Inclined analysis of water diversion project supply chain profits in the occurrence of whole supply chain damage in undeveloped regions of China

The main objective of this research is the water redistribution supply network project, which includes the water transportation company and the water work. The innovative regulatory accounting approach is used to build non-cooperative and helpful game models under government endowments. Different levels and types of government subsidies were then considered in terms of water availability, estimation, and benefit-sharing. Results reveal that water supply and price increase in cycles with the number of sponsors, while the cost of water work falls as sponsorships increase. Despite this, the cost of the water plant remained the same while sponsorship levels remained stable. Although the worth of the water transportation company fluctuates, the more endowments it receives when its value is lower. The appropriateness of the proposed game model was illustrated in the Nile Waterway Water Redirection Task.

Heavy metals in popularly sold branded cigarettes in Bangladesh and associated health hazards from inhalation exposure

Tobacco products are widely recognized as a major contributor to death. Cigarette smoke contains several toxic chemicals including heavy metals particulate causing high health risks. However, limited information has been available on the health risks associated with the heavy metals in cigarettes commonly sold in the Bangladeshi market. This study evaluated the concentrations and potential health risks posed by ten concerned heavy metals in ten widely consumed cigarette brands in Bangladesh using an atomic absorption spectrometer. The concentration (mg/kg) ranges of heavy metals Pb, Cd, Cr, As, Co, Ni, Mn, Fe, Cu, and Zn vary between 0.46-1.05, 0.55-1.03, 0.80-1.2, 0.22-0.40, 0.46-0.78, 2.59-3.03, 436.8-762.7, 115.8-184.4, 146.6-217.7, and 34.0-42.7, respectively. We assume that the heavy metals content among cigarette brands is varied due to the differences in the source of tobacco they use for cigarette preparation. The carcinogenic risks posed by heavy metals follow the order of Cr > Co > Cd > As > Ni > Pb, while the non-carcinogenic risks for Cu, Zn, Fe, and Mn were greater than unity (HQ > 1), except for Fe. The existence of toxic heavy metals in cigarette tobacco may thus introduce noticeable non-carcinogenic and carcinogenic health impacts accompanying inhalation exposure. This study provides the first comprehensive report so far on heavy metal concentration and associated health risks in branded cigarettes commonly sold in Bangladesh. Hence, this data and the information provided can serve as a baseline as well as a reference for future research and have potential implications for policy and legislation in Bangladesh.

What factors are considered in hospital funding models? A review of the literature on health services funding in organisation for economic co-operation and development countries

BACKGROUND

One of the most difficult challenges in healthcare involves equitable allocation of resources. Our review aimed to identify international funding models in Organisation for Economic Co-operation and Development (OECD) countries for government-funded public hospitals and evidence underpinning their efficacy, via review of the peer-reviewed and grey literature.

METHODS

Ovid-Medline, Ovid Embase, Scopus, and PubMed were searched for peer-reviewed literature. Advanced Google searches and targeted hand searches of relevant organisational websites identified grey literature. Inclusion criteria were: English language, published between 2011 and 2022, and that the article: (1) focused on healthcare funding; (2) reported on or identified specific factors, indexes, algorithms or formulae associated with healthcare funding; and (3) referred to countries that are members of the OECD, excluding the United States (US).

RESULTS

For peer-reviewed literature 1189 abstracts and 35 full-texts were reviewed; six articles met the inclusion criteria. For grey literature, 2996 titles or abstracts and 37 full-texts were reviewed; five articles met the inclusion criteria. Healthcare funding arrangements employed in 15 OECD countries (Australia, Belgium, Canada, Finland, France, Germany, Israel, Italy, the Netherlands, New Zealand, Norway, Spain, Sweden, Switzerland, and the United Kingdom [UK; specifically, England, Scotland, Wales and Northern Ireland]) were identified, but papers reported population-based funding arrangements for specific regions rather than hospital-specific models.

CONCLUSIONS

While some models adjusted for deprivation and ethnicity factors, none of the identified documents reported on health systems that adjusted funding allocation for social determinants such as health literacy levels.

Magneto-bioconvection flow of Casson nanofluid configured by a rotating disk in the presence of gyrotatic microorganisms and Joule heating

In this article, we investigate the bioconvection flow of Casson nanofluid by a rotating disk under the impacts of Joule heating, convective conditions, heat source/sink and gyrotactic microorganisms. When Brownian diffusion and thermophoretic effects exist, the Casson fluid is examined. The existing physical problem of Casson nanofluid flow with energy transports is demonstrated under the above considerations in the form of partial differential equations (PDEs). Using the appropriate transformations, the PDEs are converted into non-linear ordinary differential equations (ODEs). The mathematical results are calculated through MATLAB by using the function bvp4c. The problem's results are rigorously examined graphically and described with physical justifications. Velocity fields decrease as the bioconvection Rayleigh parameter rises. The thermal profile and soluteal field of species also magnify with an upsurge in thermophoresis number estimations. The microorganism's fields are decayed by larger microbes Biot number.

Innovative models of healthcare delivery: an umbrella review of reviews

OBJECTIVE

To undertake a synthesis of evidence-based research for seven innovative models of care to inform the development of new hospitals.

DESIGN

Umbrella review.

SETTING

Interventions delivered inside and outside of acute care settings.

PARTICIPANTS

Children and adults with one or more identified acute or chronic health conditions.

DATA SOURCES

PsycINFO, Ovid MEDLINE and CINAHL.

PRIMARY AND SECONDARY OUTCOME MEASURES

Clinical indicators and mortality, healthcare utilisation, quality of life, self-management and self-care and patient knowledge.

RESULTS

A total of 66 reviews were included, synthesising evidence from 1272 primary studies across the 7 models of care. Virtual care was the most common model studied, addressed by 47 (73%) of the reviews. Common outcomes evaluated across reviews were clinical indicators and mortality, healthcare utilisation, self-care and self-management, patient knowledge, quality of life and cost-effectiveness. The findings indicate that the innovative models of healthcare we identified in this review may be effective in managing patients with a range of acute and chronic conditions. Most of the included reviews reported evidence of comparable or improved care.

CONCLUSIONS

A consideration of local infrastructure and individual patient characteristics, such as health literacy, may be critical in determining the suitability of models of care for patients and their implementation in local health systems.

TRIAL REGISTRATION NUMBER

10.17605/OSF.IO/PS6ZU.

Innovative models of care for the health facility of the future: a protocol for a mixed-methods study to elicit consumer and provider views

INTRODUCTION

To address the challenges of rapidly changing healthcare, governments and health services are increasingly emphasising healthcare delivery models that are flexible, person centred, cost-effective and integrate hospital services more closely with primary healthcare and social services. In addition, such models increasingly embed consumer codesign, integration of services, and leverage digital technologies such as telehealth and sophisticated medical records systems.

OBJECTIVES

This paper provides a study protocol to describe a method to elicit consumer and healthcare provider needs and expectations for the development of innovative care models.

METHODS AND ANALYSIS

A literature review identified six key models of care, supported by a common theme of consumer-focused care, along with the international evidence supporting the efficacy of these models. A mixed-methods study of the needs and expectations of consumer members and health providers who reside or work in the area of a new hospital catchment will be undertaken. They will complete a community-specific and provider-specific, short demographic questionnaire (delivered during the recruitment process) and be assigned to facilitator-coordinated online workshops comprising small focus groups. Follow-up interviews will be offered. Culturally and linguistically diverse members and Aboriginal and Torres Strait Islander Elders and their communities will also be consulted. Data will be analysed thematically (qualitative) and statistically (quantitative), and findings synthesised using a triangulated approach.

ETHICS AND DISSEMINATION

The results will be actively disseminated through peer-reviewed journals, conference presentations and in a report to stakeholders. This study was reviewed and approved by the relevant Ethics Committee in New South Wales, Australia.

Mapping continuous learning using social network research: a social network study of Australian Genomics as a Learning Health System

OBJECTIVES

To explore a macrolevel Learning Health System (LHS) and examine if an intentionally designed network can foster a collaborative learning community over time. The secondary aim was to demonstrate the application of social network research to the field of LHS.

DESIGN

Two longitudinal online questionnaires of the Australian Genomics learning community considering relationships between network members at three time points: 2016, 2018, 2019. The questionnaire included closed Likert response questions on collaborative learning patterns and open-response questions to capture general perceptions of the community. Social network data were analysed and visually constructed using Gephi V.0.9.2 software, Likert questions were analysed using SPSS, and open responses were analysed thematically using NVivo.

SETTING

Australian Genomic Health Alliance.

PARTICIPANTS

Clinicians, scientists, researchers and community representatives.

RESULTS

Australian Genomics members highlighted the collaborative benefits of the network as a learning community to foster continuous learning in the ever-evolving field of clinical genomics. The learning community grew from 186 members (2016), to 384 (2018), to 439 (2019). Network density increased (2016=0.023, 2018=0.043), then decreased (2019=0.036). Key players remained consistent with potential for new members to achieve focal positions in the network. Informal learning was identified as the most influential learning method for genomic practice.

CONCLUSIONS

This study shows that intentionally building a network provides a platform for continuous learning-a fundamental component for establishing an LHS. The Australian Genomics learning community shows evidence of maturity and sustainability in supporting the continuous learning culture of clinical genomics. The network provides a practical means to spread new knowledge and best practice across the entire field. We show that intentionally designed networks provide the opportunity and means for interdisciplinary learning between diverse agents over time and demonstrate the application of social network research to the LHS field.

Predictors of Satisfaction with Wound Care Services in an Outpatient Setting in Kano, Nigeria

BACKGROUND

With the global increase in chronic wounds and the paucity of studies on patient experiences at wound care facilities, we assessed the factors associated with satisfaction with wound care services among patients or their caregivers in a Northwest Nigerian outpatient setting.

METHODS

Participants were systematically selected from patients or their caregivers attending the General Outpatient Clinic of Aminu Kano Teaching Hospital, Kano, for wound dressing. A structured self-administered questionnaire was used to obtain information regarding their sociodemographic and clinical characteristics and satisfaction with service domains. Data were analyzed using descriptive and inferential statistical methods.

RESULTS

There were 170 participants. Their mean age was 31.9±11.4 years, and they were mainly female (55.3%). The overall satisfaction rate was 85.9% (146/170); however, 51.8% and 55.3% of participants were dissatisfied with the advice on home wound care and waiting time, respectively. Employment status, wound location, having sickle cell disease, needing a wheelchair to reach the wound dressing room and perceived availability of a wheelchair were associated with overall satisfaction (P<0.05). The predictors of overall satisfaction were chronic wounds, wound in areas other than the lower limbs/buttocks, and perceived availability of wheelchairs.

CONCLUSION

The overall satisfaction rate was high despite service gaps. However, future improvement in patient satisfaction will require addressing challenges such as the waiting time before wound dressing, equipment (e.g., wheelchairs), and staffing.

Learning health systems: A review of key topic areas and bibliometric trends

INTRODUCTION

The emergent field of learning health systems (LHSs) has been rapidly evolving as the concept continues to be embraced by researchers, managers, and clinicians. This paper reports on a scoping review and bibliometric analysis of the LHS literature to identify key topic areas and examine the influence and spread of recent research.

METHODS

We conducted a scoping review of LHS literature published between January 2016 and May 2020. The authors extracted publication data (eg, journal, country, authors, citation count, keywords) and reviewed full-texts to identify: type of study (empirical, non-empirical, or review), degree of focus (general or specific), and the reference used when defining LHSs.

RESULTS

A total of 272 publications were included in this review. Almost two thirds (65.1%) of the included articles were non-empirical and over two-thirds (68.4%) were from authors in the United States. More than half of the publications focused on specific areas, for example: oncology, cardiovascular care, and genomic medicine. Other key topic areas included: ethics, research, quality improvement, and electronic health records. We identified that definitions of the LHS concept are converging; however, many papers focused on data platforms and analytical processes rather than organisational and behavioural factors to support change and learning activities.

CONCLUSIONS

The literature on LHSs remains largely theoretical with definitions of LHSs focusing on technical processes to reuse data collected during the clinical process and embedding analysed data back into the system. A shift in the literature to empirical LHS studies with consideration of organisational and human factors is warranted.

"Time is of the essence": relationship between hospital staff perceptions of time, safety attitudes and staff wellbeing

Background

Hospitals are perceived as fast-paced and complex environments in which a missed or incorrect diagnosis or misread chart has the potential to lead to patient harm. However, to date, limited attention has been paid to studying how hospital sociotemporal norms may be associated with staff wellbeing or patient safety. The aim of this study was to use novel network analysis, in conjunction with well-established statistical methods, to investigate and untangle the complex interplay of relationships between hospital staff perceived sociotemporal structures, staff safety attitudes and work-related well-being.

Method

Cross-sectional survey data of hospital staff (n = 314) was collected from four major hospitals in Australia. The survey included subscales from the Organizational Temporality Scale (OTS), two previously established scales of safety attitudes (teamwork climate and safety climate) and measures of staff-related wellbeing (job satisfaction, emotional exhaustion, depersonalisation).

Results

Using confirmatory factor analysis, we first tested a 19-item version of the OTS for use in future studies of hospital temporality (the OTS-H). Novel psychological network analysis techniques were then employed, which identified that “pace” (the tempo or rate of hospital activity) occupies the central position in understanding the complex relationship between temporality, safety attitudes and staff wellbeing. Using a path analysis approach, serial mediation further identified that pace has an indirect relationship with safety attitudes through wellbeing factors, that is, pace impacts on staff wellbeing, which in turn affects hospital safety attitudes.

Conclusions

The findings of this study are important in revealing that staff wellbeing and safety attitudes can be significantly improved by placing more focus on temporal norms, and in particular hospital pace. There are implications for increasing levels of trust and providing staff with opportunities to exercise greater levels of control over their work.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07275-6.

Access to surgical care as an efficiency issue: using lean management in French and Australian operating theatres

PURPOSE

Millions around the world still cannot access safe, timely and affordable surgery. Considering access as a function of efficiency, this paper examines how the latter can be improved within the context of operating theatres. Carried out in France and Australia, this study reveals different types of waste in operating theatres and a series of successful tactics used to increase efficiency and eliminate wastefulness.

DESIGN/METHODOLOGY/APPROACH

Data for this qualitative study were collected through 48 semi-structured interviews with operating theatre staff in France (n = 20) and Australia (n = 28). Transcripts were coded using a theory-driven thematic analysis to characterise sources of waste in operating theatres and the tactics used to address them.

FINDINGS

The study confirmed the prominence of seven types of waste in operating theatres commonly found in industry and originally identified by Ohno, the initiator of lean: (1) underutilised operating rooms; (2) premature or delayed arrival of patients, staff or equipment; (3) need for large onsite storage areas and inventory costs; (4) unnecessary transportation of equipment; (5) needless staff movements; (6) over-processing and (7) quality defects. The tactics used to address each of these types of waste included multiskilling staff, levelling production and implementing just-in-time principles.

ORIGINALITY/VALUE

The tactics identified in this study have the potential of addressing the chronic and structurally embedded problem of waste plaguing health systems' operating theatres, and thus potentially improve access to surgical care. In a global context of resource scarcity, it is increasingly necessary for hospitals to optimise the ways in which surgery is delivered.

Evaluation of a hospital-based integrated model of eye care for diabetic retinopathy assessment: a multimethod study

OBJECTIVES

Diabetic eye disease is a leading cause of blindness but can be mitigated by regular eye assessment. A framework of issues, developed from the literature of barriers to eye assessment, was used to structure an examination of perceptions of a new model of care for diabetic retinopathy from the perspective of staff using the model, and health professionals referring patients to the new service.

DESIGN

Multimethod: interviews and focus groups, and a separate survey.

SETTING

A new clinic based on an integrated model of care was established at a hospital in outer metropolitan Sydney, Australia in 2017. Funded jointly by Centre for Eye Health (CFEH) and the hospital, the clinic was equipped and staffed by optometrists who work alongside the ophthalmologists in the existing hospital eye clinic.

PARTICIPANTS

Five (of seven) hospital staff working in the clinic (ophthalmologists and administrative officers) or referring to it from other departments (endocrinologists); nine optometrists from CFEH who developed or worked in the clinic; 10 community-based optometrists as potential referrers.

RESULTS

The new clinic was considered to have addressed known barriers to eye assessment, including access, assistance for patients unable/unwilling to organise eye checks and efficient management of human resources. The clinic optimised known drivers of this model of care: providing clear scope of practice and protocols for shared care between optometrists and ophthalmologists, good communication between referrers and eye professionals and a collegial approach promoting interprofessional trust. Remaining areas of concern were few referrals from general practitioners, fewer referrals from hospital endocrinologists than expected and issues with stretched administrative capacity. There were also perceived mismatches between the priorities of hospital management and aims of the clinic.

CONCLUSIONS

The new model was considered to have addressed many of the barriers to assessment. While there remain issues with the model, there were also unexpected benefits.