Select, route and schedule: optimizing community paramedicine service delivery with mandatory visits and patient prioritization.

Healthcare delivery in the United States has been characterized as overly reactive and dependent on emergency department care for safety net coverage, with opportunity for improvement around discharge planning and high readmissions and emergency department bounce-back rates. Community paramedicine is a recent healthcare innovation that enables proactive visitation of patients at home, often shortly after emergency department and hospital discharge. We establish the first optimization-based framework to study efficiencies in the management and operation of a community paramedicine program. The collective innovations of our modeling include i) a novel hierarchical objective function with the goals of fairly increasing patient welfare, lowering hospital costs, and reducing readmissions and emergency department visits, ii) a new constraint set that ensures priority same-day visits for emergent patients, and iii) a further extension of our model to determine the minimum supplemental resources necessary to ensure feasibility in a single optimization formulation. Our medical-need based objective function prioritizes patients based on their clinical features and seeks to select and schedule patient visits and route healthcare providers to maximize overall patient welfare while favoring shorter tours. We use our methods to develop managerial insights via computational experiments on a variety of test instances based on real data from a hospital system in Upstate New York. We are able to identify optimal and nearly optimal tours that efficiently select, route, and schedule patients in reasonable timeframes. Our results lead to insights that can support managerial decisions about establishing (and improving existing) community paramedicine programs.

Versatile high-performance inkjet-printed paper photo-actuators based on 2D materials.

In this paper, we present high-performance and versatile inkjet-printed paper photo-actuators based on two-dimensional (2D) nanomaterials. As a rapid fabrication method, inkjet printing of 2D materials is used to promptly fabricate photo-actuators in a bi-layer paper/polymer structure. Water-based and biocompatible inks based on graphene and molybdenum disulfide are developed based on liquid phase exfoliation and differential centrifugation technique. It is shown that incorporation of 2D materials with inkjet printing techniques and liquid phase exfoliation can lead to rapid fabrication of photo-actuators with huge opto-mechanical energy release and versatility with a broad range of applications due to specific design and methods presented in this paper.

Radioprotective Effect of Cerium Oxide Nanoparticles Against Genotoxicity Induced by Ionizing Radiation on Human Lymphocytes.

BACKGROUND: Ionizing radiation induces DNA damage on normal cell results in apoptosis and cell deaths. OBJECTIVES: The radioprotective effects of cerium oxide nanoparticles (CNPs) on genotoxicity, apoptosis and necrosis induced by Ionizing Radiation (IR) in human healthy lymphocytes as highly radiosensitive cells were investigated. MATERIALS AND METHODS: Lymphocytes were prepared from three volunteers and then treated with CNPs at different concentrations and exposed to IR at dose 1.5 Gy. The radioprotective effects of CNPs were assessed by micronucleus (MN) assay and flow cytometry. Interleukin-1 was quantified in treated samples. RESULTS: It was found that CNPs reduced the percentage of MN induced by IR in lymphocytes up to 73%. CNPs treatment significantly reduced IR-induced apoptotic and necrotic incidences in human lymphocytes. CNPs significantly reduced IL-1ß produced in cell environment exposed to IR. The present study demonstrated that CNPs may be an effective radioprotector against DNA damage and apoptosis induced by IR mainly through mitigation of pro-inflammatory process in lymphocytes. CONCLUSION: This result provides a new potential indication of CNPs for protection of normal cells during radiation therapy in the treatment of cancer or unwanted radiation exposure.