Refining ambulance clinical response models: The impact on ambulance response and emergency department presentations.

OBJECTIVE: The ambulance service in Victoria, Australia implemented a revised clinical response model (CRM) in 2016 which was designed to increase the diversion of low-acuity Triple Zero (000) calls to secondary telephone triage and reduce emergency ambulance dispatches. The present study evaluates the influence of the revised CRM on emergency ambulance response times and ED presentations. METHODS: A retrospective study of emergency calls for ambulance between 1 January 2015 and 31 December 2018. Ambulance data were linked with ED presentations occurring up to 48 h after contact. Interrupted time series analyses were used to evaluate the impact of the revised CRM. RESULTS: A total of 2 365 529 calls were included. The proportion allocated a Code 1 (time-critical, lights/sirens) dispatch decreased from 56.6 to 41.0% after implementation of the revised CRM. The proportion of calls not receiving an emergency ambulance increased from 10.4 to 19.6%. Interrupted time series analyses demonstrated an improvement in Code 1 cases attended within 15 min (Key Performance Indicator). However, for patients with out-of-hospital cardiac arrest or requiring lights and sirens transport to hospital, there was no improvement in response time performance. By the end of the study period, there was also no difference in the proportion of callers presenting to ED when compared with the estimated proportion assuming the revised CRM had not been implemented. CONCLUSION: The revised CRM was associated with improved Code 1 response time performance. However, there was no improvement in response times for high acuity patients, and no change in the proportion of callers presenting to ED.

Water scarcity in the Kingdom of Saudi Arabia.

Saudi Arabia (SA) is one of the world's arid, most water-scarce nations without permanent water resources. The purpose of this article is to provide a comprehensive overview of Saudi Arabia's water resources availability and reliability in terms of water supply, demand, and the major challenges that water faces. Saudi has an annual water supply of roughly 89.5 m3 per person as consumption is rising in parallel with the country's rapid population growth and development. SA produces the most desalinated seawater in the world, accounting for 22% of worldwide consumption. Due to changes in agricultural demand, Saudi Arabia's overall water needs in 2020 were 15.98 BCM. Apart from agricultural use, the food industry utilizes up to 80% of freshwater supplies, with only around 20% of rain recharging the aquifer, meaning that the region will still be water-stressed by 2025. In addition to wastewater reuse, water expenses should be split between private investors and the government, and water losses in cities should be collected and recycled. Water development projects must also be safeguarded and have long-term viability for the community's future and well-being. Despite previous conservation efforts (public awareness campaigns, television and other public media messages, drip irrigation, and so on), more work is required, including improving water resource infrastructure, implementing environmental use of friendly technologies, and increasing economic feasibility, social acceptability, and management in light of the Sustainable Development Goals (SDG).

Wastewater treatment using moving bed biofilm reactor technology: a case study of ceramic industry.

Biological approaches and coagulation are frequently used to reduce the chemical oxygen demand (COD) for treatment of ceramic effluent water. The technology known as the moving bed biofilm reactor (MBBR) can accomplish this goal. Further, the process of emulsification-aided innovative MBBR using biosurfactants can be proposed for ceramic effluent treatment. In a step-by-step upgrading scheme, biosurfactants and a consortia of halophilic and halotolerant microbial culture was utilized for the treatment of the effluent water. Over the course of 21 days, a progressive decrease in COD of up to 95.79% was achieved. Over the next 48 h period, the biochemical oxygen demand (BOD) was reduced by 98.3%, while total suspended solids (TSS) decreased by 79.41%. With the use of this innovative MBBR technology, biofilm formation accelerated, lowering the COD, BOD, and TSS levels. This allows treated water to be used for further research on recycling it back into the ceramics sector and repurposing it for agricultural purposes. PRACTITIONER POINTS: Implementation of modified MBBR technology for the treatment of effluent water. Biosurfactants could reduce in the organic and inorganic loads. Increase in MLSS values with COD removal observed. The plant operations without the use of chemical coagulants was effective with biosurfactants. Biofilm formation on carriers was scraped and the presence of surfactin and rhamnolipid was confirmed.

A pH/ROS-responsive antioxidative and antimicrobial GelMA hydrogel for on-demand drug delivery and enhanced osteogenic differentiation in vitro.

Long-term inflammation, including those induced by bacterial infections, contributes to the superfluous accumulation of reactive oxygen species (ROS), further aggravating this condition, decreasing the local pH, and adversely affecting bone defect healing. Conventional drug delivery scaffold materials struggle to meet the demands of this complex and dynamic microenvironment. In this work, a smart gelatin methacryloyl (GelMA) hydrogel was synthesized for the dual delivery of proanthocyanidin and amikacin based on the unique pH and ROS responsiveness of boronate complexes. Fourier-transform infrared spectroscopy (FTIR) and X-ray photoelectron spectroscopy (XPS) demonstrated the co-crosslinking of two boronate complexes with GelMA. The addition of the boronate complexes improved the mechanical properties, swelling ratio, degradation kinetics and antioxidative properties of the hydrogel. The hydrogel exhibited pH and ROS responses and a synergistic control over the drug release. Proanthocyanidin was responsively released to protect mouse osteoblast precursor cells from oxidative stress and promote their osteogenic differentiation. The hydrogel responded to pH changes and released sufficient amikacin in a timely manner, thereby exerting an efficient antimicrobial effect. Overall, the hydrogel delivery system exhibited a promising strategy for solving infectious and inflammatory problems in bone defects and promoting early-stage bone healing.

Consumer preferences for attributes in sweet beverages and market impacts of beverage innovation.

Consumption of sugar-sweetened beverages (SSB) is considered as an important risk factor for the development of overweight and obesity in populations worldwide, with a particular focus on the risks in the younger parts of the population - children and adolescents. Together with fiscal measures and information tools, innovation-based approaches such as the development of sugar-free or sugar-reduced versions of established beverages and development of new beverage products have been used to reduce this challenge, but the effects of product innovation on sugar intake are not well understood from the literature, as previous studies have largely ignored substitution effects of product innovation in the beverage domain. The objective of the present study was to investigate the potential effectiveness of product innovation as a strategy to affect consumers' intake of energy from sweetened non-alcoholic beverages. Using household panel shopping data from approximately 3000 Danish households over the years 2006-2014, we developed a hedonic pricing approach to estimate the influence of product attributes on consumers' utility, based on observed data for Danish households' purchases of sweet drinks. Overall, the study found that beverages' degree of sweetness positively affected the satiation effect of beverage consumption and in turn made the demand for these beverages less sensitive to e.g. price changes or introduction of competing products, whereas the energy density of the beverages positively affected the demand sensitivity to market changes. Findings like these can be useful for assessing market effects as well as environmental and public health impacts of changes to the market environment.

Determination of seawater COD spectra using double-loop contraction and sorted frog optimization.

This study develops a novel double-loop contraction and C value sorting selection-based shrinkage frog-leaping algorithm (double-contractive cognitive random field [DC-CRF]) to mitigate the interference of complex salts and ions in seawater on the ultraviolet-visible (UV-Vis) absorbance spectra for chemical oxygen demand (COD) quantification. The key innovations of DC-CRF are introducing variable importance evaluation via C value to guide wavelength selection and accelerate convergence; a double-loop structure integrating random frog (RF) leaping and contraction attenuation to dynamically balance convergence speed and efficiency. Utilizing seawater samples from Jiaozhou Bay, DC-CRF-partial least squares regression (PLSR) reduced the input variables by 97.5% after 1,600 iterations relative to full-spectrum PLSR, RF-PLSR, and CRF-PLSR. It achieved a test R2 of 0.943 and root mean square error of 1.603, markedly improving prediction accuracy and efficiency. This work demonstrates the efficacy of DC-CRF-PLSR in enhancing UV-Vis spectroscopy for rapid COD analysis in intricate seawater matrices, providing an efficient solution for optimizing seawater spectra.

Validation of a CFD model for cell culture bioreactors at large scale and its application in scale-up.

Among all the operating parameters that control the cell culture environment inside bioreactors, appropriate mixing and aeration are crucial to ensure sufficient oxygen supply, homogeneous mixing, and CO2 stripping. A model-based manufacturing facility fit approach was applied to define agitation and bottom air flow rates during the process scale-up from laboratory to manufacturing, of which computational fluid dynamics (CFD) was the core modeling tool. The realizable k-ε turbulent dispersed Eulerian gas-liquid flow model was established and validated using experimental values for the volumetric oxygen transfer coefficient (kLa). Model validation defined the process operating parameter ranges for application of the model, identified mixing issues (e.g., impeller flooding, dissolved oxygen gradients, etc.) and the impact of antifoam on kLa. Using the CFD simulation results as inputs to the models for oxygen demand, gas entrance velocity, and CO2 stripping aided in the design of the agitation and bottom air flow rates needed to meet cellular oxygen demand, control CO2 levels, mitigate risks for cell damage due to shear, foaming, as well as fire hazards due to high O2 levels in the bioreactor gas outlet. The recommended operating conditions led to the completion of five manufacturing runs with a 100% success rate. This model-based approach achieved a seamless scale-up and reduced the required number of at-scale development batches, resulting in cost and time savings of a cell culture commercialization process.

Optimal configuration method of demand-side flexible resources for enhancing renewable energy integration.

Demand-side flexible load resources, such as Electric Vehicles (EVs) and Air Conditioners (ACs), offer significant potential for enhancing flexibility in the power system, thereby promoting the full integration of renewable energy. To this end, this paper proposes an optimal allocation method for demand-side flexible resources to enhance renewable energy consumption. Firstly, the adjustable flexibility of these resources is modeled based on the generalized energy storage model. Secondly, we generate random scenarios for wind, solar, and load, considering variable correlations based on non-parametric probability predictions of random variables combined with Copula function sampling. Next, we establish the optimal allocation model for demand-side flexible resources, considering the simulated operation of these random scenarios. Finally, we optimize the demand-side resource transformation plan year by year based on the growth trend forecast results of renewable energy installed capacity in Jiangsu Province from 2025 to 2031.

Antibiofilm activity of polyethylene glycol-quercetin nanoparticles-loaded gelatin-N,O-carboxymethyl chitosan composite nanogels against Staphylococcus epidermidis.

BACKGROUND: Biofilms, such as those from Staphylococcus epidermidis, are generally insensitive to traditional antimicrobial agents, making it difficult to inhibit their formation. Although quercetin has excellent antibiofilm effects, its clinical applications are limited by the lack of sustained and targeted release at the site of S. epidermidis infection. OBJECTIVES: Polyethylene glycol-quercetin nanoparticles (PQ-NPs)-loaded gelatin-N,O-carboxymethyl chitosan (N,O-CMCS) composite nanogels were prepared and assessed for the on-demand release potential for reducing S. epidermidis biofilm formation. METHODS: The formation mechanism, physicochemical characterization, and antibiofilm activity of PQ-nanogels against S. epidermidis were studied. RESULTS: Physicochemical characterization confirmed that PQ-nanogels had been prepared by the electrostatic interactions between gelatin and N,O-CMCS with sodium tripolyphosphate. The PQ-nanogels exhibited obvious pH and gelatinase-responsive to achieve on-demand release in the micro-environment (pH 5.5 and gelatinase) of S. epidermidis. In addition, PQ-nanogels had excellent antibiofilm activity, and the potential antibiofilm mechanism may enhance its antibiofilm activity by reducing its relative biofilm formation, surface hydrophobicity, exopolysaccharides production, and eDNA production. CONCLUSIONS: This study will guide the development of the dual responsiveness (pH and gelatinase) of nanogels to achieve on-demand release for reducing S. epidermidis biofilm formation.

The demand for skills training among Medicaid home-based caregivers.

Medicaid spends nearly 100 billion dollars annually on home and community-based care for the disabled. Much of this care is provided by personal care aides, few of whom have received training related to the services they provide. We conducted a randomized controlled trial to estimate their demand for training. We find that 13 percent of these caregivers complete training without an incentive. Paying the caregivers four times their hourly wage increases training completion by roughly nine percentage points. Additional experimental variation suggests that among individuals confirmed to be aware of the training, the financial incentive increases completion from 35 to 58 percent. Demand curves based on these results suggest that while many caregivers value the opportunity to train, policies aimed at universal take up require large financial incentives.

Own price elasticities of the demand for sugar-sweetened beverages in Bangladesh.

BACKGROUND: Consumption of sugar-sweetened beverages (SSB) is a major global public health problem. Increasing the price of SSBs through taxation is an effective tool to reduce SSB consumption. Price-elasticity estimates are useful in measuring the effect of taxation on consumption. We estimated the own price elasticities of demand for SSBs in Bangladesh, which will inform how SSB taxes could affect behaviour. METHODS: We used Household Income and Expenditure Survey (HIES) 2016 data, which is a nationally representative dataset at the household level across the country and is conducted using stratified random sampling method. Deaton's method was used to estimate the price elasticities for SSBs in Bangladesh. RESULTS: We found that the own price elasticity for SSBs varied between - 0.53% to -1.17% by types of SSBs in Bangladesh. The price elasticity for soft drinks was - 1.17, indicating that if the price of soft drinks increases by 10% via taxes, the quantity consumed of these beverages would reduce by 11.7%. CONCLUSION: This is the first study that estimates the own price elasticities of demand for SSBs in Bangladesh. Our results suggest to raise SSB prices through increased taxation in order to reduce SSB consumption and ensure public health gains in Bangladesh.

Geographic and socioeconomic inequalities in the coverage of contraception in Uttar Pradesh, India.

BACKGROUND: Uttar Pradesh (UP) is the most populous state in India, with a historically lower level of family planning coverage than the national average. In recent decades, family planning coverage in UP has significantly increased, yet there are considerable geographic and socio-economic inequalities. METHODS: The data used for the study is derived from a cross-sectional quantitative survey of 12,200 currently married women conducted during December 2020-February 2021 in UP by the Technical Support Unit. Univariate and bivariate analyses were performed and equiplots were used to make visualizing inequalities easy. RESULTS: The findings of the study reveal significant variation in family planning coverage indicators amongst currently married women in reproductive ages by administrative divisions in UP. For instance, in the Jhansi division, it was 72.4%, while in Faizabad, it was 39.3%. Jhansi division experienced the highest modern contraceptive coverage with the lowest inequity compared to other divisions. However, the range of coverage within the division by Accredited Social Health Activist (ASHA) areas is 25% to 75%. In fact, for some ASHA areas in the Jhansi division, the family planning demand satisfied for modern contraception ranged from more than 85% to less than 22%. On the other hand, the Gonda division with the lowest coverage and lowest inequity for demand satisfied for modern contraception has some ASHA areas with less than 5% and some with more than 36%. The study also revealed intersectionality of education, wealth, place of residence and geographic divisions in identifying inequity patterns. For instance, in case of Mirzapur and Varanasi, the demand satisfied among the illiterates was 69% and the corresponding percentage for literates was 49%. With respect to place of residence, Basti division, where the coverage for modern contraception is extremely low, demand satisfied for modern contraceptive methods is 16.3% among rural residents compared to 57.9% in the case of urban residents. CONCLUSIONS: The findings showed inequality in the modern family planning methods coverage in UP in both best and worst performing divisions. The inequalities exist even in extremely small geographies such as ASHA areas. Within the geographies as well, the socio-economic inequalities persisted. These inequalities at multiple levels are important to consider for effective resource allocation and utilization.

Biotechnological interventions for the production of forskolin, an active compound from the medicinal plant, Coleus forskohlii.

Coleus forskohlii, an Indian-origin medicinal plant is the sole natural source of the labdane terpenoid forskolin (C22H34O7), with growing demand. Forskolin emerged as an industrially important bioactive compound, with many therapeutic applications in human health. It has established potential effects in the treatment of various diseases and conditions such as glaucoma, asthma, obesity, allergies, skin conditions and cardiovascular diseases. Moreover, clinical trials against different types of cancers are progressing. The mechanism of action of forskolin mainly involves activating adenylyl cyclase and elevating cAMP, thereby regulating different cellular processes. For the extraction of forskolin, tuberous roots of C. forskohlii are used as they contain the highest concentration of this metabolite. Approximately 2500 tonnes of the plant are cultivated annually to produce a yield of 2000-2200 kg ha-1 of dry tubers. The forskolin content of the root is distributed in the range of 0.01-1%, which cannot meet the increasing commercial demands from industries such as pharmaceuticals, cosmetics, dietary supplements, food and beverages. Hence, various aspects of micropropagation with different culture methods that employ precursors or elicitors to improve the forskolin content have been explored. Different extraction and analytical methods are also introduced to examine the yield and purity of forskolin. This review discusses the significance, clinical importance, mechanism of action and different approaches used for mass production including tissue culture for the lead compound forskolin to meet market needs.

Uneven response of phytoplankton-bacteria coupling under Saharan dust pulse and ultraviolet radiation in the south-western Mediterranean Sea.

The microbial carbon (C) flux in the ocean is a key functional process governed by the excretion of organic carbon by phytoplankton (EOC) and heterotrophic bacterial carbon demand (BCD). Ultraviolet radiation (UVR) levels in upper mixed layers and increasing atmospheric dust deposition from arid regions may alter the degree of coupling in the phytoplankton-bacteria relationship (measured as BCD:EOC ratio) with consequences for the C-flux through these compartments in marine oligotrophic ecosystem. Firstly, we performed a field study across the south-western (SW) Mediterranean Sea to assess the degree of coupling (BCD:EOC) and how it may be related to metabolic balance (total primary production: community respiration; PPT:CR). Secondly, we conducted a microcosm experiment in two contrasting areas (heterotrophic nearshore and autotrophic open sea) to test the impact of UVR and dust interaction on microbial C flux. In the field study, we found that BCD was not satisfied by EOC (i.e., BCD:EOC >1; uncoupled phytoplankton-bacteria relationship). BCD:EOC ratio was negatively related to PPT:CR ratio across the SW Mediterranean Sea. A spatial pattern emerged, i.e. in autotrophic open sea stations uncoupling was less severe (BCD:EOC ranged 1-2), whereas heterotrophic nearshore stations uncoupling was more severe (BCD:EOC > 2). In the experimental study, in the seawater both enriched with dust and under UVR, BCD:EOC ratio decreased by stimulating autotrophic processes (particulate primary production (PPP) and EOC) in the heterotrophic nearshore area, whereas BCD:EOC increased by stimulating heterotrophic processes [heterotrophic bacterial production (HBP), bacterial growth efficiency (BGE), bacterial respiration (BR)] in the autotrophic open sea. Our results show that this spatial pattern could be reversed under future UVR × Dust scenario. Overall, the impact of greater dust deposition and higher UVR levels will alter the phytoplankton-bacteria C-flux with consequences for the productivity of both communities, their standing stocks, and ultimately, the ecosystem's metabolic balance at the sea surface.

Identifying carbon sequestration's priority supply areas from the standpoint of ecosystem service flow: A case study for Northwestern China's Shiyang River Basin.

Finding important supply areas helps maintain the ecological security of the region and promotes the creation of healthy ecosystems. By considering the ecosystem service flows (ESF), priority provisioning area studies can be approached from a new perspective. This study describes the real supply in terms of flows. The goal was to reveal the priority-ranked supply pattern of ecosystem carbon sequestration services (ECSS) in the Shiyang River Basin (SRB). First and foremost, soil respiration models and Carnegie-Ames-Stanford Approach (CASA) model were used to examine the supply of ECSS, and a combination of natural and human factors was used to determine the demand for ECSS. Second, Python was used to illustrate the ECSS flow trajectories and flows. Lastly, and utilized in conjunction with System Conservation Planning (SCP) to determine supply regions of importance. The results show that, first, the spatial distribution of ECSS supply and demand clearly demonstrates heterogeneity. This is reflected in the spatial characteristics of supply, which are "high in the south and low in the north," and demand, which is "high in the urban areas and low in the suburbs." Second, the middle and lower portions of the basin, where there is little precipitation and little vegetation, are home to the majority of the locations with poor carbon sequestration fluxes. These areas accounted for almost 60 % of the entire watershed area over time. Third, the first priority area of ECSS occupies 19.3 % of the basin's total area, while the second priority area occupies 21.46 %. For the major supply regions, strict ecological protection laws must be implemented going forward in order to ensure the ability to sustain ECSS supply. The long-term growth of SRB as well as ecological and environmental management can benefit from this research's foundational role in policymaking.

Self-actuating inflammation responsive hydrogel microsphere formulation for controlled drug release in rheumatoid arthritis (RA): Animal trials and study in human fibroblast like synoviocytes (hFLS) of RA patients.

Patients with rheumatoid arthritis (RA) often have one or more painfuljoints despite adequate medicine. Local drug delivery to the synovial cavity bids for high drug concentration with minimal systemic adverse effects. However, anti-RA drugs show short half-lives in inflamed joints after intra-articular delivery. To improve the therapeutic efficacy, it is essential to ensure that a drug is only released from the formulation when it is needed. In this work, we developed an intelligent "Self-actuating" drug delivery system where Disease-modifying anti-rheumatic Drug (DMARD) methotrexate is incorporated within a matrix intended to be injected directly into joints. This formulation has the property to sense the need and release medication only when joints are inflamed in response to inflammatory enzyme Matrix metalloproteinases (MMP). These enzymes are important proteases in RA pathology, and several MMP are present in augmented levels in synovial fluid and tissues. A high level of MMP present in synovial tissues of RA patients would facilitate the release of drugs in response and ascertain controlled drug release. The formulation is designed to be stable within the joint environment, but to dis-assemble in response to inflammation. The synthesized enzyme-responsive methotrexate (Mtx) encapsulated micron-sized polymer-lipid hybrid hydrogel microspheres (Mtx-PLHM) was physiochemically characterized and tested in synovial fluid, Human Fibroblast like synoviocytes (h-FLS) (derived from RA patients) and a rat arthritic animal model. Mtx-PLHM can self-actuate and augment the release of Mtx drug upon contact with either exogenously added MMP or endogenous MMP present in the synovial fluid of patients with RA. The drug release from the prepared formulation is significantly amplified to several folds in the presence of MMP-2 and MMP-9 enzymes. In the rat arthritic model, Mtx-PLHM showed promising therapeutic results with the significant alleviation of RA symptoms through decrease in joint inflammation, swelling, bone erosion, and joint damage examined by X-ray analysis, histopathology and immune-histology. This drug delivery system would be nontoxic as it releases more drug only during the period of exacerbation of inflammation. This will simultaneously protect patients from unwanted side effects when the disease is inactive and lower the need for repeated joint injections.

Advancing SSP-aligned scenarios of shipping toward 2050.

Developing comprehensive scenarios for the shipping sector has been a challenge for the Integrated Assessment Model (IAMs) community, influencing how attainable decarbonization is in the sector, and for Earth System Models (ESMs), impacting the climate contribution of shipping emissions. Here we present an approach to develop spatially explicit energy demand projections for shipping in alignment with the Shared Socioeconomic Pathways framework and IAMs projections of global fossil fuel demand. Our results show that shipping could require between 14 and 20 EJ by 2050, corresponding to a 3% and 44% increase from 2018 for the SSP1-1.9 and SSP3-7.0 scenarios. Furthermore, the energy projections we present in this publication can be combined with different fuel mixes to derive emission inventories for climate modeling and, thus, improve our understanding of the various challenges in mitigating emissions for shipping. Through that, we aim to present a framework to incorporate detailed spatial shipping inventories and increase transparency for the scientific community.

The Impact of Medicaid Accountable Care Organizations on Health Care Utilization, Quality Measures, Health Outcomes and Costs from 2012 to 2023: A Scoping Review.

Most of the evidence regarding the success of ACOs is from the Medicare program. This review evaluates the impacts of ACOs within the Medicaid population. We identified 32 relevant studies published between 2012 and 2023 which analyzed the association of Medicaid ACOs and health care utilization (n = 21), quality measures (n = 18), health outcomes (n = 10), and cost reduction (n = 3). The results of our review regarding the effectiveness of Medicaid ACOs are mixed. Significant improvements included increased primary care visits, reduced admissions, and reduced inpatient stays. Cost reductions were reported in a few studies, and savings were largely dependent on length of attribution and years elapsed after ACO implementation. Adopting the ACO model for the Medicaid population brings some different challenges from those with the Medicare population, which may limit its success, particularly given differences in state Medicaid programs.

Multi-objective location-routing optimization based on machine learning for green municipal waste management.

Most of the existing municipal waste management (MWM) systems focus on the optimization of the waste disposal center locations and waste collection paths, which can be modeled based on the location-routing problem (LRP). This study models a green MWM system by a three-objective location-routing problem to achieve equilibrium among the total cost, carbon emission, and residential satisfaction. The amount of waste demand for each customer is considered as an independent discrete random variable following a normal distribution. The multi-objectives and non-deterministic characteristics make this problem more intractable than the traditional LRP. A multi-objective optimization algorithm based on decision tree classifier is proposed for solving this problem. The decision tree classifier learns from previous searching experience, and then guides the following evolution process to avoid blind searching. The experimental results show that the proposed algorithm has high competitiveness compared with other state-of-art methods. A case study is also conducted for a real waste collection problem in a certain area of Beijing. The proposed method adopts efficient location-routing strategies to balance the total cost, carbon emissions, and distance between residential areas and waste disposal centers.

A data-driven combined prediction method for the demand for intensive care unit healthcare resources in public health emergencies.

BACKGROUND: Public health emergencies are characterized by uncertainty, rapid transmission, a large number of cases, a high rate of critical illness, and a high case fatality rate. The intensive care unit (ICU) is the "last line of defense" for saving lives. And ICU resources play a critical role in the treatment of critical illness and combating public health emergencies. OBJECTIVE: This study estimates the demand for ICU healthcare resources based on an accurate prediction of the surge in the number of critically ill patients in the short term. The aim is to provide hospitals with a basis for scientific decision-making, to improve rescue efficiency, and to avoid excessive costs due to overly large resource reserves. METHODS: A demand forecasting method for ICU healthcare resources is proposed based on the number of current confirmed cases. The number of current confirmed cases is estimated using a bilateral long-short-term memory and genetic algorithm support vector regression (BILSTM-GASVR) combined prediction model. Based on this, this paper constructs demand forecasting models for ICU healthcare workers and healthcare material resources to more accurately understand the patterns of changes in the demand for ICU healthcare resources and more precisely meet the treatment needs of critically ill patients. RESULTS: Data on the number of COVID-19-infected cases in Shanghai between January 20, 2020, and September 24, 2022, is used to perform a numerical example analysis. Compared to individual prediction models (GASVR, LSTM, BILSTM and Informer), the combined prediction model BILSTM-GASVR produced results that are closer to the real values. The demand forecasting results for ICU healthcare resources showed that the first (ICU human resources) and third (medical equipment resources) categories did not require replenishment during the early stages but experienced a lag in replenishment when shortages occurred during the peak period. The second category (drug resources) is consumed rapidly in the early stages and required earlier replenishment, but replenishment is timelier compared to the first and third categories. However, replenishment is needed throughout the course of the epidemic. CONCLUSION: The first category of resources (human resources) requires long-term planning and the deployment of emergency expansion measures. The second category of resources (drugs) is suitable for the combination of dynamic physical reserves in healthcare institutions with the production capacity reserves of corporations. The third category of resources (medical equipment) is more dependent on the physical reserves in healthcare institutions, but care must be taken to strike a balance between normalcy and emergencies.