Complete Documentation Research Articles

Diversity and habitat association of medium and large mammals in Gibe Sheleko National Park, Southern Ethiopia.

Complete documentation on the status of mammals is indispensable for appropriate conservation measures in protected areas. However, there is inadequate information on mammalian resources in the ecosystem of Gibe Sheleko National Park (GSNP). Thus, the study aimed to assess species diversity, abundance, and habitat association of medium‐ and large‐sized mammals in GSNP. We stratified the study area into five dominant habitat types, namely dense forest, wooded grassland, grassland, riverine forest, and farmland habitat types based on land cover and vegetation structures and further employed stratified random sampling technique across each habitat type. The sample transects covered 20% of the study area. Transect width ranged from 50 m to 400 m based on vegetation cover and visibility of mammals. The main data were collected via direct observation. Data were analyzed via chi‐square test and species diversity indexes. We recorded the total of 20 mammals species' those belong to 10 families of which 8 species were large‐sized and 12 species medium‐sized mammals. There were two IUCN vulnerable species, namely Hippopotamus amphibious and Panthera pardus, and two globally near‐threatened species, particularly Litocranius walleri and Caracal caracal in the study area. Dense forest held the highest species diversity of medium‐ and large‐sized mammals (H′ = 2.28) with the highest evenness index (J = 0.84). Riverine forest had the least diversity with uneven population distribution. Papio anubis was the most abundance species, whereas Caracal caracal was the least abundant in the study area. GSNP is home for threatened and spectacular mammals species'; hence, an appropriate conservation measure is mandatory to keep existing mammals species'.

Using Competing Risk of Mortality to Inform the Transition from Prostate Cancer Active Surveillance to Watchful Waiting

BackgroundFor men on active surveillance (AS) for prostate cancer (PCa), disease progression and age-related changes in health may influence decisions about pursuing curative treatment. ObjectiveTo evaluate the predicted PCa and non-PCa mortality at the time of reclassification among men on AS, to identify clinical criteria for considering a transition from AS to watchful waiting (WW). Design, setting, and participantsPatients enrolled in a large AS program who experienced biopsy grade reclassification (Gleason grade increase) were retrospectively examined. All patients who had complete documentation of medical comorbidities at reclassification were included. Outcome measurements and statistical analysisA validated model was used to assess 10- and 15-yr untreated PCa and non-PCa mortalities based on patient comorbidities and PCa clinical characteristics. We compared the ratio of predicted PCa mortality with predicted non-PCa mortality (“predicted mortality ratio”) and divided patients into four risk tiers based on this ratio: (1) tier 1 (ratio: >0.33), (2) tier 2 (ratio 0.33–0.20), (3) tier 3 (ratio 0.20–0.10), and (4) tier 4 (ratio <0.10). Results and limitationsOf the 344 men who were reclassified, 98 (28%) were in risk tier 1, 85 (25%) in tier 2, 93 (27%) in tier 3, and 68 (20%) in tier 4 for 10-yr mortality. Fifteen-year risk tiers were distributed similarly. The 23 (6.7%) men who met the “transition triad” (age >75 yr, Charlson Comorbidity Index >3, and grade group ≤2) had a 14-fold higher non-PCa mortality risk and a lower predicted mortality ratio than those who did not (0.07 vs 0.23, p < 0.001). The primary limitations of our study included its retrospective nature and the use of predicted mortalities. ConclusionsAt reclassification, nearly half of patients had a more than five-fold and one in five patients had a more than ten-fold higher risk of non-PCa death than patients having a risk of untreated PCa death. Despite a more significant cancer diagnosis, a transition to WW for older men with multiple comorbidities and grade group <3 PCa should be considered. Patient summaryMen with favorable-risk prostate cancer and life expectancy of >10 yr are often enrolled in active surveillance, which entails delay of curative treatment until there is evidence of more aggressive disease. We examined a group of men on active surveillance who developed more aggressive disease, and found, nevertheless, that the majority of these men continued to have a dramatically higher risk of death from non–prostate cancer causes than from prostate cancer based on a risk prediction tool. For men older than 75 yr, who have multiple medical conditions and who do not have higher-grade cancer, it may be reasonable to reconsider the need for curative treatment given the low risk of death from prostate cancer compared with the risk of death from other causes.

First Documentation of Life Cycle Completion of the Alien Rust Pathogen Melampsoridium hiratsukanum in the Eastern Alps Proves Its Successful Establishment in This Mountain Range.

Melampsoridium hiratsukanum is an alien rust fungus which has spread pervasively throughout several European countries following introduction into North Europe at the end of the 20th century. The authenticity of several records of the Melampsoridium species infecting alder (Alnus spp.) in the northern hemisphere is questionable, due to the misidentification and confusion that surround many of the older reports. Given this complicated taxonomic history, and since a M. hiratsukanum-like rust is strongly impacting Alnus incana stands in the Alps, probably affecting the bank protection role of this species along rivers, the unambiguous identification of this pathogen was a pressing epidemiological and ecological issue. In this study, field surveys, light (LM) and scanning electron microscopy (SEM), and molecular characterization were put together in an attempt to solve the conundrum. Field monitoring data, LM and SEM analyses of key taxonomic traits (length of ostiolar cells of uredinium, uredinio-spore shape and size, spore echinulation, number and position of germ pores) and ITS-rDNA sequence-based identification, convergently and unambiguously connected the rust that is causing the current epidemic to the non-native M. hiratsukanum. We documented the completion of the M. hiratsukanum life cycle on its two taxonomically unrelated broadleaf/conifer hosts. This is the first report of M. hiratsukanum from naturally infected Larix decidua in Europe.

Improved documentation following the implementation of a trauma registry: A means of sustainability for trauma registries in low- and middle-income countries

Introduction: Trauma registries in low- and middle-income countries (LMICs) are critical for improving trauma care; however, while some registries have been established in low-income settings, few are sustained due to a lack of sustainable funding. In many LMIC institutions, funding is dependent on documentation of trauma patients, but patient records may be of poor quality, missing, or incomplete. The development of a trauma registry and electronic patient registration system could be used to improve documentation of trauma patients in a low-income setting and lead to increased funding for trauma care.Methods: A retrospective chart review of trauma patients at Mbarara Regional Referral Hospital in Uganda was performed, documenting the monthly admissions from January 2015-July 2016 prior to the establishment of a trauma registry. A trauma registry and electronic patient registration system were established in 2017, and monthly admissions from February 2017-December 2019 were documented. A negative binomial regression analysis was performed comparing the incident rate of admission pre-implementation of the registry compared to post-implementation, adjusting for month and year. Completeness of trauma patient records was also assessed.Results: Prior to the implementation of the trauma registry and patient registration system (2015-2016), there was a mean of 5.2 (SD 4.4) trauma records per month identified. Following the implementation of the trauma registry, a mean of 103.4 trauma records per month were documented (SD 32.0) for an increased incident rate ratio of 20.9 (95% CI 15.7-27.6, p<0.001). There was also a significant increase in percentage of documents completed (OR 49.1, CI 12.4-193.7, p<0.001).Discussion: Following the implementation of a trauma registry and electronic patient registration system at this low-income country hospital, an increase of 20.9 times completed trauma patient documentation was identified, and completion of the records improved. This more accurate documentation could be used to apply for increased government funding for trauma patients and sustain the trauma registry in the long term and could represent a means of long-term sustainability for other trauma registries in LMICs.

Gridded daily weather data for North America with comprehensive uncertainty quantification

Access to daily high-resolution gridded surface weather data based on direct observations and over long time periods is essential for many studies and applications including vegetation, wildlife, soil health, hydrological modelling, and as driver data in Earth system models. We present Daymet V4, a 40-year daily meteorological dataset on a 1 km grid for North America, Hawaii, and Puerto Rico, providing temperature, precipitation, shortwave radiation, vapor pressure, snow water equivalent, and day length. The dataset includes an objective quantification of uncertainty based on strict cross-validation analysis for temperature and precipitation results. The dataset represents several improvements from a previous version, and this data descriptor provides complete documentation for updated methods. Improvements include: reductions in the timing bias of input reporting weather station measurements; improvement to the three-dimensional regression model techniques in the core algorithm; and a novel approach to handling high elevation temperature measurement biases. We show cross-validation analyses with the underlying weather station data to demonstrate the technical validity of new dataset generation methods, and to quantify improved accuracy.

Are incisional biopsies reliable for selecting definitive treatment of ameloblastomas? A 15-year interdisciplinary retrospective study

Sampling error in incisional biopsy can lead to under/overtreatment. The aim of this study is to determine the incidence of sampling error/discordance between incisional biopsy and final diagnosis and consequences for treatment outcomes. This study is a retrospective cohort study of patients treated for ameloblastoma at an academic medical center from 2005 to 2020. Patients with minimum of 1 year of follow-up after definitive treatment and complete documentation were included. Clinical variables included radiographic findings, incisional biopsy, and final histopathology. Outcome variables were discordance between incisional biopsy and final pathology as well as recurrence rates. Results are primarily descriptive. Fisher's exact test was used to test for differences in recurrence rates. Twenty-three patients (14 male/9 female) met the inclusion criteria. Overall, discordance was found in 2 cases (8.6%) and sampling error in 3 (13.04%). One of the 3 cases showing sampling error had recurrence and required secondary resection. Six patients (26.1%) had recurrent lesions, and all patients underwent enucleation and curettage with or without peripheral ostectomy. Incisional biopsies by themselves are not always consistent with a final diagnosis. Possibility of sampling error should be included in informed consent. Consultation with an oral pathologist is essential at initial and final histopathologic evaluation.

Expanding Field-Archaeology Education: The Integration of 3D Technology into Archaeological Training

Abstract This contribution analyses and discusses the use of 3D technology in education and learning. Basing the discussion on a case study performed during two seasons of a field school for 1st-year archaeology students, we explore how to expand traditional didactic programs by developing and testing a web-based system for educational purposes. We examine how these technologies can be used as educational means and supporting tools during an excavation; how universities can incorporate these technologies into pedagogy. We investigate whether the combination of these technologies with a successful pedagogical theory could promote students’ comprehension of the reflexive approach and engagement with the interpretative process. We introduced the students to a complete excavation methodology, including excavation, documentation, data management, and interpretation. Alongside the traditional documentation, a digital approach was added, with 3D technologies and an Interactive Visualisation System that allows fully three-dimensional reasoning from the beginning and throughout the whole archaeological process. Preliminary results show that students easily incorporate 3D documentation into their toolbox for analysing and visualising the material and understand both the possibilities and limitations of the system. However, we identified some limitations in the students’ use of the system. Together with the students’ feedback, we will use them to develop it further and discuss its use in education.

Description of the Use of Incentives and Penalties for Point-of-Care Ultrasound Documentation Compliance in an Academic Emergency Department

ObjectivesIncomplete documentation and submission to the electronic health record of performed point-of-care ultrasound (POCUS) studies is problematic from a patient care, medicolegal, and billing standpoint. Positive and negative financial incentives may be used to motivate physicians to complete documentation workflow. The most efficacious route to improve POCUS workflow completion remains to be determined.Materials and methodsA retrospective analysis of POCUS documentation in an academic emergency department during four distinct six-month blocks was performed. POCUS workflow completion was assessed without incentives (Baseline), with financial bonus (Incentive), interim period (Washout), and with a negative financial incentive (Penalty) to determine the effect of these incentives on workflow completion.ResultsThere was an appreciable increase in the rate of POCUS studies documented between the “Baseline” (no incentive) and “Incentive” (small financial bonus) time periods. The improvement remained stable during the “Washout” (interim) period, and then increased further in the “Penalty” (negative financial incentive) period. This improvement was relatively diffuse among the providers studied. A similar pattern - improvements in the Incentive and Penalty periods with stability in the Washout - was also observed in the POCUS volume data (number of studies performed).ConclusionsThis study reveals a positive association between the implementation of both financial incentives and financial penalties, which increases in POCUS documentation among attending physicians at an academic emergency department.

Clinicians' and nurses' documentation practices in palliative and hospice care.

Health workers are likely to document patients' care inaccurately, especially when using new and revised case tools, and this could negatively impact patient care. To assess nurses' and clinicians' documentation practices when using a new patients' continuation case sheet (PCCS) and explore nurses' and clinicians' experiences regarding the documentation of patients' information in the new PCCS. The purpose of introducing the PCCS was to improve the continuity of care for patients attending clinics at which they were unlikely to consistently see the same clinician or nurse. This was a mixed-methods study. The cross-sectional inquiry retrospectively reviewed 100 case notes of active patients in a hospice and palliative care programme. Data were collected using a structured questionnaire with constructs formulated from the new PCCS under study. The qualitative element was face-to-face, audio-recorded, open-ended interviews with a purposive sample of one palliative care clinician and four palliative care nurse specialists. Thematic analysis was used. Patients' biogeographic information was missing in 5% to 10% case notes. Spiritual and psychosocial issues were not documented in 42.6% of patients' case notes and vital signs, in 49.2%. The poorest documentation practices were observed in the past medical history part of the PCCS, noted in 40%-63% of the 100 case notes included in this study. Four themes emerged from interviews with clinicians and nurses: (1) what remains unclear and challenges; (2) comparing the past with the present; (3) experiential thoughts, and; (4) transition and adapting to change. The PCCS seems to be a comprehensive and simple tool that can be used to document patients' information at subsequent visits. To increase its reliability and validity, clinicians and nurses need training on how to use it. Clinicians and nurses need to prioritise accurate and complete documentation of patient care in the PCCS to ensure quality care provision. This study should be extended to other sites using similar tools to ensure representative and generalisable findings.

Are patients truly informed? A retrospective chart review of the documentation of informed consent in laparoscopic cholecystectomy.

Background:Research on informed consent (IC) has traditionally focused on the documentation of the discussion with patients of potential complications. We sought to examine the completeness of documentation for all elements of IC for laparoscopic cholecystectomy (LC): potential complications, alternatives to LC and details of the procedure. Differences in the documentation of IC for elective and emergent LC were examined.Methods:A retrospective chart review of patients undergoing LC at our institution between 2015 and 2017 was performed. Completeness of documentation was defined as documentation of all 3 elements of IC in the clinic note, the operating room note or the consent form itself. Data were analyzed descriptively. We compared documention for emergent and elective cases as well as documentation by residents and attending physicians using t tests.Results:A total of 270 patients were included in the analysis. Only 5 (2%) had complete documentation of all elements of IC. Documentation of potential complications was noted in 232 cases (86%), of which 58 (25%) were elective and 174 (75%) were emergent. Details were noted in 28 (10%) cases, of which 21 (75%) were elective and 7 (25%) were emergent. Alternatives were documented the least frequently: they were documented in 23 cases (9%), of which 20 (87%) were elective and 3 (13%) were emergent. Residents performed better than attending physicians in documenting IC discussions in clinic notes and on consent forms, but not in operating room notes.Conclusion:Documentation of the elements of IC for LC was poor. Potential complications were the most frequently documented element of IC; alternatives and details were often omitted. Future studies comparing audiotaped IC conversations with the documentation of IC are warranted. The use of procedure-specific consent forms for LC may facilitate documentation.

Nature Library: The Establishment and Analysis of the First Nature Library in Turkey

One of the basic provisions of any kind of scientific survey and study is to have a specialization library as well as adopting the principle of obtaining a complete documentation, which, today, attaches more and more importance to the special libraries. In accordance with this increasing importance, it has been observed that new generation special libraries have been established with the aim of meeting the knowledge requirements of researchers studying in specific fields. Within the scope of this study, the foundation studies of Nature Library, the establishment of which started in 2018 and which began to render service in March 2020, have been discussed in order to provide the knowledge and documentation for subjects including particularly birds, endangered species, Key Biodiversity Areas /KBA, Important Bird Areas / IBA and Indigenous Production Landscapes /IPL as well as protection of the biodiversity, the culture of nature, the law of nature, the philosophy of nature, nature literacy and natural arts both in Anatolia and in different parts of the world. Besides, the actions to be improved and recommendations have been specified in detail with the intention of carrying out services better as a result of the evaluations.

Evaluation of Pelvic Circular Compression Devices in Severely Injured Trauma Patients with Pelvic Fractures

Background: The role of pelvic circumferential compression devices (PCCD) is to temporarily stabilize the pelvic ring, reduce its volume and to tamponade bleeding. The purpose of this study was to evaluate the effect of PCCDs on mortality and bleeding in severely injured trauma patients, using a large registry database. Methods: We performed a retrospective analysis of all patients registered in the Trauma Register DGU® between 2015 and 2016. The study was limited to directly admitted patients who were alive on admission, with an injury severity score (ISS) of 9 or higher, with an Abbreviated Injury Scale AISpelvis of 3–5, aged at least 16, and with complete status documentation on pelvic circular compression devices (PCCD) and mortality. A cohort analysis was undertaken of patients suffering from relevant pelvic fractures. Data were collected on mortality and requirements for blood transfusion. The observed outcome was compared with the expected outcome as derived from version II of the Revised Injury Severity Classification (RISC II) and adjusted accordingly. A Standardized Mortality Ratio (SMR) was also calculated. Results: A total of 9,910 patients were included. 1,103 of 9,910 patients suffered from a relevant pelvic trauma (AISpelvis = 3–5). Only 41% (454 cases) of these received a PCCD. PCCD application had no significant effect on mortality and did not decrease the need for blood transfusion in the multivariate regression analysis. However, in this cohort, the application of a PCCD is a general indicator for a critical patient with increased mortality (12.0% no PCCD applied vs. 23.2% PCCD applied prehospital vs. 27.1% PCCD applied in the emergency department). The ISS was higher in patients with PCCD (34.12 ± 16.4 vs. 27.9 ± 13.8; p < 0.001). Conclusion: PCCD was applied more often in patients with severe pelvic trauma according to ISS and AISpelvis as well with deterioration in circulatory status. PCCDs did not reduce mortality or reduce the need for blood transfusion. Trial registration: TR-DGU ID 2017-003, March 2017; German clinical trial register DRKS00024948

Improving the quality of nursing documentation at a residential care home: a clinical audit

BackgroundQuality in nursing documentation holds promise to increase patient safety and quality of care. While high-quality nursing documentation implies a comprehensive documentation of the nursing process, nursing records do not always adhere to these documentation criteria. The aim of this quality improvement project was to assess the quality of electronic nursing records in a residential care home using a standardized audit tool and, if necessary, implement a tailored strategy to improve documentation practice.MethodsA criteria-based clinical audit was performed in a residential care home in Norway. Quantitative criteria in the N-Catch II audit instrument was used to give an assessment of electronic nursing records on the following: nursing assessment on admission, nursing diagnoses, aims for nursing care, nursing interventions, and evaluation/progress reports. Each criterium was scored on a 0–3 point scale, with standard (complete documentation) coinciding with the highest score. A retrospective audit was conducted on 38 patient records from January to March 2018, followed by the development and execution of an implementation strategy tailored to local barriers. A re-audit was performed on 38 patient records from March to June 2019.ResultsNone of the investigated patient records at audit fulfilled standards for recommended nursing documentation practice. Mean scores at audit varied from 0.4 (95 % confidence interval 0.3–0.6) for “aims for nursing care” to 1.1 (0.9–1.3) for “nursing diagnoses”. After implementation of a tailored multifaceted intervention strategy, an improvement (p < 0.001) was noted for all criteria except for “evaluation/progress reports” (p = 0.6). The improvement did not lead to standards being met at re-audit, where mean scores varied from 0.9 (0.8–1.1) for “evaluation/progress reports” to 1.9 (1.5–2.2) for “nursing assessment on admission”.ConclusionsA criteria-based clinical audit with multifaceted tailored interventions that addresses determinants of practice may improve the quality of nursing documentation, but further cycles of the clinical audit process are needed before standards are met and focus can be shifted to sustainment of knowledge use.

SPHinXsys: An open-source multi-physics and multi-resolution library based on smoothed particle hydrodynamics

In this paper, we present an open-source multi-resolution and multi-physics library, SPHinXsys, which is released under the Apache License (2.0). Along with the source code, a complete documentation is also distributed for easy compilation and execution. SPHinXsys aims at modeling coupled multi-physics industrial dynamic systems within a unified SPH framework. It has two important features, namely, (1) the generic design providing a C++ API with very good flexibility for domain-specific applications, (2) the unified framework within which numerous industrial or scientific applications can be coupled. The present version (v0.2.0) includes a wide range of validation tests and applications in the fields of fluid dynamics, solid dynamics, thermal and mass diffusion, reaction-diffusion, electromechanics and fluid-structure interactions. Program summaryProgram Title: SPHinXsysCPC Library link to program files:https://doi.org/10.17632/9rh6hyd89n.1Developer's repository link:https://github.com/Xiangyu-Hu/SPHinXsysCode Ocean capsule:https://doi.org/10.24433/CO.0560985.v1Licensing provisions: Apache-2.0Programming language: C++External dependencies: cmake, Boost, Threading Building Blocks (TBB), SimBodyNature of problem:: Multi-physics problems are ubiquitous in natural phenomena and play key roles in a vast range of scientific and industrial applications. Typical examples include aerial animal flying, aquatic animal swimming and the flow of blood in the heart and throughout the cardiovascular system. Due to the inter-discipline characteristics and intrinsic complexities, computational modeling of multi-physics problems is highly challenging.Solution method:: An open-source library is proposed for solving multi-physics problems in a unified multi-resolution Smoothed Particle Hydrodynamics framework. In particular, the library is applied for modeling cardiac functions where critical aspects of electrophysiology, passive and active mechanical responses are involved.

The impact of acute diarrhea on the coagulation status of patients with vitamin K antagonists

Acute diarrhea is associated with a reduced absorption of both vitamin K antagonists (VKA) and vitamin K itself. To date, the net effect on the coagulation status of subjects with VKA remains elusive. We performed a systematic retrospective single-center analysis using an electronic data extraction approach to identify subjects with plasmatic anticoagulation (either VKA or direct oral anticoagulant (DOAC)) and diarrhea in a German University Hospital over a period of eight years. Acute diarrhea and complete documentation of coagulation status on admission were defined as inclusion criteria, anticoagulation other than VKA/DOAC and obvious inadherence as exclusion criteria. Subjects with VKA/DOAC admitted for hypertension served as control group. Data extraction yielded 356 subjects with gastrointestinal diagnoses and 198 hypertensive subjects, 55 and 83 of whom fulfilled all in- and exclusion criteria. INR values of subjects with VKA were significantly higher in subjects with diarrhea than in hypertensive controls (4.3 ± 3.7 vs. 2.3 ± 0.7, p < 0.001). The distribution of subjects having INR values lower, higher or within the target range differed significantly among groups with a substantially higher prevalence of overanticoagulation in the diarrhea group (46.4% vs. 14.3%, p < 0.001). In a multinomial logistic regression model, acute diarrhea was significantly associated with overanticoagulation (odds ratio 7.2, 95% confidence interval 2.163–23.921; p < 0.001), whereas age, sex, creatinine, and indication of anticoagulation were not (p > 0.05 each). Acute diarrhea is associated with a highly increased risk for overanticoagulation in patients with VKA. Thus, gastroenteritis necessitates a close monitoring of INR in order to identify subjects needing a temporary pause of VKA therapy.

PicoRio: An open-source, RISC-V small-board computer to elevate the RISC-V software ecosystem

PicoRio™ is an open-source project stewarded by the RISC-V International Open Source (RIOS) laboratory—rioslab.org—a nonprofit research lab at Tsinghua-Berkeley Shenzhen Institute (TBSI). The RIOS Lab uses collaborative engineering from both academia and industry to elevate the RISC-V software and hardware ecosystem. In PicoRio, we create an open, affordable, Linux-capable RISC-V hardware platform to aid software developers in porting many modern programs that require Javascript or GPUs. PicoRio will build upon high-quality IPs and software components from expert industry engineers and academic researchers. PicoRio is not proprietary to any specific vendor and platform, and will have complete documentation that can help people to build quality products in a short amount of time. Our plan is to ship PicoRio 1.0 in 1H2021.

Application of Terrestrial Laser Scanning for the Inventory of Historical Buildings on the Example of Measuring the Elevations of the Buildings in the Old Market Square in Jarosław

Terrestrial laser scanning (TLS) technology is increasingly used in surveying, construction and architecture. The potential of the data obtained by this method creates the possibility of its versatile application also in conservation and revitalization of monuments, archaeology or history. The use of this technology during the creation of architectural documentation of a historic building greatly facilitates the acquisition of comprehensive information about its actual condition in a fast, non-invasive and very precise manner. Thanks to digital technology, it also creates the possibility to accurately interpret the condition of an object and present its model in a virtual space. This technology provides the ability to transfer acquired image elements with high accuracy of their mapping to plans and designs prepared by architects and contractors. It is also possible to maintain high technical standards in the processes aimed at the preparation of the required graphical studies, thanks to the use of the point cloud obtained in TLS. One of the most important advantages of using this measurement method is the possibility of combining it with data from e. g. from photogrammetric tools, which gives the possibility to fill in the missing elements creating a more complete picture of the needed data. This paper presents the implementation of terrestrial laser scanning technology as a non-invasive method for the modelling of walls and buildings of the so-called “greenfield”. Revers BIM on the example of the measurement of the facades of the buildings of the old market in Jarosław. This technology allows for preparation of precise architectural documentation including: projections, sections, elevation views, 3D models or multimedia visualizations. The use of TLS for cultural heritage research also enables the preparation of fully complete documentation for conservation and restoration works aimed at maintaining the current state of monuments or even at reconstructing their damaged architectural elements.

Techno-Economic Assessment (TEA) and Life Cycle Costing Analysis (LCCA): discussing methodological steps and integrability

Researchers have always been concerned about investigating new methods of economic evaluation, in order to endow reliable observations and support the sustainable development of new products. In this sense, clarity and homogeneity are necessary to exploit the effectiveness of such instruments that, only in this way, can provide consistent recommendations among sectors and industries of the economy. With respect to technological innovation, two diffused methods are the techno-economic assessment (TEA) and the life-cycle costing analysis (LCCA). However, despite their diffusion and approval, these instruments still lack clear guidelines and a complete documentation of their distinctive elements. Furthermore, no discussion exists about their complementarity and integrability, despite the fact that these methods are frequently concurrently used in the analyses. With the goal of reviewing what sets one method apart from the other, this research shed some lights on the distinctive elements of TEA and LCCA, as well as providing a preliminary discussion on their (possible) methodical integration. At a first glance, present literature provides numerous cues for an analysis which aim is to improve the comprehension of the norms of application of TEA and LCCA. Though, it is necessary a reorganisation of contents which, at present time, appears heterogenous and uncoordinated. Despite some limitations and its preliminary nature, this research contributes to improve the comprehension of the methods under investigation, also introducing a new vision which sees TEA and LCCA converge in a structured model.

Intravenous Iron-Induced Hypophosphatemia: An Emerging Syndrome.

Some, but not all, intravenous iron formulations have been recognized to induce renal phosphate wasting syndrome. Most commonly this has been reported following treatment of iron deficiency anemia (IDA) with ferric carboxymaltose (FCM). A search of PubMed identified relevant randomized controlled trials (RCTs), and case studies evaluating hypophosphatemia (HPP) resulting from intravenous iron treatment. While more recent larger comparative RCTs have confirmed that the majority of patients receiving FCM, especially those with normal renal function, may experience severe HPP, complete documentation is hampered by inconsistent reporting of serum phosphate in such trials. Similarly, while case series and RCTs have documented the persistence of HPP for several weeks or even months, the lack of studies lasting beyond 5–6 weeks has constrained full understanding of the duration of effect. Clinical trials have established that the mechanism involves the bone/metabolic axis with the elevation of intact fibroblast growth factor 23 playing the central role. Reports continue to accumulate of the clinical consequences of severe HPP which are, most commonly, bone abnormalities following repetitive dosing. Case reports and studies, however, have also shown that symptomatic hypophosphatemia can occur after a single FCM dose. The frequency of such events remains unknown, in part due to lack of awareness of hypophosphatemia coupled with the fact that the most common acute symptoms of HPP (fatigue and weakness) are the same for IDA and for many of the chronic diseases that cause IDA. Changes to US and European prescribing information for FCM should raise awareness of the potential for HPP and need to monitor patients at risk for it.

Abstract 057: Beyond Convenience: Video Visits Can Increase The Efficiency Of Preventive Care Delivery

Introduction: In response to the COVID-19 pandemic, medical practices have expanded utilization of telehealth. Little is known about the operational impacts of transitioning from in-person to video visits in specialty clinics. In 2018, the Stanford South Asian Translational Heart Initiative (SSATHI), a preventive cardiology clinic focused on high-risk South Asian adults, introduced CardioClick, a program replacing in-person follow-up visits with video visits. Hypothesis: We hypothesized that implementation of video visits increased the efficiency of clinic operations. Methods: We extracted visit-level data from the EHR for 134 patients enrolled in CardioClick with video follow-up visits from June 14, 2018 to April 21, 2020 and a cohort of 276 patients enrolled in the in-person SSATHI prevention program with follow-up visits from September 11, 2014 to March 6, 2020. Results: Patients in CardioClick and the in-person cohort were similar in terms of age (mean 45 years), gender balance (23 vs 21% female), and cardiometabolic risk profiles. There were 181 video and 637 in-person follow-up visits. Video visits were shorter than in-person visits, both in terms of total clinic time [median 22 min (IQR 16, 29) vs 67 min (48, 100)] and provider time required [median 22 min (IQR 16, 29) vs 30 min (12, 58)]. Video visits were more likely to end on time (71 vs 11%, p&lt;0.001). The median video visit ended on time while the median in-person visit ended 32 min late (13, 70) (see Figure). Providers were also more likely to complete video visit documentation the same day (56 vs 42%, p=0.001). Conclusions: In a preventive cardiology clinic, video follow-up visits required less clinic and provider time than in-person visits, were more likely to end on time, and were associated with increased same-day provider documentation completion. In conclusion, video visits offer benefits beyond their convenience and may increase the operational efficiency of specialty care practices focused on disease prevention, improving value in care delivery.