Faster Mean Research Articles

Effect of the Stretch-Shortening Cycle on the Relationship Between Maximum Number of Repetitions and Lifting Velocity During the Prone Bench Pull.

The fastest mean (MVfastest) and peak (PVfastest) velocity in a set are used to predict the maximum number of repetitions (RTF), but stretch-shortening cycle (SSC) effects on these relationships are unknown. Velocity values associated with each RTF would show higher values for eccentric-concentric and multiple-point methods compared with concentric-only and 2-point methods. Cross-sectional study. Level 3. After determining the prone bench pull (PBP) 1-repetition maximum (1RM), 23 resistance-trained male participants randomly performed 2 sessions (1 for each PBP exercise), consisting of single sets of RTFs against 3 relative loads (60%-80%-70%1RM). Individualized RTF-velocity relationships were constructed using the multiple-point (60%-80%-70%1RM) and 2-point (60%-80%1RM) methods. Goodness-of-fit was very high and comparable for concentric-only (RTF-MVfastest, r2 = 0.97; RTF-PVfastest, r2 = 0.98) and eccentric-concentric (RTF-MVfastest, r2 = 0.98; RTF-PVfastest, r2 = 0.99) PBP exercises. Velocity values associated with different RTFs were generally higher for eccentric-concentric compared with concentric-only PBP exercise, but these differences showed heteroscedasticity (R2 ≥ 0.143). However, velocity values associated with different RTFs were comparable for the multiple- and 2-point methods (F ≤ 2.4; P ≥ 0.13). These results suggest that the inclusion of the SSC does not impair the goodness-of-fit of RTF-velocity relationships, but these relationships should be determined specifically for each PBP exercise (ie, concentric-only and eccentric-concentric). In addition, the 2-point method serves as a quick and less strenuous procedure to estimate RTF. Practitioners only need to monitor the MVfastest or PVfastest and the RTF from 2 (2-point method) or 3 (multiple-point method) sets performed to failure to construct an RTF-velocity relationship. Once these relationships have been established, coaches need only monitor the MVfastest or PVfastest of the set to estimate RTF against a given absolute load.

Stock Returns and Volatility: Comparative Investigation from SAARC Countries

This research article analyses the stock return and volatility of three selected SAARC countries (Pakistan, India, and Bangladesh), focusing on the role of natural resources in influencing market performance. This study aims to determine the robustness of the performance, considering the economic significance of these countries' natural resources. The daily data from the PSX 100 index (Pakistan Stock Exchange), BSE index (Bombay Stock Exchange), and DSE index (Dhaka Stock Exchange) for the years 2019 to 2021 has been obtained from their websites. The data is treated in MS Excel to compute the daily Geometric Returns for BSE, PSX, and DSE indices. Furthermore, the data were analyzed using the specialized package EViews for Time Series Graph, Descriptive Statistics, Unit Root Test, and GARCH Model. The findings of this research show that the BSE index has the highest return value of 6.78 percent compared with 4.56 percent and 3.75 percent for DSE and PSX, respectively. The Half-life model has been applied to calculate the volatility observed by the indices. The result shows that BSE is the most volatile and takes the highest time of 45 days to revert to its mean position, followed by PSX and DSE, which take 19 and 10 days, respectively. Therefore, investing in the BSE index is better for risk-lover investors. At the same time, DSE has the fastest mean reversion compared to the other two indices. Therefore, it is feasible for risk-averse investors.

Comparing virtual reality and simulation to teach the assessment and management of acute surgical scenarios: A pilot study.

Traditional apprenticeship-based surgical training presents with challenges, especially in acute scenarios. Simulation provides the current standard of facilitating surgical training in a low-risk environment but is restricted by limited accessibility and high costs. Virtual reality (VR) offers immersive three-dimensional computer-generated training scenarios and can connect users from various locations. We aimed to compare the performance of junior doctors to manage an acute surgical scenario using VR and mannequin-based simulation. We hypothesised that VR would be as effective as mannequin-based simulation in performance outcomes. This multicentre, randomised controlled pilot study was conducted with eighteen junior doctor volunteers (Foundation and Core Trainee Year 1). Ten were randomly allocated to VR and eight to mannequin-based simulation. Participants completed questionnaires and a 15-min pneumothorax scenario. Quantitative metrics included overall score, time-to-critical decisions, and academic buoyancy scores (ABS). Qualitative metrics included participants' likes and dislikes of their allocated simulation modality. VR participants scored significantly higher than mannequin-based simulation participants in overall scores (74.30% (SD ± 5.08%) vs. 59.75% (SD ± 10.14) (p = 0.04)), and technical skills aspects (77.20% (SD ± 8.01%) vs. 65.00% (SD ± 8.21%) (p = 0.01)). Mannequin-based simulation participants initiated critical decisions faster and demonstrated a trend towards a faster mean time-to-completion (p = 0.06). ABS scores increased for both study groups, though was only significant for VR participants (p ≤ 0.01). VR participants liked how VR fostered independent learning but disliked the formulaic content and impaired communication-learning compared to mannequin-based simulation. Both VR and mannequin-based simulation training are effective in training junior doctors in acute surgical scenarios but present different educational benefits. Future research should recruit a larger sample size for a full comparative randomised controlled trial.

Sex and Equipment Impact on Lifting Velocity and the Maximum Repetitions in Bench Press.

This study investigated how equipment and sex affect the prediction accuracy of the maximum number of repetitions performed to failure (RTF) using the fastest mean velocity of the set (MVfastest). Sixteen men and twelve women completed four sessions (two using free-weight equipment and two sessions using the Smith machine). Each session involved three sets of repetitions to failure against the 65%, 75%, and 85% of the one-repetition maximum, interspersed by 10-min of rest. The goodness-of-fit of the individualized RTF-MVfastest relationships was comparable between both equipment types and sexes (P≥0.510). Moreover, there were not significant differences in the MVfastest associated with RTF between equipment types (P≥0.258). However, the MVfastest associated with RTF was higher for men than for women in repetitions 6 to 15 (P≤0.043; ES≥0.69). In addition, the absolute errors when predicting RTF showed no significant differences between equipment types and loads (P<0.444). Specifically, these RTF estimates were within an acceptable range for men (<2 repetitions), but not for women (≥2 repetitions) (main effect of sex: P≤0.018; ES≥0.58). These findings suggest that individualized RTF-MVfastest equations estimate the RTF with an acceptable precision in men during bench press exercises in both equipment types but exhibit lower precision for women.

Prospective Randomized Controlled Trial Comparing Anesthetic Management With Remimazolam Besylate and Flumazenil Versus Propofol During Awake Craniotomy Following an Asleep-awake-asleep Method.

Awake craniotomy is performed to resect brain tumors in eloquent brain areas to maximize tumor reduction and minimize neurological damage. Evidence suggests that intraoperative anesthetic management of awake craniotomy with remimazolam is safe. We compared the time to arousal and efficacy of anesthetic management with remimazolam and propofol during awake craniotomy. In a single-institution randomized, prospective study, patients who underwent elective awake craniotomy were randomized to receive remimazolam and reversal with flumazenil (group R) or propofol (group P). The primary end point was time to awaken. Secondary end points were time to loss of consciousness during induction of anesthesia, the frequency of intraoperative complications (pain, hypertension, seizures, nausea, vomiting, and delayed arousal), and postoperative nausea and vomiting. Intraoperative task performance was assessed using a numerical rating scale (NRS) score. Fifty-eight patients were recruited, of which 52 (26 in each group) were available for the efficacy analysis. Patients in group R had faster mean (±SD) arousal times than those in the P group (890.8±239.8 vs. 1075.4±317.5s; P=0.013)and higher and more reliable intraoperative task performance (NRS score 8.81±1.50 vs. 7.69±2.36; P=0.043). There were no significant intraoperative complications. Compared with propofol, remimazolam was associated with more rapid loss of consciousness and, after administration of flumazenil, with faster arousal times and improved intraoperative task performance.

Practical Guidelines for Farm Waste Utilization in Sustainable Kale Production

Natural amendments from agricultural waste to improve soil physicochemical properties continuously attract research interest in promoting eco-friendly plant production. The present study evaluated the proper use of sawdust, biochar, and compost made from farm waste for kale production from seedling propagation to field conditions. From the seedling propagation process, the results demonstrate that the most suitable growing medium for kale seedings was 0.5:1:1 v/v of sawdust + biochar + compost, which gave the fastest mean germination times (2.71 days) and the highest seed germination percentage (78.33%). In addition to investigating the selected growing media as the soil amendments at five different rates (0, 6.25, 12.50, 18.75, 25.00, and 31.25 t ha−1), the result reveals that the fresh weight of marketable leaves was significantly highest under the 31.25 t ha−1 treatment. The application rate that yielded the highest gross profit margins was eight times higher than the control. Moreover, in some harvesting periods, the kale leaf yields under the treatment of 31.25 t ha−1 showed higher total chlorophyll and carotenoid contents.

Impact of Lifting Straps on the Relationship Between Maximum Repetitions to Failure and Lifting Velocity During the Prone Bench Pull Exercise.

Fastest mean (MVfastest) and peak (PVfastest) velocity of the set have been proposed to predict the maximum number of repetitions to failure (RTF) during the Smith machine prone bench pull (PBP) exercise. Goodness-of-fit would be higher for individualized compared with generalized RTF-velocity relationships and comparable for both execution equipment conditions (with or without straps), and the MVfastest and PVfastest associated with each RTF would be comparable between execution equipment and prediction methods (multiple- vs 2-point method). Cross-sectional study. Level 3. After determining the PBP 1-repetition maximum (1RM), 20 resistance-trained male athletes performed 2 sessions randomly, with and without lifting straps, consisting of single sets to failure against the same load sequence (60% to 80% to 70% 1RM). Generalized (pooling data from all subjects) and individualized (separately for each subject using multiple-point or 2-point methods) RTF-velocity relationships were constructed. Individualized RTF-velocity relationships were always stronger than generalized RFT-velocity relationships, but comparable with (MVfastest: r2 = 0.87-0.99]; PVfastest: r2 = 0.88-1.00]) and without (MVfastest: r2 = 0.82-1.00; PVfastest: r2 = 0.89-0.99]) lifting straps. The velocity values associated with each RTF were comparable between execution equipment (P ≥ 0.22), but higher for the multiple-point compared with the 2-point method (P < 0.01). The use of lifting straps during the Smith machine PBP exercise does not affect the goodness-of-fit of the RTF-velocity relationships or the velocity values associated with different RTFs. However, caution should be exercised when using different methods. The benefits of the RTF-velocity relationships can be extrapolated when using lifting straps, and the 2-point method can also be used as a quick and more fatigue-free procedure. Nevertheless, it is imperative for coaches to ensure that these relationships are reflective of fatigue experienced during training.

O116: Comparing Virtual Reality versus Simulation to teach the assessment and management of acute surgical scenarios

Abstract Introduction Traditional apprenticeship-based surgical training presents with challenges, especially in acute scenarios. Simulation is the current gold standard but has its drawbacks. Virtual reality (VR) offers immersive three-dimensional computer-generated training scenarios and can connect users from various locations. We aimed to compare the performance of junior doctors to manage an acute surgical scenario using VR and mannequin-based simulation. We hypothesised that VR would be as effective as mannequin-based simulation in performance outcomes. Method This multicentre, randomised controlled pilot study was conducted with eighteen junior doctor volunteers (Foundation and Core Trainee Year 1). Ten were randomly allocated to VR and eight to mannequin-based simulation. Participants completed questionnaires and a 15-minute pneumothorax scenario. Quantitative metrics included overall score, time-to-critical decisions, and academic buoyancy scores (ABS). Qualitative metrics included participants’ likes and dislikes of their allocated simulation modality. Results VR participants scored significantly higher than simulation participants in overall scores (74.30% (SD±5.08%) versus 59.75% (SD±10.14) (p=0.04)), and technical skills (77.20% (SD±8.01%) versus 65.00% (SD±8.21%) (p=0.01)). Mannequin-based simulation participants initiated critical decisions faster and demonstrated a trend towards a faster mean time-to-completion (p=0.06). ABS scores increased for both study groups, though was only significant for VR participants (p≤0.01). Participants liked how VR fostered independent learning but disliked the formulaic content and impaired communication-learning compared to mannequin-based simulation. Conclusion VR can be as effective as mannequin-based simulation in training junior doctors in acute surgical scenarios. Future research should recruit a larger sample size for a full comparative randomised controlled trial.

Secondary metabolite profiles, antimicrobial and antioxidant activities of callus, and leaves extract of Piper sarmentosum Roxb.

This research was aimed to investigate the effect of different combination concentrations of 2,4-diclorophenoxyacetic acid (2,4-D) and benzylaminopurine (BAP) on callus induction, profiles of secondary metabolites, antimicrobial, and antioxidant activities from Piper sarmentosum leaves. These leaves explants were cultured on Murashige and Skoog (MS) medium supplemented with different combination concentrations of 2,4-D and BAP (0.5; 1.0; 1.5; 2.0; 2.5 mg/L) during 6-week culture callus period. Result showed that the morphology of callus grown during this study was compact in various colors appearance, such as light brown, brownish, and dark brown. The fastest mean of callus induction time was 0.5 mg/L 2,4-D and 1.5 mg/L BAP (10 days). The highest callus fresh weight was 1.5 mg/L 2,4-D and 2.0 mg/L BAP (0.350 g). The combination concentration of 1.5 mg/L 2,4-D and 1.5 mg/L BAP was the highest callus dry weight (0.078 g), this treatment was contained 11 different compounds, which were dominated by cyanoacetamide (25.08%) and diisooctyl-phthalate (21.81%). Myristicin and propanamide compounds were also identified in the methanol extract of P. sarmentosum callus. Methanolic extract of callus P. sarmentosum from the optimum treatment had the highest antioxidant activity (26.709 μL/mL) and antimicrobial activity against three test microbes.

Lifting velocity predicts the maximum number of repetitions to failure with comparable accuracy during the Smith machine and free-weight prone bench pull exercises

This study compared the accuracy of the fastest mean velocity from set (MVfastest) to predict the maximum number of repetitions to failure (RTF) between 2 variants of prone bench pull (PBP) exercise (Smith machine and free-weight) and 3 methods (generalized, individualized multiple-point, and individualized 2-point). Twenty-three resistance-trained males randomly performed 2 sessions during Smith machine PBP and 2 sessions during free-weight PBP in different weeks. The first weekly session determined the RTF-MVfastest relationships and subjects completed single sets of repetitions to failure against 60-70-80-90%1RM. The second weekly session explored the accuracy of RTFs prediction under fatigue conditions and subjects completed 2 sets of 65%1RM and 2 sets of 85%1RM with 2 min of rest. The MVfastest associated with RTFs from 1 to 15 were greater for Smith machine compared to free-weight PBP (F ≥ 42.9; P < 0.001) and for multiple-point compared to 2-point method (F ≥ 4.6; P ≤ 0.043). The errors when predicting RTFs did not differ between methods and PBP variants, whereas all RTF-MVfastest relationships overestimated the RTF under fatigue conditions. These results suggest that RTF–MVfastest relationships present similar accuracy during Smith machine and free-weight PBP exercises and it should be constructed under similar training conditions.

Katdetectr: an R/bioconductor package utilizing unsupervised changepoint analysis for robust kataegis detection.

Kataegis refers to the occurrence of regional genomic hypermutation in cancer and is a phenomenon that has been observed in a wide range of malignancies. A kataegis locus constitutes a genomic region with a high mutation rate (i.e., a higher frequency of closely interspersed somatic variants than the overall mutational background). It has been shown that kataegis is of biological significance and possibly clinically relevant. Therefore, an accurate and robust workflow for kataegis detection is paramount. Here we present Katdetectr, an open-source R/Bioconductor-based package for the robust yet flexible and fast detection of kataegis loci in genomic data. In addition, Katdetectr houses functionalities to characterize and visualize kataegis and provides results in a standardized format useful for subsequent analysis. In brief, Katdetectr imports industry-standard formats (MAF, VCF, and VRanges), determines the intermutation distance of the genomic variants, and performs unsupervised changepoint analysis utilizing the Pruned Exact Linear Time search algorithm followed by kataegis calling according to user-defined parameters.We used synthetic data and an a priori labeled pan-cancer dataset of whole-genome sequenced malignancies for the performance evaluation of Katdetectr and 5 publicly available kataegis detection packages. Our performance evaluation shows that Katdetectr is robust regarding tumor mutational burden and shows the fastest mean computation time. Additionally, Katdetectr reveals the highest accuracy (0.99, 0.99) and normalized Matthews correlation coefficient (0.98, 0.92) of all evaluated tools for both datasets. Katdetectr is a robust workflow for the detection, characterization, and visualization of kataegis and is available on Bioconductor: https://doi.org/doi:10.18129/B9.bioc.katdetectr.

English

Recent interest in the cultivation and use of butterfly pea (Clitoria ternatea L.) has increased demand for its commercial production. Successful germination of seed is a critical first step to its production; however, few studies have documented factors influential to germination success. To help support commercial production efforts, the influence of substrate temperature and seed scarification technique on germination parameters were evaluated. Two scarification (nicked and soaked) and three substrate temperature treatments (21, 24 and 27&deg;C) were imposed on C. ternatea seed. Following treatments, six germination parameters were recorded. Data showed seeds maintained at a substrate temperature of 21&deg;C reached maximal germination (54.8%) at the longest mean germination time (2.61 d) and slowest mean germination rate (0.39 day-1). Mechanical scarification by nicking the seed coat with a razor blade prior to soaking the seed for 24 h reached maximal germination (80.95%) at the lowest mean germination time (2.06 days) and fastest mean germination rate (0.51 day-1). Optimal germination was attained when seed was scarified and soaked and then germinated in rockwool substrate maintained at a temperature (To) of 21&deg;C. Results provide commercial growers with production technique information helpful to fast and efficient germination of C. ternatea seed. Key words: Germinability, medicinal, edible, rockwool.

UK exceptional case driving application outcomes in post-stroke homonymous hemianopia: results from a clinical study

Purpose We report results in relation to returning to driving in the UK under the exceptional cases rule for visual field loss. Methods The Hemianopia Adaptation Study is a prospective clinical study recruiting adult stroke survivors with new onset homonymous hemianopia. The mobility assessment course (MAC) was used to measure navigational scanning. Car drivers were offered a 1-year post-stroke assessment to consider referral for driving assessment. Results Of 144 participants, 51 were eligible for driving assessment, with 13 (25.4%) accepting appointment for UK Driving and Vehicle Licensing Agency (DVLA) referral. A statistically significant difference in gender and baseline Barthel (stroke severity) scores was found between those requesting referral and those declining (p = 0.046; p < 0.001). MAC outcomes were significantly different, with those referred having a lower percentage of target omissions (9.0%) and faster mean course completion time (46.0 s), than those not referred (28.3%/72.5 s) (p = 0.006/p < 0.001). Twelve of the 13 referred were offered a driving assessment by the DVLA. All 12 passed and returned to driving. Conclusions It is possible for individuals with post-stroke homonymous hemianopia to return to driving, where exceptional cases criteria are met. There is evidence to support use of the MAC as a clinical measurement of adaptation. IMPLICATIONS FOR REHABILITATION Individuals with post-stroke homonymous hemianopia should be fully informed regarding driving regulations that can differ between countries and sometimes different states within a country, as well as provided with the support and opportunity to consider a return to driving if appropriate. Professionals providing care within the stroke multi-disciplinary team should be aware that it is possible for patients with homonymous hemianopia to return to driving, when exceptional cases criteria are met. The mobility assessment course (MAC) should be considered as a clinical measurement of adaptation in homonymous hemianopia. A cut-off score of ≤25% omissions on MAC could be employed to determine those likely to adapt to hemianopia long-term and potentially return to driving.

Renoprotective Effect of Agalsidase Alfa: A Long-Term Follow-Up of Patients with Fabry Disease.

Fabry disease is a rare lysosomal storage disorder caused by mutations in the GLA gene, which, without treatment, can cause significant renal dysfunction. We evaluated the effects of enzyme replacement therapy with agalsidase alfa on renal decline in patients with Fabry disease using data from the Fabry Outcome Survey (FOS) registry. Male patients with Fabry disease aged >16 years at agalsidase alfa start were stratified by low (≤0.5 g/24 h) or high (>0.5 g/24 h) baseline proteinuria and by ‘classic’ or ‘non-classic’ phenotype. Overall, 193 male patients with low (n = 135) or high (n = 58) baseline proteinuria were evaluated. Compared with patients with low baseline proteinuria, those with high baseline proteinuria had a lower mean ± standard deviation baseline eGFR (89.1 ± 26.2 vs. 106.6 ± 21.8 mL/min/1.73 m2) and faster mean ± standard error eGFR decline (−3.62 ± 0.42 vs. −1.61 ± 0.28 mL/min/1.73 m2 per year; p < 0.0001). Patients with classic Fabry disease had similar rates of eGFR decline irrespective of baseline proteinuria; only one patient with non-classic Fabry disease had high baseline proteinuria, preventing meaningful comparisons between groups. In this analysis, baseline proteinuria significantly impacted the rate of eGFR decline in the overall population, suggesting that early treatment with good proteinuria control may be associated with renoprotective effects.

Lifting Velocity as a Predictor of the Maximum Number of Repetitions That Can Be Performed to Failure During the Prone Bench Pull Exercise.

To explore (1)the goodness of fit of generalized and individualized relationships between the maximum number of repetitions performed to failure (RTF) and the fastest mean velocity and peak velocity of the sets (RTF-velocity relationships), (2) the between-sessions reliability of mean velocity and peak velocity values associated with different RTFs, and (3) whether the errors in the prediction of the RTF under fatigued and nonfatigued conditions differ between generalized and individualized RTF-velocity relationships. Twenty-three sport-science students performed 4 testing sessions with the prone bench pull exercise in a Smith machine: a 1-repetition-maximum [1RM] session, 2 identical sessions consisting of singles sets of RTF against 4 randomized loads (60%-70%-80%-90%1RM), and 1 session consisting of 4 sets of RTF against the 75%1RM. Individualized RTF-velocity relationships presented a higher goodness of fit (r2 = .96-.97 vs .67-.70) and accuracy (absolute errors = 2.1-2.9 repetitions vs 2.8-4.3 repetitions) in the prediction of the RTF than generalized RTF-velocity relationships. The reliability of the velocity values associated with different RTFs was generally high (average within-subject coefficient of variation = 4.01% for mean velocity and 3.98% for peak velocity). The error in the prediction of the RTF increased by ~1 repetition under fatigue (ie,set 1 vs sets 2-4). Individualized RTF-velocity relationships can be used with acceptable precision and reliability to prescribe the loads associated with a given RTF during the match a specific XRM during the prone bench pull exercise, but a lower accuracy is expected in a fatigued state.

PO-678-08 NEURAL NETWORK MODEL FOR AUTOMATIC DISCRIMINATION OF ATRIAL FIBRILLATION EPISODES DETECTED BY AN INSERTABLE CARDIAC MONITOR

Insertable Cardiac Monitors (ICMs) are commonly used to detect atrial fibrillation (AF). The “key episodes” feature introduced in Abbott’s Jot Dx™ ICM reduces electrogram (EGM) review burden with no delay to diagnosis. AF episodes with the fastest mean rate, longest duration, and 2nd longest duration are selected as Key episodes. An artificial intelligence (AI)/machine learning (ML) episode discriminator may further reduce false positive AF episodes, thereby increasing the percentage of clinically actionable true AF episodes.

Alternative Input for Perfusion Management Devices: Voice Recognition for Data Input and the Effects on Charting and Perioperative Calculation Use.

Technology in healthcare has become increasingly prevalent and user friendly. In the last decade, advances in hands-free methods of data input have become more viable in a variety of medical professions. The aim of this study was to assess the advantages or disadvantages of hands-free charting through a voice-to-text app designed for perfusionists. Twelve clinical perfusion students using two different simulated bypass cases were recorded and assessed for the number of events noticed and charted, as well as the speed at which they accomplished these steps. Paper charts were compared with a custom app with voice-to-text charting capability. Data was analyzed using linear mixed models to detect differences in length of time until a chartable event was noticed, and how long after noticing an event it took to record the event. Timeliness of recording an event was made by assessing log-transformed time data. There was significantly more information recorded when charting on paper, while charting with voice-to-text resulted in significantly faster mean time from noticing an event to the recording of it. There was no significant difference between how many events were noticed and recorded. When using paper charting, a higher percentage of events that were missed were drug administration events, while voice charting had a higher percentage of missed events that were associated with cardioplegia delivery or bypass timing. With a decreased time interval between noticing an event and charting the event, speech-to-text for perfusion could be of benefit in situations where many events occur at once, such as emergency situations or highly active portions of bypass such as initiation and termination. While efforts were made to make the app as intuitive as possible, there is room for improvement.

In vitro flow rates through five different catheters intended for intravenous use in horses at two different heights

SummaryBackgroundFluid therapy is an important component of equine practice. The choice of intravenous catheter is likely to impact fluid flow rates, which is of relevance in clinical cases.Objectives(i) To assess fluid flow rates through five different equine catheters; (ii) to evaluate the impact of height on fluid flow rates and (iii) to compare agreement of flow rates achieved through identical catheters.Study designIn vitro experimental study.MethodsFlow rates were measured through five different equine catheters (2 × 14, 13, 12 and 10‐gauge) at 150 and 200 cm from ground level. Each catheter was attached to a standardised fluid administration system, time taken to reach 1000 g of fluids was measured. Three catheters were used to assess the agreement between identical catheters. Statistical analysis: (i) one‐way ANOVA assessed whether catheter type influenced flow rate and a post‐hoc Tukey's test compared mean flow rates with all other flow rates; (ii) two‐way ANOVA assessed whether height and catheter type influenced the flow rate. Finally, (iii) an intraclass correlation assessed how closely flow rates from identical catheters resembled each other.Results(i) The fastest mean flow rates were achieved through the 10‐gauge catheter at 150 (14.1 L/h) and 200 cm (17.8 L/h). (ii) Mean flow rates through all five catheters increased by a range of 25.4–28.6% at 200 vs. 150 cm. (iii) There was excellent agreement between mean fluid rates through identical catheters (intraclass correlation 0.994–0.998).Main limitationsFlow rates achievable in vivo are likely to be lower. We used water which may have a different viscosity compared with fluids used commonly in equine practice.ConclusionsFluid flow rates can be increased using wider bore catheters and increasing the height of the fluid bag. There is excellent agreement between fluid flow rates through identical catheters.

Factors affecting time from symptom onset to ovarian cancer diagnosis in the United States

<h3>Objectives:</h3> Little is known about what clinical or demographic factors affect time to diagnosis (TTD) of ovarian cancer. The objectives of our study were to examine the presenting symptoms and physician visit types leading to a diagnosis of ovarian cancer and identify any variables associated with an increased or decreased TTD. <h3>Methods:</h3> A population-based study of the Surveillance, Epidemiology, and End Results (SEER)-Medicare database was conducted on patients ≥66 years old from 1992-2015 with stage II-IV primary epithelial ovarian cancer. Diagnosis codes and claims data were extracted for analysis; symptoms specifically evaluated were abdominal pain, bloating, difficulty eating, and urinary urgency. TTD was defined from time of first coded symptom in a claim to ovarian cancer diagnosis. One-way ANOVA tests assessed significance of group measures on mean TTD and regression models evaluated number of physicians seen and TTD by covariates. <h3>Results:</h3> Of 18693 women identified for analysis, the mean overall TTD was 5.21 months. The mean TTD was significantly different based on first symptom type (p<.001), number of symptoms (p<.001), and first physician visit type (p<.001) occurring in a claim. Mean TTD by symptom type was 1.0 months with bloating, 2.7 months with abdominal pain, 2.8 months with difficulty eating, and 4.7 months with urinary urgency. Mean TTD increased with an increasing number of symptoms, from 4.6 months with 1 symptom to 5.4 months with 2 symptoms, 6.3 months with 3 symptoms, and 8.1 months with 4 symptoms. The fastest mean TTD by physician visit type was 4.2 months with gynecologic specialties, followed by 4.8 months with emergency medicine, 4.8 months with internal medicine, 6.3 months with gastroenterology, and 6.9 months with urology. In logistic regression models, the odds of seeing >4 physician types in the 30 days leading up to a diagnosis increased over time and was significantly higher in 2011-2015 compared to 1992-1999 (OR 1.17, p=.011). In linear regression models, faster TTD was associated with unmarried status (p<.001), mostly (p=.011) or all rural (p<.001) location, and BlackBlack race (p<.001); slower TTD was associated with older age (p<.001), higher comorbidity score (p<.001), non-Northeast region (p<.001), >4 physician visit types (p<.001), emergency presentation (p<.001), and diagnosis after 1992-1999 (p<.001). <h3>Conclusions:</h3> In our SEER-based database study, the mean time from symptom onset to diagnosis of ovarian cancer was 5.21 months and was influenced by presenting symptom, physician visit type, and clinical and demographic variables. Mean TTD and number of physician visit types have both increased over time, which may reflect broader changes in the United States medical system. Other significant associations warrant further exploration.

115 Age and Sex Differences in Behavioral Attention Across Baseline, Sleep Loss, and Recovery

Abstract Introduction There are established individual differences in performance resulting from sleep loss. However, differences in behavioral attention performance between demographic subgroups remain unclear, especially during recovery after sleep loss. Thus, we examined demographic subgroup performance differences during baseline, sleep loss (sleep restriction [SR] and total sleep deprivation [TSD]), and recovery (R). Methods Forty-one healthy adults participated in a 13-night experiment (2 baseline nights [10h-12h time-in-bed, TIB], 5 SR nights [4h TIB], 4 recovery nights [12h TIB], and 36h TSD). The 10-minute Psychomotor Vigilance Test (PVT), measuring behavioral attention, was administered every 2h during wakefulness. PVT lapses (reaction time [RT]&amp;gt;500ms) and 1/RT (response speed) were measured. PVT performance differences were investigated by sex (18 females) and by median split on age (range: 21-49y; median: 32y). Repeated measures ANOVAs on each study day examined PVT performance with demographic groups as the between-subject factor. Results SR1-2 and R1-2 showed significant between-subject effects by age: the older group had faster mean 1/RT than the younger group. SR2 showed a significant time*age group interaction: the older group had faster 1/RT from 0800h-1400h. B2, SR1, and R1 showed significant between-subject effects by sex: males had faster mean 1/RT than females. SR3 showed a significant time*sex interaction: males had faster 1/RT at 0800h and 1200h. PVT lapses (log transformed) analyses by age and by sex revealed significant between-subject effects at SR1 and R1. The direction of effects for lapses paralleled those for 1/RT: the younger group and females had more lapses than the older group and males, respectively. No other study days showed significant between-subjects or interaction effects. Conclusion For both age and sex, significant between-subject effects and/or interactions were revealed only in the beginning half of SR or recovery and not during TSD. These findings suggest that group differences exist when the effects of sleep loss are mild (i.e., SR1-3) or when the post-effects of sleep loss have diminished (i.e., R3-4); however, when the effects of sleep loss become more severe (i.e., SR4-5 or after a night of TSD), the well-established individual differences in response to sleep loss may overwhelm group differences. Support (if any) ONR Award No.N00014-11-1-0361;NIH UL1TR000003;NASA NNX14AN49G and 80NSSC20K0243;NIH R01DK117488