staff requirements for achieving high satisfaction andallocating resources in teacher departments. There were eight, eight, two, and two attributes in Quadrants I, II, III,and IV, respectively. The results of this study could be useful for policymakers and scholars. Policymakers couldlearn from the IPA results and the prioritized variables, and researchers could gain a better understanding of theorganizational identity of universities.

TO THE QUESTION OF THE PROBABILITY OF THE ATTACKMENT OF DAMAGE AS A RESULT OF ATTACK ON THE INFORMATION RESOURCE OF INFORMATION AND TECHNICAL SYSTEMS OF INTERNAL AFFAIRS TYPE "REFUSAL IN SERVICE"

Objectives In order to improve the security of departmental information technology systems and the rationality of the financial costs of hardware solutions in such systems, it is advisable to develop a simulation model of the information technology system of an internal affairs authority (ITS ATS) connected to the Internet to determine the likelihood of damage occurring denial of service attacks. Lead and clarify for the ITS ATS a classification of modern-time complex ITS, which will allow identifying possible threats to the ITS information resource ATS based on open federal and departmental regulatory documents in connection with Internet connection. Further development of the ATS ITS model was done in the Anylogic simulation environment, which makes it possible to simulate a denial of service attack on a departmental resource and investigate the likelihood of damage occurring. The expressions from the apparatus of queuing systems are given, which allow modeling the attack and calculating the probability of damage occurrence, which is advisable to use when designing such systems in ATS. Method. Analytical and mathematical modeling using the apparatus of queuing systems. Result. A simulation model of ITS ATS is proposed, which allows to determine the probability of a destructive impact on the departmental resources of such systems. Conclusion. The direction of this study is relevant and requires further development in order to develop a methodology for assessingthe occurrence of damage in ITS ATS.

Encryption Cipher Text Retrieval Scheme Based on Fully Homomorphic Encryption Enterprise Cloud Storage

With the development of computer networks, cloud storage has become the mainstream way for people to store information. However, some essential information is disclosed during the storage process and the security of information has become the most concerned issue at present. In order to use the powerful computing of cloud storage to realize resource sharing between relevant departments without revealing information of other unrelated departments, this paper proposes an encryption cipher text retrieval scheme based on fully homomorphic encryption enterprise cloud storage (ECRS), and designs an Enterprise-side security model. The model uses full homomorphic encryption, decryption and spatial vector cipher text retrieval to achieve the security of information and resource sharing among enterprise departments. ECRS determines the employee who can encrypt or decrypt the files, and who has access to the files by modifying the number of attributes intersected between attribute sets. The solution can provide the security for cloud storage, resources for different departments, and improve the accuracy for cipher text retrieval.

Behavioral Health Resource Utilization of Emergency Department Patients Presenting from Mass Gathering Events

Introduction:Behavioral health needs of attendees at mass gathering events who require emergency department (ED) evaluation are poorly understood. Appropriate resource allocation of mental health staff and other behavioral interventions necessary to support this patient population are also unclear.Aim:To describe behavioral characteristics and psychiatric resource utilization of patients presenting to a tertiary academic medical center emergency department from mass gathering events.Methods:Single-center retrospective study evaluating attendees at mass gathering events who presented to a Chicago ED. Electronic medical records for patients presenting between October 13, 2013, and December 31, 2015, were reviewed and descriptive analyses performed.Results:209 distinct records were reviewed. Most patients presented from large outdoor concerts (n = 186, 89%). Forty-two (20.1%) reported a mental health complaint at presentation, including concerns related to pre-existing psychiatric disturbances or onset of new symptoms. Twenty-seven of the total cohort (12.9%) endorsed a prior psychiatric history. Thirty-five (16.7%) reported use of prescribed psychotropic medications, including antidepressants, stimulants, mood stabilizers, and others. Diagnostic testing among the total sample included serum ethanol measurement (31.1%), urinary toxicology (25.4%), acetaminophen (6.2%), aspirin (5.3%), and creatine kinase measurements (11%). Computed brain tomography was ordered for 20 patients (9.6%). Twelve patients (5.7%) received an anxiolytic (lorazepam) and 113 (54.1%) received intravenous fluids. An antipsychotic (olanzapine) was administered to one patient (0.5%). There were no reports of suicidal ideation, but physical restraints for agitation were employed in 13 patients (6.2%). Police consultation occurred in 10 cases (4.8%). No formal psychiatric consultations were requested by ED providers.Discussion:Patients presenting to the emergency department from mass gathering events frequently endorse behavioral complaints requiring directed use of diagnostic and other emergency department resources for their ailments. The need for physical restraints and limited use of anxiolytics and antipsychotics in our sample suggest that psychiatric consultation is underutilized.

Student Evaluation of a Pilot Program in Clinically‐Oriented Dissection of the Upper Limb

IntroductionAnatomical teaching in the medical program at the University of Sydney is prosection‐based. Many students, however, seek the opportunity to dissect, particularly those with an interest in surgery. A one‐week dissection course on the upper limb was developed to provide students with an introduction to dissection within the limits of timetabling and departmental resources. Each day started with lectures on basic anatomy and clinical and surgical perspectives of a case relevant to the area being dissected that day. The remainder of the day was spent dissecting, with input from anatomical demonstrators and practising surgeons.This study sought to explore students' perspectives regarding their motivation and expectations prior to starting, their views on the course after completion, and whether any improvements could be made.MethodsAll students in the second year of the Sydney Medical Program were invited to apply, with twenty students selected for participation. Priority was given to those who had completed our departmental prosection workshop. A survey comprised of four open‐ended questions about goals, expectations and current knowledge was emailed to participants four days prior to the course. Immediately following the course, students were asked to complete another email survey comprised of seven open‐ended questions asking whether the course met expectations and learning goals, highlights and lowlights of the course, and ideas for improvement. The responses were de‐identified before analysis.ResultsOf the twenty students who took the course, nineteen returned the pre‐course survey. In the “goals” question nine students mentioned gaining dissection experience, while thirteen desired a better understanding of limb anatomy. A surgical perspective was sought by five responders. Seventeen students responded to the post‐course survey. All students reported an improved level of knowledge and that the course met or exceeded their expectations. All agreed the timeframe of the course was appropriate. The very few negative comments mostly concerned a lack of timely information prior to the course.ConclusionsThe expectations of the students aligned well with the course objectives, and all students responded very positively to the dissection experience. A similar course focussing on the lower limb is in production, with plans to extend the program to other body regions in the future. While traditional full body dissection remains the benchmark, the short timeframe of these courses allows more flexibility in resources, staff and student availability, potentially increasing access to dissection opportunities for students who seek a greater depth of anatomical knowledge.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Abstract 21: Melting the Plastic Ceiling: Quantifying Resources for and Identifying Barriers to Women Seeking Academic Plastic Surgery Leadership Positions

PURPOSE: To quantify departmental resources available to female plastic surgeons and identify remaining barriers to advancement for women in academic plastic surgery. METHODS: Academic plastic surgery departments were identified and a female faculty member or male program director was selected. Representatives were surveyed on their department’s resources for promoting women leaders. An optional follow-up interview discussed current barriers to women seeking leadership positions. RESULTS: 49 of 93 survey recipients participated (52.7% response rate). Departments on average provided 2.69 of 11 resources (Table 1). Departments with female chairs provided 4.30 resources vs. 2.26 resources at departments with male chairs (p=0.014). Departments with female program directors provided 4.45 resources vs. 2.22 resources at departments with male program directors (p=0.006). Of the 49 survey respondents, 9 completed the interview (18.4% completion rate). The most frequently identified barriers to aspiring women leaders (Table 2) were opaque promotion criteria (cited by 66.7% of interviewees), compensation disparities (55.6%), faculty homogeneity (55.6%), and motherhood bias (55.6%). CONCLUSIONS: The presence of a female chair or program director is associated with a greater quantity of resources for promoting female leaders. Remaining barriers to women ascending to academic leadership include compensation and promotion disparities, faculty homogeneity, and motherhood bias.

Using Lean to Improve Patient Safety and Resource Utilization After Pediatric Adenotonsillectomy.

The objective of this quality improvement project was to decrease the rate of nonemergent use of emergency department (ED) resources in children undergoing adenotonsillectomy by 50% and/or reach a future state of 5% or less overall ED visits among all postoperative patients within 1 year. A secondary objective was to standardize the preoperative, intraoperative, and postoperative management of these patients. The study was a quality improvement project using Lean. The target population was children younger than 18 years undergoing tonsillectomy with or without adenoidectomy. A retrospective review of adenotonsillectomy was performed for a 12-month period. Lean tools including A3 Thinking, Ishikawa "fishbone" diagram, and value stream mapping were used to analyze the problem and identify interventions. Postintervention data were collected for a 10-month period. Compared with the baseline period, the ED visit rate after adenotonsillectomy decreased from 36.2% to 15.5% (P = 0.0095). The rate of ED visits for nonbleeding complaints decreased from 30.4% to 12.1% (P = 0.01748). There was no significant change in rate of ED visits for bleeding (decreased from 5.8% to 3.5% [P = 0.6873]). There was no significant change in the use of intraoperative dexamethasone and acetaminophen. Postadenotonsillectomy patients often use emergency resources better reserved for other patients. Addressing this problem with Lean principles significantly decreased postoperative ED visit rates by more than 50%. To our knowledge, this is the first reported use of Lean principles to decrease utilization of emergency resources in the postoperative period. Lean can be applied to other processes in our field to eliminate waste and add value to improve patient outcomes. NA.

A COST-EFFECTIVE MODEL FOR TEACHING ELEMENTARY STATISTICS WITH IMPROVED STUDENT PERFORMANCE

Dissatisfaction with teaching a high enrollment introductory statistics course led to efforts to restructure the course to remedy the perceived problems, including lack of student participation, an excessive drain on departmental resources, failure to take into account wide differences in student learning styles, an inability of students to apply statistics after the course, and negative attitudes of students. A cost-effective redesign of the course was implemented that incorporates a learning environment that is student-oriented, involves active student participation and hands-on experience with data analysis, uses technology to reduce costs through labor-saving techniques including low-stakes computerized testing, and sharing of resources enabled by a web site for course management and delivery of course materials. Responsibility for learning basic concepts was transferred to students and motivated by readiness assessment quizzes. The redesign led to about $125,000 in cost savings to the department.

Impact of age on the discriminative ability of an emergency triage system: A cohort study.

Emergency triage systems optimize resources in emergency departments (EDs) for those who need urgent care. Five-level triage systems, such as the Canadian Triage and Acuity Scale (CTAS), have been used worldwide. We examined whether the discriminative ability of an emergency triage system varies according to age group using a patient cohort triaged with the Japan Triage and Acuity Scale (JTAS), a validated system based on the CTAS. We conducted a cohort study of 27120 self-presenting patients aged 16years and older who were triaged with (JTAS) between June 2013 and May 2014 at a Japanese tertiary care hospital. Outcome measures were admission to intensive care units (ICUs) as the primary and in-hospital death as the secondary. We described the trends of the discriminative ability of JTAS using areas under the curve of the receiver operating characteristic (AUROC), sensitivity, specificity, positive predictive value, and negative predictive value of JTAS for seven age categories. The AUROC of JTAS for ICU admission decreased with age (maximum 0.85 to minimum 0.71), sensitivity non-significantly decreased (maximum 0.67 to minimum 0.32), and specificity declined with age (maximum 0.96 to minimum 0.88). The positive and negative predictive value increased (minimum 0.03 to maximum 0.09) and decreased (minimum 0.98 to maximum 0.99), respectively, with age. Overall misclassification increased across age groups (P<0.001). This trend was mostly consistent with the analysis of in-hospital death. Our study suggests that the discriminative ability of an emergency triage system decreases as patient age increases, corresponding to a decrease in specificity. Undertriage may not significantly increase, but misclassification significantly increases as patient age increases.

Natural Language Processing of Radiology Reports in Patients With Hepatocellular Carcinoma to Predict Radiology Resource Utilization

ObjectiveRadiology is a finite health care resource in high demand at most health centers. However, anticipating fluctuations in demand is a challenge because of the inherent uncertainty in disease prognosis. The aim of this study was to explore the potential of natural language processing (NLP) to predict downstream radiology resource utilization in patients undergoing surveillance for hepatocellular carcinoma (HCC). Materials and MethodsAll HCC surveillance CT examinations performed at our institution from January 1, 2010, to October 31, 2017 were selected from our departmental radiology information system. We used open source NLP and machine learning software to parse radiology report text into bag-of-words and term frequency–inverse document frequency (TF-IDF) representations. Three machine learning models—logistic regression, support vector machine (SVM), and random forest—were used to predict future utilization of radiology department resources. A test data set was used to calculate accuracy, sensitivity, and specificity in addition to the area under the curve (AUC). ResultsAs a group, the bag-of-word models were slightly inferior to the TF-IDF feature extraction approach. The TF-IDF + SVM model outperformed all other models with an accuracy of 92%, a sensitivity of 83%, and a specificity of 96%, with an AUC of 0.971. ConclusionsNLP-based models can accurately predict downstream radiology resource utilization from narrative HCC surveillance reports and has potential for translation to health care management where it may improve decision making, reduce costs, and broaden access to care.

A Multi-Agent System for Course Timetable Generation

In the university, course scheduling and preparation for each semester can be defined as the process of determining what courses to offer, the number of sections needed for each course, assigning of a faculty member to teach each section, and allocating a timeslot and a classroom for each section to avoid clashes. The output of this activity (which is a timetable) affects every faculty member and student in various departments. This process is essentially broken down into three main stages: determining the courses to be offered as well as their section numbers, assigning faculty members to different sections, and scheduling of the sections into timeslots and classrooms. This paper investigates each of these steps and congregates them in a scheduling and Decision Support System (DSS). The DSS is used to make easy the process of course offerings by taking into consideration the students’ suggestions because the department resources are limited. The faculty member preferences are also considered in the assignment of sections for the sake of lessening disappointments in the department. Also, the couples (faculty, section) are planned into university timeslots based on faculty member preferences. Our proposed system considers student suggestions and preferences and the time availability of a faculty member since it minimizes disappointments and avoids conflicts between faculty members and classrooms and courses.

Can the emergency department sustain the first strike? Experience from the 2016 earthquake in Tainan

Background: After the main shock of a major earthquake, casualties cluster in a short period and may overwhelm the capacities of health care facilities. An earthquake with a magnitude of 6.4 on the Richter scale struck Tainan City causing 117 fatalities and 513 injuries. Objectives: We conducted a retrospective study to review the medical records of emergency department after the attack of earthquake. The aim of this study was delineating the medical resource requirements after the disaster. Methods: We reviewed the medical records of patients admitted to the emergency department of Chi Mei Medical Center. Each chart indicating that the emergency department visit was earthquake-related was reviewed. After the earthquake struck, the Chi Mei Medical Center mobilized off-duty staff through a preset 333 code. Subsequently, routine surgeries and nonurgent admissions were postponed to reserve the maximal capacity for wounded patients. Results: A total of 150 patients were reviewed during the study period. In all, 25 cases (23.8%) required admission, and 9 of them (8.6%) were admitted to the intensive care unit. Patients with earthquake-related injuries constituted 62.8% of all traumatic patients in the 24-h aftermath. The requirements for wound sutures, blood component transfusion, numbers of radiographic/computed tomographic scans, and invasive procedures increased dramatically (earthquake-related/total: 66.0%, 30.0%, 72.1%/57.4%, and 47.7%, respectively). Conclusion: Patients with earthquake-related injuries arrived at the emergency department soon after the earthquake occurred and substantial emergency department resources were utilized in the 24-h aftermath. Each hospital should have a preset mobilization signal to call in off-duty workers to treat casualties resulting from the main shock of an earthquake. Subsequently, hospital-based mobilization should be initiated to provide comprehensive care to severely injured patients.

Performance of the Manchester triage system in older emergency department patients: a retrospective cohort study

BackgroundStudies on the reliability of the MTS and its predictive power for hospitalisation and mortality in the older population have demonstrated mixed results. The objective is to evaluate the performance of the Manchester Triage System (MTS) in older patients (≥65 years) by assessing the predictive ability of the MTS for emergency department resource utilisation, emergency department length of stay (ED-LOS), hospitalisation, and in-hospital mortality rate. The secondary goal was to evaluate the performance of the MTS in older surgical versus medical patients.MethodsA retrospective cohort study was conducted of all emergency department visits by patients ≥65 years between 01 and 09-2011 and 31-08-2012. Performance of the MTS was assessed by comparing the association of the MTS with emergency department resource utilisation, ED-LOS, hospital admission, and in-hospital mortality in older patients and the reference group (18–64 years), and by estimating the area under the receiver operating characteristics curves.ResultsData on 7108 emergency department visits by older patients and 13,767 emergency department visits by patients aged 18–64 years were included. In both patient groups, a higher emergency department resource utilisation was associated with a higher MTS urgency. The AUC for the MTS and hospitalisation was 0.74 (95%CI 0.73–0.75) in older patients and 0.76 (95%CI 0.76–0.77) in patients aged 18–64 years. Comparison of the predictive ability of the MTS for in-hospital mortality in older patients with patients aged 18–64 years revealed an AUC of 0.71 (95%CI 0.68–0.74) versus 0.79 (95%CI 0.72–0.85). The majority of older patients (54.8%) were evaluated by a medical specialty and 45.2% by a surgical specialty. The predictive ability of the MTS for hospitalisation and in-hospital mortality was higher in older surgical patients than in medical patients (AUC 0.74, 95%CI 0.72–0.76 and 0.74, 95%CI 0.68–0.81 versus 0.69, 95%CI 0.67–0.71 and 0.66, 95%CI 0.62–0.69).ConclusionThe performance of the MTS appeared inferior in older patients than younger patients, illustrated by a worse predictive ability of the MTS for in-hospital mortality in older patients. The MTS demonstrated a better performance in older surgical patients than older medical patients regarding hospitalisation and in-hospital mortality.

Open Source Mapping in Latin America: Collaborative Approaches in the Classroom and Field

Open source mapping platforms (such as OSM) are innovative tools that can enhance student learning and engagement in Latin American geography courses. Use of these tools can also facilitate new collaborations between students/scholars and communities responding to social and economic challenges in Latin America. In this paper we discuss the use of these tools in three different educational settings. We begin by describing the work of YouthMappers, a new international network of open source mappers that formed in 2015 with chapters in Latin America. YouthMappers can be a resource for geography departments anywhere in the world interested in developing open source mapping skills and projects. We then provide three examples from our own department of how open source mapping is used to build skills, enhance data collection, and foster international collaboration between U.S. and Latin American researchers and students. We conclude by discussing the benefits and challenges of employing these tools in the classroom and the field.

К вопросу о сопоставимости ведомственных информационных ресурсов о земле

К вопросу о сопоставимости ведомственных информационных ресурсов о земле