Workload Distribution Research Articles

Level of burnout and associated factors among healthcare workers in central Uganda: A facility-based cross-sectional study.

Burnout among healthcare workers is a global concern with significant implications for both the well-being of the workforce and the quality of patient care. This facility-based cross-sectional study aimed to identify factors associated with burnout among healthcare workers in central Uganda. The study, conducted between June and July 2023, utilized a cross-sectional design involving physicians, nurses, and technicians. The study covered both public and private hospitals in central Uganda, incorporating urban and rural settings. A sample size of 550 healthcare workers was selected using a simple random sampling. Data collection involved a socio-demographic survey, the Professional Quality of Life (ProQOL-5). Descriptive statistics, Pearson Chi-square test, and ordinal regression models were employed to analyze demographic factors associated with burnout. Of 548 participants, 218(39.8%) experienced high burnout levels. Factors significantly associated with high burnout levels included having over 10 years of work experience (OR: 2.04, 95% CI: 1.12-3.73), working more than 40 hours per week (AOR: 4.46, 95% CI: 1.20-16.62), lack of management support (AOR: 14.45, 95% CI: 3.83-54.56), not experiencing workplace violence (AOR: 2.22, 95% CI: 1.31-3.76), and reporting inadequate sleep (AOR: 6.96, 95% CI: 3.86-12.57). Addressing burnout among healthcare workers in central Uganda requires targeted interventions tailored to the specific challenges faced in the region, including workload distribution, managerial support enhancement, violence prevention strategies, and promotion of adequate sleep. Urgent attention to these factors is essential for enhancing the well-being of healthcare professionals and maintaining quality patient care.

TeleHelp Ukraine: A distributed international telemedicine response to the ongoing war.

Humanitarian crises frequently garner solidarity and robust volunteer recruitment among health care communities. However, a common obstacle is matching providers to those in need across geographic and other barriers. We examined the application of a decentralised governance strategy in establishing an emergency telemedicine response, TeleHelp Ukraine (THU). Using a case study approach, we explored how global networking and technological advancements empower organisations to generate, access, disseminate, and utilise knowledge for sustainable health care delivery. Preliminary results suggest that a non-profit, decentralised model strengthened by robust team dynamics may optimise the distribution of clinical workload and scheduling procedures. Institutional and cultural diversity among health care providers and volunteers fosters the mobilisation of knowledge resources, synergistic collaboration, and tailored care standards that align with both provider and patient expectations. By integrating these diverse, distributed networks, a synergistic effect is achieved, combining effective learning mechanisms with intellectual capital. Our study provides insights into the structure, implementation strategies, dissemination methodologies, and initial results of THU's operation. These findings may inform future emergency telemedicine responses in humanitarian scenarios, thereby reinforcing the practical implementation of health as a human right.

The role of process monitoring devices and digital line balancing in achieving operational excellence in garment manufacturing

This study investigates the transformative potential of integrating digital technologies with lean manufacturing principles to address the evolving challenges in the garment industry. The industry demands high-quality products, rapid delivery, cost efficiency, and production flexibility to maintain competitiveness and sustainability. While traditional lean methods have focused on waste reduction and process optimization, the advent of digitalization offers unprecedented opportunities for enhancing operational excellence. This research specifically examines the role of Internet of Things-based Process Monitoring Devices (PMDs) and digital line balancing in achieving these goals. PMDs, integrated within a digital lean framework, facilitate continuous monitoring of machine performance and operator efficiency, providing real-time insights into operational processes. This real-time visibility enables data-driven decision-making and centralized analysis, fostering agility and responsiveness. Furthermore, this study presents a dynamic digital line balancing algorithm that optimizes sewing line configurations and workload distribution. This dynamic approach allows for real-time adaptations in production flows to mitigate bottlenecks and boost productivity. By exploring the synergistic relationship between PMDs, digital line balancing, and lean principles, this paper contributes to a comprehensive understanding of how digital solutions can revolutionize operational efficiency in the garment manufacturing sector.

Red Blood Cell (RBC) Antigen Confirmation Workflow – A Positive Impact at an Academic Medical Center

Abstract Introduction/Objective Introduction: Blood group antigens, present on the surface of red blood cells (RBCs), play a crucial role in transfusion medicine. These antigens are recognized serologically and form the basis of RBC phenotyping. Understanding the significance of antigen-negative RBCs is essential for mitigating the risk of hemolytic transfusion reactions and hemolytic disease of the fetus and newborn (HDFN). This study aims to assess the impact of implementing a new RBC antigen confirmation workflow on transfusion service efficiency and patient outcomes. Methods/Case Report Method: The study involved collaboration between our Transfusion Services Department (TS), the Blood Center supplier, and the Apheresis department. A comprehensive review of historical practices and FDA recommendations regarding RBC antigen labeling was conducted. Changes were implemented to streamline antigen confirmation testing and labeling processes. The impact on TS workload, turnaround time, and patient care metrics was evaluated. Results (if a Case Study enter NA) Results: Implementation of the new RBC antigen confirmation workflow led to a significant reduction in antigen confirmation tests performed by TS, with a 607% decrease observed from 2020 to 2023. Concurrently, the workload for reference lab workups increased by 337% over the same period. This shift in workload distribution allowed TS staff to focus more on patient reference workup cases and case review. The improved workflow efficiency resulted in enhanced turnaround times for providing patients with antigen-negative RBCs, ultimately improving the patient experience. Conclusion Conclusion: The adoption of the new RBC antigen confirmation workflow has resulted in compliance with FDA labeling requirements, efficient utilization of TS staff resources, and decreased turnaround times for blood delivery. These improvements have positively impacted patient care by ensuring timely access to compatible blood products. Future steps include developing reports to track turnaround time for patients with special blood product needs and continuing collaboration with the blood supplier and the Apheresis department to optimize inventory management and transfusion processes.

Pathologist Workload Assessment in Gastrointestinal Subspecialty: A Pilot comparative study in an academic setting

Abstract Introduction/Objective There are no official guidelines regarding the workload to be received by pathologists, and it is challenging to distribute equivalent workloads across subspecialties. This study aims to determine whether slide count is a reliable workload metric in gastrointestinal (GI) pathology. Additionally, we seek to compare the time allocation differences between GI pathologists involved in medical resident teaching and those dedicated only to anatomical pathology duties. Methods/Case Report This is an observational retrospective cohort study. We recorded the first two hours of a workday of three experienced GI pathologists at Stanford Healthcare in 2022, two of whom were engaged in teaching. The authors carefully retrospectively reviewed the recorded videos to extract relevant information: teaching activities, number of histological slides, specimens, types of tissues analyzed, and resultant diagnosis. Results (if a Case Study enter NA) Two attendings (2 and 3) signed out with residents, while only one worked alone (1). The mean time spent on each case was 199 and 486 seconds different between attendings 1 and 2 and 1 and 3, respectively (p<.01). There was a strong positive correlation between the number of slides and time spent analyzing each case, r =.607. The number of slides per case statistically explained 36.8% of the time spent per case, p <.001. Conclusion In conclusion, the slide count metric only explains 36.8% of the time expenditure, suggesting that more sophisticated workload assessment methods must be developed, particularly if used for workload distribution purposes. Also, GI pathologists involved in medical training take longer to sign out cases than GI pathologists who are not, suggesting that this is an essential factor that should be considered when distributing workloads.

Teachers’ Ancillary Functions and Teaching Performance

The term “ancillary functions” in the context of education refers to the tasks that teachers carry out that are not explicitly related to classroom teaching, such as serving as subject coordinators, club advisers, sports coaches, coordinators of both co-curricular and extracurricular activities, and community engagement services. Teachers still need to perform actual teaching, yet these services are vital for the school’s daily operations. Along this line, this study determined the level of teachers’ ancillary functions and level of teachers’ performance in a small-sized School Division in Norther Negros Occidental during the School Year 2023-2024. Data needed for this descriptive paper was collected from 66 public elementary school teachers using a self-made survey questionnaire that has passed the stringent tests of Validity and reliability. Data gathered revealed that teachers’ ancillary functions are high for teaching-related (M=4.0382; SD=0.32875) and administrative assignments (M=3.8644; SD=0.40228). Additionally, it was found that there was no significant relationship between teachers’ ancillary functions and their performance. The study calls for the use of differentiated instructions and requires School Heads to practice transparency and fairness in the distribution of ancillary workload to teachers. Keywords: Teachers’ ancillary functions, teaching performance, teaching-related assignments, administrative assignments, Negros Occidental, Philippines.

Radiation shielding transmission data for modern digital radiography.

Radiography is one of the most widely used x-ray imaging modalities. In National Council on Radiation Protection and Measurements (NCRP) Report No. 147, transmission data for radiographic systems were evaluated on those installed before 2000. For x-ray systems (except intraoral dental) manufactured on or after June 10, 2006, the U.S. required minimum half-value layer (HVL) was increased; for example, 2.9 (2.3) mm Al at 80kV, where the value in parenthesis denotes the earlier requirement before the above date. To calculate the transmission of the broad x-ray beam of modern digital radiography (DR) through shielding materials. X-ray beam HVLs on two DR systems (Agfa DR 600, GE Revolution XR/d) were measured in 10kV increments between 60 and 120kV, with a calibrated ionization chamber (Radcal model 10×5-60) and varying thickness of aluminum 1100 plates. Monte Carlo (Geant4) simulation was performed to calculate the transmission of broad x-ray beams through lead, concrete, gypsum, and steel, with x-ray HVLs matching those of the DR 600 at two beam filtrations (default, 1mm Al plus 0.1mm Cu added filtration). The transmission data were fitted to the Archer equation. HVLs on two DR systems with default beam filtration were consistent (median difference, 2.1%; maximum difference, 5.5%). An additional beam filtration option (1mm Al plus 0.1mm Cu) on the DR 600 substantially increased HVLs by 45.2%-61.2%. Transmission fitting parameters were provided for seven tube voltages (60-120kV) at two beam filtrations. This work presents transmission data for modern DR systems, indicating increased x-ray beam filtration compared to the primary x-ray beam in NCRP Report No. 147. The updated transmission data can enhance structural shielding evaluations at individual tube voltages or with a workload distribution.

Optimizing Cloud Computing Performance by Integrating the Novel PSBR Service Broker Policy and Load Balancing Algorithms

As cloud computing advances, organizations' IT infrastructure and application deployment processes are moving to the cloud because cloud computing provides everything as a service over the Internet. The performance of a cloud-based application is based on proper datacenter selection and workload distribution within the selected datacenter. Service broker policies are used for suitable datacenter selection, and load balancing algorithms(LBA) are applied to distribute workloads. This paper is to evaluate the effect of a proposed service broker policy (PSBR) on the performance of cloud-based applications with LBA. To achieve the objective, the behavior of the TikTok application was modeled using the worldwide users’ statistics on the cloud simulation framework, namely CloudAnalyst. As a result, the average response time and data center processing time are measured. Next, the PSBR provides better results than the existing service proximity-based policy. This paper supports cloud service providers' benefits, from coordination between data center configuration, data center selection, and workload distribution to cloud users' identification of the appropriate procedures for their organization or application. PSBR with Active Monitoring had the best average response time of 75.1 ms, while SPR consistently exhibited higher average times across all algorithms, with the highest being 84.5 ms for Round Robin. Under the PSBR policy, Throttled had the lowest average processing time (4.67), while Round Robin had the highest (5.72). Similarly, under the SPR policy, Throttled maintained its efficiency with the lowest average (4.8), while Round Robin showed the highest (5.79).

A-211 Lipids in the Afternoon: Effect on LDL-C, Triglycerides, and Collection Time When Removing Fasting Requirements for Lipid Panels

Abstract Background Calculated LDL cholesterol (LDL-C) is a standard component of the lipid panel and an important risk factor in managing atherosclerotic cardiovascular disease (ASCVD). Due to the assumptions in the derivation of the Friedwald formula, fasting (≥8 hours) and triglyceride levels ≤400mg/dL have long been recommended. More recent data have shown that in most cases fasting has minimal effect on results, leading to the endorsement of non-fasting lipid panels for routine evaluation of ASCVD risk in clinical practice guidelines. Furthermore, newer equations (e.g. Sampson-NIH) allow for more accurate estimation of LDL-C even in the presence of hypertriglyceridemia. Mayo Clinic has implemented the Sampson-NIH LDL-C calculation and removed fasting/non-fasting designation from lipid panel orders. We hypothesized that the change to fasting designation would allow more afternoon draws for routine lipid panels and that increased non-fasting collections may increase triglyceride levels, but that the Sampson-NIH equation would prevent bias in LDL-C estimation. In order to test these hypotheses, we analyzed patient data from 1 year prior and 1 year post-implementation. Methods Results of lipid panels performed for one year preceding (n=334,719) and one year after (n=381,804) removal of the fasting/non-fasting designation and implementation of Sampson-NIH equation were collected. Median, 10th, and 90th percentile of draw time, triglyceride, and LDL-C calculated by either Sampson-NIH or Friedwald formulas were compared by quantile regression. Results Draw times shifted post-implementation at the 10th percentile (7:06 vs. 7:10, p<0.0001), median (8:49 vs. 9:08, p<0.0001) and 90th (12:02 vs. 13:46, p<0.0001). No difference in median triglyceride measurement was observed between pre-and post-implementation (110mg/dL), but slight differences were observed in the 10th and 90th percentile values (60 vs 59mg/dL and 224 vs 229mg/dL, p<0.0001). No difference was observed in 10th, 50th, or 90th percentile LDL values when calculated by Sampson-NIH equation (56, 99, 153mg/dL); however, if the Friedwald formula is used, a slight shift is observed in the 10th and 50th percentile LDL values (54 vs. 53, 97 vs. 96; p<0.0001) but not the 90th (150mg/dL). Conclusions Changing to the Sampson/NIH formula for LDL-C and removing fasting vs. non-fasting designation from routine lipid panels had minimal effect on reported triglyceride and LDL-C values, while allowing increased flexibility in draw time and reporting of LDL-C on patients with triglycerides ≥400mg/dL. Patients with TG ≥400mg/dL represented 1.7% of the dataset overall, including 5,387 patients before the change in which LDL-C could not be reported and 6,697 patients in the year post-implementation for whom LDL-C was reported based on the Sampson-NIH formula. Using an equation that is robust in patients with elevated triglyceride levels and removing fasting requirements from routine lipid panels allows greater flexibility and convenience for patients while allowing for more even distribution of phlebotomy workload and reporting of LDL-C results for patients with hypertriglyceridemia without evidence of clinically significant bias in reported results.

CBWO: A novel multi-objective load balancing technique for cloud computing

In cloud computing systems, the growing demand for diverse applications has led to challenges in resource allocation and workload distribution, resulting in increased energy consumption and computational costs. To address these challenges, we propose a novel load-balancing method, namely CBWO, that integrates Chaos theory with the Black Widow Optimization algorithm. Our approach is designed to optimize cloud computing environments by improving energy efficiency and resource utilization. We employ CloudSim for simulations, evaluating key performance metrics such as energy consumption, resource utilization, makespan, task completion time, and imbalance degree. The experimental results demonstrate the superiority of our method, achieving average improvements of 67.28% in makespan and 29.03% in energy consumption compared to existing solutions.

HYBRID CLOUD DATABASES FOR BIG DATA ANALYTICS: A REVIEW OF ARCHITECTURE, PERFORMANCE, AND COST EFFICIENCY

The increasing reliance on big data analytics has driven organizations to seek more flexible, scalable, and cost-effective data management solutions, with hybrid cloud databases emerging as a prominent option. Hybrid cloud databases integrate both public and private cloud environments, allowing businesses to balance the scalability and cost advantages of public clouds with the security and control provided by private clouds. This systematic review, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, examines the architecture, performance, cost efficiency, security, and technological advancements of hybrid cloud databases. The study synthesizes findings from 40 peer-reviewed articles published between 2015 and 2024, focusing on key factors that affect the performance of hybrid cloud databases, such as workload distribution, network latency, and the use of advanced data analytics tools like Hadoop and Spark. The review also explores cost-saving mechanisms, including dynamic resource scaling and pay-as-you-go pricing models, which help organizations reduce infrastructure costs by up to 28%. Additionally, it discusses the security risks and privacy concerns associated with hybrid cloud environments, highlighting the effectiveness of encryption protocols and identity access management systems in mitigating data breaches by as much as 40%. Furthermore, the review identifies emerging trends in the integration of machine learning and artificial intelligence (AI), which have significantly enhanced system automation and resource optimization in hybrid cloud infrastructures, leading to performance improvements of up to 45%.

Взаимное влияние условий и оплаты труда на потребность системы здравоохранения в медицинских работниках

Healthcare quality depends on medical personnel, i.e., motivation, professional burnout, work-life balance, etc. The authors used standard research methods to investigate the relationship between performance, staff turnover, salary, and motivation in healthcare in various federal districts. The hypothesis was that the high workload and a disproportionate payment system reduce the motivation, which increases staff turnover and leads to shortage of qualified personnel. In this research, stronger labor intensity indeed contributed to lower motivation of medical personnel and triggered staff turnover. The labor intensity correlated with the level of staff turnover, but no correlation was revealed between the labor intensity and the wages. The article explains the need for a more effective labor rationing system and a more rational workload distribution.

The Influence of Workload and Work Environment on Employee Job Satisfaction

Abstract: This research brief examines the influence of workload and work environment on employee job satisfaction. Job satisfaction is an important driver of retention, productivity and organizational success, yet the specific factors that impact it are complex. The brief reviews literature regarding the quantitative and qualitative aspects of workload, including volume, demands, controllability, and their mixed effects on satisfaction depending on employee and job characteristics. Key dimensions of the work environment explored are physical conditions, social interactions, and organizational culture. An integrated approach is proposed to balance workload challenges with support mechanisms and control. Practical recommendations are provided for workload distribution, flexible work arrangements, team collaboration, ergonomic workspace, communication, and satisfaction measurement. The brief synthesizes knowledge on workload, environment and satisfaction to inform human resource practices aimed at fostering engagement and performance.

Technician assignment in multi-shift maintenance schedules in an offshore wind farm

Offshore wind farms are becoming more and more important to sustainable energy strategies, yet their maintenance presents unique logistical challenges. The focus of this research is the Technician Assignment Problem (TAP) which involves a complicated and fluctuating scheduling problem. The key objective is to determine the most effective assignment of technicians to maintenance tasks to maximize operational efficiency and ensure reliable service. This study introduces a mathematical optimization model that processes numerous variables—technician availability, skill sets, and temporal constraints—to minimize unmet maintenance needs and ensure equitable workload distribution. The model is based on assumptions derived from actual operational conditions and human resource practices, guaranteeing that its results are not only theoretically valid but also practically feasible. TAP adheres to labor regulations, employs human resource capabilities, and aims for a smart assignment of workforce. It complies with restrictions that prevent excessive work, require breaks, and ensure that technicians are assigned tasks that match their skills, thus promoting the well-being of the workforce and the efficiency of operations. The computational investigation of the model shows that it has a remarkable ability to improve scheduling decisions which effectively reduce unassigned positions and uniformly distribute work hours. In essence, this research contributes a methodologically robust framework to the field of workforce scheduling, with the potential to inform the maintenance strategies of offshore wind farms and similar complex service systems.

Radiation shielding calculation for interventional radiology: An updated workload survey using a dose monitoring software

Shielding design is an essential aspect of radiation protection. It is necessary to ensure that barriers safeguard workers, patients, the general public, and the environment from the harmful radiation emitted by X-ray machines. The National Council on Radiation Protection and Measurements (NCRP) 147 method is widely accepted within the radiation protection experts’ (RPEs) community for structural shielding design for medical X-ray imaging facilities. However, these indications are based on data collected in 1996. In recent years, interventional radiology procedures have seen significant developments. Therefore, it is important to evaluate whether updating the data on workload in the different specialities is necessary.We extracted all interventional radiology exposure data parameters from three angiographs from two vendors using dose monitoring software for 3066 procedures and 214,697 individual exposures. The workload distribution as a function of the kVp for five interventional rooms was calculated by summing all exposures and then normalising them by the number of patients.Analysing this data, we obtained new transmission curves through lead, concrete and gypsum wallboard, finding the parameters (α, β, and γ) in the Archer equation for the secondary radiation. Finally, our aim was to share an example of shielding calculations for haemodynamics and neuroangiography rooms to illustrate the impact of updated transmission data.

“Happily tired”: A descriptive qualitative study of the impact of the COVID-19 pandemic on women academics in Qatar

The COVID-19 pandemic highlighted existing gender inequalities and inequities in academia, such as unequal workload distribution and insufficient recognition of women's scientific and institutional contributions. This study aimed to explore the impact of the COVID-19 pandemic on women academics in Qatar. We employed a descriptive qualitative design and conducted semi-structured interviews with 17 participants from government and semi-government higher education institutions. We used the intersectionality framework to examine how various social identities interacted to influence the impact of the pandemic. Thematic analysis revealed a range of positive and negative impacts on the professional and personal lives of women, personal and institutional moderating factors, and coping strategies. We conclude that higher education institutions need to develop systems and structures to reduce existing gender inequities and mitigate the inequitable impact of emergencies and disasters.

Seasonal Changes in Match Demands and Workload Distribution in Collegiate Soccer Across Two Seasons.

Floersch, S, Vidden, C, Askow, AT, Jones, MT, Fields, JB, and Jagim, AR. Seasonal changes in match demands and workload distribution in collegiate soccer across two seasons. J Strength Cond Res 38(8): 1440-1446, 2024-The purpose of this study was to examine seasonal changes in match demands in a collegiate women's soccer team. Forty-eight NCAA Division III women soccer athletes (age: 19.5 ± 1.2 years; height: 1.67 ± 0.05 m; body mass: 64.8 ± 7.4 kg; fat-free mass: 50.0 ± 4.5 kg; body fat %: 22.6 ± 6.0) were equipped with wearable global positioning systems with inertial sensors and heart rate (HR) monitors during matches throughout the 2019 (n = 22) and 2021 seasons (n = 26). Players were classified by position: flank player (FP; n = 28), center midfielder (CM; n = 11), and center back fielder (CB; n = 9) and as starters (S, n = 17) or reserves (R, n = 31). Variables included HR, training load, total distance, high-speed distance, distance per minute, and weighted distance. Differences in match and practice session demands were analyzed using linear mixed-effects models with season (2 levels; 2019 and 2021) as a fixed factor, with alpha set to p = 0.05. Data across all matches and training sessions were collapsed and presented as mean ± SD for descriptive purposes and then grouped by session type (i.e., match or training) and position. Athletes traveled more distance at high speeds during match play in the 2021 season compared with 2019 (mean difference, 95% confidence intervals [CI]) (200, 95% CI: 104, 304 km; p < 0.05) but had a lower training load in 2021 compared with 2019 (-50, 95% CI: -63, -36; p < 0.05) during match play. For training sessions, mean HR (4, 95% CI: 2, 5 bpm), total distance (0.5, 95% CI: 0.4, 0.7), distance per minute (5.6, 95% CI: 4.5, 6.7 m·min-1), high-speed distance (43, 95% CI: 43, 18, 67 m), high accelerations (8.6, 95% CI: 5.4, 11.8 n), and high accelerations per minute (0.1, 95% CI: 0.1, 0.1 n·min-1) were all higher in 2021 compared with 2019 (p < 0.05). As a team, several differences in measures of external workload were found between seasons in both session types (training and matches). Variations in positional demands of match play appear to fluctuate by year.

Measuring Workload Among Family Medicine Health Professionals During the COVID-19 Pandemic.

The global COVID-19 pandemic presented a period of considerable stress for healthcare professionals on a global scale. The strain on healthcare facilities nationwide has resulted in profound implications for the well-being of numerous healthcare practitioners. A heightened demand for extended working hours emerged, potentially amplifying the workload for these professionals. This study aims to scrutinize the workload levels experienced by healthcare professionals specializing in family medicine at a tertiary medical center. Our findings reveal a persistent escalation in workload over the course of the study. Notably, the overall mean workload index score exhibited a substantial increase from phase one to phase two (48.07 compared to66.36). Recognizing the impact of workload variations according to professional roles is crucial for devising effective solutions. Consequently, comprehending the nuances of workload distribution among healthcare professionals is imperative for the successful implementation of targeted interventions.

The Application of the Piecewise Linear Method for Non-Linear Programming Problems in Ride-Hailing Assignment Based on Service Level, Driver Workload, and Fuel Consumption

Ride-hailing services have grown rapidly, presenting challenges such as increased traffic congestion, inefficient driver workload distribution, and environmental concerns like higher fuel consumption and emissions. This study develops a non-linear ride-hailing assignment model addressing these issues by considering service level, driver workload, and fuel consumption. A piecewise linear method was employed to handle a non-linear programming model, and the method was modified to function autonomously without operator intervention. The model’s performance was evaluated using a publicly accessible dataset of taxi trips in Manhattan, focusing on indicators such as passenger waiting time, driver workload distribution, and fuel consumption. Numerical simulations demonstrated significant improvements: a 15% reduction in average passenger waiting time, a 20% improvement in balancing driver workloads, and a 10% decrease in overall fuel consumption, contributing to reduced emissions and environmental impact. The modified piecewise linear method proved effective in optimizing ride-hailing assignments, providing a more efficient and sustainable solution. The model also showed robustness in handling large datasets, ensuring scalability and applicability to various urban settings. These findings highlight the model’s potential to enhance operational efficiency and promote sustainability in ride-hailing services. By integrating considerations for service level, driver workload, and fuel consumption, the model offers a holistic approach to addressing the key challenges faced by the ride-hailing industry. This study provides valuable insights for future ride-hailing development and implementations of ride-hailing systems, promoting practices that are both efficient and environmentally friendly.

Internal Medicine Program Directors' Perceptions About Accommodating Residents with Disabilities: A Qualitative Study.

While 26% of US adults are disabled, only 3.1 to 9.3% of practicing physicians report having a disability. Ableism within medical training and practice diminishes physician diversity and wellbeing and contributes to healthcare disparities. Explore physician barriers to disability equity and inclusion by examining internal medicine (IM) program directors' (PD) perspectives about recruiting and accommodating residents with disabilities (RWD). Qualitative study involving semi-structured virtual interviews (conducted December 2022-September 2023; analyzed through December 2023). PDs were recruited via email. Purposive sampling captured program diversity in size, location, and affiliations. Convenience sampling ensured PD diversity by gender, race/ethnicity, and age. Coders analyzed thematic and discursive content of interview transcripts to characterize PD perspectives about RWDs and accommodations. Of the 15 programs represented, 4 had ≤ 49 and 8 had ≥ 100 total residents. Three were community-based; the rest had academic affiliations. On average, PDs had 17 (SD 8.2) years in practice. Most (11/15) identified as White race; 8/15 as female; and none as disabled. PDs characterized disability as a source of grit and empathy but also as an intrinsic deficit. They worried RWDs could have unpredictable absences and clinical incompetencies. Perceived accommodation challenges included inexperience, workload distribution, information asymmetry about accommodation needs or options, barriers to disclosure (e.g., discrimination concerns), and insufficient accommodation advertising. Perceived facilitators included advanced planning; clear, publicized processes; and access to expertise (e.g., occupational health, ombudsmen). PDs held contradictory views of RWDs. PD insights revealed opportunities to alleviate PD-RWD information asymmetry in recruitment/accommodation processes, which could help align needs and improve representation and inclusion.