Impact of Hurricane Harvey on Healthcare Utilization and Emergency Department Operations

Introduction: Hurricanes have increased in severity over the past 35 years, and climate change has led to an increased frequency of catastrophic flooding. The impact of floods on emergency department (ED) operations and patient health has not been well studied. We sought to detail challenges and lessons learned from the severe weather event caused by Hurricane Harvey in Houston, Texas, in August 2017.Methods: This report combines narrative data from interviews with retrospective data on patient volumes, mode of arrival, and ED lengths of stay (LOS). We compared the five-week peri-storm period for the 2017 hurricane to similar periods in 2015 and 2016.Results: For five days, flooding limited access to the hospital, with a consequent negative impact on provider staffing availability, disposition and transfer processes, and resource consumption. Interruption of patient transfer capabilities threatened patient safety, but flexibility of operations prevented poor outcomes. The total ED patient census for the study period decreased in 2017 (7062 patients) compared to 2015 (7665 patients) and 2016 (7770) patients). Over the five-week study period, the arrival-by-ambulance rate was 12.45% in 2017 compared to 10.1% in 2016 (p < 0.0001) and 13.7% in 2015 (p < 0.0001). The median ED length of stay (LOS) in minutes for admitted patients was 976 minutes in 2015 (p < 0.0001) compared to 723 minutes in 2016 and 591 in 2017 (p < 0.0001). For discharged patients, median ED LOS was 336 minutes in 2016 compared to 356 in 2015 (p < 0.0001) and 261 in 2017 (p < 0.0001). Median boarding time for admitted ED patients was 284 minutes in 2016 compared to 470 in 2015 (p < 0.0001) and 234.5 in 2017 (p < 0.001). Water damage resulted in a loss of 133 of 179 inpatient beds (74%). Rapid and dynamic ED process changes were made to share ED beds with admitted patients and to maximize transfers post-flooding to decrease ED boarding times.Conclusion: A number of pre-storm preparations could have allowed for smoother and safer ride-out functioning for both hospital personnel and patients. These measures include surplus provisioning of staff and supplies to account for limited facility access. During a disaster, innovative flexibility of both ED and hospital operations may be critical when disposition and transfer capibilities or bedding capacity are compromised

Cyber-Physical Vulnerability Assessment in Smart Grids Based on Multilayer Complex Networks

This article belongs to the Special Issue Cybersecurity and Privacy-Preserving in Modern Smart GridIn the last decade, the main attacks against smart grids have occurred in communication networks (ITs) causing the disconnection of physical equipment from power networks (OTs) and leading to electricity supply interruptions. To deal with the deficiencies presented in past studies, this paper addresses smart grids vulnerability assessment considering the smart grid as a cyber-physical heterogeneous interconnected system. The model of the cyber-physical system is composed of a physical power network model and the information and communication technology network model (ICT) both are interconnected and are interrelated by means of the communication and control equipment installed in the smart grid. This model highlights the hidden interdependencies between power and ICT networks and contains the interaction between both systems. To mimic the real nature of smart grids, the interconnected heterogeneous model is based on multilayer complex network theory and scale-free graph, where there is a one-to-many relationship between cyber and physical assets. Multilayer complex network theory centrality indexes are used to determine the interconnected heterogeneous system set of nodes criticality. The proposed methodology, which includes measurement, communication, and control equipment, has been tested on a standardized power network that is interconnected to the ICT network. Results demonstrate the model’s effectiveness in detecting vulnerabilities in the interdependent cyber-physical system compared to traditional vulnerability assessments applied to power networks (OT).This research was funded by Fundación Iberdrola España, within the 2020 research support scholarship program

Análisis y actualización de los tiempos de entrega de los proveedores: búsqueda de mejora y entrega de resultados sostenibles

El presente trabajo tiene como objetivo desarrollar una propuesta dentro del área de control del Departamento de Compras de una compañía de electrónica ubicada en Guadalajara, Jalisco, México. La finalidad es obtener información certera sobre los tiempos de entrega de la materia prima y producto terminado que se le compran a los proveedores, para hacer una actualización de los tiempos de entrega dados de alta en el sistema. El resultado esperado es que, al tener la información precisa en el sistema, permita la correcta planeación de las partes para que la cadena de suministro fluya correctamente. Este trabajo se estaría enfocado en hacer un análisis de los tiempos de entrega reales por parte de los proveedores y compararlos contra el tiempo de entrega dado de alta en el sistema, el cual fue previamente cotizado y pactado en el contrato con los proveedores. Se pretende incrementar el porcentaje de órdenes de compra que sean entregadas a tiempo a la Planta, ya que, al hacer el análisis de las entregas durante el mes de junio del 2018, se percató que solamente el 22% de los ítems se están recibiendo dentro de los tiempos de entrega previamente cotizados y pactados con los proveedores. La investigación y los resultados que se obtengan llevarán a una propuesta aplicable a la problemática que existe en la compañía. El propósito es generar un impacto positivo mediante a la actualización de tiempos de entrega a los más precisos para hacer una correcta planeación y recibir el más material a tiempo, buscando hacer al proveedor responsable sobre su desempeño en cuanto a entregas

A nested decision tree for event detection in smart grids

Procedings of: 20th International Conference on Renewable Energies and Power Quality (ICREPQ'22), 27-29 July 2022, Vigo, Spain.Digitalization process experienced by traditional power networks towards smart grids extend the challenges faced by power grid operators to the field of cybersecurity. False data injection attacks, one of the most common cyberattacks in smart grids, could lead the power grid to sabotage itself. In this paper, an event detection algorithm for cyberattack in smart grids is developed based on a decision tree. In order to find the most accurate algorithm, two different decision trees with two different goals have been trained: one classifies the status of the network, corresponding to an event, and the other will classify the location where the event is detected. To train the decision trees, a dataset made by co-simulating a power network and a communication network has been used. The decision trees are going to be compared in different settings by changing the division criteria, the dataset used to train them and the misclassification cost. After looking at their performance independently, the best way to combine them into a single algorithm is presented.This research was funded by Fundación Iberdrola España, within the 2020 research support scholarship program

Contact based intervention reduces stigma among pharmacy students

Introduction Interventions to reduce the stigma of substance use disorders by health professionals often include didactic instruction combined with an interactive component that includes a guest speaker in recovery. Few interactive studies have focused on pharmacy students. Community pharmacists are moving to the front lines to battle the opioid epidemic; therefore, pharmacy students should be included in interventions aimed at reducing stigma by health professionals. Methods This study examined the effects of a contact-based interactive intervention delivered by a peer recovery support specialist on perceived stigma of opioid use disorder among third-year pharmacy students (N = 115) enrolled in an integrative psychiatry course. Stigma was measured using the Brief Opioid Stigma Scale. Results Our study found significant differences in students\u27 perceived stigma, both with their personal beliefs and their beliefs regarding the public, supporting the use of interactive presentations by peer recovery support specialists to decrease perceived stigma of opioid use disorder by health professionals. Conclusions This type of intervention for pharmacy students shows promise in reducing substance use disorder stigma and should be further explored

The Impact of COVID-19 on the Financial Performance of Largest Teaching Hospitals

The COVID-19 pandemic disrupted hospital operations. Anecdotal evidence suggests financial performance likewise suffered, yet little empirical research supports this claim. This study aimed to explore the impact of the pandemic on the financial performance of the most prominent academic hospitals in the United States. Data from the 115 largest major teaching hospitals in the United States were extracted from the American Hospital Directory for three years (2019-2021). We hypothesized that the year and region would moderate the relationship between a hospital\u27s return on assets (financial performance) and specific operational variables. We found evidence through descriptive statistics and multivariate moderated regressions that financial positions rebounded in 2021, mainly through reductions in adjusted full-time employees and liabilities and an increase in non-operating income. Our results also found that the Midwest region significantly outperformed the other three regions, particularly in terms of lower salaries and operational expenses. These findings suggest potential for future initiatives encouraging efficiency and finding alternate sources of income beyond patient income. Hospitals should focus on improving financial reserves, building out non-operational revenue streams, and implementing operational efficiencies to foster better financial resiliency. These suggestions may enable healthcare administrators and facilities to adapt to future pandemics and environmental turbulence

How Financial Beliefs and Behaviors Influence the Financial Health of Individuals Struggling with Opioid Use Disorder

The surge in opioid use disorder (OUD) over the past decade escalated opioid overdoses to a leading cause of death in the United States. With adverse effects on cognition, risk-taking, and decision-making, OUD may negatively influence financial well-being. This study examined the financial health of individuals diagnosed with OUD by reviewing financial beliefs and financial behaviors. We evaluated quality of life, perceptions of financial condition during active use and recovery, and total debt. We distributed a 20-item survey to 150 individuals in an outpatient treatment program for OUD in a large metropolitan area, yielding a 56% response rate. The results revealed low overall financial health, with a median debt of USD 12,961 and a quality-of-life score of 72.80, 9.4% lower than the U.S. average (82.10). Most participants (65.75%) reported improved financial health during recovery, while a higher majority (79.45%) worsened during active use. Unemployment affected 42% of respondents, and 9.52% were employed only part-time. Regression analysis highlighted a strong association between lack of full-time employment and a lack of financial advising with total debt. High financial anxiety and active use were associated with lower quality of life. Individuals with OUD may benefit from financial interventions, resources, and counseling to improve their financial health

Do Trait Emotional Intelligence and Dispositional Mindfulness Have a Complementary Effect on the Children's and Adolescents' Emotional States?

Mindfulness is both a non-judgmental and present-centered awareness, which has been applied to reduce negative emotions. On the other hand, Trait Emotional Intelligence (TEI) is the way of how good people perceive their emotional intelligence abilities (perceiving, expressing, understanding, and regulating emotions), which are involved in people's social functioning. This empirical study was designed to analyze whether dispositional mindfulness (DM) and TEI have a potential combined role for children and adolescent's emotional states. In a sample of primary school students (N = 318), age ranged from 8 to 16 years old (M = 11.25, SD = 2.20), participants filled a TEI measure (ESCQ, Emotional skills and competence questionnaire) and two measures of DM (CAMM, Child and Adolescent Mindfulness Measure and AFQ-Y, Avoidance and Fusion Questionnaire for Youth). Measures selected included: PANAS (Positive affect and negative affect schedule), White Bear Suppression Inventory (a thought suppression inventory), and STAIC (State-Trait Anxiety for Children). Findings pointed out that TEI measures (labeling and expression, understanding, and managing emotions) were positively and significantly related to positive emotional states (especially, positive affect and balance) and negatively with a lower association with state anxiety. However, DM measures were both negatively and strongly associated with negative emotional states (thought suppression, negative affect, and anxiety). Conclusions indicate that a combined effect of both TEI skills and DM based interventions would be more complete than each one separately for better social functioning of children and teenagers

The performance of human papillomavirus high-risk DNA testing in the screening and diagnostic settings.

OBJECTIVE: We sought to evaluate the performance of the human papillomavirus high-risk DNA test in patients 30 years and older. MATERIALS AND METHODS: Screening (n=835) and diagnosis (n=518) groups were defined based on prior Papanicolaou smear results as part of a clinical trial for cervical cancer detection. We compared the Hybrid Capture II (HCII) test result with the worst histologic report. We used cervical intraepithelial neoplasia (CIN) 2/3 or worse as the reference of disease. We calculated sensitivities, specificities, positive and negative likelihood ratios (LR+ and LR-), receiver operating characteristic (ROC) curves, and areas under the ROC curves for the HCII test. We also considered alternative strategies, including Papanicolaou smear, a combination of Papanicolaou smear and the HCII test, a sequence of Papanicolaou smear followed by the HCII test, and a sequence of the HCII test followed by Papanicolaou smear. RESULTS: For the screening group, the sensitivity was 0.69 and the specificity was 0.93; the area under the ROC curve was 0.81. The LR+ and LR- were 10.24 and 0.34, respectively. For the diagnosis group, the sensitivity was 0.88 and the specificity was 0.78; the area under the ROC curve was 0.83. The LR+ and LR- were 4.06 and 0.14, respectively. Sequential testing showed little or no improvement over the combination testing. CONCLUSIONS: The HCII test in the screening group had a greater LR+ for the detection of CIN 2/3 or worse. HCII testing may be an additional screening tool for cervical cancer in women 30 years and older

El índice Ka: un nuevo algoritmo para analizar los componentes de la superficie terrestre en imágenes de satélite

El cambio del paisaje de la superficie terrestre, su composición y estructura, ocurrido por causas di- versas, ha estado en la mira de toda la humanidad. Se han desarrollado diversas formas para entender- los y la sensoría remota es lo más reciente y nove- doso para tener un conocimiento rápido de gran- des extensiones. En este estudio se ha desarrollado un nuevo algoritmo para medir estos cambios, así como para identificar valores espectrales de espe- cies de coníferas, utilizando imágenes del satélite Landsat7 ETM+. Los resultados muestran un gran potencial del índice Ka para detectar los diferentes componentes superficiales y su variabilidad debi- do a efectos naturales o antropológicos, etc. The change in the landscape of the terrestrial surface, its composition, and its structure, caused by many factors, has been in the aim of all humanity. Diverse forms have been developed in order to understand them, the sensory remote being the most recent and novel thing in acquiring fast knowledge of large extensions. In this study a new algorithm has been developed to measure these changes, as well as to identify ghastly values of coniferous species using images of the satellite Landsat7 ETM+. The results show a great potential of the Ka index in detecting the different superfi- cial components and its variability due to natural effects or due to man