Half Day Research Articles

Time Course of Priming Effect of TF Inducers on Synergistic TF Expression and Intra-Cellular Gap Formation of Human Vascular Endothelial Cells via the Extrinsic Coagulation Cascade.

Chronic spontaneous urticaria (CSU) is characterized by daily recurring wheal and flare with itch for more than 6 weeks. The extrinsic coagulation system has been shown to be activated in correlation with CSU severity. We have reported that tissue factor (TF), a trigger of the extrinsic coagulation cascade, is synergistically expressed on vascular endothelial cells by simultaneous stimulation with TF inducers (TFI), followed by activation of the extrinsic coagulation cascade and hyper permeability in vitro. However, vascular endothelial cells are not likely to be simultaneously stimulated by multiple TFIs under physiological conditions. Therefore, in order to know whether sequential, rather than simultaneous, stimuli with interval may induce synergistic activation of TF, we investigated the time course of the priming effects of each TFI for synergistic TF expression in vascular endothelial cells (HUVECs). We stimulated HUVECs with a TFI (first stimulation) and then stimulated cells with another TFI at indicated time points (second stimulation) and detected TF expression and activity. The TF expression induced by simultaneous stimulation diminished in a few hours. However, both synergistic enhancement of TF expression and activation level of the coagulation cascade were detected even when the second stimulation was added 18 or 22 h after the first stimulation. Thus, the priming effect of TFI for synergistic TF expression may persist for a half day or longer.

PENGEMASAN PAKET WISATA KEBUGARAN DI DESA SAYAN, KECAMATAN UBUD, KABUPATEN GIANYAR

Wellness and village tourism are one of the travel trends that can be done during the pandemic. To increase interest in this tour, the activities are packaged in an attractive manner, in this study referring to the thematic packaging of fitness tour packages. This research was conducted to determine the potential of wellness tourism in Sayan Village, which was then packaged thematically to become a fitness tour package. The package of this tour package can then be used as a tourism product in Sayan Village. Data collection techniques used in this study, namely observation, in-depth interviews, and literature study. Then, the data analysis technique in this study used descriptive qualitative analysis. Based on data collection, the results obtained are that there are four dimensions of potential fitness tourism in Sayan Village, including the emotional dimension, spiritual dimension, mental dimension, and environmental dimension. The wellness potention is then packaged into thematic tour packages according to the dimensions of wellness. The package packages include the emotional dimension, Sayan Healing Culture Tour with a full day tour type; spiritual dimension, Sayan Authentic Spiritual Tour with half day tour activity type; mental dimension, Sayan Happy Tour with half day tour activities; and environmental dimensions, Sayan Eco Life Tour with half day tour activities.

Better safe than so ray: national survey of radiation protection amongst interventional radiology trainees in the United Kingdom.

To establish the provision and use of radiation personal protective equipment (PPE) and dosimetry amongst UK interventional radiology (IR) trainees and highlight areas of improvement in order to enhance the radiation safety. A survey questionnaire was designed by members of the British Society of Interventional Radiology (BSIR) trainee committee via survey monkey and distributed to UK IR trainees via the BSIR membership mailing list, local representatives and Twitter. The survey was open from 04/01/2021 to 20/02/2021. Only IR trainees in years ST4 and above were included. Of the 73 respondents, 62 qualified for analysis. Respondents (81% male) spent a median of 5.5 sessions (half day list) per week in the angiography suite and 58% (n=36) had difficulty finding appropriately sized lead aprons at least once a week. Overall 53% (n=33) had concerns about their radiation PPE. Furthermore 56% of trainees (n=35) experienced back pain among other symptoms attributed to wearing the lead aprons available to them. 77% (n=48) regularly wore lead glasses. For trainees requiring prescription glasses (n=22) overfit goggles were provided however 17 (77%) of these trainees felt the goggles compromised their ability to perform the procedure. Eye and finger dosimeters were used by 50% and 52% of respondents respectively. Compliance with body dosimetry was 99%. Provision of radiation PPE and dose monitoring for IR trainees is suboptimal, particularly access to adequate eye protection or suitably fitting leads. Based on the findings of this survey, recommendations have been made to promote the safety and radiation awareness of IR trainees. Radiation protection practices for IR trainees nationally are poor. Provision of suitable eye protection and well fitting lead body protection is low.

Bladder diary for illiterates: A novel method.

Bladder diary is an integral part of urologic evaluation of lower urinary tract symptoms. One of its limitations is the requirement of a literate patient or attendant to complete it. We propose a novel method for recording bladder diary in illiterate individuals, with the aid of easily available materials from hospital, without any expenditure from the patients. Forty-nine patients, who were required to fill the bladder diary as a part of their urological assessment, and were either illiterate or not literate enough to complete it themselves, were enrolled and admitted in the urology ward for 1 and a half days. Patients were provided with two 500 mL empty normal saline bottles for collection of each void, and a chart separately for day and night with diagrams of saline bottles to mark the corresponding level of urine. The amount of urine and frequency was also noted simultaneously by nursing staff each time for 24 h. The investigator interpreted the data marked on the charts by the patient and compared it with the data collected by the nursing officers. No statistically significant difference was found between the data collected by the nursing staff and patient data interpreted by the investigators, which included 24-h urine volume(p = 0.562), nocturnal output (p = 0.941), average voided volume (p = 0.709), maximum voided volume (p = 0.369), fluid intake (p = 0.401), frequency, nocturia and episodes of urgency and incontinence (p = 1). This method of recording bladder diary is a feasible, genuine, reliable and cost-free method which can be used in illiterates.

Developing multisectoral strategies to promote evidence-based practice in rehabilitation: findings from an end-of-grant knowledge translation symposium

Purpose Following a longitudinal study to understand how evidence-based practice evolves during the initial years of occupational therapy (OT) and physiotherapy (PT) practice, we held an end-of-grant symposium with representatives from education, practice, research, and policy. The objectives were to: (1) elicit feedback on the implications of the study results; and (2) co-develop a list of actionable recommendations for each sector. Methods Qualitative participatory approach. The symposium was held over two half days and consisted of a presentation of study findings, a discussion on the implications of the research for each sector and future recommendations. Discussions were audio recorded, transcribed verbatim and analyzed using qualitative thematic analysis. Results The themes related to implications of the longitudinal study included: (1) A need to rethink what evidence-based practice (EBP) really is; (2) How to practice EBP; and (3) The continuing challenge of measuring EBP. The co-development of actionable recommendations resulted in nine strategies. Conclusions This study highlighted how we may collectively promote EBP competencies in future OTs and PTs. We generated sector-specific avenues that may be pursued to promote EBP and argued for the importance of pooling efforts from the four sectors so that we may achieve the intended ethos of EBP. IMPLICATIONS FOR REHABILITATION There is a need to revisit the definition of evidence-based practice (EBP) and the traditional 3-circle model in rehabilitation to include a broader conceptualization of what constitutes evidence. We recommend using EBP measures as tools for self-reflection and professional development that can support practitioners to be reflective and accountable evidence-based practitioners. Optimal promotion of EBP competencies in occupational therapists and physiotherapists should rest upon collaborative efforts from the education, practice, research, and policy sectors.

Palliative care in a rural surgery residency program: an educational needs assessment.

There is a deficiency of palliative care education in surgical residency programs and a lack of research on palliative care education in rural surgery residency programs. Because rural palliative care presents unique challenges due to fewer specialists and resources, we investigated potential areas of improvement in palliative care education in a rural general surgery residency program. An anonymous survey was sent to all residents of a rural general surgery residency program. The survey assessed prior hospice/palliative care education in medical school, prior volunteering experience in palliative care, comfort with having "goals of care" discussions and delivering serious news, and perceived indications for palliative care consultation. A follow-up survey assessed attitudes and interest related to palliative care education integration in a rural surgical residency program. Of 17 residents, 14 (82.4%) responded to the initial survey. Four respondents (28.6%) had over a half day of palliative care education in medical school. Eight of fourteen respondents (57.1%) feel comfortable having "goals of care" discussions: 0/4 interns (0%) compared to 8/10 junior and senior residents (80%). Half of respondents feel comfortable delivering serious news: 1/4 interns (25%) compared to 6/10 junior and senior residents (60%). All respondents agreed that palliative care education is necessary. Four themes were identified in content analysis of perceived indications for palliative care consultation: future planning, deferring to the expert, patient/family education, and surgeon/trainee discomfort. The follow-up survey revealed perceived limitations in palliative care resources available in a rural surgery setting. These results highlight the need for formal palliative care education in a rural surgery residency program. Throughout training, residents appear to develop more comfort with "goals of care" discussions than delivering serious news. In response, we are instituting palliative care discussions during educational conference, including interactive simulations to improve communication skills, and a palliative care telemedicine elective.

Rebreather Forum Four consensus statements.

Closed circuit rebreathers have been widely adopted by technical divers as tools for reducing gas consumption and extending depth and duration capabilities. Rebreathers are technologically complex with many failure points, and their use appears associated with a higher accident rate than open circuit scuba. Rebreather Forum Four (RF4) was held in Malta in April 2023 attracting approximately 300 attendees and representatives of multiple manufacturers and training agencies. Over two and a half days a series of lectures was given by influential divers, engineers, researchers and educators on topics of contemporary relevance to rebreather diving safety. Each lecture was followed by a discussion session with audience participation. Potential consensus statements were drafted by the authors (SJM and NWP) during the course of the meeting. These were worded to be confluent with some important messages emerging from the presentations and subsequent discussions. The statements were presented one by one in a half-day plenary session of participants, and discussion was invited on each. After discussion and any necessary revision, the participants voted on whether to adopt the statement as a position of the forum. A clear majority was required for acceptance. Twenty-eight statements embracing thematic areas designated 'safety', 'research', 'operational issues', 'education and training', and 'engineering' were adopted. Those statements are presented along with contextualising narrative where necessary. The statements may help shape research and teaching initiatives, and research and development strategies over subsequent years.

The Sara quads.

In August 1950, Mrs Betty Sara, aged 29 years, was confined of quadruplets in the town of Bellingen, New South Wales, which is 500 km north of Sydney. All four babies were delivered vaginally, after a confinement lasting over two and a half days.

Medicine as a career choice: a comprehensive study on factors influencing Sudanese students to opt in/out medical career

BackgroundThe medical profession is one of the most highly respected and desired professions among students worldwide, most likely because it provides opportunities for both a financially and socially rewarding career. However, while it has been quite established that factors such as self-interest, family pressure, friend pressure, and socioeconomic status do influence the choice of medicine among students worldwide, the exact reasons for an individual to join a medical school may actually vary worldwide. The aim of this study was to comprehensively explore factors influencing medical students to opt in/out medical careers in Sudan.MethodsAn institutional based descriptive cross-sectional study was conducted at University of Khartoum in the year 2022 with a random sample of 330 students that was obtained from the medical students at the The University of Khartoum, Faculty of Medicine using stratified random sampling.ResultsSelf-interest was the most common factor influencing opting in (choosing) medical profession (70.6%) (n = 233), followed by getting a very high score in high-school that qualifies into the faculty (55.5%) (n = 183). Regarding the factors affecting medical students’ choices, parental pressure was the main factor (37.0%) (n = 122), followed by other relatives’ pressure (12.4%) (n = 41), and 4.2% (n = 14) chose Peer pressure. 59.7% (n = 197) of the participants stated that they were not affected by any of these factors. Most of the participants felt that the general perception of the medical profession by society is that it is prestigious and has good career opportunities, only 5.8% (n = 19) believed that it is “Not appreciated at all” by the society. A statistically significant association was found between the type of admission & parent pressure (p value 0.01). out of 330 participants, (56.1%) (n = 185) have opted out i.e. lost their interest or regretted their choice of medical career. Academic difficulties was the most common factor causing students to opt-out of the medical career (37%) (n = 122) followed by Multiple suspensions of education (35.2%) (n = 116), Current political & security conflicts in Sudan (29.7%) (n = 98), Poor quality of education (24.8%). The proportion of students having regrets for the medical profession was significantly higher among females. Over one third of the participants reported having depressive symptoms more than half days of the week. No statically significant correlation was established between the academic level and having these depressive symptoms and no statistically significant correlation was established between the decision to opt-out and the academic level (class) of the individuals (P = 0.105).ConclusionsOver half of Sudanese medical students at the University of Khartoum have already lost their interest or regretted their choice of medical career choice. Whether these future doctor chose to drop out or continue their path in the medical career suggests that they are more prone to serious hardships in their future careers. A careful comprehensive approach should further explore and try to offer solutions for problems like “Academic difficulties”, “multiple suspension of education”, and “poor quality of education” for they were the most common factors that caused medical students to opt out of the medical career.

Creating a research culture within one EP service: Practitioner reflections on using developmental work research

Aim(s)The aim of this paper is to provide a reflective account of using Cultural Historical Activity Theory (CHAT) and Developmental Work Research (DWR) when exploring the research culture of one EP service in Scotland.Melhod/RalionalePrevious research completed within the Educational Psychology Service (EPS) recommended to explore in more detail how Educational Psychologist’s (EPs) were engaging with research. Thus, three DWR workshops based on the principles of CHAT and the cycle of expansive learning (Engeström, 2015) acted as in intervention to achieve this. Each of these workshops lasted a half day and created a discourse around the role of research in our service delivery.FindingsKey insights from using DWR as a means of furthering organisational change are presented. These include the unique benefits that CHAT and DWR bring to complex systems as opposed to other approaches and how collective learning during the workshops led to a concrete outcome for the EPS. I will argue for the benefits of using DWR to reconceptualise persistent tensions within the profession whilst reflecting on the difficulties of applying these methodologies to practice.LimitationsColleagues provided positive feedback from the process but there were little in-built methods of evaluation during the workshops. Furthermore, this was my first attempt at utilising DWR to elicit change and so the main stages of DWR were not fully explored.ConclusionDWR offers a framework to reconceptualise persistent tensions within organisations. Its collaborative approach, grounded in psychology, allows for co-production of goals and for articulation of the EP role with regards to research.

Establishment of a Fellowship in Street Medicine.

The American Medical Association recognizes street homelessness as a significant barrier to the provision of high-quality care.1 Traditional medical training provides inadequate preparation for physicians to manage persons experiencing unsheltered homelessness (PEUH). Street medicine is the direct provision of health care and social support to PEUH,2 who experience high barriers to needed care and tend to use acute hospital-based care at high rates.3We established a street medicine fellowship to enable physicians to acquire the requisite clinical and organizational skills to become leaders in improving outcomes in this vulnerable population.The UPMC Mercy Street Medicine Fellowship is the first of its kind. This one-year, one fellow per year program was initiated in 2019 by UPMC Mercy, Pennsylvania. The fellowship accepts applications from physicians who have completed a residency in internal medicine, family medicine, emergency medicine, or psychiatry, and who seek to develop expertise in caring for PEUH while also participating in multidisciplinary care to enable them to serve as future leaders in this field. At the end of the fellowship training a survey is sent to learners.Fellows are instructed in comprehensive management of PEUH. The program uses the “go-to people” approach to health care as promoted by the Street Medicine Institute. Fellows are challenged to set aside the mindset of the “office approach,” which often does not embrace unique social determinants of health, and round 3 to 4 times per week on the streets, on the riverbanks, and in homeless encampments, including general rounds, targeted case management rounds, and specialty rounds (eg, psychiatric, harm reduction, intimate partner violence, etc). They participate in additional outpatient clinics, 3 half days per week, which have been established for PEUH and for those who have transitioned from street homelessness into housing. Fellows maintain this continuity group of patients throughout the fellowship year. Home visits are also conducted for newly placed patients.Fellows apply the concept of “community united” so that changes initiated in one community are spread to others. They utilize multidisciplinary mentors and engage in productive communication with experts in street medicine. They conduct a formal comparative analysis of 2 communities in which street medicine is practiced to further develop insight into improvement opportunities as well as attend the annual International Street Medicine Symposium as a learning activity and for academic presentation as applicable.Fellows are assessed monthly according to the Accreditation Council for Graduate Medical Education's Core Competencies. Fellows also complete a monthly evaluation of their assigned experience. Lastly, fellows are surveyed at the completion of the year (Figure).Our first fellow now carries a university faculty position in another city. She teaches in the outpatient setting and has integrated clinical street work with community initiatives, a street medicine interest group, and a peer outreach group. Our second fellow is practicing emergency medicine in another city and incorporating her skills to improve care in that setting for PEUH.Although our program is young, our graduates have affirmed that formal fellowship training in street medicine is a viable yet heretofore unexplored avenue toward more effectively addressing society's responsibility toward PEUH.

Demographic factors associated with time to treatment initiation in hepatocellular carcinoma.

e18546 Background: Hepatocellular carcinoma (HCC) accounts for 75% of all liver cancer diagnosis in the United States, with incidence rising in recent years. One aspect of treatment is time to treatment initiation (TTI). TTI is associated with better outcomes and lower patient anxiety. We hypothesize that demographic factors play a role in how fast a patient with HCC receives treatment. Methods: This study looked at 112,615 patients diagnosed with HCC from 2004-2019 in the National Cancer Database (NCDB). Demographic factors analyzed were biological sex, race, age, cancer stage, year of diagnosis, insurance status, household income, Charleson-Deyo score, and type of facility for treatment. Histology was determined using ICD-O-3 coding. Cross tabulation analysis was performed using ANOVA. Results: Patients with delayed TTI were more often male, black, stage III, 61-70 years old, on government insurance, diagnosed between 2016-2019, made less than $40,227, and treated at integrated cancer network programs. Patients with no insurance received a TTI 4 days faster than government insurance (p < .001). Patients with lower incomes also experienced greater than 2-day delays in TTI (p < .001) compared to higher incomes. Treatment at an integrated cancer network was associated with a 3-day delay compared to treatment at a community cancer center (p < .001). Males began treatment a half day after female patients (p < .017). Conclusions: Discrepancies exist in TTI for HCC patients, most notably for insurance status, race, year of diagnosis, income, and facility type. This data can be used when determining which patients may experience delays in TTI due to demographic factors.

0852 Insomnia with Objective, but not Subjective, Short Sleep Duration is Associated with Increased Risk of Incident Hypertension

Abstract Introduction Insomnia with objective short sleep duration (ISSD) has been associated with higher risk of cardiometabolic morbidity. In this study, we examined the association between ISSD, also based on subjective sleep duration, with incident hypertension in the Sleep Heart Health Study (SHHS). Methods We analyzed data from 1413 participants free of hypertension or sleep apnea at baseline from the SHHS with a median follow-up duration of 5.1 years. Insomnia symptoms were defined based on difficulty falling asleep, difficulty returning to sleep, early morning awakening, or sleeping pill use more than half days in a month. Objective short sleep duration was defined as polysomnography-measured total sleep time < 6 hours. Incident hypertension was defined based on blood pressure measures and/or use of antihypertensive medications at follow-up. Results Insomnia subjects who slept objectively < 6 hours had significantly higher odds of incident hypertension compared to normal sleeping subjects who slept ≥6 hours (OR=2.00, 95% CI=1.09-3.65) or < 6 hours (OR=2.00, 95%CI=1.06-3.79) or insomnia subjects who slept ≥6 hours (OR=2.79, 95%CI= 1.24-6.30). Insomnia subjects who slept ≥6 hours or normal sleepers who slept < 6 hours were not associated with increased risk of incident hypertension compared to normal sleepers who slept ≥6 hours. Finally, insomnia subjects who self-reported sleeping < 6 hours were not associated with significantly increased odds of incident hypertension. Conclusion These data further support that the ISSD phenotype based on objective, but not subjective measures is, similar to sleep apnea. Support (if any) The Sleep Heart Health Study (SHHS) was supported by National Heart, Lung, and Blood Institute cooperative agreements U01HL53916 (University of California, Davis), U01HL53931 (New York University), U01HL53934 (University of Minnesota), U01HL53937 and U01HL64360 (Johns Hopkins University), U01HL53938 (University of Arizona), U01HL53940 (University of Washington), U01HL53941 (Boston University), and U01HL63463 (Case Western Reserve University). The National Sleep Research Resource was supported by the National Heart, Lung, and Blood Institute (R24 HL114473, 75N92019R002).

Review of “Conflicted Care: Doctors Navigating Patient Welfare, Finances, and Legal Risk”

There is a quote in Hyeyoung Oh Nelson’s Conflicted Care: Doctors Navigating Patient Welfare, Finances, and Legal Risk, which captures the book’s substance beautifully. In an interview excerpt with the director of residency training at the hospital Nelson studied, the doctor explains the “single biggest dilemma” physicians face in an academic medical institution. He addresses an imaginary trainee to illustrate the problem: “Look, this is the time when you are learning to be a doctor: we want you to be cost-effective but we also want you to be thorough and humanistic and use physical diagnostic skills that you have learned appropriately, and not overorder tests. And you have to do all that within two and a half days…” (p. 37). Abundant research by medical and organizational sociologists has underscored the inescapable tension of the healthcare system in the United States: caught between the “do no harm” oath, which directs physicians to put patients’ wellbeing above everything else, and the financial and bureaucratic structuring of healthcare provision, which has introduced the principle of efficiency in every healthcare institution. In an ideal world, these mandates would align: providing the best care would also be cost-efficient (and such is the promise of managed care policies). In the real world, unsurprisingly, health logics and financial logics tend to clash.

Free Neurology Community Health Clinic: Insights on Patient Population and Resident Experience (S29.005)

<h3>Objective:</h3> To describe the patient population at FNCHC and its impact on neurology resident education and training. <h3>Background:</h3> Uninsured patients with neurologic diseases suffer worse healthcare outcomes than insured patients. Limited access to care is exacerbated by lack of subspeciality neurology care in free community health clinics. Our neurology residency partnered with the local free clinic, establishing Free Neurology Community Health Clinic (FNCHC) to provide neurology evaluations for uninsured patients. <h3>Design/Methods:</h3> FCHC operates one half day per month with 4–6 patient slots, staffed by 1–2 neurology residents and one attending. Diagnostics and medications prescribed are free for patients. Patient variables are collected from clinic EHR. Six neurology residents who volunteered 2+ clinics were given feedback surveys pertaining to educational value, clinical decision making, personal fulfillment, and career practice graded on a 5-point Likert Scale from “strongly disagree” to “strongly agree”. <h3>Results:</h3> Over the fifteen months since inception, 73 new or return clinic appointments were scheduled, 66 were seen (91.6% show rate). Most common spoken language was Spanish (66.7%), then Polish (18%). The most frequent chief complaint was headache (50%), then parasthesias (9.1%), double vision (6.1%) and stroke (4.5%). Subspecialities fields represented included vascular, headache, neuromuscular, epilepsy, movement disorders, sleep, and cognitive neurology. Most therapeutics initiated were targeted at headache management, followed by antiseizure medications, and myasthenic medications. 6/6 residents completed feedback surveys. All residents strongly agreed that their FNCHC experiences was fulfilling and educational for CDM in low resource settings. Furthermore, all residents agreed their experiences encouraged continued commitment to underprivileged populations during residency and future careers. <h3>Conclusions:</h3> Diversity of patient population and neurologic disorders are well represented in FNCHC. Resident feedback demonstrated overwhelmingly positive impact on fulfillment and clinical education, as well as future career involvement in underserved populations. Future directions for FNCHC include expanding diagnostics, therapeutics, and formal integration into residency education. <b>Disclosure:</b> Dr. Jia has nothing to disclose. Dr. Deliz Gonzalez has nothing to disclose. Dr. Attarian has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Clearview. Dr. Attarian has received publishing royalties from a publication relating to health care. Dr. Curran has nothing to disclose. Dr. Cherayil has nothing to disclose. Dr. Carroll has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly &amp; Company. Dr. Carroll has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eli Lilly &amp; Company. Dr. Carroll has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AbbVie.

A Survey of EMG Productivity Benchmarks (P4-7.002)

<h3>Objective:</h3> This study presents results from a survey of physicians who perform electromyography studies to assess average volume and factors impacting volume of studies. <h3>Background:</h3> Productivity is an important factor for physicians in many types of practice. However, unlike evaluation and management services for neurologists, there are no published data regarding benchmarks of average quantity of electrodiagnostic studies performed. <h3>Design/Methods:</h3> This survey was considered IRB exempt by UT Houston medical school. This anonymous survey was sent out via QR code or hyperlink to multiple online neurology, electromyography and neuromuscular forums. <h3>Results:</h3> During interim analysis, 118 respondents had initiated the survey. Only respondents who completed the survey and performed EMGs were analyzed. 80% were board certified through adult neurology, 11.7% though physical medicine and rehabilitation and 1.8% through pediatric neurology. 48% practiced in academic medicine and the remaining 52% were private practice, group, solo, hospital employed or other. 83% of respondents allotted a dedicated half-day to performing EMGs. The median number of EMGs scheduled during a half-day was 3–4 (44%). 33% and 6.7% scheduled 5–6 or more than 7 patients per half day respectively. The median number of EMGs performed per year were 251–500 (37%). 43% of respondents worked with trainees. Of those respondents, 96% work with residents 57% work with fellows. In regards to how trainees impact productivity, half of respondents felt there was no change. When working with trainees, 40% (residents) and 14% (fellows) felt they needed to see fewer patients and 0% (residents) and 22% (fellows) felt they could see more patients. <h3>Conclusions:</h3> To our knowledge, this is the first study to evaluate average metrics of EMG productivity and complex factors that impact volume. Current productivity measures are limited to evaluation and management services. Additionally, these measures do not consider complex factors that may impact individual physician productivity. <b>Disclosure:</b> Dr. Nguyen has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Nguyen has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for ArgenX. Dr. Nguyen has received publishing royalties from a publication relating to health care. Dr. Brown has nothing to disclose. Dr. Biliciler has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Efficient CME.

Ocean cross-validated observations from R/Vs L'Atalante, Maria S. Merian, and Meteor and related platforms as part of the EUREC4A-OA/ATOMIC campaign

Abstract. The northwestern Tropical Atlantic Ocean is a turbulent region, filled with mesoscale eddies and regional currents. In this intense dynamical context, several water masses with thermohaline characteristics of different origins are advected, mixed, and stirred at the surface and at depth. The EUREC4A-OA/ATOMIC experiment that took place in January and February 2020 was dedicated to assessing the processes at play in this region, especially the interaction between the ocean and the atmosphere. For that reason, four oceanographic vessels and different autonomous platforms measured properties near the air–sea interface and acquired thousands of upper-ocean (up to 400–2000 m depth) profiles. However, each device had its own observing capability, varying from deep measurements acquired during vessel stations to shipboard underway near-surface observations and measurements from autonomous and uncrewed systems (such as Saildrones). These observations were undertaken with a specific sampling strategy guided by near-real-time satellite maps and adapted every half day, based on the process that was investigated. These processes were characterized by different spatiotemporal scales, from mesoscale eddies, with diameters exceeding 100 km, to submesoscale filaments of 1 km width. This article describes the datasets gathered from the different devices and how the data were calibrated and validated. In order to ensure an overall consistency, the platforms' datasets are cross-validated using a hierarchy of instruments defined by their own specificity and calibration procedures. This has enabled the quantification of the uncertainty in the measured parameters when different datasets are used together, e.g., https://doi.org/10.17882/92071 (L'Hégaret et al., 2020a).

Impact of embedding a pharmacist in a dermatology clinic on outcomes in a specialty pharmacy.

Specialty pharmacists in a health system can help streamline medication access for patients and provide clinical support to providers. The University of Louisville (UofL) Health - UofL Hospital postgraduate year 2 (PGY-2) ambulatory care pharmacy resident implemented a new service in the UofL Health dermatology clinic in October 2020, with the goal of providing multidisciplinary care and ultimately improving patient access to specialty dermatology medications. To describe the financial impact (dermatology prescription volume and return on investment for the UofL Hospital Specialty Pharmacy) and clinical impact (time to medication initiation, adherence, adverse events, quality of life, pharmacist interventions, and patient satisfaction) after the addition of a pharmacist to the UofL Health dermatology clinic. Before this new service, the dermatology clinic team lacked a pharmacist. A PGY-2 ambulatory care pharmacy resident spent 1 half day per week (4 hours) in the dermatology clinic from October 2020 to April 2021 and established a workflow assisting with medication selection, initiation, access, education, and monitoring. Data were collected by retrospective chart review for patients who were seen in the UofL Health dermatology clinic and filled a specialty dermatology medication with the UofL Hospital Specialty Pharmacy from October 15, 2019, to October 14,2021. There was a 28.87% increase in prescription volume of dermatology specialty medications sent to the UofL Hospital Specialty Pharmacy during the time period after the addition of the pharmacist (P= 0.023). The average time to initiation of medications was 13.6 days for the postintervention group and 21.3 days for the preintervention group. The addition of a pharmacist to the dermatology clinic enhanced the relationship between the providers and specialty pharmacy, leading to a positive impact on clinical and financial outcomes. Health-system specialty pharmacies can mimic this model to expand pharmacy services within dermatology.

NEW ZEALAND PROVINCIAL ORTHOPAEDIC TRAUMA STUDY (NZPOTS): THE EFFECTS OF INCREASING TRAUMA ON ELECTIVE ORTHOPAEDIC SURGERY IN PROVINCIAL NEW ZEALAND

Trauma and elective orthopaedic demands in New Zealand are increasing. In this study, prospective and retrospective data has been collected at Nelson Hospital and across New Zealand to identify the percentage of elective theatre time lost due to cancellation for acute patient care. Data has been collected from theatre management systems, hospital data systems and logged against secretarial case bookings, to calculate a percentage of elective theatre time lost to acute operating or insufficient bed capacity.Data was collected over a five-month period at Nelson Hospital, with a total of 215 elective and 226 acute orthopaedic procedures completed. A total of 95 primary hip or knee arthroplasties were completed during this trial while 53 were cancelled. The total number of elective operative sessions (one session is the equivalent of a half day operating theatre time) lost to acute workload was 47.9. Thirty-three percent of allocated elective theatre time was cancelled - an equivalent of approximately one-full day elective operating per week.Over a five-week period data was collected across all provincial hospitals in New Zealand, with an average of 18% of elective operating time per week lost due to acute workload. Elective cancellations were due to acute operating 40% of the time and bed shortages 60% of the time. The worst effected centre was Palmerston North which had an average of 33% of elective operating cancelled per week to accommodate acute surgery or due to bed shortages.New Zealand's provincial orthopaedic surgeons are under immense pressure from acute operating that impedes provision of elective surgery. The New Zealand government definition of an ‘acute case’ does not reflect the nature of today's orthopaedic burden. Increasing and aging populations along with staff and infrastructure shortages have financial and societal impacts beyond medicine and require better definitions, further research, and funding from governance.

Assessment of the Role of Artificial Intelligence in the Association Between Time of Day and Colonoscopy Quality

Time of day was associated with a decline in adenoma detection during colonoscopy. Artificial intelligence (AI) systems are effective in improving the adenoma detection rate (ADR), but the performance of AI during different times of the day remains unknown. To validate whether the assistance of an AI system could overcome the time-related decline in ADR during colonoscopy. This cohort study is a secondary analysis of 2 prospective randomized controlled trials (RCT) from Renmin Hospital of Wuhan University. Consecutive patients undergoing colonoscopy were randomly assigned to either the AI-assisted group or unassisted group from June 18, 2019, to September 6, 2019, and July 1, 2020, to October 15, 2020. The ADR of early and late colonoscopy sessions per half day were compared before and after the intervention of the AI system. Data were analyzed from March to June 2022. Conventional colonoscopy or AI-assisted colonoscopy. Adenoma detection rate. A total of 1780 patients (mean [SD] age, 48.61 [13.35] years, 837 [47.02%] women) were enrolled. A total of 1041 procedures (58.48%) were performed in early sessions, with 357 randomized into the unassisted group (34.29%) and 684 into the AI group (65.71%). A total of 739 procedures (41.52%) were performed in late sessions, with 263 randomized into the unassisted group (35.59%) and 476 into the AI group (64.41%). In the unassisted group, the ADR in early sessions was significantly higher compared with that of late sessions (13.73% vs 5.70%; P = .005; OR, 2.42; 95% CI, 1.31-4.47). After the intervention of the AI system, as expected, no statistically significant difference was found (22.95% vs 22.06%, P = .78; OR, 0.96; 95% CI; 0.71-1.29). Furthermore, the AI systems showed better assistance ability on ADR in late sessions compared with early sessions (odds ratio, 3.81; 95% CI, 2.10-6.91 vs 1.60; 95% CI, 1.10-2.34). In this cohort study, AI systems showed higher assistance ability in late sessions per half day, which suggests the potential to maintain high quality and homogeneity of colonoscopies and further improve endoscopist performance in large screening programs and centers with high workloads.