Advanced Notification Research Articles

The current state of training in pain medicine fellowships: An Association of Pain Program Directors (APPD) survey of program directors.

The Accreditation Council for Graduate Medical Education (ACGME) approved the first pain medicine fellowship programs over three decades ago, designed around a pharmacological philosophy. Following that, there has been a rise in the transition of pain medicine education toward a multidisciplinary interventional model based on a tremendous surge of contemporaneous literature in these areas. This trend has created variability in clinical experience and education amongst accredited pain medicine programs with minimal literature evaluating the differences and commonalities in education and experience of different pain medicine fellowships through Program Director (PD) experiences. This study aims to gather insight from pain medicine fellowship program directors across the country to assess clinical and interventional training, providing valuable perspectives on the future of pain medicine education. This study involved 56 PDs of ACGME-accredited pain fellowship programs in the United States. The recruitment process included three phases: advanced notification, invitation, and follow-up to maximize response rate. Participants completed a standard online questionnaire, covering various topics such as subcategory fields, online platforms for supplemental education, clinical experience, postgraduate practice success, and training adequacy. Surveys were completed by 39/56 (69%) standing members of the Association of Pain Program Directors (APPD). All PDs allowed fellows to participate in industry-related and professional society-related procedural workshops, with 59% encouraging these workshops. PDs emphasized the importance of integrity, professionalism, and diligence for long-term success. Fifty-four percent of PDs expressed the need for extension of fellowship training to avoid supplemental education by industry or pain/spine societies. This study highlights the challenge of providing adequate training in all Pain Medicine subtopics within a 12-month pain medicine fellowship. PDs suggest the need for additional training for fellows and discuss the importance of curriculum standardization.

Enhancing bicyclist survival time in fatal crashes: Investigating the impact of faster crash notification time through explainable machine learning

Bicyclists are recognized as vulnerable road users, with the escalating fatalities posing a safety concern. While fatal crashes involving bicyclists are often assumed to be similar, there is a crucial distinction between instant death and death occurring several days later, with the former being substantially more severe. This study delves into the analysis of bicyclists’ time-to-death, spanning from immediate fatalities to deaths within 30 days, using data from the Fatality Analysis Reporting System from 2015 to 2019. Employing the Haddon Matrix approach, the variables are categorized into pre-crash, during-crash, and postcrash phases. This study considers crash notification time as the key postcrash measure. An explainable XGBoost model is developed using the SHAP technique to investigate the associations between variables and bicyclist time-to-death. The results show that substantial delays in crash notification time considerably reduce bicyclists’ time-to-death and increase the likelihood of early death. Specifically, hit-and-run crashes, crashes in rural areas, and crashes during late-night hours exhibit notably longer crash notification times compared to non-hit-and-run crashes, urban areas, and other hours, respectively. In such cases, when no witnesses or survivors can notify emergency responders, on-road vehicle technologies like the advanced automatic collision notification system can promptly inform responders, reducing notification delays.

Computer-Aided Pulmonary Fibrosis Detection Leveraging an Advanced Artificial Intelligence Triage and Notification Software.

Improvement in recognition and referral of pulmonary fibrosis (PF) is vital to improving patient outcomes within interstitial lung disease. We determined the performance metrics and processing time of an artificial intelligence triage and notification software, ScreenDx-LungFibrosis™, developed to improve detection of PF. ScreenDx-LungFibrosis™ was applied to chest computed tomography (CT) scans from multisource data. Device output (+/- PF) was compared to clinical diagnosis (+/- PF), and diagnostic performance was evaluated. Primary endpoints included device sensitivity and specificity > 80% and processing time < 4.5 min. Of 3,018 patients included, PF was present in 22.9%. ScreenDx-LungFibrosis™ detected PF with a sensitivity and specificity of 91.3% (95% confidence interval (CI): 89.0-93.3%) and 95.1% (95% CI: 94.2-96.0%), respectively. Mean processing time was 27.6 s (95% CI: 26.0 - 29.1 s). ScreenDx-LungFibrosis™ accurately and reliably identified PF with a rapid per-case processing time, underscoring its potential for transformative improvement in PF outcomes when routinely applied to chest CTs.

Advanced Accident Prevention and Notification System

Dangerous road conditions may be the result of natural events, such as tropical rains and flooding, that make driving unsafe. Dangerous conditions can also arise from the poor physical condition of a road and its surroundings. It may cause road accidents. Also while driving in the night just the headlights might not be a sufficient assistance for driver .Unexpected hurdles on road may cause more accidents. Also because of bad road conditions, fuel consumption of the vehicle increases; causing wastage of precious fuel .We proposed this system ‘Advanced Accident Prevention And Notification System’ to inform the driver about the pothole and controlling the speed of the vehicle and also the information has been stored in cloud and the notification about pothole has been sent to the Road Maintenance department to take a remedy to maintain the road. This system uses ultrasonic sensor to sense the potholes and GPS to track the location and wifi module to transmit the data

The saving effect using rapid response car activated by advanced automatic collision notification (D-Call Net)

The saving effect using rapid response car activated by advanced automatic collision notification (D-Call Net)

Neighborhood socioeconomic status and the effectiveness of colorectal cancer screening outreach with mailed fecal immunochemical tests within a safety net healthcare system in San Francisco, CA: A subgroup analysis of a randomized controlled trial

Neighborhood context shapes opportunities and barriers for residents to access healthcare and cancer screening. Neighborhood socioeconomic status (nSES) is associated with disparities in colorectal cancer (CRC) screening, but the extent to which the effectiveness of specific screening interventions vary by nSES has not been studied. The original trial conducted in San Francisco, CA from 2016 to 2017 randomly assigned patients eligible for CRC screening either to a multicomponent intervention including advanced notification, mailed fecal immunochemical test (FIT) kits and reminders or to a control group receiving usual care. For the nSES analysis addresses for 9699 patients were geocoded and stratified by city-wide nSES quintile (Q1 lowest, Q5 highest) using an established index at the census tract level. Compared to usual care, the outreach intervention improved FIT test completion at one year (58.7% vs 38.4%; OR 2.32 [2.14, 2.52]) but its effectiveness did not vary substantially by nSES quintile (adjusted OR Q1 2.64 [2.30, 3.04]; Q2 2.43 [2.04, 2.90]; Q3 2.31 [1.84, 2.89]; Q4 2.47 [1.86, 3.28]; Q5 2.64 [1.83, 3.81]; Wald test for interaction p = 0.87). The implementation of mailed FIT outreach has the potential to increase CRC screening completion without leading to disparities in screening related to nSES (ClinicalTrials.gov NCT02613260).

Early identification of a COVID-19 outbreak detected by wastewater surveillance at a large homeless shelter in Toronto, Ontario

SettingToronto (Ontario, Canada) is a large urban centre with a significant population of underhoused residents and several dozen shelters for this population with known medical and social vulnerabilities. A sizeable men’s homeless shelter piloted a facility-level SARS-CoV-2 wastewater surveillance program.InterventionWastewater surveillance was initiated at the shelter in January 2021. One-hour composite wastewater samples were collected twice weekly from a terminal sanitary clean-out pipe. The genetic material of the SARS-CoV-2 virus was extracted from the solid phase of each sample and analyzed using real-time qPCR to estimate the viral level. Wastewater results were reported to facility managers and Toronto Public Health within 4 days.OutcomesThere were 169 clients on-site at the time of the investigation. Wastewater surveillance alerted to the presence of COVID-19 activity at the site, prior to clinical detection. This notification acted as an early warning signal, which allowed for timely symptom screening and case finding for shelter managers and the local health unit, in preparation for the declaration of an outbreak.ImplicationsWastewater surveillance acted as an advanced notification leading to the timely deployment of enhanced testing prior to clinical presentation in a population with known vulnerabilities. Wastewater surveillance at the facility level is beneficial, particularly in high-risk congregate living settings such as shelters that house transient populations where clinical testing and vaccination can be challenging. Open communication, established individual facility response plans, and a balanced threshold for action are essential to an effective wastewater surveillance program.

Utility Relocation Concept Plan for Mitigation of Utility Relocation Delays

Utility conflicts are a primary cause of construction project delays. To mitigate delays, utility coordination is necessary. Existing utility coordination and communication studies lack an interactive method. This study aims to develop a method for utility coordination and utility conflict management that engages the utility owners early in the project development process to mitigate utility relocation delays. This study contributes to utility coordination by addressing the identified gap of improved incorporation of utility coordination processes into a project. This study provides and tests an interactive communication and model—utility relocation concept plan (URCP)—to develop utility conflict mitigation approaches that are agreeable between the utility owner, project owner, and contractor. URCP is a streamlined utility coordination technique and model that can be used in conjunction with current utility conflict management techniques in the industry. To the authors’ knowledge, a URCP is not currently in use in the industry outside of Kiewit Construction Corporation, nor is a URCP presented in the literature. The development of the URCP facilitates interactive visual discussions between the engineer, contractor, and utility owner. This interaction allows the relocations to be designed by all parties as well as provides advanced notification to the utility owners. Case study analysis revealed that when a URCP was utilized as a utility coordination tool, the amount of time it took to mitigate utility conflicts was reduced by 14.77%. Further research would be required to determine the viability of the URCP method in other geographic areas and other project delivery systems outside of design-build delivery projects.

Optimizing handover in patients with stroke symptoms utilizing an organized protocol between emergency department providers and emergency medical personnel

IntroductionStroke care is time sensitive. Providers in the emergency department (ED) depend on advanced notification from emergency medical services (EMS) transporting patients with stroke signs and symptoms. Barriers to EMS-ED information transfer can delay patient arrival preparation that may impact decisions, diagnosis, and time-sensitive transfer to next site of care. Information gaps or loss of information in the chain of care has been noted to contribute to possible safety threats for patients with stroke symptoms. MethodsThe aim of this project was to explore the feasibility of improving EMS-ED handover of patients with suspected stroke using a two-tiered checklist ranked in order of importance and a “time-out” upon EMS arrival to help standardize report, bridge the information gap, and promote earlier stroke management decisions. Paramedics from two local EMS agencies participated. Transmission and recorded report were measured before and after implementation followed by a satisfaction survey. Analysis also included a comparison group (control) of non-participating Fire Departments. ResultsOne hundred and sixty-eight potential stroke patients were transported to the ED during the 16-month intervention time frame. The pre and post intervention analysis of reported stroke symptoms showed statistically significant improvement in multiple checklist reporting areas. Noteworthy changes included improvement in reporting last time normal, current antiplatelet/anticoagulant, neurological deficits, baseline mental and functional status, medical history, code status, recent surgical history and family enroute. A post-survey demonstrated overall positive EMS-ED response to the new handover process. ConclusionThe feasibility of an EMS-ED standardized handover using a hierarchical (ranked in order of importance), two-tiered checklist and time-out process can effectively bridge the gap of communication between EMS and emergency providers to help promote timely hyperacute stroke care.

Injury prediction algorithm for rear‐seat occupants in advanced automatic crash notification systems

An advanced automatic crash notification (AACN) system can predict the injuries of a vehicle's occupants when the vehicle is involved in a collision accident. The rear-seat occupants are at significant risk in collision accidents owing to an inferior protection system and the absence of mandatory seat belt laws. However, only a few studies have focused on the injury prediction for rear-seat occupants, which can be used in AACN system. Therefore, an injury prediction algorithm is proposed for rear-seat occupants. Initially, a rear-seat occupant simulation model is established and verified and the relationship between the head, neck, and chest injury levels and velocity variation is examined. Then, a rear-seat occupant injury prediction algorithm is developed and AACN terminal is constructed to analyse the effects of the algorithm. The comparison of the obtained results with actual accident data validated that the proposed algorithm can effectively evaluate the injury levels of rear-seat occupants. The study findings can enhance the prediction accuracy of all occupants’ injury levels based on their positions inside the vehicle and improve the efficiency of rescue operations, particularly in the case of rear-seat occupants.

Advanced Alarm Method Based on Driver’s State in Autonomous Vehicles

In autonomous driving vehicles, the driver can engage in non-driving-related tasks and does not have to pay attention to the driving conditions or engage in manual driving. If an unexpected situation arises that the autonomous vehicle cannot manage, then the vehicle should notify and help the driver to prepare themselves for retaking manual control of the vehicle. Several effective notification methods based on multimodal warning systems have been reported. In this paper, we propose an advanced method that employs alarms for specific conditions by analyzing the differences in the driver’s responses, based on their specific situation, to trigger visual and auditory alarms in autonomous vehicles. Using a driving simulation, we carried out human-in-the-loop experiments that included a total of 38 drivers and 2 scenarios (namely drowsiness and distraction scenarios), each of which included a control-switching stage for implementing an alarm during autonomous driving. Reaction time, gaze indicator, and questionnaire data were collected, and electroencephalography measurements were performed to verify the drowsiness. Based on the experimental results, the drivers exhibited a high alertness to the auditory alarms in both the drowsy and distracted conditions, and the change in the gaze indicator was higher in the distraction condition. The results of this study show that there was a distinct difference between the driver’s response to the alarms signaled in the drowsy and distracted conditions. Accordingly, we propose an advanced notification method and future goals for further investigation on vehicle alarms.

Households' valuation of power outages in major cities of Ethiopia: An application of stated preference methods

In many developing countries, electricity consumers experience frequent supply interruptions, leading to high coping costs and stifled investment, which contribute to energy poverty. In 2019, we implemented stated preference experiments to estimate households' preferences for improved electricity supply in a nationally representative sample of urban households, covering 42 cities in Ethiopia. In the first split-sample experiment, we presented respondents with a contingent valuation (CV) scenario that alternatively elicited their willingness to pay (WTP) for reduced evening-time power outages, or their willingness to accept (WTA) compensation for increased disruptions. Then, we implemented a discrete choice experiment with the same respondents to understand preferences for the frequency, duration and time of a day attributes of outages, as well as the value of advanced notification. The results from the CV survey show that household WTP is approximately 40 birr (US$1.4) for a three-hour reduction of duration in power outages in the evening and that WTA is 42 birr (US$1.4) for a similar increase in the duration of outages during that period. The choice experiment meanwhile reveals that household WTP is 11 birr (US$0.4) for a one-unit reduction in the number of outages and 53 birr (US$1.8) to avoid daytime or nighttime outages relative to morning outages, on average. Households prefer a day prior outage notification to a week prior notification, with a marginal WTP of 23 birr (US$0.8). Information about the value of such outage attributes can help inform strategies that better address electricity consumers' preferences and needs. We finally discussed the relationship between energy poverty and preferences for improved electricity supply.

Injury prediction for advanced automatic crash notification system

Injury prediction for advanced automatic crash notification system

Increased Colorectal Cancer Screening Sustained with Mailed Fecal Immunochemical Test Outreach

Reports of mailed fecal immunochemical test (FIT) outreach effectiveness over time are minimal. We aimed to better evaluate a mailed FIT program with longitudinal metrics. A total of 10,771 patients aged 50 to 75 years not up-to-date with colorectal cancer screening were randomized to intervention or usual care. The intervention arm received an advanced notification call and informational postcard prior to a mailed FIT. Usual care was at the discretion of the primary care provider. Patients were followed for up to 2.5 years. The primary outcome was the difference in cumulative proportion of completed FIT screening between arms. Screening was further examined with the proportion of time up-to-date, consistency of adherence, and frequency of abnormal FIT. The cumulative proportion of FIT completion was higher in the outreach intervention (73.2% vs 55.1%; P < .001). The proportion of time covered by screening was higher in the intervention group (46.8% vs 27.3%; Δ19.6%; 95% confidence interval, 18.2%-20.9%). Patients assigned to FIT outreach were more likely to consistently complete FITs (2 completed of 2 offered) (50.1% vs 21.8%; P < .001). However, for patients who did not complete the FIT during the first cycle, only 17.1% completed a FIT during the second outreach cycle. The number and overall proportion of abnormal FIT was significantly higher in the outreach intervention (6.9% Outreach vs 4.1% Usual Care; P < .01). Organized mailed FIT outreach significantly increased colorectal cancer screening over multiple years in this safety-net health system. Although mailing was overall effective, the effect was modest in patients who did not complete FIT in first cycle of intervention. (ClincialTrials.gov, NCT02613260).

Earthquake early warning in Aotearoa New Zealand: a survey of public perspectives to guide warning system development

Earthquake early warning (EEW) can be used to detect earthquakes and provide advanced notification of strong shaking, allowing pre-emptive actions to be taken that not only benefit infrastructure but reduce injuries and fatalities. Currently Aotearoa New Zealand does not have a nationwide EEW system, so a survey of the public was undertaken to understand whether EEW was considered useful and acceptable by the public, as well as perceptions of how and when such warnings should be communicated, before making an investment in such technology. We surveyed the public’s perspectives (N = 3084) on the usefulness of EEW, preferred system attributes, and what people anticipated doing on receipt of a warning. We found strong support for EEW, for the purposes of being able to undertake actions to protect oneself and others (e.g. family, friends, and pets), and to mentally prepare for shaking. In terms of system attributes, respondents expressed a desire for being warned at a threshold of shaking intensity MM5–6. They suggested a preference for receiving a warning via mobile phone, supported by other channels. In addition to being warned about impending shaking, respondents wanted to receive messages that alerted them to other attributes of the earthquake (including the possibility of additional hazards such as tsunami), and what actions to take. People’s anticipated actions on receipt of a warning varied depending on the time available from the warning to arrival of shaking. People were more likely to undertake quicker and easier actions for shorter timeframes of <10 s (e.g., stop, mentally prepare, take protective action), and more likely to move to a nearby safe area, help others, look for more information, or take safety actions as timeframes increased. Given the public endorsement for EEW, information from this survey can be used to guide future development in Aotearoa New Zealand and internationally with respect to system attributes, sources, channels and messages, in ways that promote effective action.

Advanced Notification Calls Prior to Mailed Fecal Immunochemical Test in Previously Screened Patients: a Randomized Controlled Trial.

Phone calls as part of multimodal fecal immunochemical test (FIT) outreach are effective but resource-intensive. Previous studies of advanced notification calls before FIT mailing have not differentiated patients' prior screening status. To determine the effectiveness of a phone call preceding mailing of a FIT kit on test completion rate for patients who have completed a prior FIT. Randomized controlled trial nested within a larger study. All patients were assigned to receive organized mailed FIT outreach in the larger study. Patients in a safety-net health setting ages 50-75 years old with a previously negative FIT. Patients were assigned to either receive an advanced notification phone call or no phone call preceding a mailed FIT kit. Both groups received an informational postcard prior to the mailed FIT. The primary outcome was FIT completion rate at 1 year. The secondary outcomes were FIT completion rates at 60, 90, and 180 days, rates stratified by demographic subgroups, and rates according to outcome of the phone call. A total of 1645 patients were assigned to advanced notification calls and 1595 were assigned to no call preceding the FIT mailing. Although FIT completion rate was higher at day 60 (55.5% vs. 50.8%, p < 0.01), an advanced notification call did not significantly improve FIT completion at 1 year (70.9% vs. 69.9%, p = 0.52). Of the patients assigned to receive an advanced notification call, 90.5% were spoken with or left a voicemail; patients who were spoken with were more likely to complete a FIT at 1 year compared with patients who were only left a voicemail or could not be left a voicemail (79.9% vs. 69.2% vs. 49.6%, p < 0.01). Advanced notification phone calls prior to FIT mailing did not improve rates at 1 year for patients with a previously negative FIT.

In Case You Haven't Heard…

Will flexibility for methadone take‐homes and buprenorphine telephone inductions be continued post‐COVID‐19? We asked American Association for the Treatment of Opioid Dependence President Mark Parrino, one of the best readers of tea leaves we know, what he thinks. Here's his response: “When Secretary Azar ends the public health emergency, I expect that all HHS agencies will follow suit. In my recent discussion with SAMHSA, I asked that they do not provide another shock to the system by reverting to the pre‐COVID‐19 policy oversight without providing adequate advanced notification to the states and OTPs. I expect that they would provide, at the minimum, a 30‐day notification period. The obvious question is how they would arrive at the conclusion that the health emergency has concluded when so many states have major surges. I am getting information from Board member states over the next week that may inform SAMHSA about the OTP experiences with extended take‐home medication.” The other question — whether telehealth in general or substance use disorder telehealth in particular will continue to be reimbursed by health insurance after the emergency ends — probably lies in Azar's purview as well. Stay tuned.

Point-of-care lactate measurement for suspected sepsis in the prehospital environment: are we missing the point at the sharp end?

Expecting ambulance clinicians to dependably differentiate the life-threatening organ dysfunction caused by sepsis from an inflammatory response to a non-infectious aetiology, relying upon vital signs and a physical examination of the patient alone, must be considered unrealistic. Although lactate measurement has been integrated into numerous prehospital sepsis screening tools, it is not yet measured routinely within UK ambulance services. Research has generally focused on whether handheld point-of-care lactate measurement devices are as accurate as laboratory analysis of venous or arterial samples. The weight of literature has concluded negatively in relation to this. However, there is potential for handheld devices to be used independently to monitor trends in lactate elimination or accumulation to inform decisions on the efficacy of prehospital interventions, or simply to report categorical data in terms of whether lactate levels are elevated or not. This offers UK paramedics the opportunity to improve sepsis care through the enhanced assessment of risk and acuity, the identification of patients with cryptic shock, more aggressive fluid resuscitation and advanced notification to receiving units.

A System That Uses Advanced Automatic Collision Notification Technology to Dispatch Doctors to Traffic Accidents by Helicopter: The First 4 Cases.

To increase survival rates of patients with severe trauma from road traffic accidents, Japan launched the D-Call Net (DCN) system, which utilizes advanced automatic collision notification technology to dispatch doctors by helicopter. The DCN system began in November 2015 and, as of October 2019, has dispatched doctors 4 times. Case 1-Canceled because trauma was mild. Case 2-Doctor made contact with 2 patients with moderate trauma 29 minutes earlier than would have occurred conventionally. This was the first case in the world to use automotive engineering data to dispatch a doctor to a patient. Case 3-An accident involving 3 severely injured patients activated DCN, enabling doctor-patient contact 20 minutes earlier than would have been possible conventionally. Case 4-DCN was ineffective. According to 2008 data from Chiba Prefecture, in accidents where victims sustain severe trauma, the interval from accident occurrence to hospital arrival was 67 minutes, even when doctors were dispatched by air ambulance (Doctor-Heli [DH]). Use of accident information for faster doctor dispatch effectively improved survival rates. An algorithm was developed to use accident information to assess trauma severity (severity probability). DCN dispatches doctors by using data, including information on accident site and severity probability, which are sent to smartphones of doctors, thereby reducing the interval from accident to DH request by approximately 17 minutes. DCN is the first system in the world to use automotive engineering information for faster doctor dispatch to traffic accident sites. The system is crucial for improving survival rates and mitigating the aftereffects of traffic accidents.

Assessing the effect of the Expanding Maternal and Neonatal Survival program on improving stabilization and referral for maternal and newborn complications in Indonesia.

To determine if the Expanding Maternal and Neonatal Survival (EMAS) program was associated with improved effectiveness of the referral system in Indonesia to facilitate timely and effective management of complications experienced by women and newborns. Poisson regression using longitudinal monitoring data was used to assess the impact of the EMAS program on stabilization practices prior to referral. Data from a nonrandomized quasi-experimental pre-post evaluation study were used to assess the impact of the EMAS program along the referral pathway using χ2 analysis. Monitoring data demonstrated improvements in intervention areas for stabilization of pre-eclampsia/eclampsia (24% vs 61%, incidence rate ratio [IRR] 2.4; 95% confidence interval [CI], 2.3-2.6) and treatment of newborns with suspected severe infection (30% vs 54%, IRR 2.0; 95% CI, 1.6-2.4) prior to referral. The EMAS program was associated with significantly higher levels of communication, advanced notification, back referral, and hospital emergency readiness and staff preparedness compared with the comparison arm. The EMAS program contributed to improvements in the management of obstetric and newborn complications, including communication, transportation, and preparation of pregnant mothers in need of referral and hospital emergency readiness and staff preparedness.