Observing discrete behaviors in a techno-human-economic (THE) system under stress is an effective way to assess its resilience and survivability. This article applies the resilience-survivability framework to mathematically analyze the contributions of each component of the resilience trifecta—technology, human factors, and the economy—regarding the current state of the U.S. territory of Puerto Rico (PR). Statistical analyses were conducted using simulation modeling to calculate the contribution percentages of each component over 62 years (1960–2022), both individually and in combination. ANOVA was performed at a 1

Visual tools such as diagrams and mapping are effective research methods that help engage the community in the process and encourage active participation in generating potential solutions to a complex health problem. In participatory research, these methods help bridge potential communication gaps between community partners and academics. We present the steps we undertook to evaluate barriers to completing recommended breast and cervical cancer screenings. We engaged a community advisory board (CAB) of women who had been enrolled in the National Breast and Cervical Cancer Early Detection Program to investigate barriers to receiving recommended screenings and to brainstorm potential solutions to address the barriers. We describe the tools we used in the process: fishbone diagrams, mind mapping, and concept mapping. We were able to identify and categorize potential solutions to increase screening rates under four themes: 1) communication; 2) scheduling; 3) transportation; and 4) providers. Real-time updates and feedback loops facilitated by these tools create a continuous dialogue between researchers and community partners, which strengthens the relationship between academic and community collaborators and ensures that the research remains responsive to the evolving dynamics of the community.

This article presents a Markov-based approach that integrates technical, social, and economic aspects that describe a techno-human-economic (THE) model under disturbance. These systems replicate the complex behavior of different sectors in society and private enterprises altogether. The model incorporates resilience and survivability measures and the concepts of breaking points, referred to as divergence, and resurgence. The representation of a THE model intends to be more extensive than other representations as it evaluates systems at different performance levels and state spaces through time. The model is meant to be a tool to forecast or anticipate breaking points and resurgence events through THE's lifecycle. It is also designed as a mathematical foundation, allowing decision-makers to view multiple factors simultaneously. To prove the pertinence of the approach, the notable predicaments of Puerto Rico (PR) since 1960 have been transcribed to the mathematical dialect of a THE under stress with real historical data, socioeconomic indexes, and technological innovation indexes. The final resolved Markov chain for PR's case reveals that, for a stressed society, a contracted economy, and a survivable form of technology, the greater probabilities tend to the initial state from a survivable state (i.e., 90.32

Studies have revealed that physical and mental demands, psychosocial factors, and individual factors can contribute to the development of WMSDs. Yet, much is still unknown regarding the effects of individual characteristics on WMSDs susceptibility. Previous studies discovered people assumed more awkward body postures to perform an activity when the perception of mental workload is higher. This research study explored if individual characteristics such as age, sex, personality, and anxiety help explain changes or differences in the perception of mental workload and body postures assume when performing activities. The study provided evidence that these individual characteristics have a modifying role on perceived mental workload and body postures. The results suggest that perceived mental workload is influenced to a higher extent by individual characteristics such as anxiety, sex, and personality traits. Women have a higher (18.7%) mental workload perception than men. Likewise, NASA-TLX scores are 22% higher for feelers than thinkers. In general, higher perceptions of mental workload were observed in participants with higher anxiety levels. On the other hand, body postures seem to be influenced by different individual factors depending on the nature of the activity. RULA scores increased on average by 13.1% between baseline and time constraint conditions. Larger differences were observed in certain individuals (e.g. introverts (19.7%) and intuitors (13.8%)) across conditions. This study looked to explore if individual factors such as age, sex, personality, and anxiety have any effect in perceived mental workload and body postures. Participants performed two physical activities under four levels of mental workload. Results indicated that personality traits (sensors/intuitors), anxiety, and sex exhibited the higher contributions.

We designed a decision model for hospital selection in the emergency medical system, which integrates its actors, such as the dispatch center, emergency medical services (EMS), and emergency departments (ED). We designed and simulated the model using colored Petri nets to evaluate two policies: the nearest hospital policy (in time) and the proposed policy that integrates the proximity criteria and ED congestion. The simulation results for the Massachusetts Region 3 case study indicate that the proposed policy that considers the shortest transfer times (travel time + wait time) appropriately allocates ambulance patients to EDs. In addition, the proposed improves and balances indicators, such as average patient waiting times per ESI, physician utilization, and average patient queues, in each ED. For example, the proposed policy best scenario that adds a physician to all hospital EDs would reduce waiting times for ESI 2 and 3 patients between (26.16%-71.65%) and (74.69%-88.84%), respectively, and improve the patient queue and the allocation of ambulance patients. Finally, the proposed decision policy allows the planning of medical staff in EDs and scenario analysis using performance indicators focused on the timeliness of patient care. This approach would avoid problems such as overcrowding, delayed discharge, retention, and diversion of ambulances, putting patient health and life at risk.

Discrete event simulation is a well-established tool for examining the effect of different operating room (OR) block schedules on various performance metrics within the OR suite and adjacent units. However, one unit that has rarely been studied is the sterilization processing department (SPD), which cleans and assembles reusable OR instruments. As part of a larger research study, we developed a series of OR block assignment models that sought to reduce the workload of the SPD and developed a tray optimization model to reduce the number of instruments on increasingly bloated instrument trays. While initial numerical experiments were promising, a comprehensive simulation model of the OR and SPD was needed to more thoroughly examine how potential changes to the block schedule and/or more efficient tray configurations could improve SPD processing times. In this article, we incorporate the SPD into an existing simulation model of an OR suite, which is the first of its kind, and examine the effect that different block schedules and tray configurations have on SPD processing times. Simulation results confirm earlier numerical computations. Furthermore, simulation results suggest that more efficient instrument tray configurations are a much better and more viable method for improving SPD processing time than reconfiguring block schedules.

The Centers for Disease Control and Prevention (CDC) and the Division of Cancer Prevention of Control administer the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), designed to increase early detection of cancers among low-income uninsured and underinsured women. However, rates of cancer diagnosis and survivorship differ among women of different ethnicities. We investigated two questions: 1) what are the potential barriers and facilitators for women to complete recommended breast and cervical cancer screenings, and 2) are the barriers and facilitators different for Hispanic women when compared to non-Hispanic White women? We used a community-based participatory research approach and mixed methods: qualitative interviews with women enrolled in the program and a systematic process improvement approach to identify root causes of completing or not completing screenings. We conducted semi-structured interviews in English (n = 11) and Spanish (n = 9) and analyzed responses using fishbone diagrams. We recruited 20 participants in four categories: (a) non-Hispanic White women who completed screenings (n = 9), (b) non-Hispanic White women who did not complete screenings (n = 2), (c) Hispanic women who completed screenings (n = 7), and (d) Hispanic women who did not complete screenings (n = 2). Among all women, facilitators included assistance from program staff with appointments and reminders. Hispanic women reported barriers including language difficulties and confusion about the program. Non-Hispanic White women identified barriers as confusion about the role of insurance. We found that there are differences in barriers and facilitators for non-Hispanic White women and Hispanic women due to language, the role of insurance, and the level of trust in the program. Reasons for not completing screenings for Hispanic women were structural and systemic in nature; reasons for non-Hispanic White women were based on personal choices.

The pressures of an everchanging world have impacted the ways in which service-based systems operate, along with their forms and boundaries. Resilience and survivability have been treated interchangeably when readying a system to remain true to its functions despite disturbances. Some situations prove the concepts may not always be the equivalent of the other, not even the consequence of the other. There may come scenarios where system components fail to adhere to certain predefined thresholds and cross a breaking point. It is therefore proposed in this study that systems can be survivable, instead of resilient, when they comply in time with the resurgence property. This property signifies the systematic behavior of overcoming a certain stagnation period and, after a time range, return as a transformed system with new functions and challenges. Through this study, it was detected that the symmetries between resilience and survivability are only superficial if systems suffer breakages after misconceiving the true causes of failure. Still, a lack of consensus among scientists and practitioners remains an issue when applying resilience and survivability in their own problems. Although workful, pushing to achieve a greater consensus would signify optimal performance in multifaceted systems involving technical, social, and economic challenges.

Lean is an ideology that businesses turn to create value for customers. Research literature shows a lack of successful implementation, specifically in small and medium-sized enterprises (SMEs). This applied research analyses a local Montana startup and uses concepts from lean six sigma and industry 4.0 (I4) to reduce waste and prepare the company for future growth. The applied research uses a lean six sigma methodology to make suggestions for future improvements to scale and implementing changes. As the fourth revolution is upon us, inter-connectivity and digitization provide new tools that are expected to change the course of manufacturing radically in the near future. With it, I4 brings some tools that can potentially help SMEs overcome some of the current barriers to successfully implement lean. This research investigates what tools the fourth industrial revolution has brought us that can potentially provide lean the flexibility needed to be implemented in our study.

Poor mental health affects nearly one billion people worldwide and can end in suicide if not treated. Unfortunately, stigma and a lack of mental healthcare providers are barriers to receiving needed care. We developed a Markov chain model to determine whether decreasing stigma or increasing available resources improves mental health outcomes. We mapped potential steps in the mental health care continuum with two discrete outcomes: getting better or committing suicide. Using a Markov chain model, we calculated probabilities of each outcome based on projected increases in seeking help or availability of professional resources. Modeling for a 12% increase in awareness of mental health concerns yielded a 0.39% reduction in suicide. A 12% increase in access to professional help yielded a 0.47% reduction in suicide rate. Our results show that expanding access to professional services has a higher impact on reducing suicide rates than creating awareness. Any intervention towards awareness or access positively impacts reducing suicide rates. However, increased access results in a higher reduction in suicide rates. We have made progress in increasing awareness. Awareness campaigns help to increase recognition of mental health needs. However, focusing efforts on increasing access to care may have a higher impact on reducing suicide rates.

Mental workload is a multidimensional construct that involves the characteristics of the task, individual factors, and the environment where the task is performed. Responses to tasks that are perceived as mentally demanding can exacerbate ergonomics risk factors affecting employee behavior and attitude, leading to risky actions such as awkward body postures, and consequently increasing physiological susceptibility to work-related musculoskeletal disorders. The present study looked to establish if the perception of mental workload can be affected by psychosocial work factors that generate changes in the environment in which humans must perform the tasks. The study also looked to determine if changes in perceived mental workload generated changes in the body postures undertaken to perform an activity to lay the foundation for future exploration into the influence of perceived mental workload over physical demands. The results of this study indicate, that an increase in the perception of mental workload is associated with worse body postures. This study is novel and contributes to overcoming an important shortcoming in the field of mental workload by considering the influence of psychosocial factors, keeping the physical load constant, on the perception of mental workload and its influence on body postures. This interaction between perceived mental workload and its effects on physical risk should be considered in occupational settings since often, employees are exposed to concurrent physical and mental demands that increase the likelihood of developing WMSDs.

Emergency department (ED) visits have risen to more than 60% since 1997, with more than 90% of U.S EDs being over-stretched due to overcrowding which has only been compounded by the recent pandemic. Consequences for ED overcrowding range from less severe effects such as patient inconvenience to more severe outcomes such as patient fatality. Research shows poor crowd management at the ED does not only affect patients but takes a toll on ED staff as well. To attempt to address this issue, our study researches how patient vitals collected and transmitted in real time to ED staff can help manage patients in the ED using a triage system that orders vitals in an urgent priority listing. We gathered data from participants using non-invasive wearable devices (CareTaker4 & Oximeter) to collect vital signs information such as heart rate, respiratory rate, blood pressure, and oxygen levels. We aim to use the data to feed a mathematical model that will create a priority algorithm that can sort patients in an ED according to the urgency of their vital signs and transmit the data in real time to health personnel. This way, the patients can be moved automatically in the list as they deteriorate while waiting. We were able to plot the data to show which patients' health are deteriorating quickly and that would require immediate attention. This will be instrumental by helping ED staff attend to pressing cases faster and help control crowds according to medical urgency instead of a first come first serve basis which is not always effective.

One strategy to reduce inventories and increase on-time delivery is to use Advanced Demand Information (ADI) in which customers place their orders ahead of their due date. ADI can be divided into perfect or imperfect information. Under perfect ADI, customers send accurate demand information to the suppliers, specifying exact quantities and due dates. Under imperfect ADI, customer orders' quantities and/or due dates may change over time or order cancellations may occur. This research focuses on the effects of three types of imperfect ADI on different production systems: changing due dates, changing order quantities, and cancellations. Three different model variations simulate a pull system, a push system, and a hybrid system. We found that only cancellations and changing order quantities had a significant effect on system performance. Generally, the pull and the hybrid system behaved similarly and proved to be more suitable for managing imperfect ADI than the push system.

Group-based multi-criteria decision-making (MCDM) is a challenging and time-consuming process often rich with subjectivity. This paper outlines an algorithm created in Python to evaluate every possible criterion weighting combination to assist in making an objective decision. Implications of this study include increased efficiency and reduced subjectivity in group-based MCDM.

Mass vaccination plays an important role in increasing immunization against COVID-19 and decreasing morbidity.Drive-through and traditional walk-through centers have been set up in most cities in the United States and other countries to vaccinate large numbers of people in a short period of time.This article focuses on a pair of mass vaccination clinics conducted on a midsized, public university campus.Applying tools from Industrial Engineering, including time study, flow charts, and Queuing Theory, the team identified improvements that resulted in a 40% reduction in the duration of the second clinic while vaccinating almost the same number of patients with no increases in overall staffing.The work resulted in a model for designing mass vaccination clinics in the future and demonstrates that engineers have the ability to support healthcare personnel to increase the performance of the vaccination centers.The inclusion of engineering in the planning and execution of these vaccination clinics can help maximize clinic capacity, reduce the staff and resources needed, and reduce the patients' waiting time.

This research explores the effects of listening to music during exams for engineering college students. Students were given the option to listen to self-selected music while completing exams in three undergraduate engineering courses over four years. It was found that listening to music during an exam had no significant effect on the mean exam scores or completion times. However, when analyzing data from students who had taken exams both with and without music, it was found that these students performed significantly better in the music condition but at par with the mean score. Results indicate that allowing music during exams for students who study with music does not represent an advantage but rather an opportunity for equity in exam-taking environments.

Introduction: In 2020, 18.4% of Hispanics experienced mental illness, yet only about a third received treatment compared with nearly half of non-Hispanic Whites. In Montana, where only 11% of the mental health needs are currently met, service utilization is low. The purpose of this study was to determine the perceptions of the Hispanic immigrant population in a rural state on mental health and professional service utilization. Methods: Using a descriptive phenomenological approach, we conducted semi-structured telephone interviews in Spanish. Audio recordings were transcribed, translated to English, and analyzed for themes. Results: We recruited a sample of 14 participants from Mexico, Ecuador, Colombia, and Venezuela ranging in age from 33 to 59. We identified five themes: definitions of mental health, maintaining mental health, familismo/socialization, stigma, and acculturation stress. Discussion: Novel findings point to the need for Spanish-language services focused on reducing stigma around mental illness and incorporating the importance of social connections.

BACKGROUND:Native American communities in Montana reservations have reported low-level satisfaction in health services. This research explored if the services provided at a Blackfeet Indian Reservation outpatient clinic were designed to meet patient expectations.METHODS:Staff and patient interviews and surveys allowed service expectations to be assessed according to the clinic's ability to meet those expectations. A total of 48 patients and ten staff members (83% of the staff at this clinic) participated in the study voluntarily.RESULTS:We found a disconnect between what patients anticipate for care and what staff think they are anticipating. We also found a discontent between what staff believes patients need versus what the patients feel is needed.CONCLUSIONS:These gaps combine to increase the breach between patient expectations and perceptions of their healthcare services. With better insight that captures what patients are looking for from a service, the potential to meet those needs increases, and patients feel that their voice is respected and valued.

The Hispanic population is growing rapidly in U.S. rural states, yet limitations in Spanish-speaking behavioural health providers are a barrier to accessing care. In Montana, a new immigrant destination, mental health disparities may not yet be fully understood. We describe an interprofessional approach of nurses and engineers using the Plan-Do-Check-Act (PDCA) cycle to identify disparities in mental health access in a Hispanic community in a rural state. We recruited a community advisory board to inform researchers about potential disparities and to design interventions. The Plan phase consisted of naming the problem and its root causes. Researchers and a community advisory board created flowsheets and diagrams to uncover personal, environmental, political, and procedural contributors to poor mental health outcomes. The Do phase included implementation of a community screening for depression and anxiety. The Check phase revealed 43 mental health screenings where 21% screened positive for depression and 16% screened positive for anxiety. We made 16 referrals to a mental health intervention study. The Act phase led to plans for regular implementation of the health fairs and a study designed to provide Spanish-language mental health services. The success of our interprofessional work provides an example of how the PDCA cycle can be used to uncover potential causes for poor health outcomes and design and evaluate interventions targeted to mitigate those outcomes.