Search Results (9)

Objectives: This study evaluates the effectiveness of an innovative, integrated healthcare approach based on the “Long-term Care (LTC) in the Community” pilot project, aimed at testing solutions for the new LTC Act and associated regulations in Slovenia. It is based on a small sample, which can be financed from European project funds. This methodology is crucial for the subordinate legislation derived from the LTC Act. Methods: We selected beneficiaries who decided to receive integrated services in their home environment in rural areas. Among 132 beneficiaries who received various care services at home, 75 beneficiaries received integrated services to maintain independence, while a control group of 57 persons did not receive these despite eligibility. The hypothesis that the new reactivation and other services to strengthen and maintain independence facilitate a transition to a lower category of LTC within the system of different states of abilities and that new approaches with integrated home care are much more successful were tested using the Z + 4 test. Results: Seven out of eight users’ abilities were improved by an inventive approach to LTC at home, including reactivation activities, with p < 0.025. The probability that the new methods will outperform the old ones for an arbitrarily selected senior eligible for LTC exceeded 0.89. Thus, we used quantitative methods to confirm the reasonableness of the decisions included in the LTC Act and will help to estimate savings in the health fund. Conclusions: These positive results promote the implementation of integrated care strategies, norms, and standards, which will be further articulated in subordinate legislation. Full article

Objectives: A novel two-step flow-through in vitro lipolysis model was developed for the evaluation of drug release from a self-microemulsifying drug delivery system (SMEDDS). Methods: Firstly, the SMEDDS was dispersed in an acidic medium. Subsequently, the pH was increased, and a lipolytic reaction was immediately initiated, accompanied by medium flow onset. The latter enabled increase of the initial low pH of the medium, improving the physiological relevance of the method by simulating dosage form retainment in the stomach and transfer to the duodenum, which is very important for a weakly basic active pharmaceutical ingredient (API) incorporated in an SMEDDS. Results: Conversely to the traditional pH-stat in vitro lipolysis, the developed method is not established on titration, as the reaction vessel pH is regulated by a medium flow and buffer capacity. Individual parameters, such as pancreatin activity, buffer capacity, and medium shift, were researched using traditional pH-stat in vitro lipolysis prior to their implementation in the flow-through setup. Conclusions: The concentration of the solubilized model API, carvedilol, was increased as pancreatin activity decreased and as buffer capacity increased. The ratios between release profiles obtained under different conditions utilizing the pH-stat and novel two-step flow-through in vitro lipolysis were comparable; however, the differences were more pronounced in the flow-through method. Full article

Food can change various physiological parameters along the gastrointestinal tract, potentially impacting postprandial drug absorption. It is thus important to consider different in vivo conditions during in vitro studies. Therefore, a novel dissolution medium simulating variable postprandial pH values and lipid concentrations was developed and used in this study. Additionally, by establishing and validating a suitable analytical method, the effects of these parameters on the dissolution of a model drug, cinnarizine, and on its distribution between the lipid and aqueous phases of the medium were studied. Both parameters, pH value and lipid concentration, were shown to influence cinnarizine behavior in the in vitro dissolution studies. The amount of dissolved drug decreased with increasing pH due to cinnarizine’s decreasing solubility. At pH values 5 and 7, the higher concentration of lipids in the medium increased drug dissolution, and most of the dissolved drug was distributed in the lipid phase. In all media with a lower pH of 3, dissolution was fast and complete, with a significant amount of drug distributed in the lipid phase. These results are in accordance with the in vivo observed positive food effect on cinnarizine bioavailability described in the literature. The developed medium, with its ability to easily adjust the pH level and lipid concentration, thus offers a promising tool for assessing the effect of co-ingested food on the dissolution kinetics of poorly soluble drugs. Full article

There is evidence of benefits from the national health insurance systems in the EU Member States in the case of better-adjustment of housing units to the functional capacities of older adults. Still, the systematic approach to evaluating the social value (SV) of investments in specialised housing and other types of built environment is not yet developed. This paper aims to show how these benefits can be quantified if we evaluate the actuarial present value (APV) of reducing public expenditures in Long-term care (LTC), including Health care (HC) in these systems, after the development of specialised housing units which can accommodate the declined functional capacities of seniors. The paper presents steps to measure the SV as the impact of investments in the properly built age-friendly public housing stock, creating positive externalities for HC expenditures and LTC systems achieved for the Health Insurance Institute of Slovenia, thereby decreasing expenditures for this body. We developed a new model to forecast the SV of investments in specialised social housing as savings for national health and care systems, particularly the Central-European health and care insurance systems. We were forecasting the different demands for different specialised housing as part of the social infrastructure for insured older adults, which mitigates public expenditure on HC and LTC services. The multistate transitions are described based on projections and probability-weighted cashflows (actuarial present value, APV) are calculated. Unfortunately, there are no documents by the European Commission yet, although the Commission stresses the need to develop such a model. Full article

The Long-Term Care (LTC) industry mainly comprises networks managed by providers of services other than informal caregivers and government agencies. Among the providers are the local providers of community-based services. The segment still consists of mostly small businesses. As such, it needs many improvements in logistics, information and communication technology (ICT) support, and educational programs, specifically in the ADRION region, where the rural areas require a high percentage of travel time in a working day for service providers. The demand for LTC services must be known early enough for providers to adapt to the growth of these demands, and they also need methods to support decisions on how to optimize the number of care workers to be able to plan the necessary human resources in the long term. The results are based on the authors’ previous studies of sustainable hierarchical spatial systems. The paper presents the achievements of these research activities and policies, governance and financing in the hierarchically organized services and networks of educational programs for human resources and ICT innovations in LTC, which are currently in short supply. Projections of capacities from facilities are necessary. Logistic networks to human resources are based on geo-gerontological projections, such as the multistate transition model, which is a new achievement in this area, and the adequate norms and standards of these services. The optimal number of human resources is based on the combination of the Patterson-Albracht algorithm and Multiple Travelling Salesman Problem (mTSP), as a new Home Health Care Routing and Scheduling Problem (HHCRSP), which helps in ensuring the inclusion of travel time in the concept of norms and standards, to achieve a work balance and care schedule according to the wishes of clients. The proposed approach might help professionals adapt in advance to the coming changes caused by the growing number of seniors and rapid changes in technology, and might also help in considerations as to whether the priorities of clients should be included in the basic national insurance programs or additionally charged as a higher standard of home care services. The aim is to make care and supply networks as sustainable as possible. Full article

Urban shrinkage is a remarkable phenomenon that cannot be convincingly explained by existing theories on urban growth and is closely linked to the global supply chain (SC) nodes in the labour market. This paper shows how a municipality in which an activity SC cell (production or service) is located as a node in the SC graph can be made more attractive for industrial activities and human resources, more sustainable, and less shrinking, through appropriate tax policies and investments in the infrastructure of the central places—cities where production or services are located. To this end, we developed the decision support model for the joint control of urban rightsizing by SC managers and local authorities. In the model we linked the extended material requirements problem (MRP) with a normalised asymmetric gravity model. The paper outlines how local authorities and institutions, when planning for the growing intensity of production or services, in a city where the number of workers is insufficient, should take into account the impact of taxation as well as investment in the infrastructure of a municipality, and not just net wages, in order to attract human resources. They need a decision support model for their negotiations on the rightsizing of the city. The objective was to develop a model of fiscal mechanisms in the interactive decision making processes of local authorities and SC managers to control the availability of labour in the city where production or services are running and need to grow because SC managers want to increase production or services but the available labour force is shrinking. A case study in Slovenia shows how local authorities and SC managers should work together to maintain a sustainable activity cell in a functional region of the urban agglomeration where this production or service is located. It models how to plan the rightsizing. Such an integrated policy best achieves the desired intensity of the supply chain, thereby avoiding the relocation of activities outside the region, which allows unsustainable flows of human resources and uncontrolled shrinking of a city or region. Full article

The aim of this paper is to present how a higher income can be achieved by developing a broader and more accurate planning framework and control perishability from stable to fork if it is possible to redirect the shipments in the case of increasing perishability dynamics or longer time delays on the roads. It also gives the answer to the question of how such a Supply Chain (SC) can be evaluated using Net Present Value (NPV) approach. The procedures include a real-time calculation and communication about the remaining shelf life (RSL) during transportation and other logistic manipulations from one chain node to another if the time to exceed the contractually stipulated Customer Remaining Shelf Life (CRSL) is distributed by known distribution. Planning and control on the skeleton of the extended material requirements planning (MRP) model are advised, where time delays and their impact on the CRSL can be easily calculated. The changes in the NPV at contractually stipulated CRSL are calculated dynamically in real-time. Smart devices, tracking temperature, humidity, and gas concentration enable such reports immediately after detecting a high probability that CRSL, as stipulated in a contract, will not be achieved, based on the known parameters of the exponential distribution of the remaining shelf life as a time to failure at each node of the graph. The model includes possibilities to deliver the meat to the local market or to the reverse logistics plants in the nodes of the remaining route, if the expected contractually stipulated CRSL becomes too high. On this way, shortening unnecessary routes further contributes to less pollution. Full article

The earlier planning methods of supply chains (SC) in the skeleton of the extended material requirements planning (EMRP), where the time horizon of the reverse Laplace is infinite, were not convenient to estimate the impact of the technical obsolescence of the product or technology involved, which has economic, environmental, and social consequences. Therefore, the perturbations of timing are presented until the possible obsolescence, with parallel execution of the network simulation model (NSM) to evaluate the impact of the finite lifespan on the value of the chain. The EMRP, as well as the NSM, are based on the skeleton of the material requirements planning model, where delays and their perturbations are presented transparently. Contrary to the previous studies of the net present value (NPV) in the EMRP skeleton, where the infinite horizon is assumed, the impact of shortening the horizon of activities is shown here, in order to also evaluate the risk of financing investments in the SC with a shorter lifespan of products or technology. Owing to the simultaneous appearances of the stochastic variables, the parallel execution and exchanging of data, using NSM is advised. The procedures for estimation of correction factors of the NPV and their values are given. Full article

Many bead biopharmaceutical characteristics are dependent on the bead shape. Furthermore, the shape is one of crucial parameters for incorporation of beads in more complex drug delivery system. Therefore, the aim of this study was to evaluate the influence of various processing parameters such as hardening time, temperature and concentration of calcium chloride solution and drying conditions on size, shape and morphology of alginate beads prepared by ionotropic gelation method. Theophylline was selected as a model drug. It was found that all studied parameters markedly affected bead form, resembling in most cases to ellipsoid spheres. Their sphericity was estimated three-dimensionally by measuring diameters of frontal and lateral side which were perpendicular to each other. Smaller and more spherical beads were obtained at longer hardening time and higher temperature of calcium chloride solution. The freeze-dried beads were the largest and the most spherical. It was demonstrated that optimization of bead shape as well as size and morphology could be achieved by altering processing parameters. Full article