Service Area Research Articles

Automatic delineation of rational service areas and health professional shortage areas in GIS based on human movements and health resources

AbstractHow people travel to receive health services is essential for understanding healthcare shortages. The rational service areas (RSAs) are defined to represent local healthcare markets and used as the basic units to evaluate whether people have access to health resources. Therefore, finding an appropriate way to develop RSAs is important for understanding the utilization of health resources and supporting accurate resource allocation to the health professional shortage areas (HPSAs). Existing RSAs are usually developed based on the local knowledge of public health needs and are created through time‐intensive manual work by health service officials. In this research, a travel data‐driven and spatially constrained community detection method based on human mobility flow is proposed to automate the process of establishing the statewide RSAs and further identifying HPSAs based on healthcare criteria in a geographic information system (GIS) software. The proposed method considers the difference between rural and urban populations by assigning different parameters and delineates RSAs with the goal of reducing health resource inequalities faced by rural areas. Using the data in the State of Wisconsin, our experiment shows that the proposed RSA delineation method outperforms other baselines including the traditional Dartmouth method in the aspects of RSA compactness, region size balances, and health shortage scores. Furthermore, the whole process of delineating RSAs and identifying HPSAs is automated using Python toolboxes in ArcGIS to support future analyses and practices in a timely and repeatable manner.

Expressway Vehicle Arrival Time Estimation Algorithm Based on Electronic Toll Collection Data

Precise travel time prediction benefits travelers and traffic managers by enabling anticipation of future roadway conditions, thus aiding in pre-trip planning and the development of traffic control strategies. This approach contributes to reducing travel time and alleviating traffic congestion issues. To achieve real-time state perception of vehicles on expressways, we propose an algorithm to estimate the arrival time of vehicles in the next segment using Electronic Toll Collection (ETC) data. Firstly, the characteristics of ETC data and GPS data are meticulously described. We devise algorithms for data cleaning and fusion, subsequently segmenting the vehicle journey into multiple sub-segments. In the following step, feature vectors are constructed from the fused data to detect service areas and analyze the expressway segment characteristics, vehicle traits, and the influence of service areas. Finally, an algorithm utilizing LightGBM is introduced for estimating the arrival time of vehicles at various segments, corroborated by empirical tests using authentic traffic data. The MAE of the algorithm is recorded as 20.1 s, with an RMSE of 32.6 s, affirming its efficacy. The method proposed in this paper can help optimize transportation systems for improving efficiency, alleviating congestion, reducing emissions, and enhancing safety.

Projected Analysis of Fulfilling Pdam Clean Water Needs in Domestic Customers of Waginopo Village, Wangi-Wangi District, Wakatobi District

Clean water is a very vital need for society, to meet the needs for drinking water, bathing, cooking, washing and including industrial needs. The existence of clean water in an area is very important considering the very dynamic activities of society. In its implementation, the drinking water supply system in Waginopo Village has not been able to run smoothly. In fact, according to a temporary survey that has been carried out, PDAM water only flows once every 2 days, once a week and the maximum flow time is only 12 hours. The aim of this research is to calculate the amount of clean water needed for the service area of Waginopo Village, Wangi-Wangi District, Wakatobi Regency until 2033. In this research, not only numerical data will be collected, but also information about what the community desires regarding the performance of the clean water distribution system, so this research study approach uses a combination of quantitative and qualitative approaches. From the results of the analysis it can be said that the total water demand of PDAM Wakatobi Regency for the Waginopo Village service area in 2033 is 867,894 m3/year. Meanwhile, based on water demand in 2024, it is 592,737 m3/year. So the calculation results from 2024 to 2033 have increased.

Construction and Optimization Strategy of Ecological Security Pattern in County-Level Cities under Spatial and Temporal Variation of Ecosystem Services: Case Study of Mianzhu, China

Climate change and human activities are seriously affecting the ecological level and economic development of county-level cities. Mianzhu City is a typical county-level city located within the Chengdu-Chongqing Economic Circle and the Yangtze River Economic Belt. The study selected primary ecological sources by analyzing high-level ecosystem service functions over time, using Morphological Spatial Pattern Analysis (MSPA). Ecological resistance surfaces were constructed using natural factors to address ecological risks associated with future urbanization. The construction of the ecological security pattern (ESP) followed the source–corridor–node paradigm, incorporating changes in ecosystem service risks. From 2010 to 2020, ecosystem service functions and values in Mianzhu City declined overall, with significant spatial variations. Human activities increased in ecologically fragile areas, aggravating exposure to ecological risks from climate change and urban expansion. Ecological protection and restoration zones were identified, with nature reserves in the north and the southern center as the core. In 2020, 19 ecological sources and 46 ecological corridors were identified, with a spatial distribution pattern of “more length and short resistance in the north, less length and long resistance in the south”. Additionally, 41 ecological pinch points and 16 ecological barrier points were determined. Considering the spatial distribution of the core areas of ecosystem services and lands with human-intensive activities, setting up the general idea of the ecological restoration pattern centered on forests, river corridors, and natural and artificial landscapes. The study provides new insights into constructing and optimizing the ESP, offering crucial references for the rapid urbanization of ecological restoration and development planning in urban regions.

Are public transit investments based on accurate forecasts? An analysis of the improving trend of transit ridership forecasts in the United States

Historically, forecasts of travel demand on public transit infrastructures have been found to be optimistically biased. However, there has been a lack of data available for statistically significant analysis of factors affecting the accuracy. This paper analyzes the overall trend of transit ridership forecast accuracy in the US and contextualizes it with ridership trends based on the largest yet database of 164 large-scale transit infrastructure projects in the US. We find that transit ridership is about 24.6 % lower than forecast on average with about 70 % of the projects over-predicting ridership. Forecast accuracy varies by mode, service area characteristics, familiarity with transit, ramp up period, and time span. The accuracy has been getting better over the years, particularly after 2000 with the introduction of new analytical and evaluation tools as part of the Capital Investment Grants program. Projects that have been forecasted since 2000 have average ridership about 22 % lower than forecast, compared to about 52 % lower from pre-2000. The steadily improving accuracy, however, is offset by the unexpected decline in transit ridership since 2012. Advent of ride-hailing services and improved socio-economic trends that support auto-oriented cities have prompted this decline in ridership and have affected their forecasts as well. Despite the improving trend, we find that there remains substantial deviation in the outcomes from their forecasts. This points to the need of better scrutiny of model inputs and specifications and how they interact with the built environment to unearth the underlying reasons for inaccuracy. Planners and policymakers may make use of our results to advocate for considering the uncertainty around forecasts for any project and funding decision.

A large-scale evaluation of machine learning algorithms in mid-term water demand forecasting

ABSTRACT Water utilities currently face challenges in accurately measuring user-end consumption as they have to visit every conventional meter that is installed in their service area. This study explores the use of accessible machine learning models to forecast water demand at two crucial temporal scales, addressing practical needs such as customer billing. To draw meaningful conclusions, these models were tested and trained from actual user-end water consumption data from over 2.1 million customers over a 10-year period. These data were provided by the Water and Sewage Company of Greece (EYDAP). The large-scale experiment included the use of statistical models (ARIMA and SARIMA), deep learning [long short-term memory (LSTM)], and clustering techniques (k-NN algorithm). The model with the best performance was ARIMA, outperforming all the other models including the more complex ones. The LSTM model did not perform as expected in predicting water consumption, it excelled only in predicting the total amount of water consumed. These forecasts can be valuable tools for water utility companies, aiding in tasks such as customer billing and water balance calculations. This paper covers all the necessary steps that must be taken to achieve meaningful user-end water consumption forecasts, from raw data preprocessing to hyperparameter tuning for machine learning algorithms.

Lung Donation and Transplant Recipient Outcomes at Independent vs Hospital-Based Donor Care Units

Centralizing deceased organ donor management and organ recovery into donor care units (DCUs) may mitigate the critical organ shortage by positively impacting donation and recipient outcomes. To compare donation and lung transplant outcomes between 2 common DCU models: independent (outside of acute-care hospitals) and hospital-based. This is a retrospective cohort study of Organ Procurement and Transplantation Network deceased donor registry and lung transplant recipient files from 21 US donor service areas with an operating DCU. Characteristics and lung donation rates among deceased donors cared for in independent vs hospital-based DCUs were compared. Eligible participants included deceased organ donors (aged 16 years and older) after brain death, who underwent organ recovery procedures between April 26, 2017, and June 30, 2022, and patients who received lung transplants from those donors. Data analysis was conducted from May 2023 to March 2024. Organ recovery in an independent DCU (vs hospital-based DCU). The primary outcome was duration of transplanted lung survival (through December 31, 2023) among recipients of lung(s) transplanted from cohort donors. A Cox proportional hazards model stratified by transplant year and program, adjusting for donor and recipient characteristics was used to compare graft survival. Of 10 856 donors in the starting sample (mean [SD] age, 42.8 [15.2] years; 6625 male [61.0%] and 4231 female [39.0%]), 5149 (primary comparison group) underwent recovery procedures in DCUs including 1466 (28.4%) in 11 hospital-based DCUs and 3683 (71.5%) in 10 independent DCUs. Unadjusted lung donation rates were higher in DCUs than local hospitals, but lower in hospital-based vs independent DCUs (418 donors [28.5%] vs 1233 donors [33.5%]; P < .001). Among 1657 transplant recipients, 1250 (74.5%) received lung(s) from independent DCUs. Median (range) duration of follow-up after transplant was 734 (0-2292) days. Grafts recovered from independent DCUs had shorter restricted mean (SE) survival times than grafts from hospital-based DCUs (1548 [27] days vs 1665 [50] days; P = .04). After adjustment, graft failure remained higher among lungs recovered from independent DCUs than hospital-based DCUs (hazard ratio, 1.85; 95% CI, 1.28-2.65). In this retrospective analysis of national donor and transplant recipient data, although lung donation rates were higher from deceased organ donors after brain death cared for in independent DCUs, lungs recovered from donors in hospital-based DCUs survived longer. These findings suggest that further work is necessary to understand which factors (eg, donor transfer, management, or lung evaluation and acceptance practices) differ between DCU models and may contribute to these differences.

A column and row generation approach to the crowd-shipping problem with transfers

Crowd-shipping is a last-mile delivery concept in which commuters pick up and deliver parcels on their pre-existing paths. In urban areas, crowd-shipping circumvents problems that traditional last-mile delivery systems suffer from, such as road congestion and lack of parking spaces, especially if more sustainable modes of transport are utilized, like bikes or e-bikes. Using transfers between crowd-shippers allows for expanding the service area and improving the overall performance. However, as this requires synchronization over space and time, it makes the problem more complex. In this work, we develop a model that can encompass fully heterogeneous crowd-shippers and parcels. Thereby, it allows for both direct time-synchronized transfers as well as intermediate storage at designated parcel lockers. We design a column generation algorithm to solve large-scale realistic instances to optimality. We extend the problem to allow crowd-shippers to carry multiple parcels at the same time and for this, we extend the algorithm to simultaneous column and row generation. We evaluate the performance of our algorithm as well as the potential of crowd-shipping with transfers on a realistic case study of a bike-based crowd-shipping system in Washington DC. Our methods solve realistic instances with 1000 crowd-shippers and 1000 parcels within minutes. The results show that a gain in revenue and service level of 30% can be obtained by allowing transfers. By letting part of the population of crowd-shippers carry two or three parcels at the same time, the revenue and service level can be further increased by 30 to 50%. Maximum locker capacities are shown to be reasonable and are the highest in areas where there is a large gap between the moment when parcels are dropped off and when they are picked up from parcel points, which are mainly in the city center.

Buying And Selling Transactions On Social Media Are Prohibited: Review Of The Law Of Buying And Selling Between Justice, Welfare And Human Rights

Technology has greatly influenced commercial activity, particularly in the area of electronic commerce, where products or services can be promoted, marketed, sold and purchased electronically. While this has brought many benefits, it has also raised concerns regarding violating Consumer Rights. Law No. 8 Year 1999 aims to ensure legal certainty in e-commerce transactions. This article discusses the regulation of the legal protection of consumers in e-commerce transactions and the problems that it is facing. The research method is based on a normative legal approach. Written law and literature are examined and related to real events. The analysis conducted is descriptive, collecting data and relating it to real events. It is concluded that consumer protection regulations have not been effective in preventing fraud committed by economic actors in electronic transactions. In order to prevent crimes committed by economic actors and to provide a legal umbrella for consumers, the existence of a consumer protection law is expected.

Digital Leadership Relationships Among School Administrators with the Effectiveness of Academic Work in the New Normal Era

This research article aims to 1) study the digital leadership of educational institution administrators under the Sukhothai Primary Educational Service Area Office, Area 2, Thailand 2) study the effectiveness of academic work in the new normal era of administrators under the Sukhothai Educational Service Area Office, Area 2, Thailand. Sukhothai Primary Educational Service Area Office 2, Thailand and 3) study the relationship between digital leadership of school administrators and academic work effectiveness in the new normal era under the Sukhothai Primary Educational Service Area Office 2, Thailand. This is quantitative research. The sample group is educational institution administrators. and academic teachers of affiliated educational institutions Sukhothai Primary Educational Service Area Office 2, 230 people. The research tool is a questionnaire on digital leadership of school administrators and academic effectiveness in the new normal era. It is a 5-level rating scale questionnaire. Data is analysed using basic statistics to find the average. and standard deviation and the relationship was analysed using the Pearson correlation coefficient. The results of the research found that 1) the digital leadership of educational institution administrators under the Sukhothai Primary Educational Service Area Office, Area 2, Thailand is overall at a high level; 2) academic work effectiveness in the new normal era of administrators under the district office Sukhothai Primary Educational Service Area Office 2, Thailand, overall is at the highest level, and 3) the relationship between digital leadership of school administrators and academic work effectiveness in the new normal era under the Office of Sukhothai Primary Educational Service Area 2, Thailand, was found. that there is a statistically significant relationship at the .01 level

Geometry Optimization of Stratospheric Pseudolite Network for Navigation Applications

A stratospheric pseudolite (SP) is a pseudolite installed on a stratospheric airship. A stratospheric pseudolite network (SPN) is composed of multiple SPs, which shows promising potential in navigation applications because of its station-keeping capability, long service duration, and flexible deployment. Most traditional research about SPN geometry optimization has centered on geometric dilution of precision (GDOP). However, previous research rarely dealt with the topic of how SPN geometry configuration not only affects its GDOP, but also affects its energy balance. To obtain an optimal integrated performance, this paper employs the proportion of energy consumption in energy production as an indicator to assess SPN energy status and designs a composite indicator including GDOP and energy status to assess SPN geometry performance. Then, this paper proposes an SPN geometry optimization algorithm based on gray wolf optimization. Furthermore, this paper implements a series of simulations with an SPN composed of six SPs in a specific service area. Simulations show that the proposed algorithm can obtain SPN geometry solutions with good GDOP and energy balance performance. Also, simulations show that in the supposed scenarios and the specific area, a higher SP altitude can improve both GDOP and energy balance, while a lower SP latitude can improve SPN energy status.

Epidemiological Trends in the Incidence of Gastritis and Duodenitis among Children in Moscow

Introduction. The article analyzes the incidence of gastritis and duodenitis among children based on the data provided by medical organizations subordinate to the Moscow Healthcare Department. The disease incidence is presented by age groups. Materials and methods. The data was obtained from the Federal Statistical Observation Form No. 12 “Information on the number of diseases registered in patients living in the service area of a medical organization”, Form of Federal Statistical Monitoring No. 30 “Information about a medical organization” for the period from 2019 to 2023, as well as data on child population in Moscow published on the official website of the Federal State Statistics Service. Results and conclusions. The analysis of the incidence of gastritis and duodenitis in the observed period showed that the most vulnerable age groups are children aged 10-14 years and adolescents (39.9% and 37.0% out of the total number over the past five years, respectively). Among all age groups, there is a negative dynamic in the overall and primary incidence of gastroduodenitis. Based on the results obtained, it can be concluded that there is a moderate incidence of gastritis and duodenitis among the child population in Moscow. Special attention should be paid to preventive measures and health-improving programs in order to reduce the incidence rate and ensure the health of the rising generation.

Environmental Implications of the Soil-to-Groundwater Migration of Heavy Metals in Mining Area Hotspots

Groundwater contamination was studied at several hotspot sites in the Majdanpek copper mining area (Serbia). These sites include a milling facility, a metallurgical wastewater treatment plant, a heavy vehicle service area, and a waste disposal site. In addition to Cu, high concentrations of As and heavy metals (Cd and Pb) were detected in groundwater and soil at the same sampling points. Mining operations and heavy vehicle transport activities have been identified as the main sources of pollution. The migration of metals from soil to groundwater, expressed as a concentration ratio, were the highest for Co and the lowest for Mn. The environmental implications of groundwater pollution were studied using the heavy metal pollution index (HPI), Nemerov pollution index (NPI), hazard index (HI), and incremental lifetime cancer risk (ILCR). HPI and NPI show the high potential of groundwater to have adverse environmental effects. HPI ranges in the following descending order of metals: Cd &gt; Pb &gt; As &gt; Mn &gt; Ni &gt; Cr &gt; Hg &gt; Cu &gt; Zn. NPI exceeds the threshold of 0.7 in 66.7% of the samples. Potential human exposure to the studied groundwater may cause severe health problems in adults, with HI ranging from 0.61 to 5.45 and ILCR from 1.72 × 10−4 to 1.27 × 10−3. Children were more susceptible to non-carcinogenic risk than adults, with HI ranging from 0.95 to 8.27. However, the results indicated that children were less prone to carcinogenic risks, with ILCR ranging from 5.35 × 10−5 to 3.98 × 10−4. Arsenic is the most contributing element to both risks. This research imposes the need for enhanced groundwater monitoring at hotspots in the mining area and the adoption of remediation plans and measures.

Windbreak and sand fixation service flow simulation in the terminal lake basin of inland rivers in arid regions: A case study of the Aral Sea basin

Research on windbreak and sand fixation (WSF) services aids in soil conservation, and ecological protection. Over the past 50 years, the Aral Sea's shrinkage has intensified wind erosion, leading to significant sand and dust emissions in Central Asia (CA). This study uses the Revised wind erosion equation (RWEQ) model and the hybrid single particle Lagrangian integrated trajectory model (HYSPLIT) model to simulate the spatiotemporal variation pattern of WSF services in the Aral Sea basin (ASB). From the perspective of sand and dust transmission paths, the flow trajectory and benefit areas of WSF services are identified, the spatiotemporal correlation between the WSF service supply areas and benefit areas is established, and the potential impact of WSF services on beneficiary areas is quantitatively assessed. The results show the amount of wind erosion and the amount of WSF in the ASB from 2000 to 2019 showed a fluctuating trend of “first increasing and then decreasing”. In terms of spatial distribution, areas with large amounts of WSF are mainly distributed in the lower reaches of the Syr Darya River and the sand dunes in the northwest of the Kizilkum Desert. WSF services mainly flow through the Kizilkum Desert, Karakum Desert, Moyinkum Desert, Kazakh Hills, and the Junggar Basin and Tarim Basin in China. Generally, it flows to the northeast and southwest. In the past 20 years, the largest areas benefiting from the flow of WSF services are mainly distributed in Uzbekistan, Kyrgyzstan, and Tajikistan. The trajectory distribution frequency shows a decreasing trend from the center to the periphery. The grassland areas constituted the largest beneficiary areas in the ASB of CA, with both the beneficiary population and real GDP exhibiting an upward trend. This study holds significant importance for enhancing the management of ecosystem services in sandy regions and for establishing ecological compensation mechanisms.

Assessing regional disparities and vulnerability in stroke care across Gyeonggi Province: A focus on hospital service areas

BackgroundThis study aims to illuminate regional disparities and identify vulnerable areas in stroke care across Gyeonggi Province's hospital service areas. MethodsUsing data from the Korea National Cardio-cerebrovascular Disease Management Commission, we included 4,427 acute stroke patients admitted in 2018 to hospitals within Gyeonggi Province. Our evaluation focused on: 1) stroke care quality indicators, including rates of defect-free care, intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), and acute reperfusion therapy (either IVT or EVT); 2) intra-regional treatment rates; and 3) one-year mortality across the province and its 12 hospital service areas. These were compared both with national averages and inter-regionally. Vulnerable areas were pinpointed by evaluating the number of quality indicators falling below the national average and through visual distribution mapping, categorizing each indicator into higher (ranks 1-4), middle (ranks 5-8), and lower (ranks 9-12) tiers. ResultsDespite fewer qualified stroke centers and specialists, Gyeonggi Province exhibited higher defect-free care rates (84.6 % vs. 80.7 %), intra-regional treatment rates (57.8 % vs. 51.0 %), and marginally lower one-year mortality (16.2 % vs. 17.3 %) compared to national averages. Notable regional disparities were observed; the highest-performing areas for defect-free care and acute reperfusion therapy exceeded the lowest by 1.4 and 3.3 times, respectively. Nine out of twelve areas fell below the national average for EVT rates, seven for IVT and reperfusion therapy rates, and five for intra-regional treatment rates. Pyeongtaek, with all stroke care quality indicators below the national average coupled with the highest one-year mortality, emerges as a critical area needing improvement in acute stroke care. ConclusionThis study not only exposes the regional disparities in stroke care within Gyeonggi Province's hospital service areas but also identifies areas most vulnerable. Consequently, a customized support strategy for these areas is imperative.

Analysis of emergency assembly points for post-earthquake disaster management: a case study of Erzincan, Türkiye

The selection of emergency assembly points within the urban area holds significant importance for ensuring swift and effective intervention in the aftermath of a potential disaster until temporary shelter areas are prepared. In both historical and instrumental periods, Erzincan (Türkiye) has experienced major earthquakes resulting in significant loss of life and property. The likelihood of similar earthquakes occurring in Erzincan in the future remains high. Therefore, it is necessary to identify safe areas where people can assemble after an earthquake, moving away from hazardous zones. The aim of this study is to analyse the capacities and adequacies of emergency assembly points, which constitute a step in disaster management and enhance the earthquake resilience of the city, using Geographic Information Systems (GIS) based on selected criteria (accessibility, spatial distribution, proximity to healthcare facilities, size, capacity adequacy, and proximity to fault avoidance zones), and to propose solutions. The assessment revealed that the available assembly points are not homogeneously distributed throughout the city and are inadequate to meet the available building and population density. Therefore, in addition to the available 38 emergency assembly points, 67 new alternative emergency assembly points have been identified. The proposed emergency assembly points (in the 75–100% range) increased the number of neighborhoods within the 250 m service area by 43.75% and 42.5% for 500 m.The findings underscore the necessity for more comprehensive and effective planning for Erzincan in the event of a potential disaster or emergency.

Critical Leadership of School Administrators Under the Office of Primary and Secondary Education Service Area in Loei Province

The objective of this research is 1) to study the level of critical leadership of school administrators according to the opinions of teachers under the Office of Primary and Secondary Educational Service Area in Loei Province, and 2) to compare the level of critical leadership of school administrators according to the opinions of teachers under the Primary and Secondary Educational Service Area Office in Loei Province, classified by education, affiliation, and work experience. Which the population includes Teachers under the Primary and Secondary Educational Service Area Office in Loei Province for the academic year 2022 total 3,893 people, and the sample group used in this study was teachers in schools under the Primary and Secondary Educational Service Area Office in Loei Province in the academic year 2022, totaling 354 people. The instrument used in the study was a questionnaire regarding critical leadership characteristics of school administrators, consisting of 40 questions. There is a consistency between the questions and the objective is between 0.60-1.00 with the entire confidence value being 0.982. Statistics used in research namely mean, standard deviation, t-test, analysis of one-way variance, and pairwise mean differences were tested using Scheffe's method. Finding were as follows: 1) the Primary and Secondary Educational Service Area Office in Loei Province has a high degree of critical leadership in its overall management of school administrators, when considering each aspect, it was found that it was at a high level in every aspect, arranged from highest to lowest average as follows; cultural diversity, change, empowerment, and ethics, and 2) the findings of comparing teachers' perceptions of the critical leadership of school officials under the Primary and Secondary Educational Service Area Offices in Loei Province, classified by educational level, affiliation, and work experience, are similar in terms of the overall situation as well as income.

Provision of Behavioral Health Services at Community Health Centers and Hospital Emergency Department Visits.

Numerous US patients seek the hospital emergency department (ED) for behavioral health care. Community Health Centers (CHCs) offer a potential channel for redirecting many to a more patient-centered, lower cost setting. The aim of this study was to identify unique market areas serviced by CHCs and to examine whether CHCs are effective in offsetting behavioral health ED visits. We identified CHC-year specific service areas using patient origin zip codes. We then estimated random effects models applied to 42 federally qualified CHCs operating in New York State during 2013-2020. The dependent variables were numbers of ED mental health (substance use disorder) visits per capita in a CHC's service area, drawn from HCUP State Emergency Department Databases. Key explanatory variables measured CHC number of mental health (substance use disorder) visits, number of unique mental health (substance use disorder) patients, and mental health (substance use disorder) intensity, obtained from the HRSA Uniform Data System. Controlling for population, we observed small negative effects of CHC behavioral health integration in explaining ED behavioral health utilization. Measures of mental health utilization in CHCs were associated with 1.3%-9.3% fewer mental health emergency department visits per capita in Community Health Centers' service areas. Measures of substance use disorder utilization in Community Health Centers were associated with 1.3%-3.0% fewer emergency department visits per capita. Results suggest that behavioral health integration in CHCs may reduce reliance on hospital EDs, but that policymakers explore more avenues for regional coordination strategies that align services between CHCs and local hospitals.

An Epidemiological Study of Cervical Cancer Trends among Women with Human Immunodeficiency Virus.

The purpose of this study was to examine cervical cancer among women with Human Immunodeficiency Virus (HIV) and to discuss targeted strategies to reduce the risk of developing cervical cancer. This study used retrospective data from surveillance reports collected between January 2001 and December 2012. Women with HIV/Acquired Immunodeficiency Syndrome (AIDS) were linked through a crosswalk file to Florida's cancer registry database to determine which women developed cervical cancer during this period. We examined the cervical cancer trends using age-adjusted cervical cancer rates to examine the changes over time; the geographic variations in cervical cancer and HIV across service areas using a Geographic Information System (GIS); and finally, the cervical cancer rates among women with HIV compared with the cervical cancer rates in the general population. The results show that, over time, the cervical cancer rates in women with HIV/AIDS decreased; however, we detected increases in the cervical cancer rates among women in the general population. The findings of this study show that more work is required to address cervical cancer. This growing burden of cervical cancer implies that targeted interventions are imperative to improving the health status of women with cervical cancer. If properly addressed, the potential to reduce and prevent cervical cancer is achievable.

Achieving Sustainable Goals Using an Effective Budget-Allocation Multicriteria Mives Model: Case Study of a Spanish Water Utility Company

Within the global sustainability agenda, companies must align their operations with specific Sustainable Goals (SGs) and develop corresponding budgeting strategies. This paper presents a robust multicriteria decision-making model tailored for a Spanish utility company specializing in water services. The model ensures that financial allocations reflect the company's vision and its interpretation of sustainable development within its service areas. This approach aims to promote objectivity, traceability, and sustainability in decision-making, as a critical component in achieving SGs. The article emphasizes the importance of aligning water companies' budget allocations with SGs, highlighting key indicators for consideration. It provides a practical illustration of how the company's financial allocations were synchronized with SGs using a multicriteria decision-making model. A case study is included, involving a budget allocation of 40 million euros compared across four scenarios with the historical average of budgets from the Past Three Investment Plans (P3IP). The results reveal significant variations in budget allocation across different infrastructure categories, demonstrating the system's robustness, such as a 70% variation in production infrastructures, 27% in transportation, 25% in distribution, and 40% in the remaining areas, depending on the scenario.