The telehealth surge: Speech-language pathology mode of service delivery and consumer characteristics during COVID-19.

PURPOSE: To examine the characteristics of speech-language pathology (SLP) consumers prior to and during the COVID-19 pandemic, with respect to the mode of service delivery within a local health district in New South Wales, Australia, to inform future health service planning. METHOD: Observational study examining SLP occasions of service data pre-COVID-19 (2019-2019; n = 6413) and during the COVID-19 pandemic (2020-2021; n = 6908). Spatial mapping and multilevel models were used to examine associations between sociodemographic characteristics, telehealth utilisation, and videoconferencing. RESULT: During COVID-19, SLP occasions of service increased by 7.7% compared to pre-COVID-19. Model 1 found odds of adopting telehealth (telephone or videoconference) during COVID-19 were significantly higher for those aged 0-4 and 5-17 years compared to older age groups. Consumers in inner regional areas were significantly less likely to adopt telehealth than in major city areas, whereas females were significantly more likely to adopt telehealth. Those living in areas experiencing higher relative disadvantage were less likely to use telehealth. Model 2 found odds of adopting videoconferencing only were also significantly higher for the younger age groups (0-4 and 5-17 years) and females. CONCLUSION: A rapid transition to a virtual model of care was critical to the successful delivery of SLP services during COVID-19. Immediate prioritisation and integration of targeted models of care, where suitability is high and benefits most likely to be experienced, is feasible.

Nurses' perception of epidural services in a Johannesburg academic setting.

BACKGROUND:  Labour pain is associated with detrimental maternal and foetal physical and psychological effects. Labour analgesia is a basic right for all women and labour epidural analgesia has been accepted as the gold standard for providing such, with reported improvement in patient satisfaction. In South Africa, studies have shown that labour epidural rates are low. At an academic hospital in Johannesburg, a 24-h labour epidural service combined with an awareness campaign and educational programme (LEAP) was initiated with the aim of improving labour epidural rates. Results showed a short-lived uptake with a subsequent decline. OBJECTIVES:  This study explored the experiences of labour ward nursing staff regarding the labour epidural service at this academic hospital including perceived limitations and possible recommendations regarding improving service provision. METHOD:  A qualitative, descriptive and exploratory study was conducted. Purposive sampling was used with semistructured, audio-recorded individual interviews, thematic analysis was performed using Braun and Clarke's six-phase approach. RESULTS:  The key theme is required education and supervision of epidural insertion (see page 3), management of childbirth and challenges related to epidural service provision. CONCLUSION:  A positive sentiment was expressed by the participants; however, deficiencies in the service such as shortages of experienced personnel, work constraints and insufficient training may be affecting service sustainability. Further studies are recommended to form guidance towards the development and implementation of interventions to improve service delivery.Contribution: Provision of continual training and increased staffing of healthcare personnel will help improve the sustainability of the labour epidural service.

[Characteristics of applicants with first-time determination of need for long-term care-A nationwide analysis of care assessments of applicants insured with the AOK aged 60 years and above]. / Charakteristika von Antragstellenden bei erstmaliger Feststellung einer Pflegebedürftigkeit ­ eine bundesweite Analyse von Pflegebegutachtungen von AOK-Versicherten ab 60 Jahren.

BACKGROUND: The increasing number of care-dependent individuals requires approaches to prevent care dependency or reduce the loss of independence. Long-term care assessments can provide valuable insights into this. OBJECTIVE: The aim of this article is to describe initial applicants with an identified need for long-term care as well as to provide a differentiated analysis of care-related diagnoses by age, gender, care level and federal state. MATERIAL AND METHODS: The nationwide database consists of long-term care assessments conducted by the Medical Service (MD) of individuals insured with the AOK aged 60 years and above who received a care level (PG) for the first time in 2021. Information relevant to long-term care was analyzed descriptively. RESULTS: In this study 339,486 individuals with an average age of 79.6 years (±8.4 years) and a female proportion of 59.0% were analyzed. Approximately one half received care level 2 and 32.4% received care level 1. Care levels 3-5 were assessed less frequently (16.2% vs. 4.8% vs. 1.7%, respectively). Individuals living alone were represented more strongly in lower care levels, while individuals not living alone had a higher proportion in care levels 3-5. The most frequent care-relevant diagnoses were senility (R54), polyarthritis (M15) and dementia (F03) with significant differences observed between federal states (ICD-10 R chapter: 0.8% Berlin and Brandenburg vs. 37.9% Saxony; M chapter: 13.6% Bavaria and Hamburg vs. 39.9% Mecklenburg-Western Pomerania). CONCLUSION: Social determinants, such as age, gender, living alone, and region can play a role in the classification into a care level. Significant differences in care-related diagnoses between federal states warrant further investigation in future research.

The impact of COVID-19 restrictions on HIV prevention and treatment services for key populations in South Africa: an interrupted time series analysis.

BACKGROUND: Key populations (KP), including men who have sex with men (MSM), female sex workers (FSW), and transgender women (TGW), experience a disproportionate burden of HIV, even in generalized epidemics like South Africa. Given this disproportionate burden and unique barriers to accessing health services, sustained provision of care is particularly relevant. It is unclear how the COVID-19 pandemic and its associated restrictions may have impacted this delivery. In this study, we aimed to describe patterns of engagement in HIV prevention and treatment services among KP in South Africa and assess the impact of different COVID-19 restriction levels on service delivery. METHODS: We leveraged programmatic data collected by the US President's Emergency Plan for AIDS Relief (PEPFAR)-supported KP partners in South Africa. We divided data into three discrete time periods based on national COVID-19 restriction periods: (i) Pre-restriction period, (ii) High-level restriction period, and (iii) After-high level restriction period. Primary outcomes included monthly total HIV tests, new HIV cases identified, new initiations of pre-exposure prophylaxis (PrEP), and new enrollments in antiretroviral therapy (ART). We conducted interrupted time series segmented regression analyses to estimate the impact of COVID-19 restrictions on HIV prevention and treatment service utilization. RESULTS: Between January 2018 and June 2022, there were a total of 231,086 HIV tests, 27,051 HIV positive cases, 27,656 pre-exposure prophylaxis (PrEP) initiations, and 15,949 antiretroviral therapy initiations among MSM, FSW and TGW in PEPFAR-supported KP programs in South Africa. We recorded 90,457 total HIV tests during the 'pre-restriction' period, with 13,593 confirmed new HIV diagnoses; 26,134 total HIV tests with 2,771 new diagnoses during the 'high-level restriction' period; and 114,495 HIV tests with 10,687 new diagnoses during the after high-level restriction period. Our Poisson regression model estimates indicate an immediate and significant decrease in service engagement at the onset of COVID-19 restrictions, including declines in HIV testing, treatment, and PrEP use, which persisted. As programs adjusted to the new restrictions, there was a gradual rebound in service engagement, particularly among MSM and FSW. Towards the end of the high-level restriction period, with some aspects of daily life returning to normal but others still restricted, there was more variability. Some indicators continued to improve, while others stagnated or decreased. CONCLUSION: Service provision rebounded from the initial shock created by pandemic-related restrictions, and HIV services were largely maintained for KP in South Africa. These results suggest that HIV service delivery among programs designed for KP was able to be flexible and resilient to the evolving restrictions. The results of this study can inform plans for future pandemics and large-scale disruptions to the delivery of HIV services.

The effect of technology-based service characteristics on relationship quality in metaverse exercise services: a questionnaire survey of bicycle simulator users in Korea.

BACKGROUND: As non-face-to-face contact has become a daily routine owing to the development of science and technology and impact of the coronavirus disease (COVID-19) pandemic, online technology-based services (TBSSs) have been expanding. Consequently, in virtual metaverse exercise spaces, the number of participants using TBSS is increasing. This study aimed to examine the effects of TBSS characteristics on the quality of the relationship between service providers and users of metaverse exercise services. METHODS: The participants were metaverse exercise service users in Korea, who were selected through purposive sampling (n = 254, 194 men, 61 women). A questionnaire survey was conducted to measure the participants' TBSS characteristics (enjoyment, stability, usefulness, ease of use, and reliability) and relationship quality (satisfaction, trust, and commitment). We analyzed the frequency, validity, reliability, and descriptive statistics of the collected data. Moreover, correlation and multivariate multiple regression analyses were conducted. RESULTS: Enjoyment, stability, usefulness, and reliability of TBSS had positive effects on satisfaction; however, ease of use did not have a significant effect. In addition, enjoyment, usefulness, ease of use, and reliability of TBSS had positive effects on trust; however, stability did not have a significant effect. Furthermore, enjoyment and reliability of TBSS had positive effects on commitment; however, usefulness, ease of use, and stability had no significant effects. CONCLUSIONS: This study provides metaverse exercise service providers with management strategies for attracting and retaining members. The results of this study could help develop effective TBSS and aid metaverse service companies facing a fiercely competitive environment.

Quality and safety in prehospital airway management - retrospective analysis of 18,000 cases from an air rescue database in Germany.

BACKGROUND: Prehospital airway management remains crucial with regard to the quality and safety of emergency medical service (EMS) systems worldwide. In 2007, the benchmark study by Timmermann et al. hit the German EMS community hard by revealing a significant rate of undetected oesophageal intubations leading to an often-fatal outcome. Since then, much attention has been given to guideline development and training. This study evaluated the incidence and special circumstances of tube misplacement as an adverse peri-intubation event from a Helicopter Emergency Medical Services perspective. METHODS: This was a retrospective analysis of a German helicopter-based EMS database from January 1, 2012, to December 31, 2020. All registered patients were included in the primary analysis. The results were analysed using SPSS 27.0.1.0. RESULTS: Out of 227,459 emergency medical responses overall, a total of 18,087 (8.0%) involved invasive airway management. In 8141 (45.0%) of these patients, airway management devices were used by ground-based EMS staff, with an intubation rate of 96.6% (n = 7861), and alternative airways were used in 3.2% (n = 285). Overall, the rate of endotracheal intubation success was 94.7%, while adverse events in the form of tube misplacement were present in 5.3%, with a 1.2% rate of undetected oesophageal intubation. Overall tube misplacement and undetected oesophageal intubation occurred more often after intubation was carried out by paramedics (10.4% and 3.6%, respectively). In view of special circumstances, those errors occurred more often in the presence of trauma or cardiopulmonary resuscitation, with rates of 5.6% and 6.4%, respectively. Difficult airways with a Cormack 4 status were present in 2.1% (n = 213) of HEMS patients, accompanied by three or more intubation attempts in 5.2% (n = 11). CONCLUSIONS: Prehospital airway management success has improved significantly in recent years. However, adverse peri-intubation events such as undetected oesophageal intubation remain a persistent threat to patient safety. TRIAL REGISTRATION: The study was registered in the German Register for Clinical Studies (number DRKS00028068).

Predictors of evidence-based psychotherapy initiation among veterans with co-occurring PTSD and substance use disorder.

Objective: To compare initiation of PTSD evidence-based psychotherapy (EBP) between Veterans with and without a co-occurring substance use disorder (SUD), and identify factors associated with EBP initiation among Veterans with PTSD-SUD. Method: A national sample of Veterans with PTSD (n = 301,872) and PTSD-SUD (n = 94,515) were identified from VA Electronic Health Record data. Treatment initiation was defined as having at least one mental health encounter associated with Cognitive Processing Therapy or Prolonged Exposure therapy. Generalized estimating equations were used to compare EBP initiation between Veterans with and without co-occurring SUD, and to identify patient- and facility characteristics associated with EBP initiation among Veterans with PTSD-SUD. Results: The majority of Veterans were 30 - 44 years old, male sex, and Non-Hispanic White. No significant differences were observed in EBP initiation between Veterans with and without a co-occurring SUD (OR=1.00, p=0.985). Among Veterans with PTSD-SUD, co-occurring bipolar disorder (OR=0.83, p=.000), co-occurring psychotic disorder (OR=0.69, p=.000), service connection (OR=0.94, p=.001), female sex (OR=0.87, p=.000), and being 60 years or older (OR=0.57, p=.000) were associated with a reduced likelihood of initiating a PTSD EBP. Having a co-occurring anxiety disorder (OR=1.06, p=.020), MST history (OR=1.95, p=.000), and high risk for suicide (OR=1.15, p=.000) were associated with an increased likelihood of initiating EBP. Discussion: These findings support VA provision of EBP for Veterans with PTSD regardless of the presence of co-occurring SUD. Identifying characteristics that increase or reduce the likelihood of EBP initiation may provide insight into treatment pathways and subgroups warranting augmented outreach.

Labor market pathways to job quality mobility in the service sector: Evidence from the "Great Resignation".

Since the mid-1970s, there has been a sharp rise in the prevalence of "bad jobs" in the U.S. labor market, characterized by stagnant wages, unstable work schedules, and limited fringe benefits. Scholarly, policy, and public debate persists, however, about whether these jobs can serve as steppingstones to intra-generational job quality mobility or are instead "poverty traps." While scholarship increasingly recognizes the multi-dimensional nature of job quality, prior research on intra-generational job mobility overwhelmingly estimates only wage mobility and generally focuses on estimating the degree of mobility, to the exclusion of the contexts and mechanisms that foster such mobility. We draw on new panel data collected from 8600 hourly service sector workers between 2017 and 2022 to estimate short-run mobility into good jobs, defined as paying at least $15/hour, having a stable work schedule, and offering paid sick leave, employer-sponsored health insurance, and retirement benefits. Overall, we find that mobility into such "good jobs" is low. However, we show that the rate of transition into "good jobs" is strongly conditioned by local labor market conditions: during the "Great Resignation" and in low state-month unemployment periods, nearly twice the share of workers transitioned to "good jobs" as in less favorable contexts, particularly workers who changed sector as opposed to staying at the same firm or taking new jobs in the service sector. Notably, during periods of labor market tightness, workers who stayed at the same employer had similar rates of mobility into "good jobs" as those who changed employers within the sector.

Feasibility of using electrodermal activity responses to assess level of crowdedness of pedestrian paths.

As urban populations grow, it's imperative to evaluate and enhance the quality of pedestrian paths from the user's perspective. Crowdedness, associated with discomfort and safety, is crucial in determining the overall walking quality and user experience. Previously utilized methods for measuring crowdedness, such as travel diaries and floating population surveys, were limited to collecting perceptual data from sporadic surveys with restricted spatial coverage. Similarly, methods based on CCTV or mobile service data have been used but present issues with blind spots and fail to consider pedestrian perspectives. Against this background, this study explores the feasibility of assessing crowdedness levels by measuring subjects' physiological responses in a laboratory setting based on visual images of real and virtual environments. This study hypothesizes that the amount of people or vehicles passing by affects the electrodermal activity (EDA) of pedestrians, indicating the comfort level of using the environment. Experimental EDA data were measured using a wearable device while the subjects were watching videos showing different pedestrian traffic flows. Representative EDA signal features (e.g., skin conductance responses) were extracted after data pre-processing. Noticeable changes in EDA responses are observed when subjects countered specific environmental variations, such as differing volumes of passing people, on pedestrian paths. The findings suggest that EDA data can be instrumental in differentiating crowdedness levels on pedestrian paths. This study contributes to the body of knowledge by demonstrating the potential of EDA data to characterize the crowdedness experienced by pedestrians. This aids in the development of a novel, quantitative method to gauge pedestrian path crowdedness and to discern contributing factors, such as path width.

Assessing the digital competence of in-service university educators in China: A systematic literature review.

Rapid growth has been witnessed in digital technologies, resulting in significant productive changes in communication and information technology-oriented practices in different fields. Hybrid teaching or blended learning has gained progressively widespread acceptance in the educational process, and concerns about teachers' information and communication technology (ICT) competence or digital competence have become prevalent. This study adopts a systematic review to interpret and analyse the relevant research findings, aiming to systematically investigate the existing models and paradigms of ICT competence or digital capacities and to understand further how these models and paradigms are applied specifically within the context of Chinese universities. Based on inclusion and exclusion criteria, 12 out of 801 candidate studies were accessed from Web of Science, Scopus and the China National Knowledge Infrastructure (CNKI) databases. The findings indicate that the Technological Pedagogical Content Knowledge (TPACK) and the National Educational Technology Guides for Teachers in Higher Education (CETG) are frequently used to evaluate college educators' digital proficiency or ICT capability in China. Educators' demographic characteristics, self-efficacy, external factors such as institutional policies and the availability of infrastructure and training collectively influence how digital teaching is integrated within Chinese higher education institutions. By conducting a systematic review of research trends and the critical factors affecting the digital competence of faculty in Chinese universities, this study aims to equip policymakers and educators with a deeper understanding of how to prepare for educational shifts in the digital era and thereby ensure the sustainability of professional development.

Service time thresholds at barrier-operated freeway exit toll booths.

This paper discusses service times based on vehicle class at barrier-operated toll booths. Service times were measured using four vehicle classifications: car (C), medium goods vehicle (MGV), trucks & bus (TB), and articulated truck (AT) with two payment options: electronic (ETC) and manual toll collection (MTC). Each toll booth has both payment systems and resulting in mixed toll booth utilization in terms of payment and vehicles. The collected data was utilized to estimate logistic regression, and non-parametric statistical tests were performed. Findings indicate, when vehicle size increases, so does service time for even ETC. Furthermore, logistic regression used to compute threshold service times shifting from ETC to MTC for C, MGV, TB, and AT, which were 5.92, 7.51, 10.00, and 12.80 s, respectively. The transition time for a vehicle switch from ETC to MTC based on the logistic curve is denoted by threshold service time. Below the threshold, ETC is more favorable option and affected by barrier and vehicle class. Overall, the results indicate that operators can benefit from more dynamic operational conditions facilitated by threshold service times, enabling adaptive and efficient toll booth operations. Additionally, these thresholds can serve as valuable measure of service quality for managing freeway exits.

Public service motivation, public sector preference and employment of Kenyan medical doctor interns: a cross-sectional and prospective study.

BACKGROUND: Kenya grapples with a paradox; severe public sector workforce shortages co-exist with rising unemployment among healthcare professionals. Medical schools have increased trainee outputs, but only 45% of newly qualified/registered doctors were absorbed by the public sector during 2015-2018. In such a context, we explore what influences doctors' career choices at labour market entry, specifically understanding the role of public service motivation (PSM). METHODS: We conducted a cross-sectional and prospective study of interns and recently graduated doctors to examine PSM, their intention to work in the public sector and their final employment sector and status. We surveyed them on their PSM and job intentions and conducted a prospective follow-up survey of the interns, around one year later, to understand their employment status. FINDINGS: We recruited 356 baseline participants and followed up 76 out of 129 eligible interns. The overall PSM score was high among all participants (rated 4.50/5.00) irrespective of sector preferences. 48% (171/356) of the participants preferred to work in the public sector immediately after internship, alongside 16% (57/356) preferring direct entry into specialist training-commonly in the public sector. Only 13% (46/356) and 7% (25/365) preferred to work in the private or faith-based sector. Despite the high proportion of interns preferring public sector jobs, only 17% (13/76) were employed in the public sector at follow-up and 13% (10/76) were unemployed, due to lack of job availability. CONCLUSION: High PSM scores irrespective of sector preferences suggest that doctors are generally committed to serving the 'public good'. Many intended to work in the public sector but were unable to due to lack of job opportunities. Policymakers have an opportunity to tackle workforce gaps in the public sector as young doctors continue to express a preference for such work. To do this they should prioritise creating adequate and sustainable job opportunities.

Grade 3 cytolysis in a patient with metastatic colorectal cancer consuming a mushroom powder-based alternative therapy.

INTRODUCTION: The use of Complementary Alternative Medicine (CAM) in patients with cancer is increasing. CAM is associated with potential toxicity and drug interactions, particularly with chemotherapy. Here, we report a case of cytolysis and hepatic cholestasis in a patient who was self-medicated with a mushroom powder-based alternative therapy containing Agaricus blazei Murril (ABM) during cancer treatment. CASE REPORT: A 43-year-old woman with metastatic colorectal cancer and hepatic metastases was admitted to our hospital for intravenous chemotherapy. Markers of hepatic grade 3 cytolysis and cholestasis were identified during the pretreatment consultation. The baseline results were within normal limits. MANAGEMENT AND OUTCOME: The chemotherapy was immediately canceled, and further tests were performed. After the investigation, the patient reported taking three mushroom powder-based capsules per day since November 2023. The dietary supplement contained ABM and Hericium erinaceus (HE) powder. After Pharmaceutical analysis, treatment with the supplement was discontinued, and the patient has not resumed. The changes in liver function were also favorable. DISCUSSION: In our case, given the improvement in liver function after CAM discontinuation, hepatic cytolysis appeared to be linked to ABM consumption despite the patient's liver metastases. Pharmaceutical analysis of CAM is essential to ensure the safety and optimization of cancer treatments. Patients should also communicate their CAMs to healthcare professionals and be aware of the consequences of consuming these dietary supplements. Finally, collaboration between pharmaceutical teams and oncologists is essential for optimal management of cancer patients.

Does the Diagnosis-Intervention Packet Payment Reform Impact Medical Costs, Quality, and Medical Service Capacity in Secondary and Tertiary Hospitals? A Difference-in-Differences Analysis Based on a Province in Northwest China.

Purpose: To control medical costs and regulate the behavior of providers, China has formed an original widely piloted case-based payment under the regional global budget, called the Diagnosis-Intervention Packet (DIP). This study aimed to evaluated the impact of the DIP payment reform on medical costs, quality of care, and medical service capacity in a less-developed pilot city in Northwest China. Patients and Methods: We used the de-identified case-level discharge data of hospitalized patients from January 2021 to June 2022 in pilot and control cities located in the same province. We performed difference-in-differences (DID) analysis to examine the differential impact of the DIP reform for the entire sample and between secondary and tertiary hospitals. Results: The DIP payment reform resulted in a significant decrease of total expenditure per case in the entire sample (5.5%, P < 0.01) and tertiary hospitals (9.3%, P < 0.01). In-hospital mortality rate decreased significantly in tertiary hospitals (negligible in size, P < 0.05), as did all-cause readmission rate within 30 days in the entire sample (1.1 percentage points, P < 0.01) and secondary hospitals (1.4 percentage points, P < 0.01). Proportion of severe patients increased significantly in the entire sample (1.2 percentage points, P < 0.05) and tertiary hospitals (2.5 percentage points, P < 0.01). We did not find the DIP reform was associated with a significant change in relative weight per case. Conclusion: The DIP payment reform in the less-developed pilot city achieved short-term success in controlling medical costs without sacrificing the quality of care for the entire sample. Compared with secondary hospitals, tertiary hospitals experienced a greater decline in medical costs and received more severe patients. These findings hold lessons for less developed countries or areas to implement case-based payments and remind them of the variations between different levels of hospitals.

Evaluating customer perspectives on omnichannel shopping satisfaction in the fashion retail sector.

The effective implementation of omnichannel commerce can fundamentally alter how consumers shop online. This study attempted to understand Thai consumers' omnichannel fashion retail purchasing activities. The objectives of the study were to investigate the determinants shaping omnichannel customer experiences within the fashion retail industry and to examine the impact of omnichannel customer experiences on customer satisfaction within the Thai retail industry. The research utilized the Unified Theory of Acceptance and Use of Technology (UTAUT) model to analyze the effects of omnichannels on purchasing behaviors and levels of satisfaction of consumers. The study employed a survey research design, applying simple random sampling to select 509 respondents with omnichannel shopping experience in the clothing and fashion. The respondent data was analyzed using structural equation modeling utilizing the Amos software version 24. Analyzing the results revealed a significant correlation between omnichannel shopping and customer satisfaction in fashion retail shopping. Perceived ease of use, perceived enjoyment, integrated promotions, integrated customer service, and integrated transactions were all found to influence omnichannel experiences favorably. The findings suggest that fashion retailers prioritize customer satisfaction by enhancing their omnichannel experiences through better coordination and synchronization of their different customer service channels.

Retrospective service evaluation of a specialist weaning unit.

Specialist weaning units (SWUs) aim to liberate patients with complex weaning failure from mechanical ventilation and facilitate their discharge from the ICU. This retrospective service evaluation reports the outcomes of a SWU at Wythenshawe Hospital, Manchester between 2017 and 2019. In total, 75.0% (n = 33/44) of patients survived to hospital discharge. Of these patients, 72.7% (n = 24/33) were self-ventilating. Overall, 1-year survival was 68.2% (n = 30/44), whilst 5-year survival was 52.3% (n = 23/44). Whilst this study is relatively small, these findings are encouraging and further support the case for SWUs.

The Impact of COVID-19 on Trauma Emergency Patients in Southeastern Iran.

Objective: With the COVID-19 outbreak in countries around the world, the countries' healthcare systems underwent an unprecedented shock. This study aimed to examine the resilience of the medical service delivery system in providing emergency services during the Covid-19 pandemic. Methods: This study was conducted in a reference hospital in Kerman that provided emergency services to trauma patients. It compared service delivery before and after COVID-19, as well as during the COVID-19 peak and non-peak periods. The compared variables were the number of trauma patients admitted to the hospital and the ICU, the number of patients who died in the hospital due to trauma, and the length of stay in the hospital and the ICU. Results: The pre- and post-COVID-19 comparisons showed no significant difference in the number of daily hospital admissions, ICU admissions, and patient deaths. The median length of stay in the ICU was significantly reduced by almost 2 days during the COVID-19 outbreak. However, the length of stay at the hospital was almost the same. Furthermore, a comparison of the COVID-19 peaks and non-peak periods indicated no statistically significant difference in the number of admissions in the ICU, hospital and ICU length of stay, and trauma-induced mortality. Conclusion: Despite the substantial workload imposed by COVID-19 on hospitals, especially during the peak periods of the disease, the provision of medical services to emergency trauma patients did not drop significantly, and the quality of services provided to patients was within the acceptable range.

Digital marketing innovation: New business models for pharmaceutical and medical device product marketing.

Background: Within the rapidly evolving healthcare landscape in Japan, digital marketing innovations are transforming pharmaceutical and medical device marketing. This study explores the emergence of new business models in the digital marketing, highlighting a transition from traditional methods to more dynamic, data-driven strategies. Methods: InsighTCROSS® is a business model that qualitatively and quantitatively examines three steps based on stratified persona images: (1) verifying the effectiveness of product marketing promotions, (2) identifying competitors from the users' perspective, and (3) developing marketing strategies to counter competition. To demonstrate the effectiveness of this model, a case study was conducted focusing on the current anticoagulant drugs, including apixaban, dabigatran, edoxaban, rivaroxaban, and warfarin. Results: Rivaroxaban, the only drug prescribed for the prevention of thrombus and embolism formation in patients with peripheral artery disease after lower limb revascularization, garnered the most interest from interventional cardiologists performing peripheral vascular interventions, as determined by InsighTCROSS® factor analysis, confirming that the manufacturer's marketing activities have effectively penetrated the market. A survey conducted between 20 September 2023 and 3 October 2023, among members of a cardiology website, identified edoxaban as the market leader with a 39.1% share, followed by apixaban (32.7%) and rivaroxaban (16.8%). The main competitor of edoxaban was warfarin, whereas that of rivaroxaban was apixaban. Decision tree analysis was conducted using InsighTCROSS®, highlighting the strengths and weaknesses of each anticoagulant, providing strategic approaches to exploit competitive weaknesses. For edoxaban, increased use was driven by elderly and poorly adherent patients; for apixaban, high-volume percutaneous coronary intervention centers; and for rivaroxaban, the influence of medical representative detailing. It is recommended to avoid markets where these drugs have a strong presence and to focus marketing activities on leveraging their specific strengths. Conclusion: The findings suggest that digital marketing enhances product visibility and patient engagement, providing valuable insights into market behavior and consumer preferences.

Assessment of air pollution removal by urban trees based on the i-Tree Eco Model: The case of Tehran, Iran.

Air quality concerns have become increasingly serious in metropolises such as Tehran (Iran) in recent years. This study aims to assess the contribution of urban trees in Tehran toward mitigating air pollution and to evaluate the economic value of this ecosystem service using the i-Tree Eco model. To accomplish this objective, we utilized Tehran's original land use map, identifying five distinct land use categories: commercial and industrial, parks and urban forests, residential areas, roads and transportation, and urban services. Field data necessary for this analysis were collected from 316 designated plots, each with a radius of 11.3 m, and subsequently analyzed using the i-Tree Eco model. The locations of these plots were determined using the stratified sampling method. The results illustrate that Tehran's urban trees removed 1286.4 tons of pollutants in 2020. Specifically, the annual rates of air pollution removal were found to be 134.8 tons for CO; 299.7 tons for NO2; 270.3 tons for O3; 0.7 tons for PM2.5; 489.4 tons for PM10 (particulate matter with a diameter size between 2.5 and 10 µm); and 91.5 tons for SO2, with an associated monetary value of US$1 536 619. However, despite this significant removal capacity, the impact remains relatively small compared with the total amount of pollution emitted in 2020, accounting for only 0.17%. This is attributed to the high emissions rate and low per capita green space in the city. These findings could serve as a foundation for future research and urban planning initiatives aimed at enhancing green spaces in urban areas, thereby promoting sustainable urban development. Integr Environ Assess Manag 2024;00:1-11. © 2024 SETAC.