Dynamic Capacity Planning of Hospital Resources under COVID-19 Uncertainty using Approximate Dynamic Programming

COVID-19 pandemic has resulted in an inflow of patients into the hospitals and overcrowding of healthcare resources. Healthcare managers increased the capacities reactively by utilizing expensive but quick methods. Instead of this reactive capacity expansion approach, we propose a proactive approach considering different realizations of demand uncertainties in the future due to COVID-19. For this purpose, a stochastic and dynamic model is developed to find the right amount of capacity increase in the most critical hospital resources. Due to the problem size, the model is solved with Approximate Dynamic Programming. Based on the data collected in a large tertiary hospital in Turkey, the experiments show that ADP performs better than a benchmark myopic heuristic. Finally, sensitivity analysis is performed to explore the impact of different epidemic dynamics and cost parameters on the results.</p

Improvements of TPS-porous asphalt using wax- based additives for the application on Malaysian expressway

Porous asphalt provides a sustainable approach to reduce traffic noise at source, while at the same time offering storm-water management systems which promote infiltration and often reduce the need for a detention pool. However, porous asphalt is prone to premature deteriorations, in terms of ravelling, and air voids clogging, rendering its unpopularity as the road surfacing material for expressways construction. In this research, the comparative influences of Tough Fix (TF) and Tough Fix Hyper (TFH) additives incorporation were evaluated on the performance of Tafpack-Super modified porous asphalt mixtures (TPS-PA). The Tafpack-Super (TPS) as a modifier at 20%, and anti-stripping additives (TF and TFH) with dosages used in this study were 0.3%, and 0.15% based on the weight of asphalt binder, respectively. Initially, the PA mixtures were prepared according to a predetermined mix design, and verified based on the percentage of air voids, permeability, and connected air voids. Comprehensive experimental tests of Marshall stability, permeability, Cantabro loss, rutting resistance, and moisture induced damage resistance were performed to assess the mechanical performance of the TPS-PA mixtures. Moreover, the Texas boiling test was employed to assess the stripping potential of loose TPS-PA mixtures. The experimental results revealed that both TF and TFH are capable of improving the PA resistance against rutting, ravelling, and moisture damage. In addition, the porous asphalt with TFH anti-stripping agent incorporation exhibited a superior overall performance as compared to the PA with TF

Certolizumab Pegol Treatment in Three Patients With Takayasu Arteritis

Although glucocorticoids are the mainstay of treatment in Takayasu arteritis (TA), anti-tumor necrosis factor agents are other treatment options in refractory disease. The onset of TA is generally observed in females of reproductive age. Certolizumab pegol (CZP) lacks a fragment crystallizable region and this gives advantage of minimal transfer through the placenta, which makes CZP a safer option in pregnancy. Although there are case reports and trials about use of infliximab, etanercept, and adalimumab in TA, there are scarce data about use of CZP. In this article, we present three TA cases treated with CZP. While two patients benefited from CZP, one patient was refractory to CZP

COVID-19 in Familial Mediterranean Fever: Clinical Course and Complications Related to Primary Disease.

OBJECTIVES: To evaluate the impact of familial Mediterranean fever (FMF) features on the clinical course and outcomes of coronavirus disease 2019 (COVID-19) and clinical course of FMF after COVID-19. METHODS: Consecutive FMF patients with COVID-19 were enrolled from three referral hospitals. Clinical features of FMF and detailed COVID-19 information were obtained from patient interviews and medical records. RESULTS: Seventy-three FMF patients were included in the study. 94.5% of patients had clinical symptoms of COVID-19. We found 24.7% hospitalization, 12.3% respiratory support, 4.1% intensive care unit admission, 6.8% complication, and 1.4% mortality rate in patients. The risk factors of hospitalization for respiratory support were male gender [OR: 7.167 (95% CI: 1.368–37.535)], greater age [OR: 1.067 (95% CI: 1.016–1.121)], and non-adherence to colchicine treatment before the infection [OR: 7.5 (95% CI: 1.348–41.722)]. One-third of patients had reported attacks after COVID-19. The patterns of triggered attacks were fever, peritonitis, pleuritis, transient arthritis, chronic knee mono-arthritis, and protracted febrile myalgia. CONCLUSIONS: FMF characteristics were not associated with worse outcomes of COVID-19. Colchicine non-adherence was the risk factor of hospitalization for oxygen support. The rate of FMF attacks after COVID-19 is prominently increased, with some of them being protracted and destructive

Prevalence, Underlying Factors And Damage Associated With Chronic Persistent Inflammation In Patients With Fmf

Wo