Differences In Visit Frequency Research Articles

Effects of Florivory on Floral Visitors and Reproductive Success of Sagittaria lancifolia (Alismataceae) in a Mexican Wetland.

Florivores consume floral structures with negative effects on plant fitness and pollinator attraction. Several studies have evaluated these consequences in hermaphroditic plants, but little is known about the effects on monoecious and dioecious species. We characterize the florivory and its effects on floral visitors and reproductive success in a monoecious population of Sagittaria lancifolia. Five categories of florivory were established according to the petal area consumed. Visits were recorded in male and female flowers within the different damage categories. Reproductive success was evaluated through fruit number and weight, as well as the number of seeds per fruit. Our results show that the weevil Tanysphyrus lemnae is the main florivore, and it mainly damages the female flowers. Hymenoptera were recorded as the most frequent visitors of both male and female flowers. Male and female flowers showed differences in visit frequency, which decreases as flower damage increases. Reproductive success was negatively related to the level of damage. We found that florivory is common in the population of S. lancifolia, which can exert a strong selective pressure by making the flowers less attractive and reducing the number of seeds per fruit. Future studies are needed to know how florivores affect plant male fitness.

Minimal impacts of invasive Scaevola taccada on Scaevola plumieri via pollinator competition in Puerto Rico

IntroductionScaevola taccada and Scaevola plumieri co-occur on shorelines of the Caribbean. Scaevola taccada is introduced in this habitat and directly competes with native dune vegetation, including S. plumieri, a species listed as locally endangered and threatened in Caribbean locations. This study addresses whether the invasive S. taccada also impacts the native S. plumieri indirectly by competing for pollinators and represents the first comparative study of insect visitation between these species.MethodsInsect visitation rates were measured at sites where species co-occur and where only the native occurs. Where species cooccur, insect visitors were captured, identified and analyzed for the pollen they carry. Pollen found on open-pollinated flowers was analyzed to assess pollen movement between the two species. We also compared floral nectar from each species by measuring volume, sugar content, and presence and proportions of amine group containing constituents (AGCCs).ResultsOur results demonstrate that both species share insect visitors providing the context for possible pollinator competition, yet significant differences in visitation frequency were not found. We found evidence of asymmetrical heterospecific pollen deposition in the native species, suggesting a possible reproductive impact. Insect visitation rates for the native were not significantly different between invaded and uninvaded sites, suggesting that the invasive S. taccada does not limit pollinator visits to S. plumieri. Comparisons of nectar rewards from the invasive and the native reveal similar volumes and sugar concentrations, but significant differences in some amine group containing constituents that may enhance pollinator attraction.ConclusionOur analysis finds no evidence for pollination competition and therefore S. taccada’s main impacts on S. plumieri are through competitive displacement and possibly through reproductive impacts as a consequence of heterospecific pollen deposition.

Pharmacists as accessible health care providers: quantifying the opportunity.

BACKGROUND: Community pharmacists are well positioned to improve patient access to care, which may assist value-based care programs in reaching patients. While pharmacy accessibility is broadly acknowledged, much of the research supporting accessibility claims is poor quality. OBJECTIVE: To quantify the accessibility of pharmacists in comparison with physicians or qualified health care professionals (QHP) in a commercially insured population. METHODS: IBM MarketScan claims data from 2018 were used for this cross-sectional study. Beneficiaries included in the primary analysis were aged 18-64 years, enrolled with pharmacy benefits in 2018 for 12 months, and had at least 1 valid prescription drug claim or evaluation and management (E&M) code in 2018. Unique pharmacy visits were defined using a 6-day fill window for prescription fill dates, while visits to physicians or other QHP were defined as unique service dates tied to an E&M code. We assessed differences in visit frequency for the full sample, those with multiple chronic conditions (MCC), and "superutilizers" (top 5% based on total cost of care). Our statistical approach included descriptive statistics and the Wilcoxon sign rank test. RESULTS: After applying the inclusion criteria, 11,720,958 beneficiaries were included in the full sample. The MCC cohort contained 13.8% of the total sample (mean [SD] age: 50.8 [10.8]; 908,880 [56.1%] female). Finally, the superutilizers were 57.3% female with an average age of 48.4 years and comprised 5.3% of the total sample. The median number of pharmacy and physician or QHP visits for the full sample were 5 and 3 (P < 0.0001), yielding a pharmacy to physician or QHP visit ratio of 1.7:1. The MCC cohort had a median of 13 pharmacy visits and 7 physician or QHP visits (ratio 1.9:1; P < 0.0001), and the superutilizers had a median of 14 pharmacy visits and 9 physician or QHP visits (ratio 1.6:1; P < 0.0001). CONCLUSIONS: This study found that patients visit their community pharmacies almost twice as often as they visit their physicians or other QHP. Study findings emphasize the accessibility of community pharmacists and highlight the role of community pharmacists in improving patient engagement in all care programs, including value-based care programs. DISCLOSURES: The database infrastructure used for this project was funded by the Department of Epidemiology, University of North Carolina (UNC) Gillings School of Global Public Health; the Cecil G. Sheps Center for Health Services Research, UNC; the CER Strategic Initiative of UNC's Clinical Translational Science Award (UL1TR001111); and the UNC School of Medicine. All authors are employed by the UNC School of Pharmacy. Urick declares consulting fees from Cardinal Health. The other authors have no conflicts of interest to disclose. Portions of this work were previously presented at the AMCP 2021 Virtual, April 12-16, 2021.

Stability of food insecurity status in paediatric primary care.

The American Academy of Pediatrics recommends screening for food insecurity (FI) at all well-child visits due to well-documented negative effects of experiencing FI in childhood. Before age 3, children have twelve recommended primary care visits at which screening could occur. Little is known regarding the stability of FI status at this frequency of screening. Data derived from electronic health records were used to retrospectively examine the stability of household FI status. Age-stratified (infant v. toddler) analyses accounted for age-based differences in visit frequency. Regression models with time since last screening as the predictor of FI transitions were estimated via generalised estimating equations adjusting for age and race/ethnicity. A paediatric primary care practice in Philadelphia. 3451 distinct patients were identified whose health record documented two or more household FI screens between April 1, 2012 and July 31, 2018 and were aged 0-3 years at first screen. Overall, 9·5 % of patients had a transition in household FI status, with a similar frequency of transitioning from food insecure to secure (5·0 %) and from food secure to insecure (4·5 %). Families of toddlers whose last screen was more than a year ago were more likely to experience a transition to FI compared with those screened 0-6 months prior (OR 1·91 (95 % CI 1·05, 3·47)). Screening more than annually may not contribute substantially to the identification of transitions to FI.

Differences in Frequency of Visits to Pediatric Primary Care Practices and Emergency Departments by Body Mass Index.

To examine differences in utilization across health care settings among children by body mass index (BMI) categories to help identify opportunities for interventions. A retrospective study was conducted using 1 year of electronic health records following an index primary care visit for children 3 to 17 years old in 2016. Index visits occurred at >40 pediatric practices affiliated with a Northeastern health system. Using normal BMI as a reference group, we examined the extent to which children's BMI percentile categories were associated with primary care visits, emergency department (ED) visits, hospitalizations, and ED visit acuity. Age, sex, race/ethnicity, and insurance status were used as covariates. Of those with biologically plausible values for height and weight (n=30,352), the prevalences of overweight, obesity, and severe obesity were 16.3%, 12.4%, and 5.7%, respectively. Children outside of the normal BMI range made more primary care visits; however, relative patterns of ED utilization were not consistent. Children with obesity versus normal BMI were less likely to have ED visits of high acuity. Risk of hospitalization was higher among children with overweight or severe obesity. Children's BMI categories were associated with health care utilization, specifically primary care visits, ED visits, and hospitalizations. Further investigation is needed to explore the drivers of these differences in utilization, such as the impact of stigma and perceived weight bias on care-seeking patterns, and to examine the role of settings outside of primary care in pediatric weight management.

Utilizing a novel unified healthcare model to compare practice patterns between telemedicine and in-person visits

ObjectiveTelemedicine practice has been shown to vary from clinical guidelines. Variations in practice patterns may be caused by disruptions in the continuity of care between traditional and telemedicine providers. This study compares virtual and in-person visits in Stanford’s ClickWell Care (CWC) – where patients see the same provider for both visit modalities.MethodsClinical data for two years of patient encounters at CWC from January 2015–2017 (5772 visits) were obtained through Stanford STRIDE. For the 20 most common visit categories, including 17 specific diagnoses, we compared the frequency of prescriptions, labs, procedures, and images ordered, as well as rates of repeat visits.ResultsFor the 17 specific diagnoses, there are no differences in labs ordered. Two diagnoses show differences in images ordered, and four differences in prescriptions. Overall, there are more labs (0.16 virtual, 0.33 in-person p < 0.0001) and images ordered (0.07 virtual, 0.16 in-person, p < 0.0001) for in-person visits – due mainly to general medical exam visits. Repeat visits were more likely after in-person visits (19% virtual, 38% in-person, p < 0.0001), 10 out of 17 specific diagnoses showed differences in visit frequency between visit modalities. Visits for both anxiety (5.3x, p < 0.0001) and depression (5.1x, p < 0.0001) were much more frequent in the virtual setting.ConclusionsPrescriptions, labs, and images ordered were similar between in-person and virtual visits for most diagnoses. Overall however, for in-person visits we find increased orders for labs and images, primarily from general medical exams. Finally, for anxiety and depression patients show clear preferences for virtual visits.

Besøk på sykehjem. En kvantitativ studie av sykehjemsbeboeres besøkshyppighet

Social contact is essential for the well-being of the nursing home residents.Visiting frequency in nursing homes is rarely investigated. The purpose of this study was to map the number of visits for nursing home residents. Nursing students collected data during their nursing home practice. 355 residents were included in this cross-sectional study. We explored the association between visit frequency and age, gender, type of department, activities of daily living (ADL) and length of stay. Data was analyzed using statistical analysis. The average number of visits was 8,8 per month. However, there were differences in visit frequency among the 15 institutions. Residents in the long-term department received fewer visits compared to the dementia and short-term department. Significant correlations between ADL function, gender, length of stay, age and frequency of visits were not found. More research to identify causes for the differences in visit frequency between different institutions is needed.Keywords: nursing homes; visiting; visit frequency; sykehjem; besøk; besøkshyppighet

Effects of model-mimic frequency on insect visitation and plant reproduction in a self-mimicry pollination system.

The proportion of mimics and models is a key parameter in mimetic systems. In monoecious plants with self-mimicry pollination systems, the mimic-model ratio is determined by the floral sex ratio. While an equal sex ratio (1:1) could provide the perfect balance between pollen donors and stigma surfaces able to receive the pollen, an unequal ratio could increase pollination by production of a greater number of rewarding, model flowers. The aim of the present study is to test the differences in visitation frequency and reproductive rates of different mimic and model flower arrays in order to assess the efficacy of the mimetic system in a Begonia cucullata population. The frequencies of visitors to groups of flowers with three distinctive sex ratio arrays (male-biased, female-biased and equal ratio) were compared using a Bayesian approach. The reproductive outcomes were compared in order to detect advantages of particular sex ratios. Low visitation frequency was recorded in all arrays. Pollinators showed similar behaviour regardless of sex ratio; they tended to avoid female, rewardless flowers. Pollination quality was highest in the equal sex ratio array. The current study shows that sex ratio plays a critical role in the pollination of B. cucullata and that the efficacy of the self-mimicry system appears to be doubtful. Visitation frequency may be associated with visual or chemical cues that allow pollinators to recognize models and mimics, regardless of their frequency in the population.

Effects of local abundance on pollination and reproduction in Delphinium fissum subsp. sordidum (Ranunculaceae)

Delphinium fissum subsp. sordidum (Ranunculaceae) is an endangered, xenogamous, self-compatible hemicryptophyte endemic of the central-western Iberian Peninsula, with a disjunct distribution in the Sierra Mágina (Spain: Jaén Province). We studied the effects of local abundance, in terms of plot size (number of individuals) and plot purity (relative abundance), assessing the activity of pollinators (frequency of visits and behaviour of visitors), quantity and quality of pollinator services and seed set in two populations. Flowers of D. fissum subsp. sordidum were visited by Hymenoptera (88.8%), Lepidoptera (10.3%) and Diptera (0.9%). The most frequent pollinator was Bombus terrestris (72.6% of total visits). Differences in relative frequency of visits to plants were observed between populations. Plots with high numbers of individuals attracted more pollinators. The same pattern was observed for stigmatic pollen loads and seed set; 99.46% of pollen grains deposited on the stigmas were conspecific, and the main competitor was Ferula communis. The effects of purity were assessed by comparing pure plots with a mixed plot that included plants that coincide with the flowering stage of D. fissum subsp. sordidum and exert an effect of interspecific competition. These results may be useful for developing conservation measures, especially in the small population of Aldeadávila.

Distance Matters

One of the untested assumptions within the prison visitation literature is that inmates receive fewer visits when visitors must travel long distances to prisons. Measuring distance by comparing the addresses of the prisons where offenders were confined with the residential addresses of those who visited them, we tested this hypothesis by estimating the effects of distance on the number of times Minnesota prisoners were visited. We estimated the effects of distance by performing multilevel repeated measure analyses, measuring the frequency of visitation across the different facilities at which inmates were housed, the different neighborhoods from which they received visits, and between-inmate differences in visitation frequency. Besides distance, we also estimated the effects of social disorganization on the frequency of visitation. Finding that distance does indeed decrease the frequency of prison visitation, as does concentrated disadvantage in neighborhoods, we discuss the implications of this research for prison administrative policies.

Is Clinic Visit Frequency Associated with Weight Gain During the Interstage Period? A Report from the Joint Council on Congenital Heart Disease National Pediatric Cardiology Quality Improvement Collaborative (JCCHD-NPCQIC).

Growth problems are prevalent among infants with congenital heart disease. We sought to determine whether frequency of outpatient clinic visits correlated with weight gain in patients with hypoplastic left heart syndrome or variant during the interstage period between discharge from stage I palliation and presentation for stage II palliation (SIIP). Using prospectively collected data from the JCCHD NPC-QIC database from June 2008 to July 2013, we performed a retrospective cohort study assessing the association of days between clinic visits (DBV) with the change in weight-for-age z-score (WAZ) during the interstage period. Eligible subjects were those who survived to a SIIP performed at <270 days of age and had at least two outpatient clinic visits. There were 561 patients from 49 centers who fulfilled inclusion criteria. The average interstage change in WAZ was +0.22. The mean number of DBV was 16.1 days, and the average number of clinic visits was six. There was no correlation of change in WAZ with either DBV (r = 0.02, P = 0.62) or the number of visits (r = 0.03, P = 0.44). Subjects within this cohort are seen about every 2 weeks averaged over the interstage period. There is no correlation between interstage visit frequency and change in WAZ in this patient population. Further research is needed to describe differences in visit frequency as the patient progresses through the interstage period and to elucidate whether patient factors such as growth velocity are influencing visit frequency. The optimal visit frequency remains unknown.

Quality of care among breast cancer (BC) survivors in the University of California (UC) Athena Breast Health Network.

164 Background: Post-treatment cancer care needs improvement (IOM 2006), including use of treatment summaries (TS) and survivorship care plans (SCP). ASCO BC surveillance guidelines (2006) suggest only 1 provider needs to see patients 3 to 4 times a year in first 2 years, and every 6 to 12 months thereafter. Athena is a collaborative project designed to drive innovation in BC care among the five UC cancer centers. Interviews with Athena MDs and RNs noted visit redundancy and poor guideline adherence (Hahn ASCO Breast 2011). Methods: BC patients diagnosed in 2008-09 were recruited from UC hospital tumor registries. With UC-wide IRB approval, patients were invited to participate in a mailed survey on post-treatment care starting September 2011. A 30-page survey collected information on post treatment care including number and type of provider visits, discussion of key topics, satisfaction with care, and quality of life. We targeted 100 completed questionnaires from each site. Results: Data from the first 194 respondents are reported. Most were white, college graduates, with mean age 61 yrs, and mean time from diagnosis 3.2 ± 0.6 years. Treatments: surgery (S) only=33; S and radiation (XRT)=66; S and chemotherapy (C)=25; S, C, XRT=70. Mean number of BC follow-up care providers (2.3±1) was not related to treatment received (p=0.3). S-only treatment resulted in fewer BC specific clinic visits than C-treatment (33% vs. 45% to 58%). Of 80% who attended UC clinics, most received follow-up care every 3 to 4 months. The providers seen were: oncologists (66%), surgeon (38%), radiation oncologist (47%), primary care (40%). There were no differences in visit frequency by &lt;3 or &gt;=3 years since diagnosis. 68% had copies of medical records; 40% had received a TS; 57% had a SCP (61% at UC vs. 41% not at UC, p=0.03). The presentation will update data with a larger sample and multivariable models. Conclusions: Patient reports confirm that multiple providers are delivering BC specific follow-up care. Visit frequency may exceed guideline recommendations, and does not reflect risk of recurrence or treatment intensity. Less than half of patients received TS, but more than half had SCP. There is room to improve the coordination of post-treatment BC care.

Casino Travel Motivations of Chinese Tourists: Differences in Visitation Attributes

Tourism scholars have identified a need to understand why Chinese like to visit casinos and to segment tourists' travel motivation by their visitation characteristics. The principal purpose of this article is to explore Chinese tourists' travel motivations to casinos and to seek differences in visit frequency and length. Based on a sample of mainland Chinese tourists in Macau, the world gambling capital, the results indicate significant differences between first-time and repeat tourists in respect to casino and gambling experience seeking, socialization, and accessibility. The results also suggest that Chinese tourists' length of stay is primarily contingent on their desire to escape from pressure and mundane life. In light of these findings, managerial and theoretical implications are discussed.

Other Problems With Phase III Best Supportive Care Studies

TO THE EDITOR: In addition to the problems with such studies as discussed by Zafar et al, another surprisingly unaddressed issue is the frequency of patient visits by health care professionals. In the panitumumab versus best supportive care (BSC) studies, patients who received the drug were presumably seen by health care professionals every 2 weeks at the time of drug delivery, whereas those receiving only BSC were assessed, perhaps only, radiographically every 4 or even 8 weeks. In the cetuximab study, the differences in frequency of visits were even greater, with the treated group seen weekly and the BSC group seen every 4 weeks. This may result in the treated group having a shorter progressionfree survival because of earlier recognition of disease progression. On the other hand, complications and problems can be noted and addressed earlier in the treated group, possibly prolonging time on treatment, progression-free survival, and altering overall survival. In the future, such studies should consider having patients seen with the same frequency in both the treatment and BSC arms. Given that the overall survival differences were either not significant or perhaps not clinically meaningful, especially given the cost of the treatment, collecting the data in such a manner may have led to results different from those obtained.

Pollinators of Helleborus niger in Slovenian naturally occurring populations

The study is based on documentation and analysis of the major visitors and pollinators of the Christmas rose (Helleborus niger L.) flowers in Slovenian naturally occurring populations. The emphasis was put on 5 groups of insects: bees, bumblebees, large flies, small dipterous flies and pollinators of minor importance. Systematic observations took place in March 2003, at two different locations: on the valley of Bohinjska Bela and on the Peca Mountain. The first location was not far from a rural area, while the second one was in an isolated area, completely in the wild. The analysis of insect activity showed that there were obvious differences in frequency of visits among the insect groups investigated, locations and time of day. In the population of Bohinjska Bela, bees were the most important pollinators, with the highest activity occurred between 10 a.m. and 11 a.m. In the isolated population in Peca the most frequent visitors were small dipterous flies. The study suggests that the Christmas rose is probably an entomophylous (the most important pollinators are insects, such as bees and flies) and predominantly cross-pollinating species. The entomophylous nature appears to be closely associated with the specific botanic characteristics of flowers. Another pollinating agent is probably wind.

Relationships between species’ floral traits and pollinator visitation in a temperate grassland

Knowledge about plant-plant interactions for pollinator service at the plant community level is still scarce, although such interactions may be important to seed production and hence the population dynamics of individual plant species and the species compositions of communities. An important step towards a better understanding of pollination interactions at the community level is to assess if the variation in floral traits among plant species explain the variation in flower visitation frequency among those species. We investigated the relative importance of various floral traits for the visitation frequency of all insects, and bumblebees and flies separately, to plant species by measuring the visitation frequency to all insect-pollinated species in a community during an entire flowering season. Visitation frequency was identified to be strongly positive related to the visual display area and the date of peak flowering of plant species. Categorical variables, such as flower form and symmetry, were important to the visitation frequency of flies only. We constructed floral similarity measures based on the species' floral traits and found that the floral similarity for all species' traits combined and the continuous traits separately were positively related to individual visitation frequency. On the other hand, plant species with similar categorical floral traits did not have similar visitation frequencies. In conclusion, our results show that continuous traits, such as flower size and/or density, are more important for the variation in visitation frequency among plant species than thought earlier. Furthermore, differences in visitation frequency among pollinator groups give a poor support to the expectations derived from the classical pollination syndromes.

A multifaceted intervention in support of diabetes treatment guidelines: a cont trial

Objective: in an academic family practice clinic, we performed a controlled trial of a multifaceted intervention versus usual care for managing diabetes. Providers received didactic training and computerized compliance feedback to support staged diabetes management, an evidenced-based approach to diabetes care. Research design and methods: one firm of the clinic practice received the intervention, the other served as the control group during a 14-month baseline period and a 14-month study period. HbA1c was the principal outcome measure. Results: there was a significant 0.71% difference in change in HbA1c values between the intervention and control firms (P=0.02). The subgroup with the greatest improvement in HbA1c was those subjects who started the intervention with a HbA1c above 8%. The overall improvement in glycemic control could not be explained by differences in visit frequency or the aggressiveness of drug therapy. There were no changes in healthcare utilization or costs between the two firms. Conclusion: in an academic family practice clinic, a multifaceted intervention in support of diabetes treatment guidelines modestly improved glycemic control without incurring additional costs. The improvement was mostly due to mitigation of the natural deterioration in control usually seen. Further efforts are required to involve all patients in co-managing their diabetes.