Prioritization Of Resources Research Articles

Introduction

Introduction

One Hundred Days of Coronavirus Disease 2019 Prevention and Control in China

The epidemic of novel coronavirus diseases was first reported in China in late December 2019 and has been brought under control after some two months in China. However, it has become a global pandemic and the number of cases and deaths continues to increase outside of China. We describe the emergence of the pandemic, detail the first 100 days of China’s response as a Phase 1 Containment followed by Phase 2 Containment strategy, and briefly highlight areas of focus for the future. Specific, simple, and pragmatic strategies used in China for risk assessment, prioritization, and deployment of resources are described. Details of implementation, at different risk levels, of the traditional public health interventions are shared. Involvement of society in mounting a whole country response and challenges experienced with logistics and supply chains are described. Finally, the methods China is employing to cautiously re-start social life and economic activity are outlined.

Professional identity formation in disorienting times.

The coronavirus disease 2019 (COVID-19) is a major crisis, disrupting all facets of human life. For medical professionals and trainees, the COVID-19 pandemic creates additional concerns about one’s role in providing care, the effectiveness and limitations of medical care, and personal vulnerability to infection and asymptomatic disease spread. These challenges can shape medical students’ professional identity formation (PIF), defined as how learners come to ‘think, act, and feel like a physician.’1 Medical students develop their identities as emerging professionals through training, and a crisis such as a pandemic alters, impedes or accelerates this process. A crisis catalyses transformative learning by serving as a disorienting dilemma, and educators can harness this opportunity for growth. A longitudinal integrated PIF curriculum drawing on the work of Cruess et al.1 is included in the University of California San Francisco School of Medicine curriculum. The regular 4-year curriculum contains eight separate interspersed weeks of ‘Assessment, Reflection, Coaching, and Health’ (ARCH). These full-time learning experiences highlight factors that influence socialisation into medicine - the crux of PIF. With the health system and clinical learning environment rapidly changing in response to COVID-19, classroom curricula transitioning to online platforms, and increased isolation due to social distancing, we revamped PIF content to address these disruptions. A central component of PIF is acceptance of uncertainty and ambiguity. We emphasise this theme by examining the tensions of personal versus professional duties, rationing and prioritisation of resources, and health care disparities that have been exacerbated by COVID-19 (see https://ucsf.box.com/v/COVID19-PIF-Materials). Students discuss how they negotiate ‘playing the role’ of physician, as friends and family ask about COVID-19 or question whether they should provide care that may elevate their personal risk of infection or of spreading the virus. To mitigate anxiety, fear and stress, we provide students with links to virtual wellness offerings, including physical exercise and mindfulness. To process these emotions, we use small group-based guided reflection (see https://ucsf.box.com/v/COVID19-PIF-Materials), which is core to PIF, and adapt this strategy for asynchronous and distance learning. We increased contact with faculty coaches, many of whom are involved in care for patients with COVID-19, and peers via Zoom™ (Zoom Video Communications Inc., San Jose, CA, USA) small groups to enhance socialisation and combat isolation through communities of learning. By using pre-existing small groups, we preserve rituals such as group check-ins that provide comfort and signal membership of a group and the profession. Our experience with redesign of the PIF curriculum to meet students’ learning needs during a crisis is that students are uncertain about their roles, yet eager to contribute, and are simultaneously juggling feelings of isolation, helplessness and fear. Pausing foundational science curricula and clinical clerkships to participate in guided PIF content has been mostly met with relief. Providing time for learners to reconnect with role models has facilitated conscious reflection. Opportunity to discuss their thoughts and feelings with peers has helped to counteract isolation, normalise their reactions and reduce students’ stress and anxiety. The rapidly shifting health care landscape challenges identities for all providers. Reflecting on this evolution has enabled us to maximise the transformative effect of our current circumstances for students’ learning and development.

Understanding Public Acceptance of Autonomous Vehicles Using the Theory of Planned Behaviour.

Public acceptance of autonomous vehicles (AVs) is vital for a society to reap their intended benefits such as reduced traffic accidents, land usage, congestion and environmental pollution. The purpose of this paper is to use the theory of planned behaviour to pinpoint and examine the components affecting public acceptance of AVs. A model consisting of a network of hypothesised relationships is introduced. Thereafter, 526 residents in Seoul, Korea, were given a survey created for this research. Subsequently, to evaluate the collected information and estimate the model, structural equation modelling was adopted. The outcomes show individuals’ mindset on AVs, subjective customs, and behavioural influence directly influencing the acceptance of AVs. Furthermore, cognitive and emotive factors, namely comparative advantage, compatibility, complexity and hedonic motivation indirectly influence the acceptance of AVs via mindset and behavioural manipulation. Based on analysing the cumulative effect, attitude emerged with the strongest effect on public acceptance of autonomous vehicles. After this is, in decreasing order of influence, behavioural control, relative advantage, subjective norms, compatibility, hedonic motivation and complexity. The findings of this study implicate the prioritisation and allocation of resources, and policies relating to marketing, education, subsidisation and infrastructure development to better public acceptance of AVs.

Alien species in Norway: Results from quantitative ecological impact assessments

Abstract1. Due to globalisation, trade and transport, the spread of alien species is increasing dramatically. Some alien species become ecologically harmful by threatening native biota. This can lead to irreversible changes in local biodiversity and ecosystem functioning, and, ultimately, to biotic homogenisation.2. We risk‐assessed all alien plants, animals, fungi and algae, within certain delimitations, that are known to reproduce in Norway. Mainland Norway and the Arctic archipelago of Svalbard plus Jan Mayen were treated as separate assessment areas. Assessments followed the Generic Ecological Impact Assessment of Alien Species (GEIAA) protocol, which uses a fully quantitative set of criteria.3. A total of 1,519 species were risk‐assessed, of which 1,183 were species reproducing in mainland Norway. Among these, 9% were assessed to have a severe impact, 7% high impact, 7% potentially high impact, and 49% low impact, whereas 29% had no known impact. In Svalbard, 16 alien species were reproducing, one of which with a severe impact.4. The impact assessments also covered 319 so‐called door‐knockers, that is, species that are likely to establish in Norway within 50 years, and 12 regionally alien species. Of the door‐knockers, 8% and 10% were assessed to have a severe and high impact, respectively.5. The impact category of most species was driven by negative interactions with native species, transformation of threatened ecosystems, or genetic contamination. The proportion of alien species with high or severe impact varied significantly across the different pathways of introduction, taxonomic groups, time of introduction and the environments colonised, but not across continents of origin.6. Given the large number of alien species reproducing in Norway and the preponderance of species with low impact, it is neither realistic nor necessary to eradicate all of them. Our results can guide management authorities in two ways. First, the use of quantitative assessment criteria facilitates the prioritisation of management resources across species. Second, the background information collected for each species, such as introduction pathways, area of occupancy and ecosystems affected, helps designing appropriate management measures.

Early diagnosis and rapid isolation: response to COVID-19 outbreak in Korea

Early diagnosis and rapid isolation: response to COVID-19 outbreak in Korea

COVID-19 and Older Adults. Lessons Learned from the Italian Epicenter.

On March 13th, 2020, The World Health Organization effectively established that Europe is the new the COVID-19 pandemic world epicenter, as cases in Italy and other European nations soared. The numbers in Italy have climbed with over 80,000 cases as of March 25th, 2020 and with over 8000 deaths, placing Italy now as the country with the highest mortality rate. Importantly, older adults are particularly vulnerable to get severe illness, complications, and to have a higher mortality rate than any other age group. The clinical presentation in older adults with severe illness, in the experience from geriatricians in Lombardy, is described as quite sudden; patients can develop severe hypoxemia with the need of ventilation support in few hours. Geriatric syndromes are not a common form of presentation for COVID-19 in severe illness. It is suggested that stratification by frailty level may help to detect the most vulnerable, and decisions about healthcare resource prioritization should not be taken based only on age itself or previous diagnosis, such as having dementia.

Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 - COVID-NET, 14 States, March 1-30, 2020.

Since SARS-CoV-2, the novel coronavirus that causes coronavirus disease 2019 (COVID-19), was first detected in December 2019 (1), approximately 1.3 million cases have been reported worldwide (2), including approximately 330,000 in the United States (3). To conduct population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in the United States, the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) was created using the existing infrastructure of the Influenza Hospitalization Surveillance Network (FluSurv-NET) (4) and the Respiratory Syncytial Virus Hospitalization Surveillance Network (RSV-NET). This report presents age-stratified COVID-19-associated hospitalization rates for patients admitted during March 1-28, 2020, and clinical data on patients admitted during March 1-30, 2020, the first month of U.S. surveillance. Among 1,482 patients hospitalized with COVID-19, 74.5% were aged ≥50 years, and 54.4% were male. The hospitalization rate among patients identified through COVID-NET during this 4-week period was 4.6 per 100,000 population. Rates were highest (13.8) among adults aged ≥65 years. Among 178 (12%) adult patients with data on underlying conditions as of March 30, 2020, 89.3% had one or more underlying conditions; the most common were hypertension (49.7%), obesity (48.3%), chronic lung disease (34.6%), diabetes mellitus (28.3%), and cardiovascular disease (27.8%). These findings suggest that older adults have elevated rates of COVID-19-associated hospitalization and the majority of persons hospitalized with COVID-19 have underlying medical conditions. These findings underscore the importance of preventive measures (e.g., social distancing, respiratory hygiene, and wearing face coverings in public settings where social distancing measures are difficult to maintain)† to protect older adults and persons with underlying medical conditions, as well as the general public. In addition, older adults and persons with serious underlying medical conditions should avoid contact with persons who are ill and immediately contact their health care provider(s) if they have symptoms consistent with COVID-19 (https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html) (5). Ongoing monitoring of hospitalization rates, clinical characteristics, and outcomes of hospitalized patients will be important to better understand the evolving epidemiology of COVID-19 in the United States and the clinical spectrum of disease, and to help guide planning and prioritization of health care system resources.

Optimal spatial prioritization of control resources for elimination of invasive species under demographic uncertainty.

Populations of invasive species often spread heterogeneously across a landscape, consisting of local populations that cluster in space but are connected by dispersal. A fundamental dilemma for invasive species control is how to optimally allocate limited fiscal resources across local populations. Theoretical work based on perfect knowledge of demographic connectivity suggests that targeting local populations from which migrants originate (sources) can be optimal. However, demographic processes such as abundance and dispersal can be highly uncertain, and the relationship between local population density and damage costs (damage function) is rarely known. We used a metapopulation model to understand how budget and uncertainty in abundance, connectivity, and the damage function, together impact return on investment (ROI) for optimal control strategies. Budget, observational uncertainty, and the damage function had strong effects on the optimal resource allocation strategy. Uncertainty in dispersal probability was the least important determinant of ROI. The damage function determined which resource prioritization strategy was optimal when connectivity was symmetric but not when it was asymmetric. When connectivity was asymmetric, prioritizing source populations had a higher ROI than allocating effort equally across local populations, regardless of the damage function, but uncertainty in connectivity structure and abundance reduced ROI of the optimal prioritization strategy by 57% on average depending on the control budget. With low budgets (monthly removal rate of 6.7% of population), there was little advantage to prioritizing resources, especially when connectivity was high or symmetric, and observational uncertainty had only minor effects on ROI. Allotting funding for improved monitoring appeared to be most important when budgets were moderate (monthly removal of 13-20% of the population). Our result showed that multiple sources of observational uncertainty should be considered concurrently for optimizing ROI. Accurate estimates of connectivity direction and abundance were more important than accurate estimates of dispersal rates. Developing cost-effective surveillance methods to reduce observational uncertainties, and quantitative frameworks for determining how resources should be spatially apportioned to multiple monitoring and control activities are important and challenging future directions for optimizing ROI for invasive species control programs.

Impact of cold stress on birth and weaning weight in a composite beef cattle breed

Beef cattle are often exposed to extreme environmental conditions with varying temperatures, humidity, wind speed, and solar radiation. The objective of this study was to investigate the impact of cold stress on growth-related traits and to assess its variation between sire families in a composite beef cattle breed in eastern Montana. Weather data were collected from an airport close to the research station. Comprehensive climate index (CCI), a measure of cold load, was used to classify cold stress into mild (CCI < -5), moderate (CCI < -15), and severe (CCI < -25). The phenotypic data consisted of 4,221 and 4,217 records for birth weight (BWT) and weaning weight (WWT), respectively. For both traits, the statistical model included an overall mean, contemporary groups, and a regression on cold stress load. For WWT, the model included additional regressions on birth weight and age at weaning. The results showed that mild and moderate cold stress increased BWT by 5.88 and 0.71 kg, respectively. However, severe cold stress slightly decreased BWT (-0.010 kg). Cold stress resulted in a significant decrease in WWT for mild (27.90 kg) and moderate (17.42 kg) cold stress, while the decrease in WWT for severe (2.07 kg) cold stress was insignificant. Using only data from three different sire families with the largest paternal half-sib families, estimates of within family regression coefficients on cold stress were statistically different (based on Welch's t-test) for BWT and WWT. These results seem to indicate that cold stress has a limited negative (often positive) effect on BWT which could be due to some nutritional prioritization of nutritional resources toward the fetus. Furthermore, comparing cold stress effects across different sire families indicated the existence of potential genetic variation in cold stress response.

The development of the ‘Cancer Home-Life Intervention’: An occupational therapy-based intervention programme for people with advanced cancer living at home

Background Occupational therapy-based interventions may help people with advanced cancer to live actively despite their illness. However, there is limited evidence concerning what kinds of content intervention should encompass, and how this should be done. Objective To describe the development and content of an occupational therapy-based intervention programme for people with advanced cancer living at home. Material and methods In the development of the intervention, an evidence synthesis was performed based on a systematic literature search, data from a cross-sectional study, and experiences from an expert panel. Results The programme contains six components: 1) An initial interview to select which of the other five components to address, based on the participants’ individual needs. The interview addressed problems and needs of participants in relation to prioritized activities, in order to tailor the following components: 2) prioritisation of resources, energy and everyday activities; 3) adaptation of activities; 4) adaptation of posture and seating; 5) provision of assistive technology; and, 6) modification of the physical home environment. Conclusion An occupational therapy-based intervention programme for people with advanced cancer living at home has been developed. The study generates knowledge and insights relevant to improving the treatment of this patient group.

Practice of endoscopy during COVID-19 pandemic: position statements of the Asian Pacific Society for Digestive Endoscopy (APSDE-COVID statements)

Coronavirus-19 (COVID-19) caused by SARS-CoV-2 has become a global pandemic. Risk of transmission may occur during endoscopy and the goal is to prevent infection among healthcare professionals while providing essential...

Health risk assessment of heavy metals, BTEX and polycyclic aromatic hydrocarbons (PAHs) in the workplace in a secondary oil re-refining factory

The present study aimed to evaluate the health risk of heavy metals (iron, zinc, cadmium, arsenic, nickel, lead, and mercury), benzene, toluene, ethylbenzene and xylene (BTEX), and polycyclic aromatic hydrocarbons (PAHs) in the workplace in a secondary oil re-refining factory. In this descriptive, cross-sectional study, samples were collected and analyzed using the NIOSH 1501 method at eight sampling points with determined concentrations of BTEX, 16Ʃ PAHs, and heavy metals. The concentration of each pollutant was evaluated based on the type of workers (packaging/filtration). The risk assessment of the contaminants was carried out using the RAIS software, and the risk of non-carcinogenic compounds was estimated based on the reference respiratory concentration (mg/m3). The results showed that the lifetime cancer risk index (LCR) cumulative risk of the heavy metals was within the definitive risk range at all the sampling points. The highest carcinogenic risk of LCR belonged to arsenic at sampling point H (filtration chamber), and the highest cumulative carcinogenic risk of the total contaminants in the environmental sampling points belonged to sampling point H. At all the sampling points, the LCR carcinogenic risk accumulation for the hydrocarbon compounds was within the definitive range. The maximum cumulative lifetime cancer risk for the hydrocarbon compounds was evaluated in filtration (point B), and the most hazardous carcinogens were arsenic, benzo(a)pyrene, and naphthalene. The proposed risk assessment method was observed to be comprehensive, and its results could be used for corrective and controlling measures and the prioritization of risk reduction resources.

An update on the status of COVID-19: a comprehensive review.

The last two decades have witnessed two large-scale pandemics caused by coronaviruses, including severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). At the end of 2019, another novel coronavirus, designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), hit Wuhan, a city in the center of China, and subsequently spread rapidly to the whole world. Latest reports revealed that more than 800 thousand people in over 200 countries are involved in the epidemic disease by SARS-CoV-2. Due to the high mortality rate and the lack of optimum therapeutics, it is crucial to understand the biological characteristics of the virus and its possible pathogenesis to respond to the SARS-CoV-2. Rapid diagnostics and effective therapeutics are also important interventions for the management of infection control. However, the rapid evolution of SARS-CoV-2 exerted tremendous challenges on its diagnostics and therapeutics. Therefore, there is an urgent need to summarize the existing research results to guide decision-making on the prioritization of resources for research and development. In this review, we focus on our current understanding of epidemiology, pathogenesis, diagnostics and therapeutics of coronavirus disease 2019 (COVID-19).

Zika e microcefalia no Facebook da Fiocruz: a busca pelo diálogo com a população e a ação contra os boatos sobre a epidemia

Este artigo analisa a abordagem da epidemia de zika e microcefalia pela página da Fundação Oswaldo Cruz no Facebook entre maio de 2015 e maio de 2016. Seguindo procedimentos da análise de conteúdo, destacamos características das postagens sobre o tema a partir de sua frequência, enquadramento, formato e engajamento. Também analisamos qualitativamente parte dos comentários das postagens de maior engajamento. Os resultados mostram o destaque recebido pelo tema na página e evidenciam a priorização do enfoque científico e político-institucional, o emprego da ciência para conferir credibilidade aos conteúdos e a popularidade das postagens sobre boatos junto ao público. Constatou-se, ainda, pouca interação por parte da Fiocruz e pequena variação dos formatos empregados nas postagens, com priorização de recursos tradicionais.

Assistive technology use and unmet need in Canada

Background Around the world, variations and inequities in access to assistive technology (AT) are evident. Development of legislation, policies, and programmes has not kept pace with the increasing demand for AT. Therefore, context-specific needs assessment is required, which can assist in anticipating the accessibility and human support needs of individuals with impairments, and in turn, inform resource allocation and prioritisation of services. The purpose of this cross-sectional study was to describe the current use and unmet needs of AT use in community-dwelling Canadians experiencing activity limitation or participation restriction (disability). Data and methods Bootstrapping was used to estimate the prevalence of AT use and unmet needs using data from the 2012 Canadian Survey on Disability (CSD). The total sample size for the CSD was 45,443 individuals. Results Among the estimated 3,775,920 Canadians with a disability (13.7% of the Canadian population), 3,579,580 used some form of AT. Among these individuals, 3,050,750 use glasses or contact lenses and 1,109,060 use bathroom aids. The results of the study showed that the most common unmet need was for hearing aids (0.86% of the total population), followed by bathroom aids (0.36%). Interpretations This study comes at a time when global attention is focussed on research on access to AT. This study using data from the CSD will serve disability and social policy analysts at all levels of government, as well as associations for persons with disabilities and researchers working in the field of disability policy and programmes. Implication for Rehabilitation The current initiatives on assistive technology, including the World Health Organization’s Global Cooperation on Assistive Technology (GATE) project, recognize the substantial gap between the need for and provision of assistive devices. In Canada, for example, as well as in other countries, despite rapid growth in innovation, unmet needs for assistive devices persist and multiple barriers have been reported by individuals in accessing needed assistive devices. A better understanding of the met and unmet needs of assistive technology users can assist in anticipating accessibility and human support needs of individuals with disabilities, and in turn, inform resource allocation and prioritization of services. • The study estimates the prevalence of assistive device use in community dwelling Canadians and describes the unmet needs for assistive devices of Canadians with activity limitation (disability). • This study provides evidence on the use and unmet assistive technology needs for disability and social policy analysts at all levels of government, as well as associations for persons with disabilities and researchers working in the field of disability policy and programmes. • The results of this study can be used for planning and evaluating services, programmes and policies for Canadian adults with disabilities to help enable their full participation in society.

Reconsideración de las políticas fiscales y las responsabilidades en salud. Una nota

La igualdad de oportunidades (así como las diferencias observadas en campos como la salud) se alcanza cuando los resultados dependen de la libertad individual y suficiente información. En esta nota, se analizan la priorización de políticas fiscales y recursos sanitarios públicos. Asimismo, se exponen algunos argumentos referidos a la no discriminación, preocupación por la desigualdad y criterios de información y tutela.

Commentary on Shanahan et al. (2020): The importance of quantifying the intangible costs for family members of drug users.

Assessing preferences for treatments among family members of people with drug dependence is a key issue due to the externalities that these pathologies generate. The willingness to pay method allows researchers to obtain a monetary valuation of the intangible effects of these pathologies on family members. Drug use causes multiple consequences that the cost of illness literature usually classifies as direct (e.g. cost of health care), indirect (e.g. lost productivity) or intangibles (mainly loss of quality of life). Although the study of these consequences is usually focused on the drug user, these problems also directly affect their family members and relatives, as well as society as a whole 1. Quantifying the consequences of drug use is therefore of great interest to avoid underestimating their importance 2, 3. Within the economic evaluation of health programs framework, the literature shows different approaches to quantifying the effect of addictions in the family environment 4-6. The choice of measurement tool will depend largely on the variable under study. Focusing on intangible costs, if the objective is to measure the loss of health-related quality of life, the use of instruments proposed in cost–utility analysis studies is widely supported. Scales such as the Euroqual (EQ)-5D 7 or the Short form (SF)-6D 8 allow researchers to measure variations in quality of life and estimate losses in quality-adjusted life years 9, 10. I disagree with Shanahan et al.’s claim that the SF-6D is insensitive to the impact of drug dependence 11. This insensitivity appears to be the result of the test having a ‘floor’ effect that makes it insensitive towards discriminating small health gains in the worst-case scenarios. Part of this ‘floor’ effect seems to be due to the standard gamble technique used to obtain the test's weights. Abellán et al. have demonstrated how the use of double lottery or equivalent lottery techniques allow us to obtain weights that reduce this effect 12. Thus, there are some experiments and preference studies in which SF-6D has been shown to be sensitive to the impact of alcohol dependence 6, 10. However, if the goal is to measure other aspects, besides loss of quality of life, the willingness-to-pay method emerges as a good candidate. This recent methodology was initially proposed to assess the impact of environmental policies, but little by little it was extended to other areas, such as health interventions. This approach allows quantification of the monetary value of an intervention for a specific subject, for their family members or for society. In addition to this, said values can be incorporated later on in cost–benefit analysis studies. There are examples in the literature of researchers applying this approach to questions around illegal drugs 13-15 and alcohol 16, 17. In the paper by Shanahan et al. 11, the willingness to pay approach is adopted within a discrete choice experiment study, to assess preferences for treatment for heroin dependence among the subjects’ family members. The advantage of a discrete choice experiment is that it allows researchers to quantify preferences for several aspects of the problem and, therefore, the quantification of a monetary value for each of them. To do this, the authors identify, based on the literature, the aspects of the problem that are most relevant to the family members and then they estimate the willingness to pay for the hypothetical improvements in the aspects analyzed. The advantage of this strategy is that it not only allows one to obtain the willingness to pay for a specific treatment, but also allows one to estimate and compare the value to family members of different treatment scenarios. This type of study may be relevant both in clinical and economic settings. At the clinical level, it is not only of interest to involve family members in the treatment of the addict, but also to assess the loss of quality of life that they themselves experience. On an economic level, these types of analyses may be relevant both for their application in cost of illness studies—they permit an identification of the intangible costs analyzed in this literature 18—as well as for economic evaluation studies that lead to decisions on prioritization of health resources 19. In addition to this, although it is just a pilot study, Shanahan et al. show an analysis methodology that may be of interest to researchers who want to monetarily quantify different intangible consequences of addictions. None.

A PCA-DEA method for organizational performance evaluation based on intellectual capital and employee loyalty

PurposeThe purpose of this study is to propose a model to evaluate the performance of organizational units considering intellectual capital (IC) and employee loyalty approach applying principal component analysis and data envelopment analysis (PCA-DEA) method.Design/methodology/approachOrganization units are considered as decision-making units, IC components including human capital (HC), structural capital (SC) and customer capital are inputs and employee loyalty is output. The principal component analysis was used to converts inputs and outputs into the independent variables. As a return to scale is variable, a modified envelopment input-oriented BCC model applied to obtain the efficiency of organization units. Also, all units of organization are ranked. Eventually, sensitivity analysis performed to show how input variables influence on output variable.FindingsOperation, design and construction, production planning, internal affairs, quality control and security were recognized as efficient units. Also, units of operation, internal affairs and quality control ranked first to third, and the human resource unit earned the last rank. In addition, results of sensitivity analysis on input variables showed that the order of impact intensity is: customer capital, HC and SC, respectively.Originality/valueExistence a framework for the development of human resource strategies and prioritization in the allocation of organizational resources to improve the performance of the organization considering human resources is vital. Most of the previous studies, just have examined the impact of IC on different dimensions of organizational performance. Meanwhile, evaluating the performance of IC with employee loyalty approach, using PCA-DEA simultaneously can evaluate and measure the impact of IC on the performance of the organization and its units regarding employee loyalty, which has a significant impact on improving the organization’s level of IC and human resource management.

SAT-420 A CLINICAL SCORE TO PREDICT MORTALITY IN SEVERE LEPTOSPIROSIS

Leptospirosis is a zoonosis transmitted through contact with water or soil contaminated by urine from animal reservoirs. It is typically a mild acute febrile illness, however about 10% of patients progress to severe disease with a case fatality rate of 5-20%. This study aims to establish a clinical prediction tool that would predict the risk of progression to mortality in patients presenting to health care providers with signs and symptoms of leptospirosis. This is a retrospective case-control study on survivors and non-survivors due to severe leptospirosis admitted at our institution. Logistic regression was performed to identifysignificant predictors of mortality. A scoring system was generated and validated using the same patient population. A total of 383 patients were included in the study, 327 survivors and 56 (14.6%) non-survivors. Significant factors associated with mortality include history of hypertension (OR=3.72, 95%CI=1.16-8.91), diabetes (OR=15.46, 95%CI=4.58-52.21), presence of oliguria (OR=3.43, 95%CI=1.75-6.73), hemorrhage (OR=2.61, 95%CI=1.22-5.61), hypotension (OR=2.27, 95%CI=1.20-4.33), respiratory rate >20cpm (OR=1.87, 95%CI=1.06-3.31), crackles (OR=4.02, 95%CI=0.74-2.04), edema (OR=4.79, 95%CI=1.83-12.50), thrombocytopenia <100x103/uL (OR=3.80, 95%CI=2.11-6.83), prolonged partial thromboplastin time >45 seconds (OR=2.94, 95%CI=1.61-5.38), acidosis pH<7.30 (OR=5.11, 95%CI=2.60-10.05), atrial fibrillation (OR=11.62, 95%CI=4.48-30.14), and radiographic pulmonary congestion/edema (OR=3.78, 95%CI=1.82-7.81). A weighted scoring system was assigned and four risk categories of increasing severity and percent mortality was formed and can be used as an adjunct to guide clinical decision-making and prioritization of resources. Patients with score 0-2, mortality risk 2.42%, can be discharged with advice, or admit to a primary hospital. Patients with score 3-5, mortality risk 19.51%, can be referred or admitted to a tertiary hospital with an interim leptospirosis ward. Patients with a score of 6-8 and mortality risk 42.86%, recommend transfer to a more equipped ward with close monitoring for occurrence of complications, and possible transfer to the Intensive Care Unit (ICU). Lastly, patients with score >9 have a high mortality risk (81.82%), thus transfer to ICU. In conclusion, a clinical prediction score for mortality in severe leptospirosis is developed from the major prognostic risk factors, which may prove useful in triaging patients in the event of another leptospirosis outbreak.