A Multisite Investigation of Areas for Improvement in COVID-19 Surge Capacity Management.

The congressionally authorized National Disaster Medical System Pilot Program was created in December 2019 to strengthen the medical surge capability, capacity, and interoperability of affiliated healthcare facilities in 5 regions across the United States. The COVID-19 pandemic provided an unprecedented opportunity to learn how participating healthcare facilities handled medical surge events during an active public health emergency. We applied a modified version of the Barbisch and Koenig 4-S framework (staff, stuff, space, systems) to analyze COVID-19 surge management practices implemented by healthcare stakeholders at 5 pilot sites. In total, 32 notable practices were identified to increase surge capacity during the COVID-19 pandemic that have potential applications for other healthcare facilities. We found that systems was the most prevalent domain of surge capacity among the identified practices. Systems and staff were discussed across all 5 pilot sites and were the 2 domains co-occurring most often within each surge management practice. These results can inform strategies for scaling up and optimizing medical surge capability, capacity, and interoperability of healthcare facilities nationwide. This study also specifies areas of surge capacity worthy of strategic focus in the pilot's planning and implementation efforts while more broadly informing the US healthcare system's response to future large-scale, medical surge events.

The content and structure of reputation domains across human societies: a view from the evolutionary social sciences.

Reputations are an essential feature of human sociality and the evolution of cooperation and group living. Much scholarship has focused on reputations, yet typically on a narrow range of domains (e.g. prosociality and aggressiveness), usually in isolation. Humans can develop reputations, however, from any collective information. We conducted exploratory analyses on the content, distribution and structure of reputation domain diversity across cultures, using the Human Relations Area Files ethnographic database. After coding ethnographic texts on reputations from 153 cultures, we used hierarchical modelling, cluster analysis and text analysis to provide an empirical view of reputation domains across societies. Findings suggest: (i) reputational domains vary cross-culturally, yet reputations for cultural conformity, prosociality, social status and neural capital are widespread; (ii) reputation domains are more variable for males than females; and (iii) particular reputation domains are interrelated, demonstrating a structure consistent with dimensions of human uniqueness. We label these features: cultural group unity, dominance, neural capital, sexuality, social and material success and supernatural healing. We highlight the need for future research on the evolution of cooperation and human sociality to consider a wider range of reputation domains, as well as their social, ecological and gender-specific variability. This article is part of the theme issue 'The language of cooperation: reputation and honest signalling'.