Galactic Air Improves Ancillary Revenues with Dynamic Personalized Pricing

Ancillaries are a rapidly growing source of revenue for airlines, yet their prices are currently statically determined using rules of thumb and are matched only to the average customer or to customer groups. Offering ancillaries at dynamic and personalized prices based on flight characteristics and customer needs could greatly improve airline revenue and customer satisfaction. Through a start-up (Deepair) that builds and deploys novel machine learning techniques to introduce such dynamically priced ancillaries to airlines, we partnered with a major European airline, Galactic Air (pseudonym), to build models and algorithms for improved pricing. These algorithms recommend dynamic personalized ancillary prices for a stream of features (called context) relating to each shopping session. Our recommended prices are restricted to be lower than the human-curated prices for each customer group. We designed and compared multiple machine learning models and deployed the best-performing ones live on the airline’s booking system in an online A/B testing framework. Over a six-month live implementation period, our dynamic pricing system increased the ancillary revenue per offer by 25% and conversion rate by 15% compared with the industry standard of human-curated rule-based prices.

Implementasi Sistem Informasi untuk Pemantauan dan Evaluasi Efektivitas E-Learning

This study discusses the monitoring and evaluation of e-learning activities through the LMS (Learning Management System) application of Pamulang University. In the previous process, the system used could only display activities carried out by lecturers that were recorded in the e-learning log. The logs that are displayed only create, update, delete activity, and cannot provide information about the effectiveness of online learning. Other parameters are needed to measure the effectiveness of online learning. One of them is the number of activities lecturers have to do for each subject within a certain period. In each course, the lecturer activity frequency is called create. Create is intended to open discussion topics by providing questions and responses to students' answers. From the results of monitoring, the achievement of creation is not sufficient to determine the success of implementing e-learning at Pamulang University. So that several other restrictions are needed such as participation, intensity, and content suitability. However, problems that occur in other parameters cannot be monitored just by looking at the data from the e-learning log. From these problems, a visual presentation of the activities of lecturers and students is needed which allows Study Programs with low percentages to be identified as quickly as possible, and decision making can be determined. The results showed that the four parameters can be implemented in the system. The average value of student participation in discussion forums is 74.99%, the ratio of the intensity of the activeness of lecturers and students every day of the week during the implementation period is 49.40%. Then the content suitability obtained an average of 0.04% and an average value of 65.90% lecturer activity. The generating facility automatically shows the four parameters in cooperation with the final result considered to assess the effectiveness of e-learning.

A Novel Program to Provide Drug Recovery Assistance and Outpatient Parenteral Antibiotic Therapy in People Who Inject Drugs

Background Safe hospital discharge on parenteral antibiotic therapy is challenging for people who inject drugs (PWID) admitted with serious bacterial infections (SBI). We describe a Comprehensive Care of Drug Addiction and Infection (CCDAI) program involving a partnership between Intermountain Healthcare hospitals and a detoxification facility (DF) to provide simultaneous drug recovery assistance and parenteral antibiotic therapy (DRA-OPAT). Methods The CCDAI program was evaluated using a pre-post study design. We compared outcomes in PWID hospitalized with SBI during a 1-year post-implementation period (2018) with similar patients from a historical control period (2017), identified by propensity modeling and manual review. Results Eighty-seven patients were candidates for the CCDAI program in the implementation period. 35 participants (40.2%) enrolled in DRA-OPAT and discharged to the DF; 16 (45.7%) completed the full OPAT duration. Fifty-one patients with similar characteristics were identified as a pre-implementation control group. Median length of stay (LOS) was reduced from 22.9 days (IQI 9.8-42.7) to 10.6 days (IQI 6-17.4) after program implementation, p<0.0001. Total median cost decreased from $39,220.90 (IQI $23,300.71-$82,506.66) pre-implementation vs $27,592.39 (IQI $18,509.45-48,369.11) post-implementation, p<0.0001. 90-day readmission rates were similar (23.5% vs 24.1%), p=0.8. At 1-year follow-up, all-cause mortality was 7.1% in the pre-implementation group vs 1.2% post-implementation, p=0.06. Conclusion Partnerships between hospitals and community resources hold promise for providing resource efficient OPAT and drug recovery assistance. We observed significant reductions in length of stay and cost without increases in readmission rates; 1-year mortality may have been improved. Further study is needed to optimize benefits of the program.

The LiberAction Project: Implementation of a Pediatric Liberation Bundle to Screen Delirium, Reduce Benzodiazepine Sedation, and Provide Early Mobilization in a Human Resource-Limited Pediatric Intensive Care Unit

Background: Delirium, bed immobilization, and heavy sedation are among the major contributors of pediatric post-intensive care syndrome. Recently, the Society of Critical Care Medicine has proposed the implementation of daily interventions to minimize the incidence of these morbidities and optimize children functional outcomes and quality of life. Unfortunately, these interventions require important clinical and economical efforts which prevent their use in many pediatric intensive care units (PICU).Aim: First, to evaluate the feasibility and safety of a PICU bundle implementation prioritizing delirium screening and treatment, early mobilization (<72 h from PICU admission) and benzodiazepine-limited sedation in a human resource-limited PICU. Second, to evaluate the incidence of delirium and describe the early mobilization practices and sedative drugs used during the pre- and post-implementation periods. Third, to describe the barriers and adverse events encountered during early mobilization.Methods: This observational study was structured in a pre- (15th November 2019–30th June 2020) and post-implementation period (1st July 2020–31st December 2020). All patients admitted in PICU for more than 72 h during the pre and post-implementation period were included in the study. Patients were excluded if early mobilization was contraindicated. During the pre-implementation period, a rehabilitation program including delirium screening and treatment, early mobilization and benzodiazepine-sparing sedation guidelines was developed and all PICU staff trained. During the post-implementation period, delirium screening with the Connell Assessment of Pediatric Delirium scale was implemented at bedside. Early mobilization was performed using a structured tiered protocol and a new sedation protocol, limiting the use of benzodiazepine, was adopted.Results: Two hundred and twenty-five children were enrolled in the study, 137 in the pre-implementation period and 88 in the post-implementation period. Adherence to delirium screening, benzodiazepine-limited sedation and early mobilization was 90.9, 81.1, and 70.4%, respectively. Incidence of delirium was 23% in the post-implementation period. The median cumulative dose of benzodiazepines corrected for the total number of sedation days (mg/kg/sedation days) was significantly lower in the post-implementation period compared with the pre-implementation period: [0.83 (IQR: 0.53–1.31) vs. 0.74 (IQR: 0.55–1.16), p = 0.0001]. The median cumulative doses of fentanyl, remifentanil, and morphine corrected for the total number of sedation days were lower in the post-implementation period, but these differences were not significant. The median number of mobilizations per patient and the duration of each mobilization significantly increased in the post-implementation period [3.00 (IQR: 2.0–4.0) vs. 7.00 (IQR: 3.0–12.0); p = 0.004 and 4 min (IQR: 3.50–4.50) vs. 5.50 min (IQR: 5.25–6.5); p < 0.0001, respectively]. Barriers to early mobilization were: disease severity and bed rest orders (55%), lack of physicians' order (20%), lack of human resources (20%), and lack of adequate devices for patient mobilization (5%). No adverse events related to early mobilization were reported in both periods. Duration of mechanical ventilation and PICU length of stay was significantly lower in the post-implementation period as well as the occurrence of iatrogenic withdrawal syndrome.Conclusion: This study showed that the implementation of a PICU liberation bundle prioritizing delirium screening and treatment, benzodiazepine-limited sedation and early mobilization was feasible and safe even in a human resource-limited PICU. Further pediatric studies are needed to evaluate the clinical impact of delirium, benzodiazepine-limited sedation and early mobilization protocols on patients' long-term functional outcomes and on hospital finances.

Implementing Behavioral Health Social Workers' Increased Mental Health Care Among Older Adults

Depression is underdiagnosed and undertreated among older adults. Health systems can screen patients to identify depression, but systemic linkages to treatment are required to ensure care. We used a retrospective stepped-wedge study to identify the impact of implementing behavioral health social workers (BHSWs) on receipt of treatment after a new depression diagnosis. We included adults over 65 years of age with a primary care visit between 2016 and 2019 at a large integrated health system. We excluded patients who were diagnosed with or treated for depression in 2015. Patients were categorized into control (diagnosed before implementation) and intervention (diagnosed after implementation) groups. From our electronic health record, we collected prescriptions for pharmacotherapy and behavioral health visits. Patients were considered treated if they received pharmacotherapy or had a behavioral health visit within 30 days of diagnosis. We used multilevel logistic regression models to identify the association between implementation period (pre versus post) and treatment, adjusted for demographic variables and clustering within site. Our population included 4,475 people. The percent of patients that received treatment increased from 47% to 54% after implementation and the percent of patients with ≥1 behavioral health visit within 30 days increased from 3% to 8% (p<0.01, respectively). The adjusted odds ratio of receiving treatment (AOR: 4.13, 95%CI: 2.84-6.01) and having a behavioral health visit (AOR: 3.12, 95%CI: 2.31-4.24) was significantly higher in the post-implementation period. In conclusion, implementation of BHSWs was associated with increased treatment for older patients with depression.

Nurse-run preanaesthesia assessment clinics: an initiative towards improving the quality of perioperative care at the ambulatory care centre

IntroductionNurse-run preanaesthesia assessment is well established in ambulatory surgery. However, in the Middle East the implementation of such a service is new and needed careful preparation. Aim of this audit is to assess the feasibility and the quality of preoperative assessments by the specially trained nurses, patient and nurse satisfaction and overall perioperative quality of recovery.MethodsThe nurses were selected and trained first in an accredited programme. Then an implementation period of 3 month was used for them to gain experience. Hereafter, we performed a four-step audit on the quality of preassessment, the patient’s satisfaction, the quality of recovery and adverse events if any. Finally, we also monitored the nurse’s satisfaction of their new advanced role.ResultsThe quality of preanaesthesia assessment was high as with 95% compliance to the accepted standards. In the patient satisfaction survey, all 152 patients were either highly satisfied or satisfied with the nurse-run service. The nurses were also highly satisfied and felt that they were either highly or moderately valued. All the patients who were operated at the ambulatory care services were followed up postoperatively by telephone calls which revealed that most of them were highly satisfied. No major or minor adverse events occurred.ConclusionOur specially trained nurses perform preoperative assessments on high standard without adverse events, while patient and staff satisfaction is very high. Future projects will focus on reducing the rate of cancellation of surgeries, investigating the cost-effectiveness of this approach as well as training the specialised nurses for paediatric preoperative anaesthesia assessments. This model of care could induce further nurse-run models of care in the Middle East.

A Pilot of a Sustainability-Extending Intervention in Canadian Nursing Homes

Understanding of intervention sustainability processes is limited. Failure to sustain evidence-based innovations means that intended improvements are short-lived, scale-up and spread are unlikely, and real losses are incurred on research investments. We explored the sustainability of a health care aide (HCA)-led quality improvement (QI) initiative, Safer Care for Older Persons (in residential) Environments (SCOPE), that was implemented in long-term care homes (LTCHs) in Manitoba, Canada. Based on our understanding of factors influencing post-implementation sustainability processes, we developed and piloted a “low-dose” and “high-dose” “Booster” intervention to extend the two-year post-implementation period over which SCOPE was naturally sustained. Both versions of the “Booster” involved the following components: a HCA-led team with management support, a workshop to review SCOPE QI approaches and tools, a binder of QI resources, and supports from an experienced Quality Advisor (QA). We collected data from various sources to depict the most accurate account of QI sustainability and conducted thematic analysis to understand each team’s experience with sustainability processes. We used a qualitative assessment rubric to evaluate the impact of the “Booster” conditions on the teams’ performance against core SCOPE components. Our results suggest that the “Booster” served to establish more relaxed expectations and generally renew interest in LTCH QI initiatives. The calibre of management support was associated with teams’ performance and management support varied with the level of QA support. These pilot results will inform the next study phase, which examines longer-term sustainability of QI initiatives in LTCHs beyond the initial 2-year post-implementation period.

Automated alert and activation of medical emergency team using early warning score

Background Timely recognition of warning signs from deteriorating patients and proper treatment are important in improving patient safety. In comparison to the traditional medical emergency team (MET) activation triggered by phone calls, automated activation of MET may minimize activation delays. However, limited data are available on the effects of automated activation systems on the time from derangement to MET activation and on clinical outcomes. The objective of this study was to determine the impact of an automated alert and activation system for MET on clinical outcomes in unselected hospitalized patients. Methods This is an observational study using prospectively collected data from consecutive patients managed by the MET at a university-affiliated, tertiary hospital from March 2013 to December 2019. The automated alert system automatically calculates the Modified Early Warning Score (MEWS) and subsequently activates MET when the MEWS score is 7 or higher, which was implemented since August 2016. The outcome measures of interest including hospital mortality in patients with MEWS of 7 or higher were compared between pre-implementation and post-implementation groups of the automated alert and activation system in the primary analysis. The association between the implementation of the system and hospital mortality was evaluated with logistic regression analysis. Results Of the 7678 patients who were managed by MET during the study period, 639 patients during the pre-implementation period and 957 patients during the post-implementation period were included in the primary analysis. MET calls due to abnormal physiological variables were more common during the pre-implementation period, while MET calls due to medical staff’s worries or concern about the patient’s condition were more common during the post-implementation period. The median time from deterioration to MET activation was significantly shortened in the post-implementation period compared to the pre-implementation period (34 min vs. 60 min, P < 0.001). In addition, unplanned ICU admission rates (41.2% vs. 71.8%, P < 0.001) was reduced during the post-implementation period. Hospital mortality was decreased after implementation of the automated alert system (27.2% vs. 38.5%, P < 0.001). The implementation of the automated alert and activation system was associated with decreased risk of death in the multivariable analysis (adjusted OR 0.73, 95% CI 0.56–0.90). Conclusions After implementing an automated alert and activation system, the time from deterioration to MET activation was shortened and clinical outcomes were improved in hospitalized patients.

Effect of a Low-Dose/High-Frequency Training in Introducing a Nurse-Led Neonatal Advanced Life Support Service in a Referral Hospital in Ethiopia

Background and Objective: In Ethiopia, birth asphyxia causes ~30% of all neonatal deaths and 11–31% of deaths among neonates delivered in healthcare facilities that have breathing difficulty at birth. This study aimed to examine the impact of low-dose, high-frequency (LDHF) training for introducing a nurse-led neonatal advanced life support (NALS) service in a tertiary care hospital in Ethiopia.Methods: Through a retrospective cohort study, a total of 12,001 neonates born post-implementation of the NALS service (between June 2017 and March 2019) were compared to 2,066 neonates born before its implementation (between June 2016 and September 2016). Based on when the neonates were born, they were divided into six groups (groups A to F). All deliveries occurred in the inpatient Labor and Delivery Unit (LDU) at St. Paul's Hospital Millennium Medical College. The number of neonatal deaths in the LDU, neonatal intensive care unit (NICU) admission rate, and proportion of neonates with normal axillary temperature (36.5–37.5°C) within the first hour of life were evaluated. Data were analyzed using the χ2 test, and p-values &lt; 0.05 were considered statistically significant. Following the implementation of the NALS service, semi-structured interviews with key stakeholders were conducted to evaluate their perception of the service; the interviews were recorded, transcribed, and coded for thematic analysis.Results: There was a decrease in the proportion of neonates who died in the LDU (from 3.5 to 1%) during the immediate post-implementation period, followed by a sustained decrease over the study period (p &lt; 0.001). The change in the NICU admission rate (from 22.8 to 21.2%) was insignificant (p = 0.6) during this initial period. However, this was followed by a significant sustained decrease (7.8% in group E and 9.8% in group F, p &lt; 0.001). The proportion of newborns with normal axillary temperature improved from 46.2% during the initial post-implementation period to 87.8% (p &lt; 0.01); this proportion further increased to 99.8%. The program was perceived positively by NALS team members, NICU care providers, and hospital administrators.Conclusion: In resource-limited settings, LDHF training for neonatal resuscitation improves the neonatal resuscitation skills and management of delivery room attendants.

About Some Risks Associated with Subjective Factors, and the Methodology for their Assessment

The authors propose a methodology for assessing the risk associated with subjective factors that may affect the achievement of the final goals of business projects, including ensuring information security. Such factors may include the level of salary, the level of professionalism, and others. At the same time, we propose carrying out the risk assessment by using the fuzzy logic method, which allows us to determine the dependence of the risk on various parameters under conditions of their uncertainty. According to the authors, the proposed methodology will help avoid some incorrect management decisions in the formation of author (working) teams, which could lead to negative consequences in the further implementation of the business project. These negative consequences can be expressed in delaying the implementation period, increasing the project’s cost, or even losing business due to critical information and personnel leakage. Also, this method allows you to increase the effectiveness of personnel policy in the organisation or the company. We noted that this method is applicable not only for individual enterprises but also for corporations and associations with complex network structures.