Improving the Methodology to Estimate Joint Logistics Over-the-Shore Operational Throughput and Duration

Joint Logistics Over-the-Shore (JLOTS) is the method the United States (US) Army and Navy use to discharge cargo from large seafaring vessels onto a bare beach when an enemy force has denied access to a deep-water port or the ports have been damaged by natural disasters, terrorist actions, sabotaged by military forces, etc. The last large scale, published analytic study on JLOTS was conducted in 1993 during the Ocean Venture 93 exercise at Camp Lejeune, NC; since that time, nearly the entire US Army inventory of wheeled vehicles have been replaced and tracked systems have increased in size and weight with the additions of reactive armor tiles and urban survival kits. The current estimation method for determining how long a JLOTS operation will take relies on the median duration values in order to determine total operational length. This research shows that the JLOTS activity duration medians published in current military doctrine are no longer representative of the current inventory of US Army vehicles. New planning factors are defined based on JLOTS subject matter expert opinions as well as a new method of JLOTS duration estimation is described through the use of discrete-event simulation. The results of the proposed duration estimation method were compared to both the existing methodology using both the published planning factors and the new planning factors defined through subject matter expert opinion. In both comparisons the current estimation method was found to consistently overestimate operational throughput while underestimating duration since it fails to capture the queuing actions that occur in a resource constrained environment such as JLOTS. It is the recommendation of this research that a time and motion study be conducted on JLOTS operations in order to more accurately define the probability distributions associated with JLOTS activities. These distributions would replace the triangular distributions defined by subject matter experts in this research in order to generate a more accurate estimate of JLOTS duration and throughput. More accurate estimates for JLOTS operations will enable cost savings by providing maritime transportation providers with greater fidelity on scheduling while reducing the time these ships are vulnerable to enemy actions

Severe outcomes following pediatric cannabis intoxication: a prospective cohort study of an international toxicology surveillance registry.

INTRODUCTION: An increasing number of jurisdictions have legalized recreational cannabis for adult use. The subsequent availability and marketing of recreational cannabis has led to a parallel increase in rates and severity of pediatric cannabis intoxications. We explored predictors of severe outcomes in pediatric patients who presented to the emergency department with cannabis intoxication. METHODS: In this prospective cohort study, we collected data on all pediatric patients (\u3c18 \u3eyears) who presented with cannabis intoxication from August 2017 through June 2020 to participating sites in the Toxicology Investigators Consortium. In cases that involved polysubstance exposure, patients were included if cannabis was a significant contributing agent. The primary outcome was a composite severe outcome endpoint, defined as an intensive care unit admission or in-hospital death. Covariates included relevant sociodemographic and exposure characteristics. RESULTS: One hundred and thirty-eight pediatric patients (54% males, median age 14.0 years, interquartile range 3.7-16.0) presented to a participating emergency department with cannabis intoxication. Fifty-two patients (38%) were admitted to an intensive care unit, including one patient who died. In the multivariable logistic regression analysis, polysubstance ingestion (adjusted odds ratio = 16.3; 95% confidence interval: 4.6-58.3; CONCLUSIONS: Severe outcomes occurred for different reasons and were largely associated with the patient\u27s age. Young children, all of whom were exposed to edibles, were at higher risk of severe outcomes. Teenagers with severe outcomes were frequently involved in polysubstance exposure, while psychosocial factors may have played a role

Predictors of severe outcome following opioid intoxication in children.

INTRODUCTION: While the opioid crisis has claimed the lives of nearly 500,000 in the U.S. over the past two decades, and pediatric cases of opioid intoxications are increasing, only sparse data exist regarding risk factors for severe outcome in children following an opioid intoxication. We explore predictors of severe outcome (i.e., intensive care unit [ICU] admission or in-hospital death) in children who presented to the Emergency Department with an opioid intoxication. METHODS: In this prospective cohort study we collected data on all children (0-18 years) who presented with an opioid intoxication to the 50 medical centers in the US and two international centers affiliated with the Toxicology Investigators Consortium (ToxIC) of the American College of Medical Toxicology, from August 2017 through June 2020, and who received a bedside consultation by a medical toxicologist. We collected relevant demographic, clinical, management, disposition, and outcome data, and we conducted a multivariable logistic regression analysis to explore predictors of severe outcome. The primary outcome was a composite severe outcome endpoint, defined as ICU admission or in-hospital death. Covariates included sociodemographic, exposure and clinical characteristics. RESULTS: Of the 165 (87 females, 52.7%) children with an opioid intoxication, 89 (53.9%) were admitted to ICU or died during hospitalization, and 76 did not meet these criteria. Seventy-four (44.8%) children were exposed to opioids prescribed to family members. Fentanyl exposure (adjusted OR [aOR] = 3.6, 95% CI: 1.0-11.6; CONCLUSIONS: Children with an opioid toxicity that have been exposed to fentanyl and those aged ≥10 years had 3.6 and 2.5 higher odds of ICU admission or death, respectively, than those without these characteristics. Prevention efforts should target these risk factors to mitigate poor outcomes in children with an opioid intoxication