Large Proportion Of Time Research Articles

Opening the black box of team-based learning (TBL): A study of verbal interactions in online application sessions

Context In team-based learning (TBL), an instructional strategy that encourages in-depth team discussion and deep learning, interactions in terms of sharing, co-construction, constructive conflict and procedural interactions are important. Since TBL has also been applied online in recent years, the question is whether these interactions are sufficiently present in an online setting. Aim Gain insight into the nature and extent of these types of interactions in online TBL application sessions and to what extent these vary between teams and sessions. Methods We made audiovisual recordings of 12 TBL teams in two online application sessions during assignments. Transcripts were coded and analyzed using a framework derived. Results Teams spent more than 85% of their time on all four types of interactions in both sessions. The largest proportion of time was spent on sharing and co-construction. Constructive conflict occurred to a limited extent. We observed variation in proportion of time spent on and the distribution of the four types of interactions between teams and sessions. Discussion All interactions important for achieving deep learning occurred in online TBL application sessions. However, the effective use of these types of interaction should not be left to chance.

Characterizing psychosocial services in a pediatric urology practice

Psychosocial needs, which encompass behavioral health and social determinants of health (SDOH), are important mediators of the patient experience and health outcomes. However, many practices have limited experience with systematically assessing the non-billable psychosocial services provided to patients and families. To characterize the non-billable activities of three psychosocial providers in a pediatric urology practice at a freestanding children's hospital. Following Institutional Review Board approval, an adapted version of the Care Coordination Measurement Tool (CCMT) was used to collect data prospectively on non-billable activities performed by a psychologist, social worker (SW), and certified child life specialist (CCLS) in a pediatric urology department. Variables included activity type, time spent per activity, and outcomes affected. Demographic data included age, sex, race, state, zip code, insurance type, and language. From April to October 2022, 3096 activities were performed in support of psychosocial needs over 947 encounters for 527 patients. The median patient age was 9.2 years (IQR 4.8-12.4); 48.4% were male. The psychosocial providers most commonly identified care coordination needs related to delivery of urologic care (73.4%), mental/behavioral/developmental health (29.1%), and referral and appointment management (19.9%). The largest proportion of time was spent on providing direct psychosocial support (45.9%), consisting of psychosocial assessments, education, and other behavioral health interventions. A large proportion of time was also spent on care coordination activities, namely logistics and navigation support (35.9%). Relative time allocation across activities varied by provider type (p<0.001); care coordination constituted 64.2% of non-billable activities for the psychologist, 57.8% for the SW, and 12.3% for the CCLS. Activities were associated with treatment plan modification in 37.7% (n=357), outpatient coordination in 22.5% (n=213), and treatment plan adherence in 19.0% (n=180) of encounters. This study enhances our understanding of psychosocial needs of patients in a pediatric urology practice by assessing non-billable psychosocial services not otherwise captured in the clinical workflow. In addition to direct psychosocial support, care coordination activities constitute a large proportion of such services. These data provide valuable insight into the range of activities necessary for the provision of specialty pediatric medical care. Psychosocial providers in a pediatric urology practice perform many non-billable care coordination and psychosocial support activities. Characterizing these activities is important for beginning to understand patients' psychosocial needs and informing resource deployment.

Psychosocial Effects of Physical Activity Interventions for Preschoolers, Children, and Adolescents: Role of Intervention Settings.

Physical activity interventions are potential strategies to enhance psychosocial health of children and adolescents. Interventions are performed at diverse settings (e.g., school, home, community), but little research has addressed whether and how the effectiveness of these programs vary by setting type. The aim of this review is to summarize the psychosocial effects of physical activity programs for preschoolers, children, and adolescents at various intervention settings. A systematic search of five electronic databases, MEDLINE-PubMed, CINAHL, PsycINFO, CENTRAL, and Scopus was performed. Included studies had participants between 3-18 years, physical activity intervention duration of at least four weeks, experimental design, and at least one psychosocial health outcome. Data on participants, intervention, comparison, outcomes, and findings were extracted. Data were synthesized by the intervention setting; school, home, and community. Of the thirty-five included studies, 74% were performed at schools. Although fewer studies used community (17%)- and home-based (9%) interventions, these were similarly effective in improving psychosocial health as school-based interventions. Community- and home-based intervention settings may be underutilized despite being similarly effective as school-based settings. A large proportion of time is spent out of school during weekends and summer-break. Community- and home-based physical activity programs may be pragmatic strategies to deliver improvements in psychosocial health of preschoolers, children, and adolescents.

How do pediatric urology fellows learn outside of direct patient care? A qualitative study

A large proportion of time during pediatric urology fellowship training is focused on surgical skill development. While fellows begin their fellowship training with some knowledge of pediatric urology from residency, they rely on self-directed learning to expand their knowledge base. To assess how pediatric urology fellows learn about their field outside of direct patient care experiences. Additionally, we were interested in how the pandemic affected fellows self-directed learning. First and second year pediatric urology fellows at Accreditation Council of Graduate Medical Education (ACGME)-accredited programs were asked to participate in the study. Individual virtual interviews were conducted and transcribed. Each transcript was coded shortly after transcription. Constructivist grounded theory was used in the data collection and analysis. As interviews progressed, a constant comparative analysis was used iteratively to generate themes. A convenience sample of thirteen fellows from programs across the U.S. agreed to participate; eight were male and five were female. The following four themes emerged from the interviews: most learning in fellowship is self-directed, fellows are not the target audience for didactics, fellows have little independent study time, and there is a lack of organization and guidance for formal didactics (Summary Table). Additionally, we found that teleconferences were used for the majority of teaching after the start of the coronavirus pandemic. Fellows in pediatric urology programs are independent learners who understand the need for self-directed learning outside of the setting of formal didactics in fellowship. However, many lack appropriate time, guidance and/or mentorship to facilitate self-directed learning. We identified a need for more structure in pediatric urology fellowship clinical didactics. Videoconferencing software may enable the creation of a national pediatric urology fellowship curriculum.

Locomotor and technical characteristics of female soccer players training: exploration of differences between competition standards

ABSTRACT Objectives To (i) quantify the differences in locomotor and technical characteristics between different drill categories in female soccer and (ii) explore the training drill distributions between different standards of competition. Methods Technical (ball touches, ball releases, high-speed ball releases) and locomotor data (total distance, high-speed running distance [>5.29 m∙s−1]) were collected using foot-mounted inertial measurement units from 458 female soccer players from three Women’s Super League (WSL; n = 76 players), eight Women’s Championship (WC; n = 217) and eight WSL Academy (WSLA; n = 165) teams over a 28-week period. Data were analysed using general linear mixed effects. Results Across all standards, the largest proportion of time was spent in technical (TEC) (WSL = 38%, WC = 28%, WSLA = 29%) and small-sided extensive games (SSGe) (WSL = 20%, WC = 31%, WSLA = 30%) drills. WSL completed more TEC and tactical (TAC) training whilst WC and WSLA players completed more SSGe and possession (POS) drills. Technical drills elicited the highest number of touches, releases and the highest total distance and high-speed activity. Position-specific drills elicited the lowest number of touches and releases and the lowest total distance. When the technical and locomotor demand of each drill were made relative to time, there were limited differences between drills, suggesting drill duration was the main moderating factor. Conclusion Findings provide novel understanding of the technical and locomotor demands of different drill categories in female soccer. These results can be used by coaches and practitioners to inform training session design.

The Relationship Between Social Media Use and Well-Being: The Mediating Role of Social Support

Frequent social media usage can have negative effects on well-being, but the mechanisms involved are unclear. This study explored the mediating role of giving and receiving support. Using the Midlife in the United States Refresher eight-day daily diary study (N=782, age 25-75), multilevel structural equation modeling examined the hypothesized relationships at both the within- (intraindividual) and between-person (interindividual) levels. Results showed that at the within-person level, days with more social media use were associated with a larger proportion of time giving support and worse well-being (less positive affect and more stress, negative affect, and loneliness). At the between-person level, more social media use was associated with worse well-being. Giving support, but not receiving support, mediated the relationship between social media use and well-being at the within, but not the between-person level. Discussion focuses on ways to address the negative consequences of social media use related to social connections and well-being.

Initial analysis of the dosimetric benefit and clinical resource cost of CBCT‐based online adaptive radiotherapy for patients with cancers of the cervix or rectum

PurposeThis provides a benchmark of dosimetric benefit and clinical cost of cone‐beam CT‐based online adaptive radiotherapy (ART) technology for cervical and rectal cancer patients.MethodsAn emulator of a CBCT‐based online ART system was used to simulate more than 300 treatments for 13 cervical and 15 rectal cancer patients. CBCT images were used to generate adaptive replans. To measure clinical resource cost, the six phases of the workflow were timed. To evaluate the dosimetric benefit, changes in dosimetric values were assessed. These included minimum dose (Dmin) and volume receiving 95% of prescription (V95%) for the planning target volume (PTV) and the clinical target volume (CTV), and maximum 2 cc's (D2cc) of the bladder, bowel, rectum, and sigmoid colon.ResultsThe average duration of the workflow was 24.4 and 9.2 min for cervical and rectal cancer patients, respectively. A large proportion of time was dedicated to editing target contours (13.1 and 2.7 min, respectively). For cervical cancer patients, the replan changed the Dmin to the PTVs and CTVs for each fraction 0.25 and 0.25 Gy, respectively. The replan changed the V95% by 9.2 and 7.9%. The D2cc to the bladder, bowel, rectum, and sigmoid colon for each fraction changed −0.02, −0.08, −0.07, and −0.04 Gy, respectively. For rectal cancer patients, the replan changed the Dmin to the PTVs and CTVs for each fraction of 0.20 and 0.24 Gy, respectively. The replan changed the V95% by 4.1 and 1.5%. The D2cc to the bladder and bowel for each fraction changed 0.02 and −0.02 Gy, respectively.ConclusionsDosimetric benefits can be achieved with CBCT‐based online ART that is amenable to conventional appointment slots. The clinical significance of these benefits remains to be determined. Managing contours was the primary factor affecting the total duration and is imperative for safe and effective adaptive radiotherapy.

Different processes for translating expressive versus informative texts? A computer-assisted study of professionals’ English–Chinese translation

AbstractThis article explores the differences of translation processes for expressive and informative texts by professional translators primarily by triangulating pausing and revision data retrieved by Keystroke logging experiment and rational report thereof via questionnaire survey and interview. The article discovers that in terms of temporal distribution, the drafting of informative text accounts for a larger proportion of time, while orientation and checking accounts for a smaller proportion compared with those of expressive texts. At orientation interval, translators come to fully understand the source expressive text at the very beginning, while generally conducting syntactic analysis of and re-sequencing the semantic component of source text in target language in translating informative text. At drafting interval, structural modification frequency word rate (MWR) in translating the expressive text is larger than that in translating the informative texts, while spelling and lexical MWRs of both texts are similar. At checking interval, both texts hardly see any structural modification, but lexical MWR for the former is much bigger than that for the latter. These data, along with pausing and revision rational report, suggest the priority of familiarity with standardized grammar and expertise in specialized field for translating informative text, and the importance of embedded reading and writing training for translating expressive text.

Heavy metals in indoor dust: Spatial distribution, influencing factors, and potential health risks

Given the large proportion of time that people spend indoors, the potential health risks posed by heavy metals in the indoor environment deserve greater attention. A global-scale assessment of heavy metal contamination in indoor dust was conducted in this study based on >127 articles published between 1985 and 2019. The pollution levels, spatio-temporal variations, sources, bioaccessibilities, influencing factors, and health risks of heavy metals associated with indoor dust were analyzed. Children's blood lead levels (BLLs) were also estimated using the integrated exposure uptake biokinetic model. The results indicated that the median concentrations of Cu and Zn in 71.9% and 71.0% of the study sites surpassed the corresponding permissible limits, 100 and 300 mg/kg, respectively; thus, their control should be given priority. Heavy metal concentrations in indoor dust from different areas of the world varied greatly, which was closely associated with the type of local human activities, such as mining, melting, e-waste recycling and Pb-related industries. The bioaccessibilities of some key elements, e.g., Pb, Cd, Cu, and Zn, in household dust were high. The levels of heavy metals in indoor dust were mainly affected by a combination of outdoor and indoor sources and related critical factors, and future studies should focus on quantifying the contributions of different sources. Based on the health risk assessment, dust Pb exposure is a major health concern in e-waste recycling areas, which warrants greater attention. 49.8%, 36.8% and 14.4% of study sites showed BLLs exceeding 35 μg/L (threshold limit in Germany), 50 μg/L (threshold limit in the USA), or 100 μg/L (threshold limit in China), respectively. Finally, Pb exposure from indoor dust represents a major contributor to children's blood Pb poisoning in many developing countries. This study details the overall heavy metal contamination status of indoor dust and provides insights for policymakers with respect to pollution prevention measures.

235EMF Timeliness of Inter-Facility Transfer for Patients With Acute Large Vessel Occlusion Stroke

Mechanical thrombectomy (MT) is the preferred treatment for large vessel occlusion stroke (LVO; ie, occlusion of the basilar, middle cerebral, and internal carotid arteries), and neurological outcome improves with earlier treatment. MT requires substantial infrastructure and expertise and is primarily offered at comprehensive stroke centers (CSCs). Patients with LVO who present to facilities without MT require interfacility transfer, yet transfers are associated with delay and diminished neurological outcome. We sought to examine the time spent at transferring EDs to identify opportunities for improvement. This was a retrospective observational study conducted at our CSC with a large catchment area. Included patients were transferred from an outside ED between January 1, 2012 and December 31, 2017, and received MT after arrival. Clinical data and time intervals were collected from the medical record. Time intervals included ED Door-to-CT, CT-to-CSC Alert, CSC Alert-to-ED Departure, Total ED Length of Stay (LOS), and ED Arrival-to-OR Arrival. We estimated differences in medians for each time interval with 95% confidence intervals. Multivariable logistic regression modeling was used to examine the association of time spent in the ED with good 90-day neurologic outcome via modified Rankin Score (mRS; good ≤2, poor >3) while controlling for potential confounders (NIH stroke scale, Age, tPA administration). We identified 111 patients who met inclusion. 54 (49%) of patients were female. Outcomes at 90 days were available for 95 (86%) patients. Among patients with outcomes, 59 (62%) of patients had a poor 90-day neurologic outcome, while 36 (38%) had a good neurologic outcome. Median total ED LOS was 99 (interquartile range [IQR] 71-139) minutes, and median ED Arrival-to-OR Arrival was 239 (IQR 187-304) minutes. The largest proportion of ED time was CT-to-CSC Alert which comprised 44% of ED LOS. Component intervals were similar by neurological outcome except CT-to-CSC Alert (Figure). Patients who had good outcomes experienced a 13-minute shorter CT-to-CSC Alert (35 vs 48 minutes). However, this difference was not significant in multivariable modeling. Only initial NIH Stroke scale was associated with good 90-day neurological outcome (adjusted odds ratio 0.84, 95% CI 0.77, 0.92, p<0.0001). Among patients with LVO transferred for MT, the largest proportion of time at transferring EDs occurred between CT and the CSC Alert suggesting potential diagnostic and coordination delays. While overall time spent at transferring EDs for patients with LVO was not associated with neurologic outcomes, this study only includes patients who received MT. Future investigations should focus on the time between CT and stroke alert as potentially modifiable, the generalizability of results and interventions to other sites, and populations who did not receive MT.

67-LB: Time Spent in Glycaemic Ranges and Carbohydrate Intake during Cycling in Professional Cyclists with Type 1 Diabetes

Aim: This observational study examined in-ride interstitial glucose data and nutritional intake in a UCI-accredited professional cycling team with type 1 diabetes (T1D) over a nine-day training camp. Methods: Sixteen male professional road cyclists with T1D (age 27±4 years, T1D duration 11±5 years, BMI 21.6±1.5 kg·min-2, HbA1c 6.8±0.6 %, O2max 71.3±3.9 ml·kg·min-1) on multiple daily injections performed eight rides over nine days lasting between 2 and 6 h, traversing 56 to 182 km/day. Cycle glycemic information (G6, Dexcom) was collected, stratified into glycemic time in ranges; hypoglycemia (Level 1: 54-70, Level 2: &amp;lt;54 mg/dL), euglycemia (71-180 mg/dL) and hyperglycemia (Level 1: 181-299, Level 2: &amp;gt;299 mg/dL) and analyzed for time spent (%) within each range. Nutritional intake during each ride was determined and reported as median (range). Results: Average percentage time spent in euglycemia during cycling was 78±6% (daily range 70-86%). Hypoglycemia during cycling was 3±4% (range 0-11%, Level 1), and 1±2% (range 0-2%, Level 2). No hypoglycemic event required assistance. Percentage time spent in hyperglycemia during cycling was 17±7% (range 8-27%, Level 1), and 1±2 % (range 0-5%, Level 2). The contribution of carbohydrates, fat and protein to total in-ride energy intake was 83.8±15.4, 12.6±8.1 and 1.2±0.6 %, respectively. Macronutrient intake was dependent on cycle duration with greater carbohydrate intake rate on longer rides (2-hour cycle: 20 (4-82) g/h vs. 6-hour cycle: 51 (17-86) g/h). Conclusions: Professional cyclists with T1D maintained a large proportion of time in a euglycemic range during intense cycling sessions over a nine-day training period. The low occurrence of in-ride hypoglycemia, mostly at Level 1, suggests a protective role for consumption of carbohydrate-rich foods to maintain glycaemia, especially during longer rides. However, time spent in Level 1 hyperglycemia during cycling was notable and should be monitored. Disclosure O. McCarthy: None. O. Moser: Research Support; Self; Abbott, Dexcom, Inc., Novo Nordisk A/S. M.L. Eckstein: Research Support; Self; Novo Nordisk A/S. S.N. Scott: None. M. Riddell: Advisory Panel; Self; Xeris Pharmaceuticals, Inc. Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc., Insulet Corporation, Novo Nordisk Inc., Sanofi. Speaker’s Bureau; Self; Medtronic MiniMed, Inc., OmniPod. Stock/Shareholder; Self; Zucara Therapeutics Inc. M. Fisher: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Mylan, NAPP Pharmaceuticals Limited, Novo Nordisk A/S. Speaker’s Bureau; Self; Eli Lilly and Company, Sanofi. F.Y. Fontana: None. K. Skroce: None. L. Festa: None. P.H. Lagrou: None. P. Southerland: Other Relationship; Self; Novo Nordisk Inc. C.A. Hayes: Other Relationship; Self; Novo Nordisk A/S. M.P. Christiansen: Research Support; Self; Abbott, Biolinq, Dexcom, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Medtronic MiniMed, Inc., Novo Nordisk A/S, Sanofi-Aventis, Xeris Pharmaceuticals, Inc. B.W. Bode: Consultant; Self; ADOCIA, Lexicon Pharmaceuticals, Inc., Novo Nordisk Inc. Research Support; Self; Becton, Dickinson and Company, Dexcom, Inc., Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Eyenuk Inc., Insulet Corporation, National Institutes of Health, Novo Nordisk Inc., Sanofi Research &amp; Development, Senseonics, Xeris Pharmaceuticals, Inc. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi US, Senseonics. Stock/Shareholder; Self; AgaMatrix, Glytec, LLC. C. Stettler: None. R.M. Bracken: None.

Head postures during naturalistic driving

Objective: A rotated head posture at the time of a rear-end impact is associated with a higher risk of acute and chronic whiplash injury. The objective of this study was to quantify the amplitude and duration of rotated head postures observed in drivers during naturalistic driving.Methods: Twenty volunteers (14 males: 36 ± 12 years, 6 females: 27 ± 5 years) drove a 2010 Subaru Impreza on public roads while their 3D head angular position relative to the car was recorded using inertial measurement units. An experimenter rode in the passenger seat (right side) and logged when subjects performed one of 6 head movements: Bilateral shoulder and side mirror checks, looking at the rearview mirror, and looking at the front seat passenger. Video of the subjects was used to confirm the logged head movements and identify movements that the experimenter missed. The duration and amplitude of all 6 head movements were tabulated and then compared between periods when the car was moving and when the car was stationary.Results: During a 68 ± 5-min drive, subjects performed a median (range) of 15 (5–39) left shoulder checks, 82.5 (29–167) left mirror checks, 40.5 (10–168) rearview mirror checks, 27.5 (3–113) right mirror checks, 60 (0–185) passenger looks, and 12.5 (1–28) right shoulder checks. Peak yaw angles of the head relative to the vehicle for these 6 movements averaged −81.5°, −34.3°, 16.2°, 42.1°, 58.2°, and 84.3°, respectively. Drivers spent a larger proportion of time in nonneutral postures when the vehicle was stopped (17.5%) compared to moving (8.2%) (Z = 3.92, P < .0001). Drivers also moved their head further from neutral during the movements when the car was stationary compared to moving (t19 = 5.90, P < .0001).Conclusions: Drivers use larger and longer duration head movements when stationary than when driving. Given an increased risk of whiplash injury for initially rotated head postures, these findings provide a possible explanation for why drivers are more likely to be injured when hit from behind while their vehicle is stationary. Further, the head postures characterized in this study can be used as initial conditions in volunteer and computational studies to improve our understanding of why nonneutral head postures are associated with increased whiplash injury risk.

Intercolony variations in movement patterns and foraging behaviors among herring gulls (Larus argentatus) breeding in the eastern Wadden Sea.

Herring gulls (Larus argentatus) are opportunistic predators that prefer to forage in the intertidal zone, but an increasing degree of terrestrial foraging has recently been observed. We therefore aimed to analyze the factors influencing foraging behavior and diet composition in the German Wadden Sea. Gulls from three breeding colonies on islands at different distances from the mainland were equipped with GPS data loggers during the incubation seasons in 2012–2015. Logger data were analyzed for 37 individuals, including 1,115 foraging trips. Herring gulls breeding on the island furthest from the mainland had shorter trips (mean total distance = 12.3 km; mean maximum distance = 4.2 km) and preferred to feed on the tidal flats close to the colony, mainly feeding on common cockles (Cerastoderma edule) and shore crabs (Carcinus maenas). In contrast, herring gulls breeding close to the mainland carried out trips with a mean total distance of 26.7 km (mean maximum distance = 9.2 km). These gulls fed on the neobiotic razor clams (Ensis leei) in the intertidal zone, and a larger proportion of time was spent in distant terrestrial habitats on the mainland, feeding on earthworms. δ 13C and δ 15N values were higher at the colony furthest from the mainland and confirmed a geographical gradient in foraging strategy. Analyses of logger data, pellets, and stable isotopes revealed that herring gulls preferred to forage in intertidal habitats close to the breeding colony, but shifted to terrestrial habitats on the mainland as the tide rose and during the daytime. Reduced prey availability in the vicinity of the breeding colony might force herring gulls to switch to feed on razor clams in the intertidal zone or to use distant terrestrial habitats. Herring gulls may thus act as an indicator for the state of the intertidal system close to their breeding colony.

Block-accelerated aggregation multigrid for Markov chains with application to PageRank problems

Recently, the adaptive algebraic aggregation multigrid method has been proposed for computing stationary distributions of Markov chains. This method updates aggregates on every iterative cycle to keep high accuracies of coarse-level corrections. Accordingly, its fast convergence rate is well guaranteed, but often a large proportion of time is cost by aggregation processes. In this paper, we show that the aggregates on each level in this method can be utilized to transfer the probability equation of that level into a block linear system. Then we propose a Block–Jacobi relaxation that deals with the block system on each level to smooth error. Some theoretical analysis of this technique is presented, meanwhile it is also adapted to solve PageRank problems. The purpose of this technique is to accelerate the adaptive aggregation multigrid method and its variants for solving Markov chains and PageRank problems. It also attempts to shed some light on new solutions for making aggregation processes more cost-effective for aggregation multigrid methods. Numerical experiments are presented to illustrate the effectiveness of this technique.

Patient\u2013ventilator asynchrony during conventional mechanical ventilation in children

BackgroundWe aimed (1) to describe the characteristics of patient–ventilator asynchrony in a population of critically ill children, (2) to describe the risk factors associated with patient–ventilator asynchrony, and (3) to evaluate the association between patient–ventilator asynchrony and ventilator-free days at day 28.MethodsIn this single-center prospective study, consecutive children admitted to the PICU and mechanically ventilated for at least 24 h were included. Patient–ventilator asynchrony was analyzed by comparing the ventilator pressure curve and the electrical activity of the diaphragm (Edi) signal with (1) a manual analysis and (2) using a standardized fully automated method.ResultsFifty-two patients (median age 6 months) were included in the analysis. Eighteen patients had a very low ventilatory drive (i.e., peak Edi < 2 µV on average), which prevented the calculation of patient–ventilator asynchrony. Children spent 27% (interquartile 22–39%) of the time in conflict with the ventilator. Cycling-off errors and trigger delays contributed to most of this asynchronous time. The automatic algorithm provided a NeuroSync index of 45%, confirming the high prevalence of asynchrony. No association between the severity of asynchrony and ventilator-free days at day 28 or any other clinical secondary outcomes was observed, but the proportion of children with good synchrony was very low.ConclusionPatient–ventilator interaction is poor in children supported by conventional ventilation, with a high frequency of depressed ventilatory drive and a large proportion of time spent in asynchrony. The clinical benefit of strategies to improve patient–ventilator interactions should be evaluated in pediatric critical care.

Abstract 1743: Sedentary behavior and breast cancer in the Black Women's Health Study

Abstract Background: Rates of breast cancer incidence among African American women are increasingly similar to rates among Caucasian American women. Lifestyle behaviors, such as sedentary time, may contribute to differences in breast cancer incidence, but have not been well studied among African American women. Sedentary activities (physically inactive tasks that require little to no additional energy expenditure beyond basal metabolic rate) account for a large proportion of time per day in the United States and are more prevalent among African American women. Sedentary behavior may contribute to cancer risk independently of physical activity, but has not been well studied among African American women. Objective: The objective of this study was to evaluate the association between sedentary behaviors over time on breast cancer incidence in the Black Women's Heath Study. Methods: In this ongoing prospective cohort of African American women (analytic cohort N = 55,629), 2,482 incident breast cancer cases were diagnoses between baseline (1995) and 2013. Questionnaire data (collected every two years since 1995) was used to calculate time spent sitting. Time spent sitting at work and sitting doing recreational activities (watching TV, using internet) was summed to total sedentary time. A time-varying analytic approach was utilized (Anderson-Gill method) to reduce within-person variation and better represent long-term habits. Results: Among women in this cohort, 23.8% reported spending &amp;lt;5 hours/day in sedentary activities, while 8.2% reported spending 10 or more hours. A majority reported spending more than 5 hours/day sitting at work, while most women reported &amp;lt;5 hours sitting watching TV (or related activities). Total time spent sitting was significantly associated with breast cancer incidence overall (≥10 vs. &amp;lt;5 hours/day HR = 1.38, 95% CI: 1.16-1.65). Associations were similar for both premenopausal (≥10 vs. &amp;lt;5 hours/day HR = 1.44, 95% CI: 1.07-1.93) and postmenopausal (≥10 vs. &amp;lt;5 hours/day HR = 1.39, 95% CI: 1.09-1.78) breast cancer incidence. Associations remained regardless of leisure time physical activity levels and body size. Conclusions: Our findings suggest that high sedentary time may increase risk for breast cancer among African American women. Additionally, leisure time physical activity levels and body size did not change associations, suggesting sedentary time may confer additional risk. Previously reported frequent sedentary behavior among African Americans could contribute to breast cancer disparities and should be explored further in future studies. Citation Format: Sarah Nomura, Chiranjeev Dash, Jeffrey Yu, Julie Palmer, Lynn Rosenberg, Lucile L. Adams-Campbell. Sedentary behavior and breast cancer in the Black Women's Health Study. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1743.

Niche partitioning by three Pterodroma petrel species during non-breeding in the equatorial Pacific Ocean

Niche divergence is expected for species that compete for shared resources, including migrants that occupy similar regions during the non-breeding season. Studies of temperate seabirds indicate that both spatial and behavioural segregation can be important mechanisms for reducing competition, but there have been few investigations of resource partitioning by closely related taxa in low productivity, tropical environments. We investigated niche partitioning in 3 gadfly petrel taxa, Pterodroma leucoptera leucoptera (n = 22), P. leucoptera caledonica (n = 7) and P. pycrofti (n = 12), during their non-breeding season in the eastern tropical Pacific Ocean by combining tracking data from geolocator-immersion loggers with remotely sensed environmental data in species distribution models (SDMs), and by comparing feather stable isotope ratios. The 3 taxa showed spatial partitioning: two foraged in the North Equatorial Counter Current and one in the South Equatorial Current. This reflected differences in their realised habitat niches, with significant taxon-specific responses to thermocline depth, sea surface temperature and bathymetry. There were also differences among taxa in activity patterns, and all birds spent a much larger proportion of time in flight at night than during the day, suggesting predominance of nocturnal foraging behaviour. Comparison of stable isotope ratios in feathers suggests that P. l. leucoptera and P. pycrofti mainly consume vertically migrating mesopelagic fishes, whereas the diet of P. l. caledonica also includes some lower trophic levels including crustaceans and squid. Unique insights can be gained from studies of the foraging ecology of tropical pelagic seabirds, in comparison with temperate and polar waters, and are urgently required for understanding and protecting tropical avifauna in key marine habitats.

A Retrospective Review of High versus Standard Dose Dexmedetomidine for Sedation in Critically Ill Patients

Introduction: Studies have demonstrated safety and efficacy of dexmedetomidine infusions at doses up to 1.5 mcg/kg/hr. Data evaluating doses greater than 1.5 mcg/kg/hr is limited; however, up to 2.5 mcg/kg/hr has been utilized. It is uncertain whether higher doses provide additional benefit but may result in more adverse events. The purpose of this study was to compare the safety and efficacy of dexmedetomidine at high doses (greater than 1.5 mcg/kg/hr) versus standard doses (0.2 to 1.5 mcg/kg/hr). Methods: A retrospective cohort study was conducted in critically ill, mechanically ventilated patients receiving dexmedetomidine for at least 24 hours. Standard dose dexmedetomidine (SD-DEX) was defined as less than or equal to 1.5 mcg/kg/ hr and high dose (HD-DEX) as greater than 1.5 mcg/kg/hr. Patients were assigned to SD-DEX group if maximum dose of dexmedetomidine received was between 0.2 and 1.5 mcg/kg/hr. Conversely, patients were assigned to HD-DEX group if maximum dose of dexmedetomidine received was greater than 1.5 mcg/kg/hr. Composite incidence of bradycardia or hypotension and proportion of time within target sedation were assessed. Results: A total of 799 patients were screened for inclusion with 120 included: 69 in the HD-DEX group and 51 in the SD-DEX group. Composite incidence of bradycardia or hypotension was not statistically different. A significantly larger proportion of time was spent within target sedation in the SD-DEX group. More patients in the HD-DEX group required sedatives and antipsychotics than the SDDEX group and tended to receive higher daily doses of concomitant medications. Conclusion: Dexmedetomidine doses greater than 1.5 mcg/kg/hr may be as safe as standard doses; however, no additional benefit in maintaining target sedation level was found.

Groin pain in athletes: Differential diagnosis, assessment, and management

Groin pain in athletes is a common problem in sports medicine, accounting for 10% of all visits to sports medicine centers. Furthermore, groin injuries have been estimated to account for up to 6% of all athletic injuries, with the prevalence in sports such as football as high as 12-16%. However, despite the prevalence of this condition, its diagnosis and treatment remain a challenging problem for the sports medicine physician, and the injury is a frustrating one for the athlete. Chronic groin pain in particular can be difficult to diagnose, treat, and rehabilitate, and is responsible for a large proportion of time lost from sport and work for the athlete. A complicating component in the treatment of this condition is an extensive differential diagnosis and overlap in symptoms between possible diagnoses. Typically, groin pain develops in male and female athletes who participate in sports involving kicking, rapid accelerations and decelerations, and sudden changes of direction. The aim of this article is to briefly review the most common musculoskeletal conditions that cause groin pain in athletes and to discuss their diagnosis and management.

A Model to Analyze Airbase Oil Inventory System with Endogenous Lead Time

In this paper, we analyze airplane oil inventory problem of a base in the Republic of Korea Air Force (ROKAF) which should keep maintaining an appropriate inventory level of oil for the efficient operation of flights. In ROKAF, airplane oil supply is ordered (or delivered) at a constant time period, which means reorder point is not stochastic but deterministic. Since the airplane oil inspection time occupies large proportion of time between a reorder point and the time the oil is available for usage, it is imperative to analyze the inspection time which causes delay in fulfilling an order. In addition, if demands increase dramatically because of a war or an unexpected training, the reorder point could be shortened than in normal situations. In such abnormal circumstances, the shortened reorder point may require more delay for order fulfillment. In this setting, the inspection time endogenously determines the replenishment lead time (or supply lead time) and the pattern of the inventory. Meanwhile, since the procedure of airplane oil inspection is composed of several steps, it may be better that the distributions of inspection times are treated as phase-type distributions. In this context, we use D/PH/1/m queue and counting process of D-BMAP (Discrete-time Batch Markovian Arrival Process) with 2-class to analyze the delay (lead time) for order fulfillment. Using this model, we find a way to derive decision variables such as the number of inventory replenishments and average fill rate.