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At the beginning of 2023, the Italian former prime minister, the former health minister and 17 others including the current president of the Lombardy region were placed under investigation on suspicion of aggravated culpable epidemic in connection with the government's response at the start of the COVID-19 pandemic. The charges revolve around the failure by authorities to take adequate measures to prevent the spread of the virus in the Bergamo area, which experienced a significant excess of deaths during the initial outbreak. The aim of this paper is to analyse the pandemic data of Italy and the Lombardy region in the first 10 days of the pandemic, spanning from the 24th of February 2020 to the 4th of March 2020. The objective is to determine whether the use of early warning indicators could have facilitated the identification of a critical increase in infections. This identification, in turn, would have enabled the timely formulation of strategies for pandemic containment, thereby reducing the number of deaths. In conclusion, to translate our findings into practical guidelines, we propose a low-cost early warning method for infectious respiratory diseases with asymptomatic carriers.

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The Centers for Disease Control and Prevention promoted the Test-to-Stay (TTS) program to facilitate in-person instruction in K-12 schools during COVID-19. This program delineates guidelines for schools to regularly test students and staff to minimize risks of infection transmission. TTS enrollment can be implemented via two different consent models: opt-in, in which students do not test regularly by default, and the opposite, opt-out model. We study the impacts of the two enrollment approaches on testing and positivity rates with data from 259 schools in Illinois. Our results indicate that after controlling for other covariates, schools following the opt-out model are associated with 84% higher testing rate and 30% lower positivity rate. If all schools adopted the opt-out model, 20% of the total lost school days could have been saved. The lower positivity rate among the opt-out group is largely explained by the higher testing rate in these schools, a manifestation of status quo bias.

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This paper presents a methodology for assessing the impact of electric vehicles (EVs) on the power transmission grid of the Costa Rica Power System. The methodology considers penetration scenarios, user preferences, charging habits, and expected fleet growth. Using ETAP software, the study simulates power flow, demand behavior, and voltage levels in the presence of high penetration of electric vehicles. The analysis covers a 15-year horizon and focuses on voltage and demand profiles in 2025, 2030, and 2040. The results indicate a decline in voltage profiles that reaches dangerous levels after 2030, primarily in the distribution grid, and an increase in demand by Image 1 for 2040 in the most severe scenario. The analysis also reveals several key findings (a) the identification of problems in the electrical infrastructure starting in 2030 and a major insufficiency in accommodating the increase in EVs by 2040; (b) the need to evaluate stability in transmission grids considering loadability and voltage; (c) the necessity of investing in electrical infrastructure, driven by public policies, to meet future energy requirements and strengthen transmission networks; (d) the significance of accounting for both EV growth and electric infrastructure improvements in system analysis; and (e) the anticipation that the system's performance will fall within the extreme demand values presented in the analysis. The study emphasizes the importance of considering a broader range of scenarios and variability in parameters, especially user charging behaviors, to enable decision-makers to plan for the challenges and opportunities associated with the widespread adoption of EVs in a country's power grid.

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The fine chemical industry is currently facing challenges in energy saving, material conservation, and pollution reduction due to the dual policy pressure of precise system management and collaborative pollution and carbon reduction. However, the interweaving of materials and energy input-output was not well understood due to the incomplete coverage and the lack of a generic framework. Therefore, a methodology based on the energy-material-pollution (E-M-P) coupling nexus was proposed to quantitatively assess multi-level coupling. According to the selected generic 32 coupling units, two representative glyphosate (PMG) production processes were taken as case studies. Quantification results showed that the solvent element and the material system had a higher priority. Moreover, Process 2 owned a greater optimization potential as the coupling relationship pairs were 2.55 compared to 2.32 for Process 1, and the correlation proportions of material systems reached 69.26 % and 56.92 %, respectively. In addition, assessment results indicated that Process 2 was more environmentally friendly because of the lower ecological indexes (9.7 GPt vs. 15.8 GPt) and weaker carbon footprint (CF) (1.16E+08 vs. 2.32E+08). Combined coupling nexus and environmental assessment organically, methanol had the most optimization potential and was beneficial for the measures such as solvent substitution. This work offered theory and practice guidance with demonstrative value to support the sustainable development of precise system management.

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Healthcare System Management (HSM) is a technique for integrating technology in public hospitals. Knowledge of strategies and decision-making issues is crucial for improving hospital services during the HSM implementation since it directly impacts the efficiency of the hospital and the level of the patient healthcare system. To address the research gap, this study presents a hybrid decision making model that combines the Analysis Hierarchical Process (AHP) method and the Analytic Network Process (ANP) to select Balanced Scorecard Policy (BSP) indicators for evaluating HSM application in a resource-limited background. The hybrid modeling approach not only assists in allocating resources for the execution of HSM but also in determining the significance of the relationship between each analyzed aspect. The hierarchical structure used in this study's quantitative and qualitative relations assessment can also assist various medical facilities in determining how the evaluation criteria and the resources needed to provide HSM services are related. In addition, the management decision policy is shown by the BSP in a healthcare center by combining the two methods mentioned satisfy the goal of strategy weights and limited resources. Finally, the article results indicate that the proposed method increases the efficiency of decisions and maximizes the can improve the reliability in HSM.

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INTRODUCTION: Systematic collection and analysis of surgical outcomes data is a cornerstone of surgical quality improvement. Unfortunately, there remains a dearth of surgical outcomes data from low- and middle-income countries (LMICs). To improve surgical outcomes in LMICs, it is essential to have the ability to collect, analyze, and report risk-adjusted postoperative morbidity and mortality data. This study aimed to review the barriers and challenges to developing perioperative registries in LMIC settings. METHODS: We conducted a scoping review of all published literature on barriers to conducting surgical outcomes research in LMICs using PubMed, Embase, Scopus, and GoogleScholar. Keywords included 'surgery', 'outcomes research', 'registries', 'barriers', and synonymous Medical Subject Headings derivatives. Articles found were subsequently reference-mined. All relevant original research and reviews published between 2000 and 2021 were included. The performance of routine information system management framework was used to organize identified barriers into technical, organizational, or behavioral factors. RESULTS: Twelve articles were identified in our search. Ten articles focused specifically on the creation, success, and obstacles faced during the implementation of trauma registries. Technical factors reported by 50% of the articles included limited access to a digital platform for data entry, lack of standardization of forms, and complexity of said forms. 91.7% articles mentioned organizational factors, including the availability of resources, financial constraints, human resources, and lack of consistent electricity. Behavioral factors highlighted by 66.6% of the studies included lack of team commitment, job constraints, and clinical burden, which contributed to poor compliance and dwindling data collection over time. CONCLUSIONS: There is a paucity of published literature on barriers to developing and maintaining perioperative registries in LMICs. There is an immediate need to study and understand barriers and facilitators to the continuous collection of surgical outcomes in LMICs.

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Literature research on cocreation in healthcare indicates the theoretical sophistication of research on collaboration between healthcare professionals and patients. Our research continues in the new area of Health 4.0. Cocreation has become an essential concept in the value creation process; by involving consumers in the creation process, better results are achieved regarding product quality and alignment with customer expectations and needs. In addition, consumer involvement in the creation process improves its efficiency. Cocreation allows for more efficient diagnosis and treatment of patients, as well as better and more effective use of the skills and experience of the health workforce. Our main objective is to determine the scope and depth of the cocreation of health services based on modern technological solutions (Health 4.0). We selected four cases involving Health 4.0 solutions, verified the scale and scope of cocreation using them as examples, and used the cocreation matrix. We used literature, case studies, and interviews in our research. Our analysis shows that patients can emerge as cocreators in the value creation process in Health 4.0. This can happen when they are genuinely involved in the process and when they feel responsible for the results. The article contributes to the existing theory of service cocreation by pointing out the limited scope of patient involvement in the service management process. For cocreation in Health 4.0 to increase the effectiveness of medical services, it is necessary to implement the full scope of cocreation and meaningfully empower the patient and medical workers in the creation process. This article verifies the theoretical analysis presented in our team's previous article.

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OBJECTIVES: This study aimed to investigate the viewpoints of the main stakeholders of the Iranian healthcare system about the overutilization of hospital services and strategies to eliminate or reduce it in Iran. METHODS: This is a qualitative study and thematic data analysis using face-to-face semi-structured interviews and Focus Group Discussions (FGDs). We conducted eight interviewers and two FGDs with hospital stakeholders including faculty members, insurance organizations' authorities, experienced hospital administrative staff, hospital managers, and health-care providers. RESULTS: The factors leading to the overutilization of hospital services were categorized into four main themes including site of service, quality, supplier push, and demand pull. Strategies for eliminating or reducing the overutilization of hospital services are also identified based on the influential factors. CONCLUSION: Addressing overutilization of hospital services in the health system and adherence to policies for reducing or eliminating overutilization is a way to make preventive strategies to overcome overutilization. Developing a national plan to integrate utilization management into health system programs is a strategy to combat overutilization in various levels of the health system including hospital setting.

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Medicines for Europe held its 2022 annual conference in Sitges, Spain, from June 29 to July 1. Many topics were discussed including future-proofing healthcare systems in the E.U., methods to build a sustainable European ecosystem to incentivize the development of value-added medicines (VAMs), how to reshape national market policies and build a strong European co-operation to prevent shortages. In addition, attendants discussed key challenges and barriers that need to be addressed to ensure the E.U. remains a leader and an innovator in medicines manufacturing, as well as national strategies and practices influencing the sustainability of the biosimilar medicines market and patient access to biological medicines.

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INTRODUCTION: Maturity models assess the snapshot view of an organization and simultaneously guides the organization to advance on a road map towards ultimate levels of maturity. The health industry has recently embraced maturity models as a tool to improve the management of health information systems. Most electronic health information systems in Sri Lanka need assessment and monitoring and can benefit vastly by adopting maturity models. This study was conducted to modify and adopt a maturity model for public health institutions in Sri Lanka. METHODS: A review of the literature was done to identify a suitable model to measure the maturity of the public health information system implementations. A Modified Delphi study was then carried out with six experts to adapt the selected maturity tool, Public Health Information Technology (PHIT) maturity index, to the Sri Lankan context. Necessary modifications to the PHIT tool were done according to the comments gathered in the Modified Delphi rounds, and the validity of the tool was established. Finally, Key Informant Interviews were carried out with nine interviewees to qualitatively validate the instrument. RESULTS: The Public Health Information Technology maturity index developed by the University of Maryland, USA, was modified to suit the Sri Lankan context. Comments from the experts were accommodated during the initial rounds of the Modified Delphi study. It further derived the following values, indicating excellent content validity: I-CVI > 0.8 for 57 total items, S-CVI/Avg = 0.988, S-CVI/UA = 0.929 and Free-marginal kappa = 0.95. DISCUSSION AND CONCLUSIONS: Modified and validated PHIT tool can be used to measure the maturity of public health institutions in similar contexts.

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The development of ecological economy is one of the core elements of the ecological civilization system and an essential means to optimize the social-ecological systems. The key to developing ecological economy lies in preparing the development plan to realize concrete implementation. Given the objective and realistic demand for the development of ecological economy, it is critically needed to propose the approach of eco-economic planning and conduct empirical research. We sorted out the connotation of ecological economy, proposed the general idea of "object identification-resource evaluation-principal construction-target setting-task content-mechanism guarantee", and proposed three work modules, including "preliminary preparation, content design, review & approval", and finally built a technical system for the preparation of provincial-scale ecological economy planning. We outlined the 14th Five-Year Plan for Eco-Economic Development of Liaoning Province, and discussed critical issues such as the connotation definition and index system establishment for eco-economic development plan. This work provides ideas for the scientific and standardized preparation of ecological economy development plan at the provincial level in China.

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BACKGROUND: The quality of data in electronic health records (EHRs) depends on adherence of clinicians to principles of diagnosis documentation. OBJECTIVE: A concept mapping (CM) approach was used to extract factors related to quality of clinicians' documentation that govern EHR data quality. METHOD: Influential factors extracted from brainstorming sessions were sorted by individual participants, followed by a quantitative analysis using multidimensional scaling and cluster analysis to categorise sorted factors. Finally, a questionnaire was used to elicit the importance-feasibility of the extracted factors. Results were visualised by cluster maps and Go-Zone plots. RESULT: Factors were classified into seven clusters: "knowledge about International Classification of Diseases and clinical coding," "need for facilitators and guidelines," "explaining the importance of the issue and defining responsibilities," "cooperation of other personnel," "codify legal requirements," "workload" and "clinical obstacles," as ranked by importance. CONCLUSION: To enhance the quality of EHR data, a collaboration between physicians, nurses, managers and EHR developers is required. CM is an acceptable approach to meet this objective. Our findings highlight the significance of clinical coding knowledge, awareness about its importance and applicability and use of well-structured information systems. In combination, these three factors can have a strong positive impact on the quality of EHR data. IMPLICATIONS: A list of solutions is provided for policymakers, and two interventions suggested, based on the findings of this study, including the adoption of EHRs that incorporate documentation guidelines. We further propose updated clinical training programs and a monitoring and feedback mechanism to facilitate the EHR documentation process.

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FPGA-based data acquisition and processing systems play an important role in modern high-speed, multichannel measurement systems, especially in High-Energy and Plasma Physics. Such FPGA-based systems require an extended control and diagnostics part corresponding to the complexity of the controlled system. Managing the complex structure of registers while keeping the tight coupling between hardware and software is a tedious and potentially error-prone process. Various existing solutions aimed at helping that task do not perfectly match all specific requirements of that application area. The paper presents a new solution based on the XML system description, facilitating the automated generation of the control system's HDL code and software components and enabling easy integration with the control software. The emphasis is put on reusability, ease of maintenance in the case of system modification, easy detection of mistakes, and the possibility of use in modern FPGAs. The presented system has been successfully used in data acquisition and preprocessing projects in high-energy physics experiments. It enables easy creation and modification of the control system definition and convenient access to the control and diagnostic blocks. The presented system is an open-source solution and may be adopted by the user for particular needs.

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Pandemics can result in significantly high rates of morbidity and mortality with higher impact in Lower- and Middle-Income Countries like Nigeria. Health systems have an important role in a multi-sector response to pandemics, as there are already concerns that COVID-19 will significantly divert limited health care resources. This study appraised the readiness and resilience of the Nigerian health system to the COVID-19 pandemic, using Oyo State, southwest Nigeria, as a case study. This study was a cross-sectional qualitative study involving key informant and in-depth interviews. Purposive sampling was used in recruiting participants who were members of the Task Force on COVID-19 in the state and Emergency Operations Centre (EOC) members (physicians, nurses, laboratory scientists, "contact tracers", logistic managers) and other partners. The state's health system response to COVID 19 was assessed using the WHO health systems framework. Audio recordings of the interviews done in English were transcribed and thematic analysis of these transcripts was carried out using NVIVO software. Results show that the state government responded promptly by putting in place measures to address the COVID-19 pandemic. However, the response was not adequate owing to the fact that the health system has already been weakened by various challenges like poor funding of the health system, shortage of human resources and inadequate infrastructure. These contributed to the health system's sub-optimal response to the pandemic. In order to arm the health system for adequate and appropriate response during major health disasters like pandemics, fundamental pillars of the health system-finance, human resources, information and technology, medical equipment and leadership - need to be addressed in order to have a resilient health system.

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COVID-19 infections can spread silently, due to the simultaneous presence of significant numbers of both critical and asymptomatic to mild cases. While, for the former reliable data are available (in the form of number of hospitalization and/or beds in intensive care units), this is not the case of the latter. Hence, analytical tools designed to generate reliable forecast and future scenarios, should be implemented to help decision-makers to plan ahead (e.g., medical structures and equipment). Previous work of one of the authors shows that an alternative formulation of the Test Positivity Rate (TPR), i.e., the proportion of the number of persons tested positive in a given day, exhibits a strong correlation with the number of patients admitted in hospitals and intensive care units. In this paper, we investigate the lagged correlation structure between the newly defined TPR and the hospitalized people time series, exploiting a rigorous statistical model, the Seasonal Auto Regressive Moving Average (SARIMA). The rigorous analytical framework chosen, i.e., the stochastic processes theory, allowed for a reliable forecasting about 12 days ahead of those quantities. The proposed approach would also allow decision-makers to forecast the number of beds in hospitals and intensive care units needed 12 days ahead. The obtained results show that a standardized TPR index is a valuable metric to monitor the growth of the COVID-19 epidemic. The index can be computed on daily basis and it is probably one of the best forecasting tools available today for predicting hospital and intensive care units overload, being an optimal compromise between simplicity of calculation and accuracy.

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Description Health-system pharmacy leaders are tasked with determining key staffing decisions based on evolving patient care needs and present-day staffing capacity. A systematic approach to evaluate patient care needs, current model and potential gaps enables leaders to allocate resources in patient care need expansions or sudden fluctuations of patient volumes. Resource management, preparedness and ongoing maintenance form principles used by pharmacy leaders to create an optimal operational environment and elevate clinical pharmacy services. Use of this approach for multiple sites of care across a large network of health systems resulted in identification and improvement in pharmacist coverage and retention of clinical pharmacy services in a critical time of economic uncertainty. Hospitals working toward expanding to 24/7 pharmacist coverage may also consider this systematic approach to elucidate their needs.

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We evaluated the hygienic influence of onsite sanitation systems (OSSs) on drinking water wells in rural Sri Lanka by determining the safe setback distance between wells and the management of OSSs. Although previous studies have used bacterial indicators such as E. coli to evaluate the OSS impact, these parameters cannot assess the hygiene risk for waterborne pathogenic viruses (e.g. rotaviruses). Therefore, pepper mild mottle virus was selected as an indicator of human-specific faecal virus contamination. From a viral perspective, not only can the horizontal distance between a well and the nearest OSS reasonably represent hygiene safety, but the OSS sludge management can mitigate the contamination of wells even at short distances from the OSSs. Quantitative microbial risk assessment suggests that the infection risk of rotavirus was extremely high compared to the international standard. As proper management of OSSs would be key to reducing viral risk, it is necessary to reach out to the residents who are unaware of the importance and necessity of such management.

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This article deliberates about the importance of polymer-based bioadhesive biomaterials' medical application in healthcare and in redefining healthcare management. Nowadays, the application of bioadhesion in the health sector is one of the great interests for various researchers, due to recent advances in their formulation development. Actually, this area of study is considered as an active multidisciplinary research approach, where engineers, scientists (including chemists, physicists, biologists, and medical experts), material producers and manufacturers combine their knowledge in order to provide better healthcare. Moreover, while discussing the implications of value-based healthcare, it is necessary to mention that health comprises three main domains, namely, physical, mental, and social health, which not only prioritize the quality healthcare, but also enable us to measure the outcomes of medical interventions. In addition, this conceptual article provides an understanding of the consequences of the natural or synthetic polymer-based bioadhesion of biomaterials, and its significance for redefining healthcare management as a novel approach. Furthermore, the research assumptions highlight that the quality healthcare concept has recently become a burning topic, wherein healthcare service providers, private research institutes, government authorities, public service boards, associations and academics have taken the initiative to restructure the healthcare system to create value for patients and increase their satisfaction, and lead ultimately to a healthier society.

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BACKGROUND: Health systems worldwide function in constantly changing local and global ecosystems. This is the result of economic, demographic, and technological changes, among others. In recent decades Israel has started implementing reforms in the public health services that have led to far-reaching changes in the health system, and consequently, increased competition within it. The impact of these changes has been exacerbated by pressure to reduce per capita public health costs, coupled with increased demand and greater health awareness. All these changes have created a turbulent environment for healthcare organizations in Israel. To cope with this dynamic environment, various parts of the system have had to adopt appropriate management behaviors and business styles. This study, carried out in six public hospitals in Israel, evaluates the nature and degree of adaptation, implementation, and inculcation of management strategies in public hospitals in Israel, using the Ginter model of strategic management of health organizations. METHODS: The study used semi-structured in-depth interviews of key figures in the health system and managers at various levels in the hospitals and HMOs included in the sample. The 55 interviews, conducted in two time periods, were analyzed in accordance with an established theory of qualitative methodological analysis. RESULTS: The main findings are that the health market and hospitals in Israel are increasingly adopting competitive business behaviors. But strategic managerial behavior has been adopted only in part, and there is a lack of collaboration between staff and management in defining goals and strategic activity. These are obstacles to change and inculcation of the strategy in hospitals. CONCLUSIONS: This study affords an important view over time and a better understanding of the behavior and adaptation of hospitals in Israel to their constantly changing surroundings. Adapting and inculcating appropriate managerial strategies in hospitals requires close collaboration between staff and management; its absence is an obstacle that contributes to partial, and possibly counter-productive, strategic behavior. The solution may lie in a combination of changes: providing hospital management with the necessary tools and broad professional support by the Ministry of Health; organizational changes in hospital management and departments; the creation of a clinical leadership role; and a self-supervised planning system . POLICY RECOMMENDATIONS: These recommendations regarding training and the direction and organization of the change, coupled with systemic oversight of them by the Ministry of Health, will enable the system to become more efficient. They are particularly relevant today because the Covid-19 pandemic has exacerbated and highlighted Israeli public hospitals' financial and organizational problems. Hospitals that already faced many challenges have had to cope with an unfamiliar medical crisis and a reduction of elective medical activity, causing them various types of damage, especially in term of economic stability. The hospitals' fragile situation must become a top government priority because it can no longer be ignored. To achieve a strong healthcare system with stable hospitals, able to respond both to everyday challenges and to crises like the current pandemic, policymakers must provide financial and organizational support alongside managerial training, while maintaining an overall systemic plan.

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