Additional Time Research Articles

Investigation on displacement efficiency and enhance oil recovery performance of CO2 and CO2-chemical additive composite system flooding using LBM simulation

CO2 flooding is a promising EOR method. Chemical additives reduce oil viscosity and CO2-oil interfacial tension. In this study, we propose a multiphase and multi-component model based on the LBM to examine the effectiveness of CO2 flooding and identify the factors that influence its performance. Additionally, we present a novel approach for simulating CO2-chemical additive composite system (CCAS) flooding by modifying fluid interaction parameters and reducing oil viscosity when exposed to chemicals. A comparison was conducted between the CO2 flooding approach and the CO2-chemical additive compound systems. The results show that the force between fluid molecules has a significant impact on interfacial tension and miscibility, affecting the displacement process. The viscosity and injection speed of the displaced fluid play a crucial role in determining the initial momentum and CO2 displacement performance. Additionally, reservoir rock morphology has an impact on the velocity of fluid molecules, and affects the displacement efficiency. The CCAS flooding has the potential to increase oil recovery by 15% compared to using CO2 flooding alone. Optimizing additive concentration, injection timing, and injection rate can further improve oil displacement efficiency by 5%-10%. Valuable theoretical guidance for applying CO2 chemical additives is provided by these research findings.

So You Want to Survey a State Legislator? Call Me, Maybe

Based on legislation passed in 2021, we undertook a first-in-the-nation effort to survey elected and appointed officials in the state of New Jersey to collect basic demographic information. This survey ran into challenges that all surveys encounter, namely, how to reach respondents and how to get them to then complete the survey—especially with an elite population. An initial recruitment effort using official, and publicly available, email addresses yielded a low response rate, requiring us to revise our recruitment strategy. We settled on directly calling the offices of the New Jersey Assembly and Senate members to enlist the support for their Chiefs of Staff and legislative aides to assist us in getting the survey completed. Directly contacting the offices in this way more than doubled the response rates compared to email. Researchers should be mindful of the benefit of this recruitment mode in future efforts to survey legislators and be attentive to the additional costs and time associated with it.

Post Harvest Handling of Fruit Crops

Fruits are classified as perishable agricultural commodities. When fruits are harvested prematurely or when they are overripe, their storage life is shortened and their quality deteriorates. Therefore, it is important to harvest fruits at the appropriate stage of maturity in order to ensure good quality and better storage. Nevertheless, the inadequate implementation of proper handling techniques for agricultural produce has led to a significant occurrence of post-harvest losses, resulting in the wastage of valuable resources such as time and financial investments. The lack of appropriate handling procedures and chemical treatment methods are leading to significant losses in commodities. Therefore, it can be deduced that producers are currently experiencing significant economic detriment as a result of inadequate handling techniques, insufficient understanding of the underlying factors contributing to postharvest loss, and a dearth of effective preservation methodologies. However, the mitigation of loss can be achieved through the implementation of appropriate management and handling procedures. This review focuses on various aspects of post-harvest handling methods for preservation of fruits for longer time for processing and value addition.

Optimization of extraction process for classic prescription Yihuang Decoction based on Box-Behnken design-response surface methodology, standard relation, and analytic hierarchy process combined with entropy weight method

Based on the concept of quality by design(QbD), the Box-Behnken design-response surface methodology combined with standard relation(SR) and analytic hierarchy process(AHP)-entropy weight method(EWM) was applied to optimize the extraction process of the classic prescription Yihuang Decoction. The content of geniposidic acid, phellodendrine hydrochloride, and berberine hydrochloride in Yihuang Decoction, the extract yield, and fingerprint similarity were used as the critical quality attributes(CQAs) of the extraction process. The extraction time, water addition, and extraction times were used as the critical process parameters(CPPs). After determining the levels of each factor and level through single-factor experiments, response surface experiments were designed according to the Box-Behnken principle, and the experimental results were analyzed. The SR between each sample and the reference sample under various evaluation indicators of different extraction parameters was calculated. The weights of the five evaluation indicators were determined using AHP-EWM, followed by comprehensive evaluation. A function model between CPPs and CQAs characterized by comprehensive scores was established to predict the optimal extraction process parameters. In the final comprehensive weight coefficients, the yield rate accounted for 43.1%, and the content of berberine hydrochloride, phellodendrine hydrochloride, and geniposidic acid accounted for 35.1%, 6.3%, and 15.5%, respectively. After comprehensive score analysis with SR, the established second-order polynomial model was statistically significant(P<0.01, and the lack of fit was not significant). The predicted optimal extraction conditions for Yihuang Decoction were determined as follows: 8-fold volume of water, extraction time of 1.5 h, and extraction once. The mean comprehensive score of the validation experiment was 85.77, with an RSD of 0.99%, and it met the quality control stan-dards for the reference sample of Yihuang Decoction. The results indicate that the optimized extraction process for Yihuang Decoction is stable and reliable, and the water extract is close in quality attributes to the reference sample. This can serve as a foundation for the research and development of granules in the future. Box-Behnken design-response surface methodology combined with SR and AHP-EWM can provide references for the modern extraction process research of other classic prescriptions.

Joint Optimization of Sensing and Computation for Status Update in Mobile Edge Computing Systems

IoT devices have been widely utilized to detect state transition in the surrounding environment and transmit status updates to the base station for system operations. To guarantee the accuracy of system control, age of information (AoI) is introduced to quantify the freshness of the sensory data and meet the stringent timeliness requirement. Due to the limited computing resources, the status update can be offloaded to the mobile edge computing (MEC) server for execution. Since status updates generated by insufficient sensing operations may be invalid and lead to additional processing time, a joint data sensing and processing optimization problem needs to be considered. Therefore, this work formulates an NP-hard problem that considers the freshness of the status updates and energy consumption of the IoT devices. Subsequently, the problem is decomposed into sampling, sensing, and computation offloading optimization problems. To optimize the system overhead, a multi-variable iterative system cost minimization algorithm is proposed. Simulation results illustrate the efficacy of our method in decreasing the system cost, and indicate the influence of sensing and processing under different scenarios.

Risk factors and early outcomes of repeat sternotomy in 1960 adults with congenital heart disease: A 30-year, single-center study

ObjectivePatients with congenital heart disease (CHD) increasingly live into adulthood, often requiring cardiac reoperation. We aimed to assess the outcomes of adults with CHD (ACHD) undergoing repeat sternotomy at our institution. MethodsReview of our institution's cardiac surgery database identified 1960 ACHD patients undergoing repeat median sternotomy from 1993 to 2023. The primary outcome was early mortality, and the secondary outcome was a composite end point of mortality and significant morbidity. Univariable and multivariable logistic regression models were used to determine factors independently associated with outcomes. ResultsOf the 1960 ACHDs patient undergoing repeat sternotomy, 1183 (60.3%) underwent a second, third (n = 506, 25.8%), fourth (n = 168, 8.5%), fifth (n = 70, 3.5%), and sixth sternotomy or greater (n = 33, 1.6%). CHD diagnoses were minor complexity (n = 145, 7.4%), moderate complexity (n = 1380, 70.4%), and major complexity (n = 435, 22.1%). Distribution of procedures included valve (n = 549, 28%), congenital (n = 625, 32%), aortic (n = 104, 5.3%), and major procedural combinations (n = 682, 34.7%). Overall early mortality was 3.1%. Factors independently associated with early mortality were older age at surgery, CHD of major complexity, preoperative renal failure, preoperative ejection fraction, urgent operation, and postoperative blood transfusion. In addition, sternotomy number and bypass time were independently associated with the composite outcome. ConclusionsDespite the increase in early mortality with sternotomy number, sternotomy number was not independently associated with early mortality but with increased morbidity. Improvement strategies should target factors leading to urgent operations, early referral, along with operative efficiency including bypass time and blood conservation.

Knowledge of palliative care and barriers to access among outpatients with cancer.

271 Background: Integrated specialist palliative care (PC) is known to improve outcomes among ambulatory patients with cancer, yet it remains underutilized for this population. It is known that PC is poorly understood among the public, however very little is known about what ambulatory patients with cancer understand about PC or what barriers to access exist. Methods: Outpatients undergoing cancer treatment completed a survey evaluating their familiarity and knowledge of PC (Palliative Care Knowledge Scale; PaCKS), feelings towards PC (before and after reading a standardized definition of PC), barriers to PC, prognostic awareness, and health literacy. We examined variables associated with participants’ familiarity with PC and current interest in receiving PC by fitting logistic regression models. To determine if there was a difference in patients’ feelings toward PC before and after reading the standardized definition, a Chi-Squared test was conducted. All other responses were summarized descriptively. Results: Of 151 participants, 58.9% reported familiarity with palliative care. The average PaCKs score was 11.9 (standard deviation 1.4), and 46.4% of patients received a perfect score, indicating high knowledge of PC overall. Only time since diagnosis (> 1 year vs < 1 year) was associated with significantly increased odds of being familiar with PC (OR 2.93; 95% CI 1.37-6.25). After reading the standardized definition of PC, participants reported feeling significantly less anxious and more reassured; however, more participants were interested in receiving PC in the future compared to at the time of survey completion (74.2% vs 44.4%, respectively). Patients with stage III or IV cancer had significantly increased odds of having interest in receiving PC at the time of study completion compared to patients with stage I or II (OR 2.66; 95% CI: 1.05, 6.76). Having an aggressive cancer was not associated with interest in receiving PC at the time of study completion. Logistic barriers (additional travel or time at the hospital) were commonly reported barriers to attending palliative care appointments. Conclusions: Outpatients with cancer who are being treated at a large academic cancer center have higher familiarity and knowledge of PC than the average American adult. Despite this, anxiety surrounding PC and hesitations regarding early integration of PC persist. Therefore, factors outside of knowledge may be perpetuating the delayed or lack of involvement with PC in oncology. Future work must seek to overcome these barriers to PC integration in outpatient cancer care.

Evaluating the Impact of a Mobile Integrated Health‒Community Paramedicine Program on Health-Related Social Needs and Hospital Readmissions

Abstract: Objective. Evaluate a mobile integrated health–community paramedicine program's effect on addressing health-related social needs and their association with hospital readmissions. Methods. This observational study enrolled 1,003 patients from 5/4/2018–7/23/21. Descriptive statistics summarize social needs. A Poisson regression model examined the association of interventions for social needs with 30-day readmissions. Results. Patients who had their medication-related needs fully addressed had a 65% lower rate of total 30-day readmission compared with patients who had no such needs fully addressed (IRR=0.35, 95% CI 0.18–0.68, P=.002). No variables reached statistical significance related to unplanned 30-day readmissions, aside from the HOSPITAL Score. Conclusions. Assisting patients with medication-related needs is associated with reductions in overall 30-day readmissions. Interventions within most domains were not associated with reductions in overall or unplanned 30-day readmissions. This program had greater success addressing needs with one-step interventions, suggesting additional time and resources may be necessary to address complex social needs.

View Synthesis of Dynamic Scenes based on Deep 3D Mask Volume.

Image view synthesis has seen great success in reconstructing photorealistic visuals, thanks to deep learning and various novel representations. The next key step in immersive virtual experiences is view synthesis of dynamic scenes. However, several challenges exist due to the lack of high-quality training datasets, and the additional time dimension for videos of dynamic scenes. To address this issue, we introduce a multi-view video dataset, captured with a custom 10-camera rig in 120FPS. The dataset contains 96 high-quality scenes showing various visual effects and human interactions in outdoor scenes. We develop a new algorithm, Deep 3D Mask Volume, which enables temporally-stable view extrapolation from binocular videos of dynamic scenes, captured by static cameras. Our algorithm addresses the temporal inconsistency of disocclusions by identifying the error-prone areas with a 3D mask volume, and replaces them with static background observed throughout the video. Our method enables manipulation in 3D space as opposed to simple 2D masks, We demonstrate better temporal stability than frame-by-frame static view synthesis methods, or those that use 2D masks. The resulting view synthesis videos show minimal flickering artifacts and allow for larger translational movements.

"I had become fed up": A qualitative study of Black nurse practitioners' experiences fighting against health inequity, racism, and burnout.

Increasing diversity in the nurse practitioner (NP) workforce is key to improving outcomes among patients who experience health inequities. However, few studies to date have examined the specific mechanisms by which NPs from diverse backgrounds address inequities in care delivery. To explore Black NPs' efforts in addressing inequities, and the facilitators and barriers they face in doing so. We conducted focus groups and interviews of Black NPs (N = 16) in the greater Philadelphia area in early 2022, just following the height of the COVID-19 pandemic and the social unrest of the early 2020s. Data were analyzed using thematic analysis. Emergent themes included: Strategies Utilized to Address Health Inequities; Burnout & the Minority Tax; Risks & Rewards of Taking a Stance; and Uneven Promises of Organizational Engagement. Nurse practitioners prioritized patient-centered, culturally congruent care, taking additional time to explore community resources and learn about patients' lives to facilitate care planning. Participants advocated to administrators for resources to address inequities while simultaneously navigating organizational dynamics, microaggressions, and racism. Finally, NPs identified organizational-level barriers, leading to emotional exhaustion and several participants' intent to leave their roles. Black NPs use a myriad of strategies to improve equity, yet frequently face substantial barriers and emotional exhaustion in doing so with little change to the inequities in care. The NP workforce has a critical role to play in reducing health inequities. The strategies outlined by Black NPs in this study offer a roadmap for all clinicians and health care organizations to prioritize equity in care delivery.

Modeling and Optimizing Wastewater Stabilization Ponds for Domestic Wastewater Treatment

In Wastewater Stabilization Ponds (WSPs), baffle walls (BWs) have the dual benefit of reducing area requirements and increasing contaminant removal efficiency up to a certain threshold. However, this advantage is mitigated by the increased demand for construction materials, highlighting the need for optimization. Effectively optimizing WSPs to suit diverse climatic regions can substantially alleviate nationwide wastewater treatment challenges. This study focuses on optimizing WSPs across seven distinct climatic regions in Turkey. In the initial phase, a comprehensive analysis was conducted using design spreadsheets for the WSPs to determine the best configuration based on traditional methodology (TM). The results demonstrated a significant decrease in WSPs area and hydraulic retention time (RT), validating the effectiveness of BWs provision. However, this approach requires additional time and effort. Subsequently, mathematical modeling (MM) was used to further reduce the time required for the optimization process. Using the interior-point algorithm in MATLAB and the generalized reduced gradient (GRG) algorithm in MS Excel Solver, both algorithms within MM effectively decreased the WSPs area and RTby approximately 10%, while decreasing the required concrete volume by approximately 5% compared with TM. As other algorithms may yield better optimization, they can be investigated by developing specialized software for WSPs. Doi: 10.28991/CEJ-2023-09-11-014 Full Text: PDF

Computational framework for the evaluation of the composition and degradation state of metal heritage assets by deep learning

The accurate assessment of the material constitution and degradation in newly discovered archaeological artefacts is paramount for the decisions surrounding a thorough treatment of the object during the restoration and conservation stages. The laboratories possess competent experts and complex devices to perform this analysis properly. Nevertheless, a timely hint of an artificial intelligence assistant regarding the chemical composition and corrosion compound localization of a metal asset could save additional time and resources. The present paper proposes such a computational framework based on deep learning techniques that, on the base of its automatic determination of the chemical concentration of the predominant metal from a microscope image, can subsequently independently also recognize and delineate the corrosion spots of the products specific to that metal. The experiments have been performed on iron and copper heritage items from the Oltenia Museum, Romania. The results suggest that, even with an economic training information in terms of microscope images and annotations, the artificial intelligence framework can provide on-site support for an early examination of metal heritage assets.

A99Designing and implementing e-noting for use in simulation scenarios for sustainability and realism

Due to the nature of simulation-based education, large amounts of blank paperwork are used and disposed of in any given scenario. As many trusts are now moving towards e-noting, including e-obs and e-prescribing, the use of these in simulation can be extremely beneficial for the learners. These were highlighted by the author as areas for sustainability and increased realism throughout the simulation sessions run by the team at Dartford and Gravesham NHS Trust [1]. This initiative was developed to cut down on the amount of paper waste used during scenarios and increase the realism for the learners taking part. E-obs, e-prescribing and e-noting templates were created using Microsoft Excel and Microsoft Word that mirrored the programmes used throughout the trust, and were made readily available for the learners taking part in the simulation scenarios. These were then saved as templates, and a new version created for each existing patient throughout the scenarios. On top of this, each new scenario created also required a new set of e-noting, including a NEWS, prescription and the relevant paperwork. ‘Patients’ who had progressed through ED, for example, had a completed CAS card, and their NEWS chart reflected the several sets of observations already taken. The NEWS chart template was also adapted for patients with COPD, and PEWS charts for each paediatric age group were also created, alongside separate e-prescribing to mirror the paediatric version of the drug charts throughout the trust. Learners who participated in the scenarios using e-noting provided positive feedback, highlighting the realism and relevance to practice. 43 learners were asked to complete a short survey after taking part in 1 or more scenarios using the new e-noting system. 79% of learners reported that they found the system easy to use, 90% reported the relevance to clinical practice, 81% reported that it was realistic and 95% were happy that this is a feasible and sustainable way to utilize prescribing, observations measurement and note writing/history taking throughout the simulation sessions. 4% reported not using the e-noting system during their scenario. Although the creation of the e-noting system required additional time and resources at the start, they quickly became easy to implement and adapt to each new patient or scenario. The use of this system leads to much less paperwork being destroyed and increased the realism for the participants who use e-noting throughout the trust. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Passenger Queuing Analysis Method of Security Inspection and Ticket-Checking Area without Archway Metal Detector in Metro Stations

In order to avoid the congestion in front of the entrance gate units, it is necessary to analyse and optimise the queuing situation at the planning and design stage. The security inspection area and the ticket-checking area were jointly considered, and a queuing congestion analysis method was proposed. Firstly, the research problem was stated. Then, the problem of calculating the number of passengers in each subarea at any time was transformed into the problem of calculating the transit time of each passenger in each subarea. The transit time was divided into basic transit time and additional transit time. Based on the velocity-density relationship, a quantisation method for basic transit time was proposed related to passenger arrival time. The additional transit time was determined by the moment when the passengers left the subarea according to the sequence of arrival of passengers, the number of queuing passengers in the subarea and the congestion of the subarea to be entered. Finally, the queuing situation of passengers in each subarea at any moment was obtained through passenger flow recursion. Examples showed that the proposed method can deal with multiple working conditions and avoid the tedious and time-consuming scene construction process of the microsimulation software.

Cost Utility Analysis of an After-School Sports Sampling Program.

The purposes of this study are to describe the costs of implementing an after-school physical activity intervention in three diverse, low-resourced, schools and to understand the potential aerobic impact of this program by cost. We conducted a cost utilization study from an 8.5-month physical activity intervention. Three diverse, low-resourced, middle schools in the Midwest; The sample (N = 178) were mostly males (52.2%), African American or Black (54.8%), and divided between 6th, 7th, and 8th grades. Costs were collected from contracts, invoices, payroll, and receipts. Metabolic equivalents were collected from past literature. Costs/MET-hour were calculated for the schools and entire program by dividing costs by total MET-hours engaged in physical activity. Costs were $2.51/MET-hour, $8.96/MET-hour, and $10.73/MET-hour for the three schools. On average, the intervention had a cost of $4.73/MET-hour. Cost/MET-hour for the present study is comparable or lower than other school-based physical activity interventions that require additional staff time and programming outside of standard classroom activities. Scale-up of after-school programs may be one way to improve the costs of programs in both schools and districts.

Health economic analysis of inpatient prostate cancer treatment in Austrian hospitals

Abstract Background Prostate cancer (PrC) is the fourth most prevalent type of cancer worldwide. Its high incidence and 5-year survival rates contributing to high inpatient care costs make it an important public health issue. In Austria, surgery has been the most common inpatient procedure for PrC, despite clinical recommendations not clearly indicating its benefits over alternatives. No health economic comparison of these procedures has considered the period after treatment yet. We bridge this gap by analysing the health economic impact of treatment pathways. Methods We use a large administrative dataset of all inpatient PrC patients in Austria who received either only surgery or only radiation therapy from 2005-2014 (n = 34,286). To assess the health economic impact, we used diagnosis-related-group (DRG) points and length of stay (LOS). Monthly DRG points and LOS for each patient ±12-months around the index procedure were analysed using the difference in difference (DID) method. We controlled for age, and physical comorbidity burden using Charlson Comorbidity Index (CCI) scores. Results Looking at unadjusted averages, patients in the surgery group were significantly younger and had a lower CCI compared to the radiation group. Consequently, the surgery group had lower nominal average DRG points and LOS. However, when controlling for age and CCI, we found that radiation treatment was less resource intensive. A DID estimation found a shorter average LOS and lower DRG points for the radiation group compared to surgery for the 12 months post index. Conclusions We found significant additional costs and LOS times for surgical pathways following risk adjustment in Austria. This implies a potential excess burden of ∼4,400 hospitalisation days and ∼4 million DRG points (€4.8m) a year for the healthcare system during the observed period. Considering international evidence on higher patient burden in surgical pathways, these findings may call for clinical reconsiderations of PrC care. Key messages • Patient characteristics of different inpatient treatment pathways for PrC in Austria were very heterogenous. • Health economic outcomes in the post treatment period for PrC inpatient treatment were significantly better for radiation treatment compared to surgery.

Complex social factors in pregnancy - a Scottish health needs assessment

Abstract Issue Health inequalities begin prior to conception. In the UK, babies born to women living in the most deprived areas are twice as likely to be stillborn compared to babies from the least deprived areas. Maternity services have a vital role in tackling health inequalities during the antenatal period but are not always equipped to optimally achieve this. Description A health needs assessment (HNA) of pregnant women experiencing complex social factors (CSFs) was undertaken in NHS Lothian. The objectives were to describe the epidemiology of CSF in pregnancy, identify the needs arising from these, map the services available, and understand the experiences of staff and pregnant women. The HNA reviewed data from >42,000 maternity records between 2016-2020, engaged with midwives through focus groups and questionnaires, and undertook focus groups with women who had recently used antenatal services. Results Between 2016-2020, socio-economic deprivation was the most common CSF at booking (17%), followed by domestic abuse (4%), living in temporary accommodation (4%) and teenage pregnancy (4%). Other CSFs included problem substance use, difficulty reading/speaking English and involvement in the justice system. Midwives highlighted that CSFs could affect anyone at anytime, were often multiple and overlapping, and required additional time and partnership working to support. Whilst excellent models of care existed, there was geographical inequity in the quantity and quality of support available. Conversations with women emphasised the importance of continuity of care and described how a single point of contact through a trusted practitioner helped them access the range of services required. Lessons The HNA made 15 recommendations on how maternity services could better support CSFs. These related to developing better data systems to understand CSFs, increasing staff support, designing flexible care models, and strengthening multi-agency working. Key messages • The HNA has raised awareness of the range of CSFs encountered by pregnant women and their links to short- and long-term health inequalities for women and their babies. • The HNA is being used by maternity services to improve CSF support by using routine health data, allocating resources in a way that is proportionate to need and strengthening multi-agency working.

DataPLAN: A Web-Based Data Management Plan Generator for the Plant Sciences

Research data management (RDM) combines a set of practices for the organization, storage and preservation of data from research projects. The RDM strategy of a project is usually formalized as a data management plan (DMP)—a document that sets out procedures to ensure data findability, accessibility, interoperability and reusability (FAIR-ness). Many aspects of RDM are standardized across disciplines so that data and metadata are reusable, but the components of DMPs in the plant sciences are often disconnected. The inability to reuse plant-specific DMP content across projects and funding sources requires additional time and effort to write unique DMPs for different settings. To address this issue, we developed DataPLAN—an open-source tool incorporating prewritten DMP content for the plant sciences that can be used online or offline to prepare multiple DMPs. The current version of DataPLAN supports Horizon 2020 and Horizon Europe projects, as well as projects funded by the German Research Foundation (DFG). Furthermore, DataPLAN offers the option for users to customize their own templates. Additional templates to accommodate other funding schemes will be added in the future. DataPLAN reduces the workload needed to create or update DMPs in the plant sciences by presenting standardized RDM practices optimized for different funding contexts.

Prevalence of Neglect and Abuse During Labor and Delivery in a Tertiary Hospital

BACKGROUND:Childbirth is a significant event with a great impact on maternal physical and psychological health. Childbirth abuse has been reported in different countries with variable rates. This study aims to determine the prevalence of childbirth abuse during labor in a governmental hospital in Egypt.METHODS:This cross-sectional study was conducted from March 2020 to December 2021. We recruited 190 women. Patients were asked to fill in the Arabic-validated childbirth verbal abuse and neglect questionnaire immediately after delivery. The questionnaire consisted of four parts enquiring about personal data and childbirth history, the occurrence of physical violence, and other elements of satisfaction.RESULTS:Fifty (26.3%) patients were neglected during childbirth. Verbal abuse was reported by 25.8%. Two women (1.1%) were slapped (physical abuse) during childbirth. Women reported being satisfied and strongly satisfied at 57.9% and 37.9%, respectively. Multiparity (p-value .02), patient ignorance about the childbirth process (p-value .004), their rights (p-value .0001), and lack of participation in decision-making (p-value .0001) were associated with exposure to neglect. Verbal abuse was associated with the delivery time in addition (p-value .004).CONCLUSION:Neglect and abuse occurred significantly at the current facility.

P091 Timing Efficiencies in Tertiary Care of Patients on Non-invasive Ventilation

Abstract Introduction A lean six-sigma (LSS) approach to clinical redesign looks at aspects of patient flow, value to consumer and any areas that may be considered wasted time. This LSS approach was used to find areas of improvement in a tertiary care hospital for patients on non-invasive ventilation. The solution developed was to implement a remote download service. Methods Root cause analysis, current state process and effects analysis, staff surveys and time and motion work sampling studies were conducted. There was a post implementation time and motion work sampling study for the remote download service introduced in 2023. Results Motion, transportation, inventory and waiting time and reporting software were found to impact workflow. Time efficiencies were found for non-invasive ventilation download reports with a mean time of 14.8 mins (std 6.7min) pre-implementation down to 2.5 mins (std 0.6min) with remote software. There was an additional time saving due to batch processing prior to clinics of 2.5 mins (std 0.4mins) per patient. Staff reported workload capacity and documentation as two key barriers to effective processes. Discussion LSS identified areas to improve value and flow for staff in sleep clinics and patients on non-invasive ventilation.