Business Days Research Articles

電気の歴史を学ぶ 暮らしにおける電気の利用をめぐる格差とその縮小 ～電気事業草創期から1964 年東京オリンピックの頃，そして現在～

電気の歴史を学ぶ 暮らしにおける電気の利用をめぐる格差とその縮小 ～電気事業草創期から1964 年東京オリンピックの頃，そして現在～

ASSESSMENT OF NOISE IMPACT OF AIRCRAFT OPERATIONS AROUND PODGORICA AIRPORT

Abstract:This paper analyses impact of aircraft noise on community around Podgorica Airport, Montenegro. The airport is located 12 km from the city centre of the Montenegro capital, Podgorica. It served 1.3 million passengers and 7.5 thousand operations in 2019. The noise impact assessment is conducted in IMPACT web-based modelling platform using the distribution of operations by aircraft types, time of the day, and radar tracks for the busiest day (August 15) in 2019. Noise contours are assessed for Lden and Lnight indicators. They were merged with the Global Human Settlement Layer to assess the number of people exposed to different noise levels. In addition, based on the World Health Organization recommended exposure levels related to their health implications, the percentages of the population highly annoyed and highly sleep-disturbed are estimated. Furthermore, facilities of public importance (schools, hospitals, churches, etc.) are assessed against compatibility with the requirements set for the Zones with increased noise protection in national regulations. The results show that the exposure of community around Podgorica Airport to aircraft noise is still not a serious issue. The near vicinity of the airport is industrial zone and the number of people highly annoyed by noise is approximately 3.2% of the total city population. Nevertheless, it is crucial to draw attention to planners to preserve airport neighbourhood from potential inhabiting, to avoid problems that some airports in the region are facing nowadays.

Effect of patient information leaflet on working pattern and patient satisfaction level in a busy Indian day care operative theater complex.

Background and Aims:In a day care setting, communication of preprocedure instructions prior to general anesthesia (GA) is critical. Verbal information may be inadequate at times leading to unnecessary rescheduling. The aim of the study is to evaluate the use of patient information leaflet (PIL) and its impact on rescheduling and patients’ satisfaction levels.Material and Methods:Adult ASA I-III patients scheduled for elective day care Head Neck procedures such as direct laryngoscopy, examination under anesthesia, and biopsy under GA were recruited. In the outpatient department (OPD), the attending surgeons verbally instructed the patients as well as handed them the PIL. The process was streamlined over a month and thereafter patients’ satisfaction levels and rescheduling rates were captured over 2 months. This was compared to the data from the pre-PIL phase.Result:Prior to PIL, 12% cases were rescheduled due to avoidable causes. After introducing of the PIL, only 8% case were rescheduled (P = 0.02). There was a significant improvement seen in patient satisfaction with 89% patients reporting that the PIL was good or better while 77% were willing to recommend it to the others.Conclusion:PIL is an effective way of imparting perioperative instructions to patients which will improve not only satisfaction but also reduce patient rescheduling. The institution is in the process of implementing PIL to provide instructions to patient posted for day care procedures.

USE OF GAMIFICATION AND GAMES IN LOYALTY PROGRAMS

Introduction. A key element of loyalty programs is to stimulate customer retention, which in turn is influenced by a number of factors, such as the quality of service, the location of the business and the supply of products. In the concept of relationship marketing, consumer retention is considered as the basis of long-term profitability of the enterprise. The purpose of the article is to form a clear idea of the use of gamification and games in loyalty programs, to separate the benefits of business structures from the use of exciting group games in loyalty programs. Results. The article highlights the use of gamification and games in loyalty programs, which offer rewards, discounts and other special incentives as a way to attract and retain consumers, strengthen brand confidence, form a loyal consumer of business structures. The difference between the concepts of game and gamification is defined, which consists in different results within the application of loyalty programs and are used for deeper involvement of participants. The main facts of consumer loyalty are grouped based on the results of marketing research. The author also identified factors influencing the use of games in loyalty programs, such as the cost of games and gamification, the availability of electronic devices for games, emotions, desires and incentives of consumers and more. Based on marketing research, the main emotional reasons for players to engage in video / computer games are presented, among which the largest share should be disconnected from reality, relaxation from a busy day and wasting free time. The list of benefits of business structures from the use of group games in loyalty programs is determined. Key words: gamification, games, loyalty program, brand, emotions, reward, commitment, devotion.

A Multidisciplinary Effort to Decrease Time from Admission to Chemotherapy on an Inpatient Oncology Unit

▪BackgroundPatients with established cancer diagnoses often experience delays in starting scheduled inpatient chemotherapy (chemo) after arrival to the University of Virginia Medical Center oncology unit. These delays not only compromise the quality of individual patient care but also negatively impact hospital resource utilization, length of stay and delay other patient admissions.MethodsTo investigate these delays, we formed a multidisciplinary team of physicians, nurses, and pharmacists. Retrospective chart review was done and of the 340 planned chemo admission encounters in 2015, 100 were randomly reviewed to establish our baseline dataset. For each of these encounters, extensive patient demographic, clinical, and inpatient event data were collected and analyzed to determine time from patient arrival to start of chemotherapy (TTC). In the absence of national guidelines on TTC, we aimed to decrease TTC by 10%. With guidance from the American Society of Clinical Oncology's Quality Training Program, our team utilized multiple qualitative and quantitative tools to further understand factors contributing to TTC delays. These tools included a process map and Ishikawa cause-and-effect diagram to depict all the steps in between patient arrival on the inpatient oncology unit and the start of chemo, a Pareto chart to quantify delays of individual steps, and a priority matrix categorizing potential interventions based on impact and ease of implementation. XmR charts, a type of quality improvement control chart, were used to depict TTC and length of stay (LOS) of the baseline population and intervention groups.ResultsIn the baseline population, median TTC was 6.7 hours (h) and mean TTC was 12.1 h. The disparity in these numbers indicated the existence of extreme outliers in our population, most of which were due to urine parameter requirements. Two Plan-Do-Study-Act (PDSA) cycles of interventions were implemented and post-intervention data were collected and analyzed. The first PDSA cycle involved reforming the chemo consent process. Previously, paper forms were used for informed consent, but these forms were often lost and not scanned into the electronic medical record (EMR). When missing, chemo was not started until a physician obtained informed consent on a physical form again. This PDSA cycle involved electronic and searchable documentation of risk-benefit discussions regarding chemo in the EMR. Unfortunately, median TTC after PDSA cycle 1 (19 encounters) was unchanged at 7.2 h. Median LOS was also unchanged (4.87 days (d) in PDSA cycle 1, compared to 4.77 d at baseline). The chemo consent change, however, remained in place for the convenience of patients and physicians. A second PDSA cycle involved routine pre-review of the inpatient chemo treatment plans by a clinical pharmacist one business day prior to the patient's planned admission. This review was based on a standardized checklist of questions involving the admission, specific chemo regimen and parameters required. The XmR chart for PDSA cycle 2 showed a reduction in median TTC from 7.2 h to 6.2 h (52 encounters). This met the team's goal of improving TTC by 10%. Additionally, median LOS improved from 4.87 d in PDSA cycle 1 to 4.20 d in PDSA cycle 2. XmR charts depicting TTC of all dataset are shown in Figure 1.DiscussionThis project highlights the importance of forming a multidisciplinary team for a highly complex issue that involves multiple different types of patient care providers. Collaborative efforts to improve quality of care have far-reaching impact. The team plans to continue to make improvements in the timely administration of planned inpatient chemotherapy. The team will update the Cancer Center leadership and other UVA Medical Center leadership on key findings and proposed future interventions. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

A New Highly Sensitive Realtime PCR Assay with Faster Turnaround Time for Detecting IDH1 and IDH2 mutations in Acute Myeloid Leukemia (AML) Patients

Introduction:Genetic profiling of AML reveals distinct molecular subgroups that inform disease classification and prognostic stratification (Tayyab M et al., J. Cancer Sci. Ther. 2014). Studies have demonstrated, that the Isocitrate Dehydrogenase Isoenzymes (IDH1/2), regulating cellular metabolism co-operate to result in AML (Papaemmanuil E et al., N. Engl. J. Med. 2016). Both IDH1/2 mutations produce neomorphic activity resulting in the overproduction of an onco-metabolite 2-hydroxyglutarate (2HG) (Gross S et al., J Exp Med. 2010). IDH1 mutations affect codon 132 and IDH2 mutations affect codon 140 or 172. IDH1 mutations have been reported to occur in 6-9% of adult and 1% of pediatric AML cases respectively, while IDH2 mutations have been reported to occur in 8-12% of adult and 1-2% of pediatric AML cases respectively (Abbas, S, et al., Blood. 2010; Andersson AK et al., Leukemia. 2011). The objective of this study was to conduct workflow analysis of the Abbott RealTime IDH1 and IDH2 assays in comparison to the Sanger based sequencing assays for IDH1/2 in blood/bone marrow specimens from subjects with advanced hematological malignancies. Next Generation Sequencing (NGS) was utilized to resolve samples with discordant results.Methods:This study was approved by Medical College of Wisconsin Institutional Review Board. The clinical specimens used were blinded during the study. Blood or bone marrow aspirates from 100 AML subjects sent to the BloodCenter of Wisconsin (BCW) were tested for IDH1/2 with four different assays (Abbott RealTime IDH1, Abbott RealTime IDH2 assays, the BCW's Polymerase Chain Reaction (PCR) based Sanger sequencing assay and NGS HemeOnc panel (contains 30 genes including IDH1/2). Abbott RealTime IDH1 and IDH2 assays are qualitative in vitro PCR tests wherein, the IDH1 assay detects five IDH1 mutations (R132H, R132C, R132L, R132G and R132S) and the IDH2 assay detects nine IDH2 mutations (R140Q, R140L, R140G, R140W, R172K, R172M, R172G, R172S and R172W).The BCW's PCR based Sanger sequencing assay and NGS HemeOnc panel detect mutations in exon 4 of IDH1/2 with a sensitivity limit of 20% and 10% respectively. In this study NGS data was analyzed for only IDH1 and IDH2 .DNA was extracted from 100 clinical specimens either by the Abbott m Sample preparation system or by the Qiagen DNA extraction method and tested using the Abbott RealTime IDH1 and IDH2 assays. Additionally, a set of commercially available controls (IDH1 R132H/ IDH2 R172K, IDH1 R132C/ IDH2 R140Q) with different mutation levels (20%, 5%, 1% and 0.25%) were tested using the above mentioned four assaysResults:The Abbott RealTime IDH1 and IDH2 assays demonstrated 100% sensitivity and 95% specificity compared to the BCW Sanger sequencing assay. Five out of 100 samples with low level IDH2 mutations were missed by BCW Sanger sequencing assay but were detected as mutation positive by Abbott RealTime IDH2 assay. These five discordant samples with low level IDH2 mutations were subsequently tested with the BCW's NGS assay and two of the five samples were detected as positive by the NGS assay (Table 1). Additionally, turnaround time (TAT) analysis demonstrated that the results from the Abbott RealTime IDH1/2 assays were available in 2 business days as compared to 10 days for the BCW Sanger sequencing assay and 21 days for the BCW NGS HemOnc panel.Testing of the mixture of IDH1 and IDH2 mutations with differing mutation levels (20%, 5%, 1% and 0.25%) resulted in the Abbott RealTime IDH1 and IDH2 assay reliably detecting the mutations down to the 1% level (with some variability at 0.25%) (Table2).Conclusions:This study demonstrated that the Abbott RealTime IDH1 and IDH2 assays detected IDH1 and IDH2 mutations at 1% mutation level in AML patients. The Abbott assays were highly sensitive (1%) compared to the PCR based Sanger sequencing and NGS HemeOnc panel, which have sensitivity limits of 20% and 10% respectively. The higher sensitivity and relatively fast TAT of the Abbott assays may potentially improve the ability to diagnose new and relapsed patients in settings of lower disease burden. The relatively fast TAT could facilitate clinicians in making a quicker decision about therapeutic treatment recommendations for afflicted patients. [Display omitted] DisclosuresDash:Abbott Molecular Inc.: Other: I do not have financial relationship, however wanted to mention here is that this study was sponsored by Abbott Molecular Inc which was performed in BloodCenter of Wisconsin.

How prepared are Canadian trauma centres for mass casualty incidents?

ObjectivesMass Casualty Incidents (MCIs) are rare but devastating events that require extensive planning in order to minimize morbidity and mortality. There are two broad categories limiting a hospital's response: physical assets (e.g., critical care beds, operating rooms, food, communication devices) as well as operating procedures (e.g., MCI committees, regional coordination, provider training). The purpose of this study is to provide an examination of MCI preparedness according to these categories in Level 1 Trauma Centre across Canada. MethodsThis study surveyed all Level 1 Trauma Centres across Canada in order to assess the physical assets and operating procedures they had in place in the event of a hypothetical MCI on one of the busiest days of the year for trauma care. ResultsOf the 28 Trauma Centres contacted, 13 completed surveys (46%). Most hospitals had sufficient food (9/13) water (9/13), fuel (7/13), and communication assets (8/13) for a hypothetical MCI. A median of 38 mechanical ventilators could be mobilized. No hospitals mandated physician training for MCIs, and 6/13 centres were certain that they had a Strategic Emergency Management Plan (SEMP). Only 6/13 hospitals had dedicated MCI committees, Overall, 4/13 hospitals had explicit plans developed with community hospitals. ConclusionThis study demonstrated that physical assets are generally less limiting than operating procedures. Four key areas of potential improvement have been identified: 1) provider training (especially physicians), 2) coordination with small hospitals, 3) mechanical ventilator availability, and 4) MCI committees with explicit Strategic Emergency Management Plans.

Effectiveness of Artificial Intelligence in Stock Market Prediction based on Machine Learning

This paper tries to address the problem of stock market prediction leveraging artificial intelligence (AI) strategies. The stock market prediction can be modeled based on two principal analyses called technical and fundamental. In the technical analysis approach, the regression machine learning (ML) algorithms are employed to predict the stock price trend at the end of a business day based on the historical price data. In contrast, in the fundamental analysis, the classification ML algorithms are applied to classify the public sentiment based on news and social media. In the technical analysis, the historical price data is exploited from Yahoo Finance, and in fundamental analysis, public tweets on Twitter associated with the stock market are investigated to assess the impact of sentiments on the stock market's forecast. The results show a median performance, implying that with the current technology of AI, it is too soon to claim AI can beat the stock markets.

The Measurement of Service Quality at Linow Lake Tourist Attraction Using Servqual Method

The tourism industry sector in North Sulawesi is currently getting more attention by the government. Linow lake is one of the busiest and visited tourist attraction. The tourism industry must apply the concepts, regulations and guidelines in tourism development in order to be able to maintain and increase the number of tourist visits which will lead to economic benefits for the tourism industry and local communities. In Tomohon city itself, there are so many natural tourist attractions which as beautiful as Linow Lake. In order for tourists to feel satisfied and want to visit the Linow lake on the next day, the quality of service cannot be overlooked. For this reason, measurement of service quality was carried out using five dimensions, Tangible, Reliability, Assurance, Responsiveness, and Empathy. It will be measured to 100 respondents, how the expectations and perceptions of tourists about the service quality at Linow Lake tourist attractions. Measurements were carried out by using servqual method, which calculates the difference between the expectations and perceptions of tourists consisting of 22 questions. The result of the analysis showed a positive value of 0.17, which means that the service quality at Linow Lake tourist attractions has exceeded the expectations of visitors. However, one dimension, responsiveness, gets a negative value, and it is expected that the management can improve the quality of its services in terms of response speed, especially on busy visitor days.

One Busy Day! A Critical Analysis of New Faculty Orientation Programs

New faculty orientation programs can serve as an important introduction to an academic community. They can create expectations, provide exposure to technical assistance, and welcome faculty members to new communities. The current study explored new faculty orientation programs, cataloging their activities to identify the most common practices in research-centered universities. Findings revealed a strong reliance on one-day programs that often host a variety of speakers from different offices, yet they rarely were found to have any sort of outcomes based approach to their design. To be effective, these programs should possibly incorporate longer activities that might last an entire semester or academic year. Further, these programs might include virtual as well as in-person opportunities to learn about the institution, the students they serve, and the offices and other tools that the institution provides to help faculty be successful. Further study on the effectiveness of different models is also recommended.

The TIME Trial Network to facilitate rapid clinical trial activation, patient screening, and enrollment in molecularly targeted trials.

1563 Background: Clinical trials that require patients to have specific actionable mutations based on next generation sequencing (NGS) present unique problems, such as recruiting patients with rare mutations, low enrollment rates, and distance between patients and trial sites. Such barriers can slow the pace of trial enrollment and delay the development of new therapeutic options. Methods: Tempus Labs has partnered with experienced research sites and pharmaceutical companies with molecularly targeted clinical trials to create the TIME Trial Network. The study portfolio includes pharmaceutical sponsored phase I-III clinical trials across solid tumors and hematological malignancies, targeting actionable mutations. This network was established to ensure rapid just-in-time (JIT) activation of trials by streamlining start-up activities (i.e., execution of CTAs and study budgets/financial exhibits, regulatory paperwork, SIV planning and conduct, drug and study supply shipments, submission to the central IRB, and sponsor-specific requirements). Rapid activation begins upon receipt of an activation form from a site partner. “Site Activated” describes a site that has fulfilled all regulatory, documentation, contracting requirements, and has sponsor approval to screen and enroll patients. Results: In Q4 2020, JIT activations were completed for 6 unique interventional clinical trials across 10 sites in 8 US states in the TIME Trial Network. On average, sites were activated in 9.4 business days. Patients enrolled had rare NGS mutations and were from geographically diverse locations. In one urgent case, trial activation, patient consent, screening, and treatment were achieved in 5 business days. In total, 91.7% of patients consented to trial. The average timeline from activation to consent was 4.5 days (range 0 - 24 days), with half of patients consenting within 1 business day. 45.5% of patients who consented to trial received the study drug within 1 day of consent; 2 patients dosed on day of consent. Conclusions: Over a 3-month period, on average, TIME Trial sites were activated in 9.4 days (compared to the 20+ week industry-wide average), and patient consent was completed in 4.5 days. Rapid JIT activations through the TIME program provide significant improvements in trial enrollment timelines and increase access to therapies nationwide. JIT activations may be especially useful for rural, underserved communities, as sites can enroll diverse patient populations and help address the equity gap in clinical trials across ethnic groups.[Table: see text]

Bridging the gap by providing access to oncology care to rural communities: A hybrid delivery model combining in-person visits with Telehealth.

e18528 Background: Americans who live in rural areas experience unique barriers to access healthcare such as limited transportation, shortages in oncology providers, limited access to advanced services which contribute to poor health outcomes. The current COVID-19 pandemic has provided a catalyst for rapid adoption of telehealth. A regional cancer center has established a novel rural health partnership program that utilizes a hybrid model of on-site visits and telehealth to increase access to advanced oncology care for patients in rural communities. Here we describe the collaboration and benefits of this model. Methods: The rural health hybrid delivery model utilizes a combination of in-person and telehealth visits to provide immediate access to the regional center’s oncology care team and specialized services such as advanced surgeries, radiation, precision medicine, and clinical trials. Speed to care was built into the model as a key feature, offering initial appointments within 3 business days from the time of the referral, wherein treatment plans are developed facilitating immediate start. The model is a collaborative partnership, ensuring a coordinated care process driven by the regional oncologists working in coordination with the local provider to meet the needs of the patient. The patient is able to decrease transportation time, cost, and obtain care closer to their support system by keeping the patient in their community for basic needs. For more complex requirements, on-site visits are coordinated. This allows access to the regional center’s specialty oncology care services not available locally, while keeping the patient engaged with their local provider, which increases service utilization and expands the patient base. Leveraging telehealth visits at the local hospital ensures access to adequate broadband and technology capabilities to facilitate continuity of patient care. Results: This model provides the patient with timely access to specialty cancer care in their local community. Partnerships with two rural health systems were implemented in July and November 2020. 14 patients are enrolled in the program to date with a 100% retention rate. The turnaround time from treatment plan to treatment is 6 business days. There was a total of 62 oncology telehealth appointments, reducing patient travel by 12,705 driving miles, 310 travel hours, saving $7,380 in travel costs and accommodation. Conclusions: Telehealth provides a bridge to the rural health access gap, and advances health equity by offering specialized care to patients in their local communities. Improving access to best practice treatment strategies for all cancer patients moves us closer to resolving disparities in outcomes. Applications of this hybrid model of care to other rural sites is a promising strategy to reduce rural-urban disparities in cancer care.

Building capacity and ensuring equity in clinical trials during the COVID-19 pandemic.

e13598 Background: The impact on cancer outcomes from the Covid-19 pandemic has yet to be determined. Concerns persist on screening, delays in diagnosis, treatment interruptions and outcomes of infection in the immunosuppressed. The need for agile working has been exemplified by establishment of Nightingale Hospitals, staff redeployment and sudden integration of virtual consultations into clinical working. With most cancer clinical trials halted, recruitment into COVID-19 research became essential and embedded into the everyday. Here we present how rapid implementation of COVID-19 randomised clinical trials within an NHS organisation during the pandemic was achieved. Methods: A COVID-19 senior facilitation committee was set up to provide oversight, maximise staff capacity and resource and prioritise studies. Specific strategies to maximise access and clinical trials recruitment for patients including children and those with solid tumours were designed. These included presence of a research nurse at clinical ward rounds and team meetings, the promotion of protocol and informed consent training to all including doctors in the acute settings and weekly research meetings to share-best practice. Reflecting on learnings from this time provide an opportunity to consider how we adjust working for our patients in the future. Results: The integration of research into the everyday working of clinical teams looking after patients with COVID-19 has become the norm. The provision of protocol and informed consent training for all levels of staff and the consideration of all patients for trials during clinical ward rounds and multi-disciplinary meetings, have ensured access to trials has become embedded. The integration of research nurses working, upskilling and prompting clinical colleagues has ensured equity of access and provided a research presence and focus during the busy clinical day. The adoption of cross-disciplinary working, sharing best practice and a culture of commitment and support to the trials ensures no patient is denied the opportunity to participate. Three RTCs opened over 7 weeks. At one site 1904 patients were screened for one of the randomised-controlled trials and over 18% of these patients (351) were recruited and 175 patients declined. Conclusions: The pandemic has had a devastating impact across the UK. However, a coordinated and collaborative multi-disciplinary approach has supported high recruitment and equity of access for patients into COVID-19 trials. Learnings from this work may lead to embedding clinical trials and access to translational research for cancer patients in the future as we recover from the full impact of the pandemic. COVID-19 research has demonstrated how increased recruitment accelerates access and implementation of new innovations and novel drug combinations.The full impact of improved access to cancer research in the future during COVID recovery is worthy of more research.

The Association of Workload and Outcomes in the Pediatric Cardiac ICU.

Healthcare workload has emerged as an important metric associated with poor outcomes. To measure workload, studies have used bed occupancy as a surrogate. However, few studies have examined frontline provider (fellows, nurse practitioners, physician assistants) workload and outcomes. We hypothesize frontline provider workload, measured by bed occupancy and staffing, is associated with poor outcomes and unnecessary testing. A retrospective single-center, time-stamped orders, ordering provider identifiers, and patient data were collected. Regression was performed to study the influence of occupancy on orders, length of stay, and mortality, controlling for age, weight, admission type, Society of Thoracic Surgery-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality score, diagnosis, number of surgeries, orders, provider staffing, attending experience, and time fixed effects. Twenty-seven bed tertiary cardiac ICU in a free-standing children's hospital. Patients (0-18 yr) admitted to the pediatric cardiac ICU, January 2018 to December 2019. None. There were 16,500 imaging and 73,113 laboratory orders among 1,468 patient admissions. Median age 6 months (12 d to 5 yr), weight 6.2 kg (3.7-16.2 kg); 840 (57.2%) surgical and 628 (42.8%) medical patients. ICU teams consisted of 16 attendings and 31 frontline providers. Mortality 4.4%, median stay 5 days (2-11 d), and median bed occupancy 89% (78-93%). Every 10% increase in bed occupancy had 7.2% increase in imaging orders per patient (p < 0.01), 3% longer laboratory turn-around time (p = 0.015), and 3 additional days (p < 0.01). Higher staffing (> 3 providers) was associated with 6% less imaging (p = 0.03) and 3% less laboratory orders (p = 0.04). The number of "busy days" (bed occupancy > 89%) was associated with longer stays (p < 0.01), and increased mortality (p < 0.01). Increased bed occupancy and lower staffing were associated with increased mortality, length of stay, imaging orders, and laboratory turn-around time. The data demonstrate performance of the cardiac ICU system is exacerbated during high occupancy and low staffing.

Type 2 Diabetes Management in Older Adults: A Personalized Approach

Aging is considered a significant risk factor for diabetes, and over the next decade, the largest increase in diabetes prevalence is expected to be in older adults. Our study aimed to investigate the challenges in managing type 2 diabetes in older adults and its multifactorial components that affect diabetes goal setting. “My Diabetes GOAL” hypothesized that a nursing intervention, along with a collaborative approach to management, education, and care, can engage older patients in personalized goal setting and address barriers to quality of life. A total of 88 patients with type 2 diabetes mellitus were included in this 6-month randomized controlled trial, with 42 patients enrolled in the intervention arm and 46 patients in the delayed-start control arm. Patients were required to complete a survey delivered through the patient portal to initiate personalized goal setting and care management support. Patients in the intervention arm received their first telephonic care management call by a study team nurse within five business days of the initial survey completion. The nurse discussed survey responses, barriers, and concerns the patient may have involving their care. Barriers included hypoglycemia, medication, co-morbidity, and physical activity. For this abstract, we report the frequency of care management topics for all 88 patients. The majority of our patient population identified as African American (68%) and female (68%). The average A1c at baseline was 7 %. For every monthly call, A1c goal setting and education was a required discussion topic and did not vary significantly throughout the intervention (73% month one, 74% month six). During the first call, hypoglycemia was addressed among 56% of participants, and education on medication was provided to 64%. Co-morbidities (heart failure, incontinence, depression, chronic pain, falls, lung conditions, malignancies) were highly prevalent, with 68% having one or more. Physical activity was discussed in 42% of conversations with participants, and a referral (diabetes education, physical therapy) was needed by 25%. After six months, discussions regarding hypoglycemia (14%), medication (19%), co-morbidities (56%), physical activity (22%), and referrals (6%) were reduced. These results suggest that personalized telephonic care management for older adults can positively impact patient outcomes. Diabetes care management is not a one size fits all. Personalized goal setting was successfully discussed based on an individual’s risk factor, which took into consideration co-morbidities and physical mobility barriers. Future studies should evaluate long-term clinical outcomes with a randomized control design.

Patients’ Waiting Time in a University Health Clinic

Best practice management of a clinic can be measured through the achievement of appropriate waiting time and consultation time. These are important, especially in dealing with stable common cases seen in primary care. Among important associated factors include the number of patients per day, which can be various according to different operating days. Methods: This study aims to measure the waiting time and consultation time of common cases seen in the university health clinic for two weeks duration. The ‘time in’ and ‘time out’ information was captured on the information sheet attached to the patient’s registration slip. A descriptive analysis was done for common complaints, waiting time and consultation time duration. Kruskal-Wallis test was used to identify the association between different working days with waiting time and consultation time. Results: The results revealed a good mean waiting time 11.93 min (SD, 9.99) and consultation time 10.54 minutes (SD, 8.78) for the clinic. Waiting time is significantly associated with different operating days (P value &lt; 0.05). Conclusion: The clinic’s waiting and consultation time is acceptable according to the target set by the Ministry of Health. However, further modification can be done to improve the time management of the clinic, specifically for the busy day.

Trauma patients at the Helderberg District Hospital emergency centre, South Africa: A descriptive study.

IntroductionTrauma is a substantial component of South Africa's burden of disease. District hospitals provide primary trauma care for a large proportion of this trauma burden, although most studies are in specialised or tertiary settings. The aim was to evaluate the profile of physical trauma patients attending the emergency centre at Helderberg District Hospital, Cape Town.MethodsAn observational descriptive study was conducted between 1 January and 30 April 2019. Patients with trauma were identified from a register and systematically sampled to achieve a sample size of 377. Retrospective data from medical records was collected and analysed in the Statistical Package for Social Sciences.ResultsOf the 14,873 patients attending the emergency centre 24.6% were trauma related and 381 folders were analysed. Of these patients 30.4% were female and 69.6% male with an average age of 27.8 years. Over 60% of patients used an ambulance to get to the hospital. Sundays were the busiest days with 23.9% of all cases. Intentional trauma accounted for 45.4% of cases and accidental injuries 49.1%. The commonest mechanisms were sharp injuries (27.6%), falls (22.0%) and blunt trauma (19.4%). Intentional trauma made up more than half of all trauma in males, was more prevalent than accidental trauma between 20 and 60 years and resulted in a higher proportion of admissions.ConclusionThere were high levels of intentional trauma, especially involving young males over the weekend, mostly with sharp objects. This trauma burden resulted in high numbers of admissions and transfer to tertiary hospitals. Family physicians and other generalists need to be well trained in trauma resuscitation and stabilisation. District hospital need to be appropriately equipped and supplied to manage trauma. Further research is needed to identify underlying modifiable factors that can be addressed through community-orientated interventions.

Characteristics of Principal Components in Stock Price Correlation

The following methods are used to analyze correlations among stock returns. 1) The meaningful part of the correlation is obtained by applying random matrix theory to the equal-time cross-correlation matrix of assets returns. 2) Null-model randomness is implemented via rotational random shuffling. 3) Principal component analysis and Helmholtz-Hodge decomposition are used to extract leading and lagging relationships among assets from the complex correlation matrix constructed from the Hilbert-transformed data set of asset returns. These methods are applied to price data for 445 assets from the S&amp;amp;P 500 from 2010 to 2019 (2,510 business days). Additional analysis and discussion clarify key aspects of leading and lagging relationships among business sectors in the market. Numerical investigation of these dataset reveals the possibility that leading and lagging relationships among business sectors may depend on gross market conditions.

Measuring mobility inequalities of favela residents based on mobile phone data

This study investigated the mobility patterns of favela residents based on an analysis of their daily movements derived from high-frequency mobile phone data. Daily movements were measured considering the distance traveled at different times of day over the course of more than two months. Potential trip purposes for the most frequently visited locations were inferred based on land use data from property taxes. The high volume of geocoded data from mobile phones enabled the analysis during multiple days, also covering weekends, usually not considered in traditional transport surveys. The mobile phone data indicated that, on average, favela residents go farther from home during business days and perform less out of home activities during weekends when compared with non-favela residents. Further, distinct patterns for favelas and non-favela residents were mapped, considering different geographical areas, revealing space and time mobility inequalities.

A minute with …

A minute with …