Single Coordinator Research Articles

Distributed Broadcast Control of Multi-Agent Systems Using Hierarchical Coordination.

Broadcast control (BC) is a bio-inspired coordination technique for a swarm of agents in which a single coordinator broadcasts an identical scalar signal to all performing agents without discrimination, and the agents make appropriate moves towards the agents' collective optimal state without communicating with one another. The BC technique aims to accomplish a globally assigned task for which BC utilizes a stochastic optimization algorithm to coordinate a group of agents. However, the challenge intensifies as the system becomes larger: it requires a larger number of agents, which protracts the converging time for a single coordinator-based BC model. This paper proposes a revamped version of BC model, which assimilates distributed multiple coordinators to control a larger multi-agent system efficiently in a pragmatic manner. Precisely, in this hierarchical BC scheme, the distributed multiple sub-coordinators broadcast the identical feedback signal to the agents, which they receive from the global coordinator to accomplish the coverage control task of the ordinary agents. The dual role of sub-coordinators is manipulated by introducing weighted averaging of the gradient estimation under the stochastic optimization mechanism. The potency of the proposed model is analyzed with numerical simulation for a coverage control task, and various performance aspects are compared with the typical BC schemes to demonstrate its practicability and performance improvement. Particularly, the proposed scheme shows the same convergence with about 30% less traveling costs, and the near convergence is reached by only about one-third of iteration steps compared to the typical BC.

Lessons from a Black Swan: professionals in local co-production prior to and during Covid-19

PurposeThis study examines co-production during the Covid-19 crisis, characterized as a Black Swan event, with a specific emphasis on local professionals’ preparedness and response.Design/methodology/approachA qualitative approach combining deductive and inductive approaches was employed to gather data from professional coordinators of co-production processes in Israeli local governments. The study utilizes professionalism theory as a framework to examine such key elements as professional knowledge, autonomy, status and legitimacy. Additionally, open coding is used to investigate emerging themes.FindingsThe findings reveal that, despite preventive efforts by the central government, local professionals were unprepared to address the crisis. Traditional top-down approaches failed during the crisis, emphasizing the need for peer learning and collaboration among various stakeholders. Professionals' de facto autonomy, driven by quick decision-making and creative problem-solving, elevated their legitimacy and status. Inter- and intra-organizational collaboration was essential to maintain performance through co-producing public services. Finally, multicultural awareness proved vital; neglecting this may have severe consequences in routine times but especially during crises.Research limitations/implicationsUsing qualitative research, this study emphasizes the importance of understanding context in interpreting thoughts and actions. However, our approach has limitations. We collected data at a single point in time, which may not capture changes over time. Additionally, we relied on self-reporting from 19 public professionals in local municipalities, each managing the coproduction-based center within the respective municipality. However, this setup, where a single coordinator represents the entire co-production function of the municipality, has its limitations as only one voice is heard.Practical implicationsBy shedding light on the multifaceted aspects of co-production, policymakers and professionals could learn about such substantial factors as professionals’ autonomy, inter-organizational collaborations and sensitivity to cultural nuances, which should be established first and foremost in routine times to prepare for crisis. In our case study, governmental preventive measures were inapplicable to crises, and experience of prior crises did not necessarily bestow an ability to prepare accordingly. This is where the role of the street-level professionals becomes significant: these are the actors who experience the crisis on the ground and may provide a quick and effective response. Their ability to take the reins, to be innovative and to generate knowledge while exerting their own professional consideration, proved extremely important.Originality/valueThis research contributes to our understanding of public service professionals’ effective leveraging of the contributions of co-producers in times of crisis. It shifts focus from top-down policy preparedness and implementation to the development of appropriate organizational structures and active and routine stakeholder engagement, thereby enhancing preparedness for crises.

A distributed reliable collusion‐free algorithm for selecting multiple coordinators in IOTA using fog computing

SummaryIOTA is a distributed ledger technology with a new structure called Tangle, which offers high scalability, no fees, and near‐instant transfers for the internet‐of‐things (IoT) networks. The most important issue of IOTA is consensus achievement, which is handled by a single node acting as a coordinator. A single and default coordinator node exposes IOTA to the single point of failure and incomplete distribution issues. In this paper, a novel algorithm for selecting multiple coordinators to participate in the consensus process at milestones is proposed (i.e., MCS algorithm) to overcome the problem of a single coordinator in IOTA network. The MCS algorithm is applied in a two‐layered architecture including IoT devices (i.e., Layer 1) and fog nodes (i.e., Layer 2). We define and formulate four different properties as metrics to select multiple coordinators in this architecture. Moreover, a collusion list is defined to decrease the risk of collusion between fog nodes in the network. Experimental results show that using multiple fog nodes as coordinators in IOTA network can improve the average response time and average throughput while does not considerably sacrifice the total cost and system utilization in comparison with the use of a single default coordinator in IOTA network.

Successful Implementation Trial to Improve Stroke Risk (TCD) Screening in Children with Sickle Cell Anemia: A Roadmap to Care Enhancement

Stroke remains a devastating complication of sickle cell anemia (SCA). The STOP (Stroke Prevention Trial in Sickle Cell Anemia) protocol adopted in 2014 by the National Heart Lung and Blood Institute (NHLBI) guidelines includes stroke-risk screening using transcranial Doppler ultrasound (TCD) and prevention with chronic red cell transfusion therapy (CRCT). Theserecommendations were reinforced by the American Society of Hematology guidelines.However, despite the evidence supporting TCD screening in stroke prevention, the DISPLACE study (Dissemination and Implementation of Stroke Prevention Looking at the Care Environment) showed that real-world implementation was insufficient. To evaluate and improve sickle stroke screening, we conducted the NHLBI-funded multi-center DISPLACE study to identify barriers to TCD implementation and test novel methods for improving outcomes. DISPLACE is a 4-part study: 1) Retrospective calculation of TCD screening rates; 2) Assessment of barriers and facilitators; 3) Implementation trial to improve TCD screening and 4) Comparison of implementation sites to controls. Importantly, DISPLACE is the largest prospective study of children with SCA. This study employed a multi-level, multi-faceted cluster-randomized study of interventions to improve implementation rates of TCD. Methods: DISPLACE is a 28-center US consortium representing a range of: regions (urban vs rural), size (patient number), and institution type (academic vs community). In Part 1, sites performed a rigorous retrospective review of TCD screening from 2012-2016 to collect baseline rates. Part 2 included a barriers and facilitators assessment to TCD screening to inform the trial interventions: 1) Re-branding TCD as Sickle Stroke Screen, a meaningful name for SCD stakeholders; 2) Using a Single Coordinator (SC) for each site's TCD scheduling, and follow-up; 3) A custom designed provider-focused application, ProviderMinder TM (PM) created to remind providers to track TCD appointments and follow-up on results. When a TCD was due, PM alerted the provider to enter scan results or reason(s) missed. Once the TCD results (normal/conditional/abnormal) were entered in PM, providers were prompted to enter the next TCD date and/or intervention plan (if not normal). If a result was not entered, PM alerted the provider q3 days until the TCD was recorded as completed or rescheduled. The implementation trial (parts 3 and 4 of DISPLACE) included 16 sites that had the lowest TCD rates in part 1. The implementation trial included children with SCA aged 2-7 years (the group at highest risk for an abnormal TCD). Cluster randomization was used to allocate sites to PM alone (8 sites) or PM + SC (8 sites). The primary outcome was comparison of TCD rates between PM and PM+SC sites. Secondary outcomes included comparisons between 1) Part 3 sites' TCD rates and Part 1 baseline rates 2) Part 3 sites and control sites (to assess the impact of the educational rebranding of TCD). Results: Part 1 included 28 centers with 5246 children with SCA. Of the 16 intervention sites, 3 sites could not implement the interventions due to administrative issues but remained in the study and were re-designated as “control sites” and a 4th control site was added (they were not informed prospectively to avoid bias). Thus, there were 13 evaluable sites for the primary endpoint including 776 patients; 484 in sites using PM and 292 in sites using PM+SC. Control sites included 185 patients. The trial demonstrated superiority of the PM arm compared to the PM + SC arm (P<.0001 year 1 and p=0.002 year 2) in both years of implementation and in comparison, to the control sites (P<.0001 year 1, p=.009 year 2) with an overall improvement in mean TCD screening from part 1 by 25% (table 1). Conclusions: This was a highly successful implementation study in SCA. This study emphasizes the importance of performing barrier and facilitator assessments when introducing new guideline-recommended screenings into clinical practice. These findings also highlight the importance of ongoing quality assurance in SCA to ensure prevention practices are maintained. Despite the benefit of TCD (sickle stroke screening) in children with SCA, implementation was poor prior to these interventions. Results from this study will guide ongoing optimization of TCD screening and demonstrate the importance of adopting these interventions in the real world.

Behavioral analytics for myopic agents

Many multi-agent systems have a single coordinator providing incentives to a large number of agents. Two challenges faced by the coordinator are a finite budget from which to allocate incentives, and an initial lack of knowledge about the utility function of the agents. Here, we present a behavioral analytics approach for solving the coordinator’s problem when the agents make decisions by maximizing utility functions that depend on prior system states, inputs, and other parameters that are initially unknown. Our behavioral analytics framework involves three steps: first, we develop a model that describes the decision-making process of an agent; second, we use data to estimate the model parameters for each agent and predict their future decisions; and third, we use these predictions to optimize a set of incentives that will be provided to each agent. The framework and approaches we propose in this paper can then adapt incentives as new information is collected. Furthermore, we prove that the incentives computed by this approach are asymptotically optimal with respect to a loss function that describes the coordinator’s objective. We optimize incentives with a decomposition scheme, where each sub-problem solves the coordinator’s problem for a single agent, and the master problem is a pure integer program. We conclude with a simulation study to evaluate the effectiveness of our approach for designing a personalized weight loss program. The results show that our approach maintains efficacy of the program while reducing its costs by up to 60%, while adaptive heuristics provide substantially less savings.

Abstract TMP40: Cost Analysis Of A Pooled Coordinator Model Versus Traditional Staffing For Acute Stroke Trials

Introduction: Enrollment in acute stroke clinical trials (ASCTs) is complex and unpredictable. Traditional staffing models (TSMs) of research coordinator coverage assign a single research coordinator to cover specific clinical trials, whereas pooled staffing models (PSMs) utilize staff research coordinators to cross-cover multiple clinical trials, typically beyond traditional daytime hours. Methods: We calculated actual PSM costs accrued during one year (1/1/21-12/31/21) for two Phase III ASCTs (NCT03735979, NCT03785678). PSM costs were obtained from existing billing records for specific research coordinator tasks billed hourly ($78/hour) and a “retainer fee” ($690/month) for 24-7 on-call research coordinator coverage. Aspects of research coordinator work included: enrollment, data entry, query resolution, monitor visits, regulatory management, meetings, training/retraining, and patient visits. We compared PSM costs to the cost (salary + fringe) of a TSM full-time research nurse (1.0 full-time equivalent [FTE]) in the identical job class and salary as those employed in the PSM. Results: The estimated one-year cost (salary + fringe) of a 1.0 FTE RN research coordinator was $109,755.36. During the study period, there were 19 enrollments in NCT03735979; 9 occurred outside daytime working hours. The PSM cost was $60,813, equivalent to 0.55 FTE of coordinator coverage in a TSM with 90.0% more enrolled subjects. Additionally, there were 6 enrollments for NCT03785678; 4 outside daytime working hours. The PSM cost was $69,857.00, equivalent to the cost of 0.64 FTE of standardized research coordinator in a TSM with 200% more enrolled subjects. Conclusions: We demonstrated that a PSM for ASCT can be cost-effective for individual studies while increasing enrollment opportunities through 24-7 coordinator coverage. PSMs may offer a solution to the staffing and coverage challenges faced by many institutions seeking to participate in emergent clinical trials. Cost increases or savings with the PSM model would be dependent upon staff compensation, rates of enrollment, and reimbursement at individual sites.

Dissemination and Implementation Looking at the Care Environment (DISPLACE) Study Evaluates Novel Interventions to Improve TCD (Sickle Stroke Screening) Implementation

Background: Stroke is a devastating complication of sickle cell anemia (SCA). The STOP (Stroke Prevention Trial in Sickle Cell Anemia) protocol was adopted in 2014 by the National Heart Lung and Blood Institute (NHLBI) guidelines for stroke-risk screening using transcranial Doppler ultrasound (TCD) and prevention with chronic red cell transfusion therapy (CRCT). These guidelines were upheld in the recent American Society of Hematology guidelines. Despite strong evidence supporting TCD screening (and CRCT initiation) in stroke prevention, wide scale implementation has not been achieved 4. DISPLACE (Dissemination and Implementation Looking at the Care Environment) is a multicenter, NHLBI-funded study conducted to identify barriers to TCD implementation and test novel methods for improving outcomes. DISPLACE is a 3-part study: 1) Retrospective assessment of current practice; 2) Assessment of barriers and facilitators; and 3) Implementation trial to improve TCD screening. This report focuses on Part 3. Methods: DISPLACE is a 28-center consortium across the US representing a range of: region (urban vs rural), size, and institution type (academic vs community). During Part 1, sites performed a rigorous retrospective chart review of children with SCA aged 2-16 years from 2012-2016 to collect baseline TCD rates. Part 2 included a rigorous mixed methods of the barriers and facilitators assessment to TCD screening was performed that resulted in 3 main interventions: 1.Re-branding TCD as Sickle Stroke Screen, a meaningful name selected by patients/families with SCD; 2. A Single Coordinator (SC) for each site's TCD screening, scheduling, and follow-up; 3. A newly designed application, Provider Minder (trademarked; PM). PMwas created to remind providers of patient appointments (versus reminders only sent to patients/families). Data entry in PM included birth date (to calculate age), city/state of residence, distance from SCD clinic and insurance. Date of last TCD was recorded to calculate date of next screen. When the TCD was due, the system alerted the provider to enter appointment completion or reason(s) why it was missed. TCD results were entered for PM to prompt for the next TCD date in a 10-14 month window (normal screens), 2-6 weeks (conditional screens), and intervention plan (abnormal screens): repeat scan in <2 weeks or other. If the provider failed to enter a patient's result, PM alerted the provider q3 days until the TCD was recorded as completed/rescheduled. Part 3 included 16 sites who successfully completed data entry in Part 1 and had the lowest TCD implementation rates. Part 3 inclusion criteria were the same as Part 1 except to specifically select children with SCA now aged 2-7 (the highest risk group to have an abnormal TCD in Part 1). All 28 sites received re-branding educational material (also disseminated to non-study sites). Cluster randomization was used to allocate sites to PM (8 sites) or PM + SC (8 sites). The primary outcome is which intervention results in the best TCD rates. Secondary outcomes include Part 3 sites’ improvement in TCD rates (compared to historical rates) and impact of the educational/rebranding of TCD to "Sickle Stroke Screen” in sites (4) that did not participate in Part 3. Stroke status, presence of CRCT after an abnormal TCD, missed TCD appointments, and medical decisions following TCD were also recorded. Results: Part 1 included 28 centers with 5223 individuals with SCA in the database. Of the 16 Part 3 sites, three could not implement the interventions due to a simultaneous change in hospital administration and site PI (1), inability to use PM due to institutional firewall (1) and inability to implement due to site specific issues (1). These 3 sites remained in the study as "control sites” and a fourth control site was added. Thus, 13 sites implemented the interventions with 877 patients; 520 were in sites using PM and 357 were in sites using PM+SC. Demographic data for the 877 children with SCA are in Table 1. The study ended on May 31, 2022. Calculations of TCD rates at all sites are in process and will be presented. Conclusions: Despite the benefit of TCD screening in children with SCA, guideline-based implementation remains poor. The range of barriers to screening has been previously reported by the DISPLACE study team and were used to design the study interventions. Results from this study will guide optimization of the intervention protocol proven to enhance TCD implementation. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

A Role to Play for Interest Groups in EU Foreign and Security Policy: The Case of Migration Focused EU - Libya Policies

Following the fall of Gaddafi, Libya has fallen apart, and this vast and resource-rich country with around 1,800 km coastline to the southern side of the central Mediterranean has become a failed state. The crisis stemming from Libya has significant impact on the EU: Not only for irregular migration but also due to its security, economic and geopolitical importance to EU. Despite this multifaceted significance, EU Libya poli- cies have been focusing on the migration dimension of the crisis and making use of non-functioning Common Security and Defence Policy (CSDP) missions as the primary policy tool. That is why the EU missed the oppor- tunity to solve the crisis from an early age and has been sidelined with the escalating conflict. In the absence of EU, rival international actors took over the Libya dossier and started to shape the developments per their interests. If the EU does not take lessons from previous mistakes, it will soon lose its influence over Libya, which might turn out to be quite detrimental for its interests. As this is a multifaceted and multi-dimensional web of relations, the policy paper at hand focuses explicitly on the “migration” dimension and makes infer- ences based on this narrower scope. Interest Groups (IGs) are prominent actors in the migration dimension of the Libya crisis. This policy paper depicts that there are at least 738 IGs concerned with European or global level migration &amp; asylum policies, and they have had hundreds of interactions with members of the EU Commission and Parliament. IGs have been spending money, energy and other resources to influence the EU policies in this field. However, up to now, just like EU Libya policies, their efforts on migration-related problems stemming from Libya has failed. Following a comprehensive description of the current status of migration dimension of EU Libya policies together with the role of various IGs, this policy brief examines the causes of (in)effectiveness of IGs’ efforts in influencing EU policies. It argues that public salience, internal security concerns of the member states and highly politicised nature of the migration issue makes it difficult for IGs to be influence. Irregular migration is not a matter on its own; it is a consequence of a causal link. In solving the issue, the EU needs a multifaceted approach, which considers IGs an integral partner and utilises IGs soft power, knowledge and expertise to increase the EU’s leverage. The policy paper at hand recommends EU and IGs to develop a partnership model which requires coordi- nation and assistance in Libya matters, without damaging the neutral interlocutor position of the IGs. This new model foresees IG support in handling IDPs, refugees/irregular migrants, training and monitoring of the Libyan officials, or in reporting about the humanitarian aspects. Requires EU to utilise IGs in addressing the sources of grievances between local ethnic, tribal and religious groups, or facilitating the truth-seeking ven- tures and repairing the relations between rival groups. IGs can support EU policies by providing mentorship to sovereign economic, financial, auditing institutions or misfunctioning judiciary, public health or education institutions. EU should benefit from IGs in the prevention of radicalisation/extremism, as well. For the sake of preventing the emergence of several and conflicting member state Libya policies, EU su- pranational bodies should lead to the process vis á vis overall EU interests. To save IGs from the complex power-sharing structure, European External Action Service should undertake the one single coordinator role with IGs. EU officials should encourage or —if need be— stipulate Libyan authorities to cooperate with IGs in their operations for Libya. EU may consider using military CSDP operations or EU battlegroup to protect the peace process from spoilers or destructive foreign meddling or defend the governing institutions from the impact of various militia groups and enforce the arms embargo. EU should also activate a competent sanctions policy against the spoilers of the process. Another crucial task for the EU will be the construction of a unified and reliable security apparatus. IGs can build the support that the EU requires on the ground. EU requirements overlap with IGs interests; they both need to construct a thriving society, inclusive politics, and good governance, which will make Libya a hard-to-find neighbour/ally to the EU.

A Quadratic Convergent Iteration-Variable-Correction-Based Method for Optimal Power Flow of Transmission-Distribution-Coupled Systems

An iteration-variable-correction (IVC) based method is proposed for solving optimal power flow (OPF) of transmission-distribution-coupled (TDC) systems. First, a TDC system can be divided into a single coordinator and multiple agents. Then, the basic formulation, subproblem construction, and selection of iteration variables are given based on the conventional heterogeneous decomposition algorithm (HGD). Considering the limitations of the conventional HGD, the IVC is proposed. According to the general theory of the IVC, when it is applied to solve TDC OPF, the voltage magnitude of boundary buses and the multipliers corresponding to boundary power injections will be corrected every four iterations with first-order and second-order differential operations on historical results in the previous four iterations. The quadratic convergence of the IVC is proved under several weak assumptions. The numerical experiments demonstrate that the proposed IVC has the same accuracy as the method based on the centralized OPF model. Also, better convergence and efficiency can be achieved under the IVC compared with some conventional decomposition methods, including alternating direction method of multipliers, auxiliary problem principle method, analytical target cascading method, and the HGD.

Activities of Arctic Commission under Council of People’s Commissars of USSR in 1928—1930: from Tasks of Scientific Research to Plans for Economic Development

The organizational formation of the system of state management of the Arctic development processes in the USSR during the first fiveyear plans, is considered. The relevance of considering the problems of the development of the Arctic during the period under review is due to the growing interest in this issue in modern conditions. The activities of the Arctic Commission formed under the government, which was entrusted with the role of a single coordinator of state events and a center for regulating the activities of various institutions and departments in the Arctic region, are shown. Attention is drawn to the initial period of activity of the government commission, associated with the country's adoption of a course towards industrialization and the transition to a system of planned regulation of the economy. Under these conditions, the installations of scientific expeditions that had previously explored the Arctic possessions began to transform radically, the transfer of research work to solving applied, economic problems began. On the basis of archival sources, it has been established that the Arctic Commission initiated and led a huge complex of works on organizing and coordinating research and practical economic work in the north of the country. It is concluded that during the years of the first fiveyear plans, the process of development of the Arctic territories of the USSR entered a turning point in its development. The most important component of the new stage in the development of the Arctic was the transfer of managerial initiative in organizing work in the north of the country into the hands of the state.

A frequency-amplitude coordinator and its optimal energy consumption for biological oscillators

Biorhythm including neuron firing and protein-mRNA interaction are fundamental activities with diffusive effect. Their well-balanced spatiotemporal dynamics are beneficial for healthy sustainability. Therefore, calibrating both anomalous frequency and amplitude of biorhythm prevents physiological dysfunctions or diseases. However, many works were devoted to modulate frequency exclusively whereas amplitude is usually ignored, although both quantities are equally significant for coordinating biological functions and outputs. Especially, a feasible method coordinating the two quantities concurrently and precisely is still lacking. Here, for the first time, we propose a universal approach to design a frequency-amplitude coordinator rigorously via dynamical systems tools. We consider both spatial and temporal information. With a single well-designed coordinator, they can be calibrated to desired levels simultaneously and precisely. The practical usefulness and efficacy of our method are demonstrated in representative neuronal and gene regulatory models. We further reveal its fundamental mechanism and optimal energy consumption providing inspiration for biorhythm regulation in future.

Realization theory for poset-causal systems: controllability, observability and duality

Poset-causal systems form a class of decentralized systems introduced by Shah and Parrilo (47th IEEE conference on decision and control, IEEE, 2008) and studied mainly in the context of optimal decentralized control. In this paper, we develop part of the realization theory for poset-causal systems. More specifically, we investigate several notions of controllability and observability, and their relation under duality. These new notions extend concepts of controllability and observability in the context of coordinated linear systems (Kempker et al. in Linear Algebra Appl 437:121–167, 2012). While for coordinated linear systems there is a clear hierarchical structure with a single (main) coordinator, for poset-causal systems there need not be a single coordinator, and the communication structure between the decentralized systems allows for more intricate structures, governed by partial orders. On the other hand, we show that the class of poset-causal systems is closed under duality, which is not the case for coordinated linear systems, and that duality relations between the various notions of observability and controllability exist.

EMSNDP: Energy Minimized Optimal Zone Selection of Sensor Network to Build the Data Path for IoTN

Wireless sensor network contains a huge volume of sensors that are capable of observing environmental data and conveying that information to the base station. The zone routing is a way to group sensors into multiple clusters in sensing field. In general, each zone has a single co-ordinator that operates as a zone head and accountable to collect the data from all sensors inside the zone and then forward it to the base station. Clustering and energy efficient path construction to base station is a major issue in sensor networks. This paper concentrates on clustering the sensing field into zones and further splitting it into zone quadrants to maximize the energy efficiency of sensor nodes with minimum delay transmission time. An “Energy Minimized optimal zone selection of Sensor Networks to build the Data Path” protocol is proposed in this paper to minimize the load on zone heads by using the zone coordinators to gather the information from different quadrants of zone. Distance-based communication with the minimum hop is opted to minimize the energy cost. A critical evaluation is carried out on the proposed protocol in the context of total energy consumption of network and average energy consumed per node, lifetime of the Network, delay in reception of packet and packet delivery ratio. The results of our research work and analyzed and benchmarked against similar protocols using Network Simulator 2. The outcome of this research is a reduced delay in packet processing with low energy consumption which significantly increases lifetime of sensor network.

ZigBee-Based wireless sensor network topologies using one and multiple coordinators

Wireless Sensor Networks (WSN) have been a cost-effective and feasible solution for a wide range of applications, such as communications infrastructure, traffic networks, telecommunications systems, military operations and so forth. IEEE804.15.4 ZigBee network model is ideally suited to the constraints of WSN in terms of bandwidth, processing power and battery capacity. This paper investigated tree and mesh routing in WSN with multiple coordinators and the failure of single coordinator using OPNET Modeler v14 which is an efficient computational platform for data networks simulation. Throughput, delay, traffic received, MAC Load are studied in this system and the results showed that tree routing was better suited for WSN than mesh routing and mobility of end node in multiple coordinator network was the best.

A Guide to Establishing Ethics Committees in Behavioral Health Settings.

Ethical statements typically involve rules. All rules can vary in accuracy and specificity depending on the context to which they are applied. Codes of ethics often involve ethical rules that are written generally to cover the wide-ranging set of possible situations that any one member of the profession may encounter. But, despite being written generally, codes of ethics are applied to specific situations that professional members encounter. The application of general rules to specific contexts can sometimes be challenging and complex. Health care organizations have several options to help their employees behave ethically. One approach is to appoint a single ethics coordinator. In contrast, the dominant approach in most health care organizations is to develop an organizational ethics committee (Moon Pediatrics, 143(5), e20190659, 2019). Despite the popularity of the ethics committee in other professions, the extent to which organizations that provide applied behavior analysis services have established and operate ethics committees is unknown. Ethics coordinator roles and ethics committees both have benefits and drawbacks. This article reviews the benefits and drawbacks of appointing an ethics coordinator and establishing an ethics committee. And, for interested organizations, this article outlines the steps and considerations that organizations can use to guide the creation of an ethics committee.

Opportunities and Challenges of Telehealth in Remote Communities: Case Study of the Yukon Telehealth System

BackgroundTelehealth has been shown to improve access to health care and to reduce costs to the patient and health care system, especially for patients living in rural settings. However, unique challenges arise when implementing telehealth in remote communities.ObjectiveThe study aimed to explore the current use, challenges, and opportunities of the Yukon Telehealth System. The lessons learned from this study were used to determine important factors to consider when attempting to advance and expand telehealth programs in remote communities.MethodsA mixed methods approach was used to evaluate the Yukon Telehealth System and to determine possible future advances. Quantitative data were obtained through usage logs. Web-based questionnaires were administered to nurses in each of the 14 Yukon community health centers outside of Whitehorse and patients who had used telehealth. Qualitative data included focus groups and semistructured interviews with 36 telehealth stakeholders.ResultsSince 2008, there has been a consistent number of telehealth sessions of about 1000 per year, with clinical care as the main use (69.06% [759/1099] of all sessions in 2015). From the questionnaire (11 community nurses and 10 patients) and the interview data, there was a consensus among the clinicians and patients that the system provided timely access and cost savings from reduced travel. However, they believed that it was underutilized, and the equipment was outdated. The following 4 factors were identified, which should be considered when trying to advance and expand a telehealth program: (1) patient and clinician buy-in: past telehealth experiences (eg, negative clinician experiences with outdated technology) should be considered when advancing the system. Expansion of services in orthopedics, dermatology, and psychiatry were found to be particularly feasible and beneficial in Yukon; (2) workflow: the use and scheduling of telehealth should be streamlined and automated as much as possible to reduce dependencies on the single Yukon telehealth coordinator; (3) access to telehealth technology: clinicians and patients should have easy access to up-to-date telehealth technology. The use of consumer products, such as mobile technology, should be leveraged as appropriate; and (4) infrastructure: the required human resources and technology need to be established when expanding and advancing telehealth.ConclusionsWhile clinicians and patients had generally positive perceptions of the Yukon Telehealth System, there was consensus that it was underutilized. Many opportunities exist to expand the types of telehealth services and the number of telehealth sessions, including the expansion of services in several new specialty areas, updating telehealth equipment to streamline workflows and increase convenience and uptake, and integrating novel technologies. The identified barriers and recommendations from this evaluation can be applied to the development and expansion of telehealth in other remote communities to realize telehealth’s potential for providing efficient, safe, convenient, and cost-effective care delivery.

MON-069 OVERCOMING SHORTAGE OF PERITONEAL DIALYSIS SOLUTION IN NEPAL

Shortage of medical supplies has a negative impact on the health of people. Though manufacturers and suppliers apprehend shortages due to increased demands, it may be inevitable in circumstances such as war, earthquakes, and hurricane. There are some circumstances when companies halt production for various reasons. Continuous ambulatory peritoneal dialysis (CAPD) as an option for end-stage kidney disease patient in Nepal started in 2007. The PD Solution was purchased from Baxter, India. The supply was severely disrupted twice in 2018 (for 45 days in February-March and 58 days in May-June of 2018) when Baxter, India halted its production. To address this shortage, suppliers had to purchase from Baxter, Phillipines. This study describes the impact of the shortage and how the patients overcome the period of shortage In this retrospective study after the period of the shortage, the patients were interviewed face to face or on phone by a single CAPD coordinator. Those willing to give their information for the study were recruited. Name, age, sex, the indication of CAPD, PD vintage, actual prescription and modified prescription, the source of PD solution at the time of shortage, manipulations, switch to hemodialysis, and any complications encountered were noted. There were 113 patients between the age of 9 and 82 years (mean 51 +/- 1.76 years) who participated in the study. Sixty-eight were male patients and 45 female patients who were registered at 10 different centers of 6 cities. Most of the patients (74.33%) claimed to have been self-motivated for CAPD while 21.24% of the patients had taken CAPD as their hemodialysis access were exhausted. Three patients had started CAPD within a month while one had been on CAPD for last 7 years. Most of the patients (85.84%) of the patient were performing 3 bag/ day exchange before the crisis. 9.73% of the patients were performing 4 bags/day. All the patients seemed to be unaware of the impending crisis of PD solution and running out of fluid for a few days to weeks. Average number of days patients did not have adequate PD solution was 24.58 +/- 1.42 days. All of the patients reduced the number of exchanges per day to minimize the number of bags used. Three patients purchased Icodextrin though it is not readily available and expensive than dextrose-based PD Solution. At the time of crisis, 23.89% of the patients had turned to their doctor for solution while 19.47% consulted their CAPD coordinator. Two patient reported burrowing from other patients or hospital. Fifty-four patients purchased from alternative sources including black-market and from the neighboring country, India. When the modified CAPD prescription seemed inadequate, the patient were put on hemodialysis. Nine patients received few sessions of hemodialysis to bridge the gap. Out of 113 patients, 30 patients had to be admitted for 8.8 days due to different complications. Some of the complications included peritonitis, fluid overload, dyselectrolytemia, and death. Nine of the patients had died during the period. The incidence of peritonitis had also increased with 16 patients having peritonitis during the period of crisis. Shortage of PD solution should be perceived and prepared for. Crisis due to the shortage of PD solution is detrimental to the health of the patient leading to different complications and even death of the patients.

ASTRO's Radiation Oncology-Incident Learning System (RO-ILS): A Multi-site, Multi-faculty Radiation Department Culture Immersion into RO-ILS

The Radiation Oncology-Incident Learning System (RO-ILS) is a web based incident reporting system that provides a global mechanism for collaborative learning within radiation oncology. The RO-ILS mission encourages all members to report events as they happen in the department in a non-punitive environment. In September 2017, our multi-site radiation oncology department converted completely to RO-ILS following a decade of usage of an in-house system. The purpose of this work is to share our preliminary experience with RO-ILS, specifically focusing on comparative trends in event reporting, classification and learning. Between October 2017 and January 2018, events submitted were classified into the following categories: Therapeutic radiation incident, other safety incident, near-miss, unsafe condition, operational/process improvement. A single RO-ILS coordinator reviewed and further characterized these events into the following sub-categories for more detailed analysis and follow up. A multi-disciplinary quality management (QM) team met biweekly to investigate and develop follow-up actions which were communicated to the entire staff at monthly meetings at each geographical site to “close the loop” and demonstrate the effectiveness of event reporting. In a 4-month time period, staff reported 325 events. The distribution of events was as follows: Therapeutic radiation incident (53), Other Safety incident (10), Near-miss (19), Unsafe condition (5), and Operational/Process Improvement (238). Due to the default categories being too shallow, events were reclassified into: Communication, Prescription and Directive mismatch, Film Review, Re-simulation, New Plan, On Treatment Visit, Dosimeter, Physics, Equipment Malfunction, Information Technology, Patient on Break, Consent, No physicist on site, Patient Safety, Treatment terminated, Physics weekly chart checks not completed, Pathology, SOARIAN error, Scheduling, and Accident. Event reporting systems serve as an important function in raising awareness and generating a culture of safety. To date, our department has successfully and effectively rolled out RO-ILS and its key components. However, meaningful expansion of default classifications are recommended. RO-ILS allows our team to “track and trend” events, identify root causes, and implement targeted changes to improve patient care. We have provided feedback to the front lines monthly, closing the loop and encouraging further reporting. The frontline staff feels as though their reporting makes a difference, effecting positive changes in the department. As one of the few large multi-site institutions to fully implement RO-ILS, the amount of entries and expanded classifications submitted will provide valuable feedback to the radiation oncology community.

Argentine Integral Protection System for Transplanted Persons and on the Wait List

Introduction Argentina sanctions in December 2013 the National Law 26.928 "SYSTEM OF INTEGRAL PROTECTION FOR PERSONS TRANSPLANTED AND IN LIST OF WAITING", regulated by Decree N ° 2266 of November 2015. This law was promoted by the Patient Advisory Commission (CAP) of the National Institute Central Single Coordinator of Ablation and Implantation (INCUCAI), whose purpose is the integral protection of Transplanted people (Tx) or enrolled in waiting list (WL) for transplant in the National System of Procurement and Transplantation of the Argentine Republic (SINTRA), requirement to access the credential that is issued by the jurisdictional agency of the beneficiary's address, in our case Ente Coordinador de Ablacion e Implante Córdoba (ECODAIC). The objective of this paper is to systematize the local experience of the application of this national law in the province of Córdoba through ECODAIC, and likewise to characterize the beneficiary population of this law. Material and Method Descriptive, retrospective study, made from the registration of the delivery of the first 1000 credentials from December 2015 to September 2017. People in WL or TX with residence in the Province of Córdoba; Inclusion criteria: having applied to ECODAIC for the credential being registered in SINTRA. Results and Discussion The total population of the Province of Córdoba in WL and TX in September 2017 is 5205 people, 950 in WL (18.32%) and 4251 TX (81.67%). The sample of 1000 beneficiaries has the following characteristics: 56 credentials in 2015; 568 in 2016 and 376 in 2017; 44.8% are women and 55.2% are men; 44.2% residents of the provincial capital and 55.8% of the Interior. 41% of the credentials correspond to WL (410 people) and 59% TX (590). The beneficiaries in WL represent 42.97% of the total number of people in WL, while the TX only 13.87% of the total TX of the Province who have managed their credentials. The largest number of beneficiaries of credentials are people in WL and the Interior which tells us that this credential allows free transportation in medium and long distance. Based on the data we were obtaining promotional actions were carried out that increased the emission. Conclusion The benefits promoted by the law are acquired rights that result in a social protection system of inclusion. It is not the object of this investigation to describe the scope of these.The patient in WL is more linked to the health system and access to information. As it is a national law without provincial adherence, it hinders the application of law and limits access to benefits at the local level.The law comes to give a legal entity unique to the Tx people and in WL in Argentina and Latin America; differentiating it from the historical condition of disabled person.

Transplant Coordinators' Opinions Regarding the Decreasing Indicator of Organ Donation From Deceased Donors in Poland

Despite the good overall condition of Polish transplantation medicine there is a shortage of organs for transplantation. Health care is also in a stage of development with problems including insufficient funding and lack of personnel. In 2015 the number of deceased organ donors in Poland was 526, which was distinctly lower than in 2014 when it reached 594. The aim of this paper was to collect, elaborate on, and summarize the opinions of transplant coordinators regarding the decrease of donation indicators in Poland. Materials and MethodsThe opinions of the transplant coordinators were collected during training meetings and questionnaires performed in 2016. The questionnaires targeted coordinators of active hospitals (above 5 retrievals a year) and less active donor hospitals. Results and DiscussionTransplant coordinators indicated a number of factors that influence donor hospital activity, such as changing roles of intensive care units, changes in hospital flow of patients in critical condition, lack of nurses and anesthesiologists resulting in work overload, changes in forms of doctors' employment, low basic income of health professionals, difficulties in determination of brain death, decrease in engagement of transplant centers in cooperation with donors' hospitals, inadequate in-hospital training meetings, undermining of authority of doctors and medical personnel, change of attitude towards transplantation medicine (treated as profitable, regular specialty), insufficient funding of hospitals and personnel for deceased donor recruitment, and disobeying the rules of personnel remuneration for their engagement in donation and retrieval. ConclusionsAnalyzing the opinions of the coordinators, we can state the following: 1. support of the hospital or hospital unit management is crucial for effective donation programs, 2. there is a need to build and implement a hospital quality systems covering each stage of donor recruitment as well as hospital trainings, 3. there should be a transplant coordination team rather than a single coordinator, 4. transplantation centers should maintain good cooperation with donor hospitals, and 5. intensive care unit personnel identification with their own hospital, which is less likely in the case of "locum" employment, is one of the major factors supporting donation programs.