Hospital dual-channel adoption decisions with telemedicine referral and misdiagnosis.

With the rapid development of telemedicine and the impact of the COVID-19 pandemic, more and more patients are now resorting to using telemedicine channels for healthcare services. However, for hospitals, there exists a lack of managerial guidance in place to help them adopt telemedicine in a practical and standardized way. This study considers a hospital operating with both telemedicine (virtual) and face-to-face (physical) medical channels, and which allocates its capacity by also taking into account the possibility of both referrals and misdiagnosis. Methodologically, we construct a game model based on a queuing framework. We first analyze equilibrium strategies for patient arrivals. Then we propose the necessary conditions for a hospital to develop a telemedicine channel and to operate both channels simultaneously. Finally, we find the optimal decisions for the service level of telemedicine, which can also be regarded as the optimal proportion of diseases treated by telemedicine, and the optimal hospital capacity allocation ratio between the two channels. We also find that hospitals in a full coverage market (e.g., for certain small-scale hospitals and community hospitals or cancer hospitals) are more difficult to adopt telemedicine than hospitals in a partial coverage market (e.g., for comprehensive large-scale hospitals with many potential patients). Small-scale hospitals are more suited to operating telemedicine as a gatekeeper to help triage patients, while large hospitals are more prone to regard telemedicine as a medical channel for providing professional medical services to patients. We also analyze the effects of the telemedicine cure rate and the cost ratio of telemedicine to the physical hospital on the overall healthcare system performance, including the physical hospital arrival rate, patients' waiting time, total profit, and social welfare. Then we compare the performance, ex ante versus ex post, the implementation of telemedicine. It is shown that when the market is partially covered, the total social welfare is always higher than it was before the implementation. However, as far as the profit goes, if the telemedicine cure rate is low and the cost ratio is high, the total hospital profit may be lower than it was prior to using telemedicine. However, the profit and social welfare of hospitals in the full coverage market are always lower than it was before the implementation. In addition, the waiting time in the hospital is always higher than that before the implementation, which means that the implementation of telemedicine will make patients who must receive treatment in the physical hospital face even worse congestion than before. More insights and results are gleaned from a series of numerical studies.

The effect of biomass raw material collection distance on energy surplus factor.

The collection radius of biomass raw materials is an important factor affecting the volume of raw materials for energy utilization. At present, it is usually studied based on a single biomass combined heat and power (CHP) plant. However, as the heat transfer threshold of biomass CHP plant is limited, it is necessary to consider the optimal collection radius and biomass raw material allocation under the distribution mode of multiple power plants to improve the overall utilization rate of raw materials. Biomass raw material collection distance threshold (BCDT) refers to the maximum road length between the resource point (that allows the transportation of raw materials to the biomass CHP plant) and the biomass CHP plant. Under the mode of multi-power plant planning, the greater the BCDT is, the more destinations there will be for raw materials to be transported to from the same resource point, and the more flexible the transportation plans and allocation of transportation volumes will be. This also means more raw materials can be ultimately used for energy utilization, which leads to higher transportation cost. Therefore, determining the appropriate BCDT plays a key role in the unified planning of biomass raw materials. Based on the limitation of heat transfer threshold, this paper carries out multi-power plant planning with Fuxin City as the research object. Based on such planning, ArcGIS is used to generate biomass raw material planning schemes with different BCDTs. Then the transportation cost and energy surplus factor (ratio of renewable resource potential to energy demand) of each scheme are calculated and compared. The results show that there is a positive correlation between BCDT and the energy surplus factor. With the increase of BCDT, the growth rate of the energy surplus factor gradually becomes slower. The study also allows to set the utilization threshold of biomass energy utilization capacity and obtain the corresponding BCDT. In order to achieve a higher energy surplus factor, it is recommended that 40 km be used as the BCDT when carrying out uniform planning for biomass raw materials. At this time, the utilization of biomass energy utilization capacity is 75%, which can achieve a high degree of energy self-sufficiency and ensure its economic competitiveness.

"Poverty is the big thing": exploring financial, transportation, and opportunity costs associated with fistula management and repair in Nigeria and Uganda.

BACKGROUND: Women living with obstetric fistula often live in poverty and in remote areas far from hospitals offering surgical repair. These women and their families face a range of costs while accessing fistula repair, some of which include: management of their condition, lost productivity and time, and transport to facilities. This study explores, through women's, communities', and providers' perspectives, the financial, transport, and opportunity cost barriers and enabling factors for seeking repair services. METHODS: A qualitative approach was applied in Kano and Ebonyi in Nigeria and Hoima and Masaka in Uganda. Between June and December 2015, the study team conducted in-depth interviews (IDIs) with women affected by fistula (n = 52) - including those awaiting repair, living with fistula, and after repair, and their spouses and other family members (n = 17), along with health service providers involved in fistula repair and counseling (n = 38). Focus group discussions (FGDs) with male and female community stakeholders (n = 8) and post-repair clients (n = 6) were also conducted. RESULTS: Women's experiences indicate the obstetric fistula results in a combined set of costs associated with delivery, repair, transportation, lost income, and companion expenses that are often limiting. Medical and non-medical ancillary costs such as food, medications, and water are not borne evenly among all fistula care centers or camps due to funding shortages. In Uganda, experienced transport costs indicate that women spend Ugandan Shilling (UGX) 10,000 to 90,000 (US$3.00-US$25.00) for two people for a single trip to a camp (client and her caregiver), while Nigerian women (Kano) spent Naira 250 to 2000 (US$0.80-US$6.41) for transportation. Factors that influence women's and families' ability to cover costs of fistula care access include education and vocational skills, community savings mechanisms, available resources in repair centers, client counseling, and subsidized care and transportation. CONCLUSIONS: The concentration of women in poverty and the perceived and actual out of pocket costs associated with fistula repair speak to an inability to prioritize accessing fistula treatment over household expenditures. Findings recommend innovative approaches to financial assistance, transport, information of the available repair centers, rehabilitation, and reintegration in overcoming cost barriers.

Effects of population density of a village and town system on the transportation cost for a biomass combined heat and power plant.

Combined heat and power (CHP) generation can meet winter heating demands. Therefore, biomass CHP plants are more suitable for the development of biomass energy in village and town systems in cold regions. Transportation cost is one of the factors that determine operating costs. In this study, potential biomass energy is estimated based on the distribution of various types of crops. The locations and service areas of biomass CHP plants are determined using geographic information system analysis tools based on population distribution and energy demand data. Equations that contain multiple interference factors are used to calculate the raw material supply area and transportation cost for a biomass CHP plant to generate an optimal transportation route within a region. The analysis results show that biomass CHP plants are only suitable for village and town systems with a relatively low population density (PD). The curve of the supply area versus the PD of the village and town system (PDVTS) has an inverse-S shape. The transportation cost increases exponentially as the PDVTS increases. Biomass CHP plants can achieve higher efficiency in transportation costs when built in areas with a PDVTS ≤ 65 people/km2.

Operation of high-speed rail and reduction of corporate pollution: evidence from China.

As an environmentally friendly means of transport, the high-speed rail (HSR) is conducive to promoting corporate performance. An innovative approach extends the impact of HSR networks on pollution emissions from the regional level to the micro-enterprise level. Based on the quasi-natural experiment of the opening of HSR, a difference-in-difference model is used to investigate the impact of HSR on enterprise pollution emission levels and its action mechanism by using the matched data from the Chinese Enterprise Pollution Emission Database, the Chinese Industrial Enterprise Database, and the Chinese City Statistical Yearbook from 2000 to 2010. The results show that opening HSR significantly reduces the enterprises' pollution emission level, while reducing the number of polluting enterprises and transportation costs as well as improving the innovation capacity of enterprises are the corresponding action mechanisms. The impact of HSR on the enterprises' pollution emission varies with industry intensity, population size, and regional economic development level. The conclusions not only provide important insights to increase the ecological quality of China's environment through transportation infrastructure upgrades but also bring some guidance to more developing countries to improve their air environment.

Energy and environmental sustainability of waste personal protective equipment (PPE) treatment under COVID-19.

Combating the COVID-19 pandemic has raised the demand for and disposal of personal protective equipment in the United States. This work proposes a novel waste personal protective equipment processing system that enables energy recovery through producing renewable fuels and other basic chemicals. Exergy analysis and environmental assessment through a detailed life cycle assessment approach are performed to evaluate the energy and environmental sustainability of the processing system. Given the environmental advantages in reducing 35.42% of total greenhouse gas emissions from the conventional incineration and 43.50% of total fossil fuel use from landfilling processes, the optimal number, sizes, and locations of establishing facilities within the proposed personal protective equipment processing system in New York State are then determined by an optimization-based site selection methodology, proposing to build two pre-processing facilities in New York County and Suffolk County and one integrated fast pyrolysis plant in Rockland County. Their optimal annual treatment capacities are 1,708 t/y, 8,000 t/y, and 9,028 t/y. The proposed optimal personal protective equipment processing system reduces 31.5% of total fossil fuel use and 35.04% of total greenhouse gas emissions compared to the personal protective equipment incineration process. It also avoids 41.52% and 47.64% of total natural land occupation from the personal protective equipment landfilling and incineration processes.

Development and evaluation of an innovative grain cart with a pneumatic conveyor.

In line with the requirements of the Egyptian government to find a solution for wheat transportation during the peak harvesting season, an innovative design for a grain cart with a capacity of 8 tons supplemented with a grain hopper, a lifting double-action pneumatic conveyor, and a built-in digital scale was tested and evaluated to facilitate the transport of wheat crops from farmers' fields to storage sites. The cart was manufactured in the workshop of a local industrial company. It was tested under varying operational conditions in different wheat production areas in terms of working performance, efficiency of the grain loading and unloading mechanism, precision of the grain weighing mechanism, and cost/ton. The cart will enable wheat farmers and traders to transport and deliver their crops easily to storage sites with minimal losses and maximum working efficiency. It will also increase farmers' profit because transportation cost by using this grain cart is less than that of the current conventional method. Moreover, the developed cart can secure wheat supply in government storage sites without any interruption during the peak wheat harvesting season.

Potential CO2 reduction and cost evaluation in use and transport of coal ash as cement replacement: A case in the Philippines.

Coal ash can potentially be utilized as partial replacement for cement in concrete and mortar formulations. The use of coal ash can lessen the cost and energy production, and reduce the impact on the environment. At present, the annual coal ash generation amounts to ~2.78 Mt and may reach to ~13.02 Mt by 2035 in the Philippines. If coal ash is utilized as clinker replacement in the production of cement at a clinker-to-cement ratio of 0.7, GHG emissions can potentially be reduced to at least ~1.26 Mt CO2_eq in 2018 and could further be reduced by ~5.89 Mt CO2_eq by 2035 when surplus coal ash is utilized as partial cement replacement in concrete mixtures in concrete batching plants. As transport of coal ash can also result in GHG emission owing to fuel combustion, a critical distance is calculated in order to achieve positive net reductions. Critical distance is obtained by comparing the emission on coal ash transportation with that of cement production, while taking into consideration the emissions of the return trip. Thus, transporting the coal ash is limited to a distance of ~2841 km. Existing concrete batching plants are situated within 2,000 km from existing coal-fired power plants, where the transport of coal ash to these plants would not result in additional emissions but instead result in annual net reduction of GHG. Further, the cost of coal ash per bag varies according to the distance travelled and is much lower than the cost of cement per bag.

Modeling of starter cultures growth for improved Thai sausage fermentation and cost estimating for sausage preparation and transportation.

The purpose of this study was to improve Thai fermented sausage flavor by adding starter cultures (i.e., Pediococcus pentosaceus, Pediococcus acidilactici, Weissella cibaria, Lactobacillus plantarum, Lactobacillus pentosus, and Lactobacillus sakei) as compared with naturally fermented sausage. The predictive mathematical models for growth of P. acidilactici and natural lactic acid bacteria (LAB) in Thai fermented sausage were developed to obtain specific prepared sausage quality. Furthermore, comparisons of sausage preparation and transportation cost between nonrefrigerated and refrigerated trucks were studied. The concentration of 3-methyl-butanoic acid synthesized from LAB inoculated sausage was higher than in the control sample which contributed to the flavor forming. Moreover, the proposed unstructured kinetic models of Thai fermented sausage substrates and products describing the consumption of total protein and glucose, and the production of nonprotein nitrogen responsible for flavor enhancer, lactic acid and formic acid concentration were successfully fitted with two selected experimental data sets of the in situ fermentation of Thai fermented sausage. Finally, the transportation of inoculated sausages in a nonrefrigerated truck by combining fermentation process and transportation was more cost efficient for delivering sausages in a long distance.

[Practice evolution of hypofractionation in breast radiation therapy and medical impact]. / Évolution des pratiques médicales d'hypofractionnement en radiothérapie pour cancer du sein et impact économique.

PURPOSE: Whole breast irradiation after conservative surgery is the standard treatment for invasive breast cancer. Randomized studies indicate that hypofractionation can be equivalent for selected patients. This study focuses on fractionation practice evolution in a single centre, and analyses the economic impact of practice modification. MATERIAL AND METHODS: All prescriptions for invasive breast cancer between January 2010 and June 2014 were analyzed. Female patients 60 years or older, pN0 were considered for the economic study. Patients included in clinical trials or patient with high-grade tumours were excluded from the hypofractionation practice study, because physician could not choose fractionation. We used data from the Medical public health system to calculate cost per fraction and transportation cost. RESULTS: Two thousand thirty one patients were treated; 399 were eligible for the economic study (20%) and 282 for the practice study (14%). Treatment with 25 fractions decreased from 90% to 16% in the first half of 2014. Meanwhile, treatment with 15 or 16 fractions increased from 6% in 2010 to 68% in the first half of 2014. Hypofractionated treatment proportion was 100% with 42.5Gy in 16 fractions in 2010 and 100% 40Gy in 15 fractions in 2014, according to long-term follow-up publication of START trials. Treatment with five fractions remained stable around 7% (4 to 16%), reserved for patients over 80 years (P<0.0001). Based on data from 3451 fractions in 2013, transport cost was calculated at 62 € per fraction, in addition to a 170.77 € reimbursement per fraction, giving a cost per fraction of 232.77 €. CONCLUSION: Practice change led to an increase of hypofractionation in recent years. Hypofractionation may be currently prescribed and may concern 20% of patients. This practice evolution is beneficial for patients and the public health system.

Immigration: then, now, and in the future.

PIP: The author examines recent changes in immigration flows to the United States. Consideration is given to the increase in Caribbean, Chinese, Indian, and Muslim immigration, which he attributes to today's lower costs of air travel. The negative impact of the ability to return home easily and cheaply on migrants' desire to fully acculturate into U.S. society is noted. Mention is made of the need for new international migration policies to meet the needs of guest workers and consultants.^ieng

Trade restrictions, migration, and economic geography.

"This paper investigates why Third World cities have been growing in the last several decades much more quickly than cities in industrialized countries. For this purpose, we develop a Krugman-type model of economic geography with two continents, North and South, each of which consisting of two regions, East and West. We study the impact different levels of transport costs and tariffs exert on the distribution of economic activities among the regions. We find that lower costs for transport between the regions in the South, for instance, induced by an improved infrastructure, as well as lower tariffs on intercontinental trade tend to lead to less concentrated economies." (SUMMARY IN GER AND FRE)

[Some complementary observations on Portuguese emigration policy]. / Algumas observacoes complementares sobre a politica de emigracao portuguesa.

PIP: This is a review of factors affecting Portuguese emigration policy. Factors limiting emigration are identified as the policies of countries of destination, travel costs, illiteracy, and military service obligations in Portugal. The author also examines the extent of illegal migration from Portugal to the United States and Brazil.^ieng

Modelling the peopling of Australia: 1900-1930.

An analysis of migration from the United Kingdom to Australia during the period 1900 to 1930 is presented. The author attempts "first to explicitly develop and estimate a model of the behavioural relations of the two blades of the Marshallian scissors, rather than mixing supply and demand (under the polyglot terms of 'push-pull') in a single equation without regard to the problem of identification. And second, [he attempts] to incorporate in these structural equations key elements of government intervention in the migration process." The relationship between economic factors and Australian government support for immigration is considered. The author also identifies three factors influencing annual variations in the flow of migration from the United Kingdom: expected income gains, transport costs, and the costs of job search.