Joint Location and Dispatching Decisions for Emergency Medical Service Systems

Emergency Medical Service (EMS) systems are a service that provides acute care and transportation to a place for definitive care, to people experiencing a medical emergency. The ultimate goal of EMS systems is to save lives. The ability of EMS systems to do this effectively is impacted by several resource allocation decisions including location of servers (ambulances), districting of demand zones and dispatching rules for the servers. The location decision is strategic while the dispatching decision is operational. Those two decisions are usually made separately although both affect typical EMS performance measures. The service from an ambulance is usually time sensitive (patients generally want the ambulances to be available as soon as possible), and the demand for service is stochastic. Regulators also impose availability constraints, the most generally accepted being that 90\% of high priority calls (such as those related to cardiac arrest events) should be attended to within 8 minutes and 59 seconds. In the case of minimizing the mean response time as the only objective, previous works have shown that there are cases in which it might not be optimal to send the closest available server to achieve the minimum overall response time. Some researchers have proposed integrated models in which the two decisions are made sequentially. The main contribution of this work is precisely in developing the integration of location and dispatching decisions made simultaneously. Combining those decisions leads to complex optimization models in which even the formulation is not straightforward. In addition, given the stochastic nature of the EMS systems the models need to have a way to represent their probabilistic nature. Several researchers agree that the use of queuing theory elements in combination with location, districting and dispatching models is the best way to represent EMS systems. Often heuristic/approximate solution procedures have been proposed and used since the use of exact methods is only suitable for small instances. Performance indicators other than Response Time can be affected negatively when the dispatching rule is sending the closest server. For instance, there are previous works claiming that when the workload of the servers is taken into account, the nearest dispatching policy can cause workload imbalances. Therefore, researchers mentioned as a potential research direction to develop solution approaches in which location, districting and dispatching could be handled in parallel, due to the effect that all those decisions have on key performance measures for an EMS system. In this work the aim is precisely the development of an optimization framework for the joint problem of location and dispatching in the context of EMS systems. The optimization framework is based on meta heuristics. Fairness performance indicators are also considered, taking into account different points of view about the system, in addition to the standard efficiency criteria. Initially we cover general aspects related to EMS systems, including an overall description of main characteristics being modeled as well as an initial overview of related literature. We also include an overall description and literature review with focus on solution methodologies for real instances, of two related problems: the $p$-median problem and the maximal covering location problem (MCLP). Those two problems provide much of the basic structure upon which the main mathematical model integrating location and dispatching decisions is built later. Next we introduce the mathematical model (mixed-integer non-linear problem) which has embedded a queuing component describing the service nature of the system. Given the nature of the resulting model it was necessary to develop a solution algorithm. It was done based on Genetic Algorithms. We have found no benefit on using the joint approach regarding mean Response Time minimization or Expected Coverage maximization. We concluded that minimizing Response Time is a better approach than maximizing Expected Coverage, in terms of the trade-off between those two criteria. Once the optimization framework was developed we introduced fairness ideas to the location/allocation of servers for EMS systems. Unlike the case of Response Time, we found that the joint approach finds better solutions for the fairness criteria, both from the point of view of internal and external costumers. The importance of that result lies in the fact that people not only expect the service from ambulances to be quick, but also expect it to be fair, at least in the sense that any costumer in the system should have the same chances of receiving quick attention. From the point of view of service providers, balancing ambulance workloads is also desirable. Equity and efficiency criteria are often in conflict with each other, hence analyzing trade-offs is a first step to attempt balancing different points of view from different stakeholders. The initial modeling and solution approach solve the problem by using a heuristic method for the overall location/allocation decisions and an exact solution to the embedded queuing model. The problem of such an approach is that the embedded queuing model increases its size exponentially with relation to the number of ambulances in the system. Thus the approach is not practical for large scale real systems, say having 10+ ambulances. Therefore we addressed the scalability problem by introducing approximation procedures to solve the embedded queuing model. The approximation procedures are faster than the exact solution method for the embedded sub-problem. Previous works mentioned that the approximated solutions are only marginally apart from the exact solution (1 to 2\%). The mathematical model also changed allowing for several ambulances to be assigned to a single station, which is a typical characteristic of real world large scale EMS systems. To be able to solve bigger instances we also changed the solution procedure, using a Tabu Search based algorithm, with random initialization and dynamic size of the tabu list. The conclusions in terms of benefits of the joint approach are true for bigger systems, i.e. the joint approach allows for finding the best solutions from the point of view of several fairness criteria

Mineralogia dos aluviões diamantíferos duma área da quebrada grande afluente do Rio Guaniamo - estado Bolivar - Venezuela

Resum

Communication range dynamics using an energy saving self-adaptive transmission power controller in a wireless sensor network

The deployment of the nodes in a Wireless Sensors and Actuators Network (WSAN) is typically restricted by the sensing and acting coverage. This implies that the locations of the nodes may be, and usually are, not optimal from the point of view of the radio communication. And also when the transmission power is tuned for those locations, there are other unpredictable factors that can cause connectivity failures, like interferences, signal fading due to passing objects, and of course, radio irregularities. A control based self-adaptive system is a typical solution to improve the energy consumption while keeping a good connectivity. In this paper, we explore how the communication range for each node evolves along the iterations of an energy saving self-adaptive transmission power controller when using different parameter sets in an outdoor scenario, providing a WSAN that automatically adapts to surrounding changes keeping a good connectivity. The results obtained in this paper show how the parameters with the best performance keep a k-connected network, where k is in the range of the desired node degree plus or minus a specified tolerance value. In addition, the worst performance shows how a bad parameters choice can create isolated islands, groups of nodes disconnected from the rest of the network

Predicting Liver Transplant Capacity Using Discrete Event Simulation

The number of liver transplants (LTs) performed in the US increased until 2006 but has since declined despite an ongoing increase in demand. This decline may be due in part to decreased donor liver quality and increasing discard of poor-quality livers. We constructed a discrete event simulation (DES) model informed by current donor characteristics to predict future LT trends through the year 2030. The data source for our model is the United Network for Organ Sharing database, which contains patient-level information on all organ transplants performed in the US. Previous analysis showed that liver discard is increasing and that discarded organs are more often from donors who are older, are obese, have diabetes, and donated after cardiac death. Given that the prevalence of these factors is increasing, the DES model quantifies the reduction in the number of LTs performed through 2030. In addition, the model estimatesthe total number of future donors needed to maintain the current volume of LTs and the effect of a hypothetical scenario of improved reperfusion technology.We also forecast the number of patients on the waiting list and compare this with the estimated number of LTs to illustrate the impact that decreased LTs will have on patients needing transplants. By altering assumptions about the future donor pool, this model can be used to develop policy interventions to prevent a further decline in this lifesaving therapy. To our knowledge, there are no similar predictive models of future LT use based on epidemiological trends

Establecimiento de ensayos para modelación de frijol en el departamento del Cauca, Colombia

En el marco de los proyectos Soluciones Digitales Integradas Agroclimáticas (Agroclimas Fase 2) y Territorios Sostenibles Adaptados al Clima (TeSAC) ambos parte del programa de Investigación de CGIAR sobre Cambio Climático, Agricultura y Seguridad Alimentaria (CCAFS), se busca generar evidencia de la implementación de servicios climáticos participativos. Específicamente en el TeSAC de Cauca1, CIAT-CCAFS con el apoyo de los socios estratégicos, en particular Fundación EcoHabitats, se adelantan procesos de capacitación relacionados manejo agronómico, información climática y la toma de decisiones basadas en condiciones de tiempo y clima (Fernández Ortega et al, 2017). En este contexto CIAT-CCAFS está realizando intervenciones en sistemas de producción de fríjol del TeSAC del Cauca orientadas a mejorar la toma de decisiones con respecto a la variabilidad climática histórica y pronosticada.Within the framework of the Agro-climatic Digitally Integrated Solutions (Agroclimas Phase 2) and Climate-Smart Villages (CSV) projects, both parts of the CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS), seeks to generate evidence of the implementation of participatory climate services. Specifically, in the Cauca’s CSV, CIAT-CCAFS with the support of the strategic partners, in particular, EcoHabitats Foundation, has been carrying training processes related to agronomic management, climate information and decision-making based on weather and climate conditions (Fernández Ortega et to, 2017). In this context, CIAT-CCAFS is carrying out interventions in bean production systems of Cauca’s CSV aimed at improving decision-making regarding historical and predicted climate variabilit

Seroprevalence of rubella in Colombia: a birth-year cohort analysis

OBJETIVO : Estimar la seroprevalencia de rubéola y factores asociados. METODOS : Estudio de seroprevalencia poblacional con una muestra aleatoria de 2.124 individuos de seis a 64 años, representativa por edad, sexo y área en Medellín, Colombia, 2009. Se analizó la asociación de variables biológicas y socioeconómicas con la seroprotección para rubéola, según la cohorte del año de nacimiento antes (1954 a 1990) y después (1991 a 2003) del inicio de la vacunación universal. Se determinaron los títulos de IgG con pruebas de alta sensibilidad (AxSYM ® Rubella IgG – Laboratorio Abbott) y especificidad (VIDAS RUB IgG II ® – Laboratorio BioMerieux). Se estimaron proporciones y promedios ponderados derivados de un muestreo complejo incluyendo un factor de corrección por las diferencias en la participación por sexo. Se analizó la asociación de la protección por grupos de variables biológicas y sociales con un modelo de regresión logística, según la cohorte de nacimiento. RESULTADOS : Los títulos promedio de IgG fueron más altos en los nacidos antes del inicio de la vacunación (media 110 UI/ml; IC95% 100,5;120,2) que en los nacidos después (media 64 UI/ml; IC95% 54,4;72,8), p = 0,000. La proporción de protección fue creciente de 88,9% en los nacidos en 1990-1994, de 89,2% en 1995-1999 y de 92,1% en 2000 a 2003, posiblemente relacionado con la administración del refuerzo desde 1998. En los nacidos antes del inicio de la vacunación, la seroprotección estuvo asociada con el antecedente de contacto con casos (RD 2,6; IC95% 1,1;5,9), el estado de salud (RD 2,5; IC95% 1,05;6,0), el nivel de escolaridad (RD 0,2; IC95% 0,08;0,8) y los años de residencia del hogar en el barrio (RD 0,96; IC95% 0,98;1,0), luego de ajustar por todas las variables. En los nacidos después se asoció con el tiempo de sueño efectivo (RD 1,4; IC95%1,09;1,8) y el estado de salud (RD 5,5; IC95%1,2;23,8). CONCLUSIONES : La vacunación masiva generó un cambio en el perfil de seroprevalencia, siendo mayores los títulos en quienes nacieron antes del inicio de la vacunación. Se recomienda monitorear el sostenimiento del nivel de protección a largo plazo y concertar acciones para el mejoramiento de las condiciones socioeconómicas potencialmente asociadas.OBJECTIVE : To estimate the seroprevalence of rubella and associated factors. METHODS : Population-based seroprevalence study in a random sample of 2,124 individuals, aged six to 64 years, representative by age, sex and area in Medellín, Colombia, 2009. Biological and socioeconomic variables were analyzed for their association with serum protection against rubella, according to birth-year cohort; those born before (1954-1990) and after (1991-2003) the introduction of universal immunization. Titer of IgG antibodies against the rubella virus was detected using a high sensitivity (AxSYM®Rubella IgG – Abbott Laboratories) and a high specificity test (VIDAS RUB IgG II®– BioMerieux Laboratories). Proportions and weighted averages derived from a complex sample, including a correction factor for differences in gender participation, were estimated. Association with protection for groups of biological and social variables according to birth cohort was analyzed using a logistic regression model. RESULTS : Titers of IgG antibodies were higher in those born before (mean 110 UI/ml, 95%CI 100.5;120.2) compared to those born after (mean 64 UI/ml; 95%CI 54.4;72.8; p = 0.000) the introduction of mass immunization. The proportion of protection increased from 88.9% in those born 1990-1994, to 89.2% in those born 1995-1999 and to 92.1% in those born between 2000 and 2003, possibly due to boosters being administered from 1998 onwards. In those born before the introduction of the immunization, seroprotection was associated with previous contact with cases (OR 2.6; 95%CI 1.1;5.9), self- perceived health status (OR 2.5; 95%CI 1.05;6.0), educational level (OR 0.2; 95%CI 0.08;0.8) and years of residence in the neighborhood (RD 0,96; 95%CI 0.98;1.0) after adjusting for all variables. In those born after, serum protection was associated with effective sleep time (OR 1,4; 95%CI 1.09;1.8) and self-perceived health status (OR 5.5; 95%CI 1.2;23.8). CONCLUSIONS : The seroprevalence profile changed with the mass immunization plan, with higher titers of IgG antibodies in those born before the start of the immunization. It is recommended that the level of long-term protection be monitored and concerted action taken to improve potentially associated socioeconomic conditions.OBJETIVO : Estimar a soroprevalência de rubéola e fatores associados. MÉTODOS : Estudo de soroprevalência em população a través de uma amostra aleatória de 2.124 indivíduos de seis a 64 anos, representativa por idade, sexo e área em Medellín, Colômbia, 2009. Foi analisada a associação de variáveis biológicas e socioeconômicas com a soroproteção para rubéola, de acordo com a coorte de nascimento antes (1954 a 1990) e depois (1991 a 2003) do inicio da vacinação universal. Foram determinados os títulos de IgG com testes de alta sensibilidade (AxSYM® Rubella IgG – Laboratório Abbott) e especificidade (VIDAS RUB IgG II® – Laboratório BioMerieux). Foram estimadas proporções e médias ponderadas derivadas de amostragem complexa incluindo um fator de correição pelas diferenças na participação por sexo. Foi analisada a associação da proteção por grupos de variáveis biológicas e sociais com um modelo de regressão logística, segundo a coorte de nascimento. RESULTADOS : As médias dos títulos de IgG foram maiores nos nascidos antes do inicio da vacinação (média 110UI/ml; IC95% 100,5;120,2) do que nos nascidos posteriormente (média 64 UI/ml; IC 95% 54,4;72,8), p = 0,000. A proporção de proteção foi crescente de 88,9% nos nascidos em 1990-1994, de 89,2% em 1995-1999 e de 92,1% em 2000 a 2003, provavelmente relacionado à administração do reforço desde 1998. A soroproteção esteve associada nos nascidos antes com o fato de ter contato com casos (RD 2,6; IC95% 1,1;5,9), o estado de saúde (RD 2,5; IC95% 1,05;6,0), o nível de escolaridade (RD 0,2; IC95% 0,08;0,8) e os anos morando no bairro (RD 0,96; IC95% 0,98;1,0), após ajuste por todas as variáveis. Nos nascidos posteriormente, houve associação com o tempo de sono efetivo (RD 1,4; IC95% 1,09;1,8) e o estado de saúde (RD 5,5; IC95% 1,2;23,8). CONCLUSÕES : A vacinação massiva gerou mudanças no perfil da soroprevalência, sendo maiores os títulos naqueles nascidos antes do inicio da vacinação. Propõe-se realizar monitoramento do nível de proteção em longo prazo e concertar ações para aprimorar as condições socioeconômicas potencialmente associadas

Seroprevalencia de rubeola en Colombia: un analisis por cohorte de nacimiento

OBJETIVO : Estimar la seroprevalencia de rubéola y factores asociados. METODOS : Estudio de seroprevalencia poblacional con una muestra aleatoria de 2.124 individuos de seis a 64 años, representativa por edad, sexo y área en Medellín, Colombia, 2009. Se analizó la asociación de variables biológicas y socioeconómicas con la seroprotección para rubéola, según la cohorte del año de nacimiento antes (1954 a 1990) y después (1991 a 2003) del inicio de la vacunación universal. Se determinaron los títulos de IgG con pruebas de alta sensibilidad (AxSYM ® Rubella IgG – Laboratorio Abbott) y especificidad (VIDAS RUB IgG II ® – Laboratorio BioMerieux). Se estimaron proporciones y promedios ponderados derivados de un muestreo complejo incluyendo un factor de corrección por las diferencias en la participación por sexo. Se analizó la asociación de la protección por grupos de variables biológicas y sociales con un modelo de regresión logística, según la cohorte de nacimiento. RESULTADOS : Los títulos promedio de IgG fueron más altos en los nacidos antes del inicio de la vacunación (media 110 UI/ml; IC95% 100,5;120,2) que en los nacidos después (media 64 UI/ml; IC95% 54,4;72,8), p = 0,000. La proporción de protección fue creciente de 88,9% en los nacidos en 1990-1994, de 89,2% en 1995-1999 y de 92,1% en 2000 a 2003, posiblemente relacionado con la administración del refuerzo desde 1998. En los nacidos antes del inicio de la vacunación, la seroprotección estuvo asociada con el antecedente de contacto con casos (RD 2,6; IC95% 1,1;5,9), el estado de salud (RD 2,5; IC95% 1,05;6,0), el nivel de escolaridad (RD 0,2; IC95% 0,08;0,8) y los años de residencia del hogar en el barrio (RD 0,96; IC95% 0,98;1,0), luego de ajustar por todas las variables. En los nacidos después se asoció con el tiempo de sueño efectivo (RD 1,4; IC95%1,09;1,8) y el estado de salud (RD 5,5; IC95%1,2;23,8). CONCLUSIONES : La vacunación masiva generó un cambio en el perfil de seroprevalencia, siendo mayores los títulos en quienes nacieron antes del inicio de la vacunación. Se recomienda monitorear el sostenimiento del nivel de protección a largo plazo y concertar acciones para el mejoramiento de las condiciones socioeconómicas potencialmente asociadas

Conocimiento y prácticas sobre alimentación del preescolar en madres de niños de una Institución Educativa Inicial. Ciudad Eten. 2021

La malnutrición de los niños en edad preescolar, suele estar asociada al nivel de conocimiento y el tipo de prácticas sobre su alimentación que poseen los responsables de sus cuidados, especialmente la madre; variables, cuyas características es necesario identificar, para prevenir o corregir la problemática. Por ello, esta investigación cuantitativa-descriptiva, tuvo como objetivo determinar el nivel de conocimiento y las prácticas sobre alimentación del preescolar en madres de niños matriculados en una institución educativa inicial de Ciudad Eten en el 2021. La muestra, obtenida por muestreo estratificado, cumpliendo criterios de inclusión, estuvo constituida por 101 madres. La información sobre conocimientos fue obtenida aplicando el cuestionario de Cruz, Cruz y Villanueva (alfa de Cronbach: 0,702); para las prácticas, el inventario de Ferrel, García y Villanueva (alfa de Cronbach: 0,758), respetándose los principios éticos de Belmont. Los resultados revelan que el 70.3% de las madres alcanzan un nivel de conocimiento regular y el 89.1% tienen adecuadas prácticas sobre alimentación del preescolar. Los aspectos en que las madres demuestran deficiencia de conocimiento son: función de los nutrientes, higiene de alimentos, ración alimentaria y refrigerio del preescolar. En relación a las prácticas: no siempre proporcionan cantidad adecuada de agua, preparan alimentos que aporten poca grasa o incluyen alimentos ricos en hierro y no siempre realizan el descarte de anemia; por lo que es recomendable reforzar, en las madres, los conocimientos en los aspectos mencionados y motivarlas a practicar acciones para mejorar la calidad de la alimentación y prevenir anemias nutricionales en sus niños