scholarly journals LDP Extensions for Hub and Spoke Multipoint Label Switched Path

2014 ◽  
Author(s):  
L. Jin ◽  
F. Jounay ◽  
N. Leymann ◽  
Keyword(s):  
Hub And Spoke ◽  
Label Switched Path

P3352Telemedicine transcends national boundaries in quest of creating a behemoth ami program

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Mehta ◽  
R Botelho ◽  
F Fernandez ◽  
F Feres ◽  
A Abizaid ◽  
...  
Keyword(s):  
Community Health Centers ◽  
Developed Countries ◽  
Population Based ◽  
Primary Pci ◽  
Small Community ◽  
Hub And Spoke ◽  
Web Based ◽  
National Boundaries ◽  
Intelligent Tools ◽  
Time Of Presentation

Abstract Background The Latin America Telemedicine Infarct Network (LATIN) has exploited the remarkable competence of telemedicine for remote guidance. In doing so, LATIN created a mammoth population-based AMI network that employed experts located several hundred miles away to guide the reperfusion strategies for almost 800,000 screened patients. In this pioneering project, telemedicine was initially utilized to guide AMI management within national confines. We speculated whether LATIN telemedicine navigation could outstrip countrywide borders. Purpose To maximally harness the vast possibilities of telemedicine for improving AMI care. Methods During its pilot phase, LATIN began as a hub and spoke, AMI system in Colombia where 20 spokes (small community health centers and rural clinics) were configured with 3 hubs that could perform Primary PCI. These sites were linked through web-based connectivity. Expert cardiologists, located 50–250 miles away in Bogota, Colombia, used sophisticated telemedicine platforms for urgent EKG diagnosis and teleconsultation of the entire AMI process. Based upon the duration of chest pain and travel time to the hub, these experts guided patients through guideline-based strategies of thrombolysis, pharmaco invasive management or primary PCI. Efficiency of the telemedicine process was measured with the new metric of time to telemedicine diagnosis (TTD). Cloud computing, GPS navigation, and numerous business intelligent tools were gradually incorporated into LATIN telemedicine. As systems became more scalable, the program was expanded to Brazil, where LATIN flourished. Over the last 18 months, LATIN telemedicine capabilities have been pressed across national boundaries. Presently, all 82 LATIN centers in Mexico are guided by experts located in Bogota, Colombia and the 7 Argentina centers channeled through Santiago, Chile. Results 784,947 patients were screened for AMI at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). Navigation pathways are depicted in the attached figure. TTD remains extremely low in all four countries, and comparable efficiency and tele-accuracy have been achieved. With expanded geographic reach, 8,448 (1.08%) patients were diagnosed with STEMI and 3,911 (46.3%) urgently reperfused, including 3,049 (78%) with Primary PCI. Time to TTD ranged between 2.8 to 5.8 minutes, with a mean of 3.5 min. Tele-accuracy was 98.5%, D2B 51 min, and in-hospital mortality 5.2%. Various other comparative metrics for the 4 countries are being gathered and will be available at the time of presentation. Conclusions LATIN demonstrates the robust ability of telemedicine to transcend national boundaries to guide AMI management. This strategy can be adopted in under-developed countries in Asia and Africa to provide an umbrella of AMI care for the millions of disadvantaged patients.

scholarly journals Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis

2021 ◽  
Vol 8 (1) ◽  
pp. e000501
Author(s):  
Manu K Nayar ◽  
Noor L H Bekkali ◽  
David Bourne ◽  
Sophie Young ◽  
John S Leeds ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Secondary Care ◽  
Multiorgan Failure ◽  
Tertiary Care ◽  
Endoscopic Drainage ◽  
Hub And Spoke ◽  
Specialist Nurse ◽  
Icu Stay

ObjectiveSevere acute pancreatitis (SAP) is associated with high mortality (15%–30%). Current guidelines recommend these patients are best managed in a multidisciplinary team setting. This study reports experience in the management of SAP within the UK’s first reported hub-and-spoke pancreatitis network.DesignAll patients with SAP referred to the remote care pancreatitis network between 2015 and 2017 were prospectively entered onto a database by a dedicated pancreatitis specialist nurse. Baseline characteristics, aetiology, intensive care unit (ICU) stay, interventions, complications, mortality and follow-up were analysed.Results285 patients admitted with SAP to secondary care hospitals during the study period were discussed with the dedicated pancreatitis specialist nurse and referred to the regional service. 83/285 patients (29%; 37 male) were transferred to the specialist centre mainly for drainage of infected pancreatic fluid collections (PFC) in 95% (n=79) of patients. Among the patients transferred; 29 (35%) patients developed multiorgan failure with an inpatient mortality of 14% (n=12/83). The median follow-up was 18.2 months (IQR=11.25–35.51). Multivariate analysis showed that transferred patients had statistically significant longer overall hospital stay (p<0.001) but less ICU stay (p<0.012).ConclusionThis hub-and-spoke model facilitates the management of the majority of patients with SAP in secondary care setting. 29% warranted transfer to our tertiary centre, predominantly for endoscopic drainage of PFCs. An evidence-based approach with a low threshold for transfer to tertiary care centre can result in lower mortality for SAP and fewer days in ICU.

scholarly journals A clarified typology of core-periphery structure in networks

2021 ◽  
Vol 7 (12) ◽  
pp. eabc9800
Author(s):  
Ryan J. Gallagher ◽  
Jean-Gabriel Young ◽  
Brooke Foucault Welles
Keyword(s):  
Dense Core ◽  
Block Model ◽  
Hub And Spoke ◽  
Block Modeling ◽  
Domain Specific ◽  
The Core ◽  
Detailed Case ◽  
Rich Diversity ◽  
Modeling Techniques

Core-periphery structure, the arrangement of a network into a dense core and sparse periphery, is a versatile descriptor of various social, biological, and technological networks. In practice, different core-periphery algorithms are often applied interchangeably despite the fact that they can yield inconsistent descriptions of core-periphery structure. For example, two of the most widely used algorithms, the k-cores decomposition and the classic two-block model of Borgatti and Everett, extract fundamentally different structures: The latter partitions a network into a binary hub-and-spoke layout, while the former divides it into a layered hierarchy. We introduce a core-periphery typology to clarify these differences, along with Bayesian stochastic block modeling techniques to classify networks in accordance with this typology. Empirically, we find a rich diversity of core-periphery structure among networks. Through a detailed case study, we demonstrate the importance of acknowledging this diversity and situating networks within the core-periphery typology when conducting domain-specific analyses.

scholarly journals Environmental Impact and External Costs Associated with Hub-and-Spoke Network in Air Transport

2021 ◽  
Vol 13 (2) ◽  
pp. 465
Author(s):  
Mengyuan Sun ◽  
Yong Tian ◽  
Yao Zhang ◽  
Muhammad Nadeem ◽  
Can Xu
Keyword(s):  
Environmental Impact ◽  
Living Environment ◽  
Strategic Decision ◽  
Air Transport ◽  
Pollutant Emissions ◽  
Pollutant Emission ◽  
Civil Aviation ◽  
External Costs ◽  
Hub And Spoke ◽  
City Network

Under the background of economic globalization, the air transport industry developed rapidly. It turns out that the city-to-city network has not been able to adapt well to the development of the society, and the hub-and-spoke network came into being. The hub-and-spoke network demonstrates the advantages of reducing the operating costs of airlines to keep a competitive advantage, and by maintaining the interests of airlines in the rapidly developing context. However, during the operation of aircrafts, they consume fuel and spew a great deal of harmful pollutants into the air, which has an adverse impact on the living environment. This paper explores the impact and external costs associated with hub-and-spoke network in air transport from an environmental perspective. With some mathematical models, we construct a hub-and-spoke network and take a quantitative study on the environmental impact of air transport. For calculating pollutant emissions, meteorological conditions were considered to revise the pollutant emission factors of the Engine Emissions Data Base (EEDB) published by International Civil Aviation Organization (ICAO). The environmental external costs measurement model is employed to calculate the externality of toxic gas and greenhouse gas (GHG). In order to make the study more convincing, two alternative networks are computed: hub-and-spoke network and city-to-city network. It is found that the hub-and-spoke network is associated with poorer environmental impact and environmental external costs because of the different network characteristics and the scale of the fleets. Therefore, under the general trend of green aviation, the environmental impact and environmental external costs associated with hub-and-spoke network in air transport provides a certain reference for airlines’ strategic decision-making.

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