Design of the Reverse Logistics System for Medical Waste Recycling Part I: System Architecture, Classification & Monitoring Scheme, and Site Selection Algorithm

With social progress and the development of modern medical technology, the amount of medical waste generated is increasing dramatically. The problem of medical waste recycling and treatment has gradually drawn concerns from the whole society. The sudden outbreak of the COVID-19 epidemic further brought new challenges. To tackle the challenges, this study proposes a reverse logistics system architecture with three modules, i.e., medical waste classification & monitoring module, temporary storage & disposal site selection module, as well as route optimization module. This overall solution design won the Grand Prize of the "YUNFENG CUP" China National Contest on Green Supply and Reverse Logistics Design ranking 1st. This paper focuses on the description of architectural design and the first two modules, especially the module on site selection. Specifically, regarding the medical waste classification & monitoring module, three main entities, i.e., relevant government departments, hospitals, and logistics companies, are identified, which are involved in the five management functions of this module. Detailed data flow diagrams are provided to illustrate the information flow and the responsibilities of each entity. Regarding the site selection module, a multi-objective optimization model is developed, and considering different types of waste collection sites (i.e., prioritized large collection sites and common collection sites), a hierarchical solution method is developed employing linear programming and K-means clustering algorithms sequentially. The proposed site selection method is verified with a case study and compared with the baseline, it can immensely reduce the daily operational costs and working time. Limited by length, detailed descriptions of the whole system and the remaining route optimization module can be found at https://shorturl.at/cdY59.Comment: 8 pages, 6 figures, submitted to and under review by the IEEE Intelligent Vehicles Symposium (IV 2023

Role of the Physical Environment on Team-Based Primary Care in the Military Health System

Primary care in the United States has shifted from a physician-centered care approach to a multidisciplinary, team-based care approach. This shift has resulted in many day-to-day changes in the care delivery process including how clinical staff collaborate; interact with patients; and use space, equipment, and various technologies. Team-based approaches, such as the Patient-Centered Medical Home (PCMH) model, are demonstrating improvements in patient health outcomes. The U.S. Military Health System, one of the largest healthcare organizations in the world, has adopted the PCMH model for primary care clinics. To support this new care model, a team-based clinical module is emerging as a spatial concept that colocates the resources staff need for delivering care. Several different design configurations of team-based clinical modules exist in MHS clinics despite the organization’s emphasis on clinic standardization. The purpose of this dissertation is to understand staff perceptions concerning the environmental factors that best support team-based care in the MHS. Using a qualitative approach and a case study research strategy along with ethnographic data collection techniques, this study investigates how six team-based clinical module configurations in three different clinics influence the delivery of team-based care. Data collection included 58 semi-structured interviews with primary care providers, registered nurses, licensed practical nurses, and specialty care providers. Additionally, 11 hours of observations in team rooms provided insight on how the staff use space. Findings were translated into a set of design recommendations for planning team-based clinical modules aimed at improving staff workflow, functionality, and workspaces to facilitate both team collaboration and focused work. This study provides initial evidence that can directly support the MHS in updating design guidance criteria to support team-based primary care

Conditional cash transfers and female schooling : the impact of the female school stipend program on public school enrollments in Punjab, Pakistan

Instead of mean-tested conditional cash transfer (CCT) programs, some countries have implemented gender-targeted CCTs to explicitly address intra-household disparities in human capital investments. This study focuses on addressing the direct impact of a female school stipend program in Punjab, Pakistan: Did the intervention increase female enrollment in public schools? To address this question, the authors draw on data from the provincial school censuses of 2003 and 2005. They estimate the net growth in female enrollments in grades 6-8 in stipend eligible schools. Impact evaluation analysis, including difference-and-difference (DD), triple differencing (DDD), and regression-discontinuity design (RDD) indicate a modest but statistically significant impact of the intervention. The preferred estimator derived from a combination of DDD and RDD empirical strategies suggests that the average program impact between 2003 and 2005 was an increase of six female students per school in terms of absolute change and an increase of 9 percent in female enrollment in terms of relative change. A triangulation effort is also undertaken using two rounds of a nationally representative household survey before and after the intervention. Even though the surveys are not representative at the subprovincial level, the results corroborate evidence of the impact using school census data.Education For All,Primary Education,Tertiary Education,Gender and Education,Education Reform and Management

A Process for Extracting Knowledge in Design for the Developing World

The aim of this study was to develop the process necessary to identify design knowledge shared across product classes and contexts in Design for the Developing World. A process for extracting design knowledge in the field of Design for the Developing World was developed based on the Knowledge Discovery in Databases framework. This process was applied to extract knowledge from a sample dataset of 48 products and small-scale technologies. Unsupervised cluster analysis revealed two distinct product groups, cluster X-AA and cluster Z-AC-AD. Unique attributes of cluster XX-AA include local manufacture, local maintenance and service, human-power, distribution by a non-governmental organization, income-generation, and application in water/sanitation or agriculture sectors. The label Locally Oriented Design for the Developing World was assigned to this group based on the dominant features represented. Unique attributes of cluster Z-AC-AD include electric-power, distribution by a private organization, and application in the health or energy/communication sectors. The label Globally Oriented Design for the Developing World was assigned to this group. These findings were corroborated by additional analyses that suggest certain design knowledge is shared across classes and contexts within groups of products. The results suggest that at least two of these groups exist, which can serve as an initial framework for organizing the literature related to inter-context and inter-class design knowledge. Design knowledge was extracted from each group by collecting known approaches, principles, and methods from available literature. This knowledge may be applied as design guidance in future work by identifying a product group corresponding to the design scenario and sourcing the related set of knowledge

Non-specialist health worker interventions for mental health care in low- and middle- income countries.

This is the protocol for a review and there is no abstract. The objectives are as follows: OVERALL OBJECTIVE: In order to assess the impact of delivery by non-specialist health workers (NSHWs) and other professionals with health roles (OPHRs) on the effectiveness of mental healthcare interventions in low- and middle- income countries (LMICs), we will specifically analyse the effectiveness of NSHWs and OPHRS in delivering acute mental health interventions; as well as the effectiveness of NSHWs and OPHRs in delivering long term follow-up and rehabilitation for people with mental disorders; and the effect of the detection of mental disorders by NSHWs and OPHRs on patient and health delivery outcomes. For each of these objectives we will examine the current evidence for the impact of delivery by NSHWs and OPHRs on the resource use and costs associated with mental healthcare provision in LMICs

Spatial design for the Lansdowne Road Corridor

The current patterns of urban growth within the city of Cape Town reflect large social inequalities, which is compounded by rapid population growth and urbanisation experienced in the city. The intention of this dissertation is address current socio-spatial inequalities through the management of urban growth, specifically targeted at interventions within the poorest parts of the city through the design of the Lansdowne urban corridor. The theoretical framework for establishing the tools for the management of urban growth are informed by the generic problems with the structure of South African cities, global challenges that face the growth of all cities, and an understanding of what informs the making of spatial plans. An important finding of this is the need for the re-structuring of South African cities to increase integration of historically fragmented areas. The spatial analysis represents the application of the theoretical findings to the context of Cape Town. The analysis is undertaken at a number of scales, to establish the constraints and opportunities present in the area, to inform the spatial design of the corridor area. The intention of the plan is to establish where the investment of direct public funds should occur to generate movement of people within the area, which small scale enterprises can respond to, thus strengthening the conditions for self-sustaining livelihood strategies to occur. An essential part of this requires the restructuring of the existing spatial structure to create a more integrated urban form, which is resolved at the precinct scale

Mortality in HIV and tuberculosis patients following implementation of integrated HIV-TB treatment: Results from an open-label cluster-randomized trial

Background: HIV-TB treatment integration reduces mortality. Operational implementation of integrated services is challenging. This study assessed the impact of quality improvement (QI) for HIV-TB integration on mortality within primary healthcare (PHC) clinics in South Africa. // Methods: An open-label cluster randomized controlled study was conducted between 2016 and 2018 in 40 rural clinics in South Africa. The study statistician randomized PHC nurse-supervisors 1:1 into 16 clusters (eight nurse-supervisors supporting 20 clinics per arm) to receive QI, supported HIV-TB integration intervention or standard of care (control). Nurse supervisors and clinics under their supervision, based in the study health districts were eligible for inclusion in this study. Nurse supervisors were excluded if their clinics were managed by municipal health (different resource allocation), did not offer co-located antiretroviral therapy (ART) and TB services, services were performed by a single nurse, did not receive non-governmental organisation (NGO) support, patient data was not available for > 50% of attendees. The analysis population consists of all patients newly diagnosed with (i) both TB and HIV (ii) HIV only (among patients previously treated for TB or those who never had TB before) and (iii) TB only (among patients already diagnosed with HIV or those who were never diagnosed with HIV) after QI implementation in the intervention arm, or enrolment in the control arm. Mortality rates was assessed 12 months post enrolment, using unpaired t-tests and cox-proportional hazards model. (Clinicaltrials.gov, NCT02654613, registered 01 June 2015, trial closed). // Findings: Overall, 21 379 participants were enrolled between December 2016 and December 2018 in intervention and control arm clinics: 1329 and 841 HIV-TB co-infected (10·2%); 10 799 and 6 611 people living with Human Immunodeficiency Virus (HIV)/ acquired immunodeficiency syndrome (AIDS) (PLWHA) only (81·4%); 1 131 and 668 patients with TB only (8·4%), respectively. Average cluster sizes were 1657 (range 170–5782) and 1015 (range 33–2027) in intervention and control arms. By 12 months, 6529 (68·7%) and 4074 (70·4%) were alive and in care, 568 (6·0%) and 321 (5·6%) had completed TB treatment, 1078 (11·3%) and 694 (12·0%) were lost to follow-up, with 245 and 156 deaths occurring in intervention and control arms, respectively. Mortality rates overall [95% confidence interval (CI)] was 4·5 (3·4–5·9) in intervention arm, and 3·8 (2·6–5·4) per 100 person-years in control arm clusters [mortality rate ratio (MRR): 1·19 (95% CI 0·79–1·80)]. Mortality rates among HIV-TB co-infected patients was 10·1 (6·7–15·3) and 9·8 (5·0–18·9) per 100 person-years, [MRR: 1·04 (95% CI 0·51–2·10)], in intervention and control arm clusters, respectively. // Interpretation: HIV-TB integration supported by a QI intervention did not reduce mortality in HIV-TB co-infected patients. Demonstrating mortality benefit from health systems process improvements in real-world operational settings remains challenging. Despite the study being potentially underpowered to demonstrate the effect size, integration interventions were implemented using existing facility staff and infrastructure reflecting the real-world context where most patients in similar settings access care, thereby improving generalizability and scalability of study findings

Environmental determinants of child mortality in rural china : A competing risks approach

We use a competing risk model to analyze environmental determinants of child mortality using the 1992 China National Health Survey, which collects information on cause of death. Our primary question is whether taking into account of cause of death using a competing risk model, compared with a simple model of all-cause mortality, affects conclusions about the effectiveness of policy interventions. There are two potential analytical advantages in using cause of death information: (1) obtaining more accurate estimates and (2) validating causal relationships. Although, we do not find significant differences between estimates obtained from the competing risk model and those from simpler hazard models, we do find evidence supporting the causal interpretations of the effect of access to safe water on child mortality. Our analysis also suggests that a respondent-based health survey can be used to collect relatively reliable information on cause of death. Modifying future demographic and health survey (DHS) instruments to collect cause of death information inexpensively may be worthwhile for enhancing the analytical strength of the DHS.Disease Control&Prevention,Health Monitoring&Evaluation,Early Child and Children's Health,Public Health Promotion,Decentralization,Health Monitoring&Evaluation,Early Child and Children's Health,Demographics,Health Economics&Finance,Town Water Supply and Sanitation

From housing to human settlements: the role of public space in integrated housing developments

Since 1994 the post-apartheid South African Government has recognized the importance of housing in improving the quality of life of its citizens. Following 10 years of a housing delivery model that saw the provision of nearly 1.6 million houses, the National Government introduced a new policy that sought to shift away from an emphasis on housing and rather a holistic focus on the quality of the settlement established. This new policy, Breaking New Ground (BNG) promoted the establishment of well-managed, liveable and equitable settlements incorporating social and economic infrastructure. The quality of the urban environment and the quality of public spaces within urban developments has been identified as contributing towards improving quality of life within these settlements. In mixedincome, integrated settlements - like those BNG claims to produce - the importance of public space is further emphasised because it compensates for limited space of the private home. However, these spaces are often considered as "nice-to-haves" and neglected in favour of basic services or housing. Despite the importance of public space and its contribution to the creation of sustainable human settlements, these spaces, although planned for in the initial phases of a development, still remain largely undeveloped. This research therefore questions whether public spaces within integrated housing developments are being used as intended. It also questions to what extent the necessity for increased urban densification has affected the provision of public space in integrated housing developments. This research attempts to answer the question from the perspective of professionals involved in the planning and implementation of integrated housing developments and not from the perspective of residents. A qualitative research approach has been adopted. Three settlements each representing an integrated housing development implemented in line with BNG principles and incorporating public spaces were selected as case studies and in-depth interviews with professionals involved in the planning and implementation of these developments were conducted. The research found that while public spaces are considered as beneficial and are included in the planning stages of a development, in reality the lived experience often differs. While the objectives of housing policies are to create sustainable human settlements, professionals still struggle to translate these objectives into practical guidelines and standards. Finally, it was observed that while public spaces do play a role in the shift from housing to human settlements, the process is one that occurs incrementally and over a period of time

RFL-based customer segmentation using K-means algorithm

Customer segmentation has become crucial for the company’s survival and growth due to the rapid development of information technology (IT) and state-of-the-art databases that have facilitated the collection of customer data. Financial firms, particularly insurance companies, need to analyze these data using data mining techniques in order to identify the risk levels of their customer segments and revise the unproductive groups while retaining valuable ones. In this regard, firms have utilized clustering algorithms in conjunction with customer behavior-focused approaches, the most popular of which is RFM (recency, frequency, and monetary value). The shortcoming of the traditional RFM is that it provides a one-dimensional evaluation of customers that neglects the risk factor. Using data from 2586 insurance customers, we suggest a novel risk-adjusted RFM called RFL, where R stands for recency of policy renewal/purchase, F for frequency of policy renewal/purchase, and L for the loss ratio, which is the ratio of total incurred loss to the total earned premiums. Accordingly, customers are grouped based on the RFL variables employing the CRISP-DM and K-means clustering algorithm. In addition, further analyses, such as ANOVA as well as Duncan’s post hoc tests, are performed to ensure the quality of the results. According to the findings, the RFL performs better than the original RFM in customer differentiation, demonstrating the significant role of the risk factor in customer behavior evaluation and clustering in sectors that have to deal with customer risk