Humanitarian logistics is regarded as a key area for improved disaster management efficiency and effectiveness. In this study, a multi-objective integrated logistic model is proposed to locate disaster relief centers while taking into account network costs and responsiveness. Because this location problem is NP-hard, we present a genetic approach to solve the proposed model.
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Although homelessness is inherently associated with social exclusion, homeless individuals are rarely included in conventional studies on social exclusion. Use of longitudinal survey data from a cohort study on homeless people in four major Dutch cities (n = 378) allowed to examine: changes in indicators of social exclusion among homeless people over a 2.5-year period after reporting to the social relief system, and associations between changes in indicators of social exclusion and changes in psychological distress. Multinomial logistic regression analysis was applied to investigate the associations between changes in indicators of social exclusion and changes in psychological distress. Improvements were found in various indicators of social exclusion, whereas financial debts showed no significant improvement. Changes in unmet care needs, health insurance, social support from family and relatedness to others were related to changes in psychological distress. This study demonstrated improvements in various indicators of social exclusion among homeless people over a period of 2.5 years, and sheds light on the concept of social exclusion in relation to homelessness.
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Landside operations in air cargo terminals consist of many freight forwarders (FFWs) delivering and picking up cargo at the capacity-constrained loading docks at the airport's ground handlers' (GHs) facilities. To improve the operations of the terminal and take advantage of their geographical proximity a small set of FFWs can build a coalition to consolidate stochastically-arriving shipments and share truck fleet capacity while other FFWs continue bringing cargo to the terminal in a non-cooperative manner. Results from a detailed discrete-event simulation model of the cargo landside operations in Amsterdam Aiport showed that all operational policies had trade-offs in terms of the average shipment cycle time of coalition FFWs, the average shipment cycle time of non-coalition FFWs, and the total distance traveled by the coalition fleet, suggesting that horizontal cooperation in this context was not always beneficial, contrary to what previous studies on horizontal cooperation have found. Since dock capacity constitutes a significant constraint on operations in air cargo hubs, this paper also investigates the effect of dock capacity utilization and horizontal cooperation on the performance of consolidation policies implemented by the coalition. Thus, we built a general model of the air cargo terminal to analyze the effects caused by dock capacity utilization without the added complexity of landside operations at Amsterdam Airport to investigate whether the results hold for more general scenarios. Results from the general simulation model suggest that, in scenarios where dock and truck capacity become serious constraints, the average shipment cycle times of non-coalition FFWs are reduced at the expense of an increase in the cycle times of FFWs who constitute the coalition. A good balance among all the performance measures considered in this study is reached by following a policy that takes advantage of consolidating shipments based on individual visits to GH.
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A major challenge for disaster scholars and policymakers is to understand the power dimension in response networks, particularly relating to collaboration and coordination. We propose a conceptual framework to study interests and negotiations in and between various civic and professional, response networks drawing on the concepts of “programming” and “switching” proposed by Manuel Castells in his work on the network society. Programming in disaster response refers to the ability to constitute response networks and to program/reprogram them in terms of the goals assigned to the network. Switching is the ability to connect different net-works by sharing common goals and combining resources. We employ these concepts to understand how the US Federal Emergency Management Agency organized its response in the aftermath of Hurricanes Katrina and Sandy. Our conceptual framework can be used both by disaster scholars and policymakers to understand how networked power is constructed and utilized.
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In case of a major cyber incident, organizations usually rely on external providers of Cyber Incident Response (CIR) services. CIR consultants operate in a dynamic and constantly changing environment in which they must actively engage in information management and problem solving while adapting to complex circumstances. In this challenging environment CIR consultants need to make critical decisions about what to advise clients that are impacted by a major cyber incident. Despite its relevance, CIR decision making is an understudied topic. The objective of this preliminary investigation is therefore to understand what decision-making strategies experienced CIR consultants use during challenging incidents and to offer suggestions for training and decision-aiding. A general understanding of operational decision making under pressure, uncertainty, and high stakes was established by reviewing the body of knowledge known as Naturalistic Decision Making (NDM). The general conclusion of NDM research is that experts usually make adequate decisions based on (fast) recognition of the situation and applying the most obvious (default) response pattern that has worked in similar situations in the past. In exceptional situations, however, this way of recognition-primed decision-making results in suboptimal decisions as experts are likely to miss conflicting cues once the situation is quickly recognized under pressure. Understanding the default response pattern and the rare occasions in which this response pattern could be ineffective is therefore key for improving and aiding cyber incident response decision making. Therefore, we interviewed six experienced CIR consultants and used the critical decision method (CDM) to learn how they made decisions under challenging conditions. The main conclusion is that the default response pattern for CIR consultants during cyber breaches is to reduce uncertainty as much as possible by gathering and investigating data and thus delay decision making about eradication until the investigation is completed. According to the respondents, this strategy usually works well and provides the most assurance that the threat actor can be completely removed from the network. However, the majority of respondents could recall at least one case in which this strategy (in hindsight) resulted in unnecessary theft of data or damage. Interestingly, this finding is strikingly different from other operational decision-making domains such as the military, police and fire service in which there is a general tendency to act rapidly instead of searching for more information. The main advice is that training and decision aiding of (novice) cyber incident responders should be aimed at the following: (a) make cyber incident responders aware of how recognition-primed decision making works; (b) discuss the default response strategy that typically works well in several scenarios; (c) explain the exception and how the exception can be recognized; (d) provide alternative response strategies that work better in exceptional situations.
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Fast charging is seen as a means to facilitate long-distance driving for electric vehicles (EVs). As a result, roll-out planning generally takes a corridor approach. However, with higher penetration of electric vehicles in urban areas, cities contemplate whether inner-city fast chargers can be an alternative for the growing amount of slow public chargers. For this purpose, more knowledge is required in motives and preferences of users and actual usage patterns of fast chargers. Similarly, with increasing charging speeds of fast chargers and different modes (taxi, car sharing) also switching to electric vehicles, the effect of charging speed should be evaluated as well as preferences amongst different user groups. This research investigates the different intentions and motivations of EV drivers at fast charging stations to see how charging behaviour at such stations differs using both data analysis from charging stations as a survey among EV drivers. Additionally, it estimates the willingness of EV drivers to use fast charging as a substitute for on-street home charging given higher charging speeds. The paper concludes that limited charging speeds imply that EV drivers prefer parking and charging over fast charging but this could change if battery developments allow higher charging speeds.
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Analyse the results from a representative selection of the supply chain studies for school feeding programmes in Kenya, Ghana and Mali, and make specific suggestions for interventions that can efficiently include SHF in the supply chains.
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Introduction: Retrospective studies suggest that a rapid initiation of treatment results in a better prognosis for patients in the emergency department. There could be a difference between the actual medication administration time and the documented time in the electronic health record. In this study, the difference between the observed medication administration time and documentation time was investigated. Patient and nurse characteristics were also tested for associations with observed time differences. Methods: In this prospective study, emergency nurses were followed by observers for a total of 3 months. Patient inclusion was divided over 2 time periods. The difference in the observed medication administration time and the corresponding electronic health record documentation time was measured. The association between patient/nurse characteristics and the difference in medication administration and documentation time was tested with a Spearman correlation or biserial correlation test. Results: In 34 observed patients, the median difference in administration and documentation time was 6.0 minutes (interquartile range 2.0-16.0). In 9 (26.5%) patients, the actual time of medication administration differed more than 15 minutes with the electronic health record documentation time. High temperature, lower saturation, oxygen-dependency, and high Modified Early Warning Score were all correlated with an increasing difference between administration and documentation times. Discussion: A difference between administration and documentation times of medication in the emergency department may be common, especially for more acute patients. This could bias, in part, previously reported time-to-treatment measurements from retrospective research designs, which should be kept in mind when outcomes of retrospective time-to-treatment studies are evaluated.
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BACKGROUND: During transitions from hospital to home, up to half of all patients experience medication-related problems, such as adverse drug events. To reduce these problems, knowledge of patient experiences with medication use during this transition is needed. This study aims to identify the perspectives of patients on barriers and facilitators with medication use, during the transition from hospital to home.METHODS: A qualitative study was conducted in 2017 among patients discharged from two hospitals using a semi-structured interview guide. Patients were asked to identify all barriers they experienced with medication use during transitions from hospital to home, and facilitators needed to overcome those barriers. Data were analyzed following thematic content analysis and visualized using an "Ishikawa" diagram.RESULTS: In total, three focus groups were conducted with 19 patients (mean age: 70.8 (SD 9.3) years, 63% female). Three barriers were identified; lack of personalized care in the care continuum, insufficient information transfer (e.g. regarding changes in pharmacotherapy), and problems in care organization (e.g. medication substitution). Facilitators to overcome these barriers included a personal medication-counselor in the care continuum to guide patients with medication use and overcome communication barriers, and post-discharge follow-up care (e.g. home visits from healthcare providers).CONCLUSIONS: During transitions from hospital to home patients experience individual-, healthcare provider- and organization level barriers. Future research should focus on personal-medication counselors in the care continuum and post-discharge follow-up care as it may overcome communication, emotional, information and organization barriers with medication use.
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